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PURPOSE: Periprosthetic joint infections (PJIs) are a very demanding complication of arthroplasty. Diagnosis of PJI and pathogen identification pose considerable challenges in clinical practice. We hypothesized that the pathogen-specific immune response to PJI reflects the infection process, provides clinically relevant information on disease course, and has the potential to further optimize antimicrobial therapy. METHODS: We conducted a prospective matched cohort pilot study with 13 patients undergoing two-stage septic revision arthroplasty (PJI patients) between 06/2020 and 06/2021, as well as 11 control patients undergoing one-stage aseptic revision arthroplasty (Non-PJI patients). Pre-, intra- and postoperative serum samples were collected at standardized time points. We developed a custom Luminex®-based quantitative bead-based suspension array (Infection Array; IA), and used it for simultaneous measurement of antibody specificities against 32 pathogens commonly associated with PJI in 267 serum samples. RESULTS: The IA was able to trace the dynamics of the pathogen-specific humoral immune response in all patients against PJI-related pathogens, prominently coagulase-negative staphylococci and streptococci. Pathogen-specific serum antibody titers declined in 62% of PJI patients over the course of treatment, while no changes in antibody titers were observed in 82% of Non-PJI patients during this study. Our serological data strongly suggested that antibody signatures reflect an immune response to microbial invasion. CONCLUSION: Our results provide insights into the pathophysiology of PJI and information on the individual disease courses. The IA is therefore a promising and novel serological tool of high resolution for monitoring the immunoproteomic footprints of infectious pathogens in the course of PJI.
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INTRODUCTION: The treatment option for borderline hip dysplasia (BHD) includes hip arthroscopy and periacetabular osteotomy (PAO). To the present day the controversial discussion remains, which intervention to prefer. Literature reports supporting an educated choice are scare, based on small patient cohorts and do not address the variability of acetabular morphology. Consequently, we intended to report PAO outcomes, from patients diagnosed with BHD, dependent on acetabular morphology, in a large patient cohort and aimed to define risk factors for poor clinical results and patient satisfaction. MATERIALS AND METHODS: A prospective monocentre study was conducted. Patients enrolled underwent PAO for symptomatic BHD (LCEA, 18°-25°). A total of 107 hips were included with 94 complete data sets were available for evaluation with a minimum follow-up of 1 year and a mean follow-up of 2.3 years. The mean age was 31 ± 8.2 years, and 81.3% were female. As the primary outcome measure, we utilized the modified Harris hip score (mHHS) with minimal clinically important change (MCID) of eight to define clinical failure. Results were compared after a comprehensive radiographic assessment distinguishing between lateral deficient vs. anterior/posterolateral deficient acetabular and stable vs. unstable hip joints. RESULTS: Overall, clinical success was achieved in 91.5% of patients and the mHHS improved significantly (52 vs. 84.7, p < 0.001). Eight hips failed to achieve the MCID and four had radiographic signs of overcorrection. Comparing variable joint morphologies, the rate of clinical success was higher in patients with an anterior/posterolateral deficient acetabular covarage compared to lateral deficient acetabular (95.2% vs. 90.4%). tThe highest rate of clinical failure was recorded in unstable hip joints (85.7% vs. 92.5% in stable hips). CONCLUSIONS: This study demonstrates that PAO is an effective means to treat symptomatic BHD with variable acetabular morphologies, achieving a clinical success in 91.5% of all patients. To maintain a high level of safety and patient satisfaction technical accuracy appears crucial.
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Acetábulo , Osteotomia , Medidas de Resultados Relatados pelo Paciente , Humanos , Osteotomia/métodos , Feminino , Acetábulo/cirurgia , Acetábulo/diagnóstico por imagem , Masculino , Adulto , Estudos Prospectivos , Luxação do Quadril/cirurgia , Luxação do Quadril/diagnóstico por imagem , Adulto Jovem , Satisfação do PacienteRESUMO
The movements between the spine, pelvis and hip joints are coordinated to allow for a physiological balance of the upper body and the pelvis during sitting and standing. Degenerative changes or spondylodesis of the spine result in decreased pelvic mobility and can lead to increased rates of instability in the presence of total hip arthroplasty (THA). To reduce the risk of THA dislocation several authors have recently recommended functional radiographs of the spine and pelvis, as well as individual safe zones for THA components. The aim of this article is to summarize the current body of knowledge regarding the influence of spinopelvic alignment on THA and provide recommendations for everyday clinical practice.
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Pelve , Coluna Vertebral , Artroplastia de Quadril , Articulação do Quadril/cirurgia , Amplitude de Movimento ArticularRESUMO
The number of septic and aseptic total hip arthroplasty (THA) revisions will increase, which involves a greater financial burden. We here provide a retrospective consecutive analysis of the major variable direct costs involved in revision THA for aseptic and septic failure. A total of 144 patients (30 septic, 114 aseptic) treated between January 1, 2009 and March 31, 2012 was included. The management of septic THA loosening is much more expensive than that of aseptic loosening ($14,379.8 vs. $5,487.4). This difference is mainly attributable to the two-stage exchange technique used for septic failure (hospital stay: 40.2 vs. 15.6 days) and significantly higher implant costs ($3,930.9 vs. $2,298.2). The septic implantation part is on average $3,384.6 more expensive than aseptic procedures (P < .001).
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Artroplastia de Quadril/economia , Custos de Cuidados de Saúde , Infecções Relacionadas à Prótese/economia , Idoso , Artroplastia de Quadril/métodos , Remoção de Dispositivo/economia , Feminino , Prótese de Quadril/economia , Humanos , Masculino , Pessoa de Meia-Idade , Falha de Prótese , Reoperação/economia , Reoperação/métodos , Estudos RetrospectivosRESUMO
OBJECTIVE: Transfer of the gluteus maximus with refixation at the greater trochanter for treatment of abductor deficiency. INDICATIONS: Symptomatic abductor deficiency with atrophy and fatty degeneration of the gluteal musclesâ¯> 50% (grade 3 by quartile) with good strength of the gluteus maximus. CONTRAINDICATIONS: Low atrophy or fatty degeneration of less than 50% of the gluteal muscles, limited strength of the gluteus maximus, infection. SURGICAL TECHNIQUE: First, the fascia lata is incised dorsally to the tensor fascia latae muscle, with the incision extending approximately 1.5â¯cm proximal to the iliac crest. A second incision divides the gluteus maximus muscle longitudinally along the muscle fibers and continues towards the fascia lata distal to the greater trochanter. These incisions result in a triangular muscle flap, which is elevated and divided into anterior and posterior portions. The posterior flap is positioned ventrally over the femoral neck and fixed to the anterior capsule and the anterior edge of the greater trochanter. The anterior flap is placed directly on the proximal femur. For this purpose, a groove is prepared in the area of the proximal femur using a spherical burr to freshen up the future footprint. The anterior flap is positioned from the tip of the greater trochanter towards the insertion of the vastus lateralis muscle. Subsequently, the anterior flap is fixed to the created groove with transosseous sutures and positioned under the elevated vastus lateralis muscle in 15° abduction of the leg. To provide additional stabilization to the tendinous part of the anterior flap, a screw is inserted distally to the greater trochanter. The vastus lateralis muscle is attached to the distal tip of the anterior flap, and the remaining gluteus maximus muscle is sutured to the fascia lata to cover the anterior flap. Additionally, a flap of the tensor fascia latae muscle can be mobilized and adapted to the reconstruction. Layered wound closure is performed. RESULTS: The technique of a gluteus maximus transfer represents a method for the treatment of chronic abductor deficiencies and improves abduction function as well as the gait pattern in short-term follow-ups. Fifteen patients (mean age at time of surgery 62 years) had after a mean follow-up of 2.5 years. The modified Harris Hip Score (mHHS) improved from 48 points preoperatively to 60 points at follow-up. Preoperatively, 100% had a positive Trendelenburg sign; at follow-up, this was about 50%.
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Co-extrusion of both half-cells in tubular PEM water electrolyzers can lower the costs for hydrogen production, since the number of components is reduced and the production process is simplified. However, after co-extrusion of the inner half-cell and the ion exchange membrane, the membrane is in its fluoride sulfonyl form and must be hydrolyzed to achieve the proton conductive sulfonic acid to be ready for use. Common practice is the hydrolysis using concentrated alkaline solutions, which causes a corrosion of the laminated anode electrode. We developed a less corrosive method using triethylsilanol as reactant. Tubular membranes hydrolyzed with this new procedure were characterized and tested in an electrolyzer laboratory test setup.
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OBJECTIVE: The objective was to evaluate clinical outcome and safety of arthroscopic, autologous minced cartilage implantation for acetabular cartilage lesions observed during hip arthroscopy to treat femoroacetabular impingement syndrome (FAIS). DESIGN: Eleven male patients, average age: 29.4 ± 5.4 years, average body mass index (BMI): 24.2 ± 2.2 kg/m2, scheduled for hip arthroscopy due to FAIS accompanied by an acetabular cartilage lesion were included in the case series. Cartilage tissue was harvested and minced from the loose cartilage flap at the chondrolabral lesion by arthroscopic shaver, augmented with autologous conditioned plasma, implanted into the defect, and fixated by autologous thrombin. Concomitant interventions were performed as indicated. The patients were evaluated preoperatively and at 24-month follow-up, using the International Hip Outcome Tool-12 (iHOT-12) and Visual Analog Scale (VAS) pain score and by magnetic resonance imaging (MRI) using the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) grading scale at the 2-year follow-up. RESULTS: The defect size was on average 3.5 cm2 (1.5-4.5 cm2). From preoperatively to 2 years postoperatively, the iHOT-12 significantly improved from 50.2 ± 18 to 86.5 ± 19 (P < 0.0001), and pain score decreased from 5.6 ± 1.8 to 1.0 ± 1.5 (P < 0.0001) on the Visual Analog Scale pain score. Regarding functional outcome and pain, 10 of the 11 patients and all patients reached the minimal clinically important difference (MCID), respectively. The postoperative average MOCART score was 87.2 (± 9.2). No adverse events or reoperations were observed. CONCLUSIONS: Arthroscopic, autologous minced cartilage implantation for treating full-thickness acetabular cartilage lesions in FAIS shows statistically and clinically significant improvement at short-term follow-up.
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Doenças das Cartilagens , Impacto Femoroacetabular , Humanos , Masculino , Adulto Jovem , Adulto , Seguimentos , Cartilagem/cirurgia , Acetábulo/cirurgia , Doenças das Cartilagens/cirurgia , Impacto Femoroacetabular/diagnóstico por imagem , Impacto Femoroacetabular/cirurgia , DorRESUMO
BACKGROUND: Hip dysplasia is the most common cause of secondary hip osteoarthritis. The Ganz periacetabular osteotomy (PAO) is a well-established procedure that allows a reliable and reproducible correction of the complex pathology. The promising medium and long-term good treatment results are offset by the potential risk of complications from an invasive pelvic procedure. Considering the mainly young age of the patients, knowledge of the possible complications and the resulting adequate therapy is crucial. TREATMENT DEVELOPMENT: The continuous development of surgical techniques and increase in overall surgical experience alongside the appreciation of critical surgical steps have led to a substantial reduction of serious complications. In addition, to improve patient outcome, a greater understanding of the associated pathologies that may be related to hip dysplasia is essential.
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Luxação Congênita de Quadril , Luxação do Quadril , Humanos , Acetábulo/cirurgia , Luxação do Quadril/etiologia , Resultado do Tratamento , Estudos Retrospectivos , Luxação Congênita de Quadril/complicações , Osteotomia/efeitos adversosRESUMO
Psychologic comorbidities have been identified as risk factors for poor outcomes in orthopedic procedures, but their influence on the outcome of hip-preserving periacetabular osteotomy (PAO) remains uncertain. This retrospective cohort study aimed to assess the impact of patients' psychological health on the outcome of PAO in patients with hip dysplasia (HD) and acetabular retroversion (AR). The study included 110 patients undergoing PAO for HD or AR between 2019 and 2021. Standardized questionnaires were administered to assess psychological factors, postoperative hip function, and activity level (mean follow-up: 25 months). Linear regression analyses were used to examine the associations between psychological factors and postoperative hip function and activity level. Both HD and AR patients showed improved postoperative hip function and activity levels. Linear regression analyses revealed that depression significantly impaired postoperative outcomes in both groups, whereas somatization negatively influenced the outcome in AR patients. General health perceptions significantly contributed to an improved postoperative outcome. These findings highlight the importance of concomitantly addressing psychologically relevant factors in order to improve patient outcomes after PAO procedures. Future prospective studies should continue to investigate the impact of various psychological factors and explore possibilities of incorporating psychological support into routine postoperative care for these patient cohorts.
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Nanostructuration is a promising tool for enhancing the performance of sensors based on electrochemical transduction. Nanostructured materials allow for increasing the surface area of the electrode and improving the limit of detection (LOD). In this regard, inverse opals possess ideal features to be used as substrates for developing sensors, thanks to their homogeneous, interconnected pore structure and the possibility to functionalize their surface. However, overcoming the insulating nature of conventional silica inverse opals fabricated via sol-gel processes is a key challenge for their application as electrode materials. In this work, colloidal assembly, atomic layer deposition and selective surface functionalization are combined to design conductive inverse opals as an electrode material for novel glucose sensing platforms. An insulating inverse opal scaffold is coated with uniform layers of conducting aluminum zinc oxide and platinum, and subsequently functionalized with glucose oxidase embedded in a polypyrrole layer. The final device can sense glucose at concentrations in the nanomolar range and is not affected by the presence of common interferents gluconolactone and pyruvate. This method may also be applied to different conductive materials and enzymes to generate a new class of highly efficient biosensors.
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Nanoestruturas , Polímeros , Polímeros/química , Porosidade , Pirróis , Nanoestruturas/química , Glucose/químicaRESUMO
This study establishes a preparative route towards a model system for supported catalytically active liquid metal solutions (SCALMS) on nanostructured substrates. This model is characterized by a uniquely precise geometrical control of the gallium particle size distribution. In a SCALMS system, the Ga serves as a matrix material which can be decorated with a catalytically active material subsequently. The corresponding Ga containing precursor is spin-coated on aluminum based substrates, previously nanostructured by electrochemical anodization. The highly ordered substrates are functionalized with distinct oxide coatings by atomic layer deposition (ALD) independently from the morphology. After preparation of the metal particles on the oxide interface, the characterization of our model system in terms of its geometry parameters (droplet diameter, size distribution and population density) points to SiO2 as the best suited surface for a highly controlled geometry. This flexible model system can be functionalized with a dissolved noble metal catalyst for the application chosen.
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We aimed to determine the accuracy and reliability of measures characterizing anterior, lateral, and posterior acetabular coverage on intraoperative fluoroscopic images compared to postoperative radiographs when performing periacetabular osteotomies (PAOs). A study involving 100 PAOs was initiated applying a standardized intraoperative imaging protocol. Coverage was determined by the lateral center edge angle (LCEA), the Tönnis angle (TA), and the anterior and posterior wall index (AWI, PWI). An intraclass correlation coefficient (ICC) model was used to assess interrater (ICC (3,2)) and intrarater (ICC (2,1)) reliability. The ICC (2,2) between analyses obtained from intraoperative fluoroscopy and postoperative radiographs and the corresponding 95% confidence interval (CI) were determined and complemented by Bland-Altman analysis, the mean difference, and 95% limits of agreement (LOA). The ICCs were 0.849 for the LCEA (95% CI 0.783-0.896), 0.897 for the TA (95% CI 0.851-0.930), 0.864 for the AWI (95% CI 0.804-0.907), and 0.804 for the PWI (0.722-0.864). The assessed interrater reliability was excellent except for the AWI, which was graded good (ICC = 0.857, 95% CI 0.794-0.902). Interrater agreement was generally good and fair for the AWI (ICC = 0.715, 95% CI 0.603-0.780). For each postoperative radiograph, interrater reliability was good with ICCs ranging from 0.813 (TA) to 0.881 (PWI). Intrarater reliability was good for all measurements and excellent for the preoperative TA (ICC = 0.993, 95% CI 0.984-0.997) and PWI (ICC = 0.954, 95% CI 0.919-0.97). In summary, we confirm the validity and reliability of intraoperative fluoroscopy as an alternative imaging modality to radiography to evaluate acetabular fragment orientation during PAO. We affirm the LCEA and TA as precise measures for lateral head coverage, and show the suitability of the AWI and PWI to steadily assess acetabular version.
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OBJECTIVE: Performance of a periacetabular osteotomy (PAO) using a minimally invasive approach for three-dimensional correction of the acetabular position. INDICATIONS: Symptomatic developmental dysplasia of the hip in adolescents and adults. CONTRAINDICATIONS: Advanced osteoarthritis of the hip, incongruence of the hip joint surfaces. SURGICAL TECHNIQUE: A periacetabular osteotomy is performed via a minimally invasive approach. RESULTS: In total, 39 patients were followed up for 3.5 (3-4.5) years. The lateral center-edge angle of Wiberg increased significantly from 16.1° (7-24°) to 30.5° (25-37°) (pâ¯< 0.0001), the acetabular index changed from 13.2° (2-25.3°) to 2.8° (-3-13°; pâ¯< 0.0001). Mean duration of surgery was 88 (57-142) minutes. No major complications occurred.
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Luxação Congênita de Quadril , Luxação do Quadril , Acetábulo/diagnóstico por imagem , Acetábulo/cirurgia , Adolescente , Adulto , Luxação do Quadril/diagnóstico por imagem , Luxação do Quadril/cirurgia , Luxação Congênita de Quadril/diagnóstico por imagem , Luxação Congênita de Quadril/cirurgia , Articulação do Quadril/cirurgia , Humanos , Osteotomia/métodos , Radiografia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
STUDY DESIGN: Population-based cohort study. OBJECTIVE: We examined associations between common lumbar degenerative changes observed on magnetic resonance imaging (MRI) and present or future low back pain (LBP). SUMMARY OF BACKGROUND DATA: The association between lumbar MRI degenerative findings and LBP is unclear. Longitudinal studies are sparse. METHODS: Participants (nâ=â3369) from a population-based cohort study were imaged at study entry, with LBP status measured at baseline and 6-year follow-up. MRI scans were reported on for the presence of a range of MRI findings. LBP status was measured on a 0 to 10 scale. Regression models were used to estimate the cross-sectional and longitudinal associations between individual and multiple MRI findings and LBP severity. Separate longitudinal analyses were conducted for participants with and without baseline pain. RESULTS: MRI findings were present in persons with and without back pain at baseline. Higher proportions were found in older age groups. 76.4% of participants had a least one MRI finding and 8.3% had five or more different MRI findings. Cross-sectionally, most MRI findings were slightly more common in those with LBP and pain severity was slightly higher in those with MRI findings (ranging from 0.06 for high intensity zone to 0.83 for spondylolisthesis). In the longitudinal analyses, we found most MRI findings were not associated with future LBP-severity regardless of the presence or absence of baseline pain. Compared to zero MRI findings, having multiple MRI findings (five or more) was associated with mildly greater pain-severity at baseline (0.84; 0.50-1.17) and greater increase in pain-severity over 6âyears in those pain free at baseline (1.21; 0.04-2.37), but not in those with baseline pain (-0.30; -0.99 to 0.38). CONCLUSION: Our study shows that the MRI degenerative findings we examined, individually or in combination, do not have clinically important associations with LBP, with almost all effects less than one unit on a 0 to 10 pain scale.Level of Evidence: 3.
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Dor Lombar , Idoso , Estudos de Coortes , Estudos Transversais , Humanos , Estudos Longitudinais , Dor Lombar/diagnóstico por imagem , Dor Lombar/epidemiologia , Vértebras Lombares/diagnóstico por imagem , Imageamento por Ressonância MagnéticaRESUMO
BACKGROUND: periacetabular osteotomy (PAO) is known as the gold standard surgical treatment in young adults with symptomatic hip dysplasia. With the aim of reducing soft tissue trauma, we developed a new rectus and sartorius sparing (RASS) approach. We hypothesized that this new PAO technique was equal regarding acetabular reorientation, complication rate, and short-term clinical outcome parameters, compared to our conventional, rectus sparing (RS) approach. PATIENTS AND METHODS: we retrospectively assessed all PAO procedures performed by a single surgeon between 2016 and 2019 (n = 239 hips in 217 patients). The cases in which the new RASS technique were used (n = 48) were compared to the RS cases for acetabular orientation parameters, surgical time, perioperative reduction of hemoglobin level, and length of hospital stay (LOHS). Inclusion criteria were a lateral center-edge angle (LCEA) <25° and osteoarthritis Tönnis grade ≤1. Patients with acetabular retroversion or additional femoral osteotomy were excluded. RESULTS: the mean patient age at the time of surgery was 29 years (14 to 50, SD ± 8.5). Females accounted for 79.5% in this series. The mean preoperative LCEA were 16° (7 to 24°, SD ± 4.4) and 15° (0 to 23°, SD ± 6) in the RASS and the RS group, respectively (p = 0.96). The mean preoperative acetabular index (AI) angles were 14° (2 to 25°, SD ± 4) and 14° (7 to 29°, SD ± 4.3), respectively (p = 0.67). The mean postoperative LCEA were significantly improved to 31° (25 to 37°, SD ± 3.5, p < 0.001) and 30.2° (20 to 38°, SD ± 4, p < 0.001), respectively. The mean postoperative AI angles improved to 2.8° (-3 to 13°, SD ± 3.3, p < 0.001) and 3° (-2 to 15°, SD ± 3.3, p < 0.001), respectively. There were no significant differences between the RASS and the RS group for surgical time, perioperative reduction in hemoglobin level, and LOHS. No blood transfusions were necessary perioperatively in either group. No major perioperative complication occurred in either group. We observed one surgical site infection (SSI) requiring superficial debridement in the RS group. CONCLUSION: the RASS approach for PAO showed to be a safe procedure with equivalent acetabular reorientation and equivalent clinical outcome parameters compared to the RS approach. Additionally, patients have fewer postoperative restrictions in mobilization with the RASS approach.
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Photocorrosion of an n-type semiconductor is anticipated to be unfavorable if its decomposition potential is situated below its valence band-edge position. Tungsten trioxide (WO3) is generally considered as a stable photoanode for different photoelectrochemical (PEC) applications. Such oversimplified considerations ignore reactions with electrolytes added to the solvent. Moreover, kinetic effects are neglected. The fallacy of such approaches has been demonstrated in our previous study dealing with WO3 instability in H2SO4. In this work, in order to understand parameters influencing WO3 photocorrosion and to identify more suitable reaction environments, H2SO4, HClO4, HNO3, CH3O3SH, as electrolytes are considered. Model WO3 thin films are fabricated with a spray-coating process. Photoactivity of the samples is determined with a photoelectrochemical scanning flow cell. Photostability is measured in real time by coupling an inductively coupled plasma mass spectrometer to the scanning flow cell to determine the photoanode dissolution products. It is found that the photoactivity of the WO3 films increases as HNO3 < HClO4 ≈ H2SO4 < CH3O3SH, whereas the photostability exhibits the opposite trend. The differences observed in photocorrosion are explained considering stability of the electrolytes toward decomposition. This work demonstrates that electrolytes and their reactive intermediates clearly influence the photostability of photoelectrodes. Thus, the careful selection of the photoelectrode/electrolyte combination is of crucial importance in the design of a stable photoelectrochemical water-splitting device.
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INTRODUCTION: The German practical year is the last clinical placement period during Medical School. However, it remains unclear how medical students evaluate the practical year in orthopaedics and traumatology (Orthopädie und Unfallchirurgie; O & U) and whether it has an impact on becoming an O & U specialist. METHOD: We analysed data of 146 medical students (46,7% female) who completed the placement in O & U. From the evaluation, 37 items were included in the analyses. Participants who could imagine becoming an O & U specialist (O & U-Ja) following graduation were statistically compared to those who could not (O & U-Nein). RESULTS: Overall 123 (83.7%) trainees indicated that they would like to become an O & U specialist (O & U-Ja), 18 (12.8%) negated (O & U-Nein) and 6 (4.1%) were undecided. Groups did not differ for sex and age (sex: Chi² = 2.50, p = 0.114; age: F [1.93] < 1, p = 0.764). Group differences were found for practical orientation, independency, acquisition of anamnesis and diagnostics skills and problem-solving expertise with students who could imagine becoming an O & U specialist (O & U-Ja) giving the highest ratings. DISCUSSION: Evaluations of the last medical year are essential in order to continuously improve the internship experience and to attract students towards a certain medical field and, moreover, to post-graduate specialist training. Clinics and institutions who already emphasize on the factors derived from this evaluation, or are continuously working on improvement, might be more able to attract young professionals, since personnel acquisition is starting early in the medical field.
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Internato e Residência , Ortopedia , Estudantes de Medicina , Traumatologia , Feminino , Humanos , Masculino , Ortopedia/educação , Especialização , Traumatologia/educaçãoRESUMO
We provide a direct comparison of two distinct methods of Ti felt surface treatment and Pt/Ir electrocatalyst deposition for the positive electrode of regenerative fuel cells and vanadium-air redox flow batteries. Each method is well documented in the literature, and this paper provides a direct comparison under identical experimental conditions of electrochemical measurements and in identical units. In the first method, based on classical engineering, the bimetallic catalyst is deposited by dip-coating in a precursor solution of the salts followed by their thermal decomposition. In the alternative method, more academic in nature, atomic layer deposition (ALD) is applied to the felts after anodization. ALD allows for a controlled coating with ultralow noble-metal loadings in narrow pores. In acidic electrolyte, the ALD approach yields improved mass activity (557 A·g-1 as compared to 80 A·g-1 at 0.39 V overpotential) on the basis of the noble-metal loading, as well as improved stability.
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BACKGROUND: Benign osseous lesions of the spine are common but precise population prevalence estimates are lacking. Our study aimed to provide the first population-based prevalence estimates and examine association with back and neck pain. MATERIALS AND METHODS: We used data from the population-based Study of Health in Pomerania (SHIP). Whole-body MRI examinations (1.5 Tesla: T1, T2, and TIRM weightings) were available from 3,259 participants. Readings of the spinal MRI images were conducted according to a standardized protocol by a single reader (JS). The intra-rater reliability was greater than Kappa values of 0.98. Pain measures included the seven-day prevalence of spine pain and neck pain, and average spine pain intensity due to spine pain during the past three months. RESULTS: We found 1,200 (36.8%) participants with at least one osseous lesion (2,080 lesions in total). Osseous lesions were less common in men than in women (35.5% vs 38.9%; P = .06). The prevalence of osseous lesions was highest at L2 in both sexes. The prevalence of osseous lesions increased with age. Up to eight osseous lesions were observed in a single subject. Hemangioma (28%), and lipoma (13%) occurred most often. Sclerosis (1.7%), aneurysmal bone cysts (0.7%), and blastoma (0.3%) were rare. Different osseous lesions occurred more often in combination with each other. The association with back or neck pain was mostly negligible. CONCLUSION: Osseous lesions are common in the general population but of no clinical relevance for spinal pain. The prevalence of osseous lesions varied strongly across different regions of the spine and was also associated with age and gender. Our population-based data offer new insights and assist in judging the relevance of osseous lesions observed on MRIs of patients.
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Dor nas Costas/fisiopatologia , Cistos Ósseos Aneurismáticos/diagnóstico por imagem , Vértebras Cervicais/diagnóstico por imagem , Hemangioma/diagnóstico por imagem , Lipoma/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Cervicalgia/fisiopatologia , Adulto , Fatores Etários , Idoso , Dor nas Costas/diagnóstico por imagem , Dor nas Costas/epidemiologia , Dor nas Costas/patologia , Cistos Ósseos Aneurismáticos/epidemiologia , Cistos Ósseos Aneurismáticos/patologia , Vértebras Cervicais/inervação , Vértebras Cervicais/patologia , Feminino , Alemanha/epidemiologia , Hemangioma/epidemiologia , Hemangioma/patologia , Humanos , Lipoma/epidemiologia , Lipoma/patologia , Vértebras Lombares/inervação , Vértebras Lombares/patologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Cervicalgia/diagnóstico por imagem , Cervicalgia/epidemiologia , Cervicalgia/patologia , Variações Dependentes do Observador , Prevalência , Reprodutibilidade dos Testes , Esclerose , Fatores SexuaisRESUMO
BACKGROUND: Auricular acupuncture is a promising method for postoperative pain relief. However, there is no evidence for its use after ambulatory surgery. Our aim was to test whether auricular acupuncture is better than invasive needle control for complementary analgesia after ambulatory knee surgery. METHODS: One hundred and twenty patients undergoing ambulatory arthroscopic knee surgery under standardized general anesthesia were randomly assigned to receive auricular acupuncture or a control procedure. Fixed indwelling acupuncture needles were inserted before surgery and retained in situ until the following morning. Postoperative rescue analgesia was directed to achieve pain intensity less than 40 mm on a 100-mm visual analogue scale. The primary outcome measure was the postoperative requirement for ibuprofen between surgery and examination the following morning. RESULTS: Intention-to-treat analysis showed that patients from the control group (n = 59) required more ibuprofen than patients from the auricular acupuncture group (n = 61): median (interquartile range) 600 (200-800) v. 200 (0-600) mg (p = 0.012). Pain intensity on a visual analogue scale was similar in both groups at all time points registered. The majority of patients in both groups believed that they had received true acupuncture and wanted to repeat it in future. INTERPRETATION: Auricular acupuncture reduced the requirement for ibuprofen after ambulatory knee surgery relative to an invasive needle control procedure.