Proximal humeral fractures in elderly patients.

Proximal humeral fractures are common in the setting of osteoporosis and they represent a problem not only for increased mortality risk factors, but also in terms of costs and management. Their increased incidence has resulted in an evolution of treatment options, but currently there is no scientific evidence that defines the best treatment to choose. The choice of treatment depends on a variety of factors, such as fracture dislocation, fracture classification, bone quality, patient's age, functional requirements and general medical conditions. The debate about the treatment is still open, both for the decision between surgical and conservative treatment, and between different types of surgical techniques; nowadays it remains unclear whether surgery will produce better outcomes in function and quality of life in elderly osteoporotic patients.

The importance of rehabilitation after lower limb fractures in elderly osteoporotic patients.

Improving rehabilitation strategies after lower limb fractures among elderly patients is an urgent public health challenge due to the increasing proportion of older population and therefore the raised number of falls and fractures. Due to their strategic positioning, physiatrists should aim not only to improve functional outcomes after acute fracture treatment but also to address the underlying osteoporotic condition in order to prevent the devastating socioeconomic consequences of osteoporotic fractures.

Single-level anterior cervical discectomy and interbody fusion using PEEK anatomical cervical cage and allograft bone.

BACKGROUND: In an effort to avoid the morbidity associated with autogenous bone graft harvesting, cervical cages in combination with allograft bone are used to achieve fusion. The goal of the current study was to assess the reliability and efficacy of anterior cervical discectomy and interbody fusion (ACDF) using a PEEK anatomical cervical cage in the treatment of patients affected by single-level cervical degenerative disease. METHODS AND MATERIALS: Twenty-five patients affected by single-level cervical degenerative pathology between C4 and C7 were enrolled in this study. The clinical findings were assessed using the Neck Disability Index and the Visual Analog Scale. Surgical outcomes were rated according to Odom's criteria at last follow-up. Fusion was graded as poor, average, good or excellent by assessing the radiographs. Cervical spine alignment was evaluated by sagittal segmental alignment and sagittal alignment of the whole cervical spine preoperatively, 6 months postoperatively and at the last follow-up. RESULTS: Twenty-five patients underwent ACDF using a PEEK anatomical cervical cage. All patients had a minimum 2 years of follow-up. The operative levels were C4-C5 in 5 patients, C5-C6 in 12 patients and C6-C7 in 8 patients. Preoperatively, average NDI was 34, 13 at 6 months, and 10 at latest follow-up. The mean preoperative VAS was 7; the mean postoperative VAS at latest follow-up was 3. Good or excellent fusion was achieved in all patients within 10 months (mean 5 months). Preoperatively, average sagittal segmental alignment (SSA) was 0.2° and average sagittal alignment of the cervical spine (SACS) 15.8°. Six months after surgery, average SSA was 1.8° and average SACS 20.9°, and at last follow-up, average SSA was 1.6° and average SACS 18.5°. CONCLUSION: Anterior cervical discectomy and interbody fusion using PEEK anatomical cervical cages can be considered a safe and effective technique to cure cervical disc herniation with intractable pain or neural deficit in cases where conservative treatment failed.

Large area interference lithography using a table-top extreme ultraviolet laser: a systematic study of the degree of mutual coherence.

A prototype low cost table-top Ar capillary discharge laser source (1.5 ns pulse duration, lambda = 46.9 nm) was successfully used to produce, by means of interference lithography (with a simple Lloyd mirror setup), large area (0.1 mm(2)) regular patterns from 400 nm down to 22.5 nm (half-pitch) on PMMA/Si (PMMA: polymethylmethacrylate) substrates. The experiments allowed a systematical investigation of the degree of mutual coherence of the source, giving a clear indication that the interference lithography can be pushed down to the ultimate resolution limit of lambda/4.

Partial ACL tears augmented with distally inserted hamstring tendons and over-the-top fixation: an MRI evaluation.

This study evaluated the mid-term MRI appearance of partial ACL tear augmentation with quadrupled distally inserted hamstrings, while preserving the intact ACL bundle. Twenty-eight patients with ACL partial tear underwent augmentation. After 15-40 months follow-up, patients were evaluated clinically and by MRI. The mean IKDC score at follow-up was 93.8. Twenty-five patients were rated as excellent, three as fair. The mean tibial tunnel section area decreased by 27%. A correlation was noted between the clinical and MRI results: the graft was not visible or continuous with high intensity areas and the mean decrease in the tunnel section area was 3% in the three cases rated as fair. The graft appeared continuous and low intensity and the reduction in tibial tunnel section area was 30% in the cases with excellent clinical results. The residual part of the ACL was still recognizable in 79% of cases. The tibial hamstring attachment appeared normal in 93% of cases. In conclusion, excellent results correlated with a decrease in tunnel size and normal graft appearances on MRI. The poor results showed that the graft was not visible or not continuous, with high intensity areas and intra-ligamentous cystic formation within the tunnel. MRI scanning is useful in evaluating hamstring ACL grafts after reconstruction.

Is PAMPA a useful tool for discovery?

Experimental PAMPA data generated for 40 low molecular weight commercial drugs is reviewed in the context of its utility in the drug discovery process. Several experimental variables that have been introduced in the literature as additions or improvements to the PAMPA were also evaluated. The relationship between PAMPA data and both calculated and measured octanol/water distribution coefficients was examined. From this assessment, it was concluded that the PAMPA yields information about the lipophilicity as measured by the octanol/water partitioning of a compound, but that this same information could be derived in a simpler manner from calculated log D values.

The role of Bayesian Networks in the diagnosis of pulmonary embolism.

Pulmonary embolism (PE) is a life-threatening condition and, despite advances in diagnostic technology, it remains an elusive diagnosis. The rich variety of possible clinical presentations make it particularly difficult to represent the diagnostic process as a 'decision tree'. However, Bayesian networks offer the opportunity of a compact representation of the domain underlying the decision process: once the network portrays the natural history of the disease, the utility of investigations can be quantitatively evaluated. We developed a network for the diagnosis of PE, including 72 variables to represent both the risk factors and the pathophysiological consequences of the disease. Its structure has been specified by discussing which causal relationships explain the manifestations of the disease. The quantitative measures of associations were retrieved from the medical literature, through a critical review of available studies and agreement on the assumptions made to cope with the lack of published information. Six examples are presented to illustrate the appropriateness of 'entropy reduction' as a measure of the utility of investigation, once the set of examinations to be evaluated is bounded on the grounds of their cost and the patient's current risk. The network, which has been given the acronym 'BayPAD' (Bayesian network for Pulmonary embolism Assisted Diagnosis), appears to be able to detect which observations make others irrelevant, so that decisions can be tailored to single cases.