Two-Year Results of Ceramic-on-Ceramic Hip Resurfacing in an International Multicenter Cohort.

BACKGROUND: Hip resurfacing arthroplasty (HRA) is a bone-conserving alternative to total hip arthroplasty. We present the 2-year clinical and radiographic follow-up of a novel ceramic-on-ceramic HRA in an international multicenter cohort. METHODS: Patients undergoing HRA between September 2018 and January 2021 were prospectively included. Patient-reported outcome measures (PROMs) in the form of the Forgotten Joint Score, Hip Disability and Osteoarthritis Outcome Score Jr., Western Ontario and McMaster Universities Arthritis Index, Oxford Hip Score, and University of California, Los Angeles, Activity Score were collected preoperatively, and at 1 and 2 years postoperation. Serial radiographs were assessed for migration, component alignment, evidence of osteolysis or loosening, and heterotopic ossification formation. RESULTS: The study identified 200 patients who reached a minimum 2-year follow-up (mean 3.5 years). Of these, 185 completed PROMs follow-up at 2 years. There was a significant improvement in Hip Disability and Osteoarthritis Outcome Score (P < .001) and Oxford Hip Score (P < .001) between the preoperative, 1-year, and 2-year outcomes. Patients had improved activity scores on the University of California, Los Angeles, Active Score (P < .001), with 45% reporting a return to high-impact activity at 2 years. At 1 and 2 years, the Forgotten Joint Score was not significantly different (P = .38). There was no migration, osteolysis, or loosening of any of the implants. No fractures were reported over the 2-year follow-up, with only 1 patient reporting a sciatic nerve palsy. There were 2 revisions, 1 for unexplained pain at 3 months due to acetabular component malposition and 1 at 33.5 months for acetabular implant failure. CONCLUSIONS: The ceramic-on-ceramic resurfacing at 2 years postoperation demonstrates promising results with satisfactory outcomes in all recorded PROMs. Further long-term data are needed to support the widespread adoption of this prosthesis as an alternative to other HRA bearings.

A meta-analysis assessing time for return to sport following hip resurfacing.

BACKGROUND: Hip resurfacing arthroplasty (HRA) is associated with excellent functional outcomes and return to pre-disease level of activity. The time for return to sport (RTS) following HRA remains unknown. The aim of this meta-analysis was to establish the time for RTS following HRA. METHODS: A search was performed on PUBMED, MEDLINE, EMBASE, and the Cochrane Library for trials on HRA and RTS, in the English language, published from the inception of the database to October 2020. In addition, a manual search was performed of relevant sports medicine and orthopaedic journals, and the bibliographies reviewed for eligible trials. All clinical trials reporting on time to RTS following HRA were included. Data relating to patient demographics, methodological quality, operation type, RTS, clinical outcomes, and complications were recorded by two independent reviewers. The PRISMA guidelines for reporting meta-analyses was used to undertake this study. RESULTS: The initial literature search identified 1559 studies and nine further studies were found. Of these, 11 studies with a total of 659 patients matched the inclusion criteria. Two studies involving a total of 94 patients demonstrated an overall pooled proportion of 91.8% (95% CI 71.8-100) of patients RTS by three months post-operatively. Four studies including a total of 265 patients determined a pooled proportion of 96.8% (95% CI 91.0-99.7) of patients able to RTS by the 6-month post-operative stage. Pooled proportion analysis from all 11 studies comprising 659 patients showed 90.9% (95% CI 82.2-96.9) of patients were able to RTS by final follow up of 3 years. CONCLUSION: Pooled proportion analysis showed an increasing number of patients were able to RTS after HRA over the first one year after surgery. There remains marked inter and intra-study variations in time for RTS but the pooled analysis shows that over 80% of patients were able to RTS at 6 to 12 months after HRA. The findings of this meta-analysis will enable more informed discussions between patients and healthcare professionals about time for RTS following HRA.

Geochemical characterization and health risk assessment in two diversified environmental settings (Southern Italy).

An integrated approach using chemical and microbial indicators has been tested in two different sites of the Campania Plain (Southern Italy) with different land use covering and different hydrogeological features in order: (1) to define the water-rock interaction processes, (2) to differentiate sources of pollution in a detailed way (3) to evaluate the degree of water quality in the studied alluvial aquifer and (4) to identify the most worrying elements for human's health. Groundwater have showed a HCO3-Ca signature for both investigated sites, and a progressive enrichment in alkali ions has been highlighted moving from the boundary of the plain toward the coastal areas, due to groundwater interaction with volcanic rocks along the flow path. The application of the Factor Analysis allowed to identify different sources of pollution, which were attributed to (a) leaks in the sewer system for the Agro-Aversano Area and also the spreading of manure as fertilizers in agricultural activities for the Caiazzo Plain. Furthermore, it has been highlighted that the use of major elements, trace elements and microbiological indicators, allows to accurately differentiate contamination processes in progress. In fact, from the results of the Factor Analysis applied in the Agro-Aversano area, no significant statistically relationships between major elements and microbiological indicators of fecal contamination were highlighted, unlike the Caiazzo plain where statistically significant correlations have been found between major and trace elements and microbiological indicators. The use of a Groundwater Quality Index has shown general poor water quality for the majority of analyzed samples due to the high amount of Nitrate and Fecal indicators. The use of a Health Risk Assessment highlighted that Nitrate coupled with Fluoride represent the most important concern for human health compared to the all investigated parameters in both sites.

Water quality and probabilistic non-carcinogenic health risk of groundwater: a half decadal scenario change in Vadodara.

Groundwater is essential to secure the safety of water supply in Vadodara, Gujarat. In this study, groundwater samples were collected from various part of the city which separated in 12 wards. The present study contains analyses of 720 groundwater samples gathered from various tube and open wells and analyzed for fluoride and other physicochemical parameters during 2014 and 2019. The results indicated that fluoride and TDS were high and the overall water quality was poor in the study area. Gastrointestinal and other health-related issues increased due to higher TDS in east, north and northeast regions. Likewise, hierarchical cluster analysis also indicated that TDS and chloride-rich water. Fluoride concentration was observed in the range of 0.66-1.61 mg/l (2014) and 0.86-1.77 mg/l (2019) which indicates that 62% samples are unfit for drinking purpose, which could cause dental and skeletal fluorosis. The water quality index (WQI) indicated lack of excellent water in the studied area in the last half-decade. As per WQI calculation suggest that 82.12% (2014) and 69.00% (2019) of groundwater samples represent poor, very poor and unsuitable categories, whereas remaining 17.85% (2014) and 31.00% (2019) of the samples represent good category for drinking purposes in entire Vadodara, Gujarat. Marginal improvement in the groundwater quality is reported due to good rainfall in 2019. Health risks associated with high fluoride drinking water were assessed for various age groups of inhabitants such as children, infants and adults. The non-carcinogenic hazard quotient estimated by oral intake was 1.38-3.36 (2014) and 1.79-3.70 (2019) for infants; 0.69-1.68 (2014) and 0.90-1.85 (2019) for children, whereas 0.07-0.18 (2014) and 0.10-0.20 (2019) for adults. Therefore, infant and children are relatively at higher health risk due to the intake of fluoride-rich drinking water than adult in the studied region. Both indices were indicated contaminated water or closer to contamination which induced non-carcinogenic health risk on citizens. Thus, the comprehensive results of present study can be used as a baseline data and valuable tool for government authorities for long-term monitoring, health monitoring and sustainable development of Vadodara, Gujarat.

Short-Term Effect of Percutaneous Coronary Intervention on Heart Rate Variability in Patients with Coronary Artery Disease.

Myocardial ischemia in patients with coronary artery disease (CAD) leads to imbalanced autonomic control that increases the risk of morbidity and mortality. To systematically examine how autonomic function responds to percutaneous coronary intervention (PCI) treatment, we analyzed data of 27 CAD patients who had admitted for PCI in this pilot study. For each patient, five-minute resting electrocardiogram (ECG) signals were collected before and after the PCI procedure. The time intervals between ECG collection and PCI were both within 24 h. To assess autonomic function, normal sinus RR intervals were extracted and were analyzed quantitatively using traditional linear time- and frequency-domain measures [i.e., standard deviation of the normal-normal intervals (SDNN), the root mean square of successive differences (RMSSD), powers of low frequency (LF) and high frequency (HF) components, LF/HF] and nonlinear entropy measures [i.e., sample entropy (SampEn), distribution entropy (DistEn), and conditional entropy (CE)], as well as graphical metrics derived from Poincaré plot [i.e., Porta's index (PI), Guzik's index (GI), slope index (SI) and area index (AI)]. Results showed that after PCI, AI and PI decreased significantly (p < 0.002 and 0.015, respectively) with effect sizes of 0.88 and 0.70 as measured by Cohen's d static. These changes were independent of sex. The results suggest that graphical AI and PI metrics derived from Poincaré plot of short-term ECG may be potential for sensing the beneficial effect of PCI on cardiovascular autonomic control. Further studies with bigger sample sizes are warranted to verify these observations.

A Discourse on the Incorporation of Organizational Factors into Probabilistic Risk Assessment: Key Questions and Categorical Review.

This article presents a discourse on the incorporation of organizational factors into probabilistic risk assessment (PRA)/probabilistic safety assessment (PSA), a topic of debate since the 1980s that has spurred discussions among industry, regulatory agencies, and the research community. The main contributions of this article include (1) identifying the four key open questions associated with this topic; (2) framing ongoing debates by considering differing perspectives around each question; (3) offering a categorical review of existing studies on this topic to justify the selection of each question and to analyze the challenges related to each perspective; and (4) highlighting the directions of research required to reach a final resolution for each question. The four key questions are: (I) How significant is the contribution of organizational factors to accidents and incidents? (II) How critical, with respect to improving risk assessment, is the explicit incorporation of organizational factors into PRA? (III) What theoretical bases are needed for explicit incorporation of organizational factors into PRA? (IV) What methodological bases are needed for the explicit incorporation of organizational factors into PRA? Questions I and II mainly analyze PRA literature from the nuclear domain. For Questions III and IV, a broader review and categorization is conducted of those existing cross-disciplinary studies that have evaluated the effects of organizational factors on safety (not solely PRA-based) to shed more light on future research needs.

The acceptability of high resolution anoscopy examination in patients attending a tertiary referral centre.

BACKGROUND: High resolution anoscopy (HRA) examination is regarded as the best method for the management of anal high grade squamous intraepithelial lesions to prevent anal squamous carcinoma. However, little is known about the acceptability of this procedure. This analysis looks at patient experience of HRA examination and ablative treatment under local anaesthetic. METHODS: Patients took part in anonymised feedback of their experience immediately after their HRA examinations and/or treatments. A standard questionnaire was used that included assessment of pain and overall satisfaction scores as well as willingness to undergo future HRA examinations. RESULTS: Four hundred four (89.4%) responses were received and all responses were analysed. The group consisted of 119 females (29.4%) and 261 males (64.6%) with median age of 45 years (IQR = 19) and 45 years (IQR = 21) respectively, and included 58 new cases, 53 treatment cases and 202 surveillance cases. 158 patients (39.1%) had at least one biopsy during their visits. The median pain score was 2 [Inter Quartile Range (IQR) 3] on a visual analogue scale of 0 to 10, where 0 indicated no pain / discomfort and 10 indicated severe pain. The median pain score was 2 (IQR 2) in men and 4 (IQR = 3) in women [Dunn's Test = 4.3, p < 0.0001] and 3 (IQR 4.5) in treatment cases. Problematic pain defined as a pain score of ≥7 occurred more frequently in women (14%) than in men (6%), [Chi square test (chi2) = 5.6, p = 0.02]. Patient satisfaction with the care they received, measured on a scale of 0 (not happy) to 10 (very happy) found the median score to be 10 with 76% reporting a score of 10. Out of 360 responses, 98% of women and 99% of men said that they would be willing to have a future HRA examination. CONCLUSIONS: In this cohort, the overall pain scores were low and similar across appointment types. However, women had a higher pain score, including troublesome pain levels. Despite this, both women and men were equally satisfied with their care and were willing to have a future examination. The results of the analysis show that the procedure is acceptable to patient groups. A small number of women may need general anaesthesia for their examinations/treatment.

Periprosthetic acetabular radiolucency progression in mid-term follow-up of the articular surface replacement hip system.

INTRODUCTION: Recent registry studies show that aseptic loosening secondary to osteolysis is the second leading cause of hip implant failure in patients implanted with metal-on-metal (MoM) bearings. The primary aim of our study was to report on the progression of acetabular osteolysis during mid-term follow-up in patients treated with MoM hip resurfacing arthroplasty (HRA) and MoM total hip arthroplasty (THA). The secondary aim was to identify independent predictors of osteolytic lesion progression. MATERIALS AND METHODS: A total of 805 patients (805 hips) were included in this study (541 MoM HRA, 264 MoM THA) from a prospective, international clinical registry of the Articular Surface Replacement Hip System. Patients were enrolled a median of 6.6 years from surgery. Osteolytic lesion progression was defined either as any lesion developing de novo, or as an existing lesion progressing from radiolucency to osteolysis during the study period (range 0.5-4.3 years). RESULTS: The number of cases with any osteolysis or radiolucency was 21 (3.9%) for ASR HRA and 29 (11.0%) for ASR XL THA at enrollment and increased to 69 (12.8%) for ASR HRA and 41 (15.5%) for ASR XL THA after follow-up. Osteolytic lesion progression was found in 66 (12.2%) ASR HRA patients and 31 (11.7%) ASR XL THA patients. Multivariate models determined that lower acetabular version angle (OR 0.963, p = 0.011) and elevated whole blood chromium (OR 1.110, p = 0.044) were independent predictors of osteolytic lesion progression in ASR HRA. CONCLUSION: We suggest that physicians of patients implanted with ASR HRA implants closely monitor patients with higher chromium levels and lower version angles, as they are at increased risk for osteolytic lesion progression, and we recommend annual radiographic follow-up on all patients with ASR implants.

Area asymmetry of heart rate variability signal.

BACKGROUND: Heart rate fluctuates beat-by-beat asymmetrically which is known as heart rate asymmetry (HRA). It is challenging to assess HRA robustly based on short-term heartbeat interval series. METHOD: An area index (AI) was developed that combines the distance and phase angle information of points in the Poincaré plot. To test its performance, the AI was used to classify subjects with: (i) arrhythmia, and (ii) congestive heart failure, from the corresponding healthy controls. For comparison, the existing Porta's index (PI), Guzik's index (GI), and slope index (SI) were calculated. To test the effect of data length, we performed the analyses separately using long-term heartbeat interval series (derived from >3.6-h ECG) and short-term segments (with length of 500 intervals). A second short-term analysis was further carried out on series extracted from 5-min ECG. RESULTS: For long-term data, SI showed acceptable performance for both tasks, i.e., for task i p < 0.001, Cohen's d = 0.93, AUC (area under the receiver-operating characteristic curve) = 0.86; for task ii p < 0.001, d = 0.88, AUC = 0.75. AI performed well for task ii (p < 0.001, d = 1.0, AUC = 0.78); for task i, though the difference was statistically significant (p < 0.001, AUC = 0.76), the effect size was small (d = 0.11). PI and GI failed in both tasks (p > 0.05, d < 0.4, AUC < 0.7 for all). However, for short-term segments, AI indicated better distinguishability for both tasks, i.e., for task i, p < 0.001, d = 0.71, AUC = 0.71; for task ii, p < 0.001, d = 0.93, AUC = 0.74. The rest three measures all failed with small effect sizes and AUC values (d < 0.5, AUC < 0.7 for all) although the difference in SI for task i was statistically significant (p < 0.001). Besides, AI displayed smaller variations across different short-term segments, indicating more robust performance. Results from the second short-term analysis were in keeping with those findings. CONCLUSION: The proposed AI indicated better performance especially for short-term heartbeat interval data, suggesting potential in the ambulatory application of cardiovascular monitoring.

Nano-analyses of wear particles from metal-on-metal and non-metal-on-metal dual modular neck hip arthroplasty.

Increased failure rates due to metallic wear particle-associated adverse local tissue reactions (ALTR) is a significant clinical problem in resurfacing and total hip arthroplasty. Retrieved periprosthetic tissue of 53 cases with corrosion/conventional metallic wear particles from 285 revision operations for ALTR was selected for nano-analyses. Three major classes of hip implants associated with ALTR, metal-on-metal hip resurfacing arthroplasty (MoM HRA) and large head total hip replacement (MoM LHTHA) and non-metal-on-metal dual modular neck total hip replacement (Non-MoM DMNTHA) were included. The size, shape, distribution, element composition, and crystal structure of the metal particles were analyzed by conventional histological examination and electron microscopy with analytic tools of 2D X-ray energy dispersive spectrometry and X-ray diffraction. Distinct differences in size, shape, and element composition of the metallic particles were detected in each implant class which correlate with the histological features of severity of ALTR and variability in implant performance.

High resolution anoscopy may be useful in achieving reductions in anal cancer local disease failure rates.

Anal cancer is uncommon, with an incidence rate of 0.5-1.0 per 100,000 of the population but incidence rates have been steadily increasing over the last 3 decades. Biological and epidemiological evidence have been mounting and demonstrate that anal cancer has many similarities to cervical cancer, especially in regard to its aetiology. High-resolution anoscopy (HRA) of the anal region ­ analogous to colposcopy of the cervix, is a technique that is not well-known in the medical and surgical fraternity. Evidence to support the use of HRA for detection and treatment in the surveillance of AIN exists and strongly suggests that it is beneficial, resulting in reduced rates of cancer progression. Pilot data from our study showed a local disease failure rate of 1.73 per 1000 patient-months compared with a published rate of 9.89 per 1000 patient-months. This demonstrates a 5.72-fold reduction in local disease failure rates of patients with T1-T3 tumours; the data therefore suggests that use of HRA for detection and treatment in surveillance of anal cancer patients will help prevent local regional relapse at the anal site. There is an urgent need for a large, randomised controlled clinical trial to definitively test this hypothesis.

High-risk ARGs (HRA) Chip: A high-throughput qPCR-based array for assessment of high-risk ARGs from the environment.

The global surge in antibiotic resistance genes (ARGs) presents a serious public health challenge. While methods like metagenomic analysis and qPCR arrays have been instrumental in investigating ARG distributions and dynamics, the vast diversity of ARGs often complicates effective monitoring and risk assessment. Here, we developed a High-Risk ARGs (HRA) chip based on high-capacity quantitative PCR array targeting previously identified high-risk ARGs. These ARGs are known to be prevalent in human-related environments, exhibit gene mobility, and are present in ESKAPE pathogens. The HRA chip include 101 primer sets and the 16S rRNA gene as a reference. These primer sets consist of 34 obtained from previous studies, and 67 newly designed primer sets which were validated in silico and experimentally. Absolute quantification of targeted ARGs is accomplished by generating standard curves for all ARGs with serially ten-fold diluted mixed plasmids containing targeted ARG sequences. The amplification efficiencies of all ARGs exceed 99% via plasmid template dilution tests, suggesting high reliability in quantification. The performance of HRA chip is further evaluated by practical applications in environmental samples from wastewater treatment plants (WWTPs) and soils with various land use types and fertilization regimes. The results indicate the dynamics of high-risk ARGs during wastewater treatment process, and reveal the profiles of soil high-risk ARGs which is distinct from those derived via metagenomic approaches. These findings highlight the potentials of HRA Chip in the evaluation of anthropogenic impacts on the environmental resistome with a more focused spectrum of high-risk ARGs. Overall, the HRA Chip emerges as a powerful and efficient high-throughput tool for rapid detection and quantification of high-risk ARGs, facilitating comprehensive profiling of high-risk resistomes in environmental samples which is essential for human health risk assessment of ARGs.

The application of Kingdon's Multiple Streams Theory for human papillomavirus-related anal intraepithelial neoplasia.

AIMS: This paper presents a discussion of the advantages and disadvantages of redefining human papillomavirus-related anal intraepithelial neoplasia as a problem of sexually active people by using Kingdon's Multiple Streams Theory to examine possible policy solutions for increasing anal cancer screening. BACKGROUND: Human papillomavirus is the most common sexually transmitted infection worldwide. Anal cancer associated with human papillomavirus infections is increasing in incidence in both men and women. The prevalence of anal cancer does not decrease with age. DATA SOURCE: Pubmed was searched for articles and internet references from 1995-2012. DISCUSSION: Although a large body of literature suggests that human papillomavirus-related anal intraepithelial neoplasia is a problem, no effective policy solutions have emerged. However, as almost the entire sexually active population is exposed to human papillomavirus, it should be thought of as every person's problem. This suggests that human papillomavirus-related anal intraepithelial neoplasia calls for different types of problem definitions and policy solutions to address the disease. The issue of anal cancer is typically defined as a problem of HIV-positive individuals. IMPLICATIONS FOR NURSING: Nurses are focused on improving patient outcomes. We play a key role in helping to identify problems, moving problems onto policymaker's agendas, and influencing the creation of new healthcare policies. CONCLUSION: Human papillomavirus-related anal intraepithelial neoplasia demands attention and the development of national level policies to ensure public health and safety. Kingdon's Multiple Streams Theory has provided a pragmatic framework to evaluate the problem.

Outcome of hip resurfacing revision through the Hueter-anterior approach.

BACKGROUND: The Hueter-Anterior Approach (HAA) with its limited soft tissue and internervous dissection has been shown to be an effective approach for primary total hip and hip resurfacing arthroplasty (HRA). The purpose of this study is to evaluate the clinical outcome of patients requiring revision of HRA to total hip replacement using the HAA, assessing function and complications. METHODS: We performed a retrospective review of a prospectively maintained research database. Between 2006 and 2015, 555 primary metal-on-metal (MoM) HRAs were performed via the HAA; we identified 33 hips in 30 patients that required revisions for aseptic causes to THA: aseptic loosening of acetabulum in 12 and femoral in 7, 10 for pseudotumour/ALTR, 4 for femoral neck fracture. All revision surgeries were performed through a HAA by a single surgeon who had also performed the index operation. PROMs were collected preoperatively and yearly at various timepoints postoperatively. RESULTS: The mean age at time of revision was 48.9 years (±5.3 SD) for 22 males (67%) and 11 females (33%). The mean time to revision surgery/failure of hip resurfacing was 3.3 years (±2.4 SD). There were 5 major reoperations with 3 infections, 1 acetabular loosening and 1 trunnionosis. There were significant improvements in multiple PROMs. CONCLUSIONS: The HAA is a viable surgical approach for revision of HRA with smaller initial HRA acetabular components generally requiring a relatively larger acetabular compoent at time of revision. Patients reported improvement in symptoms and function and a lower risk of subsequent reoperation than what has previously been reported for failed MoM bearings.

Asymmetric Properties of the Heart Rate Microstructure in Healthy Adults during 48 h ECG Recordings.

Heart rate asymmetry reflects the different contributions of heart rate (HR) decelerations and accelerations to heart rate variability (HRV). We examined the contribution of monotonic runs of HR accelerations and decelerations to the asymmetric properties of the HR microstructure in the 48 h electrocardiograms (ECGs) of healthy adults (n = 101, 47 males, average age of 39 years) and analysed sex differences in the HR microstructure. The HR microstructure was asymmetric for runs of most lengths, except for sequences of two consecutive decelerations (DR2s) or accelerations (AR2s). Women had a higher prevalence of AR2s than men but fewer runs in the range of 4 to 11 consecutive accelerations (AR4-AR11s) and 5 to 11 consecutive decelerations (DR5-DR11s). The longest runs consisted of 47 consecutive accelerations (AR47s) and 27 consecutive decelerations (DR27s). More DR3s than AR3s and more DR4s than AR4s reveal a crossing of HR microstructure asymmetry. In conclusion, more acceleration than deceleration runs demonstrate that the HR microstructure was asymmetric in the 48 h ECGs. This phenomenon was present in both sexes but was more pronounced in men. For shorter runs of 3 and 4 consecutive heartbeats, there was a crossing of HR microstructure asymmetry, with more deceleration than acceleration runs.

Quantification of human behavior levels by extending Rasmussen's SRK model and the effects of time pressure and training on the levels switching.

Human factor-related accidents account for an increasing portion of the total accidents through the advancing level of system automation. Human reliability becomes the key issue in human-machine systems especially for safety-relevant tasks and operations. Rasmussen's SRK (skill-rule-knowledge) model is well known in the field of human factors. Likewise, it is well known that skill-based behaviors have the highest human reliability, while knowledge-based behaviors are associated with the lowest reliability scores. Although numerous studies exist on human error probability (HEP), correspondingly typically attributed directly or indirectly to these three levels of behavior, a coherent, consistent representation, especially using data sources, has not been available. In this contribution, the quantification of human behavior levels with Rasmussen's SRK model is given based on three databases for the first time. Effects of time pressure and training on human reliability switching are also analyzed based on related publications. To determine the HEP of these three levels, three databases, technique for human error rate prediction (THERP), Savannah river site human reliability analysis (SRS-HRA) and nuclear action reliability assessment (NARA), from human reliability analysis (HRA) methods are used. The procedure contains identifying the tasks including the operator involved and the assumptions the analysts made and classifying the tasks into suitable cognitive behavior mode (CBM). In this case, the relationship between SRK levels and HEP is mapped. The effects of the two in automation context very relevant performance shaping factors (PSFs), time pressure and training/knowledge degradation, on human behavior levels switching are analyzed and the explanations of the SRK switching are presented. In this case, a more general structure is established to illustrate the dynamic behavior of levels switching with six directions under different conditions. From the results we conclude that skill, rule, and knowledge behavior levels are continuous in terms of HEP and therefore allow a new inside into this key aspect of human factor quantification. Based on this analysis the consequences of daily automation in the context of autonomous transport systems in combination with human qualification and reliability degrading are from this specific and in the current automation discussion very intensively discussed. The presented discussion linking SRK levels and HEP gives a new perspective on the foreseeable consequences of further automation in application areas with increasing automation of everyday tasks (like using a highly automated vehicle).

Is hip resection arthroplasty a successful definitive treatment?

Purpose: Hip resection arthroplasty as a definitive treatment is an uncommon indication, although still in use selectively. This study evaluates a cohort of patients who have undergone hip resection arthroplasty surgery indicated as a definitive treatment, in order to assess the rate of re-operation, the rate of infection, and the mortality rates. Methods: We conducted a retrospective, observational, descriptive analysis of a cohort of patients who had undergone a hip resection arthroplasty intended as a definitive treatment, in two University Hospitals from 1994 to 2020. The exclusion criteria were the implantation of a hip cement spacer, or a temporary hip resection arthroplasty in patients undergoing a two-staged surgical approach. We found 26 cases of hip resection arthroplasty. We recorded the indications for a definitive hip resection arthroplasty, the outcomes and complications, and analyzed the success of the hip resection arthroplasty as a definitive surgery using a Kaplan-Meier curve. Results: Seven cases (26.9%) required a re-operation after the hip resection arthroplasty, four cases for persistent hip infection, and in the three remaining a conversion to a total hip arthroplasty was re-considered due to a good medical evolution and non-tolerance to the low functional outcome. The mortality rate was 61.5% (27 days-20 years), with a 19.2% mortality rate in the first 5 years. All the cases that required another surgery after the hip resection arthroplasty were re-operated within the first 18 months. Conclusion: Unfortunately, hip resection arthroplasty continues to show elevated re-operation rate and early mortality rate, as well as low functional outcomes. Two-staged hip revision arthroplasty is the surgical treatment of choice in patients suffering from a periprosthetic joint infection, however we believe that hip resection arthroplasty should be considered in fragile patients, who have endured multiple revision surgeries, or their comorbidities make them unfit from further surgeries.

Outcomes of single brain metastasis treated with gamma knife stereotaxic radiosurgery(GKSR). Our experience on 103 cases.

Background: Brain metastases (BM) occur in the natural course of malignant tumors in 18-40% of cases. Their management has changed considerably over the past decade thanks to the advent of Gamma knife Stereotactic Radiosurgery (GKSR). Objective: We report our experience on Single Brain metastasis treated with (GKSR). Methods: Patients treated by Gamma Knife stereotaxic radiosurgery (GKSR) in our institution between 2009 and 2021 for Single BM were recorded retrospectively. Results: A total of 103 patients (n = 52; 50.5% females) were included, with a mean age of 56.33 ± 11.33. Breast (n = 39, 37.9%) and lung (n = 36, 35%) were the common original location for the primary tumors. GKSR alone without prior surgery, radiotherapy, or chemotherapy was achieved in 81.5% (n = 84). Thirteen patients (15.1%) progressed in BM volume while finding the appearance of de novo BM in 5 (5.8%) patients. The median percentage of tumor control after radiosurgery treatment was 70% (IQR: 65-78) and only 26.2% (n = 27) of patients had > 80% tumor control and stability over the median follow-up time of 5 (95% CI, 4-6) months. We found only two cases of radionecrosis (1.9%). The median survival time was 5.21 (IQR, 3-8) months. Retreatment, recursive partitioning analysis (RPA) class, and tumor stability influenced the overall survival of BM respectively (Hazard Ratio adjust (HRa)= 5.610,p = 0.045; HRa= 6.133,p = 0.031; HRa= 22.463, p = 0.036). Conclusion: Stereotaxic Radiosurgery provides good results in terms of Overall survival with fewer neurocognitive disorders.RPA class and tumor control (stability) influenced the overall survival of single BM.

Autocrine IGF-II-Associated Cancers: From a Rare Paraneoplastic Event to a Hallmark in Malignancy.

The paraneoplastic syndrome referred in the literature as non-islet-cell tumor hypoglycemia (NICTH) and extra-pancreatic tumor hypoglycemia (EPTH) was first reported almost a century ago, and the role of cancer-secreted IGF-II in causing this blood glucose-lowering condition has been widely established. The landscape emerging in the last few decades, based on molecular and cellular findings, supports a broader role for IGF-II in cancer biology beyond its involvement in the paraneoplastic syndrome. In particular, a few key findings are constantly observed during tumorigenesis, (a) a relative and absolute increase in fetal insulin receptor isoform (IRA) content, with (b) an increase in IGF-II high-molecular weight cancer-variants (big-IGF-II), and (c) a stage-progressive increase in the IGF-II autocrine signal in the cancer cell, mostly during the transition from benign to malignant growth. An increasing and still under-exploited combinatorial pattern of the IGF-II signal in cancer is shaping up in the literature with respect to its transducing receptorial system and effector intracellular network. Interestingly, while surgical and clinical reports have traditionally restricted IGF-II secretion to a small number of solid malignancies displaying paraneoplastic hypoglycemia, a retrospective literature analysis, along with publicly available expression data from patient-derived cancer cell lines conveyed in the present perspective, clearly suggests that IGF-II expression in cancer is a much more common event, especially in overt malignancy. These findings strengthen the view that (1) IGF-II expression/secretion in solid tumor-derived cancer cell lines and tissues is a broader and more common event compared to the reported IGF-II association to paraneoplastic hypoglycemia, and (2) IGF-II associates to the commonly observed autocrine loops in cancer cells while IGF-I cancer-promoting effects may be linked to its paracrine effects in the tumor microenvironment. Based on these evidence-centered considerations, making the autocrine IGF-II loop a hallmark for malignant cancer growth, we here propose the functional name of IGF-II secreting tumors (IGF-IIsT) to overcome the view that IGF-II secretion and pro-tumorigenic actions affect only a clinical sub-group of rare tumors with associated hypoglycemic symptoms. The proposed scenario provides an updated logical frame towards biologically sound therapeutic strategies and personalized therapeutic interventions for currently unaccounted IGF-II-producing cancers.

Associations between heart rate asymmetry expression and asymmetric detrended fluctuation analysis results.

The relation between recently established asymmetry in Asymmetric Detrended Fluctuation Analysis (ADFA) and Heart Rate Asymmetry is studied. It is found that the ADFA asymmetric exponents are related both to the overall variability and to its asymmetric components at all studied time scales. We find that the asymmetry in scaling exponents, i.e., [Formula: see text] is associated with both variance-based and runs-based types of asymmetry. This observation suggests that the physiological mechanisms of both types are similar, even though their origins and mathematical methods are very different. The graphical abstract demonstrates strong, nonlinear association between the expression of Heart Rate Asymmetry measured using relative descriptors and the Asymmetric Detrended Fluctuation Analysis results. It is clear that there is a strong relation between the two theoretically disparate approaches to signal analysis. The technique to demonstrate the association is loess fit.