Infection after total ankle replacement : A 5-year retrospective analysis of 92 implanted ankle prostheses (2004-2008).

Objectives: Total ankle replacement (TAR) is increasingly used for treatment of primary or posttraumatic arthritis of the ankle joint, if joint movement is intended to be preserved. Data on characteristics and treatment of ankle prosthetic joint infection (PJI) is limited and no validated therapeutic algorithm exist. Therefore, we analyzed all infections, which occurred in a cohort of implanted ankle prostheses during a 5-year-period.Methods: Between 06/2004 and 12/2008, all patients with an implanted ankle prosthesis at our institution were retrospectively reviewed. All patients were operated by the same surgical team. Ankle PJI was defined as visible purulence, acute inflammation on histopathology, sinus tract, or microbial growth in periprosthetic tissue or sonication fluid of the removed prosthesis. The surgery on the infected ankle prosthesis and the follow-up were performed by the surgical team, who implanted the prosthesis. A specialized septic team consisting of an orthopaedic surgeon and infectious diseases consultant were included in the treatment.Results: During the study period, 92 total ankle prostheses were implanted in 90 patients (mean age 61 years, range 28-80 years). 78 patients had posttraumatic arthritis, 11 rheumatoid arthritis and 3 other degenerative disorder. Ankle PJI occurred in 3 of 92 TAR (3.3%), occurring 1, 2 and 24 months after implantation; the causative organisms were Enterobacter cloacae, Streptococcus pyogenes and Staphylococcus epidermidis, respectively. The ankle prosthesis was removed in all infected patients, including debridement of the surrounding tissue was debrided and insertion of an antibiotic loaded spacer. Provisional arthrodesis was performed by external fixation in two patients and by plaster cast in one. A definitive ankle arthrodesis with a retrograde nail was performed 6 to 8 weeks after prosthesis removal. One patient needed a flap coverage. All 3 patients received intravenous antibiotic treatment for 2 weeks, followed by oral antibiotics for 4-6 weeks. At follow-up visit up to 18 months after start of treatment, all patients were without clinical or laboratory signs of infection.Conclusions: The infection incidence after TAR was 3.3%, which is slightly higher than reported after hip (<1%) or knee arthroplasty (<2%). A two-step approach consisting of removal of the infected prosthesis, combined with local and systemic antibiotic treatment, followed by definitive ankle arthrodesis shows good results. Larger patient cohort and longer follow-up evaluation is needed to define the optimal treatment approach for ankle PJI.

Changes in volume, surface estimate, three-dimensional shape and total number of neurons of the human primary visual cortex from midgestation until old age.

Macroscopic features such as volume, surface estimate, thickness and caudorostral length of the human primary visual cortex (Brodman's area 17) of 46 human brains between midgestation and 93 years were studied by means of camera lucida drawings from serial frontal sections. Individual values were best fitted by a logistic function from midgestation to adulthood and by a regression line between adulthood and old age. Allometric functions were calculated to study developmental relationships between all the features. The three-dimensional shape of area 17 was also reconstructed from the serial sections in 15 cases and correlated with the sequence of morphological events. The sulcal pattern of area 17 begins to develop around 21 weeks of gestation but remains rather simple until birth, while it becomes more convoluted, particularly in the caudal part, during the postnatal period. Until birth, a large increase in cortical thickness (about 83% of its mean adult value) and caudorostral length (69%) produces a moderate increase in cortical volume (31%) and surface estimate (40%) of area 17. After birth, the cortical volume and surface undergo their maximum growth rate, in spite of a rather small increase in cortical thickness and caudorostral length. This is due to the development of the pattern of gyrification within and around the calcarine fissure. All macroscopic features have reached the mean adult value by the end of the first postnatal year. With aging, the only features to undergo significant regression are the cortical surface estimate and the caudorostral length. The total number of neurons in area 17 shows great interindividual variability at all ages. No decrease in the postnatal period or in aging could be demonstrated.

Effects of total fishing prohibition on the rocky fish assemblages of Medes Islands marine reserve (NW Mediterranean)

Visual scuba diving censuses were used to assess the effects of fishing prohibition on abundance and size structure of littoral fish populations by comparing the same benthic communities inside and outside the protected area of Medes Islands (NE Catalonia, Spain). The total number of species found was 43 in the reserve and 44 outside, but the mean value of species richness per sampling station was significantly higher in the protected area. However, diversity, heavily affected by the presence or absence of large schools of pelagic species, showed no significant differences between sites. The prohibition of fishing for 6 years is the first factor affecting the qualitative and quantitative structure of fish populations ('reserve effect'), and depth is the second factor. Thus, except in the cases of Serranus cabrilla and Mullus surmuletus, all other vulnerable species are highly sensitive to the protection measures. The size structure of all vulnerable species was found to be absolutely different at the reserve sites than in the unprotected zones, and the modal size classes of size frequency distributions were always higher in the reserve than outside. The reserve effect was significantly responsible of the differences observed in this change on size structure. Some highly vulnerable species, such as Epinephelus guaza and Sciaena umbra, have only been found in the protected area. Others, such as Sparus aurata, Diplodus cervinus and Dicentrarchus labrax, were much more frequent inside the reserve.

Efeito da germinação de soja CV. BR-13 e Paraná sobre ácido fítico, fósforo total e inibidores de tripsina

Este trabalho foi conduzido para avaliar o efeito da germinação sobre os constituintes antinutricionais da soja, ácido fítico, P total e inibidores de tripsina, que interferem na utilização de proteínas e outras substâncias. A diminuição no aproveitamento de nutrientes resulta em inibição de crescimento, hipoglicemia ou danos a tecidos animais. Para os ensaios foram utilizadas as cultivares de soja (Glycine max (L.) Merrill ) BR-13 e Paraná. As sementes foram incubadas em câmara de germinação a 25°C e 100% de umidade, de 0 a 72 horas, com coleta de amostras em intervalos eqüidistantes de seis horas. A cultivar Paraná apresentou teores superiores de ácido fítico, P total e inibidores de tripsina, em relação à cultivar BR-13. As análises de variância e comparações entre médias indicaram que houve aumentos significativos (p < 0,05) nos teores de P total (8,5% e 3,6% nas cultivares BR-13 e Paraná, respectivamente) e nos níveis de inibidores de tripsina (22,05% e 17,10% nas cultivares BR-13 e Paraná, respectivamente), e reduções nos teores de ácido fítico (15,96% e 9,46% nas cultivares BR-13 e Paraná, respectivamente), em 72 horas de germinação.

Comportamento físico-hídrico de um podzólico vermelho-amarelo câmbico fase terraço sob diferentes sistemas de manejo

O estudo foi desenvolvido no município de Viçosa, MG, na fazenda Fundão, pertencente ao câmpus da Universidade Federal de Viçosa (UFV), com o fim de verificar o comportamento físico- hídrico de um Podzólico Vermelho-Amarelo câmbico fase terraço, sob diferentes sistemas de manejo. Foi utilizado delineamento experimental em blocos ao acaso, com cinco tratamentos e quatro repetições. Os tratamentos foram: 1 - arado de aiveca; 2 - arado de discos; 3 - grade pesada; 4 - plantio direto; 5 - testemunha, com as parcelas mantidas em pousio. Os parâmetros avaliados foram: teores de matéria orgânica; granulometria; densidade do solo; densidade de partículas; porosidade total, macroporosidade, microporosidade, agregados e curva de retenção da água no solo. Pode-se concluir que: o uso da grade pesada reduz os teores de matéria orgânica na camada de 0-15 cm; a utilização da grade pesada acarreta adensamento da camada superficial; o revolvimento do solo ocasiona maior macroporosidade; o sistema plantio direto proporciona menor desagregação do solo; o sistema plantio direto garante maior retenção de água.

Alterações físicas introduzidas por diferentes níveis de compactação em latossolo vermelho-escuro textura média

Visando avaliar o efeito de diferentes níveis de compactação nos atributos físicos: densidade do solo, porosidade total, conteúdos volumétricos de sólidos e de água e distribuição dos poros para retenção de água/ar, diferentes quantidades de massa de um Latossolo Vermelho-Escuro textura média foram introduzidas mediante uma prensa hidráulica em anéis de PVC de 0,88 dm³. Utilizando fórmulas desenvolvidas na mecânica dos solos e com os valores de densidades obtidos no feixe de raios-gama e densidade de partículas, observou-se que a aplicação de uma carga (pressão) sobre o solo reduziu linearmente tanto a porosidade total como o espaço de aeração, e aumentou na mesma magnitude os conteúdos volumétricos de sólidos e o de água.

Influência da diferenciação pedológica no desenvolvimento da seringueira no município de Oratórios, MG

A expansão da heveicultura em regiões não tradicionais que apresentam condições edafoclimáticas diferentes do seu habitat natural, tem seu desempenho prejudicado pela carência de informações técnicas. No Estado de Minas Gerais, a falta de conhecimento dos fatores inerentes às relações solo-planta tem-se tornado uma séria limitação no processo de implantação e exploração de seringais. Neste trabalho foi estudado um transecto sob vegetação de seringueira, situada na fazenda experimental da Epamig no vale do Piranga, no município de Oratórios, MG. As caracterizações morfoestruturais revelaram forte diferenciação lateral dos solos na vertente, sendo os Latossolos predominantes no topo, e nas partes mais baixas, os Podzólicos, com presença de horizontes B texturais, maciços, coerentes, adensados e pouco porosos. Tais observações foram complementadas por determinações in situ, por meio de testes de infiltração de água e resistência à penetração. Os resultados de laboratório que abrangem as densidades (aparente e real), porosidade (macro e micro) através de curvas de retenção de água, assim como as análises físicas e químicas, confirmam as observações e determinações de campo. Os diferentes resultados foram relacionados com o desenvolvimento do clone de seringueiras IAN 873 (biomassa total, aérea e radicular) e mostram uma estreita dependência entre as características físicas dos solos e o desenvolvimento da seringueira. Foi observado um melhor comportamento do seringal nos Latossolos, quando comparados aos Podzólicos, que apresentam uma forte restrição mecânica à penetração das raízes, uma porosidade globalmente reduzida e uma drenagem interna muito deficiente.

Smart instrumentation for determination of ligament stiffness and ligament balance in total knee arthroplasty.

Ligament balance is an important and subjective task performed during total knee arthroplasty (TKA) procedure. For this reason, it is desirable to develop instruments to quantitatively assess the soft-tissue balance since excessive imbalance can accelerate prosthesis wear and lead to early surgical revision. The instrumented distractor proposed in this study can assist surgeons on performing ligament balance by measuring the distraction gap and applied load. Also the device allows the determination of the ligament stiffness which can contribute a better understanding of the intrinsic mechanical behavior of the knee joint. Instrumentation of the device involved the use of hall-sensors for measuring the distractor displacement and strain gauges to transduce the force. The sensors were calibrated and tested to demonstrate their suitability for surgical use. Results show the distraction gap can be measured reliably with 0.1mm accuracy and the distractive loads could be assessed with an accuracy in the range of 4N. These characteristics are consistent with those have been proposed, in this work, for a device that could assist on performing ligament balance while permitting surgeons evaluation based on his experience. Preliminary results from in vitro tests were in accordance with expected stiffness values for medial collateral ligament (MCL) and lateral collateral ligament (LCL).

Radiographic total disc replacement angle measurement accuracy using the Oxford Cobbometer: precision and bias.

Total disc replacement (TDR) clinical success has been reported to be related to the residual motion of the operated level. Thus, accurate measurement of TDR range of motion (ROM) is of utmost importance. One commonly used tool in measuring ROM is the Oxford Cobbometer. Little is known however on its accuracy (precision and bias) in measuring TDR angles. The aim of this study was to assess the ability of the Cobbometer to accurately measure radiographic TDR angles. An anatomically accurate synthetic L4-L5 motion segment was instrumented with a CHARITE artificial disc. The TDR angle and anatomical position between L4 and L5 was fixed to prohibit motion while the motion segment was radiographically imaged in various degrees of rotation and elevation, representing a sample of possible patient placement positions. An experienced observer made ten readings of the TDR angle using the Cobbometer at each different position. The Cobbometer readings were analyzed to determine measurement accuracy at each position. Furthermore, analysis of variance was used to study rotation and elevation of the motion segment as treatment factors. Cobbometer TDR angle measurements were most accurate (highest precision and lowest bias) at the centered position (95.5%), which placed the TDR directly inline with the x-ray beam source without any rotation. In contrast, the lowest accuracy (75.2%) was observed in the most rotated and off-centered view. A difference as high as 4 degrees between readings at any individual position, and as high as 6 degrees between all the positions was observed. Furthermore, the Cobbometer was unable to detect the expected trend in TDR angle projection with changing position. Although the Cobbometer has been reported to be reliable in different clinical applications, it lacks the needed accuracy to measure TDR angles and ROM. More accurate ROM measurement methods need to be developed to help surgeons and researchers assess radiological success of TDRs.

Efficient total variation algorithm for fetal brain MRI reconstruction.

Fetal MRI reconstruction aims at finding a high-resolution image given a small set of low-resolution images. It is usually modeled as an inverse problem where the regularization term plays a central role in the reconstruction quality. Literature has considered several regularization terms s.a. Dirichlet/Laplacian energy, Total Variation (TV)- based energies and more recently non-local means. Although TV energies are quite attractive because of their ability in edge preservation, standard explicit steepest gradient techniques have been applied to optimize fetal-based TV energies. The main contribution of this work lies in the introduction of a well-posed TV algorithm from the point of view of convex optimization. Specifically, our proposed TV optimization algorithm or fetal reconstruction is optimal w.r.t. the asymptotic and iterative convergence speeds O(1/n2) and O(1/√ε), while existing techniques are in O(1/n2) and O(1/√ε). We apply our algorithm to (1) clinical newborn data, considered as ground truth, and (2) clinical fetal acquisitions. Our algorithm compares favorably with the literature in terms of speed and accuracy.

Importance of polyethylene thickness in total shoulder arthroplasty: a finite element analysis.

BACKGROUND: Articular surfaces reconstruction is essential in total shoulder arthroplasty. Because of the limited glenoid bone support, thin glenoid component could improve anatomical reconstruction, but adverse mechanical effects might appear. METHODS: With a numerical musculoskeletal shoulder model, we analysed and compared three values of thickness of a typical all-polyethylene glenoid component: 2, 4 (reference) and 6mm. A loaded movement of abduction in the scapular plane was simulated. We evaluated the humeral head translation, the muscle moment arms, the joint force, the articular contact pattern, and the polyethylene and cement stress. Findings Decreasing polyethylene thickness from 6 to 2mm slightly increased humeral head translation and muscle moment arms. This induced a small decreased of the joint reaction force, but important increase of stress within the polyethylene and the cement mantel. Interpretation The reference thickness of 4mm seems a good compromise to avoid stress concentration and joint stuffing.

População microbiana total e solubilizadora de fosfato em solo submetido a diferentes sistemas de cultivo

O objetivo deste trabalho foi avaliar o efeito de diferentes espécies de plantas, fontes de fósforo e calagem sobre a população microbiana total e solubilizadora de fosfato. Foram isolados fungos e bactérias capazes de solubilizar hidroxiapatita, proporcionando P solúvel. O experimento utilizado foi em blocos ao acaso com fatorial 3x3x2. E os fatores avaliados foram espécies de plantas (controle, braquiária e guandu), fertilizantes (controle, superfosfato simples e fosfato de rocha, ambos na dose de 400 kg ha-1 de P(2)0(5) ) e calagem (com e sem calcário). A população bacteriana cresceu pelo efeito da calagem, e a de fungos aumentou, independentemente da calagem, nas parcelas cultivadas com braquiária e fertilizadas com superfosfato. Foi constatado incremento de biomassa-P microbiana sobre o controle por influência da braquiária (23,9%), do superfosfato (30,9%) e da calagem (46,9%). O número de bactérias solubilizadoras foi favorecido pela calagem ou pelo plantio de guandu adubado com fosfato natural ou com braquiária sem adubação. Os fungos solubilizadores aumentaram na ausência de planta ou de adubação e na presença de guandu com fosfato natural. Finalmente, a calagem favoreceumais o crescimento dos fungos solubilizadores, em comparação com o controle, nos tratamentos fosfato natural, braquiária ou guandu.

Increased tender point counts before and after total hip arthroplasty are associated with poorer outcomes but are not individually predictive.

In a prospective study, total hip arthroplasty (THA) patients were assessed preoperatively and postoperatively (n = 95) to determine if tender points (TPs) are associated with poor THA outcomes. Patients with high follow-up TP counts had higher visual analog scale (VAS) for pain and sleep, higher follow-up Western Ontario and McMaster Universities Arthritis Index (pain, stiffness, function), lower Health Assessment Questionnaire, Harris Hip, and Short Form 36 (physical functioning, bodily pain, physical component summary) scores. High follow-up TP were associated with increased pain, pain not relieved by surgery, poor function, and poor sleep. Visual analog scale pain and sleep, Short Form 36 (physical functioning, bodily pain), Western Ontario and McMaster Universities Arthritis Index, Health Assessment Questionnaire, and Harris hip scores improved significantly after THA; TP scores did not. Higher preoperative TP were predictive of higher follow-up TP but were poorly predictive of poor outcome measures after surgery in individual patients, suggesting that preoperative TPs are contraindicative for THA.