STUDY ON IMPLANT STABILITY IN CEMENTLESS TOTAL KNEE ARTHROPLASTY

Objetives: Determine the stability of tibial and femoral components of 20 cementless knee arthroplasties with rotating platform. Methods: The 20 patients (20 knees) underwent an analysis of dynamic radiographs with an image amplifier and maneuvers of varus and valgus which were compared to static frontal and lateral radiographs of the knees and analyzed by two experienced surgeons in a double-blind way. Results: We could observe in this study that both methods showed very similar results for the stability of the tibial and femoral components (p<0.001) using the Kappa method for comparison. Conclusion: The tibial component was more unstable in relation to the femoral component in both static and dynamic studies. Level of Evidence IV, Case Series.

Judet quadricepsplasty in the treatment of posttraumatic knee rigidity: Long-term outcomes of 45 cases

BACKGROUND: Posttraumatic knee stiffness is a very debilitating condition. Judet's quadricepsplasty technique has been used for more than 50 years. However, few reports of quadricepsplasty results exist in the literature. METHODS: We report the results of 45 cases of posttraumatic arthrofibrosis of the knee treated with Judet's quadricepsplasty. The results of the procedure were analyzed by measuring the degrees of flexion of the operated knees at different time points (before, immediately after, and late postoperatively). RESULTS: The degree of flexion increased from 33.6 degrees (range, 5-80 degrees) preoperatively to 105 degrees (range, 45-160 degrees) immediately after surgery, followed by a slight fall in the range of motion (ROM) in the late postoperative period, which reached an average of 84.8 degrees. There was no significant correlation between knee strength and the patient's gender, but there was a slight trend of lower strength with age. Although Judet's quadricepsplasty technique dates from more than 50 years ago, it still provides good outcomes in the treatment of rigid knees of various etiologies. In general, all cases showed the same pattern of a small decrease in the ROM in the late postoperative period. CONCLUSION: Judet's quadricepsplasty can increase the ROM of rigid knees. The ROM obtained with the surgery persists long term. (J Trauma. 2012; 72: E77-E80. Copyright (C) 2012 by Lippincott Williams & Wilkins)

Short-term efficacy of physical interventions in osteoarthritic knee pain. A systematic review and meta-analysis of randomised placebo-controlled trials

Abstract Background Treatment efficacy of physical agents in osteoarthritis of the knee (OAK) pain has been largely unknown, and this systematic review was aimed at assessing their short-term efficacies for pain relief. Methods Systematic review with meta-analysis of efficacy within 1–4 weeks and at follow up at 1–12 weeks after the end of treament. Results 36 randomised placebo-controlled trials (RCTs) were identified with 2434 patients where 1391 patients received active treatment. 33 trials satisfied three or more out of five methodological criteria (Jadad scale). The patient sample had a mean age of 65.1 years and mean baseline pain of 62.9 mm on a 100 mm visual analogue scale (VAS). Within 4 weeks of the commencement of treatment manual acupuncture, static magnets and ultrasound therapies did not offer statistically significant short-term pain relief over placebo. Pulsed electromagnetic fields offered a small reduction in pain of 6.9 mm [95% CI: 2.2 to 11.6] (n = 487). Transcutaneous electrical nerve stimulation (TENS, including interferential currents), electro-acupuncture (EA) and low level laser therapy (LLLT) offered clinically relevant pain relieving effects of 18.8 mm [95% CI: 9.6 to 28.1] (n = 414), 21.9 mm [95% CI: 17.3 to 26.5] (n = 73) and 17.7 mm [95% CI: 8.1 to 27.3] (n = 343) on VAS respectively versus placebo control. In a subgroup analysis of trials with assumed optimal doses, short-term efficacy increased to 22.2 mm [95% CI: 18.1 to 26.3] for TENS, and 24.2 mm [95% CI: 17.3 to 31.3] for LLLT on VAS. Follow-up data up to 12 weeks were sparse, but positive effects seemed to persist for at least 4 weeks after the course of LLLT, EA and TENS treatment was stopped. Conclusion TENS, EA and LLLT administered with optimal doses in an intensive 2–4 week treatment regimen, seem to offer clinically relevant short-term pain relief for OAK.

Tradução e validação da escala Knee Society Score: KSS para a Língua Portuguesa

OBJETIVO: Traduzir, adaptar culturalmente e validar o "Knee Society Score" (KSS) para a língua portuguesa e verificar suas propriedades de medida, reprodutibilidade e validade. MÉTODO: Avaliados 70 pacientes de ambos os sexos, em estudo clínico transversal, idade entre 55 e 85 anos, osteoartrose primária submetidos a artroplastia total de joelho, com o questionário KSS pelo avaliador 1 (inglês) e após 30 minutos pelo avaliador 2 (português) no pré- operatório e após três e seis meses de pós-operatório. RESULTADOS: O índice alfa de Cronbach e a diagramação de Bland-Altman não detectaram diferença entre as médias das duas avaliações no pré-operatório (p=1,000), com três meses (p=0,991) e seis meses de pós-operatório (p=0,985) na pontuação do joelho e na nota da função do joelho, p=1,000 nos três períodos. CONCLUSÃO: A versão brasileira do Knee Society Score, o Escore da Sociedade do Joelho, mostrou ser um instrumento de fácil compreensão e aplicação; válido e confiável para medir a pontuação e função do joelho de pacientes brasileiros submetidos a ATJ. Nível de Evidências: Estudos diagnósticos - Nivel de Evidência I, Teste de critérios diagnósticos desenvolvidos anteriormente em pacientes consecutivos (com padrão de referência "ouro" aplicado).

Chain extension of poly (ethylene terephthalate) by reactive extrusion with secondary stabilizer

Poly(ethylene tereftalate) (PET) is a polymer highly susceptible to the hydrolytic reactions that occur during applications and mainly in thermomechanical processing. These reactions lead to the decrease of molecular weight of the polymer, limiting the recycling number of the material. The reactive extrusion of the PET in presence of chain extenders is an alternative to recover mechanical and rheological properties that were depreciated by the polymer degradation. In this study, PET wastes from nonwoven fabrics production were extruded in presence of the secondary stabilizer Irgafos 126 (IRG) on variable concentrations. The results showed that Irgafos 126 increased molecular weight, decreased crystallinity and changed processing behavior of the PET, similarly to the effects produced by the well-known chain extender pyromellitic dianhydride (PMDA), showing that the secondary stabilizer Irgafos 126 can also act as a chain extender for the PET.

Clinical rearfoot and knee static alignment measurements are not associated with patellofemoral pain syndrome

The aim of the present study was to investigate the association between the patellofemoral pain syndrome and the clinical static measurements: the rearfoot and the Q angles. The design was a cross-sectional, observational, case-control study. We evaluated 77 adults (both genders), 30 participants with patellofemoral pain syndrome, and 47 controls. We measured the rearfoot and Q angles by photogrammetry. Independent t-tests were used to compare outcome continuous measures between groups. Outcome continuous data were also transformed into categorical clinical classifications, in order to verify their statistical association with the dysfunction, and χ2 tests for multiple responses were used. There were no differences between groups for rearfoot angle [mean differences: 0.2º (95%CI -1.4-1.8)] and Q angle [mean differences: -0.3º (95%CI -3.0-2.4). No associations were found between increased rearfoot valgus [Odds Ratio: 1.29 (95%CI 0.51-3.25)], as well as increased Q angle [Odds Ratio: 0.77 (95%CI 0.31-1.93)] and the patellofemoral pain syndrome occurrence. Although widely used in clinical practice and theoretically thought, it cannot be affirmed that increased rearfoot valgus and increased Q angle, when statically measured in relaxed stance, are associated with patellofemoral pain syndrome (PFPS). These measures may have limited applicability in screening of the PFPS development.

Hypoxia and the cardiovascular response to dynamic knee-extensor exercise

[EN] Hypoxia affects O2 transport and aerobic exercise capacity. In two previous studies, conflicting results have been reported regarding whether O2 delivery to the muscle is increased with hypoxia or whether there is a more efficient O2 extraction to allow for compensation of the decreased O2 availability at submaximal and maximal exercise. To reconcile this discrepancy, we measured limb blood flow (LBF), cardiac output, and O2 uptake during two-legged knee-extensor exercise in eight healthy young men. They completed studies at rest, at two submaximal workloads, and at peak effort under normoxia (inspired O2 fraction 0.21) and two levels of hypoxia (inspired O2 fractions 0.16 and 0.11). During submaximal exercise, LBF increased in hypoxia and compensated for the decrement in arterial O2 content. At peak effort, however, our subjects did not achieve a higher cardiac output or LBF. Thus O2 delivery was not maintained and peak power output and leg O2 uptake were reduced proportionately. These data are consistent then with the findings of an increased LBF to compensate for hypoxemia at submaximal exercise, but no such increase occurs at peak effort despite substantial cardiac capacity for an elevation in LBF.

A new approach for the dynamic modelling of the human knee

Mathematical models of the knee joint are important tools which have both theoretical and practical applications. They are used by researchers to fully understand the stabilizing role of the components of the joint, by engineers as an aid for prosthetic design, by surgeons during the planning of an operation or during the operation itself, and by orthopedists for diagnosis and rehabilitation purposes. The principal aims of knee models are to reproduce the restraining function of each structure of the joint and to replicate the relative motion of the bones which constitute the joint itself. It is clear that the first point is functional to the second one. However, the standard procedures for the dynamic modelling of the knee tend to be more focused on the second aspect: the motion of the joint is correctly replicated, but the stabilizing role of the articular components is somehow lost. A first contribution of this dissertation is the definition of a novel approach — called sequential approach — for the dynamic modelling of the knee. The procedure makes it possible to develop more and more sophisticated models of the joint by a succession of steps, starting from a first simple model of its passive motion. The fundamental characteristic of the proposed procedure is that the results obtained at each step do not worsen those already obtained at previous steps, thus preserving the restraining function of the knee structures. The models which stem from the first two steps of the sequential approach are then presented. The result of the first step is a model of the passive motion of the knee, comprehensive of the patello-femoral joint. Kinematical and anatomical considerations lead to define a one degree of freedom rigid link mechanism, whose members represent determinate components of the joint. The result of the second step is a stiffness model of the knee. This model is obtained from the first one, by following the rules of the proposed procedure. Both models have been identified from experimental data by means of an optimization procedure. The simulated motions of the models then have been compared to the experimental ones. Both models accurately reproduce the motion of the joint under the corresponding loading conditions. Moreover, the sequential approach makes sure the results obtained at the first step are not worsened at the second step: the stiffness model can also reproduce the passive motion of the knee with the same accuracy than the previous simpler model. The procedure proved to be successful and thus promising for the definition of more complex models which could also involve the effect of muscular forces.

Innovative treatments for shelf-life extension of whole and fresh-cut fruit

Maintaining the postharvest quality of whole and fresh-cut fruit during storage and distribution is the major challenge facing fruit industry. For this purpose, industry adopt a wide range of technologies to enable extended shelf-life. Many factors can lead to loss of quality in fresh product, hence the common description of these products as ‘perishable’. As a consequence normal factors such as transpiration and respiration lead ultimately to water loss and senescence of the product. Fruits and vegetables are living commodities and their rate of respiration is of key importance to maintenance of quality. It has been commonly observed that the greater the respiration rate of a product, the shorter the shelf-life. The principal problem for fresh-cut fruit industries is the relative shorter shelf-life of minimally processed fruit (MPF) compared to intact product. This fact is strictly connected with the higher ethylene production of fruit tissue stimulated during fresh-cut processing (peeling, cutting, dipping). 1-Methylcyclopropene (1-MCP) is an inhibitor of ethylene action and several researches have shown its effectiveness on the inhibition of ripening and senescence incidence for intact fruit and consequently on their shelf-life extension. More recently 1-MCP treatment has been tested also for shelf-life extension of MPF but discordant results have been obtained. Considering that in some countries 1-MCP is already a commercial product registered for the use on a number of horticultural products, the main aim of this actual study was to enhance our understanding on the effects of 1-MCP treatment on the quality maintenance of whole and fresh-cut climacteric and non-climacteric fruit (apple, kiwifruit and pineapple). Concerning the effects of 1-MCP on whole fruit, was investigated the effects of a semi-commercial postharvest treatment with 1-MCP on the quality of Pink Lady apples as functions of fruit ripening stage, 1-MCP dose, storage time and also in combination with controlled atmospheres storage in order to better understand what is the relationship among these parameters and if is possible to maximize the 1-MCP treatment to meet the market/consumer needs and then in order to put in the market excellent fruit. To achieve this purpose an incomplete three-level three-factor design was adopted. During the storage were monitored several quality parameters: firmness, ripening index, ethylene and carbon dioxide production and were also performed a sensory evaluations after 6 month of storage. In this study the higher retention of firmness (at the end of storage) was achieved by applying the greatest 1-MCP concentration to fruits with the lowest maturity stage. This finding means that in these semi-commercial conditions we may considerate completely blocked the fruit softening. 1-MCP was able to delay also the ethylene and CO2 production and the maturity parameters (soluble solids content and total acidity). Only in some cases 1-MCP generate a synergistic effect with the CA storage. The results of sensory analyses indicated that, the 1-MCP treatment did not affect the sweetness and whole fruit flavour while had a little effect on the decreasing cut fruit flavour. On the contrary the treated apple was more sour, crisp, firm and juicy. The effects of some treatment (dipping and MAP) on the nutrient stability were also investigated showing that in this case study the adopted treatments did not have drastic effects on the antioxidant compounds on the contrary the dipping may enhance the total antioxidant activity by the accumulation of ascorbic acid on the apple cut surface. Results concerning the effects of 1-MCP in combination with MAP on the quality parameters behaviour of the kiwifruit were not always consistent and clear: in terms of colour maintenance, it seemed to have a synergistic effect with N2O MAP; as far as ripening index is concerned, 1-MCP had a preservative effect, but just for sample packed in air.

Internal Model Principle: extension to the switching case and applications

This thesis deals with a novel control approach based on the extension of the well-known Internal Model Principle to the case of periodic switched linear exosystems. This extension, inspired by power electronics applications, aims to provide an effective design method to robustly achieve the asymptotic tracking of periodic references with an infinite number of harmonics. In the first part of the thesis the basic components of the novel control scheme are described and preliminary results on stabilization are provided. In the second part, advanced control methods for two applications coming from the world high energy physics are presented.

Registrazione e replicazione di procedure Web con una Firefox Extension

In questo lavoro di tesi è stata sviluppata una Firefox Extension per la registrazione e la replicazione di procedure sul Web. Si tratterà a fondo l’ambiente tecnologico nel quale è stata sviluppata l’applicazione e il contesto in cui si inserisce una Firefox Extension. Illustreremo il problema che intendiamo risolvere con la nostra estensione,il contesto applicativo in cui si inserisce e riporteremo una serie di lavori correlati che cercano, con diversi approcci, di risolvere il nostro stesso problema. Illustreremo il lavoro trattando approfonditamente l’approccio da noi utilizzato, mostrandone i vantaggi e i limiti.

Eocene nappe tectonics and late Alpine extension in the Central Anatolide belt, western Turkey

Strukturgeologische Untersuchungen belegen, daß die Anatoliden der Westtürkei im Eozän durch die Plazierung der Kykladischen Blauschiefereinheit entlang einer durchbrechenden Überschiebung auf die Menderes-Decken unter grünschieferfaziellen Metamorphosebedingungen entstanden.Die kykladischen Blauschiefer in der Westtürkei enthalten Relikte eines prograden alpinen Gefüges (DA1), welches hochruckmetamorph von Disthen und Chloritoid poikiloblastisch überwachsen wurde. Dieses Mineralstadium dauerte noch während des Beginns des nachfolgenden Deformationsereignisses (DA2) an, welches durch NE-gerichtete Scherung und Dekompression charakterisiert ist. Die nachfolgende Deformation (DA3) war das erste Ereignis, das beide Einheiten, sowohl die kykladische Blauschifereinheit als auch die Menderes-Decken, gemeinsam erfaßte. Der Überschiebungskontakt zwischen der kykladischen Blauschiefereinheit und den Menderes-Decken ist eine DA3-Scherzone: die ‘Cycladic-Menderes Thrust’ (CMT). Entlang der CMT-Überschiebungsbahn wurden die kykladischen Blauschiefer gegen veschiedene Einheiten der MN plaziert. Die CMT steigt nach S zum strukturell Hangenden hin an und kann daher als eine durchbrechende Überschiebung entlang einer nach S ansteigenden Rampe betrachtet werden. In den kykladischen Blauschiefern überprägen DA3-Strukturen, die im Zusammenhang mit der CMT stehen, hochdruckmentamorphe Gefüge.In den Menderes-Decken, dem Liegenden der CMT, wird DA3 durch regional vebreitete Gefügeelemente dokumentiert, die im Zusammenhang mit S-gerichteten Schersinnindikatoren stehen. DA3-Gefüge haben die Decken intern deformiert und bilden jene Scherzonen, welche die Decken untereinander abgrenzen. In der Çine-Decke können granitische Gesteine in Orthogneise und Metagranite unterteilt werden. Die Deformationsgeschichte dieser Gesteine dokumentiert zwei Ereignisse. Ein frühes amphibolitfazielles Ereignis erfaßte nur die Orthogneise, in denen vorwiegend NE-SW orientierte Lineare und NE-gerichtete Schersinnindikatoren entstanden. Die jüngeren Metagranite wurden sowohl durch vereinzelte DA3-Scherzonen, als auch in einer großmaßstäblichen DA3-Scherzone am Südrand des Çine-Massivs deformiert. In DA3-Scherzonen sind die Lineare N-S orientiert und die zugehörigen Schersinnindikatoren zeigen S-gerichtete Scherung unter grünschieferfaziellen Bedingungen an. Diese grünschieferfaziellen Scherzonen überprägen die amphibolitfaziellen Gefüge in den Orthogneisen. Magmatische Zirkone aus einem Metagranit, der einen Orthogneiss mit Top-NE Gefügen durchschlägt, ergaben ein 207Pb/206Pb-Alter von 547,2±1,0 Ma. Dies deutet darauf hin, daß DPA proterozoischen Alters ist. Dies wird auch durch die Tatsache gestützt, daß triassische Granite in der Çine- und der Bozdag-Decke keine DPA-Gefüge zeigen. Die jüngeren Top-S-Gefüge sind wahrscheinlich zur gleichen Zeit entstanden wie die ältesten Gefüge der Bayindir-Decke.Das Fehlen von Hochdruck-Gefügen im Liegenden der CMT impliziert eine Exhumierung der kykladischen Blauschiefer von mehr ca. 35 km, bevor diese im Eozän auf die Menderes-Decken aufgeschoben wurden. Die substantiellen Unterschiede bezüglich in der tektonometamorphen Geschichte der kykladischen Blauschiefer und der Menderes-Decken widersprechen der Modellvorstellung eines lateral kontinuierlichen Orogengürtels, nach der die Menderes-Decken als östliche Fortsezung der kykladischen Blauschiefer angesehen werden.Die Analyse spröder spätalpiner Deformationsstrukturen und das regionale Muster mit Hilfe von Spaltspurdatierung modellierter Abkühlalter deuten darauf hin, daß die Struktur des Eozänen Deckenstapels durch miozäne bis rezente Kernkomplex-Bildung stark modifiziert wurde. Eine großmaßstäbliche Muldenstruktur im zentralen Teil der Anatoliden hat sich als Folge zweier symmetrisch angeordneter Detachment-Systeme von initial steilen zu heute flachen Orientierungen im Einflußbreich von ’Rolling Hinges’ gebildet. Die Detachment-Störungen begrenzen den ‘Central Menderes metamorphic core complex’ (CMCC). Das Muster der Apatit-Spaltspuralter belegt, daß die Bildung des CMCC im Miozän begann. Durch die Rück-Deformierung von parallel zur Foliation konstruierten Linien gleicher Abkühlalter kann gezeigt werden, daß die Aufwölbung im Liegenden der Detachments zur Entstehung der Muldenstruktur führte. Das hohe topographische Relief im Bereich des CMCC ist eine Folge der Detachment-Störungen, was darauf hindeutet daß der obere Mantel in den Prozeß mit einbezogen gewesen ist.

Analysis of human body kinematics using a hybrid markerless video acquisition and processing

A main objective of the human movement analysis is the quantitative description of joint kinematics and kinetics. This information may have great possibility to address clinical problems both in orthopaedics and motor rehabilitation. Previous studies have shown that the assessment of kinematics and kinetics from stereophotogrammetric data necessitates a setup phase, special equipment and expertise to operate. Besides, this procedure may cause feeling of uneasiness on the subjects and may hinder with their walking. The general aim of this thesis is the implementation and evaluation of new 2D markerless techniques, in order to contribute to the development of an alternative technique to the traditional stereophotogrammetric techniques. At first, the focus of the study has been the estimation of the ankle-foot complex kinematics during stance phase of the gait. Two particular cases were considered: subjects barefoot and subjects wearing ankle socks. The use of socks was investigated in view of the development of the hybrid method proposed in this work. Different algorithms were analyzed, evaluated and implemented in order to have a 2D markerless solution to estimate the kinematics for both cases. The validation of the proposed technique was done with a traditional stereophotogrammetric system. The implementation of the technique leads towards an easy to configure (and more comfortable for the subject) alternative to the traditional stereophotogrammetric system. Then, the abovementioned technique has been improved so that the measurement of knee flexion/extension could be done with a 2D markerless technique. The main changes on the implementation were on occlusion handling and background segmentation. With the additional constraints, the proposed technique was applied to the estimation of knee flexion/extension and compared with a traditional stereophotogrammetric system. Results showed that the knee flexion/extension estimation from traditional stereophotogrammetric system and the proposed markerless system were highly comparable, making the latter a potential alternative for clinical use. A contribution has also been given in the estimation of lower limb kinematics of the children with cerebral palsy (CP). For this purpose, a hybrid technique, which uses high-cut underwear and ankle socks as “segmental markers” in combination with a markerless methodology, was proposed. The proposed hybrid technique is different than the abovementioned markerless technique in terms of the algorithm chosen. Results showed that the proposed hybrid technique can become a simple and low-cost alternative to the traditional stereophotogrammetric systems.