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At least 613 records · Page 34Linked to original sources
PubMed2005

The stiff total knee arthroplasty: causality and solution.

A stiff total knee arthroplasty is a disabling condition, which can be caused by technical errors, patient factors, and postoperative complications. The results of treatment are dependent on the cause of stiffness. The best treatment is prevention by providing preoperative patient education, aggressive postoperative rehabilitation, and avoidance of technical errors. Early manipulation may improve motion with a well-aligned component. Open arthrolysis and revision arthroplasty are indicated for chronic stiffness with component malposition or failure, incorrect component sizing, joint line displacement, or inadequate bone resection. When performing a revision arthroplasty, it is important to know the reason for failure and loss of motion because failure to identify the cause of stiffness may result in recurrence of the problem.

Arthroplasty, Replacement, Knee↗
PubMed2006

Comparison of initial mechanical properties of 4 hamstring graft femoral fixation systems using nonpermanent hardware for anterior cruciate ligament reconstruction: an in vitro animal study.

PURPOSE: To compare the initial mechanical characteristics of 4 systems used to fix tendons to the femur during anterior cruciate ligament reconstruction. METHODS: A total of 32 porcine femurs were used to study the following fixation systems: Bioabsorbable interference screw (Stryker, Kalamazoo, MI), Bio-Transfix Cross-pin (Arthrex, Naples, FL), Biosteon Cross-pin (Stryker), and a fixation technique based on wrapping the graft around the femoral condyle itself, thus allowing it to be fixed in place without the use of any hardware. The mechanical characteristics of each system were obtained by a preconditioned failure tensile test. RESULTS: The yield load values (990.9 +/- 242.6 N for Bio-Transfix, 905.1 +/- 158.8 N for Biosteon Cross-pin, 684.4 +/- 119.7 N for the without-hardware system (WHS), and 369.4 +/- 120.1 N for the interference screw) revealed significant differences between the techniques that used cross-pins and the other 2 techniques (P < .006) on the one hand, and between the without hardware technique and the interference screw (P < .004) on the other. The stiffness of the 2 cross-pin fixation systems (117.6 +/- 22.5 N for Bio-Transfix and 112.6 +/- 22.5 N for Biosteon) was greater (P < .01) than those of the other systems (79.4 +/- 15.2 N for the WHS and 68.5 +/- 13 N for the interference screw). CONCLUSIONS: The initial biomechanical properties of the 2 cross-pin fixation systems proved to be superior to those of the other 2 systems studied. The WHS fixation system exhibited better mechanical properties than its interference screw counterpart. CLINICAL RELEVANCE: The better initial mechanical characteristics encountered using the Bio-Transfix and Biosteon Cross-pin systems indicate that these systems are better equipped to bear the loads generated by aggressive rehabilitation. The WHS fixation system provides an alternative to interference screw fixation.

Absorbable Implants↗
PubMed2006

The structural properties of an osteochondral cylinder graft-recipient construct on autologous osteochondral transplantation.

PURPOSE: The purpose of this study was to investigate the changes in structural properties of an osteochondral cylinder graft-recipient construct after autologous osteochondral transplantation. METHODS: A full-thickness cylindrical osteochondral defect (5 mm in diameter and 3 mm in depth) was made on the femoral condyle of a mature female Japanese white rabbit using the Osteochondral Autograft Transfer System (OATS; Arthrex, Naples, FL). The defect was repaired with an osteochondral plug (6 mm in diameter and 3 mm in depth) taken from the contralateral femoral condyle using the OATS. The implanted osteochondral grafts were evaluated immediately after surgery and at postoperative weeks 1, 3, 8, and 12. The stiffness of articular cartilage was analyzed using a tactile sensor system (AXIOM, Fukushima, Japan), which measures stiffness based on changes in resonance frequency when a vibrating tactile sensor touches articular cartilage. The specimens were stained with hematoxylin and eosin and serial sections were examined microscopically. RESULTS: The cartilage stiffness of the graft immediately after surgery was 107,695.1 N/m, which was not statistically different from the normal cartilage stiffness (100,027.5 N/m). The stiffness at postoperative weeks 1, 3, 8, and 12 was 95,386.8, 92,899.3, 95,969.8, and 104,683.7 N/m, respectively. The stiffness at postoperative weeks 1, 3, and 8 was significantly lower than the normal cartilage stiffness and the stiffness at postoperative week 12 was the same as normal cartilage. A new bone formation with an increase of bone trabeculae between the osteochondral cylinder graft and the recipient was observed at postoperative weeks 1, 3, and 8. Thereafter, at postoperative week 12, bone trabeculae decreased to the same level as observed in a normal model due to the progress of bone remodeling. CONCLUSIONS: The stiffness of articular cartilage of the osteochondral graft was normal at the time the graft was initially placed and at postoperative week 12. However, the stiffness at postoperative weeks 1, 3, and 8 was lower than the normal cartilage stiffness. CLINICAL RELEVANCE: Care should be taken when planning the rehabilitation program at an early phase after osteochondral transplantation.

Animals↗
PubMed2006

Arthroscopic treatment of the arthritic elbow due to primary radiocapitellar arthritis.

PURPOSE: To retrospectively compare patients who received radial head excision for early, isolated radiocapitellar arthritis with those who had delayed surgery for the same problem in order to analyze risk factors for progression of the arthritis. Isolation of risk factors for progression should allow guidelines for early excision and perhaps prevent progression to panarticular arthritis. TYPE OF STUDY: Retrospective analysis of a group of patients with radiocapitellar arthritis. METHODS: From 1995 to 2001, 36 consecutive patients with arthritic damage to the radiocapitellar joint were treated with arthroscopic debridement and radial head excision. Twenty-eight of the 36 underwent concurrent arthroscopic modification of the Outerbridge-Kashiwagi procedure because of the additional presence of ulnohumeral arthritis. All patients were re-examined 18 to 91 months (mean, 52 months) after the procedure and evaluated using the Andrews-Carson (A-C) elbow rating system. RESULTS: In patients who underwent radial head excision alone, flexion increased 29 degrees, extension 38 degrees, with an increase in total arc of motion of 62 degrees. In patients who underwent radial head excision and ulnohumeral arthroplasty, postoperative flexion increased 19 degrees, extension 27 degrees, with an increase in total arc of motion of 46 degrees. The difference between the 2 groups of patients was significant (P = .002). The average preoperative A-C score for patients undergoing radial head excision alone was 72 and the average postoperative score was 170. The average preoperative score for patients undergoing radial head excision and ulnohumeral arthroplasty was 92 and the average postoperative score was 150. Two patients who underwent the combined procedure had to return to surgery: 1 for a contracture release and 1 for radial head replacement secondary to intractable pain. They both did well subsequently. CONCLUSIONS: Patients undergoing radial head excision alone increased their average A-C score almost 100 points. Those undergoing both procedures increased their score an average of 58 points. In addition, those undergoing only radial head excision had a 20-point higher average overall postoperative A-C rating than those undergoing both procedures. Patients who underwent radial head excision alone had a greater return of range of motion and fewer postoperative complications than those who underwent the combined procedure. LEVEL OF EVIDENCE: Level IV.

Arthroscopy↗
PubMed2005

Effect of ventricular size and patch stiffness in surgical anterior ventricular restoration: a finite element model study.

BACKGROUND: Surgical anterior ventricular restoration (SAVER) has been proposed for dilated ischemic cardiomyopathy with an akinetic distal anterior left ventricular wall. We tested the hypothesis that SAVER increases stroke volume, reduces mean myofiber stress and achieves optimal results without a patch. METHODS: A finite element model of the left ventricle (LV) with an akinetic but contractile anteroapical LV wall segment was used. Separate versions of the model with normal and dilated LV sizes were developed and used to simulate the SAVER operation with and without a patch of varying stiffness from 10 to 100 kilopascals. RESULTS: The SAVER operation reduced myofiber stress in the akinetic infarct and infarct borderzone, but caused a reduction in the Starling relationship. In all cases, stroke volume decreased while ejection fraction increased after SAVER. The SAVER operation was more beneficial in dilated ventricles, and the reduction in stroke volume after SAVER without patch was minimal. The effect of patch stiffness was mixed as stiffer material causes a greater reduction in stress yet has the greatest negative effect on stroke volume. CONCLUSIONS: These simulations support the use of SAVER in dilated hearts without a patch.

Animals↗
PubMed2006

The use of flexible silastic drains after chest surgery: novel thoracic drainage.

PURPOSE: We report a new strategy for drainage with silicon thoracic tube (Blake drain) after chest surgery. DESCRIPTION: To confirm the effect of Blake drain, we have performed a three-part study including in vitro and clinical investigations compared with those of conventional chest tubes. We carried out an in vitro analysis to achieve the best possible drainage; in the second part, we used this drain in a cohort of 30 patients to establish safety and efficacy; and in a third substudy, we carried out a nonrandomized comparison with an earlier cohort between the Blake drain group and standard, rigid drain group. EVALUATION: In vitro tests demonstrate that the drainage capability of the Blake drain depends on sufficient length in the fluted part of the structure. Clinical outcome demonstrates no significant differences. The Silastic drain (Ethicon, Inc, Somerville, NJ) group had a significantly shorter period of tube drainage compared with the conventional drain group. CONCLUSIONS: From this small study the Blake drains seem to be safe and effective. Therefore, a prospective, randomized comparison should be carried out.

Air↗
PubMed2006

Recognition characters in peptide-polyphenol complex formation.

Dietary polyphenols have received attention for their anti-oxidative, anti-carcinogenic and anti-neurodegenerative effects. Polyphenols bind to proteins leading to the formation of soluble or insoluble protein-polyphenol complexes which could significantly influence their biological activities. NMR and molecular modeling studies were performed to investigate the influence of the bulk, flexibility and hydrophobicity of polyphenols on the association with bradykinin, the peptide model. Our results show that the strength of the interactions could be positively correlated with polyphenol hydrophobicity and a comparison between pentagalloylglucose and vescalagin indicated that flexibility might play a positive role in the interaction with peptides and proteins.

Biphenyl Compounds↗
PubMed2004

The alphaM1 segment of the nicotinic acetylcholine receptor exhibits conformational flexibility in a membrane environment.

The transmembrane domain of the nicotinic acetylcholine receptor (nAChR) is predominantly alpha-helical, and of the four distinctly different transmembrane M-segments, only the helicity of M1 is ambiguous. In this study, we have investigated the conformation of a membrane-embedded synthetic M1 segment by solid-state nuclear magnetic resonance (NMR) methods. A 35-residue peptide representing the extended alphaM1 domain 206-240 of the Torpedo californica nAChR was synthesized with specific 13C - and 15N-labelled amino acids, and was incorporated in different phosphatidylcholine model membranes. The chemical shift of the isotopic labels was resolved by magic angle spinning (MAS) NMR and could be related to the secondary structure of the alphaM1 analog at the labelled sites. Our results show that the membrane-embedded alphaM1 segment forms an unstable alpha-helix, particularly near residue Leu18 (alphaLeu223 in the entire nAChR). This non-helical tendency was most pronounced when the peptide was incorporated in fully hydrated phospholipid bilayers, with an estimated 40-50% of the peptides having an extended conformation at position Leu18. We propose that the conserved proline residue at position 16 in the alphaM1 analog imparts a conformational flexibility on the M1 segments that could enable membrane-mediated modulation of nAChR activity.

Amino Acid Sequence↗
PubMed2006

Aerobic exercise, but not flexibility/resistance exercise, reduces serum IL-18, CRP, and IL-6 independent of beta-blockers, BMI, and psychosocial factors in older adults.

Increased serum levels of inflammatory mediators have been associated with numerous disease states including atherosclerosis, Type II diabetes, hypertension, depression, and overall mortality. We hypothesized that a long-term exercise intervention among older adults would reduce serum inflammatory cytokines, and this reduction would be mediated, in part, by improvements in psychosocial factors and/or by beta-adrenergic receptor mechanisms. Adults age 64 were randomly assigned to either an aerobic exercise treatment (CARDIO) or a flexibility/strength exercise treatment (FLEX) 3 days/week, 45 min/day for 10 months. A subgroup of subjects treated with non-selective beta(1)beta(2) adrenergic antagonists were included to evaluate the potential role of beta-adrenergic receptor adaptations as mediators of an exercise-induced change in inflammation. The inflammatory mediators [C-reactive protein (CRP), IL-6, tumor necrosis factor (TNF)-alpha, and IL-18] and the psychosocial factors (depression, perceived stress, optimism, sense of coherence, and social support) were measured pre- and post-intervention. The CARDIO treatment resulted in significant reductions in serum CRP, IL-6, and IL-18 compared to the FLEX treatment (significant treatment x time interaction, p<.05), whereas TNFalpha declined in both groups (main effect of time, p=.001). However, several psychosocial factors (depression, optimism, and sense of coherence) improved in both groups suggesting that the reduction of CRP, IL-6, and IL-18 in the CARDIO group was not mediated by improvements in psychosocial scores. With respect to the potential role of beta-adrenergic receptors, both CARDIO subjects treated with beta-adrenergic antagonists and those who were not treated with those medications demonstrated similar reductions in serum CRP, IL-6, IL-18, and TNFalpha. In summary, we have observed that an aerobic exercise intervention can significantly reduce serum inflammatory mediators, but beta-adrenergic receptors and psychosocial factors do not appear to be involved.

Adaptation, Physiological↗
PubMed2004

Individual coping characteristics, rearing conditions and behavioural flexibility in pigs.

Several studies suggest that classification of piglets early in life based on the degree of resistance they display in a so-called Backtest may be indicative of their coping style at a later age. In the present study behavioural flexibility was investigated in pigs diverging for Backtest response and housing environment during rearing. Pigs were housed either without a rooting substrate (barren housing, B) or in identical pens enriched with deep straw bedding (enriched housing, E) from birth. During the suckling period piglets were subjected to the Backtest. Each piglet was restrained on its back for 1 min and the resistance (i.e. number of escape attempts) was scored. Pigs classified as 'high-resisting' (HR) or as 'low-resisting' (LR) were subjected to a simple (left/right) spatial discrimination (T-maze) task at 8 weeks of age. The effect of a single, subtle intramaze change was determined after acquisition of the task. In addition, pigs were subjected to reversal learning to assess their ability to modulate established behaviour patterns. Housing and its interaction with Backtest classification influenced the behavioural response to the intramaze change: E pigs were considerably more distracted than B pigs. Housing condition affected LR pigs more than HR pigs, as indicated by the interaction effects on various recorded behaviours. These interactions indicate that behavioural responding of pigs with diverging coping characteristics cannot simply be generalised across rearing conditions. Furthermore, HR pigs were less successful in reversal learning than LR pigs, suggesting that they have a higher propensity to develop inflexible behavioural routines.

Adaptation, Psychological↗
PubMed2004

Bimanual coordination involving homologous and heterologous joint combinations: when lower stability is associated with higher flexibility.

Variability in behavior is often put in an unfavorable light as a marker of lack of skill. Here, we provide evidence that increased variability during preferred patterns of coordination is associated with higher flexibility in adopting new patterns. Twelve right-handed subjects performed cyclical bimanual flexion and extension patterns with four homologous and six heterologous joint combinations involving shoulder, elbow, wrist, and finger movements. Preferred (isofrequency) as well as less preferred (multifrequency) coordination patterns were studied. The findings revealed less accurate and less stable 1:1 coordination patterns during heterologous as compared to homologous limb segment combinations. Conversely, coordination patterns with a 2:1 frequency ratio were performed more accurately and more consistently during heterologous as compared to homologous conditions. Accordingly, a lower degree of coupling between effectors during performance of preferred coordination patterns was associated with more successful performance of less familiar patterns. This suggests that variability may promote the creative exploration of new performance modes.

Adult↗
PubMed2005

The influence of the phosphorus content on the bioactivity of sol-gel glass ceramics.

The aim of this work was to study the influence of the phosphorus on the crystallization and bioactivity of glass-ceramics obtained from sol-gel glasses. For this purpose two sol-gel glasses with a similar composition but one of them containing P2O5 (70% SiO2; 30% CaO and 70% SiO2; 26% CaO; 4% P2O5, mol%) were prepared. Pieces of these glasses were treated at temperatures ranging between 700 degrees C and 1400 degrees C for 3 h. The obtained materials were characterized by XRD, FTIR, SEM-EDS and the biaxial flexural strength was determined in samples heated at 1100 degrees C. In addition, an in vitro bioactivity study in simulated body fluid (SBF) was carried out. The results showed that phosphorus plays an important role in the crystallization of the glasses: it induced the crystallization of calcium phosphate phases, the stabilization of the wollastonite phase at high temperature as well as the crystallization of SiO2 phases at low temperatures. Moreover, the presence of phosphorus produced a heterogeneous distribution of defects in the pieces and, therefore, the flexural strength of samples containing this element decreased. Finally, glass-ceramics obtained from glasses containing phosphorus showed the fastest formation rate of the apatite layer when soaked in SBF.

Body Fluids↗
PubMed2005

Motor flexibility problems as a marker for genetic susceptibility to attention-deficit/hyperactivity disorder.

BACKGROUND: Since many children with attention-deficit/hyperactivity disorder (ADHD) have fine visuomotor problems that are already evident at a young age, motor dysfunctioning is investigated in family-genetic perspective. We hypothesized that if fine motor problems may be a marker for genetic susceptibility to ADHD, nonaffected siblings of ADHD probands would experience motor problems similar to those of their ADHD siblings. METHODS: Twenty-five carefully phenotyped ADHD probands with a family history of ADHD, their nonaffected siblings (n = 25), and 48 normal control subjects (aged 6 to 17) completed a motor fluency task and a motor flexibility task. The motor fluency task involved completion of a familiar, automatized trajectory, whereas the motor flexibility task required continuous adjustment of movement to complete an unpredictable random trajectory. RESULTS: On the motor fluency task, the performance of the nonaffected children was significantly better than that of the ADHD probands; strikingly, on the motor flexibility task, they performed as well as their ADHD siblings. CONCLUSIONS: Nonaffected siblings experience complex motor problems similar to their ADHD siblings but only in nonautomatized movements that require controlled processing. The results suggest that higher-order controlled motor deficits in ADHD may be associated with genetic susceptibility for ADHD.

Adolescent↗
PubMed2006

Molecular flexibility in protein-DNA interactions.

In living cells protein-DNA interactions are fundamental processes. Here, we compare the 3D structures of several DNA-binding proteins frequently determined with and without attached DNA. We studied the global structure (backbone-traces) as well as the local structure (binding sites) by comparing pair-wise the related atoms. The DNA-interaction sites of uncomplexed proteins show conspicuously high local structural flexibility. Binding to DNA results in specific local conformations, which are clearly distinct from the unbound states. The adaptation of the protein's binding site to DNA can never be described by the lock and key model but in all cases by the induced fit model. Conformational changes in the seven protein backbone traces take place in different ways. Two of them dock onto DNA without a significant change, while the other five proteins are characterized by a backbone conformation change caused by DNA docking. In the case of three proteins of the latter group the DNA-complexed conformation also occurs in a few uncomplexed structures. This behavior can be described by a conformational ensemble, which is narrowed down by DNA docking until only one single DNA-complexed conformation occurs. Different docking models are discussed and each of the seven proteins is assigned to one of them.

Binding Sites↗
PubMed2006

Immediate mechanical stability of sagittal split ramus osteotomy fixed with resorbable compared with titanium bicortical screws in mandibles of sheep.

Ten fresh mandibles from adult sheep were stripped of all soft tissues and sectioned in the midline. We did sagittal split osteotomies and 5 mm advancement on all the 20 hemimandibles. Ten hemimandibles were fixed with three 2.0 mm x 13 mm titanium bicortical screws, and the other 10 were fixed with three 2.0 mm x 13 mm poly-l-lactic acid/polyglycolic acid (PLLA/PGA) bicortical screws in an inverted L pattern. All the hemimandibles were then mounted in a servohydraulic testing unit and tested to permanent deformation. Maximum forces that the mandibles resisted before breaking, maximum displacements, and the displacement values under 20, 60, 120, and 150 N were compared using the Mann-Whitney U-test. There were no significant differences in stability between the bones fixed with titanium and those fixed with resorbable screws.

Absorbable Implants↗
PubMed2006

Biomechanical study of prophylactic internal fixation of the radial osteocutaneous donor site using the sheep tibia model.

This study investigated the strengthening effect of different types of plate and position after osteotomy of the sheep tibia, which is a model for the radial osteocutaneous donor site. Fifty matched pairs of adult sheep tibias were tested in torsion and four-point bending. Firstly, the weakening effect of an osteotomy was compared with the intact bone. Then pairs of bones with an osteotomy were compared with and without reinforcement with different types of 3.5mm plate. The plate was placed in either the anterior (over the defect) or posterior (on the intact cortex) position. In torsion the mean strength of the intact bone was 45% greater than after osteotomy (P=0.02). The reinforced bone was on average 61% stronger than the unreinforced bone (P<0.001). In bending the mean strength of the intact bone was 188% greater than after osteotomy (P=0.02). The reinforced bone was on average 184% stronger then the unreinforced bone (P<0.001). The tibia was able to withstand much greater loads in bending. The dynamic compression plate was the strongest reinforcement in both torsion and bending. The position of the plate did not alter the strengthening effect in torsion but the posterior position resisted greater bending loads (P=0.01). This may not be relevant in clinical practice as the radius is likely to fracture first as a result of lower torsional forces.

Analysis of Variance↗
PubMed2005

Mechanical loading modulates glutamate receptor subunit expression in bone.

The cellular mechanisms coupling mechanical loading with bone remodeling remain unclear. In the CNS, the excitatory amino acid glutamate (Glu) serves as a potent neurotransmitter exerting its effects via various membrane Glu receptors (GluR). Nerves containing Glu exist close to bone cells expressing functional GluRs. Demonstration of a mechanically sensitive glutamate/aspartate transporter protein and the ability of glutamate to stimulate bone resorption in vitro suggest a role for glutamate linking mechanical load and bone remodeling. We used immunohistochemical techniques to identify the expression of N-methyl-d-aspartate acid (NMDA) and non-NMDA (AMPA or kainate) ionotropic GluR subunits on bone cells in vivo. In bone sections from young adult rats, osteoclasts expressed numerous GluR subunits including AMPA (GluR2/3 and GluR4), kainic acid (GluR567) and NMDA (NMDAR2A, NMDAR2B and NMDAR2C) receptor subtypes. Bone lining cells demonstrated immunoexpression for NMDAR2A, NMDAR2B, NMDAR2C, GluR567, GluR23, GluR2 and GluR4 subunits. Immunoexpression was not evident on osteocytes, chondrocytes or vascular channels. To investigate the effects of mechanical loading on GluR expression, we used a Materials Testing System (MTS) to apply 10 N sinusoidal axial compressive loads percutaneously to the right limbs (radius/ulna, tibia/fibula) of rats. Each limb underwent 300-load cycles/day (cycle rate, 1 Hz) for 4 consecutive days. Contralateral, non-loaded limbs served as controls. Mechanically loaded limbs revealed a load-induced loss of immunoexpression for GluR2/3, GluR4, GluR567 and NMDAR2A on osteoclasts and NMDAR2A, NMDAR2B, GluR2/3 and GluR4 on bone lining cells. Both neonatal rabbit and rat osteoclasts were cultured on bone slices to investigate the effect of the NMDA receptor antagonist, MK801, and the AMPA/kainic acid receptor antagonist, NBQX, on osteoclast resorptive activity in vitro. The inhibition of resorptive function seen suggested that both NMDAR and kainic acid receptor function are required for normal osteoclast function. While the exact role of ionotropic GluRs in skeletal tissue remains unclear, the modulation of GluR subunit expression by mechanical loading lends further support for participation of Glu as a mechanical loading effector. These ionotropic receptors appear to be functionally relevant to normal osteoclast resorptive activity.

Acid Phosphatase↗