Is a grooved collar implant design superior to a machined design regarding bone level alteration? An observational pilot study.

OBJECTIVE This retrospective observational pilot study examined differences in peri-implant bone level changes (ΔIBL) between two similar implant types differing only in the surface texture of the neck. The hypothesis tested was that ΔIBL would be greater with machined-neck implants than with groovedneck implants. METHOD AND MATERIALS 40 patients were enrolled; n = 20 implants with machined (group 1) and n = 20 implants with a rough, grooved neck (group 2), all placed in the posterior mandible. Radiographs were obtained after loading (at 3 to 9 months) and at 12 to 18 months after implant insertion. Case number calculation with respect to ΔIBL was conducted. Groups were compared using a Brunner-Langer model, the Mann-Whitney test, the Wilcoxon signed rank test, and linear model analysis. RESULTS After the 12- to 18-month observation period, mean ΔIBL was -1.11 ± 0.92 mm in group 1 and -1.25 ± 1.23 mm in group 2. ΔIBL depended significantly on time (P < .001), but not on group. In both groups, mean marginal ΔIBL was significantly less than -1.5 mm. Only insertion depth had a significant influence on the amount of periimplant bone loss (P = .013). Case number estimate testing for a difference between group 1 and 2 with a power of 90% revealed a sample size per group of 1,032 subjects. CONCLUSION ΔIBL values indicated that both implant designs fulfilled implant success criteria, and the modification of implant neck texture had no significant influence on ΔIBL.

Five-Year Outcome of Catheter Ablation of Persistent Atrial Fibrillation Using Termination of Atrial Fibrillation as a Procedural Endpoint.

BACKGROUND -This study aimed to determine five-year efficacy of catheter ablation for persistent atrial fibrillation (PsAF) using AF termination as a procedural endpoint. METHODS AND RESULTS -150 patients (57±10 years) underwent PsAF ablation using a stepwise ablation approach (pulmonary vein isolation, electrogram-guided and linear ablation) with the desired procedural endpoint being AF termination. Repeat ablation was performed for recurrent AF or atrial tachycardia (AT). AF was terminated by ablation in 120 patients (80%). Arrhythmia-free survival rates after a single procedure were 35.3±3.9%, 28.0±3.7%, and 16.8±3.2% at 1, 2, and 5 years, respectively. Arrhythmia-free survival rates after the last procedure (mean 2.1±1.0 procedures) were 89.7±2.5%, 79.8±3.4%, and 62.9±4.5%, at 1, 2, and 5 years, respectively. During a median follow-up of 58 (IQR 43-73) months following the last ablation procedure, 97 of 150 (64.7%) patients remained in sinus rhythm without antiarrhythmic drugs (AADs). Another 14 (9.3%) patients maintained sinus rhythm after re-initiation of AADs, and an additional 15 (10.0%) patients regressed to paroxysmal recurrences only. Failure to terminate AF during the index procedure (HR 3.831; 95%CI: 2.070-7.143; p<0.001), left atrial diameter ≥50mm (HR 2.083; 95%CI: 1.078-4.016; p=0.03), continuous AF duration ≥18 months (HR 1.984; 95%CI: 1.024-3.846; p<0.04) and structural heart disease (HR 1.874; 95% CI: 1.037-3.388; p=0.04) predicted arrhythmia recurrence. CONCLUSIONS -In patients with PsAF, an ablation strategy aiming at AF termination is associated with freedom from arrhythmia recurrence in the majority of patients over a 5-year follow up period.Procedural AF non-termination and specific baseline factors predict long-term outcome after ablation.

Anatomic foveal reconstruction of the triangular fibrocartilage complex with a tendon graft

An acute injury to the triangular fibrocartilage complex (TFCC) with avulsion of the foveal attachment can produce distal radioulnar joint (DRUJ) instability. The avulsed TFCC is translated distally so the footprint will be bathed in synovial fluid from the DRUJ and will become covered in synovitis. If the TFCC fails to heal to the footprint, then persistent instability can occur. The authors describe a surgical technique indicated for the treatment of persistent instability of the DRUJ due to foveal detachment of the TFCC. The procedure utilizes a loop of palmaris longus tendon graft passed through the ulnar aspect of the TFCC and into an osseous tunnel in the distal ulna to reconstruct the foveal attachment. This technique provides stability of the distal ulna to the radius and carpus. We recommend this procedure for chronic instability of the DRUJ due to TFCC avulsion, but recommend that suture repair remain the treatment of choice for acute instability. An arthroscopic assessment includes the trampoline test, hook test, and reverse hook test. DRUJ ballottement under arthroscopic vision details the direction of instability, the functional tear pattern, and unmasks concealed tears. If the reverse hook test demonstrates a functional instability between the TFCC and the radius, then a foveal reconstruction is contraindicated, and a reconstruction that stabilizes the radial and ulnar aspects of the TFCC is required. The foveal reconstruction technique has the advantage of providing a robust anatomically based reconstruction of the TFCC to the fovea, which stabilizes the DRUJ and the ulnocarpal sag.

State-of-the-art of imaging detecting endoleaks post-EVAR with special focus on low-flow endoleaks.

Endovascular aortic repair (EVAR) necessitates lifelong surveillance for the patient, in order to detect complications timely. Endoleaks (ELs) are among the most common complications of EVAR. Especially type II ELs can have a very unpredictable clinical course and this can range from spontaneous sealing to aortic rupture. Subgroups of this type of EL need to be identified in order to make a proper risk stratification. Aim of this review is to describe the existing imaging techniques, including their advantages and disadvantages in the context of post-EVAR surveillance with a particular emphasis on low-flow ELs. Low flow ELs cause pressurization of the aortic aneurysm sac with a low velocity filling, leading to difficulty of detection by routine imaging protocols for EVAR surveillance, e.g. bi- or triphasic multislice computed tomographic angiography, magnetic resonance imaging and contrast enhanced ultrasound. In this article, we review the imaging possibilities of ELs and discuss the different imaging strategies available for depicting low flow ELs.

Cancer's positive flip side: posttraumatic growth after childhood cancer.

BACKGROUND Surviving childhood cancer may result in positive psychological changes called posttraumatic growth (PTG). Knowing about the possibility of positive changes may facilitate survivors' reintegration in daily life. We aimed to (1) describe PTG in Swiss childhood cancer survivors including the most and the least common PTG phenomena on the subscale and item levels and (2) determine factors associated with PTG. METHOD Within the Swiss Childhood Cancer Survivor Study (SCCSS), we sent two questionnaires to childhood cancer survivors registered in the Swiss Childhood Cancer Registry (SCCR). Eligible survivors were diagnosed after 1990 at age ≤16 years, survived ≥5 years, and were aged ≥18 years at the time the second questionnaire was sent. We included the Posttraumatic Growth Inventory (PTGI) to assess five areas of PTG. We investigated the association of PTG with socio-demographic characteristics, self-reported late effects, and psychological distress, which were assessed in the SCCSS and clinical variables extracted from the SCCR. We used descriptive statistics to describe PTG and linear regressions to investigate factors associated with PTG. RESULTS We assessed PTG in 309 childhood cancer survivors. Most individuals reported to have experienced some PTG. The most endorsed change occurred in "relation with others," the least in "spiritual change." PTG was significantly higher in survivors with older age at diagnosis (p = 0.001) and those with a longer duration of treatment (p = 0.042), while it was lower in male survivors (p = 0.003). CONCLUSIONS Supporting experiences of PTG during follow-up may help survivors successfully return to daily life.

The impact of a child's unexpected hospitalization upon Taiwanese parents' situational anxiety

Background. The parents of a sick child likely experience situational anxiety due to their young child being unexpectedly hospitalized. The emotional upheaval may be great enough that their anxiety inhibits them in providing positive support to their hospitalized child. Because anxiety affects psychological distress as well as behavioral distress, identifying parental distress helps parents improving their coping mechanisms. ^ Purpose. The study compared situational anxiety levels between Taiwanese fathers and mothers and focused on differences between parental anxiety levels at the beginning of the child's unplanned hospitalization and at time of discharge. The study also identified factors related to the parents' distress and use of coping mechanisms. ^ Methods. A descriptive, comparative research design was used to determine the difference between the anxiety levels of 62 Taiwanese father-mother dyads during the situational crisis of their child's unexpected hospitalization. The Mandarin version (M) of Visual Analog Scale (VAS-M), State-Trait Anxiety Inventory (STAI-M), and the Index of Parent Participation/Hospitalized Child (IPP/HC-M) were used to differentiate maternal and paternal anxiety levels and identify factors related to the parents' distress. Questionnaires were completed by parents within 24-36 hours of the child's hospital admission and within 24 hours prior to discharge. A paired t-test, two sample t-test, and linear mixed regression model were used to test and support the study hypothesis. ^ Results. The findings reveal that the mothers' anxiety levels did not significantly differ from the fathers' anxiety level when their child had a sudden admission to the hospital. In particular, parental state anxiety levels did not decrease during the child's hospital stay and subsequent discharge. Moreover, anxiety levels did not differ between parents regardless of whether the child's disease was acute or chronic. The most effective factor related to parental situational anxiety was parental perception of the severity of the child's illness. ^ Conclusions. Parental anxiety was found to be significantly related to changes in their perception of the severity of their child's illness. However, the study was not able to illustrate how parental involvement in the child's hospital care was related to parental perception of the severity of their child's illness. Future studies, using a qualitative approach to gamer more information as to what variables influence parental anxiety during a situational crisis, may provide a richer database from which to modify key variables as well as the instruments used to improve the quality of the data obtained. ^

Evaluation of memory B cells among perinatally HIV infected children from Houston Texas

Background: HIV associated B cell exhaustion is a notable characteristic of HIV viremic adults. However, it is not known if such alterations are present in perinatal HIV infected children, whose viral dynamics differs from those seen in adults. In the present study we perform an analysis of B cells subsets and measure antigen-specific memory B cells (MBC) in a pediatric HIV infected cohort. ^ Methods: Peripheral mononuclear cells (PBMC) of perinatal HIV infected individuals are characterized into naïve (CD21hi/CD27−), classic (CD27+), tissue like (CD21lo/CD27 −) and activated MBC (CD27+CD21− ) by FACS. A memory ELISPOT assay is used to detect antibody secreting cells. We measure total IgG and antibodies specific for influenza, HBV, mumps, measles, rubella and VZV. Memory was expressed as spot forming cells (SPC) /million of PBMC. Wilcoxon rank-sum was used to compare unpaired groups and linear regression analysis was used to determine predictors of B cell dysfunction ^ Results: 41 HIV perinatal infected children are included (51.2% females and 65.9% Black). Age at study is median (range) 8.78 years (4.39-11.57). At the time of testing they have a CD4% of 30.9 (23.2-39.4), a viral load (VL) of 1.95 log10 copies/ml (1.68-3.29) and a cumulative VL of 3.4 log10 copy × days (2.7-4.0). Ninety two percent of the children are on cARV for > 6 months. Overall, HIV+ children compared with controls have a significant lower number of IgG and antigen specific SFC. In addition, they have a lower proportion of classical MBC 12.9 (8.09-19.85) vs 29.4 (18.7-39.05); 0.01, but a significant higher proportion of tissue like memory MBC 6.01 (2.79-12.7) vs 0.99 (0.87-1.38); 0.003, compared with controls. Patients are parsed on VL (<400 and ≥ 400 copies/ml) with the objective to evaluate the effect of VL on B cell status. Patients with a VL ≥ 400 copies/ml have a significantly lower IgG, HBV, measles, rubella and VZV SPC compared with those with a VL < 400 copies/ml. There are no significant differences in B cell subpopulations between the groups. A moderate negative correlation was observed between the time of cARV initiation and the frequency of IgG memory B cells, suggesting that early initiation of cARV appears to lead to a better functionality of the IgG memory B cells (P=0.05). A statistically significant positive correlation was observed between the total number of IgG memory cells and the number of antigen-specific memory B cells/SPCs. Suggesting that the progressive recovery of the IgG memory B cell pull goes along with a progressive increase in the number of antigen-specific SPCs. ^ Conclusion: A pediatric cohort in overall good status with respect to HIV infection and on ART has defects in B cell function and numbers (reduced total and antigen specific MBC and increased tissue like and reduced classical MBC).^

Apropiación social e hibridación de conocimientos en los procesos de extensión universitaria

El concepto de extensión universitaria ha recorrido un largo trayecto desde sus primeras formulaciones durante el siglo XIX. A lo largo del mismo ha ido incorporando distintos significados, generalmente enmarcados en un modelo de relación asimétrica entre la sociedad y la población asistida. El concepto de apropiación social del conocimiento, de factura más reciente, pretende una aproximación más efectiva y dinámica del público al conocimiento científico. Sin embargo, ambos conceptos mantienen de manera más o menos explícita la relación lineal y asimétrica entre el conocimiento experto y el conocimiento profano. En este trabajo se reflexiona sobre la extensión universitaria como un marco de relación en el que tienda a conjugarse una dinámica de producción de decisiones basadas en la hibridación de conocimientos heterogéneos, con articulación de conocimientos universales y locales, en los que el público y los beneficiarios de las acciones de extensión universitaria asumen papeles activos para la construcción de las soluciones a los problemas acotados localmente.

Apropiación social e hibridación de conocimientos en los procesos de extensión universitaria

El concepto de extensión universitaria ha recorrido un largo trayecto desde sus primeras formulaciones durante el siglo XIX. A lo largo del mismo ha ido incorporando distintos significados, generalmente enmarcados en un modelo de relación asimétrica entre la sociedad y la población asistida. El concepto de apropiación social del conocimiento, de factura más reciente, pretende una aproximación más efectiva y dinámica del público al conocimiento científico. Sin embargo, ambos conceptos mantienen de manera más o menos explícita la relación lineal y asimétrica entre el conocimiento experto y el conocimiento profano. En este trabajo se reflexiona sobre la extensión universitaria como un marco de relación en el que tienda a conjugarse una dinámica de producción de decisiones basadas en la hibridación de conocimientos heterogéneos, con articulación de conocimientos universales y locales, en los que el público y los beneficiarios de las acciones de extensión universitaria asumen papeles activos para la construcción de las soluciones a los problemas acotados localmente.

Apropiación social e hibridación de conocimientos en los procesos de extensión universitaria

El concepto de extensión universitaria ha recorrido un largo trayecto desde sus primeras formulaciones durante el siglo XIX. A lo largo del mismo ha ido incorporando distintos significados, generalmente enmarcados en un modelo de relación asimétrica entre la sociedad y la población asistida. El concepto de apropiación social del conocimiento, de factura más reciente, pretende una aproximación más efectiva y dinámica del público al conocimiento científico. Sin embargo, ambos conceptos mantienen de manera más o menos explícita la relación lineal y asimétrica entre el conocimiento experto y el conocimiento profano. En este trabajo se reflexiona sobre la extensión universitaria como un marco de relación en el que tienda a conjugarse una dinámica de producción de decisiones basadas en la hibridación de conocimientos heterogéneos, con articulación de conocimientos universales y locales, en los que el público y los beneficiarios de las acciones de extensión universitaria asumen papeles activos para la construcción de las soluciones a los problemas acotados localmente.

Continuous measurements at Schwingbachtal Studienlandschaft in the growing seasons 2013-2014

The recent development of in-situ monitoring devices, such as UV-spectrometers, makes the study of short-term stream chemistry variation relevant, especially the study of diurnal cycles, which are not yet fully understood. Our study is based on high-frequency data from an agricultural catchment (Studienlandschaft Schwingbachtal, Germany). We propose a novel approach, i.e. the combination of cluster analysis and Linear Discriminant Analysis, to mine from these data nitrate behavior patterns. As a result, we observe a seasonality of nitrate diurnal cycles, that differs from the most common cycle seasonality described in the literature, i.e. pre-dawn peaks in spring. Our cycles appear in summer and the maximum and minimum shift to a later time in late summer/autumn. This is observed both for water- and energy-limited years, thus potentially stressing the role of evapotranspiration. This concluding hypothesis on the role of evapotranspiration on nitrate stream concentration, which was obtained through data mining, broadens the perspective on the diurnal cycling of stream nitrate concentrations.

Spiral optical designs for nonimaging applications

Manufacturing technologies as injection molding or embossing specify their production limits for minimum radii of the vertices or draft angle for demolding, for instance. In some demanding nonimaging applications, these restrictions may limit the system optical efficiency or affect the generation of undesired artifacts on the illumination pattern. A novel manufacturing concept is presented here, in which the optical surfaces are not obtained from the usual revolution symmetry with respect to a central axis (z axis), but they are calculated as free-form surfaces describing a spiral trajectory around z axis. The main advantage of this new concept lies in the manufacturing process: a molded piece can be easily separated from its mold just by applying a combination of rotational movement around axis z and linear movement along axis z, even for negative draft angles. Some of these spiral symmetry examples will be shown here, as well as their simulated results.

Novel free-form optical surface design with spiral symmetry

Manufacturing technologies as injection molding or embossing specify their production limits for minimum radii of the vertices or draft angle for demolding, for instance. These restrictions may limit the system optical efficiency or affect the generation of undesired artifacts on the illumination pattern when dealing with optical design. A novel manufacturing concept is presented here, in which the optical surfaces are not obtained from the usual revolution symmetry with respect to a central axis (z axis), but they are calculated as free-form surfaces describing a spiral trajectory around z axis. The main advantage of this new concept lies in the manufacturing process: a molded piece can be easily separated from its mold just by applying a combination of rotational movement around axis z and linear movement along axis z, even for negative draft angles. The general designing procedure will be described in detail

Spiral nonimaging optical designs

Manufacturing technologies as injection molding or embossing specify their production limits for minimum radii of the vertices or draft angle for demolding, for instance. In some demanding nonimaging applications, these restrictions may limit the system optical efficiency or affect the generation of undesired artifacts on the illumination pattern. A novel manufacturing concept is presented here, in which the optical surfaces are not obtained from the usual revolution symmetry with respect to a central axis (z axis), but they are calculated as free-form surfaces describing a spiral trajectory around z axis. The main advantage of this new concept lies in the manufacturing process: a molded piece can be easily separated from its mold just by applying a combination of rotational movement around axis z and linear movement along axis z, even for negative draft angles. Some of these spiral symmetry examples will be shown here, as well as their simulated results.

Operational Modal Analysis on laminated glass beams

Laminated glass is a sandwich element consisting of two or more glass sheets, with one or more interlayers of polyvinyl butyral (PVB). The dynamic response of laminated glass beams and plates can be predicted using analytical or numerical models in which the glass and the PVB are usually modelled as linear-elastic and linear viscoelastic materials, respectively. In this work the dynamic behavior of laminated glass beams are predicted using a finite element model and the analytical model of Ross-Kerwin-Ungar. The numerical and analytical results are compared with those obtained by operational modal analysis performed at different temperatures.