Total knee arthroplasty - a clinical and numerical study of the micromovements of the tibial implant

Introduction The importance of the micromovements in the mechanism of aseptic loosening is clinically difficult to evaluate. To complete the analysis of a series of total knee arthroplasties (TKA), we used a tridimensional numerical model to study the micromovements of the tibial implant.Material and Methods Fifty one patients (with 57 cemented Porous Coated Anatomic TKAs) were reviewed (mean follow-up 4.5 year). Radiolucency at the tibial bone-cement interface was sought on the AP radiographs and divided in 7 areas. The distribution of the radiolucency was then correlated with the axis of the lower limb as measured on the orthoradiograms.The tridimensional numerical model is based on the finite element method. It allowed the measurement of the cemented prosthetic tibial implant's displacements and the microvements generated at bone-ciment interface. A total load (2000 Newton) was applied at first vertically and asymetrically on the tibial plateau, thereby simulating an axial deviation of the lower limbs. The vector's posterior inclination then permitted the addition of a tangential component to the axial load. This type of effort is generated by complex biomechanical phenomena such as knee flexion.Results 81 per cent of the 57 knees had a radiolucent line of at least 1 mm, at one or more of the tibial cement-epiphysis jonctional areas. The distribution of these lucent lines showed that they came out more frequently at the periphery of the implant. The lucent lines appeared most often under the unloaded margin of the tibial plateau, when axial deviation of lower limbs was present.Numerical simulations showed that asymetrical loading on the tibial plateau induced a subsidence of the loaded margin (0-100 microns) and lifting off at the opposite border (0-70 microns). The postero-anterior tangential component induced an anterior displacement of the tibial implant (160-220 microns), and horizontal micromovements with non homogenous distribution at the bone-ciment interface (28-54 microns).Discussion Comparison of clinical and numerical results showed a relation between the development of radiolucent lines and the unloading of the tibial implant's margin. The deleterious effect of lower limbs' axial deviation is thereby proven. The irregular distribution of lucent lines under the tibial plateau was similar of the micromovements' repartition at the bone-cement interface when tangential forces were present. A causative relation between the two phenomenaes could not however be established.Numerical simulation is a truly useful method of study; it permits to calculate micromovements which are relative, non homogenous and of very low amplitude. However, comparative clinical studies remain as essential to ensure the credibility of results.

Is there a wage penalty for horizontal and vertical mismatch?

This paper studies how the horizontal and vertical mismatches in the labor market affect wage. We do so by taking into account that by choosing a job, wage and mismatches are simultaneously determined. The Seemingly Unrelated Equations model also allows us to control for any omitted variable that could cause biased estimators. We use REFLEX data for Spain. Results reveal that in most cases being horizontally matched has a wage premium and being over-educated does not affect wage. Results suggest that the modeling strategy successfully accounts for some omitted variable that affects simultaneously the probability of being horizontally matched and the wage. This could explain the existence of a wage penalty for over-educated workers when the omitted variable issue is not dealt with.

Identification and characterization of the Arabidopsis PHO1 gene involved in phosphate loading to the xylem.

The Arabidopsis mutant pho1 is deficient in the transfer of Pi from root epidermal and cortical cells to the xylem. The PHO1 gene was identified by a map-based cloning strategy. The N-terminal half of PHO1 is mainly hydrophilic, whereas the C-terminal half has six potential membrane-spanning domains. PHO1 shows no homology with any characterized solute transporter, including the family of H(+)-Pi cotransporters identified in plants and fungi. PHO1 shows highest homology with the Rcm1 mammalian receptor for xenotropic murine leukemia retroviruses and with the Saccharomyces cerevisiae Syg1 protein involved in the mating pheromone signal transduction pathway. PHO1 is expressed predominantly in the roots and is upregulated weakly under Pi stress. Studies with PHO1 promoter-beta-glucuronidase constructs reveal predominant expression of the PHO1 promoter in the stelar cells of the root and the lower part of the hypocotyl. There also is beta-glucuronidase staining of endodermal cells that are adjacent to the protoxylem vessels. The Arabidopsis genome contains 10 additional genes showing homology with PHO1. Thus, PHO1 defines a novel class of proteins involved in ion transport in plants.

In vivo loading increases mechanical properties of scaffold by affecting bone formation and bone resorption rates.

A successful bone tissue engineering strategy entails producing bone-scaffold constructs with adequate mechanical properties. Apart from the mechanical properties of the scaffold itself, the forming bone inside the scaffold also adds to the strength of the construct. In this study, we investigated the role of in vivo cyclic loading on mechanical properties of a bone scaffold. We implanted PLA/β-TCP scaffolds in the distal femur of six rats, applied external cyclic loading on the right leg, and kept the left leg as a control. We monitored bone formation at 7 time points over 35 weeks using time-lapsed micro-computed tomography (CT) imaging. The images were then used to construct micro-finite element models of bone-scaffold constructs, with which we estimated the stiffness for each sample at all time points. We found that loading increased the stiffness by 60% at 35 weeks. The increase of stiffness was correlated to an increase in bone volume fraction of 18% in the loaded scaffold compared to control scaffold. These changes in volume fraction and related stiffness in the bone scaffold are regulated by two independent processes, bone formation and bone resorption. Using time-lapsed micro-CT imaging and a newly-developed longitudinal image registration technique, we observed that mechanical stimulation increases the bone formation rate during 4-10 weeks, and decreases the bone resorption rate during 9-18 weeks post-operatively. For the first time, we report that in vivo cyclic loading increases mechanical properties of the scaffold by increasing the bone formation rate and decreasing the bone resorption rate.

Effect of sodium loading/depletion on renal oxygenation in young normotensive and hypertensive men.

The goal of this study was to investigate the effect of sodium intake on renal tissue oxygenation in humans. To this purpose, we measured renal hemodynamics, renal sodium handling, and renal oxygenation in normotensive (NT) and hypertensive (HT) subjects after 1 week of a high-sodium and 1 week of a low-sodium diet. Renal oxygenation was measured using blood oxygen level-dependent magnetic resonance. Tissue oxygenation was determined by the measurement of R2* maps on 4 coronal slices covering both kidneys. The mean R2* values in the medulla and cortex were calculated, with a low R2* indicating a high tissue oxygenation. Ten male NT (mean age: 26.5+/-7.4 years) and 8 matched HT subjects (mean age: 28.8+/-5.7 years) were studied. Cortical R2* was not different under the 2 conditions of salt intake. Medullary R2* was significantly lower under low sodium than high sodium in both NT and HT subjects (28.1+/-0.8 versus 31.3+/-0.6 s(-1); P<0.05 in NT; and 27.9+/-1.5 versus 30.3+/-0.8 s(-1); P<0.05, in HT), indicating higher medullary oxygenation under low-sodium conditions. In NT subjects, medullary oxygenation was positively correlated with proximal reabsorption of sodium and negatively with absolute distal sodium reabsorption, but not with renal plasma flow. In HT subjects, medullary oxygenation correlated with the 24-hour sodium excretion but not with proximal or with the distal handling of sodium. These data demonstrate that dietary sodium intake influences renal tissue oxygenation, low sodium intake leading to an increased renal medullary oxygenation both in normotensive and young hypertensive subjects.

Horizontal innovation in the theory of growth and development

We analyze recent contributions to growth theory based on the model of expanding variety of Romer (1990). In the first part, we present different versions of the benchmark linear model with imperfect competition. These include the labequipment model, labor-for-intermediates and directed technical change . We review applications of the expanding variety framework to the analysis of international technology diffusion, trade, cross-country productivity differences, financial development and fluctuations. In many such applications, a key role is played by complementarities in the process of innovation.

Endotoxin impairs cardiac hemodynamics by affecting loading conditions but not by reducing cardiac inotropism.

Acute myocardial dysfunction is a typical manifestation of septic shock. Experimentally, the administration of endotoxin [lipopolysacharride (LPS)] to laboratory animals is frequently used to study such dysfunction. However, a majority of studies used load-dependent indexes of cardiac function [including ejection fraction (EF) and maximal systolic pressure increment (dP/dt(max))], which do not directly explore cardiac inotropism. Therefore, we evaluated the direct effects of LPS on myocardial contractility, using left ventricular (LV) pressure-volume catheters in mice. Male BALB/c mice received an intraperitoneal injection of E. coli LPS (1, 5, 10, or 20 mg/kg). After 2, 6, or 20 h, cardiac function was analyzed in anesthetized, mechanically ventilated mice. All doses of LPS induced a significant drop in LV stroke volume and a trend toward reduced cardiac output after 6 h. Concomitantly, there was a significant decrease of LV preload (LV end-diastolic volume), with no apparent change in LV afterload (evaluated by effective arterial elastance and systemic vascular resistance). Load-dependent indexes of LV function were markedly reduced at 6 h, including EF, stroke work, and dP/dt(max). In contrast, there was no reduction of load-independent indexes of LV contractility, including end-systolic elastance (ejection phase measure of contractility) and the ratio dP/dt(max)/end-diastolic volume (isovolumic phase measure of contractility), the latter showing instead a significant increase after 6 h. All changes were transient, returning to baseline values after 20 h. Therefore, the alterations of cardiac function induced by LPS are entirely due to altered loading conditions, but not to reduced contractility, which may instead be slightly increased.

Allocating ideas: Horizontal competition in tournaments

We develop a stylized model of horizontal and vertical competition intournaments with two competing firms. The sponsor cares about the qualityof the design but also about the design location. A priori not even thesponsor knows his preferred design location, which is only discoveredonce he has seen the actual proposals. We show that the more efficientfirm is more likely to be conservative when choosing the design location.Also, to get some differentiation in design locations, the cost differencebetween contestants can neither be too small nor too big. Therefore, ifthe sponsor mainly cares about the design location, participation in thetournaments by the two lowest cost contestants cannot be optimal for thesponsor.

Distribución horizontal de la anchoveta peruana con relación a variables ambientales en el período 1986 - 2000

Se analizó la distribución horizontal de la anchoveta Engraulis ringens utilizando sistemas de información geográfica. Los datos fueron obtenidos de los cruceros de evaluación hidroacústica de recursos pelágicos realizados durante los veranos de 1986 al 2000. Los resulitados indican que la distribución horizontal de la anchoveta está asociada a parámetros oceanográficos superficiales del mar, como rangos de temperatura, salinidad y clorofila a; sin embargo,parece ser que el parámetro más importante es la salinidad.

Horizontal and vertical distributions of zooplanckton numbers and biomass off the coast of Peru

Estudio de las distribuciones horizontales y verticales del zooplancton a lo largo de una línea desde cerca de la costa hasta el borde de la plataforma.

Distribución horizontal de los Amphipoda (crustacea) en el mar peruano durante el fenómeno "El niño" verano 1983

Los anfípodos hepéridos son microcrustáceos marinos que tienen un rol importante en la ecología trófica de especies pesqueras, se caracterizan por su voraz comportamiento predador sobre otros componentes del zooplancton (NELSON, 1979) y debido a su abundancia constituyen una fuente de alimento para niveles tróficos superiores (ALVAREZ y VIÑAS, 1994). El área de estudio comprende desde 03°29.80´S hasta los 12°54.50´S, abarcando los perfiles de Puerto Pizarro, Cabo Blanco, Talara, Paita, Punta Falsa, Pimentel, Chicama, Salaverry, Chimbote, Huarmey, Supe, Guacho, Chancay, Callao, Pucusana y Cerro Azul, cubriendo de esta manera la parte norte y centro del litoral peruano hasta las 100 millas náuticas de la costa y 50 metros de profundidad. Se determinan 34 especies de anfípodos, con 26 nuevos registros para el país y 2 especies nuevas. La familia Hyperridae es la que registra mayor representatividad a nivel específico destacando por su abundancia las especies Hyperioides sibaginis e Hyperietta vossleri. El presente trabajo, contribuye principalmente a ampliar el conocimiento de especies de anfípodos y asociarlas con las características ambientales, así las especies Vibilia chuni, Partaphronima gracilis, Hemithiphys tenuimanuss, Euscelus robustus y Schizoscelus ornatus, se encuentran relacionados con salinidades que fluctuan entre 34.8 y 35.1‰ y temperaturas de 25.4 hasta 28.2°C, rangos correspondientes a aguas de mezcla de Aguas Ecuatoriales Superficiales (AES) y Aguas Subtropicales superficiales (ASS).

Variabilidade horizontal de atributos de fertilidade e amostragem do solo no sistema plantio direto

As adubações, a lanço, quando desuniformes, ou as em linhas, no sistema plantio direto, aumentam a variabilidade dos atributos químicos do solo. Nestas condições, há necessidade de se saber qual a melhor forma e o número de subamostras por coletar para uma boa representatividade da fertilidade da área a ser cultivada. O objetivo deste estudo foi quantificar a variabilidade horizontal de atributos de fertilidade do solo no sistema plantio direto com diferentes modos de adubação e tempos de cultivo, com vistas em definir o número de subamostras necessárias para formar uma amostra representativa da fertilidade do solo de uma área. Foram coletadas, em novembro de 1997, 36 amostras simples, com pá de corte, na camada de 0-10 cm, de forma diferenciada nas adubações a lanço (5 e 10 cm, espessura da fatia e largura) e em linhas (5 cm de espessura da fatia pela largura das entrelinhas de semeadura da última cultura), em oito lavouras comerciais na região noroeste do Rio Grande do Sul. O número mínimo de subamostras para estimar com boa representatividade (α = 0,05 e erro em relação à média de 10%) o pH, o índice SMP e o teor de matéria orgânica foi baixo (menor do que 8) e alto (maior do que 40) para fósforo e potássio (Mehlich-1). O número de subamostras indicado para o sistema convencional (20) pode ser usado no sistema plantio direto, desde que seja admitido um erro de 20% em relação à média.

Variabilidade horizontal da fertilidade do solo de uma unidade de amostragem em sistema plantio direto

A coleta de amostras de solo com trado é mais simples e rápida do que com a pá de corte, sendo esta, freqüentemente, utilizada no sistema plantio direto para amostragem e determinação da fertilidade média do solo. Com o objetivo de comparar dois sistemas de amostragem localizada do solo (pá de corte ou trado de caneca) quanto à variabilidade horizontal de características químicas, determinar o número de unidades de amostra necessário à formação de uma amostra representativa da unidade de amostragem e demonstrar que a análise da amostra composta apresenta iguais resultados aos obtidos pelas médias aritméticas das análises das amostras simples, realizou-se um estudo em área há 15 anos sob sistema plantio direto. Os sistemas de amostragem localizada foram: pá de corte (24 amostras simples coletadas perpendicularmente ao sulco de plantio e no espaço compreendido entre os pontos médios entre sulcos) e trado (20 amostras simples coletadas no sulco de plantio (Ts), 20 amostras simples coletadas lateralmente a 10 cm do sulco (T10) e 20 amostras simples coletadas a 40 cm do sulco (T40)). Subamostras representativas das amostras simples foram misturadas, visando à formação de amostras compostas, tanto para pá de corte quanto para trado. Nas amostras simples e compostas foram determinados os teores de P, K, Ca2+, Mg2+ e Al3+ e os valores de pH, H + Al e P-rem. Foram calculadas as médias das determinações das amostras simples e das compostas, os desvios-padrão e os coeficientes de variação, sendo as médias comparadas pelo teste t de Student. Foi também calculado o número de amostras simples necessário à formação de uma amostra composta, para os dois sistemas de amostragem. Os resultados mostraram que apenas os teores de K e Mg2+ e os valores de H + Al diferiram de um método de amostragem para outro. Na amostragem com trado de caneca, a variabilidade de todas as características avaliadas foi maior do que na amostragem com pá de corte. A variabilidade foi baixa para pH, P-rem e H + Al e alta para P, Al3+, Mg2+, K e Ca2+. Dez amostras simples coletadas com pá de corte ou 27 amostras simples coletadas de forma localizada com trado de caneca (cinco amostras coletadas no sulco de plantio, nove coletadas a 10 cm do sulco e 13 coletadas no ponto médio entre sulcos) foram necessárias à formação de amostras compostas representativas. As análises das amostras compostas, tanto de pá de corte quanto de trado, apresentaram valores semelhantes às médias das análises das respectivas amostras simples, caracterizando corretamente a fertilidade média da unidade de amostragem.

Efficacy of the barbecue manoeuvre in benign paroxysmal vertigo of the horizontal canal

Five to ten percent of benign paroxysmal positional vertigo are caused by the horizontal semi-circular variant (h-BPPV). In this study, we reviewed the efficacy of the Barbecue repositioning manoeuvre in h-BPPV, and we assessed the possible effect of different factors on the outcome. Barbecue manoeuvre consists in turning the supine patient around his longitudinal axis toward the unaffected side until 360 degrees are accomplished. After every 90 degrees step the patient is maintained in the new position for 30 s. We reviewed 46 patients with h-BPPV, treated by barbecue rotation from 2003 to 2005. After the first Barbecue manoeuvre, the patients were followed-up at intervals of approximately 1 week and the rotation was repeated if h-BPPV persisted (up to three rotations). Factors assessed were age, gender, duration of symptoms before treatment and type of h-BPPV (canalolithiasis vs. cupulolithiasis). Fisher's exact test was used for the analysis. Results: 85% of patients (39/46) were cured after a maximum of 3 rotations. 74% (34/46) were cured after the first manoeuvre and 80% (37/46) after the second one. None of the evaluated factors did significantly affect the efficacy (P > 0.05). The Barbecue manoeuvre is an efficient treatment of h-BPPV demonstrating 85% cure rate after a maximum of three sessions. 74% of the patients are healed after one manoeuvre. The efficacy is not affected by the evaluated factors.