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Sample records for large-head metal-on-metal total

  1. Early failures in large head metal-on-metal total hip arthroplasty.

    PubMed

    Althuizen, Martje N R; V Hooff, Miranda L; v d Berg-v Erp, Saskia H M; V Limbeek, Jacques; Nijhof, Marc W

    2012-01-01

    Concerns have recently been raised about large head metal-on-metal total hip arthroplasties (LDH THA). Metal ion release due to wear may cause osteolysis, pseudotumours and necrosis. In addition, fixation of certain acetabular components is thought to be suboptimal. We present the short term outcome of the Durom LDH THA. Retrospectively, a consecutive series of 64 implants in 60 patients was analysed with a mean follow-up of 37 months. Clinical and radiological evaluation was performed on a regular basis, followed by additional evaluations when indicated. The 10-year revision percentage was calculated and compared with National Institute for Health and Clinical Excellence (NICE) standards. Six patients (six hips) underwent cup revision (9%). Four of these cups showed no or minimal bone fixation. Three patients had a pseudotumour. In two revision cases, ALVAL (aseptic lymphocyte-dominated vasculitis-associated lesion) was present. Lack of bone ingrowth and the presence of ARMD (adverse reaction to metal debris) seem to contribute to a high failure rate of the Durom LDH THA. The predicted ten-year revision rate of 14.2% (95% CI 5.6-22.8) is, given the broad confidence interval, not significantly outside NICE recommended standards. However, it is not clear which factors, if any, predict implant failure. Therefore, we do not advocate the use of this implant. PMID:23233178

  2. Large-head metal-on-metal total hip arthroplasty using the Durom acetabular component at minimum 1-year interval.

    PubMed

    Illgen, Richard L; Heiner, John P; Squire, Matthew W; Conrad, David N

    2010-09-01

    Large-head metal-on-metal total hip arthroplasty represents novel technology, and outcome data are lacking. We prospectively compared the performance of a nonmodular metal-on-metal acetabular component (Durom; Zimmer, Warsaw, IN) with a modular titanium component (Trilogy, Zimmer). All Durom components placed at our institution with minimum 1-year follow up (n = 63) were compared with an age- and sex-matched Trilogy control group (n = 100). Failure defined as revision or persistent moderate/severe groin pain was significantly higher for the Durom (11.1%) compared with the Trilogy group (0%) (P = .002). Although all acetabular components in both groups appeared radiographically stable, no significant bone ingrowth was noted at the time of Durom revisions. We could not identify any patient/surgical-related factors predictive of failure. Further study is needed to determine the scientific basis for these observations. PMID:20570096

  3. Large head metal-on-metal cementless total hip arthroplasty versus 28mm metal-on-polyethylene cementless total hip arthroplasty: design of a randomized controlled trial

    PubMed Central

    Zijlstra, Wierd P; Bos, Nanne; van Raaij, Jos JAM

    2008-01-01

    Background Osteoarthritis of the hip is successfully treated by total hip arthroplasty with metal-on-polyethylene articulation. Polyethylene wear debris can however lead to osteolysis, aseptic loosening and failure of the implant. Large head metal-on-metal total hip arthroplasty may overcome polyethylene wear induced prosthetic failure, but can increase systemic cobalt and chromium ion concentrations. The objective of this study is to compare two cementless total hip arthroplasties: a conventional 28 mm metal-on-polyethylene articulation and a large head metal-on-metal articulation. We hypothesize that the latter arthroplasties show less bone density loss and higher serum metal ion concentrations. We expect equal functional scores, greater range of motion, fewer dislocations, fewer periprosthetic radiolucencies and increased prosthetic survival with the metal-on-metal articulation. Methods A randomized controlled trial will be conducted. Patients to be included suffer from non-inflammatory degenerative joint disease of the hip, are aged between 18 and 80 and are admitted for primary cementless unilateral total hip arthroplasty. Patients in the metal-on-metal group will receive a cementless titanium alloy acetabular component with a cobalt-chromium liner and a cobalt-chromium femoral head varying from 38 to 60 mm. Patients in the metal-on-polyethylene group will receive a cementless titanium alloy acetabular component with a polyethylene liner and a 28 mm cobalt-chromium femoral head. We will assess acetabular bone mineral density by dual energy x-ray absorptiometry (DEXA), serum ion concentrations of cobalt, chromium and titanium, self reported functional status (Oxford hip score), physician reported functional status and range of motion (Harris hip score), number of dislocations and prosthetic survival. Measurements will take place preoperatively, perioperatively, and postoperatively (6 weeks, 1 year, 5 years and 10 years). Discussion Superior results of large head metal-on-metal total hip arthroplasty over conventional hip arthroplasty have been put forward by experts, case series and the industry, but to our knowledge there is no randomized controlled evidence. Conclusion This randomized controlled study has been designed to test whether large head metal-on-metal cementless total hip arthroplasty leads to less periprosthetic bone density loss and higher serum metal ion concentrations compared to 28 mm metal-on-polyethylene cementless total hip arthroplasty. Trial registration Netherlands Trial Registry NTR1399 PMID:18842151

  4. No association between serum metal ions and implant fixation in large-head metal-on-metal total hip arthroplasty

    PubMed Central

    Søballe, Kjeld; Jakobsen, Stig Storgaard; Lorenzen, Nina Dyrberg; Mechlenburg, Inger; Stilling, Maiken

    2014-01-01

    Background The mechanism of failure of metal-on-metal (MoM) total hip arthroplasty (THA) has been related to a high rate of metal wear debris, which is partly generated from the head-trunnion interface. However, it is not known whether implant fixation is affected by metal wear debris. Patients and methods 49 cases of MoM THA in 41 patients (10 women) with a mean age of 52 (28–68) years were followed with stereoradiographs after surgery and at 1, 2, and 5 years to analyze implant migration by radiostereometric analysis (RSA). Patients also participated in a 5- to 7-year follow-up with measurement of serum metal ions, questionnaires (Oxford hip score (OHS) and Harris hip score (HHS)), and measurement of cup and stem positions and systemic bone mineral density. Results At 1–2 years, mean total translation (TT) was 0.04 mm (95% CI: –0.07 to 0.14; p = 0.5) for the stems; at 2–5 years, mean TT was 0.13 mm (95% CI: –0.25 to –0.01; p = 0.03), but within the precision limit of the method. For the cups, there was no statistically significant TT or total rotation (TR) at 1–2 and 2–5 years. At 2–5 years, we found 4 cups and 5 stems with TT migrations exceeding the precision limit of the method. There was an association between cup migration and total OHS < 40 (4 patients, 4 hips; p = 0.04), but there were no statistically significant associations between cup or stem migration and T-scores < –1 (n = 10), cup and stem positions, or elevated serum metal ion levels (> 7µg/L (4 patients, 6 hips)). Interpretation Most cups and stems were well-fixed at 1–5 years. However, at 2–5 years, 4 cups and 5 stems had TT migrations above the precision limits, but these patients had serum metal ion levels similar to those of patients without measurable migrations, and they were pain-free. Patients with serum metal ion levels > 7 µg/L had migrations similar to those in patients with serum metal ion levels < 7 µg/L. Metal wear debris does not appear to influence the fixation of hip components in large-head MoM articulations at medium-term follow-up. PMID:24847790

  5. Does bearing size influence metal ion levels in large-head metal-on-metal total hip arthroplasty? A comparison of three total hip systems

    PubMed Central

    2014-01-01

    Background The purpose of the study was twofold: first, to determine whether there is a statistically significant difference in the metal ion levels among three different large-head metal-on-metal (MOM) total hip systems. The second objective was to assess whether position of the implanted prostheses, patient demographics or factors such as activity levels influence overall blood metal ion levels and whether there is a difference in the functional outcomes between the systems. Methods In a cross-sectional cohort study, three different metal-on-metal total hip systems were assessed: two monoblock heads, the Durom socket (Zimmer, Warsaw, IN, USA) and the Birmingham socket (Smith and Nephew, Memphis, TN, USA), and one modular metal-on-metal total hip system (Pinnacle, Depuy Orthopedics, Warsaw, IN, USA). Fifty-four patients were recruited, with a mean age of 59.7 years and a mean follow-up time of 41 months (12 to 60). Patients were evaluated clinically, radiologically and biochemically. Statistical analysis was performed on all collected data to assess any differences between the three groups in terms of overall blood metal ion levels and also to identify whether there was any other factor within the group demographics and outcomes that could influence the mean levels of Co and Cr. Results Although the functional outcome scores were similar in all three groups, the blood metal ion levels in the larger monoblock large heads (Durom, Birmingham sockets) were significantly raised compared with those of the Pinnacle group. In addition, the metal ion levels were not found to have a statistically significant relationship to the anteversion or abduction angles as measured on the radiographs. Conclusions When considering a MOM THR, the use of a monoblock large-head system leads to higher elevations in whole blood metal ions and offers no advantage over a smaller head modular system. PMID:24472283

  6. Shorter, rough trunnion surfaces are associated with higher taper wear rates than longer, smooth trunnion surfaces in a contemporary large head metal-on-metal total hip arthroplasty system.

    PubMed

    Brock, Timothy M; Sidaginamale, Raghavendra; Rushton, Steven; Nargol, Antoni V F; Bowsher, John G; Savisaar, Christina; Joyce, Tom J; Deehan, David J; Lord, James K; Langton, David J

    2015-12-01

    Taper wear at the head-neck junction is a possible cause of early failure in large head metal-on-metal (LH-MoM) hip replacements. We hypothesized that: (i) taper wear may be more pronounced in certain product designs; and (ii) an increased abductor moment arm may be protective. The tapers of 104 explanted LH-MoM hip replacements revised for adverse reaction to metal debris (ARMD) from a single manufacturer were analyzed for linear and volumetric wear using a co-ordinate measuring machine. The mated stem was a shorter 12/14, threaded trunnion (n=72) or a longer, smooth 11/13 trunnion (n=32). The abductor moment arm was calculated from pre-revision radiographs. Independent predictors of linear and volumetric wear included taper angle, stem type, and the horizontal moment arm. Tapers mated with the threaded 12/14 trunnion had significantly higher rates of volumetric wear (0.402 mm3/yr vs. 0.123 mm3/yr [t=-2.145, p=0.035]). There was a trend to larger abductor moment arms being protective (p=0.055). Design variation appears to play an important role in taper-trunnion junction failure. We recommend that surgeons bear these findings in mind when considering the use of a short, threaded trunnion with a cobalt-chromium head. PMID:26135357

  7. Functional outcome following a large head total hip arthroplasty: A retrospective analysis of mid term results

    PubMed Central

    Agarwala, Sanjay; Mohrir, Ganesh; Moonot, Pradeep

    2014-01-01

    Background: One of the reasons that hip resurfacing and large head metal on metal (MOM) total hip arthroplasty (THA) became popular in Asia was the possible increased range of movement and thereby improved function of the hip joint. Due to concerns of MOM articulation an alternative bearing was sought. Hence, a shift from large head MOM to large head ceramic on ceramic (COC) was made. The aim of this study was to compare the functional outcome including range of motion (ROM) and dislocation rates following large head MOM and large head COC THA. Materials and Methods: Retrospectively, 39 primary THA with large head MOM with a mean age of 56 years (range 36-72 years) and average followup of 54 months (range 38-70 months) were compared with 23 primary THA with large head COC bearing with a mean age of 48 years (range 36-68 years) and an average followup of 18 months (range 12-26 months). Functional outcome was assessed using the Modified Harris Hip Score. Dislocation rate and ROM were compared. Results: Global ROM averaged 248 degrees with MOM group and 252 degrees with the COC group. One patient with metal bearing had dislocation at an average 3 year followup which required revision THA while there were no complications in the COC group. MHHS averaged 89 points in MOM and 94 in COC THR. Conclusion: This study has shown that large head ceramic on ceramic THA is a good alternative to large head metal on metal THA with comparable dislocation rates and range of movements and without complications of metallosis in Asian patients. PMID:25143647

  8. Metal-on-metal total hip arthroplasty: is there still a role in 2016?

    PubMed

    Silverman, Edward J; Ashley, Blair; Sheth, Neil P

    2016-03-01

    The use of metal-on-metal (MoM) bearings in total hip arthroplasty (THA) was popularized due to its enhanced wear profile and the ability to use large femoral heads to reduce post-operative instability. However, enthusiasm for the bearing declined following serious complications encountered at the primary articulation. This review discusses the development of MoM and the subsequent unexpected downstream challenges, most notably elevated serum metal ion levels, aseptic lymphocyte-dominated vasculitis-associated lesions (ALVAL), pseudotumor formation, and subsequent soft tissue and bone destruction. Both patient centered risk factors as well as component design led to high early failure rates resulting in product recalls and an overall decline in the use of MoM. In 2016, there is not a role for large-head MoM bearing in THA. Alternatively, the bearing has shown promise in hip resurfacing procedures for carefully selected patients. PMID:26791173

  9. Metal-on-Metal Total Hip Resurfacing Arthroplasty

    PubMed Central

    2006-01-01

    Executive Summary Objective The objective of this review was to assess the safety and effectiveness of metal on metal (MOM) hip resurfacing arthroplasty for young patients compared with that of total hip replacement (THR) in the same population. Clinical Need Total hip replacement has proved to be very effective for late middle-aged and elderly patients with severe degenerative diseases of the hips. As indications for THR began to include younger patients and those with a more active life style, the longevity of the implant became a concern. Evidence suggests that these patients experience relatively higher rates of early implant failure and the need for revision. The Swedish hip registry, for example, has demonstrated a survival rate in excess of 80% at 20 years for those aged over 65 years, whereas this figure was 33% by 16 years in those aged under 55 years. Hip resurfacing arthroplasty is a bone-conserving alternative to THR that restores normal joint biomechanics and load transfer. The technique has been used around the world for more than 10 years, specifically in the United Kingdom and other European countries. The Technology Metal-on-metal hip resurfacing arthroplasty is an alternative procedure to conventional THR in younger patients. Hip resurfacing arthroplasty is less invasive than THR and addresses the problem of preserving femoral bone stock at the initial operation. This means that future hip revisions are possible with THR if the initial MOM arthroplasty becomes less effective with time in these younger patients. The procedure involves the removal and replacement of the surface of the femoral head with a hollow metal hemisphere, which fits into a metal acetabular cup. Hip resurfacing arthroplasty is a technically more demanding procedure than is conventional THR. In hip resurfacing, the femoral head is retained, which makes it much more difficult to access the acetabular cup. However, hip resurfacing arthroplasty has several advantages over a conventional THR with a small (28 mm) ball. First, the large femoral head reduces the chance of dislocation, so that rates of dislocation are less than those with conventional THR. Second, the range of motion with hip resurfacing arthroplasty is higher than that achieved with conventional THR. A variety of MOM hip resurfacing implants are used in clinical practice. Six MOM hip resurfacing implants have been issued licences in Canada. Review Strategy A search of electronic bibliographies (OVID Medline, Medline In-Process and Other Non-Indexed Citations, Embase, Cochrane CENTRAL and DSR, INAHTA) was undertaken to identify evidence published from Jan 1, 1997 to October 27, 2005. The search was limited to English-language articles and human studies. The literature search yielded 245 citations. Of these, 11 met inclusion criteria (9 for effectiveness, 2 for safety). The result of the only reported randomized controlled trial on MOM hip resurfacing arthroplasty could not be included in this assessment, because it used a cemented acetabular component, whereas in the new generation of implants, a cementless acetabular component is used. After omitting this publication, only case series remained. Summary of Findings   Health Outcomes The Harris hip score and SF-12 are 2 measures commonly used to report health outcomes in MOM hip resurfacing arthroplasty studies. Other scales used are the Oxford hip score and the University of California Los Angeles hip score. The case series showed that the mean revision rate of MOM hip resurfacing arthroplasty is 1.5% and the incidence of femoral neck fracture is 0.67%. Across all studies, 2 cases of osteonecrosis were reported. Four studies reported improvement in Harris hip scores. However, only 1 study reported a statistically significant improvement. Three studies reported improvement in SF-12 scores, of which 2 reported a significant improvement. One study reported significant improvement in UCLA hip score. Two studies reported postoperative Oxford hip scores, but no preoperative values were reported. None of the reviewed studies reported procedure-related deaths. Four studies reported implant survival rates ranging from 94.4% to 99.7% for a follow-up period of 2.8 to 3.5 years. Three studies reported on the range of motion. One reported improvement in all motions including flexion, extension, abduction-adduction, and rotation, and another reported improvement in flexion. Yet another reported improvement in range of motion for flexion abduction-adduction and rotation arc. However, the author reported a decrease in the range of motion in the arc of flexion in patients with Brooker class III or IV heterotopic bone (all patients were men). Safety of Metal-on-Metal Hip Resurfacing Arthroplasty There is a concern about metal wear debris and its systemic distribution throughout the body. Detectable metal concentrations in the serum and urine of patients with metal hip implants have been described as early as the 1970s, and this issue is still controversial after 35 years. Several studies have reported high concentration of cobalt and chromium in serum and/or urine of the patients with metal hip implants. Potential toxicological effects of the elevated metal ions have heightened concerns about safety of MOM bearings. This is of particular concern in young and active patients in whom life expectancy after implantation is long. Since 1997, 15 studies, including 1 randomized clinical trial, have reported high levels of metal ions after THR with metal implants. Some of these studies have reported higher metal levels in patients with loose implants. Adverse Biological Effects of Cobalt and Chromium Because patients who receive a MOM hip arthroplasty are shown to be exposed to high concentrations of metallic ions, the Medical Advisory Secretariat searched the literature for reports of adverse biological effects of cobalt and chromium. Cobalt and chromium make up the major part of the metal articulations; therefore, they are a focus of concern. Risk of Cancer To date, only one study has examined the incidence of cancer after MOM and polyethylene on metal total hip arthroplasties. The results were compared to that of general population in Finland. The mean duration of follow-up for MOM arthroplasty was 15.7 years; for polyethylene arthroplasty, it was 12.5 years. The standardized incidence ratio for all cancers in the MOM group was 0.95 (95% CI, 0.79–1.13). In the polyethylene on metal group it was 0.76 (95% CI, 0.68–0.86). The combined standardized incidence ratio for lymphoma and leukemia in the patients who had MOM THR was 1.59 (95% CI, 0.82–2.77). It was 0.59 (95% CI, 0.29–1.05) for the patients who had polyethylene on metal THR. Patients with MOM THR had a significantly higher risk of leukemia. All patients who had leukemia were aged over than 60 years. Cobalt Cardiotoxicity   Epidemiological Studies of Myocardiopathy of Beer Drinkers An unusual type of myocardiopathy, characterized by pericardial effusion, elevated hemoglobin concentrations, and congestive heart failure, occurred as an epidemic affecting 48 habitual beer drinkers in Quebec City between 1965 and 1966. This epidemic was directly related the consumption of a popular beer containing cobalt sulfate. The epidemic appeared 1 month after cobalt sulfate was added to the specific brewery, and no further cases were seen a month after this specific chemical was no longer used in making this beer. A beer of the same name is made in Montreal, and the only difference at that time was that the Quebec brand of beer contained about 10 times more cobalt sulphate. Cobalt has been added to some Canadian beers since 1965 to improve the stability of the foam but it has been added in larger breweries only to draught beer. However, in small breweries, such as those in Quebec City, separate batches were not brewed for bottle and draught beer; therefore, cobalt was added to all of the beer processed in this brewery. In March 1966, a committee was appointed under the chairmanship of the Deputy Minister of Health for Quebec that included members of the department of forensic medicine of Quebec’s Ministry of Justice, epidemiologists, members of Food and Drug Directorate of Ottawa, toxicologists, biomedical researchers, pathologists, and members of provincial police. Epidemiological studies were carried out by the Provincial Ministry of Health and the Quebec City Health Department. The association between the development of myocardiopathy and the consumption of the particular brand of beer was proven. The mortality rate of this epidemic was 46.1% and those who survived were desperately ill, and recovered only after a struggle for their lives. Similar cases were seen in Omaha (Nebraska). The epidemic started after a cobalt additive was used in 1 of the beers marketed in Nebraska. Sixty-four patients with the clinical diagnosis of alcoholic myocardiopathy were seen during an 18-month period (1964–1965). Thirty of these patients died. The first patient became ill within 1 month after cobalt was added to the beer, and the last patient was seen within 1 month of withdrawal of cobalt. A similar epidemic occurred in Minneapolis, Minnesota. Between 1964 and 1967, 42 patients with acute heart failure were admitted to a hospital in Minneapolis, Minnesota. Twenty of these patients were drinking 6 to 30 bottles per day of a particular brand of beer exclusively. The other 14 patients also drank the same brand of beer, but not exclusively. The mortality rate from the acute illness was 18%, but late deaths accounted for a total mortality rate of 43%. Examination of the tissue from these patients revealed markedly abnormal changes in myofibrils (heart muscles), mitochondria, and sarcoplasmic reticulum. In Belgium, a similar epidemic was reported in 1966, in which, cobalt was used in some Belgian beers. There was a difference in mortality between the Canadian or American epidemic and this series. Only 1 of 24 patients died, 1.5 years after the diagnosis. In March 1965, at an international meeting in Brussels, a new heart disease in chronic beer drinkers was described. This disease consists of massive pericardial effusion, low cardiac output, raised venous pressure, and polycythemia in some cases. This syndrome was thought to be different from the 2 other forms of alcoholic heart disease (beriberi and a form characterized by myocardial fibrosis). The mystery of the above epidemics as stated by investigators is that the amount of cobalt added to the beer was below the therapeutic doses used for anemia. For example, 24 pints of Quebec brand of beer in Quebec would contain 8 mg of cobalt chloride, whereas an intake of 50 to 100 mg of cobalt as an antianemic agent has been well tolerated. Thus, greater cobalt intake alone does not explain the occurrence of myocardiopathy. It seems that there are individual differences in cobalt toxicity. Other features, like subclinical alcoholic heart disease, deficient diet, and electrolyte imbalance could have been precipitating factors that made these patients susceptible to cobalt’s toxic effects. In the Omaha epidemic, 60% of the patients had weight loss, anorexia, and occasional vomiting and diarrhea 2 to 6 months before the onset of cardiac symptoms. In the Quebec epidemic, patients lost their appetite 3 to 6 months before the diagnosis of myocardiopathy and developed nausea in the weeks before hospital admission. In the Belgium epidemic, anorexia was one of the most predominant symptoms at the time of diagnosis, and the quality and quantity of food intake was poor. Alcohol has been shown to increase the uptake of intracoronary injected cobalt by 47%. When cobalt enters the cells, calcium exits; this shifts the cobalt to calcium ratio. The increased uptake of cobalt in alcoholic patients may explain the high incidence of cardiomyopathies in beer drinkers’ epidemics. As all of the above suggest, it may be that prior chronic exposure to alcohol and/or a nutritionally deficient diet may have a marked synergistic effect with the cardiotoxicity of cobalt. Conclusions MOM hip resurfacing arthroplasty has been shown to be an effective arthroplasty procedure as tested in younger patients. However, evidence for effectiveness is based only on 7 case series with short duration of follow-up (2.8–3.5 years). There are no RCTs or other well-controlled studies that compare MOM hip resurfacing with THR. Revision rates reported in the MOM studies using implants currently licensed in Canada (hybrid systems, uncemented acetabular, and cemented femoral) range from 0.3% to 3.6% for a mean follow-up ranging from 2.8 to 3.5 years. Fracture of femoral neck is not very common; it occurs in 0.4% to 2.2% of cases (as observed in a short follow-up period). All the studies that measured health outcomes have reported improvement in Harris Hip and SF-12 scores; 1 study reported significant reduction in pain and improvement in function, and 2 studies reported significant improvement in SF-12 scores. One study reported significant improvement in UCLA Hip scores. Concerns remain on the potential adverse effects of metal ions. Longer-term follow-up data will help to resolve the inconsistency of findings on adverse effects, including toxicity and carcinogenicity. Ontario-Based Economic Analysis The device cost for MOM ranges from $4,300 to $6,000 (Cdn). Traditional hip replacement devices cost about $2,000 (Cdn). Using Ontario Case Costing Initiative data, the total estimated costs for hip resurfacing surgery including physician fees, device fees, follow-up consultation, and postsurgery rehabilitation is about $15,000 (Cdn). Figure 1: Cost of Total Hip Replacement Surgery in Ontario Hip Resurfacing Surgery (Based on 2005/06 inflationary-adjusted rates) Weighted Average (Academic Community! al-inclusive hospitalization cost of surgery $ 6.767.18 Device Cost $ 5,400.00 Additional Medication $ 330.75 Follow-up Consultation $ 190.30 Rehab (per outpatient CCAC case) $ 1,500.00 OH P costs (average) $ 1,068.60 Total Estimated Cost $ 15,256.83 MOM hip arthroplasty is generally recommended for patients aged under 55 years because its bone-conserving advantage enables patients to “buy time” and hence helps THRs to last over the lifetime of the patient. In 2004/2005, 15.9% of patients who received THRs were aged 55 years and younger. It is estimated that there are from 600 to 1,000 annual MOM hip arthroplasty surgeries in Canada with an estimated 100 to 150 surgeries in Ontario. Given the increased public awareness of this device, it is forecasted that demand for MOM hip arthroplasty will steadily increase with a conservative estimate of demand rising to 1,400 cases by 2010 (Figure 10). The net budget impact over a 5-year period could be $500,000 to $4.7 million, mainly because of the increasing cost of the device. Figure 2: Projected Number of Metal-on-Metal Hip Arthroplasty Surgeries in Ontario: to 2010 PMID:23074495

  10. Complications Related to Metal-on-Metal Articulation in Trapeziometacarpal Joint Total Joint Arthroplasty

    PubMed Central

    Frølich, Christina; Hansen, Torben Bæk

    2015-01-01

    Adverse reactions to metal-on-metal (MoM) prostheses are well known from total hip joint resurfacing arthroplasty with elevated serum chrome or cobalt, pain and pseudo tumor formation. It may, however, also be seen after total joint replacement of the trapeziometacarpal joint using MoM articulation, and we present two cases of failure of MoM prostheses due to elevated metal-serum levels in one case and pseudo tumor formation in another case. Furthermore, we suggest a diagnostic algorithm for joint pain after MoM trapeziometacarpal joint replacement based on published experiences from MoM hip prostheses and adverse reactions to metal. PMID:26020592

  11. Delayed Hypersensitivity Reaction: An Increasingly Recognized Complication of Metal-on-Metal Total Disc Replacement

    PubMed Central

    Karnoub, Mélodie-Anne; Zairi, Fahed; Aboukais, Rabih; Assaker, Richard

    2015-01-01

    We report the case of a 32-year-old woman who presented with pain recurrence 20 months after she underwent a C5C6 metal-on-metal total replacement. Plan radiographs demonstrated a modification of the shape of the vertebral bodies making the prosthesis more protruding. Then, infection has been ruled out and patch testing revealed a strongly positive reaction for chromium and cobalt. The prosthesis has been removed and a fusion achieved using a cage filled with bone graft. She has been immediately and fully relieved from her pain. We report the radiological signs that enabled early diagnosis and treatment allowing favorable outcome. PMID:26346567

  12. Metal-on-Metal Total Hip Arthroplasty: Patient Evaluation and Treatment.

    PubMed

    Bolognesi, Michael P; Ledford, Cameron K

    2015-12-01

    Metal-on-metal (MoM) hip articulations were thought to represent a biologic and biomechanically favorable alternative to conventional metal-on-polyethylene total hip arthroplasty implants. However, concerns emerged when registry data reported significantly higher failure rates associated with MoM implants compared with other contemporary hip implants. These high implant failure rates have been attributed to the release of metal particles into the periprosthetic space, creating macroscopic necrosis; corrosive osteolysis; large, sterile hip effusions; and periprosthetic solid and cystic masses (ie, pseudotumors)-a spectrum of findings termed adverse reaction to metal debris. A thorough clinical history and physical examination, along with laboratory data and imaging surveillance of these patients, is critical for appropriate diagnosis and treatment. The decision to perform revision hip arthroplasty of a metal-on-metal implant is multifactorial and should be based on documented, objective clinical indications. A systematic and objective approach to this evaluation and treatment is essential to optimize the care of patients who undergo total hip arthroplasty with MoM implants. PMID:26493972

  13. High Re-Operation Rates Using Conserve Metal-On-Metal Total Hip Articulations

    PubMed Central

    Mogensen, S.L.; Jakobsen, T.; Christoffersen, H.; Krarup, N.

    2016-01-01

    Introduction: Metal-on-metal hip articulations have been intensely debated after reports of adverse reactions and high failure rates. The aim of this study was to retrospectively evaluate the implant of a metal-on.metal total hip articulation (MOM THA) from a single manufacture in a two-center study. Materials and Methods: 108 CONSERVE® MOM THA were implanted in 92 patients between November 2005 and December 2010. Patients had at time of retrospective evaluation their journals reviewed for re-operations and adverse reactions. Results: 20 hips were re-operated (18.4%) at a mean follow up of 53 months. 4 pseudotumors were diagnosed at time of follow up but no substantiated link was made between adverse reactions and re-operations. Conclusion: The high re-operation rates found in this study raised concern about the usage of the MOM THA and subsequently lead to the termination of implantation of this MOM THA at the two orthopaedic departments. PMID:27099640

  14. A finite element method comparison of wear in two metal-on-metal total hip prostheses.

    PubMed

    Cosmi, F; Hoglievina, M; Fancellu, G; Martinelli, B

    2006-11-01

    The contact mechanics of two metal-on-metal (MOM) total hip prostheses was studied by means of the finite element method (FEM). The purpose of the work was to compare two total hip replacements (Durom and Metasul) with regard to the amount of wear debris released. Wear on the bearing surfaces was evaluated following Reye hypotheses from the pressure distribution, computed by means of three-dimensional FEM models; an approximate analytical model based on Hertz contact theory has also been developed and discussed. The results show that in the dry friction condition the Durom joint releases almost twice as much wear volume as produced by the Metasul joint. Therefore, while Durom implants can improve hip stability by increasing the prosthetic impingement-free range of motion (PIF-ROM), Metasul prostheses can be a valuable solution whenever wear represents a critical choice factor. PMID:17236520

  15. A comparative assessment of small-head metal-on-metal and ceramic-on-polyethylene total hip replacement.

    PubMed

    Lübbeke, A; Gonzalez, A; Garavaglia, G; Roussos, C; Bonvin, A; Stern, R; Peter, R; Hoffmeyer, P

    2014-07-01

    Large-head metal-on-metal (MoM) total hip replacements (THR) have given rise to concern. Comparative studies of small-head MoM THRs over a longer follow-up period are lacking. Our objective was to compare the incidence of complications such as infection, dislocation, revision, adverse local tissue reactions, mortality and radiological and clinical outcomes in small-head (28 mm) MoM and ceramic-on-polyethylene (CoP) THRs up to 12 years post-operatively. A prospective cohort study included 3341 THRs in 2714 patients. The mean age was 69.1 years (range 24 to 98) and 1848 (55.3%) were performed in women, with a mean follow-up of 115 months (18 to 201). There were 883 MoM and 2458 CoP bearings. Crude incidence rates (cases/1000 person-years) were: infection 1.3 vs 0.8; dislocation 3.3 vs 3.1 and all-cause revision 4.3 vs 2.2, respectively. There was a significantly higher revision rate after ten years (adjusted hazard ratio 9.4; 95% CI 2.6 to 33.6) in the MoM group, and ten of 26 patients presented with an adverse local tissue reaction at revision. No differences in mortality, osteolysis or clinical outcome were seen. In conclusion, we found similar results for small-head MoM and CoP bearings up to ten years post-operatively, but after ten years MoM THRs had a higher risk of all-cause revision. Furthermore, the presence of an adverse response to metal debris seen in the small-head MOM group at revision is a cause for concern. PMID:24986938

  16. Large diameter metal on metal total hip replacement for femoral neck fractures with neurological conditions

    PubMed Central

    Li, Jia; Zheng, Wei; Zhao, Jinzhu; Liu, Denghui; Xu, Weidong

    2014-01-01

    Background: Patients with Parkinson's disease and poliomyelitis can have a femoral neck fracture; yet, the optimal methods of treatment for these hips remains controversial. Many constrained or semi-constrained prostheses, using constrained liners (CLs) with a locking mechanism to capture the femoral head, were used to treat femoral neck fractures in patients with neurological disorders. We retrospectively studied a group of patients with Parkinson's disease and poliomyelitis who sustained femoral neck fractures and were treated by total hip arthroplasty using an L-MoM prosthesis. Materials and Methods: We retrospectively reviewed 12 hips in 12 patients who underwent large-diameter metal-on-metal (L-MoM) total hip replacement between May 2007 and October 2009. Eight of the 12 patients (8 hips; 66.7%) had Parkinson's disease and 4 patients (4 hips; 33.3%) were affected with poliomyelitis. Results: The followup time was 5.2 years (range 3.6-6.0 years). At the latest followup, all the patients showed satisfactory clinical and radiographic results, with pain relief. No complications, such as dislocation or aseptic loosening occurred. Conclusion: We believe the use of L-MoM can diminish the rate of instability or dislocation, after operation. The L-MoM is an option for patients with Parkinson's disease and poliomyelitis with femoral neck fracture. PMID:25404774

  17. Metal on metal total hip arthroplasty and a large groin mass: Not always adverse reaction to metallic debris

    PubMed Central

    Krishnan, Harry; Magnussen, Alex; Sharma, Aadhar; Skinner, John

    2014-01-01

    Due to their improved wear rates, Metal-on-metal bearings have been increasingly used in the past decade by orthopaedic surgeons carrying out total hip arthroplasty. However there is increasing evidence that there are significant complications associated with such implants. One well documented complication is that of metallic debris leading to pseudotumour formation, however there is less known about associations with other tumours within the pelvis. We present two cases where an intra-pelvic mass in patients with metal-on-metal implants were diagnosed as being of a different aetiology. This highlights the need for careful assessment of such patients in order to guide appropriate management. PMID:25560054

  18. Metallic debris from metal-on-metal total hip arthroplasty regulates periprosthetic tissues

    PubMed Central

    Lohmann, Christoph H; Singh, Gurpal; Willert, Hans-Georg; Buchhorn, Gottfried H

    2014-01-01

    The era of metal-on-metal (MoM) total hip arthroplasty has left the orthopaedic community with valuable insights and lessons on periprosthetic tissue reactions to metallic debris. Various terms have been used to describe the tissue reactions. Sometimes the nomenclature can be confusing. We present a review of the concepts introduced by Willert and Semlitsch in 1977, along with further developments made in the understanding of periprosthetic tissue reactions to metallic debris. We propose that periprosthetic tissue reactions be thought of as (1) gross (metallosis, necrosis, cyst formation and pseudotumour); (2) histological (macrophage-dominated, lymphocyte-dominated or mixed); and (3) molecular (expression of inflammatory mediators and cytokines such as interleukin-6 and tumor necrosis factor-alpha). Taper corrosion and modularity are discussed, along with future research directions to elucidate the antigen-presenting pathways and material-specific biomarkers which may allow early detection and intervention in a patient with adverse periprosthetic tissue reactions to metal wear debris. PMID:25405095

  19. Distributed Analysis of Hip Implants Using Six National and Regional Registries: Comparing Metal-on-Metal with Metal-on-Highly Cross-Linked Polyethylene Bearings in Cementless Total Hip Arthroplasty in Young Patients

    PubMed Central

    Furnes, Ove; Paxton, Elizabeth; Cafri, Guy; Graves, Stephen; Bordini, Barbara; Comfort, Thomas; Rivas, Moises Coll; Banerjee, Samprit; Sedrakyan, Art

    2014-01-01

    Background: The regulation of medical devices has attracted controversy recently because of problems related to metal-on-metal hip implants. There is growing evidence that metal-on-metal implants fail early and cause local and systemic complications. However, the failure associated with metal-on-metal head size is not consistently documented and needs to be communicated to patients and surgeons. The purpose of this study is to compare implant survival of metal on metal with that of metal on highly cross-linked polyethylene. Methods: Using a distributed health data network, primary total hip arthroplasties were identified from six national and regional total joint arthroplasty registries (2001 to 2010). Inclusion criteria were patient age of forty-five to sixty-four years, cementless total hip arthroplasties, primary osteoarthritis diagnosis, and exclusion of the well-known outlier implant ASR (articular surface replacement). The primary outcome was revision for any reason. A meta-analysis of survival probabilities was performed with use of a fixed-effects model. Metal-on-metal implants with a large head size of >36 mm were compared with metal-on-highly cross-linked polyethylene implants. Results: Metal-on-metal implants with a large head size of >36 mm were used in 5172 hips and metal-on-highly cross-linked polyethylene implants were used in 14,372 hips. Metal-on-metal total hip replacements with a large head size of >36 mm had an increased risk of revision compared with metal-on-highly cross-linked polyethylene total hip replacements with more than two years of follow-up, with no difference during the first two years after implantation. The results of the hazard ratios (and 95% confidence intervals) from the multivariable model at various durations of follow-up were 0.95 (0.74 to 1.23) at zero to two years (p = 0.698), 1.42 (1.16 to 1.75) at more than two years to four years (p = 0.001), 1.78 (1.45 to 2.19) at more than four years to six years (p < 0.001), and 2.15 (1.63 to 2.83) at more than six years to seven years (p < 0.001). Conclusions: We conducted a comparison of large-head-size, metal-on-metal implants and metal-on-highly cross-linked polyethylene implants in younger patients with uncemented fixation. We found consistent and strong evidence worldwide that large-head-size, metal-on-metal implants were associated with increased risk of revision after two years compared with metal-on-highly cross-linked polyethylene implants, with the effect becoming more pronounced over time. PMID:25520416

  20. Increased risk of revision of cementless stemmed total hip arthroplasty with metal-on-metal bearings

    PubMed Central

    Pedersen, Alma B; Mäkelä, Keijo; Eskelinen, Antti; Havelin, Leif Ivar; Furnes, Ove; Kärrholm, Johan; Garellick, Göran; Overgaard, Søren

    2015-01-01

    Background and purpose Data from the national joint registries in Australia and England and Wales have revealed inferior medium-term survivorship for metal-on-metal (MoM) total hip arthroplasty (THA) than for metal-on-polyethylene (MoP) THA. Based on data from the Nordic Arthroplasty Register Association (NARA), we compared the revision risk of cementless stemmed THA with MoM and MoP bearings and we also compared MoM THA to each other. Patients and methods We identified 32,678 patients who were operated from 2002 through 2010 with cementless stemmed THA with either MoM bearings (11,567 patients, 35%) or MoP bearings (21,111 patients, 65%). The patients were followed until revision, death, emigration, or the end of the study period (December 31, 2011), and median follow-up was 3.6 (interquartile range (IQR): 2.4–4.8) years for MoM bearings and 3.4 (IQR: 2.0–5.8) years for MoP bearings. Multivariable regression in the presence of competing risk of death was used to assess the relative risk (RR) of revision for any reason (with 95% confidence interval (CI)). Results The cumulative incidence of revision at 8 years of follow-up was 7.0% (CI: 6.0–8.1) for MoM bearings and 5.1% (CI: 4.7–5.6) for MoP bearings. At 6 years of follow-up, the RR of revision for any reason was 1.5 (CI: 1.3–1.7) for MoM bearings compared to MoP bearings. The RR of revision for any reason was higher for the ASR (adjusted RR = 6.4, CI: 5.0–8.1), the Conserve Plus (adjusted RR = 1.7, CI: 1.1–2.5) and “other” acetabular components (adjusted RR = 2.4, CI: 1.5–3.9) than for MoP THA at 6 years of follow-up. Interpretation At medium-term follow-up, the survivorship for cementless stemmed MoM THA was inferior to that for MoP THA, and metal-related problems may cause higher revision rates for MoM bearings with longer follow-up. PMID:25715878

  1. Understanding the differences between the wear of metal-on-metal and ceramic-on-metal total hip replacements.

    PubMed

    Figueiredo-Pina, C G; Yan, Y; Neville, A; Fisher, J

    2008-04-01

    Hip simulator studies have been carried out extensively to understand and test artificial hip implants in vitro as an efficient alternative to obtaining long-term results in vivo. Recent studies have shown that a ceramic-on-metal material combination lowers the wear by up to 100 times in comparison with a typical metal-on-metal design. The reason for this reduction remains unclear and for this reason this study has undertaken simple tribometer tests to understand the fundamental material loss mechanisms in two material combinations: metal-on-metal and ceramic-on-ceramic. A simple-configuration reciprocating pin-on-plate wear study was performed under open-circuit potential (OCP) and with applied cathodic protection (CP) in a serum solution using two tribological couples: firstly, cobalt-chromium (Co-Cr) pins against Co-Cr plates; secondly, Co-Cr pins against alumina (Al2O3) plates. The pin and plate surfaces prior to and after testing were examined by profilometry and scanning electron microscopy. The results showed a marked reduction in wear when CP was applied, indicating that total material degradation under the OCP condition was attributed to corrosion processes. The substitution of the Co-Cr pin with an Al2O3 plate also resulted in a dramatic reduction in wear, probably due to the reduction in the corrosion-wear interactions between the tribological pair. PMID:18491698

  2. Serum aluminium and cobalt levels after ceramic-on-ceramic and metal-on-metal total hip replacement.

    PubMed

    Grübl, A; Weissinger, M; Brodner, W; Gleiss, A; Giurea, A; Gruber, M; Pöll, G; Meisinger, V; Gottsauner-Wolf, F; Kotz, R

    2006-08-01

    In a randomised study, 28 patients with a mean age of 62.2 years (32 to 81) with osteoarthritis or avascular necrosis of the hip received either a ceramic-on-ceramic or a metal-on-metal total hip replacement. Apart from the liners the acetabular and femoral components were made of Ti-Al-Nb alloy. The serum aluminium and cobalt levels were measured before, and at one year after surgery. The 15 patients in the ceramic-on-ceramic group had a median pre-operative aluminium level of 1.3 microg/l (0.25 to 8.4) and a cobalt level below the detection limit. At one year the aluminium level was 1.1 microg/l (0.25 to 2.3) and the cobalt level was 0.4 microg/l (0.15 to 0.7). The 13 patients in the metal-on-metal group had a median pre-operative aluminium level of 1.9 microg/l (0.25 to 4.4) and a cobalt level below the detection limit. At one year the median aluminium level was 0.9 microg/l (0.25 to 3.9) whereas the cobalt level was 1.4 microg/l (0.5 to 10.5). This increase in the cobalt level at one year was significant (p < 0.001). Our findings indicate that ceramic-on-ceramic bearings do not cause elevated levels of serum aluminium in the first post-operative year. PMID:16877596

  3. Mortality rates at 10 years after metal-on-metal hip resurfacing compared with total hip replacement in England: retrospective cohort analysis of hospital episode statistics

    PubMed Central

    Kendal, Adrian R; Prieto-Alhambra, Daniel; Arden, Nigel K; Judge, Andrew

    2013-01-01

    Objectives To compare 10 year mortality rates among patients undergoing metal-on-metal hip resurfacing and total hip replacement in England. Design Retrospective cohort study. Setting English hospital episode statistics database linked to mortality records from the Office for National Statistics. Population All adults who underwent primary elective hip replacement for osteoarthritis from April 1999 to March 2012. The exposure of interest was prosthesis type: cemented total hip replacement, uncemented total hip replacement, and metal-on-metal hip resurfacing. Confounding variables included age, sex, Charlson comorbidity index, rurality, area deprivation, surgical volume, and year of operation. Main outcome measures All cause mortality. Propensity score matching was used to minimise confounding by indication. Kaplan-Meier plots estimated the probability of survival up to 10 years after surgery. Multilevel Cox regression modelling, stratified on matched sets, described the association between prosthesis type and time to death, accounting for variation across hospital trusts. Results 7437 patients undergoing metal-on-metal hip resurfacing were matched to 22 311 undergoing cemented total hip replacement; 8101 patients undergoing metal-on-metal hip resurfacing were matched to 24 303 undergoing uncemented total hip replacement. 10 year rates of cumulative mortality were 271 (3.6%) for metal-on-metal hip resurfacing versus 1363 (6.1%) for cemented total hip replacement, and 239 (3.0%) for metal-on-metal hip resurfacing versus 999 (4.1%) for uncemented total hip replacement. Patients undergoing metal-on-metal hip resurfacing had an increased survival probability (hazard ratio 0.51 (95% confidence interval 0.45 to 0.59) for cemented hip replacement; 0.55 (0.47 to 0.65) for uncemented hip replacement). There was no evidence for an interaction with age or sex. Conclusions Patients with hip osteoarthritis undergoing metal-on-metal hip resurfacing have reduced mortality in the long term compared with those undergoing cemented or uncemented total hip replacement. This difference persisted after extensive adjustment for confounding factors available in our data. The study results can be applied to matched populations, which exclude patients who are very old and have had complex total hip replacements. Although residual confounding is possible, the observed effect size is large. These findings require validation in external cohorts and randomised clinical trials. PMID:24284336

  4. Arthroprosthetic cobaltism and pseudotumour also occur in patients with small diameter femoral ball head metal-on-metal total hip arthroplasties

    PubMed Central

    Roessler, Philip P; Witt, Florian; Efe, Turgay; Schmitt, Jan

    2014-01-01

    Metal-on-metal implants have been widely discredited in public during the past few months. At the same time patients' awareness has risen leading to an increased number of consultations regarding the topic. As hip resurfacings and total hip arthroplasties with large diameter femoral ball heads are already known for excessive metal wear, even small diameter ball heads with low friction get into focus now. We report a case of a 75-year-old man with recurrent hip pain almost 14 years after low friction metal-on-metal total hip arthroplasty. In addition to elevated serum cobalt levels, a type IV sensitivity reaction to cobalt could be noted. Explantation of a highly worn small diameter femoral ball head as well as development of the so-called pseudotumour indicate that all patients should be screened for signs of metal wear regardless of their specific risk factors or the type of metal-on-metal implant. PMID:24682139

  5. Perfusion MRI in hips with metal-on-metal and metal-on-polyethylene total hip arthroplasty

    PubMed Central

    Anwander, H.; Cron, G. O.; Rakhra, K.

    2016-01-01

    Objectives Hips with metal-on-metal total hip arthroplasty (MoM THA) have a high rate of adverse local tissue reactions (ALTR), often associated with hypersensitivity reactions. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) measures tissue perfusion with the parameter Ktrans (volume transfer constant of contrast agent). Our purpose was 1) to evaluate the feasibility of DCE-MRI in patients with THA and 2) to compare DCE-MRI in patients with MoM bearings with metal-on-polyethylene (MoP) bearings, hypothesising that the perfusion index Ktrans in hips with MoM THA is higher than in hips with MoP THA. Methods In this pilot study, 16 patients with primary THA were recruited (eight MoM, eight MoP). DCE-MRI of the hip was performed at 1.5 Tesla (T). For each patient, Ktrans was computed voxel-by-voxel in all tissue lateral to the bladder. The mean Ktrans for all voxels was then calculated. These values were compared with respect to implant type and gender, and further correlated with clinical parameters. Results There was no significant difference between the two bearing types with both genders combined. However, dividing patients by THA bearing and gender, women with MoM bearings had the highest Ktrans values, exceeding those of women with MoP bearings (0.067 min−1 versus 0.053 min−1; p-value < 0.05) and men with MoM bearings (0.067 min−1 versus 0.034 min−1; p-value < 0.001). Considering only the men, patients with MoM bearings had lower Ktrans than those with MoP bearings (0.034 min−1 versus 0.046 min−1; p < 0.05). Conclusion DCE-MRI is feasible to perform in tissues surrounding THA. Females with MoM THA show high Ktrans values in DCE-MRI, suggesting altered tissue perfusion kinematics which may reflect relatively greater inflammation. Cite this article: Dr P. E. Beaule. Perfusion MRI in hips with metal-on-metal and metal-on-polyethylene total hip arthroplasty: A pilot stud. Bone Joint Res 2016;5:73–79. DOI: 10.1302/2046-3758.53.2000572. PMID:26935768

  6. Metal-on-metal vs conventional total hip arthroplasty: a systematic review and meta-analysis of randomized controlled trials.

    PubMed

    Voleti, Pramod B; Baldwin, Keith D; Lee, Gwo-Chin

    2012-12-01

    Metal-on-metal (MOM) hip articulations represent a potential alternative to conventional metal-on-polyethylene total hip arthroplasty (THA). We performed a systematic review of the peer-reviewed literature in search of studies comparing MOM with conventional primary THA with regard to functional outcomes, radiographic outcomes, and complication rates. Four Level I randomized controlled trials remained following our screening process. The data published in these studies were extracted and aggregated using a Mantel-Haenszel cumulative fixed effects meta-analysis. We found no significant difference between MOM and conventional THA with regard to functional outcomes as measured by Harris hip scores and radiographic outcomes as measured by radiolucent lines. Patients with MOM THA did however demonstrate a 3.37 times greater complication rate (1.57, 7.26). In light of the lack of superiority, the increased complication rate, the greater cost, and the potential for adverse medical consequences associated with MOM THA, these bearing surfaces should be used with caution. PMID:22771090

  7. Prediction of contact mechanics in metal-on-metal Total Hip Replacement for parametrically comprehensive designs and loads.

    PubMed

    Donaldson, Finn E; Nyman, Edward; Coburn, James C

    2015-07-16

    Manufacturers and investigators of Total Hip Replacement (THR) bearings require tools to predict the contact mechanics resulting from diverse design and loading parameters. This study provides contact mechanics solutions for metal-on-metal (MoM) bearings that encompass the current design space and could aid pre-clinical design optimization and evaluation. Stochastic finite element (FE) simulation was used to calculate the head-on-cup contact mechanics for five thousand combinations of design and loading parameters. FE results were used to train a Random Forest (RF) surrogate model to rapidly predict the contact patch dimensions, contact area, pressures and plastic deformations for arbitrary designs and loading. In addition to widely observed polar and edge contact, FE results included ring-polar, asymmetric-polar, and transitional categories which have previously received limited attention. Combinations of design and load parameters associated with each contact category were identified. Polar contact pressures were predicted in the range of 0-200 MPa with no permanent deformation. Edge loading (with subluxation) was associated with pressures greater than 500 MPa and induced permanent deformation in 83% of cases. Transitional-edge contact (with little subluxation) was associated with intermediate pressures and permanent deformation in most cases, indicating that, even with ideal anatomical alignment, bearings may face extreme wear challenges. Surrogate models were able to accurately predict contact mechanics 18,000 times faster than FE analyses. The developed surrogate models enable rapid prediction of MoM bearing contact mechanics across the most comprehensive range of loading and designs to date, and may be useful to those performing bearing design optimization or evaluation. PMID:25980556

  8. Evaluation of the wear properties of a metal-on-metal total joint replacement system and in vitro macrophage response to resultant wear particles

    NASA Astrophysics Data System (ADS)

    St. John, Kenneth Raymond

    The wear of the polyethylene in total joint prostheses has been a source of morbidity and early device failure which has been extensively reported in the last ten to twelve years. While research continues to attempt to reduce the wear of polyethylene joint bearing surfaces by modifications in polymer processing, there is a renewed interest in the use of metal-on-metal bearing couples for hip replacement devices. This study investigated the in vitro wear resistance of two cobalt/chromium/molybdenum alloys, which differed primarily in the carbon content, as potential alloys for use in such a metal-on-metal hip bearing couple. The results showed that the alloy with the higher (0.25%) carbon content was more wear resistant and this alloy was chosen for testing in a hip simulator system which modeled the loads and motions which might be exerted on a clinically implanted hip replacement. Comparison of the results of metal-on-polyethylene specimens to metal-on-metal specimens showed that the volumetric wear of the metal-on-polyethylene bearing couple over 5,000,000 cycles was 110--180 times as great as that for the metal bearing couple. Polyethylene and metal particles retrieved from either pin-on-disk testing lubricant or hip simulator testing lubricant were cleaned and examined for consistency with the particles reported by other laboratories for particles from periprosthetic tissues and found to be similar. The particles were then added to macrophage (J774a) cell cultures and the release of Prostaglandin E2, Interleukin-6, and Tumor Necrosis Factor alpha measured for each experiment in response to the particles. The cell mediators released by the cells was found to correlate with the dosage of particles and the chemical identity of the particles. Most of the cellular response to the polyethylene particles seemed to be as a result of phagocytosis of the particles while most of the response to metal particles seemed to be related to cytotoxicity of the particles. Based upon the results of this study, metal-on-metal hip prostheses prepared from the high carbon cobalt/chromium alloy (CCM+) that was investigated seem to hold sufficient promise to justify human clinical trials.

  9. A longitudinal study of MARS MRI scanning of soft-tissue lesions around metal-on-metal total hip arthroplasties and disease progression.

    PubMed

    Briant-Evans, T W; Lyle, N; Barbur, S; Hauptfleisch, J; Amess, R; Pearce, A R; Conn, K S; Stranks, G J; Britton, J M

    2015-10-01

    We investigated the changes seen on serial metal artefact reduction magnetic resonance imaging scans (MARS-MRI) of metal-on-metal total hip arthroplasties (MoM THAs). In total 155 THAs, in 35 male and 100 female patients (mean age 70.4 years, 42 to 91), underwent at least two MRI scans at a mean interval of 14.6 months (2.6 to 57.1), at a mean of 48.2 months (3.5 to 93.3) after primary hip surgery. Scans were graded using a modification of the Oxford classification. Progression of disease was defined as an increase in grade or a minimum 10% increase in fluid lesion volume at second scan. A total of 16 hips (30%) initially classified as 'normal' developed an abnormality on the second scan. Of those with 'isolated trochanteric fluid' 9 (47%) underwent disease progression, as did 7 (58%) of 'effusions'. A total of 54 (77%) of hips initially classified as showing adverse reactions to metal debris (ARMD) progressed, with higher rates of progression in higher grades. Disease progression was associated with high blood cobalt levels or an irregular pseudocapsule lining at the initial scan. There was no association with changes in functional scores. Adverse reactions to metal debris in MoM THAs may not be as benign as previous reports have suggested. Close radiological follow-up is recommended, particularly in high-risk groups. PMID:26430006

  10. The Latest Lessons Learned from Retrieval Analyses of Ultra-High Molecular Weight Polyethylene, Metal-on-Metal, and Alternative Bearing Total Disc Replacements

    PubMed Central

    Kurtz, Steven M.; Toth, Jeffrey M.; Siskey, Ryan; Ciccarelli, Lauren; MacDonald, Dan; Isaza, Jorge; Lanman, Todd; Punt, Ilona; Steinbeck, Marla; Goffin, Jan; van Ooij, André

    2012-01-01

    Knowledge regarding the in vivo performance and periposthetic tissue response of cervical and lumbar total disc replacements (TDRs) continues to expand. This review addresses the following four main questions: 1) What are the latest lessons learned from polyethylene in large joints and how are they relevant to current TDRs? 2) What are the latest lessons learned regarding adverse local tissue reactions from metal-on-metal, CoCr bearings in large joints and how are they relevant to current TDRs? 3) What advancements have been made in understanding the in vivo performance of alternative biomaterials, such as stainless steel and polycarbonate urethane, for TDRs in the past five years? 4) How has retrieval analysis of all these various artificial disc bearing technologies advanced the state of the art in preclinical testing of TDRs? The study of explanted artificial discs and their associated tissues can help inform bearing selection as well as the design of future generations of disc arthroplasty. Analyzing retrieved artificial discs is also essential for validating preclinical test methods. PMID:22904606

  11. Adverse reaction to metal debris after ReCap-M2A-Magnum large-diameter-head metal-on-metal total hip arthroplasty

    PubMed Central

    2013-01-01

    Background and purpose The clinical findings of adverse reaction to metal debris (ARMD) following large-diameter-head metal-on-metal total hip arthroplasty (LDH MoM THA) may include periarticular fluid collections, soft tissue masses, and gluteal muscle necrosis. The ReCap-M2a-Magnum LDH MoM THA was the most commonly used hip device at our institution from 2005 to 2012. We assessed the prevalence of and risk factors for ARMD with this device. Methods 74 patients (80 hips) had a ReCap-M2a-Magnum LDH MoM THA during the period August 2005 to December 2006. These patients were studied with hip MRI, serum chromium and cobalt ion measurements, the Oxford hip score questionnaire, and by clinical examination. The prevalence of ARMD was recorded and risk factors for ARMD were assessed using logistic regression models. The mean follow-up time was 6.0 (5.5–6.7) years. Results A revision operation due to ARMD was needed by 3 of 74 patients (3 of 80 hips). 8 additional patients (8 hips) had definite ARMD, but revision was not performed. 29 patients (32 hips) were considered to have a probable or possible ARMD. Altogether, 43 of 80 hips had a definite, probable, or possible ARMD and 34 patients (37 hips) were considered not to have ARMD. In 46 of 78 hips, MRI revealed a soft tissue mass or a collection of fluid (of any size). The symptoms clicking in the hip, local hip swelling, and a feeling of subluxation were associated with ARMD. Interpretation ARMD is common after ReCap-M2a-Magnum total hip arthroplasty, and we discourage the use of this device. Asymptomatic patients with a small fluid collection on MRI may not need instant revision surgery but must be followed up closely. PMID:24171688

  12. Ion release in patients with metal-on-metal hip bearings in total joint replacement: a comparison with metal-on-polyethylene bearings.

    PubMed

    Savarino, L; Granchi, D; Ciapetti, G; Cenni, E; Nardi Pantoli, A; Rotini, R; Veronesi, C A; Baldini, N; Giunti, A

    2002-01-01

    Polyethylene (PE) wear has been shown to be a problem in long-term joint replacement using metal-on-PE bearing. The use of metallic heads articulating with metallic cups could solve this problem: success will be enhanced if wear and corrosion of the articulating surfaces are maintained at a low level. New models with metal-on-metal bearing have been proposed, to be used mainly for young subjects: such coupling seems to have a reduced release, but it is unclear yet if the medium-term corrosion rate is really negligible or, on the contrary, it is significantly higher than in the metal-on-PE bearing. Aim of our study was the comparison of ion release in the serum of two groups of patients who had the same type of stable cementless prosthesis, but different bearing: twenty-six patients with metal-on-metal (Group A) and fifteen patients with metal-on-PE bearing (Group B) were examined. The follow-up was 14-38 months for group A and 18-34 months for group B. The serum concentration of chromium (Cr), cobalt (Co) and molybdenum (Mo) was measured. Twenty-two patients before surgery were used for comparison (Group C). The reference values were obtained from a population of twenty-two healthy subjects (Group D). Our findings indicate that metal-on-metal bearings produce a significantly higher systemic release of cobalt and chromium (ng/ml) when compared with levels found in metal-on-PE, pre-surgery and reference groups. Such a high release should induce to improve the bearing materials or, at least, to study the biologic fate of metal ions and consequently their long-term effects. In such a way a risk-to-benefit ratio for the patient could be established. PMID:12209889

  13. Changes in early serum metal ion levels and impact on liver, kidney, and immune markers following metal-on-metal total hip arthroplasty.

    PubMed

    Chen, Zhefeng; Wang, Zhen; Wang, Qing; Cui, Weiding; Liu, Feng; Fan, Weimin

    2014-03-01

    We retrospectively studied 32 consecutive patients (32 hips) who underwent THA with a Durom large-head, MOM articulation between January 2008 and December 2010. Of the patients who underwent THA using a Trilogy metal on polyethylene prosthesis during the same period, 32 were chosen to form the Trilogy group. 32 volunteers were chosen to form the control group. At the last follow-up, serum metal ion levels, liver and kidney function and host immunologic immune responses were evaluated. The mean Co and Cr levels in the Durom group were 4.33- and 1.95-fold higher than those in the Trilogy group. CD3+, CD4+ and CD8+ cell levels in the Durom group were significantly decreased. The INF-? level in the Durom group was significantly higher than that in the Trilogy and control groups. PMID:23993737

  14. Strong association between smoking and the risk of revision in a cohort study of patients with metal-on-metal total hip arthroplasty.

    PubMed

    Lübbeke, Anne; Rothman, Kenneth J; Garavaglia, Guido; Barea, Christophe; Christofilopoulos, Panayiotis; Stern, Richard; Hoffmeyer, Pierre

    2014-06-01

    Thus far the ability to predict who will develop early failure following the insertion of a metal-on-metal (MoM) bearing has been very limited. Our objective was to assess the effect of smoking on failure rates in patients with MoM bearing, compared with patients with ceramic-on-polyethylene (CoP) bearing. From a prospective hospital-based registry we included all primary THAs operated upon between 1/2001 and 12/2011 with MoM or CoP bearings of the same cup design and head size (28 mm). We compared revision rates through 10/2013 classified by smoking status and type of bearing. We included 1,964 patients (median age 71, 57% women), 663 with MoM and 1,301 with CoP bearing. Mean follow-up was 6.9 years (range 1.8-12.8). Revisions were required for 56 THAs. In patients with MoM bearing the adjusted incidence rate of revision among ever-smokers was four times greater than among never-smokers (95% CI 1.4-10.9). Among those with CoP bearing, the rate ratio was only 1.3 (95% CI 0.6-2.5). We found a strong association between smoking and increased failure of MoM THAs. In contrast, the association was weak for patients with CoP bearing. Smoking might be a trigger or an effect amplifier for adverse reactions to metal debris from MoM bearings. PMID:24615914

  15. Metal-on-metal hip joint tribology.

    PubMed

    Dowson, D; Jin, Z M

    2006-02-01

    The basic tribological features of metal-on-metal total hip replacements have been reviewed to facilitate an understanding of the engineering science underpinning the renaissance of these hard-on-hard joints. Metal-on-polymer hip replacements operate in the boundary lubrication regime, thus leading to the design guidance to reduce the femoral head diameter as much as is feasible to minimize frictional torque and volumetric wear. This explains why the gold-standard implant of this form from the past half-century had a diameter of only 22.225 mm (7/8 in). Metal-on-metal implants can operate in the mild mixed lubrication regime in which much of the applied load is supported by elastohydrodynamic films. Correct tribological design leads to remarkably low steady state wear rates. Promotion of the most effective elastohydrodynamic films calls for the largest possible head diameters and the smallest clearances that can reasonably be adopted, consistent with fine surface finishes, good sphericity and minimal structural elastic deformation of the cup on its foundations. This guidance, which is opposite in form to that developed for metal-on-polymer joints, is equally valid for solid (monolithic) metallic heads on metallic femoral stems and surface replacement femoral shells. Laboratory measurements of friction and wear in metal-on-metal joints have confirmed their potential to achieve a very mild form of mixed lubrication. The key lies in the generation of effective elastohydrodynamic lubricating films of adequate thickness compared with the composite roughness of the head and cup. The calculation of the film thickness is by no means easy, but the full procedure is outlined and the use of an empirical formula that displays good agreement with calculations based upon the full numerical solutions is explained. The representation of the lambda ratio, lambda, embracing both film thickness and composite roughness, is described. PMID:16669380

  16. Metal-on-Metal Hip Retrieval Analysis: A Case Report

    PubMed Central

    Pace, Thomas B.; Rusaw, Kara A.; Minette, Lawrence J.; Shirley, Brayton R.; Snider, Rebecca G.; DesJardins, John D.

    2013-01-01

    This is a case report involving a single case with severe bone and soft tissue destruction in a young male patient with a 10-year-metal on-metal total hip arthroplasty. Following complete aseptic erosion of the affected hip greater trochanter and abductor muscles, the hip was revised for recurrent instability. Histological examination of the patient's periprosthetic tissues, serological studies, and review of recent medical reports of similar cases were used to support an explanation of the destructive process and better contribute to our understanding of human reaction to metal debris in some patients following metal-on-metal hip arthroplasty. PMID:23840999

  17. Adverse local tissue reaction (ALTR) associated with corrosion products in metal-on-metal and dual modular neck total hip replacements is associated with upregulation of interferon gamma-mediated chemokine signaling.

    PubMed

    Kolatat, Kritti; Perino, Giorgio; Wilner, Gabrielle; Kaplowitz, Elianna; Ricciardi, Benjamin F; Boettner, Friedrich; Westrich, Geoffrey H; Jerabek, Seth A; Goldring, Steven R; Purdue, P Edward

    2015-10-01

    Adverse local tissue reactions (ALTR) associated with tribocorrosion following total hip arthroplasty (THA) have become a significant clinical concern in recent years. In particular, implants featuring metal-on-metal bearing surfaces and modular femoral stems have been reported to result in elevated rates of ALTR. These tribocorrosion-related tissue reactions are characterized by marked necrosis and lymphocytic infiltration, which contrasts sharply with the macrophagic and foreign body giant cell inflammation associated with polyethylene wear particle induced peri-implant osteolysis. In this study, we characterize tribocorrosion-associated ALTR at a molecular level. Gene expression profiling of peri-implant tissue around failing implants identifies upregulation of numerous inflammatory mediators in ALTR, including several interferon gamma inducible factors, most notably the chemokines MIG/CXCL9 and IP-10/CXCL10. This expression profile is distinct from that associated with polyethylene wear induced osteolysis, which is characterized by induction of markers of alternative macrophage activation, such as chitotriosidase (CHIT-1). Importantly, MIG/CXCL9 and IP-10/CXCL10 are also elevated at the protein level in the synovial fluid and, albeit more moderately, the serum, of ALTR patients, raising the possibility that these factors may serve as circulating biomarkers for the early detection of ALTR in at-risk patients. PMID:25940887

  18. Pseudotumour formation and subsequent resolution in metal-on-metal total hip arthroplasty following revision: Instructional review and an illustrative case report with revision using a dual mobility design.

    PubMed

    Sassoon, A A; Barrack, R L

    2016-06-01

    The use of large-diameter metal-on-metal (MoM) components in total hip arthroplasty (THA) is associated with an increased risk of early failure due to adverse local tissue reaction to metal debris (ARMD) in response to the release of metal ions from the bearing couple and/or head-neck taper corrosion. The aim of this paper was to present a review of the incidence and natural history of ARMD and the forms of treatment, with a focus on the need for and extent of resection or debulking of the pseudotumour. An illustrative case report is presented of a patient with an intra-pelvic pseudotumour associated with a large diameter MoM THA, which was treated successfully with revision of the bearing surface to a dual mobility couple and retention of the well-fixed acetabular and femoral components. The pseudotumour was left in situ Resolution of the intra-pelvic mass and normalisation of metal ion levels was observed seven months post-operatively. Cite this article: Bone Joint J 2016;98-B:736-40. PMID:27235513

  19. [The hard lesson of metal-on-metal hip implants].

    PubMed

    Verhaar, J A N Jan

    2012-01-01

    Metal-on-metal hip implants with a large metal head (≥ 36 mm) have shown periprosthetic adverse soft tissue reactions and high blood concentrations of metal ions in patients. This has raised concern that exposure to metal ions may induce complications and could increase the risk of cancer. In view of the present level of uncertainty and for reasons of patient safety, the Dutch Orthopaedic Association (NOV) has advised its members to suspend utilisation of all metal-on-metal hip implants with a large head (≥ 36 mm) until the safety and long-term effectiveness have been established. All patients with these implants will be invited for an annual check-up according to a set protocol. This outpatient examination will also include assessment of cobalt ion levels and X-ray diagnostics. Based on the blood concentration of cobalt, the clinical status and the X-ray, the patient will be advised to undergo a revision procedure of the implant. PMID:23075779

  20. Similar incidence of periprosthetic fluid collections after ceramic-on-polyethylene total hip arthroplasties and metal-on-metal resurfacing arthroplasties: results of a screening metal artefact reduction sequence-MRI study.

    PubMed

    Bisseling, P; de Wit, B W K; Hol, A M; van Gorp, M J; van Kampen, A; van Susante, J L C

    2015-09-01

    Patients from a randomised trial on resurfacing hip arthroplasty (RHA) (n = 36, 19 males; median age 57 years, 24 to 65) comparing a conventional 28 mm metal-on-metal total hip arthroplasty (MoM THA) (n = 28, 17 males; median age 59 years, 37 to 65) and a matched control group of asymptomatic patients with a 32 mm ceramic-on-polyethylene (CoP) THA (n = 33, 18 males; median age 63 years, 38 to 71) were cross-sectionally screened with metal artefact reducing sequence-MRI (MARS-MRI) for pseudotumour formation at a median of 55 months (23 to 72) post-operatively. MRIs were scored by consensus according to three different classification systems for pseudotumour formation. Clinical scores were available for all patients and metal ion levels for MoM bearing patients. Periprosthetic lesions with a median volume of 16 mL (1.5 to 35.9) were diagnosed in six patients in the RHA group (17%), one in the MoM THA group (4%) and six in the CoP group (18%). The classification systems revealed no clear differences between the groups. Solid lesions (n = 3) were exclusively encountered in the RHA group. Two patients in the RHA group and one in the MoM THA group underwent a revision for pseudotumour formation. There was no statistically significant relationship between clinical scoring, metal ion levels and periprosthetic lesions in any of the groups. Periprosthetic fluid collections are seen on MARS-MRI after conventional CoP THA and RHA and may reflect a soft-tissue collection or effusion. Currently available MRI classification systems seem to score these collections as pseudotumours, causing an-overestimatation of the incidence of pseudotumours. PMID:26330582

  1. Metal-on-polyethylene versus metal-on-metal bearing surfaces in total hip arthroplasty: a prospective randomised study investigating metal ion levels and chromosomal aberrations in peripheral lymphocytes.

    PubMed

    Briggs, T W R; Hanna, S A; Kayani, B; Tai, S; Pollock, R C; Cannon, S R; Blunn, G W; Carrington, R W J

    2015-09-01

    The long term biological effects of wear products following total hip arthroplasty (THA) are unclear. However, the indications for THA are expanding, with increasingly younger patients undergoing the procedure. This prospective, randomised study compared two groups of patients undergoing THA after being randomised to receive one of two different bearing surfaces: metal-on-polyethylene (MoP) n = 22 and metal-on-metal (MoM) n = 23. We investigated the relationship between three variables: bearing surface (MoP vs MoM), whole blood levels of chromium (Cr) and cobalt (Co) and chromosomal aberrations in peripheral lymphocyte pre-operatively and at one, two and five years post-surgery. Our results demonstrated significantly higher mean cobalt and chromium (Co and Cr) blood levels in the MoM group at all follow-up points following surgery (p < 0.01), but there were no significant differences in the chromosomal aberration indices between MoM and MoP at two or five years (two years: p = 0.56, p = 0.08, p = 0.91, p = 0.51 and five years: p = 0.086, p = 0.73, p = 0.06, p = 0.34) for translocations, breaks, loss and gain of chromosomes respectively. Regression analysis showed a strong linear relationship between Cr levels and the total chromosomal aberration indices in the MoM group (R(2) = 0.90016), but this was not as strong for Co (R(2) = 0.68991). In the MoP group, the analysis revealed a poor relationship between Cr levels and the total chromosomal aberration indices (R(2) = 0.23908) but a slightly stronger relationship for Co (R(2) = 0.64292). Across both groups, Spearman's correlation detected no overall association between Co and Cr levels and each of the studied chromosomal aberrations. There remains no clear indication which THA bearing couple is the most biocompatible, especially in young active patients. While THA continues to be very successful at alleviating pain and restoring function, the long-term biological implications of the procedure still require further scrutiny. PMID:26330583

  2. Metal-on-Metal Hip Resurfacing Arthroplasty

    PubMed Central

    Sehatzadeh, S; Kaulback, K; Levin, L

    2012-01-01

    Background Metal-on-metal (MOM) hip resurfacing arthroplasty (HRA) is in clinical use as an appropriate alternative to total hip arthroplasty in young patients. In this technique, a metal cap is placed on the femoral head to cover the damaged surface of the bone and a metal cup is placed in the acetabulum. Objectives The primary objective of this analysis was to compare the revision rates of MOM HRA using different implants with the benchmark set by the National Institute of Clinical Excellence (NICE). The secondary objective of this analysis was to review the literature regarding adverse biological effects associated with implant material. Review Methods A literature search was performed on February 13, 2012, to identify studies published from January 1, 2009, to February 13, 2012. Results The revision rates for MOM HRA using 6 different implants were reviewed. The revision rates for MOM HRA with 3 implants met the NICE criteria, i.e., a revision rate of 10% or less at 10 years. Two implants had short-term follow-ups and MOM HRA with one of the implants failed to meet the NICE criteria. Adverse tissue reactions resulting in failure of the implants have been reported by several studies. With a better understanding of the factors that influence the wear rate of the implants, adverse tissue reactions and subsequent implant failure can be minimized. Many authors have suggested that patient selection and surgical technique affect the wear rate and the risk of tissue reactions. The biological effects of high metal ion levels in the blood and urine of patients with MOM HRA implants are not known. Studies have shown an increase in chromosomal aberrations in patients with MOM articulations, but the clinical implications and long-term consequences of this increase are still unknown. Epidemiological studies have shown that patients with MOM HRA implants did not have an overall increase in mortality or risk of cancer. There is insufficient clinical data to confirm the teratogenicity of MOM implants in humans. Conclusions Metal-on-metal HRA can be beneficial for appropriately selected patients, provided the surgeon has the surgical skills required for performing this procedure. Plain Language Summary There are many young patients with hip diseases who need to have hip replacement surgery. Although a traditional hip replacement is an acceptable procedure for these patients, some surgeons prefer using a newer technique in young patients called hip resurfacing. In this technique, instead of removing the head of the femoral bone, a metal cap is placed on the femoral head to cover the damaged surface of the bone and a metal cup is placed in the hip socket, similar to the cups used in traditional hip replacement. The analysis of the revision rates (i.e., how soon and in how many patients the surgery needs to be redone) and safety of resurfacing implants showed that generally these implants can last 10 years or more for the majority of young people. Good outcomes can be expected when skilled surgeons perform the surgery in properly selected patients. However, since these implants are made of metal (cobalt and chromium alloy), there is concern about excess metal debris production due to friction between the 2 metal components leading to high levels of metal ions in the blood and urine of patients. The production of metal debris may result in inflammation in the joint or development of a benign soft tissue mass leading to implant failure. However, it has been shown that this risk can be reduced by proper positioning of the implant and the careful selection of patients for this procedure. Little is known about the long-term biological effects of high levels of metal ions in the blood and urine of patients who have received metal implants. There is concern about potential increases in the risk of cancer and the risk of fetal abnormalities, but these effects have not been established yet. However, since cobalt and chromium can pass the placental barrier, implants that are not metal-on-metal are recommended for women at childbearing ages if they need a hip replacement. PMID:23074429

  3. Edge loading in metal-on-metal hips: low clearance is a new risk factor

    PubMed Central

    Zografos, Angelos; Sayles, Ritchie S; Hart, Alister; Cann, Philippa

    2012-01-01

    The revision rate of large head metal-on-metal and resurfacing hips are significantly higher than conventional total hip replacements. The revision of these components has been linked to high wear caused by edge loading; which occurs when the headcup contact patch extends over the cup rim. There are two current explanations for this; first, there is loss of entrainment of synovial fluid resulting in breakdown of the lubricating film and second, edge loading results in a large local increase in contact pressure and consequent film thickness reduction at the cup rim, which causes an increase in wear. This paper develops a method to calculate the distance between the joint reaction force vector and the cup rim the contact patch centre to rim (CPCR) distance. However, the critical distance for the risk of edge loading is the distance from the contact patch edge to rim (CPER) distance. An analysis of explanted hip components, divided into edge worn and non-edge-worn components showed that there was no statistical difference in CPCR values, but the CPER value was significantly lower for edge worn hips. Low clearance hips, which have a more conformal contact, have a larger diameter contact patch and thus are more at risk of edge loading for similarly positioned hips. PMID:22558836

  4. Retrospective cohort study of the performance of the Pinnacle metal on metal (MoM) total hip replacement: a single-centre investigation in combination with the findings of a national retrieval centre

    PubMed Central

    Langton, David John; Sidaginamale, Raghavendra Prasad; Avery, Peter; Waller, Sue; Tank, Ghanshyabhai; Lord, James; Joyce, Thomas; Cooke, Nick; Logishetty, Raj; Nargol, Antoni Viraf Francis

    2016-01-01

    Objectives To determine risk factors for revision in patients implanted with a commonly used metal on metal (MoM) hip replacement. Design Retrospective cohort study in combination with a prospective national retrieval study (Northern Retrieval Registry (NRR)). Setting Combined orthopaedic unit in combination with the NRR. Participants All patients implanted with a DePuy Pinnacle MoM hip prostheses by the 2 senior authors were invited to attend for a review which included clinical examination, blood metal ion measurements, radiographs and targeted imaging. Explanted components underwent wear analysis using validated methodology and these results were compared with those obtained from the NRR. Results 489 MoM Pinnacle hips were implanted into 434 patients (243 females and 191 males). Of these, 352 patients attended the MoM recall clinics. 64 patients had died during the study period. For the purposes of survival analysis, non-attendees were assumed to have well-functioning prostheses. The mean follow-up of the cohort as a whole was 89 months. 71 hips were revised. Prosthetic survival for the whole cohort was 83.6% (79.9–87.3) at 9 years. The majority of explanted devices exhibited signs of taper junction failure. Risk factors for revision were bilateral MoM prostheses, smaller Pinnacle liners, and implantation in 2006 and later years. A significant number of devices were found to be manufactured out of their specifications. This was confirmed with analysis of the wider data set from the NRR. Conclusions This device was found to have an unacceptably high revision rate. Bilateral prostheses, those implanted into female patients and devices implanted in later years were found to be at greater risk. A significant number of explanted components were found to be manufactured with bearing diameters outside of the manufacturer's stated tolerances. Our findings highlight the clinical importance of hitherto unrecognised variations in device production. PMID:27130159

  5. Metal-on-metal: history, state of the art (2010)

    PubMed Central

    2011-01-01

    The history of metal-on-metal bearing began with K. Mc Kee. Several "episodes" have marked the history of metal-on-metal articulations, and each has contributed to a better understanding of this type of tribology. But to date the indications for this bearing are debated and are subject to reservations because of the existence of permanently elevated levels of circulating metal ions. It therefore appears that the monitoring of our patients, the documentation of our revisions and the collaboration with our industry partners as well as communicating with our biology and pathology colleagues is necessary to help us solve these problems. PMID:21234564

  6. Taper junction failure in large-diameter metal-on-metal bearings

    PubMed Central

    Langton, D. J.; Sidaginamale, R.; Lord, J. K.; Nargol, A. V. F.; Joyce, T. J.

    2012-01-01

    Objectives An ongoing prospective study to investigate failing metal-on-metal hip prostheses was commenced at our centre in 2008. We report on the results of the analysis of the first consecutive 126 failed mated total hip prostheses from a single manufacturer. Methods Analysis was carried out using highly accurate coordinate measuring to calculate volumetric and linear rates of the articular bearing surfaces and also the surfaces of the taper junctions. The relationship between taper wear rates and a number of variables, including bearing diameter and orientation of the acetabular component, was investigated. Results The measured rates of wear and distribution of material loss from the taper surfaces appeared to show that the primary factor leading to taper failure is the increased lever arm acting on this junction in contemporary large-diameter metal-on-metal hip replacements. Conclusions Our analysis suggests that varus stems, laterally engaging taper systems and larger head diameters all contribute to taper failure. PMID:23610672

  7. Graphitic Tribological Layers in Metal-on-Metal Hip Replacements

    NASA Astrophysics Data System (ADS)

    Liao, Y.; Pourzal, R.; Wimmer, M. A.; Jacobs, J. J.; Fischer, A.; Marks, L. D.

    2011-12-01

    Arthritis is a leading cause of disability, and when nonoperative methods have failed, a prosthetic implant is a cost-effective and clinically successful treatment. Metal-on-metal replacements are an attractive implant technology, a lower-wear alternative to metal-on-polyethylene devices. Relatively little is known about how sliding occurs in these implants, except that proteins play a critical role and that there is a tribological layer on the metal surface. We report evidence for graphitic material in the tribological layer in metal-on-metal hip replacements retrieved from patients. As graphite is a solid lubricant, its presence helps to explain why these components exhibit low wear and suggests methods of improving their performance; simultaneously, this raises the issue of the physiological effects of graphitic wear debris.

  8. CoCrMo metal-on-metal hip replacements.

    PubMed

    Liao, Yifeng; Hoffman, Emily; Wimmer, Markus; Fischer, Alfons; Jacobs, Joshua; Marks, Laurence

    2013-01-21

    After the rapid growth in the use of CoCrMo metal-on-metal hip replacements since the second generation was introduced circa 1990, metal-on-metal hip replacements have experienced a sharp decline in the last two years due to biocompatibility issues related to wear and corrosion products. Despite some excellent clinical results, the release of wear and corrosion debris and the adverse response of local tissues have been of great concern. There are many unknowns regarding how CoCrMo metal bearings interact with the human body. This perspective article is intended to outline some recent progresses in understanding wear and corrosion of metal-on-metal hip replacement both in vivo and in vitro. The materials, mechanical deformation, corrosion, wear-assisted corrosion, and wear products will be discussed. Possible adverse health effects caused by wear products will be briefly addressed, as well as some of the many open questions such as the detailed chemistry of corrosion, tribochemical reactions and the formation of graphitic layers. Nowadays we design almost routinely for high performance materials and lubricants for automobiles; humans are at least as important. It is worth remembering that a hip implant is often the difference between walking and leading a relatively normal life, and a wheelchair. PMID:23196425

  9. CoCrMo Metal-on-Metal Hip Replacements

    PubMed Central

    Liao, Yifeng; Hoffman, Emily; Wimmer, Markus; Fischer, Alfons; Jacobs, Joshua; Marks, Laurence

    2012-01-01

    After the rapid growth in the use of CoCrMo metal-on-metal hip replacements since the second generation was introduced circa 1990, metal-on-metal hip replacements have experienced a sharp decline in the last two years due to biocompatibility issues related to wear and corrosion products. Despite some excellent clinical results, the release of wear and corrosion debris and the adverse response of local tissues have been of great concern. There are many unknowns regarding how CoCrMo metal bearings interact with the human body. This perspective article is intended to outline some recent progresses in understanding wear and corrosion of metal-on-metal hip replacement both in-vivo and in-vitro. The materials, mechanical deformation, corrosion, wear-assisted corrosion, and wear products will be discussed. Possible adverse health effects caused by wear products will be briefly addressed, as well as some of the many open questions such as the detailed chemistry of corrosion, tribochemical reactions and the formation of graphitic layers. Nowadays we design almost routinely for high performance materials and lubricants for automobiles; humans are at least as important. It is worth remembering that a hip implant is often the difference between walking and leading a relatively normal life, and a wheelchair. PMID:23196425

  10. Metal-on-metal joint bearings and hematopoetic malignancy

    PubMed Central

    2012-01-01

    Abstract This is a review of the hip arthroplasty era. We concentrate on new metal bearings, surface replacements, and the lessons not learned, and we highlight recent reports on malignancies and joint implants. A low incidence of blood malignancies has been found in bone marrow taken at prosthetic surgery. The incidence is increased after replacement with knee implants that release very low systemic levels of metal ions. A carcinogenic effect of the high levels of metal ions released by large metal-on-metal implants cannot be excluded. Ongoing Swedish implant registry studies going back to 1975 can serve as a basis for evaluation of this risk. PMID:23140092

  11. Independent predictors of revision following metal-on-metal hip resurfacing: a retrospective cohort study using National Joint Registry data.

    PubMed

    Jameson, S S; Baker, P N; Mason, J; Porter, M L; Deehan, D J; Reed, M R

    2012-06-01

    Modern metal-on-metal hip resurfacing has been widely performed in the United Kingdom for over a decade. However, the literature reports conflicting views of the benefits: excellent medium- to long-term results with some brands in specific subgroups, but high failure rates and local soft-tissue reactions in others. The National Joint Registry for England and Wales (NJR) has collected data on all hip resurfacings performed since 2003. This retrospective cohort study recorded survival time to revision from a resurfacing procedure, exploring risk factors independently associated with failure. All patients with a primary diagnosis of osteoarthritis who underwent resurfacing between 2003 and 2010 were included in the analyses. Cox's proportional hazard models were used to analyse the extent to which the risk of revision was related to patient, surgeon and implant covariates. A total of 27 971 hip resurfacings were performed during the study period, of which 1003 (3.59%) underwent revision surgery. In the final adjusted model, we found that women were at greater risk of revision than men (hazard ratio (HR) = 1.30, p = 0.007), but the risk of revision was independent of age. Of the implant-specific predictors, five brands had a significantly greater risk of revision than the Birmingham Hip Resurfacing (BHR) (ASR: HR = 2.82, p < 0.001, Conserve: HR = 2.03, p < 0.001, Cormet: HR = 1.43, p = 0.001, Durom: HR = 1.67, p < 0.001, Recap: HR = 1.58, p = 0.007). Smaller femoral head components were also significantly more likely to require revision (? 44 mm: HR = 2.14, p < 0.001, 45 to 47 mm: HR = 1.48, p = 0.001) than medium or large heads, as were operations performed by low-volume surgeons (HR = 1.36, p < 0.001). Once these influences had been removed, in 4873 male patients < 60 years old undergoing resurfacing with a BHR, the five-year estimated risk of revision was 1.59%. In summary, after adjustment for a range of covariates we found that there were significant differences in the rate of failure between brands and component sizes. Younger male patients had good five-year implant survival when the BHR was used. PMID:22628587

  12. Metal Ion Concentrations in Body Fluids after Implantation of Hip Replacements with Metal-on-Metal Bearing – Systematic Review of Clinical and Epidemiological Studies

    PubMed Central

    Hartmann, Albrecht; Hannemann, Franziska; Lützner, Jörg; Seidler, Andreas; Drexler, Hans; Günther, Klaus-Peter; Schmitt, Jochen

    2013-01-01

    Introduction The use of metal-on-metal (MoM) total hip arthroplasty (THA) increased in the last decades. A release of metal products (i.e. particles, ions, metallo-organic compounds) in these implants may cause local and/or systemic adverse reactions. Metal ion concentrations in body fluids are surrogate measures of metal exposure. Objective To systematically summarize and critically appraise published studies concerning metal ion concentrations after MoM THA. Methods Systematic review of clinical trials (RCTs) and epidemiological studies with assessment of metal ion levels (cobalt, chromium, titanium, nickel, molybdenum) in body fluids after implantation of metalliferous hip replacements. Systematic search in PubMed and Embase in January 2012 supplemented by hand search. Standardized abstraction of pre- and postoperative metal ion concentrations stratified by type of bearing (primary explanatory factor), patient characteristics as well as study quality characteristics (secondary explanatory factors). Results Overall, 104 studies (11 RCTs, 93 epidemiological studies) totaling 9.957 patients with measurement of metal ions in body fluids were identified and analyzed. Consistently, median metal ion concentrations were persistently elevated after implantation of MoM-bearings in all investigated mediums (whole blood, serum, plasma, erythrocytes, urine) irrespective of patient characteristics and study characteristics. In several studies very high serum cobalt concentrations above 50 µg/L were measured (detection limit typically 0.3 µg/L). Highest metal ion concentrations were observed after treatment with stemmed large-head MoM-implants and hip resurfacing arthroplasty. Discussion Due to the risk of local and systemic accumulation of metallic products after treatment with MoM-bearing, risk and benefits should be carefully balanced preoperatively. The authors support a proposed „time out“ for stemmed large-head MoM-THA and recommend a restricted indication for hip resurfacing arthroplasty. Patients with implanted MoM-bearing should receive regular and standardized monitoring of metal ion concentrations. Further research is indicated especially with regard to potential systemic reactions due to accumulation of metal products. PMID:23950923

  13. On the inflammatory response in metal-on-metal implants

    PubMed Central

    2014-01-01

    Background Metal-on-metal implants are a special form of hip endoprostheses that despite many advantages can entail serious complications due to release of wear particles from the implanted material. Metal wear particles presumably activate local host defence mechanisms, which causes a persistent inflammatory response with destruction of bone followed by a loosening of the implant. To better characterize this inflammatory response and to link inflammation to bone degradation, the local generation of proinflammatory and osteoclast-inducing cytokines was analysed, as was systemic T cell activation. Methods By quantitative RT-PCR, gene expression of cytokines and markers for T lymphocytes, monocytes/macrophages and osteoclasts, respectively, was analysed in tissue samples obtained intraoperatively during exchange surgery of the loosened implant. Peripheral T cells were characterized by cytofluorometry before surgery and 7 to 10 days thereafter. Results At sites of osteolysis, gene expression of cathepsin K, CD14 and CD3 was seen, indicating the generation of osteoclasts, and the presence of monocytes and of T cells, respectively. Also cytokines were highly expressed, including CXCL8, IL-1ß, CXCL2, MRP-14 and CXCL-10. The latter suggest T cell activation, a notion that could be confirmed by detecting a small, though conspicuous population of activated CD4+ cells in the peripheral blood T cells prior to surgery. Conclusion Our data support the concept that metallosis is the result of a local inflammatory response, which according to histomorphology and the composition of the cellular infiltrate classifies as an acute phase of a chronic inflammatory disease. The proinflammatory environment, particularly the generation of the osteoclast-inducing cytokines CXCL8 and IL1-ß, promotes bone resorption. Loss of bone results in implant loosening, which then causes the major symptoms of metallosis, pain and reduced range of motion. PMID:24650243

  14. Muscle atrophy and metal-on-metal hip implants

    PubMed Central

    Berber, Reshid; Khoo, Michael; Cook, Erica; Guppy, Andrew; Hua, Jia; Miles, Jonathan; Carrington, Richard; Skinner, John; Hart, Alister

    2015-01-01

    Background and purpose Muscle atrophy is seen in patients with metal-on-metal (MOM) hip implants, probably because of inflammatory destruction of the musculo-tendon junction. However, like pseudotumors, it is unclear when atrophy occurs and whether it progresses with time. Our objective was to determine whether muscle atrophy associated with MOM hip implants progresses with time. Patients and methods We retrospectively reviewed 74 hips in 56 patients (32 of them women) using serial MRI. Median age was 59 (23–83) years. The median time post-implantation was 83 (35–142) months, and the median interval between scans was 11 months. Hip muscles were scored using the Pfirrmann system. The mean scores for muscle atrophy were compared between the first and second MRI scans. Blood cobalt and chromium concentrations were determined. Results The median blood cobalt was 6.84 (0.24–90) ppb and median chromium level was 4.42 (0.20–45) ppb. The median Oxford hip score was 34 (5–48). The change in the gluteus minimus mean atrophy score between first and second MRI was 0.12 (p = 0.002). Mean change in the gluteus medius posterior portion (unaffected by surgical approach) was 0.08 (p = 0.01) and mean change in the inferior portion was 0.10 (p = 0.05). Mean pseudotumor grade increased by 0.18 (p = 0.02). Interpretation Worsening muscle atrophy and worsening pseudotumor grade occur over a 1-year period in a substantial proportion of patients with MOM hip implants. Serial MRI helps to identify those patients who are at risk of developing worsening soft-tissue pathology. These patients should be considered for revision surgery before irreversible muscle destruction occurs. PMID:25588091

  15. Microseparation, fluid pressure and flow in failures of metal-on-metal hip resurfacing arthroplasties

    PubMed Central

    Wroblewski, B. M.; Siney, P. D.; Fleming, P. A.

    2012-01-01

    Objectives Metal-on-metal (MoM) hip resurfacing was introduced into clinical practice because it was perceived to be a better alternative to conventional total hip replacement for young and active patients. However, an increasing number of reports of complications have arisen focusing on design and orientation of the components, the generation of metallic wear particles and serum levels of metallic ions. The procedure introduced a combination of two elements: large-dimension components and hard abrasive particles of metal wear. The objective of our study was to investigate the theory that microseparation of the articular surfaces draws in a high volume of bursal fluid and its contents into the articulation, and at relocation under load would generate high pressures of fluid ejection, resulting in an abrasive water jet. Methods This theoretical concept using MoM resurfacing components (head diameter 55 mm) was modelled mathematically and confirmed experimentally using a material-testing machine that pushed the head into the cup at a rate of 1000 mm/min until fully engaged. Results The mathematical model showed the pattern but not the force of fluid ejection, the highest pressures were expected when the separation of the components was only a fraction of one millimetre. The experimental work confirmed the results; with the mean peak ejection pressure of 43 763 N/m2 equivalent to 306 mmHg or 5 psi. Conclusions The mechanical effect of the high-pressure abrasive water jet is the likely cause of the spectrum of complications reported with metal-on-metal resurfacing. Investigating serum levels of metallic elements may not be the best method for assessing the local mechanical effects of the abrasive water jet. PMID:23610667

  16. Assessing the material loss of the modular taper interface in retrieved metal-on-metal hip replacements

    NASA Astrophysics Data System (ADS)

    Bills, Paul J.; Racasan, R.; Tessier, P.; Blunt, L. A.

    2015-06-01

    Measuring the amount of material loss in the case of revised hip replacements is considered to be a prerequisite of understanding and assessing the true in vivo performance of the implant. This paper outlines a method developed by the authors for quantifying taper material loss as well as more general taper interface parameters. Previous studies have mostly relied on visual inspection to assess the material loss at the taper interface, whereas this method aims to characterize any surface and form changes through the use of an out-of-roundness measurement machine. Along with assessing the volumetric wear, maximum linear penetration and taper contact length can also be determined. The method was applied to retrieved large head metal-on-metal femoral heads in order to quantify the material loss at this junction. Material loss from the female femoral head taper can be characterized as a localized area that is in contact with the stem taper surface. The study showed that this method has good repeatability and a low level of interoperability variation between operators.

  17. Tribolayer Formation in a Metal-on-Metal (MoM) Hip Joint: An Electrochemical Investigation

    PubMed Central

    Mathew, MT; Nagelli, C; Pourzal, R; Fischer, A; Laurent, MP; Jacobs, JJ; Wimmer, MA

    2013-01-01

    The demand for total hip replacement (THR) surgery is increasing in the younger population due to faster rehabilitation and more complete restoration of function. Up to 2009, metal-on-metal (MoM) hip joint bearings were a popular choice due to their design flexibility, post-operative stability and relatively low wear rates. The main wear mechanisms that occur along the bearing surface of MoM joints are tribochemical reactions that deposit a mixture of wear debris, metal ions and organic matrix of decomposed proteins known as a tribolayer. No in-depth electrochemical studies have been reported on the structure and characteristics of this tribolayer or about the parameters involved in its formation. In this study, we conducted an electrochemical investigation of different surfaces (bulk-like: control, nano-crystalline: new implant and tribolayer surface: retrieved implant) made out of two commonly used hip CoCrMo alloys (high-carbon and low-carbon). As per ASTM standard, cyclic polarization tests and electrochemical impedance spectroscopy tests were conducted. The results obtained from electrochemical parameters for different surfaces clearly indicated a reduction in corrosion for the tribolayer surface (Icorr: 0.76 μA/cm2). Further, polarization resistance (Rp:2.39±0.60MΩ/cm2) and capacitance (Cdl:15.20±0.75 μF/cm2) indicated variation in corrosion kinetics for the tribolayer surface, that attributed to its structure and stability in a simulated body environment. PMID:24099949

  18. Management of metal-on-metal hip implant patients: Who, when and how to revise?

    PubMed Central

    Berber, Reshid; Skinner, John A; Hart, Alister J

    2016-01-01

    The debate on how best to manage patients with metal-on-metal (MOM) hip implants continues. With over 1 million patients affected worldwide, the impact is far reaching. The majority of the aggressive failures of MOM hip implants have been dealt with by revision hip surgery, leaving patients with a much more indolent pattern of failure of devices that have been in situ for more than 10 years. The longer-term outcome for such patients remains unknown, and much debate exists on how best to manage these patients. Regulatory guidance is available but remains open to interpretation due to the lack of current evidence and long-term studies. Metal ion thresholds for concern have been suggested at 7 ppb for hip resurfacing arthroplasty and below this level for large diameter total hip arthroplasties. Soft tissue changes including pseudotumours and muscle atrophy have been shown to progress, but this is not consistent. New advanced imaging techniques are helping to diagnose complications with metal hips and the reasons for failure, however these are not widely available. This has led to some centres to tackle difficult cases through multidisciplinary collaboration, for both surgical management decisions and also follow-up decisions. We summarise current evidence and consider who is at risk, when revision should be undertaken and how patients should be managed. PMID:27190754

  19. Management of metal-on-metal hip implant patients: Who, when and how to revise?

    PubMed

    Berber, Reshid; Skinner, John A; Hart, Alister J

    2016-05-18

    The debate on how best to manage patients with metal-on-metal (MOM) hip implants continues. With over 1 million patients affected worldwide, the impact is far reaching. The majority of the aggressive failures of MOM hip implants have been dealt with by revision hip surgery, leaving patients with a much more indolent pattern of failure of devices that have been in situ for more than 10 years. The longer-term outcome for such patients remains unknown, and much debate exists on how best to manage these patients. Regulatory guidance is available but remains open to interpretation due to the lack of current evidence and long-term studies. Metal ion thresholds for concern have been suggested at 7 ppb for hip resurfacing arthroplasty and below this level for large diameter total hip arthroplasties. Soft tissue changes including pseudotumours and muscle atrophy have been shown to progress, but this is not consistent. New advanced imaging techniques are helping to diagnose complications with metal hips and the reasons for failure, however these are not widely available. This has led to some centres to tackle difficult cases through multidisciplinary collaboration, for both surgical management decisions and also follow-up decisions. We summarise current evidence and consider who is at risk, when revision should be undertaken and how patients should be managed. PMID:27190754

  20. The Durom large diameter head acetabular component: early results with a large-diameter metal-on-metal bearing.

    PubMed

    Berton, C; Girard, J; Krantz, N; Migaud, H

    2010-02-01

    Implantation of a large-diameter femoral head prosthesis with a metal-on-metal bearing surface reduces the risk of dislocation, increases the range of movement, minimises the risk of impingement and, in theory, results in little wear. Between February 2004 and March 2007 we implanted 100 consecutive total hip replacements with a metal-on-metal bearing and a large femoral head into 92 patients. There were 51 men and 41 women with a mean age of 50 years (18 to 70) at the time of surgery. Outcome was assessed using the Western Ontario McMaster University osteoarthritis index and the Harris hip score as well as the Devane activity score. These all improved significantly (p < 0.0001). At the last follow-up there were no cases of dislocation, no impingement, a good range of movement and no osteolysis, but seven revisions, two for infection and five for aseptic loosening. The probability of groin pain increased if the other acetabular component inclination exceeded 50 degrees (p = 0.0007). At 4.8 years of follow-up, the projected survival of the Durom acetabular component, with revision for any reason, was 92.4% (sd 2.8) (95% confidence interval 89.6 to 95.2). The design of the component made it difficult both to orientate and seat, which when combined with a poor porous coating, produced unpredictable fixation and a low survival at five years. PMID:20130309

  1. Does Ion Release Differ Between Hip Resurfacing and Metal-on-metal THA?

    PubMed Central

    Moroni, Antonio; Cadossi, Matteo; Baldini, Nicola; Giannini, Sandro

    2008-01-01

    Modern metal-on-metal hip resurfacing was introduced as a bone-preserving method of joint reconstruction for young and active patients; however, the large diameter of the bearing surfaces is of concern for potential increased metal ion release. We hypothesized there were no differences in serum concentrations of chromium, cobalt, and molybdenum between patients who had metal-on-metal hip resurfacing (Group A; average head diameter, 48 mm; median followup, 24 months) and patients who had 28-mm metal-on-metal THA (Group B; median followup, 25 months). Serum concentrations also were compared with concentrations in healthy subjects. We identified no differences in ion levels between Groups A and B. A distinction was made according to gender. Women showed a higher chromium release in Group A whereas men had a higher cobalt release in Group B. Values obtained from Group A were higher than those of the control subjects. Our data suggest metal-on-metal bearings for THA should not be rejected because of concern regarding potential increased metal ion release; however, patients with elevated ion levels, even without loosening or toxicity, could be at higher risk and should be followed up periodically. Level of Evidence: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. PMID:18196364

  2. Progressive Cardiomyopathy in a Patient With Elevated Cobalt Ion Levels and Bilateral Metal-on-Metal Hip Arthroplasties.

    PubMed

    Mosier, Brian A; Maynard, Lance; Sotereanos, Nicholas G; Sewecke, Jeffrey J

    2016-01-01

    Systemic cobalt toxicity is a rare complication after metal-on-metal (MOM) total hip arthroplasty. Here we present a case of progressive cardiomyopathy, as evidenced by biopsy and cardiac magnetic resonance imaging (MRI), in a patient with bilateral MOM total hip arthroplasties. To our knowledge, it is one of the first cases in which cardiomyopathy resulting from systemic cobalt disease has been shown on MRI. While there is no guideline to unequivocally diagnose cobalt cardiomyopathy, the constellation of findings, including pathologic, biologic, blood levels, imaging, and surgical, all uniformly indicate a unifying diagnosis. The lack of improvement after removal of the prosthetic device supports a diagnosis of permanent myocardial damage, which is consistent with cardiomyopathy of advanced toxic etiology. PMID:26991580

  3. New Insights into Wear and Biological Effects of Metal-on-Metal Bearings

    PubMed Central

    Catelas, Isabelle; Wimmer, Markus A.

    2011-01-01

    Background: Despite the renewed interest in metal-on-metal implants in the past two decades, the underlying wear mechanisms and biological effects are still not fully understood. Methods: This paper first reviews the tribology of metal-on-metal bearings, bringing new insights into the interaction of wear and corrosion, and putting the characteristics and the potential origin of wear particles in perspective with the proposed wear mechanisms. It then summarizes the current knowledge on the biological effects of particles and metal ions in relation to these wear mechanisms. Results: Tribochemical reactions play an important role in the wear of metal-on-metal joints. The generated tribomaterial, which progressively forms by mechanical mixing of the uppermost nanocrystalline zone of the metal surface with proteins from the synovial fluid, governs the wear rate and influences the corrosive behavior of the bearing. Nanometer-sized wear particles may initially originate from the passivation layer covering the implant surface and then detach from this tribolayer. The inflammatory response observed surrounding metal-on-metal implants appears to be lower than that around metal-on-polyethylene implants. However, metallic byproducts, which can complex with proteins, may lead to a T lymphocyte-mediated hypersensitivity response. Conclusions: The tribolayer appears to have beneficial effects on the wear rate. Much information has been gained on wear particle characteristics, but the exact mechanisms of particle detachment remain to be further elucidated. Excessive wear along with a hypersensitivity response may be at the origin of the early adverse tissue reactions that have been recently reported in some patients with metal-on-metal implants. Clinical Relevance: Future development of new methods to improve the tribolayer retention and optimize the tribocorrosive properties of the implant may minimize the clinical impact of implant wear and immune responses. PMID:21543694

  4. Influence of the clearance on in-vitro tribology of large diameter metal-on-metal articulations pertaining to resurfacing hip implants.

    PubMed

    Rieker, Claude B; Schön, Rolf; Konrad, Reto; Liebentritt, Gernot; Gnepf, Patric; Shen, Ming; Roberts, Paul; Grigoris, Peter

    2005-04-01

    Large-diameter metal-on-metal articulations may provide an opportunity for wear reduction in total hip implants because earlier studies have shown that the formation of a fluid film that completely separates the bearing surfaces is theoretically possible. In such a lubrication mode and under ideal conditions, there is theoretically no amount of wear. Studies have suggested that the two primary parameters controlling the lubrication mode are the diameter and the clearance of the articulation. The goal of the present study was to experimentally investigate the influence of these two parameters on the wear behavior of large-diameter metal-on-metal articulations pertaining to resurfacing hip implants. The results of this in vitro investigation showed that longer running-in periods and higher amounts of running-in wear were associated with larger clearances. PMID:15833451

  5. Effects of metal-on-metal wear on the host immune system and infection in hip arthroplasty

    PubMed Central

    2010-01-01

    Background and purpose Joint replacement with metal-on-metal (MOM) bearings have gained popularity in the last decades in young and active patients. However, the possible effects of MOM wear debris and its corrosion products are still the subject of debate. Alongside the potential disadvantages such as toxicity, the influences of metal particles and metal ions on infection risk are unclear. Methods We reviewed the available literature on the influence of degradation products of MOM bearings in total hip arthroplasties on infection risk. Results Wear products were found to influence the risk of infection by hampering the immune system, by inhibiting or accelerating bacterial growth, and by a possible antibiotic resistance and heavy metal co-selection mechanism. Interpretation Whether or not the combined effects of MOM wear products make MOM bearings less or more prone to infection requires investigation in the near future. PMID:20860450

  6. Metal-on-Metal Hip Prostheses and Systemic Health: A Cross-Sectional Association Study 8 Years after Implantation

    PubMed Central

    Prentice, Jennifer R.; Clark, Matthew J.; Hoggard, Nigel; Morton, Allison C.; Tooth, Claire; Paley, Martyn N.; Stockley, Ian; Hadjivassiliou, Marios; Wilkinson, J. Mark

    2013-01-01

    There is public concern over the long term systemic health effects of metal released from hip replacement prostheses that use large-diameter metal-on-metal bearings. However, to date there has been no systematic study to determine which organs may be at risk, or the magnitude of any effect. We undertook a detailed cross-sectional health screen at a mean of 8 years after surgery in 35 asymptomatic patients who had previously received a metal-on-metal hip resurfacing (MoMHR) versus 35 individually age and sex matched asymptomatic patients who had received a conventional hip replacement. Total body bone mineral density was 5% higher (mean difference 0.05 g/cm2, P = 0.02) and bone turnover was 14% lower (TRAP 5b, mean difference −0.56IU/L, P = 0.006; osteocalcin, mean difference −3.08 ng/mL, P = 0.03) in the hip resurfacing versus conventional hip replacement group. Cardiac ejection fraction was 7% lower (mean absolute difference −5%, P = 0.04) and left ventricular end-diastolic diameter was 6% larger (mean difference 2.7 mm, P = 0.007) in the hip resurfacing group versus those patients who received a conventional hip replacement. The urinary fractional excretion of metal was low (cobalt 5%, chromium 1.5%) in patients with MoMHR, but creatinine clearance was normal. Diuretic prescription was associated with a 40% increase in the fractional excretion of chromium (mean difference 0.5%, P = 0.03). There was no evidence of difference in neuropsychological, renal tubular, hepatic or endocrine function between groups (P>0.05). Our findings of differences in bone and cardiac function between patient groups suggest that chronic exposure to low elevated metal concentrations in patients with well-functioning MoMHR prostheses may have systemic effects. Long-term epidemiological studies in patients with well-functioning metal on metal hip prostheses should include musculoskeletal and cardiac endpoints to quantitate the risk of clinical disease. PMID:23762480

  7. The effect of the metal-on-metal hip controversy on Internet search activity.

    PubMed

    Phelan, Nigel; Kelly, John C; Moore, David P; Kenny, Patrick

    2014-10-01

    The recall of the articular surface replacement (ASR) hip prosthesis in 2010 represents one of the most controversial areas in orthopaedic surgery in recent years. The aim of this study was to compare the impact of the metal-on-metal hip controversy on Internet search activity in four different regions and determine whether the number of related news reports affected Internet search activity. The Google Trends, Keywords and News applications were used to record the number of news articles and Internet search activity for the terms "hip recall", "metal-on-metal hip" and "ASR hip" from October 2009 to October 2012 in the USA, the UK, Australia and Ireland. There was a large increase in search activity following the official recall in August 2010 in all countries. There was significantly greater search activity after the recall in Ireland compared with the UK for the search term "hip recall" (P = 0.004). For the term "metal-on-metal hip", the UK had significantly more search activity (P = 0.0009). There was a positive correlation between the number of news stories in UK and Ireland with Internet search activity but not in the USA or Australia. Differences between countries affected by the same recall highlight the complex effects of the media on public awareness. The data demonstrates a window of opportunity prior to the official recall for the development of an awareness campaign to provide patients with accurate information. PMID:24390041

  8. A retrieval analysis of explanted Durom metal-on-metal hip arthroplasties.

    PubMed

    Matthies, Ashley K; Henckel, Johann; Skinner, John A; Hart, Alister J

    2011-01-01

    Given the recent reports of high failure rates, an improved understanding of the mechanism of failure of large diameter metal-on-metal hip arthroplasties is essential. We present clinical data and tribological analysis of a consecutive series of 74 failed large diameter metal-on-metal hips, comparing the Durom (Zimmer) with the Birmingham hip resurfacing (BHR) (Smith and Nephew). We retrospectively analysed pre-, intra-, and post-operative clinical data and measured the linear wear and component form of the explanted components using a roundness measuring machine. A significantly higher proportion of hips in the Durom group failed as a result of acetabular loosening (p=0.001) and this was supported by evidence of reduced bone in-growth on the backside of the cup. Comparison of roundness measurement revealed that the Durom hip was significantly lower wearing than the BHR (p<0.05) but the Durom femoral components were subject to significantly greater form errors (p<0.001), the pole of the head being flattened by up to 31 microns. Although the Durom hip is low wearing, reduced sphericity of the femoral component may have resulted in equatorial bearing, leading to an increased frictional torque at the cup-bone interface, preventing bone in-growth, and culminating in acetabular loosening. This supports recent clinical findings of high revision rates as a result of acetabular loosening for the Durom metal-on-metal hip system. PMID:22144337

  9. Revision of metal-on-metal hip arthroplasty in a tertiary center

    PubMed Central

    2013-01-01

    Background and purpose Operative findings during revision of metal-on-metal hip arthroplasty (MOMHA) vary widely and can involve massive soft tissue and bone disruption. As a result, planning of theater time and resources is difficult, surgery is challenging, and outcomes are often poor. We describe our experience with revision of MOMHA and provide recommendations for management. Patients and methods We present the findings and outcomes of 39 consecutive MOMHAs (in 35 patients) revised in a tertiary unit (median follow-up time 30 (1254) months). The patients underwent a preoperative work-up including CT, metal artifact reduction sequence (MARS) MRI, and blood metal ion levels. Results We determined 5 categories of failure. 8 of 39 hips had conventional failure mechanisms including infection and impingement. Of the other 31 hips, 14 showed synovitis without significant disruption of soft tissue; 6 had a cystic pseudotumor with significant soft tissue disruption; 7 had significant osteolysis; and 4 had a solid pseudotumor. Each category of failure had specific surgical hazards that could be addressed preoperatively. There were 2 reoperations and 1 patient (2 hips) died of an unrelated cause. Median Oxford hip score (OHS) was 37 (948); median change (?OHS) was 17 (10 to 41) points. ?OHS was similar in all groupsexcept those patients with solid pseudotumors and those revised to metal-on-metal bearings, who fared worse. Interpretation Planning in revision MOMHA is aided by knowledge of the different categories of failure to enable choice of appropriate personnel, theater time, and equipment. With this knowledge, satisfactory outcomes can be achieved in revision of metal-on-metal hip arthroplasty. PMID:23621810

  10. Metal-on-Metal Hip Arthroplasty: A Review of Adverse Reactions and Patient Management

    PubMed Central

    Drummond, James; Tran, Phong; Fary, Camdon

    2015-01-01

    Recent alarming joint registry data highlighting increased revision rates has prompted further research into the area of metal-on-metal hip replacements and resurfacings. This review article examines the latest literature on the topic of adverse reactions to metal debris and summarises the most up-to-date guidelines on patient management. Adverse reactions to metal debris can cause significant damage to soft tissue and bone if not diagnosed early. Furthermore, not every patient with an adverse reaction to metal debris will be symptomatic. As such, clinicians must remain vigilant when assessing and investigating these patients in order to detect failing implants and initiate appropriate management. PMID:26132653

  11. Diagnosis of adverse local tissue reactions following metal-on-metal hip arthroplasty.

    PubMed

    Chalmers, Brian P; Perry, Kevin I; Taunton, Michael J; Mabry, Tad M; Abdel, Matthew P

    2016-03-01

    Metal-on-metal (MOM) bearing surfaces in hip arthroplasty have distinct advantages that led to the increase in popularity in North America in the early 2000s. However, with their increased use, concerns such as local cytotoxicity and hypersensitivity reactions leading to soft tissue damage and cystic mass formation (known collectively as adverse local tissue reactions (ALTR)) became apparent. The clinical presentation of ALTR is highly variable. The diagnosis of ALTR in MOM articulations in hip arthroplasty can be challenging and a combination of clinical presentation, physical examination, implant track record, component positioning, serum metal ion levels, cross-sectional imaging, histopathologic analysis, and consideration of alternative diagnoses are essential. PMID:26816329

  12. The Management of the Symptomatic Patient With a Metal-on-Metal Hip Prosthesis.

    PubMed

    Harrington, Kate; Phelan, Emma; Torreggiani, William C; Doody, Orla

    2016-02-01

    Metal-on-metal (MoM) hip implants have gained popularity due to their greater stability and reduction in implant failure compare to metal-on-polyethylene prostheses. However, as well as carrying general risks of hip implantation, risks specifically associated with MoM implants have been well documented in recent years. Conditions such as pseudotumours or aseptic lymphocyte-dominated vasculitis-associated lesions are specific to MoM hip implants. In this review we discuss the typical patient presentation, the investigations that should be performed, the typical findings on various imaging modalities, and the treatment options of symptomatic patients with MoM hip arthroplasties. PMID:26800622

  13. Azzopardi phenomenon in cystic pseudotumours associated with retrieved metal-on-metal arthroplasty.

    PubMed

    Zustin, Jozef; Skinner, John A; Hart, Alister J

    2016-05-01

    The Azzopardi phenomenon represents a morphologically well defined lesion characterised by a deposition of basophilic material in the vessel walls associated with several malignant tumours. We report on 4 cases (3 men and 1 woman) showing the Azzopardi effect in retrieved metal-on-metal arthroplasty unrelated to malignancy. All cases were revised for groin pain and radiological findings of so-called pseudotumours. The Azzopardi phenomenon was seen in cases with cystic pseudotumours characterised by superficial necrobiosis, proliferative desquamative synovitis, finding of metal and corrosion wear particles and cellular infiltration by macrophages. The lesions, which were recognized as bluish substance in the hematoxylin and eosin staining, demonstrated a positive Feulgen reaction. We report on the Azzopardi phenomenon in non-neoplastic cystic pseudotumours from retrieved metal-on-metal arthroplasties. Although clinical relevance of this finding remains unclear, further research is necessary to investigate the possible relationship of this lesion with deliberation of metal ions from metal and corrosion wear particles and their role in a broad spectrum of adverse reactions to metal debris. PMID:27067791

  14. Surface engineering: a low wearing solution for metal-on-metal hip surface replacements.

    PubMed

    Leslie, Ian J; Williams, Sophie; Brown, Chris; Anderson, James; Isaac, Graham; Hatto, Peter; Ingham, Eileen; Fisher, John

    2009-08-01

    Increased patient blood and serum levels of Co and Cr and dissemination of metal wear particles throughout organs and tissues are the primary concerns with metal-on-metal surface replacements. Surface engineering, providing a ceramic bearing surface on a metal substrate, could provide a solution. This study investigated thick (>10 microm) arc evaporation plasma vapor deposition chromium nitride (CrN) coated surface replacements in terms of wear, ion levels, and wear particles in a 10 million cycle hip simulator study, compared to a contemporary metal-on-metal surface replacement. The ion levels were measured by inductively coupled plasma mass spectroscopy. The wear particles were imaged by field emission gun scanning electron microscopy. The CrN-coated bearings had 80% lower wear than the MoM controls. The Cr and Co ion levels in the lubricant of the CrN bearings were 73 and 98% lower than in the MoM controls. The wear particles produced were in the nanometer size range and round to oval in morphology. The CrN coating could provide a reduction in the wear and ion release of MoM surface replacements, thereby reducing the perceived risks to the patient associated with these prostheses. PMID:19195030

  15. Lubrication and friction prediction in metal-on-metal hip implants

    NASA Astrophysics Data System (ADS)

    Wang, F. C.; Brockett, C.; Williams, S.; Udofia, I.; Fisher, J.; Jin, Z. M.

    2008-03-01

    A general methodology of mixed lubrication analysis and friction prediction for a conforming spherical bearing in hip implants was developed, with particular reference to a typical metal-on-metal hip replacement. Experimental measurement of frictional torque for a similar implant was carried out to validate the theoretical prediction. A ball-in-socket configuration was adopted to represent the articulation between the femoral head and the acetabular cup under cyclic operating conditions of representative load and motion. The mixed lubrication model presented in this study was first applied to identify the contact characteristics on the bearing surfaces, consisting of both fluid-film and boundary lubricated regions. The boundary lubricated contact was assumed to occur when the predicted fluid film thickness was less than a typical boundary protein layer absorbed on the bearing surfaces. Subsequently, the friction was predicted from the fluid-film lubricated region with viscous shearing due to both Couette and Poiseuille flows and the boundary protein layer contact region with a constant coefficient of friction. The predicted frictional torque of the typical metal-on-metal hip joint implant was compared with the experimental measurement conducted in a functional hip simulator and a reasonably good agreement was found. The mixed lubrication regime was found to be dominant for the conditions considered. Although the percentage of the boundary lubricated region was quite small, the corresponding contribution to friction was quite large and the resultant friction factor was quite high.

  16. Ion release in stable hip arthroplasties using metal-on-metal articulating surfaces: a comparison between short- and medium-term results.

    PubMed

    Savarino, L; Granchi, D; Ciapetti, G; Cenni, E; Greco, M; Rotini, R; Veronesi, C A; Baldini, N; Giunti, A

    2003-09-01

    The use of metallic heads articulating with metallic cups could solve the problem of polyethylene (PE) wear in total hip replacement (THR) with metal-on-PE bearings. A conspicuous release of metal ions from new models of metal-on-metal bearings has been found in the short-term, but it is yet unclear whether the medium-term corrosion rate is high or, on the contrary, it becomes negligible, because of the continuous surface finishing. Our purpose was to compare the serum ion values (nanograms per milliliter) in 15 patients with metal-on-metal stable prosthesis (Group A), in the short-term (subgroup A(1); mean follow-up: 24 mo) and medium-term (subgroup A(2); mean follow-up: 52 mo), in order to determine whether the ion release decreased with time of implant. Chromium (Cr), cobalt (Co), molybdenum (Mo) and aluminum (Al) were analyzed. Twenty-two presurgical patients were used for comparison (Group B). The reference range was obtained from a population of 27 healthy subjects (Group C). Co and Cr levels in the medium-term (subgroup A(2)) were not decreased in comparison with the short-term values (subgroup A(1)) and were significantly higher (p < 0.001) than presurgical and reference values. Otherwise, Mo and Al concentrations were not significantly increased in comparison with reference values. In conclusion, despite the apparent advantage of metal-on-metal coupling, especially in younger patient populations, there is a major concern about the extent and duration of the relevant "internal" exposure to Cr and Co ions. This exposure should be carefully monitored, in order to clarify the biologic effects of ion dissemination and, consequently, to identify risks concerning long-term toxicity of metals. PMID:12918026

  17. Are all metal-on-metal hip revision operations contributing to the National Joint Registry implant survival curves?

    PubMed Central

    Sabah, S. A.; Henckel, J.; Koutsouris, S.; Rajani, R.; Hothi, H.; Skinner, J. A.; Hart, A. J.

    2016-01-01

    Aims The National Joint Registry for England, Wales and Northern Ireland (NJR) has extended its scope to report on hospital, surgeon and implant performance. Data linkage of the NJR to the London Implant Retrieval Centre (LIRC) has previously evaluated data quality for hip primary procedures, but did not assess revision records. Methods We analysed metal-on-metal hip revision procedures performed between 2003 and 2013. A total of 69 929 revision procedures from the NJR and 929 revised pairs of components from the LIRC were included. Results We were able to link 716 (77.1%) revision procedures on the NJR to the LIRC. This meant that 213 (22.9%) revision procedures at the LIRC could not be identified on the NJR. We found that 349 (37.6%) explants at the LIRC completed the full linkage process to both NJR primary and revision databases. Data completion was excellent (> 99.9%) for revision procedures reported to the NJR. Discussion This study has shown that only approximately one third of retrieved components at the LIRC, contributed to survival curves on the NJR. We recommend prospective registry-retrieval linkage as a tool to feedback missing and erroneous data to the NJR and improve data quality. Take home message: Prospective Registry – retrieval linkage is a simple tool to evaluate and improve data quality on the NJR. Cite this article: Bone Joint J 2016;98-B:33–9. PMID:26733513

  18. The effect of microstructure on the wear of cobalt-based alloys used in metal-on-metal hip implants.

    PubMed

    Varano, R; Bobyn, J D; Medley, J B; Yue, S

    2006-02-01

    The influence of microstructure on the wear of cobalt-based alloys used in metal-on-metal hip implants was investigated in a boundary lubrication regime designed to represent the conditions that occurred some of the time in vivo. These cobalt-chromium-molybdenum alloys were either wrought, with a total carbon content of 0.05 or 0.23 wt %, cast with a solution-annealing procedure or simply as-cast but not solution annealed. Bars of these different alloy grades were subjected to various heat treatments to develop different microstructures. The wear was evaluated in a linear-tracking reciprocating pin-on-plate apparatus with a 25 per cent bovine serum lubricant. The wear was found to be strongly affected by the dissolved carbon content of the alloys and mostly independent of grain size or the carbide characteristics. The increased carbon in solid solution caused reductions in volumetric wear because carbon helped to stabilize a face-centred cubic crystal structure, thus limiting the amount of strain-induced transformation to a hexagonal close-packed crystal structure. Based on the observed surface twining in and around the contact zone and the potentially detrimental effect of the hexagonal close-packed phase, it was postulated that the wear of cobalt-based alloys in the present study was controlled by a deformation mechanism. PMID:16669383

  19. Novel method for characterization and compensation for canopy distortion over a large head box

    NASA Astrophysics Data System (ADS)

    Atac, Robert; Fischler, Mark

    2013-05-01

    Thales Visionix, a wholly owned subsidiary of Thales Communications, Inc., has developed a novel method for characterization of canopy distortion for a large head box. Canopy distortion occurs when the user is looking through any curved transparency. Any helmet mounted display system must either compensate for this distortion, or add canopy distortion error to its total error budget. To date, canopies have been characterized for only a few discrete locations in the cockpit. This results in a dilution of canopy distortion compensation as the pilot will rarely sit in one of the few defined locations. The method described herein allows for canopy distortion characterization and compensation for the entire HMD head-box.

  20. The medical ecoculture at work: the case of the metal-on-metal hip.

    PubMed

    Gillick, Muriel R

    2013-01-01

    The United States has the most expensive, technologically intensive system of medical care in the world, but not the most effective. Reforming health care will require understanding the interactions among the many individuals and institutions that collectively constitute the health-care ecoculture, an ecosystem with a major human component. Because technology is a key driver of health-care costs and a critical component of the patient's experience of American medicine, it is fruitful to consider an example of a particular technology: why it was embraced, who benefited from its use, and the response of the ecoculture when a critical flaw in the technology emerged. The case of the introduction, diffusion, and withdrawal of metal-on-metal hip prostheses will be discussed from the perspective of patients, physicians, device manufacturers, regulators, and the legal system. Each of these groups responded to external stimuli by adaptation in an attempt to maximize its own interests. Interactions between the groups served as a further mechanism of maintaining the status quo within medicine. A single change, such as modification of the payment system or incentivizing patients, is thus unlikely to be effective in transforming health care; instead, a multi-pronged approach, along with reforms outside medicine, will likely be necessary. PMID:24769749

  1. Fast growing pseudotumour in a hairdresser after metal-on-metal hip resurfacing: a case report.

    PubMed

    Cadossi, M; Chiarello, E; Savarino, L; Mazzotti, A; Tedesco, G; Greco, M; Giannini, S

    2014-01-01

    A 44-year-old female hairdresser who underwent metal-on-metal hip resurfacing (MOMHR) for hip osteoarthritis developed a benign pelvic pseudotumour. Elevated levels of chromium and cobalt ions were detected in the blood. Patch testing after pseudotumor formation, showed positive skin reactions to cobalt and nickel. Marked hypereosinophilia was noted, as well as the presence of eosinophils in the pseudotumor mass. A revision to a ceramic-on-ceramic implant was performed. Radiographs showed no implant loosening or bone resorption. We hypothesized that a steep cup positioning as well as hypersensitivity response to the metal nanoparticles and ion release may have induced pseudotumour development. Currently there is no evidence that negative patch testing reduces the probability to develop an adverse reaction to metal debris therefore we suggest to carefully investigate patient medical history regarding occupation exposure and daily contact with jewellery, beauty and cleaning products before implanting MOMHR. The main challenge is to identify a sensitive patient candidate to MOMHR never suspected to be. PMID:24825038

  2. A lexicon for wear of metal-on-metal hip prostheses.

    PubMed

    McKellop, Harry A; Hart, Alister; Park, Sang-Hyun; Hothi, Harry; Campbell, Pat; Skinner, John A

    2014-09-01

    Research on metal-on-metal (MoM) hip bearings has generated an extensive vocabulary to describe the wear processes and resultant surface damage. However, a lack of consistency and some redundancy exist in the current terminology. To facilitate the understanding of MoM tribology and to enhance communication of results among researchers and clinicians, we propose four categories of wear terminology: wear modes refer to the in vivo conditions under which the wear occurred; wear mechanisms refer to fundamental wear processes (adhesion, abrasion, fatigue, and tribochemical reactions); wear damage refers to the resultant changes in the morphology and/or composition of the surfaces; and wear features refer to the specific wear phenomena that are described in terms of the relevant modes, mechanisms, and damage. Clarifying examples are presented, but it is expected that terms will be added to the lexicon as new mechanisms and types of damage are identified. Corrosion refers to electrochemical processes that can remove or add material and thus also generate damage. Corrosion can act alone or may interact with mechanical wear. Examples of corrosion damage are also presented. However, an in-depth discussion of the many types of corrosion and their effects is beyond the scope of the present wear lexicon. PMID:24844814

  3. Prevalence of Pseudotumor in Patients After Metal-On-Metal Hip Arthroplasty Evaluated with Metal Ion Analysis and MARS-MRI.

    PubMed

    Sutphen, Sean A; MacLaughlin, Lewis H; Madsen, Adam A; Russell, Jackie H; McShane, Michael A

    2016-01-01

    The purpose of this study is to quantify the prevalence of pseudotumors in patients with well-functioning and painful metal-on-metal total hip arthroplasty, to characterize the pseudotumor with the use of MARS-MRI, and to assess the relationship between pseudotumors and metal ions. We retrospectively reviewed 102 single surgeon patients. The results showed that 68.6% developed pseudotumor with 60.9% of the asymptomatic group developing pseudotumor. The symptomatic group had a higher proportion of patients with elevated serum cobalt levels (P=0.035). There was no difference found with elevated metal ions and prevalence of pseudotumor, but elevated cobalt levels were associated with larger pseudotumor size (P=0.001). The available evidence indicated that most patients that develop pseudotumors are asymptomatic, and that elevated serum cobalt levels may be associated with symptoms and pseudotumor size. PMID:26253484

  4. Wear behaviour of cobalt-chromium-molybdenum alloys used in metal-on-metal hip implants

    NASA Astrophysics Data System (ADS)

    Varano, Rocco

    The influence of carbon (C) content, microstructure, crystallography and mechanical properties on the wear behaviour of metal-on-metal (MM) hip implants made from commercially available cobalt-chromium-molybdenum (CoCrMo) alloys designated as American Society of Testing and Materials (ASTM) grade F1537, F75 and as-cast were studied in this work. The as-received bars of wrought CoCrMo alloys (ASTM F1537 of either about 0.05% or 0.26% C) were each subjected to various heat treatments to develop different microstructures. Pin and plate specimens were fabricated from each bar and were tested against each other using a linear reciprocating pin-on-plate apparatus in 25% by volume bovine serum solution. The applied normal load was 9.81 N and the reciprocating plate had a sinusoidal velocity with an average speed of 26 mm/s. The wear was measured gravimetrically and it was found to be most strongly affected by alloy C content, irrespective of grain size or carbide morphology. More precisely, the wear behaviour was directly correlated to the dissolved C content of the alloys. Increased C in solid-solution coincided with lower volumetric wear since C helps to stabilize the face-centred cubic (FCC) crystal structure thus limiting the amount of strain induced transformation (SIT) to the hexagonal close-packed crystal structure (HCP). Based on the observed surface twinning in and around the contact zone and the potentially detrimental effect of the HCP phase, it was postulated that the MM wear behaviour of CoCrMo alloys in the present study was controlled by a deformation mechanism, rather than corrosion or tribochemical reactions.

  5. Changes in blood ion levels after removal of metal-on-metal hip replacements

    PubMed Central

    Durrani, Salim K; Sampson, Barry; Panetta, Therese; Liddle, Alexander D; Sabah, Shiraz A; Chan, Newton K; Skinner, John A; Hart, Alister J

    2014-01-01

    Background and purpose In patients with metal-on-metal (MoM) hip prostheses, pain and joint effusions may be associated with elevated blood levels of cobalt and chromium ions. Since little is known about the kinetics of metal ion clearance from the body and the rate of resolution of elevated blood ion levels, we examined the time course of cobalt and chromium ion levels after revision of MoM hip replacements. Patients and methods We included 16 patients (13 female) who underwent revision of a painful MoM hip (large diameter, modern bearing) without fracture or infection, and who had a minimum of 4 blood metal ion measurements over an average period of 6.1 (0–12) months after revision. Results Average blood ion concentrations at the time of revision were 22 ppb for chromium and 43 ppb for cobalt. The change in ion levels after revision surgery varied extensively between patients. In many cases, over the second and third months after revision surgery ion levels decreased to 50% of the values measured at revision. Decay of chromium levels occurred more slowly than decay of cobalt levels, with a 9% lag in return to normal levels. The rate of decay of both metals followed second-order (exponential) kinetics more closely than first-order (linear) kinetics. Interpretation The elimination of cobalt and chromium from the blood of patients who have undergone revision of painful MoM hip arthroplasties follows an exponential decay curve with a half-life of approximately 50 days. Elevated blood levels of cobalt and chromium ions can persist for at least 1 year after revision, especially in patients with high levels of exposure. PMID:24758321

  6. Cross-sectional imaging of metal-on-metal hip arthroplasties

    PubMed Central

    Robinson, Elizabeth; Henckel, Johann; Sabah, Shiraz; Satchithananda, Keshthra; Skinner, John; Hart, Alister

    2014-01-01

    Background and purpose — Metal artifact reduction sequence (MARS) MRI is widely advocated for surveillance of metal-on-metal hip arthroplasties (MOM-HAs). However, its use is limited by susceptibility artifact at the prosthesis-bone interface, local availability, patient compliance, and cost (Hayter et al. 2011a). We wanted to determine whether CT is a suitable substitute for MARS MRI in evaluation of the painful MOM-HA. Patients and methods — 50 MOM-HA patients (30 female) with unexplained painful prostheses underwent MARS MRI and CT imaging. 2 observers who were blind regarding the clinical data objectively reported the following outcomes: soft tissue lesions (pseudotumors), muscle atrophy, and acetabular and femoral osteolysis. Diagnostic test characteristics were calculated. Results — Pseudotumor was diagnosed in 25 of 50 hips by MARS MRI and in 11 of 50 by CT. Pseudotumors were classified as type 1 (n = 2), type 2A (n = 17), type 2B (n = 4), and type 3 (n = 2) by MARS MRI. CT did not permit pseudotumor classification. The sensitivity of CT for diagnosis of pseudotumor was 44% (95% CI: 25–65). CT had “slight” agreement with MARS MRI for quantification of muscle atrophy (κ = 0.23, CI: 0.16–0.29; p < 0.01). Osteolysis was identified in 15 of 50 patients by CT. 4 of these lesions were identified by MARS MRI. Interpretation — CT was found to be superior to MRI for detection of osteolysis adjacent to MOM-HA, and should be incorporated into diagnostic algorithms. CT was unable to classify and failed to detect many pseudotumors, and it was unreliable for assessment of muscle atrophy. Where MARS MRI is contraindicated or unavailable, CT would be an unsuitable substitute and other modalities such as ultrasound should be considered PMID:25267500

  7. Microfocus study of metal distribution and speciation in tissue extracted from revised metal on metal hip implants

    NASA Astrophysics Data System (ADS)

    Hart, Alister J.; Sandison, Ann; Quinn, Paul; Sampson, Barry; Atkinson, Kirk D.; Skinner, John A.; Goode, Angela; Powell, Jonathan J.; Mosselmans, J. Frederick W.

    2009-11-01

    Unexplained tissue inflammation in metal-on-metal hip replacements is suspected to be caused by implant-derived nanoparticles. The aim of this study was to investigate the nature of the metal particles in tissue surrounding metal-on-metal (MOM) hips that has been extracted during revision. Mapping of tissue surrounding the failed MOM hips was performed using microfocus X-ray Fluorescence (XRF). This revealed mainly Cr which was localized to the cellular regions. There was co-localisation of Co, were present, to areas of high Cr abundance. XANES of the tissue and appropriate standards revealed that the most common species were Cr(III) and Co(II). EXAFS analysis of the tissue and various metal standards revealed that the most abundant implant-related species was Cr(III) phosphate. Different tissue preparation methods, including frozen sectioning, were examined but were found not to affect the distribution or speciation of the metals in the tissue.

  8. Validation of primary metal-on-metal hip arthroplasties on the National Joint Registry for England, Wales and Northern Ireland using data from the London Implant Retrieval Centre

    PubMed Central

    Sabah, S. A.; Henckel, J.; Cook, E.; Whittaker, R.; Hothi, H.; Pappas, Y.; Blunn, G.; Skinner, J. A.; Hart, A. J.

    2015-01-01

    Arthroplasty registries are important for the surveillance of joint replacements and the evaluation of outcome. Independent validation of registry data ensures high quality. The ability for orthopaedic implant retrieval centres to validate registry data is not known. We analysed data from the National Joint Registry for England, Wales and Northern Ireland (NJR) for primary metal-on-metal hip arthroplasties performed between 2003 and 2013. Records were linked to the London Implant Retrieval Centre (RC) for validation. A total of 67045 procedures on the NJR and 782 revised pairs of components from the RC were included. We were able to link 476 procedures (60.9%) recorded with the RC to the NJR successfully. However, 306 procedures (39.1%) could not be linked. The outcome recorded by the NJR (as either revised, unrevised or death) for a primary procedure was incorrect in 79 linked cases (16.6%). The rate of registry-retrieval linkage and correct assignment of outcome code improved over time. The rates of error for component reference numbers on the NJR were as follows: femoral head category number 14/229 (5.0%); femoral head batch number 13/232 (5.3%); acetabular component category number 2/293 (0.7%) and acetabular component batch number 24/347 (6.5%). Registry-retrieval linkage provided a novel means for the validation of data, particularly for component fields. This study suggests that NJR reports may underestimate rates of revision for many types of metal-on-metal hip replacement. This is topical given the increasing scope for NJR data. We recommend a system for continuous independent evaluation of the quality and validity of NJR data. Cite this article: Bone Joint J 2015;97-B:1018. PMID:25568407

  9. Longitudinal evaluation of time related femoral neck narrowing after metal-on-metal hip resurfacing

    PubMed Central

    Wang, Wenbao; Geller, Jeffrey A; Hasija, Rohit; Choi, Jung Keun; Patrick, David A Jr.; Macaulay, William

    2013-01-01

    AIM: To track the short-term neck narrowing changes in Birmingham metal-on-metal hip resurfacing (MOMHR) patients. METHODS: Since 2001, the Center for Hip and Knee Replacement started a registry to prospectively collect data on hip and knee replacement patients. From June 2006 to October 2008, 139 MOMHR were performed at our center by two participate surgeons using Birmingham MOMHR prosthesis (Smith Nephew, United States). It is standard of care for patients to obtain low, anteriorposterior (LAP) pelvis radiographs immediately after MOMHR procedure and then at 3 mo, 1 year and 2 year follow up office visits. Inclusion criteria for the present study included patients who came back for follow up office visit at above mentioned time points and got LAP radiographs. Exclusion criteria include patients who missed more than two follow up time points and those with poor-quality X-rays. Two orthopaedic residency trained research fellows reviewed the X-rays independently at 4 time points, i.e., immediate after surgery, 3 mo, 1 year and 2 year. Neck-to-prosthesis ratio (NPR) was used as main outcome measure. Twenty cases were used as subjects to identify the reliability between two observers. An intraclass correlation coefficient at 0.8 was considered as satisfied. A paired t-test was used to evaluate the significant difference between different time points with P < 0.05 considered to be statistically significant. RESULTS: The mean NPRs were 0.852 ± 0.056, 0.839 ± 0.052, 0.835 ± 0.051, 0.83 ± 0.04 immediately, 3 mo, 1 year and 2 years post-operatively respectively. At 3 mo, NPR was significantly different from immediate postoperative X-ray (P < 0.001). There was no difference between 3 mo and 1 year (P = 0.14) and 2 years (P = 0.53). Femoral neck narrowing (FNN) exceeding 10% of the diameter of the neck was observed in only 4 patients (5.6%) at two years follow up. None of these patients developed a femoral neck fracture (FNF). CONCLUSION: Femoral neck narrowing after MOMHR occurred as early as 3 mo postoperatively, and stabilized thereafter. Excessive FNN was not common in patients within the first two years of surgery and was not correlated with risk of FNF. PMID:23610755

  10. Blood metal ion testing is an effective screening tool to identify poorly performing metal-on-metal bearing surfaces

    PubMed Central

    Sidaginamale, R. P.; Joyce, T. J.; Lord, J. K.; Jefferson, R.; Blain, P. G.; Nargol, A. V. F.; Langton, D. J.

    2013-01-01

    Objectives The aims of this piece of work were to: 1) record the background concentrations of blood chromium (Cr) and cobalt (Co) concentrations in a large group of subjects; 2) to compare blood/serum Cr and Co concentrations with retrieved metal-on-metal (MoM) hip resurfacings; 3) to examine the distribution of Co and Cr in the serum and whole blood of patients with MoM hip arthroplasties; and 4) to further understand the partitioning of metal ions between the serum and whole blood fractions. Methods A total of 3042 blood samples donated to the local transfusion centre were analysed to record Co and Cr concentrations. Also, 91 hip resurfacing devices from patients who had given pre-revision blood/serum samples for metal ion analysis underwent volumetric wear assessment using a coordinate measuring machine. Linear regression analysis was carried out and receiver operating characteristic curves were constructed to assess the reliability of metal ions to identify abnormally wearing implants. The relationship between serum and whole blood concentrations of Cr and Co in 1048 patients was analysed using Bland-Altman charts. This relationship was further investigated in an in vitro study during which human blood was spiked with trivalent and hexavalent Cr, the serum then separated and the fractions analysed. Results Only one patient in the transfusion group was found to have a blood Co > 2 g/l. Blood/Serum Cr and Co concentrations were reliable indicators of abnormal wear. Blood Co appeared to be the most useful clinical test, with a concentration of 4.5 g/l showing sensitivity and specificity for the detection of abnormal wear of 94% and 95%, respectively. Generated metal ions tended to fill the serum compartment preferentially in vivo and this was replicated in the in vitro study when blood was spiked with trivalent Cr and bivalent Co. Conclusions Blood/serum metal ion concentrations are reliable indicators of abnormal wear processes. Important differences exist however between elements and the blood fraction under study. Future guidelines must take these differences into account. PMID:23836464

  11. Metal ion release from bearing wear and corrosion with 28 mm and large-diameter metal-on-metal bearing articulations: a follow-up study.

    PubMed

    Vendittoli, P-A; Roy, A; Mottard, S; Girard, J; Lusignan, D; Lavigne, M

    2010-01-01

    We have updated our previous randomised controlled trial comparing release of chromium (Cr) and cobalt (Co) ions and included levels of titanium (Ti) ions. We have compared the findings from 28 mm metal-on-metal total hip replacement, performed using titanium CLS/Spotorno femoral components and titanium AlloFit acetabular components with Metasul bearings, with Durom hip resurfacing using a Metasul articulation or bearing and a titanium plasma-sprayed coating for fixation of the acetabular component. Although significantly higher blood ion levels of Cr and Co were observed at three months in the resurfaced group than in total hip replacement, no significant difference was found at two years post-operatively for Cr, 1.58 microg/L and 1.62 microg/L respectively (p = 0.819) and for Co, 0.67 microg/L and 0.94 microg/L respectively (p = 0.207). A steady state was reached at one year in the resurfaced group and after three months in the total hip replacement group. Interestingly, Ti, which is not part of the bearing surfaces with its release resulting from metal corrosion, had significantly elevated ion levels after implantation in both groups. The hip resurfacing group had significantly higher Ti levels than the total hip replacement group for all periods of follow-up. At two years the mean blood levels of Ti ions were 1.87 microg/L in hip resurfacing and and 1.30 microg/L in total hip replacement (p = 0.001). The study confirms even with different bearing diameters and clearances, hip replacement and 28 mm metal-on-metal total hip replacement produced similar Cr and Co metal ion levels in this randomised controlled trial study design, but apart from wear on bearing surfaces, passive corrosion of exposed metallic surfaces is a factor which influences ion concentrations. Ti plasma spray coating the acetabular components for hip resurfacing produces significantly higher release of Ti than Ti grit-blasted surfaces in total hip replacement. PMID:20044673

  12. Clinical Usefulness of SPECT-CT in Patients with an Unexplained Pain in Metal on Metal (MOM) Total Hip Arthroplasty.

    PubMed

    Berber, Reshid; Henckel, Johann; Khoo, Michael; Wan, Simon; Hua, Jia; Skinner, John; Hart, Alister

    2015-04-01

    SPECT-CT is increasingly used to assess painful knee arthroplasties. The aim of this study was to evaluate the clinical usefulness of SPECT-CT in unexplained painful MOM hip arthroplasty. We compared the diagnosis and management plan for 19 prosthetic MOM hips in 15 subjects with unexplained pain before and after SPECT-CT. SPECT-CT changed the management decision in 13 (68%) subjects, Chi-Square=5.49, P=0.24. In 6 subjects (32%) pain remained unexplained however the result reassured the surgeon to continue with non-operative management. SPECT-CT should be reserved as a specialist test to help identify possible causes of pain where conventional investigations have failed. It can help reassure surgeons making management decisions for patients with unexplained pain following MOM hip arthroplasty. PMID:25583682

  13. Is Increased Modularity Associated With Increased Fretting and Corrosion Damage in Metal-On-Metal Total Hip Arthroplasty Devices?

    PubMed Central

    Higgs, Genymphas B.; Hanzlik, Josa A.; MacDonald, Daniel W.; Gilbert, Jeremy L.; Rimnac, Clare M.; Kurtz, Steven M.

    2014-01-01

    This retrieval study documents taper damage at modular interfaces in retrieved MOM THA systems and investigates if increased modularity is associated with increased fretting and corrosion. One hundred thirty-four (134) heads and 60 stems (41 modular necks) of 8 different bearing designs (5 manufacturers) were analyzed. Damage at the shell–liner interface of 18 modular CoCr acetabular liners and the corresponding 11 acetabular shells was also evaluated. The results of this study support the hypothesis that fretting and corrosion damage occurs at a variety of modular component interfaces in contemporary MOM THAs. We also found that modularity of the femoral stem was associated with increased damage at the head. An analysis of component and patient variables revealed that dissimilar alloy pairing, larger head sizes, increased medio-lateral offsets and longer neck moment arms were all associated with increased taper damage at the modular interfaces. PMID:23910820

  14. Lessons learnt from metal-on-metal hip arthroplasties will lead to safer innovation for all medical devices.

    PubMed

    Hart, Alister J; Sabah, Shiraz A; Henckel, Johann; Lloyd, Gwynneth; Skinner, John A

    2015-01-01

    Metal-on-metal bearings were re-popularised in the late 1990s with the introduction of modern hip resurfacing. Large diameter (LD) metal-on-metal (MoM) hips became more prevalent and have been the least successful group of hip implants ever used. They were rapidly adopted from 2004 until the British Hip Society stopped their use in 2012. Well functioning MoM hip results (including the BHR and Metasul) are hidden in the mire of poor results from the group of all MoM bearings.We have reviewed what happened and we make 3 observations. Firstly, collaboration between surgeons and then between surgeons and other disciplines, first identified and then solved the clinical management problems. Secondly, the problems with MoM hips occurred because hip simulation was inadequate at predicting performance in patients. They gave no indications of the biological effects of wear in the human environment. Lastly, retrieval of failed implants was essential to understanding why failure occurred.These lessons must never be forgotten and must form the basis by which new or altered implants are introduced and how they should be monitored. This will enable safer innovation for patients, surgeons and manufacturers. The problems with MoM hips will not have been in vain. PMID:26165359

  15. Combined Vascular and Orthopaedic Approach for a Pseudotumor Causing Deep Vein Thrombosis after Metal-on-Metal Hip Resurfacing Arthroplasty

    PubMed Central

    Abdel-Hamid, Hossam; Miles, Jonathan; Carrington, Richard W. J.; Hart, Alister; Loh, Alex; Skinner, John A.

    2015-01-01

    Introduction. Metal-on-metal (MoM) hip resurfacings have been associated with a variety of complications resulting from adverse reaction to metal debris. Pseudotumors have rarely been reported to cause deep venous thrombosis (DVT). Study Design. A case report and a review of the literature. Case Presentation. A 75-year-old female who had left metal-on-metal hip resurfacing 6 years ago presented with left groin pain associated with unilateral lower limb edema and swelling. By duplex and MRI studies, our patient had an extensive soft tissue necrosis associated with a large pelvic mass causing extensive DVT of the lower limb secondary to mechanical compression of the left iliac vein. Results. Our case was initially treated for DVT followed by dual surgical approach. The pseudotumor was excised through a separate iliofemoral approach and revision of the hip implant was undertaken through a posterior approach in the same setting. An inferior vena cava (IVC) filter was inserted to minimise the perioperative risks of handling the iliac veins. Conclusion. A combined approach with vascular surgeons is required. Combined resection of the pseudotumor and revision of the metal bearing surfaces is essential, in order to achieve a good surgical outcome in this rare complication. PMID:26457216

  16. Chromium-induced diffuse dermatitis with lymph node involvement resulting from Langerhans cell histiocytosis after metal-on-metal hip resurfacing.

    PubMed

    Bizzotto, N; Sandri, A; Trivellin, G; Magnan, B; Micheloni, G M; Zamò, A; Bernardi, P; Sbarbati, A; Regis, D

    2015-06-01

    Total hip arthroplasty (THA) is a highly effective surgical treatment for severe joint involvement. However, due to the release of metal ions in the blood, the patients who undergo hip replacement with metal-on-metal (MOM) bearings may develop signs of allergic skin disease. We report a case of a 60-year-old man who had received MOM hip resurfacing 5 years earlier for osteoarthritis. He presented with a 3-year history of diffuse dermatitis that did not respond to antihistamines and corticosteroids and also had elevated serum levels of chromium and cobalt. A patch test revealed chromium-sulfate hypersensitivity. A skin biopsy showed nonspecific perivascular lymphocytic infiltrate associated with histiocytes. A biopsy of an inguinal lymph node demonstrated large aggregates of Langerhans cells, suggesting type IV delayed-type hypersensitivity. The prosthesis was replaced using ceramic-on-ceramic bearings and the dermatitis resolved after 3 months. The lymph nodes decreased in volume and the serum chromium levels normalized within 24 months of revision surgery. The high levels of serum ions associated with the metal debris from MOM-THAs may induce sensitization and type IV hypersensitivity reactions. Replacing the prosthesis using alternative coupling surfaces is the only approach that has the capacity to resolve these symptoms. Physicians who are not familiar with this issue may misdiagnose systemic symptoms and provide inadequate treatment. PMID:25385406

  17. A safe zone for acetabular component position in metal-on-metal hip resurfacing arthroplasty: winner of the 2012 HAP PAUL award.

    PubMed

    Liu, Fei; Gross, Thomas P

    2013-08-01

    A safe zone for acetabular component positioning in hip resurfacing (RAIL: Relative Acetabular Inclination Limit) was calculated based on implant size and acetabular inclination angle (AIA). For AIA below the RAIL, there were no adverse wear failures or dislocations, and only 1% of cases with ion levels above 10 μg/L. Other than high inclination angle and small bearing size, female gender was the only other factor that correlated with high ion levels in the multivariate analysis. Seven hundred sixty-one hip resurfacing cases are included in this study. The UCLA activity score, femoral shaft angle, body mass index, weight, American Society of Anesthesiologists score, combined range of motion, diagnosis, age, gender, implant brand, AIA, bearing size, and duration of implantation were analyzed to determine the potential risk factors for elevated metal ion levels. These findings apply to sub hemispheric metal-on-metal bearings with similar coverage arcs as the Biomet and Corin hip resurfacing brands. Additional problems may occur when these bearings are connected with trunions on stems for total hip arthroplasty. PMID:23540536

  18. Metal-on-metal resurfacing arthroplasty: no way under the sun!--in opposition.

    PubMed

    Schmalzried, Thomas P

    2005-06-01

    The functional demands and the longevity of hip arthroplasty patients are increasing. High volumetric wear and osteolysis limit the durability of metal-ultra high molecular weight polyethylene resurfacing. Cemented femoral hemiresurfacing components (no acetabular component) do not develop osteolysis and rarely loosen. Consistent long-term fixation has been demonstrated with hemispherical cementless acetabular components. Metal-metal bearings have demonstrated low wear and rare osteolysis over 3 decades of use. These facts form foundation for total hip resurfacing with metal-metal bearings. PMID:15991135

  19. Early failure of the Durom prosthesis in metal-on-metal hip resurfacing in Chinese patients.

    PubMed

    Li, Jia; He, Chongru; Li, Dahe; Zheng, Wei; Liu, Denghui; Xu, Weidong

    2013-12-01

    Hip resurfacing (HR) is being used increasingly as an alterative to total hip arthroplasty in osteonecrosis (ON) and ankylosing spondylitis (AS) of the hip. We performed 141 consecutive HR arthroplasties in 111 patients comprising 3 etiology groups: ON, AS, and osteoarthritis (OA). After retrospective study of retrieved components, we hypothesized that the main reason for revision was femoral loosening in the ON group (4 of 46 hips; 8.7%) and femoral-neck fracture in the AS group (3 of 58 hips; 5.2%). Necrotic areas were seen on femoral heads retrieved from patients with femoral loosening, whereas femoral heads were fixed tightly to components in patients with femoral-neck fractures. Etiology may be an important risk factor for postoperative complications. PMID:23831082

  20. Current expert views on metal-on-metal hip resurfacing arthroplasty. Consensus of the 6th advanced Hip resurfacing course, Ghent, Belgium, May 2014.

    PubMed

    Van Der Straeten, Catherine; De Smet, Koen A

    2016-02-01

    This paper reports the consensus of an international faculty of expert metal-on-metal (MoM) hip resurfacing surgeons, with a combined experience of over 40,000 cases, on the current status of hip resurfacing arthroplasty. Indications, design and metallurgy issues, release of metal ions and adverse soft tissue reactions to particles, management of problematic cases and revisions, as well as required experience and training are covered. The overall consensus is that MoM hip resurfacing should not be banned and should be viewed separately from MoM total hip arthroplasty (THA) with a large diameter head because of the different design and wear behaviour related to the taper/trunnion connection. The use of hip resurfacing has decreased worldwide but specialist centres continue to advocate hip resurfacing in young and active male patients. Regarding age the general recommendation is to avoid hip resurfacing in men older than 65 and in women older than 55, depending on the patient activity and bone quality. Female gender is considered a relative contraindication. Most surgeons would not implant a MoM hip in women who would still like a child. Regardless of gender, there is a consensus not to perform hip resurfacing in case of a femoral head size smaller than 46 mm and in patients with renal insufficiency or with a known metal allergy. Regarding follow-up of hip resurfacing and detection of adverse local tissue reactions, metal ion measurements, MRI and ultrasound are advocated depending on the local expertise. The consensus is that hip resurfacing should be limited to high volume hip surgeons, who are experienced in hip resurfacing or trained to perform hip resurfacing in a specialist centre. PMID:26449333

  1. Auditory and Visual Health after Ten Years of Exposure to Metal-on-Metal Hip Prostheses: A Cross-Sectional Study Follow Up

    PubMed Central

    Prentice, Jennifer R.; Blackwell, Christopher S.; Raoof, Naz; Bacon, Paul; Ray, Jaydip; Hickman, Simon J.; Wilkinson, J. Mark

    2014-01-01

    Case reports of patients with mal-functioning metal-on-metal hip replacement (MoMHR) prostheses suggest an association of elevated circulating metal levels with visual and auditory dysfunction. However, it is unknown if this is a cumulative exposure effect and the impact of prolonged low level exposure, relevant to the majority of patients with a well-functioning prosthesis, has not been studied. Twenty four male patients with a well-functioning MoMHR and an age and time since surgery matched group of 24 male patients with conventional total hip arthroplasty (THA) underwent clinical and electrophysiological assessment of their visual and auditory health at a mean of ten years after surgery. Median circulating cobalt and chromium concentrations were higher in patients after MoMHR versus those with THA (P<0.0001), but were within the Medicines and Healthcare Products Regulatory Agency (UK) investigation threshold. Subjective auditory tests including pure tone audiometric and speech discrimination findings were similar between groups (P>0.05). Objective assessments, including amplitude and signal-to-noise ratio of transient evoked and distortion product oto-acoustic emissions (TEOAE and DPOAE, respectively), were similar for all the frequencies tested (P>0.05). Auditory brainstem responses (ABR) and cortical evoked response audiometry (ACR) were also similar between groups (P>0.05). Ophthalmological evaluations, including self-reported visual function by visual functioning questionnaire, as well as binocular low contrast visual acuity and colour vision were similar between groups (P>0.05). Retinal nerve fibre layer thickness and macular volume measured by optical coherence tomography were also similar between groups (P>0.05). In the presence of moderately elevated metal levels associated with well-functioning implants, MoMHR exposure does not associate with clinically demonstrable visual or auditory dysfunction. PMID:24621561

  2. Contact mechanics studies of an ellipsoidal contact bearing surface of metal-on-metal hip prostheses under micro-lateralization.

    PubMed

    Wang, Ling; Liu, Xiaohua; Li, Dichen; Liu, Feng; Jin, Zhongmin

    2014-04-01

    The morphology of the contact bearing surfaces plays an important role in the contact mechanics and potential wear of metal-on-metal (MOM) hip prostheses. An ellipsoidal bearing surface was proposed for MOM hip implants and the corresponding contact mechanics were studied by using the finite element method (FEM) under both standard and micro-lateralization conditions. When under micro-lateralization, the maximum contact pressure decreased from 927.3MPa to 203.0MPa, with increased ellipticity ratio medial-laterally. And the contact region was found to shift from the rim of the cup to the inner region compared to the spherical design. Under standard conditions, an increasing trend of the maximum contact pressure for the acetabular component was predicted as the major radius of the ellipsoidal bearing surface was increased. Nevertheless, the maximum contact pressure reached an asymptotic value when the ellipticity ratio was increased to 1.04. Therefore it is critical to optimize the ellipticity ratio in order to reduce the contact pressure under micro-lateralization condition and yet not to cause a markedly increased contact pressure under normal condition. Additionally, the maximum contact pressure in the ellipsoidal bearing surface remained relatively constant with the increased micro-lateralization. It is concluded that an ellipsoidal bearing surface morphology may be a promising alternative by offering better contact mechanisms when micro-lateralization should occur and attributing to minimized wear. PMID:24461516

  3. Metal ion levels and revision rates in metal-on-metal hip resurfacing arthroplasty: a comparative study.

    PubMed

    Robinson, Patrick G; Wilkinson, Andrew J; Meek, Robert M D

    2014-01-01

    Metal-on-metal (MoM) bearings in hip surgery are related to increased blood levels of metal ions. The nature of the relationship between ion levels and failure is still not fully understood. This study compares three cohorts of patients, 120 patients in each cohort, treated with a hip resurfacing arthroplasty, grouped by brand and diameter of femoral component on average four years postoperatively: Birmingham Hip Resurfacing ?50 mm, Durom resurfacing ?50 mm and Durom resurfacing <50 mm. The median blood ion levels of cobalt and chromium were significantly lower in the cohort with the large Durom resurfacing than the other two cohorts (P<0.05). The large BHR and large Durom HRA had revision rates of 3.3%. The small Durom HRA had a revision rate of 8.3%. Elevated blood ion levels can indicate a failing MoM bearing. The large BHR and large Durom HRA have similar revision rates yet the large Durom HRA had significantly lower metal ion levels. When similar ion levels were reported for BHR and small Durom the latter had significantly higher revision rates. This suggests ion levels do not absolutely predict the rate of HRA failure. Since MoM generation of metal ions is not the sole reason of failure, regular clinical and radiographic follow-up should also be in place for patients with these joints. PMID:24500833

  4. Good sensitivity and specificity of ultrasound for detecting pseudotumors in 83 failed metal-on-metal hip replacements

    PubMed Central

    Lainiala, Olli; Elo, Petra; Reito, Aleksi; Pajamäki, Jorma; Puolakka, Timo; Eskelinen, Antti

    2015-01-01

    Background and purpose Ultrasound is used for imaging of pseudotumors associated with metal-on-metal (MoM) hips. Ultrasound has been compared with magnetic resonance imaging, but to date there have been no studies comparing ultrasound findings and revision findings. Methods We evaluated the sensitivity and specificity of preoperative ultrasound for detecting pseudotumors in 82 patients with MoM hip replacement (82 hips). Ultrasound examinations were performed by 1 of 3 musculoskeletal radiologists, and pseudotumors seen by ultrasound were retrospectively classified as fluid-filled, mixed-type, or solid. Findings at revision surgery were retrieved from surgical notes and graded according to the same system as used for ultrasound findings. Results Ultrasound had a sensitivity of 83% (95% CI: 63–93) and a specificity of 92% (CI: 82–96) for detecting trochanteric region pseudotumors, and a sensitivity of 79% (CI: 62–89) and a specificity of 94% (CI: 83–98) for detecting iliopsoas-region pseudotumors. Type misclassification of pseudotumors found at revision occurred in 8 of 23 hips in the trochanteric region and in 19 of 33 hips in the iliopsoas region. Interpretation Despite the discrepancy in type classification between ultrasound and revision findings, the presence of pseudotumors was predicted well with ultrasound in our cohort of failed MoM hip replacements. PMID:25582840

  5. The chemical form of metallic debris in tissues surrounding metal-on-metal hips with unexplained failure.

    PubMed

    Hart, Alister J; Quinn, Paul D; Sampson, Barry; Sandison, Ann; Atkinson, Kirk D; Skinner, John A; Powell, Jonathan J; Mosselmans, J Fred W

    2010-11-01

    Implant-derived material from metal-on-metal (MOM) hip arthroplasties may be responsible for an unexplained tissue inflammatory response. The chemical form of the metal species in the tissues is predominantly chromium (Cr), but the currently used techniques have not been able to determine whether this is Cr(III) phosphate or Cr(III) oxide. The analytical challenge must overcome the fact that the metal in the tissues is at a relatively low concentration and tissue preparation or the microscopy beam used can affect the results. Microfocus X-ray spectroscopy using a synchrotron beam is useful in addressing both these issues. Using this technique we compared tissue from failed MOM hips with: (1) tissue from metal-on-polyethylene (MOP) hips; (2) chemical standards; (3) metal discs cut from MOM hips. The most abundant implant-related species in all MOM hip tissues contained Cr. Comparison with standards revealed the chemical form was Cr(III) phosphate, which did not vary with manufacturer type (four types analysed) or level of blood metal ions. Cobalt (Co) and molybdenum (Mo) were occasionally present in areas of high Cr. Co was normally found in a metallic state in the tissue, while Mo was found in an oxidized state. The variety of metallic species may have arisen from corrosion, wear or a combination of both. No evidence of Cr(VI) was seen in the tissues examined. PMID:20541630

  6. A comparison of the diagnostic accuracy of MARS MRI and ultrasound of the painful metal-on-metal hip arthroplasty

    PubMed Central

    Siddiqui, Imran A; Sabah, Shiraz A; Satchithananda, Keshthra; Lim, Adrian K; Cro, Suzie; Henckel, Johann; Skinner, John A

    2014-01-01

    Background and purpose Metal artifact reduction sequence (MARS) MRI and ultrasound scanning (USS) can both be used to detect pseudotumors, abductor muscle atrophy, and tendinous pathology in patients with painful metal-on-metal (MOM) hip arthroplasty. We wanted to determine the diagnostic test characteristics of USS using MARS MRI as a reference for detection of pseudotumors and muscle atrophy. Patients and methods We performed a prospective cohort study to compare MARS MRI and USS findings in 19 consecutive patients with unilateral MOM hips. Protocolized USS was performed by consultant musculoskeletal radiologists who were blinded regarding clinical details. Reports were independently compared with MARS MRI, the imaging gold standard, to calculate predictive values. Results The prevalence of pseudotumors on MARS MRI was 68% (95% CI: 43–87) and on USS it was 53% (CI: 29–76). The sensitivity of USS in detecting pseudotumors was 69% (CI 39–91) and the specificity was 83% (CI: 36–97). The sensitivity of detection of abductor muscle atrophy was 47% (CI: 24–71). In addition, joint effusion was detected in 10 cases by USS and none were seen by MARS MRI. Interpretation We found a poor agreement between USS and MARS MRI. USS was inferior to MARS MRI for detection of pseudotumors and muscle atrophy, but it was superior for detection of joint effusion and tendinous pathologies. MARS MRI is more advantageous than USS for practical reasons, including preoperative planning and longitudinal comparison. PMID:24694273

  7. Clinical usefulness of blood metal measurements to assess the failure of metal-on-metal hip implants

    PubMed Central

    Sampson, Barry; Hart, Alister

    2012-01-01

    In April 2010, a Medicines and Healthcare Products Regulatory Agency safety alert concerning all metal-on-metal (MOM) hip replacements recommended measuring chromium and cobalt concentrations when managing patients with painful prostheses. The need for this review is illustrated by the recent surge in requests for these blood tests from orthopaedic surgeons following this alert. The aim is to provide guidance to laboratories in assessing these requests and advising clinicians on interpretation. First, we summarize the basic terminology regarding the types of hip replacements, with emphasis on the MOM type. Second, we describe the clinical concerns over implant-derived wear debris in the local tissues and distant sites. Analytical aspects of the measurement of the relevant metal ions and what factors affect the levels measured are discussed. The application of inductively coupled plasma mass spectrometry techniques to the measurement of these metals is considered in detail. The biological effects of metal wear products are summarized with local toxicity and systemic biological effects considered, including carcinogenicity, genotoxicity and systemic toxicity. Clinical cases are used to illustrate pertinent points. PMID:22155921

  8. A simulator study of adverse wear with metal and cement debris contamination in metal-on-metal hip bearings

    PubMed Central

    Halim, T.; Clarke, I. C.; Burgett-Moreno, M. D.; Donaldson, T. K.; Savisaar, C.; Bowsher, J. G.

    2015-01-01

    Objectives Third-body wear is believed to be one trigger for adverse results with metal-on-metal (MOM) bearings. Impingement and subluxation may release metal particles from MOM replacements. We therefore challenged MOM bearings with relevant debris types of cobalt–chrome alloy (CoCr), titanium alloy (Ti6Al4V) and polymethylmethacrylate bone cement (PMMA). Methods Cement flakes (PMMA), CoCr and Ti6Al4V particles (size range 5 µm to 400 µm) were run in a MOM wear simulation. Debris allotments (5 mg) were inserted at ten intervals during the five million cycle (5 Mc) test. Results In a clean test phase (0 Mc to 0.8 Mc), lubricants retained their yellow colour. Addition of metal particles at 0.8 Mc turned lubricants black within the first hour of the test and remained so for the duration, while PMMA particles did not change the colour of the lubricant. Rates of wear with PMMA, CoCr and Ti6Al4V debris averaged 0.3 mm3/Mc, 4.1 mm3/Mc and 6.4 mm3/Mc, respectively. Conclusions Metal particles turned simulator lubricants black with rates of wear of MOM bearings an order of magnitude higher than with control PMMA particles. This appeared to model the findings of black, periarticular joint tissues and high CoCr wear in failed MOM replacements. The amount of wear debris produced during a 500 000-cycle interval of gait was 30 to 50 times greater than the weight of triggering particle allotment, indicating that MOM bearings were extremely sensitive to third-body wear. Cite this article: Bone Joint Res 2015;4:29–37. PMID:25736072

  9. Chromium and cobalt ion concentrations in blood and serum following various types of metal-on-metal hip arthroplasties

    PubMed Central

    2013-01-01

    Background and purpose Widely different metal ion concentrations in blood and serum have been reported with metal-on-metal (MoM) implants. We reviewed the literature on blood and serum ion concentrations of chromium (Cr) and cobalt (Co) following various MoM hip arthroplasties. Methods Studies were searched for in the Medline database, Embase, and the Cochrane Database of Systematic Reviews. Highest mean or median ion concentrations of Cr and Co after a minimum of 1 year of follow-up were extracted and grouped according to sample- and articulation type, and average values were calculated. Results 43 studies were included and 16 different MoM implants were identified. For the different types of bearings, average ion concentrations and range were calculated from the mean or median ion concentration. The average Cr concentration ranged between 0.5 and 2.5 μg/L in blood and between 0.8 and 5.1 μg/L in serum. For Co, the range was 0.7–3.4 μg/L in blood and 0.3–7.5 μg/L in serum. Interpretation When the average blood ion concentrations calculated for the different implants, together with the concentrations measured in the individual studies, were compared with the upper acceptable limit for Cr and Co in blood, no clear pattern was recognized. Furthermore, we were unable to detect any clear difference in ion concentrations between different types of implants (THA and resurfacing). PMID:23594249

  10. Genetic alterations in periprosthetic soft-tissue masses from patients with metal-on-metal hip replacement.

    PubMed

    Sarhadi, Virinder Kaur; Parkkinen, Jyrki; Reito, Aleksi; Nieminen, Jyrki; Porkka, Noora; Wirtanen, Tiina; Laitinen, Minna; Eskelinen, Antti; Knuutila, Sakari

    2015-11-01

    Adverse soft tissue reactions in patients with metal-on-metal (MoM) hip replacement are associated with cobalt (Co) and chromium (Cr) particles released from the implant. Exposing the patients to long periods of increased metal ions concentrations resulting from the wear of these implants poses an increased risk of genotoxicity/mutagenicity. A variable proportion of patients develop periprosthetic soft-tissue masses or pseudotumors at the site of the implant. There is a concern that exposure to increased metal ions could increase the risk of cancer. In order to investigate whether the periprosthetic soft-tissue mass harbours any cancer- related genetic alterations, we studied DNA isolated from periprosthetic tissues of 20 patients with MoM hip replacement, for copy number alterations and mutations in hotspot regions of 50 cancer genes using aCGH and amplicon-based next generation sequencing. Our results showed copy number gains at 12q14.3 and 21q21.1in tumour from patient diagnosed with liposarcoma. Copy number alterations in periprosthetic tissues were seen in three other patients, one had a region of gain at 9q24.1 affecting JAK2 and INSL6, and two patients had region of gain at 6p21.1, affecting RUNX2. Mutation analysis showed V1578del mutation in NOTCH1 in two patients. The copy number alterations and mutations seen in periprosthetic soft-tissue masses are earlier reported in either haematological malignancies or in osteoblast related bone dysplasia. The presence of genetic anomalies was associated with longer in-situ time of the implant. Our findings warrant the need of similar studies in larger patient cohorts to evaluate the risk of development of neoplastic alterations in periprosthetic tissues of patients with MoM hip replacement. PMID:26355908

  11. Effect of microseparation on contact mechanics in metal-on-metal hip replacements-A finite element analysis.

    PubMed

    Liu, Feng; Williams, Sophie; Fisher, John

    2015-08-01

    Some early failures of metal-on-metal (MoM) hip replacements associated with elevated wear have caused concerns for the use of this bearing combination. Simulator studies have shown that microseparation and its associated rim contact and edge loading may produce the most severe wear in MoM bearings. It is generally recognized that this high wear can be attributed to the high contact stress of the head on the rim of the cup. In this study, an improved finite element contact model that incorporates an elastic-perfectly plastic material property for cobalt-chrome alloy of the metal bearing was developed in an attempt to provide an accurate prediction of the stress and strain for the rim contact. The effects of the microseparation displacement (0.1-2 mm), cup inclination angle (25-65°) and cup rim radius (0.5-4 mm) on the contact stress/strain were investigated. The results show that a translational displacement >0.1 mm under a load >0.5 kN can produce a highly concentrated contact stress at the surface of the cup rim which can lead to plastic deformation. This study also suggests that the magnitude of translational displacement was the major factor that determined the severity of the contact conditions and level of stress and strain under microseparation conditions. Future studies will address the effect of surgical translational and rotational malposition and component design on the magnitude of microseparation, contact stress and strain and severity of wear. PMID:25370809

  12. Which imaging modality is most effective for identifying pseudotumours in metal-on-metal hip resurfacings requiring revision

    PubMed Central

    Matharu, G. S.; Mansour, R.; Dada, O.; Ostlere, S.; Pandit, H. G.; Murray, D. W.

    2016-01-01

    Aims The aims of this study were to compare the diagnostic test characteristics of ultrasound alone, metal artefact reduction sequence MRI (MARS-MRI) alone, and ultrasound combined with MARS-MRI for identifying intra-operative pseudotumours in metal-on-metal hip resurfacing (MoMHR) patients undergoing revision surgery. Methods This retrospective diagnostic accuracy study involved 39 patients (40 MoMHRs). The time between imaging modalities was a mean of 14.6 days (0 to 90), with imaging performed at a mean of 5.3 months (0.06 to 12) before revision. The prevalence of intra-operative pseudotumours was 82.5% (n = 33). Results Agreement with the intra-operative findings was 82.5% (n = 33) for ultrasound alone, 87.5% (n = 35) for MARS-MRI alone, and 92.5% (n = 37) for ultrasound and MARS-MRI combined. The diagnostic characteristics for ultrasound alone and MARS-MRI alone reached similar sensitivities (90.9% vs 93.9%) and positive predictive values (PPVs; 88.2% vs 91.2%), but higher specificities (57.1% vs 42.9%) and negative predictive values (NPVs; 66.7% vs 50.0%) were achieved with MARS-MRI. Ultrasound and MARS-MRI combined produced 100% sensitivity and 100% NPV, whilst maintaining both specificity (57.1%) and PPV (91.7%). For the identification of a pseudotumour, which was confirmed at revision surgery, agreement was substantial for ultrasound and MARS-MRI combined (κ = 0.69), moderate for MARS-MRI alone (κ = 0.54), and fair for ultrasound alone (κ = 0.36). Discussion These findings suggest that ultrasound and/or MARS-MRI have a role when assessing patients with a MoMHR, with the choice dependent on local financial constraints and the availability of ultrasound expertise. However in patients with a MoMHR who require revision, combined imaging was most effective. Take home message: Combined imaging with ultrasound and MARS-MRI always identified intra-operative pseudotumours if present. Furthermore, if neither imaging modality showed a pseudotumour, one was not found intra-operatively. Cite this article: Bone Joint J 2016;98-B:40–8. PMID:26733514

  13. Activation of noble metals on metal-carbide surfaces: novel catalysts for CO oxidation, desulfurization and hydrogenation reactions.

    PubMed

    Rodriguez, José A; Illas, Francesc

    2012-01-14

    This perspective article focuses on the physical and chemical properties of highly active catalysts for CO oxidation, desulfurization and hydrogenation reactions generated by depositing noble metals on metal-carbide surfaces. To rationalize structure-reactivity relationships for these novel catalysts, well-defined systems are required. High-resolution photoemission, scanning tunneling microscopy (STM) and first-principles periodic density-functional (DF) calculations have been used to study the interaction of metals of Groups 9, 10 and 11 with MC(001) (M = Ti, Zr, V, Mo) surfaces. DF calculations give adsorption energies that range from 2 eV (Cu, Ag, Au) to 6 eV (Co, Rh, Ir). STM images show that Au, Cu, Ni and Pt grow on the carbide substrates forming two-dimensional islands at very low coverage, and three-dimensional islands at medium and large coverages. In many systems, the results of DF calculations point to the preferential formation of admetal-C bonds with significant electronic perturbations in the admetal. TiC(001) and ZrC(001) transfer some electron density to the admetals facilitating bonding of the adatom with electron-acceptor molecules (CO, O(2), C(2)H(4), SO(2), thiophene, etc.). For example, the Cu/TiC(001) and Au/TiC(001) systems are able to cleave both S-O bonds of SO(2) at a temperature as low as 150 K, displaying a reactivity much larger than that of TiC(001) or extended surfaces of bulk copper and gold. At temperatures below 200 K, Au/TiC is able to dissociate O(2) and perform the 2CO + O(2)→ 2CO(2) reaction. Furthermore, in spite of the very poor hydrodesulfurization performance of TiC(001) or Au(111), a Au/TiC(001) surface displays an activity for the hydrodesulfurization of thiophene higher than that of conventional Ni/MoS(x) catalysts. In general, the Au/TiC system is more chemically active than systems generated by depositing Au nanoparticles on oxide surfaces. Thus, metal carbides are excellent supports for enhancing the chemical reactivity of noble metals. PMID:22108864

  14. The immunobiology of cobalt: demonstration of a potential aetiology for inflammatory pseudotumours after metal-on-metal replacement of the hip.

    PubMed

    Lawrence, H; Deehan, D; Holland, J; Kirby, J; Tyson-Capper, A

    2014-09-01

    Abnormal wear of cobalt-containing metal-on-metal joints is associated with inflammatory pseudotumours. Cobalt ions activate human toll-like receptor 4 (TLR4), which normally responds to bacterial lipopolysaccharide (LPS) in sepsis. Activation of TLR4 by LPS increases the expression of chemokines IL-8 and CXCL10, which recruit leukocytes and activated T-cells, respectively. This study was designed to determine whether cobalt induces a similar inflammatory response to LPS by promoting the expression of IL-8 and CXCL10. A human monocytic cell line, derived from acute monocytic leukaemia, was treated with cobalt ions and expression of IL-8 and CXCL10 measured at mRNA and protein levels. Cobalt-treated macrophages showed a 60-fold increase in IL-8 mRNA, and an eightfold increase in production of the mature chemokine (both p < 0.001); expression of the CXCL10 gene and protein was also significantly increased by cobalt (both p < 0.001). Experiments were also performed in the presence of CLI-095, a TLR4-specific antagonist which abrogated the cobalt-mediated increase in IL-8 and CXCL10 expression. These findings suggest that cobalt ions induce inflammation similar to that observed during sepsis by the simultaneous activation of two TLR4-mediated signalling pathways. These pathways result in increased production of IL-8 and CXCL10, and may be implicated in pseudotumour formation following metal-on-metal replacement. PMID:25183586

  15. A Two Centre Study to Assess the Long-term Performance of the Pinnacle™ Cup With a Metal-on-Metal Bearing in Primary Total Hip Replacement

    ClinicalTrials.gov

    2014-04-29

    Rheumatoid Arthritis; Osteoarthritis; Post-traumatic Arthritis; Collagen Disorders; Avascular Necrosis; Traumatic Femoral Fractures; Nonunion of Femoral Fractures; Congenital Hip Dysplasia; Slipped Capital Femoral Epiphysis

  16. Optimal acetabular component orientation estimated using edge-loading and impingement risk in patients with metal-on-metal hip resurfacing arthroplasty.

    PubMed

    Mellon, Stephen J; Grammatopoulos, George; Andersen, Michael S; Pandit, Hemant G; Gill, Harinderjit S; Murray, David W

    2015-01-21

    Edge-loading in patients with metal-on-metal resurfaced hips can cause high serum metal ion levels, the development of soft-tissue reactions local to the joint called pseudotumours and ultimately, failure of the implant. Primary edge-loading is where contact between the femoral and acetabular components occurs at the edge/rim of the acetabular component whereas impingement of the femoral neck on the acetabular component's edge causes secondary or contrecoup edge-loading. Although the relationship between the orientation of the acetabular component and primary edge-loading has been identified, the contribution of acetabular component orientation to impingement and secondary edge-loading is less clear. Our aim was to estimate the optimal acetabular component orientation for 16 metal-on-metal hip resurfacing arthroplasty (MoMHRA) subjects with known serum metal ion levels. Data from motion analysis, subject-specific musculoskeletal modelling and Computed Tomography (CT) measurements were used to calculate the dynamic contact patch to rim (CPR) distance and impingement risk for 3416 different acetabular component orientations during gait, sit-to-stand, stair descent and static standing. For each subject, safe zones free from impingement and edge-loading (CPR <10%) were defined and, consequently, an optimal acetabular component orientation was determined (mean inclination 39.7° (SD 6.6°) mean anteversion 14.9° (SD 9.0°)). The results of this study suggest that the optimal acetabular component orientation can be determined from a patient's motion and anatomy. However, 'safe' zones of acetabular component orientation associated with reduced risk of dislocation and pseudotumour are also associated with a reduced risk of edge-loading and impingement. PMID:25482661

  17. Influence of head size on the development of metallic wear and on the characteristics of carbon layers in metal-on-metal hip joints

    PubMed Central

    Sprecher, Christoph M; Wimmer, Markus A; Milz, Stefan; Taeger, Georg

    2009-01-01

    Background and purpose Particles originating from the articulating surfaces of hip endoprostheses often induce an inflammatory response, which can be related to implant failure. We therefore analyzed the metal content in capsular tissue from 44 McKee-Farrar metal-on-metal hip prostheses (with 3 different head sizes) and we also analyzed the morphological structure of layers located on articulating surfaces. Methods Atomic absorption spectrometry (AAS) was used to analyze the metal content in capsular tissue. Visually detectable carbon layers located on the articulating surfaces were evaluated using scanning electron microscopy (SEM), energy-dispersive Xray spectroscopy (EDX), and X-ray photoelectron spectroscopy (XPS). Results Metallic debris was detected in all capsular tissue samples but no statistically significant differences in metal content were found in relation to implant head size. The morphological characteristics of the different layer zones allowed an exact analysis of contact and non-contact areas. Furthermore, surface layers appear to have a protective function because they can prevent sharp-edged particles from damaging the prostheses surface. Interpretation The implant head size does not appear to influence the amount of metallic debris. The layers obviously act like a lubricating agent because the protection function does not occur in regions without layers where the metal surface often shows numerous scratches. As layers are not generated immediately after the implantation of hip prostheses, these findings may at least partially explain the high amount of wear early after implantation. PMID:19421914

  18. Chromium and cobalt ion release following the Durom high carbon content, forged metal-on-metal surface replacement of the hip.

    PubMed

    Vendittoli, P-A; Mottard, S; Roy, A G; Dupont, C; Lavigne, M

    2007-04-01

    We evaluated the concentrations of chromium and cobalt ions in blood after metal-on-metal surface replacement arthroplasty using a wrought-forged, high carbon content chromium-cobalt alloy implant in 64 patients. At one year, mean whole blood ion levels were 1.61 microg/L (0.4 to 5.5) for chromium and 0.67 microg/L (0.23 to 2.09) for cobalt. The pre-operative ion levels, component size, female gender and the inclination of the acetabular component were inversely proportional to the values of chromium and/or cobalt ions at one year postoperatively. Other factors, such as age and level of activity, did not correlate with the levels of metal ions. We found that the levels of the ions in the serum were 1.39 and 1.37 times higher for chromium and cobalt respectively than those in the whole blood. The levels of metal ions obtained may be specific to the hip resurfacing implant and reflect its manufacturing process. PMID:17463109

  19. N-Acetyl-Cysteine as Effective and Safe Chelating Agent in Metal-on-Metal Hip-Implanted Patients: Two Cases

    PubMed Central

    Lonati, Davide; Ragghianti, Benedetta; Ronchi, Anna; Vecchio, Sarah; Locatelli, Carlo Alessandro

    2016-01-01

    Systemic toxicity associated with cobalt (Co) and chromium (Cr) containing metal hip alloy may result in neuropathy, cardiomyopathy, and hypothyroidism. However clinical management concerning chelating therapy is still debated in literature. Here are described two metal-on-metal hip-implanted patients in which N-acetyl-cysteine decreased elevated blood metal levels. A 67-year-old male who underwent Co/Cr hip implant in September 2009 referred to our Poison Control Centre for persisting elevated Co/Cr blood levels (from March 2012 to November 2014). After receiving oral high-dose N-acetyl-cysteine, Co/Cr blood concentrations dropped by 86% and 87% of the prechelation levels, respectively, and persisted at these latter concentrations during the following 6 months of follow-up. An 81-year-old female who underwent Co/Cr hip implant in January 2007 referred to our Centre for detection of high Co and Cr blood levels in June 2012. No hip revision was indicated. After a therapy with oral high-dose N-acetyl-cysteine Co/Cr blood concentrations decreased of 45% and 24% of the prechelation levels. Chelating agents reported in hip-implanted patients (EDTA, DMPS, and BAL) are described in few cases. N-acetyl-cysteine may provide chelating sites for metals and in our cases reduced Co and Cr blood levels and resulted well tolerable. PMID:27148463

  20. N-Acetyl-Cysteine as Effective and Safe Chelating Agent in Metal-on-Metal Hip-Implanted Patients: Two Cases.

    PubMed

    Giampreti, Andrea; Lonati, Davide; Ragghianti, Benedetta; Ronchi, Anna; Petrolini, Valeria Margherita; Vecchio, Sarah; Locatelli, Carlo Alessandro

    2016-01-01

    Systemic toxicity associated with cobalt (Co) and chromium (Cr) containing metal hip alloy may result in neuropathy, cardiomyopathy, and hypothyroidism. However clinical management concerning chelating therapy is still debated in literature. Here are described two metal-on-metal hip-implanted patients in which N-acetyl-cysteine decreased elevated blood metal levels. A 67-year-old male who underwent Co/Cr hip implant in September 2009 referred to our Poison Control Centre for persisting elevated Co/Cr blood levels (from March 2012 to November 2014). After receiving oral high-dose N-acetyl-cysteine, Co/Cr blood concentrations dropped by 86% and 87% of the prechelation levels, respectively, and persisted at these latter concentrations during the following 6 months of follow-up. An 81-year-old female who underwent Co/Cr hip implant in January 2007 referred to our Centre for detection of high Co and Cr blood levels in June 2012. No hip revision was indicated. After a therapy with oral high-dose N-acetyl-cysteine Co/Cr blood concentrations decreased of 45% and 24% of the prechelation levels. Chelating agents reported in hip-implanted patients (EDTA, DMPS, and BAL) are described in few cases. N-acetyl-cysteine may provide chelating sites for metals and in our cases reduced Co and Cr blood levels and resulted well tolerable. PMID:27148463

  1. Prevalence of Failure due to Adverse Reaction to Metal Debris in Modern, Medium and Large Diameter Metal-on-Metal Hip Replacements - The Effect of Novel Screening Methods: Systematic Review and Metaregression Analysis.

    PubMed

    Reito, Aleksi; Lainiala, Olli; Elo, Petra; Eskelinen, Antti

    2016-01-01

    Metal-on-metal (MoM) hip replacements were used for almost a decade before adverse reactions to metal debris (ARMD) were found to be a true clinical problem. Currently, there is a paucity of evidence regarding the usefulness of systematic screening for ARMD. We implemented a systematic review and meta-analysis to establish the prevalence of revision confirmed ARMD stratified by the use of different screening protocols in patients with MoM hip replacements. Five levels of screening were identified: no screening (level 0), targeted blood metal ion measurement and/or cross-sectional imaging (level 1), metal ion measurement without imaging (level 2), metal ion measurement with targeted imaging (level 3) and comprehensive screening (both metal ions and imaging for all; level 4). 122 studies meeting our eligibility criteria were included in analysis. These studies included 144 study arms: 100 study arms with hip resurfacings, 33 study arms with large-diameter MoM total hip replacements (THR), and 11 study arms with medium-diameter MoM THRs. For hip resurfacing, the lowest prevalence of ARMD was seen with level 0 screening (pooled prevalence 0.13%) and the highest with level 4 screening (pooled prevalace 9.49%). Pooled prevalence of ARMD with level 0 screening was 0.29% and with level 4 screening 21.3% in the large-diameter MoM THR group. In metaregression analysis of hip resurfacings, level 4 screening was superior with regard to prevalence of ARMD when compared with other levels. In the large diameter THR group level 4 screening was superior to screening 0,2 and 3. These outcomes were irrespective of follow-up time or study publication year. With hip resurfacings, routine cross-sectional imaging regardless of clinical findings is advisable. It is clear, however, that targeted metal ion measurement and/or imaging is not sufficient in the screening for ARMD in any implant concepts. However, economic aspects should be weighed when choosing the preferred screening level. PMID:26930057

  2. Prevalence of Failure due to Adverse Reaction to Metal Debris in Modern, Medium and Large Diameter Metal-on-Metal Hip Replacements – The Effect of Novel Screening Methods: Systematic Review and Metaregression Analysis

    PubMed Central

    Reito, Aleksi; Lainiala, Olli; Elo, Petra; Eskelinen, Antti

    2016-01-01

    Metal-on-metal (MoM) hip replacements were used for almost a decade before adverse reactions to metal debris (ARMD) were found to be a true clinical problem. Currently, there is a paucity of evidence regarding the usefulness of systematic screening for ARMD. We implemented a systematic review and meta-analysis to establish the prevalence of revision confirmed ARMD stratified by the use of different screening protocols in patients with MoM hip replacements. Five levels of screening were identified: no screening (level 0), targeted blood metal ion measurement and/or cross-sectional imaging (level 1), metal ion measurement without imaging (level 2), metal ion measurement with targeted imaging (level 3) and comprehensive screening (both metal ions and imaging for all; level 4). 122 studies meeting our eligibility criteria were included in analysis. These studies included 144 study arms: 100 study arms with hip resurfacings, 33 study arms with large-diameter MoM total hip replacements (THR), and 11 study arms with medium-diameter MoM THRs. For hip resurfacing, the lowest prevalence of ARMD was seen with level 0 screening (pooled prevalence 0.13%) and the highest with level 4 screening (pooled prevalace 9.49%). Pooled prevalence of ARMD with level 0 screening was 0.29% and with level 4 screening 21.3% in the large-diameter MoM THR group. In metaregression analysis of hip resurfacings, level 4 screening was superior with regard to prevalence of ARMD when compared with other levels. In the large diameter THR group level 4 screening was superior to screening 0,2 and 3. These outcomes were irrespective of follow-up time or study publication year. With hip resurfacings, routine cross-sectional imaging regardless of clinical findings is advisable. It is clear, however, that targeted metal ion measurement and/or imaging is not sufficient in the screening for ARMD in any implant concepts. However, economic aspects should be weighed when choosing the preferred screening level. PMID:26930057

  3. Peri-acetabular bone mineral density in total hip replacement

    PubMed Central

    Gauthier, L.; Dinh, L.; Beaulé, P. E.

    2013-01-01

    Objectives To quantify and compare peri-acetabular bone mineral density (BMD) between a monoblock acetabular component using a metal-on-metal (MoM) bearing and a modular titanium shell with a polyethylene (PE) insert. The secondary outcome was to measure patient-reported clinical function. Methods A total of 50 patients (25 per group) were randomised to MoM or metal-on-polyethlene (MoP). There were 27 women (11 MoM) and 23 men (14 MoM) with a mean age of 61.6 years (47.7 to 73.2). Measurements of peri-prosthetic acetabular and contralateral hip (covariate) BMD were performed at baseline and at one and two years’ follow-up. The Western Ontario and McMaster Universities osteoarthritis index (WOMAC), University of California, Los Angeles (UCLA) activity score, Harris hip score, and RAND-36 were also completed at these intervals. Results At two years, only zone 1 showed a loss in BMD (-2.5%) in MoM group compared with a gain in the MoP group (+2.2%). Zone 2 showed loss in both groups (-2.2% for MoM; -3.9% for MoP) and zones 3 and 4 a gain in both groups (+0.1% for MoM; +3.3% for MoP). No other between-group differences were detected. When adjusting for BMD of the contralateral hip, no differences in BMD were observed. The only significant differences in functional scores at two years were higher UCLA activity (7.3 (sd 1.2) vs 6.1 (sd 1.5); p = 0.01) and RAND-36 physical function (82.1 (sd 13.0) vs 64.5 (sd 26.4); p = 0.02) for MoM bearings versus MoP. One revision was performed in the MoM group, for aseptic acetabular loosening at 11 months. Conclusions When controlling for systemic BMD, there were no significant differences between MoM and MoP groups in peri-acetabular BMD. However, increasing reports of adverse tissue reactions with large head MoM THR have restricted the use of the monoblock acetabular component to resurfacing only. PMID:23913361

  4. Toxicology of wear particles of cobalt-chromium alloy metal-on-metal hip implants Part II: Importance of physicochemical properties and dose in animal and in vitro studies as a basis for risk assessment.

    PubMed

    Madl, Amy K; Kovochich, Michael; Liong, Monty; Finley, Brent L; Paustenbach, Dennis J; Oberdrster, Gnter

    2015-07-01

    The objective of the Part II analysis was to evaluate animal and in vitro toxicology studies of CoCr particles with respect to their physicochemistry and dose relevance to metal-on-metal (MoM) implant patients as derived from Part I. In the various toxicology studies, physicochemical characteristics were infrequently considered and administered doses were orders of magnitude higher than what occurs in patients. Co was consistently shown to rapidly release from CoCr particles for distribution and elimination from the body. CoCr micron sized particles appear more biopersistent in vivo resulting in inflammatory responses that are not seen with similar mass concentrations of nanoparticles. We conclude, that in an attempt to obtain data for a complete risk assessment, future studies need to focus on physicochemical characteristics of nano and micron sized particles and on doses and dose metrics relevant to those generated in patients or in properly conducted hip simulator studies. PMID:25735266

  5. Profiling the third-body wear damage produced in CoCr surfaces by bone cement, CoCr, and Ti6Al4V debris: a 10-cycle metal-on-metal simulator test.

    PubMed

    Halim, Thomas; Burgett, Michelle; Donaldson, Thomas K; Savisaar, Christina; Bowsher, John; Clarke, Ian C

    2014-07-01

    Particles of bone cement (polymethyl methacrylate), CoCr and Ti6Al4V were compared for their abrasion potential against CoCr substrates. This appears to be the first study utilizing CoCr and Ti6Al4V particulates to abrade CoCr bearings and the first study profiling the morphology of third-body abrasive wear scratches in a hip simulator. The 5 mg debris allotments (median size range 140-300 m) were added to cups mounted both inverted and anatomically with metal-on-metal (MOM) bearings in a 10-cycle, hip simulator test. Surface abrasion was characterized by roughness indices and scratch profiles. Compared to third-body abrasion with metal debris, polymethyl methacrylate debris had minimal effect on the CoCr surfaces. In all, 10 cycles of abrasion with metal debris demonstrated that roughness indices (Ra, PV) increased approximately 20-fold from the unworn condition. The scratch profiles ranged 20-108 m wide and 0.5-2.8 m deep. The scratch aspect ratio (W/PV) averaged 0.03, and this very low ratio indicated that the 140 m CoCr beads had plastically deformed to create wide but shallow scratches. There was no evidence of transfer of CoCr beads to CoCr bearings. The Ti64 particles produced similar scratch morphology with the same aspect ratio as the CoCr particulates. However, the titanium particulates also showed a unique ability to flatten and adhere to the CoCr, forming smears and islands of contaminating metal on the CoCr bearings. The morphology of scratches and metal transfer produced by these large metal particulates in the simulator appeared identical to those reported on retrieved metal-on-metal bearings. PMID:25062741

  6. Diamond coated total hip replacements.

    PubMed

    Lappalainen, R; Anttila, A; Heinonen, H

    1998-07-01

    Diamond has many superior, desired characteristics of implant materials such as low friction, high wear and corrosion resistance, and well bonding surface to bone. The potential of diamond for total hip replacement implants was studied in the form of amorphous diamond coatings on conventional metal implant materials. Amorphous diamond coatings (sp3 bonding fraction 80%, thickness 0.2 to 10 microns) were deposited on stainless steel AISI316L, Ti6A14V, and CoCrMo alloys using filtered pulsed plasma are discharge method. Superior attachment of coatings to the implant materials was achieved by using high energy plasma beams to deposit amorphous diamond and proper intermediate layers. Previously it was shown that these coatings are biocompatible causing no local tissue reactions. Tribologic studies using a pin on disk apparatus with coated or uncoated implant materials in 1 wt.% NaCl distilled water were performed. A simplified hip joint simulator was used for preliminary testing of metal on polyethylene and metal on metal artificial hip joints modified with amorphous diamond coating. The average coefficients of friction were typically in the range of 0.03 to 0.11 for amorphous diamond coated materials. In the case of metal on metal hip implants, the average friction during initial running in period was improved (coefficient of friction = 0.07) compared with the same metal on metal pair (coefficient of friction = 0.22) and sliding was significantly smoother. In pin on disk wear tests, the average wear factors obtained were 140.10(-6), 5.0.10(-6), and < 0.1.10(-6) mm3/Nm for the pairs of AISI316L, CoCrMo, and the same materials with amorphous diamond coating. The corrosion rates of these implant materials in 10 wt.% HCl solution were decreased by a factor of 10,000 to 15,000 and any damage of the coatings was not observed in 6 months. The results of the tests show that in all the combinations studied, amorphous diamond coating improved definitely the wear and corrosion resistance compared with the uncoated materials. PMID:9678039

  7. Uneven damage on head and liner contact surfaces of a retrieved Co-Cr-based metal-on-metal hip joint bearing: An important reason for the high failure rate.

    PubMed

    Koizumi, Yuichiro; Chen, Yan; Li, Yunping; Yamanaka, Kenta; Chiba, Akihiko; Tanaka, Shun-Ichiro; Hagiwara, Yoshihiro

    2016-05-01

    Detailed metallurgical investigations have been performed on a used Co-Cr-based metal-on-metal (MoM) hip joint bearing containing a type of liner that is commonly used in such joints. The damage on the metal-liner sliding surface was considerably more severe than that on the metal head counterpart, in terms of wear-scar density and width and microcrack frequency. Cross-sectional transmission electron microscopy revealed that a thick (>3μm) nanocrystalline layer formed on the sliding surface of the head, whereas the liner had coarse carbides embedded in it and nanocrystals were formed in a very limited region no deeper than 1μm. Comparative investigation of an unused head and a liner of identical type showed that although the chemical compositions of the liner and head were nearly identical, their microstructures were significantly different. Specifically, the grain size in the liner was larger than that in the head on average, and the grain boundaries of the liner were decorated with coarse carbides. Moreover, X-ray diffraction analysis revealed a large tensile residual stress only in the liner. These differences are possibly responsible for the wear damage on the liner being more serious than that on the head. PMID:26952456

  8. Prediction of Impact Shock Vibrations at Tennis Player's Wrist Joint: Comparison between Conventional Weight Racket and Light Weight Racket with Super Large Head Size

    NASA Astrophysics Data System (ADS)

    Kawazoe, Yoshihiko; Takeda, Yukihiro; Nakagawa, Masamichi; Casolo, Federico; Tomosue, Ryoso; Yoshinari, Keiko

    The lightweight racket with handle-light configuration and large head size is recent tendency of high-tech tennis rackets, increasing power or post-impact ball velocity with an increasing racket swing speed. This paper investigated the performance of lightweight tennis racket with super-large head size in terms of feel or comfort. It predicted the effect of the mass and mass distribution of super-large sized rackets on the impact shock vibrations of the racket handle and the player's wrist joint when a player hits a flat forehand drive. The prediction is based on the identification of the racket characteristics, the damping of the racket-arm system, equivalent mass of the player's arm system and the approximate nonlinear impact analysis in tennis. A super-light weight balanced racket (mass: 292 g, the center of gravity LG: 363 mm from the butt end) and a conventional weight and weight balanced racket (349 g, LG: 323 mm) are selected as representatives. They are the super-large sized rackets made of carbon graphite with a head size of 120 square inches and the same geometry. The result showed that the shock vibration of the super-light weight balanced racket with super-large sized head is much larger than that of the conventional weight balanced type racket. It also showed that the sweet area of the former in terms of the shock vibration shifts from the center to the topside on the racket face compared to the latter. This is because the location of the grip on the racket handle is further from the location of the node on the handle of the first mode of super-light racket than that of the conventional weight racket.

  9. Is There a Benefit to Head Size Greater Than 36 mm in Total Hip Arthroplasty?

    PubMed

    Haughom, Bryan D; Plummer, Darren R; Moric, Mario; Della Valle, Craig J

    2016-01-01

    This study compares the rate of dislocation and revision for instability between 36-mm and anatomic femoral heads (large diameter metal-on-metal THA, dual-mobility bearings, and hip resurfacing arthroplasty) in patients at high risk for dislocation. A total of 501 high-risk patients, over a 10-year period, were identified (282 36-mm THA, 24 dual-mobility bearings, 83 metal-on-metal arthroplasty, and 112 hip resurfacing arthroplasty). There were 13 dislocations in the 36-mm group compared to 1 in the anatomic group (4.6% vs 0.5%; P = .005). Four patients dislocated more than once in the 36-mm group (1.4% vs 0%; P = .04), and 2 patients in the 36-mm group required a revision for instability (0.7% vs 0%; P = .11). These results suggest that anatomic head sizes significantly lower the risk of dislocation in high-risk patients. PMID:26360768

  10. CoCr wear particles generated from CoCr alloy metal-on-metal hip replacements, and cobalt ions stimulate apoptosis and expression of general toxicology-related genes in monocyte-like U937 cells

    SciTech Connect

    Posada, Olga M.; Gilmour, Denise; Tate, Rothwelle J.; Grant, M. Helen

    2014-11-15

    Cobalt-chromium (CoCr) particles in the nanometre size range and their concomitant release of Co and Cr ions into the patients' circulation are produced by wear at the articulating surfaces of metal-on-metal (MoM) implants. This process is associated with inflammation, bone loss and implant loosening and led to the withdrawal from the market of the DePuy ASR™ MoM hip replacements in 2010. Ions released from CoCr particles derived from a resurfacing implant in vitro and their subsequent cellular up-take were measured by ICP-MS. Moreover, the ability of such metal debris and Co ions to induce both apoptosis was evaluated with both FACS and immunoblotting. qRT-PCR was used to assess the effects on the expression of lymphotoxin alpha (LTA), BCL2-associated athanogene (BAG1), nitric oxide synthase 2 inducible (NOS2), FBJ murine osteosarcoma viral oncogene homolog (FOS), growth arrest and DNA-damage-inducible alpha (GADD45A). ICP-MS showed that the wear debris released significant (p < 0.05) amounts of Co and Cr ions into the culture medium, and significant (p < 0.05) cellular uptake of both ions. There was also an increase (p < 0.05) in apoptosis after a 48 h exposure to wear debris. Analysis of qRT-PCR results found significant up-regulation (p < 0.05) particularly of NOS2 and BAG1 in Co pre-treated cells which were subsequently exposed to Co ions + debris. Metal debris was more effective as an inducer of apoptosis and gene expression when cells had been pre-treated with Co ions. This suggests that if a patient receives sequential bilateral CoCr implants, the second implant may be more likely to produce adverse effects than the first one. - Highlights: • Effects of CoCr nanoparticles and Co ions on U937 cells were investigated. • Ions released from wear debris play an important role in cellular response, • Toxicity of Co ions could be related to NO metabolic processes and apoptosis. • CoCr particles were a more effective inducer of apoptosis after cell priming. • CoCr particles were a more effective inducer of gene expression after cell priming.

  11. Effect of femoral head size on risk of revision for dislocation after total hip arthroplasty

    PubMed Central

    Kostensalo, Inari; Junnila, Mika; Virolainen, Petri; Remes, Ville; Matilainen, Markus; Vahlberg, Tero; Pulkkinen, Pekka; Eskelinen, Antti; Mkel, Keijo T

    2013-01-01

    Background and purpose Previous population-based registry studies have shown that larger femoral head size is associated with reduced risk of revision for dislocation. However, the previous data have not included large numbers of hip resurfacing arthroplasties or large metal-on-metal (> 36-mm) femoral head arthroplasties. We evaluated the association between femoral component head size and the risk of revision for dislocation after THA by using Finnish Arthroplasty Register data. Patients and methods 42,379 patients who were operated during 19962010 fulfilled our criteria. 18 different cup/stem combinations were included. The head-size groups studied (numbers of cases) were 28 mm (23,800), 32 mm (4,815), 36 mm (3,320), and > 36 mm (10,444). Other risk factors studied were sex, age group (1849 years, 5059 years, 6069 years, 7079 years, and > 80 years), and time period of operation (19962000, 20012005, 20062010). Results The adjusted risk ratio in the Cox model for a revision operation due to dislocation was 0.40 (95% CI: 0.260.62) for 32-mm head size, 0.41 (0.240.70) for 36-mm head size, and 0.09 (0.050.17) for > 36-mm head size compared to implants with a head size of 28 mm. Interpretation Larger femoral heads clearly reduce the risk of dislocation. The difference in using heads of > 36 mm as opposed to 28-mm heads for the overall revision rate at 10 years follow-up is about 2%. Thus, although attractive from a mechanical point of view, based on recent less favorable clinical outcome data on these large heads, consisting mainly of metal-on-metal prostheses, one should be cautious using these implants. PMID:23799348

  12. A frictional study of total hip joint replacements

    NASA Astrophysics Data System (ADS)

    Scholes, S. C.; Unsworth, A.; Goldsmith, A. A. J.

    2000-12-01

    Polymeric wear debris produced by articulation of the femoral head against the ultra-high-molecular-weight polyethylene socket of a total hip replacement has been implicated as the main cause of osteolysis and subsequent failure of these implants. Potential solutions to this problem are to employ hard bearing surface combinations such as metal-on-metal or ceramic-on-ceramic prostheses. The aim of this study was to investigate the difference in lubrication modes and friction of a range of material combinations using synthetic and biological fluids as the lubricants. The experimental results were compared with theoretical predictions of film thicknesses and lubrication modes. A strong correlation was observed between experiment and theory when employing carboxy methyl cellulose (CMC) fluids as the lubricant. Under these conditions the ceramic-on-ceramic joints showed full fluid film lubrication while the metal-on-metal, metal-on-plastic, diamond-like carbon-coated stainless steel (DLC)-on-plastic and ceramic-on-plastic prostheses operated under a mixed lubrication regime. With bovine serum as the lubricant in the all ceramic joints, however, the full fluid film lubrication was inhibited due to adsorbed proteins. In the metal-on-metal joints this adsorbed protein layer acted to reduce the friction while in the ceramic coupling the friction was increased. The use of bovine serum as the lubricant also significantly increased the friction in both the metal-on-plastic and ceramic-on-plastic joints. The friction produced by the DLC-on-plastic joints depended on the quality of the coating. Those joints with a less consistent coating and therefore a higher surface roughness gave significantly higher friction than the smoother, more consistently coated heads.

  13. Biomaterial Hypersensitivity: Is It Real? Supportive Evidence and Approach Considerations for Metal Allergic Patients following Total Knee Arthroplasty

    PubMed Central

    Mihalko, William M.; Grupp, Thomas M.; Manning, Blaine T.; Dennis, Douglas A.; Goodman, Stuart B.; Saleh, Khaled J.

    2015-01-01

    The prospect of biomaterial hypersensitivity developing in response to joint implant materials was first presented more than 30 years ago. Many studies have established probable causation between first-generation metal-on-metal hip implants and hypersensitivity reactions. In a limited patient population, implant failure may ultimately be related to metal hypersensitivity. The examination of hypersensitivity reactions in current-generation metal-on-metal knee implants is comparatively limited. The purpose of this study is to summarize all available literature regarding biomaterial hypersensitivity after total knee arthroplasty, elucidate overall trends about this topic in the current literature, and provide a foundation for clinical approach considerations when biomaterial hypersensitivity is suspected. PMID:25883940

  14. Incidence of metal sensitivity in patients with total joint replacements.

    PubMed

    Elves, M W; Wilson, J N; Scales, J T; Kemp, H B

    1975-11-15

    Sensitivity to chromium, cobalt, nickel, molybdenum, vanadium, and titanium was studied by patch tests in 50 patients who had received total joint replacements. Nineteen (38%) were sensitive to one or more of the metals. In 23 patients non-traumatic failure of the prosthesis had occurred, and 15 of these patients were sensitive to metal. Out of 27 patients with no evidence of prosthesis loosening, four were sensitive to nickel and cobalt or nickel only. Dermatological reactions occurred in 13 patients after surgery; in only eight, however, was there evidence of metal sensitivity. These findings indicate that metal-on-metal total joint replacements may sensitise the patient to metals contained in the prosthesis. Although there is a high incidence of prosthesis failure among metal-sensitive patients it remains uncertain whether the loosening causes the sensitisation or vice versa. PMID:1192079

  15. The current state of bearing surfaces in total hip replacement.

    PubMed

    Rajpura, A; Kendoff, D; Board, T N

    2014-02-01

    We reviewed the literature on the currently available choices of bearing surface in total hip replacement (THR). We present a detailed description of the properties of articulating surfaces review the understanding of the advantages and disadvantages of existing bearing couples. Recent technological developments in the field of polyethylene and ceramics have altered the risk of fracture and the rate of wear, although the use of metal-on-metal bearings has largely fallen out of favour, owing to concerns about reactions to metal debris. As expected, all bearing surface combinations have advantages and disadvantages. A patient-based approach is recommended, balancing the risks of different options against an individual's functional demands. PMID:24493177

  16. Serum metal ion exposure after total knee arthroplasty.

    PubMed

    Luetzner, Joerg; Krummenauer, Frank; Lengel, Attila Michael; Ziegler, Joerg; Witzleb, Wolf-Christoph

    2007-08-01

    All metal implants release metal ions because of corrosion. This has been studied and debated, especially in metal-on-metal total hip arthroplasties. Total knee arthroplasty implants have large metal surface areas and therefore substantial potential for corrosion. We determined changes in serum levels of metal ions in 41 patients after cemented unconstrained total knee arthroplasty without patellar resurfacing, 18 with unilateral total knee arthroplasty (median, 66 months after surgery) and 23 patients with bilateral total knee arthroplasties (75 and 50 months after first and second surgeries, respectively). Serum concentrations of chromium, cobalt, and molybdenum were analyzed and related to the number of total knee arthroplasties and compared with those of 130 control patients without implants. The median chromium, cobalt, and molybdenum concentrations were 0.92, 3.28, and 2.55 microg/L, respectively, in the unilateral total knee arthroplasty sample and 0.98, 4.28, and 2.40 microg/L, respectively, in the bilateral total knee arthroplasty sample. We observed no difference between the serum levels in patients with unilateral and bilateral arthroplasties, but the serum levels of chromium and cobalt of both study groups were greater than those of the control group (less than 0.25 microg/L). The patients who had total knee arthroplasty had molybdenum profiles that were similar to those of the control group (median, 2.11 microg/L). PMID:17438467

  17. Femoral head diameter considerations for primary total hip arthroplasty.

    PubMed

    Girard, J

    2015-02-01

    The configuration of total hip arthroplasty (THA) implants has constantly evolved since they were first introduced. One of the key components of THA design is the diameter of the prosthetic femoral head. It has been well established that the risk of dislocation is lower as the head diameter increases. But head diameter impacts other variables beyond joint stability: wear, cam-type impingement, range of motion, restoration of biomechanics, proprioception and groin pain. The introduction of highly cross-linked polyethylene and hard-on-hard bearings has allowed surgeons to implant large-diameter heads that almost completely eliminate the risk of dislocation. But as a result, cup liners have become thinner. With femoral head diameters up to 36 mm, the improvement in joint range of motion, delay in cam-type impingement and reduction in dislocation risk have been clearly demonstrated. Conversely, large-diameter heads do not provide any additional improvements. If an "ecologically sound" approach to hip replacement is embraced (e.g. keeping the native femoral head diameter), hip resurfacing with a metal-on-metal bearing must be carried out. The reliability of large-diameter femoral heads in the longer term is questionable. Large-diameter ceramic-on-ceramic bearings may be plagued by the same problems as metal-on-metal bearings: groin pain, squeaking, increased stiffness, irregular lubrication, acetabular loosening and notable friction at the Morse taper. These possibilities require us to be extra careful when using femoral heads with a diameter greater than 36 mm. PMID:25596984

  18. Formation of a pseudotumor in total hip arthroplasty using a tribological metal–polyethylene pair☆

    PubMed Central

    Fagotti, Lorenzo; Vicente, José Ricardo Negreiros; Miyahara, Helder Souza; de Oliveira, Pedro Vitoriano; Bernabé, Antônio Carlos; Croci, Alberto Tesconi

    2015-01-01

    The aim here was to report a case of a young adult patient who evolved with tumor formation in the left thigh, 14 years after revision surgery on hip arthroplasty. Davies in 2005 made the first description of this disease in patients undergoing metal-on-metal hip arthroplasty. Over the last decade, however, pseudotumors around metal-on-polyethylene surfaces have become more prevalent. Our patient presented with increased volume of the left thigh 8 years after hip arthroplasty revision surgery. Two years before the arising of the tumor in the thigh, a nodule in the inguinal region was investigated to rule out a malignant neoplastic process, but the results were inconclusive. The main preoperative complaints were pain, functional limitation and marked reduction in the range of motion of the left hip. Plain radiographs showed loosening of acetabular and femoral, and a large mass between the muscle planes was revealed through magnetic resonance imaging of the left thigh. The surgical procedure consisted of resection of the lesion and removal of the components through lateral approach. In respect of total hip arthroplasty, pseudotumors are benign neoplasms in which the bearing surface consists of metal-on-metal, but they can also occur in different tribological pairs, as presented in this case.

  19. Mid-term clinical results of total hip arthroplasty using a Wagner standard cup for dysplastic hip

    PubMed Central

    Maezawa, Katsuhiko; Nozawa, Masahiko; Yuasa, Takahito; Aritomi, Kentaro; Ogawa, Seiki; Maruyama, Yuichiro; Kaneko, Kazuo

    2014-01-01

    Background The outcome of cementless total hip arthroplasty depends on many factors. We must not forget fundamental things those are design of outer surface of the component, that leads bone ingrowth into the prosthesis, better initial stability, and better insertional techniques. The purpose of this study was to review our experience with metal-on-metal total hip arthroplasty with a Wagner standard cup for patients who had acetabular dysplasia. Patients and methods Fifty-four patients with 55 hips underwent primary metal-on-metal total hip arthroplasty (Metasul prosthesis) with a Wagner standard cup (4448mm in outer diameter) and were followed for a minimum of 10 years. All patients received the same type of cementless femoral component (Natural hip stem) and femoral head (28mm in diameter). Results Seventeen of the 55 Wagner standard cups (30.9%) showed aseptic loosening over a mean period of 3.6 years after surgery, and there were no bone anchors on the outer surface of the 16 retrieved cups. Conclusion From our experience, the small Wagner standard cup does not achieve sufficient osteointegration and we do not recommend the use of this cup, especially for patients with acetabular dysplasia and/or those with a small stature. PMID:25561751

  20. Total protein

    MedlinePLUS

    The total protein test measures the total amount of two classes of proteins found in the fluid portion of your blood. These are albumin and globulin. Proteins are important parts of all cells and tissues. ...

  1. Total Knee Arthroplasty Failure Induced by Metal Hypersensitivity

    PubMed Central

    Gupta, Ryan; Phan, Duy; Schwarzkopf, Ran

    2015-01-01

    Patient: Female, 70 Final Diagnosis: Metal hypersensitivity Symptoms: Joint pain • swelling • instability Medication: — Clinical Procedure: Revision total knee arthroplasty Specialty: Orthopedics and Traumatology Objective: Unusual clinical course Background: Metal hypersensitivity is an uncommon complication after total knee arthroplasty (TKA) that can lead to significant functional impairment and aseptic prosthesis failure. Case Report: We describe a 70-year-old patient who presented with persistent pain, swelling, and instability 2 years after a primary TKA. The patient had a history of metal hypersensitivity following bilateral metal-on-metal total hip arthroplasty (THA) that was revised to ceramic-on-polyethylene implants. Knee radiographs showed severe osteolysis with implant loosening. Serum cobalt was elevated and serum chromium was significantly elevated, while joint aspiration and inflammatory marker levels ruled out a periprosthetic infection. Revision TKA was performed, with intraoperative tissue pathology and postoperative leukocyte transformation testing confirming metal hypersensitivity as the cause for aseptic implant failure. Conclusions: This case report demonstrates the clinical and laboratory signs that suggest metal hypersensitivity in total knee arthroplasty and the potential for joint function restoration with revision surgery. PMID:26278890

  2. Comparison of Acetabular Bone Resection, Offset, Leg Length and Post Operative Function Between Hip Resurfacing Arthroplasty and Total Hip Arthroplasty.

    PubMed

    Parry, Michael C; Povey, James; Blom, Ashley W; Whitehouse, Michael R

    2015-10-01

    Controversy exists regarding the amount of acetabular bone resection, biomechanics and function of patients receiving either total hip arthroplasty (THA) or hip resurfacing arthroplasty (HRA). A cohort of patients undergoing 36 mm ceramic-on-ceramic THA (89) or metal-on-metal HRA (86) were compared. No difference was observed when the ratio of native femoral head size was compared to the implanted acetabular component size (1.15 ± 0.1 HRA c.f. 1.13 ± 0.1 THA). No difference was observed in acetabular offset, vertical centre of rotation or function (OHS mean 47 in both groups) but leg length discrepancy (1.8 mm c.f. 5.5 mm) and femoral offset did differ (0.6 mm c.f. 4.1 mm). This demonstrates that 36 mm ceramic-on-ceramic THA is not associated with more bone resection than HRA and achieves equivalent function whilst avoiding the problems of metal-on-metal bearings. PMID:25981328

  3. Optimal bearing surfaces for total hip replacement in the young patient: a meta-analysis.

    PubMed

    Shetty, Vijay; Shitole, Bhushan; Shetty, Gautam; Thakur, Harshad; Bhandari, Mohit

    2011-09-01

    Although there is general consensus about the efficacy of total hip replacement (THR) in young patients, the most appropriate bearings in young patients remain highly debated. The three most popular bearings in use include metal-on-polyethylene (MOP), metal-on-metal (MOM) and ceramic-on-ceramic (COC). We conducted a systematic review and meta-analysis of literature to summarise the best available evidence on relative success of the three most popular bearings used in THR in young active patients. Our findings support the use of MOM bearings in the management of the young arthritic hip. These findings, largely based upon observational studies, should be taken in the context of the limitations of such non-randomised study designs. PMID:20686893

  4. Fracture of the modular femoral neck component in total hip arthroplasty.

    PubMed

    Ellman, Michael B; Levine, Brett R

    2013-01-01

    The use of modularity, specifically dual modular femoral stems, in total hip arthroplasty has increased in popularity over the past 2 decades. While offering several distinct advantages intraoperatively, the long-term success of adding a second modular junction has yet to be established. One potential complication of increasing modularity is component fracture. We present a case of modular femoral neck prosthesis fracture necessitating revision surgery to treat this complication. Careful preoperative planning during revision of these failures is essential to avoid morbidity and unnecessary subsequent revision surgeries, as demonstrated in this case. The combined effects of crevice and fretting corrosion, large-diameter femoral head, long modular neck, metal-on-metal articulation, patient size, and activity level may have all played integral roles in creating an environment susceptible to this classic pattern of fatigue fracture. PMID:21798696

  5. Hard-on-Hard Total Hip Impingement Causes Extreme Contact Stress Concentrations

    PubMed Central

    Elkins, Jacob M.; O’Brien, Megan K.; Stroud, Nicholas J.; Pedersen, Douglas R.; Callaghan, John J.

    2010-01-01

    Background Impingement events, in addition to their role immediately proximate to frank dislocation, hold the potential to damage new-generation hard-on-hard bearings as a result of the relatively unforgiving nature of the materials and designs. Because of the higher stiffness and tighter design tolerances of metal-on-metal and ceramic implants, surgical positioning plausibly has become even more important. Questions/purposes We asked (1) whether, and under what cup orientation conditions, hard-on-hard impingements might challenge implant material failure strength; and (2) whether particle generation propensity at impingement and egress sites would show similar dependence on cup orientation. Methods Realistic computational simulations were enabled by multistage finite element analyses, addressing both global construct motion and loading, and focal stress concentrations at neck impingement and rim egress sites. The global model, validated by a cadaveric simulation in a servohydraulic hip simulator, included both hardware components and advanced anisotropic capsule characterization. Parametric computational runs explored the effect of cup orientation for both ceramic-on-ceramic and metal-on-metal bearing couples for two distinct motion sequences associated with dislocation. Results Stress concentrations from impingement increased nearly linearly with increased cup tilt and with cup anteversion. In some situations, peak values of stress approached or exceeded 1 GPa, levels challenging the yield strength of cobalt-chromium implants, and potentially the fracture strength of ceramics. The tendency for impingement events to generate debris, indexed in terms of a new scraping severity metric, showed orientation dependences similar to that for bulk material failure. Conclusions Damage propensity arising from impingement events in hard total hip bearings is highly orientation-dependent. PMID:20953853

  6. Presence of corrosion products and hypersensitivity-associated reactions in periprosthetic tissue after aseptic loosening of total hip replacements with metal bearing surfaces.

    PubMed

    Huber, Monika; Reinisch, Georg; Trettenhahn, Günter; Zweymüller, Karl; Lintner, Felix

    2009-01-01

    Aseptic loosening of articular implants is frequently associated with tissue reactions to wear particles. Some patients, who had received metal-on-metal articulations, present early symptoms including persistent pain and implant failure. These symptoms raise the suspicion about the development of an immunological response. Furthermore, the generation of rare corrosion products in association with metallic implants has been observed. Corrosion products are known to enhance third-body wear and contribute to the loss of the implant. The purpose of this study was to investigate periprosthetic tissue containing solid corrosion products after aseptic loosening of second-generation metal-on-metal total hip replacements made of low-carbon cobalt-chromium-molybdenum alloy for the presence of immunologically determined tissue changes. Periprosthetic tissue of 11 cases containing uncommon solid deposits was investigated by light microscopy. In order to confirm the presence of corrosion products, additional methods including scanning electron microscopy (SEM) investigation, energy dispersive X-ray (EDX) and Fourier transform infrared microspectroscopy (FTIR) analysis were used. All investigated cases revealed solid chromium orthophosphate corrosion products as well as metallic wear particles to a various extent. Moreover, various intense tissue reactions characteristic of immune response were observed in all cases. The simultaneous presence of corrosion products and hypersensitivity-associated tissue reaction indicates that a relationship between corrosion development and implant-related hypersensitivity may exist. PMID:18725188

  7. Alternative bearing surface options for revision total hip arthroplasty.

    PubMed

    Patel, Deepan; Parvizi, Javad; Sharkey, Peter F

    2011-01-01

    Despite the overall success of total hip arthroplasty (THA), there has been an increase in the rate of revision hip surgeries performed each year in the United States. These revision surgeries result in several billion dollars in health care costs. Bearing surface wear can result in the need for revision surgery through a variety of mechanisms. Many implant failures necessitating the need for revision surgeries occur secondary to dislocations, which are often related to prothesis wear and eventual loosening of the components. Wear also can lead to osteolysis and may play a role in aseptic loosening. Specific concerns regarding the wear rates of metal-on-polyethylene (the most common bearing surface) have encouraged the manufacture of newer polyethylene implants with improved wear properties, as well as alternative bearing surfaces. The goal is to improve the durability of revision implants and/or reduce the incidence of revision THAs. Revision arthroplasty involves using alternative surfaces, such as replacing the metal femoral head with a ceramic component or changing the entire prosthesis to a metal-on-metal or ceramic-on-ceramic articulation. It is important to review the characteristics of these alternative bearing surface options and their contributions to improved THA tribology and prolonged prosthesis longevity. The choice of a bearing surface for a revision THA should consider factors such as the patient's age and activity level, the cost of the implant, and both the surgeons' and patients' preferences. Although laboratory studies and small clinical trials have generated optimistic results for these alternative implants in vitro and in vivo, much still needs to be learned about the long-term performance of these materials in patients after total hip revision surgery. PMID:21553778

  8. Early surveillance of ceramic-on-metal total hip arthroplasty.

    PubMed

    Hill, J C; Diamond, O J; O'Brien, S; Boldt, J G; Stevenson, M; Beverland, D E

    2015-03-01

    Ceramic-on-metal (CoM) is a relatively new bearing combination for total hip arthroplasty (THA) with few reported outcomes. A total of 287 CoM THAs were carried out in 271 patients (mean age 55.6 years (20 to 77), 150 THAs in female patients, 137 in male) under the care of a single surgeon between October 2007 and October 2009. With the issues surrounding metal-on-metal bearings the decision was taken to review these patients between March and November 2011, at a mean follow-up of 34 months (23 to 45) and to record pain, outcome scores, radiological analysis and blood ion levels. The mean Oxford Hip Score was 19.2 (12 to 53), 254 patients with 268 hips (95%) had mild/very mild/no pain, the mean angle of inclination of the acetabular component was 44.8(o) (28(o) to 63(o)), 82 stems (29%) had evidence of radiolucent lines of > 1 mm in at least one Gruen zone and the median levels of cobalt and chromium ions in the blood were 0.83 μg/L (0.24 μg/L to 27.56 μg/L) and 0.78 μg/L (0.21 μg/L to 8.84 μg/L), respectively. The five-year survival rate is 96.9% (95% confidence interval 94.7% to 99%). Due to the presence of radiolucent lines and the higher than expected levels of metal ions in the blood, we would not recommend the use of CoM THA without further long-term follow-up. We plan to monitor all these patients regularly. PMID:25737511

  9. Alumina-on-alumina total hip replacement for femoral neck fracture in healthy patients

    PubMed Central

    2011-01-01

    Background Total hip replacement is considered the best option for treatment of displaced intracapsular fractures of the femoral neck (FFN). The size of the femoral head is an important factor that influences the outcome of a total hip arthroplasty (THA): implants with a 28 mm femoral head are more prone to dislocate than implants with a 32 mm head. Obviously, a large head coupled to a polyethylene inlay can lead to more wear, osteolysis and failure of the implant. Ceramic induces less friction and minimal wear even with larger heads. Methods A total of 35 THAs were performed for displaced intracapsular FFN, using a 32 mm alumina-alumina coupling. Results At a mean follow-up of 80 months, 33 have been clinically and radiologically reviewed. None of the implants needed revision for any reason, none of the cups were considered to have failed, no dislocations nor breakage of the ceramic components were recorded. One anatomic cementless stem was radiologically loose. Conclusions On the basis of our experience, we suggest that ceramic-on-ceramic coupling offers minimal friction and wear even with large heads. PMID:21284879

  10. Serum Metal Ion Concentrations in Paediatric Patients following Total Knee Arthroplasty Using Megaprostheses

    PubMed Central

    Friesenbichler, Jörg; Sadoghi, Patrick; Maurer-Ertl, Werner; Szkandera, Joanna; Glehr, Mathias; Ogris, Kathrin; Wolf, Matthias; Weger, Christian; Leithner, Andreas

    2014-01-01

    The purpose of this study was to determine the concentrations of cobalt, chromium, and molybdenum in the serum of paediatric tumour patients after fixed hinge total knee arthroplasty. Further, these metal ion levels were compared with serum metal ion levels of patients with other orthopaedic devices such as hip and knee prostheses with metal-on-metal or metal-on-polyethylene articulation to find differences between anatomical locations, abrasion characteristics, and bearing surfaces. After an average follow-up of 108 months (range: 67 to 163) of 11 paediatric patients with fixed hinge total knee arthroplasty, the mean concentrations for Co and Cr were significantly increased while Mo was within the limits compared to the upper values from the reference laboratory. Furthermore, these serum concentrations were significantly higher compared to patients with a standard rotating hinge device (P = 0.002 and P < 0.001) and preoperative controls (P < 0.001). On the other hand, the serum levels of patients following MoM THA or rotating hinge arthroplasty using megaprostheses were higher. Therefore, periodic long-term follow-ups are recommended due to the rising concerns about systemic metal ion exposure in the literature. Upon the occurrence of adverse reactions to metal debris the revision of the fixed hinge implant should be considered. PMID:25276819

  11. Corrosion of the Head-neck Junction After Total Hip Arthroplasty.

    PubMed

    Jennings, Jason M; Dennis, Douglas A; Yang, Charlie C

    2016-06-01

    Corrosion of the head-neck junction of implants used in total hip arthroplasty is a complex problem. Clinical severity appears to be multifactorial, and the predictive variables have yet to be consistently identified in the literature. Corrosion should be considered in the differential diagnosis of hip pain following total hip arthroplasty regardless of the type of bearing surface used. The most common presentation, pain followed by instability, is similar to complications associated with metal-on-metal articulations. The diagnosis of implant corrosion of the head-neck junction can be challenging; an infection workup should be performed along with analysis of serum metal ion levels and cross-sectional imaging. In the short term, a well-fixed stem may be retained, and the exchange of an isolated head with a ceramic femoral head seems to be a promising option for certain implants. Further research with longer follow-up is warranted, and high levels of evidence are needed to determine whether this approach is generalizable. PMID:27213620

  12. TETE: Total Education in the Total Environment.

    ERIC Educational Resources Information Center

    Eblen, William R.

    The Hudson River Museum's Environmental Arts and Science Division has published this booklet describing their model educational program, "TETE: Total Education in the Total Environment," a multidisciplinary approach to environmental education utilizing existing curricula. For conducting the program model communities strategically located along the…

  13. Expression of CD11c in periprosthetic tissues from failed total hip arthroplasties.

    PubMed

    Chamaon, Kathrin; Barber, Henriette; Awiszus, Friedemann; Feuerstein, Bernd; Lohmann, Christoph H

    2016-01-01

    In this work, we characterize integrin CD11c (αXß2) expression in periprosthetic tissues of 45 hip revisions. Tissues were retrieved from 23 ceramic-on-ultra-high molecular weight polyethylene (UHMWPE), 20 metal-on-UHMWPE, and 2 metal-on-metal total hip arthroplasties (THAs). Capsular tissue retrieved during primary THA from 19 patients served as controls. We identified a system to identify important immunohistochemical markers that are expressed in aseptic loosening. We focused on CD11c, CD68 and CD14. We observed that the CD11c molecule possesses four different cellular patterns in the periprosthetic tissues. Three of them are associated with the occurrence of UHMWPE abrasive material. Double staining with CD14 and CD68 was used for a more detailed analysis of the CD11c expressing cells. We observed that all forms of CD11c positive cells are CD68 positive however, only two forms of CD11c expressing cells are positive for CD14. Providing cellular diversity of CD11c expression in periprosthetic tissue, our results provide a contribution toward the further understanding of different cellular mechanisms to foreign body material. PMID:26255872

  14. Resurfacing is Comparable to Total Hip Arthroplasty at Short-term Followup

    PubMed Central

    Marker, David R.; Smith, Jonathan M.; Ulrich, Slif D.; McGrath, Mike S.

    2008-01-01

    Metal-on-metal total hip resurfacing arthroplasty has had excellent reported results at early to midterm followup, and some studies suggest that outcomes are comparable to conventional THA. We compared the clinical and radiographic outcomes of two closely matched groups of 54 patients who underwent resurfacing and conventional THA, respectively. Each group consisted of 36 men and 18 women who had a mean age of 52 years and a mean body mass index of 29 kg/m2. At a minimum followup of 24 months (mean, 40 months; range, 24–60 months), the mean Harris hip scores increased similarly in both groups (from 52 to 90 points and from 50 to 91 points for the resurfacing and conventional groups, respectively). Radiographic outcomes, revision rates, complications, pain scores, and satisfaction ratings of the two groups were similar. The patients who underwent resurfacing had higher postoperative weighted activity scores than the patients who underwent conventional THA, although they had higher preoperative weighted activity scores as well. The early outcomes of resurfacing are comparable to those of conventional THA. Level of Evidence: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. PMID:18841436

  15. Total Artificial Heart

    MedlinePLUS

    ... the NHLBI on Twitter. What Is a Total Artificial Heart? A total artificial heart (TAH) is a ... outside power source. Normal Heart and CardioWest Total Artificial Heart Figure A shows the normal structure and ...

  16. Cost-effectiveness of total hip arthroplasty versus resurfacing arthroplasty: economic evaluation alongside a clinical trial

    PubMed Central

    Edlin, Richard; Tubeuf, Sandy; Achten, Juul; Parsons, Nicholas; Costa, Matthew

    2012-01-01

    Objective To report on the relative cost-effectiveness of total hip arthroplasty and resurfacing arthroplasty (replacement of articular surface of femoral head only) in patients with severe arthritis suitable for hip joint resurfacing arthroplasty. Design Cost-effectiveness analysis on an intention-to-treat basis of a single-centre, single-blind randomised controlled trial of 126 adult patients within 12 months of treatment. Missing data were imputed using multiple imputations with differences in baseline quality of life and gender adjusted using regression techniques. Setting A large teaching hospital trust in the UK. Participants A total of 126 adult patients with severe arthritis of the hip joint suitable for a resurfacing arthroplasty of the hip. Results Data were received for 126 patients, 4 of whom did not provide any resource use data. For the remainder, data were imputed for costs or quality of life in at least one time point (baseline, 3, 6 months and 1 year) for 18 patients. Patients in the resurfacing arm had higher quality of life at 12 months (0.795 vs 0.727) and received 0.032 more QALYs within the first 12 months postoperation. At an additional cost of £564, resurfacing arthroplasty offers benefits at £17 451 per QALY within the first 12 months of treatment. When covariates are considered, the health economic case is stronger in men than in women. Conclusions Resurfacing arthroplasty appears to offer very short-term efficiency benefits over total hip arthroplasty within a selected patient group. The short-term follow-up in this trial should be noted, particularly in light of the concerns raised regarding adverse reactions to metal debris from metal-on-metal bearing surfaces in the longer term. Longer-term follow-up of resurfacing arthroplasty patients and decision analytic modelling is also advised. Trial registration Current controlled Trials ISRCTN33354155. UKCRN 4093. PMID:23065450

  17. Squeaking in large diameter ceramic-on-ceramic bearings in total hip arthroplasty.

    PubMed

    Tai, Stephen M; Munir, Selin; Walter, William L; Pearce, Simon J; Walter, William K; Zicat, Bernard A

    2015-02-01

    We analyzed the results of 206 consecutive total hip arthroplasties performed using large diameter ceramic-on-ceramic bearings. At an average follow-up of 28months, the mean Harris Hip Score improved from 54 to 92. Fifteen (7.3%) hips were noted to squeak. There was no significant difference between silent and squeaking hips with regards to age, weight, height, BMI, range of movement, femoral head diameter, leg length, and offset or center of rotation. No correlation was present between incidence of squeaking and increasing cup inclination and anteversion. 5.2% of cups orientated within Lewinnek's safe zone squeaked. No hips required revision for squeaking. While large diameter ceramic bearings may produce squeaking, our early results of surgery using large head ceramic bearings are encouraging. However, long-term follow-up is required. PMID:25304938

  18. Metallosis: A diagnosis not only in patients with metal-on-metal prostheses

    PubMed Central

    Oliveira, Catarina A.; Candelria, Isabel S.; Oliveira, Pedro B.; Figueiredo, Antonio; Caseiro-Alves, Filipe

    2014-01-01

    Although the real actual incidence of metallosis is unknown, it is described as a rare diagnosis with a 5% estimated incidence in the hip prosthetic replacements. The adoption of non-metallic articular prosthetic devices, made of polyethylene and ceramic, is the main reason to the diminishing number of reported cases. We present a case of metallosis with a clinical systemic presentation in a patient with a non-metallic hip prosthesis, which occurred due to a fracture of the acetabular liner component, leading to abnormal metalmetal contact. The metallic debris leads to a massive local and systemic release of cytokines. Revision is necessary whenever osteolysis and loosening of the prosthesis occur. Imaging evaluation, especially CT, has a central role in diagnosis and planning the surgical treatment.

  19. Information for Patients Who Have Metal-on-Metal Hip Implants

    MedlinePLUS

    ... their implants. These problems included: General hypersensitivity reaction (skin rash) Cardiomyopathy Neurological changes including sensory changes (auditory, or visual impairments) Psychological status change ( ...

  20. Metal release and metal allergy after total hip replacement with resurfacing versus conventional hybrid prosthesis

    PubMed Central

    Gustafson, Klas; Jakobsen, Stig S; Lorenzen, Nina D; Thyssen, Jacob P; Johansen, Jeanne D; Bonefeld, Charlotte M; Stilling, Maiken; Baad-Hansen, Thomas; Søballe, Kjeld

    2014-01-01

    Background Metal-on-metal (MOM) total hip arthroplasties were reintroduced because of the problems with osteolysis and aseptic loosening related to polyethylene wear of early metal-on-polyethylene (MOP) arthroplasties. The volumetric wear rate has been greatly reduced with MOM arthroplasties; however, because of nano-size wear particles, the absolute number has been greatly increased. Thus, a source of metal ion exposure with the potential to sensitize patients is present. We hypothesized that higher amounts of wear particles result in increased release of metal ions and ultimately lead to an increased incidence of metal allergy. Methods 52 hips in 52 patients (median age 60 (51–64) years, 30 women) were randomized to either a MOM hip resurfacing system (ReCap) or a standard MOP total hip arthoplasty (Mallory Head/Exeter). Spot urine samples were collected preoperatively, postoperatively, after 3 months, and after 1, 2, and 5 years and tested with inductively coupled plasma-sector field mass spectrometry. After 5 years, hypersensitivity to metals was evaluated by patch testing and lymphocyte transformation assay. In addition, the patients answered a questionnaire about hypersensitivity. Results A statistically significant 10- to 20-fold increase in urinary levels of cobalt and chromium was observed throughout the entire follow-up in the MOM group. The prevalence of metal allergy was similar between groups. Interpretation While we observed significantly increased levels of metal ions in the urine during the entire follow-up period, no difference in prevalence of metal allergy was observed in the MOM group. However, the effect of long-term metal exposure remains uncertain. PMID:24930546

  1. The Epidemiology and National Trends of Bearing Surface Usage in Primary Total Hip Arthroplasty in Korea

    PubMed Central

    Yoon, Pil Whan; Kim, Yunjung; Yoo, Seungmi; Lee, Sahnghoon; Kim, Hee Joong

    2016-01-01

    Background We analyzed the data for primary total hip arthroplasty (THA) in the Korean nationwide database to assess (1) the epidemiology and national trends of bearing surface usage in THAs and (2) the prevalence of each type of bearing surface according to age, gender, hospital type, primary payer, and hospital procedure volume. Methods A total of 30,881 THAs were analyzed using the Korean Health Insurance Review and Assessment Service database for 2007 through 2011. Bearing surfaces were sub-grouped according to device code for national health insurance claims and consisted of ceramic-on-ceramic (CoC), metal-on-polyethylene (MoP), ceramic-on-polyethylene (CoP), and metal-on-metal (MoM). The prevalence of each type of bearing surface was calculated and stratified by age, gender, hospital type, primary payer, and procedure volume of each hospital. Results CoC was the most frequently used bearing surface (76.7%), followed by MoP (11.9%), CoP (7.3%), and MoM (4.1%). The proportion of THAs using a CoC bearing surface increased steadily from 71.6% in 2007 to 81.4% in 2011, whereas the proportions using CoP, MoP, and MoM bearing surfaces decreased. The order of prevalence was identical to that in the general population regardless of age, gender, hospital type, primary payer, and hospital procedure volume. Conclusions The trends and epidemiology of bearing surface usage in THAs in Korea are different from those in other countries, and the CoC bearing surface is the most prevalent articulation. In future, the results of a large-scale study using nationwide data of THAs involving a CoC bearing surface will be reported in Korea. PMID:26929796

  2. Total financial management.

    PubMed

    Katz, R W

    1991-01-01

    Total financial management is a program designed by author Robert Katz, M.S., C.P.A., which says that by managing from the top down, the physician/administrator team can regain control of the practice and its major financial centers. His article describes the two-phased approach to total financial management. PMID:10114600

  3. Parallel Total Energy

    Energy Science and Technology Software Center (ESTSC)

    2004-10-21

    This is a total energy electronic structure code using Local Density Approximation (LDA) of the density funtional theory. It uses the plane wave as the wave function basis set. It can sue both the norm conserving pseudopotentials and the ultra soft pseudopotentials. It can relax the atomic positions according to the total energy. It is a parallel code using MP1.

  4. Total Quality Leadership

    NASA Technical Reports Server (NTRS)

    1991-01-01

    More than 750 NASA, government, contractor, and academic representatives attended the Seventh Annual NASA/Contractors Conference on Quality and Productivity. The panel presentations and Keynote speeches revolving around the theme of total quality leadership provided a solid base of understanding of the importance, benefits, and principles of total quality management (TQM). The presentations from the conference are summarized.

  5. Enhanced wear and corrosion in modular tapers in total hip replacement is associated with the contact area and surface topography.

    PubMed

    Panagiotidou, Anna; Meswania, Jay; Hua, Jia; Muirhead-Allwood, Sarah; Hart, Alister; Blunn, Gordon

    2013-12-01

    Widespread concern exists about adverse tissue reactions after metal-on-metal (MoM) total hip replacement (THR). Concerns have also been expressed with wear and corrosion of taper junctions in THR. We report the effect of surface finish and contact area associated with a single combination of materials of modular tapers. In an in vitro test, we investigated the head/neck (CoCrMo/Ti) interface of modular THRs using commercially available heads. Wear and corrosion of taper surfaces was compared following a 10 million loading cycle. Surface parameters and profiles were measured before and after testing. Electrochemical static and dynamic corrosion tests were performed under loaded and non-loaded conditions. After the load test, the surface roughness parameters on the head taper were significantly increased where the head/neck contact area was reduced. Similarly, the surface roughness parameters on the head taper were significantly increased where rough neck tapers were used. Corrosion testing showed breaching of the passive film on the rough but not the smooth neck tapers. Thus, surface area and surface finish are important factors in wear and corrosion at modular interfaces. PMID:23966288

  6. Total hip arthroplasty.

    PubMed Central

    Siopack, J S; Jergesen, H E

    1995-01-01

    Total hip arthroplasty, or surgical replacement of the hip joint with an artificial prosthesis, is a reconstructive procedure that has improved the management of those diseases of the hip joint that have responded poorly to conventional medical therapy. In this review we briefly summarize the evolution of total hip arthroplasty, the design and development of prosthetic hip components, and the current clinical indications for this procedure. The possible complications of total hip arthroplasty, its clinical performance over time, and future directions in hip replacement surgery are also discussed. Images PMID:7725707

  7. The Total Irradiance Monitors

    NASA Astrophysics Data System (ADS)

    Kopp, Greg

    2015-08-01

    The first Total Irradiance Monitor (TIM) launched on NASA’s Solar Radiation and Climate Experiment in 2003 and quickly proved to be the most accurate and stable instrument on orbit for measuring the total solar irradiance (TSI). The TIM’s design improvements over the older classical radiometers helped its selection on many subsequent missions, including NASA’s Glory, NOAA’s TSI Calibration Transfer Experiment, and the series of NASA’s Total and Spectral Solar Irradiance Sensor instruments currently underway. I will summarize the status of and differences between each of the TIMs currently on-orbit or in production.

  8. Total Water Management - slides

    EPA Science Inventory

    Total Water Management (TWM) examines urban water systems in an interconnected manner. It encompasses reducing water demands, increasing water recycling and reuse, creating water supply assets from stormwater management, matching water quality to end-use needs, and achieving envi...

  9. Tourniquetless Total Knee Arthroplasty

    MedlinePLUS Videos and Cool Tools

    Tourniquetless Total Knee Arthroplasty You must have Javascript enabled in your web browser. View Program Transcript Click Here to view the OR-Live, Inc. Privacy Policy and Legal Notice © 2010 OR- ...

  10. Total parenteral nutrition - infants

    MedlinePLUS

    Total parenteral nutrition (TPN) is a method of feeding that bypasses the gastrointestinal tract. Fluids are given into a vein to ... babies. It can provide a better level of nutrition than regular intravenous (IV) feedings, which provide only ...

  11. Total lymphoid irradiation

    SciTech Connect

    Sutherland, D.E.; Ferguson, R.M.; Simmons, R.L.; Kim, T.H.; Slavin, S.; Najarian, J.S.

    1983-05-01

    Total lymphoid irradiation by itself can produce sufficient immunosuppression to prolong the survival of a variety of organ allografts in experimental animals. The degree of prolongation is dose-dependent and is limited by the toxicity that occurs with higher doses. Total lymphoid irradiation is more effective before transplantation than after, but when used after transplantation can be combined with pharmacologic immunosuppression to achieve a positive effect. In some animal models, total lymphoid irradiation induces an environment in which fully allogeneic bone marrow will engraft and induce permanent chimerism in the recipients who are then tolerant to organ allografts from the donor strain. If total lymphoid irradiation is ever to have clinical applicability on a large scale, it would seem that it would have to be under circumstances in which tolerance can be induced. However, in some animal models graft-versus-host disease occurs following bone marrow transplantation, and methods to obviate its occurrence probably will be needed if this approach is to be applied clinically. In recent years, patient and graft survival rates in renal allograft recipients treated with conventional immunosuppression have improved considerably, and thus the impetus to utilize total lymphoid irradiation for its immunosuppressive effect alone is less compelling. The future of total lymphoid irradiation probably lies in devising protocols in which maintenance immunosuppression can be eliminated, or nearly eliminated, altogether. Such protocols are effective in rodents. Whether they can be applied to clinical transplantation remains to be seen.

  12. Totally unimodular nets.

    PubMed

    Eon, Jean-Guillaume; Proserpio, Davide M; Blatov, Vladislav A

    2012-03-01

    p-Periodic nets can be derived from a voltage graph G with voltages in Z(p), the free abelian group of rank p, if the cyclomatic number γ of G is larger than p. Equivalently, one may describe a net by providing a set of (γ - p) cycle vectors of G forming a basis of the subspace of the cycle space of G with zero net voltage. Let M be the matrix of this basis expressed in the edge basis of the 1-chain space of G. A net is called totally unimodular whenever every sub-determinant of M belongs to the set {-1, 0, 1}. Only a finite set of totally unimodular nets can be derived from some finite graph. It is shown that totally unimodular nets are stable under the operation of edge-lattice deletion in a sense that makes them comparable to minimal nets. An algorithm for the complete determination of totally unimodular nets derived from some finite graph is presented. As an application, the full list of totally unimodular nets derived from graphs of cyclomatic numbers 3 and 4, without bridges, is given. It is shown that many totally unimodular nets frequently occur in crystal structures. PMID:22338663

  13. Mixing of components from different manufacturers in total hip arthroplasty: prevalence and comparative outcomes

    PubMed Central

    Tucker, Keith; Pickford, Martin; Newell, Claire; Howard, Peter; Hunt, Linda P; Blom, Ashley W

    2015-01-01

    Background and purpose — There have recently been highly publicized examples of suboptimal outcomes with some newer implant designs used for total hip replacement. This has led to calls for tighter regulation. However, surgeons do not always adhere to the regulations already in place and often use implants from different manufacturers together to replace a hip, which is against the recommendations of the Medicines and Healthcare Products Regulatory Agency (MHRA) and the directions of the manufacturers. Patients and methods — We used data from the National Joint Registry of England and Wales (NJR) to investigate this practice. Results — Mixing of components was common, and we identified over 90,000 cases recorded between 2003 and 2013. In the majority of these cases (48,156), stems and heads from one manufacturer were mixed with polyethylene cemented cups from another manufacturer. When using a cemented stem and a polyethylene cup, mixing of stems from one manufacturer with cups from another was associated with a lower revision rate. At 8 years, the cumulative percentage of revisions was 1.9% (95% CI: 1.7–2.1) in the mixed group as compared to 2.4% (2.3–2.5) in the matched group (p = 0.001). Mixing of heads from one manufacturer with stems from another was associated with a higher revision rate (p < 0.001). In hip replacements with ceramic-on-ceramic or metal-on-metal bearings, mixing of stems, heads, and cups from different manufacturers was associated with similar revision rates (p > 0.05). Interpretation — Mixing of components from different manufacturers is a common practice, despite the fact that it goes against regulatory guidance. However, it is not associated with increased revision rates unless heads and stems from different manufacturers are used together. PMID:26201845

  14. Total Health Organization.

    PubMed

    1993-01-01

    Total Health Organization is a holistic care an humanitarian relief agency with special emphasis on Africa and Third World countries. It was founded in 1987 with a focus on hunger relief, health assistance, handicap, habitat and human rights of destitutes, socially disadvantaged persons and communities which it has adopted as the socially forgotten people (SFP). Total Health Organization is a non-political, non-profit, and international non-governmental organization, having official relations with several national, regional and world bodies. Some of the project activities include: free mobile clinics to rural destitutes, AIDS and related health education, an information and research library, and an NGO Development Center. For more information, please contact: Dr. Obi Osisiogu, Founder and President, Total Health International Center, 147 Ikot-Ekpene Road, P.O. Box 1726, Aba, Abia State Nigeria, Tel: 082-222279, Telex: 63311 ANYA NG, Fax: 234-82-227512. PMID:12159248

  15. Total Energy Monitor

    SciTech Connect

    Friedrich, S

    2008-08-11

    The total energy monitor (TE) is a thermal sensor that determines the total energy of each FEL pulse based on the temperature rise induced in a silicon wafer upon absorption of the FEL. The TE provides a destructive measurement of the FEL pulse energy in real-time on a pulse-by-pulse basis. As a thermal detector, the TE is expected to suffer least from ultra-fast non-linear effects and to be easy to calibrate. It will therefore primarily be used to cross-calibrate other detectors such as the Gas Detector or the Direct Imager during LCLS commissioning. This document describes the design of the TE and summarizes the considerations and calculations that have led to it. This document summarizes the physics behind the operation of the Total Energy Monitor at LCLS and derives associated engineering specifications.

  16. [Total joint arthroplasty].

    PubMed

    Mibe, Junya; Yamamoto, Kengo

    2013-07-01

    Control of the disease activity is enabled due to the progress of drug therapy for rheumatoid arthritis. However, surgical treatments are necessary for unresponsive cases to the drug or for achieving higher QOL, and we can attain more tight control or cure by combination of drug therapy and surgical treatments. Total joint arthroplasty provides indolence, mobility, stability and is an useful joint reconstruction method. Shoulder and elbow joint work as a reach function together, and total joint arthroplasty become adaptation when extensive joint destruction or severe pain occurrs. With the usage of biologic agents joint repair is possible in small joints, but if the joint destruction progress in weight-bearing joints, repair is impossible and total joint arthroplasty can be required. PMID:23961679

  17. Total synthesis of (-)-goniomitine.

    PubMed

    Zhou, Shiqiang; Jia, Yanxing

    2014-06-20

    The total synthesis of (-)-goniomitine has been accomplished in 11 steps starting from commercially available diethyl l-malate. The synthesis features a chiral pool approach to prepare the chiral C-9 unit containing a quaternary carbon center, an Ir-catalyzed C-H borylation to synthesize the 2-indoleboronic acid pinacol ester, and a Suzuki reaction to couple together the two key intermediates. Notably, the high degree of convergence of this strategy makes it particularly amenable to the total synthesis of other aspidosperma family natural products. PMID:24885528

  18. TOTAL DIET STUDY

    EPA Science Inventory

    The Total Diet Study (TDS), sometimes called the Market Basket Study, is an ongoing FDA program that determines levels of various pesticide residues, contaminants, and nutrients in foods, for the purpose of estimating intakes of these substances in representative diets of specifi...

  19. Total Quality Management Simplified.

    ERIC Educational Resources Information Center

    Arias, Pam

    1995-01-01

    Maintains that Total Quality Management (TQM) is one method that helps to monitor and improve the quality of child care. Lists four steps for a child-care center to design and implement its own TQM program. Suggests that quality assurance in child-care settings is an ongoing process, and that TQM programs help in providing consistent, high-quality…

  20. Total Quality Management Seminar.

    ERIC Educational Resources Information Center

    Massachusetts Career Development Inst., Springfield.

    This booklet is one of six texts from a workplace literacy curriculum designed to assist learners in facing the increased demands of the workplace. The booklet contains seven sections that cover the following topics: (1) meaning of total quality management (TQM); (2) the customer; (3) the organization's culture; (4) comparison of management…

  1. Estuarine Total Ecosystem Metabolism

    EPA Science Inventory

    Total ecosystem metabolism (TEM), both as discrete measurements and as a theoretical concept, has an important history in ecosystem ecology, particularly in estuaries. Some of the earliest ecological studies were developed to determine how energy flowed through an ecosystem and w...

  2. Total Water Management - Report

    EPA Science Inventory

    There is a growing need for urban water managers to take a more holistic view of their water resource systems as population growth, urbanization, and current operations put different stresses on the environment and urban infrastructure. Total Water Management (TWM) is an approac...

  3. "Total Deposition (TDEP) Maps"

    EPA Science Inventory

    The presentation provides an update on the use of a hybrid methodology that relies on measured values from national monitoring networks and modeled values from CMAQ to produce of maps of total deposition for use in critical loads and other ecological assessments. Additionally, c...

  4. Total Synthesis of Kopsinine

    PubMed Central

    Xie, Jian; Wolfe, Amanda L.; Boger, Dale L.

    2013-01-01

    The use of a powerful intramolecular [4 + 2]/[3 + 2] cycloaddition cascade of an 1,3,4-oxadiazole in the divergent total synthesis of kopsinine (1), featuring an additional unique SmI2-promoted transannular cyclization reaction for formation of the bicyclo[2.2.2]octane central to its hexacyclic ring system, is detailed. PMID:23391149

  5. Total Precipitable Water

    SciTech Connect

    2012-01-01

    The simulation was performed on 64K cores of Intrepid, running at 0.25 simulated-years-per-day and taking 25 million core-hours. This is the first simulation using both the CAM5 physics and the highly scalable spectral element dynamical core. The animation of Total Precipitable Water clearly shows hurricanes developing in the Atlantic and Pacific.

  6. Total Synthesis of Jiadifenolide**

    PubMed Central

    Paterson, Ian; Xuan, Mengyang; Dalby, Stephen M

    2014-01-01

    As a potent neurotrophic agent, the sesquiterpenoid jiadifenolide represents a valuable small-molecule lead for the potential therapeutic treatment of neurodegenerative diseases. A stereocontrolled total synthesis of this densely functionalized natural product is reported, central to which is an adventurous samarium-mediated cyclization reaction to establish the tricyclic core and the adjacent C5 and C6 quaternary stereocenters. PMID:24861364

  7. Total synthesis of jiadifenolide.

    PubMed

    Paterson, Ian; Xuan, Mengyang; Dalby, Stephen M

    2014-07-01

    As a potent neurotrophic agent, the sesquiterpenoid jiadifenolide represents a valuable small-molecule lead for the potential therapeutic treatment of neurodegenerative diseases. A stereocontrolled total synthesis of this densely functionalized natural product is reported, central to which is an adventurous samarium-mediated cyclization reaction to establish the tricyclic core and the adjacent C5 and C6 quaternary stereocenters. PMID:24861364

  8. Total Quality Management.

    ERIC Educational Resources Information Center

    Focus in Change, 1992

    1992-01-01

    The philosophy known as Total Quality Management (TQM) is frequently presented as a way to change and improve public education. This issue of "Focus in Change" examines Deming's original 14 TQM points and their application to education. Myron Tribus lays out the core philosophy of the movement and discusses its possible application to schools,…

  9. CSF total protein

    MedlinePLUS

    CSF total protein is a test to determine the amount of protein in your spinal fluid, also called cerebrospinal fluid (CSF). ... The normal protein range varies from lab to lab, but is typically about 15 to 60 mg/dL. Note: mg/dL = ...

  10. Totally parallel multilevel algorithms

    NASA Technical Reports Server (NTRS)

    Frederickson, Paul O.

    1988-01-01

    Four totally parallel algorithms for the solution of a sparse linear system have common characteristics which become quite apparent when they are implemented on a highly parallel hypercube such as the CM2. These four algorithms are Parallel Superconvergent Multigrid (PSMG) of Frederickson and McBryan, Robust Multigrid (RMG) of Hackbusch, the FFT based Spectral Algorithm, and Parallel Cyclic Reduction. In fact, all four can be formulated as particular cases of the same totally parallel multilevel algorithm, which are referred to as TPMA. In certain cases the spectral radius of TPMA is zero, and it is recognized to be a direct algorithm. In many other cases the spectral radius, although not zero, is small enough that a single iteration per timestep keeps the local error within the required tolerance.

  11. Total synthesis of clostrubin

    PubMed Central

    Yang, Ming; Li, Jian; Li, Ang

    2015-01-01

    Clostrubin is a potent antibiotic against methicillin- and vancomycin-resistant bacteria that was isolated from a strictly anaerobic bacterium Clostridium beijerinckii in 2014. This polyphenol possesses a fully substituted arene moiety on its pentacyclic scaffold, which poses a considerable challenge for chemical synthesis. Here we report the first total synthesis of clostrubin in nine steps (the longest linear sequence). A desymmetrization strategy is exploited based on the inherent structural feature of the natural product. Barton–Kellogg olefination forges the two segments together to form a tetrasubstituted alkene. A photo-induced 6π electrocyclization followed by spontaneous aromatization constructs the hexasubstituted B ring at a late stage. In total, 200 mg of clostrubin are delivered through this approach. PMID:25759087

  12. Total synthesis of brazilin.

    PubMed

    Jung, Youngeun; Kim, Ikyon

    2015-02-01

    Described herein is a highly efficient total synthesis of brazilin from commercially available starting materials in 9 steps with 70% overall yield. Mitsunobu coupling followed by In(III)-catalyzed alkyne-aldehyde metathesis allowed for rapid construction of brazilin core skeleton in quantitative yield. Subsequent modulation of oxidation levels and acid-catalyzed cyclization led to the trimethyl ether of brazilin. Asymmetric dihydroxylation of the key intermediate was also demonstrated, which would permit asymmetric access to (+)-brazilin. PMID:25562504

  13. Total synthesis of xanthohumol.

    PubMed

    Khupse, Rahul S; Erhardt, Paul W

    2007-09-01

    The total synthesis of xanthohumol (1) was accomplished in 10% overall yield from phloracetophenone after six steps. Insertion of a prenyl group onto the aryl ring was achieved by a para-Claisen rearrangement after using a Mitsunobu reaction to establish the key prenyl ether precursor. A Claisen-Schmidt condensation was deployed to construct the chalcone scaffold followed by removal of MOM protecting groups under acidic conditions that were optimized to prevent concomitant cyclization to the flavone. PMID:17844997

  14. Total synthesis of ochnaflavone

    PubMed Central

    Ndoile, Monica M

    2013-01-01

    Summary The first total syntheses of ochnaflavone, an asymmetric biflavone consisting of apigenin and luteolin moieties, and the permethyl ether of 2,3,2'',3''-tetrahydroochnaflavone have been achieved. The key steps in the synthesis of ochnaflavone were the formation of a diaryl ether and ring cyclization of an ether-linked dimeric chalcone to assemble the two flavone nuclei. Optimal experimental conditions for the oxidative cyclization to form ochnaflavone were established. PMID:23946830

  15. Physician Update: Total Health

    PubMed Central

    Tuso, Phillip

    2014-01-01

    As an integrated prepaid health care system, Kaiser Permanente (KP) is in a unique position to demonstrate that affordability in health care can be achieved by disease prevention. During the past decade, KP has significantly improved the quality care outcomes of its members with preventable diseases. However, because of an increase in the incidence of preventable disease, and the potential long-term and short-term costs associated with the treatment of preventable disease, KP has developed a new strategy called Total Health to meet the current and future needs of its patients. Total Health means healthy people in healthy communities. KP’s strategic vision is to be a leader in Total Health by making lives better. KP hopes to make lives better by 1) measuring vital signs of health, 2) promoting healthy behaviors, 3) monitoring disease incidence, 4) spreading leading practices, and 5) creating healthy environments with our community partners. Best practices, spread to the communities we serve, will make health care more affordable, prevent preventable diseases, and save lives. PMID:24694316

  16. Head size and dislocation rate in primary total hip arthroplasty

    PubMed Central

    Singh, Somesh P; Bhalodiya, Haresh P

    2013-01-01

    Background: Dislocation after total hip arthroplasty (THA) has a multifactorial etiology with variables such as surgical approach, component orientation and position, type of cup, stem and head size. Review of the literature regarding the relationship of head size and dislocation rate in THA is suggestive that large femoral head size is associated with lower dislocation rate after THA. However, limited data is available as a proof of this hypothesis. The purpose of this study was to determine that the use of large head size would lead to a decreased incidence of dislocations following THA. Materials and Methods: 317 primary THAs were performed using the posterolateral approach with posterior soft-tissue repair between January 2006 and December 2009. Cases were divided into two groups (A and B). Femoral head diameter size 36 mm was used in 163 THA in group A and 28 mm in 154 THA in group B. Average period of followup being 2 years (6 month to 4 years). Patients were routinely followed at definite intervals and were specifically assessed for dislocation. Results: One or more dislocations occurred in 11 out of 317 hips with the overall rate of dislocation being 3.47%. Dislocation rate was 0.6% in 36 mm head size and 6.49% with 28 mm head size (P value is 0.0107). Keeping the stem design variable as a constant, the difference in the rate of dislocation between the two groups was again found to be statistically significant for both un-cemented and cemented stem. Conclusion: Dislocation rate decreased significantly as the size of the head increased in primary THA. However, longer followup is necessary as rate of dislocation or in vivo highly cross linked poly failure or fracture may increase in future affecting the rate of dislocations in primary THA. PMID:24133302

  17. Total Synthesis of (-)-Exiguolide.

    PubMed

    Zhang, Zhigao; Xie, Hengmu; Li, Hongze; Gao, Lu; Song, Zhenlei

    2015-10-01

    A concise total synthesis of (-)-exiguolide has been completed in an overall 2.8% yield over 20 steps in the longest linear path. The key strategies involve (1) Prins cyclization/homobromination of dienyl alcohol with the B ring-substituted aldehyde, prepared by Prins cyclization/bromination, to construct the A ring with excellent cis-Z stereochemical control and (2) an unusual side chain installation/macrocyclization strategy featuring Sonogashira cross-coupling followed by a ring-closing metathesis reaction to deliver the target. PMID:26371396

  18. Total Synthesis of ()-Strictamine.

    PubMed

    Ren, Weiwu; Wang, Qian; Zhu, Jieping

    2016-03-01

    The total synthesis of strictamine has been achieved in nine steps from a known enol triflate. Characteristic features of our approach included: a)?creation of a C7 all-carbon quaternary stereocenter at an early synthetic stage; b)?use of an N,N-dimethyl tertiary amine as a surrogate of the primary amine for the rapid build-up of a functionalized 2-azabicyclo[3,3,1]nonan-9-one skeleton (achieved by using a reaction sequence of ?-bromination of the ketone, followed by a stereoconvergent intramolecular nucleophilic substitution reaction); and c)?a late-stage construction of the indolenine unit. PMID:26845231

  19. Immediate total tooth replacement.

    PubMed

    Garber, D A; Salama, M A; Salama, H

    2001-03-01

    Successful implant placement at the time of extraction has been documented. Implant placement at the time of extraction was initially performed as a two-stage procedure often with barrier membranes and sophisticated second-stage surgical uncoverings. The authors describe the next generation of this technique, including atraumatic tooth removal with simultaneous root form, implant placement, and temporization at one appointment. This technique of "Immediate Total Tooth Replacement" allows for the maintenance of the bony housing and soft-tissue form that existed before extraction, while at the same time establishing a root form anchor in the bone for an esthetic restoration. PMID:11913258

  20. Total photoabsorption in nuclei

    SciTech Connect

    Bianchi, N.

    1992-06-01

    The Frascati-Genova collaboration proposes to measure the total photonuclear cross section on a wide range of nuclei between 500 MeV and 2 GeV, to obtain informations on the interaction of baryon resonances with nucleons and on the onset of the shadowing effect. The experiment could be performed in the Hall B as soon as the tagging facility will be ready and before the end of the installation of the CLAS spectrometer. The requirements for the photon beam, like maximum energy, intensity and beam definition, are not so strong so that the experiment would also be a good first test of the tagged photon facility.

  1. Cementless total knee arthroplasty

    PubMed Central

    Risitano, Salvatore; Sabatini, Luigi; Giachino, Matteo; Agati, Gabriele; Massè, Alessandro

    2016-01-01

    Interest for uncemented total knee arthroplasty (TKA) has greatly increased in recent years. This technique, less used than cemented knee replacement in the last decades, sees a revival thanks an advance in prosthetic design, instrumentation and operative technique. The related literature in some cases shows conflicting data on survival and on the revision’s rate, but in most cases a success rate comparable to cemented TKA is reported. The optimal fixation in TKA is a subject of debate with the majority of surgeons favouring cemented fixation. PMID:27162779

  2. Total Synthesis of (-)-Daphenylline.

    PubMed

    Yamada, Ryosuke; Adachi, Yohei; Yokoshima, Satoshi; Fukuyama, Tohru

    2016-05-10

    Total synthesis of (-)-daphenylline, a hexacyclic Daphniphyllum alkaloid, was achieved. Construction of the tricyclic DEF ring system was initiated by asymmetric Negishi coupling followed by an intramolecular Friedel-Crafts reaction. Installation of a side chain onto the tricyclic core was carried out through Sonogashira coupling, stereocontrolled Claisen rearrangement by taking advantage of the characteristic conformation of the tricyclic DEF core, and the stereoselective alkylation of a lactone. After the introduction of a glycine unit, the ABC ring system was stereoselectively constructed through intramolecular cycloaddition of the cyclic azomethine ylide. PMID:27062676

  3. The Total Eclipse 1999

    NASA Astrophysics Data System (ADS)

    Gaina, Alexei B.

    1999-01-01

    The article represents an interview to the journalist Irina A. Anatol'eva (Subbotovich) from the "Nezavisimaya Moldova" Newspaper, concerning the Total Eclipse of the Sun from August 11, 1999. One discusses also about History of Astronomy, particularly about the Astronomer Alexander Nikolaevich Deutsch (31.12.1900/1.01.1901-1986), astrometrist, professor and director of the Observatory in Pulkovo, born in the town of Reni (South Bessarabia). Another subjects were concerned to manifestations of gravity at cosmic scales (Time-mashine) and astrology.

  4. Anisotropic Total Variation Filtering

    SciTech Connect

    Grasmair, Markus; Lenzen, Frank

    2010-12-15

    Total variation regularization and anisotropic filtering have been established as standard methods for image denoising because of their ability to detect and keep prominent edges in the data. Both methods, however, introduce artifacts: In the case of anisotropic filtering, the preservation of edges comes at the cost of the creation of additional structures out of noise; total variation regularization, on the other hand, suffers from the stair-casing effect, which leads to gradual contrast changes in homogeneous objects, especially near curved edges and corners. In order to circumvent these drawbacks, we propose to combine the two regularization techniques. To that end we replace the isotropic TV semi-norm by an anisotropic term that mirrors the directional structure of either the noisy original data or the smoothed image. We provide a detailed existence theory for our regularization method by using the concept of relaxation. The numerical examples concluding the paper show that the proposed introduction of an anisotropy to TV regularization indeed leads to improved denoising: the stair-casing effect is reduced while at the same time the creation of artifacts is suppressed.

  5. TOTAL user manual

    NASA Technical Reports Server (NTRS)

    Johnson, Sally C.; Boerschlein, David P.

    1994-01-01

    Semi-Markov models can be used to analyze the reliability of virtually any fault-tolerant system. However, the process of delineating all of the states and transitions in the model of a complex system can be devastatingly tedious and error-prone. Even with tools such as the Abstract Semi-Markov Specification Interface to the SURE Tool (ASSIST), the user must describe a system by specifying the rules governing the behavior of the system in order to generate the model. With the Table Oriented Translator to the ASSIST Language (TOTAL), the user can specify the components of a typical system and their attributes in the form of a table. The conditions that lead to system failure are also listed in a tabular form. The user can also abstractly specify dependencies with causes and effects. The level of information required is appropriate for system designers with little or no background in the details of reliability calculations. A menu-driven interface guides the user through the system description process, and the program updates the tables as new information is entered. The TOTAL program automatically generates an ASSIST input description to match the system description.

  6. Total organic carbon analyzer

    NASA Technical Reports Server (NTRS)

    Godec, Richard G.; Kosenka, Paul P.; Smith, Brian D.; Hutte, Richard S.; Webb, Johanna V.; Sauer, Richard L.

    1991-01-01

    The development and testing of a breadboard version of a highly sensitive total-organic-carbon (TOC) analyzer are reported. Attention is given to the system components including the CO2 sensor, oxidation reactor, acidification module, and the sample-inlet system. Research is reported for an experimental reagentless oxidation reactor, and good results are reported for linearity, sensitivity, and selectivity in the CO2 sensor. The TOC analyzer is developed with gravity-independent components and is designed for minimal additions of chemical reagents. The reagentless oxidation reactor is based on electrolysis and UV photolysis and is shown to be potentially useful. The stability of the breadboard instrument is shown to be good on a day-to-day basis, and the analyzer is capable of 5 sample analyses per day for a period of about 80 days. The instrument can provide accurate TOC and TIC measurements over a concentration range of 20 ppb to 50 ppm C.

  7. Cervical Total Disc Arthroplasty

    PubMed Central

    Basho, Rahul; Hood, Kenneth A.

    2012-01-01

    Symptomatic adjacent segment degeneration of the cervical spine remains problematic for patients and surgeons alike. Despite advances in surgical techniques and instrumentation, the solution remains elusive. Spurred by the success of total joint arthroplasty in hips and knees, surgeons and industry have turned to motion preservation devices in the cervical spine. By preserving motion at the diseased level, the hope is that adjacent segment degeneration can be prevented. Multiple cervical disc arthroplasty devices have come onto the market and completed Food and Drug Administration Investigational Device Exemption trials. Though some of the early results demonstrate equivalency of arthroplasty to fusion, compelling evidence of benefits in terms of symptomatic adjacent segment degeneration are lacking. In addition, non-industry-sponsored studies indicate that these devices are equivalent to fusion in terms of adjacent segment degeneration. Longer-term studies will eventually provide the definitive answer. PMID:24353955

  8. Total ankle joint replacement.

    PubMed

    2016-02-01

    Ankle arthritis results in a stiff and painful ankle and can be a major cause of disability.(1) For people with end-stage ankle arthritis, arthrodesis (ankle fusion) is effective at reducing pain in the shorter term, but results in a fixed joint, and over time the loss of mobility places stress on other joints in the foot that may lead to arthritis, pain and dysfunction.(2) Another option is to perform a total ankle joint replacement, with the aim of giving the patient a mobile and pain-free ankle. In this article we review the efficacy of this procedure, including how it compares to ankle arthrodesis, and consider the indications and complications. PMID:26868932

  9. On total disc replacement.

    PubMed

    Berg, Svante

    2011-02-01

    Low back pain consumes a large part of the community's resources dedicated to health care and sick leave. Back disorders also negatively affect the individual leading to pain suffering, decreased quality-of-life and disability. Chronic low back pain (CLBP) due to degenerative disc disease (DDD) is today often treated with fusion when conservative treatment has failed and symptoms are severe. This treatment is as successful as arthroplasty is for hip arthritis in restoring the patient's quality of life and reducing disability. Even so, there are some problems with this treatment, one of these being recurrent CLBP from an adjacent segment (ASD) after primarily successful surgery. This has led to the development of alternative surgical treatments and devices that maintain or restore mobility, in order to reduce the risk for ASD. Of these new devices, the most frequently used are the disc prostheses used in Total Disc Replacement (TDR). This thesis is based on four studies comparing total disc replacement with posterior fusion. The studies are all based on a material of 152 patients with DDD in one or two segments, aged 20-55 years that were randomly treated with either posterior fusion or TDR. The first study concerned clinical outcome and complications. Follow-up was 100% at both one and two years. It revealed that both treatment groups had a clear benefit from treatment and that patients with TDR were better in almost all outcome scores at one-year follow-up. Fusion patients continued to improve during the second year. At two-year follow-up there was a remaining difference in favour of TDR for back pain. 73% in the TDR group and 63% in the fusion group were much better or totally pain-free (n.s.), while twice as many patients in the TDR group were totally pain free (30%) compared to the fusion group (15%). Time of surgery and total time in hospital were shorter in the TDR group. There was no difference in complications and reoperations, except that seventeen of the patients in the fusion group were re-operated for removal of their implants. The second study concerned sex life and sexual function. TDR is performed via an anterior approach, an approach that has been used for a long time for various procedures on the lumbar spine. A frequent complication reported in males when this approach is used is persistent retrograde ejaculation. The TDR group in this material was operated via an extra-peritoneal approach to the retroperitoneal space, and there were no cases of persistent retrograde ejaculation. There was a surprisingly high frequency of men in the fusion group reporting deterioration in ability to have an orgasm postoperatively. Preoperative sex life was severely hampered in the majority of patients in the entire material, but sex life underwent a marked improvement in both treatment groups by the two-year follow-up that correlated with reduction in back pain. The third study was on mobility in the lumbar spinal segments, where X-rays were taken in full extension and flexion prior to surgery and at two-year follow-up. Analysis of the films showed that 78% of the patients in the fusion group reached the surgical goal (non-mobility) and that 89% of the TDR patients maintained mobility. Preoperative disc height was lower than in a normative database in both groups, and remained lower in the fusion group, while it became higher in the TDR group. Mobility in the operated segment increased in the TDR group postoperatively. Mobility at the rest of the lumbar spine increased in both treatment groups. Mobility in adjacent segments was within the norm postoperatively, but slightly larger in the fusion group. In the fourth study the health economics of TDR vs Fusion was analysed. The hospital costs for the procedure were higher for patients in the fusion group compared to the TDR group, and the TDR patients were on sick-leave two months less. In all, these studies showed that the results in the TDR group were as good as in the fusion group. Patients are more likely to be totally pain-free when treated with TDR compared to fusion. Treatment with this new procedure seems justified in selected patients at least in the short-term perspective. Long-term follow-up is underway and results will be published in due course. PMID:21542779

  10. Primary total elbow arthroplasty

    PubMed Central

    Kumar, Suresh; Mahanta, Sunayan

    2013-01-01

    Background: Primary total elbow arthroplasty (TEA) is a challenging procedure for orthopedic surgeons. It is not performed as frequently as compared to hip or knee arthroplasty. The elbow is a nonweight-bearing joint; however, static loading can create forces up to three times the body weight and dynamic loading up to six times. For elderly patients with deformity and ankylosis of the elbow due to posttraumatic arthritis or rheumatoid arthritis or comminuted fracture distal humerus, arthroplasty is one of the option. The aim of this study is to analyze the role of primary total elbow arthroplasty in cases of crippling deformity of elbow. Materials and Methods: We analyzed 11 cases of TEA, between December 2002 and September 2012. There were 8 females and 3 males. The average age was 40 years (range 30-69 years). The indications for TEA were rheumatoid arthritis, comminuted fracture distal humerus with intraarticular extension, and posttraumatic bony ankylosis of elbow joint. The Baksi sloppy (semi constrained) hinge elbow prosthesis was used. Clinico-radiological followup was done at 1 month, 3 months, 6 months, 1 year, and then yearly basis. Results: In the present study, average supination was 70° (range 60-80°) and average pronation was 70° (range 60-80°). Average flexion was 135° (range 130-135°). However, in 5 cases, there was loss of 15 to 35° (average 25°) of extension (45°) out of 11 cases. The mean Mayo elbow performance score was 95.4 points (range 70-100). Arm length discrepancy was only in four patients which was 36% out of 11 cases. Clinico-radiologically all the elbows were stable except in one case and no immediate postoperative complication was noted. Radiolucency or loosening of ulnar stem was seen in 2 cases (18%) out of 11 cases, in 1 case it was noted after 5 years and in another after 10 years. In second case, revision arthroplasty was done, in which only ulnar hinge section, hinge screw and lock screw with hexagonal head were replaced. Conclusion: Elbow arthroplasty remains a valuable option for deformed and ankylosed elbows especially in the demanding patients with crippling deformity of the elbow. PMID:24379468

  11. Total synthesis of depsilairdin.

    PubMed

    Ward, Dale E; Pardeshi, Sandip G

    2010-08-01

    The total synthesis of depsilairdin, a host-selective phytotoxin isolated from Leptosphaeria maculans (the causal agent of blackleg disease of oilseed Brassicas), has been achieved by N-terminal extension of a suitably protected derivative of the hitherto unknown amino acid (2S,3S,4R)-3,4-dihydroxy-3-methyl-proline (Dhmp) followed by esterification with lairdinol A. The latter esterification, complicated by the sterically hindered nature of the carboxyl group, was accomplished by a novel method involving reaction of the 1-hydroxybenzotriazole (HOBt) derived active ester with the bromomagnesium alkoxide of lairdinol A. Three depsilairdin analogues were also prepared by replacing the Dhmp residue with L-proline and cis- and trans-4-hydroxy-L-proline. Phytotoxicity assays showed that the analogues were nontoxic to both blackleg-susceptible (brown mustard) and -resistant (canola) plants, suggesting that the presence of the Dhmp residue in depsilairdin is important for its host-selective toxicity toward brown mustard. PMID:20670027

  12. The total artificial heart

    PubMed Central

    Cook, Jason A.; Shah, Keyur B.; Quader, Mohammed A.; Cooke, Richard H.; Kasirajan, Vigneshwar; Rao, Kris K.; Smallfield, Melissa C.; Tchoukina, Inna

    2015-01-01

    The total artificial heart (TAH) is a form of mechanical circulatory support in which the patient’s native ventricles and valves are explanted and replaced by a pneumatically powered artificial heart. Currently, the TAH is approved for use in end-stage biventricular heart failure as a bridge to heart transplantation. However, with an increasing global burden of cardiovascular disease and congestive heart failure, the number of patients with end-stage heart failure awaiting heart transplantation now far exceeds the number of available hearts. As a result, the use of mechanical circulatory support, including the TAH and left ventricular assist device (LVAD), is growing exponentially. The LVAD is already widely used as destination therapy, and destination therapy for the TAH is under investigation. While most patients requiring mechanical circulatory support are effectively treated with LVADs, there is a subset of patients with concurrent right ventricular failure or major structural barriers to LVAD placement in whom TAH may be more appropriate. The history, indications, surgical implantation, post device management, outcomes, complications, and future direction of the TAH are discussed in this review. PMID:26793338

  13. Total Energy CMR Production

    SciTech Connect

    Friedrich, S; Kolagani, R M

    2008-08-11

    The following outlines the optimized pulsed laser deposition (PLD) procedure used to prepare Nd{sub 0.67}Sr{sub 0.33}MnO{sub 3} (NSMO) temperature sensors at Towson University (Prof. Rajeswari Kolagani) for the LCLS XTOD Total Energy Monitor. The samples have a sharp metal/insulator transition at T {approx} 200 K and are optimized for operation at T {approx} 180 K, where their sensitivity is the highest. These samples are epitaxial multilayer structures of Si/YSZ/CeO/NSMO, where these abbreviations are defined in table 1. In this heterostructure, YSZ serves as a buffer layer to prevent deleterious chemical reactions, and also serves to de-oxygenate the amorphous SiO{sub 2} surface layer to generate a crystalline template for epitaxy. CeO and BTO serve as template layers to minimize the effects of thermal and lattice mismatch strains, respectively. More details on the buffer and template layer scheme are included in the attached manuscript accepted for publication in Sensor Letters (G. Yong et al., 2008).

  14. Comparison between 28 mm and 32 mm ceramic-on-ceramic bearings in total hip replacement.

    PubMed

    Lee, Y K; Ha, Y C; Koo, K H

    2014-11-01

    Large femoral heads have become popular in total hip replacement (THR) as a method of reducing the risk of dislocation. However, if large heads are used in ceramic-on-ceramic THR, the liner must be thinner, which may increase the risk of fracture. To compare the rates of ceramic fracture and dislocation between 28 mm and 32 mm ceramic heads, 120 hips in 109 patients (51 men and 58 women, mean age 49.2 years) were randomised to THR with either a 28 mm or a 32 mm ceramic articulation. A total of 57/60 hips assigned to the 28 mm group and 55/60 hips assigned to the 32 mm group were followed for at least five years. No ceramic component fractures occured in any patient in either group. There was one dislocation in the 32 mm group and none in the 28 mm group (p = 0.464). No hip had detectable wear, focal osteolysis or prosthetic loosening. In our small study the 32 mm ceramic articulation appeared to be safe in terms of ceramic liner fracture. PMID:25371457

  15. Determination of Total Petroleum Hydrocarbons (TPH) Using Total Carbon Analysis

    SciTech Connect

    Ekechukwu, A.A.

    2002-05-10

    Several methods have been proposed to replace the Freon(TM)-extraction method to determine total petroleum hydrocarbon (TPH) content. For reasons of cost, sensitivity, precision, or simplicity, none of the replacement methods are feasible for analysis of radioactive samples at our facility. We have developed a method to measure total petroleum hydrocarbon content in aqueous sample matrixes using total organic carbon (total carbon) determination. The total carbon content (TC1) of the sample is measured using a total organic carbon analyzer. The sample is then contacted with a small volume of non-pokar solvent to extract the total petroleum hydrocarbons. The total carbon content of the resultant aqueous phase of the extracted sample (TC2) is measured. Total petroleum hydrocarbon content is calculated (TPH = TC1-TC2). The resultant data are consistent with results obtained using Freon(TM) extraction followed by infrared absorbance.

  16. The clinical and radiological outcomes of hip resurfacing versus total hip arthroplasty: a meta-analysis and systematic review

    PubMed Central

    2010-01-01

    Background and purpose Hip resurfacing (HRS) procedures have gained increasing popularity for younger, higher-demand patients with degenerative hip pathologies. However, with concerns regarding revision rates and possible adverse metal hypersensitivity reactions with metal-on-metal articulations, some authors have questioned the hypothesized superiority of hip resurfacing over total hip arthroplasty (THA). In this meta-analysis, we compared the clinical and radiological outcomes and complication rates of these 2 procedures. Methods A systematic review was undertaken of all published (Medline, CINAHL, AMED, EMBASE) and unpublished or gray literature research databases up to January 2010. Clinical and radiological outcomes as well as complications of HRS were compared to those of THA using risk ratio, mean difference, and standardized mean difference statistics. Studies were critically appraised using the CASP appraisal tool. Results 46 studies were identified from 1,124 citations. These included 3,799 HRSs and 3,282 THAs. On meta-analysis, functional outcomes for subjects following HRS were better than or the same as for subjects with a THA, but there were statistically significantly greater incidences of heterotopic ossification, aseptic loosening, and revision surgery with HRS compared to THA. The evidence base showed a number of methodological inadequacies such as the limited use of power calculations and poor or absent blinding of both patients and assessors, possibly giving rise to assessor bias. Interpretation On the basis of the current evidence base, HRS may have better functional outcomes than THA, but the increased risks of heterotopic ossification, aseptic loosening, and revision surgery following HRS indicate that THA is superior in terms of implant survival. PMID:21067432

  17. Total Quality and Organization Development. Total Quality Series.

    ERIC Educational Resources Information Center

    Lindsay, William M.; Petrick, Joseph A.

    As the global business environment becomes more turbulent, quality management seems more indispensable. This book offers strategies for integrating the theory and practice of Total Quality Management (TQM) with organizational-development (OD) theory at all organizational levels. Chapter 1 answers the question "Why Total Quality Management and…

  18. The Interchangeability of Plasma and Whole Blood Metal Ion Measurement in the Monitoring of Metal on Metal Hips

    PubMed Central

    Malek, Ibrahim A.; Rogers, Joanne; King, Amanda Christina; Clutton, Juliet; Winson, Daniel; John, Alun

    2015-01-01

    One hundred and twenty six paired samples of plasma and whole blood were measured with inductively coupled plasma mass spectrometry technique for metal ions analysis to determine a relationship between them. There was a significant difference between the mean plasma and whole blood concentrations of both cobalt (Co) and chromium (Cr) (p < 0.0001 for both Co and Cr). The mean ratio between plasma and whole blood Cr and Co was 1.56 (range: 0.39–3.85) and 1.54 (range: 0.64–18.26), respectively, but Bland and Altman analysis illustrated that this relationship was not universal throughout the range of concentrations. There was higher variability at high concentrations for both ions. We conclude that both these concentrations should not be used interchangeably and conversion factors are unreliable due to concentration dependent variability. PMID:26798516

  19. Effect of acetabular cup design on metal ion release in two designs of metal-on-metal hip resurfacing.

    PubMed

    Cadossi, Matteo; Tedesco, Giuseppe; Savarino, Lucia; Baldini, Nicola; Mazzotti, Antonio; Greco, Michelina; Giannini, Sandro

    2014-10-01

    The purpose of this observational prospective cohort study was to evaluate the serum concentrations of cobalt (Co), chromium (Cr), and nickel (Ni) at a 2-year follow-up in patients operated on with a novel design of hip resurfacing: Romax resurfacing system (RRS). RRS is characterized by the presence of an acetabular notch which theoretically provides a wider range of motion and a reduced incidence of groin pain. The presence of radiolucencies and functional outcome, assessed using the Harris hip score (HHS) and the University of California Activity scale (UCLA), were secondary endpoints. Moreover, these results were compared with those obtained in our previous study from a similar cohort of patients implanted using the Birmingham Hip Resurfacing (BHR) system. At a 2-year follow-up, the serum levels of Co in patients operated on using the RRS were five times higher (p = 0.0002) than those found before surgery (Co, means: 1.04 and 0.20 ng/mL, respectively); similarly, Cr levels were 13 times higher (p < 0.0001) at a 2-year follow-up than before surgery (Cr, means: 1.69 and 0.13 ng/mL, respectively). Ni concentrations (0.42 and 0.78 ng/mL) were not significantly different (p = 0.16), even if they increased 86% after surgery. In the RRS patients, an inverse correlation was found between Co and Cr concentrations and length of follow-up (Co: r = -0.64, p = 0.0096; Cr: r= -0.45, p = 0.08). The serum levels of Co and Cr were not significantly different between RRS (Co: 1.04 ng/mL and Cr: 1.69 ng/mL) and BHR (Co: 1.39 ng/mL and Cr: 2.30 ng/mL) patients at 2 years (p = 0.95 and 0.26 for Co and Cr, respectively). Our results showed that RRS patients achieved an excellent clinical outcome with limited metal ion release. PMID:24962936

  20. The total charm cross section

    SciTech Connect

    Vogt, R

    2007-09-14

    We assess the theoretical uncertainties on the total charm cross section. We discuss the importance of the quark mass, the scale choice and the parton densities on the estimate of the uncertainty. We conclude that the uncertainty on the total charm cross section is difficult to quantify.

  1. Minimally invasive total hip arthroplasty.

    PubMed

    Hohler, Sharon E

    2004-06-01

    Total hip arthroplasty procedures relieve patients' arthritic hip pain. Since the first procedure was performed in the 1960s, surgeons and implant companies have worked to improve prosthesis design, composition of implants, and the mechanisms for holding the implants in place. Recently, surgeons have focused on minimizing the surgical incision. Smaller incisions have resulted in smaller scars and faster recoveries. This article presents a brief historical overview of, as well as current trends in, minimally invasive total hip arthroplasty. All aspects of care for a patient undergoing total hip arthroplasty are discussed. PMID:15239326

  2. Total anomalous pulmonary venous return

    MedlinePLUS

    TAPVR; Total veins ... lungs. It then returns through the pulmonary (lung) veins to the left side of the heart, which ... lungs to the right atrium or to a vein flowing into the right atrium, instead of the ...

  3. Total Synthesis of Epicoccin G

    PubMed Central

    Nicolaou, K. C.; Totokotsopoulos, Sotirios; Giguère, Denis; Sun, Ya-Ping; Sarlah, David

    2011-01-01

    An expedient enantioselective total synthesis of epicoccin G and related dithiodiketopiperazines through a strategy featuring direct two-directional sulfenylation, photooxygenation and Kornblum–DeLaMare rearrangement is described. PMID:21548595

  4. Pyodermatitis vegetans after total colectomy

    PubMed Central

    Uzunçakmak, Tuğba Kevser; Akdeniz, Necmettin; Karadağ, Ayşe Serap; Çobanoğlu, Bengü

    2015-01-01

    Pyostomatitis–pyodermatitis vegetans (PPV) is a rare dermatological manifestation of inflammatory bowel disease, characterized by erythematous, vesiculopustular, exudative, annular, and/or vegetating plaques over the intertriginous regions that may precede or appear at the same time as the mucosal lesions. Systemic corticosteroids, dapsone, sulfasalazine, azathioprine, cyclosporine, and subtotal/total colectomy are the most common treatment options. A 16-year-old male patient presented to our outpatient clinic with a four months history of thickly crusted erosions on his trunk, back, and lower extremity. He had ulcerative colitis for four years and total colectomy was done seven months ago. Clinical and histopathological examination of his lesions were consistent with pyostomatitis vegetans. Although subtotal/total colectomy has been reported as a treatment option for PPV, lesions reappeared three months after total colectomy in our patient. PMID:26904460

  5. Total Knee Replacement for Women

    MedlinePLUS Videos and Cool Tools

    ... then? 80 percent. Only because of my patient population. Yeah. I’ve had excellent results doing cementless ... obviously patients that we feel because of their health and age has the potential for a total ...

  6. Total synthesis of salinosporamide A.

    PubMed

    Fukuda, Takeo; Sugiyama, Kouhei; Arima, Shiho; Harigaya, Yoshihiro; Nagamitsu, Tohru; Omura, Satoshi

    2008-10-01

    The total synthesis of salinosporamide A has been achieved through enzymatic desymmetrization, diastereoselective aldol reaction, intramolecular aldol reaction, and intermolecular Reformatsky-type reaction followed by 1,4-reduction as key reactions. PMID:18763797

  7. Pyodermatitis vegetans after total colectomy.

    PubMed

    Uzunçakmak, Tuğba Kevser; Akdeniz, Necmettin; Karadağ, Ayşe Serap; Çobanoğlu, Bengü

    2015-12-01

    Pyostomatitis-pyodermatitis vegetans (PPV) is a rare dermatological manifestation of inflammatory bowel disease, characterized by erythematous, vesiculopustular, exudative, annular, and/or vegetating plaques over the intertriginous regions that may precede or appear at the same time as the mucosal lesions. Systemic corticosteroids, dapsone, sulfasalazine, azathioprine, cyclosporine, and subtotal/total colectomy are the most common treatment options. A 16-year-old male patient presented to our outpatient clinic with a four months history of thickly crusted erosions on his trunk, back, and lower extremity. He had ulcerative colitis for four years and total colectomy was done seven months ago. Clinical and histopathological examination of his lesions were consistent with pyostomatitis vegetans. Although subtotal/total colectomy has been reported as a treatment option for PPV, lesions reappeared three months after total colectomy in our patient. PMID:26904460

  8. Fracture After Total Hip Replacement

    MedlinePLUS

    ... er Total Hip Replacement cont. • Dislocation • Limb length inequality • Poor fracture healing • Repeat fracture • Lack of in- ... Surgeons (AAOS). To learn more about your orthopaedic health, please visit orthoinfo.org. Page ( 5 ) AAOS does ...

  9. Stereoselective Total Synthesis of (-)-Depudecin.

    PubMed

    García-Ruiz, Cristina; Cheng-Sánchez, Iván; Sarabia, Francisco

    2015-11-20

    The total synthesis of the natural product depudecin, an antiangiogenic microbial polyketide with inhibitory activity against histone deacetylases, is reported. Characterized by a highly oxidized 11-carbon chain containing two epoxides conjugated through a trans-disubstituted olefin, its total synthesis was efficiently accomplished by a novel asymmetric methodology of epoxide formation based on a new class of chiral sulfonium salts, allowing for the construction of the oxirane rings in an efficient and stereoselective fashion. PMID:26517569

  10. Total Irradiance Monitor Observations of Total Solar Irradiance

    NASA Astrophysics Data System (ADS)

    Kopp, G.

    2007-12-01

    The Total Irradiance Monitor (TIM) is the most recent instrument launched to measure total solar irradiance (TSI) from space. This electrical substitution radiometer has on-orbit degradation tracking to provide very stable long- term measurements of the net solar radiation incident on the Earth, and the instrument continues the 29-year record of this natural driver of Earth climate. Currently flying on the SOlar Radiation and Climate Experiment (SORCE), the TIM has been providing stable, low-noise, and accurate measurements of TSI since early 2003. The TIM will next be flying on NASA's Glory climate mission and is one instrument of the Total Solar Irradiance Sensor (TSIS) selected to continue this important climate record well into the future. The SORCE/TIM has created renewed interest in the TSI absolute value and has acquired the first measurements of the total radiant energy released by large solar flares. Improvements in ground-based calibrations starting with the Glory/TIM will establish traceability linking current to upcoming measurements, solidifying the existing TSI climate data record in the undesirable event of a future data gap.

  11. Total Quality Management Is Total at Fox Valley Technical College.

    ERIC Educational Resources Information Center

    Tyler, Carol R.

    1993-01-01

    At Fox Valley Technical College (Wisconsin), application of Total Quality Management (TQM) brought positive outcomes and other effects. Areas in which TQM was used are considered, including admissions, employee safety, customer focus, policy formation, management performance appraisal, student services, creation of a self-managing class, TQM for

  12. Total Quality in Higher Education. Total Quality Series.

    ERIC Educational Resources Information Center

    Lewis, Ralph G.; Smith, Douglas H.

    This volume offers a detailed argument for and description of Total Quality Management (TQM) for institutions of higher education. Chapter 1 elaborates on why TQM is good for higher education and includes some warning as to why implementation at colleges and universities may not be easy. Chapter 2 provides an overview of the history of the TQM…

  13. Total body water and total body potassium in anorexia nervosa

    SciTech Connect

    Dempsey, D.T.; Crosby, L.O.; Lusk, E.; Oberlander, J.L.; Pertschuk, M.J.; Mullen, J.L.

    1984-08-01

    In the ill hospitalized patient with clinically relevant malnutrition, there is a measurable decrease in the ratio of the total body potassium to total body water (TBK/TBW) and a detectable increase in the ratio of total exchangeable sodium to total exchangeable potassium (Nae/Ke). To evaluate body composition analyses in anorexia nervosa patients with chronic uncomplicated semistarvation, TBK and TBW were measured by whole body K40 counting and deuterium oxide dilution in 10 females with stable anorexia nervosa and 10 age-matched female controls. The ratio of TBK/TBW was significantly (p less than 0.05) higher in anorexia nervosa patients than controls. The close inverse correlation found in published studies between TBK/TBW and Nae/Ke together with our results suggest that in anorexia nervosa, Nae/Ke may be low or normal. A decreased TBK/TBW is not a good indicator of malnutrition in the anorexia nervosa patient. The use of a decreased TBK/TBW ratio or an elevated Nae/Ke ratio as a definition of malnutrition may result in inappropriate nutritional management in the patient with severe nonstressed chronic semistarvation.

  14. Noise from total hip replacements

    PubMed Central

    Wyatt, M. C.; Jesani, S.; Frampton, C.; Devane, P.; Horne, J. G.

    2014-01-01

    Objectives Our study aimed to examine not only the incidence but also the impact of noise from two types of total hip replacement articulations: ceramic-on-ceramic and ceramic-on-polyethylene. Methods We performed a case-controlled study comparing subjective and objective questionnaire scores of patients receiving a ceramic-on-ceramic or a ceramic-on-polyethylene total hip replacement by a single surgeon. Results There was a threefold higher incidence of noise from patients in the ceramic-on-ceramic group compared with the control group. The impact of this noise was significant for patients both subjectively and objectively. Conclusions This study reports a high patient impact of noise from ceramic-on-ceramic total hip replacements. This has led to a change in practice by the principal author. Cite this article: Bone Joint Res 2014;3:183–6. PMID:24920252

  15. Total internal inflection fluorescent microscopy.

    PubMed

    Axelrod, D; Thompson, N L; Burghardt, T P

    1983-01-01

    This review discusses applications of fluorescence microscopy using totally internally reflected excitation light. When totally internally reflected in a transparent solid at its interface liquid, the excitation light beam penetrates only a short distance into the liquid. This surface electromagnetic field, called the 'evanescent wave', can selectively excite fluorescent molecules in the liquid near the interface. Total internal reflection fluorescence (TIRF) has been used to examine the cell/substrate contact regions of primary cultured rat myotubes with acetylcholine receptors labelled by fluorescent alpha-bungarotoxin and human skin fibroblasts labelled with a membrane-incorporated fluorescent lipid. TIRF examination of cell/surface contacts dramatically reduces background from cell autofluorescence and debris. TIRF has also been combined with fluorescence photobleaching recovery and correlation spectroscopy to measure the chemical kinetic binding rates and surface diffusion constant of fluorescent labelled serum protein binding (at equilibrium) to a surface. PMID:6827590

  16. Totally Ossified Metaplastic Spinal Meningioma

    PubMed Central

    Hida, Kazutoshi; Yamauchi, Tomohiro; Houkin, Kiyohiro

    2013-01-01

    A 61-year-old woman with a very rare case of totally ossified large thoracic spinal metaplastic meningioma, showing progressing myelopathy is presented. Computed tomographic images showed a large totally ossfied intradural round mass occupying the spinal canal on T9-10 level. Magnetic resonance imaging revealed a large T9-10 intradural extramedullary mass that was hypointense to spinal cord on T1- and T2-weighted sequences, partial enhancement was apparent after Gadolinium administration. The spinal cord was severely compressed and displaced toward the right at the level of T9-10. Surgical removal of the tumor was successfully accomplished via the posterior midline approach and the histological diagnosis verified an ossified metaplastic meningioma. The clinical neurological symptoms of patient were improved postoperatively. In this article we discuss the surgical and pathological aspects of rare case of spinal totally ossified metaplastic meningioma. PMID:24278660

  17. Total eclipses of the sun.

    PubMed

    Zirker, J B

    1980-12-19

    Total eclipses of the sun offer research opportunities in a variety of sciences. Some of the advances in solar physics resulting from eclipse observations are discussed. Experiments at the total eclipse of 16 February 1980 in India are also described. These included a test of general relativity, studies in coronal physics, investigations of solar prominences, diameter measurements, a search for interplanetary dust, a study of the gravity waves in the earth's atmosphere, and experiments on the biological effects on animals and humans. PMID:17817829

  18. Infection Following Total Knee Arthroplasty

    PubMed Central

    Chun, Keun Churl; Kim, Kwang Mee

    2013-01-01

    For most orthopedists, total knee arthroplasty (TKA) has been regarded as the most effective surgery for patients with severe knee diseases. Though seldom occur, postoperative infection certainly remains one of the most devastating and dreaded complications of TKA. Thus, careful and early diagnosis is needed. After diagnosis, categorize the infection type and choose a rightful and sequential step of treatment are recommended. PMID:24032096

  19. Total Quality Management in Education.

    ERIC Educational Resources Information Center

    Johnson, James H.

    1993-01-01

    Ways to apply the concepts and processes of Total Quality Management (TQM) to education are discussed in this document. Following the introduction and the preface, chapter 1 provides a historical overview and describes the four cornerstones of TQM--an understanding of systems, psychology, knowledge, and statistics. Chapter 2 describes some of the…

  20. Total Library Computerization for Windows.

    ERIC Educational Resources Information Center

    Combs, Joseph, Jr.

    1999-01-01

    Presents a general review of features of version 2.1 of Total Library Computerization (TLC) for Windows from On Point, Inc. Includes information about pricing, hardware and operating systems, modules/functions available, user interface, security, on-line catalog functions, circulation, cataloging, and documentation and online help. A table…

  1. Total synthesis of clavatadine A.

    PubMed

    Conn, Stephanie J; Vreeland, Shannon M; Wexler, Alexandra N; Pouwer, Rebecca H; Pouwer, Rebecca N; Quinn, Ronald J; Chamberland, Stephen

    2015-01-23

    The first total synthesis of the potent and selective human blood coagulation factor XIa inhibitor clavatadine A (1) is described. Direct, early-stage guanidinylation enabled rapid, convergent access to an immediate clavatadine A precursor. Concomitant lactone hydrolysis and guanidine deprotection with aqueous acid cleanly provided clavatadine A (1) in only four steps (longest linear sequence, 41-43% overall yield). PMID:25517413

  2. The Total Synthesis of Neoamphimedine

    PubMed Central

    LaBarbera, Daniel V.; Bugni, Tim S.; Ireland, Chris M.

    2008-01-01

    Neoamphimedine, a Pyridoacridine alkaloid from Xestospongia sp., is a potent antitumor agent both in vitro and in vivo. Neoamphimedine can efficiently induce topoisomerase II mediated catenation of plasmid DNA in vitro, and is the only member of more than one hundred pyridoacridines thus far to have this mechanism of action. Herein we report the first total synthesis of Neoamphimedine. PMID:17900144

  3. The Total Cost of Ownership.

    ERIC Educational Resources Information Center

    Day, C. William

    2000-01-01

    Examines what Total Cost of Ownership is regarding the purchase of technological resources for schools and the major expenses that are likely to occur after technological hardware and software have been installed. A list of best practices that can reduce costs approximately 15 percent and a checklist for technology budgeting are provided. (GR)

  4. Total Quality Management for Schools.

    ERIC Educational Resources Information Center

    Greenwood, Malcolm S.; Gaunt, Helen J.

    Education in the United Kingdom has been shaped by the advent of local school management and the rapid growth of grant-maintained schools. Total Quality Management (TQM) offers a new way of looking at management principles and structures by identifying the needs of both internal and external customers. This book applies principles of TQM…

  5. Enantioselective total synthesis of (+)-amabiline.

    PubMed

    Senter, Timothy J; Fadeyi, Olugbeminiyi O; Lindsley, Craig W

    2012-04-01

    The first total synthesis of (+)-amabiline, an unsaturated pyrrolizidine alkaloid from Cynoglossum amabile, is reported. This convergent, enantioselective synthesis proceeds in 15 steps (10-step longest linear sequence) in 6.2% overall yield and features novel methodology to construct the unsaturated pyrrolizidine or (-)-supinidine core. PMID:22432912

  6. Enantioselective Total Synthesis of (+)-Amabiline

    PubMed Central

    Senter, Timothy J.; Fadeyi, Olugbeminiyi O.; Lindsley, Craig W.

    2012-01-01

    The first total synthesis of (+)-amabiline, an unsaturated pyrrolizidine alkaloid from Cynoglossum amabile is reported. This convergent, enantioselective synthesis proceeds in 15 steps, 10 steps longest linear sequence, in 6.2% overall yield and features novel methodology to construct the unsaturated pyrrolizidine or (−)-supinidine core. PMID:22432912

  7. Total Synthesis of Propolisbenzofuran B†

    PubMed Central

    Jones, Brian T.; Avetta, Christopher T.; Thomson, Regan J.

    2014-01-01

    The first total synthesis of propolisbenzofuran B, a bioactive natural product isolated from honeybee propolis resin, is reported. The convergent synthesis makes use of a silicon-tether controlled oxidative ketone–ketone cross-coupling and a novel benzofuran-generating cascade reaction to deliver the core structure of the natural product from readily prepared precursors. PMID:24976944

  8. Total synthesis of spirobacillene A.

    PubMed

    Unsworth, William P; Cuthbertson, James D; Taylor, Richard J K

    2013-07-01

    The first total synthesis of spirobacillene A, an indole alkaloid isolated from Lysinibacillus fusiformis, is reported. A Lewis acid mediated spirocyclization of an anisole derivative onto a tethered ynone was used as a key step, drawing inspiration from a potential biosynthesis of the natural product. PMID:23786419

  9. Thyroidectomy in Graves' disease: subtotal, near total or total?

    PubMed

    Hoffmann, Rainer

    2009-01-01

    Thyroidectomy is one of the possible therapeutic options in Graves' disease as are antithyroid drugs and (131)radioiodine. Emerging data reveal an advantage of total thyroidal ablation as the method of choice in patients with impending or overt Graves' orbitopathy. Pros and cons are discussed as presented at the 1st Swiss Symposium on Thyroid Eye Disease in Pontresina, Switzerland in December 2007. PMID:19839882

  10. Total sternectomy for malignant disease.

    PubMed

    París, F; Blasco, E; Tarazona, V; Pastor, J; Zarza, A G; Padilla, J

    1980-09-01

    From 1972 to 1978, six total sternectomies for malignant disease of the sternum were carried out. The clinical data are summarized and the surgical technique is described. After sternectomy, the area of chest wall resection was repaired by suturing a sheet of silicone rubber to the edges of the defect and chest wall stability was assured by using one or two stainless steel struts. Finally the defect was covered with methylmethacrylate prepared and applied inthe operative field. The prosthetic material was shaped until curing by polymerization was complete. We discuss the advantages of this type of reconstruction, the technical details, the use of antibiotics, the surgical drainage, and the need for biopsy prior to carrying out a total sternectomy. PMID:7412352

  11. A simple total energy sensor

    NASA Technical Reports Server (NTRS)

    Nicks, O. W.

    1976-01-01

    This research concerns a simple technique for total energy compensation having the primary requirement of good compensation with a low cost, easy to make sensor. A comprehensive library search and a small wind tunnel were used to explore fundamentals and to develop a number of probes which were flight tested with satisfactory results. Simple probe configurations were tested using the characteristics of laminar flow separation around a small cylinder to produce a sensor pressure having the desired relationship between static and dynamic pressures. Wind tunnel and flight tests confirmed the concepts for a wide range of speeds, altitudes, and flow directions encountered in soaring. Data and findings are presented, along with a discussion of factors important to total energy compensation.

  12. Solar total energy project Shenandoah

    NASA Astrophysics Data System (ADS)

    1980-01-01

    A description of the final design for the Solar Total Energy System to be installed at the Shenandoah, Georgia, site of utilization by the Bleyle knitwear plant, is presented. The system is a fully cascaded total energy system design featuring high temperature paraboloidal dish solar collectors with a 235 concentration ratio, a steam Rankine cycle power conversion system capable of supplying 100 to 400 kW(e) output with an intermediate process steam take-off point, and a back pressure condenser for heating and cooling. The design also includes an integrated control system employing the supervisory control concept to allow maximum experimental flexibility. The system design criteria and requirements are presented including the performance criteria and operating requirements, environmental conditions of operation; interface requirements with the Bleyle plant and the Georgia Power Company lines; maintenance, reliability, and testing requirements; health and safety requirements; and other applicable ordinances and codes.

  13. Asymmetric total synthesis of neoxaline.

    PubMed

    Ideguchi, Tetsuya; Yamada, Takeshi; Shirahata, Tatsuya; Hirose, Tomoyasu; Sugawara, Akihiro; Kobayashi, Yoshinori; Ōmura, Satoshi; Sunazuka, Toshiaki

    2013-08-28

    A first asymmetric total synthesis and determination of the absolute configuration of neoxaline has been accomplished through the highly stereoselective introduction of a reverse prenyl group to create a quaternary carbon stereocenter using (-)-3a-hydroxyfuroindoline as a building block, construction of the indoline spiroaminal via cautious stepwise oxidations with cyclizations from the indoline, assembly of (Z)-dehydrohistidine, and photoisomerization of unnatural (Z)-neoxaline to the natural (E)-neoxaline as the key steps. PMID:23957424

  14. Advances in total knee arthroplasty.

    PubMed

    Aumiller, Wade D; Dollahite, Harry Anderson

    2016-03-01

    Total knee arthroplasty (TKA) is one of the success stories of modern surgery. Primary TKA is commonly used when nonsurgical treatments for osteoarthritis fail. The need for TKA is projected to increase by 673% between 2005 and 2030, creating a tremendous burden on the healthcare system. This article reviews selected perioperative management strategies, computer-aided navigation, patient-specific cutting blocks, and medial pivot knee implants as potential sources of improvements in clinical efficiency and patient outcomes. PMID:26840607

  15. Total synthesis of (+)-isatisine A.

    PubMed

    Lee, Jihoon; Panek, James S

    2011-02-01

    Total synthesis of (+)-isatisine A is described based on the application of a silyl-directed Mukaiyama-type [3 + 2]-annulation for the preparation of a fully substituted furan core. The indole branch forming the quaternary carbon center at C2 was constructed by addition to an intermediate N-acyliminium ion derived from aminal 4. In addition, the fused tetracyclic framework including furan core was built up using modified Buchwald amidation conditions. PMID:21188973

  16. Instability After Total Knee Arthroplasty.

    PubMed

    Cottino, Umberto; Sculco, Peter K; Sierra, Rafael J; Abdel, Matthew P

    2016-04-01

    Instability is one of the most common causes of failure after total knee arthroplasty. Although there are several contributing causes, surgical error and poor implant design selection contribute. For this reason, an accurate diagnosis is fundamental and is largely based on a thorough history and physical examination. In general, tibiofemoral instability can be classified into 3 different patterns: flexion instability, genu recurvatum, and extension instability. In this article, these 3 patterns are reviewed in greater depth. PMID:26772939

  17. Total Synthesis of Aplyronine C

    PubMed Central

    2013-01-01

    A highly stereocontrolled total synthesis of the cytotoxic marine macrolide aplyronine C is described. The route exploits aldol methodology to install the requisite stereochemistry and features a crucial boron-mediated aldol coupling of an N-vinylformamide-bearing methyl ketone with a macrocyclic aldehyde to introduce the full side chain. The synthesis of two novel C21–C34 side chain analogs is also reported. PMID:23730909

  18. Total Synthesis of Brevetoxin A

    PubMed Central

    Crimmins, Michael T.; Zuccarello, J. Lucas; Ellis, J. Michael; McDougall, Patrick J.; Haile, Pamela A.; Parrish, Jonathan D.; Emmitte, Kyle A.

    2009-01-01

    A total synthesis of brevetoxin A is reported. Two tetracyclic coupling partners, prepared from previously reported advanced fragments, were effectively united via a Horner—Wittig olefination. The resulting octacycle was progressed to substrates that were explored for reductive etherification, the success of which led to a penultimate tetraol intermediate. The tetraol was converted to the natural product through an expeditious selective oxidative process, followed by methylenation. PMID:19099481

  19. Enantioselective Total Synthesis of Aplyviolene

    PubMed Central

    Overman, Larry E.; Schnermann, Martin J.

    2011-01-01

    The enantioselective total synthesis of the rearranged spongian diterpene aplyviolene has been completed in 14 steps from the known hydroazulenone 8. The key junction of the hydrocarbon and oxygenated fragments to form the critical C8 quaternary carbon stereocenter and set the stage for elaborating the delicate bicyclic lactone functionality was accomplished in high yield and exquisite stereoselectivity by Michael addition of an enantioenriched hydroazulenone enolate to an enantiopure α-bromocyclopentenone. PMID:21936525

  20. Total Pancreatectomy With Islet Autotransplantation

    PubMed Central

    Bellin, Melena D.; Gelrud, Andres; Arreaza-Rubin, Guillermo; Dunn, Ty B.; Humar, Abhinav; Morgan, Katherine A.; Naziruddin, Bashoo; Rastellini, Cristiana; Rickels, Michael R.; Schwarzenberg, Sarah J.; Andersen, Dana K.

    2015-01-01

    A workshop sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases focused on research gaps and opportunities in total pancreatectomy with islet autotransplantation (TPIAT) for the management of chronic pancreatitis. The session was held on July 23, 2014 and structured into 5 sessions: (1) patient selection, indications, and timing; (2) technical aspects of TPIAT; (3) improving success of islet autotransplantation; (4) improving outcomes after total pancreatectomy; and (5) registry considerations for TPIAT. The current state of knowledge was reviewed; knowledge gaps and research needs were specifically highlighted. Common themes included the need to identify which patients best benefit from and when to intervene with TPIAT, current limitations of the surgical procedure, diabetes remission and the potential for improvement, opportunities to better address pain remission, GI complications in this population, and unique features of children with chronic pancreatitis considered for TPIAT. The need for a multicenter patient registry that specifically addresses the complexities of chronic pancreatitis and total pancreatectomy outcomes and postsurgical diabetes outcomes was repeatedly emphasized. PMID:25599324

  1. CLINICAL OUTCOME AFTER INFECTED TOTAL KNEE AND TOTAL HIP ARTHROPLASTY

    PubMed Central

    Mittag, Falk; Leichtle, Carmen Ina; Schlumberger, Michael; Leichtle, Ulf Gunther; Wünschel, Markus

    2016-01-01

    ABSTRACT Objective: Infection after total hip (THA) and knee arthroplasty (TKA) is a serious complication which typically leads to a long lasting and intensive surgical and medicamentous treatment. The aim of this study was to identify factors that influence outcome after revision surgery caused by prosthetic infection. Methods: We retrospectively analyzed 64 patients who had revision surgery between 1989 and 2009 due to periprosthetic infection. We examined a total of 69 joints (TKA: 36%, THA: 64%), follow-up 5.1 years (0.5-21 years) after the initial surgical intervention. The mean patient age at time of surgery was 67 years old (43-79 years old). Clinical data and scores including the Western Ontario and McMaster Universities (WOMAC)-Index, the Harris Hip Score (HHS) and the Hospital for Special Surgery Score (HSS) were surveyed. Results: There was no difference in clinical scores regarding treatment between a single and a multiple stage treatment regime. Infections with multiple microorganisms and Enterococcus spp. lead to a significantly higher number of interventions. Using a modified Tsukayama system we classified 24% as type I, 34% type II and 42% type III- infections, with no differences in clinical outcome. Overweight patients had a significantly lower HHS and WOMAC-score. Immunosuppression leads to a worse WOMAC and HSS-Score. An increased number of procedures was associated to a limping gait. Conclusion: Thorough surgical technique leads to good clinical results independent of infection-type and treatment philosophy. Level of Evidence III, Case Control Study.

  2. Implant based differences in adverse local tissue reaction in failed total hip arthroplasties: a morphological and immunohistochemical study

    PubMed Central

    2014-01-01

    Background Adverse local tissue reaction (ALTR) is characterized by periprosthetic soft tissue inflammation composed of a mixed inflammatory cell infiltrate, extensive soft tissue necrosis, and vascular changes. Multiple hip implant classes have been reported to result in ALTR, and clinical differences may represent variation in the soft tissue response at the cellular and tissue levels. The purpose of this study was to describe similarities and differences in periprosthetic tissue structure, organization, and cellular composition by conventional histology and immunohistochemistry in ALTR resulting from two common total hip arthroplasty (THA) implant classes. Methods Consecutive patients presenting with ALTR from two major hip implant classes (N = 54 patients with Dual-Modular Neck implant; N = 14 patients with Metal-on-Metal implant) were identified from our prospective Osteolysis Tissue Database and Repository. Clinical characteristics including age, sex, BMI, length of implantation, and serum metal ion levels were recorded. Retrieved synovial tissue morphology was graded using light microscopy and cellular composition was assessed using immunohistochemistry. Results Length of implantation was shorter in the DMN group versus MoM THA group (21.3 [8.4] months versus 43.6 [13.8] months respectively; p < 0.005) suggesting differences in implant performance. Morphologic examination revealed a common spectrum of neo-synovial proliferation and necrosis in both groups. Macrophages were more commonly present in diffuse sheets (Grade 3) in the MoM relative to DMN group (p = 0.016). Perivascular lymphocytes with germinal centers (Grade 4) were more common in the DMN group, which trended towards significance (p = 0.066). Qualitative differences in corrosion product morphology were seen between the two groups. Immunohistochemistry showed features of a CD4 and GATA-3 rich lymphocyte reaction in both implants, with increased ratios of perivascular T-cell relative to B-cell markers in the DMN relative to the MoM group (p = 0.032). Conclusion Our results demonstrate that both implant classes display common features of neo-synovial proliferation and necrosis with a CD4 and GATA-3 rich inflammatory infiltrate. Qualitative differences in corrosion product appearance, macrophage morphology, and lymphocyte distributions were seen between the two implant types. Our data suggests that ALTR represents a histological spectrum with implant-based features. PMID:25242891

  3. Epithelial phenotype in total sclerocornea

    PubMed Central

    Yeh, Lung-Kun; Chen, Hung-Chi; Chang, Anna Marie; Ho, Yi-Ju; Chang, Shirley H.L.; Yang, Unique

    2014-01-01

    Purpose To understand whether the epithelial phenotype in total sclerocornea is corneal or conjunctival in origin. Methods Four cases of total sclerocornea (male:female = 1:3; mean age = 5.4±4.3; 1–11 years old) who received penetrating keratoplasty (PKP) at our hospital between 2008 and 2011 were included. Corneal buttons obtained during PKP were used for transmission electron microscopy (TEM) as well as immunoconfocal microscopy for cytokeratins 3, 12, and 13, goblet cell mucin MUC5AC, connexin 43, stem cell markers p63 and ABCG2, laminin-5, and fibronectin. Results After a mean follow-up period of 38.8±14.0 (12–54) months, the grafts remained clear in half of the patients. TEM examination revealed a markedly attenuated Bowman’s layer in the scleralized corneas, with irregular and variably thinned collagen lamellar layers, and disorganization and random distribution of collagen fibrils, which were much larger in diameter compared with a normal cornea. Immunoconfocal microscopy showed that keratin 3 was expressed in all four patients, while p63, ABCG2, and MUC5AC were all absent. Cornea-specific keratin 12 was universally expressed in Patients 1 to 3, while mucosa (including conjunctiva)-specific keratin 13 was negative in these patients. Interestingly, keratin 12 and 13 were expressed in Patient 4 in a mutually exclusive manner. Linear expression of laminin-5 in the basement membrane zone and similar expression of fibronectin were observed. Conclusions The epithelia in total sclerocornea are essentially corneal in phenotype, but in the event of massive corneal angiogenesis, invasion by the conjunctival epithelium is possible. PMID:24744607

  4. The Painful Total Knee Arthroplasty.

    PubMed

    McDowell, Mitchell; Park, Andrew; Gerlinger, Tad L

    2016-04-01

    There are many causes of residual pain after total knee arthroplasty (TKA). Evaluation and management begins with a comprehensive history and physical examination, followed by radiographic evaluation of the replaced and adjacent joints, as well as previous films of the replaced joint. Further workup includes laboratory analysis, along with a synovial fluid aspirate to evaluate the white blood cell count with differential as well as culture. Advanced imaging modalities may be beneficial when the diagnosis remains unclear. Revision surgery is not advisable without a clear diagnosis, as it may be associated with poor results. PMID:26772940

  5. Antarctic total ozone in 1958

    SciTech Connect

    Newman, P.A. )

    1994-04-22

    The Antarctic ozone hole results from catalytic destruction of ozone by chlorine radicals. The hole develops in August, reaches its full depth in early October, and is gone by early December of each year. Extremely low total ozone measurements were made at the Antarctic Dumont d'Urville station in 1958. These measurements were derived from spectrographic plates of the blue sky, the moon, and two stars. These Dumont plate data are inconsistent with 1958 Dobson spectrophotometer ozone measurements, inconsistent with present-day Antarctic observations, and inconsistent with meteorological and theoretical information. There is no credible evidence for an ozone hole in 1958.

  6. Total synthesis of heronapyrrole C.

    PubMed

    Ding, Xiao-Bo; Furkert, Daniel P; Capon, Robert J; Brimble, Margaret A

    2014-01-17

    A flexible total synthesis of the 2-nitropyrrole-derived marine natural product, (+)-heronapyrrole C, is reported. The approach is based on regioselective access to key building blocks containing the rare 4-substituted 2-nitropyrrole motif. Sharpless asymmetric epoxidation and dihydroxylation and a Shi epoxidation were used to introduce the five stereogenic centers of the bis-THF-diol side chain. The N-benzoyloxymethyl (Boz) protecting group was crucial for functionalization of the 2-nitropyrrole moiety and enabling final deprotection under mild conditions. PMID:24351092

  7. Total synthesis of (-)-salinosporamide A.

    PubMed

    Satoh, Nobuhiro; Yokoshima, Satoshi; Fukuyama, Tohru

    2011-06-17

    A concise and stereoselective total synthesis of (-)-salinosporamide A (1), a potent inhibitor of the 20S proteasome that is in clinical development as an anticancer drug candidate, has been accomplished in 14 steps with 19% overall yield from 4-pentenoic acid. Our synthesis features a stereoselective alkylation utilizing a chiral auxiliary, formation of a pyrrolidine unit, and oxidation of the pyrrolidine to a γ-lactam. To demonstrate the scalability of our synthesis, (-)-salinosporamide A has been synthesized on a gram scale. PMID:21591679

  8. Characterization of total flare energy

    NASA Technical Reports Server (NTRS)

    Hudson, H. S.

    1986-01-01

    It is concluded that the estimates of total energy in the prime flares lie well below the Active Cavity Radiometer Irradiance Monitor upper limits. This is consistent with our knowledge of the energy distribution in solar flares. Insufficient data exist for us to be very firm about this conclusion, however, and major energetic components could exist undetected, especially in the EUV-XUV and optical bands. In addition, the radiant energy cannot quantitatively be compared at this time with non-radiant terms because of even larger uncertainties in the latter.

  9. Total quality in health care.

    PubMed

    Brannan, K M

    1998-05-01

    Quality is at the top of American consumers' demand list, and consequently American manufacturing companies have been forced to assign priority to the development of high-quality products. To improve the quality of what they offer, many manufacturers use the management philosophy known as total quality management (TQM), and now the service sector is following in their footsteps. The health care industry is a good example of a service industry that can benefit greatly from TQM, and it is the purpose of this article to show how a health care provider can implement TQM and evaluate its effects. PMID:10178544

  10. Cardiac dysrhythmia complicating total parotidectomy.

    PubMed

    Prakash, Smita; Sahni, Ameeta; Bamba, Charu; Chintamani; Gogia, Anoop Raj

    2013-08-01

    Sudden severe dysrhythmias during anaesthesia can be life- threatening for the patient. We describe a case in which ventricular dysrhythmias and severe bradycardia occurred during dissection and mobilization of the deep lobe of the parotid gland during total parotidectomy under general anaesthesia. We believe that these dysrhythmias were caused by a trigemino- vagal reflex similar to the oculocardiac reflex, but with afferent innervation from mandibular division of the trigeminal nerve. The case report is presented to illustrate a possible existence and importance of reflex bradycardic responses that may occur during surgical procedures involving the parotid gland. PMID:24818345

  11. Development of a totally implantable total artificial heart controller.

    PubMed

    Lee, S H; Choi, W W; Min, B G

    1991-01-01

    Using a one chip microcontroller, 87C196 (One chip EPROM), and an erasable and programmable logic device (EPLD), an implantable control system to drive a pendulum type electromechanical total artificial heart was developed. This control system consists of four parts: a main management system, a motor driver with power regulator, a state monitoring system, and a communication portion. The main system has a speed detector, proportional and integral (PI) control, pulse width modulation (PWM) generation, serial communication, and an analog data processor. Two kinds of power system are used, separated by eight photocoupler arrays to improve system stability. When the performance of each compartment was compared with that of the previously used Z80 microprocessor based control system, good correspondence was shown. Logic power consumption was reduced to one third that of the previous controller. Using mock circulation tests, the overall performance of the control system was evaluated. PMID:1751254

  12. Is there any difference in survivorship of total hip arthroplasty with different bearing surfaces? A systematic review and network meta-analysis

    PubMed Central

    Yin, Si; Zhang, Dangfeng; Du, Hui; Du, Heng; Yin, Zhanhai; Qiu, Yusheng

    2015-01-01

    Purpose: Although many total hip bearing implants are widely used all over the world, simultaneous comparisons across the numerous available bearing surfaces are rare. The purpose of this study was to compare the survivorship of total hip arthroplasty (THA) with six available bearing implants. Methods: We conducted a systematic review of randomized controlled trials (RCTs) reporting survivorship or revision of ceramic-on-ceramic (CoC), ceramic-on-conventional polyethylene (CoPc), ceramic-on-highly-crosslinked polyethylene (CoPxl), metal-on-conventional polyethylene (MoPc), metal-on-highly-crosslinked polyethylene (MoPxl), or metal-on-metal (MoM) bearing implants. The synthesis of present evidence was performed by both the traditional direct-comparison meta-analysis and network meta-analysis. Results: In total, 40 RCTs involving a total of 5321 THAs were identified. The pooled data of network meta-analysis showed no difference in relative risk (RR) of revision across CoC, CoPc, CoPxl and MoPxl bearings. However, the MoM bearing was demonstrated with a significant higher risk of revision compared with CoC (RR 5.10; 95% CI=1.62 to 16.81), CoPc (RR 4.80; 95% CI=1.29 to 17.09), or MoPxl (RR 3.85; 95% CI=1.16 to 14.29), and the MoPc bearing was indicated with a higher risk of revision compared with CoC (RR 2.83; 95% CI=1.20 to 6.63). The ranking probabilities of the effective interventions also revealed the inferiority of the MoM and MoPc implants in survivorship (both 0%, 95% CI=0% to 0%) compared with CoC (39%, 95% CI=0% to 100%), CoPc (33%, 95% CI=0% to 100%), CoPxl (7%, 95% CI=0% to 100%) or MoPxl (21%, 95% CI=0% to 100%). Conclusions: The present evidence indicated the similar performance in survivorship among CoC, CoPc, CoPxl and MoPxl bearing implants, and that all likely have superiority compared with the MoM and MoPc bearing implants in THA procedures. Long-term RCT data are required to confirm these conclusions and better inform clinical decisions. PMID:26885157

  13. Shenandoah Solar Total Energy Project

    SciTech Connect

    Leonard, J.A.; Hunke, R.W.

    1981-01-01

    The design of the world's first solar total energy plant in the private sector has been completed and construction is underway. The project, a major element of the Department of Energy's Solar Thermal Program, is the Solar Total Energy Project at Shenandoah, Georgia. When operational in early 1982, the solar plant will furnish electrical power, process steam, and other thermal energy to a nearby knitwear factory. The solar system consists of a collector field containing 114 parabolic dish collectors which supply thermal energy at 400/sup 0/C to drive a 400 kW multi-stage Rankine cycle turbine generator. Some steam is extracted from the turbine and supplied to the knitwear manufacturing processes. The system will be grid-connected, and the Georgia Power Company, through a cooperative agreement with DOE, is a participant in the project. Included are: (1) a description of the system and components being installed; (2) a summary of performance testing of the extraction turbine and of four prototype parabolic dish collectors; and (3) a discussion of design considerations and insights which have general applicability to solar thermal system designs.

  14. Solar total energy project Shenandoah

    SciTech Connect

    1980-01-10

    This document presents the description of the final design for the Solar Total Energy System (STES) to be installed at the Shenandoah, Georgia, site for utilization by the Bleyle knitwear plant. The system is a fully cascaded total energy system design featuring high temperature paraboloidal dish solar collectors with a 235 concentration ratio, a steam Rankine cycle power conversion system capable of supplying 100 to 400 kW(e) output with an intermediate process steam take-off point, and a back pressure condenser for heating and cooling. The design also includes an integrated control system employing the supervisory control concept to allow maximum experimental flexibility. The system design criteria and requirements are presented including the performance criteria and operating requirements, environmental conditions of operation; interface requirements with the Bleyle plant and the Georgia Power Company lines; maintenance, reliability, and testing requirements; health and safety requirements; and other applicable ordinances and codes. The major subsystems of the STES are described including the Solar Collection Subysystem (SCS), the Power Conversion Subsystem (PCS), the Thermal Utilization Subsystem (TUS), the Control and Instrumentation Subsystem (CAIS), and the Electrical Subsystem (ES). Each of these sections include design criteria and operational requirements specific to the subsystem, including interface requirements with the other subsystems, maintenance and reliability requirements, and testing and acceptance criteria. (WHK)

  15. Total ozone trend over Cairo

    NASA Technical Reports Server (NTRS)

    Hassan, G. K. Y.

    1994-01-01

    A world wide interest in protecting ozone layer against manmade effects is now increasing. Assessment of the ozone depletion due to these activities depends on how successfully we can separate the natural variabilities from the data. The monthly mean values of total ozone over Cairo (30 05N) for the period 1968-1988, have been analyzed using the power spectral analysis technique. The technique used in this analysis does not depend on a pre-understanding of the natural fluctuations in the ozone data. The method depends on increasing the resolution of the spectral peaks in order to obtain the more accurate sinusoidal fluctuations with wavelength equal to or less than record length. Also it handles the possible sinusoidal fluctuations with wavelength equal to or less than record length. The results show that it is possible to detect some of the well known national fluctuations in the ozone record such as annual, semiannual, quasi-biennial and quasi-quadrennial oscillations. After separating the natural fluctuations from the ozone record, the trend analysis of total ozone over Cairo showed that a decrease of about -1.2% per decade has occurred since 1979.

  16. Total synthesis of mycalamide A.

    PubMed

    Sohn, Jeong-Hun; Waizumi, Nobuaki; Zhong, H Marlon; Rawal, Viresh H

    2005-05-25

    This communication describes a concise and efficient total synthesis of mycalamide A by the convergent coupling of pederic acid unit with the mycalamine unit. The left-half, (+)-7-benzoylpederic acid, was synthesized from (2R,3R)-3-methylpent-4-en-2-ol in seven steps and 34.6% overall yield through a route that features a one-step Pd(II)-catalyzed tandem Wacker/Heck cyclization reaction to prepare the tetrahydropyran ring system. The right-half, the mycalamine unit, was synthesized in 21 steps and 10.5% overall yield from diethyl d-tartrate. Effective, stereoselective methods were developed for the assembly of the two parts to yield either mycalamide A or C(10)-epi-mycalamide A. PMID:15898759

  17. NAVIGATION IN TOTAL KNEE ARTHROPLASTY

    PubMed Central

    da Mota e Albuquerque, Roberto Freire

    2015-01-01

    Navigation was the most significant advance in instrumentation for total knee arthroplasty over the last decade. It provides surgeons with a precision tool for carrying out surgery, with the possibility of intraoperative simulation and objective control over various anatomical and surgical parameters and references. Since the first systems, which were basically used to control the alignment of bone cutting referenced to the mechanical axis of the lower limb, many other surgical steps have been incorporated, such as component rotation, ligament balancing and arranging the symmetry of flexion and extension spaces, among others. Its efficacy as a precision tool with an effective capacity for promoting better alignment of the lower-limb axis has been widely proven in the literature, but the real value of optimized alignment and the impact of navigation on clinical results and the longevity of arthroplasty have yet to be established. PMID:27026979

  18. Tribology of total artificial joints.

    PubMed

    Fisher, J; Dowson, D

    1991-01-01

    The tribology of total artificial replacement joints is reviewed. The majority of prosthesis currently implanted comprise a hard metallic component which articulates on ultra high molecular weight polyethylene surface. These relatively hard bearing surfaces operate with a mixed or boundary lubrication regime, which results in wear and wear debris from the ultra high molecular weight polyethylene surface. This debris can contribute to loosening and ultimate failure of the prostheses. The tribological performance of these joints has been considered and a number of factors which may contribute to increased wear rates have been identified. Cushion bearing surfaces consisting of low elastic modulus materials which can articulate with full fluid film lubrication are also described. These bearing surfaces have shown the potential for greatly reducing wear debris. PMID:1840723

  19. Total synthesis of (-)-salinosporamide A.

    PubMed

    Kaiya, Yuji; Hasegawa, Jun-ichi; Momose, Takayuki; Sato, Takaaki; Chida, Noritaka

    2011-01-01

    A detailed description of our second-generation total synthesis of salinosporamide A is presented. Three contiguous stereocenters in the γ-lactam structure seen in the natural product were established by stereoselective functionalization of a D-arabinose scaffold, including an Overman rearrangement to generate a highly congested tetrasubstituted carbon center. One of the definitive reactions in the synthesis was a Lewis acid mediated skeletal rearrangement of a pyranose structure, which enabled the practical conversion of the carbohydrate scaffold to the γ-lactam structure embedded in salinosporamide A. The use of a benzyl ester as a protective group for a sterically hindered carboxylic acid led to a one-pot global deprotection at the end of the synthesis. PMID:21058386

  20. Concise total synthesis of glucosepane.

    PubMed

    Draghici, Cristian; Wang, Tina; Spiegel, David A

    2015-10-16

    Glucosepane is a structurally complex protein posttranslational modification that is believed to exist in all living organisms. Research in humans suggests that glucosepane plays a critical role in the pathophysiology of both diabetes and human aging, yet comprehensive biological investigations of this metabolite have been hindered by a scarcity of chemically homogeneous material available for study. Here we report the total synthesis of glucosepane, enabled by the development of a one-pot method for preparation of the nonaromatic 4H-imidazole tautomer in the core. Our synthesis is concise (eight steps starting from commercial materials), convergent, high-yielding (12% overall), and enantioselective. We expect that these results will prove useful in the art and practice of heterocyclic chemistry and beneficial for the study of glucosepane and its role in human health and disease. PMID:26472902

  1. Total quality management implementation guidelines

    SciTech Connect

    Not Available

    1993-12-01

    These Guidelines were designed by the Energy Quality Council to help managers and supervisors in the Department of Energy Complex bring Total Quality Management to their organizations. Because the Department is composed of a rich mixture of diverse organizations, each with its own distinctive culture and quality history, these Guidelines are intended to be adapted by users to meet the particular needs of their organizations. For example, for organizations that are well along on their quality journeys and may already have achieved quality results, these Guidelines will provide a consistent methodology and terminology reference to foster their alignment with the overall Energy quality initiative. For organizations that are just beginning their quality journeys, these Guidelines will serve as a startup manual on quality principles applied in the Energy context.

  2. Total synthesis of maoecrystal V.

    PubMed

    Zhang, Wei-Bin; Lin, Guang; Shao, Wen-Bin; Gong, Jian-Xian; Yang, Zhen

    2015-04-01

    Maoecrystal V (1) is a novel diterpenoid, which was originally isolated from the leaves of the Chinese medicinal herb Isodon eriocalyx in 2004 by Sun et al.1 It has been found to be selectively cytotoxic towards HeLa cells, with an IC50 value of 20 ng mL(-1) . Significant research efforts have been devoted to the synthesis of maoecrystal V because of its intriguing biological properties, rarity in nature, and complex structural features. Herein, we describe our recent investigations, which have culminated in the total synthesis of (±)-maoecrystal V. The current strategy involved three key steps for the successful construction of the key tetrahydrofuran oxa-bridge skeleton, including a Wessely oxidative dearomatization, a novel intramolecular Diels-Alder reaction, and a Rh(II) -catalyzed O - H insertion reaction. PMID:25504983

  3. Conversion total hip arthroplasty: Primary or revision total hip arthroplasty.

    PubMed

    Schwarzkopf, Ran; Baghoolizadeh, Mahta

    2015-11-18

    Total hip arthroplasty (THA) is an increasingly common procedure among elderly individuals. Although conversion THA is currently bundled in a diagnosis related group (DRG) with primary THA, there is a lack of literature supporting this classification and it has yet to be identified whether conversion THA better resembles primary or revision THA. This editorial analyzed the intraoperative and postoperative factors and functional outcomes following conversion THA, primary THA, and revision THA to understand whether the characteristics of conversion THA resemble one procedure or the other, or are possibly somewhere in between. The analysis revealed that conversion THA requires more resources both intraoperatively and postoperatively than primary THA. Furthermore, patients undergoing conversion THA present with poorer functional outcomes in the long run. Patients undergoing conversion THA better resemble revision THA patients than primary THA patients. As such, patients undergoing conversion THA should not be likened to patients undergoing primary THA when determining risk stratification and reimbursement rates. Conversion THA procedures should be planned accordingly with proper anticipation of the greater needs both in the operating room, and for in-patient and follow-up care. We suggest that conversion THA be reclassified in the same DRG with revision THA as opposed to primary THA as a step towards better allocation of healthcare resources for conversion hip arthroplasties. PMID:26601055

  4. Total quality management program planning

    SciTech Connect

    Thornton, P.T.; Spence, K.

    1994-05-01

    As government funding grows scarce, competition between the national laboratories is increasing dramatically. In this era of tougher competition, there is no for resistance to change. There must instead be a uniform commitment to improving the overall quality of our products (research and technology) and an increased focus on our customers` needs. There has been an ongoing effort to bring the principles of total quality management (TQM) to all Energy Systems employees to help them better prepare for future changes while responding to the pressures on federal budgets. The need exists for instituting a vigorous program of education and training to an understanding of the techniques needed to improve and initiate a change in organizational culture. The TQM facilitator is responsible for educating the work force on the benefits of self-managed work teams, designing a program of instruction for implementation, and thus getting TQM off the ground at the worker and first-line supervisory levels so that the benefits can flow back up. This program plan presents a conceptual model for TQM in the form of a hot air balloon. In this model, there are numerous factors which can individually and collectively impede the progress of TQM within the division and the Laboratory. When these factors are addressed and corrected, the benefits of TQM become more visible. As this occurs, it is hoped that workers and management alike will grasp the ``total quality`` concept as an acceptable agent for change and continual improvement. TQM can then rise to the occasion and take its rightful place as an integral and valid step in the Laboratory`s formula for survival.

  5. Defying entropy: forming large head-to-tail macrocycles in the gas phase.

    PubMed

    Tirado, Marcus; Polfer, Nicolas C

    2012-06-25

    Spectral fingerprints: Collision-induced dissociation (CID) of protonated peptides in the gas phase results in linear fragment ions with a five-membered oxazolone ring on their C-terminal side. Infrared spectroscopy confirms that smaller fragments adopt oxazolone structures. Conversely, in mid-sized and larger fragments an isomerization to "head-to-tail" macrocycles is observed (see picture). PMID:22615257

  6. Enantioselective total synthesis of (-)-acutumine.

    PubMed

    Li, Fang; Tartakoff, Samuel S; Castle, Steven L

    2009-12-01

    An account of the total synthesis of the tetracyclic alkaloid (-)-acutumine is presented. A first-generation approach to the spirocyclic subunit was unsuccessful as a result of incorrect regioselectivity in a radical cyclization. However, this work spawned a second-generation strategy in which the spirocycle was fashioned via a radical-polar crossover reaction. This process merged an intramolecular radical conjugate addition with an enolate hydroxylation and created two stereocenters with excellent diastereoselectivity. The reaction was promoted by irradiation with a sunlamp, and a ditin reagent was required for aryl radical formation. These facts suggest that the substrate may function as a sensitizer, thereby facilitating homolytic cleavage of the ditin reagent. The propellane motif of the target was then installed via annulation of a pyrrolidine ring onto the spirocycle. The sequence of reactions used included a phenolic oxidation, an asymmetric ketone allylation mediated by Nakamura's chiral allylzinc reagent, an anionic oxy-Cope rearrangement, a one-pot ozonolysis-reductive amination, and a Lewis acid promoted cyclization of an amine onto an alpha,beta-unsaturated dimethyl ketal. Further studies of the asymmetric ketone allylation demonstrated the ability of the Nakamura reagent to function well in a mismatched situation. A TiCl(4)-catalyzed regioselective methyl enol etherification of a 1,3-diketone completed the synthesis. PMID:19904909

  7. Total hydrocarbon analyzer evaluation study

    SciTech Connect

    Shamat, N. ); Crumpler, E. ); Roddan, A. )

    1991-10-01

    Measuring and controlling organic emissions from incineration processes has become a major environmental concern in recent years. The US Environmental Protection Agency (EPA) recently proposed a regulation for sewage sludge incinerators under section 405(d) of the Clean Water Act that will require all sludge incinerators to monitor total hydrocarbon emissions (THCs) on a continuous basis. Such a requirement would be part of National Pollutant Discharge Elimination (NPDES) permits and site-specific THC limits would be established for facilities based on a risk assessment of organic emissions. Before EPA can finalize the proposed requirement, THC monitoring must be successfully conducted in a plant environment and the system required by any final regulation must be kept in operation so that facilities can comply with their permits. The Metropolitan Waste Control Commission (MWCC) in St. Paul, Minn., and Rosemount Analytical Division in La Habre, Calif., entered into a joint agreement with EPA to demonstrate a hot' THC monitoring system to detect THCs in stack gases. The objectives of the study are to determine the feasibility of THC monitoring of sludge incinerator emissions; evaluate the long term reliability, cost of operation, and consistency of a continuous THC monitoring system in an incinerator environment; and determine the correlation of THC stack concentration to incinerator and scrubber operating conditions, carbon monoxide concentration, and specific VOC emissions.

  8. Total joint replacement preadmission programs.

    PubMed

    Messer, B

    1998-01-01

    Patients begin to formulate their expectations of the postoperative hospitalization during the preadmission program. The challenge is to better understand the factors patients consider when formulating judgments about the quality of preadmission education. For example, it may be that perceptions of the preadmission program are influenced by what patients believe about their postoperative pain and functional abilities. Specific attention needs to be given both preoperatively and postoperatively to instructing patients on realistic expectations for recovery. One other method of measuring patient outcomes is with the Health Status Profile (SF-36) (Response Healthcare Information Management, 1995). The SF-36 approach emphasizes the outcome of medical care as the patient sees it, in addition to a clinical evaluation of successful health care. This form is currently initiated in the physician's office and returned for scanning at the preadmission class. The patient then completes another SF-36 at 6 months and every year thereafter to compare measurable outcomes. Patients intending to have elective total joint replacements experience anxiety and require much support and education. An effective preadmission program is a major investment in a patient's recovery, as well as a unique marketing tool to customers. Preadmission programs can be viewed as an opportunity to enhance customer satisfaction. Preadmission clinics are an excellent means for nurses to improve the quality of patient care through patient education. the overall goal of preadmission testing programs is to ensure patient preparedness while increasing quality health care and overall customer satisfaction. To enhance program effectiveness, health care providers must lead collaborative efforts to improve the efficiency of systems. PMID:9601410

  9. CALIFORNIA CITIES WITH 1990 & 2000 POPULATION TOTALS

    EPA Science Inventory

    Point locations represent cities with Census 2000 population totals and 1990 Census population totals. Cities represent Census Designated Place (CDP) as classified by the US Bureau of the Census. CDP comprise densely settled concentrations of population that are identifiable by...

  10. NEVADA CITIES WITH 1990 & 2000 POPULATION TOTALS

    EPA Science Inventory

    Point locations represent cities with Census 2000 population totals and 1990 Census population totals. Cities represent Census Designated Place (CDP) as classified by the US Bureau of the Census. CDP comprise densely settled concentrations of population that are identifiable by...

  11. HAWAII CITIES WITH 1990 & 2000 POPULATION TOTALS

    EPA Science Inventory

    Point locations represent cities with Census 2000 population totals and 1990 Census population totals. Cities represent Census Designated Place (CDP) as classified by the US Bureau of the Census. CDP comprise densely settled concentrations of population that are identifiable by...

  12. ARIZONA CITIES WITH 1990 & 2000 POPULATION TOTALS

    EPA Science Inventory

    Point locations represent cities with Census 2000 population totals and 1990 Census population totals. Cities represent Census Designated Place (CDP) as classified by the US Bureau of the Census. CDP comprise densely settled concentrations of population that are identifiable by...

  13. 2 CFR 170.330 - Total compensation.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 2 Grants and Agreements 1 2013-01-01 2013-01-01 false Total compensation. 170.330 Section 170.330... REPORTING SUBAWARD AND EXECUTIVE COMPENSATION INFORMATION Definitions § 170.330 Total compensation. Total Compensation has the meaning given in paragraph e.5 of the award term in Appendix A to this part....

  14. 2 CFR 170.330 - Total compensation.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 2 Grants and Agreements 1 2014-01-01 2014-01-01 false Total compensation. 170.330 Section 170.330 Grants and Agreements Office of Management and Budget Guidance for Grants and Agreements OFFICE OF... EXECUTIVE COMPENSATION INFORMATION Definitions § 170.330 Total compensation. Total Compensation has...

  15. Defense meteorological satellite measurements of total ozone

    NASA Technical Reports Server (NTRS)

    Lovill, J. E.; Ellis, J. S.; Luther, F. M.; Sullivan, T. J.; Weichel, R. L.

    1982-01-01

    A multichannel filter radiometer (MFR) on Defense Meteorological Satellites (DMS) that measured total ozone on a global-scale from March 1977 - February 1980 is described. The total ozone data measured by the MFR were compared with total ozone data taken by surfaced-based Dobson spectrophotometers. When comparisons were made for five months, the Dobson spectrophotometer measured 2-5% more total ozone than the MFR. Comparisons between the Dobson spectrophotometer and the MFR showed a reduced RMS difference as the comparisons were made at closer proximity. A Northern Hemisphere total ozone distribution obtained from MFR data is presented.

  16. Prosthetic Design in Total Wrist Arthroplasty.

    PubMed

    Kennedy, Colin D; Huang, Jerry I

    2016-01-01

    Total wrist arthroplasty (TWA) provides a motion-preserving alternative to total wrist arthrodesis for low-demand patients with debilitating pancarpal arthritis. The earlier generation total wrist implants had high complication and failure rates. Advances in prosthetic design have contributed to improved clinical outcomes and implant survivorship. The current fourth-generation implants allow for expansion of indications for TWA. Careful patient selection remains critical; patients with high-demand lifestyles and poor bone stock may not be candidates. Long-term studies on implant survival and patient outcomes are critical for the current generation total wrist implants in assessing their long-term value compared with total wrist arthrodesis. PMID:26614934

  17. Trends in total column ozone measurements

    NASA Technical Reports Server (NTRS)

    Rowland, F. S.; Angell, J.; Attmannspacher, W.; Bloomfield, P.; Bojkov, R. D.; Harris, N.; Komhyr, W.; Mcfarland, M.; Mcpeters, R.; Stolarski, R. S.

    1989-01-01

    It is important to ensure the best available data are used in any determination of possible trends in total ozone in order to have the most accurate estimates of any trends and the associated uncertainties. Accordingly, the existing total ozone records were examined in considerable detail. Once the best data set has been produced, the statistical analysis must examine the data for any effects that might indicate changes in the behavior of global total ozone. The changes at any individual measuring station could be local in nature, and herein, particular attention was paid to the seasonal and latitudinal variations of total ozone, because two dimensional photochemical models indicate that any changes in total ozone would be most pronounced at high latitudes during the winter months. The conclusions derived from this detailed examination of available total ozone can be split into two categories, one concerning the quality and the other the statistical analysis of the total ozone record.

  18. Deformation of the Durom Acetabular Component and Its Impact on Tribology in a Cadaveric Model—A Simulator Study

    PubMed Central

    Gu, Yanqing; Wang, Qing; Cui, Weiding; Fan, Weimin

    2012-01-01

    Background Recent studies have shown that the acetabular component frequently becomes deformed during press-fit insertion. The aim of this study was to explore the deformation of the Durom cup after implantation and to clarify the impact of deformation on wear and ion release of the Durom large head metal-on-metal (MOM) total hips in simulators. Methods Six Durom cups impacted into reamed acetabula of fresh cadavers were used as the experimental group and another 6 size-paired intact Durom cups constituted the control group. All 12 Durom MOM total hips were put through a 3 million cycle (MC) wear test in simulators. Results The 6 cups in the experimental group were all deformed, with a mean deformation of 41.78±8.86 µm. The average volumetric wear rate in the experimental group and in the control group in the first million cycle was 6.65±0.29 mm3/MC and 0.89±0.04 mm3/MC (t = 48.43, p = 0.000). The ion levels of Cr and Co in the experimental group were also higher than those in the control group before 2.0 MC. However there was no difference in the ion levels between 2.0 and 3.0 MC. Conclusions This finding implies that the non-modular acetabular component of Durom total hip prosthesis is likely to become deformed during press-fit insertion, and that the deformation will result in increased volumetric wear and increased ion release. Clinical Relevance This study was determined to explore the deformation of the Durom cup after implantation and to clarify the impact of deformation on wear and ion release of the prosthesis. Deformation of the cup after implantation increases the wear of MOM bearings and the resulting ion levels. The clinical use of the Durom large head prosthesis should be with great care. PMID:23144694

  19. Free radical scavenging activity, total phenolic content, total antioxidant status, and total oxidant status of endemic Thermopsis turcica

    PubMed Central

    Aksoy, Laçine; Kolay, Erdi; Ağılönü, Yasin; Aslan, Zeyneb; Kargıoğlu, Mustafa

    2013-01-01

    Thermopsis turcica, endemic to Turkey, is in danger of extinction. Studies on this species are very few due to the fact that it was only discovered in 1983 and grows in a small circumscribed area in Turkey. In this study, free radical scavenging activity, total phenolic content, total oxidant status (TOS), and total antioxidant status (TAS) of methanol (TTM) and acetone (TTA) extracts of T. turcica were measured spectroscopically. Free radical scavenging activity was determined according to the elimination of DPPH radicals and total phenol content was determined by the Folin–Ciocalteu reaction. Total oxidant status (TOS) and total antioxidant status (TAS) were measured with commercially available kits. Methanol and acetone extracts of T. turcica were found to have a specific radical scavenging effect. This effect was found to be related to the total phenolic content of the extracts. Since the TTA had a higher phenolic content than the methanol extract, it had a stronger radical scavenging effect. In addition, the total antioxidant capacity of the methanol extract was observed to be higher than that of its acetone counterpart. As a result, due to its antioxidative properties, T. turcica is thought to be a natural source of antioxidants. PMID:23961240

  20. Water-Cooled Total-Temperature Probe

    NASA Technical Reports Server (NTRS)

    Lagen, Nicholas T.; Reece, Garland D.

    1992-01-01

    Water-cooled supersonic total-pressure, static-pressure, and total-temperature probes developed to study high-temperature jet plumes. Total-temperature probe tested up to 2,000 degrees F incorporates annular cooling system up to thermocouple lead. Lead extends into test chamber to sense temperature of supersonic external flow. Design novel and significant. Applicable in development of jet engines and in research on fast flows of hot gases.

  1. Total solar eclipse of 3 November 1994

    NASA Technical Reports Server (NTRS)

    Espenak, Fred; Anderson, Jay

    1993-01-01

    A total eclipse of the Sun will be visible from the southern half of the Western Hemisphere on 3 November 1994. The path of the Moon's shadow passes through Peru, Chile, Bolivia, Paraguay, and Brazil. Detailed predictions for this event are presented and include tables of geographic coordinates of the path of totality, local circumstances for hundreds of cities, maps of the path of total and partial eclipse, weather prospects, and the lunar limb profile.

  2. Total pollution effect of urban surface runoff.

    PubMed

    Luo, Hongbing; Luo, Lin; Huang, Gu; Liu, Ping; Li, Jingxian; Hu, Sheng; Wang, Fuxiang; Xu, Rui; Huang, Xiaoxue

    2009-01-01

    For pollution research with regard to urban surface runoff, most sampling strategies to date have focused on differences in land usage. With single land-use sampling, total surface runoff pollution effect cannot be evaluated unless every land usage spot is monitored. Through a new sampling strategy known as mixed stormwater sampling for a street community at discharge outlet adjacent to river, this study assessed the total urban surface runoff pollution effect caused by a variety of land uses and the pollutants washed off from the rain pipe system in the Futian River watershed in Shenzhen City of China. The water quality monitoring indices were COD (chemical oxygen demand), TSS (total suspend solid), TP (total phosphorus), TN (total nitrogen) and BOD (biochemical oxygen demand). The sums of total pollution loads discharged into the river for the four indices of COD, TSS, TN, and TP over all seven rainfall events were very different. The mathematical model for simulating total pollution loads was established from discharge outlet mixed stormwater sampling of total pollution loads on the basis of four parameters: rainfall intensity, total land area, impervious land area, and pervious land area. In order to treat surface runoff pollution, the values of MFF30 (mass first flush ratio) and FF30 (first 30% of runoff volume) can be considered as split-flow control criteria to obtain more effective and economical design of structural BMPs (best management practices) facilities. PMID:19999964

  3. Total quality management in American industry.

    PubMed

    Widtfeldt, A K; Widtfeldt, J R

    1992-07-01

    The definition of total quality management is conformance to customer requirements and specifications, fitness for use, buyer satisfaction, and value at an affordable price. The three individuals who have developed the total quality management concepts in the United States are W.E. Deming, J.M. Juran, and Philip Crosby. The universal principles of total quality management are (a) a customer focus, (b) management commitment, (c) training, (d) process capability and control, and (e) measurement through quality improvement tools. Results from the National Demonstration Project on Quality Improvement in Health Care showed the principles of total quality management could be applied to healthcare. PMID:1616505

  4. EVALUATION OF TOTAL ORGANIC EMISSIONS ANALYSIS METHODS

    EPA Science Inventory

    The rationale and supporting experimental data for revising EPA's 1996 "Guidance for Total Organics" are summarized in this document. It reports the results of reseach and investigation of improvements to the Total Organic Emissions (TOE) guidance used by EPA to measure recovera...

  5. Total Quality Management in Education. Second Edition.

    ERIC Educational Resources Information Center

    Sallis, Edward

    Quality is at the top of most agendas, and improving quality is probably the most important task facing any institution. In addition, quality is difficult to define or measure. This book, the second edition of "Total Quality Management in Education," introduces the key concepts of Total Quality Management (TQM) and demonstrates how they can be put…

  6. 75 FR 22418 - FHA TOTAL Mortgage Scorecard

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-28

    ... URBAN DEVELOPMENT FHA TOTAL Mortgage Scorecard AGENCY: Office of the Chief Information Officer, HUD... samples at FHA's request, and appeals in writing for loss of privilege to use the scorecard. DATES... following information: Title of Proposal: FHA TOTAL Mortgage Scorecard. OMB Approval Number: 2502-0556....

  7. 'Total disability' and the wrongness of killing.

    PubMed

    Omelianchuk, Adam

    2015-08-01

    Walter Sinnott-Armstrong and Franklin G Miller recently argued that the wrongness of killing is best explained by the harm that comes to the victim, and that 'total disability' best explains the nature of this harm. Hence, killing patients who are already totally disabled is not wrong. I maintain that their notion of total disability is ambiguous and that they beg the question with respect to whether there are abilities left over that remain relevant for the goods of personhood and human worth. If these goods remain, then something more is lost in death than in 'total disability,' and their explanation of what makes killing wrong comes up short. But if total disability is equivalent with death, then their argument is an interesting one. PMID:25323315

  8. Enantioselective total syntheses of cyathane diterpenoids.

    PubMed

    Nakada, Masahisa

    2014-08-01

    A Personal Account describing the enantioselective total syntheses of cyathane diterpenoids achieved in the Nakada group. A convergent approach to the cyathane scaffold, the [5-6-7] tricyclic carbon skeleton commonly found in cyathane diterpenoids, has been developed using the catalytic asymmetric intramolecular cyclopropanation (CAIMCP) and baker's yeast reduction. This approach has been successfully applied for the enantioselective total syntheses of (+)-allocyathin B2 , (-)-erinacine B, and (-)-erinacine E. The total synthesis of (-)-erinacine E has been achieved via the acyl group migratory intramolecular aldol reaction, which prevents the retro-aldol reaction and allows the construction of the strained structure. The highly efficient and stereoselective total syntheses of (-)-scabronines G, A, D, and (-)-episcabronine A have been achieved via the oxidative dearomatization/inverse electron demand Diels-Alder reaction cascade. Cascade reactions comprising three and five consecutive reactions were employed for the highly efficient total syntheses of (-)-scabronine A and (-)-episcabronine A, respectively. PMID:25065736

  9. Wear mechanisms and improvements of wear resistance in cobalt-chromium alloy femoral components in artificial total knee joints

    NASA Astrophysics Data System (ADS)

    Que, Like

    Wear is one of the major causes of artificial total knee arthroplasty (TKA) failure. Wear debris can cause adverse reactions to the surrounding tissue which can ultimately lead to loosening of the prosthesis. The wear behavior of UHMWPE tibial components have been studied extensively, but relatively little attention has been paid to the CoCrMo femoral component. The goal of the present study was to investigate the wear mechanisms of CoCrMo femoral components, to study the effect of CoCrMo alloy surface roughness on the wear of UHMWPE, and to determine the effect of heat treatments on the wear resistance of the CoCrMo implant alloys. The surface roughness of twenty-seven retrieved CoCrMo femoral components was analyzed. A multiple station wear testing machine and a wear fixture attached to an MTS 858 bionix system were built and used for in vitro wear studies of the CoCrMo/UHMWPE bearing couple. Solution and aging treatments were applied to the CoCrMo alloys. A white light interference surface profilometer (WLISP) and a scanning electron microscope (SEM) were used to measure the surface roughness and to study wear mechanisms of CoCrMo alloy. An optical microscope was used for alloy microstructure study. X-ray diffraction tests were performed to identify alloy phase transformation after aging. The micro-structure, hardness, and wear resistance of the alloys were studied. Surface roughness was used to quantify alloy wear, and the minimum number of surface roughness measurements required to obtain a reliable and repeatable characterization of surface roughness for a worn alloy surface was determined. The surfaces of the retrieved CoCrMo femoral components appeared to be damaged by metal particles embedded in the UHMWPE tibial component and metal-on-metal wear due to UHMWPE tibial component through-wear. Surface roughness of the femoral components was not correlated with patient age, weight, sex, or length of implantation. In vitro wear tests showed that when the CoCrMo alloy surface roughness was higher than 0.022 mum Ra (surface roughness average), UHMWPE wear increased with increasing CoCrMo alloy surface roughness. Bone and poly(methyl methacrylate) (PMMA) bone cement abrasive particles created scratches on the alloy via a ploughing mechanism, and resulted in significantly rougher surfaces than controls without particles (P < 0.01). Solution treatments at 1230sp°C and 1245sp°C reduced the hardness and wear resistance of the as-cast F75 CoCrMo alloy. Aging at 700sp°C caused recrystallization of the forged F799 alloy and improved wear resistance. Thermo-mechanical treatments have the potential to increase the lifetime of artificial joints by increasing the wear resistance of CoCrMo components.

  10. Total ankle replacement: a historical perspective.

    PubMed

    Overley, Benjamin D

    2012-10-01

    In the early 1970s, total ankle replacement was criticized because of poor outcomes with initial implant designs. Modifications were made that lead to the development of several generations of implants. The early shortcomings gave researchers and surgeons the impetus to improve implant designs and surgical technique. Total ankle replacement has become more widely accepted in recent years because of improved design and survivorship rates for the implants, as well as improved patient satisfaction scores. Indications for total ankle replacement have broadened. To continue these successes, it is important for surgeons to select appropriate patients for this procedure. PMID:23044062

  11. Total body calcium analysis. [neutron irradiation

    NASA Technical Reports Server (NTRS)

    Lewellen, T. K.; Nelp, W. B.

    1974-01-01

    A technique to quantitate total body calcium in humans is developed. Total body neutron irradiation is utilized to produce argon 37. The radio argon, which diffuses into the blood stream and is excreted through the lungs, is recovered from the exhaled breath and counted inside a proportional detector. Emphasis is placed on: (1) measurement of the rate of excretion of radio argon following total body neutron irradiation; (2) the development of the radio argon collection, purification, and counting systems; and (3) development of a patient irradiation facility using a 14 MeV neutron generator. Results and applications are discussed in detail.

  12. 2016 Total Solar Eclipse Expedition of KASI

    NASA Astrophysics Data System (ADS)

    Bong, Su-Chan; Choi, SeongHwan; Jang, Bi-Ho; Park, Jongyeob; Jeon, Young-Beom; Cho, Kyuhyoun; Chae, Jongchul

    2016-05-01

    A total solar eclipse occurred on March 9 along the path through Indonesia and the Pacific. KASI organized an expedition team for total solar eclipse observation. The main purpose of this observation is to test the coronal temperature and outflow velocity diagnostics based on filter observation, which is proposed for the next generation coronagraph. In addition, various white light observations were tried. Although we could not get satisfactory data for the quantitative diagnostics due to system problem and weather, we could get some useful experimental data and nice white light images. We plan next expedition for 2017 total solar eclipse in USA.

  13. Total solar eclipse of 1995 October 24

    NASA Technical Reports Server (NTRS)

    Espenak, Fred; Anderson, Jay

    1994-01-01

    A total eclipse of the sun will be visible from Asia and the Pacific Ocean on 24 Oct. 1995. The path of the moon's shadow begins in the Middle East and sweeps across India, Southeast Asia, and the waters of the Indonesian archipelago before ending at sunset in the Pacific. Detailed predictions for this event are presented and include besselian elements, geographic coordinates of the path of totality, physical ephemeris of the umbra, topocentric limb profile corrections, local circumstances for 400 cities, maps of the eclipse path, weather prospects, the lunar limb profile, and the sky during totality.

  14. Total to withdraw from Qatar methanol - MTBE?

    SciTech Connect

    1996-05-01

    Total is rumored to be withdrawing from the $700-million methanol and methyl tert-butyl ether (MTBE) Qatar Fuel Additives Co., (Qafac) project. The French company has a 12.5% stake in the project. Similar equity is held by three other foreign investors: Canada`s International Octane, Taiwan`s Chinese Petroleum Corp., and Lee Change Yung Chemical Industrial Corp. Total is said to want Qafac to concentrate on methanol only. The project involves plant unit sizes of 610,000 m.t./year of MTBE and 825,000 m.t./year of methanol. Total declines to comment.

  15. UNDERSTANDING CHILDREN'S TOTAL DIETARY EXPOSURE TO PESTICIDES

    EPA Science Inventory

    Recent residential monitoring studies have demonstrated that significant portion of total exposure of infants and children to environmental contaminants can result from contamination of food in the home. Children's foods become contaminated through handling and contact with surf...

  16. Solar Total Energy Project construction cost history

    SciTech Connect

    Hunke, R.W.; Pappas, G.N.

    1983-03-01

    A solar energy project using parabolic dish collectors was designed, fabricated, and installed near Shenandoah, GA. A cost history of the construction of the Solar Total Energy Project is presented. Costs are broken down into the various project elements.

  17. [Total situs inversus associated with Lutembacher syndrome].

    PubMed

    Malkun, C; Alvarado, M; Hurtado, R; Badui, E; Taveras, M; Rivera, C

    1986-01-01

    We describe a 19 years old patient with total situs inversus in association with Lutembacher's syndrome, and surgical intervention. Our review of the literature, did not disclosed any similar case. PMID:2948456

  18. Total lymphoid irradiation in alloimmunity and autoimmunity

    SciTech Connect

    Strober, S.

    1987-12-01

    Total lymphoid irradiation has been used as an immunosuppressive regimen in autoimmune disease and organ transplantation. The rationale for its use originated from studies of patients with Hodgkin disease, in whom this radiotherapy regimen was noted to induce profound and long-lasting immune suppression and yet was well tolerated, with few long-term side effects. Total lymphoid irradiation is a unique immunosuppressive regimen that produces a selective (and long-lasting) reduction in the number and function of helper T cells and certain subsets of B cells. Conventional immunosuppressive drugs show little selectivity, and their effects are short-lived. The most important aspect of total lymphoid irradiation is the potential for achieving transplantation tolerance and permanent remissions in autoimmune disease in laboratory animals. Attempts are being made to achieve similar goals in humans given total lymphoid irradiation, so that immunosuppressive drugs can be ultimately withdrawn from transplant recipients and patients with lupus nephritis. 28 references.

  19. TECAB - Totally Endoscopic Coronary Artery Bypass

    MedlinePLUS

    ... completely endoscopic coronary artery bypass grafting procedure using robotics. We call this operation a “TECAB,” “Totally Endoscopic ... scrub nurse, also a lot of experience with robotics now. And Dr. Atiq Rahman, fellow here for ...

  20. Outdoor Activities for a Total Lunar Eclipse

    ERIC Educational Resources Information Center

    Glenn, William H.

    1977-01-01

    Describes several activities involving a total eclipse of the moon. Included are observations with binoculars, naked eye, and telescope; timing activities and observations of color changes during penumbral and umbral phases; and photography activities. (CS)

  1. Total Solar Eclipse--A Caribbean Adventure.

    ERIC Educational Resources Information Center

    Green, Steven; Tunstall, Louisa; Tunstall, Neil

    1999-01-01

    Describes the experiences of two high school students who traveled to the Caribbean island of Curacao to view a total solar eclipse and prepare methods for teaching classmates about the eclipse the following school year. (Author/WRM)

  2. Total synthesis and structural revision of hericerin.

    PubMed

    Kobayashi, Shoji; Inoue, Tomoharu; Ando, Ami; Tamanoi, Hidetsugu; Ryu, Ilhyong; Masuyama, Araki

    2012-07-01

    The total synthesis of hericerin, a pollen growth inhibitor from Hericium erinaceum, was achieved. We found that the reported structure of hericerin should be revised to be the carbonyl regioisomer. PMID:22670711

  3. Total Synthesis of the Proposed Banyasin A

    NASA Astrophysics Data System (ADS)

    Gao, Xuguang; Ren, Qi; Choi, Sun; Xu, Zhengshuang; Ye, Tao

    2015-03-01

    The first total synthesis of four possible isomers of a molecule possessing the stereochemistry proposed for banyasin A is described. The structure synthesized appears to be different from that of the natural product.

  4. Total Enterprise Simulation Performance and Participant Learning.

    ERIC Educational Resources Information Center

    Washbush, John B.; Gosen, Jerry

    1998-01-01

    A series of evaluations of total enterprise simulation in business capstone courses found no direct positive relationship between performance in the management game and learning outcomes. Ability to play the game did not correlate to learning. (SK)

  5. Total synthesis of leucosceptroids A and B.

    PubMed

    Guo, Sheng; Liu, Jie; Ma, Dawei

    2015-01-19

    Leucosceptroids?A and B are sesterterpenoids with potent antifeedant and antifungal activities. A more efficient gram-scale total synthesis of leucosceptroid?B and the first total synthesis of leucosceptroid?A are presented. The key transformations include an aldol reaction between a substituted dihydrofuranone and an (S)-citronellal-derived aldehyde, a SmI2-mediated intramolecular ketyl-olefin radical cyclization, and final-stage alcohol oxidation. PMID:25470240

  6. Proximal tibial fracture following total knee arthroplasty.

    PubMed

    Krause, Heike; Dunleavy, Kim

    2011-09-01

    The patient was a 74-year-old man, with a history of total knee arthoplasty 14 years earlier, after having sustained a pathological fracture of the proximal diaphysis of the left tibia following a fall. Given the unstable nature of the fracture and the severe osteolysis noted below the total knee arthroplasty, surgical management 1 day after the fall entailed packing cancellous bone graft into the defect and realigning the fracture. PMID:21885911

  7. NEW BEARING SURFACES IN TOTAL HIP REPLACEMENT

    PubMed Central

    Schwartsmann, Carlos Roberto; Boschin, Leonardo Carbonera; Gonçalves, Ramiro Zilles; Yépez, Anthony Kerbes; de Freitas Spinelli, Leandro

    2015-01-01

    Total hip arthroplasty is being increasingly indicated for younger and more active patients, in addition to a naturally growing demand for the procedure because of increasing life expectancy among patients. The high costs of this surgery and the controversies regarding implant performance have made this topic the subject of constant research, seeking new materials with better resistance to wear and better biocompatibility. The present article provides a review of new surfaces in total hip arthroplasty. PMID:27042614

  8. Photoproduction total cross section and shower development

    NASA Astrophysics Data System (ADS)

    Cornet, F.; García Canal, C. A.; Grau, A.; Pancheri, G.; Sciutto, S. J.

    2015-12-01

    The total photoproduction cross section at ultrahigh energies is obtained using a model based on QCD minijets and soft-gluon resummation and the ansatz that infrared gluons limit the rise of total cross sections. This cross section is introduced into the Monte Carlo system AIRES to simulate extended air showers initiated by cosmic ray photons. The impact of the new photoproduction cross section on common shower observables, especially those related to muon production, is compared with previous results.

  9. Concomitant Total Wrist and Total Elbow Arthroplasty in a Rheumatoid Patient.

    PubMed

    Kane, Patrick M; Stull, Justin D; Culp, Randall W

    2016-05-01

    Background Concomitant arthroplasty has been described to have several benefits over multistage procedures. Ipsilateral total elbow and total shoulder arthroplasty has been reported with good outcomes in upper extremity concomitant arthroplasty. Case Description A 65-year-old woman presented with ipsilateral left-sided wrist and elbow joint degeneration as a result of longstanding rheumatoid arthritis. Concomitant total wrist and total elbow arthroplasty was performed with satisfactory results at both joints. She tolerated the procedure well and had an uneventful clinical course postoperatively. Literature Review Currently, no literature exists that describes one-stage total wrist and total elbow arthroplasty. Individually, total wrist and total elbow arthroplasty have both been reported to result in good outcomes and patient satisfaction. Previous studies have reported the utility of concomitant ipsilateral upper extremity procedures with a one-stage total elbow and total shoulder arthroplasty having been identified as a cost-saving procedure with expedited return to functionality versus a two-stage procedure. Clinical Relevance Patients with ipsilateral degenerative changes in the wrist and elbow should be considered on an individual case basis for concomitant total wrist and total elbow arthroplasty. PMID:27104080

  10. A high performance totally ordered multicast protocol

    NASA Technical Reports Server (NTRS)

    Montgomery, Todd; Whetten, Brian; Kaplan, Simon

    1995-01-01

    This paper presents the Reliable Multicast Protocol (RMP). RMP provides a totally ordered, reliable, atomic multicast service on top of an unreliable multicast datagram service such as IP Multicasting. RMP is fully and symmetrically distributed so that no site bears un undue portion of the communication load. RMP provides a wide range of guarantees, from unreliable delivery to totally ordered delivery, to K-resilient, majority resilient, and totally resilient atomic delivery. These QoS guarantees are selectable on a per packet basis. RMP provides many communication options, including virtual synchrony, a publisher/subscriber model of message delivery, an implicit naming service, mutually exclusive handlers for messages, and mutually exclusive locks. It has commonly been held that a large performance penalty must be paid in order to implement total ordering -- RMP discounts this. On SparcStation 10's on a 1250 KB/sec Ethernet, RMP provides totally ordered packet delivery to one destination at 842 KB/sec throughput and with 3.1 ms packet latency. The performance stays roughly constant independent of the number of destinations. For two or more destinations on a LAN, RMP provides higher throughput than any protocol that does not use multicast or broadcast.

  11. Current status of permanent total artificial hearts.

    PubMed

    Davis, P K; Rosenberg, G; Snyder, A J; Pierce, W S

    1989-01-01

    Pneumatic total artificial heats, although demonstrating utility as temporary mechanical circulatory support devices, have not demonstrated a great deal of promise as permanent cardiac replacements. The increasing number of patients who would be candidates for total heart replacement suggests a large role for a permanent implantable total artificial heart. To that end, the Pennsylvania State University is developing an electric motor-driven total artificial heart; the results with implants in calves are encouraging. In this device, a roller-screw mechanism is used to translate the rotation of a brushless direct-current motor into rectilinear motion of a pusher-plate assembly, which in turn empties the blood sacs. The total artificial heart of the future will function under automatic control without percutaneous leads, and this should provide the patient with a nearly normal life-style. Although further experimental efforts are necessary to prepare the device for clinical trials, the technology to provide a safe and reliable electric blood-pump system is at hand. PMID:2912392

  12. Ultra-low wear rates for rigid-on-rigid bearings in total hip replacements.

    PubMed

    Clarke, I C; Good, V; Williams, P; Schroeder, D; Anissian, L; Stark, A; Oonishi, H; Schuldies, J; Gustafson, G

    2000-01-01

    With the increased clinical interest in metal-on-metal and ceramic-on-ceramic total-hip replacements (THRs), the objective of this hip simulator study was to identify the relative wear ranking of three bearing systems, namely CoCr-polyethylene (M-PE), CoCr-CoCr (M-M) and ceramic-on-ceramic (C-C). Volumetric wear rates were used as the method of comparison. The seven THR groupings included one M-PE study, two M-M studies and four C-C studies. Special emphasis was given to defining the 'run-in' phase of accelerated wear that rigid-on-rigid bearings generally exhibit. The hypothesis was that characterization of the run-in and steady state wear phases would clarify not only the tribological performance in vitro but also help correlate these in vitro wear rates with the 'average' wear rates measured on retrieved implants. The implant systems were studied on multichannel hip simulators using the Paul gait cycle and bovine serum as the lubricant. With 28 mm CoCr heads, the PE (2.5 Mrad/N2) wear rates averaged 13 mm3/10(6) cycles duration. This was considered a low value compared with the clinical model of 74 mm3/year (for 28 mm heads). Our later studies established that this low laboratory value was a consequence of the serum parameters then in use. The mating CoCr heads (with PE cups) wore at the steady state rate of 0.028 mm3/10(6) cycles. The concurrently run Metasul M-M THRs wore at the steady state rate of 0.119 mm3/10(6) cycles with high-protein serum. In the second Metasul M-M study with low-protein serum, the THR run-in rate was 2.681 mm3/10(6) cycles and steady state was 0.977 mm3/10(6) cycles. At 10 years, these data would predict a 70-fold reduction in M-M wear debris compared with the clinical PE wear model. All M-M implants exhibited biphasic wear trends, with the transition point at 0.5 x 10(6) cycles between run-in and steady state phases, the latter averaging a 3-fold decrease in wear rate. White surface coatings on implants (coming from the serum solution) were a confounding factor but did not obscure the two orders of magnitude wear performance improvement for CoCr over PE cups. The liners in the alumina head-alumina cup combination wore at the steady state rate of 0.004 mm3/10(6) cycles over 14 x 10(6) cycles duration (high-protein serum). The zirconia head-alumina cup THR combination wore at 0.174 and 0.014 mm3/10(6) cycles for run-in and steady state rates respectively (low-protein serum). The zirconia head and cup THR combination wore slightly higher initially with 0.342 and 0.013 mm3/10(6) cycles for run-in and steady state rates respectively. Other wear studies have generally predicted catastrophic wear for such zirconia-ceramic combinations. It was noted that the zirconia wear trends were frequently masked by the effects of tenacious white surface coatings. It was possible that these coatings protected the zirconia surfaces somewhat in this simulator study. The experimental ceramic Crystaloy THR had the highest ceramic run-in wear at 0.681 mm3/10(6) cycles and typical 0.016 mm3/10(6) cycles for steady state. Since these implants represented the first Crystaloy THR sets made, it was likely that the surface conditions of this high-strength ceramic could be improved in the future. Overall, the ceramic THRs demonstrated three orders of magnitude wear performance improvement over PE cups. With zirconia implants, while the cup wear was sometimes measurable, head wear was seldom discernible. Therefore, we have to be cautious in interpreting such zirconia wear data. Identifying the run-in and steady state wear rates was a valuable step in processing the ceramic wear data and assessing its reliability. Thus, the M-M and C-C THRs have demonstrated two to three orders of reduction in volumetric wear in the laboratory compared with the PE wear standard, which helps to explain the excellent wear performance and minimal osteolysis seen with such implants at retrieval operations. PMID:10997055

  13. COMPONENT VERSION IN MODULAR TOTAL HIP REVISION

    PubMed Central

    Kopec, Michael A.; Pemberton, Aaron; Milbrandt, Joseph C.; Allan, Gordon

    2009-01-01

    Morphologic changes of the proximal femur make revision total hip arthroplasty challenging. Metaphyseal retroversion and diaphyseal varus are common in this scenario. Twenty-one total hip revisions using a modular femoral prosthesis were examined by obtaining three radiographs (A/P, surgical lateral, and true lateral of the femur) to assemble CAD models for determining the range of modular component positioning. An average of femoral neck anteversion was observed. Seventeen of 21 cases (81%) had retroverted metaphyseal segments (−23.2°+/−17.4°) and/or varus stems (−32.1°+/−13.0°). Neck anteversion averaged 21.4°(+/−10.0°). One of 21 cases (5%) resulted in component orientation similar to a non-modular prosthesis. Modular components provide options to accommodate proximal femoral remodeling not afforded by monobloc stems in total hip revision surgery. PMID:19742077

  14. Total pancreatectomy with islet autotransplantation: an overview

    PubMed Central

    Ong, Seok L; Gravante, Gianpiero; Pollard, Cristina A; Webb, M'Balu A; Illouz, Severine; Dennison, Ashley R

    2009-01-01

    Pain control is one of the most challenging aspects in the management of chronic pancreatitis. Total pancreatectomy can successfully relieve the intractable abdominal pain in these patients but will inevitably result in insulin-dependent diabetes. Islet autotransplantation aims to preserve, as far as possible, the insulin secretory function of the islet cell mass thereby reducing (or even removing) the requirement for exogenous insulin administration after a total pancreactomy. Despite the relatively small number of centres able to perform these procedures, there are important technical variations in the details of their approaches. The aim of this review is to provide details of the current surgical practice for total pancreatectomy combined with islet autotransplantation, and outline the potential advantages and disadvantages of the variations adopted in each centre. PMID:20495628

  15. Total artificial hearts: past, present, and future.

    PubMed

    Cohn, William E; Timms, Daniel L; Frazier, O H

    2015-10-01

    A practical artificial heart has been sought for >50 years. An increasing number of people succumb to heart disease each year, but the number of hearts available for transplantation remains small. Early total artificial hearts mimicked the pumping action of the native heart. These positive-displacement pumps could provide adequate haemodynamic support and maintain the human circulation for short periods, but large size and limited durability adversely affected recipients' quality of life. Subsequent research into left ventricular assist devices led to the use of continuous-flow blood pumps with rotating impellers. Researchers have attempted to integrate this technology into modern total artificial hearts with moderate clinical success. The importance of pulsatile circulation remains unclear. Future research is, therefore, needed into positive-displacement and rotary total artificial hearts. PMID:26031698

  16. KP solitons, total positivity, and cluster algebras

    PubMed Central

    Kodama, Yuji; Williams, Lauren K.

    2011-01-01

    Soliton solutions of the KP equation have been studied since 1970, when Kadomtsev and Petviashvili [Kadomtsev BB, Petviashvili VI (1970) Sov Phys Dokl 15:539–541] proposed a two-dimensional nonlinear dispersive wave equation now known as the KP equation. It is well-known that the Wronskian approach to the KP equation provides a method to construct soliton solutions. The regular soliton solutions that one obtains in this way come from points of the totally nonnegative part of the Grassmannian. In this paper we explain how the theory of total positivity and cluster algebras provides a framework for understanding these soliton solutions to the KP equation. We then use this framework to give an explicit construction of certain soliton contour graphs and solve the inverse problem for soliton solutions coming from the totally positive part of the Grassmannian. PMID:21562211

  17. Total Solar Eclipse of 2006 March 29

    NASA Technical Reports Server (NTRS)

    Espenak, F.; Anderson, J.

    2004-01-01

    On 2006 March 29, a total eclipse of the Sun will be visible from within a narrow corridor which traverses half the Earth. The path of the Moon's umbral shadow begins in Brazil and extends across the Atlantic, northern Africa, and central Asia where it ends at sunset in western Mongolia. A partial eclipse will be seen within the much broader path of the Moon's penumbral shadow, which includes the northern two thirds of Africa, Europe, and central Asia.Detailed predictions for this event are presented and include besselian elements, geographic coordinates of the path of totality, physical ephemeris of the umbra, topocentric limb profile corrections, local circumstances for approximately 350 cities, maps of the eclipse path, weather prospects, the lunar limb profile, and the sky during totality. Information on safe eclipse viewing and eclipse photography is included.

  18. Total Solar Eclipse of 2001 June 21

    NASA Technical Reports Server (NTRS)

    Espenak, Fred; Anderson, Jay

    1999-01-01

    On 2001 June 21, a total eclipse of the Sun will be visible from within a narrow corridor which traverses the Southern Hemisphere. The path of the Moon's umbral shadow begins in the South Atlantic, crosses southern Africa and Madagascar, and ends at sunset in the Indian Ocean. A partial eclipse will be seen within the much broader path of the Moon's penumbral shadow, which includes eastern South America and the southern two thirds of Africa. Detailed predictions for this event are presented and include besselian elements, geographic coordinates of the path of totality, physical ephemeris of the umbra, topocentric limb profile corrections, local circumstances for approximately 350 cities, maps of the eclipse path, weather prospects, the lunar limb profile and the sky during totality. Tips and suggestions are also given on how to safely view and photograph the eclipse.

  19. Total Solar Eclipse of 2002 December 04

    NASA Technical Reports Server (NTRS)

    Espenak, Fred; Anderson, Jay

    2001-01-01

    On 2002 December 04, a total eclipse of the Sun will be visible from within a narrow corridor which traverses the Southern Hemisphere. The path of the Moon's umbral shadow begins in the South Atlantic, crosses southern Africa and the Indian Ocean, and ends at sunset in southern Australia. A partial eclipse will be seen within the much broader path of the Moon's penumbral shadow, which includes the southern two thirds of Africa, Antarctica, Indian Ocean and Australia. Detailed predictions for this event are presented and include besselian elements, geographic coordinates of the path of totality, physical ephemeris of the umbra, topocentric limb profile corrections, local circumstances for approximately 400 cities, maps of the eclipse path, weather prospects, the lunar limb profile and the sky during totality. Information on safe eclipse viewing and eclipse photography is included.

  20. Total Solar Eclipse of 1999 August 11

    NASA Technical Reports Server (NTRS)

    Espenak, Fred; Anderson, Jay

    1997-01-01

    On 1999 August 11, a total eclipse of the Sun will be visible from within a narrow corridor which traverses the Eastern Hemisphere. The path of the Moon's umbral shadow begins in the Atlantic and crosses central Europe, the Middle East, and India, where it ends at sunset in the Bay of Bengal. A partial eclipse will be seen within the much broader path of the Moon's penumbral shadow, which includes northeastern North America, all of Europe, northern Africa, and the western half of Asia. Detailed predictions for this event are presented and include besselian elements, geographic coordinates of the path of totality, physical ephemeris of the umbra, topocentric limb profile corrections, local circumstances for approximately 1400 cities, maps of the eclipse path, weather prospects, the lunar limb profile, and the sky during totality. Tips and suggestions are also given on how to safely view and photograph the eclipse.

  1. Total Solar Eclipse of 1997 March 9

    NASA Technical Reports Server (NTRS)

    Espenak, Fred; Anderson, Jay

    1995-01-01

    A total eclipse of the Sun will be visible from Asia and the Pacific Ocean on 1997 March 9. The path of the Moon's umbral shadow begins in eastern Kazakhstan and travels through Mongolia and eastern Siberia, where it swings northward to end at sunset in the Arctic Ocean. A partial eclipse will be seen within the much broader path of the Moon's penumbral shadow, which includes eastern Asia, the northern Pacific, and the northwest corner of North America. Detailed predictions for this event are presented and include besselian elements, geographic coordinates of the path of totality, physical ephemeris of the umbra, topocentric limb profile corrections, local circumstances for 280 cities, maps of the eclipse path, weather prospects, the lunar limb profile, and the sky during totality. Tips and suggestions are also given on how to safely view and photograph the eclipse.

  2. Uncommon Indications for Reverse Total Shoulder Arthroplasty

    PubMed Central

    Hyun, Yoon Suk; Huri, Gazi; Garbis, Nickolas G.

    2013-01-01

    Total shoulder arthroplasty and shoulder hemiarthroplasty have been the traditional method for treating a variety of shoulder conditions, including arthritis, cuff tear arthropathy, and some fracture types. However, these procedures did not provide consistently good results for patients with torn rotator cuffs. The development of the reverse prosthesis by Grammont in the late 20th century revolutionized the treatment of the rotator-cuff-deficient shoulder with arthritis. The main indication for the reverse prosthesis remains the patient with cuff tear arthropathy who has pain and loss of motion. Because the reverse total shoulder arthroplasty produced such good results in these patients, the indications for the reverse prosthesis have expanded to include other shoulder conditions that have previously been difficult to treat successfully and predictably. This review discusses and critically reviews these newer indications for the reverse total shoulder arthroplasty. PMID:24340143

  3. Total Solar Eclipse of 2008 August 01

    NASA Technical Reports Server (NTRS)

    Espenak, F.; Anderson, J.

    2007-01-01

    On 2008 August 01, a total eclipse of the Sun is visible from within a narrow corridor that traverses half the Earth. The path of the Moon's umbral shadow begins in northern Canada and extends across Greenland, the Arctic, central Russia, Mongolia, and China. A partial eclipse is seen within the much broader path of the Moon's penumbral shadow, which includes northeastern North America, most of Europe and Asia. Detailed predictions for this event are presented and include besselian elements, geographic coordinates of the path of totality, physical ephemeris of the umbra, topocentric limb profile corrections, local circumstances for 308 cities, maps of the eclipse path, weather prospects, the lunar limb profile and the sky during totality. Information on safe eclipse viewing and eclipse photography is included.

  4. Correlations between corneal and total wavefront aberrations

    NASA Astrophysics Data System (ADS)

    Mrochen, Michael; Jankov, Mirko; Bueeler, Michael; Seiler, Theo

    2002-06-01

    Purpose: Corneal topography data expressed as corneal aberrations are frequently used to report corneal laser surgery results. However, the optical image quality at the retina depends on all optical elements of the eye such as the human lens. Thus, the aim of this study was to investigate the correlations between the corneal and total wavefront aberrations and to discuss the importance of corneal aberrations for representing corneal laser surgery results. Methods: Thirty three eyes of 22 myopic subjects were measured with a corneal topography system and a Tschernig-type wavefront analyzer after the pupils were dilated to at least 6 mm in diameter. All measurements were centered with respect to the line of sight. Corneal and total wavefront aberrations were calculated up to the 6th Zernike order in the same reference plane. Results: Statistically significant correlations (p < 0.05) between the corneal and total wavefront aberrations were found for the astigmatism (C3,C5) and all 3rd Zernike order coefficients such as coma (C7,C8). No statistically significant correlations were found for all 4th to 6th order Zernike coefficients except for the 5th order horizontal coma C18 (p equals 0.003). On average, all Zernike coefficients for the corneal aberrations were found to be larger compared to Zernike coefficients for the total wavefront aberrations. Conclusions: Corneal aberrations are only of limited use for representing the optical quality of the human eye after corneal laser surgery. This is due to the lack of correlation between corneal and total wavefront aberrations in most of the higher order aberrations. Besides this, the data present in this study yield towards an aberration balancing between corneal aberrations and the optical elements within the eye that reduces the aberration from the cornea by a certain degree. Consequently, ideal customized ablations have to take both, corneal and total wavefront aberrations, into consideration.

  5. Imaging Total Stations - Modular and Integrated Concepts

    NASA Astrophysics Data System (ADS)

    Hauth, Stefan; Schlüter, Martin

    2010-05-01

    Keywords: 3D-Metrology, Engineering Geodesy, Digital Image Processing Initialized in 2009, the Institute for Spatial Information and Surveying Technology i3mainz, Mainz University of Applied Sciences, forces research towards modular concepts for imaging total stations. On the one hand, this research is driven by the successful setup of high precision imaging motor theodolites in the near past, on the other hand it is pushed by the actual introduction of integrated imaging total stations to the positioning market by the manufacturers Topcon and Trimble. Modular concepts for imaging total stations are manufacturer independent to a large extent and consist of a particular combination of accessory hardware, software and algorithmic procedures. The hardware part consists mainly of an interchangeable eyepiece adapter offering opportunities for digital imaging and motorized focus control. An easy assembly and disassembly in the field is possible allowing the user to switch between the classical and the imaging use of a robotic total station. The software part primarily has to ensure hardware control, but several level of algorithmic support might be added and have to be distinguished. Algorithmic procedures allow to reach several levels of calibration concerning the geometry of the external digital camera and the total station. We deliver insight in our recent developments and quality characteristics. Both the modular and the integrated approach seem to have its individual strengths and weaknesses. Therefore we expect that both approaches might point at different target applications. Our aim is a better understanding of appropriate applications for robotic imaging total stations. First results are presented. Stefan Hauth, Martin Schlüter i3mainz - Institut für Raumbezogene Informations- und Messtechnik FH Mainz University of Applied Sciences Lucy-Hillebrand-Straße 2, 55128 Mainz, Germany

  6. Failure of aseptic revision total knee arthroplasties

    PubMed Central

    Leta, Tesfaye H; Lygre, Stein Håkon L; Skredderstuen, Arne; Hallan, Geir; Furnes, Ove

    2015-01-01

    Background and purpose In Norway, the proportion of revision knee arthroplasties increased from 6.9% in 1994 to 8.5% in 2011. However, there is limited information on the epidemiology and causes of subsequent failure of revision knee arthroplasty. We therefore studied survival rate and determined the modes of failure of aseptic revision total knee arthroplasties. Method This study was based on 1,016 aseptic revision total knee arthroplasties reported to the Norwegian Arthroplasty Register between 1994 and 2011. Revisions done for infections were not included. Kaplan-Meier and Cox regression analyses were used to assess the survival rate and the relative risk of re-revision with all causes of re-revision as endpoint. Results 145 knees failed after revision total knee arthroplasty. Deep infection was the most frequent cause of re-revision (28%), followed by instability (26%), loose tibial component (17%), and pain (10%). The cumulative survival rate for revision total knee arthroplasties was 85% at 5 years, 78% at 10 years, and 71% at 15 years. Revision total knee arthroplasties with exchange of the femoral or tibial component exclusively had a higher risk of re-revision (RR = 1.7) than those with exchange of the whole prosthesis. The risk of re-revision was higher for men (RR = 2.0) and for patients aged less than 60 years (RR = 1.6). Interpretation In terms of implant survival, revision of the whole implant was better than revision of 1 component only. Young age and male sex were risk factors for re-revision. Deep infection was the most frequent cause of failure of revision of aseptic total knee arthroplasties. PMID:25267502

  7. An Operational Perspective of Total Lightning Information

    NASA Technical Reports Server (NTRS)

    Nadler, David J.; Darden, Christopher B.; Stano, Geoffrey; Buechler, Dennis E.

    2009-01-01

    The close and productive collaborations between the NWS Warning and Forecast Office, the Short Term Prediction and Research Transition Center at NASA Marshall Space Flight Center and the University of Alabama in Huntsville have provided a unique opportunity for science sharing and technology transfer. One significant technology transfer that has provided immediate benefits to NWS forecast and warning operations is the use of data from the North Alabama Lightning Mapping Array. This network consists of ten VHF receivers deployed across northern Alabama and a base station located at the National Space Science and Technology Center. Preliminary investigations done at WFO Huntsville, along with other similar total lightning networks across the country, have shown distinct correlations between the time rate-of-change of total lightning and trends in intensity/severity of the parent convective cell. Since May 2003 when WFO HUN began receiving these data - in conjunction with other more traditional remotely sensed data (radar, satellite, and surface observations) -- have improved the situational awareness of the WFO staff. The use of total lightning information, either from current ground based systems or future space borne instrumentation, may substantially contribute to the NWS mission, by enhancing severe weather warning and decision-making processes. Operational use of the data has been maximized at WFO Huntsville through a process that includes forecaster training, product implementation, and post event analysis and assessments. Since receiving these data, over 50 surveys have been completed highlighting the use of total lightning information during significant events across the Tennessee Valley. In addition, around 150 specific cases of interest have been archived for collaborative post storm analysis. From these datasets, detailed trending information from radar and total lightning can be compared to corresponding damage reports. This presentation will emphasize the effective use of total lightning information in warning decision making along with best practices for implementation of new technologies into operations.

  8. Nucleon-Nucleon Total Cross Section

    NASA Technical Reports Server (NTRS)

    Norbury, John W.

    2008-01-01

    The total proton-proton and neutron-proton cross sections currently used in the transport code HZETRN show significant disagreement with experiment in the GeV and EeV energy ranges. The GeV range is near the region of maximum cosmic ray intensity. It is therefore important to correct these cross sections, so that predictions of space radiation environments will be accurate. Parameterizations of nucleon-nucleon total cross sections are developed which are accurate over the entire energy range of the cosmic ray spectrum.

  9. Laparoscopic total extraperitoneal repair of lumbar hernia

    PubMed Central

    Lim, Man Sup; Lee, Hae Wan; Yu, Chang Hee

    2011-01-01

    Lumbar hernia is a rare surgical entity without a standard method of repair. With advancements in laparoscopic techniques, successful lumbar herniorrhaphy can be achieved by the creation of a completely extraperitoneal working space and secure fixation of a wide posterior mesh. We present a total extraperitoneal laparoendoscopic repair of lumbar hernia, which allowed for minimal invasiveness while providing excellent anatomical identification, easy mobilization of contents and wide secure mesh fixation. A total extraperitoneal method of lumbar hernia repair by laparoscopic approach is feasible and may be an ideal option. PMID:22111086

  10. Employee benefits in a total rewards framework.

    PubMed

    Kwon, Jane; Hein, Pam

    2013-01-01

    Benefits represent one of the largest investments a company makes in its talent. However, our tendency can be to design, deliver and communicate benefits programs independently, without fully considering how those programs fit within a bigger picture of total rewards. Sure, we need to manage and execute individual benefit programs--but not at the expense of getting a real return on our more significant investment in talent. This article provides employers with perspectives on the value of managing benefits within the broader framework of total rewards, why it works and, most importantly, how to make it work. PMID:23488085

  11. Measuring Total and Germinable Spore Populations

    NASA Technical Reports Server (NTRS)

    Noell, A.C.; Yung, P.T.; Yang, W.; Lee, C.; Ponce, A.

    2011-01-01

    It has been shown that bacterial endospores can be enumerated using a microscopy based assay that images the luminescent halos from terbium ions bound to dipicolinic acid, a spore specific chemical marker released upon spore germination. Further development of the instrument has simplified it towards automation while at the same time improving image quality. Enumeration of total spore populations has also been developed allowing measurement of the percentage of viable spores in any population by comparing the germinable/culturable spores to the total. Percentage viability will allow a more quantitative comparison of the ability of spores to survive across a wide range of extreme environments.

  12. Determination of total solutes in synfuel wastewaters

    SciTech Connect

    Wallace, J.R.; Bonomo, F.S.

    1984-03-01

    Efforts to investigate both lyophilization and the measurement of colligative properties as an indication of total solute content are described. The objective of the work described is to develop a method for measuring total dissolved material in retort wastewaters which is simple and rugged enough to be performed in a field laboratory in support of pollution control tests. The analysis should also be rapid enough to provide timely and pertinent data to the pollution control plant operator. To be of most value, the technique developed also should be applicable to other synfuel wastewaters, most of which contain similar major components as oil shale retort waters. 4 references, 1 table.

  13. [Staged total cavopulmonary connection following Starnes operation].

    PubMed

    Tsuru, Yusuke; Kumagai, K; Endo, M; Tabayashi, K; Ohmi, M

    2004-07-01

    A three-year-old boy with Ebstein's anomaly, who had received Starnes operation in the neonate state, successfully underwent staged total cavopulmonary connection. Despite of hypoplasticity of the pulmonary artery, the postoperative cardiac catheterization showed no elevation of pulmonary artery pressure and good cardiac performance. Although he suffered from supraventricular tachycardia in the early postoperative period, subsequent course was uneventful. PMID:15285379

  14. Total Quality Management: The Emperor's Tailor.

    ERIC Educational Resources Information Center

    Alexander, Gary C.; Keeler, Carolyn M.

    Conversations among educators, business leaders, legislators, and educational reformers have generated support for the application of Total Quality Management (TQM) to education. This paper considers whether TQM is indeed the solution to education's problems. After a brief explanation of TQM theory, the paper is organized around four broad issues…

  15. Multicultural Leadership, Sustainable Total School Environment

    ERIC Educational Resources Information Center

    Yeung, See-Wai Alison; Lee, Yeung; Yue, K. W. Ryan

    2006-01-01

    Banks (2002) stated that to implement multicultural education successfully, we must think of the school as a social system. Therefore, if educational equity and excellence are to be provided to all students, a systemic Total School Environment [Banks (2001) "Cultural diversity and education: Foundations curriculum and teaching, 4th ed." Allyn and…

  16. Total Quality Management in Higher Education.

    ERIC Educational Resources Information Center

    Rieley, James B.

    In order for an educational institution to utilize Total Quality Management as a tool for improving effectiveness, the culture of the college must foster a belief in change and a focus on the customer. A disciplined approach to planning and a commitment to the concept of Continuous Improvement (CI) are also required. Concerning acceptance of…

  17. Biomimetic total synthesis of (-)-isatisine A.

    PubMed

    Wu, Wei; Xiao, Mingxing; Wang, Jiangbing; Li, Ying; Xie, Zhixiang

    2012-03-16

    The biomimetic total synthesis of (-)-isatisine A, a novel alkaloid with an unprecedented fused tetracyclic skeleton, was accomplished in 8 steps from indole and 4,6-O-isopropylidene-protected glucal. The synthesis features a convergent synthetic strategy which relies on nucleophilic addition and a biomimetic benzilic ester rearrangement as key reactions. PMID:22372625

  18. Total synthesis of (±)-hippolachnin A.

    PubMed

    Ruider, Stefan A; Sandmeier, Tobias; Carreira, Erick M

    2015-02-16

    The first total synthesis of the marine polyketide (±)-hippolachnin A has been achieved in nine linear steps and an overall yield of 9%. Rapid access to the oxacyclobutapentalene core structure was secured by strategic application of an ene cyclization. PMID:25476132

  19. Nutrition, total fluid and bladder cancer.

    PubMed

    Brinkman, Maree; Zeegers, Maurice P

    2008-09-01

    Bladder cancer is a major health concern for older males in Western populations. About 30 years ago there was a suggestion that nutrition may have a role in the aetiology of the disease. Although the literature has been accumulating since then, owing to heterogeneity between studies results have often been inconsistent and unclear. The aim of this paper was to present an updated summary of the scientific evidence on the association between nutrition, total fluid intake and bladder cancer. A search of computerized databases, PubMed, ISI, Embase and Cochrane Library, was conducted to identify all epidemiological studies published between 1966 and October 2007. The level of scientific evidence for the various nutritional factors and total fluid intake was ranked according to the number of studies reporting a statistically significant association and the existence of mechanistic evidence. The levels of association were based on a ranking of statistically significant relative risks. Fruit and yellow-orange vegetables, particularly carrots and selenium, are probably associated with a moderately reduced risk of bladder cancer. Citrus fruits and cruciferous vegetables were also identified as having a possible protective effect. Possible risk factors are salted and barbecued meat, pork, total fat, pickled vegetables, salt, soy products, spices and artificial sweeteners. No clear association could be determined for beef, eggs, processed meats and total fluid intake. In conclusion, specific fruit and vegetables may act to reduce the risk of bladder cancer. Future studies on bladder cancer should investigate the effect of food categorization, amount and gender. PMID:18815914

  20. Mineral Analysis of Whole Grain Total Cereal

    ERIC Educational Resources Information Center

    Hooker, Paul

    2005-01-01

    The quantitative analysis of elemental iron in Whole Grain Total Cereal using visible spectroscopy is suitable for a general chemistry course for science or nonscience majors. The more extensive mineral analysis, specifically for the elements iron, calcium and zinc, is suitable for an instrumental or quantitative analysis chemistry course.

  1. Total main rotor isolation system analysis

    NASA Technical Reports Server (NTRS)

    Sankewitsch, V.

    1981-01-01

    Requirements, preliminary design, and verification procedures for a total main rotor isolation system at n/rev are presented. The fuselage is isolated from the vibration inducing main rotor at one frequency in all degrees of freedom by four antiresonant isolation units. Effects of parametric variations on isolation system performance are evaluated.

  2. Application of Total Quality Management in Education

    ERIC Educational Resources Information Center

    Farooq, M. S.; Akhtar, M. S.; Ullah, S. Zia; Memon, R. A.

    2007-01-01

    The purpose of the paper is to analyzing thoughts of the modern management paradigm "Total Quality Management" (TQM), and its application in the field of education. The basic theme of TQM is participatory approach to address the question(s) of quality in business aswell as in the field of education. Reviewing fresh literature from the internet …

  3. Total Quality Management in Higher Education.

    ERIC Educational Resources Information Center

    Sherr, Lawrence A.; Lozier, G. Gredgory

    1991-01-01

    Total Quality Management, based on theories of W. Edward Deming and others, is a style of management using continuous process improvement characterized by mission and customer focus, a systematic approach to operations, vigorous development of human resources, long-term thinking, and a commitment to ensuring quality. The values espoused by this…

  4. Coordinating Council. Ninth Meeting: Total Quality Management

    NASA Technical Reports Server (NTRS)

    1992-01-01

    This report summarizes the 9th meeting of the STI Coordinating Council. The council listened to the speakers' understanding of Total Quality Management (TQM) principles and heard stories of successful applications of these principles. Definitions of quality stated were focused on customer satisfaction. Reports presented by the speakers are also included.

  5. English in a Program of Total Innovation

    ERIC Educational Resources Information Center

    Knoll, Robert E.

    1970-01-01

    Explains an experimental program designed to give the student a total look at himself and his society through literature, politics, and history; a paper presented at annual convention of National Council of Teachers of English (Washington, D. C., November 28, 1969) and published in Kansas English" (February 1970). (Editor/SW)

  6. Total Quality Management. ERIC Digest, Number 73.

    ERIC Educational Resources Information Center

    Weaver, Tyler

    The Japanese success story has made W. Edwards Deming's Total Quality Management (TQM) theory increasingly popular among American managers, from car manufacturers to educational leaders. TQM is based on two tenets: the primacy of customer satisfaction and the necessity of tapping nontraditional sources (especially employee ideas) to institute…

  7. A Campus Is a Total Community.

    ERIC Educational Resources Information Center

    Hunt, Robert E.

    1979-01-01

    Described are the various components of the total college or university community and their associated environmental health and safety problems. Included are food service, insect and rodent control, multi-use athletic facilities, housing, laboratory animal facilities, laboratory biosafety, radiological health, fire protection, and emergency

  8. Total Quality Management: Implications for Higher Education.

    ERIC Educational Resources Information Center

    Hoffman, Allan M., Ed.; Julius, Daniel J., Ed.

    This book contains 19 papers describing the implementation of Total Quality Management in a variety of higher education settings. Following a Foreword by Peter Likins and a Preface by Daniel J. Julius, the chapter titles and authors are: (1) "TQM: Implications for Higher Education--A Look Back to the Future" (Allan M. Hoffman and Randall Summers);…

  9. A Campus Is a Total Community.

    ERIC Educational Resources Information Center

    Hunt, Robert E.

    1979-01-01

    Described are the various components of the total college or university community and their associated environmental health and safety problems. Included are food service, insect and rodent control, multi-use athletic facilities, housing, laboratory animal facilities, laboratory biosafety, radiological health, fire protection, and emergency…

  10. Applying Total Quality Management in Cooperative Extension.

    ERIC Educational Resources Information Center

    Fredendall, Lawrence D.; Lippert, Robert M.

    1995-01-01

    South Carolina's Agricultural Service Laboratory received responses from 252 of 500 farmers who currently use the soil testing service; 97% were pleased with accuracy, 89% with turnaround time, 18% thought the fee too high. Nonusers (100 of 520) were mainly dissatisfied with turnaround time. Total quality management methods were used to improve…

  11. Strainrange partitioning: A total strain range version

    NASA Technical Reports Server (NTRS)

    Halford, G. R.; Saltsman, J. F.

    1983-01-01

    Procedures are presented for expressing the Strainrange Partitioning (SRP) method for creep fatigue life prediction in terms of total strain range. Inelastic and elastic strain-range - life relations are summed to give total strain-range - life relations. The life components due to inelastic strains are dealt with using conventional SRP procedures while the life components due to elastic strains are expressed as families of time-dependent terms for each type of SRP cycle. Cyclic constitutive material behavior plays an important role in establishing the elastic strain-range - life relations as well as the partitioning of the inelastic strains. To apply the approach, however, it is not necessary to have to determine the magnitude of the inelastic strain range. The total strain SRP approach is evaluated and verified using two nickel base superalloys, AF2-1DA and Rene 95. Excellent agreement is demonstrated between observed and predicted cyclic lifetimes with 70 to 80 percent of the predicted lives falling within factors of two of the observed lives. The total strain-range SRP approach should be of considerable practical value to designers who are faced with creep-fatigue problems for which the inelastic strains cannot be calculated with sufficient accuracy to make reliable life predictions by the conventional inelastic strain range SRP approach.

  12. Recurrent hemarthrosis after total knee arthroplasty

    PubMed Central

    Rukavina, Alexander; Schneider, Philipp; Kuster, Markus S.

    2010-01-01

    This report describes a case of spontaneous recurrent hemarthrosis of the knee that presented 4 weeks after total knee arthroplasty. Femoral arteriography showed a false aneurysm of a branch of the inferior lateral geniculate artery. Therapeutic embolization of the arterial branch was performed using three platinum coils with good clinical result and good knee joint function. Hemarthrosis has not recurred since embolization. PMID:20076944

  13. Enantioselective total synthesis of (-)-erinacine B.

    PubMed

    Watanabe, Hideaki; Takano, Masashi; Umino, Akinori; Ito, Toshiya; Ishikawa, Hiroyuki; Nakada, Masahisa

    2007-01-18

    The first enantioselective total synthesis of (-)-erinacine B has been achieved. Our approach features convergent construction of the 5-6-7 tricyclic cyathane core system via chiral building blocks prepared using asymmetric catalysis developed by us and highly stereoselective construction of all stereogenic centers in the aglycon. [reaction: see text]. PMID:17217304

  14. Total Quality Management: Implications for Educational Assessment.

    ERIC Educational Resources Information Center

    Rankin, Stuart C.

    1992-01-01

    Deming's "System of Profound Knowledge" is even more fundamental than his 14-principle system transformation guide and is based on 4 elements: systems theory, statistical variation, a theory of knowledge, and psychology. Management should revamp total system processes so that quality of product is continually improved. Implications for educational

  15. The Leica TCRA1105 Reflectorless Total Station

    SciTech Connect

    Gaudreault, F.

    2005-09-06

    This poster provides an overview of SLAC's TCRA1105 reflectorless total station for the Alignment Engineering Group. This instrument has shown itself to be very useful for planning new construction and providing quick measurements to difficult to reach or inaccessible surfaces.

  16. The Total Solar Eclipse, March 1970

    ERIC Educational Resources Information Center

    Glenn, William H.

    1970-01-01

    Describes the circumstances of the total and partial solar eclipse of March 7, 1970 in certain American cities. Also discussed are (1) a classroom demonstration of the cause of solar eclipses, (2) techniques for safely observing the eclipse, and (3) what to observe during the eclipse. Bibliography. (LC)

  17. Total Quality Management (TQM) in Higher Education.

    ERIC Educational Resources Information Center

    Sullivan, Michael F.

    This document consists largely of paper versions of the transparencies used by the author to give his conference paper on Total Quality Management (TQM) in the college and university setting. An introduction lists a series of definitional phrases, a list of what TQM is not, and 11 fundamental principles describing what TQM is. The three major…

  18. [Standardized total fertility rates by prefectures].

    PubMed

    Yamaguchi, K; Kasahara, R

    1983-10-01

    Data on standardized total fertility rates in Japan by prefecture are presented. A table shows 7 age divisions of women ranging from 15-49 on the national level as well as in Tokyo. The ratio of married females to total number of females in the nation, then the ratio of the number of births in Tokyo to the number of married females in Tokyo, and finally the ratio of the former to the latter are calculated. Data indicating normal and standard fertility rates in 1970, 1972, 1975, and 1980 are given for the nation as well as for each prefecture in Japan. Another table gives normal and standard fertility rates for the nation and each prefecture in 1972, 1977, 1982, and 1987. Using these data, the maximum and minimum normal as well as standardized total fertility rates for 1970, 1975, and 1980, are presented in addition to the distribution ranges, averages, standard deviations, and fluctuation coefficients. In 1980, the Okinawa prefecture had the maximum normal (2.378) and standardize (2.376) total fertility rates, Tokyo had the minimum normal fertility rate (1.437), and Toyama had the minimum standardized fertility rate (1.562). In 1980, the average standardized fertility rate in Japan was 1.781, the distribution range was .814, the standard deviation was .145, and the fluctuation coefficient was 8.1%. PMID:12155000

  19. Revitalizing Space Operations through Total Quality Management

    NASA Technical Reports Server (NTRS)

    Baylis, William T.

    1995-01-01

    The purpose of this paper is to show the reader what total quality management (TQM) is and how to apply TQM in the space systems and management arena. TQM is easily understood, can be implemented in any type of business organization, and works.

  20. Total Quality Management Goes to Community College.

    ERIC Educational Resources Information Center

    DeCosmo, Richard D.; And Others

    1991-01-01

    This article details the four-year implementation of Total Quality Management at Delaware County Community College (Pennsylvania) to conserve resources, improve effectiveness, assure quality, and increase participation in decision making. Reported are planning, execution, and monitoring activities of the Implementation Team; specific problems…

  1. Total Quality Management: Making Camps Successful.

    ERIC Educational Resources Information Center

    Trotter, Kathleen M.

    1995-01-01

    Total Quality Management for camps involves establishing ongoing assessment of campers' and parents' needs, marketing the capabilities of the organization, applying input of key staff members, and constantly making program improvements. This approach calls for discretionary decision making at all levels, and empowers staff to enter into the…

  2. Total internal reflection laser tools and methods

    DOEpatents

    Zediker, Mark S.; Faircloth, Brian O.; Kolachalam, Sharath K.; Grubb, Daryl L.

    2016-02-02

    There is provided high power laser tools and laser heads that utilize total internal reflection ("TIR") structures to direct the laser beam along a laser beam path within the TIR structure. The TIR structures may be a TIR prism having its hypotenuse as a TIR surface.

  3. Total Quality Management in Libraries: A Sourcebook.

    ERIC Educational Resources Information Center

    O'Neil, Rosanna M., Comp.

    Total Quality Management (TQM) brings together the best aspects of organizational excellence by driving out fear, offering customer-driven products and services, doing it right the first time by eliminating error, and maintaining inventory control without waste. Libraries are service organizations which are constantly trying to improve service.…

  4. Total Energy Management for Minnesota Schools.

    ERIC Educational Resources Information Center

    Minnesota State Dept. of Energy, Planning and Development, St. Paul.

    Total Energy Management (TEM) is a unified, planned approach to reducing the energy use and costs of an individual school or school district. The program increases energy awareness and improves school energy efficiency through: (1) careful energy accounting; (2) changes in operations and maintenance procedures; (3) modifications in the building…

  5. Total main rotor isolation system analysis

    NASA Technical Reports Server (NTRS)

    Halwes, D. R.

    1981-01-01

    The requirements for a preliminary design study and verification procedure for a total main rotor isolation system at n/rev are established. The system is developed and analyzed, and predesign drawings are created for an isolation system that achieves over 95 percent isolation of all six degrees of freedom.

  6. PROCEDURE FOR ESTIMATING PERMANENT TOTAL ENCLOSURE COSTS

    EPA Science Inventory

    The paper discusses a procedure for estimating permanent total enclosure (PTE) costs. (NOTE: Industries that use add-on control devices must adequately capture emissions before delivering them to the control device. One way to capture emissions is to use PTEs, enclosures that mee...

  7. Total proctocolectomy, pancreaticoduodenectomy and total gastrectomy for multiple carcinomas in a patient with familial adenomatous polyposis.

    PubMed

    Schachter, P P; Alfie, M; Leukemovich, P; Horowitz, A; Ayalon, A

    1994-11-01

    A unique case of familial adenomatous polyposis presenting with simultaneous adenocarcinoma of the periampullary region, gallbladder and several gastric lesions, 10 years after a total proctocolectomy, is reported. Multiple gastrointestinal carcinomas associated with familial polyposis have been reported sporadically. However, this is the only known patient who successfully underwent a pancreaticoduodenectomy (Whipple procedure) and a total gastrectomy in addition to a previous total proctocolectomy. PMID:7982773

  8. Temporal bone chondroblastoma totally invisible on MRI.

    PubMed

    Hiraumi, Harukazu; Arakawa, Yoshiki; Yamamoto, Norio; Sakamoto, Tatsunori; Ito, Juichi

    2016-08-01

    We report a case of temporal bone chondroblastoma that was totally invisible on MRI. The patient was a 64-year-old man who presented with several months history of vertigo. The CT scan with bone window setting showed destruction of the temporomandibular joint, the floor of the middle cranial fossa, and the superior semicircular canal. Calcific foci were seen within the tumor. On MR imaging, the tumor, situating mainly medial to the temporomandibular joint, showed no signal on both T1- and T2-weighted images. The tumor was not enhanced with gadolinium. In summary, the tumor was totally signal negative or "invisible" on pre- and postcontrast T1- and T2-weighted images. The tumor was resected through transpetrosal - transzygomatic approach. PMID:26743837

  9. Pain Management After Total Joint Arthroplasty.

    PubMed

    McDonald, Lisa T; Corbiere, Nicole C; DeLisle, Jay A; Clark, Alexander Martin; Kuxhaus, Laurel

    2016-06-01

    Controlling pain after total joint arthroplasty (TJA) is critical to minimizing complications, decreasing costs, and expediting patients' return to function. We implemented a TJA multimodal pain management protocol at a Level III trauma center in a small, rural community in New York. We retrospectively reviewed 266 patient charts and collected patient demographics, pain management information, and discharge data. Our primary goals were to quantify the total number of narcotic medication doses used and length of hospital stay. The multimodal pain management protocol significantly reduced the number of narcotic doses used (P < .01). Hospital length of stay decreased slightly; although not statistically significant (P = .25), this may be clinically significant. Gender, age, and type of arthroplasty (ie, knee, hip) were not significant factors. A multimodal approach to pain management after TJA can reduce narcotic use and hospital length of stay, thereby also reducing the incidence of side effects from narcotics. PMID:27234795

  10. Solar Total Energy Project Shenandoah, Georgia

    SciTech Connect

    King, J.W.; Geurts, G.F.

    1983-06-01

    The Solar Total Energy Project (STEP) at Shenandoah, Georgia is the world's largest industrial application of solar cogeneration. It is a cooperative effort between the U. S. Department of Energy (DOE) and the Georgia Power Company to further America's search for alternative sources of energy. It is an outgrowth of research started in 1972 by Sandia National Laboratories for the U. S. Energy Research and Development Administration. The objective of the Shenandoah project is to evaluate a solar total energy system that provides electrical power, process steam, and air conditioning for a knitwear factory operated by Bleyle of America, Inc. Solar energy will displace a large part of the electricity and fossil fuels normally used to run the factory and produce the clothing.

  11. Generalized Principles of Unchanging Total Concentration

    PubMed Central

    Kottke, Peter A.; Fedorov, Andrei G.

    2008-01-01

    We consider transport of multiple reacting species under the continuum assumption in situations such as those that frequently arise in electroanalytical chemistry. Under certain limitations, it has been shown that the total species concentration (as defined by Oldham and Feldberg1) of such a system is uniform and constant. In this work, we extend the limits of the previous analysis to enable greater applicability. This is accomplished by using either of two new dependent variables, which are generalizations of the concept of total concentration. Then conditions are determined under which the dependent variable will be uniform, and constant in time. From a practical viewpoint, the described formalism allows one to simplify the multispecies transport problem formulation by eliminating one equation from the system of governing equations. PMID:16853140

  12. Total body irradiation in chronic myeloid leukemia

    SciTech Connect

    Advani, S.H.; Dinshaw, K.A.; Nair, C.N.; Ramakrishnan, G.

    1983-04-01

    Total body irradiation (TBI), given as 10 rad daily for five days a week for a total dose of 150 rad has been used in an attempt to control the chronic phase of chronic myeloid leukemia (CML). Thirteen patients with CML received fractionated TBI leading to rapid and good control of WBC count without any adverse reaction. The chronic phase of CML could also be controlled with TBI, even in three patients who were resistant to busulfan. Following TBI, WBC count remained under control for a period of 32 weeks as compared to 40 weeks following vusulfan alone. Repeat TBI was also well tolerated with good response. It appears that TBI is an effective and safe therapy for controlling the chronic phase of CML.

  13. Generalized Higher Degree Total Variation (HDTV) Regularization

    PubMed Central

    Hu, Yue; Ongie, Greg; Ramani, Sathish; Jacob, Mathews

    2015-01-01

    We introduce a family of novel image regularization penalties called generalized higher degree total variation (HDTV). These penalties further extend our previously introduced HDTV penalties, which generalize the popular total variation (TV) penalty to incorporate higher degree image derivatives. We show that many of the proposed second degree extensions of TV are special cases or are closely approximated by a generalized HDTV penalty. Additionally, we propose a novel fast alternating minimization algorithm for solving image recovery problems with HDTV and generalized HDTV regularization. The new algorithm enjoys a ten-fold speed up compared to the iteratively reweighted majorize minimize algorithm proposed in a previous work. Numerical experiments on 3D magnetic resonance images and 3D microscopy images show that HDTV and generalized HDTV improve the image quality significantly compared with TV. PMID:24710832

  14. Joint load considerations in total knee replacement.

    PubMed

    Kuster, M S; Wood, G A; Stachowiak, G W; Gächter, A

    1997-01-01

    Estimates of knee joint loadings were calculated for 12 normal subjects from kinematic and kinetic measures obtained during both level and downhill walking. The maximum tibiofemoral compressive force reached an average load of 3.9 times body-weight (BW) for level walking and 8 times BW for downhill walking, in each instance during the early stance phase. Muscle forces contributed 80% of the maximum bone-on-bone force during downhill walking and 70% during level walking whereas the ground reaction forces contributed only 20% and 30% respectively. Most total knee designs provide a tibiofemoral contact area of 100 to 300 mm2. The yield point of these polyethylene inlays will therefore be exceeded with each step during downhill walking. Future evaluation of total knee designs should be based on a tibiofemoral joint load of 3.5 times BW at 20 degrees knee flexion, 8 times BW at 40 degrees and 6 times BW at 60 degrees. PMID:9020457

  15. Total Internal Reflection Fluorescence (TIRF) Microscopy

    PubMed Central

    Fish, Kenneth N.

    2015-01-01

    Total internal reflection fluorescence (TIRF) microscopy (TIRFM) is an elegant optical technique that provides for the excitation of fluorophores in an extremely thin axial region (‘optical section’). The method is based on the principle that when excitation light is totally internally reflected in a transparent solid (e.g., coverglass) at its interface with liquid an electromagnetic field, called the evanescent wave, is generated in the liquid at the solid-liquid interface and is the same frequency as the excitation light. Since the intensity of the evanescent wave exponentially decays with distance from the surface of the solid, only fluorescent molecules within a few hundred nanometers of the solid are efficiently excited. This unit will briefly review the history, optical theory, and the different hardware configurations used in TIRFM. In addition, it will provide experimental details and methodological considerations for studying receptors at the plasma membrane in neurons. PMID:19816922

  16. Metallosis in a total knee arthroplasty

    PubMed Central

    Vivegananthan, Bhairavi; Shah, Rohi; Karuppiah, A S; Karuppiah, S V

    2014-01-01

    A 70-year-old woman presented with right knee pain and a ‘grinding’ sensation 6 months after a total knee replacement for osteoarthritis. Clinical examination revealed a valgus deformity, patellofemoral crepitus and a reduced knee flexion. Radiographs revealed distinctive findings including the ‘bubble sign’, ‘cloud sign’ and the ‘metal line sign’, which are diagnostic of metallosis.Metallosis is an uncommon complication of total joint replacements, where bone and periprosthetic soft tissues are infiltrated by metallic debris from wearing of the prostheses. This usually occurs in high-wear joints such as hips and knees. Treatment for patients diagnosed with metallosis is synovectomy and a revision surgery. Our patient underwent revision surgery 5 years after her initial surgery. PMID:24642179

  17. [Bearing selection in total hip arthroplasty].

    PubMed

    Sonntag, R; Reinders, J; Mller, U; Kretzer, J P

    2015-12-01

    Different bearing materials are available in total hip arthroplasty and it's the surgeon who has the choice between hard-on-soft, hard-on-hard and alternative materials. Ideally, the material selection should rely on evidence-based data regarding the wear performance, the incidence of revision surgery and other potential bearing-associated risk factors for the corresponding combinations of materials in the individual patient. While there are high-quality studies available for some materials, adequate data is lacking for other materials. Therefore, the current article aims to provide bearing selection criteria for the surgeon and to review the current literature regarding different combinations of bearing materials in total hip arthroplasty. PMID:26367145

  18. Total quality management and the silent patient.

    PubMed

    Mills, Ann E; Rorty, Mary V

    2002-10-01

    This essay examines the impact of the imposition of businesses techniques, in particular, those associated with Total Quality Management, on the relationships of important components of the health care delivery system, including payers, managed care organizations, institutional and individual providers, enrollees, and patients. It examines structural anomalies within the delivery system and concludes that the use of Total Quality Management techniques within the health care system cannot prevent the shift of attention of other components away from the enrollee and the patient, and may even contribute to it. It speculates that the organization ethics process may serve as a quality control mechanism to prevent this shift and so help eliminate some of the ethically problematic processes and outcomes within the health care delivery system. PMID:12708457

  19. Total synthesis of palau'amine

    PubMed Central

    Namba, Kosuke; Takeuchi, Kohei; Kaihara, Yukari; Oda, Masataka; Nakayama, Akira; Nakayama, Atsushi; Yoshida, Masahiro; Tanino, Keiji

    2015-01-01

    Palau'amine has received a great deal of attention in the past two decades as an attractive synthetic target by virtue of its intriguing molecular architecture and significant immunosuppressive activity. Here we report the total synthesis of palau'amine characterized by the construction of an ABDE tetracyclic ring core including a trans-bicylo[3.3.0]octane skeleton at a middle stage of total synthesis. The ABDE tetracyclic ring core is constructed by a cascade reaction of a cleavage of the N–N bond, including simultaneous formation of imine, the addition of amide anion to the resulting imine (D-ring formation) and the condensation of pyrrole with methyl ester (B-ring formation) in a single step. The synthetic palau'amine is confirmed to exhibit excellent immunosuppressive activity. The present synthetic route has the potential to help elucidate a pharmacophore as well as the mechanistic details of immunosuppressive activity. PMID:26530707

  20. Kelvin waves in total column ozone

    NASA Technical Reports Server (NTRS)

    Ziemke, J. R.; Stanford, J. L.

    1993-01-01

    Tropical Kelvin waves have been observed previously in ozone mixing ratio data from the SBUV (Solar Backscatter Ultraviolet) and LIMS (Limb Infrared Monitor of the Stratosphere) instruments on board the Nimbus-7 satellite. Kelvin wave features in total column ozone, using version 6 data from the Total Ozone Mapping Spectrometer (TOMS) instrument (also on board Nimbus-7) are investigated. Results show eastward-propagating zonal waves 1-2 with periods approximately 5-15 days, amplitudes approximately 3-5 DU, and latitudinal symmetry typical of Kelvin waves. A simplified model calculation suggests that the primary source for the perturbations is slow Kelvin waves in the lower-to-middle stratosphere. Maximum Kelvin wave signatures occur in conjunction with westward lower-to-middle stratospheric equatorial zonal winds (a quasi-biennial oscillation (QBO) wind modulation effect).

  1. Frustrated total internal reflection acoustic field sensor

    DOEpatents

    Kallman, Jeffrey S.

    2000-01-01

    A frustrated total internal reflection acoustic field sensor which allows the acquisition of the acoustic field over an entire plane, all at once. The sensor finds use in acoustic holography and acoustic diffraction tomography. For example, the sensor may be produced by a transparent plate with transparent support members tall enough to support one or more flexible membranes at an appropriate height for frustrated total internal reflection to occur. An acoustic wave causes the membrane to deflect away from its quiescent position and thus changes the amount of light that tunnels through the gap formed by the support members and into the membrane, and so changes the amount of light reflected by the membrane. The sensor(s) is illuminated by a uniform tight field, and the reflection from the sensor yields acoustic wave amplitude and phase information which can be picked up electronically or otherwise.

  2. Fast total focusing method for ultrasonic imaging

    NASA Astrophysics Data System (ADS)

    Carcreff, Ewen; Dao, Gavin; Braconnier, Dominique

    2016-02-01

    Synthetic aperture focusing technique (SAFT) and total focusing method (TFM) have become popular tools in the field of ultrasonic non destructive testing. In particular, they are employed for detection and characterization of flaws. From data acquired with a transducer array, those techniques aim at reconstructing an image of the inspected object from coherent summations. In this paper, we make a comparison between the standard technique and a migration approach. Using experimental data, we show that the developed approach is faster and offers a better signal to noise ratio than the standard total focusing method. Moreover, the migration is particularly effective for near-surface imaging where standard methods used to fail. On the other hand, the migration approach is only adapted to layered objects whereas the standard technique can fit complex geometries. The methods are tested on homogeneous pieces containing artificial flaws such as side drilled holes.

  3. Increasing productivity through Total Reuse Management (TRM)

    NASA Technical Reports Server (NTRS)

    Schuler, M. P.

    1991-01-01

    Total Reuse Management (TRM) is a new concept currently being promoted by the NASA Langley Software Engineering and Ada Lab (SEAL). It uses concepts similar to those promoted in Total Quality Management (TQM). Both technical and management personnel are continually encouraged to think in terms of reuse. Reuse is not something that is aimed for after a product is completed, but rather it is built into the product from inception through development. Lowering software development costs, reducing risk, and increasing code reliability are the more prominent goals of TRM. Procedures and methods used to adopt and apply TRM are described. Reuse is frequently thought of as only being applicable to code. However, reuse can apply to all products and all phases of the software life cycle. These products include management and quality assurance plans, designs, and testing procedures. Specific examples of successfully reused products are given and future goals are discussed.

  4. A Modern Approach to Total Wellbeing

    NASA Astrophysics Data System (ADS)

    Hadzic, Maja; Chen, Meifania; Brouwer, Rick; Dillon, Tharam

    The events of the last decades have impacted our lives and our health significantly. We expected that the technology boom will improve our lives. While this may be true in a specific context, generally speaking our societies are suffering from moral decays, terrorism fears, wars, financial crisis and unpredictable acts of nature that are increasing in frequency and in intensity. The complex nature of the world we live is impacting our health and wellbeing considerably. Our health is not only determined by our physical health but is the end product of the interplay of the physical, mental, emotional, financial, relational and spiritual events of a lifetime. In this paper we develop a framework that will help us define and measure total wellbeing of individuals in our volatile societies. This framework will help us better understand the complex nature of total wellbeing and develop effective prevention and intervention strategies.

  5. Total knee arthroplasty in patients with poliomyelitis.

    PubMed

    Jordan, Louis; Kligman, Mordechai; Sculco, Thomas P

    2007-06-01

    Between 1991 and 2001, 17 primary total knee arthroplasties were performed in 15 patients with limbs affected by poliomyelitis. Eight patients had a constrained condylar knee design, 8 a posterior stabilized design, and 1 a hinged design. Mean follow-up was 41.5 months. The mean Knee Society knee score improved from 45 preoperatively to 87 postoperative. Knee stability was obtained in all patients, including 4 patients with less than antigravity quadriceps strength. Radiologic evaluation showed satisfactory alignment with no signs of loosening. Complications included 1 case of deep venous thrombosis and 2 knees that required a manipulation for stiffness. Pain relief, functional improvement, and knee stability can be achieved after constrained total knee arthroplasty in patients with poliomyelitis despite impaired quadriceps strength, and osseous and soft tissue abnormalities. PMID:17562411

  6. Total π-electron and HOMO energy

    NASA Astrophysics Data System (ADS)

    Gutman, Ivan; Radenković, Slavko; Ðorđević, Slađana; Milovanović, Igor Ž.; Milovanović, Emina I.

    2016-04-01

    A relation is obtained between the total π-electron energy Eπ and the HOMO energy EHOMO, valid within the HMO approximation. This seems to be the very first relation between Eπ and EHOMO ever established. It enables a much more accurate assessment of Eπ of alternant conjugated hydrocarbons than that based on McClelland's formula and on other (n, m)-type approximate expressions.

  7. Renal function after elective total hip replacement.

    PubMed

    Perregaard, Helene; Damholt, Mette B; Solgaard, Søren; Petersen, Morten B

    2016-06-01

    Background and purpose - Acute kidney injury (AKI) is associated with increased short-term and long-term mortality in intensive care populations and in several surgical specialties, but there are very few data concerning orthopedic populations. We have studied the incidence of AKI and the prevalence of chronic kidney disease (CKD) in an elective population of orthopedic patients undergoing primary total hip replacement, hypothesizing that chronic kidney disease predisposes to AKI. Patients and methods - This was a single-center, population-based, retrospective, registry-based cohort study involving all primary elective total hip replacements performed from January 2003 through December 2012. Patient demographics and creatinine values were registered. We evaluated the presence of CKD and AKI according to the international guidelines for kidney disease (KDIGO Acute Kidney Injury Workgroup 2013 ). Results - 3,416 patients were included (2,064 females (60%)). AKI (according to KDIGO criteria) was seen in 75 patients (2.2%, 95% CI: 1.7-2.7) in the course of primary total hip replacement. Of these, 26 had pre-existing CKD of class 3-5. Pre-existing CKD of class 3-5, indicating moderately to severely reduced kidney function, was seen in 374 individuals (11%). Interpretation - Development of acute kidney injury appears to be a substantial problem compared to other complications related to elective total hip arthroplasty, i.e. luxation and infection. Patients with pre-existing chronic kidney disease may be especially vulnerable. The clinical impact of acute kidney injury in an elective orthopedic population remains to be elucidated. PMID:26937782

  8. Total synthesis of hapalindoles J and U.

    PubMed

    Rafferty, Ryan J; Williams, Robert M

    2012-01-01

    The total synthesis of D,L-hapalindoles J and U has been accomplished. Hapalindole J was prepared in 11% overall yield over 11 synthetic steps and hapalindole U was prepared in 25% overall yield over 13 synthetic steps from commercially available materials. The route employs a novel silyl ether-based strategy for accessing the 6:5:6:6 ring system of the hapalindoles rapidly and in good yields. PMID:22126131

  9. Total Synthesis of Hapalindoles J and U

    PubMed Central

    Rafferty, Ryan J.; Williams, Robert M.

    2011-01-01

    The total synthesis of D,L-hapalindoles J and U has been accomplished. Hapalindole J was prepared in 11% overall yield over eleven synthetic steps and hapalindole U was prepared in 25% overall yield over thirteen synthetic steps from commercially available materials. The route employs a novel silyl ether-based strategy for accessing the 6:5:6:6 ring system of the hapalindoles rapidly and in good yields. PMID:22126131

  10. Total synthesis of (+)-antroquinonol and (+)-antroquinonol D.

    PubMed

    Sulake, Rohidas S; Chen, Chinpiao

    2015-03-01

    The first total synthesis of (+)-antroquinonol and (+)-antroquinonol D, two structurally unique quinonols with a sesquiterpene side chain, is described. The route features an iridium-catalyzed olefin isomerization-Claisen rearrangement reaction (ICR), lactonization, and Grubbs olefin metathesis. The requisite α,β-unsaturation was achieved via the selenylation/oxidation protocol and elimination of β-methoxy group to provide two natural products from a common intermediate. PMID:25679542

  11. NASA total quality management 1989 accomplishments report

    NASA Technical Reports Server (NTRS)

    1990-01-01

    Described here are the accomplishments of NASA as a result of the use of Total Quality Management (TQM). The principles in practice which led to these process refinements are important cultural elements to any organization's productivity and quality efforts. The categories of TQM discussed here are top management leadership and support, strategic planning, focus on the customer, employee training and recognition, employee empowerment and teamwork, measurement and analysis, and quality assurance.

  12. NASA total quality management 1990 accomplishments report

    NASA Technical Reports Server (NTRS)

    1991-01-01

    NASA's efforts in Total Quality Management are based on continuous improvement and serve as a foundation for NASA's present and future endeavors. Given here are numerous examples of quality strategies that have proven effective and efficient in a time when cost reduction is critical. These accomplishment benefit our Agency and help to achieve our primary goal, keeping American in the forefront of the aerospace industry.

  13. Techniques in Total Mesorectal Excision Surgery

    PubMed Central

    Lichliter, Warren E.

    2015-01-01

    Advances in the surgical management of rectal cancer have placed the quality of total mesorectal excision (TME) as the major predictor in overall survival. A standardized TME technique along with quality increases the percentage of patients undergoing a complete TME. Quality measurements of TME will place increasing demands on surgeons maintaining competence with present and future techniques. These efforts will improve the outcome of the rectal cancer patients. PMID:25733970

  14. Total Hip Joint Replacement Biotelemetry System

    NASA Technical Reports Server (NTRS)

    Boreham, J. F.; Postal, R. B.; Luntz, R. A.

    1981-01-01

    The development of a biotelemetry system that is hermetically sealed within a total hip replacement implant is reported. The telemetry system transmits six channels of stress data to reconstruct the major forces acting on the neck of the prosthesis and uses an induction power coupling technique to eliminate the need for internal batteries. The activities associated with the telemetry microminiaturization, data recovery console, hardware fabrications, power induction systems, electrical and mechanical testing and hermetic sealing test results are discussed.

  15. Assessing Operational Total Lightning Visualization Products

    NASA Technical Reports Server (NTRS)

    Stano, Geoffrey T.; Darden, Christopher B.; Nadler, David J.

    2010-01-01

    In May 2003, NASA's Short-term Prediction Research and Transition (SPoRT) program successfully provided total lightning data from the North Alabama Lightning Mapping Array (NALMA) to the National Weather Service (NWS) office in Huntsville, Alabama. The major accomplishment was providing the observations in real-time to the NWS in the native Advanced Weather Interactive Processing System (AWIPS) decision support system. Within days, the NALMA data were used to issue a tornado warning initiating seven years of ongoing support to the NWS' severe weather and situational awareness operations. With this success, SPoRT now provides real-time NALMA data to five forecast offices as well as working to transition data from total lightning networks at Kennedy Space Center and the White Sands Missile Range to the surrounding NWS offices. The only NALMA product that has been transitioned to SPoRT's partner NWS offices is the source density product, available at a 2 km resolution in 2 min intervals. However, discussions with users of total lightning data from other networks have shown that other products are available, ranging from spatial and temporal variations of the source density product to the creation of a flash extent density. SPoRT and the Huntsville, Alabama NWS are evaluating the utility of these variations as this has not been addressed since the initial transition in 2003. This preliminary analysis will focus on what products will best support the operational warning decision process. Data from 19 April 2009 are analyzed. On this day, severe thunderstorms formed ahead of an approaching cold front. Widespread severe weather was observed, primarily south of the Tennessee River with multiple, weak tornadoes, numerous severe hail reports, and wind. This preliminary analysis is the first step in evaluation which product(s) are best suited for operations. The ultimate goal is selecting a single product for use with all total lightning networks to streamline training and science sharing.

  16. Measurement of total organic concentration in water

    NASA Technical Reports Server (NTRS)

    Winkler, E.

    1978-01-01

    Instrument for determining total organic concentration in water uses no corrosive reagents or gases. Instead continuous ultraviolet photolysis process converts organic compounds to carbon dioxide (CO2). CO2 electrode is used to measure CO2 content. Only reagent necessary is oxygen, generated in situ by electrolyzing some water. In addition to application in aerospace industry, system has potential uses in pollution monitoring and in laboratory analyses.

  17. Nonlinear identification of the total baroreflex arc.

    PubMed

    Moslehpour, Mohsen; Kawada, Toru; Sunagawa, Kenji; Sugimachi, Masaru; Mukkamala, Ramakrishna

    2015-12-15

    The total baroreflex arc [the open-loop system relating carotid sinus pressure (CSP) to arterial pressure (AP)] is known to exhibit nonlinear behaviors. However, few studies have quantitatively characterized its nonlinear dynamics. The aim of this study was to develop a nonlinear model of the sympathetically mediated total arc without assuming any model form. Normal rats were studied under anesthesia. The vagal and aortic depressor nerves were sectioned, the carotid sinus regions were isolated and attached to a servo-controlled piston pump, and the AP and sympathetic nerve activity (SNA) were measured. CSP was perturbed using a Gaussian white noise signal. A second-order Volterra model was developed by applying nonparametric identification to the measurements. The second-order kernel was mainly diagonal, but the diagonal differed in shape from the first-order kernel. Hence, a reduced second-order model was similarly developed comprising a linear dynamic system in parallel with a squaring system in cascade with a slower linear dynamic system. This "Uryson" model predicted AP changes 12% better (P < 0.01) than a linear model in response to new Gaussian white noise CSP. The model also predicted nonlinear behaviors, including thresholding and mean responses to CSP changes about the mean. Models of the neural arc (the system relating CSP to SNA) and peripheral arc (the system relating SNA to AP) were likewise developed and tested. However, these models of subsystems of the total arc showed approximately linear behaviors. In conclusion, the validated nonlinear model of the total arc revealed that the system takes on an Uryson structure. PMID:26354845

  18. Biocompatibility of materials for total joint replacement.

    PubMed

    Escalas, F; Galante, J; Rostoker, W

    1976-03-01

    The clinical use of total joint prostheses demands absolute biocompatibility of the materials employed. The purpose of this experiment was the bioassay of some materials considered as possible candidates for use in total joint prostheses as load-bearing members or as wear-resistant surfaces. Some materials already in use were also tested. 316L stainless steel was used as a control. The materials were implanted as a standardized rod and in particulate form. An average of 12 samples per material were implanted in soft tissue for six months and a total of 145 rabbits were used in this study. Twenty-five materials including metals, polymers, and ceramics were tested in solid and powdered form. A semiquantitative evaluation of local tissue reaction and a study of organs was performed. Polymers and metallic materials showed in general a mild tissue reaction. Ceramics, which some authors describe as the best tolerated materials, elicited variable tissue responses. Some of these (glass-ceramics) presented very poor tissue tolerance. The least reactive, titanium oxide, titanium aluminate, and aluminum oxide, presented a degree of tissue reaction comparable to that of corrosion resistant metals, but not superior to them. Moderate reactivity was the general rule for particulate materials except for the Pyroceram glass-ceramics, polymides, and Teflon. Ultrahigh molecular weight polyethylene in particulate form elicited a rather cellular tissue response, a fact to be considered when projecting long-term results in total joint arthroplasty. No pathological changes compatible with systemic toxicity by materials tested were observed in the study of the organs. PMID:1254613

  19. Modular tibial augmentations in total knee arthroplasty.

    PubMed

    Fehring, T K; Peindl, R D; Humble, R S; Harrow, M E; Frick, S L

    1996-06-01

    Proximal tibial bony deficiencies are not uncommon in primary and revision total knee arthroplasty. Modular tibial augmentations were introduced to address these deficiencies. Alterations in strain distribution as a result of medial wedge and block augmentations were evaluated for a modular total knee arthroplasty system in 6 fresh frozen anatomic specimen tibias. Full-field strain patterns were examined using photoelastic coating methods, and high strain regions were evaluated using strain gage rosette techniques. The total knee arthroplasty installations were tested in static physiologic axial and torsional load configurations. The relative effects of sequential wedge and block augmentations compared with the nonaugmented case were statistically analyzed. There were no overall statistical differences in the 3 treatments in terms of maximal (principal) strains. A secondary analysis that evaluated specific location and load pattern combinations established several minor statistical differences along with insights into the manner in which each construct loads the proximal tibia. Although metal wedge augmentation commonly is used, block augmentation seems to be an appropriate alternative from a strain distribution standpoint in cases in which the block geometry better approximates the bony defect. PMID:8641065

  20. Total quality management -- Remedial actions planning program

    SciTech Connect

    Petty, J.L.; Horne, T.E.

    1989-01-01

    This paper describes the management approach being taken within the Hazardous Waste Remedial Actions Program (HAZWRAP) Support Contractor Office (SCO) to ensure quality of services in a highly competitive waste management environment. An overview is presented of the contractor support role assigned to Martin Marietta Energy Systems, Inc., by the Department of Energy (DOE) national program for managing hazardous waste. The HAZWRAP SCO mission, organizational structure, and major programs are outlined, with emphasis on waste management planning for the DOE Work for Others (WFO) Program. The HAZWRAP SCO provides waste management technical support, via interagency agreements between DOE and various Department of Defense (DOD) agencies for DOD sponsors planning remedial response actions. The remainder of the paper focuses on how the concept of Total Quality Management is applied to the HAZWRAP Remedial Actions Planning (RAP) Program. The management challenge is to achieve quality on a ''system'' basis where all functional elements of program management synergistically contribute to the total quality of the effort. The quality assurance (QA) program requirements applied to the RAP Program and its subcontractors are discussed. The application of management principles in the areas of program management, procurement, and QA to achieve total quality is presented. 3 refs.

  1. Improved selection in totally monotone arrays

    SciTech Connect

    Mansour, Y. . Aiken Computation Lab.); Park, J.K. ); Schieber, B. . Thomas J. Watson Research Center); Sen, S. )

    1991-01-01

    This paper's main result is an O(({radical}{bar m}lgm)(n lg n) + mlg n)-time algorithm for computing the kth smallest entry in each row of an m {times} n totally monotone array. (A two-dimensional A = a(i,j) is totally monotone if for all i{sub 1} < i{sub 2} and j{sub 1} < j{sup 2}, < a(i{sub 1},j{sub 2}) implies a(i{sub 2},j{sub 1})). For large values of k (in particular, for k=(n/2)), this algorithm is significantly faster than the O(k(m+n))-time algorithm for the same problem due to Kravets and Park. An immediate consequence of this result is an O(n{sup 3/2} lg{sup 2}n)-time algorithm for computing the kth nearest neighbor of each vertex of a convex n-gon. In addition to the main result, we also give an O(n lg m)-time algorithm for computing an approximate median in each row of an m {times} n totally monotone array; this approximate median is an entry whose rank in its row lies between (n/4) and (3n/4) {minus} 1. 20 refs., 3 figs.

  2. [Total ankle arthroplasty in valgus ankle osteoarthritis].

    PubMed

    Valderrabano, V; Frigg, A; Leumann, A; Horisberger, M

    2011-11-01

    Ankle osteoarthritis (OA) is often associated with deformities. Valgus OA is less frequent than varus OA and causes of valgus OA include medial ligament instability, flat foot and posttraumatic situations, e.g. fractures of the fibula or lateral tibial plafond. The importance of the mechanical axis is generally accepted in orthopedic surgery. In cases of implantation of total ankle replacements the normal biomechanics need to be restored in order to have a correct and pain-free functioning total ankle replacement both in the short and long-term. The two most important criteria are (1) an anterior tibio-talar angle of about 90 and (2) a neutral hindfoot position. The hindfoot position is measured with the hindfoot alignment view according to Saltzman. In this view, healthy feet are in neutral or minimal varus position of 1-2 and not in a valgus position as generally assumed. The following operative steps are performed depending on the degree and localization of the valgus deformity: (1) total ankle replacement, (2) supramalleolar or (3) inframalleolar osteotomy/arthrodesis, (4) medial ligament repair, (5) fibula osteotomy and (6) syndesmotic reconstruction. PMID:22009496

  3. [Total temporomandibular joint replacement with alloplastic prosthesis].

    PubMed

    García-Huerta, Marco Antonio; Romero-Flores, Jovita; Mena-Gómez, Eddy

    2012-01-01

    Three total temporomandibular joint (TMJ) replacement surgeries were performed on two patients with TMJ ankylosis using W. Lorenz system. The first surgery was performed on a female patient with osseous ankylosis who had no mandibular movement since she was 18 months old. The second surgery was on a patient with fibrous ankylosis who had an interincisive opening distance of 12 mm. Her condition was the result of a three year old subcondylar fracture which didn't receive any treatment. The first patient had total replacement of both TMJs, while the other just one TMJ. The follow up until today has been of eight months with an interincisive opening of 29 mm in the first patient and 34 mm in the other. There has not been any mandibular deviation during opening, nor postoperative pain in both cases. Facial nerve affection was not permanent in both patients. For all of this, we can conclude that total TMJ replacement is an effective treatment with stable results in patients with TMJ ankylosis. PMID:23234748

  4. Climate Change and Tropical Total Lightning

    NASA Technical Reports Server (NTRS)

    Albrecht, R.; Petersen, W.; Buechler, D.; Goodman, S.; Blakeslee, R.; Christian, H.

    2009-01-01

    While global warming is regarded as a fact by many in the scientific community, its future impact remains a challenge to be determined and measured. The International Panel on Climate Change (IPCC) assessment report (IPCC, 2007) shows inconclusive answers on global rainfall trends and general agreement on a future drier climate with increased global warming. The relationship between temperature, humidity and convection is not linear and is strongly dependent on regional scale features, such as topography and land cover. Furthermore, the relationship between convective lightning production (thunderstorms) and temperature is even more complicated, being subjected to the cloud dynamics and microphysics. Total lightning (intracloud and cloud-to-ground) monitoring is a relatively new field of observation. Global and tropical total lightning began to be more extensively measured by satellites in the mid 90s. In this scope, the Lightning Imaging Sensor (LIS) onboard of the Tropical Rainfall Measurement Mission (TRMM) has been operational for over 11 years. Here we address total lightning trends observed by LIS from 1998 to 2008 in different temporal (annual and seasonal) and spatial (large and regional) scales. The observed 11-year trends are then associate to different predicted/hypothesized climate change scenarios.

  5. [Simultaneous determination of total flavone and total saponin in Gynostemma pentaphyllum by signal multiplier spectrophotometry].

    PubMed

    Hui, Rui-Hua; Hou, Dong-Yan; Li, Tie-Chun; Liu, Xiao-Yuan

    2006-09-01

    Important chemical constituents analysis for the total flavone and total saponin in Gynostemma pentaphyllum is described. The colour reactions of flavones and saponines with vanillin-perchloric acid in acetic acid produced the good absorptions at 451 and 547 nm, but the absorption peaks too overlapped to be determined simultaneously. A new method for the total flavone and the total saponin in Gynostemma pentaphyllum to be determined by signal multiplier spectrophotometry simultaneously without any preliminary separation was proposed. For quantitative analysis, the rutinum as a standard of the total flavone and the ginsenoside Rb1 as standard of the total saponin were applied. The experiment results showed that the regression equations of concentration and deltaA were obtained: deltaAflavone = 0.0133+4.417 0Cflavone, relation coefficient rflavone = 0.9994, and the total flavone concentrations were in 0-0. 16 microg x mI(-1) with deltaA obeying linear relation; deltaAsaporin = 2.775 5Csaponin -0.8881 x 10(-2), relation coefficient rsaponin = 0.9991, and the total saponin concentrations were in 0-0.30 microg x mL(-1) with deltaA obeying linear relation respectively. The recovery ratio was 104.0%-113.0% and 86.8%-94.6% respectively. The RSDflavone was less than 0.58% (n = 9) and RSDsaponin was less than 0. 35% (n=9) respectively. The proposed method is simple, rapid accurate and feasible. PMID:17112063

  6. Fluorogenic membrane overlays to enumerate total coliforms, Escherichia coli, and total Vibrionaceae in shellfish and seawater

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Three assays were developed to enumerate total coliforms, Escherichia coli, and total Vibrionaceae in shellfish and other foods and in seawater and other environmental samples. Assays involve membrane overlays of overnight colonies on non-selective agar plates to detect ß-glucuronidase and lysyl am...

  7. Observation of the total solar eclipsis. L'observation des eclipses totales solaires

    SciTech Connect

    Koutchmy, S.

    1987-03-01

    A brief historical account of the solar-total-eclipses events is presented to show their importance, including their use for the scientific analysis of the solar corona, since 1848. The main parameters and a schema of the eclipses are given. Several examples of investigations performed during a solar total eclipse are discussed.

  8. Bilateral chylothorax after transsternal total thymectomy: resolution with short period of fasting and total parenteral nutrition

    PubMed Central

    Kim, Jinsik; Kim, Su Wan; Lee, Seogjae

    2016-01-01

    Bilateral chylothorax after transsternal total thymectomy is very rare, but can be a serious complication. Disruption of minor lymphatic channels in the anterior mediastinum which is remote from thoracic duct is considered to be the cause of chylothorax. We report the case of bilateral chylothorax followed by thymectomy which was treated with pleural drainage, total parenteral nutrition, and fasting without octreotide injection. PMID:27076983

  9. Relationship between electron-scattering grand total and ionization total cross sections

    NASA Astrophysics Data System (ADS)

    Kwitnewski, Stanisław; Ptasińska-Denga, Elżbieta; Szmytkowski, Czesław

    2003-09-01

    Regression formula which relates grand total cross section and ionization total cross section for electron scattering from simple hydrocarbons and from perfluorinated molecules has been proposed. This formula was then used to evaluate the ionization total cross sections for WF 6 and for structured isomers of C 3H 4 and C 4H 6, at intermediate electron-impact energies. For WF 6 the estimated ionization cross section is compared with available experimental and theoretical data. In addition, for C 3H 4 and C 4H 6 ionization total cross sections were calculated with the binary-encounter Bethe (BEB) model to compare with the values predicted from the regression formula. Grand total cross section for electron scattering from UF 6 molecules was also estimated over energy range from 20 to 400 eV.

  10. Mesh Excision: Is Total Mesh Excision Necessary?

    PubMed

    Wolff, Gillian F; Winters, J Christian; Krlin, Ryan M

    2016-04-01

    Nearly 29 % of women will undergo a secondary, repeat operation for pelvic organ prolapse (POP) symptom recurrence following a primary repair, as reported by Abbott et al. (Am J Obstet Gynecol 210:163.e1-163.e1, 2014). In efforts to decrease the rates of failure, graft materials have been utilized to augment transvaginal repairs. Following the success of using polypropylene mesh (PPM) for stress urinary incontinence (SUI), the use of PPM in the transvaginal repair of POP increased. However, in recent years, significant concerns have been raised about the safety of PPM mesh. Complications, some specific to mesh, such as exposures, erosion, dyspareunia, and pelvic pain, have been reported with increased frequency. In the current literature, there is not substantive evidence to suggest that PPM has intrinsic properties that warrant total mesh removal in the absence of complications. There are a number of complications that can occur after transvaginal mesh placement that do warrant surgical intervention after failure of conservative therapy. In aggregate, there are no high-quality controlled studies that clearly demonstrate that total mesh removal is consistently more likely to achieve pain reduction. In the cases of obstruction and erosion, it seems clear that definitive removal of the offending mesh is associated with resolution of symptoms in the majority of cases and reasonable practice. There are a number of complications that can occur with removal of mesh, and patients should be informed of this as they formulate a choice of treatment. We will review these considerations as we examine the clinical question of whether total versus partial removal of mesh is necessary for the resolution of complications following transvaginal mesh placement. PMID:26905696

  11. The 2012 Total Eclipse Expeditions in Queensland

    NASA Astrophysics Data System (ADS)

    Pasachoff, Jay M.; Babcock, B. A.; Lu, M.; Dantowitz, R.; Lucas, R.; Seiradakis, J. H.; Voulgaris, A.; Gaintatzis, P.; Steele, A.; Sterling, A. C.; Rusin, V.; Saniga, M.

    2013-07-01

    A total eclipse swept across Queensland and other sites in northeastern Australia on the early morning of 14 November 2012, local time. We mounted equipment to observe coronal images and spectra during the approximately 2 minutes of totality, the former for comparison with spacecraft images and to fill in the doughnut of imaging not well covered with space coronagraphs. Matching weather statistics, viewing was spotty, and our best observations were from a last-minute inland site on the Tablelands, with some observations from a helicopter at 9000 feet altitude over our original viewing site at Miallo. Only glimpses of the corona were visible at our Port Douglas and Trinity Beach, Cairns, locations, with totality obscured from our sites at Newell and Miallo, though some holes in the clouds provided coronal views from Palm Cove and elsewhere along the coast. Preliminary analysis of the spectra again shows Fe XIV stronger than Fe X, as in 2010 but not earlier, a sign of solar maximum, as was the coronal shape. An intriguing CME is discernible in the SE. Acknowledgments: We thank Terry Cuttle, Aram Friedman, Michael Kentrianakis, and Nicholas Weber for assistance and collaboration in Australia and Wendy Carlos for image processing. Our expedition was supported in part by NSF grant AGS-1047726 from Solar Terrestrial Research of the Atmospheric and Geospace Sciences Division, and by the Rob Spring Fund and Science Center funds at Williams College. ML was also supported in part by a Grant-In-Aid of Research from the National Academy of Sciences, administered by Sigma Xi, The Scientific Research Society (Grant ID: G20120315159311). VR and MS acknowledge support from projects VEGA 2/0003/13 and NGS-3139-12 of the National Geographic Society. We are grateful to K. Shiota (Japan) for kindly providing us with some of his 2012 eclipse coronal images.

  12. Total thyroid ablation in Graves' orbitopathy.

    PubMed

    Menconi, F; Leo, M; Vitti, P; Marcocci, C; Marinò, M

    2015-08-01

    Graves' orbitopathy (GO) is an autoimmune condition almost always associated with autoimmune thyroid disease, especially Graves' disease (GD). According to the most widely accepted model, the autoantigens responsible for GO would include molecules expressed by thyroid epithelial cells that are present also in orbital tissues. The high likelihood that the etiologies of GO and of the underlying autoimmune thyroid diseases are somehow linked is confirmed by the very close relationship between GO, the onset and the course of Graves' diseases, the size of the thyroid gland, and most importantly, thyroid function and thyroid treatment. Based on these considerations, it has been proposed that complete removal of thyroid antigens and of thyroid infiltrating lymphocytes, the so-called total thyroid ablation (TTA), may be followed by an attenuation of the immune reaction against orbital antigens, and ultimately by an amelioration of GO. The possibility that TTA, achieved by near total thyroidectomy followed by radioiodine, may be beneficial for GO was initially suggested by two retrospective studies and more recently by two prospective, randomized clinical trials conducted in patients with moderate GO treated with intravenous glucocorticoids. Although there seemed to be no difference in the long term, compared with near total thyroidectomy alone TTA was associated with a shorter time required for GO to improve, or anyway to reach its best possible outcome, and with a lesser requirement for additional treatments for GO to improve. Whether this is sufficient to offer ablation to patients remains a matter of discussion. At present, this procedure could be offered only to patients scheduled to thyroidectomy and glucocorticoid treatment. PMID:25740065

  13. Pathologic Processing of the Total Mesorectal Excision

    PubMed Central

    Campa-Thompson, Molly; Weir, Robert; Calcetera, Natalie; Quirke, Philip; Carmack, Susanne

    2015-01-01

    Total mesorectal excision (TME) is the current optimal surgical treatment for patients with rectal carcinoma. A complete TME is related to lower local recurrence rates and increased patient survival. Many confounding factors in the patient's anatomy and prior therapy can make it difficult to obtain a perfect plane, and thus a complete TME. The resection specimen can be thoroughly evaluated, grossly and microscopically, to identify substandard surgical outcomes and increased risk of local recurrence. Complete and accurate data reporting is critical for patient care and helps surgeons improve their technique. PMID:25733973

  14. Total quality management approach improves medication replacement.

    PubMed

    Anderson, L K

    1994-07-01

    Total quality management (TQM) is based on understanding customer needs, improving key processes that affect customer satisfaction, and creating cross-functional teams to resolve process problems. This article describes application of TQM principles and problem-solving processes to improve one OR's medication exchange system. The problem was excessive monthly pharmacy medication replacement costs. The goal was to reduce the monthly medication replacement costs by 50%. Within four months, monthly medication replacement charges decreased from $656 to $302, and by one year, monthly charges decreased to $160. The new process had fewer steps, fewer staff members involved, and fewer delays in medication replacement. PMID:8085806

  15. Total-variation regularization with bound constraints

    SciTech Connect

    Chartrand, Rick; Wohlberg, Brendt

    2009-01-01

    We present a new algorithm for bound-constrained total-variation (TV) regularization that in comparison with its predecessors is simple, fast, and flexible. We use a splitting approach to decouple TV minimization from enforcing the constraints. Consequently, existing TV solvers can be employed with minimal alteration. This also makes the approach straightforward to generalize to any situation where TV can be applied. We consider deblurring of images with Gaussian or salt-and-pepper noise, as well as Abel inversion of radiographs with Poisson noise. We incorporate previous iterative reweighting algorithms to solve the TV portion.

  16. PERIPROSTHETIC FRACTURES IN TOTAL KNEE ARTHROPLASTY

    PubMed Central

    de Alencar, Paulo Gilberto Cimbalista; De Bortoli, Giovani; Ventura Vieira, Inácio Facó; Uliana, Christiano Saliba

    2015-01-01

    The increasing number of total knee arthroplasties, in combination with the population's longer life expectancy, has led to a greater number of long-term complications. These add to the poor bone quality of elderly patients and often culminate in periprosthetic fractures. This complex orthopedic problem has a great diversity of clinical presentation. It may affect any of the bones in the knee and, because of the difficulty in finding solutions, may lead to disastrous outcomes. Its treatment requires that orthopedists should have broad knowledge both of arthroplasty techniques and of osteosynthesis, as well as an elaborate therapeutic arsenal including, for example, access to a bone bank. PMID:27022546

  17. Enantioselective total synthesis of (+)-lyngbyabellin M.

    PubMed

    Pirovani, Rodrigo V; Brito, Gilmar A; Barcelos, Rosimeire C; Pilli, Ronaldo A

    2015-06-01

    Lyngbyabellin M is a non-ribosomal peptide synthetase/polyketide synthase derived metabolite isolated from the cyanobacterium M. bouillonii displaying thiazole rings and a distinct chlorinated octanoic acid chain. Its absolute configuration was proposed based on the comparison of its spectroscopic data with those of other representatives of this family of marine natural products, as well as degradation and derivatization studies. Here the first total synthesis of (+)-lyngbyabellin M is described based on the coupling of three key intermediates: two chiral thiazole moieties and an anti hydroxycarboxylic acid prepared stereoselectively via a boron enolate mediated aldol reaction directed by Masamune's chiral auxiliary. PMID:26023838

  18. Security Systems Consideration: A Total Security Approach

    NASA Astrophysics Data System (ADS)

    Margariti, S. V.; Meletiou, G.; Stergiou, E.; Vasiliadis, D. C.; Rizos, G. E.

    2007-12-01

    The "safety" problem for protection systems is to determine in a given situation whether a subject can acquire a particular right to an object. Security and audit operation face the process of securing the application on computing and network environment; however, storage security has been somewhat overlooked due to other security solutions. This paper identifies issues for data security, threats and attacks, summarizes security concepts and relationships, and also describes storage security strategies. It concludes with recommended storage security plan for a total security solution.

  19. Total knee arthroplasty in vascular malformation

    PubMed Central

    Bhende, Harish; Laud, Nanadkishore; Deore, Sandeep; Shashidhar, V

    2015-01-01

    In Klippel–Trenaunay syndrome, vascular malformations are not only in skin and superficial soft tissues but also in deep tissues like muscles bones and joints. It is well documemted that these recurrent intraarticular bleeds can cause early arthritis and joint pain. Performing arthroplasty in such patients is difficult and fraught with complications. We describe such a case where navigated total knee arthroplasty was performed with success to avoid the problems of intra medullary alignment used in the presence of intra medullary vascular malformations. We also suggest certain measures when knee arthroplasty is considered in such patients. PMID:26538765

  20. Enantioselective Total Synthesis of (-)-Terengganensine A.

    PubMed

    Piemontesi, Cyril; Wang, Qian; Zhu, Jieping

    2016-05-23

    A seven-step enantioselective total synthesis of (-)-terengganensine A, a complex heptacyclic monoterpene indole alkaloid, was accomplished. Key steps included: a) Noyori's catalytic enantioselective transfer hydrogenation of the iminium salt to set up the absolute configuration at the C21 position; b) a highly diastereoselective C7 benzoyloxylation with dibenzoyl peroxide under mild conditions; and c) an integrated one-pot oxidative cleavage of cyclopentene/triple cyclization/hydrolysis sequence for the construction of the dioxa azaadamantane motif with complete control of four newly generated stereocenters. PMID:27094030

  1. Solar Total Energy Project summary description

    NASA Astrophysics Data System (ADS)

    Hunke, R. W.; Leonard, J. A.

    1983-03-01

    The Solar Total Energy Project (STEP) at Shenandoah, GA is described. A summary description of the energy system, its location, and the project site are presented. The system is further described including design criteria and requirements, performance criteria, and operating requirements. The major subsystems of the STEP - the solar collection subsystem (SCS), the power conversion subsystem, the thermal utilization subsystem, the control and instrumentation subsystem, and the electrical subsystem are described, including their major components. Specific features of the control and instrumentation provisions for the system and subsystem operational modes are also described and the costs of construction presented.

  2. Solar total energy project summary description

    SciTech Connect

    Hunke, R.W.; Leonard, J.A.

    1983-03-01

    The Solar Total Energy Project (STEP) at Shenandoah, GA is described. A summary description of the energy system, its location, and the project site are presented. The system is further described including design criteria and requirements, performance criteria, and operating requirements. The major subsystems of the STEP--the Solar Collection Subsystem (SCS), the Power Conversion Subsystem (PCS), the Thermal Utilization Subsystem (TUS), the Control and Instrumentation Subsystem (CAIS), and the Electrical Subsystem (ES)--are described, including their major components. Specific features of the control and instrumentation provisions for the system and subsystem operational modes are also described and the costs of construction presented.

  3. [Nurses' role in cases of total pain].

    PubMed

    Sánchez Castilla, M José; Calderón Carrasco, Justo

    2009-06-01

    Health professional daily confront the pain and suffering persons who need our help undergo. From a nurse's methodology this article describes a new perspective about nurses' role regarding total pain, employing as a tool to deal with this topic the AREA holistic pain model, a model which centers on the person and his/her family permanently seeking results derived from a plan which joins together all treatments and based on the creation of a reasoning network that will provide prioritized nursing diagnoses. PMID:19653527

  4. Total Ankle Arthroplasty: An Imaging Overview

    PubMed Central

    Kim, Da-Rae; Potter, Hollis G.; Li, Angela E.; Chun, Ka-Young; Jung, Yoon Young; Kim, Jin-Su; Young, Ki-Won

    2016-01-01

    With advances in implant technology, total ankle arthroplasty (TAA) has become an increasingly popular alternative to arthrodesis for the management of end-stage ankle arthritis. However, reports in the literature do not focus on the imaging features of TAA. Through a literature review, we demonstrate basic design features of the current ankle arthroplasty system, and the normal and abnormal postoperative imaging features associated with such devices. Pre- and postoperative evaluations of ankle arthroplasty mainly include radiography; in addition, computed tomography and magnetic resonance imaging provide further characterization of imaging abnormalities. Familiarization with multimodal imaging features of frequent procedural complications at various postoperative intervals is important in radiological practice. PMID:27134529

  5. Soft tissue balancing in total knee arthroplasty

    PubMed Central

    MELONI, MARIA CHIARA; HOEDEMAEKER, RUSSALKA W.; VIOLANTE, BRUNO; MAZZOLA, CLAUDIO

    2014-01-01

    A good outcome in total knee arthroplasty depends on many factors: joint alignment, range of motion, patellar tracking and ligament stability. A correct soft tissue balance keeps the joint aligned in flexion and extension, and therefore constitutes the most important factor for durability of the implant. Indeed, incorrect soft tissue balancing is the primary cause of early implant failure necessitating revision surgery. Soft tissue releases, serving to correct imbalances, are performed until the flexion and extension gaps appear symmetrical and balanced. A knee is considered perfectly balanced when the flexion and extension gaps are perfectly rectangular and all the measurements are absolutely equal. PMID:25606540

  6. [Determination of the total work incapacity].

    PubMed

    Ferrant, Ophélie; Barthès, Agnès

    2012-06-01

    At the request of the patient or required by a requisition, the physician may be asked to deliver medical certificates with determination of total work incapacity (TWI). This is an attestation of what he has observed and incurs his penal, civil and ethical responsability. The drafting of such certificates implies not only the doctor and the patient, but also the judicial authorities and the alleged offender or offenders. The impact of the determination of the TWI is important to know in order to write "good" certificates before justifying TWI. PMID:22838276

  7. Enantioselective Total Synthesis of Secalonic Acid E.

    PubMed

    Ganapathy, Dhandapani; Reiner, Johannes R; Lffler, Lorenz E; Ma, Ling; Gnanaprakasam, Boopathy; Nieptter, Benedikt; Koehne, Ingo; Tietze, Lutz F

    2015-11-16

    The first enantioselective synthesis of a secalonic acid containing a dimeric tetrahydroxanthenone skeleton is described, using a Wacker-type cyclization of a methoxyphenolic compound to form a chiral chroman with a quaternary carbon stereogenic center with >99% ee. Further steps are a Sharpless dihydroxylation and a Dieckmann condensation to give a tetrahydroxanthenone. A late-stage one-pot palladium-catalyzed Suzuki-dimerization reaction leads to the 2,2'-biphenol linkage to complete the enantioselective total synthesis of secalonic acid E in 18?steps with 8% overall yield. PMID:26447631

  8. Total synthesis and structural revision of engelhardione

    PubMed Central

    Shen, Li; Sun, Dianqing

    2011-01-01

    The total synthesis of the macrocyclic natural product engelhardione is reported. This effort led to the structural revision of the published structure of engelhardione to that of pterocarine. The revision reflects the change of the substitution pattern of one phenyl ether ring from the meta to the para position. To confirm, pterocarine (2) and its close regioisomer 3 were subsequently synthesized for comparison. Moreover, to the best of our knowledge, our synthesis of 1 represents the first example of a 14-membered macrocyclic diarylheptanoid with a meta-meta substitution pattern at the diphenyl ether moiety. PMID:21927512

  9. Surgical approaches in total knee arthroplasty

    PubMed Central

    SANNA, MARCO; SANNA, CRISTINA; CAPUTO, FRANCESCO; PIU, GIUSEPPE; SALVI, MASSIMILIANO

    2013-01-01

    Total knee replacement surgery begins with correct planning of both the incision and the exposure of the joint. Indeed, these are factors that are just as crucial to an optimal outcome as choosing the right implant, positioning the components, and balancing the ligaments. While it is true that the standard incision and arthrotomy (with which we are most familiar) will, in most primary implant cases, provide adequate joint exposure, it is also true that cases characterized by certain conditions, such as previous cutaneous incisions, a stiff knee or patella baja, present specific skin and exposure problems that need to be recognized, planned for and overcome. PMID:25606515

  10. [Bilateral vocal cord paresis after total thyroidectomy].

    PubMed

    Dralle, H; Neu, J; Musholt, T J; Nies, C

    2016-01-01

    A 66-year-old female patient complained of hoarseness and dyspnea under exertion following total thyroidectomy. Due to a faulty operating technique both nerves to the vocal cords were damaged. From the operation report it emerged that the dissection was carried out by protecting the border lamellae but the recurrent laryngeal nerve could not be found on both sides. This article presents the external expert opinion, the decision of the arbitration board and the assessment of the case by two specialist physicians. PMID:26683653

  11. Total Hip Arthroplasty in Mucopolysaccharidosis Type IH.

    PubMed

    O'heireamhoin, S; Bayer, T; Mulhall, K J

    2011-01-01

    Children affected by mucopolysaccharidosis (MPS) type IH (Hurler Syndrome), an autosomal recessive metabolic disorder, are known to experience a range of musculoskeletal manifestations including spinal abnormalities, hand abnormalities, generalised joint stiffness, genu valgum, and hip dysplasia and avascular necrosis. Enzyme therapy, in the form of bone marrow transplantation, significantly increases life expectancy but does not prevent the development of the associated musculoskeletal disorders. We present the case of a 23-year-old woman with a diagnosis of Hurler syndrome with a satisfactory result following uncemented total hip arthroplasty. PMID:23259102

  12. Total Elbow Arthroplasty for Distal Humerus Fractures.

    PubMed

    Harmer, Luke S; Sanchez-Sotelo, Joaquin

    2015-11-01

    Total elbow arthroplasty is a good treatment alternative for selected patients with distal humerus fractures. Its attractiveness is related to several factors, including the possibility of performing the procedure; leaving the extensor mechanism intact; faster, easier rehabilitation compared with internal fixation; and overall good outcomes reported in terms of both pain relief and function. Implant failure leading to revision surgery does happen, and patients must comply with certain limitations to extend the longevity of their implant. Development of high-performance implants may allow expanding the indications of elbow arthroplasty for fractures. PMID:26498549

  13. Recent large fluctuations in total ozone

    NASA Technical Reports Server (NTRS)

    Newell, Reginald E.; Selkirk, Henry B.

    1988-01-01

    The present examination of total ozone changes in the global ozone network's data for the past 29 years notes recent changes to have been dominated by negative anomalies of two types: (1) reductions over the Antarctic, since 1980; and (2) deficits centered on winter and spring at middle latitudes, since 1982. Springtime correlations between ozone and temperature at the South Pole for 1963-1979 are used in linear regression models to predict ozone from temperature for the period since 1980; recent ozone values are found to be consistently lower than those predicted by these models.

  14. Total skin electron irradiation techniques: a review

    PubMed Central

    Milecki, Piotr; Skórska, Małgorzata; Fundowicz, Dorota

    2013-01-01

    Total skin electron irradiation (TSEI) has been employed as one of the methods of mycosis fungoides treatment since the mid-twentieth century. In order to improve the effects and limit the complications following radiotherapy, a number of varieties of the TSEI method, frequently differing in the implementation mode have been developed. The paper provides a systematic review of the different varieties of TSEI. The discussed differences concerned especially: (i) technological requirements and geometric conditions, (ii) the alignment of the patient, (iii) the number of treatment fields, and (iv) dose fractionation scheme. PMID:24278046

  15. Total synthesis of brasoside and littoralisone.

    PubMed

    Mangion, Ian K; MacMillan, David W C

    2005-03-23

    The first total syntheses of littoralisone (1) and brasoside (2) have been achieved in 13 overall steps. Both natural products are forged from a common intermediate which is rapidly assembled using organocatalytic technology, including a proline-catalyzed alpha-aminoxylation and a contra-thermodynamic intramolecular Michael addition. Application of the two-step carbohydrate synthesis technology has enabled to access a selectively substituted glucose derivative for use as an intramolecular cycloaddition tether. This synthesis culminates with an intramolecular [2+2] photocycloaddition that serves to support the proposed biosynthetic origins of 1 from 2. PMID:15771494

  16. Vocal Rehabilitation after Partial or Total Laryngectomy

    PubMed Central

    Calcaterra, Thomas C.; Zwitman, Daniel H.

    1972-01-01

    One of the paramount concerns of a patient who must undergo surgical intervention for laryngeal cancer is the effect on his speech. The type of operation is based on the anatomic extent of the cancer, but each procedure presents inherent problems in vocal rehabilitation. Glottic incompetence is the primary deficit to be overcome following hemilaryngectomy, whereas the aspirate voice is the principal problem with supraglottic laryngectomy. When the larynx must be sacrificed by total laryngectomy, the patient attempts to learn esophageal speech. If this fails, a vibrating sound source for speech can be acquired, either by the construction of a trachealpharyngeal communication or by use of a manual electric vibrator. PMID:5052051

  17. Enantioselective Total Synthesis of (+)-Lyngbyabellin M

    PubMed Central

    Pirovani, Rodrigo V.; Brito, Gilmar A.; Barcelos, Rosimeire C.; Pilli, Ronaldo A.

    2015-01-01

    Lyngbyabellin M is a non-ribosomal peptide synthetase/polyketide synthase derived metabolite isolated from the cyanobacterium M. bouillonii displaying thiazole rings and a distinct chlorinated octanoic acid chain. Its absolute configuration was proposed based on the comparison of its spectroscopic data with those of other representatives of this family of marine natural products, as well as degradation and derivatization studies. Here the first total synthesis of (+)-lyngbyabellin M is described based on the coupling of three key intermediates: two chiral thiazole moieties and an anti hydroxycarboxylic acid prepared stereoselectively via a boron enolate mediated aldol reaction directed by Masamune’s chiral auxiliary. PMID:26023838

  18. Catalytic Asymmetric Total Synthesis of (-)-Actinophyllic Acid.

    PubMed

    Cai, Lingchao; Zhang, Kui; Kwon, Ohyun

    2016-03-16

    Described herein is a catalytic asymmetric total synthesis of (-)-actinophyllic acid, with the key step being a chiral phosphine-catalyzed [3 + 2] annulation between an imine and an allenoate to form a pyrroline intermediate in 99% yield and 94% ee. The synthesis also features CuI-catalyzed coupling between a ketoester and a 2-iodoindole to shape the tetrahydroazocine ring; intramolecular alkylative lactonization; SmI2-mediated intramolecular pinacol coupling between ketone and lactone subunits to assemble the complex skeleton of (-)-actinophyllic acid; and an unprecedented regioselective dehydroxylation. PMID:26910382

  19. Biomimetic total synthesis of santalin Y.

    PubMed

    Strych, Sebastian; Journot, Guillaume; Pemberton, Ryan P; Wang, Selina C; Tantillo, Dean J; Trauner, Dirk

    2015-04-20

    A biomimetic total synthesis of santalin Y, a structurally complex but racemic natural product, is described. The key step is proposed to be a (3+2) cycloaddition of a benzylstyrene to a "vinylogous oxidopyrylium", which is followed by an intramolecular Friedel-Crafts reaction. This cascade generates the unique oxafenestrane framework of the target molecule and sets its five stereocenters in one operation. Our work provides rapid access to santalin Y and clarifies its biosynthetic relationship with other colorants isolated from red sandalwood. PMID:25858797

  20. Total body nitrogen analysis. [neutron activation analysis

    NASA Technical Reports Server (NTRS)

    Palmer, H. E.

    1975-01-01

    Studies of two potential in vivo neutron activation methods for determining total and partial body nitrogen in animals and humans are described. A method using the CO-11 in the expired air as a measure of nitrogen content was found to be adequate for small animals such as rats, but inadequate for human measurements due to a slow excretion rate. Studies on the method of measuring the induced N-13 in the body show that with further development, this method should be adequate for measuring muscle mass changes occurring in animals or humans during space flight.

  1. Rheumatoid arthritis: preoperative evaluation for total hip and total knee replacement surgery.

    PubMed

    Goodman, Susan M

    2013-06-01

    The role of total joint replacement surgery remains significant in the contemporary management of patients with rheumatoid arthritis (RA), despite the impact of potent biologic and synthetic disease-modifying drugs. Patients with RA have a systemic polyarticular disease, with extra-articular manifestations such as anemia as well as specific comorbidities such as cardiovascular disease, which require careful preoperative assessment for optimal outcomes and fewer adverse events. This review describes the important preoperative considerations taken to prepare a patient with RA for total hip and total knee replacement surgery. PMID:23669794

  2. Footprint mismatch in lumbar total disc arthroplasty.

    PubMed

    Gstoettner, Michaela; Michaela, Gstoettner; Heider, Denise; Denise, Heider; Liebensteiner, Michael; Bach, Christian Michael; Michael, Bach Christian

    2008-11-01

    Lumbar disc arthroplasty has become a popular modality for the treatment of degenerative disc disease. The dimensions of the implants are based on early published geometrical measurements of vertebrae; the majority of these were cadaver studies. The fit of the prosthesis in the intervertebral space is of utmost importance. An undersized implant may lead to subsidence, loosening and biomechanical failure due to an incorrect center of rotation. The aim of the present study was to measure the dimensions of lumbar vertebrae based on CT scans and assess the accuracy of match in currently available lumbar disc prostheses. A total of 240 endplates of 120 vertebrae were included in the study. The sagittal and mediolateral diameter of the upper and lower endplates were measured using a digital measuring system. For the levels L4/L5 and L5/S1, an inappropriate size match was noted in 98.8% (Prodisc L) and 97.6% (Charite) with regard to the anteroposterior diameter. Mismatch in the anterior mediolateral diameter was noted in 79.3% (Prodisc L) and 51.2% (Charite) while mismatch in the posterior mediolateral diameter was observed in 91.5% (Prodisc L) and 78% (Charite) of the endplates. Surgeons and manufacturers should be aware of the size mismatch of currently available lumbar disc prostheses, which may endanger the safety and efficacy of the procedure. Larger footprints of currently available total disc arthroplasties are required. PMID:18791748

  3. Footprint mismatch in lumbar total disc arthroplasty

    PubMed Central

    Michaela, Gstoettner; Denise, Heider; Liebensteiner, Michael

    2008-01-01

    Lumbar disc arthroplasty has become a popular modality for the treatment of degenerative disc disease. The dimensions of the implants are based on early published geometrical measurements of vertebrae; the majority of these were cadaver studies. The fit of the prosthesis in the intervertebral space is of utmost importance. An undersized implant may lead to subsidence, loosening and biomechanical failure due to an incorrect center of rotation. The aim of the present study was to measure the dimensions of lumbar vertebrae based on CT scans and assess the accuracy of match in currently available lumbar disc prostheses. A total of 240 endplates of 120 vertebrae were included in the study. The sagittal and mediolateral diameter of the upper and lower endplates were measured using a digital measuring system. For the levels L4/L5 and L5/S1, an inappropriate size match was noted in 98.8% (Prodisc L) and 97.6% (Charite) with regard to the anteroposterior diameter. Mismatch in the anterior mediolateral diameter was noted in 79.3% (Prodisc L) and 51.2% (Charite) while mismatch in the posterior mediolateral diameter was observed in 91.5% (Prodisc L) and 78% (Charite) of the endplates. Surgeons and manufacturers should be aware of the size mismatch of currently available lumbar disc prostheses, which may endanger the safety and efficacy of the procedure. Larger footprints of currently available total disc arthroplasties are required. PMID:18791748

  4. Periprosthetic Fractures Following Total Knee Arthroplasty

    PubMed Central

    Kim, Nam Ki

    2015-01-01

    Periprosthetic fractures after total knee arthroplasty may occur in any part of the femur, tibia and patella, and the most common pattern involves the supracondylar area of the distal femur. Supracondylar periprosthetic fractures frequently occur above a well-fixed prosthesis, and risk factors include anterior femoral cortical notching and use of the rotational constrained implant. Periprosthetic tibial fractures are frequently associated with loose components and malalignment or malposition of implants. Fractures of the patella are much less common and associated with rheumatoid arthritis, use of steroid, osteonecrosis and malalignment of implants. Most patients with periprosthetic fractures around the knee are the elderly with poor bone quality. There are many difficulties and increased risk of nonunion after treatment because reduction and internal fixation is interfered with by preexisting prosthesis and bone cement. Additionally, previous soft tissue injury is another disadvantageous condition for bone healing. Many authors reported good clinical outcomes after non-operative treatment of undisplaced or minimally displaced periprosthetic fractures; however, open reduction or revision arthroplasty was required in displaced fractures or fractures with unstable prosthesis. Periprosthetic fractures around the knee should be prevented by appropriate technique during total knee arthroplasty. Nevertheless, if a periprosthetic fracture occurs, an appropriate treatment method should be selected considering the stability of the prosthesis, displacement of fracture and bone quality. PMID:25750888

  5. Reduction Methods for Total Reaction Cross Sections

    NASA Astrophysics Data System (ADS)

    Gomes, P. R. S.; Mendes Junior, D. R.; Canto, L. F.; Lubian, J.; de Faria, P. N.

    2016-03-01

    The most frequently used methods to reduce fusion and total reaction excitation functions were investigated in a very recent paper Canto et al. (Phys Rev C 92:014626, 2015). These methods are widely used to eliminate the influence of masses and charges in comparisons of cross sections for weakly bound and tightly bound systems. This study reached two main conclusions. The first is that the fusion function method is the most successful procedure to reduce fusion cross sections. Applying this method to theoretical cross sections of single channel calculations, one obtains a system independent curve (the fusion function), that can be used as a benchmark to fusion data. The second conclusion was that none of the reduction methods available in the literature is able to provide a universal curve for total reaction cross sections. The reduced single channel cross sections keep a strong dependence of the atomic and mass numbers of the collision partners, except for systems in the same mass range. In the present work we pursue this problem further, applying the reduction methods to systems within a limited mass range. We show that, under these circumstances, the reduction of reaction data may be very useful.

  6. Solar Total Energy Project final test report

    SciTech Connect

    Nelson, R.F.; Abney, L.O.; Towner, M.L. )

    1990-09-01

    The Solar Total Energy Project (STEP), a cooperative effort between the United States Department of Energy (DOE) and Georgia Power Company (GPC) located at Shenandoah, Georgia, has undergone several design modifications based on experience from previous operations and test programs. The experiences encountered were discussed in detail in the Solar Total Energy Project Summary Report'' completed in 1987 for DOE. Most of the proposed changes discussed in this report were installed and tested in 1987 as part of two 15-day test programs (SNL Contract No. 06-3049). However, several of the suggested changes were not completed before 1988. These plant modifications include a new distributed control system for the balance of plant (BOP), a fiber a optical communications ring for the field control system, and new control configuration reflecting the new operational procedures caused by the plant modifications. These modifications were tested during a non-consecutive day test, and a 60-day field test conducted during the autumn of 1989. These test were partially funded by SNL under Contract No. 42-4859, dated June 22, 1989. Results of these tests and preliminary analysis are presented in this test summary report. 9 refs., 19 figs., 7 tabs.

  7. Postoperative Autologous Reinfusion in Total Knee Replacement

    PubMed Central

    Crescibene, A.; Martire, F.; Gigliotti, P.; Rende, A.; Candela, M.

    2015-01-01

    Surgeries for total knee replacement (TKR) are increasing and in this context there is a need to develop new protocols for management and use of blood transfusion therapy. Autologous blood reduces the need for allogeneic blood transfusion and the aim of the present study was to verify the safety and the clinical efficacy. An observational retrospective study has been conducted on 124 patients, undergoing cemented total knee prosthesis replacement. Observed population was stratified into two groups: the first group received reinfusion of autologous blood collected in the postoperative surgery and the second group did not receive autologous blood reinfusion. Analysis of data shows that patients undergoing autologous blood reinfusion received less homologous blood bags (10.6% versus 30%; p = 0.08) and reduced days of hospitalization (7.88 ± 0.7 days versus 8.96 ± 2.47 days for the control group; p = 0.03). Microbiological tests were negative in all postoperatively salvaged and reinfused units. Our results emphasize the effectiveness of this procedure and have the characteristics of simplicity, low cost (€97.53 versus €103.79; p < 0.01), and easy reproducibility. Use of autologous drainage system postoperatively is a procedure that allows reducing transfusion of homologous blood bags in patients undergoing TKR. PMID:26442168

  8. Total quality drives nuclear plant improvements

    SciTech Connect

    Richey, R.B. )

    1991-01-01

    Total quality (TQ) at Carolina Power and Light (CP and L) is fulfilling a 1985 vision of Sherwood H. Smith, Jr., CP and L's chairman, president, and chief executive officer. The TQ concept has provided a way for employees to align their creative energies toward meeting the business needs of the company. Throughout CP and L, TQ has been recognized as the vehicle for reducing operating costs and improving customer satisfaction. Within the nuclear organization, application of the TQ process has helped to improve communications, resolve challenges, and provide more consistent work practices among CP and L's three nuclear plants. Total quality was introduced from the top down, with initial benefits coming from team interactions. Senior management at CP and L defined the corporate expectations and outlined the training requirements for implementing TQ. Management staffs at each organizational level became steering committees for TQ team activities within their departments. Teams of employees most knowledgeable about a given work area were empowered to solve problems or overcome obstacles related to that work area. Employees learned to become better team players and to appreciate the quality of decisions reached through group consensus. Now, formalized methods that started TQ are becoming part of the day-to-day work ethic.

  9. Kelvin waves in total column ozone

    NASA Technical Reports Server (NTRS)

    Ziemke, J. R.; Stanford, J. L.

    1994-01-01

    Tropical Kelvin waves have been observed previously in ozone mixing ratio data from the SBUV (Solar Backscatter Ultraviolet) and LIMS (Limb Infrared Monitor of the Stratosphere) instruments on board the Nimbus-7 satellite. The present study investigates Kelvin wave features in total column ozone, using version 6 data from the Total Ozone Mapping Spectrometer (TOMS) instrument (also on Nimbus-7). Results show eastward-propagating zonal waves 1-2 with periods approx. 5-15 days, amplitudes approx. 3-5 Dobson Units (1-2% of the time mean), and latitudinal symmetry typical of Kelvin waves. The analyses and a linear model in this study suggest that the primary source of the perturbations is slow Kelvin waves in the lower-to-middle stratosphere. Maximum Kelvin wave signatures occur in conjunction with westward lower-to-middle stratospheric equatorial zonal winds (a quasi-biennial oscillation (QBO) wind modulation effect). The significance of these results is that the TOMS data are shown to be useful for investigations with global coverage of a major component of tropical stratospheric dynamics, Kelvin waves. The TOMS data set with its excellent coverage and high quality should be useful in validating model studies in the relatively data sparse and dynamically difficult tropical region.

  10. Total mass of the Jupiter Trojans

    NASA Astrophysics Data System (ADS)

    Vinogradova, T. A.; Chernetenko, Yu. A.

    2015-12-01

    The total mass of the Jupiter Trojans is estimated at (0.30 ± 0.19) × 10-10 M Sun using all available physical characteristics of these asteroids. The mass of asteroids in the L4 swarm ((0.19 ± 0.11) × 10-10 M Sun) is higher than that in the L5 swarm ((0.11 ± 0.07) × 10-10 M Sun) by a factor of 1.7. The obtained estimates include the hidden mass of asteroids that are not discovered yet. This hidden component constitutes 7% of the total mass. The number of Trojans with diameters larger than 1 km is estimated at 6 × 105. The number of such asteroids at the L4 Lagrangian point ( N L4 = 4 × 105) is two times higher than that at the L5 Lagrangian point ( N L5 = 2 × 105). It is found that the N L4/ N L5 ratio is increased at smaller asteroid sizes or higher absolute magnitudes H. This ratio equals just 1.3 for asteroids with H <11m (i.e., asteroids with diameters D > 30 km). The effect of gravitational perturbations from Trojans on the motion of Hildian asteroids and centaurs is evaluated. This effect turned out to be at the limit of accuracy of modern observations.

  11. Annular and Total Solar Eclipses of 2010

    NASA Technical Reports Server (NTRS)

    Espenak, Fred; Anderson, J.

    2008-01-01

    While most NASA eclipse bulletins cover a single eclipse, this publication presents predictions for two solar eclipses during 2010. This has required a different organization of the material into the following sections. Section 1 -- Eclipse Predictions: The section consists of a general discussion about the eclipse path maps, Besselian elements, shadow contacts, eclipse path tables, local circumstances tables, and the lunar limb profile. Section 2 -- Annular Solar Eclipse of 2010 Ja n 15: The section covers predictions and weather prospects for the annular eclipse. Section 3 -- Total Solar Eclipse of 2010 Jul 11: The se ction covers predictions and weather prospects for the total eclipse. Section 4 -- Observing Eclipses: The section provides information on eye safety, solar filters, eclipse photography, and making contact timings from the path limits. Section 5 -- Eclipse Resources: The final section contains a number of resources including information on the IAU Working Group on Eclipses, the Solar Eclipse Mailing List, the NASA eclipse bulletins on the Internet, Web sites for the two 2010 eclipses, and a summary identifying the algorithms, ephemerides, and paramete rs used in the eclipse predictions.

  12. Total Lightning Activity Associated with Tornadic Storms

    NASA Technical Reports Server (NTRS)

    Goodman, Steven J.; Buechler, Dennis; Hodanish, Stephen; Sharpe, David; Williams, Earle R.; Boldi, Bob; Matlin, Anne; Weber, Mark

    1999-01-01

    Prior studies have examined the association of lightning activity with the occurrence of severe weather. Severe storms often have high flash rates (in excess of one flash per second) and are dominated by intracloud lightning activity. Most recently, we have identified a rapid change (referred to as a "jump") in total flash rate which precedes the occurrence of severe weather by ten or more minutes. This relationship is associated with updraft intensification. In this paper we examine whether there exist unique characteristics of the total lightning and the lightning jumps associated with tornadoes in Florida, and explain how they might relate to the interaction of mesocyclonic shear, the rear flank downdraft and outflow boundaries that can lead to tornadogenesis. In several cases, evidence for diminishment of midlevel rotation and the descent of angular momentum from aloft is present prior to the appearance of the surface tornado. The relatively long lead time between the lighting jump and the occurrence of the tornado is attributed to the time lag between updraft invigoration and the boundary layer spin up of vorticity.

  13. Dual mobility cups in total hip arthroplasty

    PubMed Central

    De Martino, Ivan; Triantafyllopoulos, Georgios Konstantinos; Sculco, Peter Keyes; Sculco, Thomas Peter

    2014-01-01

    Total hip arthroplasty (THA) is considered one of the most successful surgical procedures in orthopaedics. With the increase in the number of THAs performed in the world in the next decades, reducing or preventing medical and mechanical complications such as post-operative THA instability will be of paramount importance, particularly in an emerging health care environment based on quality control and patient outcome. Dual mobility acetabular component (also known as unconstrained tripolar implant) was introduced in France at the end of the 1970s as an alternative to standard sockets, to reduce the risk of THA dislocation in patients undergoing primary THA in France. Dual mobility cups have recently gained wider attention in the United States as an alternative option in the prevention and treatment of instability in both primary and revision THA and offer the benefit of increased stability without compromising clinical outcomes and implant longevity. In this article, we review the use of dual mobility cup in total hip arthroplasty in terms of its history, biomechanics, outcomes and complications based on more than 20 years of medical literature. PMID:25035820

  14. Methods development for total organic carbon accountability

    NASA Technical Reports Server (NTRS)

    Benson, Brian L.; Kilgore, Melvin V., Jr.

    1991-01-01

    This report describes the efforts completed during the contract period beginning November 1, 1990 and ending April 30, 1991. Samples of product hygiene and potable water from WRT 3A were supplied by NASA/MSFC prior to contract award on July 24, 1990. Humidity condensate samples were supplied on August 3, 1990. During the course of this contract chemical analyses were performed on these samples to qualitatively determine specific components comprising, the measured organic carbon concentration. In addition, these samples and known standard solutions were used to identify and develop methodology useful to future comprehensive characterization of similar samples. Standard analyses including pH, conductivity, and total organic carbon (TOC) were conducted. Colorimetric and enzyme linked assays for total protein, bile acid, B-hydroxybutyric acid, methylene blue active substances (MBAS), urea nitrogen, ammonia, and glucose were also performed. Gas chromatographic procedures for non-volatile fatty acids and EPA priority pollutants were also performed. Liquid chromatography was used to screen for non-volatile, water soluble compounds not amenable to GC techniques. Methods development efforts were initiated to separate and quantitate certain chemical classes not classically analyzed in water and wastewater samples. These included carbohydrates, organic acids, and amino acids. Finally, efforts were initiated to identify useful concentration techniques to enhance detection limits and recovery of non-volatile, water soluble compounds.

  15. Preoperative Planning in Primary Total Knee Arthroplasty.

    PubMed

    Tanzer, Michael; Makhdom, Asim M

    2016-04-01

    Preoperative planning is of paramount importance in primary total knee arthroplasty. A thorough preoperative analysis helps the surgeon envision the operation, anticipate any potential issues, and minimize the risk of premature implant failure. Obtaining a thorough history is critical for appropriate patient selection. The physical examination should evaluate the integrity of the soft tissues, the neurovascular status, range of motion, limb deformity, and the status of the collateral ligaments to help determine the soft-tissue balancing and constraint strategy required. Standard radiographs, with a known magnification, should be obtained for preoperative total knee arthroplasty templating. Routine standing AP, lateral, and skyline radiographs of the knee can help the surgeon plan the bone cuts and tibial slope as well as the implant size and position at the time of surgery. In certain circumstances, such as severe coronal deformities, bone deficiencies, and/or extra-articular deformities, additional measures are frequently necessary to successfully reconstruct the knee. Constrained implants, metal augments, and bone graft must be part of the surgeon's armamentarium. PMID:26990712

  16. Esophagojejunostomy after total gastrectomy for caustic injuries.

    PubMed

    Chirica, M; Kraemer, A; Petrascu, E; Vuarnesson, H; Pariente, B; Halimi, B; Munoz-Bongrand, N; Sarfati, E; Cattan, P

    2014-01-01

    The objective of the study was to compare outcomes of emergency esophagogastrectomy (EGT) and total gastrectomy with immediate esophagojejunostomy (EJ) in patients with full-thickness caustic necrosis of the stomach and mild esophageal injuries. After caustic ingestion, optimal management of the esophageal remnant following removal of the necrotic stomach remains a matter of debate. Between 1987 and 2012, 26 patients (men 38%, median age 44 years) with isolated transmural gastric necrosis underwent EGT (n = 14) or EJ (n = 12). Early and long-term outcomes of both groups were compared. The groups were similar regarding age (P = 0.66), gender (0.24), and severity of esophageal involvement. Functional success was defined as nutritional autonomy after removal of the jejunostomy and tracheotomy tubes. Emergency morbidity (67% vs. 64%, P = 0.80), mortality (17% vs. 7%, P = 0.58), and reoperation rates (25% vs.14%, P = 0.63) were similar after EJ and EGT. One patient (8%) experienced EJ leakage. One patient in the EJ group and 13 patients in the EGT group underwent esophageal reconstruction (P < 0.0001). Aggregate in hospital length of stay was significantly longer in patients who underwent EGT (median 83 [33-201] vs. 36 [10-82] days, P = 0.001). Functional success after EJ and EGT was similar (90% vs.69%, P = 0.34). Immediate EJ can be safely performed after total gastrectomy for caustic injuries and reduces the need of further esophageal reconstruction. PMID:23621347

  17. Infrared polarimetry using attenuated total reflection

    NASA Astrophysics Data System (ADS)

    Deibler, Lynn L.; Smith, Matthew H.

    1999-10-01

    Most organic materials are quite opaque to IR radiation, making it nearly impossible to measure the polarization properties at these wavelengths. By placing the highly absorbing organic material on a high index of refraction prism and making use of the evanescent field present at the interface for angles exceeding the critical angle, it is possible to measure the organic material's polarization characteristics. Attenuated Total Reflection (ATR) devices have been constructed in-house for use in our IR polarimeter operating over the spectral range of 3-14 microns. Single bounce internal reflection ZnSe prisms are used in our devices to measure the polarization characteristics of highly absorbing materials. Using attenuated total reflection along with a dual rotating retarder polarimeter, it is possible to determine the full Mueller Matrix, and thus determine the linear and circular diattenuation and retardance. With this information we can determine the complex index of refraction, dichroic ratio, and isotropic ratio of materials which are opaque in the IR region. With this knowledge of the material polarization properties, it may be possible to determine the orientation of the molecules in films made of long helical organic molecules and determine the enantiomeric purity of stereo-isomers. The theoretical performance of these devices with a focus on the organic chemical applications has been determined and compared with experiments. In this paper we present a summary of the theoretical basis for the measurements and make comparisons with our measurements.

  18. Spatial modelling of total storm rainfall

    NASA Technical Reports Server (NTRS)

    Rodriguez-Iturbe, I.; Cox, D. R.; Eagleson, P. S.

    1986-01-01

    The spatial structure of the depth of rainfall from a stationary storm event is investigated by using point process techniques. Cells are assumed to be stationary and to be distributed in space either independently according to a Poisson process, or with clustering according to a Neyman-Scott scheme. Total storm rainfall at the centre of each cell is a random variable and rainfall is distributed around the centre in a way specified by a spread function that may incorporate random parameters. The mean, variance and covariance structure of the precipitation depth at a point are obtained for different spread functions. For exponentially distributed centre depth and a spread function having quadratically exponential decay, the total storm depth at any point in the field is shown to have a gamma distribution. The probability of zero rainfall at a point is investigated, as is the stochastic variability of model parameters from storm to storm. Data from the Upper Rio Guaire basin in Venezuela are used in illustration.

  19. 38 CFR 3.340 - Total and permanent total ratings and unemployability.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... are met. (3) Ratings of total disability on history. In the case of disabilities which have undergone... disability will be taken to exist when such impairment is reasonably certain to continue throughout the...

  20. MEASUREMENT AND DECOMPOSITION OF TOTAL EXPOSURE USING THE TOTAL-ISOLATED-BY-MICROENVIRONMENT-EXPOSURE (TIME) MONITOR

    EPA Science Inventory

    This paper describes a new, highly compact and lightweight monitor that directly measures personal exposure resolved into four microenvironments. he device is the "Total-Isolated-by-Microenvironment-Exposure (TIME)" monitor. he monitor can identify electronically a subject's micr...

  1. Calculation of the total and total ionization cross sections for positron scattering on atomic hydrogen

    SciTech Connect

    Bray, I. ); Stelbovics, A.T. )

    1994-04-01

    The total and total ionization cross sections for positron scattering on atomic hydrogen are calculated by applying the convergent-close-coupling method to the model where positronium-formation channels are omitted. This model accurately describes the physics of the scattering whenever the positronium formation cross section is negligible, in particular, above 100 eV for this system. The total ionization cross section results in this energy region are in excellent agreement with the recent measurements of Jones [ital et] [ital al]. [J. Phys. B 26, L483 (1993)], and so lie below the earlier measurements of Spicher [Phys. Rev. Lett. 64, 1019 (1990)], and the recent calculations of Acacia [ital et] [ital al]. [Phys. Rev. Lett. (to be published)]. The total cross section is in very good agreement with the recent measurements of Zhou [ital et] [ital al]. (unpublished) down to 30 eV.

  2. 38 CFR 3.340 - Total and permanent total ratings and unemployability.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... are met. (3) Ratings of total disability on history. In the case of disabilities which have undergone... disability will be taken to exist when such impairment is reasonably certain to continue throughout the...

  3. Positron interactions with water-total elastic, total inelastic, and elastic differential cross section measurements

    NASA Astrophysics Data System (ADS)

    Tattersall, Wade; Chiari, Luca; Machacek, J. R.; Anderson, Emma; White, Ron D.; Brunger, M. J.; Buckman, Stephen J.; Garcia, Gustavo; Blanco, Francisco; Sullivan, James P.

    2014-01-01

    Utilising a high-resolution, trap-based positron beam, we have measured both elastic and inelastic scattering of positrons from water vapour. The measurements comprise differential elastic, total elastic, and total inelastic (not including positronium formation) absolute cross sections. The energy range investigated is from 1 eV to 60 eV. Comparison with theory is made with both R-Matrix and distorted wave calculations, and with our own application of the Independent Atom Model for positron interactions.

  4. Positron interactions with water–total elastic, total inelastic, and elastic differential cross section measurements

    SciTech Connect

    Tattersall, Wade; Centre for Antimatter-Matter Studies, School of Engineering and Physical Sciences, James Cook University, Townsville, 4810 Queensland ; Chiari, Luca; Machacek, J. R.; Anderson, Emma; Sullivan, James P.; White, Ron D.; Brunger, M. J.; Institute of Mathematical Sciences, University of Malaya, 50603 Kuala Lumpur ; Buckman, Stephen J.; Institute of Mathematical Sciences, University of Malaya, 50603 Kuala Lumpur ; Garcia, Gustavo; Blanco, Francisco

    2014-01-28

    Utilising a high-resolution, trap-based positron beam, we have measured both elastic and inelastic scattering of positrons from water vapour. The measurements comprise differential elastic, total elastic, and total inelastic (not including positronium formation) absolute cross sections. The energy range investigated is from 1 eV to 60 eV. Comparison with theory is made with both R-Matrix and distorted wave calculations, and with our own application of the Independent Atom Model for positron interactions.

  5. Changes in total body water during spaceflight

    NASA Technical Reports Server (NTRS)

    Leach, Carolyn S.; Inners, L. D.; Charles, John B.

    1991-01-01

    Total body water (TBW) changes occurring in humans as a consequence of prolonged exposure to microgravity were measured in five male crewmembers of Space Shuttle missions STS-61C and STS-26. It was found that the inflight mean TBW values were significantly different from the preflight and postflight values, while the preflight TBW values were not significantly different from the postflight values. It was also found that individuals may differ in the rate at which they respond to weightlessness. Of the three crewmen who reported experiencing no symptoms of space motion sickness (SMS), two had not exhibited a decrease of TBW at the time of measurements (24 hrs after launch), while the two crewmen who reported SMS of intermediate severity showed a decrease of several kg by 24 hrs, suggesting that dehydration might be an important factor affecting the rate of TBW decrease.

  6. Total nitrogen content of deep sea basalts

    NASA Technical Reports Server (NTRS)

    Norris, T. L.; Schaeffer, O. A.

    1982-01-01

    An estimate of the total nitrogen content of the earth's mantle, aimed at furnishing a further constraint for earth atmosphere origin and evolution models, was attempted through thermal neutron activation analysis via N-14(n,p)C-14 for the case of deep sea basalt glasses from the East Pacific Rise, the Mid-Atlantic Rift, and the Juan de Fuca Ridge. The increased nitrogen abundance of matrix material from the same samples as the glasses may be due to the incorporation of chemically-bound nitrogen from sea water, rather than dissolved molecular nitrogen. A discussion is presented of factors affecting observed basalt nitrogen content and its interpretation in terms of mantle nitrogen abundance. A 2 ppm N lower limit is estimated for the mantle.

  7. Total synthesis of the Daphniphyllum alkaloid daphenylline

    NASA Astrophysics Data System (ADS)

    Lu, Zhaoyong; Li, Yong; Deng, Jun; Li, Ang

    2013-08-01

    The Daphniphyllum alkaloids are a large class of natural products isolated from a genus of evergreen plants widely used in Chinese herbal medicine. They display a remarkable range of biological activities, including anticancer, antioxidant, and vasorelaxation properties as well as elevation of nerve growth factor. Daphenylline is a structurally unique member among the predominately aliphatic Daphniphyllum alkaloids, and contains a tetrasubstituted arene moiety mounted on a sterically compact hexacyclic scaffold. Herein, we describe the first total synthesis of daphenylline. A gold-catalysed 6-exo-dig cyclization reaction and a subsequent intramolecular Michael addition reaction, inspired by Dixon's seminal work, were exploited to construct the bridged 6,6,5-tricyclic motif of the natural product at an early stage, and the aromatic moiety was forged through a photoinduced olefin isomerization/6π-electrocyclization cascade followed by an oxidative aromatization process.

  8. Doppler tomography by total variation minimization

    NASA Astrophysics Data System (ADS)

    Uemura, Makoto; Kato, Taichi; Nogami, Daisaku; Mennickent, Ronald

    2015-04-01

    We have developed a new model of Doppler tomography using total variation minimization (DTTVM). This method can reconstruct localized and nonaxisymmetric profiles with sharp edges in the Doppler map. This characteristic is emphasized in the case where input data are small in number. We apply this model to natural data for the dwarf nova WZ Sge in superoutburst and TU Men in quiescence. We confirm that DTTVM can reproduce the observed spectra with high precision. Compared with the models based on the maximum entropy method, our new model can provide Doppler maps that little depend on the hyperparameter and on the presence of the absorption core. We also introduce a cross-validation method of estimating reasonable values of a hyperparameter in the model from the data themselves.

  9. Shenandoah Solar Total-Energy Project

    NASA Astrophysics Data System (ADS)

    Leonard, J. A.; Hunke, R. W.

    1982-12-01

    The design and construction of the world's first solar total energy plant in the private sector was completed and checkout is underway. During its operational phase, the solar plant will furnish electrical power, process steam, and other thermal energy to a nearby knitwear factory. The solar system consists of a collector field containing 114 parabolic dish collectors which supply thermal energy at 4000 C to drive a 400 kW multistage Rankine cycle turbine generator. Some steam is extracted from the turbine and supplied to the knitwear manufacturing processes. The system will be grid connected. Presented are a description of the system and components being installed; a summary of performance testing of the extraction turbine and of four prototype parabolic dish collectors; and a discussion of design considerations and insights which have general applicability to solar thermal system designs.

  10. Shenandoah Solar Total-Energy Project

    SciTech Connect

    Leonard, J.A.; Hunke, R.W.

    1982-12-01

    The design and construction of the world's first solar total-energy plant in the private sector has been completed and checkout is underway. During its operational phase, the solar plant will furnish electrical power, process steam, and other thermal energy to a nearby knitwear factory. The solar system consists of a collector field containing 114 parabolic-dish collectors which supply thermal energy at 400/sup 0/C to drive a 400 kW multi-stage Rankine-cycle turbine generator. Some steam is extracted from the turbine and supplied to the knitwear manufacturing processes. The system will be grid-connected. Presented are: (1) a description of the system and components being installed; (2) a summary of performance testing of the extraction turbine and of four prototype parabolic-dish collectors; and (3) a discussion of design considerations and insights which have general applicability to solar-thermal-system designs.

  11. Trunnionosis in total hip arthroplasty: a review.

    PubMed

    Mistry, Jaydev B; Chughtai, Morad; Elmallah, Randa K; Diedrich, Aloise; Le, Sidney; Thomas, Melbin; Mont, Michael A

    2016-03-01

    Trunnionosis is defined as wear of the femoral head-neck interface and has recently been acknowledged as a growing cause of total hip arthroplasty failure. Some studies have reported that it accounts for up to 3 % of all revisions. The exact cause of trunnionosis is currently unknown; however, postulated etiologies include modular junction wear, corrosion damage, and metal ion release. Additionally, implant design and trunnion geometries may contribute to the progression of component failure. In order to aid in our understanding of this phenomenon, our aim was to present the current literature on (1) the effect of femoral head size on trunnionosis, (2) the effect of trunnion design on trunnionosis, (3) localized biological reactions associated with trunnionosis, and (4) gross trunnion failures. It is hoped that this will encourage further research and interest aimed at minimizing this complication. PMID:26868420

  12. Current uses of total parenteral nutrition.

    PubMed

    Meguid, M M; Muscaritoli, M

    1993-02-01

    Total parenteral nutrition has become a well-established intervention for the following indications: to sustain life in patients with short-bowel syndrome; for perioperative use in nutritionally deprived patients; to improve quality of life for patients with inflammatory bowel diseases; to assist the healing of enterocutaneous and pancreatic fistulas; for supportive care in patients with acute pancreatitis; as an adjunct to therapy in patients with acute renal or hepatic failure; for hypermetabolic states such as sepsis, trauma, burns and acquired immunodeficiency syndrome; in neonatal and pediatric patients; in transplantation recipients, including bone marrow, renal, cardiac and liver transplants; for precoronary artery bypass graft myocardial glycogen loading; in the field of obstetrics; to enhance survival in patients with closed head injuries; to treat life-threatening anorexia nervosa; in patients with cystic fibrosis and for nutritional support in home use. PMID:8430592

  13. Radiological evaluation of painful total hip replacement

    SciTech Connect

    Jamshid, T.; Schneider, R.; Freiberger, R.H.

    1981-11-01

    Ninety-four cases of clinically failed, cemented, total hip prostheses requiring surgery were reviewed to determine the accuracy of preoperative plain radiography, culture of aspirated fluid, arthrography, and bone scanning. When radiopaque cement had been used to embed the prosthesis, plain radiography was highly accurate in detecting a loose femoral component, less so in detecting a loose acetabular component. Culture of aspirated fluid was accurate in diagnosing infection. A positive arthrogram identified loosening with good accuracy; however, a negative arthrogram did not reliably exclude loosening. /sup 99/mTc bone scans frequently differentiated loosening from loosening with infection. The suggested sequence of diagnostic tests is plain radiography followed by bone scanning. If the bone scan shows diffuse augmented uptake, culture of aspirated fluid followed by arthrography is indicated.

  14. Radiological evaluation of painful total hip replacement

    SciTech Connect

    Tehranzadeh, J.; Schneider, R.; Freiberger, R.H.

    1981-01-01

    Ninety-four cases of clinically failed, cemented, total hip prostheses requiring surgery were reviewed to determine the accuracy of preoperative plain radiography, culture of aspirated fluid, arthrography, and bone scanning. When radiopaque cement had been used to embed the prosthesis, plain radiography was highly accurate in detecting a loose femoral component, less so in detecting a loose acetabular component. Culture of aspirated fluid was accurate in diagnosing infection. A positive arthrogram identified loosening with good accuracy; however, a negative arthrogram did not reliably exclude loosening. /sup 99/mTc bone scans frequently differentiated loosening from loosening with infection. The suggested sequence of diagnostic tests is plain radiography followed by bone scanning. If the bone scan shows diffuse augmented uptake, culture of aspirated fluid followed by arthrography is indicated.

  15. Total synthesis of (±)-antroquinonol d.

    PubMed

    Sulake, Rohidas S; Jiang, Yan-Feng; Lin, Hsiao-Han; Chen, Chinpiao

    2014-11-21

    Total synthesis of (±)-antroquinonol D, which is isolated from very expensive and rarely found Antrodia camphorata and which has potential anticancer properties, was achieved from 4-methoxyphenol. In addition, a Michael addition to dimethoxy cyclohexadienones was studied. The main step involved chelation and substrate-controlled diastereoselective reduction of cyclohexenone and lactonization. Lactone synthesis facilitated the diastereoselective reduction of ketone, which help control the desired stereochemistry at the crucial stereogenic center in the natural product. Other key reactions in the synthesis involved a Michael addition of dimethyl malonate on cyclohexadienone, dihydroxylation, and Wittig olefination. A sesquiterpene side chain was synthesized through coupling with geranyl phenyl sulfide and Bouveault-Blanc reduction. PMID:25375772

  16. UPRE method for total variation parameter selection

    SciTech Connect

    Wohlberg, Brendt; Lin, Youzuo

    2008-01-01

    Total Variation (TV) Regularization is an important method for solving a wide variety of inverse problems in image processing. In order to optimize the reconstructed image, it is important to choose the optimal regularization parameter. The Unbiased Predictive Risk Estimator (UPRE) has been shown to give a very good estimate of this parameter for Tikhonov Regularization. In this paper we propose an approach to extend UPRE method to the TV problem. However, applying the extended UPRE is impractical in the case of inverse problems such as de blurring, due to the large scale of the associated linear problem. We also propose an approach to reducing the large scale problem to a small problem, significantly reducing computational requirements while providing a good approximation to the original problem.

  17. Neck after total laryngectomy: CT study

    SciTech Connect

    DiSantis, D.J.; Balfe, D.M.; Hayden, R.E.; Sagel, S.S.; Sessions, D.; Lee, J.K.T.

    1984-12-01

    Computed tomographic scans in 23 patients who had undergone total laryngectomy were analyzed retrospectively to determine normal postoperative appearance and to evaluate the role of CT in assessing recurrent neoplasm. Nine patients without clinical evidence of recurrence illustrated the normal postoperative changes: a round or ovoid neopharynx connecting the base of the tongue with the cervical esophagus and intact fat planes surrounding the neopharynx, neurovascular bundles, and sternocleidomastoid muscles. In the 12 patients with recurrent neoplasm, the CT manifestations included masses involving the internal jugular lymph node chain, tracheostomy site, or paratracheal region. CT supplemented physical examination and indirect mirror examination, providing data regarding presence and extent of recurrent tumor and aiding in planning the mode and scope of therapy.

  18. Enantioselective Total Synthesis of (-)-Alstoscholarisine A.

    PubMed

    Liang, Xiao; Jiang, Shi-Zhi; Wei, Kun; Yang, Yu-Rong

    2016-03-01

    We report a concise and highly enantioselective total synthesis of (-)-alstoscholarisine A (1), a recently isolated monoterpenoid indole alkaloid that has significant bioactivity in promoting adult neuronal stem cells proliferation. A highly enantioselective (99% ee), intramolecular Ir-catalyzed Friedel-Crafts alkylation of indole 9 with a secondary allylic alcohol was utilized to establish the first stereogenic center upon which the other three contiguous chiral centers were readily set by a highly stereoselective tandem 1,4-addition and aldol reaction. The key tetrahydropyran was constructed through a hemiacetal reduction, and the final aminal bridge was forged by a one-pot reductive amination/cyclization. The conciseness of this approach was highlighted by building core bonds in each step with a minimalist protecting group strategy. PMID:26882407

  19. Material Science in Cervical Total Disc Replacement.

    PubMed

    Pham, Martin H; Mehta, Vivek A; Tuchman, Alexander; Hsieh, Patrick C

    2015-01-01

    Current cervical total disc replacement (TDR) designs incorporate a variety of different biomaterials including polyethylene, stainless steel, titanium (Ti), and cobalt-chrome (CoCr). These materials are most important in their utilization as bearing surfaces which allow for articular motion at the disc space. Long-term biological effects of implanted materials include wear debris, host inflammatory immune reactions, and osteolysis resulting in implant failure. We review here the most common materials used in cervical TDR prosthetic devices, examine their bearing surfaces, describe the construction of the seven current cervical TDR devices that are approved for use in the United States, and discuss known adverse biological effects associated with long-term implantation of these materials. It is important to appreciate and understand the variety of biomaterials available in the design and construction of these prosthetics and the considerations which guide their implementation. PMID:26523281

  20. p-MOSFET total dose dosimeter

    NASA Technical Reports Server (NTRS)

    Buehler, Martin G. (Inventor); Blaes, Brent R. (Inventor)

    1994-01-01

    A p-MOSFET total dose dosimeter where the gate voltage is proportional to the incident radiation dose. It is configured in an n-WELL of a p-BODY substrate. It is operated in the saturation region which is ensured by connecting the gate to the drain. The n-well is connected to zero bias. Current flow from source to drain, rather than from peripheral leakage, is ensured by configuring the device as an edgeless MOSFET where the source completely surrounds the drain. The drain junction is the only junction not connected to zero bias. The MOSFET is connected as part of the feedback loop of an operational amplifier. The operational amplifier holds the drain current fixed at a level which minimizes temperature dependence and also fixes the drain voltage. The sensitivity to radiation is made maximum by operating the MOSFET in the OFF state during radiation soak.