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1.
Artigo em Inglês | MEDLINE | ID: mdl-39120613

RESUMO

The 17 Sustainable Development Goals (SDGs) of the United Nations, established in 2015, aim to achieve global sustainability by 2030 through the improvement of environmental, social, and economic parameters. However, unlike earlier concepts such as the Agenda 21 of 1992, the SDGs overlook radioactive waste management and related challenges of radiation itself. First, we investigate the historic consideration and unexplained disappearance of radioactive waste in earlier sustainability concepts. Then, we propose amending seven SDGs to address this gap. For SDGs 6 (Clean Water and Sanitation), 14 (Life Below Water), and 15 (Life on Land), new or revised indicators should monitor the release of hazardous materials. SDGs 9 (Industry, Innovation and Infrastructure), 16 (Peace, Justice and Strong Institutions), and 17 (Partnerships for the Goals) require additional targets and indicators to integrate international cooperation and social implications of nuclear facilities' operation. Redefining "hazardous waste" in SDG 12 (Responsible Consumption and Production) and "environmentally sound technologies" in SDG 17 is necessary to encompass radioactive waste. Implementing these changes demands statistical efforts, but the existing monitoring infrastructure, particularly in Europe and North America, can facilitate this. As 2030 approaches, it is crucial to reintroduce radioactive waste management into sustainability agendas, whether within the SDGs themselves or in a subsequent framework.

3.
Technol Health Care ; 32(5): 3497-3504, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38820038

RESUMO

BACKGROUND: Wound complications after lumbar spine surgery may result in prolonged hospitalization and increased morbidity. Early identification can trigger appropriate management. OBJECTIVE: The aim of this study was to investigate the efficacy of infrared-based wound assessment (FLIR) after lumbar spine surgery in the context of identifying wound healing disorders. METHODS: 62 individuals who underwent lumbar spine surgery were included. The immediate postoperative course was studied, and the patient's sex, age, body mass index (BMI), heart rate, blood pressure, body temperature, numeric rating scale for pain (NRS), C-reactive protein (CRP), leukocyte, and hemoglobin levels were noted and compared to thermographic measurement of local surface temperature in the wound area. RESULTS: Measurement of local surface temperature in the wound area showed a consistent temperature distribution while it was uneven in case of wound healing disorder. In this instance, the region of the wound where the wound healing disorder occured had a lower temperature than the surrounding tissue (p> 0.05). CONCLUSIONS: This study demonstrates the ongoing importance of clinical wound assessment for early detection of complications. While laboratory parameter measurement is crucial, FLIR may serve as a cost-effective supplemental tool in clinical wound evaluation. Patient safety risks appear minimal since local ST is measured without touch.


Assuntos
Vértebras Lombares , Temperatura Cutânea , Termografia , Humanos , Termografia/métodos , Masculino , Feminino , Projetos Piloto , Pessoa de Meia-Idade , Temperatura Cutânea/fisiologia , Vértebras Lombares/cirurgia , Idoso , Adulto , Cicatrização/fisiologia , Complicações Pós-Operatórias/diagnóstico
4.
Infection ; 52(4): 1489-1497, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38592659

RESUMO

PURPOSE: Since an increase in the occurrence of native vertebral osteomyelitis (VO) is expected and reliable projections are missing, it is urgent to provide a reliable forecast model and make it a part of future health care considerations. METHODS: Comprehensive nationwide data provided by the Federal Statistical Office of Germany were used to forecast total numbers and incidence rates (IR) of VO as a function of age and gender until 2040. Projections were done using autoregressive integrated moving average model on historical data from 2005 to 2019 in relation to official population projections from 2020 to 2040. RESULTS: The IR of VO is expected to increase from 12.4 in 2019 to 21.5 per 100,000 inhabitants [95% CI 20.9-22.1] in 2040. The highest increase is predicted in patients over 75 years of age for both men and women leading to a steep increase in absolute numbers, which is fourfold higher compared to patients younger than 75 years. While the IR per age group will not increase any further after 2035, the subsequent increase is due to a higher number of individuals aged 75 years or older. CONCLUSIONS: Our data suggest that increasing IR of VO will seriously challenge healthcare systems, particularly due to demographic change and increasing proportions of populations turning 75 years and older. With respect to globally fast aging populations, future health care policies need to address this burden by anticipating limitations in financial and human resources and developing high-level evidence-based guidelines for prevention and interdisciplinary treatment.


Assuntos
Osteomielite , Humanos , Alemanha/epidemiologia , Idoso , Osteomielite/epidemiologia , Masculino , Feminino , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Adulto , Incidência , Adulto Jovem , Doenças da Coluna Vertebral/epidemiologia , Previsões , Adolescente , Fatores Etários
5.
Clin Biomech (Bristol, Avon) ; 114: 106239, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38599132

RESUMO

BACKGROUND: The application of expandable titanium-cages has gained widespread use in vertebral body replacement for indications such as burst fractures, tumors and infectious destruction. However, torque forces necessary for a satisfactory expansion of these implants and for subsidence of them into the adjacent vertebrae are unknown within the osteoporotic spine. METHODS: Six fresh-frozen human, osteoporotic, lumbar spines were dorsally instrumented with titanium implants (L2-L4) and a partial corpectomy of L3 was performed. An expandable titanium-cage was inserted ventrally and expanded by both residents and senior surgeons until fixation was deemed sufficient, based on haptic feedback. Torque forces for expansion were measured in Nm. Expansion was then continued until cage subsidence occurred. Torque forces necessary for subsidence were recorded. Strain of the dorsal rods during expansion was measured with strain gauges. FINDINGS: The mean torque force for fixation of cages was 1.17 Nm (0.9 Nm for residents, 1.4 Nm for senior surgeons, p = .06). The mean torque force for subsidence of cages was 3.1 Nm (p = .005). Mean peak strain of the dorsal rods was 970 µm/m during expansion and 1792 µm/m at subsidence of cages (p = .004). INTERPRETATION: The use of expandable titanium-cages for vertebral body replacement seems to be a primarily safe procedure even within the osteoporotic spine as torque forces required for subsidence of cages are nearly three times higher than those needed for fixation. Most of the expansion load is absorbed by straining of the dorsal instrumentation. Rod materials other than titanium may alter the torque forces found in this study.


Assuntos
Fusão Vertebral , Titânio , Humanos , Corpo Vertebral , Torque , Vértebras Lombares/cirurgia , Próteses e Implantes
6.
Radiat Environ Biophys ; 63(1): 1-6, 2024 03.
Artigo em Inglês | MEDLINE | ID: mdl-38367061

RESUMO

This report summarizes the findings of a workshop held at the safeND Research Symposium and hosted by the German Federal Office for the Safety of Radioactive Waste Management (BASE) in Berlin in September 2023. The workshop aimed to channel perspectives from various fields of expertise to discuss key sustainability concepts in terms of radioactive waste management. Therefore, the report highlights that current sustainability concepts, such as the United Nations' Sustainable Development Goals (SDG) as well as the concept of Planetary Boundaries, neglect challenges arising from the production and storage of human-made radioactive materials. The workshop consisted of three group tasks. The first attempted at identifying the interrelations between "sustainability" and radioactive waste management. The second was to map the global nature of the challenges. The third took first steps to determine a human-made radioactive material as a potential planetary sub-boundary for "novel entities". All three groups identified valuable knowledge gaps that should be addressed by future research and concluded that radioactive waste management is underrepresented in these sustainability concepts.


Assuntos
Resíduos Radioativos , Gerenciamento de Resíduos , Humanos
7.
J Biomed Mater Res B Appl Biomater ; 112(1): e35339, 2024 01.
Artigo em Inglês | MEDLINE | ID: mdl-37955803

RESUMO

Pedicle screw instrumentation has become "state of the art" in surgical treatment of many spinal disorders. Loosening of pedicle screws due to poor bone mineral density is a frequent complication in osteoporotic patients. As prevalence of osteoporosis and spinal disorders are increasing with an aging demographic, optimizing the biomechanical properties of pedicle screw constructions and therefore outcome after spinal surgery in osteoporotic patients is a key factor in future surgical therapy. Therefore, this biomechanical study investigated the stability of polymethylmethacrylate (PMMA)-augmented pedicle screw-rod constructions under a deviating distribution of PMMA applied to the instrumentation in osteoporotic human cadaveric vertebrae. We showed that PMMA-augmented pedicle screw-rod constructions tend to be more stable than those with non-augmented pedicle screws. Further, there appears to be a larger risk of screw loosening in unilateral augmented pedicle screws than in non-augmented, therefore a highly asymmetrically distributed PMMA should be avoided.


Assuntos
Parafusos Pediculares , Humanos , Polimetil Metacrilato , Vértebras Lombares/cirurgia , Fenômenos Biomecânicos , Cimentos Ósseos
8.
Surg Oncol ; 52: 102029, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38134591

RESUMO

BACKGROUND: While predictors for postoperative survival in spine tumour patients have been identified, there is limited evidence for predictors of postoperative Quality of Life (QoL), pain and functional outcome. METHODS: One hundred and fifty-three consecutive patients, who had undergone surgery for symptomatic spinal metastases between June 2016 and April 2019, were interviewed preoperatively and during follow-ups at three, six and 12 months using the EQ-5D-3L, COMI, and ODI questionnaires. Differences in means exceeding the specific Minimal Clinically Important Difference (MCID) values were considered clinically significant. RESULTS: Thirty-three percent of the patients were reported dead after 12 months. Only one metastasis compared to multiple metastases has 7.9 the Odds for an improved EQ-5D-3L score at three months. No neoadjuvant metastatic irradiation has 6.8 the Odds for the improvement at that time against performed radiation. A preoperative ODI score between 50.1 and 100 has 22.0 times the odds compared to the range from 0 to 50 for an improved EQ-5D-3L after three months, and 12.5 times the odds in favour of improved COMI after three months, and 13.6 times the odds for improvement of ODI at the three-month follow-up. A preoperative COMI score ranging from 5.0 to 10 has 21 times the odds of a COMI between 0 and 5 for an improved EQ-5D-3L score and 11 times the odds for an improved ODI after 12 months. Other predictors showed no statistically significant improvement. CONCLUSION: An improvement in QoL, pain and spinal function after 12 months can be predicted by a subjective preoperative poor health condition. Impaired spinal function before surgery, a singular metastasis and no previous irradiation is predictive of improved spinal function and quality of life three months after surgery.


Assuntos
Neoplasias , Qualidade de Vida , Humanos , Resultado do Tratamento , Dor Pós-Operatória
9.
Cancers (Basel) ; 15(19)2023 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-37835444

RESUMO

BACKGROUND: Surgical decompression (SD), with or without posterior stabilization followed by radiotherapy, is an established treatment for patients with metastatic spinal disease with epidural spinal cord compression (ESCC). This study aims to identify risk factors for occurrence of neurological compromise resulting from local recurrence. METHODS: All patients who received surgical treatment for metastatic spinal disease at our center between 2011 and 2022 were included in this study. Cases were evaluated for tumor entity, surgical technique for decompression (decompression, hemilaminectomy, laminectomy, corpectomy) neurological deficits, grade of ESCC, time interval to radiotherapy, and perioperative complications. RESULTS: A total of 747 patients were included in the final analysis, with a follow-up of 296.8 days (95% CI (263.5, 330.1)). During the follow-up period, 7.5% of the patients developed spinal cord/cauda syndrome (SCS). Multivariate analysis revealed prolonged time (>35 d) to radiation therapy as a solitary risk factor (p < 0.001) for occurrence of SCS during follow-up. CONCLUSION: Surgical treatment of spinal metastatic disease improves patients' quality of life and Frankel grade, but radiation therapy needs to be scheduled within a time frame of a few weeks in order to reduce the risk of tumor-induced neurological compromise.

10.
Neurochirurgie ; 69(5): 101482, 2023 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-37586480

RESUMO

OBJECTIVE: Back pain is a very widespread disease pattern and is one of the most frequent causes for consultation of a physician in general. In most cases, discogenic changes are the pathomorphological correlate of back pain. Numerous risk factors have been identified for these degenerative changes, but the influence and significance of the risk factors remain unclear, which was the aim of this systematic review. METHODS: A systematic literature search of the commonly used Pubmed database was performed using specific MESH terms. Further selection of the included studies was performed according to the PRISMA scheme, taking into account scientific merit as well as the relation to the research question. RESULTS: A total of 111 studies out of 1035 found were finally included in the literature search. 134 risk factors for disc degeneration and disc herniation were identified. These were divided into (1) patient-specific risk factors (n░=░34), (2) radiological risk factors (n░=░31), (3) lifestyle risk factors (n░=░6), (4) workplace-related risk factors (n░=░12), (5) genetic risk factors (n░=░50), and (6) other risk factors (n░=░1). Non-adjustable risk factors were age >50 years (OR 1.7/year), female gender (OR 1.41), family disposition (OR 4.0), comorbidities like atherosclerosis (OR 2.24), arthritic changes in other joints (OR 3.1) and history of injuries of the back (OR 3.1). Adjustable factors were elevated BMI (OR 2.77), comorbidities like hypertension (OR 1.25), dyslipidemia (OR 1.26) and diabetes mellitus (OR 6.8), as well as lifestyle habits like smoking (OR 3.8). DISCUSSION: In summary, intervertebral disc degenerations and herniations represent multifactorial events whose risk factors can be partly influenced and partly not influenced. This systematic review highlights the current state of knowledge as a basis for creating patient-specific algorithms to calculate risk for the development or progression of degenerative disc changes and disc herniations.


Assuntos
Degeneração do Disco Intervertebral , Deslocamento do Disco Intervertebral , Dor Lombar , Humanos , Feminino , Pessoa de Meia-Idade , Degeneração do Disco Intervertebral/complicações , Dor Lombar/etiologia , Deslocamento do Disco Intervertebral/etiologia , Deslocamento do Disco Intervertebral/complicações , Fatores de Risco , Estilo de Vida , Vértebras Lombares
11.
Clin Biomech (Bristol, Avon) ; 109: 106075, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37651900

RESUMO

BACKGROUND: Vertebral body replacement is a common surgical procedure for treatment of disorders associated with spinal instability. Therefore, pedicle screws are usually inserted in adjacent vertebrae for stabilization of the posterior column, however, there is lack of evidence whether implantation of index-level pedicle screws is beneficial or not. This biomechanical study aims to investigate the effect of pedicle screw instrumentation on axial stability following vertebral body replacement. METHODS: Unstable fracture at L3 level was simulated in lumbar spines from six human cadaveric specimens. Then instrumentation was performed one level above / one level below index level in three specimens and further, three specimens were instrumented at index-level (L3) additionaly. Then we used a testing protocol for biomechanical evaluation of axial loading on human cadaveric lumbar spines until cage subsidence occurred. FINDINGS: Our results show that index-level instrumented spines endured significantly higher load until cage subsidence occurred compared to non-index-level instrumented specimens (p = 0.05). INTERPRETATION: Our results demonstrate pedicle screw instrumentation at index-level vertebra should be considered when possbile as it may have a protective effect against cage subsidence in patients undergoing vertebral body replacement surgery.

12.
Arch Orthop Trauma Surg ; 143(10): 6243-6249, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37421514

RESUMO

PURPOSE: Postoperative soft tissue swelling is a significant factor influencing outcomes after elbow surgery. It can crucially affect important parameters such as postoperative mobilization, pain, and subsequently the range of motion (ROM) of the affected limb. Furthermore, lymphedema is considered a significant risk factor for numerous postoperative complications. Manual lymphatic drainage is nowadays part of the standardized post-treatment concept, basing on the concept of activating the lymphatic tissue to absorb stagnated fluid from the tissue into the lymphatic system. This prospective study aims to investigate the influence of technical device-assisted negative pressure therapy (NP) on early functional outcomes after elbow surgery. NP was therefore compared to manual lymphatic drainage (MLD). Is a technical device-based NP suitable for treatment of lymphedema after elbow surgery? METHODS: A total of 50 consecutive patients undergoing elbow surgery were enrolled. The patients were randomized into 2 groups. 25 participants per group were either treated by conventional MLD or NP. The primary outcome parameter was defined as the circumference of the affected limb in cm postoperative up to seven days postoperatively. The secondary outcome parameter was a subjective perception of pain (measured via visual analogue scale, VAS). All parameters were measured on each day of postoperative inpatient care. RESULTS AND CONCLUSION: NP showed an overall equivalent influence compared to MLD in reducing upper limb swelling after surgery. Moreover, the application of NP showed a significant decrease in overall pain perception compared to manual lymphatic drainage on days 2, 4 and 5 after surgery (p < 0.05). CONCLUSION: Our findings show that NP could be a useful supplementary device in clinical routine treating postoperative swelling after elbow surgery. Its application is easy, effective and comfortable for the patient. Especially due to the shortage of healthcare workers and physical therapists, there is a need for supportive measures which NP could be.


Assuntos
Linfedema , Drenagem Linfática Manual , Humanos , Drenagem Linfática Manual/efeitos adversos , Estudos Prospectivos , Cotovelo , Edema/etiologia , Edema/terapia , Linfedema/complicações , Dor , Resultado do Tratamento
13.
In Vivo ; 37(4): 1688-1693, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37369515

RESUMO

BACKGROUND/AIM: Surgical site infection (SSI) is a severe complication of spinal surgery, which typically results in prolonged length of hospital stay, an increased number of revision surgeries, re-hospitalizations, worse clinical functional outcomes, and increased healthcare costs. The aim of the present study was to analyse if the duration of surgery can predict the spectrum of pathogens causing SSI in orthopaedic spine surgery. PATIENTS AND METHODS: We conducted a retrospective study over a period of two years at the University Hospital of Cologne in which all patients with postoperative surgical site infections were included. In addition to descriptive characteristics (such as sex, age, BMI), the duration of the surgery, the administration of intra-operative antibiotics, the main diagnosis, the postoperative course of the infection parameters (CRP & WBC) and the responsible pathogens were analysed. RESULTS: A total of 75 patients were included with a median age of 64 years. The mean time of operation time was 131.52±70.91 min (range=23-285 min). The most frequently isolated germs in the postoperative blood culture were S. aureus (n=7), S. haemolyticus and S. hominis (n=2). There was a significant correlation between the duration of the primary surgical intervention and the postoperatively detected pathogens (p=0.002). CONCLUSION: A significant correlation was shown between the duration of surgery and the species of pathogens detected causing postoperative SSI. The use of perioperative antibiotics, the use of longer-lasting antibiotics or the repeated intravenous administration of prophylactic antibiotics should be evaluated.


Assuntos
Staphylococcus aureus , Infecção da Ferida Cirúrgica , Humanos , Pessoa de Meia-Idade , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/etiologia , Estudos Retrospectivos , Antibacterianos/uso terapêutico , Coluna Vertebral/cirurgia
14.
Z Orthop Unfall ; 2023 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-37308096

RESUMO

Tumors of the spine are challenging in terms of diagnoses and interdisciplinary treatment. This study was conducted to evaluate and characterize a large multicenter cohort of surgically treated spine tumor patients.Data of the German Spine Society (DWG) were used to characterize a cohort of all surgically treated spine tumor cases that were registered between 2017 and 2021. Subgroup analysis was performed for tumor entity, tumor localization, height of most severely affected segments, surgical treatment, and demographic parameters.In total, there were 9686 cases, of which 6747 were "malignant", 1942 were "primary benign", 180 were "tumor-like lesions", and 488 were "other" spinal tumors. Subgroups showed differences in number of affected segments as well as localization. There were further significant differences in surgical complication rates (p = 0.003), age (p < 0.001), morbidity (p < 0.001), and duration of surgery (p = 0.004).This is a representative study on spinal tumors from a large spine registry and allows for the epidemiological characterization of surgically treated tumor subgroups and quality control of registry data.

15.
Injury ; 2023 Mar 27.
Artigo em Inglês | MEDLINE | ID: mdl-37005138

RESUMO

BACKGROUND: The use of the posterior arch of C1 as pedicle has shown beneficial stability regarding screw loosening, however, the C1 pedicle screw placement is challenging. Therefore, the study aimed to analyse the bending forces of the Harms construct used in fixation of C1/C2 when using pedicle screws compared to lateral mass screws. METHODS: Five cadaveric specimens with a mean age of 72 years at death and bone mineral density measuring for 512.4 Hounsfield Units (HU) on average were used. A custom-made biomechanical setup was used to test the specimens with a C1/C2 Harms construct each with the use of lateral mass screws and pedicle screws in sequence. Strain gauges were used to analyse the bending forces from C1 to C2 in cyclic axial compression (µm/m). All underwent cyclic biomechanical testing using 50, 75 and 100 N. FINDINGS: In all specimens, placement of lateral mass screws and pedicle screws was feasible. All underwent cyclic biomechanical testing. For the lateral mass screw, a bending of 142.04 µm/m at 50 N, 166.56 µm/m at 75 N and 188.54 µm/m at 100 N was measured. For the pedicle screws, bending force was slightly elevated with 165.98 µm/m at 50 N, 190.58 µm/m at 75 N and 195.95 µm/m at 100 N. However, bending forces did not vary significantly. In all measurements, no statistical significance was found when comparing pedicle screws and lateral mass screws. INTERPRETATION: The lateral mass screw used in the Harms Construct to stabilize C1/2 showed less bending forces, therefore the construct with lateral mass screws appears more stable in axial compression compared to the one with pedicle screws. However, bending forces did not vary significantly.

16.
Front Med (Lausanne) ; 10: 1088709, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36910485

RESUMO

According to the Berlin Definition of acute respiratory distress syndrome (ARDS), a positive end-expiratory pressure (PEEP) of at least 5 cmH2O is required to diagnose and grade ARDS. While the Berlin consensus statement specifically acknowledges the role of non-invasive ventilation (NIV) in mild ARDS, this stratification has traditionally presumed a mechanically ventilated patient in the context of moderate to severe ARDS. This may not accurately reflect today's reality of clinical respiratory care. NIV and high-flow nasal cannula oxygen therapy (HFNO) have been used for managing of severe forms of acute hypoxemic respiratory failure with growing frequency, including in patients showing pathophysiological signs of ARDS. This became especially relevant during the COVID-19 pandemic. The levels of PEEP achieved with HFNO have been particularly controversial, and the exact FiO2 it achieves is subject to variability. Pinpointing the presence of ARDS in patients receiving HNFO and the severity in those receiving NIV therefore remains methodically problematic. This narrative review highlights the evolution of the ARDS definition in the context of non-invasive ventilatory support and provides an overview of the parallel development of definitions and ventilatory management of ARDS. It summarizes the methodology applied in clinical trials to classify ARDS in non-intubated patients and the respective consequences on treatment. As ARDS severity has significant therapeutic and prognostic consequences, and earlier treatment in non-intubated patients may be beneficial, closing this knowledge gap may ultimately be a relevant step to improve comparability in clinical trial design and outcomes.

17.
Clin Biomech (Bristol, Avon) ; 103: 105925, 2023 03.
Artigo em Inglês | MEDLINE | ID: mdl-36863219

RESUMO

INTRODUCTION: Despite good screw anchorage and safe screw trajectory, screw loosening occurs in several cases, especially in osteoporotic individuals. The aim of this biomechanical analysis was to evaluate the primary stability of revision screw placement in individuals with reduced bone quality. Therefore, revision via enlarged diameter screws was compared to the use of human bone matrix as augmentation to improve the bone stock and screw coverage. METHODS: 11 lumbar vertebral bodies from cadaveric specimens with a mean age of 85.7 years (± 12.0 years) at death were used. 6.5 mm diameter pedicle screws were inserted in both pedicles and hereafter loosened using a fatigue protocol. Screws were revised inserting a larger diameter screw (8.5 mm) in one pedicle and a same diameter screw with human bone matrix augmentation in the other pedicle. The previous loosening protocol was then reapplied, comparing maximum load and cycles to failure between both revision techniques. Insertional torque was continuously measured during insertion of both revision screws. FINDINGS: The number of cycles and the maximum load until failure were significantly greater in enlarged diameter screws than in augmented screws. The enlarged screws' insertional torque was also significantly higher than of the augmented screws. INTERPRETATION: Human bone matrix augmentation does not reach the same ad-hoc fixation strength as enlarging the screw's diameter by 2 mm and is therefore biomechanically inferior. Regarding the immediate stability, a thicker screw should therefore be prioritised.


Assuntos
Osteoporose , Parafusos Pediculares , Humanos , Idoso de 80 Anos ou mais , Matriz Óssea , Osso e Ossos , Vértebras Lombares/cirurgia , Osteoporose/cirurgia , Fenômenos Biomecânicos , Cimentos Ósseos , Cadáver
18.
Sensors (Basel) ; 22(9)2022 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-35590944

RESUMO

The Wireless Sensor Network (WSN) is one of the most promising solutions for the supervision of multiple phenomena and for the digitisation of the Internet of Things (IoT). The Wake-up Receiver (WuRx) is one of the most trivial and effective solutions for energy-constrained networks. This technology allows energy-autonomous on-demand communication for continuous monitoring instead of the conventional radio. The routing process is one of the most energy and time-consuming processes in WSNs. It is, hence, crucial to conceive an energy-efficient routing process. In this paper, we propose a novel Wake-up Receiver-based routing protocol called Clustered WuRx based on Multicast wake-up (CWM), which ensures energy optimisation and time-efficiency at the same time for indoor scenarios. In our proposed approach, the network is divided into clusters. Each Fog Node maintains the routes from each node in its cluster to it. When a sink requires information from a given node, it's corresponding Fog Node uses a multicast wake-up mechanism to wake up the intended node and all the intermediate nodes that will be used in the routing process simultaneously. Measurement results demonstrate that our proposed approach exhibits higher energy efficiency and has drastic performance improvements in the delivery delay compared with other routing protocols.

19.
J Digit Imaging ; 35(2): 340-355, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35064372

RESUMO

Imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI) are widely used in diagnostics, clinical studies, and treatment planning. Automatic algorithms for image analysis have thus become an invaluable tool in medicine. Examples of this are two- and three-dimensional visualizations, image segmentation, and the registration of all anatomical structure and pathology types. In this context, we introduce Studierfenster ( www.studierfenster.at ): a free, non-commercial open science client-server framework for (bio-)medical image analysis. Studierfenster offers a wide range of capabilities, including the visualization of medical data (CT, MRI, etc.) in two-dimensional (2D) and three-dimensional (3D) space in common web browsers, such as Google Chrome, Mozilla Firefox, Safari, or Microsoft Edge. Other functionalities are the calculation of medical metrics (dice score and Hausdorff distance), manual slice-by-slice outlining of structures in medical images, manual placing of (anatomical) landmarks in medical imaging data, visualization of medical data in virtual reality (VR), and a facial reconstruction and registration of medical data for augmented reality (AR). More sophisticated features include the automatic cranial implant design with a convolutional neural network (CNN), the inpainting of aortic dissections with a generative adversarial network, and a CNN for automatic aortic landmark detection in CT angiography images. A user study with medical and non-medical experts in medical image analysis was performed, to evaluate the usability and the manual functionalities of Studierfenster. When participants were asked about their overall impression of Studierfenster in an ISO standard (ISO-Norm) questionnaire, a mean of 6.3 out of 7.0 possible points were achieved. The evaluation also provided insights into the results achievable with Studierfenster in practice, by comparing these with two ground truth segmentations performed by a physician of the Medical University of Graz in Austria. In this contribution, we presented an online environment for (bio-)medical image analysis. In doing so, we established a client-server-based architecture, which is able to process medical data, especially 3D volumes. Our online environment is not limited to medical applications for humans. Rather, its underlying concept could be interesting for researchers from other fields, in applying the already existing functionalities or future additional implementations of further image processing applications. An example could be the processing of medical acquisitions like CT or MRI from animals [Clinical Pharmacology & Therapeutics, 84(4):448-456, 68], which get more and more common, as veterinary clinics and centers get more and more equipped with such imaging devices. Furthermore, applications in entirely non-medical research in which images/volumes need to be processed are also thinkable, such as those in optical measuring techniques, astronomy, or archaeology.


Assuntos
Computação em Nuvem , Processamento de Imagem Assistida por Computador , Humanos , Imageamento por Ressonância Magnética , Redes Neurais de Computação , Tomografia Computadorizada por Raios X
20.
Longit Life Course Stud ; 13(2): 239-261, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-35920639

RESUMO

This article examines the role of language skills in socially stratified educational attainment. Using essays written at the age of 11 in a large British cohort study, the National Child Development Study (NCDS), two measures of written language skills are derived: lexical diversity and the number of spelling and grammar errors. Results show that participants from the lower social strata misspelt more words and used a smaller variety of words in their essays than more socially privileged cohort members. Those language skills mediate part of the association between social origin and the highest level of educational attainment achieved. An even higher mediation of about half can be observed if standardised test measures for verbal and non-verbal cognitive abilities are included in the model. The models show that language skills mediate the social origin effect on educational attainment by about a quarter.


Assuntos
Cognição , Idioma , Criança , Estudos de Coortes , Humanos , Testes de Linguagem , Estudantes
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