Summary Introduction The literature has recently underlined the interest of pelvic and acetabular component orientation measurements in the standing and sitting position. Radiographic follow-up of ...total hip arthroplasty (THA) is based on standard AP and lateral X-rays. The use of EOS™ 2D imaging system reduces patient's radiation exposure compared to conventional X-rays. However, using this system, the validity and reproducibility of angular measurements, have not been studied yet for the measurement of pelvic and acetabular parameters in patients with THA. Hypothesis The EOS™ 2D imaging system offers similar advantages to conventional X-rays in the measurement of pelvic and acetabular orientation parameters which are commonly used. Patients and method Five angular parameters characterizing pelvic tilt and acetabular cup orientation were determined using the same digital measurement Imagika™ software based on two series of standard X-rays and EOS™ 2D images acquired in both standing and sitting positions. Radiographs from 50 patients with unilateral THA were measured three times by two observers. Intra- and interobserver reproducibility using each method was independently studied then paired comparison was performed. Results The ICC and Spearman rank correlation coefficient demonstrated an excellent EOS/conventional X-ray correlation. According to the parameters, the mean difference between these two imaging modalities ranged from 0.30° to 3.43° ( P < 0.05). The intra- and interobserver variability ranged from ± 2.97° to ± 6.46° using the EOS™ imaging system and from ± 4.26° to ± 10.22° using conventional X-rays ( P < 0.05). Discussion The EOS™ 2D imaging system may replace conventional X-rays in the assessment and monitoring of pelvic and acetabular cup orientation in THA. Level of evidence Level III. Prospective diagnostic study.
The laparoscopic approach to donor nephrectomy is becoming increasingly common. While it is felt that the recovery from laparoscopic nephrectomy is quicker and less painful, a number of complications ...have been reported. A rarely reported on complication in the literature with significant morbidity is ipsilateral orchalgia. From 1998 to 2008, 257 hand‐assisted laparoscopic donor nephrectomies were performed at our institution. Eight of 129 (6.2%) men complained of de novo ipsilateral orchalgia postoperatively. The average duration of pain was 402 days. Patients reported significant morbidity related to this complication. None, however, required further treatment. Three patients reported that they would reconsider organ donation as a result of testicular pain. Our technique originally included dissection and ligation of the gonadal vein en bloc with the ureter at the level of the left common iliac artery. Since recognizing this complication, we have adopted a gonadal vein sparing approach so as not to disturb the vessel below its point of ligation at the renal vein. To date, 50 patients have undergone the modified technique without experiencing orchalgia. In conclusion, ipsilateral testicular pan is a relatively frequent complication of laparoscopic donor nephrectomy and may be a source of significant morbidity. Using a modified surgical technique, this complication can be reduced or eradicated.
The authors present a modified surgical technique for laparoscopic donor nephrectomy to minimize the procedure‐related complication of testicular pain.
The objective of this study was to conduct a radiological analysis of posture before and after lumbosacral fusion to evaluate the influence of spinal alignment on the occurrence and pattern of post ...surgical pain. The study included 81 patients, of whom 51 had a history of previous low back surgery. We excluded patients with suspected or confirmed nonunion. In the fusion group, the 27 patients who were pain free after the procedure were compared to the 54 patients with residual pain. Thirty patients had pain only or primarily when they were standing immobile, 18 when they were sitting immobile, and six in both positions. Measurements were done on full-length lateral radiographs of the spine, with the patient standing according to Duval Beaupère criteria. The subgroup with postfusion pain was characterized at baseline by a more vertical sacrum with less sacral tilt (ST) (P < 0.0062) and more pelvic tilt (PT) (P < 0.0160). PT at last follow-up (PT fu) correlated with the presence of postfusion pain (NP: P = 0.0003). In the patients with postfusion pain, PT was almost twice the normal value. ST at last follow-up (ST fu) in the standing position was also correlated with the presence of postfusion pain (P < 0.0001) indicating that the sacrum remained abnormally vertical in the subjects with postfusion pain. Using logistic regression, the only prognostic factor for residual pain at last follow-up was ST fu. Both at pre-operative evaluation and at last follow-up, patients with pain in the standing position or in both the standing and sitting positions were characterized at pre-operative status by a more vertical sacrum with less sacral tilt. The results of this study indicate that, achieving a strong fusion should not be the only goal. Appropriate position of the fused vertebrae is also of paramount importance to minimize muscle work during posture maintenance. The main risk is failing to correct or to causing excessive pelvic retroversion with a vertical sacrum leading to a sagittal alignment that replicates the sitting position. This situation is often accompanied by loss of lumbar lordosis and adversely affects stiff or degenerative hips.
A comparative analysis of the life cycle of powertrains based on internal combustion engines powered by diesel fuel and natural gas, on batteries, and on hydrogen fuel cells was made. The inventory ...information on the stages of the life cycle of powertrains was collected, including production of structural materials and assembling of powertrain components, production of fuel and power, operation, and recycling/disposal after the service life completion. The results of comprehensive estimation of the energy consumption and СО
2
emissions in the life cycle are presented. The structure of the electric power production in the Moscow oblast was used for the comprehensive estimation of the parameters. The cost of hydrogen at which the powertrains based on fuel cells become economically competitive was estimated.
The criteria for acetabular cup positioning during total hip replacement are a matter of considerable discussion, particularly with regards to the optimal degree of anteversion. "Anatomical ...anteversion" is defined in the transverse plane, and "surgical anteversion" in the sagittal plane. Computed tomography measurements of anteversion are characteristic of a given transverse section plane and fail to take into account the position of the pelvis. We suggest a simple method for evaluating acetabular cup position in both the transverse and sagittal planes during standing and sitting. By shedding new light on the relationships between the pelvis and the spine, this method may help to understand some cases of impingement, instability or abnormal wear.
The oral antiestrogen tamoxifen has demonstrated efficacy in the treatment of metastatic breast cancer and as adjuvant therapy in early-stage disease. Clinical trials of tamoxifen in chemoprevention ...of breast cancer among high-risk women have focused attention on potential adverse effects of long-term tamoxifen use, including the possibility of ocular toxicity. This review evaluates the published case reports, clinical series, and clinical trial data on ocular toxicities attributed to tamoxifen. Clinical issues of surveillance, differential diagnosis, and management of tamoxifen-related eye disease are discussed.
National Library of Medicine online bibliographic services were used to identify case reports and clinical studies of ocular adverse effects that occurred in patients receiving tamoxifen published through the fall of 1994. The medical literature relevant to issues raised by the reports and studies was similarly identified and reviewed.
Case reports and case series identify crystalline retinal deposits, macular edema, and corneal changes as potential tamoxifen ocular toxicities. Extensive retinal lesions and macular edema with visual impairment have been reported in a few patients receiving high-dose tamoxifen. Less extensive retinal changes may occur in patients receiving low doses for long periods, and isolated retinal crystals may be observed in patients without visual symptoms.
Ocular toxicity is uncommon in the current clinical setting of long-term, low-dose tamoxifen use. Physicians should be aware of the potential for ocular toxicity among patients receiving the drug and should assure appropriate surveillance and prompt evaluation of visual complaints.
This study aimed to survey urologists regarding their knowledge, acceptance and practice of active surveillance (AS) for low-risk prostate cancer.
An email-based survey was distributed to 4987 ...urologists. Respondents were surveyed regarding their knowledge and acceptance of AS. Those who felt AS was a reasonable strategy were asked their opinions on the criteria for AS enrollment and the details of their practice of AS. Respondents who felt AS was not a reasonable alternative were queried as to the reasons why.
A total of 425 (9%) urologists successfully completed the survey and 387 (91%) were both familiar with AS and aware that AS differed from watchful waiting. Of this latter group, 370 (96%) respondents felt AS was a reasonable management strategy, 95% of whom manage patients with this approach. A minority of respondents (6%) felt that patients with a PSA>10 ng ml(-1) were eligible for AS. Further, most participants (74%) felt that patients required a Gleason score ≤6. There was little agreement on the timing of follow-up biopsies. Respondents who objected to AS were most commonly concerned with missing an opportunity for curative treatment (76%) and the risk of tumor undergrading (65%).
The majority of participants were knowledgeable and accepting of AS. Respondents were in relative agreement regarding the PSA and Gleason score criteria for AS enrollment. In contrast, there was a lack of agreement on the timing of follow-up biopsies. In the future, comparative studies are required to determine the optimal enrollment criteria and follow-up protocol for patients managed with AS.
Military servicemembers identifying as sexual and gender minorities (SGM) are at increased risk for military sexual trauma (MST) exposure and Post-traumatic Stress Disorder (PTSD). Although ...evidence-based treatments can reduce symptoms of PTSD, treatment attrition is concerning. Unfortunately, evaluations of such approaches with veterans identifying as SGM are currently restricted to case studies offering limited information regarding treatment completion. Both historic and current contextual factors related to military and mental health practices may uniquely influence minority veterans' treatment engagement in veteran healthcare settings. We explored associations between SGM identification and treatment of MST-focused therapy completion patterns (finishing the full protocol FP or receiving minimally adequate care MAC; defined as attending eight or more sessions). Veterans (N = 271, 12.5% SGM) enrolled in individual Prolonged Exposure or Cognitive Processing Therapies at a Midwestern veterans hospital system. Those identifying as SGM were more likely than non-identifying peers to complete FP treatment and, even when attrition occurred, they were retained longer. For MAC, the SGM group was as likely as non-SGM peers to be retained. This research suggests SGM veterans represent a notable minority of those seeking treatment in association with MST and do not appear at greater risk for discontinuation from trauma-focused treatment.
Observation of K+→π+π0π0γ decay Artamonov, A. V.; Bychkov, V. N.; Donskov, S. V. ...
The European physical journal. C, Particles and fields,
04/2024, Letnik:
84, Številka:
4
Journal Article
Recenzirano
Odprti dostop
The
K
+
→
π
+
π
0
π
0
γ
decay is observed by the OKA collaboration. About 60 events of the decay observed with signal:noise
≈
1
. The branching ratio obtained by normalization to
K
+
→
π
+
π
0
π
0
is ...measured to be
(
3.7
±
0.9
(
s
t
a
t
)
±
0.3
(
s
y
s
t
)
)
×
10
-
6
for
E
γ
∗
>
10
MeV
. The branching ratio,
γ
energy spectrum and angular distribution are consistent with ChPT prediction.
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