Sample records for modular prosthetic replacement

  1. Shoulder arthroplasty in osteoarthritis: current concepts in biomechanics and surgical technique

    PubMed Central

    Merolla, G; Nastrucci, G; Porcellini, G

    Shoulder arthroplasty is a technically demanding procedure to restore shoulder function in patients with severe osteoarthritis of the glenohumeral joint. The modern prosthetic system exploit the benefits of modularity and the availibility of additional sizes of the prosthetic components. In this paper we describe the biomechanics of shoulder arthroplasty and the technique for shoulder replacement including total shoulder arthroplasty (TSA) with all-polyethylene and metal-backed glenoid component, humeral head resurfacing and stemless humeral replacement. PMID:24251240

  2. Rapid prototyping prosthetic hand acting by a low-cost shape-memory-alloy actuator.

    PubMed

    Soriano-Heras, Enrique; Blaya-Haro, Fernando; Molino, Carlos; de Agustín Del Burgo, José María

    2018-06-01

    The purpose of this article is to develop a new concept of modular and operative prosthetic hand based on rapid prototyping and a novel shape-memory-alloy (SMA) actuator, thus minimizing the manufacturing costs. An underactuated mechanism was needed for the design of the prosthesis to use only one input source. Taking into account the state of the art, an underactuated mechanism prosthetic hand was chosen so as to implement the modifications required for including the external SMA actuator. A modular design of a new prosthesis was developed which incorporated a novel SMA actuator for the index finger movement. The primary objective of the prosthesis is achieved, obtaining a modular and functional low-cost prosthesis based on additive manufacturing executed by a novel SMA actuator. The external SMA actuator provides a modular system which allows implementing it in different systems. This paper combines rapid prototyping and a novel SMA actuator to develop a new concept of modular and operative low-cost prosthetic hand.

  3. [Intra-prosthetic dislocation of the Bousquet dual mobility socket].

    PubMed

    Lecuire, F; Benareau, I; Rubini, J; Basso, M

    2004-05-01

    The Bousquet system is a dual mobility head-polyethylene polyethylene-metal cup socket. The polyethylene insert retaining the femoral head moves in the noncemented metal cup, increasing both mobility and stability. Between 1989 and 1997, seven cases of intra-prosthetic dislocation (six patients) were observed. The femoral head escaped from the polyethylene insert due to wear. On the average, this complication occurred ten Years after implantation. Risk of dislocation was high in six of the seven hips. All patients had a large sized stem screwed into the femoral neck. There was a characteristic radiological aspect with loss of the concentric head metal cup configuration. The head was applied against the upper wall of the metal cup. Surgical replacement was undertaken early in six patients by simply changing the insert without modifying the other stable components. Outcome remained good at three to eight Years. One patient underwent late surgery. The insert and the cup were replaced with a classical implant. Functional outcome was good but recurrent dislocation occurred. At mid-term, intra-prosthetic dislocation of dual mobility sockets appears to be exceptional. Dislocation results from polyethylene wear leading to failure of the insert to retain the prosthetic head. Wear is favored by direct phenomena (direct contact between neck and insert which can occur early if there is a small difference in the head and neck diameters) or indirect phenomena (factors limiting polyethylene metal-cup mobility). Surgical treatment is necessary. If undertaken early, replacement with a modular head and insert can be sufficient if the prosthesis has not loosened but the metal cup may have to be replaced in the event of metal-metal contact between the head and the cup. Prosthesis loosening, wear of the metal cup, or an identified cause of dislocation imply replacing the failing implants. Implantation of the dual mobility system is particularly interesting for patients with a high risk of dislocation or a chronically unstable hip prosthesis. Careful technique is required to reduce or retard the risk of intra-prosthetic dislocation. Intra-prosthetic dislocation of a dual mobility socket is an exceptional complication at mid-term. Surgical treatment is required but may be limited to simple insert replacement. Systematic use of this type of implant in young subjects must be carefully examined, but for us, the risk of dislocation does not outweigh the advantages of this original concept of dual mobility. This type of socket remains an useful preventive technique for high-risk hips or for curative treatment of recurrent dislocation.

  4. The contact mechanics and occurrence of edge loading in modular metal-on-polyethylene total hip replacement during daily activities.

    PubMed

    Hua, Xijin; Li, Junyan; Jin, Zhongmin; Fisher, John

    2016-06-01

    The occurrence of edge loading in hip joint replacement has been associated with many factors such as prosthetic design, component malposition and activities of daily living. The present study aimed to quantify the occurrence of edge loading/contact at the articulating surface and to evaluate the effect of cup angles and edge loading on the contact mechanics of a modular metal-on-polyethylene (MoP) total hip replacement (THR) during different daily activities. A three-dimensional finite element model was developed based on a modular MoP bearing system. Different cup inclination and anteversion angles were modelled and six daily activities were considered. The results showed that edge loading was predicted during normal walking, ascending and descending stairs activities under steep cup inclination conditions (≥55°) while no edge loading was observed during standing up, sitting down and knee bending activities. The duration of edge loading increased with increased cup inclination angles and was affected by the cup anteversion angles. Edge loading caused elevated contact pressure at the articulating surface and substantially increased equivalent plastic strain of the polyethylene liner. The present study suggested that correct positioning the component to avoid edge loading that may occur during daily activities is important for MoP THR in clinical practice. Copyright © 2016. Published by Elsevier Ltd.

  5. Modular socket system versus traditionally laminated socket: a cost analysis.

    PubMed

    Normann, Elna; Olsson, Anna; Brodtkorb, Thor-Henrik

    2011-03-01

    Using the new modular socket system (MSS) to produce a prosthetic socket directly on the patient has the potential of being easier and quicker to manufacture but also incurring higher costs. The purpose of the study was to compare the costs of manufacturing a transtibial prosthetic socket using either a MSS or a standard laminated socket (PC). Concurrent controlled trial. A total of 20 patients at two orthopaedic facilities were followed with regards to the cost of manufacturing a prosthetic socket using either MSS or PC. Time aspects and material costs were considered in the cost analysis. Other factors studied include delivery time and number of visits. For the cost analysis, only direct costs pertaining to the prosthetic socket were considered. The total cost of MSS was found to be significantly higher (p < 0.01) compared to PC. However, the production and time cost was significantly lower. Delivery time to the patient was 1 day for MSS compared to 17 days for PC. Our study shows that the direct prosthetic cost of treating a patient using MSS is significantly higher than treating a patient using PC. However, the MSS prosthesis can be delivered significantly faster and with fewer visits. Further studies taking the full societal costs of MSS into account should therefore be performed. This study shows that the direct prosthetic cost of treating a patient with Modular Socket System is significantly higher than treating a patient with plastercasting with standard laminated socket. However, the Modular Socket System prosthesis can be delivered significantly faster and with fewer visits.

  6. The modular socket system in a rural setting in Indonesia.

    PubMed

    Giesberts, Bob; Ennion, Liezel; Hjelmstrom, Olle; Karma, Agusni; Lechler, Knut; Hekman, Edsko; Bergsma, Arjen

    2018-06-01

    Prosthetic services are inaccessible to people living in rural areas. Systems like the modular socket system have the potential to be fabricated outside of the prosthetic workshop. This study aimed to evaluate the patient's performance and satisfaction with the use of the modular socket system, and the technical feasibility of its implementation in a rural setting. A quantitative longitudinal descriptive study design was followed. A total of 15 persons with a lower limb amputation were fitted with the modular socket system and followed over 4-6 months. Performance was measured using a 2-min walk test, 10-m walk test and mobility and function questionnaire. Satisfaction was measured by the Socket Fit Comfort Score, Prosthesis Evaluation Questionnaire and EuroQoL 5 Dimensions 5 Levels. Notes on technical feasibility were taken at the moment of fitting ( t 0 ), at 1-3 months post fitting ( t 1 ) and at the end evaluation at 4-6 months post fitting ( t 2 ). Performance did not change between t 0 and t 2 . The comfort of the socket fit reduced between t 0 and t 2 . Satisfaction with prosthesis and general health status stayed constant over time. The average fitting-time for the modular socket system was 6.4 h. The modular socket system can be considered a useful alternative for use in rural settings. Clinical relevance The use of the modular socket system is feasible and can improve accessibility to prosthetic technology in rural areas. Experienced prosthetic users were satisfied with the performance and the device. The shorter manufacturing time and use of only hand-held tools makes it an ideal alternative for use in remote and rural settings.

  7. Development of an above-knee prosthesis equipped with a microcomputer-controlled knee joint: first test results.

    PubMed

    Aeyels, B; Peeraer, L; Vander Sloten, J; Van der Perre, G

    1992-05-01

    The shortcomings of conventional above-knee prostheses are due to their lack of adaptive control. Implementation of a microcomputer controlling the knee joint in a passive way has been suggested to enhance the patient's gait comfort, safety and cosmesis. This approach was used in the design of a new prosthetic system for the above-knee amputee, and tested on one patient. The knee joint of a conventional, modular prosthesis was replaced by a knee joint mechanism, equipped with a controllable brake on the knee joint axis. Sensors and a microcomputer were added, keeping the system self-contained. The modularity of the design permits the use of an alternative, external, PC-based control unit, emulating the self-contained one, and offering extended data monitoring and storage facilities. For both units an operating environment was written, including sensor/actuator interfacing and the implementation of a real-time interrupt, executing the control algorithm. A double finite state approach was used in the design of the control algorithm. On a higher level, the mode identification algorithm reveals the patient's intent. Within a specific mode (lower level), the relevant mode control algorithm looks for the current phase within the gait cycle. Within a particular phase, a specific simple control action with the brake replaces normal knee muscle activity. Tests were carried out with one prosthetic patient using a basic control algorithm for level walking, allowing controlled knee flexion during stance phase. The technical feasibility of such a concept is illustrated by the test results, even though only flexion during early stance phase was controlled during the trials.(ABSTRACT TRUNCATED AT 250 WORDS)

  8. Alteration of the end-plane angle in press-fit cylindrical stem radial head prosthesis: an in vitro study.

    PubMed

    Luenam, Suriya; Chalongviriyalert, Piti; Kosiyatrakul, Arkaphat; Thanawattano, Chusak

    2012-01-01

    Many studies comparing the morphology of native radial head with the prosthesis have been published. However, there is limited information regarding the postoperative alignment of the articular surface following the radial head replacement. The purpose of this study is to evaluate the alteration of the end-plane angle in the modular radial head prosthesis with a press-fit cementless cylindrical stem. The study used 36 cadaveric radii. The press-fit size prosthesis with cylindrical stem was inserted into each specimen. The end-plane angles of the radial head before and after prosthetic replacement, were measured in coronal and sagittal planes with a digital inclinometer. The data were analyzed by paired t-test. From paired t-test, there were statistically symmetrical end-plane angles before and after radial head replacement in both coronal and sagittal planes (p-value < 0.01). The mean of radial head end-plane angle alteration in the coronal plane was 3.62° (SD, 2.76°) (range, 0.3°-8.9°). In the sagittal plane, the mean of alteration was 5.85° (SD, 3.56°) degrees (range, 0.3° - 14.2°). The modular radial head prosthesis with cylindrical stem is in vitro able to restore the native end-plane angles of radial heads statistically when used in a press-fit fashion.

  9. Red flag in the emergency department: fracture and primary failure of a prosthetic valve.

    PubMed

    Ozsarac, Murat; Karcioglu, Ozgur; Ayrik, Cuneyt; Bozkurt, Seyran; Turkcuer, Ibrahim; Gumrukcu, Serhat

    2005-07-01

    This case report concerns a patient with fracture and primary dysfunction of a prosthetic valve. A 40-year-old man presented to the Emergency Department with a chief complaint of breakthrough pleuritic back pain and shortness of breath. Past surgical history was significant only for an aortic valve replacement and mitral valve replacement performed 16 years prior. The transthoracic echocardiography raised suspicion of prosthesis malposition. The patient was taken to the operating room by cardiothoracic surgeons for valve replacement. Operative findings revealed that a prosthetic valve leaflet in the mitral position had broken off. Primary prosthetic valve failure should not be overlooked in the differential diagnosis of patients with valve replacement and a rapidly deteriorating clinical course. Emergency echocardiography is a guide to convenient diagnosis and management. Early surgical consultation and early reparative surgery might prevent unnecessary morbidity and mortality.

  10. Recurrent pannus formation causing prosthetic aortic valve dysfunction: Is excision without valve re-replacement applicable?

    PubMed Central

    2012-01-01

    Prosthetic valve dysfunction at aortic position is commonly caused by pannus formation. The exact etiology is not known. It arises from ventricular aspect of the prosthesis encroaching its leaflets causing stenosis or it may remain localized causing left ventricular outflow tract obstruction without affecting valve function. The difference in location entails different approaches in management. Such a pathology requires surgical excision of the pannus with or without valve re-replacement. A recurrent pannus was observed in a female patient who needed repeated surgical intervention to excise a localized pannus without re-replacement of a well functioning prosthetic valve. Management of our case presents several questions, whether recurrence of pannus is caused by sparing the prosthetic valve, is it simply an exaggeration of an inflammatory healing process in certain individuals or is it ideal to re-replace the valve despite a well preserved function. PMID:22747790

  11. Recurrent pannus formation causing prosthetic aortic valve dysfunction: is excision without valve re-replacement applicable?

    PubMed

    Darwazah, Ahmad K

    2012-06-29

    Prosthetic valve dysfunction at aortic position is commonly caused by pannus formation. The exact etiology is not known. It arises from ventricular aspect of the prosthesis encroaching its leaflets causing stenosis or it may remain localized causing left ventricular outflow tract obstruction without affecting valve function.The difference in location entails different approaches in management. Such a pathology requires surgical excision of the pannus with or without valve re-replacement.A recurrent pannus was observed in a female patient who needed repeated surgical intervention to excise a localized pannus without re-replacement of a well functioning prosthetic valve.Management of our case presents several questions, whether recurrence of pannus is caused by sparing the prosthetic valve, is it simply an exaggeration of an inflammatory healing process in certain individuals or is it ideal to re-replace the valve despite a well preserved function.

  12. Complementary role of cardiac CT in the assessment of aortic valve replacement dysfunction

    PubMed Central

    Moss, Alastair J; Dweck, Marc R; Dreisbach, John G; Williams, Michelle C; Mak, Sze Mun; Cartlidge, Timothy; Nicol, Edward D; Morgan-Hughes, Gareth J

    2016-01-01

    Aortic valve replacement is the second most common cardiothoracic procedure in the UK. With an ageing population, there are an increasing number of patients with prosthetic valves that require follow-up. Imaging of prosthetic valves is challenging with conventional echocardiographic techniques making early detection of valve dysfunction or complications difficult. CT has recently emerged as a complementary approach offering excellent spatial resolution and the ability to identify a range of aortic valve replacement complications including structural valve dysfunction, thrombus development, pannus formation and prosthetic valve infective endocarditis. This review discusses each and how CT might be incorporated into a multimodal cardiovascular imaging pathway for the assessment of aortic valve replacements and in guiding clinical management. PMID:27843568

  13. 77 FR 14989 - Medicare Program; Revisions to the Durable Medical Equipment, Prosthetics, Orthotics, and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-14

    ... wheelchairs. Prosthetic devices are included in the definition of ``medical and other health services'' in section 1861(s)(8) of the Act. Prosthetic devices are defined as devices (other than dental) which replace... examples of prosthetic devices include cardiac pacemakers, cochlear implants, electrical continence aids...

  14. Single-stage revision for fungal peri-prosthetic joint infection: a single-centre experience.

    PubMed

    Klatte, T O; Kendoff, D; Kamath, A F; Jonen, V; Rueger, J M; Frommelt, L; Gebauer, M; Gehrke, T

    2014-04-01

    Fungal peri-prosthetic infections of the knee and hip are rare but likely to result in devastating complications. In this study we evaluated the results of their management using a single-stage exchange technique. Between 2001 and 2011, 14 patients (ten hips, four knees) were treated for a peri-prosthetic fungal infection. One patient was excluded because revision surgery was not possible owing to a large acetabular defect. One patient developed a further infection two months post-operatively and was excluded from the analysis. Two patients died of unrelated causes. After a mean of seven years (3 to 11) a total of ten patients were available for follow-up. One patient, undergoing revision replacement of the hip, had a post-operative dislocation. Another patient, undergoing revision replacement of the knee, developed a wound infection and required revision 29 months post-operatively following a peri-prosthetic femoral fracture. The mean Harris hip score increased to 74 points (63 to 84; p < 0.02) in those undergoing revision replacement of the hip, and the mean Hospital for Special Surgery knee score increased to 75 points (70 to 80; p < 0.01) in those undergoing revision replacement of the knee. A single-stage revision following fungal peri-prosthetic infection is feasible, with an acceptable rate of a satisfactory outcome.

  15. Thirty-Seven-Year Durability of a Starr-Edwards Aortic Prosthesis

    PubMed Central

    Ozkokeli, Mehmet; Ates, Mehmet; Ekinci, Abdurrahman; Akcar, Murat

    2005-01-01

    We report the case of a patient who was diagnosed with prosthetic valve endocarditis caused by Staphylococcus aureus. He had undergone aortic valve replacement with a Starr-Edwards prosthesis 37 years earlier. Because of uncontrolled infection despite antibiotic treatment, the patient underwent successful surgical replacement of the prosthetic valve. PMID:15902834

  16. Differences in the stress distribution in the distal femur between patellofemoral joint replacement and total knee replacement: a finite element study

    PubMed Central

    2012-01-01

    Background Patellofemoral joint replacement is a successful treatment option for isolated patellofemoral osteoarthritis. However, results of later conversion to total knee replacement may be compromised by periprosthetic bone loss. Previous clinical studies have demonstrated a decrease in distal femoral bone mineral density after patellofemoral joint replacement. It is unclear whether this is due to periprosthetic stress shielding. The main objective of the current study was to evaluate the stress shielding effect of prosthetic replacement with 2 different patellofemoral prosthetic designs and with a total knee prosthesis. Methods We developed a finite element model of an intact patellofemoral joint, and finite element models of patellofemoral joint replacement with a Journey PFJ prosthesis, a Richards II prosthesis, and a Genesis II total knee prosthesis. For each of these 4 finite element models, the average Von Mises stress in 2 clinically relevant regions of interest were evaluated during a simulated squatting movement until 120 degrees of flexion. Results During deep knee flexion, in the anterior region of interest, the average Von Mises stress with the Journey PFJ design was comparable to the physiological knee, while reduced by almost 25% for both the Richards II design and the Genesis II total knee joint replacement design. The average Von Mises stress in the supracondylar region of interest was similar for both patellofemoral prosthetic designs and the physiological model, with slightly lower stress for the Genesis II design. Conclusions Patellofemoral joint replacement results in periprosthetic stress-shielding, although to a smaller degree than in total knee replacement. Specific patellofemoral prosthetic design properties may result in differences in femoral stress shielding. PMID:22704638

  17. A rare case of prosthetic endocarditis and dehiscence in a mechanical valved conduit

    PubMed Central

    Kannan, Arun; Smith, Cristy; Subramanian, Sreekumar; Janardhanan, Rajesh

    2014-01-01

    A middle-aged adult patient with a history of aortic root replacement with a mechanical valved conduit and remote chest trauma was referred to our institution with prosthetic endocarditis. Transoesophageal echocardiogram at our institution confirmed a near-complete dehiscence of the prosthetic aortic valve from the conduit, with significant perivalvular flow forming a pseudoaneurysm. The patient underwent a high-risk re-operation, involving redo aortic root replacement with a homograft after extensive debridement of the infected tissue. The patient was discharged to an outside facility after an uncomplicated hospital course, and remains stable. PMID:24510692

  18. A rare case of prosthetic endocarditis and dehiscence in a mechanical valved conduit.

    PubMed

    Kannan, Arun; Smith, Cristy; Subramanian, Sreekumar; Janardhanan, Rajesh

    2014-02-07

    A middle-aged adult patient with a history of aortic root replacement with a mechanical valved conduit and remote chest trauma was referred to our institution with prosthetic endocarditis. Transoesophageal echocardiogram at our institution confirmed a near-complete dehiscence of the prosthetic aortic valve from the conduit, with significant perivalvular flow forming a pseudoaneurysm. The patient underwent a high-risk re-operation, involving redo aortic root replacement with a homograft after extensive debridement of the infected tissue. The patient was discharged to an outside facility after an uncomplicated hospital course, and remains stable.

  19. NT-proBNP and exercise capacity in adult patients with congenital heart disease and a prosthetic valve: a multicentre PROSTAVA study.

    PubMed

    Schoonbeek, R C; Pieper, P G; van Slooten, Y J; Freling, H G; Sieswerda, G T; van Dijk, A P J; Jongbloed, M R M; Post, M C; Bouma, B J; Berger, R M F; Ebels, T; van Melle, J P

    2016-11-01

    N-terminal B‑type natriuretic peptide (NT-proBNP) is an important biomarker for the detection of heart failure. Adults with congenital heart disease (ACHD) and a prosthetic heart valve are at risk for heart failure. This study aimed to determine the value of NT-proBNP in ACHD patients with a prosthetic valve and investigate its relationship with cardiac function and exercise capacity. In this multi-centre cross-sectional observational study, data regarding medical history, echocardiography, exercise testing (VO 2 peak) and laboratory blood evaluation (including NT-proBNP) were collected in ACHD patients with a single prosthetic valve (either homografts, heterografts or mechanical valves). A total of 306 ACHD patients with pulmonary valve replacement (PVR, n = 139), aortic valve replacement (n = 141), mitral valve replacement (n = 21) or tricuspid valve replacement (n = 5) were investigated. The majority of patients (77 %) were in NYHA class I or II. Elevated NT-proBNP levels (cut-off ≥125 pg/ml) were found in 50 % of the patients, with the highest levels in patients with mitral valve replacements. In this study population, NT-proBNP levels were associated with gender (p = 0.029) and VO 2 max (p < 0.001). In PVR patients, NT-proBNP levels were associated with lower VO 2 peak, also after adjustment for age, gender and age at valve replacement in a multivariate model (p = 0.015). In patients with ACHD and a prosthetic valve, elevated NT-proBNP levels are frequently observed despite preserved NYHA class. In PVR patients, a higher NT-proBNP level was associated with a lower VO 2 peak. These results may be of importance in the ongoing discussion about the timing of valve replacement in patients with CHD.

  20. Correctness of multi-detector-row computed tomography for diagnosing mechanical prosthetic heart valve disorders using operative findings as a gold standard.

    PubMed

    Tsai, I-Chen; Lin, Yung-Kai; Chang, Yen; Fu, Yun-Ching; Wang, Chung-Chi; Hsieh, Shih-Rong; Wei, Hao-Ji; Tsai, Hung-Wen; Jan, Sheng-Ling; Wang, Kuo-Yang; Chen, Min-Chi; Chen, Clayton Chi-Chang

    2009-04-01

    The purpose was to compare the findings of multi-detector computed tomography (MDCT) in prosthetic valve disorders using the operative findings as a gold standard. In a 3-year period, we prospectively enrolled 25 patients with 31 prosthetic heart valves. MDCT and transthoracic echocardiography (TTE) were done to evaluate pannus formation, prosthetic valve dysfunction, suture loosening (paravalvular leak) and pseudoaneurysm formation. Patients indicated for surgery received an operation within 1 week. The MDCT findings were compared with the operative findings. One patient with a Björk-Shiley valve could not be evaluated by MDCT due to a severe beam-hardening artifact; thus, the exclusion rate for MDCT was 3.2% (1/31). Prosthetic valve disorders were suspected in 12 patients by either MDCT or TTE. Six patients received an operation that included three redo aortic valve replacements, two redo mitral replacements and one Amplatzer ductal occluder occlusion of a mitral paravalvular leak. The concordance of MDCT for diagnosing and localizing prosthetic valve disorders and the surgical findings was 100%. Except for images impaired by severe beam-hardening artifacts, MDCT provides excellent delineation of prosthetic valve disorders.

  1. 21 CFR 870.3935 - Prosthetic heart valve holder.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Prosthetic heart valve holder. 870.3935 Section... heart valve holder. (a) Identification. A prosthetic heart valve holder is a device used to hold a replacement heart valve while it is being sutured into place. (b) Classification. Class I. The device is...

  2. 21 CFR 870.3935 - Prosthetic heart valve holder.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Prosthetic heart valve holder. 870.3935 Section... heart valve holder. (a) Identification. A prosthetic heart valve holder is a device used to hold a replacement heart valve while it is being sutured into place. (b) Classification. Class I. The device is...

  3. 21 CFR 870.3935 - Prosthetic heart valve holder.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Prosthetic heart valve holder. 870.3935 Section... heart valve holder. (a) Identification. A prosthetic heart valve holder is a device used to hold a replacement heart valve while it is being sutured into place. (b) Classification. Class I. The device is...

  4. 21 CFR 870.3935 - Prosthetic heart valve holder.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Prosthetic heart valve holder. 870.3935 Section... heart valve holder. (a) Identification. A prosthetic heart valve holder is a device used to hold a replacement heart valve while it is being sutured into place. (b) Classification. Class I. The device is...

  5. 21 CFR 870.3935 - Prosthetic heart valve holder.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Prosthetic heart valve holder. 870.3935 Section... heart valve holder. (a) Identification. A prosthetic heart valve holder is a device used to hold a replacement heart valve while it is being sutured into place. (b) Classification. Class I. The device is...

  6. Surgery for rheumatic mitral valve disease in sub-saharan African countries: why valve repair is still the best surgical option.

    PubMed

    Mvondo, Charles Mve; Pugliese, Marta; Giamberti, Alessandro; Chelo, David; Kuate, Liliane Mfeukeu; Boombhi, Jerome; Dailor, Ellen Marie

    2016-01-01

    Rheumatic valve disease, a consequence of acute rheumatic fever, remains endemic in developing countries in the sub-Saharan region where it is the leading cause of heart failure and cardiovascular death, involving predominantly a young population. The involvement of the mitral valve is pathognomonic and mitral surgery has become the lone therapeutic option for the majority of these patients. However, controversies exist on the choice between valve repair or prosthetic valve replacement. Although the advantages of mitral valve repair over prosthetic valve replacement in degenerative mitral disease are well established, this has not been the case for rheumatic lesions, where the use of prosthetic valves, specifically mechanical devices, even in poorly compliant populations remains very common. These patients deserve more accurate evaluation in the choice of the surgical strategy which strongly impacts the post-operative outcomes. This report discusses the factors supporting mitral repair surgery in rheumatic disease, according to the patients' characteristics and the effectiveness of the current repair techniques compared to prosthetic valve replacement in developing countries.

  7. Design and clinical outcome of a novel 3D-printed prosthetic joint replacement for the human temporomandibular joint.

    PubMed

    Ackland, David; Robinson, Dale; Lee, Peter Vee Sin; Dimitroulis, George

    2018-05-11

    Stock prosthetic temporomandibular joint replacements come in limited sizes, and do not always encompass the joint anatomy that presents clinically. The aims of this study were twofold. Firstly, to design a personalized prosthetic total joint replacement for the treatment of a patient's end-stage temporomandibular joint osteoarthritis, to implant the prosthesis into the patient, and assess clinical outcome 12-months post-operatively; and secondly, to evaluate the influence of changes in prosthetic condyle geometry on implant load response during mastication. A 48-year-old female patient with Grade-5 osteoarthritis to the left temporomandibular joint was recruited, and a prosthesis developed to match the native temporomandibular joint anatomy. The prosthesis was 3D printed, sterilized and implanted into the patient, and pain and function measured 12-months post-operatively. The prosthesis load response during a chewing-bite and maximum-force bite was evaluated using a personalized multi-body musculoskeletal model. Simulations were performed after perturbing condyle thickness, neck length and head sphericity. Increases in prosthetic condyle neck length malaligned the mandible and perturbed temporomandibular joint force. Changes in condylar component thickness greatly influenced fixation screw stress response, while a more eccentric condylar head increased prosthetic joint-contact loading. Post-operatively, the prosthetic temporomandibular joint surgery reduced patient pain from 7/10 to 1/10 on a visual analog scale, and increased intercisal opening distance from 22 mm to 38 mm. This study demonstrates effectiveness of a personalized prosthesis that may ultimately be adapted to treat a wide-range of end-stage temporomandibular joint conditions, and highlights sensitivity of prosthesis load response to changes in condylar geometry. Copyright © 2018 Elsevier Ltd. All rights reserved.

  8. A new paradigm for obtaining marketing approval for pediatric-sized prosthetic heart valves.

    PubMed

    Yoganathan, Ajit P; Fogel, Mark; Gamble, Susan; Morton, Michael; Schmidt, Paul; Secunda, Jeff; Vidmar, Sara; Del Nido, Pedro

    2013-10-01

    Congenital heart valve disease is one of the most common abnormalities in children. There are limited technological solutions available for treating children with congenital heart valve diseases. The aim of this study is to provide the details of the consensus reached in terms of pediatric definitions, design approach, in vitro testing, and clinical trials, which may be used as guidance for developing prosthetic heart valves for the pediatric indication. In stark contrast to the various designs of adult-sized replacement valves available in the market, there are no Food and Drug Administration (FDA)-approved prosthetic heart valves available for use in the pediatric population. There is a pressing need for FDA-approved pediatric valve devices in the United States. The pediatric patient population has been typically excluded from replacement heart valve trials for several reasons. In January 2010, heart valve manufacturers and pediatric clinicians collaborated with academicians and FDA staff in a workshop to suggest ways to successfully evaluate pediatric prosthetic valves and conduct pediatric clinical trials to provide acceptable heart valve replacement options for this patient population. Recommendations, derived from ISO 5840:2005 and the 2010 FDA Draft Replacement Heart Valve Guidance, are provided for hydrodynamic, durability, and fatigue testing. The article specifically addresses in vitro and premarket and postmarket approval clinical studies that should be considered by a heart valve manufacturer for obtaining regulatory approval of pediatric sizes of prosthetic heart valve designs that are already approved for adult clinical use. Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  9. Prosthetic Aortic Valves: Challenges and Solutions

    PubMed Central

    Musumeci, Lucia; Jacques, Nicolas; Hego, Alexandre; Nchimi, Alain; Lancellotti, Patrizio; Oury, Cécile

    2018-01-01

    Aortic Valve Disease (AVD) is the most common Valvular Heart Disease (VHD), affecting millions of people worldwide. Severe AVD is treated in most cases with prosthetic aortic valve replacement, which involves the substitution of the native aortic valve with a prosthetic one. In this review we will discuss the different types of prosthetic aortic valves available for implantation and the challenges faced by patients, medical doctors, researchers and manufacturers, as well as the approaches that are taken to overcome them. PMID:29868612

  10. Recurrent prosthetic valve endocarditis caused by Aspergillus delacroxii (formerly Aspergillus nidulans var. echinulatus)

    PubMed Central

    Uhrin, Gábor Balázs; Jensen, Rasmus Hare; Korup, Eva; Grønlund, Jens; Hjort, Ulla; Moser, Claus; Arendrup, Maiken Cavling; Schønheyder, Henrik Carl

    2015-01-01

    We report Aspergillus delacroxii (formerly Aspergillus nidulans var. echinulatus) causing recurrent prosthetic valve endocarditis. The fungus was the sole agent detected during replacement of a mechanical aortic valve conduit due to abscess formation. Despite extensive surgery and anti-fungal treatment, the patient had a cerebral hemorrhage 4 months post-surgery prompting a diagnosis of recurrent prosthetic valve endocarditis and fungemia. PMID:26909244

  11. Experimental validation of finite element modelling of a modular metal-on-polyethylene total hip replacement.

    PubMed

    Hua, Xijin; Wang, Ling; Al-Hajjar, Mazen; Jin, Zhongmin; Wilcox, Ruth K; Fisher, John

    2014-07-01

    Finite element models are becoming increasingly useful tools to conduct parametric analysis, design optimisation and pre-clinical testing for hip joint replacements. However, the verification of the finite element model is critically important. The purposes of this study were to develop a three-dimensional anatomic finite element model for a modular metal-on-polyethylene total hip replacement for predicting its contact mechanics and to conduct experimental validation for a simple finite element model which was simplified from the anatomic finite element model. An anatomic modular metal-on-polyethylene total hip replacement model (anatomic model) was first developed and then simplified with reasonable accuracy to a simple modular total hip replacement model (simplified model) for validation. The contact areas on the articulating surface of three polyethylene liners of modular metal-on-polyethylene total hip replacement bearings with different clearances were measured experimentally in the Leeds ProSim hip joint simulator under a series of loading conditions and different cup inclination angles. The contact areas predicted from the simplified model were then compared with that measured experimentally under the same conditions. The results showed that the simplification made for the anatomic model did not change the predictions of contact mechanics of the modular metal-on-polyethylene total hip replacement substantially (less than 12% for contact stresses and contact areas). Good agreements of contact areas between the finite element predictions from the simplified model and experimental measurements were obtained, with maximum difference of 14% across all conditions considered. This indicated that the simplification and assumptions made in the anatomic model were reasonable and the finite element predictions from the simplified model were valid. © IMechE 2014.

  12. Three-dimensional precise orientation of bilateral auricular trial prosthesis using a facebow for a young adult with Crouzon syndrome

    PubMed Central

    Rathee, Manu; Tamrakar, Amit Kumar; Kundu, Renu; Yunus, Nadeem

    2014-01-01

    Facial deformity can be debilitating, especially in the psychological and cosmetic aspects. Although surgical correction or replacement of deformed or missing parts is the ideal treatment, prosthetic replacement serves the purpose in case of surgical limitations. Prosthetic rehabilitation of a missing auricle is an acceptable option as it provides better control over the tortuous anatomical shape and shade of the missing portion. Improper spatial orientation of the prosthetic ear on the face can damage the results of even the most aesthetic prosthesis. This case report describes a simple and innovative method for precise spatial orientation of auricular trial prosthesis using a facebow and custom-made adjustable mechanical retention design using stainless steel wire. PMID:25096652

  13. Three-dimensional human femoral strain analysis using ESPI

    NASA Astrophysics Data System (ADS)

    Tyrer, J. R.; Heras-Palou, C.; Slater, T.

    With age, disease or injury the joints in the human body can wear out or bones may even fail catastrophically. In many cases it is possible to replace joints and bones with artificial components (prostheses). However, prosthetic joints can have a very limited life (often less than 10 years) and require replacement or 'revision'. In order to optimise prosthetic life, it is necessary to improve the design of components and implantation techniques, which is clearly also beneficial to both patients and hospitals.

  14. Acute Mitral Valve Dysfunction Due to Escape of Prosthetic Mechanical Leaflet and Peripheral Leaftlet Embolization.

    PubMed

    Calik, Eyup Serhat; Limandal, Husnu Kamil; Arslan, Umit; Tort, Mehmet; Yildiz, Ziya; Bayram, Ednan; Dag, Ozgur; Kaygin, Mehmet Ali; Erkut, Bilgehan

    2015-12-14

    Leaflet escape of prosthetic valve is rare but potentially life threatening. Early diagnosis is essential on account of avoiding mortality, and emergency surgical correction is compulsory. This complication has previously been reported for both monoleaflet and bileaflet valve models. A 30-year-old man who had undergone mitral valve replacement with a bileaflet valve 8 years prior at another center was admitted with acute-onset with cardiogenic shock as an emergency case. Transthoracic echocardiograms showed acute-starting severe mitral regurgitation associated with prosthetic mitral valve. There was a suspicious finding of a single prosthetic mitral leaflet. But the problem related with the valve wasn't specifically determined. The patient underwent emergent surgery for replacement of the damaged prosthetic valves immediately. There was no tissue impingement and thrombosis, one of the two leaflets was absent, and there were no signs of endocarditis or pannus formation in the prosthetic valve. The missing leaflet could not be found within the cardiac cavity. The abdominal fluoroscopic study and plain radiography were unable to detect the escaped leaflet during surgery. The damaged valve was removed and a replacement 29 mm bileaflet mechanical valve was inserted by right lateral thoracotomy. After post-operative week one, the abdominal computed tomography scan and the ultrasound showed the escaped leaflet in the left femoral artery. Fifteen days after the surgery the escaped leaflet was removed safely from the left femoral artery and the patient made a complete recovery. The escaped leaflet showed a fracture of one of the pivot systems caused by structural failure. Early cardiac surgery should be applied because of life-threatening problems.

  15. 21 CFR 870.3710 - Pacemaker repair or replacement material.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Pacemaker repair or replacement material. 870.3710... (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3710 Pacemaker repair or replacement material. (a) Identification. A pacemaker repair or replacement material is an...

  16. 21 CFR 870.3710 - Pacemaker repair or replacement material.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Pacemaker repair or replacement material. 870.3710... (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3710 Pacemaker repair or replacement material. (a) Identification. A pacemaker repair or replacement material is an...

  17. 21 CFR 870.3710 - Pacemaker repair or replacement material.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Pacemaker repair or replacement material. 870.3710... (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3710 Pacemaker repair or replacement material. (a) Identification. A pacemaker repair or replacement material is an...

  18. 21 CFR 870.3710 - Pacemaker repair or replacement material.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Pacemaker repair or replacement material. 870.3710... (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3710 Pacemaker repair or replacement material. (a) Identification. A pacemaker repair or replacement material is an...

  19. Open arthrolysis and prosthetic replacement of the radial head for elbow stiffness associated with rotation limitation.

    PubMed

    Liu, Shen; Liu, Jun-jian; Li, Xu-jun; Ruan, Hong-jiang; Fan, Cun-yi

    2013-02-01

    Limited forearm rotation is a frequent combined disorder in elbow stiffness. If the radial head cannot be saved during open arthrolysis, prosthetic replacement might be considered because it enhances stability and allows early motion. In this study we retrospectively analyzed the outcome of 8 patients (7 men, 1 woman) who underwent open arthrolysis and simultaneous prosthetic replacement after resection of the radial head to restore elbow range of motion and forearm rotation. Patients were a mean age of 31.7 years (range, 22-40 years). Postoperatively, the mean (range) active range of motion improved from 29.4° (0°-70°) to 113.1° (80°-135°), mean (range) supination increased from 38.8° (0°-80°) to 77.5° (50°-90°), and mean (range) pronation improved from 18.8° (0°-80°) to 68.8° (50°-80°). The Mayo Elbow Performance Score improved from a mean (range) of 57.5 (50-70) to 92.5 (85-100) points. No elbow valgus instability was detected over a mean duration of 26 months of follow-up. The implant was considered stable in all patients. Open arthrolysis and prosthetic replacement of the radial head are effective in treating elbow stiffness with associated rotation limitation after resection of the radial head. Copyright © 2013 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  20. A personalized 3D-printed prosthetic joint replacement for the human temporomandibular joint: From implant design to implantation.

    PubMed

    Ackland, David C; Robinson, Dale; Redhead, Michael; Lee, Peter Vee Sin; Moskaljuk, Adrian; Dimitroulis, George

    2017-05-01

    Personalized prosthetic joint replacements have important applications in cases of complex bone and joint conditions where the shape and size of off-the-shelf components may not be adequate. The objective of this study was to design, test and fabricate a personalized 3D-printed prosthesis for a patient requiring total joint replacement surgery of the temporomandibular joint (TMJ). The new 'Melbourne' prosthetic TMJ design featured a condylar component sized specifically to the patient and fixation screw positions that avoid potential intra-operative damage to the mandibular nerve. The Melbourne prosthetic TMJ was developed for a 58-year-old female recipient with end-stage osteoarthritis of the TMJ. The load response of the prosthesis during chewing and a maximum-force bite was quantified using a personalized musculoskeletal model of the patient's masticatory system developed using medical images. The simulations were then repeated after implantation of the Biomet Microfixation prosthetic TMJ, an established stock device. The maximum condylar stresses, screw stress and mandibular stress at the screw-bone interface were lower in the Melbourne prosthetic TMJ (259.6MPa, 312.9MPa and 198.4MPa, respectively) than those in the Biomet Microfixation device (284.0MPa, 416.0MPa and 262.2MPa, respectively) during the maximum-force bite, with similar trends also observed during the chewing bite. After trialing surgical placement and evaluating prosthetic TMJ stability using cadaveric specimens, the prosthesis was fabricated using 3D printing, sterilized, and implanted into the female recipient. Six months post-operatively, the prosthesis recipient had a normal jaw opening distance (40.0 mm), with no complications identified. The new design features and immediate load response of the Melbourne prosthetic TMJ suggests that it may provide improved clinical and biomechanical joint function compared to a commonly used stock device, and reduce risk of intra-operative nerve damage during placement. The framework presented may be useful for designing and testing customized devices for the treatment of debilitating bone and joint conditions. Copyright © 2017 Elsevier Ltd. All rights reserved.

  1. 21 CFR 870.3925 - Replacement heart valve.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Replacement heart valve. 870.3925 Section 870.3925...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3925 Replacement heart valve. (a) Identification. A replacement heart valve is a device intended to perform the function of any...

  2. 21 CFR 870.3925 - Replacement heart valve.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Replacement heart valve. 870.3925 Section 870.3925...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3925 Replacement heart valve. (a) Identification. A replacement heart valve is a device intended to perform the function of any...

  3. 21 CFR 870.3925 - Replacement heart valve.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Replacement heart valve. 870.3925 Section 870.3925...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3925 Replacement heart valve. (a) Identification. A replacement heart valve is a device intended to perform the function of any...

  4. 21 CFR 870.3925 - Replacement heart valve.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Replacement heart valve. 870.3925 Section 870.3925...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3925 Replacement heart valve. (a) Identification. A replacement heart valve is a device intended to perform the function of any...

  5. 21 CFR 870.3925 - Replacement heart valve.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Replacement heart valve. 870.3925 Section 870.3925...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3925 Replacement heart valve. (a) Identification. A replacement heart valve is a device intended to perform the function of any...

  6. An extremely lightweight fingernail worn prosthetic interface device

    NASA Astrophysics Data System (ADS)

    Yetkin, Oguz; Ahluwalia, Simranjit; Silva, Dinithi; Kasi-Okonye, Isioma; Volker, Rachael; Baptist, Joshua R.; Popa, Dan O.

    2016-05-01

    Upper limb prosthetics are currently operated using several electromyography sensors mounted on an amputee's residual limb. In order for any prosthetic driving interface to be widely adopted, it needs to be responsive, lightweight, and out of the way when not being used. In this paper we discuss the possibility of replacing such electrodes with fingernail optical sensor systems mounted on the sound limb. We present a prototype device that can detect pinch gestures and communicate with the prosthetic system. The device detects the relative position of fingers to each other by measuring light transmitted via tissue. Applications are not limited to prosthetic control, but can be extended to other human-machine interfaces.

  7. Retrieval of a leaflet escaped in a Tri-technologies bileaflet mechanical prosthetic valve.

    PubMed

    Cianciulli, Tomás F; Lax, Jorge A; Saccheri, María C; Guidoin, Robert; Salvado, César M; Fernández, Adrián J; Prezioso, Horacio A

    2008-01-01

    The escape of the prosthetic heart valve disc is one of the causes of prosthetic dysfunction that requires emergency surgery. The removal of the embolized disc should be carried out because of the risk of a progressive extrusion on the aortic wall. Several imaging techniques can be used for the detection of the missing disc localization. In this report we describe a 32-year-old man who underwent mitral valve replacement with a Tri-technologies bileaflet valve three years ago, and was admitted in cardiogenic shock. Transesophageal echocardiography showed acute-onset massive mitral regurgitation. The patient underwent emergency replacement of the prosthetic valve. Only one of the two leaflets remained in the removed prosthetic valve. The missing leaflet could not be found within the cardiac cavity. The abdominal fluoroscopic study and plain radiography were unable to detect the escaped leaflet. The abdominal computed tomography scan and the ultrasound showed the escaped leaflet in the terminal portion of the aortic bifurcation. To retrieve the embolized disc laparotomy and aortotomy were performed three months later. The escaped leaflet shows a fracture of one of the pivot systems caused by structural failure. This kind of failure mode is usually the result of high stress concentration.

  8. Use of a Valved-Conduit for Exclusion of the Infected Portion in the Prosthetic Pulmonary Valve Endocarditis

    PubMed Central

    Jung, Joonho; Lee, Cheol Joo; Lim, Sang-Hyun; Choi, Ho; Park, Soo-Jin

    2013-01-01

    A 51-year-old male was admitted to the hospital with complaints of fever and hemoptysis. After evaluation of the fever focus, he was diagnosed with pulmonary valve infective endocarditis. Thus pulmonary valve replacement and antibiotics therapy were performed and discharged. He was brought to the emergency unit presenting with a high fever (>39℃) and general weakness 6 months after the initial operation. The echocardiography revealed prosthetic pulmonary valve endocarditis. Therefore, redo-pulmonary valve replacement using valved conduit was performed in the Rastelli fashion because of the risk of pulmonary arterial wall injury and recurrent endocarditis from the remnant inflammatory tissue. We report here on the successful surgical treatment of prosthetic pulmonary valve endocarditis with an alternative surgical method. PMID:23772409

  9. Three-dimensional precise orientation of bilateral auricular trial prosthesis using a facebow for a young adult with Crouzon syndrome.

    PubMed

    Rathee, Manu; Tamrakar, Amit Kumar; Kundu, Renu; Yunus, Nadeem

    2014-08-05

    Facial deformity can be debilitating, especially in the psychological and cosmetic aspects. Although surgical correction or replacement of deformed or missing parts is the ideal treatment, prosthetic replacement serves the purpose in case of surgical limitations. Prosthetic rehabilitation of a missing auricle is an acceptable option as it provides better control over the tortuous anatomical shape and shade of the missing portion. Improper spatial orientation of the prosthetic ear on the face can damage the results of even the most aesthetic prosthesis. This case report describes a simple and innovative method for precise spatial orientation of auricular trial prosthesis using a facebow and custom-made adjustable mechanical retention design using stainless steel wire. 2014 BMJ Publishing Group Ltd.

  10. Evaluation of mitral valve replacement anchoring in a phantom

    NASA Astrophysics Data System (ADS)

    McLeod, A. Jonathan; Moore, John; Lang, Pencilla; Bainbridge, Dan; Campbell, Gordon; Jones, Doug L.; Guiraudon, Gerard M.; Peters, Terry M.

    2012-02-01

    Conventional mitral valve replacement requires a median sternotomy and cardio-pulmonary bypass with aortic crossclamping and is associated with significant mortality and morbidity which could be reduced by performing the procedure off-pump. Replacing the mitral valve in the closed, off-pump, beating heart requires extensive development and validation of surgical and imaging techniques. Image guidance systems and surgical access for off-pump mitral valve replacement have been previously developed, allowing the prosthetic valve to be safely introduced into the left atrium and inserted into the mitral annulus. The major remaining challenge is to design a method of securely anchoring the prosthetic valve inside the beating heart. The development of anchoring techniques has been hampered by the expense and difficulty in conducting large animal studies. In this paper, we demonstrate how prosthetic valve anchoring may be evaluated in a dynamic phantom. The phantom provides a consistent testing environment where pressure measurements and Doppler ultrasound can be used to monitor and assess the valve anchoring procedures, detecting pararvalvular leak when valve anchoring is inadequate. Minimally invasive anchoring techniques may be directly compared to the current gold standard of valves sutured under direct vision, providing a useful tool for the validation of new surgical instruments.

  11. Extrinsic mechanism obstructing the opening of a prosthetic mitral valve: an unusual case of suture entrapment.

    PubMed

    Ozkan, Mehmet; Astarcioglu, Mehmet Ali; Karakoyun, Suleyman; Balkanay, Mehmet

    2012-02-01

    Obstruction to a prosthetic cardiac valve is a well-recognized complication of cardiac valve replacement. Malfunction of the mobile component of a prosthetic valve to open or close correctly may occur in consequence of intrinsic or extrinsic causes (thrombus, vegetation, entrapment of left ventricular myocardium, suture entanglement, and pannus formation) that may result prosthetic valve stenosis and/or insufficiency. In the case we report a 48-year-old female with valve dysfunction occurred early after surgery, as one valve leaflet was only able to partially open due to suture entrapment. © 2011, Wiley Periodicals, Inc.

  12. First metatarsophalangeal joint replacement with modular three-component press-fit implant. Preliminary report.

    PubMed

    Kolodziej, L; Bohatyrewicz, A; Zietek, P

    2013-01-01

    The aim of this retrospective study was to assess functional and radiographic results of the first metatarsophalangeal joint replacement with use of unconstrained, modular, three components, porous titanium and hydroxyapatite coated, press-fit METIS® prosthesis. According to author's knowledge, results of that type of prosthesis have never been published before. 25 prosthesis were implanted in 24 patients between February 2009 and May 2011. American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal Interphalangeal scoring system (AOFAS-HMI) was used to assess functional results. Patients were also asked if they would undergo procedure again or recommend it to other people. Weight bearing radiographs ware made at final follow up and analyzed for presence of osteolysis and radiolucencies. In 8 patients total joint replacement was introduced as a salvage after failure of previous surgery like Keller resection arthroplasty, failed arthrodesis, avascular necrosis and postoperative arthritis. In 11 patients the reason for prosthetic replacement were hallux rigidus, in 4 cases rheumatoid arthritis and gout in one patient. In two patients additional procedures like Akin phalangeal osteotomy and in one case fifth metatarsal osteotomy, was performed. There were 20 females and 4 males in presented group. The mean age at the operation was 56 years. The average follow up period was 18 months (from 12 to 36 months). The median postoperative value of AOFAS-HMI scores was 88 points (from 75 to 95 points). First metatarsophalangeal joint motion (dorsiflexion plus plantarflexion) was classified according to AOFAS-HMI ranges as: moderately restricted (between 30 to 70 degrees) in 19 patients 80% (20 prosthesis) and severely restricted (less then 30 degrees) in 5 patients (20%). 15 (64%) patients were completely satisfied, 5 (20%) reported moderate satisfaction and (16%) 4 were totally disappointed and would not undergo this procedure again. A limited hallux dorsiflexion was the main dissatisfaction reason. Partial radiolucent line was seen in one patient (4%). Authors noticed two serious complications. In one patient, with rheumatoid arthritis, deep infection occurred 12 months after prosthesis implantation. In second case phalangeal implant was revised due to misalignment. METIS® metatarsophalangeal joint replacement allows alleviate of pain relating to hallux rigidus and partial restoration of joint movement, even in patients after failures of primary metatarsophalangeal joint surgery. AOFAS-HMI results are better than previously reported in the literature in assessment of the first metatarsophalangeal joint replacement. Radiographic results imply satisfactory bone ingrowth into the cementless implants.

  13. Outdoor dynamic subject-specific evaluation of internal stresses in the residual limb: hydraulic energy-stored prosthetic foot compared to conventional energy-stored prosthetic feet.

    PubMed

    Portnoy, Sigal; Kristal, Anat; Gefen, Amit; Siev-Ner, Itzhak

    2012-01-01

    The prosthetic foot plays an important role in propelling, breaking, balancing and supporting body loads while the amputee ambulates on different grounds. It is therefore important to quantify the effect of the prosthetic foot mechanism on biomechanical parameters, in order to prevent pressure ulcers and deep tissue injury. Our aim was to monitor the internal stresses in the residuum of transtibial amputation (TTA) prosthetic-users ambulating on different terrains, which the amputees encounter during their daily activities, i.e. paved floor, grass, ascending and descending stairs and slope. We specifically aimed to compare between the internal stresses in the TTA residuum of amputees ambulating with a novel hydraulic prosthetic foot compared to conventional energy storage and return (ESR) prosthetic feet. Monitoring of internal stresses was accomplished using a portable subject-specific real-time internal stress monitor. We found significant decrease (p<0.01) in peak internal stresses and in the loading rate of the amputated limb, while walking with the hydraulic foot, compared to walking with ESR feet. The loading rate calculated while ambulating with the hydraulic foot was at least three times lower than the loading rate calculated while ambulating with the ESR foot. Although the average decrease in internal stresses was ≈ 2-fold larger when replacing single-toe ESR feet with the hydraulic foot than when replacing split-toed ESR feet with the hydraulic foot, the differences were statistically insignificant. Our findings suggest that using a hydraulic prosthetic foot may protect the distal tibial end of the TTA residuum from high stresses, therefore preventing pressure-related injury and pain. Copyright © 2011 Elsevier B.V. All rights reserved.

  14. Aortic valve insufficiency in the teenager and young adult: the role of prosthetic valve replacement.

    PubMed

    Bradley, Scott M

    2013-10-01

    The contents of this article were presented in the session "Aortic insufficiency in the teenager" at the congenital parallel symposium of the 2013 Society of Thoracic Surgeons (STS) annual meeting. The accompanying articles detail the approaches of aortic valve repair and the Ross procedure.(1,2) The current article focuses on prosthetic valve replacement. For many young patients requiring aortic valve surgery, either aortic valve repair or a Ross procedure provides a good option. The advantages include avoidance of anticoagulation and potential for growth. In other patients, a prosthetic valve is an appropriate alternative. This article discusses the current state of knowledge regarding mechanical and bioprosthetic valve prostheses and their specific advantages relative to valve repair or a Ross procedure. In current practice, young patients requiring aortic valve surgery frequently undergo valve replacement with a prosthetic valve. In STS adult cardiac database, among patients ≤30 years of age undergoing aortic valve surgery, 34% had placement of a mechanical valve, 51% had placement of a bioprosthetic valve, 9% had aortic valve repair, and 2% had a Ross procedure. In the STS congenital database, among patients 12 to 30 years of age undergoing aortic valve surgery, 21% had placement of a mechanical valve, 18% had placement of a bioprosthetic valve, 30% had aortic valve repair, and 24% had a Ross procedure. In the future, the balance among these options may be altered by design improvements in prosthetic valves, alternatives to warfarin, the development of new patch materials for valve repair, and techniques to avoid Ross autograft failure.

  15. Graft-Sparing Strategy for Thoracic Prosthetic Graft Infection.

    PubMed

    Uchino, Gaku; Yoshida, Takeshi; Kakii, Bunpachi; Furui, Masato

    2018-04-01

     Thoracic prosthetic graft infection is a rare but serious complication with no standard management. We reported our surgical experience on graft-sparing strategy for thoracic prosthetic graft infection.  This study included patients who underwent graft-sparing surgery for thoracic prosthetic graft infection at Matsubara Tokushukai Hospital in Japan from January 2000 to October 2017.  There were 17 patients included in the analyses, with a mean age at surgery of 71.0 ± 10.5 years; 11 were men. In-hospital mortality was observed in five patients (29.4%).  Graft-sparing surgery for thoracic prosthetic graft infection is an alternative option particularly for early graft infection after hemiarch replacement. Georg Thieme Verlag KG Stuttgart · New York.

  16. Clinical characteristics, microbiology, and outcomes of prosthetic joint infection in Taiwan.

    PubMed

    Tsai, Jen-Chih; Sheng, Wang-Huei; Lo, Wan-Yu; Jiang, Ching-Chuan; Chang, Shan-Chwen

    2015-04-01

    Prosthetic joint infection (PJI) after total knee or hip replacement is a devastating complication associated with substantial morbidity and economic cost. The incidence of prosthetic joint infection is increasing as the use of mechanical joint replacement increases. The treatment approach to prosthetic joint infection is based on different clinical situations such as a patient's comorbidities, epidemic microbiology data, and surgical procedures. The aim of our study was to understand clinical characteristics of prosthetic joint infection, the microbiology of the prosthetic joint infection, and the outcomes of different treatment strategies during 2006-2011. We retrospectively collected cases of prosthetic joint infection in the National Taiwan University Hospital between January 1, 2006 and December 31, 2011. The patients' characteristics, microbiology, outcomes, and factors associated with treatment success were recorded. One hundred and forty-four patients were identified as having PJI. Of these, 92 patients were entered into per-protocol analysis. Staphylococcus aureus was the most common causative organism (29.9%), followed by coagulase-negative Staphylococci (16.7%), and Enterococci (9.7%). The overall treatment success rate was 50%. Patients who received a two-stage revision had a better outcome, compared to patients who underwent other types of surgeries (70% vs. 32.7%, respectively; p < 0.001). In multivariate analysis, the two-stage revision was significantly associated with treatment success (odds ratio = 3.923, 95% confidence interval = 1.53-10.04). Our study demonstrates that Staphylococcus aureus was the most common causative organisms in PJI. Performing two-stage revisions was significantly associated with a better outcome. Copyright © 2013. Published by Elsevier B.V.

  17. Dissection of the atrial wall after mitral valve replacement.

    PubMed Central

    Lukács, L; Kassai, I; Lengyel, M

    1996-01-01

    We describe an unusual sequela of mitral valve replacement in a 50-year-old woman who had undergone a closed mitral commissurotomy in 1975. She was admitted to our hospital because of mitral restenosis in November 1993, at which time her mitral valve was replaced with a mechanical prosthesis. On the 8th postoperative day, the patient developed symptoms of heart failure; transesophageal echocardiography revealed dissection and rupture of the left atrial wall. At prompt reoperation, we found an interlayer dissection and rupture of the atrial wall into the left atrium. We repaired the ruptured atrial wall with a prosthetic patch. The postoperative course was uneventful, and postoperative transesophageal echocardiography showed normal prosthetic valve function and no dissection. Images PMID:8680278

  18. A Compliant Four-bar Linkage Mechanism that Makes the Fingers of a Prosthetic Hand More Impact Resistant

    PubMed Central

    Choi, Kyung Yun; Akhtar, Aadeel; Bretl, Timothy

    2017-01-01

    Repeated mechanical failure due to accidental impact is one of the main reasons why people with upper-limb amputations abandon commercially-available prosthetic hands. To address this problem, we present the design and evaluation of a compliant four-bar linkage mechanism that makes the fingers of a prosthetic hand more impact resistant. Our design replaces both the rigid input and coupler links with a monolithic compliant bone, and replaces the follower link with three layers of pre-stressed spring steel. This design behaves like a conventional four-bar linkage but adds lateral compliance and eliminates a pin joint, which is a main site of failure on impact. Results from free-end and fixed-end impact tests show that, compared to those made with a conventional four-bar linkage, fingers made with our design absorb up to 11% more energy on impact with no mechanical failure. We also show the integration of these fingers in a prosthetic hand that is low-cost, light-weight, and easy to assemble, and that has grasping performance comparable to commercially-available hands. PMID:29527386

  19. Second-site prosthetic joint infection in patients with multiple prosthetic joints.

    PubMed

    Clesham, Kevin; Hughes, Andrew J; O' hEireamhoin, Sven; Fleming, Catherine; Murphy, Colin G

    2018-04-10

    Prosthetic joint infections (PJIs) are among the most serious complications in arthroplasty. A second-site PJI in patients with multiple prosthetic joints increases morbidity, with many requiring further revision procedures. We aimed to establish why some patients with multiple joints develop second-site infections. Our institution's arthroplasty database was reviewed from 2004 to 2017. All PJIs were identified, and all patients with more than one prosthetic joint in situ were included. We recorded risk factors, causative organisms, number of procedures and length of stay. Forty-four patients meeting the criteria were identified. Four patients (9.1%) developed second-site infection. Eight patients (18.2%) developed re-infection of the primary PJI. Positive MRSA carrier status and PJI of a total knee replacement were associated with an increased risk of a second episode of infection. Patients who developed further infection had more frequent admission and longer lengths of stay than isolated PJIs. Higher morbidity and use of hospital resources are associated with this cohort of patients. PJIs in total knee replacements and positive MRSA status are associated with higher rates of second infection. Identifying this vulnerable cohort of patients at an early stage is critical to ensure measures are taken to reduce the risks of further infection.

  20. Poor short term outcome with a metal-on-metal total hip arthroplasty.

    PubMed

    Levy, Yadin D; Ezzet, Kace A

    2013-08-01

    Metal-on-metal (MoM) bearings for total hip arthroplasty (THA) have come under scrutiny with reports of high failure rates. Clinical outcome studies with several commercially available MoM THA bearings remain unreported. We evaluated 78 consecutive MoM THAs from a single manufacturer in 68 patients. Sixty-six received cobalt-chrome (CoCr) monoblock and 12 received modular titanium acetabular cups with internal CoCr liners. Femoral components were titanium with modular necks. At average 2.1 years postoperatively, 12 THAs (15.4%) demonstrated aseptic failure (10 revisions, 2 revision recommended). All revised hips demonstrated capsular necrosis with positive histology reaction for aseptic lymphocytic vasculitis-associated lesions/adverse local tissue reactions. Prosthetic instability following revision surgery was relatively common. Female gender was a strong risk factor for failure, though smaller cups were not. Both monoblock and modular components fared poorly. Corrosion was frequently observed around the proximal and distal end of the modular femoral necks. Copyright © 2013 Elsevier Inc. All rights reserved.

  1. Prosthetics socket that incorporates an air splint system focusing on dynamic interface pressure.

    PubMed

    Razak, Nasrul Anuar Abd; Osman, Noor Azuan Abu; Gholizadeh, Hossein; Ali, Sadeeq

    2014-08-01

    The interface pressure between the residual limb and prosthetic socket has a significant effect on an amputee's satisfaction and comfort. This paper presents the design and performance of a new prosthetic socket that uses an air splint system. The air splint prosthetic socket system was implemented by combining the air splint with a pressure sensor that the transhumeral user controls through the use of a microcontroller. The modular construction of the system developed allows the FSR pressure sensors that are placed inside the air splint socket to determine the required size and fitting for the socket used. Fifteen transhumeral amputees participated in the study. The subject's dynamic pressure on the socket that's applied while wearing the air splint systems was recorded using F-socket transducers and microcontroller analysis. The values collected by the F-socket sensor for the air splint prosthetic socket system were determined accordingly by comparing the dynamic pressure applied using statically socket. The pressure volume of the air splint fluctuated and was recorded at an average of 38 kPa (2.5) to 41 kPa (1.3) over three hours. The air splint socket might reduce the pressure within the interface of residual limb. This is particularly important during the daily life activities and may reduce the pain and discomfort at the residual limb in comparison to the static socket. The potential development of an auto-adjusted socket that uses an air splint system as the prosthetic socket will be of interest to researchers involved in rehabilitation engineering, prosthetics and orthotics.

  2. Prosthetics socket that incorporates an air splint system focusing on dynamic interface pressure

    PubMed Central

    2014-01-01

    Background The interface pressure between the residual limb and prosthetic socket has a significant effect on an amputee’s satisfaction and comfort. This paper presents the design and performance of a new prosthetic socket that uses an air splint system. Methods The air splint prosthetic socket system was implemented by combining the air splint with a pressure sensor that the transhumeral user controls through the use of a microcontroller. The modular construction of the system developed allows the FSR pressure sensors that are placed inside the air splint socket to determine the required size and fitting for the socket used. Fifteen transhumeral amputees participated in the study. Results The subject’s dynamic pressure on the socket that’s applied while wearing the air splint systems was recorded using F-socket transducers and microcontroller analysis. The values collected by the F-socket sensor for the air splint prosthetic socket system were determined accordingly by comparing the dynamic pressure applied using statically socket. The pressure volume of the air splint fluctuated and was recorded at an average of 38 kPa (2.5) to 41 kPa (1.3) over three hours. Conclusion The air splint socket might reduce the pressure within the interface of residual limb. This is particularly important during the daily life activities and may reduce the pain and discomfort at the residual limb in comparison to the static socket. The potential development of an auto-adjusted socket that uses an air splint system as the prosthetic socket will be of interest to researchers involved in rehabilitation engineering, prosthetics and orthotics. PMID:25085005

  3. International normalized ratio self-management lowers the risk of thromboembolic events after prosthetic heart valve replacement.

    PubMed

    Eitz, Thomas; Schenk, Soren; Fritzsche, Dirk; Bairaktaris, Andreas; Wagner, Otto; Koertke, Heinrich; Koerfer, Reiner

    2008-03-01

    Although prosthetic valves are durable and easy to implant, the need for lifetime warfarin-based anticoagulation restricts their exclusive usage. We investigated if anticoagulation self-management improves outcome in a single-center series. Between 1994 and 1998, 765 patients with prosthetic valve replacements were prospectively enrolled and randomized to receive conventional anticoagulation management by their primary physician (group 1, n = 295) or to pursue anticoagulation self-management (group 2, n = 470). A study head office was implemented to coordinate and monitor anticoagulation protocols, international normalized ratios (INR), and adverse events. Patients were instructed on how to obtain and test their own blood samples and to adjust warfarin dosages according to the measured INR (target range, 2.5 to 4). Mean INR values were slightly yet significantly smaller in group 1 than in group 2 (2.8 +/- 0.7 vs 3.0 +/- .6, p < 0.001). Moreover, INR values of patients with conventional INR management were frequently measured outside the INR target range, whereas those with anticoagulation self-management mostly remained within the range (35% vs 21%, p < 0.001). In addition, the scatter of INR values was smaller if self-managed. Freedom from thromboembolism at 3, 12, and 24 months, respectively, was 99%, 95%, and 91% in group 1 compared with 99%, 98%, and 96% in group 2 (p = 0.008). Bleeding events were similar in both groups. Time-related multivariate analysis identified INR self-management and higher INR as independent predictors for better outcome. Anticoagulation self-management can improve INR profiles up to 2 years after prosthetic valve replacement and reduce adverse events. Current indications of prosthetic rather than biologic valve implantations may be extended if the benefit of INR self-management is shown by future studies with longer follow-up.

  4. Awareness, attitudes, need and demand on replacement of missing teeth among a group of partially dentate patients attending a University Dental Hospital.

    PubMed

    Jayasinghe, Rasika Manori; Perera, Janana; Jayasinghe, Vajira; Thilakumara, Indika P; Rasnayaka, Sumudu; Shiraz, Muhammad Hanafi Muhammad; Ranabahu, Indra; Kularatna, Sanjeewa

    2017-07-27

    Our objective was to assess awareness, attitudes, need and demand on replacement of missing teeth according to edentulous space, age, gender, ethnicity, educational level and socio-economical status of the patient. 76.2% of the study group was opined that the missing teeth should be replaced by prosthetic means. Majority were keen in getting them replaced mainly for the comfort in mastication. Although 77.9 and 32.9% were aware of the removable prostheses and implants respectively, only 25.2% knew about tooth supported bridges as an option of replacement of missing teeth. Participants' awareness on tooth and implant supported prostheses is at a higher level. Participants' opinion on need of regular dental visit was statistically significant when gender, ethnicity and education level were considered. The highest demand for replacement of missing teeth was observed in Kennedy class I and II situations in both upper and lower arches. Demand for fixed prostheses was significantly highest in Kennedy class II in upper and lower arches. In conclusion, although removable prosthodontic options are known to most of the patients, their awareness on tooth and implant supported prostheses is also at a higher level. The highest demand for replacement of missing teeth is by patients with Kennedy class I and II situations whereas Kennedy class II being the category with highest demand for fixed prostheses. We recommend that the location of missing teeth to be considered as a priority when educating patients on the most appropriate prosthetic treatment options. Dentists' involvement in educating patients on prosthetic options needs to be improved.

  5. A new three-dimensional, print-on-demand temporomandibular prosthetic total joint replacement system: Preliminary outcomes.

    PubMed

    Dimitroulis, George; Austin, Stephen; Sin Lee, Peter Vee; Ackland, David

    2018-05-16

    The aim of this study is to present the preliminary clinical data on the OMX Temporomandibular Joint (TMJ) Prosthetic total joint replacement system. A prospective, cohort, clinical study was undertaken of consecutive adult patients with Category 5 end-stage joint disease who were implanted with the OMX TMJ prosthesis between May 2015 and April 2017. A total of 50 devices were implanted in 38 patients, with 12 patients receiving bilateral prosthetic joints. There were 31 females and 7 males in this cohort, who ranged in age from 20 to 66 years, with a mean of 43.8 years (±14.0 years). Ten of the 50 prosthetic joints (20%) were fully customized, while the remaining were patient matched using virtual planning software. Based on a mean follow-up period of 15.3 months (range 12-24 months) following the TMJ total joint replacement, preliminary results suggest the OMX TMJ prosthesis has made a positive impact on clinical outcomes, with a mean 74.4% reduction in joint pain levels and significant improvements (p < 0.05) in jaw function as measured by the visual analogue scales for mouth opening (30.8%), diet (77.1%), and function (59.2%). No device failures were reported during the study period. This study suggests that the print-on-demand OMX TMJ prosthesis, designed for rapid delivery of both patient-matched and fully customize devices, represents a safe, reliable and versatile implantable joint replacement system for the treatment of category 5 end-stage TMJ disease. Copyright © 2018 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  6. Three-Dimensional Printing of Prosthetic Hands for Children.

    PubMed

    Burn, Matthew B; Ta, Anderson; Gogola, Gloria R

    2016-05-01

    Children with hand reductions, whether congenital or traumatic, have unique prosthetic needs. They present a challenge because of their continually changing size due to physical growth as well as changing needs due to psychosocial development. Conventional prosthetics are becoming more technologically advanced and increasingly complex. Although these are welcome advances for adults, the concomitant increases in weight, moving parts, and cost are not beneficial for children. Pediatric prosthetic needs may be better met with simpler solutions. Three-dimensional printing can be used to fabricate rugged, light-weight, easily replaceable, and very low cost assistive hands for children. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  7. Individual Finger Control of the Modular Prosthetic Limb using High-Density Electrocorticography in a Human Subject

    PubMed Central

    Fifer, Matthew S.; Johannes, Matthew S.; Katyal, Kapil D.; Para, Matthew P.; Armiger, Robert; Anderson, William S.; Thakor, Nitish V.; Wester, Brock A.; Crone, Nathan E.

    2016-01-01

    Objective We used native sensorimotor representations of fingers in a brain-machine interface to achieve immediate online control of individual prosthetic fingers. Approach Using high gamma responses recorded with a high-density ECoG array, we rapidly mapped the functional anatomy of cued finger movements. We used these cortical maps to select ECoG electrodes for a hierarchical linear discriminant analysis classification scheme to predict: 1) if any finger was moving, and, if so, 2) which digit was moving. To account for sensory feedback, we also mapped the spatiotemporal activation elicited by vibrotactile stimulation. Finally, we used this prediction framework to provide immediate online control over individual fingers of the Johns Hopkins University Applied Physics Laboratory (JHU/APL) Modular Prosthetic Limb (MPL). Main Results The balanced classification accuracy for detection of movements during the online control session was 92% (chance: 50%). At the onset of movement, finger classification was 76% (chance: 20%), and 88% (chance: 25%) if the pinky and ring finger movements were coupled. Balanced accuracy of fully flexing the cued finger was 64%, and 77% had we combined pinky and ring commands. Offline decoding yielded a peak finger decoding accuracy of 96.5% (chance: 20%) when using an optimized selection of electrodes. Offline analysis demonstrated significant finger-specific activations throughout sensorimotor cortex. Activations either prior to movement onset or during sensory feedback led to discriminable finger control. Significance Our results demonstrate the ability of ECoG-based BMIs to leverage the native functional anatomy of sensorimotor cortical populations to immediately control individual finger movements in real time. PMID:26863276

  8. Individual finger control of a modular prosthetic limb using high-density electrocorticography in a human subject

    NASA Astrophysics Data System (ADS)

    Hotson, Guy; McMullen, David P.; Fifer, Matthew S.; Johannes, Matthew S.; Katyal, Kapil D.; Para, Matthew P.; Armiger, Robert; Anderson, William S.; Thakor, Nitish V.; Wester, Brock A.; Crone, Nathan E.

    2016-04-01

    Objective. We used native sensorimotor representations of fingers in a brain-machine interface (BMI) to achieve immediate online control of individual prosthetic fingers. Approach. Using high gamma responses recorded with a high-density electrocorticography (ECoG) array, we rapidly mapped the functional anatomy of cued finger movements. We used these cortical maps to select ECoG electrodes for a hierarchical linear discriminant analysis classification scheme to predict: (1) if any finger was moving, and, if so, (2) which digit was moving. To account for sensory feedback, we also mapped the spatiotemporal activation elicited by vibrotactile stimulation. Finally, we used this prediction framework to provide immediate online control over individual fingers of the Johns Hopkins University Applied Physics Laboratory modular prosthetic limb. Main results. The balanced classification accuracy for detection of movements during the online control session was 92% (chance: 50%). At the onset of movement, finger classification was 76% (chance: 20%), and 88% (chance: 25%) if the pinky and ring finger movements were coupled. Balanced accuracy of fully flexing the cued finger was 64%, and 77% had we combined pinky and ring commands. Offline decoding yielded a peak finger decoding accuracy of 96.5% (chance: 20%) when using an optimized selection of electrodes. Offline analysis demonstrated significant finger-specific activations throughout sensorimotor cortex. Activations either prior to movement onset or during sensory feedback led to discriminable finger control. Significance. Our results demonstrate the ability of ECoG-based BMIs to leverage the native functional anatomy of sensorimotor cortical populations to immediately control individual finger movements in real time.

  9. Neuroprosthetic limb control with electrocorticography: approaches and challenges.

    PubMed

    Thakor, Nitish V; Fifer, Matthew S; Hotson, Guy; Benz, Heather L; Newman, Geoffrey I; Milsap, Griffin W; Crone, Nathan E

    2014-01-01

    Advanced upper limb prosthetics, such as the Johns Hopkins Applied Physics Lab Modular Prosthetic Limb (MPL), are now available for research and preliminary clinical applications. Research attention has shifted to developing means of controlling these prostheses. Penetrating microelectrode arrays are often used in animal and human models to decode action potentials for cortical control. These arrays may suffer signal loss over the long-term and therefore should not be the only implant type investigated for chronic BMI use. Electrocorticographic (ECoG) signals from electrodes on the cortical surface may provide more stable long-term recordings. Several studies have demonstrated ECoG's potential for decoding cortical activity. As a result, clinical studies are investigating ECoG encoding of limb movement, as well as its use for interfacing with and controlling advanced prosthetic arms. This overview presents the technical state of the art in the use of ECoG in controlling prostheses. Technical limitations of the current approach and future directions are also presented.

  10. Quadriceps muscle injury in trans-femoral amputees.

    PubMed

    Alsindi, Z; Datta, D

    1998-12-01

    Two male trans-femoral amputees using modular trans-femoral prostheses lost control and fell to the ground when their prosthetic knees gave way. The semi-automatic knee lock malfunctioned in the first case while the free knee stabilising mechanics gave way in the second case. This resulted in a high tensile force acting on the contralateral quadriceps muscle causing it to rupture. As there are a significant number of patients with both kinds of prostheses it is important to be aware of this possibility so that necessary actions can be taken to minimise its occurrence. Even with the currently available weight activated stance phase control, the prosthetic knee will give way if the knee is flexed more than 20 degrees on weight bearing. Good power and control of hip extensors on the amputation side is needed to control the prosthetic knee joint, especially in the early stage of the walking cycle, i.e., from heel strike to mid-stance. Quadriceps muscle injury in amputees, as far as the authors are aware, has not been reported previously.

  11. Factors Associated with Prosthetic Looseness in Lower Limb Amputees.

    PubMed

    Phonghanyudh, Thong; Sutpasanon, Taweesak; Hathaiareerug, Chanasak; Devakula, M L Buddhibongsa; Kumnerddee, Wipoo

    2015-12-01

    To determine the factors associated with prosthetic looseness in lower limb amputees in Sisaket province. The present was a cross-sectional descriptive study. Subjects were lower limb amputees who previously obtained prostheses and required prosthetic replacements at the mobile prosthetic laboratory unit under the Prostheses Foundation of H.R.H. the Princess Mother at Khun Han Hospital, Sisaket province, in February 2013. Data including participant characteristics, prosthetic looseness data, and various variables were collected by direct semi-structured interview. Energy expenditures in physical activities were measured using the Thai version of the short format international physical activity questionnaire. Data between participants with and without prosthetic looseness were compared to determine prosthetic loosening associated factors. Among 101 participants enrolled, 33 (32.7%) had prosthetic looseness with average onset of 1.76 ± 1.67 years. Diabetes mellitus was the only significant factor associated with prosthetic looseness from both univariate and multivariate analyses (HR = 7.05, p = 0.002 and HR = 5.93, p = 0.007 respectively). Among the lower limb amputees in Sisaket province, diabetes mellitus was the only factor associated with prosthetic looseness. Therefore, diabetic screening should be supplemented in lower limb amputee assessment protocol. In addition, we recommend that amputees with diabetes mellitus should receive prosthesis check out at approximately

  12. Surgical treatment of Behçet's disease involving aortic regurgitation.

    PubMed

    Ando, M; Kosakai, Y; Okita, Y; Nakano, K; Kitamura, S

    1999-12-01

    Behçet's disease involving aortic regurgitation is rare, and prosthetic valve detachment after aortic valve replacement is one of the most serious complications reported. We investigated the surgical results in 10 patients with aortic regurgitation caused by Behçet's disease. Between 1981 and 1997, 10 patients with aortic regurgitation secondary to Behçet's disease had surgery. There were 8 men and 2 women, and their ages ranged from 33 to 60 years (mean, 46+/-8 years). The surgical procedures for aortic regurgitation were aortic valve replacement in 6 patients and Bentall type operation in 4. No patient died during the hospital stay. The follow-up periods ranged from 11 to 185 months (mean, 87 months). Two patients died during the follow-up period. The acturial survival rate was 89% at 5 years and 67% at 10 years. Prosthetic valve detachment or suture detachment requiring redo operation occurred in 4 patients, 3 of whom had redo operations twice. Four patients had a composite graft replacement, and 1 patient died after the operation. No prosthetic valve detachment was noted in 64% of the patients at 5 years and in 43% at 10 years. The rate of prosthetic valve detachment was 40% (4 of 10 patients), with a higher incidence in patients with Behçet's disease than in those treated during the same period at the same hospital for aortitis caused by other diseases. Surgical techniques for treatment of this condition should be modified to improve the surgical outcome in these patients.

  13. [Influence of preoperative bone mass density in periprosthetic bone remodeling after implantation of ABG-II prosthesis: A 10-year follow-up].

    PubMed

    Aguilar Ezquerra, A; Panisello Sebastiá, J J; Mateo Agudo, J

    2016-01-01

    Preoperative bone mass index has shown to be an important factor in peri-prosthetic bone remodelling in short follow-up studies. Bone density scans (DXA) were used to perform a 10-year follow-up study of 39 patients with a unilateral, uncemented hip replacement. Bone mass index measurements were made at 6 months, one year, 3 years, 5 years, and 10 years after surgery. Pearson coefficient was used to quantify correlations between preoperative bone mass density (BMD) and peri-prosthetic BMD in the 7 Gruen zones at 6 months, one year, 3 years, 5 years, and 10 years. Pre-operative BMD was a good predictor of peri-prosthetic BMD one year after surgery in zones 1, 2, 4, 5 and 6 (Pearson index from 0.61 to 0.75). Three years after surgery it has good predictive power in zones 1, 4 and 5 (0.71-0.61), although in zones 3 and 7 low correlation was observed one year after surgery (0.51 and 0.57, respectively). At the end of the follow-up low correlation was observed in the 7 Gruen zones. Sex and BMI were found to not have a statistically significant influence on peri-prosthetic bone remodelling. Although preoperative BMD seems to be an important factor in peri-prosthetic remodelling one year after hip replacement, it loses its predictive power progressively, until not being a major factor in peri-prosthetic remodelling ten years after surgery. Copyright © 2015 SECOT. Published by Elsevier Espana. All rights reserved.

  14. Dissociation of modular total hip arthroplasty at the neck-stem interface without dislocation.

    PubMed

    Kouzelis, A; Georgiou, C S; Megas, P

    2012-12-01

    Modular femoral and acetabular components are now widely used, but only a few complications related to the modularity itself have been reported. We describe a case of dissociation of the modular total hip arthroplasty (THA) at the femoral neck-stem interface during walking. The possible causes of this dissociation are discussed. Successful treatment was provided with surgical revision and replacement of the modular neck components. Surgeons who use modular components in hip arthroplasties should be aware of possible early complications in which the modularity of the prostheses is the major factor of failure.

  15. Measurement of installation deformation of the acetabulum during prosthetic replacement of a hip joint using digital image correlation

    NASA Astrophysics Data System (ADS)

    Lei, Dong; Bai, Pengxiang; Zhu, Feipeng

    2018-01-01

    Nowadays, acetabulum prosthesis replacement is widely used in clinical medicine. However, there is no efficient way to evaluate the implantation effect of the prosthesis. Based on a modern photomechanics technique called digital image correlation (DIC), the evaluation method of the installation effect of the acetabulum was established during a prosthetic replacement of a hip joint. The DIC method determines strain field by comparing the speckle images between the undeformed sample and the deformed counterpart. Three groups of experiments were carried out to verify the feasibility of the DIC method on the acetabulum installation deformation test. Experimental results indicate that the installation deformation of acetabulum generally includes elastic deformation (corresponding to the principal strain of about 1.2%) and plastic deformation. When the installation angle is ideal, the plastic deformation can be effectively reduced, which could prolong the service life of acetabulum prostheses.

  16. Prosthesis Material

    NASA Technical Reports Server (NTRS)

    1995-01-01

    In this photograph, Sandra Rossi user her NASA-developed prosthesis for the first time. Derived from foam insulation technology used to protect the Space Shuttle External Tank from excessive heat, FAB/CAD, a subsidiary of the Harshberger Prosthetic and Orthotic Center, utilized the technology to replace the heavy, fragile plaster they used to produce master molds for prosthetics. The new material was lighter, cheaper and easier to manufacture than plaster, resulting in lower costs to the customer.

  17. Rotationplasty with vascular reconstruction for prosthetic knee joint infection.

    PubMed

    Fujiki, Masahide; Miyamoto, Shimpei; Nakatani, Fumihiko; Kawai, Akira; Sakuraba, Minoru

    2015-01-01

    Rotationplasty is used most often as a function-preserving salvage procedure after resection of sarcomas of the lower extremity; however, it is also used after infection of prosthetic knee joints. Conventional vascular management during rotationplasty is to preserve and coil major vessels, but recently, transection and reanastomosis of the major vessels has been widely performed. However, there has been little discussion regarding the optimal vascular management of rotationplasty after infection of prosthetic knee joints because rotationplasty is rarely performed for this indication. We reviewed four patients who had undergone resection of osteosarcomas of the femur, placement of a prosthetic knee joint, and rotationplasty with vascular reconstruction from 2010 to 2013. The mean interval between prosthetic joint replacement and rotationplasty was 10.4 years and the mean interval between the diagnosis of prosthesis infection and rotationplasty was 7.9 years. Rotationplasty was successful in all patients; however, in one patient, arterial thrombosis developed and necessitated urgent surgical removal and arterial reconstruction. All patients were able to walk independently with a prosthetic limb after rehabilitation. Although there is no consensus regarding the most appropriate method of vascular management during rotationplasty for revision of infected prosthetic joints, vascular transection and reanastomosis is a useful option.

  18. 21 CFR 870.3710 - Pacemaker repair or replacement material.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Pacemaker repair or replacement material. 870.3710 Section 870.3710 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3710 Pacemaker...

  19. Pannus-related prosthetic valve dysfunction. Case report

    PubMed Central

    MOLDOVAN, MARIA-SÎNZIANA; BEDELEANU, DANIELA; KOVACS, EMESE; CIUMĂRNEAN, LORENA; MOLNAR, ADRIAN

    2016-01-01

    Pannus-related prosthetic valve dysfunction, a complication of mechanical prosthetic valve replacement, is rare, with a slowly progressive evolution, but it can be acute, severe, requiring surgical reintervention. We present the case of a patient with a mechanical single disc aortic prosthesis, with moderate prosthesis-patient mismatch, minor pannus found on previous ultrasound examinations, who presented to our service with angina pain with a duration of 1 hour, subsequently interpreted as non-ST segment elevation myocardial infarction (NSTEMI) syndrome. Coronarography showed normal epicardial coronary arteries, an ample movement of the prosthetic disc, without evidence of coronary thromboembolism, and Gated Single-Photon Emission Computerized Tomography (SPECT) with Technetium (Tc)-99m detected no perfusion defects. Transthoracic echocardiography (TTE) evidenced a dysfunctional prosthesis due to a subvalvular mass; transesophageal echocardiography (TOE) showed the interference of this mass, with a pannus appearance, with the closure of the prosthetic disc. Under conditions of repeated angina episodes, under anticoagulant treatment, surgery was performed, with the intraoperative confirmation of pannus and its removal. Postoperative evolution was favorable. This case reflects the diagnostic and therapeutic management problems of pannus-related prosthetic valve dysfunction. PMID:27004041

  20. Pannus-related prosthetic valve dysfunction. Case report.

    PubMed

    Moldovan, Maria-Sînziana; Bedeleanu, Daniela; Kovacs, Emese; Ciumărnean, Lorena; Molnar, Adrian

    2016-01-01

    Pannus-related prosthetic valve dysfunction, a complication of mechanical prosthetic valve replacement, is rare, with a slowly progressive evolution, but it can be acute, severe, requiring surgical reintervention. We present the case of a patient with a mechanical single disc aortic prosthesis, with moderate prosthesis-patient mismatch, minor pannus found on previous ultrasound examinations, who presented to our service with angina pain with a duration of 1 hour, subsequently interpreted as non-ST segment elevation myocardial infarction (NSTEMI) syndrome. Coronarography showed normal epicardial coronary arteries, an ample movement of the prosthetic disc, without evidence of coronary thromboembolism, and Gated Single-Photon Emission Computerized Tomography (SPECT) with Technetium (Tc)-99m detected no perfusion defects. Transthoracic echocardiography (TTE) evidenced a dysfunctional prosthesis due to a subvalvular mass; transesophageal echocardiography (TOE) showed the interference of this mass, with a pannus appearance, with the closure of the prosthetic disc. Under conditions of repeated angina episodes, under anticoagulant treatment, surgery was performed, with the intraoperative confirmation of pannus and its removal. Postoperative evolution was favorable. This case reflects the diagnostic and therapeutic management problems of pannus-related prosthetic valve dysfunction.

  1. Consequences of tooth loss: 2. Dentist considerations--restorative problems and implications.

    PubMed

    Craddock, Helen L

    2010-01-01

    Partial tooth loss is much less well tolerated by patients than was previously the case and, on occasions, when extraction is inevitable, they may seek prosthetic replacement. This paper explores some of the consequences of tooth loss that may cause difficulties in tooth replacement, particularly if replacement is delayed for some time. An awareness of potential difficulties, particularly with posterior tooth replacement, will allow clinicians to make treatment decisions in the light of current evidence.

  2. Benefit from NASA

    NASA Image and Video Library

    1995-01-01

    In this photograph, Sandra Rossi user her NASA-developed prosthesis for the first time. Derived from foam insulation technology used to protect the Space Shuttle External Tank from excessive heat, FAB/CAD, a subsidiary of the Harshberger Prosthetic and Orthotic Center, utilized the technology to replace the heavy, fragile plaster they used to produce master molds for prosthetics. The new material was lighter, cheaper and easier to manufacture than plaster, resulting in lower costs to the customer.

  3. Benefit from NASA

    NASA Image and Video Library

    1995-01-01

    In this photograph, James Carden uses a NASA-developed prosthesis to moved planks around his home. Derived from foam insulation technology used to protect the Space Shuttle External Tank from excessive heat, FAB/CAD, a subsidiary of the Harshberger Prosthetic and Orthotic Center, utilized the technology to replace the heavy, fragile plaster they used to produce master molds for prosthetics. The new material was lighter, cheaper and easier to manufacture than plaster, resulting in lower costs to the customer.

  4. Benefit from NASA

    NASA Image and Video Library

    2004-04-15

    In this photograph, Amputee Amie Bradly uses a NASA-developed prosthesis to paint her fingernails. Derived from foam insulation technology used to protect the Space Shuttle External Tank from excessive heat, FAB/CAD, a subsidiary of the Harshberger Prosthetic and Orthotic Center, utilized the technology to replace the heavy, fragile plaster they used to produce master molds for prosthetics. The new material was lighter, cheaper and easier to manufacture than plaster, resulting in lower costs to the customer.

  5. Prosthesis Material

    NASA Technical Reports Server (NTRS)

    2004-01-01

    In this photograph, Amputee Amie Bradly uses a NASA-developed prosthesis to paint her fingernails. Derived from foam insulation technology used to protect the Space Shuttle External Tank from excessive heat, FAB/CAD, a subsidiary of the Harshberger Prosthetic and Orthotic Center, utilized the technology to replace the heavy, fragile plaster they used to produce master molds for prosthetics. The new material was lighter, cheaper and easier to manufacture than plaster, resulting in lower costs to the customer.

  6. Prosthesis Material

    NASA Technical Reports Server (NTRS)

    1995-01-01

    In this photograph, James Carden uses a NASA-developed prosthesis to moved planks around his home. Derived from foam insulation technology used to protect the Space Shuttle External Tank from excessive heat, FAB/CAD, a subsidiary of the Harshberger Prosthetic and Orthotic Center, utilized the technology to replace the heavy, fragile plaster they used to produce master molds for prosthetics. The new material was lighter, cheaper and easier to manufacture than plaster, resulting in lower costs to the customer.

  7. Echocardiographic Assessment of Heart Valve Prostheses

    PubMed Central

    Sordelli, Chiara; Severino, Sergio; Ascione, Luigi; Coppolino, Pasquale; Caso, Pio

    2014-01-01

    Patients submitted to valve replacement with mechanical or biological prosthesis, may present symptoms related either to valvular malfunction or ventricular dysfunction from other causes. Because a clinical examination is not sufficient to evaluate a prosthetic valve, several diagnostic methods have been proposed to assess the functional status of a prosthetic valve. This review provides an overview of echocardiographic and Doppler techniques useful in evaluation of prosthetic heart valves. Compared to native valves, echocardiographic evaluation of prosthetic valves is certainly more complex, both for the examination and the interpretation. Echocardiography also allows discriminating between intra- and/or peri-prosthetic regurgitation, present in the majority of mechanical valves. Transthoracic echocardiography (TTE) requires different angles of the probe with unconventional views. Transesophageal echocardiography (TEE) is the method of choice in presence of technical difficulties. Three-dimensional (3D)-TEE seems to be superior to 2D-TEE, especially in the assessment of paravalvular leak regurgitation (PVL) that it provides improved localization and analysis of the PVL size and shape. PMID:28465917

  8. Structural Integration and Control of Peerless Human-like Prosthetic Hand

    NASA Astrophysics Data System (ADS)

    Dave, Ankit; Muthu, P.; Karthikraj, V.; Latha, S.

    2018-04-01

    Limb damage can create severe disturbance in movement and operative abilities wherein the prosthetic rehabilitation has the potential to replace function and enhance the quality of life. This paper presents a humanlike prosthetic hand using such unique design concept of hand model using artificial bones, ligaments, and tendons controlled using Arduino. Amongst various platforms available, Arduino is known for its adaptability, adoration and low cost. The design of prosthetic hand has a unique structure with all carpal, metacarpal, and phalanges which are bones of the hand. These bones are attached to each other following the pattern of human hand using the polymeric rubber as a functioning ligament. Furthermore, this structure of finger is driven by tendons attached to all fingers and passes through the ligaments working as pulley resulting in more degrees of freedom. The motor can twitch the tendons to achieve the action of fingers. Thus the servos, controlled by an Arduino, are used to regulate the movement mechanism of the prosthetic hand.

  9. Remote monitoring of lower-limb prosthetic socket fit using wireless technologies.

    PubMed

    Sahandi, R; Sewell, P; Noroozi, S; Hewitt, M

    2012-01-01

    Accurate fitting of a lower-limb prosthetic socket is the most important factor affecting amputee satisfaction and rehabilitation. The technology is now available to allow real-time monitoring of in-service pressure distribution of prosthetic limbs. This paper proposes a remote interfacial pressure monitoring system necessary for the assessment of fit. The suitability of a wireless ZigBee network due to its relevant technical specification is investigated. The system enables remote monitoring of a prosthetic socket and its fit under different operating conditions thereby improving design, efficiency and effectiveness. The data can be used by prosthetists and may also be recorded for future training or for patient progress monitoring. This can minimize the number of iterations by getting it right first time, thereby minimizing the number of replacement prostheses. Copyright © 2012 Informa UK, Ltd.

  10. [ANALYSIS OF IMPLANT-RELATED COMPLICATIONS AFTER HINGE KNEE REPLACEMENT FOR TUMORS AROUND THE KNEE].

    PubMed

    Li, Dong; Ma, Huanzhi; Zhang, Wei; Sun, Chengliang; Lu, Xiaoyong; Gao, Yutong; Zhou, Dongsheng

    2015-08-01

    To investigate the reasons and managements of implant-related complications after hinge knee replacement for tumors around the knee. A retrospective analysis was made on the clinical data of 96 patients undergoing hinge knee replacement between January 2000 and December 2012. There were 64 males and 32 females with the mean age of 31.0 years (range, 15-72 years). The most common tumor type was osteosarcoma (72 cases), and the second was giant cell tumor (15 cases). The tumor located at the distal femurs in 52 cases and at the proximal tibias in 44 cases. Fifteen hinge and 81 rotating hinge prostheses were used. The recurrence, metastasis, and survival were recorded. The implant-related complications were observed. The median follow-up time was 43.5 months (range, 10-156 months). Complications were observed in 21 patients (25 implant-related complications); 13 complications located at the femur and 12 complications at the tibia. The complications included aseptic loosening (8 cases), deep infection (7 cases), prosthetic breakage (4 cases), peri-prosthetic fracture (2 cases), and dislocation (4 cases). Most deep infection occurred within 12 months after operation (6/7), and most aseptic loosening after 40 months of operation (6/8). The rate of limb salvage was 90.6% (87/96) and the amputation rate was 9.4% (9/96). The overall survival rate of the prosthesis was 76.7% (5-year) and 47.2% (10-year). The 5-year survival rate was 82.9% for femoral prosthesis and 71.0% for tibial prosthesis, showing no significant difference (P = 0.954). Hinge knee prosthesis still has a high rate of complications. Deep infection is main reason to decrease short-term prosthetic survival rate, and aseptic loosening shortens the long-short prosthetic survival time.

  11. Fluctuating residual limb volume accommodated with an adjustable, modular socket design: A novel case report.

    PubMed

    Mitton, Kay; Kulkarni, Jai; Dunn, Kenneth William; Ung, Anthony Hoang

    2017-10-01

    This novel case report describes the problems of prescribing a prosthetic socket in a left transfemoral amputee secondary to chronic patellofemoral instability compounded by complex regional pain syndrome. Case Description and Methods: Following the amputation, complex regional pain syndrome symptoms recurred in the residual limb, presenting mainly with oedema. Due to extreme daily volume fluctuations of the residual limb, a conventional, laminated thermoplastic socket fitting was not feasible. Findings and Outcomes: An adjustable, modular socket design was trialled. The residual limb volume fluctuations were accommodated within the socket. Amputee rehabilitation could be continued, and the rehabilitation goals were achieved. The patient was able to wear the prosthesis for 8 h daily and to walk unaided indoors and outdoors. An adjustable, modular socket design accommodated the daily residual limb volume fluctuations and provided a successful outcome in this case. It demonstrates the complexities of socket fitting and design with volume fluctuations. Clinical relevance Ongoing complex regional pain syndrome symptoms within the residual limb can lead to fitting difficulties in a conventional, laminated thermoplastic socket due to volume fluctuations. An adjustable, modular socket design can accommodate this and provide a successful outcome.

  12. 21 CFR 874.3540 - Prosthesis modification instrument for ossicular replacement surgery.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Prosthesis modification instrument for ossicular replacement surgery. 874.3540 Section 874.3540 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES EAR, NOSE, AND THROAT DEVICES Prosthetic Devices § 874.3540 Prosthesis modification...

  13. 21 CFR 874.3540 - Prosthesis modification instrument for ossicular replacement surgery.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Prosthesis modification instrument for ossicular replacement surgery. 874.3540 Section 874.3540 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES EAR, NOSE, AND THROAT DEVICES Prosthetic Devices § 874.3540 Prosthesis modification...

  14. 21 CFR 874.3540 - Prosthesis modification instrument for ossicular replacement surgery.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Prosthesis modification instrument for ossicular replacement surgery. 874.3540 Section 874.3540 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES EAR, NOSE, AND THROAT DEVICES Prosthetic Devices § 874.3540 Prosthesis modification...

  15. 21 CFR 874.3540 - Prosthesis modification instrument for ossicular replacement surgery.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Prosthesis modification instrument for ossicular replacement surgery. 874.3540 Section 874.3540 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES EAR, NOSE, AND THROAT DEVICES Prosthetic Devices § 874.3540 Prosthesis modification...

  16. 21 CFR 874.3540 - Prosthesis modification instrument for ossicular replacement surgery.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Prosthesis modification instrument for ossicular replacement surgery. 874.3540 Section 874.3540 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES EAR, NOSE, AND THROAT DEVICES Prosthetic Devices § 874.3540 Prosthesis modification...

  17. Modified Nance palatal arch appliance for anterior tooth replacement.

    PubMed

    Sethi, Ntasha; Shanthraj, Srinivas L; Muraleedharan, Manju; Mallikarjuna, Rachappa

    2013-06-07

    The following case report presents a new and an innovative technique for the postextraction replacement of maxillary central incisors using the natural teeth as pontics. The novel appliance fabricated fully satisfied the demands of the adolescent patient for a fixed prosthetic, while fulfilling the aesthetic and functional requirements presented by the case.

  18. Modified Nance palatal arch appliance for anterior tooth replacement

    PubMed Central

    Sethi, Ntasha; Shanthraj, Srinivas L; Muraleedharan, Manju; Mallikarjuna, Rachappa

    2013-01-01

    The following case report presents a new and an innovative technique for the postextraction replacement of maxillary central incisors using the natural teeth as pontics. The novel appliance fabricated fully satisfied the demands of the adolescent patient for a fixed prosthetic, while fulfilling the aesthetic and functional requirements presented by the case. PMID:23749860

  19. Contact mechanics of modular metal-on-polyethylene total hip replacement under adverse edge loading conditions

    PubMed Central

    Hua, Xijin; Li, Junyan; Wang, Ling; Jin, Zhongmin; Wilcox, Ruth; Fisher, John

    2014-01-01

    Edge loading can negatively impact the biomechanics and long-term performance of hip replacements. Although edge loading has been widely investigated for hard-on-hard articulations, limited work has been conducted for hard-on-soft combinations. The aim of the present study was to investigate edge loading and its effect on the contact mechanics of a modular metal-on-polyethylene (MoP) total hip replacement (THR). A three-dimensional finite element model was developed based on a modular MoP bearing. Different cup inclination angles and head lateral microseparation were modelled and their effect on the contact mechanics of the modular MoP hip replacement were examined. The results showed that lateral microseparation caused loading of the head on the rim of the cup, which produced substantial increases in the maximum von Mises stress in the polyethylene liner and the maximum contact pressure on both the articulating surface and backside surface of the liner. Plastic deformation of the liner was observed under both standard conditions and microseparation conditions, however, the maximum equivalent plastic strain in the liner under microseparation conditions of 2000 µm was predicted to be approximately six times that under standard conditions. The study has indicated that correct positioning the components to avoid edge loading is likely to be important clinically even for hard-on-soft bearings for THR. PMID:25218504

  20. Electronic Repair Concepts for Long-Duration Spaceflight

    NASA Technical Reports Server (NTRS)

    Easton, John; Pettegrew, Richard D.; Struk, Peter M.

    2007-01-01

    Constraints on the mass and volume that can be allocated for electronics spares and repair equipment on long-duration space missions mean that NASA must look at repair strategies beyond the traditional approach, which has been to replace faulty subsystems in a modular form, termed Orbital Replacement Units or Line Replacement Units. Other possible strategies include component and board-level replacement, modular designs that allow reprogramming of less-critical systems to take the place of more critical failed systems, and a blended approach which uses elements of each of these approaches, along with a limited number of Line Replacement Units. This paper presents some of the constraints and considerations that affect the decision on how to approach electronics repair for long duration space missions, and discusses the benefits and limitations of each of the previously mentioned strategies.

  1. Alignment of angular velocity sensors for a vestibular prosthesis.

    PubMed

    Digiovanna, Jack; Carpaneto, Jacopo; Micera, Silvestro; Merfeld, Daniel M

    2012-02-13

    Vestibular prosthetics transmit angular velocities to the nervous system via electrical stimulation. Head-fixed gyroscopes measure angular motion, but the gyroscope coordinate system will not be coincident with the sensory organs the prosthetic replaces. Here we show a simple calibration method to align gyroscope measurements with the anatomical coordinate system. We benchmarked the method with simulated movements and obtain proof-of-concept with one healthy subject. The method was robust to misalignment, required little data, and minimal processing.

  2. Factors associated with tooth loss and prosthodontic status among Sudanese adults.

    PubMed

    Khalifa, Nadia; Allen, Patrick F; Abu-bakr, Neamat H; Abdel-Rahman, Manar E

    2012-01-01

    A study was conducted to determine the degree of tooth loss, factors influencing tooth loss, and the extent of prosthodontic rehabilitation in Sudanese adults (≥ 16 years old) attending outpatient clinics in Khartoum State. Pearson and multivariate analyses were used to examine the relationships between tooth loss and specific characteristics determined through interviews and clinical examinations. The mean number of missing teeth was 3.6 (SD, 4.9) and the prevalence of edentulism was 0.1%. The prevalence of tooth loss (missing at least one tooth) was 78%; 66.9% of tooth loss was due to caries, and 11.2% was attributable to other reasons. Prosthetic replacement of missing teeth was evident in 3%, whereas a need for prosthetic replacement was evident in 57%. Having < 20 teeth was associated with age, gender, and socioeconomic status; tooth loss due to caries was associated with age, tribe, frequency of tooth-brushing, and a low rate of dental consultation. Tooth loss due to other reasons was associated with age, tribe, education, periodontal pocketing, tobacco use, tooth wear, and prosthetic status. The results of the present study indicated that the major cause of tooth loss was dental caries, thus emphasizing the importance of a public prevention-based healthcare program. Replacement of missing teeth was uncommon in the study subjects, which may reflect lack of access to this type of oral healthcare.

  3. Bio-inspired mechanical design of a tendon-driven dexterous prosthetic hand.

    PubMed

    Controzzi, Marco; Cipriani, Christian; Jehenne, Beryl; Donati, Marco; Carrozza, Maria Chiara

    2010-01-01

    This paper presents the preliminary design of a new dexterous upper-limb prosthesis provided with a novel anthropomorphic hand, a compact wrist based on bevel gears and a modular forearm able to cover different levels of upper-limb amputations. The hand has 20 DoFs and 11 motors, with a dexterous three fingered subsystem composed by a fully actuated thumb, and an hybrid index and middle fingers to enable dexterous manipulation and enhance grasp performance.

  4. Non-Traumatic Anterior Dislocation of a Total Knee Replacement Associated with Neurovascular Injury

    PubMed Central

    Aderinto, Joseph; Gross, Allan E; Rittenhouse, Bryan

    2009-01-01

    Prosthetic total knee replacements rarely dislocate. When dislocation does occur, it is usually in a posterior direction in association with a posterior stabilised, cruciate-sacrificing prosthesis. Neurovascular injury is unusual. In this report, we describe a case of anterior dislocation of a cruciate-retaining total knee replacement in a 67-year-old woman. The dislocation occurred in the absence of overt trauma and resulted in severe neurovascular injury. PMID:19686618

  5. Fast Computation on the Modern Battlefield

    DTIC Science & Technology

    2015-04-01

    the performance of offloading systems in current and future scenarios. The modularity of this model allows system designers to replace model...goals were simplicity and modularity . We wanted the model to not necessarily answer every question for every scenario, but rather expose easy to...acquisitions for future systems. Again, because of the modularity of the model, it is possible for designers to substitute the most accurate value for

  6. Late leaflet fracture and embolization of a Duromedics mitral prosthesis.

    PubMed

    Sudo, K; Sasagawa, N; Ide, H; Nunokawa, M; Fujiki, T; Tonari, K

    2000-08-01

    A case of leaflet fracture and embolization of a mitral prosthetic valve is described. A 54-year-old man had received mitral valve replacement with an Edwards-Duromedics 29M prosthetic valve, at 10 years ago. Emergency mitral valve replacement was performed because the patient had severe congestive left heart failure with severe acute mitral regurgitation caused by a fracture in one of the mitral valve leaflets. The leaflet, which was fractured into 2 pieces, was removed from the right common iliac artery at 3 months after valve replacement. Visual inspection revealed that the leaflet contained a midline fracture. The fracture originated within a cavitary erosion pit near the major radius of the leaflet. The patient recovered from acute renal failure, requiring hemodialysis for 80 days, and is currently without complaints. We have used a Duromedics mitral valve in 11 patients, from April 1987 to April 1988. No subsequent valve failure has occurred. The diagnosis, treatment and cause of a mechanical valve fracture are discussed.

  7. An unusual cause of hemolysis in a patient with an aortic valved conduit replacement.

    PubMed

    Allman, Christine; Rajaratnam, Rohan; Kachwalla, Hashim; Hughes, Clifford F; Bannon, Paul; Leung, Dominic Y

    2003-02-01

    Hemolytic anemia is a well-known but uncommon complication in patients with prosthetic heart valves. It is most commonly a result of prosthetic valve dysfunction, periprosthetic valvular regurgitation, or both. We report a case of a 41-year-old man who had a previous aortic valve and root replacement for acute proximal aortic dissection, now presenting with hemolytic anemia. This was a result of flow obstruction at the distal anastomosis of the aortic conduit by the presence of multiple dissection flaps resulting in severe flow turbulence. Although the pathology was at the blind spot for transesophageal echocardiography, the dissection flaps, the flow turbulence, and the degree of obstruction were well-demonstrated by this technique after careful manipulation of the probe and a high index of suspicion.

  8. Injectible bodily prosthetics employing methacrylic copolymer gels

    DOEpatents

    Mallapragada, Surya K.; Anderson, Brian C.

    2007-02-27

    The present invention provides novel block copolymers as structural supplements for injectible bodily prosthetics employed in medical or cosmetic procedures. The invention also includes the use of such block copolymers as nucleus pulposus replacement materials for the treatment of degenerative disc disorders and spinal injuries. The copolymers are constructed by polymerization of a tertiary amine methacrylate with either a (poly(ethylene oxide)-b-poly(propylene oxide)-b-poly(ethylene oxide) polymer, such as the commercially available Pluronic.RTM. polymers, or a poly(ethylene glycol) methyl ether polymer.

  9. Mitral valve-sparing procedures and prosthetic heart valve failure: A case report

    PubMed Central

    Khan, Nasir A; Butany, Jagdish; Leong, Shaun W; Rao, Vivek; Cusimano, Robert J; Ross, Heather J

    2009-01-01

    Prosthetic heart valve dysfunction due to thrombus or pannus formation can be a life-threatening complication. The present report describes a 47-year-old woman who developed valvular cardiomyopathy after chorda-sparing mitral valve replacement, and subsequently underwent heart transplantation for progressive heart failure. The explanted mitral valve prosthesis showed significant thrombus and pannus leading to reduced leaflet mobility and valvular stenosis. The present report illustrates the role of the subvalvular apparatus and pannus in prosthesis dysfunction. PMID:19279993

  10. Comparative fixation methods of cervical disc arthroplasty versus conventional methods of anterior cervical arthrodesis: serration, teeth, keels, or screws?

    PubMed

    Cunningham, Bryan W; Hu, Nianbin; Zorn, Candace M; McAfee, Paul C

    2010-02-01

    Using a synthetic vertebral model, the authors quantified the comparative fixation strengths and failure mechanisms of 6 cervical disc arthroplasty devices versus 2 conventional methods of cervical arthrodesis, highlighting biomechanical advantages of prosthetic endplate fixation properties. Eight cervical implant configurations were evaluated in the current investigation: 1) PCM Low Profile; 2) PCM V-Teeth; 3) PCM Modular Flange; 4) PCM Fixed Flange; 5) Prestige LP; 6) Kineflex/C disc; 7) anterior cervical plate + interbody cage; and 8) tricortical iliac crest. All PCM treatments contained a serrated implant surface (0.4 mm). The PCM V-Teeth and Prestige contained 2 additional rows of teeth, which were 1 mm and 2 mm high, respectively. The PCM Modular and Fixed Flanged devices and anterior cervical plate were augmented with 4 vertebral screws. Eight pullout tests were performed for each of the 8 conditions by using a synthetic fixation model consisting of solid rigid polyurethane foam blocks. Biomechanical testing was conducted using an 858 Bionix test system configured with an unconstrained testing platform. Implants were positioned between testing blocks, using a compressive preload of -267 N. Tensile load-to-failure testing was performed at 2.5 mm/second, with quantification of peak load at failure (in Newtons), implant surface area (in square millimeters), and failure mechanisms. The mean loads at failure for the 8 implants were as follows: 257.4 +/- 28.54 for the PCM Low Profile; 308.8 +/- 15.31 for PCM V-Teeth; 496.36 +/- 40.01 for PCM Modular Flange; 528.03+/- 127.8 for PCM Fixed Flange; 306.4 +/- 31.3 for Prestige LP; 286.9 +/- 18.4 for Kineflex/C disc; 635.53 +/- 112.62 for anterior cervical plate + interbody cage; and 161.61 +/- 16.58 for tricortical iliac crest. The anterior plate exhibited the highest load at failure compared with all other treatments (p < 0.05). The PCM Modular and Fixed Flange PCM constructs in which screw fixation was used exhibited higher pullout loads than all other treatments except the anterior plate (p < 0.05). The PCM VTeeth and Prestige and Kineflex/C implants exhibited higher pullout loads than the PCM Low Profile and tricortical iliac crest (p < 0.05). Tricortical iliac crest exhibited the lowest pullout strength, which was different from all other treatments (p < 0.05). The surface area of endplate contact, measuring 300 mm(2) (PCM treatments), 275 mm(2) (Prestige LP), 250 mm(2) (Kineflex/C disc), 180 mm(2) (plate + cage), and 235 mm(2) (tricortical iliac crest), did not correlate with pullout strength (p > 0.05). The PCM, Prestige, and Kineflex constructs, which did not use screw fixation, all failed by direct pullout. Screw fixation devices, including anterior plates, led to test block fracture, and tricortical iliac crest failed by direct pullout. These results demonstrate a continuum of fixation strength based on prosthetic endplate design. Disc arthroplasty constructs implanted using vertebral body screw fixation exhibited the highest pullout strength. Prosthetic endplates containing toothed ridges (>or= 1 mm) or keels placed second in fixation strength, whereas endplates containing serrated edges exhibited the lowest fixation strength. All treatments exhibited greater fixation strength than conventional tricortical iliac crest. The current study offers insights into the benefits of various prosthetic endplate designs, which may potentially improve acute fixation following cervical disc arthroplasty.

  11. Reoperation for non-structural valvular dysfunction caused by pannus ingrowth in aortic valve prosthesis.

    PubMed

    Oh, Se Jin; Park, Samina; Kim, Jun Sung; Kim, Kyung-Hwan; Kim, Ki Bong; Ahn, Hyuk

    2013-07-01

    The authors' clinical experience is presented of non-structural valvular dysfunction of the prosthetic aortic valve caused by pannus ingrowth during the late postoperative period after previous heart valve surgery. Between January 1999 and April 2012, at the authors' institution, a total of 33 patients underwent reoperation for increased mean pressure gradient of the prosthetic aortic valve. All patients were shown to have pannus ingrowth. The mean interval from the previous operation was 16.7 +/- 4.3 years, and the most common etiology for the previous aortic valve replacement (AVR) was rheumatic valve disease. The mean effective orifice area index (EOAI) of the previous prosthetic valve was 0.97 +/- 0.11 cm2/m2, and the mean pressure gradient on the aortic prosthesis before reoperation was 39.1 +/- 10.7 mmHg. Two patients (6.1%) died in-hospital, and late death occurred in six patients (18.2%). At the first operation, 30 patients underwent mitral or tricuspid valve surgery as a concomitant procedure. Among these operations, mitral valve replacement (MVR) was combined in 24 of all 26 patients with rheumatic valve disease. Four patients underwent pannus removal only while the prosthetic aortic valve was left in place. The mean EOAI after reoperation was significantly increased to 1.16 +/- 0.16 cm2/m2 (p < 0.001), and the mean pressure gradient was decreased to 11.9 +/- 1.9 mmHg (p < 0.001). Non-structural valvular dysfunction caused by pannus ingrowth was shown in patients with a small EOAI of the prosthetic aortic valve and combined MVR for rheumatic disease. As reoperation for pannus overgrowth showed good clinical outcomes, an aggressive resection of pannus and repeated AVR should be considered in symptomatic patients to avoid the complications of other cardiac diseases.

  12. Cost analysis of debridement and retention for management of prosthetic joint infection.

    PubMed

    Peel, T N; Dowsey, M M; Buising, K L; Liew, D; Choong, P F M

    2013-02-01

    Prosthetic joint infection remains one of the most devastating complications of arthroplasty. Debridement and retention of the prosthesis is an attractive management option in carefully selected patients. Despite this, there are no data investigating the cost of this management modality for prosthetic joint infections. The aim of this case-control study was to calculate the cost associated with debridement and retention for management of prosthetic joint infection compared with primary joint replacement surgery without prosthetic joint infection. From 1 January 2008 to 30 June 2010, there were 21 prosthetic joint infections matched to 42 control patients. Controls were matched to cases according to the arthroplasty site, age and sex. Cases had a greater number of unplanned readmissions (100% vs. 7.1%; p <0.001), more additional surgery (3.3 vs. 0.07; p <0.001) and longer total bed days (31.6 vs. 7.9 days; p <0.001). In addition they had more inpatient, outpatient and emergency department visits (p <0.001, respectively). For patients with prosthetic joint infection the total cost, including index operation and costs of management of the prosthetic joint infection, was 3.1 times the cost of primary arthoplasty; the mean cost for cases was Australian dollars (AUD) $69,414 (±29,869) compared with $22,085 (±8147) (p <0.001). The demand for arthroplasty continues to grow and with that, the number of prosthetic joint infections will also increase, placing significant burden on the health system. Our study adds significantly to the growing body of evidence highlighting the substantial costs associated with prosthetic joint infection. © 2011 The Authors. Clinical Microbiology and Infection © 2011 European Society of Clinical Microbiology and Infectious Diseases.

  13. Prosthetic valve endocarditis due to Propionibacterium acnes.

    PubMed

    van Valen, Richard; de Lind van Wijngaarden, Robert A F; Verkaik, Nelianne J; Mokhles, Mostafa M; Bogers, Ad J J C

    2016-07-01

    To study the characteristics of patients with Propionibacterium acnes prosthetic valve endocarditis (PVE) who required surgery. A single-centre retrospective cohort study was conducted during a 7-year period. Patients with definite infective P. acnes endocarditis, according to the modified Duke criteria, were included. An extended culture protocol was applied. Information on medical health status, surgery, antibiotic treatment and mortality was obtained. Thirteen patients fulfilled the criteria for P. acnes endocarditis (0.53% of 2466 patients with valve replacement in a 7-year period). All patients were male and had a previous valve replacement. The health status of patients was poor at diagnosis of P. acnes PVE. Most patients (11 of 13, 85%) were admitted with signs of heart failure due to a significant paravalvular leak; 2 of 13 (15%) patients presented with septic emboli. Twelve patients needed redo surgery, whereas one could be treated with antibiotic therapy only. The time between the index surgery and presentation with P. acnes PVE varied between 5 and 135 months (median 26.5 months). Replacement and reconstruction of the dysfunctional valve and affected anatomical structures was mainly performed with a mechanical valve (n = 5, 42%) or a (bio-) Bentall prosthesis (n = 6, 50%). Antibiotic therapy consisted of penicillin with or without rifampicin for 6 weeks after surgery. The mortality in this series was low (n = 1, 8%) and no recurrent endocarditis was found during a median follow-up of 38 months. Propionibacterium acnes PVE is a rare complication after valve surgery. Redo surgery is often required. Treatment of the dysfunctional prosthetic aortic valve most often consists of root replacement, in combination with antibiotic therapy. © The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  14. Fungal prosthetic valve endocarditis with mycotic aneurysm: Case report.

    PubMed

    Brandão, Mariana; Almeida, Jorge; Ferraz, Rita; Santos, Lurdes; Pinho, Paulo; Casanova, Jorge

    2016-09-01

    Fungal prosthetic valve endocarditis is an extremely severe form of infective endocarditis, with poor prognosis and high mortality despite treatment. Candida albicans is the most common etiological agent for this rare but increasingly frequent condition. We present a case of fungal prosthetic valve endocarditis due to C. albicans following aortic and pulmonary valve replacement in a 38-year-old woman with a history of surgically corrected tetralogy of Fallot, prior infective endocarditis and acute renal failure with need for catheter-based hemodialysis. Antifungal therapy with liposomal amphotericin B was initiated prior to cardiac surgery, in which the bioprostheses were replaced by homografts, providing greater resistance to recurrent infection. During hospitalization, a mycotic aneurysm was diagnosed following an episode of acute arterial ischemia, requiring two vascular surgical interventions. Despite the complications, the patient's outcome was good and she was discharged on suppressive antifungal therapy with oral fluconazole for at least a year. The reported case illustrates multiple risk factors for fungal endocarditis, as well as complications and predictors of poor prognosis, demonstrating its complexity. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  15. Prosthetic Tricuspid Valve Thrombosis: Three Case Reports and Literature Review

    PubMed Central

    Yaminisharif, Ahmad; Alemzadeh-Ansari, Mohammad Javad; Ahmadi, Seyed Hossein

    2012-01-01

    A common complication of prosthetic heart valves is thrombosis. Although the incidence of prosthetic valve thrombosis (PVT) in the tricuspid position is high, there are not enough data on the management of it, in contrast to left-sided PVT. Here, we describe three cases of tricuspid PVT with three different management approaches: thrombolytic therapy; close observation with oral anticoagulants; and surgery. The first case was a woman who suffered from recurrent PVT, for which we successfully used Tenecteplase for second and third episodes. We employed Tenecteplase in this case for the first time in the therapy of tricuspid PVT. The second case had fixed leaflets in open position while being symptomless. At six months' follow-up, with the patient having taken oral anticoagulants, the motion of the leaflets was restricted and she was symptomfree. The last case was a woman who had a large thrombus in the right atrium immediately after mitral and tricuspid valvular replacement. The patient underwent re-replacement surgery and a new biological valve was implanted in the tricuspid position. Also, we review the literature on the pathology, signs and symptoms, diagnosis, and management of tricuspid PVT. PMID:23323074

  16. Material Science in Cervical Total Disc Replacement.

    PubMed

    Pham, Martin H; Mehta, Vivek A; Tuchman, Alexander; Hsieh, Patrick C

    2015-01-01

    Current cervical total disc replacement (TDR) designs incorporate a variety of different biomaterials including polyethylene, stainless steel, titanium (Ti), and cobalt-chrome (CoCr). These materials are most important in their utilization as bearing surfaces which allow for articular motion at the disc space. Long-term biological effects of implanted materials include wear debris, host inflammatory immune reactions, and osteolysis resulting in implant failure. We review here the most common materials used in cervical TDR prosthetic devices, examine their bearing surfaces, describe the construction of the seven current cervical TDR devices that are approved for use in the United States, and discuss known adverse biological effects associated with long-term implantation of these materials. It is important to appreciate and understand the variety of biomaterials available in the design and construction of these prosthetics and the considerations which guide their implementation.

  17. Material Science in Cervical Total Disc Replacement

    PubMed Central

    Pham, Martin H.; Mehta, Vivek A.; Tuchman, Alexander; Hsieh, Patrick C.

    2015-01-01

    Current cervical total disc replacement (TDR) designs incorporate a variety of different biomaterials including polyethylene, stainless steel, titanium (Ti), and cobalt-chrome (CoCr). These materials are most important in their utilization as bearing surfaces which allow for articular motion at the disc space. Long-term biological effects of implanted materials include wear debris, host inflammatory immune reactions, and osteolysis resulting in implant failure. We review here the most common materials used in cervical TDR prosthetic devices, examine their bearing surfaces, describe the construction of the seven current cervical TDR devices that are approved for use in the United States, and discuss known adverse biological effects associated with long-term implantation of these materials. It is important to appreciate and understand the variety of biomaterials available in the design and construction of these prosthetics and the considerations which guide their implementation. PMID:26523281

  18. Vent-induced prosthetic leaflet thrombosis treated by open-heart valve-in-valve implantation.

    PubMed

    Stamm, Christof; Pasic, Miralem; Buz, Semih; Hetzer, Roland

    2015-09-01

    A patient required emergency mitral valve replacement and extracorporeal membrane oxygenation (ECMO) support for acute biventricular failure. The left ventricular (LV) vent inserted via the left upper pulmonary vein induced thrombotic immobilization of a prosthetic valve leaflet, with significant intra-prosthesis regurgitation after ECMO explantation. Therefore, the left atrium was opened on the beating heart during conventional extracorporeal circulation, all prosthesis leaflets were excised and a 29-mm expandable Edwards Sapien prosthesis was inserted within the scaffold of the original prosthesis under direct vision. This case illustrates the benefits and potential problems of LV venting on ECMO support, and a rapid and safe way of replacing the prosthesis leaflets in a critical situation. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  19. [Tuberculous prosthetic knee joint infection: a case report and literature review].

    PubMed

    Lara-Oya, A; Liébana-Martos, M C; Rodríguez-Granger, J; Sampedro-Martínez, A; Aliaga-Martínez, L; Gutierrez-Fernández, J; Navarro-Marí, J M

    2016-08-01

    Prosthetic late infection occurs in the second month after surgery in the context of haematogenous spread from another source. Prosthetic mycobacterial infection is a rare complication whose clinical management is not standardized. Patient of 77 years with no personal history except for diabetes and a prosthetic replacement of right knee with osteoarthritis three years ago. Patient goes to hospital emergency box for 6 months pain in the right knee with mechanical inflammatory signs but no fever associated. After their return within 5 days and clinical worsening is reporting growth of Mycobacterium tuberculosis in knee aspirate and antitubercular treatment is established for 9 months. Nuclear magnetic resonance imaging studies also confirmed the diagnosis of tuberculosis spondylitis in the clinical context of the patients. After surgery, M. tuberculosis was again isolated from intraoperative samples and therefore the patient received another batch of treatment for 9 months. After a year of monitoring, the development was acceptable but few months later, the patient died for cardiovascular causes. In the literature review, 15 publications with a total of 17 clinical cases of prosthetic infection by M. tuberculosis were found from 1980 to 2014. Prosthetic tuberculous arthritis, although it is a rare presentation, it should be noted, especially in patients with predisposing conditions with a history of tuberculosis infection.

  20. Prosthetic Aortic Valve Fixation Study: 48 Replacement Valves Analyzed Using Digital Pressure Mapping.

    PubMed

    Lee, Candice Y; Wong, Joshua K; Ross, Ronald E; Liu, David C; Khabbaz, Kamal R; Martellaro, Angelo J; Gorea, Heather R; Sauer, Jude S; Knight, Peter A

    Prostheses attachment is critical in aortic valve replacement surgery, yet reliable prosthetic security remains a challenge. Accurate techniques to analyze prosthetic fixation pressures may enable the use of fewer sutures while reducing the risk of paravalvular leaks (PVL). Customized digital thin film pressure transducers were sutured between aortic annulus models and 21-mm bioprosthetic valves with 15 × 4-mm, 12 × 4-mm, or 9 × 6-mm-wide pledgeted mattress sutures. Simulating open and minimally invasive access, 4 surgeons, blinded to data acquisition, each secured 12 valves using manual knot-tying (hand-tied [HT] or knot-pusher [KP]) or automated titanium fasteners (TFs). Real-time pressure measurements and times were recorded. Two-dimensional (2D) and 3D pressure maps were generated for all valves. Pressures less than 80 mm Hg were considered at risk for PVL. Pressures under each knot (intrasuture) fell less than 80 mm Hg for 12 of 144 manual knots (5/144 HT, 7/144 KP) versus 0 of 288 TF (P < 0.001). Pressures outside adjacent sutures (extrasuture) were less than 80 mm Hg in 10 of 60 HT, zero of 60 KP, and zero of 120 TF sites for 15 × 4-mm valves; 17 of 48 HT, 25 of 48 KP, and 12 of 96 TF for 12 × 4-mm valves; and 15 of 36 HT, 17 of 36 KP, and 9 and 72 TF for 9 × 6-mm valves; P < 0.001 all manual versus TF. Annular areas with pressures less than 80 mm Hg ranged from 0% of the sewing-ring area (all open TF) to 31% (12 × 4 mm, KP). The average time per manual knot, 46 seconds (HT, 31 seconds; KP, 61 seconds), was greater than TF, 14 seconds (P < 0.005). Reduced operative times and PVL risk would fortify the advantages of surgical aortic valve replacement. This research encourages continued exploration of technical factors in optimizing prosthetic valve security.

  1. Outlet strut fracture and leaflet escape of Bjork-Shiley convexo-concave valve.

    PubMed

    Uchino, Gaku; Yoshida, Hideo; Sakoda, Naoya; Hattori, Shigeru; Kawabata, Takuya; Saiki, Munehiro; Fujita, Yasufumi; Yunoki, Keiji; Hisamochi, Kunikazu; Mine, Yoshinari

    2017-06-01

    Prosthetic valve fracture is a serious complication and may arise in patient post-valve replacement. We experienced an outlet strut fracture and leaflet escape of a Bjork-Shiley convexo-concave valve. We performed an emergency redo mitral valve replacement and successfully retrieved the fractured strut and escaped leaflet from superficial femoral artery and the abdominal aorta. The patient showed an uneventful postoperative recovery.

  2. The clinical significance of perivalvular pannus in prosthetic mitral valves: Can cardiac CT be helpful?

    PubMed

    Chang, Suyon; Suh, Young Joo; Han, Kyunghwa; Kim, Jin Young; Kim, Young Jin; Chang, Byung-Chul; Choi, Byoung Wook

    2017-12-15

    The clinical significance of pannus in the prosthetic mitral valve (MV) is not well documented. To investigate the clinical significance of pannus on cardiac computed tomography (CT) in patients with a prosthetic MV. A total of 130 patients with previous MV replacement who underwent cardiac CT were retrospectively included in this study. The presence of pannus, paravalvular leak (PVL) around the prosthetic MV and limitation of motion (LOM) of the MV were analyzed using CT. Between patients with MV pannus and those without pannus, CT, echocardiographic, and redo-surgery findings were compared. The diagnostic performance of CT and transesophageal echocardiography (TEE) for the detection of MV pannus was also compared, using surgical findings as a standard reference. MV pannus was observed on cardiac CT in 32.3% of the study population. Patients with MV pannus detected on CT more commonly had LOM (28.2% vs. 15.2%) and less frequently had PVL of the prosthetic MV (16.7% vs. 25%) than patients without MV pannus (P>0.05). Prosthetic valve obstruction (PVO) due prosthetic MV pannus requiring redo-surgery was present in only five patients (11.9%). Cardiac CT detected MV pannus with sensitivity of 65.2% and specificity of 80.9% and showed better diagnostic performance than TEE (P<0.05). Prosthetic MV pannus can frequently be seen on cardiac CT. However, its clinical significance should be assessed with careful consideration, because PVO due to MV pannus is relatively uncommon, and pannus can be seen in patients without any clinical problems. Copyright © 2017 Elsevier B.V. All rights reserved.

  3. Prosthetic tricuspid valve dysfunction assessed by three-dimensional transthoracic and transesophageal echocardiography.

    PubMed

    Yuasa, Toshinori; Takasaki, Kunitsugu; Mizukami, Naoko; Ueya, Nami; Kubota, Kayoko; Horizoe, Yoshihisa; Chaen, Hideto; Kuwahara, Eiji; Kisanuki, Akira; Hamasaki, Shuichi

    2013-09-01

    A 39-year-old male who had undergone tricuspid valve replacement for severe tricuspid regurgitation was admitted with palpitation and general edema. Two-dimensional (2D) echocardiography showed tricuspid prosthetic valve dysfunction. Additional three-dimensional (3D) transthoracic and transesophageal echocardiography (TEE) could clearly demonstrate the disabilities of the mechanical tricuspid valve. Particularly, 3D TEE demonstrated a mass located on the right ventricular side of the tricuspid prosthesis, which may have caused the stuck disk. This observation was confirmed by intra-operative findings.

  4. Prosthetic Mitral Valve Leaflet Escape

    PubMed Central

    Kim, Darae; Hun, Sin Sang; Cho, In-Jeong; Shim, Chi-Young; Ha, Jong-Won; Chung, Namsik; Ju, Hyun Chul; Sohn, Jang Won

    2013-01-01

    Leaflet escape of prosthetic valve is rare but potentially life threatening. It is essential to make timely diagnosis in order to avoid mortality. Transesophageal echocardiography and cinefluoroscopy is usually diagnostic and the location of the missing leaflet can be identified by computed tomography (CT). Emergent surgical correction is mandatory. We report a case of fractured escape of Edward-Duromedics mitral valve 27 years after the surgery. The patient presented with symptoms of acute decompensated heart failure and cardiogenic shock. She was instantly intubated and mechanically ventilated. After prompt evaluation including transthoracic echocardiography and CT, the escape of the leaflet was confirmed. The patient underwent emergent surgery for replacement of the damaged prosthetic valves immediately. Eleven days after the surgery, the dislodged leaflet in iliac artery was removed safely and the patient recovered well. PMID:23837121

  5. Acute failure of a St. Jude's prosthetic aortic valve: large pannus formation masked by a small thrombus.

    PubMed

    Hurwitz, Seth Eric; Waxman, Daniel; Hecht, Susan

    2009-09-01

    Pannus formation and valve thrombus can cause prosthetic valve failure. The authors report the case of a 50-year-old woman who presented to the emergency room with decompensated heart failure secondary to mechanical valve dysfunction. On two-dimensional and transesophageal echocardiography, the patient had severe aortic stenosis and regurgitation. A thrombus seen on the valve was felt to be the etiology of her prosthetic valve failure. She underwent emergent cardiac surgery for aortic valve replacement. Pathology revealed that although a small thrombus was present, extensive pannus was the underlying mechanism of valve dysfunction. Differentiation between pannus and thrombus may have important clinical implications, but this case illustrates that distinguishing between these entities by echocardiographic and clinical criteria may not be possible.

  6. A patterned microtexture to reduce friction and increase longevity of prosthetic hip joints

    PubMed Central

    Chyr, Anthony; Qiu, Mingfeng; Speltz, Jared; Jacobsen, Ronald L.; Sanders, Anthony P.; Raeymaekers, Bart

    2014-01-01

    More than 285,000 total hip replacement surgeries are performed in the US each year. Most prosthetic hip joints consist of a cobalt-chromium (CoCr) femoral head that articulates with a polyethylene acetabular component, lubricated with synovial fluid. The statistical survivorship of these metal-on-polyethylene prosthetic hip joints declines significantly after 10 to 15 years of use, primarily as a result of polyethylene wear and wear debris incited disease. The current engineering paradigm to increase the longevity of prosthetic hip joints is to improve the mechanical properties of the polyethylene component, and to manufacture ultra-smooth articulating surfaces. In contrast, we show that adding a patterned microtexture to the ultra-smooth CoCr femoral head reduces friction when articulating with the polyethylene acetabular liner. The microtexture increases the load-carrying capacity and the thickness of the joint lubricant film, which reduces contact between the articulating surfaces. As a result, friction and wear is reduced. We have used a lubrication model to design the geometry of the patterned microtexture, and experimentally demonstrate reduced friction for the microtextured compared to conventional smooth surrogate prosthetic hip joints. PMID:25013240

  7. Open heart surgery after renal transplantation.

    PubMed

    Yamamura, Mitsuhiro; Miyamoto, Yuji; Mitsuno, Masataka; Tanaka, Hiroe; Ryomoto, Masaaki; Fukui, Shinya; Tsujiya, Noriko; Kajiyama, Tetsuya; Nojima, Michio

    2014-09-01

    to evaluate the strategy for open heart surgery after renal transplantation performed in a single institution in Japan. we reviewed 6 open heart surgeries after renal transplantation in 5 patients, performed between January 1992 and December 2012. The patients were 3 men and 2 women with a mean age of 60 ± 11 years (range 46-68 years). They had old myocardial infarction and unstable angina, aortic and mitral stenosis, left arterial myxoma, aortic stenosis, and native valve endocarditis followed by prosthetic valve endocarditis. Operative procedures included coronary artery bypass grafting, double-valve replacement, resection of left arterial myxoma, 2 aortic valve replacements, and a double-valve replacement. Renal protection consisted of steroid cover (hydrocortisone 100-500 mg or methylprednisolone 1000 mg) and intravenous immunosuppressant infusion (cyclosporine 30-40 mg day(-1) or tacrolimus 1.0 mg day(-1)). 5 cases were uneventful and good renal graft function was maintained at discharge (serum creatinine 2.1 ± 0.5 mg dL(-1)). There was one operative death after emergency double-valve replacement for methicillin-resistant Staphylococcus aureus-associated prosthetic valve endocarditis. Although the endocarditis improved after valve replacement, the patient died of postoperative pneumonia on postoperative day 45. careful perioperative management can allow successful open heart surgery after renal transplantation. However, severe complications, especially methicillin-resistant Staphylococcus aureus infection, may cause renal graft loss. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  8. Profix cemented total knee replacement: a 5-year outcome review from Lagos, Nigeria.

    PubMed

    Ugbeye, M E; Odunubi, O O; Dim, E M; Ekundayo, O O

    2012-01-01

    Total knee replacement is a standard treatment for severe osteoarthritis of the knees. It is however, still a novel procedure in Nigeria. Literature on the procedure and outcome of management are sparse in Nigeria. This study aimed at describing Total Knee prosthetic Replacement as it is practiced in National Orthopaedic Hospital, Lagos. Data on patients treated with Total knee replacement between 2006 and 2010 were analyzed retrospectively. The standard anterior approach, with a medial parapatellar incision under pneumatic tourniquet was used in all cases. There were a total of 59 knees in 48 patients operated, with a female: male ratio of 5:1. Patients were in the sixth to ninth decades of life. There was a statistically significant relationship between duration of symptoms and severity of angular deformity. The average pre-operative Knee score (KS) was 27 and average function score (FS) was 43. Average duration of surgery was 126.38 minutes. Tourniquet removal after wound closure was associated with reduced intra-operative blood loss (p < 0.05). Post-operative complications included peri-prosthetic fracture (1.69%), post-operative anaemia (8.47%), superficial wound dehiscence (3.39%) and foot drop (3.39%). The mean post-operative KS and FS increased to 80 and 75 respectively. Total knee replacement, though a novel procedure in our institution is beneficial to patients with severe osteoarthritis. A long term outcome study is being planned.

  9. Modular bicompartmental knee arthroplasty : Indications, technique, prosthetic design, and results.

    PubMed

    Kanna, R

    2017-03-01

    The shifting demographics of patients with localized knee arthritis, including younger, more active patients, is a chief motivation for mounting interest in tissue preserving surgical substitutes for total knee arthroplasty (TKA). Unlinked, modular bi-compartmental knee arthroplasty (MBKA) is an emerging knee-resurfacing approach that provides a conservative alternative to TKA. Arthritis involving both patellofemoral and either medial or lateral tibiofemoral compartments, with no significant deformity or bone deficiency, preserved motion, and intact cruciate ligaments, can be effectively managed with MBKA. It is tailored to treat the pathologic areas of knees with bicompartmental arthritis with the benefit of improved function and tissue conservation. MBKA done in appropriate patients, using precise technique, with appropriate implants has shown to give good short and long term functional results. Long term results using modern MBKA implants are awaited and may further establish the durability and success of the procedure.

  10. Live 3D TEE demonstrates and guides the management of prosthetic mitral valve obstruction.

    PubMed

    Chahal, Mangeet; Pandya, Utpal; Adlakha, Satjit; Khouri, Samer J

    2011-08-01

    A 43-year-old woman, with a remote history of rheumatic mitral stenosis and a St. Jude prosthetic mitral valve replacement, presented with shortness of breath and palpitations, shortly after a long flight. On admission, atrial fibrillation with a rapid ventricular response was noted in the setting of a long history of noncompliance with her anticoagulation. Transesophageal echocardiography (TEE) demonstrated multiple laminated thrombi in the left atrial appendage. Live three-dimensional (3D) TEE confirmed this diagnosis and demonstrated an immobile posterior leaflet of the mitral prosthesis, which had direct implications in her management. She successfully underwent surgery for mitral valve replacement, left atrial appendage ligation, and a Maze procedure on the following day. The multiple thrombi within the atrial appendage were confirmed intraoperatively and pannus formation was determined to be the etiology of the leaflet immobility. © 2011, Wiley Periodicals, Inc.

  11. [Custom-made implant for complex facial reconstruction: A case of total replacement of temporo-mandibular joint, zygomatic arch and malar bone].

    PubMed

    Guillier, D; Moris, V; See, L-A; Girodon, M; Wajszczak, B-L; Zwetyenga, N

    2017-02-01

    Total prosthetic replacement of the temporo-mandibular joint (TMJ) has become a common procedure, but it is usually limited to the TMJ itself. We report about one case of complex prosthetic joint reconstruction extending to the neighbouring bony structures. A 57-year-old patient, operated several times for a cranio-facial fibrous dysplasia, presented with a recurring TMJ ankylosis and a complexe latero-facial bone loss on the right side. We performed a reconstruction procedure including the TMJ, the zygomatic arch and the malar bone by mean of custom made composite prosthesis (chrome-cobalt-molybdenum-titanium and polyethylene). Five years postoperatively, mouth opening, nutrition, pain and oral hygiene were significantly improved. Nowadays technical possibilities allow for complex facial alloplastic reconstructions with good medium term results. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  12. Modular container assembled from fiber reinforced thermoplastic sandwich panels

    DOEpatents

    Donnelly, Mathew William; Kasoff, William Andrew; Mcculloch, Patrick Carl; Williams, Frederick Truman

    2007-12-25

    An improved, load bearing, modular design container structure assembled from thermoformed FRTP sandwich panels in which is utilized the unique core-skin edge configuration of the present invention in consideration of improved load bearing performance, improved useful load volume, reduced manufacturing costs, structural weight savings, impact and damage tolerance and repair and replace issues.

  13. Prosthetic replacement of the infrahepatic inferior vena cava for leiomyosarcoma.

    PubMed

    Illuminati, Giulio; Calio', Francesco G; D'Urso, Antonio; Giacobbi, Daniela; Papaspyropoulos, Vassilios; Ceccanei, Gianluca

    2006-09-01

    Resection of the infrahepatic inferior vena cava associated with prosthetic graft replacement for caval leiomyosarcoma is an acceptable procedure to obtain prolonged and good-quality survival. A consecutive sample clinical study with a mean follow-up of 40 months. The surgical department of an academic tertiary center and an affiliated secondary care center. Eleven patients, with a mean age of 51 years, who have primary leiomyosarcoma of the infrahepatic inferior vena cava. All of the patients underwent radical resection of the tumor en bloc with the affected segment of the vena cava. Reconstruction consisted of 10 cavocaval polytetrafluoroethylene grafts and 1 cavobiliac graft. An associated right nephrectomy was performed in 2 cases. The left renal vein was reimplanted in the graft in 3 cases. Cumulative disease-specific survival, disease-free survival, and graft patency rates expressed by standard life-table analysis. No patients died in the postoperative period. The cumulative (SE) disease-specific survival rate was 53% (21%) at 5 years. The cumulative (SE) disease-free survival rate was 44% (19%) at 5 years. The cumulative (SE) graft patency rate was 67% (22%) at 5 years. Radical resection followed by prosthetic graft reconstruction is a valuable method for treating primary leiomyosarcoma of the infrahepatic inferior vena cava.

  14. Prosthetics in antiquity-An early medieval wearer of a foot prosthesis (6th century AD) from Hemmaberg/Austria.

    PubMed

    Binder, M; Eitler, J; Deutschmann, J; Ladstätter, S; Glaser, F; Fiedler, D

    2016-03-01

    Even though the earliest prosthetic devices date to the Ancient Egyptian Empire and iconographic sources attest their use in the Greco-Roman world, archaeological evidence for this practice prior to 2nd millennium AD is very scant. In 2013, a skeleton dating to the Frankish period (6th century AD) was excavated at the Hemmaberg in southern Austria. The middle adult male was missing his left foot from above the ankle. In its place, an iron-ring and wooden remains were recovered and interpreted as a prosthesis replacing the lost foot. This represents one of the oldest examples of prosthetic limb replacement associated with the skeleton of its wearer in Europe to date. Analysis through macroscopic assessment, radiography and CT-scanning revealed healing of the lesion even though it may have initially been complicated by osteomyelitis. Atrophy of the left lower leg further indicates immobilisation and suggests survival of several years. Osteoarthritis in the knees and shoulder girdle provides tentative indications towards the functionality of the prosthesis, perhaps aided through a crutch. These findings are set against the historic, archaeological, bioarchaeological and social context of the man in order to discuss whether removal of the foot was due to medical, punitive or traumatic causes. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. Transverse joint configuration development and testing for a modular bridge deck replacement system.

    DOT National Transportation Integrated Search

    2011-03-01

    According to the 2009 Report Card for Americas Infrastructure, one in four of the nations bridges are listed as : structurally deficient of functionally obsolete, establishing a dire need for new and innovative repair and replacement : techniqu...

  16. CardiaMed mechanical valve: mid-term results of a multicenter clinical trial.

    PubMed

    Nazarov, Vladimir M; Zheleznev, Sergey I; Bogachev-Prokophiev, Alexandr V; Afanasyev, Alexandr V; Nemchenko, Eugene V; Jeltovskiy, Yuri V; Lavinyukov, Sergey O

    2014-01-01

    Prosthesis choice is a major concern in valvular surgery. A multicenter clinical trial was performed to assess the efficacy and safety of the CardiaMed prosthetic heart valve. The study enrolled 420 patients who underwent mitral (209) or aortic (211) valve replacement from 2003 to 2004 at 7 institutions in Russia, and who were followed up from 2006 to 2011. The mean age was 52.2 ± 10.2 years (range, 12-78 years), 47.4% were female, and 99.05% completed the study. The maximum observation term was 7.5 years (2188.5 patient-years); 1081.6 patient-years for aortic and 1106.9 patient-years for mitral valve replacement. The overall 7-year survival rate was 85.1%  ± 3.7%; 86.1%  ± 4.8% and 84.4%  ± 5.4% for aortic and mitral valve replacement, respectively. The 7-year freedom from valve-related death was 93.9%  ± 3.7% and 94.5%  ± 3.2% for aortic and mitral valve replacement, respectively. When early mortality (<30 days) was excluded, these rates were 94.8%  ± 3.1% and 93.8%  ± 3.82%, respectively. Linearized valve-dependent complication rates were determined for structural valve failure (0%/patient-year overall), thrombosis (0.63%/patient-year, all for mitral valve replacement), thromboembolic complications including transient neurologic deficits (0.13%/patient-year overall, 0.5%/patient-year for aortic valve replacement, 0.8%/patient-year for mitral valve replacement), hemorrhagic bleeding (0.64%/patient-year overall, 0.55%/patient-year for aortic valve replacement, 0.09%/patient-year for mitral valve replacement), prosthetic endocarditis (0.28%/patient-year overall, 0.28%/patient-year for aortic valve replacement, 0%/patient-year for mitral valve replacement), and hemolysis (0%/patient-year overall). The CardiaMed mechanical heart valve prostheses meets world standards of safety and efficacy.

  17. Prosthesis Material

    NASA Technical Reports Server (NTRS)

    1995-01-01

    FAB/CAM, a subsidiary of the Harshberger Prosthetic and Orthotic Center, Inc., approached Marshall for help in replacing the heavy, fragile plaster they used to produce master molds for prosthetics. Concurrently, Marshall and Martin Marietta were creating a commercial derivative of the foam insulation used to protect the Space Shuttle External Tank from excessive heat. FAB/CAM found the foam blanks to be lighter, cheaper and easier to manufacture than plaster, resulting in lower costs to the consumer. Martin Marietta markets the foam system, MARCORE, for the prosthesis market. The system also has commercial potential in high temperature insulation and structural applications.

  18. [Incidence of hip and knee prosthetic infections in a specialized center of Mexico City].

    PubMed

    Franco-Cendejas, Rafael; Contreras-Córdova, Erika Lizbeth; Mondragón-Eguiluz, Jaime Arturo; Vanegas-Rodríguez, Edgar Samuel; Ilizaliturri-Sánchez, Víctor Manuel; Galindo-Fraga, Arturo

    Hip and knee prosthetic replacements have proven to be the most appropriate treatment in the joints that do not benefit from medical or arthroscopic interventions; however, infections are the most feared complication. It is recommended that the incidence of infection should not exceed 2%. This was an observational, prospective, longitudinal and observational study conducted in patients fitted with a prosthetic joint from August 2011 to July 2012. Patients were followed up pre and post-surgery for one year to identify a prosthetic infection, diagnosed using international parameters. We calculated the incidence of prosthetic infection, as well as the incidence density. A total of 339 patients (179 hip and 160 knee) were included. Variations in the time of pre-operative antibiotics' administration were observed. Six prosthetic infections were identified with an incidence rate of 1.79/339 arthroplasties, 2.2/179 hip procedures, and 1.25/160 knee arthroplasties. An incidence density of 0.02/year for hip arthroplasties and 0.11/year for knee procedures was identified. There were 4 infections of hip and 2 of knee. Five infections were acute and one chronic. The isolated microorganisms were E. faecalis, S. epidermidis (2), S. mitis, S. aureus and P. stomatis. The incidence of prosthetic joint infection in the first year of follow-up at our centre is within the recommended parameters. Surgical techniques and organizational practices influence the results. Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  19. 32 CFR 728.12 - Extent of care.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL MEDICAL AND DENTAL CARE FOR..., prosthetic dental appliances, hearing aids, spectacles, orthopedic footwear, and other orthopedic appliances... through negligence, repair or replacement is authorized at Government expense. (iv) Routine dental care...

  20. Rapid pannus formation after few months of obstructing aortic mechanical prosthesis.

    PubMed

    Al-Alao, Bassel; Simoniuk, Urszula; Heron, Brian; Parissis, Haralabos

    2015-11-01

    We report a rare case of a prosthetic aortic valve obstruction due to pannus formation only 3 months following aortic and mitral valve replacement. Fragments of asymmetrical pannus formation affected one of the leaflets of the bi-leaflet mechanical valve; the leaflet appeared immobile due to pannus ingrowth into the mechanical skeleton resulting in encroachment of the leaflet, which in turn became immobile. The patient successfully underwent emergency redo-aortic valve replacement.

  1. Treatment and outcomes of aortic endograft infection.

    PubMed

    Smeds, Matthew R; Duncan, Audra A; Harlander-Locke, Michael P; Lawrence, Peter F; Lyden, Sean; Fatima, Javariah; Eskandari, Mark K

    2016-02-01

    This study examined the medical and surgical management and outcomes of patients with aortic endograft infection after abdominal endovascular aortic repair (EVAR) or thoracic endovascular aortic repair (TEVAR). Patients diagnosed with infected aortic endografts after EVAR/TEVAR between January 1, 2004, and January 1, 2014, were reviewed using a standardized, multi-institutional database. Demographic, comorbidity, medical management, surgical, and outcomes data were included. An aortic endograft infection was diagnosed in 206 patients (EVAR, n = 180; TEVAR, n = 26) at a mean 22 months after implant. Clinical findings at presentation included pain (66%), fever/chills (66%), and aortic fistula (27%). Ultimately, 197 patients underwent surgical management after a mean of 153 days. In situ aortic replacement was performed in 186 patients (90%) using cryopreserved allograft in 54, neoaortoiliac system in 21, prosthetic in 111 (83% soaked in antibiotic), and 11 patients underwent axillary-(bi)femoral bypass. Graft cultures were primarily polymicrobial (35%) and gram-positive (22%). Mean hospital length of stay was 23 days, with perioperative 30-day morbidity of 35% and mortality of 11%. Of the nine patients managed only medically, four of five TEVAR patients died after mean of 56 days and two of four EVAR patients died; both deaths were graft-related (mean follow-up, 4 months). Nineteen replacement grafts were explanted after a mean of 540 days and were most commonly associated with prosthetic graft material not soaked in antibiotic and extra-anatomic bypass. Mean follow-up was 21 months, with life-table survival of 70%, 65%, 61%, 56%, and 51% at 1, 2, 3, 4, and 5 years, respectively. Aortic endograft infection can be eradicated by excision and in situ or extra-anatomic replacement but is often associated with early postoperative morbidity and mortality and occasionally with a need for late removal for reinfection. Prosthetic graft replacement after explanation is associated with higher reinfection and graft-related complications and decreased survival compared with autogenous reconstruction. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  2. MANAGEMENT OF FAILED MITRAL VALVE REPLACEMENT. THE DURBAN EXPERIENCE.

    PubMed

    Kistan, D; Booysen, M; Alexander, G; Madiba, T E

    2017-06-01

    Mitral valve replacement is the procedure of choice in patients with severe mitral valve disease. However, these patients are surviving longer and are thus at an increased risk of prosthesis failure or valve-related complications. Study setting: Inkosi Albert Luthuli Central Hospital, a tertiary referral Hospital in Durban. Study population: All patients undergoing redo mechanical mitral valve replacement surgery between January 2005 and December 2014. Study design: Retrospective analysis of patients undergoing redo mitral valve replacement. Patients were identified from theatre record books, their files were electronically accessed and pertinent information extracted onto a data capture sheet. Information documented included demographics, duration to failure, INR, Albumin, HIV status, clinical findings and outcome. The data was stored on an Excel datasheet. Fifty-eight patients were documented (mean age 32 ± 15.81 years; M:F 1:3). Ten patients (17%) were HIV positive (median CD4 count 478). Mean duration between first surgery and redo was 8.8 years. Thirty-five patients (60%) had no co-morbidities. Presenting features at redo surgery were congestive cardiac failure (27), chest pain (11) and palpitations (17). Mean preoperative Ejection Fraction was 51.65 %. Twenty-nine patients (55%) had emergency redo surgery. Twenty-two patients (75%) had acute prosthetic valve thrombosis. Thirty-two patients had tricuspid regurgitation. Original pathology was documented in 23 patients (40%) as Rheumatic valve disease. Prosthetic valve thrombosis was documented in 31 patients (54%). The most commonly used valve was the On-X. Mean presenting INR was 1.96 + 1.2 and mean presenting serum albumin was 36.7 + 7.8 g/l. Forty-one patients (71%) were found to be compliant to Warfarin therapy prior to redo surgery. Mean ICU stay was 6 +9 days. Two patients died postoperatively. Mean followup was 32 + 26.6 months. Twelve patients (20.7%) developed postoperative complications. Patients were younger than world literature suggests. Rheumatic heart disease was the common underlying pathology. Prosthetic valve thrombosis was common. More than half had emergency surgery. Mortality rate was negligible.

  3. Corrosion on the acetabular liner taper from retrieved modular metal-on-metal total hip replacements.

    PubMed

    Gascoyne, Trevor C; Dyrkacz, Richard M; Turgeon, Thomas R; Burnell, Colin D; Wyss, Urs P; Brandt, Jan-M

    2014-10-01

    Eight retrieved metal-on-metal total hip replacements displayed corrosion damage along the cobalt-chromium alloy liner taper junction with the Ti alloy acetabular shell. Scanning electron microscopy indicated the primary mechanism of corrosion to be grain boundary and associated crevice corrosion, which was likely accelerated through mechanical micromotion and galvanic corrosion resulting from dissimilar alloys. Coordinate measurements revealed up to 4.3mm(3) of the cobalt-chromium alloy taper surface was removed due to corrosion, which is comparable to previous reports of corrosion damage on head-neck tapers. The acetabular liner-shell taper appears to be an additional source of metal corrosion products in modular total hip replacements. Patients with these prostheses should be closely monitored for signs of adverse reaction towards corrosion by-products. Copyright © 2014 Elsevier Inc. All rights reserved.

  4. Modularity Induced Gating and Delays in Neuronal Networks

    PubMed Central

    Shein-Idelson, Mark; Cohen, Gilad; Hanein, Yael

    2016-01-01

    Neural networks, despite their highly interconnected nature, exhibit distinctly localized and gated activation. Modularity, a distinctive feature of neural networks, has been recently proposed as an important parameter determining the manner by which networks support activity propagation. Here we use an engineered biological model, consisting of engineered rat cortical neurons, to study the role of modular topology in gating the activity between cell populations. We show that pairs of connected modules support conditional propagation (transmitting stronger bursts with higher probability), long delays and propagation asymmetry. Moreover, large modular networks manifest diverse patterns of both local and global activation. Blocking inhibition decreased activity diversity and replaced it with highly consistent transmission patterns. By independently controlling modularity and disinhibition, experimentally and in a model, we pose that modular topology is an important parameter affecting activation localization and is instrumental for population-level gating by disinhibition. PMID:27104350

  5. Lopez-Alegria performs EMCS-EC replace activity in Destiny laboratory module

    NASA Image and Video Library

    2006-12-29

    ISS014-E-10647 (29 Dec. 2006) --- Astronaut Michael E. Lopez-Alegria, Expedition 14 commander and NASA space station science officer, performs the European Modular Cultivation System (EMSC) -- Experiment Container (EC) replacement in the Destiny laboratory of the International Space Station.

  6. Lopez-Alegria performs EMCS-EC replace activity in Destiny laboratory module

    NASA Image and Video Library

    2006-12-29

    ISS014-E-10639 (29 Dec. 2006) --- Astronaut Michael E. Lopez-Alegria, Expedition 14 commander and NASA space station science officer, performs the European Modular Cultivation System (EMSC) -- Experiment Container (EC) replacement in the Destiny laboratory of the International Space Station.

  7. Development of a ceramic surface replacement for the hip. An experimental Sialon model.

    PubMed

    Clarke, I C; Phillips, W; McKellop, H; Coster, I R; Hedley, A; Amstutz, H C

    1979-01-01

    The objective of this study was to investigate the design and fixation advantages of Sialon ceramic surface replacements implanted without acrylic bone cement. The biocompatibility and friction and wear properties of Sialon ceramic were compared with more conventional prosthetic materials such as stainless steel and alumina. A functional load-bearing canine hip surface replacement model was established to test Sialon femoral cups designed for fixation by bone ingrowth. The results of the polyethylene wear tests on highly polished ceramic and stainless steel counterfaces were essentially similar. These laboratory data indicated that the in-vivo polyethylene wear performance on metal or ceramic prosthetic surfaces could be expected to be indistinguishable, i.e. the ceramic/polyethylene combination would not offer any improved wear resistance in-vivo. It was found possible to get bone ingrowth into the macrokeying areas of the ceramic femoral cups but not into the microporous surfaces due to the presence of a fibrous membrane lining their internal surfaces. The biocompatability specimens also appeared to be invested with a fibrous membrane. Further studies are under way to determine the relationship between reaming procedures, micro motion at the interfaces and Sialon biocompatibility.

  8. Stress distribution of various designs of prostheses on short implants or standard implants in posterior maxilla: a three dimensional finite element analysis

    PubMed Central

    JOMJUNYONG, K.; RUNGSIYAKULL, P.; RUNGSIYAKULL, C.; AUNMEUNGTONG, W.; CHANTARAMUNGKORN, M.; KHONGKHUNTHIAN, P.

    2017-01-01

    SUMMARY Introduction. Although many previous studies have reported on the high success rate of short dental implants, prosthetic design still plays an important role in the long-term implant treatment results. This study aims to evaluate stress distribution characteristics involved with various prosthetic designs on standard implants or short implants in the posterior maxilla. Materials and methods. Six finite element models were simulated representing the missing first and second maxillary molars. A standard implant (PW+ implant: 5.0×10 mm) and a short implant (PW+ implant: 5.0×6.0 mm) were applied under the various prosthetic conditions. The peri-implant maximum bone stress (V on mises stress) was evaluated when 200 N 30° oblique load was applied. A type III bone was approximated and complete osseous integration was assumed. Results. Maximum Von mises stress was numerically located at the cortical bone around the implant neck in all models. In every standard implant model shows better stress distribution. Stress values and concentration area decreased in the cortical and cancellous bone when implants were splinted in both the standard and short implant models. With regard to the non-replacing second molar models found that the area of stress at the cortical bone around the first molar implant to be more intensive. Moreover, in the non-replacing second molar models, the stress also spread to the second pre-molar in both the standard and short implant models. Conclusions. The length of the implant and prosthetics designs both affect the stress value and distribution of stress to the cortical and cancellous bones around the implant. PMID:29682254

  9. Long-term prosthetic aftercare of direct vs. indirect attachment incorporation techniques to mandibular implant-supported overdenture.

    PubMed

    Nissan, Joseph; Oz-Ari, Beni; Gross, Ora; Ghelfan, Oded; Chaushu, Gavriel

    2011-06-01

    The aim of this long-term study was to compare the need for prosthetic aftercare of direct vs. indirect attachment incorporation techniques to mandibular implant-supported overdenture. Forty-five consecutive patients were included (130 implants were placed). Treatment was randomly allocated, resulting in 22 patients (group A) to be treated with direct ball attachment incorporation and 23 patients (group B) to be treated with indirect ball attachment incorporation. All patients were treated by experienced oral-maxillofacial surgeons/periodontists and experienced prosthodontists/residents. From the first day that the patients visited the clinic up to 20 years after the first treatment session, all surgical or prosthetic therapeutic interventions were recorded. The recorded data for the present study included the number of aftercare visits and dental treatment received (pressure sores relieve, liner changes due to loss of retention and attachment replacement due to wear). The mean follow-up was 93±57 months. No implants were lost. Statistical analysis revealed a statistically significantly (P<0.001) greater need for prosthetic interventions in group B vs. group A. The mean number of visits dedicated to - pressure sores relieve (7.04±1.4 vs. 3.63±0.84); liner exchange due to loss of retention (3.6±1.3 vs. 1.09±1.06) was significantly higher in group B. Attachment replacement due to wear occurred only in group B (11/23 - 47.8%). The direct technique for attachment incorporation in mandibular implant-supported overdentures using ball attachments is superior to the indirect technique from the aftercare perspective during a long-term evaluation period. © 2010 John Wiley & Sons A/S.

  10. Bioactive Coatings for Orthopaedic Implants—Recent Trends in Development of Implant Coatings

    PubMed Central

    Zhang, Bill G. X.; Myers, Damian E.; Wallace, Gordon G.; Brandt, Milan; Choong, Peter F. M.

    2014-01-01

    Joint replacement is a major orthopaedic procedure used to treat joint osteoarthritis. Aseptic loosening and infection are the two most significant causes of prosthetic implant failure. The ideal implant should be able to promote osteointegration, deter bacterial adhesion and minimize prosthetic infection. Recent developments in material science and cell biology have seen the development of new orthopaedic implant coatings to address these issues. Coatings consisting of bioceramics, extracellular matrix proteins, biological peptides or growth factors impart bioactivity and biocompatibility to the metallic surface of conventional orthopaedic prosthesis that promote bone ingrowth and differentiation of stem cells into osteoblasts leading to enhanced osteointegration of the implant. Furthermore, coatings such as silver, nitric oxide, antibiotics, antiseptics and antimicrobial peptides with anti-microbial properties have also been developed, which show promise in reducing bacterial adhesion and prosthetic infections. This review summarizes some of the recent developments in coatings for orthopaedic implants. PMID:25000263

  11. Corynebacterium endocarditis species-specific risk factors and outcomes

    PubMed Central

    Belmares, Jaime; Detterline, Stephanie; Pak, Janet B; Parada, Jorge P

    2007-01-01

    Background Corynebacterium species are recognized as uncommon agents of endocarditis, but little is known regarding species-specific risk factors and outcomes in Corynebacterium endocarditis. Methods Case report and Medline search of English language journals for cases of Corynebacterium endocarditis. Inclusion criteria required that cases be identified as endocarditis, having persistent Corynebacterium bacteremia, murmurs described by the authors as identifying the affected valve, or vegetations found by echocardiography or in surgical or autopsy specimens. Cases also required patient-specific information on risk factors and outcomes (age, gender, prior prosthetic valve, other prior nosocomial risk factors (infected valve, involvement of native versus prosthetic valve, need for valve replacement, and death) to be included in the analysis. Publications of Corynebacterium endocarditis which reported aggregate data were excluded. Univariate analysis was conducted with chi-square and t-tests, as appropriate, with p = 0.05 considered significant. Results 129 cases of Corynebacterium endocarditis involving nine species met inclusion criteria. Corynebacterium endocarditis typically infects the left heart of adult males and nearly one third of patients have underlying valvular disease. One quarter of patients required valve replacement and one half of patients died. Toxigenic C. diphtheriae is associated with pediatric infections (p < 0.001). Only C. amycolatum has a predilection for women (p = 0.024), while C. pseudodiphtheriticum infections are most frequent in men (p = 0.023). C. striatum, C. jeikeium and C. hemolyticum are associated with nosocomial risk factors (p < 0.001, 0.028, and 0.024, respectively). No species was found to have a predilection for any particular heart valve. C. pseudodiphtheriticum is associated with a previous prosthetic valve replacement (p = 0.004). C. jeikeium infections are more likely to require valve replacement (p = 0.026). Infections involving toxigenic C. diphtheriae and C. pseudodiphtheriticum are associated with decreased survival (p = 0.001 and 0.032, respectively). Conclusion We report the first analysis of species-specific risk factors and outcomes in Corynebacterium endocarditis. In addition to species-specific associations with age, gender, prior valvular diseases, and other nosocomial risk factors, we found differences in rates of need for valve replacement and death. This review highlights the seriousness of these infections, as up to 28% of patients required valve replacement and 43.5% died. PMID:17284316

  12. Surgery Versus Transcatheter Interventions for Significant Paravalvular Prosthetic Leaks.

    PubMed

    Millán, Xavier; Bouhout, Ismail; Nozza, Anna; Samman, Karla; Stevens, Louis-Mathieu; Lamarche, Yoan; Serra, Antonio; Asgar, Anita W; El-Hamamsy, Ismail; Cartier, Raymond; Pellerin, Michel; Noble, Stephane; Demers, Phillipe; Ibrahim, Reda; Jolicœur, E Marc; Bouchard, Denis

    2017-10-09

    This study sought to assess the relative merit of surgical correction (SC) versus transcatheter reduction on long-term outcomes in patients with significant paravalvular leak (PVL) refractory to medical therapy. PVL is the most frequent dysfunction following prosthetic valve replacement. Although repeat surgery is the gold standard, transcatheter reduction (TR) of PVL has been associated with reduced mortality. From 1994 to 2014, 231 patients underwent SC (n = 151) or TR (n = 80) PVL correction. Propensity matching and Cox proportional hazards regression models were used to assess the effect of either intervention on long-term rates of all-cause death or hospitalization for heart failure. Survival after TR and SC were further compared with the survival in a matched general population and to matched patients undergoing their first surgical valve replacement. Over a median follow-up of 3.5 years, SC was associated with an important reduction in all-cause death or hospitalization for heart failure compared with TR (hazard ratio: 0.28; 95% confidence interval: 0.18 to 0.44; p < 0.001). There was a trend towards reduced all-cause death following SC versus TR (hazard ratio: 0.61; 95% confidence interval: 0.37 to 1.02; p = 0.06). Neither intervention normalized survival when compared with a general population or patients undergoing their first surgical valve replacement. In patients with significant prosthetic PVL, surgery is associated with better long-term outcomes compared with transcatheter intervention, but results in important perioperative mortality and morbidity. Future studies are needed in the face of increasing implementation of transcatheter PVL interventions across the world. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  13. Legionella micdadei prosthetic valve endocarditis complicated by brain abscess: case report and review of the literature.

    PubMed

    Fukuta, Yuriko; Yildiz-Aktas, Isil Z; William Pasculle, A; Veldkamp, Peter J

    2012-06-01

    Legionella endocarditis is extremely uncommon, and embolic phenomena have never been reported. We report the first case of Legionella micdadei prosthetic valve endocarditis complicated by brain abscess. A 57-y-old immunocompromised woman with a history of mitral valve replacement developed confusion and left-sided weakness. Brain magnetic resonance imaging showed a 3-cm peripheral-enhancing mass. Transoesophageal echocardiography suggested a perivalvular abscess. Blood cultures and valve cultures were negative. She was diagnosed with 16S rRNA polymerase chain reaction and silver stain, and was discharged with levofloxacin after a redo mitral valve replacement. Twelve cases of Legionella endocarditis were reviewed. Only one case had a native valve, and her endocarditis occurred after pneumonia. All cases were cured. The duration of antibiotic therapy was variable. Legionella species should be considered in the differential diagnosis of culture-negative endocarditis in both immunocompetent and immunocompromised patients. Molecular techniques and silver impregnation stains are useful, especially when cultures using buffered charcoal-yeast extract agar are negative.

  14. Unusual cause of central aortic prosthetic regurgitation during transcatheter replacement.

    PubMed

    López-Mínguez, José Ramón; Millán-Núñez, Victoria; González-Fernández, Reyes; Nogales-Asensio, Juan Manuel; Fuentes-Cañamero, María Eugenia; Merchán-Herrera, Antonio

    2016-04-01

    Transcatheter aortic valve replacement (TAVR) is an increasingly common procedure for the treatment of aortic stenosis in elderly patients with comorbidities that prevent the use of standard surgery. It has been shown that implantation without aortic regurgitation is related to lower mortality. Mild paravalvular regurgitation is inevitable in some cases due to calcification of the aortic annulus and its usually somewhat elliptical shape. Central regurgitation is less common, but has been associated with valve overdilatation in cases in which reduction of paravalvular regurgitation was attempted after the initial inflation. However, there are no reported cases of central prosthetic aortic regurgitation due to acute LV dysfunction. We report a case in which central aortic regurgitation occurred due to transient ventricular dysfunction secondary to occlusion of the right coronary artery by an embolus. The regurgitation disappeared after thrombus aspiration and normal ventricular function was immediately recovered. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  15. Nuclear medicine and the failed joint replacement: Past, present, and future

    PubMed Central

    Palestro, Christopher J

    2014-01-01

    Soon after the introduction of the modern prosthetic joint, it was recognized that radionuclide imaging provides useful information about these devices. The bone scan was used extensively to identify causes of prosthetic joint failure. It became apparent, however, that although sensitive, regardless of how the images were analyzed or how it was performed, the test was not specific and could not distinguish among the causes of prosthetic failure. Advances in anatomic imaging, notably cross sectional modalities, have facilitated the diagnosis of many, if not most, causes of prosthetic failure, with the important exception of infection. This has led to a shift in the diagnostic paradigm, in which nuclear medicine investigations increasingly have focused on diagnosing infection. The recognition that bone scintigraphy could not reliably diagnose infection led to the development of combined studies, first bone/gallium and subsequently leukocyte/bone and leukocyte/marrow imaging. Labeled leukocyte imaging, combined with bone marrow imaging is the most accurate (about 90%) imaging test for diagnosing joint arthroplasty infection. Its value not withstanding, there are significant disadvantages to this test. In-vivo techniques for labeling leukocytes, using antigranulocyte antibodies have been explored, but have their own limitations and the results have been inconsistent. Fluorodeoxyglucose (FDG)-positron emission tomography (FDG-PET) has been extensively investigated for more than a decade but its role in diagnosing the infected prosthesis has yet to be established. Antimicrobial peptides bind to bacterial cell membranes and are infection specific. Data suggest that these agents may be useful for diagnosing prosthetic joint infection, but large scale studies have yet to be undertaken. Although for many years nuclear medicine has focused on diagnosing prosthetic joint infection, the advent of hybrid imaging with single-photon emission computed tomography(SPECT)/electronic computer X-ray tomography technique (CT) and the availability of fluorine-18 fluoride PET suggests that the diagnostic paradigm may be shifting again. By providing the anatomic information lacking in conventional radionuclide studies, there is renewed interest in bone scintigraphy, performed as a SPECT/CT procedure, for detecting joint instability, mechanical loosening and component malpositioning. Fluoride-PET may provide new insights into periprosthetic bone metabolism. The objective of this manuscript is to provide a comprehensive review of the evolution of nuclear medicine imaging of joint replacements. PMID:25071885

  16. Prosthetic valve sparing aortic root replacement: an improved technique.

    PubMed

    Leacche, Marzia; Balaguer, Jorge M; Umakanthan, Ramanan; Byrne, John G

    2008-10-01

    We describe a modified surgical technique to treat patients with a previous history of isolated aortic valve replacement who now require aortic root replacement for an aneurysmal or dissected aorta. This technique consists of replacing the aortic root with a Dacron conduit, leaving intact the previously implanted prosthesis, and re-implanting the coronary arteries in the Dacron graft. Our technique differs from other techniques in that we do not leave behind any aortic tissue remnant and also in that we use a felt strip to obliterate any gap between the old sewing ring and the newly implanted graft. In our opinion, this promotes better hemostasis. We demonstrate that this technique is safe, feasible, and results in acceptable outcomes.

  17. The role of virtual articulator in prosthetic and restorative dentistry.

    PubMed

    Koralakunte, Pavankumar Ravi; Aljanakh, Mohammad

    2014-07-01

    Virtual reality is a computer based technology linked with the future of dentistry and dental practice. The virtual articulator is one such application in prosthetic and restorative dentistry based on virtual reality that will significantly reduce the limitations of the mechanical articulator, and by simulation of real patient data, allow analyses with regard to static and dynamic occlusion as well as to jaw relation. It is the purpose of this article to present the concepts and strategies for a future replacement of the mechanical articulator by a virtual one. Also, a brief note on virtual reality haptic system has been highlighted along with newly developed touch enabled virtual articulator.

  18. Modular optical detector system

    DOEpatents

    Horn, Brent A [Livermore, CA; Renzi, Ronald F [Tracy, CA

    2006-02-14

    A modular optical detector system. The detector system is designed to detect the presence of molecules or molecular species by inducing fluorescence with exciting radiation and detecting the emitted fluorescence. Because the system is capable of accurately detecting and measuring picomolar concentrations it is ideally suited for use with microchemical analysis systems generally and capillary chromatographic systems in particular. By employing a modular design, the detector system provides both the ability to replace various elements of the detector system without requiring extensive realignment or recalibration of the components as well as minimal user interaction with the system. In addition, the modular concept provides for the use and addition of a wide variety of components, including optical elements (lenses and filters), light sources, and detection means, to fit particular needs.

  19. Upper extremity transplantation: current concepts and challenges in an emerging field.

    PubMed

    Elliott, River M; Tintle, Scott M; Levin, L Scott

    2014-03-01

    Loss of an isolated upper limb is an emotionally and physically devastating event that results in significant impairment. Patients who lose both upper extremities experience profound disability that affects nearly every aspect of their lives. While prosthetics and surgery can eventually provide the single limb amputee with a suitable assisting hand, limited utility, minimal haptic feedback, weight, and discomfort are persistent problems with these techniques that contribute to high rates of prosthetic rejection. Moreover, despite ongoing advances in prosthetic technology, bilateral amputees continue to experience high levels of dependency, disability, and distress. Hand and upper extremity transplantation holds several advantages over prosthetic rehabilitation. The missing limb is replaced with one of similar skin color and size. Sensibility, voluntary motor control, and proprioception are restored to a greater degree, and afford better dexterity and function than prosthetics. The main shortcomings of transplantation include the hazards of immunosuppression, the complications of rejection and its treatment, and high cost. Hand and upper limb transplantation represents the most commonly performed surgery in the growing field of Vascularized Composite Allotransplantation (VCA). As upper limb transplantation and VCA have become more widespread, several important challenges and controversies have emerged. These include: refining indications for transplantation, optimizing immunosuppression, establishing reliable criteria for monitoring, diagnosing, and treating rejection, and standardizing outcome measures. This article will summarize the historical background of hand transplantation and review the current literature and concepts surrounding it.

  20. Candida glabrata prosthetic joint infection, successfully treated with anidulafungin: A case report and review of the literature.

    PubMed

    Koutserimpas, Christos; Samonis, George; Velivassakis, Emmanouil; Iliopoulou-Kosmadaki, Stylliani; Kontakis, Georgios; Kofteridis, Diamantis P

    2018-04-01

    Non-albicans Candida prosthetic joint infection (PJI) is extremely rare. A case of a Candida glabrata knee PJI is a 68-year-old splenectomised female smoker, suffering from chronic obstructive pulmonary disease (COPD) and alcoholism is reported. The patient presented with a peri-prosthetic fracture, 15 years after total knee replacement surgery. Cultures of the intraoperative peri-prosthetic tissue and materials yielded C. glabrata, as well as a methicillin-resistant S. epidermitis. The patient was treated with anidulafungin and vancomycin. The knee prosthetic joint was removed and cement-spacer with vancomycin and gentamycin was placed. Additionally, an external fixation was performed. A second stage revision surgery was planned, after completion of the antimicrobial and antifungal treatment. The patient is followed up for 4 months without signs, symptoms or findings of infection. PJI Candida infections require a high clinical suspicion index. It is of utmost importance to report these cases, since there is no consensus yet of the proper antifungal treatment. Furthermore, a literature review regarding treatment of those cases is provided. First-line treatment with an echinocandin seems most proper, due to their fungicidal properties, their effectiveness against biofilm, as well as their minimal toxicity, making them ideal for long-term use. Further experience is needed, for better understanding the disease's pathogenesis and optimal treatment. © 2017 Blackwell Verlag GmbH.

  1. Attachment systems for mandibular implant overdentures: a systematic review

    PubMed Central

    Kim, Ha-Young; Lee, Jeong-Yol; Bryant, S. Ross

    2012-01-01

    PURPOSE The aim of this systematic review was to address treatment outcome according to attachment systems for mandibular implant overdentures in terms of implant survival rate, prosthetic maintenance and complications, and patient satisfaction. MATERIALS AND METHODS A systematic literature search was conducted using PubMed and hand searching of relevant journals considering inclusion and exclusion criteria. Clinical trial studies on mandibular implant overdentures until August, 2010 were selected if more than one type of overdenture attachment was reported. Twenty four studies from 1098 studies were finally included and the data on implant survival rate, prosthetic maintenance and complications, patient satisfaction were analyzed relative to attachment systems. RESULTS Four studies presented implant survival rates (95.8 - 97.5% for bar, 96.2 - 100% for ball, 91.7% for magnet) according to attachment system. Ten other studies presented an implant survival rate ranging from 93.3% to 100% without respect to the attachment groups. Common prosthetic maintenance and complications were replacement of an assay for magnet attachments, and activation of a matrix or clip for ball or bar attachments. Prosthetic maintenance and complications most commonly occurred in the magnet groups. Conflicting findings were found on the rate of prosthetic maintenance and complications comparing ball and bar attachments. Most studies showed no significant differences in patient satisfaction depending upon attachment systems. CONCLUSION The implant survival rate of mandibular overdentures seemed to be high regardless attachment systems. The prosthetic maintenance and complications may be influenced by attachment systems. However patient satisfaction may be independent of the attachment system. PMID:23236571

  2. Large-scale modular biofiltration system for effective odor removal in a composting facility.

    PubMed

    Lin, Yueh-Hsien; Chen, Yu-Pei; Ho, Kuo-Ling; Lee, Tsung-Yih; Tseng, Ching-Ping

    2013-01-01

    Several different foul odors such as nitrogen-containing groups, sulfur-containing groups, and short-chain fatty-acids commonly emitted from composting facilities. In this study, an experimental laboratory-scale bioreactor was scaled up to build a large-scale modular biofiltration system that can process 34 m(3)min(-1)waste gases. This modular reactor system was proven effective in eliminating odors, with a 97% removal efficiency for 96 ppm ammonia, a 98% removal efficiency for 220 ppm amines, and a 100% removal efficiency of other odorous substances. The results of operational parameters indicate that this modular biofiltration system offers long-term operational stability. Specifically, a low pressure drop (<45 mmH2O m(-1)) was observed, indicating that the packing carrier in bioreactor units does not require frequent replacement. Thus, this modular biofiltration system can be used in field applications to eliminate various odors with compact working volume.

  3. 21 CFR 886.3600 - Intraocular lens.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Intraocular lens. 886.3600 Section 886.3600 Food... DEVICES OPHTHALMIC DEVICES Prosthetic Devices § 886.3600 Intraocular lens. (a) Identification. An intraocular lens is a device made of materials such as glass or plastic intended to be implanted to replace...

  4. 21 CFR 888.3660 - Shoulder joint metal/polymer semi-constrained cemented prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3660... device are: (1) FDA's: (i) “Use of International Standard ISO 10993 ‘Biological Evaluation of Medical... metal/polymer semi-constrained cemented prosthesis is a device intended to be implanted to replace a...

  5. 21 CFR 888.3650 - Shoulder joint metal/polymer non-constrained cemented prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3650... are: (1) FDA's: (i) “Use of International Standard ISO 10993 ‘Biological Evaluation of Medical Devices... metal/polymer non-constrained cemented prosthesis is a device intended to be implanted to replace a...

  6. Cyborg beast: a low-cost 3d-printed prosthetic hand for children with upper-limb differences.

    PubMed

    Zuniga, Jorge; Katsavelis, Dimitrios; Peck, Jean; Stollberg, John; Petrykowski, Marc; Carson, Adam; Fernandez, Cristina

    2015-01-20

    There is an increasing number of children with traumatic and congenital hand amputations or reductions. Children's prosthetic needs are complex due to their small size, constant growth, and psychosocial development. Families' financial resources play a crucial role in the prescription of prostheses for their children, especially when private insurance and public funding are insufficient. Electric-powered (i.e., myoelectric) and body-powered (i.e., mechanical) devices have been developed to accommodate children's needs, but the cost of maintenance and replacement represents an obstacle for many families. Due to the complexity and high cost of these prosthetic hands, they are not accessible to children from low-income, uninsured families or to children from developing countries. Advancements in computer-aided design (CAD) programs, additive manufacturing, and image editing software offer the possibility of designing, printing, and fitting prosthetic hands devices at a distance and at very low cost. The purpose of this preliminary investigation was to describe a low-cost three-dimensional (3D)-printed prosthetic hand for children with upper-limb reductions and to propose a prosthesis fitting methodology that can be performed at a distance. No significant mean differences were found between the anthropometric and range of motion measurements taken directly from the upper limbs of subjects versus those extracted from photographs. The Bland and Altman plots show no major bias and narrow limits of agreements for lengths and widths and small bias and wider limits of agreements for the range of motion measurements. The main finding of the survey was that our prosthetic device may have a significant potential to positively impact quality of life and daily usage, and can be incorporated in several activities at home and in school. This investigation describes a low-cost 3D-printed prosthetic hand for children and proposes a distance fitting procedure. The Cyborg Beast prosthetic hand and the proposed distance-fitting procedures may represent a possible low-cost alternative for children in developing countries and those who have limited access to health care providers. Further studies should examine the functionality, validity, durability, benefits, and rejection rate of this type of low-cost 3D-printed prosthetic device.

  7. Acquired discrete subaortic stenosis late after mitral valve replacement.

    PubMed

    Mohan, Jagdish C; Shukla, Madhu; Mohan, Vishwas; Sethi, Arvind

    2016-09-01

    Although acquired left ventricular outflow obstruction has been reported in a variety of conditions, there are scant reports of its occurrence following mitral valve replacement (MVR). This study describes two female patients, who developed severe discrete subaortic stenosis, five years following MVR. In both cases, the mitral valve was replaced by a porcine Carpentier-Edwards 27-mm bioprosthesis with preservation of mitral valve leaflets. The risk of very late left ventricular outflow tract obstruction after bio-prosthetic MVR with preservation of subvalvular apparatus needs to be kept in mind in symptomatic patients. Copyright © 2016 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

  8. A two DoF finger for a biomechatronic artificial hand.

    PubMed

    Carrozza, M C; Massa, B; Dario, P; Zecca, M; Micera, S; Pastacaldi, P

    2002-01-01

    Current prosthetic hands are basically simple grippers with one or two degrees of freedom, which barely restore the capability of the thumb-index pinch. Although most amputees consider this performance as acceptable for usual tasks, there is ample room for improvement by exploiting recent progresses in mechatronics design and technology. We are developing a novel prosthetic hand featured by multiple degrees of freedom, tactile sensing capabilities, and distributed control. Our main goal is to pursue an integrated design approach in order to fulfill critical requirements such as cosmetics, controllability, low weight, low energy consumption and noiselessness. This approach can be synthesized by the definition "biomechatronic design", which means developing mechatronic systems inspired by living beings and able to work harmoniously with them. This paper describes the first implementation of one single finger of a future biomechatronic hand. The finger has a modular design, which allows to obtain hands with different degrees of freedom and grasping capabilities. Current developments include the implementation of a hand comprising three fingers (opposing thumb, index and middle) and an embedded controller.

  9. Improving performances of the knee replacement surgery process by applying DMAIC principles.

    PubMed

    Improta, Giovanni; Balato, Giovanni; Romano, Maria; Ponsiglione, Alfonso Maria; Raiola, Eliana; Russo, Mario Alessandro; Cuccaro, Patrizia; Santillo, Liberatina Carmela; Cesarelli, Mario

    2017-12-01

    The work is a part of a project about the application of the Lean Six Sigma to improve health care processes. A previously published work regarding the hip replacement surgery has shown promising results. Here, we propose an application of the DMAIC (Define, Measure, Analyse, Improve, and Control) cycle to improve quality and reduce costs related to the prosthetic knee replacement surgery by decreasing patients' length of hospital stay (LOS) METHODS: The DMAIC cycle has been adopted to decrease the patients' LOS. The University Hospital "Federico II" of Naples, one of the most important university hospitals in Southern Italy, participated in this study. Data on 148 patients who underwent prosthetic knee replacement between 2010 and 2013 were used. Process mapping, statistical measures, brainstorming activities, and comparative analysis were performed to identify factors influencing LOS and improvement strategies. The study allowed the identification of variables influencing the prolongation of the LOS and the implementation of corrective actions to improve the process of care. The adopted actions reduced the LOS by 42%, from a mean value of 14.2 to 8.3 days (standard deviation also decreased from 5.2 to 2.3 days). The DMAIC approach has proven to be a helpful strategy ensuring a significant decreasing of the LOS. Furthermore, through its implementation, a significant reduction of the average costs of hospital stay can be achieved. Such a versatile approach could be applied to improve a wide range of health care processes. © 2017 John Wiley & Sons, Ltd.

  10. Prevalence of pannus formation after aortic valve replacement: clinical aspects and surgical management.

    PubMed

    Sakamoto, Yoshimasa; Hashimoto, Kazuhiro; Okuyama, Hiroshi; Ishii, Shinichi; Shingo, Taguchi; Kagawa, Hiroshi

    2006-01-01

    Pannus formation after aortic valve replacement is not common, but obstruction due to chronic pannus is one of the most serious complications of valve replacement. The causes of pannus formation are still unknown and effective preventive methods have not been fully elucidated. We reviewed our clinical experience of all patients who underwent reoperation for prosthetic aortic valve obstruction due to pannus formation between 1973 and 2004. We compared the initial 18-year period of surgery, when the Björk-Shiley tilting-disk valve was used, and the subsequent 13-year period of surgery, when the St. Jude Medical valve was used. Seven of a total of 390 patients (1.8%) required reoperation for prosthetic aortic valve obstruction due to pannus formation. All seven patients were women; four patients underwent resection of the pannus and three patients needed replacement of the valve. The frequency of pannus formation in the early group was 2.4% (6/253), whereas it was 0.73% (1/137) in the late group (P < 0.05). Pannus was localized at the minor orifice of the Björk-Shiley valve in the early group and turbulent transvalvular blood flow was considered to be one of the important factors triggering its growth. We also consider that small bileaflet valves have the possibility of promoting pannus formation and that the implantation of a larger prosthesis can contribute to reducing the occurrence of pannus.

  11. The Role of Virtual Articulator in Prosthetic and Restorative Dentistry

    PubMed Central

    Aljanakh, Mohammad

    2014-01-01

    Virtual reality is a computer based technology linked with the future of dentistry and dental practice. The virtual articulator is one such application in prosthetic and restorative dentistry based on virtual reality that will significantly reduce the limitations of the mechanical articulator, and by simulation of real patient data, allow analyses with regard to static and dynamic occlusion as well as to jaw relation. It is the purpose of this article to present the concepts and strategies for a future replacement of the mechanical articulator by a virtual one. Also, a brief note on virtual reality haptic system has been highlighted along with newly developed touch enabled virtual articulator. PMID:25177664

  12. Achromobacter species endocarditis: A case report and literature review

    PubMed Central

    Derber, Catherine; Elam, Kara; Forbes, Betty A; Bearman, Gonzalo

    2011-01-01

    Endocarditis due to Achromobacter species is a rare, yet serious, endovascular infection. Achromobacter species infective endocarditis is associated with underlying immunodeficiencies or prosthetic heart valves and devices. A case of prosthetic pulmonary valve endocarditis secondary to Achromobacter xylosoxidans subspecies denitrificans is described in the present report. This life-threatening infection was successfully treated with combined valve replacement and prolonged antibiotic therapy. A Medline/PubMed literature review of Achromobacter endocarditis was also performed. Achromobacter species are an uncommon, yet important, cause of nosocomial endocarditis. Given the significant associated morbidity and mortality, along with a high degree of intrinsic antibiotic resistance, Achromobacter species infective endocarditis remains a clinical treatment challenge. PMID:22942890

  13. Mechanical valve obstruction: Review of diagnostic and treatment strategies

    PubMed Central

    Salamon, Jason; Munoz-Mendoza, Jerson; Liebelt, Jared J; Taub, Cynthia C

    2015-01-01

    Prosthetic valve obstruction (PVO) is a rare but feared complication of mechanical valve replacement. Diagnostic evaluation should focus on differentiating prosthetic valve thrombosis (PVT) from pannus formation, as their treatment options differ. History of sub-optimal anti-coagulation and post-op time course to development of PVO are useful clinical characteristics in differentiating thrombus from pannus formation. Treatment of PVT is influenced by the patient’s symptoms, valve location, degree of obstruction and thrombus size and may include thrombolysis or surgical intervention. Alternatively, pannus formation requires surgical intervention. The purpose of this article is to review the pathophysiology, epidemiology, diagnostic approach and treatment options for aortic and mitral valve PVO. PMID:26730292

  14. Full-arch implant-retained prosthetics in general dental practice.

    PubMed

    Rosenbaum, Nigel

    2012-03-01

    The loss of all teeth from one or both dental arches is a significant disability affecting self-confidence, communication, masticatory function and aesthetics. Whilst missing teeth cannot be restored to the natural state, the development of a prosthetic dentition has been a goal of dental science throughout the centuries. Contemporary techniques allow for the replacement of missing dentition with fixed or removable solutions, solving many of the problems. Implant dentistry has transformed this area of medicine. This article provides dental practitioners with an overview of this important area of patient care. Dental practitioners in clinical practice will frequently see edentulism; a good understanding of the available options for rehabilitation is essential.

  15. Alcoholic Chlorhexidine or Alcoholic Iodine Skin Antisepsis (ACAISA): protocol for cluster randomised controlled trial of surgical skin preparation for the prevention of superficial wound complications in prosthetic hip and knee replacement surgery

    PubMed Central

    Peel, T N; Cheng, A C; Buising, K L; Dowsey, M M; Choong, P F M

    2014-01-01

    Introduction Wound complications following arthroplasty are associated with significant impact on the patient and healthcare system. Skin cleansing prior to surgical incision is a simple and effective method to prevent wound complications however, the question of which agent is superior for surgical skin antisepsis is unresolved. Methods and analysis This cluster randomised controlled trial aims to compare the incidence of superficial wound complications in patients undergoing elective prosthetic hip or knee replacement surgery receiving surgical skin antisepsis with either: 0.5% chlorhexidine gluconate (CHG) in 70% alcohol or 10% povidone in 70% alcohol. The trial will be conducted at an Australian tertiary, university affiliated hospital over a 3-year period involving 750 participants. Participants will be drawn from the surgical waiting list. Consent for this study will be ‘opt-out’ consent. On a given day, all eligible participants will have skin preparation either with 0.5% chlorhexidine in 70% alcohol or 10% povidone iodine in 70% alcohol. The primary outcome is superficial wound complications (comprised of superficial incisional surgical site infections (SSI) and/or prolonged wound ooze) in the first 30 days following prosthetic joint replacement surgery. Secondary outcomes will include the incidence of wound complications according to the joint replaced, assessment of the causative agents of SSI and cost-effectiveness analysis. The primary analysis is an intention-to-treat analysis including all participants who undergo randomisation and will be performed at the individual level taking into account the clustering effect. Ethics and dissemination The study design and protocol was reviewed and approved by the St Vincent's Hospital Human Research Ethics Committee (HREC-A 016/14 10/3/2014). Study findings will be disseminated in the printed media, and learned forums. A written lay summary will be available to study participants on request. Trial registration number The trial has been registered with the Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12614000177651. PMID:24833699

  16. Prosthetic valve endocarditis 7 months after transcatheter aortic valve implantation diagnosed with 3D TEE.

    PubMed

    Sarı, Cenk; Durmaz, Tahir; Karaduman, Bilge Duran; Keleş, Telat; Bayram, Hüseyin; Baştuğ, Serdal; Özen, Mehmet Burak; Bayram, Nihal Akar; Bilen, Emine; Ayhan, Hüseyin; Kasapkara, Hacı Ahmet; Bozkurt, Engin

    2016-01-01

    Transcatheter aortic valve implantation (TAVI) was introduced as an alternative treatment for patients with severe symptomatic aortic stenosis for whom surgery would be high-risk. Prosthetic aortic valve endocarditis is a serious complication of surgical AVR (SAVR) with high morbidity and mortality. According to recent cases, post-TAVI prosthetic valve endocarditis (PVE) seems to occur very rarely. We present the case of a 75-year-old woman who underwent TAVI (Edwards Saphien XT) with an uneventful postoperative stay. She was diagnosed with endocarditis using three dimensional (3D) echocardiography on the TAVI device 7 months later and she subsequently underwent surgical aortic valve replacement. Little experience of the interpretation of transoesophageal echocardiography (TEE) and the clinical course and effectiveness of treatment strategies in post-TAVI endocarditis exists. We report a case of PVE in a TAVI patient which was diagnosed with three-dimensional transoesophageal echocardiography (3DTEE). Copyright © 2016 Hellenic Cardiological Society. Published by Elsevier B.V. All rights reserved.

  17. Acinetobacter Prosthetic Joint Infection Treated with Debridement and High-Dose Tigecycline.

    PubMed

    Vila, Andrea; Pagella, Hugo; Amadio, Claudio; Leiva, Alejandro

    2016-12-01

    Prosthesis retention is not recommended for multidrug-resistant Acinetobacter prosthetic joint infection due to its high failure rate. Nevertheless, replacing the prosthesis implies high morbidity and prolonged hospitalization. Although tigecycline is not approved for the treatment of prosthetic joint infection due to multidrug resistant Acinetobacter baumannii, its appropriate use may preclude prosthesis exchange. Since the area under the curve divided by the minimum inhibitory concentration is the best pharmacodynamic predictor of its efficacy, we used tigecycline at high dose, in order to optimize its efficacy and achieve implant retention in 3 patients who refused prosthesis exchange. All patients with prosthetic joint infections treated at our Institution are prospectively registered in a database. Three patients with early prosthetic joint infection of total hip arthroplasty due to multidrug resistant A. baumannii were treated with debridement, antibiotics and implant retention, using a high maintenance dose of tigecycline (100 mg every 12 hours). The cases were retrospectively reviewed. All patients signed informed consent for receiving off-label use of tigecycline. Tigecycline was well tolerated, allowing its administration at high maintenance dose for a median of 40 days (range 30-60). Two patients were then switched to minocycline at standard doses for a median of 3.3 months in order to complete treatment. Currently, none of the patients showed relapse. Increasing the dose of tigecycline could be considered as a means to better attain pharmacodynamic targets in patients with severe or difficult-to-treat infections. Tigecycline at high maintenance dose might be useful when retention of the implant is attempted for treatment for prosthetic joint infections due to multidrug resistant Acinetobacter. Although this approach might be promising, off-label use of tigecycline should be interpreted cautiously until prospective data are available. Tigecycline is probably under-dosed for the treatment of implant and biofilm associated infections.

  18. [Intravascular Hemolysis Caused by Stenosis of an Elephant Trunk;Report of a Case].

    PubMed

    Takamaru, Rikako; Kawahito, Koji; Aizawa, Kei; Misawa, Yoshio

    2017-07-01

    Symptomatic intravascular hemolysis after prosthetic aortic graft replacement is rare. It is primarily attributed to mechanical injury of red blood cells caused by stenosis of the vascular graft. A 50-year-old man presented with hemolytic anemia, 5 years after total arch replacement with an elephant trunk for type A aortic dissection. The hemolysis was caused by graft stenosis of the elephant trunk. Endovascular treatment for the stenotic elephant trunk was successfully performed. The postoperative course was uneventful, and the hemolysis was resolved immediately after operation.

  19. Coronary ostia obstruction after replacement of aortic valve prostesis

    PubMed Central

    2011-01-01

    Aortic valve replacement (AVR) is the gold standard for the treatment of severe symptomatic aortic stenosis. Complications directly related to surgical procedure are relatively infrequent. Coronary ostial stenosis is, generally, referred as late complication. Anecdotal reports concern coronary ostial stenosis as acute complication. A unique fatal case of intraoperative, bilateral coronary ostial obstruction by prosthetic valve leading to an extensive myocardial infarction is reported. Surgeons must have a high level of vigilance regarding the occurrence of acute myocardial ischemia and sudden death soon after AVR. PMID:21810231

  20. The value of real-time three-dimensional transesophageal echocardiography in the assessment of paravalvular leak origin following prosthetic mitral valve replacement.

    PubMed

    Yildiz, Mustafa; Duran, Nilüfer Ekşi; Gökdeniz, Tayyar; Kaya, Hasan; Ozkan, Mehmet

    2009-09-01

    Two-dimensional (2D) echocardiographic approaches are not sufficient to determine the origin of paravalvular leak (PVL) that occurs after prosthetic mitral valve replacement (MVR). In this study, we investigated the role of real-time three-dimensional transesophageal echocardiography (RT-3D TEE) in detecting the origin and size of PVL occurring after prosthetic MVR. The study included 13 patients (7 females; 6 males; mean age 56+/-10 years; range 37 to 71 years) who developed PVL within a mean of 8.3+/-3.8 years following mechanical prosthetic MVR. Nine patients (69.2%) had atrial fibrillation, and four patients (30.8%) had normal sinus rhythm. Four patients (30.8%) had hemolysis. Paravalvular leak was mild, moderate, and severe in two, six, and five patients, respectively. Real-time 3D TEE was performed using a 3D matrix-array TEE transducer immediately after detection of PVL on 2D TEE examination. Localization of PVL was made using a clock-wise format in relation to the aortic valve and the size of dehiscence was measured. The mean PVL width measured by 2D TEE was 3.00+/-0.92 mm. The mean length of dehiscence was 13.6+/-8.8 mm, and the mean width was 3.88+/-2.04 mm on RT-3D TEE. The PVLs were mainly localized in the posterior and anterior annular positions between 12 to 03 hours (n=7) and 06 to 09 hours (n=3) on RT-3D TEE, respectively, which corresponded to the posteromedial or anterolateral sectors of the posterior annulus. Considering that only the width of the PVL defect can be assessed by 2D TEE, delineation by RT-3D TEE includes the localization of PVL together with the length and width of the defect.

  1. Anaerobic prosthetic joint infection.

    PubMed

    Shah, Neel B; Tande, Aaron J; Patel, Robin; Berbari, Elie F

    2015-12-01

    In an effort to improve mobility and alleviate pain from degenerative and connective tissue joint disease, an increasing number of individuals are undergoing prosthetic joint replacement in the United States. Joint replacement is a highly effective intervention, resulting in improved quality of life and increased independence [1]. By 2030, it is predicted that approximately 4 million total hip and knee arthroplasties will be performed yearly in the United States [2]. One of the major complications associated with this procedure is prosthetic joint infection (PJI), occurring at a rate of 1-2% [3-7]. In 2011, the Musculoskeletal Infectious Society created a unifying definition for prosthetic joint infection [8]. The following year, the Infectious Disease Society of America published practice guidelines that focused on the diagnosis and management of PJI. These guidelines focused on the management of commonly encountered organisms associated with PJI, including staphylococci, streptococci and select aerobic Gram-negative bacteria. However, with the exception of Propionibacterium acnes, management of other anaerobic organisms was not addressed in these guidelines [1]. Although making up approximately 3-6% of PJI [9,10], anaerobic microorganisms cause devastating complications, and similar to the more common organisms associated with PJI, these bacteria also result in significant morbidity, poor outcomes and increased health-care costs. Data on diagnosis and management of anaerobic PJI is mostly derived from case reports, along with a few cohort studies [3]. There is a paucity of published data outlining factors associated with risks, diagnosis and management of anaerobic PJI. We therefore reviewed available literature on anaerobic PJI by systematically searching the PubMed database, and collected data from secondary searches to determine information on pathogenesis, demographic data, clinical features, diagnosis and management. We focused our search on five commonly encountered anaerobic organisms associated with PJI. Since anaerobic PJI has also been linked to dental procedures, we also reviewed information on the use of dental procedures and prophylaxis, when available. Copyright © 2015 Elsevier Ltd. All rights reserved.

  2. Description of the rates, trends and surgical burden associated with revision for prosthetic joint infection following primary and revision knee replacements in England and Wales: an analysis of the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man.

    PubMed

    Lenguerrand, Erik; Whitehouse, Michael R; Beswick, Andrew D; Toms, Andrew D; Porter, Martyn L; Blom, Ashley W

    2017-07-10

    To describe the prevalence rates of revision surgery for the treatment of prosthetic joint infection (PJI) for patients undergoing knee replacement, their time trends, the cumulative incidence function of revision for PJI and estimate the burden of PJI at health service level. We analysed revision knee replacements performed due to a diagnosis of PJI and the linked index procedures recorded in the National Joint Registry from 2003 to 2014 for England and Wales. The cohort analysed consisted of 679 010 index primary knee replacements, 33 920 index revision knee replacements and 8247 revision total knee replacements performed due to a diagnosis of PJI. The prevalence rates, their time trends investigated by time from index surgery to revision for PJI, cumulative incidence functions and the burden of PJI (total procedures) were calculated. Overall linear trends were investigated with log-linear regression. The incidence of revision total knee replacement due to PJI at 2 years was 3.2/1000 following primary and 14.4/1000 following revision knee replacement, respectively. The prevalence of revision due to PJI in the 3 months following primary knee replacement has risen by 2.5-fold (95% CI 1.2 to 5.3) from 2005 to 2013 and 7.5-fold (95% CI 1.0 to 56.1) following revision knee replacement. Over 1000 procedures per year are performed as a consequence of knee PJI, an increase of 2.8 from 2005 to 2013. Overall, 75% of revisions were two-stage with an increase in use of single-stage from 7.9% in 2005 to 18.8% in 2014. Although the risk of revision due to PJI following knee replacement is low, it is rising, and coupled with the established and further predicted increased incidence of both primary and revision knee replacements, this represents an increasing and substantial treatment burden for orthopaedic service delivery in England and Wales. This has implications for future service design and the funding of individual and specialist centres. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  3. Description of the rates, trends and surgical burden associated with revision for prosthetic joint infection following primary and revision knee replacements in England and Wales: an analysis of the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man

    PubMed Central

    Lenguerrand, Erik; Whitehouse, Michael R; Beswick, Andrew D; Toms, Andrew D; Porter, Martyn L; Blom, Ashley W

    2017-01-01

    Objectives To describe the prevalence rates of revision surgery for the treatment of prosthetic joint infection (PJI) for patients undergoing knee replacement, their time trends, the cumulative incidence function of revision for PJI and estimate the burden of PJI at health service level. Design We analysed revision knee replacements performed due to a diagnosis of PJI and the linked index procedures recorded in the National Joint Registry from 2003 to 2014 for England and Wales. The cohort analysed consisted of 679 010 index primary knee replacements, 33 920 index revision knee replacements and 8247 revision total knee replacements performed due to a diagnosis of PJI. The prevalence rates, their time trends investigated by time from index surgery to revision for PJI, cumulative incidence functions and the burden of PJI (total procedures) were calculated. Overall linear trends were investigated with log-linear regression. Results The incidence of revision total knee replacement due to PJI at 2 years was 3.2/1000 following primary and 14.4/1000 following revision knee replacement, respectively. The prevalence of revision due to PJI in the 3 months following primary knee replacement has risen by 2.5-fold (95% CI 1.2 to 5.3) from 2005 to 2013 and 7.5-fold (95% CI 1.0 to 56.1) following revision knee replacement. Over 1000 procedures per year are performed as a consequence of knee PJI, an increase of 2.8 from 2005 to 2013. Overall, 75% of revisions were two-stage with an increase in use of single-stage from 7.9% in 2005 to 18.8% in 2014. Conclusions Although the risk of revision due to PJI following knee replacement is low, it is rising, and coupled with the established and further predicted increased incidence of both primary and revision knee replacements, this represents an increasing and substantial treatment burden for orthopaedic service delivery in England and Wales. This has implications for future service design and the funding of individual and specialist centres. PMID:28698316

  4. Quadriceps force during knee extension in different replacement scenarios with a modular partial prosthesis.

    PubMed

    Calliess, Tilman; Schado, Ssuheib; Richter, Berna I; Becher, Christoph; Ezechieli, Marco; Ostermeier, Sven

    2014-02-01

    Previous biomechanical studies have shown that bi-cruciate retaining knee replacement does not significantly alter normal knee kinematics, however, there are no data on the influence of a combined medial and patellofemoral bi-compartimental arthroplasty. The purpose of this in vitro study was to evaluate the effect of different replacement scenarios with a modular partial knee replacement system on the amount of quadriceps force required to extend the knee during an isokinetic extension cycle. Ten human knee specimens were tested in a kinematic knee simulator under (1) physiologic condition and after subsequent implantation of (2) a medial unicondylar and (3) a trochlear replacement. An isokinetic extension cycle of the knee with a constant extension moment of 31 Nm was simulated. The resulting quadriceps extension force was measured from 120° to full knee extension. The quadriceps force curve described a typically sinusoidal characteristic before and after each replacement scenario. The isolated medial replacement resulted in a slightly, but significantly higher maximum quadriceps force (1510 N vs. 1585 N, P = 0.006) as well as the subsequent trochlear replacement showed an additional increase (1801 N, P = 0.008). However, for both replacements no significant difference to the untreated condition could be detected in mid-flexion (10-50°). When considering a bi-compartimental replacement an increase of required maximum quadriceps force needed to extend the knee has to keep in mind. However, the close to physiological movement in mid-flexion suggests that patients with a bi-crutiate retaining arthroplasty might have an advantage in knee stability compared to total knee arthroplasty. Copyright © 2013 Elsevier Ltd. All rights reserved.

  5. 3D Assessment of Features Associated With Transvalvular Aortic Regurgitation After TAVR: A Real-Time 3D TEE Study.

    PubMed

    Shibayama, Kentaro; Mihara, Hirotsugu; Jilaihawi, Hasan; Berdejo, Javier; Harada, Kenji; Itabashi, Yuji; Siegel, Robert; Makkar, Raj R; Shiota, Takahiro

    2016-02-01

    This study of 3-dimensional (3D) transesophageal echocardiography (TEE) aimed to demonstrate features associated with transvalvular aortic regurgitation (AR) after transcatheter aortic valve replacement (TAVR) and to confirm the fact that a gap between the native aortic annulus and prosthesis is associated with paravalvular AR. The mechanism of AR after TAVR, particularly that of transvalvular AR, has not been evaluated adequately. All patients with severe aortic stenosis who underwent TAVR with the Sapien device (Edwards Lifesciences, Irvine, California) had 3D TEE of the pre-procedural native aortic annulus and the post-procedural prosthetic valve. In the 201 patients studied, the total AR was mild in 67 patients (33%), moderate in 21 patients (10%), and severe in no patients. There were 20 patients with transvalvular AR and 82 patients with paravalvular AR. Fourteen patients had both transvalvular and paravalvular AR. Patients with transvalvular AR had larger prosthetic expansion (p <0.05), a more elliptical prosthetic shape at the prosthetic commissure level (p <0.01) and more anti-anatomical position (p <0.001), which was defined as malposition of the prosthetic commissures in relation to the native commissures, than the patients without transvalvular AR. Age (odds ratio [OR]: 1.05; 95% confidence interval [CI]: 1.01 to 1.09; p < 0.05) and effective area oversizing (OR: 0.97; 95% CI: 0.93 to 0.99, p <0.05) were associated with mild or greater paravalvular AR. 3D TEE successfully demonstrated the features associated with transvalvular AR, such as large prosthetic expansion, elliptical prosthetic shape, and anti-anatomical position of prosthesis. Additionally, effective area oversizing was associated with paravalvular AR. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  6. Survival of modern knee tumor megaprostheses: failures, functional results, and a comparative statistical analysis.

    PubMed

    Pala, Elisa; Trovarelli, Giulia; Calabrò, Teresa; Angelini, Andrea; Abati, Caterina N; Ruggieri, Pietro

    2015-03-01

    Modular megaprostheses are now the most common method of reconstruction after segmental resection of the long bones in the lower extremities. Previous studies reported variable outcome and failure rates after knee megaprosthetic reconstructions. The objectives of this study were to analyze the results of a modular tumor prosthesis after resection of bone tumor around the knee with respect to (1) survivorship; (2) failure rate; (3) comparative survivorship against different sites of reconstructions and of primary and revision implants; and (4) functional results on the Musculoskeletal Tumor Society (MSTS) scoring system. Between 2003 and 2010, 247 rotating-hinge Global Modular Reconstruction System (GMRS) knee prostheses were implanted in our institute for malignant and aggressive benign tumors. During this time, that group represented 23% of the patients who had oncologic megaprosthesis reconstruction about the knee after resection of primary or metastatic bone tumors (247 of 1086 patients). In the other 77% of cases we used other types of oncologic prostheses. Before 2003 we used the older Howmedica Modular Resection System and Kotz Modular Femur/Tibia Replacement from 2003 we used mostly the GMRS but we continued to use the HMRS in some cases such as patients with poor prognoses, elderly patients, or metastatic patients. Sites included 187 distal femurs and 60 proximal tibias. Causes of megaprosthesis failure were classified according to Henderson et al. in five types: Type 1 (soft tissue failure), Type 2 (aseptic loosening), Type 3 (structural failure), Type 4 (infection), and Type 5 (tumor progression). Followup was at a minimum oncologic followup of 2 years (mean, 4 years; range, 2-8 years). Kaplan-Meier actuarial curves of implant survival to major failures were done. Functional results were analyzed according to the MSTS II system; 223 of the 247 were available for functional scoring (81%). At latest followup, among 175 treated patients for primary reconstruction, 117 are continuously disease-free, 26 have no evidence of disease after treatment of relapse, eight are alive with disease, and 24 died from disease. The overall failure rate of the megaprostheses in our series was 29.1% (72 of 247). Type 1 failure occurred in 8.5% (21 of 247) cases, Type 2 in 5.6% (14 of 247), Type 3 in 0%, Type 4 in 9.3% (23 of 247), and Type 5 in 5.6% (14 of 247). Kaplan-Meier curve showed an overall implant survival rate for all types of failures of 70% at 4 years and 58% at 8 years. Prosthetic survivorship for revisions was 80% at 5 years and for primary reconstructions was 60% at 5 years (p = 0.013). Survivorship to infection was 95% at 5 years for revision patients and 84% at 5 years for primary patients (p = 0.475). The mean MSTS score was 84 (25.2; range, 8-30) with no difference between sites of localization (24.7 in proximal tibia versus 25.4 in distal femur reconstruction; p = 0.306). Results at a minimum of 2 years with this modular prosthesis are satisfactory in terms of survivorship (both oncologic and reconstructive) and causes and rates of failure. Although these results seem comparable with other like implants, we will continue to follow this cohort, and we believe that comparative trials among the available megaprosthesis designs are called for. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

  7. Clinical field follow-up of high density polyethylene (HDPE)-Jaipur prosthetic technology for trans-femoral amputees.

    PubMed

    Jensen, J S; Craig, J G; Mtalo, L B; Zelaya, C M

    2004-08-01

    The purpose of this study was to examine the outcome of the application of the high density polyethylene (HDPE)-Jaipur prosthetic construction in fitting trans-femoral amputees in a number of projects throughout the developing world. Projects in Honduras, Uganda and India were included. One hundred and fifty eight (158) patients had been provided with the HDPE-Jaipur prosthesis and of these 72 were seen for a clinical and technical follow-up after a median of 32 months. More than half the amputees seen had amputation due to trauma and the remainder due to disease. Fabrication and fitting in the three projects was carried out by individuals who had undertaken a three week training course provided by Bhagwan Mahaveer Viklang Sahayata Samiti limb centre in Jaipur. The individuals involved had limited background training in prosthetics. Craftsmanship and fit were assessed as being poor in 86% of cases. Failure requiring replacement of components was observed in 50% of cases. There was low patient satisfaction (58%) and patient compliance (65%). The outcome was considered unsatisfactory both technically and clinically. This was a reflection of the inadequacies of the prosthetic construction, particularly the knee joint, and the inadequate training of those involved in fitting and fabrication of the devices.

  8. Special features of total knee replacement in hemophilia.

    PubMed

    Rodriguez-Merchan, Emerito Carlos

    2013-12-01

    Total knee replacement is an operation frequently needed by hemophilia patients, which greatly improves their quality of life. This operation, however, carries a higher risk of bleeding and infection for hemophiliacs than it does for osteoarthritis sufferers. It is advisable to implant prosthetic components using antibiotic-loaded cement. It is essential to maintain a level of 100% of the replacement clotting factor for 2 weeks. Hematological treatment must be established, depending on the patient's factor levels and other pharmacokinetic parameters such as recovery and half-life, optimal doses and treatment time. It is preferable to use general anesthesia due to the risk of spinal bleeding. The lifespan of total knee replacement in hemophilic patients is shorter than in patients with osteoarthritis because of the increased risk of infection.

  9. The current status of fluoroscopy and echocardiography in the diagnosis of prosthetic valve thrombosis-a review article.

    PubMed

    Gürsoy, Mustafa Ozan; Kalçik, Macit; Karakoyun, Süleyman; Özkan, Mehmet

    2015-01-01

    Prosthetic valve thrombosis (PVT) is a potentially life-threatening complication of heart valve replacement. Early diagnosis is crucial for the prevention of significantly morbid and lethal complications. Cinefluoroscopy (CF) and echocardiography have been widely used for diagnosing PVT. In recent years, the role of CF has declined since the introduction of transesophageal echocardiography and the great improvements in ultrasound technology including real time three-dimensional imaging. Nevertheless, both echocardiography and CF provide different kinds of information on prosthesis function, and therefore they are considered as complementary and not alternative. In this review, we aimed to summarize the current status of CF and echocardiography in the diagnosis of PVT. © 2014, Wiley Periodicals, Inc.

  10. Disc dislodgment in Björk Shiley mitral valve prosthesis: two successfully operated cases.

    PubMed

    Dubernet, J; Irarrázaval, M J; Urzúa, J; Maturana, G; Morán, S; Lema, G; Asenjo, F; Fajuri, A

    1986-02-01

    Two patients with Björk Shiley mitral valve replacement had migration and embolization of the occluding disc. One patient suffered migration of the disc a few hours after surgery and the other had a strut fracture with disc translocation six years after the initial operation. Clinical signs in both cases were pulmonary edema, cardiogenic shock, and absence of prosthetic sounds. Both patients were reoperated on an emergency basis, recovering after a complicated postoperative course. They are on functional Class I, 8 and 1 years later, respectively, with their dislodged discs still in the abdominal aorta. The only hope for survival in these patients is emergency reoperation, once the prosthetic mitral valve dysfunction is confirmed.

  11. Prosthetic joint infection caused by Trueperella bernardiae.

    PubMed

    Gilarranz, Raul; Chamizo, Francisco; Horcajada, Iballa; Bordes-Benítez, Ana

    2016-09-01

    Trueperella bernardiae is a Gram-positive coryneform bacilli which role as human pathogen is unknown because it has been usually considered a contaminant. Furthermore its identification by biochemical test was difficult. We describe a prosthetic joint infection in a women who years ago underwent a total knee replacement with superinfection and necrosis of the patellar tendon as major complications. In the sample of synovial fluid collected grew a gram-positive bacilli which was identified by matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) as T. bernardiae. The patient was treated with ciprofloxacin and currently preserves the prosthesis without signs of infection. Copyright © 2016 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  12. Do the radial head prosthesis components fit with the anatomical structures of the proximal radioulnar joint?

    PubMed

    Wegmann, Kilian; Hain, Moritz K; Ries, Christian; Neiss, Wolfram F; Müller, Lars P; Burkhart, Klaus J

    2015-09-01

    The fitting accuracy of radial head components has been investigated in the capitulo-radial joint, and reduced contact after prosthetic replacement of the radial head has been observed. The kinematics of the proximal radioulnar joint (PRUJ) are affected by radial head arthroplasty as well, but have not yet been investigated in this regard. The elbow joints of 60 upper extremities of formalin-fixed body donors were disarticulated to obtain a good view of the PRUJ. Each specimen was mounted on the examining table and radial head position in the native PRUJ was assessed in neutral position, full pronation, and full supination. Measurements were repeated after implantation of mono- and bi-polar prostheses. Analysis of the distribution of the joint contacts in the compartments showed significant differences after radial head replacement. In comparison to the native joint, after bipolar and monopolar radial head replacement, the physiological shift of the proximal radius was altered. The physiological shift of the joint contact of the radial head from anterior to posterior during forearm rotation that was found in the native joint in our cadaver model was not observed after prosthetic replacement. With higher conformity and physiological kinematic of radial head prostheses, possibly lower shear forces and lower contact pressures would be generated. The tested radial head prostheses do not replicate the physiological kinematics of the radial head. Further development in the prosthesis design has to be made. The meticulous reconstruction of the annular ligament seems to be of importance to increase joint contact.

  13. 21 CFR 888.3540 - Knee joint patellofemoral polymer/metal semi-constrained cemented prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices... Medical Devices—Part I: Evaluation and Testing,’ ” (ii) “510(k) Sterility Review Guidance of 2/12/90 (K90... device intended to be implanted to replace part of a knee joint in the treatment of primary...

  14. Successful treatment of a patient after sudden loss of the disc in a Björk-Shiley convexo-concave mitral prosthesis.

    PubMed

    Scalia, D; Giacomin, A; Da Col, U; Valfre, C

    1987-10-01

    The patient's survival after minor strut fracture and migration of a Björk-Shiley mitral prosthetic disc is presented. The operation was carried out in two stages: first emergency replacement of the mitral prosthesis and, later, elective removal of the dislocated disc.

  15. 75 FR 9422 - Orthopaedic and Rehabilitation Devices Panel of the Medical Devices Advisory Committee; Notice of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-02

    ... repair of soft tissue injuries of the medial meniscus. In repairing and reinforcing medial meniscal... zone of the meniscus to provide sufficient vascularization. The CS reinforces soft tissue and provides a resorbable scaffold that is replaced by the patient's own soft tissue. The CS is not a prosthetic...

  16. Post-treatment glenoid classification system for total shoulder arthroplasty.

    PubMed

    Churchill, R Sean

    2012-04-01

    Over the past 10 years, numerous advancements in glenoid preparation and resurfacing have occurred. Current glenoid classification systems are either focused solely on the patient's preoperative glenoid bone configuration or on the available glenoid bone stock in revision arthroplasty cases. While these systems provide value in preoperative planning, they fail to properly classify the surgical reconstruction completed. A literature review of common bone preparation methods and sources of glenoid prosthetic failure was performed. Based upon this review, a classification system for grading the status of the glenoid after prosthetic implantation was developed. A 6 category, post-treatment, glenoid classification system is proposed: type 0: no reaming; type I: glenoid reaming into but not through the subchondral bone; type II: glenoid reaming which perforates through <50% of the subchondral bone surface area; type III: glenoid reaming which perforates through >50% of the subchondral bone surface area; type IV: use of structural bone graft; and type V: use of a posterior augmented glenoid prosthesis. Types I-III are further subdivided into subtype A which have 100% bone support of the prosthesis, and subtype B which have a region of unsupported prosthesis. The classification system proposed addresses the surgical management of the glenoid during prosthetic replacement. This unique approach to classifying the glenoid following surgical intervention will allow direct follow-up comparison of similarly treated glenoid replacements. Future multicenter studies, possibly through joint registry databases, could then determine the long-term efficacy of the various glenoid preparation methods. Copyright © 2012 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  17. Mycobacterium smegmatis infection of a prosthetic total knee arthroplasty.

    PubMed

    Saffo, Zaid; Ognjan, Anthony

    2016-01-01

    The most common organisms causing prosthetic knee joint infections are staphylococci. However, arthroplasty infections with atypical microbial pathogens, such as Mycobacteria can occur. Due to the rarity of mycobacterial prosthetic joint infections, diagnosis, treatment, and management of these atypical infections represent a clinical challenge. A 71-year old female post-operative day 40 after a left total knee arthroplasty was hospitalized secondary to left knee pain and suspected arthroplasty infection. She had failed outpatient oral antimicrobial treatment for superficial stitch abscess; and outpatient IV/Oral antimicrobials for a clinical postoperative septic bursitis. Ultimately, resection arthroplasty with operative tissue acid fast bacterial cultures demonstrated growth of the Mycobacterium smegmatis group. Post-operatively, she completed a combination course of oral doxycycline and levofloxacin and successfully completed a replacement arthroplasty with clinical and microbial resolution of the infection. To our knowledge, literature review demonstrates three case of knee arthroplasty infection caused by the Mycobacterium smegmatis group. Correspondingly, optimal surgical procedures and antimicrobial management including antimicrobial selection, treatment duration are not well defined. Presently, the best treatment options consists of two step surgical management including prosthesis hardware removal followed by extended antimicrobial therapy, followed by consideration for re-implantation arthroplasty. Our case illustrates importance of considering atypical mycobacterial infections in post-operative arthroplasty infections not responding to traditional surgical manipulations and antimicrobials. For an arthroplasty infection involving the atypical Mycobacterium smegmatis group, two step arthroplasty revision, including arthroplasty resection, with a combination of oral doxycycline and levofloxacin can lead to successful infection resolution, allowing for a successful replacement arthroplasty.

  18. Detection of thoracic aortic prosthetic graft infection with 18F-fluorodeoxyglucose positron emission tomography/computed tomography.

    PubMed

    Tokuda, Yoshiyuki; Oshima, Hideki; Araki, Yoshimori; Narita, Yuji; Mutsuga, Masato; Kato, Katsuhiko; Usui, Akihiko

    2013-06-01

    To investigate the diagnostic value of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in detecting thoracic aortic prosthetic graft infection. Nine patients with clinically suspected thoracic aortic graft infection underwent FDG-PET/CT scanning. In these patients, the diagnoses could not be confirmed using conventional modalities. The patients' clinical courses were retrospectively reviewed. On the basis of surgical, microbiological and clinical follow-up findings, the aortic grafts were considered infected in 4 patients and not infected in 5. All 4 patients with graft infection (root: 2 cases, arch: 1 case and descending: 1 case) eventually underwent in situ re-replacement. Two of the 4 patients also had abdominal grafts; however, only the thoracic grafts were replaced because uptake was low around the abdominal grafts. The maximal standardized uptake value (SUVmax) in the perigraft area was higher in the infected group than in the non-infected group (11.4 ± 4.5 vs 6.9 ± 6.4), although the difference was not statistically significant. According to the receiver operating characteristic analysis, SUVmax >8 appeared to be the cut-off value in distinguishing the two groups (sensitivity: 1.0 and specificity: 0.8). FDG-PET/CT is useful for confirming the presence of graft infection by detecting high uptake around grafts and excluding other causes of inflammation. An SUVmax value greater than 8 around a graft suggests the presence of graft infection. In addition, FDG-PET/CT can be used to clarify the precise extent of infection. This is especially useful if multiple separated prosthetic grafts have been implanted.

  19. Predicting 3D pose in partially overlapped X-ray images of knee prostheses using model-based Roentgen stereophotogrammetric analysis (RSA).

    PubMed

    Hsu, Chi-Pin; Lin, Shang-Chih; Shih, Kao-Shang; Huang, Chang-Hung; Lee, Chian-Her

    2014-12-01

    After total knee replacement, the model-based Roentgen stereophotogrammetric analysis (RSA) technique has been used to monitor the status of prosthetic wear, misalignment, and even failure. However, the overlap of the prosthetic outlines inevitably increases errors in the estimation of prosthetic poses due to the limited amount of available outlines. In the literature, quite a few studies have investigated the problems induced by the overlapped outlines, and manual adjustment is still the mainstream. This study proposes two methods to automate the image processing of overlapped outlines prior to the pose registration of prosthetic models. The outline-separated method defines the intersected points and segments the overlapped outlines. The feature-recognized method uses the point and line features of the remaining outlines to initiate registration. Overlap percentage is defined as the ratio of overlapped to non-overlapped outlines. The simulated images with five overlapping percentages are used to evaluate the robustness and accuracy of the proposed methods. Compared with non-overlapped images, overlapped images reduce the number of outlines available for model-based RSA calculation. The maximum and root mean square errors for a prosthetic outline are 0.35 and 0.04 mm, respectively. The mean translation and rotation errors are 0.11 mm and 0.18°, respectively. The errors of the model-based RSA results are increased when the overlap percentage is beyond about 9%. In conclusion, both outline-separated and feature-recognized methods can be seamlessly integrated to automate the calculation of rough registration. This can significantly increase the clinical practicability of the model-based RSA technique.

  20. Implant Rehabilitation Planning Protocol for the Edentulous Patient According to Denture Space, Lip Support, and Smile Line.

    PubMed

    Lago, Laura; Rilo, Benito; Fernández-Formoso, Noelia; DaSilva, Luis

    2017-08-01

    Rehabilitation with implants is a challenge. Having previous evaluation criteria is key to establishing the best treatment for the patient. In addition to clinical and radiological aspects, the prosthetic parameters must be taken into account in the initial workup, since they allow discrimination between fixed and removable rehabilitation. We present a study protocol that analyzes three basic prosthetic aspects. First, denture space defines the need to replace teeth, tissue, or both. Second, lip support focuses on whether or not to include a flange. Third, the smile line warns of potential risks in esthetic rehabilitation. Combining these parameters allows us to make a decision as to the most suitable type of prosthesis. The proposed protocol is useful for assessing the prosthetic parameters that influence decision making as to the best-suited type of restoration. From this point of view, we think it is appropriate for the initial approach to the patient. In any case, other considerations of study may amend the proposal. © 2016 by the American College of Prosthodontists.

  1. A financial analysis of revision hip arthroplasty: the economic burden in relation to the national tariff.

    PubMed

    Vanhegan, I S; Malik, A K; Jayakumar, P; Ul Islam, S; Haddad, F S

    2012-05-01

    Revision arthroplasty of the hip is expensive owing to the increased cost of pre-operative investigations, surgical implants and instrumentation, protracted hospital stay and drugs. We compared the costs of performing this surgery for aseptic loosening, dislocation, deep infection and peri-prosthetic fracture. Clinical, demographic and economic data were obtained for 305 consecutive revision total hip replacements in 286 patients performed at a tertiary referral centre between 1999 and 2008. The mean total costs for revision surgery in aseptic cases (n = 194) were £11 897 (sd 4629), for septic revision (n = 76) £21 937 (sd 10 965), for peri-prosthetic fracture (n = 24) £18 185 (sd 9124), and for dislocation (n = 11) £10 893 (sd 5476). Surgery for deep infection and peri-prosthetic fracture was associated with longer operating times, increased blood loss and an increase in complications compared to revisions for aseptic loosening. Total inpatient stay was also significantly longer on average (p < 0.001). Financial costs vary significantly by indication, which is not reflected in current National Health Service tariffs.

  2. Total elbow arthroplasty in primary osteoarthritis of the elbow.

    PubMed

    Kozak, T K; Adams, R A; Morrey, B F

    1998-10-01

    Primary osteoarthritis of the elbow is an infrequent condition typically managed by some form of debridement. There is no comment in the literature regarding prosthetic replacement for this condition. We report 5 patients (mean age, 68), with a minimum assessment of 3 years (range, 37-125 years) after total elbow arthroplasty. Complications in 4 patients included subluxation, fracture of a humeral component with particulate synovitis, heterotopic ossification, recurrent osteophyte formation, and transient ulnar neuropathy. Although revision was required in 2 of the 5, currently all experience had satisfactory outcomes. While replacement has proven ultimately to be a successful option for this high-demand patient group because of the high complication rate, we do not recommend replacement unless alternate operative options are deemed unacceptable.

  3. Neutral Buoyancy Test - Hubble Space Telescope Scientific Instruments (SI)

    NASA Technical Reports Server (NTRS)

    1979-01-01

    The Hubble Space Telescope (HST) is a cooperative program of the European Space Agency (ESA) and the National Aeronautical and Space Administration (NASA) to operate a long-lived space-based observatory. It was the first and flagship mission of NASA's Great Observatories program. The HST program began as an astronomical dream in the 1940s. During the 1970s and 1980s, the HST was finally designed and built becoming operational in the 1990s. The HST was deployed into a low-Earth orbit on April 25, 1990 from the cargo bay of the Space Shuttle Discovery (STS-31). The design of the HST took into consideration its length of service and the necessity of repairs and equipment replacement by making the body modular. In doing so, subsequent shuttle missions could recover the HST, replace faulty or obsolete parts and be re-released. Pictured is MSFC's Neutral Buoyancy Simulator that served as the test center for shuttle astronauts training for Hubble related missions. Shown is an astronaut training on a mock-up of a modular section of the HST in the removal and replacement of scientific instruments.

  4. Training needs for general dentistry residents to place and restore two-implant-retained mandibular overdentures.

    PubMed

    Malmstrom, Hans; Xiao, Jin; Romanos, Georgios E; Ren, Yan-Fang

    2015-01-01

    Implant therapy is rapidly becoming a standard of care for replacing missing dentition. Predoctoral dental curricula include some training in the implant restorative phase but offer limited exposure to the surgical phase, so it is important for postdoctoral general dentistry residency programs to provide competency training in all phases of implant therapy. The aim of this study was to determine the training needed for general dentistry residents to achieve competence in this area, specifically by defining the number of clinical experiences necessary in both the surgical and prosthetic phases of implant-retained mandibular overdenture construction (IRMOD). Fifteen Advanced Education in General Dentistry (AEGD) residents at one academic dental institution placed two implants in a total of 50 patients with edentulous mandibles and subsequently restored them with IRMOD. The supervising faculty member and the residents evaluated the competency level on a five-point scale after each implant placement and prosthetic case completion. According to the faculty evaluations, the residents achieved surgical competence after placing two implants in four to six cases and prosthetic management competence after restoring two to four cases of IRMOD. All 50 patients were satisfied with the treatment outcomes of IRMOD. This study concluded that general dentistry residents could potentially achieve competence in both the surgical and prosthetic phases of implant therapy while enrolled in an AEGD program.

  5. Early Transcatheter Aortic Valve Function With and Without Therapeutic Anticoagulation.

    PubMed

    Hiremath, Pranoti G; Kearney, Kathleen; Smith, Bryn; Don, Creighton; Dvir, Danny; Aldea, Gabriel; Reisman, Mark; McCabe, James M

    2017-11-01

    Prosthetic leaflet thrombosis is a growing concern in transcatheter aortic valve replacement (TAVR). Given the uncertainty of best practices for antiplatelet and anticoagulation therapies in the post-TAVR period, additional evidence regarding the impact of anticoagulation on prosthetic valve function after TAVR is needed. Patients undergoing native-valve TAVR at a single academic institution between 2012 and 2015 were analyzed based on any anticoagulant use at hospital discharge post TAVR. Changes in prosthetic valve peak velocity and mean gradient were assessed based on transthoracic echocardiograms performed immediately following valve implant and at 4-week follow-up. Multivariate regression analyses were performed to explore the impact of anticoagulation status on early TAVR valve performance. For 403 patients, there were no available data to analyze. Of those, 29.6% were discharged on anticoagulation. Following TAVR, the average mean prosthetic valve gradient was 11.8 ± 5.6 mm Hg and peak velocity was 2.33 ± 0.52 m/s. There were no significant differences between anticoagulated and non-anticoagulated groups in the mean or peak gradients or velocity immediately following implant or at 4 weeks, which remained true following multivariate adjustment (P=.80 for delta mean gradient; P=.91 for delta peak velocity). Our data suggest that the absence of anticoagulation is not associated with short-term degradation in TAVR performance and do not support the routine use of anticoagulation following native-valve TAVR.

  6. Cryopreserved Human Allografts for the Reconstruction of Aortic and Peripheral Prosthetic Graft Infection.

    PubMed

    Bossi, Matteo; Tozzi, Matteo; Franchin, Marco; Ferraro, Stefania; Rivolta, Nicola; Ferrario, Massimo; Guttadauro, Chiara; Castelli, Patrizio; Piffaretti, Gabriele

    2017-12-25

    Background : This study aimed to present cases with cryopreserved human allografts (CHAs) for vascular reconstruction in both aortic and peripheral infected prosthetic grafts. Materials and Methods : This is a single center, observational descriptive study with retrospective analysis. In all cases, the infected prosthetic graft material was completely removed. At discharge, patients were administered anticoagulants. Follow-up examinations included clinical visits, echo-color-Doppler ultrasounds, or computed tomography angiography within 30 days and at 3, 6, and 12 months after the treatment, and then twice per year. Results : We treated 21 patients (90% men, n=19) with the mean age of 71±12 years and mean interval between the initial operation and replacement with CHA of 30 months [range, 1-216; interquartile range (IQR), 2-36]. In-hospital mortality was 14% (n=3); no CHA-related complication led to death. Limb salvage was 100%. No patient was lost at the median follow-up of 14 months (range, 2-61; IQR, 6-39). No rupture, aneurysmal degeneration, or re-infection occurred. Estimated freedom from CHA-related adverse events (95% confidence interval, 43-63) was 95% at 3 years. Conclusion : In our experience, CHAs are a viable option for prosthetic graft infections and provide satisfactory clinical results and favorable stability because of a very low rate of CHA-related adverse events during follow-up.

  7. The electrical properties and glass transition of some dental materials after temperature exposure.

    PubMed

    Marcinkowska, Agnieszka; Gauza-Wlodarczyk, Marlena; Kubisz, Leszek; Hedzelek, Wieslaw

    2017-10-17

    The physicochemical properties of dental materials will remain stable only when these materials in question are resistant to the changes in the oral cavity. The oral environment is subject to large temperature variations. The aim of the study was the assessment of electrical properties and glass transition of some dental materials after temperature exposure. Composite materials, compomers, materials for temporary prosthetic replacement and resin-based pit and fissure sealants were used in the study. The method used was electric conductivity of materials under changing temperature. The order of materials presenting the best characteristics for insulators was as follows: materials for temporary prosthetic replacement, resin-based pit and fissure sealants, composites, and compomers. Thanks to comparisons made between graphs during I and II heating run, the method could be used to observe changes in the heated material and determine whether the changes observed are reversible or permanent. The graphs also provided temperature values which contain information on glass transition during heating. In the oral cavity the effect of the constant temperature stimulus influences maturity of dental materials and improves their properties. But high temperatures over glass transition temperature can cause irreversible deformation and changes of the materials properties, even in a short time.

  8. The Evolution of Dental Materials for Hybrid Prosthesis

    PubMed Central

    Gonzalez, Jorge

    2014-01-01

    Since the immemorial, the replacement of missing teeth has been a medical and cosmetic necessity for human kind. Nowadays, middle-aged population groups have experienced improved oral health, as compared to previous generations, and the percentage of edentulous adults can be expected to further decline. However, with the continued increase in the number of older adult population, it is anticipated that the need for some form of full-mouth restoration might increase from 53.8 million in 1991 to 61 million in 2020 [1]. Denture prosthetics has undergone many development stages since the first dentures were fabricated. The introduction of computer-aided design/computer aided manufacturing (CAD/CAM) has resulted in a more accurate manufacturing of prosthetic frameworks, greater accuracy of dental restorations, and in particular, implant supported prosthesis. PMID:24893781

  9. Prosthetic valve endocarditis.

    PubMed Central

    Moore-Gillon, J; Eykyn, S J; Phillips, I

    1983-01-01

    During 1965 to 1982, 32 episodes of infective endocarditis on prosthetic valves in 30 patients were treated at this hospital. In early endocarditis (presenting within four months of operation) staphylococci were the organisms most commonly responsible. Early endocarditis appears to be declining in incidence and is largely preventable; sternal sepsis was the main predisposing factor, requiring urgent and effective treatment. Streptococci were the most common organisms in late onset disease, but as with natural valve endocarditis a wide range or organisms was responsible. All but one of the patients with early onset disease were treated conservatively, but mortality was high; prompt surgical replacement of infected prostheses is probably indicated in such patients. Medical management was effective in most patients with late onset disease, and for them early surgical intervention may not be justified. PMID:6412805

  10. Complete Transversal Disc Fracture in a Björk-Shiley Delrin Mitral Valve Prosthesis 43 Years After Implantation.

    PubMed

    González-Santos, Jose María; Arnáiz-García, María Elena; Dalmau-Sorlí, María José; Sastre-Rincón, Jose Alfonso; Hernández-Hernández, Jesús; Pérez-Losada, María Elena; Sagredo-Meneses, Víctor; López-Rodríguez, Javier

    2016-10-01

    A patient who underwent previous implantation of a mitral valve replacement with a Björk-Shiley Delrin (BSD) mitral valve prosthesis during infancy was admitted to our institution 43 years later after an episode of syncope and cardiac arrest. Under extreme hemodynamic instability, a mitral valve prosthetic dysfunction causing massive mitral regurgitation was identified. The patient underwent an emergent cardiac operation, and a complete disc fracture with partial disc migration was found. Exceptional cases of mechanical prosthetic heart valve fracture exist. We report the first case of complete transversal disc rupture of a BSD mitral valve prosthesis after the longest period of implantation ever reported in that position. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  11. Total hip replacement infected with Mycobacterium tuberculosis complicated by Addison disease and psoas muscle abscess: a case report.

    PubMed

    De Nardo, Pasquale; Corpolongo, Angela; Conte, Aristide; Gentilotti, Elisa; Narciso, Pasquale

    2012-01-10

    Prosthetic joint infection due to Mycobacterium tuberculosis is occasionally encountered in clinical practice. To the best of our knowledge, this is the first report of a prosthetic joint infection due to Mycobacterium tuberculosis complicated by psoas abscesses and secondary Addison disease. A 67-year-old immunocompetent Caucasian woman underwent total left hip arthroplasty because of osteoarthritis. After 18 months, she underwent arthroplasty revision for a possible prosthetic infection. Periprosthetic tissue specimens for bacteria were negative, and empirical antibiotic therapy was unsuccessful. She was then admitted to our department because of complications arising 22 months after arthroplasty. A physical examination revealed a sinus tract overlying her left hip and skin and mucosal pigmentation. Her levels of C-reactive protein, basal cortisol, adrenocorticotropic hormone, and sodium were out of normal range. Results of the tuberculin skin test and QuantiFERON-TB Gold test were positive. Computed tomography revealed a periprosthetic abscess and the inclusion of the left psoas muscle. Results of microbiological tests were negative, but polymerase chain reaction of a specimen taken from the hip fistula was positive for Mycobacterium tuberculosis. Our patient's condition was diagnosed as prosthetic joint infection and muscle psoas abscess due to Mycobacterium tuberculosis and secondary Addison disease. She underwent standard treatment with rifampicin, ethambutol, isoniazid, and pyrazinamide associated with hydrocortisone and fludrocortisone. At 15 months from the beginning of therapy, she was in good clinical condition and free of symptoms. Prosthetic joint infection with Mycobacterium tuberculosis is uncommon. A differential diagnosis of tuberculosis should be considered when dealing with prosthetic joint infection, especially when repeated smears and histology examination from infected joints are negative. Clinical outcomes of prosthetic joint infection by Mycobacterium tuberculosis are unpredictable, especially given the limited literature in this field and the uncertainty of whether medical treatment alone can eradicate the infection without prosthesis removal. Furthermore, this case report raises interesting issues such as the necessity of a follow-up evaluation after treatment based on clinical conditions, the utility of a more standardized length of treatment for periprosthetic tuberculous infection, and the importance of a high diffusion capacity of anti-mycobacterial agents in order to eradicate the infection.

  12. Oral health-related quality of life and prosthetic status of nursing home residents with or without dementia.

    PubMed

    Klotz, Anna-Luisa; Hassel, Alexander Jochen; Schröder, Johannes; Rammelsberg, Peter; Zenthöfer, Andreas

    2017-01-01

    The objective of this cross-sectional study was to evaluate the effect of prosthetic status on the oral health-related quality of life (OHRQoL) of nursing home residents with or without dementia. The study was performed in 14 nursing homes across the federal state of Baden-Württemberg, Germany. All eligible participants were included, and general and medical information and information about their dental and prosthetic statuses were collected. The Geriatric Oral Health Assessment Index (GOHAI) was administered to evaluate OHRQoL. The Mini-Mental State Examination (MMSE) served to classify participants into living or not living with dementia according to the established cutoff value for dementia (MMSE <24). Parametric bivariate statistics and logistic regression models were used to analyze data at P <0.05. A total of 169 participants were included in this study. The mean age of the participants was 82.9 years. A total of some 70% of the sample was living with dementia. The mean GOHAI score along the sample was 49.1 (8.3), and 41% of the sample reported substantially compromised OHRQoL (GOHAI <50). OHRQoL was statistically similar for people with or without dementia ( P =0.234); objective oral health was also similar in both groups ( P >0.05). The number of teeth (odds ratio [OR]: 2.0), the type of prosthetic status (OR: 6.5), and denture-related treatment needs (OR: 2.4) were the major factors significantly affecting OHRQoL ( P <0.05). The OHRQoL of elderly nursing home residents is substantially compromised. Several prosthetic treatment needs for residents living with or without dementia were identified. Edentulism without tooth replacement and having <5 teeth resulted in an increased risk of substantially compromised OHRQoL. Further studies should be conducted to determine whether improvements in prosthetic status can increase OHRQoL.

  13. Impact of pannus formation on hemodynamic dysfunction of prosthetic aortic valve: pannus extent and its relationship to prosthetic valve motion and degree of stenosis.

    PubMed

    Koo, Hyun Jung; Ha, Hojin; Kang, Joon-Won; Kim, Jeong A; Song, Jae-Kwan; Kim, Hwa Jung; Lim, Tae-Hwan; Yang, Dong Hyun

    2018-02-19

    Although pannus is an important cause of prosthetic valve dysfunction, the minimum pannus size that can induce hemodynamic dysfunction has not yet been determined. This study investigated the correlation between the limitation of motion (LOM) of the prosthetic valve and pannus extent and determined the pannus extent that could induce severe aortic stenosis. This study included 49 patients who underwent mechanical aortic valve replacement (AVR) and showed pannus on cardiac computed tomography (CT). Pannus width, ratio of pannus width to valve diameter, pannus area, effective orifice area, encroachment ratio by pannus, pannus involvement angle and percent LOM of mechanical valves were evaluated on CT. Transvalvular peak velocity (TPV) and transvalvular pressure gradient (TPG) were measured by transesophageal echocardiography to determine the degree of aortic stenosis. The relationship between percent LOM of the prosthetic valve and pannus extent and the cut-off of pannus extent required to induce severe aortic stenosis were evaluated. The mean interval between AVR and pannus formation was 11 years and was longer in patients with than without severe aortic stenosis (14.0 vs. 7.3 years). On CT, the percent LOM of the prosthetic valve was significantly associated with the extent of pannus only in patients with pannus involvement angle > 180° (r = 0.55-0.68, P < 0.01). Pannus width, effective orifice area, and encroachment ratio were significantly associated with increased TPV and TPG (r = 0.51-0.62, P < 0.01). Pannus width > 3.5 mm, pannus width/valve inner diameter > 0.15, and encroachment ratio > 0.14 were significantly associated with severe aortic stenosis (TPV > 4 m/s; mean TPG ≥ 35 mmHg), with c-indices of 0.74-079 (P < 0.005). CT-derived pannus extent parameters are good indicators of significant hemodynamic changes with increased TPV and mean TPG.

  14. Modular error embedding

    DOEpatents

    Sandford, II, Maxwell T.; Handel, Theodore G.; Ettinger, J. Mark

    1999-01-01

    A method of embedding auxiliary information into the digital representation of host data containing noise in the low-order bits. The method applies to digital data representing analog signals, for example digital images. The method reduces the error introduced by other methods that replace the low-order bits with auxiliary information. By a substantially reverse process, the embedded auxiliary data can be retrieved easily by an authorized user through use of a digital key. The modular error embedding method includes a process to permute the order in which the host data values are processed. The method doubles the amount of auxiliary information that can be added to host data values, in comparison with bit-replacement methods for high bit-rate coding. The invention preserves human perception of the meaning and content of the host data, permitting the addition of auxiliary data in the amount of 50% or greater of the original host data.

  15. Appraisal of evidence base for introduction of new implants in hip and knee replacement: a systematic review of five widely used device technologies.

    PubMed

    Nieuwenhuijse, Marc J; Nelissen, R G H H; Schoones, J W; Sedrakyan, A

    2014-09-09

    To determine the evidence of effectiveness and safety for introduction of five recent and ostensibly high value implantable devices in major joint replacement to illustrate the need for change and inform guidance on evidence based introduction of new implants into healthcare. Systematic review of clinical trials, comparative observational studies, and registries for comparative effectiveness and safety of five implantable device innovations. PubMed (Medline), Embase, Web of Science, Cochrane, CINAHL, reference lists of articles, annual reports of major registries, summaries of safety and effectiveness for pre-market application and mandated post-market studies at the US Food and Drug Administration. The five selected innovations comprised three in total hip replacement (ceramic-on-ceramic bearings, modular femoral necks, and uncemented monoblock cups) and two in total knee replacement (high flexion knee replacement and gender specific knee replacement). All clinical studies of primary total hip or knee replacement for symptomatic osteoarthritis in adults that compared at least one of the clinical outcomes of interest (patient centred outcomes or complications, or both) in the new implant group and control implant group were considered. Data searching, abstraction, and analysis were independently performed and confirmed by at least two authors. Quantitative data syntheses were performed when feasible. After assessment of 10,557 search hits, 118 studies (94 unique study cohorts) met the inclusion criteria and reported data related to 15,384 implants in 13,164 patients. Comparative evidence per device innovation varied from four low to moderate quality retrospective studies (modular femoral necks) to 56 studies of varying quality including seven high quality (randomised) studies (high flexion knee replacement). None of the five device innovations was found to improve functional or patient reported outcomes. National registries reported two to 12 year follow-up for revision occurrence related to more than 200,000 of these implants. Reported comparative data with well established alternative devices (over 1,200,000 implants) did not show improved device survival. Moreover, we found higher revision occurrence associated with modular femoral necks (hazard ratio 1.9) and ceramic-on-ceramic bearings (hazard ratio 1.0-1.6) in hip replacement and with high flexion knee implants (hazard ratio 1.0-1.8). We did not find convincing high quality evidence supporting the use of five substantial, well known, and already implemented device innovations in orthopaedics. Moreover, existing devices may be safer to use in total hip or knee replacement. Improved regulation and professional society oversight are necessary to prevent patients from being further exposed to these and future innovations introduced without proper evidence of improved clinical efficacy and safety. © Nieuwenhuijse et al 2014.

  16. Appraisal of evidence base for introduction of new implants in hip and knee replacement: a systematic review of five widely used device technologies

    PubMed Central

    Nieuwenhuijse, Marc J; Nelissen, R G H H; Schoones, J W

    2014-01-01

    Objective To determine the evidence of effectiveness and safety for introduction of five recent and ostensibly high value implantable devices in major joint replacement to illustrate the need for change and inform guidance on evidence based introduction of new implants into healthcare. Design Systematic review of clinical trials, comparative observational studies, and registries for comparative effectiveness and safety of five implantable device innovations. Data sources PubMed (Medline), Embase, Web of Science, Cochrane, CINAHL, reference lists of articles, annual reports of major registries, summaries of safety and effectiveness for pre-market application and mandated post-market studies at the US Food and Drug Administration. Study selection The five selected innovations comprised three in total hip replacement (ceramic-on-ceramic bearings, modular femoral necks, and uncemented monoblock cups) and two in total knee replacement (high flexion knee replacement and gender specific knee replacement). All clinical studies of primary total hip or knee replacement for symptomatic osteoarthritis in adults that compared at least one of the clinical outcomes of interest (patient centred outcomes or complications, or both) in the new implant group and control implant group were considered. Data searching, abstraction, and analysis were independently performed and confirmed by at least two authors. Quantitative data syntheses were performed when feasible. Results After assessment of 10 557 search hits, 118 studies (94 unique study cohorts) met the inclusion criteria and reported data related to 15 384 implants in 13 164 patients. Comparative evidence per device innovation varied from four low to moderate quality retrospective studies (modular femoral necks) to 56 studies of varying quality including seven high quality (randomised) studies (high flexion knee replacement). None of the five device innovations was found to improve functional or patient reported outcomes. National registries reported two to 12 year follow-up for revision occurrence related to more than 200 000 of these implants. Reported comparative data with well established alternative devices (over 1 200 000 implants) did not show improved device survival. Moreover, we found higher revision occurrence associated with modular femoral necks (hazard ratio 1.9) and ceramic-on-ceramic bearings (hazard ratio 1.0-1.6) in hip replacement and with high flexion knee implants (hazard ratio 1.0-1.8). Conclusion We did not find convincing high quality evidence supporting the use of five substantial, well known, and already implemented device innovations in orthopaedics. Moreover, existing devices may be safer to use in total hip or knee replacement. Improved regulation and professional society oversight are necessary to prevent patients from being further exposed to these and future innovations introduced without proper evidence of improved clinical efficacy and safety. PMID:25208953

  17. A generalization of Cesàro sequence spaces in the Orlicz space

    NASA Astrophysics Data System (ADS)

    Haryadi; Supama; Zulijanto, A.

    2018-04-01

    In this paper, we generalize the Cesàro sequence spaces in the classic Banach space Lp to the generalized Orlicz space Lφ . We construct the space by replacing the norm {\\Vert \\cdot \\Vert }p in Lp with modular ρφ in Lφ . This generalization has lead to the use of the Luxemburg norm to discuss some topological properties of the spaces. We prove results regarding to modular and norm convergence. We also describe some properties of the spaces and a closed subspaces of the space.

  18. Improvement of chronic corneal opacity in ocular surface disease with prosthetic replacement of the ocular surface ecosystem (PROSE) treatment.

    PubMed

    Cressey, Anna; Jacobs, Deborah S; Remington, Crystal; Carrasquillo, Karen G

    2018-06-01

    To demonstrate clearing of chronic corneal opacities and improvement of visual acuity with the use of BostonSight prosthetic replacement of the ocular surface ecosystem (PROSE) treatment in ocular surface disease. We undertook retrospective analysis of the medical records of a series of patients who underwent PROSE treatment from August 2006 to December 2014. Patients were referred for ocular surface disease of various etiologies. Primary inclusion criterion was corneal opacity that improved with PROSE treatment. Patients were excluded if topical steroids or adjuvant therapy used once PROSE treatment was initiated. Underlying disease, prior treatment, clinical presentation, and clinical course were extracted from the medical record. Four patients are included in this series. There were three females and one male; median age at time of treatment initiation was 30 years (range = 0.5-58 years). Median duration of PROSE treatment at time of retrospective analysis was 3.5 years (range = 1-8 years). Two cases had corneal opacification in the context of neurotrophic keratopathy: a unilateral case due to presumed herpes simplex keratitis and a bilateral case due to congenital corneal anesthesia associated with familial dysautonomia. One case had corneal opacity from exposure related to seventh nerve palsy, and one had corneal opacification associated with recurrent surface breakdown, neurotrophic keratopathy, and limbal stem deficiency of uncertain etiology. After consistent wear of prosthetic devices used in PROSE treatment for support of the ocular surface, visual acuity improved and clearing of the opacities was observed, without use of topical steroids or adjuvant therapy. These cases demonstrate clearing of chronic corneal opacity with PROSE treatment for ocular surface disease. This clearing can occur with no adjuvant therapy, suggesting that restoration of ocular surface function and integrity allows for corneal remodeling.

  19. Temporomandibular joint arthroplasty for osteoarthrosis: A series of 24 patients that received a uni- or bilateral inter-positional silicone sheet.

    PubMed

    Boutault, F; Cavallier, Z; Lauwers, F; Prevost, A

    2018-06-01

    To evaluate mid-term results from using a silicone sheet for inter-positional arthroplasty in moderate or severe cases of osteoarthrosis of the temporo-mandibular joint (TMJ). To also determine any remaining indications from this method. This retrospective study included patients that underwent surgery between 2008 and 2016. Pre- and post-operative mouth opening (MO), according to inter-incisal distance (mm) and pain score (PS: 0=no pain to 4=very severe pain) were recorded for 24 patients. Patients were divided according to thickness of the silicone sheet (group A: 1.0 mm, group B: 1.5 mm). The cohort included 22 females (92%). Mean age at surgery was 55 years±13 (26-80). Mean length of follow-up was 26 months±24 (6-80). Mean improvement in MO was 8.2 mm (+33%) and of PS was 1.7 (-68%). MO was not improved for two patients and worsened for one. PS score improved for all patients. No statistical difference was found between groups A and B. There was also a tendency for degradation of outcomes over time. The poor reputation of prosthetic discoplasty was not as evident in our series, even though anatomical and functional status seemed to deteriorate over time. This is because total-joint prosthetic replacement is often proposed instead. However, for elderly or fragile patients that have severe pain, and regarding cost-benefit aspects, conventional arthroplasty can still be discussed, especially since French national health-care insurance does not yet support TMJ prosthetic replacement for osteoarthrosis. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

  20. Polyethylene wear debris in modular acetabular prostheses.

    PubMed

    Chen, P C; Mead, E H; Pinto, J G; Colwell, C W

    1995-08-01

    The longevity of total hip arthroplasty has brought forth the recognition of aseptic loosening of prosthetic components as the leading cause of implant failure. Modularity of implants, although a significant improvement in versatility, may increase debris formation, a recognized cause of implant failure. This study was designed to measure the relative motion, and to assess the polyethylene wear debris production at the interface between the metal acetabular shell and the back side of the polyethylene liner, in modular hip prostheses. Five models from 4 manufacturers with different locking mechanisms and acetabular shell surface treatments were tested under long-term simultaneous sinusoidal and static loading (10(7) cycles at 3 Hz with +/- 2.5 Nmeter and 220 N static load). Results showed that there were marked differences in the security of the acetabular shell and polyethylene liner locking mechanism, wear pattern, damage sites, and amount of polyethylene debris on the acetabular shell and polyethylene liner surfaces. The range of polyethylene liner motion observed among the 5 models during 1 cycle of testing varied from an average of 0.96 degrees to movement too small to be detected by the test machines. Image and scanning electron microscopy analysis showed different wear patterns and a wide range in the average polyethylene liner surface wear area (0.26 cm2-4.61 cm2). In general, a stable locking mechanism and a smooth acetabular shell surface are essential in minimizing polyethylene liner wear and polyethylene debris production.

  1. Mitral valve replacement with the Hancock stabilized glutaraldehyde valve. Clinical and laboratory evaluation.

    PubMed

    Buch, W S; Pipkin, R D; Hancock, W D; Fogarty, T J

    1975-11-01

    From March 1971 through April 1975, one hundred twenty patients underwent mitral valve replacement with a Hancock "stabilized glutaraldehyde process" porcine aortic xenograft. A simultaneous canine experimental series was also carried out. In the clinical series, the early mortality was 8.3%. Actuarial analyses of all patients predicts survival at two years of 81.0% and at four years of 70.0%. The predicted survival for patients without coronary disease or prior prosthetic valve replacement is 87.5% at two years and 77.5% at four years. There were four thromboembolic episodes, a rate of 2.4% per patient-year. None were fatal. No valve failure were noted. Histologic examination and shrink temperature analysis of recovered valves show excellent tissue preservation at 40 months. The data indicate that the Hancock valve is durable, enjoys a low incidence of thromboembolism, and may be the valve of choice for mitral valve replacement.

  2. A dynamic model-based approach to motion and deformation tracking of prosthetic valves from biplane x-ray images.

    PubMed

    Wagner, Martin G; Hatt, Charles R; Dunkerley, David A P; Bodart, Lindsay E; Raval, Amish N; Speidel, Michael A

    2018-04-16

    Transcatheter aortic valve replacement (TAVR) is a minimally invasive procedure in which a prosthetic heart valve is placed and expanded within a defective aortic valve. The device placement is commonly performed using two-dimensional (2D) fluoroscopic imaging. Within this work, we propose a novel technique to track the motion and deformation of the prosthetic valve in three dimensions based on biplane fluoroscopic image sequences. The tracking approach uses a parameterized point cloud model of the valve stent which can undergo rigid three-dimensional (3D) transformation and different modes of expansion. Rigid elements of the model are individually rotated and translated in three dimensions to approximate the motions of the stent. Tracking is performed using an iterative 2D-3D registration procedure which estimates the model parameters by minimizing the mean-squared image values at the positions of the forward-projected model points. Additionally, an initialization technique is proposed, which locates clusters of salient features to determine the initial position and orientation of the model. The proposed algorithms were evaluated based on simulations using a digital 4D CT phantom as well as experimentally acquired images of a prosthetic valve inside a chest phantom with anatomical background features. The target registration error was 0.12 ± 0.04 mm in the simulations and 0.64 ± 0.09 mm in the experimental data. The proposed algorithm could be used to generate 3D visualization of the prosthetic valve from two projections. In combination with soft-tissue sensitive-imaging techniques like transesophageal echocardiography, this technique could enable 3D image guidance during TAVR procedures. © 2018 American Association of Physicists in Medicine.

  3. Ten-dimensional anthropomorphic arm control in a human brain-machine interface: difficulties, solutions, and limitations

    NASA Astrophysics Data System (ADS)

    Wodlinger, B.; Downey, J. E.; Tyler-Kabara, E. C.; Schwartz, A. B.; Boninger, M. L.; Collinger, J. L.

    2015-02-01

    Objective. In a previous study we demonstrated continuous translation, orientation and one-dimensional grasping control of a prosthetic limb (seven degrees of freedom) by a human subject with tetraplegia using a brain-machine interface (BMI). The current study, in the same subject, immediately followed the previous work and expanded the scope of the control signal by also extracting hand-shape commands from the two 96-channel intracortical electrode arrays implanted in the subject’s left motor cortex. Approach. Four new control signals, dictating prosthetic hand shape, replaced the one-dimensional grasping in the previous study, allowing the subject to control the prosthetic limb with ten degrees of freedom (three-dimensional (3D) translation, 3D orientation, four-dimensional hand shaping) simultaneously. Main results. Robust neural tuning to hand shaping was found, leading to ten-dimensional (10D) performance well above chance levels in all tests. Neural unit preferred directions were broadly distributed through the 10D space, with the majority of units significantly tuned to all ten dimensions, instead of being restricted to isolated domains (e.g. translation, orientation or hand shape). The addition of hand shaping emphasized object-interaction behavior. A fundamental component of BMIs is the calibration used to associate neural activity to intended movement. We found that the presence of an object during calibration enhanced successful shaping of the prosthetic hand as it closed around the object during grasping. Significance. Our results show that individual motor cortical neurons encode many parameters of movement, that object interaction is an important factor when extracting these signals, and that high-dimensional operation of prosthetic devices can be achieved with simple decoding algorithms. ClinicalTrials.gov Identifier: NCT01364480.

  4. Evaluation of p53 Polymorphism in Patients with Pannus-Derived Prosthetic Dysfunction.

    PubMed

    Gursoy, Mustafa Ozan; Karakoyun, Suleyman; Kalcik, Macit; Yesin, Mahmut; Gunduz, Sabahattin; Astarcioğlu, Mehmet Ali; Oğuz, Ali Emrah; Ozkan, Mehmet

    2015-09-01

    Prosthetic valve dysfunction (PVD) due to pannus formation is considered to occur due to a bioreaction to prosthetic material. The p53 gene plays a critical role in apoptosis and cell proliferation. p53 Arg72Pro polymorphism has been found to be associated with coronary stent restenosis, but has not yet been studied in prosthetic heart valve dysfunction. The study aim was to evaluate the association between pannus-derived PVD and p53 G72C(Arg72Pro) polymorphism. This single-center, prospective study included 25 patients (20 females, five males; mean age 45.6 +/- 12.5 years; group 1) who underwent redo valve surgery due to PVD, and 49 age- and gender-matched control patients (44 females, five males; mean age 47.3 +/- 12.2 years; group 2) with normofunctional prostheses. The prostheses were examined using transthoracic and transesophageal echocardiography. Analyses of p53 G72C(Arg72Pro) polymorphism were performed using Roche LightCyler 2.0 Real-time polymerase chain reaction. The most common location of replaced valves was the mitral position in both groups (88% and 89.8%, respectively). In group 1, normal alleles (GG) were observed in 12 patients (48%), while one patient (4%) showed a homozygous mutation (GC) and 12 patients (48%) showed a heterozygous mutation (CC). In group 2, 21 patients (42.9%) had normal alleles (GG), while four (8.2%) had a homozygous mutation (CC) and 24 (48.9%) had a heterozygous mutation (GC). No significant difference was observed between the groups with regards to p53 Arg72Pro polymorphism (p = 0.769). In patients with prosthetic valves, the underlying mechanism behind pannus formation is unrelated to p53 Arg72Pro polymorphism.

  5. Does the Use of a Decision Aid Improve Decision Making in Prosthetic Heart Valve Selection? A Multicenter Randomized Trial.

    PubMed

    Korteland, Nelleke M; Ahmed, Yunus; Koolbergen, David R; Brouwer, Marjan; de Heer, Frederiek; Kluin, Jolanda; Bruggemans, Eline F; Klautz, Robert J M; Stiggelbout, Anne M; Bucx, Jeroen J J; Roos-Hesselink, Jolien W; Polak, Peter; Markou, Thanasie; van den Broek, Inge; Ligthart, Rene; Bogers, Ad J J C; Takkenberg, Johanna J M

    2017-02-01

    A Dutch online patient decision aid to support prosthetic heart valve selection was recently developed. A multicenter randomized controlled trial was conducted to assess whether use of the patient decision aid results in optimization of shared decision making in prosthetic heart valve selection. In a 5-center randomized controlled trial, patients were allocated to receive either standard preoperative care (control group) or additional access to the patient decision aid (intervention group). Legally capable adult patients accepted for elective isolated or combined aortic and mitral valve replacement were included. Primary outcome was preoperative decisional conflict (Decisional Conflict Scale); secondary outcomes included patient knowledge, involvement in valve selection, anxiety and depression, (valve-specific) quality of life, and regret. Out of 306 eligible patients, 155 were randomized (78 control and 77 intervention). Preoperative decisional conflict did not differ between the groups (34% versus 33%; P =0.834). Intervention patients felt better informed (median Decisional Conflict Scale informed subscore: 8 versus 17; P =0.046) and had a better knowledge of prosthetic valves (85% versus 68%; P =0.004). Intervention patients experienced less anxiety and depression (median Hospital Anxiety and Depression Scale score: 6 versus 9; P =0.015) and better mental well-being (mean Short Form Health Survey score: 54 versus 50; P =0.032). Three months postoperatively, valve-specific quality of life and regret did not differ between the groups. A patient decision aid to support shared decision making in prosthetic heart valve selection does not lower decisional conflict. It does result in more knowledgeable, better informed, and less anxious and depressed patients, with a better mental well-being. http://www.trialregister.nl. Unique identifier: NTR4350. © 2017 American Heart Association, Inc.

  6. Five-year results after valve replacement with the Björk-Shiley 70 degrees convexo-concave prosthesis.

    PubMed

    Koldsland, S; Svennevig, J L; Abdelnoor, M; Aas, H; Semb, G

    1992-01-01

    In the 18 months up to July 1983, 120 Björk-Shiley convexo-concave prostheses with 70 degrees opening angle were implanted in 47 women and 61 men aged 19-78 (mean 58.6) years. The prosthetic valves were aortic in 65 cases, mitral in 23 and both aortic and mitral in 20 cases. Emergency operation was required in ten cases, and concomitant surgery was performed in 43 (39.8%). The early mortality was 5.5%. A follow-up study, comprising 498 patient years, revealed 73.1% 5-year survival. There were three mechanical failures of prosthesis, in one of which re-replacement was successful. Elective prosthesis replacement was performed in four other cases judged to be at high risk of strut fracture.

  7. Nickel-hydrogen battery integration study for the Multimission Modular Spacecraft

    NASA Technical Reports Server (NTRS)

    Mueller, V. C.

    1980-01-01

    A study has been performed to determine the feasibility of using nickel-hydrogen batteries as replacements for the nickel-cadmium batteries currently used for energy storage in the Multimission Modular Spacecraft under a contract with NASA Goddard Space Flight Center. The battery configuration was selected such that it meets volumetric and mounting constraints of the existing battery location, interfaces electrically with existing power conditioning and distribution equipment, and maintains acceptable cell operating temperatures. The battery contains 21, 50 ampere-hour cells in a cast aluminum structural frame. Cells used in the battery design are those developed under the Air Force's Aero Propulsion Laboratory funding and direction. Modifications of the thermal control system were necessary to increase the average output power capability of the Modular Power Subsystem.

  8. IN VIVO SEVERE CORROSION AND HYDROGEN EMBRITTLEMENT OF RETRIEVED MODULAR BODY TITANIUM ALLOY HIP-IMPLANTS

    PubMed Central

    Rodrigues, Danieli C.; Urban, Robert M.; Jacobs, Joshua J.; Gilbert, Jeremy L.

    2009-01-01

    Titanium alloys are widely used in total-joint replacements due to a combination of outstanding mechanical properties, biocompatibility, passivity and corrosion resistance. Nevertheless, retrieval studies have pointed out that these materials can be subjected to localized or general corrosion in modular interfaces when mechanical abrasion of the oxide film (fretting) occurs. Modularity adds large crevice environments, which are subject to micromotion between contacting interfaces and differential aeration of the surface. Titanium alloys are also known to be susceptible to hydrogen absorption, which can induce precipitation of hydrides and subsequent brittle failure. In this work, the surface of three designs of retrieved hip-implants with Ti-6Al-4V/Ti-6Al-4V modular taper interfaces in the stem were investigated for evidence of severe corrosion and precipitation of brittle hydrides during fretting-crevice corrosion in the modular connections. The devices were retrieved from patients and studied by means of scanning electron microscopy (SEM), x-ray diffraction (XRD) and chemical analysis. The surface qualitative investigation revealed severe corrosion attack in the mating interfaces with evidence of etching, pitting, delamination and surface cracking. In vivo hydrogen embrittlement was shown to be a mechanism of degradation in modular connections resulting from electrochemical reactions induced in the crevice environment of the tapers during fretting-crevice corrosion. PMID:18683224

  9. Intracardiac echocardiography to diagnose pannus formation after aortic valve replacement.

    PubMed

    Yamamoto, Yoshiya; Ohara, Takahiro; Funada, Akira; Takahama, Hiroyuki; Amaki, Makoto; Hasegawa, Takuya; Sugano, Yasuo; Kanzaki, Hideaki; Anzai, Toshihisa

    2016-03-01

    A 66-year-old female, under regular follow-up for 20 years after aortic valve replacement (19-mm Carbomedics), presented dyspnea on effort and hypotension during hemodialysis. A transthoracic echocardiogram showed elevation of transvalvular velocity up to 4 m/s, but the structure around the aortic prosthesis was difficult to observe due to artifacts. Fluoroscopy revealed normal motion of the leaflets of the mechanical valve. Intracardiac echocardiography (ICE) revealed a pannus-like structure in the left ventricular outflow tract. Transesophageal echocardiogram also revealed this structure. ICE can visualize structural abnormalities around a prosthetic valve after cardiac surgery even in patients in whom conventional imaging modalities failed.

  10. Clinical and Radiographic Mid-Term Outcomes After Total Shoulder Replacement: A Retrospective Study Protocol Including 400 Anatomical and Reverse Prosthetic Implants

    PubMed Central

    Merolla, Giovanni; Tartarone, Antonio; Porcellini, Giuseppe

    2016-01-01

    Objectives: To obtain outcomes data on anatomical and reverse total shoulder arthroplasty by analysis of clinical scores and standard radiographs. Subject selection and enrollment: 400 consecutive series of patients replaced with anatomical and reverse total shoulder arthroplasty (minimum 3 years follow-up). Study Design: retrospective monocenter. Preoperative assessment: Demographics, clinical scores (Constant-Murley) as available, shoulder X-ray (AP, outlet and axillary views) . Last follow-up: Postoperative radiographhs and clinical scores. Adverse events and complications to be reported as occurred since implantation. Statistical analysis: Data collected will be summarized and analyzed for statistical significance. PMID:27326389

  11. NASA Tech Briefs, February 2006

    NASA Technical Reports Server (NTRS)

    2006-01-01

    Topics discussed include: Nearly Direct Measurement of Relative Permittivity; DCS-Neural-Network Program for Aircraft Control and Testing; Dielectric Heaters for Testing Spacecraft Nuclear Reactors; Using Doppler Shifts of GPS Signals To Measure Angular Speed; Monitoring Temperatures of Tires Using Luminescent Materials; Highly Efficient Multilayer Thermoelectric Devices; Very High-Speed Digital Video Capability for In-Flight Use; MMIC DHBT Common-Base Amplifier for 172 GHz; Modular, Microprocessor-Controlled Flash Lighting System; Generic Environment for Simulating Launch Operations; Modular Aero-Propulsion System Simulation; X-Windows Socket Widget Class; Infrastructure for Rapid Development of Java GUI Programs; Processing Raman Spectra of High-Pressure Hydrogen Flames; X-Windows Information Sharing Protocol Widget Class; Simulating Humans as Integral Parts of Spacecraft Missions; Analyzing Power Supply and Demand on the ISS; Polyimides From a-BPDA and Aromatic Diamines; Making Plant-Support Structures From Waste Plant Fiber; Large Deployable Reflectarray Antenna; Periodically Discharging, Gas-Coalescing Filter; Ion Milling On Steps for Fabrication of Nanowires; Neuro-Prosthetic Implants With Adjustable Electrode Arrays; Microfluidic Devices for Studying Biomolecular Interactions; Studying Functions of All Yeast Genes Simultaneously; Polarization Phase-Compensating Coats for Metallic Mirrors; Tunable-Bandwidth Filter System; Methodology for Designing Fault-Protection Software; and Ground-Based Localization of Mars Rovers.

  12. Simplified Prosthetic Rehabilitation of a Patient after Oral Cancer Removal.

    PubMed

    Kranjčić, Josip; Džakula, Nikola; Vojvodić, Denis

    2016-09-01

    The treatment of patients with oral cancer is complex: a multidisciplinary approach needs to be taken and maxillofacial and oral surgeons, an oncologist, a prosthodontist should be included, and a psychologist is often needed. This case report describes the prosthetic rehabilitation of a patient after surgical removal of oral cancer with obturator prosthesis. Resection cavity was located in central part of the hard palate and the condition belonged to Aramany class 3 maxillary defects. The two-step impression technique of denture bearing area was used and the resection of cavity was performed. A primary impression-the impression of denture bearing area was made using irreversible hydrocolloid material, while the second impression - the impression of resection cavity was made using condensation silicone material and obturator prosthesis framework. The obturator prosthesis replaced lost teeth, improved oral function and esthetics at minimal costs.

  13. Virtual surgical planning and 3D printing in prosthetic orbital reconstruction with percutaneous implants: a technical case report

    PubMed Central

    Huang, Yu-Hui; Seelaus, Rosemary; Zhao, Linping; Patel, Pravin K; Cohen, Mimis

    2016-01-01

    Osseointegrated titanium implants to the cranial skeleton for retention of facial prostheses have proven to be a reliable replacement for adhesive systems. However, improper placement of the implants can jeopardize prosthetic outcomes, and long-term success of an implant-retained prosthesis. Three-dimensional (3D) computer imaging, virtual planning, and 3D printing have become accepted components of the preoperative planning and design phase of treatment. Computer-aided design and computer-assisted manufacture that employ cone-beam computed tomography data offer benefits to patient treatment by contributing to greater predictability and improved treatment efficiencies with more reliable outcomes in surgical and prosthetic reconstruction. 3D printing enables transfer of the virtual surgical plan to the operating room by fabrication of surgical guides. Previous studies have shown that accuracy improves considerably with guided implantation when compared to conventional template or freehand implant placement. This clinical case report demonstrates the use of a 3D technological pathway for preoperative virtual planning through prosthesis fabrication, utilizing 3D printing, for a patient with an acquired orbital defect that was restored with an implant-retained silicone orbital prosthesis. PMID:27843356

  14. Virtual surgical planning and 3D printing in prosthetic orbital reconstruction with percutaneous implants: a technical case report.

    PubMed

    Huang, Yu-Hui; Seelaus, Rosemary; Zhao, Linping; Patel, Pravin K; Cohen, Mimis

    2016-01-01

    Osseointegrated titanium implants to the cranial skeleton for retention of facial prostheses have proven to be a reliable replacement for adhesive systems. However, improper placement of the implants can jeopardize prosthetic outcomes, and long-term success of an implant-retained prosthesis. Three-dimensional (3D) computer imaging, virtual planning, and 3D printing have become accepted components of the preoperative planning and design phase of treatment. Computer-aided design and computer-assisted manufacture that employ cone-beam computed tomography data offer benefits to patient treatment by contributing to greater predictability and improved treatment efficiencies with more reliable outcomes in surgical and prosthetic reconstruction. 3D printing enables transfer of the virtual surgical plan to the operating room by fabrication of surgical guides. Previous studies have shown that accuracy improves considerably with guided implantation when compared to conventional template or freehand implant placement. This clinical case report demonstrates the use of a 3D technological pathway for preoperative virtual planning through prosthesis fabrication, utilizing 3D printing, for a patient with an acquired orbital defect that was restored with an implant-retained silicone orbital prosthesis.

  15. Advanced Implant-Prosthetic Rehabilitation: How to Obtain a Correct Restoration of Both Functions and Aesthetics in Patients with Complex Combined Dental and Maxillofacial Trauma: A Case Report and Topical Review of the Literature.

    PubMed

    Figliuzzi, M M; Giudice, A; Fortunato, L

    2017-01-01

    Aim . This study aims to explain the main steps that characterize the implant-prosthetic rehabilitation in complex combined dental and maxillofacial trauma. Material and Methods . A 20-year-old patient reported an extensive facial trauma which also involved the alveolar process of the maxillary bone. The patient reported a maxillofacial fracture and the loss of teeth 1.3, 1.2, 1.1, and 2.1. A "Le Fort" type 2 fracture was also reported, with the malar bone involvement. After reduction and containment of bone fractures, through appropriate mounting plates, appropriate functional and aesthetic rehabilitation of the patient were replaced thanks to a temporary removable prosthesis. After 6 months, the patient performed numerous clinical investigations, aimed at a proper planning of implant-prosthetic rehabilitation of the upper dental arch. Conclusion . With the planning of the case, as well as respecting the surrounding biological structures, the surgery of implants can be carried out with the most appropriate procedure. Lastly, new dental implants with highly bioactive surfaces have been developed, providing an excellent and rapid bone integration.

  16. Evaluation of prosthetic valve obstruction on electrocardiographically gated multidetector-row computed tomography--identification of subprosthetic pannus in the aortic position.

    PubMed

    Ueda, Tomohiro; Teshima, Hideki; Fukunaga, Shuji; Aoyagi, Shigeaki; Tanaka, Hiroyuki

    2013-01-01

    This study was performed to evaluate the diagnostic role of electrocardiographically gated multidetector-row computed tomography (MDCT) for prosthetic valve obstruction (PVO) in the aortic position. Between 2002 and 2006, 9 patients were diagnosed with PVO of an aortic bileaflet mechanical valve based on echocardiographic and cineradiographic criteria. These 9 patients were examined using MDCT before replacement of the mechanical valve, and intraoperative findings were compared to morphologic periprosthetic abnormalities observed on MDCT. CT attenuation (Hounsfield units; HU) of the periprosthetic abnormalities was measured to investigate the underlying cause of the PVO. MDCT showed subprosthetic masses extending beyond the prosthetic ring into the orifice of the valve. At reoperation, presence of subprosthetic pannus was confirmed in all of the 9 patients, but no periprosthetic thrombus was found. The mean CT attenuation of the subprosthetic pannus was 170 HU, and it was significantly greater than that obtained from the interventricular septum (108 HU; P<0.0001). MDCT can be used to clearly visualize subprosthetic pannus causing PVO and the mean CT attenuation of subprosthetic pannus is significantly higher than that of the interventricular septum on MDCT.

  17. EMCS Experiment Container Replacement

    NASA Image and Video Library

    2018-01-26

    iss054e023800 (Jan. 26, 2018) --- NASA astronaut Joe Acaba placing an Experiment Container (EC) on the European Modular Cultivation System (EMCS) for the the first run of the Plant Gravity Perception experiment to test the gravity-sensing ability of plants in microgravity.

  18. EMCS Experiment Container Replacement

    NASA Image and Video Library

    2018-01-26

    iss054e023776 (Jan. 26, 2018) --- NASA astronaut Joe Acaba removing an Experiment Container (EC) on the European Modular Cultivation System (EMCS) for the the first run of the Plant Gravity Perception experiment to test the gravity-sensing ability of plants in microgravity.

  19. Novel implant for peri-prosthetic proximal tibia fractures.

    PubMed

    Tran, Ton; Chen, Bernard K; Wu, Xinhua; Pun, Chung Lun

    2018-03-01

    Repair of peri-prosthetic proximal tibia fractures is very challenging in patients with a total knee replacement or arthroplasty. The tibial component of the knee implant severely restricts the fixation points of the tibial implant to repair peri-prosthetic fractures. A novel implant has been designed with an extended flange over the anterior of tibial condyle to provide additional points of fixation, overcoming limitations of existing generic locking plates used for proximal tibia fractures. Furthermore, the screws fixed through the extended flange provide additional support to prevent the problem of subsidence of tibial component of knee implant. The design methodology involved extraction of bone data from CT scans into a flexible CAD format, implant design and structural evaluation and optimisation using FEM as well as prototype development and manufacture by selective laser melting 3D printing technology with Ti6Al4 V powder. A prototype tibia implant was developed based on a patient-specific bone structure, which was regenerated from the CT images of patient's tibia. The design is described in detail and being applied to fit up to 80% of patients, for both left and right sides based on the average dimensions and shape of the bone structure from a wide range of CT images. A novel tibial implant has been developed to repair peri-prosthetic proximal tibia fractures which overcomes significant constraints from the tibial component of existing knee implant. Copyright © 2018 Elsevier Ltd. All rights reserved.

  20. A modular optical sensor

    NASA Astrophysics Data System (ADS)

    Conklin, John Albert

    This dissertation presents the design of a modular, fiber-optic sensor and the results obtained from testing the modular sensor. The modular fiber-optic sensor is constructed in such manner that the sensor diaphragm can be replaced with different configurations to detect numerous physical phenomena. Additionally, different fiber-optic detection systems can be attached to the sensor. Initially, the modular sensor was developed to be used by university of students to investigate realistic optical sensors and detection systems to prepare for advance studies of micro-optical mechanical systems (MOMS). The design accomplishes this by doing two things. First, the design significantly lowers the costs associated with studying optical sensors by modularizing the sensor design. Second, the sensor broadens the number of physical phenomena that students can apply optical sensing techniques to in a fiber optics sensor course. The dissertation is divided into seven chapters covering the historical development of fiber-optic sensors, a theoretical overview of fiber-optic sensors, the design, fabrication, and the testing of the modular sensor developed in the course of this work. Chapter 1 discusses, in detail, how this dissertation is organized and states the purpose of the dissertation. Chapter 2 presents an historical overview of the development of optical fibers, optical pressure sensors, and fibers, optical pressure sensors, and optical microphones. Chapter 3 reviews the theory of multi-fiber optic detection systems, optical microphones, and pressure sensors. Chapter 4 presents the design details of the modular, optical sensor. Chapter 5 delves into how the modular sensor is fabricated and how the detection systems are constructed. Chapter 6 presents the data collected from the microphone and pressure sensor configurations of the modular sensor. Finally, Chapter 7 discusses the data collected and draws conclusions about the design based on the data collected. Chapter 7 also presents future work needed to expand the functionality and utility of the modular sensor.

  1. Preliminary development of an advanced modular pressure relief cushion: Testing and user evaluation.

    PubMed

    Freeto, Tyler; Mitchell, Steven J; Bogie, Kath M

    2018-02-01

    Effective pressure relief cushions are identified as a core assistive technology need by the World Health Organization Global Cooperation on Assistive Technology. High quality affordable wheelchair cushions could provide effective pressure relief for many individuals with limited access to advanced assistive technology. Value driven engineering (VdE) principles were employed to develop a prototype modular cushion. Low cost dynamically responsive gel balls were arranged in a close packed array and seated in bilayer foam for containment and support. Two modular cushions, one with high compliance balls and one with moderate compliance balls were compared with High Profile and Low Profile Roho ® and Jay ® Medical 2 cushions. ISO 16480-2 biomechanical standardized tests were applied to assess cushion performance. A preliminary materials cost analysis was carried out. A prototype modular cushion was evaluated by 12 participants who reported satisfaction using a questionnaire based on the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST 2.0) instrument. Overall the modular cushions performed better than, or on par with, the most widely prescribed commercially available cushions under ISO 16480-2 testing. Users rated the modular cushion highly for overall appearance, size and dimensions, comfort, safety, stability, ease of adjustment and general ease of use. Cost-analysis indicated that every modular cushion component a could be replaced several times and still maintain cost-efficacy over the complete cushion lifecycle. A VdE modular cushion has the potential provide effective pressure relief for many users at a low lifetime cost. Copyright © 2017. Published by Elsevier Ltd.

  2. The development of artificial organs and prostheses worldwide and in the Ottoman Empire.

    PubMed

    Birdane, Leman; Cingi, Cemal; Elçioğlu, Ömür; Muluk, Nuray Bayar

    2016-08-01

    An artificial organ or prosthesis is a man-made device that is implanted or integrated into a human to replace a natural organ. There were many historical steps in the development of artificial organs and prostheses. New surgical techniques, the development of prosthetic materials and the creative ideas of engineers led to progress in this field. © The European Society of Cardiology 2014.

  3. Excessive strut wear allowing ball-poppet embolization in a DeBakey-Surgitool aortic valve prosthesis.

    PubMed

    Sutherland, R D; Guynes, W A; Nichols, C T; Martinez, H E

    1982-01-01

    Excessive cage strut wear allowing ball-poppet embolization caused the sudden death of a 47 year old lady in whom a DeBakey-Surgitool aortic prosthesis had been implanted nine years earlier. Patients with this type of prosthesis should have periodic valvular cine fluoroscopy with image intensification to allow visualization of significant strut wear or fracture, and appropriate prosthetic valve replacement.

  4. Lean Six Sigma: a new approach to the management of patients undergoing prosthetic hip replacement surgery.

    PubMed

    Improta, Giovanni; Balato, Giovanni; Romano, Maria; Carpentieri, Francesco; Bifulco, Paolo; Alessandro Russo, Mario; Rosa, Donato; Triassi, Maria; Cesarelli, Mario

    2015-08-01

    In 2012, health care spending in Italy reached €114.5 billion, accounting for 7.2% of the Gross Domestic Product (GDP) and 14.2% of total public spending. Therefore, reducing waste in health facilities could generate substantial cost savings. The objective of this study is to show that Lean Six Sigma represents an appropriate methodology for the development of a clinical pathway which allows to improve quality and to reduce costs in prosthetic hip replacement surgery. The methodology used for the development of a new clinical pathway was Lean Six Sigma. Problem solving in Lean Six Sigma is the DMAIC (Define, Measure, Analyse, Improve, Control) roadmap, characterized by five operational phases which make possible to reach fixed goals through a rigorous process of defining, measuring, analysing, improving and controlling business problems. The following project indicated several variables influencing the inappropriate prolongation of the length of stay for inpatient treatment and corrective actions were performed to improve the effectiveness and efficiency of the process of care. The average length of stay was reduced from 18.9 to 10.6 days (-44%). This article shows there is no trade-off between quality and costs: Lean Six Sigma improves quality and, at the same time, reduces costs. © 2015 John Wiley & Sons, Ltd.

  5. Nucleic acid amplification using modular branched primers

    DOEpatents

    Ulanovsky, Levy; Raja, Mugasimangalam C.

    2001-01-01

    Methods and compositions expand the options for making primers for use in amplifying nucleic acid segments. The invention eliminates the step of custom synthesis of primers for Polymerase Chain Reactions (PCR). Instead of being custom-synthesized, a primer is replaced by a combination of several oligonucleotide modules selected from a pre-synthesized library. A modular combination of just a few oligonucleotides essentially mimics the performance of a conventional, custom-made primer by matching the sequence of the priming site in the template. Each oligonucleotide module has a segment that matches one of the stretches within the priming site.

  6. Modularization of gradient-index optical design using wavefront matching enabled optimization.

    PubMed

    Nagar, Jogender; Brocker, Donovan E; Campbell, Sawyer D; Easum, John A; Werner, Douglas H

    2016-05-02

    This paper proposes a new design paradigm which allows for a modular approach to replacing a homogeneous optical lens system with a higher-performance GRadient-INdex (GRIN) lens system using a WaveFront Matching (WFM) method. In multi-lens GRIN systems, a full-system-optimization approach can be challenging due to the large number of design variables. The proposed WFM design paradigm enables optimization of each component independently by explicitly matching the WaveFront Error (WFE) of the original homogeneous component at the exit pupil, resulting in an efficient design procedure for complex multi-lens systems.

  7. A technique of snaring method for fitting a prosthetic valve into the annulus.

    PubMed

    Nagasaka, Shigeo; Kawata, Tetsuji; Matsuta, Masahiro; Taniguchi, Shigeki

    2005-01-01

    Tourniquetting technique to fit a prosthetic valve (PV) into the annulus in valve replacement surgery has been previously reported. We modified the previously reported method and designed a simpler tying technique. We performed 11 aortic (AVR: including four cases for calcified aortic stenosis (AS) with a small annulus and one cases for infective endocarditis with intramuscular abscess cavity), eight mitral valve replacements (MVR), and one tricuspid valve replacement (TVR: for corrected transposition of the great arteries). A PV was implanted using 2-0 polyester mattress sutures with a pledget. Each of the two tourniquets held a suture at the bottom of the annulus and at the opposite position to fit a PV. The sutures between each snare were tied down from the bottom to the top. In MVR, after seating of a PV with two tourniquets, we could make sure that no native tissue of any preserved mitral apparatus disturbed PV leaflet motion. In calcific AS, a PV had a good fitting into the annulus because of tourniquets applied to unseated part during tying sutures. In AVR for infective endocarditis, mattress sutures supported by a Teflon pledget were placed to close the abscess cavity. After snaring on one of these sutures, we tied down the sutures, ensuring that they did not cut through the friable tissues. In TVR, we found that native leaflets interfered with PV motion after seating down the prosthesis and those leaflets were resected before tying down the sutures. Postoperative transesophageal echocardiography showed no paravalvular leakage in any patients and excellent PV functions.

  8. Mitral valve replacement complicated by iatrogenic left ventricular outflow obstruction and paravalvular leak: case report and review of literature.

    PubMed

    Lee, Justin Z; Tey, Kai R; Mizyed, Ahmad; Hennemeyer, Charles T; Janardhanan, Rajesh; Lotun, Kapildeo

    2015-10-09

    Left ventricular outflow tract (LVOT) obstruction and paravalvular leak (PVL) are relatively uncommon, but are serious complications of prosthetic valve replacement. We present a case that displays the unique therapeutic challenges of treating a patient who developed both LVOT obstruction and mitral PVL after undergoing surgical aortic and mitral valve replacement (MVR). We also describe the use of alcohol septal ablation and albumin-glutaraldehyde (BioGlue) for septal ablation to percutaneously treat the patient's LVOT obstruction, followed by use of an Amplatzer vascular plug for percutaneous closure of an antero-medial mitral PVL associated with severe regurgitation. Percutaneous interventional management of these entities may be considered as an initial therapeutic option, especially in high-risk patients with significant morbidity and mortality of repeat surgical operations.

  9. Total humerus replacement for osteosarcoma with proximal part of humerus: a case report

    PubMed Central

    2012-01-01

    Incisional biopsy and intramedullary pinning were performed for pathological fracture associated with a malignant bone tumor of the proximal humerus. Osteosarcoma, for which preoperative chemotherapy had been performed, was confirmed by postoperative pathological examination. To achieve wide resection and acquire a safe resected margin, total humerus replacement was performed, and the whole humerus was reconstructed using the Howmedica Modular Reconstruction system. The patient resumed normal activities, although mild contracture of the elbow joint remains 8 years after surgery. PMID:22333118

  10. Simplified Prosthetic Rehabilitation of a Patient after Oral Cancer Removal

    PubMed Central

    Džakula, Nikola; Vojvodić, Denis

    2016-01-01

    The treatment of patients with oral cancer is complex: a multidisciplinary approach needs to be taken and maxillofacial and oral surgeons, an oncologist, a prosthodontist should be included, and a psychologist is often needed. This case report describes the prosthetic rehabilitation of a patient after surgical removal of oral cancer with obturator prosthesis. Resection cavity was located in central part of the hard palate and the condition belonged to Aramany class 3 maxillary defects. The two-step impression technique of denture bearing area was used and the resection of cavity was performed. A primary impression-the impression of denture bearing area was made using irreversible hydrocolloid material, while the second impression – the impression of resection cavity was made using condensation silicone material and obturator prosthesis framework. The obturator prosthesis replaced lost teeth, improved oral function and esthetics at minimal costs. PMID:27847400

  11. Replacement of the Thoracoabdominal Aorta after Endovascular Abdominal Aneurysm Repair for Ruptured Infected Aneurysm: A Case Report

    PubMed Central

    Kondo, Nobuo; Tamura, Kentaro; Sakaguchi, Taichi; Chikazawa, Genta; Yoshitaka, Hidenori

    2017-01-01

    A 73-year-old man underwent emergency endovascular abdominal aneurysm repair (EVAR) for a ruptured infected abdominal aortic aneurysm. Two years after EVAR, he was admitted with a spiking fever and left lower back pain. Computed tomography scan revealed not only recurrent graft infection with psoas abscess but also infection around the orifice of the superior mesenteric artery. Because conservative medical therapy with antibiotics could not control the infection, we performed complete removal of the infected stent graft, debridement of psoas abscess, and in situ replacement of the thoracoabdominal aorta using rifampicin-soaked prosthetic grafts, followed by the omental flap. He was discharged with no complications. PMID:29034025

  12. Impact of depressive symptoms on prosthetic status--results of the study of health in Pomerania (SHIP).

    PubMed

    Samietz, Stefanie A; Kindler, Stefan; Schwahn, Christian; Polzer, Ines; Hoffmann, Wolfgang; Kocher, Thomas; Grabe, Hans Jörgen; Mundt, Torsten; Biffar, Reiner

    2013-05-01

    Previous investigations have confirmed that every fifth dental patient suffers from clinically significant depressive symptoms. However, the putative impact of depressive symptoms on the prosthetic status has not been addressed in these studies. The objective of this study was to investigate the association between depressive symptoms and prosthetic status based on data from the Study of Health in Pomerania (SHIP-0). Data from 2,135 participants aged 30 to 59 years were analyzed. A classification (six classes regarding the number and position of missing teeth per jaw) was used to identify the degree of prosthetic status (no/suboptimal/optimal tooth replacement). The presence of depressive symptoms was assessed with a modified version of von Zerssen's complaints scale. Screening for lifetime diagnoses of mental disorders was performed with the Composite International Diagnostic-Screener (CID-S). Multivariable logistic regressions including several confounders were calculated. A significant protective dose-response effect of depressive symptoms on prosthetic status was found only in men for the lower jaw [0-1 depressive symptoms: odds ratio (OR) = 3.84, 95 % confidence interval (CI, 1.65-8.92), p < 0.01; 2-3: OR = 2.87 (CI, 1.22-6.74), p < 0.05; reference, ≥8; adjusted for age, school education, smoking status, household income, marital status, living without a partner, risky alcohol consumption, obesity, diabetes, and physical activity]. There was no such association in women or for the upper jaw. The analyses using the CID-S confirmed these results. In the lower jaw, men with depressive symptoms had a better prosthetic status than men without depressive symptoms suggesting a higher level of concern regarding their personal health. If dentists might have an opportunity to identify men with depressive symptoms they can provide a wide range of treatment options that may enhance patients' self-esteem and contribute to the patient' well-being. Furthermore, depressive symptoms could indicate a discrepancy between self-perception of the dental health and the actual status which influence the dentists' treatment decision making.

  13. ADVANCED SEISMIC BASE ISOLATION METHODS FOR MODULAR REACTORS

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    E. Blanford; E. Keldrauk; M. Laufer

    2010-09-20

    Advanced technologies for structural design and construction have the potential for major impact not only on nuclear power plant construction time and cost, but also on the design process and on the safety, security and reliability of next generation of nuclear power plants. In future Generation IV (Gen IV) reactors, structural and seismic design should be much more closely integrated with the design of nuclear and industrial safety systems, physical security systems, and international safeguards systems. Overall reliability will be increased, through the use of replaceable and modular equipment, and through design to facilitate on-line monitoring, in-service inspection, maintenance, replacement,more » and decommissioning. Economics will also receive high design priority, through integrated engineering efforts to optimize building arrangements to minimize building heights and footprints. Finally, the licensing approach will be transformed by becoming increasingly performance based and technology neutral, using best-estimate simulation methods with uncertainty and margin quantification. In this context, two structural engineering technologies, seismic base isolation and modular steel-plate/concrete composite structural walls, are investigated. These technologies have major potential to (1) enable standardized reactor designs to be deployed across a wider range of sites, (2) reduce the impact of uncertainties related to site-specific seismic conditions, and (3) alleviate reactor equipment qualification requirements. For Gen IV reactors the potential for deliberate crashes of large aircraft must also be considered in design. This report concludes that base-isolated structures should be decoupled from the reactor external event exclusion system. As an example, a scoping analysis is performed for a rectangular, decoupled external event shell designed as a grillage. This report also reviews modular construction technology, particularly steel-plate/concrete construction using factory prefabricated structural modules, for application to external event shell and base isolated structures.« less

  14. Therapeutic avenues for hereditary forms of retinal blindness.

    PubMed

    Kannabiran, Chitra; Mariappan, Indumathi

    2018-03-01

    Hereditary retinal diseases, known as retinal degenerations or dystrophies, are a large group of inherited eye disorders resulting in irreversible visual loss and blindness. They develop due to mutations in one or more genes that lead to the death of the retinal photoreceptor cells. Till date, mutations in over 200 genes are known to be associated with all different forms of retinal disorders. The enormous genetic heterogeneity of this group of diseases has posedmany challenges in understanding the mechanisms of disease and in developing suitable therapies. Therapeutic avenues that are being investigated for these disorders include gene therapy to replace the defective gene, treatment with neurotrophic factors to stimulate the growth of photoreceptors, cell replacement therapy, and prosthetic devices that can capture light and transmit electrical signals through retinal neurons to the brain. Several of these are in process of human trials in patients, and have shown safety and efficacy of the treatment. A combination of approaches that involve both gene replacement and cell replacement may be required for optimum benefit.

  15. Cobalt toxicity after revision total hip replacement due to fracture of a ceramic head.

    PubMed

    Pelayo-de Tomás, J M; Novoa-Parra, C; Gómez-Barbero, P

    Symptomatic cobalt toxicity from a failed total hip replacement is a rare, but devastating complication. Potential clinical findings include cardiomyopathy, hypothyroidism, skin rash, visual and hearing impairment, polycythaemia, weakness, fatigue, cognitive impairment, and neuropathy. The case is presented of a 74year-old man in whom, after a ceramic-ceramic replacement and two episodes of prosthetic dislocation, it was decided to replace it with a polyethylene-metal total hip arthroplasty (THA). At 6months after the revision he developed symptoms of cobalt toxicity, confirmed by analytical determination (serum cobalt level=651.2μg/L). After removal of the prosthesis, the levels of chromium and cobalt in blood and urine returned to normal, with the patient currently being asymptomatic. It is recommended to use a new ceramic on ceramic bearing at revision, in order to minimise the risk of wear-related cobalt toxicity following breakage of ceramic components. Copyright © 2016 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  16. Internal Prosthetic Replacement of Skeletal Segments Lost in Combat Injuries.

    DTIC Science & Technology

    1973-08-31

    osteo- articular bone grafts. Clin. Ortho., 87: 156, 1972. 8. Tuli, S. M.: Bridging of bone defects by massive bone grafts in tumorous conditions. Clin...fashion in its proximal one-third to "prevent distractic ,n of the fragments. The fiber metal segment was then placed in the appropriate defect and the...defect slightly oversized and also osteotomizing the fibula to delete any possible distracting forces or angulating forces. The only complication in

  17. Sealing maxillary titanium obturators with removable flexible caps.

    PubMed

    Reitemeier, Bernd; Schaal, Wolfgang; Wolf, Annette; Walter, Michael

    2016-03-01

    Maxillary obturator prostheses with hollow metal obturators can be made of titanium to reduce weight. To prevent perforation of the hollow obturator during modifications, the obturator is slightly undersized and covered with a replaceable cap. This cap is made of a soft copolymer to facilitate uncomplicated modifications in the resection area and to improve function. Copyright © 2016 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

  18. New type of hip arthroplasty failure related to modular femoral components: breakage at the neck-stem junction.

    PubMed

    Wodecki, P; Sabbah, D; Kermarrec, G; Semaan, I

    2013-10-01

    Total hip replacements (THR) with modular femoral components (stem-neck interface) make it possible to adapt to extramedullary femoral parameters (anteversion, offset, and length) theoretically improving muscle function and stability. Nevertheless, adding a new interface has its disadvantages: reduced mechanical resistance, fretting corrosion and material fatigue fracture. We report the case of a femoral stem fracture of the female part of the component where the modular morse taper of the neck is inserted. An extended trochanteric osteotomy was necessary during revision surgery because the femoral stump could not be grasped for extraction, so that a long stem had to be used. In this case, the patient had the usual risk factors for modular neck failure: he was an active overweight male patient with a long varus neck. This report shows that the female part of the stem of a small femoral component may also be at increased failure risk and should be added to the list of risk factors. To our knowledge, this is the first reported case of this type of failure. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  19. Hemolytic anemia caused by aortic flap and inversion of felt strip after ascending aorta replacement.

    PubMed

    Sakaguchi, Masayuki; Takano, Tamaki

    2016-08-02

    Hemolysis related to a kinked prosthetic graft or inner felt strip is a very rare complication after aortic surgery. We describe herein a case of hemolytic anemia that developed due to aortic flap of the dissection and inversion of an inner felt strip that was applied at the proximal anastomosis of a replaced ascending aorta 10 years previously. A 74-year-old woman presented with consistent hemolytic anemia 10 years after replacement of the ascending aorta to treat Stanford type A acute aortic dissection. The cause of hemolysis was attributed to mechanical injury of red blood cells at a site of stenosis caused by aortic flap of the dissection and inversion of the felt strip used for the proximal anastomosis. Repeated resection of the strip and graft replacement of the ascending aorta resolved this problem. We considered that blood flow disrupted by a jet of blood at the site of the proximal inner felt strip was the cause of severe hemolysis, we describe rare hemolytic anemia at the site of aortic flap and inverted felt strip after replacement of the ascending aorta.

  20. Photovoltaic restoration of sight with high visual acuity

    PubMed Central

    Lorach, Henri; Goetz, Georges; Smith, Richard; Lei, Xin; Mandel, Yossi; Kamins, Theodore; Mathieson, Keith; Huie, Philip; Harris, James; Sher, Alexander; Palanker, Daniel

    2015-01-01

    Patients with retinal degeneration lose sight due to gradual demise of photoreceptors. Electrical stimulation of the surviving retinal neurons provides an alternative route for delivery of visual information. We demonstrate that subretinal arrays with 70 μm photovoltaic pixels provide highly localized stimulation, with electrical and visual receptive fields of comparable sizes in rat retinal ganglion cells. Similarly to normal vision, retinal response to prosthetic stimulation exhibits flicker fusion at high frequencies, adaptation to static images and non-linear spatial summation. In rats with retinal degeneration, these photovoltaic arrays provide spatial resolution of 64 ± 11 μm, corresponding to half of the normal visual acuity in pigmented rats. Ease of implantation of these wireless and modular arrays, combined with their high resolution opens the door to functional restoration of sight. PMID:25915832

  1. Stemless shoulder arthroplasty: a literature review

    PubMed Central

    PETRICCIOLI, DARIO; BERTONE, CELESTE; MARCHI, GIACOMO

    2015-01-01

    The design of humeral implants for shoulder arthroplasty has evolved over the years. The new-generation modular shoulder prostheses have an anatomical humeral stem that replicates the three-dimensional parameters of the proximal humerus. An anatomical reconstruction is the best way to restore stability and mobility of the prosthetic shoulder and improve implant durability. However, a perfect anatomical match is not always possible in, for example, patients with post-traumatic osteoarthritis of the shoulder and deformities in the metaphyseal region. To avoid stem-related complications while retaining the advantages of the fourth generation of shoulder implants, different stemless implants have been developed. The stemless shoulder prosthesis is a new concept in shoulder arthroplasty. The authors review the indications, surgical technique, clinical and radiological midterm results, and complications of these humeral implants. PMID:26151038

  2. Bringing down the Wall

    ERIC Educational Resources Information Center

    Raths, David

    2013-01-01

    Could new types of pedagogy that involve more classroom projects and peer instruction encourage school districts to replace outdated furniture and redesign classrooms? Or could new classroom designs using modular furniture have an impact on how teachers engage their students? These are just a few of the questions that educators, instructional…

  3. 100-kA vacuum current breaker of a modular design

    NASA Astrophysics Data System (ADS)

    Ivanov, V. P.; Vozdvijenskii, V. A.; Jagnov, V. A.; Solodovnikov, S. G.; Mazulin, A. V.; Ryjkov, V. M.

    1994-05-01

    Direct current breaker of a modular design is developed for the strong field tokamak power supply system. The power supply system comprises four 800 MW alternative current generators with 4 GJ flywheels, thyristor rectifiers providing inductive stores pumping by a current up to 100 kA for 1 - 4 sec. To form current pulses of various shapes in the tokamak windings current breakers are used with either pneumatic or explosive drive, at a current switching synchronously of not worse than 100 mks. Current breakers of these types require that the current conducting elements be replaced after each shot. For recent years vacuum arc quenching chambers with an axial magnetic field are successfully employed as repetitive performance current breakers, basically for currents up to 40 kA. In the report some results of researches of a vacuum switch modular are presented which we used as prototype switch for currents of the order of 100 kA.

  4. Dental practice during a world cruise: characterisation of oral health at sea.

    PubMed

    Sobotta, Bernhard A J; John, Mike T; Nitschke, Ina

    2006-01-01

    To describe oral health of passengers and crew attending the dental service aboard during a two months world cruise. In a retrospective, descriptive epidemiologic study design the routine documentation of all dental treatment provided at sea was analysed after the voyage. Subjects were n = 57 passengers (3.5 % of 1619) with a mean age of 71 (+/- 9.8) years and n =56 crew (5.6 % of 999) with a mean age of 37 (+/- 12.0) years. Age, gender, nationality, number of natural teeth and implants were extracted. The prosthetic status was described by recording the number of teeth replaced by fixed prosthesis and number of teeth replaced by removable prosthesis. Oral health-related quality of life (OHRQoL) was measured using the 14-item Oral Health Impact Profile (OHIP-14) and characterised by the OHIP sum score. Women attended for treatment more often than men. Passengers had a mean number of 20 natural teeth plus substantial fixed and removable prosthodontics. Crew had a mean of 26 teeth. British crew and Australian passengers attended the dental service above average. Crew tended to have a higher average OHIP-14 sum score than passengers indicating an increased rate of perceived problems. Emergency patients from both crew and passengers have a higher sum score than patients attending for routine treatment. In passengers the average number of teeth appears to be higher than that of an age matched population of industrialized countries. However, the passengers' socioeconomic status was higher which has an effect on this finding. Socioeconomic factors also serve to explain the high standard of prosthetic care in passengers. Crew in general present with less sophisticated prosthetic devices. This is in line with their different socioeconomic status and origin from developing countries. The level of dental fees aboard in comparison to treatment costs in home countries may explain some of the differences in attendance. Passengers have enjoyed high standards of prosthetic care in the past and will expect a similarly high standard from ship based facilities. The ease of access to quality dental care may explain the relatively low level of perceived problems as characterised by oral health-related quality of life scores. The dental officer aboard has to be prepared to care for very varied diagnostic and treatment needs.

  5. Identification of bacteria on the surface of clinically infected and non-infected prosthetic hip joints removed during revision arthroplasties by 16S rRNA gene sequencing and by microbiological culture

    PubMed Central

    Dempsey, Kate E; Riggio, Marcello P; Lennon, Alan; Hannah, Victoria E; Ramage, Gordon; Allan, David; Bagg, Jeremy

    2007-01-01

    It has been postulated that bacteria attached to the surface of prosthetic hip joints can cause localised inflammation, resulting in failure of the replacement joint. However, diagnosis of infection is difficult with traditional microbiological culture methods, and evidence exists that highly fastidious or non-cultivable organisms have a role in implant infections. The purpose of this study was to use culture and culture-independent methods to detect the bacteria present on the surface of prosthetic hip joints removed during revision arthroplasties. Ten consecutive revisions were performed by two surgeons, which were all clinically and radiologically loose. Five of the hip replacement revision surgeries were performed because of clinical infections and five because of aseptic loosening. Preoperative and perioperative specimens were obtained from each patient and subjected to routine microbiological culture. The prostheses removed from each patient were subjected to mild ultrasonication to dislodge adherent bacteria, followed by aerobic and anaerobic microbiological culture. Bacterial DNA was extracted from each sonicate and the 16S rRNA gene was amplified with the universal primer pair 27f/1387r. All 10 specimens were positive for the presence of bacteria by both culture and PCR. PCR products were then cloned, organised into groups by RFLP analysis and one clone from each group was sequenced. Bacteria were identified by comparison of the 16S rRNA gene sequences obtained with those deposited in public access sequence databases. A total of 512 clones were analysed by RFLP analysis, of which 118 were sequenced. Culture methods identified species from the genera Leifsonia (54.3%), Staphylococcus (21.7%), Proteus (8.7%), Brevundimonas (6.5%), Salibacillus (4.3%), Methylobacterium (2.2%) and Zimmermannella (2.2%). Molecular detection methods identified a more diverse microflora. The predominant genus detected was Lysobacter, representing 312 (60.9%) of 512 clones analysed. In all, 28 phylotypes were identified: Lysobacter enzymogenes was the most abundant phylotype (31.4%), followed by Lysobacter sp. C3 (28.3%), gamma proteobacterium N4-7 (6.6%), Methylobacterium SM4 (4.7%) and Staphylococcus epidermidis (4.7%); 36 clones (7.0%) represented uncultivable phylotypes. We conclude that a diverse range of bacterial species are found within biofilms on the surface of clinically infected and non-infected prosthetic hip joints removed during revision arthroplasties. PMID:17501992

  6. Immediate loading of unsplinted implants in the anterior mandible for overdentures: 3-year results.

    PubMed

    Roe, Phillip; Kan, Joseph Y K; Rungcharassaeng, Kitichai; Lozada, Jaime L

    2011-01-01

    This 3-year study evaluated the implant survival rate, peri-implant tissue response, prosthetic maintenance, and prosthetic complications in a series of patients who received two immediately loaded unsplinted threaded implants to retain a mandibular overdenture. Eight completely edentulous patients were evaluated clinically and radiographically immediately after implant placement, at 3 months, and at 1, 2, and 3 years after implant placement. Data were analyzed using repeated-measures one-way analysis of variance and the Wilcoxon signed rank test at a significance level of α = .05. At 3 years, all implants remained osseointegrated (16/16), with an overall mean marginal bone change of -0.58 ± 0.39 mm and a mean Periotest value of -7.19 ± 0.54. The modified Plaque Index scores showed marked improvement in oral hygiene during the first year, but some relapse was observed thereafter. Prosthetic maintenance and complications included replacement of the attachment inserts, abutment loosening, dislodgement of the attachment housing, overdenture reline, denture tooth fracture, and overdenture base fracture. This 3-year study suggests that, despite less than ideal oral hygiene and a high incidence of complete/partial fracture of overdentures, favorable implant survival rate and peri-implant tissue responses can be achieved in mandibular overdentures retained with two immediately loaded unsplinted threaded implants.

  7. Long-term Outcomes of Mitral Valve Repair Versus Replacement for Degenerative Disease: A Systematic Review

    PubMed Central

    McNeely, Christian A; Vassileva, Christina M

    2015-01-01

    The short-term advantage of mitral valve repair versus replacement for degenerative disease has been extensively documented. These advantages include lower operative mortality, improved survival, better preservation of left-ventricular function, shorter post-operative hospital stay, lower total costs, and fewer valve-related complications, including thromboembolism, anticoagulation-related bleeding events and late prosthetic dysfunction. More recent written data are available indicating the long-term advantage of repair versus replacement. While at some institutions, the repair rate for degenerative disease may exceed 90%, the national average in 2007 was only 69%. Making direct comparisons between mitral valve repair and replacement using the available studies does present some challenges however, as there are often differences in baseline characteristics between patient groups as well as other dissimilarities between studies. The purpose of this review is to systematically summarize the long-term survival and reoperation data of mitral valve repair versus replacement for degenerative disease. A PubMed search was done and resulted in 12 studies that met our study criteria for comparing mitral valve repair versus replacement for degenerative disease. A systematic review was then conducted abstracting survival and reoperation data. PMID:25158683

  8. Surgical treatment of infective endocarditis with aortic and tricuspid valve involvement using cryopreserved aortic and mitral valve allografts.

    PubMed

    Ostrovsky, Yury; Spirydonau, Siarhei; Shchatsinka, Mikalai; Shket, Aliaksandr

    2015-05-01

    Surgical treatment of infective and prosthetic endocarditis using allografts gives good results. Aortic allograft implantation is a common technique, while tricuspid valve replacement with a mitral allograft is very rare. Multiple valve disease in case of infective endocarditis is a surgical challenge as such patients are usually in a grave condition and results of surgical treatment are often unsatisfactory. In this article we describe a clinical case of successful surgical treatment in a patient with active infective endocarditis of aortic and tricuspid valve, complicated by an aortic-right ventricular fistula. The aortic valve and ascending aorta were replaced with a cryopreserved aortic allograft; the tricuspid valve was replaced with a cryopreserved mitral allograft. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  9. [Pannus Formation Six-years after Aortic and Mitral Valve Replacement with Tissue Valves;Report of a Case].

    PubMed

    Nakamura, Makoto; Muraoka, Arata; Aizawa, Kei; Akutsu, Hirohiko; Kurumisawa, Soki; Misawa, Yoshio

    2015-07-01

    A 77-year-old man presented with exertional dyspnea. He had undergone aortic and mitral valve replacement with tissue valves 6-years earlier. The patient's hemoglobin level was 9.8 g/dl and serum aspartate aminotransferase (70 mU/ml) and lactate dehydrogenase (1,112 mU/ml) were elevated. Echocardiography revealed stenosis of the prosthetic valve in the aortic position with peak flow velocity of 3.8 m/second and massive mitral regurgitation. The patient underwent repeat valve replacement. Pannus formation around both implanted valves was observed. The aortic valve orifice was narrowed by the pannus, and one cusp of the prosthesis in the mitral position was fixed and caused the regurgitation, but they were free from cusp laceration or calcification. The patient's postoperative course was uneventful, and he continues to do well 14 months after surgery.

  10. 49 CFR 228.101 - Distance requirement; definitions.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... determined in accordance with rules prescribed by the Secretary of Transportation) of any area where railroad... of a new facility; (ii) Expansion of an existing facility; (iii) Placement of a mobile or modular...) Replacement of an existing facility with a new facility on the same site; or (ii) Rehabilitation or...

  11. Introduction of Sustainability Concepts into Industrial Engineering Education: A Modular Approach

    ERIC Educational Resources Information Center

    Nazzal, Dima; Zabinski, Joseph; Hugar, Alexander; Reinhart, Debra; Karwowski, Waldemar; Madani, Kaveh

    2015-01-01

    Sustainability in operations, production, and consumption continues to gain relevance for engineers. This trend will accelerate as demand for goods and services grows, straining resources and requiring ingenuity to replace boundless supply in meeting the needs of a more crowded, more prosperous world. Industrial engineers are uniquely positioned…

  12. Subprosthetic Pannus after Aortic Valve Replacement Surgery: Cardiac CT Findings and Clinical Features.

    PubMed

    Han, Kichang; Yang, Dong Hyun; Shin, So Youn; Kim, Namkug; Kang, Joon-Won; Kim, Dae-Hee; Song, Jong-Min; Kang, Duk-Hyun; Song, Jae-Kwan; Kim, Joon Bum; Jung, Sung-Ho; Choo, Suk Jung; Chung, Cheol Hyun; Lee, Jae Won; Lim, Tae-Hwan

    2015-09-01

    To investigate the cardiac computed tomographic (CT) findings and clinical implications of subprosthetic pannus in patients who have undergone aortic valve replacement. The institutional review board approved this retrospective study, and the need to obtain written informed consent was waived. From April 2011 to March 2012, 88 patients (mean age, 63 years; 45 men) with a prosthetic aortic valve who underwent cardiac CT were retrospectively selected. Dynamic cardiac CT images were analyzed by using a multiplanar reformatted technique. The presence or absence of subprosthetic pannus and its extent were evaluated at cardiac CT. The geometric orifice area and the effective orifice area of each prosthetic valve were measured to enable analysis of the pannus encroachment ratio in the systolic phase. Hemodynamic parameters at echocardiography, including mean transprosthetic pressure gradient (MTPG), were compared between patients with and those without pannus. The encroachment ratio and the MTPG were correlated by using the Spearman test to evaluate the relationship between the two variables. Seventeen patients (19%) had subprosthetic pannus at cardiac CT. In patients with subprosthetic pannus, MTPG, peak pressure gradient, transvalvular peak velocity, and left ventricular ejection fraction (LVEF) were significantly higher than in patients without pannus (MTPG: 28.1 mm Hg ± 19.8 [standard deviation] vs 14.0 mm Hg ± 6.5, P = .004; peak pressure gradient: 53.1 mm Hg ± 38.4 vs 26.1 mm Hg ± 11.4, P = .004; transvalvular peak velocity: 3.3 m/sec ± 1.3 vs 2.5 m/sec ± 0.5; and LVEF: 64.7% ± 7.4 vs 56.8% ± 10.5, P = .004). A high MTPG (≥40 mm Hg) was observed in four patients at echocardiography, and subprosthetic panni were identified at CT in all four patients. In patients with increased MTPGs, the encroachment ratio by subprosthetic pannus at CT was significantly higher than that in patients with MTPGs of less than 40 mm Hg (42.7 ± 13.3 vs 7.6 ± 3, P = .012). Cardiac CT revealed subprosthetic pannus to be a cause of the hemodynamic changes in patients who had undergone aortic valve replacement. By helping quantify the encroachment ratio by pannus, cardiac CT may help differentiate which subprosthetic panni might lead to substantial flow limitation over the prosthetic aortic valve.

  13. Transcatheter Pulmonary Valve Replacement by Hybrid Approach Using a Novel Polymeric Prosthetic Heart Valve: Proof of Concept in Sheep

    PubMed Central

    Xu, Tong-yi; Zhang, Zhi-gang; Li, Xin; Han, Lin; Xu, Zhi-yun

    2014-01-01

    Background Since 2000, transcatheter pulmonary valve replacement has steadily advanced. However, the available prosthetic valves are restricted to bioprosthesis which have defects like poor durability. Polymeric heart valve is thought as a promising alternative to bioprosthesis. In this study, we introduced a novel polymeric transcatheter pulmonary valve and evaluated its feasibility and safety in sheep by a hybrid approach. Methods We designed a novel polymeric trileaflet transcatheter pulmonary valve with a balloon-expandable stent, and the valve leaflets were made of 0.1-mm expanded polytetrafluoroethylene (ePTFE) coated with phosphorylcholine. We chose glutaraldehyde-treated bovine pericardium valves as control. Pulmonary valve stents were implanted in situ by a hybrid transapical approach in 10 healthy sheep (8 for polymeric valve and 2 for bovine pericardium valve), weighing an average of 22.5±2.0 kg. Angiography and cardiac catheter examination were performed after implantation to assess immediate valvular functionality. After 4-week follow-up, angiography, echocardiography, computed tomography, and cardiac catheter examination were used to assess early valvular function. One randomly selected sheep with polymeric valve was euthanized and the explanted valved stent was analyzed macroscopically and microscopically. Findings Implantation was successful in 9 sheep. Angiography at implantation showed all 9 prosthetic valves demonstrated orthotopic position and normal functionality. All 9 sheep survived at 4-week follow-up. Four-week follow-up revealed no evidence of valve stent dislocation or deformation and normal valvular and cardiac functionality. The cardiac catheter examination showed the peak-peak transvalvular pressure gradient of the polymeric valves was 11.9±5.0 mmHg, while that of two bovine pericardium valves were 11 and 17 mmHg. Gross morphology demonstrated good opening and closure characteristics. No thrombus or calcification was seen macroscopically. Conclusions This design of the novel ePTFE transcatheter pulmonary valve is safe and effective to deploy in sheep by hybrid approach, and the early valvular functionality is good. PMID:24926892

  14. Initial experience with xenograft bioconduit for the treatment of complex prosthetic valve endocarditis.

    PubMed

    Roubelakis, Apostolos; Karangelis, Dimos; Sadeque, Syed; Yanagawa, Bobby; Modi, Amit; Barlow, Clifford W; Livesey, Steven A; Ohri, Sunil K

    2017-07-01

    The treatment of complex prosthetic valve endocarditis (PVE) with aortic root abscess remains a surgical challenge. Several studies support the use of biological tissues to minimize the risk of recurrent infection. We present our initial surgical experience with the use of an aortic xenograft conduit for aortic valve and root replacement. Between October 2013 and August 2015, 15 xenograft bioconduits were implanted for complex PVE with abscess (13.3% female). In 6 patients, concomitant procedures were performed: coronary bypass (n=1), mitral valve replacement (n=5) and tricuspid annuloplasty (n=1). The mean age at operation was 60.3±15.5 years. The mean Logistic European system for cardiac operating risk evaluation (EuroSCORE) was 46.6±23.6. The median follow-up time was 607±328 days (range: 172-1074 days). There were two in-hospital deaths (14.3% mortality), two strokes (14.3%) and seven patients required permanent pacemaker insertion for conduction abnormalities (46.7%). The mean length of hospital stay was 26 days. At pre-discharge echocardiography, the conduit mean gradient was 9.3±3.3mmHg and there was either none (n=6), trace (n=6) or mild aortic insufficiency (n=1). There was no incidence of mid-term death, prosthesis-related complications or recurrent endocarditis. Xenograft bioconduits may be safe and effective for aortic valve and root replacement for complex PVE with aortic root abscess. Although excess early mortality reflects the complexity of the patient population, there was good valve hemodynamics, with no incidence of recurrent endocarditis or prosthesis failure in the mid-term. Our data support the continued use and evaluation of this biological prosthesis in this high-risk patient cohort.

  15. Efficacy of a novel strategy for poststernotomy deep sternal infection after thoracic aorta replacement using a prosthetic graft.

    PubMed

    Kuriyama, Motone; Yoshida, Yukitaka; Ninomiya, Hitoshi; Yamamoto, Shin; Sasaguri, Shiro; Akita, Shinsuke; Mitsukawa, Nobuyuki

    2018-05-01

    Poststernotomy deep sternal wound infections are persistent and occasionally fatal, especially in cases involving prosthetic grafts, because of their complicated structure and virtual impossibility of removal. We aimed to verify the influence of cooperation with plastic surgeons and our novel strategy for treating deep sternal wound infection after aortic replacement on cardiovascular surgery outcomes. Nine hundred eighty-three consecutive patients were divided into two groups: an early group (2012-2013) and a late group (2014-2015). The late group had received cooperatively improved perioperative wound management: our novel strategy of deep sternal infection based on radical debridement and immediate reconstruction decided by reference to severities of the patient's general condition and widespread infection by early intervention of plastic surgeons. The groups were analysed retrospectively. Binary variables were analysed statistically with the Fisher exact test and continuous variables with the Mann-Whitney U test. Inter-group differences were assessed with the chi-square test. Twenty of 390 cases in the early group and 13 of 593 cases in the late group were associated with deep sternal infection. Morbidity rates of deep sternal wound infection and associated mortality rates 1 year after reconstruction surgery were significantly less (p <0.05 for both) in the late group. Intervention by plastic surgeons improved perioperative wound management outcomes. Our treatment strategy for deep sternal wound infection also reduced associated mortality rates. Facilities should consider the early inclusion of plastic surgeons in the treatment of patients undergoing aortic replacement to facilitate better outcomes. Copyright © 2018 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  16. Tricuspid regurgitation due to chest trauma: an unusual laceration around the annulus of the anterior leaflet.

    PubMed

    Ishii, K; Koga, Y; Maeda, M; Nakamura, K; Sekiya, R; Yonezawa, T; Onitsuka, T; Shibata, K

    1988-01-01

    A 70-year-old male with tricuspid regurgitation due to a blunt chest trauma inflicted 16 years previously underwent prosthetic valve replacement. At surgery, a tear, which produced tricuspid regurgitation, was found around the annulus of the anterior leaflet of the tricuspid valve. Since this area has not been reported as a location for heart trauma-producing tricuspid regurgitation, a possible mechanism of tricuspid regurgitation is discussed in this patient.

  17. Multidisciplinary management including periodontics, orthodontics, implants, and prosthetics for an adult.

    PubMed

    Pinho, Teresa; Neves, Manuel; Alves, Célia

    2012-08-01

    This article describes the complex dental treatment of an adult patient with multiple missing teeth, mild chronic periodontitis, and a malocclusion with a cant of the occlusal plane. After periodontal treatment, titanium implants and a miniscrew were placed to correct the occlusal plane canting with orthodontic treatment. Prosthodontic treatment was completed by using osseointegrated implants to replace the missing teeth. Copyright © 2012 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

  18. Visual performance with changes in eccentricity in PROSE device: a case report.

    PubMed

    Jagadeesh, Divya; Mahadevan, Rajeswari

    2014-01-01

    This case report describes the variations in visual performance of a subject with moderate keratoconus with changes in front surface eccentricities (FSEs) of PROSE (Prosthetic Replacement of Ocular Surface Ecosystem). PROSE device of 0.6 FSE provided maximum visual improvement and reduction in Higher Order Aberrations (HOAs) compared to 0, 0.3 and 0.8 FSEs in this clinical condition. Copyright © 2013 Spanish General Council of Optometry. Published by Elsevier Espana. All rights reserved.

  19. Internal Prosthetic Replacement of Skeletal Segments Lost in Combat Related Injuries.

    DTIC Science & Technology

    1981-08-01

    1-cm segment from the proximal third to prevent distraction of the fragments. The fiber metal segment is then placed in the appropriate defect and the...articularis genu suprema. The medial collateral ligament is sectioned through this incision and the medial meniscus removed in toto. The articular capsule...the image intensifier showed no evidence of motion. A physical therapy was instituted to mobilize and strengthen her knee. Case #11. This 52 year old

  20. Hereditary spherocytosis and elliptocytosis associated with prosthetic heart valve replacement: rheological study of erythrocyte modifications.

    PubMed

    Caprari, Patrizia; Tarzia, Anna; Mojoli, Giorgio; Cianciulli, Paolo; Mannella, Emilio; Martorana, Maria Cristina

    2009-04-01

    The implantation of a prosthetic heart valve (HVP) in patients with hereditary spherocytosis (HS) and hereditary elliptocytosis (HE) is rare, and the changes in the structure and deformability of erythrocytes that follow implantation in these patients have been poorly described. In the present study, the erythrocytes in HS and HE patients with mechanical HVP were compared to the erythrocytes in patients with only congenital membrane defects, in terms of biochemical modifications and rheological behaviour. Integral and cytoskeletal erythrocyte membrane proteins were studied, and blood viscosity (shear rate/shear stress ratio), aggregation ratio [eta(1 s(-1))/eta(200 s(-1))], and red cell visco-elasticity were determined. Valve replacement with a mechanical prosthesis worsened anaemia and resulted in a change in haemolysis, from sub-clinical to evident. The rheological investigation of erythrocytes from HS patients confirmed the characteristic increased viscosity and aggregation ratio and the decreased deformability. The rheological behaviour of erythrocytes from patients with HVP showed a decrease in viscosity and an increase in elastic modulus. In these patients, the prosthesis seems to have induced traumatic damage to the erythrocyte membrane, leading to fragmentation and lysis, which in turn modified rheological parameters. The biochemical and rheological investigation allowed us to understand the clinical and haematological pictures of the patients and to describe the role played by different factors in haemolytic anaemia.

  1. Implant-supported single-tooth restorations. A 12-year prospective study.

    PubMed

    Donati, Mauro; Ekestubbe, Annika; Lindhe, Jan; Wennström, Jan L

    2016-10-01

    The aim of this study was to evaluate prospectively the 12-year outcome of implant-supported single-tooth restorations. Originally 45 self-tapping Astra Tech TiOblast ® ST-implants were installed by a two-stage protocol in 40 subjects requiring single-tooth prosthetic replacement for a missing tooth. Clinical and radiologic examinations were performed at completion of the prosthetic treatment 4-7 months after implant installation surgery and after 5 and 12 years in function. At 12 years 31 patients and 35 implants were available for evaluation. The overall failure rate after 12 years was 10.3% on the subject level and 9.1% on the implant level. The mean bone loss amounted to 0.67 mm (SD 2.20) on a subject level and 0.47 mm (1.72) on an implant level. Three subjects (10%) and three implants (8.6%) were diagnosed with peri-implantitis. Five subjects had experienced technical complications; three incidences of loosening of the abutment retention screw during the first 5 years and two minor porcelain fracture of the crown (two patients) between 5- and 12-years of follow-up. The findings reported in this 12-year prospective case series suggest that the use of the Astra Tech dental implants may be a valid treatment alternative for single-tooth replacement prostheses. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  2. Late complications in patients with Björk-Shiley and St. Jude Medical heart valve replacement.

    PubMed

    Horstkotte, D; Körfer, R; Seipel, L; Bircks, W; Loogen, F

    1983-09-01

    Valve-related complications after Björk-Shiley mitral valve implantation (n = 475), aortic valve implantation (n = 424), or mitral-aortic valve implantation (n = 119) were compared with those after St. Jude Medical mitral valve replacement (n = 173), aortic valve replacement (n = 152), or mitral-aortic valve replacement (n = 69). All patients were placed on anticoagulant therapy with phenprocoumon early after operation. All patients had a comparable follow-up time of approximately 23 months, which showed that cumulative thromboembolic rates were significantly higher after St. Jude valve implantation than after Björk-Shiley valve implantation. Reoperations were necessary because of valve thrombosis (0.46%), perivalvular leakage (2.2%), or prosthetic valve endocarditis with perivalvular regurgitation (0.46%). One Björk-Shiley mitral valve prosthesis had to be replaced because of fracture of the outlet strut. Without significant intergroup differences, hemorrhage due to anticoagulant treatment was the most frequent complication. Thromboembolic complications were significantly more frequent after Björk-Shiley mitral, aortic, and double valve replacements than after St. Jude valve implantation. This may lead to consideration of changes in the prophylaxis of thrombus formations in the St. Jude valve, especially in aortic valve replacements, in patients with sinus rhythm.

  3. A Canadian Electric-Arm Prosthesis for Children

    PubMed Central

    Nicholls, Peter B.; Stevenson, David A.; Sherman, E. David; Lippay, Andrew L.; Gingras, Gustave

    1967-01-01

    The thalidomide tragedy in Canada initiated new efforts to produce functional prosthetic appliances for very young amputees. In 1962, the Rehabilitation Institute of Montreal began to fit 36 babies with adapted conventional and gas-operated devices. Practical experience with the Soviet prosthesis proved the feasibility of myoelectric control, and indicated the possibility of using skin electrodes over an active muscle for control purposes in children. We obtained assistance from the Northern Electric Company, whose research laboratories produced the prototype arms described in this report. An all-electric prosthetic system was developed which carries out four different movements driven by a single motor. Function is effected by switches, but a myoelectric control system could be readily adapted without major changes. In the description of our needs for the proposed arm, we asked for modular construction and a minimum service life of one year between major repairs. Details of design and performance are outlined in this report. Initial clinical experience indicates that the prosthesis is completely accepted by the young patient, in spite of its excessive weight and inconvenient control. Four powered joints give the child greater functional freedom. In future we plan to fit an older child and will study more bilateral installations in the next 14 months. After further use, study and improvement, this device will become a useful prosthesis. ImagesFig. 1Fig. 2Fig. 3Fig. 4Fig. 5 PMID:6021562

  4. Demonstration of a Semi-Autonomous Hybrid Brain-Machine Interface using Human Intracranial EEG, Eye Tracking, and Computer Vision to Control a Robotic Upper Limb Prosthetic

    PubMed Central

    McMullen, David P.; Hotson, Guy; Katyal, Kapil D.; Wester, Brock A.; Fifer, Matthew S.; McGee, Timothy G.; Harris, Andrew; Johannes, Matthew S.; Vogelstein, R. Jacob; Ravitz, Alan D.; Anderson, William S.; Thakor, Nitish V.; Crone, Nathan E.

    2014-01-01

    To increase the ability of brain-machine interfaces (BMIs) to control advanced prostheses such as the modular prosthetic limb (MPL), we are developing a novel system: the Hybrid Augmented Reality Multimodal Operation Neural Integration Environment (HARMONIE). This system utilizes hybrid input, supervisory control, and intelligent robotics to allow users to identify an object (via eye tracking and computer vision) and initiate (via brain-control) a semi-autonomous reach-grasp-and-drop of the object by the MPL. Sequential iterations of HARMONIE were tested in two pilot subjects implanted with electrocorticographic (ECoG) and depth electrodes within motor areas. The subjects performed the complex task in 71.4% (20/28) and 67.7% (21/31) of trials after minimal training. Balanced accuracy for detecting movements was 91.1% and 92.9%, significantly greater than chance accuracies (p < 0.05). After BMI-based initiation, the MPL completed the entire task 100% (one object) and 70% (three objects) of the time. The MPL took approximately 12.2 seconds for task completion after system improvements implemented for the second subject. Our hybrid-BMI design prevented all but one baseline false positive from initiating the system. The novel approach demonstrated in this proof-of-principle study, using hybrid input, supervisory control, and intelligent robotics, addresses limitations of current BMIs. PMID:24760914

  5. Demonstration of a semi-autonomous hybrid brain-machine interface using human intracranial EEG, eye tracking, and computer vision to control a robotic upper limb prosthetic.

    PubMed

    McMullen, David P; Hotson, Guy; Katyal, Kapil D; Wester, Brock A; Fifer, Matthew S; McGee, Timothy G; Harris, Andrew; Johannes, Matthew S; Vogelstein, R Jacob; Ravitz, Alan D; Anderson, William S; Thakor, Nitish V; Crone, Nathan E

    2014-07-01

    To increase the ability of brain-machine interfaces (BMIs) to control advanced prostheses such as the modular prosthetic limb (MPL), we are developing a novel system: the Hybrid Augmented Reality Multimodal Operation Neural Integration Environment (HARMONIE). This system utilizes hybrid input, supervisory control, and intelligent robotics to allow users to identify an object (via eye tracking and computer vision) and initiate (via brain-control) a semi-autonomous reach-grasp-and-drop of the object by the MPL. Sequential iterations of HARMONIE were tested in two pilot subjects implanted with electrocorticographic (ECoG) and depth electrodes within motor areas. The subjects performed the complex task in 71.4% (20/28) and 67.7% (21/31) of trials after minimal training. Balanced accuracy for detecting movements was 91.1% and 92.9%, significantly greater than chance accuracies (p < 0.05). After BMI-based initiation, the MPL completed the entire task 100% (one object) and 70% (three objects) of the time. The MPL took approximately 12.2 s for task completion after system improvements implemented for the second subject. Our hybrid-BMI design prevented all but one baseline false positive from initiating the system. The novel approach demonstrated in this proof-of-principle study, using hybrid input, supervisory control, and intelligent robotics, addresses limitations of current BMIs.

  6. Computerized system for the follow-up of patients with heart valve replacements.

    PubMed

    Bain, W H; Fyfe, I C; Rodger, R A

    1985-04-01

    A system is described which will accept, store, retrieve and analyze information on large numbers of patients who undergo valve replacement surgery. The purpose of the database is to yield readily available facts concerning the patient's clinical course, prosthetic valve function, length of survival, and incidence of complications. The system uses the Apple Macintosh computer, which is one of the current examples of small, desk-top microprocessors. The software for the input, editing and analysis programs has been written by a professional software writer in close collaboration with a cardiac surgeon. Its content is based on 8 years' experience of computer-based valve follow-up. The system is inexpensive and has proved easy to use in practice.

  7. KSC-06pd0395

    NASA Image and Video Library

    2006-03-01

    KENNEDY SPACE CENTER, FLA. - This aerial view shows the Press Site (in the foreground) comprising the NASA TV studio, the NASA News Center behind it, buildings used by local NBC and CBS television stations, and newly erected prefabricated buildings for local newspapers and correspondents for CNN, AP and others. A year-long project removed and replaced hurricane-damaged trailers and grandstands from the site. In the background, at right, is the newly built Operations Support Building II, which replaced modular housing and trailers in the Launch Complex 39 area. Photo credit: Cory Huston

  8. Computational redesign of a protein-protein interface for high affinity and binding specificity using modular architecture and naturally occurring template fragments.

    PubMed

    Potapov, V; Reichmann, D; Abramovich, R; Filchtinski, D; Zohar, N; Ben Halevy, D; Edelman, M; Sobolev, V; Schreiber, G

    2008-12-05

    A new method is presented for the redesign of protein-protein interfaces, resulting in specificity of the designed pair while maintaining high affinity. The design is based on modular interface architecture and was carried out on the interaction between TEM1 beta-lactamase and its inhibitor protein, beta-lactamase inhibitor protein. The interface between these two proteins is composed of several mostly independent modules. We previously showed that it is possible to delete a complete module without affecting the overall structure of the interface. Here, we replace a complete module with structure fragments taken from nonrelated proteins. Nature-optimized fragments were chosen from 10(7) starting templates found in the Protein Data Bank. A procedure was then developed to identify sets of interacting template residues with a backbone arrangement mimicking the original module. This generated a final list of 361 putative replacement modules that were ranked using a novel scoring function based on grouped atom-atom contact surface areas. The top-ranked designed complex exhibited an affinity of at least the wild-type level and a mode of binding that was remarkably specific despite the absence of negative design in the procedure. In retrospect, the combined application of three factors led to the success of the design approach: utilizing the modular construction of the interface, capitalizing on native rather than artificial templates, and ranking with an accurate atom-atom contact surface scoring function.

  9. KSC-04PD-1290

    NASA Technical Reports Server (NTRS)

    2004-01-01

    KENNEDY SPACE CENTER, FLA. Towers and girders are the current construction components on the Operations Support Building (OSB) II in the Launch Complex 39 Area. The new building, which replaces modular housing constructed more than 20 years ago, will house NASA and contractor support staff for shuttle operations. The new structure is projected to be ready in April 2005.

  10. KSC-04PD-1288

    NASA Technical Reports Server (NTRS)

    2004-01-01

    KENNEDY SPACE CENTER, FLA. Another phase of construction is shown on the Operations Support Building (OSB) II in the Launch Complex 39 Area. The new building, which replaces modular housing constructed more than 20 years ago, will house NASA and contractor support staff for shuttle operations. The new structure is projected to be ready in April 2005.

  11. KSC-04PD-1291

    NASA Technical Reports Server (NTRS)

    2004-01-01

    KENNEDY SPACE CENTER, FLA. Towers and girders are the current construction components on the Operations Support Building (OSB) II in the Launch Complex 39 Area. The new building, which replaces modular housing constructed more than 20 years ago, will house NASA and contractor support staff for shuttle operations. The new structure is projected to be ready in April 2005.

  12. KSC-04PD-1289

    NASA Technical Reports Server (NTRS)

    2004-01-01

    KENNEDY SPACE CENTER, FLA. Towers and girders are the current construction components on the Operations Support Building (OSB) II in the Launch Complex 39 Area. The new building, which replaces modular housing constructed more than 20 years ago, will house NASA and contractor support staff for shuttle operations. The new structure is projected to be ready in April 2005.

  13. [Microfiche/Audiotape and Teeth. An Experimental Trial of New Technology: The Second Year.

    ERIC Educational Resources Information Center

    Dills, Charles R.; Bass, Ronald K.

    Two papers describe a 3-year project being conducted to evaluate the feasibility of replacing traditional slide-tape materials in a criterion-referenced, modularized, self-paced curriculum in dentistry with color microfiche and audiotapes. The experimental materials are being used with a microfiche-audiotape unit controlled by a microprocessor.…

  14. Astronaut Anna Fisher Suiting Up For NBS Training

    NASA Technical Reports Server (NTRS)

    1980-01-01

    The Hubble Space Telescope (HST) is a cooperative program of the European Space Agency (ESA) and the National Aeronautical and Space Administration (NASA) to operate a long-lived space-based observatory. It was the flagship mission of NASA's Great Observatories program. The HST program began as an astronomical dream in the 1940s. During the 1970s and 1980s, the HST was finally designed and built becoming operational in the 1990s. The HST was deployed into a low-Earth orbit on April 25, 1990 from the cargo bay of the Space Shuttle Discovery (STS-31). The design of the HST took into consideration its length of service and the necessity of repairs and equipment replacement by making the body modular. In doing so, subsequent shuttle missions could recover the HST, replace faulty or obsolete parts and be re-released. Marshall Space Flight Center's (MSFC's) Neutral Buoyancy Simulator (NBS) served as the test center for shuttle astronauts training for Hubble related missions. Shown is astronaut Anna Fisher suiting up for training on a mockup of a modular section of the HST for an axial scientific instrument change out.

  15. Astronaut Anna Fisher Suited Up For NBS Training

    NASA Technical Reports Server (NTRS)

    1980-01-01

    The Hubble Space Telescope (HST) is a cooperative program of the European Space Agency (ESA) and the National Aeronautical and Space Administration (NASA) to operate a long-lived space-based observatory. It was the flagship mission of NASA's Great Observatories program. The HST program began as an astronomical dream in the 1940s. During the 1970s and 1980s, the HST was finally designed and built becoming operational in the 1990s. The HST was deployed into a low-Earth orbit on April 25, 1990 from the cargo bay of the Space Shuttle Discovery (STS-31). The design of the HST took into consideration its length of service and the necessity of repairs and equipment replacement by making the body modular. In doing so, subsequent shuttle missions could recover the HST, replace faulty or obsolete parts and be re-released. Marshall Space Flight Center's (MSFC's) Neutral Buoyancy Simulator (NBS) served as the test center for shuttle astronauts training for Hubble related missions. Shown is astronaut Anna Fisher suited up for training on a mockup of a modular section of the HST for an axial scientific instrument change out.

  16. Astronaut Anna Fisher Suited Up For NBS Training

    NASA Technical Reports Server (NTRS)

    1980-01-01

    The Hubble Space Telescope (HST) is a cooperative program of the European Space Agency (ESA) and the National Aeronautical and Space Administration (NASA) to operate a long-lived space-based observatory. It was the flagship mission of NASA's Great Observatories program. The HST program began as an astronomical dream in the 1940s. During the 1970s and 1980s, the HST was finally designed and built becoming operational in the 1990s. The HST was deployed into a low-Earth orbit on April 25, 1990 from the cargo bay of the Space Shuttle Discovery (STS-31). The design of the HST took into consideration its length of service and the necessity of repairs and equipment replacement by making the body modular. In doing so, subsequent shuttle missions could recover the HST, replace faulty or obsolete parts and be re-released. Marshall SPace Flight Center's (MSFC's) Neutral Buoyancy Simulator (NBS) served as the test center for shuttle astronauts training for Hubble related missions. Shown is astronaut Anna Fisher suited up for training on a mockup of a modular section of the HST for an axial scientific instrument change out.

  17. Astronaut Anna Fisher Suits Up for NBS Training

    NASA Technical Reports Server (NTRS)

    1980-01-01

    The Hubble Space Telescope (HST) is a cooperative program of the European Space Agency (ESA) and the National Aeronautical and Space Administration (NASA) to operate a long-lived space-based observatory. It was the flagship mission of NASA's Great Observatories program. The HST program began as an astronomical dream in the 1940s. During the 1970s and 1980s, the HST was finally designed and built becoming operational in the 1990s. The HST was deployed into a low-Earth orbit on April 25, 1990 from the cargo bay of the Space Shuttle Discovery (STS-31). The design of the HST took into consideration its length of service and the necessity of repairs and equipment replacement by making the body modular. In doing so, subsequent shuttle missions could recover the HST, replace faulty or obsolete parts and be re-released. Marshall Space Flight Center's (MSFC's) Neutral Buoyancy Simulator (NBS) served as the test center for shuttle astronauts training for Hubble related missions. Shown is astronaut Anna Fisher suiting up for training on a mockup of a modular section of the HST for an axial scientific instrument change out.

  18. Astronaut Anna Fisher Suiting Up For NBS Training

    NASA Technical Reports Server (NTRS)

    1980-01-01

    The Hubble Space Telescope (HST) is a cooperative program of the European Space Agency (ESA) and the National Aeronautical and Space Administration (NASA) to operate a long-lived space-based observatory. It was the flagship mission of NASA's Great Observatories program. The HST program began as an astronomical dream in the 1940s. During the 1970s and 1980s, the HST was finally designed and built becoming operational in the 1990s. The HST was deployed into a low-Earth orbit on April 25, 1990 from the cargo bay of the Space Shuttle Discovery (STS-31). The design of the HST took into consideration its length of service and the necessity of repairs and equipment replacement by making the body modular. In doing so, subsequent shuttle missions could recover the HST, replace faulty or obsolete parts and be re-released. MSFC's Neutral Buoyancy Simulator (NBS) served as the test center for shuttle astronauts training for Hubble related missions. Shown is astronaut Anna Fisher suiting up for training on a mockup of a modular section of the HST for an axial scientific instrument change out.

  19. Astronaut Anna Fisher in NBS Training For Hubble Space Telescope

    NASA Technical Reports Server (NTRS)

    1980-01-01

    The Hubble Space Telescope (HST) is a cooperative program of the European Space Agency (ESA) and the National Aeronautical and Space Administration (NASA) to operate a long-lived space-based observatory. It was the flagship mission of NASA's Great Observatories program. The HST program began as an astronomical dream in the 1940s. During the 1970s and 1980s, the HST was finally designed and built becoming operational in the 1990s. The HST was deployed into a low-Earth orbit on April 25, 1990 from the cargo bay of the Space Shuttle Discovery (STS-31). The design of the HST took into consideration its length of service and the necessity of repairs and equipment replacement by making the body modular. In doing so, subsequent shuttle missions could recover the HST, replace faulty or obsolete parts and be re-released. Marshall Space Flight Center's (MSFC's) Neutral Buoyancy Simulator (NBS) served as the test center for shuttle astronauts training for Hubble related missions. Shown is astronaut Anna Fisher training on a mock-up of a modular section of the HST for an axial scientific instrument change out.

  20. Astronaut Anna Fisher Suits Up For NBS Training

    NASA Technical Reports Server (NTRS)

    1980-01-01

    The Hubble Space Telescope (HST) is a cooperative program of the European Space Agency (ESA) and the National Aeronautical and Space Administration (NASA) to operate a long-lived space-based observatory. It was the flagship mission of NASA's Great Observatories program. The HST program began as an astronomical dream in the 1940s. During the 1970s and 1980s, the HST was finally designed and built becoming operational in the 1990s. The HST was deployed into a low-Earth orbit on April 25, 1990 from the cargo bay of the Space Shuttle Discovery (STS-31). The design of the HST took into consideration its length of service and the necessity of repairs and equipment replacement by making the body modular. In doing so, subsequent shuttle missions could recover the HST, replace faulty or obsolete parts and be re-released. Marshall Space Flight Center's (MSFC's) Neutral Buoyancy Simulator (NBS) served as the test center for shuttle astronauts training for Hubble related missions. Shown is astronaut Anna Fisher suiting up for training on a mockup of a modular section of the HST for an axial scientific instrument change out.

  1. Human-technology Integration

    NASA Astrophysics Data System (ADS)

    Mullen, Katharine M.

    Human-technology integration is the replacement of human parts and extension of human capabilities with engineered devices and substrates. Its result is hybrid biological-artificial systems. We discuss here four categories of products furthering human-technology integration: wearable computers, pervasive computing environments, engineered tissues and organs, and prosthetics, and introduce examples of currently realized systems in each category. We then note that realization of a completely artificial sytem via the path of human-technology integration presents the prospect of empirical confirmation of an aware artificially embodied system.

  2. Cementless total knee arthroplasty

    PubMed Central

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

    2016-01-01

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

  3. Importance of increased intraosseous pressure in the development of osteonecrosis of the femoral head: implications for treatment

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Hungerford, D.S.; Lennox, D.W.

    1985-10-01

    Early diagnosis of osteonecrosis by radiograph, bone scan, CT scan, magnetic resonance imaging (MRI), intraosseous pressure measurement, or intraosseous venogram can lead to early successful treatment. For early (Ficat stages I and II) osteonecrosis of the hip, core decompression can provide diagnostic confirmation and pain relief and may prevent progression of disease. For more advanced disease (Ficat stages II and IV), osteotomy, endoprosthetic or bipolar prosthetic replacement, total hip arthroplasty, and arthrodesis are surgical options.86 references.

  4. Outcome of bioprosthetic valve replacement in dogs with tricuspid valve dysplasia.

    PubMed

    Bristow, P; Sargent, J; Luis Fuentes, V; Brockman, D

    2017-04-01

    To describe the short-term and long-term outcome in dogs with tricuspid valve dysplasia undergoing tricuspid valve replacement under cardiopulmonary bypass. Data were collected from the hospital records of all dogs that had undergone tricuspid valve replacement under cardiopulmonary bypass between 2006 and 2012. Dogs were considered candidates for tricuspid valve replacement if they had severe tricuspid valve regurgitation associated with clinical signs of cardiac compromise. Nine dogs of six different breeds were presented. Median age was 13 months (range 7 to 61 months), median weight 26·5 kg (range 9·7 to 59 kg). Eight bovine pericardial valves and one porcine aortic valve were used. One non-fatal intraoperative complication occurred. Complications during hospitalisation occurred in six dogs, four of which were fatal. Of the five dogs discharged, one presented dead due to haemothorax after minor trauma seven days later. The four remaining dogs survived a median of 533 days; all of these dogs received a bovine pericardial valve. Based on our results, tricuspid valve replacement with bovine or porcine prosthetic valves is associated with a high incidence of complications. © 2017 British Small Animal Veterinary Association.

  5. A 3D velocimetry study of the flow through prosthetic heart valves

    NASA Astrophysics Data System (ADS)

    Ledesma, R.; Zenit, R.; Pulos, G.; Sanchez, E.; Juarez, A.

    2006-11-01

    Blood damage commonly appears in medical valve prothesis. It is a mayor concern for the designers and surgeons. It is well known that this damage and other complications result from the modified fluid dynamics through the replacement valve. To evaluate the performance of prosthetic heart valves, it is necessary to study the flow through them. To conduct this study , we have built a flow channel that emulates cardiac conditions and allows optical access such that a 3D-PIV velocimetry system could be used. The experiments are aimed to reconstruct the downstream structure of the flow through a mechanical and a bio-material tricuspid heart valve prothesis. Preliminary results show that the observed coherent structures can be related with haemolysis and trombosis, illnesses commonly found in valve prothesis recipients. The mean flow, the levels of strain rate and the turbulence intensity generated by the valves can also be directly related to blood damage. In general, bio-material made valves tend to reduce these complications.

  6. The Mulcahy Salvage: Past and Present Innovations.

    PubMed

    Mellon, Matthew J; Broghammer, Joshua R; Henry, Gerard D

    2015-11-01

    Inflatable penile implants are a mainstay for the surgical correction of erectile dysfunction. For the last 40 years they have provided reliable outcomes with durable patient satisfaction. Infection of the implant continues to remain the primary surgical concern, despite the advent of antibiotic-coated devices and improved skin preparation solutions. In this article, we review and evaluate the published literature for important contributions surrounding the various salvage techniques and washout strategies. In addition, the role of biofilm in prosthetic infection will be discussed. First described by Mulcahy for instances of device infection, the salvage or rescue procedure was established to avoid complete removal and staged replacement. This approach, with its avoidance of difficult revision surgery, penile shortening and patient discomfort, has produced success as high as 84%. Mulcahy's innovative approach at salvage or rescue reimplantation has proven to be a highly successful approach to this difficult surgical problem. Without question, the report of the long-term results of his salvage patients has directly influenced a generation of prosthetic surgeons. © 2015 International Society for Sexual Medicine.

  7. Prosthetic liner wear in total hip replacement: a longitudinal 13-year study with computed tomography.

    PubMed

    Weidenhielm, Lars; Olivecrona, Henrik; Maguire, Gerald Q; Noz, Marilyn E

    2018-06-01

    This case report follows a woman who had a total hip replacement in 1992 when she was 45 years old. Six serial computed tomography (CT) examinations over a period of 13 years provided information that allowed her revision surgery to be limited to liner replacement as opposed to replacement of the entire prosthesis. Additionally, they provided data that ruled out the presence of osteolysis and indeed none was found at surgery. In 2004, when the first CT was performed, the 3D distance the femoral head had penetrated into the cup was determined to be 2.6 mm. By 2017, femoral head penetration had progressed to 5.0 mm. The extracted liner showed wear at the thinnest part to be 5.5 mm, as measured with a micrometer. The use of modern CT techniques can identify problems, while still correctable without major surgery. Furthermore, the ability of CT to assess the direction of wear revealed that the liner wear changed from the cranial to dorsal direction.

  8. Long-term follow-up of the experimental replacement of the esophagus with a collagen-silicone composite tube.

    PubMed

    Takimoto, Y; Okumura, N; Nakamura, T; Natsume, T; Shimizu, Y

    1993-01-01

    This study investigated ways of preventing late stenosis after replacing the esophagus with a prosthetic device and increasing survival time in an animal model. In a previous study, the authors induced neoesophageal formation and re-epithelialization at an early stage, although stenosis in the chronic stage remained a problem, and long-term survival was prevented. The authors developed an artificial esophagus made from a collagen-silicone composite tube. The silicone tube (25 mm in diameter, 50 mm long, and 1 mm thick) was covered with collagen sponge (5 mm thick). The collagen sponge was intended to be replaced by host tissue, leading to neoesophageal regeneration. The authors thought stenosis was caused primarily by poor regeneration of submucosal tissue, rather than reepithelialization. Thus, they examined the grade of stenosis relative to the time the stent became dislodged. They concluded that the occurrence of stenosis after anastomosis depends upon the duration of stenting and that stenosis did not develop when the portion replaced by the artificial esophagus was stented for at least 4 weeks.

  9. The economic impact of surgically treated peri-prosthetic hip fractures on a university teaching hospital in Wales 7.5-year study.

    PubMed

    Jones, Andrew R; Williams, Tim; Paringe, Vishal; White, Simon P

    2016-02-01

    The number of total hip replacements taking place across the UK continues to grow. In an ageing population, with people placing greater demands on their prostheses, the number of peri-prosthetic fractures is increasing. We studied the economic impact this has on a large teaching hospital. All patients with peri-prosthetic femoral fracture in a 7.5 year period were identified. Radiographic and case note analysis was performed. Costings from the finance departments were obtained. 90 cases were identified, 58 female and 32 male, with a mean age of 76 (range: 38-91). 89 of the cases were managed surgically, 66% undergoing revision and 33% receiving open reduction and internal fixation. According to the Vancouver Classification, 3% were Type A, 79% Type B and 18% Type C. The mean length of stay was 43 days. The mean cost of management was £31,370 (range: £6885-£112,327). Patients with type C fractures had the highest mean length of stay at 53 days and mean cost of £33,417. Including rehabilitation costs, our study illustrated a mean cost of £31,370, roughly four times the current basic NHS tariff of £8552. Although implant costs are greater, treatment with revision where appropriate allows earlier weight bearing, reduced length of stay and lower overall cost. Copyright © 2015 Elsevier Ltd. All rights reserved.

  10. "Split Cast Mounting: Review and New Technique".

    PubMed

    Gundawar, S M; Pande, Neelam A; Jaiswal, Priti; Radke, U M

    2014-12-01

    For the fabrication of a prosthesis, the Prosthodontist meticulously performs all the steps. The laboratory technician then make every effort/strives to perform the remaining lab procedures. However when the processed dentures are remounted on the articulator, some changes are seen. These changes may be divided into two categories: Pre-insertion and post-insertion changes, which deal with the physical properties of the materials involved (Parker, J Prosthet Dent 31:335-342, 1974). Split cast mounting is the method of mounting casts on the articulator. It is essentially a maxillary cast constructed in two parts with a horizontal division. The procedure allows for the verification of the accuracy of the initial mounting and the ease of removal and replacement of the cast. This provides a precise means of correcting the changes in occlusion occurring as a result of the processing technique (Nogueira et al., J Prosthet Dent 91:386-388, 2004). Instability of the split mounting has always been a problem to the Prosthodontist thereby limiting its use. There are various materials mentioned in the literature. The new technique by using Dowel pins and twill thread is very easy, cheaper and simple way to stabilize the split mounting. It is useful and easy in day to day laboratory procedures. The article presents different methods of split cast mounting and the new procedure using easily available materials in prosthetic laboratory.

  11. Intra-prosthetic breast MR virtual navigation: a preliminary study for a new evaluation of silicone breast implants.

    PubMed

    Moschetta, Marco; Telegrafo, Michele; Capuano, Giulia; Rella, Leonarda; Scardapane, Arnaldo; Angelelli, Giuseppe; Stabile Ianora, Amato Antonio

    2013-10-01

    To assess the contribute of intra-prosthetic MRI virtual navigation for evaluating breast implants and detecting implant ruptures. Forty-five breast implants were evaluated by MR examination. Only patients with a clinical indication were assessed. A 1.5-T device equipped with a 4-channel breast coil was used by performing axial TSE-T2, axial silicone-only, axial silicone suppression and sagittal STIR images. The obtained dicom files were also analyzed by using virtual navigation software. Two blinded radiologists evaluated all MR and virtual images. Eight patients for a total of 13 implants underwent surgical replacement. Sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were calculated for both imaging strategies. Intra-capsular rupture was diagnosed in 13 out of 45 (29%) implants by using MRI. Basing on virtual navigation, 9 (20%) cases of intra-capsular rupture were diagnosed. Sensitivity, specificity, accuracy, PPV and NPV values of 100%, 86%, 89%, 62% and 100%, respectively, were found for MRI. Virtual navigation increased the previous values up to 100%, 97%, 98%, 89% and 100%. Intra-prosthetic breast MR virtual navigation can represent an additional promising tool for the evaluation of breast implants being able to reduce false positives and to provide a more accurate detection of intra-capsular implant rupture signs. Copyright © 2013 Elsevier Inc. All rights reserved.

  12. The conceptual design of a robust, compact, modular tokamak reactor based on high-field superconductors

    NASA Astrophysics Data System (ADS)

    Whyte, D. G.; Bonoli, P.; Barnard, H.; Haakonsen, C.; Hartwig, Z.; Kasten, C.; Palmer, T.; Sung, C.; Sutherland, D.; Bromberg, L.; Mangiarotti, F.; Goh, J.; Sorbom, B.; Sierchio, J.; Ball, J.; Greenwald, M.; Olynyk, G.; Minervini, J.

    2012-10-01

    Two of the greatest challenges to tokamak reactors are 1) large single-unit cost of each reactor's construction and 2) their susceptibility to disruptions from operation at or above operational limits. We present an attractive tokamak reactor design that substantially lessens these issues by exploiting recent advancements in superconductor (SC) tapes allowing peak field on SC coil > 20 Tesla. A R˜3.3 m, B˜9.2 T, ˜ 500 MW fusion power tokamak provides high fusion gain while avoiding all disruptive operating boundaries (no-wall beta, kink, and density limits). Robust steady-state core scenarios are obtained by exploiting the synergy of high field, compact size and ideal efficiency current drive using high-field side launch of Lower Hybrid waves. The design features a completely modular replacement of internal solid components enabled by the demountability of the coils/tapes and the use of an immersion liquid blanket. This modularity opens up the possibility of using the device as a nuclear component test facility.

  13. A Case of an Aortic Abscess around the Elephant Trunk.

    PubMed

    Fujii, Takeshiro; Kawasaki, Muneyasu; Katayanagi, Tomoyuki; Okuma, Shinnosuke; Masuhara, Hiroshi; Shiono, Noritsugu; Watanabe, Yoshinori

    2015-01-01

    A 52-year-old male patient with a history of total arch replacement using the elephant trunk technique for acute aortic dissection 4 years before visited our hospital with the chief complaint of persistent fever. Chest computed tomography (CT) suggested prosthetic vascular graft infection, which was treated surgically after chemotherapy. The first surgery consisted of debridement of an abscess around the vascular graft and in the aorta around the elephant trunk, and thoracic descending aorta replacement and vacuum-assisted closure (VAC) in view of the risk of bleeding from the peripheral region of the elephant trunk. One week later, omental filling was performed as the second step. This is a very rare case of aortic abscess around the elephant trunk that could successfully be managed by graft-conserving treatment.

  14. Recurrent protein-losing enteropathy and tricuspid valve insufficiency in a transplanted heart: a causal relationship?

    PubMed

    Aggarwal, Sanjeev; Delius, Ralph E; Walters, Henry L; L'Ecuyer, Thomas J

    2012-01-01

    This case report describes a toddler who developed a protein-losing enteropathy (PLE) 4 years after orthotopic heart transplantation (OHT). He was born with a hypoplastic left heart syndrome for which he underwent a successful Norwood procedure, a Hemi-Fontan palliation, and a Fontan palliation at 18 months of age. Fifteen months following the Fontan operation, he developed a PLE and Fontan failure requiring OHT. Four years after OHT, he developed a severe tricuspid regurgitation and a PLE. His PLE improved after tricuspid valve replacement. It is now 2 years since his tricuspid valve replacement and he remains clinically free of ascites and peripheral edema with a normal serum albumin level. His prosthetic tricuspid valve is functioning normally. © 2011 Wiley Periodicals, Inc.

  15. Influence of the ischaemic tourniquet in antibiotic prophylaxis in total knee replacement.

    PubMed

    Prats, Laura; Valls, Joan; Ros, Joaquim; Jover, Alfredo; Pérez-Villar, Ferran; Fernández-Martínez, José Juan

    2015-01-01

    There is level iv evidence that the preoperative administration of antibiotics helps in the prevention of prosthetic infection. There is controversy on whether the ischemia applied during surgery may affect the minimum inhibitory concentration of the antibiotic in the peri-prosthetic tissues. The aim of this study is to review this phenomenon through the determination of antibiotic concentration in the synovial tissue. A prospective observational clinical study was conducted on 32 patients undergoing total knee replacement. Cefonicid 2g was administered as prophylaxis, with a tourniquet used for all patients. The antibiotic concentration was quantified by high performance liquid chromatography in samples of synovial tissue collected at the beginning and at the end of the intervention. The mean concentration of antibiotic was 23.16 μg/g (95% CI 19.19 to 27.13) in the samples at the beginning of the intervention and 15.45 μg/g (95% CI 13.20 to 17.69) in the final samples, being higher than the minimum inhibitory concentration of cefonicid, set at 8 μg/g. These results were statistically significant for both concentrations (P<.00001). The antibiotic concentration throughout the standard total knee prosthesis surgery performed with tourniquet gradually decreases throughout the intervention. The concentration determined at the end of the intervention was higher than the minimum inhibitory concentration required for the antibiotic studied. In conclusion, the use of a tourniquet does not increase the risk of infection. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

  16. The Best Anticoagulation Therapy in Multiple-Trauma Patients with Mechanical Heart Valves: Evaluation of Latest Guidelines and Studies.

    PubMed

    Moeinipour, Aliasghar; Zarifian, Ahmadreza; Sheikh Andalibi, Mohammad Sobhan; Shamloo, Alireza Sepehri; Ahmadabadi, Ali; Amouzeshi, Ahmad; Hoseinikhah, Hamid

    2015-12-22

    It is common practice for patients with prosthetic cardiac devices, especially heart valve prosthesis, arterial stents, defibrillators, and pacemaker devices, to use anticoagulation treatment. When these patients suffer from multiple trauma after motor vehicle accidents, the best medical management for this challenging position is mandatory. This strategy should include a rapid diagnosis of all possible multiple organ injuries, with special attention to anticoagulation therapy so as to minimize the risk of thromboembolism complication in prosthetic devices. In this review, we describe the best medical management for patients with multiple trauma who use anticoagulants after heart valve replacement. We searched electronic databases PubMed/Medline, Scopus, Embase, and Google Scholar using the following terms: anticoagulant, warfarin, heparin, and multiple trauma. Also, similar studies suggested by the databases were included. Non-English articles were excluded from the review. For patients who use anticoagulation therapy, teamwork between cardiac surgeons, general surgeons, anesthesiologists, and cardiologists is essential. For optimal medical management, multiple consults between members of this team is mandatory for rapid diagnosis of all possible damaged organs, with special attention to the central nervous system, chest, and abdominal traumas. With this strategy, it is important to take note of anticoagulation drugs to minimize the risk of thromboembolism complications in cardiac devices. The best anticoagulant agents for emergency operations in patients with multiple trauma who are using an anticoagulant after heart valve replacement are fresh frozen plasma (FFP) and prothrombin complex concentrates (PCC).

  17. Osseointegrated total knee replacement connected to a lower limb prosthesis: 4 cases

    PubMed Central

    Khemka, Aditya; Frossard, Laurent; Lord, Sarah J; Bosley, Belinda; Al Muderis, Munjed

    2015-01-01

    Background and purpose — Osseointegrated implants are an alternative for prosthetic attachment in individuals with amputation who are unable to wear a socket. However, the load transmitted through the osseointegrated fixation to the residual tibia and knee joint can be unbearable for those with transtibial amputation and knee arthritis. We report on the feasibility of combining total knee replacement (TKR) with an osseointegrated implant for prosthetic attachment. Patients and methods — We retrospectively reviewed all 4 cases (aged 38–77 years) of transtibial amputations managed with osseointegration and TKR in 2012–2014. The below-the-knee prosthesis was connected to the tibial base plate of a TKR, enabling the tibial residuum and knee joint to act as weight-sharing structures. A 2-stage procedure involved connecting a standard hinged TKR to custom-made implants and creation of a skin-implant interface. Clinical outcomes were assessed at baseline and after 1–3 years of follow-up using standard measures of health-related quality of life, ambulation, and activity level including the questionnaire for transfemoral amputees (Q-TFA) and the 6-minute walk test. Results — There were no major complications, and there was 1 case of superficial infection. All patients showed improved clinical outcomes, with a Q-TFA improvement range of 29–52 and a 6-minute walk test improvement range of 37–84 meters. Interpretation — It is possible to combine TKR with osseointegrated implants. PMID:26145721

  18. Early implant placement for a patient with ectodermal dysplasia: Thirteen years of clinical care.

    PubMed

    Knobloch, Lisa A; Larsen, Peter E; Saponaro, Paola C; L'Homme-Langlois, Emilie

    2017-11-29

    Patients with ectodermal dysplasia have abnormalities of 2 or more structures that originate from the ectoderm. The oral manifestations often include the congenital absence of teeth and malformed teeth. This clinical report describes the interdisciplinary care from childhood through the definitive dental rehabilitation completed at skeletal maturation to replace the missing teeth in a patient with ectodermal dysplasia. Treatment began at 9 years of age with an implant-assisted mandibular overdenture to improve function and replace the missing mandibular teeth. Orthodontic treatment for the consolidation of space, composite resin restorations, and interim removable dental prostheses were provided to improve esthetics and replace the missing maxillary teeth. Skeletal growth was monitored, and orthognathic surgery was performed at the cessation of growth. The definitive rehabilitation consisted of a mandibular fixed dental prosthesis supported by dental implants and a maxillary removable dental prosthesis to restore the patient to esthetics and function. Copyright © 2017 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

  19. Hemophilia A Pseudoaneurysm in a Patient with High Responding Inhibitors Complicating Total Knee Arthroplasty: Embolization: A Cost-Reducing Alternative to Medical Therapy

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Kickuth, Ralph, E-mail: ralph.kickuth@insel.ch; Anderson, Suzanne; Peter-Salonen, Kristiina

    2006-12-15

    Joint hemorrhages are very common in patients with severe hemophilia. Inhibitors in patients with hemophilia are allo-antibodies that neutralize the activity of the clotting factor. After total knee replacement, rare intra-articular bleeding complications might occur that do not respond to clotting factor replacement. We report a 40-year-old male with severe hemophilia A and high responding inhibitors presenting with recurrent knee joint hemorrhage after bilateral knee prosthetic surgery despite adequate clotting factor treatment. There were two episodes of marked postoperative hemarthrosis requiring extensive use of subsititution therapy. Eleven days postoperatively, there was further hemorrhage into the right knee. Digital subtraction angiographymore » diagnosed a complicating pseudoaneurysm of the inferior lateral geniculate artery and embolization was successfully performed. Because clotting factor replacement therapy has proved to be excessively expensive and prolonged, especially in patients with inhibitors, we recommend the use of cost-effective early angiographic embolization.« less

  20. Modeling and stress analyses of a normal foot-ankle and a prosthetic foot-ankle complex.

    PubMed

    Ozen, Mustafa; Sayman, Onur; Havitcioglu, Hasan

    2013-01-01

    Total ankle replacement (TAR) is a relatively new concept and is becoming more popular for treatment of ankle arthritis and fractures. Because of the high costs and difficulties of experimental studies, the developments of TAR prostheses are progressing very slowly. For this reason, the medical imaging techniques such as CT, and MR have become more and more useful. The finite element method (FEM) is a widely used technique to estimate the mechanical behaviors of materials and structures in engineering applications. FEM has also been increasingly applied to biomechanical analyses of human bones, tissues and organs, thanks to the development of both the computing capabilities and the medical imaging techniques. 3-D finite element models of the human foot and ankle from reconstruction of MR and CT images have been investigated by some authors. In this study, data of geometries (used in modeling) of a normal and a prosthetic foot and ankle were obtained from a 3D reconstruction of CT images. The segmentation software, MIMICS was used to generate the 3D images of the bony structures, soft tissues and components of prosthesis of normal and prosthetic ankle-foot complex. Except the spaces between the adjacent surface of the phalanges fused, metatarsals, cuneiforms, cuboid, navicular, talus and calcaneus bones, soft tissues and components of prosthesis were independently developed to form foot and ankle complex. SOLIDWORKS program was used to form the boundary surfaces of all model components and then the solid models were obtained from these boundary surfaces. Finite element analyses software, ABAQUS was used to perform the numerical stress analyses of these models for balanced standing position. Plantar pressure and von Mises stress distributions of the normal and prosthetic ankles were compared with each other. There was a peak pressure increase at the 4th metatarsal, first metatarsal and talus bones and a decrease at the intermediate cuneiform and calcaneus bones, in prosthetic ankle-foot complex compared to normal one. The predicted plantar pressures and von Misses stress distributions for a normal foot were consistent with other FE models given in the literature. The present study is aimed to open new approaches for the development of ankle prosthesis.

  1. Improvement in the clinical practicability of roentgen stereophotogrammetric analysis (RSA): free from the use of the dual X-ray equipment.

    PubMed

    Shih, Kao-Shang; Lee, Chian-Her; Syu, Ci-Bin; Lai, Jiing-Yih; Chen, Kuo-Jen; Lin, Shang-Chih

    2012-10-01

    After total knee replacement, the monitoring of the prosthetic performance is often done by roentgenographic examination. However, the two-dimensional (2D) roentgen images only provide information about the projection onto the anteroposterior (AP) and mediolateral (ML) planes. Historically, the model-based roentgen stereophotogrammetric analysis (RSA) technique has been developed to predict the spatial relationship between prostheses by iteratively comparing the projective data for the prosthetic models and the roentgen images. During examination, the prosthetic poses should be stationary. This should be ensured, either by the use of dual synchronized X-ray equipment or by the use of a specific posture. In practice, these methods are uncommon or technically inconvenient during follow-up examination. This study aims to develop a rotation platform to improve the clinical applicability of the model-based RSA technique. The rotation platform allows the patient to assume a weight-bearing posture, while being steadily rotated so that both AP and ML knee images can be obtained. This study uses X-ray equipment with a single source and flat panel detectors (FPDs). Four tests are conducted to evaluate the quality of the FPD images, steadiness of the rotation platform, and accuracy of the RSA results. The results show that the distortion-induced error of the FPD image is quite minor, and the prosthetic size can be cautiously calibrated by means of the scale ball(s). The rotation platform should be placed closer to the FPD and orthogonal to the projection axis of the X-ray source. Image overlap of the prostheses can be avoided by adjusting both X-ray source and knee posture. The device-induced problems associated with the rotation platform include the steadiness of the platform operation and the balance of the rotated subject. Sawbone tests demonstrate that the outline error, due to the platform, is of the order of the image resolution (= 0.145 mm). In conclusion, the rotation platform with steady rotation, a knee support, and a handle can serve as an alternative method to take prosthetic images, without the loss in accuracy associated with the RSA method.

  2. Prefrontal cortical minicolumn: from executive control to disrupted cognitive processing

    PubMed Central

    Casanova, Manuel F.

    2014-01-01

    The prefrontal cortex of the primate brain has a modular architecture based on the aggregation of neurons in minicolumnar arrangements having afferent and efferent connections distributed across many brain regions to represent, select and/or maintain behavioural goals and executive commands. Prefrontal cortical microcircuits are assumed to play a key role in the perception to action cycle that integrates relevant information about environment, and then selects and enacts behavioural responses. Thus, neurons within the interlaminar microcircuits participate in various functional states requiring the integration of signals across cortical layers and the selection of executive variables. Recent research suggests that executive abilities emerge from cortico-cortical interactions between interlaminar prefrontal cortical microcircuits, whereas their disruption is involved in a broad spectrum of neurologic and psychiatric disorders such as autism, schizophrenia, Alzheimer’s and drug addiction. The focus of this review is on the structural, functional and pathological approaches involving cortical minicolumns. Based on recent technological progress it has been demonstrated that microstimulation of infragranular cortical layers with patterns of microcurrents derived from supragranular layers led to an increase in cognitive performance. This suggests that interlaminar prefrontal cortical microcircuits are playing a causal role in improving cognitive performance. An important reason for the new interest in cortical modularity comes from both the impressive progress in understanding anatomical, physiological and pathological facets of cortical microcircuits and the promise of neural prosthetics for patients with neurological and psychiatric disorders. PMID:24531625

  3. STS multimission modular spacecraft - A new horizon in social and industrial benefits

    NASA Technical Reports Server (NTRS)

    Cepollina, F. J.; Pritchard, E. I.

    1977-01-01

    Economics and benefits of orbiting observatory Multi-mission Modular Spacecraft are discussed. The Space Shuttle can be used both to place these satellites in low-altitude workhorse orbits and to maintain their functioning in any of three ways - on-orbit service (by visiting the satellite with the Shuttle), Shuttle retrieval and ground refurbishment of the entire satellite, and replacement of a failed satellite with a new one. Individuals could receive information from these satellites either indirectly, by turning to a specialty television station, or directly, by calling up information on their television sets as needed. Such information, for example, might include reconnoitering interesting areas, following the weather, or locating migratory fish. Equipment and costs of the proposed Landsats and Seasats are discussed.

  4. Modular Scanning Confocal Microscope with Digital Image Processing.

    PubMed

    Ye, Xianjun; McCluskey, Matthew D

    2016-01-01

    In conventional confocal microscopy, a physical pinhole is placed at the image plane prior to the detector to limit the observation volume. In this work, we present a modular design of a scanning confocal microscope which uses a CCD camera to replace the physical pinhole for materials science applications. Experimental scans were performed on a microscope resolution target, a semiconductor chip carrier, and a piece of etched silicon wafer. The data collected by the CCD were processed to yield images of the specimen. By selecting effective pixels in the recorded CCD images, a virtual pinhole is created. By analyzing the image moments of the imaging data, a lateral resolution enhancement is achieved by using a 20 × / NA = 0.4 microscope objective at 532 nm laser wavelength.

  5. A pancreas specificity results from the combination of polyomavirus and Moloney murine leukemia virus enhancer.

    PubMed Central

    Rochford, R; Campbell, B A; Villarreal, L P

    1987-01-01

    An infectious recombinant polyomavirus was constructed in which a regulatory region of its genome, the B enhancer region (nucleotides 5128-5265) has been replaced with the 72- or 73-base-pair repeat enhancer from the Moloney murine leukemia virus genome. We show that this recombinant polyomavirus displays a strong tissue specificity for the pancreas of mice. This organ was not permissive for either the parental polyomavirus, which is predominantly kidney and salivary gland specific, or the Moloney murine leukemia virus, which is lymphotropic. This result indicated that tissue specificity can be achieved by a combination of apparently modular elements. Some of the implications of a modular mechanism of tissue specificity are considered. Images PMID:3025873

  6. In-hospital and 1-year mortality in patients undergoing early surgery for prosthetic valve endocarditis.

    PubMed

    Lalani, Tahaniyat; Chu, Vivian H; Park, Lawrence P; Cecchi, Enrico; Corey, G Ralph; Durante-Mangoni, Emanuele; Fowler, Vance G; Gordon, David; Grossi, Paolo; Hannan, Margaret; Hoen, Bruno; Muñoz, Patricia; Rizk, Hussien; Kanj, Souha S; Selton-Suty, Christine; Sexton, Daniel J; Spelman, Denis; Ravasio, Veronica; Tripodi, Marie Françoise; Wang, Andrew

    2013-09-09

    There are limited prospective, controlled data evaluating survival in patients receiving early surgery vs medical therapy for prosthetic valve endocarditis (PVE). To determine the in-hospital and 1-year mortality in patients with PVE who undergo valve replacement during index hospitalization compared with patients who receive medical therapy alone, after controlling for survival and treatment selection bias. Participants were enrolled between June 2000 and December 2006 in the International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS), a prospective, multinational, observational cohort of patients with infective endocarditis. Patients hospitalized with definite right- or left-sided PVE were included in the analysis. We evaluated the effect of treatment assignment on mortality, after adjusting for biases using a Cox proportional hazards model that included inverse probability of treatment weighting and surgery as a time-dependent covariate. The cohort was stratified by probability (propensity) for surgery, and outcomes were compared between the treatment groups within each stratum. Valve replacement during index hospitalization (early surgery) vs medical therapy. In-hospital and 1-year mortality. Of the 1025 patients with PVE, 490 patients (47.8%) underwent early surgery and 535 individuals (52.2%) received medical therapy alone. Compared with medical therapy, early surgery was associated with lower in-hospital mortality in the unadjusted analysis and after controlling for treatment selection bias (in-hospital mortality: hazard ratio [HR], 0.44 [95% CI, 0.38-0.52] and lower 1-year mortality: HR, 0.57 [95% CI, 0.49-0.67]). The lower mortality associated with surgery did not persist after adjustment for survivor bias (in-hospital mortality: HR, 0.90 [95% CI, 0.76-1.07] and 1-year mortality: HR, 1.04 [95% CI, 0.89-1.23]). Subgroup analysis indicated a lower in-hospital mortality with early surgery in the highest surgical propensity quintile (21.2% vs 37.5%; P = .03). At 1-year follow-up, the reduced mortality with surgery was observed in the fourth (24.8% vs 42.9%; P = .007) and fifth (27.9% vs 50.0%; P = .007) quintiles of surgical propensity. Prosthetic valve endocarditis remains associated with a high 1-year mortality rate. After adjustment for differences in clinical characteristics and survival bias, early valve replacement was not associated with lower mortality compared with medical therapy in the overall cohort. Further studies are needed to define the effect and timing of surgery in patients with PVE who have indications for surgery.

  7. Simultaneous targeting of prostate stem cell antigen and prostate-specific membrane antigen improves the killing of prostate cancer cells using a novel modular T cell-retargeting system.

    PubMed

    Arndt, Claudia; Feldmann, Anja; Koristka, Stefanie; Cartellieri, Marc; Dimmel, Maria; Ehninger, Armin; Ehninger, Gerhard; Bachmann, Michael

    2014-09-01

    Recently, we described a novel modular platform technology in which T cell-recruitment and tumor-targeting domains of conventional bispecific antibodies are split to independent components, a universal effector module (EM) and replaceable monospecific/monovalent target modules (TMs) that form highly efficient T cell-retargeting complexes. Theoretically, our unique strategy should allow us to simultaneously retarget T cells to different tumor antigens by combining the EM with two or more different monovalent/monospecific TMs or even with bivalent/bispecific TMs, thereby overcoming limitations of a monospecific treatment such as the selection of target-negative tumor escape variants. In order to advance our recently introduced prostate stem cell antigen (PSCA)-specific modular system for a dual-targeting of prostate cancer cells, two additional TMs were constructed: a monovalent/monospecific TM directed against the prostate-specific membrane antigen (PSMA) and a bivalent/bispecific TM (bsTM) with specificity for PSMA and PSCA. The functionality of the novel dual-targeting strategies was analyzed by performing T cell activation and chromium release assays. Similar to the PSCA-specific modular system, the novel PSMA-specific modular system mediates an efficient target-dependent and -specific tumor cell lysis at low E:T ratios and picomolar Ab concentrations. Moreover, by combination of the EM with either the bispecific TM directed to PSMA and PSCA or both monospecifc TMs directed to either PSCA or PSMA, dual-specific targeting complexes were formed which allowed us to kill potential escape variants expressing only one or the other target antigen. Overall, the novel modular system represents a promising tool for multiple tumor targeting. © 2014 Wiley Periodicals, Inc.

  8. [Comparison of in vivo characteristics of polyethylene wear particles produced by a metal and a ceramic femoral component in total knee replacement].

    PubMed

    Veigl, D; Vavřík, P; Pokorný, D; Slouf, M; Pavlova, E; Landor, I

    2011-01-01

    The aim of the study was to evaluate in vivo and compare, in terms of the quality and number of ultra high-molecular polyethylene (UHMWPE) wear particles, total knee replacements of identical construction differing only in the material used for femoral component production, i.e., CoCrMo alloy or ZrO2 ceramics. Samples of peri-prosthetic granuloma tissue were collected in two patients with total knee replacement suffering from implant migration, who were matched in relevant characteristics. The primary knee replacement in Patient 1 with a CoCrMo femoral component was done 7.2 years and in Patient 2 with a ZrO2 implant 6.8 years before this assessment. The polyethylene wear-induced granuloma was analysed by the MORF method enabling us to assess the shape and size of wear debris and the IRc method for assessment of particle concentration. In the granuloma tissue samples of Patient 1, on the average, particles were 0.30 mm in size and their relative volume was 0.19. In the Patient 2 tissue samples, the average size of particles was 0.33 mm and their relative volume was 0.26. There was no significant difference in either particle morphology or their concentration in the granuloma tissue between the two patients. One of the options of how to reduce the production of polyethylene wear particles is to improve the tribological properties of contacting surfaces in total knee replacement by substituting a cobalt-chrome femoral component with a zirconia ceramic femoral component. The previous in vitro testing carried out with a mechanical simulator under conditions approaching real weight-bearing in the human body did show a nearly three-fold decrease in the number of UHMWPE wear particles in zirconia components. The evaluation of granuloma tissue induced by the activity of a real prosthetic joint for nearly seven years, however, did not reveal any great difference in either quality or quantity of polyethylene debris between the two replacements. The difference of surface roughness between CoCrMo (Ra = 0.05) and ZrO2 (Ra = 0.02) components did not play any role in in vivo conditions. CONCLUSIONS In accordance with a previous clinical study, this evaluation of the quality and quantity of UHMWPE wear particles produced by a ceramic femoral component in vivo failed to demonstrate any advantage of zirconia ceramic components over the cobalt-chrome femoral components so far used.

  9. Evaluation philosophy for shuttle launched payloads

    NASA Technical Reports Server (NTRS)

    Heuser, R. E.

    1975-01-01

    Some approaches to space-shuttle payload evaluation are examined. Issues considered include subsystem replacement in low-cost modular spacecraft (LCMS), validation of spacelab payloads, the use of standard components in shuttle-era spacecraft, effects of shuttle-induced environments on payloads, and crew safety. The LCMS is described, and goals are discussed for its evaluation program. Concepts regarding how the evaluation should proceed are considered.

  10. Engineered cartilaginous tubes for tracheal tissue replacement via self-assembly and fusion of human mesenchymal stem cell constructs.

    PubMed

    Dikina, Anna D; Strobel, Hannah A; Lai, Bradley P; Rolle, Marsha W; Alsberg, Eben

    2015-06-01

    There is a critical need to engineer a neotrachea because currently there are no long-term treatments for tracheal stenoses affecting large portions of the airway. In this work, a modular tracheal tissue replacement strategy was developed. High-cell density, scaffold-free human mesenchymal stem cell-derived cartilaginous rings and tubes were successfully generated through employment of custom designed culture wells and a ring-to-tube assembly system. Furthermore, incorporation of transforming growth factor-β1-delivering gelatin microspheres into the engineered tissues enhanced chondrogenesis with regard to tissue size and matrix production and distribution in the ring- and tube-shaped constructs, as well as luminal rigidity of the tubes. Importantly, all engineered tissues had similar or improved biomechanical properties compared to rat tracheas, which suggests they could be transplanted into a small animal model for airway defects. The modular, bottom up approach used to grow stem cell-based cartilaginous tubes in this report is a promising platform to engineer complex organs (e.g., trachea), with control over tissue size and geometry, and has the potential to be used to generate autologous tissue implants for human clinical applications. Copyright © 2015 Elsevier Ltd. All rights reserved.

  11. A Reconfigurable Pneumatic Bending Actuator with Replaceable Inflation Modules.

    PubMed

    Natividad, Rainier; Del Rosario, Manuel; Chen, Peter C Y; Yeow, Chen-Hua

    2018-06-01

    A fully reconfigurable, pneumatic bending actuator is fabricated by implementing the concept of modularity to soft robotics. The actuator features independent, removable, fabric inflation modules that are attached to a common flexible but non-inflating plastic spine. The fabric modules are individually fabricated by heat sealing a thermoplastic polyurethane-coated nylon fabric, whereas the spine is manufactured through fused deposition modeling 3D printing; the components can be assembled and dismantled without the aid of any external tools. The replacement of specific modules along the array facilitates the reconfiguration of the actuator's bending trajectory and torque output; likewise, the combination of inflation modules with dissimilar geometries translates to several different trajectories on a single spine and allows the actuator to bend into assorted, unique structures. A detailed description of the actuator's design is thoroughly presented. We explored how reconfiguration of the actuator's modular geometry affected both the steady state and the dynamic characteristics of the actuator. The torque output of the actuator is proportional to the magnitude of the pressure applied. The actuator was excited by sinusoidal and square pressure inputs, and a second-order linear fit was performed. There were no perceived changes in its performance even after 100,000 inflation and deflation cycles.

  12. Orthodontic management of bilateral maxillary canine-first premolar transposition and bilateral agenesis of maxillary lateral incisors: a case report.

    PubMed

    Di Palma, Elena; Di Giuseppe, Biagio; Tepedino, Michele; Chimenti, Claudio

    2015-01-01

    Maxillary canine-first premolar transposition (Mx.C.P1) is an uncommon dental positional anomaly that may create many orthodontic problems from both esthetic and functional points of view. In this report we show the orthodontic management of a case of Mx.C.P1 associated with bilateral maxillary lateral incisor agenesis and unilateral mandibular second premolar agenesis The patient was treated with a multibracket appliance and the extraction of the lower premolar. treatment was completed without the need for any prosthetic replacement.

  13. Total prosthetic replacement of atrioventricular valves in the dog

    PubMed Central

    Den Otter, G.

    1968-01-01

    The free-floating cone and cage valve, described in a previous study as being successful as a substitute for the right atrioventricular valve, does not perform well when it is inserted in the mitral ostium. A tilting cone or disc was constructed and tested in a series of 15 dogs. This prosthesis gave excellent results in 12 animals. The reasons for its failure in the remaining three is discussed. The prosthesis presented has advantages over any ball and cage valve, mainly because of its smaller volume. Images PMID:5654076

  14. Simulation of personalised haemodynamics by various mounting positions of a prosthetic valve using computational fluid dynamics.

    PubMed

    Bongert, Markus; Geller, Marius; Pennekamp, Werner; Nicolas, Volkmar

    2018-03-03

    Diseases of the cardiovascular system account for nearly 42% of all deaths in the European Union. In Germany, approximately 12,000 patients receive surgical replacement of the aortic valve due to heart valve disease alone each year. A three-dimensional (3D) numerical model based on patient-specific anatomy derived from four-dimensional (4D) magnetic resonance imaging (MRI) data was developed to investigate preoperatively the flow-induced impact of mounting positions of aortic prosthetic valves to select the best orientation for individual patients. Systematic steady-state analysis of blood flow for different rotational mounting positions of the valve is only possible using a virtual patient model. A maximum velocity of 1 m/s was used as an inlet boundary condition, because the opening angle of the valve is at its largest at this velocity. For a comparative serial examination, it is important to define the standardised general requirements to avoid impacts other than the rotated implantation of the prosthetic aortic valve. In this study, a uniform velocity profile at the inlet for the inflow of the aortic valve and the real aortic anatomy were chosen for all simulations. An iterative process, with the weighted parameters flow resistance (1), shear stress (2) and velocity (3), was necessary to determine the best rotated orientation. Blood flow was optimal at a 45° rotation from the standard implantation orientation, which will offer a supply to the coronary arteries.

  15. Prosthetic reconstruction of a patient with an acquired nasal defect using extraoral implants and a CAD/CAM copy-milled bar.

    PubMed

    Vera, Carolina; Barrero, Carlos; Shockley, William; Rothenberger, Sandra; Minsley, Glenn; Drago, Carl

    2014-10-01

    Traditionally, patients with maxillofacial defects have been challenging to treat. A multitude of challenges associated with maxillofacial prosthetic treatment are not typically seen with patients who need conventional prosthodontic treatment. These types of patients generally require replacement of significant amounts of hard and soft tissues than do conventional prosthodontic patients. Most maxillofacial patients also warrant more emotional support than do conventional prosthodontic patients. Successful maxillofacial prosthetics still need to embrace the traditional goals of prosthodontic treatment: stability, support, retention, and esthetics. It is unlikely that a maxillofacial prosthesis will exactly duplicate the anatomy and function of missing or damaged structures. Although craniofacial implants (CFI's) have lower cumulative survival rates (CSR's) than intraoral endosseous implants, osseointegrated CFI's have proven to be significant adjuncts to improving retention of maxillofacial prostheses. However, CSR's of CFI's have been reported to be lower than CSR's for intraoral endosseous implants. Lately, computer-assisted design and computer-assisted machining (CAD/CAM) has been used in dentistry to facilitate fabrication of implant-supported frameworks. CAD/CAM protocols have numerous advantages over conventional casting techniques, including improved accuracy and biocompatibility, and decreased costs. The purpose of this paper is to review the literature on cumulative survival rates (CSR's) reported for CFI's and to illustrate the treatment of a maxillofacial patient using CFI's and a CAD/CAM copy-milled framework for retention and support of a nasal prosthesis. © 2014 by the American College of Prosthodontists.

  16. Prosthetic avian vocal organ controlled by a freely behaving bird based on a low dimensional model of the biomechanical periphery.

    PubMed

    Arneodo, Ezequiel M; Perl, Yonatan Sanz; Goller, Franz; Mindlin, Gabriel B

    2012-01-01

    Because of the parallels found with human language production and acquisition, birdsong is an ideal animal model to study general mechanisms underlying complex, learned motor behavior. The rich and diverse vocalizations of songbirds emerge as a result of the interaction between a pattern generator in the brain and a highly nontrivial nonlinear periphery. Much of the complexity of this vocal behavior has been understood by studying the physics of the avian vocal organ, particularly the syrinx. A mathematical model describing the complex periphery as a nonlinear dynamical system leads to the conclusion that nontrivial behavior emerges even when the organ is commanded by simple motor instructions: smooth paths in a low dimensional parameter space. An analysis of the model provides insight into which parameters are responsible for generating a rich variety of diverse vocalizations, and what the physiological meaning of these parameters is. By recording the physiological motor instructions elicited by a spontaneously singing muted bird and computing the model on a Digital Signal Processor in real-time, we produce realistic synthetic vocalizations that replace the bird's own auditory feedback. In this way, we build a bio-prosthetic avian vocal organ driven by a freely behaving bird via its physiologically coded motor commands. Since it is based on a low-dimensional nonlinear mathematical model of the peripheral effector, the emulation of the motor behavior requires light computation, in such a way that our bio-prosthetic device can be implemented on a portable platform.

  17. Björk-Shiley convexoconcave valves: susceptibility artifacts at brain MR imaging and mechanical valve fractures.

    PubMed

    van Gorp, Maarten J; van der Graaf, Yolanda; de Mol, Bas A J M; Bakker, Chris J G; Witkamp, Theo D; Ramos, Lino M P; Mali, Willem P T M

    2004-03-01

    To assess the relationship between heart valve history and susceptibility artifacts at magnetic resonance (MR) imaging of the brain in patients with Björk-Shiley convexoconcave (BSCC) valves. MR images of the brain were obtained in 58 patients with prosthetic heart valves: 20 patients had BSCC valve replacements, and 38 had other types of heart valves. Two experienced neuroradiologists determined the presence or absence of susceptibility artifacts in a consensus reading. Artifacts were defined as characteristic black spots that were visible on T2*-weighted gradient-echo MR images. The statuses of the 20 explanted BSCC valves-specifically, whether they were intact or had an outlet strut fracture (OSF) or a single-leg fracture (SLF)-had been determined earlier. Number of artifacts seen at brain MR imaging was correlated with explanted valve status, and differences were analyzed with nonparametric statistical tests. Significantly more patients with BSCC valves (17 [85%] of 20 patients) than patients with other types of prosthetic valves (18 [47%] of 38 patients) had susceptibility artifacts at MR imaging (P =.005). BSCC valve OSFs were associated with a significantly higher number of artifacts than were intact BSCC valves (P =.01). No significant relationship between SLF and number of artifacts was observed. Susceptibility artifacts at brain MR imaging are not restricted to patients with BSCC valves. These artifacts can be seen on images obtained in patients with various other types of fractured and intact prosthetic heart valves. Copyright RSNA, 2004

  18. Successful management of multiple permanent pacemaker complications – infection, 13 year old silent lead perforation and exteriorisation following failed percutaneous extraction, superior vena cava obstruction, tricuspid valve endocarditis, pulmonary embolism and prosthetic tricuspid valve thrombosis

    PubMed Central

    Kaul, Pankaj; Adluri, Krishna; Javangula, Kalyana; Baig, Wasir

    2009-01-01

    A 59 year old man underwent mechanical tricuspid valve replacement and removal of pacemaker generator along with 4 pacemaker leads for pacemaker endocarditis and superior vena cava obstruction after an earlier percutaneous extraction had to be abandoned, 13 years ago, due to cardiac arrest, accompanied by silent, unsuspected right atrial perforation and exteriorisation of lead. Postoperative course was complicated by tricuspid valve thrombosis and secondary pulmonary embolism requiring TPA thrombolysis which was instantly successful. A review of literature of pacemaker endocarditis and tricuspid thrombosis along with the relevant management strategies is presented. We believe this case report is unusual on account of non operative management of right atrial lead perforation following an unsuccessful attempt at percutaneous removal of right sided infected pacemaker leads and the incidental discovery of the perforated lead 13 years later at sternotomy, presentation of pacemaker endocarditis with a massive load of vegetations along the entire pacemaker lead tract in superior vena cava, right atrial endocardium, tricuspid valve and right ventricular endocardium, leading to a functional and structural SVC obstruction, requirement of an unusually large dose of warfarin postoperatively occasioned, in all probability, by antibiotic drug interactions, presentation of tricuspid prosthetic valve thrombosis uniquely as vasovagal syncope and isolated hypoxia and near instantaneous resolution of tricuspid prosthetic valve thrombosis with Alteplase thrombolysis. PMID:19239701

  19. Closed-loop control of grasping with a myoelectric hand prosthesis: which are the relevant feedback variables for force control?

    PubMed

    Ninu, Andrei; Dosen, Strahinja; Muceli, Silvia; Rattay, Frank; Dietl, Hans; Farina, Dario

    2014-09-01

    In closed-loop control of grasping by hand prostheses, the feedback information sent to the user is usually the actual controlled variable, i.e., the grasp force. Although this choice is intuitive and logical, the force production is only the last step in the process of grasping. Therefore, this study evaluated the performance in controlling grasp strength using a hand prosthesis operated through a complete grasping sequence while varying the feedback variables (e.g., closing velocity, grasping force), which were provided to the user visually or through vibrotactile stimulation. The experiments were conducted on 13 volunteers who controlled the Otto Bock Sensor Hand Speed prosthesis. Results showed that vibrotactile patterns were able to replace the visual feedback. Interestingly, the experiments demonstrated that direct force feedback was not essential for the control of grasping force. The subjects were indeed able to control the grip strength, predictively, by estimating the grasping force from the prosthesis velocity of closing. Therefore, grasping without explicit force feedback is not completely blind, contrary to what is usually assumed. In our study we analyzed grasping with a specific prosthetic device, but the outcomes are also applicable for other devices, with one or more degrees-of-freedom. The necessary condition is that the electromyography (EMG) signal directly and proportionally controls the velocity/grasp force of the hand, which is a common approach among EMG controlled prosthetic devices. The results provide important indications on the design of closed-loop EMG controlled prosthetic systems.

  20. Intramedullary Stabilization of Periprosthetic Fractures of the Femur Taking Special Account of Bone Defects.

    PubMed

    Eingartner, Christoph; Volkmann, Rüdiger; Ochs, Uwe; Egetemeyr, Daniel; Weise, Kuno

    2007-10-01

    Healing of the periprosthetic fracture and area of defective bone by the bone healing mechanisms of intramedullary stabilization. Reconstruction of the correct length, axial alignment, and rotation of the fractured femoral shaft by anchoring a revision stem in the intact femoral diaphysis. Periprosthetic femoral shaft fracture in the region of the prosthetic stem combined with preexistent loosening and/or defect in the periprosthetic bone bed (Vancouver classification type B2 and B3). General contraindications, local infection. Lateral transmuscular approach to the femoral shaft. Longitudinal osteotomy of the proximal femur taking the geometry of the fracture into account. Opening of an anterior "bone shell". Removal of the loose prosthetic stem and cement. Debridement. Preparation of the femoral diaphysis and insertion of a distally anchored revision stem. Distal locking. Repositioning of the "bone shell", reduction of the fracture, and retention with cerclage wires. Bed rest for approximately 1 week, mobilization with 20 kg partial weight bearing for 12 weeks, gradual increase in weight bearing with radiologic checks on progress, removal of the distal locking bolts after 12-24 months at the earliest. 21 patients (13 women, eight men) aged between 43 and 86 years (mean age: 71.2 years) with periprosthetic fracture of the femur, additional loosening of the stem in eight cases (Vancouver B2) and additional bone loss in 13 cases (Vancouver B3). Postoperative complications: two fractures following another fall (repeat operations: one replacement, one plate), four revisions due to subsidence of the stem (three replacements involving change to a standard stem with healed proximal femur, one replacement with another interlocked revision stem). Bone healing occurred for all fractures after a mean 5.6 months (3-11 months). Follow- up examination after a mean 4.5 years: all patients were able to walk, average Harris Score 70.5 points (29- 95 points).

  1. Intramedullary stabilization of periprosthetic fractures of the femur taking special account of bone defects.

    PubMed

    Eingartner, Christoph; Volkmann, Rüdiger; Ochs, Uwe; Egetemeyr, Daniel; Weise, Kuno

    2006-10-01

    Healing of the periprosthetic fracture and area of defective bone by the bone healing mechanisms of intramedullary stabilization. Reconstruction of the correct length, axial alignment, and rotation of the fractured femoral shaft by anchoring a revision stem in the intact femoral diaphysis. Periprosthetic femoral shaft fracture in the region of the prosthetic stem combined with preexistent loosening and/or defect in the periprosthetic bone bed (Vancouver classification type B2 and B3). General contraindications, local infection. Lateral transmuscular approach to the femoral shaft. Longitudinal osteotomy of the proximal femur taking the geometry of the fracture into account. Opening of an anterior "bone shell". Removal of the loose prosthetic stem and cement. Debridement. Preparation of the femoral diaphysis and insertion of a distally anchored revision stem. Distal locking. Repositioning of the "bone shell", reduction of the fracture, and retention with cerclage wires. Bed rest for approximately 1 week, mobilization with 20 kg partial weight bearing for 12 weeks, gradual increase in weight bearing with radiologic checks on progress, removal of the distal locking bolts after 12-24 months at the earliest. 21 patients (13 women, eight men) aged between 43 and 86 years (mean age: 71.2 years) with periprosthetic fracture of the femur, additional loosening of the stem in eight cases (Vancouver B2) and additional bone loss in 13 cases (Vancouver B3). Postoperative complications: two fractures following another fall (repeat operations: one replacement, one plate), four revisions due to subsidence of the stem (three replacements involving change to a standard stem with healed proximal femur, one replacement with another interlocked revision stem). Bone healing occurred for all fractures after a mean 5.6 months (3-11 months). Follow-up examination after a mean 4.5 years: all patients were able to walk, average Harris Score 70.5 points (29-95 points).

  2. In Vitro Evaluation of a Novel Hemodynamically Optimized Trileaflet Polymeric Prosthetic Heart Valve

    PubMed Central

    Claiborne, Thomas E.; Sheriff, Jawaad; Kuetting, Maximilian; Steinseifer, Ulrich; Slepian, Marvin J.; Bluestein, Danny

    2013-01-01

    Calcific aortic valve disease is the most common and life threatening form of valvular heart disease, characterized by stenosis and regurgitation, which is currently treated at the symptomatic end-stages via open-heart surgical replacement of the diseased valve with, typically, either a xenograft tissue valve or a pyrolytic carbon mechanical heart valve. These options offer the clinician a choice between structural valve deterioration and chronic anticoagulant therapy, respectively, effectively replacing one disease with another. Polymeric prosthetic heart valves (PHV) offer the promise of reducing or eliminating these complications, and they may be better suited for the new transcatheter aortic valve replacement (TAVR) procedure, which currently utilizes tissue valves. New evidence indicates that the latter may incur damage during implantation. Polymer PHVs may also be incorporated into pulsatile circulatory support devices such as total artificial heart and ventricular assist devices that currently employ mechanical PHVs. Development of polymer PHVs, however, has been slow due to the lack of sufficiently durable and biocompatible polymers. We have designed a new trileaflet polymer PHV for surgical implantation employing a novel polymer—xSIBS—that offers superior bio-stability and durability. The design of this polymer PHV was optimized for reduced stresses, improved hemodynamic performance, and reduced thrombogenicity using our device thrombogenicity emulation (DTE) methodology, the results of which have been published separately. Here we present our new design, prototype fabrication methods, hydrodynamics performance testing, and platelet activation measurements performed in the optimized valve prototype and compare it to the performance of a gold standard tissue valve. The hydrodynamic performance of the two valves was comparable in all measures, with a certain advantage to our valve during regurgitation. There was no significant difference between the platelet activation rates of our polymer valve and the tissue valve, indicating that similar to the latter, its recipients may not require anticoagulation. This work proves the feasibility of our optimized polymer PHV design and brings polymeric valves closer to clinical viability. PMID:23445066

  3. Biomechanical Analysis of a Novel Intercalary Prosthesis for Humeral Diaphyseal Segmental Defect Reconstruction.

    PubMed

    Zhao, Li-Ming; Tian, Dong-Mu; Wei, Yue; Zhang, Jun-Hui; Di, Zheng-Lin; He, Zhi-Yong; Hu, Yong-Cheng

    2018-02-01

    To study the biomechanical properties of a novel modular intercalary prosthesis for humeral diaphyseal segmental defect reconstruction, to establish valid finite element humerus and prosthesis models, and to analyze the biomechanical differences in modular intercalary prostheses with or without plate fixation. Three groups were set up to compare the performance of the prosthesis: intact humerus, humerus-prosthesis and humerus-prosthesis-plate. The models of the three groups were transferred to finite element software. Boundary conditions, material properties, and mesh generation were set up for both the prosthesis and the humerus. In addition, 100 N or 2 N.m torsion was loaded to the elbow joint surface with the glenohumeral joint surface fixed. Humeral finite element models were established according to CT scans of the cadaveric bone; reverse engineering software Geomagic was used in this procedure. Components of prosthetic models were established using 3-D modeling software Solidworks. To verify the finite element models, the in vitro tests were simulated using a mechanical testing machine (Bionix; MTS Systems Corporation, USA). Starting with a 50 N preload, the specimen was subjected to 5 times tensile (300 N) and torsional (5 N.m) strength; interval time was 30 min to allow full recovery for the next specimen load. Axial tensile and torsional loads were applied to the elbow joint surface to simulate lifting heavy objects or twisting something, with the glenohumeral joint surface fixed. Stress distribution on the humerus did not change its tendency notably after reconstruction by intercalary prosthesis whether with or without a plate. The special design which included a plate and prosthesis effectively diminished stress on the stem where aseptic loosening often takes place. Stress distribution major concentrate upon two stems without plate addition, maximum stress on proximal and distal stem respectively diminish 27.37% and 13.23% under tension, 10.66% and 11.16% under torsion after plate allied. The novel intercalary prosthesis has excellent ability to reconstruct humeral diaphyseal defects. The accessory fixation system, which included a plate and prosthesis, improved the rigidity of anti-tension and anti-torsion, and diminished the risk of prosthetic loosening and dislocation. A finite element analysis is a kind of convenient and practicable method to be used as the confirmation of experimental biomechanics study. © 2018 Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd.

  4. Knee stabilisation following infected knee arthroplasty with bone loss and extensor mechanism impairment using a modular cemented nail.

    PubMed

    Rao, M C; Richards, O; Meyer, C; Jones, R Spencer

    2009-12-01

    Infected Total Knee Replacement with significant bone loss and loss of extensor mechanism poses a difficult management problem. Arthrodesis relying on bony union can be difficult to achieve and can result in significant limb shortening. We retrospectively looked at the outcome of seven patients with significant bone loss and extensor mechanism insufficiency following infected TKR who underwent knee stabilisation using a modular cemented nail. The nail relied on the strong coupling mechanism between the modular femoral and tibial components. Pain score improved from a mean of 7.9 pre-operatively to 1.5 post-operatively at a mean follow up of 39.6 months (range 7-68) months. Two patients underwent technically easy revision nailing for recurrent infection and aseptic loosening. The Endo-Model(R) Knee Fusion Nail (Newsplint, UK/Waldemar Link, GmbH & Co. KG, Hamburg, Germany) has good early results in terms of pain relief and provides a stable knee in cases with significant bone loss and extensor mechanism insufficiency following an infected TKR thus avoiding an above knee amputation.

  5. Alloplastic temporomandibular joint replacement systems: a systematic review of their history.

    PubMed

    De Meurechy, N; Mommaerts, M Y

    2018-06-01

    This systematic review provides an overview of the historical evolution of the prosthetic temporomandibular joint and addresses the challenges and complications faced by engineers and surgeons, in an effort to shed light on why only a few systems remain available. A better understanding of the history of temporomandibular joint prostheses might also provide insights into the origin of the negative public opinion of the prosthesis, which is based on outdated information. A computerized search using the PubMed Central, ScienceDirect, Wiley Online, Ovid, and Cochrane Library databases was performed following the PRISMA guidelines. Out of 7122 articles identified, 41 met the inclusion criteria for this systematic review. Although several historical reviews have been published previously, none has covered such an extensive time period or has described all designs. Furthermore, besides providing a historical overview, this review discusses the rationale behind the evolution in design and biomaterials, which have largely contributed to the outcomes of the prosthetic systems. Copyright © 2018 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  6. A regenerative microchannel device for recording multiple single-unit action potentials in awake, ambulatory animals.

    PubMed

    Srinivasan, Akhil; Tipton, John; Tahilramani, Mayank; Kharbouch, Adel; Gaupp, Eric; Song, Chao; Venkataraman, Poornima; Falcone, Jessica; Lacour, Stéphanie P; Stanley, Garrett B; English, Arthur W; Bellamkonda, Ravi V

    2016-02-01

    Despite significant advances in robotics, commercially advanced prosthetics provide only a small fraction of the functionality of the amputated limb that they are meant to replace. Peripheral nerve interfacing could provide a rich controlling link between the body and these advanced prosthetics in order to increase their overall utility. Here, we report on the development of a fully integrated regenerative microchannel interface with 30 microelectrodes and signal extraction capabilities enabling evaluation in an awake and ambulatory rat animal model. In vitro functional testing validated the capability of the microelectrodes to record neural signals similar in size and nature to those that occur in vivo. In vitro dorsal root ganglia cultures revealed striking cytocompatibility of the microchannel interface. Finally, in vivo, the microchannel interface was successfully used to record a multitude of single-unit action potentials through 63% of the integrated microelectrodes at the early time point of 3 weeks. This marks a significant advance in microchannel interfacing, demonstrating the capability of microchannels to be used for peripheral nerve interfacing. © 2015 Federation of European Neuroscience Societies and John Wiley & Sons Ltd.

  7. Non-obstructive prosthetic aortic valve thrombosis presenting with acute myocardial infarction and stroke in a patient with inadequate low-molecular-weight heparin treatment. The unlucky patient and the (pseudo)prudent physician.

    PubMed

    Paci, Anna Maria; Lattanzi, Fabio; Cabani, Enrico; Conti, Umberto; De Tommasi, Salvatore Mario

    2007-04-01

    Non-obstructive prosthetic valve thrombosis is a rare and underestimated complication in patients with left-sided mechanical heart valves. Systemic embolisation, mainly involving the cerebral circulation, often represents the first clinical manifestation. We report a case of multiple, successive embolizations in the coronary and cerebral circulation, presenting with an acute myocardial infarction and stroke in a patient with latent, non-obstructive thrombosis of a mechanical bileaflet aortic valve. Because of scheduled urological surgery, chronic vitamin K antagonist treatment had previously been discontinued and replaced with low-molecular-weight heparin, at inadequate dosage. Following coronary arteriography, brain computed tomography scan and transoesophageal echocardiography, thrombolysis was performed successfully. This case emphasises the utility of performing transoesophageal echocardiography routinely in the presence of ischaemic signs in patients with mechanical heart valves. In patients requiring discontinuation of oral anticoagulant therapy, accurate management and continuous monitoring of alternative medications are needed in order to avoid severe thromboembolic complications.

  8. Indications for cardiac surgery in patients with active infective endocarditis.

    PubMed

    Alsip, S G; Blackstone, E H; Kirklin, J W; Cobbs, C G

    1985-06-28

    Currently, absolute indications for valve replacement during active infective endocarditis include severe heart failure, the presence of an infecting microorganism that is not susceptible to available antimicrobial agents, and, in patients with an infected prosthetic valve, an unstable device. Relative indications include an etiologic microorganism other than a susceptible Streptococcus, relapse after presumed effective therapy, evidence of intracardiac extension of the infection, two or more systemic emboli, vegetations large enough to be demonstrated by echocardiography, and, in patients with an infected prosthetic device, early disease and periprosthetic leak. With use of data from the medical literature, a study generated by the cardiovascular surgical group at the University of Alabama School of Medicine, and a brief cost analysis, a point system was constructed to assist in decision-making concerning surgery in patients with active infective endocarditis. The usefulness of this system will depend on experience generated from its utilization in a larger number of patients as well as new data relative to a more complete understanding of the risks and benefits of surgery in this condition.

  9. Limb salvage after infected knee arthroplasty with bone loss and extensor mechanism deficiency using a modular segmental replacement system.

    PubMed

    Namdari, Surena; Milby, Andrew H; Garino, Jonathan P

    2011-09-01

    Multiple total knee arthroplasty revisions pose significant surgical challenges, such as bone loss and soft tissue compromise. For patients with bone loss and extensor mechanism insufficiency after total knee arthroplasty, arthrodesis is a treatment option for the avoidance of amputation. However, arthrodesis is both difficult to achieve in situations with massive bone loss and potentially undesirable due to the dramatic shortening that follows. Although intramedullary nailing for knee arthrodesis has been widely reported, this technique has traditionally relied on the achievement of bony union. We report a case of a patient with massive segmental bone loss in which a modular intercalary prosthesis was used for arthrodesis to preserve limb length without bony union. Copyright © 2011 Elsevier Inc. All rights reserved.

  10. Modular Scanning Confocal Microscope with Digital Image Processing

    PubMed Central

    McCluskey, Matthew D.

    2016-01-01

    In conventional confocal microscopy, a physical pinhole is placed at the image plane prior to the detector to limit the observation volume. In this work, we present a modular design of a scanning confocal microscope which uses a CCD camera to replace the physical pinhole for materials science applications. Experimental scans were performed on a microscope resolution target, a semiconductor chip carrier, and a piece of etched silicon wafer. The data collected by the CCD were processed to yield images of the specimen. By selecting effective pixels in the recorded CCD images, a virtual pinhole is created. By analyzing the image moments of the imaging data, a lateral resolution enhancement is achieved by using a 20 × / NA = 0.4 microscope objective at 532 nm laser wavelength. PMID:27829052

  11. KSC-03pd0578

    NASA Image and Video Library

    2003-03-04

    KENNEDY SPACE CENTER, FLA. -- -- Lifting their shovels for the groundbreaking of the Operations Support Building II are (left to right) Bill Pickavance, Vice President & Deputy Program Manager Florida Operations, United Space Alliance; Mike Wetmore, director of Shuttle Processing; Miguel Morales, chief, Facilities Division, Spaceport Services; Mike Sumner, chief of operations, Spaceport Services; David Wolfberg, designer of the facility, with Architect and Engineers Wolfberg, Alvarez and Partners of Coral Gables; Roy Bridges, KSC director; and Don Minderman, OSB II project manager, Spaceport Services. Not shown: David Boland, David Boland Inc.(construction company). The new building will replace modular housing constructed more than 20 years ago and house NASA and contractor support staff for shuttle operations. The demolition of the modular buildings has begun and construction will immediately follow. The new structure is projected to be ready in April 2005.

  12. KSC-03PD-0578

    NASA Technical Reports Server (NTRS)

    2003-01-01

    KENNEDY SPACE CENTER, FLA. -- -- Lifting their shovels for the groundbreaking of the Operations Support Building II are (left to right) Bill Pickavance, Vice President & Deputy Program Manager Florida Operations, United Space Alliance; Mike Wetmore, director of Shuttle Processing; Miguel Morales, chief, Facilities Division, Spaceport Services; Mike Sumner, chief of operations, Spaceport Services; David Wolfberg, designer of the facility, with Architect and Engineers Wolfberg, Alvarez and Partners of Coral Gables; Roy Bridges, KSC director; and Don Minderman, OSB II project manager, Spaceport Services. Not shown: David Boland, David Boland Inc.(construction company). The new building will replace modular housing constructed more than 20 years ago and house NASA and contractor support staff for shuttle operations. The demolition of the modular buildings has begun and construction will immediately follow. The new structure is projected to be ready in April 2005.

  13. [A new method of osteosynthesis in proximal humeral fractures: a new internal fixation device. Apropos of 17 cases followed over more than 2 years].

    PubMed

    Doursounian, L; Grimberg, J; Cazeau, C; Touzard, R C

    1996-01-01

    The authors describe a new internal fixation device, and report on 17 proximal humeral fractures managed with this technique. The fracture patterns, using Neer's classification were: 9 displaced three-part fractures, 4 displaced four-part fractures and 4 interior fracture dislocations (mean age of the patients: 70 years). The device is a two-part titanium device. The humeral component has a long vertical stem cemented in the humeral shaft; and a short proximal portion set at an angle of 135 degrees on the stem, with a neck and a Morse taper cone. The other part is a crown-shaped stapple, whose base is a perforated disk with a central Morse taper socket. The rim of the crown has five prongs which, together with the central socket, are impacted in the cancellous bone of the humeral head. The taper of the humeral component is inserted into the central socket of the stapple to provide fracture fixation. Tuberosities are reattached to the shaft with non absorbable sutures. Mean follow-up was 29 months. The global ratings were as follows: 4 excellent results, 6 good results, 4 fair results, 3 poor results. Mean active forward flexion: 100 degrees, and mean active external rotation 22 degrees. After exclusion of the 4 fracture-dislocations, the global rating became: 4 excellent results, 5 good results, 3 fair results, 1 poor result. Mean active forward flexion: 110 degrees and mean active external rotation: 31.5 degrees. There were no case of avascular necrosis in 13 patients. Complications requiring surgery occurred in one case: an upper protrusion of the stapple which required replacement of the stapple by a prosthetic humeral head. Other complications included: 2 asymptomatic partial protrusions of the stapple, 2 complete and two partial avascular necrosis in fracture-dislocations. Except for the fracture-dislocations our device confers several major benefits. The humeral head is preserved. Typical problems associated with joint replacement (dislocations, loosening, glenoid degeneration) are avoided. Humeral head conservation enhances healing of the tuberosities. Fixation could always be obtained, regardless of the complexity of the fracture pattern. An hemiarthroplasty (e.g. in case of avascular necrosis) is possible by the modular design of the device.

  14. Surgical and Antimicrobial Treatment of Prosthetic Vascular Graft Infections at Different Surgical Sites: A Retrospective Study of Treatment Outcomes

    PubMed Central

    Elzi, Luigia; Gurke, Lorenz; Battegay, Manuel; Widmer, Andreas F.; Weisser, Maja

    2014-01-01

    Objective Little is known about optimal management of prosthetic vascular graft infections, which are a rare but serious complication associated with graft implants. The goal of this study was to compare and characterize these infections with respect to the location of the graft and to identify factors associated with outcome. Methods This was a retrospective study over more than a decade at a tertiary care university hospital that has an established multidisciplinary approach to treating graft infections. Cases of possible prosthetic vascular graft infection were identified from the hospital's infectious diseases database and evaluated against strict diagnostic criteria. Patients were divided into groups according to the locations of their grafts: thoracic-aortic, abdominal-aortic, or peripheral-arterial. Statistical analyses included evaluation of patient and infection characteristics, time to treatment failure, and factors associated specifically with cure rates in aortic graft infections. The primary endpoint was cure at one year after diagnosis of the infection. Results Characterization of graft infections according to the graft location did show that these infections differ in terms of their characteristics and that the prognosis for treatment seems to be influenced by the location of the infection. Cure rate and all-cause mortality at one year were 87.5% and 12.5% in 24 patients with thoracic-aortic graft infections, 37.0% and 55.6% in 27 patients with abdominal-aortic graft infections, and 70.0% and 30.0% in 10 patients with peripheral-arterial graft infections. In uni- and multivariate analysis, the type of surgical intervention used in managing infections (graft retention versus graft replacement) did not affect primary outcome, whereas a rifampicin-based antimicrobial regimen was associated with a higher cure rate. Conclusions We recommend that future prospective studies differentiate prosthetic vascular graft infections according to the location of the grafts and that rifampicin-based antimicrobial regimens be evaluated in clinical trials involving vascular graft infections caused by staphylococci. PMID:25393400

  15. Image Intensifier Modules For Use With Commercially Available Solid State Cameras

    NASA Astrophysics Data System (ADS)

    Murphy, Howard; Tyler, Al; Lake, Donald W.

    1989-04-01

    A modular approach to design has contributed greatly to the success of the family of machine vision video equipment produced by EG&G Reticon during the past several years. Internal modularity allows high-performance area (matrix) and line scan cameras to be assembled with two or three electronic subassemblies with very low labor costs, and permits camera control and interface circuitry to be realized by assemblages of various modules suiting the needs of specific applications. Product modularity benefits equipment users in several ways. Modular matrix and line scan cameras are available in identical enclosures (Fig. 1), which allows enclosure components to be purchased in volume for economies of scale and allows field replacement or exchange of cameras within a customer-designed system to be easily accomplished. The cameras are optically aligned (boresighted) at final test; modularity permits optical adjustments to be made with the same precise test equipment for all camera varieties. The modular cameras contain two, or sometimes three, hybrid microelectronic packages (Fig. 2). These rugged and reliable "submodules" perform all of the electronic operations internal to the camera except for the job of image acquisition performed by the monolithic image sensor. Heat produced by electrical power dissipation in the electronic modules is conducted through low resistance paths to the camera case by the metal plates, which results in a thermally efficient and environmentally tolerant camera with low manufacturing costs. A modular approach has also been followed in design of the camera control, video processor, and computer interface accessory called the Formatter (Fig. 3). This unit can be attached directly onto either a line scan or matrix modular camera to form a self-contained units, or connected via a cable to retain the advantages inherent to a small, light weight, and rugged image sensing component. Available modules permit the bus-structured Formatter to be configured as required by a specific camera application. Modular line and matrix scan cameras incorporating sensors with fiber optic faceplates (Fig 4) are also available. These units retain the advantages of interchangeability, simple construction, ruggedness, and optical precision offered by the more common lens input units. Fiber optic faceplate cameras are used for a wide variety of applications. A common usage involves mating of the Reticon-supplied camera to a customer-supplied intensifier tube for low light level and/or short exposure time situations.

  16. Modular manifold for integrated fluidics and electronics

    DOEpatents

    Adkins, Douglas Ray

    2010-03-30

    An airtight preconcentrator housing and/or a sensor housing for chemical testing, the housing(s) comprising internal dimensions such that a pre-manufactured preconcentrator and/or sensor can be disposed therein. The housings can also comprise electrical contacts disposed therein which align with and thus provide electrical connection to the preconcentrator and/or sensor. The preconcentrator and/or sensor can be easily and quickly replaced.

  17. KSC-06pd0396

    NASA Image and Video Library

    2006-03-01

    KENNEDY SPACE CENTER, FLA. - The Operations Support Building II at NASA's Kennedy Space Center is seen here, newly built and landscaped. The building replaced modular housing and trailers in the Launch Complex 39 area. The five-story, 189,000-square-foot building consists of approximately 860 office spaces, training rooms, computer rooms, multimedia conference rooms, technical libraries, and a 352-person mission conference center with observation deck. Photo credit: Cory Huston

  18. [Modularization by the open standard. (II)].

    PubMed

    Muto, M; Takaha, Y; Chiba, N

    2000-10-01

    In recent years, accompanied by the marvelous development and spread of Laboratory Automation System(LAS), the NCCLS is now proposing five international standards for laboratory automation. We have based our laboratory on these "NCCLS standards of laboratory automation", we take these standards ahead first, and we now propose an open standard called "Open LA 21", to establish more detailed standard replacing the NCCLS laboratory automation standards.

  19. JPRS Report, Science and Technology, Europe.

    DTIC Science & Technology

    1991-02-15

    VIDP furnace is a further development of the conventional vacuum induction melter (VIM). It has an independent smelting and processing unit, to...which various casting systems can be linked according to the modular principle. Unlike the conventional vacuum induction melter, the VIDP furnace does... induction coil and the crucible. The furnace body can be extracted for relining or replacement with another, ready-lined, fur- nace body. This

  20. Incidence, predictors and outcomes of infective endocarditis in a contemporary adult congenital heart disease population.

    PubMed

    Moore, Benjamin; Cao, Jacob; Kotchetkova, Irina; Celermajer, David S

    2017-12-15

    The prevalence of congenital heart disease (CHD) in the adult population is steadily increasing. A substrate of prosthetic material and residual lesions, constantly evolving as surgical techniques change over time, predispose these patients to the potentially devastating complication of infective endocarditis (IE). We retrospectively reviewed 2935 patients in our adult CHD database for all cases of endocarditis between 1991 and 2016. Incidence, clinical course and predictors of outcomes were analysed. We document 74 episodes in 62 patients, with an incidence of 0.9 cases/1000 patient years (py). IE was more common in complex CHD (1.4 cases/1000py) and ventricular septal defects (VSDs) (1.9 cases/1000py). Prosthetic material was involved in 47% and left-sided infection predominated (66%). The incidence in bicuspid aortic valves post aortic valve replacement (AVR) was significantly higher than in unoperated valves, being 1.8 and 1.1 cases/1000 patient years respectively. Streptococcus was the most frequently implicated causative organism (37%). Emboli occurred in 34% of cases with a cerebral predilection. 46% of patients required surgery during the admission for IE, most frequently to replace a severely regurgitant bicuspid aortic valve. Early endocarditis-related mortality was 15%, associated with cerebral emboli and acute renal failure. In a contemporary adult CHD cohort, those with complex underlying lesions, VSDs or an AVR were at higher risk for IE. Mortality remains substantial and is more likely in patients with cerebral emboli and/or acute renal failure. Copyright © 2017 Elsevier B.V. All rights reserved.

  1. Torque removal evaluation of prosthetic screws after tightening and loosening cycles: an in vitro study.

    PubMed

    Cardoso, Mayra; Torres, Marcelo Ferreira; Lourenço, Eduardo José Veras; de Moraes Telles, Daniel; Rodrigues, Renata Cristina Silveira; Ribeiro, Ricardo Faria

    2012-04-01

    The aim of this study was to evaluate the variation in removal torque of implant prosthetic abutment screws after successive tightening and loosening cycles, in addition to evaluating the influence of the hexagon at the abutment base on screw removal torque. Twenty hexagonal abutments were tightened to 20 regular external hex implants with a titanium alloy screw, with an insertion torque of 32 N cm, measured with a digital torque gauge. The implant/abutment/screw assemblies were divided into two groups: (1) abutments without hexagon at the base and (2) abutments with a hexagon at the base. Each assembly received a provisional restoration and was submitted to mechanical loading cycles. After this, the screws were removed and the removal torque was measured. This sequence was repeated 10 times, then the screw was replaced by a new one, and another cycle was performed. Linear regression analysis was performed. Removal torque values tended to decrease as the number of insertion/removal cycles increased, for both groups. Comparisons of the slopes and the intercepts between groups showed no statistical difference. There was no significant difference between the mean values of last five cycles and the 11th cycle. Within the limitations of this in vitro study, it was concluded that (1) repeated insertion/removal cycles promoted gradual reduction in removal torque of screws, (2) replacing the screw with a new one after 10 cycles did not increase resistance to loosening, and (3) removal of the hexagon from the abutment base had no effect on the removal torque of the screws. © 2011 John Wiley & Sons A/S.

  2. In vitro simulation of fretting-corrosion in hip implant modular junctions: The influence of pH.

    PubMed

    Royhman, Dmitry; Patel, Megha; Jacobs, Joshua J; Wimmer, Markus A; Hallab, Nadim J; Mathew, Mathew T

    2018-02-01

    The fretting-corrosion behavior of mixed metal contacts is affected by various mechanical and electrochemical parameters. Crevice conditions at the junction and patient-specific pathologies can affect the pH of the prosthetic environment. The main objective of this study is to understand the effect of pH variation at the stem/head junction of the hip implant under fretting corrosion exposure. We hypothesized that pH will have a significant influence on the fretting-corrosion behavior hip implant modular junctions. A custom-made setup was used to evaluate the fretting corrosion behavior of hip implant modular junctions. A Newborn calf serum solution (30 g/L protein content) was used to simulate the synovial fluid environment. A sinusoidal fretting motion, with a displacement amplitude of +50 µm, was applied to the Ti alloy rod. The effects of pathology driven, periprosthetic pH variation were simulated at four different pH levels (3.0, 4.5, 6.0 and 7.6). Electrochemical and mechanical properties were evaluated before, during, and after the applied fretting motion. The impedance of the system was increased in response to the fretting motion. The hysteresis tangential load/displacement behavior was not affected by pH level. The worn surfaces of CoCrMo pins exhibited the presence of tribolayer or organic deposits, in the pH 4.5 group, which may explain the lower drop in potential and mass loss observed in that group. Mechanically dominated wear mechanisms, namely, adhesive wear was shown in the pH 7.6 group, which may account for a higher potential drop and metal content loss. This study suggests that the fretting-corrosion mechanisms in hip implant are affected by the pH levels of the surrounding environment and patient-specific factors. Copyright © 2017. Published by Elsevier Ltd.

  3. Identifying the values and preferences of prosthetic users: a case study series using the repertory grid technique.

    PubMed

    Schaffalitzky, Elisabeth; NiMhurchadha, Sinead; Gallagher, Pamela; Hofkamp, Susan; MacLachlan, Malcolm; Wegener, Stephen T

    2009-06-01

    The matching of prosthetic devices to the needs of the individual is a challenge for providers and patients. The aims of this study are to explore the values and preferences that prosthetic users have of their prosthetic devices; to investigate users' perceptions of alternative prosthetic options and to demonstrate a novel method for exploring the values and preferences of prosthetic users. This study describes four case studies of upper limb and lower limb high tech and conventional prosthetic users. Participants were interviewed using the repertory grid technique (RGT), a qualitative technique to explore individual values and preferences regarding specific choices and events. The participants generated distinctive patterns of personal constructs and ratings regarding prosthetic use and different prosthetic options available. The RGT produced a unique profile of preferences regarding prosthetic technologies for each participant. User choice is an important factor when matching prosthetic technology to the user. The consumer's values regarding different prosthetic options are likely to be a critical factor in prosthetic acceptance and ultimate quality of life. The RGT offers a structured method of exploring these attitudes and values without imposing researcher or practitioner bias and identifies personalized dimensions for providers and users to evaluate the individuals' preferences in prosthetic technology.

  4. Architectural design of diamond-like carbon coatings for long-lasting joint replacements.

    PubMed

    Liu, Yujing; Zhao, Xiaoli; Zhang, Lai-Chang; Habibi, Daryoush; Xie, Zonghan

    2013-07-01

    Surface engineering through the application of super-hard, low-friction coatings as a potential approach for increasing the durability of metal-on-metal replacements is attracting significant attention. In this study innovative design strategies are proposed for the development of diamond-like-carbon (DLC) coatings against the damage caused by wear particles on the joint replacements. Finite element modeling is used to analyze stress distributions induced by wear particles of different sizes in the newly-designed coating in comparison to its conventional monolithic counterpart. The critical roles of architectural design in regulating stress concentrations and suppressing crack initiation within the coatings is elucidated. Notably, the introduction of multilayer structure with graded modulus is effective in modifying the stress field and reducing the magnitude and size of stress concentrations in the DLC diamond-like-carbon coatings. The new design is expected to greatly improve the load-carrying ability of surface coatings on prosthetic implants, in addition to the provision of damage tolerance through crack arrest. Copyright © 2013 Elsevier B.V. All rights reserved.

  5. The biological response to orthopedic implants for joint replacement. II: Polyethylene, ceramics, PMMA, and the foreign body reaction

    PubMed Central

    Gibon, Emmanuel; Córdova, Luis A.; Lu, Laura; Lin, Tzu-Hua; Yao, Zhenyu; Hamadouche, Moussa; Goodman, Stuart B.

    2017-01-01

    Novel evidence-based prosthetic designs and biomaterials facilitate the performance of highly successful joint replacement (JR) procedures. To achieve this goal, constructs must be durable, biomechanically sound, and avoid adverse local tissue reactions. Different biomaterials such as metals and their alloys, polymers, ceramics, and composites are currently used for JR implants. This review focuses on (1) the biological response to the different biomaterials used for TJR and (2) the chronic inflammatory and foreign-body response induced by byproducts of these biomaterials. A homeostatic state of bone and surrounding soft tissue with current biomaterials for JR can be achieved with mechanically stable, infection free and intact (as opposed to the release of particulate or ionic byproducts) implants. Adverse local tissue reactions (an acute/chronic inflammatory reaction, periprosthetic osteolysis, loosening and subsequent mechanical failure) may evolve when the latter conditions are not met. This article (Part 2 of 2) summarizes the biological response to the non-metallic materials commonly used for joint replacement including polyethylene, ceramics, and polymethylmethacrylate (PMMA), as well as the foreign body reaction to byproducts of these materials. PMID:27080740

  6. Test Tube Tooth: The Next Big Thing.

    PubMed

    Yadav, Preeti; Tahir, Mohammed; Yadav, Harsh; Sureka, Rakshit; Garg, Aarti

    2016-06-01

    Unlike some vertebrates and fishes, humans do not have the capacity for tooth regeneration after the loss of permanent teeth. Although artificial replacement with removable dentures, fixed prosthesis and implants is possible through advances in the field of prosthetic dentistry, it would be ideal to recreate a third set of natural teeth to replace lost dentition. For many years now, researchers in the field of tissue engineering have been trying to bioengineer dental tissues as well as whole teeth. In order to attain a whole tooth through dental engineering, that has the same or nearly same biological, mechanical and physical properties of a natural tooth, it's necessary to deal with all the cells and tissues which are concerned with the formation, maintenance and repair of the tooth. In this article we review the steps involved in odontogenesis or organogenesis of a tooth and progress in the bioengineering of a whole tooth.

  7. Salvage Procedures for Management of Prosthetic Joint Infection After Hip and Knee Replacements

    PubMed Central

    Mahmoud, Samer S.S.; Sukeik, Mohamed; Alazzawi, Sulaiman; Shaath, Mohammed; Sabri, Omar

    2016-01-01

    Background: The increasing load placed by joint replacement surgery on health care systems makes infection, even with the lowest rates, a serious concern that needs to be thoroughly studied and addressed using all possible measures. Methods: A comprehensive review of the current literature on salvage procedures for recurrent PJIs using PubMed, EMBASE and CINAHL has been conducted. Results: Prolonged suppressive antibiotic therapy (PSAT), resection arthroplasty and arthrodesis were the most common procedures performed. Suppressive antibiotic therapy is based on the use of well tolerated long term antibiotics in controlling sensitive organisms. Resection arthroplasty which should be reserved as a last resort provided more predictable outcomes in the hip whereas arthrodesis was associated with better outcomes in the knee. Various methods for arthrodesis including internal and external fixation have been described. Conclusion: Despite good union and infection control rates, all methods were associated with complications occasionally requiring further surgical interventions. PMID:28144373

  8. The tribology of metal-on-metal total hip replacements.

    PubMed

    Scholes, S C; Unsworth, A

    2006-02-01

    Total hip surgery is an effective way of alleviating the pain and discomfort caused by diseased or damaged joints. However, in the majority of cases, these joints have a finite life. The main reason for failure is osteolysis (bone resorption). It is well documented that an important cause of osteolysis, and therefore the subsequent loosening and failure of conventional metal- or ceramic-on-ultra-high molecular weight polyethylene joints, is the body's immunological response to the polyethylene wear particles. To avoid this, interest has been renewed in metal-on-metal joints. The intention of this paper is to review the studies that have taken place within different laboratories to determine the tribological performance of new-generation metal-on-metal total hip replacements. These types of joint offer a potential solution to enhance the longevity of prosthetic hip systems; however, problems may arise owing to the effects of metal ion release, which are, as yet, not fully understood.

  9. Fungal Endocarditis Due to Aspergillus oryzae: The First Case Reported in the Literature.

    PubMed

    Mazza, Andrea; Luciani, Nicola; Luciani, Marco; Cammertoni, Federico; Giaquinto, Alessia; Pavone, Natalia; Bruno, Piergiorgio; Massetti, Massimo

    2017-03-01

    Infective endocarditis (IE) is a severe disease with high mortality and morbidity. Prosthetic valve endocarditis is a life-threatening complication which can occur in less than 10% of patients with valve prosthesis. A fungal etiology of IE is rare and accounts for only 2-4% of all case of endocarditis, but is associated with a higher mortality and morbidity. Herein is reported the first case of fungal endocarditis of aortic valve prosthesis due to Aspergillus oryzae in a 67-year-old caucasian man who nine years previously underwent mitral and aortic valve replacement with mechanical prostheses, and tricuspid annuloplasty for acute IE due to Enterococcus spp. Seven months previously, the patient also underwent a redo cardiac procedure to replace a mitral valve prosthesis with a new mechanical device due to a leakage. Aspergillus oryzae showed impressive growth with strong and unexpected virulence in both local and systemic settings.

  10. Dental procedures, antibiotic prophylaxis, and endocarditis among people with prosthetic heart valves: nationwide population based cohort and a case crossover study

    PubMed Central

    Blotière, Pierre-Olivier; Hoen, Bruno; Lesclous, Philippe; Millot, Sarah; Rudant, Jérémie; Weill, Alain; Coste, Joel; Alla, François; Duval, Xavier

    2017-01-01

    Objective To assess the relation between invasive dental procedures and infective endocarditis associated with oral streptococci among people with prosthetic heart valves. Design Nationwide population based cohort and a case crossover study. Setting French national health insurance administrative data linked with the national hospital discharge database. Participants All adults aged more than 18 years, living in France, with medical procedure codes for positioning or replacement of prosthetic heart valves between July 2008 and July 2014. Main outcome measures Oral streptococcal infective endocarditis was identified using primary discharge diagnosis codes. In the cohort study, Poisson regression models were performed to estimate the rate of oral streptococcal infective endocarditis during the three month period after invasive dental procedures compared with non-exposure periods. In the case crossover study, conditional logistic regression models calculated the odds ratio and 95% confidence intervals comparing exposure to invasive dental procedures during the three month period preceding oral streptococcal infective endocarditis (case period) with three earlier control periods. Results The cohort included 138 876 adults with prosthetic heart valves (285 034 person years); 69 303 (49.9%) underwent at least one dental procedure. Among the 396 615 dental procedures performed, 103 463 (26.0%) were invasive and therefore presented an indication for antibiotic prophylaxis, which was performed in 52 280 (50.1%). With a median follow-up of 1.7 years, 267 people developed infective endocarditis associated with oral streptococci (incidence rate 93.7 per 100 000 person years, 95% confidence interval 82.4 to 104.9). Compared with non-exposure periods, no statistically significant increased rate of oral streptococcal infective endocarditis was observed during the three months after an invasive dental procedure (relative rate 1.25, 95% confidence interval 0.82 to 1.82; P=0.26) and after an invasive dental procedure without antibiotic prophylaxis (1.57, 0.90 to 2.53; P=0.08). In the case crossover analysis, exposure to invasive dental procedures was more frequent during case periods than during matched control periods (5.1% v 3.2%; odds ratio 1.66, 95% confidence interval 1.05 to 2.63; P=0.03). Conclusion Invasive dental procedures may contribute to the development of infective endocarditis in adults with prosthetic heart valves. PMID:28882817

  11. Sonication contribution to identifying prosthetic joint infection with Ralstonia pickettii: a case report and review of the literature.

    PubMed

    Birlutiu, Rares Mircea; Roman, Mihai Dan; Cismasiu, Razvan Silviu; Fleaca, Sorin Radu; Popa, Crina Maria; Mihalache, Manuela; Birlutiu, Victoria

    2017-07-19

    In the context of an increase number of primary and revision total hip and total knee arthroplasty performed yearly, an increased risk of complication is expected. Prosthetic joint infection (PJI) remains the most common and feared arthroplasty complication. Ralstonia pickettii is a Gram-negative bacterium, that has also been identified in biofilms. It remains an extremely rare cause of PJI. There is no report of an identification of R. pickettii on an extracted spacer loaded with antibiotic. We present the case of an 83-years-old Caucasian male patient, that underwent a right cemented total hip replacement surgery. The patient is diagnosed with an early PJI with no isolated microorganism. A debridement and change of mobile parts is performed. At the beginning of 2016, the patient in readmitted into the Orthopedic Department for sever, right abdominal and groin pain and elevated serum erythrocyte sedimentation rate and C-reactive protein. A joint aspiration is performed with a negative microbiological examination. A two-stage exchange with long interval management is adopted, and a preformed spacer loaded with gentamicin was implanted. In July 2016, based on the proinflammatory markers evolution, a shift a three-stage exchange strategy is decided. In September 2016, a debridement, and changing of the preformed spacer loaded with gentamicin with another was carried out. Bacteriological examination of the tissues sampled intraoperatively was positive for Pseudomonas aeruginosa. From the sonication fluid, no bacteria were isolated on culture or identified using the bbFISH assay. During the hospitalization period, the patient received i.v. ceftazidime 3x2g/day and p.o. ciprofloxacin 2x750mg/day, antibiotic therapy that was continued after discharge with p.o. ciprofloxacin 2x750mg/day for 6 weeks. In February 2017, a reimplantation of a revision prosthesis is performed. The retrieved spacer is sonicated, and after 4 days of incubation of the sonication fluid, R. pickettii is isolated. A long term antibiotic therapy with cotrimoxazole being prescribed. Bacteria culture of sonication fluid remains the gold standard in diagnosing prosthetic joint infections. R. pickettii remains an extremely rare cause of prosthetic joint infection. Optimal management of R. pickettii prosthetic joint infections of has not been established.

  12. Sensory feedback in prosthetics: a standardized test bench for closed-loop control.

    PubMed

    Dosen, Strahinja; Markovic, Marko; Hartmann, Cornelia; Farina, Dario

    2015-03-01

    Closing the control loop by providing sensory feedback to the user of a prosthesis is an important challenge, with major impact on the future of prosthetics. Developing and comparing closed-loop systems is a difficult task, since there are many different methods and technologies that can be used to implement each component of the system. Here, we present a test bench developed in Matlab Simulink for configuring and testing the closed-loop human control system in standardized settings. The framework comprises a set of connected generic blocks with normalized inputs and outputs, which can be customized by selecting specific implementations from a library of predefined components. The framework is modular and extensible and it can be used to configure, compare and test different closed-loop system prototypes, thereby guiding the development towards an optimal system configuration. The use of the test bench was demonstrated by investigating two important aspects of closed-loop control: performance of different electrotactile feedback interfaces (spatial versus intensity coding) during a pendulum stabilization task and feedforward methods (joystick versus myocontrol) for force control. The first experiment demonstrated that in the case of trained subjects the intensity coding might be superior to spatial coding. In the second experiment, the control of force was rather poor even with a stable and precise control interface (joystick), demonstrating that inherent characteristics of the prosthesis can be an important limiting factor when considering the overall effectiveness of the closed-loop control. The presented test bench is an important instrument for investigating different aspects of human manual control with sensory feedback.

  13. Accuracy of femoral templating in reproducing anatomical femoral offset in total hip replacement.

    PubMed

    Davies, H; Foote, J; Spencer, R F

    2007-01-01

    Restoration of hip biomechanics is a crucial component of successful total hip replacement. Preoperative templating is recommended to ensure that the size and orientation of implants is optimised. We studied how closely natural femoral offset could be reproduced using the manufacturers' templates for 10 femoral stems in common use in the UK. A series of 23 consecutive preoperative radiographs from patients who had undergone unilateral total hip replacement for unilateral osteoarthritis of the hip was employed. The change in offset between the templated position of the best-fitting template and the anatomical centre of the hip was measured. The templates were then ranked according to their ability to reproduce the normal anatomical offset. The most accurate was the CPS-Plus (Root Mean Square Error 2.0 mm) followed in rank order by: C stem (2.16), CPT (2.40), Exeter (3.23), Stanmore (3.28), Charnley (3.65), Corail (3.72), ABG II (4.30), Furlong HAC (5.08) and Furlong modular (7.14). A similar pattern of results was achieved when the standard error of variability of offset was analysed. We observed a wide variation in the ability of the femoral prosthesis templates to reproduce normal femoral offset. This variation was independent of the seniority of the observer. The templates of modern polished tapered stems with high modularity were best able to reproduce femoral offset. The current move towards digitisation of X-rays may offer manufacturers an opportunity to improve template designs in certain instances, and to develop appropriate computer software.

  14. Heart valve replacement with the Sorin tilting-disc prosthesis. A 10-year experience.

    PubMed

    Milano, A; Bortolotti, U; Mazzucco, A; Mossuto, E; Testolin, L; Thiene, G; Gallucci, V

    1992-02-01

    From 1978 to 1988, 697 patients with a mean age of 48 +/- 11 years (range 5 to 75 years) received a Sorin tilting-disc prosthesis; 358 had had aortic valve replacement, 247 mitral valve replacement, and 92 mitral and aortic valve replacement. Operative mortality rates were 7.8%, 11.3%, and 10.8%, respectively, in the three groups. Cumulative duration of follow-up is 1650 patient-years for aortic valve replacement (maximum follow-up 11.4 years), 963 patient-years for mitral valve replacement (maximum follow-up 9.9 years) and 328 patient-years for mitral and aortic valve replacement (maximum follow-up 9.4 years). Actuarial survival at 9 years is 72% +/- 4% after mitral valve replacement, 70% +/- 3% after aortic valve replacement, and 50% +/- 12% after mitral and aortic valve replacement, and actuarial freedom from valve-related deaths is 97% +/- 2% after mitral valve replacement, 92% +/- 2% after aortic valve replacement, and 62% +/- 15% after mitral and aortic valve replacement. Thromboembolic events occurred in 21 patients with aortic valve replacement (1.3% +/- 0.2%/pt-yr), in 12 with mitral valve replacement (1.2% +/- 0.3% pt-yr), and in seven with mitral and aortic valve replacement (2.1% +/- 0.8%), with one case of prosthetic thrombosis in each group; actuarial freedom from thromboembolism at 9 years is 92% +/- 3% after mitral valve replacement, 91% +/- 3% after aortic valve replacement, and 74% +/- 16% after mitral and aortic valve replacement. Anticoagulant-related hemorrhage was observed in 15 patients after aortic valve replacement (0.9% +/- 0.2%/pt-yr), in 9 after mitral valve replacement (0.9% +/- 0.3%/pt-yr), and in 6 with mitral and aortic valve replacement (0.9% +/- 0.5%/pt-yr); actuarial freedom from this complication at 9 years is 94% +/- 2% after aortic valve replacement, 91% +/- 4% after mitral valve replacement, and 68% +/- 16% after mitral and aortic valve replacement. Actuarial freedom from reoperation at 9 years is 97% +/- 2% after mitral and aortic valve replacement, 92% +/- 4% after mitral valve replacement, and 89% +/- 3% after aortic valve replacement, with no cases of mechanical fracture. The Sorin valve has shown a satisfactory long-term overall performance, comparable with other mechanical prostheses, and an excellent durability that renders it a reliable heart valve substitute for the mitral and aortic positions.

  15. Implantation of Vascular Grafts Lined with Genetically Modified Endothelial Cells

    NASA Astrophysics Data System (ADS)

    Wilson, James M.; Birinyi, Louis K.; Salomon, Robert N.; Libby, Peter; Callow, Allan D.; Mulligan, Richard C.

    1989-06-01

    The possibility of using the vascular endothelial cell as a target for gene replacement therapy was explored. Recombinant retroviruses were used to transduce the lacZ gene into endothelial cells harvested from mongrel dogs. Prosthetic vascular grafts seeded with the genetically modified cells were implanted as carotid interposition grafts into the dogs from which the original cells were harvested. Analysis of the graft 5 weeks after implantation revealed genetically modified endothelial cells lining the luminal surface of the graft. This technology could be used in the treatment of atherosclerosis disease and the design of new drug delivery systems.

  16. Artificial Muscle Kits for the Classroom

    NASA Technical Reports Server (NTRS)

    2004-01-01

    Commonly referred to as "artificial muscles," electroactive polymer (EAP) materials are lightweight strips of highly flexible plastic that bend or stretch when subjected to electric voltage. EAP materials may prove to be a substitution for conventional actuation components such as motors and gears. Since the materials behave similarly to biological muscles, this emerging technology has the potential to develop improved prosthetics and biologically-inspired robots, and may even one day replace damaged human muscles. The practical application of artificial muscles provides a challenge, however, since the material requires improved effectiveness and durability before it can fulfill its potential.

  17. Prosthetic valve implantation with preservation of the entire valvular and subvalvular apparatus of the tricuspid valve in congenitally corrected transposition of the great arteries.

    PubMed

    Ergenoglu, Mehmet U; Yerebakan, Halit; Ozveren, Olcay; Koner, Ozge; Kalangos, Afksendiyos; Demirsoy, Ergun

    2011-10-01

    Congenitally corrected transposition of the great arteries, which is characterized by atrioventricular and ventriculoarterial discordance, is a rare congenital heart disease. Most of the cases are diagnosed in childhood, owing to associated cardiac anomalies, such as ventricular septal defect, pulmonary stenosis or pulmonary atresia, and Ebstein-like malformation of the tricuspid valve. We present a patient with congenitally corrected transposition of the great arteries who underwent surgical replacement of the tricuspid valve with a bioprosthesis and reconstruction of the left ventricular outflow tract with bovine conduit.

  18. Intracardiac echocardiographic guidance for hemodynamic assessment in a patient with congenital abnormalities and a prosthetic aortic valve.

    PubMed

    Papafaklis, M I; Ligthart, J M R; Vaina, S; Witsenburg, M; Bogers, A J J C; Serruys, P W

    2005-01-01

    In this case report, we present the use of intracardiac echocardiography (ICE) for guiding the cardiac catheterization and subsequent hemodynamic investigation in an unusual patient case with multiple congenital abnormalities (bicuspid aortic valve, left cervical aortic arch, two aortic coarctations) and two aortic valve replacement operations in the past. The ICE catheter (AcuNav) permitted us to accurately and safely puncture the interatrial septum and place the Swan-Ganz catheter in the left ventricle; additionally, visualization of the aortic coarctation in the ascending aorta was also achieved.

  19. Leaflet embolisation from Duromedics valves: a report of two cases.

    PubMed

    Kumar, N; Balasundaram, S; Rickard, M; al Halees, Z; Duran, C M

    1991-12-01

    Embolization of parts of mechanical valves has been reported since the inception of prosthetic valve implantation. We report here two cases of embolization of one hemileaflet of a Duromedic bileaflet prosthesis in the mitral position due to a pivot fracture. Both presented with moderately severe mitral regurgitation and pulmonary edema and were successfully managed by replacement of the malfunctioning prostheses. The embolised disc was located in the left common iliac artery by abdominal ultrasound and removed by an inguinal, retroperitoneal approach with low morbidity. Both patients left hospital and are doing well to-date.

  20. Use of multidetector-row computed tomography scan to detect pannus formation in prosthetic mechanical aortic valves.

    PubMed

    Aladmawi, Mohamed A; Pragliola, Claudio; Vriz, Olga; Galzerano, Domenico

    2017-04-01

    Obstruction of a mechanical aortic valve by pannus formation at the subvalvular level is a major long-term complication of aortic valve replacement (AVR). In fact, pannus is sometime difficult to differentiate from patient-prosthesis mismatch or valve thrombosis. In most cases cine-angiography and echocardiography, either transthoracic or transesophageal, cannot correctly visualize the complication when the leaflets show a normal mobility. Recent technological refinements made this difficult diagnosis possible by ECG-gated computed tomography (CT) scan which shows adequate images in 90% of the cases and can differentiate pannus from fresh and organized thrombus.

  1. Mitral valve stenosis caused by abnormal pannus extension over the prosthetic ring and leaflets after Duran ring mitral annuloplasty.

    PubMed

    Yunoki, Junji; Minato, Naoki; Katayama, Yuji; Sato, Hisashi

    2009-01-01

    We treated a 61-year-old woman with mitral stenosis caused by pannus formation after Duran ring annuloplasty. Pannus overgrowth on the ring with extension onto both leaflets narrowed the mitral orifice and severely restricted the mobility of the valve leaflets. Mitral valve replacement with a St. Jude Medical mechanical heart valve prosthesis was successfully performed, and the postoperative course was uneventful. Patients undergoing Duran ring annuloplasty should be followed up with the consideration of possible mitral stenosis caused by pannus extension, as the cause for pannus formation remains unclear.

  2. Disto-angular transmigrated impacted mandibular molar with enostosis: A rare intraoral lesion

    PubMed Central

    Natarajan, Shanmuganathan; Madhankumar, Seenivasan; Jeyapalan, Karthigeyan; Athiban, I.; Elengkumaran, S.; Periyakaruppiah, K. P. S.

    2015-01-01

    A 29-year-old male patient reported for replacement of missing teeth. The patient gave history of unerupted right lower posterior teeth and the orthopantomogram revealed transmigrated mandibular second molar to the inferior border of mandible just below the root apices of second premolar associated with enostosis distally toward the ramus of mandible with size of about 21 mm Χ 20 mm. This rare interosseous defect plays a vital role in deciding prosthetic treatment options for missing teeth and utmost care should be taken to preserve the health of the patient during such procedures. PMID:26538971

  3. Disto-angular transmigrated impacted mandibular molar with enostosis: A rare intraoral lesion.

    PubMed

    Natarajan, Shanmuganathan; Madhankumar, Seenivasan; Jeyapalan, Karthigeyan; Athiban, I; Elengkumaran, S; Periyakaruppiah, K P S

    2015-08-01

    A 29-year-old male patient reported for replacement of missing teeth. The patient gave history of unerupted right lower posterior teeth and the orthopantomogram revealed transmigrated mandibular second molar to the inferior border of mandible just below the root apices of second premolar associated with enostosis distally toward the ramus of mandible with size of about 21 mm Χ 20 mm. This rare interosseous defect plays a vital role in deciding prosthetic treatment options for missing teeth and utmost care should be taken to preserve the health of the patient during such procedures.

  4. Bacterial colonization of penile prosthesis after its withdrawal due to mechanical failure.

    PubMed

    Etcheverry-Giadrosich, B; Torremadé-Barreda, J; Pujol-Galarza, L; Vigués-Julià, F

    2017-12-01

    Prosthetic surgery to treat erectile dysfunction has a risk of infection of up to 3%, but this risk can increase to 18% when the surgery involves replacement. This increased risk of infection is attributed to the bacterial colonization of the prosthesis during the initial surgery. To analyse the presence of germs in the prosthesis that is withdrawn due to mechanical failure (not infection), as well as the surgical results and its progression. A retrospective study was conducted of all replacements performed between 2013 and 2016 at a single centre. We analysed demographic data, prior type of prosthesis, surgical procedure, microbiological study and follow-up. Of the 12 replacement procedures, a microbiological study of the extracted prosthesis was performed in a total of 10 cases. Of the 10 replacements, the cultures were positive in 5 cases (50%). Staphylococcus epidermidis was the most prevalent germ. All patients underwent a flushing procedure, and an antibiotic-coated prosthesis was implanted. We recorded no infections with the new implanted device after a mean follow-up of 27.33 months (SD 4.13; 95% CI 18.22-36.43). In our study population, we observed a high rate of bacterial colonization of the prostheses that were replaced due to mechanical failure. When a flushing procedure was performed during the replacement surgery, there were no more infections than those reported in treatment-naive cases. Copyright © 2017 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  5. [Endoprostheses in geriatric traumatology].

    PubMed

    Buecking, B; Eschbach, D; Bliemel, C; Knobe, M; Aigner, R; Ruchholtz, S

    2017-01-01

    Geriatric traumatology is increasing in importance due to the demographic transition. In cases of fractures close to large joints it is questionable whether primary joint replacement is advantageous compared to joint-preserving internal fixation. The aim of this study was to describe the importance of prosthetic joint replacement in the treatment of geriatric patients suffering from frequent periarticular fractures in comparison to osteosynthetic joint reconstruction and conservative methods. A selective search of the literature was carried out to identify studies and recommendations concerned with primary arthroplasty of fractures in the region of the various joints (hip, shoulder, elbow and knee). The importance of primary arthroplasty in geriatric traumatology differs greatly between the various joints. Implantation of a prosthesis has now become the gold standard for displaced fractures of the femoral neck. In addition, reverse shoulder arthroplasty has become an established alternative option to osteosynthesis in the treatment of complex proximal humeral fractures. Due to a lack of large studies definitive recommendations cannot yet be given for fractures around the elbow and the knee. Nowadays, joint replacement for these fractures is recommended only if reconstruction of the joint surface is not possible. The importance of primary joint replacement for geriatric fractures will probably increase in the future. Further studies with larger patient numbers must be conducted to achieve more confidence in decision making between joint replacement and internal fixation especially for shoulder, elbow and knee joints.

  6. Modular Systems Of Fixation And Position Jigs In The Production Process For Products And Systems

    NASA Astrophysics Data System (ADS)

    Babík, Ondrej; Šajgalík, Michal; Zaušková, Lucia; Czán, Andrej

    2015-12-01

    The project deals with design and implementation of adjustment onto mounting tables in the automotive industry. Manual control system of the jigs is replaced by a pneumatic system. Advantages of the pneumatic system are eliminating service side-time, improving work flow and increasing safety and ergonomics at work. Thanks to higher effectivity of the work process, manpower can be used in other work positions.

  7. TVC actuator model. [for the space shuttle main engine

    NASA Technical Reports Server (NTRS)

    Baslock, R. W.

    1977-01-01

    A prototype Space Shuttle Main Engine (SSME) Thrust Vector Control (TVC) Actuator analog model was successfully completed. The prototype, mounted on five printed circuit (PC) boards, was delivered to NASA, checked out and tested using a modular replacement technique on an analog computer. In all cases, the prototype model performed within the recording techniques of the analog computer which is well within the tolerances of the specifications.

  8. 2014 Overview of NASA GRC Electrochemical Power and Energy Storage Technology

    NASA Technical Reports Server (NTRS)

    Reid, Concha M.

    2014-01-01

    Overview presentation to the IAPG Chemical Working Group meeting, discussing current electrochemical power and energy storage R and D at NASA GRC including missions, demonstrations, and reserch projects. Activities such as ISS Lithium-Ion Battery Replacements, the Advanced Exploration Systems Modular Power Systems project, Enabling Electric Aviation with Ultra-High Energy Litium Metal Batteries, Advanced Space Power Systems project, and SBIR STTR work, will be discussed.

  9. Multidisciplinary Thermal Analysis of Hot Aerospace Structures

    DTIC Science & Technology

    2010-05-02

    Seidel iteration. Such a strategy simplifies explicit/implicit treatment , subcycling, load balancing, software modularity, and replacements as better... Stefan -Boltzmann constant , E is the emissivity of the surface, f is the form factor from the surface to the reference surface, Br is the temperature of...Stokes equations using Gauss- Seidel line Relaxation, Computers and Fluids, 17, pp.l35-150, 1989. [22] Hung C.M. and MacCormack R.W., Numerical

  10. Re-treatment decisions for failed posterior fillings by Finnish general practitioners.

    PubMed

    Heinikainen, Mia; Vehkalahti, Miira; Murtomaa, Heikki

    2002-06-01

    To evaluate treatment decisions of general dental practitioners (GDPs) in the private and public sector in cases of re-treatment of failed posterior fillings. A questionnaire on six cases from 400 GDPs, selected by stratified randomisation by gender, and main occupation (public vs. private sector). Others were all full-time dental teachers (DTs; n=47) representing clinical disciplines other than surgery and orthodontics. Restorative cases were described in detail, including figures drawn on four subcases involving the first permanent upper molar where the filling to be replaced increased in size from occlusal filling to the entire clinical crown. For each case, respondents chose the optimal treatment from eight alternatives, later re-classified as amalgam restoration, direct composite restoration, prosthetic restoration (indirect composite, cast gold inlay/onlay, ceramic inlay/onlay, ceramic crown, or bridge construction following tooth extraction). For re-treatment of the occlusal filling, composite restoration was preferred both by GDPs (92%) and DTs (83%). For three-surface fillings, prosthetic restorations were dominant in the private sector (OR=2.3; 95% CI: 1.4, 3.8; P<0.001). In total loss of the clinical crown, prosthetic restoration was chosen by all the DTs, public-sector dentists, and 95% of private-sector dentists. No more than 10% of GDPs chose amalgam and 2% gold; the rest chose composites. Treatment decisions were similar in public and private sectors for cases with the smallest and largest fillings. Wide variation in cases of medium-sized restorations indicated a lack of generally accepted guidelines of good clinical practice and of evidence-based treatment practice.

  11. Prosthetic Avian Vocal Organ Controlled by a Freely Behaving Bird Based on a Low Dimensional Model of the Biomechanical Periphery

    PubMed Central

    Arneodo, Ezequiel M.; Perl, Yonatan Sanz; Goller, Franz; Mindlin, Gabriel B.

    2012-01-01

    Because of the parallels found with human language production and acquisition, birdsong is an ideal animal model to study general mechanisms underlying complex, learned motor behavior. The rich and diverse vocalizations of songbirds emerge as a result of the interaction between a pattern generator in the brain and a highly nontrivial nonlinear periphery. Much of the complexity of this vocal behavior has been understood by studying the physics of the avian vocal organ, particularly the syrinx. A mathematical model describing the complex periphery as a nonlinear dynamical system leads to the conclusion that nontrivial behavior emerges even when the organ is commanded by simple motor instructions: smooth paths in a low dimensional parameter space. An analysis of the model provides insight into which parameters are responsible for generating a rich variety of diverse vocalizations, and what the physiological meaning of these parameters is. By recording the physiological motor instructions elicited by a spontaneously singing muted bird and computing the model on a Digital Signal Processor in real-time, we produce realistic synthetic vocalizations that replace the bird's own auditory feedback. In this way, we build a bio-prosthetic avian vocal organ driven by a freely behaving bird via its physiologically coded motor commands. Since it is based on a low-dimensional nonlinear mathematical model of the peripheral effector, the emulation of the motor behavior requires light computation, in such a way that our bio-prosthetic device can be implemented on a portable platform. PMID:22761555

  12. Experimental and failure analysis of the prosthetic finger joint implants

    NASA Astrophysics Data System (ADS)

    Naidu, Sanjiv H.

    Small joint replacement arthroplasty of the hand is a well accepted surgical procedure to restore function and cosmesis in an individual with a crippled hand. Silicone elastomers have been used as prosthetic material in various small hand joints for well over three decades. Although the clinical science aspects of silicone elastomer failure are well known, the physical science aspects of prosthetic failure are scant and vague. In the following thesis, using both an animal model, and actual retrieved specimens which have failed in human service, experimental and failure analysis of silicone finger joints are presented. Fractured surfaces of retrieved silicone trapezial implants, and silicone finger joint implants were studied with both FESEM and SEM; the mode of failure for silicone trapezium is by wear polishing, whereas the finger joint implants failed either by fatigue fracture or tearing of the elastomer, or a combination of both. Thermal analysis revealed that the retrieved elastomer implants maintained its viscoelastic properties throughout the service period. In order to provide for a more functional and physiologic arthroplasty a novel finger joint (Rolamite prosthesis) is proposed using more recently developed thermoplastic polymers. The following thesis also addresses the outcome of the experimental studies of the Rolamite prosthesis in a rabbit animal model, in addition to the failure analysis of the thermoplastic polymers while in service in an in vivo synovial environment. Results of retrieved Rolamite specimens suggest that the use for thermoplastic elastomers such as block copolymer based elastomers in a synovial environment such as a mammalian joint may very well be limited.

  13. Prosthetic limb sockets from plant-based composite materials.

    PubMed

    Campbell, Andrew I; Sexton, Sandra; Schaschke, Carl J; Kinsman, Harry; McLaughlin, Brian; Boyle, Martin

    2012-06-01

    There is a considerable demand for lower limb prostheses globally due to vascular disease, war, conflict, land mines and natural disasters. Conventional composite materials used for prosthetic limb sockets include acrylic resins, glass and carbon fibres, which produce harmful gasses and dust in their manufacture. To investigate the feasibility of using a renewable plant oil-based polycarbonate-polyurethane copolymer resin and plant fibre composite, instead of conventional materials, to improve safety and accessibility of prosthetic limb manufacture. Experimental, bench research. Test pieces of the resin with a range of plant fibres (10.0% by volume) were prepared and tensile strengths were tested. Test sockets of both conventional composite materials and plant resin with plant fibres were constructed and tested to destruction. Combinations of plant resin and either banana or ramie fibres gave high tensile strengths. The conventional composite material socket and plant resin with ramie composite socket failed at a similar loading, exceeding the ISO 10328 standard. Both wall thickness and fibre-matrix adhesion played a significant role in socket strength. From this limited study we conclude that the plant resin and ramie fibre composite socket has the potential to replace the standard layup. Further mechanical and biocompatibility testing as well as a full economic analysis is required. Using readily sourced and renewable natural fibres and a low-volatile bio-resin has potential to reduce harm to those involved in the manufacture of artificial limb sockets, without compromising socket strength and benefitting clinicians working in poorer countries where safety equipment is scarce. Such composite materials will reduce environmental impact.

  14. Paré and prosthetics: the early history of artificial limbs.

    PubMed

    Thurston, Alan J

    2007-12-01

    There is evidence for the use of prostheses from the times of the ancient Egyptians. Prostheses were developed for function, cosmetic appearance and a psycho-spiritual sense of wholeness. Amputation was often feared more than death in some cultures. It was believed that it not only affected the amputee on earth, but also in the afterlife. The ablated limbs were buried and then disinterred and reburied at the time of the amputee's death so the amputee could be whole for eternal life. One of the earliest examples comes from the 18th dynasty of ancient Egypt in the reign of Amenhotep II in the fifteenth century bc. A mummy in the Cairo Museum has clearly had the great toe of the right foot amputated and replaced with a prosthesis manufactured from leather and wood. The first true rehabilitation aids that could be recognized as prostheses were made during the civilizations of Greece and Rome. During the Dark Ages prostheses for battle and hiding deformity were heavy, crude devices made of available materials - wood, metal and leather. Such were the materials available to Ambroise Paré who invented both upper-limb and lower-limb prostheses. His 'Le Petit Lorrain', a mechanical hand operated by catches and springs, was worn by a French Army captain in battle. Subsequent refinements in medicine, surgery and prosthetic science greatly improved amputation surgery and the function of prostheses. What began as a modified crutch with a wooden or leather cup and progressed through many metamorphoses has now developed into a highly sophisticated prosthetic limb made of space-age materials.

  15. Neuroengineering tools/applications for bidirectional interfaces, brain-computer interfaces, and neuroprosthetic implants - a review of recent progress.

    PubMed

    Rothschild, Ryan Mark

    2010-01-01

    The main focus of this review is to provide a holistic amalgamated overview of the most recent human in vivo techniques for implementing brain-computer interfaces (BCIs), bidirectional interfaces, and neuroprosthetics. Neuroengineering is providing new methods for tackling current difficulties; however neuroprosthetics have been studied for decades. Recent progresses are permitting the design of better systems with higher accuracies, repeatability, and system robustness. Bidirectional interfaces integrate recording and the relaying of information from and to the brain for the development of BCIs. The concepts of non-invasive and invasive recording of brain activity are introduced. This includes classical and innovative techniques like electroencephalography and near-infrared spectroscopy. Then the problem of gliosis and solutions for (semi-) permanent implant biocompatibility such as innovative implant coatings, materials, and shapes are discussed. Implant power and the transmission of their data through implanted pulse generators and wireless telemetry are taken into account. How sensation can be relayed back to the brain to increase integration of the neuroengineered systems with the body by methods such as micro-stimulation and transcranial magnetic stimulation are then addressed. The neuroprosthetic section discusses some of the various types and how they operate. Visual prosthetics are discussed and the three types, dependant on implant location, are examined. Auditory prosthetics, being cochlear or cortical, are then addressed. Replacement hand and limb prosthetics are then considered. These are followed by sections concentrating on the control of wheelchairs, computers and robotics directly from brain activity as recorded by non-invasive and invasive techniques.

  16. Neuroengineering Tools/Applications for Bidirectional Interfaces, Brain–Computer Interfaces, and Neuroprosthetic Implants – A Review of Recent Progress

    PubMed Central

    Rothschild, Ryan Mark

    2010-01-01

    The main focus of this review is to provide a holistic amalgamated overview of the most recent human in vivo techniques for implementing brain–computer interfaces (BCIs), bidirectional interfaces, and neuroprosthetics. Neuroengineering is providing new methods for tackling current difficulties; however neuroprosthetics have been studied for decades. Recent progresses are permitting the design of better systems with higher accuracies, repeatability, and system robustness. Bidirectional interfaces integrate recording and the relaying of information from and to the brain for the development of BCIs. The concepts of non-invasive and invasive recording of brain activity are introduced. This includes classical and innovative techniques like electroencephalography and near-infrared spectroscopy. Then the problem of gliosis and solutions for (semi-) permanent implant biocompatibility such as innovative implant coatings, materials, and shapes are discussed. Implant power and the transmission of their data through implanted pulse generators and wireless telemetry are taken into account. How sensation can be relayed back to the brain to increase integration of the neuroengineered systems with the body by methods such as micro-stimulation and transcranial magnetic stimulation are then addressed. The neuroprosthetic section discusses some of the various types and how they operate. Visual prosthetics are discussed and the three types, dependant on implant location, are examined. Auditory prosthetics, being cochlear or cortical, are then addressed. Replacement hand and limb prosthetics are then considered. These are followed by sections concentrating on the control of wheelchairs, computers and robotics directly from brain activity as recorded by non-invasive and invasive techniques. PMID:21060801

  17. Three-dimensional construction and omni-directional rolling analysis of a novel frame-like lattice modular robot

    NASA Astrophysics Data System (ADS)

    Ding, Wan; Wu, Jianxu; Yao, Yan'an

    2015-07-01

    Lattice modular robots possess diversity actuation methods, such as electric telescopic rod, gear rack, magnet, robot arm, etc. The researches on lattice modular robots mainly focus on their hardware descriptions and reconfiguration algorithms. Meanwhile, their design architectures and actuation methods perform slow telescopic and moving speeds, relative low actuation force verse weight ratio, and without internal space to carry objects. To improve the mechanical performance and reveal the locomotion and reconfiguration binary essences of the lattice modular robots, a novel cube-shaped, frame-like, pneumatic-based reconfigurable robot module called pneumatic expandable cube(PE-Cube) is proposed. The three-dimensional(3D) expanding construction and omni-directional rolling analysis of the constructed robots are the main focuses. The PE-Cube with three degrees of freedom(DoFs) is assembled by replacing the twelve edges of a cube with pneumatic cylinders. The proposed symmetric construction condition makes the constructed robots possess the same properties in each supporting state, and a binary control strategy cooperated with binary actuator(pneumatic cylinder) is directly adopted to control the PE-Cube. Taking an eight PE-Cube modules' construction as example, its dynamic rolling simulation, static rolling condition, and turning gait are illustrated and discussed. To testify telescopic synchronization, respond speed, locomotion feasibility, and repeatability and reliability of hardware system, an experimental pneumatic-based robotic system is built and the rolling and turning experiments of the eight PE-Cube modules' construction are carried out. As an extension, the locomotion feasibility of a thirty-two PE-Cube modules' construction is analyzed and proved, including dynamic rolling simulation, static rolling condition, and dynamic analysis in free tipping process. The proposed PE-Cube module, construction method, and locomotion analysis enrich the family of the lattice modular robot and provide the instruction to design the lattice modular robot.

  18. Cardiac Surgery in Patients Infected with Human Immunodeficiency Virus

    PubMed Central

    Abad, Cipriano; Cárdenes, Miguel Angel; Jiménez, Pedro Conrado; Armas, Mario-Vicente; Betancor, Pedro

    2000-01-01

    From January 1991 through December 1999, 5 consecutive patients who were infected with human immunodeficiency virus presented in need of cardiac surgery. All were men; the median age was 44 years. Two of them presented with mitral and aortic infectious valve endocarditis, 1 with tricuspid endocarditis, 1 with prosthetic valve endocarditis, and 1 with pericarditis and pericardial tamponade. Under cardiopulmonary bypass, the 4 patients with endocarditis underwent these procedures: mitral and aortic valve replacement (2), tricuspid valve replacement (1), and aortic valve replacement (reoperation) and concomitant repair of a mycotic ascending aortic aneurysm (1). In the patient who had pericardial effusion, subxifoid pericardiostomy and drainage were performed, and a pericardial window was created. There was no intraoperative mortality. The patient with pericardial effusion died 8 days after surgery; he was in septic shock and had multiple organ failure. Two deaths occurred at 2 and 63 months, due to hemoptysis and sudden death, respectively. The 2 patients who underwent double valve replacement are alive and in good condition after a median follow-up of 71 months. Cardiac surgery is indicated in selected patients infected by the human immunodeficiency virus. These patients are frequently drug abusers or homosexual. Valvular endocarditis is the most common finding. Hospital morbidity and mortality rates are higher than usual in this group of patients. PMID:11198308

  19. Beating heart mitral valve replacement with a bovine pericardial bioprosthesis for treatment of mitral valve dysplasia in a Bull Terrier.

    PubMed

    Behr, Luc; Chetboul, Valérie; Sampedrano, Carolina Carlos; Vassiliki, Gouni; Pouchelon, Jean-Louis; Laborde, François; Borenstein, Nicolas

    2007-04-01

    To describe an open, beating heart surgical technique and use of a bovine pericardial prosthetic valve for mitral valve replacement (MVR) in the dog. Clinical case report. Male Bull Terrier (17-month-old, 26 kg) with mitral valve dysplasia and severe regurgitation. A bovine pericardial bioprosthesis was used to replace the mitral valve using an open beating heart surgical technique and cardiopulmonary bypass. Successful MVR was achieved using a beating heart technique. Mitral regurgitation resolved and cardiac performances improved (left ventricular end-diastolic diameter decreased from 57.6 to 48.7 mm, and left atrium/aorta ratio returned to almost normal, from 1.62 to 1.19). Cardiopulmonary by-pass time and total surgical duration were decreased compared with standard cardioplegic techniques. Surgical recovery was uneventful and on echocardiography 6 months later valve function was excellent. Considering the technique advantages (no cardiac arrest, ischemic reperfusion injury, and hypothermia, or the need for aortic dissection and cannulation for administration of cardioplegic solution), short-term mortality and morbidity may be reduced compared with standard cardioplegic techniques. Based on experience in this dog, beating heart mitral valvular replacement is a seemingly safe and viable option for the dog and bovine pericardial prosthesis may provide better long-term survival than mechanical prostheses.

  20. The modular architecture of protein-protein binding interfaces.

    PubMed

    Reichmann, D; Rahat, O; Albeck, S; Meged, R; Dym, O; Schreiber, G

    2005-01-04

    Protein-protein interactions are essential for life. Yet, our understanding of the general principles governing binding is not complete. In the present study, we show that the interface between proteins is built in a modular fashion; each module is comprised of a number of closely interacting residues, with few interactions between the modules. The boundaries between modules are defined by clustering the contact map of the interface. We show that mutations in one module do not affect residues located in a neighboring module. As a result, the structural and energetic consequences of the deletion of entire modules are surprisingly small. To the contrary, within their module, mutations cause complex energetic and structural consequences. Experimentally, this phenomenon is shown on the interaction between TEM1-beta-lactamase and beta-lactamase inhibitor protein (BLIP) by using multiple-mutant analysis and x-ray crystallography. Replacing an entire module of five interface residues with Ala created a large cavity in the interface, with no effect on the detailed structure of the remaining interface. The modular architecture of binding sites, which resembles human engineering design, greatly simplifies the design of new protein interactions and provides a feasible view of how these interactions evolved.

  1. Trauma: An Unusual Cause of Endocarditis.

    PubMed

    Braga, Ana; Marques, Marta; Abecacis, Miguel; Neves, José Pedro

    2017-01-01

    Infective endocarditis (IE) remains a dangerous condition with considerable associated mortality. Usual risk factors for IE include the presence of a prosthetic heart valve, structural or congenital heart disease, intravenous drug use, and a recent history of invasive procedures. The authors describe the case report of a patient with IE having trauma as an unusual risk factor. A 33-year old male patient was referred to our department due to infective endocarditis. The patient had a fever of unknown origin for 15 days before going to the emergency department. After admission it was identified by transthoracic echocardiography a 14mm posterior abscess of the aortic valve provoking major aortic regurgitation with moderate LV dysfunction. After careful evaluation of the clinical history it was found that the patient had a known bicuspid aortic valve with follow-up since the age of 14. All other usual risk factors for IE were excluded, including intravenous drug use and recent history of invasive procedures. The only relevant previous event was a traumatic haemathoma in his left jaw caused by a working accident with an iron beam in a construction site as the patient is a civil engineer. Vancomycin plus gentamicin were empirically started after blood cultures taken. The isolated infective agent was Staphylococcus lugdunensis methicillin sensitive and the antibiotherapy was de-escalated to flucloxacilin plus gentamicin. Due to cardiac dysfunction the patient was submitted to cardiac surgery on the fourth day of directed antibiotic therapy and a replacement of the aortic valve by a mechanical prosthetic valve and closure of the abscess with bovine pericardial patch was performed. The valve sent to microbiology evaluation showed the same infective provocative agent. The patient had a good clinical and laboratorial recovery completing the 42-day antibiotic scheme. After antibiotherapy period completion, echocardiography was repeated and the abscess found was larger then the previous one, presenting itself like an aortic pseudo aneurysm. The patient was resubmitted to surgery with re-closure of the initial abscess with autologous pericardial patch and replacement of the prosthetic mechanical valve for an undersized one. The patient was discharger clinically well, having a complete normal life at the moment. This clinical case illustrates trauma as an unusual cause of endocarditis and emphasizes the importance of a detailed clinical history.

  2. Managing uncertainty - a qualitative study of surgeons' decision-making for one-stage and two-stage revision surgery for prosthetic hip joint infection.

    PubMed

    Moore, Andrew J; Blom, Ashley W; Whitehouse, Michael R; Gooberman-Hill, Rachael

    2017-04-12

    Approximately 88,000 primary hip replacements are performed in England and Wales each year. Around 1% go on to develop deep prosthetic joint infection. Between one-stage and two-stage revision arthroplasty best treatment options remain unclear. Our aims were to characterise consultant orthopaedic surgeons' decisions about performing either one-stage or two-stage revision surgery for patients with deep prosthetic infection (PJI) after hip arthroplasty, and to identify whether a randomised trial comparing one-stage with two-stage revision would be feasible. Semi-structured interviews were conducted with 12 consultant surgeons who perform revision surgery for PJI after hip arthroplasty at 5 high-volume National Health Service (NHS) orthopaedic departments in England and Wales. Surgeons were interviewed before the development of a multicentre randomised controlled trial. Data were analysed using a thematic approach. There is no single standardised surgical intervention for the treatment of PJI. Surgeons balance multiple factors when choosing a surgical strategy which include multiple patient-related factors, their own knowledge and expertise, available infrastructure and the infecting organism. Surgeons questioned whether it was appropriate that the two-stage revision remained the best treatment, and some surgeons' willingness to consider more one-stage revisions had increased over recent years and were influenced by growing evidence showing equivalence between surgical techniques, and local observations of successful one-stage revisions. Custom-made articulating spacers was a practice that enabled uncertainty to be managed in the absence of definitive evidence about the superiority of one surgical technique over the other. Surgeons highlighted the need for research evidence to inform practice and thought that a randomised trial to compare treatments was needed. Most surgeons thought that patients who they treated would be eligible for trial participation in instances where there was uncertainty about the best treatment option. Surgeons highlighted the need for evidence to support their choice of revision. Some surgeons' willingness to consider one-stage revision for infection had increased over time, largely influenced by evidence of successful one-stage revisions. Custom-made articulating spacers also enabled surgeons to manage uncertainty about the superiority of surgical techniques. Surgeons thought that a prospective randomised controlled trial comparing one-stage with two-stage joint replacement is needed and that randomisation would be feasible.

  3. Five-year decreased incidence of surgical site infections following gastrectomy and prosthetic joint replacement surgery through active surveillance by the Korean Nosocomial Infection Surveillance System.

    PubMed

    Choi, H J; Adiyani, L; Sung, J; Choi, J Y; Kim, H B; Kim, Y K; Kwak, Y G; Yoo, H; Lee, Sang-Oh; Han, S H; Kim, S R; Kim, T H; Lee, H M; Chun, H K; Kim, J-S; Yoo, J D; Koo, H-S; Cho, E H; Lee, K W

    2016-08-01

    Surveillance of healthcare-associated infection has been associated with a reduction in surgical site infection (SSI). To evaluate the Korean Nosocomial Infection Surveillance System (KONIS) in order to assess its effects on SSI since it was introduced. SSI data after gastrectomy, total hip arthroplasty (THA), and total knee arthroplasty (TKA) between 2008 and 2012 were analysed. The pooled incidence of SSI was calculated for each year; the same analyses were also conducted from hospitals that had participated in KONIS for at least three consecutive years. Standardized SSI rates for each year were calculated by adjusting for SSI risk factors. SSI trends were analysed using the Cochran-Armitage test. The SSI rate following gastrectomy was 3.12% (522/16,918). There was a significant trend of decreased crude SSI rates over five years. This trend was also evident in analysis of hospitals that had participated for more than three years. The SSI rate for THA was 2.05% (157/7656), which decreased significantly from 2008 to 2012. The risk factors for SSI after THA included the National Nosocomial Infections Surveillance risk index, trauma, reoperation, and age (60-69 years). The SSI rate for TKA was 1.90% (152/7648), which also decreased significantly during a period of five years. However, the risk-adjusted analysis of SSI did not show a significant decrease for all surgical procedures. The SSI incidence of gastrectomy and prosthetic joint replacement declined over five years as a result of active surveillance by KONIS. Copyright © 2016 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  4. 21 CFR 870.3945 - Prosthetic heart valve sizer.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Prosthetic heart valve sizer. 870.3945 Section 870...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3945 Prosthetic heart valve sizer. (a) Identification. A prosthetic heart valve sizer is a device used to measure the size of the...

  5. 21 CFR 870.3945 - Prosthetic heart valve sizer.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Prosthetic heart valve sizer. 870.3945 Section 870...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3945 Prosthetic heart valve sizer. (a) Identification. A prosthetic heart valve sizer is a device used to measure the size of the...

  6. 21 CFR 870.3945 - Prosthetic heart valve sizer.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Prosthetic heart valve sizer. 870.3945 Section 870...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3945 Prosthetic heart valve sizer. (a) Identification. A prosthetic heart valve sizer is a device used to measure the size of the...

  7. 21 CFR 870.3945 - Prosthetic heart valve sizer.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Prosthetic heart valve sizer. 870.3945 Section 870...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3945 Prosthetic heart valve sizer. (a) Identification. A prosthetic heart valve sizer is a device used to measure the size of the...

  8. 21 CFR 870.3945 - Prosthetic heart valve sizer.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Prosthetic heart valve sizer. 870.3945 Section 870...) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3945 Prosthetic heart valve sizer. (a) Identification. A prosthetic heart valve sizer is a device used to measure the size of the...

  9. Prototype space erectable radiator system ground test article development

    NASA Technical Reports Server (NTRS)

    Alario, Joseph P.

    1988-01-01

    A prototype heat rejecting system is being developed by NASA-JSC for possible space station applications. This modular system, the Space-Erectable Radiator System Ground Test Article (SERS-GTA) with high-capacity radiator panels, can be installed and replaced on-orbit. The design, fabrication and testing of a representative ground test article are discussed. Acceptance test data for the heat pipe radiator panel and the whiffletree clamping mechanism have been presented.

  10. Neuronal ensemble control of prosthetic devices by a human with tetraplegia

    NASA Astrophysics Data System (ADS)

    Hochberg, Leigh R.; Serruya, Mijail D.; Friehs, Gerhard M.; Mukand, Jon A.; Saleh, Maryam; Caplan, Abraham H.; Branner, Almut; Chen, David; Penn, Richard D.; Donoghue, John P.

    2006-07-01

    Neuromotor prostheses (NMPs) aim to replace or restore lost motor functions in paralysed humans by routeing movement-related signals from the brain, around damaged parts of the nervous system, to external effectors. To translate preclinical results from intact animals to a clinically useful NMP, movement signals must persist in cortex after spinal cord injury and be engaged by movement intent when sensory inputs and limb movement are long absent. Furthermore, NMPs would require that intention-driven neuronal activity be converted into a control signal that enables useful tasks. Here we show initial results for a tetraplegic human (MN) using a pilot NMP. Neuronal ensemble activity recorded through a 96-microelectrode array implanted in primary motor cortex demonstrated that intended hand motion modulates cortical spiking patterns three years after spinal cord injury. Decoders were created, providing a `neural cursor' with which MN opened simulated e-mail and operated devices such as a television, even while conversing. Furthermore, MN used neural control to open and close a prosthetic hand, and perform rudimentary actions with a multi-jointed robotic arm. These early results suggest that NMPs based upon intracortical neuronal ensemble spiking activity could provide a valuable new neurotechnology to restore independence for humans with paralysis.

  11. Man in his 50s with chest pain and dyspnoea.

    PubMed

    Obayashi, Yuki; Izumi, Chisato; Nakagawa, Yoshihisa

    2018-05-01

    A man in his 50s with sudden-onset chest pain and dyspnoea was transferred to the emergency room. He had a history of aortic valve replacement due to aortic regurgitation with a mechanical valve 6 years previously. Heart rate was 90 bpm, and blood pressure was too low to measure. In the emergency room, he presented with severe dyspnoea and a chest X-ray showed severe lung congestion (figure 1A). ECG showed complete left bundle branch block. His respiratory status rapidly worsened, and he went into cardiopulmonary arrest. After cardiopulmonary resuscitation, transthoracic echocardiography was performed (figure 1B, online supplementary video 1).DC1SP110.1136/heartjnl-2017-312477.supp1Supplementary file 1 heartjnl;104/10/868/F1F1F1Figure 1(A) Chest X-ray. (B) Colour Doppler image from apical five-chamber view. What is the most likely cause of the patient's cardiopulmonary arrest?Myocardial infarction in left main trunkAortic dissectionProsthetic valve thrombosisProsthetic valve embolisationPulmonary embolism. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  12. Design Optimization and Development of Tubular Isogrid Composites Tubes for Lower Limb Prosthesis

    NASA Astrophysics Data System (ADS)

    Junqueira, Diego Morais; Gomes, Guilherme Ferreira; Silveira, Márcio Eduardo; Ancelotti, Antonio Carlos

    2018-04-01

    From the beginnings of humanity, natural or unnatural misfortunes such as illnesses, wars, automobile accidents cause loss of body limbs like teeth, arms, legs, etc. The solution found for the replacement of these missing limbs is in the use of prostheses. Lower limbs tubes or pylons are prosthetics components that are claimed to support loads during walking and other daily tasks activities. Commonly, prosthetic tubes are manufactured using metal materials such as stainless steel, aluminum and titanium. The mass of these tubes is generally high compared to tubes made of carbon fiber reinforced polymer matrix (CFRP) composite. Therefore, this work has the objective of design, manufacturing and analyzing the feasibility of a new tube concept, made of composite material, which makes use of lattice structure and inner layer. Until the present moment, lower limb prosthesis tubes using lattice structure and ineer layer have never been studied and/or tested to date. It can be stated that the tube of rigid ribs with inner layer and angle of 40° is more efficient than those of 26° and 30°. The proposed design allows a structural weight reduction in high performance prostheses from 120 g to 40 g.

  13. Transmutation of a heme protein.

    PubMed Central

    Barker, P D; Ferrer, J C; Mylrajan, M; Loehr, T M; Feng, R; Konishi, Y; Funk, W D; MacGillivray, R T; Mauk, A G

    1993-01-01

    Residue Asn57 of bovine liver cytochrome b5 has been replaced with a cysteine residue, and the resulting variant has been isolated from recombinant Escherichia coli as a mixture of four major species: A, BI, BII, and C. A combination of electronic spectroscopy, 1H NMR spectroscopy, resonance Raman spectroscopy, electrospray mass spectrometry, and direct electrochemistry has been used to characterize these four major cytochrome derivatives. The red form A (E(m) = -19 mV) is found to possess a heme group bound covalently through a thioether linkage involving Cys57 and the alpha carbon of the heme 4-vinyl group. Form BI has a covalently bound heme group coupled through a thioether linkage involving the beta carbon of the heme 4-vinyl group. Form BII is similar to BI except that the sulfur involved in the thioether linkage is oxidized to a sulfoxide. The green form C (E(m) = 175 mV) possesses a noncovalently bound prosthetic group with spectroscopic properties characteristic of a chlorin. A mechanism is proposed for the generation of these derivatives, and the implications of these observations for the biosynthesis of cytochrome c and naturally occurring chlorin prosthetic groups are discussed. PMID:8341666

  14. Dengue hemorrhagic fever and severe thrombocytopenia in a patient on mandatory anticoagulation: balancing two life threatening conditions: a case report.

    PubMed

    Gamakaranage, Champika; Rodrigo, Chaturaka; Samarawickrama, Sincy; Wijayaratne, Dilushi; Jayawardane, Malaka; Karunanayake, Panduka; Jayasinghe, Saroj

    2012-10-26

    Managing a severe dengue infection is a challenge specially when complicated by other comorbidities. We report a patient with dengue haemorrhagic fever and spontaneous bleeding who required mandatory anticoagulation for a prosthetic mitral valve replacement. This is the first case report in published literature describing this therapeutic dilemma. A fifty one year old Sri Lankan woman was diagnosed with dengue haemorrhagic fever with bleeding manifestations. During the critical phase of her illness, the platelet count dropped to 5,000/ɥl. She was also on warfarin 7 mg daily following a prosthetic mitral valve insertion. In managing the patient, the risk of bleeding had to be balanced against the risk of valve thrombosis without anticoagulation. Warfarin was withheld when the platelet count dropped to 100,000/ɥl and restarted when it recovered above 50,000/ɥl. The patient was off anticoagulation for 10 days. We managed this patient with close observation and continuous risk benefit assessments of management decisions. However, experience with one patient cannot be generalized to others. Therefore, it is essential that clinicians share their experiences in managing such difficult patients.

  15. A Prosthetic Foot Emulator to Optimize Prescription of Prosthetic Feet in Veterans and Service Members with Leg Amputations

    DTIC Science & Technology

    2017-09-01

    AWARD NUMBER: W81XWH-16-1-0569 TITLE: A Prosthetic Foot Emulator to Optimize Prescription of Prosthetic Feet in Veterans and Service Members...Headquarters Services , Directorate for Information Operations and Reports (0704-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202- 4302...GRANT NUMBER A Prosthetic Foot Emulator to Optimize Prescription of Prosthetic Feet in Veterans and Service Members with Leg Amputations 5c

  16. Prosthesis use in adult acquired major upper-limb amputees: patterns of wear, prosthetic skills and the actual use of prostheses in activities of daily life.

    PubMed

    Østlie, Kristin; Lesjø, Ingrid Marie; Franklin, Rosemary Joy; Garfelt, Beate; Skjeldal, Ola Hunsbeth; Magnus, Per

    2012-11-01

    To describe patterns of prosthesis wear and perceived prosthetic usefulness in adult acquired upper-limb amputees (ULAs). To describe prosthetic skills in activities of daily life (ADL) and the actual use of prostheses in the performance of ADL tasks. To estimate the influence of prosthetic skills on actual prosthesis use and the influence of background factors on prosthetic skills and actual prosthesis use. Cross-sectional study analysing population-based questionnaire data (n = 224) and data from interviews and clinical testing in a referred/convenience sample of prosthesis-wearing ULAs (n = 50). Effects were analysed using linear regression. 80.8% wore prostheses. 90.3% reported their most worn prosthesis as useful. Prosthetic usefulness profiles varied with prosthetic type. Despite demonstrating good prosthetic skills, the amputees reported actual prosthesis use in only about half of the ADL tasks performed in everyday life. In unilateral amputees, increased actual use was associated with sufficient prosthetic training and with the use of myoelectric vs cosmetic prostheses, regardless of amputation level. Prosthetic skills did not affect actual prosthesis use. No background factors showed significant effect on prosthetic skills. Most major ULAs wear prostheses. Individualised prosthetic training and fitting of myoelectric rather than passive prostheses may increase actual prosthesis use in ADL.

  17. Rothia mucilaginosa Prosthetic Device Infections: a Case of Prosthetic Valve Endocarditis

    PubMed Central

    Tokarczyk, Mindy J.; Jungkind, Donald; DeSimone, Joseph A.

    2013-01-01

    Rothia mucilaginosa is increasingly recognized as an emerging opportunistic pathogen associated with prosthetic device infections. Infective endocarditis is one of the most common clinical presentations. We report a case of R. mucilaginosa prosthetic valve endocarditis and review the literature of prosthetic device infections caused by this organism. PMID:23467598

  18. Clinical Presentation, Risk Factors, and Outcomes of Hematogenous Prosthetic Joint Infection in Patients with Staphylococcus aureus Bacteremia.

    PubMed

    Tande, Aaron J; Palraj, Bharath Raj; Osmon, Douglas R; Berbari, Elie F; Baddour, Larry M; Lohse, Christine M; Steckelberg, James M; Wilson, Walter R; Sohail, M Rizwan

    2016-02-01

    Staphylococcus aureus bacteremia is a life-threatening condition that may lead to metastatic infection, including prosthetic joint infection. To assess clinical factors associated with hematogenous prosthetic joint infection, we retrospectively reviewed all patients with a joint arthroplasty in place at the time of a first episode of S. aureus bacteremia over a 5-year period at our institution. Patients with postsurgical prosthetic joint infection without hematogenous prosthetic joint infection were excluded. There were 85 patients (143 arthroplasties) with either no prosthetic joint infection (n = 50; 58.8%) or hematogenous prosthetic joint infection in at least one arthroplasty (n = 35; 41.2%). The odds of hematogenous prosthetic joint infection was significantly increased among patients with community-acquired S. aureus bacteremia (odds ratio [OR] 18.07; 95% confidence interval [CI] 2.64-infinity; P = .001), as compared with nosocomial S. aureus bacteremia, in which there were no patients with hematogenous prosthetic joint infection. After adjusting for S. aureus bacteremia classification, the presence of ≥3 joint arthroplasties in place was associated with a nearly ninefold increased odds of hematogenous prosthetic joint infection as compared with those with 1-2 joint arthroplasties in place (OR 8.55; 95% CI 1.44-95.71; P = .012). All but one joint with prosthetic joint infection demonstrated at least one clinical feature suggestive of infection. There were 4 additional S. aureus prosthetic joint infections diagnosed during a median of 3.4 years of follow-up post hospitalization for S. aureus bacteremia. Prosthetic joint infection is frequent in patients with existing arthroplasties and concomitant S. aureus bacteremia, particularly with community-acquired S. aureus bacteremia and multiple prostheses. In contrast, occult S. aureus prosthetic joint infection without clinical features suggestive of prosthetic joint infection at the time of S. aureus bacteremia is rare. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. iBodies: Modular Synthetic Antibody Mimetics Based on Hydrophilic Polymers Decorated with Functional Moieties.

    PubMed

    Šácha, Pavel; Knedlík, Tomáš; Schimer, Jiří; Tykvart, Jan; Parolek, Jan; Navrátil, Václav; Dvořáková, Petra; Sedlák, František; Ulbrich, Karel; Strohalm, Jiří; Majer, Pavel; Šubr, Vladimír; Konvalinka, Jan

    2016-02-12

    Antibodies are indispensable tools for biomedicine and anticancer therapy. Nevertheless, their use is compromised by high production costs, limited stability, and difficulty of chemical modification. The design and preparation of synthetic polymer conjugates capable of replacing antibodies in biomedical applications such as ELISA, flow cytometry, immunocytochemistry, and immunoprecipitation is reported. The conjugates, named "iBodies", consist of an HPMA copolymer decorated with low-molecular-weight compounds that function as targeting ligands, affinity anchors, and imaging probes. We prepared specific conjugates targeting several proteins with known ligands and used these iBodies for enzyme inhibition, protein isolation, immobilization, quantification, and live-cell imaging. Our data indicate that this highly modular and versatile polymer system can be used to produce inexpensive and stable antibody substitutes directed toward virtually any protein of interest with a known ligand. © 2016 The Authors. Published by Wiley-VCH Verlag GmbH & Co. KGaA.

  20. iBodies: Modular Synthetic Antibody Mimetics Based on Hydrophilic Polymers Decorated with Functional Moieties

    PubMed Central

    Šácha, Pavel; Knedlík, Tomáš; Schimer, Jiří; Tykvart, Jan; Parolek, Jan; Navrátil, Václav; Dvořáková, Petra; Sedlák, František; Ulbrich, Karel; Strohalm, Jiří; Majer, Pavel

    2016-01-01

    Abstract Antibodies are indispensable tools for biomedicine and anticancer therapy. Nevertheless, their use is compromised by high production costs, limited stability, and difficulty of chemical modification. The design and preparation of synthetic polymer conjugates capable of replacing antibodies in biomedical applications such as ELISA, flow cytometry, immunocytochemistry, and immunoprecipitation is reported. The conjugates, named “iBodies”, consist of an HPMA copolymer decorated with low‐molecular‐weight compounds that function as targeting ligands, affinity anchors, and imaging probes. We prepared specific conjugates targeting several proteins with known ligands and used these iBodies for enzyme inhibition, protein isolation, immobilization, quantification, and live‐cell imaging. Our data indicate that this highly modular and versatile polymer system can be used to produce inexpensive and stable antibody substitutes directed toward virtually any protein of interest with a known ligand. PMID:26749427

  1. Positron emission particle tracking using a modular positron camera

    NASA Astrophysics Data System (ADS)

    Parker, D. J.; Leadbeater, T. W.; Fan, X.; Hausard, M. N.; Ingram, A.; Yang, Z.

    2009-06-01

    The technique of positron emission particle tracking (PEPT), developed at Birmingham in the early 1990s, enables a radioactively labelled tracer particle to be accurately tracked as it moves between the detectors of a "positron camera". In 1999 the original Birmingham positron camera, which consisted of a pair of MWPCs, was replaced by a system comprising two NaI(Tl) gamma camera heads operating in coincidence. This system has been successfully used for PEPT studies of a wide range of granular and fluid flow processes. More recently a modular positron camera has been developed using a number of the bismuth germanate (BGO) block detectors from standard PET scanners (CTI ECAT 930 and 950 series). This camera has flexible geometry, is transportable, and is capable of delivering high data rates. This paper presents simple models of its performance, and initial experience of its use in a range of geometries and applications.

  2. Flat-panel video resolution LED display system

    NASA Astrophysics Data System (ADS)

    Wareberg, P. G.; Kennedy, D. I.

    The system consists of a 128 x 128 element X-Y addressable LED array fabricated from green-emitting gallium phosphide. The LED array is interfaced with a 128 x 128 matrix TV camera. Associated electronics provides for seven levels of grey scale above zero with a grey scale ratio of square root of 2. Picture elements are on 0.008 inch centers resulting in a resolution of 125 lines-per-inch and a display area of approximately 1 sq. in. The LED array concept lends itself to modular construction, permitting assembly of a flat panel screen of any desired size from 1 x 1 inch building blocks without loss of resolution. A wide range of prospective aerospace applications exist extending from helmet-mounted systems involving small dedicated arrays to multimode cockpit displays constructed as modular screens. High-resolution LED arrays are already used as CRT replacements in military film-marking reconnaissance applications.

  3. Thermal performance of a modularized replaceable multilayer insulation system for a cryogenic stage

    NASA Technical Reports Server (NTRS)

    Knoll, R. H.

    1977-01-01

    A rugged modularized MLI system for a 2.23-meter-diameter (87.6-in.-diam) liquid hydrogen tank was designed, fabricated, and tested under simulated near-earth and deep-space environments. The two blankets of the system were each composed of 17 double-aluminized Mylar radiation shields separated by silk net. The unit area weight of the installed system was 1.54 kg/sqm (0.32 lb/sq ft). The overall average heat transferred into the insulated tank was 22.7 and 0.98 watts (77.4 and 3.3 Btu/hr) during simulated near-earth and deep-space testing, respectively. The near-earth result was only 2.6 times that predicted for an undisturbed insulation system (i.e., no seams or penetrations). Tests indicate that this insulation concept could be useful for a cryogenic space tug or orbit transfer vehicle application.

  4. LST and instrument considerations. [modular design

    NASA Technical Reports Server (NTRS)

    Levin, G. M.

    1974-01-01

    In order that the LST meet its scientific objectives and also be a National Astronomical Space Facility during the 1980's and 1990's, broad requirements have been levied by the scientific community. These scientific requirements can be directly translated into design requirements and specifications for the scientific instruments. The instrument ensemble design must be consistent with a 15-year operational lifetime. Downtime for major repair/refurbishment or instrument updating must be minimized. The overall efficiency and performance of the instruments should be maximized. Modularization of instruments and instrument subsystems, some degree of on-orbit servicing (both repair and replacement), on-axis location, minimizing the number of reflections within instruments, minimizing polarization effects, and simultaneous operation of the F/24 camera with other instruments, are just a few of the design guidelines and specifications which can and will be met in order that these broader scientific requirements be satisfied.-

  5. METAPHOR: Probability density estimation for machine learning based photometric redshifts

    NASA Astrophysics Data System (ADS)

    Amaro, V.; Cavuoti, S.; Brescia, M.; Vellucci, C.; Tortora, C.; Longo, G.

    2017-06-01

    We present METAPHOR (Machine-learning Estimation Tool for Accurate PHOtometric Redshifts), a method able to provide a reliable PDF for photometric galaxy redshifts estimated through empirical techniques. METAPHOR is a modular workflow, mainly based on the MLPQNA neural network as internal engine to derive photometric galaxy redshifts, but giving the possibility to easily replace MLPQNA with any other method to predict photo-z's and their PDF. We present here the results about a validation test of the workflow on the galaxies from SDSS-DR9, showing also the universality of the method by replacing MLPQNA with KNN and Random Forest models. The validation test include also a comparison with the PDF's derived from a traditional SED template fitting method (Le Phare).

  6. Applicability of STEM-RTG and High-Power SRG Power Systems to the Discovery and Scout Mission Capabilities Expansion (DSMCE) Study of ASRG-Based Missions

    NASA Technical Reports Server (NTRS)

    Colozza, Anthony J.; Cataldo, Robert L.

    2015-01-01

    This study looks at the applicability of utilizing the Segmented Thermoelectric Modular Radioisotope Thermoelectric Generator (STEM-RTG) or a high-power radioisotope generator to replace the Advanced Stirling Radioisotope Generator (ASRG), which had been identified as the baseline power system for a number of planetary exploration mission studies. Nine different Discovery-Class missions were examined to determine the applicability of either the STEM-RTG or the high-power SRG power systems in replacing the ASRG. The nine missions covered exploration across the solar system and included orbiting spacecraft, landers and rovers. Based on the evaluation a ranking of the applicability of each alternate power system to the proposed missions was made.

  7. Basic Science Considerations in Primary Total Hip Replacement Arthroplasty

    PubMed Central

    Mirza, Saqeb B; Dunlop, Douglas G; Panesar, Sukhmeet S; Naqvi, Syed G; Gangoo, Shafat; Salih, Saif

    2010-01-01

    Total Hip Replacement is one of the most common operations performed in the developed world today. An increasingly ageing population means that the numbers of people undergoing this operation is set to rise. There are a numerous number of prosthesis on the market and it is often difficult to choose between them. It is therefore necessary to have a good understanding of the basic scientific principles in Total Hip Replacement and the evidence base underpinning them. This paper reviews the relevant anatomical and biomechanical principles in THA. It goes on to elaborate on the structural properties of materials used in modern implants and looks at the evidence base for different types of fixation including cemented and uncemented components. Modern bearing surfaces are discussed in addition to the scientific basis of various surface engineering modifications in THA prostheses. The basic science considerations in component alignment and abductor tension are also discussed. A brief discussion on modular and custom designs of THR is also included. This article reviews basic science concepts and the rationale underpinning the use of the femoral and acetabular component in total hip replacement. PMID:20582240

  8. Flow in prosthetic heart valves: state-of-the-art and future directions.

    PubMed

    Yoganathan, Ajit P; Chandran, K B; Sotiropoulos, Fotis

    2005-12-01

    Since the first successful implantation of a prosthetic heart valve four decades ago, over 50 different designs have been developed including both mechanical and bioprosthetic valves. Today, the most widely implanted design is the mechanical bileaflet, with over 170,000 implants worldwide each year. Several different mechanical valves are currently available and many of them have good bulk forward flow hemodynamics, with lower transvalvular pressure drops, larger effective orifice areas, and fewer regions of forward flow stasis than their earlier-generation counterparts such as the ball-and-cage and tilting-disc valves. However, mechanical valve implants suffer from complications resulting from thrombus deposition and patients implanted with these valves need to be under long-term anti-coagulant therapy. In general, blood thinners are not needed with bioprosthetic implants, but tissue valves suffer from structural failure with, an average life-time of 10-12 years, before replacement is needed. Flow-induced stresses on the formed elements in blood have been implicated in thrombus initiation within the mechanical valve prostheses. Regions of stress concentration on the leaflets during the complex motion of the leaflets have been implicated with structural failure of the leaflets with bioprosthetic valves. In vivo and in vitro experimental studies have yielded valuable information on the relationship between hemodynamic stresses and the problems associated with the implants. More recently, Computational Fluid Dynamics (CFD) has emerged as a promising tool, which, alongside experimentation, can yield insights of unprecedented detail into the hemodynamics of prosthetic heart valves. For CFD to realize its full potential, however, it must rely on numerical techniques that can handle the enormous geometrical complexities of prosthetic devices with spatial and temporal resolution sufficiently high to accurately capture all hemodynamically relevant scales of motion. Such algorithms do not exist today and their development should be a major research priority. For CFD to further gain the confidence of valve designers and medical practitioners it must also undergo comprehensive validation with experimental data. Such validation requires the use of high-resolution flow measuring tools and techniques and the integration of experimental studies with CFD modeling.

  9. Patient satisfaction and prosthetic aspects with mini-implants retained mandibular overdentures. A 5-year prospective study.

    PubMed

    Elsyad, Moustafa Abdou

    2016-07-01

    This study aimed to evaluate patient satisfaction and prosthetic aspects during a 5-year prospective clinical study of mini dental implants (MDIs) retaining mandibular overdentures. This observational prospective clinical study was conducted on a group of completely edentulous patients (n = 28) with retention problems of conventional mandibular dentures. All patients received new maxillary and mandibular conventional dentures. A total of 112 MDIs (four per patient) were inserted using the flapless surgical approach and immediately loaded by the new mandibular dentures (overdentures). Patients indicated satisfaction with their prosthesis using a questionnaire and a visual analogue scale (VAS). Patient satisfaction and prosthetic complications were recorded 6 months (T6 m ), 1 (T1), 3 (T3), and 5 (T5) years after overdenture insertion. The patient satisfaction with eating (hard/soft) food (P < 0.001), talking (P < 0.001), appearance (P = 0.001), comfort (P < 0.001), healing process (P = 0.013), socialization (P < 0.001), stability/retention of mandibular dentures (P = 0.001), ease of oral hygiene (P = 0.008), and ease of handling the dentures (P < 0.001) increased significantly with time. After 5 years, the most common complication was wear/damage of O/rings (n = 235), O/ring replacement (n = 125), maxillary denture relining times (n = 13), worn teeth (n = 10), overdentures relines (n = 10), detachment of the metal housings (n = 9), and fracture of mandibular overdentures (n = 8). Mucositis, soreness, and decubitis ulcer under overdenture occurred most often at T6 m and decreased significantly with time (P = 0.002, 0.005, and 0.024, respectively). Within the limitations of this clinical study, patient satisfaction with mini-implant retained mandibular overdentures increased significantly with time. However, this treatment required a considerable amount of prosthetic maintenance and repair after 5 years of service. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  10. Tibial rotation kinematics subsequent to knee arthroplasty

    PubMed Central

    Collins, Duane J.; Khatib, Yasser H.; Parker, David A.; Jenkin, Deanne E.; Molnar, Robert B.

    2015-01-01

    Background The use of computer assisted joint replacement has facilitated precise intraoperative measurement of knee kinematics. The changes in “screw home mechanism” (SHM) resulting from Total Knee Arthroplasty (TKA) with different prostheses and constraints has not yet been accurately described. Methods A pilot study was first completed. Intraoperative kinematic data was collected two groups of 15 patients receiving different prostheses. Results On average, patients lost 5.3° of ER (SD = 6.1°). There was no significant difference between the prostheses or different prosthetic constraints. Conclusions There significant loss of SHM after TKA. Further research is required to understand its impact on patient function. PMID:25829754

  11. Alternatives to amputation.

    PubMed Central

    Lendrum, J.

    1980-01-01

    Alternatives to conventional skin flap cover for limb wounds extend both the number and type of defects which can now be closed with reconstruction of both form and function for patients who might otherwise come to amputation. The old adage that where a sinus leads to dead or foreign material it can only be closed after removal of that dead or foreign material is no longer true. The number of patients coming to above-knee amputation after prosthetic replacement of the knee joint could be reduced by muscle flap cover of exposed arthroplasty prostheses. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6 PMID:7377695

  12. Use of multidetector-row computed tomography scan to detect pannus formation in prosthetic mechanical aortic valves

    PubMed Central

    Aladmawi, Mohamed A.; Vriz, Olga; Galzerano, Domenico

    2017-01-01

    Obstruction of a mechanical aortic valve by pannus formation at the subvalvular level is a major long-term complication of aortic valve replacement (AVR). In fact, pannus is sometime difficult to differentiate from patient-prosthesis mismatch or valve thrombosis. In most cases cine-angiography and echocardiography, either transthoracic or transesophageal, cannot correctly visualize the complication when the leaflets show a normal mobility. Recent technological refinements made this difficult diagnosis possible by ECG-gated computed tomography (CT) scan which shows adequate images in 90% of the cases and can differentiate pannus from fresh and organized thrombus. PMID:28540078

  13. Subvalvular pannus and thrombosis in a mitral valve prosthesis.

    PubMed

    Kim, Gun Ha; Yang, Dong Hyun; Kang, Joon-Won; Kim, Dae-Hee; Jung, Sung-Ho; Lim, Tae-Hwan

    2016-01-01

    A 69-year-old female underwent cardiac CT to evaluate prosthetic valve (PHV) dysfunction detected on echocardiography. A CT coronal and en face views of the mitral annular plane showed a low-density, mass-like lesion on the left atrial side of the PHV and a high-density, plate-like lesion on the left ventricular side of PHV. A repeat of the mitral valve replacement was performed, and preoperative CT findings of both the thrombus on the left atrial side and pannus formation on the LV side were confirmed in the operative findings. Copyright © 2016 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.

  14. Clinical outcomes of Kyocera Modular Limb Salvage system after resection of bone sarcoma of the distal part of the femur: the Japanese Musculoskeletal Oncology Group study.

    PubMed

    Nakamura, Tomoki; Matsumine, Akihiko; Uchida, Atsumasa; Kawai, Akira; Nishida, Yoshihiro; Kunisada, Toshiyuki; Araki, Nobuhito; Sugiura, Hideshi; Tomita, Masato; Yokouchi, Masahiro; Ueda, Takafumi; Sudo, Akihiro

    2014-04-01

    The Japanese Musculoskeletal Oncology Group have developed an original prosthesis called the Kyocera Modular Limb Salvage system (KMLS system). This prosthesis has a semi-rotating hinge joint and is particularly designed for people with an Asian body type. The metallic parts of the prosthesis are made entirely of titanium alloy. The purpose of this study is to evaluate the clinical outcomes of treatment using this system following tumour resection of primary bone sarcoma of the distal femur. Between 2002 and 2010, 82 patients with primary bone sarcomas of the distal femur were treated. Seventeen patients underwent stem cementation, while 65 patients were treated with cementless prostheses. The mean follow-up period after surgery was 61 months. Complications were observed in 28 of the 82 patients. Forty-one complications occurred in these 28 patients. Thirteen prostheses (16%) required revision surgery due to complications, including five cases of stem breakage, three deep infections, three cases of aseptic loosening, one case of displacement of the shaft cap and one case of breakage of the tibial tray. The five-year overall prosthetic survival rate was 80.0%. Four of the 82 patients underwent subsequent amputation due to local recurrence. The five-year limb salvage rate was 94.5%. The mean function score according to the scoring system of the Musculoskeletal Tumour Society was 21.8 points (72.5%). Although further follow-up is required to determine the performance, this prosthesis is considered to be satisfactory for reconstruction of the distal femur after resection of bone sarcoma.

  15. In vitro investigation of a novel elastic vascular prosthesis for valve-sparing aortic root and ascending aorta replacement.

    PubMed

    Scharfschwerdt, Michael; Leonhard, Moritz; Lehmann, Judith; Richardt, Doreen; Goldmann, Helmut; Sievers, Hans-Hinrich

    2016-05-01

    Prosthetic replacement of the thoracic aorta with common Dacron prostheses impairs the aortic 'windkessel' and, in valve-sparing procedures, also aortic valve function. Elastic graft material may overcome these deficiencies. Fresh porcine aortas including the root were set up in a mock circulation before and after replacement of the ascending part with a novel vascular prosthesis providing elastic behaviours. In a first series (n = 14), haemodynamics and leaflet motions of the aortic valve were investigated and also cyclic changes of aortic dimensions at different levels of the root. In a second series (n = 7), intravascular pressure and dimensions of the proximal descending aorta were measured and the corresponding wall tension was calculated. Haemodynamics of the aortic valve remain comparable after replacement. Though the novel prosthesis does not feature such high distensibility as the native aorta, the dynamic of the root was significantly increased compared with common Dacron prostheses at the commissural level, preserving 'windkessel' function. Thus, wall tension of the residual aorta remained unchanged; nevertheless, maximum pressure-time differential dp/dt increased by 13%. The use of the novel elastic prosthesis for replacement of the ascending aorta seems to be beneficial, especially with regard to the preservation of the aortic windkessel. Further studies will be needed to clarify long-term utilization of the material in vivo. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  16. Macro-retentive replaceable veneers on crowns and fixed dental prostheses: a new approach in implant-prosthodontics.

    PubMed

    Schweiger, Josef; Neumeier, Peter; Stimmelmayr, Michael; Beuer, Florian; Edelhoff, Daniel

    2013-04-01

    Implant-supported prosthetic restorations with veneered crowns and fixed dental prostheses are a proven, scientifically accepted treatment concept in fixed prosthodontics. However, in this area of indication there is a comparatively high technical complication rate, which occurs mainly in the area of the superstructure in the form of minor or major chipping of the veneering material. Various studies have shown that purely implant-supported restorations are subjected to higher loading than those on natural abutment teeth due to the special biomechanical conditions. A possible approach to prevent technical complications is to create higher stability for the implant superstructure through the use of high-strength materials. This would, however, result in undiminished overloading being transmitted to the implant components and could cause increased technical and biological complications. This article describes a new procedure for the use of replaceable veneers made from high-performance polymer material on modified implant abutments. By storing digital datasets for the veneer section, it can be replaced easily and quickly if it becomes worn or is fractured. A reduction in the stresses for the implant components and biological structures under the polymer is also to be expected due the material properties of polymers.

  17. [Experience of Mitral Valve Replacement Using a Pulmonary Autograft (Ross II Operation) in an Infant;Report of a Case].

    PubMed

    Kawahito, Tomohisa; Egawa, Yoshiyasu; Yoshida, Homare; Shimoe, Yasushi; Onishi, Tatsuya; Miyagi, Yuhichi; Terada, Kazuya; Ohta, Akira

    2015-07-01

    A 24-day-old boy suddenly developed progressive heart failure and was transported to our hospital. Echocardiography showed massive mitral regurgitation due to chordal rupture. Mitral valve repair was performed at 28 days of life, but postoperative valvular function was not satisfactory. A mechanical valve was implanted in the supra-annular position at 37 days of life. Two months after valve replacement, the mechanical valve was suddenly stuck. Emergent redo valve replacement was performed, but the prosthetic valve became stuck again 2 months after the 3rd operation, despite sufficient anti-coagulation therapy. At the 4th operation (6 months after birth), we implanted a pulmonary autograft in the mitral position instead of another mechanical valve in an emergent operation. The right ventricular outflow tract was reconstructed with a valved conduit. A postoperative catheter examination, which was performed 1 year after the Ross II operation, showed mild mitral stenosis with no regurgitation. Previous reports of Ross II operations in infants are rare and long-term results are unknown. However, we advocate that this procedure should be a rescue operation for mitral valve dysfunction in the early period of infants.

  18. Dynamic tracking of prosthetic valve motion and deformation from bi-plane x-ray views: feasibility study

    NASA Astrophysics Data System (ADS)

    Hatt, Charles R.; Wagner, Martin; Raval, Amish N.; Speidel, Michael A.

    2016-03-01

    Transcatheter aortic valve replacement (TAVR) requires navigation and deployment of a prosthetic valve within the aortic annulus under fluoroscopic guidance. To support improved device visualization in this procedure, this study investigates the feasibility of frame-by-frame 3D reconstruction of a moving and expanding prosthetic valve structure from simultaneous bi-plane x-ray views. In the proposed method, a dynamic 3D model of the valve is used in a 2D/3D registration framework to obtain a reconstruction of the valve. For each frame, valve model parameters describing position, orientation, expansion state, and deformation are iteratively adjusted until forward projections of the model match both bi-plane views. Simulated bi-plane imaging of a valve at different signal-difference-to-noise ratio (SDNR) levels was performed to test the approach. 20 image sequences with 50 frames of valve deployment were simulated at each SDNR. The simulation achieved a target registration error (TRE) of the estimated valve model of 0.93 +/- 2.6 mm (mean +/- S.D.) for the lowest SDNR of 2. For higher SDNRs (5 to 50) a TRE of 0.04 mm +/- 0.23 mm was achieved. A tabletop phantom study was then conducted using a TAVR valve. The dynamic 3D model was constructed from high resolution CT scans and a simple expansion model. TRE was 1.22 +/- 0.35 mm for expansion states varying from undeployed to fully deployed, and for moderate amounts of inter-frame motion. Results indicate that it is feasible to use bi-plane imaging to recover the 3D structure of deformable catheter devices.

  19. Dynamic tracking of prosthetic valve motion and deformation from bi-plane x-ray views: feasibility study.

    PubMed

    Hatt, Charles R; Wagner, Martin; Raval, Amish N; Speidel, Michael A

    2016-01-01

    Transcatheter aortic valve replacement (TAVR) requires navigation and deployment of a prosthetic valve within the aortic annulus under fluoroscopic guidance. To support improved device visualization in this procedure, this study investigates the feasibility of frame-by-frame 3D reconstruction of a moving and expanding prosthetic valve structure from simultaneous bi-plane x-ray views. In the proposed method, a dynamic 3D model of the valve is used in a 2D/3D registration framework to obtain a reconstruction of the valve. For each frame, valve model parameters describing position, orientation, expansion state, and deformation are iteratively adjusted until forward projections of the model match both bi-plane views. Simulated bi-plane imaging of a valve at different signal-difference-to-noise ratio (SDNR) levels was performed to test the approach. 20 image sequences with 50 frames of valve deployment were simulated at each SDNR. The simulation achieved a target registration error (TRE) of the estimated valve model of 0.93 ± 2.6 mm (mean ± S.D.) for the lowest SDNR of 2. For higher SDNRs (5 to 50) a TRE of 0.04 mm ± 0.23 mm was achieved. A tabletop phantom study was then conducted using a TAVR valve. The dynamic 3D model was constructed from high resolution CT scans and a simple expansion model. TRE was 1.22 ± 0.35 mm for expansion states varying from undeployed to fully deployed, and for moderate amounts of inter-frame motion. Results indicate that it is feasible to use bi-plane imaging to recover the 3D structure of deformable catheter devices.

  20. Influence of surgical and prosthetic techniques on marginal bone loss around titanium implants. Part I: immediate loading in fresh extraction sockets.

    PubMed

    Berberi, Antoine N; Tehini, Georges E; Noujeim, Ziad F; Khairallah, Alexandre A; Abousehlib, Moustafa N; Salameh, Ziad A

    2014-10-01

    Delayed placement of implant abutments has been associated with peri-implant marginal bone loss; however, long-term results obtained by modifying surgical and prosthetic techniques after implant placement are still lacking. This study aimed to evaluate the marginal bone loss around titanium implants placed in fresh extraction sockets using two loading protocols after a 5-year follow-up period. A total of 36 patients received 40 titanium implants (Astra Tech) intended for single-tooth replacement. Implants were immediately placed into fresh extraction sockets using either a one-stage (immediate loading by placing an interim prosthesis into functional occlusion) or a two-stage prosthetic loading protocol (insertion of abutments after 8 weeks of healing time). Marginal bone levels relative to the implant reference point were evaluated at four time intervals using intraoral radiographs: at time of implant placement, and 1, 3, and 5 years after implant placement. Measurements were obtained from mesial and distal surfaces of each implant (α = 0.05). One-stage immediate implant placement into fresh extraction sockets resulted in a significant reduction in marginal bone loss (p < 0.002) compared to the traditional two-stage technique. Whereas mesial surfaces remained stable for the 5-year observation period, significant marginal bone loss was observed on distal surfaces of implants after cementation of interim prostheses (p < 0.007) and after 12 months (p < 0.034). Within the limitations of this study, immediate loading of implants placed into fresh extraction sockets reduced marginal bone loss and did not compromise the success rate of the restorations. © 2014 by the American College of Prosthodontists.

  1. Prosthetic complications in fixed endosseous implant-borne reconstructions after an observations period of at least 40 months.

    PubMed

    De Boever, A L; Keersmaekers, K; Vanmaele, G; Kerschbaum, T; Theuniers, G; De Boever, J A

    2006-11-01

    One hundred and seventy-two fixed reconstructions (317 prosthetic units), made on 283 ITI implants in 105 patients (age range 25-86 years) with a minimum follow-up period of 40 months, were taken into the study to analyse technical complication rate, complication type and costs for repair. The mean evaluation time was 62.5 +/- 25.3 months. Eighty were single crowns and 92 different types of fixed partial dentures (FPDs). In 45 cases the construction was screw retained and in 127 cases cemented with zinc phosphate cement or an acrylic-based cement. Complications occurred after a minimum period of 2 months and a maximum period of 100 months (mean: 35.9 +/- 21.4 months). Fifty-five prosthetic interventions were needed on 44 constructions (25%) of which 88% in the molar/premolar region. The lowest percentage of complications occurred in single crowns (25%), the highest in 3-4 unit FPDs (35%) and in FPDs with an extension (44%). Of the necessary clinical repair, 36% was recementing and 38% tightening the screws. Of all interventions, 14% were classified as minor (no treatment or <10 min chair time), 70% as moderate (>10 min but <60 min chair time) and 14% as major interventions (>60 min and additional costs for replacement of parts and/or laboratory). For seven patients the additional costs ranged from euro 28 to euro 840. Bruxing seemed to play a significant role in the frequency of complications. Longer constructions seemed to be more prone to complications. The relatively high occurrence of technical complications should be discussed with the patient before the start of the treatment.

  2. Current antibiotic management of prosthetic joint infections in Italy: the 'Udine strategy'.

    PubMed

    Bassetti, Matteo; Cadeo, Barbara; Villa, Giovanni; Sartor, Assunta; Cainero, Vanni; Causero, Araldo

    2014-09-01

    The rate of prosthetic joint infections followed and cured at our institution is constantly increasing, in line with epidemiological data from the recent literature. This is probably related to the greater number of knee and hip prostheses implanted every year. For intermediate and late infections, only the two-stage approach is applied, as this demonstrates the best outcome in our experience. Particular attention is paid to microbiological isolation of the pathogen: multiple samples of tissue are collected during the interventions, and kept in culture for a longer period of time than usual. Sonication of prosthetic devices is used to enhance the sensitivity and specificity of the microbiological cultures. Histological examination influences surgical choices either towards implantation of a new prosthesis or replacement of the spacer. An empirical antibiotic backbone of a glycopeptide/lipopeptide and rifampicin is chosen, due to the leading role of Gram-positive bacteria in this setting and the high incidence of methicillin resistance in our centre (>30%), followed by an antibiotic regimen containing linezolid. If specific risk factors are present, an anti-Gram-negative drug is added to the regimen. Duration of therapy depends upon the approach that is chosen, usually being 6 weeks when the prosthesis is removed. Despite at the moment being limited by its small sample size, data from our experience confirms that our empirical approach may represent a valid choice during the early phase of treatment, by keeping linezolid for a step-down therapy of shorter duration (4 weeks). © The Author 2014. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  3. DOE Office of Scientific and Technical Information (OSTI.GOV)

    Fetterly, K; Mathew, V

    Purpose: Transcatheter aortic valve replacement (TAVR) procedures provide a method to implant a prosthetic aortic valve via a minimallyinvasive, catheter-based procedure. TAVR procedures require use of interventional fluoroscopy c-arm projection angles which are aligned with the aortic valve plane to minimize prosthetic valve positioning error due to x-ray imaging parallax. The purpose of this work is to calculate the continuous range of interventional fluoroscopy c-arm projection angles which are aligned with the aortic valve plane from a single planar image of a valvuloplasty balloon inflated across the aortic valve. Methods: Computational methods to measure the 3D angular orientation of themore » aortic valve were developed. Required inputs include a planar x-ray image of a known valvuloplasty balloon inflated across the aortic valve and specifications of x-ray imaging geometry from the DICOM header of the image. A-priori knowledge of the species-specific typical range of aortic orientation is required to specify the sign of the angle of the long axis of the balloon with respect to the x-ray beam. The methods were validated ex-vivo and in a live pig. Results: Ex-vivo experiments demonstrated that the angular orientation of a stationary inflated valvuloplasty balloon can be measured with precision less than 1 degree. In-vivo pig experiments demonstrated that cardiac motion contributed to measurement variability, with precision less than 3 degrees. Error in specification of x-ray geometry directly influences measurement accuracy. Conclusion: This work demonstrates that the 3D angular orientation of the aortic valve can be calculated precisely from a planar image of a valvuloplasty balloon inflated across the aortic valve and known x-ray geometry. This method could be used to determine appropriate c-arm angular projections during TAVR procedures to minimize x-ray imaging parallax and thereby minimize prosthetic valve positioning errors.« less

  4. Diagnosis Of Persistent Infection In Prosthetic Two-Stage Exchange: PCR analysis of Sonication fluid From Bone Cement Spacers.

    PubMed

    Mariaux, Sandrine; Tafin, Ulrika Furustrand; Borens, Olivier

    2017-01-01

    Introduction: When treating periprosthetic joint infections with a two-stage procedure, antibiotic-impregnated spacers are used in the interval between removal of prosthesis and reimplantation. According to our experience, cultures of sonicated spacers are most often negative. The objective of our study was to investigate whether PCR analysis would improve the detection of bacteria in the spacer sonication fluid. Methods: A prospective monocentric study was performed from September 2014 to January 2016. Inclusion criteria were two-stage procedure for prosthetic infection and agreement of the patient to participate in the study. Beside tissues samples and sonication, broad range bacterial PCRs, specific S. aureus PCRs and Unyvero-multiplex PCRs were performed on the sonicated spacer fluid. Results: 30 patients were identified (15 hip, 14 knee and 1 ankle replacements). At reimplantation, cultures of tissue samples and spacer sonication fluid were all negative. Broad range PCRs were all negative. Specific S. aureus PCRs were positive in 5 cases. We had two persistent infections and four cases of infection recurrence were observed, with bacteria different than for the initial infection in three cases. Conclusion: The three different types of PCRs did not detect any bacteria in spacer sonication fluid that was culture-negative. In our study, PCR did not improve the bacterial detection and did not help to predict whether the patient will present a persistent or recurrent infection. Prosthetic 2-stage exchange with short interval and antibiotic-impregnated spacer is an efficient treatment to eradicate infection as both culture- and molecular-based methods were unable to detect bacteria in spacer sonication fluid after reimplantation.

  5. The Ligand Trans Influence Governs Conformation in Cobalamin-Dependent Methionine Synthase†

    PubMed Central

    Fleischhacker, Angela S.; Matthews, Rowena G.

    2008-01-01

    Cobalamin-dependent methionine synthase (MetH) of Escherichia coli is a large, modular enzyme that uses a cobalamin prosthetic group as a donor or acceptor in three separate methyl transfer reactions. The prosthetic group alternates between methylcobalamin and cob(I)alamin during catalysis as homocysteine is converted to methionine using a methyl group derived from methyltetrahydrofolate. Occasional oxidation of cob(I)alamin to cob(II)alamin inactivates the enzyme. Reductive methylation with flavodoxin and adenosylmethionine returns the enzyme to an active methylcobalamin state. At different points during the reaction cycle, the coordination of the cobalt of the cobalamin changes. The imidazole side chain of His759 coordinates to cobalamin in a “His-on” state and dissociates to produce a “His-off” state. The His-off state has been associated with a conformation of MetH that is poised for reactivation of cobalamin by reductive methylation rather than catalysis. Our studies on cob(III)alamins bound to MetH, specifically aqua-, methyl-, and n-propylcobalamin, show a correlation between the accessibility of the reactivation conformation and the order of the established ligand trans influence. The trans influence also controls the affinity of MetH in the cob(III)alamin form for flavodoxin. Flavodoxin, which acts to shift the conformational equilibrium towards the reactivation conformation, binds less tightly to MetH when the cob(III)alamin has a strong trans ligand and therefore has less positive charge on cobalt. These results are compared to those for cob(II)alamin MetH, illustrating that access to the reactivation conformation is governed by the net charge on the cobalt as well as the trans influence in cob(III)alamins. PMID:17924667

  6. [Pathological fractures of the femoral neck in hemodialyzed patients. Apropos of 26 cases].

    PubMed

    Hardy, P; Benoit, J; Donneaud, B; Jehanno, P; Lortat-Jacob, A

    1994-01-01

    This study is based on a retrospective analysis of 26 pathological fractures of the femoral neck in 19 chronic haemodialysis patients. The purpose of this study is to analyze the epidemiological and etiological factors of these fractures in relation to osteo-arthropathy of the dialyzed patient, as well as the results of various treatments, both curative and preventive. 26 pathological fractures of the femoral neck appeared in 19 chronic haemodialysis patients, 11 men and 8 women, 6 patients presented bilateral fractures. The patient's average age at the time of the fracture was 61 years (27 to 82). The average duration of dialysis was 11 years with a minimum of 2 years and a maximum of 21 years. Hyper parathyroidism was found in 14 patients, aluminic intoxication in 6 and amyloidosis at the level of the coxo-femoral joint 18 times. Surgical treatment consisted of 6 osteosynthesis, 2 cephalic arthroplasties, 13 modular arthroplasties and 5 total hip arthroplasties. For each case, we studied the presence of necrosis of the femoral neck due to aluminic intoxication, osteoporosis due to hyperparathyroidism and also the presence of amyloidosis without aluminic intoxication. Cortisonic necrosis and porosis was found 4 times out of 26 cases, hyperparathyroidism once, aluminic osteomalacy 3 times and beta-2-microglobulin amyloid 18 times. Amyloidosis remains the most frequent etiological factor. All patients had been operated for median nerve compression in the carpal tunnel, usually 2.5 years before appearance of the pathological fracture. Non surgical treatment was used 5 times in undisplaced fractures without any sign of amyloidosis and was successful 3 times and unsuccessful twice necessitating a new operation by osteosynthesis. Out of 6 osteosynthesis performed for fractures either with little or no displacement we observed 4 failures, all of them in the cases with intra-osseous amyloidosis. Best results were obtained by arthroplasties. Modular arthroplasty has given us 11 long term excellent results in 11 of 13 cases. The analysis of etiological factors shows two very different groups. The first one consisted of 8 fractures without coxofemoral amyloidosis. The average duration of dialysis was 5 years, average age, 44 years. Etiology was 3 times aluminic osteomalacy, once the only factor found was osteoporosis and 4 times necrosis and porosis as a complication, not of haemodialysis but of renal transplantation with concomittant corticosteroid treatment. The second group consisted of 18 fractures with hip amyloidosis in 14 patients. The average age was 63.5 years, the dialysis duration was 11.5 years, the two extremes 5 and 21 years. Etiology was beta-2-microglobulin amylosis. The pathological fracture was due to the presence of voluminous subchondral amyloidosis geodes. Amyloidosis always associated with hyperparathyroidism and aluminic intoxication in one of 3 cases. Osteosynthesis gave good results only in cases presenting no intra-osseous amyloidosis. Modular arthroplasty has allowed us to obtain excellent long term functional results with simpler outcome. Total arthroplasty should be used only for evident acetabular involvement. Amyloidosis remains the etiological factor most frequently found in pathological fractures of the femoral neck in chronic haemodialysis patients. The study of the etiological factors is essential since they will guide us in the choice of the mode or treatment. It is totally licit to propose conservative treatment for non displaced fractures without osseous amylosis. In all other cases, prosthetic replacement is necessary and osteosynthesis contra-indicated. When the acetabulum is not altered a modular arthroplasty must be used. We do not recommend preventive surgical treatment for patients having a threatening geode of the femoral neck as all osteosynthesis realized on amyloidotic bone, even without any displacement, resulted

  7. Cloud Top Scanning radiometer (CTS)

    NASA Technical Reports Server (NTRS)

    1978-01-01

    A scanning radiometer to be used for measuring cloud radiances in each of three spectral regions is described. Significant features incorporated in the Cloud Top Scanner design are: (1) flexibility and growth potential through use of easily replaceable modular detectors and filters; (2) full aperture, multilevel inflight calibration; (3) inherent channel registration through employment of a single shared field stop; and (4) radiometric sensitivity margin in a compact optical design through use of Honeywell developed (Hg,Cd)Te detectors and preamplifiers.

  8. Modularly assembled designer TAL effector nucleases for targeted gene knockout and gene replacement in eukaryotes

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Li, T; Huang, S; Zhao, XF

    Recent studies indicate that the DNA recognition domain of transcription activator-like (TAL) effectors can be combined with the nuclease domain of FokI restriction enzyme to produce TAL effector nucleases (TALENs) that, in pairs, bind adjacent DNA target sites and produce double-strand breaks between the target sequences, stimulating non-homologous end-joining and homologous recombination. Here, we exploit the four prevalent TAL repeats and their DNA recognition cipher to develop a 'modular assembly' method for rapid production of designer TALENs (dTALENs) that recognize unique DNA sequence up to 23 bases in any gene. We have used this approach to engineer 10 dTALENs tomore » target specific loci in native yeast chromosomal genes. All dTALENs produced high rates of site-specific gene disruptions and created strains with expected mutant phenotypes. Moreover, dTALENs stimulated high rates (up to 34%) of gene replacement by homologous recombination. Finally, dTALENs caused no detectable cytotoxicity and minimal levels of undesired genetic mutations in the treated yeast strains. These studies expand the realm of verified TALEN activity from cultured human cells to an intact eukaryotic organism and suggest that low-cost, highly dependable dTALENs can assume a significant role for gene modifications of value in human and animal health, agriculture and industry.« less

  9. Which primary total knee replacement? A review of currently available TKR in the United Kingdom.

    PubMed Central

    Liow, R. Y.; Murray, D. W.

    1997-01-01

    Comparative information on total knee replacements (TKRs) is not readily available. With the help of implant manufacturers and distributors, we have compiled a list of TKRs on the market in the UK and summarised the information about these implants in a table. There are 37 different TKRs, marketed by 14 companies; 54% have been introduced since 1990. The number of different implants is increasing. At least eight designs have undergone major modifications, while many have had minor alterations. Of the TKRs on the market, 60% are modular. Some 54% of TKRs have no published results in peer-reviewed journals; only one of the four most widely used prostheses has published survival figures. New and modified implants are introduced without clinical evidence of their superiority over other available designs. Published results in peer-reviewed journals are currently the best evidence available on the reliability of an implant. When selecting an implant, surgeons should be aware if the prosthesis has any such results, the length of the follow-up, and the survival rates that are achieved. More detailed interpretation is difficult because of the different combinations used in modular implants and because of the frequent modification of existing designs. Properly conducted long-term clinical trials should be encouraged as they are the only means of evaluating new designs. PMID:9326124

  10. Oral health-related quality of life after prosthetic rehabilitation: a longitudinal study with the OHIP questionnaire.

    PubMed

    Jenei, Ágnes; Sándor, János; Hegedűs, Csaba; Bágyi, Kinga; Nagy, László; Kiss, Csongor; Szabó, Gyula; Márton, Ildikó J

    2015-07-10

    Aspects of oral health related quality of life (OHRQoL) attracted an increased attention recently. The aim of the study was to assess self-reported oral health related quality of life (OHRQoL) among patients requiring prosthetic rehabilitation and to determine the rate of improvement 1 month and 6-12 months after therapy. In addition, effect of age, gender, oral health indicators and denture types before treatment were assessed on OHRQoL as evaluated and reported by the patients. Hungarian version of OHIP-49 (OHIP-49-H) questionnaire was completed before oral rehabilitation (T0-phase) by 389 patients undergoing prosthetic replacement. After 1 month (T1-phase) and 6-12 months (T2-phase) recall periods 235 and 92 patients completed the questionnaire. The median interquartile range (IQR) values of the total OHIP-49-H score were calculated for T0-, T1- and T2-phases. Reliability of the questionnaire was checked by Cronbach's statistics. Age, gender, oral health indicators and denture types of patients before and after treatment were recorded and treatment-associated changes in OHRQoL were evaluated. The study demonstrated the excellent reliability and internal consistency of OHIP-49-H by a high and narrow range of Cronbach's alpha value (0.81-0.93). A median OHIP-49-H score of 52; IQR = 25-83 demonstrated a poor OHRQoL on first admission. Decreasing median total OHIP-49-H scores 1 month (24; IQR = 9-51; p < 0.001) and 6-12 months (20; IQR = 7-37; p = 0,055) after therapy indicated an improvement of OHRQoL. Patients' age and CPI value assessed before treatment proved to be significant factors of OHRQoL. Here we presented representative data about self-assessed OHRQoL of patients requiring prosthetic treatment from Hungary using OHIP-49-H questionnaire. The results demonstrated that the restoration of oral health was associated with an improvement in patients' OHRQoL. According to the demographical and T0 phase clinical status, the treatment was more effective in the respect of OHIP-49-H score improvement among females (than among males), among younger (than among more aged), and among patients with more serious CPI assessed at T0. The type of prosthetic interventions did not exert a significant effect on total OHIP-49-H score, suggesting that the improvement in OHRQoL is independent from the type of denture applied.

  11. Fluid mechanics of heart valves.

    PubMed

    Yoganathan, Ajit P; He, Zhaoming; Casey Jones, S

    2004-01-01

    Valvular heart disease is a life-threatening disease that afflicts millions of people worldwide and leads to approximately 250,000 valve repairs and/or replacements each year. Malfunction of a native valve impairs its efficient fluid mechanic/hemodynamic performance. Artificial heart valves have been used since 1960 to replace diseased native valves and have saved millions of lives. Unfortunately, despite four decades of use, these devices are less than ideal and lead to many complications. Many of these complications/problems are directly related to the fluid mechanics associated with the various mechanical and bioprosthetic valve designs. This review focuses on the state-of-the-art experimental and computational fluid mechanics of native and prosthetic heart valves in current clinical use. The fluid dynamic performance characteristics of caged-ball, tilting-disc, bileaflet mechanical valves and porcine and pericardial stented and nonstented bioprostheic valves are reviewed. Other issues related to heart valve performance, such as biomaterials, solid mechanics, tissue mechanics, and durability, are not addressed in this review.

  12. [Dental loss and prosthetic replacement expectation: qualitative study].

    PubMed

    Silva, Maria Elisa de Souza E; Magalhães, Cláudia Silami de; Ferreira, Efigênia Ferreira E

    2010-05-01

    This qualitative research analyses the repercussions of total dental loss on people's quality of life. The Oral Health Impact Profile short-form (OHIP14) was applied to 50 volunteers, and after analyzing the results, 13 out of those 50, were selected to be individually interviewed in an opened questions script. The criteria to select these 13 people were: perception of the impact of mouth condition on quality of life measured by the score reached on OHIP. We tried to comprise the sample with a good variety, according to the profile of the initial sample. After analyzing people's statements, it was possible to verify that dental loss had strong negative consequences on people's life, like shame, difficulty to eat, impact on social relationship and feeling of not being complete. The possibility of having their teeth replaced generates some anxiety. Although being aware that wearing total prosthesis represents some sacrifices, people considered it worthwhile because the possibility of regaining the social pattern and the self-image is renewed.

  13. [Minor strut fracture of the Björk-Shiley mitral valve].

    PubMed

    Sugita, T; Yasuda, R; Watarida, S; Onoe, M; Tabata, R; Mori, A

    1990-06-01

    In May, 1982, a 49-year-old man underwent mitral valve replacement (MVR) in our hospital with a 31 mm Björk-Shiley prosthesis for mitral regurgitation. He had been doing well until his episode of palpitation and dyspnea of sudden onset, and was transferred to our ICU with severe cardiogenic shock in Aug, 1986. Chest X-ray film revealed pulmonary edema and breakage of the valve with migration of the disc and the minor strut of the prosthesis. He was operated upon 5 hours after the onset of his complaints. The minor strut was removed from the left upper pulmonary vein and mitral valve re-replacement was done with a 29 mm Björk-Shiley Monostrut valve. The disc which had dislocated into the abdominal aorta was also recovered on the twenty-third post operative day. His postoperative course was uneventful. Immediate diagnosis and subsequent re-operation is absolute indication for rescue from acute cardiac failure due to mechanical failure of any prosthetic valve.

  14. [Aortic Valve Replacement after Balloon Valvuloplasty for Aortic Valve Stenosis in a Dialysis Patient with Cardiogenic Shock;Report of a Case].

    PubMed

    Takamatsu, Masanori; Hirotani, Takashi; Ohtsubo, Satoshi; Saito, Sumikatsu; Takeuchi, Shigeyuki; Hasegawa, Tasuku; Endo, Ayaka; Yamasaki, Yu; Hayashida, Kentaro

    2015-06-01

    A 67-year-old man on chronic hemodialysis was admitted with worsening congestive heart failure due to critical aortic stenosis. Echocardiography showed severe aortic stenosis with a valve area of 0.67 cm2 and an ejection fraction of 0.31. Cardiac catheterization revealed severe pulmonary hypertension with pulmonary artery pressures of 62/32 mmHg. In the middle of cardiac catheterization, the systolic pressure declined to 60 mmHg due to cardiogenic shock. Dopamine hydrochloride and dobutamine hydrochloride infusions were necessary to maintain a systolic pressure greater than 80 mmHg. Balloon aortic valvuloplasty was urgently performed. The patient's symptoms rapidly resolved except for angina on exertion. One month later, elective aortic valve replacement was performed. The postoperative course was uneventful and the he was discharged on the 60th postoperative day. A follow-up echocardiogram 6 months postoperatively revealed normal prosthetic valve function and an ejection fraction of 0.6.

  15. Towards Optogenetic Sensory Replacement

    PubMed Central

    Doroudchi, M. Mehdi; Greenberg, Kenneth P.; Zorzos, Anthony N.; Hauswirth, William W.; Fonstad, Clifton G.; Horsager, Alan; Boyden, Edward S.

    2013-01-01

    Over the last several years we have developed a rapidly-expanding suite of genetically-encoded reagents (e.g., ChR2, Halo, Arch, Mac, and others) that, when expressed in specific neuron types in the nervous system, enable their activities to be powerfully and precisely activated and silenced in response to light. If the genes that encode for these reagents can be delivered to cells in the body using gene therapy methods, and if the resultant protein payloads operate safely and effectively over therapeutically important periods of time, these molecules could subserve a set of precise prosthetics that use light as the trigger of information entry into the nervous system, e.g. for sensory replacement. Here we discuss the use of ChR2 to make the photoreceptor-deprived retina, as found in diseases such as retinitis pigmentosa, sensitive to light, enabling restoration of functional vision in a mouse model of blindness. We also discuss arrays of light sources that could be useful for delivering patterned sensory information into the nervous system. PMID:22255005

  16. Threshold concepts in prosthetics.

    PubMed

    Hill, Sophie

    2017-12-01

    Curriculum documents identify key concepts within learning prosthetics. Threshold concepts provide an alternative way of viewing the curriculum, focussing on the ways of thinking and practicing within prosthetics. Threshold concepts can be described as an opening to a different way of viewing a concept. This article forms part of a larger study exploring what students and staff experience as difficult in learning about prosthetics. To explore possible threshold concepts within prosthetics. Qualitative, interpretative phenomenological analysis. Data from 18 students and 8 staff at two universities with undergraduate prosthetics and orthotics programmes were generated through interviews and questionnaires. The data were analysed using an interpretative phenomenological analysis approach. Three possible threshold concepts arose from the data: 'how we walk', 'learning to talk' and 'considering the person'. Three potential threshold concepts in prosthetics are suggested with possible implications for prosthetics education. These possible threshold concepts involve changes in both conceptual and ontological knowledge, integrating into the persona of the individual. This integration occurs through the development of memories associated with procedural concepts that combine with disciplinary concepts. Considering the prosthetics curriculum through the lens of threshold concepts enables a focus on how students learn to become prosthetists. Clinical relevance This study provides new insights into how prosthetists learn. This has implications for curriculum design in prosthetics education.

  17. Salvage of infected total knee fusion: the last option.

    PubMed

    Wiedel, Jerome D

    2002-11-01

    Currently the most common indication for an arthrodesis of the knee is a failed infected total knee prosthesis. Other causes of a failed total knee replacement that might necessitate a knee fusion include aseptic loosening, deficient extensor mechanism, poor soft tissues, and Charcot joint. Techniques available for achieving a knee fusion are external fixation and internal fixation methods. The external fixation compression devices have been the most widely used for knee fusion and have been successful until the indications for fusion changed to mostly failed prosthetic knee replacement. With failed total knee replacement, the problem of severe bone loss became an issue, and the external fixation compression devices, even including the biplane external fixators, have been the least successful method reported for gaining fusion. The Ilizarov technique has been shown to achieve rigid fixation despite this bone loss, and a review of reports are showing high fusion rates using this method. Internal fixation methods including plate fixation and intramedullary nails have had the best success in gaining fusion in the face of this bone loss and have replaced external fixation methods as the technique of choice for knee fusion when severe bone loss is present. A review of the literature and a discussion of different fusion techniques are presented including a discussion of the influence that infection has on the success of fusion.

  18. Advanced upper limb prosthetic devices: implications for upper limb prosthetic rehabilitation.

    PubMed

    Resnik, Linda; Meucci, Marissa R; Lieberman-Klinger, Shana; Fantini, Christopher; Kelty, Debra L; Disla, Roxanne; Sasson, Nicole

    2012-04-01

    The number of catastrophic injuries caused by improvised explosive devices in the Afghanistan and Iraq Wars has increased public, legislative, and research attention to upper limb amputation. The Department of Veterans Affairs (VA) has partnered with the Defense Advanced Research Projects Agency and DEKA Integrated Solutions to optimize the function of an advanced prosthetic arm system that will enable greater independence and function. In this special communication, we examine current practices in prosthetic rehabilitation including trends in adoption and use of prosthetic devices, financial considerations, and the role of rehabilitation team members in light of our experiences with a prototype advanced upper limb prosthesis during a VA study to optimize the device. We discuss key challenges in the adoption of advanced prosthetic technology and make recommendations for service provision and use of advanced upper limb prosthetics. Rates of prosthetic rejection are high among upper limb amputees. However, these rates may be reduced with sufficient training by a highly specialized, multidisciplinary team of clinicians, and a focus on patient education and empowerment throughout the rehabilitation process. There are significant challenges emerging that are unique to implementing the use of advanced upper limb prosthetic technology, and a lack of evidence to establish clinical guidelines regarding prosthetic prescription and treatment. Finally, we make recommendations for future research to aid in the identification of best practices and development of policy decisions regarding insurance coverage of prosthetic rehabilitation. Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  19. A modular and low­cost 3D­-printed microfluidic device with assembly of capillaries for droplet mass production

    NASA Astrophysics Data System (ADS)

    Aguirre-Pablo, A. A.; Zhang, J. M.; Li, E. Q.; Thoroddsen, S. T.

    2015-11-01

    We report a new 3D­-printed microfluidic system with assembly of capillaries for droplet generation. The system consists of the following parts: 3D­printed Droplet Generation Units (DGUs) with embedded capillaries and two 3D-printed pyramid distributors for supplying two different fluid phases into every DGU. A single DGU consists of four independent parts: a top channel, a bottom channel, a capillary and a sealing gasket. All components are produced by 3d­printing except the capillaries, which are formed in a glass-­puller. DGUs are independent of the distributor and from each other; they can easily be assembled, replaced and modified due to its modular design which is an advantage in case of a faulty part or clogging, eliminating the need to fabricate a complete new system which is cost and time demanding. We assessed the feasibility of producing droplets in this device varying different fluid parameters, such as liquid viscosity and flow rate, which affect droplet size and generation frequency. The design and fabrication of this device is simple and low­-cost with the 3D printing technology. Due to the modular design of independent parts, low-cost fabrication and easy parallelization of multiple DGU's, this system provides great flexibility for industrial applications.

  20. AB0 blood types: impact on development of prosthetic mechanical valve thrombosis

    PubMed Central

    Astarcıoğlu, Mehmet Ali; Kalçık, Macit; Yesin, Mahmut; Gürsoy, Mustafa Ozan; Şen, Taner; Karakoyun, Süleyman; Gündüz, Sabahattin; Özkan, Mehmet

    2016-01-01

    Objective: The non-O alleles of the ABO genotype have been associated with an increased risk of thrombosis. We aimed to assess the association between blood group status and prosthetic valve thrombosis. Methods: The association between AB0 blood group status and prosthetic valve thrombosis was assessed in this retrospective study. Transesophageal echocardiography was performed in 149 patients with a diagnosis of prosthetic valve thrombosis and in 192 control subjects. Results: Non-0 blood group type (p<0.001), presence of NYHA class III-IV status (p<0.001), and central nervous system (p<0.001) and non-central nervous system (p<0.001) emboli were significantly more prevalent in prosthetic valve thrombosis patients than in the control subjects. The incidence of ineffective anticoagulation was higher in patients with prosthetic valve thrombosis than in controls (p<0.001), as was the presence of moderate to severe left atrial spontaneous echo contrast (p<0.001). The non-0 blood prosthetic valve thrombosis subgroup had a higher incidence of obstructive thrombi and central nervous system thrombotic events than having 0 blood prosthetic valve thrombosis subgroup. Non-0 blood group, ineffective anticoagulation, left atrial spontaneous echo contrast, and a poor NYHA functional capacity were identified to be the predictors of prosthetic valve thrombosis. Conclusion: Our data demonstrate that patients with non-0 compared with 0 blood groups have higher incidence of prosthetic valve thrombosis and central nervous system embolism and similar rates of non-central nervous system embolism at presentation compared with 0 blood group type. Thus, non-O blood group may be a risk factor that may be prone to the development of prosthetic valve thrombosis in patients with prosthetic heart valves. PMID:27488753

  1. The Effect of Prosthetic Foot Push-off on Mechanical Loading Associated with Knee Osteoarthritis in Lower Extremity Amputees

    PubMed Central

    Morgenroth, David C.; Segal, Ava D.; Zelik, Karl E.; Czerniecki, Joseph M.; Klute, Glenn K.; Adamczyk, Peter G.; Orendurff, Michael S.; Hahn, Michael E.; Collins, Steven H.; Kuo, Art D.

    2011-01-01

    Lower extremity amputation not only limits mobility, but also increases the risk of knee osteoarthritis of the intact limb. Dynamic walking models of non-amputees suggest that pushing-off from the trailing limb can reduce collision forces on the leading limb. These collision forces may determine the peak knee external adduction moment (EAM), which has been linked to the development of knee OA in the general population. We therefore hypothesized that greater prosthetic push-off would lead to reduced loading and knee EAM of the intact limb in unilateral transtibial amputees. Seven unilateral transtibial amputees were studied during gait under three prosthetic foot conditions that were intended to vary push-off. Prosthetic foot-ankle push-off work, intact limb knee EAM and ground reaction impulses for both limbs during step-to-step transition were measured. Overall, trailing limb prosthetic push-off work was negatively correlated with leading intact limb 1st peak knee EAM (slope = −0.72 +/− 0.22; p=0.011). Prosthetic push-off work and 1st peak intact knee EAM varied significantly with foot type. The prosthetic foot condition with the least push-off demonstrated the largest knee EAM, which was reduced by 26% with the prosthetic foot producing the most push-off. Trailing prosthetic limb push-off impulse was negatively correlated with leading intact limb loading impulse (slope = −0.34 +/− 0.14; p=.001), which may help explain how prosthetic limb push-off can affect intact limb loading. Prosthetic feet that perform more prosthetic push-off appear to be associated with a reduction in 1st peak intact knee EAM, and their use could potentially reduce the risk and burden of knee osteoarthritis in this population. PMID:21803584

  2. The effect of prosthetic foot push-off on mechanical loading associated with knee osteoarthritis in lower extremity amputees.

    PubMed

    Morgenroth, David C; Segal, Ava D; Zelik, Karl E; Czerniecki, Joseph M; Klute, Glenn K; Adamczyk, Peter G; Orendurff, Michael S; Hahn, Michael E; Collins, Steven H; Kuo, Art D

    2011-10-01

    Lower extremity amputation not only limits mobility, but also increases the risk of knee osteoarthritis of the intact limb. Dynamic walking models of non-amputees suggest that pushing-off from the trailing limb can reduce collision forces on the leading limb. These collision forces may determine the peak knee external adduction moment (EAM), which has been linked to the development of knee OA in the general population. We therefore hypothesized that greater prosthetic push-off would lead to reduced loading and knee EAM of the intact limb in unilateral transtibial amputees. Seven unilateral transtibial amputees were studied during gait under three prosthetic foot conditions that were intended to vary push-off. Prosthetic foot-ankle push-off work, intact limb knee EAM and ground reaction impulses for both limbs during step-to-step transition were measured. Overall, trailing limb prosthetic push-off work was negatively correlated with leading intact limb 1st peak knee EAM (slope=-.72±.22; p=.011). Prosthetic push-off work and 1st peak intact knee EAM varied significantly with foot type. The prosthetic foot condition with the least push-off demonstrated the largest knee EAM, which was reduced by 26% with the prosthetic foot producing the most push-off. Trailing prosthetic limb push-off impulse was negatively correlated with leading intact limb loading impulse (slope=-.34±.14; p=.001), which may help explain how prosthetic limb push-off can affect intact limb loading. Prosthetic feet that perform more prosthetic push-off appear to be associated with a reduction in 1st peak intact knee EAM, and their use could potentially reduce the risk and burden of knee osteoarthritis in this population. Published by Elsevier B.V.

  3. Perceived self-efficacy and specific self-reported outcomes in persons with lower-limb amputation using a non-microprocessor-controlled versus a microprocessor-controlled prosthetic knee.

    PubMed

    Möller, Saffran; Hagberg, Kerstin; Samulesson, Kersti; Ramstrand, Nerrolyn

    2018-04-01

    To measure self-efficacy in a group of individuals who have undergone a lower-limb amputation and investigate the relationship between self-efficacy and prosthetic-specific outcomes including prosthetic use, mobility, amputation-related problems and global health. A second purpose was to examine if differences exist in outcomes based upon the type of prosthetic knee unit being used. Cross-sectional study using the General Self-Efficacy (GSE) Scale and the Questionnaire for Persons with a Transfemoral Amputation (Q-TFA). Forty-two individuals participated in the study. Twenty-three used a non-microprocessor-controlled prosthetic knee joint (non-MPK) and 19 used a microprocessor-controlled prosthetic knee joint (MPK). The study sample had quite high GSE scores (32/40). GSE scores were significantly correlated to the Q-TFA prosthetic use, mobility and problem scores. High GSE scores were related to higher levels of prosthetic use, mobility, global scores and negatively related to problem score. No significant difference was observed between individuals using a non-MPK versus MPK joints. Individuals with high self-efficacy used their prosthesis to a higher degree and high self-efficacy was related to higher level of mobility, global scores and fewer problems related to the amputation in individuals who have undergone a lower-limb amputation and were using a non-MPK or MPK knee. Implications for rehabilitation Perceived self-efficacy has has been shown to be related to quality of life, prosthetic mobility and capability as well as social activities in daily life. Prosthetic rehabilitation is primary focusing on physical improvement rather than psychological interventions. More attention should be directed towards the relationship between self-efficacy and prosthetic related outcomes during prosthetic rehabilitation after a lower-limb amputation.

  4. APS deposition facility upgrades and future plans

    NASA Astrophysics Data System (ADS)

    Conley, Ray; Shi, Bing; Erdmann, Mark; Izzo, Scott; Assoufid, Lahsen; Goetze, Kurt; Mooney, Tim; Lauer, Kenneth

    2014-09-01

    The Advanced Photon Source (APS) has recently invested resources to upgrade or replace aging deposition systems with modern equipment. Of the three existing deposition systems, one will receive an upgrade, while two are being replaced. A design which adds a three-substrate planetary for the APS rotary deposition system is almost complete. The replacement for the APS large deposition system, dubbed the "Modular Deposition System", has been conceptually designed and is in the procurement process. Eight cathodes will sputter horizontally on mirrors up to 1.5 meters in length. This new instrument is designed to interface with ion-milling instruments and various metrology equipment for ion-beam figuring. A third linear machine, called the APS Profile Coating System, has two cathodes and is designed to accept substrates up to 200mm in length. While this machine is primarily intended for fabrication of figured KB mirrors using the profile-coating technique, it has also been used to produce multilayer monochromators for beamline use.

  5. 14- by 22-Foot Subsonic Tunnel Laser Velocimeter Upgrade

    NASA Technical Reports Server (NTRS)

    Meyers, James F.; Lee, Joseph W.; Cavone, Angelo A.; Fletcher, Mark T.

    2012-01-01

    A long-focal length laser velocimeter constructed in the early 1980's was upgraded using current technology to improve usability, reliability and future serviceability. The original, free-space optics were replaced with a state-of-the-art fiber-optic subsystem which allowed most of the optics, including the laser, to be remote from the harsh tunnel environment. General purpose high-speed digitizers were incorporated in a standard modular data acquisition system, along with custom signal processing software executed on a desktop computer, served as the replacement for the signal processors. The resulting system increased optical sensitivity with real-time signal/data processing that produced measurement precisions exceeding those of the original system. Monte Carlo simulations, along with laboratory and wind tunnel investigations were used to determine system characteristics and measurement precision.

  6. The Modernization of a Long-Focal Length Fringe-Type Laser Velocimeter

    NASA Technical Reports Server (NTRS)

    Meyers, James F.; Lee, Joseph W.; Cavone, Angelo A.; Fletcher, Mark T.

    2012-01-01

    A long-focal length laser velocimeter constructed in the early 1980's was upgraded using current technology to improve usability, reliability and future serviceability. The original, free-space optics were replaced with a state-of-the-art fiber-optic subsystem which allowed most of the optics, including the laser, to be remote from the harsh tunnel environment. General purpose high-speed digitizers were incorporated in a standard modular data acquisition system, along with custom signal processing software executed on a desktop computer, served as the replacement for the signal processors. The resulting system increased optical sensitivity with real-time signal/data processing that produced measurement precisions exceeding those of the original system. Monte Carlo simulations, along with laboratory and wind tunnel investigations were used to determine system characteristics and measurement precision.

  7. Orbit Transfer Rocket Engine Technology Program: Advanced engine study, task D.1/D.3

    NASA Technical Reports Server (NTRS)

    Martinez, A.; Erickson, C.; Hines, B.

    1986-01-01

    Concepts for space maintainability of OTV engines were examined. An engine design was developed which was driven by space maintenance requirements and by a failure mode and effects (FME) analysis. Modularity within the engine was shown to offer cost benefits and improved space maintenance capabilities. Space operable disconnects were conceptualized for both engine change-out and for module replacement. Through FME mitigation the modules were conceptualized to contain the least reliable and most often replaced engine components. A preliminary space maintenance plan was developed around a controls and condition monitoring system using advanced sensors, controls, and condition monitoring concepts. A complete engine layout was prepared satisfying current vehicle requirements and utilizing projected component advanced technologies. A technology plan for developing the required technology was assembled.

  8. Target of physiological gait: Realization of speed adaptive control for a prosthetic knee during swing flexion.

    PubMed

    Cao, Wujing; Yu, Hongliu; Zhao, Weiliang; Li, Jin; Wei, Xiaodong

    2018-01-01

    Prosthetic knee is the most important component of lower limb prosthesis. Speed adaptive for prosthetic knee during swing flexion is the key method to realize physiological gait. This study aims to discuss the target of physiological gait, propose a speed adaptive control method during swing flexion and research the damping adjustment law of intelligent hydraulic prosthetic knee. According to the physiological gait trials of healthy people, the control target during swing flexion is defined. A new prosthetic knee with fuzzy logical control during swing flexion is designed to realize the damping adjustment automatically. The function simulation and evaluation system of intelligent knee prosthesis is provided. Speed adaptive control test of the intelligent prosthetic knee in different velocities are researched. The maximum swing flexion of the knee angle is set between sixty degree and seventy degree as the target of physiological gait. Preliminary experimental results demonstrate that the prosthetic knee with fuzzy logical control is able to realize physiological gait under different speeds. The faster the walking, the bigger the valve closure percentage of the hydraulic prosthetic knee. The proposed fuzzy logical control strategy and intelligent hydraulic prosthetic knee are effective for the amputee to achieve physiological gait.

  9. Reduced prosthetic stiffness lowers the metabolic cost of running for athletes with bilateral transtibial amputations.

    PubMed

    Beck, Owen N; Taboga, Paolo; Grabowski, Alena M

    2017-04-01

    Inspired by the springlike action of biological legs, running-specific prostheses are designed to enable athletes with lower-limb amputations to run. However, manufacturer's recommendations for prosthetic stiffness and height may not optimize running performance. Therefore, we investigated the effects of using different prosthetic configurations on the metabolic cost and biomechanics of running. Five athletes with bilateral transtibial amputations each performed 15 trials on a force-measuring treadmill at 2.5 or 3.0 m/s. Athletes ran using each of 3 different prosthetic models (Freedom Innovations Catapult FX6, Össur Flex-Run, and Ottobock 1E90 Sprinter) with 5 combinations of stiffness categories (manufacturer's recommended and ± 1) and heights (International Paralympic Committee's maximum competition height and ± 2 cm) while we measured metabolic rates and ground reaction forces. Overall, prosthetic stiffness [fixed effect (β) = 0.036; P = 0.008] but not height ( P ≥ 0.089) affected the net metabolic cost of transport; less stiff prostheses reduced metabolic cost. While controlling for prosthetic stiffness (in kilonewtons per meter), using the Flex-Run (β = -0.139; P = 0.044) and 1E90 Sprinter prostheses (β = -0.176; P = 0.009) reduced net metabolic costs by 4.3-4.9% compared with using the Catapult prostheses. The metabolic cost of running improved when athletes used prosthetic configurations that decreased peak horizontal braking ground reaction forces (β = 2.786; P = 0.001), stride frequencies (β = 0.911; P < 0.001), and leg stiffness values (β = 0.053; P = 0.009). Remarkably, athletes did not maintain overall leg stiffness across prosthetic stiffness conditions. Rather, the in-series prosthetic stiffness governed overall leg stiffness. The metabolic cost of running in athletes with bilateral transtibial amputations is influenced by prosthetic model and stiffness but not height. NEW & NOTEWORTHY We measured the metabolic rates and biomechanics of five athletes with bilateral transtibial amputations while running with different prosthetic configurations. The metabolic cost of running for these athletes is minimized by using an optimal prosthetic model and reducing prosthetic stiffness. The metabolic cost of running was independent of prosthetic height, suggesting that longer legs are not advantageous for distance running. Moreover, the in-series prosthetic stiffness governs the leg stiffness of athletes with bilateral leg amputations.

  10. Grumman evaluates Space Station thermal control and power systems

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Kandebo, S.W.

    1985-09-01

    Attention is given to the definition of requirements for the NASA Space Station's electrical power and thermal control systems, which must be highly dependable to minimize the need for external support and will embody a highly flexible modular design concept. Module maintenance will be performed by in-orbit replacement of failed modules, and energy storage system growth will be accomplished by the incorporation of additional modules. Both photovoltaic and solar heat-driven electrical generator concepts are under consideration as the basis of the power system.

  11. Journal of Rehabilitation Research and Development Progress Reports 1994, Volume 32, June 1995

    DTIC Science & Technology

    1995-06-01

    Stepping Over an Obstacle: Effect of Reduced Visual Field 50 Effect of Reduced Optic Flow on Gait 51 Effects of Robotic-Assisted Weight Support on Gait...Geometry in Hip Replacement 240 Wear Debris Generation in Hip Modular Head and Neck Components 241 Changes in Bone Blood Flow Associated with...rectangular cross-section to form a continuously flowing ribbon of melted plastic. Rib- bon dimensions are 0.75 mm thick and 5 mm wide, corresponding to

  12. Firefighters' Radios

    NASA Technical Reports Server (NTRS)

    1976-01-01

    Public Technology Inc. asked for NASA assistance to devise the original firefighter's radio. Good short-range radio communications are essential during a fire to coordinate hose lines, rescue victims, and otherwise increase efficiency. Useful firefighting tool is lower cost, more rugged short range two-way radio. Inductorless electronic circuit replaced inductances and coils in radio circuits with combination of transistors and other low-cost components. Substitution promises reduced circuit size and cost. Enhanced electrical performance made radio more durable and improved maintainability by incorporating modular construction.

  13. An integrated environment for tactical guidance research and evaluation

    NASA Technical Reports Server (NTRS)

    Goodrich, Kenneth H.; Mcmanus, John W.

    1990-01-01

    NASA-Langley's Tactical Guidance Research and Evaluation System (TGRES) constitutes an integrated environment for the development of tactical guidance algorithms and evaluating the effects of novel technologies; the modularity of the system allows easy modification or replacement of system elements in order to conduct evaluations of alternative technologies. TGRES differs from existing systems in its capitalization on AI programming techniques for guidance-logic implementation. Its ability to encompass high-fidelity, six-DOF simulation models will facilitate the analysis of complete aircraft dynamics.

  14. 75 FR 52629 - Medicare Program; Establishing Additional Medicare Durable Medical Equipment, Prosthetics...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-27

    ... wheelchairs. Prosthetic devices are included in the definition of ``medical and other health services'' under section 1861(s)(8) of the Act. Prosthetic devices are defined in this section of the Act as ``devices... insertion of an intraocular lens.'' Other examples of prosthetic devices include cardiac pacemakers...

  15. Modular, Adaptive, Reconfigurable Systems: Technology for Sustainable, Reliable, Effective, and Affordable Space Exploration

    NASA Technical Reports Server (NTRS)

    Esper, Jaime

    2004-01-01

    In order to execute the Vision for Space Exploration, we must find ways to reduce cost, system complexity, design, build, and test times, and at the same time increase flexibility to satisfy multiple functions. Modular, Adaptive, Reconfigurable System (MARS) technologies promise to set the stage for the delivery of system elements that form the building blocks of increasingly ambitious missions involving humans and robots. Today, space systems are largely specialized and built on a case-by-case basis. The notion of modularity however, is nothing new to NASA. The 1970's saw the development of the Multi-Mission Modular spacecraft (MMS). From 1980 to 1992 at least six satellites were built under this paradigm, and included such Goddard Space Flight Center missions as SSM, EUVE, UARS, and Landsat 4 and 5. Earlier versions consisted of standard subsystem "module" or "box" components that could be replaced within a structure based on predefined form factors. Although the primary motivation for MMS was faster/cheaper integration and test, standardization of interfaces, and ease of incorporating new subsystem technology, it lacked the technology maturity and programmatic "upgrade infrastructure" needed to satisfy varied mission requirements, and ultimately it lacked user buy-in. Consequently, it never evolved and was phased out. Such concepts as the Rapid Spacecraft Development Office (RSDO) with its regularly updated catalogue of prequalified busses became the preferred method for acquiring satellites. Notwithstanding, over the past 30 years since MMS inception, technology has advanced considerably and now modularity can be extended beyond the traditional MMS module or box to cover levels of integration, from the chip, card, box, subsystem, to the space system and to the system-of-systems. This paper will present the MARS architecture, cast within the historical context of MMS. Its application will be highlighted by comparing a state-of-the-art point design vs. a MARS-enabled lunar mission, as a representative robotic case design.

  16. Modular, Adaptive, Reconfigurable Systems: Technology for Sustainable, Reliable, Effective, and Affordable Space Exploration

    NASA Astrophysics Data System (ADS)

    Esper, Jaime

    2005-02-01

    In order to execute the Vision for Space Exploration, we must find ways to reduce cost, system complexity, design, build, and test times, and at the same time increase flexibility to satisfy multiple functions. Modular, Adaptive, Reconfigurable System (MARS) technologies promise to set the stage for the delivery of system elements that form the building blocks of increasingly ambitious missions involving humans and robots. Today, space systems are largely specialized and built on a case-by-case basis. The notion of modularity however, is nothing new to NASA. The 1970's saw the development of the Multi-Mission Modular spacecraft (MMS). From 1980 to 1992 at least six satellites were built under this paradigm, and included such Goddard Space Flight Center missions as SSM, EUVE, UARS, and Landsat 4 and 5. Earlier versions consisted of standard subsystem ``module'' or ``box'' components that could be replaced within a structure based on predefined form factors. Although the primary motivation for MMS was faster/cheaper integration and test, standardization of interfaces, and ease of incorporating new subsystem technology, it lacked the technology maturity and programmatic ``upgrade infrastructure'' needed to satisfy varied mission requirements, and ultimately it lacked user buy-in. Consequently, it never evolved and was phased out. Such concepts as the Rapid Spacecraft Development Office (RSDO) with its regularly updated catalogue of pre-qualified busses became the preferred method for acquiring satellites. Notwithstanding, over the past 30 years since MMS inception, technology has advanced considerably and now modularity can be extended beyond the traditional MMS module or box to cover levels of integration, from the chip, card, box, subsystem, to the space system and to the system-of-systems. This paper will present the MARS architecture, cast within the historical context of MMS. Its application will be highlighted by comparing a state-of-the-art point design vs. a MARS-enabled lunar mission, as a representative robotic case design.

  17. [Fixed restorations of a dentition with reduced periodontal support in partially edentulous patients].

    PubMed

    De Boever, J A

    1990-05-01

    Placing restorations in patients who have a limited number of teeth and reduced periodontal support is no longer controversial, given careful selection of patients, preprosthetic periodontal treatment, and a thorough maintenance program. In this paper, attention is drawn to general prosthetic planning, including the use of long-span bridges. Because of increased tooth mobility, cross-arch stabilization of the bridges with interlocks or with postsolder connections is advocated. The framework should be rigid enough to avoid deflection of the bridges. Preparation of the vital and nonvital abutment teeth needs much attention. To avoid using a removable prosthesis, a cantilever bridge can be used, but it makes the construction more prone to fracture. A number of periodontal-prosthetic patients demonstrate a "posterior collapsed bite." Rehabilitation requires the restoration at a "new" vertical dimension of occlusion. This can be done, without functional hazards, in a one-step clinical procedure. A long functional adaptation period is unnecessary. The treatment outcome of furcations is not always predictable. Therefore, hemisection or amputation are often the treatments of choice. On these hemisected roots, bridges can be made and successfully maintained. Finally, it should be stressed that not all teeth have to be replaced: a premolar, shortened-arch occlusion is often sufficient for adequate function.

  18. Virtual Preoperative Planning and Intraoperative Navigation in Facial Prosthetic Reconstruction: A Technical Note.

    PubMed

    Verma, Suzanne; Gonzalez, Marianela; Schow, Sterling R; Triplett, R Gilbert

    This technical protocol outlines the use of computer-assisted image-guided technology for the preoperative planning and intraoperative procedures involved in implant-retained facial prosthetic treatment. A contributing factor for a successful prosthetic restoration is accurate preoperative planning to identify prosthetically driven implant locations that maximize bone contact and enhance cosmetic outcomes. Navigational systems virtually transfer precise digital planning into the operative field for placing implants to support prosthetic restorations. In this protocol, there is no need to construct a physical, and sometimes inaccurate, surgical guide. The report addresses treatment workflow, radiologic data specifications, and special considerations in data acquisition, virtual preoperative planning, and intraoperative navigation for the prosthetic reconstruction of unilateral, bilateral, and midface defects. Utilization of this protocol for the planning and surgical placement of craniofacial bone-anchored implants allows positioning of implants to be prosthetically driven, accurate, precise, and efficient, and leads to a more predictable treatment outcome.

  19. 21 CFR 895.101 - Prosthetic hair fibers.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Prosthetic hair fibers. 895.101 Section 895.101 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES BANNED DEVICES Listing of Banned Devices § 895.101 Prosthetic hair fibers. Prosthetic hair fibers are devices intended for implantation...

  20. 38 CFR 17.122 - Payment or reimbursement of the expenses of repairs to prosthetic appliances and similar devices...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... of the expenses of repairs to prosthetic appliances and similar devices furnished without prior... Payment or reimbursement of the expenses of repairs to prosthetic appliances and similar devices furnished without prior authorization. The expenses of repairs to prosthetic appliances, or similar appliances...

  1. 76 FR 18472 - Medicare Program; Revisions to the Durable Medical Equipment, Prosthetics, Orthotics, and...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-04-04

    ....Prosthetic devices are included in the definition of ``medical and other health services'' under section 1861(s)(8) of the Act. Prosthetic devices are defined in this section of the Act as ``devices (other than... intraocular lens.'' Other examples of prosthetic devices include cardiac pacemakers, cochlear implants...

  2. The effect of anti-gravity treadmill training for prosthetic rehabilitation of a case with below-knee amputation.

    PubMed

    Mikami, Yukio; Fukuhara, Kouki; Kawae, Toshihiro; Kimura, Hiroaki; Ochi, Mitsuo

    2015-12-01

    The aim of this case study was to verify the efficacy and safety of anti-gravity treadmill training for prosthetic rehabilitation following below-knee amputation. The patient underwent left below-knee amputation as a result of diabetic foot gangrene. Since his physical strength and vitality had declined during the perioperative period, anti-gravity treadmill training was introduced for his outpatient prosthetic rehabilitation. Stable prosthetic gait exercise could be carried out under guidance on the anti-gravity treadmill, quickly resulting in improved gait. Furthermore, the patient's self-efficacy and exercise tolerance were elevated after the period of anti-gravity treadmill training. At the final evaluation following 6 weeks of rehabilitation with the anti-gravity treadmill, he had acquired prosthetic gait with the assistance of a T-cane. The anti-gravity treadmill was found to be a useful instrument for prosthetic rehabilitation following below-knee amputation. Anti-gravity treadmill training has the potential to support the prosthetic rehabilitation of below-knee amputees, especially for patients whose physical strength and vitality are decreased. © The International Society for Prosthetics and Orthotics 2014.

  3. The History and Evolution of Surgery on the Vestibular Labyrinth.

    PubMed

    Naples, James G; Eisen, Marc D

    2016-11-01

    The history of surgery on the vestibular labyrinth is rich but sparsely documented in the literature. The story begins over a century ago with the labyrinthectomy in an era that consisted exclusively of ablative surgery for infection or vertigo. Improved understanding of vestibular physiology and pathology produced an era of selective ablation and hearing preservation that includes semicircular canal occlusion for benign paroxysmal positional vertigo. An era of restoration began with a discovery of superior semicircular canal dehiscence and its repair. The final era of vestibular replacement is upon us as the possibility of successful prosthetic vestibular implantation becomes reality. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

  4. Insidious strut fractures in a DeBakey-Surgitool aortic valve prosthesis.

    PubMed

    Scott, S M; Sethi, G K; Paulson, D M; Takaro, T

    1978-04-01

    Recent reports of cage wear occurring in DeBakey-Surgitool aortic valve prostheses prompted us to examine with image intensification all our patients who have had this type of prosthesis implanted. One patient, who was asymptomatic, was discovered to have a prosthesis with two fractured struts. This patient's prosthetic valve was replaced successfully with a stented porcine heterograft prosthesis. Including the valve removed from this patient, 8 DeBakey-Surgitool aortic valves with structural defects have been reported to the manufacturer. In the absence of a catastrophic event, patients with valves having fractured or worn struts may be totally asymptomatic, and routine periodic roentgenographic examination may be the only way of detecting strut wear or fracture.

  5. Riding pontic: a tool to keep patients smiling.

    PubMed

    Sharma, Narendra Shriram

    2013-05-01

    All patients expect a beautiful smile at the completion of orthodontic treatment, but some patients show concern regarding their appearance while undergoing treatment. The appearance of a gap from a missing tooth can be a concern, especially if it is in the display zone of a patient's smile. If the treatment plan includes prosthetic replacement of the missing tooth rather then space closure, then space maintenance is also an issue. In an appearance conscious patient use of riding pontic as space maintainers is a good option during treatment. How to cite this article: Sharma NS. Riding Pontic: A Tool to Keep Patients Smiling. Int J Clin Pediatr Dent 2013;6(2): 127-131.

  6. Position of the prosthesis components in total ankle replacement and the effect on motion at the replaced joint.

    PubMed

    Cenni, Francesco; Leardini, Alberto; Cheli, Andrea; Catani, Fabio; Belvedere, Claudio; Romagnoli, Matteo; Giannini, Sandro

    2012-03-01

    In some cases of total ankle replacement, perfect alignment of the prosthetic components is not achieved. This study analyses the extent to which component positioning is critical for the final range of motion. Fourteen patients undergoing total ankle replacement were assessed preoperatively and postoperatively at seven and 13 months follow-up. X-ray pictures of the ankle were taken in static double leg stance, i.e. at neutral joint position, and in maximum plantarflexion and dorsiflexion. Measurements were obtained by a specially devised computer program based on anatomical reference points digitised on the radiograms. These allowed calculation of the position and orientation of the components in the sagittal and coronal planes, together with the joint range of motion. The mean range of motion was about 34 degrees at the first follow-up and maintained at the second. Tibial and talar components were more anterior than the mid-tibial shaft in 11 and nine patients, respectively. Mean inclination was about four degrees posterior for the tibial component and nearly one degree anterior for the talar component. A significantly larger range of motion was found in ankles both with the talar component located and inclined more anteriorly than the tibial. Correlation, though weak, was found between motion at the replaced ankle and possible residual subluxation and inclination of the components. However, a satisfactory range of motion was also achieved in those patients where recommended locations for the components could not be reached because of the size of the original joint deformity.

  7. Kinematics in the terminal swing phase of unilateral transfemoral amputees: microprocessor-controlled versus swing-phase control prosthetic knees.

    PubMed

    Mâaref, Khaled; Martinet, Noël; Grumillier, Constance; Ghannouchi, Slaheddine; André, Jean Marie; Paysant, Jean

    2010-06-01

    To analyze the spatiotemporal parameters in the terminal swing phase of the prosthetic limb in unilateral transfemoral amputees (TFAs) compared with a group of asymptomatic subjects, and to identify a latency period (LP) in the TFA between the full extension of the prosthetic knee and the initial ground contact of the ipsilateral foot. To study the correlation between the LP and the duration of the swing phase. To evaluate the influence of the type of knee, the time since amputation, and the amputation level on the latency period. Three-dimensional gait analysis with an optoelectronic device. Gait analysis laboratory of a re-education and functional rehabilitation service. TFA (n=29) and able-bodied (n=15) subjects. Not applicable. Spatiotemporal and kinematics gait parameters. The swing phase and the LP of the prosthetic limb, associated with a consequently longer single-limb stance phase in the intact limb, were significantly longer than those measured in the intact limbs of these subjects, as well as those measured on both lower limbs of the able-bodied subjects (P<.05). There is a positive correlation (P<.05; r(2)=.58 between the LP and the swing phase on the TFA's prosthetic side. The LP measured in the prosthetic limb of TFA with a swing-phase control prosthetic knee is significantly greater than in those using the microprocessor-controlled prosthetic knee (P<.05). Of negligible duration in able-bodied subjects and in the intact limb of TFA, the LP is significantly greater in the prosthetic limb. It can explain the lengthened swing phase on the prosthetic side of those subjects. The use of a microprocessor-controlled prosthetic knee allows the LP to be reduced. This LP appears to be necessary to insure the stability of the prosthetic knee. We suggest calling this time "confidence time." Copyright 2010 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  8. Advanced Prosthetic Gait Training Tool

    DTIC Science & Technology

    2014-10-01

    AWARD NUMBER: W81XWH-10-1-0870 TITLE: Advanced Prosthetic Gait Training Tool...October 2014 2. REPORT TYPE Annual Report 3. DATES COVERED 20 Sep 2013 to 19 Sep 2014 4. TITLE AND SUBTITLE Advanced Prosthetic Gait Training...produce a computer-based Advanced Prosthetic Gait Training Tool to aid in the training of clinicians at military treatment facilities providing care

  9. Prosthetic Consideration in Implant-supported Prosthesis: A Review of Literature

    PubMed Central

    Gowd, Manga Snigdha; Shankar, Thatapudi; Ranjan, Rajeev; Singh, Arpita

    2017-01-01

    Modern dentistry has changed tremendously with implant therapy. For the successful implant therapy, making a proper treatment plan considering both surgical and prosthetic part in mind is the key of success. Often practitioners tend to create a treatment plan overlooking the basic principles of prosthetic part. This present review has discussed various prosthetic consideration of implant-supported prosthesis. A step-by-step detailed prosthetic option with their indications has been discussed to help all dental implant practitioners in making of an optimal treatment plan for each case. PMID:28713760

  10. Functional modules, mutational load and human genetic disease.

    PubMed

    Zaghloul, Norann A; Katsanis, Nicholas

    2010-04-01

    The ability to generate a massive amount of sequencing and genotyping data is transforming the study of human genetic disorders. Driven by such innovation, it is likely that whole exome and whole-genome resequencing will replace regionally focused approaches for gene discovery and clinical testing in the next few years. However, this opportunity brings a significant interpretative challenge to assigning function and phenotypic variance to common and rare alleles. Understanding the effect of individual mutations in the context of the remaining genomic variation represents a major challenge to our interpretation of disease. Here, we discuss the challenges of assigning mutation functionality and, drawing from the examples of ciliopathies as well as cohesinopathies and channelopathies, discuss possibilities for the functional modularization of the human genome. Functional modularization in addition to the development of physiologically relevant assays to test allele functionality will accelerate our understanding of disease architecture and enable the use of genome-wide sequence data for disease diagnosis and phenotypic prediction in individuals. Copyright 2010 Elsevier Ltd. All rights reserved.

  11. Functional modules, mutational load and human genetic disease

    PubMed Central

    Zaghloul, Norann A.; Katsanis, Nicholas

    2013-01-01

    The ability to generate a massive amount of sequencing and genotyping data is transforming the study of human genetic disorders. Driven by such innovation, it is likely that whole exome and whole-genome resequencing will replace regionally focused approaches for gene discovery and clinical testing in the next few years. However, this opportunity brings a significant interpretative challenge to assigning function and phenotypic variance to common and rare alleles. Understanding the effect of individual mutations in the context of the remaining genomic variation represents a major challenge to our interpretation of disease. Here, we discuss the challenges of assigning mutation functionality and, drawing from the examples of ciliopathies as well as cohesinopathies and channelopathies, discuss possibilities for the functional modularization of the human genome. Functional modularization in addition to the development of physiologically-relevant assays to test allele functionality will accelerate our understanding of disease architecture and enable the use of genome-wide sequence data for disease diagnosis and phenotypic prediction in individuals. PMID:20226561

  12. Design and testing of a coil-unit barrel for helical coil electromagnetic launcher

    NASA Astrophysics Data System (ADS)

    Yang, Dong; Liu, Zhenxiang; Shu, Ting; Yang, Lijia; Ouyang, Jianming

    2018-01-01

    A coil-unit barrel for a helical coil electromagnetic launcher is described. It provides better features of high structural strength and flexible adjustability. It is convenient to replace the damaged coil units and easy to adjust the number of turns in the stator coils due to the modular design. In our experiments, the highest velocity measured for a 4.5-kg projectile is 47.3 m/s and the mechanical reinforcement of the launcher could bear 35 kA peak current. The relationship between the energy conversion efficiency and the inductance gradient of the launcher is also studied. In the region of low inductance gradient, the efficiency is positively correlated with the inductance gradient. However, in the region of high inductance gradient, the inter-turn arc erosion becomes a major problem of limiting the efficiency and velocity of the launcher. This modular barrel allows further studies in the inter-turn arc and the variable inductance gradient helical coil launcher.

  13. Design and testing of a coil-unit barrel for helical coil electromagnetic launcher.

    PubMed

    Yang, Dong; Liu, Zhenxiang; Shu, Ting; Yang, Lijia; Ouyang, Jianming

    2018-01-01

    A coil-unit barrel for a helical coil electromagnetic launcher is described. It provides better features of high structural strength and flexible adjustability. It is convenient to replace the damaged coil units and easy to adjust the number of turns in the stator coils due to the modular design. In our experiments, the highest velocity measured for a 4.5-kg projectile is 47.3 m/s and the mechanical reinforcement of the launcher could bear 35 kA peak current. The relationship between the energy conversion efficiency and the inductance gradient of the launcher is also studied. In the region of low inductance gradient, the efficiency is positively correlated with the inductance gradient. However, in the region of high inductance gradient, the inter-turn arc erosion becomes a major problem of limiting the efficiency and velocity of the launcher. This modular barrel allows further studies in the inter-turn arc and the variable inductance gradient helical coil launcher.

  14. Environmental Systems Test Stand

    NASA Astrophysics Data System (ADS)

    Barta, D.; Young, J.; Ewert, M.; Lee, S.; Wells, P.; Fortson, R.; Castillo, J.

    A test stand has been developed for the evaluation of prototype lighting, environmental control and crop cultivation technologies for plant production within an advanced life support system. Design of the test stand was based on preliminary designs of the center growth bay of the Biomass Production Chamber, one of several modules of the Bioregenerative Planetary Life Support Systems Test Complex (BIO- Plex). It consists of two controlled-environment shelves, each with 4.7 m2 of area for crop growth (150 cm width, 315 cm length). There are two chilled water loops, one for operation at conventional temperatures (5-10C) for air temperature and humidity control and one for operation at higher temperatures (15-50C) for waste heat acquisition and heating. Modular light boxes, utilizing either air-cooled or water- jacketed HPS lamps, have been developed. This modular design will allow for easy replacement of new lighting technologies within the light banks. An advanced data acquisition and control system has been developed utilizing localized, networked- based data acquisition modules and programmed with object-based control software.

  15. Algorithmic-Reducibility = Renormalization-Group Fixed-Points; ``Noise''-Induced Phase-Transitions (NITs) to Accelerate Algorithmics (``NIT-Picking'') Replacing CRUTCHES!!!: Gauss Modular/Clock-Arithmetic Congruences = Signal X Noise PRODUCTS..

    NASA Astrophysics Data System (ADS)

    Siegel, J.; Siegel, Edward Carl-Ludwig

    2011-03-01

    Cook-Levin computational-"complexity"(C-C) algorithmic-equivalence reduction-theorem reducibility equivalence to renormalization-(semi)-group phase-transitions critical-phenomena statistical-physics universality-classes fixed-points, is exploited with Gauss modular/clock-arithmetic/model congruences = signal X noise PRODUCT reinterpretation. Siegel-Baez FUZZYICS=CATEGORYICS(SON of ``TRIZ''): Category-Semantics(C-S) tabular list-format truth-table matrix analytics predicts and implements "noise"-induced phase-transitions (NITs) to accelerate versus to decelerate Harel [Algorithmics(1987)]-Sipser[Intro. Theory Computation(1997) algorithmic C-C: "NIT-picking" to optimize optimization-problems optimally(OOPO). Versus iso-"noise" power-spectrum quantitative-only amplitude/magnitude-only variation stochastic-resonance, this "NIT-picking" is "noise" power-spectrum QUALitative-type variation via quantitative critical-exponents variation. Computer-"science" algorithmic C-C models: Turing-machine, finite-state-models/automata, are identified as early-days once-workable but NOW ONLY LIMITING CRUTCHES IMPEDING latter-days new-insights!!!

  16. Assessment of Hemodynamic Conditions in the Aorta Following Root Replacement with Composite Valve-Conduit Graft.

    PubMed

    Cheng, Zhuo; Kidher, Emaddin; Jarral, Omar A; O'Regan, Declan P; Wood, Nigel B; Athanasiou, Thanos; Xu, Xiao Yun

    2016-05-01

    This paper presents the analysis of detailed hemodynamics in the aortas of four patients following replacement with a composite bio-prosthetic valve-conduit. Magnetic resonance image-based computational models were set up for each patient with boundary conditions comprising subject-specific three-dimensional inflow velocity profiles at the aortic root and central pressure waveform at the model outlet. Two normal subjects were also included for comparison. The purpose of the study was to investigate the effects of the valve-conduit on flow in the proximal and distal aorta. The results suggested that following the composite valve-conduit implantation, the vortical flow structure and hemodynamic parameters in the aorta were altered, with slightly reduced helical flow index, elevated wall shear stress and higher non-uniformity in wall shear compared to normal aortas. Inter-individual analysis revealed different hemodynamic conditions among the patients depending on the conduit configuration in the ascending aorta, which is a key factor in determining post-operative aortic flow. Introducing a natural curvature in the conduit to create a smooth transition between the conduit and native aorta may help prevent the occurrence of retrograde and recirculating flow in the aortic arch, which is particularly important when a large portion or the entire ascending aorta needs to be replaced.

  17. The biological response to orthopedic implants for joint replacement. II: Polyethylene, ceramics, PMMA, and the foreign body reaction.

    PubMed

    Gibon, Emmanuel; Córdova, Luis A; Lu, Laura; Lin, Tzu-Hua; Yao, Zhenyu; Hamadouche, Moussa; Goodman, Stuart B

    2017-08-01

    Novel evidence-based prosthetic designs and biomaterials facilitate the performance of highly successful joint replacement (JR) procedures. To achieve this goal, constructs must be durable, biomechanically sound, and avoid adverse local tissue reactions. Different biomaterials such as metals and their alloys, polymers, ceramics, and composites are currently used for JR implants. This review focuses on (1) the biological response to the different biomaterials used for TJR and (2) the chronic inflammatory and foreign-body response induced by byproducts of these biomaterials. A homeostatic state of bone and surrounding soft tissue with current biomaterials for JR can be achieved with mechanically stable, infection free and intact (as opposed to the release of particulate or ionic byproducts) implants. Adverse local tissue reactions (an acute/chronic inflammatory reaction, periprosthetic osteolysis, loosening and subsequent mechanical failure) may evolve when the latter conditions are not met. This article (Part 2 of 2) summarizes the biological response to the non-metallic materials commonly used for joint replacement including polyethylene, ceramics, and polymethylmethacrylate (PMMA), as well as the foreign body reaction to byproducts of these materials. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 1685-1691, 2017. © 2016 Wiley Periodicals, Inc.

  18. Case study: survey of patient satisfaction with prosthesis quality and design among below-knee prosthetic leg socket users.

    PubMed

    Mohd Hawari, Nurhanisah; Jawaid, Mohammad; Md Tahir, Paridah; Azmeer, Raja Ahmad

    2017-11-01

    The aim of this case study was to explore patient satisfaction with the quality of prosthetic leg sockets intended for persons with lower limb amputations. A qualitative study based on in-depth interviews, preceded by a questionnaire session, was carried out with patients from the Rehabilitation Center and Hospital in Malaysia. Twelve out-patient and in-patient amputees with lower limb amputations, specifically below-knee amputations, were chosen randomly. The analysis of patients' narratives aimed to identify the functional and esthetic characteristics of currently used prosthetic leg sockets and any problems related to them. The obtained results indicated that out of the 12 participants, 41.7% and 25% were satisfied and somewhat satisfied with their current prosthetic sockets. Durability and comfort were rated by the participants as the most important characteristics of prosthetic sockets, with 83.3%. As regards the esthetic appearance of the socket, 66.7% of the respondents considered that the most important feature was the material from which the socket was fabricated. Thus, we conclude that current satisfaction levels with the quality of prosthetic sockets among amputees in Malaysia are suitable, prosthesis being preferred by many amputees. The results can be used to direct future research on cosmesis and functionality of prosthetic socket design. Implications for Rehabilitation Case study will help participants to get cost effective prosthetic leg socket. Develop prosthetic leg socket comfortable as comparative to existing one. Help Malaysian government to make policy to develop local prosthetic leg socket at affordable price.

  19. Undergraduate prosthetics and orthotics teaching methods: A baseline for international comparison.

    PubMed

    Aminian, Gholamreza; O'Toole, John M; Mehraban, Afsoon Hassani

    2015-08-01

    Education of Prosthetics and Orthotics is a relatively recent professional program. While there has been some work on various teaching methods and strategies in international medical education, limited publication exists within prosthetics and orthotics. To identify the teaching and learning methods that are used in Bachelor-level prosthetics and orthotics programs that are given highest priority by expert prosthetics and orthotics instructors from regions enjoying a range of economic development. Mixed method. The study partly documented by this article utilized a mixed method approach (qualitative and quantitative methods) within which each phase provided data for other phases. It began with analysis of prosthetics and orthotics curricula documents, which was followed by a broad survey of instructors in this field and then a modified Delphi process. The expert instructors who participated in this study gave high priority to student-centered, small group methods that encourage critical thinking and may lead to lifelong learning. Instructors from more developed nations placed higher priority on student's independent acquisition of prosthetics and orthotics knowledge, particularly in clinical training. Application of student-centered approaches to prosthetics and orthotics programs may be preferred by many experts, but there appeared to be regional differences in the priority given to different teaching methods. The results of this study identify the methods of teaching that are preferred by expert prosthetics and orthotics instructors from a variety of regions. This treatment of current instructional techniques may inform instructor choice of teaching methods that impact the quality of education and improve the professional skills of students. © The International Society for Prosthetics and Orthotics 2014.

  20. Assessment of a press-fit proximal femoral modular reconstruction implant (PFMR®) at 14.5 years. A 48-case series with a disturbing rate of implant fracture.

    PubMed

    Dumoulin, Q; Sabau, S; Goetzmann, T; Jacquot, A; Sirveaux, F; Mole, D; Roche, O

    2018-05-01

    The PFMR ® proximal femoral modular reconstruction implant (Protek, Sulzer Orthopedics, Switzerland) is a straight modular stem in sanded titanium with press-fit anchorage, intended to achieve spontaneous bone reconstruction following Wagner's principle. The aim of the present study was to analyze long-term clinical and radiological outcome. A single-center retrospective study included 48 PFMR stems implanted in 47 patients between 1998 and 2002. Results in this series were previously reported at 7 years' follow-up. Clinical assessment used PMA and Harris scores. Radiologic assessment focused on stem stability and osseointegration, and bone stock following Le Béguec. Twenty-three patients were seen at a mean 14.5 years' follow-up (13 deceased, 11 lost to follow-up), including 1 with bilateral implants, i.e., 24 stems. PMA and Harris scores, stem stability and osseointegration and bone stock were stable with respect to the 7-year findings. Radiology found 7 stem fractures in the Morse taper, i.e., in 29% of implants. Two of these cases required femoral implant replacement; 5 were asymptomatic. Long-term outcome for PFMR stems was clinically and radiologically satisfactory for the 16 patients free of mechanical complications. The Morse taper fracture rate was high, and higher than reported elsewhere. The usual risk factors for implant fracture were not found in the present series. The modular design of the press-fit revision implant is its weak point; monoblock implants should be used in patients with good life-expectancy. IV (retrospective study). Copyright © 2018 Elsevier Masson SAS. All rights reserved.

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