Ethamsylate and blood loss in total hip replacement.

Science.gov (United States)

Keith, I

1979-01-01

Nineteen consecutive patients undergoing total hip replacement under epidural anaesthesia were randomly divided into two groups. The treatment group received 1000 mg of ethamsylate intravenously before induction of anaesthesia. Blood lost during surgery was measured by a colorimetric technique. Closed suction drains were used and all blood lost after operation collected for measurement. Ethamsylate did not decrease the average volumes of blood lost during or after the operation. Neither did it reduce the requirements for blood transfusion. Although there were no side-effects attributable to ethamyslate, there seems to be no indication for its use in total hip replacement under epidural anaesthesia.

Failure rate of cemented and uncemented total hip replacements

DEFF Research Database (Denmark)

Makela, K. T.; Matilainen, M.; Pulkkinen, P.

2014-01-01

). Participants 347 899 total hip replacements performed during 1995-2011. Main outcome measures Probability of implant survival (Kaplan-Meier analysis) along with implant survival with revision for any reason as endpoint (Cox multiple regression) adjusted for age, sex, and diagnosis in age groups 55-64, 65......Objective To assess the failure rate of cemented, uncemented, hybrid, and reverse hybrid total hip replacements in patients aged 55 years or older. Design Register study. Setting Nordic Arthroplasty Register Association database (combined data from Sweden, Norway, Denmark, and Finland......-74, and 75 years or older. Results The proportion of total hip replacements using uncemented implants increased rapidly towards the end of the study period. The 10 year survival of cemented implants in patients aged 65 to 74 and 75 or older (93.8%, 95% confidence interval 93.6% to 94.0% and 95.9%, 95...

Autologous blood transfusion in total knee replacement surgery.

Science.gov (United States)

Sarkanović, Mirka Lukić; Gvozdenović, Ljiljana; Savić, Dragan; Ilić, Miroslav P; Jovanović, Gordana

2013-03-01

Total knee replacement (TKR) surgery is one of the most frequent and the most extensive procedures in orthopedic surgery, accompanied with some serious complications. Perioperative blood loss is one of the most serious losses, so it is vital to recognize and treat such losses properly. Autologous blood transfusion is the only true alternative for the allogeneic blood. The aim of this study was to to examine if autologous blood transfusion reduces usage of allogenic blood in total knee replacement surgery, as well as to examine possible effect of autologous blood transfusion on postoperative complications, recovery and hospital stay of patients after total knee replacement surgery. During the controlled, prospective, randomised study we compared two groups of patients (n = 112) with total prosthesis implanted in their knee. The group I consisted of the patients who received the transfusion of other people's (allogeneic) blood (n = 57) and the group II of the patients whose blood was collected postoperatively and then given them [their own (autologous) blood] (n = 55). The transfusion trigger for both groups was hemoglobin level of 85 g/L. In the group of patients whose blood was collected perioperatively only 9 (0.9%) of the patients received transfusion of allogeneic blood, as opposed to the control group in which 98.24% of the patients received the transfusion of allogeneic blood (p blood was collected stayed in hospital for 6.18 days, while the patients of the control group stayed 7.67 days (p blood transfusion is a very effective method for reducing consumption of allogenic blood and thus, indirectly for reducing all complications related to allogenic blood transfusion. There is also a positive influence on postoperative recovery after total knee replacement surgery due to the reduction of hospital stay, and indirectly on the reduction of hospital costs.

A general approach to total repair cost limit replacement policies

Directory of Open Access Journals (Sweden)

F. Beichelt

2014-01-01

Full Text Available A common replacement policy for technical systems consists in replacing a system by a new one after its economic lifetime, i.e. at that moment when its long-run maintenance cost rate is minimal. However, the strict application of the economic lifetime does not take into account the individual deviations of maintenance cost rates of single systems from the average cost development. Hence, Beichet proposed the total repair cost limit replacement policy: the system is replaced by a new one as soon as its total repair cost reaches or exceeds a given level. He modelled the repair cost development by functions of the Wiener process with drift. Here the same policy is considered under the assumption that the one-dimensional probability distribution of the process describing the repair cost development is given. In the examples analysed, applying the total repair cost limit replacement policy instead of the economic life-time leads to cost savings of between 4% and 30%. Finally, it is illustrated how to include the reliability aspect into the policy.

Replacing the nucleus pulposus of the intervertebral disk: prediction of suitable properties of a replacement material using finite element analysis.

Science.gov (United States)

Meakin, J R

2001-03-01

An axisymmetric finite element model of a human lumbar disk was developed to investigate the properties required of an implant to replace the nucleus pulposus. In the intact disk, the nucleus was modeled as a fluid, and the annulus as an elastic solid. The Young's modulus of the annulus was determined empirically by matching model predictions to experimental results. The model was checked for sensitivity to the input parameter values and found to give reasonable behavior. The model predicted that removal of the nucleus would change the response of the annulus to compression. This prediction was consistent with experimental results, thus validating the model. Implants to fill the cavity produced by nucleus removal were modeled as elastic solids. The Poisson's ratio was fixed at 0.49, and the Young's modulus was varied from 0.5 to 100 MPa. Two sizes of implant were considered: full size (filling the cavity) and small size (smaller than the cavity). The model predicted that a full size implant would reverse the changes to annulus behavior, but a smaller implant would not. By comparing the stress distribution in the annulus, the ideal Young's modulus was predicted to be approximately 3 MPa. These predictions have implications for current nucleus implant designs. Copyright 2001 Kluwer Academic Publishers

Primary total hip replacement for displaced subcapital fractures of the femur.

Science.gov (United States)

Taine, W H; Armour, P C

1985-03-01

The management of displaced subcapital fracture of the hip is still controversial because of the high incidence of complications after internal fixation or hemiarthroplasty. To avoid some of these complications we have used primary total hip replacement for independently mobile patients over 65 years of age. A total of 163 cases, operated on over four years, have been reviewed. There were relatively more dislocations after operation for fracture than after total replacement for arthritis, and these were associated with a posterior approach to the hip. Only seven revision operations have been required. Of 57 patients who were interviewed an average of 42 months after replacement, 62% had excellent or good results as assessed by the Harris hip score. All the others had major systemic disease which affected their assessment. This inadequacy of current systems of hip assessment is discussed. It is concluded that total hip replacement is the best management for a selected group of patients with this injury, and that further prospective studies are indicated.

Verbatim Floppy Disk

CERN Multimedia

1976-01-01

Introduced under the name "Verbatim", Latin for "literally", these disks that sized more than 5¼ inches have become almost universal on dedicated word processing systems and personal computers. This format was replaced more slowly by the 3½-inch format, introduced for the first time in 1982. Compared to today, these large format disks stored very little data. In reality, they could only contain a few pages of text.

Radiological examinations of complications after total hip replacement Pt. 1

International Nuclear Information System (INIS)

Luzsa, Gyoergy; Reti, Peter; Lakatos, Jozsef

1985-01-01

The radiological findings of complications after total hip replacement are summarized by analizing the data of control examinations of the operated patients at the National Institute for Rheumatology and Physiotherapy. In this first part the types of total hip replacements and the radiological methods (native x-ray, fistulography, arthrography, needle biopsy and scintigraphy using sup(99m)Tc isotope) are surveyed, and the radiological findings of the septic surgical complications are described. (author)

Primary Total Knee Replacement: Is Suction a Portal of Infection?

Science.gov (United States)

Budnar, Vijaya M; Amirfeyz, Rouin; Ng, Michael; Bannister, Gordon C; Blom, Ashley W

2009-01-01

INTRODUCTION Pulsed lavage during a total knee replacement usually leaves a pool of fluid on the surgical drapes. It is common practice to suck away this fluid using the same suction device used intra-operatively. This could be a cause of direct wound contamination. We hypothesised that bacteria contaminate fluid that collects around the foot in total knee replacement surgery and that suction equipment could be a portal of contamination. We also hypothesised that bacterial count in the fluid is lower if chlorhexidine, rather than saline, is used in the pulsed lavage. PATIENTS AND METHODS Forty patients undergoing primary total knee replacement were divided into two groups. The first group had pulsed lavage with normal saline and the second with 0.05% chlorhexidine. RESULTS At the end of the operation, 20 ml of fluid, pooled on the surgical drapes was aspirated and cultured for bacterial growth. None of the fluid samples showed bacterial growth. CONCLUSIONS Suction device used peri-operatively during knee replacement is unlikely to be a cause of wound contamination. Pulsed lavage with normal saline is as effective as lavage with chlorhexidine. PMID:19335972

Total knee replacement in patients with diffuse villonodular synovitis

Directory of Open Access Journals (Sweden)

Lucio Flávio Biondi Pinheiro Júnior

Full Text Available ABSTRACT This paper reports a case of diffuse pigmented villonodular synovitis (DPVNS, associated with advanced gonarthrosis, submitted to total knee replacement. The patient had progressive pain and swelling. She had two previous surgeries, firstly arthroscopic , synovectomy and subsequently open synovectomy associated with radiotherapy, with recurrence of the disease. Magnetic resonance imaging revealed diffuse synovitis, advanced arthrosis, and bone cysts. The patient was submitted to a total knee replacement and synovectomy. There was a good postoperative clinical course, with improvement of pain, function, and joint edema on examination. The patient will be followed regarding the possibility of disease recurrence and implant survival.,

The cyclops lesion after bicruciate-retaining total knee replacement

Directory of Open Access Journals (Sweden)

Mark A. Klaassen, MD, FACS

2017-12-01

Full Text Available The cyclops lesion is a localized anterior arthrofibrosis most commonly seen following anterior cruciate ligament reconstruction. The lesion forms at the anterior cruciate ligament insertion creating a painful extension block between femoral intercondylar notch and tibial plateau. We present 2 cases (3 knees in which cyclops lesions appeared atypically following bicruciate-retaining total knee replacement. Two lesions occurred in a single patient following bilateral knee replacement. One lesion occurred in an active sportswoman. All 3 resolved following arthroscopic debridement. We describe the presentation of this unusual complication and suggest keys to its diagnosis, treatment, and prevention. Keywords: Cyclops lesion, Bicruciate-retaining, Total knee arthroplasty, Extension deficit

Analgesia after total hip replacement: epidural versus psoas ...

African Journals Online (AJOL)

tive analgesia following total hip replacement surgery. The research design was a ... matoma, intra-abdominal injury and pain due to spasm of the lumbar paravertebral ..... 2. Brown DL. Spinal, epidural, and caudal anesthesia In: Miller RD, ed.

A small punch test technique for characterizing the elastic modulus and fracture behavior of PMMA bone cement used in total joint replacement.

Science.gov (United States)

Giddings, V L; Kurtz, S M; Jewett, C W; Foulds, J R; Edidin, A A

2001-07-01

Polymethylmethacrylate (PMMA) bone cement is used in total joint replacements to anchor implants to the underlying bone. Establishing and maintaining the integrity of bone cement is thus of critical importance to the long-term outcome of joint replacement surgery. The goal of the present study was to evaluate the suitability of a novel testing technique, the small punch or miniaturized disk bend test, to characterize the elastic modulus and fracture behavior of PMMA. We investigated the hypothesis that the crack initiation behavior of PMMA during the small punch test was sensitive to the test temperature. Miniature disk-shaped specimens, 0.5 mm thick and 6.4 mm in diameter, were prepared from PMMA and Simplex-P bone cement according to manufacturers' instructions. Testing was conducted at ambient and body temperatures, and the effect of test temperature on the elastic modulus and fracture behavior was statistically evaluated using analysis of variance. For both PMMA materials, the test temperature had a significant effect on elastic modulus and crack initiation behavior. At body temperature, the specimens exhibited "ductile" crack initiation, whereas at room temperature "brittle" crack initiation was observed. The small punch test was found to be a sensitive and repeatable test method for evaluating the mechanical behavior of PMMA. In light of the results of this study, future small punch testing should be conducted at body temperature.

Renal function after elective total hip replacement

DEFF Research Database (Denmark)

Perregaard, Helene; Damholt, Mette B; Solgaard, Søren

2016-01-01

Background and purpose - Acute kidney injury (AKI) is associated with increased short-term and long-term mortality in intensive care populations and in several surgical specialties, but there are very few data concerning orthopedic populations. We have studied the incidence of AKI and the prevale......Background and purpose - Acute kidney injury (AKI) is associated with increased short-term and long-term mortality in intensive care populations and in several surgical specialties, but there are very few data concerning orthopedic populations. We have studied the incidence of AKI...... and the prevalence of chronic kidney disease (CKD) in an elective population of orthopedic patients undergoing primary total hip replacement, hypothesizing that chronic kidney disease predisposes to AKI. Patients and methods - This was a single-center, population-based, retrospective, registry-based cohort study...... involving all primary elective total hip replacements performed from January 2003 through December 2012. Patient demographics and creatinine values were registered. We evaluated the presence of CKD and AKI according to the international guidelines for kidney disease (KDIGO Acute Kidney Injury Workgroup 2013...

Changing trends in total knee replacement

OpenAIRE

Goudie, Ewan; Robinson, Cal; Walmsley, Phil; Brenkel, Ivan

2017-01-01

Introduction:  This study evaluates a possible change in the demographics and surgical practice observed in a large cohort of patients undergoing total knee replacement (TKR). Patients and methods:  We performed a retrospective analysis of a prospectively collected data on two groups of consecutive patients undergoing primary TKR. Group one consisted of patients who underwent surgery between 1994 and 1998. Group two consisted of patients who had surgery between 2009 and 2012. Results:  The me...

Total ankle joint replacement.

Science.gov (United States)

2016-02-01

Ankle arthritis results in a stiff and painful ankle and can be a major cause of disability. For people with end-stage ankle arthritis, arthrodesis (ankle fusion) is effective at reducing pain in the shorter term, but results in a fixed joint, and over time the loss of mobility places stress on other joints in the foot that may lead to arthritis, pain and dysfunction. Another option is to perform a total ankle joint replacement, with the aim of giving the patient a mobile and pain-free ankle. In this article we review the efficacy of this procedure, including how it compares to ankle arthrodesis, and consider the indications and complications. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

A 5-year profile of the incidence of total joint replacement in South ...

African Journals Online (AJOL)

During this period there was a 28% increase in the number of TJRs performed annually with an average increase of 20% in total hip replacements and 40% in total knee replacements. The number of surgeons involved in joint replacement during the survey period decreased by 7% in state-subsidised institutions but ...

Chronic asymptomatic dislocation of a total hip replacement: a case report

Directory of Open Access Journals (Sweden)

Lidder Surjit

2009-08-01

Full Text Available Abstract Introduction Dislocation of a prosthetic hip is the second most common complication after thromboembolic disease in patients undergoing total hip arthroplasty, with an incidence reported as 0.5 to 20%. Although the period of greatest risk for dislocation has been reported to be within the first few months after surgery, late dislocation occurs more commonly then previously thought. Case presentation A 60-year-old man underwent a right Exeter cemented total hip replacement and was subsequently discharged after appropriate follow-up. He next presented 8 years later complaining of pain in the left groin. An anterioposterior radiograph of the pelvis revealed degenerative changes in the left hip and a dislocated right total hip replacement. The dislocated femoral component had formed a neoacetabulum within the ilium, in which it was freely articulating. He remained pain-free on this side, had 5 cm of true leg length shortening with a good range of movement and was very pleased with his hip replacement. He was later placed on the waiting list for a left total hip replacement. Conclusion This case illustrates that a dislocated total hip replacement may occasionally not cause symptoms that cause significant discomfort or reduction in range of movement. The prosthetic femoral head can form a neoacetabulum allowing a full range of pain-free movement. Furthermore it emphasises that with an increased trend to earlier hospital discharge and shorter follow-up, potential complications may be missed. We urge a low index of suspicion for potential complications and suggest that regular review with radiographic follow-up should be made.

The cyclops lesion after bicruciate-retaining total knee replacement

OpenAIRE

Klaassen, Mark A.; Aikins, Jerry L.

2017-01-01

The cyclops lesion is a localized anterior arthrofibrosis most commonly seen following anterior cruciate ligament reconstruction. The lesion forms at the anterior cruciate ligament insertion creating a painful extension block between femoral intercondylar notch and tibial plateau. We present 2 cases (3 knees) in which cyclops lesions appeared atypically following bicruciate-retaining total knee replacement. Two lesions occurred in a single patient following bilateral knee replacement. One les...

Influence of Total Knee Arthroplasty on Gait Mechanics of the Replaced and Non-Replaced Limb During Stair Negotiation.

Science.gov (United States)

Standifird, Tyler W; Saxton, Arnold M; Coe, Dawn P; Cates, Harold E; Reinbolt, Jeffrey A; Zhang, Songning

2016-01-01

This study compared biomechanics during stair ascent in replaced and non-replaced limbs of total knee arthroplasty (TKA) patients with control limbs of healthy participants. Thirteen TKA patients and fifteen controls performed stair ascent. Replaced and non-replaced knees of TKA patients were less flexed at contact compared to controls. The loading response peak knee extension moment was greater in control and non-replaced knees compared with replaced. The push-off peak knee abduction moment was elevated in replaced limbs compared to controls. Loading and push-off peak hip abduction moments were greater in replaced limbs compared to controls. The push-off peak hip abduction moment was greater in non-replaced limbs compared to controls. Future rehabilitation protocols should consider the replaced knee and also the non-replaced knee and surrounding joints. Copyright © 2016 Elsevier Inc. All rights reserved.

Total hip and knee joint replacement: perioperative clinical aspects

Directory of Open Access Journals (Sweden)

Luciana Pereira Almeida de Piano

2010-09-01

Full Text Available Objective: To understand the profile of patients undergoing hip and knee replacement during two years, and to compare the data obtained with the literature. Methods: A total of 323 medical records were reviewed to analyze the perioperative data of patients submitted to hip and knee replacement. Results: Osteoarthritis was the main indication for both procedures and male patients were heavier than females (p < 0.05. Hypertension was the prevalent disease among patients. Blood loss was more frequent in knee surgery than in the hip. Conclusions: The profile of patients undergoing total arthroplasty improved substantially over the past decade due to shorter hospital stay, lower risk of thromboembolic events and no infection as compared to previous reports.

Total hip replacements at Kikuyu Hospital, Kenya | Kingori | East ...

African Journals Online (AJOL)

Background: Total joint arthroplasty is a highly effective procedure that is frequently performed in elderly patients. This is not so in the third world and is not frequently performed. Total hip replacement (THR) relieves the pain and functional disability experienced by patients with moderate to severe arthritis of the hip, ...

Analytical calculations of the efficiency of gamma scintillators total efficiency for coaxial disk sources

Energy Technology Data Exchange (ETDEWEB)

Selim, Y S; Abbas, M I; Fawzy, M A [Physics Department, Faculty of Science, Alexandria University, Aleaxndria (Egypt)

1997-12-31

Total efficiency of clad right circular cylindrical Nal(TI) scintillation detector from a coaxial isotropic radiating circular disk source has been calculated by the of rigid mathematical expressions. Results were tabulated for various gamma energies. 2 figs., 5 tabs.

Fast-track surgery for bilateral total knee replacement

DEFF Research Database (Denmark)

Husted, H; Troelsen, A; Otte, K S

2011-01-01

Bilateral simultaneous total knee replacement (TKR) has been considered by some to be associated with increased morbidity and mortality. Our study analysed the outcome of 150 consecutive, but selected, bilateral simultaneous TKRs and compared them with that of 271 unilateral TKRs in a standardised...

The use of synthetic ligaments in the design of an enhanced stability total knee joint replacement.

Science.gov (United States)

Stokes, Michael D; Greene, Brendan C; Pietrykowski, Luke W; Gambon, Taylor M; Bales, Caroline E; DesJardins, John D

2018-03-01

Current total knee replacement designs work to address clinically desired knee stability and range of motion through a balance of retained anatomy and added implant geometry. However, simplified implant geometries such as bearing surfaces, posts, and cams are often used to replace complex ligamentous constraints that are sacrificed during most total knee replacement procedures. This article evaluates a novel total knee replacement design that incorporates synthetic ligaments to enhance the stability of the total knee replacement system. It was hypothesized that by incorporating artificial cruciate ligaments into a total knee replacement design at specific locations and lengths, the stability of the total knee replacement could be significantly altered while maintaining active ranges of motion. The ligament attachment mechanisms used in the design were evaluated using a tensile test, and determined to have a safety factor of three with respect to expected ligamentous loading in vivo. Following initial computational modeling of possible ligament orientations, a physical prototype was constructed to verify the function of the design by performing anterior/posterior drawer tests under physiologic load. Synthetic ligament configurations were found to increase total knee replacement stability up to 94% compared to the no-ligament case, while maintaining total knee replacement flexion range of motion between 0° and 120°, indicating that a total knee replacement that incorporates synthetic ligaments with calibrated location and lengths should be able to significantly enhance and control the kinematic performance of a total knee replacement system.

Use of Tranexamic Acid during Total Endoprosthetic Replacement of the Hip Joint

Directory of Open Access Journals (Sweden)

D. D. Selivanov

2010-01-01

Full Text Available Objective: to evaluate the blood-saving activity, efficacy, and safety of tranexamic acid. Subjects and methods. Thirty-seven patients allocated into two groups were enrolled in the study of the efficacy of tranexamic acid as an agent in reducing blood loss during hip joint replacement. Group 2 patients were injected tranexamic acid, 10 mg/kg body weight, 20—30 minutes before and 3 hours after surgery in the same dosage. This resulted in a significant (48.5% reduction in total blood loss (from 1089.6 to 560.8 ml (p<0.05. No tranexamic acid-induced complications were found. The administration of tranexamic acid during total endoprosthetic replacement of the hip joint could reduce blood loss by 35 and 59.4% in the intraoperative and postoperative periods, respectively, and total blood loss by 48.4%. The use of tranexamic acid allows one to refuse transfusion of blood components during total endoprosthetic replacement of the hip joint. Key words: hip joint replacement, blood loss, tranexamic acid.

Differences in the stress distribution in the distal femur between patellofemoral joint replacement and total knee replacement: a finite element study

Directory of Open Access Journals (Sweden)

van Jonbergen Hans-Peter W

2012-06-01

Full Text Available Abstract Background Patellofemoral joint replacement is a successful treatment option for isolated patellofemoral osteoarthritis. However, results of later conversion to total knee replacement may be compromised by periprosthetic bone loss. Previous clinical studies have demonstrated a decrease in distal femoral bone mineral density after patellofemoral joint replacement. It is unclear whether this is due to periprosthetic stress shielding. The main objective of the current study was to evaluate the stress shielding effect of prosthetic replacement with 2 different patellofemoral prosthetic designs and with a total knee prosthesis. Methods We developed a finite element model of an intact patellofemoral joint, and finite element models of patellofemoral joint replacement with a Journey PFJ prosthesis, a Richards II prosthesis, and a Genesis II total knee prosthesis. For each of these 4 finite element models, the average Von Mises stress in 2 clinically relevant regions of interest were evaluated during a simulated squatting movement until 120 degrees of flexion. Results During deep knee flexion, in the anterior region of interest, the average Von Mises stress with the Journey PFJ design was comparable to the physiological knee, while reduced by almost 25% for both the Richards II design and the Genesis II total knee joint replacement design. The average Von Mises stress in the supracondylar region of interest was similar for both patellofemoral prosthetic designs and the physiological model, with slightly lower stress for the Genesis II design. Conclusions Patellofemoral joint replacement results in periprosthetic stress-shielding, although to a smaller degree than in total knee replacement. Specific patellofemoral prosthetic design properties may result in differences in femoral stress shielding.

Differences in the stress distribution in the distal femur between patellofemoral joint replacement and total knee replacement: a finite element study

Science.gov (United States)

2012-01-01

Background Patellofemoral joint replacement is a successful treatment option for isolated patellofemoral osteoarthritis. However, results of later conversion to total knee replacement may be compromised by periprosthetic bone loss. Previous clinical studies have demonstrated a decrease in distal femoral bone mineral density after patellofemoral joint replacement. It is unclear whether this is due to periprosthetic stress shielding. The main objective of the current study was to evaluate the stress shielding effect of prosthetic replacement with 2 different patellofemoral prosthetic designs and with a total knee prosthesis. Methods We developed a finite element model of an intact patellofemoral joint, and finite element models of patellofemoral joint replacement with a Journey PFJ prosthesis, a Richards II prosthesis, and a Genesis II total knee prosthesis. For each of these 4 finite element models, the average Von Mises stress in 2 clinically relevant regions of interest were evaluated during a simulated squatting movement until 120 degrees of flexion. Results During deep knee flexion, in the anterior region of interest, the average Von Mises stress with the Journey PFJ design was comparable to the physiological knee, while reduced by almost 25% for both the Richards II design and the Genesis II total knee joint replacement design. The average Von Mises stress in the supracondylar region of interest was similar for both patellofemoral prosthetic designs and the physiological model, with slightly lower stress for the Genesis II design. Conclusions Patellofemoral joint replacement results in periprosthetic stress-shielding, although to a smaller degree than in total knee replacement. Specific patellofemoral prosthetic design properties may result in differences in femoral stress shielding. PMID:22704638

Midflexion instability in primary total knee replacement: a review

Directory of Open Access Journals (Sweden)

Ramappa Manjunath

2015-01-01

Full Text Available Introduction: Midflexion instability in primary total knee replacement (TKR is an evolving concept. Successful treatment of instability requires an understanding of the different types of instability. Methods: A literature review was performed to identify information pertinent to midflexion instability in primary total knee replacement, utilising PRISMA guidelines. Databases searched included Embase, Medline, All of the Cochrane Library, PubMed and cross references. Results: Three factors, i.e., elevated joint line, multiradii femoral component and medial collateral ligament (MCL laxity, were identified to influence midflexion instability. Literature suggested mediolateral instability at 30–60° of flexion as diagnostic of midflexion instability. Literature search also revealed paucity in clinical studies analysing midflexion instability. Most of the evidence was obtained from cadaveric studies for elevated joint line and MCL laxity. Clinical studies on multiradii femoral component were limited by their small study size and early followup period. Conclusion: Elevated joint line, multiradii femoral component and MCL laxity have been suggested to cause midflexion laxity in primary TKR. Due to limitations in available evidence, this review was unable to raise the strength of overall evidence. Future well-designed clinical studies are essential to make definitive conclusions. This review serves as a baseline for future researchers and creates awareness for routine assessment of midflexion instability in primary total knee replacement.

A longitudinal study of quality of life and functional status in total hip and total knee replacement patients.

Science.gov (United States)

Mandzuk, Lynda L; McMillan, Diana E; Bohm, Eric R

2015-05-01

Primary total hip and primary total knee surgeries are commonly performed to improve patients' quality of life and functional status. This longitudinal retrospective study (N = 851) examined self-reported quality of life and functional status over the preoperative and postoperative periods: 12 months prior to surgery, one month prior to surgery and 12 months following surgery. A linear mixed effects model was used to analyze the changes in quality of life and functional status over the sampling period. Patients in the convenience sample reported improvements in quality of life and functional status utilizing the SF-12 and Oxford Hip and Oxford Knee, although differences were noted by procedure and gender. Total hip patients tended to demonstrate greater improvement than total knee patients and males reported higher levels of physical and mental quality of life as well as functional status when compared to females. Of particular note was that mental health scores were consistently lower in both total hip and total knee replacement patients across the perioperative period and up to one year postoperative. This study identifies an opportunity for health care providers to proactively address the mental health of total hip and total knee replacement patients throughout their joint replacement trajectory. Copyright © 2014 Elsevier Ltd. All rights reserved.

Total Knee Replacement in A Resource Constrained Environment: A ...

African Journals Online (AJOL)

2017-03-06

Mar 6, 2017 ... care patronage, and the recent trends of religious/faith healings. • Beliefs ... Prevalence and Pattern of Knee Osteoarthritis in a North Eastern. Nigerian Rural ... epidemiology of total knee replacement in South Korea: national.

Structural valve deterioration in a starr-edwards mitral caged-disk valve prosthesis.

Science.gov (United States)

Aoyagi, Shigeaki; Tayama, Kei-Ichiro; Okazaki, Teiji; Shintani, Yusuke; Kono, Michitaka; Wada, Kumiko; Kosuga, Ken-Ichi; Mori, Ryusuke; Tanaka, Hiroyuki

2013-01-01

The durability of the Starr-Edwards (SE) mitral caged-disk valve, model 6520, is not clearly known, and structural valve deterioration in the SE disk valve is very rare. Replacement of the SE mitral disk valve was performed in 7 patients 23-40 years after implantation. Macroscopic examination of the removed disk valves showed no structural abnormalities in 3 patients, in whom the disk valves were removed at valves excised >36 years after implantation in 4 patients. Disk fracture, a longitudinal split in the disk along its circumference at the site of incorporation of the titanium ring, was detected in the valves removed 36 and 40 years after implantation, respectively, and many cracks were also observed on the outflow aspect of the disk removed 40 years after implantation. Disk fracture and localized disk wear were found in the SE mitral disk valves implanted >36 years previously. The present results suggest that SE mitral caged-disk valves implanted >20 years previously should be carefully followed up, and that those implanted >30 years previously should be electively replaced with modern prosthetic valves

Jejunal Replacement of Stomach in Two Children with Total Gastric Necrosis

Directory of Open Access Journals (Sweden)

Onder Ozden

2014-04-01

Full Text Available Total gastrectomy is an extremely rare procedure in children and experience with its replacement is very limited. We present two patients who had jejunal replacement due to total gastric necrosis. The first patient was a- 2-year-old boy who admitted with a history of caustic ingestion. He was taken operation because of gastric perforation and necrosis. Anastomosis was applied by using jejunal segments. The second patient was an 11-years-old girl who left diaphragmatic hernia and acute gastric volvulus. At laparotomy, Total gastrectomy and Hunt-Lawrence type gastroesophostomy were made. Reconstruction with jejunum is thought as a good option in total gastric necrosis according to our 2 patient experiences. [Cukurova Med J 2014; 39(2.000: 403-407

Dislocation of total hip replacement in patients with fractures of the femoral neck.

Science.gov (United States)

Enocson, Anders; Hedbeck, Carl-Johan; Tidermark, Jan; Pettersson, Hans; Ponzer, Sari; Lapidus, Lasse J

2009-04-01

Total hip replacement is increasingly used in active, relatively healthy elderly patients with fractures of the femoral neck. Dislocation of the prosthesis is a severe complication, and there is still controversy regarding the optimal surgical approach and its influence on stability. We analyzed factors influencing the stability of the total hip replacement, paying special attention to the surgical approach. We included 713 consecutive hips in a series of 698 patients (573 females) who had undergone a primary total hip replacement (n = 311) for a non-pathological, displaced femoral neck fracture (Garden III or IV) or a secondary total hip replacement (n = 402) due to a fracture-healing complication after a femoral neck fracture. We used Cox regression to evaluate factors associated with prosthetic dislocation after the operation. Age, sex, indication for surgery, the surgeon's experience, femoral head size, and surgical approach were tested as independent factors in the model. The overall dislocation rate was 6%. The anterolateral surgical approach was associated with a lower risk of dislocation than the posterolateral approach with or without posterior repair (2%, 12%, and 14%, respectively (p replacement in patients with femoral neck fractures.

Exercise therapy may postpone total hip replacement surgery in patients with hip osteoarthritis

DEFF Research Database (Denmark)

Svege, Ida; Nordsletten, Lars; Fernandes, Linda

2015-01-01

Exercise treatment is recommended for all patients with hip osteoarthritis (OA), but its effect on the long-term need for total hip replacement (THR) is unknown.......Exercise treatment is recommended for all patients with hip osteoarthritis (OA), but its effect on the long-term need for total hip replacement (THR) is unknown....

Age Related Macular Degeneration and Total Hip Replacement Due to Osteoarthritis or Fracture: Melbourne Collaborative Cohort Study.

Directory of Open Access Journals (Sweden)

Elaine W Chong

Full Text Available Osteoarthritis is the leading cause of total hip replacement, accounting for more than 80% of all total hip replacements. Emerging evidence suggests that osteoarthritis has a chronic inflammatory component to its pathogenesis similar to age-related macular degeneration. We evaluated the association between age-related macular degeneration and total hip replacement as proxy for severe osteoarthritis or fractured neck of femur in the Melbourne Collaborative Cohort Study. 20,744 participants had complete data on both age-related macular degeneration assessed from colour fundus photographs taken during 2003-2007 and total hip replacement. Total hip replacements due to hip osteoarthritis and fractured neck of femur during 2001-2011 were identified by linking the cohort records to the Australian Orthopedic Association National Joint Replacement Registry. Logistic regression was used to examine the association between age-related macular degeneration and risk of total hip replacement due to osteoarthritis and fracture separately, adjusted for confounders. There were 791 cases of total hip replacement for osteoarthritis and 102 cases of total hip replacement due to fractured neck of femur. After adjustment for age, sex, body mass index, smoking, and grouped country of birth, intermediate age-related macular degeneration was directly associated with total hip replacement for osteoarthritis (odds ratio 1.22, 95% CI 1.00-1.49. Late age-related macular degeneration was directly associated with total hip replacement due to fractured neck of femur (odds ratio 5.21, 95% CI2.25-12.02. The association between intermediate age-related macular degeneration and an increased 10-year incidence of total hip replacement due to osteoarthritis suggests the possibility of similar inflammatory processes underlying both chronic diseases. The association of late age-related macular degeneration with an increased 10-year incidence of total hip replacement due to fractured

Functional assessment of patients after total knee replacement

Directory of Open Access Journals (Sweden)

Matla Joanna

2017-06-01

Full Text Available Introduction: In the society of the 21st century, osteoarthritis is considered one of the primary causes of the occurrence of pain and disability. Arthroplasty is the treatment of choice for advanced degenerative changes. The aim of the study was to carry out a functional assessment of patients at early stages of rehabilitation after total knee replacement.

Variation in age and physical status prior to total knee and hip replacement surgery

DEFF Research Database (Denmark)

Ackerman, Ilana N; Dieppe, Paul A; March, Lyn M

2009-01-01

OBJECTIVE: To investigate whether variation exists in the preoperative age, pain, stiffness, and physical function of people undergoing total knee replacement (TKR) and total hip replacement (THR) at several centers in Australia and Europe. METHODS: Individual Western Ontario and McMaster Univers...

Total Humeral Endoprosthetic Replacement following Excision of Malignant Bone Tumors

Directory of Open Access Journals (Sweden)

Suhel Kotwal

2016-01-01

Full Text Available Humerus is a common site for malignant tumors. Advances in adjuvant therapies and reconstructive methods provide salvage of the upper limb with improved outcomes. Reports of limb salvage with total humeral replacement in extensive humeral tumors are sparse. We undertook a retrospective study of 20 patients who underwent total humeral endoprosthetic replacement as limb salvage following excision of extensile malignant tumor from 1990 to 2011. With an average followup of 42.9, functional and oncological outcomes were analyzed. Ten patients were still alive at the time of review. Mean estimated blood loss was 1131 mL and duration of surgery was 314 minutes. Deep infection was encountered in one patient requiring debridement while mechanical loosening of ulnar component was identified in one patient. Subluxation of prosthetic humeral head was noted in 3 patients. Mean active shoulder abduction was 12.5° and active flexion was 15°. Incompetence of abduction mechanism was the major determinant of poor active functional outcome. Mean elbow flexion was 103.5° with 30.5° flexion contracture in 10 patients with good and useful hand function. Average MSTS score was 71.5%. Total humeral replacement is a reliable treatment option in restoring mechanical stability and reasonable functional results without compromising patient survival, with low complication rate.

Managing infection in the revision total hip replacement patient.

Science.gov (United States)

Halley, D K

1993-01-01

Deep infection is one of the most devastating complications in total hip replacement. This dreaded complication is presented in considerable detail with special emphasis on prevention, diagnosis, and various methods of surgical and antibiotic treatment. Basic fundamentals of antibiotic therapy are reviewed. In addition, guidelines are given for the indications of surgical intervention, the type and staging of operative procedures, with detailed techniques of the various operative procedures used to treat the infected total hip implant patient.

Total hip replacement surgery in Ethiopia | Gokcen | East and ...

African Journals Online (AJOL)

Background: Total hip replacement (THR) surgery has evolved over years to the point that it has been considered as "the operation of the century". For developed countries, arthroplasty is well established for the management of various joint disorders and has completely revolutionised the treatment of the arthritic hip.

Influence of conformity on the wear of total knee replacement: An experimental study.

Science.gov (United States)

Brockett, Claire L; Carbone, Silvia; Fisher, John; Jennings, Louise M

2018-02-01

Wear of total knee replacement continues to be a significant factor influencing the clinical longevity of implants. Historically, failure due to delamination and fatigue directed design towards more conforming inserts to reduce contact stress. As new generations of more oxidatively stable polyethylene have been developed, more flexibility in bearing design has been introduced. The aim of this study was to investigate the effect of insert conformity on the wear performance of a fixed bearing total knee replacement through experimental simulation. Two geometries of insert were studied under standard gait conditions. There was a significant reduction in wear with reducing implant conformity. This study has demonstrated that bearing conformity has a significant impact on the wear performance of a fixed bearing total knee replacement, providing opportunities to improve clinical performance through enhanced material and design selection.

Physical health problems experienced in the early postoperative recovery period following total knee replacement

DEFF Research Database (Denmark)

Szötz, Kirsten; Pedersen, Preben Ulrich; Hørdam, Britta

2015-01-01

of exercising in the early recovery period after discharge from hospital following total knee replacement. METHOD: A cross-sectional survey was conducted using a questionnaire. A total of 86 patients were included following first-time elective total knee replacement. Descriptive statistics were used. RESULTS......: The majority of the patients experienced leg oedema (90.7%). Secondary to this were pain (81.4%), sleeping disorders (47.7%) problems with appetite (38.4%) and bowel function (34.9%) were the most frequently identified physical health problems. In total, 69.8% of the patients indicated that they did...... not exercise or only partly exercise as recommended, but without associated experience of pain. CONCLUSION: Patients experienced a wide range of physical health problems following total knee replacement and deviation from recommended self-training was identified. These findings are valuable for health...

Matched cohort study of topical tranexamic acid in cementless primary total hip replacement.

Science.gov (United States)

Sanz-Reig, Javier; Mas Martinez, Jesus; Verdu Román, Carmen; Morales Santias, Manuel; Martínez Gimenez, Enrique; Bustamante Suarez de Puga, David

2018-03-29

Tranexamic acid has been shown to be effective in reducing blood loss after total hip replacement. The purpose of this study was to prospectively assess the effectiveness of topical TXA use to reduce blood loss after primary total hip replacement and to compare these outcomes with those of a matched control group from a similar cohort that did not have received tranexamic acid. This is a prospective matched control study to assess the effect of a 2 g topical tranexamic acid in 50 mL physiological saline solution in total hip replacement. Primary outcomes were hemoglobin and hematocrit drop, and total blood loss. Secondary outcomes were transfusion rates, length of hospital stay, deep vein thrombosis, and pulmonary embolism events. We could match 100 patients to a control group. There were no statistical significantly differences between the two groups. The hemoglobin and hematocrit postoperative values were significantly higher in topical tranexamic acid group than in control group (P tranexamic acid group and 1163 in control group with significant differences (P = 0.001), which meant 34% reduction in total blood loss. Length of stay was lower in topical tranexamic acid group. The risk of deep vein thrombosis and pulmonary events did not increase. A single dose of 2 g tranexamic acid in 50 mL physiological saline solution topical administration was effective and safe in reducing bleeding in patients undergoing unilateral primary non-cemented total hip replacement compared to a matched control group.

Surface neuromuscular electrical stimulation for quadriceps strengthening pre and post total knee replacement.

LENUS (Irish Health Repository)

Monaghan, Brenda

2010-01-01

Total knee replacement has been demonstrated to be one of the most successful procedures in the treatment of osteoarthritis. However quadriceps weakness and reductions in function are commonly reported following surgery. Recently Neuromuscular Electrical Stimulation (NMES) has been used as an adjunct to traditional strengthening programmes. This review considers the effectiveness of NMES as a means of increasing quadriceps strength in patients before and after total knee replacement.

Non-Traumatic Anterior Dislocation of a Total Knee Replacement Associated with Neurovascular Injury

Science.gov (United States)

Aderinto, Joseph; Gross, Allan E; Rittenhouse, Bryan

2009-01-01

Prosthetic total knee replacements rarely dislocate. When dislocation does occur, it is usually in a posterior direction in association with a posterior stabilised, cruciate-sacrificing prosthesis. Neurovascular injury is unusual. In this report, we describe a case of anterior dislocation of a cruciate-retaining total knee replacement in a 67-year-old woman. The dislocation occurred in the absence of overt trauma and resulted in severe neurovascular injury. PMID:19686618

Magnetohydrodynamics of accretion disks

International Nuclear Information System (INIS)

Torkelsson, U.

1994-04-01

The thesis consists of an introduction and summary, and five research papers. The introduction and summary provides the background in accretion disk physics and magnetohydrodynamics. The research papers describe numerical studies of magnetohydrodynamical processes in accretion disks. Paper 1 is a one-dimensional study of the effect of magnetic buoyancy on a flux tube in an accretion disk. The stabilizing influence of an accretion disk corona on the flux tube is demonstrated. Paper 2-4 present numerical simulations of mean-field dynamos in accretion disks. Paper 11 verifies the correctness of the numerical code by comparing linear models to previous work by other groups. The results are also extended to somewhat modified disk models. A transition from an oscillatory mode of negative parity for thick disks to a steady mode of even parity for thin disks is found. Preliminary results for nonlinear dynamos at very high dynamo numbers are also presented. Paper 3 describes the bifurcation behaviour of the nonlinear dynamos. For positive dynamo numbers it is found that the initial steady solution is replaced by an oscillatory solution of odd parity. For negative dynamo numbers the solution becomes chaotic at sufficiently high dynamo numbers. Paper 4 continues the studies of nonlinear dynamos, and it is demonstrated that a chaotic solution appears even for positive dynamo numbers, but that it returns to a steady solution of mixed parity at very high dynamo numbers. Paper 5 describes a first attempt at simulating the small-scale turbulence of an accretion disk in three dimensions. There is only find cases of decaying turbulence, but this is rather due to limitations of the simulations than that turbulence is really absent in accretion disks

The role of the posterior cruciate ligament in total knee replacement

Science.gov (United States)

Ritter, M. A.; Davis, K. E.; Meding, J. B.; Farris, A.

2012-01-01

Objectives The purpose of this study was to examine the effect of posterior cruciate ligament (PCL) retention, PCL recession, and PCL excision during cruciate-retaining total knee replacement. Methods A total of 3018 anatomic graduated component total knee replacements were examined; 1846 of these retained the PCL, 455 PCLs were partially recessed, and in 717 the PCL was completely excised from the back of the tibia. Results Clinical scores between PCL groups favored excision for flexion (p knees, 98.2% for recessed knees, and 96.4% for excised knees (p = 0.0934, Wilcoxon; p = 0.0202, log-rank). Conclusions Despite some trade off in clinical performance, if the PCL is detached at the time of operation, conversion to a posterior-stabilised prosthesis may not be necessarily required as long as stability in the anteroposterior and coronal planes is achieved. PMID:23610673

The influence of optimism on functionality after total hip replacement surgery.

Science.gov (United States)

Balck, Friedrich; Lippmann, Maike; Jeszenszky, Csilla; Günther, Klaus-Peter; Kirschner, Stephan

2016-08-01

Among other factors, optimism has been shown to significantly influence the course of some diseases (cancer, HIV, coronary heart disease). This study investigated whether optimism of a patient before a total hip replacement can predict the functionality of the lower limbs 3 and 6 months after surgery. A total of 325 patients took part in the study (age: 58.7 years; w: 55%). The functionality was measured with the Western Ontario and McMaster Universities arthrosis index, and optimism with the Life Orientation Test. To analyse the influences of age, gender and optimism, general linear models were calculated. In optimistic patients, functionality improved significantly over time. The study showed a clear influence of dispositional optimism on the recovery after total hip replacement in the first 3 months after surgery. © The Author(s) 2015.

Total knee replacement in a resource constrained environment: A ...

African Journals Online (AJOL)

Introduction: Total knee replacement surgery is relatively new in Nigeria and available in few centres only. It has been evolving at a slow pace because of the lack of facilities, structures and adequate surgical expertise alongside patient ignorance and poverty. Objective: The aim of this article is to review the cases done in a ...

Differences in the stress distribution in the distal femur between patellofemoral joint replacement and total knee replacement: a finite element study

NARCIS (Netherlands)

van Jonbergen, H.P.; Innocenti, B.; Gervasi, G.L.; Labey, L.; Verdonschot, N.J.

2012-01-01

BACKGROUND: Patellofemoral joint replacement is a successful treatment option for isolated patellofemoral osteoarthritis. However, results of later conversion to total knee replacement may be compromised by periprosthetic bone loss. Previous clinical studies have demonstrated a decrease in distal

Multi-ligament instability after early dislocation of a primary total knee replacement - case report.

Science.gov (United States)

Sisak, Krisztian; Lloyd, John; Fiddian, Nick

2011-01-01

Peripheral nerve blocks have found increased popularity in providing prolonged post-operative analgesia following total knee replacement surgery. They generally provide effective analgesia with fewer complications than epidurals. This report describes an acute low-energy knee dislocation after a well balanced, fixed bearing, cruciate-retaining primary total knee replacement performed under a spinal anaesthetic with combined complimentary femoral and sciatic nerve blocks. The dislocation was not accompanied by neurovascular compromise. Due to the subsequent instability and injury to both collaterals, the posterior cruciate ligament and posterolateral corner structures, the knee was treated with a rotating-hinge revision total knee replacement. The dislocation occurred whilst the peripheral nerve blocks (PNB) were still working. We review our incidence of PNB related complications and conclude that PNB remain a safe and effective analgesia for total knee replacements. However, we advocate that ward staff and patients should be sufficiently educated to ensure that unaided post-operative mobilisation is prevented until such a time that patients have regained complete voluntary muscle control. Copyright © 2009 Elsevier B.V. All rights reserved.

Dislocation of total hip replacement in patients with fractures of the femoral neck

OpenAIRE

Enocson, Anders; Hedbeck, Carl-Johan; Tidermark, Jan; Pettersson, Hans; Ponzer, Sari; Lapidus, Lasse J

2009-01-01

Background Total hip replacement is increasingly used in active, relatively healthy elderly patients with fractures of the femoral neck. Dislocation of the prosthesis is a severe complication, and there is still controversy regarding the optimal surgical approach and its influence on stability. We analyzed factors influencing the stability of the total hip replacement, paying special attention to the surgical approach. Patients and methods We included 713 consecutive hips in a series of 698 p...

EXPERIMENTAL RESEARCH OF REGENERATIVE FEATURES IN BONE TISSUES AROUND IMPLANTS AFTER ONE-STAGE BILATERAL TOTAL HIP REPLACEMENT

Directory of Open Access Journals (Sweden)

V. M. Mashkov

2012-01-01

Full Text Available Objective: to research the specific features of regenerative processes of bone tissue around implants after one-stage bilateral total hip replacement in experiment. Material and methods: 27 total hip replacement operations have been performed in 18 rabbits of breed "chinchilla" to which bipolar femoral endoprosthesis made of titanic alloy PT-38, one type-size, with friction pair metal-on-metal and neck-shaft angle 165 degrees have been implanted: total unilateral hip replacement operations have been performed in 9 animals (control group, one-stage bilateral total hip replacement operations have been performed in 9 animals (experimental group. During research they have been on radiological and clinical checking-up. After the experiment the animals had histological tests of the tissues around endoprosthesis components. Results and conclusions: After one-stage bilateral total hip replacement in early terms of research more expressed changes of bone tissue in the form of its thinning and decompaction were found around implants. One-stage bilateral total hip replacement did not essentially influence on the speed of osteogenesis around endoprothesis components in comparison with unilateral total hip replacement, so in late terms of observation in both groups the fixing of endoprothesis components did not differ.

Outcomes of single-stage total arch replacement via clamshell incision

Directory of Open Access Journals (Sweden)

Ishizaka Toru

2011-09-01

Full Text Available Abstract Background Treatment of complex aortic pathologies involving the transverse arch with extensive involvement of the descending aorta remains a surgical challenge. Since clamshell incision provides superior exposure of the entire thoracic aorta, we evaluated the use of this technique for single-stage total arch replacement by arch vessel reconstruction. Methods The arch-first technique combined with clamshell incision was used in 38 cases of aneurysm and aortic disease in 2008 and 2009. Extensive total arch replacement was used with clamshell incision for reconstruction of arch vessels under deep hypothermic circulatory arrest. Results Overall 30-day mortality was 13%. The mean operating time was approximately 8 hours. Deep hypothermia resulted in mean CPB time exceeding 4.5 hours and mean duration of circulatory arrest was 25 minutes. The overall postoperative temporary and permanent neurologic dysfunction rates were 3% and 3% for elective and 3% and 0% for emergency surgery, respectively. All patients except the five who died in hospital were discharged without nursing care after an average post-operative hospital stay of 35 days. Conclusions The arch-first technique, combined with clamshell incision, provides expeditious replacement of the thoracic aorta with an acceptable duration of hypothermic circulatory arrest and minimizes the risk of retrograde atheroembolism by using antegrade perfusion.

Comparing 30-day all-cause readmission rates between tibiotalar fusion and total ankle replacement.

Science.gov (United States)

Merrill, Robert K; Ferrandino, Rocco M; Hoffman, Ryan; Ndu, Anthony; Shaffer, Gene W

2018-01-12

End-stage ankle arthritis is a debilitating condition that negatively impacts patient quality of life. Tibiotalar fusion and total ankle replacement are treatment options for managing ankle arthritis. Few studies have examined short term readmission rates of these two procedures. The objective of this study was compare all-cause 30-day readmission rates between patients undergoing tibiotalar fusion vs. total ankle replacement. This study queried the Nationwide Readmission Database (NRD) from 2013-2014 and used international classification of disease, 9th revision (ICD-9) procedure codes to identify all patients who underwent a tibiotalar fusion or a total ankle replacement. Comorbidities, insurance status, hospital characteristics, and readmission rates were statistically compared between the two cohorts. Risk factors were then identified for 30-day readmission. A total of 5660 patients were analyzed with 2667 in the tibiotalar fusion cohort and 2993 in the total ankle replacement cohort. Univariate analysis revealed that the readmission rate after tibiotalar fusion (4.4%) was statistically greater than after total ankle replacement (1.4%). Multivariable regression analysis indicated that deficiency anemia (OR 2.18), coagulopathy (OR 3.51), renal failure (OR 2.83), other insurance relative to private (OR 3.40), and tibiotalar fusion (OR 2.51) were all statistically significant independent risk factors for having a readmission within 30-days. These findings suggest that during the short-term period following discharge from the hospital, patients who received a tibiotalar fusion are more likely to experience a 30-day readmission. These findings are important for decision making when a surgeon encounters a patient with end stage ankle arthritis. Level III, cohort study. Published by Elsevier Ltd.

THICK-DISK EVOLUTION INDUCED BY THE GROWTH OF AN EMBEDDED THIN DISK

International Nuclear Information System (INIS)

Villalobos, Alvaro; Helmi, Amina; Kazantzidis, Stelios

2010-01-01

We perform collisionless N-body simulations to investigate the evolution of the structural and kinematical properties of simulated thick disks induced by the growth of an embedded thin disk. The thick disks used in the present study originate from cosmologically common 5:1 encounters between initially thin primary disk galaxies and infalling satellites. The growing thin disks are modeled as static gravitational potentials and we explore a variety of growing-disk parameters that are likely to influence the response of thick disks. We find that the final thick-disk properties depend strongly on the total mass and radial scale length of the growing thin disk, and much less sensitively on its growth timescale and vertical scale height as well as the initial sense of thick-disk rotation. Overall, the growth of an embedded thin disk can cause a substantial contraction in both the radial and vertical direction, resulting in a significant decrease in the scale lengths and scale heights of thick disks. Kinematically, a growing thin disk can induce a notable increase in the mean rotation and velocity dispersions of thick-disk stars. We conclude that the reformation of a thin disk via gas accretion may play a significant role in setting the structure and kinematics of thick disks, and thus it is an important ingredient in models of thick-disk formation.

Femoral nerve palsy caused by ileopectineal bursitis after total hip replacement: a case report

Directory of Open Access Journals (Sweden)

Bähr Mathias

2011-05-01

Full Text Available Abstract Introduction Infectious ileopectineal bursitis is a rare complication after total hip replacement and is associated mainly with rheumatoid arthritis. The main complications are local swelling and pain, but communication of the inflamed bursa with the joint can occur, leading to subsequent cartilage damage and bone destruction. Case presentation We report a case of a 47-year-old Caucasian woman without rheumatoid arthritis who reported pain and palsy in her left leg almost one year after total hip replacement. She was diagnosed with an ileopectineal bursitis after total hip replacement, leading to femoral nerve palsy. The diagnosis was obtained by thorough clinical examination, the results of focused computed tomography and magnetic resonance imaging. Conclusion To the best of our knowledge, this is the first report of non-infectious ileopectineal bursitis in a patient without rheumatoid arthritis as a complication of total hip replacement. This rare case underlines the importance of proper neurologic examination of persistent conditions after orthopedic intervention in otherwise healthy individuals. We believe this case should be useful for a broad spectrum of medical specialties, including orthopedics, neurology, radiology, and general practice.

Case Study of a physiotherapy treatment of a patient after total hip replacement

OpenAIRE

Havlíčková, Barbora

2013-01-01

The bachelor's thesis consists of two parts. The general part includes anatomy and kinesiology of the hip joint and also the topic of coxarthrosis as the most common reason for the total hip replacement surgery. An integral part of this part is the elaboration of a rehabilitation plan for patients undergoing such procedure. The practical part of the thesis is conceived a case study of a patient after total hip replacement because of coxarthrosis. Finally, the thesis includes the therapeutic o...

TOTAL HIP REPLACEMENT IN LEGG-CALVÉ-PERTHES DISEASE

DEFF Research Database (Denmark)

Froberg, Lonnie; Christensen, Finn; Pedersen, Niels Wisbech

2009-01-01

INTRODUCTION Poor long-time results in patients with Legg-Calvé-Perthes disease (LCP) are most often due to degenerative hip disease. The purpose of this study was to investigate if patients with LCP have an increased rate of total hip replacement (THR) compared to sex- and age-matched persons....... MATERIAL AND METHODS 167 LCP patients presented to our institution from 1941 to 1962. All patients were treated conservatively by a Thomas splint. Retrospectively medical records and radiographs were retrieved. Data from the Danish Hip Replacement Register and the Registries of the National Board of Health...... to follow-up and 3) patients with previous surgery to pelvis or lower limbs. 135 patients (156 hips) were enrolled in this study and 32 patients (35 hips) were excluded. RESULTS 20 hips out of 156 hips in patients with LCP have had a THR. Mean age at operation for the women was 50 years and 44 years...

Does total hip replacement affect sexual quality of life?

Science.gov (United States)

Harmsen, Rita Th E; Haanstra, Tsjitske M; Sierevelt, Inger N; Jansma, Elise P; Nolte, Peter A; Nicolai, Melianthe P J; Wall, Peter D H; Van Royen, Barend J

2016-05-04

Total Hip Replacement (THR) is an effective treatment for end-stage hip osteoarthritis. Since the introduction of total joint replacement, the effect on the Sexual Quality of Life (SQoL) following THR has been addressed in scant studies. The aim of our study was to systematically review the literature, to summarise effects of THR on patients' SQoL. We searched PubMed, EMBASE and PsycINFO between January 1970 and February 9th, 2015 with search terms including Total Hip, Osteoarthritis, SQoL, and THR. Eligible studies were identified and two independent authors extracted data including details of SQoL, study quality and risk of bias. There were 12 eligible studies, which included a total of 2099 patients with an age range of 20-85 years. The methodological quality of ten studies was rated as low, and of two as moderate. Amongst the majority of patients, SQoL improved after surgery, both in terms of physical-functional and psychosocial well-being. However, changes between pre-operative and postoperative SQoL ranged extensively: for example, Sexual Dysfunction Δ 8-51% and Sexual Activity (SA) Δ 0-77%. Three studies reported that some patients never resumed SA again after surgery. In over 40 years of THR treatment, scant studies have examined the effect of THR on patients' SQoL. This review suggests that SQol improves after THR, although the magnitude of effects varies highly. However, the quality of the supporting evidence was rated as low to moderate. This suggests a need for more high quality evidence about the effects of THR on SQoL.

Wear prediction on total ankle replacement effect of design parameters

CERN Document Server

Saad, Amir Putra Bin Md; Harun, Muhamad Noor; Kadir, Mohammed Rafiq Abdul

2016-01-01

This book develops and analyses computational wear simulations of the total ankle replacement for the stance phase of gait cycle. The emphasis is put on the relevant design parameters. The book presents a model consisting of three components; tibial, bearing and talar representing their physiological functions.

Wear debris. An environmental issue in total joint replacement.

Science.gov (United States)

Manley, M T; Serekian, P

1994-01-01

There is a growing concern that osteolytic lesions, often adjacent to otherwise stable implants, are a recent phenomenon caused by some recent change in polyethylene, metal, or other aspect of the total hip construction. This study investigates the possibility that bearings and modular connections used in modern hip replacements are an unappreciated source of particulate debris. Measurements taken from contemporary femoral bearings show a significant mismatch in both surface finish and sphericity of mating metal and polyethylene components, with sphericity of inserts being much worse then sphericity of femoral heads. The tolerances for sphericity of polyethylene inserts were further changed by the placement of an insert into its metal shell. Hip simulator tests of assembled inserts and shells showed greater polyethylene weight loss for metal-backed shells than for inserts alone. Bending and torsional tests of metal/metal modular connections showed that dynamic loads can release large numbers of debris particles from taper junctions. Because osteolytic lesions clearly are associated with overload of tissue by debris particles, the design, manufacture, and tolerances of modular connections in total hip replacement all seem to require reevaluation.

MRI as a problem-solving tool in unexplained failed total hip replacement following conventional assessment

International Nuclear Information System (INIS)

Johnston, Ciaran; Kerr, Jennifer; Ford, Stephanie; Eustace, Stephen; O'Byrne, John

2007-01-01

To evaluate MRI as a problem-solving tool for patients with an unexplained failed total hip replacement following conventional radiological assessment. Patients' informed consent was obtained in all cases. Institutional review board approval was obtained. Twenty-eight patients with unexplained failed total hip replacements following conventional radiological assessment underwent additional MR imaging with an optimised turbo-spin echo sequence. Images were reviewed by two musculoskeletal radiologists by consensus and compared with findings at surgery, or following response to image-guided intervention or clinical follow-up. Of the 28 patients, MRI revealed an unsuspected diagnosis explaining the cause of prosthesis failure in 15 patients. In eight of 15 patients in this group, subsequent minimally invasive image-guided intervention obviated the need for revision total hip replacement. No cause for prosthesis failure was identified in 13 patients. MRI may be successfully undertaken in patients following total hip replacement, and, when performed, it frequently leads to an unsuspected diagnosis, allowing informed patient treatment. In this study it allowed the identification of an unsuspected diagnosis in over 50% of cases. (orig.)

Embedded piezoelectrics for sensing and energy harvesting in total knee replacement units

Science.gov (United States)

Wilson, Brooke E.; Meneghini, Michael; Anton, Steven R.

2015-04-01

The knee replacement is the second most common orthopedic surgical intervention in the United States, but currently only 1 in 5 knee replacement patients are satisfied with their level of pain reduction one year after surgery. It is imperative to make the process of knee replacement surgery more objective by developing a data driven approach to ligamentous balance, which increases implant life. In this work, piezoelectric materials are considered for both sensing and energy harvesting applications in total knee replacement implants. This work aims to embed piezoelectric material in the polyethylene bearing of a knee replacement unit to act as self-powered sensors that will aid in the alignment and balance of the knee replacement by providing intraoperative feedback to the surgeon. Postoperatively, the piezoelectric sensors can monitor the structural health of the implant in order to perceive potential problems before they become bothersome to the patient. Specifically, this work will present on the use of finite element modeling coupled with uniaxial compression testing to prove that piezoelectric stacks can be utilized to harvest sufficient energy to power sensors needed for this application.

Generation and Development of Paravertebral Ossification in Cervical Artificial Disk Replacement: A Detailed Analytic Report Using Coronal Reconstruction CT.

Science.gov (United States)

Tian, Wei; Han, Xiao; Liu, Bo; He, Da; Lv, Yanwei; Yue, James

2017-04-01

A retrospective follow-up study and review of images in published papers. To determine whether true heterotopic ossification (HO) occurs in artificial disk replacement (ADR); to evaluate the incidence of paravertebral ossification (PO) and its influence on ADR. HO is typically defined as the abnormal formation of true bone within extraskeletal soft tissues. However, HO in ADR does not fit this definition precisely, as it originates from vertebral body, making it hard to distinguish radiologically from preexisting osteophytes. In this study, the term used for bone formation around ADR is PO. First, all images in the published papers were evaluated as to whether the presented PO in ADR fit the classic definition of HO or osteophytes. Second, we studied 37 consecutive patients who underwent ADR and follow-up for minimum 24 months. The preoperative and follow-up incidence of PO and its influence on range of motion were evaluated using x-ray and computed tomography. All 52 images of PO were found adjacent to the disk in 1 segment rather than entire cervical spine. Fifty (96.2%) of the POs were found to originate from the vertebral body rather than in the soft tissue. A total of 31 patients were included in the follow-up study. No significant difference was found in the incidence of PO between the follow-up and preoperation (61.29% vs. 48.39%, P>0.05). The range of motion of the ADR segment in patients with progressed PO (7.44±4.64 degrees) was significantly lower than that of patients with stable PO grade (12.13±4.42 degrees, P<0.01) at last follow-up. A proportion of HO might in fact be the natural development of preoperative osteophytes, which is unrelated to ADR; the remaining HO might be due to changes in biomechanical environment after surgery, which promotes the grade of osteophytes and affects the segment motion.

Comparative study of total shoulder arthroplasty versus total shoulder surface replacement for glenohumeral osteoarthritis with minimum 2-year follow-up

NARCIS (Netherlands)

Kooistra, B.W.; Willems, W.J.H.; Lemmens, E.; Hartel, B.P.; Bekerom, M.P. van den; Deurzen, D.F.P. van

2017-01-01

BACKGROUND: Compared with total shoulder arthroplasty (TSA), total shoulder surface replacement (TSSR) may offer the advantage of preservation of bone stock and shorter surgical time, possibly at the expense of glenoid component positioning and increasing lateral glenohumeral offset. We hypothesized

Difference between right and left side in total knee and unicondylar knee replacement: An interesting observation

Directory of Open Access Journals (Sweden)

Vasudevan Thirumal Selvan

2005-02-01

Full Text Available We report an observation made about the differences between right and left side in case of total knee and unicondylar knee replacement. It was found that unicondylar knee replacement was performed more commonly on the left side (66%, as compared to only 34% on right side, where as total knee replacement was more common on the right side (64% as compared to 36% on left side. The exact clinical utility of this difference is yet to be known.

Functional exercise after total hip replacement (FEATHER): a randomised control trial.

LENUS (Irish Health Repository)

Monaghan, Brenda

2012-11-01

Prolonged physical impairments in range of movement, postural stability and walking speed are commonly reported following total hip replacement (THR). It is unclear from the current body of evidence what kind of exercises should be performed to maximize patient function and quality of life.

Patient outcomes using Wii-enhanced rehabilitation after total knee replacement - the TKR-POWER study.

Science.gov (United States)

Negus, J J; Cawthorne, D P; Chen, J S; Scholes, C J; Parker, D A; March, L M

2015-01-01

Home-based rehabilitation following total knee replacement surgery can be as effective as clinic-based or in-patient rehabilitation. The use of the Nintendo Wii has been postulated as a novel rehabilitation tool that adds an additional focus on balance and proprioception into the recovery protocol. The aim of the proposed clinical trial is to investigate the effectiveness of this novel rehabilitation tool, used at home for three months after total knee replacement surgery and to assess any lasting improvements in functional outcome at one year. This will be a randomised controlled trial of 128 patients undergoing primary total knee replacement. The participants will be recruited preoperatively from three surgeons at a single centre. There will be no change to the usual care provided until 6 weeks after the operation. Then participants will be randomised to either the Wii-Fit group or usual rehabilitative care group. Outcomes will be assessed preoperatively, a 6-week post surgery baseline and then at 18 weeks, 6 months and 1 year. The primary outcome is the change in self-reported WOMAC total score from week 6 to 18 weeks. Secondary outcomes include objective measures of strength, function and satisfaction scores. The results of this clinical trial will be directly relevant for implementation into clinical practice. If beneficial, this affordable technology could be used by many patients to rehabilitate at home. Not only could it optimize the outcomes from their total knee replacement surgery but decrease the need for clinic-based or outpatient therapy for the majority. (ACTRN12611000291987). Copyright © 2014 Elsevier Inc. All rights reserved.

Experience with Designing and Implementing a Bundled Payment Program for Total Hip Replacement.

Science.gov (United States)

Whitcomb, Winthrop F; Lagu, Tara; Krushell, Robert J; Lehman, Andrew P; Greenbaum, Jordan; McGirr, Joan; Pekow, Penelope S; Calcasola, Stephanie; Benjamin, Evan; Mayforth, Janice; Lindenauer, Peter K

2015-09-01

Bundled payments, also known as episode-based payments, are intended to contain health care costs and promote quality. In 2011 a bundled payment pilot program for total hip replacement was implemented by an integrated health care delivery system in conjunction with a commercial health plan subsidiary. In July 2015 the Centers for Medicare & Medicaid Services (CMS) proposed the Comprehensive Care for Joint Replacement Model to test bundled payment for hip and knee replacement. Stakeholders were identified and a structure for program development and implementation was created. An Oversight Committee provided governance over a Clinical Model Subgroup and a Financial Model Subgroup. The pilot program included (1) a clinical model of care encompassing the period from the preoperative evaluation through the third postoperative visit, (2) a pricing model, (3) a program to share savings, and (4) a patient engagement and expectation strategy. Compared to 32 historical controls-patients treated before bundle implementation-45 post-bundle-implementation patients with total hip replacement had a similar length of hospital stay (3.0 versus 3.4 days, p=.24), higher rates of discharge to home or home with services than to a rehabilitation facility (87% versus 63%), similar adjusted median total payments ($22,272 versus $22,567, p=.43), and lower median posthospital payments ($704 versus $1,121, p=.002), and were more likely to receive guideline-consistent care (99% versus 95%, p=.05). The bundled payment pilot program was associated with similar total costs, decreased posthospital costs, fewer discharges to rehabilitation facilities, and improved quality. Successful implementation of the program hinged on buy-in from stakeholders and close collaboration between stakeholders and the clinical and financial teams.

STUDY OF FUNCTIONAL RESULTS OF CEMENTED TOTAL HIP REPLACEMENT BY MOORE’S APPROACH

Directory of Open Access Journals (Sweden)

Arunim

2016-02-01

Full Text Available INTRODUCTION The total hip replacement (THR has probably become the surgical procedure of choice for vide variety of hip joint disabling diseases. The prosthesis used for THR is often grouped into cemented, cement-less and hybrid ones. There has been increasing trends in use of cement-less components citing more number of complications namely loosening, increased infection rate etc. however with additional cost factors as well. We conducted this study to ascertain whether in a developing country like ours should we really switch over to un-cemented hip replacements dreading such complications or can we still use cemented prosthesis with equally good if not better results. METHODS A study of functional results of cemented total hip replacement was done in patients with varied age groups ranging from 40 years to 75 years with the average age being 54.8 years. 20 patients with 21 diseased hips were treated with cemented total hip replacement by Moore’s posterior approach at NSCB Subharti medical college, Meerut, UP from December 2010 to December 2013 and reviewed thereafter with an average follow-up period of 4.2 years. Average surgical time required was one and half hour. Patients were asked to come for follow up on 1st month, 3rd month and 6th month and then every 6 months and were assessed as per modified Harris Hip Score. RESULTS All the patients were evaluated according to the Modified Harris Hip Scoring system. The results showed 14(67% hips with excellent results, 4(19% with good results, and 3(14% hips with fair results. No poor outcome was noted in this study. 2 cases of dislocation (10% were noted one on the 5th post-operative day and the other occurred after the patient was discharged from the institution. CONCLUSIONS The management of diseased and destroyed hips with chronic pain with cemented total hip replacement is effective and gives stable, mobile and painless hip joint to the patient. Functional results are excellent and

Quality of life: patient-reported outcomes after total replacement of the temporomandibular joint.

Science.gov (United States)

Kunjur, J; Niziol, R; Matthews, N S

2016-09-01

Since publication of the UK guidelines on total replacement of the temporomandibular joint (TMJ) in 2008 by the British Association of Oral and Maxillofacial Surgeons (BAOMS), pain scores, mouth opening, and diet have been used as markers of success. We have looked at quality of life (QoL) as another. We analysed the data from a single surgeon on patients who had had joints replaced and devised a questionnaire to find out about the subjective, functional, psychological, and social aspects of TMJ disease. A total of 18 patients who had the same operation were included (mean (range) age 50 (33 - 73) years, mean (range) follow up 30 (18 - 48) months). Jaw function and facial aesthetics had improved, and patients needed less analgesia. Overall, they reported a better QoL with improvements in mood and social interaction, and the activities of daily life were easier. The NHS uses QoL questionnaires to measure success in fields such as orthopaedic surgery, but currently we know of no nationally accepted questionnaire that measures success after total replacement of the TMJ. Copyright © 2016 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Resource use and costs associated with opioid-induced constipation following total hip or total knee replacement surgery

Directory of Open Access Journals (Sweden)

Wittbrodt ET

2018-05-01

Full Text Available Eric T Wittbrodt,1 Tong J Gan,2 Catherine Datto,1 Charles McLeskey,1 Meenal Sinha3 1US Medical Affairs, AstraZeneca, Wilmington, DE, USA; 2Department of Anesthesiology, Stony Brook Medicine, Stony Brook, NY, USA; 3Premier Applied Sciences, Premier, Inc., Charlotte, NC, USA Purpose: Constipation is a well-known complication of surgery that can be exacerbated by opioid analgesics. This study evaluated resource utilization and costs associated with opioid-induced constipation (OIC. Patients and methods: This retrospective, observational, and propensity-matched cohort study utilized the Premier Healthcare Database. The study included adults ≥18 years of age undergoing total hip or total knee replacement as inpatients who received an opioid analgesic and were discharged between January 1, 2012, and June 30, 2015. Diagnosis codes identified patients with OIC who were then matched 1:1 to patients without OIC. Generalized linear and logistic regression models were used to compare inpatient resource utilization, total hospital costs, inpatient mortality, and 30-day all-cause readmissions and emergency department visits. Results: Of 788,448 eligible patients, 40,891 (5.2% had OIC. Covariates were well balanced between matched patients with and without OIC (n=40,890 each. In adjusted analyses, patients with OIC had longer hospital lengths of stay (3.6 versus 3.3 days; p<0.001, higher total hospital costs (US$17,479 versus US$16,265; p<0.001, greater risk of intensive care unit admission (odds ratio [OR]=1.12, 95% CI: 1.01–1.24, and increased likelihood of 30-day hospital readmissions (OR=1.16, 95% CI: 1.11–1.22 and emergency department visits (OR=1.38, 95% CI: 1.07–1.79 than patients without OIC. No statistically significant difference was found with inpatient mortality (OR=0.89, 95% CI: 0.59–1.35. Conclusion: OIC was associated with greater resource utilization and hospital costs for patients undergoing primarily elective total hip or total knee

Analgesic effect of continuous femoral nerve block combined with infiltration anesthesia after total knee replacement

OpenAIRE

Jian-Guo Tan

2016-01-01

Objective: To study the analgesic effect of continuous femoral nerve block combined with infiltration anesthesia after total knee replacement. Methods: Patients who received unilateral total knee replacement in our hospital from May 2012 to August 2015 were included for study and randomly divided into experimental group who received continuous femoral nerve block combined with infiltration anesthesia and control group who received continuous femoral nerve block, and then the co...

Late rupture of the posterior cruciate ligament after total knee replacement.

OpenAIRE

Montgomery, R. L.; Goodman, S. B.; Csongradi, J.

1993-01-01

To our knowledge there have been no reports of late rupture of the posterior cruciate ligament (PCL) as a cause of instability in PCL-retaining total knee prostheses. In our experience of 150 total knee replacements using PCL-retaining prosthesis, three cases (2.0%) of late rupture of the posterior cruciate ligament have occurred, each leading to chronic instability, disabling pain, and revision arthroplasty. In each case rupture of the posterior cruciate ligament was confirmed at the time of...

The Effect on Long-Term Survivorship of Surgeon Preference for Posterior-Stabilized or Minimally Stabilized Total Knee Replacement: An Analysis of 63,416 Prostheses from the Australian Orthopaedic Association National Joint Replacement Registry.

Science.gov (United States)

Vertullo, Christopher J; Lewis, Peter L; Lorimer, Michelle; Graves, Stephen E

2017-07-05

Controversy still exists as to the optimum management of the posterior cruciate ligament (PCL) in total knee arthroplasty. Surgeons can choose to kinematically substitute the PCL with a posterior-stabilized total knee replacement or alternatively to utilize a cruciate-retaining, also known as minimally stabilized, total knee replacement. Proponents of posterior-stabilized total knee replacement propose that the reported lower survivorship in registries when directly compared with minimally stabilized total knee replacement is due to confounders such as selection bias because of the preferential usage of posterior-stabilized total knee replacement in more complex or severe cases. In this study, we aimed to eliminate these possible confounders by performing an instrumental variable analysis based on surgeon preference to choose either posterior-stabilized or minimally stabilized total knee replacement, rather than the actual prosthesis received. Cumulative percent revision, hazard ratio (HR), and revision diagnosis data were obtained from the Australian Orthopaedic Association National Joint Replacement Registry from September 1, 1999, to December 31, 2014, for 2 cohorts of patients, those treated by high-volume surgeons who preferred minimally stabilized replacements and those treated by high-volume surgeons who preferred posterior-stabilized replacements. All patients had a diagnosis of osteoarthritis and underwent fixed-bearing total knee replacement with patellar resurfacing. At 13 years, the cumulative percent revision was 5.0% (95% confidence interval [CI], 4.0% to 6.2%) for the surgeons who preferred the minimally stabilized replacements compared with 6.0% (95% CI, 4.2% to 8.5%) for the surgeons who preferred the posterior-stabilized replacements. The revision risk for the surgeons who preferred posterior-stabilized replacements was significantly higher for all causes (HR = 1.45 [95% CI, 1.30 to 1.63]; p total knee replacement compared with the patients of

Segmental blood pressure after total hip replacement

DEFF Research Database (Denmark)

Gebuhr, Peter Henrik; Soelberg, M; Henriksen, Jens Henrik Sahl

1992-01-01

Twenty-nine patients due to have a total hip replacement had their systemic systolic and segmental blood pressures measured prior to operation and 1 and 6 weeks postoperatively. No patients had signs of ischemia. The segmental blood pressure was measured at the ankle and at the toes. A significant...... drop was found in all pressures 1 week postoperatively. The decrease followed the systemic pressure and was restored to normal after 6 weeks. In a group of six patients with preoperatively decreased ankle pressure, a significant transient further decrease in the ankle-toe gradient pressure was found...... on the operated side. None of the patients had symptoms from the lowered pressure. We conclude that in patients without signs of ischemia, the postoperative segmental pressure decrease is reversible and therefore not dangerous....

Weight-bearing radiography in total hip replacement

International Nuclear Information System (INIS)

Turula, K.B.; Haajanen, J.; Friberg, O.; Lindholm, T.S.; Tallroth, K.

1985-01-01

Serial anteroposterior (AP) radiographs of the weight-bearing pelvis and hips were taken of 29 patients with total hip replacement (THR). For constant positioning the patient stands with straight knees on a board with a block between the heels. A U-shaped mercury level strapped to the patient provides a horizontal reference line on the radiograph. On the average, individual variation of pelvic tilt in serial films was 1 0 and pelvic rotation 3.5 0 confirming satisfactory reproducibility. The horizontal reference enables estimation of pre- and postoperative leg length inequality (LLI) and of the angle of the acetabular cup (AA). Reproducibility allows assessment of the exact position of the femoral component and quantitative evaluation of radiolucency and bone resorption around the prosthetic implant in the follow-up of THR. (orig.)

Study The Validity of The Direct Mathematical Method For Calculation The Total Efficiency Using Point And Disk Sources

International Nuclear Information System (INIS)

Hagag, O.M.; Nafee, S.S.; Naeem, M.A.; El Khatib, A.M.

2011-01-01

The direct mathematical method has been developed for calculating the total efficiency of many cylindrical gamma detectors, especially HPGe and NaI detector. Different source geometries are considered (point and disk). Further into account is taken of gamma attenuation from detector window or any interfacing absorbing layer. Results are compared with published experimental data to study the validity of the direct mathematical method to calculate total efficiency for any gamma detector size.

A Water Rehabilitation Program in Patients with Hip Osteoarthritis Before and After Total Hip Replacement.

Science.gov (United States)

Łyp, Marek; Kaczor, Ryszard; Cabak, Anna; Tederko, Piotr; Włostowska, Ewa; Stanisławska, Iwona; Szypuła, Jan; Tomaszewski, Wiesław

2016-07-25

BACKGROUND Pain associated with coxarthrosis, typically occurring in middle-aged and elderly patients, very commonly causes considerable limitation of motor fitness and dependence on pharmacotherapy. This article provides an assessment of a rehabilitation program with tailored water exercises in patients with osteoarthritis before and after total hip replacement. MATERIAL AND METHODS A total of 192 patients (the mean age 61.03±10.89) suffering from hip osteoarthritis (OA) were evaluated before and after total hip replacement (THR). The clinical study covered measurements of hip active ranges of motion (HAROM) and the forces generated by pelvis stabilizer muscles. Pain intensity was assessed according to analogue-visual scale of pain (VAS) and according to the Modified Laitinen Questionnaire. The patients were divided into 6 groups (4 treatment and 2 control). We compared 2 rehabilitation programs using kinesitherapy and low-frequency magnetic field. One of them also had specially designed exercises in the water. Statistical analysis was carried out at the significance level α=0.05. This was a cross-sectional study. RESULTS A positive effect of water exercises on a number of parameters was found in patients with OA both before and after total hip replacement surgery. We noted a significant reduction of pain (pwater exercises most significantly reduced pain in patients with OA before and after total hip replacement surgery. 2. Inclusion of water exercises in a rehabilitation program can reduce the use of medicines in patient with OA and after THR.

The Cost of Joint Replacement: Comparing Two Approaches to Evaluating Costs of Total Hip and Knee Arthroplasty.

Science.gov (United States)

Palsis, John A; Brehmer, Thomas S; Pellegrini, Vincent D; Drew, Jacob M; Sachs, Barton L

2018-02-21

In an era of mandatory bundled payments for total joint replacement, accurate analysis of the cost of procedures is essential for orthopaedic surgeons and their institutions to maintain viable practices. The purpose of this study was to compare traditional accounting and time-driven activity-based costing (TDABC) methods for estimating the total costs of total hip and knee arthroplasty care cycles. We calculated the overall costs of elective primary total hip and total knee replacement care cycles at our academic medical center using traditional and TDABC accounting methods. We compared the methods with respect to the overall costs of hip and knee replacement and the costs for each major cost category. The traditional accounting method resulted in higher cost estimates. The total cost per hip replacement was $22,076 (2014 USD) using traditional accounting and was $12,957 using TDABC. The total cost per knee replacement was $29,488 using traditional accounting and was $16,981 using TDABC. With respect to cost categories, estimates using traditional accounting were greater for hip and knee replacement, respectively, by $3,432 and $5,486 for personnel, by $3,398 and $3,664 for space and equipment, and by $2,289 and $3,357 for indirect costs. Implants and consumables were derived from the actual hospital purchase price; accordingly, both methods produced equivalent results. Substantial cost differences exist between accounting methods. The focus of TDABC only on resources used directly by the patient contrasts with the allocation of all operating costs, including all indirect costs and unused capacity, with traditional accounting. We expect that the true costs of hip and knee replacement care cycles are likely somewhere between estimates derived from traditional accounting methods and TDABC. TDABC offers patient-level granular cost information that better serves in the redesign of care pathways and may lead to more strategic resource-allocation decisions to optimize

A Report Of Two Cases Of Uncemented Total Hip Replacement In ...

African Journals Online (AJOL)

This is a report of two sickle cell patients (HbSS) with advanced osteoarthritis of the right hip. The patients were in Ficat and Arlet\\'s stage 3 and 4 respectively. Both were females aged 23 and 46 years and they had uncemented hydroxyapatite coated omnifit (Stryker Howmedica Osteonics) total hip prosthetic replacement.

Can shared care deliver better outcomes for patients undergoing total hip replacement?

NARCIS (Netherlands)

Rosendal, H.; Beekum, W.T. van; Nijhof, P.; Witte, L.P. de; Schrijvers, A.J.P.

2000-01-01

Objectives: To assess whether shared care for patients undergoing total hip replacement delivers better outcomes compared to care as usual. Design: Prospective, observational cohort study. Setting: Two regions in the Netherlands where different organisational health care models have been

Total Ossicular Replacement Prosthesis: A New Fat Interposition Technique

Directory of Open Access Journals (Sweden)

Issam Saliba

2018-01-01

Full Text Available Objective: To compare audiometric results between the standard total ossicular replacement prosthesis (TORP-S and a new fat interposition total ossicular replacement prosthesis (TORP-F in pediatric and adult patients and to assess the complication and the undesirable outcome. Study design: This is a retrospective study. Methods: This study included 104 patients who had undergone titanium implants with TORP-F and 54 patients who had undergone the procedure with TORP-S between 2008 and 2013 in our tertiary care centers. The new technique consists of interposing a fat graft between the 4 legs of the universal titanium prosthesis (Medtronic Xomed Inc, Jacksonville, FL, USA to provide a more stable TORP in the ovale window niche. Normally, this prosthesis is designed to fit on the stapes’ head as a partial ossicular replacement prosthesis. Results: The postoperative air-bone gap less than 25 dB for the combined cohort was 69.2% and 41.7% for the TORP-F and the TORP-S groups, respectively. The mean follow-up was 17 months postoperatively. By stratifying data, the pediatric cohort shows 56.5% in the TORP-F group (n = 52 compared with 40% in the TORP-S group (n = 29. However, the adult cohort shows 79.3% in the TORP-F group (n = 52 compared with 43.75% in the TORP-S group (n = 25. These improvements in hearing were statistically significant. There were no statistically significant differences in the speech discrimination scores. The only undesirable outcome that was statistically different between the 2 groups was the prosthesis displacement: 7% in the TORP-F group compared with 19% in the TORP-S group ( P  = .03. Conclusions: The interposition of a fat graft between the legs of the titanium implants (TORP-F provides superior hearing results compared with a standard procedure (TORP-S in pediatric and adult populations because of its better stability in the oval window niche.

Total Ossicular Replacement Prosthesis: A New Fat Interposition Technique.

Science.gov (United States)

Saliba, Issam; Sabbah, Valérie; Poirier, Jackie Bibeau

2018-01-01

To compare audiometric results between the standard total ossicular replacement prosthesis (TORP-S) and a new fat interposition total ossicular replacement prosthesis (TORP-F) in pediatric and adult patients and to assess the complication and the undesirable outcome. This is a retrospective study. This study included 104 patients who had undergone titanium implants with TORP-F and 54 patients who had undergone the procedure with TORP-S between 2008 and 2013 in our tertiary care centers. The new technique consists of interposing a fat graft between the 4 legs of the universal titanium prosthesis (Medtronic Xomed Inc, Jacksonville, FL, USA) to provide a more stable TORP in the ovale window niche. Normally, this prosthesis is designed to fit on the stapes' head as a partial ossicular replacement prosthesis. The postoperative air-bone gap less than 25 dB for the combined cohort was 69.2% and 41.7% for the TORP-F and the TORP-S groups, respectively. The mean follow-up was 17 months postoperatively. By stratifying data, the pediatric cohort shows 56.5% in the TORP-F group (n = 52) compared with 40% in the TORP-S group (n = 29). However, the adult cohort shows 79.3% in the TORP-F group (n = 52) compared with 43.75% in the TORP-S group (n = 25). These improvements in hearing were statistically significant. There were no statistically significant differences in the speech discrimination scores. The only undesirable outcome that was statistically different between the 2 groups was the prosthesis displacement: 7% in the TORP-F group compared with 19% in the TORP-S group ( P  = .03). The interposition of a fat graft between the legs of the titanium implants (TORP-F) provides superior hearing results compared with a standard procedure (TORP-S) in pediatric and adult populations because of its better stability in the oval window niche.

Arthroscopic treatment of patients with moderate arthrofibrosis after total knee replacement.

Science.gov (United States)

Jerosch, Joerg; Aldawoudy, Akram M

2007-01-01

The purpose of this study was to document the effect of arthroscopic management in patients with knee stiffness after total knee replacement. We present a case series study, in which 32 patients have been treated for moderate arthrofibrosis of the knee after total knee replacement, with the same regimen. We have excluded all cases of stiffness, because of infection, mechanical mal-alignment, loosening of the implants and other obvious reasons of stiffness of the knee, rather than pure arthrofibrosis. All patients first underwent a trial of conservative treatment before going for arthroscopic management. A pain catheter for femoral nerve block was inserted just before anesthesia for post-operative pain management. Arthroscopic arthrolysis of the intra-articular pathology was performed in a standardized technique with release of all fibrous bands in the suprapatellar pouch, reestablishing the medial and lateral gutter, release of the patella, resection of the remaining meniscal tissue or an anterior cyclops, if needed. Intensive physiotherapy and continuous passive motion were to start immediately post-operatively. All the patients were available for the follow up and they were evaluated using the knee society rating system. A total of 25 of the 32 procedures resulted in an improvement of the patients knee score. All the knees operated upon had intra-articular fibrous bands, hypertrophic synovitis and peri-patellar adhesions. A total of eight patients suffered from an anterior cyclops lesion and six patients showed pseudomenicus. In 19 cases a medial and lateral relapse of the patella was performed; only 5 patients got an isolated lateral release. The mean knee flexion was 119 degrees (100-130) at the end of arthroscopy and was 97 degrees (75-115) at the last follow up. The eight patients with extension lags decreased from 27 degrees (10 degrees-35 degrees) pre-operatively to 4 degrees (0-10) at time of follow up. The average knee society ratings increased from 70

Impact of the economic downturn on total joint replacement demand in the United States: updated projections to 2021.

Science.gov (United States)

Kurtz, Steven M; Ong, Kevin L; Lau, Edmund; Bozic, Kevin J

2014-04-16

Few studies have explored the role of the National Health Expenditure and macroeconomics on the utilization of total joint replacement. The economic downturn has raised questions about the sustainability of growth for total joint replacement in the future. Previous projections of total joint replacement demand in the United States were based on data up to 2003 using a statistical methodology that neglected macroeconomic factors, such as the National Health Expenditure. Data from the Nationwide Inpatient Sample (1993 to 2010) were used with United States Census and National Health Expenditure data to quantify historical trends in total joint replacement rates, including the two economic downturns in the 2000s. Primary and revision hip and knee arthroplasty were identified using codes from the International Classification of Diseases, Ninth Revision, Clinical Modification. Projections in total joint replacement were estimated using a regression model incorporating the growth in population and rate of arthroplasties from 1993 to 2010 as a function of age, sex, race, and census region using the National Health Expenditure as the independent variable. The regression model was used in conjunction with government projections of National Health Expenditure from 2011 to 2021 to estimate future arthroplasty rates in subpopulations of the United States and to derive national estimates. The growth trend for the incidence of joint arthroplasty, for the overall United States population as well as for the United States workforce, was insensitive to economic downturns. From 2009 to 2010, the total number of procedures increased by 6.0% for primary total hip arthroplasty, 6.1% for primary total knee arthroplasty, 10.8% for revision total hip arthroplasty, and 13.5% for revision total knee arthroplasty. The National Health Expenditure model projections for primary hip replacement in 2020 were higher than a previously projected model, whereas the current model estimates for total

Comparative responsiveness of measures of pain and function after total hip replacement

DEFF Research Database (Denmark)

Nilsdotter, A K; Roos, Ewa M.; Westerlund, J P

2001-01-01

To compare the responsiveness of the Functional Assessment System (FAS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Medical Outcomes Study 36-item Short Form (SF-36) in patients with osteoarthritis (OA) scheduled for total hip replacement....

Timing of Re-Transfusion Drain Removal Following Total Knee Replacement

Science.gov (United States)

Leeman, MF; Costa, ML; Costello, E; Edwards, D

2006-01-01

INTRODUCTION The use of postoperative drains following total knee replacement (TKR) has recently been modified by the use of re-transfusion drains. The aim of our study was to investigate the optimal time for removal of re-transfusion drains following TKR. PATIENTS AND METHODS The medical records of 66 patients who had a TKR performed between October 2003 and October 2004 were reviewed; blood drained before 6 h and the total volume of blood drained was recorded. RESULTS A total of 56 patients had complete records of postoperative drainage. The mean volume of blood collected in the drain in the first 6 h was 442 ml. The mean total volume of blood in the drain was 595 ml. Therefore, of the blood drained, 78% was available for transfusion. CONCLUSION Re-transfusion drains should be removed after 6 h, when no further re-transfusion is permissible. PMID:16551400

The patient's experience of temporary paralysis from spinal anaesthesia, a part of total knee replacement

DEFF Research Database (Denmark)

Bager, Louise; Konradsen, Hanne; Dreyer, Pia Sander

2015-01-01

AIMS AND OBJECTIVES: The aim of this study was to describe the meaning of being temporary paralysed from spinal anaesthesia when undergoing total knee replacement. BACKGROUND: Total knee arthroplasty is a common procedure, and regional anaesthesia is used as a method for anaesthetising the patient...... of the experience of spinal anaesthesia, as a part of having a total knee replacement. METHODS: Twelve patients were interviewed in March 2014 after undergoing an elective total knee arthroplasty under spinal anaesthesia. The interviews were analysed with a Ricoeur-inspired interpretation method. RESULTS: Three...... TO CLINICAL PRACTICE: The results of this study contribute to insights and deeper knowledge that can enhance staff's ability to provide care for patients undergoing total knee arthroplasty in spinal anaesthesia. The results provide perspectives that argue for care in accordance to individual needs....

Material Science in Cervical Total Disc Replacement

Science.gov (United States)

Pham, Martin H.; Mehta, Vivek A.; Tuchman, Alexander; Hsieh, Patrick C.

2015-01-01

Current cervical total disc replacement (TDR) designs incorporate a variety of different biomaterials including polyethylene, stainless steel, titanium (Ti), and cobalt-chrome (CoCr). These materials are most important in their utilization as bearing surfaces which allow for articular motion at the disc space. Long-term biological effects of implanted materials include wear debris, host inflammatory immune reactions, and osteolysis resulting in implant failure. We review here the most common materials used in cervical TDR prosthetic devices, examine their bearing surfaces, describe the construction of the seven current cervical TDR devices that are approved for use in the United States, and discuss known adverse biological effects associated with long-term implantation of these materials. It is important to appreciate and understand the variety of biomaterials available in the design and construction of these prosthetics and the considerations which guide their implementation. PMID:26523281

Material Science in Cervical Total Disc Replacement.

Science.gov (United States)

Pham, Martin H; Mehta, Vivek A; Tuchman, Alexander; Hsieh, Patrick C

2015-01-01

Current cervical total disc replacement (TDR) designs incorporate a variety of different biomaterials including polyethylene, stainless steel, titanium (Ti), and cobalt-chrome (CoCr). These materials are most important in their utilization as bearing surfaces which allow for articular motion at the disc space. Long-term biological effects of implanted materials include wear debris, host inflammatory immune reactions, and osteolysis resulting in implant failure. We review here the most common materials used in cervical TDR prosthetic devices, examine their bearing surfaces, describe the construction of the seven current cervical TDR devices that are approved for use in the United States, and discuss known adverse biological effects associated with long-term implantation of these materials. It is important to appreciate and understand the variety of biomaterials available in the design and construction of these prosthetics and the considerations which guide their implementation.

Experimental chemonucleolysis with chymopapain in canine intervertebral disks

International Nuclear Information System (INIS)

Kudo, T.; Sumi, A.; Hashimoto, A.

1993-01-01

The present study describes the radiological and histological changes in the canine intervertebral disk after the experimental injection of chymopapain as the chemical reagent, and determines the appropriate dose of the enzyme for treatment of herniated disks. By radiography, narrowing of the disk space was observed within 2 weeks after the injection of chymopapain, and recovered to 74.1% in the 0.1 mg group, 61.1% in the 1.0 mg group and 71.7% in the 10.0 mg group at 12 weeks. The disk space recovery showed a tendency to delay with aging. Microscopically, proteoglycan positive matrix appeared and the nuclear space was reduced in each disk at 2 weeks after chymopapain injection. The nucleus pulposus contained an irregularly-defined mass consisting of clusters of degenerated notochordal cells surrounded by proliferated chondrocytes and collagen matrix. In each disk at 12 weeks after chymopapain injection, the center of the nucleus pulposus was replaced by fibrocartilage tissue. In the disk into which 10.0 mg chymopapain was injected, the nuclear space filled with dense fibrocartilage tissue without a regenerated matrix component and narrowing of the disk were maintained. It is suggested that canine chemonucleolysis with 10.0 mg of chymopapain reduces the interdiskal pressure. This treatment may therefore relieve the signs and symptoms of herniation of the nucleus pulposus, and may effect chemical disk decompression

Quantification of in vivo implant wear in total knee replacement from dynamic single plane radiography

Science.gov (United States)

Teeter, Matthew G.; Seslija, Petar; Milner, Jaques S.; Nikolov, Hristo N.; Yuan, Xunhua; Naudie, Douglas D. R.; Holdsworth, David W.

2013-05-01

An in vivo method to measure wear in total knee replacements was developed using dynamic single-plane fluoroscopy. A dynamic, anthropomorphic total knee replacement phantom with interchangeable, custom-fabricated components of known wear volume was created, and dynamic imaging was performed. For each frame of the fluoroscopy data, the relative location of the femoral and tibial components were determined, and the apparent intersection of the femoral component with the tibial insert was used to calculate wear volume, wear depth, and frequency of intersection. No difference was found between the measured and true wear volumes. The precision of the measurements was ±39.7 mm3 for volume and ±0.126 mm for wear depth. The results suggest the system is capable of tracking wear volume changes across multiple time points in patients. As a dynamic technique, this method can provide both kinematic and wear measurements that may be useful for evaluating new implant designs for total knee replacements.

Quantification of in vivo implant wear in total knee replacement from dynamic single plane radiography

International Nuclear Information System (INIS)

Teeter, Matthew G; Naudie, Douglas D R; Holdsworth, David W; Seslija, Petar; Milner, Jaques S; Nikolov, Hristo N; Yuan Xunhua

2013-01-01

An in vivo method to measure wear in total knee replacements was developed using dynamic single-plane fluoroscopy. A dynamic, anthropomorphic total knee replacement phantom with interchangeable, custom-fabricated components of known wear volume was created, and dynamic imaging was performed. For each frame of the fluoroscopy data, the relative location of the femoral and tibial components were determined, and the apparent intersection of the femoral component with the tibial insert was used to calculate wear volume, wear depth, and frequency of intersection. No difference was found between the measured and true wear volumes. The precision of the measurements was ±39.7 mm 3 for volume and ±0.126 mm for wear depth. The results suggest the system is capable of tracking wear volume changes across multiple time points in patients. As a dynamic technique, this method can provide both kinematic and wear measurements that may be useful for evaluating new implant designs for total knee replacements. (paper)

Bentall operation, total aortic replacement and mitral valve replacement for a young adult with Marfan syndrome: a case of three-staged operation.

Science.gov (United States)

Inui, K; Shimazaki, Y; Watanabe, T; Kuraoka, S; Minowa, T; Miura, M; Oshikiri, S; Toyama, H

1998-08-01

In Marfan syndrome, the most common cardiovascular abnormalities are dilatation of the aorta and aortic valve regurgitation in adult patients. Mitral valve dysfunction is the most common cause of morbidity and mortality in infants and children with Marfan syndrome, and is not frequently operated on in adult Marfan patients who undergo surgery for diseases of the aortic root and total aorta. This report describes a successfully three-staged operation for a 24 year-old man with Marfan syndrome who underwent an emergent Bentall operation and aortic arch replacement, total aortic replacement and mitral valve replacement over 2 years. Mitral valve regurgitation was mild but increased after the second operation. The graft was tightly adhesive and invasive to the sternum. Endoscopic view was helpful to avoid graft damage at resternotomy. The postoperative course was uneventful in each operation. Microscopic examination of the mitral valve leaflets showed abnormal increase of mucopolysaccharides, and disruption and fragmentation of elastic fibers.

Sciatic nerve block causing heel ulcer after total knee replacement in 36 patients.

Science.gov (United States)

Todkar, Manoj

2005-12-01

Femoral and sciatic nerve blocks are often used for postoperative analgesia following total knee replacement surgery. In this report, we focus on cases of heel ulcers which occurred following the implementation of peripheral nerve block in concert with knee replacement surgery. In some instances, heel ulcers have resulted in delayed rehabilitation and prolonged hospital stays in this group of patients, which makes this phenomenon a potential burden on the healthcare system. Pressure points in the foot should be protected after the implementation of nerve blocks to prevent pressure sores. An awareness of this unusual complication related to knee replacement surgery is necessary to prevent its occurrence and avoid delays in patient rehabilitation and recovery.

Patient-Controlled Oral Analgesia for Postoperative Pain Management Following Total Knee Replacement

Directory of Open Access Journals (Sweden)

Patti Kastanias

2010-01-01

Full Text Available PURPOSE: To investigate whether patient-controlled oral analgesia (PCOA used by individuals receiving a total knee replacement could reduce pain, increase patient satisfaction, reduce opioid use and/or reduce opioid side effects when compared with traditional nurse (RN-administered oral analgesia.

[Mini-subvastus approach for total knee replacement].

Science.gov (United States)

Halder, Andreas; Beier, Alexander; Neumann, Wolfram

2009-03-01

Total knee replacement in minimally invasive technique without any trauma to the extensor apparatus and with soft-tissue-referenced bone resections. Only the subvastus approach preserves the integrity of the extensor apparatus and has therefore been modified to become a minimally invasive technique with a shorter skin incision and lateralization instead of eversion of the patella. Soft-tissue balancing is done through this direct anterior approach. Mild to moderate varus osteoarthritis of the knee up to 15 degrees of malalignment, mild and passively correctable valgus osteoarthritis of the knee up to 10 degrees of malalignment. Severe, contract varus osteoarthritis of the knee, severe and moderate, contract valgus osteoarthritis of the knee, severe obesity, exceptionally muscular patients, decreased skin perfusion. Central skin incision from the superior pole of the patella to the tibial tubercle. Exposure of the medial retinaculum and mobilization of the vastus medialis muscle subcutaneously. Incision of the medial retinaculum and blunt separation of the vastus medialis muscle from the intermuscular septum. Lateralization of the patella and flexion of the knee joint. Resection of the tibia perpendicular to the diaphysis. Adjustment of the anteroposterior (AP) resection block at the level of the anterior femoral cortex and of rotation by applying equal tension to the collateral ligaments. Balancing of soft-tissue tension in flexion gap by release, if necessary. After AP resection fixation of distal resection block in planned valgus angle. Balancing of soft-tissue tension in extension gap by release, if necessary. After distal femur resection facet resection, adaptation of posterior femoral condyles, and implantation of prosthesis. Check on stability and range of motion. Wound closure. Full weight bearing from the 1st postoperative day, CPM (continuous passive motion) with up to 90 degrees flexion with peridural anesthesia as tolerated, stair climbing starting on

Risk factors for renal dysfunction after total hip joint replacement

DEFF Research Database (Denmark)

Hassan, Basim Kamil; Sahlström, Arne; Dessau, Ram Benny Christian

2015-01-01

BACKGROUND AND PURPOSE OF THE STUDY: Renal injury and dysfunction are serious complications after major surgery, which may lead to increased morbidity and mortality. The objective of our study was to identify the possible risk factors for renal dysfunction after total hip joint replacement surger...... creatinine. Smoking, diabetes mellitus, high BMI, gender, and duration of surgery were not identified as significant risk factors........ METHODS: A retrospective study was conducted among 599 consecutive primary hip joint replacements performed between January 2011 and December 2013. According to the RIFLE criteria, increased postoperative serum creatinine was considered indicative of postoperative renal injury. The Welch two-sample test......, hypertension, general anesthesia, high ASA scores, low intra-operative systolic BP, and prophylactic dicloxacillin as significant risk factors. Low baseline systolic BP, low baseline diastolic blood pressure, and hip fracture diagnosis were independent risk factors for postoperative increase in serum...

Material Science in Cervical Total Disc Replacement

Directory of Open Access Journals (Sweden)

Martin H. Pham

2015-01-01

Full Text Available Current cervical total disc replacement (TDR designs incorporate a variety of different biomaterials including polyethylene, stainless steel, titanium (Ti, and cobalt-chrome (CoCr. These materials are most important in their utilization as bearing surfaces which allow for articular motion at the disc space. Long-term biological effects of implanted materials include wear debris, host inflammatory immune reactions, and osteolysis resulting in implant failure. We review here the most common materials used in cervical TDR prosthetic devices, examine their bearing surfaces, describe the construction of the seven current cervical TDR devices that are approved for use in the United States, and discuss known adverse biological effects associated with long-term implantation of these materials. It is important to appreciate and understand the variety of biomaterials available in the design and construction of these prosthetics and the considerations which guide their implementation.

Application of bone scintigrams in total knee replacement (Okayama MK-II type)

Energy Technology Data Exchange (ETDEWEB)

Umeda, T.; Inoue, S.; Matsui, N.; Moriya, H. (Chiba Univ. (Japan). School of Medicine)

1982-02-01

Eighteen patients with 21 total knee replacements (OKAYAMA MK-II type) were examined by radionuclide imaging in order to assess the prosthetic complaints such as loosening, infection, fracture and lasting pain. The following results and conclusions were obtained. 1) Bone imaging can reveal the condition of the attachment of bone and prosthesis. 2) Diffuse uptake gradually diminished until 18 months after surgery. 3) In front view on bone imaging, tibial uptake corresponded highly with the part of the weight area. 4) In cases of high uptake of posterior femoral component in lateral view, the range of knee flexion was mostly restricted. 5) Long-period persistent local uptake suggested loosening of the prosthesis or fracture of the tibial plateau. 6) Patello-femoral uptake showed no relation to the patellofemoral complaints. Radionuclide bone imaging is considered to represent one of the most valuable diagnostic procedures for assessing the clinical results after total knee replacement.

Application of bone scintigrams in total knee replacement (Okayama MK-II type)

International Nuclear Information System (INIS)

Umeda, Tohru; Inoue, Shunichi; Matsui, Nobuo; Moriya, Hideshige

1982-01-01

Eighteen patients with 21 total knee replacements (OKAYAMA MK-II type) were examined by radionuclide imaging in order to assess the prosthetic complaints such as loosening, infection, fracture and lasting pain. The following results and conclusions were obtained. 1) Bone imaging can reveal the condition of the attachment of bone and prosthesis. 2) Diffuse uptake gradually diminished until 18 months after surgery. 3) In front view on bone imaging, tibial uptake corresponded highly with the part of the weight area. 4) In cases of high uptake of posterior femoral component in lateral view, the range of knee flexion was mostly restricted. 5) Long-period persistent local uptake suggested loosening of the prosthesis or fracture of the tibial plateau. 6) Patello-femoral uptake showed no relation to the patellofemoral complaints. Radionuclide bone imaging is considered to represent one of the most valuable diagnostic procedures for assessing the clinical results after total knee replacement. (author)

Unilateral vs one stage bilateral total knee replacement in rheumatoid and osteoarthritis - A comparative study

Directory of Open Access Journals (Sweden)

Kiran E

2005-01-01

Full Text Available Background : A controversy exists regarding simultaneous or staged bilateral total knee replacement. Methods: Fifty patients undergoing simultaneous bilateral and 50 undergoing unilateral total knee arthroplasty were evaluated prospectively to compare the clinical, radiological results and complication rates. Eighty-four patients belonged to ASA category II or III preoperatively. The study included a high proportion of rheumatoid patients and osteoarthritis patients with severe deformities. Results: Bilateral group had greater blood loss and required more blood transfusion, but there was no difference in requirement of postoperative intensive care and the complication rates. Rheumatoid knees had lower pre and postoperative knee score and functional score as compared to osteoarthritic knees. Morbidity and mortality of one stage bilateral knee replacement was no greater than unilateral operation. Conclusion: Simultaneous bilateral knee replacement in younger patients with advanced rheumatoid arthritis is safe and effective

The infection of Mycoplasma hominis after total knee replacement: Case report and literature review

Directory of Open Access Journals (Sweden)

Hong-Jiu Qiu

2017-08-01

Full Text Available The Mycoplasma hominis infection is a rare postoperative complication after joint replacement. Based on our knowledge, there were only two cases reported by Korea all over the world currently. A case of postoperative Mycoplasma hominis infection after total knee replacement in our hospital was reported in this article. It was confirmed through mass spectrometer and Mycoplasma cultivation and treated by the first stage debridement, polyethylene insert replacement, and then drainage and irrigation combined with sensitive antibiotics after the operation. We observed that the C reactive protein (CRP level correlates with the development of disease, while the erythrocyte sedimentation rate (ESR remains at a high level, indicating the relevance between the Mycoplasma hominis infection caused by knee joint replacement and CRP. This study aims to report the case and review relevant literature.

Incidence, risk factors and the healthcare cost of falls postdischarge after elective total hip and total knee replacement surgery: protocol for a prospective observational cohort study

Science.gov (United States)

Hill, Anne-Marie; Ross-Adjie, Gail; McPhail, Steven M; Monterosso, Leanne; Bulsara, Max; Etherton-Beer, Christopher; Powell, Sarah-Jayne; Hardisty, Gerard

2016-01-01

Introduction The number of major joint replacement procedures continues to increase in Australia. The primary aim of this study is to determine the incidence of falls in the first 12 months after discharge from hospital in a cohort of older patients who undergo elective total hip or total knee replacement. Methods and analyses A prospective longitudinal observational cohort study starting in July 2015, enrolling patients aged ≥60 years who are admitted for elective major joint replacement (n=267 total hip replacement, n=267 total knee replacement) and are to be discharged to the community. Participants are followed up for 12 months after hospital discharge. The primary outcome measure is the rate of falls per thousand patient-days. Falls data will be collected by 2 methods: issuing a falls diary to each participant and telephoning participants monthly after discharge. Secondary outcomes include the rate of injurious falls and health-related quality of life. Patient-rated outcomes will be measured using the Oxford Hip or Oxford Knee score. Generalised linear mixed modelling will be used to examine the falls outcomes in the 12 months after discharge and to examine patient and clinical characteristics predictive of falls. An economic evaluation will be conducted to describe the nature of healthcare costs in the first 12 months after elective joint replacement and estimate costs directly attributable to fall events. Ethics and dissemination The results will be disseminated through local site networks and will inform future services to support older people undergoing hip or knee joint replacement and also through peer-reviewed publications and medical conferences. This study has been approved by The University of Notre Dame Australia and local hospital human research ethics committees. Trial registration number ACTRN12615000653561; Pre-results. PMID:27412102

Controlling costs without compromising quality: paying hospitals for total knee replacement.

Science.gov (United States)

Pine, Michael; Fry, Donald E; Jones, Barbara L; Meimban, Roger J; Pine, Gregory J

2010-10-01

Unit costs of health services are substantially higher in the United States than in any other developed country in the world, without a correspondingly healthier population. An alternative payment structure, especially for high volume, high cost episodes of care (eg, total knee replacement), is needed to reward high quality care and reduce costs. The National Inpatient Sample of administrative claims data was used to measure risk-adjusted mortality, postoperative length-of-stay, costs of routine care, adverse outcome rates, and excess costs of adverse outcomes for total knee replacements performed between 2002 and 2005. Empirically identified inefficient and ineffective hospitals were then removed to create a reference group of high-performance hospitals. Predictive models for outcomes and costs were recalibrated to the reference hospitals and used to compute risk-adjusted outcomes and costs for all hospitals. Per case predicted costs were computed and compared with observed costs. Of the 688 hospitals with acceptable data, 62 failed to meet effectiveness criteria and 210 were identified as inefficient. The remaining 416 high-performance hospitals had 13.4% fewer risk-adjusted adverse outcomes (4.56%-3.95%; P costs ($12,773-$11,512; P costs. A payment system based on the demonstrated performance of effective, efficient hospitals can produce sizable cost savings without jeopardizing quality. In this study, 96% of total excess hospital costs resulted from higher routine costs at inefficient hospitals, whereas only 4% was associated with ineffective care.

Understanding Total Hip Replacement Recovery towards the Design of a Context-Aware Systems

NARCIS (Netherlands)

Jimenez Garcia, Juan

2011-01-01

Total Hip Replacement (THR) is a common procedure to improve the mobility of elderly with osteoarthritis. Presently information about the recovery process after discharge is unclear. As consequence patients and physiotherapists face uncertainties to follow an adequate trajectory for recovery.

Grain surface chemistry in protoplanetary disks

International Nuclear Information System (INIS)

Reboussin, Laura

2015-01-01

Planetary formation occurs in the protoplanetary disks of gas and dust. Although dust represents only 1% of the total disk mass, it plays a fundamental role in disk chemical evolution since it acts as a catalyst for the formation of molecules. Understanding this chemistry is therefore essential to determine the initial conditions from which planets form. During my thesis, I studied grain-surface chemistry and its impact on the chemical evolution of molecular cloud, initial condition for disk formation, and protoplanetary disk. Thanks to numerical simulations, using the gas-grain code Nautilus, I showed the importance of diffusion reactions and gas-grain interactions for the abundances of gas-phase species. Model results combined with observations also showed the effects of the physical structure (in temperature, density, AV) on the molecular distribution in disks. (author)

Infection after total knee replacement: diagnosis and treatment

Directory of Open Access Journals (Sweden)

Lucio Honorio de Carvalho Junior

2013-09-01

Full Text Available Infection after total knee replacement (IATJ is a rare complication. It is associated with increased morbidity and mortality increasing the final costs. Gram positive coccus and Staphylococcus coagulase-negative and Staphylococcus aureus are the most common isolated germs (>50% of the cases. Conditions related to the patient, to the surgical procedure and even to the post op have been identified as risk factors to IATJ. Many complementary methods together with clinical symptoms are useful to a proper diagnosis. Treatment for IATJ must be individualized but generally is a combination of systemic antibiotic therapy and surgical treatment. Prosthesis exchange in one or two stages is the first choice procedure. Debridement with prosthesis retention is an option in acute cases with stable implants and antibiotic sensible germs.

OPTIMAL IMPROVEMENT IN FUNCTION AFTER TOTAL HIP AND KNEE REPLACEMENT: HOW DEEP DO YOU KNOW YOUR PATIENT’S MIND?

Science.gov (United States)

De Caro, M F; Vicenti, G; Abate, A; Picca, G; Leoncini, V; Lomuscio, M; Casalino, A; Solarino, G; Moretti, B

2015-01-01

Osteoarthritis (OA) of the hip and knee causes pain and loss of joint mobility, leading to limitations in physical function. When conservative treatment fails total hip and knee replacement is a cost-effective surgical option. Patients have high expectations regarding functional outcome after these procedures. If such expectations are not met, they may still be dissatisfied with the outcome of a technically successful procedure. Recently, numerous studies reported that psychological factors can influence the outcome of total knee replacement (tkr) and total hip artrhoplasty with total hip replacement (thr). We conducted a prospective study on a consecutive sample of 280 patients affected by hip or knee OA who underwent total joint replacement. At patients’ admission, Harris Hip Score (HHS) and Knee Society Score (KSS) were used to assess pain and function. Furthermore, SF-36, Mini-Mental Status Examination (MMSE), Symptom Checklist-90-R (SCL-90-R), Coping Orientation to Problems Experienced (BRIEF-COPE) and the Amsterdam Preoperative Anxiety and Information Scale (APAIS) were administered. Patients had clinical and radio graphical follow up at 1, 3 and 6 months post-operatively. The HHS and KSS values before surgery showed a linear correlation with both SCL-90-R and MMSE. None of the investigated variables influenced post-operative HHS and KSS scores; however, the improvement of functional scores resulted conditioned by SCL-90-R values, VAS score, schooling and MMSE. Psychological factors and mental status in primary total hip and knee replacement can affect outcome and patient satisfaction. Strategies focused on identification and facing of these conditions must be considered to improve outcome of total replacement.

The tribology of metal-on-metal total hip replacements.

Science.gov (United States)

Scholes, S C; Unsworth, A

2006-02-01

Total hip surgery is an effective way of alleviating the pain and discomfort caused by diseased or damaged joints. However, in the majority of cases, these joints have a finite life. The main reason for failure is osteolysis (bone resorption). It is well documented that an important cause of osteolysis, and therefore the subsequent loosening and failure of conventional metal- or ceramic-on-ultra-high molecular weight polyethylene joints, is the body's immunological response to the polyethylene wear particles. To avoid this, interest has been renewed in metal-on-metal joints. The intention of this paper is to review the studies that have taken place within different laboratories to determine the tribological performance of new-generation metal-on-metal total hip replacements. These types of joint offer a potential solution to enhance the longevity of prosthetic hip systems; however, problems may arise owing to the effects of metal ion release, which are, as yet, not fully understood.

Do we need a gender-specific total knee replacement?

DEFF Research Database (Denmark)

Thomsen, M G; Husted, H; Bencke, J

2012-01-01

The purpose of this study was to investigate whether a gender-specific high-flexion posterior-stabilised (PS) total knee replacement (TKR) would offer advantages over a high-flex PS TKR regarding range of movement (ROM), 'feel' of the knee, pain and satisfaction, as well as during activity. A total......, satisfaction and daily 'feel' of each knee. Patients underwent gait analysis pre-operatively and at one year, which yielded kinematic, kinetic and temporospatial parameters indicative of knee function during gait. At final follow-up we found no statistically significant differences in ROM (p = 0.......82). The median pain score was 0 (0 to 8) in both groups (p = 0.95). The median satisfaction score was 9 (4 to 10) in the high-flex group and 8 (0 to 10) in the gender-specific group (p = 0.98). The median 'feel' score was 9 (3 to 10) in the high-flex group and 8 (0 to 10) in the gender-specific group (p = 0...

Controversial bulb disks still marketed as energy savers

Energy Technology Data Exchange (ETDEWEB)

Andrews, W.

1982-05-24

Despite a 1980 DOE study showing that incandescent bulb disks decrease lamp efficiency by reducing light output as well as energy consumption, at least two manufacturers are still marketing the disks. The companies claim that the Power Disc and Lite-Saver will extend bulb life up to 100 times and reduce wattage 42%, although they both acknowledge that light output is reduced as much as 74% for a 53% efficiency drop. Some users claim the life-extension feature is important when bulb replacement is difficult. The DOE study concludes that the disks are not cost-effective if the user wants equivalent lighting, and questions some of the manufacturers' advertising claims. Satisfied users counter with reports of good performance and no problems with shock or other safety hazards. (DCK)

Do intra-articular hyaluronic acid injections delay total knee replacement in patients with osteoarthritis - A Cox model analysis.

Science.gov (United States)

Delbarre, Angélique; Amor, Bernard; Bardoulat, Isabelle; Tetafort, Aymeric; Pelletier-Fleury, Nathalie

2017-01-01

This study aimed to describe patients treated for knee osteoarthritis between 2006 and 2013 in France and to compare the delay from diagnosis to total knee replacement between patients who received intra-articular hyaluronic acid injections and those who did not receive the injections. A second objective was to compare direct medical costs for ambulatory care between treatment groups. Patients were selected from a representative sample of the real world administrative claims database using an algorithm developed by experts from the scientific committee of the study. Data were matched with the medico-administrative database for hospital care. A Cox proportional hazards model was stratified for the treatment group and adjusted for available socio-demographic and medical covariates to compare restricted mean survival times at different time points (1, 3, 5 and 7.5 years) between groups. Costs were expressed in 2013 euros. A total of 14,782 patients were treated for knee osteoarthritis (67% women; mean age = 68 years). Among this population, 1,662 patients had total knee replacement (11.2%). At each time point, restricted mean survival time without total knee replacement was significantly higher (p-valueshyaluronic acid group, from +51 to +217 days at 1 and 7.5 years, respectively. For the year preceding total knee replacement, the means for total direct medical costs were similar between groups, €744 vs €805 for treatment and control groups, respectively, (p-value = 0.104). Intra-articular injections accounted for less than 10% of the total costs. This is the first retrospective longitudinal study involving knee osteoarthritis patients using medico-administrative databases in France. The results support the effectiveness of hyaluronic acid injections in delaying total knee replacement and show that patients treated with hyaluronic acid have similar direct medical costs for ambulatory care compared to patients treated with corticosteroids only.

Instabilities at planetary gap edges in 3D self-gravitating disks

Directory of Open Access Journals (Sweden)

Lin Min-Kai

2013-04-01

Full Text Available Numerical simulations are presented to study the stability of gaps opened by giant planets in 3D self-gravitating disks. In weakly self-gravitating disks, a few vortices develop at the gap edge and merge on orbital time-scales. The result is one large but weak vortex with Rossby number -0.01. In moderately self-gravitating disks, more vortices develop and their merging is resisted on dynamical time-scales. Self-gravity can sustain multi-vortex configurations, with Rossby number -0.2 to -0.1, over a time-scale of order 100 orbits. Self-gravity also enhances the vortex vertical density stratification, even in disks with initial Toomre parameter of order 10. However, vortex formation is suppressed in strongly self-gravitating disks and replaced by a global spiral instability associated with the gap edge which develops during gap formation.

WIND-ACCRETION DISKS IN WIDE BINARIES, SECOND-GENERATION PROTOPLANETARY DISKS, AND ACCRETION ONTO WHITE DWARFS

International Nuclear Information System (INIS)

Perets, Hagai B.; Kenyon, Scott J.

2013-01-01

Mass transfer from an evolved donor star to its binary companion is a standard feature of stellar evolution in binaries. In wide binaries, the companion star captures some of the mass ejected in a wind by the primary star. The captured material forms an accretion disk. Here, we study the evolution of wind-accretion disks, using a numerical approach which allows us to follow the long-term evolution. For a broad range of initial conditions, we derive the radial density and temperature profiles of the disk. In most cases, wind accretion leads to long-lived stable disks over the lifetime of the asymptotic giant branch donor star. The disks have masses of a few times 10 –5 -10 –3 M ☉ , with surface density and temperature profiles that follow broken power laws. The total mass in the disk scales approximately linearly with the viscosity parameter used. Roughly, 50%-80% of the mass falling into the disk accretes onto the central star; the rest flows out through the outer edge of the disk into the stellar wind of the primary. For systems with large accretion rates, the secondary accretes as much as 0.1 M ☉ . When the secondary is a white dwarf, accretion naturally leads to nova and supernova eruptions. For all types of secondary star, the surface density and temperature profiles of massive disks resemble structures observed in protoplanetary disks, suggesting that coordinated observational programs might improve our understanding of uncertain disk physics.

Physiotherapy rehabilitation after total knee or hip replacement: an evidence-based analysis.

Science.gov (United States)

2005-01-01

The objective of this health technology policy analysis was to determine, where, how, and when physiotherapy services are best delivered to optimize functional outcomes for patients after they undergo primary (first-time) total hip replacement or total knee replacement, and to determine the Ontario-specific economic impact of the best delivery strategy. The objectives of the systematic review were as follows: To determine the effectiveness of inpatient physiotherapy after discharge from an acute care hospital compared with outpatient physiotherapy delivered in either a clinic-based or home-based setting for primary total joint replacement patientsTo determine the effectiveness of outpatient physiotherapy delivered by a physiotherapist in either a clinic-based or home-based setting in addition to a home exercise program compared with a home exercise program alone for primary total joint replacement patientsTo determine the effectiveness of preoperative exercise for people who are scheduled to receive primary total knee or hip replacement surgery Total hip replacements and total knee replacements are among the most commonly performed surgical procedures in Ontario. Physiotherapy rehabilitation after first-time total hip or knee replacement surgery is accepted as the standard and essential treatment. The aim is to maximize a person's functionality and independence and minimize complications such as hip dislocation (for hip replacements), wound infection, deep vein thrombosis, and pulmonary embolism. THE THERAPY: The physiotherapy rehabilitation routine has 4 components: therapeutic exercise, transfer training, gait training, and instruction in the activities of daily living. Physiotherapy rehabilitation for people who have had total joint replacement surgery varies in where, how, and when it is delivered. In Ontario, after discharge from an acute care hospital, people who have had a primary total knee or hip replacement may receive inpatient or outpatient

The economics of using prophylactic antibiotic-loaded bone cement in total knee replacement.

Science.gov (United States)

Gutowski, C J; Zmistowski, B M; Clyde, C T; Parvizi, J

2014-01-01

The rate of peri-prosthetic infection following total joint replacement continues to rise, and attempts to curb this trend have included the use of antibiotic-loaded bone cement at the time of primary surgery. We have investigated the clinical- and cost-effectiveness of the use of antibiotic-loaded cement for primary total knee replacement (TKR) by comparing the rate of infection in 3048 TKRs performed without loaded cement over a three-year period versus the incidence of infection after 4830 TKRs performed with tobramycin-loaded cement over a later period of time of a similar duration. In order to adjust for confounding factors, the rate of infection in 3347 and 4702 uncemented total hip replacements (THR) performed during the same time periods, respectively, was also examined. There were no significant differences in the characteristics of the patients in the different cohorts. The absolute rate of infection increased when antibiotic-loaded cement was used in TKR. However, this rate of increase was less than the rate of increase in infection following uncemented THR during the same period. If the rise in the rate of infection observed in THR were extrapolated to the TKR cohort, 18 additional cases of infection would have been expected to occur in the cohort receiving antibiotic-loaded cement, compared with the number observed. Depending on the type of antibiotic-loaded cement that is used, its cost in all primary TKRs ranges between USD $2112.72 and USD $112 606.67 per case of infection that is prevented.

Posterior Slope of the Tibia Plateau in Malaysian Patients Undergoing Total Knee Replacement

Directory of Open Access Journals (Sweden)

R Yoga

2009-05-01

Full Text Available The posterior slope of the tibial plateau is an important feature to preserve during knee replacement. The correct slope aids in the amount of flexion and determines if the knee will be loose on flexion. This is a study on the posterior tibial plateau slope based on preoperative and postoperative radiographs of 100 consecutive patients who had total knee replacements. The average posterior slope of the tibia plateau was 10.1 degrees. There is a tendency for patients with higher pre-operative posterior tibial plateau slope to have higher post-operative posterior tibial plate slope.

Flowtron foot-pumps for prevention of venous thromboembolism in total hip and knee replacement.

Science.gov (United States)

Pitto, Rocco P; Koh, Chuan K

2015-03-01

Mechanical prophylaxis with foot-pumps provides an interesting alternative to chemical agents in the prevention of venous thomboembolism following major orthopaedic surgery procedures. The aim of this prospective study was to assess efficacy and safety of the Flowtron(®) foot-pumps system following total hip and knee replacement. The foot pumps were used as main tool for prevention of thromboembolic events, in most cases in association with a variety of chemicals. The primary endpoint of the study was to assess the incidence of deep vein thrombosis and pulmonary embolism after total hip and knee replacement. The secondary endpoints included postoperative bleeding, swelling, bruising and wound ooze. 424 consecutive patients were included in the study. Symptomatic deep vein thrombosis was detected in 7 patients (1.6%). All symptomatic deep vein thromboses were detected after discharge before the six week follow-up clinic. Five non-fatal pulmonary embolisms occurred (1.2%). Only one patient presented a major wound bleeding (0.2%). The mean difference of swelling of thigh pre-versus postoperatively was only 22.8 mm. In conclusion, thromboembolism prophylaxis after total hip and knee replacement using Flowtron(®) foot-pumps as main prevention tool of an individualised protocol appears effective and safe. This is the first clinical report related to this popular brand of foot pumps.

CT recognition of lateral lumbar disk herniation

International Nuclear Information System (INIS)

Williams, A.L.; Haughton, V.M.; Daniels, D.L.; Thornton, R.S.

1982-01-01

Although computed tomography (CT) has been shown to be useful in diagnosing posterolateral and central lumbar disk herniations, its effectiveness in demonstrating lateral herniated disks has not been emphasized. The myelographic recognition of those herniations may be difficult because root sheaths or dural sacs may not be deformed. A total of 274 CT scans interpreted as showing lumbar disk herniation was reviewed. Fourteen (5%) showed a lateral disk herniation. The CT features of a lateral herniated disk included: (1) focal protrusion of the disk margin within or lateral to the intervertebral foramen: (2) displacement of epidural fat within the intervertebral foramen; (3) absence of dural sac deformity; and (4) soft-tissue mass within or lateral to the intervertebral foramen. Because it can image the disk margin and free disk fragments irrespective of dural sac or root sheath deformity, CT may be more effective than myelography for demonstrating the presence and extent of lateral disk herniation

Hemiarch versus total aortic arch replacement in acute type A dissection: a systematic review and meta-analysis.

Science.gov (United States)

Poon, Shi Sum; Theologou, Thomas; Harrington, Deborah; Kuduvalli, Manoj; Oo, Aung; Field, Mark

2016-05-01

Despite recent advances in aortic surgery, acute type A aortic dissection remains a surgical emergency associated with high mortality and morbidity. Appropriate management is crucial to achieve satisfactory outcomes but the optimal surgical approach is controversial. The present systematic review and meta-analysis sought to access cumulative data from comparative studies between hemiarch and total aortic arch replacement in patients with acute type A aortic dissection. A systematic review of the literature using six databases. Eligible studies include comparative studies on hemiarch versus total arch replacement reporting short, medium and long term outcomes. A meta-analysis was performed on eligible studies reporting outcome of interest to quantify the effects of hemiarch replacement on mortality and morbidity risk compared to total arch replacement. Fourteen retrospective studies met the inclusion criteria and 2,221 patients were included in the final analysis. Pooled analysis showed that hemiarch replacement was associated with a lower risk of post-operative renal dialysis [risk ratio (RR) =0.72; 95% confidence interval (CI): 0.56-0.94; P=0.02; I(2)=0%]. There was no significant difference in terms of in-hospital mortality between the two groups (RR =0.84; 95% CI: 0.65-1.09; P=0.20; I(2)=0%). Cardiopulmonary bypass, aortic cross clamp and circulatory arrest times were significantly longer in total arch replacement. During follow up, no significant difference was reported from current studies between the two operative approaches in terms of aortic re-intervention and freedom from aortic reoperation. Within the context of publication bias by high volume aortic centres and non-randomized data sets, there was no difference in mortality outcomes between the two groups. This analysis serves to demonstrate that for those centers doing sufficient total aortic arch activity to allow for publication, excellent and equivalent outcomes are achievable. Conclusions on

Scientific Opinion on the essential composition of total diet replacements for weight control

DEFF Research Database (Denmark)

Tetens, Inge

2015-01-01

or authoritative bodies. Derived from the minimum content of macronutrients, the Panel proposed a minimum energy content of total diet replacements for weight control of 2 510 kJ/day (600 kcal/day). The Panel also advised on potential conditions and restrictions of use for these products....

WIND-ACCRETION DISKS IN WIDE BINARIES, SECOND-GENERATION PROTOPLANETARY DISKS, AND ACCRETION ONTO WHITE DWARFS

Energy Technology Data Exchange (ETDEWEB)

Perets, Hagai B. [Technion-Israel Institute of Technology, Haifa (Israel); Kenyon, Scott J., E-mail: hperets@physics.technion.ac.il [Harvard-Smithsonian Center for Astrophysics, 60 Garden Street, Cambridge, MA 02138 (United States)

2013-02-20

Mass transfer from an evolved donor star to its binary companion is a standard feature of stellar evolution in binaries. In wide binaries, the companion star captures some of the mass ejected in a wind by the primary star. The captured material forms an accretion disk. Here, we study the evolution of wind-accretion disks, using a numerical approach which allows us to follow the long-term evolution. For a broad range of initial conditions, we derive the radial density and temperature profiles of the disk. In most cases, wind accretion leads to long-lived stable disks over the lifetime of the asymptotic giant branch donor star. The disks have masses of a few times 10{sup -5}-10{sup -3} M {sub Sun }, with surface density and temperature profiles that follow broken power laws. The total mass in the disk scales approximately linearly with the viscosity parameter used. Roughly, 50%-80% of the mass falling into the disk accretes onto the central star; the rest flows out through the outer edge of the disk into the stellar wind of the primary. For systems with large accretion rates, the secondary accretes as much as 0.1 M {sub Sun }. When the secondary is a white dwarf, accretion naturally leads to nova and supernova eruptions. For all types of secondary star, the surface density and temperature profiles of massive disks resemble structures observed in protoplanetary disks, suggesting that coordinated observational programs might improve our understanding of uncertain disk physics.

Thermal Comptonization in standard accretion disks

International Nuclear Information System (INIS)

Maraschi, L.; Molendi, S.

1990-01-01

Using the theory of geometrically thin accretion disks (where the effects of viscosity are parametrized in terms of the total pressure, viscosity parameter, α) equations are presented for the innermost region of the disk (where the pressure is due to radiation, and the main source of opacity is Thompson scattering). It is important to stress that the four equations can be solved without making use of an equation for the temperature. This is not true for the other regions of the disk. An equation given is used to determine the temperature, assuming that the disk is homogeneous and isothermal in the vertical direction. (author)

Disk

NARCIS (Netherlands)

P.A. Boncz (Peter); L. Liu (Lei); M. Tamer Özsu

2008-01-01

htmlabstractIn disk storage, data is recorded on planar, round and rotating surfaces (disks, discs, or platters). A disk drive is a peripheral device of a computer system, connected by some communication medium to a disk controller. The disk controller is a chip, typically connected to the CPU of

Catastrophizing and Depressive Symptoms as Prospective Predictors of Outcomes Following Total Knee Replacement

Directory of Open Access Journals (Sweden)

Robert R Edwards

2009-01-01

Full Text Available Several recent reports suggest that pain-related catastrophizing is a risk factor for poor acute pain outcomes following surgical interventions. However, it has been less clear whether levels of catastrophizing influence longer-term postoperative outcomes. Data were analyzed from a relatively small number (n=43 of patients who underwent total knee replacement and were followed for 12 months after their surgery. Previous research has suggested that high levels of both catastrophizing and depression are associated with elevated acute postoperative pain complaints among patients undergoing knee surgery. In this sample, catastrophizing and depression at each of the assessment points were studied as prospective predictors of pain (both global pain ratings and pain at night at the subsequent assessment point over the course of one year. The predictive patterns differed somewhat across measures of pain reporting; depressive symptoms were unique predictors of greater global pain complaints, while catastrophizing was a specific and unique predictor of elevated nighttime pain. While surgical outcomes following total knee replacement are, on average, quite good, a significant minority of patients continue to experience long-term pain. The present findings suggest that high levels of catastrophizing and depression may promote enhanced pain levels, indicating that interventions designed to reduce catastrophizing and depressive symptoms may have the potential to further improve joint replacement outcomes.

Use of tranexamic acid in primary total knee replacement: effects on perioperative blood loss.

Science.gov (United States)

Volquind, Daniel; Zardo, Remi Antônio; Winkler, Bruno Costamilan; Londero, Bruno Bertagnolli; Zanelatto, Natália; Leichtweis, Gisele Perondi

2016-01-01

The use of tranexamic acid in primary total knee replacement surgeries has been the subject of constant study. The strategies to reduce bleeding are aimed at reducing the need for blood transfusion due to the risks involved. In this study we evaluated the use of tranexamic acid in reducing bleeding, need for blood transfusion, and prevalence of postoperative deep vein thrombosis in primary total knee replacement. 62 patients undergoing primary total knee replacement were enrolled in the study, from June 2012 to May 2013, and randomized to receive a single dose of 2.5g of intravenous tranexamic acid (Group TA) or saline (Group GP), 5min before opening the pneumatic tourniquet, respectively. Hemoglobin, hematocrit, and blood loss were recorded 24h after surgery. Deep vein thrombosis was investigated during patient's hospitalization and 15 and 30 days after surgery in review visits. There was no demographic difference between groups. Group TA had 13.89% decreased hematocrit (p=0.925) compared to placebo. Group TA had a decrease of 12.28% (p=0.898) in hemoglobin compared to Group GP. Group TA had a mean decrease of 187.35mL in blood loss (25.32%) compared to group GP (p=0.027). The number of blood transfusions was higher in Group GP (p=0.078). Thromboembolic events were not seen in this study. Tranexamic acid reduced postoperative bleeding without promoting thromboembolic events. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

Acute normovolaemic haemodilution decreases postoperative allogeneic blood transfusion after total knee replacement.

Science.gov (United States)

Olsfanger, D; Fredman, B; Goldstein, B; Shapiro, A; Jedeikin, R

1997-09-01

We hypothesized that the success of postoperative blood conservation after acute normovolaemic haemodilution (NVHD) is influenced by the extent of intraoperative bleeding and surgical trauma, and the timing of autologous blood transfusion. As total knee replacement is associated with minimal intraoperative but extensive postoperative blood loss, this procedure is ideally suited to acute NVHD. Therefore, to test our hypothesis, 30 patients undergoing elective total knee replacement were enrolled in a prospective, randomized, controlled study. In groups NVHD-2 and NVHD-6, before induction of anaesthesia patients were bled to a target packed cell volume (PCV) of 28-30%, and in the post-anaesthesia care unit autologous blood was transfused over a 2-h period terminating after operation at 2 and 6 h, respectively. In the control group, NVHD was not performed. After operation, platelets, fibrinogen, prothrombin and partial thromboplastin time, and liver function, urea and electrolytes were measured and compared with preoperative baseline values. Significantly (P conservation strategy. However, there was no difference in allogeneic blood administration between the two NVHD groups. Coagulation and liver function, and urea and electrolyte concentrations were unaffected by treatment.

Interventions for the prediction and management of chronic postsurgical pain after total knee replacement: systematic review of randomised controlled trials.

Science.gov (United States)

Beswick, Andrew D; Wylde, Vikki; Gooberman-Hill, Rachael

2015-05-12

Total knee replacement can be a successful operation for pain relief. However, 10-34% of patients experience chronic postsurgical pain. Our aim was to synthesise evidence on the effectiveness of applying predictive models to guide preventive treatment, and for interventions in the management of chronic pain after total knee replacement. We conducted a systematic review of randomised controlled trials using appropriate search strategies in the Cochrane Library, MEDLINE and EMBASE from inception to October 2014. No language restrictions were applied. Adult patients receiving total knee replacement. Predictive models to guide treatment for prevention of chronic pain. Interventions for management of chronic pain. Reporting of specific outcomes was not an eligibility criterion but we sought outcomes relating to pain severity. No studies evaluated the effectiveness of predictive models in guiding treatment and improving outcomes after total knee replacement. One study evaluated an intervention for the management of chronic pain. The trial evaluated the use of a botulinum toxin A injection with antinociceptive and anticholinergic activity in 49 patients with chronic postsurgical pain after knee replacement. A single injection provided meaningful pain relief for about 40 days and the authors acknowledged the need for a large trial with repeated injections. No trials of multidisciplinary interventions or individualised treatments were identified. Our systematic review highlights a lack of evidence about the effectiveness of prediction and management strategies for chronic postsurgical pain after total knee replacement. As a large number of people are affected by chronic pain after total knee replacement, development of an evidence base about care for these patients should be a research priority. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Cerebral fat embolism after bilateral total knee replacement arthroplasty -A case report-

OpenAIRE

Chang, Ri-Na; Kim, Jong-Hak; Lee, Heeseung; Baik, Hee-Jung; Chung, Rack Kyung; Kim, Chi Hyo; Hwang, Tae-Hu

2010-01-01

Fat embolism syndrome is a rare and potentially lethal complication most commonly seen in long bone fractures and intramedullary manipulation. The clinical triad of fat embolism syndrome consists of mental confusion, respiratory distress, and petechiae. This study reports a case of cerebral fat embolism syndrome following elective bilateral total knee replacement. After an uneventful anesthesia and initial recovery, the patient developed neurologic symptoms nine hours postoperatively.

Circumferential electrocautery of the patella in primary total knee replacement without patellar replacement: a meta-analysis and systematic review

Science.gov (United States)

Fan, Lihong; Ge, Zhaogang; Zhang, Chen; Li, Jia; Yu, Zefeng; Dang, Xiaoqian; Wang, Kunzheng

2015-03-01

The purpose of this meta-analysis and systematic review was to identify and assess whether circumferential electrocautery is useful for improving outcomes after primary total knee replacement(TKR). We searched MEDLINE, EMBASE, PubMed, SpringerLink, Web of Knowledge, OVID CINAHL, OVID EBM and Google Scholar and included articles published through January 2014. A total of 6 articles met the inclusion criteria. Of the 776 cases included in the analysis, 388 cases involved patellar denervation, and 388 cases were designated as the control group. The meta-analysis revealed no significant difference in the incidence of anterior knee pain (AKP, p = 0.18) or in the visual analogue scale score (VAS, p = 0.23) between the two groups. In addition, AKSS Function Score indicated no significant difference between the two groups (p = 0.28). However, the OKS (p = 0.02), patellar score (p = 0.01), AKSS-Knee Score (p = 0.004), range of motion (ROM, p electrocautery. The results indicate that circumferential electrocautery of the patella does not significantly improve AKP compared with non-electrocautery techniques but that circumferential electrocautery significantly improves patients' knee function after surgery. Therefore, we believe that circumferential electrocautery is beneficial to the outcome of primary TKR surgery without patellar replacement.

Ankle replacement

Science.gov (United States)

Ankle arthroplasty - total; Total ankle arthroplasty; Endoprosthetic ankle replacement; Ankle surgery ... Ankle replacement surgery is most often done while you are under general anesthesia. This means you will ...

In Vivo Wear Performance of Cobalt-Chromium Versus Oxidized Zirconium Femoral Total Knee Replacements.

Science.gov (United States)

Gascoyne, Trevor C; Teeter, Matthew G; Guenther, Leah E; Burnell, Colin D; Bohm, Eric R; Naudie, Douglas R

2016-01-01

This study examines the damage and wear on the polyethylene (PE) inserts from 52 retrieved Genesis II total knee replacements to identify differences in tribological performance between matched pairs of cobalt-chromium (CoCr) and oxidized zirconium (OxZr) femoral components. Observer damage scoring and microcomputed tomography were used to quantify PE damage and wear, respectively. No significant differences were found between CoCr and OxZr groups in terms of PE insert damage, surface penetration, or wear. No severe damage such as cracking or delamination was noted on any of the 52 PE inserts. Observer damage scoring did not correlate with penetrative or volumetric PE wear. The more costly OxZr femoral component does not demonstrate clear tribological benefit over the standard CoCr component in the short term with this total knee replacement design. Copyright © 2016 Elsevier Inc. All rights reserved.

A randomised, controlled trial of circumpatellar electrocautery in total knee replacement without patellar resurfacing.

Science.gov (United States)

van Jonbergen, H P W; Scholtes, V A B; van Kampen, A; Poolman, R W

2011-08-01

The efficacy of circumpatellar electrocautery in reducing the incidence of post-operative anterior knee pain is unknown. We conducted a single-centre, outcome-assessor and patient-blinded, parallel-group, randomised, controlled trial to compare circumpatellar electrocautery with no electrocautery in total knee replacement in the absence of patellar resurfacing. Patients requiring knee replacement for primary osteoarthritis were randomly assigned circumpatellar electrocautery (intervention group) or no electrocautery (control group). The primary outcome measure was the incidence of anterior knee pain. A secondary measure was the standardised clinical and patient-reported outcomes determined by the American Knee Society scores and the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index. A total of 131 knees received circumpatellar electrocautery and 131 had no electrocautery. The overall incidence of anterior knee pain at follow-up at one year was 26% (20% to 31%), with 19% (12% to 26%) in the intervention group and 32% (24% to 40%) in the control group (p = 0.02). The relative risk reduction from electrocautery was 40% (9% to 61%) and the number needed to treat was 7.7 (4.3 to 41.4). The intervention group had a better mean total WOMAC score at follow-up at one year compared with the control group (16.3 (0 to 77.7) versus 21.6 (0 to 76.7), p = 0.04). The mean post-operative American Knee Society knee scores and function scores were similar in the intervention and control groups (knee score: 92.4 (55 to 100) versus 90.4 (51 to 100), respectively (p = 0.14); function score: 86.5 (15 to 100) versus 84.5 (30 to 100), respectively (p = 0.49)). Our study suggests that in the absence of patellar resurfacing electrocautery around the margin of the patella improves the outcome of total knee replacement.

Late results of total shoulder replacement in patients with rheumatoid arthritis

DEFF Research Database (Denmark)

Søjbjerg, J.O.; Frich, Lars Henrik; Johannsen, H.V.

1999-01-01

at the authors' institution. Total shoulder replacement yields satisfactory short and long term results even in patients with severely destructed joints. Pain relief is reliable and significant as reported in short and long term studies. In most patients the functional result is good or acceptable. Although...... range of motion is only slightly increased, a satisfactory overall range of motion is achieved by most patients because of the unaffected scapulothoracic motion. However, deteriorating results, emphasizing the complexity of shoulder arthroplasty, were seen with increasing observation time in patients...

Embolization of Spontaneous Hemarthrosis Post Total Knee Replacement

International Nuclear Information System (INIS)

Given, M. F.; Smith, P.; Lyon, S. M.; Robertson, D.; Thomson, K. R.

2008-01-01

Spontaneous nonhemophiliac hemarthrosis is an unusual entity, which has been little described. We present three cases of spontaneous recurrent hemarthrosis post total knee replacement (TKR) and successful management with embolization. Three male patients were referred to our service for angiography and treatment of recurrent hemarthrosis post TKR. In all three patients antegrade ipsilateral common femoral artery punctures and selective angiography of the geniculate branches were performed with a microcatheter. Abnormal vasculature was noted in all cases. Subsequent embolization was performed with Contour (Boston Scientific, Target Vascular, Cork, Ireland) embolization particles (150-250 and 250-355 μm) in two patients and microcoils in the third (TornadoR; Cook Inc., Bloomington, IN, USA). Technical success was 100%. One patient had a recurrence of symptoms requiring a repeat procedure 6 months later. No complications were encountered. Selective angiography and particle embolization is an effective technique for management of this unusual but problematic postoperative sequelae.

Analgesic effect of continuous femoral nerve block combined with infiltration anesthesia after total knee replacement

Directory of Open Access Journals (Sweden)

Jian-Guo Tan

2016-06-01

Full Text Available Objective: To study the analgesic effect of continuous femoral nerve block combined with infiltration anesthesia after total knee replacement. Methods: Patients who received unilateral total knee replacement in our hospital from May 2012 to August 2015 were included for study and randomly divided into experimental group who received continuous femoral nerve block combined with infiltration anesthesia and control group who received continuous femoral nerve block, and then the contents of postoperative serum pain-promoting-related mediators, painsuppressing-related mediators and pain-related signal molecules were detected. Results: Serum CGRP, PS, Hist, 5-HT, AM and BK contents of experimental group were significantly lower than those of control group, AEA, β-EP, RvE1, LXA4 and LXB4 contents were significantly higher than those of control group, and P2X2, P2X7, P2X3, P2X4, P2Y1, P2Y2, P2Y4, P2Y6, P2Y 13, P2Y14, p38MAPK and PI3K contents were significantly lower than those of control group. Conclusions: Continuous femoral nerve block combined with infiltration anesthesia after total knee replacement can increase the generation of pain-suppressing mediators, decrease the generation of pain-promoting mediators and achieve more exact analgesic effect.

Comparison of femoral neck fracture healing and affected limb pain after anterolateral-approach minimally invasive total hip replacement and hemiarthroplasty

Directory of Open Access Journals (Sweden)

Xiao-Dong Cao

2017-04-01

Full Text Available Objective: To study the differences in femoral neck fracture healing and affected limb pain after anterolateral-approach minimally invasive total hip replacement and hemiarthroplasty. Methods: A total of 92 patients with femoral neck fracture who received hip replacement in our hospital between May 2013 and December 2015 were selected and randomly divided into total hip and half hip group, total hip group received anterolateral-approach minimally invasive total hip replacement, half hip group received anterolateral-approach minimally invasive hemiarthroplasty, and 1 month after operation, serum was collected to detect the levels of bone metabolism markers, osteocyte cytokines, SP and CGRP. Results: 1 month after operation, serum PINP, PICP, BMP, TGF-β, FGF, IGF-I and IGF-II levels of total hip group were significantly higher than those of half hip group while TRAP5b and CatK levels were significantly lower than those of half hip group; the day after operation, serum pain media SP and CGRP levels were not significantly different between the two groups of patients; 36 h after operation, serum SP and CGRP levels of total hip group were significantly lower than those of half hip group. Conclusion: The bone metabolism after anterolateral-approach minimally invasive total hip replacement is better than that after hemiarthroplasty, and the degree of pain is less than that after hemiarthroplasty.

The effect of radial migration on galactic disks

International Nuclear Information System (INIS)

Vera-Ciro, Carlos; D'Onghia, Elena; Navarro, Julio; Abadi, Mario

2014-01-01

We study the radial migration of stars driven by recurring multi-arm spiral features in an exponential disk embedded in a dark matter halo. The spiral perturbations redistribute angular momentum within the disk and lead to substantial radial displacements of individual stars, in a manner that largely preserves the circularity of their orbits and that results, after 5 Gyr (∼40 full rotations at the disk scale length), in little radial heating and no appreciable changes to the vertical or radial structure of the disk. Our results clarify a number of issues related to the spatial distribution and kinematics of migrators. In particular, we find that migrators are a heavily biased subset of stars with preferentially low vertical velocity dispersions. This 'provenance bias' for migrators is not surprising in hindsight, for stars with small vertical excursions spend more time near the disk plane, and thus respond more readily to non-axisymmetric perturbations. We also find that the vertical velocity dispersion of outward migrators always decreases, whereas the opposite holds for inward migrators. To first order, newly arrived migrators simply replace stars that have migrated off to other radii, thus inheriting the vertical bias of the latter. Extreme migrators might therefore be recognized, if present, by the unexpectedly small amplitude of their vertical excursions. Our results show that migration, understood as changes in angular momentum that preserve circularity, can strongly affect the thin disk, but cast doubts on models that envision the Galactic thick disk as a relic of radial migration.

The current state of bearing surfaces in total hip replacement.

Science.gov (United States)

Rajpura, A; Kendoff, D; Board, T N

2014-02-01

We reviewed the literature on the currently available choices of bearing surface in total hip replacement (THR). We present a detailed description of the properties of articulating surfaces review the understanding of the advantages and disadvantages of existing bearing couples. Recent technological developments in the field of polyethylene and ceramics have altered the risk of fracture and the rate of wear, although the use of metal-on-metal bearings has largely fallen out of favour, owing to concerns about reactions to metal debris. As expected, all bearing surface combinations have advantages and disadvantages. A patient-based approach is recommended, balancing the risks of different options against an individual's functional demands.

Accretion in Radiative Equipartition (AiRE) Disks

Energy Technology Data Exchange (ETDEWEB)

Yazdi, Yasaman K.; Afshordi, Niayesh, E-mail: yyazdi@pitp.ca, E-mail: nafshordi@pitp.ca [Perimeter Institute for Theoretical Physics, 31 Caroline Street N, Waterloo, ON N2L 2Y5 (Canada)

2017-07-01

Standard accretion disk theory predicts that the total pressure in disks at typical (sub-)Eddington accretion rates becomes radiation pressure dominated. However, radiation pressure dominated disks are thermally unstable. Since these disks are observed in approximate steady state over the instability timescale, our accretion models in the radiation-pressure-dominated regime (i.e., inner disk) need to be modified. Here, we present a modification to the Shakura and Sunyaev model, where the radiation pressure is in equipartition with the gas pressure in the inner region. We call these flows accretion in radiative equipartition (AiRE) disks. We introduce the basic features of AiRE disks and show how they modify disk properties such as the Toomre parameter and the central temperature. We then show that the accretion rate of AiRE disks is limited from above and below, by Toomre and nodal sonic point instabilities, respectively. The former leads to a strict upper limit on the mass of supermassive black holes as a function of cosmic time (and spin), while the latter could explain the transition between hard and soft states of X-ray binaries.

Patterns of pharmacotherapy and health care utilization and costs prior to total hip or total knee replacement in patients with osteoarthritis.

Science.gov (United States)

Berger, Ariel; Bozic, Kevin; Stacey, Brett; Edelsberg, John; Sadosky, Alesia; Oster, Gerry

2011-08-01

To examine patterns of pharmacotherapy and health care utilization and costs prior to total knee replacement (TKR) or total hip replacement (THR) in patients with osteoarthritis (OA). Using a large US health insurance claims database, we identified all patients with OA who were ages ≥40 years and had undergone TKR or THR between January 1, 2006 and December 31, 2007. Patients with care utilization and costs over the 2-year period preceding surgery. A total of 16,527 patients met all study entry criteria. Their mean ± SD age was 56.6 ± 6.1 years, and 56% of them were women. In the 2 years preceding surgery, 55% of patients received prescription nonsteroidal antiinflammatory drugs, 58% received opioids, and 50% received injections of corticosteroids. The numbers of patients receiving these drugs increased steadily during the presurgery period. The mean ± SD total health care costs in the 2 years preceding surgery were $19,466 ± 29,869, of which outpatient care, inpatient care, and pharmacotherapy represented 45%, 20%, and 20%, respectively. Costs increased from $2,094 in the eighth calendar quarter prior to surgery to $3,100 in the final quarter. Patients with OA who undergo THR or TKR have relatively high levels of use of pain-related pharmacotherapy and high total health care costs in the 2-year period preceding surgery. Levels of utilization and cost increase as the date of surgery approaches. Copyright © 2011 by the American College of Rheumatology.

Preoperative information provided to Swedish and immigrant patients before total hip replacement.

Science.gov (United States)

Krupic, Ferid; Määttä, Sylvia; Garellick, Göran; Lyckhage, Elisabeth Dahlborg; Kärrholm, Johan

2012-01-01

Total hip replacement is an operation that usually leads to pain relief and improved health related quality of life (HRQoL). Previous studies have demonstrated the importance of information about upcoming surgery. Therefore, it was of interest to study how both immigrants, whose first language was not Swedish, and Swedish patients described pre-operative information. Individual interviews were conducted with 10 immigrants and 10 Swedish participants. The data were analysed using qualitative content analysis. The study was carried out in western Sweden from March to November 2010. The findings revealed that pre-operative information for all patients undergoing elective total hip replacement was limited. Patients from both groups expressed concern about inadequate preoperative information pertaining to the surgery, implant selection, pain relief, choice of anaesthesia, no or too short a time to put questions to the surgeon and an overall stressful situation. Adequate preoperative information is important for optimising pain relief and shortening the hospital stay. The fact that the patients overwhelmingly rated the preoperative information as inadequate may be due to several reasons. Mental distress and the two-week interval between the time when the patient received the information and the operation might have contributed to the low degree of retention.

Rehabilitation of patients aged 65 and over after total hip replacement

DEFF Research Database (Denmark)

Hørdam, Britta

by a randomised clinical trial by using telephone interviews and counseling postoperatively, and testing improvement in patients´health status after THR. The last study involved testing the effect of nursing intervention by providing a measurement of patients´healthrelated quality of life.......The overall aim of this thesis was to investigate improvement in health status of patients aged 65 and over after total hip replacement (THR) as a result of nursing rehabilitation. The projects conssits of three studies, first a description of patients´health status after THR, followed...

Influence of Minimally Invasive Total Hip Replacement on Hip Reaction Forces and Their Orientations

NARCIS (Netherlands)

Weber, Tim; Al-Munajjed, Amir A.; Verkerke, Gijsbertus Jacob; Dendorfer, Sebastian; Renkawitz, Tobias

2014-01-01

Minimally invasive surgery (MIS) is becoming increasingly popular. Supporters claim that the main advantages of MIS total hip replacement (THR) are less pain and a faster rehabilitation and recovery. Critics claim that safety and efficacy of MIS are yet to be determined. We focused on a

Do intra-articular hyaluronic acid injections delay total knee replacement in patients with osteoarthritis – A Cox model analysis

Science.gov (United States)

Amor, Bernard; Bardoulat, Isabelle; Tetafort, Aymeric; Pelletier-Fleury, Nathalie

2017-01-01

Due to the growing worldwide prevalence of knee osteoarthritis, the optimal management of this issue is critical for reducing its burden. Objectives This study aimed to describe patients treated for knee osteoarthritis between 2006 and 2013 in France and to compare the delay from diagnosis to total knee replacement between patients who received intra-articular hyaluronic acid injections and those who did not receive the injections. A second objective was to compare direct medical costs for ambulatory care between treatment groups. Materials and methods Patients were selected from a representative sample of the real world administrative claims database using an algorithm developed by experts from the scientific committee of the study. Data were matched with the medico-administrative database for hospital care. A Cox proportional hazards model was stratified for the treatment group and adjusted for available socio-demographic and medical covariates to compare restricted mean survival times at different time points (1, 3, 5 and 7.5 years) between groups. Costs were expressed in 2013 euros. Results A total of 14,782 patients were treated for knee osteoarthritis (67% women; mean age = 68 years). Among this population, 1,662 patients had total knee replacement (11.2%). At each time point, restricted mean survival time without total knee replacement was significantly higher (p-valueshyaluronic acid group, from +51 to +217 days at 1 and 7.5 years, respectively. For the year preceding total knee replacement, the means for total direct medical costs were similar between groups, €744 vs €805 for treatment and control groups, respectively, (p-value = 0.104). Intra-articular injections accounted for less than 10% of the total costs. Conclusion This is the first retrospective longitudinal study involving knee osteoarthritis patients using medico-administrative databases in France. The results support the effectiveness of hyaluronic acid injections in delaying total knee

Ultrasonic inspection method and system for detection of steeple cracking in turbine disk rims

International Nuclear Information System (INIS)

Birring, A.S.; Lamping, G.A.; Van der Veer, W.R.; Hanley, J.J.

1990-01-01

Steam turbine disks which operate under high cyclic stress in a moist environment can develop cracks in the disk-rim steeples. Detection of these cracks using nondestructive testing methods is necessary to assure safe operation and avoid unnecessary disk replacement. Both magnetic particle (MT) and ultrasonic testing (UT) can be used to inspect the steeples; however, UT can be used without removing the blades. A system for inspecting bladed steeples has been developed that can be applied on a range of disks including those in Westinghouse, General Electric, and Allis Chalmers turbines. The system performs an inspection as the turbine is rotated at slow speeds over turning rolls. This procedure greatly reduces inspection time because the inspection can be done without deblading the disk or resetting the inspection equipment for different rim segments

Preoperative therapeutic exercise in frail elderly scheduled for total hip replacement: A randomized pilot trial

NARCIS (Netherlands)

Hoogeboom, T.J.; Dronkers, J.J.; Ende, C.H.M. van den; Oosting, E.; Meeteren, N.L.U. van

2010-01-01

Objective: To evaluate the feasibility and preliminary effectiveness of therapeutic exercise before total hip replacement in frail elderly. Design: A single-blind, randomized clinical pilot trial. Setting: Outpatient physiotherapy department. Subjects: Frail elderly with hip osteoarthritis awaiting

The stability of the femoral component of a minimal invasive total hip replacement system.

NARCIS (Netherlands)

Willems, M.M.M.; Kooloos, J.G.M.; Gibbons, P.; Minderhoud, N.; Weernink, T.; Verdonschot, N.J.J.

2006-01-01

In this study, the initial stability of the femoral component of a minimal invasive total hip replacement was biomechanically evaluated during simulated normal walking and chair rising. A 20 mm diameter canal was created in the femoral necks of five fresh frozen human cadaver bones and the femoral

The relationship of hospital charges and volume to surgical site infection after total hip replacement.

Science.gov (United States)

Boas, Rebecca; Ensor, Kelsey; Qian, Edward; Hutzler, Lorraine; Slover, James; Bosco, Joseph

2015-05-01

The purpose of this study was to analyze the effect of hospital volume and charges on the rate of surgical site infections for total hip replacements (THRs) in New York State (NYS). In NYS, higher volume hospitals have higher charges after THR. The study team analyzed 93,620 hip replacements performed in NYS between 2008 and 2011. Hospital charges increased significantly from $43,713 in 2008 to $50,652 in 2011 (P<.01). Compared with lower volume hospitals, patients who underwent THR at the highest volume hospitals had significantly lower surgical site infection rates (P=.003) and higher total hospital charges (P<.0001). The study team found that in the highest volume hospitals, preventing one surgical site infection was associated with $1.6 million dollars in increased charges. © 2014 by the American College of Medical Quality.

Process optimized minimally invasive total hip replacement

Directory of Open Access Journals (Sweden)

Philipp Gebel

2012-02-01

Full Text Available The purpose of this study was to analyse a new concept of using the the minimally invasive direct anterior approach (DAA in total hip replacement (THR in combination with the leg positioner (Rotex- Table and a modified retractor system (Condor. We evaluated retrospectively the first 100 primary THR operated with the new concept between 2009 and 2010, regarding operation data, radiological and clinical outcome (HOOS. All surgeries were perfomed in a standardized operation technique including navigation. The average age of the patients was 68 years (37 to 92 years, with a mean BMI of 26.5 (17 to 43. The mean time of surgery was 80 min. (55 to 130 min. The blood loss showed an average of 511.5 mL (200 to 1000 mL. No intra-operative complications occurred. The postoperative complication rate was 6%. The HOOS increased from 43 points pre-operatively to 90 (max 100 points 3 months after surgery. The radiological analysis showed an average cup inclination of 43° and a leg length discrepancy in a range of +/- 5 mm in 99%. The presented technique led to excellent clinic results, showed low complication rates and allowed correct implant positions although manpower was saved.

Thermal stress in the edge cladding of Nova glass laser disks

International Nuclear Information System (INIS)

Pitts, J.H.; Kong, M.K.; Gerhard, M.A.

1987-01-01

We calculated thermal stresses in Nova glass laser disks having light-absorbing edge cladding glass attached to the periphery with an epoxy adhesive. Our closed-form solutions indicated that, because the epoxy adhesive is only 25 μm across, it does not significantly affect the thermal stress in the disk or cladding glass. Our numerical results showed a peak tensile stress in the cladding glass of 24 MPa when the cladding glass had a uniform absorption coefficient of 7.5 cm -1 . This peak value is reduced to 19 MPa if surface parasitic oscillation heating is eliminated by tilting the disk edges. The peak tensile stresses exceed the typical 7 to 14-MPa working stress for glass; however, we have not observed any disk or cladding glass failures at peak Nova fluences of 20 J/cm 2 . We have observed delamination of the epoxy adhesive bond at fluences several times that which would occur on Nova. Replacement laser disks will incorporate cladding with a reduced absorption coefficient of 4.5 cm -1 . Recent experiments show that this reduced absorption coefficient is satisfactory

Parametric analysis of electromechanical and fatigue performance of total knee replacement bearing with embedded piezoelectric transducers

Science.gov (United States)

Safaei, Mohsen; Meneghini, R. Michael; Anton, Steven R.

2017-09-01

Total knee arthroplasty is a common procedure in the United States; it has been estimated that about 4 million people are currently living with primary knee replacement in this country. Despite huge improvements in material properties, implant design, and surgical techniques, some implants fail a few years after surgery. A lack of information about in vivo kinetics of the knee prevents the establishment of a correlated intra- and postoperative loading pattern in knee implants. In this study, a conceptual design of an ultra high molecular weight (UHMW) knee bearing with embedded piezoelectric transducers is proposed, which is able to measure the reaction forces from knee motion as well as harvest energy to power embedded electronics. A simplified geometry consisting of a disk of UHMW with a single embedded piezoelectric ceramic is used in this work to study the general parametric trends of an instrumented knee bearing. A combined finite element and electromechanical modeling framework is employed to investigate the fatigue behavior of the instrumented bearing and the electromechanical performance of the embedded piezoelectric. The model is validated through experimental testing and utilized for further parametric studies. Parametric studies consist of the investigation of the effects of several dimensional and piezoelectric material parameters on the durability of the bearing and electrical output of the transducers. Among all the parameters, it is shown that adding large fillet radii results in noticeable improvement in the fatigue life of the bearing. Additionally, the design is highly sensitive to the depth of piezoelectric pocket. Finally, using PZT-5H piezoceramics, higher voltage and slightly enhanced fatigue life is achieved.

Resumption of car driving after total hip replacement.

Science.gov (United States)

Abbas, Ghulam; Waheed, Abdul

2011-04-01

To assess periods required for resuming car driving in 130 patients who had undergone total hip replacement (THR). 80 men and 50 women aged 39 to 80 years who had been driving automatic (n=49) or manual (n=81) cars in the previous 3 months and underwent unilateral primary THR of the right (n=85) or left (n=45) hip were recruited. Patients were advised to resume driving after 6 weeks if they felt comfortable to do so. 105 (81%) patients were able to resume driving at week 6 to 8; 67 (64%) had had a right THR and 65 (62%) were manual car drivers. 22 (17%) patients were able to do so at week 12. The remaining 3 (2%) patients were not confident to drive even at week 12. No patient reported deterioration in driving ability, whereas 48 (38%) felt a subjective improvement in their driving ability. The time to resume driving varies in different patients. The advice should be individualised, depending on the patient's recovery and confidence level.

Lifetime risk of primary total hip replacement surgery for osteoarthritis from 2003-2013

DEFF Research Database (Denmark)

Ackerman, Ilana N; Bohensky, Megan A; de Steiger, Richard

2017-01-01

OBJECTIVE: To compare the lifetime risk of total hip replacement surgery (THR) for osteoarthritis (OA) between countries, and over time. METHODS: Data on primary THR procedures performed for OA in 2003 and 2013 were extracted from national arthroplasty registries in Australia, Denmark, Finland, N....... These multi-national risk estimates can inform resource planning for OA service delivery. This article is protected by copyright. All rights reserved....

A Water Rehabilitation Program in Patients with Hip Osteoarthritis Before and After Total Hip Replacement

OpenAIRE

?yp, Marek; Kaczor, Ryszard; Cabak, Anna; Tederko, Piotr; W?ostowska, Ewa; Stanis?awska, Iwona; Szypu?a, Jan; Tomaszewski, Wies?aw

2016-01-01

Background Pain associated with coxarthrosis, typically occurring in middle-aged and elderly patients, very commonly causes considerable limitation of motor fitness and dependence on pharmacotherapy. This article provides an assessment of a rehabilitation program with tailored water exercises in patients with osteoarthritis before and after total hip replacement. Material/Methods A total of 192 patients (the mean age 61.03?10.89) suffering from hip osteoarthritis (OA) were evaluated before an...

High-resolution observations of IRAS 08544-4431. Detection of a disk orbiting a post-AGB star and of a slow disk wind

Science.gov (United States)

Bujarrabal, V.; Castro-Carrizo, A.; Winckel, H. Van; Alcolea, J.; Contreras, C. Sánchez; Santander-García, M.; Hillen, M.

2018-06-01

Context. Aims: In order to study the effects of rotating disks in the post-asymptotic giant branch (post-AGB) evolution, we observe a class of binary post-AGB stars that seem to be systematically surrounded by equatorial disks and slow outflows. Although the rotating dynamics had only been well identified in three cases, the study of such structures is thought to be fundamental to the understanding of the formation of disks in various phases of the late evolution of binary stars and the ejection of planetary nebulae from evolved stars. Methods: We present ALMA maps of 12CO and 13CO J = 3-2 lines in the source IRAS 08544-4431, which belongs to the above mentioned class of objects. We analyzed the data by means of nebula models, which account for the expectedly composite source and can reproduce the data. From our modeling, we estimated the main nebula parameters, including the structure and dynamics and the density and temperature distributions. We discuss the uncertainties of the derived values and, in particular, their dependence on the distance. Results: Our observations reveal the presence of an equatorial disk in rotation; a low-velocity outflow is also found, probably formed of gas expelled from the disk. The main characteristics of our observations and modeling of IRAS 08544-4431 are similar to those of better studied objects, confirming our interpretation. The disk rotation indicates a total central mass of about 1.8 M⊙, for a distance of 1100 pc. The disk is found to be relatively extended and has a typical diameter of 4 × 1016 cm. The total nebular mass is 2 × 10-2 M⊙, of which 90% corresponds to the disk. Assuming that the outflow is due to mass loss from the disk, we derive a disk lifetime of 10 000 yr. The disk angular momentum is found to be comparable to that of the binary system at present. Assuming that the disk angular momentum was transferred from the binary system, as expected, the high values of the disk angular momentum in this and other

Numerical Modelling of the Weight-Bearing Total Knee Joint Replacement and Usage in Practice

Czech Academy of Sciences Publication Activity Database

Daněk, Josef; Nedoma, Jiří; Hlaváček, Ivan; Vavřík, P.; Denk, F.

2007-01-01

Roč. 76, č. 1-3 (2007), s. 49-56 ISSN 0378-4754 R&D Projects: GA MPO FT-TA/087 Institutional research plan: CEZ:AV0Z10300504 Keywords : total knee joint replacement * contact problem * non-overlapping domain decomposition method Subject RIV: BA - General Mathematics Impact factor: 0.738, year: 2007

Pain and senzitisation after total knee replacement or nonsurgical treatment in patients with knee osteoarthritis

DEFF Research Database (Denmark)

Arendt-Nielsen, Lars; Simonsen, Ole; Laursen, Mogens Berg

2018-01-01

BACKGROUND: This study is a secondary analysis of 12-month follow-ups from two parallel, randomised controlled trials (RCT) in painful knee osteoarthritis patients. RCT1: Total knee replacement (TKR) followed by non-surgical treatment compared with non-surgical treatment. RCT2: Non...

The dramatic increase in total knee replacement utilization rates in the United States cannot be fully explained by growth in population size and the obesity epidemic.

Science.gov (United States)

Losina, Elena; Thornhill, Thomas S; Rome, Benjamin N; Wright, John; Katz, Jeffrey N

2012-02-01

Total knee replacement utilization in the United States more than doubled from 1999 to 2008. Although the reasons for this increase have not been examined rigorously, some have attributed the increase to population growth and the obesity epidemic. Our goal was to investigate whether the rapid increase in total knee replacement use over the past decade can be sufficiently attributed to changes in these two factors. We used data from the Nationwide Inpatient Sample to estimate changes in total knee replacement utilization rates from 1999 to 2008, stratified by age (eighteen to forty-four years, forty-five to sixty-four years, and sixty-five years or older). We obtained data on obesity prevalence and U.S. population growth from federal sources. We compared the rate of change in total knee replacement utilization with the rates of population growth and change in obesity prevalence from 1999 to 2008. In 2008, 615,050 total knee replacements were performed in the United States adult population, 134% more than in 1999. During the same time period, the overall population size increased by 11%. While the population of forty-five to sixty-four-year-olds grew by 29%, the number of total knee replacements in this age group more than tripled. The number of obese and non-obese individuals in the United States increased by 23% and 4%, respectively. Assuming unchanged indications for total knee replacement among obese and non-obese individuals with knee osteoarthritis over the last decade, these changes fail to account for the 134% growth in total knee replacement use. Population growth and obesity cannot fully explain the rapid expansion of total knee replacements in the last decade, suggesting that other factors must also be involved. The disproportionate increase in total knee replacements among younger patients may be a result of a growing number of knee injuries and expanding indications for the procedure.

Time-based analysis of total cost of patient episodes: a case study of hip replacement.

Science.gov (United States)

Peltokorpi, Antti; Kujala, Jaakko

2006-01-01

Healthcare in the public and private sectors is facing increasing pressure to become more cost-effective. Time-based competition and work-in-progress have been used successfully to measure and improve the efficiency of industrial manufacturing. Seeks to address this issue. Presents a framework for time based management of the total cost of a patient episode and apply it to the six sigma DMAIC-process development approach. The framework is used to analyse hip replacement patient episodes in Päijät-Häme Hospital District in Finland, which has a catchment area of 210,000 inhabitants and performs an average of 230 hip replacements per year. The work-in-progress concept is applicable to healthcare--notably that the DMAIC-process development approach can be used to analyse the total cost of patient episodes. Concludes that a framework, which combines the patient-in-process and the DMAIC development approach, can be used not only to analyse the total cost of patient episode but also to improve patient process efficiency. Presents a framework that combines patient-in-process and DMAIC-process development approaches, which can be used to analyse the total cost of a patient episode in order to improve patient process efficiency.

Patterns of Ninety-Day Readmissions Following Total Joint Replacement in a Bundled Payment Initiative.

Science.gov (United States)

Behery, Omar A; Kester, Benjamin S; Williams, Jarrett; Bosco, Joseph A; Slover, James D; Iorio, Richard; Schwarzkopf, Ran

2017-04-01

Alternative payment models aim to improve quality and decrease costs associated with total joint replacement. Postoperative readmissions within 90 days are of interest to clinicians and administrators as there is no additional reimbursement beyond the episode bundled payment target price. The aim of this study is to improve the understanding of the patterns of readmission which would better guide perioperative patient management affecting readmissions. We hypothesize that readmissions have different timing, location, and patient health profile patterns based on whether the readmission is related to a medical or surgical diagnosis. A retrospective cohort of 80 readmissions out of 1412 total joint replacement patients reimbursed through a bundled payment plan was analyzed. Patients were grouped by readmission diagnosis (surgical or medical) and the main variables analyzed were time to readmission, location of readmission, and baseline Perioperative Orthopaedic Surgical Home and American Society of Anesthesiologists scores capturing pre-existing state of health. Nonparametric tests and multivariable regressions were used to test associations. Surgical readmissions occurred earlier than medical readmissions (mean 18 vs 33 days, P = .011), and were more likely to occur at the hospital where the surgery was performed (P = .035). Perioperative Orthopaedic Surgical Home and American Society of Anesthesiologists scores did not predict medical vs surgical readmissions (P = .466 and .879) after adjusting for confounding variables. Readmissions appear to follow different patterns depending on whether they are surgical or medical. Surgical readmissions occur earlier than medical readmissions, and more often at the hospital where the surgery was performed. The results of this study suggest that these 2 types of readmissions have different patterns with different implications toward perioperative care and follow-up after total joint replacement. Copyright © 2016 Elsevier Inc

Cardiac stroke following total knee replacement in an ochronotic arthropathy: Case report and literature review

Directory of Open Access Journals (Sweden)

Saurabh Jain

2016-01-01

Full Text Available Alkaptonuria is a rare autosomal recessive disorder caused by defective metabolism of homogentisic acid (HGA which on accumulation in the connective tissues causes arthritis, darkening of urine and connective tissue pigmentation. Knee is most commonly affected joint whereas pigment deposition is seen in entire body causing cardiovascular, genitourinary, ocular, cutaneous, and musculoskeletal complications. We here report such a case of bilateral ochronotic arthropathy, who was diagnosed to be alkaptonuric only during joint exploration. He sustained a cardiac catastrophic stroke on 3 rd post operative day of the left knee replacement which was done one week after the right knee replacement. With prompt treatment and good hospital care, the patient was revived successfully, without valvulotomy or valvular replacement. The spectrum of clinical manifestations are discussed in the report with emphasis on thorough history and clinical examination of the patient, before taking the patient to the total knee replacement to make accurate diagnosis before hand and be prepared for the complications or catastrophic by a multidisciplinary approach.

Oxygenation impairment after total arch replacement with a stented elephant trunk for type-A dissection.

Science.gov (United States)

Shen, Yuwen; Liu, Chuanzhen; Fang, Changcun; Xi, Jie; Wu, Shuming; Pang, Xinyan; Song, Guangmin

2018-06-01

To study the risk factors of oxygenation impairment in patients with type-A acute aortic dissection who underwent total arch replacement with a stented elephant trunk. In this study, 169 consecutive patients were enrolled who were diagnosed with type-A acute aortic dissection and underwent a total arch replacement procedure at the Qilu Hospital of Shandong University between January 2015 and February 2017. Postoperative oxygenation impairment was defined as arterial oxygen partial pressure/inspired oxygen fraction ≤ 200 with positive end expiratory pressure ≥ 5 cm H 2 O that occurred within 72 hours of surgery. Perioperative clinical characteristics of all patients were collected and univariable analyses were performed. Risk factors associated with oxygenation impairment identified by univariable analyses were included in the multivariable regression analysis. The incidence of postoperative oxygenation impairment was 48.5%. Postoperative oxygenation impairment was associated with prolonged mechanical ventilation time, intensive care unit stay, and hospital stay. Multivariable regression analysis demonstrated that body mass index (odds ratio [OR], 1.204; 95% confidence interval [CI], 1.065-1.361; P = .003), preoperative oxygenation impairment (OR, 9.768; 95% CI, 4.159-22.941; P impairment. Postoperative oxygenation impairment is a common complication of surgery for type-A acute aortic dissection. Body mass index, preoperative oxygenation impairment, preoperative homocysteine, circulatory arrest time, and plasma transfusion were independent risk factors for oxygenation impairment after a total arch replacement procedure. Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

The DiskMass Survey. II. Error Budget

Science.gov (United States)

Bershady, Matthew A.; Verheijen, Marc A. W.; Westfall, Kyle B.; Andersen, David R.; Swaters, Rob A.; Martinsson, Thomas

2010-06-01

We present a performance analysis of the DiskMass Survey. The survey uses collisionless tracers in the form of disk stars to measure the surface density of spiral disks, to provide an absolute calibration of the stellar mass-to-light ratio (Υ_{*}), and to yield robust estimates of the dark-matter halo density profile in the inner regions of galaxies. We find that a disk inclination range of 25°-35° is optimal for our measurements, consistent with our survey design to select nearly face-on galaxies. Uncertainties in disk scale heights are significant, but can be estimated from radial scale lengths to 25% now, and more precisely in the future. We detail the spectroscopic analysis used to derive line-of-sight velocity dispersions, precise at low surface-brightness, and accurate in the presence of composite stellar populations. Our methods take full advantage of large-grasp integral-field spectroscopy and an extensive library of observed stars. We show that the baryon-to-total mass fraction ({F}_bar) is not a well-defined observational quantity because it is coupled to the halo mass model. This remains true even when the disk mass is known and spatially extended rotation curves are available. In contrast, the fraction of the rotation speed supplied by the disk at 2.2 scale lengths (disk maximality) is a robust observational indicator of the baryonic disk contribution to the potential. We construct the error budget for the key quantities: dynamical disk mass surface density (Σdyn), disk stellar mass-to-light ratio (Υ^disk_{*}), and disk maximality ({F}_{*,max}^disk≡ V^disk_{*,max}/ V_c). Random and systematic errors in these quantities for individual galaxies will be ~25%, while survey precision for sample quartiles are reduced to 10%, largely devoid of systematic errors outside of distance uncertainties.

A comprehensive combined experimental and computational framework for pre-clinical wear simulation of total knee replacements.

Science.gov (United States)

Abdelgaied, A; Fisher, J; Jennings, L M

2018-02-01

A more robust pre-clinical wear simulation framework is required in order to simulate wider and higher ranges of activities, observed in different patient populations such as younger more active patients. Such a framework will help to understand and address the reported higher failure rates for younger and more active patients (National_Joint_Registry, 2016). The current study has developed and validated a comprehensive combined experimental and computational framework for pre-clinical wear simulation of total knee replacements (TKR). The input mechanical (elastic modulus and Poisson's ratio) and wear parameters of the moderately cross-linked ultra-high molecular weight polyethylene (UHMWPE) bearing material were independently measured from experimental studies under realistic test conditions, similar to the loading conditions found in the total knee replacements. The wear predictions from the computational wear simulation were validated against the direct experimental wear measurements for size 3 Sigma curved total knee replacements (DePuy, UK) in an independent experimental wear simulation study under three different daily activities; walking, deep squat, and stairs ascending kinematic conditions. The measured compressive mechanical properties of the moderately cross-linked UHMWPE material were more than 20% lower than that reported in the literature under tensile test conditions. The pin-on-plate wear coefficient of moderately cross-linked UHMWPE was significantly dependant of the contact stress and the degree of cross-shear at the articulating surfaces. The computational wear predictions for the TKR from the current framework were consistent and in a good agreement with the independent full TKR experimental wear simulation measurements, with 0.94 coefficient of determination of the framework. In addition, the comprehensive combined experimental and computational framework was able to explain the complex experimental wear trends from the three different daily

Extramedullary versus intramedullary tibial cutting guides in megaprosthetic total knee replacement

Directory of Open Access Journals (Sweden)

Karade Vikas

2012-10-01

Full Text Available Abstract Background In a standard total knee replacement, tibial component alignment is a key factor for the long term success of the surgery. The purpose of this study is to compare the accuracy of extramedullary and intramedullary tibial cutting guides used in indigenous and imported implants respectively, in positioning of the tibial components in megaprosthetic knee replacements. Methods A comparative study of the accuracy of extramedullary and intramedullary tibial cutting guides was carried out in 92 megaprosthetic knee replacements for distal femoral tumors. For the proximal tibia cut for tibial component placement, an extramedullary guide was used in 65 patients and an intramedullary guide was used in 27 patients. Tibial component alignment angles were measured in postoperative X-rays with the help of CAD software. Results There was more varus placement in coronal plane with extramedullary cutting guide (−1.18 +/− 2.4 degrees than the intramedullary guide (−0.34 +/− 2.31 degrees but this did not reach statistical significance. The goal of 90 +/− 2 degrees alignment of tibial component was achieved in 54% of patients in the extramedullary group versus 67% in the intramedullary group. In terms of sagittal plane alignment, extramedullary guide showed less accurate results (2.09 +/− 2.4 degrees than intramedullary guide (0.50 +/− 3.80 degrees for tibial component alignment, though 78% of patients were aligned within the goal of 0–5 degrees of tibial slope angle in extramedullary group versus 63% in intramedullary group. The mean error in the measurements due to rotation of the knee during taking the X-rays was less than 0.1 degrees and distribution of the X-rays with the rotation of knee was similar in both the groups. Conclusions Overall, in megaprosthetic knee replacement intramedullary guides gave more accurate results in sagittal plane and exhibited similar variability as of extramedullary guides in coronal plane.

Analysis of mean time to data loss of fault-tolerant disk arrays RAID-6 based on specialized Markov chain

Science.gov (United States)

Rahman, P. A.; D'K Novikova Freyre Shavier, G.

2018-03-01

This scientific paper is devoted to the analysis of the mean time to data loss of redundant disk arrays RAID-6 with alternation of data considering different failure rates of disks both in normal state of the disk array and in degraded and rebuild states, and also nonzero time of the disk replacement. The reliability model developed by the authors on the basis of the Markov chain and obtained calculation formula for estimation of the mean time to data loss (MTTDL) of the RAID-6 disk arrays are also presented. At last, the technique of estimation of the initial reliability parameters and examples of calculation of the MTTDL of the RAID-6 disk arrays for the different numbers of disks are also given.

A Numerical Study of Effects of the Manufacture Perturbations to Contacts of the Total Hip Replacement

Czech Academy of Sciences Publication Activity Database

Koukal, M.; Fuis, Vladimír; Florian, Z.; Janíček, P.

2011-01-01

Roč. 18, č. 1 (2011), s. 33-42 ISSN 1802-1484 Institutional research plan: CEZ:AV0Z20760514 Keywords : total hip replacement * FEM * roundness * contact pressure * frictional moment Subject RIV: BO - Biophysics

Opinions among Danish knee surgeons about indications to perform total knee replacement showed considerable variation

DEFF Research Database (Denmark)

Troelsen, Anders; Schrøder, Henrik; Husted, Henrik

2012-01-01

During the past decade, the incidence of primary total knee replacement (TKA) surgery in Denmark has approximately doubled. This increase could be due to weakened indications to perform TKA surgery. We aimed to investigate variation in opinions about indications to perform TKA among Danish knee...

THE VLA VIEW OF THE HL TAU DISK: DISK MASS, GRAIN EVOLUTION, AND EARLY PLANET FORMATION

Energy Technology Data Exchange (ETDEWEB)

Carrasco-González, Carlos; Rodríguez, Luis F.; Galván-Madrid, Roberto [Instituto de Radioastronomía y Astrofísica UNAM, Apartado Postal 3-72 (Xangari), 58089 Morelia, Michoacán, México (Mexico); Henning, Thomas; Linz, Hendrik; Birnstiel, Til; Boekel, Roy van; Klahr, Hubert [Max-Planck-Institut für Astronomie Heidelberg, Königstuhl 17, D-69117 Heidelberg (Germany); Chandler, Claire J.; Pérez, Laura [National Radio Astronomy Observatory, P.O. Box O, 1003 Lopezville Road, Socorro, NM 87801-0387 (United States); Anglada, Guillem; Macias, Enrique; Osorio, Mayra [Instituto de Astrofísica de Andalucía (CSIC), Apartado 3004, E-18080 Granada (Spain); Flock, Mario [Jet Propulsion Laboratory, California Institute of Technology, 4800 Oak Grove Drive, Pasadena, CA 91109 (United States); Menten, Karl [Jansky Fellow of the National Radio Astronomy Observatory (United States); Testi, Leonardo [European Southern Observatory, Karl-Schwarzschild-Str. 2, D-85748 Garching bei München (Germany); Torrelles, José M. [Institut de Ciències de l’Espai (CSIC-IEEC) and Institut de Ciències del Cosmos (UB-IEEC), Martí i Franquès 1, E-08028 Barcelona (Spain); Zhu, Zhaohuan, E-mail: c.carrasco@crya.unam.mx, E-mail: l.rodriguez@crya.unam.mx, E-mail: r.galvan@crya.unam.mx, E-mail: henning@mpia.de, E-mail: linz@mpia.de [Department of Astrophysical Sciences, Princeton University, Princeton, NJ 08544 (United States)

2016-04-10

The first long-baseline ALMA campaign resolved the disk around the young star HL Tau into a number of axisymmetric bright and dark rings. Despite the very young age of HL Tau, these structures have been interpreted as signatures for the presence of (proto)planets. The ALMA images triggered numerous theoretical studies based on disk–planet interactions, magnetically driven disk structures, and grain evolution. Of special interest are the inner parts of disks, where terrestrial planets are expected to form. However, the emission from these regions in HL Tau turned out to be optically thick at all ALMA wavelengths, preventing the derivation of surface density profiles and grain-size distributions. Here, we present the most sensitive images of HL Tau obtained to date with the Karl G. Jansky Very Large Array at 7.0 mm wavelength with a spatial resolution comparable to the ALMA images. At this long wavelength, the dust emission from HL Tau is optically thin, allowing a comprehensive study of the inner disk. We obtain a total disk dust mass of (1–3) × 10{sup −3} M {sub ⊙}, depending on the assumed opacity and disk temperature. Our optically thin data also indicate fast grain growth, fragmentation, and formation of dense clumps in the inner densest parts of the disk. Our results suggest that the HL Tau disk may be actually in a very early stage of planetary formation, with planets not already formed in the gaps but in the process of future formation in the bright rings.

THE VLA VIEW OF THE HL TAU DISK: DISK MASS, GRAIN EVOLUTION, AND EARLY PLANET FORMATION

International Nuclear Information System (INIS)

Carrasco-González, Carlos; Rodríguez, Luis F.; Galván-Madrid, Roberto; Henning, Thomas; Linz, Hendrik; Birnstiel, Til; Boekel, Roy van; Klahr, Hubert; Chandler, Claire J.; Pérez, Laura; Anglada, Guillem; Macias, Enrique; Osorio, Mayra; Flock, Mario; Menten, Karl; Testi, Leonardo; Torrelles, José M.; Zhu, Zhaohuan

2016-01-01

The first long-baseline ALMA campaign resolved the disk around the young star HL Tau into a number of axisymmetric bright and dark rings. Despite the very young age of HL Tau, these structures have been interpreted as signatures for the presence of (proto)planets. The ALMA images triggered numerous theoretical studies based on disk–planet interactions, magnetically driven disk structures, and grain evolution. Of special interest are the inner parts of disks, where terrestrial planets are expected to form. However, the emission from these regions in HL Tau turned out to be optically thick at all ALMA wavelengths, preventing the derivation of surface density profiles and grain-size distributions. Here, we present the most sensitive images of HL Tau obtained to date with the Karl G. Jansky Very Large Array at 7.0 mm wavelength with a spatial resolution comparable to the ALMA images. At this long wavelength, the dust emission from HL Tau is optically thin, allowing a comprehensive study of the inner disk. We obtain a total disk dust mass of (1–3) × 10 −3 M ⊙ , depending on the assumed opacity and disk temperature. Our optically thin data also indicate fast grain growth, fragmentation, and formation of dense clumps in the inner densest parts of the disk. Our results suggest that the HL Tau disk may be actually in a very early stage of planetary formation, with planets not already formed in the gaps but in the process of future formation in the bright rings

Hip joint replacement

Science.gov (United States)

Hip arthroplasty; Total hip replacement; Hip hemiarthroplasty; Arthritis - hip replacement; Osteoarthritis - hip replacement ... Your hip joint is made up of 2 major parts. One or both parts may be replaced during surgery: ...

Assessment and validation of CT scanogram to compare per-operative and post-operative mechanical axis after navigated total knee replacement

Science.gov (United States)

Jain, Sunil

2008-01-01

Our objective was to assess and validate low-dose computed tomography (CT) scanogram as a post-operative imaging modality to measure the mechanical axis after navigated total knee replacement. A prospective study was performed to compare intra-operative and post-operative mechanical axis after navigated total knee replacements. All consecutive patients who underwent navigated total knee replacement between May and December 2006 were included. The intra-operative final axis was recorded, and post-operatively a CT scanogram of lower limbs was performed. The mechanical axis was measured and compared against the intra-operative measurement. There were 15 patients ranging in age from 57 to 80 (average 70) years. The average final intra-operative axis was 0.56° varus (4° varus to 1.5° valgus) and post-operative CT scanogram axis was 0.52° varus (3.1° varus to 1.8° valgus). The average deviation from final axes to CT scanogram axes was 0.12° valgus with a correlation coefficient of 0.9. Our study suggests that CT scanogram is an imaging modality with reasonable accuracy for measuring mechanical axis despite significantly low radiation. It also confirms a high level of correlation between intra-operative and post-operative mechanical axis after navigated total knee replacement. PMID:18696064

Shoulder replacement - discharge

Science.gov (United States)

Total shoulder arthroplasty - discharge; Endoprosthetic shoulder replacement - discharge; Partial shoulder replacement - discharge; Partial shoulder arthroplasty - discharge; Replacement - shoulder - discharge; Arthroplasty - shoulder - discharge

Ankle replacement - discharge

Science.gov (United States)

... total - discharge; Total ankle arthroplasty - discharge; Endoprosthetic ankle replacement - discharge; Osteoarthritis - ankle ... You had an ankle replacement. Your surgeon removed and reshaped ... an artificial ankle joint. You received pain medicine and were ...

Intrinsic constraint of unlinked total elbow replacements--the ulnotrochlear joint.

Science.gov (United States)

Kamineni, S; O'Driscoll, S W; Urban, M; Garg, A; Berglund, L J; Morrey, B F; An, K N

2005-09-01

Many unlinked total elbow replacement designs with radically differing articular geometries exist, suggesting that there is no consensus regarding an optimal design. A feature inherent to the articular design is the intrinsic constraint afforded to the joint by the implant. Our aim was to compare the intrinsic constraints of unlinked implants with that of the normal ulnotrochlear joint. We tested twelve cadaveric ulnotrochlear joints with a custom-made multiple-axis materials testing machine. With compressive loads ranging from 10 to 100 N, the joints were moved in either valgus or varus directions at 90 degrees of flexion. The ulnotrochlear components from a single example of five medium-sized unlinked elbow replacements (Ewald, Kudo, Pritchard ERS, Sorbie-Questor, and Souter-Strathclyde) were also tested. The recorded measurements included the torques and forces, angular displacement, and axial displacement of the humerus relative to the ulna. In general, the peak torque and the constraint ratio significantly increased with increasing compressive load for the implants as well as for the normal elbow. In valgus displacement, the Souter-Strathclyde implant had the highest and the Sorbie-Questor had the smallest peak torque and the Souter-Strathclyde had the highest and the Ewald had the smallest constraint ratio. In varus displacement, the Kudo had the highest and the Ewald had the smallest peak torque and constraint ratio. The constraint ratio is a characteristic that is useful for describing elbow joint behavior and for comparing the behavior of implants with that of the human elbow. Of the unlinked implants tested, the Souter-Strathclyde and Kudo prostheses most closely approximated the behavior of the human elbow joint. Implants that resemble the human elbow in appearance do not replicate normal behavior consistently, whereas other implants that do not resemble the human elbow closely do not deviate markedly from human behavior. Thus, much basic information

The role of hinges in primary total knee replacement.

Science.gov (United States)

Gehrke, T; Kendoff, D; Haasper, C

2014-11-01

The use of hinged implants in primary total knee replacement (TKR) should be restricted to selected indications and mainly for elderly patients. Potential indications for a rotating hinge or pure hinge implant in primary TKR include: collateral ligament insufficiency, severe varus or valgus deformity (>20°) with necessary relevant soft-tissue release, relevant bone loss including insertions of collateral ligaments, gross flexion-extension gap imbalance, ankylosis, or hyperlaxity. Although data reported in the literature are inconsistent, clinical results depend on implant design, proper technical use, and adequate indications. We present our experience with a specific implant type that we have used for over 30 years and which has given our elderly patients good mid-term results. Because revision of implants with long cemented stems can be very challenging, an effort should be made in the future to use shorter stems in modular versions of hinged implants. ©2014 The British Editorial Society of Bone & Joint Surgery.

A new three-dimensional, print-on-demand temporomandibular prosthetic total joint replacement system: Preliminary outcomes.

Science.gov (United States)

Dimitroulis, George; Austin, Stephen; Sin Lee, Peter Vee; Ackland, David

2018-05-16

The aim of this study is to present the preliminary clinical data on the OMX Temporomandibular Joint (TMJ) Prosthetic total joint replacement system. A prospective, cohort, clinical study was undertaken of consecutive adult patients with Category 5 end-stage joint disease who were implanted with the OMX TMJ prosthesis between May 2015 and April 2017. A total of 50 devices were implanted in 38 patients, with 12 patients receiving bilateral prosthetic joints. There were 31 females and 7 males in this cohort, who ranged in age from 20 to 66 years, with a mean of 43.8 years (±14.0 years). Ten of the 50 prosthetic joints (20%) were fully customized, while the remaining were patient matched using virtual planning software. Based on a mean follow-up period of 15.3 months (range 12-24 months) following the TMJ total joint replacement, preliminary results suggest the OMX TMJ prosthesis has made a positive impact on clinical outcomes, with a mean 74.4% reduction in joint pain levels and significant improvements (p < 0.05) in jaw function as measured by the visual analogue scales for mouth opening (30.8%), diet (77.1%), and function (59.2%). No device failures were reported during the study period. This study suggests that the print-on-demand OMX TMJ prosthesis, designed for rapid delivery of both patient-matched and fully customize devices, represents a safe, reliable and versatile implantable joint replacement system for the treatment of category 5 end-stage TMJ disease. Copyright © 2018 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Patients' journeys through total joint replacement: patterns of medication use.

Science.gov (United States)

Johnson, Emma C; Horwood, Jeremy; Gooberman-Hill, Rachael

2014-06-01

Medication is used to manage pain that results from both osteoarthritis and total joint replacement (TJR). Research has provided insight into how people living with osteoarthritis use pain relief medication. However, it is not known whether elective TJR affects existing attitudes and behaviours with regard to pain medications. Using qualitative methods, the present study explored patterns of pain relief use around the time of TJR. In-depth face-to-face qualitative interviews were carried out with 24 patients two to four weeks after they had undergone TJR for hip or knee osteoarthritis. Participants were asked to reflect on their use of pain medication pre-surgery, while in hospital and while recovering from their operation at home. Transcripts of the audio-recorded interviews were imported into Atlas.ti® and thematic analysis was used. Attitudes to pain relief medication and their use are not static. Many participants change their use of pain medication around the time of surgery. This shift was influenced by interactions with health professionals and changing views on the acceptability, necessity and value of pain relief in helping to manage an altered pain experience. Understanding reasons for medication-taking behaviour during the journey through joint replacement may be helpful to health professionals. Health professionals have a fundamental role to play in challenging or reinforcing different treatment beliefs, which is the basis for effective use of pain relief over the pre- to postoperative period. © 2013 John Wiley & Sons, Ltd.

Is Lumbosacral Plexus Block an Effective and Safe Alternative as Surgical Anesthesia for Total Hip Replacement?

DEFF Research Database (Denmark)

Nielsen, Niels Dalsgaard; Larsen, Jens Rolighed; Børglum, Jens

BACKGROUND An increasing number of patients for total hip replacement presents with cardiovascular comorbidities, that render them fragile to traditional methods of anesthesia. The aim of this intended study is to compare lumbosacral plexus blockade with continuous spinal anesthesia for surgical ...

Radiography, radionuclide imaging, and asthrography in the evaluation of total hip and knee replacement

International Nuclear Information System (INIS)

Gelman, M.I.; Coleman, R.E.; Stevens, P.M.; Davey, B.W.

1978-01-01

Twenty patients with 21 total joint replacements including 17 hips and 4 knees were studied by plain film radiography, radionuclide imaging, and subtraction arthrography to evaluate these procedures for assessing prosthetic complications. Surgery was performed in 14 patients and confirmed loosening of 8 femoral and 7 acetabular hip prosthesis components and 1 femoral and 4 tibial knee prosthesis components. Plain films suggested loosening of only 9 hip components and no knee components. In contrast, radionuclide imaging and subtraction arthrography were considerably more effective in demonstrating loosening as well as other causes of the painful total joint prosthesis

Strain rate dependent orthotropic properties of pristine and impulsively loaded porcine temporomandibular joint disk.

Science.gov (United States)

Beatty, M W; Bruno, M J; Iwasaki, L R; Nickel, J C

2001-10-01

The purpose of this study was to characterize the tensile stress-strain behavior of the porcine temporomandibular joint (TMJ) disk with respect to collagen orientation and strain rate dependency. The apparent elastic modulus, ultimate tensile strength, and strain at maximum stress were measured at three elongation rates (0.5, 50, and 500 mm/min) for dumbbell-shaped samples oriented along either anteroposterior or mediolateral axes of the disks. In order to study the effects of impact-induced fissuring on the mechanical behavior, the same properties were measured along each orientation at an elongation rate of 500 mm/min for disks subjected to impulsive loads of 0.5 N. s. The results suggested a strongly orthotropic nature to the healthy pristine disk. The values for the apparent modulus and ultimate strength were 10-fold higher along the anteroposterior axis (p disks for either orientation (p > 0.05). The results demonstrated the importance of choosing an orthotropic model for the TMJ disk to conduct finite element modeling, to develop failure criteria, and to construct tissue-engineered replacements. Impact-induced fissuring requires further study to determine if the TMJ disk is orthotropic with respect to fatigue.

Effect of pre-operative neuromuscular training on functional outcome after total knee replacement

DEFF Research Database (Denmark)

Huber, Erika O; de Bie, Rob A; Roos, Ewa M.

2013-01-01

Total Knee Replacement (TKR) is the standard treatment for patients with severe knee osteoarthritis (OA). Significant improvement in pain and function are seen after TKR and approximately 80% of patients are very satisfied with the outcome. Functional status prior to TKR is a major predictor...... of outcome after the intervention. Thus, improving functional status prior to surgery through exercise may improve after surgery outcome. However, results from several previous trials testing the concept have been inconclusive after surgery....

[Clinical evaluation of the ceramic femoral component used for reconstruction of total knee replacement].

Science.gov (United States)

Vavrík, P; Landor, I; Denk, F

2008-12-01

The study evaluates mid-term results of total knee replacement with a zirconia ceramic (ZrO2) femoral component. The evaluated group comprised 20 knees in 19 patients (4 men and 15 women). In one patient the replacement was performed bilaterally. Two patients had in the contralateral knee the same type of prosthesis with a femoral chrome-cobalt component.The mean age at the time of operation was 65.2 years (range, 38-81 years).The primary indication was 14 times osteoarthritis and 5 times rheumatoid arthritis. The average follow-up period was 6.5 years (range, 2.1-8.5 years). Patients included in the study regardless of age, body mass and the basic diagnosis, agreed with the use of the ceramic femoral component. The evaluation covered a range of motion, mechanical axis, joint stability, pain, swelling, ability to walk on level ground and on stairs, subjective satisfaction (EULAR Knee Chart). Radiograph were assessed at one year intervals in two projections to identify the incidence of radiolucency around the implant. The Kaplan-Meier survival curve was used and compared with the survival curve in identical chrome-cobalt implants. At he final follow-up, 14 knees were evaluated, because 3 patients died without any connection with the implant, in one case the tibial component migrated due to necrosis of the tibial condyle in a patient with RA and two implants had to be revised and replaced due to polyethylene wear. No infection or negative tissue reaction was recorded in the evaluated group. The average flexion range was 109 degrees. All knees were stable and without swelling, in two cases there occurred slight femoropatellar pain. Twelve patients were fully satisfied, 2 patients were satisfied with a certain reservation. The differences in the course of the survival curves of chrome-cobalt and ceramic implants were statistically insignificant. Although the use of zirconia ceramics in vitro reduces the amount of polyethylene wear, the clinical outcomes of total knee

Negative Outcomes of Poly(l-Lactic Acid) Fiber-Reinforced Scaffolds in an Ovine Total Meniscus Replacement Model.

Science.gov (United States)

Patel, Jay M; Merriam, Aaron R; Kohn, Joachim; Gatt, Charles J; Dunn, Michael G

2016-09-01

Our objective was to test the efficacy of collagen-hyaluronan scaffolds reinforced with poly(l-lactic acid) (PLLA) fibers in an ovine total meniscus replacement model. Scaffolds were implanted into 9 sheep (n = 1 at 8 weeks, n = 2 at 16 weeks, n = 3 at both 24, 32 weeks) following total medial meniscectomy. From 16 weeks on, explants were characterized by confined compression creep, histological, and biochemical analyses. Articular surfaces were observed macroscopically and damage was ranked histologically using the Mankin score. At sacrifice, three of the nine PLLA scaffolds had completely ruptured, and the intact scaffolds experienced progressive shape changes and severe narrowing in the body region at 16, 24, and 32 weeks. Aggregate compressive modulus and permeability did not improve with time. Histological and biochemical analyses showed significantly less extracellular matrix and less matrix organization compared to native tissue. Osteophytes, bone erosion, and cartilage damage were observed, increasing with time postimplantation. A buildup of lactic acid and/or the rapid loss of scaffold mechanical integrity due to PLLA degradation are probable causes for the joint abnormalities observed in this study. These results are in sharp contrast to those of our previous successful total meniscus replacement studies using polyarylate [p(DTD DD)] fiber-reinforced scaffolds. This suggests that PLLA fiber as produced in this study cannot be used as reinforcement for a meniscus replacement scaffold.

Intravenous dex medetomidine or propofol adjuvant to spinal anesthesia in total knee replacement surgery

International Nuclear Information System (INIS)

AlOweidi, A.S.; Al-Mustafa, M.M.; Alghanem, S.M.; Qudaisat, Y.; Halaweh, S.A.; Massad, I.M.; Al Ajlouni, J.M; Mas'ad, D. F.

2011-01-01

The purpose of this study was to compare effect of intravenous dex medetomidine with the intravenous propofol adjuvant to spinal intrathecal anesthesia on the duration of spinal anesthesia and hemodynamic parameters during total knee replacement surgery. Supplementation of spinal anesthesia with intravenous dexemedetomidine or propofol produces good sedation levels without significant clinical hemodynamic changes. Adding dex medetomidine produces significantly longer sensory and motor block than propofol . (authors).

Impact of sarcopenia on the outcomes of elective total arch replacement in the elderly†.

Science.gov (United States)

Ikeno, Yuki; Koide, Yutaka; Abe, Noriyuki; Matsueda, Takashi; Izawa, Naoto; Yamazato, Takahiro; Miyahara, Shunsuke; Nomura, Yoshikatsu; Sato, Shunsuke; Takahashi, Hiroaki; Inoue, Takeshi; Matsumori, Masamichi; Tanaka, Hiroshi; Ishihara, Satoshi; Nakayama, Shinichi; Sugimoto, Koji; Okita, Yutaka

2017-06-01

The purpose of this study was to identify the cut-off value of sarcopenia based on the psoas muscle area index and evaluate early and late outcomes following elective total arch replacement in the elderly. Sarcopenia was assessed by the psoas muscle area index [defined as the psoas muscle area at the L3 level on computed tomography (cm 2 )/body surface area (m 2 )]. The cut-off value for sarcopenia was defined as > 2 standard deviations below the mean psoas muscle area index value obtained from 464 normal control patients. Between October 1999 and July 2015, 266 patients who were ≥ 65 years and had undergone psoas muscle area index measurement underwent elective total arch replacement. These patients were classified into the sarcopenia (Group S, n  = 81) and non-sarcopenia (Group N, n  = 185) groups. The mean age was 76.2 ± 5.6 years in Group S and 75.7 ± 5.7 years in Group N ( P  = 0.553). Hospital mortality was 3.7% (3/81) in Group S and 2.2% (4/185) in Group N ( P  = 0.483). Mean follow-up was 48.3 ± 38.7 months. Five-year survival was significantly worse in Group S (S: 63.2 ± 6.6% vs N: 88.7 ± 2.6%, P  sarcopenia significantly predicted poor survival (hazard ratio 2.59; 95% confidence interval 1.27-5.29; P  = 0.011). Sarcopenia did not predict hospital death following total arch replacement, but it was negatively associated with overall survival. Sarcopenia can be an additional risk factor to estimate the outcomes of thoracic aortic surgery. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Identifying Likely Disk-hosting M dwarfs with Disk Detective

Science.gov (United States)

Silverberg, Steven; Wisniewski, John; Kuchner, Marc J.; Disk Detective Collaboration

2018-01-01

M dwarfs are critical targets for exoplanet searches. Debris disks often provide key information as to the formation and evolution of planetary systems around higher-mass stars, alongside the planet themselves. However, less than 300 M dwarf debris disks are known, despite M dwarfs making up 70% of the local neighborhood. The Disk Detective citizen science project has identified over 6000 new potential disk host stars from the AllWISE catalog over the past three years. Here, we present preliminary results of our search for new disk-hosting M dwarfs in the survey. Based on near-infrared color cuts and fitting stellar models to photometry, we have identified over 500 potential new M dwarf disk hosts, nearly doubling the known number of such systems. In this talk, we present our methodology, and outline our ongoing work to confirm systems as M dwarf disks.

Is Total Femur Replacement a Reliable Treatment Option for Patients With Metastatic Carcinoma of the Femur?

Science.gov (United States)

Sevelda, Florian; Waldstein, Wenzel; Panotopoulos, Joannis; Kaider, Alexandra; Funovics, Philipp Theodor; Windhager, Reinhard

2018-05-01

The majority of metastatic bone lesions to the femoral bone can be treated without surgery or with minimally invasive intramedullary nailing. In rare patients with extensive metastatic disease to the femur, total femur replacement may be the only surgical alternative to amputation; however, little is known about this approach. In a highly selected small group of patients with metastatic carcinoma of the femur, we asked: (1) What was the patient survivorship after this treatment? (2) What was the implant survivorship free from all-cause revision and amputation, and what complications were associated with this treatment? (3) What functional outcomes were achieved by patients after total femur replacement for this indication? Eleven patients (three men, eight women) with a mean age of 64 years (range, 41-78 years) received total femur replacements between 1986 and 2016; none were lost to followup. The most common primary disease was breast cancer. In general, during this period, our indications for this procedure were extensive metastatic disease precluding internal fixation or isolated proximal or distal femur replacement, and an anticipated lifespan exceeding 6 months. Our contraindication for this procedure during this time was expected lifespan less than 6 months. Patient survival was assessed by Kaplan-Meier analysis; implant survival free from revision surgery and amputation were assessed by competing risk analysis. Function was determined preoperatively and 6 to 12 weeks postoperatively with the Musculoskeletal Tumor Society (MSTS) score normalized to a 100-point scale, with higher scores representing better function from a longitudinally maintained institutional database. Eleven patients died at a median of 5 months (range, 1-31 months) after surgery. One-year revision-free and limb survival were 82% (95% CI, 51%-98%) and 91% (95% CI, 61%-99%), respectively. Reasons for reoperation were hip dislocation, infection and local recurrence in one patient each. The

Equilibrium figures for beta Lyrae type disks

International Nuclear Information System (INIS)

Wilson, R.E.

1981-01-01

Accumulated evidence for a geometrically and optically thick disk in the β Lyrae system has now established the disk's basic external configuration. Since the disk has been constant in its main properties over the historical interval of β Lyrae observations and also seems to have a basically well-defined photosphere, it is now time to being consideration of its sturcture. Here, we compute equilibrium figures for self-gravitating disks around stars in binary systems as a start toward eventual computation of complete disk models. A key role is played by centrifugally limited rotation of the central star, which would naturally arise late in the rapid phase of mass transfer. Beta Lyrae is thus postulated to be a double-contact binary, which makes possible nonarbitrary separation of star and disk into separate structures. The computed equilibrium figures are three-dimensional, as the gravitation of the second star is included. Under the approximation that the gravitational potential of the disk is that of a thin wire and that the local disk angular velocity is proportional to u/sup n/ (u = distance from rotation axis), we comptue the total potential and locate equipotential surfaces. The centrifugal potential is written in a particularly convenient form which permits one to change the rotation law discontinuously (for example, at the star-disk coupling point) while ensuring that centrifugal potential and centrifigual force are continuous functions of position. With such a one-parameter rotation law, one can find equilibrium disk figures with dimensions very similar to those found in β Lyrae, but considerations of internal consistency demand at least a two-parameter law

Concerns of patients actively contemplating total knee replacement: differences by race and gender.

Science.gov (United States)

Chang, Huan J; Mehta, Priya S; Rosenberg, Aaron; Scrimshaw, Susan C

2004-02-15

To examine differences by race/ethnicity and gender in patients' concerns regarding total knee replacement (TKR). Focus groups of patients actively considering TKR were conducted. Discussion included patients' questions and concerns regarding TKR. The software ATLAS.ti was used to tabulate themes by race/ethnicity and gender. Concerns raised by focus group participants were compared with thematic content from patient joint replacement information materials. This comparison used patient literature from 3 high-volume academic TKR centers, the Arthritis Foundation, and the American Academy of Orthopedic Surgeons. All groups shared similar concerns. However, some issues were more prevalent among certain gender and racial groups. For instance, concerns regarding anesthesia were more important to white Americans and concerns regarding recovery were more important to women. Some of these concerns were not addressed in the available patient literature. Different gender and racial subgroups focus on different concerns when considering TKR. These differences may contribute to gender and race/ethnicity disparity seen in TKR use.

Periprosthetic femoral fracture within two years after total hip replacement:

DEFF Research Database (Denmark)

Thien, T. M.; Chatziagorou, G.; Garellick, G.

2014-01-01

BACKGROUND: We used the Nordic Arthroplasty Register Association database to evaluate whether age, sex, preoperative diagnosis, fixation, and implant design influence the risk of revision arthroplasty due to periprosthetic fracture within two years from operation of a primary total hip replacement....... METHODS: Included in the study were 325,730 cemented femoral stems and 111,899 uncemented femoral stems inserted from 1995 to 2009. Seven frequently used stems (two cemented stems [Exeter and Lubinus SP II] and five uncemented stems [Bi-Metric, Corail, CLS Spotorno, ABG I, and ABG II]) were specifically...... studied. RESULTS: The incidence of revision at two years was low: 0.47% for uncemented stems and 0.07% for cemented stems. Uncemented stems were much more likely to have this complication (relative risk, 8.72 [95% confidence interval, 7.37 to 10.32]; p

Total knee replacement and non-surgical treatment of knee osteoarthritis

DEFF Research Database (Denmark)

Skou, Søren T; Roos, Ewa M; Laursen, Mogens B

2018-01-01

OBJECTIVES: To compare 2-year outcomes of total knee replacement (TKR) followed by non-surgical treatment to that of non-surgical treatment alone and outcomes of the same non-surgical treatment to that of written advice. DESIGN: In two randomized trials, 200 (mean age 66) adults with moderate...... to severe knee osteoarthritis (OA), 100 eligible for TKR and 100 not eligible for TKR, were randomized to TKR followed by non-surgical treatment, non-surgical treatment alone, or written advice. Non-surgical treatment consisted of 12 weeks of supervised exercise, education, dietary advice, use of insoles......, and pain medication. The primary outcome was the mean score of the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales, covering pain, symptoms, activities of daily living (ADL), and quality of life (QOL). RESULTS: Patients randomized to TKR had greater improvements than patients randomized...

[Prevention and treatment of perioperative period complication of total ankle replacement].

Science.gov (United States)

Liao, Xiang; Gao, Zhizeng; Huang, Shanhu; Yang, Shuhua

2008-01-01

To explore the cause of the perioprative period complication of scandinavian total ankle replacement (STAR) and to summarize the experience in the treatment and prevention. From March 1999 to November 2006, 35 patients were given total ankle replacement (TAR) with STAR system. There were 19 males and 16 females with an average age of 50.5 years (27 to 68 years), including 12 cases of posttraumatic arthritis, 8 cases of osteoarthritis and 15 cases of rheumatoid arthritis. All patients had pain of ankle joint, swelling and limitation of joint motion. The disease course was 9-64 months. The curative effect was estimated by Kofoed total ankle scoring system. The mean preoperative ankle score was 29 (6-48); the mean pain score was 18.3 (0-35); the mean function score was 11.7 (6-18); and the mean activity score was 9.2 (3-12). The type of all complications were record, and its cause, prevetion and treatment were analyszed. Thirty-three patients achieved healing by first intention, 2 achieved delayed union because of infection. Twenty-eight patients were followed up 3-80 months (mean 43.5 months). Medial malleolus fracture occurred in 2 cases, unstable ankle joint introversion in 2 cases, limitation of ankle dorsiextension in 1 case and 1 case had hypoesthesia at intermediate dorsal skin of foot and 3rd-5th metatarsal skin without obvious dysfunction; all were treated with symptomatic medication. The postoperative mean ankle score was 85.5 (58-95); the mean pain score was 48.3 (35-50); the mean function score was 20.7 (18-30); the mean activity score was 17.2 (16-20). There were statistically significant differences when compared with preoperative score (P<0.01). The clinical results were excellent in 16 patients, good in 9 patients and fair in 3 patients. The X-ray films showed no loosening and subsidence of prosthesis. Although STAR can retain the functions of the operated joint, it has its special complications. It is important to obey operation principle with

LUNAR ACCRETION FROM A ROCHE-INTERIOR FLUID DISK

Energy Technology Data Exchange (ETDEWEB)

Salmon, Julien; Canup, Robin M., E-mail: julien@boulder.swri.edu, E-mail: robin@boulder.swri.edu [Department of Space Studies, Southwest Research Institute, 1050 Walnut Street, Suite 300, Boulder, CO 80302 (United States)

2012-11-20

We use a hybrid numerical approach to simulate the formation of the Moon from an impact-generated disk, consisting of a fluid model for the disk inside the Roche limit and an N-body code to describe accretion outside the Roche limit. As the inner disk spreads due to a thermally regulated viscosity, material is delivered across the Roche limit and accretes into moonlets that are added to the N-body simulation. Contrary to an accretion timescale of a few months obtained with prior pure N-body codes, here the final stage of the Moon's growth is controlled by the slow spreading of the inner disk, resulting in a total lunar accretion timescale of {approx}10{sup 2} years. It has been proposed that the inner disk may compositionally equilibrate with the Earth through diffusive mixing, which offers a potential explanation for the identical oxygen isotope compositions of the Earth and Moon. However, the mass fraction of the final Moon that is derived from the inner disk is limited by resonant torques between the disk and exterior growing moons. For initial disks containing <2.5 lunar masses (M{sub Last-Quarter-Moon }), we find that a final Moon with mass > 0.8 M{sub Last-Quarter-Moon} contains {<=}60% material derived from the inner disk, with this material preferentially delivered to the Moon at the end of its accretion.

The comparison of clinical features and quality of life after total knee replacement.

Science.gov (United States)

Lee, Jiyeon; Kim, Jung-Hee; Jung, Eun-Jung; Lee, Byoung-Hee

2017-06-01

[Purpose] The purpose of this study is to provide fundamental information for efficient management of patients after a total knee replacement (TKR) through the evaluation of changes of range of motion, pain, functional level, and quality of life. [Subjects and Methods] For a total of 63 knee osteoarthritis patients, VAS, KSKS, KSFS, HSS, WOMAC scores and quality of life were evaluated for functional levels at pre-operation, post-operation, six months after operation, and 12 months after operation. [Results] After the TKR operations, participants showed significant improvement in KSKS, KSFS, WOMAC, and SF-36 scores when compared to pre-operation. [Conclusion] After a TKR operation, ROM, and pain management, along with a therapeutic program for improvement of function, should be conducted 6 months after the operation.

ALMA Survey of Lupus Protoplanetary Disks. II. Gas Disk Radii

Science.gov (United States)

Ansdell, M.; Williams, J. P.; Trapman, L.; van Terwisga, S. E.; Facchini, S.; Manara, C. F.; van der Marel, N.; Miotello, A.; Tazzari, M.; Hogerheijde, M.; Guidi, G.; Testi, L.; van Dishoeck, E. F.

2018-05-01

We present Atacama Large Millimeter/Sub-Millimeter Array (ALMA) Band 6 observations of a complete sample of protoplanetary disks in the young (∼1–3 Myr) Lupus star-forming region, covering the 1.33 mm continuum and the 12CO, 13CO, and C18O J = 2–1 lines. The spatial resolution is ∼0.″25 with a medium 3σ continuum sensitivity of 0.30 mJy, corresponding to M dust ∼ 0.2 M ⊕. We apply Keplerian masking to enhance the signal-to-noise ratios of our 12CO zero-moment maps, enabling measurements of gas disk radii for 22 Lupus disks; we find that gas disks are universally larger than millimeter dust disks by a factor of two on average, likely due to a combination of the optically thick gas emission and the growth and inward drift of the dust. Using the gas disk radii, we calculate the dimensionless viscosity parameter, α visc, finding a broad distribution and no correlations with other disk or stellar parameters, suggesting that viscous processes have not yet established quasi-steady states in Lupus disks. By combining our 1.33 mm continuum fluxes with our previous 890 μm continuum observations, we also calculate the millimeter spectral index, α mm, for 70 Lupus disks; we find an anticorrelation between α mm and millimeter flux for low-mass disks (M dust ≲ 5), followed by a flattening as disks approach α mm ≈ 2, which could indicate faster grain growth in higher-mass disks, but may also reflect their larger optically thick components. In sum, this work demonstrates the continuous stream of new insights into disk evolution and planet formation that can be gleaned from unbiased ALMA disk surveys.

Comparison of the far wake behind dual rotor and dual disk configurations

DEFF Research Database (Denmark)

Okulov, Valery; Mikkelsen, Robert Flemming; Naumov, I. V.

2016-01-01

wake features for two rotors subjected to different operating and spatial conditions. As a part of this, a comparison with the wake development behind two disks replacing the rotor models was performed to determine the difference between the two wake systems.LDA and Stereo PIV experiments were carried...

DUST DISTRIBUTION IN THE β PICTORIS CIRCUMSTELLAR DISKS

International Nuclear Information System (INIS)

Ahmic, Mirza; Croll, Bryce; Artymowicz, Pawel

2009-01-01

We present three-dimensional models of dust distribution around β Pictoris that produce the best fits to the Hubble Space Telescope/Advanced Camera for Surveys' images obtained by Golimowski and coworkers. We allow for the presence of either one or two separate axisymmetric dust disks. The density models are analytical, radial two power laws joined smoothly at a crossover radius with density exponentially decreasing away from the midplane of the disks. Two-disk models match the data best, yielding a reduced χ 2 of ∼1.2. Our two-disk model reproduces many of the asymmetries reported in the literature and suggests that it is the secondary (tilted) disk which is largely responsible for them. Our model suggests that the secondary disk is not constrained to the inner regions of the system (extending out to at least 250 AU) and that it has a slightly larger total area of dust than the primary, as a result of slower falloff of density with radius and height. This surprising result raises many questions about the origin and dynamics of such a pair of disks. The disks overlap, but can coexist owing to their low optical depths and therefore long mean collision times. We find that the two disks have dust replenishment times on the order of 10 4 yr at ∼100 AU, hinting at the presence of planetesimals that are responsible for the production of second generation dust. A plausible conjecture, which needs to be confirmed by physical modeling of the collisional dynamics of bodies in the disks, is that the two observed disks are derived from underlying planetesimal disks; such disks would be anchored by the gravitational influence of planets located at less than 70 AU from β Pic that are themselves in slightly inclined orbits.

Use of Tranexamic acid is a cost effective method in preventing blood loss during and after total knee replacement

Directory of Open Access Journals (Sweden)

Umer Chaudhry Muhammad

2011-05-01

Full Text Available Abstract Background & Purpose Allogenic blood transfusion in elective orthopaedic surgery is best avoided owing to its associated risks. Total knee replacement often requires blood transfusion, more so when bilateral surgery is performed. Many strategies are currently being employed to reduce the amount of peri-operative allogenic transfusions. Anti-fibrinolytic compounds such as aminocaproic acid and tranexamic acid have been used systemically in perioperative settings with promising results. This study aimed to evaluate the effectiveness of tranexamic acid in reducing allogenic blood transfusion in total knee replacement surgery. Methodology This was a retrospective cohort study conducted on patients undergoing total knee replacement during the time period November 2005 to November 2008. Study population was 99 patients, of which 70 underwent unilateral and 29 bilateral knee replacement. Forty-seven patients with 62 (49.5% knees (group-I had received tranexamic acid (by surgeon preference while the remaining fifty-two patients with 66 (51.5% knees (group-II had did not received any tranexamic acid either pre- or post-operatively. Results The mean drop in the post-operative haemoglobin concentration in Group-II for unilateral and bilateral cases was 1.79 gm/dl and 2.21 gm/dl, with a mean post-operative drainage of 1828 ml (unilateral and 2695 ml (bilateral. In comparison, the mean drop in the post-op haemoglobin in Group-I was 1.49 gm/dl (unilateral and 1.94 gm/dl (bilateral, with a mean drainage of 826 ml (unilateral and 1288 ml (bilateral (p-value Interpretation Tranexamic acid is effective in reducing post-operative drainage and requirement of blood transfusion after knee replacement.

DEEP MIPS OBSERVATIONS OF THE IC 348 NEBULA: CONSTRAINTS ON THE EVOLUTIONARY STATE OF ANEMIC CIRCUMSTELLAR DISKS AND THE PRIMORDIAL-TO-DEBRIS DISK TRANSITION

International Nuclear Information System (INIS)

Currie, Thayne; Kenyon, Scott J.

2009-01-01

We describe new, deep MIPS photometry and new high signal-to-noise optical spectroscopy of the 2.5 Myr old IC 348 Nebula. To probe the properties of the IC 348 disk population, we combine these data with previous optical/infrared photometry and spectroscopy to identify stars with gas accretion, to examine their mid-IR colors, and to model their spectral energy distributions. IC 348 contains many sources in different evolutionary states, including protostars and stars surrounded by primordial disks, two kinds of transitional disks, and debris disks. Most disks surrounding early/intermediate spectral-type stars (>1.4 M sun at 2.5 Myr) are debris disks; most disks surrounding solar and subsolar-mass stars are primordial disks. At the 1-2 σ level, more massive stars also have a smaller frequency of gas accretion and smaller mid-IR luminosities than lower-mass stars. These trends are suggestive of a stellar mass-dependent evolution of disks, where most disks around high/intermediate-mass stars shed their primordial disks on rapid, 2.5 Myr timescales. The frequency of MIPS-detected transitional disks is ∼15%-35% for stars plausibly more massive than 0.5 M sun . The relative frequency of transitional disks in IC 348 compared to that for 1 Myr old Taurus and 5 Myr old NGC 2362 is consistent with a transition timescale that is a significant fraction of the total primordial disk lifetime.

Total knee replacement influences both knee and hip joint kinematics during stair climbing

OpenAIRE

Saari, Tuuli; Tranberg, Roy; Zügner, Roland; Uvehammer, Johan; Kärrholm, Johan

2004-01-01

A gait analysis system was used to evaluate the kinematics of the hip and knee during stair ascending and descending after operation with total knee replacement. Patients with 5° varus/valgus alignment or less were selected randomly to receive either a flat or a concave tibial component with retention of the posterior cruciate ligament. Patients who had more than 5° varus/valgus alignment and/or an extension defect of 10° or more were selected randomly to receive the concave or posterior-stab...

Oscillations of disks

CERN Document Server

Kato, Shoji

2016-01-01

This book presents the current state of research on disk oscillation theory, focusing on relativistic disks and tidally deformed disks. Since the launch of the Rossi X-ray Timing Explorer (RXTE) in 1996, many high-frequency quasiperiodic oscillations (HFQPOs) have been observed in X-ray binaries. Subsequently, similar quasi-periodic oscillations have been found in such relativistic objects as microquasars, ultra-luminous X-ray sources, and galactic nuclei. One of the most promising explanations of their origin is based on oscillations in relativistic disks, and a new field called discoseismology is currently developing. After reviewing observational aspects, the book presents the basic characteristics of disk oscillations, especially focusing on those in relativistic disks. Relativistic disks are essentially different from Newtonian disks in terms of several basic characteristics of their disk oscillations, including the radial distributions of epicyclic frequencies. In order to understand the basic processes...

Gravitomagnetic acceleration of accretion disk matter to polar jets

Science.gov (United States)

Poirier, John; Mathews, Grant

2016-03-01

The motion of the masses of an accretion disk around a black hole creates a general relativistic, gravitomagnetic field (GEM) from the moving matter (be it charged or uncharged) of the accretion disk. This GEM field accelerates moving masses (neutral or charged) near the accretion disk vertically upward and away from the disk, and then inward toward the axis of the disk. As the accelerated material nears the axis with approximately vertical angles, a frame dragging effect contributes to the formation of narrow jets emanating from the poles. This GEM effect is numerically evaluated in the first post Newtonian (1PN) approximation from observable quantities like the mass and velocity of the disk. This GEM force is linear in the total mass of the accretion disk matter and quadratic in the velocity of matter near to the disk with approximately the same velocity. Since these masses and velocities can be quite high in astrophysical contexts, the GEM force, which in other contexts is weak, is quite significant. This GEM effect is compared to the ordinary electromagnetic effects applied to this problem in the past.

Effects of balance and proprioceptive training on total hip and knee replacement rehabilitation: A systematic review and meta-analysis.

Science.gov (United States)

Domínguez-Navarro, Fernando; Igual-Camacho, Celedonia; Silvestre-Muñoz, Antonio; Roig-Casasús, Sergio; Blasco, José María

2018-05-01

Balance and proprioceptive deficits are frequently persistent after total joint replacement, limiting functionality and involving altered movement patterns and difficulties in walking and maintaining postural control among patients. The goal of this systematic review was to evaluate the short- and mid-term effects of proprioceptive and balance training for patients undergoing total knee and hip replacement. This is a systematic review of literature. MEDLINE, Embase, Cochrane Library, PEDro, and Scopus were the databases searched. The review included randomized clinical trials in which the experimental groups underwent a training aimed at improving balance and proprioception, in addition to conventional care. The studies had to assess at least one of the following outcomes: self-reported functionality or balance (primary outcomes), knee function, pain, falls, or quality of life. Eight trials were included, involving 567 participants. The quantitative synthesis found a moderate to high significant effect of balance and proprioceptive trainings on self-reported functionality and balance after total knee replacement. The effects were maintained at mid-term in terms of balance alone. Conversely, preoperative training did not enhance outcomes after total hip arthroplasty. The synthesis showed that, in clinical terms, balance trainings are a convenient complement to conventional physiotherapy care to produce an impact on balance and functionality after knee replacement. If outcomes such as improvement in pain, knee range of movement, or patient quality of life are to be promoted, it would be advisable to explore alternative proposals specifically targeting these goals. Further research is needed to confirm or discard the current evidence ultimately, predominantly in terms of the effects on the hips and those yielded by preoperative interventions. Copyright © 2018 Elsevier B.V. All rights reserved.

Intermediate and long-term quality of life after total knee replacement: a systematic review and meta-analysis.

Science.gov (United States)

Shan, Leonard; Shan, Bernard; Suzuki, Arnold; Nouh, Fred; Saxena, Akshat

2015-01-21

Total knee replacement is a highly successful and frequently performed operation. Technical outcomes of surgery are excellent, with favorable early postoperative health-related quality of life. This study reviews intermediate and long-term quality of life after surgery. A systematic review and meta-analysis of all studies published from January 2000 onward was performed to evaluate health-related quality of life after primary total knee replacement for osteoarthritis in patients with at least three years of follow-up. Key outcomes were postoperative quality of life, function, and satisfaction compared with the preoperative status. Strict inclusion and exclusion criteria were applied. Quality appraisal and data tabulation were performed with use of predefined criteria. Data were synthesized by narrative review and random-effects meta-analysis utilizing standardized mean differences. Heterogeneity was assessed with the tau(2) and I(2) statistics. Nineteen studies were included in the review. Intermediate and long-term postoperative quality of life was superior to the preoperative level in qualitative and quantitative analyses. The pooled effect in combined WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) and KSS (Knee Society Score) outcomes was a marked improvement from baseline with respect to the total score (2.17; 95% CI [confidence interval], 1.13 to 3.22; p Total knee replacement confers significant intermediate and long-term benefits with respect to both disease-specific and generic health-related quality of life, especially pain and function, leading to positive patient satisfaction. Recommendations for necessary future studies are provided. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

Sexual activity after total hip replacement in Korean patients: how they do, what they want, and how to improve.

Science.gov (United States)

Yoon, Byung-Ho; Lee, Kyung-Hag; Noh, Serae; Ha, Yong-Chan; Lee, Young-Kyun; Koo, Kyung-Hoi

2013-12-01

Concerns of patients on sexual activity after total hip arthroplasty have not been well studied in Asian patients. This study aimed to determine the following: (1) what are the concerns of patients related to sexual activity after total hip arthroplasty? (2) what are the changes in sexual activity after total hip replacement in Korean patients? Details of sexual activity and concerns were obtained using a questionnaire designed specifically for the study. The questionnaire was administered to 64 patients in a face-to-face interview at an outpatient clinic. Preoperatively, 53.1% of patients experienced difficulties, primarily due to hip pathology and limitations of motion. The median time to the resumption of sexual activity was 3 months postoperatively, and most patients had no increase in the frequency of sexual activity after the total hip replacement. In 39.1% of patients were seen having difficulties with leg positioning following total hip replacement, and they were likely to change coital positions. The most common concern regarding sexual activity of patients was the fear of dislocation. Furthermore, patients with a higher stress level had lower satisfaction rates. Most patients were unable to obtain information on sexual activity following the total hip arthroplasty, and they did not consult with a physician due to the private nature of the topic. Dislocation was the most common concern of patients during sexual activity following a total hip arthroplasty, and a higher stress level was found to be associated with a lower satisfaction rate. Because most patients were unprepared to consult a physician, the provision of appropriate information before a consultation might be beneficial.

Prosthetic liner wear in total hip replacement: a longitudinal 13-year study with computed tomography.

Science.gov (United States)

Weidenhielm, Lars; Olivecrona, Henrik; Maguire, Gerald Q; Noz, Marilyn E

2018-06-01

This case report follows a woman who had a total hip replacement in 1992 when she was 45 years old. Six serial computed tomography (CT) examinations over a period of 13 years provided information that allowed her revision surgery to be limited to liner replacement as opposed to replacement of the entire prosthesis. Additionally, they provided data that ruled out the presence of osteolysis and indeed none was found at surgery. In 2004, when the first CT was performed, the 3D distance the femoral head had penetrated into the cup was determined to be 2.6 mm. By 2017, femoral head penetration had progressed to 5.0 mm. The extracted liner showed wear at the thinnest part to be 5.5 mm, as measured with a micrometer. The use of modern CT techniques can identify problems, while still correctable without major surgery. Furthermore, the ability of CT to assess the direction of wear revealed that the liner wear changed from the cranial to dorsal direction.

Aquatic exercises versus land based exercises for elderly patients after a total hip replacement

OpenAIRE

Miroljub Jakovljevič; Renata Vauhnik

2011-01-01

Background: Aquatic therapy allows secure, active exercise with pain reduction using a combination of the water’s buoyancy, hydrostatic pressure, resistance and warmth. By aquatic therapy, elderly patients after total hip replacement can achieve more positive effects than by land-based exercise. The aim of the study was to investigate the use of aquatic-based exercises in the rehabilitation programme after a hip fracture surgery in elderly adults. Results: Both groups, regardless of the ty...

High resolution computed tomography evaluation of cervical disk hernia

International Nuclear Information System (INIS)

Halversen, G.L.; Thoen, D.D.; Satovick, R.M.; Goldstein, M.L.

1986-01-01

Previous difficulties in the diagnosis of cervical disk hernia were related to lack of non-invasive imaging techniques, but the gap has now been filled by CT scan imaging. A total of 442 patients with pains in neck, shoulder or arm were referred for a CT scan to exclude a cervical disk hernia. Of the group studied, 2% were found to have a herniated disk, 16% a lateral hernia and 9% combined lateral hernia-narrow cervical canal due to concomitant arthrotic changes. Assessment of correlation between CT scan images and myelographic and surgical findings indicated that CT scan imaging is a very precise, non-invasive method for investigation of cervical disk hernia [fr

High resolution computed tomography evaluation of cervical disk hernia

Energy Technology Data Exchange (ETDEWEB)

Halversen, G.L.; Thoen, D.D.; Satovick, R.M.; Goldstein, M.L.

1986-05-01

Previous difficulties in the diagnosis of cervical disk hernia were related to lack of non-invasive imaging techniques, but the gap has now been filled by CT scan imaging. A total of 442 patients with pains in neck, shoulder or arm were referred for a CT scan to exclude a cervical disk hernia. Of the group studied, 2% were found to have a herniated disk, 16% a lateral hernia and 9% combined lateral hernia-narrow cervical canal due to concomitant arthrotic changes. Assessment of correlation between CT scan images and myelographic and surgical findings indicated that CT scan imaging is a very precise, non-invasive method for investigation of cervical disk hernia.

No Effect of Acupuncture as Adjunctive Therapy for Patients with Total Knee Replacement

DEFF Research Database (Denmark)

Petersen, Tom; Hautopp, Holger; Duus, Benn

2018-01-01

Objective: Acupuncture is a low risk option in pain management following total knee replacement as an alternative to opioid analgesics. Therefore, the benefit of acupuncture as adjunct to an exercise program was investigated. Furthermore, the modifying effect of previous benefit from acupuncture...... was explored. Design: Three weeks postoperatively, eligible patients were randomized to acupuncture and exercises or exercises alone. Setting: An outpatient rehabilitation centre in the municipality of Copenhagen, Denmark. Subjects: A total of 172 patients were included. Methods: Main outcome was proportion...... of the course of treatment were assessed. Results: No additional benefit of acupuncture was found on any of the main outcomes. Between-group differences were non-significant in proportions of patients with a clinically important reduction of night pain (Relative Risk: 0.98; 95% Confidence Interval (CI): 0...

Plutonium-241 processing: from impure oxide to high purity metal target disks

International Nuclear Information System (INIS)

Conner, W.V.; Baaso, D.L.

1975-01-01

The preparation of three plutonium-241 metal target disks, using a precision casting technique, is described. The disks were 0.625 inch in diameter and 0.125, 0.025, and 0.010 inch thick. All three disks were prepared simultaneously in a single casting. The variation in thickness of each disk was within +-1 percent of the disk's average thickness. The plutonium-241 was highly pure, and the finished disks contained a total of only 297 parts per million of detectable impurities. Purification of the plutonium oxide ( 241 PuO 2 ) and the conversion of the purified 241 PuO 2 to metal are also described. (U.S.)

In vitro degradability and total gas production of biodiesel chain byproducts used as a replacement for cane sugar feed

Directory of Open Access Journals (Sweden)

Milenna Nunes Moreira

2014-09-01

Full Text Available This study aimed to determine the in vitro degradability of dry matter and the total gas production of oil seed press cake from biodiesel production (Gossypium hirsutum L., Helianthus annuus L., Ricinus communis, Moringa oleífera L. and Pinhão manso curcas L. at four different levels of replacement (0, 30, 50, and 70% for cane sugar (Saccharum officinarum RB. in ruminant feed. Inocula were prepared using the ruminal fluid of three Holstein cows, and data were collected after 48 hours of incubation. The byproducts of Moringa had the highest degradability, and castor presented the lowest values at all evaluated levels of replacement. Castor bean byproduct showed the highest total gas production, cotton showed the lowest production, and the byproduct of Moringa at the 70% level showed the best ruminal fermentation results. These results demonstrate that the use of oil seed press cake from biodiesel production (Helianthus annuus L. and Ricinus communis can replace cane sugar in ruminant feed.

CT-based quantification of bone stock in large head metal-on-metal unilateral total hip replacements

NARCIS (Netherlands)

Boomsma, Martijn F.; Slouwerhof, Inge; van Lingen, Christiaan; Pakvis, Dean F. M.; van Dalen, Jorn A.; Edens, Mireille A.; Ettema, Harmen B.; Verheyen, Cees C. P. M.; Maas, Mario

2016-01-01

To explore ipsilateral and contralateral acetabular roof bone stock density in unilateral large head MoM THA whether there is a significant lower acetabular bone stock in the hip with a metal-on-metal (MoM) total hip replacement compared to the contralateral side. Second part of this study is to

BRICKS WITH TOTAL REPLACEMENT OF CLAY BY FLY ASH MIXED WITH DIFFERENT MATERIALS

OpenAIRE

J.N Akhtar; J.Alam; M.N Akhtar

2011-01-01

Fly ash is a powdery substance obtained from the dust collectors in the Thermal power plants that use coal as fuel. From the cement point of view the mineralogy of Fly ash is important as it contains 80% - 90% of glass. The impurities in coal-mostly clays, shale’s, limestone & dolomite; they cannot be burned so they turn up as ash. The Fly ash of class C category was used as a raw material to total replacement of clay for making Fly ash bricks. In present study the effect of Fly ash with high...

Magnetically Induced Disk Winds and Transport in the HL Tau Disk

International Nuclear Information System (INIS)

Hasegawa, Yasuhiro; Flock, Mario; Turner, Neal J.; Okuzumi, Satoshi

2017-01-01

The mechanism of angular momentum transport in protoplanetary disks is fundamental to understanding the distributions of gas and dust in the disks. The unprecedented ALMA observations taken toward HL Tau at high spatial resolution and subsequent radiative transfer modeling reveal that a high degree of dust settling is currently achieved in the outer part of the HL Tau disk. Previous observations, however, suggest a high disk accretion rate onto the central star. This configuration is not necessarily intuitive in the framework of the conventional viscous disk model, since efficient accretion generally requires a high level of turbulence, which can suppress dust settling considerably. We develop a simplified, semi-analytical disk model to examine under what condition these two properties can be realized in a single model. Recent, non-ideal MHD simulations are utilized to realistically model the angular momentum transport both radially via MHD turbulence and vertically via magnetically induced disk winds. We find that the HL Tau disk configuration can be reproduced well when disk winds are properly taken into account. While the resulting disk properties are likely consistent with other observational results, such an ideal situation can be established only if the plasma β at the disk midplane is β 0 ≃ 2 × 10 4 under the assumption of steady accretion. Equivalently, the vertical magnetic flux at 100 au is about 0.2 mG. More detailed modeling is needed to fully identify the origin of the disk accretion and quantitatively examine plausible mechanisms behind the observed gap structures in the HL Tau disk.

Magnetically Induced Disk Winds and Transport in the HL Tau Disk

Energy Technology Data Exchange (ETDEWEB)

Hasegawa, Yasuhiro; Flock, Mario; Turner, Neal J. [Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91109 (United States); Okuzumi, Satoshi, E-mail: yasuhiro@caltech.edu [Department of Earth and Planetary Sciences, Tokyo Institute of Technology, Meguro-ku, Tokyo 152-8551 (Japan)

2017-08-10

The mechanism of angular momentum transport in protoplanetary disks is fundamental to understanding the distributions of gas and dust in the disks. The unprecedented ALMA observations taken toward HL Tau at high spatial resolution and subsequent radiative transfer modeling reveal that a high degree of dust settling is currently achieved in the outer part of the HL Tau disk. Previous observations, however, suggest a high disk accretion rate onto the central star. This configuration is not necessarily intuitive in the framework of the conventional viscous disk model, since efficient accretion generally requires a high level of turbulence, which can suppress dust settling considerably. We develop a simplified, semi-analytical disk model to examine under what condition these two properties can be realized in a single model. Recent, non-ideal MHD simulations are utilized to realistically model the angular momentum transport both radially via MHD turbulence and vertically via magnetically induced disk winds. We find that the HL Tau disk configuration can be reproduced well when disk winds are properly taken into account. While the resulting disk properties are likely consistent with other observational results, such an ideal situation can be established only if the plasma β at the disk midplane is β {sub 0} ≃ 2 × 10{sup 4} under the assumption of steady accretion. Equivalently, the vertical magnetic flux at 100 au is about 0.2 mG. More detailed modeling is needed to fully identify the origin of the disk accretion and quantitatively examine plausible mechanisms behind the observed gap structures in the HL Tau disk.

Total knee replacement with retention of both cruciate ligaments: a 22-year follow-up study.

Science.gov (United States)

Sabouret, P; Lavoie, F; Cloutier, J-M

2013-07-01

We report on the long-term results of 163 bicruciate-retaining Hermes 2C total knee replacements in 130 patients at a mean follow-up of 22.4 years (20.3 to 23.5). Even when the anterior cruciate ligament had a partially degenerative appearance it was preserved as long as the knee had a normal anterior drawer and Lachman's test pre-operatively. The description and surgical technique of this minimally constrained prosthesis were published in 1983 and the ten-year clinical results in 1999. A total of 12% of the knees (20 of 163) in this study were revised because of wear of the polyethylene tibial insert. Excellent stability was achieved and the incidence of aseptic component loosening was 4.3% (seven of 163). The survival rate using revision for any reason as the endpoint was 82% (95% confidence interval 76.2 to 88.0). Although this series included a relatively small number of replacements, it demonstrated that the anterior cruciate ligament, even when partially degenerated at the time of TKR, remained functional and provided adequate stability at a long-term follow-up.

Effect of total lumbar disc replacement on lumbosacral lordosis.

Science.gov (United States)

Kasliwal, Manish K; Deutsch, Harel

2012-10-01

Original article : To study effect of lumbar disc replacement on lumbosacral lordosis. There has been a growing interest in total disc replacement (TDR) for back pain with the rising concern of adjacent segment degeneration. Lumbar fusion surgery has been shown to lead to decrease in lumbar lordosis, which may account for postfusion pain resulting in less acceptable clinical outcome after successful fusion. TDR has recently emerged as an alternative treatment for back pain. There have been very few studies reporting lumbar sagittal outcome after TDR. Retrospective study of radiographic data of 17 patients who underwent TDR for single level degenerative disc disease at the author's institution was carried out. Study included measurement of preoperative and postoperative segmental and global lumbar lordosis and angle of lordosis. Patients age varied from 19 to 54 (mean, 35) years. Follow-up ranged from 12 to 24 months. TDR was performed at L4-5 level in 3 patients and L5-S1 level in 14 patients. The average values for segmental lordosis, global lordosis, and angle of lordosis at the operated level before and after surgery were 17.3, 49.7, and 8.6 degrees and 21.6, 54, and 9.5 degrees, respectively. There was a trend toward significant (P=0.02) and near significant (P=0.057) increase in segmental and global lordosis, respectively after TDR. Although prosthesis increased angle of lordosis at the level implanted in majority of the patients, the difference in preoperative and postoperative angle of lordosis was not significant (P=0.438). In addition, there was no correlation between the angle of implant of chosen and postoperative angle of lordosis at the operated level. The effect of TDR on sagittal balance appears favorable with an increase in global and segmental lumbar lordosis after single level TDR for degenerative disc disease. The degree of postoperative angle of lordosis was not affected by the angle of implant chosen at the operated level and varied

Knee injury and Osteoarthritis Outcome Score (KOOS – validation and comparison to the WOMAC in total knee replacement

Directory of Open Access Journals (Sweden)

Roos Ewa M

2003-05-01

Full Text Available Abstract Background The Knee injury and Osteoarthritis Outcome Score (KOOS is an extension of the Western Ontario and McMaster Universities Osteoarthrtis Index (WOMAC, the most commonly used outcome instrument for assessment of patient-relevant treatment effects in osteoarthritis. KOOS was developed for younger and/or more active patients with knee injury and knee osteoarthritis and has in previous studies on these groups been the more responsive instrument compared to the WOMAC. Some patients eligible for total knee replacement have expectations of more demanding physical functions than required for daily living. This encouraged us to study the use of the Knee injury and Osteoarthritis Outcome Score (KOOS to assess the outcome of total knee replacement. Methods We studied the test-retest reliability, validity and responsiveness of the Swedish version LK 1.0 of the KOOS when used to prospectively evaluate the outcome of 105 patients (mean age 71.3, 66 women after total knee replacement. The follow-up rates at 6 and 12 months were 92% and 86%, respectively. Results The intraclass correlation coefficients were over 0.75 for all subscales indicating sufficient test-retest reliability. Bland-Altman plots confirmed this finding. Over 90% of the patients regarded improvement in the subscales Pain, Symptoms, Activities of Daily Living, and knee-related Quality of Life to be extremely or very important when deciding to have their knee operated on indicating good content validity. The correlations found in comparison to the SF-36 indicated the KOOS measured expected constructs. The most responsive subscale was knee-related Quality of Life. The effect sizes of the five KOOS subscales at 12 months ranged from 1.08 to 3.54 and for the WOMAC from 1.65 to 2.56. Conclusion The Knee injury and Osteoarthritis Outcome Score (KOOS is a valid, reliable, and responsive outcome measure in total joint replacement. In comparison to the WOMAC, the KOOS improved validity

Corrosion fatigue of bladed disk attachments of low-pressure turbine

International Nuclear Information System (INIS)

Asai, K.; Sakurai, S.; Nomura, K.; Saito, E.; Namura, K.

2004-01-01

The mechanism of a disk cracking in a low-pressure steam turbine was investigated by finite-element and fracture mechanics analysis and, based on the results of the investigation, a life assessment method was derived. The disk cracking was found to be caused by growth of corrosion pits, superposition of multiple vibration modes, and an increase in the standard deviation of the natural frequency of grouped blades after long-term operation. Taking these findings into consideration, the authors then developed a life-assessment method for disk cracking composed of evaluations (1) maximum corrosion pit size at the current situation, (2) corrosion pit growth after a certain term, and (3) failure-occurrence ratio for the estimated corrosion pit depth. Maximum corrosion-pit size is evaluated by extreme value statistical analysis using the data obtained by replica inspection. The failure-occurrence ratio is evaluated by Monte Carlo simulation considering two uncertainties, namely, the standard deviation of the natural frequency of grouped blades and the stimulus ratio. The values of both uncertainties were determined by the inverse problem analysis of the disk cracking. In light of these results, the authors found that replacing conventional tenon-shroud grouped blades with continuous-cover blades is effective from the view point of vibratory behavior. (orig.)

Computer Assisted Surgery and Current Trends in Orthopaedics Research and Total Joint Replacements

Science.gov (United States)

Amirouche, Farid

2008-06-01

Musculoskeletal research has brought about revolutionary changes in our ability to perform high precision surgery in joint replacement procedures. Recent advances in computer assisted surgery as well better materials have lead to reduced wear and greatly enhanced the quality of life of patients. The new surgical techniques to reduce the size of the incision and damage to underlying structures have been the primary advance toward this goal. These new techniques are known as MIS or Minimally Invasive Surgery. Total hip and knee Arthoplasties are at all time high reaching 1.2 million surgeries per year in the USA. Primary joint failures are usually due to osteoarthristis, rheumatoid arthritis, osteocronis and other inflammatory arthritis conditions. The methods for THR and TKA are critical to initial stability and longevity of the prostheses. This research aims at understanding the fundamental mechanics of the joint Arthoplasty and providing an insight into current challenges in patient specific fitting, fixing, and stability. Both experimental and analytical work will be presented. We will examine Cementless total hip arthroplasty success in the last 10 years and how computer assisted navigation is playing in the follow up studies. Cementless total hip arthroplasty attains permanent fixation by the ingrowth of bone into a porous coated surface. Loosening of an ingrown total hip arthroplasty occurs as a result of osteolysis of the periprosthetic bone and degradation of the bone prosthetic interface. The osteolytic process occurs as a result of polyethylene wear particles produced by the metal polyethylene articulation of the prosthesis. The total hip arthroplasty is a congruent joint and the submicron wear particles produced are phagocytized by macrophages initiating an inflammatory cascade. This cascade produces cytokines ultimately implicated in osteolysis. Resulting bone loss both on the acetabular and femoral sides eventually leads to component instability. As

Custom total knee replacement in a dog with femoral condylar bone loss.

Science.gov (United States)

Liska, William D; Marcellin-Little, Denis J; Eskelinen, Esa V; Sidebotham, Christopher G; Harrysson, Ola L A; Hielm-Björkman, Anna K

2007-06-01

To report surgical planning, technique, and outcome of custom total knee replacement (TKR) performed to manage a medial femoral condylar nonunion in a dog. Clinical case report. A 3-year-old, 20 kg Karelian Bear Hound. Computed tomographic scan of the left pelvic limb was used to build a stereolithography model of the distal portion of the femur. The model was used to create a custom augment to replace the missing medial femoral condyle and a custom stem for intramedullary condylar cemented fixation. The augment and stem were adapted to femoral and tibial components already available. The model was used to rehearse the surgery and then the custom prosthesis was implanted. Weight bearing returned 8 hours after surgery and improved thereafter. Joint alignment was normal and prosthetic joint motion was 60-165 degrees postoperatively. The dog resumed moose hunting 3 months after surgery. Peak vertical force and impulse of the operated limb measured 17 months after surgery were 65% and 47% of the normal, contralateral limb. Based on short-term follow-up, cemented canine TKR was successfully achieved for management of a severely abnormal stifle joint. With further refinement and development of commercially available prostheses, TKR should be possible for canine patients.

Short Term Evaluation of an Anatomically Shaped Polycarbonate Urethane Total Meniscus Replacement in a Goat Model.

Directory of Open Access Journals (Sweden)

A C T Vrancken

Full Text Available Since the treatment options for symptomatic total meniscectomy patients are still limited, an anatomically shaped, polycarbonate urethane (PCU, total meniscus replacement was developed. This study evaluates the in vivo performance of the implant in a goat model, with a specific focus on the implant location in the joint, geometrical integrity of the implant and the effect of the implant on synovial membrane and articular cartilage histopathological condition.The right medial meniscus of seven Saanen goats was replaced by the implant. Sham surgery (transection of the MCL, arthrotomy and MCL suturing was performed in six animals. The contralateral knee joints of both groups served as control groups. After three months follow-up the following aspects of implant performance were evaluated: implant position, implant deformation and the histopathological condition of the synovium and cartilage.Implant geometry was well maintained during the three month implantation period. No signs of PCU wear were found and the implant did not induce an inflammatory response in the knee joint. In all animals, implant fixation was compromised due to suture breakage, wear or elongation, likely causing the increase in extrusion observed in the implant group. Both the femoral cartilage and tibial cartilage in direct contact with the implant showed increased damage compared to the sham and sham-control groups.This study demonstrates that the novel, anatomically shaped PCU total meniscal replacement is biocompatible and resistant to three months of physiological loading. Failure of the fixation sutures may have increased implant mobility, which probably induced implant extrusion and potentially stimulated cartilage degeneration. Evidently, redesigning the fixation method is necessary. Future animal studies should evaluate the improved fixation method and compare implant performance to current treatment standards, such as allografts.

Dust in protoplanetary disks: observations*

Directory of Open Access Journals (Sweden)

Waters L.B.F.M.

2015-01-01

Full Text Available Solid particles, usually referred to as dust, are a crucial component of interstellar matter and of planet forming disks surrounding young stars. Despite the relatively small mass fraction of ≈1% (in the solar neighborhood of our galaxy; this number may differ substantially in other galaxies that interstellar grains represent of the total mass budget of interstellar matter, dust grains play an important role in the physics and chemistry of interstellar matter. This is because of the opacity dust grains at short (optical, UV wavelengths, and the surface they provide for chemical reactions. In addition, dust grains play a pivotal role in the planet formation process: in the core accretion model of planet formation, the growth of dust grains from the microscopic size range to large, cm-sized or larger grains is the first step in planet formation. Not only the grain size distribution is affected by planet formation. Chemical and physical processes alter the structure and chemical composition of dust grains as they enter the protoplanetary disk and move closer to the forming star. Therefore, a lot can be learned about the way stars and planets are formed by observations of dust in protoplanetary disks. Ideally, one would like to measure the dust mass, the grain size distribution, grain structure (porosity, fluffiness, the chemical composition, and all of these as a function of position in the disk. Fortunately, several observational diagnostics are available to derive constrains on these quantities. In combination with rapidly increasing quality of the data (spatial and spectral resolution, a lot of progress has been made in our understanding of dust evolution in protoplanetary disks. An excellent review of dust evolution in protoplanetary disks can be found in Testi et al. (2014.

Monitoring the quality of total hip replacement in a tertiary care department using a cumulative summation statistical method (CUSUM).

Science.gov (United States)

Biau, D J; Meziane, M; Bhumbra, R S; Dumaine, V; Babinet, A; Anract, P

2011-09-01

The purpose of this study was to define immediate post-operative 'quality' in total hip replacements and to study prospectively the occurrence of failure based on these definitions of quality. The evaluation and assessment of failure were based on ten radiological and clinical criteria. The cumulative summation (CUSUM) test was used to study 200 procedures over a one-year period. Technical criteria defined failure in 17 cases (8.5%), those related to the femoral component in nine (4.5%), the acetabular component in 32 (16%) and those relating to discharge from hospital in five (2.5%). Overall, the procedure was considered to have failed in 57 of the 200 total hip replacements (28.5%). The use of a new design of acetabular component was associated with more failures. For the CUSUM test, the level of adequate performance was set at a rate of failure of 20% and the level of inadequate performance set at a failure rate of 40%; no alarm was raised by the test, indicating that there was no evidence of inadequate performance. The use of a continuous monitoring statistical method is useful to ensure that the quality of total hip replacement is maintained, especially as newer implants are introduced.

Patient-controlled oral analgesia for postoperative pain management following total knee replacement.

Science.gov (United States)

Kastanias, Patti; Gowans, Sue; Tumber, Paul S; Snaith, Kianda; Robinson, Sandra

2010-01-01

To investigate whether patient-controlled oral analgesia (PCOA) used by individuals receiving a total knee replacement could reduce pain, increase patient satisfaction, reduce opioid use and/or reduce opioid side effects when compared with traditional nurse (RN)-administered oral analgesia. Patients who underwent an elective total knee replacement at a quaternary care centre (Toronto Western Hospital, Toronto, Ontario) were randomly assigned to either PCOA or RN-administered short-acting oral opioids on postoperative day 2. Subjects in the RN group called the RN to receive their prescribed short-acting opioid. Subjects in the PCOA group kept a single dose of their prescribed oral opioid at their bedside and took this dose when they felt they needed it, to a maximum of one dose every 2 h. Study outcomes, collected on postoperative day 2, included pain (measured by the Brief Pain Inventory - Short Form), patient satisfaction (measured by the Pain Outcome Questionnaire Satisfaction subscale - component II), opioid use (oral morphine equivalents), opioid side effects (nausea, pruritus and/or constipation) and knee measures (maximum passive knee flexion and pain at maximum passive knee flexion, performed on the operative knee). Study outcomes were analyzed twice. First, for a subset of 73 subjects who remained in their randomly assigned group (PCOA group, n=36; RN group, n=37), randomized analyses were performed. Second, for the larger sample of 88 subjects who were categorized by their actual method of receiving oral opioids (PCOA group, n=41; RN group, n=47), as-treated analyses were performed. There were no differences in study outcomes between the PCOA and RN groups in either analysis. PCOA was not superior to RN administration on study outcomes. However, PCOA did not increase opioid use or pain. PCOA remains an important element in the patient-centred care facility.

Return to work and workplace activity limitations following total hip or knee replacement.

Science.gov (United States)

Sankar, A; Davis, A M; Palaganas, M P; Beaton, D E; Badley, E M; Gignac, M A

2013-10-01

Total hip (THR) and knee (TKR) replacements increasingly are performed on younger people making return to work a salient outcome. This research evaluates characteristics of individuals with early and later return to work following THR and TKR. Additionally, at work limitations pre-surgery and upon returning to work, and factors associated with work limitations were evaluated. 190 THR and 170 TKR of a total 931 cohort participants were eligible (i.e., working or on short-term disability pre-surgery). They completed questionnaires pre-surgery and 1, 3, 6 and 12 months post-surgery that included demographics, type of occupation, and the Workplace Activity Limitations Scale (WALS). 166 (87%) and 144 (85%) returned to work by 12 months following THR and TKR, respectively. Early (1 month) return to work was associated with, male gender, university education, working in business, finance or administration, and low physical demand work. People with THR returned to work earlier than those with TKR. For both groups, less pain and every day functional limitations were associated with less workplace activity limitations at the time return to work. The majority of individuals working prior to surgery return to work following hip or knee replacement for osteoarthritis (OA) and experience fewer limitations at work than pre-surgery. The changing workforce dynamics and trends toward surgery at younger ages mean that these are important outcomes for clinicians to assess. Additionally, this is important information for employers in understanding continued participation in employment for people with OA. Copyright © 2013 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Contact statuses between functionally graded brake disk and pure pad disk

International Nuclear Information System (INIS)

Shahzamanian, M.M.; Sahari, B.B.; Bayat, M.; Mustapha, F.; Ismarrubie, Z.N.; Shahrjerdi, A.

2009-01-01

Full text: The contact statuses between functionally graded (FG) brake disks and pure pad disk are investigated by using finite element method (FEM). Two types of variation is considered for FG brake disk, the variation of materials are considered change in radial and thickness direction of disk. The material properties of these two types of FG brake disks are assumed to be represented by power-law distributions in the radius and thickness direction. The results are obtained and then compared. For the radial FG brake disk, the inner and outer surfaces are considered metal and ceramic respectively, and friction coefficient between metal surface and ceramic surface of FG brake dick with pad are considered 1.4 and 0.75 respectively. For the thickness FG brake disk the contact surface with pure pad brake disk is ceramic and the free surface is metal and friction coefficient between ceramic (contact) surface and pure pad brake disk is considered 0.75. In both types of FG brake disks the Coulomb contact friction is applied. Mechanical response of FG brake disks are compared and verified with the known results in the literatures. Three types of contact statuses are introduced as Sticking, Contact and Near Contact. The contact status between pad and disk for different values for pad thickness, grading index,n , and percentage of friction coefficient (λ) is shown. It can be seen that for all values of percentage of friction coefficient,λ , and grading indices, n, by increasing the thickness of pad cause the contact status changes from sticking to contact and then to near contact. (author)

Increased body mass index is a predisposition for treatment by total hip replacement

DEFF Research Database (Denmark)

Jacobsen, Steffen; Sonne-Holm, Stig

2005-01-01

We investigated the radiological and epidemiological data of 4,151 subjects followed up from 1976 to 2003 to determine individual risk factors for hip osteoarthritis (OA), hip pain and/or treatment by total hip replacement (THR). Pelvic radiographs recorded in 1992 were assessed for evidence of hip......-joint degeneration and dysplasia. Sequential body mass index (BMI) measurements from 1976 to 1992, age, exposure to daily lifting and hip dysplasia were entered into logistic regression analyses. The prevalence of hip dysplasia ranged from 5.4% to 12.8% depending on the radiographical index used. Radiological hip OA...

GIANT PLANET MIGRATION, DISK EVOLUTION, AND THE ORIGIN OF TRANSITIONAL DISKS

International Nuclear Information System (INIS)

Alexander, Richard D.; Armitage, Philip J.

2009-01-01

We present models of giant planet migration in evolving protoplanetary disks. Our disks evolve subject to viscous transport of angular momentum and photoevaporation, while planets undergo Type II migration. We use a Monte Carlo approach, running large numbers of models with a range in initial conditions. We find that relatively simple models can reproduce both the observed radial distribution of extrasolar giant planets, and the lifetimes and accretion histories of protoplanetary disks. The use of state-of-the-art photoevaporation models results in a degree of coupling between planet formation and disk clearing, which has not been found previously. Some accretion across planetary orbits is necessary if planets are to survive at radii ∼<1.5 AU, and if planets of Jupiter mass or greater are to survive in our models they must be able to form at late times, when the disk surface density in the formation region is low. Our model forms two different types of 'transitional' disks, embedded planets and clearing disks, which show markedly different properties. We find that the observable properties of these systems are broadly consistent with current observations, and highlight useful observational diagnostics. We predict that young transition disks are more likely to contain embedded giant planets, while older transition disks are more likely to be undergoing disk clearing.

The black disk to be observed in the Orear region

International Nuclear Information System (INIS)

Dremin, I.M.

2012-01-01

It is argued that the very first signatures of the approach to the black disk asymptotical limit in hadron collisions may be observed in the differential cross section of elastic scattering. The exponentially decreasing with the angle (or √(|t|) ) regime beyond the diffraction peak will become replaced by an oscillatory behavior or by the power-like falloff. Some estimates of energies where this can happen are presented.

ES-5052 storage devices on magnetic disks for the BESM-4 computer

International Nuclear Information System (INIS)

Bezrukova, N.B.; Vinogradov, A.F.; Eliseev, G.N.; Ivanchenko, Z.M.; Pervushov, V.I.; Samojlov, V.N.; Stuk, G.P.; Shchelev, S.A.; Chulkov, N.I.

1975-01-01

The basic principles of connection between ES-5052 magnetic disk storage devices and a BESM-4 computer are set forth. The interchange of instructions and guidance information between computer and magnetic disk storage is accomplished through a disk controlling unit. The time taken to find the required cylinder (to pass from track to track) is 20 ms, the access time is 60 to 95 ms. The data transfer rate (512 45-digit machine words) is 20 ms. The total disk storage capacity is equivalent to 250 BESM-4 memory units. The instructions for BESM-4 access to the ES-5052 magnetic disk storage are described

Feasibility of Early-Initiated Progressive Resistance Training after Total Hip Replacement

DEFF Research Database (Denmark)

Mikkelsen, Lone Ramer; Mechlenburg, Inger; Petersen, Annemette Krintel

during the exercises were measured at each training session. Isometric muscle strength was measured before and 4 weeks after the THR. Findings / Results: Pain during exercises and resting pain before and after each training session was unchanged or decreased during the 4 weeks of training. Averaged...... across exercises pain during training decreased from 3.6 (sd: 2.8) at the first session to 1.52 (sd: 1.8) VAS-mm at the last session, ptraining load increased progressively for all 4 exercises during the 4 weeks of training. For example: 2nd, 5th and 8th training session. Hip......Background: Muscle atrophy, reduced hip muscle strength and function are documented within the first weeks after Total Hip Replacement (THR). Purpose / Aim of Study: The purpose of this study was to evaluate the feasibility of early-initiated progressive resistance training (PRT) after THR...

Disk accretion onto a black hole at subcritical luminosity

International Nuclear Information System (INIS)

Bisnovatyi-Kogan, G.S.; Blinnikov, S.I.

1977-01-01

The influence of radiation pressure on the structure of an accretion disk is considered when the total luminosity L approaches the Eddington limit Lsub(c). The motion of particles in the disk radiation field and gravitational field of a nonrotating black hole is investigated. It is shown that the disk accretion is destroyed when L approximately equal to (0.6 / 1.0) Lsub(c). Matter outflow from the central parts of the disk to infinity then sets in. We conclude that the luminosity cannot significantly exceed the Eddington limit. We show that for L > approximately 0.1 Lsub(c) the plasma in the upper layers of the central region of the disk is heated up to temperatures T approximately 10 9 K and the disk becomes thicker as compared with the standard theory. It is shown that the radiative force can generate magnetic fields B approximately 100 G. We find that convection is the main energy transfer mechanism along z-coordinate in the central parts of the disk. The convection generates an acoustic flux which dissipates in the upper, optically thin layers of the disk and heats them. The comptonization of soft photons going from layers to the hot upper layers and variable accretion rate may explain the spectrum and variations of X-ray emission of the CygX-1. (orig.) [de

The use of autologous concentrated growth factors to promote syndesmosis fusion in the Agility total ankle replacement. A preliminary study.

Science.gov (United States)

Coetzee, J Chris; Pomeroy, Gregory C; Watts, J David; Barrow, Craig

2005-10-01

The Agility (DePuy, Warsaw, Indiana) total ankle replacement has been in use since 1984. One of the most common complications continues to be delayed union or nonunions of the distal tibiofibular syndesmosis. In the reported studies on the Agility ankle the delayed union and nonunion rate can be as high as 38%. Since 1999, 114 Agility total ankle replacements were done at two centers in the United States without the use of autologous concentrated growth factors. Since July of 2001, 66 Agility ankles were implanted with Symphony (DePuy, Warsaw, Indiana) augmented bone grafting. The standard operative technique was followed in all the patients. Prospective data was collected on all patients. The standard ankle radiographs were taken preoperatively and postoperative at 8 weeks, 12 weeks, 16 weeks, 6 months, and yearly. CT scans were obtained at 6 months if fusion at the syndesmosis was questionable. The Graphpad Instat software (Graphpad Software Inc., San Diego, CA) was used for statistical analysis. The two-tailed unpaired t-test was used, and the value ankle replacements without autologous concentrated growth factors 70 fused at 8 weeks (61%), 14 fused at 12 weeks (12%), 13 fused at 6 months (12%). There were 17 nonunions (15%); delayed unions (3 to 6 months) and nonunions, therefore, equaled 27%. The syndesmosis fused in 50 of the 66 ankle replacements (76%) that had autologous concentrated growth fractures at 8 weeks (76%); 12 fused at 3 months (18%), 2 fused at 6 months (3%), 2 had nonunions (3%). Delayed unions (3 to 6 months) and nonunions equaled 6%. There was a statistically significant improvement in the 8- and 12-week fusion rates, and a statistically significant reduction in delayed unions and nonunions. Autologous concentrated growth factors appear to make a significant positive difference in the syndesmosis union rate in total ankle replacements.

Innovative opto-mechanical design of a laser head for compact thin-disk

Science.gov (United States)

Macúchová, Karolina; Smrž, Martin; Řeháková, Martina; Mocek, Tomáš

2016-11-01

We present recent progress in design of innovative versatile laser head for lasers based on thin-disk architecture which are being constructed at the HiLASE centre of the IOP in the Czech Republic. Concept of thin-disk laser technology allows construction of lasers providing excellent beam quality with high average output power and optical efficiency. Our newly designed thin-disk carrier and pump module comes from optical scheme consisting of a parabolic mirror and roof mirrors proposed in 90's. However, mechanical parts and a cooling system were in-house simplified and tailor-made to medium power lasers since no suitable setup was commercially available. Proposed opto-mechanical design is based on stable yet easily adjustable mechanics. The only water nozzle-cooled component is a room-temperature-operated thindisk mounted on a special cooling finger. Cooling of pump optics was replaced by heat conductive transfer from mirrors made of special Al alloy to a massive brass baseplate. Such mirrors are easy to manufacture and very cheap. Presented laser head was manufactured and tested in construction of Er and Yb doped disk lasers. Details of the latest design will be presented.

Assessment of the Patient-Centered and Family-Centered Care Experience of Total Joint Replacement Patients Using a Shadowing Technique.

Science.gov (United States)

Marcus-Aiyeku, Ulanda; DeBari, Margaret; Salmond, Susan

2015-01-01

In 2030, when baby boomers reach 65 years of age and represent 18% of the population, it is anticipated that 67 million adults will have a diagnosis of arthritis increasing the demand for total hip and knee arthroplasty. With the growing emphasis on patient- and family-centered care, the aim of this project was to assess the patient experience of patients and families throughout the entire spectrum of the total joint replacement service line care at a university regional trauma hospital. A shadowing methodology as defined by the Institute for Health Improvement was utilized. Eight patient/family groups undergoing total joint replacements were shadowed. The mapped care experience included time, caregiver, activity, shadower observations, and impressions. Findings revealed inconsistencies in the delivery of patient- and family-centered care. Communication and interactions were predominantly provider-centric, with a focus on care routines versus the patient and family, and anticipation that care would be medically directed.

Distribution of polyethylene wear debris and bone particles in granuloma tissue around total hip joint replacements

Czech Academy of Sciences Publication Activity Database

Zolotarevova, E.; Lapčíková, Monika; Šlouf, Miroslav; Entlicher, G.; Pokorný, D.; Veselý, F.; Sosna, A.

2008-01-01

Roč. 18, č. 2 (2008), s. 173-174 ISSN 1120-7000. [Domestic Meeting of the European Hip Society /8./. 11.06.2008-13.06.2008, Madrid] R&D Projects: GA MŠk 2B06096 Institutional research plan: CEZ:AV0Z40500505 Keywords : wear debris * bone particles * total hip joint replacement Subject RIV: CD - Macromolecular Chemistry www. hip -int.com

Giant Planets Can Act as Stabilizing Agents on Debris Disks

Energy Technology Data Exchange (ETDEWEB)

Muñoz-Gutiérrez, M. A.; Pichardo, B.; Peimbert, A., E-mail: mmunoz.astro@gmail.com [Instituto de Astronomía, Universidad Nacional Autónoma de México, Apdo. postal 70-264 Ciudad Universitaria, México (Mexico)

2017-07-01

We have explored the evolution of a cold debris disk under the gravitational influence of dwarf-planet-sized objects (DPs), both in the presence and absence of an interior giant planet. Through detailed long-term numerical simulations, we demonstrate that when the giant planet is not present, DPs can stir the eccentricities and inclinations of disk particles, in linear proportion to the total mass of the DPs; on the other hand, when the giant planet is included in the simulations, the stirring is approximately proportional to the mass squared. This creates two regimes: below a disk mass threshold (defined by the total mass of DPs), the giant planet acts as a stabilizing agent of the orbits of cometary nuclei, diminishing the effect of the scatterers; above the threshold, the giant contributes to the dispersion of the particles.

CT-guided percutaneous laser disk decompression for cervical and lumbar disk hernia

International Nuclear Information System (INIS)

Shimizu, Kanichiro; Koyama, Tutomu; Harada, Junta; Abe, Toshiaki

2008-01-01

Percutaneous laser disk decompression under X-ray fluoroscopy was first reported in 1987 for minimally invasive therapy of lumbar disk hernia. In patients with disk hernia, laser vaporizes a small portion of the intervertebral disk thereby reducing the volume and pressure of the affected disk. We present the efficacy and safety of this procedure, and analysis of fair or poor response cases. In our study, 226 cases of lumbar disk hernia and 7 cases of cervical disk hernia were treated under CT guided PLDD. Japan Orthopedic Association (JOA) score and Mac-Nab criteria were investigated to evaluate the response to treatment. Improvement ratio based on the JOA score was calculated as follows. Overall success rate was 91.6% in cases lumber disk hernia, and 100% in cases of cervical disk hernia. We experienced two cases with two cases with postoperative complication. Both cases were treated conservatively. The majority of acute cases and post operative cases were reported to be 'good' on Mac-Nab criteria. Cases of fair or poor response on Mac-Nab criteria were lateral type, foraminal stenosis or large disk hernia. CT-guided PLDD is a safe and accurate procedure. The overall success rate can be increased by carefully selecting patients. (author)

Disk Storage Server

CERN Multimedia

This model was a disk storage server used in the Data Centre up until 2012. Each tray contains a hard disk drive (see the 5TB hard disk drive on the main disk display section - this actually fits into one of the trays). There are 16 trays in all per server. There are hundreds of these servers mounted on racks in the Data Centre, as can be seen.

Analysing uncertainty around costs of innovative medical technologies: the case of fibrin sealant (QUIXIL) for total knee replacement.

NARCIS (Netherlands)

Steuten, Lotte Maria Gertruda; Vallejo-Torres, Laura; Bastide, Philippe; Buxton, Martin J.

2009-01-01

This paper presents a relatively simple cost model comparing the costs of using a commercial fibrin sealant (QUIXIL®) in addition to conventional haemostatic treatment vs. conventional treatment alone in total knee replacement (TKR) surgery, and demonstrates and discusses how one- and two-way

Using a calliper to restore the centre of the femoral head during total hip replacement.

Science.gov (United States)

Hill, J C; Archbold, H A P; Diamond, O J; Orr, J F; Jaramaz, B; Beverland, D E

2012-11-01

Restoration of leg length and offset is an important goal in total hip replacement. This paper reports a calliper-based technique to help achieve these goals by restoring the location of the centre of the femoral head. This was validated first by using a co-ordinate measuring machine to see how closely the calliper technique could record and restore the centre of the femoral head when simulating hip replacement on Sawbone femur, and secondly by using CT in patients undergoing hip replacement. Results from the co-ordinate measuring machine showed that the centre of the femoral head was predicted by the calliper to within 4.3 mm for offset (mean 1.6 (95% confidence interval (CI) 0.4 to 2.8)) and 2.4 mm for vertical height (mean -0.6 (95% CI -1.4 to 0.2)). The CT scans showed that offset and vertical height were restored to within 8 mm (mean -1 (95% CI -2.1 to 0.6)) and -14 mm (mean 4 (95% CI 1.8 to 4.3)), respectively. Accurate assessment and restoration of the centre of the femoral head is feasible with a calliper. It is quick, inexpensive, simple to use and can be applied to any design of femoral component.

Periprosthetic fracture-dislocation in a loosened total knee replacement treated by knee arthrodesis

International Nuclear Information System (INIS)

Lozano Moreno, Francisco Jose

2004-01-01

We present a patient who was operated four years before performing a total knee replacement. She fell down resulting a periprosthetic femoral fracture and a prosthetic dislocation. After evaluating different treatments, we decided to do prosthetic removal and a knee arthrodesis using an intramedullar nail. The femoral fracture was fixed with wire cerclages. Knee arthrodesis is a procedure uses as a last option for the treatment of infected or loosed arthroplasties. In our case it was difficult to consider any other reconstructive procedure due to the association of fracture, dislocation and loosening. The evolution has been satisfactory with good functional result and without pain

HNC IN PROTOPLANETARY DISKS

International Nuclear Information System (INIS)

Graninger, Dawn; Öberg, Karin I.; Qi, Chunhua; Kastner, Joel

2015-01-01

The distributions and abundances of small organics in protoplanetary disks are potentially powerful probes of disk physics and chemistry. HNC is a common probe of dense interstellar regions and the target of this study. We use the Submillimeter Array (SMA) to observe HNC 3–2 toward the protoplanetary disks around the T Tauri star TW Hya and the Herbig Ae star HD 163296. HNC is detected toward both disks, constituting the first spatially resolved observations of HNC in disks. We also present SMA observations of HCN 3–2 and IRAM 30 m observations of HCN and HNC 1–0 toward HD 163296. The disk-averaged HNC/HCN emission ratio is 0.1–0.2 toward both disks. Toward TW Hya, the HNC emission is confined to a ring. The varying HNC abundance in the TW Hya disk demonstrates that HNC chemistry is strongly linked to the disk physical structure. In particular, the inner rim of the HNC ring can be explained by efficient destruction of HNC at elevated temperatures, similar to what is observed in the ISM. However, to realize the full potential of HNC as a disk tracer requires a combination of high SNR spatially resolved observations of HNC and HCN and disk-specific HNC chemical modeling

HNC IN PROTOPLANETARY DISKS

Energy Technology Data Exchange (ETDEWEB)

Graninger, Dawn; Öberg, Karin I.; Qi, Chunhua [Harvard-Smithsonian Center for Astrophysics, 60 Garden Street, Cambridge, MA 02138 (United States); Kastner, Joel, E-mail: dgraninger@cfa.harvard.edu [Center for Imaging Science, School of Physics and Astronomy, and Laboratory for Multiwavelength Astrophysics, Rochester Institute of Technology, 54 Lomb Memorial Drive, Rochester, NY 14623 (United States)

2015-07-01

The distributions and abundances of small organics in protoplanetary disks are potentially powerful probes of disk physics and chemistry. HNC is a common probe of dense interstellar regions and the target of this study. We use the Submillimeter Array (SMA) to observe HNC 3–2 toward the protoplanetary disks around the T Tauri star TW Hya and the Herbig Ae star HD 163296. HNC is detected toward both disks, constituting the first spatially resolved observations of HNC in disks. We also present SMA observations of HCN 3–2 and IRAM 30 m observations of HCN and HNC 1–0 toward HD 163296. The disk-averaged HNC/HCN emission ratio is 0.1–0.2 toward both disks. Toward TW Hya, the HNC emission is confined to a ring. The varying HNC abundance in the TW Hya disk demonstrates that HNC chemistry is strongly linked to the disk physical structure. In particular, the inner rim of the HNC ring can be explained by efficient destruction of HNC at elevated temperatures, similar to what is observed in the ISM. However, to realize the full potential of HNC as a disk tracer requires a combination of high SNR spatially resolved observations of HNC and HCN and disk-specific HNC chemical modeling.

Immediate mobilisation with complete weight bearing after uncemented total hip replacement in elderly

Directory of Open Access Journals (Sweden)

Sankarlingam P, Shivraj V, V R Subramaniyam

2014-11-01

Full Text Available This prospective study was analyzed in 23 patients who were allowed to do immediate weight bearing after uncemented total hip arthroplasty. Immediate mobilization shortened the hospital stay and facilitated early rehabilitation of hip. Immediate mobilization was started on postoperative Day 3 rather than Day 7 without any adverse consequences to the patients. A series of 23 elderly patients of age more than 60 years, who were diagnosed with conditions such as avascular necrosis of hip, non union of fracture neck of femur, trochanteric non union and rheumatoid arthritis, underwent uncemented total hip replacement and immediate mobilization was started in our hospital. Patients were evaluated by Harris Hip Scoring Scale. All ambulated patients had painless hip and the mean Harris Hip Score was 85. There were no incidence of stem subsidence, acetabular component loosening, and heterotrophic ossification. This data concluded that early intensive rehabilitation yielded faster attainment of short-term functional milestones in fewer days.

Nursing intervention by telephone interviews of patients aged over 65 years after total hip replacement improves health status: a randomised clinical trial Nursing intervention by telephone interviews of patients aged over 65 years after total hip replacement improves health status: a randomised

DEFF Research Database (Denmark)

Hørdam, Britta

2010-01-01

and over by using telephone support and counselling 2 and 10 weeks after surgery compared with a control group receiving conventional care and treatment. Design: A randomised clinical trial focusing on patients' health status by using short-form 36 at 4 weeks preoperatively and 3 and 9 months...... postoperatively was carried out. Sample: 180 patients aged 65 years and over were randomised 4 weeks preoperatively to either control or intervention groups. Measurements: both groups received conventional surgical treatment, but the intervention group was interviewed by telephone 2 and 10 weeks after surgery......Nursing intervention by telephone interviews of patients aged over 65 years after total hip replacement improves health status: a randomised clinical trial Objective: We hypothesised that all areas of health status after total hip replacement could be improved in patients aged over 65 years...

Application of the kappa statistic in MRI diagnosis of lumbar disk herniation

International Nuclear Information System (INIS)

Li Dasheng; Zhang Fang; Gao Shuming; Gu Jinxiang; Li Lu; Qu Hui

2008-01-01

A and doctor B, respectively;that accounted for 55.6% (20/36) and 73.2% (30/41) of total variation respectively. The diagnostic difference between the 2 doctors happened mainly on differentiation of bulging disks and normal disks, which happened in 56 disks, accountiong for 70.9% (56/79) of total variation. Conclusion: Variation on diagnoses of the same radiologist or between two radiologists was mainly caused by disagreement on bulging disks. (authors)

A Modified Method for Reconstruction of Chronic Rupture of the Quadriceps Tendon after Total Knee Replacement

Directory of Open Access Journals (Sweden)

S Singh

2008-11-01

Full Text Available We describe herein a modified technique for reconstruction of chronic rupture of the quadriceps tendon in a patient with bilateral total knee replacement and distal realignment of the patella. The surgery involved the application of a Dacron graft and the ‘double eights’ technique. The patient achieved satisfactory results after surgery and we believe that this technique of reconstruction offers advantages over other methods.

Predictors of clinical outcome in total hip and knee replacement : a methodological appraisal of implants and patient factors

NARCIS (Netherlands)

Keurentjes, Johan Christiaan

2014-01-01

In this thesis, we studied both implants and patient and surgeon factors as predictors of clinical outcome after total hip and knee replacement. Additionally, we studied a number of methodological aspects of orthopaedic research, such as competing risks in estimating the probability of revision

Development of Disk Rover, wall-climbing robot using permanent magnet disk

International Nuclear Information System (INIS)

Hirose, Shigeo; Tsutsumitake; Hiroshi; Toyama, Ryousei; Kobayashi, Kengo.

1992-01-01

A new type of wall climbing robot, named Disk Rover, using permanent magnet disks are developed. The newly introduced permanent magnet disk is to rotate the magnet disk on the surface of wall with partly contacted posture. It allows to produce high magnetic attraction force compared with conventional permanent wheel which utilizes only a small portion of the magnet installed around the wheel. The optimum design of the magnetic wheel is done by using finit element method and it is shown that the magnetic attraction force vs. weight ratio can be designed about three times higher than conventional type magnet wheel. The developed Disk Rover is 25 kg in weight including controller and battery, about 685 mm in diameter, 239 mm in height and has a pair of permanent magnet disks. It is demonstrated by the experiments that the Disk Rover can move around on the surface of the wall quite smoothly by radio control and has payload of about its own weight. Several considerations are also done in order to surmount bead weld. (author)

STABILITY OF MAGNETIZED DISKS AND IMPLICATIONS FOR PLANET FORMATION

International Nuclear Information System (INIS)

Lizano, Susana; Galli, Daniele; Cai, Mike J.; Adams, Fred C.

2010-01-01

This paper considers gravitational perturbations in geometrically thin disks with rotation curves dominated by a central object, but with substantial contributions from magnetic pressure and tension. The treatment is general, but the application is to the circumstellar disks that arise during the gravitational collapse phase of star formation. We find the dispersion relation for spiral density waves in these generalized disks and derive the stability criterion for axisymmetric (m = 0) disturbances (the analog of the Toomre parameter Q T ) for any radial distribution of the mass-to-flux ratio λ. The magnetic effects work in two opposing directions: on one hand, magnetic tension and pressure stabilize the disk against gravitational collapse and fragmentation; on the other hand, they also lower the rotation rate making the disk more unstable. For disks around young stars the first effect generally dominates, so that magnetic fields allow disks to be stable for higher surface densities and larger total masses. These results indicate that magnetic fields act to suppress the formation of giant planets through gravitational instability. Finally, even if gravitational instability can form a secondary body, it must lose an enormous amount of magnetic flux in order to become a planet; this latter requirement represents an additional constraint for planet formation via gravitational instability and places a lower limit on the electrical resistivity.

Repair of Medial Patellofemoral, Ligament Improves Patellar, Tracking in Total Knee Replacement.

Science.gov (United States)

Meneghini, R Michael; Ziemba-Davis, Mary; Smits, Shelly; Bicos, James

2015-11-01

The medial patellofemoral ligament (MPFL) is essential to maintain patella stability; however, its role in total knee replacement (TKR) has not been studied. Forty-six consecutive TKRs in 40 patients were reviewed. Standard closure was performed in 29 TKRs. The MPFL was isolated and anatomically re-approximated in 17 subsequent TKRs. Blinded radiographic evaluation of patellar tilt and subluxation was performed preoperatively and 4 months postoperatively. Despite greater preoperative lateral tilt, the MPFL repair group demonstrated greater correction in patellar tilt compared with the standard closure group (p = 0.02). Patellar tracking also was optimized in the MPFL group, despite equivalent preoperative lateral patellar subluxation in the two groups. Simple repair of the MPFL at arthrotomy closure appears to optimize patellar stability radiographically and may improve long-term results by minimizing patellar complications and wear.

Patient-reported outcome of hip resurfacing arthroplasty and standard total hip replacement after short-term follow-up

DEFF Research Database (Denmark)

Nissen, Nina; Douw, Karla; Overgaard, Søren

2011-01-01

The purpose of this study was to investigate patientreported outcome in terms of satisfaction in two study groups that had undergone hip resurfacing arthro-plasty (HRA) or total hip replacement (THR). The procedure consists of placing a hollow, mushroom-shaped metal cap over the femoral head whil...... a matching metal cup is placed in the acetabulum (pelvis socket)....

Mass models for disk and halo components in spiral galaxies

International Nuclear Information System (INIS)

Athanassoula, E.; Bosma, A.

1987-01-01

The mass distribution in spiral galaxies is investigated by means of numerical simulations, summarizing the results reported by Athanassoula et al. (1986). Details of the modeling technique employed are given, including bulge-disk decomposition; computation of bulge and disk rotation curves (assuming constant mass/light ratios for each); and determination (for spherical symmetry) of the total halo mass out to the optical radius, the concentration indices, the halo-density power law, the core radius, the central density, and the velocity dispersion. Also discussed are the procedures for incorporating galactic gas and checking the spiral structure extent. It is found that structural constraints limit disk mass/light ratios to a range of 0.3 dex, and that the most likely models are maximum-disk models with m = 1 disturbances inhibited. 19 references

Routine one-stage exchange for chronic infection after total hip replacement.

Science.gov (United States)

Jenny, Jean-Yves; Lengert, Régis; Diesinger, Yann; Gaudias, Jeannot; Boeri, Cyril; Kempf, Jean-François

2014-12-01

We hypothesized that a routine one-stage exchange for treatment of chronically infected total hip replacement (THR) will lead to (1) a higher rate of infection recurrence and (2) a poorer hip outcome than the published rates after two-stage exchange. Sixty-five cases have been treated consecutively with one-stage exchange. All patients have been followed for a period of three to six years or until death or infection recurrence. The five-year rate for infection recurrence was 16%. The five-year survival rate for recurrence of the index infection was 8%. Forty-two percent of the hips had a good or excellent PMA score, and 46% a good or excellent OH score. Routine one-stage exchange was not associated with a higher recurrence rate and a poorer hip function than previously published series of two-stage exchange. Therefore, there is little support to choose two-stage exchange as the routine treatment for management of chronically infected THR.

A new system of computer-assisted navigation leading to reduction in operating time in uncemented total hip replacement in a matched population.

Science.gov (United States)

Chaudhry, Fouad A; Ismail, Sanaa Z; Davis, Edward T

2018-05-01

Computer-assisted navigation techniques are used to optimise component placement and alignment in total hip replacement. It has developed in the last 10 years but despite its advantages only 0.3% of all total hip replacements in England and Wales are done using computer navigation. One of the reasons for this is that computer-assisted technology increases operative time. A new method of pelvic registration has been developed without the need to register the anterior pelvic plane (BrainLab hip 6.0) which has shown to improve the accuracy of THR. The purpose of this study was to find out if the new method reduces the operating time. This was a retrospective analysis of comparing operating time in computer navigated primary uncemented total hip replacement using two methods of registration. Group 1 included 128 cases that were performed using BrainLab versions 2.1-5.1. This version relied on the acquisition of the anterior pelvic plane for registration. Group 2 included 128 cases that were performed using the newest navigation software, BrainLab hip 6.0 (registration possible with the patient in the lateral decubitus position). The operating time was 65.79 (40-98) minutes using the old method of registration and was 50.87 (33-74) minutes using the new method of registration. This difference was statistically significant. The body mass index (BMI) was comparable in both groups. The study supports the use of new method of registration in improving the operating time in computer navigated primary uncemented total hip replacements.

Blood loss associated with Ring uncemented total knee replacement: comparison between continuous and intermittent suction drainage.

Science.gov (United States)

Wittmann, F W; Ring, P A

1984-01-01

In a retrospective comparison of blood loss following uncemented total knee replacement, in which either continuous or intermittent suction drainage was used, measured blood loss was significantly greater with continuous drainage. However, a method of calculating actual blood loss demonstrated no significant difference. With intermittent drainage, more blood remains undetected around the knee joint; this technique should therefore be abandoned in favour of continuous suction drainage. PMID:6747978

MIGRATION OF EXTRASOLAR PLANETS: EFFECTS FROM X-WIND ACCRETION DISKS

International Nuclear Information System (INIS)

Adams, Fred C.; Cai, Mike J.; Lizano, Susana

2009-01-01

Magnetic fields are dragged in from the interstellar medium during the gravitational collapse that forms star/disk systems. Consideration of mean field magnetohydrodynamics in these disks shows that magnetic effects produce sub-Keplerian rotation curves and truncate the inner disk. This Letter explores the ramifications of these predicted disk properties for the migration of extrasolar planets. Sub-Keplerian flow in gaseous disks drives a new migration mechanism for embedded planets and modifies the gap-opening processes for larger planets. This sub-Keplerian migration mechanism dominates over Type I migration for sufficiently small planets (m P ∼ + ) and/or close orbits (r ∼< 1 AU). Although the inclusion of sub-Keplerian torques shortens the total migration time by only a moderate amount, the mass accreted by migrating planetary cores is significantly reduced. Truncation of the inner disk edge (for typical system parameters) naturally explains final planetary orbits with periods P ∼ 4 days. Planets with shorter periods, P ∼ 2 days, can be explained by migration during FU-Orionis outbursts, when the mass accretion rate is high and the disk edge moves inward. Finally, the midplane density is greatly increased at the inner truncation point of the disk (the X-point); this enhancement, in conjunction with continuing flow of gas and solids through the region, supports the in situ formation of giant planets.

Understanding Floppy Disks.

Science.gov (United States)

Valentine, Pamela

1980-01-01

The author describes the floppy disk with an analogy to the phonograph record, and discusses the advantages, disadvantages, and capabilities of hard-sectored and soft-sectored floppy disks. She concludes that, at present, the floppy disk will continue to be the primary choice of personal computer manufacturers and their customers. (KC)

OT1_ipascucc_1: Understanding the Origin of Transition Disks via Disk Mass Measurements

Science.gov (United States)

Pascucci, I.

2010-07-01

Transition disks are a distinguished group of few Myr-old systems caught in the phase of dispersing their inner dust disk. Three different processes have been proposed to explain this inside-out clearing: grain growth, photoevaporation driven by the central star, and dynamical clearing by a forming giant planet. Which of these processes lead to a transition disk? Distinguishing between them requires the combined knowledge of stellar accretion rates and disk masses. We propose here to use 43.8 hours of PACS spectroscopy to detect the [OI] 63 micron emission line from a sample of 21 well-known transition disks with measured mass accretion rates. We will use this line, in combination with ancillary CO millimeter lines, to measure their gas disk mass. Because gas dominates the mass of protoplanetary disks our approach and choice of lines will enable us to trace the bulk of the disk mass that resides beyond tens of AU from young stars. Our program will quadruple the number of transition disks currently observed with Herschel in this setting and for which disk masses can be measured. We will then place the transition and the ~100 classical/non-transition disks of similar age (from the Herschel KP "Gas in Protoplanetary Systems") in the mass accretion rate-disk mass diagram with two main goals: 1) reveal which gaps have been created by grain growth, photoevaporation, or giant planet formation and 2) from the statistics, determine the main disk dispersal mechanism leading to a transition disk.

A 5 year prospective study of patient-relevant outcomes after total knee replacement

DEFF Research Database (Denmark)

Nilsdotter, A-K; Toksvig-Larsen, S; Roos, E M

2008-01-01

men, mean age 71 (51-86) assigned for TKR at the Department of Orthopaedics at Lund University Hospital were included in the study. The self-administered questionnaires Knee injury and Osteoarthritis Outcome Score (KOOS) and SF-36 were mailed preoperatively and 6 months, 12 months and at 5 years......OBJECTIVE: To prospectively describe self-reported outcomes up to 5 years after total knee replacement (TKR) in Osteoarthritis (OA) and to study which patient-relevant factors may predict outcomes for pain and physical function (PF). METHODS: 102 consecutive patients with knee OA, 63 women and 39...... postoperatively. RESULTS: Response rate at 5 years was 86%. At 6 months significant improvement was seen in all KOOS and SF-36 scores (P

Effect of preoperative neuromuscular training (NEMEX-TJR) on functional outcome after total knee replacement

DEFF Research Database (Denmark)

Huber, Erika O; Roos, Ewa M.; Meichtry, André

2015-01-01

baseline to 3 months after Total Knee Replacement (TKR) following a neuromuscular exercise programme (NEMEX-TJR) plus a knee school educational package (KS) or KS alone. METHODS: 45 patients (55-83 years, 53% male, waiting for TKR) were randomized to receive a minimum of 8 sessions of NEMEXTJR plus 3...... and after the intervention, and at 6 weeks, 3 months and 12 months after surgery by a physiotherapist, blinded to group allocation. RESULTS: After intervention before surgery we observed a small improvement for primary and secondary endpoints in both groups, which did not differ significantly between groups...

Exploring Disks Around Planets

Science.gov (United States)

Kohler, Susanna

2017-07-01

Giant planets are thought to form in circumstellar disks surrounding young stars, but material may also accrete into a smaller disk around the planet. Weve never detected one of these circumplanetary disks before but thanks to new simulations, we now have a better idea of what to look for.Image from previous work simulating a Jupiter-mass planet forming inside a circumstellar disk. The planet has its own circumplanetary disk of accreted material. [Frdric Masset]Elusive DisksIn the formation of giant planets, we think the final phase consists of accretion onto the planet from a disk that surrounds it. This circumplanetary disk is important to understand, since it both regulates the late gas accretion and forms the birthplace of future satellites of the planet.Weve yet to detect a circumplanetary disk thus far, because the resolution needed to spot one has been out of reach. Now, however, were entering an era where the disk and its kinematics may be observable with high-powered telescopes (like the Atacama Large Millimeter Array).To prepare for such observations, we need models that predict the basic characteristics of these disks like the mass, temperature, and kinematic properties. Now a researcher at the ETH Zrich Institute for Astronomy in Switzerland, Judit Szulgyi, has worked toward this goal.Simulating CoolingSzulgyi performs a series of 3D global radiative hydrodynamic simulations of 1, 3, 5, and 10 Jupiter-mass (MJ) giant planets and their surrounding circumplanetary disks, embedded within the larger circumstellar disk around the central star.Density (left column), temperature (center), and normalized angular momentum (right) for a 1 MJ planet over temperatures cooling from 10,000 K (top) to 1,000 K (bottom). At high temperatures, a spherical circumplanetary envelope surrounds the planet, but as the planet cools, the envelope transitions around 64,000 K to a flattened disk. [Szulgyi 2017]This work explores the effects of different planet temperatures and

After total knee replacement younger patients demonstrate superior balance control compared to older patients when recovering from a forward fall.

Science.gov (United States)

Street, Brian D; Gage, William

2017-05-01

National joint replacement registries have reported a substantial growth in younger knee osteoarthritic patients (controlled perturbation have shown age-related differences between younger and older healthy adults, whether similar age-related differences exist among total knee replacement patients is unknown. A total of 59 participants, including 29 unilateral total knee replacement patients (six-months post-surgery) made up the four experimental groups: 1) younger patient (54.3 (SD 7.9) years), 2) younger control (55.2 (SD 4.0) years), 3) older patient (76.9 (SD 4.7) years), and 4) older control (77.7 (SD 4.1) years). Using a tether-release method to perturb balance and simulate a forward fall, center of mass and stepping characteristics were analyzed. Younger patients recovered following the perturbation with a significantly smaller center of mass displacement compared to the older patients (14.85 (SD 0.01) v. 18.13 (SD 0.02) %ht, p=0.02); utilizing a longer (0.43 (SD 0.02) v. 0.39 (SD 0.03) m, pcontrols in center of mass displacement or recovery step characteristics (p>0.05). The younger patients demonstrated superior center of mass control in response to a forward perturbation, suggesting that younger patients would be at a reduced risk of falling when recovering from a forward-directed postural perturbation compared to older patients. Copyright © 2017 Elsevier Ltd. All rights reserved.

Total hip replacement with a superolateral bone graft for osteoarthritis secondary to dysplasia: a long-term follow-up

NARCIS (Netherlands)

de Jong, P. T.; Haverkamp, D.; van der Vis, H. M.; Marti, R. K.

2006-01-01

We evaluated the long-term results of 116 total hip replacements with a superolateral shelfplasty in 102 patients with osteoarthritis secondary to developmental dysplasia of the hip. After a mean follow-up of 19.5 years (11.5 to 26.0), 14 acetabular components (12%) had been revised. The cumulative

Waiting for total knee replacement surgery: factors associated with pain, stiffness, function and quality of life

Directory of Open Access Journals (Sweden)

Dionne Clermont E

2009-05-01

Full Text Available Abstract Background Recent evidences show that education and rehabilitation while waiting for knee replacement have positive effects on the patients' health status. Identification of factors associated with worse pain, function and health-related quality of life (HRQoL while waiting for surgery could help develop pre-surgery rehabilitation interventions that target specifically these factors and prioritize patients that may benefit the most from them. The objectives of this study were to measure pain, stiffness, function and HRQoL in patients at enrolment on waiting lists for knee replacement and to identify demographic, clinical, socioeconomic and psychosocial characteristics associated with these outcomes. Methods This study is part of a broader study measuring the effects of pre-surgery wait in patients scheduled for knee replacement. From 02/2006 to 09/2007, 197 patients newly scheduled for total knee replacement were recruited from the waiting lists of three university hospitals in Quebec City, Canada. Pain, stiffness and function were measured with the Western Ontario and McMaster Osteoarthritis Index (WOMAC and HRQoL was measured with the SF-36 Health Survey. Stepwise multiple regression analysis was used to assess the strength of the associations between the independent variables and the WOMAC and SF-36 scores. Results The scores of all eight HRQoL physical and mental domains of the SF-36 were significantly lower than aged matched Canadian normative data (p Conclusion Patients waiting for knee replacement have poor function and HRQoL. Characteristics that were found to be associated with these outcomes could help develop pre-surgery rehabilitation program and prioritize patients that may benefit the most from them. Such programs could include interventions to reduce psychological distress, therapeutic exercises targeting both knees and weight loss management.

The Influence of Component Alignment and Ligament Properties on Tibiofemoral Contact Forces in Total Knee Replacement

OpenAIRE

Smith, Colin R.; Vignos, Michael F.; Lenhart, Rachel L.; Kaiser, Jarred; Thelen, Darryl G.

2016-01-01

The study objective was to investigate the influence of coronal plane alignment and ligament properties on total knee replacement (TKR) contact loads during walking. We created a subject-specific knee model of an 83-year-old male who had an instrumented TKR. The knee model was incorporated into a lower extremity musculoskeletal model and included deformable contact, ligamentous structures, and six degrees-of-freedom (DOF) tibiofemoral and patellofemoral joints. A novel numerical optimization ...

Equilibrium configuration of a stratus floating above accretion disks: Full-disk calculation

Science.gov (United States)

Itanishi, Yusuke; Fukue, Jun

2017-06-01

We examine floating strati above a luminous accretion disk, supported by the radiative force from the entire disk, and calculate the equilibrium locus, which depends on the disk luminosity and the optical depth of the stratus. Due to the radiative transfer effect (albedo effect), the floating height of the stratus with a finite optical depth generally becomes high, compared with the particle case. In contrast to the case of the near-disk approximation, moreover, the floating height becomes yet higher in the present full-disk calculation, since the intense radiation from the inner disk is taken into account. As a result, when the disk luminosity normalized by the Eddington luminosity is ˜0.3 and the stratus optical depth is around unity, the stable configuration disappears at around r ˜ 50 rg, rg being the Schwarzschild radius, and the stratus would be blown off as a cloudy wind consisting of many strati with appropriate conditions. This luminosity is sufficiently smaller than the Eddington one, and the present results suggest that the radiation-driven cloudy wind can be easily blown off from the sub-Eddington disk, and this can explain various outflows observed in ultra-fast outflow objects as well as in broad-absorption-line quasars.

Tribology and total hip joint replacement: current concepts in mechanical simulation.

Science.gov (United States)

Affatato, S; Spinelli, M; Zavalloni, M; Mazzega-Fabbro, C; Viceconti, M

2008-12-01

Interest in the rheology and effects of interacting surfaces is as ancient as man. This subject can be represented by a recently coined word: tribology. This term is derived from the Greek word "tribos" and means the "science of rubbing". Friction, lubrication, and wear mechanism in the common English language means the precise field of interest of tribology. Wear of total hip prosthesis is a significant clinical problem that involves, nowadays, a too high a number of patients. In order to acquire further knowledge on the tribological phenomena that involve hip prosthesis wear tests are conducted on employed materials to extend lifetime of orthopaedic implants. The most basic type of test device is the material wear machine, however, a more advanced one may more accurately reproduce some of the in vivo conditions. Typically, these apparatus are called simulators, and, while there is no absolute definition of a joint simulator, its description as a mechanical rig used to test a joint replacement, under conditions approximating those occurring in the human body, is acceptable. Simulator tests, moreover, can be used to conduct accelerated protocols that replicate/simulate particularly extreme conditions, thus establishing the limits of performance for the material. Simulators vary in their level of sophistication and the international literature reveals many interpretations of the design of machines used for joint replacement testing. This paper aims to review the current state of the art of the hip joint simulators worldwide. This is specified through a schematic overview by describing, in particular, constructive solutions adopted to reproduce in vivo conditions. An exhaustive commentary on the evolution and actually existing simulation standards is proposed by the authors. The need of a shared protocol among research laboratories all over the world could lead to a consensus conference.

Development and application of biomimetic electrospun nanofibers in total joint replacement

Science.gov (United States)

Song, Wei

Failure of osseointegration (direct anchorage of an implant by bone formation at the bone-implant surface) and implant infection (such as that caused by Staphylococcus aureus, S. aureus) are the two main causes of implant failure and loosening. There is a critical need for orthopedic implants that promote rapid osseointegration and prevent bacterial colonization, particularly when placed in bone compromised by disease or physiology of the patients. A better understanding of the key factors that influence cell fate decisions at the bone-implant interface is required. Our study is to develop a class of "bone-like" nanofibers (NFs) that promote osseointegration while preventing bacterial colonization and subsequent infections. This research goal is supported by our preliminary data on the preparation of coaxial electrospun NFs composed of polycaprolactone (PCL) and polyvinyl alcohol (PVA) polymers arranged in a core-sheath shape. The PCL/PVA NFs are biocompatible and biodegradable with appropriate fiber diameter, pore size and mechanical strength, leading to enhanced cell adhesion, proliferation and differentiation of osteoblast precursor cells. The objective is to develop functionalized "bone-like" PCL/PVA NFs matrix embedded with antibiotics (doxycycline (Doxy), bactericidal and anti-osteoclastic) on prosthesis surface. Through a rat tibia implantation model, the Doxy incorporated coaxial NFs has demonstrated excellent in promoting osseointegration and bacteria inhibitory efficacy. NFs coatings significantly enhanced the bonding between implant and bone remodeling within 8 weeks. The SA-induced osteomyelitis was prevented by the sustained release of Doxy from NFs. The capability of embedding numerous bio-components including proteins, growth factors, drugs, etc. enables NFs an effective solution to overcome the current challenged issue in Total joint replacement. In summary, we proposed PCL/PVA electrospun nanofibers as promising biomaterials that can be applied on

Contact stresses, pressure and area in a fixed-bearing total ankle replacement: a finite element analysis.

Science.gov (United States)

Martinelli, Nicolo; Baretta, Silvia; Pagano, Jenny; Bianchi, Alberto; Villa, Tomaso; Casaroli, Gloria; Galbusera, Fabio

2017-11-25

Mobile-bearing ankle implants with good clinical results continued to increase the popularity of total ankle arthroplasty to address endstage ankle osteoarthritis preserving joint movement. Alternative solutions used fixed-bearing designs, which increase stability and reduce the risk of bearing dislocation, but with a theoretical increase of contact stresses leading to a higher polyethylene wear. The purpose of this study was to investigate the contact stresses, pressure and area in the polyethylene component of a new total ankle replacement with a fixed-bearing design, using 3D finite element analysis. A three-dimensional finite element model of the Zimmer Trabecular Metal Total Ankle was developed and assembled based on computed tomography images. Three different sizes of the polyethylene insert were modeled, and a finite element analysis was conducted to investigate the contact pressure, the von Mises stresses and the contact area of the polyethylene component during the stance phase of the gait cycle. The peak value of pressure was found in the anterior region of the articulating surface, where it reached 19.8 MPa at 40% of the gait cycle. The average contact pressure during the stance phase was 6.9 MPa. The maximum von Mises stress of 14.1 MPa was reached at 40% of the gait cycle in the anterior section. In the central section, the maximum von Mises stress of 10.8 MPa was reached at 37% of the gait cycle, whereas in the posterior section the maximum stress of 5.4 MPa was reached at the end of the stance phase. The new fixed-bearing total ankle replacement showed a safe mechanical behavior and many clinical advantages. However, advanced models to quantitatively estimate the wear are need. To the light of the clinical advantages, we conclude that the presented prosthesis is a good alternative to the other products present in the market.

Characterizing Dusty Debris Disks with the Gemini Planet Imager

Science.gov (United States)

Chen, Christine; Arriaga, Pauline; Bruzzone, Sebastian; Choquet, Elodie; Debes, John H.; Donaldson, Jessica; Draper, Zachary; Duchene, Gaspard; Esposito, Thomas; Fitzgerald, Michael P.; Golimowski, David A.; Hines, Dean C.; Hinkley, Sasha; Hughes, A. Meredith; Kalas, Paul; Kolokolova, Ludmilla; Lawler, Samantha; Matthews, Brenda C.; Mazoyer, Johan; Metchev, Stanimir A.; Millar-Blanchaer, Max; Moro-Martin, Amaya; Nesvold, Erika; Padgett, Deborah; Patience, Jenny; Perrin, Marshall D.; Pueyo, Laurent; Rantakyro, Fredrik; Rodigas, Timothy; Schneider, Glenn; Soummer, Remi; Song, Inseok; Stark, Chris; Weinberger, Alycia J.; Wilner, David J.

2017-01-01

We have been awarded 87 hours of Gemini Observatory time to obtain multi-wavelength observations of HST resolved debris disks using the Gemini Planet Imager. We have executed ~51 hours of telescope time during the 2015B-2016B semesters observing 12 nearby, young debris disks. We have been using the GPI Spec and Pol modes to better constrain the properties of the circumstellar dust, specifically, measuring the near-infrared total intensity and polarization fraction colors, and searching for solid-state spectral features of nearby beta Pic-like disks. We expect that our observations will allow us to break the degeneracy among the particle properties such as composition, size, porosity, and shape. We present some early results from our observations.

Comparison of Venous Thromboembolism after Total Artificial Joint Replacement between Musculoskeletal Tumors and Osteoarthritis of the Knee by a Single Surgeon.

Directory of Open Access Journals (Sweden)

Dong Fu

Full Text Available The purpose of this study was to compare and evaluate the event of VTE (Venous Thromboembolism Event after total artificial joint replacement between two groups diagnosed with either musculoskeletal tumors or osteoarthritis (OA of the knee. From 2004 to 2014, a total of 1,402 patients (308 in tumor group, 1,094 in OA group were involved in this study. The rate of asymptomatic DVT (Deep vein thrombosis was significantly higher in tumor group when compared with OA group. Though both the incidence of symptomatic DVT and PE (Pulmonary embolism were slightly higher in tumor group, no significant difference was detected. Tumor patients suffered an almost equal risk of VTE compared with OA patients except a higher rate of asymptomatic DVT after total artificial joint replacement. For patients with tumor, no significant association was observed between any potential risk factor and DVT.

Role of self-efficacy and social support in short-term recovery after total hip replacement: a prospective cohort study.

NARCIS (Netherlands)

Brembo, E.A.; Kapstad, H.; Dulmen, S. van; Eide, H.

2017-01-01

Background: Despite the overall success of total hip replacement (THR) in patients with symptomatic osteoarthritis (OA), up to one-quarter of patients report suboptimal recovery. The aim of this study was to determine whether social support and general self-efficacy predict variability in short-term

Cemented total hip replacement cable debris and acetabular construct durability.

Science.gov (United States)

Altenburg, Aaron J; Callaghan, John J; Yehyawi, Tameem M; Pedersen, Douglas R; Liu, Steve S; Leinen, Jessica A; Dahl, Kevin A; Goetz, Devon D; Brown, Thomas D; Johnston, Richard C

2009-07-01

wire groups, respectively, at twenty years (p = 0.03). Because cable trochanteric attachment led to significantly greater polyethylene wear, osteolysis, acetabular loosening, and acetabular revision, presumably due to third-body metallic debris generation in this cemented total hip replacement construct, surgeons should be aware of the deleterious effects of third-body debris and avoid the use of potential debris generators in the total hip arthroplasty construct. If cable is used and fretting is recognized, especially with intra-articular migration of metallic material or nonunion of the greater trochanter, consideration should be given to cable removal.

Audit on the Efficient Use of Cross-Matched Blood in Elective Total Hip and Total Knee Replacement

Science.gov (United States)

Rogers, BA; Johnstone, DJ

2006-01-01

INTRODUCTION This prospective audit studies the use of cross-matched blood in 301 patients over a 1-year period undergoing total knee (TKR) and total hip replacement (THR) surgery in an orthopaedic unit. PATIENTS AND METHODS Analysis over the first 6 months revealed a high level of unnecessary cross-matched blood. The following interventions were introduced: (i) to cease routine cross-matching for THR; (ii) all patients to have a check full blood count on day 2 after surgery; and (iii) Hb < 8 g/dl to be considered as the trigger for transfusion in patients over 65 years and free from significant co-morbidity. These changes are in accordance with published national guidelines [Anon. Guidelines for the clinical use of red cell transfusions. Br J Haematol 2001; 113: 24–31]. RESULTS In the next 6 months, the number of units cross-matched but not transfused fell by 96% for THR, and the cross-match transfusion (C:T) ratio reduced from 3.21 to 1.62. Reductions were also observed for the TKR cohort. These results provide evidence of a substantial risk and cost benefit in the use of this limited resource. A telephone survey of 44 hospitals revealed that 20 hospitals routinely cross-matched blood for THR and 11 do so for TKR. CONCLUSIONS Changes can be made to the Maximum Surgical Blood Ordering Schedules (MSBOS) in other orthopaedic units according to national guidelines. PMID:16551419

Early self-managed focal sensorimotor rehabilitative training enhances functional mobility and sensorimotor function in patients following total knee replacement: a controlled clinical trial.

Science.gov (United States)

Moutzouri, Maria; Gleeson, Nigel; Coutts, Fiona; Tsepis, Elias; John, Gliatis

2018-02-01

To assess the effects of early self-managed focal sensorimotor training compared to functional exercise training after total knee replacement on functional mobility and sensorimotor function. A single-blind controlled clinical trial. University Hospital of Rion, Greece. A total of 52 participants following total knee replacement. The primary outcome was the Timed Up and Go Test and the secondary outcomes were balance, joint position error, the Knee Outcome Survey Activities of Daily Living Scale, and pain. Patients were assessed on three separate occasions (presurgery, 8 weeks post surgery, and 14 weeks post surgery). Participants were randomized to either focal sensorimotor exercise training (experimental group) or functional exercise training (control group). Both groups received a 12-week home-based programme prescribed for 3-5 sessions/week (35-45 minutes). Consistently greater improvements ( F 2,98  = 4.3 to 24.8; P effect size range of 1.3-6.5. Overall, the magnitude of improvements in functional mobility and sensorimotor function endorses using focal sensorimotor training as an effective mode of rehabilitation following knee replacement.

Traumatic Dislodgement of Tibial Polyethylene Insert after a High-Flex Posterior-Stabilized Total Knee Replacement

Directory of Open Access Journals (Sweden)

Juan Felix Astoul Bonorino

2015-01-01

Full Text Available Many pathologic entities can produce a painful total knee replacement (TKR that may lead to potential prosthetic failure. Polyethylene insert dissociation from the tibial baseplate has been described most frequently after mobile-bearing and cruciate-retaining TKRs. However, only 3 tibial insert dislocations in primary fixed-bearing High-Flex posterior-stabilized TKRs have been reported. We present a new case of tibial insert dislocation in a High-Flex model that shares similarities and differences with the cases reported, facilitating the analysis of the potential causes, which still remain undefined.

Late Streptococcus bovis infection of total knee replacement complicated by infective endocarditis and associated with colonic ulcers

Science.gov (United States)

Nagy, Mathias Thomas; Hla, Sann Minn; Keys, Graham Watson

2013-01-01

Streptococcus bovis is rare cause of late infections after total knee replacement (TKR). This report presents a case of confirmed late septic arthritis following TKR caused by S bovis that was further complicated with infective endocarditis resulting in aortic valve insufficiency in an immunecompetent patient. As an association between S bovis and gastrointestinal malignancies is suggested, a workup for such malignancies was performed that revealed non-malignant ulcers in patient's ascending colon. The patient is currently recovering from his aortic valve replacement surgery and is scheduled to have annual colonoscopies. His knee joint has improved; however, he developed constant pain because of underlying chronic infection in the affected joint and has difficulties mobilising. Therefore, a revision TKR is considered but postponed until he fully recovers from his heart valve surgery. PMID:23744853

[Total reverse shoulder replacement. Evaluation of the clinical results and complications in a series of 52 cases].

Science.gov (United States)

Cáceres-Sánchez, L; Mesa-Mateo, A; Barrionuevo-Sánchez, F J; García-Benítez, B; Expósito-Triano, S

2015-01-01

To evaluate the clinical results and analyse the complications of total reverse shoulder replacement performed in our centre over an 8 year period. A retrospective study was conducted on 50 patients (52 shoulders), with a mean age of 70.15 years (range 51 to 84 years) between December 2004 and December 2012, who received a total reverse shoulder replacement, all performed by the same surgeon. The results have been evaluated according to clinical data, radiography study, a satisfaction scale, and the Constant scale, with a minimum follow-up of 16 months. Five of the cases (9.62%) had been intervened due to fractures of the proximal end of the humerus, 6 cases (11.53%) as surgical consequence of a prosthesis revision, 10 cases (19.23%) due to fracture sequelae, and 30 cases (59.62%) were patients with arthropathy due to a massive fracture of the rotator cuff. After a mean follow up of 35.78 months (range, 16-82), satisfactory clinical results were obtained in 80% of cases, with a mean preoperative Constant of 27.7 points, and reaching 67.1 points 12 months after the operation. On the visual analogue scale, 8.25 points were obtained before the surgery, which decreased to 2.25 points 12 months later. The complications rate was 15.38%, which were due to an intra-operative fracture (1.92%), deep infection (3.84%), instability (3.84%), and early mechanical loosening (3.84%). Scapular notching was observed in the radiographic study in 9 (17.3%) cases. After the results obtained, it could be said that total reverse shoulder replacement achieved encouraging results in the short term for the treatment of glenohumeral arthrosis and massive tears of the rotary cuff. On analysing our series, it can be seen that the complications rate is much higher when it is used to treat fracture sequelae in which there is a loss of proximal humerus bone stock. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

Ranking hospitals for outcomes in total hip replacement - administrative data with or without patient surveys? - Part 2: Patient survey and administrative data

Directory of Open Access Journals (Sweden)

Schäfer, Thomas

2007-03-01

Full Text Available Background: Many hospital rankings rely on the frequency of adverse outcomes and are based on administrative data. In the study presented here, we tried to find out, to what extent available administrative data of German Sickness Funds allow for an adequate hospital ranking and compared this with rankings based on additional information derived from a patient survey. Total hip replacement was chosen as an example procedure. In part II of the publication, we present the results of the approach based on administrative and patient-derived data. Methods: We used administrative data from a large health insurance (AOK-Lower Saxony of the year 2002 and from a patient survey. The study population comprised mainly beneficiaries, who received primary total hip replacement in the year 2002, were mailed a survey 6 month post-operatively and participated in the survey. Performance indicators used where “Revision”, “Complications” and “Change of functional impairment”. Hospitals were ranked if they performed at least 20 procedures on AOK-beneficiaries. Multivariate modelling (logistic regression and generalized linear models was used to estimate the performance indicators by case-mix variables (a.o. age, sex, co-morbidity, medical history and hospital characteristics (hospital size, surgical volume. The actual ranking was based on these multivariate models, excluding hospital variables and adding dummy-variables for each hospital. Hospitals were ranked by their case-mix adjusted odds ratio or Standardized Difference (SDR with respect to a pre-selected reference hospital. The resulting rankings were compared with each other and with regard to the impact of case-mix variables. Results: 4089 beneficiaries received primary total hip replacement in 2002. 3293 patients participated in the survey (80.5%. The ranking included 60 hospitals. The agreement of rankings based on different performance indicators in the same year was low to high (a correlation

2TB hard disk drive

CERN Multimedia

This particular object was used up until 2012 in the Data Centre. It slots into one of the Disk Server trays. Hard disks were invented in the 1950s. They started as large disks up to 20 inches in diameter holding just a few megabytes (link is external). They were originally called "fixed disks" or "Winchesters" (a code name used for a popular IBM product). They later became known as "hard disks" to distinguish them from "floppy disks (link is external)." Hard disks have a hard platter that holds the magnetic medium, as opposed to the flexible plastic film found in tapes and floppies.

The effect of tourniquet deflation on hemodynamics and regional cerebral oxygen saturation in aged patients undergoing total knee replacement surgery.

Science.gov (United States)

Song, Inkyung; Kim, Dong Yeon; Kim, Youn Jin

2012-11-01

Inflation and deflation of a pneumatic tourniquet used in total knee replacement surgery induces various changes in patient's hemodynamic and metabolic status, which may result in serious complications, especially in aged patients. Near-infrared spectroscopy (NIRS) is a monitoring device designed to estimate the regional cerebral oxygen saturation. We evaluated the effect of tourniquet deflation on hemodynamics and regional cerebral oxygen saturation in aged patients undergoing total knee replacement surgery, using NIRS. Twenty-eight American Society of Anesthesiologists physical status I or II patients, over the age of sixty-five years undergoing total knee replacement surgery, were included. Under general anesthesia, the mean arterial pressure (MAP), heart rate (HR), cardiac output (CO), stroke volume (SV), and regional cerebral oxygen saturation (rSO(2)) were recorded before induction of anesthesia and every 2 min after tourniquet deflation for 20 min. Arterial blood gas analysis was performed 5 min before, in addition to 0, and 10 min after tourniquet deflation. The decrease of rSO(2) was not significant during 20-min deflation period. MAP, CO and SV showed significant decrease during 2 to 12, 4 to 6 and 2 to 6-min period after tourniquet deflation, respectively (P deflation caused significant changes in hemodynamic and metabolic status, but not in regional cerebral oxygen saturation. It is recommended to monitor neurologic status, as well as hemodynamic and metabolic status to avoid serious complications, especially in aged patients.

The use of clinical analysis of movements in evaluation of motor functional status of patients after total hip replacement

Directory of Open Access Journals (Sweden)

Romakina N.A.

2016-06-01

Full Text Available Aim: to estimate functional status of coxarthrosis in patients requiring total hip replacement of the two hip joints. Material and methods. The biomechanical examination of 94 patients with bilateral primary coxarthrosis before and after total hip replacement was performed using clinical stabilometric software complex. The ability to perceive the mechanical load during standing and walking was evaluated at different stages of the treatment. The difference between the samples was estimated with the use of Mann — Whitney U-test. The rank correlation of biomechanical parameters was measured by Spearman coefficient. Results. It was revealed that the most responsive indicators are the transfer period, the first and second periods of double support and the deviation of the center of pressure relative to the average position in the frontal plane. Conclusion. After surgical treatment there was observed some improvement: the-left-and-right-step asymmetry decrease, rhythm rate increase, improved ability to maintain body balance, jog reactions increase.

Complications in total and partial hip and knee replacement in the San Jose Universitary Hospital Popayan

Directory of Open Access Journals (Sweden)

Alejandro Sandoval-Daza

2010-03-01

Full Text Available Introduction: Total hip and knee replacements are surgical procedures commonly used in cases of degenerative articular problems, intrarticular fractures and less common in tumor conditions. Despite its great success complications can arise. Objective: Describe complications in total knee and hip replacements. Methods: A descriptive study, cases serie was done in Hospital Universitario San José in Popayán Colombia, analyzing the period between January 2004 and January 2009, Seventy six patients were included: 53 total hips replacements, 12 cases of partial hip replacements and 11 total knee replacements. Patient's age was in the range between 27 and 97. Results: The main complications founded were: respiratory insufficiency, inability to place the prosthesis, prosthesis dislocation, anemic syndrome, acetabular protrusion, infection, iatrogenic Gushing's syndrome, discrepancy of length limb, residual pain, inability to walk, nosocomial pneumonia, renal failure and periprosthetic fracture. An average of 4, 6% mortality index, 10, 8% hip prosthesis dislocation, 9, 2% infections, all these indices over the different literature reports.

DISK DETECTIVE: DISCOVERY OF NEW CIRCUMSTELLAR DISK CANDIDATES THROUGH CITIZEN SCIENCE

Energy Technology Data Exchange (ETDEWEB)

Kuchner, Marc J.; McElwain, Michael; Padgett, Deborah L. [NASA Goddard Space Flight Center Exoplanets and Stellar Astrophysics Laboratory, Code 667 Greenbelt, MD 21230 (United States); Silverberg, Steven M.; Wisniewski, John P. [Homer L. Dodge Department of Physics and Astronomy The University of Oklahoma 440 W. Brooks St. Norman, OK 73019 (United States); Bans, Alissa S. [Valparaiso University, Department of Physics and Astronomy, Neils Science Center, 1610 Campus Drive East, Valparaiso, IN 46383 (United States); Bhattacharjee, Shambo [International Space University 1 Rue Jean-Dominique Cassini F-67400 Illkirch-Graffenstaden (France); Kenyon, Scott J. [Smithsonian Astrophysical Observatory 60 Garden Street Cambridge, MA 02138 (United States); Debes, John H. [Space Telescope Science Institute 3700 San Martin Dr. Baltimore, MD 21218 (United States); Currie, Thayne [National Astronomical Observatory of Japan 650 N A’ohokhu Place Hilo, HI 96720 (United States); García, Luciano [Observatorio Astronómico de Córdoba Universidad Nacional de Córdoba Laprida 854, X5000BGR, Córdoba (Argentina); Jung, Dawoon [Korea Aerospace Research Institute Lunar Exploration Program Office 169-84 Gwahak-ro, Yuseong-gu, Daejeon 34133 (Korea, Republic of); Lintott, Chris [Denys Wilkinson Building Keble Road Oxford, OX1 3RH (United Kingdom); Rebull, Luisa M. [Infrared Processing and Analaysis Center Caltech M/S 314-6 1200 E. California Blvd. Pasadena, CA 91125 (United States); Nesvold, Erika, E-mail: Marc.Kuchner@nasa.gov, E-mail: michael.w.mcelwain@nasa.gov, E-mail: deborah.l.padgett@nasa.gov, E-mail: carol.a.grady@nasa.gov, E-mail: silverberg@ou.edu, E-mail: wisniewski@ou.edu [Department of Terrestrial Magnetism, Carnegie Institution of Washington, 5241 Broad Branch Road, NW, Washington, DC 20015-1305 (United States); Collaboration: Disk Detective Collaboration; and others

2016-10-20

The Disk Detective citizen science project aims to find new stars with 22 μ m excess emission from circumstellar dust using data from NASA’s Wide-field Infrared Survey Explorer ( WISE ) mission. Initial cuts on the AllWISE catalog provide an input catalog of 277,686 sources. Volunteers then view images of each source online in 10 different bands to identify false positives (galaxies, interstellar matter, image artifacts, etc.). Sources that survive this online vetting are followed up with spectroscopy on the FLWO Tillinghast telescope. This approach should allow us to unleash the full potential of WISE for finding new debris disks and protoplanetary disks. We announce a first list of 37 new disk candidates discovered by the project, and we describe our vetting and follow-up process. One of these systems appears to contain the first debris disk discovered around a star with a white dwarf companion: HD 74389. We also report four newly discovered classical Be stars (HD 6612, HD 7406, HD 164137, and HD 218546) and a new detection of 22 μ m excess around the previously known debris disk host star HD 22128.

DISK DETECTIVE: DISCOVERY OF NEW CIRCUMSTELLAR DISK CANDIDATES THROUGH CITIZEN SCIENCE

International Nuclear Information System (INIS)

Kuchner, Marc J.; McElwain, Michael; Padgett, Deborah L.; Silverberg, Steven M.; Wisniewski, John P.; Bans, Alissa S.; Bhattacharjee, Shambo; Kenyon, Scott J.; Debes, John H.; Currie, Thayne; García, Luciano; Jung, Dawoon; Lintott, Chris; Rebull, Luisa M.; Nesvold, Erika

2016-01-01

The Disk Detective citizen science project aims to find new stars with 22 μ m excess emission from circumstellar dust using data from NASA’s Wide-field Infrared Survey Explorer ( WISE ) mission. Initial cuts on the AllWISE catalog provide an input catalog of 277,686 sources. Volunteers then view images of each source online in 10 different bands to identify false positives (galaxies, interstellar matter, image artifacts, etc.). Sources that survive this online vetting are followed up with spectroscopy on the FLWO Tillinghast telescope. This approach should allow us to unleash the full potential of WISE for finding new debris disks and protoplanetary disks. We announce a first list of 37 new disk candidates discovered by the project, and we describe our vetting and follow-up process. One of these systems appears to contain the first debris disk discovered around a star with a white dwarf companion: HD 74389. We also report four newly discovered classical Be stars (HD 6612, HD 7406, HD 164137, and HD 218546) and a new detection of 22 μ m excess around the previously known debris disk host star HD 22128.

Disk Detective: Discovery of New Circumstellar Disk Candidates Through Citizen Science

Science.gov (United States)

Kuchner, Marc J.; Silverberg, Steven M.; Bans, Alissa S.; Bhattacharjee, Shambo; Kenyon, Scott J.; Debes, John H.; Currie, Thayne; Garcia, Luciano; Jung, Dawoon; Lintott, Chris;

Biomechanical Considerations in the Design of High-Flexion Total Knee Replacements

Directory of Open Access Journals (Sweden)

Cheng-Kung Cheng

2014-01-01

Full Text Available Typically, joint arthroplasty is performed to relieve pain and improve functionality in a diseased or damaged joint. Total knee arthroplasty (TKA involves replacing the entire knee joint, both femoral and tibial surfaces, with anatomically shaped artificial components in the hope of regaining normal joint function and permitting a full range of knee flexion. In spite of the design of the prosthesis itself, the degree of flexion attainable following TKA depends on a variety of factors, such as the joint’s preoperative condition/flexion, muscle strength, and surgical technique. High-flexion knee prostheses have been developed to accommodate movements that require greater flexion than typically achievable with conventional TKA; such high flexion is especially prevalent in Asian cultures. Recently, computational techniques have been widely used for evaluating the functionality of knee prostheses and for improving biomechanical performance. To offer a better understanding of the development and evaluation techniques currently available, this paper aims to review some of the latest trends in the simulation of high-flexion knee prostheses.

Preparation of thin actinide metal disks using a multiple disk casting technique

International Nuclear Information System (INIS)

Conner, W.V.

1975-01-01

A casting technique has been developed for preparing multiple actinide metal disks which have a minimum thickness of 0.006 inch. This technique was based on an injection casting procedure which utilizes the weight of a tantalum metal rod to force the molten metal into the mold cavity. Using the proper mold design and casting parameters, it has been possible to prepare ten 1/2 inch diameter neptunium or plutonium metal disks in a single casting, This casting technique is capable of producing disks which are very uniform. The average thickness of the disks from a typical casting will vary no more than 0.001 inch and the variation in the thickness of the individual disks will range from 0.0001 to 0.0005 inch. (Auth.)

Preparation of thin actinide metal disks using a multiple disk casting technique

International Nuclear Information System (INIS)

Conner, W.V.

1976-01-01

A casting technique has been developed for preparing multiple actinide metal disks which have a minimum thickness of 0.006 inch. This technique was based on an injection casting procedure which utilizes the weight of a tantalum metal rod to force the molten metal into the mold cavity. Using the proper mold design and casting parameters, it has been possible to prepare ten 1/2 inch diameter neptunium or plutonium metal disks in a single casting. This casting technique is capable of producing disks which are very uniform. The average thickness of the disks from a typical casting will vary no more than 0.001 inch and the variation in the thickness of the individual disks will range from 0.0001 to 0.0005 inch. (author)

STELLAR POPULATIONS AND RADIAL MIGRATIONS IN VIRGO DISK GALAXIES

International Nuclear Information System (INIS)

Roediger, Joel C.; Courteau, Stéphane; Sánchez-Blázquez, Patricia; McDonald, Michael

2012-01-01

We present new stellar age profiles, derived from well-resolved optical and near-infrared images of 64 Virgo cluster disk galaxies, whose analysis poses a challenge for current disk galaxy formation models. Our ability to break the age-metallicity degeneracy and the significant size of our sample represent key improvements over complementary studies of field disk galaxies. Our results can be summarized as follows: first, and contrary to observations of disk galaxies in the field, these cluster galaxies are distributed almost equally amongst the three main types of disk galaxy luminosity profiles (I/II/III), indicating that the formation and/or survival of Type II breaks is suppressed within the cluster environment. Second, we find examples of statistically significant inversions ( U -shapes ) in the age profiles of all three disk galaxy types, reminiscent of predictions from high-resolution simulations of classically truncated Type II disks in the field. These features characterize the age profiles for only about a third (≤36%) of each disk galaxy type in our sample. An even smaller fraction of cluster disks (∼11% of the total sample) exhibit age profiles that decrease outward (i.e., negative age gradients). Instead, flat and/or positive age gradients prevail (≥50%) within our Type I, II, and III subsamples. These observations thus suggest that while stellar migrations and inside-out growth can play a significant role in the evolution of all disk galaxy types, other factors contributing to the evolution of galaxies can overwhelm the predicted signatures of these processes. We interpret our observations through a scenario whereby Virgo cluster disk galaxies formed initially like their brethren in the field but which, upon falling into the cluster, were transformed into their present state through external processes linked to the environment (e.g., ram-pressure stripping and harassment). Current disk galaxy formation models, which have largely focused on field

Technical advantages of disk laser technology in short and ultrashort pulse processes

Science.gov (United States)

Graham, P.; Stollhof, J.; Weiler, S.; Massa, S.; Faisst, B.; Denney, P.; Gounaris, E.

2011-03-01

This paper demonstrates that disk-laser technology introduces advantages that increase efficiency and allows for high productivity in micro-processing in both the nanosecond (ns) and picosecond (ps) regimes. Some technical advantages of disk technology include not requiring good pump beam quality or special wavelengths for pumping of the disk, high optical efficiencies, no thermal lensing effects and a possible scaling of output power without an increase of pump beam quality. With cavity-dumping, the pulse duration of the disk laser can be specified between 30 and hundreds of nanoseconds, but is independent of frequency, thus maintaining process stability. TRUMPF uses this technology in the 750 watts average power laser TruMicro 7050. High intensity, along with fluency, is important for high ablation rates in thinfilm removal. Thus, these ns lasers show high removal rates, above 60 cm2/s, in thin-film solar cell production. In addition, recent results in paint-stripping of aerospace material prove the green credentials and high processing rates inherent with this technology as it can potentially replace toxic chemical processes. The ps disk technology meanwhile is used in, for example, scribing of solar cells, wafer dicing and drilling injector nozzles, as the pulse duration is short enough to minimize heat input in the laser-matter interaction. In the TruMicro Series 5000, the multi-pass regenerative amplifier stage combines high optical-optical efficiencies together with excellent output beam quality for pulse durations of only 6 ps and high pulse energies of up to 0.25 mJ.

The natural course of radionuclide bone scanning in the evaluation of total knee replacement--a 2 year prospective study

DEFF Research Database (Denmark)

Duus, B R; Boeckstyns, M; Stadeager, Carsten Preben

1990-01-01

In order to establish the natural course of radionuclide bone scanning images after total knee replacement 41 consecutive patients were scheduled for examination 3, 7, 12 and 24 months after surgery. The mean age was 69 years (range 50-80 years); the female:male ratio was 4:1. Thirty-two patients...... completed the entire program. A total of 143 99Tcm medronic acid complex scintigrams was performed. No significant difference between the grades of total scintigraphic uptake at any of the four examinations nor any difference between the first and the last examinations could be demonstrated (P = 0...

Total knee replacement induces peripheral blood lymphocytes apoptosis and it is not prevented by regional anesthesia - a randomized study.

Science.gov (United States)

Kosel, Juliusz; Rusak, Małgorzata; Gołembiewski, Łukasz; Dąbrowska, Milena; Siemiątkowski, Andrzej

2016-01-01

Among the many changes caused by a surgical insult one of the least studied is postoperative immunosuppression. This phenomenon is an important cause of infectious complications of surgery such as surgical site infection or hospital acquired pneumonia. One of the mechanisms leading to postoperative immunosuppression is the apoptosis of immunological cells. Anesthesia during surgery is intended to minimize harmful changes and maintain perioperative homeostasis. The aim of the study was evaluation of the effect of the anesthetic technique used for total knee replacement on postoperative peripheral blood lymphocyte apoptosis. 34 patients undergoing primary total knee replacement were randomly assigned to two regional anesthetic protocols: spinal anesthesia and combined spinal-epidural anesthesia. 11 patients undergoing total knee replacement under general anesthesia served as control group. Before surgery, immediately after surgery, during first postoperative day and seven days after the surgery venous blood samples were taken and the immunological status of the patient was assessed with the use of flow cytometry, along with lymphocyte apoptosis using fluorescent microscopy. Peripheral blood lymphocyte apoptosis was seen immediately in the postoperative period and was accompanied by a decrease of the number of T cells and B cells. There were no significant differences in the number of apoptotic lymphocytes according to the anesthetic protocol. Changes in the number of T CD3/8 cells and the number of apoptotic lymphocytes were seen on the seventh day after surgery. Peripheral blood lymphocyte apoptosis is an early event in the postoperative period that lasts up to seven days and is not affected by the choice of the anesthetic technique. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

Total knee replacement induces peripheral blood lymphocytes apoptosis and it is not prevented by regional anesthesia - a randomized study

Directory of Open Access Journals (Sweden)

Juliusz Kosel

2016-04-01

Full Text Available ABSTRACT BACKGROUND: Among the many changes caused by a surgical insult one of the least studied is postoperative immunosuppression. This phenomenon is an important cause of infectious complications of surgery such as surgical site infection or hospital acquired pneumonia. One of the mechanisms leading to postoperative immunosuppression is the apoptosis of immunological cells. Anesthesia during surgery is intended to minimize harmful changes and maintain perioperative homeostasis. The aim of the study was evaluation of the effect of the anesthetic technique used for total knee replacement on postoperative peripheral blood lymphocyte apoptosis. METHODS: 34 patients undergoing primary total knee replacement were randomly assigned to two regional anesthetic protocols: spinal anesthesia and combined spinal-epidural anesthesia. 11 patients undergoing total knee replacement under general anesthesia served as control group. Before surgery, immediately after surgery, during first postoperative day and seven days after the surgery venous blood samples were taken and the immunological status of the patient was assessed with the use of flow cytometry, along with lymphocyte apoptosis using fluorescent microscopy. RESULTS: Peripheral blood lymphocyte apoptosis was seen immediately in the postoperative period and was accompanied by a decrease of the number of T cells and B cells. There were no significant differences in the number of apoptotic lymphocytes according to the anesthetic protocol. Changes in the number of T CD3/8 cells and the number of apoptotic lymphocytes were seen on the seventh day after surgery. CONCLUSION: Peripheral blood lymphocyte apoptosis is an early event in the postoperative period that lasts up to seven days and is not affected by the choice of the anesthetic technique.

ON THE TRANSITIONAL DISK CLASS: LINKING OBSERVATIONS OF T TAURI STARS AND PHYSICAL DISK MODELS

International Nuclear Information System (INIS)

Espaillat, C.; Andrews, S.; Qi, C.; Wilner, D.; Ingleby, L.; Calvet, N.; Hernández, J.; Furlan, E.; D'Alessio, P.; Muzerolle, J.

2012-01-01

Two decades ago 'transitional disks' (TDs) described spectral energy distributions (SEDs) of T Tauri stars with small near-IR excesses, but significant mid- and far-IR excesses. Many inferred this indicated dust-free holes in disks possibly cleared by planets. Recently, this term has been applied disparately to objects whose Spitzer SEDs diverge from the expectations for a typical full disk (FD). Here, we use irradiated accretion disk models to fit the SEDs of 15 such disks in NGC 2068 and IC 348. One group has a 'dip' in infrared emission while the others' continuum emission decreases steadily at all wavelengths. We find that the former have an inner disk hole or gap at intermediate radii in the disk and we call these objects 'transitional disks' and 'pre-transitional disks' (PTDs), respectively. For the latter group, we can fit these SEDs with FD models and find that millimeter data are necessary to break the degeneracy between dust settling and disk mass. We suggest that the term 'transitional' only be applied to objects that display evidence for a radical change in the disk's radial structure. Using this definition, we find that TDs and PTDs tend to have lower mass accretion rates than FDs and that TDs have lower accretion rates than PTDs. These reduced accretion rates onto the star could be linked to forming planets. Future observations of TDs and PTDs will allow us to better quantify the signatures of planet formation in young disks.

Disk storage at CERN

CERN Document Server

Mascetti, L; Chan, B; Espinal, X; Fiorot, A; Labrador, H Gonz; Iven, J; Lamanna, M; Presti, G Lo; Mościcki, JT; Peters, AJ; Ponce, S; Rousseau, H; van der Ster, D

2015-01-01

CERN IT DSS operates the main storage resources for data taking and physics analysis mainly via three system: AFS, CASTOR and EOS. The total usable space available on disk for users is about 100 PB (with relative ratios 1:20:120). EOS actively uses the two CERN Tier0 centres (Meyrin and Wigner) with 50:50 ratio. IT DSS also provide sizeable on-demand resources for IT services most notably OpenStack and NFS-based clients: this is provided by a Ceph infrastructure (3 PB) and few proprietary servers (NetApp). We will describe our operational experience and recent changes to these systems with special emphasis to the present usages for LHC data taking, the convergence to commodity hardware (nodes with 200-TB each with optional SSD) shared across all services. We also describe our experience in coupling commodity and home-grown solution (e.g. CERNBox integration in EOS, Ceph disk pools for AFS, CASTOR and NFS) and finally the future evolution of these systems for WLCG and beyond.

Disk storage at CERN

Science.gov (United States)

Mascetti, L.; Cano, E.; Chan, B.; Espinal, X.; Fiorot, A.; González Labrador, H.; Iven, J.; Lamanna, M.; Lo Presti, G.; Mościcki, JT; Peters, AJ; Ponce, S.; Rousseau, H.; van der Ster, D.

2015-12-01

CERN IT DSS operates the main storage resources for data taking and physics analysis mainly via three system: AFS, CASTOR and EOS. The total usable space available on disk for users is about 100 PB (with relative ratios 1:20:120). EOS actively uses the two CERN Tier0 centres (Meyrin and Wigner) with 50:50 ratio. IT DSS also provide sizeable on-demand resources for IT services most notably OpenStack and NFS-based clients: this is provided by a Ceph infrastructure (3 PB) and few proprietary servers (NetApp). We will describe our operational experience and recent changes to these systems with special emphasis to the present usages for LHC data taking, the convergence to commodity hardware (nodes with 200-TB each with optional SSD) shared across all services. We also describe our experience in coupling commodity and home-grown solution (e.g. CERNBox integration in EOS, Ceph disk pools for AFS, CASTOR and NFS) and finally the future evolution of these systems for WLCG and beyond.

THE SPITZER INFRARED SPECTROGRAPH SURVEY OF PROTOPLANETARY DISKS IN ORION A. I. DISK PROPERTIES

Energy Technology Data Exchange (ETDEWEB)

Kim, K. H. [Korea Astronomy and Space Science Institute (KASI), 776, Daedeokdae-ro, Yuseong-gu, Daejeon 305-348 (Korea, Republic of); Watson, Dan M.; Manoj, P.; Forrest, W. J. [Department of Physics and Astronomy, University of Rochester, Rochester, NY 14627 (United States); Furlan, Elise [Infrared Processing and Analysis Center, Caltech, 770 S. Wilson Avenue, Pasadena, CA 91125 (United States); Najita, Joan [National Optical Astronomy Observatory, 950 North Cherry Avenue, Tucson, AZ 85719 (United States); Sargent, Benjamin [Center for Imaging Science and Laboratory for Multiwavelength Astrophysics, Rochester Institute of Technology, 54 Lomb Memorial Dr., Rochester, NY 14623 (United States); Hernández, Jesús [Centro de Investigaciones de Astronomía, Apdo. Postal 264, Mérida 5101-A (Venezuela, Bolivarian Republic of); Calvet, Nuria [Department of Astronomy, University of Michigan, 830 Dennison Building, 500 Church Street, Ann Arbor, MI 48109 (United States); Adame, Lucía [Facultad de Ciencias Físico-Matemáticas, Universidad Autónoma de Nuevo León, Av. Universidad S/N, San Nicolás de los Garza, Nuevo León, C.P. 66451, México (Mexico); Espaillat, Catherine [Department of Astronomy, Boston University, 725 Commonwealth Avenue, Boston, MA 02215 (United States); Megeath, S. T. [Ritter Astrophysical Research Center, Department of Physics and Astronomy, University of Toledo, 2801 W. Bancroft St., Toledo, OH 43606 (United States); Muzerolle, James, E-mail: quarkosmos@kasi.re.kr [Space Telescope Science Institute, 3700 San Martin Drive, Baltimore, MD 21218 (United States); and others

2016-09-01

We present our investigation of 319 Class II objects in Orion A observed by Spitzer /IRS. We also present the follow-up observations of 120 of these Class II objects in Orion A from the Infrared Telescope Facility/SpeX. We measure continuum spectral indices, equivalent widths, and integrated fluxes that pertain to disk structure and dust composition from IRS spectra of Class II objects in Orion A. We estimate mass accretion rates using hydrogen recombination lines in the SpeX spectra of our targets. Utilizing these properties, we compare the distributions of the disk and dust properties of Orion A disks with those of Taurus disks with respect to position within Orion A (Orion Nebular Cluster [ONC] and L1641) and with the subgroups by the inferred radial structures, such as transitional disks (TDs) versus radially continuous full disks (FDs). Our main findings are as follows. (1) Inner disks evolve faster than the outer disks. (2) The mass accretion rates of TDs and those of radially continuous FDs are statistically significantly displaced from each other. The median mass accretion rate of radially continuous disks in the ONC and L1641 is not very different from that in Taurus. (3) Less grain processing has occurred in the disks in the ONC compared to those in Taurus, based on analysis of the shape index of the 10 μ m silicate feature ( F {sub 11.3}/ F {sub 9.8}). (4) The 20–31 μ m continuum spectral index tracks the projected distance from the most luminous Trapezium star, θ {sup 1} Ori C. A possible explanation is UV ablation of the outer parts of disks.

Brown dwarf disks with ALMA

Energy Technology Data Exchange (ETDEWEB)

Ricci, L.; Isella, A. [Department of Astronomy, California Institute of Technology, MC 249-17, Pasadena, CA 91125 (United States); Testi, L.; De Gregorio-Monsalvo, I. [European Southern Observatory, Karl-Schwarzschild-Strasse 2, D-85748 Garching (Germany); Natta, A. [INAF-Osservatorio Astrofisico di Arcetri, Largo E. Fermi 5, I-50125 Firenze (Italy); Scholz, A., E-mail: lricci@astro.caltech.edu [School of Cosmic Physics, Dublin Institute for Advanced Studies, 31 Fitzwilliam Place, Dublin 2 (Ireland)

2014-08-10

We present Atacama Large Millimeter/submillimeter Array continuum and spectral line data at 0.89 mm and 3.2 mm for three disks surrounding young brown dwarfs and very low mass stars in the Taurus star forming region. Dust thermal emission is detected and spatially resolved for all the three disks, while CO(J = 3-2) emission is seen in two disks. We analyze the continuum visibilities and constrain the disks' physical structure in dust. The results of our analysis show that the disks are relatively large; the smallest one has an outer radius of about 70 AU. The inferred disk radii, radial profiles of the dust surface density, and disk to central object mass ratios lie within the ranges found for disks around more massive young stars. We derive from our observations the wavelength dependence of the millimeter dust opacity. In all the three disks, data are consistent with the presence of grains with at least millimeter sizes, as also found for disks around young stars, and confirm that the early stages of the solid growth toward planetesimals occur also around very low-mass objects. We discuss the implications of our findings on models of solids evolution in protoplanetary disks, the main mechanisms proposed for the formation of brown dwarfs and very low-mass stars, as well as the potential of finding rocky and giant planets around very low-mass objects.

PLANETESIMAL DISK MICROLENSING

International Nuclear Information System (INIS)

Heng, Kevin; Keeton, Charles R.

2009-01-01

Motivated by debris disk studies, we investigate the gravitational microlensing of background starlight by a planetesimal disk around a foreground star. We use dynamical survival models to construct a plausible example of a planetesimal disk and study its microlensing properties using established ideas of microlensing by small bodies. When a solar-type source star passes behind a planetesimal disk, the microlensing light curve may exhibit short-term, low-amplitude residuals caused by planetesimals several orders of magnitude below Earth mass. The minimum planetesimal mass probed depends on the photometric sensitivity and the size of the source star, and is lower when the planetesimal lens is located closer to us. Planetesimal lenses may be found more nearby than stellar lenses because the steepness of the planetesimal mass distribution changes how the microlensing signal depends on the lens/source distance ratio. Microlensing searches for planetesimals require essentially continuous monitoring programs that are already feasible and can potentially set constraints on models of debris disks, the progeny of the supposed extrasolar analogues of Kuiper Belts.

Dusty disks around young stars

NARCIS (Netherlands)

Verhoeff, A.

2009-01-01

Stars are formed through the collapse of giant molecular clouds. During this contraction the matter spins up and naturally forms a circumstellar disk. Once accretion comes to a halt, these disks are relatively stable. Some disks are known to last up to 10 Myrs. Most disks however, dissipate on

Debris Disks: Probing Planet Formation

OpenAIRE

Wyatt, Mark C.

2018-01-01

Debris disks are the dust disks found around ~20% of nearby main sequence stars in far-IR surveys. They can be considered as descendants of protoplanetary disks or components of planetary systems, providing valuable information on circumstellar disk evolution and the outcome of planet formation. The debris disk population can be explained by the steady collisional erosion of planetesimal belts; population models constrain where (10-100au) and in what quantity (>1Mearth) planetesimals (>10km i...

Fast, Capacious Disk Memory Device

Science.gov (United States)

Muller, Ronald M.

1990-01-01

Device for recording digital data on, and playing back data from, memory disks has high recording or playback rate and utilizes available recording area more fully. Two disks, each with own reading/writing head, used to record data at same time. Head on disk A operates on one of tracks numbered from outside in; head on disk B operates on track of same number in sequence from inside out. Underlying concept of device applicable to magnetic or optical disks.

The Circumstellar Disk and Asymmetric Outflow of the EX Lup Outburst System

Science.gov (United States)

Hales, A. S.; Pérez, S.; Saito, M.; Pinte, C.; Knee, L. B. G.; de Gregorio-Monsalvo, I.; Dent, B.; López, C.; Plunkett, A.; Cortés, P.; Corder, S.; Cieza, L.

2018-06-01

We present Atacama Large Millimeter/submillimeter Array (ALMA) observations at 0.″3 resolution of EX Lup, the prototype of the EXor class of outbursting pre-main-sequence stars. The circumstellar disk of EX Lup is resolved for the first time in 1.3 mm continuum emission and in the J = 2–1 spectral line of three isotopologues of CO. At the spatial resolution and sensitivity achieved, the compact dust continuum disk shows no indications of clumps, fragments, or asymmetries above the 5σ level. Radiative transfer modeling constrains the characteristic radius of the dust disk to 23 au and the total dust mass to 1.0 × 10‑4 M ⊙ (33 M ⊕), similar to other EXor sources. The 13CO and C18O line emissions trace the disk rotation and are used to constrain the disk geometry, kinematics, and a total gas disk mass of 5.1 × 10‑4 M ⊙. The 12CO emission extends out to a radius of 200 au and is asymmetric, with one side deviating from Keplerian rotation. We detect blueshifted, 12CO arc-like emission located 0.″8 to the northwest and spatially disconnected from the disk emission. We interpret this extended structure as the brightened walls of a cavity excavated by an outflow, which are more commonly seen in FUor sources. Such outflows have also been seen in the borderline FU/EXor object V1647 Ori, but not toward EXor objects. Our detection provides evidence that the outflow phenomenon persists into the EXor phase, suggesting that FUor and EXor objects are a continuous population in which outflow activity declines with age, with transitional objects such as EX Lup and V1647 Ori.

Gas Mass Tracers in Protoplanetary Disks: CO is Still the Best

Science.gov (United States)

Molyarova, Tamara; Akimkin, Vitaly; Semenov, Dmitry; Henning, Thomas; Vasyunin, Anton; Wiebe, Dmitri

2017-11-01

Protoplanetary disk mass is a key parameter controlling the process of planetary system formation. CO molecular emission is often used as a tracer of gas mass in the disk. In this study, we consider the ability of CO to trace the gas mass over a wide range of disk structural parameters, and we search for chemical species that could possibly be used as alternative mass tracers to CO. Specifically, we apply detailed astrochemical modeling to a large set of models of protoplanetary disks around low-mass stars to select molecules with abundances correlated with the disk mass and being relatively insensitive to other disk properties. We do not consider sophisticated dust evolution models, restricting ourselves to the standard astrochemical assumption of 0.1 μm dust. We find that CO is indeed the best molecular tracer for total gas mass, despite the fact that it is not the main carbon carrier, provided reasonable assumptions about CO abundance in the disk are used. Typically, chemical reprocessing lowers the abundance of CO by a factor of 3, compared to the case where photodissociation and freeze-out are the only ways of CO depletion. On average, only 13% C atoms reside in gas-phase CO, albeit with variations from 2% to 30%. CO2, H2O, and H2CO can potentially serve as alternative mass tracers, with the latter two only applicable if disk structural parameters are known.

Mass distributions in disk galaxies

NARCIS (Netherlands)

Martinsson, Thomas; Verheijen, Marc; Bershady, Matthew; Westfall, Kyle; Andersen, David; Swaters, Rob

We present results on luminous and dark matter mass distributions in disk galaxies from the DiskMass Survey. As expected for normal disk galaxies, stars dominate the baryonic mass budget in the inner region of the disk; however, at about four optical scale lengths (hR ) the atomic gas starts to

Partial and total fish meal replacement by agricultural products in the diets improve sperm quality in African catfish (Clarias gariepinus)

NARCIS (Netherlands)

Nyina-wamwiza, L.; Milla, S.; Pierrard, M.A.; Rurangwa, E.; Mandiki, S.N.M.; Look, van K.J.W.; Kestemont, P.

2012-01-01

This study investigated the long-term effects of total and partial replacement of dietary fish meal (FM) by a mixture of agricultural products on sperm quality of African catfish Clarias gariepinus. Four isonitrogenous and isoenergetic diets were formulated containing graded levels of either 50% FM

Calculation of total counting efficiency of a NaI(Tl) detector by hybrid Monte-Carlo method for point and disk sources

Energy Technology Data Exchange (ETDEWEB)

Yalcin, S. [Education Faculty, Kastamonu University, 37200 Kastamonu (Turkey)], E-mail: yalcin@gazi.edu.tr; Gurler, O.; Kaynak, G. [Department of Physics, Faculty of Arts and Sciences, Uludag University, Gorukle Campus, 16059 Bursa (Turkey); Gundogdu, O. [Department of Physics, School of Engineering and Physical Sciences, University of Surrey, Guildford GU2 7XH (United Kingdom)

2007-10-15

This paper presents results on the total gamma counting efficiency of a NaI(Tl) detector from point and disk sources. The directions of photons emitted from the source were determined by Monte-Carlo techniques and the photon path lengths in the detector were determined by analytic equations depending on photon directions. This is called the hybrid Monte-Carlo method where analytical expressions are incorporated into the Monte-Carlo simulations. A major advantage of this technique is the short computation time compared to other techniques on similar computational platforms. Another advantage is the flexibility for inputting detector-related parameters (such as source-detector distance, detector radius, source radius, detector linear attenuation coefficient) into the algorithm developed, thus making it an easy and flexible method to apply to other detector systems and configurations. The results of the total counting efficiency model put forward for point and disc sources were compared with the previous work reported in the literature.

Calculation of total counting efficiency of a NaI(Tl) detector by hybrid Monte-Carlo method for point and disk sources

International Nuclear Information System (INIS)

Yalcin, S.; Gurler, O.; Kaynak, G.; Gundogdu, O.

2007-01-01

This paper presents results on the total gamma counting efficiency of a NaI(Tl) detector from point and disk sources. The directions of photons emitted from the source were determined by Monte-Carlo techniques and the photon path lengths in the detector were determined by analytic equations depending on photon directions. This is called the hybrid Monte-Carlo method where analytical expressions are incorporated into the Monte-Carlo simulations. A major advantage of this technique is the short computation time compared to other techniques on similar computational platforms. Another advantage is the flexibility for inputting detector-related parameters (such as source-detector distance, detector radius, source radius, detector linear attenuation coefficient) into the algorithm developed, thus making it an easy and flexible method to apply to other detector systems and configurations. The results of the total counting efficiency model put forward for point and disc sources were compared with the previous work reported in the literature

Total hip and knee replacement surgery results in changes in leukocyte and endothelial markers

Directory of Open Access Journals (Sweden)

Maclean Kirsty M

2010-01-01

Full Text Available Abstract Background It is estimated that over 8 million people in the United Kingdom suffer from osteoarthritis. These patients may require orthopaedic surgical intervention to help alleviate their clinical condition. Investigations presented here was to test the hypothesis that total hip replacement (THR and total knee replacement (TKR orthopaedic surgery result in changes to leukocyte and endothelial markers thus increasing inflammatory reactions postoperatively. Methods During this 'pilot study', ten test subjects were all scheduled for THR or TKR elective surgery due to osteoarthritis. Leukocyte concentrations were measured using an automated full blood count analyser. Leukocyte CD11b (Mac-1 and CD62L cell surface expression, intracellular production of H2O2 and elastase were measured as markers of leukocyte function. Von Willebrand factor (vWF and soluble intercellular adhesion molecule-1 (sICAM-1 were measured as markers of endothelial activation. Results The results obtained during this study demonstrate that THR and TKR orthopaedic surgery result in similar changes of leukocyte and endothelial markers, suggestive of increased inflammatory reactions postoperatively. Specifically, THR and TKR surgery resulted in a leukocytosis, this being demonstrated by an increase in the total leukocyte concentration following surgery. Evidence of leukocyte activation was demonstrated by a decrease in CD62L expression and an increase in CD11b expression by neutrophils and monocytes respectively. An increase in the intracellular H2O2 production by neutrophils and monocytes and in the leukocyte elastase concentrations was also evident of leukocyte activation following orthopaedic surgery. With respect to endothelial activation, increases in vWF and sICAM-1 concentrations were demonstrated following surgery. Conclusion In general it appeared that most of the leukocyte and endothelial markers measured during these studies peaked between days 1

A High-mass Protobinary System with Spatially Resolved Circumstellar Accretion Disks and Circumbinary Disk

Energy Technology Data Exchange (ETDEWEB)

Kraus, S.; Kluska, J.; Kreplin, A.; Bate, M.; Harries, T. J.; Hone, E.; Anugu, A. [School of Physics, Astrophysics Group, University of Exeter, Stocker Road, Exeter EX4 4QL (United Kingdom); Hofmann, K.-H.; Weigelt, G. [Max-Planck-Institut für Radioastronomie, Auf dem Hügel 69, D-53121 Bonn (Germany); Monnier, J. D. [Department of Astronomy, University of Michigan, 311 West Hall, 1085 South University Avenue, Ann Arbor, MI 48109 (United States); De Wit, W. J. [ESO, Alonso de Cordova 3107, Vitacura, Santiago 19 (Chile); Wittkowski, M., E-mail: skraus@astro.ex.ac.uk [ESO, Karl-Schwarzschild-Str. 2, D-85748 Garching bei München (Germany)

2017-01-20

High-mass multiples might form via fragmentation of self-gravitational disks or alternative scenarios such as disk-assisted capture. However, only a few observational constraints exist on the architecture and disk structure of high-mass protobinaries and their accretion properties. Here, we report the discovery of a close (57.9 ± 0.2 mas = 170 au) high-mass protobinary, IRAS17216-3801, where our VLTI/GRAVITY+AMBER near-infrared interferometry allows us to image the circumstellar disks around the individual components with ∼3 mas resolution. We estimate the component masses to ∼20 and ∼18 M {sub ⊙} and find that the radial intensity profiles can be reproduced with an irradiated disk model, where the inner regions are excavated of dust, likely tracing the dust sublimation region in these disks. The circumstellar disks are strongly misaligned with respect to the binary separation vector, which indicates that the tidal forces did not have time to realign the disks, pointing toward a young dynamical age of the system. We constrain the distribution of the Br γ and CO-emitting gas using VLTI/GRAVITY spectro-interferometry and VLT/CRIRES spectro-astrometry and find that the secondary is accreting at a higher rate than the primary. VLT/NACO imaging shows L ′-band emission on (3–4)× larger scales than the binary separation, matching the expected dynamical truncation radius for the circumbinary disk. The IRAS17216-3801 system is ∼3× more massive and ∼5× more compact than other high-mass multiplies imaged at infrared wavelength and the first high-mass protobinary system where circumstellar and circumbinary dust disks could be spatially resolved. This opens exciting new opportunities for studying star–disk interactions and the role of multiplicity in high-mass star formation.

Canine total knee replacement performed due to osteoarthritis subsequent to distal femur fracture osteosynthesis: two-year objective outcome.

Science.gov (United States)

Eskelinen, E V; Liska, W D; Hyytiäinen, H K; Hielm-Björkman, A

2012-01-01

A 27-kg German Shorthaired Pointer was referred for evaluation due to the complaint of left pelvic limb lameness and signs of pain in the left stifle joint. Radiographs revealed signs of a healed supracondylar femoral fracture that had been previously repaired at another hospital with an intramedullary pin and two cross pins. In addition, there were signs of severe osteoarthritis (OA). The OA had been managed medically with administration of carprofen and nutraceuticals for nine months without any improvement. Left total knee replacement (TKR) surgery was performed to alleviate signs of pain. The patient was assessed preoperatively and at six months, one year, and two years after surgery using radiology, force platform analysis of gait, thigh circumference measures, goniometry, and lameness evaluation. Following surgery, the dog resumed normal activity without any signs of pain and a good quality of life at 3.5 months. Force plate analysis found that peak vertical force on the TKR limb was 85.7% of the normal contralateral limb after two years. Total knee replacement was a successful treatment to manage knee OA associated with a healed distal femoral fracture and internal fixation in this dog.

Source to Accretion Disk Tilt

OpenAIRE

Montgomery, M. M.; Martin, E. L.

2010-01-01

Many different system types retrogradely precess, and retrograde precession could be from a tidal torque by the secondary on a misaligned accretion disk. However, a source to cause and maintain disk tilt is unknown. In this work, we show that accretion disks can tilt due to a force called lift. Lift results from differing gas stream supersonic speeds over and under an accretion disk. Because lift acts at the disk's center of pressure, a torque is applied around a rotation axis passing through...

The effect of tranexamic acid on blood coagulation in total hip replacement arthroplasty: rotational thromboelastographic (ROTEM®) analysis.

Science.gov (United States)

Na, H S; Shin, H J; Lee, Y J; Kim, J H; Koo, K H; Do, S H

2016-01-01

We evaluated changes in rotational thromboelastometry (ROTEM(®) ) parameters and clinical outcomes in patients undergoing total hip replacement arthroplasty, with concomitant infusions of tranexamic acid and of 6% hydroxyethyl starch 130/0.4. Fifty-five patients were randomly assigned to either the tranexamic acid (n = 29) or the control (n = 26) group. Hydroxyethyl starch was administered in the range of 10-15 ml.kg(-1) during the operation in both groups. In the control group, the clot formation time and maximum clot firmness of APTEM showed significant differences when compared with those of EXTEM at one hour postoperatively, suggestive of fibrinolysis. In the tranexamic acid group, there was no significant difference between each postoperative EXTEM and APTEM parameter. In the tranexamic acid and control group, postoperative blood loss was 308 ml (210-420 [106-745]) and 488 ml (375-620 [170-910], p = 0.002), respectively, and total blood loss was 1168 ml (922-1470 [663-2107]) and 1563 ml (1276-1708 [887-1494], p = 0.003). Haemoglobin concentration was higher in the tranexamic acid group on the second postoperative day (10.5 (9.4-12.1 [7.9-14.0]) vs. 9.6 (8.9-10.5[7.3-16.0]) g.dl(-1) , p = 0.027). In patients undergoing total hip replacement arthroplasty, postoperative fibrinolysis aggravated by hydroxyethyl starch was attenuated by co-administration of 10 mg.kg(-1) tranexamic acid, which may have led to less postoperative blood loss. © 2015 The Association of Anaesthetists of Great Britain and Ireland.

Evolution of magnetic disk subsystems

Science.gov (United States)

Kaneko, Satoru

1994-06-01

The higher recording density of magnetic disk realized today has brought larger storage capacity per unit and smaller form factors. If the required access performance per MB is constant, the performance of large subsystems has to be several times better. This article describes mainly the technology for improving the performance of the magnetic disk subsystems and the prospects of their future evolution. Also considered are 'crosscall pathing' which makes the data transfer channel more effective, 'disk cache' which improves performance coupling with solid state memory technology, and 'RAID' which improves the availability and integrity of disk subsystems by organizing multiple disk drives in a subsystem. As a result, it is concluded that since the performance of the subsystem is dominated by that of the disk cache, maximation of the performance of the disk cache subsystems is very important.

STELLAR MASS DEPENDENT DISK DISPERSAL

International Nuclear Information System (INIS)

Kennedy, Grant M.; Kenyon, Scott J.

2009-01-01

We use published optical spectral and infrared (IR) excess data from nine young clusters and associations to study the stellar mass dependent dispersal of circumstellar disks. All clusters older than ∼3 Myr show a decrease in disk fraction with increasing stellar mass for solar to higher mass stars. This result is significant at about the 1σ level in each cluster. For the complete set of clusters we reject the null hypothesis-that solar and intermediate-mass stars lose their disks at the same rate-with 95%-99.9% confidence. To interpret this behavior, we investigate the impact of grain growth, binary companions, and photoevaporation on the evolution of disk signatures. Changes in grain growth timescales at fixed disk temperature may explain why early-type stars with IR excesses appear to evolve faster than their later-type counterparts. Little evidence that binary companions affect disk evolution suggests that photoevaporation is the more likely mechanism for disk dispersal. A simple photoevaporation model provides a good fit to the observed disk fractions for solar and intermediate-mass stars. Although the current mass-dependent disk dispersal signal is not strong, larger and more complete samples of clusters with ages of 3-5 Myr can improve the significance and provide better tests of theoretical models. In addition, the orbits of extra-solar planets can constrain models of disk dispersal and migration. We suggest that the signature of stellar mass dependent disk dispersal due to photoevaporation may be present in the orbits of observed extra-solar planets. Planets orbiting hosts more massive than ∼1.6 M sun may have larger orbits because the disks in which they formed were dispersed before they could migrate.

Manipulation of magnetic vortex parameters in disk-on-disk nanostructures with various geometry

Directory of Open Access Journals (Sweden)

Maxim E. Stebliy

2015-03-01

Full Text Available Magnetic nanostructures in the form of a sandwich consisting of two permalloy (Py disks with diameters of 600 and 200 nm separated by a nonmagnetic interlayer are studied. Magnetization reversal of the disk-on-disk nanostructures depends on the distance between centers of the small and big disks and on orientation of an external magnetic field applied during measurements. It is found that manipulation of the magnetic vortex chirality and the trajectory of the vortex core in the big disk is only possible in asymmetric nanostructures. Experimentally studied peculiarities of a motion path of the vortex core and vortex parameters by the magneto-optical Kerr effect (MOKE magnetometer are supported by the magnetic force microscopy imaging and micromagnetic simulations.

Global Simulations of the Inner Regions of Protoplanetary Disks with Comprehensive Disk Microphysics

Energy Technology Data Exchange (ETDEWEB)

Bai, Xue-Ning, E-mail: xbai@cfa.harvard.edu [Institute for Theory and Computation, Harvard-Smithsonian Center for Astrophysics, 60 Garden St., MS-51, Cambridge, MA 02138 (United States)

2017-08-10

The gas dynamics of weakly ionized protoplanetary disks (PPDs) are largely governed by the coupling between gas and magnetic fields, described by three non-ideal magnetohydrodynamical (MHD) effects (Ohmic, Hall, ambipolar). Previous local simulations incorporating these processes have revealed that the inner regions of PPDs are largely laminar and accompanied by wind-driven accretion. We conduct 2D axisymmetric, fully global MHD simulations of these regions (∼1–20 au), taking into account all non-ideal MHD effects, with tabulated diffusion coefficients and approximate treatment of external ionization and heating. With the net vertical field aligned with disk rotation, the Hall-shear instability strongly amplifies horizontal magnetic field, making the overall dynamics dependent on initial field configuration. Following disk formation, the disk likely relaxes into an inner zone characterized by asymmetric field configuration across the midplane, which smoothly transitions to a more symmetric outer zone. Angular momentum transport is driven by both MHD winds and laminar Maxwell stress, with both accretion and decretion flows present at different heights, and modestly asymmetric winds from the two disk sides. With anti-aligned field polarity, weakly magnetized disks settle into an asymmetric field configuration with supersonic accretion flow concentrated at one side of the disk surface, and highly asymmetric winds between the two disk sides. In all cases, the wind is magneto-thermal in nature, characterized by a mass loss rate exceeding the accretion rate. More strongly magnetized disks give more symmetric field configuration and flow structures. Deeper far-UV penetration leads to stronger and less stable outflows. Implications for observations and planet formation are also discussed.

Global Simulations of the Inner Regions of Protoplanetary Disks with Comprehensive Disk Microphysics

Science.gov (United States)

Bai, Xue-Ning

2017-08-01

The gas dynamics of weakly ionized protoplanetary disks (PPDs) are largely governed by the coupling between gas and magnetic fields, described by three non-ideal magnetohydrodynamical (MHD) effects (Ohmic, Hall, ambipolar). Previous local simulations incorporating these processes have revealed that the inner regions of PPDs are largely laminar and accompanied by wind-driven accretion. We conduct 2D axisymmetric, fully global MHD simulations of these regions (˜1-20 au), taking into account all non-ideal MHD effects, with tabulated diffusion coefficients and approximate treatment of external ionization and heating. With the net vertical field aligned with disk rotation, the Hall-shear instability strongly amplifies horizontal magnetic field, making the overall dynamics dependent on initial field configuration. Following disk formation, the disk likely relaxes into an inner zone characterized by asymmetric field configuration across the midplane, which smoothly transitions to a more symmetric outer zone. Angular momentum transport is driven by both MHD winds and laminar Maxwell stress, with both accretion and decretion flows present at different heights, and modestly asymmetric winds from the two disk sides. With anti-aligned field polarity, weakly magnetized disks settle into an asymmetric field configuration with supersonic accretion flow concentrated at one side of the disk surface, and highly asymmetric winds between the two disk sides. In all cases, the wind is magneto-thermal in nature, characterized by a mass loss rate exceeding the accretion rate. More strongly magnetized disks give more symmetric field configuration and flow structures. Deeper far-UV penetration leads to stronger and less stable outflows. Implications for observations and planet formation are also discussed.

Optimal graft diameter and location reduce postoperative complications after total arch replacement with long elephant trunk for arch aneurysm.

Science.gov (United States)

Kondoh, Haruhiko; Funatsu, Toshihiro; Toda, Koich; Kainuma, Satoshi; Kuki, Satoru; Taniguchi, Kazuhiro

2011-08-01

Total arch replacement with an elephant trunk is a standard treatment for arch aneurysm, but serious complications, such as paraplegia and peripheral embolization caused by flapping of the elephant trunk, remain. Moreover, dilation of the descending aorta and retrograde flow into the peri-graft space at the distal elephant trunk are frequent problems. We hypothesized that optimal graft diameter and location would reduce complications after total arch replacement with a long elephant trunk by achieving complete thrombosis and minimal dilation of the descending aorta around the elephant trunk. We treated 65 patients with arch aneurysm by total arch replacement with a long elephant trunk anastomosed at the base of the innominate artery. The graft diameter was undersized (10%-20% of the distal aorta's diameter). Elephant trunk length was determined by preoperative computed tomography to locate the distal end at Th6 to Th8. Thrombosis around the elephant trunk, diameter of the descending aorta, and distance between the descending aorta and the graft near the distal end of the elephant trunk were evaluated using computed tomography. The distal end of the elephant trunk was located at Th 8 ± 1. There were no operative deaths, 3 patients (5%) died in the hospital, and 3 patients (5%) experienced spinal cord injury, including 1 in whom permanent paraplegia developed. Computed tomography revealed complete thrombosis around the elephant trunk in 58 patients (89%). The descending aorta did not dilate further, and distance between the descending aorta and the graft progressively decreased. Optimal graft diameter and location minimized postoperative complications, with complete thrombosis and no dilation of the descending aorta around the long elephant trunk in most patients. Copyright © 2011 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

Effects of music on psychophysiological responses and opioid dosage in patients undergoing total knee replacement surgery.

Science.gov (United States)

Chen, Hsin-Ji; Chen, Tsung-Ying; Huang, Chiung-Yu; Hsieh, Yuan-Mei; Lai, Hui-Ling

2015-10-01

The present authors examined the effects of listening to music on psychophysiological parameters (blood pressure, heart rate, and respiratory rate) during preoperative and postoperative days and determined whether listening to music could lower pain intensity and opioid dosage during postoperative days in patients who underwent total knee replacements. This was a two group repeated measures design for 30 subjects aged 53-85 years who were scheduled for total knee replacement. Subjects were randomly assigned to either a music group or a control group. Psychophysiological parameters were obtained from patients' monitors. A visual analog scale was used to assess postoperative pain. Opioid dosage was recorded and converted to standardized units. Mann-Whitney U-test and generalized estimating equation analysis were used to compare groups. Respiratory rates while in the surgical waiting area were lower for the music group than for the control group (P = 0.02). There was no significant difference between these groups for blood pressure, heart rate, pain intensity, or opioid dosage. However, a within-group comparison showed that systolic blood pressure in the music group was significantly and consistently decreased during postoperative recovery (Wald = 9.21, P = 0.007). These results suggest that listening to music stabilized systolic blood pressure in patients during postoperative recovery. However, the effects of music on psychophysiological parameters, pain intensity, and opioid dosage in a surgical setting require further research. © 2015 The Authors. Japan Journal of Nursing Science © 2015 Japan Academy of Nursing Science.

MODELING CIRCUMSTELLAR DISKS OF B-TYPE STARS WITH OBSERVATIONS FROM THE PALOMAR TESTBED INTERFEROMETER

International Nuclear Information System (INIS)

Grzenia, B. J.; Tycner, C.; Jones, C. E.; Sigut, T. A. A.; Rinehart, S. A.; Van Belle, G. T.

2013-01-01

Geometrical (uniform disk) and numerical models were calculated for a set of B-emission (Be) stars observed with the Palomar Testbed Interferometer (PTI). Physical extents have been estimated for the disks of a total of 15 stars via uniform disk models. Our numerical non-LTE models used parameters for the B0, B2, B5, and B8 spectral classes and following the framework laid by previous studies, we have compared them to infrared K-band interferometric observations taken at PTI. This is the first time such an extensive set of Be stars observed with long-baseline interferometry has been analyzed with self-consistent non-LTE numerical disk models.

The influence of NSAIDs on coumarin sensitivity in patients with CYP2C9 polymorphism after total hip replacement surgery.

NARCIS (Netherlands)

Beinema, M.J.; Jong, P.H. de; Salden, H.J.; Wijnen, M.H.W.A.; Meer, J.W.M. van der; Brouwers, J.R.B.J.

2007-01-01

OBJECTIVE: To determine the influence of NSAIDs on the international normalized ratio (INR) in patients with cytochrome P450 (CYP)-2C9 enzyme variants starting acenocoumarol (an oral coumarin) therapy during the first 7 days after total hip replacement surgery. METHODS: In this prospective study, an

The influence of NSAIDs on coumarin sensitivity in patients with CYP2C9 polymorphism after total hip replacement surgery

NARCIS (Netherlands)

Beinema, Maarten J.; de Jong, Petra H.; Salden, Har J. M.; van Wijnen, Merel; van der Meer, Jan; Brouwers, Jacobus R. B. J.

2007-01-01

Objective: To determine the influence of NSAIDs on the international normalized ratio (INR) in patients with cytochrome P450 (CYP)-2C9 enzyme variants starting acenocoumarol (an oral coumarin) therapy during the first 7 days after total hip replacement surgery. Methods: In this prospective study, an

Outcome of total knee replacement following explantation and cemented spacer therapy.

Science.gov (United States)

Ghanem, Mohamed; Zajonz, Dirk; Bollmann, Juliane; Geissler, Vanessa; Prietzel, Torsten; Moche, Michael; Roth, Andreas; Heyde, Christoph-E; Josten, Christoph

2016-01-01

Infection after total knee replacement (TKR) is one of the serious complications which must be pursued with a very effective therapeutic concept. In most cases this means revision arthroplasty, in which one-setting and two-setting procedures are distinguished. Healing of infection is the conditio sine qua non for re-implantation. This retrospective work presents an assessment of the success rate after a two-setting revision arthroplasty of the knee following periprosthetic infection. It further considers drawing conclusions concerning the optimal timing of re-implantation. A total of 34 patients have been enclosed in this study from September 2005 to December 2013. 35 re-implantations were carried out following explantation of total knee and implantation of cemented spacer. The patient's group comprised of 53% (18) males and 47% (16) females. The average age at re-implantation time was 72.2 years (ranging from 54 to 85 years). We particularly evaluated the microbial spectrum, the interval between explantation and re-implantation, the number of surgeries that were necessary prior to re-implantation as well as the postoperative course. We reported 31.4% (11) reinfections following re-implantation surgeries. The number of the reinfections declined with increasing time interval between explantation and re-implantation. Patients who developed reinfections were operated on (re-implantation) after an average of 4.47 months. Those patients with uncomplicated course were operated on (re-implantation) after an average of 6.79 months. Nevertheless, we noticed no essential differences in outcome with regard to the number of surgeries carried out prior to re-implantation. Mobile spacers proved better outcome than temporary arthrodesis with intramedullary fixation. No uniform strategy of treatment exists after peri-prosthetic infections. In particular, no optimal timing can be stated concerning re-implantation. Our data point out to the fact that a longer time interval between

Outcome of total knee replacement following explantation and cemented spacer therapy

Directory of Open Access Journals (Sweden)

Ghanem, Mohamed

2016-03-01

Full Text Available Background: Infection after total knee replacement (TKR is one of the serious complications which must be pursued with a very effective therapeutic concept. In most cases this means revision arthroplasty, in which one-setting and two-setting procedures are distinguished. Healing of infection is the conditio sine qua non for re-implantation. This retrospective work presents an assessment of the success rate after a two-setting revision arthroplasty of the knee following periprosthetic infection. It further considers drawing conclusions concerning the optimal timing of re-implantation.Patients and methods: A total of 34 patients have been enclosed in this study from September 2005 to December 2013. 35 re-implantations were carried out following explantation of total knee and implantation of cemented spacer. The patient’s group comprised of 53% (18 males and 47% (16 females. The average age at re-implantation time was 72.2 years (ranging from 54 to 85 years. We particularly evaluated the microbial spectrum, the interval between explantation and re-implantation, the number of surgeries that were necessary prior to re-implantation as well as the postoperative course. Results: We reported 31.4% (11 reinfections following re-implantation surgeries. The number of the reinfections declined with increasing time interval between explantation and re-implantation. Patients who developed reinfections were operated on (re-implantation after an average of 4.47 months. Those patients with uncomplicated course were operated on (re-implantation after an average of 6.79 months. Nevertheless, we noticed no essential differences in outcome with regard to the number of surgeries carried out prior to re-implantation. Mobile spacers proved better outcome than temporary arthrodesis with intramedullary fixation.Conclusion: No uniform strategy of treatment exists after peri-prosthetic infections. In particular, no optimal timing can be stated concerning re

Increased body mass index is a predisposition for treatment by total hip replacement

DEFF Research Database (Denmark)

Jacobsen, Steffen; Sonne-Holm, Stig

2005-01-01

-joint degeneration and dysplasia. Sequential body mass index (BMI) measurements from 1976 to 1992, age, exposure to daily lifting and hip dysplasia were entered into logistic regression analyses. The prevalence of hip dysplasia ranged from 5.4% to 12.8% depending on the radiographical index used. Radiological hip OA...... prevalence was 1.0--2.5% in subjects or=60 years of age. While radiological OA was significantly influenced by hip dysplasia in men and hip dysplasia and age in women, the risk of THR being performed was only influenced by BMI assessed in 1976. Hip......We investigated the radiological and epidemiological data of 4,151 subjects followed up from 1976 to 2003 to determine individual risk factors for hip osteoarthritis (OA), hip pain and/or treatment by total hip replacement (THR). Pelvic radiographs recorded in 1992 were assessed for evidence of hip...

Home-Based versus Hospital-Based Rehabilitation Program after Total Knee Replacement

Directory of Open Access Journals (Sweden)

Remedios López-Liria

2015-01-01

Full Text Available Objectives. To compare home-based rehabilitation with the standard hospital rehabilitation in terms of improving knee joint mobility and recovery of muscle strength and function in patients after a total knee replacement. Materials and Methods. A non-randomised controlled trial was conducted. Seventy-eight patients with a prosthetic knee were included in the study and allocated to either a home-based or hospital-based rehabilitation programme. Treatment included various exercises to restore strength and joint mobility and to improve patients’ functional capacity. The primary outcome of the trial was the treatment effectiveness measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC. Results. The groups did not significantly differ in the leg side (right/left or clinical characteristics (P>0.05. After the intervention, both groups showed significant improvements (P<0.001 from the baseline values in the level of pain (visual analogue scale, the range of flexion-extension motion and muscle strength, disability (Barthel and WOMAC indices, balance, and walking. Conclusions. This study reveals that the rehabilitation treatments offered either at home or in hospital settings are equally effective.

Effect of Degeneration on Fluid-Solid Interaction within Intervertebral Disk Under Cyclic Loading - A Meta-Model Analysis of Finite Element Simulations.

Science.gov (United States)

Nikkhoo, Mohammad; Khalaf, Kinda; Kuo, Ya-Wen; Hsu, Yu-Chun; Haghpanahi, Mohammad; Parnianpour, Mohamad; Wang, Jaw-Lin

2015-01-01

The risk of low back pain resulted from cyclic loadings is greater than that resulted from prolonged static postures. Disk degeneration results in degradation of disk solid structures and decrease of water contents, which is caused by activation of matrix digestive enzymes. The mechanical responses resulted from internal solid-fluid interactions of degenerative disks to cyclic loadings are not well studied yet. The fluid-solid interactions in disks can be evaluated by mathematical models, especially the poroelastic finite element (FE) models. We developed a robust disk poroelastic FE model to analyze the effect of degeneration on solid-fluid interactions within disk subjected to cyclic loadings at different loading frequencies. A backward analysis combined with in vitro experiments was used to find the elastic modulus and hydraulic permeability of intact and enzyme-induced degenerated porcine disks. The results showed that the averaged peak-to-peak disk deformations during the in vitro cyclic tests were well fitted with limited FE simulations and a quadratic response surface regression for both disk groups. The results showed that higher loading frequency increased the intradiscal pressure, decreased the total fluid loss, and slightly increased the maximum axial stress within solid matrix. Enzyme-induced degeneration decreased the intradiscal pressure and total fluid loss, and barely changed the maximum axial stress within solid matrix. The increase of intradiscal pressure and total fluid loss with loading frequency was less sensitive after the frequency elevated to 0.1 Hz for the enzyme-induced degenerated disk. Based on this study, it is found that enzyme-induced degeneration decreases energy attenuation capability of disk, but less change the strength of disk.

Truncation of the Inner Accretion Disk Around a Black Hole at Low Luminosity

Science.gov (United States)

Tomsick, John A.; Yamoka, Kazutaka; Corbel, Stephane; Kaaret, Philip; Kalemci, Emrah; Migliari, Simone

2011-01-01

Most black hole binaries show large changes in X-ray luminosity caused primarily by variations in mass accretion rate. An important question for understanding black hole accretion and jet production is whether the inner edge of the accretion disk recedes at low accretion rate. Measurements of the location of the inner edge (R(sub in)) can be made using iron emission lines that arise due to fluorescence of iron in the disk, and these indicate that R(sub in) is very close to the black hole at high and moderate luminosities (greater than or equal to 1% of the Eddington luminosity, L(sub Edd). Here, we report on X-ray observations of the black hole GX 339-4 in the hard state by Suzaku and the Rossi X-ray Timing Explorer that extend iron line studies to 0.14% L(sub Edd) and show that R(sub in) increases by a factor of greater than 27 over the value found when GX 339-4 was bright. The exact value of R(sub in) depends on the inclination of the inner disk (i), and we derive 90% confidence limits of R(sub in) greater than 35 R(sub g) at i = 0 degrees and R(sub in) greater than 175 R(sub g) at i = 30 degrees. This provides direct evidence that the inner portion of the disk is not present at low luminosity, allowing for the possibility that the inner disk is replaced by advection- or magnetically dominated accretion flows.

Physical properties of dusty protoplanetary disks in Lupus: evidence for viscous evolution?

Science.gov (United States)

Tazzari, M.; Testi, L.; Natta, A.; Ansdell, M.; Carpenter, J.; Guidi, G.; Hogerheijde, M.; Manara, C. F.; Miotello, A.; van der Marel, N.; van Dishoeck, E. F.; Williams, J. P.

2017-10-01

Context. The formation of planets strongly depends on the total amount as well as on the spatial distribution of solids in protoplanetary disks. Thanks to the improvements in resolution and sensitivity provided by ALMA, measurements of the surface density of mm-sized grains are now possible on large samples of disks. Such measurements provide statistical constraints that can be used to inform our understanding of the initial conditions of planet formation. Aims: We aim to analyze spatially resolved observations of 36 protoplanetary disks in the Lupus star forming complex from our ALMA survey at 890 μm, aiming to determine physical properties such as the dust surface density, the disk mass and size, and to provide a constraint on the temperature profile. Methods: We fit the observations directly in the uv-plane using a two-layer disk model that computes the 890 μm emission by solving the energy balance at each disk radius. Results: For 22 out of 36 protoplanetary disks we derive robust estimates of their physical properties. The sample covers stellar masses between 0.1 and 2 M⊙, and we find no trend in the relationship between the average disk temperatures and the stellar parameters. We find, instead, a correlation between the integrated sub-mm flux (a proxy for the disk mass) and the exponential cut-off radii (a proxy of the disk size) of the Lupus disks. Comparing these results with observations at similar angular resolution of Taurus-Auriga and Ophiuchus disks found in literature and scaling them to the same distance, we observe that the Lupus disks are generally fainter and larger at a high level of statistical significance. Considering the 1-2 Myr age difference between these regions, it is possible to tentatively explain the offset in the disk mass-size relation with viscous spreading, however with the current measurements other mechanisms cannot be ruled out.

Vibration of imperfect rotating disk

Directory of Open Access Journals (Sweden)

Půst L.

2011-12-01

Full Text Available This study is concerned with the theoretical and numerical calculations of the flexural vibrations of a bladed disk. The main focus of this study is to elaborate the basic background for diagnostic and identification methods for ascertaining the main properties of the real structure or an experimental model of turbine disks. The reduction of undesirable vibrations of blades is proposed by using damping heads, which on the experimental model of turbine disk are applied only on a limited number of blades. This partial setting of damping heads introduces imperfection in mass, stiffness and damping distribution on the periphery and leads to more complicated dynamic properties than those of a perfect disk. Calculation of FEM model and analytic—numerical solution of disk behaviour in the limited (two modes frequency range shows the splitting of resonance with an increasing speed of disk rotation. The spectrum of resonance is twice denser than that of a perfect disk.

Is lumbosacral plexus blockade effective and safe for surgical anesthesia in total hip replacement?

DEFF Research Database (Denmark)

Nielsen, Niels Dalsgaard; Larsen, Jens Rolighed; Børglum, Jens

Background and Aims Patients scheduled for total hip replacement often presents cardiovascular comorbidity, which increases perioperative risk of complications. This pilot study aimed to compare lumbosacral plexus blockade with continuous and single-dose spinal anesthesia for surgical anesthesia...... had lumbosacral plexus blockade (lumbar plexus block, sacral plexus block and fascia transversalis plane block) with ropivacaine. Group 2 had continuous spinal anesthesia with repeated bupivacaine-doses. Group 3 had single-dose spinal anesthesia with bupivacaine. Hemodynamic data were recorded during...... vascular resistance, and arterial and central venous pressures. (table 1) No patients in group 1 achieved complete surgical anesthesia due to lack of anesthesia of the cranial part of the surgical incision. Conclusions Neither lumbosacral plexus block nor continuous spinal anesthesia affected any...

RINGED ACCRETION DISKS: EQUILIBRIUM CONFIGURATIONS

Energy Technology Data Exchange (ETDEWEB)

Pugliese, D.; Stuchlík, Z., E-mail: d.pugliese.physics@gmail.com, E-mail: zdenek.stuchlik@physics.cz [Institute of Physics and Research Centre of Theoretical Physics and Astrophysics, Faculty of Philosophy and Science, Silesian University in Opava, Bezručovo náměstí 13, CZ-74601 Opava (Czech Republic)

2015-12-15

We investigate a model of a ringed accretion disk, made up by several rings rotating around a supermassive Kerr black hole attractor. Each toroid of the ringed disk is governed by the general relativity hydrodynamic Boyer condition of equilibrium configurations of rotating perfect fluids. Properties of the tori can then be determined by an appropriately defined effective potential reflecting the background Kerr geometry and the centrifugal effects. The ringed disks could be created in various regimes during the evolution of matter configurations around supermassive black holes. Therefore, both corotating and counterrotating rings have to be considered as being a constituent of the ringed disk. We provide constraints on the model parameters for the existence and stability of various ringed configurations and discuss occurrence of accretion onto the Kerr black hole and possible launching of jets from the ringed disk. We demonstrate that various ringed disks can be characterized by a maximum number of rings. We present also a perturbation analysis based on evolution of the oscillating components of the ringed disk. The dynamics of the unstable phases of the ringed disk evolution seems to be promising in relation to high-energy phenomena demonstrated in active galactic nuclei.

Space-based Coronagraphic Imaging Polarimetry of the TW Hydrae Disk: Shedding New Light on Self-shadowing Effects

Science.gov (United States)

Poteet, Charles A.; Chen, Christine H.; Hines, Dean C.; Perrin, Marshall D.; Debes, John H.; Pueyo, Laurent; Schneider, Glenn; Mazoyer, Johan; Kolokolova, Ludmilla

2018-06-01

We present Hubble Space Telescope Near-Infrared Camera and Multi-Object Spectrometer coronagraphic imaging polarimetry of the TW Hydrae protoplanetary disk. These observations simultaneously measure the total and polarized intensity, allowing direct measurement of the polarization fraction across the disk. In accord with the self-shadowing hypothesis recently proposed by Debes et al., we find that the total and polarized intensity of the disk exhibits strong azimuthal asymmetries at projected distances consistent with the previously reported bright and dark ring-shaped structures (∼45–99 au). The sinusoidal-like variations possess a maximum brightness at position angles near ∼268°–300° and are up to ∼28% stronger in total intensity. Furthermore, significant radial and azimuthal variations are also detected in the polarization fraction of the disk. In particular, we find that regions of lower polarization fraction are associated with annuli of increased surface brightness, suggesting that the relative proportion of multiple-to-single scattering is greater along the ring and gap structures. Moreover, we find strong (∼20%) azimuthal variation in the polarization fraction along the shadowed region of the disk. Further investigation reveals that the azimuthal variation is not the result of disk flaring effects, but is instead from a decrease in the relative contribution of multiple-to-single scattering within the shadowed region. Employing a two-layer scattering surface, we hypothesize that the diminished contribution in multiple scattering may result from shadowing by an inclined inner disk, which prevents direct stellar light from reaching the optically thick underlying surface component.

CN rings in full protoplanetary disks around young stars as probes of disk structure

Science.gov (United States)

Cazzoletti, P.; van Dishoeck, E. F.; Visser, R.; Facchini, S.; Bruderer, S.

2018-01-01

Aims: Bright ring-like structure emission of the CN molecule has been observed in protoplanetary disks. We investigate whether such structures are due to the morphology of the disk itself or if they are instead an intrinsic feature of CN emission. With the intention of using CN as a diagnostic, we also address to which physical and chemical parameters CN is most sensitive. Methods: A set of disk models were run for different stellar spectra, masses, and physical structures via the 2D thermochemical code DALI. An updated chemical network that accounts for the most relevant CN reactions was adopted. Results: Ring-shaped emission is found to be a common feature of all adopted models; the highest abundance is found in the upper outer regions of the disk, and the column density peaks at 30-100 AU for T Tauri stars with standard accretion rates. Higher mass disks generally show brighter CN. Higher UV fields, such as those appropriate for T Tauri stars with high accretion rates or for Herbig Ae stars or for higher disk flaring, generally result in brighter and larger rings. These trends are due to the main formation paths of CN, which all start with vibrationally excited H_2^* molecules, that are produced through far ultraviolet (FUV) pumping of H2. The model results compare well with observed disk-integrated CN fluxes and the observed location of the CN ring for the TW Hya disk. Conclusions: CN rings are produced naturally in protoplanetary disks and do not require a specific underlying disk structure such as a dust cavity or gap. The strong link between FUV flux and CN emission can provide critical information regarding the vertical structure of the disk and the distribution of dust grains which affects the UV penetration, and could help to break some degeneracies in the SED fitting. In contrast with C2H or c-C3H2, the CN flux is not very sensitive to carbon and oxygen depletion.

HERSCHEL OBSERVATIONS OF THE T CHA TRANSITION DISK: CONSTRAINING THE OUTER DISK PROPERTIES

International Nuclear Information System (INIS)

Cieza, Lucas A.; Olofsson, Johan; Henning, Thomas; Harvey, Paul M.; Evans II, Neal J.; Pinte, Christophe; Augereau, Jean-Charles; Ménard, Francois; Merín, Bruno; Najita, Joan

2011-01-01

T Cha is a nearby (d ∼ 100 pc) transition disk known to have an optically thin gap separating optically thick inner and outer disk components. Huélamo et al. recently reported the presence of a low-mass object candidate within the gap of the T Cha disk, giving credence to the suspected planetary origin of this gap. Here we present the Herschel photometry (70, 160, 250, 350, and 500 μm) of T Cha from the 'Dust, Ice, and Gas in Time' Key Program, which bridges the wavelength range between existing Spitzer and millimeter data and provide important constraints on the outer disk properties of this extraordinary system. We model the entire optical to millimeter wavelength spectral energy distribution (SED) of T Cha (19 data points between 0.36 and 3300 μm without any major gaps in wavelength coverage). T Cha shows a steep spectral slope in the far-IR, which we find clearly favors models with outer disks containing little or no dust beyond ∼40 AU. The full SED can be modeled equally well with either an outer disk that is very compact (only a few AU wide) or a much larger one that has a very steep surface density profile. That is, T Cha's outer disk seems to be either very small or very tenuous. Both scenarios suggest a highly unusual outer disk and have important but different implications for the nature of T Cha. Spatially resolved images are needed to distinguish between the two scenarios.

HERSCHEL OBSERVATIONS OF THE T CHA TRANSITION DISK: CONSTRAINING THE OUTER DISK PROPERTIES

Energy Technology Data Exchange (ETDEWEB)

Cieza, Lucas A. [Institute for Astronomy, University of Hawaii at Manoa, Honolulu, HI 96822 (United States); Olofsson, Johan; Henning, Thomas [Max Planck Institut fuer Astronomie, Koenigstuhl 17, 69117 Heidelberg (Germany); Harvey, Paul M.; Evans II, Neal J. [Department of Astronomy, University of Texas at Austin, Austin, TX 78712 (United States); Pinte, Christophe; Augereau, Jean-Charles; Menard, Francois [UJF-Grenoble 1/CNRS-INSU, Institut de Planetologie et d' Astrophysique de Grenoble (IPAG) UMR 5274, Grenoble, F-38041 (France); Merin, Bruno [Herschel Science Centre, European Space Agency (ESAC), P.O. Box 78, 28691 Villanueva de la Canada, Madrid (Spain); Najita, Joan, E-mail: lcieza@ifa.hawaii.edu [National Optical Astronomy Observatory, 950 N. Cherry Avenue, Tucson, AZ 86719 (United States)

2011-11-10

T Cha is a nearby (d {approx} 100 pc) transition disk known to have an optically thin gap separating optically thick inner and outer disk components. Huelamo et al. recently reported the presence of a low-mass object candidate within the gap of the T Cha disk, giving credence to the suspected planetary origin of this gap. Here we present the Herschel photometry (70, 160, 250, 350, and 500 {mu}m) of T Cha from the 'Dust, Ice, and Gas in Time' Key Program, which bridges the wavelength range between existing Spitzer and millimeter data and provide important constraints on the outer disk properties of this extraordinary system. We model the entire optical to millimeter wavelength spectral energy distribution (SED) of T Cha (19 data points between 0.36 and 3300 {mu}m without any major gaps in wavelength coverage). T Cha shows a steep spectral slope in the far-IR, which we find clearly favors models with outer disks containing little or no dust beyond {approx}40 AU. The full SED can be modeled equally well with either an outer disk that is very compact (only a few AU wide) or a much larger one that has a very steep surface density profile. That is, T Cha's outer disk seems to be either very small or very tenuous. Both scenarios suggest a highly unusual outer disk and have important but different implications for the nature of T Cha. Spatially resolved images are needed to distinguish between the two scenarios.

The Biologic Response to Polyetheretherketone (PEEK) Wear Particles in Total Joint Replacement: A Systematic Review.

Science.gov (United States)

Stratton-Powell, Ashley A; Pasko, Kinga M; Brockett, Claire L; Tipper, Joanne L

2016-11-01

Polyetheretherketone (PEEK) and its composites are polymers resistant to fatigue strain, radiologically transparent, and have mechanical properties suitable for a range of orthopaedic applications. In bulk form, PEEK composites are generally accepted as biocompatible. In particulate form, however, the biologic response relevant to joint replacement devices remains unclear. The biologic response to wear particles affects the longevity of total joint arthroplasties. Particles in the phagocytozable size range of 0.1 µm to 10 µm are considered the most biologically reactive, particularly particles with a mean size of PEEK-based wear debris from total joint arthroplasties. (1) What are the quantitative characteristics of PEEK-based wear particles produced by total joint arthroplasties? (2) Do PEEK wear particles cause an adverse biologic response when compared with UHMWPE or a similar negative control biomaterial? (3) Is the biologic response affected by particle characteristics? Embase and Ovid Medline databases were searched for studies that quantified PEEK-based particle characteristics and/or investigated the biologic response to PEEK-based particles relevant to total joint arthroplasties. The keyword search included brands of PEEK (eg, MITCH, MOTIS) or variations of PEEK types and nomenclature (eg, PAEK, CFR-PEEK) in combination with types of joint (eg, hip, knee) and synonyms for wear debris or immunologic response (eg, particles, cytotoxicity). Peer-reviewed studies, published in English, investigating total joint arthroplasty devices and cytotoxic effects of PEEK particulates were included. Studies investigating devices without articulating bearings (eg, spinal instrumentation devices) and bulk material or contact cytotoxicity were excluded. Of 129 studies, 15 were selected for analysis and interpretation. No studies were found that isolated and characterized PEEK wear particles from retrieved periprosthetic human tissue samples. In the four studies that

Effectiveness of Music Listening in Patients With Total Knee Replacement During CPM Rehabilitation.

Science.gov (United States)

Hsu, Chih-Chung; Chen, Wei-Ming; Chen, Su-Ru; Tseng, Yen-Ting; Lin, Pi-Chu

2016-01-01

This study investigated the effects of music listening on the anxiety, heart rate variability (HRV), and joint range of motion (ROM) of patients undergoing continuous passive motion (CPM) after total knee replacement surgery. An experimental design was used. Participants in the experimental group (n = 49) listened to music from 10 min before receiving CPM until the end of the session (25 min in total) on the first and second day following surgery, whereas participants in the control group (n = 42) did not listen to music but rested quietly in bed starting 10 min before and throughout CPM. Compared with the control group, the experimental group exhibited significantly lower anxiety levels (p CPM angles (p < .05) during treatment and increased active flexion ROM (p < .05) upon discharge. The low-frequency (LF)/high-frequency (HF) power ratio, normalized LF HRV, and normalized HF HRV of the two groups differed significantly, indicating that the patients in the experimental group had greater parasympathetic activity compared with those in the control group. Music listening can effectively reduce patient anxiety and enhance the ROM of their joints during postoperative rehabilitation. Health-care practitioners should consider including music listening as a routine practice for postoperative rehabilitation following orthopedic surgery. © The Author(s) 2015.

Audit: Automated Disk Investigation Toolkit

Directory of Open Access Journals (Sweden)

Umit Karabiyik

2014-09-01

Full Text Available Software tools designed for disk analysis play a critical role today in forensics investigations. However, these digital forensics tools are often difficult to use, usually task specific, and generally require professionally trained users with IT backgrounds. The relevant tools are also often open source requiring additional technical knowledge and proper configuration. This makes it difficult for investigators without some computer science background to easily conduct the needed disk analysis. In this paper, we present AUDIT, a novel automated disk investigation toolkit that supports investigations conducted by non-expert (in IT and disk technology and expert investigators. Our proof of concept design and implementation of AUDIT intelligently integrates open source tools and guides non-IT professionals while requiring minimal technical knowledge about the disk structures and file systems of the target disk image.

YottaYotta announces new world record set for TCP disk-to-disk bulk transfer

CERN Document Server

2002-01-01

The Yottabyte NetStorage(TM) Company, today announced a new world record for TCP disk-to-disk data transfer using the company's NetStorager(R) System. The record-breaking demonstration transferred 5 terabytes of data between Chicago, Il. to Vancouver, BC and Ottawa, ON, at a sustained average throughput of 11.1 gigabits per second. Peak throughput exceeded 11.6 gigabits per second, more than 15-times faster than previous records for TCP transfer from disk-to-disk (1 page).

The safety of peri-articular local anaesthetic injection for patients undergoing total knee replacement with autologous blood transfusion: a randomised trial.

Science.gov (United States)

Wallace, D F; Emmett, S R; Kang, K K; Chahal, G S; Hiskens, R; Balasubramanian, S; McGuinness, K; Parsons, H; Achten, J; Costa, M L

2012-12-01

Intra-operative, peri-articular injection of local anaesthesia is an increasingly popular way of controlling pain following total knee replacement. At the same time, the problems associated with allogenic blood transfusion have led to interest in alternative methods for managing blood loss after total knee replacement, including the use of auto-transfusion of fluid from the patient's surgical drain. It is safe to combine peri-articular infiltration with auto-transfusion from the drain. We performed a randomised clinical trial to compare the concentration of local anaesthetic in the blood and in the fluid collected in the knee drain in patients having either a peri-articular injection or a femoral nerve block. Clinically relevant concentrations of local anaesthetic were found in the fluid from the drains of patients having peri-articular injections (4.92 μg/ml (sd 3.151)). However, none of the patients having femoral nerve blockade had detectable levels. None of the patients in either group had clinically relevant concentrations of local anaesthetic in their blood after re-transfusion. The evidence from this study suggests that it is safe to use peri-articular injection in combination with auto-transfusion of blood from peri-articular drains during knee replacement surgery.

Total shoulder replacement in rheumatoid arthritis

DEFF Research Database (Denmark)

Sneppen, O; Fruensgaard, S; Johannsen, Hans Viggo

1996-01-01

A prospective study of 62 Neer mark II total shoulder arthroplasties performed during the period from 1981 to 1990 on 51 patients with rheumatoid arthritis was undertaken to evaluate factors associated with component loosening and proximal humeral migration. Thirty-two (51%) showed proximal......, range of movement, abduction force, or function. The risk of clinical asymptomatic loosening is a relatively late complication that is eventually followed by pronounced bone destruction related to the loose component. Long-term radiographic control of total shoulders with rheumatoid arthritis...... is recommended. Hemiarthroplasty with a cemented humeral prosthesis may be a better treatment in the end stage of rheumatoid arthritis of the shoulder....

Disk-to-Disk network transfers at 100 Gb/s

Science.gov (United States)

Barczyk, Artur; Gable, Ian; Hay, Marilyn; Leavett-Brown, Colin; Legrand, Iosif; Lewall, Kim; McKee, Shawn; McWilliam, Donald; Mughal, Azher; Newman, Harvey; Rozsa, Sandor; Savard, Yvan; Sobie, Randall J.; Tam, Thomas; Voicu, Ramiro

2012-12-01

A 100 Gbps network was established between the California Institute of Technology conference booth at the Super Computing 2011 conference in Seattle, Washington and the computing center at the University of Victoria in Canada. A circuit was established over the BCNET, CANARIE and Super Computing (SCInet) networks using dedicated equipment. The small set of servers at the endpoints used a combination of 10GE and 40GE technologies, and SSD drives for data storage. The configuration of the network and the server configuration are discussed. We will show that the system was able to achieve disk-to-disk transfer rates of 60 Gbps and memory-to-memory rates in excess of 180 Gbps across the WAN. We will discuss the transfer tools, disk configurations, and monitoring tools used in the demonstration.

Disk-to-Disk network transfers at 100 Gb/s

International Nuclear Information System (INIS)

Barczyk, Artur; Legrand, Iosif; Mughal, Azher; Newman, Harvey; Rozsa, Sandor; Voicu, Ramiro; Gable, Ian; Leavett-Brown, Colin; Lewall, Kim; Savard, Yvan; Sobie, Randall J; Hay, Marilyn; McWilliam, Donald; McKee, Shawn; Tam, Thomas

2012-01-01

A 100 Gbps network was established between the California Institute of Technology conference booth at the Super Computing 2011 conference in Seattle, Washington and the computing center at the University of Victoria in Canada. A circuit was established over the BCNET, CANARIE and Super Computing (SCInet) networks using dedicated equipment. The small set of servers at the endpoints used a combination of 10GE and 40GE technologies, and SSD drives for data storage. The configuration of the network and the server configuration are discussed. We will show that the system was able to achieve disk-to-disk transfer rates of 60 Gbps and memory-to-memory rates in excess of 180 Gbps across the WAN. We will discuss the transfer tools, disk configurations, and monitoring tools used in the demonstration.

MODELING DUST EMISSION OF HL TAU DISK BASED ON PLANET–DISK INTERACTIONS

International Nuclear Information System (INIS)

Jin, Sheng; Ji, Jianghui; Li, Shengtai; Li, Hui; Isella, Andrea

2016-01-01

We use extensive global two-dimensional hydrodynamic disk gas+dust simulations with embedded planets, coupled with three-dimensional radiative transfer calculations, to model the dust ring and gap structures in the HL Tau protoplanetary disk observed with the Atacama Large Millimeter/Submillimeter Array (ALMA). We include the self-gravity of disk gas and dust components and make reasonable choices of disk parameters, assuming an already settled dust distribution and no planet migration. We can obtain quite adequate fits to the observed dust emission using three planets with masses of 0.35, 0.17, and 0.26 M Jup at 13.1, 33.0, and 68.6 AU, respectively. Implications for the planet formation as well as the limitations of this scenario are discussed

Fast disk array for image storage

Science.gov (United States)

Feng, Dan; Zhu, Zhichun; Jin, Hai; Zhang, Jiangling

1997-01-01

A fast disk array is designed for the large continuous image storage. It includes a high speed data architecture and the technology of data striping and organization on the disk array. The high speed data path which is constructed by two dual port RAM and some control circuit is configured to transfer data between a host system and a plurality of disk drives. The bandwidth can be more than 100 MB/s if the data path based on PCI (peripheral component interconnect). The organization of data stored on the disk array is similar to RAID 4. Data are striped on a plurality of disk, and each striping unit is equal to a track. I/O instructions are performed in parallel on the disk drives. An independent disk is used to store the parity information in the fast disk array architecture. By placing the parity generation circuit directly on the SCSI (or SCSI 2) bus, the parity information can be generated on the fly. It will affect little on the data writing in parallel on the other disks. The fast disk array architecture designed in the paper can meet the demands of the image storage.

Prevalence of pannus formation after aortic valve replacement: clinical aspects and surgical management.

Science.gov (United States)

Sakamoto, Yoshimasa; Hashimoto, Kazuhiro; Okuyama, Hiroshi; Ishii, Shinichi; Shingo, Taguchi; Kagawa, Hiroshi

2006-01-01

Pannus formation after aortic valve replacement is not common, but obstruction due to chronic pannus is one of the most serious complications of valve replacement. The causes of pannus formation are still unknown and effective preventive methods have not been fully elucidated. We reviewed our clinical experience of all patients who underwent reoperation for prosthetic aortic valve obstruction due to pannus formation between 1973 and 2004. We compared the initial 18-year period of surgery, when the Björk-Shiley tilting-disk valve was used, and the subsequent 13-year period of surgery, when the St. Jude Medical valve was used. Seven of a total of 390 patients (1.8%) required reoperation for prosthetic aortic valve obstruction due to pannus formation. All seven patients were women; four patients underwent resection of the pannus and three patients needed replacement of the valve. The frequency of pannus formation in the early group was 2.4% (6/253), whereas it was 0.73% (1/137) in the late group (P Pannus was localized at the minor orifice of the Björk-Shiley valve in the early group and turbulent transvalvular blood flow was considered to be one of the important factors triggering its growth. We also consider that small bileaflet valves have the possibility of promoting pannus formation and that the implantation of a larger prosthesis can contribute to reducing the occurrence of pannus.

A Comparison of Galaxy Bulge+Disk Decomposition Between Pan-STARRS and SDSS

Science.gov (United States)

Lokken, Martine Elena; McPartland, Conor; Sanders, David B.

2018-01-01

Measurements of the size and shape of bulges in galaxies provide key constraints for models of galaxy evolution. A comprehensive catalog of bulge measurements for Sloan Digital Sky Survey (SDSS) DR7 galaxies is currently available to the public. However, the Pan-STARRS1 (PS1) 3π survey now covers the same region with ~1-2 mag deeper photometry, a ~10-30% smaller PSF, and additional coverage in y-band. To test how much improvement in galaxy parameter measurements (e.g. bulge + disk) can be achieved using the new PS1 data, we make use of ultra-deep imaging data from the Hyper Suprime-Cam (HSC) Subaru Strategic Program (SSP). We fit bulge+disk models to images of 372 bright (mi SSP images shows a tighter correlation between PS1 and SSP measurements for both bulge and disk parameters. Bulge parameters, such as bulge-to-total fraction and bulge radius, show the strongest improvement. However, measurements of all parameters degrade for galaxies with total r-band magnitude below the SDSS spectroscopic limit, mr = 17.7. We plan to use the PS1 3π survey data to produce an updated catalog of bulge+disk decomposition measurements for the entire SDSS DR7 spectroscopic galaxy sample.

Replacement Models Revisited | Alabi | Journal of Research in ...

African Journals Online (AJOL)

The objective is to review the annual total cost and the cumulative annual total cost average hitherto used as replacement methods. The study showed some disparity in the optimal age of single replacement as used by some authors. Hence, an arithmetic mean method of finding the optimal single- replacement- age of an ...

Effect of Degeneration on Fluid–Solid Interaction within Intervertebral Disk Under Cyclic Loading – A Meta-Model Analysis of Finite Element Simulations

Science.gov (United States)

Nikkhoo, Mohammad; Khalaf, Kinda; Kuo, Ya-Wen; Hsu, Yu-Chun; Haghpanahi, Mohammad; Parnianpour, Mohamad; Wang, Jaw-Lin

2015-01-01

The risk of low back pain resulted from cyclic loadings is greater than that resulted from prolonged static postures. Disk degeneration results in degradation of disk solid structures and decrease of water contents, which is caused by activation of matrix digestive enzymes. The mechanical responses resulted from internal solid–fluid interactions of degenerative disks to cyclic loadings are not well studied yet. The fluid–solid interactions in disks can be evaluated by mathematical models, especially the poroelastic finite element (FE) models. We developed a robust disk poroelastic FE model to analyze the effect of degeneration on solid–fluid interactions within disk subjected to cyclic loadings at different loading frequencies. A backward analysis combined with in vitro experiments was used to find the elastic modulus and hydraulic permeability of intact and enzyme-induced degenerated porcine disks. The results showed that the averaged peak-to-peak disk deformations during the in vitro cyclic tests were well fitted with limited FE simulations and a quadratic response surface regression for both disk groups. The results showed that higher loading frequency increased the intradiscal pressure, decreased the total fluid loss, and slightly increased the maximum axial stress within solid matrix. Enzyme-induced degeneration decreased the intradiscal pressure and total fluid loss, and barely changed the maximum axial stress within solid matrix. The increase of intradiscal pressure and total fluid loss with loading frequency was less sensitive after the frequency elevated to 0.1 Hz for the enzyme-induced degenerated disk. Based on this study, it is found that enzyme-induced degeneration decreases energy attenuation capability of disk, but less change the strength of disk. PMID:25674562

Correlation between T2 relaxation time and intervertebral disk degeneration

Energy Technology Data Exchange (ETDEWEB)

Takashima, Hiroyuki; Takebayashi, Tsuneo; Yoshimoto, Mitsunori; Terashima, Yoshinori; Tsuda, Hajime; Ida, Kazunori; Yamashita, Toshihiko [Sapporo Medical University, Department of Orthopedic Surgery, School of Medicine, Sapporo, Hokkaido (Japan)

2012-02-15

Magnetic resonance T2 mapping allows for the quantification of water and proteoglycan content within tissues and can be used to detect early cartilage abnormalities as well as to track the response to therapy. The goal of the present study was to use T2 mapping to quantify intervertebral disk water content according to the Pfirrmann classification. This study involved 60 subjects who underwent lumbar magnetic resonance imaging (a total of 300 lumbar disks). The degree of disk degeneration was assessed in the midsagittal section on T2-weighted images according to the Pfirrmann classification (grades I to V). Receiver operating characteristic (ROC) analysis was performed among grades to determine the cut-off values. In the nucleus pulposus, T2 values tended to decrease with increasing grade, and there was a significant difference in T2 values between each grade from grades I to IV. However, there was no significant difference in T2 values in the anterior or posterior annulus fibrosus. T2 values according to disk degeneration level classification were as follows: grade I (>116.8 ms), grade II (92.7-116.7 ms), grade III (72.1-92.6 ms), grade IV (<72.0 ms). T2 values decreased with increasing Pfirrmann classification grade in the nucleus pulposus, likely reflecting a decrease in proteoglycan and water content. Thus, T2 value-based measurements of intervertebral disk water content may be useful for future clinical research on degenerative disk diseases. (orig.)

Unlocking CO Depletion in Protoplanetary Disks. I. The Warm Molecular Layer

Science.gov (United States)

Schwarz, Kamber R.; Bergin, Edwin A.; Cleeves, L. Ilsedore; Zhang, Ke; Öberg, Karin I.; Blake, Geoffrey A.; Anderson, Dana

2018-03-01

CO is commonly used as a tracer of the total gas mass in both the interstellar medium and in protoplanetary disks. Recently, there has been much debate about the utility of CO as a mass tracer in disks. Observations of CO in protoplanetary disks reveal a range of CO abundances, with measurements of low CO to dust mass ratios in numerous systems. One possibility is that carbon is removed from CO via chemistry. However, the full range of physical conditions conducive to this chemical reprocessing is not well understood. We perform a systematic survey of the time dependent chemistry in protoplanetary disks for 198 models with a range of physical conditions. We vary dust grain size distribution, temperature, comic-ray and X-ray ionization rates, disk mass, and initial water abundance, detailing what physical conditions are necessary to activate the various CO depletion mechanisms in the warm molecular layer. We focus our analysis on the warm molecular layer in two regions: the outer disk (100 au) well outside the CO snowline and the inner disk (19 au) just inside the midplane CO snowline. After 1 Myr, we find that the majority of models have a CO abundance relative to H2 less than 10‑4 in the outer disk, while an abundance less than 10‑5 requires the presence of cosmic-rays. Inside the CO snowline, significant depletion of CO only occurs in models with a high cosmic-ray rate. If cosmic-rays are not present in young disks, it is difficult to chemically remove carbon from CO. Additionally, removing water prior to CO depletion impedes the chemical processing of CO. Chemical processing alone cannot explain current observations of low CO abundances. Other mechanisms must also be involved.

Debris Disks in Aggregate: Using Hubble Space Telescope Coronagraphic Imagery to Understand the Scattered-Light Disk Detection Rate

Science.gov (United States)

Grady, Carol A.

2011-01-01

Despite more than a decade of coronagraphic imaging of debris disk candidate stars, only 16 have been imaged in scattered light. Since imaged disks provide our best insight into processes which sculpt disks, and can provide signposts of the presence of giant planets at distances which would elude radial velocity and transit surveys, we need to understand under what conditions we detect the disks in scattered light, how these disks differ from the majority of debris disks, and how to increase the yield of disks which are imaged with 0.1" angular resolution. In this talk, I will review what we have learned from a shallow HSTINICMOS NIR survey of debris disks, and present first results from our on-going HST /STIS optical imaging of bright scattered-light disks.

Complex Spiral Structure in the HD 100546 Transitional Disk as Revealed by GPI and MagAO

Energy Technology Data Exchange (ETDEWEB)

Follette, Katherine B.; Macintosh, Bruce; Mullen, Wyatt; Bailey, Vanessa P. [Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics, Stanford University, Stanford, CA, 94305 (United States); Rameau, Julien [Institut de Recherche sur les Exoplanètes, Départment de Physique, Université de Montréal, Montréal QC H3C 3J7 (Canada); Dong, Ruobing; Close, Laird M.; Males, Jared R.; Morzinski, Katie M. [Steward Observatory, University of Arizona, Tucson, AZ 85721 (United States); Pueyo, Laurent; Perrin, Marshall [Space Telescope Science Institute, Baltimore, MD 21218 (United States); Duchêne, Gaspard; Fung, Jeffrey; Wang, Jason [Astronomy Department, University of California, Berkeley, Berkeley CA 94720 (United States); Leonard, Clare; Spiro, Elijah [Physics and Astronomy Department, Amherst College, 21 Merrill Science Drive, Amherst, MA 01002 (United States); Marois, Christian [National Research Council of Canada Herzberg, 5071 West Saanich Road, Victoria, BC V9E 2E7 (Canada); Millar-Blanchaer, Maxwell A. [Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA 91125 (United States); Ammons, S. Mark [Lawrence Livermore National Laboratory, Livermore, CA 94551 (United States); Barman, Travis [Lunar and Planetary Laboratory, University of Arizona, Tucson, AZ 85721 (United States); and others

2017-06-01

We present optical and near-infrared high-contrast images of the transitional disk HD 100546 taken with the Magellan Adaptive Optics system (MagAO) and the Gemini Planet Imager (GPI). GPI data include both polarized intensity and total intensity imagery, and MagAO data are taken in Simultaneous Differential Imaging mode at H α . The new GPI H -band total intensity data represent a significant enhancement in sensitivity and field rotation compared to previous data sets and enable a detailed exploration of substructure in the disk. The data are processed with a variety of differential imaging techniques (polarized, angular, reference, and simultaneous differential imaging) in an attempt to identify the disk structures that are most consistent across wavelengths, processing techniques, and algorithmic parameters. The inner disk cavity at 15 au is clearly resolved in multiple data sets, as are a variety of spiral features. While the cavity and spiral structures are identified at levels significantly distinct from the neighboring regions of the disk under several algorithms and with a range of algorithmic parameters, emission at the location of HD 100546 “ c ” varies from point-like under aggressive algorithmic parameters to a smooth continuous structure with conservative parameters, and is consistent with disk emission. Features identified in the HD 100546 disk bear qualitative similarity to computational models of a moderately inclined two-armed spiral disk, where projection effects and wrapping of the spiral arms around the star result in a number of truncated spiral features in forward-modeled images.

Coevolution of Binaries and Circumbinary Gaseous Disks

Science.gov (United States)

Fleming, David; Quinn, Thomas R.

2018-04-01

The recent discoveries of circumbinary planets by Kepler raise questions for contemporary planet formation models. Understanding how these planets form requires characterizing their formation environment, the circumbinary protoplanetary disk, and how the disk and binary interact. The central binary excites resonances in the surrounding protoplanetary disk that drive evolution in both the binary orbital elements and in the disk. To probe how these interactions impact both binary eccentricity and disk structure evolution, we ran N-body smooth particle hydrodynamics (SPH) simulations of gaseous protoplanetary disks surrounding binaries based on Kepler 38 for 10^4 binary orbital periods for several initial binary eccentricities. We find that nearly circular binaries weakly couple to the disk via a parametric instability and excite disk eccentricity growth. Eccentric binaries strongly couple to the disk causing eccentricity growth for both the disk and binary. Disks around sufficiently eccentric binaries strongly couple to the disk and develop an m = 1 spiral wave launched from the 1:3 eccentric outer Lindblad resonance (EOLR). This wave corresponds to an alignment of gas particle longitude of periastrons. We find that in all simulations, the binary semi-major axis decays due to dissipation from the viscous disk.

Fractionation and characterization of particles simulating wear of total joint replacement (TJR) following ASTM standards.

Science.gov (United States)

Saha, Subrata; Musib, Mrinal

2011-01-01

Reactions of bone cells to orthopedic wear debris produced by the articulating motion of total joint replacements (TJRs) are largely responsible for the long-term failure of such replacements. Metal and polyethylene (PE) wear particles isolated from fluids from total joint simulators, as well as particles that are fabricated by other methods, are widely used to study such in vitro cellular response. Prior investigations have revealed that cellular response to wear debris depends on the size, shape, and dose of the particles. Hence, to have a better understanding of the wear-mediated osteolytic process it is important that these particles are well characterized and clinically relevant, both qualitatively, and quantitatively. In this study we have fractionated both ultra-high molecular weight polyethylene (UHMWPE) and Ti particles, into micron (1.0-10.0 μm), submicron (0.2-1.0 μm), and nanoparticle (0.01-0.2 μm) fractions, and characterized them based on the following size-shape descriptors as put forth in ASTM F1877: i) equivalent circle diameter (ECD), ii) aspect ratio (AR), iii) elongation (E), iv) roundness (R), and v) form factor (FF). The mean (± SD) ECDs (in μm) for micron, submicron, and nanoparticles of UHMWPE were 1.652 ± 0.553, 0.270 ± 0.180, and 0.061 ± 0.035, respectively, and for Ti were 1.894 ± 0.667, 0.278 ± 0.180, and 0.055 ± 0.029, respectively. The values for other descriptors were similar (no statistically significant difference). The nanofraction particles were found to be more sphere-like (higher R and FF values, and lower E and AR values) as compared to larger particles. Future experiments will involve use of these well characterized particles for in vitro studies.

Knee injury and obesity in patients undergoing total knee replacement: a retrospective study in 115 patients

DEFF Research Database (Denmark)

Jensen, Claus Hjorth; Rofail, S

1999-01-01

The prevalence of obesity and previous knee injury was assessed in a retrospective study of 115 patients under-going total knee replacement due to osteoarthritis. Obesity was considered a contributing factor in the development of osteoarthritis in 37% of the patients, and 33% of the patients had...... had an injury to the knee in question. Unilateral osteoarthritis was significantly more frequent than bilateral osteoarthritis among patients with a history of previous knee injury. The association of previous injury to the knee and unilateral osteoarthritis was stronger in men than women. Aggressive...... treatment of patients with knee injuries seems warranted....

Radiography, radionuclide imaging, and asthrography in the evaluation of total hip and knee replacement. [/sup 99m/Tc-phosphate

Energy Technology Data Exchange (ETDEWEB)

Gelman, M.I.; Coleman, R.E.; Stevens, P.M.; Davey, B.W.

1978-09-01

Twenty patients with 21 total joint replacements including 17 hips and 4 knees were studied by plain film radiography, radionuclide imaging, and subtraction arthrography to evaluate these procedures for assessing prosthetic complications. Surgery was performed in 14 patients and confirmed loosening of 8 femoral and 7 acetabular hip prosthesis components and 1 femoral and 4 tibial knee prosthesis components. Plain films suggested loosening of only 9 hip components and no knee components. In contrast, radionuclide imaging and subtraction arthrography were considerably more effective in demonstrating loosening as well as other causes of the painful total joint prosthesis.

Lactobacillus as a rare cause of an infected total knee replacement: a case report

Science.gov (United States)

2009-01-01

Introduction We report a rare case of an infected revision total knee replacement as a result of a Lactobacillus species infection. Lactobacillus infections have been associated with prolonged broad-spectrum antibiotic use. This can have implications in revision surgery, especially when patients have been on previous long-term suppressive antibiotic therapy. Case presentation An 81-year-old British man with a previous history of complex revision knee arthroplasty for infection presented with a hot, swollen knee joint. He had previously been on long-term suppressive antibiotic therapy. Aspiration of the knee joint yielded a culture of Lactobacillus species. Conclusion In patients undergoing revision joint arthroplasty, especially for previous infection, the presence of common and uncommon bacterial species must be excluded and eradicated before further surgical intervention. PMID:19830207

TOTAL JOINT REPLACEMENT OF THE LOWER EXTREMITY IN PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS

Directory of Open Access Journals (Sweden)

Стюарт Б. Гудмэн

2014-03-01

Full Text Available Joint replacement of the lower extremity in Juvenile Idiopathic Arthritis (JIA is becoming more commonly performed worldwide. These young adults experience severe pain and disability from end-stage arthritis, and require joint replacement of the hip or knee to alleviate pain, and restore ambulation and function. These procedures are very challenging from the anesthesia and surgical point of view, due to small overall proportions, numerous bony and other deformities and soft tissue contractures. Joint replacement operations for JIA are best performed by experienced teams, where pre-operative and peri-operative care, and post-operative rehabilitation can be optimized in a collaborative, patient-centered environment.

Peripheral nerve blocks versus general anesthesia for total knee replacement in elderly patients on the postoperative quality of recovery

Directory of Open Access Journals (Sweden)

Liu JL

2014-02-01

Full Text Available JunLe Liu,1,* WeiXiu Yuan,1,* XiaoLin Wang,1,* Colin F Royse,2,3 MaoWei Gong,1 Ying Zhao,1 Hong Zhang1 1Anesthesia and Operation Center, Chinese People's Liberation Army General Hospital and Medical School of Chinese People's Liberation Army, Beijing, People's Republic of China; 2Anesthesia and Pain Management Unit, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia; 3Department of Anesthesia and Pain Management, The Royal Melbourne Hospital, Melbourne, Victoria, Australia *These authors contributed equally to this work Background: Both peripheral nerve blocks with sedation or general anesthesia can be used for total knee replacement surgery. Objectives: We compared these anesthetic techniques on the postoperative quality of recovery early in elderly patients. Materials and methods: In our study, 213 patients who were ≥65 years old and undergoing total knee replacement were randomized to peripheral nerve blocks (PNBs – lumbar plexus and sciatic – with propofol sedation, or general anesthesia with combined propofol and remifentanil. Blocks were performed using nerve stimulation and 0.35% ropivacaine. All patients received postoperative multimodal analgesia. Postoperative recovery was assessed at 15 minutes, 40 minutes, 1 day, 3 days, and 7 days after surgery, with the Postoperative Quality of Recovery Scale, in physiological, nociceptive, emotive, modified activities of daily living, modified cognitive, and overall patient perspective domains. Results: Intraoperative blood pressure and heart rate were more stable with PNBs (P<0.001. The recovery was better with PNBs in physiological (P<0.001, emotive (depression and anxiety (P<0.001, nociceptive (pain and nausea (P<0.001, modified cognitive (P<0.001, and all domains recovery (P<0.001, but not in activities of daily living (P=0.181. Intraoperative drugs and the postoperative sulfentanil requirement of the PNBs group were lower (all P<0.001. Differences were

Polietileno tibial móvel na artroplastia total do joelho Mobile polyethylene bearing in total knee replacement

Directory of Open Access Journals (Sweden)

Hugo Alexandre de Araújo Barros Cobra

2009-01-01

Full Text Available O desgaste do polietileno tibial utilizado nas artroplastias de joelho origina partículas que, quando fagocitadas, dão início à cascata de eventos biológicos que levam à osteólise e consequente afrouxamento dos componentes da prótese. Assim sendo, alternativas para o polietileno têm sido pesquisadas com o objetivo de minimizar o desgaste e, com isso, aumentar a durabilidade das artroplastias. Uma dessas opções é a utilização de polietilenos tibiais móveis, que apresentam maior conformidade do que os polietilenos fixos, ao mesmo tempo em que permitem autoalinhamento rotacional entre os componentes, melhorando, dessa forma, a cinética e a cinemática da prótese. São apresentados aqui, de forma resumida, porém abrangente, o conceito, os fundamentos biomecânicos, as indicações, os resultados esperados e complicações dos polietilenos tibiais móveis nas artroplastias totais do joelho.Debris of polyethylene tibial bearings have been recognized as a major cause for the onset of the cascade of biological events leading to osteolysis and loosening of prosthetic components after total knee arthroplasty. Since then, research has been focused on alternative bearing surfaces in order to minimize the amount and rate of polyethylene wear off and, in doing so, increasing the survivorship rate for knee arthroplasties. One such option is to have a mobile tibial bearing allowing more conformity and rotational self-alignment of the components, improving kinetics and kinematics of the prosthesis. The authors present a resumed but throughout and comprehensive review of the rationale, biomechanics fundamentals, indications, pitfalls, outcomes and complications for the use of mobile tibial bearings in total knee replacement.

Synthesis and characterization of injectable composites of poly[D,L-lactide-co-(ε-caprolactone)] reinforced with β-TCP and CaCO3 for intervertebral disk augmentation.

Science.gov (United States)

López, Alejandro; Persson, Cecilia; Hilborn, Jöns; Engqvist, Håkan

2010-10-01

Degeneration of the intervertebral disk constitutes one of the major causes of low back pain in adults aged 20-50 years old. In this study, injectable, in situ setting, degradable composites aimed for intervertebral disk replacement were prepared. β-TCP and calcium carbonate particles were mixed into acrylic-terminated oligo[D,L-lactide-co-(ε-caprolactone)], which were crosslinked at room temperature. The structure of the oligomers was confirmed by 1H-NMR spectroscopy. The composites were examined via SEM, and the mechanical properties of the crosslinked networks were determined. The porous β-TCP particles showed good mechanical anchorage to the matrix due to polymer penetration into the pores. In vitro degradation tests showed that the composites containing β-TCP slowly degraded, whereas the composites containing CaCO3 exhibited apatite formation capacity. It was concluded that the surface area, morphology, and solubility of the fillers might be used to control the degradation properties. The incorporation of fillers also increased both the elastic modulus and the maximum compression strength of the composites, properties that were similar to those of the physiological disk. These materials have potential for long-term intervertebral disk replacement and regenerative scaffolds because of their low degradation rates, bioactivity, and mechanical properties.

Can shared care deliver better outcomes for patients undergoing total hip replacement? A prospective assessment of patient outcomes and associated service use

NARCIS (Netherlands)

Rosendal, H.; Beekum, W.T. van; Nijhof, P.; Witte, L.P. de; Schrijvers, A.J.P.

2000-01-01

Objectives: To assess whether shared care for patients undergoing total hip replacement delivers better outcomes compared to care as usual. Design: Prospective, observational cohort study. Setting: Two regions in the Netherlands where different organisational health care models have been

MOLECULAR GAS IN YOUNG DEBRIS DISKS

International Nuclear Information System (INIS)

Moor, A.; Abraham, P.; Kiss, Cs.; Juhasz, A.; Kospal, A.; Pascucci, I.; Apai, D.; Henning, Th.; Csengeri, T.; Grady, C.

2011-01-01

Gas-rich primordial disks and tenuous gas-poor debris disks are usually considered as two distinct evolutionary phases of the circumstellar matter. Interestingly, the debris disk around the young main-sequence star 49 Ceti possesses a substantial amount of molecular gas and possibly represents the missing link between the two phases. Motivated to understand the evolution of the gas component in circumstellar disks via finding more 49 Ceti-like systems, we carried out a CO J = 3-2 survey with the Atacama Pathfinder EXperiment, targeting 20 infrared-luminous debris disks. These systems fill the gap between primordial and old tenuous debris disks in terms of fractional luminosity. Here we report on the discovery of a second 49 Ceti-like disk around the 30 Myr old A3-type star HD21997, a member of the Columba Association. This system was also detected in the CO(2-1) transition, and the reliable age determination makes it an even clearer example of an old gas-bearing disk than 49 Ceti. While the fractional luminosities of HD21997 and 49 Ceti are not particularly high, these objects seem to harbor the most extended disks within our sample. The double-peaked profiles of HD21997 were reproduced by a Keplerian disk model combined with the LIME radiative transfer code. Based on their similarities, 49 Ceti and HD21997 may be the first representatives of a so far undefined new class of relatively old (∼>8 Myr), gaseous dust disks. From our results, neither primordial origin nor steady secondary production from icy planetesimals can unequivocally explain the presence of CO gas in the disk of HD21997.

Deformation and Life Analysis of Composite Flywheel Disk and Multi-disk Systems

Science.gov (United States)

Arnold, S. M.; Saleeb, A. F.; AlZoubi, N. R.

2001-01-01

In this study an attempt is made to put into perspective the problem of a rotating disk, be it a single disk or a number of concentric disks forming a unit. An analytical model capable of performing an elastic stress analysis for single/multiple, annular/solid, anisotropic/isotropic disk systems, subjected to both pressure surface tractions, body forces (in the form of temperature-changes and rotation fields) and interfacial misfits is derived and discussed. Results of an extensive parametric study are presented to clearly define the key design variables and their associated influence. In general the important parameters were identified as misfit, mean radius, thickness, material property and/or load gradation, and speed; all of which must be simultaneously optimized to achieve the "best" and most reliable design. Also, the important issue of defining proper performance/merit indices (based on the specific stored energy), in the presence of multiaxiality and material anisotropy is addressed. These merit indices are then utilized to discuss the difference between flywheels made from PMC and TMC materials with either an annular or solid geometry. Finally two major aspects of failure analysis, that is the static and cyclic limit (burst) speeds are addressed. In the case of static limit loads, upper, lower, and out-of-plane bounds for disks with constant thickness are presented for both the case of internal pressure loading (as one would see in a hydroburst test) and pure rotation (as in the case of a free spinning disk). The results (interaction diagrams) are displayed graphically in designer friendly format. For the case of fatigue, a representative fatigue/life master curve is illustrated in which the normalized limit speed versus number of applied cycles is given for a cladded TMC disk application.

Functional exercise after total hip replacement (FEATHER a randomised control trial

Directory of Open Access Journals (Sweden)

Monaghan Brenda

2012-11-01

Full Text Available Abstract Background Prolonged physical impairments in range of movement, postural stability and walking speed are commonly reported following total hip replacement (THR. It is unclear from the current body of evidence what kind of exercises should be performed to maximize patient function and quality of life. Methods/design This will be a single blind multi centre randomized control trial with two arms. Seventy subjects post primary total hip arthroplasty will be randomized into either an experimental group (n=35, or to a control group (n=35. The experimental group will attend a functional exercise class twice weekly for a six week period from week 12 to week 18 post surgery. The functional exercise group will follow a circuit based functional exercise class supervised by a chartered Physiotherapist. The control group will receive usual care. The principal investigator (BM will perform blinded outcome assessments on all patients using validated measures for pain, stiffness, and function using the Western Ontario and Mc Master Universities Osteoarthritis index (WOMAC. This is the primary outcome measurement tool. Secondary outcome measurements include Quality of life (SF-36, 6 min walk test, Visual Analogue Scale, and the Berg Balance score. The WOMAC score will be collated on day five post surgery and repeated at week twelve and week eighteen. All other measurements will be taken at week 12 and repeated at week eighteen. In addition a blinded radiologist will measure gluteus medius cross sectional area using real time ultrasound for all subjects at week 12 and at week 18 to determine if the functional exercise programme has any effect on muscle size. Discussion This randomised controlled trial will add to the body of evidence on the relationship between muscle size, functional ability, balance, quality of life and time post surgery in patients following total hip arthroplasty. The CONSORT guidelines will be followed to throughout. Ethical

[Bentall operation combined with total arch replacement and stented elephant trunk implantation for serious Debakey I aortic dissecting aneurysm].

Science.gov (United States)

Gu, Tian-Xiang; Wang, Chun; Zhang, Yu-Hai

2008-12-01

To summarize the clinical experience of Bentall operation combined with total arch replacement and stented elephant trunk implantation for serious Debakey I aortic dissecting aneurysm. Twelve patients with serious Debakey I aortic dissecting aneurysm underwent surgical treatment from January 2005 to December 2007. There were 10 male and 2 female with the mean age of (40.1 +/- 9.5) years old. There were acute aortic dissection in 9 cases, chronic aortic dissection in 3 cases. The inner diameter of aorta was (5.3 +/- 1.8) cm. There were Marfan syndrome in 4 cases, aortic regurgitation in all cases, severely persistent chest pain in 9 cases, acute left heart failure in 8 cases, and cardiac tamponade in 4 cases. Bentall operations combined with total arch replacement and stented elephant trunk implantation were performed by using deep hypothermic circulatory arrest and antegrade selective cerebral perfusion in all cases. Urgent surgery underwent in 9 cases. The mean interval between the onset of aortic dissection and the accomplishment of surgery was (41.0 +/- 15.9) hours. Cardiopulmonary bypass time was (191 +/- 26) min, average cross clamp time was (134 +/- 31) min, and average deep hypothermic circulatory arrest time was (50.0 +/- 14.5) min. One patient died in hospital. The time stayed in ICU was 3 to 27 d. Mental disorder in 6 cases, hemi-paralysis in 1 case, amputation in 1 case, hemorrhage of anastomosis in 1 case, hemorrhage of alimentary tract in 1 case, and pleural effusion in 4 cases were recorded. Eleven cases were followed-up for 8 weeks to 36 months. There were no bending of the stents and no obstruction in the vascular prosthesis.No re-operation was needed. One case died 6 months postoperatively. Bentall operation combined with total arch replacement and stented elephant trunk implantation is safe and effective for serious Debakey I aortic dissecting aneurysm, while good organs protection and consummate cardiopulmonary bypass were taken.

GEMINI PLANET IMAGER OBSERVATIONS OF THE AU MICROSCOPII DEBRIS DISK: ASYMMETRIES WITHIN ONE ARCSECOND

International Nuclear Information System (INIS)

Wang, Jason J.; Graham, James R.; De Rosa, Robert J.; Kalas, Paul; Chiang, Eugene; Duchêne, Gaspard; Pueyo, Laurent; Chen, Christine; Greenbaum, Alexandra Z.; Nielsen, Eric L.; Millar-Blanchaer, Max; Ammons, S. Mark; Bulger, Joanna; Cardwell, Andrew; Goodsell, Stephen J.; Chilcote, Jeffrey K.; Doyon, René; Draper, Zachary H.; Esposito, Thomas M.; Fitzgerald, Michael P.

2015-01-01

We present Gemini Planet Imager (GPI) observations of AU Microscopii, a young M dwarf with an edge-on, dusty debris disk. Integral field spectroscopy and broadband imaging polarimetry were obtained during the commissioning of GPI. In our broadband imaging polarimetry observations, we detect the disk only in total intensity and find asymmetries in the morphology of the disk between the southeast (SE) and northwest (NW) sides. The SE side of the disk exhibits a bump at 1″ (10 AU projected separation) that is three times more vertically extended and three times fainter in peak surface brightness than the NW side at similar separations. This part of the disk is also vertically offset by 69 ± 30 mas to the northeast at 1″ when compared to the established disk midplane and is consistent with prior Atacama Large Millimeter/submillimeter Array and Hubble Space Telescope/Space Telescope Imaging Spectrograph observations. We see hints that the SE bump might be a result of detecting a horizontal sliver feature above the main disk that could be the disk backside. Alternatively, when including the morphology of the NW side, where the disk midplane is offset in the opposite direction ∼50 mas between 0.″4 and 1.″2, the asymmetries suggest a warp-like feature. Using our integral field spectroscopy data to search for planets, we are 50% complete for ∼4 M Jup planets at 4 AU. We detect a source, resolved only along the disk plane, that could either be a candidate planetary mass companion or a compact clump in the disk

99mTc-HMPAO-labelled leucocyte scintigraphy in the diagnosis of infection after total knee replacement arthroplasty

International Nuclear Information System (INIS)

Park, Dong Rib; Kim, Jae Seung; Ryu, Jin Sook; Moon, Dae Hyuk; Bin, Seong Il; Cho, Woo Shin; Lee, Hee Kyung

1999-01-01

This study was performed to evaluate the usefulness of 99m Tc-HMPAO-labelled leucocyte scintigraphy for diagnosing prosthetic infection after total knee replacement arthroplasty without the aid of following bone marrow scintigraphy. The study subjects were 25 prostheses of 17 patients (one man and 16 women, mean age: 65 years) who had total knee replacement arthroplasty. After injection of 99m Tc-HMPAO-labelled leucocyte, the whole body planar and knee SPECT images were obtained in all patients. The subjects were classified into three groups according to clinical suspicion of prosthetic infection: Group A (n=11) with high suspicion of infection; Group B (n=6) with equivocal suspicion of infection, and Group C (n=8) with asymptomatic contralateral prostheses. Final diagnosis of infection was based on surgical, histological and bacteriological data and clinical follow-up. Infection was confirmed in 13 prostheses (11 in Group A and 2 in Group B). All prostheses in Group A were true positive. There were two true positive, one false positive and three true negative in Group B, and six true negatives and two false positive in Group C. Overall sensitivity, specificity, and accuracy for diagnosis of the infected knee prosthesis were 100%, 75% and 88%, respectively. 99m Tc-HMPAO-labelled leucocyte scintigraphy is a sensitive method for the diagnosis of infected knee prosthesis. However, false positive uptakes even in asymptomatic prosthesis suggest that bone marrow scintigraphy may be needed to achieve improved specificity

STUDY OF ULTRASOUND-GUIDED CONTINUOUS FEMORAL NERVE BLOCKADE WITH EPIDURAL ANALGESIA FOR PAIN RELIEF AFTER TOTAL KNEE REPLACEMENT

Directory of Open Access Journals (Sweden)

Srinivas Rapolu

2016-11-01

Full Text Available BACKGROUND Total knee replacement causes moderate-to-severe pain requiring effective analgesia. With use of ultrasound guidance, we may prove a more suitable approach compared with the epidural technique. Aim of this study is the comparison between Continuous Epidural Analgesia (CEA and Continuous Femoral Block (CFB techniques in Total Knee Replacement surgeries. MATERIALS AND METHODS This study was conducted on 60 adult male and female patients undergoing total knee replacement surgery for a period of 2 years. Patients were divided into 2 groups. Group - 1: Continuous epidural analgesia patients, Group - 2: Continuous femoral blockage patients. All patients were assessed clinically preoperatively and investigated to rule out any systemic disease. RESULTS The mean age of patient in Group - 1 was 66.54 ± 4.98 and in Group - 2 was 66.98 ± 5.02 years. P value was > 0.05, which was not significant. No significant differences in gender is observed between the groups. VAS scores were significantly high (P < 0.05 in the femoral group at 6 h, after which there was a declining trend and scores were essentially similar from 24 h. The use of rescue analgesic was also higher in the femoral group. Analysis of side-effects showed that all the five common sideeffects were twice as common in the epidural group than in the femoral study group. Only one patient in the femoral group had urinary retention when compared with four in the epidural group. The differences were not statistically significant. Muscle power at 48 h, time getting out of the bed and time stay in hospital (days are significant in comparison in 2 groups, range of movement is insignificant in groups. Patient satisfaction score was measured on a scale of 1 - 10. Patients in the Femoral group were slightly more satisfied with a mean ± SD score of 8.1 ± 1.2 when compared with the epidural group 7.3 ± 1.01. CONCLUSION Continuous femoral blockade using US guidance provides equivalent analgesia

FOMALHAUT'S DEBRIS DISK AND PLANET: CONSTRAINING THE MASS OF FOMALHAUT B FROM DISK MORPHOLOGY

International Nuclear Information System (INIS)

Chiang, E.; Kalas, P.; Graham, J. R.; Kite, E.; Clampin, M.

2009-01-01

Following the optical imaging of exoplanet candidate Fomalhaut b (Fom b), we present a numerical model of how Fomalhaut's debris disk is gravitationally shaped by a single interior planet. The model is simple, adaptable to other debris disks, and can be extended to accommodate multiple planets. If Fom b is the dominant perturber of the belt, then to produce the observed disk morphology it must have a mass M pl J , an orbital semimajor axis a pl > 101.5 AU, and an orbital eccentricity e pl = 0.11-0.13. These conclusions are independent of Fom b's photometry. To not disrupt the disk, a greater mass for Fom b demands a smaller orbit farther removed from the disk; thus, future astrometric measurement of Fom b's orbit, combined with our model of planet-disk interaction, can be used to determine the mass more precisely. The inner edge of the debris disk at a ∼ 133 AU lies at the periphery of Fom b's chaotic zone, and the mean disk eccentricity of e ∼ 0.11 is secularly forced by the planet, supporting predictions made prior to the discovery of Fom b. However, previous mass constraints based on disk morphology rely on several oversimplifications. We explain why our constraint is more reliable. It is based on a global model of the disk that is not restricted to the planet's chaotic zone boundary. Moreover, we screen disk parent bodies for dynamical stability over the system age of ∼ 100 Myr, and model them separately from their dust grain progeny; the latter's orbits are strongly affected by radiation pressure and their lifetimes are limited to ∼ 0.1 Myr by destructive grain-grain collisions. The single planet model predicts that planet and disk orbits be apsidally aligned. Fomalhaut b's nominal space velocity does not bear this out, but the astrometric uncertainties may be large. If the apsidal misalignment proves real, our calculated upper mass limit of 3M J still holds. If the orbits are aligned, our model predicts M pl = 0.5M J , a pl = 115 AU, and e pl = 0

Influence of the ischaemic tourniquet in antibiotic prophylaxis in total knee replacement.

Science.gov (United States)

Prats, Laura; Valls, Joan; Ros, Joaquim; Jover, Alfredo; Pérez-Villar, Ferran; Fernández-Martínez, José Juan

2015-01-01

There is level iv evidence that the preoperative administration of antibiotics helps in the prevention of prosthetic infection. There is controversy on whether the ischemia applied during surgery may affect the minimum inhibitory concentration of the antibiotic in the peri-prosthetic tissues. The aim of this study is to review this phenomenon through the determination of antibiotic concentration in the synovial tissue. A prospective observational clinical study was conducted on 32 patients undergoing total knee replacement. Cefonicid 2g was administered as prophylaxis, with a tourniquet used for all patients. The antibiotic concentration was quantified by high performance liquid chromatography in samples of synovial tissue collected at the beginning and at the end of the intervention. The mean concentration of antibiotic was 23.16 μg/g (95% CI 19.19 to 27.13) in the samples at the beginning of the intervention and 15.45 μg/g (95% CI 13.20 to 17.69) in the final samples, being higher than the minimum inhibitory concentration of cefonicid, set at 8 μg/g. These results were statistically significant for both concentrations (P<.00001). The antibiotic concentration throughout the standard total knee prosthesis surgery performed with tourniquet gradually decreases throughout the intervention. The concentration determined at the end of the intervention was higher than the minimum inhibitory concentration required for the antibiotic studied. In conclusion, the use of a tourniquet does not increase the risk of infection. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

Analysis of in vitro and in vivo function of total knee replacements using dynamic contact models

Science.gov (United States)

Zhao, Dong

Despite the high incidence of osteoarthritis in human knee joint, its causes remain unknown. Total knee replacement (TKR) has been shown clinically to be effective in restoring the knee function. However, wear of ultra-high molecular weight polyethylene has limited the longevity of TKRs. To address these important issues, it is necessary to investigate the in vitro and in vivo function of total knee replacements using dynamic contact models. A multibody dynamic model of an AMTI knee simulator was developed. Incorporating a wear prediction model into the contact model based on elastic foundation theory enables the contact surface to take into account creep and wear during the dynamic simulation. Comparisons of the predicted damage depth, area, and volume lost with worn retrievals from a physical machine were made to validate the model. In vivo tibial force distributions during dynamic and high flexion activities were investigated using the dynamic contact model. In vivo medial and lateral contact forces experienced by a well-aligned instrumented knee implant, as well as upper and lower bounds on contact pressures for a variety of activities were studied. For all activities, the predicted medial and lateral contact forces were insensitive to the selected material model. For this patient, the load split during the mid-stance phase of gait and during stair is more equal than anticipated. The external knee adduction torque has been proposed as a surrogate measure for medial compartment load during gait. However, a direct link between these two quantities has not been demonstrated using in vivo measurement of medial compartment load. In vivo data collected from a subject with an instrumented knee implant were analyzed to evaluate this link. The subject performed five different overground gait motions (normal, fast, slow, wide, and toe out) while instrumented implant, video motion, and ground reaction data were simultaneously collected. The high correlation coefficient

Prospective analysis of a first MTP total joint replacement. Evaluation by bone mineral densitometry, pedobarography, and visual analogue score for pain

DEFF Research Database (Denmark)

Wetke, Eva; Zerahn, Bo; Kofoed, Hakon

2012-01-01

We hypothesized that a total replacement of the first metatarsophalangeal joint (MTP-1) would alter the walking pattern with medialisation of the ground reaction force (GRF) of the foot and subsequently cause an increase in bone mineral density (BMD) in the medial metatarsal bones and a decline o...

DISCOVERY OF AN EDGE-ON DEBRIS DISK WITH A DUST RING AND AN OUTER DISK WING-TILT ASYMMETRY

International Nuclear Information System (INIS)

Kasper, Markus; Apai, Dániel; Wagner, Kevin; Robberto, Massimo

2015-01-01

Using Very Large Telescope/SPHERE near-infrared dual-band imaging and integral field spectroscopy, we discovered an edge-on debris disk around the 17 Myr old A-type member of the Scorpius–Centaurus OB association HD 110058. The edge-on disk can be traced to about 0.″6 or 65 AU projected separation. In its northern and southern wings, the disk shows at all wavelengths two prominent, bright, and symmetrically placed knots at 0.″3 or 32 AU from the star. We interpret these knots as a ring of planetesimals whose collisions may produce most of the dust observed in the disk. We find no evidence for a bow in the disk, but we identify a pair of symmetric, hooklike features in both wings. Based on similar features in the Beta Pictoris disk, we propose that this wing-tilt asymmetry traces either an outer planetesimal belt that is inclined with respect to the disk midplane or radiation-pressure-driven dust blown out from a yet unseen inner belt that is inclined with respect to the disk midplane. The misaligned inner or outer disk may be a result of interaction with a yet unseen planet. Overall, the disk geometry resembles the nearby disk around Beta Pictoris, albeit seen at smaller radial scales

Evaluation of thermal effects on the beam quality of disk laser with unstable resonator

Science.gov (United States)

Shayganmanesh, Mahdi; Beirami, Reza

2017-01-01

In this paper thermal effects of the disk active medium and associated effects on the beam quality of laser are investigated. Using Collins integral and iterative method, transverse mode of an unstable resonator including a Yb:YAG active medium in disk geometry is calculated. After that the beam quality of the laser is calculated based on the generalized beam characterization method. Thermal lensing of the disk is calculated based on the OPD (Optical Path Difference) concept. Five factors influencing the OPD including temperature gradient, disk thermal expansion, photo-elastic effect, electronic lens and disk deformation are considered in our calculations. The calculations show that the effect of disk deformation factor on the quality of laser beam in the resonator is strong. However the total effect of all the thermal factors on the internal beam quality is fewer. Also it is shown that thermal effects degrade the output power, beam profile and beam quality of the output laser beam severely. As well the magnitude of each of affecting factors is evaluated distinctly.

Alternative materials to improve total hip replacement tribology.

Science.gov (United States)

Santavirta, Seppo; Böhler, Max; Harris, William H; Konttinen, Yrjö T; Lappalainen, Reijo; Muratoglu, Orhun; Rieker, Claude; Salzer, Martin

2003-08-01

An improvement in tribology of bearing surfaces is an effective means of increasing the longevity of total hip replacement (THR). Currently, 3 approaches are available to achieve this aim: first, use of highly cross-linked UHMWPE; second, aluminum oxide ceramic bearings, and third, metal-on-metal bearings. Cross-linking reduces the wear resistance of UHMWPE markedly without impairment of other significant properties of the material. Simulator studies and some clinical long-term (10-22 years) follow-up surveys suggest an almost immeasurable wear of the highly cross-linked UHMWPE-based acetabular components during an expected clinical life span. Bioinert alumina ceramic (aluminum oxide) was introduced 3 decades ago for THR-bearing surfaces to improve performance and longevity. Alumina ceramic is entirely biostable and bioinert and has good mechanical properties. For correctly positioned alumina-on-alumina bearings, the annual linear wear rate has been reported to be 3.9 microm. Alumina heads have been successfully used in combination with polyethylene sockets, but as regards wear, the best results have been obtained with alumina-on-alumina bearings. In ceramic THR bearings, precise manufacture and contact surface geometry, including optimal clearance, are most important. For the currently available products, the component fracture risk is almost nonexistent (less than 1 per 1000). Metal-on-metal bearings were used in the early stage of THR surgery, although not all old designs were successful. More recent analyses of the early series have shown the advantages of metal-on-metal to be better and have led to a renaissance of this articulation. Initially, stainless steel was used because it was easy to manufacture and polish. Current metal-on-metal bearings are based on cobalt-chromium-molybdenum alloys with varying carbon contents. Such bearings are self-polishing. Linear wear rates remain at the level of a few microm a year. An improvement in technology has increased

CIRCUMSTELLAR DEBRIS DISKS: DIAGNOSING THE UNSEEN PERTURBER

Energy Technology Data Exchange (ETDEWEB)

Nesvold, Erika R. [Department of Terrestrial Magnetism, Carnegie Institution for Science, 5241 Broad Branch Rd., Washington, DC 20015 (United States); Naoz, Smadar; Vican, Laura [Department of Physics and Astronomy, UCLA, 475 Portola Plaza, Los Angeles, CA 90095 (United States); Farr, Will M. [School of Physics and Astronomy, University of Birmingham, Birmingham, B15 2TT (United Kingdom)

2016-07-20

The first indication of the presence of a circumstellar debris disk is usually the detection of excess infrared emission from the population of small dust grains orbiting the star. This dust is short-lived, requiring continual replenishment, and indicating that the disk must be excited by an unseen perturber. Previous theoretical studies have demonstrated that an eccentric planet orbiting interior to the disk will stir the larger bodies in the belt and produce dust via interparticle collisions. However, motivated by recent observations, we explore another possible mechanism for heating a debris disk: a stellar-mass perturber orbiting exterior to and inclined to the disk and exciting the disk particles’ eccentricities and inclinations via the Kozai–Lidov mechanism. We explore the consequences of an exterior perturber on the evolution of a debris disk using secular analysis and collisional N -body simulations. We demonstrate that a Kozai–Lidov excited disk can generate a dust disk via collisions and we compare the results of the Kozai–Lidov excited disk with a simulated disk perturbed by an interior eccentric planet. Finally, we propose two observational tests of a dust disk that can distinguish whether the dust was produced by an exterior brown dwarf or stellar companion or an interior eccentric planet.

Circumstellar and circumplanetary disks

Science.gov (United States)

Chiang, Eugene

2000-11-01

This thesis studies disks in three astrophysical contexts: (1)protoplanetary disks; (2)the Edgeworth-Kuiper Belt; and (3)planetary rings. We derive hydrostatic, radiative equilibrium models of passive protoplanetary disks surrounding T Tauri and Herbig Ae/Be stars. Each disk is encased by an optically thin layer of superheated dust grains. This layer is responsible for up to ~70% of the disk luminosity at wavelengths between ~5 and 60 μm. The heated disk flares and absorbs more stellar radiation at a given stellocentric distance than a flat disk would. Spectral energy distributions are computed and found to compare favorably with the observed flattish infrared excesses of several young stellar objects. Spectral features from dust grains in the superheated layer appear in emission if the disk is viewed nearly face-on. We present the results of a pencil-beam survey of the Kuiper Belt using the Keck 10-m telescope. Two new objects are discovered. Data from all surveys are pooled to construct the luminosity function from mR = 20 to 27. The cumulative number of objects per square degree, Σ(surface area but the largest bodies contain most of the mass. To order-of-magnitude, 0.2 M⊕ and 1 × 1010 comet progenitors lie between 30 and 50 AU. The classical Kuiper Belt appears truncated at a distance of 50 AU. We propose that rigid precession of narrow eccentric planetary rings surrounding Uranus and Saturn is maintained by a balance of forces due to ring self- gravity, planetary oblateness, and interparticle collisions. Collisional impulses play an especially dramatic role near ring edges. Pressure-induced accelerations are maximal near edges because there (1)velocity dispersions are enhanced by resonant satellite perturbations, and (2)the surface density declines steeply. Remarkably, collisional forces felt by material in the last ~100 m of a ~10 km wide ring can increase equilibrium masses up to a factor of ~100. New ring surface densities are derived which accord with

Head-Disk Interface Technology: Challenges and Approaches

Science.gov (United States)

Liu, Bo

Magnetic hard disk drive (HDD) technology is believed to be one of the most successful examples of modern mechatronics systems. The mechanical beauty of magnetic HDD includes simple but super high accuracy positioning head, positioning technology, high speed and stability spindle motor technology, and head-disk interface technology which keeps the millimeter sized slider flying over a disk surface at nanometer level slider-disk spacing. This paper addresses the challenges and possible approaches on how to further reduce the slider disk spacing whilst retaining the stability and robustness level of head-disk systems for future advanced magnetic disk drives.

Neuraxial anesthesia improves long-term survival after total joint replacement: a retrospective nationwide population-based study in Taiwan.

Science.gov (United States)

Chen, Wei-Hung; Hung, Kuo-Chuan; Tan, Ping-Heng; Shi, Hon-Yi

2015-04-01

This study explored the effects of general (GA) and neuraxial (NA) anesthesia on the outcomes of primary total joint replacement (TJR) in terms of postoperative mortality, length of stay (LOS), and hospital treatment costs. From 1997 to 2010, this nationwide population-based study retrospectively evaluated 7,977 patients in Taiwan who underwent primary total hip or knee replacement. We generated two propensity-score-matched subgroups, each containing an equal number of patients who underwent TJR with either GA or NA. Of the 7,977 patients, 2,990 (37.5%) underwent GA and 4,987 (62.5%) underwent NA. Propensity-score matching was used to create comparable GA and NA groups adjusted for age, sex, comorbidities, surgery type, hospital volume, and surgeon volume. Survival over the first three years following surgery was similar. The proportion of patients alive up to 14 years postoperatively for those undergoing NA was 58.2% (95% confidence interval [CI] 50.4 to 66.0), and for those undergoing GA it was 57.3% (95% CI 51.4 to 63.2). Neuraxial anesthesia was associated with lower median [interquartile range; IQR] hospital treatment cost ($4,079 [3,805-4,444] vs $4,113 [3,812-4,568]; P anesthesia costs are removed. The mechanism underlying the association between NA and long-term survival is unknown.

International comparative evaluation of fixed-bearing non-posterior-stabilized and posterior-stabilized total knee replacements.

Science.gov (United States)

Comfort, Thomas; Baste, Valborg; Froufe, Miquel Angel; Namba, Robert; Bordini, Barbara; Robertsson, Otto; Cafri, Guy; Paxton, Elizabeth; Sedrakyan, Art; Graves, Stephen

2014-12-17

Differences in survivorship of non-posterior-stabilized compared with posterior-stabilized knee designs carry substantial economic consequences, especially with limited health-care resources. However, these comparisons have often been made between relatively small groups of patients, often with short-term follow-up, with only small differences demonstrated between the groups. The goal of this study is to compare the outcomes of non-posterior-stabilized and posterior-stabilized total knee arthroplasties with use of a unique collaboration of multiple established knee arthroplasty registries. A distributed health data network was developed by the International Consortium of Orthopaedic Registries and was used in this study to reduce barriers to participation (such as security, propriety, legal, and privacy issues) compared with a centralized data warehouse approach. The study included only replacements in osteoarthritis patients who underwent total knee procedures involving fixed-bearing devices from 2001 to 2010. The outcome of interest was time to first revision. On average, not resurfacing showed a more harmful effect than resurfacing did when posterior-stabilized and non-posterior-stabilized knee replacements were compared, while the risk of revision for posterior-stabilized compared with non-posterior-stabilized knees was highest in year zero to one, followed by year one to two, years eight through ten, and years two through eight. Posterior-stabilized knees did significantly worse than non-posterior-stabilized knees did when the patella was not resurfaced. This difference was most pronounced in the first two years (year zero to one: hazard ratio [HR] = 2.15, 95% confidence interval [CI] = 1.56 to 2.95, p < 0.001; year one to two: HR = 1.61, 95% CI = 1.48 to 1.75, p < 0.001). When the patella was resurfaced, posterior-stabilized knees did significantly worse than non-posterior-stabilized knees did. This was again most pronounced in the first two years (year zero

An Optimal Strategy for Accurate Bulge-to-disk Decomposition of Disk Galaxies

Energy Technology Data Exchange (ETDEWEB)

Gao Hua [Department of Astronomy, School of Physics, Peking University, Beijing 100871 (China); Ho, Luis C. [Kavli Institute for Astronomy and Astrophysics, Peking University, Beijing 100871 (China)

2017-08-20

The development of two-dimensional (2D) bulge-to-disk decomposition techniques has shown their advantages over traditional one-dimensional (1D) techniques, especially for galaxies with non-axisymmetric features. However, the full potential of 2D techniques has yet to be fully exploited. Secondary morphological features in nearby disk galaxies, such as bars, lenses, rings, disk breaks, and spiral arms, are seldom accounted for in 2D image decompositions, even though some image-fitting codes, such as GALFIT, are capable of handling them. We present detailed, 2D multi-model and multi-component decomposition of high-quality R -band images of a representative sample of nearby disk galaxies selected from the Carnegie-Irvine Galaxy Survey, using the latest version of GALFIT. The sample consists of five barred and five unbarred galaxies, spanning Hubble types from S0 to Sc. Traditional 1D decomposition is also presented for comparison. In detailed case studies of the 10 galaxies, we successfully model the secondary morphological features. Through a comparison of best-fit parameters obtained from different input surface brightness models, we identify morphological features that significantly impact bulge measurements. We show that nuclear and inner lenses/rings and disk breaks must be properly taken into account to obtain accurate bulge parameters, whereas outer lenses/rings and spiral arms have a negligible effect. We provide an optimal strategy to measure bulge parameters of typical disk galaxies, as well as prescriptions to estimate realistic uncertainties of them, which will benefit subsequent decomposition of a larger galaxy sample.

An Optimal Strategy for Accurate Bulge-to-disk Decomposition of Disk Galaxies

Science.gov (United States)

Gao, Hua; Ho, Luis C.

2017-08-01

The development of two-dimensional (2D) bulge-to-disk decomposition techniques has shown their advantages over traditional one-dimensional (1D) techniques, especially for galaxies with non-axisymmetric features. However, the full potential of 2D techniques has yet to be fully exploited. Secondary morphological features in nearby disk galaxies, such as bars, lenses, rings, disk breaks, and spiral arms, are seldom accounted for in 2D image decompositions, even though some image-fitting codes, such as GALFIT, are capable of handling them. We present detailed, 2D multi-model and multi-component decomposition of high-quality R-band images of a representative sample of nearby disk galaxies selected from the Carnegie-Irvine Galaxy Survey, using the latest version of GALFIT. The sample consists of five barred and five unbarred galaxies, spanning Hubble types from S0 to Sc. Traditional 1D decomposition is also presented for comparison. In detailed case studies of the 10 galaxies, we successfully model the secondary morphological features. Through a comparison of best-fit parameters obtained from different input surface brightness models, we identify morphological features that significantly impact bulge measurements. We show that nuclear and inner lenses/rings and disk breaks must be properly taken into account to obtain accurate bulge parameters, whereas outer lenses/rings and spiral arms have a negligible effect. We provide an optimal strategy to measure bulge parameters of typical disk galaxies, as well as prescriptions to estimate realistic uncertainties of them, which will benefit subsequent decomposition of a larger galaxy sample.

An Optimal Strategy for Accurate Bulge-to-disk Decomposition of Disk Galaxies

International Nuclear Information System (INIS)

Gao Hua; Ho, Luis C.

2017-01-01

The development of two-dimensional (2D) bulge-to-disk decomposition techniques has shown their advantages over traditional one-dimensional (1D) techniques, especially for galaxies with non-axisymmetric features. However, the full potential of 2D techniques has yet to be fully exploited. Secondary morphological features in nearby disk galaxies, such as bars, lenses, rings, disk breaks, and spiral arms, are seldom accounted for in 2D image decompositions, even though some image-fitting codes, such as GALFIT, are capable of handling them. We present detailed, 2D multi-model and multi-component decomposition of high-quality R -band images of a representative sample of nearby disk galaxies selected from the Carnegie-Irvine Galaxy Survey, using the latest version of GALFIT. The sample consists of five barred and five unbarred galaxies, spanning Hubble types from S0 to Sc. Traditional 1D decomposition is also presented for comparison. In detailed case studies of the 10 galaxies, we successfully model the secondary morphological features. Through a comparison of best-fit parameters obtained from different input surface brightness models, we identify morphological features that significantly impact bulge measurements. We show that nuclear and inner lenses/rings and disk breaks must be properly taken into account to obtain accurate bulge parameters, whereas outer lenses/rings and spiral arms have a negligible effect. We provide an optimal strategy to measure bulge parameters of typical disk galaxies, as well as prescriptions to estimate realistic uncertainties of them, which will benefit subsequent decomposition of a larger galaxy sample.

On the thermal stability of radiation-dominated accretion disks

Energy Technology Data Exchange (ETDEWEB)

Jiang, Yan-Fei; Stone, James M. [Department of Astrophysical Sciences, Princeton University, Princeton, NJ 08544 (United States); Davis, Shane W. [Canadian Institute for Theoretical Astrophysics, Toronto, ON M5S3H4 (Canada)

2013-11-20

We study the long-term thermal stability of radiation-dominated disks in which the vertical structure is determined self-consistently by the balance of heating due to the dissipation of MHD turbulence driven by magneto-rotational instability (MRI) and cooling due to radiation emitted at the photosphere. The calculations adopt the local shearing box approximation and utilize the recently developed radiation transfer module in the Athena MHD code based on a variable Eddington tensor rather than an assumed local closure. After saturation of the MRI, in many cases the disk maintains a steady vertical structure for many thermal times. However, in every case in which the box size in the horizontal directions are at least one pressure scale height, fluctuations associated with MRI turbulence and dynamo action in the disk eventually trigger a thermal runaway that causes the disk to either expand or contract until the calculation must be terminated. During runaway, the dependence of the heating and cooling rates on total pressure satisfy the simplest criterion for classical thermal instability. We identify several physical reasons why the thermal runaway observed in our simulations differ from the standard α disk model; for example, the advection of radiation contributes a non-negligible fraction to the vertical energy flux at the largest radiation pressure, most of the dissipation does not happen in the disk mid-plane, and the change of dissipation scale height with mid-plane pressure is slower than the change of density scale height. We discuss how and why our results differ from those published previously. Such thermal runaway behavior might have important implications for interpreting temporal variability in observed systems, but fully global simulations are required to study the saturated state before detailed predictions can be made.

Could wind replace nuclear?

International Nuclear Information System (INIS)

2017-01-01

This article aims at assessing the situation produced by a total replacement of nuclear energy by wind energy, while facing consumption demand at any moment, notably in December. The authors indicate the evolution of the French energy mix during December 2016, and the evolution of the rate between wind energy production and the sum of nuclear and wind energy production during the same month, and then give briefly some elements regarding necessary investments in wind energy to wholly replace nuclear energy. According to them, such a replacement would be ruinous

Foundations of Black Hole Accretion Disk Theory

Directory of Open Access Journals (Sweden)

Marek A. Abramowicz

2013-01-01

Full Text Available This review covers the main aspects of black hole accretion disk theory. We begin with the view that one of the main goals of the theory is to better understand the nature of black holes themselves. In this light we discuss how accretion disks might reveal some of the unique signatures of strong gravity: the event horizon, the innermost stable circular orbit, and the ergosphere. We then review, from a first-principles perspective, the physical processes at play in accretion disks. This leads us to the four primary accretion disk models that we review: Polish doughnuts (thick disks, Shakura-Sunyaev (thin disks, slim disks, and advection-dominated accretion flows (ADAFs. After presenting the models we discuss issues of stability, oscillations, and jets. Following our review of the analytic work, we take a parallel approach in reviewing numerical studies of black hole accretion disks. We finish with a few select applications that highlight particular astrophysical applications: measurements of black hole mass and spin, black hole vs. neutron star accretion disks, black hole accretion disk spectral states, and quasi-periodic oscillations (QPOs.

Foundations of Black Hole Accretion Disk Theory.

Science.gov (United States)

Abramowicz, Marek A; Fragile, P Chris

2013-01-01

This review covers the main aspects of black hole accretion disk theory. We begin with the view that one of the main goals of the theory is to better understand the nature of black holes themselves. In this light we discuss how accretion disks might reveal some of the unique signatures of strong gravity: the event horizon, the innermost stable circular orbit, and the ergosphere. We then review, from a first-principles perspective, the physical processes at play in accretion disks. This leads us to the four primary accretion disk models that we review: Polish doughnuts (thick disks), Shakura-Sunyaev (thin) disks, slim disks, and advection-dominated accretion flows (ADAFs). After presenting the models we discuss issues of stability, oscillations, and jets. Following our review of the analytic work, we take a parallel approach in reviewing numerical studies of black hole accretion disks. We finish with a few select applications that highlight particular astrophysical applications: measurements of black hole mass and spin, black hole vs. neutron star accretion disks, black hole accretion disk spectral states, and quasi-periodic oscillations (QPOs).

Community reintegration following a total joint replacement: a pilot study.

Science.gov (United States)

Stergiou-Kita, Mary; Grigorovich, Alisa

2014-06-01

To examine community reintegration following a hip or knee total joint replacement (TJR) from the perspective of rehabilitation clients. A phenomenological frame of reference guided the present study. Ten participants who received inpatient rehabilitation completed semi-structured qualitative interviews to explore their experiences with reintegrating back into their chosen communities and the meanings that they ascribed to their reintegration. Interview data were analysed using thematic analysis. Demographic data, and information regarding participants' living situation and supports were extracted from existing databases and used to characterize the sample. Participants revealed that reintegration after a TJR encompassed two key elements of meaning: i) engagement in meaningful activities; and ii) satisfaction levels. Additionally, the following five factors were identified as facilitators or barriers to community reintegration following a TJR: i) ongoing preparation and education; ii) confounding health issues; iii) driving and transportation; iv) personal facilitators; v) access to supports from professionals, family and friends, and community programmes. The present study highlights the significance of engaging in meaningful activities and being satisfied in one's level of engagement to achieving a sense of community reintegration following a TJR. This suggests that reintegration post-TJR has broader meanings than just improvements in functional abilities. Practitioners are encouraged to inquire about patients' meaningful activities, support their preparedness throughout the rehabilitation process, to identify confounding health issues that may limit reintegration, consider patients' fears and anxieties and establish supports to enhance their feelings of self-efficacy and abilities to cope following a TJR. © 2014 John Wiley & Sons, Ltd.

PROTOPLANETARY AND TRANSITIONAL DISKS IN THE OPEN STELLAR CLUSTER IC 2395

Energy Technology Data Exchange (ETDEWEB)

Balog, Zoltan [Max Planck Institute for Astronomy, Heidelberg, D-69117 (Germany); Siegler, Nick [NASA Exoplanet Exploration Program, Jet Propulsion Laboratory, California Institute of Technology, 4800 Oak Grove Drive, Pasadena, CA 91109 (United States); Rieke, G. H.; Su, K. Y. L.; Gáspár, András [Steward Observatory, 933 N. Cherry Ave, University of Arizona, Tucson, AZ 85721 (United States); Kiss, L. L. [Konkoly Observatory, Research Center for Astronomy and Earth Sciences, P.O. Box 67, H-1525 Budapest (Hungary); Muzerolle, James [Space Telescope Science Institute, 3700 San Martin Drive, Baltimore, MD 21218 (United States); Gutermuth, R. A. [Department of Astronomy, University of Massachusetts, Amherst, MA (United States); Bell, Cameron P. M. [Institute for Astronomy, ETH Zürich, Wolfgang-Pauli-Strasse 27, 8093, Zürich (Switzerland); Vinkó, J. [Dept. of Optics and Quantum Electronics, University of Szeged, H-6720 Szeged (Hungary); Young, E. T., E-mail: balog@mpia-hd.mpg.de [NASA Ames SOFIA Science Center, N211, Mountain View, CA 94043 (United States)

2016-11-20

We present new deep UBVRI images and high-resolution multi-object optical spectroscopy of the young (∼6–10 Myr old), relatively nearby (800 pc) open cluster IC 2395. We identify nearly 300 cluster members and use the photometry to estimate their spectral types, which extend from early B to middle M. We also present an infrared imaging survey of the central region using the IRAC and MIPS instruments on board the Spitzer Space Telescope , covering the wavelength range from 3.6 to 24 μ m. Our infrared observations allow us to detect dust in circumstellar disks originating over a typical range of radii from ∼0.1 to ∼10 au from the central star. We identify 18 Class II, 8 transitional disk, and 23 debris disk candidates, respectively, 6.5%, 2.9%, and 8.3% of the cluster members with appropriate data. We apply the same criteria for transitional disk identification to 19 other stellar clusters and associations spanning ages from ∼1 to ∼18 Myr. We find that the number of disks in the transitional phase as a fraction of the total with strong 24 μ m excesses ([8] – [24] ≥ 1.5) increases from (8.4 ± 1.3)% at ∼3 Myr to (46 ± 5)% at ∼10 Myr. Alternative definitions of transitional disks will yield different percentages but should show the same trend.

GEMINI PLANET IMAGER OBSERVATIONS OF THE AU MICROSCOPII DEBRIS DISK: ASYMMETRIES WITHIN ONE ARCSECOND

Energy Technology Data Exchange (ETDEWEB)

Wang, Jason J.; Graham, James R.; De Rosa, Robert J.; Kalas, Paul; Chiang, Eugene; Duchêne, Gaspard [Astronomy Department, University of California, Berkeley, Berkeley, CA 94720 (United States); Pueyo, Laurent; Chen, Christine; Greenbaum, Alexandra Z. [Space Telescope Science Institute, 3700 San Martin Drive, Baltimore, MD 21218 (United States); Nielsen, Eric L. [SETI Institute, Carl Sagan Center, 189 Bernardo Avenue, Mountain View, CA 94043 (United States); Millar-Blanchaer, Max [Department of Astronomy and Astrophysics, University of Toronto, Toronto, ON M5S 3H4 (Canada); Ammons, S. Mark [Lawrence Livermore National Laboratory, 7000 East Avenue, Livermore, CA 94040 (United States); Bulger, Joanna [School of Earth and Space Exploration, Arizona State University, P.O. Box 871404, Tempe, AZ 85287 (United States); Cardwell, Andrew; Goodsell, Stephen J. [Gemini Observatory, Casilla 603, La Serena (Chile); Chilcote, Jeffrey K. [Dunlap Institute for Astronomy and Astrophysics, University of Toronto, 50 St. George Street, Toronto, ON M5S 3H4 (Canada); Doyon, René [Institut de Recherche sur les Exoplanètes, Départment de Physique, Université de Montréal, Montréal, QC H3C 3J7 (Canada); Draper, Zachary H. [University of Victoria, 3800 Finnerty Road, Victoria, BC V8P 5C2 (Canada); Esposito, Thomas M.; Fitzgerald, Michael P. [Department of Physics and Astronomy, University of California, Los Angeles, Los Angeles, CA 90095 (United States); and others

2015-10-01

We present Gemini Planet Imager (GPI) observations of AU Microscopii, a young M dwarf with an edge-on, dusty debris disk. Integral field spectroscopy and broadband imaging polarimetry were obtained during the commissioning of GPI. In our broadband imaging polarimetry observations, we detect the disk only in total intensity and find asymmetries in the morphology of the disk between the southeast (SE) and northwest (NW) sides. The SE side of the disk exhibits a bump at 1″ (10 AU projected separation) that is three times more vertically extended and three times fainter in peak surface brightness than the NW side at similar separations. This part of the disk is also vertically offset by 69 ± 30 mas to the northeast at 1″ when compared to the established disk midplane and is consistent with prior Atacama Large Millimeter/submillimeter Array and Hubble Space Telescope/Space Telescope Imaging Spectrograph observations. We see hints that the SE bump might be a result of detecting a horizontal sliver feature above the main disk that could be the disk backside. Alternatively, when including the morphology of the NW side, where the disk midplane is offset in the opposite direction ∼50 mas between 0.″4 and 1.″2, the asymmetries suggest a warp-like feature. Using our integral field spectroscopy data to search for planets, we are 50% complete for ∼4 M{sub Jup} planets at 4 AU. We detect a source, resolved only along the disk plane, that could either be a candidate planetary mass companion or a compact clump in the disk.

A SPITZER CENSUS OF TRANSITIONAL PROTOPLANETARY DISKS WITH AU-SCALE INNER HOLES

International Nuclear Information System (INIS)