Modular organization of functional brain networks in patients with degenerative cervical myelopathy.

Previous studies have indicated that brain functional plasticity and reorganization in patients with degenerative cervical myelopathy (DCM). However, the effects of cervical cord compression on the functional integration and separation between and/or within modules remain unclear. This study aimed to address these questions using graph theory. Functional MRI was conducted on 46 DCM patients and 35 healthy controls (HCs). The intra- and inter-modular connectivity properties of the whole-brain functional network and nodal topological properties were then calculated using theoretical graph analysis. The difference in categorical variables between groups was compared using a chi-squared test, while that between continuous variables was evaluated using a two-sample t-test. Correlation analysis was conducted between modular connectivity properties and clinical parameters. Modules interaction analyses showed that the DCM group had significantly greater inter-module connections than the HCs group (DMN-FPN: t = 2.38, p = 0.02); inversely, the DCM group had significantly lower intra-module connections than the HCs group (SMN: t = - 2.13, p = 0.036). Compared to HCs, DCM patients exhibited higher nodal topological properties in the default-mode network and frontal-parietal network. In contrast, DCM patients exhibited lower nodal topological properties in the sensorimotor network. The Japanese Orthopedic Association (JOA) score was positively correlated with inter-module connections (r = 0.330, FDR p = 0.029) but not correlated with intra-module connections. This study reported alterations in modular connections and nodal centralities in DCM patients. Decreased nodal topological properties and intra-modular connection in the sensory-motor regions may indicate sensory-motor dysfunction. Additionally, increased nodal topological properties and inter-modular connection in the default mode network and frontal-parietal network may serve as a compensatory mechanism for sensory-motor dysfunction in DCM patients. This could provide an implicative neural basis to better understand alterations in brain networks and the patterns of changes in brain plasticity in DCM patients.

Mechanistic interactions as the origin of modularity in biological networks.

Biological networks are often modular. Explanations for this peculiarity either assume an adaptive advantage of a modular design such as higher robustness, or attribute it to neutral factors such as constraints underlying network assembly. Interestingly, most insights on the origin of modularity stem from models in which interactions are either determined by highly simplistic mechanisms, or have no mechanistic basis at all. Yet, empirical knowledge suggests that biological interactions are often mediated by complex structural or behavioural traits. Here, we investigate the origins of modularity using a model in which interactions are determined by potentially complex traits. Specifically, we model system elements-such as the species in an ecosystem-as finite-state machines (FSMs), and determine their interactions by means of communication between the corresponding FSMs. Using this model, we show that modularity probably emerges for free. We further find that the more modular an interaction network is, the less complex are the traits that mediate the interactions. Altogether, our results suggest that the conditions for modularity to evolve may be much broader than previously thought.

Congruence modules in higher codimension and zeta lines in Galois cohomology.

This article builds on recent work of the first three authors where a notion of congruence modules in higher codimension is introduced. The main results are a criterion for detecting regularity of local rings in terms of congruence modules, and a more refined version of a result tracking the change of congruence modules under deformation. Number theoretic applications include the construction of canonical lines in certain Galois cohomology groups arising from adjoint motives of Hilbert modular forms.

Anatomical total shoulder arthroplasty revision to reverse shoulder arthroplasty using convertible glenoid: a systematic review of clinical and radiological outcomes.

PURPOSE: The aim of the present systematic review is to collect all the available evidence regarding the clinical and radiological results of revision to reverse shoulder arthroplasty (RSA) of modular anatomic shoulder prostheses (TSA) using a convertible metal-backed glenoid (MBG). METHODS: This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Studies investigating revision of TSA to RSA utilizing a convertible MBG and reporting clinical and radiological outcomes were identified. RESULTS: A total of five studies on the use of convertible modular glenoid component in the setting of TSA revision to RSA were finally included in the present systematic review. A total of 60 procedures were reported. Mean operative times was 65 min. Intraoperative complications included 3 cases of glenoid loosening. Only one case of dislocation was reported as postoperative complication. At mean follow-up of 32.3 months post-revision, no glenoid loosening was reported, VAS score decreased from 7.7 to 1.5, Constant Score increased from 24.8 to 57.6. CONCLUSIONS: Revision to RSA after failed TSA using a convertible modular glenoid component was associated with a low rate of intraoperative and postoperative complications, low surgical time and led to good results in term of pain relieve and functional outcomes. Given the complexity and risk associated with revision of anatomic shoulder prosthesis having a convertible glenoid may help to simplify the procedure and improve clinical results.

Clinical and radiological outcomes and analysis of failures of modular revisions stems at long-term follow-up: a systematic review and meta-analysis.

Background: Increasingly hip replacements at young age exposes the patient to an increased risk of failure of the implant over the years. In case of failure, revision specific stems were designed to overcome bone loss. Modularity of these devices is an important resource for the surgeon as they allow the new implant to be better adapted to the patient's anatomy. The purpose of this systematic review is to provide data about the outcome at long-term follow-up (>8 years) of hip modular revision femoral stems. Methods: This systematic review and meta-analysis were conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement guidelines. PubMed and Google Scholar databases were systematically and independently searched, according to the inclusion and exclusion criteria. Two reviewers performed the data extraction independently. In case of disagreement, the senior authors were sought to resolve the divergences. Quality of the involved studies was evaluated with National Institute for Health and Care Excellence (NICE) guidelines (eight-item list) and the Newcastle-Ottawa scale (NOS). Primary and secondary outcomes were evaluated. The statistical analysis of this meta-analysis was performed by using Excel Microsoft and the software STATA. Results: The primary outcome was the re-revision rate of modular revision stems at long-term follow-up. It ranged from 1.4% to 45.6%: random effect pooled estimate was 5.5% [95% confidence interval (CI): 4% to 7%], with a I2 of 12.3% (P=0.332). Mean Harris Hip Score (HHS) was 83 [min: 79; max: 87.6; standard deviation (SD): 3.55]. Secondary evaluated outcomes were: subsidence >5 mm, rate of periprosthetic infection or fractures (intra- and post-operative) and dislocations. The mean value for the NICE tool was 5.5 (SD: 1.13) and 7.3 (SD: 0.79) for the NOS tool. The survival rate was >90% at long-term follow-up (min: 60%; max: 97%). Conclusions: The modular femoral revision stems have demonstrated good long-term reliability and efficacy. This meta-analysis demonstrates that the re-revision rate after 8 years of follow-up is low and 90% of the implants did not fail.

Functional Implications of the Prosomeric Brain Model.

Brain models present a viewpoint on the fundamental structural components of the brain and their mutual organization, generally relative to a particular concept of the brain axis. A model may be based on adult brain structure or on developmental morphogenetic aspects. Brain models usually have functional implications, depending on which functional properties derive from the postulated organization. This essay examines the present scenario about brain models, emphasizing the contrast between columnar or other longitudinal models and transverse subdivisional neuromeric models. In each case, the main functional implications and apparent problems are explored and commented. Particular attention is given to the modern molecularly based 'prosomeric model', which postulates a set of 20 transverse prosomeres as the developmental units that serve to construct all the cerebral parts and the particular typology of many different neuronal populations within the forebrain and the hindbrain, plus a number of additional spinal cord units. These metameric developmental units (serially repeated, but with unique molecular profiles) confer to this model remarkable functional properties based mainly on its multiplicity and modularity. Many important brain functions can be decomposed into subfunctions attended to by combined sets of neuronal elements derived from different neuromeres. Each neuromere may participate in multiple functions. Most aspects related to creation of precise order in neural connections (axonal navigation and synaptogenesis) and function is due to the influence of neuromeric anteroposterior and dorsoventral positional information. Research on neuromeric functionality aspects is increasing significantly in recent times.

Dorsal and Ventral Plumage Coloration Evolve as Distinct Modules with Different Environmental Correlations.

AbstractMany animals exhibit contrast between their dorsal coloration and their ventral coloration. If selection acts differently on dorsal versus ventral coloration, ancestral covariance between these traits should break down, eventually leading to independent modules of trait evolution. Here, we compare the evolution of feather color across body regions for a clade of Australasian songbirds (Meliphagoidea). We find evidence for three modules of covarying color regions. Among these modules, ventral feathers evolve with high lability, evolving at three times the rate of dorsal plumage and 20 times the rate of flight feathers. While both dorsal plumage and ventral plumage are darker in areas with more precipitation and vegetation, we find that dorsal plumage is twice as similar to colors in satellite photos of background substrates. Overall, differential selection on ventral and dorsal colors likely maintains these as distinct modules over evolutionary timescales-a novel explanation for dorsoventral contrast in pigmentation.

Revisiting the Modularity-Disease transmission Link: Uncovering the importance of intra-modular structure.

Studies have shown that the internal structure of modules is hardly important for the spread of epidemics. However, most of these studies have assumed that intra-module connectivity and inter-module connectivity do not affect each other. In reality, changes in the internal structure of modules may affect inter-module links and thus change the modularity of the entire network. Therefore, we have developed a theoretical network model with adjustable modularity to investigate the impact of this situation on disease transmission. Our findings indicate that the intra-module structure plays a crucial role in disease outbreaks. Changes in intra-module structure lead to significant numerical changes in peak prevalence and duration of disease. This implies that the potential impact of changes in exposure patterns within modules should also be considered when investigating the exact impact of modular social networks on disease burden.

Continuity of care for children with anorexia nervosa in the Netherlands: a modular perspective.

Care provision for children with anorexia nervosa is provided by outpatient care teams in hospitals, but the way these teams are organized differs per hospital and hampers the continuity of care. The aim of this study is to explore the organization and continuity of care for children with anorexia nervosa in the Netherlands by using a modular perspective.We conducted a qualitative, exploratory case study and took the healthcare provision for children with anorexia nervosa, provided by outpatient care teams, as our case. We conducted nine interviews with healthcare professionals involved in outpatient care teams from six hospitals. A thematic analysis was used to analyze the data.The modular perspective offered insights into the work practices and working methods of outpatient care teams. We were able to identify modules (i.e. the separate consultations with the various professionals), and components (i.e. elements of these consultations). In addition, communication mechanisms (interfaces) were identified to facilitate information flow and coordination among healthcare professionals. Our modular perspective revealed gaps and overlap in outpatient care provision, consequently providing opportunities to deal with unnecessary duplications and blind spots.   Conclusion: A modular perspective can be applied to explore the organization of outpatient care provision for children with anorexia nervosa. We specifically highlight gaps and overlap in healthcare provision, which in turn leads to recommendations on how to support the three essential parts of continuity of care: informational continuity, relational continuity, and management continuity. What is Known: • Care provision for children with anorexia nervosa requires a network of health care professionals from different organizations, as a result the organization and provision of care faces challenges. What is New: • Modular care provision sheds light on the complexity and organization of outpatient care provision and supports the three dimensions of continuity of care as experienced by children with anorexia nervosa and their parents/caregivers.

Electroconvulsive therapy regulates brain connectome dynamics in patients with major depressive disorder.

BACKGROUND: Electroconvulsive therapy (ECT) is an effective treatment for patients with major depressive disorder (MDD), but its underlying neural mechanisms remain largely unknown. The aim of this study was to identify changes in brain connectome dynamics after ECT in MDD and to explore their associations with treatment outcome. METHODS: We collected longitudinal resting-state fMRI data from 80 MDD patients (50 with suicidal ideation and 30 without; SI and NSI, respectively) before and after ECT and 37 age- and sex-matched healthy controls. A multilayer network model was used to assess modular switching over time in functional connectomes. Support vector regression was used to assess whether pre-ECT network dynamics could predict treatment response in terms of symptom severity. RESULTS: At baseline, MDD patients had lower global modularity and higher modular variability in functional connectomes compared to controls. Network modularity increased and network variability decreased after ECT in MDD patients, predominantly located in the default mode and somatomotor networks. Moreover, ECT was associated with decreased modular variability in the left dorsal anterior cingulate cortex of MDD-SI, but not MDD-NSI patients, and pre-ECT modular variability could significantly predict symptom improvement in the MDD-SI group, but not in the MDD-NSI group. CONCLUSIONS: We highlight ECT-induced changes in MDD brain network dynamics and their predictive value for treatment outcome, particularly in patients with suicidal ideation. This study advances our understanding of the neural mechanisms of ECT from a dynamic brain network perspective and suggests potential prognostic biomarkers for predicting ECT efficacy in patients with MDD.

Untangling biodiversity interactions: A meta network on pollination in Earth's most diverse tropical savanna.

Pollination is vital for ecosystem functioning, especially in biodiversity-rich regions like the Brazilian Cerrado. Our research establishes a comprehensive meta network of pollinator-plant interactions within this biome. We quantified the importance of different pollinator groups, identifying keystone species. We examined potential biases in sampling effort and the spatial behavior of interactions within the heterogeneous Cerrado plant physiognomies. Our investigation uncovered 1499 interactions among 293 plant species and 386 visitor species, with legitimate pollination accounting for 42.4% of the interactions. The network exhibited modularity, driven by bees and insects, with vertebrates bridging diurnal and nocturnal modules. While a generalized pattern emerged, high specialization existed within modules due to habitat diversity. Bees, particularly Apis mellifera (exotic) and Trigona spinipes (native), played central roles as network hubs. Hummingbirds and bats, engaged in specialized interactions showing strong connectivity within and between modules. Interestingly, invertebrate-vertebrate modules were more prevalent than expected in the meta network. However, a bias was evident, primarily within specific biogeographical districts with fragmented landscapes and intrusion from other biomes. Variations in plant species and endemism rates influenced pollinator occurrence and the Cerrado network topology. Our study offers valuable insights into pollinator-plant interactions within the Cerrado, encompassing both invertebrates and vertebrates. The modeled network represents a significant step in understanding the structural complexity of pollination networks, integrating partial networks from diverse pollination systems within heterogeneous habitats. Nevertheless, a biogeographical bias could limit a comprehensive understanding of network functionality across the Cerrado.

Linking shape conspicuous asymmetry with shape covariation patterns and performance in the insect head and mandibles.

Bilateral symmetry is widespread across animals, yet, among bilaterians, many cases of conspicuous asymmetries evolved. This means that bilaterally homologous structures on the left and right side display divergent phenotypes. Evolution of such divergent phenotypes between otherwise similarly shaped structures can be thought to be favoured by modularity, but this has rarely been studied in the context of left-right differences. Here, we provide an empirical example, using geometric morphometrics, to assess patterns of asymmetry and covariation between landmark partitions in a grasshopper with conspicuously asymmetric mandibles. Our morphometric data confirms the presence of strictly directional conspicuous asymmetry in the mandibles, and surrounding structures. Covariance patterns and tests hint at a strong integration between mandibles despite their divergent morphologies, and variational modularity with the head capsule. While mandibles have been selected to achieve a key-and-lock morphology by having interlocking shapes, the developmental modularity required to achieve this seems to be overwritten by developmental and/or functional integration, allowing the precise matching required for feeding. The consequent conflicting covariation patterns are reminiscent of the palimpsest model. Finally, the degree of directional asymmetry appears to be under selection, although we find no relationship between bite force and mandible shape or asymmetry.

Triply Selective & Sequential Diversification at Csp 3: Expansion of Alkyl Germane Reactivity for C-C & C-Heteroatom Bond Formation.

We report the triply selective and sequential diversification of a single Csp 3 carbon carrying Cl, Bpin and GeEt3 for the modular and programmable construction of sp3-rich molecules. Various functionalizations of Csp 3-Cl and Csp 3-BPin (e.g. alkylation, arylation, homologation, amination, hydroxylation) were tolerated by the Csp 3-GeEt3 group. Moreover, the methodological repertoire of alkyl germane functionalization was significantly expanded beyond the hitherto known Giese addition and arylation to alkynylation, alkenylation, cyanation, halogenation, azidation, C-S bond formation as well as the first demonstration of stereo-selective functionalization of a Csp 3-[Ge] bond.

A network model of legal relations.

From at least the early twentieth century, legal scholars have recognized that rights and other legal relations inhere between individual legal actors, forming a vast and complex social network. Yet, no legal scholar has used the mathematical machinery of network theory to formalize these relationships. Here, we propose the first such approach by modelling a rudimentary, static set of real property relations using network theory. Then, we apply our toy model to measure the level of modularity-essentially, the community structure-among aggregations of these real property relations and associated actors. In so doing, we show that even for a very basic set of relations and actors, law may employ modular structures to manage complexity. Property, torts, contracts, intellectual property, and other areas of the law arguably reduce information costs in similar, quantifiable ways by chopping up the world of interactions between parties into manageable modules that are semi-autonomous. We also posit that our network science approach to jurisprudential issues can be adapted to quantify many other important aspects of legal systems. This article is part of the theme issue 'A complexity science approach to law and governance'.

Community detection with Greedy Modularity disassembly strategy.

Community detection recognizes groups of densely connected nodes across networks, one of the fundamental procedures in network analysis. This research boosts the standard but locally optimized Greedy Modularity algorithm for community detection. We introduce innovative exploration techniques that include a variety of node and community disassembly strategies. These strategies include methods like non-triad creating, feeble, random as well as inadequate embeddedness for nodes, as well as low internal edge density, low triad participation ratio, weak, low conductance as well as random tactics for communities. We present a methodology that showcases the improvement in modularity across the wide variety of real-world and synthetic networks over the standard approaches. A detailed comparison against other well-known community detection algorithms further illustrates the better performance of our improved method. This study not only optimizes the process of community detection but also broadens the scope for a more nuanced and effective network analysis that may pave the way for more insights as to the dynamism and structures of its functioning by effectively addressing and overcoming the limitations that are inherently attached with the existing community detection algorithms.

Measures of resting-state brain network segregation and integration vary in relation to data quantity: implications for within and between subject comparisons of functional brain network organization.

Measures of functional brain network segregation and integration vary with an individual's age, cognitive ability, and health status. Based on these relationships, these measures are frequently examined to study and quantify large-scale patterns of network organization in both basic and applied research settings. However, there is limited information on the stability and reliability of the network measures as applied to functional time-series; these measurement properties are critical to understand if the measures are to be used for individualized characterization of brain networks. We examine measurement reliability using several human datasets (Midnight Scan Club and Human Connectome Project [both Young Adult and Aging]). These datasets include participants with multiple scanning sessions, and collectively include individuals spanning a broad age range of the adult lifespan. The measurement and reliability of measures of resting-state network segregation and integration vary in relation to data quantity for a given participant's scan session; notably, both properties asymptote when estimated using adequate amounts of clean data. We demonstrate how this source of variability can systematically bias interpretation of differences and changes in brain network organization if appropriate safeguards are not included. These observations have important implications for cross-sectional, longitudinal, and interventional comparisons of functional brain network organization.

Re-oligotrophication and warming stabilize phytoplankton networks.

Phytoplankton taxa are strongly interconnected as a network, which could show temporal dynamics and non-linear responses to changes in drivers at both seasonal and long-term scale. Using a high quality dataset of 20 Danish lakes (1989-2008), we applied extended Local Similarity Analysis to construct temporal network of phytoplankton communities for each lake, obtained sub-network for each sampling month, and then measured indices of network complexity and stability for each sub-network. We assessed how lake re-oligotrophication, climate warming and grazers influenced the temporal dynamics on network complexity and stability of phytoplankton community covering three aspects: seasonal trends, long-term trends and detrended variability. We found strong seasonality for the complexity and stability of phytoplankton network, an increasing trend for the average degree, modularity, nestedness, persistence and robustness, and a decreasing trend for connectance, negative:positive interactions and vulnerability. Our study revealed a cascading effect of lake re-oligotrophication, climate warming and zooplankton grazers on phytoplankton network stability through changes in network complexity characterizing diversity, interactions and topography. Network stability of phytoplankton increased with average degree, modularity, nestedness and decreased with connectance and negative:positive interactions. Oligotrophication and warming stabilized the phytoplankton network (enhanced robustness, persistence and decreased vulnerability) by enhancing its average degree, modularity, nestedness and by reducing its connectance, while zooplankton richness promoted stability of phytoplankton network through increases in average degree and decreases in negative interactions. Our results further indicate that the stabilization effects might lead to more closed, compartmentalized and nested interconnections especially in the deeper lakes, in the warmer seasons and during bloom periods. From a temporal dynamic network view, our findings highlight stabilization of the phytoplankton community as an adaptive response to lake re-oligotrophication, climate warming and grazers.

The dimensionality of infection networks among viruses infecting microbial eukaryotes and bacteria.

Diverse viruses and their hosts are interconnected through complex networks of infection, which are thought to influence ecological and evolutionary processes, but the principles underlying infection network structure are not well understood. Here we focus on network dimensionality and how it varies across 37 networks of viruses infecting eukaryotic phytoplankton and bacteria. We find that dimensionality is often strikingly low, with most networks being one- or two-dimensional, although dimensionality increases with network richness, suggesting that the true dimensionality of natural systems is higher. Low-dimensional networks generally exhibit a mixture of host partitioning among viruses and nestededness of host ranges. Networks of bacteria-infecting and eukaryote-infecting viruses possess comparable distributions of dimensionality and prevalence of nestedness, indicating that fundamentals of network structure are similar among domains of life and different viral lineages. The relative simplicity of many infection networks suggests that coevolutionary dynamics are often driven by a modest number of underlying mechanisms.

Modular Control of Biological Networks.

The concept of control is central to understanding and applications of biological network models. Some of their key structural features relate to control functions, through gene regulation, signaling, or metabolic mechanisms, and computational models need to encode these. Applications of models often focus on model-based control, such as in biomedicine or metabolic engineering. This paper presents an approach to model-based control that exploits two common features of biological networks, namely their modular structure and canalizing features of their regulatory mechanisms. The paper focuses on intracellular regulatory networks, represented by Boolean network models. A main result of this paper is that control strategies can be identified by focusing on one module at a time. This paper also presents a criterion based on canalizing features of the regulatory rules to identify modules that do not contribute to network control and can be excluded. For even moderately sized networks, finding global control inputs is computationally very challenging. The modular approach presented here leads to a highly efficient approach to solving this problem. This approach is applied to a published Boolean network model of blood cancer large granular lymphocyte (T-LGL) leukemia to identify a minimal control set that achieves a desired control objective.

Evolución de los niveles séricos de cromo y cobalto tras el empleo de un vástago con cuello modular en la artroplastia total de cadera primaria / Evolution of chromium and cobalt serum levels after the use of a modular neck stem in primary total hip arthroplasty

Introducción y objetivos: Los vástagos primarios con cuellos modulares fueron introducidos con la ventaja teórica de restaurar la anatomía de la cadera de forma más precisa. Sin embargo, la presencia de un segundo encaje se ha asociado a una mayor corrosión y liberación de detritos metálicos. El objetivo de nuestro estudio es cuantificar los valores séricos de cromo y de cobalto, y analizar su evolución temporal durante cinco años. Material y métodos: Se presenta una serie prospectiva de 61 pacientes intervenidos de artroplastia total de cadera primaria mediante la implantación del vástago HMAX-M® (Limacorporate, San Daniele, Italia) en los que se realizó una determinación sérica de cromo y cobalto a los seis meses, a los dos años y a los cinco años. Resultados: Nuestra serie presenta una elevación progresiva de los niveles de cromo, con una diferencia significativa entre los valores de cromo a los seis meses (0,35±0,18) y los cinco años (0,52±0,36), p=0,01. Respecto al cobalto, se observa una elevación estadísticamente significativa entre los seis meses y los dos años y una posterior estabilización hasta los cinco años, siendo la media de cobalto a los seis meses (1,17±0,8) significativamente menor que a los dos años (2,63±1,76) y a los cinco años (2,84±2,1), p=0,001. Conclusión: Se ha observado una elevación de los niveles séricos de cobalto en aquellos pacientes a los que se les implantó un vástago con cuello modular. Los resultados obtenidos en este estudio han limitado el uso de vástagos con cuello modular en nuestra práctica habitual.(AU)

Introduction and objectives: Modular neck primary stems were introduced with the theoretical advantage of restoring the hip anatomy more precisely. However, the presence of a second junction has been associated with increased corrosion and release of metal debris. The objective of our study is to quantify of chromium and cobalt serum values, and to analyze their temporal evolution during five years. Material and methods: We present a prospective series of 61 patients who underwent primary total hip arthroplasty by implantation of the HMAX-M® stem (Limacorporate, San Daniele, Italy). Serum chromium and cobalt determinations were performed at six months, two years and five years. Results: Our series shows a progressive elevation in chromium levels with a significant difference between chromium values at six months (0.35±0.18) and five years (0.52±0.36), P=.01. Regarding cobalt, a statistically significant elevation is observed between six months and two years and a subsequent stabilization of values between two and five years, with a cobalt mean at six months (1.17±0.8) significantly lower than at two (2.63±1.76) and five years (2.84±2.1), P=.001. Conclusion: Elevated serum cobalt levels have been observed in patients who underwent modular neck stem implantation. The results obtained in this study have limited the use of stems with a modular neck in our clinical practice.(AU)