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  • 1
    Language: English
    In: Journal of Biomechanics, 15 March 2013, Vol.46(5), pp.949-955
    Description: Stem–cement and cement–bone interfacial failures as well as cement fractures have been noted in cemented total hip arthroplasty (THA) as the cause of aseptic loosening. Attempts to reduce the risk of femoral component loosening include improving the stem–cement interface by various coatings, using a textured or porous coated stem surfaces or by using a tapered stem having a highly-polished surface. The latter approach, often referred to as “force-closed” femoral stem design, would theoretically result in stem stabilization subsequent to debonding and ‘taper-lock’. Previous work using three-dimensional finite element analysis has shown a state of stress at the stem–cement interface indicative of ‘taper-lock’ for the debonded stem and indicated that stem–cement interface friction and bone cement creep played a significant role in the magnitudes of stresses and subsidence of the stem. However, the previous analysis did not include the viscoelastic properties of bone, which has been hypothesized to permit additional expansion of the bone canal and allow additional stem subsidence ( ). The goal of this study was to investigate the effect of bone viscoelastic behavior on stem subsidence using a 3D finite element analysis. It was hypothesized that the viscoelastic behavior of bone in the hoop direction would allow expansion of the bone reducing the constraint on bone over time and permit additional stem subsidence, which may account for the discrepancies between predicted and clinical subsidence measurements. Analyses were conducted using physiological loads, ‘average peak loads’ and ‘high peak loads’ for ‘normal patient’ and ‘active patient’ ( ) from which short and long term subsidence was predicted. Results indicated that bone creep does contribute to higher stem subsidence initially and after 10 years of simulated loading. However, it was concluded that the “constraint” upon the cement mantle is not mitigated enough to result in stem subsidence equivalent to that observed clinically.
    Keywords: Cemented Total Hip Arthroplasty ; Cortical Bone Creep ; Bone Cement Creep ; Stem Subsidence ; Stem–Cement Interface Failure ; Medicine ; Engineering ; Anatomy & Physiology
    ISSN: 0021-9290
    E-ISSN: 1873-2380
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  • 2
    Language: English
    In: Journal of Clinical Epidemiology, May 2013, Vol.66(5), pp.503-510.e4
    Description: To identify high-priority research questions for osteoarthritis systematic reviews with consideration of health equity and the social determinants of health (SDH). We consulted with experts and conducted a literature search to identify a priority-setting method that could be adapted to address the health equity and SDH. We selected the Global Evidence Mapping priority-setting method, and through consultations and consensus, we adapted the method to meet our objectives. This involves developing an evidence map of the existing systematic reviews on osteoarthritis; conducting one face-to-face workshop with patients and another one with clinicians, researchers, and patients; and conducting an online survey of patients to rank the top 10 research questions. We piloted the adapted method with the Cochrane Musculoskeletal Review Group to set research priorities for osteoarthritis. Our focus was on systematic reviews: we identified 34 high-priority research questions for osteoarthritis systematic reviews. Prevention and self-management interventions, mainly diet and exercise, are top priorities for osteoarthritis systematic reviews. Evaluation against our predefined objectives showed that this method did prioritize SDH (50% of the research questions considered SDH). There were marked gaps: no high-priority topics were identified for access to care until patients had advanced disease–lifestyle changes once the disease was diagnosed. This method was felt feasible if conducted annually. We confirmed the utility of an adapted priority-setting method that is feasible and considers SDH. Further testing of this method is needed to assess whether considerations of health equity are prioritized and involve disadvantaged groups of the population.
    Keywords: Priority Setting ; Health Equity ; Osteoarthritis ; Social Determinants of Health ; Systematic Reviews ; Methods ; Methodology ; Research Priorities ; Medicine
    ISSN: 0895-4356
    E-ISSN: 1878-5921
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  • 3
    In: The Journal of Bone & Joint Surgery, 2011, Vol.93(16), pp.1519-1526
    Description: BACKGROUND:: Implant-related impingement has been reported following metal-on-metal hip resurfacing, and reactive osseous patterns associated with implant-bone impingement have been identified. The purpose of this study was to determine the prevalence and clinical implications of radiographic signs of femoral neck-acetabular cup impingement following metal-on-metal hip resurfacing. METHODS:: Serial anteroposterior and lateral radiographs made five to 12.9 years postoperatively were available for ninety-one of the first 100 metal-on-metal hip resurfacing procedures (in eighty-nine patients) performed by the senior author. These radiographs were reviewed by a single independent observer, who was blinded to the clinical results. Radiographic signs of impingement were assessed and were correlated with clinical outcomes. RESULTS:: Twenty hips (in eighteen patients) had at least one of two reactive osseous signs: a solitary exostosis (six hips, 7%) and an erosive “divot-type” deformity (twenty hips, 22%). Each radiographic sign occurred predominantly at the superior aspect of the femoral neck just distal to the femoral component. None of the patients with such an impingement sign reported any symptoms or discomfort during examination of the range of hip motion. These patients had a greater mean postoperative University of California Los Angeles activity score and a greater mean range of hip motion than the patients without an impingement sign. Based on the numbers available, there was no association between component size, abduction angle and anteversion angle of the socket, femoral stem-femoral shaft angle, or femoral component-femoral neck ratio and the occurrence of repetitive impingement signs on radiographs. CONCLUSIONS:: The reactive osseous features identified in this study should facilitate the radiographic assessment of impingement in other patients following hip resurfacing arthroplasty. Longer-term follow-up is needed to determine whether radiographic signs of impingement are of prognostic consequence. LEVEL OF EVIDENCE:: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.
    Keywords: Adolescent–Methods ; Adult–Diagnostic Imaging ; Aged–Epidemiology ; Arthroplasty, Replacement, Hip–Etiology ; Female–Diagnostic Imaging ; Femoracetabular Impingement–Surgery ; Hip–Diagnostic Imaging ; Hip Joint–Surgery ; Hip Prosthesis–Adverse Effects ; Humans–Adverse Effects ; Male–Adverse Effects ; Middle Aged–Adverse Effects ; Prevalence–Adverse Effects ; Radiography–Adverse Effects ; Range of Motion, Articular–Adverse Effects ; Abridged;
    ISSN: 0021-9355
    E-ISSN: 15351386
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  • 4
    In: The Journal of Bone and Joint Surgery, 2014, Vol.96(11), pp.e91-e91
    Description: BACKGROUND:: The treatment of highly comminuted tibial pilon fractures is controversial. The aim of this study was to determine the effectiveness and outcomes of primary arthrodesis following highly comminuted tibial plafond fractures. METHODS:: A database search was performed to identify all patients who underwent blade plate arthrodesis at our institution over a sixteen-year period. Inclusion criteria included patients with an Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association type-C2 or type-C3 pilon fracture that was deemed to be non-reconstructable by the treating surgeon. Outcomes were measured using the Short-Form 36-Item Health Survey, time to independent walking, time to consolidation of the arthrodesis, and wound-healing complications. RESULTS:: A total of twenty patients were included in this study, and seventeen patients (85%) were available for follow-up at a minimum of two years after their surgery. Wound infections or wound dehiscence did not occur in this series. All patients were walking without crutches or a walker at their latest follow-up. One patient developed an aseptic nonunion and healed successfully after revision surgery. CONCLUSIONS:: Blade plate ankle fusion using a posterior approach is a reliable method for the treatment of a small subset of patients with severely comminuted, non-reconstructable pilon fractures. LEVEL OF EVIDENCE:: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
    Keywords: Adolescent–Surgery ; Adult–Methods ; Aged–Methods ; Aged, 80 and Over–Surgery ; Ankle Fractures–Surgery ; Arthrodesis–Surgery ; Bone Plates–Surgery ; Female–Surgery ; Fracture Fixation, Internal–Surgery ; Fractures, Comminuted–Surgery ; Humans–Surgery ; Male–Surgery ; Middle Aged–Surgery ; Tibial Fractures–Surgery ; Treatment Outcome–Surgery ; Abridged;
    ISSN: 0021-9355
    E-ISSN: 15351386
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  • 5
    In: Circulation, 2012, Vol.125(18), pp.e640-e644
    Description: A 68-year-old white man presented for work-up of recurring atypical resting chest pain in the setting of known coronary artery disease. ECG and chest x-ray on admission can be viewed in Figures 1 and 2. Two years previously, invasive angiography was performed because of unstable angina revealing dilative coronary sclerosis of all coronaries with a proximal right coronary artery stenosis, which was treated with percutaneous intervention by another cardiologist at that time (Figure 3 and online-only Data Supplement Movies I–III). Figure 1. Twelve-lead ECG on admission demonstrating left-axis deviation, ectopic beats, and nonsignificant ST-segment abnormalities. Figure 2. Chest x-ray on admission revealing a normal-size heart, aspects of pulmonary emphysema, and small amounts of fluid in the right costophrenic angle. Figure 3. First invasive coronary angiography of the left (LCA) ( A ) and the right (RCA) ( B ) coronary arteries performed by another cardiologist 2 years previously. Note the proximal RCA stenosis (white arrows) in the setting of diffuse dilative coronary sclerosis ( C ), which was treated by percutaneous intervention. To evaluate possible progress of coronary artery disease, adenosine stress first-pass perfusion cardiovascular magnetic resonance (CMR) using a 1.5T Magnetom Aera (Siemens Healthcare, Erlangen, Germany) was performed. However, no myocardial ischemia could be detected by CMR in …
    Keywords: Medicine ; Anatomy & Physiology;
    ISSN: 0009-7322
    E-ISSN: 15244539
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  • 6
    In: The Journal of Trauma: Injury, Infection, and Critical Care, 2011, Vol.71(3), pp.523-527
    Description: BACKGROUND:: The optimal method for spinal evaluation after penetrating trauma is currently unknown. The goal of this study was to determine the sensitivity and specificity of a standardized clinical examination for the detection of spinal injuries after penetrating trauma. METHODS:: After Institutional Review Board approval, all evaluable penetrating trauma patients aged 15 years or more admitted to the Los Angeles County + University of Southern California Medical Center were prospectively evaluated for spinal pain, tenderness to palpation, deformity, and neurologic deficit. RESULTS:: During the 6-month study period, 282 patients were admitted after sustaining a penetrating injury; 143 (50.7%) as a result of gunshot wound (GSW) and 139 (49.3%) as a result of stab wound (SW). None of the patients sustaining a SW had a spinal injury. Of the 112 evaluable GSW patients, 9 sustained an injury: 6 with a true-positive and 3 with a false-negative clinical examination. The overall sensitivity, specificity, positive predictive value, and negative predictive value were 66.7%, 89.6%, 46.2% and 95.2%, respectively. For clinically significant injuries requiring surgical intervention, cervical or thoracolumbar spine orthosis, or cord transections, however, the sensitivity of clinical examination was 100.0%, specificity 87.5%, positive predictive value 30.8%, and negative predictive value 87.5%. CONCLUSION:: Clinically significant spinal injury, although rare after SWs, is not uncommon after GSWs. A structured clinical examination of the spine in evaluable patients who have sustained a GSW is highly reliable for identifying those with clinically significant injuries.
    Keywords: Adolescent–Diagnosis ; Adult–Etiology ; Aged–Complications ; Aged, 80 and Over–Diagnosis ; Clinical Protocols–Complications ; Cohort Studies–Diagnosis ; Female–Diagnosis ; Humans–Diagnosis ; Male–Diagnosis ; Middle Aged–Diagnosis ; Physical Examination–Diagnosis ; Predictive Value of Tests–Diagnosis ; Reproducibility of Results–Diagnosis ; Spinal Injuries–Diagnosis ; Tomography, Spiral Computed–Diagnosis ; Wounds, Gunshot–Diagnosis ; Wounds, Stab–Diagnosis ; Young Adult–Diagnosis ; Abridged;
    ISSN: 0022-5282
    E-ISSN: 15298809
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  • 7
    Language: English
    In: The Journal of applied psychology, May 2005, Vol.90(3), pp.574-85
    Description: This article presents an empirical test of organizational identification in the context of customer-company (C-C) relationships. It investigates whether customers identify with companies and what the antecedents and consequences of such identification are. The model posits that perceived company characteristics, construed external image, and the perception of the company's boundary-spanning agent lead to C-C identification. In turn, such identification is expected to impact both in-role behavior (i.e., product utilization) as well as extra-role behavior (i.e., citizenship). The model was tested in a consultative selling context of pharmaceutical sales reps calling on physicians. Results from the empirical test indicated that customers do indeed identify with organizations and that C-C identification positively impacts both product utilization behavior and extra-role behavior even when the effect of brand perception is accounted for. Second, the study found that the organization's characteristics as well as the salesperson's characteristics contributed to the development of C-C identification.
    Keywords: Drug Industry ; Interprofessional Relations ; Marketing ; Models, Organizational ; Organizational Affiliation ; Social Identification ; Physicians -- Psychology
    ISSN: 0021-9010
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  • 8
    Language: English
    In: PLoS ONE, 01 January 2014, Vol.9(4), p.e95624
    Description: To examine LMP10 expression and its possible impact on clinical outcome in human papillomavirus (HPV) positive and HPV-negative tonsillar and base of tongue squamous cell carcinoma (TSCC and BOTSCC).Outcome is better in HPV-positive TSCC and BOTSCC compared to matching HPV-negative tumours, with roughly 80% vs. 40% 5-year disease free survival (DFS) with less aggressive treatment than today's chemoradiotherapy. Since current treatment often results in harmful side effects, less intensive therapy, with sustained patient survival would be an attractive alternative. However, other markers together with HPV status are necessary to select patients and for this purpose LMP10 expression is investigated here in parallel to HPV status and clinical outcome.From 385 patients diagnosed between 2000 and 2007 at the Karolinska University Hospital, 278 formalin fixed paraffin embedded TSCC and BOTSCC biopsies, with known HPV DNA status, were tested for LMP10 nuclear and cytoplasmic expression (fraction of positive cells and staining intensity). The data was then correlated to clinical outcome.An absent/low compared to a moderate/high LMP10 nuclear fraction of positive cells was correlated to a better 3-year DFS in the HPV-positive group of patients (log-rank p = 0.005), but not in the HPV-negative group. In the HPV-negative group of patients, in contrast to the HPV-positive group, moderate/high LMP10 cytoplasmic fraction and weak/moderate/high LMP10 cytoplasmic intensity correlated to a better 3-year DFS (p = 0.003 and p = 0.001) and 3-year overall survival (p = 0.001 and 0.009).LMP10 nuclear expression in the HPV-positive group and LMP10 cytoplasmic expression in the HPV-negative group of patients correlated to better clinical outcome.
    Keywords: Sciences (General)
    E-ISSN: 1932-6203
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  • 9
    Language: English
    In: Journal of Psychosomatic Research, February 2018, Vol.105, pp.125-131
    Description: Low socio-economic status (SES) has been associated with an increased coronary risk in Western countries. All stress experiences are more pronounced in low SES patients with stress emanating from problems with family, job, or money. The SPIRR-CAD study offered an excellent opportunity to examine these risk factors in German speaking mildly and medium depressed patients. In the SPIRR CAD study, a German multi centre randomized clinical trial of 450 male and 120 female coronary patients, we examined the standard and psychosocial risk factor profiles in relation to SES, as assessed by educational level. All differences in risk factors between low and high SES were in the inverse direction. Of standard risk factors, only smoking was socially graded and more common in low SES. Of psychosocial factors and emotions, exhaustion showed the strongest and most consistent inverse social gradient, but also anger, anxiety and depression were socially graded. The findings suggest that in German patients, as in other national groups, social gradients in CHD risk are considerable. They can be ascribed to both psychosocial and to standard risk factors. In the present two years follow-up, the prospective significance of psychological and social risk factors was analyzed showing that emotional factors played an important role, in that low and high SES patients differed in the expected direction. However, the differences were not statistically significant and therefore firm conclusions from follow up were not possible. Trial registration: ISRCTN 76240576;
    Keywords: Coronary Artery Disease ; Risk Factors ; Social Grade ; Low Socio Economic Status ; Psycho Social Stress ; Gender
    ISSN: 0022-3999
    E-ISSN: 1879-1360
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  • 10
    In: Spine, 2013, Vol.38(2), pp.169-177
    Description: STUDY DESIGN.: Retrospective cohort study. OBJECTIVE.: To identify early independent mortality predictors after spine trauma. SUMMARY OF BACKGROUND DATA.: Spine trauma consists of spinal cord and spine column injury. The ability to identify early (within 24 hours) risk factors predictive of mortality in spine trauma has the potential to reduce mortality and improve spine trauma management. METHODS.: Analysis was performed on 215 spine column and/or spinal cord injured patients from July 2008 to August 2011. Univariate and multivariate logistic regression models were applied to investigate the effects of the Injury Severity Score, age, mechanism of injury, blood glucose level, vital signs, brain trauma severity, morbidity before trauma, coagulation profile, neurological status, and spine injuries on the risk of in-hospital death. RESULTS.: Applying a multivariate logistic regression model, there were 7 independent early predictive factors for mortality after spine injury. They were (1) Injury Severity Score more than 15 (odds ratio [OR] = 3.67; P = 0.009), (2) abnormal coagulation profile (OR = 6; P 〈 0.0001), (3) patients 65 years or older (OR = 3.49; P = 0.007), (4) hypotension (OR = 2.9; P = 0.033), (5) tachycardia (OR = 4.04; P = 0.005), (6) hypoxia (OR = 2.9; P = 0.033), and (7) multiple comorbidities (OR = 3.49; P = 0.007). Severe traumatic brain injury was also associated with mortality but was excluded from multivariate analysis because there were no patients with this variable in the comparison group. CONCLUSION.: Mortality predictors for spine trauma patients are similar to those for general trauma patients. Spine injury variables were shown not to be independent predictors of spine trauma mortality.
    Keywords: Aged–Epidemiology ; Australia–Diagnosis ; Cause of Death–Mortality ; Comorbidity–Diagnosis ; Early Diagnosis–Mortality ; Female–Mortality ; Humans–Mortality ; Male–Mortality ; Prognosis–Mortality ; Retrospective Studies–Mortality ; Risk Factors–Mortality ; Spinal Cord Injuries–Mortality ; Spinal Injuries–Mortality ; Survival Rate–Mortality ; Time Factors–Mortality ; Trauma Severity Indices–Mortality ; Vital Signs–Mortality;
    ISSN: 0362-2436
    E-ISSN: 15281159
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