Custom-made hinged total knee arthroplasties in the context of extra-articular deformity: a case series.

PURPOSE: Treatment of secondary knee osteoarthritis with a significant extra-articular deformity can be challenging. In such cases, an osteotomy or a custom-made hinged knee arthroplasy (CMH) are treatment options. However, there are limited data on the outcomes of using CMHs. Thus, the aim of this retrospective study was to assess the clinical results and subjective outcomes of CMHs. METHODS: We reviewed 9 CMHs (Endo-Model, LINK) in 7 patients with a minimum of 2-year follow-up. Upon the last follow-up, we evaluated MA, stability and range of movement (ROM). Oxford Knee Score (OKS) was used to evaluate patient-reported outcomes. RESULTS: The average age upon surgery was 61 years (48-76 years), and the follow-up period was 66 months. There were no early complications. Two CMHs were revised, one due to aseptic loosening and one due to late-onset haematogenic infection. Pre-operatively, MA varied from 18° (average 11°) valgus-deformity to 30° (average 17°) varus-deformity. Post-operatively, 7/9 (78%) of patients achieved better MA. Upon follow-up, the average OKS was 41/48, and ROM was 113°. CONCLUSIONS: Patients treated with CMHs achieved good clinical and patient-reported outcomes. There were no early reoperations, and revision rate was relatively low. Overall, CMH could be considered for low-demand patients with increased operative risks.

A rapid magnetization preparation for MRI measurements of sprays.

The process of spray atomization, i.e., the transformation of a continuous liquid jet into µm-sub-mm sized droplets, is ubiquitous in industry yet quite complex to analyze theoretically and study experimentally. One of the main strengths of MRI is its ability to sensitize spatially-resolved NMR signal to a wide variety of physical and chemical parameters. However, standard preparation schemes are difficult to employ for studies of sprays due to sprays' fast speeds (>10-20m/s). In addition, sprays are usually low-density systems, leading to a poor SNR and a need for massive signal averaging and long acquisition time. In this paper, we reduced the interval between the preparation and the readout stages by performing SPI encoding on the rising gradients. This also enabled the use of 90-degree flip angles to maximize the spray signal and saturate the stationary water signal while avoiding unwanted slice-selection. The use of gradients during preparation stage was eliminated due to their time-consuming rise and stabilization times limiting possible preparation schemes to a combination of RF pulses and delays. The two preparation schemes presented here are Time-of-Flight (TOF) and T1ρ-weighting schemes. The total duration of the sequence (without TR) was 240-1100µs for the TOF and 410µs for T1ρ. The T1ρ prepared images of the near-atomization region (11 spin-locking frequencies, 0-15kHz) showed a strong signal attenuation at higher frequencies. In series of TOF images the clearly noticeable displacement of the liquid parcel can be utilized to measure spray speeds.

Behavior of sulfate reducing bacteria under oligotrophic conditions and oxygen stress in particle-free systems related to drinking water.

The response of sulfate reducing bacteria (SRB) to oxygen stress under oligotrophic conditions in particle-free systems was studied in (i) sterile Berlin drinking water; (ii) mineral medium; and (iii) in coculture experiments with aerobic bacteria. Using a polyphasic approach including anaerobic cultivation, fluorescent in situ hybridization (FISH) and digital image analysis, the behavior of the strains zt3l and zt10e, isolated from Berlin groundwater and affiliated to the family Desulfovibrionaceae, was compared to the type strains Desulfomicrobium baculatum and Desulfovibrio desulfuricans. Anaerobic deep agar dilution series were performed for the determination of cell culturability. FISH and subsequent digital image analysis of probe-conferred fluorescence intensities were used for the assessment of metabolic activity. For the in situ identification of both isolates in coculture tests, two strain-specific oligonucleotides were developed and evaluated. The total cell counts of stressed SRB in drinking water decreased during the course of the assay dependent on the strain. Both environmental isolates could be cultured for a longer period than cells of D. baculatum and D. desulfuricans, respectively. The FISH intensities showed a strain-specific behavior. When exposed to simultaneous oxygen stress and carbon limitation in mineral medium, total cell counts of all four strains remained constant throughout a period of 72 days. The rate of culturability differed between the investigated strains. The decrease of metabolic activity as assessed by FISH was a strain-specific property. Exposure of SRB to oxygen stress and carbon starvation in coculture experiments with Aquabacterium commune resulted in strain dependent prolonged culturability and a delayed decrease of the metabolic activity compared to pure culture tests for all strains tested. Total cell counts of SRB were constant throughout the whole experiment.

Lessons from the field--health care experiences and preferences in a Latino community.

As part of Midwest Bioethics Center's PATHWAYS to Improve End-of-Life Care project, we conducted an exploratory study in the Latino community of Kansas City to understand health beliefs, practices, and values, particularly as they relate to end-of-life care. We conducted ten focus groups and interviewed more than seventeen individuals who serve the Latino community in a social service, ministry, or health care capacity. We found that people were very concerned with "barriers to health care" (our term), and very willing to reveal their preferences for health care decision making and end-of-life care treatment options. We believe that bioethicists should conduct other, similar projects because they can improve our engagement with the Latino population and help Latinos find a greater voice in health care settings.

Toxic spongiform leucoencephalopathy after inhaling heroin vapour.

This is a report of clinical, CT and MRI findings in a patient with toxic spongiform leucoencephalopathy after heroin ingestion. The disease is observed in drug addicts who inhale pre-heated heroin. The clinical onset, which usually occurs some days or even longer after the last heroin consumption, is characterized by a cerebellar syndrome. The cerebellar hemispheres, the cerebellar and cerebral peduncles and the pyramidal tract may be affected. Spongiform demyelination is the morphological substrate of the lesions, which are not contrast enhancing, hypodense on CT and hyperintense on T2-weighted MRI. The frequently perfect symmetry of the affection of functional systems points to a toxic and/or metabolic pathophysiological mechanism.