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1.
Artigo em Inglês | MEDLINE | ID: mdl-32748043

RESUMO

INTRODUCTION: Tibial component design and positioning contribute more to patient satisfaction than previously realized. A surgeon needs to decide on the size and rotation, bearing in mind that coverage should be as high as possible, whilst malrotation and overhang should be avoided. No study investigates the impact of each of these components on clinical outcomes in a single cohort. MATERIALS AND METHODS: This is a retrospective analysis of 1-year postoperative outcomes measured with the Knee Injury and Osteoarthritis Outcome (KOOS) Score, as well as a previously validated rotational CT protocol. Coverage, rotation from Insall's axis, and overhang of an asymmetric tibial baseplate were measured, and positive and negative correlations to clinical outcomes were calculated. RESULTS: A total of 499 knees were analyzed. Patient average age was 68.4 years. Rotation within 7° internal and 5° external from Insall's axis was a "safe zone". Mean coverage was 76%. A total of 429 knees (94%) had a coverage of at least 70% and 102 knees (22%) greater than 80%. Overhang was detected in 23% of the cohort. Increased coverage was correlated to increased KOOS score and overhang correlated with a decreased KOOS score (p = 0.008). CONCLUSIONS: This study demonstrates the individual role of three aspects of tibial component implantation properties in postoperative pain and short-term functional outcomes. Upsizing to the point of overhang with rotational tolerance of 7° internal and 3° external to Insall's axis demonstrates best patient reported outcomes. Overhang decreases the clinical outcome by the same margin as loss of 16% of coverage.

2.
Acc Chem Res ; 2020 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-32667187

RESUMO

ConspectusComplexes of lanthanide(III) ions are being actively studied because of their unique ground and excited state properties and the associated optical and magnetic behavior. In particular, they are used as emissive probes in optical spectroscopy and microscopy and as contrast agents in magnetic resonance imaging (MRI). However, the design of new complexes with specific optical and magnetic properties requires a thorough understanding of the correlation between molecular structure and electric and magnetic susceptibilities, as well as their anisotropies. The traditional Judd-Ofelt-Mason theory has failed to offer useful guidelines for systematic design of emissive lanthanide optical probes. Similarly, Bleaney's theory of magnetic anisotropy and its modifications fail to provide accurate detail that permits new paramagnetic shift reagents to be designed rather than discovered.A key determinant of optical and magnetic behavior in f-element compounds is the ligand field, often considered as an electrostatic field at the lanthanide created by the ligands. The resulting energy level splitting is a sensitive function of several factors: the nature and polarizability of the whole ligand and its donor atoms; the geometric details of the coordination polyhedron; the presence and extent of solvent interactions; specific hydrogen bonding effects on donor atoms and the degree of supramolecular order in the system. The relative importance of these factors can vary widely for different lanthanide ions and ligands. For nuclear magnetic properties, it is both the ligand field splitting and the magnetic susceptibility tensor, notably its anisotropy, that determine paramagnetic shifts and nuclear relaxation enhancement.We review the factors that control the ligand field in lanthanide complexes and link these to aspects of their utility in magnetic resonance and optical emission spectroscopy and imaging. We examine recent progress in this area particularly in the theory of paramagnetic chemical shift and relaxation enhancement, where some long-neglected effects of zero-field splitting, magnetic susceptibility anisotropy, and spatial distribution of lanthanide tags have been accommodated in an elegant way.

3.
Science ; 369(6501): 307-309, 2020 07 17.
Artigo em Inglês | MEDLINE | ID: mdl-32675372

RESUMO

Knowledge of rotational energy transfer (RET) involving carbon monoxide (CO) molecules is crucial for the interpretation of astrophysical data. As of now, our nearly perfect understanding of atom-molecule scattering shows that RET usually occurs by only a simple "bump" between partners. To advance molecular dynamics to the next step in complexity, we studied molecule-molecule scattering in great detail for collision between two CO molecules. Using advanced imaging methods and quasi-classical and fully quantum theory, we found that a synchronous movement can occur during CO-CO collisions, whereby a bump is followed by a move similar to a "do-si-do" in square dancing. This resulted in little angular deflection but high RET to both partners, a very unusual combination. The associated conditions suggest that this process can occur in other molecule-molecule systems.

4.
J Occup Environ Med ; 62(7): 519-525, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32730028

RESUMO

OBJECTIVES: Career technical education (CTE) programs prepare new generations of technicians in a variety of trades. Even though occupational safety and health (OSH) ought to be included as an essential part of CTE curricula it is frequently absent or inadequately taught. METHODS: OSH knowledge and beliefs were assessed in a national sample of 125 secondary and post-secondary faculty in autobody collision repair technology. RESULTS: Over 50% of faculty thought at least 75% of OSH knowledge was learned at school, and 9% felt that safety was primarily learned on the job. Knowledge scores ranged from 22% to 78%. Overall knowledge scores were significantly lower high school than post-secondary instructors (42% vs 50%, P ≤ 0.001) and in two categories: hazard recognition (44% vs 54%, P ≤ 0.05) and hazard control and shop equipment (30% vs 37%, P ≤ 0.05). CONCLUSIONS: There are substantial gaps in OSH knowledge among secondary and post-secondary CTE instructors. CTE programs should address these gaps by providing trade-specific safety and health education to their instructors upon hiring.

5.
Nat Chem Biol ; 2020 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-32719558

RESUMO

The direct C-H carboxylation of aromatic compounds is an attractive route to the corresponding carboxylic acids, but remains challenging under mild conditions. It has been proposed that the first step in anaerobic microbial degradation of recalcitrant aromatic compounds is a UbiD-mediated carboxylation. In this study, we use the UbiD enzyme ferulic acid decarboxylase (Fdc) in combination with a carboxylic acid reductase to create aromatic degradation-inspired cascade reactions, leading to efficient functionalization of styrene through CO2 fixation. We reveal that rational structure-guided laboratory evolution can expand the substrate scope of Fdc, resulting in activity on a range of mono- and bicyclic aromatic compounds through a single mutation. Selected variants demonstrated 150-fold improvement in the conversion of coumarillic acid to benzofuran + CO2 and unlocked reactivity towards naphthoic acid. Our data demonstrate that UbiD-mediated C-H activation is a versatile tool for the transformation of aryl/alkene compounds and CO2 into commodity chemicals.

6.
Surg Obes Relat Dis ; 2020 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-32580922

RESUMO

BACKGROUND: Male sex has long been identified as a risk factor for adverse outcomes, including mortality, after Roux-en-Y gastric bypass (RYGB). OBJECTIVES: The objective of this study was to compare short-term outcomes of patients undergoing laparoscopic RYGB based on biologic sex. SETTING: Geisinger Medical Center, Danville, PA. METHODS: Patients undergoing RYGB in the 2015, 2016, and 2017 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database were propensity matched 1:1 to compare 30-day outcomes between male and female sex. RESULTS: A total 47,906 patients were included (23,953 men/23,953 women). The overall complication rate was higher in female patients (11.5% versus 10.2%; P < .001) with no difference in mortality related to RYGB at 30 days. No significant differences were seen between sexes for organ space surgical site infection or septic shock. Women had significantly more superficial surgical site infections (P = .002), urinary tract infections (P < .001), readmissions (P < .001), and reinterventions (P < .001). Men had significantly more episodes of unplanned intubation (P = .008), extended ventilator use (P = .01), progressive renal insufficiency (P = .01), acute renal failure (P = .008), cardiac arrest (P = .005), intensive care unit admission (P < .001), all-cause 30-day mortality (P = .038), and inpatient mortality rate (P < .001). CONCLUSIONS: Male sex has been identified as a risk factor for adverse events and mortality after RYGB in several risk models. This study demonstrates an overall increased risk of both all-cause mortality and inpatient mortality. The study, however, did not demonstrate a difference in bariatric-related mortality. The prevalence of both major and minor complications was mixed between sexes, while women had a higher overall complication rate after RYGB. The abundance of data available within the MBSAQIP Participant Use Data File facilitates the creation of tools like risk models for bariatric surgery, such as the MBSAQIP Risk calculator.

7.
J Biomech Eng ; 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32529203

RESUMO

Computational modeling of cardiovascular flows is becoming increasingly important in a range of biomedical applications, and understanding the fundamentals of computational modeling is important for engineering students. In addition to their purpose as research tools, integrated image-based computational fluid dynamics platforms can be used to teach the fundamental principles involved in computational modeling and generate interest in studying cardiovascular disease. We report the results of a study performed at five institutions designed to investigate the effectiveness of an integrated modeling platform as an instructional tool and describe "best practices" for using an integrated modeling platform in the classroom. Use of an integrated modeling platform as an instructional tool in nontraditional educational settings (workshops, study abroad programs, in outreach) is also discussed. Results of the study show statistically significant improvements in understanding after using the integrated modeling platform, suggesting such platforms can be effective tools for teaching fundamental cardiovascular computational modeling principles.

8.
Obes Surg ; 2020 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-32495073

RESUMO

BACKGROUND: The objective of this study was to examine the MBSAQIP database to assess efficiency trends and perioperative outcomes in robotic bariatric surgery. METHODS: Robotic (RA) and laparoscopic (L) sleeve gastrectomy (SG) and gastric bypass (RYGB) were compared using the 2015-2018 MBSAQIP Participant Use Data Files. Patients were propensity matched 1:1 based on sex, body mass index, assistant, and previous obesity or foregut surgery. A total of 93,802 patients were included. RESULTS: Median operative times were significantly longer for both RA-SG (89 vs. 62 min; p < 0.0001) and RA-RYGB (141 vs. 105 min; p < 0.0001) compared with laparoscopic. Over the 4-year period, the difference in operative times (OR delta) between RA-SG and L-SG was unchanged while the difference in operative times between RA-RYGB and L-RYGB increased. Both robotic groups were significantly more likely to be readmitted (RA-SG p = 0.001, RA-RYGB p = 0.006). Robotic SG was more likely to have a reintervention (p = 0.018) and extended length of stay (LOS) (> 4 days) compared with laparoscopic (p = < 0.0002). No significant differences were noted in morbidity and mortality by approach. CONCLUSIONS: Operative times were 30% longer for RA-SG and 25% longer for RA-RYGB when compared with laparoscopic. There was no significant improvement in OR delta for either RA-SG or RA-RYGB over the four years. Readmission rates were higher for both RA-SG and RA-RYGB. Robotic SG had a greater percentage of patients with extended LOS compared with laparoscopic. No evidence of improved efficiency for robotic bariatric surgery as defined by operative time or clinical outcomes was identified.

9.
Clin Biomech (Bristol, Avon) ; 77: 105065, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32504897

RESUMO

BACKGROUND: Newer repair techniques of anterior cruciate ligament tears, including augmentation with internal brace, have shown promising clinical results. Few biomechanical studies exist comparing anterior cruciate ligament repair only versus repair with internal brace. The purpose of this study was to compare the load to failure and stiffness of anterior cruciate ligament repair with internal brace augmentation versus repair-only. METHODS: Proximal femoral avulsion type anterior cruciate ligament injuries were created in 20 cadaver knees. Anterior cruciate ligament repair-only or repair with internal brace was performed using arthroscopic tools. Load to failure and failure modes were collected, with calculations of stiffness and energy to failure performed. FINDINGS: The average load to failure for the internal brace group was higher than the repair-only group: 693 N (SD 248) versus 279 N (SD 91), P = .002. The stiffness and energy to failure values were higher for the internal brace group than the repair-only group: 83 N/mm versus 58 N/mm, P = .02 and 16.88 J (SD 12.44) versus 6.91 J (SD 2.49), P = .04, respectively. Failure modes differed between groups (P = .00097) with 80% failure in the repair-only due to suture pull through the anterior cruciate ligament and 90% failure in the internal brace group due to suture button pull through the femur. INTERPRETATION: There was higher load to failure, stiffness, and energy to failure for the internal brace group compared to the repair-only group, and a high positive correlation between bone density and load to failure for the internal brace group. CLINICAL SIGNIFICANCE: Anterior cruciate ligament repair with internal brace augmentation demonstrates significantly higher load to failure. It may be a useful adjunct to protect the anterior cruciate ligament repair from failure during the early stages of healing.

10.
J Knee Surg ; 2020 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-32450604

RESUMO

Despite multiple studies, there remains a debate on the safety of bilateral total knee arthroplasty (BTKA) in the average age patient, with a paucity of data on the outcome of BTKA in an elderly population. This study included 89 patients aged 80 years and older undergoing sequential BTKA over 14 years were identified in a prospectively collected database. Two matched comparison groups were created: patients under 80 undergoing sequential BTKA and patients over 80 undergoing unilateral TKA (UTKA). An analysis of complications, mortality, revision, and patient-reported outcome measures was performed. Mean age of the elderly cohorts was similar: 82.6 for BTKA and 82.9 for UTKA. The average age BTKA cohort had a mean age of 69.1. Complication rates were higher in bilateral cohorts, more so in the elderly BTKA cohort. Pulmonary embolism (PE) was observed in bilateral cohorts only. In these patients, history of PE and ischemic heart disease was a strong predictive factor for developing a major complication. There was no difference in revision rates and infection rates between the three cohorts, and no difference in patient survivorship between the two elderly cohorts. Through the combination of low revision and high survivorship rates and comparable clinical outcomes, this article demonstrates that simultaneous BTKA is an appropriate option to consider for an elderly patient, with proper patient selection and perioperative management. The demonstrated risk groups show that emphasis on patient selection should be focused on medical history rather than chronological age.

11.
J Occup Environ Med ; 2020 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-32358473

RESUMO

OBJECTIVES: Career technical education (CTE) programs prepare new generations of technicians in a variety of trades. Even though occupational safety and health (OSH) ought to be included as an essential part of CTE curricula. METHODS: OSH knowledge and beliefs were assessed in a national sample of 125 secondary and post-secondary faculty in autobody collision repair technology. RESULTS: Over 50% of faculty thought at least 75% of OSH knowledge was learned at school, and 9% felt that safety was primarily learned on the job. Knowledge scores ranged from 22% to 78%. Overall knowledge scores were significantly lower high school than post-secondary instructors (42% vs 50%, p ≤ 0.001) and in two categories: hazard recognition (44% vs 54%, p ≤ 0.05) and hazard control and shop equipment (30% vs 37%, p ≤ 0.05).. CONCLUSIONS: There are substantial gaps in OSH knowledge among secondary and post-secondary CTE instructors. CTE programs should address these gaps by providing trade-specific safety and health education to their instructors upon hiring.

12.
Nat Commun ; 11(1): 1676, 2020 04 03.
Artigo em Inglês | MEDLINE | ID: mdl-32245991

RESUMO

Circular polarisation luminescence (CPL) emission spectroscopy is a powerful tool for probing the fundamental chiroptical features of optically emissive chiral molecular systems. However, uptake of CPL spectroscopy has been impeded by the limitations of conventional scanning monochromator (SM) CPL spectrometers, which are costly to acquire and maintain, and typically require tens of minutes to acquire a typical CPL spectrum. Here, we demonstrate a design of CPL spectrometer which uses rapid readout solid state (SS) spectrometer detectors and a dual channel optical layout to acquire CPL spectra in as little as 10 milliseconds. We validate and demonstrate equivalent CPL measurement by measuring CPL spectra of two reference europium(III) complexes. Further, we demonstrate time-gated CPL acquisition, enabling long-lived CPL luminescence to be distinguished from short-lived emission of other fluorescent species. We anticipate that SS-CPL spectrometers will enable flexible, rapid, and relatively low-cost CPL spectroscopy for diverse applications.

13.
Artigo em Inglês | MEDLINE | ID: mdl-32240345

RESUMO

PURPOSE: Laximeters were designed to diagnose an anterior cruciate ligament (ACL) deficient knee, but their use has now focused on providing an objective assessment of the anterior translation (AT) of an intact and ACL-reconstructed knee. In this study we report the introduction and direct comparison of an automated and computerized AT measurement device, GNRB, with the device previously established by the institute and as the current literature standard, the KT1000. METHODS: A prospective data collection was commenced upon introduction of the GNRB. The measurements of AT in each patient were performed by the same investigator with each device using 134 N applied to both knees, giving a side-to-side difference. The investigators were a sport scientist, a biomechanical engineer and a physiotherapist. Increased AT was defined as a difference > 3 mm. RESULTS: Three investigators performed the measurements in 122 patients, 9.8 (± 1.8) months after ACL reconstruction. Mean AT of the healthy knee was 5.7 mm with KT1000 and 4.4 mm with GNRB (p = 0.002). Mean AT of the ACL reconstructed knee was 7.0 mm with the KT1000 and 5.3 mm with the GNRB (p = 0.037). The KT1000 had a higher variance of results than the GNRB (p < 0.001). There were 25 patients with increased AT measured by KT1000 compared with 12 patients using the GNRB (p < 0.016), with only 5 on both devices. CONCLUSIONS: GNRB has better consistency of results when compared to the KT1000. Both devices lack comparability for detecting increased AT, with the KT1000 recording a side-to-side difference of more than 3 mm in twice as many patients as the GNRB. LEVEL OF EVIDENCE: II.

14.
Knee Surg Sports Traumatol Arthrosc ; 28(7): 2105-2115, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32157364

RESUMO

PURPOSE: The aim of this study was to determine if a difference exists in the relationship between the femoral intercondylar notch volume, and the volumes of anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) in ACL injured patients and healthy subjects. METHODS: Intact knees of 19 healthy subjects and bilateral knees of 18 ipsilateral ACL reconstructed patients were scanned using 3-tesla high-resolution magnetic resonance imaging. The intercondylar notch, ACL, PCL and hamstring graft were segmented using three-dimensional (3D) processing software. The native intercondylar notch, ACL, and PCL volumes were compared between both groups. The volumes of native ACL and graft were compared in ACL injured patients. RESULTS: The following volumes showed no significant differences between the ACL injured group and control group; intercondylar notch (9.9 ± 2.3 vs 9.6 ± 1.7 cm3), ACL (2.4 ± 0.7 vs 2.4 ± 0.6 cm3) and PCL (3.9 ± 1.0 vs 3.4 ± 0.8 cm3), and the ratio of the ACL to the intercondylar notch (24.6 ± 5.0 vs 25.4 ± 2.9%). There was a significant difference in the ratio of PCL to the intercondylar notch (39.1 ± 4.3 vs 35.9 ± 4.9%, p = 0.023). The graft was significantly larger than native ACL volume (3.0 ± 0.7 vs 2.4 ± 0.7 cm3, p = 0.012). CONCLUSIONS: The ratio of the PCL volume in the femoral intercondylar notch was higher in the ACL injured group compared to the healthy control group, despite the ratio of ACL volume in the femoral intercondylar notch being similar in both groups. A greater awareness of the potentially limited space for the graft alongside the PCL within the femoral intercondylar notch may allow surgeons a more informed choice of graft type and size. LEVEL OF EVIDENCE: IV.

15.
J Phys Condens Matter ; 32(29): 295602, 2020 Mar 10.
Artigo em Inglês | MEDLINE | ID: mdl-32155601

RESUMO

It is noteworthy that chemical substitution of BaFe2As2 (122) with the noble elements Cu and Au gives superconductivity with a maximum T c ≈ 3 K, while Ag substitution (Ag-122) stays antiferromagnetic. For Ba(Fe1-x TM x )2As2, TM = Cu, Au, or Ag, and by doping an amount of x = 0.04, a-lattice parameter slightly increases (0.4%) for all TM dopants, while c-lattice decreases (-0.2%) for TM = Cu, barely moves (0.05%) for Au, and increases (0.2%) for Ag. Despite the naive expectation that the noble elements of group 11 should affect the quantum properties of 122 similarly, they produce significant differences extending to the character of the ground state. For the Ag-122 crystal, evidence of only a filamentary superconductivity is noted with pressure. However, for Au and Cu doping (x ≈ 0.03) we find a substantial improvement in the superconductivity, with T c increasing to 7 K and 7.5 K, respectively, under 20 kbar of pressure. As with the ambient pressure results, the identity of the dopant therefore has a substantial impact on the ground state properties. Density functional theory calculations corroborate these results and find evidence of strong electronic scattering for Au and Ag dopants, while Cu is comparatively less disruptive to the 122 electronic structure.

16.
PLoS One ; 15(2): e0228167, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32040518

RESUMO

A key challenge in the field of cognitive neuroscience is to identify discriminable cognitive functions, and then map these functions to brain activity. In the current study, we set out to explore the relationships between performance arising from different cognitive tasks thought to tap different domains of cognition, and then to test whether these distinct latent cognitive abilities also are subserved by corresponding "latent" brain substrates. To this end, we tested a large sample of adults under the age of 40 on twelve cognitive tasks as they underwent fMRI scanning. Exploratory factor analysis revealed 4-factor model, dissociating tasks into processes corresponding to episodic memory retrieval, reasoning, speed of processing and vocabulary. An analysis of the topographic covariance patterns of the BOLD-response acquired during each task similarity also converged on four neural networks that corresponded to the 4 latent factors. These results suggest that distinct ontologies of cognition are subserved by corresponding distinct neural networks.


Assuntos
Ontologias Biológicas , Encéfalo/fisiologia , Cognição , Modelos Neurológicos , Adulto , Comportamento/fisiologia , Feminino , Humanos , Análise de Classes Latentes , Masculino , Adulto Jovem
17.
Arthroscopy ; 36(2): 501-512, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31901384

RESUMO

PURPOSE: The purpose of this study was to perform an evidence-based, expert consensus survey using the Delphi panel methodology to develop recommendations for the treatment of degenerative meniscus tears. METHODS: Twenty panel members were asked to respond to 10 open-ended questions in rounds 1 and 2. The results of the first 2 rounds served to develop a Likert-style questionnaire for round 3. In round 4, the panel members outside consensus were contacted and asked to either change their score in view of the group's response or argue their case. The level of agreement for round 4 was defined as 80%. RESULTS: There was 100% agreement on the following items: insidious onset, physiological part of aging, tears often multiplanar, not all tears cause symptoms, outcomes depend on degree of osteoarthritis, obesity is a predictor of poor outcome, and younger patients (<50 years) have better outcomes. There was between 90% and 100% agreement on the following items: tears are nontraumatic, radiographs should be weightbearing, initial treatment should be conservative, platelet-rich plasma is not a good option, repairable and peripheral tears should be repaired, microfracture is not a good option for chondral defects, the majority of patients obtain significant improvement and decrease in pain with surgery but results are variable, short-term symptoms have better outcomes, and malalignment and root tears have poor outcomes. CONCLUSIONS: This consensus statement agreed that degenerative meniscus tears are a normal part of aging. Not all tears cause symptoms and, when symptomatic, they should initially be treated nonoperatively. Repairable tears should be repaired. The outcome of arthroscopic partial meniscectomy depends on the degree of osteoarthritis, the character of the meniscus lesion, the degree of loss of joint space, the amount of malalignment, and obesity. The majority of patients had significant improvement, but younger patients and patients with short-term symptoms have better outcomes. LEVEL OF EVIDENCE: Level V - expert opinion.

18.
Knee Surg Sports Traumatol Arthrosc ; 28(3): 906-914, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31209542

RESUMO

PURPOSE: To present the clinical outcomes and magnetic resonance imaging (MRI) analysis of adjustable cortical suspensory fixation for the femur and tibia in hamstring autograft anterior cruciate ligament reconstruction. METHODS: A cohort of 233 sequential patients was analysed for graft failure rate and subjective IKDC, Tegner and Lysholm scores. 144 validated 1-year MRIs assessed and correlated graft healing and tunnel widening. RESULTS: At mean follow-up of 28 months ± 8.2 [median 26, range 12-49], the graft failure rate was 4.7%. Significant improvements were seen in all clinical scores (p < 0.001). MRI analysis showed 71% with fully integrated grafts in the tibia and 24% in the femur, with the remainder all showing greater than 50% integration. Graft signal was low and homogenous in 67% in the tibia, 29% in the intra-articular portion and 20% in the femur. One patient had greater than 50% high signal in the tibial graft and one in the intra-articular graft, all others demonstrated greater than 50% low signal. Both graft integration and signal were significantly better in the tibia than the femur (p < 0.01). Tunnel widening was 2.2 ± 1.4 mm and 2.7 ± 1.3 mm in the tibia and femur, respectively. Comparison of individual MRI appearances and overall clinical outcome at the same 12-month point demonstrated no consistent significant correlation. CONCLUSION: Adjustable cortical suspensory fixation in both femoral and tibial tunnels provides good clinical outcomes and a low graft rupture rate. Grafts demonstrate healing with comparatively low tunnel widening. There was no consistent significant correlation between the appearances on MRI and clinical outcome. LEVEL OF EVIDENCE: Case-control study, Level III.

19.
J Palliat Med ; 23(1): 147-149, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31170022

RESUMO

Pediatric palliative care deals with the physical, psychosocial, and spiritual concerns of patients and their families. And to do this, clinicians must use all the tools at their disposal, including pharmacological and nonpharmacological modalities. Virtual reality is quickly becoming a useful tool in many areas of medicine, including surgical planning, simulation training, rehabilitation, and pain prevention and treatment. Recently it has been used in the adult palliative care population, for symptom management, and memory and legacy creation. We present a case report for, what we believe to be, the first time in the pediatric palliative care population.

20.
J Arthroplasty ; 35(2): 401-406, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31635904

RESUMO

BACKGROUND: The mortality and risks of bilateral total knee arthroplasty (BTKA) have been reported to be far greater than in unilateral total knee arthroplasty (UTKA). This study aimed to determine whether this remains the case using contemporary anesthetic and surgical techniques for one-stage single anesthetic sequential BTKA. METHODS: Two cohorts of 394 patients were created by propensity matching for gender, age, body mass index, American Society of Anesthesiologists grade, and Veterans Rand-12 health survey scores. Primary outcome was morbidity and mortality, with satisfaction measures using patient-reported outcome measures. RESULTS: The mortality rate was low with one case after BTKA. Major complications were also low; however, a pulmonary embolism rate of 2% in BTKA patients was significantly higher than 0.3% after UTKA (P < .05), and associated with an American Society of Anesthesiologists grade ≥3. The rate of minor complications between the 2 cohorts was comparable (P = .95). Blood transfusions were uncommon and not significantly different between cohorts (2.5% vs 1.3%, P = .3). BTKA patients stayed in hospital a mean 1.3 days longer with greater rehabilitation requirements. At final follow-up, patient satisfaction was high with all patient-reported outcome measures significantly improved and comparable between cohorts. CONCLUSION: BTKA is safe and effective in the majority of patients. Transfusion rates were far lower than historically reported and major complications were rare after both UTKA and BTKA. A significant increase in the rate of pulmonary embolism after BTKA was observed, especially in high risk patients. At minimum 1-year postoperatively, cohorts had the same significant clinical improvement and high level of satisfaction.

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