A 9-year retrospective evaluation of 102 pressure ulcer reconstructions.

OBJECTIVE: Several pressure ulcer (PU) risk factors including paralysis and age greater than 70 have been identified, while others such as nutrition are debated. The object of this study is to identify perioperative risk factors that may predict improved outcomes and reduced complications in primary and recurrent PU reconstructions. METHOD: A retrospective chart review of patients treated surgically for PUs from 2004 to 2013 at the University of Toledo Medical Center, Toledo, Ohio, US, was completed. Data collected included ulcer and medical history, as well as risk factors, complications and postoperative outcome. Data were statistically analysed for perioperative variances between primary and recurrent ulcers and closure status. RESULTS: A total of 49 patients with 102 reconstructions were reviewed. Spinal cord injured patients accounted for 90% receiving flap coverage of ulcers. Numerous differences between primary and recurrent ulcers were identified, including ulcer location, patient nutritional status, wound infection, postoperative course and recurrence. Multivariate analysis revealed a flap reconstruction prediction model using creatinine, haematocrit, haemoglobin, and prealbumin that is able to successfully predict closure outcome in 83.6% of cases. CONCLUSION: Many factors play a role in the development, course and treatment of PUs. It is vital to understand the role of patient risk factors in the development of PUs, to direct subsequent management and reconstruction, and to prevent future recurrences. DECLARATION OF INTEREST: The authors have no conflicts of interest to disclose.

Various bone parameters are positively correlated with hen body weight while range access has no beneficial effect on tibia health of free-range layers.

The aim of this study was to determine if body weight or range use has a significant impact on bone health in commercial free-range laying hens, and to correlate tibia bone quality parameters with individual range usage and body weight. A total of 30 Lohmann Brown hens at 74 wk of age were selected from a commercial free-range farm and were either classified as heavy (mean ± SEM body weight 2.11 ± 0.034 kg, n = 14) or light (1.68 ± 0.022 kg, n = 16) body weight, and also classified as rangers (accessed the range for 86.7% of available days, n = 16) or stayers (accessed the range for 5.00% of available days, n = 14). The left tibiae of all individuals were analyzed for morphological parameters using computed tomography, evaluated for bone breaking strength, and ashed to determine mineral composition. Keel bone scoring was performed based on observation. Data were analyzed using a 2 × 2 factorial ANOVA, and regression analysis was performed. There was no measurable effect of range usage on any of the tibia parameters investigated. The body weight was significantly correlated with tibia breaking strength (r = 0.59), tibia weight (r = 0.56), tibia length (r = 0.64), diaphyseal diameter (r = 0.61), and total tibia volume (r = 0.67). In conclusion, range access had no beneficial effect on bone health. The impact of internal hen house furnishing and movement on bone health needs further investigation.

Self-bearing, uncemented, ceramic total hip replacement arthroplasty.

The results for young patients in three diagnostic groups--osteoarthritis, posttraumatic arthritis, and osteonecrosis--show clearly that the uncemented procedure requires longer a recovery time than the cemented procedure. A more aggressive physical therapy program has resulted in an earlier return to function, as shown in these graphs. In conclusion, our experience with this operative procedure includes excellent patient acceptance, a failure rate comparable to that in Europe, a longer period of recovery than that for cemented arthroplasty, excellent results in revision of failed cemented arthroplasty, and an encouraging facility in the difficult case.

Applying GIS and high performance agent-based simulation for managing an Old World Screwworm fly invasion of Australia.

Agent-based modelling has proven to be a promising approach for developing rich simulations for complex phenomena that provide decision support functions across a broad range of areas including biological, social and agricultural sciences. This paper demonstrates how high performance computing technologies, namely General-Purpose Computing on Graphics Processing Units (GPGPU), and commercial Geographic Information Systems (GIS) can be applied to develop a national scale, agent-based simulation of an incursion of Old World Screwworm fly (OWS fly) into the Australian mainland. The development of this simulation model leverages the combination of massively data-parallel processing capabilities supported by NVidia's Compute Unified Device Architecture (CUDA) and the advanced spatial visualisation capabilities of GIS. These technologies have enabled the implementation of an individual-based, stochastic lifecycle and dispersal algorithm for the OWS fly invasion. The simulation model draws upon a wide range of biological data as input to stochastically determine the reproduction and survival of the OWS fly through the different stages of its lifecycle and dispersal of gravid females. Through this model, a highly efficient computational platform has been developed for studying the effectiveness of control and mitigation strategies and their associated economic impact on livestock industries can be materialised.

The hazards of tibial pin replacement in 90--90 skeletal traction.

Tibial pin placement and 90--90 traction may lead to serious knee difficulties. Not only proximal tibial epiphyseal insult, but also serious displacement of the tibia on the femur may occur. In light of these potential complications, distal femoral pin placement should always be preferable for 90--90 traction in treatment of fractured femurs in children.

Arthroscopic-assisted arthrodesis of the knee.

Arthrodesis of the knee is an accepted procedure to alleviate pain and deformity in posttraumatic degenerative arthritis, in patients who are not candidates for total joint arthroplasty. Most all of the accepted surgical methods involve an arthrotomy to remove bone and prepare the surfaces for fusion. We present an unusual case of posttraumatic arthritis of the knee in a young woman with a history of osteomyelitis. An arthrodesis was planned, but an arthrotomy was precluded. Arthroscopically assisted preparation of the fusion bed was performed for compression arthrodesis of the knee with an external fixator. A successful arthrodesis was obtained in 14 weeks.