OBJECTIVE: Successful total hip arthroplasty relies on accurate preoperative planning. However, the conventional preoperative planning, a two-dimensional method using X-ray template, has shown poor reliability of predicting component size. To our knowledge, artificial intelligence technology assisted three-dimensional preoperative planning is promising to improve the accuracy of preoperative planning but there is a dearth of clinical evidence. Therefore, in this study we compared the prediction accuracy of these two maneuvers. METHODS: We conducted a prospective study consisting of 117 consecutive patients who underwent a primary cementless total hip arthroplasty to compare the prediction accuracy of these two methods. The two-dimensional and artificial intelligence assisted three-dimensional planning results of the same patient were compared with the definitive implant size respectively. RESULTS: The prediction accuracy of artificial intelligence assisted three-dimensional planning for cup and the stem sizes were 66.67% (78/117) and 65.81% (77/117), two-dimensional planning was 30.77% (36/117) and 37.61% (44/117) (p < 0.05). There were poor prediction results of two-dimensional planning in patients with hip dysplasia (p = 0.004, OR = 7.143) and excessive femoral anteversion (p = 0.012, OR = 1.052), meanwhile the failure risk of stem side two-dimensional planning increased as patients got older (p = 0.003, OR = 1.118). The accuracy of artificial intelligence assisted three-dimensional planning cannot be affected by above factors. CONCLUSIONS: We confirmed that artificial intelligence assisted three-dimensional preoperative planning showed higher accuracy and stability than two-dimensional preoperative planning in primary cementless total hip arthroplasty. We believe artificial intelligence assisted three-dimensional preoperative planning technology provides surgeons a new reliable choice and offers advantages whether in simple or complicated cases.
[This corrects the article DOI: 10.3389/fgene.2021.760760.].
Adderall is one of the most commonly prescribed stimulant medications for attention deficit hyperactivity disorder (ADHD). Although safe and effective when clinically indicated at the appropriate dose, stimulant misuse may lead to serious adverse effects. We report a 29-year-old male with a diagnosis of ADHD who took more than the recommended therapeutic dose of Adderall prescribed by his psychiatrist. He subsequently presented with persistent psychotic symptoms, which responded to oral haloperidol. Due to treatment non-compliance with multiple recurring psychiatric hospitalizations, long-acting injectable haloperidol decanoate was considered to improve compliance and prognosis. The patient's psychosis remained in remission while on the long-acting injectable. In this case study, we highlight the need for future research to identify stimulant misuse risk factors. Randomized clinical trials are needed to determine the effectiveness of long-acting injectable antipsychotic medication in the management of persistent psychosis secondary to stimulant misuse.
Pseudobulbar affect (PBA) is an affective disorder of emotional expression characterized by frequent uncontrollable outbursts of laughing or crying. It is usually associated with stroke, traumatic brain injury, and other neurological conditions. This disorder can present a challenge to clinicians to distinguish this from mood disorders or to diagnose this disorder in the context of underlying mood disorders. In addition, the delay in the diagnosis can impact patients' quality of life. We describe a 48-year-old man who presented with frequent episodes of sudden, frequent, uncontrollable laughing two years after his recurrent stroke. The patient initially had his first stroke about three years ago and had a recurrent stroke eight months after his first stroke. A few days after getting discharged after his second stroke, the patient was admitted to the psychiatric unit after his family members reported aggressive behavior. The patient also reported symptoms of depression and was discharged on escitalopram for mood and divalproex for his aggressive behavior. Unfortunately, the patient was not compliant with these medications with no resolution of his symptoms. The patient was then treated with dextromethorphan-quinidine, escitalopram, and divalproex, resulting in significant improvement in his mood and aggressive behavior with a resolution of uncontrollable laughing spells. Clinicians are encouraged to inquire about symptoms of pseudobulbar affect in the context of stroke or other neurological disorders. Appropriate management of this condition can help improve patients' symptoms and positively affect their wellbeing.
Background Thalassemia is an inherited blood disorder characterized by reduced hemoglobin synthesis. Aim of our study is to assess the parental knowledge of thalassemia patients and their awareness regarding treatment and preventive measures against thalassemia. Methods It is an observational study done at Ali Zaib Foundation Thalassemia Center in Sahiwal, Pakistan, in May 2019. One hundred parents were enrolled in this study and a subjective questionnaire was used to collect data through direct structured survey method over a period of 30 days. Results There were parents of 62 (62%) male patients and 38 (38%) female patients, with a median age of 8.5 ± 6.2 years. Forty-three (43%) parents were illiterate while eight (8%) parents were highly educated. Sixty-six (66%) patients were born to parents with consanguineous marriages. Eighty-two (82%) parents were aware of thalassemia, 72 (72%) were aware of the risk of thalassemia due to cousin marriages, 76 (76%) parents were aware of the importance of prenatal diagnosis (PND), while 88 (88%) believed that a PND was beneficial. Fifty-two (52%) parents knew about thalassemia treatment, 80 (80%) were aware of the importance of blood screening, and 14 (14%) patients were receiving iron chelation therapy. Seventy-eight (78%) parents were aware of thalassemia prevention. All parents believed that the public requires awareness of the importance of premarital screening and PND. Conclusion Parental awareness regarding ß-thalassemia, its treatment and prevention is fair but far from ideal. Premarital screening, provision of accurate information to the public by professionals, and adequate screening and PND of at-risk families can significantly reduce the rates of thalassemias.
The Xinjiang Uyghur Autonomous Region of China (XUARC) harbors almost 50 ethnic groups including the Uyghur (UGR: 45.84%), Han (HAN: 40.48%), Kazakh (KZK: 6.50%), Hui (HUI: 4.51%), Kyrgyz (KGZ: 0.86%), Mongol (MGL: 0.81%), Manchu (MCH: 0.11%), and Uzbek (UZK: 0.066%), which make it one of the most colorful regions with abundant cultural and genetic diversities. In our previous study, we established allelic frequency databases for 14 autosomal short tandem repeats (STRs) for four minority populations from XUARC (MCH, KGZ, MGL, and UZK) using the AmpFlSTR® Identifiler PCR Amplification Kit. In this study, we genotyped 2,121 samples using the GoldenEye™ 20A Kit (Beijing PeopleSpot Inc., Beijing, China) amplifying 19 autosomal STR loci for four major ethnic groups (UGR, HAN, KZK, and HUI). These groups make up 97.33% of the total XUARC population. The total number of alleles for all the 19 STRs in these populations ranged from 232 (HAN) to 224 (KZK). We did not observe any departures from the Hardy-Weinberg equilibrium (HWE) in these populations after sequential Bonferroni correction. We did find minimal departure from linkage equilibrium (LE) for a small number of pairwise combinations of loci. The match probabilities for the different populations ranged from 1 in 1.66 × 1023 (HAN) to 6.05 × 1024 (HUI), the combined power of exclusion ranged from 0.999 999 988 (HUI) to 0.999 999 993 (UGR), and the combined power of discrimination ranged from 0.999 999 999 999 999 999 999 983 (HAN) to 0.999 999 999 999 999 999 999 997 (UGR). Genetic distances, principal component analysis (PCA), STRUCTURE analysis, and the phylogenetic tree showed that genetic affinity among studied populations is consistent with linguistic, ethnic, and geographical classifications.
AIMS: To investigate the impact of subchondral bone cysts (SBCs) in stress-induced osseous and articular variations in cystic and non-cystic knee models using finite element analysis. MATERIALS AND METHODS: 3D knee joint models were reconstructed from computed tomography (CT) and magnetic resonance imaging (MRI). Duplicate 3D models were also created with a 3D sphere mimicking SBCs in medial tibia. Models were divided into three groups. In group A, a non-cystic knee model was used, whereas in groups B and C, SBCs of 4 and 12 mm size were simulated, respectively. Cyst groups were further divided into three sub-groups. Each of sub-group 1 was composed of a solitary SBC in the anterior half of tibia adjacent to joint line. In sub-group 2, a solitary cyst was modeled at a lower-joint location, and in sub-group 3, two SBCs were used. All models were vertically loaded with weights representing double- and single-leg stances. RESULTS: During single-leg stance, increase in subchondral bone stress in sub-groups B-1 and B-3 were significant (p = 0.044, p = 0.026). However, in sub-group B-2, a slight increase was observed than non-cystic knee model (9.93 ± 1.94 vs. 9.35 ± 1.85; p = 0.254). All the sub-groups in group C showed significantly increased articular stress (p < 0.001). Conversely, a prominent increase in peri-cystic cancellous bone stress was produced by SBCs in groups B and C (p < 0.001). Mean cartilage shear stress in sub-groups B-1 and B-2 (0.66 ± 0.56, 0.58 ± 0.54) was non-significant (p = 0.374, p = 0.590) as compared to non-cystic model (0.47 ± 0.67). But paired cysts of the same size (B-3) produced a mean stress of 0.98 ± 0.49 in affected cartilage (p = 0.011). Models containing 12 mm SBCs experienced a significant increase in cartilage stress (p = 0.001, p = 0.006, p < 0.001) in sub-groups C-1, C-2, and C-3 (1.25 ± 0.69, 1.01 ± 0.54, and 1.26 ± 0.59), respectively. CONCLUSION: The presence of large-sized SBCs produced an increased focal stress effect in articular cartilage. Multiple cysts further deteriorate the condition by increased osseous stress effect and high tendency of peripheral cyst expansion in simulated cystic knee models than non-cystic knee models.
Different fixation modalities are available for fixation of posterior malleolar fractures (PMFs), but the best method is still unclear. The purpose of this study was to carry out a comparative biomechanical analysis of three commonly used fixation constructs for PMFs using experimental and finite element analysis (FEA). 15 human cadaveric ankle specimens were randomly divided into three groups. Specimens in group-A were fixed with two anteroposterior (AP) lag screws, group-B with two posteroanterior (PA) lag screws, and for group-C, a posterior plate was used. Each model was subjected to axial load. Outcomes included loads for 0.5 mm, 1 mm, 1.5 mm, and 2 mm vertical displacements of posterior fragments were noted. 3D FE models were reconstructed from computed tomography (CT) images and subjected to vertical loads. The model's stress, fracture step-off, and resultant strains in implants were also studied in 3D FE models. Significantly higher amounts of mean compressive loads were observed to cause the same amount of vertical displacements in plate group (265 ± 60.21 N, 796 ± 57.27 N, 901.18 ± 8.88 N, 977.26 ± 13.04 N) than AP (102.7 ± 16.78 N, 169.5 ± 19.91 N, 225.32 ± 15.92 N, 269.32 ± 17.29 N) and PA (199.88 ± 31.43 N, 362.80 ± 28.46 N, 431.3 ± 28.12 N, 541.86 ± 36.05 N) lag screws respectively (P < 0.05). Simulated micro-motion analysis demonstrated that fracture step-off values in plate group (0.03 ± 0.001 mm, 0.06 ± 0.003 mm and 0.13 ± 0.010 mm) were the lowest among the three groups (P < 0.001). The cancellous bone showed the highest amount of stress in AP and PA lag groups respectively, whereas the lowest stress was noted in the plate-group. This biomechanical study concluded that posterior plating is biomechanically the most stable fixation construct for PMFs fixation. AP and PA lag screws with higher bone stress and fracture step-off values have a high tendency of bone cut-through and loss of fixation respectively.
Ankle Fractures/surgery , Cadaver , Fracture Fixation, Internal/methods , Ankle Fractures/diagnostic imaging , Biomechanical Phenomena , Finite Element Analysis , Humans , Tomography, X-Ray Computed/methods
AIMS: In this study we have considered the three dimensional corrective forces for correction of scoliosis by using a patient specific finite element model. MATERIALS AND METHODS: An objective function of corrective forces in three-dimensional space was defined. Computed tomography images were used to reconstruct three dimensional model of scoliotic trunk. Computer aided engineering software Abaqus was used to establish finite element model of deformed spine and its biomechanical characteristics were analyzed. By adjusting magnitude and position of corrective forces, objective function was minimized to achieve best orthopedic effect. The proposed corrective conditions were divided into three groups: (1) thoracic deformity; (2) lumbar deformity; (3) both thoracic and lumbar deformities were considered. RESULTS: In all three cases, the objective function was reduced by 58, 52, and 63%, respectively. The best correction forces point was located on convex side of maximum displacement of vertebral body. CONCLUSION: Using minimum objective function method, spinal deformity in three-dimensional space can be sufficiently reduced. This study provides scientific basis for design of a new corrective brace for treatment of scoliosis.
OBJECTIVE: To study the effects of age and duration of symptoms on the outcomes of scrotal explorations for acute scrotal pain at our institution. STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: Bradford Teaching Hospital NHS Trust, from January 2006 to December 2017. METHODOLOGY: Retrospective data was collected from electronic case records of the patients who required scrotal exploration for suspected torsion of the testis. Group difference between continuous variables (age and duration of symptoms) were assessed by Kruskal Wallis and independent samples Mann-Whitney U-tests. The Fisher Exact and Chisquare tests were used to analyse relationships between categorical data. RESULTS: In total, 502 patients required scrotal exploration. The median age (years) and duration of symptoms (hours) were 16.4 years (1.3 - 77) and 4 hours (1 - 336), respectively. Torsion of the testis was found in 231 (46%), torsion of the testicular appendix in 126 (25%), epididymal inflammation in 46 (9.2%), and no cause identified in 99 (19.7%). Immediate orchidectomy for non-viable testis performed in 34 (14.7% of TT group and 6.8% of the overall cohort). Duration of symptoms was significantly associated with risk of orchidectomy in torsion patients 4 vs. 27 hours (p <0.0001). Overall 47 (9.3%) patients presented after 12 hours, 22 (46.8%) had TT. There were 13 (2.6%) patients older than 40 years and 8 (61.5%) of these had torsion. CONCLUSION: The most commonest diagnosis for patients presenting with acute scrotal pain was torsion of the testis followed by torsion of appendix testis. Testicular salvage was inversely related to the duration of symptoms. Patient's age did not predict the need for orchidectomy. This data supports the practice of urgent scrotal exploration for acute scrotal pain with a clinical suspicion of torsion regardless of age and duration of symptoms.
Epididymitis/diagnosis , Pain/etiology , Scrotum/physiopathology , Testicular Diseases/diagnosis , Adolescent , Adult , Aged , Child , Child, Preschool , Epididymitis/complications , Humans , Infant , Male , Middle Aged , Necrosis , Orchiectomy , Orchiopexy , Orchitis/complications , Orchitis/diagnosis , Retrospective Studies , Spermatic Cord Torsion/complications , Spermatic Cord Torsion/diagnosis , Spermatic Cord Torsion/surgery , Testicular Diseases/complications , Testicular Diseases/surgery , Torsion Abnormality/complications , Torsion Abnormality/diagnosis , Treatment Outcome , Young Adult
Plutella xylostella L. (Lepidoptera: Plutellidae) is an important pest causing significant losses to vegetables worldwide. Insecticides resistance in P. xylostella is a serious issue for scientists since last 30â¯years. However, deltamethrin and Bt Cry1Ac are commonly used insecticides against P. xylostella but studies involving development of resistance in P. xylostella against these two insecticides at different temperatures are lacking. The current study was aimed to find out the toxicity of deltamethrin and Bt Cry1Ac, and resistance development in P. xylostella. Results showed that the positive correlation between the temperature and toxicities of deltamethrin and Bt Cry1Ac. The results indicated -0.051, -0.049, -0.047, and -0.046 folds of deltamethrin resistance at 15⯰C, 20⯰C, 25⯰C, and 30⯰C temperatures, respectively from 1st to 12th generations. The toxicity of Bt Cry1Ac after 24â¯h was 2.2 and 4.8 folds on 1st generation at 20⯰C and 25⯰C temperatures, respectively compared to the toxicity recorded at 15⯰C (non-overlapping of 95% confidence limits). Based on the results of this study, it is concluded that the temperature has a positive correlation with the toxicity of deltamethrin and Bt Cry1Ac against the larvae of P. xylostella. This study suggests that deltamethrin and Bt Cry1Ac can be included in the management program of P. xylostella on many vegetable crops. The baseline susceptibility data might be helpful to understand the resistance mechanisms in P. xylostella.
Salt stress causes nutritional imbalance and ion toxicity which affects wheat growth and production. A population of recombinant inbred lines (RILs) were developed by crossing Pasban90 (salt tolerant) and Frontana (salt suceptible) for identification of quantitative trait loci (QTLs) for physiological traits including relative water content, membrane stability index, water potential, osmotic potential, total chlorophyll content, chlorophyll a, chlorophyll b and biochemical traits including proline contents, superoxide dismutase, sodium content, potassium content, chloride content and sodium/potassium ratio by tagging 202 polymorphic simple sequence repeats (SSR) markers. Linkage map of RILs comprised of 21 linkage group covering A, B and D genome for tagging and maped a total of 60 QTLs with major and minor effect. B genome contributed to the highest number of QTLs under salt stress condition. Xgwm70 and Xbarc361 mapped on chromosome 6B was linked with Total chlorophyll, water potential and sodium content. The increasing allele for all these QTLs were advanced from parent Pasban90. Current study showed that Genome B and D had more potentially active genes conferring plant tolerance against salinity stress which may be exploited for marker assisted selection to breed salinity tolerant high yielding wheat varieties.
Biosolids can be effectively recycled and applied as soil amendments for agricultural crops because they contain several important micro and macronutrients including nitrogen, phosphorus, potassium, manganese. In the current study, we evaluated the effectiveness of seven biosoilds on different growth parameters of wheat crop. The biosolids used were lime stabilized, composted, liquid mesophilic anaerobically digested (liquid MAD), thermally dried mesophilic anaerobically digested (thermally dried MAD), thermally hydrolyzed mesophilic anaerobically digested (thermally hydrolysed MAD), dewatered mesophilic anaerobically digested (dewatered MAD) and thermally dried raw biosolids. We also analysed biosolids for their nutrient contents before application. The results revealed that different types of biosolids differed in nitrogen and phosphorous contents with highest contents observed in dewatered (5.70% nitrogen, 2.32% phosphorous) and liquid biosolids (2.35% phosphorous). The plant height, plant diameter and dry weight yield of wheat was increased with the increase in concentrations of biosolids. Liquid MAD resulted in maximum plant height of 120.35⯱â¯3.23, 133.2⯱â¯3.67 and 147.25⯱â¯3.11 at 3.33, 6.66 and 9.99â¯tons/ha concentration. The highest plant diameter was recorded (1.05-1.45â¯cm) where mineral nitrogen was applied. The study will be helpful in replacing the synthetic fertilizer with biosolids to fulfil the nutritional requirements of agricultural crops.
Cereals are staple food for many countries and are grown on millions of hectares of land, but much of the harvest is wasted due to losses by pests. To minimize these losses, many pesticides are used which are damaging to the environment and human health. There are debates to get rid of these chemicals but they are still in use at large scale. An alternative control strategy for insect pests in storage houses is the use of botanicals. In this study, four plant essential oils, two plant extracts, two herbicides, and two insecticides were used against Tribolium confusum and the comparison of toxicity was made by calculating LC50 and LT50 values. LC50 values were higher for abamectin (2.09-10.23â¯mg/L) and cypermethrin (3.41-11.78â¯mg/L) insecticides followed by neem essential oil (7.39-19.24â¯mg/L) and citrus extract (10.14-24.50â¯mg/L). However, LC50 values were maximum in case of jaman plant extract (22.38-176.42â¯mg/L) followed by two herbicides, Logran (19.66-39.72â¯mg/L) and Topik (29.09-47.67â¯mg/L) However, LC50 values were higher for topic herbicide (24.098â¯ppm) and jaman essential oil (16.383â¯ppm) after four days of treatment. Abamectin and cypermethrin insecticides, neem essential oil and citrus plant extract also killed adults of T. confusum quicker as compared other essential oils, extracts and herbicides. Results revealed that botanical formulations being environmentally safe could be used instead of highly hazardous pesticides for stored products' pests. This study also elaborates the non-host toxicity of herbicides commonly applied in our agroecosystem.
PURPOSE: In this era of life highly comminuted and multi planar tibial plateau fractures involving the posterior corners are more commonly seen and addressed in the literature than before. Among these several types have not been described in the currently used classification systems. In fact simple classification systems ignore several fracture types and leniently grouped the fractures with different mechanism, morphology, treatment modalities and prognosis in same category. On the other hand, more extensive nature classifications with detailed subdivisions are difficult to remember for clinicians. The clinical reliability of these classifications is another problem. All these issues demand the potential need of a new classification. The aim of this study was to describe a quadrant specific two column classification of tibial plateau fractures and to analyse its inter-observer and intra-observer reliability, clinical assessment and application. MATERIALS AND METHODS: From January 2009 to December 2015, 44 patients with tibial plateau fractures were studied retrospectively. The antero-posterior (AP), lateral X-rays and computed tomography (CT) with axial transverse, sagittal, coronal and three dimensional (3D) reconstruction images were performed for all the patients. All of the fractures were categorized according to quadrant specific two column classification and the traditional Schatzker's classification. The comparative analysis for inter-observer and intra-observer reliability of the new classification and the Schatzker's classification was conducted by four observers. RESULTS: Three cases didn't match any type in the Schatzker's classification. While on the other hand, all cases were classified by two column classification. The mean kappa values for inter-observer reliability by using the Schatzker's classification was 0.723 (range, 0.674-0.823), representing substantial agreement, whereas the mean kappa value was 0.939 (range: 0.897-0.974), representing almost perfect agreement according to two column classification. The mean kappa values for intra-observer reliability using the Schatzker's classification and two column classification were 0.789 (range: 0.590-0.864) and 0.955 (range:0.923-0.948) showing substantial agreement and almost perfect agreement. CONCLUSION: The quadrant specific two column classification is anatomically oriented, CT based and clinically valid. The different fracture types according to anatomic location are represented alphanumerically so that treatment matched to specific fracture type (quadrant specific anatomic fixation) for optimal outcomes. Furthermore, it demonstrates higher inter-observer and intra-observer reliability. This classification can be adopted to strengthen the traditional Schatzker's classification, particularly in the multi planar and posteriorly extended plateau fractures. It can be used as a reliable research tool. The database can be used to distinguish different fracture types, individual type incidences, specific treatment and also prognosis. Authors suggest a large multi-centre study.
Intra-Articular Fractures/classification , Radiography , Tibial Fractures/classification , Adult , Aged , Clinical Decision-Making , Female , Fracture Fixation, Internal , Humans , Image Processing, Computer-Assisted , Intra-Articular Fractures/diagnostic imaging , Intra-Articular Fractures/surgery , Male , Middle Aged , Observer Variation , Reproducibility of Results , Retrospective Studies , Tibial Fractures/diagnostic imaging , Tibial Fractures/surgery
Livestock manure is a valuable source of nutrients for plants. However, poor handling practices during storage resulted in nutrient losses from the manure and decrement in its nitrogen (N) fertilizer value. We explored the influence of divergent storage methods on manure chemical composition, carbon (C) and N losses to the environment as well as fertilizer value of storage products after their application to the wheat. Fresh buffalo manure (FM) was subjected to different storage operations for a period of â¼6 months, (i) fermentation by covering with a plastic sheet (CM) (ii) placed under the roof (RM) (iii) heap was unturned (SM) to remain stacked at an open space and (iv) manure heap turned monthly (TM) to make compost. During storage, 8, 24, 45 and 46% of the initial Ntotal was lost from CM, RM, SM, and TM, respectively. The respective C losses from these treatments were 16, 34, 47 and 44% of the initial C content. After stored manures application to the wheat crop, mineral N in the soil remained 27% higher in CM (14.1 vs. 11.1â¯kgâ¯ha-1) and 3% (10.8 vs. 11.1â¯kgâ¯ha-1) lower in SM compared to FM treatment. In contrast, microbial biomass C and N was 35 (509 vs.782â¯mgâ¯C kg-1 soil) and 25% (278 vs.370â¯mgâ¯N kg-1 soil) lower in CM than FM treatment, respectively indicating lower N immobilization of CM in the soil. These findings could result in the highest grain yield (5166â¯kgâ¯ha-1) and N uptake (117â¯kgâ¯ha-1) in CM and the lowest in SM treatments (3105 and 61â¯kgâ¯ha-1, respectively). Similarly, wheat crop recovered 44, 15 and 13% N from CM, TM and SM, respectively. Hence, management operations play a critical role in conserving N during storage phase and after stored manure application to the field. Among the studied operations, storing animal manure under an impermeable plastic sheet is a much better and cheaper option for decreasing N losses during storage and improving wheat yield when incorporated into the soil. Therefore, by adopting this manure storage technique, farmers can improve the agro-environmental value of animal manure in Pakistan.
Manure , Soil , Animals , Fertilizers , Nitrogen , Nutrients , Pakistan , Triticum
BACKGROUND: Clinically there are different fixation methods used for fixation of the posterior malleolar fractures (PMF), but the best treatment modality is still not clear. Few studies have concentrated on this issue, least of all using a biomechanical comparison. The purpose of this study was to carry out a computational comparative biomechanics of three different commonly used fixation constructs for the fixation of PMF by finite element analysis (FEA). METHODS: Computed tomography (CT) images were used to reconstruct three dimensional (3D) model of the tibia. Computer aided design (CAD) software was used to design 3D models of PMF. Finally, 3D models of PMF fixed with two antero-posterior (AP) lag screws, two postero-anterior (PA) lag screws and posterior plate were simulated through computational processing. Simulated loads of 500 N, 1000 N and 1500 N were applied to the PMF and proximal ends of the models were fixed in all degrees of freedom. Output results representing the model von Mises stress, relative fracture micro-motion and vertical displacement of the fracture fragment were analyzed. RESULTS: The mean vertical displacement value in the posterior plate group (0.52 mm) was lower than AP (0.68 mm) and PA (0.69 mm) lag groups. Statistically significant low amount of the relative micro-motion (P < 0.05) was observed in the posterior plate group. CONCLUSIONS: It was concluded that the posterior plate is biomechanically the most stable fixation method for fixation of PMF.
Ankle Fractures/diagnostic imaging , Bone Plates , Bone Screws , Finite Element Analysis , Imaging, Three-Dimensional/methods , Ankle Fractures/surgery , Biomechanical Phenomena/physiology , Humans , Stress, Mechanical , Tomography, X-Ray Computed/methods
PURPOSE: Appropriate fixation method for the posterior malleolar fractures (PMF) according to the fracture size is still not clear. Aim of this study was to evaluate the outcomes of the different fixation methods used for fixation of PMF by finite element analysis (FEA) and to compare the effect of fixation constructs on the size of the fracture computationally. MATERIALS AND METHODS: Three dimensional model of the tibia was reconstructed from computed tomography (CT) images. PMF of 30%, 40% and 50% fragment sizes were simulated through computational processing. Two antero-posterior (AP) lag screws, two postero-anterior (PA) lag screws and posterior buttress plate were analysed for three different fracture volumes. The simulated loads of 350N and 700N were applied to the proximal tibial end. Models were fixed distally in all degrees of freedom. RESULTS: In single limb standing condition, the posterior plate group produced the lowest relative displacement (RD) among all the groups (0.01, 0.03 and 0.06mm). Further nodal analysis of the highest RD fracture group showed a higher mean displacement of 4.77mm and 4.23mm in AP and PA lag screws model (p=0.000). The amounts of stress subjected to these implants, 134.36MPa and 140.75MPa were also significantly lower (p=0.000). There was a negative correlation (p=0.021) between implant stress and the displacement which signifies a less stable fixation using AP and PA lag screws. CONCLUSION: Progressively increasing fracture size demands more stable fixation construct because RD increases significantly. Posterior buttress plate produces superior stability and lowest RD in PMF models irrespective of the fragment size.
Ankle Fractures/diagnostic imaging , Fracture Fixation, Internal , Imaging, Three-Dimensional , Tarsal Bones/diagnostic imaging , Tibia/diagnostic imaging , Ankle Fractures/classification , Ankle Fractures/surgery , Biomechanical Phenomena , Bone Plates , Bone Screws , Finite Element Analysis , Humans , Stress, Mechanical , Weight-Bearing
INTRODUCTION: Bladder cancers are not very common in the young population below 20 years of age, especially in those who have not been exposed to chemotherapy, bladder augmentation surgery and other known risk factors. By highlighting this case we hope to raise awareness in the medical community, that the symptom of visible haematuria can potentially be due to a bladder malignancy and therefore this should be thoroughly investigated. PRESENTATION OF CASE: An 18-year-old female presented with intermittent macroscopic haematuria and non-specific abdominal pain. Physical examination and routine blood tests were normal. An ultrasound scan initially showed a bladder wall lesion, which a flexible cystoscopy confirmed. Histology revealed grade 2 papillary transitional cell carcinoma of the bladder with no invasion into the lamina propria (G2pTa TCCB). DISCUSSION: We recognise through our literature review that paediatric bladder cancers are not commonly reported in the UK. In our paper we highlight the relevant major studies that have been carried out world-wide, the reported incidence so far and gaps in the evidence base. CONCLUSION: Despite the dearth of data about paediatric bladder malignancies there is enough case-based evidence, from world-wide sources, to support that bladder cancer must be suspected in the event of macroscopic haematuria. Ultrasound and cystoscopy are the standard diagnostic tools for bladder tumours. Endoscopic resection of the tumour followed up by interval ultrasound scans and flexible cystoscopy checks remain the mainstay of treatment hitherto.
