No added value for Computer-Assisted surgery to improve femoral component positioning and Patient Reported Outcomes in Hip Resurfacing Arthroplasty; a multi-center randomized controlled trial.

BACKGROUND: Computer Assisted Surgery (CAS) has proven to improve the accuracy in several orthopedic procedures. Therefore we used this technique to evaluate femoral component positioning in Hip Resurfacing Arthroplasty (HRA). The aim of this study was to evaluate imageless CAS compared to manually implanted femoral components and subsequently evaluates Patient Related Outcome Measures (PROMs). We hypothesized that the use of CAS optimizes the position of the femoral component and improves PROMs. METHODS: This is a multicenter, single-blinded, randomized, controlled trial of two groups. In the CAS group guiding of the femoral component was done with imageless navigation. In the Conventional (control) group the femoral component was placed manually according to the preplanned position. The primary outcome measure consists of a maximum of 3 degrees difference between the postoperative Stem Shaft Angle (SSA) and preplanned SSA. Secondary outcome measures consist of the Hip disability and Osteoarthritis Outcome Scale (HOOS), the Harris Hip Score (HHS) and Visual Analogue Scale (VAS) pain score. RESULTS: A total of 122 patients were randomized, 61 in the CAS group and 61 in the conventional group. There was no significant differences in accuracy of femoral implant position. The mean difference between the postoperative- and preplanned SSA was - 2.26 and - 1.75 degrees (more varus) respectively in the CAS and Conventional group. After surgery both groups show significant improvement in all PROMs compared to the baseline measurements, with no significant differences between the groups. CONCLUSION: Our cohort indicates no benefit for the use of CAS in accuracy of placement of the femoral component in HRA compared to manual implantation. There are no clinical differences in PROMs after 1 year follow up. This study showed no added value and no justification for the use of CAS in femoral component positioning in HRA. TRIAL REGISTRATION: This trial is registered at ClinicalTrails.gov ( https://clinicaltrials.gov/ ) on the 25th of October 2006: NCT00391937. LEVEL OF INCIDENCE: Level IIb, multicenter randomized controlled trial.

Forearm rotation improves after corrective osteotomy in patients with symptomatic distal radius malunion.

Objectives: Distal radius malunion can result in pain and functional complaints. One of the functional problems that can affect daily life is impaired forearm rotation. The primary aim of this study was to investigate the effect of corrective osteotomy for distal radius malunion on forearm rotation at 12 months after surgery. We secondarily studied the effect on grip strength, radiological measurements, and patient-reported outcome measurements (PROMs). Patients and methods: This cohort study analysed prospectively collected data of adult patients with symptomatic distal radius malunion. All patients underwent corrective osteotomy for malunion and were followed for 1 year. We measured forearm rotation (pronation and supination) and grip strength and analysed radiographs. PROMs consisted of the Patient-Rated Hand/Wrist Evaluation (PRWHE) questionnaire, Visual Analogue Scale for pain, and satisfaction with hand function. Results: Preoperative total forearm rotation was 112° (SD: 34°), of which supination of 49° (SD: 25°) was more impaired than pronation of 63° (SD: 17°). Twelve months after surgery, an unpaired Student's t-test showed a significant improvement of total forearm rotation to 142° (SD: 17°) (p < 0.05). Pronation improved to 72° (SD: 10°), and supination to 69° (SD: 13°) (p < 0.05). Grip strength, PROMs, as well as inclination and volar tilt on radiographs improved significantly during the first year after surgery (p < 0.05). Conclusion: In patients with reduced forearm rotation due to distal radius malunion, corrective osteotomy is an effective treatment that significantly improves forearm rotation. In addition, this intervention improves grip strength, the PRWHE-score, pain, and satisfaction with hand function.

Development of a reference material for analysing naturally occurring radioactive material from the steel industry.

Accurate measurement of naturally occurring radionuclides in blast furnace slag, a by-product of the steel industry, is required for compliance with building regulations where it is often used as an ingredient in cement. A matrix reference blast furnace slag material has been developed to support traceability in these measurements. Raw material provided by a commercial producer underwent stability and homogeneity testing, as well as characterisation of matrix constituents, to provide a final candidate reference material. The radionuclide content was then determined during a comparison exercise that included 23 laboratories from 14 countries. Participants determined the activity per unit mass for 226Ra, 232Th and 40K using a range of techniques. The consensus values obtained from the power-moderated mean of the reported participant results were used as indicative activity per unit mass values for the three radionuclides: A0(226Ra) = 106.3 (34) Bq·kg-1, A0(232Th) = 130.0 (48) Bq·kg-1 and A0(40K) = 161 (11) Bq·kg-1 (where the number in parentheses is the numerical value of the combined standard uncertainty referred to the corresponding last digits of the quoted result). This exercise helps to address the current shortage of NORM industry reference materials, putting in place infrastructure for production of further reference materials.

Exploring a route to a selective and sensitive portable system for explosive detection- swab spray ionisation coupled to of high-field assisted waveform ion mobility spectrometry (FAIMS).

Paper spray mass spectrometry is a rapid and sensitive tool for explosives detection but has so far only been demonstrated using high resolution mass spectrometry, which bears too high a cost for many practical applications. Here we explore the potential for paper spray to be implemented in field applications with portable mass spectrometry. This involved (a) replacing the paper substrate with a swabbing material (which we call "swab spray") for compatibility with standard collection materials; (b) collection of explosives from surfaces; (c) an exploration of interferences within a ±â€¯0.5 m/z window; and (d) demonstration of the use of high-field assisted waveform ion mobility spectrometer (FAIMS) for enhanced selectivity. We show that paper and Nomex® are viable collection materials, with Nomex providing cleaner spectra and therefore greater potential for integration with portable mass spectrometers. We show that sensitive detection using swab spray will require a mass spectrometer with a mass resolving power of 4000 or more. We show that by coupling the swab spray ionisation source with FAIMS, it is possible to reduce background interferences, thereby facilitating the use of a low resolving power (e.g. quadrupole) mass spectrometer.

Development of a method for rapid analysis of Ra-226 in groundwater and discharge water samples by ICP-QQQ-MS.

A novel and rapid method has been developed for pre-concentration and measurement of 226Ra in groundwater and discharge water samples using the latest generation triple quadrupole inductively coupled plasma mass spectrometry (ICP-QQQ-MS). Cation exchange and extraction chromatography are capable of pre-concentration factors of ~200 based on 1L samples. The sensitivity and interference removal capability of ICP-QQQ-MS was assessed from spiked groundwaters, with the introduction of He collision gas required to minimise instrument background in high-matrix samples. The technique developed is potentially capable of detecting 226Ra activities as low as 5mBqL-1 when combined with pre-concentration prior to measurement.

The behaviour of 226Ra in high-volume environmental water samples on TK100 resin.

Accurate, low-level measurement of 226Ra in high volume water samples requires rapid pre-concentration and robust separation techniques prior to measurement in order to comply with discharge limits and drinking water regulations. This study characterises the behaviour of 226Ra and interfering elements on recently developed TK100 (Triskem International) extraction chromatography resin. Distribution coefficients over a range of acid concentrations are given, along with an optimised procedure that shows rapid pre-concentration and separation of 226Ra on TK100 resin is achievable for high volume (1 L) water samples without the need for sample pre-treatment.

Evaluation of the separation and purification of 227Th from its decay progeny by anion exchange and extraction chromatography.

Thorium-227 is currently undergoing evaluation as a potential radionuclide for targeted cancer therapy, and as such a high chemical purity of the material is required. To establish a reliable procedure for radiochemical isolation of 227Th from the parent 227Ac and decay progeny, which includes the radiotherapeutic 223Ra, the performance of three different separation schemes based on ion-exchange and extraction chromatography have been evaluated. The results suggest that both ion exchange and extraction chromatographic techniques can be successfully used for the separation of 227Th from its decay progeny, however extraction chromatographic resins demonstrate favourable performance in terms of Th recovery and purification from radionuclide impurities.

Heat strain and gross efficiency during endurance exercise after lower, upper, or whole body precooling in the heat.

The maximal power that muscles can generate is reduced at low muscle temperatures. However, in prolonged heavy exercise in the heat, a high core temperature may be the factor limiting performance. Precooling has been shown to delay the attainment of hyperthermia. It is still unclear if the whole body should be cooled or if the active muscles should be excluded from cooling in order to maintain muscle power. An experiment was performed to compare thermal strain and gross efficiency following whole body or partial body cooling. Eight well-trained participants performed 40 min of 60% VO2max cycling exercise in a 30 degrees C, 70% relative humidity climatic chamber after four different precooling sessions in a water perfused suit: N (no precooling), CC (45 min whole body precooling), WC (45 min lower body precooling), and CW (45 min upper body precooling). The uncooled body part was warmed in such a way that the core temperature did not differ from that in session N. Gross efficiency was used to compare performance between the sessions since it indicates how much oxygen is needed for a certain external load. The gross efficiency did not differ significantly between the sessions. Differences in heat loss and heat storage were observed during the first 20 min of exercise. The evaporative heat loss in session WC (305 +/- 67 W) and CW (284 +/- 68 W) differed from session N (398 +/- 77 W) and CC (209 +/- 58 W). More heat was stored in session CC (442 +/- 125 W) than in sessions WC (316 +/- 39 W), CW (307 +/- 63 W), and N (221 +/- 65 W). It was confirmed that precooling reduces heat strain during exercise in the heat. No differences in heat strain and gross efficiency were observed between precooling of the body part with the exercising muscles and precooling of the tissues elsewhere in the body.