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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
    Language: English
    In: Journal of Biomechanics, 03 May 2016, Vol.49(7), pp.1214-1220
    Description: During intervertebral disc (IVD) injury and degeneration, annulus fibrosus (AF) cells experience large mechanical strains in a pro-inflammatory milieu. We hypothesized that TNF-α, an initiator of IVD inflammation, modifies AF cell mechanobiology via cytoskeletal changes, and interacts with mechanical strain to enhance pro-inflammatory cytokine production. Human AF cells ( =5, Thompson grades 2–4) were stretched uniaxially on collagen-I coated chambers to 0%, 5% (physiological) or 15% (pathologic) strains at 0.5 Hz for 24 h under hypoxic conditions with or without TNF-α (10 ng/mL). AF cells were treated with anti-TNF-α and anti-IL-6. ELISA assessed IL-1β, IL-6, and IL-8 production and immunocytochemistry measured F-actin, vinculin and α-tubulin in AF cells. TNF-α significantly increased AF cell pro-inflammatory cytokine production compared to basal conditions (IL-1β:2.0±1.4–84.0±77.3, IL-6:10.6±9.9–280.9±214.1, IL-8:23.9±26.0–5125.1±4170.8 pg/ml for basal and TNF-α treatment, respectively) as expected, but mechanical strain did not. Pathologic strain in combination with TNF-α increased IL-1β, and IL-8 but not IL-6 production of AF cells. TNF-α treatment altered F-actin and α-tubulin in AF cells, suggestive of altered cytoskeletal stiffness. Anti-TNF-α (infliximab) significantly inhibited pro-inflammatory cytokine production while anti-IL-6 (atlizumab) did not. In conclusion, TNF-α altered AF cell mechanobiology with cytoskeletal remodeling that potentially sensitized AF cells to mechanical strain and increased TNF-α-induced pro-inflammatory cytokine production. Results suggest an interaction between TNF-α and mechanical strain and future mechanistic studies are required to validate these observations.
    Keywords: Annulus Fibrosus ; Intervertebral Disc Degeneration ; Tnf-Α ; Mechanical Stretch ; Mechanotransduction ; Infliximab ; Medicine ; Engineering ; Anatomy & Physiology
    ISSN: 0021-9290
    E-ISSN: 1873-2380
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  • 7
    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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  • 8
    Language: English
    In: International Journal of Radiation Oncology, Biology, Physics, 01 February 2012, Vol.82(2), pp.e137-e143
    Description: To demonstrate the feasibility and safety of the simultaneous integrated boost technique for dose escalation in combination with helical tomotherapy in patients with cervical cancer. Forty patients (International Federation of Gynecology and Obstetrics Stage IB1 pN1–IVA) underwent primary chemoradiation with helical tomotherapy. Before therapy, 29/40 patients underwent laparoscopic pelvic and para-aortic lymphadenectomy. In 21%, 31%, and 3% of the patients, pelvic, pelvic and para-aortic, and skip metastases in the para-aortic region could be confirmed. All patients underwent radiation with 1.8–50.4 Gy to the tumor region and the pelvic (para-aortic) lymph node region (planning target volume-A), and a simultaneous boost with 2.12–59.36 Gy to the boost region (planning target volume-B). The boost region was defined using titan clips during laparoscopic staging. In all other patients, standardized borders for the planning target volume-B were defined. High-dose-rate brachytherapy was performed in 39/40 patients. The mean biologic effective dose to the macroscopic tumor ranged from 87.5 to 97.5 Gy. Chemotherapy consisted of weekly cisplatin 40 mg/m . Dose–volume histograms and acute gastrointestinal, genitourinary, and hematologic toxicity were evaluated. The mean treatment time was 45 days. The mean doses to the small bowel, rectum, and bladder were 28.5 ± 6.1 Gy, 47.9 ± 3.8 Gy, and 48 ± 3 Gy, respectively. Hematologic toxicity Grade 3 occurred in 20% of patients, diarrhea Grade 2 in 5%, and diarrhea Grade 3 in 2.5%. There was no Grade 3 genitourinary toxicity. All patients underwent curettage 3 months after chemoradiation, which confirmed complete pathologic response in 38/40 patients. The concept of simultaneous integrated boost for dose escalation in patients with cervical cancer is feasible, with a low rate of acute gastrointestinal and genitourinary toxicity. Whether dose escalation can be translated into improved outcome will be assessed after a longer follow-up time.
    Keywords: Chemoradiation ; Helical Tomotherapy ; Cervical Cancer ; Toxicity ; Simultaneous Boost ; Medicine
    ISSN: 0360-3016
    E-ISSN: 1879-355X
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  • 9
    Language: English
    In: Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al], June 2011, Vol.187(6), pp.344-9
    Description: Compared to laparotomic surgery, laparoscopically assisted radical vaginal hysterectomy (LARVH) offers decreased blood loss during surgery and faster convalescence of the patient postoperatively, while at the same time delivering similar oncologic results. However, there is no data on outcome and toxicity of LARVH followed by (chemo)radiation. A total of 55 patients (range 28-78 years) with cervical cancer on FIGO stages IB1-IIIA (Tables 1 and 2) with risk factors were submitted to either external beam radiotherapy alone [EBRT, n = 8 (14%), including paraaortic irradiation, n = 4 (2.2%); EBRT and brachytherapy (BT), n = 33 (60%); BT alone, n = 14 (25.5%)] or chemoradiation after LARVH. At a median follow-up of 4.4 years, the 5-year disease-free survival (DFS) was 81.8% with 84.5% overall survival (OS). Acute grade 3 side effects were seen in 4 patients. These were mainly gastrointestinal (GI) and genitourinary (GU) symptoms. Grade 4 side effects were not observed. With similar oncologic outcome data and mostly mild side effects, LARVH followed by (chemo)radiation is a valid alternative in the treatment of cervical cancer patients.
    Keywords: Hysterectomy, Vaginal ; Laparoscopy ; Radiotherapy ; Adenocarcinoma -- Therapy ; Antineoplastic Agents -- Therapeutic Use ; Carcinoma, Squamous Cell -- Therapy ; Uterine Cervical Neoplasms -- Therapy
    ISSN: 01797158
    E-ISSN: 1439-099X
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  • 10
    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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