Total Hip and Knee Arthoplasty for Osteoarthritis : Factors Related to the Early Outcome of Surgery

Some perioperative clinical factors related to the primary cemented arthroplasty operation for osteoarthritis of the hip or knee joint are studied and discussed in this thesis. In a randomized, double-blind study, 39 patients were divided into two groups: one receiving tranexamic acid and the other not receiving it. Tranexamic acid was given in a dose of 10 mg/kg before the operation and twice thereafter, at 8-hour intervals. Total blood loss was smaller in the tranexamic acid group than in the control group. No thromboembolic complications were noticed. In a prospective, randomized study, 58 patients with hip arthroplasty and 39 patients with knee arthroplasty were divided into groups with postoperative closed-suction drainage and without drainage. There was no difference in healing of the wounds, postoperative blood transfusions, complications or range of motion. As a result of this study, the use of drains is no longer recommended. In a randomised study the effectiveness of a femoral nerve block (25 patients) was compared with other methods of pain control (24 patients) on the first postoperative day after total knee arthroplasty. The femoral block consisted of a single injection administered at patients´ bedside during the surgeon´s hospital rounds. Femoral block patients reported less pain and required half of the amount of oxycodone. Additional femoral block or continued epidural analgesia was required more frequently by the control group patients. Pain management with femoral blocks resulted in less work for nursing staff. In a retrospective study of 422 total hip and knee arthroplasty cases the C-reactive protein levels and clinical course were examined. After hip and knee arthroplasty the maximal C-reactive protein values are seen on the second and third postoperative days, after which the level decreases rapidly. There is no difference between patients with cemented or uncemented prostheses. Major postoperative complications may cause a further increase in C-reactive protein levels at one and two weeks. In-hospital and outpatient postoperative control radiographs of 200 hip and knee arthroplasties were reviewed retrospectively. If postoperative radiographs are of good quality, there seems to be no need for early repetitive radiographs. The quality and safety of follow-up is not compromised by limiting follow-up radiographs to those with clinical indications. Exposure of the patients and the staff to radiation is reduced. Reading of the radiographs by only the treating orthopaedic surgeon is enough. These factors may seem separate from each other, but linking them together may help the treating orthopaedic surgeon to adequate patient care strategy. Notable savings can be achieved.

A stereoselective total synthesis of (−)-seychellene

A stereoselective total synthesis of the tricyclic sesquiterpene (−)-seychellene, starting from (R)-carvone via (R)-3-methylcarvone has been accomplished, employing a combination of intermolecular Michael addition–intramolecular Michael addition sequence, a stereoselective hydrogenation, and an intramolecular alkylation reaction.

QCD and total cross-sections : photons and hadrons

In this contribution, we discuss a total cross-section model which can be applied to both photon and purely hadronic processes. We find that the model can reproduce photo-production cross-sections, as well as extrapolation of gamma*p processes to gamma p using Vector Meson Dominance models, with minimal modifications from the proton case.

QCD and total cross-sections : photons and hadrons

In this contribution, we discuss a total cross-section model which can be applied to both photon and purely hadronic processes. We find that the model can reproduce photo-production cross-sections, as well as extrapolation of gamma*p processes to gamma p using Vector Meson Dominance models, with minimal modifications from the proton case.

Estimation of thermal breakdown voltage of HVDC cables - A theoretical framework

The insulation in a dc cable is subjected to both thermal and electric stress at the same time. While the electric stress is generic to the cable, the temperature rise in the insulation is, by and large, due to the Ohmic losses in the conductor. The consequence of this synergic effect is to reduce the maximum operating voltage and causes a premature failure of the cable. The authors examine this subject in some detail and propose a comprehensive theoretical formulation relating the maximum thermal voltage (MTV) to the physical and geometrical parameters of the insulation. The heat flow patterns and boundary conditions considered by the authors here and those found in earlier literature are provided. The MTV of a dc cable is shown to be a function of the load current apart from the resistance of the insulation. The results obtained using the expressions, developed by the authors, are compared with relevant results published in the literature and found to be in close conformity.

Modeling and analysis of a tunable piezoelectric structure for transverse shear wave generation

An analytical investigation of the transverse shear wave mode tuning with a resonator mass (packing mass) on a Lead Zirconium Titanate (PZT) crystal bonded together with a host plate and its equivalent electric circuit parameters are presented. The energy transfer into the structure for this type of wave modes are much higher in this new design. The novelty of the approach here is the tuning of a single wave mode in the thickness direction using a resonator mass. First, a one-dimensional constitutive model assuming the strain induced only in the thickness direction is considered. As the input voltage is applied to the PZT crystal in the thickness direction, the transverse normal stress distribution induced into the plate is assumed to have parabolic distribution, which is presumed as a function of the geometries of the PZT crystal, packing mass, substrate and the wave penetration depth of the generated wave. For the PZT crystal, the harmonic wave guide solution is assumed for the mechanical displacement and electric fields, while for the packing mass, the former is solved using the boundary conditions. The electromechanical characteristics in terms of the stress transfer, mechanical impedance, electrical displacement, velocity and electric field are analyzed. The analytical solutions for the aforementioned entities are presented on the basis of varying the thickness of the PZT crystal and the packing mass. The results show that for a 25% increase in the thickness of the PZT crystal, there is ~38% decrease in the first resonant frequency, while for the same change in the thickness of the packing mass, the decrease in the resonant frequency is observed as ~35%. Most importantly the tuning of the generated wave can be accomplished with the packing mass at lower frequencies easily. To the end, an equivalent electric circuit, for tuning the transverse shear wave mode is analyzed.

The Exeter Contemporary flanged cemented acetabular component in primary total hip arthroplasty

Aims: We report on the outcome of the Exeter Contemporary flanged cemented all-polyethylene acetabular component with a mean follow-up of 12 years (10 to 13.9). This study reviewed 203 hips in 194 patients. 129 hips in 122 patients are still in situ; 66 hips in 64 patients were in patients who died before ten years, and eight hips (eight patients) were revised. Clinical outcome scores were available for 108 hips (104 patients) and radiographs for 103 hips (100 patients). Patients and Methods: A retrospective review was undertaken of a consecutive series of 203 routine primary cemented total hip arthroplasties (THA) in 194 patients. Results: There were no acetabular component revisions for aseptic loosening. Acetabular revision was undertaken in eight hips. In four hips revision was necessitated by periprosthetic femoral fractures, in two hips by recurrent dislocation, in one hip for infection and in one hip for unexplained ongoing pain. Oxford and Harris hip scores demonstrated significant clinical improvement (all p < 0.001). Radiolucent lines were present in 37 (36%) of the 103 acetabular components available for radiological evaluation. In 27 of these, the line was confined to zone 1. No component had migrated. Conclusion: Kaplan–Meier survivorship, with revision for aseptic loosening as the endpoint, was 100% at 12.5 years and for all causes was 97.8% (95% confidence interval 95.6 to 100) when 40 components remained at risk. The Exeter Contemporary flanged cemented acetabular component demonstrates excellent survivorship at 12.5 years. Take home message: The Exeter Contemporary flanged cemented acetabular component has excellent clinical outcomes and survivorship when used with the Exeter stem in total hip arthroplasty.

Morbid obesity in total hip arthroplasty: Redefining outcomes for operative time, length of stay, and readmission

Background The incidence of obesity amongst patients presenting for elective Total Hip Arthroplasty (THA) has increased in the last decade and the relationship between obesity and the need for joint replacement has been demonstrated. This study evaluates the effects of morbid obesity on outcomes following primary THA by comparing short-term outcomes in THA between a morbidly obese (BMI ≥40) and a normal weight (BMI 18.5 - <25) cohort at our institution between January 2003 and December 2010. Methods Thirty-nine patients included in the morbidly obese group were compared with 186 in the normal weight group. Operative time, length of stay, complications, readmission and length of readmission were compared. Results Operative time was increased in the morbidly obese group at 122 minutes compared with 100 minutes (p=0.002). Post-operatively there was an increased 30-day readmission rate related to surgery of 12.8% associated with BMI ≥40 compared with 2.7% (p= 0.005) as well as a 5.1 fold increase in surgery related readmitted bed days - 0.32 bed days per patient for normal weight compared with 1.64 per patient for the morbidly obese (p=0.026). Conclusion Morbidly obese patients present a technical challenge and likely this and the resultant complications are underestimated. More work needs to be performed in order to enable suitable allocation of resources.

The third post-Newtonian gravitational wave polarizations and associated spherical harmonic modes for inspiralling compact binaries in quasi-circular orbits

The gravitational waveform (GWF) generated by inspiralling compact binaries moving in quasi-circular orbits is computed at the third post-Newtonian (3PN) approximation to general relativity. Our motivation is two-fold: (i) to provide accurate templates for the data analysis of gravitational wave inspiral signals in laser interferometric detectors; (ii) to provide the associated spin-weighted spherical harmonic decomposition to facilitate comparison and match of the high post-Newtonian prediction for the inspiral waveform to the numerically-generated waveforms for the merger and ringdown. This extension of the GWF by half a PN order (with respect to previous work at 2.5PN order) is based on the algorithm of the multipolar post-Minkowskian formalism, and mandates the computation of the relations between the radiative, canonical and source multipole moments for general sources at 3PN order. We also obtain the 3PN extension of the source multipole moments in the case of compact binaries, and compute the contributions of hereditary terms (tails, tails-of-tails and memory integrals) up to 3PN order. The end results are given for both the complete plus and cross polarizations and the separate spin-weighted spherical harmonic modes.

Total cross-section at LHC from minijets and soft gluon resummation in the infrared region

A model for total cross-sections incorporating QCD jet cross-sections and soft gluon resummation is described and compared with present data on pp and pp cross-sections. Predictions for LHC are presented for different parameter sets. It is shown that they differ according to the small x-behaviour of available parton density functions.

Three-level inverter fed open-end winding IM drive with common mode voltage elimination and reduced power device count

A three-level space phasor generation scheme with common mode elimination and with reduced power device count is proposed for an open end winding induction motor in this paper. The open end winding induction motor is fed by the three-level inverters from both sides. Each two level inverter is formed by cascading two two-level inverters. By sharing the bottom inverter for the two three-level inverters on either side, the power device count is reduced. The switching states with zero common mode voltage variation are selected for PWM switching so that there is no alternating common mode voltage in the pole voltages as well as in phase voltages. Only two isolated DC-links, with half the voltage rating of a conventional three-level neutral point clamped inverter, are needed for the proposed scheme.

Infrared gluons, intrinsic transverse momentum and rising total cross-sections

We discuss the infrared limit for soft gluon k(t)-resummation and relate it to physical observables such as the intrinsic transverse momentum and the high energy limit of total cross-sections.

An expeditious enantiospecific total synthesis of (+)-7-epi-goniofufurone

Stereoselective synthesis of styryl lactone, (+)-7-epi-goniofufurone was achieved in high yield via simple transformations from tartaric acid. The key step involves the successive stereoselective reduction of ketones with borohydride and selectride.

A voltage-sensorless control method to balance the input currents of a three-wire boost rectifier under unbalanced input voltages condition

This paper proposes a control method that can balance the input currents of the three-phase three-wire boost rectifier under unbalanced input voltage condition. The control objective is to operate the rectifier in the high-power-factor mode under balanced input voltage condition but to give overriding priority to the current balance function in case of unbalance in the input voltage. The control structure has been divided into two major functional blocks. The inner loop current-mode controller implements resistor emulation to achieve high-power-factor operation on each of the two orthogonal axes of the stationary reference frame. The outer control loop performs magnitude scaling and phase-shifting operations on current of one of the axes to make it balanced with the current on the other axis. The coefficients of scaling and shifting functions are determined by two closed-loop prportional-integral (PI) controllers that impose the conditions of input current balance as PI references. The control algorithm is simple and high performing. It does not require input voltage sensing and transformation of the control variables into a rotating reference frame. The simulation results on a MATLAB-SIMULINK platform validate the proposed control strategy. In implementation Texas Instrument's digital signal processor TMS320F24OF is used as the digital controller. The control algorithm for high-power-factor operation is tested on a prototype boost rectifier under nominal and unbalanced input voltage conditions.