Clinical outcomes of Schatzker type II tibial plateau fractures using joint depression morphology: A cross-sectional study.

Tibial plateau fracture is a common intra-articular fracture caused by axial compression and Varus or Valgus force. This study aimed at the relationship between Luo classification morphology of tibial plateau fractures with clinical outcomes and surgical complications. The cross-sectional study was conducted on patients with Schatzker type II tibial plateau fracture who underwent surgery between May 2018 and January 2021. Clinical outcomes were measured by the AKSS, VAS, Lysholm score, alignment, and ROM. A total of 65 patients with a mean age of 36.38 years were enrolled. There was a significant difference in AKSS (p=0.001), VAS score (p=0.011), and mechanical axis alignment (p=0.037) between the groups by pre-operative joint depression depth below and above 10 millimeters. The higher pre-operative or post- operative size of joint depression depth in patients with Schatzker type II tibial plateau fractures was associated with poor outcomes, more pain, and malalignment. A higher surface area of joint depression was associated with a lower clinical outcome score and more pain.

Integrating behavioral assessment in instructional design for competency-based medical education.

As institutions continuously strive to align with the standards set forth within competency-based medical education, there is an increased need to produce evidence of learner achievement in the form of observable behaviors. However, the complexity of healthcare education and clinical environments make it challenging to generate valid and reliable behavioral assessments. In this article, we utilize our interdisciplinary knowledge from the perspectives of experts in medical education, assessment, and academic administration to provide tips to successfully incorporate behavioral assessments into instructional designs. These include tips for identifying the best assessment methods fit for purpose, guiding instructors in establishing boundaries of assessment, managing instructors, selecting raters, generating behavioral assessment guides, training raters, ensuring logistics support assessment strategies, and fostering capacity for iteration. These can be used by institutions to improve planning and implementation for longitudinal behavioral assessments.

An investigation on low velocity impact response of multilayer sandwich composite structures.

The effects of adding an extra layer within a sandwich panel and two different core types in top and bottom cores on low velocity impact loadings are studied experimentally in this paper. The panel includes polymer composite laminated sheets for faces and the internal laminated sheet called extra layer sheet, and two types of crushable foams are selected as the core material. Low velocity impact tests were carried out by drop hammer testing machine to the clamped multilayer sandwich panels with expanded polypropylene (EPP) and polyurethane rigid (PUR) in the top and bottom cores. Local displacement of the top core, contact force and deflection of the sandwich panel were obtained for different locations of the internal sheet; meanwhile the EPP and PUR were used in the top and bottom cores alternatively. It was found that the core material type has made significant role in improving the sandwich panel's behavior compared with the effect of extra layer location.

Percutaneous reduction and screw fixation for all types of intra-articular calcaneal fractures.

INTRODUCTION: This study compares the outcomes of consecutive of patients with Sanders II and III and IV calcaneal fractures that were stabilized by either close reduction and internal fixation (CRIF) or open reduction and internal fixation (ORIF). MATERIALS AND METHODS: Group I (N = 49) underwent close reduction internal fixation (CRIF). Group II (N = 39) underwent open reduction internal fixation (ORIF). The clinical outcomes included time to operation, operative duration, visual analog score (VAS), length of hospital stay, wound-related complications and AOFAS SF-36 score. Preoperative and postoperative radiographic measures also were compared. RESULTS: The duration of operation in the CRIF group was considerably shorter than in ORIF group (P = 0.0001). Postoperatively, at seventh day, the VAS in the CRIF group (4.2 ± 1.1) was meaningfully lower than those of the ORIF patients group (4.7 ± 1.2, P = 0.04). Totally, the prevalence of wound complications in CRIF group was significantly lower than in ORIF group. In final follow-up visit after one year, AOFAS scores and SF-36 scores between groups were comparable. Comparable radiographic measures were found in both groups. There was no significant difference between groups regarding preoperative radiographic measures (P > 0.05), while in postoperative imaging acceptable calcaneal fracture reduction was found in both groups. CONCLUSION: We believed that for treatment of various types of calcaneal fracture compared with ORIF the percutaneous reduction and screw fixation may lead to shorter hospital stay, decreased subtalar joint stiffness and earlier weight bearing along with much favorable patients' satisfaction.

How does tissue regeneration influence the mechanical behavior of additively manufactured porous biomaterials?

Although the initial mechanical properties of additively manufactured porous biomaterials are intensively studied during the last few years, almost no information is available regarding the evolution of the mechanical properties of implant-bone complex as the tissue regeneration progresses. In this paper, we studied the effects of tissue regeneration on the static and fatigue behavior of selective laser melted porous titanium structures with three different porosities (i.e. 77, 81, and 85%). The porous structures were filled with four different polymeric materials with mechanical properties in the range of those observed for de novo bone (0.7GPa

Mechanical properties of additively manufactured octagonal honeycombs.

Honeycomb structures have found numerous applications as structural and biomedical materials due to their favourable properties such as low weight, high stiffness, and porosity. Application of additive manufacturing and 3D printing techniques allows for manufacturing of honeycombs with arbitrary shape and wall thickness, opening the way for optimizing the mechanical and physical properties for specific applications. In this study, the mechanical properties of honeycomb structures with a new geometry, called octagonal honeycomb, were investigated using analytical, numerical, and experimental approaches. An additive manufacturing technique, namely fused deposition modelling, was used to fabricate the honeycomb from polylactic acid (PLA). The honeycombs structures were then mechanically tested under compression and the mechanical properties of the structures were determined. In addition, the Euler-Bernoulli and Timoshenko beam theories were used for deriving analytical relationships for elastic modulus, yield stress, Poisson's ratio, and buckling stress of this new design of honeycomb structures. Finite element models were also created to analyse the mechanical behaviour of the honeycombs computationally. The analytical solutions obtained using Timoshenko beam theory were close to computational results in terms of elastic modulus, Poisson's ratio and yield stress, especially for relative densities smaller than 25%. The analytical solutions based on the Timoshenko analytical solution and the computational results were in good agreement with experimental observations. Finally, the elastic properties of the proposed honeycomb structure were compared to those of other honeycomb structures such as square, triangular, hexagonal, mixed, diamond, and Kagome. The octagonal honeycomb showed yield stress and elastic modulus values very close to those of regular hexagonal honeycombs and lower than the other considered honeycombs.

Mechanics of additively manufactured porous biomaterials based on the rhombicuboctahedron unit cell.

Thanks to recent developments in additive manufacturing techniques, it is now possible to fabricate porous biomaterials with arbitrarily complex micro-architectures. Micro-architectures of such biomaterials determine their physical and biological properties, meaning that one could potentially improve the performance of such biomaterials through rational design of micro-architecture. The relationship between the micro-architecture of porous biomaterials and their physical and biological properties has therefore received increasing attention recently. In this paper, we studied the mechanical properties of porous biomaterials made from a relatively unexplored unit cell, namely rhombicuboctahedron. We derived analytical relationships that relate the micro-architecture of such porous biomaterials, i.e. the dimensions of the rhombicuboctahedron unit cell, to their elastic modulus, Poisson's ratio, and yield stress. Finite element models were also developed to validate the analytical solutions. Analytical and numerical results were compared with experimental data from one of our recent studies. It was found that analytical solutions and numerical results show a very good agreement particularly for smaller values of apparent density. The elastic moduli predicted by analytical and numerical models were in very good agreement with experimental observations too. While in excellent agreement with each other, analytical and numerical models somewhat over-predicted the yield stress of the porous structures as compared to experimental data. As the ratio of the vertical struts to the inclined struts, α, approaches zero and infinity, the rhombicuboctahedron unit cell respectively approaches the octahedron (or truncated cube) and cube unit cells. For those limits, the analytical solutions presented here were found to approach the analytic solutions obtained for the octahedron, truncated cube, and cube unit cells, meaning that the presented solutions are generalizations of the analytical solutions obtained for several other types of porous biomaterials.

Mechanical properties of regular porous biomaterials made from truncated cube repeating unit cells: Analytical solutions and computational models.

Additive manufacturing (AM) has enabled fabrication of open-cell porous biomaterials based on repeating unit cells. The micro-architecture of the porous biomaterials and, thus, their physical properties could then be precisely controlled. Due to their many favorable properties, porous biomaterials manufactured using AM are considered as promising candidates for bone substitution as well as for several other applications in orthopedic surgery. The mechanical properties of such porous structures including static and fatigue properties are shown to be strongly dependent on the type of the repeating unit cell based on which the porous biomaterial is built. In this paper, we study the mechanical properties of porous biomaterials made from a relatively new unit cell, namely truncated cube. We present analytical solutions that relate the dimensions of the repeating unit cell to the elastic modulus, Poisson's ratio, yield stress, and buckling load of those porous structures. We also performed finite element modeling to predict the mechanical properties of the porous structures. The analytical solution and computational results were found to be in agreement with each other. The mechanical properties estimated using both the analytical and computational techniques were somewhat higher than the experimental data reported in one of our recent studies on selective laser melted Ti-6Al-4V porous biomaterials. In addition to porosity, the elastic modulus and Poisson's ratio of the porous structures were found to be strongly dependent on the ratio of the length of the inclined struts to that of the uninclined (i.e. vertical or horizontal) struts, α, in the truncated cube unit cell. The geometry of the truncated cube unit cell approaches the octahedral and cube unit cells when α respectively approaches zero and infinity. Consistent with those geometrical observations, the analytical solutions presented in this study approached those of the octahedral and cube unit cells when α approached respectively 0 and infinity.

Expression of neurotrophin-3 in the growing velvet antler of the red deer Cervus elaphus.

Antlers are organs of bone which regenerate each year from the heads of male deer. In addition to bone, support tissues such as nerves also regenerate. Nerves must grow at up to 1 cm/day. The control of this rapid growth of nerves is unknown. We examined the relative expression of neurotrophin-3 (NT-3) mRNA in the different tissues of the growing antler tip and along the epidermal/dermal layer of the antler shaft of the red deer Cervus elaphus, using semi-quantitative reverse transcription-polymerase chain reaction. Expression in the tip was found to be highest in the epidermal/dermal layer and lowest in the cartilaginous layer in all developmental stages examined. These data correlate well with the density and pattern of innervation of these tissues. Along the epidermal/dermal layer of the antler shaft, expression was highest in the segments subjacent to the tip and lowest near the base, arguing for differences in the temporal expression of NT-3 in these segments. The expression of NT-3 in cells isolated from the different layers of 60-day antlers did not mirror that observed when whole tissues were used and may suggest regional specificity of NT-3 expression within antler tissues.

Effects of insulin-like growth factor-I (IGF-I) and IGF-II on the growth of antler cells in vitro.

The effects of insulin-like growth factors -I and -II (IGF-I and -II) on the growth of undifferentiated (fibroblast zone) cells from the growing tip of red deer velvet antlers and from cells 1.5 cm distal to the growing tip (cartilage zone) were investigated in primary cell culture. The addition of IGF-I or IGF-II to the medium of cultures preincubated in serum-free medium for 24 h increased the rate of [3H]thymidine uptake in a dose-dependent manner in both cell types, with maximal stimulation occurring when 1 nM-30 nM was added. The addition of IGF-II to the incubation medium containing IGF-I did not cause a further increase in [3H]thymidine uptake in either cell type over and above each growth factor alone, indicating that there were unlikely to be synergistic effects of IGF-II on the mitogenicity of IGF-I. Binding studies were carried out using 3 x 10(5) fibroblast zone cells and cartilage zone cells after they had been incubated in serum-free medium for 24 h. 125I-Labelled IGF-I (10(-9) M) in a final volume of 200 microliters was added to each culture and incubation carried out at 4 degrees C for a further hour. 125I-Labelled IGF-I bound specifically to both fibroblasts and cartilage zone cells; binding was displaced by both unlabelled IGF-I and by IGF-I antibody.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of testosterone either alone or with IGF-I on growth of cells derived from the proliferation zone of regenerating antlers in vitro.

Deer antlers are male secondary sexual characters and are the fastest growing mammalian tissue. As such, both androgens and growth factors play a major role in antler development. The timing of the antler cycle is controlled by the seasonal fluctuations of testosterone, and the actual growth of antlers is mainly stimulated by growth factors including insulin-like growth factor-1 (IGF-I). However, whether or not testosterone at low levels plays a growth-promoting role during antler formation is controversial. In the present study, we took an in vitro approach to investigate whether testosterone either alone or with IGF-I had mitogenic effects on mesenchymal or cartilaginous cells derived from the proliferation zone of regenerating antlers. In addition, a binding assay was carried out to determine whether the specific binding sites for testosterone were preserved after cell disaggregation. The results showed that testosterone either in physiological concentrations or at low levels did not exert direct mitogenic effects on antler cells derived from the proliferation zone in serum-free medium in vitro (P>0.05), even if the specific binding sites for testosterone in these cells were well preserved. Likewise, testosterone in a very wide range of concentrations not only failed to enhance (P>0.05), but at certain levels (0.1-5 nM) impaired the mitogenic effects of IGF-I on these antler cells in vitro (P<0.001). Therefore, these results support neither a conclusion that low level testosterone has growth-promoting effects on antler formation nor the hypothesis that testosterone effects may be achieved through sensitizing these antler cells to the mitogenic effects of IGF-I.

J-based Magnetic Resonance Conductivity Tensor Imaging (MRCTI) at 3 T.

In this study, current density (J) - based Magnetic Resonance Conductivity Tensor Imaging (MRCTI) reconstruction algorithms namely, the Anisotropic Equipotential Projection (AEPP), the Anisotropic J-Substitution (AJS) and the Anisotropic Hybrid J-Substitution (AHJS) algorithms are implemented to reconstruct conductivity tensor images of a physical phantom using a 3T magnetic resonance imaging system. 10mA current pulses are injected in synchrony with a conventional spin-echo pulse sequence. Furthermore, a new J-based hybrid algorithm namely, the Anisotropic Hybrid Equipotential Projection (AHEPP) is proposed. In addition, reconstruction performances of the four algorithms are evaluated.

Realization of magnetic resonance current density imaging at 3 tesla.

Magnetic Resonance Current Density Imaging (MRCDI) is an imaging modality, which reconstructs electrical current density distribution inside a material by using Magnetic Resonance Imaging (MRI) techniques. In this study, a current source with maximum current injection capability of 224.7mA, under 1kΩ resistive load is used. Experiments are performed with a 2D uniform phantom, in which a current steering insulator is inserted. Magnetic flux density distributions are measured, and current density images are reconstructed. The reconstructed images are in agreement with the reconstructions obtained with simulated measurements.

Phosphorylation of hormone sensitive phosphodiesterase in isolated adipocytes.

Cyclic AMP phosphodiesterase in rat adipocytes is stimulated by insulin and also by agents that increase cyclic AMP levels. When the enzyme is immunoprecipitated from a solubilised microsomal preparation from adipocytes prelabelled with radioactive phosphate and separated on SDS polyacrylamide gels, label is found in a protein band at the expected Mr for adipose tissue phosphodiesterase. Treatment of the adipocytes with isoproterenol or methyl isobutylxanthine increased the labelling of this band. Insulin alone had no effect on its labelling but did decrease the incorporation of label caused by isoproterenol.

Isolation and sequencing of deer and sheep insulin-like growth factors-I and -II.

We have developed a simple method for the isolation of highly purified cervine (c) and ovine (o) insulin-like growth factors-I (IGF-I) and -II. The IGFs were isolated from acidified serum by cation exchange chromatography and then purified by gel filtration, chromatofocusing, and reverse-phase chromatography. The IGF preparations are > 95% pure. The cIGF-I preparation contains < 0.056% cIGF-II and the oIGF-I preparation contains < 0.01% oIGF-II. Both the IGF-II preparations contain < 0.01% IGF-I. The amino acid sequence of cIGF-I has two differences when compared with human (h) IGF-I. The cIGF-II sequence, which is identical to bovine IGF-II, has three differences when compared with hIGF-II.