New functional and biomechanical assessments for the improvement of the surgical navigation systems for joint replacement in the human lower limb

In case of severe osteoarthritis at the knee causing pain, deformity, and loss of stability and mobility, the clinicians consider that the substitution of these surfaces by means of joint prostheses. The objectives to be pursued by this surgery are: complete pain elimination, restoration of the normal physiological mobility and joint stability, correction of all deformities and, thus, of limping. The knee surgical navigation systems have bee developed in computer-aided surgery in order to improve the surgical final outcome in total knee arthroplasty. These systems provide the surgeon with quantitative and real-time information about each surgical action, like bone cut executions and prosthesis component alignment, by mean of tracking tools rigidly fixed onto the femur and the tibia. Nevertheless, there is still a margin of error due to the incorrect surgical procedures and to the still limited number of kinematic information provided by the current systems. Particularly, patello-femoral joint kinematics is not considered in knee surgical navigation. It is also unclear and, thus, a source of misunderstanding, what the most appropriate methodology is to study the patellar motion. In addition, also the knee ligamentous apparatus is superficially considered in navigated total knee arthroplasty, without taking into account how their physiological behavior is altered by this surgery. The aim of the present research work was to provide new functional and biomechanical assessments for the improvement of the surgical navigation systems for joint replacement in the human lower limb. This was mainly realized by means of the identification and development of new techniques that allow a thorough comprehension of the functioning of the knee joint, with particular attention to the patello-femoral joint and to the main knee soft tissues. A knee surgical navigation system with active markers was used in all research activities presented in this research work. Particularly, preliminary test were performed in order to assess the system accuracy and the robustness of a number of navigation procedures. Four studies were performed in-vivo on patients requiring total knee arthroplasty and randomly implanted by means of traditional and navigated procedures in order to check for the real efficacy of the latter with respect to the former. In order to cope with assessment of patello-femoral joint kinematics in the intact and replaced knees, twenty in-vitro tests were performed by using a prototypal tracking tool also for the patella. In addition to standard anatomical and articular recommendations, original proposals for defining the patellar anatomical-based reference frame and for studying the patello-femoral joint kinematics were reported and used in these tests. These definitions were applied to two further in-vitro tests in which, for the first time, also the implant of patellar component insert was fully navigated. In addition, an original technique to analyze the main knee soft tissues by means of anatomical-based fiber mappings was also reported and used in the same tests. The preliminary instrumental tests revealed a system accuracy within the millimeter and a good inter- and intra-observer repeatability in defining all anatomical reference frames. In in-vivo studies, the general alignments of femoral and tibial prosthesis components and of the lower limb mechanical axis, as measured on radiographs, was more satisfactory, i.e. within ±3°, in those patient in which total knee arthroplasty was performed by navigated procedures. As for in-vitro tests, consistent patello-femoral joint kinematic patterns were observed over specimens throughout the knee flexion arc. Generally, the physiological intact knee patellar motion was not restored after the implant. This restoration was successfully achieved in the two further tests where all component implants, included the patellar insert, were fully navigated, i.e. by means of intra-operative assessment of also patellar component positioning and general tibio-femoral and patello-femoral joint assessment. The tests for assessing the behavior of the main knee ligaments revealed the complexity of the latter and the different functional roles played by the several sub-bundles compounding each ligament. Also in this case, total knee arthroplasty altered the physiological behavior of these knee soft tissues. These results reveal in-vitro the relevance and the feasibility of the applications of new techniques for accurate knee soft tissues monitoring, patellar tracking assessment and navigated patellar resurfacing intra-operatively in the contest of the most modern operative techniques. This present research work gives a contribution to the much controversial knowledge on the normal and replaced of knee kinematics by testing the reported new methodologies. The consistence of these results provides fundamental information for the comprehension and improvements of knee orthopedic treatments. In the future, the reported new techniques can be safely applied in-vivo and also adopted in other joint replacements.

Medienpädagogische Handlungskompetenzen: Problemorientierung und Kompetenzerwerb beim Lernen mit neuen Medien

Vor dem Hintergrund sich wandelnder (medialer) Lebenswelten von Schülerinnen und Schülern gewinnen Bestimmungsversuche um medienpädagogische Handlungskompetenzen von Lehrpersonen an Bedeutung. Der Erwerb medienpädagogischer Kompetenz, verstanden als dynamisches Zusammenspiel von domänenspezifischem Wissen und anwendungsorientiertem Können, wird in der vorliegenden Arbeit als wesentliches Lernziel der medienpädagogischen (Aus-)Bildung bestimmt. Als ein Weg zur Förderung medienpädagogischer Handlungskompetenz wird von der Autorin auf der Folie konstruktivistischer Vorstellungen über das Lehren und Lernen die Methode der Problemorientierung vorgeschlagen. Im ersten Teil der Arbeit werden Modelle und Konzepte diskutiert, die Bausteine für ein Modell medienpädagogischer Kompetenz liefern. Im zweiten Teil wird eine empirische Untersuchung zum Erwerb medienpädagogischer Handlungskompetenz auf der Basis eines von der Autorin erarbeiteten Modells vorgestellt und die Ergebnisse diskutiert. Eine kompetenztheoretische Annäherung erfolgt auf der Basis zweier Konzepte. Dies sind die Ausführungen zu einem Konzept kommunikativer Kompetenz nach Jürgen Habermas sowie dessen Überführung in die Medienpädagogik durch Dieter Baacke. Ferner wird die rezente bildungspolitische Kompetenzdebatte in Anbindung an Franz E. Weinert analysiert. Es folgt eine Zusammenschau über die methodischen Konzepte zur Erfassung von Kompetenzen in der Erziehungswissenschaft und deren Anwendbarkeit für die medienpädagogische Kompetenzforschung. Die gegenwärtig vorliegenden Entwürfe zu einer inhaltlichen Bestimmung medienpädagogischer Kompetenzen werden besprochen (Sigrid Blömeke, Werner Sesink, International Society for Technology in Education). Im Rekurs auf konstruktivistische lerntheoretische Überlegungen erfährt das problemorientierte Lernen beim Aufbau von Kompetenzen eine enorme Aufwertung. In der Arbeit wird insbesondere den Arbeiten von David Jonassen zu einer konstruktivistisch-instruktionistischen Herangehensweise bei der Gestaltung problemorientierter Lernumgebungen eine große Bedeutung zugesprochen (vgl. auch Ansätze des Goal-based Scenarios/Roger Schank und des Learning by Design/Janet Kolodner). Im zweiten Teil wird die Interventionsstudie im Kontrollgruppendesign vorgestellt. Anhand eines Modells medienpädagogischer Kompetenz, dass auf den Dimensionen Wissen einerseits und Können andererseits basiert, wurden Studierende (n=59) in einem Pre-Posttestverfahren auf diese Dimensionen getestet. Die Studierenden der Interventionsgruppe (n=30) arbeiteten über ein Semester mit einer problemorientierten Lernanwendung, die Studierenden der Kontrollgruppe (n=29) in einem klassischen Seminarsetting. Hauptergebnis der Untersuchung ist es, das die Intervention zu einem messbaren Lernerfolg beim medienpädagogischen Können führte. In der Diskussion der Ergebnisse werden Empfehlungen zur Gestaltung problemorientierter Lernumgebungen formuliert. Die Chancen einer Orientierung an problemorientierten Lernsettings für das Lernen an Hochschulen werden herausgestellt.

Development of empirical potentials for amorphous silica

Development of empirical potentials for amorphous silica Amorphous silica (SiO2) is of great importance in geoscience and mineralogy as well as a raw material in glass industry. Its structure is characterized as a disordered continuous network of SiO4 tetrahedra. Many efforts have been undertaken to understand the microscopic properties of silica by classical molecular dynamics (MD) simulations. In this method the interatomic interactions are modeled by an effective potential that does not take explicitely into account the electronic degrees of freedom. In this work, we propose a new methodology to parameterize such a potential for silica using ab initio simulations, namely Car-Parrinello (CP) method [Phys. Rev. Lett. 55, 2471 (1985)]. The new potential proposed is compared to the BKS potential [Phys. Rev. Lett. 64, 1955 (1990)] that is considered as the benchmark potential for silica. First, CP simulations have been performed on a liquid silica sample at 3600 K. The structural features so obtained have been compared to the ones predicted by the classical BKS potential. Regarding the bond lengths the BKS tends to underestimate the Si-O bond whereas the Si-Si bond is overestimated. The inter-tetrahedral angular distribution functions are also not well described by the BKS potential. The corresponding mean value of theSiOSi angle is found to be ≃ 147◦, while the CP yields to aSiOSi angle centered around 135◦. Our aim is to fit a classical Born-Mayer/Coulomb pair potential using ab initio calculations. To this end, we use the force-matching method proposed by Ercolessi and Adams [Europhys. Lett. 26, 583 (1994)]. The CP configurations and their corresponding interatomic forces have been considered for a least square fitting procedure. The classical MD simulations with the resulting potential have lead to a structure that is very different from the CP one. Therefore, a different fitting criterion based on the CP partial pair correlation functions was applied. Using this approach the resulting potential shows a better agreement with the CP data than the BKS ones: pair correlation functions, angular distribution functions, structure factors, density of states and pressure/density were improved. At low temperature, the diffusion coefficients appear to be three times higher than those predicted by the BKS model, however showing a similar temperature dependence. Calculations have also been carried out on crystalline samples in order to check the transferability of the potential. The equilibrium geometry as well as the elastic constants of α-quartz at 0 K are well described by our new potential although the crystalline phases have not been considered for the parameterization. We have developed a new potential for silica which represents an improvement over the pair potentials class proposed so far. Furthermore, the fitting methodology that has been developed in this work can be applied to other network forming systems such as germania as well as mixtures of SiO2 with other oxides (e.g. Al2O3, K2O, Na2O).

Primary tumors of the submandibular glands: a retrospective study based on 41 cases

We report our experience on the diagnostic approach, treatment, and follow-up of primary submandibular gland tumors. Retrospective review. Tertiary referral center. Forty-one adult patients, 22 male and 19 female, with primary submandibular gland tumors, 20 benign and 21 malignant. Age, gender, clinical findings, cyto- and histopathology, treatment and outcome were analyzed. Most tumors presented as a painless submandibular mass. Thirty three patients underwent a fine needle aspiration, the sensitivity, specificity and accuracy of which--in detecting malignant tumors--were 79%, 100% and 88%, respectively. Preoperative radiological imaging was performed in 30 cases. Patients with benign tumors were treated with surgery. Most malignant tumors were treated with a combined modality, including neck dissection and radiation therapy. Five patients developed a postoperative complication. Recurrent disease was encountered in 5 malignant tumors. The 2, 5 and 10 year disease-specific survival of patients with malignancy were 84%, 75% and 41%, respectively. The preoperative assessment of the nature of submandibular gland tumors remains challenging. Aggressive treatment of patients with malignant disease may help to avoid poor prognosis.

Evaluation of chronic HCV infection in transplanted livers using a modified histological activity index

The majority of histopathological classifications of primary chronic viral hepatitis and recurrence of HCV infection in liver transplants is based on the histological activity index (HAI) introduced by Knodell et al in 1981; however, correlation between HAI and clinical/laboratory data is poor. Therefore, the aim of this study was to present a modification of HAI (mHAI) adapted to distinct features of graft infection, and to evaluate its usefulness in the description of disease activity.

On Ribosome Load, Codon Bias and Protein Abundance

Different codons encoding the same amino acid are not used equally in protein-coding sequences. In bacteria, there is a bias towards codons with high translation rates. This bias is most pronounced in highly expressed proteins, but a recent study of synthetic GFP-coding sequences did not find a correlation between codon usage and GFP expression, suggesting that such correlation in natural sequences is not a simple property of translational mechanisms. Here, we investigate the effect of evolutionary forces on codon usage. The relation between codon bias and protein abundance is quantitatively analyzed based on the hypothesis that codon bias evolved to ensure the efficient usage of ribosomes, a precious commodity for fast growing cells. An explicit fitness landscape is formulated based on bacterial growth laws to relate protein abundance and ribosomal load. The model leads to a quantitative relation between codon bias and protein abundance, which accounts for a substantial part of the observed bias for E. coli. Moreover, by providing an evolutionary link, the ribosome load model resolves the apparent conflict between the observed relation of protein abundance and codon bias in natural sequences and the lack of such dependence in a synthetic gfp library. Finally, we show that the relation between codon usage and protein abundance can be used to predict protein abundance from genomic sequence data alone without adjustable parameters.

7-year follow-up after open reduction and internal screw fixation in Bennett fractures

Bennett fractures are unstable, and, with inadequate treatment, lead to osteoarthritis, weakness and loss of function of the first carpometacarpal joint. This study focuses on long-term functional and radiological outcomes after open reduction and internal fixation.

[Treatment of nonalcoholic steatohepatitis]

NASH associates steatosis with parenchymal inflammation and signs of hepatocellular injuy and even apoptosis. This leads in a minority of patients to fibrosis and in the long term to cirrhosis. NASH regularly occurs in a metabolic context characterized by insulin resistance. Several drugs have been tested in randomized controlled studies. Glitazones improve insulin resistance and also NASH, but are associated with side effects particularly unwelcome in NASH patients. Ursodesoxycholic acid, an hydrophilic biliary acid with hepatoprotective properties, does not improve the histological lesions of NASH. Vitamin E is the only compound which showed so far a positive effect without relevant side effects. However, it is too early to recommend its long-term use in this indication. Finally, the best treatment is not with drugs, but relies on behavioural changes: NASH patients should regularly exercise!