Microvascular reconstruction in extremity soft tissue sarcoma surgery

Soft tissue sarcomas (STS) are rare tumors of soft tissue occurring most frequently in the extremities. Modern treatment of extremity STS is based on limb-sparing surgery combined with radiotherapy. To prevent local recurrence, a healthy tissue margin of 2.5 cm around the resected tumor is required. This results in large defects of soft tissue and bone, necessitating the use of reconstructive surgery to achieve wound closure. When local or pedicled soft tissue flaps are unavailable, reconstruction with free flaps is used. Free flaps are elevated at a distant site, and have their blood flow restored at the recipient site through microvascular anastomosis. When limb-sparing surgery is made impossible, amputation is the only option. Proximal amputation such as forequarter amputation (FQA) causes considerable morbidity, but is nevertheless warranted for carefully selected patients for cure or palliation. 116 patients treated in 1985 - 2006 were included in the study. Of these, 93 patients treated with limb-sparing surgery and microvascular reconstructive surgery after resection of extremity STS. 25 patients who underwent FQA were also included. Patients were identified and their medical records retrospectively reviewed. In all, 105 free flap procedures were performed for 103 patients. A total of 95 curatively treated STS patients were included in survival analysis. The latissimus dorsi, used in 56% of cases, was the most frequently used free flap. Free flap success rate was 96%. There were 9% microvascular anastomosis complications and 15% wound complications. For curatively treated STS patients, local recurrence-free survival at 5 years was 73.1%, metastasis-free survival 58.3%, and overall disease-specific survival 68.9%. Functional results were good, with 75% of patients regaining normal or near-normal function after lower extremity, and 55% after upper extremity STS resection. Among curatively treated forequarter amputees, 5-year disease-free survival was 44%. In the palliatively treated group median time until disease death was 14 months. Microvascular reconstruction after extremity soft tissue sarcoma resection is safe and reliable, and produces well-healing wounds allowing early oncological treatment. Oncological outcome after these procedures is comparable to that of other extremity sarcoma patients. Functional results are generally good. Forequarter amputation is a useful treatment option for soft tissue tumors of the shoulder girdle and proximal upper extremity. When free flap coverage of extended forequarter amputation is required, the preferable flap is a fillet flap from the amputated extremity. Acceptable oncological outcome is achieved for curatively treated FQA patients. In the palliatively treated patient considerable periods of increased quality of life can be achieved.

The good, the bad and the ugly of bone-anchored prostheses: Guideline to assess true clinical outcomes

The aim of this study is to share the key elements of an evaluation framework to determine the true clinical outcomes of bone-anchored prostheses. Scientists, clinicians and policy makers are encouraged to implement their own evaluations relying on the proposed framework using a single database to facilitate reflective practice and, eventually, robust prospective studies.

Genetic variation in the LDL receptor-related protein 5 (LRP5) gene : Association with bone health and metabolic parameters

Bone mass accrual and maintenance are regulated by a complex interplay between genetic and environmental factors. Recent studies have revealed an important role for the low-density lipoprotein receptor-related protein 5 (LRP5) in this process. The aim of this thesis study was to identify novel variants in the LRP5 gene and to further elucidate the association of LRP5 and its variants with various bone health related clinical characteristics. The results of our studies show that loss-of-function mutations in LRP5 cause severe osteoporosis not only in homozygous subjects but also in the carriers of these mutations, who have significantly reduced bone mineral density (BMD) and increased susceptibility to fractures. In addition, we demonstrated for the first time that a common polymorphic LRP5 variant (p.A1330V) was associated with reduced peak bone mass, an important determinant of BMD and osteoporosis in later life. The results from these two studies are concordant with results seen in other studies on LRP5 mutations and in association studies linking genetic variation in LRP5 with BMD and osteoporosis. Several rare LRP5 variants were identified in children with recurrent fractures. Sequencing and multiplex ligation-dependent probe amplification (MLPA) analyses revealed no disease-causing mutations or whole-exon deletions. Our findings from clinical assessments and family-based genotype-phenotype studies suggested that the rare LRP5 variants identified are not the definite cause of fractures in these children. Clinical assessments of our study subjects with LPR5 mutations revealed an unexpectedly high prevalence of impaired glucose tolerance and dyslipidaemia. Moreover, in subsequent studies we discovered that common polymorphic LRP5 variants are associated with unfavorable metabolic characteristics. Changes in lipid profile were already apparent in pre-pubertal children. These results, together with the findings from other studies, suggest an important role for LRP5 also in glucose and lipid metabolism. Our results underscore the important role of LRP5 not only in bone mass accrual and maintenance of skeletal health but also in glucose and lipid metabolism. The role of LRP5 in bone metabolism has long been studied, but further studies with larger study cohorts are still needed to evaluate the specific role of LRP5 variants as metabolic risk factors.

Simplified Treatment of Childhood Acute Bone and Joint Infections

Acute childhood osteomyelitis (OM), septic arthritis (SA), and their combination osteomyelitis with adjacent septic arthritis (OM+SA), are treated with long courses of antimicrobials and immediate surgery. We conducted a prospective multi-center randomized trial among Finnish children at age 3 months to 15 years in 1983-2005. According to the two-by-two factorial study design, children with OM or OM+SA received 20 or 30 days of antimicrobials, whereas those with SA were treated for 10 or 30 days. In addition, the whole series was randomized to be treated with clindamycin or a first-generation cephalosporin. Cases were included only if the causative agent was isolated. The treatment was instituted intravenously, but only for the first 2-4 days. Percutaneous aspiration was done to obtain a representative sample for bacteriology, but all other surgical intervention was kept at a minimum. A total of 265 patients fulfilled our strict inclusion criteria and were analyzed; 106 children had OM, 134 SA, and 25 OM+SA. In the OM group, one child in the long and one child in the short-term treatment group developed sequelae. One child with SA twice developed a late re-infection of the same joint, but the causative agents differed. Regarding surgery, diagnostic arthrocentesis or corticotomy was the only surgical procedure performed in most cases. Routine arthrotomy was not required even in hip arthritis. Serum C-reactive protein (CRP) proved to be a reliable laboratory index in the diagnosis and monitoring of osteoarticular infections. The recovery rate was similar regardless of whether clindamycin or a first-generation cephalosporin was used. We conclude that a course of 20 days of these well-absorbing antimicrobials is sufficient for OM or OM+SA, and 10 days for SA in most cases beyond the neonatal age. A short intravenous phase of only 2-5 days often suffices. CRP gives valuable information in monitoring the course of illness. Besides diagnostic aspiration, surgery should be reserved for selected cases.

Topological defects in crystals: A density-wave theory

A new approach for describing dislocations and other topological defects in crystals, based on the density wave theory of Ramakrishnan and Yussouff is presented. Quantitative calculations are discussed in brief for the order parameter profiles, the atomic configuration and the free energy of a screw dislocation with Burgers vector b = (a/2, a/2,a/2 ) in a bcc solid. Our results for the free energy of the dislocation in a crystal of sizeR, when expressed as (λb 2/4π) ln (αR/|b|) whereλ is the shear elastic constant, yield, for example, the valueα ⋍ 1·85 for sodium at its freezing temperature (371°K). The density distribution in the presence of the dislocation shows that the dislocation core has a columnar character. To our knowledge, this study represents the first calculation of dislocation structure, including the core, within the framework of an order parameter theory incorporating thermal effects.

Characterization of defects in gallium arsenide

It is well-known that the properties of semiconductor materials including gallium arsenide are controlled by defects and impurities. The characterization of these defects is important not only for better understanding of the solid state phenomena but also for improved reliability and performance of electronic devices. We have been investigating the defects in gallium arsenide for several years using deep level transient spectroscopy, photoconductivity, transient photoconductivity, photoluminescence etc. Results drawn from our recent studies are presented here to illustrate some of the problems concerning transition metal impurities, process-induced defects, occurrence of intracentre transitions and metastability of deep levels in gallium arsenide.

Influence of Circular Defects on the Flexural Strength of Kevlar/Epoxy Composites

The flexural strength of the Kevlar/epoxy composite laminates, in the pres ence of unfilled and filled circular defects, was studied. Circular drillings of two different diameters extending up to the neutral axis from the compression face as well as through holes, at three different positions from the midspan, have been considered as simplified cases of dents and defects. Bonded buttons of aluminium metal have been tested and shown to yield a strength-wise compensation for test samples with depressions. Macrography of the failed specimens is also discussed.

Defects induced enhancement of Eu3+Emission in yttria (Y2O3:Eu3+)

Bixbyite type Y2O3:Eu3+ apart from being the efficient red phosphor extensively used in trichromatic fluorescent lamps, it is a typical system one can apply Jorgensen's refined electron spin pairing theory. This can be used to explain the enhancement in Eu3+ emission intensity observed with the aliovalent substitution in the yttria host matrix. Results based on these are explained qualitatively by considering a simple configurational coordinate model. Futhermore, an insight into the different types of defects induced with the aliovalent substitution in the yttria lattice has become possible with EPR probe.

Role of lattice defects and crystallite morphology in the UV and visible-light-induced photo-catalytic properties of combustion-prepared TiO2

The physico-chemical, photo-physical and micro-structural properties responsible for the strikingly different photocatalytic behavior of combustion-prepared TiO2 (c.TiO2) and Degussa P25 (d.TiO2) samples are elucidated in this study. Electron microscopy and selected area electron diffraction micrographs revealed that the two samples exhibited different morphologies. The grains of c.TiO2 were spherical and comprised of 5-6 nm size primary particle. On the other hand, d.TiO2 consisted of large (0.5-3.0 mu m) size and irregular shape aggregates having primary particles of 15-40 nm cross-sectional diameter. The ESR study revealed that the presence of certain defect states in c.TiO2 helped in stabilization of O-. and Ti3+-OH type species during room-temperature UV-irradiation. No such paramagnetic species were however formed over d.TiO2 under similar conditions. C1s and Ti 2p XPS spectra provide evidence for the presence of some lattice vacancies in c.TiO2 and also for the bulk Ti4+ -> Ti3+ conversion during its UV-irradiation. Compared to d.TiO2, c.TiO2 displayed considerably higher activity for discoloration of methyl orange but very poor activity for splitting of water, both under UV and visible light radiations. This is attributed to enhanced surface adsorption of dye molecules over c.TiO2, because of its textural features and also the presence of photo-active ion-radicals. On the other hand, the poor activity of c.TiO2 for water splitting is related to certain defect-induced inter-band charge trapping states in the close vicinity of valence and conduction bands of c.TiO2, as revealed by thermoluminescence spectroscopy. Further, the dispersion of nanosize gold particles gave rise to augmented activity of both the catalysts, particularly for water splitting. This is explained by the promotional role of Au-0 or Au-0/TiO2 interfacial sites in the adsorption and charge-adsorbate interaction processes. (C) 2011 Elsevier B.V. All rights reserved.

Crystal growth and defects characterization of zinc tris (thiourea) sulfate: a novel metalorganic nonlinear optical crystal

Single crystals of the metalorganic nonlinear optical material zinc tris (thiourea) sulfate (ZTS) were grown from aqueous solution. The morphology of the crystals was indexed. The grown crystals were characterized by recording the powder X-ray diffraction pattern and by identifying the diffracting planes. Spectrophotometric studies on ZTS reveal that it has good transparency for the Nd: YAG laser fundamental wavelength. Differential thermal analysis of ZTS indicates that the material does not sublime before melting but decomposes immediately after melting. The defect content of the crystals was estimated using etching and X-ray topography. The mechanical hardness anisotropy was evaluated in the (100) plane, which indicates the presence of soft directions.

Passivation of surface and bulk defects in p-GaSb by hydrogenated amorphous silicon treatment

Passivation of point and extended defects in GaSb has been observed as a result of hydrogenated amorphous silicon (a-Si:H) treatment by the glow discharge technique. Cathodoluminescence (CL) images recorded at various depths in the samples clearly show passivation of defects on the surface as well as in the bulk region. The passivation of various recombination centers in the bulk is attributed to the formation of hydrogen-impurity complexes by diffusion of hydrogen ions from the plasma a-Si:H acts as a protective cap layer and prevents surface degradation which is usually encountered by bare exposure to hydrogen plasma. An enhancement in luminescence intensity up to 20 times is seen due to the passivation of nonradiative recombination centers. The passivation efficiency is found to improve with an increase in a-Si:H deposition temperature. The relative passivation efficiency of donors and acceptors by hydrogen in undoped and Te-compensated p-GaSb has been evaluated by CL and by the temperature dependence of photoluminescence intensities. Most notably, effective passivation of minority dopants in tellurium compensated p-GaSb is evidenced for the first time. (C) 1996 American Institute of Physics.

Electrical characterization of surface defects in GaSb created by hydrogen plasma

Using steady state and transient capacitance measurements, the electrical characteristics of a defect layer on the surface of bulk GaSb created during the hydrogen plasma treatment is presented. The trap density, activation energies, and the thickness of the defect layer have been calculated. The trap densities are comparable in magnitude to the carrier concentration. The defects introduce multiple energy levels in the band gap. Typical defect layer thicknesses range from a few angstroms to a fraction of a micron. © 1995 American Institute of Physics.

Liquid phase epitaxial growth of pure and doped GaSb layers: morphological evolution and native defects

Undoped and Te-doped gallium antimonide (GaSb) layers have been grown on GaSb bulk substrates by the liquid phase epitaxial technique from Ga-rich and Sb-rich melts. The nucleation morphology of the grown layers has been studied as a function of growth temperature and substrate orientation. MOS structures have been fabricated on the epilayers to evaluate the native defect content in the grown layers from the C-V characteristics. Layers grown from antimony rich melts always exhibit p-type conductivity. In contrast, a type conversion from p- to n- was observed in layers grown from gallium rich melts below 400 degrees C. The electron mobility of undoped n-type layers grown from Ga-rich melts and tellurium doped layers grown from Sb- and Ga-rich solutions has been evaluated.