Multiplex PCR of sonication fluid accurately differentiates between prosthetic joint infection and aseptic failure.

OBJECTIVE: Cultures have limited sensitivity in the diagnosis of prosthetic joint infection (PJI), especially in low-grade infections. We assessed the value of multiplex PCR in differentiating PJI from aseptic failure (AF). METHODS: Included were patients in whom the joint prosthesis was removed and submitted for sonication. The resulting sonication fluid was cultured and investigated by multiplex PCR, and compared with periprosthetic tissue culture. RESULTS: Among 86 explanted prostheses (56 knee, 25 hip, 3 elbow and 2 shoulder prostheses), AF was diagnosed in 62 cases (72%) and PJI in 24 cases (28%). PJI was more common detected by multiplex PCR (n=23, 96%) than by periprosthetic tissue (n=17, 71%, p=0.031) or sonication fluid culture (n=16, 67%, p=0.016). Among 12 patients with PJI who previously received antibiotics, periprosthetic tissue cultures were positive in 8 cases (67%), sonication fluid cultures in 6 cases (50%) and multiplex PCR in 11 cases (92%). In AF cases, periprosthetic tissue grew organisms in 11% and sonication fluid in 10%, whereas multiplex PCR detected no organisms. CONCLUSIONS: Multiplex PCR of sonication fluid demonstrated high sensitivity (96%) and specificity (100%) for diagnosing PJI, providing good discriminative power towards AF, especially in patients previously receiving antibiotics.

Risk Mitigation Strategies for Operations and Maintenance Activities, Final Report, April 2012

The objective of this research was to investigate the application of integrated risk modeling to operations and maintenance activities, specifically moving operations, such as pavement testing, pavement marking, painting, snow removal, shoulder work, mowing, and so forth. The ultimate goal is to reduce the frequency and intensity of loss events (property damage, personal injury, and fatality) during operations and maintenance activities. This report includes a literature review that identifies the current and common practices adopted by different state departments of transportation (DOTs) and other transportation agencies for safe and efficient highway operations and maintenance (O/M) activities. The final appendix to the report includes information for eight innovative O/M risk mitigation technologies/equipment and covers the following for these technologies/equipment: Appropriate conditions for deployment Performance/effectiveness, depending on hazard/activity Cost to purchase Cost to operate and maintain Availability (resources and references)

Importance of a three-dimensional measure of humeral head subluxation in osteoarthritic shoulders.

HYPOTHESIS: During total shoulder arthroplasty (TSA), humeral head subluxation may be difficult to manage. Furthermore, there is a risk for postoperative recurrence of subluxation, affecting the outcome of TSA. An accurate evaluation of the subluxation is necessary to evaluate this risk. Currently, subluxation is measured in 2 dimensions (2D), usually relative to the glenoid face. The goal of this study was to extend this measure to 3 dimensions (3D) to compare glenohumeral and scapulohumeral subluxation and to evaluate the association of subluxation with the glenoid version. MATERIALS AND METHODS: The study analyzed 112 computed tomography scans of osteoarthritic shoulders. We extended the usual 2D definition of glenohumeral subluxation, scapulohumeral subluxation, and glenoid version by measuring their orientation in 3D relative to the scapular plane and the scapular axis. We evaluated statistical associations between subluxation and version in 2D and 3D. RESULTS: Orientation of subluxation and version covered all sectors of the glenoid surface. Scapulohumeral subluxation and glenoid version were highly correlated in amplitude (R(2) = 0.71; P < .01) and in orientation (R(2) = 0.86; P < .01). Approximately every degree of glenoid version induced 1% of scapulohumeral subluxation in the same orientation of the version. Conversely, glenohumeral subluxation was not correlated to glenoid version in 2D or in 3D. CONCLUSIONS: Orientation of the humeral subluxation is rarely within the arbitrary computed tomography plane and should therefore be measured in 3D to detect out-of-plane subluxation. Scapulohumeral subluxation and glenoid version measured in 3D could bring valuable information for decision making during TSA.

Scapulalgie et neuropathie sus-scapulaire en pathologie sportive [Scapular pain and supra-scapular neuropathy in sports medicine]

Eight patients with shoulder pain are reported with a history of athletic activities. On examination, performed with a delay of several months, all patients had painful paresis and atrophy of spinati fossa. Electroneuromyography was carried out in all cases and showed a suprascapular nerve axonal loss from the spinati muscles or infraspinatus muscle, signs of denervation-reinnervation in spinati or infraspinatus muscles, normal examination of other scapular girdle muscles, and a coordinate spinati contraction with shoulder displacement excluding rotator cuff tears. All patients had conservative treatment and only two improved. Six patients underwent surgical decompression of the suprascapular nerve; in three, motor function clearly improved, and in three others pain improved. The factors leading to entrapment include stretch mechanisms associated with shoulder movements, leading to suprascapular nerve liability to mechanical lesions. In patients with shoulder pain, the authors recommend an early electrophysiological work-up to recognize an isolated suprascapular neuropathy. The surgical decompression of the nerve should be based on persistent shoulder pain after conservative treatment.

Evaluating Roadway Subsurface Drainage Practices, 2013

The bearing capacity and service life of a pavement is affected adversely by the presence of undrained water in the pavement layers. In cold winter climates like in Iowa, this problem is magnified further by the risk of frost damage when water is present. Therefore, well-performing subsurface drainage systems form an important aspect of pavement design by the Iowa Department of Transportation (DOT). However, controversial findings are also reported in the literature regarding the benefits of subsurface drainage. The goal of this research was not to investigate whether subdrains are needed in Iowa pavements, but to conduct an extensive performance review of primary interstate pavement subdrains in Iowa, determine the cause of the problem if there are drains that are not functioning properly, and investigate the effect of poor subdrain performance due to improper design, construction, and maintenance on pavement surface distresses, if any. An extensive literature review was performed covering national-level and state-level research studies mainly focusing on the effects of subsurface drainage on performance of asphalt and concrete pavements. Several studies concerning the effects of a recycled portland cement concrete (RPCC) subbase on PCC pavement drainage systems were also reviewed. A detailed forensic test plan was developed in consultation with the project technical advisory committee (TAC) for inspecting and evaluating the Iowa pavement subdrains. Field investigations were conducted on 64 selected (jointed plain concrete pavement/JPCP and hot-mix asphalt/HMA) pavement sites during the fall season of 2012 and were mainly focused on the drainage outlet conditions. Statistical analysis was conducted on the compiled data from field investigations to further investigate the effect of drainage on pavement performance. Most Iowa subsurface drainage system outlet blockage is due to tufa, sediment, and soil. Although higher blockage rates reduce the flow rate of water inside outlet pipes, it does not always stop water flowing from inside the outlet pipe to outside the outlet pipe unless the outlet is completely blocked. Few pavement surface distresses were observed near blocked subsurface drainage outlet spots. More shoulder distresses (shoulder drop or cracking) were observed near blocked drainage outlet spots compared to open ones. Both field observations and limited performance analysis indicate that drainage outlet conditions do not have a significant effect on pavement performance. The use of RPCC subbase in PCC pavements results in tufa formation, a primary cause of drainage outlet blockage in JPCP. Several useful recommendations to potentially improve Iowa subdrain performance, which warrant detailed field investigations, were made

Evaluating Roadway Subsurface Drainage Practices: Tech Transfer Summary, 2013.

The bearing capacity and service life of a pavement is affected adversely by the presence of undrained water in the pavement layers. In cold winter climates like in Iowa, this problem is magnified further by the risk of frost damage when water is present. Therefore, well-performing subsurface drainage systems form an important aspect of pavement design by the Iowa Department of Transportation (DOT). However, controversial findings are also reported in the literature regarding the benefits of subsurface drainage. The goal of this research was not to investigate whether subdrains are needed in Iowa pavements, but to conduct an extensive performance review of primary interstate pavement subdrains in Iowa, determine the cause of the problem if there are drains that are not functioning properly, and investigate the effect of poor subdrain performance due to improper design, construction, and maintenance on pavement surface distresses, if any. An extensive literature review was performed covering national-level and state-level research studies mainly focusing on the effects of subsurface drainage on performance of asphalt and concrete pavements. Several studies concerning the effects of a recycled portland cement concrete (RPCC) subbase on PCC pavement drainage systems were also reviewed. A detailed forensic test plan was developed in consultation with the project technical advisory committee (TAC) for inspecting and evaluating the Iowa pavement subdrains. Field investigations were conducted on 64 selected (jointed plain concrete pavement/JPCP and hot-mix asphalt/HMA) pavement sites during the fall season of 2012 and were mainly focused on the drainage outlet conditions. Statistical analysis was conducted on the compiled data from field investigations to further investigate the effect of drainage on pavement performance. Most Iowa subsurface drainage system outlet blockage is due to tufa, sediment, and soil. Although higher blockage rates reduce the flow rate of water inside outlet pipes, it does not always stop water flowing from inside the outlet pipe to outside the outlet pipe unless the outlet is completely blocked. Few pavement surface distresses were observed near blocked subsurface drainage outlet spots. More shoulder distresses (shoulder drop or cracking) were observed near blocked drainage outlet spots compared to open ones. Both field observations and limited performance analysis indicate that drainage outlet conditions do not have a significant effect on pavement performance. The use of RPCC subbase in PCC pavements results in tufa formation, a primary cause of drainage outlet blockage in JPCP. Several useful recommendations to potentially improve Iowa subdrain performance, which warrant detailed field investigations, were made.

Freeway Work Zone Lane Capacity, TPF-5(081), 2009

The focus of this report is a capacity analysis of two long-term urban freeway Work Zones. Work Zone #1 tapered four mainline lanes to two, using two separate tapers; Work Zone #2 tapered two mainline lanes to one. Work Zone throughput was analyzed throughout the day over multiple days and traffic operations conditions were analyzed up to a distance of five miles upstream of the Work Zone entrance. Historical data from pavement-embedded detectors were used to analyze traffic conditions. The database consisted of five-minute volume, speed and occupancy data collected from 78 detectors for a total of 50 days. Congestion during each analyzed Work Zone existed for more than fourteen hours each day; Work Zone impacts adversely affected freeway operations over distances of 3.7 to 4.2 miles. Speed and occupancy conditions further upstream were, however, not affected, or even improved due to significant trip diversion. Work Zone capacity was defined based on the maximum traffic flows observed over a one-hour period; throughput values were also compiled over longer periods of time when traffic was within 90% of the maximum observed one-hour flows, as well as over the multi-hour mid-day period. The Highway Capacity Manual freeway capacity definition based on the maximum observed 15-min period was not used, since it would have no practical application in estimating Work Zone throughput when congested conditions prevail for the majority of the hours of the day. Certain noteworthy changes took place for the duration of the analyzed Work Zones: per-lane throughput dropped; morning peak periods started earlier, evening peak periods ended later and lasted longer; mid-day volumes dropped accompanied by the highest occupancies of the day. Trip diversion was evident in lower volumes entering the analyzed freeway corridor, higher volumes using off-ramps and lower volumes using onramps upstream of the Work Zones. The majority of diverted traffic comprised smaller vehicles (vehicles up to 21 feet in length); combination truck volumes increased and their use of the median lane increased, contrary to smaller vehicles that shifted toward a heavier use of the shoulder lane.

Evaluation of muscular activity duration in shoulders with rotator cuff tears using inertial sensors and electromyography.

Shoulder disorders, including rotator cuff tears, affect the shoulder function and result in adapted muscle activation. Although these adaptations have been studied in controlled conditions, free-living activities have not been investigated. Based on the kinematics measured with inertial sensors and portable electromyography, the objectives of this study were to quantify the duration of the muscular activation in the upper trapezius (UT), medial deltoid (MD) and biceps brachii (BB) during motion and to investigate the effect of rotator cuff tear in laboratory settings and daily conditions. The duration of movements and muscular activations were analysed separately and together using the relative time of activation (TEMG/mov). Laboratory measurements showed the parameter's reliability through movement repetitions (ICC > 0.74) and differences in painful shoulders compared with healthy ones (p < 0.05): longer activation for UT; longer activation for MD during abduction and tendency to shorter activation in other movements; shorter activation for BB. In daily conditions, TEMG/mov for UT was longer, whereas it was shorter for MD and BB (p < 0.05). Moreover, significant correlations were observed between these parameters and clinical scores. This study thus provides new insights into the rotator cuff tear effect on duration of muscular activation in daily activity.

Is the function of the serratus anterior muscle disturbed following division during a standard thoracotomy?

In a prospective study the functional results after dissection or preservation of the serratus anterior muscle in the postero-lateral standard thoracotomy were evaluated. In 14 patients of our clinic with dissection and suture and in 14 patients with preservation of the serratus muscle the muscle function was assessed and compared preoperatively, within the first two post-operative weeks, and three months after the operation by the same physiotherapists. The two groups were blinded in regard to age, original disease, and mode of intervention. We compared the wing position of the scapula in the sitting position and the positioning of the scapula at fixation of the shoulder joint in the sitting and in the supine position. Using a four-grade function assessment scheme, both groups obtained the same functional results. There was no seroma in either group. After 2.8 (2.5 to 3.0) years all the surviving patients described symmetric functional conditions. We therefore conclude that in order to achieve a better view of the operative field the serratus muscle may be dissected close to the origin if it is then readapted.

Diagnostic et prise en charge des douleurs de la région scapulaire [Diagnosis and treatments of scapular pain].

Shoulder pain is one of the most common reasons for bone and joint consultations in general practice. In most situations, it is due to a lesion of the rotator cuff. A detailed history can often exclude a cervical or visceral origin of the pain. A full clinical examination especially active and passive mobility provides a good diagnostic approach. It can be refined by specific clinical tests that must nevertheless be interpreted with caution. The management of pathologies of the rotator cuff does not require imaging immediately. Ultrasound is increasingly recognized as the imaging procedure of choice in most situations. For abarticular shoulder pathologies, therapy is primarily conservative. The exact role of infiltration of steroids remains unclear. Only an acute traumatic rupture of the rotator cuff warrants prompt surgical intervention.

A new technique to improve tissue grip and contact force in arthroscopic capsulolabral repair: the MIBA stitch.

The success of anatomic repair of Bankart lesion diminishes in the presence of a capsule stretching and/or attenuation is reported in a variable percentage of patients with a chronic gleno-humeral instability. We introduce a new arthroscopic stitch, the MIBA stitch, designed with a twofold aim: to improve tissue grip to reduce the risk of soft tissue tear, particularly cutting through capsular-labral tissue, to and address capsule-labral detachment and capsular attenuation using a double loaded suture anchor. This stitch is a combination of horizontal mattress stitch passing through the capsular-labral complex in a "south-to-north" direction and an overlapping single vertical suture passing through the capsule and labrum in a "east-to-west" direction. The mattress stitch is tied before the vertical stitch in order to reinforce the simple vertical stitch, improving grip and contact force between capsular-labral tissue and glenoid bone.

Early Entry Sawed Portland Cement Concrete Transverse Joint Ends, MLR-97-5, 2003

Experiments with early entry light sawing of Portland cement concrete (PCC) contraction joints began in Iowa in 1989. Since that time, changes in early sawing equipment have occurred as well as changes in specifications for sawing. The option to use early sawing for transverse contraction joints was specified in 1992. A problem happening occasionally with early sawing was the break out of some of the concrete around the end of the joint as the saw blade approached the edge of the slab. To prevent this, it was proposed that the sawing would terminate approximately 1/2" to 3/4" before the edge of the slab, creating a "short joint". This procedure would also leave a concrete "dam" to prevent the run-out and waste of the hot liquid joint sealant onto the shoulder. It would also eliminate the need for the labor and material for applying a duct tape dam at the open ends of each sawed joint to stop hot liquid sealant run-out Agreements were made with the contractor to apply the "short joint" technique for 1 day of paving. The evaluation and results are compared with an adjoining control section. The research found no negative aspects from sawing the "short joint". Three specific findings were noted. They are the following: 1) No joint end "blow-out" spalls of concrete occurred. 2) The need for the duct tape dam to stop liquid sealant overflow was eliminated. 3) Joint end corner spalls appear to be caused mainly by construction shouldering operations equipment. The "short joint" sawing technique can be routinely applied to early entry sawed transverse contraction joints with expectations of only positive results.

Asphalt Emulsions for Highway Construction, HR-216, 1985

A 5.8 mile section of Dubuque County (Iowa) Road D-53 was selected for this project, the objective of which were to: 1. identify a cost effective asphalt emulsion bound macadam typical cross section; 2. determine the effectiveness of engineering fabric placed under macadam roadbeds; and 3. evalaute the use of emulsions in surface seal coats. A number of conclusions were reached: 1. The minus #200 sieve material for the macadam stone should be held to a minimum. For the emulsion used on this project, the minus #200 material had less than 4 percent to achieve satisfactory coating of the macadam stone. 2. The placement of the emulsion treated macadam required no additional equipment or time than the plain macadam placement. 3. Emulsion treating the macadam stone for the shoulder base appears unnecessary. 4. The emulsion treated macadam base beneath an asphaltic concrete wearing surface yielded a higher structural rating than the plain macadam beneath a comparable ashaltic concrete surface. 5. The performance of the fabric between the subgrade and the macadam base to prevent soil intrusion into the base could not be determined by the non-destructive testing conducted. 6. When no choke stone is used over the macadam base, allowance for ac mix overrun should be made. 7. Use of an emulsion instead of a cutback asphalt saved money and energy. However, the poor performance of the seal coat negated any real savings.

Macadam Base Shoulders, HR-181, 1977

Highway safety and pavement performance can be directly influenced by the type of shoulders that are constructed. Shoulder design alternatives have always been rather limited. Moreover, the use of some of the alternatives has always been restricted by funding limitations. This research project seeks to explore the use of modified macadam base construction for shoulders. This type of shoulder design could offer the designer another option when paved or stabilized shoulders are being considered. Macadam base construction has in the past been shown to be quite strong and freedraining. Two macadam base shoulder designs were developed and constructed for this research project. A new roadway embankment and P.C.C. pavement were constructed on a section of US 6 east of Adel in Dallas County. The macadam base shoulders were constructed adjacent to the pavement as part of the project. The north shoulder was finished with a choke stone course and bituminous surface treatment and the south shoulder was finished with a two (2) inch layer of Type B Class II asphalt concrete. The initial results are considered satisfactory. Follow-up performance evaluation and load bearing tests are planned.

Résultats préliminaires de l'enclouage rétrograde de l'humérus [Preliminary results of retrograde nailing of the humerus]

A group of nine patients with a diaphyseal fracture of the humerus and treated with retrograde nailing were studied with a mean follow-up of 15.3 months. Six patients with a humeral fracture without neurological deficit showed a good shoulder and elbow mobility at the last visit. Three patients with neurological lesion preoperatively suffer from a diminished range of movement not related to the surgical procedure. During the operation and postoperatively we found no complication related to the implant and more precisely we could not find a iatrogenic fracture or nervous lesion except one intraoperative lesion of the radial nerve probably related to an important traction movement during reduction with complete remission. Consolidation has been achieved for all fractures but one. This patient suffers from a lesion of the brachial plexus with complete plegia of the arm and a vascular lesion. This patient had to be reoperated for an atrophic non-union by bone grafting and plate fixation. The retrograde nail is a good implant and must be considered in our treatment plans as much as conservative treatment or surgical treatment with plating, anterograde nailing or the use of an external fixator. Only then will we be able to give to the patient the most adapted treatment for his fracture.