Intraoperative 3D imaging in intraarticular tibial plateau fractures - Does it help to improve the patients' outcomes?

BACKGROUND: In tibial plateau fractures (TPF) the restoration of an anatomical joint surface as well as an exact subchondral screw position for postoperative stability is crucial for the outcome. The aim of this study was to determine whether the additional use of an intraoperative 3D imaging intensifier (3D) might help to improve the outcome of complex TPF. METHODS: We performed a retrospective case-control study of a level 1 trauma center. Patients with AO/OTA 41 B3 and C-TPF operated on using a 3D imaging intensifier between November 2015 and December 2018 (3D group) were included. The outcomes of this patients were compared to patients operated without 3D imaging between January 2005 to December 2014 (2D group). The comparison of the groups was performed by matched pair analysis. The functional outcome of both groups was measured by KOOS and Lysholm Score after a follow-up period of at least 12 months. Operation time, infections and postoperative revisions were registered. RESULTS: In total, 18 patients were included in the 3D group (mean age: 51.0± 16.4 years; 12 females) and an equal number of matching partners from the 2D group (mean age: 50.3± 15.2 years; 11 females) were found (p=0.82; p=0.79). We found 9x B3, 2x C1, 1x C2, 6x C3 fractures according to AO/OTA for each group (p=1.00) with comparable ASA score (p=0.27). The mean operation time was 127.9± 45.9 min and 116.1± 45.7 min for the 3D and 2D group (p=0.28). The mean follow-up time was 20.9± 10.7 months for the 3D and 55.5± 34.7 months for the 2D group (p< 0.001). For the 3D group a mean Lysholm overall score of 67.4± 26.8 and KOOS overall score of 72.6± 23.5 could be assessed. In contrast, a mean Lysholm overall score of 62.0± 21.4 and KOOS overall score of 65.8± 21.6 could be measured in the 2D group (p=0.39; p=0.31). Thereby, functional outcome of the 3D group showed a significant higher KOOS Sport/Rec sub score of 54.7± 35.0 in comparison to the 2D group with 26.7± 31.6 (p= 0.01). Postoperative revisions had to be performed in 27.8% of cases in both groups (p=1.00). Due to the 3D imaging an intraoperative revision was performed in 33.3% (6/18). CONCLUSION: In our study we could show that re-reduction of the fracture or implant re-positioning were performed in relevant numbers based on the 3D imaging. This was associated with a midterm clinical benefit in regard to better KOOS Sport/Rec scores. TRIAL REGISTRATION: AZ 488 /20-ek.

3D ultrasound biomicroscopy for assessment of cartilage repair tissue: volumetric characterisation and correlation to established classification systems.

Objective and sensitive assessment of cartilage repair outcomes lacks suitable methods. This study investigated the feasibility of 3D ultrasound biomicroscopy (UBM) to quantify cartilage repair outcomes volumetrically and their correlation with established classification systems. 32 sheep underwent bilateral treatment of a focal cartilage defect. One or two years post-operatively the repair outcomes were assessed and scored macroscopically (Outerbridge, ICRS-CRA), by magnetic resonance imaging (MRI, MOCART), and histopathology (O'Driscoll, ICRS-I and ICRS-II). The UBM data were acquired after MRI and used to reconstruct the shape of the initial cartilage layer, enabling the estimation of the initial cartilage thickness and defect volume as well as volumetric parameters for defect filling, repair tissue, bone loss and bone overgrowth. The quantification of the repair outcomes revealed high variations in the initial thickness of the cartilage layer, indicating the need for cartilage thickness estimation before creating a defect. Furthermore, highly significant correlations were found for the defect filling estimated from UBM to the established classification systems. 3D visualisation of the repair regions showed highly variable morphology within single samples. This raises the question as to whether macroscopic, MRI and histopathological scoring provide sufficient reliability. The biases of the individual methods will be discussed within this context. UBM was shown to be a feasible tool to evaluate cartilage repair outcomes, whereby the most important objective parameter is the defect filling. Translation of UBM into arthroscopic or transcutaneous ultrasound examinations would allow non-destructive and objective follow-up of individual patients and better comparison between the results of clinical trials.

Determination of k0-values for the reactions 94Zr (n, gamma) 95Zr and 96Zr (n, gamma) 97Zr-97mNb by irradiation in highly thermalized neutron flux.

Determination of k(0)-factors for zirconium isotopes was performed by co-irradiation of Zr and Au-Al. Due to the highly thermalized irradiation position at FRM-II, interferences from epithermal neutrons were found largely decreased for (96)Zr (n, gamma) (97)Zr-(97m)Nb, the reaction with the highest Q(0)-value in all (n, gamma) reactions. Results showed that, the (95)Zr k(0)-values from this work were the same as the recommended ones. For (97)Zr-(97m)Nb 743.4 keV gamma-line, the new k(0)-value was 2.8% higher compared to the recommended value, which is not a significant difference. These results are helpful in clarifying the suspicion about the Zr k(0)-factors.

Target burn-up corrected specific activity of 177Lu produced via 176Lu(n, gamma) 177Lu nuclear reactions.

Nuclear transformation of the target material is considered as an essential parameter for the specific activity of (177)Lu produced via (176)Lu(n, gamma)(177)Lu nuclear reactions. It is shown that (176)Lu burn-up has to be taken into account to estimate the (177)Lu specific activity related to the total mass or amount of lutetium in the system.

Production of 177Lu at the new research reactor FRM-II: Irradiation yield of 176Lu(n,gamma)177Lu.

Due to its physical and chemical characteristics, 177Lu is a very attractive radionuclide for use in nuclear medicine. This paper introduces a method for a precise calculation of the irradiation yield of 177Lu produced by neutron activation of 176Lu in a nuclear reactor. The calculation is based on the Westcott convention which requires the knowledge of the neutron flux parameters. In this work, the neutron flux parameters of the new research reactor FRM-II (Garching, Germany) were determined and the stability of thermal neutron flux and thermal neutron flux temperature was monitored. The comparison of theoretically calculated and experimentally determined yield for Lu176(n,gamma)Lu177 reaction is presented.

The internal comparator method.

An internal comparator method is proposed which offers reliable instrumental neutron activation analysis (INAA) results for samples with an irregular geometry and/or measured at the closest position to the Ge detector. Because the selected internal comparator in the sample analyzed will receive exactly the same thermal neutron flux as the other components, this method can be applied to the INAA of materials suffering from thermal neutron self-shielding. To apply the internal comparator method, the k(0)-method must be installed and the analytes, including the internal comparator, should be homogeneously distributed in the test portion.

Elemental contents in Napoleon's hair cut before and after his death: did Napoleon die of arsenic poisoning?

Whether or not Napoleon died of arsenic poisoning is an open question on which debate has been active since 1960. This work examined several of his hairs, cut at different times and in different places: two pieces cut the day after his death on the island of St. Helena (1821) and two pieces cut seven years earlier (1814) during his first exile on the island of Elba. INAA results show that all of the samples of Napoleon's hair have an elevated arsenic concentration. These results disfavor the arsenic poisoning theory. Aside from arsenic, 18 other elements are reported, providing additional information for examining the arsenic poisoning theory.

[The effectiveness of rare earth elements as a possible alternative growth promoter for pigs and poultry]. / Untersuchungen zur Wirkung Seltener Erden als mögliche Alternative zu Leistungsförderern bei Schweinen und Geflügel.

Mixtures of Rare Earth Elements (REE) have been used as animal growth-promoters on a large scale in China during the last 20 years. Numerous studies carried out in China claim it produces quite sensational growth-promoting effects in all categories of farm animals. To explore the question of whether REE's might prove suitable as a growth-promoter under western keeping conditions, feeding experiments were performed on pigs and poultry. The animals received a typical diet, supplemented with REE salts in concentrations between 75 and 300 mg/kg feed. Weight-gain, feed-intake, feed-conversion and (where applicable) laying parameters were observed. It was shown that in pigs receiving feed supplemented with REEs, an increase in daily weight gain of up to 19% and an improvement in feed-conversion of up to 11% can be achieved, whereas, for poultry, no positive effects on growth or productivity of the animals could be observed. Testing of important organs via Neutron Activating Analysis (NAA) showed a minute accumulation of REE, principally in liver and bones. Analysis of the poultry gut-flora, using selective media, showed that the main microorganism populations of the alimentary canal were unaffected by feed-supplementation with REE.

Endovascular irradiation from beta-particle-emitting gold stents results in increased neointima formation in a porcine restenosis model.

BACKGROUND: Recent studies have shown that ionizing radiation reduces neointima formation after balloon angioplasty and stent implantation in experimental models of restenosis and first clinical trials. The objective of this study was to determine the dose distribution of a new beta-particle-emitting radioactive gold stent and to evaluate the dose-dependent vascular response in the coronary overstretch pig model. METHODS AND RESULTS: Sixteen Göttinger minipigs underwent placement of 11 nonradioactive and 36 beta-particle-emitting stents with activity levels of 10.4+/-0.6, 14.9+/-2.4, 22.8+/-1.3, 35.8+/-2. 8, and 55.4+/-5.3 microCi of (198)Au. Three months after implantation, the percent area stenosis, neointimal thickness, neointimal area, and vessel injury were analyzed by quantitative histomorphometry. The lifetime radiation doses at a depth of 1 mm were 3.3+/-0.2, 4.7+/-0.5, 7.2+/-0.4, 11.4+/-0.9, and 17.6+/-1.7 Gy for the different activity groups. No dose-response relationship was observed in the radioactive stents with respect to percent area stenosis (P=0.297), mean neointimal thickness (P=0.82), or mean neointimal area (P=0.65). Significantly lower neointima formation and less luminal narrowing was seen in the control group than in the beta-particle-emitting stents (P<0.001). Multilinear regression analysis revealed that only radioactivity made a significant independent contribution to the degree of percent area stenosis (P<0. 001). CONCLUSIONS: Neointima formation in pigs is markedly increased by beta-particle-emitting stents with (198)Au as the radioisotope. This study provides evidence that dosages of 3 to 18 Gy of low-dose-rate beta-particle irradiation via endovascular stents cause pronounced luminal narrowing in the animal model at 3 months.