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Prevalence of impingement in explanted Charnley acetabular components.

: Impingement of the femoral neck against the rim of the socket bore has often been cited as one of the contributory factors in the acetabular loosening process. However, there has been little research on its clinical prevalence or on the effects of both linear wear and the diameter of the femoral neck. With this aim in mind, 74 Charnley prostheses were examined after being removed at revision surgery and the sockets interrogated for evidence of impingement. The probability of impingement was assessed using logistic regression analysis. A strong positive association was observed between penetration depth and impingement (chi2 = 12.8; P = 0.0004) regardless of differences in the femoral neck diameter. Further, the introduction of femoral components which comprised a reduced diameter neck had a positive effect, in that the 50% probability of impingement occurred at approximately 2 mm of penetration. For those components with standard necks, the 50% probability of impingement occurred at zero mm of penetration. If impingement is a problem then a reduced diameter neck would appear to be a solution in cutting rates of long-term loosening. However, whether or not this reduction in rim damage, and therefore impingement, is clinically significant in terms of loosening can only be fully assessed from long-term survival analysis and comparison with autopsy retrieved specimens.

Acetabulum↗

Flexural strength of composites: influences of polyethylene fiber reinforcement and type of composite.

MAIN PROBLEM: The microfill veneering of hybrid composite restorations has been indicated to improve esthetics. Also, polyethylene fiber reinforcement has been proposed for use in composite restorations in high-stress clinical situations. However, minimal information in the literature addresses the influence of such combinations on the resistance to fracture. The purpose of this study was to investigate the flexural strength of two composites, a microfill and a hybrid, the effect of their combination, and the influence of polyethylene fiber reinforcement. MATERIALS AND METHODS: Twenty-eight specimens were prepared using a standard metallic mold (20x2x2 mm) and divided into groups of seven each: Filtek Z-250 (3M ESPE, St. Paul, Minn., USA) (group I), Filtek A-110 (3M ESPE) (group II), Filtek Z-250 combined with Filtek A-110 (group III), and Filtek Z-250 combined with polyethylene fiber (Ribbond, Seattle, Wash., USA) (group IV). The specimens were stress-loaded to fracture in a three-point bending device according to International Standardization Organization (ISO) 4049. RESULTS: Data were analyzed using analysis of variance and Tukey's test at a 0.05 level of significance. No statistically significant differences were observed between groups I and IV. Group II, however, exhibited statistically lower resistance to fracture than the other groups. Group III presented intermediate results, showing statistically higher fracture resistance than group II but lower than group I. CONCLUSIONS: With the methodology employed, microfill composite presented the lowest flexural strength, but its association with hybrid composite increased the resistance to fracture. The combination of polyethylene fiber and hybrid composite did not present higher flexural strength than hybrid composite alone.

Analysis of Variance↗

Resin composites: strength of the bond to dentin versus mechanical properties.

This study (1) investigated whether the combination of an adhesive system from one manufacturer with a resin composite from the same manufacturer provides superior bonding of the resin composite to dentin compared with the combination of an adhesive system from one manufacturer with a resin composite from another manufacturer, and (2) tested for a possible influence on bond strength of mechanical properties of the resin composite. After application of an adhesive system, a resin composite was bonded to flattened human dentin and tested in shear after 1 week. Five adhesive systems (AdheSE, Adper Prompt L-Pop, Clearfil SE Bond, Optibond Solo Plus, and Xeno III) were tested with each of five resin composites (Tetric Ceram, Filtek Supreme, Clearfil AP-X, Premise, and EsthetX). The mechanical properties flexural strength and flexural modulus were determined by three-point loading. Bond strengths were influenced by the brand of adhesive system (P < 0.0001) and by the brand of resin composite (P < 0.0001), but the combination of an adhesive system from one manufacturer with a resin composite from the same manufacturer did not provide bond strengths that were superior to those obtained when an adhesive system from one manufacturer was combined with a resin composite from another manufacturer. Independent of the brand of resin composite, the adhesive system Clearfil SE Bond mediated the highest bond strength to dentin. For each adhesive system, the resin composite Clearfil AP-X resulted in the highest bond strength to dentin. Significant positive correlations were found between bond strength and flexural strength (P < 0.0026, r = 0.21) and between bond strength and flexural modulus (P < 0.0017, r = 0.22).

Composite Resins↗

Comparison between a plasma arc light source and conventional halogen curing units regarding flexural strength, modulus, and hardness of photoactivated resin composites.

The plasma arc curing light Apollo 95 E (DMDS) is compared to conventional curing lights of different radiation intensities (Vivalux, Vivadent, 250 mW/cm2; Spectrum, DeTrey, 550 mW/cm2; Translux CL, Kulzer, 950 mW/cm2). For this purpose, photoactivated resin composites were irradiated using the respective curing lights and tested for flexural strength, modulus of elasticity (ISO 4049), and hardness (Vickers, Knoop) 24 h after curing. For the hybrid composites containing only camphoroquinone (CQ) as a photoinitiator (Herculite XRV, Kerr; Z100, 3 M), flexural strength, modulus of elasticity, and surface hardness after plasma curing with two cycles of 3 s or with the step-curing mode were not significantly lower than after 40 s of irradiation using the high energy (Translux CL) or medium energy conventional light (Spectrum). However, irradiation by only one cycle of 3 s failed to produce adequate mechanical properties. Similar results were observed for the surface hardness of the CQ containing microfilled composite (Silux Plus, 3 M), whereas flexural strength and modulus of elasticity after plasma curing only reached the level of the weak conventional light (Vivalux). For the hybrid composites containing both CQ and photoinitiators absorbing at shorter wavelengths (370-450 nm) (Solitaire, Kulzer; Definite, Degussa), plasma curing produced inferior properties mechanical than conventional curing; only the flexural strength of Solitaire and the Vickers hardness of Definite reached levels not significantly lower than those observed for the weak conventional light (Vivalux). The suitability of plasma arc curing for different resin composites depends on which photoinitiators they contain.

Composite Resins↗

In vivo forces on oral implants supporting a mandibular overdenture: the influence of attachment system.

This study was designed to gain insight into the influence of the attachment system on the loading conditions of oral implants supporting a mandibular overdenture on two implants. Five patients were selected and were provided with two implants in the canine area of the mandible (Brånemark System). All patients received a new mandibular overdenture that could be mounted on an ovoid-shaped bar (Dolder, C&M): (a) with and (b) without bilateral extensions and (c) on ball-attachments (Nobel Biocare). Using three strain gauges attached to the outer surface of the 5.5-mm standard abutments, the axial forces and bending moments on both supporting implants could be quantified. Load registrations were made during application of 50 N on seven predetermined positions along the occlusal surface of the prosthesis and during maximal biting in maximal occlusion (clenching). The results revealed no differences in induced axial force for the various anchorage devices, unlike the differences in bending moment. Although there is a tendency for better axial load sharing with bars and better sharing of bending moments with ball attachments, these differences were not significant.

Dental Implantation, Endosseous↗

Structure and dynamics of Candida rugosa lipase: the role of organic solvent.

The effect of organic solvent on the structure and dynamics of proteins was investigated by multiple molecular dynamics simulations (1 ns each) of Candida rugosa lipase in water and in carbon tetrachloride. The choice of solvent had only a minor structural effect. For both solvents the open and the closed conformation of the lipase were near to their experimental X-ray structures (C(alpha) rms deviation 1-1.3 A). However, the solvents had a highly specific effect on the flexibility of solvent-exposed side chains: polar side chains were more flexible in water, but less flexible in organic solvent. In contrast, hydrophobic residues were more flexible in organic solvent, but less flexible in water. As a major effect solvent changed the dynamics of the lid, a mobile element involved in activation of the lipase, which fluctuated as a rigid body about its average position. While in water the deviations were about 1.6 A, organic solvent reduced flexibility to 0.9 A. This increase rigidity was caused by two salt bridges (Lys85-Asp284, Lys75-Asp79) and a stable hydrogen bond (Lys75-Asn 292) in organic solvent. Thus, organic solvents stabilize the lid but render the side chains in the hydrophobic substrate-binding site more mobile. [figure: see text]. Superimposition of open (black, PDB entry 1CRL) and closed (gray, PDB entry 1TRH) conformers of C. rugosa lipase. The mobile lid is indicated.

Candida↗

[Custom moldable hydroxyapatite collagen composite for repair of osseous defects].

AIM: In the following study we evaluated the biological response of a new freely moldable bone substitute in an animal model. MATERIAL AND METHODS: Critically sized defects were created surgically in the lower jaw of ten adult minipigs. The drill defects were filled with hydroxyapatite collagen paste. After observation periods of 1, 3, 6, 12, and 18 months the mandibles were harvested without wound healing defects for histological evaluation of resorption and bone ingrowth with a sawing and grinding technique. RESULTS: The result of the remodeling process was a complete degradation of hydroxyapatite collagen implants after 12-18 months with reorganization of vital trabeculae oriented in a mature pattern. CONCLUSION: The hydroxyapatite collagen cement works as an osteoconductor and shows signs of direct osseointegration and resorption.

Animals↗

Lumbar stiffness but not thoracic radiographic changes relate to alteration of lung function tests in ankylosing spondylitis.

Involvement of the costovertebral (CV) and costotransverse (CT) as well as the sacroiliac (SI) joints is known to occur in patients with ankylosing spondylitis (AS). The functional significance of these changes is not clear. We have performed clinical and radiological evaluations and assessed the effect of joint involvement on pulmonary function. We detected radiologic evidence of involvement of the CV joint in 80% of patients and of the CT joint in 60 %. We found a direct relation between the severity of CV, CT and SI joint affliction, and the severity of CV and SI joints were related to time of evolution of the disease. Pulmonary function tests revealed neither restrictive nor obstructive defects. No relation was found between pulmonary function and CV and CT joint affliction. Patients with stiffer spines had a tendency to have pulmonary function tests within the lower limit of the normal range. In patients with AS diaphragmatic breathing might compensate the chest respiration to some extent.

Adult↗

The laser diffractoscope - a new and fast system to analyse red blood cell flexibility with high accuracy.

Red blood cell (RBC) flexibility is one of the determining parameters of the microcirculation. As capillaries are smaller in diameter than RBC, RBC can only pass through by deformation. Reduced flexibility is associated with a reduced microcirculation. In obstetrics, pre-eclampsia and intrauterine growth retardation are regarded as diseases exhibiting a reduced microcirculation. With this new system it might be possible to achieve new data concerning the microcirculation in these diseases. The laser diffractoscope is based on laser light diffraction and computer-assisted image analysis. It offers the ability to determine the flexibility of RBC in whole blood with high accuracy between 0 and 30 Pa. Two hundred microlitres of whole blood are required, and the analysis is carried out in less than 5 min, with a standard deviation < or =1%. The laser diffractoscope is a new system which offers the ability to measure RBC deformability with high accuracy in a short time. Evaluation of reproducibility and validity, as well as comparison with data from other measuring systems, proves the excellence of the laser diffractoscope. An example of its application is shown by analysing the deformability of RBC in 10 uncomplicated pregnancies at term.

Erythrocyte Deformability↗

Stretching increases heart rate variability in healthy athletes complaining about limited muscular flexibility.

An increase in muscular flexibility, as well as a significant beneficial effect on heart rate and heart rate variability (HRV), was observed in healthy male athletes after performing a standardized 15-minute stretching-program over a period of 28 days. We believe the HRV increase to be due, at least in part, to the improved vagal and/or diminished sympathetic control. Therefore, we recommend stretching as an effective and gentle technique for health protection.

Adult↗

The processing, mechanical properties and bioactivity of zinc based glass ionomer cements.

The suitability of Glass Ionomer Cements (GICs) for use in orthopaedics is retarded by the presence in the glass phase of aluminium, a neurotoxin. Unfortunately, the aluminium ion plays an integral role in the setting process of a GIC and its absence is likely to hinder cement formation. However, zinc oxide, a bacteriocide, can act both as a network modifying oxide and an intermediate oxide in a similar fashion to alumina and so ternary systems based on zinc silicates often have extensive regions of glass formation. The purpose of this research was to produce novel GICs based on calcium zinc silicate glasses and to evaluate their rheological, mechanical and biocompatible properties with the ultimate objective of developing a new range of cements for skeletal applications. The work reported shows that GICs based on two different glasses, A and B (0.05CaO.0.53ZnO.0.42SiO2 and 0.14CaO.0.29ZnO.0.57SiO2, respectively), exhibited handling properties and flexural strengths comparable to conventional GICs. Upon immersion in simulated body fluid of a GIC based on glass B, an amorphous calcium phosphate layer nucleated on the surface of the cement indicating that these cements are bioactive in nature.

Aluminum↗

Mechanical and degradation behavior of polymer-calcium sulfate composites.

Calcium sulfate (CS) is one of the oldest bone graft materials still in use. Its main limitations are poor handling characteristics, poor mechanical properties, and a resorption rate that is too fast for some applications. The present study investigated the effect of viscous polymers, such as carboxymethylcellulose (CMC) and hyaluronan (HY), on the handling characteristics, mechanical properties, and degradation behavior of CS. CMC and HY were added to CS at concentrations from 1-10 wt%. Addition of CMC to CS at more than 4 wt% produced a putty-like material and decreased the density of the composite, while also increasing flexural and compressive strength at higher loadings. Incorporation of CMC produced a concentration-dependent increase in water absorption and degradation rate. At an equivalent loading, HY-containing CS composites showed better compressive strength than CS with CMC. Overall, addition of CMC or HY to CS resulted in composite materials with better handling characteristics and improved mechanical properties after set, however the degradation rate of the augmented materials was increased. These properties suggest that the enhanced CS materials may be useful in certain clinical situations, such as filling non-uniform bone defects and situations that require mechanical integrity of the bone graft substitute during implantation.

Biocompatible Materials↗

Back strength and flexibility of EMS providers in practicing prehospital providers.

In the execution of prehospital care duties, an EMS provider may be required to carry equipment and patients over long distances or over multiple flights of stairs at any time of the day. At a minimum, a prehospital provider must have sufficient lower back strength and hamstring flexibility to prevent musculoskeletal injury while lifting. This study administered fitness assessments related to the occupational activities of the prehospital provider with the purpose of describing the incidence of occupational back injury and percentage of providers with known risk factors for back injury. Ninety subjects were tested during a regional EMS conference. Men were significantly taller and heavier than women and had significantly less hamstring flexibility. Body Mass Index was 30.7 +/- 7.2 in men and 28 +/- 5.7 in women. However, no significant differences were noted in an extension test of back strength. When surveyed, 47.8% of subjects reported a back injury in the previous 6 months but only 39.1% of these injuries were sustained while performing EMS duties. While only 13% of these injuries resulted in missed work, 52.2% reported their injury interfered with their daily activities. In spite of the physical nature of the profession, EMS providers in our sample were significantly overweight according to their Body Mass Index and may lack sufficient back strength and flexibilityfor safe execution of their duties. This group of professionals may be at risk for occupational injury and should be targeted for interventions to improve strength and flexibility.

Adult↗

Effect of bilateral facetectomy of thoracolumbar spine T11-L1 on spinal stability.

Spinal stenosis can be found in any part of the spine, though it is most commonly located on the lumbar and cervical areas. It has been documented in the literature that bilateral facetectomy in a lumbar motion segment to increase the space induces an increase in flexibility at the level at which the surgery was performed. However, the result of bilateral facetectomy on the stability of the thoracolumbar spine has not been studied. A nonlinear three-dimensional finite element (FE) model of thoracolumbar T11-L1 was built to explore the influence of bilateral facetectomy. The FE model of T11-L1 was validated against published experimental results under various physiological loadings. The FE model with bilateral facetectomy was evaluated under flexion, extension, lateral bending and axial rotation to determine alterations in kinematics. Results show that bilateral facetectomy causes increase in motion, considerable increase in axial rotation and least increase in lateral bending. Removal of facets did not result in significant change in the sagittal motion in flexion and extension.

Biomechanical Phenomena↗

Flexible ex vivo phantoms for validation of diffusion tensor tractography on a clinical scanner.

PURPOSE: The aim of this study was to develop ex vivo diffusion tensor (DT) flexible phantoms. MATERIALS AND METHODS: Materials were bundles of textile threads of cotton, monofilament nylon, rayon, and polyester bunched with spiral wrapping bands and immersed in water. DT images were acquired on a 1.5-Tesla clinical magnetic resonance scanner using echo planar imaging sequences with 15 motion probing gradient directions. DT tractography with seeding and a line-tracking method was carried out by software originally developed on a PC-based workstation. RESULTS: We observed relatively high fractional anisotropy on the polyester phantom and were able to reconstruct tractography. Straight tracts along the bundle were displayed when it was arranged linearly. It was easy to bend arcuately or bifurcate at one end; and tracts followed the course of the bundle, whether it was curved or branched and had good agreement with direct visual observation. Tractography with the other fibers was unsuccessful. CONCLUSION: The polyester phantom revealed a diffusion anisotropic structure according to its shape and would be utilizable repeatedly under the same conditions, differently from living central neuronal system. It would be useful to validate DT sequences and to optimize an algorithm or parameters of DT tractography software. Additionally, the flexibility of the phantom would enable us to model human axonal projections.

Anisotropy↗

Initial experience with the Cosgrove-Edwards Annuloplasty System.

BACKGROUND: The mitral valve has a nonplanar shape and a sphincter action. Pathologic dilatation occurs along the posterior annulus. To preserve the physiologic function and correct annular dilatation, we developed an annuloplasty system that is universally flexible and produces a measured plication of the posterior annulus (Cosgrove-Edwards Annuloplasty System). METHODS: The results of 150 consecutive mitral valve repairs using this system were analyzed. Mean age was 58 +/- 13 years; 59% were men. The cause of the valve disease was degenerative in 75% of the patients, rheumatic in 13%, ischemic in 8%, and infectious in 4%. Associated procedures were performed in 61 patients (41%). RESULTS: Echocardiographic mitral regurgitation decreased from 3.7 +/- 0.6 before repair to 0.2 +/- 0.4 after repair (p < 0.0001). There were no hospital deaths and no cases of hemodynamically significant systolic anterior motion or other annuloplasty-related complications. Follow-up was 100% complete at a mean of 3.1 +/- 3.6 months. There were three late deaths, three transient ischemic attacks, and one episode of endocarditis. Five patients (3.3%) have undergone reoperation for recurrent mitral insufficiency; no reoperations were related to the annuloplasty system. At a mean of 9 months, three-dimensional reconstruction of the mitral annulus from multiple echocardiographic images confirmed the nonplanar shape and sphincter mechanism of the annulus. Annular orifice area decreased 19% during the cardiac cycle from a mean of 10.3 cm2 in diastole to 8.6 cm2 in systole. CONCLUSIONS: This annuloplasty system is effective for repair of insufficiency secondary to all causes, preserves physiologic annulus function, and is associated with a low incidence of valve-related complication.

Adult↗

Autologous monocusp pulmonary valve: preliminary results.

BACKGROUND: There is growing recognition that postoperative pulmonary regurgitation may result in early or late progressive right heart failure. METHOD: A technique for fashioning an autologous monocusp pulmonary valve from the wall of the pulmonary artery was developed. The monocusp valve was fashioned from the anterior wall of the main pulmonary artery, and the remaining defect was filled with autologous pericardium. The procedure was performed in 8 dogs and 5 children. RESULTS: Early follow-up and serial echocardiographic assessment in both dogs and children proved the functionality of this monocusp pulmonary valve. All valves were pliable and demonstrated mild to moderate pulmonary stenosis and insufficiency. CONCLUSIONS: Construction of the autologous monocusp pulmonary valve is a feasible technique, and the valve performs efficiently. The acute performance in the canine model was excellent, and preliminary midterm results in the clinical study are reasonable. It is logical to assume that the monocusp, being an integral part of the arterial wall, will retain its viability and share in the subsequent growth of the pulmonary artery. Should follow-up studies demonstrate its long-term competence, this autologous valve may provide a good solution for various forms of pulmonary regurgitation and be useful in pulmonary autograft replacement of the aortic valve.

Animals↗

A six-degrees-of-freedom instrumented linkage for measuring the flexibility characteristics of the ankle joint complex.

Diagnosis of ligament injuries to the ankle joint complex is a difficult clinical problem which relies primarily on manual physical examination and on radiographic evaluations. In an attempt to develop a reliable, quantitative diagnostic tool for such injuries we developed a six-degrees-of-freedom instrumented linkage (Ankle Flexibility Tester-AFT) capable of measuring the flexibility characteristics of the ankle joint complex in vivo. The unique non-serial structure of this linkage was such that these characteristics were recorded directly in an ]anatomical coordinate system which enhanced clinical interpretation. The goal of the present study was to develop this linkage and to test its accuracy and its test-retest reliability. The positional accuracy of the AFT was measured and was found to be better than 0.5 mm for translation and 1.2 degrees for rotations. The results obtained from a study conducted on two cadaveric specimens indicate negligible effect of loading rate on the flexibility characteristics within the range of possible manually applied loads. Finally, the reliability of the AFT was examined from test-retest studies conducted on a total of thirteen young healthy volunteers. The intraclass correlation coefficient (ICC), calculated from the test-retest data, indicated a reliability higher than 0.85. It was concluded that the high reliability and accuracy of the AFT, its simplicity of operation, the easy alignment procedure, the on-line load-displacement results, and the elimination of complex data processing render this device suitable for use in the clinic as well as in the research laboratory.

Ankle Injuries↗