1,194 research outputs found
The Effect of Conservative Treatment in Symptomatic Midgrade Knee Osteoarthritis. 5-Year-Results of a Retrospective Study and of a Systematic Review
No full textPurpose: This study was performed to evaluate the effect (subjective complaints and conversion to the knee replacement) of a conservative treatment protocol in patients who are suffering from middle-stage knee osteoarthritis. Another goal of this current study was to perform a systematic review of the international literature for a comparison with the own results. Methods: A total of 63 grade III (Kellgren Lawrence Score) patients did undergo conservative treatment of knee osteoarthritis. The evaluation was made at baseline and yearly up to 5 years by using the KOOS (Knee Injury and Osteoarthritis Outcome Score). Results: At baseline the KOOS amounted 99.2 points. At the 1-year control, the score did increased to 134.8 points. This result debased within the 2-year follow-up to 120.3 points. In comparison to the baseline, the 2-year outcome still was significantly better. After 3 years there only was a tendency superior outcome in comparison to the baseline score (KOOS= 115.9). In the 4(th) (KOOS= 93.2 points) and 5(th) (KOOS =81.3 points) year, after initial treatment there was a continuous debasement of the results. A total of 22 patients (34.9%) did undergo a total knee replacement during the follow-up. The mean time for survival was 44.2 (95 %-CI 38.6-49.9) months. The number of studies which reports about middle or long-term reports is rare. We only evaluated 12 studies with reports about a follow-up >12 months. The mean increase of patients complaints in all studies was Random effects = 1.04 (95% CI=0.7-1.4), p <0.001. Conclusion: The conservative treatment of knee osteoarthritis is method of choice in a large number of patients. After 1-2 years, the results debase significantly
Patient Blood Management: a fresh look at a new approach to blood transfusion
No full textThe overall use of allogeneic blood transfusions in clinical practice remains relatively high and still varies widely among centres and practitioners. Moreover, allogeneic blood transfusions have historically been linked with risks and complications: some of them (e.g. transfusion reactions and transmission of pathogens) have been largely mitigated through advancements in blood banking whereas some others (e.g. immunomodulation and transfusion--related acute lung injury) appear to have more subtle aetiologies and are more difficult to tackle. Furthermore, blood transfusions are costly and the supply of blood is limited. Finally, evidence indicates that a great number of the critically ill patients who are being transfused today may not be having tangible benefits from the transfusion. Patient blood management is an evidence--based, multidisciplinary, multimodal, and patient--tailored approach aimed at reducing or eliminating the need for allogeneic transfusion by managing anaemia, perioperative blood conservation, surgical haemostasis, and blood as well as plasma--derivative drug use. From this point of view, the reduction of allogeneic blood usage is not an end in itself but a tool to achieve better patient clinical outcome. This article focuses on the three--pillar matrix of patient blood management where the understanding of basic physiology and pathophysiology is at the core of evidence--based approaches to optimizing erythropoiesis, minimising bleeding and tolerating anaemia. Anaesthesiologists and Critical Care physicians clearly have a key role in patient blood management programmes are and should incorporate its principles into clinical practice--based initiatives that improve patient safety and clinical outcomes
Arthroscopic Debridement of Irreparable Massive Rotator Cuff Tears — A Comparison of Debridement Alone and Combined Procedure with Biceps Tenotomy
No full textThe goal of the study was to compare the results of arthroscopic debridement in massive, irreparable rotator cuff tears with and without tenotomy of the long head of the biceps (LHB). We evaluated 41 patients who were treated by a single surgeon for massive, irreparable rotator cuff tears either by arthroscopic debridement alone (24 patients) or with additional tenotomy of LHB (17 patients). The mean age was 67 years (range : 61 to 82 years) and the average follow-up was 31 months (range : 24 to 48 months). There was no significant difference between the two groups in age, gender, pain, function, and follow-up. All patients had significant disabling pain weakness preoperatively. Assessments were made using the Constant score. The average Constant score for the group without LHB tenotomy improved from a mean of 39 points (range : 19 to 54 points) preoperatively to a mean of 67 points (range : 41 to 87 points) and for the group with additional LHB tenotomy from a mean of 41 points (range : 16 to 54 points) preoperatively to a mean of 69 points (range : 49 to 87 points) at the time of follow-up. The radiological study showed no significant narrowing of the subacromial space. No statistical significance (P > .05) was found between the two groups. However, patients with additional LHB tenotomy had a longer duration of postoperative pain relief, but final pain score difference was not statistically significant. There was no complication related to the procedure. Arthroscopic debridement of massive, irreparable rotator cuff tears provides reliable expectation for improvement in function, decrease in pain, and improvement in shoulder scores for most patients. Additional LHB tenotomy did not significantly influence the postoperative results at the latest follow-up. In our series we noted no significant humeral head migration or developing rotator cuff arthropathy
Evaluation of Cartilage Degeneration by Near Infrared Spectroscopy (NIRS): Methodical Description and Systematic Literature Review
No full textDamage to hyaline cartilage is the most important pathophysiological tool in the development of osteoarthritis. Cartilage lesions are the most frequent pathological findings during arthroscopic operations. Arthroscopies as well asmagnetic resonance tomography are gold standards for detection of cartilage lesions. But the arthroscopic evaluation of cartilage lesions is descriptive and subjective only. The surgeon is able to differentiate between intact cartilage surface, softening, superficial or deep fissure or flake and finally a complete defect. In routine arthroscopy the grading mostly is made by use of different scores [e.g. ICRS (International Cartilage Repair Society), Outer-bridge, Insall, Jager-Wirth or others]. Because the arthroscopic evaluation is subjective the reliability of this method is poor. Spectroscopic methods are established for evaluation of different tissue diseases in different indications. NIRS (near infrared spectroscopy) has become an important method for medical diagnostics in the last years. NIR is very energy-rich and suitable for glass fibre transport without relevant reduction. Insofar this technology may be ideal for endoscopic procedures. Our systematic literature review reveals that NIRS is a sufficient method for an objective diagnosis of cartilage lesions. In the current work we demonstrate an NIRS-based device for intraoperative, real-time cartilage evaluation. Furthermore, we discuss the possible clinical consequences from such measurements
Variations on inductive-recursive definitions
No full textDybjer and Setzer introduced the definitional principle of inductive-recursively defined families — i.e. of families ( U : Set , T : U → D ) such that the inductive definition of U may depend on the recursively defined T — by defining a type DS D E of codes. Each c : DS D E defines a functor J c K : Fam D → Fam E , and ( U , T ) = μ J c K : Fam D is exhibited as the initial algebra of J c K . This paper considers the composition of DS -definable functors: Given F : Fam C → Fam D and G : Fam D → Fam E , is G ◦ F : Fam C → Fam E DS -definable, if F and G are? We show that this is the case if and only if powers of families are DS -definable, which seems unlikely. To construct composition, we present two new systems UF and PN of codes for inductive-recursive definitions, with UF ↪ → DS ↪ → PN . Both UF and PN are closed under composition. Since PN defines a potentially larger class of functors, we show that there is a model where initial algebras of PN -functors exist by adapting Dybjer-Setzer’s proof for DS
Knorpelregeneration nach valgisierender Tibiakopfosteotomie. Ergebnisse einer arthroskopischen Studie
No full textAim: High tibial osteotomy (HTO) has been established as an effective method for the treatment of unicondylar knee osteoarthritis. This study was undertaken to quantify the potential for restoration of cartilage lesions or defects after HTO in relation to different cartilage treatment modalities. Control arthroscopy was undertaken to identify the cartilage lesions within the knee joint 1.5 years after medial opening wedge osteotomy. Material and Method: A total of 135 patients (72 male and 63 female) had undergone medial-opening high tibial osteotomy and arthroscopy. The mean age at operation was 48.8 (36 to 65) years. All HTO were fixed with an angle-stable, mobile spacer-containing plate (HTO-Platte, Konigsee, Deutschland). All HTO were combined with a simultaneous arthroscopy. Grade III cartilage lesions had undergone either shaving or temperature-controlled chondroplasty (Paragon ArthroW Austin, TX, USA). In some case these cartilage lesions had remained untreated. Control arthroscopy and removal of the implants was performed 1.5 years after HTO. The cartilage lesions were graded accordingly to the ICRS guidelines (International Cartilage Repair Society). Results: The KOOS at HTO was 49.9 (SD 10.6) points. We observed at follow-up a mean increase from 66.1 (SD 28.8, 95% CI: 61.2-71.1) points. The KOOS at follow-up was 16.1 (SD 29.8) points. There was no delayed union of the HTO space. Before HTO the varus angle Was 10.4 degrees (SD 3.9 range 5 to 20 degrees). The correction angle was 13.6 degrees (SD 4.4, 95% CI: 12.9-14.4 degrees). Finally we determined a valgus angle of-3.2 degrees (SD 1.8 minimum 0 degrees varus, maximum -6 degrees valgus. The clinical outcome (KOOS) significantly (p<0.001) correlated (R = 0.605) with the extension of valgisation. Patients with a valgus angle of 3 degrees and more had the best outcome. Of the grade III lesions 40.4% in the medial femoral condyle and 62.3% in the medial tibial plateau increased to grade II or I lesions. In 13.1% of the medial femoral condyle and 8.5% of medial tibial plateau cases we found complete (grade IV) defects at control arthroscopy. The highest rate of regenerations was detected after temperature-controlled chondroplasty. The worst results were produced after mechanical debridement. Microfracturing of complete defects produced regeneration in about 2/3 in the medial femoral condyle and about 1/3 in the medial tibial plateau. No increase was observed within the lateral or patello-femoral compartment. No correlation was seen between cartilage regeneration and outcome. The extension of valgisation did not influence the cartilage regeneration. Conclusions: The main effect of the HTO is the shift of the weight-bearing line from the arthritic compartment to the opposite femorotibial healthy one. In addition, HTO also produces a partial restoration of cartilage lesions. Deep cartilage lesions (grade III) restore in about 60% of the cases after HTO. The worst restoration is found after mechanical shaving. This method should be avoided in the future. The best restoration was found in deep lesions after thermochondroplasty. Furthermore, in about half of the patients with complete (grade IV) defects, microfracturing caused the formation of fibrocartilaginous regenerates. This procedure should always be performed if possible
Stop the Press: A Baseball Legend and Biography
No full textThis chapter explores Warren Spahn's lawsuit against a publishing house in Spahn v. Julian Messner, Inc. Spahn was remarkable baseball pitcher and a veteran of World War II. In 1964, Julian Messner Inc. published a child-targeted biography (called in the business at the time, a juvenile biography) of Spahn, who then sued to stop publication on the grounds that it violated all four of the tenants of privacy: invasion, false light, private facts, and appropriation. The Warren Spahn Story told the story of the perfect man: a good son, a good baseball player, a good husband, and a good soldier. The author of the book admitted that his research consisted of looking at a few magazine stories and clippings, and that he had made no effort to speak with Spahn himself, his family, his teammates, or any of his friends or acquaintances. Spahn won an injunction against future distribution of the book and $10,000 in damages. Ultimately, the U.S. Supreme Court ordered the case re-tried using the actual malice standard of the Butts case, and Spahn won again. The decisions concluded that Spahn had the right to demand that the basic facts of his life be told accurately, and it required authors of biographies to make a good faith effort to represent their subjects truthfully.</p
Patient blood management: a fresh look at a fresh approach to blood transfusion.
No full textThe overall use of allogeneic blood transfusions in clinical practice remains relatively high and still varies widely among centres and practitioners. Moreover, allogeneic blood transfusions have historically been linked with risks and complications: some of them (e.g. transfusion reactions and transmission of pathogens) have been largely mitigated through advancements in blood banking whereas some others (e.g. immunomodulation and transfusion-related acute lung injury) appear to have more subtle etiologies and are more difficult to tackle. Furthermore, blood transfusions are costly and the supply of blood is limited. Finally, evidence indicates that a great number of the critically ill patients who are being transfused today may not be having tangible benefits from the transfusion. Patient blood management is an evidence-based, multidisciplinary, multimodal, and patient-tailored approach aimed at reducing or eliminating the need for allogeneic transfusion by managing anaemia, perioperative blood conservation, surgical haemostasis, and blood as well as plasma-derivative drug use. From this point of view, the reduction of allogeneic blood usage is not an end in itself but a tool to achieve better patient clinical outcome. This article focuses on the three-pillar matrix of patient blood management where the understanding of basic physiology and pathophysiology is at the core of evidence-based approaches to optimizing erythropoiesis, minimising bleeding and tolerating anemia. Anesthesiologists and critical care physicians clearly have a key role in patient blood management programmes are and should incorporate its principles into clinical practice-based initiatives that improve patient safety and clinical outcomes
Autotuning Symbolic Optimization Fabrics for Trajectory Generation
No full textIn this paper, we present an automated parameter optimization method for trajectory generation. We formulate parameter optimization as a constrained optimization problem that can be effectively solved using Bayesian optimization. While the approach is generic to any trajectory generation method, we showcase it using optimization fabrics. Optimization fabrics are a geometric trajectory generation method based on non-Riemannian geometry. By symbolically pre-solving the structure of the tree of fabrics, we obtain a parameterized trajectory generator, called symbolic fabrics. We show that autotuned symbolic fabrics reach expert-level performance in a few trials. Additionally, we show that tuning transfers across different robots, motion planning problems and between simulation and real world. Finally, we qualitatively showcase that the framework could be used for coupled mobile manipulation.Green Open Access added to TU Delft Institutional Repository 'You share, we take care!' - Taverne project https://www.openaccess.nl/en/you-share-we-take-care Otherwise as indicated in the copyright section: the publisher is the copyright holder of this work and the author uses the Dutch legislation to make this work public.Learning & Autonomous Contro
Cassini dust measurements at Enceladus and implications for the origin of the E ring
No full textSpahn F, Schmidt J, Albers N, et al. Cassini dust measurements at Enceladus and implications for the origin of the E ring. Science. 2006;311(5766):1416-1418
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