Operative Treatment of Acute Fractures of the Tarsal Navicular Body: Midterm Results With a New Classification.

BACKGROUND Treatment of displaced tarsal navicular body fractures usually consists of open reduction and internal fixation. However, there is little literature reporting results of this treatment and correlation to fracture severity. METHODS We report the results of 24 patients treated in our institution over a 12-year period. Primary outcome measurements were Visual-Analogue-Scale Foot and Ankle score (VAS-FA), AOFAS midfoot score, and talonavicular osteoarthritis at final follow-up. According to a new classification system reflecting talonavicular joint damage, 2-part fractures were classified as type I, multifragmentary fractures as type II, and fractures with talonavicular joint dislocation and/or concomitant talar head fractures as type III. Spearman's coefficients tested this classification's correlation with the primary outcome measurements. Mean patient age was 33 (range 16-61) years and mean follow-up duration 73 (range 24-159) months. RESULTS Average VAS-FA score was 74.7 (standard deviation [SD] 16.9), and average AOFAS midfoot score was 83.8 (SD = 12.8). Final radiographs showed no talonavicular arthritis in 5 patients, grade 1 in 7, grade 2 in 3, grade 3 in 6, and grade 4 in 1 patient. Two patients had secondary or spontaneous talonavicular fusion. Spearman coefficients showed strong correlation of the classification system with VAS-FA score (r = -0.663, P < .005) and talonavicular arthritis (r = 0.600, P = .003), and moderate correlation with AOFAS score (r = -.509, P = .011). CONCLUSION At midterm follow-up, open reduction and internal fixation of navicular body fractures led to good clinical outcome but was closely related to fracture severity. A new classification based on the degree of talonavicular joint damage showed close correlation to clinical and radiologic outcome. LEVEL OF EVIDENCE Level IV, retrospective case series.

Modeling soil system: complexity under your feet

A clear statement in these lines textually cited (Byers et al., 1938) defines the framework of this special issue: “True soil is the product of the action of climate and living organism upon the parent material, as conditioned by the local relief. The length of time during which these forces are operative is of great importance in determining the character of the ultimate product. Drainage conditions are also important and are controlled by local relief, by the nature of the parent material or underlying rock strata, or by the amount of precipitation in relation to rate of percolation and runoff water. There are, therefore, five principal factors of soil formation: Parent material, climate, biological activity, relief and time. These soil forming factors are interdependent, each modifying the effectiveness of the others.” Due to these various processes associated to its formation and genesis soil dynamics reveals high complexity that creates several levels of structure using this term in a broad sense

RADIANCE-A planning software for intra-operative radiation therapy

In the last decades accumulated clinical evidence has proven that intra-operative radiation therapy (IORT) is a very valuable technique. In spite of that, planning technology has not evolved since its conception, being outdated in comparison to current state of the art in other radiotherapy techniques and therefore slowing down the adoption of IORT. RADIANCE is an IORT planning system, CE and FDA certified, developed by a consortium of companies, hospitals and universities to overcome such technological backwardness. RADIANCE provides all basic radiotherapy planning tools which are specifically adapted to IORT. These include, but are not limited to image visualization, contouring, dose calculation algorithms-Pencil Beam (PB) and Monte Carlo (MC), DVH calculation and reporting. Other new tools, such as surgical simulation tools have been developed to deal with specific conditions of the technique. Planning with preoperative images (preplanning) has been evaluated and the validity of the system being proven in terms of documentation, treatment preparation, learning as well as improvement of surgeons/radiation oncologists (ROs) communication process. Preliminary studies on Navigation systems envisage benefits on how the specialist to accurately/safely apply the pre-plan into the treatment, updating the plan as needed. Improvements on the usability of this kind of systems and workflow are needed to make them more practical. Preliminary studies on Intraoperative imaging could provide an improved anatomy for the dose computation, comparing it with the previous pre-plan, although not all devices in the market provide good characteristics to do so. DICOM.RT standard, for radiotherapy information exchange, has been updated to cover IORT particularities and enabling the possibility of dose summation with external radiotherapy. The effect of this planning technology on the global risk of the IORT technique has been assessed and documented as part of a failure mode and effect analysis (FMEA). Having these technological innovations and their clinical evaluation (including risk analysis) we consider that RADIANCE is a very valuable tool to the specialist covering the demands from professional societies (AAPM, ICRU, EURATOM) for current radiotherapy procedures.

The condition of women workers under the present industrial system: an address by Ida M. Van Etten at the National Convention of the American Federation of Labor held at Detroit, Michigan, December 8th, 1890

At head of title: Publication of the American Federation of Labor.

Description of the ITER Tokamak Cooling Water System

In questa tesi ho inizialmente esposto cenni teorici sulle reazioni di fusione nucleare e le motivazioni che hanno spinto la comunità scientifica verso la ricerca di questa nuova fonte energetica. Ho descritto il progetto ITER nei suoi obiettivi e nei principi di funzionamento di un reattore di tipo Tokamak e di tutti i componenti principali dell'intero impianto. In primo piano, mi sono focalizzato sul sistema di raffreddamento primario ad acqua del Tokamak (TCWS), con una prima panoramica sui suoi sottosistemi descrivendo i loro obiettivi, quali asportazione di calore e sicurezza dell'impianto. Successivamente ho analizzato nello specifico i particolari tecnici dei principali sottosistemi quali i vari circuiti di asportazione primaria del calore (PHTS Loops) dei diversi componenti del Tokamak, il Vacuum Vessel, il First Wall Blanket, il Divertor e il Neutral Beam Injector; ho esaminato i processi di controllo della qualità e del volume del fluido refrigerante nei circuiti (CVCS); ed infine le funzioni e le caratteristiche dei sistemi di drenaggio e di riempimento dei circuiti con i propri serbatoi ordinari e di sicurezza, e del sistema di asciugatura del fluido refrigerante con le sue diverse modalità operative.

A system of surgery : theoretical and practical /

Imprint varies: v. 2-3 published by Parker, son, and Bourn; v. 4 by Longman, Green, Longman, Roberts, and Green.

Annual for the year ... : containing full particulars of the system of conducting its business, and statistics of the society from its commencement in 1884.

Absorbed by the People's year book in 1919.

A system of surgery, theoretical and practical.

v. I. General pathology. Morbid processes. Injuries in general. Complications of injuries. Injuries of regions. 1881.--v. 2. Diseases of organs of special sense. Diseases of circulatory system. Diseases of digestive tract. Diseases of genito-urinary organs. 1881.--v. 3. Diseases of the respiratory organs. Diseases of the bones, joints, and muscles. Diseases of the nervous system. Gunshot wounds. Operative and minor surgery. Miscellaneous subjects. 1882.

A system of practical surgery.

Mode of access: Internet.

Rose's notes on the United States Supreme court reports (2 Dallas to 241 United States reports) showing the present value as authority of all cases therein reported as disclosed by all subsequent citations in all the courts of last resort, both federal and state, and in the annotations in American decisions, American reports, American state reports, Annotated cases (American and English), Lawyers' reports annotated, English ruling cases, British ruling cases, Negligence and compensation cases annotated, with parallel references to the above-mentioned Annotated cases, the Lawyers' edition of the U. S. reports and the Reporter system,

Kept up to date by supplements

A system of practical surgery /

Includes index.

American jurisprudence : a comprehensive text statement of American case law as developed in the cases and annotations in the Annotated reports system, being a rewriting of Ruling case law to reflect the modern developments of the law /

Kept up to date by "revised" or replacement vols. ; subtitle varies.

Exercise ech predicts development of late post-operative left ventricular dysfunction and cardiac morbidity in asymptomatic severe mitral regurgitation

Objective: Mitral repair is increasingly performed in asymptomatic mitral regurgitation (MR). Previous work showed that pre-operative documentation of loss of contractile reserve (Cr) by exercise echo (ExE) may predict LV dysfunction early after repair. We sought the value of Cr in predicting late post-op LV dysfunction and clinical outcome. Methods: Pre-op ExE was performed in 41 pts with isolated MR without coronary disease undergoing repair. LV end-systolic and end-diastolic volumes were measured at rest and post-stress and EF was calculated using modified Simpson’s rule. Intact Cr was defined by >4% increment of stress compared with rest EF. During follow up (3±1 years), EF was serially assessed and occurrence of cardiac events was documented. Results: Cr was present in 19 pts (Cr+)(peak EF 76±7%) and absent in 22 pts (Cr-)(peak EF 56±11%, p

A simulation of a workflow management system

Suggests that simulation of the workflow component of a computer supported co-operative work (CSCW) system has the potential to reduce the costs of system implementation, while at the same time improving the quality of the delivered system. Demonstrates the value of being able to assess the frequency and volume of workflow transactions using a case study of CSCW software developed for estate agency co-workers in which a model was produced based on a discrete-event simulation approach with implementation on a spreadsheet platform.