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PubMedDate not supplied

An in vitro biomechanical comparison of the insertion variables and pullout mechanical properties of ao 6.5-mm standard cancellous and 7.3-mm self-tapping, cannulated bone screws in foal femoral bone.

OBJECTIVE: To compare screw insertion variables and pullout mechanical properties between AO 6.5-mm cancellous and 7.3-mm cannulated bone screws in foal femoral bone. STUDY DESIGN: A paired, in vitro mechanical study. SAMPLE POPULATION: Seven pairs of femora from immature (1-7 months) foals. METHODS: The 6.5 cancellous and 7.3-mm cannulated screws were inserted at standardized proximal and distal metaphyseal, and mid-diaphyseal locations. Insertion torque, force, and time to drill, tap (6.5-mm cancellous), guide wire insertion (7.3-mm cannulated), and screw insertion were measured. Screw pullout properties (yield and failure load, displacement, and energy, and stiffness) were determined from mechanical tests. The effects of screw type and location on insertion variables and pullout properties were assessed with repeated measures ANOVA. Pairwise comparisons were examined with post hoc contrasts. Significance was set at P<.05 for all comparisons. RESULTS: Insertion torques for the 7.3-mm cannulated screws were significantly greater than for the 6.5-mm tap, but significantly lower than for the 6.5-mm cancellous screws. Total screw insertion times were similar. Pullout properties of both screws were similar at each femoral location. The holding power of both screws was significantly greater in the mid-diaphysis than in either metaphyseal location. Pullout failure occurred by bone shearing at the bone-screw interface in all specimens. CONCLUSIONS: The 6.5-mm cancellous and 7.3-mm cannulated screws vary in insertion properties, but have similar pullout properties in the mid-diaphysis, proximal, and distal metaphysis of foal femora. Both screw types have greater holding power at the mid-diaphyseal location compared with metaphyseal locations. Based on overall similar holding powers of 6.5-mm cancellous and 7.3-mm cannulated screws, it is unlikely that increasing the screw diameter beyond 6.5 mm will provide increased holding power in foal femoral bone. CLINICAL RELEVANCE: Use of the 7.3-mm cannulated screw should be considered for foal femoral fracture repair when greater accuracy is needed, or when bone threads for the 6.5-mm cancellous screw have been stripped.

Animals↗
PubMed2005

Navigated vs. conventional implant insertion for maxillary single tooth replacement.

UNLABELLED: Abstract Introduction: Computer-guided navigation has proven a valuable tool in several surgical disciplines. During oral implant placement, its application is intended to accomplish optimal implant localization and to reduce the risk of damage to adjacent structures. The aim of this study was to compare the precision limits of conventional vs. navigated implant insertion in practice. MATERIALS AND METHODS: In cast models of the maxilla, implants were inserted to replace the left central incisor (n = 40) and the right canine (n = 40); each of those were inserted either conventionally (n = 20) or navigated (n = 20). Implant position, angulation and insertion depth were calculated from computer tomography scans of the implants that were connected to an index abutment of 40 cm length. RESULTS: The variations of implant positions were reduced for implants that were inserted by navigation (P < 0.05). In both the axial and the transversal plane, the variations of implant angulations were reduced for implants that were inserted by a navigation protocol (P < 0.05). The variations of insertion depth were less (P < 0.05) when the implants were placed by navigation in comparison with conventional insertion procedures. CONCLUSIONS: Given the experimental conditions, although they tried to mimic a clinical situation, no final conclusions can be drawn. The in vitro application of a navigation system resulted in an improved precision of insertion surgery regarding the position, angulation and depth of an implant. Clinical studies will have to prove if routine image guidance will result in superior surgical outcome.

Cuspid↗
PubMed2000

Design and validation of a machine for reproducible precision insertion of femoral hip prostheses for preclinical testing.

Preclinical testing of orthopaedic implants is becoming increasingly important to eliminate inferior designs before animal experiments or clinical trials are begun. Preclinical tests can include both laboratory bench tests and computational modeling. One problem with bench tests is that variability in prosthesis insertion can significantly influence the failure rate; this makes comparison of prostheses more difficult. To solve this problem an insertion method is required that is both accurate and reproducible. In this work, a general approach to the insertion of hip prostheses into femoral bones is proposed based on physically replicating an insertion path determined using computer animation. As a first step, the seated prosthesis position is determined from templates and femur radiographs. Three-dimensional images of the prosthesis and bone are then imported into computer animation software and an insertion path in the coronal plane is determined. The insertion path is used to determine the profile of a cam. By attaching the prosthesis to a carriage, which is pneumatically moved along this cam, the required insertion motion of the prosthesis in the coronal plane can be achieved. This paper describes the design and validation of the insertion machine. For the validation study, a nonsymmetric hip prosthesis design (Lubinus SPII, Waldemar Link, Germany) is used. It is shown that the insertion machine has sufficient accuracy and reproducibility for preclinical mechanical testing.

Animals↗
PubMed1988

Cloning and transposon insertion mutagenesis of virulence genes of the 100-kilobase plasmid of Salmonella typhimurium.

We have cloned regions of the 100-kilobase (kb) plasmid, pStSR100, of Salmonella typhimurium SR-11 that confer virulence to plasmid-cured S. typhimurium. Cells carrying recombinant plasmids that conferred virulence were selected by inoculating mice orally with recombinant libraries in virulence plasmid-cured S. typhimurium and harvesting isolates that infected spleens. Three plasmids, pYA401, pYA402, and pYA403, constructed with the cosmid vector pCVD305 conferred wild-type levels of virulence to plasmid-cured S. typhimurium and had a common 14-kb DNA insert sequence. Another recombinant plasmid, pYA422, constructed with the vector pACYC184, conferred to plasmid-cured S. typhimurium a wild-type 50% lethal dose (LD50) level, but mice died more slowly than when infected with wild-type S. typhimurium. Furthermore, pYA422 conferred the ability to cause a higher, but not a wild-type, level of splenic infection on plasmid-cured S. typhimurium. pYA422 had a 3.2-kb insert sequence which mapped to the center of the 14-kb common sequence of the cosmid clones. Transposon Tn5 insertion mutations in pYA403 inhibited virulence to various degrees, and when transduced into the native virulence plasmid of S. typhimurium, these Tn5 insertions decreased virulence to degrees similar to those observed when the Tn5 insertions were present in pYA403. vir-22::Tn5 in pStSR100 greatly lowered infection of spleens relative to unmutagenized virulence plasmid, while vir-26::Tn5 and vir-27::Tn5 lowered splenic infection to lesser degrees. At least three proteins were encoded by pYA403 containing 23 kb of insert sequence and subclone pYA420, containing the 14-kb common insert sequence present in all of the cosmid clones. One of these proteins, with an apparent molecular weight of 28,000, was also encoded by pYA422. The Tn5 insertion that most attenuated virulence, vir-22::Tn5, inhibited synthesis of the 28,000-molecular-weight protein. The vir-22::Tn5 insertion was complemented by recombinant plasmids encoding only the 28,000-molecular-weight protein, suggesting a role of this protein in virulence. However, recombinant plasmids, exemplified by pYA422, that encoded only the 28,000-molecular-weight protein did not confer full virulence.

Animals↗
PubMed1999

Genomic loci of the Porphyromonas gingivalis insertion element IS1126.

The Porphyromonas gingivalis genome contains multiple copies of insertion element IS1126. When chromosomal DNA digests of different strains were probed with IS1126, between 25 and 35 hybridizing fragments per genome were detected, depending on the strain. Unrelated strains had very different restriction fragment length polymorphism (RFLP) patterns. When different laboratory copies of a specific strain were examined, the IS1126 RFLP patterns were very similar but small differences were observed, indicating that element-associated changes had occurred during laboratory passage. Within the next year, genome sequencing, assembly, and annotation for P. gingivalis W83 will be completed. Because repetitive elements complicate the assembly of randomly sequenced DNA fragments, we isolated and sequenced the flanking regions of IS1126 copies in strain W83. We also isolated and sequenced the flanking regions of IS1126 copies in strain ATCC 33277 in order to compare insertion sites in phylogenetically divergent strains. We identified 37 new sequences flanking IS1126 from strain ATCC 33277 and 30 from strain W83. The insertion element was found between genes except where it transposed into another insertion element. Examination of identifiable flanking genes or open reading frames indicated that the insertion sites were different in the two strains, except that both strains possess an insertion adjacent to the Lys-gingipain gene (J. P. Lewis and F. L. Macrina, Infect. Immun. 66:3035-3042, 1998). Most of the genes or sequences flanking IS1126 in ATCC 33277 were present in W83 but were contiguous and not insertion element associated. Thus, where genes were identified in both strains, their order was maintained, indicating that the two genomes are organized similarly, but the loci of IS1126 are different. In both strains, insertion element-associated duplicated target sites were lost from several copies of IS1126, providing evidence of homologous recombination between elements. Larger organizational differences between the genomes, such as deletions and inversions, may result from insertion element-mediated recombination events.

DNA Transposable Elements↗
PubMed1980

Characterization of Tn904 insertions in octopine Ti plasmid mutants of Agrobacterium tumefaciens.

Seven Tn904 insertion mutants of pTi Ach5 affecting Agrobacterium tumefaciens virulence were studied. The mutant character was shown to be plasmid borne. Four of these mutants were avirulent and carried an insertion in restriction endonuclease HpaI fragment 12, a 3.3-megadalton fragment, which therefore appears to be a Ti plasmid region essential for virulence. Two mutants were attenuated in virulence. The inserts mapped close to HpaI fragment 12. One mutant giving rise to small tumors with excessive adventitious root formation on Kalanchoe daigremontiana carried an insertion in the right side of the common sequence in the deoxyribonucleic acid of the Ti plasmid detected in crown gall tumors. The insertion behavior of Tn904 was studied by analyzing 11 independently isolated and randomly chosen mutants. The Tn904 inserts did not affect oncogenicity, tumor morphology, bacterial transfer functions, octopine catabolism functions, or vital parts of the Ti plasmid, such as the origin of replication. Most of the Tn904 inserts were concentrated in a small part of the map. The size of additional deoxyribonucleic acid as a result of Tn904 inserts varied between 5 and 15 megadaltons. In two cases a Ti plasmid was found with two Tn904 insertions at different positions.

Arginine↗
PubMed1991

An Acetobacter xylinum insertion sequence element associated with inactivation of cellulose production.

An insertion sequence (IS) element, IS1031, caused insertions associated with spontaneous cellulose deficient (Cel-) mutants of Acetobacter xylinum ATCC 23769. The element was discovered during hybridization analysis of DNAs from Cel- mutants of A. xylinum ATCC 23769 with pAXC145, an indigenous plasmid from a Cel- mutant of A. xylinum NRCC 17005. An IS element, IS1031B, apparently identical to IS1031, was identified on pAXC145. IS1031 is about 950 bp. DNA sequencing showed that the two elements had identical termini with inverted repeats of 24 bp containing two mismatches and that they generated 3-bp target sequence duplications. The A. xylinum ATCC 23769 wild type carries seven copies of IS1031. Southern hybridization showed that 8 of 17 independently isolated spontaneous Cel- mutants of ATCC 23769 contained insertions of an element homologous to IS1031. Most insertions were in unique sites, indicating low insertion specificity. Significantly, two insertions were 0.5 kb upstream of a recently identified cellulose synthase gene. Attempts to isolate spontaneous cellulose-producing revertants of these two Cel- insertion mutants by selection in static cultures were unsuccessful. Instead, pseudorevertants that made waxlike films in the liquid-air interface were obtained. The two pseudorevertants carried new insertions of an IS1031-like element in nonidentical sites of the genome without excision of the previous insertions. Taken together, these results suggest that indigenous IS elements contribute to genetic instability in A. xylinum. The elements might also be useful as genetic tools in this organism and related species.

Base Sequence↗
PubMed1992

Insertion and excision of Bacteroides conjugative chromosomal elements.

Many strains of Bacteroides harbor large chromosomal elements that can transfer themselves from the chromosome of the donor to the chromosome of the recipient. Most of them carry a tetracycline resistance (Tcr) gene and have thus been designated Tcr elements. In the present study, we have used transverse alternating field electrophoresis to show that all but one of the Tcr elements screened were approximately 70 to 80 kbp in size. The exception (Tcr Emr 12256) was 150 to 200 kbp in size and may be a hybrid element. All of the Tcr elements inserted in more than one site, but insertion was not random. The Tcr elements sometimes cotransfer unlinked chromosomal segments, or nonreplicating Bacteroides units (NBUs). Transverse alternating field electrophoresis analysis showed that insertion of NBUs was not random and that the NBUs did not insert near the Tcr element. Although attempts to clone one or both ends of a Tcr element have not been successful, ends of a cryptic element (XBU4422) were cloned previously and shown to be homologous to the ends of Tcr elements. We have obtained DNA sequences of junction regions between XBU4422 and its target from several different insertions. Comparison of junction sequences with target sequences showed that no target site duplication occurred during insertion and that XBU4422 carried 4 to 5 bp of adjacent chromosomal DNA when it excised from the chromosome and inserted in a plasmid. We identified a short region of sequence similarity between one of the ends of XBU4422 and its target site that may be important for insertion. This sequence contained an 8-bp segment that was identical to the recombinational hot spot sequence on Tn21. XBU4422 could exise itself from plasmids into which it inserted. In most cases, the excision left a single additional A behind in the target site, but precise excision was seen in one case.

Bacteroides↗
PubMed2004

Prediction and identification of a permissive epitope insertion site in the vesicular stomatitis virus glycoprotein.

We developed a rational approach to identify a site in the vesicular stomatitis virus (VSV) glycoprotein (G) that is exposed on the protein surface and tolerant of foreign epitope insertion. The foreign epitope inserted was the six-amino-acid sequence ELDKWA, a sequence in a neutralizing epitope from human immunodeficiency virus type 1. This sequence was inserted into six sites within the VSV G protein (Indiana serotype). Four sites were selected based on hydrophilicity and high sequence variability identified by sequence comparison with other vesiculovirus G proteins. The site showing the highest variability was fully tolerant of the foreign peptide insertion. G protein containing the insertion at this site folded correctly, was transported normally to the cell surface, had normal membrane fusion activity, and could reconstitute fully infectious VSV. The virus was neutralized by the human 2F5 monoclonal antibody that binds the ELDKWA epitope. Additional studies showed that this site in G protein tolerated insertion of at least 16 amino acids while retaining full infectivity. The three other insertions in somewhat less variable sequences interfered with VSV G folding and transport to the cell surface. Two additional insertions were made in a conserved sequence adjacent to a glycosylation site and near the transmembrane domain. The former blocked G-protein transport, while the latter allowed transport to the cell surface but blocked membrane fusion activity of G protein. Identification of an insertion-tolerant site in VSV G could be important in future vaccine and targeting studies, and the general principle might also be useful in other systems.

Amino Acid Sequence↗
PubMed2005

In Trypanosoma brucei RNA editing, band II enables recognition specifically at each step of the U insertion cycle.

Trypanosome RNA editing is the posttranscriptional insertion and deletion of uridylate (U) residues, often to a massive extent, through cycles of cleavage, U addition or U removal, and ligation. These editing cycles are catalyzed by a complex that we purified to seven major proteins (bands I through VII). Here we analyze the role of band II using extracts of clonal band II RNA interference (RNAi) cell lines prepared by a rapid protocol that enables retention of activities that are lost during traditional extract preparation. By individually scoring each step of editing, we show that band II is critical for all steps of U insertion but is not important for any of the steps of U deletion or for their coordination into the U deletion cycle. This specificity supports the long- standing model that U-insertional and U-deletional activities are separated within the editing complex. Furthermore, by assaying the basic activities of the enzymes that catalyze the steps of U insertion, independent of their action in editing, we show that band II is not any of those enzymes. Rather, band II enables endonuclease action at authentic U insertion sites, terminal-uridylyl-transferase (TUTase) action at cleaved U insertion sites, and U-insertion-specific ligase (band V/IREL) action in the editing complex. Thus, band II facilitates each step of U insertion by providing proper RNA and/or protein recognition. We propose that band II (TbMP81) be called IRER, indicating its essential nature in U-insertional RNA editing recognition.

Animals↗
PubMed1993

Radiofrequency endocardial catheter ablation of accessory atrioventricular pathway atrial insertion sites.

BACKGROUND: High rates of success using radiofrequency ablation energy have rapidly transformed catheter ablation from an investigational procedure to the nonpharmacological therapy of choice for symptomatic Wolff-Parkinson-White syndrome. Prior studies of radiofrequency accessory pathway ablation were based on a ventricular approach. Risks associated with prolonged arterial catheter manipulation, retrograde left ventricular catheterization, and production of ventricular lesions required for successful ventricular insertion ablation can be avoided using atrial insertion ablation procedures. The purpose of the present study was to define the safety and efficacy of accessory pathway ablation using radiofrequency energy delivered solely to accessory atrioventricular pathway atrial insertion sites. METHODS AND RESULTS: One hundred fourteen patients with accessory pathway-mediated tachycardia underwent attempted radiofrequency current ablation at the accessory pathway atrial insertion site. All catheters were introduced transvenously. Left-sided accessory pathways were approached using transseptal left atrial catheterization techniques. Retrograde localization of the atrial insertion site during reentrant tachycardia was characterized by 40 +/- 15-msec local ventriculoatrial and 79 +/- 17-msec surface QRS to local atrial electrogram intervals. Presumed accessory pathway potentials were present in only 30% of ablation site electrograms. Successful ablation required 6.2 +/- 5.3 radiofrequency energy applications. Cumulative energy dose required for success was 2,341 +/- 2,233 J. There were no complications associated with transseptal catheterization. Energy delivery to accessory pathway atrial insertion sites was associated with non-life-threatening complications in two patients. Recurrent conduction requiring repeat ablation occurred in 10 of 115 (9%) successfully ablated accessory pathways, all within 1 month of the ablation procedure. After 21.2 +/- 4.6 months of follow-up, 108 of 114 (95%) patients are asymptomatic and without evidence of accessory pathway conduction. CONCLUSIONS: The atrial insertion approach to accessory pathway ablation is safe and highly effective. This approach compares favorably with the retrograde ventricular insertion ablation technique. Atrial insertion ablation eliminates the need to produce ventricular lesions and avoids the risks of prolonged arterial catheter manipulation and retrograde left ventricular catheterization.

Adult↗
PubMed2005

Randomized double-blind comparison of ketamine-propofol, fentanyl-propofol and propofol-saline on haemodynamics and laryngeal mask airway insertion conditions.

The aim of this prospective, double-blind, randomized, placebo-controlled clinical trial was to investigate whether the administration of ketamine before induction with propofol improves its associated haemodynamic profile and laryngeal mask airway (LMA) insertion conditions. Ninety adult patients were randomly allocated to receive either ketamine 0.5 mg x kg(-1) (n = 30), fentanyl 1 microg x kg(-1) (n = 30) or normal saline (n = 30), before induction of anaesthesia with propofol 2.5 mg x kg(-1). Insertion of the LMA was performed 60s after injection of propofol. Arterial blood pressure and heart rate were measured before induction (baseline), immediately after induction, immediately before LMA insertion, immediately after LMA insertion and every minute for three minutes after LMA insertion. Following LMA insertion, the following six subjective endpoints were graded by a blinded anaesthestist using ordinal scales graded 1 to 3: mouth opening, gagging, swallowing, movement, laryngospasm and ease of insertion. Systolic blood pressure was significantly higher following ketamine than either fentanyl (P = 0.010) or saline (P = 0.0001). The median (interquartile range) summed score describing the overall insertion conditions were similar in the ketamine [median 7.0, interquartile range (6.0-8.0)] and fentanyl groups [median 7.0, interquartile range (6.0-8.0)]. Both appeared significantly better than the saline group [median 8.0, interquartile range (6.75-9.25); P = 0.024]. The incidence of prolonged apnoea (> 120s) was higher in the fentanyl group [23.1% (7/30)] compared with the ketamine [6.3% (2/30)] and saline groups [3.3% (1/30)]. We conclude that the addition of ketamine 0.5 mg x kg(-1) improves haemodynamics when compared to fentanyl 1 microg x kg(-1), with less prolonged apnoea, and is associated with better LMA insertion conditions than placebo (saline).

Adjuvants, Anesthesia↗
PubMed2003

Relative movements between Kinemax Plus tibial inserts and the tibial base-plates.

Tests were performed on six large Kinemax Plus knee bearings (snap-fit design) to evaluate the amount of movement between 10- and 15-mm-thick tibial inserts and the tibial base plates. The knee bearings were tested up to 1 x 10(6) cycles on the Durham six-station knee wear simulator which subjected the bearings to similar motion and loading profiles that would be experienced by the natural knee during walking. Although passive internal/external (I/E) rotation was allowed, no active I/E rotation was applied. The movement of the tibial inserts was measured with dial gauges (accuracy +/-0.01 mm) before and after the bearings were tested on the simulator, when unloaded, and throughout the tests while the bearings were being dynamically loaded in the simulator. Movement occurred between the tibial insert and the tibial base plate after initial assembly due to the snap-fit mechanism used to locate the tibial insert within the tibial base plate. However this decreased appreciably when the bearings were loaded in the simulator. The amount of movement did not change with time when the bearings were continuously loaded in the simulator. However, after each test the amount of movement of the tibial inserts, when unloaded, was only 65 per cent (anterior-posterior) and 46 per cent (medial-lateral) of the values before the test. This was thought to be due to creep of the ultra-high molecular weight polyethylene (UHMWPE) inserts. The movement between the tibial insert and tibial base plate in situ is likely to be much less than that observed by a surgeon at the time of assembly due to loading of the knee bearing in the body. However, the amount of movement when the tibial inserts are loaded may still be great enough to produce a second interface where wear of the tibial insert may take place.

Coated Materials, Biocompatible↗
PubMed2005

GnRH treatment at CIDR insertion influences ovarian follicular dynamics in Japanese black cows.

Ovarian follicular dynamics and estrous synchronization after Gonadotropin-releasing hormone (GnRH) treatment at Controlled Internal Drug Releasing device (CIDR) insertion were investigated in Japanese Black cows. CIDR was inserted for eight cows at 7 days after estrus. Cows were allocated to either Group A: 8-day CIDR insertion with GnRH treatment on d 0 (n=4, d 0=CIDR insertion) or Group B: 8-day CIDR insertion (n=4). Both groups were injected with prostaglandin F2alpha (PGF2alpha) on d 7. Ultrasonography and blood sampling were performed twice daily. Intensive sampling was performed every 15 min for 8 hr to determine the pulsatile release of LH on d -1, d 5 and d 10. Three of four cows showed intermediate ovulation within 2 days after GnRH treatment during CIDR insertion in Group A, whereas no ovulation was found in Group B. Three of four cows in Group A and all four cows in Group B ovulated after CIDR removal. Plasma progesterone concentrations from d 3 to d 7 in three intermediate ovulatory cows in Group A (8.4 +/- 1.6 ng/ml) was significantly higher than those in Group B (4.1 +/- 1.2 ng/ml; 4 cows) during CIDR insertion (P<0.01). Interval to estrus and ovulation after CIDR removal was observed at 60.0 +/- 12.0 hr and 76.0 +/- 6.9 hr in three cows in Group A, and 75.0 +/- 15.1 hr and 93.0 +/- 20.5 hr in Group B, respectively. There was a significant increase in LH pulse frequency on d 10 compared on d -1 or d 5 in both groups (P<0.05), in addition those on d 10 in Group A tended to be higher than in Group B. As a result, GnRH treatment at CIDR insertion at 7 days after estrus induced intermediate ovulation with formation of corpus luteum (CL) and rather synchronized emergence of ovulatory follicle during CIDR insertion. These induced CL increased plasma progesterone concentrations and contributed to precise synchronization.

Animals↗
PubMed1993

Pain and discomfort levels in patients during root surface debridement with sonic metal or plastic inserts.

The study was designed to evaluate whether root surface debridement with a sonic scaler plastic insert would cause less pain and discomfort to patients than an ordinary, probe-shaped metal sonic insert. One quadrant in each of 23 patients was debrided with each insert. Blood pressure, mean arterial pressure, and heart rate were monitored before, during, and immediately after each treatment. Pain was also evaluated on a visual analogue scale (VAS) after each treatment, as well as 2 weeks later following pain-provoking stimuli. Blood pressure, mean arterial pressure, and heart rate did not reveal any differences between quadrants treated with plastic or metal inserts. Heart rate had a weak, positive association with treatment time. The VAS gave a higher pain score for the plastic (30.8) than for the metal insert (24.4), but this difference was not statistically significant (P = 0.055). Following pain-provoking stimuli at the 2-week follow-up visit, quadrants debrided with the metal insert (31.3) scored significantly lower (less pain) (P < 0.01) on the VAS than quadrants treated with the plastic insert (30.7). It is concluded that the sonic metal insert caused less pain and discomfort to the patients due to its superior accessibility and water spray cooling. The significant difference between metal and plastic tip debrided quadrants at the follow-up visit was probably caused by the smearing effect of the metal insert with partial closure of the dentin tubule orifices.

Adult↗
PubMed2002

The effectiveness of isolated tibial insert exchange in revision total knee arthroplasty.

BACKGROUND: Despite improvements in the design and manufacturing of the components used in total knee arthroplasty, wear of the polyethylene bearing remains a potential source of failure. One theoretical advantage of modular tibial implants is that, when the components are well fixed, patients with wear or instability of the tibial insert can be treated with isolated polyethylene exchange. The aim of this study was to assess the results of isolated tibial insert exchange during revision surgery in a relatively large, consecutive group of patients. METHODS: From 1985 through 1997, we performed fifty-six isolated tibial insert exchanges in fifty-five patients (twenty-nine men [one man had bilateral revision] and twenty-six women; mean age, sixty-six years) primarily because of wear or instability. Patients with loosening of any of the components, a history of infection, severe stiffness of the knee, recognized malposition of any component, or problems with the extensor mechanism were excluded. Twelve knees had had one, two, or three prior revisions. The duration of follow-up averaged 8.3 years (range, 1.6 to 16.2 years) after the index arthroplasty and 4.6 years (range, two to fourteen years) after the revision. RESULTS: The mean Knee Society knee and function scores improved from 56 and 50.9 points prior to the revision to 76 and 59 points at the time of final follopcow-up. Fourteen (25%) of the fifty-six knees subsequently required rerevision at a mean of only three years (range, 0.5 to 6.8 years) after the tibial insert exchange. The cumulative survival rate at 5.5 years was 63.5% (95% confidence interval, 14.4%, with nineteen patients remaining at risk). Of the twenty-seven knees with preoperative instability, eight were rerevised and another four were considered failures because of severe pain. Of the twenty-four knees that were treated with the index revision because of wear of the insert, five were rerevised. In addition, one extremity in this group was amputated above the knee as a result of chronic osteomyelitis of the ankle concomitant with chronic pain at the site of the total knee arthroplasty and another two inserts were considered failures because of severe pain. CONCLUSIONS: Isolated tibial insert exchange led to a surprisingly high rate of early failure. Tibial insert exchange as an isolated method of total knee revision should therefore be undertaken with caution even in circumstances for which the modular insert was designed and believed to be of greatest value.

Adult↗
PubMed2001

Effectiveness of intravaginal progesterone inserts and FSH for inducing synchronized estrus and increasing lambing rate in anestrous ewes.

The objectives of this study were to determine whether a new progesterone (P4)-releasing intravaginal insert would induce fertile estrus and whether FSH combined with the insert would increase prolificacy in anestrous ewes introduced to rams. Ewes of mixed breeding on six farms were assigned to four randomized treatments: control (C), n = 73; 12 d P4 (polycapralactone [PCL] insert with 0.82 g P4), (P12), n = 73; 12 d P4 plus i.m. FSH (Folltropin, 55 mg NIH-FSH-P1 equivalent) in propylene glycol, 24 h before insert removal, (P12F), n = 71; and 5 d P4 plus FSH (P5F), n = 77. Growth and ovulation of follicles were observed ultrasonographically in 20 ewes at four farms (five/treatment) at insert removal and 36, 48, 72, and 96 h later. Intact rams (1:15 ewes in multiple-sire groups) were joined at insert removal, and raddle marks were observed every 12 h for 5 d. On d 26 to 30, rams were removed; ewes were examined for pregnancy then and 20 d later. Percentage of ewes marked by rams was greater in P4-treated (66 to 79%) than in C (12%; P < 0.01) ewes and in P5F (79%) than in P12F (66%; P < 0.05). Diameters of largest follicles at insert removal were greater (P < 0.05) in P4-treated (5.5 +/- 0.2) than in C ewes (4.8 +/- 0.2). Progesterone increased numbers of follicles > 3 mm (P < 0.01) or ovulated (P < 0.05; 2.6 +/- 0.6 vs 1.3 +/- 0.6 in C ewes) and FSH increased number of follicles > 3 mm (P < 0.05). In FSH-treated ewes, ovulation rate tended to be greater after treatment with P4 for 5 than for 12 d (P = 0.09, 3.3 +/- 0.6 and 2.2 +/- 0.4, respectively). More P4-treated than C ewes lambed (P < 0.01) to the first (38 to 45 vs 0%) or both (63 to 66 vs 41%) service periods. Prolificacy (first service) did not differ between FSH-treated ewes (P12F + P5F; 1.8 +/- 0.1) and ewes treated with P4 only (P12; 1.6 +/- 0.1). However, FSH increased prolificacy to first service (1.8 +/- 0.1) over prolificacy to second service (C ewes 1.5 +/- 0.1; P < 0.05, and all ewes 1.4 +/- 0.1; P < 0.01). Pregnancy retention did not differ among treatments but was greater (P < 0.01) in ewes that conceived at the first (90.9 +/- 3.7) than at the second (72.5 +/- 3.3) service period. In conclusion, a PCL insert in combination with ram introduction at insert removal was more effective than ram introduction alone to induce synchronized estrus and ovulation and to yield pregnancy after one or two service periods. Treatment with P4 for 5 d was as effective as for 12 d to induce fertile estrus in FSH-treated anestrous ewes.

Administration, Intravaginal↗
PubMed2001

Effects of hole preparation on screw pullout resistance and insertional torque: a biomechanical study.

OBJECT: The authors conducted a study to assess the effect of a pilot hole preparation on screw pullout resistance and screw insertional torque. METHODS: Three different screws were tested: cancellous lateral mass screws, cortical lateral mass screws, and pedicle screws. Synthetic bone blocks were used as the host material. Each screw group was separated into two subgroups. The first subgroup of screws was inserted into the test material following pilot hole preparation. Pilot holes were prepared; a drill bit diameter size smaller than the core diameter of the screws was used. The second group of screws was inserted into the test material without pilot hole preparation (a 3- or 4-mm hole drilled for entrance site preparation only). The insertional torque was measured as the screw was advanced into the material. The screws were axially extracted from the host material at a constant speed of 2.5 mm/minute. The pullout resistances and insertional torques for the pilot hole and the nonpilot hole groups were then statistically compared. The authors found that preparation of a pilot hole caused a significant decrease in the insertional torque. The screws inserted without a pilot hole showed greater pullout resistances compared with those inserted following a pilot hole preparation; however, there was no statistically significant difference. CONCLUSIONS: The optimum screw insertion technique may involve drilling a short pilot hole and using a drill bit with a smaller diameter than the screw core diameter to increase bone-screw purchase. This applies to cancellous and cortical lateral mass screws as well as pedicle screws.

Biomechanical Phenomena↗