The fixation of the cemented femoral component. Effects of stem stiffness, cement thickness and roughness of the cement-bone surface.

After cemented total hip arthroplasty (THA) there may be failure at either the cement-stem or the cement-bone interface. This results from the occurrence of abnormally high shear and compressive stresses within the cement and excessive relative micromovement. We therefore evaluated micromovement and stress at the cement-bone and cement-stem interfaces for a titanium and a chromium-cobalt stem. The behaviour of both implants was similar and no substantial differences were found in the size and distribution of micromovement on either interface with respect to the stiffness of the stem. Micromovement was minimal with a cement mantle 3 to 4 mm thick but then increased with greater thickness of the cement. Abnormally high micromovement occurred when the cement was thinner than 2 mm and the stem was made of titanium. The relative decrease in surface roughness augmented slipping but decreased debonding at the cement-bone interface. Shear stress at this site did not vary significantly for the different coefficients of cement-bone friction while compressive and hoop stresses within the cement increased slightly.

Haemodialysis acutely reduces the plasma levels of ADMA without reversing impaired NO-dependent vasodilation.

End-stage renal disease patients have endothelial dysfunction and high plasma levels of ADMA (asymmetric omega-NG,NG-dimethylarginine), an endogenous inhibitor of NOS (NO synthase). The actual link between these abnormalities is controversial. Therefore, in the present study, we investigated whether HD (haemodialysis) has an acute impact on NO-dependent vasodilation and plasma ADMA in these patients. A total of 24 patients undergoing maintenance HD (HD group) and 24 age- and gender-matched healthy controls (Control group) were enrolled. The increase in forearm SkBF (skin blood flow) caused by local heating to 41 degrees C (SkBF41), known to depend on endothelial NO production, was determined with laser Doppler imaging. SkBF41 was expressed as a percentage of the vasodilatory reserve obtained from the maximal SkBF induced by local heating to 43 degrees C (independent of NO). In HD patients, SkBF41 was assessed on two successive HD sessions, once immediately before and once immediately after HD. Plasma ADMA was assayed simultaneously with MS/MS (tandem MS). In the Control group, SkBF41 was determined twice, on two different days, and plasma ADMA was assayed once. In HD patients, SkBF41 was identical before (82.2+/-13.1%) and after (82.7+/-12.4%) HD, but was lower than in controls (day 1, 89.6+/-6.1; day 2, 89.2+/-6.9%; P<0.01 compared with the HD group). In contrast, plasma ADMA was higher before (0.98+/-0.17 micromol/l) than after (0.58+/-0.10 micromol/l; P<0.01) HD. ADMA levels after HD did not differ from those obtained in controls (0.56+/-0.11 micromol/l). These findings show that HD patients have impaired NO-dependent vasodilation in forearm skin, an abnormality not acutely reversed by HD and not explained by ADMA accumulation.

Impact of physical activity on activity of daily living in moderate to severe dementia: a critical review

The objectives of this study were to describe the different modalities of physical activity programs designed for moderate to severe dementia and to identify their impact on functional independence in activities of daily living (ADL). A critical review of randomized controlled trials related to the impact of physical activity programs in moderately to severely demented persons on ADL performance and meta-analysis of the identified studies were performed. Among the 303 identified articles, five responded to the selection criteria. Four out of the five studies demonstrated limited methodological quality. In one high-quality study, physical activity programs significantly delayed deterioration of ADL performance. The program components and ADL assessment tools vary widely across studies. Although the proposed treatments have not proven their efficiency in improving the ADL status of the patients, they were able to limit the decline in ADL functioning. Future research is warranted in order to identify clinically relevant modalities for physical activity programs for people with moderate to severe dementia.

Pronostic à long terme des patients ayant bénéficié d'une thrombolyse au stade aigu de l'infarctus du myocarde [Long-term prognosis for patients undergoing thrombolysis during the acute phase of myocardial infarction]

OBJECTIVE: The objective of this study was to analyse the long-term mortality and morbidity of a group of patients undergoing thrombolysis during the acute phase of myocardial infarction and to determine the factors influencing the prognosis. One hundred and seventy five patients (149 mean and 26 women, mean age: 54 years) were included in a randomized study, comparing the efficacy of 2 thrombolytic substances administered during the acute phase of myocardial infarction. A standard questionnaire was sent to the various attending physicians to follow-up of these 175 patients. RESULTS: The hospital mortality was 5% (9 patients) and 14 patients (9%) died after a mean follow-up of 4.3 +/- 2.1 years. The 5-year actuarial survival was 81%. Fourteen patients (8%) were lost to follow-up and 49 patients (32%) underwent surgical or percutaneous revascularization during follow-up. Revascularized patients had a significantly better survival than non-revascularized patients. The mean left ventricular ejection fraction of patients who died was lower (48% versus 71%) than that of survivors. Patients with an ejection fraction < 40% also had a significantly lower survival (p = 0.01). Patency of the vessel after thrombolysis was associated with a slightly better survival; this difference was not significant. The ejection fraction at 6 month was also significantly higher (60 +/- 10% versus 49 +/- 11%) for patients with a patent artery. Three risk factors for death or reinfarction were identified: age > 65 years at the time of infarction, disease in more than one coronary vessel and absence of angina pectoris before infarction. The probability of a coronary accident varied from 2 to 88% according to the number of risk factors present. At the time of follow-up, 60% of patients presented hypercholesterolaemia versus only 7% before infarction 73% of patients received anticoagulant or antiaggregant treatment and 81% of patients were asymptomatic. CONCLUSION: The mortality and the acute and long-term morbidity of myocardial infarction remain high, as only 34% of our patients did not develop any events during follow-up, despite serious medical management and follow-up. The ejection fraction has an important prognostic value. Patient management should take the abovementioned risk factors into account.

Childhood epilepsy with neuropsychological regression and continuous spike waves during sleep: epilepsy surgery in a young adult.

We describe the case of a man with a history of complex partial seizures and severe language, cognitive and behavioural regression during early childhood (3.5 years), who underwent epilepsy surgery at the age of 25 years. His early epilepsy had clinical and electroencephalogram features of the syndromes of epilepsy with continuous spike waves during sleep and acquired epileptic aphasia (Landau-Kleffner syndrome), which we considered initially to be of idiopathic origin. Seizures recurred at 19 years and presurgical investigations at 25 years showed a lateral frontal epileptic focus with spread to Broca's area and the frontal orbital regions. Histopathology revealed a focal cortical dysplasia, not visible on magnetic resonance imaging. The prolonged but reversible early regression and the residual neuropsychological disorders during adulthood were probably the result of an active left frontal epilepsy, which interfered with language and behaviour during development. Our findings raise the question of the role of focal cortical dysplasia as an aetiology in the syndromes of epilepsy with continuous spike waves during sleep and acquired epileptic aphasia.

1003-001 Williamson Pond Final Report

Williamson Pond is a 26-acre publicly owned lake located about 2 miles east of the town of Williamson, in Lucas County. It has a watershed area of 1,499 acres. It has been managed since 1976 by the Lucas County Conservation Board (while still under state ownership) for fishing, boating, hunting, picnicking and other passive uses. Designated uses are Class AI, primary contact, and Class B (LW) aquatic life. Williamson Pond is on the 2004 EPA 303(d) List of Impaired Waters. A Total Maximum Daily Load (TMDL) for turbidity and nutrients at Williamson Pond was prepared by IDNR in 2005 and approved by EPA in 2006. The TMDL set reduction targets for both suspended sediment and phosphorus. The Williamson Pond Watershed Management Plan has provided the local work group and partners with information to develop and implement strategies to improve and protect water quality. These strategies are based on a three phase approach that will ultimately lead the removal of Williamson Pond from the Impaired Waters List. The goals identified in this proposal (Phase I) will reduce sediment and phosphorus delivery by 453 tons and 589 pounds annually. The Lucas County SWCD has and will continue to provide leadership on the Williamson Pond Project and has secured the partnerships necessary to address water quality problems and hired a part-time project coordinator to manage, implement, and oversee all activities pertaining to this proposal.

09005-002 Silver Creek Watershed Final Report

Silver Creek is a warm water stream resource located in one of the most intensely cropped portions of Clayton County. The stream has been included on Iowa’s 303(d) list of impaired waters since 2002. Aquatic life, which should be present in Silver Creek, isn’t there. According to the Draft Total Maximum Daily Load (TMDL) for Silver Creek, the primary nonpoint pollution sources are soil erosion from agricultural land uses and direct deposition of ammonia by livestock with access to the stream. The Clayton Soil & Water Conservation District has begun efforts to remove Silver Creek from the impaired waters list. The District has promoted stream corridor and sinkhole protection, and the installation of buffer practices along Silver Creek and its tributaries. Conservation practices have been targeted to crop fields to reduce sediment delivery to the stream. A series of news articles, newsletters, and field days have been utilized to increase public understanding of water quality issues. Landowner interest has outweighed available cost share resources. Additional financial support will allow the project to build upon its early successes, to further address the identified impairments, and to respond to a long list of landowners that are interested in conservation work on their farms.

1017-011 Tuttle Lake Watershed Final Report

The Tuttle Lake Watershed is approximately 125,000 acres and Tuttle Lake itself is 2,270 acres; 5,609 acres of the watershed lies in Iowa territory within Emmet County. It is a sub-watershed of the larger East Fork Des Moines River Watershed, also referred to as Hydrologic Unit Code 07100003. For the purpose of this document, grant money is only being applied for the project implementation in the Iowa portion of the Tuttle Lake Watershed. Tuttle Lake was placed on the 2002 EPA 303(d) Impaired Waters List due to a “very large population of suspended algae and very high levels of inorganic turbidity.” In 2004, the Iowa Department of Natural Resources (IDNR) completed a Total Maximum Daily Load (TMDL) study on Tuttle Lake and found excess sediment and phosphorus levels being the primary pollutants causing the algae and turbidity impairment. Although two point sources were located in Minnesota, IDNR determined that the influx of nutrients is likely from agricultural runoff and re-suspension of lake sediment. The condition of Tuttle Lake is such that the reduction of sediment, nutrients [phosphorus and nitrogen] and pathogens is the primary objective. To achieve that objective, wetlands will be constructed in this first phase to reduce the delivery of nitrogen, phosphorus, and sediment to Tuttle Lake.

09007-004 Upper Buffalo Creek Watershed Final Report

The main channel of Upper Buffalo Creek has been identified on Iowa's 303(d) List of Impaired Waters as having a biological impairment (i.e., greater than 50% decrease in mussel species) due to habitat modification, stream alteration, nutrients, and/or siltation. The Buchanan County SWCD has identified this as a priority watershed because mussel population decreases have been well documented to be directly associated with decreases in ecological value, recreational value, and overall water quality. The presence of a diverse and reproducing mussel population indicates that a healthy aquatic ecosystem is intact, which means good fishing, good water quality for wildlife, and assurance that water is safe for recreation. Dan Cohen, Buchanan Conservation Board Director, stated that "should water quality conditions improve, and fishing holes and habitat be enhanced, there is no doubt that many people would take advantage of the renewed recreational opportunities". This watershed contains two "threatened" species of mussels and five "sensitive" species of fish. The District feels that a watershed project will assist in implementing conservation practices that will greatly improve water quality and enhance biological and recreational venues.

1012-007 Yellow River Headwaters Final Report

The Yellow River Headwaters Watershed (YRHW) drains 26,730 acres of rural land within Winneshiek and Allamakee Counties. While portions of the river have been designated as a High Quality Resource by the State of Iowa, other portions appear on the State's 303(d) List of Impaired Waters due to excessive nutrients, sediment and other water quality issues. The Winneshiek SWCD was fortunate enough to secure WSPF/WPF funds for FY2009 to begin addressing many of the sources of the identified problems, especially along the all-to-critical stream corridor. Initial landowner I producer interest has exceeded expectations and several key BMPs have been installed within the identified critical areas. Yet due to the current budget constraints in the WSPF/WPF programs, we currently have greater landowner I producer interest than we do funds, which is why the District is applying for WIRB funding, to provide supplemental incentives to continue the installation of needed Grade Stabilization Structures, Terraces and Manure Management Systems in identified critical areas. Other funding, currently available to the District, will cover the remaining portions of the project's budget, including staff and our outreach efforts.

1241-018 Swan Lake Watershed Final Report

This project would construct a sediment basin on the main inlet stream to Swan Lake, an impaired waterbody currently on the 303(d) list. This project is one of the highest priorities in our Watershed Management Plan. According to STEPL modeling, it would sequester over 1/3 of the total phosphorus (the pollutant of main concern) coming into the lake.

06015-008 Bear Creek Watershed Final Report

Big Bear Creek is the upper portion of Bear Creek which drains 26,734 acres and ends at the Highway 136 crossing of Bear Creek. Bear Creek flows into the section of the Maquoketa River, which is on the EPA’s 303(d) List of Impaired Waters. Monitoring by the Iowa DNR indicates that Bear Creek is contributing significant amounts of sediment and nutrients to the Maquoketa River. The primary use of land in the Big Bear Creek Watershed is row crop production. A roadside survey completed by Anamosa Field Office Staff indicated that 123,747 tons/yr. of sediment was being lost due to sheet and rill erosion only. The sediment delivered to Big Bear Creek is 24,447 tons/yr. Based on this data, 34,226 lbs. of Phosphorus is reaching the stream per year. With the added amount of sediment and phosphorus delivery through gully and streambank erosion, one can clearly see that the water quality in Bear Creek is severely impaired. The Big Bear Watershed Project will work to reduce the sediment and phosphorus delivered to the stream by 30% through the installation of practices that trap sediment and reduce erosion.

1118-007 Lake Hendricks Watershed Final Report

Lake Hendricks is a 54 acre man-made lake that is encompassed by a 1,209 acre watershed. Lake Hendricks is currently on the 303(d) Impaired Waters List for algae and pH impairments due to an abundance of algae growth caused by nutrients being delivered to the lake via 11 separate tile lines draining adjoining cropland areas. In 2009, a Watershed Management Plan was developed in partnership with IDALS and the IDNR 319 programs and $256,500 was awarded to address the nutrient and sediment loading of the lake. Over the past three years a total of $251,000 were spent to implement one grade stabilization structure, two sediment basins, two bioreactors, 700 feet of streambank stabilization, 30.7 acres oftimber stand improvement, and 39.4 acres of Conservation Reserve Program (CRP). A proposed wetland structure and three sediment basins are scheduled to be constructed in the fall of 2011. Current water monitoring data is showing an average of 54% Nitrate (N) loading reductions as a result of the installed BMPs. The District feels further reductions are possible by addressing nutrient management issues in the cropland areas, stabilizing additional streambanks, and improving the surrounding woodland areas. The goal is to reduce N loading by an additional 20% and sediment loading by 50 tlac/yr. The resulting collaborative effort may lead to the future de-listing of Lake Hendricks from the 303(d) Impaired Waters List.

09006-003 Bear Creek Watershed Final Report

Bear Creek is an impaired warm water fishery designated as class B(LR) by the Iowa DNR and is on 303 impaired waters list for fish kills and ammonia. Bear Creek is located in eastern Delaware County. This project is designed to improve the water quality of Bear Creek by educating the landowners, operators and watershed community about the importance of this water resource. The goal of the Bear Creek Watershed Project is to improve the water quality of Bear Creek by reducing the amounts of ammoniated manure discharge, fecal coliform bacteria, sediment, nitrogen, and phosphorous. The Bear Creek Watershed Project has been a watershed project since July 2004, first as a Demo project FY 2004-2005 and then full time WSPF/319 project FY06-09. Fish kills have not occurred in 2008-2009. Sediment delivery has decreased in the Bear Creek Watershed by 5,328 tons per year. The objectives of this watershed project will be to improve Livestock Waste Storage, to improve Livestock Waste Usage, to decrease Sediment Losses, and to improve Education & Area Outreach. This project will install 2 manure storage structures (EQIP/project funded), 19 ac of CRP waterways, 12 ac of project waterways, 17 ac of CRP filter strips along stream, 12 water and sediment control basins, 18,000 ft of terraces, 350 ac of new notill planting, and 3,700 ft of streambank protection.