Orthopedic Surgery is that surgical discipline which deals with the musculoskeletal system. Orthopedists therefore operate on joints, the spine and long bones and engage in such subsecialities as sports medicine, hand surgery, trauma surgery, and joint replacements. Since they must cut and shape bone, cartilage, tendon, and ligament, orthopedists have developed a number of mechanical techniques to achieve these ends and surgical lasers have found few applications in orthopedics because until now they have not been useful for cutting bone. In the past several years, however, there has been considerable interest in several areas within the field of orthopedic surgery that do not entail actual bone surgery and it is expected that as newer and more powerful lasers become available laser osteotomy may become feasible and even routine.
Sherk, Henry H.; Rhodes, Anthony L.; Meller, Menachem M.
The program was designed as a pilot project to establish new techniques for making orthopedic prosthetic materials. The basic idea was to make metal supported ceramic composites, so that the metal provided strength (and an element of ductility) and the re...
B. J. Shaw
In orthopedic surgery the manipulation “bone drilling” is used very often and it is performed by hand drilling, which causes a lot of problems—getting the big outlets, breaking the tendons or blood vessels, protecting the rear bone wall (which brings one more cutting of the tissue), overheating, and so on. Automatic bone drilling could successfully solve these problems. The drilling
Tony Boiadjiev; Kazimir Zagurski; George Boiadjiev; Kamen Delchev; Vladimir Vitkov; Ivanka Veneva; Rumen Kastelov
Orthopedic disorders, although rarely fatal, are the leading cause of morbidity and impose a huge socioeconomic burden. Their prevalence will increase dramatically as populations age and gain weight. Many orthopedic conditions are difficult to treat by conventional means; however, they are good candidates for gene therapy. Clinical trials have already been initiated for arthritis and the aseptic loosening of prosthetic
Christopher H Evans; Steven C Ghivizzani; Paul D Robbins
The fixation of orthopedic implants has been one of the most difficult and challenging problems. The fixation can be achieved via: (a) direct mechanical fixation using screws, pins, wires, etc.; (b) passive or interference mechanical fixation where the implants are allowed to move or merely positioned onto the tissue surfaces; (c) bone cement fixation which is actually a grouting material; (d) biological fixation by allowing tissues to grow into the interstices of pores or textured surfaces of implants; (e) direct chemical bonding between implant and tissues; or (f) any combination of the above techniques. This article is concerned with various fixation techniques including the potential use of electrical, pulsed electromagnetic field, chemical stimulation using calcium phosphates for the enhancement of tissue ingrowth, direct bonding with bone by glass-ceramics and resorbable particle impregnated bone cement to take advantages of both the immediate fixation offered by the bone cement and long term fixation due to tissue ingrowth. PMID:1449228
Park, J B
The demand for hip and knee replacement surgery is substantial and growing. Unfortunately, most joint replacement surgeries will fail within 10-25 years, thereby requiring an arduous, painful, and expensive revision surgery. To address this issue, a novel orthopedic implant coating material ("eXalt") has been developed. eXalt is comprised of super elastic nitinol wire that is knit into a three-dimensional spacer fabric structure. eXalt expands in vivo to conform to the implantation site and is porous to allow for bone ingrowth. The safety and efficacy of eXalt were evaluated through structural analysis, mechanical testing, and a rabbit implantation model. The results demonstrate that eXalt meets or exceeds the performance of current coating technologies with reduced micromotion, improved osseointegration, and stronger implant fixation in vivo.
Fournier, Eric; Devaney, Robert; Palmer, Matthew; Kramer, Joshua; El Khaja, Ragheb; Fonte, Matthew
Physicians are exposed to occupational hazards of which they are often unaware. Orthopedic surgery has a particularly hazardous work environment in which surgeons are at increased risk for exposure to infection, radiation, smoke, chemicals, excessive noise, musculoskeletal injuries, as well as emotional and psychological disturbances. Understanding these risks and the precautions that can be taken to avoid them will help protect orthopedic surgeons from potential harm. PMID:22530210
Lester, J D; Hsu, S; Ahmad, C S
Various effects of plasmas irradiation on cells, tissues, and biomaterials relevant for orthopedic applications have been examined. For direct application of plasmas to living cells or tissues, dielectric barrier discharges (DBDs) with helium flows into ambient air were used. For biomaterial processing, on the other hand, either helium DBDs mentioned above or low-pressure discharges generated in a chamber were used. In this presentation, plasma effects on cell proliferation and plasma treatment for artificial bones will be discussed. First, the conditions for enhanced cell proliferation in vitro by plasma applications have been examined. The discharge conditions for cell proliferation depend sensitively on cell types. Since cell proliferation can be enhanced even when the cells are cultured in a plasma pre-treated medium, long-life reactive species generated in the medium by plasma application or large molecules (such as proteins) in the medium modified by the plasma are likely to be the cause of cell proliferation. It has been found that there is strong correlation between (organic) hydroperoxide generation and cell proliferation. Second, effects of plasma-treated artificial bones made of porous hydroxyapatite (HA) have been examined in vitro and vivo. It has been found that plasma treatment increases hydrophilicity of the surfaces of microscopic inner pores, which directly or indirectly promotes differentiation of mesenchymal stem cells introduced into the pores and therefore causes faster bone growth. The work has been performed in collaboration with Prof. H. Yoshikawa and his group members at the School of Medicine, Osaka University.
Every year, 4 billion pounds of waste are produced by health care facilities, and the amount continues to increase annually. In response, a movement toward greening health care has been building, with a particular focus on the operating room. Between 20% and 70% of health care waste originates from a hospital's operating room, and up to 90% of operating room waste is improperly sorted and sent for costly and unneeded hazardous waste processing. Recent successful changes include segregation of hospital waste, substitution of the ubiquitous polypropylene plastic wrap used for the sterilization and handling of surgical equipment with metal cases, and the reintroduction of reusable surgical gowns. Orthopedic-related changes include the successful reprocessing and reuse of external fixators, shavers, blades, burs, and tourniquets. These changes have been shown to be environmentally and economically beneficial. Early review indicates that these changes are feasible, but a need exists for further evaluation of the effect on the operating room and flow of the surgical procedure and of the risks to the surgeons and operating room staff. Other key considerations are the effects of reprocessed and reused equipment on patient care and outcome and the role of surgeons in helping patients make informed decisions regarding surgical care. The goals of this study were to summarize the amount and types of waste produced in hospitals and operating rooms, highlight the methods of disposal used, review disposal methods that have been developed to reduce waste and improve recycling, and explore future developments in greening health care. PMID:22691671
Lee, Rushyuan J; Mears, Simon C
Radiographic correlation is an essential adjunct for the accurate diagnosis of orthopedic lesions, yet it is a skill neglected by pathologists. The purpose of this review is to demonstrate why performing this correlation is an essential part of the diagnostic process and not merely an interesting adjunct to the surgical pathology of orthopedic lesions. The relationships between x-rays and tissues are explored with an emphasis on bone and soft tissue composition and structure. In addition, the rudiments of complementary imaging studies and how to incorporate their data into diagnoses are examined. PMID:16096379
Klein, Michael J
The book illustrates and discusses general principles including bone growth, dysplasia, trauma, infection, positional abnormalities, and metabolic disease, followed by detailed consideration of each region of the extremities and then the trunk. Those radiographic findings of orthopedic importance are emphasized, with images selected for their instructive value.
Oestreich, A.E.; Crawford, A.H.
A locking mechanism for orthopedic braces is described which automatically prevents or permits the relative pivotable movement between a lower brace member and an upper brace member. The upper and lower brace members are provided with drilled bores within which a slidable pin is disposed, and depending upon the inclination of the brace members with respect to a vertical plane, the slidable pin will be interposed between both brace members. The secondary or auxiliary latching device includes a spring biased, manually operable lever bar arrangement which is manually unlatched and automatically latched under the influence of the spring.
I-Lechao, J.; Epps, C. H., Jr. (inventors)
An orthopedic brace locking mechanism is described which under standing or walking conditions cannot be unlocked, however under sitting conditions the mechanism can be simply unlocked so as to permit bending of the patient's knee. Other features of the device include: (1) the mechanism is rendered operable, and inoperable, dependent upon the relative inclination of the brace with respect to the ground; (2) the mechanism is automatically locked under standing or walking conditions and is manually unlocked under sitting conditions; and (3) the mechanism is light in weight and is relatively small in size.
Chao, J. I.; Epps, C. H., Jr.
Collagen and collagen-based scaffolds offer distinct advantages when selected as biomaterials for use across a broad spectrum of regenerative medicine applications. However, relatively poor mechanical properties are often perceived to limit their usefulness for orthopedic applications. These problems can be overcome through enhanced crosslinking mechanisms or through the addition of a second, stiffer phase such as hydroxyapatite, thus allowing tailored composite scaffolds to meet specific tissue requirements. This overview will highlight the current state of the art of these scaffolds, and consider the exciting prospects and future directions of collagen-based technologies for orthopedic regenerative medicine.
Cunniffe, Gráinne M.; O'Brien, Fergal J.
Robot manipulators were the topic of this article. A large number of robot manipulators have been designed over the last half century, and several of these have become standard platforms for R&D efforts. The most widely used is the Unimate PUMA 560 series. Recently, there have been attempts to utilize standard platforms, as exemplified by the learning applied to ground
Christian Smith; HENRIK I. CHRISTENSEN
Background Emotional intelligence (EI) is the ability to understand and manage emotions in oneself and others. It was originally popularized in the business literature as a key attribute for success that was distinct from cognitive intelligence. Increasing focus is being placed on EI in medicine to improve clinical and academic performance. Despite the proposed benefits, to our knowledge, there have been no previous studies on the role of EI in orthopedic surgery. We evaluated baseline data on EI in a cohort of orthopedic surgery residents. Methods We asked all orthopedic surgery residents at a single institution to complete an electronic version of the Mayer–Salovey–Caruso Emotional Intelligence Test (MSCEIT). We used completed questionnaires to calculate total EI scores and 4 branch scores. Data were analyzed according to a priori cutoff values to determine the proportion of residents who were considered competent on the test. Data were also analyzed for possible associations with age, sex, race and level of training. Results Thirty-nine residents (100%) completed the MSCEIT. The mean total EI score was 86 (maximum score 145). Only 4 (10%) respondents demonstrated competence in EI. Junior residents (p = 0.026), Caucasian residents (p = 0.009) and those younger than 30 years (p = 0.008) had significantly higher EI scores. Conclusion Our findings suggest that orthopedic residents score low on EI based on the MSCEIT. Optimizing resident competency in noncognitive skills may be enhanced by dedicated EI education, training and testing.
Chan, Kevin; Petrisor, Brad; Bhandari, Mohit
Summary The use of prophylactic antibiotics was studied prospectively in 2371 consecutive clean orthopedic operations. The infection rates for operations with obvious selection for antibiotic prophylaxis were twice as high (7.2%) as compared with operations with planned prophylaxis (3.4%) and with operations without such prophylaxis (3.7%).
V. Surin; E. Borgström; L. Bäckman
Background Highly successful orthopedic surgeons are a small group of individuals who exert a large influence on the orthopedic field. However, the characteristics of these leaders have not been well-described or studied. Methods Orthopedic surgeons who are departmental chairs, journal editors, editorial board members of the Journal of Bone and Joint Surgery (British edition), or current or past presidents of major orthopedic associations were invited to complete a survey designed to provide insight into their motivations, academic backgrounds and accomplishments, emotional and physical health, and job satisfaction. Results In all, 152 surgeons completed the questionnaire. We identified several characteristics of highly successful surgeons. Many have contributed prolific numbers of publications and book chapters and obtained considerable funding for research. They were often motivated by a “desire for personal development (interesting challenge, new opportunities),” whereas “relocating to a new institution, financial gain, or lack of alternative candidates” played little to no role in their decisions to take positions of leadership. Most respondents were happy with their specialty choice despite long hours and high levels of stress. Despite challenges to their time, successful orthopedic surgeons made a strong effort to maintain their health; compared with other physicians, they exercise more, are more likely to have a primary care physician and feel better physically. Conclusion Departmental chairs, journal editors and presidents of orthopedic associations cope with considerable demands of clinical, administrative, educational and research duties while maintaining a high level of health, happiness and job satisfaction.
Klein, Guy; Hussain, Nasir; Sprague, Sheila; Mehlman, Charles T.; Dogbey, Godwin; Bhandari, Mohit
The concept of dynamic manipulability measure of robot arms is proposed as a quantitative measure of their manipulating ability in positioning and orienting the end-effectors, which takes the arm dynamics into consideration. This measure is defined on the basis of the relationship between the joint driving force and the acceleration of the end-effector. Some properties of the measure are established. A two-joint link mechanism is analyzed and its best posture is obtained under certain conditions from the viewpoint of this measure. A numerical example is also given to illustrate the utilization of this concept for the design of robot manipulators.
Parents often seek orthopedic evaluation of their young children because of apparent abnormalities. However, many of these are simply developmental variations that are part of normal growth and development. Pes planus, or flat foot, is one of the earliest and most common concerns. Torsional variations are also often seen; the presenting complaint may be intoeing (metatarsus adductus, tibial torsion and increased femoral anteversion) or out-toeing (pes calcaneovalgus and external rotation contractures of the hips). Angular variations (genu varum and genu valgum) are also seen frequently in young children. In assessing each finding, consideration must be given to the age at which the finding may be considered within normal limits, methods of examination and documentation, the expected course, findings that may signify abnormality, and appropriate follow-up and referral. An understanding of these common developmental variations in the orthopedic assessment of young children will enable the health care provider to respond to parents' concerns with accurate information and counseling. PMID:2664594
Killam, P E
Computer-assisted navigation has a role in some orthopedic procedures. It allows the surgeons to obtain real-time feedback and offers the potential to decrease intra-operative errors and optimize the surgical result. Computer-assisted navigation systems can be active or passive. Active navigation systems can either perform surgical tasks or prohibit the surgeon from moving past a predefined zone. Passive navigation systems provide intraoperative information, which is displayed on a monitor, but the surgeon is free to make any decisions he or she deems necessary. This article reviews the available types of computer-assisted navigation, summarizes the clinical applications and reviews the results of related series using navigation, and informs surgeons of the disadvantages and pitfalls of computer-assisted navigation in orthopedic surgery. PMID:23937743
Mavrogenis, Andreas F; Savvidou, Olga D; Mimidis, George; Papanastasiou, John; Koulalis, Dimitrios; Demertzis, Nikolaos; Papagelopoulos, Panayiotis J
The development and distribution of mobile applications, or apps, designed for medical professionals and patients is quickly expanding, and within this group are apps designed specifically for orthopedic use. Currently, the most popular mobile apps are sponsored by private companies and focus on delivering device-specific information. If this trend toward the use of privately funded educational materials continues, regulations may need to be established to ensure that the information provided is accurate, honest, and supported by peer-reviewed literature. It will likely be the responsibility of the orthopedic community to ensure that the development and use of these apps has appropriate oversight and validation as they are incorporated into clinical practice and training. PMID:22147214
Franko, Orrin I; Bhola, Siddharth
Background Thrombotic and bleeding complications are major concerns during orthopedic surgery. Given the frequency of orthopedic surgical procedures and the limited data in the literature, we sought to investigate the incidence and risk factors for thrombotic (myocardial necrosis and infarction) and bleeding events in patients undergoing orthopedic surgery. Methods and Results We performed a retrospective cohort analysis of 3,082 consecutive subjects ? 21 years of age undergoing hip, knee, or spine surgery between November 1, 2008, and December 31, 2009. Patient characteristics were ascertained using ICD-9 diagnosis coding and retrospective review of medical records, and laboratory/blood bank databases. In-hospital outcomes included myocardial necrosis (elevated troponin), major bleeding, coded myocardial infarction (MI), and coded hemorrhage as defined by ICD-9 coding. Of the 3,082 subjects, mean age was 60.8 ± 13.3 years and 59% were female. Myocardial necrosis, coded MI, major bleeding, and coded hemorrhage occurred in 179 (5.8%), 20 (0.7%), 165 (5.4%), and 26 (0.8%) subjects, respectively. Increasing age (P<0.001), CAD (P<0.001), cancer (P=0.004), and chronic kidney disease (P=0.01) were independent predictors of myocardial necrosis, while procedure type (P<0.001), cancer (P<0.001), female sex (P<0.001), CAD (P<0.001), and COPD (P=0.01) were independent predictors of major bleeding. Conclusion There is a delicate balance between thrombotic and bleeding events in the perioperative period following orthopedic surgery. Perioperative risk of both thrombosis and bleeding deserve careful attention in preoperative evaluation and future prospective studies aimed at attenuating this risk are warranted.
Oberweis, Brandon S.; Nukala, Swetha; Rosenberg, Andrew; Guo, Yu; Stuchin, Steven; Radford, Martha J.; Berger, Jeffrey S.
Adhesives, especially bone adhesives, are resorbed and degraded to non-toxic products after fulfilling their function in contact\\u000a with the living organism. The use of such bone adhesives has found growing interest in all fields of medicine in the last\\u000a 50 years. The dream of trauma and orthopedic surgeons for alternatives to osteosynthesis and pins is reflected in the development\\u000a of
Christian Heiss; Ralf Kraus; Dominique Schluckebier; Ann-Christin Stiller; Sabine Wenisch; Reinhard Schnettler
Self-contained, waterproof, water-submersible, remote-controlled apparatus is described for manipulating a device, such as an ultrasonic transducer for measuring crack propagation on an underwater specimen undergoing shock testing. The subject manipulator includes metal bellows for transmittal of angular motions without the use of rotating shaft seals or O-rings. Inside the manipulator, a first stepper motor controls angular movement. In the preferred embodiment, the bellows permit the first stepper motor to move an ultrasonic transducer [plus minus]45 degrees in a first plane and a second bellows permit a second stepper motor to move the transducer [plus minus]10 degrees in a second plane orthogonal to the first. In addition, an XY motor-driven table provides XY motion.
Schrum, P.B.; Cohen, G.H.
Self-contained, waterproof, water-submersible, remote-controlled apparatus is provided for manipulating a device, such as an ultrasonic transducer for measuring crack propagation on an underwater specimen undergoing shock testing. The subject manipulator includes metal bellows for transmittal of angular motions without the use of rotating shaft seals or O-rings. Inside the manipulator, a first stepper motor controls angular movement. In the preferred embodiment, the bellows permit the first stepper motor to move an ultrasonic transducer .+-.45 degrees in a first plane and a second bellows permit a second stepper motor to move the transducer .+-.10 degrees in a second plane orthogonal to the first. In addition, an XY motor-driven table provides XY motion.
Schrum, Phillip B. (Clairton, PA); Cohen, George H. (Pittsburgh, PA)
Although orthopedic injury has been reported to be the most frequent injury associated with facial trauma, their relationship has not been sufficiently evaluated in the literature. To evaluate this relationship, we compared 263 patients with concomitant facial and orthopedic injuries with 2006 patients with facial injuries alone. The rate of associated orthopedic injuries was 11.5%. Motor vehicle accidents, falls, mandibular fractures, and Le Fort I fractures increased the chance of sustaining orthopedic injuries nearly 17-, 15-, 10-, 4.4-, and 4.5-fold, respectively. Most fractures occurred in large bones with their inherent potential to cause severe, life-threatening complications. The high rates of mortality and morbidities associated with orthopedic injuries and the frequent occurrence of these injuries in patients with facial trauma emphasize upon the fact that maxillofacial surgeons, residents, and trauma nurses need more training in early diagnosis and appropriate management of associated orthopedic injuries. PMID:23722224
Zandi, Mohammad; Saleh, Majid
"This manipulative uses United States currency, both coins and bills. Images of bills include a circled number to identify their value: one, five, ten, twenty, or fifty dollars. The coins (pennies, nickels, dimes, quarters, and half dollars) should be easily identifiable, but it may take a little practice." (from NLVM) Tip: There are more instructions on the right side of the Java applet.
University, Utah S.
Background: VTE is a serious, but decreasing complication following major orthopedic surgery. This guideline focuses on optimal prophylaxis to reduce postoperative pulmonary embolism and DVT. Methods: The methods of this guideline follow those described in Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines in this supplement. Results: In patients undergoing major orthopedic surgery, we recommend the use of one of the following rather than no antithrombotic prophylaxis: low-molecular-weight heparin; fondaparinux; dabigatran, apixaban, rivaroxaban (total hip arthroplasty or total knee arthroplasty but not hip fracture surgery); low-dose unfractionated heparin; adjusted-dose vitamin K antagonist; aspirin (all Grade 1B); or an intermittent pneumatic compression device (IPCD) (Grade 1C) for a minimum of 10 to 14 days. We suggest the use of low-molecular-weight heparin in preference to the other agents we have recommended as alternatives (Grade 2C/2B), and in patients receiving pharmacologic prophylaxis, we suggest adding an IPCD during the hospital stay (Grade 2C). We suggest extending thromboprophylaxis for up to 35 days (Grade 2B). In patients at increased bleeding risk, we suggest an IPCD or no prophylaxis (Grade 2C). In patients who decline injections, we recommend using apixaban or dabigatran (all Grade 1B). We suggest against using inferior vena cava filter placement for primary prevention in patients with contraindications to both pharmacologic and mechanical thromboprophylaxis (Grade 2C). We recommend against Doppler (or duplex) ultrasonography screening before hospital discharge (Grade 1B). For patients with isolated lower-extremity injuries requiring leg immobilization, we suggest no thromboprophylaxis (Grade 2B). For patients undergoing knee arthroscopy without a history of VTE, we suggest no thromboprophylaxis (Grade 2B). Conclusions: Optimal strategies for thromboprophylaxis after major orthopedic surgery include pharmacologic and mechanical approaches.
Francis, Charles W.; Johanson, Norman A.; Curley, Catherine; Dahl, Ola E.; Schulman, Sam; Ortel, Thomas L.; Pauker, Stephen G.; Colwell, Clifford W.
A challenge for new residents and senior residents preparing for board examinations is refreshing their knowledge of basic science disciplines, such as human gross anatomy. The Department of Orthopaedics at the University of Utah School of Medicine has for many years held an annual Orthopedic Resident Anatomy Review Course during the summer months…
DeFriez, Curtis B.; Morton, David A.; Horwitz, Daniel S.; Eckel, Christine M.; Foreman, K. Bo; Albertine, Kurt H.
We abstracted records of 369 patients whose recommendations for elective orthopedic surgery were not confirmed by a second opinion consultant. Six months or more after the initial recommendation for surgery, 82 per cent had not had the operation performed, irrespective of the diagnosis and the characteristics of the physician recommending surgery. Reasons for consultant non-confirmation included: use of a cast, brace, or corrective footwear preferable (26.3 per cent), symptoms not severe enough (18.4 per cent), and physical therapy/exercises preferable (17.8 per cent).
McCarthy, E G; Finkel, M L
SPAR Aerospace Limited's "Canadarm," Canada's contribution to the space shuttle. It is a crane which can operate as a 50 foot extension of an astronaut's arm. It can lift 65,000 pounds in space and retrieve satellites for repair, etc. Redesigned versions have energy and mining applications. Some of its hardware has been redeveloped for use as a Hydro manipulator in a nuclear reactor where it is expected to be extremely cost effective.
Internet access has lagged behind for patients with lower incomes and from certain ethnic groups. This study investigated the possible improvement of access to health-related information on the Internet for all patients in an urban outpatient setting, regardless of socioeconomic background. A 28-question survey was completed by 100 orthopedic outpatients evaluating associations between their age, ethnicity, income, or education level and their access to the Internet. The survey also examined how patients used the Internet to obtain information about their medical condition, their privacy concerns when conducting online research, and their use of mobile phones as a primary means of Internet access. The Internet was used by 57% of orthopedic outpatients in this urban setting. Internet access decreased with advancing age but increased with increasing income and education, findings consistent with similar studies. Despite the inability to identify an association between ethnicity and Internet access in this patient population, fewer Latinos (33%) than whites (67%) or African Americans (77%) sought information about their medical condition. Among patients who used a mobile phone as the primary method for online access, 74% were African American or Latino and 26% were white. This difference in mobile phone use for online access suggests that mobile phones have provided ethnic minorities with greater Internet access and thus may have narrowed the digital divide among the races. PMID:24679198
Walsh, Kenneth P; Rehman, Saqib; Goldhirsh, Jessie
Introduction: Piriformis fossa is an important anatomical landmark having significant clinical value in orthopedic surgery; but its location and anatomical relationship with surrounding structures are not clearly defined. Hence it is necessary to clearly describe it in respect to anatomical and orthopedic aspect. Materials and Methods: Fifty Cadaveric dry femoral bones and Dissection of the four hip specimens were used to study the Piriformis fossa in respect to location and its relationship with surrounding structures. Clinical importance of piriformis fossa was determined in reference to antegrade femoral nail insertion. Observations: Piriformis muscle and so called piriformis fossa are unrelated entities. Piriformis fossa is anatomical site of insertion of obturator externus. In dry cadaveric femora; fossa was not always located in the direction of femoral shaft. It was located in the direction of femoral shaft in 24% cases only. In 68% cases femoral canal was aligned lateral and in 8% cases, it lies medial to the fossa. Conclusion: Piriformis fossa should be named as Trorchanteric fossa or Obturator fossa for better anatomical description. So called Piriformis fossa does not found to be universally corresponding to femoral shaft hence selection of entry site should be based on variable proximal femur and area on femur which corresponds to femoral shaft. PMID:24783092
Lakhwani, O P; Mittal, P S; Naik, D C
Introduction: Piriformis fossa is an important anatomical landmark having significant clinical value in orthopedic surgery; but its location and anatomical relationship with surrounding structures are not clearly defined. Hence it is necessary to clearly describe it in respect to anatomical and orthopedic aspect. Materials and Methods: Fifty Cadaveric dry femoral bones and Dissection of the four hip specimens were used to study the Piriformis fossa in respect to location and its relationship with surrounding structures. Clinical importance of piriformis fossa was determined in reference to antegrade femoral nail insertion. Observations: Piriformis muscle and so called piriformis fossa are unrelated entities. Piriformis fossa is anatomical site of insertion of obturator externus. In dry cadaveric femora; fossa was not always located in the direction of femoral shaft. It was located in the direction of femoral shaft in 24% cases only. In 68% cases femoral canal was aligned lateral and in 8% cases, it lies medial to the fossa. Conclusion: Piriformis fossa should be named as Trorchanteric fossa or Obturator fossa for better anatomical description. So called Piriformis fossa does not found to be universally corresponding to femoral shaft hence selection of entry site should be based on variable proximal femur and area on femur which corresponds to femoral shaft.
Lakhwani, O.P.; Mittal, P.S.; Naik, D.C.
For a better definition of diagnostic subgroups of patients with temporomandibular disorders (TMD), clinical orthopedic tests have been developed for the masticatory system, for use together with the commonly used active movement tests and palpation. In the present study, the characteristics and additional diagnostic value of four orthopedic tests-namely, passive opening, the joint play test, compression, and the static pain
A. M. Lobbezoo-Scholte; M. H. Steenks; J. A. J. Faber; F. Bosman
Metallic bone implants possess numerous problems limiting their efficacy, such as poor osseointegration, stress shielding, and corrosion in in vivo environments. In addition, these materials were not originally developed to simultaneously serve as an orthopedic implant and treat bone cancer (for which some patients require an orthopedic implant). This study is to investigate the potential use of selenium in bone
Phong Tran; Thomas J. Webster
The objective of this work is to develop bioactive glass coatings for metallic orthopedic implants. A new family of glasses in the SiO2-Na2O-K2O-CaO-MgO-P2O5 system has been synthesized and characterized. The glass properties (thermal expansion, softening and transformation temperatures, density and hardness) are in line with the predictions of established empirical models. The optimized firing conditions to fabricate coatings on Ti-based and Co-Cr alloys have been determined and related to the glass properties and the interfacial reactions. Excellent adhesion to alloys has been achieved through the formation of 100-200 nm thick interfacial layers (Ti5Si3 on Ti-based alloys and CrOx on Co-Cr). Finally, glass coatings, approximately 100 mu m thick, have been fabricated onto commercial Ti alloy-based dental implants.
Lopez-Esteban, Sonia; Saiz, Eduardo; Fujino, Sigheru; Oku, Takeo; Suganuma, Katsuaki; Tomsia, Antoni P.
Since the spine is one of the most complex joint structures in the human body, its surgical treatment requires careful planning and high degree of precision to avoid any unwanted neurological compromises. In addition, comprehensive biomechanical analysis can be very helpful because the spine is subject to a variety of load. In case for the osteoporotic spine in which the structural integrity has been compromised, it brings out the double challenges for a surgeon both clinically and biomechanically. Thus, we have been developing an integrated medical image system that is capable of doing the both. This system is called orthopedic surgical analyzer and it combines the clinical results from image-guided examination and the biomechanical data from finite element analysis. In order to demonstrate its feasibility, this system was applied to percutaneous vertebroplasty. Percutaneous vertebroplasty is a surgical procedure that has been recently introduced for the treatment of compression fracture of the osteoporotic vertebrae. It involves puncturing vertebrae and filling with polymethylmethacrylate (PMMA). Recent studies have shown that the procedure could provide structural reinforcement for the osteoporotic vertebrae while being minimally invasive and safe with immediate pain relief. However, treatment failures due to excessive PMMA volume injection have been reported as one of complications. It is believed that control of PMMA volume is one of the most critical factors that can reduce the incidence of complications. Since the degree of the osteoporosis can influence the porosity of the cancellous bone in the vertebral body, the injection volume can be different from patient to patient. In this study, the optimal volume of PMMA injection for vertebroplasty was predicted based on the image analysis of a given patient. In addition, biomechanical effects due to the changes in PMMA volume and bone mineral density (BMD) level were investigated by constructing clinically relevant finite element models. In conclusion, we were able to demonstrate the feasibility of our orthopedic surgical analyzer in a case for percutaneous vertebroplasty.
Tack, Gye Rae; Choi, Hyung Guen; Lim, Do H.; Lee, Sung J.
The purpose of this pictorial essay is to describe the sonographic appearance of orthopedic hardware impingement of the extremities. Sonography is not limited by metallic artifacts, can show the orthopedic hardware, and can be used to assess damage of adjacent soft tissues, including tendons, synovial bursas, muscles, nerves, and vessels. Its dynamic capabilities permit assessment of orthopedic hardware impingement present only in certain joint positions, during muscle contractions, and during tendon movements. Local pain elicited with application of pressure from the transducer confirms the diagnosis. Sonographically guided injections of steroid-anesthetic mixtures have both diagnostic and therapeutic effects. PMID:22922627
Guillin, Raphaël; Botchu, Rajesh; Bianchi, Stefano
The art of orthopedics traces its history back to ancient civilizations like those of the Egyptians. The evolution of this branch of medicine is indebted to investigations of many scientists, including Greek, Roman and Persian scholars. The Persian physician Avicenna (980-1037 AD) is one such scientist who investigated different aspects of orthopedics. It is possible to analyze Avicenna’s knowledge of orthopedics and his contributions to this branch of medicine by an examination of his epic encyclopedia of medicine, Al-Qanun fi al-Tibb (The Canon of Medicine).
Dalfardi, Behnam; Yarmohammadi, Hassan; Meibodi, Mohammad Kalantari
Titanium is broadly used in orthopedic and dental applications mainly because of its optimal mechanical properties in load-bearing applications. However, insufficient new bone formation is frequently observed on titanium which sometimes leads to implant l...
C. Yao E. B. Slamovich T. J. Webster
A systematic review of 179 articles published between January 1980 and May 2011 sought to determine the comparative effectiveness, benefits, and adverse effects of venous thromboembolism (VTE) prophylaxis for patients undergoing orthopedic surgery. The re...
A research evaluation of performance requirements for metallic orthopedic implants covered a comprehensive review of related literature from 1960 to 1974 and the test and evaluation of groups of successful, failed and unusual metallic implants. A total of...
A. U. Daniels H. K. Dunn K. D. Johnson W. E. Cosgrove N. H. Price
...tissue, or for use with other devices in orthopedic surgery. This generic type of device includes the cerclage applier, awl, bender, drill brace, broach, burr, corkscrew, countersink, pin crimper, wire cutter, prosthesis driver, extractor,...
...tissue, or for use with other devices in orthopedic surgery. This generic type of device includes the cerclage applier, awl, bender, drill brace, broach, burr, corkscrew, countersink, pin crimper, wire cutter, prosthesis driver, extractor,...
A novel ankle rehabilitation device is being developed for home use, allowing remote monitoring by therapists. The system will allow patients to perform a variety of exercises while interacting with a virtual environment (VE). These game-like VEs created with WorldToolKit run on a host PC that controls the movement and output forces of the device via an RS232 connection. Patients will develop strength, flexibility, coordination, and balance as they interact with the VEs. The device will also perform diagnostic functions, measuring the ankle's range of motion, force exertion capabilities and coordination. The host PC transparently records patient progress for remote evaluation by therapists via our existing telerehabilitation system. The "Rutgers Ankle" Orthopedic Rehabilitation Interface uses double-acting pneumatic cylinders, linear potentiometers, and a 6 degree-of-freedom (DOF) force sensor. The controller contains a Pentium single-board computer and pneumatic control valves. Based on the Stewart platform, the device can move and supply forces and torques in 6 DOFs. A proof-of-concept trial conducted at the University of Medicine and Dentistry of New Jersey (UMDNJ) provided therapist and patient feedback. The system measured the range of motion and maximum force output of a group of four patients (male and female). Future medical trials are required to establish clinical efficacy in rehabilitation. PMID:10977590
Girone, M; Burdea, G; Bouzit, M; Popescu, V; Deutsch, J E
A new nuclear scanning technique was found more specific for bone, joint, and soft tissue infections than any previously described scanning technique. The leukocyte scan, whereby a patient's own cells are labeled with a radioactive tagging agent (/sup 111/In oxine), can distinguish an active infectious process from other pain-inducing conditions. Ninety-seven /sup 111/In labeled autologous leukocyte scans were performed in 88 patients. The findings in 17 of 40 patients scanned for possible acute osteomyelitis, six of nine for suspected septic arthritis, and six for possible soft tissue infections, were positive. Subsequent clinical courses verified the infectious nature of these processes in all patients. Patients who had chronic osteomyelitis (14), bony metastases (four patients), heterotopic ossification (three), and degenerative arthritis (two) demonstrated negative findings. Of the seven patients scanned for acute long-bone fractures, one demonstrated positive findings. Nine scans demonstrated positive findings without determined causes. The leukocyte scan is a useful addition to the diagnostic tools of the orthopedic surgeon.
Propst-Proctor, S.L.; Dillingham, M.F.; McDougall, I.R.; Goodwin, D.
Evidence-based medicine (EBM) is regarded as a new paradigm in medical practice, equal in enormity to the human genome project. However, there is still much confusion and misunderstanding about the concept and content of EBM. It is often limited to searching the literature and reading papers, serving cost cutters, and suppressing clinical freedom. Some believe that the use of clinical guidelines or the managed care system intimidates doctors' discretion during clinical practice and that EBM is a fashionable tendency of a group of medical academics armed with epidemiological and statistical jargon. Medical practice is a lifelong, continuous process of self-learning, and it requires clinicians to keep up to date on various developments. EBM is our practice for integrating individual clinical expertise with the best available evidence when making decisions about our care for each patient. EBM is one answer for making it possible to cover most of our activities as orthopedic surgeons, from the daily practice of patient care to writing and reading scientific papers. PMID:12486483
OBJECTIVE: Pulmonary embolism (PE) is an important complication of major orthopedic surgery. The aim of this study was to evaluate the incidence of venous thromboembolism (VTE) and factors influencing the development of VTE in patients undergoing major orthopedic surgery in a university hospital. METHODS: Patients who underwent major orthopedic surgery (hip arthroplasty, knee arthroplasty, or femur fracture repair) between February of 2006 and June of 2012 were retrospectively included in the study. The incidences of PE and deep vein thrombosis (DVT) were evaluated, as were the factors influencing their development, such as type of operation, age, and comorbidities. RESULTS: We reviewed the medical records of 1,306 patients. The proportions of knee arthroplasty, hip arthroplasty, and femur fracture repair were 63.4%, 29.9%, and 6.7%, respectively. The cumulative incidence of PE and DVT in patients undergoing major orthopedic surgery was 1.99% and 2.22%, respectively. Most of the patients presented with PE and DVT (61.5% and 72.4%, respectively) within the first 72 h after surgery. Patients undergoing femur fracture repair, those aged ? 65 years, and bedridden patients were at a higher risk for developing VTE. CONCLUSIONS: Our results show that VTE was a significant complication of major orthopedic surgery, despite the use of thromboprophylaxis. Clinicians should be aware of VTE, especially during the perioperative period and in bedridden, elderly patients (? 65 years of age).
Akpinar, Evrim Eylem; Hosgun, Derya; Akan, Burak; Ates, Can; Gulhan, Meral
Costello syndrome is a rare genetic condition caused by heterozygous alterations in HRAS and characterized by multi-system abnormalities. Individuals with Costello syndrome usually present with severe feeding difficulties in infancy, short stature, coarse facial features, increased tumor risks, cardiac and neurological complications, intellectual disability and orthopedic complications. This study further defines the orthopedic manifestations affecting individuals with Costello syndrome. We studied 43 participants and performed medical records review, clinical examinations and orthopedic inquiry forms. In 23 participants, hip and or spinal imaging assessments were completed. Serial radiographs were analyzed when available. A total of 25 orthopedic manifestations were identified. Ten manifestations were seen in the majority of the participants: hypotonia (87%), ligamentous laxity (85%), scoliosis (63%), kyphosis (58%), characteristic hand deformities (85%), ulnar deviation of the wrist (63%), elbow (55%) and shoulder contractures (65%), tight Achilles tendon (73%), and pes planus (53%). Other characteristics of special note were hip dysplasia (45%), foot deformities requiring surgical intervention (38%) and osteopenia/osteoporosis (47%). We also studied the development of the hips and spine. Uni- or bilateral hip dysplasia was congenital in some, while it developed throughout childhood in others. Spinal involvement included scoliosis, kyphosis, lordosis, and curvature reversal (thoracic lordosis and lumbar kyphosis). Based on these findings, we recommend routine referral to an orthopedic surgeon as well as instituting screening protocols for hips and spine for individuals with Costello syndrome. PMID:23813656
Detweiler, Stacey; Thacker, Mihir M; Hopkins, Elizabeth; Conway, Laura; Gripp, Karen W
A novel hybrid coating process, combining NanoSpray® (built on electrostatic spray coating) technology with microwave sintering process, was developed for synthesizing hydroxyapatite- (HA-) based nanostructured coating with favorable properties for dental and orthopedic implants. Specifically, HA nanoparticles were deposited on commercially pure titanium substrates using NanoSpray technique to produce the HA coating, which was then sintered in a microwave furnace under controlled conditions. The study showed that the use of NanoSpray followed by microwave sintering results in nanoscale HA coating for dental/orthopedic application.
Liu, Huinan; Jiang, Wenping; Malshe, Ajay
Long-term follow-up studies have revealed that the shields of the function regulator are capable of influencing the circumoral soft tissue capsule in size and shape. As a result, the disturbed or restricted displacement of teeth and jaw bones could be corrected. The dramatic changes in dentoskeletal development thus achieved demonstrate the morphogenetic impact of the circumoral capsule. In clinical application, the function regulator offers the opportunity to realize Roux's concept of functional orthopedics in the treatment of orofacial dysmorphology, as has long been practiced in the medical field of orthopedics. PMID:11227203
Fränkel, R; Fränkel, C
Achilles tendon rupture is a relatively uncommon occurrence in a general ED population. The history can be subtle, and physical findings may not be clear-cut. Prompt diagnosis and treatment of these injuries, however, is important to improved clinical outcome. The emergency physician needs to remain vigilant for this diagnosis to avoid this orthopedic pitfall. This review article examines the clinical
Jacob Ufberg; Richard A. Harrigan; Thomas Cruz; Andrew D. Perron
This study was designed to determine how employers viewed orthopedically handicapped persons as prospective workers. Data indicated significant differences in employers' views toward both limitations and modifications, which could be attributed to the size and purpose of their firms and their experience with disabled employees. The data were used…
Grace, Harry A.
Hydroxyapatite (HA) has received wide attention in orthopedics, due to its biocompatibility and osseointegration ability. Despite these advantages, the brittle nature and low fracture toughness of HA often results in rapid wear and premature fracture of implant. Hence, there is a need to improve the fracture toughness and wear resistance of HA without compromising its biocompatibility. ^ The aim of
A spot-mounted, variable, rate-controlled hydraulic manipulator was developed for the cable-controlled undersea research vehicles, CURV 2 and CURV 3. This manipulator incorporates a mechanical linkage arm which provides linear hand extension and eliminate...
It is over 12 years since "APMC" published Bob Perry and Peter Howard's research on the use of mathematics manipulative materials in primary mathematics classrooms. Since then the availability of virtual manipulatives and associated access to computers and interactive whiteboards have caused educators to rethink the use of mathematics manipulative…
Swan, Paul; Marshall, Linda
The aim of this study was to describe concepts of health economics in order to update and provide the orthopedic practitioner decision making parameters based on preferences. Four basic types of studies of economical evaluation were presented (cost minimization analysis, cost-benefit, cost-effectiveness and cost-utility), as well as the origin, the concept, advantages and disadvantages of using QALY and utility. It was discussed the importance of costs and of SF-6D, an instrument able to get through the utility data from the Medical Outcomes Study 36-item Short Form Health Survey (SF-36). Physicians, especially orthopedic practitioners, are increasingly using technologies which are progressively expensive, thus, they should be able to understand health economics concepts, the importance of utility in clinical decision making process and economic analysis in health.09+
Araujo, Carlos Delano Mundim; Veiga, Daniela Francescato; Hochman, Bernardo; Abla, Luiz Eduardo Felipe; Novo, Neil Ferreira; Ferreira, Lydia Masako
Intraosseous (IO) catheters have been used for vascular access in trauma and critically ill patients with increasing frequency in emergency departments and critical care units across the United States. Their use has long been accepted as a reliable method of obtaining vascular access in pediatric patients with difficult intravascular access. Articles about the complications of using IO catheters are scarce. Although orthopedic surgeons are not likely to place an IO catheter in an emergency situation, they often become involved when complications of IO catheter use arise. In a literature search, we identified 5,759 patients treated with IO catheters. The overall complication rate was 2.1%. In this article, we discuss the literature on IO catheter complications and report 2 cases of orthopedic management of IO catheter complications. PMID:24730005
Barlow, Brian; Kuhn, Kevin
Objectives To understand racial disparities in the use of total joint replacement, we examined whether there were racial differences in patient-provider communication about treatment of chronic knee/hip osteoarthritis in a sample of African American and white patients referred to Veterans Affairs (VA) orthopedic clinics. Methods Audio-recorded visits between patients and orthopedic surgeons were coded using the Roter Interaction Analysis System and the Informed Decision Making Model. Racial differences in communication outcomes were assessed using linear regression models adjusted for study design, patient characteristics, and clustering by provider. Results The sample (N=402) included 296 white and 106 African American patients. Most patients were male (95%) and 50-64 years old (68%). Almost half (41%) reported an income <$20,000. African American patients were younger and reported lower incomes than white patients. Visits with African American patients contained less discussion of biomedical topics (Beta=-9.14, 95% CI=-16.73,-1.54) and more rapport-building statements (Beta=7.84, 95% CI=1.85,13.82) than visits with white patients. However, no racial differences were observed with regard to length of visit, overall amount of dialogue, discussion of psychosocial issues, patient activation/engagement statements, physician verbal dominance, display of positive affect by patients or providers, or discussion related to informed decision making. Conclusions In this sample, communication between orthopedic surgeons and patients regarding the management of chronic knee/hip osteoarthritis did not, for the most part, vary by patient race. These findings diminish the potential role of communication in VA orthopedic settings as an explanation for well-documented racial disparities in the use of total joint replacement.
Hausmann, Leslie R.M.; Hanusa, Barbara H.; Kresevic, Denise M.; Zickmund, Susan; Ling, Bruce S.; Gordon, Howard S.; Kwoh, C. Kent; Mor, Maria K.; Hannon, Michael J.; Cohen, Peter Z.; Grant, Richard; Ibrahim, Said A.
We examined the effect of telephone follow-up on surgical orthopedic patients' postdischarge recovery. The sample consisted of 438 patients randomly assigned to receive routine care with or without telephone follow-up 24 to 72 hours after discharge (intervention). During the intervention, the nurse caller assessed each patient's status, identified problems, and provided needed follow-up care. Structured telephone interviews were conducted with
Marilyn J. Hodgins; Louiselle L. Ouellet; Sandra Pond; Shelley Knorr; Geri Geldart
A major focus in the field of orthopedic tissue engineering is the development of tissue engineered bone and soft tissue grafts\\u000a with biomimetic functionality to allow for their translation to the clinical setting. One of the most significant challenges\\u000a of this endeavor is promoting the biological fixation of these grafts with each other as well as the implant site. Such
Helen H. Lu; Siddarth D. Subramony; Margaret K. Boushell; Xinzhi Zhang
In a double-blind, placebo-controlled, single-dose, parallel-group study, oral doses (5, 10 and 25 mg) of the prostaglandin synthetase inhibitor bromfenac were compared with acetaminophen (1000 mg) and placebo for postoperative orthopedic pain. Analgesic measurements were made by nurse observers by use of standard verbal rating and visual analog scales. For most pain intensity and pain relief measurements, 1000 mg acetaminophen
Henry J McQuay; Dawn Carroll; Terry Frankland; Mark Harvey; Andrew Moore; H J McQuay DM
Community-acquired methicillin-resistant Staphylococcus aureus (MRSA) has been recognized as a public health concern since the mid-1990s. Because of the increase in reports of this pathogen, it has become increasingly tempting for clinicians to provide prophylaxis against this entity using antibiotics known to be effective against MRSA. The goal of this study was to assess the use of MRSA prophylaxis to determine whether it is safe and effective. A systematic search of the literature was performed to identify articles that examined the use of vancomycin in clean orthopedic surgery. Infection rates and adverse events were extracted, and the data were aggregated and analyzed using a DerSimonian and Laird random effects model. Publication bias and study quality were also assessed. No benefit of parenteral administration of vancomycin was identified. Local, vancomycin-impregnated cement and powder are associated with lower infection rates. Few adverse events occurred, and most of those that occurred involved infusion rate.Cost, resistance, and side effects are concerns in using vancomycin therapy in addition to standard antibiotic prophylaxis. Given the lack of efficacy of intravenous vancomycin, the authors do not recommend its routine use in clean orthopedic surgery. However, local administration appears to be safe and effective. The data are most compelling in orthopedic spine surgery in which a patient without prophylaxis is more than 4 times as likely to have a deep postoperative wound infection compared with a patient who received local vancomycin. The authors recommend the use of local antibiotics when possible in clean orthopedic surgery. PMID:23379827
Kanj, Wajdi W; Flynn, John M; Spiegel, David A; Dormans, John P; Baldwin, Keith D
OBJECTIVE.Few studies have quantified the prevalence of weight-related orthopedic conditions in otherwise healthy overweight children. The goal of the present investigation was to describe the musculoskeletal consequences of pediatric over- weight in a large pediatric cohort of children that included severely overweight children. METHODS.Medical charts from 227 overweight and 128 nonoverweight children and adolescents who were enrolled in pediatric clinical
Erica D. Taylor; Kelly R. Theim; Margaret C. Mirch; Samareh Ghorbani; Marian Tanofsky-Kraff; Diane C. Adler-Wailes; Sheila Brady; James C. Reynolds; Karim A. Calis; Jack A. Yanovski
Background Purpura fulminans is a rare and extremely severe infection, mostly due to Neisseria meningitidis frequently causing early orthopedic lesions. Few studies have reported on the initial surgical management of acute purpura fulminans. The aim of this study is to look at the predictive factors in orthopedic outcome in light of the initial surgical management in children surviving initial resuscitation. Methods Nineteen patients referred to our institution between 1987 and 2005 were taken care of at the very beginning of the purpura fulminans. All cases were retrospectively reviewed so as to collect information on the total skin necrosis, vascular insufficiency, gangrene, and total duration of vasopressive treatment. Results All patients had multiorgan failure; only one never developed any skin necrosis or ischemia. Eighteen patients lost tissue, leading to 22 skin grafts, including two total skin grafts. There was only one graft failure. Thirteen patients were concerned by an amputation, representing, in total, 54 fingers, 36 toes, two transmetatarsal, and ten transtibial below-knee amputations, with a mean delay of 4 weeks after onset of the disease. Necrosis seems to affect mainly the lower limbs, but there is no predictive factor that impacted on the orthopedic outcome. We did not perform any fasciotomy or compartment pressure measurement to avoid non-perfusion worsening; nonetheless, our outcome in this series is comparable to existing series in the literature. V.A.C.® therapy could be promising regarding the management of skin necrosis in this particular context. While suffering from general multiorgan failure, great care should be observed not to miss any additional osseous or articular infection, as some patients also develop local osteitis and osteomyelitis that are often not diagnosed. Conclusions We do not advocate very early surgery during the acute phase of purpura fulminans, as it does not change the orthopedic outcome in these children. By performing amputations and skin coverage some time after the acute phase, we obtained similar results to those found in the literature.
Mezel, A.; Raux, S.; Fron, D.; Maillet, M.; Herbaux, B.
In orthopedics management of surgical blood loss is an important aspect which has evolved along with modern surgeries. Replacement of lost blood by transfusion alone is not the answer as was considered earlier. Complications like infection and immune reaction due to blood transfusion are a major concern. Today numerous techniques are available in place of allogenic blood transfusion which can be employed safely and effectively. In this article we have reviewed these techniques, their merits and demerits.
Sambandam, Balaji; Batra, Sahil; Gupta, Rajat; Agrawal, Nidhi
Bone and tissue adhesives are common and beneficial supplements to standard methods of musculoskeletal tissue suture repair. Knowledge and development of biologically derived or inspired adhesives useful in orthopedic surgery are rapidly advancing. Recent literature demonstrates the increased adjunct or primary use of biological adhesives in the repair of musculoskeletal soft tissues, chondral fractures, and osteochondral fractures. Adhesives offer more benefits and enhancements to tissue healing than current fixation methods afford, including improved biocompatibility, resorbability, and non-immunogenicity. Further investigation is required to determine the extent of the role that these bioadhesives can play in orthopedic surgery. The largest group of biologically derived adhesives and sealants is fibrin sealants, which include first- and second-generation commercially available fibrin sealants, autologous fibrin sealants, and variants. Other groups include gelatin-resorcin aldehydes, protein-aldehyde systems, collagen-based adhesives, polysaccharide- based adhesives, mussel adhesive proteins, and various biologically inspired or biomimetic glues. Potential uses include applications in orthopedic-related blood conservation, arthroplasty, articular cartilage disorders, sports medicine, spine surgery, trauma, and tumors. The development of an adhesive with universal application is likely unfeasible, given the unique characteristics of various musculoskeletal tissues. However, the literature demonstrates the overall underuse of adhesives and indicates the rising probability of the development of a successful variety of bioadhesives for use in orthopedic surgery. As a result of reading this article, physicians should be able to: 1. Describe the difference between adhesives and sealants. 2. Recognize fibrin adhesives commonly used in practice today and identify other biological adhesives with rising potential. 3. Analyze how fibrin sealants work relative to fibrin and fibrinogen. 4. Identify anatomical areas and techniques in which fibrin sealants are used. PMID:24579215
Shah, Neil V; Meislin, Robert
Hydroxyapatite (HA) has received wide attention in orthopedics, due to its biocompatibility and osseointegration ability. Despite these advantages, the brittle nature and low fracture toughness of HA often results in rapid wear and premature fracture of implant. Hence, there is a need to improve the fracture toughness and wear resistance of HA without compromising its biocompatibility.\\u000aThe aim of the
Other articles have been written about resident selection, musculoskeletal education, work hours, and call coverage, but none has described orthopedic applicants' opinions on these issues. We conducted a study to gain insight into applicants' attitudes about issues relevant to the specialty. We distributed a survey to 53 applicants interviewing for an orthopedic residency. The survey used both a multiple-choice format and a Likert scale ranging from 1 (strongly disagree or least important) to 5 (strongly agree or most important). Respondents rated the adequacy of musculoskeletal education in medical school a mean standard deviation (SD) of 2.00 (0.8) on the Likert scale. Ranking the factors most valuable to an orthopedic surgery application, they rated United States Medical Licensing Examination (USMLE) Step 1 board examination scores a mean (SD) of 4.26 (0.9). In addition, of the 53 respondents, 46 (87%) anticipated working as a resident more than 80 hours per week, and 36 (68%) anticipated working as an attending 60 to 70 hours per week or less. Respondents also agreed that they should receive compensation for call coverage. Therefore, students agreed that medical school education is insufficient, rated USMLE scores the most important application factor, anticipated working more than 80 hours per week, and agreed that call coverage should be compensated. PMID:24078953
Hussain, Waqas; Hussain, Haroon; Manning, David W
Acromicric dysplasia (AD) is an autosomal dominant disorder characterized by short stature, short extremities, stiff joint and skeleton features including brachymetacarpia, cone-shaped epiphyses, internal notch of the femoral head, and delayed bone age. Recently, we identified fibrillin 1 (FBN1) as the disease gene of AD. The aim of our study was to further describe the long-term follow up of AD patients with an emphasis on orthopedic management. Nine patients with FBN1 mutations were included in the study ranging in age from 5.5 to 64 years. For all, detailed clinical and radiological data were available. Results: Birth parameters were always normal and patients progressively developed short stature <-3 SD. Carpal tunnel syndrome was observed in four patients. We found discrepancy between the carpal bone age and the radius and ulna epiphysis bone ages, a variable severity of hip dysplasia with acetabular dysplasia, epiphyseal and metaphyseal femoral dysplasia resembling Legg-Perthes-Calvé disease and variable pelvic anteversion and hyperlordosis. Orthopedic surgery was required in two patients for hip dysplasia, in one for limb lengthening and in three for carpal tunnel syndrome. Our observations expand the AD phenotype and emphasize the importance of regular orthopedic survey. PMID:24339047
Klein, Céline; Le Goff, Carine; Topouchian, Vicken; Odent, Sylvie; Violas, Philippe; Glorion, Christophe; Cormier-Daire, Valérie
This paper discusses the manipulating ability of robotic mechanisms in positioning and orienting end-effectors and proposes a measure of manipulability. Some properties of this measure are obtained, the best postures of various types of manipulators are given, and a four-degree-of-freedom finger is considered from the viewpoint of the measure. The pos tures somewhat resemble those of human arms and fingers.
This article provides information from research on the benefits and cautions associated with using manipulatives to teach children. The authors urge that much care be used in assessing whether the learner regards the activity with concrete objects in the same context as was intended by the instructor. The article looks at the comparative advantages of computer manipulatives and gives advice on the selection and use of both physical and computer manipulatives. An extensive reference list is included.
Clements, Douglas; Mcmillen, Sue
A transfer platform for the conveyance of objects by a manipulator includes a bed frame and saddle clamp secured along an edge of the bed frame and adapted so as to secure the bed frame to a horizontal crosspiece of the manipulator. The platform may thus move with the manipulator in a reciprocal linear path defined by a guide rail. A bed insert may be provided for the support of conveyed objects and a lifting bail may be provided to permit the manipulator arm to install the bed frame upon the crosspiece under remote control.
Dobbins, James C. (Idaho Falls, ID); Hoover, Mark A. (Idaho Falls, ID); May, Kay W. (Idaho Falls, ID); Ross, Maurice J. (Pocatello, ID)
As unmanned systems become more commonplace in military, police, and other security forces, they are tasked to perform missions that the original hardware was not designed for. Current military robots are built for rough outdoor conditions and have strong inflexible manipulators designed to handle a wide range of operations. However, these manipulators are not well suited for some essential indoor
Erik Schoenfeld; Lawrence Parrington; Stephan von Muehlen
Recent advances in the lab-on-a-chip field in association with nano/microfluidics have been made for new applications and functionalities to the fields of molecular biology, genetic analysis and proteomics, enabling the expansion of the cell biology field. Specifically, microfluidics has provided promising tools for enhancing cell biological research, since it has the ability to precisely control the cellular environment, to easily mimic heterogeneous cellular environment by multiplexing, and to analyze sub-cellular information by high-contents screening assays at the single-cell level. Various cell manipulation techniques in microfluidics have been developed in accordance with specific objectives and applications. In this review, we examine the latest achievements of cell manipulation techniques in microfluidics by categorizing externally applied forces for manipulation: (i) optical, (ii) magnetic, (iii) electrical, (iv) mechanical and (v) other manipulations. We furthermore focus on history where the manipulation techniques originate and also discuss future perspectives with key examples where available. PMID:23403762
Yun, Hoyoung; Kim, Kisoo; Lee, Won Gu
Dermatological diseases, such as dysesthesia syndromes, stasis dermatoses, and hyperhidrosis are difficult to treat due to their complex etiologies. Current theories suggest these diseases are caused by physiological imbalances, such as nerve impingement, localized tissue congestion, and impaired autonomic regulation. Osteopathic manipulative therapy targets these physiological dysfunctions and may serve as a beneficial therapeutic option. Osteopathic manipulative therapy techniques include high velocity low amplitude, muscle energy, counterstrain, myofascial release, craniosacral, and lymphatic drainage. An osteopathic manipulative therapy technique is chosen based on its physiological target for a particular disease. Osteopathic manipulative therapy may be useful alone or in combination with standard therapeutic options. However, due to the lack of standardized trials supporting the efficacy of osteopathic manipulative therapy treatment for dermatological disease, randomized, well-controlled studies are necessary to confirm its therapeutic value.
Campbell, Shannon M.; Walkowski, Stevan
The management of the polytraumatized orthopedic patient remains a challenging issue. In recent years many efforts have been made to develop rescue techniques and to promote guidelines for the management of these patients. Currently controversies persist between two orthopedic approaches: the Early Total Care and the Damage Control Orthopedics. An overview of the current literature on the orthopedic management of polytrauma patient is provided. Subsequently, femoral shaft fractures, representing extremely common lesions, and pelvic ring injuries, that are associated with a high mortality rate, are analyzed in detail.
Purpose: The goal of the present study was to quantify the high-velocity, low-amplitude spinal manipulation biomechanical parameters in two cohorts of students from different teaching institutions. The first cohort of students was taught chiropractic techniques in a patient–doctor positioning practice setting, while the second cohort of students was taught in a “complete practice” manipulation setting, thus performing spinal manipulation skills on fellow student colleagues. It was hypothesized that the students exposed to complete practice would perform the standardized spinal manipulation with better biomechanical parameters. Methods: Participants (n = 88) were students enrolled in two distinct chiropractic programs. Thoracic spine manipulation skills were assessed using an instrumented manikin, which allowed the measurement of applied force. Dependent variables included peak force, time to peak force, rate of force production, peak force variability, and global coordination. Results: The results revealed that students exposed to complete practice demonstrated lower time to peak force values, higher peak force, and a steeper rate of force production compared with students in the patient–doctor positioning scenario. A significant group by gender interaction was also noted for the time to peak force and rate of force production variables. Conclusion: The results of the present study confirm the importance of chiropractic technique curriculum and perhaps gender in spinal manipulation skill learning. It also stresses the importance of integrating spinal manipulation skills practice early in training to maximize the number and the quality of significant learner–instructor interactions.
Harvey, Marie-Pierre; Wynd, Shari; Richardson, Lance; Dugas, Claude; Descarreaux, Martin
Background Performing multiple tests in primary research is a frequent subject of discussion. This discussion originates from the fact that when multiple tests are performed, it becomes more likely to reject one of the null hypotheses, conditional on that these hypotheses are true and thus commit a type one error. Several correction methods for multiple testing are available. The primary aim of this study was to assess the quantity of articles published in two highly esteemed orthopedic journals in which multiple testing was performed. The secondary aims were to determine in which percentage of these studies a correction was performed and to assess the risk of committing a type one error if no correction was applied. Methods The 2010 annals of two orthopedic journals (A and B) were systematically hand searched by two independent investigators. All articles on original research in which statistics were applied were considered. Eligible publications were reviewed for the use of multiple testing with respect to predetermined criteria. Results A total of 763 titles were screened and 127 articles were identified and included in the analysis. A median of 15 statistical inference results were reported per publication in both journal A and B. Correction for multiple testing was performed in 15% of the articles published in journal A and in 6% from journal B. The estimated median risk of obtaining at least one significant result for uncorrected studies was calculated to be 54% for both journals. Conclusion This study shows that the risk of false significant findings is considerable and that correcting for multiple testing is only performed in a small percentage of all articles published in the orthopedic literature reviewed.
The management of complex wounds remains a challenge, and although there have been many promising advances, patients often undergo a morbid and lengthy process to obtain sufficient, satisfactory healing. Sarcoma patients are especially vulnerable to soft tissue wound-healing complications. These patients are often treated with neoadjuvant radiation and/or chemotherapy and have compromised local vascularity to healing tissue. The advent and refinement of wound vacuum-assisted closure technology have been shown to have a tremendous impact. This article reviews the benefits of some novel technologies currently undergoing investigation in orthopedic oncology that will likely have applications in wound management from other causes. PMID:24267211
Siegel, Herrick J
The unique development of early medical specialization in the West can be traced to California's geography and economic development. Such early specialization produced men with orthopedic inclinations. Early orthopedists founded the first medical school and the first modern teaching hospital, helped to found Stanford's Lane Medical Library and made the first use of x-rays in the West. In addition many of these orthopedists were prominent in the political and social activities of the time. ImagesFigure 1.Figure 2.Figure 3.Figure 4.
Mandell, Peter; Raih, Thomas; Taylor, Lloyd W.
The first issue of World Journal of Orthopedics (WJO), whose preparatory work was initiated on March 11, 2010, will be published on November 18, 2010. The WJO Editorial Board has now been established and consists of 114 distinguished experts from 26 countries. Our purpose of launching WJO is to publish peer-reviewed, high-quality articles via an open-access online publishing model, thereby acting as a platform for communication between peers and the wider public, and maximizing the benefits to editorial board members, authors and readers.
Two-armed telerobot undergoing development manipulates objects with dexterity approaching that of human. Designed to be remotely operated by human. Operator wears harness with exoskeletonlike sleeves and gloves; remote manipulator follows operator's arm, hand, and finger movements and feeds back position and force information so operator has sense of manipulating object held by telerobot. Developed for use in outer space. Suited for such terrestrial uses as handling materials and maintaining equipment in hazardous environments where mechanical dexterity and nearly instantaneous feedback of sensory information needed.
Jau, Bruno M.
Various topics on the biochemistry of genetic manipulation are discussed. These include genetic transformation and DNA; genetic expression; DNA replication, repair, and mutation; technology of genetic manipulation; and applications of genetic manipulation. Other techniques employed are also considered. (JN)
Barker, G. R.
This virtual manipulative provides base blocks that consist of individual "units," "longs," "flats," and "blocks" (ten of each set for base 10). They can be used to show place value for numbers and to increase understanding of addition and subtraction.
Manipulatives, National L.
A simulator to generate the real time visual scenes required to perform man in the loop investigations of remote manipulator application and design concepts for the space shuttle is described. The simulated remote manipulator consists of a computed display system that uses a digital computer, the electronic scene generator, an operator's station, and associated interface hardware. A description of the capabilities of the implemented simulation is presented. The mathematical models and programs developed for the simulation are included.
Wild, E. C.; Donges, P. K.; Garand, W. A.
Research in the optimum design of a manipulator has taken different directions. One of those was to define the kinematic or\\u000a dynamic parameters that determine the characteristics of the manipulator in order to justify the best design. In most of the\\u000a studies that are under way, the possible solutions are restricted to one feasible region in which all of the
A. Rojas Salgado; Y. Ledezma Rubio
This paper presents a taxonomy for detailed classification of human and anthropomorphic manipulation behavior. This hand-centric, motion-centric taxonomy differentiates tasks based on criteria such as object contact, prehension, and the nature of object motion relative to a hand frame. A sub-classification of the most dexterous categories, within-hand manipulation, is also presented, based on the principal axis of object rotation or
Ian M. Bullock; Aaron M. Dollar
Previous studies have confirmed that natural bone apatite crystals are bound with citrate-rich molecules. Citrates on apatite crystals impact bone development and its load-bearing function. However, such understanding has never been translated into bone biomaterials design. Herein, a first citrate-based injectable composite material for orthopedic applications is developed based on our recently developed biodegradable poly(ethylene glycol) maleate citrate (PEGMC) and hydroxyapatite (HA). PEGMC contains rich carboxylic groups that could chelate with calcium-containing HA thus facilitating polymer/HA interactions, similar to natural citrate-bound apatite crystal. The crosslinking of poly(ethylene glycol) diacrylate (PEGDA) with PEGMC/HA composites allows an addition control over degradation and mechanical properties of the crosslinked PEGMC/HA (CPEGMC/HA) composites. CPEGMC/HA composite can serve as an ideal injectable cell carrier as confirmed by the enhanced DNA content, ALP activity, and calcium production through a human fetal osteoblast encapsulation study. Ex vivo study on porcine femoral head demonstrated that PEGMC/HA is a potentially promising injectable biodegradable bone material for the treatment of osteonecrosis of the femoral head. Development of biodegradable citrate-based injectable PEGMC/HA composite is an initial step for the development of the next generation of bone tissue engineering and orthopedic biomaterials.
Gyawali, Dipendra; Nair, Parvathi; Kim, Harry K.W.; Yang, Jian
The purpose of this study was to examine the angiogenic and the subsequent osteogenic responses during a 96-hour time-course after sutural expansion. Fifty rats were divided into: (1) a control group that received only angiogenic induction through injection of 5 ng/gm recombinant human endothelial cell growth factor (rhECGF); (2) an experimental group that received orthopedic expansion and rhECGF; (3) a sham group that received expansion and sodium chloride (NaCl) injection; and (4) a baseline group that received no expansion or injection. All rats were injected with 3H-thymidine (1.0 microCi/gm) 1 hour before death to label the DNA of S-phase cells. Demineralized sections (4 microm thick) were stained with hematoxylin and eosin. Angiogenesis and cell migration were analyzed with a previously established cell kinetics model. Analysis of variance was used to test the hypothesis that enhancement of angiogenesis stimulates reestablishment of osteogenic capability. Blood vessel number, area, and endothelial cell-labeled index significantly increased in experimental groups, but no difference was found between control and baseline groups. Labeled-pericyte index and activated pericyte numbers in the experimental group were also higher than in the sham groups. These results show that supplemental rhECGF enhances angiogenesis in expanded sutures but not in nonexpanded sutures. Data also suggest that pericytes are the source of osteoblasts in an orthopedically expanded suture.
Chang, H. N.; Garetto, L. P.; Potter, R. H.; Katona, T. R.; Lee, C. H.; Roberts, W. E.
Porous tantalum, a new low modulus metal with a characteristic appearance similar to cancellous bone, is currently available for use in several orthopedic applications (hip and knee arthroplasty, spine surgery, and bone graft substitute). The open-cell structure of repeating dodecahedrons is produced via carbon vapor deposition/infiltration of commercially pure tantalum onto a vitreous carbon scaffolding. This transition metal maintains several interesting biomaterial properties, including: a high volumetric porosity (70-80%), low modulus of elasticity (3MPa), and high frictional characteristics. Tantalum has excellent biocompatibility and is safe to use in vivo as evidenced by its historical and current use in pacemaker electrodes, cranioplasty plates and as radiopaque markers. The bioactivity and biocompatibility of porous tantalum stems from its ability to form a self-passivating surface oxide layer. This surface layer leads to the formation of a bone-like apatite coating in vivo and affords excellent bone and fibrous in-growth properties allowing for rapid and substantial bone and soft tissue attachment. Tantalum-chondrocyte composites have yielded successful early results in vitro and may afford an option for joint resurfacing in the future. The development of porous tantalum is in its early stages of evolution and the following represents a review of its biomaterial properties and applications in orthopedic surgery. PMID:16737737
Levine, Brett Russell; Sporer, Scott; Poggie, Robert A; Della Valle, Craig J; Jacobs, Joshua J
Determining if a Propionibacterium acnes culture is a true infection or a contaminant remains a challenge. We conducted a study to distinguish between a true infection and a contaminated culture based on the P acnes hemolytic phenotype and clinical presentation. All P acnes strains were from orthopedic patients who had undergone arthroplasty or nonarthroplasty shoulder procedures. Hemolysis was determined according to P acnes growth on brucella blood agar plates after 48 to 72 hours. Each patient record that corresponded to the obtained P acnes strains was retrospectively reviewed for clinical data. An orthopedic surgeon involved in the care of the patients, but blinded to the hemolytic status of the bacteria, classified these infections as definite, likely, or unlikely. Of the 22 P acnes strains, 13 were hemolytic, and 9 were nonhemolytic. Of the 13 hemolytic strains, 10 were definite infections; only 3 of the 9 nonhemolytic strains were definite infections. Mean (SD) C-reactive protein level was significantly higher (P = .03) in the hemolytic group, 16 (11) mg/mL, than in the nonhemolytic group, 7.9 (10) mg/mL. A hemolytic phenotype of P acnes may represent a more pathogenic strain of bacteria, and may be more likely to be found in patients with a definite infection with P acnes rather than a contaminated culture. PMID:24839635
Nodzo, Scott R; Hohman, Donald W; Crane, John K; Duquin, Thomas R
BACKGROUND: The Medical Outcomes General Health Survey (SF-36) is a widely used health status measure; however, limited evidence is available for its performance in orthopedic settings. The aim of this study was to examine the magnitude and meaningfulness of change and sensitivity of SF-36 subscales following orthopedic surgery. METHODS: Longitudinal data on outcomes of total hip replacement (THR, n =
Lucy Busija; Richard H Osborne; Anna Nilsdotter; Rachelle Buchbinder; Ewa M Roos
Preparation for teaching dance to orthopedically handicapped students is discussed in addition to specific suggestions for teaching popular dance, square dance, folk dance, modern dance, and ballet. Dancing is seen as a way to give orthopedically handicapped students physical education success without competition. Recommended music for each type…
Harris, Cordelia Graves
Aprotinin therapy is a promising strategy for reduc- ing blood loss and blood transfusion requirements. Theefficacyandsafetyofaprotinininorthopedicsur- gery, however, remain controversial. We searched electronic databases for randomized controlled trials on the efficacy and safety of the use of aprotinin in orthopedic surgery. Thirteen trials that included at o- tal of 506 patients who underwent major orthopedic surgery were analyzed. The pooled
Toshiya Shiga; Tetsuo Inoue; Atsuhiro Sakamoto
This study describes the implications of the Individual Psychology of Alfred Adler and field theory associated with Kurt Lewin in understanding orthopedically disabled children and points out that orthopedically disabled youngsters have a remarkable range of individual differences both in type of disability as well as level of adjustment.…
Sigmon, Scott B.
This paper proposes an architecture of the wireless monitoring system for the real-time monitoring of the orthopedic implants, which monitors the implant duty cycle, detects abnormal asymmetry, high amounts of force, and other conditions of the orthopedic implants. Data for diagnosis are communicated wirelessly by the radio-frequency (RF) signal between the embedded chip and the remote circuit. In different working
Hong Chen; Ming Liu; Wenhan Hao; Yi Chen; Chen Jia; Chun Zhang; Zihua Wang
Venous thromboembolism (VTE), which includes deep vein thrombosis and pulmonary embolism, is a major cause of morbidity and mortality in patients undergoing major orthopedic surgery, and routine thromboprophylaxis has been the standard of care over the last 20 years. Currently available options for the prevention of VTE in major orthopedic surgery include low-molecular-weight heparins, vitamin K antagonists and, more recently,
Davide Imberti; Domenico Prisco
The Manipulator Comparative Testing Program compared performance of selected manipulator systems under typical remote handling conditions. The site of testing was the Remote Operations and Maintenance Demonstration Facility operated by the Consolidated Fuel Reprocessing Program of the Oak Ridge National Laboratory. Three experiment examined differences among manipulator systems from the US and Japan. The manipulator systems included the Meidensha BILARM 83A, Central Research Laboratories' (CRL's) Model M-2, and GCA PaR systems Model 6000. Six manipulator and control mode combinations were evaluated: (a) the BILARM in master-slave mode without force reflection; (b) the BILARM in master-slave mode with force reflection; (c) the Model M-2 in master-slave mode without force reflection; (d) the Model M-2 in master-slave mode with force reflection; (e) the BILARM with switchbox controls; and (f) the PaR 6000 with switchbox controls. The experiments also examined differences between master-slave systems with and without force reflections, and differences between master-slave systems and switchbox-controlled systems.
Draper, J.V.; Handel, S.J.; Sundstrom, E.; Herndon, J.N.; Fujita, Y.; Maida, M.
Remote-manipulator concept for retrieval or inspection of objects in outer space applied to underwater or in tanks of hazardous chemicals. System includes tether head on outer end of tether cable wound on motor-driven takeup reel. Head includes mounting plate with four canted thrustors facing rearward, solid-state camera with patterned sources of light facing forward, and pneumatic inflatable end effector. Also includes device to cut head loose in emergency. Intended for use in places beyond reach of jointed rigid-arm manipulator and where unsafe or impractical to send humans.
Bryan, Thomas C.
The feasibility of using model based control (MBC) for robotic manipulators was investigated. A double inverted pendulum system was constructed as the experimental system for a general study of dynamically stable manipulation. The original interest in dynamically stable systems was driven by the objective of high vertical reach (balancing), and the planning of inertially favorable trajectories for force and payload demands. The model-based control approach is described and the results of experimental tests are summarized. Results directly demonstrate that MBC can provide stable control at all speeds of operation and support operations requiring dynamic stability such as balancing. The application of MBC to systems with flexible links is also discussed.
Petrosky, Lyman J.; Oppenheim, Irving J.
To prevent pulmonary embolism due to deep venous thrombosis (DVT), we have treated 611 patients undergoing orthopedic surgery of the lower extremities with our protocol including pre- and postoperative ultrasonic venous screening and anticoagulant therapy if necessary. A total of 118 patients (19.3%) developed DVT. Among demographic and clinical factors, the site of operation (knee joint surgery: odds ratio 5.17), age (>60: odds ratio 3.91), and operation time (>120 minutes: odds ratio 4.52) were identified as significant risk factors of development of DVT. One patient received an infusion of urokinase for DVT of femoral vein, but no patients developed serious postoperative bleeding or pulmonary thromboembolisms. (*English Translation of J Jpn Coll Angiol, 2010, 50: 95-100.)
This article presents a radiologic review of the spectrum of acquired and congenital orthopedic abnormalities found in patients with myelomeningocele. These abnormalities are caused predominantly by muscle imbalance, paralysis, and decreased sensation in the lower extremity. Iatrogenic injury, such as a postoperative tethered cord, may also cause bone abnormalities. Selected images were obtained from more than 800 children. Important entities presented include spinal curvatures such as kyphosis, scoliosis, and lordosis; subluxation and dislocation of the hip, coxa valga, contractures of the hip, and femoral torsion; knee deformities; rotational abnormalities of the lower extremity and external and internal torsion; ankle and foot abnormalities such as ankle valgus, calcaneus foot, congenital vertical talus (rocker-bottom deformity), and talipes equinovarus; and metaphyseal, diaphyseal, and physeal fractures. Familiarity with congenital abnormalities and an understanding of the pathogenesis of acquired disorders in patients with myelomeningocele are essential for proper radiologic interpretation and timely therapy. PMID:1439018
Westcott, M A; Dynes, M C; Remer, E M; Donaldson, J S; Dias, L S
Battery lifetime has been the stumbling block for many power-critical or maintenance-free real-time embedded applications, such as wireless sensors and orthopedic implants. Thus a piezoelectric material that could convert human motion into electrical energy provides a very attractive solution for clinical implants. In this work, we analyze the power generation characteristics of stiff lead zirconate titanate (PZT) ceramics and the equivalent circuit through extensive experiments. Our experimental framework allows us to explore many important design considerations of such a PZT-based power generator. Overall we can achieve a PZT element volume of 0.5 x 0.5 x 1.8 cm, which is considerably smaller than the results reported so far. Finally, we outline the application of our PZT elements in a total knee replacement (TKR) implant. PMID:19812004
Chen, Hong; Liu, Ming; Jia, Chen; Wang, Zihua
In order to impede infection and achieve accelerated wound healing in the postorthopaedic surgery patients, a simple and benign procedure for creating nanotubular or nanofibrillar structure of photoactive TiO2 on the surface of Ti plates and wires is described. The nanoscale TiO2 films on titanium were grown by hydrothermal processing in one case and by anodization in the presence of dilute mineral acids under mild and benign conditions in the other. Confocal microscopy results demonstrated at least 50% reduction in the population of E. coli colonies (concentration 2.15 × 107?cells/mL) on TiO2-coated implants upon an IR exposure of up to 30?s; it required ?20?min of exposure to UV beam for the same effect. These findings suggest the probability of eliminating wound infection during and after orthopedic surgical procedures by brief illumination of photoactive titania films on the implants with an IR beam.
Azad, Abdul-Majeed; Hershey, Ryan; Aboelzahab, Asem; Goel, Vijay
Infections in orthopaedic surgery are a serious issue. Antibiotic-loaded bone cement was developed for the treatment of infected joint arthroplasties and for prophylaxes in total joint replacement in selected cases. Despite the widespread use of the antibiotic-loaded bone cement in orthopedics, many issues are still unclear or controversial: bacterial adhesion and antibiotic resistance, modification of mechanical properties which follows the addition of the antibiotic, factors influencing the release of the antibiotic from the cement and the role of the surface, the method for mixing the cement and the antibiotic, the choice and the effectiveness of the antibiotic, the combination of two or more antibiotics, and the toxicity. This review discusses all these topics, focusing on properties, merits, and defects of the antibiotic loaded cement. The final objective is to provide the orthopaedic surgeons clear and concise information for the correct choice of cement in their clinical practice.
Bistolfi, Alessandro; Massazza, Giuseppe; Verne, Enrica; Masse, Alessandro; Deledda, Davide; Ferraris, Sara; Miola, Marta; Galetto, Fabrizio; Crova, Maurizio
Traditional orthodontic treatments do not adequately address the skeletal problems of retrognathic, hyperdivergent, Class II adolescents; the few approaches that do require long-term patient compliance. This paper introduces a novel approach using miniscrew implants (MSIa) and growth to treat retrognathic hyperdivergent adolescents. Nine consecutive patients were evaluated at the start of treatment (13.2 ±1.1 years of age) and again at the end of the orthopedic phase (after 1.9 ±0.3 years). Each patient had two MSIs placed in either side of the palate. Coil springs (150 g) extended from the MSIs to a RPE, which served as a rigid segment for intruding the maxillary premolar and molars. Two additional MSIs were placed between the first mandibular molars and second premolars; coil spring (150 g) extended from the MSIs to hold or intrude the mandibular molars. Prior to treatment, the patients exhibited substantial and significant mandibular retrusion (Z-score=?1.0), facial convexity (Z-score=0.7), and hyperdivergence (Z-score=1.6). Treatment produced consistent and substantial orthopedic effects. The chin was advanced an average of 2.4 mm, the SNB angle increased by 2.1°, the mandibular plane angle decreased 3.9°, and facial convexity decreased by approximately 3.2°. Questionnaires showed that this treatment approach was not painful or uncomfortable; the majority of the patients indicated that they were very likely to recommend the treatment to others. Treatment was accomplished by titrating the amount of orthodontic intrusion performed based on the individuals’ growth potential.
Buschang, Peter H.; Carrillo, Roberto; Rossouw, P. Emile
Research in different areas of orthopedic and trauma surgery requires a methodology that allows both a more economic approach and the ability to reproduce different situations in an easy way. Simulation models have been introduced recently in bioengineering and could become an essential tool in the study of any physiological unity, regardless of its complexity. The main problem in modeling with finite elements simulation is to achieve an accurate reproduction of the anatomy and a perfect correlation of the different structures, in any region of the human body. Authors have developed a mixed technique, joining the use of a three-dimensional laser scanner Roland Picza captured together with computed tomography (CT) and 3D CT images, to achieve a perfect reproduction of the anatomy. Finite element (FE) simulation lets us know the biomechanical changes that take place after hip prostheses or osteosynthesis implantation and biological responses of bone to biomechanical changes. The simulation models are able to predict changes in bone stress distribution around the implant, so allowing preventing future pathologies. The development of a FE model of lumbar spine is another interesting application of the simulation. The model allows research on the lumbar spine, not only in physiological conditions but also simulating different load conditions, to assess the impact on biomechanics. Different degrees of disc degeneration can also be simulated to determine the impact on adjacent anatomical elements. Finally, FE models may be useful to test different fixation systems, i.e., pedicular screws, interbody devices or rigid fixations compared with the dynamic ones. We have also developed models of lumbar spine and hip joint to predict the occurrence of osteoporotic fractures, based on densitometric determinations and specific biomechanical models, including approaches from damage and fracture mechanics. FE simulations also allow us to predict the behavior of orthopedic splints applied to the correction of deformities, providing the recovering force-displacement and angle-moment curves that characterize the mechanical behavior of the splint in the overall range of movement.
Herrera, Antonio; Ibarz, Elena; Cegonino, Jose; Lobo-Escolar, Antonio; Puertolas, Sergio; Lopez, Enrique; Mateo, Jesus; Gracia, Luis
Hydroxyapatite (HA) has received wide attention in orthopedics, due to its biocompatibility and osseointegration ability. Despite these advantages, the brittle nature and low fracture toughness of HA often results in rapid wear and premature fracture of implant. Hence, there is a need to improve the fracture toughness and wear resistance of HA without compromising its biocompatibility. The aim of the current research is to explore the potential of nanotubes as reinforcement to HA for orthopedic implants. HA- 4 wt.% carbon nanotube (CNT) composites and coatings are synthesized by spark plasma sintering and plasma spraying respectively, and investigated for their mechanical, tribological and biological behavior. CNT reinforcement improves the fracture toughness (>90%) and wear resistance (>66%) of HA for coating and free standing composites. CNTs have demonstrated a positive influence on the proliferation, differentiation and matrix mineralization activities of osteoblasts, during in-vitro biocompatibility studies. In-vivo exposure of HA-CNT coated titanium implant in animal model (rat) shows excellent histocompatibility and neobone integration on the implant surface. The improved osseointegration due to presence of CNTs in HA is quantified by the adhesion strength measurement of single osteoblast using nano-scratch technique. Considering the ongoing debate about cytotoxicity of CNTs in the literature, the present study also suggests boron nitride nanotube (BNNT) as an alternative reinforcement. BNNT with the similar elastic modulus and strength as CNT, were added to HA. The resulting composite having 4 wt.% BNNTs improved the fracture toughness (˜85%) and wear resistance (˜75%) of HA in the similar range as HA-CNT composites. BNNTs were found to be non-cytotoxic for osteoblasts and macrophages. In-vitro evaluation shows positive role of BNNT in osteoblast proliferation and viability. Apatite formability of BNNT surface in ˜4 days establishes its osseointegration ability.
As physician involvement in health policy grows, there will be an increasing need for future leaders in orthopedics. Interested orthopedic residents may be unaware of opportunities for leadership involvement in professional and subspecialty organizations. This article investigates whether national and subspecialty organizations offer membership to residents, allow residents to participate in committees, and provide opportunities for scholarly activity and mentorship. The authors surveyed 20 national orthopedic professional and subspecialty societies to evaluate the availability and cost of resident membership, meeting attendance and participation, research funding, committee membership, and mentorship opportunities. Each society's Web site was reviewed, and societies were contacted by phone if further inquiry was needed. Of the 20 orthopedic societies surveyed, 11 allowed resident membership. Five of 20 societies allowed residents to serve on committees, with a total of 14 total positions for residents. Four organizations provided formalized mentorship programs to residents. Although opportunities for resident involvement in subspecialty and professional societies are available in the majority of groups surveyed, the Orthopaedic Trauma Association and American Society for Surgery of the Hand provided the most comprehensive collection of opportunities. Residents should also pursue involvement in other organizations that may be more readily accessible, such as local, state, and regional orthopedic and medical societies. Increased resident participation in these organizations may help in increasing the 14 nationally available committee positions for orthopedic residents. Our orthopedic profession and societies should encourage motivated residents to pursue involvement and leadership at the national level. PMID:21956064
Dy, Christopher J; Cross, Michael B; Osbahr, Daryl C; Parks, Michael L; Green, Daniel W
Level I trauma centers frequently see trauma at or below the ankle, which requires consultation with the orthopedic surgery department. However, as podiatry programs begin to firmly establish themselves in more Level I trauma centers, their consultations increase, ultimately taking those once seen by orthopedic surgery. A review of the literature demonstrates that this paradigm shift has yet to be discussed. The purpose of this study was to determine how many, if any, lower extremity fracture consultations a newly developed podiatry program would take from the orthopedic surgery department. A retrospective review was performed of emergency department records from January 2007 to December 2011. Seventeen different emergency department diagnoses were used to search the database. Ultimately, each patient's emergency department course was researched. Several trends were noted. First, if trauma surgery was involved, only the orthopedic surgery department was consulted for any injuries at or below the ankle. Second, the emergency department tended to consult the podiatry program only between the hours of 8 am and 6 pm. Third, as the podiatry program became more established, their number of consultations increased yearly, and, coincidentally, the orthopedic surgery department's consultations decreased. Finally, high-energy traumas involved only the orthopedic surgery department. Whether the orthopedic surgery department or podiatry program is consulted regarding trauma surgery is likely hospital dependent. PMID:24972439
Jakoi, Andre M; Old, Andrew B; O'Neill, Craig A; Stein, Benjamin E; Stander, Eric P; Rosenblatt, Joseph; Herman, Martin J
This invention is comprised of an apparatus for manipulating a vacuum hose in a reactor vessel comprising a housing with two opposing openings, an arm carried by the housing and deployable from a stowed position essentially completely within the housing t...
W. T. Zollinger
We introduce a cooperative learning, group lab for a Calculus III course to facilitate comprehension of the gradient vector and directional derivative concepts. The lab is a hands-on experience allowing students to manipulate a tangent plane and empirically measure the effect of partial derivatives on the direction of optimal ascent. (Contains 7…
Gaze, Eric C.
We introduce a simple, experimentally realizable, entanglement manipulation protocol for exploring mixed-state entanglement. We show that for both nonmaximally entangled pure, and mixed polarization-entangled two-qubit states, an increase in the degree of entanglement and purity, is achievable.
R. T. Thew
We introduce a simple, experimentally realisable, entanglement manipulation\\u000aprotocol for exploring mixed state entanglement. We show that for both\\u000anon-maximally entangled pure, and mixed polarisation-entangled two qubit\\u000astates, an increase in the degree of entanglement and purity, which we define\\u000aas concentration, is achievable.
R. T. Thew
Robots that work alongside us in our homes and workplaces could extend the time an elderly person can live at home, provide physical assistance to a worker on an assembly line, or help with household chores. In order to assist us in these ways, robots will need to successfully perform manipulation tasks within human environments. Human environments present special challenges
Aaron Edsinger; Charles C. Kemp
The free evolution of a non-relativistic charged particle is manipulated using time-dependent magnetic fields. It is shown that the application of a programmed sequence of magnetic pulses can invert the free evolution process, forcing an arbitrary wave pa...
D. J. F. Cabera, B. Mielnik
Diffy is a virtual manipulative that allows students to practice their subtraction facts with whole numbers, integers, fractions, decimals, or money. It is a puzzle of sorts with four black numbers placed at the corners of a black square. The first goal is to fill in the four blanks in the blue circles in the middle of each side of the black square.
University, Utah S.
As unmanned systems become more commonplace in military, police, and other security forces, they are tasked to perform missions that the original hardware was not designed for. Current military robots are built for rough outdoor conditions and have strong inflexible manipulators designed to handle a wide range of operations. However, these manipulators are not well suited for some essential indoor tasks, including opening doors. This is a complicated kinematic task that places prohibitively difficult control challenges on the robot and the operator. Honeybee and iRobot have designed a modular door-breaching manipulator that mechanically simplifies the demands upon operator and robot. The manipulator connects to the existing robotic arm of the iRobot PackBot EOD. The gripper is optimized for grasping a variety of door knobs, levers, and car-door handles. It works in conjunction with a compliant wrist and magnetic lock-out mechanism that allows the wrist to remain rigid until the gripper has a firm grasp of the handle and then bend with its rotation and the swing of the door. Once the door is unlatched, the operator simply drives the robot through the doorway while the wrist compensates for the complex, multiple degree-of-freedom motion of the door. Once in the doorway the operator releases the handle, the wrist pops back into place, and the robot is ready for the next door. The new manipulator dramatically improves a robot's ability to non-destructively breach doors and perform an inspection of a room's content, a capability that was previously out of reach of unmanned systems.
Schoenfeld, Erik; Parrington, Lawrence; von Muehlen, Stephan
To study characteristics of headache combined with orthopedic disorders in children and adolescents and to develop treatment approaches, we examined 116 patients aged from 5 to 17 years. Headache of tension was found in 89 (77%) and chronic headache in 27 (23%) patients. Along with clinical/neurological and orthopedic examination, all patients were studied using a special device that allowed to quantitatively measure the bearing (in three dimensions) and biomechanic body balance. Electroencephalography, Doppler ultrasound and transcranial tests of neck vessels and ophthalmological examination were carried out. Based on the features of headache characteristic of some groups of patients, the authors suggest using a multidiscipline approach including the day-to-day interaction between neurologist and orthopedist, pharmacological therapy, therapeutic physical training, specific orthopedic inner sole and other rehabilitation methods. This treatment has led to better recovery of patients compared to the treatment using only neurological or orthopedic techniques. PMID:24430031
Gaiduk, A A; Korostovtsev, D D; Gaiduk, Yu V; Ageeva, L Ya
This article reviews recent significant advances in the design of nanofiber scaffolds for orthopedic tissue repair and regeneration. It begins with a brief introduction on the limitations of current approaches for orthopedic tissue repair and regeneration. It then illustrates that rationally designed scaffolds made up of electrospun nanofibers could be a promising solution to overcome the problems that current approaches encounter. The article also discusses the intriguing properties of electrospun nanofibers, including control of composition, structures, orders, alignments and mechanical properties, use as carriers for topical drug and/or gene sustained delivery, and serving as substrates for the regulation of cell behaviors, which could benefit musculoskeletal tissue repair and regeneration. It further highlights a few of the many recent applications of electrospun nanofiber scaffolds in repairing and regenerating various orthopedic tissues. Finally, the article concludes with perspectives on the challenges and future directions for better design, fabrication and utilization of nanofiber scaffolds for orthopedic tissue engineering.
Ma, Bing; Xie, Jingwei; Jiang, Jiang; Shuler, Franklin D; Bartlett, David E
Instructions are presented on the use of ADMAP, (automatic data manipulation program) an aerospace data manipulation computer program. The program was developed to aid in processing, reducing, plotting, and publishing electric propulsion trajectory data g...
F. I. Mann
This site offers three interactive modules that treat teachers to a direct look at scientists who worked to unlock the mysteries of genes and the technological advancements that aided their discoveries. The modules are arranged by topics that focus on how to manipulate genes, how enzymes are used in manipulation, and the possibilities inherent in recombinant DNA technology. Each module is subdivided into additional parts. These parts include images of scientists who contributed to the history of gene discoveries. By clicking on the images, teachers are taken to a new window to watch short videos by or about the scientists. Teachers can also click on links to computer simulations, such as a tutorial to see how yeast is used to make human insulin. Copyright 2005 Eisenhower National Clearinghouse
Laboratory, Dolan D.
In order to improve dental and orthopedic implant performance, the objective of this study was to synthesize nanocrystalline hydroxyapatite (HA) powders to coat metals (specifically, titanium and tantalum). Precipitated HA powders were either sintered in order to produce UltraCaP HA (or microcrystalline size HA) or were treated hydrothermally to produce nanocrystalline HA. Some of the UltraCaP and nanocrystalline HA powders were doped with yttrium (Y) since previous in vitro studies demonstrated that Y-doped HA in bulk improved osteoblast (or bone-forming cell) function over undoped HA. The nanocrystalline HA powders were also mixed with nanophase titania powders because previous studies demonstrated that titania/HA composite coatings increased coating adhesive strength and HA nucleation. These powders were then deposited onto titanium by a novel room-temperature process, called IonTiteT(TM). The results demonstrated that the chemical properties and crystallite size of the original HA powders were maintained in the coatings. More importantly, in vitro studies showed increased osteoblast (bone-forming cell) adhesion on the single phase nanocrystalline HA and nano-titania/HA coatings compared to traditionally used plasma-sprayed HA coatings and uncoated metals. Results further demonstrated greater amounts of calcium deposition by osteoblasts cultured on nanocrystalline HA coatings compared to UltraCaP coatings and conventionally used plasma-sprayed HA coatings. To elucidate mechanisms that influenced osteoblast functions on the HA coatings, the amount of proteins (fibronectin and vitronectin) onto the HA powders and the adsorbed fibronectin conformation were investigated. Exposure of cell integrin binding domains (in fibronectin III10 segments) was greater in fibronectin adsorbed onto 1.2 mole% Y-doped UltraCaP HA coatings compared to nanocrystalline HA coatings tested. However, 1.2 mole% Y-doped UltraCaP HA coatings did not increase mineralization by osteoblasts compared to the nanocrystalline HA coatings. These results suggested that the availability of integrin binding domains in fibronectin did not correlate to enhanced mineralization by osteoblasts on nanocrystalline HA coatings. Lastly, undoped nanocrystalline HA coatings were studied using a well-established rat calvaria in vivo. Histological analysis showed that nanocrystalline HA coated on tantalum scaffolds increased bone and fibrous tissue infiltration into the scaffolds while uncoated and UltraCaP HA coated scaffolds did not after as early as 6 weeks. In summary, these results encourage further studies on nanocrystalline IonTiteTM HA coatings on various metals for orthopedic and dental applications.
A method and apparatus for radiographic characterization of small hollow spherical members (microspheres), constructed of either optically transparent or opaque materials. The apparatus involves a microsphere manipulator which holds a batch of microspheres between two parallel thin plastic films for contact microradiographic characterization or projection microradiography thereof. One plastic film is translated to relative to and parallel to the other to roll the microspheres through any desired angle to allow different views of the microspheres.
Singleton, Russell M. (Livermore, CA)
In this chapter, we consider problems that arise in designing, building, planning, and controlling operations of robotic hands\\u000a and end-effectors. The purpose of such devices is often manifold, and it typically includes grasping and fine manipulation\\u000a of objects in an accurate, delicate yet firm way. We survey the state-of-the-art reached by scientific research and literature\\u000a about the problems engendered by
Antonio Bicchi; Vijay Kumar
Background At present in Japan, there are neither reports on antibiotic prophylaxis regardless of underlying diseases nor precise guidelines\\u000a on prophylactic antibiotics in orthopedic surgery. Therefore, the preventive effect of antimicrobial agents on surgical site\\u000a infection (SSI) after clean orthopedic surgery was studied to control the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in our ward and to reduce SSI caused by
Daisuke Kato; Katsuhiko Maezawa; Ikuho Yonezawa; Yoshiyuki Iwase; Hiroshi Ikeda; Masahiko Nozawa; Hisashi Kurosawa
CoCrMo alloys are used as orthopedic implant materials because of their excellent mechanical and corrosion properties. However, when placed in vivo, these alloys release Co, Cr, Mo ions to host tissues, which may give rise to significant health concerns over time. Nitrogen ion implantation can be used to form protective layers on the surface of CoCrMo orthopedic alloys by modifying
Venous thromboembolism (VTE), which includes deep vein thrombosis and pulmonary embolism, is a major cause of morbidity and\\u000a mortality in patients undergoing major orthopedic surgery. Routine thromboprophylaxis has been the standard of care over the\\u000a last 20 years. Currently available options for the prevention of VTE in major orthopedic surgery include low molecular weight\\u000a heparins, vitamin K antagonists, and, more
Davide Imberti; Chiara Dall’Asta; Matteo Giorgi Pierfranceschi
We developed two similar structure manipulators for medical endocavity ultrasound probes with 3 and 4 degrees of freedom (DoF). These robots allow scanning with ultrasound for 3-D imaging and enable robot-assisted image-guided procedures. Both robots use remote center of motion kinematics, characteristic of medical robots. The 4-DoF robot provides unrestricted manipulation of the endocavity probe. With the 3-DoF robot the insertion motion of the probe must be adjusted manually, but the device is simpler and may also be used to manipulate external-body probes. The robots enabled a novel surgical approach of using intraoperative image-based navigation during robot-assisted laparoscopic prostatectomy (RALP), performed with concurrent use of two robotic systems (Tandem, T-RALP). Thus far, a clinical trial for evaluation of safety and feasibility has been performed successfully on 46 patients. This paper describes the architecture and design of the robots, the two prototypes, control features related to safety, preclinical experiments, and the T-RALP procedure.
Stoianovici, Dan; Kim, Chunwoo; Schafer, Felix; Huang, Chien-Ming; Zuo, Yihe; Petrisor, Doru; Han, Misop
Since the 1980s, polyaryletherketones (PAEKs) have been increasingly employed as biomaterials for trauma, orthopedic, and spinal implants. We have synthesized the extensive polymer science literature as it relates to structure, mechanical properties, and chemical resistance of PAEK biomaterials. With this foundation, one can more readily appreciate why this family of polymers will be inherently strong, inert, and biocompatible. Due to its relative inertness, PEEK biomaterials are an attractive platform upon which to develop novel bioactive materials, and some steps have already been taken in that direction, with the blending of HA and TCP into sintered PEEK. However, to date, blended HA-PEEK composites have involved a trade-off in mechanical properties in exchange for their increased bioactivity. PEEK has had the greatest clinical impact in the field of spine implant design, and PEEK is now broadly accepted as a radiolucent alternative to metallic biomaterials in the spine community. For mature fields, such as total joint replacements and fracture fixation implants, radiolucency is an attractive but not necessarily critical material feature.
Kurtz, S. M.; Devine, J. N.
A major focus in the field of orthopedic tissue engineering is the development of tissue engineered bone and soft tissue grafts with biomimetic functionality to allow for their translation to the clinical setting. One of the most significant challenges of this endeavor is promoting the biological fixation of these grafts with each other as well as the implant site. Such fixation requires strategic biomimicry to be incorporated into the scaffold design in order to re-establish the critical structure-function relationship of the native soft tissue-to-bone interface. The integration of distinct tissue types (e.g. bone and soft tissues such as cartilage, ligaments, or tendons), necessitates a multi-phased or stratified scaffold with distinct yet continuous tissue regions accompanied by a gradient of mechanical properties. This review discusses tissue engineering strategies for regenerating common tissue-to-tissue interfaces (ligament-to-bone, tendon-to-bone, or cartilage-to-bone), and the strategic biomimicry implemented in stratified scaffold design for multi-tissue regeneration. Potential challenges and future directions in this emerging field will also be presented. It is anticipated that interface tissue engineering will enable integrative soft tissue repair, and will be instrumental for the development of complex musculoskeletal tissue systems with biomimetic complexity and functionality. PMID:20422291
Lu, Helen H; Subramony, Siddarth D; Boushell, Margaret K; Zhang, Xinzhi
Amino acid containing glass-ionomer cements were synthesized, formulated, and evaluated for orthopedic application. The formulation of different amino acid containing glass-ionomer bone cements was optimized, and conventional and resin-modified glass-ionomer bone cements were compared. Properties of interest included handling characteristics, physical and chemical properties, and mechanical strength of the bone cement. The study was based on the synthesis of different vinyl containing amino acids, different polyelectrolytes containing these amino acid residues, and different resin-modified polyelectrolytes, as well as formulation and evaluation of conventional and resin-modified glass-ionomer bone cements using these polyelectrolytes. Systematic preparation of polyelectrolytes and formulation of glass-ionomer bone cements were essential features of this work, since we anticipated that the mechanical properties of the glass-ionomer bone cements could be strongly affected by the nature of the polyelectrolytes and formulation. Mechanical properties were evaluated in a screw driven mechanical testing machine, and structure-property relationships were determined by scanning electron microscopic (SEM) observation of the fracture surface of the specimens. How the structure of polyelectrolytes, such as different amino acid residues, molecular weight, different modifying resin, and formulation of glass-ionomer bone cement, affected the mechanical properties was also studied.
From the technical point of view different groups must be distinguished in the provision of orthopedic shoes for athletes. The one group encompasses athletes who are provided with insoles in the hope of improved comfort or better performance. The other group includes athletes with diseases or injuries of the lower limbs for whom the provision of appropriate shoes and insoles makes it possible for them to participate again actively in their chosen sport. In such cases one has to differentiate between the purely physical disorder of the foot and biomechanical disorders. For the first group the correct fitting of the shoe is the most important factor whereas in the second group attempts are made to correct and/or compensate for the deficit by means of insoles and wedges as well as supporting or bedding elements. The particular challenge for all such measures is to achieve an as small as possible impairment on the sport activity or, in the ideal cases, even to support it. PMID:23487344
Walther, M; Volkering, C; Röser, A
In Total Knee Arthroplasty (TKA), accurate balancing of the medial and lateral collateral ligaments is considered by orthopedic surgeons as one of the most challenging and complicated tasks to achieve. Therefore, an efficient solution is needed to assist the surgeons in achieving this crucial task without resulting in tibiofemoral misalignment. The required solution consists in developing either a completely automated smart ligament balancer for intraoperative use or adjustable tibial implant for postoperative use. The smart ligament balancer allows the surgeon to accurately balance the collateral ligaments at the time of surgery while the adjustable tibial implant can be controlled in the postoperative period in order to correct the residual ligament imbalance. In this paper, we propose a miniature device that can be used as a smart ligament balancer during TKA or as an adjustable tibial implant in the period following the surgery. Three designs of the smart ligament balancer have been developed using 3-Dimensional (3D) Computer Assisted Design (CAD) software. The proposed balancer can also be used as an adjustable tibial implant after slightly modifying its design. Finite element study of each design has been conducted in order to predict the lifetime of this implant in both cases of intraoperative or postoperative uses. PMID:23366812
Almouahed, Shaban; Hamitouche, Chafiaa; Stindel, Eric; Roux, Christian
We report the synthesis of mechanically favorable, bioactive, and biodegradable copolymer nanocomposites for potential bone applications. The nanocomposites consist of in situ polymerized biodegradable copolyester with hydroxyapatite (HA). Biodegradable copolyesters comprise carboxy terminated poly(propylene fumarate) (CT-PPF) and poly(trimethylol propane fumarate co mannitol sebacate) (TF-Co-MS). Raman spectral imaging clearly reveals a uniform homogenous distribution of HA in the copolymer matrix. The mechanical studies reveal that improved mechanical properties formed when crosslinked with methyl methacrylate (MMA) when compared to N-vinyl pyrrolidone (NVP). The SEM micrographs of the copolymer nanocomposites reveal a serrated structure reflecting higher mechanical strength, good dispersion, and good interfacial bonding of HA in the polymer matrix. In vitro degradation of the copolymer crosslinked with MMA is relatively more than that of NVP and the degradation decreases with an increase in the amount of the HA filler. The mechanically favorable and degradable MMA based nanocomposites also have favorable bioactivity, blood compatibility, cytocompatibility and cell adhesion. The present nanocomposite is a more promising material for orthopedic applications. PMID:24863211
Victor, Sunita Prem; Muthu, Jayabalan
The ultimate goal in manipulating the surface and substrate of a cross-linked polyethylene (CLPE) liner is to obtain not only high wear resistance but also high oxidative stability and high-mechanical properties for life-long orthopedic bearings. We have demonstrated the fabrication of highly hydrophilic and lubricious poly(2-methacryloyloxyethyl phosphorylcholine) (PMPC) grafting layer onto the antioxidant vitamin E-blended CLPE (HD-CLPE(VE)) surface. The PMPC grafting layer with a thickness of 100 nm was successfully fabricated on the vitamin E-blended CLPE surface by using photoinduced-radical graft polymerization. Since PMPC has a highly hydrophilic nature, the water wettability and lubricity of the PMPC-grafted CLPE and HD-CLPE(VE) surfaces were greater than that of the untreated CLPE surface. The PMPC grafting contributed significantly to wear reduction in a hip-joint simulator wear test. Despite high-dose gamma-ray irradiation for cross-linking and further UV irradiation for PMPC grafting, the substrate modified by vitamin E blending maintained high-oxidative stability because vitamin E is an extremely efficient radical scavenger. Furthermore, the mechanical properties of the substrate remained almost unchanged even after PMPC grafting or vitamin E blending, or both PMPC grafting and vitamin E blending. In conclusion, the PMPC-grafted HD-CLPE(VE) provided simultaneously high-wear resistance, oxidative stability, and mechanical properties. PMID:24836953
Kyomoto, Masayuki; Moro, Toru; Yamane, Shihori; Watanabe, Kenichi; Hashimoto, Masami; Takatori, Yoshio; Tanaka, Sakae; Ishihara, Kazuhiko
Mucopolysaccharidosis type II (MPS II or Hunter syndrome) is a rare, inherited disorder caused by deficiency of the lysosomal enzyme iduronate-2-sulfatase. As a result of this deficiency, glycosaminoglycans accumulate in lysosomes in many tissues, leading to progressive multisystemic disease. The cardiopulmonary and neurological problems associated with MPS II have received considerable attention. Orthopedic manifestations are common but not as well characterized. This study aimed to characterize the prevalence and severity of orthopedic manifestations of MPS II and to determine the relationship of these signs and symptoms with cardiovascular, pulmonary and central nervous system involvement. Orthopedic manifestations of MPS II were studied using cross-sectional data from the Hunter Outcome Survey (HOS). The HOS is a global, physician-led, multicenter observational database that collects information on the natural history of MPS II and the long-term safety and effectiveness of enzyme replacement therapy. As of January 2009, the HOS contained baseline data on joint range of motion in 124 males with MPS II. In total, 79% of patients had skeletal manifestations (median onset, 3.5 years) and 25% had abnormal gait (median onset, 5.4 years). Joint range of motion was restricted for all joints assessed (elbow, shoulder, hip, knee and ankle). Extension was the most severely affected movement: the exception to this was the shoulder. Surgery for orthopedic problems was rare. The presence of orthopedic manifestations was associated with the presence of central nervous system and pulmonary involvement, but not so clearly with cardiovascular involvement. Orthopedic interventions should be considered on an individual-patient basis. Although some orthopedic manifestations associated with MPS II may be managed routinely, a good knowledge of other concurrent organ system involvement is essential. A multidisciplinary approach is required.
Link, Bianca; de Camargo Pinto, Louise Lapagesse; Giugliani, Roberto; Wraith, James Edmond; Guffon, Nathalie; Eich, Elke; Beck, Michael
Few studies have examined the trajectory of recovery of executive function (EF) after mild TBI (mTBI). Therefore, consensus has not been reached on the incidence and extent of EF impairment after mTBI. The present study investigated trajectory of change in executive memory over 3 months after mTBI on 59 right-handed participants with mTBI, as defined by Centers for Disease Control criteria, ages 14-30 years, recruited within 96 hours post-injury and tested <1 week (baseline), 1 month, and 3 months after injury. Also included were 58 participants with orthopedic injury (OI) and 27 typically developing (TD) non-injured participants with similar age, socioeconomic status, sex, and ethnicity. MRI data were acquired at baseline and 3 months. Although criteria included a normal CT scan, lesions were detected by MRI in 19 mTBI patients. Participants completed the KeepTrack task, a verbal recall task placing demands on goal maintenance, semantic memory, and memory updating. Scores reflected items recalled and semantic categories maintained. The mTBI group was divided into two groups: high (score ?12) or low (score <12) symptoms based on the Rivermead Post-Concussion Symptoms Questionnaire (RPQ). Mixed model analyses revealed the trajectory of change in mTBI patients (high and low RPQ), OI patients, and TD subjects were similar over time (although the TD group differed from other groups at baseline), suggesting no recovery from mTBI up to 90 days. For categories maintained, differences in trajectory of recovery were discovered, with the OI comparison group surprisingly performing similar to those in the mTBI group with high RPQ symptoms, and different from low RPQ and the TD groups, bringing up questions about utility of OIs as a comparison group for mTBI. Patients with frontal lesions (on MRI) were also found to perform worse than those without lesions, a pattern that became more pronounced with time. PMID:23227898
Hanten, Gerri; Li, Xiaoqi; Ibarra, Alyssa; Wilde, Elisabeth A; Barnes, Amanda; McCauley, Stephen R; McCarthy, James; Hoxhaj, Shkelzen; Mendez, Donna; Hunter, Jill V; Levin, Harvey S; Smith, Douglas H
Bioactive ceramics bond to bone and enhance bone formation. However, they have poor mechanical properties which restrict their machinability as well as their application as load bearing implants. The goal of this study was to machine bioactive fixation screws using a silica-calcium phosphate nanocomposite (SCPC50). The effect of compact pressure, holding time, and thermal treatment on the microstructure, machinability, and mechanical properties of SCPC50 cylinders were investigated. Samples prepared by powder metallurgy technique at compact pressure range of 100-300 MPa and treated at 900°C/1 h scored a poor machinability rating of (1/5) due to the significant formation of amorphous silicate phase at the grain boundaries. On the other hand, lowering of compact pressure and sintering temperature to 30 MPa/3 h and 700°C/2 h, respectively, minimized the formation of the amorphous phase and raised the machinability rating to (5/5). The modulus of elasticity and ultimate strength of machinable SCPC50 were 10.8 ± 2.0 GPa and 72.8 ± 22.8 MPa, respectively, which are comparable to the corresponding values for adult human cortical bone. qRT-PCR analyses showed that bone cells attached to SCPC50 significantly upregulated osteocalcin mRNA expression as compared to the cells on Ti-6Al-4V. Moreover, cells attached to SCPC50 produced mineralized bone-like tissue within 8 days. On the other hand, cells attached to Ti-6Al-4V failed to produce bone mineral under the same experimental conditions. Results of the study suggest that machinable SCPC50 has the potential to serve as an attractive new material for orthopedic fixation devices. PMID:22692822
Sparnell, Amie; Aniket; El-Ghannam, Ahmed
Background Stereotype threat, defined as the predicament felt by people in either positive or negative learning experiences where they could conform to negative stereotypes associated with their own group membership, can interfere with learning. The purpose of this study was to determine if a simple orientation session could reduce stereotype threat for orthopedic residents. Methods The intervention group received an orientation on 2 occasions focusing on their possible responses to perceived poor performance in teaching rounds and the operating room (OR). Participants completed a survey with 7 questions typical for stereotype threat evaluating responses to their experiences. The questions had 7 response options with a maximum total score of 49, where higher scores indicated greater degree of experiences typical of stereotype threat. Results Of the 84 eligible residents, 49 participated: 22 in the nonintervention and 27 in the intervention group. The overall scores were 29 and 29.4, and 26.2 and 25.8 in the nonintervention and intervention groups for their survey responses to perceived poor performance in teaching rounds (p = 0.85) and the OR (p = 0.84), respectively. Overall, responses typical of stereotype threat were greater for perceived poor performance at teaching rounds than in the OR (p = 0.001). Conclusion Residents experience low self-esteem following perceived poor performance, particularly at rounds. A simple orientation designed to reduce stereotype threat was unsuccessful in reducing this threat overall. Future research will need to consider longer-term intervention as possible strategies to reduce perceived poor performance at teaching rounds and in the OR.
Gomez, Everlyne; Wright, James G.
A case of Larsen's syndrome in a boy is presented. The syndrome is characterized by flattened facies, multiple congenital dislocations and foot deformities as a result of connective tissue maldevelopment during gestation. The importance of early intensive conservative therapy is emphasized. In the case reported, conservative therapy led, in the first stage, to the management of subluxation of both hips and improvement in left foot position and in the state of both knees. Subsequently, dislocations of the right and the left knee joint were surgically treated at 16 and 20 months, respectively, by reduction and transfixation with Kirschner's wires according to Niebauer and King. After six weeks of plaster immobilization, the wires were removed and the knee position was corrected with laminate splints. The authors point out that the syndrome is often associated with cardiovascular anomalies. Although these were not present in the case reported, due to the repeated occurrence of pericardial exudates from 2 years of the child' age, it was not possible to manage his left foot (pes equinovarus) surgically earlier than at 36 months. For that procedure, the method of posteroplantar release was used. The authors also discuss the occurrence of vertebral anomalies in Larsen's syndrome that may lead to cervical kyphosis and, potentially, to cervical spine instability. In our case, the signs of kyphosis were observed in the C1-C3 region but magnetic resonance imaging did not show any signs of either myelopathy or narrowing of the spinal canal. The intensive conservative and surgical treatment with subsequent thorough rehabilitation enabled the patient to stand up and walk without any support or orthotics. The fact that the boy was able to integrate in healthy children's playgroups can be considered a great achievement of orthopedic therapy. PMID:12807046
Schejbalová, A; Trc, T
Cerclage cables have proven to be very useful in the orthopedic field for bones stabilization and plate fixation but the initial enthusiasm for metallic cables has declined with their high complication rates. Metal materials provide limited elastic deformation compromising their ability to maintain compression. This study compares the mechanical properties of new elastic cables with cobalt-chrome and stainless-steel cables. Methods: Stainless-steel, cobalt-chrome, nylon and nickel-titanium cables were first loaded up to 356 N, then elongation was maintained for 12 hours, next unloaded and finally reloaded to failure. Initial elongation (%), Relative force relaxation (% loss of initial load after a 12h), elastic springback (%) and force to failure (N) were extracted from force-elongation curves. Findings: Initial elongation was the highest for nylon cables (9%), followed by the nickel-titanium (4%) and both metallic cables (0.3%). During 12 hours, no relaxation was observed for the nickel-titanium and the cobalt-chrome cables, whereas 28 and 45% of the tension was lost respectively for the stainless-steel and the nylon cables. The elastic springback of the nickel-titanium and nylon cables (4.4 and 4.7% respectively) was 20 times higher than that of the stainless-steel and cobalt-chrome cables (0.12 and 0.16% respectively). The force to failure of the stainless steel and cobalt-chrome cables was twice that of the nickel-titanium cables. Interpretation: Multi-braided stainless-steel and cobalt-chrome cables have a high-stiffness with limited ability to tolerate displacement, leading to early cable loosening. Novel low-stiffness cables made of nylon or nickel-titanium offer significant elastic springback improving binding stability. PMID:22255648
Canet, Fanny; Baril, Yannick; Brailovski, Vladimir; Petit, Yvan; Bissonnette, Guillaume; Laflamme, G-Yves
Abstract Few studies have examined the trajectory of recovery of executive function (EF) after mild TBI (mTBI). Therefore, consensus has not been reached on the incidence and extent of EF impairment after mTBI. The present study investigated trajectory of change in executive memory over 3 months after mTBI on 59 right-handed participants with mTBI, as defined by Centers for Disease Control criteria, ages 14–30 years, recruited within 96 hours post-injury and tested <1 week (baseline), 1 month, and 3 months after injury. Also included were 58 participants with orthopedic injury (OI) and 27 typically developing (TD) non-injured participants with similar age, socioeconomic status, sex, and ethnicity. MRI data were acquired at baseline and 3 months. Although criteria included a normal CT scan, lesions were detected by MRI in 19 mTBI patients. Participants completed the KeepTrack task, a verbal recall task placing demands on goal maintenance, semantic memory, and memory updating. Scores reflected items recalled and semantic categories maintained. The mTBI group was divided into two groups: high (score ?12) or low (score <12) symptoms based on the Rivermead Post-Concussion Symptoms Questionnaire (RPQ). Mixed model analyses revealed the trajectory of change in mTBI patients (high and low RPQ), OI patients, and TD subjects were similar over time (although the TD group differed from other groups at baseline), suggesting no recovery from mTBI up to 90 days. For categories maintained, differences in trajectory of recovery were discovered, with the OI comparison group surprisingly performing similar to those in the mTBI group with high RPQ symptoms, and different from low RPQ and the TD groups, bringing up questions about utility of OIs as a comparison group for mTBI. Patients with frontal lesions (on MRI) were also found to perform worse than those without lesions, a pattern that became more pronounced with time.
Li, Xiaoqi; Ibarra, Alyssa; Wilde, Elisabeth A.; Barnes, Amanda; McCauley, Stephen R.; McCarthy, James; Hoxhaj, Shkelzen; Mendez, Donna; Hunter, Jill V.; Levin, Harvey S.; Smith, Douglas H.
The corrosion behavior of combinations of materials used in an orthopedic implant: the spherical part (forged or forged and annealed) constituting the head, the weld (tungsten inert gas (TIG) or electron beam (EB) techniques), and the cylindrical part (annealed) constituting the shaft of a femoral prosthesis - has been investigated. Open-circuit potentials, potentiodynamic curves, Tafel slope, mixed potential theory and susceptibility to intergranular attack are electrochemical and chemical procedures selected for this work. Electrochemical measurements using a microelectrode have been made in the following zones: spherical part, cylindrical part, weld, and weld/sphere, and weld/shaft interfaces. To detect intergranular attack, the Strauss test has been used. At the interfaces, corrosion currents, measured (Icorr) and predicted (Icouple) are low, in the order of the pico- to nanoampere. The electrochemical behavior of the electron beam (EB) weld is better than that of the tungsten inert gas (TIG). Welds at interfaces can behave either anodically or cathodically. It is better if welds, which are sensitive parts of the femoral prosthesis, behave cathodically. In this way, the risk of starting localized corrosion (pitting, crevice or intergranular corrosion) from a galvanic couple, remains low. From this point of view, the sample with the EB weld offers the best behavior. All the other samples containing a TIG type of weld exhibit a less favorable behavior. The mechanical treatments (forged, and forged and annealed) of the steel sphere did not show any difference in the corrosion behavior. No intergranular corrosion has been observed at the weld/steel interface for unsensitized samples. With sensitized samples, however, a TIG sample has exhibited some localized intergranular corrosion at a distance of 500 microm along the weld/stainless steel (sphere) interface. PMID:11197502
Reclaru, L; Lerf, R; Eschler, P Y; Meyer, J M
The method of camera-space manipulation is extended to wheeled systems. A minimum of two cameras is required to place points on end-effectors (or objects in their grasp) of n-degree-of-freedom manipulators relative to other bodies where the nonholonomic degrees of freedom on a mobile manipulator base may be included. The target bodies do not have a precisely known location relative to
Steven B. Skaar; Issac Yalda-Mooshabad; William H. Brockman
Recently we presented how Camponotus ants in Thailand infected with the fungus Ophiocordyceps unilateralis are behaviorally manipulated into dying where the conditions are optimal for fungal development. Death incurred in a very narrow zone of space and here we compare this highly specific manipulation with a related system in Brazil. We show that the behavioral manipulation is less fine-tuned and discuss the potential explanations for this by examining differences in ant host and environmental characteristics.
Pain is a common symptom in orthopedic patients, but is managed sub-optimally, partly due to scarce opioid use in severe cases. The aim of the Orthopedic Instant Pain Survey (POIS) was to evaluate changes in pain management in Italian orthopedic practice 2 years after a legislative change (Law 38/2010) simplifying opioid access for pain control. A web-based survey on the knowledge of this law and trends observed in clinical practice for severe pain treatment was administered to 143 Italian orthopedic specialists. In total, 101 (70%) respondents showed a high level of knowledge. Nevertheless, 54.5% stated that they do not use opioids for severe osteo-articular pain management. Main barriers to opioid use are fear of adverse events (61.4%), especially nausea/vomiting and constipation, and patient resistance (29.7%). A modest knowledge of pain classification was also demonstrated. Opioid use remains very limited in Italian orthopedic practice. Physicians’ fear of side effects showed poor knowledge of strategies for effective management of opioid-related adverse events, such as combined oral prolonged-release oxycodone/naloxone. Continuing educational programs could improve delivery of evidence-based pain management.
Fanelli, Guido; Cherubino, Paolo; Compagnone, Christian
The international strategies in the treatment of rheumatic diseases have changed dramatically in the last 10 years. In addition to the prescription of a basic medication as soon as possible, biologics are increasingly being used for drug treatment of rheumatic diseases in Germany. The domains of orthopedic surgeons and orthopedic rheumatologists are still the extended conservative and surgical treatment of inflammatory systemic diseases, which continue to play an important role despite the improved drug therapy options. Orthopedic surgeons should principally be familiar with the use of antirheumatic drugs, especially with respect to the perioperative management. However, there is also a role for the orthopedic surgeon in the early detection of inflammatory systemic diseases and in cooperation with rheumatologists in the medicinal treatment of selected diseases. Because patients with initial stages of joint pain, e.g. from rheumatoid arthritis (RA), spondyloarthritis (SpA) or psoriatic arthropathy often present first to an orthopedic surgeon, recognition of the early stages by the primary treating physician, including the necessary rapid induction of drug therapy is especially important. In addition there is a shortage of internist rheumatologists in Germany so that selective referral and close cooperation between the two physicians become of great importance. PMID:24891252
Rehart, S; Henniger, M
Introduction. Pompe disease (PD), a lysosomal storage disease as well as a neuromuscular disorder, is a rare disease marked by progressive muscle weakness. Enzyme replacement therapy (ERT) in recent years allowed longer survival but brought new problems to the treatment of PD with increasing affection of the musculoskeletal system, particularly with a significantly higher prevalence of scoliosis. The present paper deals with the orthopedic problems in patients with PD and is the first to describe surgical treatment of scoliosis in PD patients. Patients and Methods. The orthopedic problems and treatment of eight patients with PD from orthopedic consultation for neuromuscular disorders are retrospectively presented. We analyzed the problems of scoliosis, hip dysplasia, feet deformities, and contractures and presented the orthopedic treatment options. Results. Six of our eight PD patients had scoliosis and two young patients were treated by operative spine stabilization with benefits for posture and sitting ability. Hip joint surgery, operative contracture release, and feet deformity correction were performed with benefits for independent activity. Conclusion. Orthopedic management gains importance due to extended survival and musculoskeletal involvement under ERT. Surgical treatment is indicated in distinct cases. Further investigation is required to evidence the effect of surgical spine stabilization in PD.
Forst, Jurgen; Forst, Raimund
A device for manipulating a workpiece in space includes a fixture, a stanchion assembly, a manipulation mechanism, an actuation mechanism, and a reaction mechanism. The fixture has an end onto which the workpiece affixes. The stanchion assembly has an upper and a lower end. The manipulation mechanism connects the fixture and the upper end of the stanchion assembly. The lower end of the stanchion assembly mounts, via probe and a socket, to a structure. The actuation mechanism operably connects to the manipulation mechanism, and moves the fixture in space. The reaction mechanism provides a point through which force inputs into the actuation mechanism may react.
Moetteli, John B. (Inventor)
Discusses figurate number learning activities using patterns and manipulative models. Provides examples of square numbers, triangular numbers, pentagonal numbers, hexagonal numbers, and oblong numbers. (YP)
Robold, Alice I.
An advanced servo manipulator has modular parts. Modular motor members drive individual input gears to control shoulder roll, shoulder pitch, elbow pitch, wrist yaw, wrist pitch, wrist roll, and tong spacing. The modules include a support member, a shoulder module for controlling shoulder roll, and a sleeve module attached to the shoulder module in fixed relation thereto. The shoulder roll sleeve module has an inner cylindrical member rotatable relative to the outer cylindrical member, and upon which a gear pod assembly is mounted. A plurality of shafts are driven by the gears, which are in turn driven by individual motor modules to transmit rotary power to control elbow pitch as well as to provide four different rotary shafts across the bendable elbow joint to supply rotary motive power to a wrist member and tong member. 41 figs.
Holt, W.E.; Kuban, D.P.; Martin, H.L.
An advanced servo manipulator has modular parts. Modular motor members drive individual input gears to control shoulder roll, shoulder pitch, elbow pitch, wrist yaw, wrist pitch, wrist roll, and tong spacing. The modules include a support member, a shoulder module for controlling shoulder roll, and a sleeve module attached to the shoulder module in fixed relation thereto. The shoulder roll sleeve module has an inner cylindrical member rotatable relative to the outer cylindrical member, and upon which a gear pod assembly is mounted. A plurality of shafts are driven by the gears, which are in turn driven by individual motor modules to transmit rotary power to control elbow pitch as well as to provide four different rotary shafts across the bendable elbow joint to supply rotary motive power to a wrist member and tong member.
Holt, William E. (Knoxville, TN); Kuban, Daniel P. (Oak Ridge, TN); Martin, H. Lee (Knoxville, TN)
Apparatus for manipulating a vacuum hose in a reactor vessel comprises a housing with two opposing openings, an arm carried by the housing and deployable from a stowed position essentially completely within the housing to an extended position where the arm extends through the two openings in a generally horizontal position. The arm preferably has a two-fingered gripping device for gripping the vacuum hose but may carry a different end effector such as a grinding wheel. The fingers are opened and closed by one air cylinder. A second air cylinder extends the device. A third air cylinder within the housing pivotally pulls the opposing end of the arm into the housing via a pivoting member pivotally connected between the third air cylinder shaft and the arm. 6 figures.
Apparatus for manipulating a vacuum hose in a reactor vessel comprises a housing with two opposing openings, an arm carried by the housing and deployable from a stowed position essentially completely within the housing to an extended position where the arm extends through the two openings in a generally horizontal position. The arm preferably has a two-fingered gripping device for gripping the vacuum hose but may carry a different end effector such as a grinding wheel. The fingers are opened and closed by one air cylinder. A second air cylinder extends the device. A third air cylinder within the housing pivotally pulls the opposing end of the arm into the housing via a pivoting member pivotally connected between the third air cylinder shaft and the arm.
Zollinger, William T. (3927 Almon Dr., Martinez, GA 30907)
Fluids are difficult to manage in the space environment. Without gravity, the liquid and gas do not always remain separated as they do in the 1g environment of Earth. Instead the liquid and gas volumes mix and migrate under the influence of surface tension, thermodynamic forces, and external disturbances. As a result, liquid propellants may not be in a useable location or may even form a chaotic mix of liquid and gas bubbles. In the past, mechanical pumps, baffles, and a variety of specialized passive devices have been used to control the liquid and gas volumes. These methods need to be carefully tuned to a specific configuration to be effective. With increasing emphasis on long-term human activity in space there is a trend toward liquid systems that are more flexible and provide greater control. We are exploring new methods of manipulating liquids by using the nonlinear acoustic effects achieved by using beams of highly directed high-intensity acoustic waves.
Oeftering, Richard C.; Chato, David J.; Mann, Adin, III
A new definition of grasping and manipulating forces for multifingered robot hands is proposed. First, a short discussion of the grasping and manipulating forces for two-fingered hands with linear motion is given to explain the motivation more clearly and to give the basic idea of the new definition. Then, for three-fingered hands, based on a representation of the internal force,
Tsuneo Yoshikawa; Kiyoshi Nagai
Osteoporosis is a common condition. As the population ages, more patients with osteoporosis will require orthopedic procedures, including arthroplasty. Adverse outcomes are more likely for patients with osteoporosis requiring orthopedic procedures, for example those with intraoperative fractures, periprosthetic osteolysis with implant migration, and postoperative periprosthetic fractures. Cemented prosthetic hip replacements may be more successful among patients with poor bone quality. Femoral neck fracture is a concern during hip resurfacing among patients with osteoporosis. Vitamin D deficiency is common among patients undergoing joint arthroplasty and the ideal vitamin D level for joint arthroplasty has yet to be determined. Both bisphosphonates and teriparatide may aide successful osteointegration among patients undergoing noncemented joint arthroplasty. Focusing on bone health perioperatively should result in better outcomes for orthopedic procedures. PMID:24085661
Russell, Linda A
ProteinShop Gives Researchers a Hands-On Tool for Manipulating, Visualizing Protein Structures. The Human Genome Project and other biological research efforts are creating an avalanche of new data about the chemical makeup and genetic codes of living organisms. But in order to make sense of this raw data, researchers need software tools which let them explore and model data in a more intuitive fashion. With this in mind, researchers at Lawrence Berkeley National Laboratory and the University of California, Davis, have developed ProteinShop, a visualization and modeling program which allows researchers to manipulate protein structures with pinpoint control, guided in large part by their own biological and experimental instincts. Biologists have spent the last half century trying to unravel the ''protein folding problem,'' which refers to the way chains of amino acids physically fold themselves into three-dimensional proteins. This final shape, which resembles a crumpled ribbon or piece of origami, is what determines how the protein functions and translates genetic information. Understanding and modeling this geometrically complex formation is no easy matter. ProteinShop takes a given sequence of amino acids and uses visualization guides to help generate predictions about the secondary structures, identifying alpha helices and flat beta strands, and the coil regions that bind them. Once secondary structures are in place, researchers can twist and turn these pre-configurations until they come up with a number of possible tertiary structure conformations. In turn, these are fed into a computationally intensive optimization procedure that tries to find the final, three-dimensional protein structure. Most importantly, ProteinShop allows users to add human knowledge and intuition to the protein structure prediction process, thus bypassing bad configurations that would otherwise be fruitless for optimization. This saves compute cycles and accelerates the entire process, so that more and larger problems can be attempted. Currently, the program designers are working to make ProteinShop more applicable and adaptable to different protein folding methodologies. If users could manipulate structures from a biological point of view, and then put them back in the queue for more optimization, the process of experimentation and discovery in protein research could be greatly enhanced. The group is also investigating the use of stereoscopic rendering and three-dimensional input devices to remove the limitations of a two-dimensional interface. Clearly, protein-folding research will have far-reaching ramifications. It could lead to new insights about diseases ranging from Alzheimer's to Cystic fibrosis, which scientists believe are caused by protein folding gone wrong. A better understanding of protein structures could also lead to the engineering of altogether new proteins, and shed light on how drugs bind proteins to alter their structure and function. Above all, ProteinShop is an important tool that will help scientists unravel one of the most challenging problems that theoretical and computational chemistry has to offer.
Simon, Horst D.
The images of photography have been manipulated almost from the moment of their discovery. The blending together in the studio and darkroom of images not found in actual scenes from life has been a regular feature of modern photography in both art and advertising. Techniques of photograph manipulation include retouching; blocking out figures or…
Sutton, Ronald E.
As residents and medical students progress through their medical training, they are presented with multiple instances in which they feel they must manipulate the healthcare system and deceive others in order to efficiently treat their patients. This, however, creates a culture of manipulation resulting in untoward effects on trainees' ethical and…
Dailey, Jason I.
Using data from 503 inservice elementary teachers, this study investigated the relationship between teachers' background characteristics, teachers' beliefs about manipulatives, and the frequency with which teachers use manipulatives as part of their mathematics instruction. Findings from the study show that teachers' grade level and beliefs about…
Uribe-Florez, Lida J.; Wilkins, Jesse L. M.
I have argued that early human embryos are not human beings, and do not have normal rights. Like human sperm and ova, they are both alive and biologically human. However, they lack the physiological development necessary to sustain a capacity for sentience. If Ford is right, then they are not yet individual human organisms. But the more important point is that their lack of a capacity for sentience makes them inappropriate candidates for the ascription of moral rights. Thus, research on human embryos produced in vitro is not a wrong against them--at least so long as experimentally manipulated embryos are not returned to the womb, or artificially gestated to a stage at which they might become sentient. Some of the more difficult issues about embryo experimentation involve the rights of women as experimental subject and donors. The consent of both male and female gamete donors should normally be required for the production or experimental use of IVF embryos. (Possible exceptions might include cases in which one or both progenitors have died, and the survivor or other responsible family member wished to donate the (frozen) IVF embryos for research or other uses.) However, it is women's rights that are most apt to be endangered, for example, if the large scale therapeutic or commercial use of human embryos leads to a demand for large numbers of ova. Thus, it is vital that researchers and policy-makers heed feminist concerns about embryo research and the new biomedical technologies it may yield. Given adequate information and appropriate procedural protections, women are capable of making autonomous decisions about donating ova or embryos for biomedical research. But regulatory safeguards are needed to ensure against their being coerced, deceived, or manipulated into becoming ovum or embryo donors. As Daniel Callahan has detailed, biomedical technology has reached the point where we can no longer afford to provide everyone with all of the innovative therapies that might prove beneficial (Callahan, 1989, p 523). Thus, questions about the just and cost-effective distribution of medical resources will become increasingly difficult and important. Among these questions will be whether it is wise or just to invest large sums in the development of innovative methods of assisting human reproduction. We must also consider the interests of future persons who may suffer because of the methods used to bring them into existence.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:1954730
Warren, M A
Pedal macrodactyly is a rare clinical entity that poses a challenge to practicing pediatric orthopedic surgeons. Many treatment options have been proposed. In 1967, Kenya Tsuge proposed a method to decrease the length, width, and circumference of a macrodactylous digit, while maintaining the cosmetic benefit of keeping the nail. We retrospectively reviewed our experience with using this technique in four children (six toes) over a 4-year period. The surgery is described and our results reviewed. We believe that the Tsuge procedure is a technically feasible, effective, single-stage reconstructive technique for pedal macrodactyly that pediatric orthopedic surgeons should have in their armamentarium. PMID:24598536
Morrell, Nathan T; Fitzpatrick, Jennifer; Szalay, Elizabeth A
Up to 20% of all patients with pectoral symptoms have an underlying orthopedic problem. The most common orthopedic conditions that may mimic chest pain radiating into the left arm include slipped disc, cervicothoracic tension syndrome, blockage of intervertebral or rib joints, and intercostal neuralgia. Less common causes of such pain are arthrosis of the shoulder, spondylocystitis, osteoporotic fractures or tumors of the bone. Management is oriented to the underlying cause, and treatment extends from physiotherapeutic measures (rest, heat treatment) via medication (non-steroidal anti-inflammatory drugs, myotonolytic agents) to operative interventions. PMID:12048845
A low power IC of the Wireless Monitoring System of the Orthopedic Implants (WMSoOI) is put forth. The analog-digital mix-mode system monitors the implant duty cycle, detects abnormal asymmetry, wear, and high amounts of force, and other conditions of the orthopedic implants. Data for diagnosis is communicated wirelessly between the embedded chip (inside body) and the remote circuit (outside body). The Radio Frequency (RF) circuits have been taped out and tested. The power circuit is presented and verified by simulation. Future work includes the test of circuits of Analog Digital Converter (ADC) and Micro control Unit (MCU) and the integrating of the entire system. PMID:18003323
Chen, Hong; Liu, Ming; Jia, Chen; Zhang, Chun; Wang, Zhihua
Objective: To study the relationship between postoperative infectious complications and glycemic control for diabetic patients in an orthopedic hospital in Kuwait. Subjects and Methods: Patients who underwent surgical orthopedic procedures between 2006 and 2007 were identified to provide demographic and clinical informations including age, gender, type of surgery, length of operation, HbA1c values, nature of specimens and species of the
S. M. Lamloum; L. A. Mobasher; A. H. Karar; L. Basiony; T. H. Abdallah; A. I. Al-Saleh; N. A. Al-Shamali
Advanced teleoperators are discussed, with emphasis on the remote manipulation system designed to perform such actions as grasping, orienting, moving, placing, and inserting objects. Geometrical performance dimensions are considered, indicating that a manipulator is limited to three-orders-of-magnitude ratio of workspace extension to positioning accuracy. The control system is examined, showing that a manipulative task requires coordination of several joints, with the relationship between the task definers and the joint variables given by complex trigonometrical transformations. Control modes developed in the last 30 years are noted, including program controlled industrial 'robots' which can endlessly repeat a fixed sequence of motions without operator intervention, and the sensor-referenced/computer-controlled mode manipulators. Advanced proximity sensor systems are taken into account, with emphasis on the applications of the force-torque and slip models. The proximity sensor system for the shuttle-size manipulator is described.
Bejczy, A. K.
Continuum manipulators, inspired by the natural capabilities of elephant trunks and octopus tentacles, may find niche applications in areas like human-robot interaction, multiarm manipulation, and unknown environment exploration. However, their true capabilities will remain largely inaccessible without proper analytical tools to evaluate their unique properties. Ellipsoids have long served as one of the foremost analytical tools available to the robotics researcher, and the purpose of this paper is to first formulate, and then to examine, three types of ellipsoids for continuum robots: manipulability, force, and compliance.
Gravagne, Ian A.; Walker, Ian D.
Perhaps the most basic barrier to the widespread deployment of remote manipulators is that they are very difficult to use. Remote manual operations are fatiguing and tedious, while fully autonomous systems are seldom able to function in changing and unstructured environments. An alternative approach to these extremes is to exploit computer control while leaving the operator in the loop to take advantage of the operator's perceptual and decision-making capabilities. This report describes research that is enabling gradual introduction of computer control and decision making into operator-supervised robotic manipulation systems, and its integration on a commercially available, manually controlled mobile manipulator.
HARRIGAN, RAYMOND W.; BENNETT, PHIL C.
Background The burden of chronic kidney disease (CKD) is a growing concern worldwide. The prevalence of hemodialysis in Taiwan is the highest in the world, and this may increase the prevalence of orthopedic fractures. The aim of this study was to explore the incidences of various orthopedic injuries and the related risk factors. Methods A nationwide prospective study based on the Taiwan National Health Insurance dataset was conducted during 2004–2008. A total of 82,491 CKD patients were selected as the fixed cohort population. The International Classification of Diseases 9-CM diagnosis codes and treatment codes were identified as the inclusion criteria for orthopedic injury. Results A total of 82,491 Taiwanese people with CKD were identified in 2004, and 4915 orthopedic injuries occurred during the 5-year follow-up period. The cumulative incidences of orthopedic injuries were 42.56‰ for lower limb fractures, and 12.93‰, 3.27‰, and 1.64‰ for upper limb fractures, vertebrae fractures, and joint dislocations, respectively. All three types of orthopedic fractures were more common in the oldest age stratum (?65 years old). In the CKD patients, the risk ratio of osteoporosis was 3.47 (95% confidence interval, 3.10–3.89) for all orthopedic injuries. Patients of advanced age, the female gender, and those with high comorbidity were also at significant risk of sustaining orthopedic fractures. Conclusion The results from this Taiwanese CKD cohort support the strong influence of aging and osteoporosis on all kinds of orthopedic injuries. The postponing of osteoporosis may need to be taken into consideration for the prevention of orthopedic injury among CKD patients undergoing hemodialysis.
Chang, Nien-Tzu; Lee, Yi-Hui; Hsu, Jiin-Chyr; Chan, Chien-Lung; Huang, Guey-Shiun; Renn, Jenn-Huei; Yang, Nan-Ping
Virtual Reality interfaces offer several advantages for scientific visualization such as the ability to perceive three-dimensional data structures in a natural way. The focus of this chapter is direct manipulation, the ability for a user in virtual reality to control objects in the virtual environment in a direct and natural way, much as objects are manipulated in the real world. Direct manipulation provides many advantages for the exploration of complex, multi-dimensional data sets, by allowing the investigator the ability to intuitively explore the data environment. Because direct manipulation is essentially a control interface, it is better suited for the exploration and analysis of a data set than for the publishing or communication of features found in that data set. Thus direct manipulation is most relevant to the analysis of complex data that fills a volume of three-dimensional space, such as a fluid flow data set. Direct manipulation allows the intuitive exploration of that data, which facilitates the discovery of data features that would be difficult to find using more conventional visualization methods. Using a direct manipulation interface in virtual reality, an investigator can, for example, move a data probe about in space, watching the results and getting a sense of how the data varies within its spatial volume.
A versatile line manipulator which is capable of achieving various data manipulating functions is described. This manipulator design is particularly attractive in applications requiring extensive spacing functions and/or operations for non 2's power set o...
Between 1970 and 1984, 31 children with biopsy-proven Wilms' tumor received nephrectomy, chemotherapy, and abdominal irradiation and were followed beyond skeletal maturity. Three patients (10%) developed late orthopedic abnormalities requiring intervention. Ten children received orthovoltage irradiation, and all cases requiring orthopedic intervention or developing a scoliotic curve of greater than 20 degrees were confined to this group, for a complication frequency of 50%. Those children who developed a significant late orthopedic abnormality (SLOA) as defined were treated to a higher median dose (2,890 cGy) and a larger field size (150 cm2) than those who did not (2,580 cGy and 120 cm2). Age at irradiation, sex, and initial stage of disease did not appear to influence the risk of developing an SLOA. No child who received megavoltage irradiation developed an SLOA despite treatment up to 4,000 cGy or to field sizes of 400 cm2. We conclude that modern radiotherapy techniques rarely lead to significant late orthopedic abnormalities previously associated with abdominal irradiation in children with Wilms' tumor.
Rate, W.R.; Butler, M.S.; Robertson, W.W. Jr.; D'Angio, G.J. (Univ. of Pennsylvania School of Medicine, Philadelphia (USA))
Current orthopedic implants have several problems that include poor osseointegration for extended periods of time, stress shielding and wear debris-associated bone cell death. In addition, numerous patients receive orthopedic implants as a result of bone cancer resection, yet current orthopedic materials were not designed to prevent either the occurrence or reoccurrence of cancer. The objective of this in vitro study was to create a new biomaterial which can both restore bone and prevent cancer growth at the implant-tissue interface. Elemental selenium was chosen as the biologically active agent in this study because of its known chemopreventive and chemotherapeutic properties. It was found that when selenite salts were reduced by glutathione in the presence of an immersed titanium substrate, elemental selenium nucleated and grew into adherent, hemispherical nanoclusters that formed a nanostructured composite surface. Three types of surfaces with different selenium surface densities on titanium were fabricated and confirmed by SEM images, AFM, and XPS profiles. Compared to conventional untreated titanium, a high-density selenium-doped surface inhibited cancerous bone cell proliferation while promoting healthy bone cell functions (including adhesion, proliferation, alkaline phosphatase activity and calcium deposition). These findings showed for the first time the potential of selenium nanoclusters as a chemopreventive titanium orthopedic material coating that can also promote healthy bone cell functions. PMID:19918919
Tran, Phong A; Sarin, Love; Hurt, Robert H; Webster, Thomas J
The design process for medical devices is highly regulated to ensure the safety of patients. This paper will present a review of the design process for implantable orthopedic medical devices. It will cover the main stages of feasibility, design reviews, design, design verification, manufacture, design validation, design transfer and design changes.
Aitchison, G.A; Hukins, D.W.L; Parry, J.J; Shepherd, D.E.T; Trotman, S.G
Realistic modeling of soft tissue deformation is crucial to virtual orthopedic surgery, especially orthopedic trauma surgery which involves layered heterogeneous soft tissues. In this paper, a novel modeling framework for multilayered soft tissue deformation is proposed in order to facilitate the development of orthopedic surgery simulators. We construct our deformable model according to the layered structure of real human organs, and this results in a multilayered model. The division of layers is based on the segmented Chinese Visible Human (CVH) dataset. This enhances the realism and accuracy in the simulation. For the sake of efficiency, we employ 3D mass-spring system to our multilayered model. The nonlinear passive biomechanical properties of skin and skeletal muscle are achieved by introducing a bilinear elasticity scheme to the springs in the mass-spring system. To efficiently and accurately reproduce the biomechanical properties of certain human tissues, an optimization approach is employed in configuring the parameters of the springs. Experimental data from biomechanics literatures are used as benchmarking references. With the employment of Physics Processing Unit (PPU) and high quality volume visualization, our framework is developed into an interactive and intuitive platform for virtual surgery training systems. Several experiments demonstrate the feasibility of the proposed framework in providing interactive and realistic deformation for orthopedic surgery simulation. PMID:20503610
Qin, Jing; Pang, Wai-Man; Chui, Yim-Pan; Wong, Tien-Tsin; Heng, Pheng-Ann
The resection of a bone segment by a malign bone tumor in modern orthopedic oncology is possible to be recon- structed using massive allograft or massive endoprosthesis plus adjuvant therapy. The difficulties to get massive allograft lead us to use massive endoprosthesis mostly. The bone segments where we have been able to make a reconstruction has been: femur, proximal humerus,
The putpose of this qualitative case study was to further investigate the work of muster and nouice clinicians within the practice setting. The sample consisted of three master clinicians and three novice clinicians practicing in orthopedic outpa- tient physical therapy settings in three dz&-ent regions of the United States. Data collection by three researchers included observation of each clinician treating
Gall M Jensen; Katherine F Shepard; Jan Gwyer; Laurlta M Hack
There are more than 30,000 orthopedic implant revision surgeries necessary each year in part due to poor implant fixation with juxtaposed bone. A further emphasis on the current problems associated with insufficient bone implant performance is the fact that many patients are receiving hip implants earlier in life, remaining active older, and that the human lifespan is continuously increasing. Collectively, it is clear that there is a strong clinical need to improve implant performance through proper, prolonged fixation. For these reasons, the objective of the present in vitro study was to improve the performance of titanium (Ti), one of the most popular orthopedic implant materials. Accordingly, the proliferative response of osteoblasts (bone-forming cells) on novel nanostructured Ti/PLGA (poly-lactic-co-glycolic acid) composites was examined. This study showed that nano-topography can be easily applied to Ti (through anodization) and porous PLGA (through NaOH chemical etching) to enhance osteoblast cell proliferation which may lead to better orthopedic implant performance. This straight forward application of nano-topography on current bone implant materials represents a new direction in the design of enhanced biomaterials for the orthopedic industry. PMID:18019847
Smith, Lester J; Swaim, John S; Yao, Chang; Haberstroh, Karen M; Nauman, Eric A; Webster, Thomas J
Purpose Hospitalists specialize in the management of hospitalized patients. They work with several health care professionals to provide patient care. There has been little research examining the perceived impact of the hospitalist’s role on staff working in an orthopedic environment. This study examined the experiences of staff across several professional backgrounds in working with a hospitalist in an orthopedic environment. Participants and methods A qualitative descriptive approach was taken to investigate the experience of staff working with a hospitalist at a specialized orthopedic hospital. Purposive sampling was used to recruit interview participants including nurses, internists, pharmacists, physiotherapists, anesthetists, senior administration, and orthopedic surgeons to the point of theoretical saturation, which occurred after 12 interviews. Interviews were coded, and these codes were combined into categories and predominant themes were identified. Findings Overall, staff believed that the hospitalist role was a positive addition to the facility. The role benefitted patients and supported the clinical well-being and education of staff. Many staff felt the hospitalist had no impact on their workload, but others reported that their work had decreased or increased. Several described the potential for role overlap between the hospitalist and other physicians. Conclusion The importance of interprofessional collaboration in the implementation of the hospitalist role was a recurring theme in our analysis. This study demonstrates the importance of educating staff about the hospitalist role boundaries prior to implementing hospitalist care.
Webster, Fiona; Bremner, Samantha; Jackson, Megan; Bansal, Vikas; Sale, Joanna
Over the last 15 years, with the advent of modern standards in the control of sterility within the operating room environment and adequate protocols of peri-operative antibiotic prophylaxis, the incidence of infections associated to orthopedic implants has become very low. Nevertheless, the event of infection still represents one of the most serious and devastating complications which may involve prosthetic devices.
Davide Campoccia; Lucio Montanaro; Carla Renata Arciola
Background: Despite antibiotic prophylaxis and treatment, the incidence of wound infections in orthopedic surgery is significant. Postoperative wound infection is a multifactorial process, which can be modified by several bacterial factors. Cell surface hydrophobicity of bacteria is a very important physicochemical feature, which has a great influence on the ability of bacteria to adhere to the surface of host cells
Tamás Kustos; Ildikó Kustos; Ferenc Kilár; Gábor Rappai; Béla Kocsis
Active learning is a teaching methodology with a focus on student-centered learning that engages students in the educational process. This study implemented active learning techniques in an orthopedic assessment laboratory, and the effects of these teaching techniques. Mean scores from written exams, practical exams, and final course evaluations…
Nottingham, Sara; Verscheure, Susan
Rural American residents prefer to receive their medical care locally. Lack of specific medical services in the local community necessitates travel to a larger center which is less favorable. This study was done to identify how rural hospitals choose to provide orthopedic surgical services to their communities. Methods: All hospitals in 5 states…
The project was a joint research effort between the U. S. Department of Energy's (DOE) Kansas City Plant (KCP) and Brandon Research, Inc. to develop ways to improve implants used for orthopedic surgery for joint replacement. The primary product produced b...
W. R. Freeman
The use of methyl methacrylate (MMA) bone cement during orthopedic procedures has been seen as a potential exposure hazard to health care professionals. However, that assessment is based on a number of investigations with problems in experimental design, analysis, and data inter- pretation. The current investigation quantified differences in MMA vapors produced during the preparation of competing bone cements using
Leslie J. Ungers; Timothy G. Vendrely; C. Lowry Barnes
The orthodontic and orthopedic effects of the Activator, Activator-Headgear Combination (ACHG) and the Bass appliance systems were compared by analyzing the cephalometric records of 64 subjects, who were treated for skeletal Class II malocclusion, with both conventional and Pancherz's methods. Differences between observations on the different occasions (starting and ending values) were tested with Wilcoxon's matched pairs rank test. Kruskal-Wallis
Nil Cura; Müyesser Saraç; Yildiz Öztürk; Nazan Sürmeli
Background Control of surgical site infections (SSI) is imperative for the safety of our patients. As orthopedic surgeons we strive to have the lowest infection rate possible for all our surgical procedures. this study evaluates the effects of a simple outpatient peri-operative patient cleaning protocol (The Steiros Algorithm® Outpatient Surgery Protocol) on SSI rates. Methods We retrospectively reviewed the hospital's infection rate database for all procedures from July 2005 until February 2011 performed by one general orthopedic surgeon (PAW) within one hospital system. The Steiros Algorithm® Outpatient Surgery Protocol was instituted on January 1st, 2009. We calculated and compared the deep and superficial SSI rate for orthopedic surgeries performed before and after the Outpatient Protocol was instituted. All patients had a minimum of one-year follow-up data. Lowest previously published estimated costs for SSI were used for a cost analysis ($17,708). Results The July 1st, 2005 through December 31st, 2008 SSI rate was 1.0% (13/1292). From January 1st, 2009 through February 28th, 2011 the SSI rate was zero (0/875). the SSI rates decreased 100%. Due to the reduction in SSI, the hospital saved a minimum of $154,059 over a two year period. Conclusions In this retrospective review, the Steiros Algorithm® Outpatient Surgery Protocol dramatically reduced the overall SSI rate to zero and saved money. We believe this is a simple, effective protocol that can be used for all orthopedic surgical procedures.
Watson, Paul A.; Watson, Luke; Torress-Cook, Alfonso
BACKGROUND: Climate- or holiday-related seasonality in hospital admission rates is well known for many diseases. However, little research has addressed the impact of tourism on seasonality in admission rates. We therefore investigated the influence of tourism on emergency admission rates in Switzerland, where winter and summer leisure sport activities in large mountain regions can generate orthopedic injuries. METHODS: Using small
Klazien Matter-Walstra; Marcel Widmer; André Busato
Background Both occupational physicians and orthopedic surgeons can be involved in the management of work relevant musculoskeletal disorders. These physicians hardly communicate with each other and this might lead to different advices to the patient. Therefore, we evaluated a standardized information exchange form for the exchange of relevant information between the orthopedic surgeon and the occupational physician. The main goals of this qualitative study are to evaluate whether the form improved information exchange, whether the form gave relevant information, and to generate ideas to further improve this information exchange. Methods The information exchange form was developed in two consensus meetings with five orthopedic surgeons and five occupational physicians. To evaluate the information exchange form, a qualitative evaluation was set up. Structured telephone interviews were undertaken with the patients, interviews with the physicians were face-to-face and semi-structured, based on a topic list. These interviews were recorded and literally transcribed. Each interview was analyzed separately in Atlas-Ti. Results The form was used for 8 patients, 7 patients agreed to participate in the qualitative evaluation. All three orthopedic surgeons involved and three of the six involved occupational physicians agreed to be interviewed. The form was transferred to 4 occupational physicians, the other 3 patients recovered before they visited the occupational physician. The information on the form was regarded to be useful. All orthopedic surgeons agreed that the occupational physician should take the initiative. Most physicians felt that the form should not be filled out for each patient visiting an orthopedic surgeon, but only for those patients who do not recover as expected. Orthopedic surgeons suggested that a copy of the medical information provided to the general practitioner could also be provided to occupational physicians. Conclusion The information exchange form was regarded to be useful and could be used in practice. The occupational physician should take the initiative for using this form and most physicians felt the information should only be exchanged for patients who do not recover as expected. That means that the advantage of giving information early in the treatment is lost.
Faber, Elske; Burdorf, Alex; van Staa, Anne Loes; Miedema, Harald S; Verhaar, Jan AN
Uses manipulative materials to build and examine geometric models that simulate the self-similarity properties of fractals. Examples are discussed in two dimensions, three dimensions, and the fractal dimension. Discusses how models can be misleading. (Contains 10 references.) (MDH)
Chiropractic's popularity is rising among the general population. Moreover, few studies have been conducted to properly evaluate its safety. We report three cases of serious neurological adverse events in patients treated with chiropractic manipulation. The first case is a 41 years old woman who developed a vertebro-basilar stroke 48 h after cervical manipulation. The second case represents a 68 years old woman who presented a neuropraxic injury of both radial nerves after three sessions of spinal manipulation. The last case is a 34 years old man who developed a cervical epidural haematoma after a chiropractic treatment for neck pain. In all three cases there were criteria to consider a causality relation between the neurological adverse events and the chiropractic manipulation. The described serious adverse events promptly recommend the implementation of a risk alert system. PMID:17904731
Gouveia, Liliana Olim; Castanho, Pedro; Ferreira, Joaquim J; Guedes, Miguel Moura; Falcão, Filipa; e Melo, Teresa Pinho
Digital photography and image-manipulation software allow biologists to tweak their data as never before. But there's a fine line between acceptable enhancements and scientific misconduct. Helen Pearson investigates.
Introduction: Ultrasonography and magnetic resonance imaging (MRI) are used to evaluate shoulder disorders. This implementation study investigated outpatient ultrasonography at an orthopedic practice in a managed care setting. Methods: A portable ultrasound machine was introduced at an orthopedic clinic in a group practice. An orthopedic surgeon who primarily treated shoulder disorders received 15 hours of training. The impact of physician-performed ultrasonography on subsequent MRI and other outcomes of patients with shoulder disorders from January 2011 through October 2011 was determined using automated administrative and clinical data. Comparisons were made to patients who did not undergo ultrasonography at the experimental practice and 2 orthopedic clinics in the same practice. Results: During the study, 146 ultrasound examinations were administered. Compared with patients who did not undergo ultrasonography, patients who received ultrasonography had significantly higher comorbidity. However, they were significantly less likely to have MRI (9.7% with ultrasonography vs 14.4% without; p = 0.03) although equally likely to undergo surgery (33.6% with ultrasonography vs 22.1% without, p = 0.77). Mean time to surgery was 89.3 ± 49.3 days for patients with ultrasonography vs 32.9 ± 43.3 days for patients without (p < 0.05). No ultrasonography-examined patients had an incorrect diagnosis at surgery. For patients receiving ultrasonography, an estimated 35 MRIs were avoided, saving a predicted $17,603, a 50% return in less than 1 year on a $34,897 investment for an ultrasound machine and supplies. Conclusion: Outpatient ultrasonography by an orthopedic surgeon can be useful for diagnosing shoulder disorders and might reduce MRI utilization.
Adelman, Sean; Fishman, Paul
[Purpose] The purpose of this study was to measure the muscle activities of the trunk muscles and upper limb muscles during maximum isometric contraction when temporomandibular joint alignment was achieved with a mandibular orthopedic repositioning appliance in order provide basic data on the effects of mandibular orthopedic repositioning appliance on the entire body. [Subjects] The present study was conducted with healthy Korean adults in their 20s (males=10, females=10). [Methods] An 8 channel surface electromyography system was used to measure the muscle activities of the upper limb muscles and neck muscles of the subjects during maximum isometric contraction with and without use of a mandibular orthopedic repositioning appliance. [Results] The maximum isometric contractions of the trunk and upper limb muscles when mandibular orthopedic repositioning appliance were used were compared with those when no mandibular orthopedic repositioning appliance was used. The results showed that the sternocleidomastoid muscle, cervical and lumbar erector spinae, upper trapezius, biceps, triceps, rectus abdominis and internal oblique and external oblique muscles all showed significant increases in maximum isometric contractions with a mandibular orthopedic repositioning appliance. [Conclusion] The use of a mandibular orthopedic repositioning appliance is considered to be a method for normal adults to improve the stability of the entire body with the improvement of the stability of the TMJ. The proximal improvement in stability improves of the proximal thereby improving not only muscle strength with increased muscle activation but also stability during exercises.
Lee, Sang-Yeol; Hong, Min-Ho; Park, Min-Chull; Choi, Sung-Min
Motion planning and control for the joints of flexible manipulators are discussed. Specific topics covered include control of a flexible braced manipulator, control of a small working robot on a large flexible manipulator to suppress vibrations, control strategies for ensuring cooperation among disparate manipulators, and motion planning for robots in free-fall.
Book, Wayne J.
The invention is a method of using computer vision to control systems consisting of a combination of holonomic and nonholonomic degrees of freedom such as a wheeled rover equipped with a robotic arm, a forklift, and earth-moving equipment such as a backhoe or a front-loader. Using vision sensors mounted on the mobile system and the manipulator, the system establishes a relationship between the internal joint configuration of the holonomic degrees of freedom of the manipulator and the appearance of features on the manipulator in the reference frames of the vision sensors. Then, the system, perhaps with the assistance of an operator, identifies the locations of the target object in the reference frames of the vision sensors. Using this target information, along with the relationship described above, the system determines a suitable trajectory for the nonholonomic degrees of freedom of the base to follow towards the target object. The system also determines a suitable pose or series of poses for the holonomic degrees of freedom of the manipulator. With additional visual samples, the system automatically updates the trajectory and final pose of the manipulator so as to allow for greater precision in the overall final position of the system.
Seelinger, Michael J. (Inventor); Yoder, John-David S. (Inventor); Skaar, Steven B. (Inventor)
A high precision redundant robotic manipulator for overcoming contents imposed by obstacles or imposed by a highly congested work space is disclosed. One embodiment of the manipulator has four degrees of freedom and another embodiment has seven degrees of freedom. Each of the embodiments utilize a first selective compliant assembly robot arm (SCARA) configuration to provide high stiffness in the vertical plane, a second SCARA configuration to provide high stiffness in the horizontal plane. The seven degree of freedom embodiment also utilizes kinematic redundancy to provide the capability of avoiding obstacles that lie between the base of the manipulator and the end effector or link of the manipulator. These additional three degrees of freedom are added at the wrist link of the manipulator to provide pitch, yaw and roll. The seven degrees of freedom embodiment uses one revolute point per degree of freedom. For each of the revolute joints, a harmonic gear coupled to an electric motor is introduced, and together with properly designed based servo controllers provide an end point repeatability of less than 10 microns. 3 figs.
A high precision redundant robotic manipulator for overcoming contents imposed by obstacles or imposed by a highly congested work space. One embodiment of the manipulator has four degrees of freedom and another embodiment has seven degreed of freedom. Each of the embodiments utilize a first selective compliant assembly robot arm (SCARA) configuration to provide high stiffness in the vertical plane, a second SCARA configuration to provide high stiffness in the horizontal plane. The seven degree of freedom embodiment also utilizes kinematic redundancy to provide the capability of avoiding obstacles that lie between the base of the manipulator and the end effector or link of the manipulator. These additional three degrees of freedom are added at the wrist link of the manipulator to provide pitch, yaw and roll. The seven degrees of freedom embodiment uses one revolute point per degree of freedom. For each of the revolute joints, a harmonic gear coupled to an electric motor is introduced, and together with properly designed based servo controllers provide an end point repeatability of less than 10 microns.
Young, Kar-Keung David (Mountain View, CA)
Modular manipulator designs have long been considered for use as research tools, and as the basis for easily modified industrial manipulators. In these manipulators the links and joints are discrete and modular components that can be assembled into a desired manipulator configuration. As hardware advances have made actual modular manipulators practical, various capabilities of such manipulators have gained interest. Particularly desirable is the ability to rapidly reconfigure such a manipulator, in order to custom tailor it to specific tasks. The reconfiguration greatly enhances the capability of a given amount of manipulator hardware. The development of a prototype modular manipulator is discussed as well as the implementation of a configuration independent manipulator kinematics algorithm used for path planning in the prototype.
Schmitz, Donald; Khosia, Pradeep; Kanade, Takeo
Instructions are presented on the use of ADMAP, (automatic data manipulation program) an aerospace data manipulation computer program. The program was developed to aid in processing, reducing, plotting, and publishing electric propulsion trajectory data generated by the low thrust optimization program, HILTOP. The program has the option of generating SC4020 electric plots, and therefore requires the SC4020 routines to be available at excution time (even if not used). Several general routines are present, including a cubic spline interpolation routine, electric plotter dash line drawing routine, and single parameter and double parameter sorting routines. Many routines are tailored for the manipulation and plotting of electric propulsion data, including an automatic scale selection routine, an automatic curve labelling routine, and an automatic graph titling routine. Data are accepted from either punched cards or magnetic tape.
Mann, F. I.
Recent developments in the field of metamaterials have revealed unparalleled opportunities for “engineering” space for light propagation; opening a new paradigm in spin- and quantum-related phenomena in optical physics. Here we show that unique optical properties of metamaterials (MMs) open unlimited prospects to “engineer” light itself. We propose and demonstrate for the first time a novel way of complex light manipulation in few-mode optical fibers using optical MMs. Most importantly, these studies highlight how unique properties of MMs, namely the ability to manipulate both electric and magnetic field components of electromagnetic (EM) waves, open new degrees of freedom in engineering complex polarization states of light at will, while preserving its orbital angular momentum (OAM) state. These results lay the first steps in manipulating complex light in optical fibers, likely providing new opportunities for high capacity communication systems, quantum information, and on-chip signal processing.
Zeng, Jinwei; Wang, Xi; Sun, Jingbo; Pandey, Apra; Cartwright, Alexander N.; Litchinitser, Natalia M.
Method of controlling mechanical impedance of end effector of robotic manipulator related to method described in "Adaptive Impedance Control of Redundant Manipulators" (NPO-18606). Present method does not require detailed knowledge and computation of dynamics and inverse kinematic transformation of manipulator. Provides for control globally stable in presence of bounded disturbances. Applicable to both nonredundant and redundant manipulators performing tasks involving impacts between manipulator and objects in its environment, and controlled contact between end effector and object, such as deburring.
Seraji, Homayoun; Colbaugh, Richard D.; Glass, Kristin L.
This paper presents a novel orthopedics surgery training system with both the components for modeling as well as simulating the deformation and visualization in an efficient way. By employing techniques such as optimization, segmentation and center line extraction, the modeling of deformable model can be completed with minimal manual involvement. The novel trainer can simulate rigid body, soft tissue and blood with state-of-the-art techniques, so that convincing deformation and realistic bleeding can be achieved. More important, newly released Physics Processing Unit (PPU) is adopted to tackle the high requirement for physics related computations. Experiment shows that the acceleration gain from PPU is significant for maintaining interactive frame rate under a complex surgical environments of orthopedics surgery. PMID:18044647
Pang, Wai-Man; Qin, Jing; Chui, Yim-Pan; Wong, Tien-Tsin; Leung, Kwok-Sui; Heng, Pheng-Ann
Metal alloys are currently the most popular materials for manufacture of fracture-fixation devices. Two major disadvantages of these materials are their extreme stiffness, which causes stress shielding of the underlying bone, and the necessity, in a significant number of cases, of removing metallic implants after fracture healing is complete. These shortcomings of metal alloys have led to the study of bioresorbable materials for use in fracture fixation. Currently, polylactic acid, polyglycolic acid, and polydioxanone implants are available to the orthopedic surgeon for the fixation of small cancellous bone fractures. Part I of this article provides an overview of the basic science of bioresorbable materials and presents a comprehensive review of preclinical studies reported in the orthopedic literature. Clinical studies will be reviewed in Part II. PMID:9349887
Simon, J A; Ricci, J L; Di Cesare, P E
The effective maxillary orthopedic protraction is an innovative technique for maxillary protraction in Class III growing patients. It includes three components: a new 2-hinged rapid maxillary expander for a greater amount of anterior displacement of maxilla, repetitive weekly protocol of Alternate Rapid Maxillary Expansion and Constriction (Alt-RAMEC) for disarticulating the maxilla, and intraoral maxillary protraction springs for non-compliant protraction. On average, the maxilla could be protracted for 5.8 mm in 3 months and the result remains stable at least 2 years later. The rationale for this technique is sutural expansion/ protraction osteogenesis. Sutural expansion/ protraction osteogenesis is a form of distraction osteogenesis. However, it still needs to be scrutinized experimentally for the sutural reactions corresponding to the effective maxillary orthopedic protraction. PMID:16276426
Liou, Eric Jein-Wein
To increase an orthopedic implant's lifetime, research trends have included the development of new titanium alloys made of nontoxic elements with suitable mechanical properties (low Young's modulus - high fatigue strength), good workability and corrosion resistance. In accordance with the background on titanium and metallic biomaterials, recent interesting developments in titanium-based biomaterials are reported in this review, with a special emphasis on the design of new metastable beta-titanium alloys for orthopedic applications. In addition, as the concept of titanium alloys can now be regarded as relatively old, having emerged at the beginning of the 1980s, the author suggests some future directions that would permit the emergence of a new generation of titanium implants. PMID:16293101
The leadership organization focuses on education, teamwork, customer relationship and developing strategy which help in building added value, in managing activities, time and quality. Everyday orthopedic experience shows that medical education is a mixture of: specific knowledge, skills and attitudes of people working together, and that creates effective teamwork in a hospital environment. Apart from the main reason of medical education, teaching about disease treatment and health problem solving, medical education should also concentrate on human factors and behavioral aspects of patient treatment in hospital.Assessment of an organization and medical education process by cultural and teamwork criteria, offers a powerful new way to think about performance at the frontlines of healthcare and in the future it could be gold standard for assessing the success of an organization, and standards in medical education, not only in orthopedics.
Rosiek, Anna; Leksowski, Krzysztof
The aim of this study was to evaluate the diagnostic value of 99mTc-HMPAO leukocyte scintigraphy (LS) by means of a retrospective review of its use in 14 horses that were evaluated for orthopedic infection as a cause of lameness. A total of 17 LS exams were performed in 14 horses. LS studies were positive in 10 of 14 horses. A bacterial infection was confirmed with cytology or culture in 9 of 10 positive horses. Negative LS studies occurred in 4 of 14 horses. Necropsy confirmed the lack of infection in 2 of the 4 horses. Other clinical data and a favorable clinical outcome supported a negative study in the other 2 horses. No false negative or false positive studies were identified. It may be concluded that HMPAO-LS is an effective tool for the diagnosis of orthopedic infection in horses. PMID:10955500
Long, C D; Galuppo, L D; Waters, N K; Hornof, W J
Magnetic particles that will bind to cell surfaces have become an important tool for the application of force in cell biology and biotechnology. Functionalized magnetic nanowires offer significant potential advantages over the magnetic beads currently in widespread use for cell manipulation. The nanowires are made by electrochemical deposition in nanoporous templates, a process that permits detailed control of their morphology, magnetic properties, and surface chemistry. We report experiments that demonstrate cell manipulation using magnetic nickel nanowires in conjunction with 3T3 mouse fibroblast cells. The implications for magnetic cell sorting and other applications will be discussed.
Hultgren, A.; Tanase, M.; Chen, C. S.; Meyer, G. J.; Reich, D. H.
To assess the benefits of nitric oxide (NO)-releasing sol-gels as potential antibacterial coatings for orthopedic devices, medical- grade stainless steel is coated with a sol-gel film of 40% N-aminohexyl-N-aminopropyltrimethoxysilane and 60% isobutyl- trimethoxysilane. Upon converting the diamine groups in these films to diazeniumdiolate NO donors, the NO release from the sol- gel-coated stainless steel is evaluated at both ambient and
Brian J. Nablo; Aaron R. Rothrock; Mark H. Schoenfisch
This paper is a review of articles published in Brazilian scientific periodicals in recent years. Its main purpose is to bring to the attention of the readership of Acta Ortopedica Brasileira original contributions to the field published in non-specialized journals. We hope that this will serve as a general scientific update for readers. The review includes works published in six ISI indexed non-orthopedic journals, following a literature search conducted in fourteen such journals.
Rocha-e-Silva, Mauricio; Gomes, Ariane Maris
Patients undergoing major orthopedic surgery are at high venous thromboembolism (VTE) risk, with morbid and potentially fatal consequences. Anticoagulant VTE prophylaxis reduces rates of postoperative deep vein thrombosis by up to 60% to 70% in these patients. Therefore, pharmacological prophylaxis with low-molecular-weight heparins (LMWHs), vitamin K antagonists, or fondaparinux is recommended by current guidelines. However, there remains an ongoing debate regarding when to initiate and the optimal duration for prophylaxis. Here, we discuss the mechanisms underlying thrombus formation in patients undergoing major orthopedic surgery, and we review the current literature on the benefit-to-risk ratio associated with preoperative and postoperative initiation of thromboprophylaxis and also the benefit-to-risk ratio in cases of neuraxial anesthesia. We also discuss the duration of postoperative VTE risk following major orthopedic surgery and assess the ''critical thrombosis period'' when prophylaxis should be provided. Current literature reflects the need to balance the improved efficacy of initiating prophylaxis close to the surgery with increased risk of perioperative bleeding. Evidence from pathology, epidemiology, and clinical studies suggests the risk period for VTE begins at surgery and extends well beyond hospitalization-a crucial issue when considering how long to give prophylaxis-and, in the case of total hip arthroplasty, for at least 3 months after surgery. Literature supports the greater use of ''just-in-time'' thromboprophylaxis initiation and after-discharge continuation of optimal prophylaxis in orthopedic surgery patients. Providing optimal thromboprophylaxis throughout the critical thrombosis period where a patient is at VTE risk will ensure the best reductions in VTE-related morbidity and mortality. PMID:20019020
Warwick, David; Rosencher, Nadia
This descriptive, correlational study was conducted to determine orthopedic patients’ night-time pain characteristics, their quality of sleep and the contributing factors to poor sleep experiences, and the relationship between pain and sleep. Data were collected by using the McGill Pain Questionnaire-SF (MPQ-SF) and Pittsburgh Sleep Quality Index (PSQI) on the second postoperative day. Data were analyzed using the SPSS version
Funda Esen Büyüky?lmaz; Merdiye ?endir; Rengin Acaro?lu
Minimally invasive surgery in orthopedic field is considered to be a challenging problem with a milling robot. One objective\\u000a of this study is to minimize collision of the cutting tool with soft tissue. The authors have developed a robot with redundant\\u000a axis to avoid the collision so far. Some important components are modeled based on physical requirements, and a geometric
Naohiko Sugita; Yoshikazu Nakajima; Mamoru Mitsuishi; Shosaku Kawata; Kazuo Fujiwara; Nobuhiro Abe; Toshifumi Ozaki; Masahiko Suzuki
To assess the benefits of nitric oxide (NO)-releasing sol–gels as potential antibacterial coatings for orthopedic devices, medical-grade stainless steel is coated with a sol–gel film of 40% N-aminohexyl-N-aminopropyltrimethoxysilane and 60% isobutyltrimethoxysilane. Upon converting the diamine groups in these films to diazeniumdiolate NO donors, the NO release from the sol–gel-coated stainless steel is evaluated at both ambient and physiological temperature. Sol–gel
Brian J. Nablo; Aaron R. Rothrock; Mark H. Schoenfisch
Abstract Surgical site infection (SSI) is disastrous in orthopedic practice as it is difficult to rid the bone and joint of the infection. This study was aimed to assess the prevalence of SSI in orthopedic practice and to identify risk factors associated with surgical site infections. All patients admitted to the orthopedic male and female wards between January 2006 and December 2011 were included in the study group. The data, which were collected from the medical charts and from the QuadraMed patient filing system, included age, sex, date of admission, type of admission (elective versus emergency), and classification of fractures. Analyses were made to find out the association between infection and risk factors, the ? (2) test was used. The strength of association of the single event with the variables was estimated using Relative Risk, with a 95% confidence interval and P < 0.05. A total of 79 of 3096 patients (2.55%) were included: 60 males and 19 females with the average age of 38.13 ± 19.1 years. Fifty-three patients were admitted directly to the orthopedic wards, 14 were transferred from the surgical intensive care unit, and 12 from other surgical wards. The most common infective organism was Staphylococcus species including Methicillin Resistant Staphylococcus aureus (MRSA), 23 patients (29.11%); Acinetobacter species, 17 patients (21.5%); Pseudomonas species, 15 patients (18.9%); and Enterococcus species, 14 patients (17.7%). Fifty-two (65.8%) had emergency procedures, and in 57 patients trauma surgery was performed. Three (3.78%) patients died as a result of uncontrolled septicemia. SSI was found to be common in our practice. Emergency surgical procedures carried the greatest risk with Staphylococcus species and Acinetobacter species being the most common infecting organisms. Proper measures need to be undertaken to control infection rates by every available method; antibiotics alone may not be sufficient to win this war. PMID:24833150
Al-Mulhim, Fahad A; Baragbah, Mohammed A; Sadat-Ali, Mir; Alomran, Abdallah S; Azam, Md Q
Two-hundred and fifty-two patients were included in a prospective, randomized, double-blind trial comparing the efficacy of flucloxacillin with that of cefazolin for clean orthopedic surgery. The preventive antibiotic regimen consisted of three 1-g injections perioperatively. There were 126 patients in each group, and the follow-up period was at least 6 months. Two deep (1.6%) and five superficial (4.0%) infections occurred
J. Van Meirhaeghe; R. Verdonk; G. Verschraegen; P. Myny; G. Paeme; H. Claessens
Objective To evaluate the effectiveness of the use of antibiotic prophylaxis in preventing surgical site infections, at orthopedic surgery unit in tertiary hospital, Dr. Mintohardjo Navy Hospital, Jakarta, Indonesia. Methods This study was a cross-sectional study conducted retrospectively on the orthopedic unit of the Dr. Mintohardjo Navy Hospital, Jakarta, Indonesia between January to December 2012. Assessment of appropriateness of antibiotic prophylaxis was carried out based on the Scottish Intercollegiate Guidelines and The National Guidelines of Antibiotic Usage in Indonesia. Results A total of 163 samples consisted of men (73%) and women (27%) with an age range less than 12 years (9.8%), 12-25 years (23.3%), 26-65 years (58.9%) and over 65 years (8.0%). The most commonly antibiotic prophylaxis used in this study was ceftriaxone (87.8%), followed by gentamycin (3.7%), cefotaxime (3.7%), cefoporaxone (1.2%), siprofloksasin (1.2%), fosfomycin (0.6%), meropenem (0.6%), and vancomycin (0.6%). Of the 163 patients 8 (4.9%) patients developed a surgical site infection of all orthopedic surgical patients who received antibiotic prophylaxis. The pathogens isolated from surgical site infection were Escherichia coli (23.08%), coliform (18.62%), Staphylococcus aureus (18.00%), Pseudomonas aeruginosa (12.15%), and Alkaligenes sp. (9.31%). Conclusions The Compliance of antibiotics prophylaxis administration at orthopedic surgery unit in Dr. Mintohardjo Naval Hospital has not been in accordance with the guidelines of the national or international standards. Therefore it is necessary to do some improvements to ensure better compliance with standard guidelines.
Radji, Maksum; Aini, Fithrotul; Fauziyah, Siti
A novel contact-free magnetoelastic microsensor for diagnosing failing orthopedic implants is introduced. It uses an implant-embedded 30-mum-thick MetGlas-2826 film and a sensing coil placed 30 mm away from the film. Implant loading generates thin-film magnetoelastic response, passively (contact-free) detected as voltage by the coil. A specific integrated stochastic nonlinear filter performs data denoising, and a decision-making module concludes (via data
Dionysios E. Mouzakis; Dimitrios Dimogianopoulos; Dimitrios Giannikas
Purpose To develop novel biomineral-binding liposomes (BBL) for the prevention of orthopedic implant associated osteomyelitis. Methods A biomineral-binding lipid, alendronate-tri(ethylene-glycol)-cholesterol conjugate (ALN-TEG-Chol), was synthesized through Cu(I)-catalyzed Huisgen 1,3-dipolar cycloaddition (a versatile click reaction). Mixing with other excipients, the new lipid was used to develop BBL. Thermodynamic behavior was studied by differential scanning calorimetry (DSC). In vitro biomineral-binding potential and kinetics were evaluated on hydroxyapatite (HA, a widely used material for orthopedic implant devices) particles. Oxacillin was encapsulated into BBL and used for in vitro evaluation in preventing Staphylococcus aureus biofilm formation. Results DSC analysis showed that ALN-TEG-Chol could inhibit the phase transition of liposomes by reducing its cooperativity, yielding liposomes with thermodynamic stability similar to liposomes containing regular cholesterol. BBL showed fast and strong binding ability to HA. Oxacillin-loading BBL demonstrated significantly better preventive efficacy against bacteria colonization when challenged with S. aureus isolate, implying its potential in preventing orthopedic implant associated osteomyelitis. Conclusions In this proof of concept study, novel BBL has been successfully developed and validated for reducing the frequency of implantable device-related infections.
Liu, Xin-Ming; Zhang, Yijia; Chen, Fu; Khutsishvili, Irine; Fehringer, Edward V.; Marky, Luis A.; Bayles, Kenneth W.
Pedestrian versus motor vehicle accidents (PVMVAs) are a common cause of morbidity and mortality around the globe. Past models of PVMVAs assume lower-extremity vehicle contact as the initiating event, with a subsequent predicted injury sequence consisting of a lower extremity injury followed by injury to the body, head, and upper extremities. The term “fatal triad” was first coined by Farley, which described concomitant injuries to the skull, pelvis, and extremity fractures. Over the years, this once well-accepted model of injury has been under scrutiny by numerous orthopedic researchers, and it has lost credibility. This case presentation glaring reveals that the patient incurred which is referred to as the “fatal triad”, in contrast to the commonly circulated thoughts of biodynamic mechanisms of PVMVA fractures. More research in this arena is warranted. This lack of information contributes to the morbidity and mortality associated with such devastating injuries. The overlying theme displayed in the data analyzed in this paper demonstrates the vital importance of the orthopedic surgeon in the management of the PVMVA patient. No matter the particular mechanism of injury, occurrence, or agreed-upon treatment protocol, the role of the orthopedic physician is instrumental to the wellbeing of the PVMVA trauma patient.
Samona, Jason; Colen, Robert
Nanomaterials play a significant role in biomedical research and applications because of their unique biological, mechanical, and electrical properties. In recent years, they have been utilized to improve the functionality and reliability of a wide range of implantable medical devices ranging from well-established orthopedic residual hardware devices (e.g., hip implants) that can repair defects in skeletal systems to emerging tissue engineering scaffolds that can repair or replace organ functions. This review summarizes the applications and efficacies of these nanomaterials that include synthetic or naturally occurring metals, polymers, ceramics, and composites in orthopedic implants, the largest market segment of implantable medical devices. The importance of synergistic engineering techniques that can augment or enhance the performance of nanomaterial applications in orthopedic implants is also discussed, the focus being on a low-intensity direct electric current (LIDC) stimulation technology to promote the long-term antibacterial efficacy of oligodynamic metal-based surfaces by ionization, while potentially accelerating tissue growth and osseointegration. While many nanomaterials have clearly demonstrated their ability to provide more effective implantable medical surfaces, further decisive investigations are necessary before they can translate into medically safe and commercially viable clinical applications. The article concludes with a discussion about some of the critical impending issues with the application of nanomaterials-based technologies in implantable medical devices, and potential directions to address these. PMID:23335493
Shirwaiker, Rohan A; Samberg, Meghan E; Cohen, Paul H; Wysk, Richard A; Monteiro-Riviere, Nancy A
The major problem in operating an implantable radio-frequency identification (RFID) tag embedded on an orthopedic implant is low efficiency because of metallic interference. To improve the efficiency, this paper proposes a method of operating an implantable passive RFID tag using a touch probe at 13.56 MHz. This technology relies on the electric field interaction between two pairs of electrodes, one being a part of the touch probe placed on the surface of tissue and the other being a part of the tag installed under the tissue. Compared with using a conventional RFID antenna such as a loop antenna, this method has a better performance in the near field operation range to reduce interference with the orthopedic implant. Properly matching the touch probe and the tag to the tissue and the implant reduces signal attenuation and increases the overall system efficiency. The experiments have shown that this method has a great performance in the near field transcutaneous operation and can be used for orthopedic implant identification. PMID:23853323
Liu, Xiaoyu; Berger, J Lee; Ogirala, Ajay; Mickle, Marlin H
Purpose This systematic review updates one conducted in 2008 into extended scope practice (ESP) in physiotherapy in orthopedics. Methods A comprehensive open-ended search was conducted using electronic library data-bases and Google Scholar to identify any primary study design reporting on physiotherapists working in ESP roles within orthopedic settings. Studies were allocated to the National Health and Medical Research Council hierarchy of evidence, although only studies in levels I, II, or III_1 were critically appraised using a purpose-built critical appraisal tool. Information was extracted on the country of origin, ESP tasks, relevant training, patient types, health, process, and cost measures. Results 1071 studies were identified, and twelve were included in the review (including diagnostic and evaluative research). The hierarchy of evidence ranged from II to IV, from which only two diagnostic studies met the criteria for critical appraisal. ESP tasks included injection therapy, removing k-wires, and requesting investigations. The education of ESP physiotherapists varied widely, and included formal and informal training. The positive outcomes of ESP initiatives were reported, in diagnostic ability, reduced costs and waiting times, and improved health outcomes. Conclusion Despite the positive results, the generally low level of evidence and the range of outcome measures reported, constrained clear conclusions regarding the health, process, and cost implications of ESP physiotherapy roles in orthopedic settings. The need for formalized, widely recognized training was highlighted, to give ESP physiotherapy roles credibility.
Stanhope, Jessica; Grimmer-Somers, Karen; Milanese, Steve; Kumar, Saravana; Morris, Joanne
Over the last 15 years, with the advent of modern standards in the control of sterility within the operating room environment and adequate protocols of peri-operative antibiotic prophylaxis, the incidence of infections associated to orthopedic implants has become very low. Nevertheless, the event of infection still represents one of the most serious and devastating complications which may involve prosthetic devices. It leads to complex revision procedures and, often, to the failure of the implant and the need for its complete removal. In orthopedics, for the enormous number of surgical procedures involving invasive implant materials, even if nowadays rare, infections have a huge impact in terms of morbidity, mortality, and medical costs. The difficult battle to prevent and fight bacterial infections associated to prosthetic materials must be played on different grounds. A winning strategy requires a clear view of the pathogenesis and the epidemiology of implant-related infections, with a special attention on the alarming phenomenon of antibiotic resistance. In this regard staphylococci are the prevalent and most important causative pathogens involved in orthopedic implant-related infections, and, thus, the main enemy to defeat. In this paper, we offer an overview of the complexity of this battleground and of the current and new, in our opinion most promising, strategies in the field of biomaterials to reduce the risks and counteract the establishment of implant infections. PMID:16364434
Campoccia, Davide; Montanaro, Lucio; Arciola, Carla Renata
Compared with nonfunded or peer-reviewed funded projects, industry-sponsored clinical trials have traditionally been associated with more positive results. This relationship has been extensively studied in the nonsurgical literature. Although a few authors have addressed specialties, little has been reported on orthopedic clinical trials and their association with funding, study outcome, and efforts to reduce bias after randomization across journals of multiple subspecialties. For the study reported here, we selected 5 major orthopedic subspecialty journals: Journal of Bone and Joint Surgery (American Volume), Spine, Journal of Arthroplasty, Journal of Orthopaedic Trauma, and American Journal of Sports Medicine. We chose a 2-year limit for investigation (2002-2004); included all original randomized clinical trials reported in these 5 journals; and examined these trials for their study design, funding source, outcome, bias potential, and conclusion reached. Support for the 100 eligible orthopedic clinical trials was stated as coming from industry (26 trials, 26%), nonprofit sources (19 trials, 19%), and mixed sources (5 trials, 5%); no support was stated in 46 trials (46%), and support was not reported in 4 trials (4%). Of the 26 trials reporting industry support, 22 (85%) were graded as indicating an outcome favorable to the new treatment. The association between industry funding and favorable outcome was strong and significant (P<.001). In almost half of the studies reported in Journal of Bone and Joint Surgery and Spine, measures taken to reduce bias were not documented. PMID:19212579
Khan, Safdar N; Mermer, Matthew J; Myers, Elizabeth; Sandhu, Harvinder S
Purpose: To assess the feasibility and effectiveness of emergency endovascular treatment of acute arterial injuries after orthopedic surgery. Materials and Methods: Fifteen patients (mean age 68.3 years) with acute arterial injuries after orthopedic surgery were observed, in particular, 5 patients with pseudoaneurysm, 9 patients with active bleeding, and 1 patient with arterial dissection. Transarterial embolization (TAE) and positioning of covered and noncovered stents were the treatments performed. Follow-up after stent implantation (mean 36 months) was performed with color Doppler US (CDU) at 1, 3, 6, and 12 months and yearly thereafter. Plain X-ray was performed to evidence dislodgment or fracture of the graft. A minimum of 12 months' follow-up is available after TAE. Results: Immediate technical success was obtained in all cases. No major complications occurred. Overall clinical success rate was 100%. During mean follow-up, stent-graft occlusions did not occurred. No recurrence and/or consequence of TAE was registered during a minimum follow-up of 12 months. Conclusions: Percutaneous treatment is a feasible and safe tool for treating arterial injuries because it can provide fast and definitive resolution of the damage. This low-invasiveness approach can be proposed as first-line treatment in patients with acute injuries after orthopedic surgery.
Carrafiello, Gianpaolo, E-mail: email@example.com; Fontana, Federico, E-mail: firstname.lastname@example.org; Mangini, Monica, E-mail: email@example.com; Ierardi, Anna Maria, E-mail: firstname.lastname@example.org; Lagana, Domenico; Piacentino, Filippo, E-mail: email@example.com; Vizzari, Francesco Alberto, E-mail: firstname.lastname@example.org; Spano, Emanuela, E-mail: email@example.com; Fugazzola, Carlo, E-mail: firstname.lastname@example.org [Insubria University, Interventional Radiology, Department of Radiology (Italy)
Among the different strategies used by parasites to usurp the behaviour of their host, one of the most fascinating is bodyguard manipulation. While all classic examples of bodyguard manipulation involve insect parasitoids, induced protective behaviours have also evolved in other parasite-host systems, typically as specific dimensions of the total manipulation. For instance, parasites may manipulate the host to reduce host mortality during their development or to avoid predation by non-host predators. This type of host manipulation behaviour is rarely described, probably due to the fact that studies have mainly focused on predation enhancement rather than studying all the dimensions of the manipulation. Here, in addition to the classic cases of bodyguard manipulation, we also review these 'bodyguard dimensions' and propose extending the current definition of bodyguard manipulation to include the latter. We also discuss different evolutionary scenarios under which such manipulations could have evolved. PMID:23225865
Maure, Fanny; Daoust, Simon Payette; Brodeur, Jacques; Mitta, Guillaume; Thomas, Frédéric
System capabilities are equivalent to mobility, dexterity, and strength of human arm. Arrangement of torque motor, harmonic drive, and potentiometer combination allows all power and control leads to pass through center of slave with position-transducer arrangement of master, and "stovepipe joint" is incorporated for manipulator applications.
Vykukal, H. C.; King, R. F.; Vallotton, W. C.
In this paper, we present an algorithm for manip- ulability based trajectory generation for any serial manipulator that has an inverse kinematic model that can obtain all solutions. Our strategy is a search-based approach that analyzes candidate configurations at discrete points along the workspace trajectory. Given such a model we prove the configuration space trajectories generated by our method are
Luis Guilamo; James J. Kuffner Jr.; Koichi Nishiwaki; Satoshi Kagami
Calculus students' difficulties in understanding integration have been extensively studied. Research shows that the difficulty lies with students understanding of the definition of the definite integral as a limit of a Riemann sum and with the idea of accumulation inherent in integration. We have created a set of manipulatives and activities…
Bhatia, Kavita; Premadasa, Kirthi; Martin, Paul
DATACUBE is a command-line package for manipulating and visualizing data cubes. It was designed for integral field spectroscopy but has been extended to be a generic data cube tool, used in particular for sub-millimeter data cubes from the James Clerk Maxwell Telescope. It is part of the Starlink software collection (ascl:1110.012).
Allan, Alasdair; Currie, Malcolm J.
The Johnson Space Center has developed a new mobile manipulation system with the combination of a Robonaut upper body mounted onto a Segway mobile base. The objective is to study a fluid and coordinated control of dexterous limbs on a mobile robot. The system has been demonstrated interacting with people, tools, and urban interfaces built for humans. Human interactions have
Robert O. Ambrose; Robert T. Savely; S. M. Goza; Philip Strawser; Myron A. Diftler; I. M. Spain; N. Radford
Background The Medical Outcomes General Health Survey (SF-36) is a widely used health status measure; however, limited evidence is available for its performance in orthopedic settings. The aim of this study was to examine the magnitude and meaningfulness of change and sensitivity of SF-36 subscales following orthopedic surgery. Methods Longitudinal data on outcomes of total hip replacement (THR, n = 255), total knee replacement (TKR, n = 103), arthroscopic partial meniscectomy (APM, n = 74) and anterior cruciate ligament reconstruction (ACL, n = 62) were used to estimate the effect sizes (ES, magnitude of change) and minimal detectable change (sensitivity) at the group and individual level. To provide context for interpreting the magnitude of changes in SF-36 scores, we also compared patients' scores with age and sex-matched population norms. The studies were conducted in Sweden. Follow-up was five years in THR and TKR studies, two years in ACL, and three months in APM. Results On average, large effect sizes (ES?0.80) were found after orthopedic surgery in SF-36 subscales measuring physical aspects (physical functioning, role physical, and bodily pain). Small (0.20–0.49) to moderate (0.50–0.79) effect sizes were found in subscales measuring mental and social aspects (role emotional, vitality, social functioning, and mental health). General health scores remained relatively unchanged during the follow-up. Despite improvements, post-surgery mean scores of patients were still below the age and sex matched population norms on physical subscales. Patients' scores on mental and social subscales approached population norms following the surgery. At the individual level, scores of a large proportion of patients were affected by floor or ceiling effects on several subscales and the sensitivity to individual change was very low. Conclusion Large to moderate meaningful changes in group scores were observed in all SF-36 subscales except General Health across the intervention groups. Therefore, in orthopedic settings, the SF-36 can be used to show changes for groups in physical, mental, and social dimensions and in comparison with population norms. However, SF-36 subscales have low sensitivity to individual change and so we caution against using SF-36 to monitor the health status of individual patients undergoing orthopedic surgery.
Busija, Lucy; Osborne, Richard H; Nilsdotter, Anna; Buchbinder, Rachelle; Roos, Ewa M
The present study investigated the effects of step frequency manipulation during training on slopes (2%) on biomechanical parameters at Iso-Efficiency Speed (without increasing the metabolic demand). 24 male marathon runners were randomly allocated to one of 2 training groups for 3 weeks: step frequency manipulation group (SFM, n=12) and free step frequency group (SFF, n=12). Lower limb kinematic parameters were measured before and after the 3 weeks training. The SFM group increased step length 4.30% (p<0.001), flight time 29.48% (p<0.001) and decreased contact time 14% (p<0.01). These findings coincide with characteristics of better running performances. The SFF group did not elicit such results. The results from the study could help coaches to devise training methods which could improve an athlete's performance through increasing step length. The method provided may aid faster race times for athletes. PMID:22972239
Padulo, J; Degortes, N; Migliaccio, G M; Attene, G; Smith, L; Salernitano, G; Annino, G; D'Ottavio, S
The discovery of the third domain of life, the Archaea, is one of the most exciting findings of the last century. These remarkable prokaryotes are well known for their adaptations to extreme environments; however, Archaea have also conquered moderate environments. Many of the archaeal biochemical processes, such as methane production, are unique in nature and therefore of great scientific interest. Although formerly restricted to biochemical and physiological studies, sophisticated systems for genetic manipulation have been developed during the last two decades for methanogenic archaea, halophilic archaea and thermophilic, sulfur-metabolizing archaea. The availability of these tools has allowed for more complete studies of archaeal physiology and metabolism and most importantly provides the basis for the investigation of gene expression, regulation and function. In this review we provide an overview of methods for genetic manipulation of Methanosarcina spp., a group of methanogenic archaea that are key players in the global carbon cycle and which can be found in a variety of anaerobic environments.
Kohler, Petra R. A.; Metcalf, William W.
A method was proposed to manipulate nanoparticles through a thermal gradient. The motion of a fullerene molecule enclosed inside a (10, 10) carbon nanotube with a thermal gradient was studied by molecular dynamics simulations. We created a one-dimensional potential valley by imposing a symmetrical thermal gradient inside the nanotube. When the temperature gradient was large enough, the fullerene sank into the valley and became trapped. The escaping velocities of the fullerene were evaluated based on the relationship between thermal gradient and thermophoretic force. We then introduced a new way to manipulate the position of nanoparticles by translating the position of thermostats with desirable thermal gradients. Compared to nanomanipulation using a scanning tunneling microscope or an atomic force microscope, our method for nanomanipulation has a great advantage by not requiring a direct contact between the probe and the object.
A method was proposed to manipulate nanoparticles through a thermal gradient. The motion of a fullerene molecule enclosed inside a (10, 10) carbon nanotube with a thermal gradient was studied by molecular dynamics simulations. We created a one-dimensional potential valley by imposing a symmetrical thermal gradient inside the nanotube. When the temperature gradient was large enough, the fullerene sank into the valley and became trapped. The escaping velocities of the fullerene were evaluated based on the relationship between thermal gradient and thermophoretic force. We then introduced a new way to manipulate the position of nanoparticles by translating the position of thermostats with desirable thermal gradients. Compared to nanomanipulation using a scanning tunneling microscope or an atomic force microscope, our method for nanomanipulation has a great advantage by not requiring a direct contact between the probe and the object. PMID:22364240
Wei, Ning; Wang, Hui-Qiong; Zheng, Jin-Cheng
Radiation pressure from a tightly focused laser beam can be used as optical tweezers to confine, position, and transport microparticles.\\u000a Ashkin’s group first demonstrated this technique in 1986 . Optical tweezers provide unique features such as remote manipulation\\u000a of micro\\/nano particles in unique features such as remote manipulation of micro\\/nano particles in liquid, noninvasive manipulation\\u000a of biological samples, precise manipulation
The primary goal of this paper is a descriptive explanation, based on typical illustrative examples, of what happens precisely when a serial non-redundant manipulator is changing its posture. This work focuses on the cuspidal robot manipulators, i.e. those robot manipulators which can change posture without meeting a singularity. The analysis is done for 3-DOF positioning manipulators. It applies to 6-DOF
P. Wenger; J. El Omri
Clostridium difficile is a Gram-positive, spore forming, anaerobic, intestinal bacterium and is the most common cause of antibiotic-associated colitis. For many years this organism was considered genetically intractable, but in the past 10 years, multiple methods have been developed or adapted for genetic manipulation of C. difficile. This unit describes the molecular techniques used for genetic modification of this organism, including methods for gene disruption, complementation, plasmid introduction and integration, and cross-species conjugations.
Bouillaut, Laurent; McBride, Shonna M.; Sorg, Joseph A.
Robotic assembly operations such as mating and fastening of parts are more successful if the robot manipulator compliance can be controlled so that various coordinates are free to comply with external constraints. This paper presents the design of a hybrid controller to provide active compliance to a six-degree-of-freedom robot built at NASA/GSFC using force and position feedback. Simulation results of a 2 degree-of-freedom model is presented and discussed.
Nguyen, Charles C.; Pooran, Farhad J.; Premack, Timothy
An overview of research on a flow control technique called Coanda-assisted Spray Manipulation (CSM) is presented. CSM uses a high-momentum control jet under the influence of the Coanda effect to vector a high volume-flow jet or spray. Actuators provide the capability of moving the location of applied control flow making rotary or arbitrary motion of the vectored flow possible. The
Katie Mabey; Barton Smith; Reid Archibald; Brian West
\\u000a In this chapter,we present a summary of nanorobotic manipulations under various microscopes and their nanobioscience applications.\\u000a Until now, nanomanipulation is mainly applied to the scientific exploration of mesoscopic phenomena and the construction of\\u000a prototype nanodevices. Recently, the evaluation of bio-samples has gotten much attention for nanobio applications in nano-biotechnology.\\u000a Singlecell analysis gets a lot of attention because of its potential
Toshio Fukuda; Masahiro Nakajima
One of the goals of biology for the next fifty years is to understand how cells work. This fundamentally requires a diverse\\u000a set of approaches for performing measurements on cells in order to extract information from them. Manipulating the physical\\u000a location and organization of cells or other biologically important particles is an important part in this endeavor. Apart\\u000a from the
The primary goal of this research is to develop theoretical tools for analysis, synthesis, and application of primitive manipulator operations. The primary method is to extend an apply traditional tools of classical mechanics. The results are of such a general nature that they address many different aspects of industrial robotics, including effector and sensor design, planning and programming tools, and design of auxiliary equipment. Some of the manipulator operations studied are: Grasping an object: The object will usually slide and rotate during the period between first contact and prehension; Placing an object: The object may slip slightly in the fingers upon contact with the table as the base aligns with the table; and Pushing: Often the final stage of mating two parts involves pushing one object into the other. In each of these operations the motion of the object is determined partly by the manipulator and partly by frictional forces. hence the theoretical analysis focuses on the problem of partially constrained motion with friction.
The biofilm mode of growth provides such significant advantages to the members of the consortium that most organisms in important habitats are found in biofilms. The study of factors that allow manipulation of biofilm microbes in the biofilm growth state requires that reproducible biofilms be generated. The most effective monitoring of biofilm formation, succession and desaturation is with on-line monitoring of microbial biofilms with flowcell for direct observation. The biofilm growth state incorporates a second important factor, the heterogeneity in distribution in time and space of the component members of the biofilm consortium. This heterogeneity is reflected not only in the cellular distribution but in the metabolic activity within a population of cells. Activity and cellular distribution can be mapped in four dimensions with confocal microscopy, and function can be ascertained by genetically manipulated reporter functions for specific genes or by vital stains. The methodology for understanding the microbial ecology of biofilms is now much more readily available and the capacity to manipulate biofilms is becoming an important feature of biotechnology.
White, D.C.; Palmer, R.J., Jr.; Zinn, M.; Smith, C.A.; Burkhalter, R.; Macnaughton, S.J.; Whitaker, K.W.; Kirkegaard, R.D.
Compares the manipulative exploration of objects of 30 nine-month-old preterm infants with that of 20 nine-month-old full-term infants. Although no difference between the preterms and the full terms was noted, a high-risk preterm subgroup manipulated objects less. A relationship was found between manipulative exploration at nine months and later…
Ruff, Holly A.; And Others
Trajectory planning of redundant manipulator is a very active area since many tasks are requiring special characteristics to be satisfied. The importance of redundant manipulators has been increased for the last two decades because of the possibility to avoid singularities as well as obstacles within the course of motion. A soft motion planning for redundant planar manipulators is introduced in
Atef A. Ata; Mohamed Y. Sa'adah
Ultrasonic particle manipulation tools have many promising applications in life sciences research, expanding on the capabilities of current manipulation technologies. In this paper the feasibility of ultrasonic manipulation of particles and cells along a microfluidic channel with an array is investigated. An array integrated into a multilayer resonator structure drives particles towards the pressure nodal plane along the axis of
Christine Demore; Yongqiang Qiu; Sandy Cochran; Peter Glynne-Jones; Congwei Ye; Martyn Hill
Individuals can manipulate the behavior of social partners. However, manipulation may conflict with the fitness interests of the manipulated individuals. Manipulated individuals can then be favored to resist manipulation, possibly reducing or eliminating the manipulated behavior in the long run. I use a mathematical model to show that conflicts where manipulation and resistance coevolve can disappear as a result of the coevolutionary process. I find that while manipulated individuals are selected to resist, they can simultaneously be favored to express the manipulated behavior at higher efficiency (i.e., providing increasing fitness effects to recipients of the manipulated behavior). Efficiency can increase to a point at which selection for resistance disappears. This process yields an efficient social behavior that is induced by social partners, and over which the inducing and induced individuals are no longer in conflict. A necessary factor is costly inefficiency. I develop the model to address the evolution of advanced eusociality via maternal manipulation (AEMM). The model predicts AEMM to be particularly likely in taxa with ancestrally imperfect resistance to maternal manipulation. Costly inefficiency occurs if the cost of delayed dispersal is larger than the benefit of exploiting the maternal patch. I discuss broader implications of the process. PMID:24725252
Viewgraphs on active damping in a flexible manipulator are presented. Topics covered include: Shuttle Remote Manipulator System (SRMS); flexible structures; vibration; modeling of a flexible manipulator dynamical structure; designing control law criterion that minimizes vibration; and candidate application of fuzzy logic control law to the problem.
Pham, Trung T.
This paper presents our approach to extending the niche of behaviour-based robotics towards manipulation. We use results from neuroscience to derive some qualitative design rules for the mechanics of the manipulator, resulting in a next-generation manipulator, the 'soft arm'. By defining the basic behaviours of the manipulator as trajectory producing behaviours (which is also biologically plausible), we have designed a
B. J. W. Waarsing; M. Nuttin; H. Van Brussel; B. Corteville
This paper proposes an architecture of the wireless monitoring system for the real-time monitoring of the orthopedic implants, which monitors the implant duty cycle, detects abnormal asymmetry, high amounts of force, and other conditions of the orthopedic implants. Data for diagnosis are communicated wirelessly by the radio-frequency (RF) signal between the embedded chip and the remote circuit. In different working modes, the system can be powered by the RF signal or stiff lead zirconate-titanate (PZT) ceramics which are able to convert mechanical energy inside the orthopedic implant into electrical energy. The power circuits with a variable ratio switched-capacitor (SC) dc-dc converter have been taped out with 0.35-mum complementary metal-oxide semiconductor (CMOS) technology. The test results show that the SC converter can transfer the input voltage that ranges from 5 V to 14 V from the PZT ceramics into the voltage ranging from 2 V to 2.5 V which will be dealt with by a low drop-out circuit in the future work. The total efficiency of the SC converter is from 28% to 42% at full-time working mode. The analog-to-digital converter (ADC) circuits have been fabricated in a 0.18-mum 1P6M CMOS process. The test results show that the ADC chip consumes only 12.5 muW in working mode and 150 nW in the sleep mode. The circuits, including RF circuits, ADC, and the microcontrol unit, have been implemented in a 0.18-mu m CMOS process. Future work includes some clinical experiments test in the application where PZT elements are used for power generation in total knee-replacement implants. PMID:23853291
Hong Chen; Ming Liu; Wenhan Hao; Yi Chen; Chen Jia; Chun Zhang; Zihua Wang
Background Locus of pain control (LPC) is characterized by the behavior of people coping with their health problems, as a result of their own actions (internal control) or external factors or other people (external control). This parameter can be associated with medication adherence, in addition to other psychosocial factors that may also influence this behavior. This study was performed to investigate the influence of the LPC on medication adherence in patients undergoing an orthopedic procedure. Subjects and methods We conducted a prospective cohort study on patients who attended an orthopedic clinic for arthroscopy treatment. The patients’ LPC and pain intensity data were obtained on the day of admission through the use of the LPC scale and the visual analog scale (VAS), respectively, both being validated tools. After arthroscopic surgery, the patients received drug prescriptions and were reassessed after 15 days regarding treatment adherence, using the Morisky test. A P-value <0.05 was considered statistically significant. Results We assessed 79 individuals from both the internal LPC group (n=35) and external LPC group (n=44) and found that there were no group differences in sex, affected limb, cause of injury, repetitive strain injury, duration of pain, or pain intensity. However, there was a higher proportion of patients in the external LPC group that adhered to the prescribed medication compared with the internal LPC group (P<0.01). Conclusion The results showed that among patients who underwent an orthopedic procedure, there was a higher adherence rate to prescribed medication in the external LPC group compared with the internal LPC group.
Porto, Thaisy Mendes; Machado, Daniele Caferatti; Martins, Rafael Olivio; Galato, Dayani; Piovezan, Anna Paula
Venous thromboembolism (VTE) is one of the most common preventable cause of morbidity and mortality after trauma. Though most of the western countries have their guidelines for thromboprophylaxis in these patients, India still does not have these. The increasing detection of VTE among Indian population, lack of awareness, underestimation of the risk, and fear of bleeding complications after chemical prophylaxis have made deep vein thrombosis (DVT) a serious problem, hence a standard guideline for thromboprophylaxis after trauma is essential. The present review article discusses the incidence of DVT and role of thromboprophylaxis in Indian patients who have sustained major orthopedic trauma. A thorough search of ‘PubMed’ and ‘Google Scholar’ revealed 10 studies regarding venous thromboembolism in Indian patients after major orthopedic trauma surgery (hip or proximal femur fracture and spine injury). Most of these studies have evaluated venous thromboembolism in patients of arthroplasty and trauma. The incidence, risk factors, diagnosis and management of VTE in the subgroup of trauma patients (1049 patients) were separately evaluated after segregating them from the arthroplasty patients. Except two studies, which were based on spinal injury, all other studies recommended screening/ thromboprophylaxis in posttraumatic conditions in the Indian population. Color Doppler was used as common diagnostic or screening tool in most of the studies (eight studies, 722 patients). The incidence of VTE among thromboprophylaxis-receiving group was found to be 8% (10/125), whereas it was much higher (14.49%, 40/276) in patients not receiving any form of prophylaxis. Indian patients have definite risk of venous thromboembolism after major orthopedic trauma (except spinal injury), and thromboprophylaxis either by chemical or mechanical methods seems to be justified in them.
Sen, Ramesh K; Tripathy, Sujit K; Singh, Amit K
The management of pediatric patients with complex spinal deformity often requires both an orthopedic and a neurosurgical intervention. The reasons for multiple subspecialty involvement include, but are not limited to, the presence of a tethered cord requiring release or a syrinx requiring decompression. It has been common practice to perform these procedures in a staged manner, although there is little evidence in the literature to support separate interventions. We reviewed a series of consecutive patients who underwent spinal deformity correction and a neurosurgical intervention concurrently in an attempt to assess the safety, efficacy, and possible complications associated with such an approach. Eleven patients were reviewed who underwent concurrent orthopedic and neurosurgical procedures. Data were collected for patient demographics, preoperative diagnosis, procedures performed, intraoperative and perioperative complications, as well as any unexpected return to the operating room for any reason. Operative notes and anesthesia records were reviewed to determine estimated blood loss, surgical time, and the use of intraoperative neurological monitoring. Patient diagnoses included myelodysplasia (N=6), congenital scoliosis and/or kyphosis (N=4), and scoliosis associated with Noonan syndrome (N=1). Age at the time of surgery averaged 9 years 2 months (range=14 months to 17 years 2 months). Estimated blood loss averaged 605 ml (range=50-3000 ml). The operative time averaged 313 min (range=157-477 min). There were no intraoperative complications, including incidental dural tears or deterioration in preoperative neurological status. One patient developed a sore associated with postoperative cast immobilization that led to a deep wound infection. It appears that concurrent orthopedic and neurosurgical procedures in pediatric patients with significant spinal deformities can be performed safely and with minimal intraoperative and postoperative complications when utilizing modern surgical and neuromonitoring techniques. Level of evidence=Level IV. PMID:22863686
Mooney, James F; Glazier, Stephen S; Barfield, William R
Neck pain is an extremely common symptom with many possible etiologies. A substantial number of patients are turning to complementary and alternative medicine (CAM). Low-quality evidence supports the beneficial effects of CAM. Feldenkrais, massage therapy, and spinal manipulation are discussed in detail. Complications are generally benign and self-limited, although occasional catastrophic consequences have been documented. Despite the favorable opinion many rheumatologists have of some CAM therapy, many patients are not disclosing CAM use to their medical providers. By expressing interest, asking questions, and taking a shared-decision-making approach, providers can encourage disclosure and provide valuable input. PMID:23666468
Plastaras, Christopher; Schran, Seth; Kim, Natasha; Darr, Deborah; Chen, Mary Susan
A high consumption of clindamycin was noted in an orthopedics ward with high rates of Clostridium difficile infection (CDI). We restricted clindamycin for the entire ward. A reduction of 88% in CDI (1.07 to 0.12 × 1,000 patients-days, P = .056) and 84% for all-cause diarrhea (2.40 to 0.38 × 1,000 patients-days, P = .021) was achieved. Clindamycin was reduced 92.61% without an increase in other antibiotics. We identified high consumption of clindamycin as a risk factor for CDI. PMID:24837129
Cruz-Rodríguez, Nora Cecilia; Hernández-García, Raúl; Salinas-Caballero, Ana Gabriela; Pérez-Rodríguez, Edelmiro; Garza-González, Elvira; Camacho-Ortiz, Adrián
A clear cell hidradenoma is a rare dermal tumor, which is believed to originate from the apical portion of the sweat glands. The usual size reported is 5–30 mm. It is generally found in the head, face, and upper extremity regions. This lesion has not been reported to be large enough to impinge a joint range of motion. Hence, its description in the orthopedic literature is extremely rare. We present a giant benign nodular hidradenoma presenting as painful restriction of the right shoulder joint in a 35-year-old male.
Singhal, Vibhore; Sharma, Sansar C.; Anil, Juyal; Sachan, P. K.; Harsh, Meena; Singhal, Surina; Raghuvanshi, Shailendra
Penile strangulation is an infrequent clinical condition that has widely been reported. It usually results following placement of a constriction device to enhance sexual stimulation. Early treatment is essential to avoid potential complications, including ischemic necrosis and autoamputation. We describe the use of a Large Orthopedic Pin Cutter to remove a metal penile constriction device in the Emergency Department (ED). This case report describes the relatively safe technique of using an instrument available in many hospitals that can be added to the physician's arsenal in the removal of metal constriction devices.
Wenzler, David; Fischer, Melissa
Negative pressure wound therapy is a popular treatment for the management of both acute and chronic wounds. Its use in trauma and orthopedics is diverse and includes the acute traumatic setting as well as chronic troublesome wounds associated with pressure sores and diabetic foot surgery. Efforts have been made to provide an evidence base to guide its use however this has been limited by a lack of good quality evidence. The following review article explores the available evidence and describes future developments for its use in trauma and orthopaedic practice.
A, Novak; Khan, Wasim S; J, Palmer
The operator's ability to perform five manipulator tip movements while using monoptic and stereoptic video systems was assessed. Test data obtained were compared with previous results to determine the impact of camera placement and stereoptic viewing on manipulator system performance. The tests were performed using the NASA MSFC extendible stiff arm Manipulator and an analog joystick controller. Two basic manipulator tasks were utilized. The minimum position change test required the operator to move the manipulator arm to touch a target contract. The dexterity test required removal and replacement of pegs.
Brye, R. G.; Frederick, P. N.; Kirkpatrick, M., III; Shields, N. L., Jr.
Robots involved in high value manipulation must be effectively coupled to a human operator either at the work-site or remotely connected via communication links. In order to make use of experimental performance evaluation data, models must be developed. Powerful models of remote manipulation by humans can be used to predict manipulation performance in future systems based on today's laboratory systems. In this paradigm, the models are developed from experimental data, and then used to predict performance in slightly different situations. Second, accurate telemanipulation will allow design of manipulation systems which extend manipulation capability beyond its current bounds.
Robotic manipulators carried by future spacecraft are expected to perform important tasks in space, such as the servicing of satellites. However, the performance of these systems could be severely degraded by dynamic disturbances to the spacecraft caused by manipulator motions. This paper presents a method for representing the dynamics of space manipulator systems using the recently developed Virtual Manipulator (VM) concept. This representation is then applied to develop algorithms which can be used to plan manipulator motions that minimize disturbances of the spacecraft.
Vafa, Z.; Dubowsky, S.
Spin dynamics of polarized deuteron beams near depolarization resonances, including a new polarization preservation concept based on specially-designed multiple resonance crossings, has been tested in a series of experiments in the COSY synchrotron. Intricate spin dynamics with sophisticated pre-programmed patterns as well as effects of multiple crossings of a resonance were studied both theoretically and experimentally with excellent agreement. Possible applications of these results to preserve, manipulate and spin-flip polarized beams in synchrotrons and storage rings are discussed.
Morozov, V S; Krisch, A D; Leonova, M A; Raymond, R S; Sivers, D W; Wong, V K; Hinterberger, F; Kondratenko, A M
Staphylococcus aureus is a facultative anaerobic Gram-positive coccus and a member of the normal skin flora, as well as that of the nasal passages of humans. However, S. aureus can also gain entry into the host and cause life-threatening infections or persist as disease foci that develop into suppurative abscesses. While genetically tractable, the manipulation of S. aureus remains challenging. This unit describes methods developed in our laboratory for gene disruption by allelic replacement and transposition. We also provide a protocol for bacteriophage-mediated transduction of mutants marked with selectable alleles and describe plasmid utilization for complementation studies. PMID:24510849
Schneewind, Olaf; Missiakas, Dominique
... that cut into bone to remove inflammatory cells. Antibiotic Resistance Antibiotics successfully treat most infections caused by bacteria. However, some microorganisms are developing resistance to standard antibiotic treatments. Each time you use an antibiotic, bacteria ...
Both early and late complications following open reduction and internal fixation of proximal humerus fractures have been reported extensively in the literature. Although orthopedic implants are known to cause irritation and inflammation, to our knowledge, this is the first case report to describe a patient with rice bodies secondary to an orthopedic implant. Although the etiology of rice bodies is unclear, histological studies reveal that they are composed of an inner amorphous core surrounded by collagen and fibrin. The differential diagnosis in this case included synovial chondromatosis, infection, and the formation of a malignant tumor. Additional imaging studies, such as magnetic resonance imaging, and more specific tests were necessary to differentiate the rice bodies due to bursitis versus neoplasm, prior to excision. The patient presented 5 years following open reduction and internal fixation of a displaced proximal humerus fracture, with swelling in the area of the previous surgical site. Examination revealed a large, painless tumor-like mass on the anterior aspect of the shoulder. The patient's chief concern was the unpleasant aesthetic of the mass; no pain was reported. Upon excision of the mass, the patient's full, painless range of motion returned. PMID:23365810
Urruela, Adriana M; Rapp, Timothy B; Egol, Kenneth A
Natural bone consists of hard nanostructured hydroxyapatite (HA) in a nanostructured protein-based soft hydrogel template (ie, mostly collagen). For this reason, nanostructured HA has been an intriguing coating material on traditionally used titanium for improving orthopedic applications. In addition, helical rosette nanotubes (HRNs), newly developed materials which form through the self-assembly process of DNA base pair building blocks in body solutions, are soft nanotubes with a helical architecture that mimics natural collagen. Thus, the objective of this in vitro study was for the first time to combine the promising attributes of HRNs and nanocrystalline HA on titanium and assess osteoblast (bone-forming cell) functions. Different sizes of nanocrystalline HA were synthesized in this study through a wet chemical precipitation process following either hydrothermal treatment or sintering. Transmission electron microscopy images showed that HRNs aligned with nanocrystalline HA, which indicates a high affinity between both components. Some of the nanocrystalline HA formed dense coatings with HRNs on titanium. More importantly, results demonstrated enhanced osteoblast adhesion on the HRN/nanocrystalline HA-coated titanium compared with conventional uncoated titanium. Among all the HRN/nanocrystalline HA coatings tested, osteoblast adhesion was the greatest when HA nanometer particle size was the smallest. In this manner, this study demonstrated for the first time that biomimetic HRN/nanocrystalline HA coatings on titanium were cytocompatible for osteoblasts and, thus, should be further studied for improving orthopedic implants. PMID:18990941
Zhang, Lijie; Chen, Yupeng; Rodriguez, Jose; Fenniri, Hicham; Webster, Thomas J
Patients undergoing arthroplasty or other orthopedic surgery show a high risk of venous thromboembolism (VTE), involving mortality, morbidity, and social costs; however, the risk for VTE in minor orthopedic surgery should not be underestimated and antithrombotic prophylaxis may be required. According to the literature, low-molecular-weight heparins (LMWHs) are more effective in preventing VTE than unfractionated heparins (UFHs) or vitamin K antagonists, and have a lower hemorrhagic risk. By comparing different prophylactic regimens, it has been shown that starting the prophylaxis near the time of the operation is the most critical point for efficacy, whether or not the first dose is administered pre- or post-operatively. Moreover, most thromboembolic complications are observed after discharge and, therefore, many clinicians advocate continuing prophylaxis for longer times (6–8 weeks) in order to further reduce the rate for VTE. The literature on parnaparin, a new LMWH, in VTE prophylaxis was reviewed. Parnaparin is equally effective as UFH, but it offers the advantages of a once-daily administration and improved tolerability, thus allowing the home management of patients with no need for laboratory coagulation tests.
Bugamelli, Stefano; Zangheri, Elena; Montebugnoli, Milena; Guerra, Lucia
The focus of this study was to fabricate and investigate the mechanical behavior of porous poly(para-phenylene) (PPP) for potential use as a load-bearing orthopedic biomaterial. PPPs are known to have exceptional mechanical properties due to their aromatic backbone; however, the manufacturing and properties of PPP porous structures have not been previously investigated. Tailored porous structures with either small (150-250µm) or large (420-500µm) pore sizes were manufactured using a powder-sintering/salt-leaching technique. Porosities were systematically varied using 50 to 90vol%. Micro-computed tomography (µCT) and scanning electron microscopy (SEM) were used to verify an open-cell structure and investigate pore morphology of the scaffolds. Uniaxial mechanical behavior of solid and porous PPP samples was characterized through tensile and compressive testing. Both modulus and strength decreased with increasing porosity and matched well with foam theory. Porous scaffolds showed a significant decrease in strain-to-failure (<4%) under tensile loading and experienced linear elasticity, plastic deformation, and densification under compressive loading. Over the size ranges tested, pore size did not significantly influence the mechanical behavior of the scaffolds on a consistent basis. These results are discussed in regards to use of porous PPP for orthopedic applications and a prototype porous interbody fusion cage is presented. PMID:24374261
DiRienzo, Amy L; Yakacki, Christopher M; Frensemeier, Mareike; Schneider, Andreas S; Safranski, David L; Hoyt, Anthony J; Frick, Carl P
Presently, orthopedic and oral/maxillofacial implants represent a combined $2.8 billion market, a figure expected to experience significant and continued growth. Although traditional permanent implants have been proved clinically efficacious, they are also associated with several drawbacks, including secondary revision and removal surgeries. Non-permanent, biodegradable implants offer a promising alternative for patients, as they provide temporary support and degrade at a rate matching tissue formation, and thus, eliminate the need for secondary surgeries. These implants have been in clinical use for nearly 25 years, competing directly with, or maybe even exceeding, the performance of permanent implants. The initial implantation of biodegradable materials, as with permanent materials, mounts an acute host inflammatory response. Over time, the implant degradation profile and possible degradation product toxicity mediate long-term biodegradable implant-induced inflammation. However, unlike permanent implants, this inflammation is likely to cease once the material disappears. Implant-mediated inflammation is a critical determinant for implant success. Thus, for the development of a proactive biodegradable implant that has the ability to promote optimal bone regeneration and minimal detrimental inflammation, a thorough understanding of short- and long-term inflammatory events is required. Here, we discuss an array of biodegradable orthopedic implants, their associated short- and long- term inflammatory effects, and methods to mediate these inflammatory events.
Amini, Ami R.; Wallace, James S.; Nukavarapu, Syam P.
This descriptive, correlational study was conducted to determine orthopedic patients' night-time pain characteristics, their quality of sleep and the contributing factors to poor sleep experiences, and the relationship between pain and sleep. Data were collected by using the McGill Pain Questionnaire-SF (MPQ-SF) and Pittsburgh Sleep Quality Index (PSQI) on the second postoperative day. Data were analyzed using the SPSS version 10.0 for Windows. Mean age of the 75 patients was 49.55 ± 21.10 years and were hospitalized in the orthopedic wards for 10.56 ± 14.74 days. Of the sample, 65.3% were female and 36% had hip/knee arthroplasty surgery. Pain (45%) and noise (23%) were found to be the most cited factors affecting the sleep of patients in postoperative periods. They experienced "external" pain at the surgical site and verbalized their pain as "stabbing" and "tiring-exhausting." Patients' night-time pain was determined to be severe (6.59 ± 1.62); their quality of sleep was also poor (9.24 ± 3.53). A statistically significant correlation was found between patients' pain intensity and quality of sleep (p?.05). PMID:21521827
Büyükyilmaz, Funda Esen; ?endir, Merdiye; Acaro?lu, Rengin
Magnesium (Mg) has a long history of investigation as a degradable biomaterial. Physicians first began using Mg for biomedical applications in the late 19th century. Experimentation continued with varying levels of success until the mid-20th century when interest in the metal waned. In recent years the field of Mg-based biomaterials has once again become popular, likely due to advancements in technology allowing improved control of corrosion. Although this has led to success in vascular applications, continued difficulties in predicting and controlling the corrosion rate of Mg in an intraosseous environment has impeded the development of Mg-based biomaterials for orthopedic applications. In this review, an initial summary of the basic properties and the physiological role of Mg are followed by a discussion of the physical characteristics of the metal which lend it to use as a degradable biomaterial. A description of the historical and modern applications for Mg in the medical field is followed by a discussion of the methods used to control and assess Mg corrosion, with an emphasis on alloying. The second part of this review concentrates on the methods used to assess the corrosion and biocompatibility of Mg-based orthopedic biomaterials. This review provides a summary of Mg as a biomaterial from a biological perspective. © 2014 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 102B: 1316-1331, 2014. PMID:24458999
Walker, Jemimah; Shadanbaz, Shaylin; Woodfield, Timothy B F; Staiger, Mark P; Dias, George J
Natural bone consists of hard nanostructured hydroxyapatite (HA) in a nanostructured protein-based soft hydrogel template (ie, mostly collagen). For this reason, nanostructured HA has been an intriguing coating material on traditionally used titanium for improving orthopedic applications. In addition, helical rosette nanotubes (HRNs), newly developed materials which form through the self-assembly process of DNA base pair building blocks in body solutions, are soft nanotubes with a helical architecture that mimics natural collagen. Thus, the objective of this in vitro study was for the first time to combine the promising attributes of HRNs and nanocrystalline HA on titanium and assess osteoblast (bone-forming cell) functions. Different sizes of nanocrystalline HA were synthesized in this study through a wet chemical precipitation process following either hydrothermal treatment or sintering. Transmission electron microscopy images showed that HRNs aligned with nanocrystalline HA, which indicates a high affinity between both components. Some of the nanocrystalline HA formed dense coatings with HRNs on titanium. More importantly, results demonstrated enhanced osteoblast adhesion on the HRN/nanocrystalline HA-coated titanium compared with conventional uncoated titanium. Among all the HRN/nanocrystalline HA coatings tested, osteoblast adhesion was the greatest when HA nanometer particle size was the smallest. In this manner, this study demonstrated for the first time that biomimetic HRN/nanocrystalline HA coatings on titanium were cytocompatible for osteoblasts and, thus, should be further studied for improving orthopedic implants.
Zhang, Lijie; Chen, Yupeng; Rodriguez, Jose; Fenniri, Hicham; Webster, Thomas J
Different orthopedic tests are used to evaluate internal derangements of joints. Radiologic examinations like magnetic resonance (MR) imaging are ordered on the basis of results of these tests to narrow the clinical diagnosis and formulate a treatment plan. Although these tests are clinically useful, the test terminology can be confusing and the significance of the tests not clearly understood. This article helps explain the clinical jargon of tests performed for the major joints of the upper extremity and their proper use and diagnostic value in conjunction with MR imaging. The article presents a structured algorithmic approach to explain the tests. For each joint, a hierarchy of clinical tests is performed, starting with general observation and range of motion, followed by more specific tests tailored to evaluate individual or grouped anatomic structures. MR imaging findings and clinical tests complement each other in making a final diagnosis. However, because of the varied sensitivity and specificity of the clinical tests and MR imaging, it is important to be familiar with their diagnostic value before making clinical decisions. Knowledge of clinical jargon and the proper use and diagnostic value of orthopedic tests can aid in interpretation of radiologic images by focusing search patterns, thus allowing comprehensive evaluation and optimized reporting. It also enhances communication with the orthopedist, thereby helping maintain continuity of care. Online supplemental material is available for this article. PMID:24617698
Pandey, Tarun; Slaughter, Aubrey J; Reynolds, Kirk A; Jambhekar, Kedar; David, Ryan M; Hasan, S Ashfaq
Our current in Mexico is that it represents a serious health problem not yet recognized as low-energy fractures in older adults account for approximately 10% of subjects over 65 years (compared with 29% in Japan) about 4.4 million fractures in patients over 70 years, taking into account that we are a nation of 112 million, the problem is minor compared with other diseases in this and other population groups. In the Mexican health system, orthopedic services instead share with other health priorities, so that the authorities do not understand osteoporosis as a health problem, not observe increased morbidity and mortality that implicitly leads, there are few centers to support the diagnosis of osteoporosis (densitometers do not have), and recruitment, diagnosis and management of patients who have suffered a broken ground mechanically compromised. Have increased the frequency of fractures in osteoporotic ground, and institutional level has only treatments based on calcitriol and calcium to maintain bone mineral density. In the Mexican health system, orthopedic services instead share with other health priorities, so that the authorities do not understand osteoporosis as a health problem, not observe increased morbidity and mortality that implicitly leads, there are few centers to support the diagnosis of osteoporosis (we don't count with densitometers), and recruitment, diagnosis and management of patients who have suffered a broken ground mechanically compromised. Have increased the frequency of fractures in osteoporotic ground, and institutional level has only treatments based on calcitriol and calcium to maintain bone mineral density. PMID:22509637
Cymet-Ramírez, J; Cisneros-Dreinhofer, F A; Alvarez-Martínez, M M; Cruz-González, I; de la Fuente-Zuno, J C; Figueroa-Cal y Mayor, F J; García-López, O F; Gómez-García, F; Mirassou-Ortega, M; Legorreta-Cuevas, J G; Medinaveitia, A; Nájera-Castro, M A; Sierra-Martínez, O; Ojeda-Padilla, E A; Suárez-Espinosa, V F; Vallejo-Almada, J; Valles-Figueroa, J F; Villalobos-Garduño, F E; Vázquez-Camacho, L
Hip fracture is one of the most common orthopedic conditions and is associated with significant morbidity and mortality. With a progressively aging population, the annual incidence of hip fracture is expected to increase substantially. Emerging evidence suggests that early surgery (<24 h) minimizes complications secondary to immobilization, including orthostatic pneumonia and venous thromboembolism. Delayed surgical repair (>48 h) has been consistently demonstrated to be associated with an increased risk of 30-day and 1-year mortality. Nonetheless, early surgery necessitates a shorter time for preoperative medical preparation, in particular cardiac assessment. Patients who undergo emergent orthopedic surgery are therefore at greater risk of perioperative cardiac events than those who undergo elective surgery. In addition, the prompt triage system for preoperative cardiac assessment not only identifies patients at high risk of perioperative cardiac complications but also reduces unnecessary cardiac consultations for low-risk patients. We review the current recommendations for preoperative cardiac assessment adapted for patients with hip fracture and describe our current triage system for preoperative cardiac consultation. PMID:21057998
Siu, C W; Sun, N C H; Lau, T W; Yiu, K H; Leung, F; Tse, H F
The potential of barium titanate (BT) to be electrically active makes it a material of interest in regenerative medicine. To enhance the understanding of this material for orthopedic applications, the in vitro biocompatibility of porous BT fabricated using a direct foaming technique was investigated. Characterization of the resultant foams yielded an overall porosity between 50 and 70% with average pore size in excess of 30 µm in diameter. A mouse osteoblast (7F2) cell line was cultured with the BT to determine the extent of the foams' toxicity using a LDH assay. After 72 h, BT foams showed a comparable cytotoxicity of 6.4?±?0.8% to the 8.4?±?1.5% of porous 45S5 Bioglass®. The in vitro inflammatory response elicited from porous BT was measured as a function of tumor necrosis factor alpha (TNF-?) secreted from a human monocytic leukemia cell line (THP-1). Results indicate that the BT foams do not cause a significant inflammatory response, eliciting a 9.4?±?1.3 pg of TNF-? per mL of media compared with 20.2?±?2.3 pg/mL from untreated cells. These results indicate that porous BT does not exhibit short term cytotoxicity and has potential for orthopedic tissue engineering applications. © 2013 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 102A: 2089-2095, 2014. PMID:23894063
Ball, Jordan P; Mound, Brittnee A; Nino, Juan C; Allen, Josephine B
Background Angular deformities about the knee are one of the common disorders. High Tibial osteotomy is a way of correcting the deformity. Although the general agreement is focused toward the open wedge technique, discussion about the type of device is a subject to debate. Objectives This current study has attempted to evaluate the results of Orthopedic Dual Sliding Compression Plate (ODSCP) in high medial open wedge osteotomies of the tibia. Patients and Methods In this cross-sectional study, 16 patients with genuvarum undergone high medial tibial open wedge osteotomy and fixed by Orthopedic Dual Sliding Compression Plate. At the time of the last follow up visit, Lysholm score was gathered. Results The mean follow-up time was 9.33 ± 1.87 month. The average age was 45.13 ± 7.25 years. Three patients were male and 13 patients were female. The lysholm score showed a significant difference before and after surgery. Conclusions The ODSCP has many advantages over the other type of plates. It can help the surgeon to operate with a relaxed mind and it is advisable for high tibial medial open wedge osteotomies.
Samani, Seyed Salman; Kachooei, Amir Reza; Ebrahimzadeh, Mohammad Hosein; Omidi Kashani, Farzad; Mahdavian Naghashzargar, Reza; Razi, Shiva
Dentofacial Orthopedics directed to a hypoplastic maxilla in the prepubertal period redirects growth of the maxilla in the vertical, transverse and sagittal planes of space. The orthopedic correction of maxillary hypoplasia in the early mixed dentition period thus intercepts the establishment of permanent structural asymmetry in the mandible and helps in the achievement of optimal dentofacial esthetics. This paper presents the growth redirection in a hypoplastic maxilla of an 8-year-old girl with simultaneous rapid maxillary expansion and protraction headgear therapy for a period of 11 months which corrected the posterior unilateral cross-bite, the positional asymmetry of the mandible and established an orthognathic profile in the individual.
Talapaneni, Ashok Kumar; Kumar, Karnati Praveen; Kommi, Pradeep Babu; Nuvvula, Sivakumar
BACKGROUND: This study was designed to obtain data on the incidence of postoperative infection in patients undergoing elective orthopedic surgery and receiving white blood cell (WBC)-filtered blood components pre- pared according to current standards. STUDY DESIGN AND METHODS: A total of 308 con- secutive orthopedic patients who opted for preoperative autologous blood donation (PAD) for primary unilateral hip and knee
Petra Innerhofer; Anton Klingler; Christian Klimmer; Dietmar Fries; Walter Nussbaumer
The objectives of this report are to review the assessment of patient-focused outcomes in pediatric orthopedic surgery, to describe a framework for identifying appropriate sets of measures, and to illustrate an application of the framework to a challenging orthopedic problem. A detailed framework of study design and measurement factors is described. The factors are important for selecting appropriate instruments to
William Furlong; Ronald D Barr; David Feeny; Suzanne Yandow
A mobile remote manipulator system is disclosed for assembly, repair and logistics transport on, around and about a space station square bay truss structure. The vehicle is supported by a square track arrangement supported by guide pins integral with the space station truss structure and located at each truss node. Propulsion is provided by a central push-pull drive mechanism that extends out from the vehicle one full structural bay over the truss and locks drive rods into the guide pins. The draw bar is now retracted and the mobile remote manipulator system is pulled onto the next adjacent structural bay. Thus, translation of the vehicle is inchworm style. The drive bar can be locked onto two guide pins while the extendable draw bar is within the vehicle and then push the vehicle away one bay providing bidirectional push-pull drive. The track switches allow the vehicle to travel in two orthogonal directions over the truss structure which coupled with the bidirectional drive, allow movement in four directions on one plane. The top layer of this trilayered vehicle is a logistics platform. This platform is capable of 369 degees of rotation and will have two astronaut foot restraint platforms and a space crane integral.
Bush, Harold G. (inventor); Mikulas, Martin M., Jr. (inventor); Wallsom, Richard E. (inventor); Jensen, J. Kermit (inventor)
The discovery of the third domain of life, the Archaea, is one of the most exciting findings of the last century. These remarkable prokaryotes are well known for their adaptations to extreme environments; however, Archaea have also conquered moderate environments. Many of the archaeal biochemical processes, such as methane production, are unique in nature and therefore of great scientific interest. Although formerly restricted to biochemical and physiological studies, sophisticated systems for genetic manipulation have been developed during the last two decades for methanogenic archaea, halophilic archaea and thermophilic, sulfur-metabolizing archaea. The availability of these tools has allowed for more complete studies of archaeal physiology and metabolism and most importantly provides the basis for the investigation of gene expression, regulation and function. In this review we provide an overview of methods for genetic manipulation of Methanosarcina spp., a group of methanogenic archaea that are key players in the global carbon cycle and which can be found in a variety of anaerobic environments. PMID:22837755
Kohler, Petra R A; Metcalf, William W
The robotic manipulator can be decomposed into distinct subsytems. One particular area of interest of mechanical subsystems is electromechanical actuators (or drives). A drive is defined as a motor with an appropriate transmission. An overview is given of existing, as well as state-of-the-art drive systems. The scope is limited to space applications. A design philosophy and adequate requirements are the initial steps in designing a space-qualified actuator. The focus is on the d-c motor in conjunction with several types of transmissions (harmonic, tendon, traction, and gear systems). The various transmissions will be evaluated and key performance parameters will be addressed in detail. Included in the assessment is a shuttle RMS joint and a MSFC drive of the Prototype Manipulator Arm. Compound joints are also investigated. Space imposes a set of requirements for designing a high-performance drive assembly. Its inaccessibility and cryogenic conditions warrant special considerations. Some guidelines concerning these conditions are present. The goal is to gain a better understanding in designing a space actuator.
Chun, W.; Brunson, P.
The design and experimental testing of end point position controllers for a very flexible one link lightweight manipulator are summarized. The latest upgraded version of the experimental set up, and the basic differences between conventional joint angle feedback and end point position feedback are described. A general procedure for application of modern control methods to the problem is outlined. The relationship between weighting parameters and the bandwidth and control stiffness of the resulting end point position closed loop system is shown. It is found that joint rate angle feedback in addition to the primary end point position sensor is essential for adequate disturbance rejection capability of the closed loop system. The use of a low order multivariable compensator design computer code; called Sandy is documented. A solution to the problem of control mode switching between position sensor sets is outlined. The proof of concept for endpoint position feedback for a one link flexible manipulator was demonstrated. The bandwidth obtained with the experimental end point position controller is about twice as fast as the beam's first natural cantilevered frequency, and comes within a factor of four of the absolute physical speed limit imposed by the wave propagation time of the beam.
Cannon, R. H., Jr.; Bindford, T. O.; Schmitz, E.
A six degree-of-freedom computer-controlled manipulator is examined, and the relationships between the arm's joint variables and 3-space are derived. Arm trajectories using sequences of third-degree polynomials to describe the time history of each joint variable are presented and two approaches to the avoidance of obstacles are given. The equations of motion for the arm are derived and then decomposed into time-dependent factors and time-independent coefficients. Several new and simplifying relationships among the coefficients are proven. Two sample trajectories are analyzed in detail for purposes of determining the most important contributions to total force in order that relatively simple approximations to the equations of motion can be used.
Lewis, R. A.
This paper suggests the use of a model based control law which uses joint rate feedback to stabilize the contact modes, and joint velocity feedforward to provide the required freespace performance throughout a task. An additional benefit of this controller is the capability to stiffen a soft manipulator. This provides an option for impedance control to provide any desired manipulator stiffness. Impedance control is implemented as an outer Cartesian loop which uses the dynamic relationship between manipulator commanded position and applied force to change the mechanical impedance through programmable filter coefficients. The impedance control discussed in this paper does not give the capability to specify the full impedance of the manipulator. However, it does give the capability to specify the manipulator Cartesian stiffness while maintaining stability in contact with the environment. This controller was designed for the Flight Telerobotic Servicer dextrous manipulator and has been validated experimentally on a single joint controller, as well as on 3 DOF planar arms.
Goldenberg, Stewart; Clark, William
The authors consider the dynamical modeling of robot manipulators whose joint actuators consist of motors driving the joints through gears. The dynamical models for such manipulators are significantly more complex than those for direct drive manipulators. The authors develop recursive O(n) inverse and forward dynamics algorithms as well as recursive O(n2) algorithms for the computation of the mass matrix for geared manipulators. It is shown that, despite the added complexity of the dynamical models for geared manipulators, the algorithms closely resemble the corresponding algorithms for direct drive manipulators, and that the additional algorithmic or computational complexity is relatively insignificant. As a consequence, with little additional cost, existing direct drive algorithms can be easily extended to handle the effects of gearing at the joints.
Jain, A.; Rodriguez, G.
Simplified scheme proposed for dynamic control of robotic manipulator having redundant joints; that is, extra degrees of freedom beyond needed to perform task, to position and orient end effector at specified position and/or move it along specified trajectory. Extra degrees of freedom used to perform simultaneous subtask. Scheme adaptive and based on observed performance of manipulator. Involves neither complicated mathematical model of dynamics of manipulator nor time-consuming inverse kinematic transformation.
There are two bridge type electromechanical manipulators within a nuclear fuel handling facility which were constructed over twenty-five years ago. At that time, there were only minimal seismic considerations. These manipulators together with the facility are being reactivated. Detailed analyses have shown that the manipulators will satisfy the requirements of ANSI\\/AISC N690-1984 when they are subjected to loadings including the
Ting-shu Wu; T. J. Moran
Report discusses spatial-operator algebra developed in recent studies of mathematical modeling, control, and design of trajectories of robotic manipulators. Provides succinct representation of mathematically complicated interactions among multiple joints and links of manipulator, thereby relieving analyst of most of tedium of detailed algebraic manipulations. Presents analytical formulation of spatial-operator algebra, describes some specific applications, summarizes current research, and discusses implementation of spatial-operator algebra in the Ada programming language.
Rodriguez, Guillermo; Kreutz, Kenneth K.; Milman, Mark H.
The performance of an orbital teleoperator system which includes small dextrous servicing manipulators to be used in satellite servicing was examined. System/operator performance testing was implemented and the results of a fine positioning control test using two different manipulator systems varying widely in manipulator configuration and control systems are presented. Fine position control is viewed as representing a fundamental requirement placed on manipulator control. The relationship of position control to more complex tasks which directly represent on-orbit servicing operations are also presented.
Kirkpatrick, M., III; Shields, N. L., Jr.; Frederick, P. N.; Brye, R.; Malone, T. B.
We have proposed the concept of reconfigurable manipulators as a solution to tasks that require varied configurations of manipulators. Using modules of varying sizes and performance specifications, it is possible to build manipulators to suit the task at hand. Our research is not only addressing the issue of creating such manipulators but also the interesting theoretical challenges posed in mapping tasks to manipulators. We have developed strategies that allow us to determine the kinematic and dynamic configuration of a non-redundant manipulator from task specifications such as reachability, obstacle avoidance, manipulability, joint, limits, and joint velocities and accelerations. We are presently extending this design methodology for design of redundant and fault tolerant manipulator systems. Further, we are also addressing issues in automatic generation of software for kinematics, dynamics, and controllers for the configured manipulators. During the next year, we will be demonstrating automatic generation of software on the prototype system that we are building. We expect to have 4 joint and link modules available for this demonstration. The joint and link modules will also incorporate concepts for making power and data connections when the mechanical connection is made. Further, they will also include electronics, housed within the module, for communication and real-time control.
Khosla, P.K.; Kanade, T.
Infertility studies are an important growing field, where new methods for the manipulation, enrichment and selection of sperm cells are required. Microfluidic techniques offer attractive advantages such as requirement of low sample volume and short processing times in the range of second or minutes. Presented here is the application of insulator-based dielectrophoresis (iDEP) for the enrichment and separation of mature and spermatogenic cells by employing a microchannel with cylindrical insulating structures with DC electric potentials in the range of 200-1500 V. The results demonstrated that iDEP has the potential to concentrate sperm cells and distinguish between mature and spermatogenic cells by exploiting the differences in shape which lead to differences in electric polarization. Viability assessments revealed that a significant percentage of the cells are viable after the dielectrophoretic treatment, opening the possibility for iDEP to be developed as a tool in infertility studies. PMID:23086549
Rosales-Cruzaley, E; Cota-Elizondo, P A; Sánchez, D; Lapizco-Encinas, Blanca H
The Dextrous Manipulation Laboratory is a project within the Design Division of the Department of Mechanical Engineering at Stanford University. The website describes some of the lab's past and current projects on robotic hands and tactile sensors, as well as teleoperated hands using haptic information. The two current projects highlighted include work on "a new class of biologically inspired robots" and progress made in developing "a telemanipulation system that allows a person to control a dexterous robotic hand in an intuitive manner." Various conference papers and theses from the Lab are posted online. Project pages provide overviews of the lab's research and development in hardware and software as well as video footage displaying some of its accomplishments. Research methods and system designs are further detailed in the Research sections of the project websites. Links to related course pages, research labs, and images make this a dynamic resource for anyone interested in robotics research.
A prototype of the RIPS architecture (Robotic Instruction Processing System) was developed. A two arm robot control experiment is underway to characterize the architecture as well as research multi-arm control. This experiment uses two manipulators to cooperatively position an object. The location of the object is specified by the host computer's mouse. Consequently, real time kinematics and dynamics are necessary. The RIPS architecture is specialized so that it can satisfy these real time constraints. The two arm experimental set-up is discussed. A major part of this work is the continued development of a good programming environment for RIPS. The C++ language is employed and favorable results exist in the targeting of this language to the RIPS hardware.
Wang, Yulun; Jordan, Steve; Mangaser, Amante; Butner, Steve
The development of robust genetic tools to manipulate Borrelia burgdorferi, the etiologic agent of Lyme disease, now allows investigators to assess the role(s) of individual genes in the context of experimental Lyme borreliosis. This unit is devoted to the description of experimental approaches that are available for the molecular genetic analysis of B. burgdorferi with an emphasis placed on the cultivation, electrotransformation, the selection of desired mutants, and the genetic complementation of the mutants acquired. The intent here is to provide a consensus protocol that encapsulates the methodologies currently employed by the B. burgdorferi research community and describe pertinent issues that must be accounted for when working with these pathogenic spirochetal bacteria.
Hyde, Jenny A.; Weening, Eric H.; Skare, Jon T.
Cell biologists have been afforded extraordinary new opportunities for experimentation by the emergence of powerful technologies that allow the selective manipulation of gene expression. Currently, RNA interference is very much in the limelight; however, significant progress has also been made with two other approaches. Thus, antisense oligonucleotide technology is undergoing a resurgence as a result of improvements in the chemistry of these molecules, whereas designed transcription factors offer a powerful and increasingly convenient strategy for either up- or down-regulation of targeted genes. This mini-review will highlight some of the key features of these three approaches to gene regulation, as well as provide pragmatic guidance concerning their use in cell biological experimentation based on our direct experience with each of these technologies. The approaches discussed here are being intensely pursued in terms of possible therapeutic applications. However, we will restrict our comments primarily to the cell culture situation, only briefly alluding to fundamental differences between utilization in animals versus cells.
Juliano, Rudy L.; Dixit, Vidula R.; Kang, Hyunmin; Kim, Tai Young; Miyamoto, Yuko; Xu, Dong
Background This study aims to determine the incidence of pulmonary embolism (PE) in trauma and orthopedic patients within a regional tertiary referral center and its association with the pattern of injury, type of treatment, co-morbidities, thromboprophylaxis and mortality. Methods All patients admitted to our institution between January 2010 and December 2011, for acute trauma or elective orthopedic procedures, were eligible to participate in this study. Our cohort was formed by identifying all patients with clinical features of PE who underwent Computed Tomography-Pulmonary Angiogram (CT-PA) to confirm or exclude the clinical suspicion of PE, within six months after the injury or the surgical procedure. Case notes and electronic databases were reviewed retrospectively to identify each patient’s venous thromboembolism (VTE) risk factors, type of treatment, thromboprophylaxis and mortality. Results Out of 18,151 patients admitted during the study period only 85 (0.47%) patients developed PE (positive CT-PA) (24 underwent elective surgery and 61 sustained acute trauma). Of these, only 76% of the patients received thromboprophylaxis. Hypertension, obesity and cardiovascular disease were the most commonly identifiable risk factors. In 39% of the cases, PE was diagnosed during the in-hospital stay. The median time of PE diagnosis, from the date of injury or the surgical intervention was 23 days (range 1 to 312). The overall mortality rate was 0.07% (13/18,151), but for those who developed PE it was 15.29% (13/85). Concomitant deep venous thrombosis (DVT) was identified in 33.3% of patients. The presence of two or more co-morbidities was significantly associated with the incidence of mortality (unadjusted odds ratio (OR)?=?3.52, 95% confidence interval (CI) (1.34, 18.99), P?=?0.034). Although there was also a similar clinical effect size for polytrauma injury on mortality (unadjusted OR?=?1.90 (0.38, 9.54), P?=?0.218), evidence was not statistically significant for this factor. Conclusions The incidence of VTE was comparable to previously reported rates, whereas the mortality rate was lower. Our local protocols that comply with the National Institute for Health and Clinical Excellence (NICE) guidelines in the UK appear to be effective in preventing VTE and reducing mortality in trauma and orthopedic patients.
We examined the effectiveness and safety of the combination of rifampin plus ofloxacin given orally for treating prosthetic orthopedic implants infected with staphylococci. The prospective cohort study was conducted in a referral public hospital with ambulatory care services between 1985 and 1991. Consecutive patients from whom Staphylococcus organisms susceptible to the study drugs were isolated from their orthopedic implants and who had no contraindication to the treatment were eligible for the study. All patients were treated orally with rifampin, 900 mg/day, plus ofloxacin, 600 mg/day. Patients with hip prosthesis infection were treated for 6 months, with removal of any unstable prostheses after 5 months of treatment; patients with knee prosthesis infection were treated for 9 months, with removal of the prosthesis after 6 months of treatment; and patients with infected bone plates were treated for 6 months, with removal of the plate after 3 months of treatment, if necessary. Monthly clinical evaluations were conducted until the completion of the treatment and follow-up or telephone interviews were conducted at 6, 12, 24, 36, 48, and 60 months thereafter. Treatment failures were documented by clinical evaluation, sampling of the infected site for culture and antibiotic activity measurement, and fistulography, if possible. Cure was defined as the absence of clinical, biological, and radiological evidence of infection 6 months after the completion of treatment, treatment failure was defined as the absence of cure, and relapse was defined as the reappearance of infection caused by the same Staphylococcus isolate that caused the original infection, regardless of the timing of this secondary infection. Among 51 patients included in the study and evaluable for safety, 4 patients had side effects and were not evaluable for treatment effectiveness; the overall success rate was 74% among 47 patients, with a success rate of 81% for the hip prosthesis group, 69% for the knee prosthesis group, and 69% for the osteosynthesis device group. Eight treatment failures were relaxed to the isolation of a resistant bacterium. The combination of rifampin administered orally plus ofloxacin is a suitable alternative to the conventional long-term intravenous therapy for treatment of orthopedic implants infected with staphylococci.
Drancourt, M; Stein, A; Argenson, J N; Zannier, A; Curvale, G; Raoult, D
Venous Thromboembolism (VTE) remains a major complication following orthopedic surgery despite heparin prophylaxis. Clinical consequences associated with this complication are deep vein thrombosis (DVT), pulmonary embolism, and long-term consequences of DVT, especially Postthrombotic syndrome (PTS). The purpose of the present study was to estimate the annual direct costs of VTE following major orthopedic surgery of the lower limb in France. This cost of illness study was performed by using available information from health system databases (1999) and literature and specific surveys (2002). Direct costs were calculated by using estimates of the number of patients with major orthopedic surgery in France during one year. Patients presenting with VTE were identified from the national disease-related group inpatient database. Additional resource consumption was identified by comparison with disease-related groups without the VTE complications. Ambulatory care costs after hospitalization, for recurrences and PTS, were estimated from specific surveys of general practitioners and venous disease specialists. Total annual costs of VTE associated with major orthopedic surgery for the French Sickness Fund were estimated to be approximately 60 million euros over 1 year with 28 million euros for inpatient care and 30 million euros for recurrences and PTS. PMID:17000893
Tilleul, Patrick; LaFuma, Antoine; Colin, Xavier; Ozier, Yves
Anatomic study of the pelvis of 30 fetuses and newborn children, yielded gave precise relationship between the sacrotuberous ligaments and size of the gluteal region. At birth, the distance between the posterior superior iliac spine and the ischium is 40 mm. Closure of the anterior defect in bladder exstrophy sometimes requires an orthopedic surgical procedure. Bilateral posterior iliac osteotomy and
P. Lascombes; G. Dautel; G. Grosdidier; J. Borrelly
Background: The increasing incidence of bacterial infections in orthopedic surgery might be related to the increasing application of artificial devices. In most cases, bacteria multiply on the surface of implants in biofilms. Poor penetration of antibiotics, frequent necessity of prosthesis removal, chronic processes and financial costs emphasize the significance of preventive measures. Method: Adhesion of bacterial strains (two Staphylococcus aureus,
Ildikó Kustos; Tamás Kustos; Ferenc Kilár; Gábor Rappai; Béla Kocsis
This dissertation focuses on the kinematics and control of robot manipulators. The contribution to kinematics is a fundamental theorem on the design of manipulators with six revolute joints. The theorem states, roughly speaking, that manipulators which have six revolute joints and are modeled after the human arm are optimal and essentially unique. In developing the mathematical framework to prove this theorem, we define precisely the notions of length of a manipulator, well-connected-workspace, and work-volume. We contribute to control a set of analysis techniques for the design of variable structure (sliding mode) controllers for manipulators. The organization of the dissertation is the following. After introductory remarks in chapter one, the group of proper rigid motions, G, is introduced in chapter two. The tangent bundle of G is introduced and it is shown that the velocity of a rigid body can be represented by an element in the Lie algebra of G (commonly called a twist). Further, rigid motions which are exponentials of twists are used to describe four commonly occurring subproblems in robot kinematics. In chapter three, the exponentials of twists are used to write the forward kinematic map of robot manipulators and the subproblems of chapter two are used to solve the Stanford manipulator and an elbow manipulator. Chapter four focuses on manipulator singularities. Twist coordinates are used to find critical points of the forward kinematic map. The contribution to kinematics is contained in chapter five where a mathematical framework for studying the relationship between the design of 6R manipulators and their performance is developed. Chapter seven contains the contribution to control. The work of A. F. Filippov on differential equations with discontinuous right-hand-side and the work of F. H. Clarke on generalized gradients are combined to obtain a calculus for analyzing nonsmooth gradient systems. The techniques developed are applied to design a simple variable structure controller for the nonlinear dynamics of robot manipulators.
Paden, Bradley Evan
\\u000a Robotic manipulators carried by future spacecraft are expected to perform important tasks in space, such as the servicing\\u000a of satellites. However, the performance of these systems could be severely degraded by dynamic disturbances to the spacecraft\\u000a caused by manipulator motions. This paper presents a method for representing the dynamics of space manipulator systems using\\u000a the recently developed Virtual Manipulator (VM)
Z. Vafa; S. Dubowsky
Improved method of mathematical modeling of dynamics of flexible robotic manipulators developed for use in controlling motions of manipulators. Involves accounting for effect, upon modes of vibration of manipulator, of changes in configuration of manipulator and manipulated payload(s). Flexible manipulator has one or more long, slender articulated link(s), like those used in outer space, method also applicable to terrestrial industrial robotic manipulators with relatively short, stiff links, or to such terrestrial machines as construction cranes.
Pacific Northwest Laboratory (PNL) has developed a manipulator workcell to load and unload nuclear weapon pit assemblies from a cart. To develop this workcell, PNL procured a commercially available manipulator, equipped it with force-sensing and vision equipment, and developed manipulator control software. Manipulator workcell development demonstrated that commercially available manipulator systems can successfully perform this task if the appropriate manipulator is selected and the manipulator workcell tooling and software are carefully designed.
In a prospectively randomized therapy study the influence of a new therapeutical approach, called "Orthopedic Horseback-Riding-Therapy (OHRT)", was evaluated on the postoperative rehabilitation after lumbal discectomie in 16 patients against an identical numbered control group. In comparison with the reference group the utilization of OHRT not only produced an improvement in the patients' self evaluation of their postoperative condition (McNab Score). Also a significant reduction of postoperative work disablement could be achieved. Compared with the reference group influences of previously detected negative psychic predictors (Hs and Hy scales of MMPI) could be reduced. Thus the OHRT is a serious therapy concept in postoperative treatment of patients with lumbal disc herniation. PMID:9333973
Rothhaupt, D; Laser, T; Ziegler, H; Liebig, K
The orthopedic hippotherapy represents a new form of therapeutic exercise in the conservative treatment of segmental instabilities in the lumbar spine region. This kind of therapy works on the principle of conveying to the patient the three-dimensional swinging motion of the horse's back. The patient reacts to these movement impulses by moving up and down (vertical movement of the spine), back and forth (sagittal movement) and to the right and the left (horizontal movement). The small movements of the spine thus produced bring about a mobilization of the segments involved in movement and therefore eliminate articular hypomobilities. Moreover, the short monosegmental muscles of the back are subjected to an excentric training which leads to a muscular stabilization of segmental hypermobilities. Due to the varying pressure load during the riding exercise the trophic conditions of the active and passive structures of the spine are improved. PMID:9487617
Rothhaupt, D; Ziegler, H; Laser, T
The demand for efficiency in OR management and increase in the necessity of surgical documentation require the use of software applications in hospitals. A client-server based OP-planning and documentation system has been in use in the department of orthopedic surgery in Giessen University since 1992 and is being continuously further developed. Aside from the lawful requirements, the demands of clinical doctors have been especially considered. The main functions are management of non medical patient data, scheduling and documentation of operations with coding of diagnoses and therapy, tissue banking, implant inventory, on call scheduling, storage of medical video images, clinical word processing and e-mail. With an integrated web-server, MedXS has the capabilities to offer functions accessible over any webbrowser (Netscape, Internet-Explorer) in the internet or intranet. Through the usage of this application clinical procedures could be more efficiently realized and better agreeing positions with the insurance companies could be reached. PMID:10326211
OBJECTIVE: To make an analysis of the care of elderly in an Emergency Department of Orthopedics with the primary objective to know the percentage of elderly treated, their conditions of origin and level of accidental conditions, and examine possible comorbidities, evolution and mortality rate. METHODS: Retrospective observational epidemiological study based on survey records of a tertiary hospital during one year (January to December 2006) RESULTS: In the year 2006 (January to December) 12,916 calls to patients older than 60 were performed. CONCLUSION: Massive attendance of the elderly population was observed, however, the vast majority related to chronic problems that do not require urgent attention. Patients requiring urgent attention suffer from trauma related to falls and are between the seventh and ninth decades of life, mostly female and requiring hospitalization for longer periods. Level of Evidence VI, Cases Series.
Dotta, Thiago de Angelis Guerra; Bonadio, Marcelo Batista; Furlaneto, Maria Elisabet; Silva, Jorge dos Santos; Leme, Luiz Eugenio Garcez
As healthcare providers, nurses in an acute care setting have the opportunity to review and evaluate the impact of their care delivery. The orthopedic nursing staff at a not-for-profit tertiary care community hospital in Michigan decided to undertake this challenge when they began to pursue a quality management (QM) review of patients admitted to their unit. The QM study targeted the elective surgical candidate admitted for a lumbar decompression with spinal fusion. The quality care issue focused on the complication known as an abdominal ileus. Two basic questions helped the staff to establish the indicators within this project: (1) what common variables could be measured within the high-risk patient population, and (2) by assessing these variables within the plan of care, could a link or association be made to reduce the incidence of the ileus complication? PMID:10171717
Benacker, S A
Polyvinyl alcohol (PVA) is a synthetic polymer derived from polyvinyl acetate through partial or full hydroxylation. PVA is commonly used in medical devices due to its low protein adsorption characteristics, biocompatibility, high water solubility, and chemical resistance. Some of the most common medical uses of PVA are in soft contact lenses, eye drops, embolization particles, tissue adhesion barriers, and as artificial cartilage and meniscus. The purpose of this review is to evaluate the available published information on PVA with respect to its safety as a medical device implant material for cartilage replacement. The review includes historical clinical use of PVA in orthopedics, and in vitro and in vivo biocompatibility studies. Finally, the safety recommendation involving the further development of PVA cryogels for cartilage replacement is addressed. PMID:22514196
Baker, Maribel I; Walsh, Steven P; Schwartz, Zvi; Boyan, Barbara D
Indwelling device infections are associated with considerable morbidity and extremely high cost. Pseudomonas aeruginosa is the most frequent gram-negative etiologic agent associated with infections of indwelling catheters and foreign body implants. It is generally agreed that eradication of infection in the presence of a foreign body requires removal of the foreign body. Using a combination of ceftazidime and ciprofloxacin, we cured nine of nine patients with P. aeruginosa-infected osteosynthetic material and four of five patients with hip and knee prostheses without removing the foreign material. Follow-up was for a mean of 21 months (range, 6 to 60 months). Some patients experienced minor side effects (arthralgia in one patient and rash in another patient). We conclude that this combination is effective and safe and should be useful in the treatment of P. aeruginosa-infected orthopedic implants.
Brouqui, P; Rousseau, M C; Stein, A; Drancourt, M; Raoult, D
Prosthesis-related infection is a serious complication for patients after orthopedic joint replacement, which is currently difficult to treat with antibiotic therapy. Consequently, in most cases, removal of the infected prosthesis is the only solution to cure the infection. It is, therefore, important to understand the comprehensive interaction between the microbiological situation and the host immune responses that lead to prosthesis infections. Evidence indicates that prosthesis infections are actually biofilm-correlated infections that are highly resistant to antibiotic treatment and the host immune responses. The authors reviewed the related literature in the context of their clinical experience, and discussed the possible etiology and mechanism leading to the infections, especially problems related to bacterial biofilm, and prophylaxis and treatment of infection, including both microbiological and surgical measures. Recent progress in research into bacterial biofilm and possible future treatment options of prosthesis-related infections are discussed.
Song, Zhijun; Borgwardt, Lotte; H?iby, Niels; Wu, Hong; S?rensen, Torben Sandberg; Borgwardt, Arne
The effects of two types of argon ion sputter etched surface structures on the tensile stress fatigue properties of orthopedic implant alloy MP35N were investigated. One surface structure was a natural texture resulting from direct bombardment by 1 keV argon ions. The other structure was a pattern of square holes milled into the surface by a 1 keV argon ion beam through a Ni screen mask. The etched surfaces were subjected to tensile stress only in fatigue tests designed to simulate the cyclic load conditions experienced by the stems of artificial hip joint implants. Both types of sputter etched surface structures were found to reduce the fatigue strength below that of smooth surface MP35N.
Wintucky, E. G.; Christopher, M.; Bahnuik, E.; Wang, S.
Data that can be used to guide perioperative antibiotic prophylaxis in our era of emerging antibiotic resistance are limited. We reviewed orthopedic surgeries complicated by surgical site infections (SSIs). Eighty percent of 69 arthroplasty and 80 spine fusion SSIs were infected with Gram-positive bacteria; most were staphylococcal species; and more than 25% of Staphylococcus aureus and more than 65% of coagulase-negative staphylococci were methicillin-resistant. Gram-negative bacteria were isolated from 30% of arthroplasty SSIs and 25% of spine fusion SSIs. Resistance to cefazolin was higher than 40%. A significant proportion of SSIs were caused by resistant organisms, and antibiotic guidelines were altered to provide more adequate surgical prophylaxis. PMID:24839634
Norton, Thomas D; Skeete, Faith; Dubrovskaya, Yanina; Phillips, Michael S; Bosco, Joseph D; Mehta, Sapna A
Optimal management of deep infections in orthopedic and trauma surgery is often challenging. Traditional prophylactic and treatment approaches are based on the systemic administration of relatively high doses of antibiotics, which may result in a number of side effects. Furthermore, systemically administered antimicrobials may not reach adequate concentration at the desired site. Finally, traditional approaches are based on two-step protocols, thus delaying definite fixation. In recent years, antibiotic-coated intramedullary nails (ACINs) have been introduced, which offer the advantage of delivering antibiotics locally, thus increasing their local concentrations and length of action. In addition, ACINs offer the great advantage of combining antimicrobial prophylaxis/treatment and stabilization in a single step. Preliminary evidence by small clinical studies appears to support the effectiveness of ACINs in the management of chronic osteomyelitis and infected non-unions, with high rates of infection eradication and bone union. However, randomized clinical trials are needed to definitely establish ACINs ' effectiveness and safety. PMID:21669150
Nizegorodcew, T; Palmieri, G; Marzetti, E
Chitosan (CS) is a linear polysaccharide with good biodegradability, biocompatibility and antimicrobial activity, which makes it potentially useful for biomedical applications, including an antimicrobial agent either alone or blended with other polymers. However, the poor solubility of CS in most solvents at neutral or high pH substantially limits its use. Quaternary ammonium CS, which was prepared by introducing a quaternary ammonium group on a dissociative hydroxyl group or amino group of the CS, exhibited improved water solubility and stronger antibacterial activity relative to CS over an entire range of pH values; thus, this quaternary modification increases the potential biomedical applications of CS in the field of anti-infection. This review discusses the current findings on the antimicrobial properties of quaternized CS synthesized using different methods and the mechanisms of its antimicrobial actions. The potential antimicrobial applications in the orthopedic field and perspectives regarding future studies in this field are also considered.
Tan, Honglue; Ma, Rui; Lin, Chucheng; Liu, Ziwei; Tang, Tingting
Medical imaging plays a central role in a vast range of healthcare practices. The usefulness of 3D visualizations has been demonstrated for many types of treatment planning. Nevertheless, full access to 3D renderings outside of the radiology department is still scarce even for many image-centric specialties. Our work stems from the hypothesis that this under-utilization is partly due to existing visualization systems not taking the prerequisites of this application domain fully into account. We have developed a medical visualization table intended to better fit the clinical reality. The overall design goals were two-fold: similarity to a real physical situation and a very low learning threshold. This paper describes the development of the visualization table with focus on key design decisions. The developed features include two novel interaction components for touch tables. A user study including five orthopedic surgeons demonstrates that the system is appropriate and useful for this application domain. PMID:22034294
Lundström, Claes; Rydell, Thomas; Forsell, Camilla; Persson, Anders; Ynnerman, Anders
Poly(para-phenylene) (PPP) exhibits exceptional mechanical strength, stiffness, toughness, and chemical inertness, although it is not currently used in any biomedical applications. The purpose of this study is to serve as a preliminary investigation into the potential of PPP as a biomaterial in orthopedic load-bearing applications. Nuclear magnetic resonance (NMR) analysis confirmed a polymer structure composed of an aromatic backbone and side groups. Tensile PPP specimens along with samples from several other polymers often used for orthopedic applications were elongated to failure after being soaked in phosphate buffered saline (PBS) for 1 h, 1 day, 1 week, 2 weeks, 1 month, and more than 1 year. Results showed that PBS absorption of the PPP plateaued at 1 week at values of ?0.7 wt % and remained within one standard deviation when soaked for over 1 year. PBS absorption did not affect elastic modulus (5.0 GPa), yield strength (141 MPa), fracture strength (120 MPa) and strain-to-failure (17%) more than one standard deviation. Zero-to-tension fatigue testing established an endurance limit of approximately 35 MPa, which was relatively insensitive to frequency (1-10 Hz). Eagle's minimum essential medium (MEM) elution assay with fibroblasts confirmed that the PPP was noncytotoxic. Relative to other polymers used for load-bearing biomedical applications, PPP displays promising mechanical properties that remain stable in aqueous solution. Lastly, prototype PPP and polyetheretherketone (PEEK) bone plates were manufactured and tested, with the PPP plate showing a 38% higher maximum tensile load before failure. © 2013 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 102A: 3122-3129, 2014. PMID:24123879
Frick, Carl P; DiRienzo, Amy L; Hoyt, Anthony J; Safranski, David L; Saed, Mohand; Losty, Eric J; Yakacki, Christopher M
BACKGROUND: Pain as a main social problem has involved millions of people. Usually pharmaceutical methods use for treating pain but they have side effects which make them less effective. Massage is one of the effective ways for reducing pain after surgery. The aim of this study was to evaluate the effect of massage therapy on pain severity in orthopedic patients. METHODS: This is a clinical trial study on 60 arthroscopic knee surgery patients who were hospitalized in men's orthopedic ward of Al-Zahra and Kashani hospitals. A two part questionnaire was used for collecting data. Samples were selected using easy continuity method and then they were randomly divided into two groups. In intervention group, besides routine treatments, patients were massaged by the researcher for 20 minutes each day and pain severity was evaluated before and after the massage. Data was analyzed using descriptive and inferential statistics and SPSS software. RESULTS: Results showed that there was a meaningful different between mean score of pain severity before and after the massage in intervention group (p < 0.001) but this difference wasn?t meaningful in control group (p = 0.32). Also comparing the mean score of pain severity in both groups before any interventions showed that there were no meaningful differences (p = 0.34) but this difference was meaningful after interventions (p = 0.001). CONCLUSIONS: Considering massage as a safe and effective intervention, it could be used as an easy, cheap and executable method for treating pain in all medical health care centers and even at patient's home.
Eghbali, Maryam; Lellahgani, Hedayatollah; Alimohammadi, Nasrollah; Daryabeigi, Reza; Ghasempour, Zahra
Manipulation and separation of micro-sized particles, particularly biological particles, using the dielectrophoretic (DEP) force is an emerging technique in MEMS technology. This paper presents a DEP-based microsystem for the selective manipulation and separation of bioparticles using dielectrophoretic effects. The microfabricated DEP device consists of a sandwich structure, in which a microchannel with electrode array lining on its bottom is sandwiched
D. F. Chen; H. Du; W. H. Li
Parallel manipulator robots have complex kinematics and present singular positions within their workspace. For these reasons, in most software simulating parallel robots, each kinematic model should be given in advance by users or programmers. In this paper we present a new tool used to design and to simulate parallel manipulator robots. Explicit kinematic equations are generated automatically depending on the
SAMIR LAHOUAR; SAID ZEGHLOUL; LOTFI ROMDHANE
The manipulator systems tested included the Meidensha BILARM 83A, the Central Research Laboratories Model M-2, and the GCA PaR Systems Model 6000. Six manipulator and control mode combinations were evaluated: (1) the BILARM in master/slave mode without fo...
J. V. Draper S. J. Handel E. Sundstrom J. N Herndon Y. Fujita
Following a prescribed trajectory with a manipulator tip in an ideal manner results in a one DOF overall motion whatever the configuration of the manipulator and of the path might be. Thus, a transformation of the equations of motion from joint coordinates to path coordinates leads to a set, which cannot only be solved by formal quadrature but defines as
F. Pfeiffer; R. Johanni
A new adaptive robot control algorithm is derived, which consists of a PD feedback part and a full dynamics feedfor ward compensation part, with the unknown manipulator and payload parameters being estimated online. The algorithm is computationally simple, because of an effective exploitation of the structure of manipulator dynamics. In particular, it requires neither feedback of joint accelerations nor inversion
Jean-Jacques E. Slotine; Weiping Li
The abridged contents include: Kinematic and force analysis of articulated hands: contact - freedom and constraint; contacts in groups; force application and velocity analysis; force error analysis. Manipulator grasping and pushing operations: theory of pushing; application; conclusion. Index. This book, based on the doctoral dissertations of the two authors, examines several aspects of manipulating objects. At present, the authors believe
M. T. Mason; J. K. Jr. Salisbury
In many educational settings, manipulative materials (such as Cuisenaire Rods and Pattern Blocks) play an important role in children's learning, enabling children to explore mathematical and scientific concepts (such as number and shape) through direct manipulation of physical objects. Our group at de MJT Media Lab has developed a new generation of \\
Mitchel Resnick; Fred Martin; Robert Berg; Richard Borovoy; Vanessa Colella; Kwin Kramer; Brian Silverman
Hydraulic manipulators are candidate for fusion reactor maintenance. Their main advantages are their large payload with respect to volume and mass, their reliability and their robustness. However, due to their force control limitations, they are disqualified for precise manipulation and are dangerous for the environment and themselves in case of unexpected collision. CEA, in collaboration with CYBERNETIX and IFREMER has
Y. Measson; O. David; F. Louveau; J. P. Friconneau
Learning about various branches of mathematics can be tough at any age, and this fine set of resources created by staff members who are primarily based at the Utah State University is designed to make this process just a bit easier. With substantial funding from the National Science Foundation, they have successfully developed a large set of interactive online learning units that deal with topics such as geometry, arithmetic, and trigonometry. First-time visitors may want to begin by looking over the "About" section, which includes a tutorial designed for educators who wish to use the materials as well as another tutorial that will teach educators how to create lessons and activities. Delving into the learning materials at the site, visitors can browse through the learning modules by subject or grade level. Visitors can also browse teacher published lessons, all of which have been vetted by staff members at the National Library. Finally, visitors will want to definitely look over the virtual manipulatives library, which includes instructional materials that students will find quite engaging.
The system is designed for manipulation, analysis, interpretation, and processing of a wide variety of image data. LANDSAT (ERTS) and other data in digital form can be input directly into the system. Photographic prints and transparencies are first converted to digital form with an on-line high-resolution microdensitometer. The system is implemented on a Hewlett-Packard 3000 computer with 128 K bytes of core memory and a 47.5 megabyte disk. It includes a true color display monitor, with processing memories, graphics overlays, and a movable cursor. Image data formats are flexible so that there is no restriction to a given set of remote sensors. Conversion between data types is available to provide a basis for comparison of the various data. Multispectral data is fully supported, and there is no restriction on the number of dimensions. In this way multispectral data collected at more than one point in time may simply be treated as a data collected with twice (three times, etc.) the number of sensors. There are various libraries of functions available to the user: processing functions, display functions, system functions, and earth resources applications functions.
Henze, J.; Dezur, R.
The manipulation of ribosomal RNA (rRNA) extracted from E. coli cells by dielectrophoresis (DEP) has been demonstrated over the range of 3 kHz–50 MHz using interdigitated microelectrodes. Quantitative measurement using total internal reflection fluorescence microscopy of the time dependent collection indicated a positive DEP response characterized by a plateau between 3 kHz and 1 MHz followed by a decrease in response at higher frequencies. Negative DEP was observed above 9 MHz. The positive DEP response below 1 MHz is described by the Clausius–Mossotti model and corresponds to an induced dipole moment of 3300 D with a polarizability of 7.8×10?32 F m2. The negative DEP response above 9 MHz indicates that the rRNA molecules exhibit a net moment of ?250 D, to give an effective permittivity value of 78.5 ?0, close to that of the aqueous suspending medium, and a relatively small surface conductance value of ?0.1 nS. This suggests that our rRNA samples have a fairly open structure accessible to the surrounding water molecules, with counterions strongly bound to the charged phosphate groups in the rRNA backbone. These results are the first demonstration of DEP for fast capture and release of rRNA units, opening new opportunities for rRNA-based biosensing devices.
Giraud, Gerard; Pethig, Ronald; Schulze, Holger; Henihan, Grace; Terry, Jonathan G.; Menachery, Anoop; Ciani, Ilenia; Corrigan, Damion; Campbell, Colin J.; Mount, Andrew R.; Ghazal, Peter; Walton, Anthony J.; Crain, Jason; Bachmann, Till T.
An overview of research on a flow control technique called Coanda-assisted Spray Manipulation (CSM) is presented. CSM uses a high-momentum control jet under the influence of the Coanda effect to vector a high volume-flow jet or spray. Actuators provide the capability of moving the location of applied control flow making rotary or arbitrary motion of the vectored flow possible. The presented work includes a fundamental isothermal study on the effects of rotation speed and Reynolds number on a vectored jet using a belt-driven CSM actuator. Three-component velocity data were acquired for three Reynolds numbers and three rotation speeds using timed resolved high-speed stereo Particle Image Velocimetry. A second CSM system with 16 pneumatically-driven control ports has been retrofitted to a flame spray gun. This combination provides the capability to rapidly alter the direction of applied metal powders. High speed video of this process will also be presented. Finally, a fundamental study on the pneumatic system's response to minor losses and connection lines of varying lengths is presented.
Mabey, Katie; Smith, Barton; Archibald, Reid; West, Brian
Members of the genus Propionibacterium are widely used in the production of vitamin B12, tetrapyrrole compounds, and propionic acid as well as in probiotic and cheese industries. Shuttle vectors were developed in propionibacteria using replicons from endogenous plasmids in Propionibacterium and Escherichia coli and an appropriate selection marker. The efficient transformation was achieved using the shuttle vector prepared from Propionibacterium freudenreichii to overcome the high restriction modification system in propionibacteria. Expression vectors with native promoters for use in propionibacteria were also developed. Using this system, cholesterol oxidase, which is used as a diagnostic enzyme, was produced in P. freudenreichii. Genes involved in 5-aminolevulinic acid (ALA) and vitamin B12 biosynthesis in propionibacteria were isolated. ALA in propionibacteria could be synthesized via both the C4 pathway (condensation of glycine and succinyl CoA) and the C5 pathway (from glutamate). The hemA gene encoding ALA synthase from Rhodobacter spheroides, was overexpressed and ALA accumulated in P. freudenreichii. Thus, the genetic manipulation systems in propionibacteria will facilitate genetic studies of probiotics and the vitamin B12 biosynthetic pathway. PMID:16233156
Kiatpapan, Pornpimon; Murooka, Yoshikatsu
This paper presents a grasping\\/manipulating control method using mode transformation. Discrete Fourier transform (DFT) matrices are utilized as transformation matrices. In grasping\\/manipulating control systems, decomposition into grasping motion and manipulating motion remains a key problem. By means of the proposed method, the grasping controller and the manipulating controller can be designed independently as a grasping mode and a manipulating mode,
Ryogo Kubo; Kouhei Ohnishi
Telerobot systems for advanced applications will require manipulators with redundant 'degrees of freedom' (DOF) that are capable of adapting manipulator configurations to avoid obstacles while achieving the user specified goal. Conventional methods for control of manipulators (based on solution of the inverse kinematics) cannot be easily extended to these situations. Fuzzy logic control offers a possible solution to these needs. A current research program at SRI developed a fuzzy logic controller for a redundant, 4 DOF, planar manipulator. The manipulator end point trajectory can be specified by either a computer program (robot mode) or by manual input (teleoperator). The approach used expresses end-point error and the location of manipulator joints as fuzzy variables. Joint motions are determined by a fuzzy rule set without requiring solution of the inverse kinematics. Additional rules for sensor data, obstacle avoidance and preferred manipulator configuration, e.g., 'righty' or 'lefty', are easily accommodated. The procedure used to generate the fuzzy rules can be extended to higher DOF systems.
Franke, Ernest A.; Nedungadi, Ashok
A robot manipulator is said to be kinematically redundant when it has more degrees of freedom than are necessary to accomplish a particular task. Useful control strategies are designed for kinematically redundant manipulators in order to enhance their performance. Following the impedance control approach, the problem of minimizing redundant manipulator collision impacts is addressed. The configuration control approach is used to reduce impulsive forces, while a simplified impedance control scheme is formulated to minimize rebound effects. A new Cartesian control strategy for redundant flexible-joint manipulators is proposed. The main idea in this hybrid scheme is to control not only the manipulator's end-effector but also its links, so as to achieve specified positions and velocities for the end-effector and the links. Finally, a new application of kinematically redundant manipulators is proposed: using redundancy resolution to compensate for joint flexibility. This redundancy resolution scheme is incorporated in a control strategy for redundant flexible-joint manipulators. The problem of possible algorithmic singularities is considered, and a scheme is suggested which makes the controller robust with respect to such singularities.
The nanocar molecule - four fullerene wheels connected by rotating alkyne axles to a central chassis - is the first molecule designed and fabricated specifically for nanoscale manipulation. We have investigated the imaging and manipulation of the nanocar molecule on Au(111) by variable-temperature STM. From the observed movement of the nanocars, we can show that their motion is due to rolling, not sliding, across the gold surface. Additionally, we have begun to explore the conditions for nanoscale rolling in a number of other molecules built from our set of ``molecular tinker toys'' with an eye towards remote manipulation and increased system complexity.
Osgood, A. J.; Shirai, Y.; Zhao, Y.; Tour, J. M.; Kelly, K. F.
Mobile manipulation in many respects represents the next generation of robot applications. An important part of design of such systems is the integration of techniques for navigation, recognition, control, and planning to achieve a robust solution. To study this problem three different approaches to mobile manipulation have been designed and implemented. A prototypical application that requires navigation and manipulation has been chosen as a target for the systems. In this paper we present the basic design of the three systems and draw some general lessons on design and implementation.
Anderson, Cressel; Axelrod, Ben; Case, J. Philip; Choi, Jaeil; Engel, Martin; Gupta, Gaurav; Hecht, Florian; Hutchinson, John; Krishnamurthi, Niyant; Lee, Jinhan; Nguyen, Hai Dai; Roberts, Richard; Rogers, John G.; Trevor, Alexander J. B.; Christensen, Henrik I.; Kemp, Charles
The direct manipulation (DM) approach to user-computer interaction, where the user directly manipulates the object presented on the screen is discussed. It is shown that DM is quite complex with respect to conventional dialog styles. Direct manipulation i...
J. M. Versendaal
This report presents the design and development of a robotic tentacle manipulator research platform as a tool to explore new methods of enhancing the capabilities of remotely operated manipulators, autonomous manipulation, and autonomous search. We review...
D. Scherer M. C. Pekala
Background: Postoperative analgesia is one of the concerns of anesthesiologists and patients. Systemic opioid administration is the gold standard in reducing the severe pain after the surgery but some side effects prevent the use of adequate dosage of opioids. Objectives: The aim of this study was to evaluate the result of adding magnesium sulphate to sufentanil in patient-controlled intravenous analgesia (PCIA) system. Patients and Methods: In this randomized clinical trial, 60 patients candidate for lower limb orthopedic surgery were recruited in Poursina Medical Center for six months. They were randomly classified in two group of patient-controlled intravenous analgesia for postoperative pain control, one was group S [(sufentanil) (n = 30)] and the other was group S + M [(magnesium sulphate/sufentanil) (n = 30)]. The drug infusion rate was 5 mL/h. Each mL of solution in group S contained 1 mcg of sufentanil and in group M + S, 1 mcg of sufentanil and 200 mcg magnesium sulphate, respectively. Pain score, sedation score, satisfaction score, nausea and vomiting score were evaluated 6, 12, 24, 36 and 48 hours after surgery. Results: The demographic data between two groups were not significantly different. The pain scores after 6, 12 and 24 hours in S and S + M groups were significantly different. But the comparison of Visual Analogue Scale (VAS) scores after 36 and 48 hours didn’t show significant differences (P < 0.001). Comparison of the sedation, nausea and vomiting scores between two groups did not show any difference. But the number of patient’s satisfaction in S + M group was more than S group which suggests significant differences (P < 0.05). Conclusions: This study showed that magnesium sulphate added to sufentanil through PCIA is an effective method to alleviate pain in patients undergoing lower limb orthopedic surgery. Moreover, we found fewer side effects on magnesium-sufentanil regimen in terms of in nausea, vomiting, and sedation; and patients’ satisfaction in this regimen was more rather than that in the regiment of sufentanil alone.
Sedighinejad, Abass; Haghighi, Mohammad; Naderi Nabi, Bahram; Rahimzadeh, Poupak; Mirbolook, Ahmadreza; Mardani-Kivi, Mohsen; Nekufard, Majid; Biazar, Gelareh
Biocomposite consists of gold nanoparticles (AuNPs) and a natural polymer as Chitosan (CS) was electrodeposited over NiTi alloy to improve biocompatibility, biostability, surface corrosion resistance and antibacterial effect for orthopedic implantation. The forming process and surface morphology of this biocomposite coats over NiTi alloy were studied. The results showed that the nm-scale gold particles were embedded in the composite forming compact, thick and smooth coat. Elemental analysis revealed significant less Ni ion release from the coated NiTi alloy compared with the uncoated one by 20 fold. Furthermore, the electrochemical corrosion measurements indicated that AuNPs/CS composite coat was effective for improving corrosion resistance in different immersion times and at all pH values, which suggests that the coated NiTi alloys have potential for orthopedic applications. Additionally, the efficiencies of the biocomposite coats for inhibiting bacterial growth indicate high antibacterial effect.
Ahmed, Rasha A.; Fadl-allah, Sahar A.; El-Bagoury, Nader; El-Rab, Sanaa M. F. Gad
Recent concerns about global climate change have focused attention on the methodology for manipulating field soil temperatures. The objective of this study was to evaluate several simple, inexpensive, passive systems for changing soil surface temperature ...
G. M. Marion D. E. Pidgeon
Six-degree-of-freedom simulator uses economical components. Reduction in complexity makes this or similar system cost-effective for training manipulator operators, such as those in industries handling nuclear wastes and hazardous chemicals.
Orr, D. H.; Ward, L. C.
An interactive micro-computer program that performs some manipulations on an input x-ray spectrum is introduced and described. The program is used to calculate the effect of absorption of filters, transmission through fibers, responsivity of photocathodes...
G. A. Kyrala
The National Aeronautics and Space Administration (NASA) Space Station Program marks the beginning of a new era in space utilization and habitation. Extensive use of remote manipulation and robotics to reduce astronaut extra-vehicular activity is expected...
J. N. Herndon W. R. Hamel D. P. Kuban
The need for a telerobotic vehicle with hazard sensing and integral manipulation capabilities has been identified for use in transportation accidents where nuclear weapons are involved. The Accident Response Mobile Manipulation System (ARMMS) platform has been developed to provide remote dexterous manipulation and hazard sensing for the Accident Response Group (ARG) at Sandia National Laboratories. The ARMMS' mobility platform is a military HMMWV [High Mobility Multipurpose Wheeled Vehicle] that is teleoperated over RF or Fiber Optic communication channels. ARMMS is equipped with two high strength Schilling Titan II manipulators and a suite of hazardous gas and radiation sensors. Recently, a modular telerobotic control architecture call SMART (Sandia Modular Architecture for Robotic and Teleoperation) has been applied to ARMMS. SMART enables input devices and many system behaviors to be rapidly configured in the field for specific mission needs. This paper summarizes current SMART developments applied to ARMMS.
ANDERSON,ROBERT J.; MORSE,WILLIAM D.; SHIREY,DAVID L.; CDEBACA,DANIEL M.; HOFFMAN JR.,JOHN P.; LUCY,WILLIAM E.
Cell signaling involves complex transduction mechanisms in which information released by nearby cells or extracellular cues are transmitted to the cell, regulating fundamental cellular activities. Understanding such mechanisms requires cell stimulation with precise control of low numbers of active molecules at high spatial and temporal resolution under physiological conditions. Optical manipulation techniques, such as optical tweezing, mechanical stress probing or nano-ablation, allow handling of probes and sub-cellular elements with nanometric and millisecond resolution. PicoNewton forces, such as those involved in cell motility or intracellular activity, can be measured with femtoNewton sensitivity while controlling the biochemical environment. Recent technical achievements in optical manipulation have new potentials, such as exploring the actions of individual molecules within living cells. Here, we review the progress in optical manipulation techniques for single-cell experiments, with a focus on force probing, cell mechanical stimulation and the local delivery of active molecules using optically manipulated micro-vectors and laser dissection.
Difato, Francesco; Pinato, Giulietta; Cojoc, Dan
We have investigated the use of optically dark states for quantum information processing. We have developed a systematic theoretical approach relating atomic dark states to decoherence-free subspaces and have shown that single qubit manipulations on such ...
K. B. Whaley
Hybrid Image-Plane/Stereo (HIPS) manipulation is a method of processing image data, and of controlling a robotic manipulator arm in response to the data, that enables the manipulator arm to place an end-effector (an instrument or tool) precisely with respect to a target (see figure). Unlike other stereoscopic machine-vision-based methods of controlling robots, this method is robust in the face of calibration errors and changes in calibration during operation. In this method, a stereoscopic pair of cameras on the robot first acquires images of the manipulator at a set of predefined poses. The image data are processed to obtain image-plane coordinates of known visible features of the end-effector. Next, there is computed an initial calibration in the form of a mapping between (1) the image-plane coordinates and (2) the nominal three-dimensional coordinates of the noted end-effector features in a reference frame fixed to the main robot body at the base of the manipulator. The nominal three-dimensional coordinates are obtained by use of the nominal forward kinematics of the manipulator arm that is, calculated by use of the currently measured manipulator joint angles and previously measured lengths of manipulator arm segments under the assumption that the arm segments are rigid, that the arm lengths are constant, and that there is no backlash. It is understood from the outset that these nominal three-dimensional coordinates are likely to contain possibly significant calibration errors, but the effects of the errors are progressively reduced, as described next. As the end-effector is moved toward the target, the calibration is updated repeatedly by use of data from newly acquired images of the end-effector and of the corresponding nominal coordinates in the manipulator reference frame. By use of the updated calibration, the coordinates of the target are computed in manipulator-reference-frame coordinates and then used to the necessary manipulator joint angles to position and orient the end-effector at the target with respect to the same kinematic model from the calibration step. As the end-effector/target distance decreases, the computed coordinates of the end-effector and target become more nearly affected by the same errors, so that the differences between their coordinates become increasingly precise. When the end-effector reaches the target, the remaining effective position error is the distance that corresponds to more than about one pixel in the stereoscopic images of the target.
Baumgartner, Eric; Robinson, Matthew
Background Manipulation and mobilisation are often used, either alone or combined with other treatment approaches, to treat neck pain. Objectives To assess if manipulation or mobilisation improves pain, function\\/disability, patient satisfaction, quality of life, and global perceived effect in adults with acute\\/subacute\\/chronic neck pain with or without cervicogenic headache or radicular findings. Search strategy CENTRAL (The Cochrane Library 2009, issue
A. Gross; J. Miller; J. D'Sylva; S. J. Burnie; C. H. Goldsmith; N. Graham; T. Haines; G. Brønfort; J. L. Hoving
A novel manipulator trajectory planning approach using geodesic is proposed in this paper. Geodesic is the necessary condition\\u000a of the shortest length between two points on the Riemannian surface in which the covariant derivative of the geodesic’s tangent\\u000a vector is zero. The geometric characteristic of geodesic is discussed and used to implement trajectory planning of the manipulator.\\u000a First, the Riemannian
Liandong Zhang; Changjiu Zhou; Delun Wang
A new fault-tolerant redundancy resolution scheme is presented that allows a single six degree of freedom (DOF) command to be distributed over a small remotely operated underwater vehicle–manipulator (ROVM) system. ROVM systems are composed of a remotely operated underwater vehicle (ROV) and serial manipulator. The combined system is often kinematically redundant for the six-DOF end-effector command, and such a ROVM
Serdar Soylu; Bradley J. Buckham; Ron P. Podhorodeski
A multi-input multi-output (MIMO) controlled auto regressive integrated moving average (CARIMA) model which has the input vector consisting of the joint torques and the output vector consisting of the velocities of the gripper expressed in the world coordinate system, is proposed for the motion of the end-effector of a robotic manipulator system. Since the manipulator is a time-varying system, because
C. Ozsoy; R. Kazan
The expectation value of a quantum system observable can be written as a sum over interfering pathway amplitudes. In this Letter, we demonstrate for the fist time adaptive manipulation of quantum pathways using the Hamiltonian encoding-observable decoding (HE-OD) technique. The principles of HE-OD are illustrated for population transfer in atomic rubidium using shaped femtosecond laser pulses. The ability to manipulate multiple pathway amplitudes is of fundamental importance in all quantum control applications.
Rey-de-Castro, Roberto; Leghtas, Zaki; Rabitz, Herschel
Improved method for computation of manipulator inertia matrix developed, based on concept of spatial inertia of composite rigid body. Required for implementation of advanced dynamic-control schemes as well as dynamic simulation of manipulator motion. Motivated by increasing demand for fast algorithms to provide real-time control and simulation capability and, particularly, need for faster-than-real-time simulation capability, required in many anticipated space teleoperation applications.
Fijany, Amir; Bejczy, Antal K.
Decisions regarding choice of thromboprophylaxis in patients undergoing major orthopedic surgery are based on assessment of\\u000a individual patient risk for thrombosis versus risk for bleeding. An international survey sought physician views on definitions\\u000a and relative importance of different types of major bleeding. A random sample of physicians from five countries (100 physicians\\u000a per country, mainly surgeons) completed an internet-based 13-question
Enrique Ginzburg; Franck Dujardin
This paper presents experimental evidence that thin (200 nm) boron coatings, deposited with a (vacuum) cathodic arc technique on pre-polished Co–Cr–Mo surfaces, could potentially extend the life of metal-on-polymer orthopedic devices using cast Co–Cr–Mo alloy for the metal component. The primary tribological test used a linear, reciprocating pin-on-disc arrangement, with pins made of ultra-high molecular weight polyethylene. The disks were cast
C. C. Klepper; J. M. Williams; Truhan Jr. John J; Jun Qu; Laura Riester; R. C. Hazelton; J. J. Moschella; P. J. Blau; J. P. Anderson; O. O. Popoola; M. D. Keitz
All research results about flexible manipulator control were integrated to show a control scenario of a bracing manipulator. First, dynamic analysis of a flexible manipulator was done for modeling. Second, from the dynamic model, the inverse dynamic equation was derived, and the time domain inverse dynamic method was proposed for the calculation of the feedforward torque and the desired flexible coordinate trajectories. Third, a tracking controller was designed by combining the inverse dynamic feedforward control with the joint feedback control. The control scheme was applied to the tip position control of a single link flexible manipulator for zero and non-zero initial condition cases. Finally, the contact control scheme was added to the position tracking control. A control scenario of a bracing manipulator is provided and evaluated through simulation and experiment on a single link flexible manipulator.
Traumatology and orthopedic surgery can benefit from the use of efficient local antibiotic-eluting systems to avoid bacterial contamination of implanted materials. In this work a new percutaneous porous-wall hollow implant was successfully used as a local antibiotic-eluting device both in vitro and in vivo. The implant is a macroporous 316 L stainless steel filter tube with a nominal filtration cut-off size of 200 nm with one open end which was used to load the synthetic antibiotic linezolid and an opposite blind end. The antibiotic release kinetics from the device on a simulated biological fluid under in vitro conditions demonstrated an increased concentration during the first five days that subsequently was sustained for at least seven days, showing a kinetic close to a zero order release. Antibiotic-loaded implants were placed in the tibia of four sheep which were trans-surgically experimentally infected with a biofilm forming strain of Staphylococcus aureus. After 7 and 9 days post infection, sheep did not show any evidence of infection as demonstrated by clinical, pathological and microbiological findings. These results demonstrate the capability of such an antibiotic-loaded implant to prevent infection in orthopedic devices in vivo. Further research is needed to assess its possible use in traumatology and orthopedic surgery. PMID:23651643
Gimeno, Marina; Pinczowski, Pedro; Vázquez, Francisco J; Pérez, Marta; Santamaría, Jesús; Arruebo, Manuel; Luján, Lluís
Accurate diagnosis of orthopedic device-associated infections can be challenging. Culture of tissue biopsy specimens is often considered the gold standard; however, there is currently no consensus on the ideal incubation time for specimens. The aim of our study was to assess the yield of a 14-day incubation protocol for tissue biopsy specimens from revision surgery (joint replacements and internal fixation devices) in a general orthopedic and trauma surgery setting. Medical records were reviewed retrospectively in order to identify cases of infection according to predefined diagnostic criteria. From August 2009 to March 2012, 499 tissue biopsy specimens were sampled from 117 cases. In 70 cases (59.8%), at least one sample showed microbiological growth. Among them, 58 cases (82.9%) were considered infections and 12 cases (17.1%) were classified as contaminations. The median time to positivity in the cases of infection was 1 day (range, 1 to 10 days), compared to 6 days (range, 1 to 11 days) in the cases of contamination (P < 0.001). Fifty-six (96.6%) of the infection cases were diagnosed within 7 days of incubation. In conclusion, the results of our study show that the incubation of tissue biopsy specimens beyond 7 days is not productive in a general orthopedic and trauma surgery setting. Prolonged 14-day incubation might be of interest in particular situations, however, in which the prevalence of slow-growing microorganisms and anaerobes is higher.
Wahl, Peter; Fracheboud, Dominique; Gautier, Emanuel
A real-time control method for a humanoid in mobile manipulation, doing tasks with its arms while moving, is proposed. The arm tips always follow their desired position with external force applied by impedance control, for carrying out a given task with the arms. An evaluation function consisting of not only stability but also arm manipulability-both are important for mobile manipulation-is
Kenji Inoue; Haruyuki Yoshida; Tatsuo Arai; Yasushi Mae
ABSTRACT Purpose: This practice survey describes how Fellows of the Canadian Academy of Manipulative Physiotherapy (FCAMPT) use spinal manipulation and mobilization and how they perceive their competence in performing spinal assessment; it also quantifies relationships between clinical experience and use of spinal manipulation. Methods: A cross-sectional survey was designed based on input from experts and the literature was administered to a random sample of the FCAMPT mailing list. Descriptive (including frequencies) and inferential statistical analyses (including linear regression) were performed. Results: The response rate was 82% (278/338 eligible FCAMPTs). Most (99%) used spinal manipulation. Two-thirds (62%) used clinical presentation as a factor when deciding to mobilize or manipulate. The least frequently manipulated spinal region was the cervical spine (2% of patients); 60% felt that cervical manipulation generated more adverse events. Increased experience was associated with increased use of upper cervical manipulation among male respondents (14% more often for every 10 years after certification; ?, 95% CI=1.37, 0.89–1.85, p<0.001) but not among female respondents. Confidence in palpation accuracy decreased in lower regions of the spine. Conclusion: The use of spinal manipulation/mobilization is prevalent among FCAMPTs, but is less commonly used in the neck because of a perceived association with adverse events.
Macdermid, Joy C.; Santaguida, P. Lina; Thabane, Lehana; Giulekas, Kevin; Larocque, Leo; Millard, James; Williams, Caitlin; Miller, Jack; Chesworth, Bert M.
Background Second opinion is a treatment ratification tool that may critically influence diagnosis, treatment, and prognosis. Second opinions constitute one of the largest expenditures of the supplementary health insurance programs provided by the Israeli health funds. The scarcity of data on physicians’ attitudes toward second opinion motivated this study to explore those attitudes within the Israeli healthcare system. Methods We interviewed 35 orthopedic surgeons and neurologists in Israel and qualitatively analyzed the data using the Grounded Theory approach. Results As a common tool, second opinion reflects the broader context of the Israeli healthcare system, specifically tensions associated with health inequalities. We identified four issues: (1) inequalities between central and peripheral regions of Israel; (2) inequalities between private and public settings; (3) implementation gap between the right to a second opinion and whether it is covered by the National Health Insurance Law; and (4) tension between the authorities of physicians and religious leaders. The physicians mentioned that better mechanisms should be implemented for guiding patients to an appropriate consultant for a second opinion and for making an informed choice between the two opinions. Conclusions While all the physicians agreed on the importance of the second opinion as a tool, they raised concerns about the way it is provided and utilized. To be optimally implemented, second opinion should be institutionalized and regulated. The National Health Insurance Law should strive to provide the mechanisms to access second opinion as stipulated in the Patient’s Rights Law. Further studies are needed to assess the patients' perspectives.
Background Several methods for assessment of severity of pain have been proposed but all of them are subjective. Objectives This study evaluated the association concerning changes in electrical resistance (ER) between two acupuncture points and severity of postoperative pain in order to define an objective measurement of pain. Patients and Methods In a cross-sectional study, 50 patients undergoing lower extremity orthopedic surgery with postoperative moderate to severe pain (VAS > 4,) were consecutively enrolled. In the recovery room, the patients' pain scores were assessed and in patients with VAS > 4, the electrical resistance between Li4 and Li11 acupuncture points as well as pain scores was measured prior and following analgesic administration. Results Following meperidine use, the mean VAS significantly decreased and the ER between the two acupoints was significantly increased. However, Pearson correlation analysis did not reveal any association between the trends of pain intensity and ER (P > 0.05). The ER change in patients operated under epidural anesthesia was significantly less than those who experienced general or spinal anesthesia. Conclusions There is a coincidence of pain relief and change in the ER of acupuncture meridians without significant association. The diagnostic value of ER for pain, stress response or any other physiologic outcome needs to be investigated in clinical trials with a well-defined control group, with more accurate instruments and probably in different acupuncture meridians.
Rezvani, Mehran; Alebouyeh, Mahmoud-Reza; Imani, Farnad; Entezary, Saeid Reza; Mohseni, Masood
Previous studies have suggested a potential risk to healthcare workers applying isocyanate-containing casts, but the authors reached their conclusions based on immunological or clinical pulmonology test results alone. We designed a study to assess potential exposure to methylene diphenyl diisocyanate (MDI) among medical personnel applying orthopedic casts using two different application methods. Air, dermal, surface, and glove permeation sampling methods were combined with urinary biomonitoring to assess the overall risk of occupational asthma to workers handling these materials. No MDI was detected in any of the personal and area air samples obtained. No glove permeation of MDI was detected. A small proportion of surface (3/45) and dermal wipe (1/60) samples were positive for MDI, but were all from inexperienced technicians. Urinary metabolites of MDI [methylenedianiline (MDA)] were detected in three of six study participants prior to both a ‘dry’ and ‘wet’ application method, five of six after the dry method, and three of six after the wet method. All MDA results were below levels noted in worker or general populations. Our conclusion is that the risk of MDI exposure is small, but unquantifiable. Because there is some potential risk of dermal exposure, medical personnel are instructed to wear a minimum of 5-mil-thick (5 mil = 0.005 inches) nitrile gloves and avoid contact to unprotected skin. This could include gauntlets, long sleeves, and/or a laboratory coat.
Pearson, Ronald L.
The efficacy and safety of preoperative intravenous administration of parecoxib sodium, a novel parenteral prodrug of a cyclooxygenase-2 selective inhibitor, in treating postoperative pain resulting from bunionectomy were evaluated in 50 patients who were part of a larger cohort of orthopedic and podiatric patients. Following bunionectomy, the median time to rescue medication (survival analysis) was 4 hours 18 min (95% confidence interval, 3 hours 4 min to 4 hours 37 min) in the placebo group, 7 hours 5 min (95% confidence interval, 3 hours 20 min to >24 hours) in the 20-mg parecoxib sodium group, and 10 hours 43 min (95% confidence interval, 4 hours 42 min to 14 hours 7 min) in the 40-mg parecoxib sodium group (significant for 40-mg parecoxib sodium versus placebo). Four or more hours after surgery, the mean pain-intensity (categorical) score was significantly lower in both parecoxib sodium groups than in the placebo group. Preoperative administration of parecoxib sodium was well tolerated and significantly reduced postoperative pain in patients who had undergone bunionectomy. PMID:15153593
Desjardins, Paul J; Traylor, Louise; Hubbard, Richard C
Previous studies have suggested a potential risk to healthcare workers applying isocyanate-containing casts, but the authors reached their conclusions based on immunological or clinical pulmonology test results alone. We designed a study to assess potential exposure to methylene diphenyl diisocyanate (MDI) among medical personnel applying orthopedic casts using two different application methods. Air, dermal, surface, and glove permeation sampling methods were combined with urinary biomonitoring to assess the overall risk of occupational asthma to workers handling these materials. No MDI was detected in any of the personal and area air samples obtained. No glove permeation of MDI was detected. A small proportion of surface (3/45) and dermal wipe (1/60) samples were positive for MDI, but were all from inexperienced technicians. Urinary metabolites of MDI [methylenedianiline (MDA)] were detected in three of six study participants prior to both a 'dry' and 'wet' application method, five of six after the dry method, and three of six after the wet method. All MDA results were below levels noted in worker or general populations. Our conclusion is that the risk of MDI exposure is small, but unquantifiable. Because there is some potential risk of dermal exposure, medical personnel are instructed to wear a minimum of 5-mil-thick (5 mil = 0.005 inches) nitrile gloves and avoid contact to unprotected skin. This could include gauntlets, long sleeves, and/or a laboratory coat. PMID:23680587
Pearson, Ronald L; Logan, Perry W; Kore, Anita M; Strom, Constance M; Brosseau, Lisa M; Kingston, Richard L
The molecular events following shock wave treatment of bone are widely unknown. Nevertheless patients with osteonecrosis and non unions are already treated partly successful with shock waves. Concerning the first indication, the question of the permeation of the shock wave into the bone was addressed. Therefore shockwaves were applied to porcine femoral heads and the intraosseous pressure was measured. A linear correlation of the pressure to the intraosseous distance was found. Approximately 50% of the pressure are still measurable 10 mm inside the femoral head. These findings should encourage continued shock wave research on this indication. Concerning the second indication (non union), osteoblasts were subjected to 250 or 500 shock waves at 25 kV. After 24, 48, and 72 h the levels of the bone and vascular growth factors bFGF, TGFbeta1, and VEGF were examined. After 24 h there was a significant increase in bFGF levels (p<0.05) with significant correlation (p<0.05) to the number of impulses. TGFbeta1, and VEGF showed no significant changes. This may be one piece in the cascade of new bone formation following shock wave treatment and may lead to a more specific application of shock waves in orthopedic surgery.
Hausdorf, Joerg; Jansson, Volkmar; Maier, Markus; Delius, Michael
This work tries to clarify the place which is due to the modified Lyons orthopaedic treatment of scolioses. Actually, nowadays, because of progress in surgery, some people abandon all orthopaedic treatment which caught severe progressive scolioses at the end of the growth period. The study covers 70 patients from a minimum distance of 3 years after the end of orthopaedic treatment. The treatment, in comparison with the classical Lyons treatment has two principle modifications: sequence protocol plaster then corset, purely external, not necessitizing hospitalisation or a stay in a specialised centre; and the use of resine which lightens the plaster. The results are given in angular loss as regards to the end of treatment, according to 3 factors; chronological form of the scoliosis, localization of the scoliosis, degree of the initial curvature. It emerges that in spite of the absence of hospitalisation at the beginning of the treatment, the results are comparable to those in literature (8, 19). We obtained 39 stabilizations of progression, 8 moderate aggravations without ulterior surgery, that is 67% good results. Our study confirms the high failure rate of orthopedic treatment of initial scolioses of 50 degrees and more (50%); compared to initial scolioses of 49 degrees to 20 degrees (29%); of dorsal scolioses (42%) compared to lumbar scolioses (18%); of child scolioses (40%) compared to adolescent scolioses (17%). It leads us to keep the Lyons treatment for progressive scolioses of 25 degrees to 40 degrees, from the start of puberty, or as preparation for surgical treatment. PMID:2268950
Pries, P; Gayet, L E; Clarac, J P; Launay, L; Brax, P
Physicochemical properties of hydroxyapatite (HAp) synthesized by the chemical precipitation method are heavily dependent on the chosen process parameters. A Box-Behnken three-level experimental design was therefore, chosen to determine the optimum set of process parameters and their effect on various HAp characteristics. These effects were quantified using design of experiments (DoE) to develop mathematical models using the Box-Behnken design, in terms of the chemical precipitation process parameters. Findings from this research show that the HAp possessing optimum powder characteristics for orthopedic application via a thermal spray technique can therefore be prepared using the following chemical precipitation process parameters: reaction temperature 60 °C, ripening time 48 h, and stirring speed 1500 rpm using high reagent concentrations. Ripening time and stirring speed significantly affected the final phase purity for the experimental conditions of the Box-Behnken design. An increase in both the ripening time (36-48 h) and stirring speed (1200-1500 rpm) was found to result in an increase of phase purity from 47(±2)% to 85(±2)%. Crystallinity, crystallite size, lattice parameters, and mean particle size were also optimized within the research to find desired settings to achieve results suitable for FDA regulations.
Kehoe, S.; Stokes, J.
The Orthopaedic In-Training Examination (OITE) has been administered to orthopedic residents to assess knowledge and measure teaching quality. We performed a detailed analysis of the shoulder and elbow (S&E) section of the OITE relating to question content, recommended American Academy of Orthopaedic Surgeons references, and resident performance. S&E questions from the 2005-2009 examinations were analyzed for resident performance scores, tested topics, tested imaging modalities, tested treatment modalities, taxonomy classification, and recommended references. The S&E section made up 5.9% of the OITE. Mean resident performance on the entire OITE and on the S&E section improved during each training year. Imaging modality questions typically involved radiographs, magnetic resonance imaging, and computed tomography. These questions made up 37.5% of the S&E section. Treatment modality questions made up 45% of the S&E section and related mostly to shoulder arthroplasty and rehabilitation. Taxonomy classification showed that recall questions were most common. However, mean resident performance was minimally affected by question type. Recommended references were most commonly journal articles. Results of this study provided unique information related to content, recommended references, and resident performance on the S&E section of the OITE. We hope that use of this information will help improve resident performance and optimize S&E curricula. PMID:22482089
Osbahr, Daryl C; Cross, Michael B; Taylor, Samuel A; Bedi, Asheesh; Dines, David M; Dines, Joshua S
Interface tissue engineering is a promising new strategy aimed at the regeneration of tissue interfaces and ultimately enabling the biological fixation of soft tissue grafts used in orthopedic repair and sports medicine. Many ligaments and tendons with direct insertions into subchondral bone exhibit a complex enthesis consisting of several distinct yet continuous regions of soft tissue, noncalcified fibrocartilage, calcified fibrocartilage, and bone. Regeneration of this multi-tissue interface will be critical for functional graft integration and improving long-term clinical outcome. This review highlights current knowledge of the structure-function relationship at the interface, the mechanism of interface regeneration, and the strategic biomimicry implemented in stratified scaffold design for interface tissue engineering and multi-tissue regeneration. Potential challenges and future directions in this emerging field are also discussed. It is anticipated that interface tissue engineering will lead to the design of a new generation of integrative fixation devices for soft tissue repair, and it will be instrumental for the development of integrated musculoskeletal tissue systems with biomimetic complexity and functionality. PMID:19064172
Moffat, Kristen L; Wang, I-Ning Elaine; Rodeo, Scott A; Lu, Helen H
Fibromyalgia Syndrome (FMS) is a chronic pain syndrome characterized by widespread musculoskeletal pain and fatigue. The current study was designed to evaluate the awareness and skills of orthopedic surgeons (OS) regarding FMS diagnosis and treatment. For the examination of awareness and familiarity of OS in Israel to Fibromyalgia, a questionnaire-based survey was conducted. Two hundred and nineteen OS, residents and specialists, were asked anonymously about awareness, knowledge, and treatment of FM. Multivariable statistical analysis was performed. 91 % (199) of responders reported that they recognized the disease. Notwithstanding, the mean knowledge score was 7.6 out of 17. In addition, OS who were trained in the south of Israel were found to have a better degree of knowledge about FM (9.7 vs. 7.4; p < 0.03). The awareness and knowledge among OS regarding FM needs to be improved. OS who were trained in the south of Israel were found to have better degree of knowledge regarding FM. PMID:22821335
Bloom, Shlomo; Ablin, Jacob N; Lebel, David; Rath, Ehud; Faran, Yifat; Daphna-Tekoah, Shir; Buskila, Dan
At various times after orthopedic operations (more than a few weeks, with an average of 29.9 days), 11 patients had a sudden onset of high temperature (average 38.9°C) and local cellulitis at different sites on the operated sides. The wounds had completely healed, without complicated infections, when the cellulitis occurred. The clinical picture of cellulitis in all patients was atypical: diffuse salmon-pink skin color, local heat, swelling, spontaneous pain, and tenderness but no eruptions. No patient had any underlying immunocompromising conditions or had been given immunosuppressive agents. Gram-negative spiral bacteria were isolated from blood cultures and were identified as Helicobacter cinaedi on the basis of 16S rRNA gene sequencing and DNA-DNA hybridization using standard strains. By means of phylogenetic analysis, we divided these clinical isolates into two clones. The H. cinaedi strain isolated via fecal cultures from two patients without intestinal symptoms was the same clone as the blood isolate. All isolates were quite susceptible to various antibiotics, and clinical and inflammatory symptoms of bacteremia and cellulitis improved after treatment with penicillins and cephalosporins. A relatively high incidence of recurrence of the same disease was observed, however. Almost all patients responded immunologically to the infection, as evidenced by the production of serum antibody against H. cinaedi. We thus suggest that H. cinaedi should not be regarded as simply an opportunistic pathogen but that it may be a pathogen in immunocompetent hosts and may cause infections together with bacteremia and cellulitis.
Kitamura, Toshio; Kawamura, Yoshiaki; Ohkusu, Kiyofumi; Masaki, Takayuki; Iwashita, Hirofumi; Sawa, Tomohiro; Fujii, Shigemoto; Okamoto, Tatsuya; Akaike, Takaaki
The review of X-ray endovascular surgical methods applied in the practice of FSF CITO named after N.N. Priorov since 1970 is presented. The complex evaluation of the altered conditions of performing angiographic examinations for the time present was carried out. The main regulations of anesthesiological provisions for angiographic studies in conditions of an in-patient trauma department are described. The methods of interventional X-ray surgery became use in patients with vertebral column and spinal medulla injuries, traumas with the threat of pulmonary thromboembolism and in patients with bone pathology. More than 200 patients with a traumatic disease of the spinal medulla and scoliotic deformities were investigated. In all patients spinal angiography with the evaluation of the spinal cord blood supply was performed. The results of more than 450 angiographic examinations the patients with bone pathology are presented. In 83 cases X-ray endovascular embolizations of the regional blood flow were done. 63 Cava Filters were implanted in patients with floating pelvic and leg vein thrombosis. Own expertise of the use of tentative Cava Filters is described. These and other data testify of X-ray endovascular methods prove to be in demand in traumatological and orthopedic practice. Their application will open new possibilities for traumatologists and orthopedists in the process of preventive measures, diagnostics and treatment the patients PMID:18822476
Mironov, S P; Morozov, A K; Khokhrikov, G I; Samochatov, D N; Spirin, A V
Bisphosphonates (BPs) are a group of well-established drugs that are applied in the development of metabolic bone disorder-related therapies. There is increasing interest also in the application of BPs in the context of bone tissue engineering, which is the topic of this review, in which an extensive overview of published studies on the development and applications of BPs-based strategies for bone regeneration is provided with special focus on the rationale for the use of different BPs in three-dimensional (3D) bone tissue scaffolds. The different alternatives that are investigated to address the delivery and sustained release of these therapeutic drugs in the nearby tissues are comprehensively discussed, and the most significant published approaches on bisphosphonate-conjugated drugs in multifunctional 3D scaffolds as well as the role of BPs within coatings for the improved fixation of orthopedic implants are presented and critically evaluated. Finally, the authors' views regarding the remaining challenges in the fields and directions for future research efforts are highlighted. PMID:22440082
Cattalini, Juan Pablo; Boccaccini, Aldo R; Lucangioli, Silvia; Mouriño, Viviana
Background Erythromycin, a hydrophobic antibiotic used to treat infectious diseases, is now gaining attention because of its anti-inflammatory effects and ability to inhibit osteoclasts formation. The aim of this study was to explore a cyclodextrin-erythromycin (CD-EM) complex for sustained treatment of orthopedic inflammation. Methods and results Erythromycin was reacted with ?-cyclodextrin to form a nonhost-guest CD-EM complex using both kneading and stirring approaches. Physiochemical measurement data indicated that erythromycin and cyclodextrin formed a packing complex driven by intermolecular forces instead of a host-guest structure due to the limited space in the inner cavity of ?-cyclodextrin. The CD-EM complex improved the stability of erythromycin in aqueous solution and had a longer duration of bactericidal activity than free erythromycin. Cytotoxicity and cell differentiation were evaluated in both murine MC3T3 preosteoblast cells and RAW 264.7 murine macrophage cells. The CD-EM complex was noncytotoxic and showed significant inhibition of osteoclast formation but had little effect on osteoblast viability and differentiation. Conclusion These attributes are especially important for the delivery of an adequate amount of erythromycin to the site of periprosthetic inflammation and reducing local inflammation in a sustained manner.
Song, Wei; Yu, Xiaowei; Wang, Sunxi; Blasier, Ralph; Markel, David C; Mao, Guangzhao; Shi, Tong; Ren, Weiping
Molecular medicine uses knowledge about cell structure and function for disease, diagnostics, stage characterisation and treatment. The advent of genomic technologies is considerably leading to developments in the field of molecular medicine. The accumulation of detailed information about gene expression, epigenetic variability, protein transcription and functional modulation is contributing to a new era in medicine. Rapid and early diagnostic procedures, molecular characterisation of degenerative and proliferative diseases and personalized therapies are predicted to lead to advancements in health prevention and treatment of disease. Diagnostic tools and therapies based on local and /or general modulation of cellular processes for traumatic or degenerative musculoskeletal conditions are becoming available. A logical consequence of the information derived from extensive data gathering, systems biology and systemic medicine has lead to significant improvements in understanding biological structure and function in a simultaneous bottom top and integrative, holistic manner. The description of disease mechanism at an intimate, subcellular level has a dual benefit. A thorough understanding of the crosstalk involved in molecular pathways both in the normal and the diseased state are expanding scientific knowledge and simultaneously are enabling design cell-targeted and individualized therapies. This paper presents a brief overview of current molecular based treatments available to the orthopedic surgeon and introduces the concept of systemic medicine from the perspective of musculoskeletal pathology.
Mashayekhi, Kaveh; O'Brien, Margaret; Zugun-Eloae, Florin; Labusca, Luminita
X-ray imaging is one of the most commonly used medical imaging modality. Albeit X-ray radiographs provide important clinical information for diagnosis, planning and post-operative follow-up, the challenging interpretation due to its 2D projection characteristics and the unknown magnification factor constrain the full benefit of X-ray imaging. In order to overcome these drawbacks, we proposed here an easy-to-use X-ray calibration object and developed an optimization method to robustly find correspondences between the 3D fiducials of the calibration object and their 2D projections. In this work we present all the details of this outlined concept. Moreover, we demonstrate the potential of using such a method to precisely extract information from calibrated X-ray radiographs for two different orthopedic applications: post-operative acetabular cup implant orientation measurement and 3D vertebral body displacement measurement during preoperative traction tests. In the first application, we have achieved a clinically acceptable accuracy of below 1° for both anteversion and inclination angles, where in the second application an average displacement of 8.06±3.71mm was measured. The results of both applications indicate the importance of using X-ray calibration in the clinical routine. PMID:24834855
Schumann, Steffen; Thelen, Benedikt; Ballestra, Steven; Nolte, Lutz-P; Büchler, Philippe; Zheng, Guoyan
To assess the benefits of nitric oxide (NO)-releasing sol-gels as potential antibacterial coatings for orthopedic devices, medical-grade stainless steel is coated with a sol-gel film of 40% N-aminohexyl-N-aminopropyltrimethoxysilane and 60% isobutyltrimethoxysilane. Upon converting the diamine groups in these films to diazeniumdiolate NO donors, the NO release from the sol-gel-coated stainless steel is evaluated at both ambient and physiological temperature. Sol-gel films incubated at 25 degrees C have a lower NO flux over the first 24 h compared to those at 37 degrees C, but release more than five times longer. The bacterial adhesion resistance of NO-releasing coatings is evaluated in vitro by exposing bare steel, sol-gel, and NO-releasing sol-gel-coated steel to cell suspensions of Pseudomonas aeruginosa, Staphylococcus aureus, and Staphylococcus epidermidis at 25 degrees C and 37 degrees C. Cell adhesion to bare and sol-gel-coated steel is similar, while NO-releasing surfaces have significantly less bacterial adhesion for all species and temperatures investigated. PMID:15353203
Nablo, Brian J; Rothrock, Aaron R; Schoenfisch, Mark H
Microstructure and mechanical properties of laser deposited complex quaternary Ti-34Nb-7Zr-7Ta (all wt%), an orthopedic load-bearing implant alloy, has been investigated in detail in both as-deposited as well as heat-treated (?-solutionized and quenched) conditions. The difference in stress-strain behavior of this alloy in the above conditions has been characterized using scanning electron microscopy (SEM), orientation imaging microscopy (OIM™) and transmission electron microscopy (TEM). Compared to the sample in heat-treated condition, the as-deposited sample showed evidence of strong growth related texture. Again in the as-deposited post tensile-tested condition formation of a high density of shear bands, possibly arising from slip localization due to shearing of ? precipitates in the ? matrix is observed. TEM investigations also show the presence of lenticular shaped deformation induced ? phase within the shear bands. In contrast, in case of the ?-solutionized sample, twinning and the formation of stress-induced plates appears to be the primary mode of deformation. The change in deformation mechanism and thus the tensile property of this alloy could be attributed to the crystallographic texture along the growth direction as well as diffusion mediated isothermal ? precipitates, that cause an enrichment of Nb and Ta in the ? matrix, during the laser-deposition process. This is no longer present after the solutionizing treatment. PMID:23137619
Nag, S; Banerjee, R
Though the basic principles of antibiotic prophylaxis have been well established, there is still considerable incorrect usage, including how much is prescribed and especially in the duration of treatment, which is generally superior to what is indicated. The adequate use of these drugs contributes towards decreasing the time of internment of the patient, prevents surgical site infection (SSI), decreasing the development of resistant microorganisms, and towards reduced costs for the hospital pharmacy. A protocol for the use of antibiotic prophylaxis in the Orthopedics and Traumatology Service of the Hospital do Servidor Público Estadual de São Paulo was developed. The objectives of the study were to promote rational antibiotic surgical prophylaxis, through the implantation of a protocol for the use of these drugs in a surgical unit, with the direct contribution of a druggist in collaboration with the Infection Control Committee, to evaluate the adhesion of the health team to the protocol during three distinct periods (daily pre-protocol, early post-protocol and late post-protocol) and to define the consumption of antimicrobials used, measured as daily defined dose. PMID:16270119
Queiroz, Raquel; Grinbaum, Renato S; Galvão, Luciana L; Tavares, Fernando G; Bergsten-Mendes, Gun
In order to gather more data on the use of teicoplanin for reducing MRSA infections in high-risk populations, the present study was conducted. At a hospital in Barcelona, Spain, there was a high prevalence of MRSA infections among patients who underwent surgery for femoral neck fracture during the first 5 months of 2002 (period A) when cefuroxime was the antibiotic prophylaxis. During the following 12 months (period B) 600 mg of teicoplanin was added to cefuroxime. The rates of overall and MRSA infection during period A were 5.07 and 2.73%, respectively. Pulsed-field gel electrophoresis demonstrated there was no clonal relationship among MRSA strains. No nasal carriers of MRSA were detected among health workers. During period B the rates of overall and MRSA infection were 2.36 and 0.19%, respectively. Both rates were statistically significantly lower than those in period A (p<0.05). These results suggest teicoplanin may be useful in patients undergoing orthopedic surgery when the prevalence of MRSA is high. PMID:16424973
Soriano, A; Popescu, D; García, S; Bori, G; Martínez, J A; Balasso, V; Marco, F; Almela, M; Mensa, J
The use of methyl methacrylate (MMA) bone cement during orthopedic procedures has been seen as a potential exposure hazard to health care professionals. However, that assessment is based on a number of investigations with problems in experimental design, analysis, and data interpretation. The current investigation quantified differences in MMA vapors produced during the preparation of competing bone cements using various methods of preparation. Unlike previous investigations, this effort employs modern validated sampling and analytical methods, and considers the affect of censored results. Measurements of sufficient quality and number were collected to allow for a statistical treatment of the data. The ability of two controlled preparation techniques to reduce MMA emissions were compared with a traditional open container. The results confirmed that the preparation of bone cement releases MMA vapors into the breathing zone of the preparer. One preparation technique (Stryker Bowl) controlled emissions during mixing and curing and affected a 73% reduction in measured MMA concentrations. In addition to mixing and curing, the second technique (UltraMix System) also controlled the MMA during pouring of the monomer and affected a 90% reduction in MMA concentrations. An ANOVA test of interaction indicates that the reductions are attributable to the preparation technique regardless of the type of cement being used. Both a Fisher's PLSD and Games/Howell post hoc test of the results indicate that the mean differences between the uncontrolled open container and the controlled preparation techniques are significant (p < 0.05). PMID:17365499
Ungers, Leslie J; Vendrely, Timothy G; Barnes, C Lowry
The high corrosion rate of Mg alloys has hindered their application in various areas, particularly for orthopedic applications. In order to decrease the corrosion rate and to improve the bioactivity, mechanical stability and cytocompatibility of the Mg alloy, nanostructured diopside (CaMgSi2O6) has been coated on AZ91 Mg alloy using a combined micro arc oxidation (MAO) and electrophoretic deposition (EPD) method. The crystalline structure, the morphology and the composition of the samples were characterized by X-ray diffraction (XRD), scanning electron microscopy (SEM) and Fourier transform infrared spectroscopy (FTIR). Electrochemical corrosion test, immersion test, and compression test were used to evaluate the corrosion resistance, the in vitro bioactivity and the mechanical stability of the samples, respectively. The cytocompatibility of the samples was tested by the cell viability and the cell attachment of L-929 cells. The results confirmed that the diopside coating not only slows down the corrosion rate, but also enhances the in vitro bioactivity, mechanical stability and cytocompatibility of AZ91 Mg alloy. Therefore, Mg alloy coated with nanostructured diopside offers a promising approach for biodegradable bone implants. PMID:24907750
Razavi, Mehdi; Fathi, Mohammadhossein; Savabi, Omid; Vashaee, Daryoosh; Tayebi, Lobat
Calcium phosphate materials have been used increasingly in the past 40 years as bone graft substitutes in the dental and orthopedic fields. Accordingly, numerous fabrication methods have been proposed and used. However, the controlled production of spherical calcium phosphate particles remains a challenge. Since such particles are essential for the synthesis of pastes and cements delivered into the host bone by minimally-invasive approaches, the aim of the present document is to review their synthesis and applications. For that purpose, production methods were classified according to the used reagents (solutions, slurries, pastes, powders), dispersion media (gas, liquid, solid), dispersion tools (nozzle, propeller, sieve, mold), particle diameters of the end product (from 10 nm to 10 mm), and calcium phosphate phases. Low-temperature calcium phosphates such as monetite, brushite or octacalcium phosphate, as well as high-temperature calcium phosphates, such as hydroxyapatite, ?-tricalcium phosphate or tetracalcium phosphate, were considered. More than a dozen production methods and over hundred scientific publications were discussed.
Bohner, Marc; Tadier, Solene; van Garderen, Noemie; de Gasparo, Alex; Dobelin, Nicola; Baroud, Gamal
Infection is a major complication of total joint arthroplasty (TJA) surgery, and even though it is now as low as 1 % in some hospitals, the increasing number of primary surgeries translates to tens of thousands of revisions due to prosthetic joint infection (PJI). In many cases the only solution is revision surgery in which the hardware is removed. This process is extremely long and painful for patients and is a considerable financial burden for the health-care system. A significant proportion of the difficulties in diagnosis and treatment of PJI are associated with biofilm formation where bacteria attach to the surface of the prosthesis and periprosthetic tissue and build a 3-D biofilm community encased in an extracellular polymeric slime (EPS) matrix. Bacteria in biofilms have a low metabolic rate which is thought to be a major contributor to their recalcitrance to antibiotic treatment. The diagnosis of biofilm infections is difficult due to the fact that bacteria in biofilms are not readily cultured with standard clinical microbiology techniques. To identify and visualize in situ biofilm bacteria in orthopedic samples, we have developed protocols for the collection of samples in the operating room, for molecular fluorescent staining with 16S rRNA fluorescence in situ hybridization (FISH), and for imaging of samples using confocal laser scanning microscopy (CLSM). Direct imaging is the only method which can definitively identify biofilms on implants and complements both culture and culture-independent diagnostic methods. PMID:24664829
Nistico, Laura; Hall-Stoodley, Luanne; Stoodley, Paul
This study compared mathematical outcomes in children with predominantly moderate to severe traumatic brain injury (TBI; n =50) or orthopedic injury (OI; n=47) at 2 and 24 months post-injury. Working memory and its contribution to math outcomes at 24 months post-injury was also examined. Participants were administered an experimental cognitive addition task and standardized measures of calculation, math fluency, and applied problems; as well as experimental measures of verbal and visual-spatial working memory. Although children with TBI did not have deficits in foundational math fact retrieval, they performed more poorly than OIs on standardized measures of math. In the TBI group, performance on standardized measures was predicted by age at injury, socioeconomic status, and the duration of impaired consciousness. Children with TBI showed impairments on verbal, but not visual working memory relative to children with OI. Verbal working memory mediated group differences on math calculations and applied problems at 24 months post-injury. Children with TBI have difficulties in mathematics, but do not have deficits in math fact retrieval, a signature deficit of math disabilities. Results are discussed with reference to models of mathematical cognition and disability and the role of working memory in math learning and performance for children with TBI.
Raghubar, Kimberly P.; Barnes, Marcia A.; Prasad, Mary; Johnson, Chad P.; Ewing-Cobbs, Linda
The injectability of Portland cement (PC) with calcium chloride and calcium nitrate additives was investigated using a syringe with a 2 mm aperture for potential clinical applications such as vertebroplasty. Addition of either additive at 10 wt % increased the quantity of cement extruded through the syringe from approximately 25 wt % for the PC standard, to over 95 wt %. 10 wt % additions of either additive also decreased setting times from over 2 h to below 25 min. The compressive strength of the modified cements was all greater than the compressive strength of a human vertebral body. Decreasing either additive to 5 wt % generated compressive strengths after 24 h setting equal to polymethylmethacrylate, the cement used for the majority of vertebroplasty procedures. An initial early exotherm in the chloride cements was coupled with an X-ray diffraction (XRD) peak that indicated the early formation of the ettringite cement phase. In contrast, Fourier transform infrared (FTIR) spectroscopy and XRD data indicated that calcium nitrate may have stimulated early calcium silicate hydrate (C-S-H) production (the main strength producing phase of PC). Combining the two additives produced a synergistic effect with cements having increased injectabilities and compressive strengths compared with either addition used individually. This study has demonstrated that by modifying PC with nonproprietary chemicals it was possible to significantly increase cement injectability and reduce setting times whilst maintaining compressive strengths, making PC suitable for potential orthopedic applications. PMID:22887643
Wynn-Jones, Gareth; Shelton, Richard M; Hofmann, Michael P
Polymeric film coatings were applied by dip coating on two magnesium alloy systems, AZ31 and Mg4Y, in an attempt to slow the degradation of these alloys under in vitro conditions. Poly(lactic-co-glycolic acid) polymer in solution was explored at various concentrations, yielding coatings of varying thicknesses on the alloy substrates. Electrochemical corrosion studies indicate that the coatings initially provide some corrosion protection. Degradation studies showed reduced degradation over 3 days, but beyond this time point however, do not maintain a reduction in corrosion rate. Scanning electron microscopy indicates inhomogeneous coating durability, with gas pocket formation in the polymer coating, resulting in eventual detachment from the alloy surface. In vitro studies of cell viability utilizing mouse osteoblast cells showed improved biocompatibility of polymer coated substrates over the bare AZ31 and Mg4Y substrates. Results demonstrate that while challenges remain for long term degradation control, the developed polymeric coatings nevertheless provide short term corrosion protection and improved biocompatibility of magnesium alloys for possible use in orthopedic applications. PMID:23053803
Ostrowski, Nicole J; Lee, Boeun; Roy, Abhijit; Ramanathan, Madhumati; Kumta, Prashant N
Interacting with a Virtual Environment (VE) generally requires the user to correctly perceive the relative position and orientation of virtual objects. For applications requiring interaction in personal space, the user may also need to accurately judge the position of the virtual object relative to that of a real object, for example, a virtual button and the user's real hand. This is difficult since VEs generally only provide a subset of the cues experienced in the real world. Complicating matters further, VEs presented by currently available visual displays may be inaccurate or distorted due to technological limitations. Fundamental physiological and psychological aspects of vision as they pertain to the task of object manipulation were thoroughly reviewed. Other sensory modalities -- proprioception, haptics, and audition -- and their cross-interactions with each other and with vision are briefly discussed. Visual display technologies, the primary component of any VE, were canvassed and compared. Current applications and research were gathered and categorized by different VE types and object interaction techniques. While object interaction research abounds in the literature, pockets of research gaps remain. Direct, dexterous, manual interaction with virtual objects in Mixed Reality (MR), where the real, seen hand accurately and effectively interacts with virtual objects, has not yet been fully quantified. An experimental test bed was designed to provide the highest accuracy attainable for salient visual cues in personal space. Optical alignment and user calibration were carefully performed. The test bed accommodated the full continuum of VE types and sensory modalities for comprehensive comparison studies. Experimental designs included two sets, each measuring depth perception and object interaction. The first set addressed the extreme end points of the Reality-Virtuality (R-V) continuum -- Immersive Virtual Environment (IVE) and Reality Environment (RE). This validated, linked, and extended several previous research findings, using one common test bed and participant pool. The results provided a proven method and solid reference points for further research. The second set of experiments leveraged the first to explore the full R-V spectrum and included additional, relevant sensory modalities. It consisted of two full-factorial experiments providing for rich data and key insights into the effect of each type of environment and each modality on accuracy and timeliness of virtual object interaction. The empirical results clearly showed that mean depth perception error in personal space was less than four millimeters whether the stimuli presented were real, virtual, or mixed. Likewise, mean error for the simple task of pushing a button was less than four millimeters whether the button was real or virtual. Mean task completion time was less than one second. Key to the high accuracy and quick task performance time observed was the correct presentation of the visual cues, including occlusion, stereoscopy, accommodation, and convergence. With performance results already near optimal level with accurate visual cues presented, adding proprioception, audio, and haptic cues did not significantly improve performance. Recommendations for future research include enhancement of the visual display and further experiments with more complex tasks and additional control variables.
Nguyen, Long K.
Binary manipulators are powered by actuators which have only two stable states. Therefore, they can reach only a discrete (but possibly large) number of locations. Compared to a manipulator built with continuous actuators, a binary manipulator provides reasonable performance, and is relatively inexpensive (up to an order of magnitude cheaper). The number of states of a binary manipulator grows exponentially
David S. Lees; Gregory S. Chirikjian
We present a new optimal control approach to the robust control of robot manipulators in the framework of Lin et al. Because of the unknown load placed on a manipulator and the other uncertainties in the manipulator dynamics, it is important to design a robust control law that will guarantee the performance of the manipulator under these uncertainties. To solve
Feng Lin; Robert D. Brandt
We present a new optimal control approach to robust control of robot manipulators in the framework of Lin (1997). Due to the unknown load placed on a manipulator and the other uncertainties in the manipulator dynamics, it is important to design a robust control law that will guarantee the performance of the manipulator under these uncertainties. To solve this robust
Feng Lin; Robert D. Brandt
In this thesis, we discuss a framework for describing and synthesizing precision manipulation tasks with a robot hand. Precision manipulations are those in which the motions of grasped objects are caused by finger motions alone (as distinct from arm or wrist motion). Experiments demonstrating the capabilities of the Utah-MIT hand are presented. This work begins by examining current research on biological motor control to raise a number of questions. For example, is the control centralized and organized by a central processor? Or is the control distributed throughout the nervous system? Motor control research on manipulation has focused on developing classifications of hand motions, concentrating solely on finger motions, while neglecting grasp stability and interaction forces that occur in manipulation. In addition, these taxonomies have not been explicitly functional. This thesis defines and analyzes a basic set of manipulation strategies that includes both position and force trajectories. The fundamental purposes of the manipulations are: (1) rectilinear and rotational motion of grasped objects of different geometries; and (2) the application of forces and moments against the environment by the grasped objects. First, task partitioning is described to allocate the fingers their roles in the task. Second, for each strategy, the mechanics and workspace of the tasks are analyzed geometrically to determine the gross finger trajectories required to achieve the tasks. Techniques illustrating the combination of simple manipulations into complex, multiple degree-of-freedom tasks are presented. There is a discussion of several tasks that use multiple elementary strategies. The tasks described are removing the top of a childproof medicine bottle, putting the top back on, rotating and regrasping a block and a cylinder within the grasp. Finally, experimental results are presented. The experimental setup at Columbia University's Center for Research in Intelligent Systems and experiments with a Utah-MIT hand is discussed. First, the overall system design is described. Two hybrid position/force controllers were designed and built. After a discussion of the entire system, experimental results are presented describing each of the basic manipulation and complex manipulation strategies.
The creation of dynamic manipulation behaviors for high degree of freedom, mobile robots will allow them to accomplish increasingly difficult tasks in the field. We are investigating how the coordinated use of the body, legs, and integrated manipulator, on a mobile robot, can improve the strength, velocity, and workspace when handling heavy objects. We envision that such a capability would aid in a search and rescue scenario when clearing obstacles from a path or searching a rubble pile quickly. Manipulating heavy objects is especially challenging because the dynamic forces are high and a legged system must coordinate all its degrees of freedom to accomplish tasks while maintaining balance. To accomplish these types of manipulation tasks, we use trajectory optimization techniques to generate feasible open-loop behaviors for our 28 dof quadruped robot (BigDog) by planning trajectories in a 13 dimensional space. We apply the Covariance Matrix Adaptation (CMA) algorithm to solve for trajectories that optimize task performance while also obeying important constraints such as torque and velocity limits, kinematic limits, and center of pressure location. These open-loop behaviors are then used to generate desired feed-forward body forces and foot step locations, which enable tracking on the robot. Some hardware results for cinderblock throwing are demonstrated on the BigDog quadruped platform augmented with a human-arm-like manipulator. The results are analogous to how a human athlete maximizes distance in the discus event by performing a precise sequence of choreographed steps.
Abe, Yeuhi; Stephens, Benjamin; Murphy, Michael P.; Rizzi, Alfred A.
Teleoperator experiments were conducted which have demonstrated that a realistic, complex task, typical of those accomplished on-orbit by EVA astronauts, can be done in a smooth, timely manner with manipulators remotely controlled by humans. The real concerns were: (1) do manipulators have sufficient dexterity for these tasks, (2) can sufficient information from the remote site be provided to permit adequate teleoperator control, (3) can reasonable times relative to EVA times be achieved, (4) can the task be completed without frequent and/or damaging impacts among the task components and the manipulators? Positive answers were found to all of these concerns. Tasks times, operator fatigue, and smoothness of operation could be improved by designing the task components and the manipulators for greater compatibility. The data recorded supplements a data base of performance metrics for the same task done in the water immersion training facility as well as space flight and provides management with an objective basis for deciding how and where to apply manipulators in space.
Hankins, Walter W., III; Mixon, Randolph W.; Jones, Howard C.; Burgess, Thomas W.
Manipulation is an important issue for both developed and emerging stock markets. For the study of manipulation, it is critical to analyze investor behavior in the stock market. In this paper, an analysis of the full transaction records of over a hundred stocks in a one-year period is conducted. For each stock, a trading network is constructed to characterize the relations among its investors. In trading networks, nodes represent investors and a directed link connects a stock seller to a buyer with the total trade size as the weight of the link, and the node strength is the sum of all edge weights of a node. For all these trading networks, we find that the node degree and node strength both have tails following a power-law distribution. Compared with non-manipulated stocks, manipulated stocks have a high lower bound of the power-law tail, a high average degree of the trading network and a low correlation between the price return and the seller-buyer ratio. These findings may help us to detect manipulated stocks.
Sun, Xiao-Qian; Cheng, Xue-Qi; Shen, Hua-Wei; Wang, Zhao-Yang
This paper presents a new mobile robot design based on hybridization of the mobile platform and manipulator arm as one entity for robot locomotion as well as manipulation. The novel mechanical design is described in detail. To analyse the design, a virtual prototype tool was developed with ADAMS software for multi-body dynamic motion simulations of the complete robotic system. The
Pinhas Ben-tzvi; Andrew A. Goldenberg; Jean W. Zu
Background National and international evidence-based guidelines for hip and knee osteoarthritis recommend to start with (a combination of) conservative treatments, followed by surgical intervention if a patient does not respond sufficiently to conservative treatment options. Despite these recommendations, there are strong indications that conservative treatments are not optimally used in orthopedic practice. Our study aims to quantify the use of conservative treatments in Dutch orthopedic practice and to explore the barriers and facilitators for the use of conservative treatments that should be taken into account in a strategy to improve the embedding of conservative treatments in hip and knee osteoarthritis in orthopedic practice. Methods This study consists of three phases. First, current use of conservative treatments in patients with hip and knee osteoarthritis will be explored using an internet-based survey among at least 100 patients to identify the underused conservative treatments. Second, barriers and facilitators for the use of conservative treatments in orthopedic practice will be identified using semi-structured interviews among 10 orthopedic surgeons and 5 patients. The interviews will be followed by an internet-based survey among approximately 450 orthopedic surgeons and at least 100 patients in which the identified barriers and facilitators will be ranked by importance. Finally, an implementation strategy will be developed based on the results of the previous phases using intervention mapping. Discussion The developed strategy is likely to result in an optimal and standardized use of conservative treatment options in hip and knee osteoarthritis in orthopedic practice, because it is focused on identified barriers and facilitators. In addition, the results of this study can be used as an example for optimizing the use of conservative care in other patient groups. In a subsequent study, the developed implementation strategy will be assessed on its effectiveness, feasibility and costs.
A force reflecting hand controller based upon a six degree of freedom fully parallel mechanism, often termed a Stewart Platform, has been designed, constructed, and tested as an integrated system with a slave robot manipulator test bed. A force reflecting hand controller comprises a kinesthetic device capable of transmitting position and orientation commands to a slave robot manipulator while simultaneously representing the environmental interaction forces of the slave manipulator back to the operator through actuators driving the hand controller mechanism. The Stewart Platform was chosen as a novel approach to improve force reflecting teleoperation because of its inherently high ratio of load generation capability to system mass content and the correspondingly high dynamic bandwidth. An additional novelty of the program was to implement closed loop force and torque control about the hand controller mechanism by equipping the handgrip with a six degree of freedom force and torque measuring cell. The mechanical, electrical, computer, and control systems are discussed and system tests are presented.
Bryfogle, Mark D.
Ultrasonic manipulation is a contactless and gentle method to manipulate a large number of particles. The method presented here exploits the advantage to simultaneously move bacteria away from a surface by means of acoustic radiation forces. The device for the manipulation consists of five layers (transducer, epoxy adhesive layer, carrier, fluid, reflector), stacked like a conventional planar resonator. The resonator behavior was simulated using the transfer matrix method (TMM). Validation of the model was realized with admittance measurements performed over a wide frequency range (100 kHz - 16 MHz). The TMM-model was used to optimize frequency, layer thickness and material of the resonator in order to find a combination with a high force potential gradient pointing away from the reflector surface into the fluid. The resonator has been experimentally tested with polystyrene particles (1 ?m in diameter) which revealed a good matching with the TMM-model. First preliminary tests with Salmonella Thyphimurium have been done.
Schwarz, T.; Dual, J.
The paper presents a simple method for the design of linear multivariable controllers for multi-link robot manipulators. The control scheme consists of multivariable feedforward and feedback controllers. The feedforward controller is the minimal inverse of the linearized model of robot dynamics and contains only proportional-double-derivative (PD2) terms. This controller ensures that the manipulator joint angles track any reference trajectories. The feedback controller is of proportional-integral-derivative (PID) type and achieves pole placement. This controller reduces any initial tracking error to zero as desired and also ensures that robust steady-state tracking of step-plus-exponential trajectories is achieved by the joint angles. The two controllers are independent of each other and are designed separately based on the linearized robot model and then integrated in the overall control scheme. The proposed scheme is simple and can be implemented for real-time control of robot manipulators.
The control of multi-armed robotic systems is inherently more complex than that of single-arm systems. Whereas a single manipulator can be controlled purely through positions or velocities, multiple manipulators handling a common payload must also be controlled in terms of forces. In this paper, the problem of finding force setpoints for the controller is formulated as a constrained optimization problem where the constraints are provided by the dynamics equations and the actuator capabilities. A number of potential objective functions which may be minimized are reviewed including the internal force, a norm of the vector of actuator torques and power losses in the system. These are then compared for a task in which the Special Purpose Dextrous Manipulator (SPDM) moves a payload in the absence of gravity. It is concluded that the actuator torque criterion appears to offer the worst compromise in performance, while the minimum internal force and minimum power loss criteria each have their advantages.
Nahon, M.; Angeles, J.
Acoustic liquid manipulation is a family of techniques that employ the nonlinear acoustic effects of acoustic radiation pressure and acoustic streaming to manipulate the behavior of liquids. Researchers at the NASA Glenn Research Center are exploring new methods of manipulating liquids for a variety of space applications, and we have found that acoustic techniques may also be used in the normal Earth gravity environment to enhance the performance of existing fluid processes. Working in concert with the NASA Commercial Technology Office, the Great Lakes Industrial Technology Center, and Alchemitron Corporation (Elgin, IL), researchers at Glenn have applied nonlinear acoustic principles to industrial applications. Collaborating with Alchemitron Corporation, we have adapted the devices to create acoustic streaming in a conventional electroplating process.
Oeftering, Richard C.
Spirulina sp. as a bioregenerative photosynthetic and an edible alga for spacecraft crew in a CELSS, was characterized for the biomass yield in batch cultures, under various environmental conditions. The partitioning of the assimalitory products (proteins, carbohydrates, lipids) were manipulated by varying the environmental growth conditions. Experiments with Spirulina have shown that under stress conditions (i.e., high light 160 uE/sq m/s, temperature 38 C, nitrogen or phosphate limitation; 0.1 M sodium chloride) carbohydrates increased at the expense of proteins. In other experiments, where the growth media were sufficient in nutrients and incubated under optimum growth conditions, the total of the algal could be manipulated by growth conditions. These results support the feasibility of considering Spirulina as a subsystem in CELSS because of the ease with which its nutrient content can be manipulated.
Tadros, Mahasin G.; Smith, Woodrow; Mbuthia, Peter; Joseph, Beverly
This paper describes an underwater 3500 m electric manipulator (named Huahai-4E, stands for four functions deep ocean electric\\u000a manipulator in China), which has been developed at underwater manipulation technology lab in Huazhong University of Science\\u000a and Technology (HUST) for a test bed of studying of deep ocean manipulation technologies. The manipulator features modular\\u000a integration joints, and layered architecture control system.
Zhi-Hu Xiao; Guo-Hua Xu; Fu-Yuan Peng; Guo-Yuan Tang; Xiong Shen; Bo Yang
Background Previous reviews of the diagnostic performances of physical tests of the hip in orthopedics have drawn limited conclusions because of the low to moderate quality of primary studies published in the literature. This systematic review aims to build on these reviews by assessing a broad range of hip pathologies, and employing a more selective approach to the inclusion of studies in order to accurately gauge diagnostic performance for the purposes of making recommendations for clinical practice and future research. It specifically identifies tests which demonstrate strong and moderate diagnostic performance. Methods A systematic search of Medline, Embase, Embase Classic and CINAHL was conducted to identify studies of hip tests. Our selection criteria included an analysis of internal and external validity. We reported diagnostic performance in terms of sensitivity, specificity, predictive values and likelihood ratios. Likelihood ratios were used to identify tests with strong and moderate diagnostic utility. Results Only a small proportion of tests reported in the literature have been assessed in methodologically valid primary studies. 16 studies were included in our review, producing 56 independent test-pathology combinations. Two tests demonstrated strong clinical utility, the patellar-pubic percussion test for excluding radiologically occult hip fractures (negative LR 0.05, 95% Confidence Interval [CI] 0.03-0.08) and the hip abduction sign for diagnosing sarcoglycanopathies in patients with known muscular dystrophies (positive LR 34.29, 95% CI 10.97-122.30). Fifteen tests demonstrated moderate diagnostic utility for diagnosing and/or excluding hip fractures, symptomatic osteoarthritis and loosening of components post-total hip arthroplasty. Conclusions We have identified a number of tests demonstrating strong and moderate diagnostic performance. These findings must be viewed with caution as there are concerns over the methodological quality of the primary studies from which we have extracted our data. Future studies should recruit larger, representative populations and allow for the construction of complete 2×2 contingency tables.
The aim of this work was to discribe the lesions caused by the use of blasting landmines among civilians in south Senegal, and to evaluate their surgical management. The prospective study, which was conducted from February 2001 to September 2002, took place in the orthopedics and trauma clinic of the Ziguinchor regionle hospital. The average age of the patients was 22, and they included 13 men and 2 women. In 12 cases, the lesions were unilateral and bilateral in 3 cases. Surgical management began with an assessment of the lesions using the classification of Coupland and De Wind. Treatment was based on a pre-established protocol in order to end up with a stump of good quality. The major lesion would consist in one or both lower limbs crushed or amputated. It would be open and of the I- type according to Coupland and De Wind. Lesions as a result of several shrapnel impact and burns were considered as associated lesions with the main lesion. Six patients presented an infection of the stump. Some stumps healed completely after about 15 days, and some took no more than 75 days before closing up. Only one stump needed grafting. All our patients had the advantage of a casting off. The young and rural people were the most vulnerable. Lesions were rather distal-based. Infection delayed healing. No matter what the form of the lesion, there was always a partial loss of a limb. Landmine feet injuries as serious lesions. The objective of the surgical treatment is to facilitate the further use of a prosthesis. PMID:16190119
Dieme, C; Senghor, J; Sane, A; Dansokho, A; Ndiaye, A; Seye, S
Introduction Hypomelanosis of Ito was originally described as a purely cutaneous disease. Extracutaneous manifestations were described later, forming a neurocutaneous syndrome including skeletal, muscular, ocular and central nervous system symptoms. Hypomelanosis of Ito is characterized by a depigmentation along the lines of Blaschko on the trunk and extremities in certain patterns. The aim of this article was to report another case and give an overview of the related orthopedic symptoms that have been previously described. It was also our wish to contribute with recommendations for consideration with regard to bandages on eczematous rashes, especially on clubfeet. Case presentation A one-and-a-half-month-old boy of Caucasian background born with talipes equinovarus, or clubfoot, on his right foot presented with an eczematous rash after surgical correction and plaster bandaging. Conclusions It is the appearance of hypopigmentation, either alone or in combination with a congenital malformation, particularly central nervous system or musculoskeletal anomalies, which should form the basis of a presumptive diagnosis. This should then lead to further investigations and should always include skin biopsies and a test for chromosomal mosaicism. We report the case of a boy with a clinical picture consisting of a depigmented skin pattern, mental retardation, pes cavus, talipes equinovarus, clinodactyly, eczema, inverted cilia of the eye, strabismus, reduced hearing, ventral hernia, glomerulonephritis, missing testicles, leg length discrepancy with scoliosis, back pain and a syrinx. It is perhaps impossible to make any conclusions about extracutaneous symptoms. However, some symptoms such as retardation, cramps and seizures, delayed development and hypotonia cannot be ignored. Because of the possibility of creating an undesirable and long postoperative period with complications, it is very important to have this diagnosis in mind when deciding to do surgery or not if there are signs of dermatological problems before surgery. In this case, it could also be good clinical practice to test the patient’s reaction to plaster or other bandages.
The design of synthetic bone grafts that mimic the structure and composition of bone and possess good surgical handling characteristics remains a major challenge. We report the development of poly(2-hydroxyethyl methacrylate) (pHEMA)-hydroxyapatite (HA) composites termed “FlexBone” that possess osteoconductive mineral content approximating that of human bone yet exhibit elastomeric properties enabling the press-fitting into a defect site. The approach involves crosslinking pHEMA hydrogel in the presence of HA using viscous ethylene glycol as a solvent. The composites exhibit excellent structural integration between the apatite mineral component and the hydroxylated hydrogel matrix. The stiffness of the composite and the ability to withstand compressive stress correlate with the microstructure and content of the mineral component. The incorporation of porous aggregates of HA nanocrystals rather than compact micrometer-sized calcined HA effectively improved the resistance of the composite to crack propagation under compression. Freeze-dried FlexBone containing 50 wt % porous HA nanocrystals could withstand hundreds-of-megapascals compressive stress and >80% compressive strain without exhibiting brittle fractures. Upon equilibration with water, FlexBone retained good structural integration and withstood repetitive moderate (megapascals) compressive stress at body temperature. When subcutaneously implanted in rats, FlexBone supported osteoblastic differentiation of the bone marrow stromal cells pre-seeded on FlexBone. Taken together, the combination of high osteoconductive mineral content, excellent organic-inorganic structural integration, elasticity, and the ability to support osteoblastic differentiation in vivo makes FlexBone a promising candidate for orthopedic applications.
Song, Jie; Xu, Jianwen; Filion, Tera; Saiz, Eduardo; Tomsia, Antoni P.; Lian, Jane B.; Stein, Gary S.; Ayers, David C.; Bertozzi, Carolyn R.
Several species belonging to Staphylococcus genus (non Sau/ non Sep species) exhibit increasing abilities as opportunistic pathogens in colonisation of periprosthesis tissues. Here we report on antibiotic resistance of 193 strains, belonging to non Sau/ non Sep species, consecutively collected from orthopedic implant infections in a period of about 40 months. The 193 strains (representing 17% of all staphylococci isolated) were analysed for their antibiotic resistance to 16 different drugs. Five species turned out more prevalent, ranging from 1 to 5%: S. hominis (4.2%), S. haemolyticus (3.7%), S. capitis (2.7%), S. warneri (2.6%), and S. cohnii (1.6%). Among these, the prevalence of antibiotic resistance to penicillins was similar, ranging from 51% to 66%. Conversely, significant differences were observed for all the remaining antibiotics. For S. haemolyticus the resistances to oxacillin and imipenem, the four aminoglycosides and erythromycin were at least twice that of the other three species which were compared. S. warneri was on the contrary the species with the lowest occurrence of resistant strains. Ten species appeared only rarely at the infection sites: S. lugdunensis, S. caprae, S. equorum, S. intermedius, S. xylosus, S. simulans, S. saprophyticus, S. pasteuri, S. sciuri, and S. schleiferi. The behaviours of these species, often resistant to penicillins, were individually analysed. Differences in both the frequencies and the panels of antibiotic resistances observed among the non Sau/ non Sep species: i) suggest that horizontal spreading of resistance factors, if acting, was not sufficient per se to level their bio-diversities; ii) highlight and confirm the worrisome appearance within the Staphylococcus genus of emerging "new pathogens", not homogeneous for their virulence and antibiotic resistance prevalence, which deserve to be recognised and treated individually. PMID:16705608
Arciola, C R; Campoccia, D; An, Y H; Baldassarri, L; Pirini, V; Donati, M E; Pegreffi, F; Montanaro, L
OBJECTIVES To examine the effect of a multi-component intervention on pain and function following orthopedic surgery. DESIGN Controlled prospective propensity score matched clinical trial. SETTING New York City acute rehabilitation hospital. PARTICIPANTS 249 patients admitted to rehabilitation following hip fracture repair (N=51) hip (N=64) or knee (N=134) arthroplasty. INTERVENTION Pain assessment at rest and with physical therapy (PT) by staff using numeric rating scales (1 to 5). Physician protocols for standing analgesia and pre-emptive analgesia prior to PT were implemented on the intervention unit. Control unit patients received usual care. MAIN OUTCOME MEASURES Pain, analgesic prescribing, gait speed, transfer time, and percent of PT sessions completed during admission. Pain and difficulty walking at 6, 12, 18, and 24 weeks following discharge. RESULTS In multivariable analyses compared to controls, intervention patients were significantly more likely to report no or mild pain at rest (66% versus 49%, P=.004) and with PT (52% versus 38%, P=.02) on average for the first 7 days of rehabilitation; had faster 8 foot walk times on days four (9.3 seconds versus 13.2 seconds, P=.02) and seven (6.9 versus 9.2 seconds, P=.02); received more analgesia (8.0 milligrams of morphine sulfate equivalents/day, P<0.001); were more likely to receive standing analgesia (98% versus 48%, P<.001); and had significantly shorter lengths of stay (10.1 versus 11.3 days, P=.005). At 6 months compared to controls, intervention patients were less likely to report moderate/severe pain with walking (15% versus 4%, P=.02), that pain did not interfere with walking (7% versus 18%, P=.004), and were less likely to be taking analgesics (35% versus 51%, P=.03). CONCLUSION The intervention improved post-operative pain, reduced chronic pain, and improved function.
Morrison, R. Sean; Flanagan, Steven; Fischberg, Daniel; Cintron, Alexie; Siu, Albert L
Causes of bone deficiency are numerous, but biomimetic alloplastic grafts provide an alternative to repair tissue naturally. Previously, a hydroxyapatite-gelatin modified siloxane (HAp-Gemosil) composite was prepared by cross-linking (N, N'-bis[(3-trimethoxysilyl)propyl]ethylene diamine (enTMOS) around the HAp-Gel nanocomposite particles, to mimic the natural composition and properties of bone. However, the tensile strength remained too low for many orthopedic applications. It was hypothesized that incorporating a polymer chain into the composite could help improve long range interaction. Furthermore, designing this polymer to interact with the enTMOS siloxane cross-linked matrix would provide improved adhesion between the polymer and the ceramic composite, and improve mechanical properties. To this end, copolymers of L-Lactide (LLA), and a novel alkyne derivatized trimethylene carbonate, propargyl carbonate (PC), were synthesized. Incorporation of PC during copolymerization affects properties of copolymers such as molecular weight, T(g), and % PC incorporation. More importantly, PC monomers bear a synthetic handle, allowing copolymers to undergo post-polymerization functionalization with graft monomers to specifically tailor the properties of the final composite. For our investigation, P(LLA-co-PC) copolymers were functionalized by an azido-silane (AS) via copper catalyzed azide-alkyne cycloaddition (CuAAC) through terminal alkyne on PC monomers. The new functionalized polymer, P(LLA-co-PC)(AS) was blended with HAp-Gemosil, with the azido-silane linking the copolymer to the silsesquioxane matrix within the final composite.These HAp-Gemosil/P(LLA-co-PC)(AS) composites were subjected to mechanical and biological testing, and the results were compared with those from the HAp-Gemosil composites. This study revealed that incorporating a cross-linkable polymer served to increase the flexural strength of the composite by 50%, while maintaining the biocompatibility of HAp-Gemosil ceramics. PMID:23139457
Dyke, Jason Christopher; Knight, Kelly Jane; Zhou, Huaxing; Chiu, Chi-Kai; Ko, Ching-Chang; You, Wei
Causes of bone deficiency are numerous, but biomimetic alloplastic grafts provide an alternative to repair tissue naturally. Previously, a hydroxyapatite-gelatin modified siloxane (HAp-Gemosil) composite was prepared by cross-linking (N, N?-bis[(3-trimethoxysilyl)propyl]ethylene diamine (enTMOS) around the HAp-Gel nanocomposite particles, to mimic the natural composition and properties of bone. However, the tensile strength remained too low for many orthopedic applications. It was hypothesized that incorporating a polymer chain into the composite could help improve long range interaction. Furthermore, designing this polymer to interact with the enTMOS siloxane cross-linked matrix would provide improved adhesion between the polymer and the ceramic composite, and improve mechanical properties. To this end, copolymers of L-Lactide (LLA), and a novel alkyne derivatized trimethylene carbonate, propargyl carbonate (PC), were synthesized. Incorporation of PC during copolymerization affects properties of copolymers such as molecular weight, Tg, and % PC incorporation. More importantly, PC monomers bear a synthetic handle, allowing copolymers to undergo post-polymerization functionalization with graft monomers to specifically tailor the properties of the final composite. For our investigation, P(LLA-co-PC) copolymers were functionalized by an azido-silane (AS) via copper catalyzed azide-alkyne cycloaddition (CuAAC) through terminal alkyne on PC monomers. The new functionalized polymer, P(LLA-co-PC)(AS) was blended with HAp-Gemosil, with the azido-silane linking the copolymer to the silsesquioxane matrix within the final composite. These HAp-Gemosil/P(LLA-co-PC)(AS) composites were subjected to mechanical and biological testing, and the results were compared with those from the HAp-Gemosil composites. This study revealed that incorporating a cross-linkable polymer served to increase the flexural strength of the composite by 50%, while maintaining the biocompatibility of HAp-Gemosil ceramics.
Dyke, Jason Christopher; Knight, Kelly Jane; Zhou, Huaxing; Chiu, Chi-Kai; Ko, Ching-Chang; You, Wei
Using manipulators with a fixed configuration for specific tasks is appropriate when the task requirements are known beforehand. However, in less predictable situations, such as an outdoor construction site or aboard a space station, a manipulator system requires a wide range of capabilities, probably beyond the limitations of a single, fixed-configuration manipulator. To fulfill this need, researchers have been working on a Reconfigurable Modular Manipulator System (RMMS). Researchers have designed and are constructing a prototype RMMS. The prototype currently consists of two joint modules and four link modules. The joints utilize a conventional harmonic drive and torque motor actuator, with a small servo amplifier included in the assembly. A brushless resolver is used to sense the joint position and velocity. For coupling the modules together, a standard electrical connector and V-band clamps for mechanical connection are used, although more sophisticated designs are under way for future versions. The joint design yields an output torque to 50 ft-lbf at joint speeds up to 1 radian/second. The resolver and associated electronics have resolutions of 0.0001 radians, and absolute accuracies of plus or minus 0.001 radians. Manipulators configured from these prototype modules will have maximum reaches in the 0.5 to 2 meter range. The real-time RMMS controller consists of a Motorola 68020 single-board computer which will perform real time servo control and path planning of the manipulator. This single board computer communicates via shared memory with a SUN3 workstation, which serves as a software development system and robot programming environment. Researchers have designed a bus communication network to provide multiplexed communication between the joint modules and the computer controller. The bus supports identification of modules, sensing of joint states, and commands to the joint actuator. This network has sufficient bandwidth to allow servo sampling rates in excess of 500 Hz.
Schmitz, D.; Kanade, T.
We report a simple but straightforward approach to fabricate magnetic nanofiber segments for cell manipulation. Electrospinning was used to produce nanofibers from a magnetic nanoparticles containing polymethylglutarimide (PMGI) precursor solution. After sonication, the fabricated nanofibers were uniformly segmented. When dispersed in an aqueous solution, the orientation of the fiber segments could easily be controlled by an external magnetic field. NIH 3T3 cells were then cultured in a medium containing magnetic fibers, resulting in stable cell-nanofiber hybrids which can be conveniently manipulated with a magnet.
Liu, Jun; Shi, Jian; Jiang, Lianmei; Zhang, Fan; Wang, Li; Yamamoto, Shinpei; Takano, Mikio; Chang, Mengjie; Zhang, Haoli; Chen, Yong
The development is described of a nonlinear dynamic model for large oscillations of a robotic manipulator arm about a single joint. Optimization routines are formulated and implemented for the identification of electrical and physical parameters from dynamic data taken from an industrial robot arm. Special attention is given to the role of sensitivity in the formulation of robust models of this motion. The importance of actuator effects in the reduction of sensitivity is established and used to develop an electromechanical model of the manipulator system.
Brewer, D. W.; Gibson, J. S.
A manipulator is disclosed which provides fast, accurate rotational positioning of a small sphere, such as an inertial confinement fusion target, which allows inspecting of the entire surface of the sphere. The sphere is held between two flat, flexible tips which move equal amounts in opposite directions. This provides rolling of the ball about two orthogonal axes without any overall translation. The manipulator may be controlled, for example, by an x- and y-axis driven controlled by a mini-computer which can be programmed to generate any desired scan pattern. 8 figs.
Weinstein, B.W.; Willenborg, D.L.
A manipulator which provides fast, accurate rotational positioning of a small sphere, such as an inertial confinement fusion target, which allows inspecting of the entire surface of the sphere. The sphere is held between two flat, flexible tips which move equal amounts in opposite directions. This provides rolling of the ball about two orthogonal axes without any overall translation. The manipulator may be controlled, for example, by an x- and y-axis driven controlled by a mini-computer which can be programmed to generate any desired scan pattern.
Weinstein, Berthold W. (Livermore, CA); Willenborg, David L. (Livermore, CA)
A control hierarchy for a robotic manipulator is described. The hierarchy includes perception and robot/environment interaction, the latter consisting of planning, path control, and terminal guidance loops. Environment-sensitive features include the provision of control governed by proximity, tactile, and visual sensors as well as the usual kinematic sensors. The manipulator is considered as part of an overall robot system. 'Adaptive control' in the present context refers to both the hierarchical nature of the control system and to its environment-responsive nature.
Lewis, R. A.
A new conceptually simple approach to controlling compliant motions of a robot manipulator is presented. The 'hybrid' technique described combines force and torque information with positional data to satisfy simultaneous position and force trajectory constraints specified in a convenient task related coordinate system. Analysis, simulation, and experiments are used to evaluate the controller's ability to execute trajectories using feedback from a force sensing wrist and from position sensors found in the manipulator joints. The results show that the method achieves stable, accurate control of force and position trajectories for a variety of test conditions.
Raibert, M. H.; Craig, J. J.
The manipulation of atomic and molecular species on metal surfaces with the scanning tunneling microscope (STM) operated at low temperature is a well established method for bottom-up nanofabrication [G. Meyer et al., Single Mol. 1, 79 (2000); N. Lorente, R. Rurali, H. Tang, J. Phys. Condens. Matter 17, S1049 (2005)], but is limited in its understanding and applications by restrictions inherent to the STM technique. These limitations can be overcome by using a dynamic scanning force microscope (SFM) for atomic manipulation that offers three major advantages compared to STM. First, the force microscope allows a quantification of the forces applied during the manipulation process (see Chap. 9), second, it facilitates manipulation at room temperature (see Chaps. 8 and 11) and, third, the technique allows manipulation on electrically insulating surfaces. However, examples for force controlled manipulation of atomic size species on an insulator surface are still scarce regarding experimental evidence [S. Hirth, F. Ostendorf, M. Reichling, Nanotechnology 17, S148 (2006); R. Nishi et al., Nanotechnology 17, S142 (2006)] as well as theoretical explanation [T. Trevethan et al., Phys. Rev. Lett. 98, 028101 (2007); T. Trevethan et al., Phys. Rev. B 76, 085414 (2007)]. Here we demonstrate the force controlled manipulation of water related defects on a CaF2 (111) surface by a raster scanning motion of the tip over a specific surface region. Manipulation is facilitated by repulsive forces exerted by approaching the tip very closely to the detects. We focus mainly on the presentation of manipulation results and discuss the circumstances that allow a control of the manipulation process. The CaF2 (111) surface is specifically well suited for such studies as this surface has been very well characterized by NC-AFM in previous studies [M. Reichling, C. Barth, Phys. Rev. Lett. 83, 768 (1999); C. Barth, M. Reichling, Surf. Sci. 470, L99 (2000); F.J. Giessibl, M. Reichling, Nanotechnology 16, S118 (2005); R. Hoffmann et al., J. Am. Chem. Soc. 127, 17863 (2005)] and contrast formation is understood on a quantitative level [A.S. Foster et al., Phys. Rev. Lett. 86, 2373 (2001); C. Barth et al., J. Phys. Condens. Matter 13, 2061 (2001); A.S. Foster et al., Phys. Rev. B 66, 235417 (2002)]. Furthermore, the geometric and electronic structures of this surface is well understood from a variety of theoretical simulations [A.V. Puchina et al., Solid State Commun. 106, 285 (1998); V.E. Puchin et al., J. Phys. Condens. Matter 13, 2081 (2001); Y. Ma, M. Rohlfing, Phys. Rev. B 75, 205114 (2007); Y. Ma, M. Rohlfing, Phys. Rev. B 77, 115118 (2008)]. Therefore, it can be expected that the experimental evidence of force controlled manipulation presented here will finally be fully explained by further theoretical modeling.
Hirth, Sabine; Ostendorf, Frank; Reichling, Michael
During orthopedic procedures, the tourniquets use