Background/Purpose This study retrospectively evaluated the benefits and prognostic factors of slotted acetabular augmentation (SAA) used for treating painful residual or neglected dysplastic hips in ...adolescents and young adults. Methods Sixteen hips in 15 patients underwent SAA at an average age of 14.4 years. The radiologic and functional outcomes were reviewed after an average follow-up of 6.6 years. Results All the patients obtained marked alleviation of pain ( p < 0.05). Harris hip score (HHS) was improved from 74.7 to 92.7 on average ( p < 0.05). Postoperative center-edge angle, Sharp's angle, c/b ratio and femoral head coverage showed significant improvement ( p < 0.01). Among the radiographic parameters, only the postoperative measurement of the femoral head coverage was significantly correlated with improvement of HHS ( p < 0.05). Detectable progression of osteoarthritis, from grade III to IV, was found in one patient 12 years after surgery. None of the hips required conversion to joint replacement. There were no surgical complications. Three-dimensional computed tomography showed that the grafts remained intact and provided congruent coverage at the latest follow-up, and none of them required arthroplasty. Conclusion The major benefit of SAA was to alleviate hip pain by increasing load-bearing area. This benefit was not sensitive to preoperative radiographic parameters. There were no postoperative complications. Compared with other complex reconstructive acetabuloplasty procedures, SAA is a simple, safe and effective pain-reducing procedure for symptomatic dysplastic hips in adolescents and young adults.
The issue of too much medicine and overdiagnosis has drawn considerable attention in the high-income countries. However, in the low-income and low-middle income countries (LMIC) where the problem is ...equally, if not more rampant, it has not come to attention. Although the undersupply and inaccessibility of healthcare remain major problems in most of these countries, the emerging issue of overdiagnosis threatens health systems, health financing and health equity, and cannot be neglected. Preventing Overdiagnosis Conference, first organized in 2013, has become a strong international platform which brings together a wide range of stake holders working on preventing overdiagnosis - although to date, the focus has been more on the developed countries. In 2019, with the conference being held for the first time in the Asia Pacific region, we aim to bring more attention to the key drivers of overdiagnosis and possible solutions in LMICs, which may be very different from high-income countries. In this workshop, we attempt to 1. Better understand the issue of over-diagnosis in LMICs 2. Identify and describe the possible drivers and potential solutions for overdiagnosis in LMIC. 3. Explore opportunities for collaborations with developed countries and other international stakeholders working on preventing overdiagnosis In the LMICs, patients’ expectations for a rapid recovery, doctor shopping, less onus with life-style modification and lack of follow-up in primary care, play a vital role in overtesting and overtreatment. Thus, the overarching cultural norms of ‘more is better’, ‘quicker is better’ in a background of lack of knowledge and awareness about the negative effects of overdiagnosis only add to the epidemic of it. Compared to high-income countries, fear of litigation plays minimal (if any) role. The doctors who practice medicine primarily as a business commonly receive undeclared industry sponsored financial and other incentives for laboratory tests and treatment. These practices are invigorated by the lack of local evidence-based guidelines (e.g. breast cancer screening, prescribing antivirals/antibiotics, cut-offs for hypertension, diabetes, ordering CT/MRI) and quality control measures for laboratory results. The medical education system in the region is based on the western/allopathic system with emphasis on secondary and tertiary care, which places too much emphasis on ‘diagnosis/labelling’ and treatments. Most of the medical graduates have limited skills in primary care, and lack specific skills dealing with tolerance and uncertainty. To address these complex and multifaceted drivers we propose focused awareness campaigns for health professionals as well as the public. In addition, generating point of care evidence-based guidelines and introducing shared decision making to the patient management process will be novel but important strategies for our region. Ensuring comprehensive evaluation prior to introduction of new tests will help in reducing the negative effects of overdiagnosis, associated overtreatment and overuse. These strategies may support maintaining sustainability of resource poor health systems in the region. Introduction to the topic; Presentations by invited health professionals from China, India, Sri Lanka and an eastern European country – focusing on current status of this issue and strategies proposed/undertaken to address it in their countries; Small Group discussion – To discuss the drivers and solutions for overdiagnosis in LMIC; Panel discussion with the speakers, and invited experts from high income countries and international organizations – The ideas generated from the group discussions will be shared with the audience. The panel discussion will focus on these as well as explore opportunities for collaborations with developed countries and other international stakeholders working on preventing overdiagnosis; Conclusion.
Axial flux and radial flux cycloidal permanent magnetic gears are characterized by high gear ratios and high torque densities; however, their rotors experience large unbalanced forces, which stress ...the bearings used in the gear. This paper presents a new cycloidal magnetic gear topology that combines the radial and axial flux topologies. The paper analyzes the forces and torques contributed by the axial and radial magnets in this topology using 3D finite element analysis. It was found that the perpendicular force is necessary to transfer torque to the high-speed shaft and, thus, cannot be cancelled out, but the eccentric component of the magnetic forces can be largely cancelled out, potentially reducing bearing losses and increasing the lifespan of the bearings used in the gear. A proof-of-concept prototype was constructed. Experimental slip torque results matched 3D finite element analysis (FEA) simulations to within 15%, and testing showed that no-load losses were reduced and the slip torque was increased by combining both axial and radial topologies, compared to using an axial configuration alone.
Several causes of spatial inaccuracies in image-guided surgery have been carefully studied and documented for several systems. These include error in identifying the external features used for ...registration, geometrical distortion in the preoperative images, and error in tracking the surgical instruments. Another potentially important source of error is brain deformation between the time of imaging and the time of surgery or during surgery. In this study, we measured the deformation of the dura and brain surfaces between the time of imaging and the start of surgical resection for 21 patients.
All patients underwent intraoperative functional mapping, allowing us to measure brain surface motion at two times that were separated by nearly an hour after opening the dura but before performing resection. The positions of the dura and brain surfaces were recorded and transformed to the coordinate space of a preoperative magnetic resonance image, using the Acustar surgical navigation system (manufactured by Johnson & Johnson Professional, Inc., Randolph, MA) (the Acustar trademark and associated intellectual property rights are now owned by Picker International, Highland Heights, OH). This system performs image registration with bone-implanted markers and tracks a surgical probe by optical triangulation.
The mean displacements of the dura and the first and second brain surfaces were 1.2, 4.4, and 5.6 mm, respectively, with corresponding mean volume reductions under the craniotomy of 6, 22, and 29 cc. The maximum displacement was greater than 10 mm in approximately one-third of the patients for the first brain surface measurement and one-half of the patients for the second. In all cases, the direction of brain shift corresponded to a "sinking" of the brain intraoperatively, compared with its preoperative position. Analysis of the measurement error revealed that its magnitude was approximately 1 to 2 mm. We observed two different patterns of the brain surface deformation field, depending on the inclination of the craniotomy with respect to gravity. Separate measurements of brain deformation within the closed cranium caused by changes in patient head orientation with respect to gravity suggested that less than 1 mm of the brain shift recorded intraoperatively could have resulted from the change in patient orientation between the time of imaging and the time of surgery.
These results suggest that intraoperative brain deformation is an important source of error that needs to be considered when using surgical navigation systems.
The present study is a replication and extension of previous research examining the effects of others’ gaze direction and gaze shifts on both participants’ (
N
= 32) manual responses, as an indicator ...of covert processes, and their visual attention, as an indicator of overt processes, within an experimental response time (RT) paradigm, under both fixed- and free-viewing instructions. Participants viewed arrays of faces displaying direct or averted gaze, which shifted or held their gaze, concurrent with the presentation of a target letter that participants had to identify overlaid on one face, all while their gaze was recorded with an eye-tracking system. Participants’ RTs and eye movements both revealed faster responses when the target face displayed either direct or shifted gaze, and especially when its gaze had shifted from averted to direct, though these effects were modulated by the viewing instructions. Thus, the findings replicate and extend previous research by revealing that direct gaze and dynamic motion onset affect both covert and overt attention.
Inequitable distribution of public electric vehicle (EV) charging facilitiesmay result in disparities in charging accessibility, potentially impeding the uptake of EVs. In response, this paper ...proposes an analytical framework to assess the accessibility-based equity of public EV charging infrastructure systematically, using Hong Kong (HK) as the study area. The results demonstrated severe spatial inequity of charging facilities in central, north, and southwest HK. Meanwhile, the Gini index of all public EV charger types for the total population was 0.751, and the indices for low-income, low-education level, and government-funded housing subgroups were 0.791, 0.809, and 0.893, respectively. These indicated considerable horizontal and vertical inequity from a statistical perspective. Furthermore, age, education level, family structure, and housing type were identified as significant socio-demographic characteristics correlated to the accessibility-based equity of public EV charging infrastructure in HK. These findings are expected to be useful for future policymaking and infrastructure planning.
Varicose Veins Wang, Matthew; Sharma, Ashwani K.
Journal of radiology nursing,
September 2019, 2019-09-00, Letnik:
38, Številka:
3
Journal Article
Recenzirano
Varicose veins are enlarged, tortuous veins that are commonly found in the lower extremities, affecting people over a wide age range with increasing prevalence with age. This pathology is typically a ...benign process with complications that can decrease a person's quality of life and lead to potentially life-threatening complications. There are surgical, endovascular, and chemical treatments which improve quality of life and decrease secondary complications of varicose veins. This review article will discuss the technical aspects of these procedures, potential and rare complications, preprocedural and postprocedural considerations, and overall comparison of technique efficacy.
A case of Cryptococcus neoformans osteomyelitis involving both the femur and rib is reported. A 50-year-old male presented with a 1-month history of a persistently painful right hip. Radiography ...revealed an osteolytic area in the subcapital region of the right femoral neck and trochanteric region, and magnetic resonance imaging (MRI) revealed an intramedullary lesion in the peritrochanteric region. A Tc99m whole body bone scan showed significantly increased uptake in the posterior aspect of the right 7th rib as well as the right femoral region. Hemiarthroplasty with a bipolar prosthesis was performed. Because a permeative osteolytic lesion was identified intraoperatively, surgical resection was also performed. A culture from intraoperative specimens yielded C. neoformans. The rib infection was not treated surgically. Intravenous fluconazole was administered postoperatively. The patient became seronegative for cryptococcal antigen with no further illness over the next five years.
Common bacterial blight (CBB), caused by Xanthomonas axonopodis pv. phaseoli and Xanthomonas fuscans subsp. fuscans (Xff), is a worldwide disease of common bean (Phaseolus vulgaris L.). Longyundou 5, ...a Chinese cultivar in the Mesoamerican gene pool of common bean, displays resistance to the Xff strain XSC3-1. To identify the genetic mechanisms behind this resistance, we crossed Long 5 with a susceptible genotype to develop a mapping population of F2 plants. Plant resistance to CBB was identified at 14 and 21days after inoculation with Xff strain XSC3-1. A major QTL at 14 and 21days after inoculation was mapped on chromosome Pv10 with LOD scores of 6.41 and 5.35, respectively. This locus was associated with SAP6, a previously-identified and much-used dominant marker, but in a 4.2cM interval between new codominant markers BMp10s174 and BMp10s244. Ten candidate genes were found between markers BMp10s174 and BMp10s244 on chromosome Pv10 and could encode defense response proteins responding to CBB pathogens. Four pairs each of epistatic QTL for CBB resistance were detected at 14 and 21days after inoculation. Phenotypic variation explained by the epistatic QTL ranged from 7.19% to 12.15% and 7.72% to 8.80% at 14 and 21days after inoculation, respectively. These results confirmed the importance of epistasis in CBB resistance in common bean. The adjacent markers found may be more efficient for marker assisted selection in common bean breeding for CBB resistance owing to their closer linkage to the target QTL.
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