Functional outcome and quality of life following resection of the proximal humerus performed for musculoskeletal tumors and reconstruction done by four different methods.

INTRODUCTION: The proximal humerus is a frequent site for both primary and secondary bone tumors. Several options are currently available to reconstruct the resected humerus, but there is no consensus regarding optimal reconstruction. The aim of this retrospective study was to compare the functional outcome, complications and patient compliance following four different types of reconstructive techniques. MATERIAL AND METHODS: The authors performed 90 proximal humerus resections due to primary and secondary bone tumors over the past 21 years. Four different procedures were performed for reconstruction following the resection: fibula autograft transplantation, osteoarticular allograft implantation, modular tumor endoprosthesis (hemiarthroplasty) and reconstruction of the defect with a reverse shoulder prosthesis-allograft composite. A retrospective analysis of the complications and patient's physical status was performed. Functional outcome and life quality was evaluated by using the MSTS and SF-36 scores. RESULTS: The best range of motion was observed following arthroplasty with a reverse shoulder prosthesis-homograft composite followed by a fibula autograft reconstruction. Revision surgery was required due to major complications most frequently in the osteoarticular allograft group, followed by the reverse shoulder prosthesis-allograft composite group, the autologous fibula transplantation group; the tumor endoprosthesis hemiarthroplasty group had superior results regarding revision surgery (40, 25, 24 and 14% respectively). MSTS was 84% on average for the reverse shoulder prosthesis-allograft composite group, 70% for the autologous fibula group, 67% for the anatomical hemiarthroplasty group and 64% for the osteoartricular allograft group. Using the SF-36 questionnaire for assessment no significant differences were found between the four groups regarding quality of life. DISCUSSION: Based on the results of our study the best functional performance (range of motion and patient compliance) was achieved in the a reverse prosthesis-allograft combination group-in cases where the axillary nerve could be spared. The use of an osteoarticular allograft resulted in unsatisfying functional results and high complication rates, therefore we do not recommend it as a reconstructive method following resection of the proximal humerus due to either primary or metastatic bone tumors. Young patients who have good life expectancy but a small humerus or intramedullar cavity reconstruction by implantation of a fibula autograft is a good option. For patients with a poor prognosis (i.g. bone metastases) or in cases where the axillary nerve must be sacrificed, hemiarthroplasty using a tumor endoprosthesis was found to have acceptable results with a low complication rate. According to the MSTS and SF-36 functional scoring systems patients compliance was nearly identical following all four types of reconstruction techniques; the underlying cause may be the complexity of the shoulder girdle. However, we recommend the implantation of a reverse shoulder prosthesis-allograft whenever indication is appropriate, as it has been demonstrated to provide excellent functional outcomes, especially in young adults.

BAHA Attract to Osia conversion patients: comparison of the two systems and long-term outcomes.

OBJECTIVE: Osia is a new, transcutaneous, active bone-conduction implant. This study aimed to compare the BAHA Attract and the first-generation Osia system after BAHA Attract to Osia conversion surgery. METHOD: Five patients who had previously used the BAHA Attract system were converted to the first generation of the Osia system. Surgical aspects of the two different systems, audiological performance and subjective opinions of the patients were investigated. Pure tone audiometry and speech audiometry in quiet was performed with each patient's BAHA 5 sound processor on Attract, and the test battery was repeated six weeks after the Attract to Osia conversion and at different time points after the first fitting. Details of the surgery and patients' feedback were analysed. RESULTS: Audiology tests showed significant improvement when using either system; however, the Osia system performance was better. Based on patient feedback, all the five implantees preferred the Osia system. CONCLUSION: The study results suggest that the Osia system is a safe and powerful hearing implant that provides good clinical outcomes.

Digital Variance Angiography in Lower-Limb Angiography with Metal Implants.

PURPOSE: The presence of metal implants may reduce angiographic image quality due to automated beam adjustments. Digital variance angiography (DVA) is reported to be superior to digital subtraction angiography (DSA) with increased contrast-to-noise ratio (CNR) and better image quality. The aim of the study was to evaluate whether DVA could counterbalance the image quality impairment of lower-limb angiographies with metal implants. MATERIALS AND METHODS: From November 2019 to January 2020, 85 raw lower-limb iodine contrast angiograms of 12 patients with metal implants were processed retrospectively with DVA analyses. For objective comparison, CNR of DSA and DVA images was calculated and the ratio CNRDVA/CNRDSA was determined. Visual image quality was evaluated in a paired comparison and by a five-grade Likert scale by three experienced radiologists. RESULTS: The CNR was calculated and compared in 1252 regions of interest in 37 image pairs containing metal implants. The median ratio of CNRDVA/CNRDSA was 1.84 with an interquartile range of 1.35-2.32. Paired comparison resulted in 84.5% in favour of DVA with an interrater agreement of 83.2% (Fleiss κ 0.454, p < 0.001). The overall image quality scores for DSA and DVA were 3.64 ± 0.08 and 4.43 ± 0.06, respectively (p < 0.001, Wilcoxon signed-rank test) with consistently higher individual ratings for DVA. CONCLUSION: Our small-sample pilot study shows that DVA provides significantly improved image quality in lower-limb angiography with metal implants, compared to DSA imaging. The improved CNR suggest that this approach could reduce radiation exposure for lower-limb angiography with metal implants. LEVEL OF EVIDENCE: Level 4, case studies.

Early experience on a modern, thin cochlear implant family. A retrospective, international multicenter study.

RATIONALE: Cochlear implantation is the most effective method of rehabilitation for patients with severe to profound sensorineural hearing loss. Binaural hearing forms the basis of the development of hearing-associated cortical networks in infants and toddlers, but simultaneous bilateral implantation is often postponed due to the demands of classical surgical methods, which are associated with large incisions and a deep bony well. OBJECTIVE: The authors report on the use of a modern, thin implant type and the possibilities it provided to simplify the surgical technique. METHODS AND RESULTS: Recent models of the Cochlear™ Nucleus® implant family were studied in an international retrospective multi-center study: 6 otolaryngologists in 5 centers shared their experiences on 73 consecutively implanted, thin implants. The surgical incision could be made shorter than before and only shallow bony wells or none at all were created in 4 out of 5 centers. No complications occurred. DISCUSSION: This study underlines that implants with thin electronics capsules enable a simplified, fast and safe implantation procedure that allows simultaneous bilateral cochlear implantation.

Tailoring the hexagonal boron nitride nanomesh on Rh(111) with gold.

It is known that the hexagonal boron nitride (h-BN) monolayer has a periodically corrugated structure on Rh(111), termed "nanomesh", while the h-BN layer is planar on the close packed surfaces of coinage metals (Cu, Ag, Au) due the weak interactions. Our studies are aimed at understanding the metal-h-BN interaction, when both Rh and Au are present. On the one hand, the growth and thermal properties of gold deposited on h-BN nanomesh prepared on Rh(111) were studied. On the other hand, the formation of h-BN was examined on Au/Rh surface alloys prepared by the deposition of Au on Rh(111) and subsequent annealing at 1000 K. In each case, the h-BN was prepared by the decomposition of borazine at about 1000 K. Low energy ion scattering (LEIS), X-ray photoelectron spectroscopy (XPS) and scanning tunneling microscopy (STM) measurements revealed that the growth of Au on h-BN/Rh(111) at room temperature leads to the formation of mainly three dimensional (3D) gold nanoparticles, although at low coverages (<0.2 ML) 2D particles formed as well. Stepwise annealing to higher temperatures induces the intercalation of Au below the nanomesh, which was complete at around 1050 K. Some agglomeration and desorption of Au also took place. Interestingly, the nanomesh structure was observable after intercalation up to relatively large Au coverages. Measurements performed in the reverse order, namely exposing a Au/Rh(111) surface alloy to borazine, revealed that Rh atoms get covered by h-BN (or by its precursors) at significantly smaller borazine exposures than Au atoms. The nanomesh structure was essentially present up to a gold coverage of 0.9 ML, but with a smaller pore diameter, while it gradually disappeared at higher gold amounts. In this way the application of surface alloy supports provides a key for gradual tuning of the mesh morphology. Density functional theory calculations confirmed the decreased pore diameter of the BN layer upon the formation of a surface Rh-Au alloy layer.

Probing the interaction of Rh, Co and bimetallic Rh-Co nanoparticles with the CeO2 support: catalytic materials for alternative energy generation.

The interaction of CeO2-supported Rh, Co and bimetallic Rh-Co nanoparticles, which are active catalysts in hydrogen production via steam reforming of ethanol, a process related to renewable energy generation, was studied by X-ray diffraction (XRD), high resolution electron microscopy (HRTEM), X-ray photoelectron spectroscopy (XPS) and low energy ion scattering (LEIS). Furthermore, diffuse reflectance infrared spectroscopy (DRIFTS) of adsorbed CO as a probe molecule was used to characterize the morphology of metal particles. At small loadings (0.1%), Rh is in a much dispersed state on ceria, while at higher contents (1-5%), Rh forms 2-8 nm particles. Between 473-673 K pronounced oxygen transfer from ceria to Rh is observed and at 773 K significant agglomeration of Rh occurs. On reduced ceria, XPS indicates a possible electron transfer from Rh to ceria. The formation of smaller ceria crystallites upon loading with Co was concluded from XRD and HRTEM; for 10% Co, the CeO2 particle size decreased from 27.6 to 10.7 nm. A strong dissolution of Co into ceria and a certain extent of encapsulation by ceria were deduced by XRD, XPS and LEIS. In the bimetallic system, the presence of Rh enhances the reduction of cobalt and ceria. During thermal treatments, reoxidation of Co occurs, and Rh agglomeration as well as oxygen migration from ceria to Rh are hindered in the presence of cobalt.

LEIS and XPS investigation into the growth of cerium and cerium dioxide on Cu(111).

The controlled growth of Ce and CeO2 on Cu(111) was investigated applying low energy ion scattering spectroscopy (LEIS) and X-ray photoelectron spectroscopy (XPS). Previous LEIS studies on metallic and oxidised cerium deposits using other metallic substrates reported serious difficulties related to the neutralization of noble gas ions. For this reason, special attention was paid here to reveal possible matrix effects for the neutralization ("neutralization effects"), which would severely hinder quantitative evaluation of the LEIS data. The adsorption of O2 on Cu(111) induced no neutralization effects either with He(+) or Ne(+). Similarly, no neutralization effects were identified using He(+) upon the deposition of metallic Ce on Cu(111), but it arises for the Ce peak monitored with Ne(+). The initial growth of Ce is two dimensional up to ΘCe ∼ 0.5 ML, while almost complete coverage of Cu(111) is achieved at ΘCe = 2 ML. CeO2(111) was deposited evaporating Ce in a background of O2 at a sample temperature of 523 K. No neutralization effects were observed either with He(+) or Ne(+). In harmony with literature data, the growth mode is three dimensional. Here it was demonstrated that the continuity of the film, which could be efficiently checked by LEIS, is influenced by the applied oxygen pressure in the range of 5 × 10(-7)-3 × 10(-6) mbar. At pO2 = 3 × 10(-6) mbar the film was not completely closed even at relatively large coverages (16 ML), and a significant part of copper atoms were oxidized to Cu(1+). Deposition of CeO2 at pO2 = 5 × 10(-7) mbar was characterized by a nearly perfect wetting, with metallic copper atoms at the interface, and with a slightly more reduced ceria layer.

The strategies to reduce iron deficiency in blood donors randomized trial: design, enrolment and early retention.

BACKGROUND AND OBJECTIVES: Repeated blood donation produces iron deficiency. Changes in dietary iron intake do not prevent donation-induced iron deficiency. Prolonging the interdonation interval or using oral iron supplements can mitigate donation-induced iron deficiency. The most effective operational methods for reducing iron deficiency in donors are unknown. MATERIALS AND METHODS: 'Strategies To Reduce Iron Deficiency' (STRIDE) was a two-year, randomized, placebo-controlled study in blood donors. 692 donors were randomized into one of two educational groups or one of three interventional groups. Donors randomized to educational groups either received letters thanking them for donating, or, suggesting iron supplements or delayed donation if they had low ferritin. Donors randomized to interventional groups either received placebo, 19-mg or 38-mg iron pills. RESULTS: Iron deficient erythropoiesis was present in 52·7% of males and 74·6% of females at enrolment. Adverse events within 60 days of enrolment were primarily mild gastrointestinal symptoms (64%). The incidence of de-enrolment within 60 days was more common in the interventional groups than in the educational groups (P = 0·002), but not more common in those receiving iron than placebo (P = 0·68). CONCLUSION: The prevalence of iron deficient erythropoiesis in donors enrolled in the STRIDE study is comparable to previously described cohorts of regular blood donors. De-enrolment within 60 days was higher for donors receiving tablets, although no more common in donors receiving iron than placebo.

Influence of gold additives on the stability and phase transformation of titanate nanostructures.

Gold nanoparticles were prepared and characterized on protonated (H-form) titanate nanotubes (TiONTs) and nanowires (TiONWs). The chemical nature and morphology of gold particles were monitored by X-ray photoelectron spectroscopy (XPS), Raman spectroscopy, X-ray diffraction (XRD) and high resolution electron microscopy (HRTEM). The optical properties of Au-containing titanate nanowires were explored by means of ultraviolet-visible diffuse reflectance spectroscopy. The size distribution and homogeneity of gold particles depend on the reduction mode from the corresponding gold salt to metal particles. Smaller clusters (3-8 nm) were obtained with the NaBH4 reactant at 293 K than with molecular hydrogen reduction. An unexpectedly high binding energy gold state was found by XPS in gold-loaded titanate nanostructures. This state was absent from the spectra of gold-loaded TiO2(110). A likely explanation for this phenomenon, supported also by the characteristic decrease of band gap energy from 3.10 eV to 2.74 eV with increasing Au content, is that depending on the metal loading and titanate structure, Au is stabilized on titanate nanowires partially in positively charged gold form by ion exchange and also as Au clusters. Our important new finding is that the thermal annealing behavior of Au-loaded titanate nanotubes and nanowires is different. The former lose their tubular morphology and are readily transformed into anatase even at a very low temperature of 473 K. On the other hand, gold stabilizes the layered structure of titanate nanowires up to 873 K.

Large noncollinearity and spin reorientation in the novel Mn2RhSn Heusler magnet.

Noncollinear magnets provide essential ingredients for the next generation memory technology. It is a new prospect for the Heusler materials, already well known due to the diverse range of other fundamental characteristics. Here, we present a combined experimental and theoretical study of novel noncollinear tetragonal Mn(2)RhSn Heusler material exhibiting unusually strong canting of its magnetic sublattices. It undergoes a spin-reorientation transition, induced by a temperature change and suppressed by an external magnetic field. Because of the presence of Dzyaloshinskii-Moriya exchange and magnetic anisotropy, Mn(2)RhSn is suggested to be a promising candidate for realizing the Skyrmion state in the Heusler family.

Plant biology in reduced gravity on the Moon and Mars.

While there have been numerous studies on the effects of microgravity on plant biology since the beginning of the Space Age, our knowledge of the effects of reduced gravity (less than the Earth nominal 1 g) on plant physiology and development is very limited. Since international space agencies have cited manned exploration of Moon/Mars as long-term goals, it is important to understand plant biology at the lunar (0.17 g) and Martian levels of gravity (0.38 g), as plants are likely to be part of bioregenerative life-support systems on these missions. First, the methods to obtain microgravity and reduced gravity such as drop towers, parabolic flights, sounding rockets and orbiting spacecraft are reviewed. Studies on gravitaxis and gravitropism in algae have suggested that the threshold level of gravity sensing is around 0.3 g or less. Recent experiments on the International Space Station (ISS) showed attenuation of phototropism in higher plants occurs at levels ranging from 0.l g to 0.3 g. Taken together, these studies suggest that the reduced gravity level on Mars of 0.38 g may be enough so that the gravity level per se would not be a major problem for plant development. Studies that have directly considered the impact of reduced gravity and microgravity on bioregenerative life-support systems have identified important biophysical changes in the reduced gravity environments that impact the design of these systems. The author suggests that the current ISS laboratory facilities with on-board centrifuges should be used as a test bed in which to explore the effects of reduced gravity on plant biology, including those factors that are directly related to developing life-support systems necessary for Moon and Mars exploration.

Metal loading determines the stabilization pathway for Co2+ in titanate nanowires: ion exchange vs. cluster formation.

Co nanoparticles were produced and characterized on protonated titanate nanowires. Co deposits were obtained after low-temperature decomposition of Co2(CO)8 on titanate nanostructures. The carbonylation was carried out by vapor-phase adsorption in a fluidized bed reactor and the decarbonylation processes were followed by FT-IR spectroscopy and microbalance combined with temperature programmed reaction mass spectrometry. The band gap of Co-decorated titanate nanostructures determined by UV-VIS diffuse reflectance spectroscopy decreased sharply from 3.14 eV to 2.41 eV with increasing Co content up to 2 wt%. The Co-decorated titanate morphology was characterized by high-resolution transmission electron microscopy (HRTEM) and electron diffraction (ED). The chemical environment of Co deposition was studied by photoelectron spectroscopy (XPS). A certain amount of cobalt underwent an ion exchange process. Higher cobalt loadings led to the formation of nanosized-dispersed particles complexed to oxygen vacancies. The average sizes were found to be mostly between 2 and 6 nm. This size distribution and the measured band gap could be favorable regimes for some important low-temperature thermal- and photo-induced catalytic reactions.

Rh-induced support transformation phenomena in titanate nanowire and nanotube catalysts.

High-aspect-ratio titanate nanotubes (NT) and nanowires (NW) were produced by the hydrothermal conversion of TiO2 at 400 K. The titanate morphology was studied by high-resolution transmission electron microscopy (HRTEM). The formation of ordered titanate nanoobjects depended on the time of conversion. Shorter synthesis times favored hollow nanotube production while during prolonged treatment the thermodynamically more stable nanowires were formed. Titanate nanotubes and nanowires were decorated by Rh nanoparticles. The structure and stability of titanate nanocomposites were studied by thermal gravimetric (TG), X-ray diffraction (XRD), X-ray photoelectron spectroscopic (XPS), Fourier transformed infrared spectroscopic (FTIR), and Raman spectroscopic methods. The nanowires preserve their structure up to 850 K, while the nanotubes start to recrystallize above 600 K. FTIR measurements showed that the water and hydroxyl content gradually decreased with increasing temperature in both cases. XPS data revealed the existence of high binding energy, highly dispersed Rh species on both supports. A small portion of Rh may participate in an ion exchange process. Support transformation phenomena were observed in Rh containing titanate nanowires and nanotubes. Rh decorated nanowires transform into the ß-TiO2 structure, whereas their pristine counterparts' recrystallize into anatase. The formation of anatase was dominant during the thermal annealing process in both acid treated and Rh decorated nanotubes. Transformation to anatase was enhanced in the presence of Rh. The average diameters Rh nanoparticles were 4.9 ± 1.4 and 2.8 ± 0.7 nm in the case of nanowires and nanotubes, respectively.

New pool of cortical interneuron precursors in the early postnatal dorsal white matter.

The migration of cortical γ-aminobutyric acidergic interneurons has been extensively studied in rodent embryos, whereas few studies have documented their postnatal migration. Combining in vivo analysis together with time-lapse imaging on cortical slices, we explored the origin and migration of cortical interneurons during the first weeks of postnatal life. Strikingly, we observed that a large pool of GAD65-GFP-positive cells accumulate in the dorsal white matter region during the first postnatal week. Part of these cells divides and expresses the transcription factor paired box 6 indicating the presence of local transient amplifying precursors. The vast majority of these cells are immature interneurons expressing the neuronal marker doublecortin and partly the calcium-binding protein calretinin. Time-lapse imaging reveals that GAD65-GFP-positive neurons migrate from the white matter pool into the overlying anterior cingulate cortex (aCC). Some interneurons in the postnatal aCC express the same immature neuronal markers suggesting ongoing migration of calretinin-positive interneurons. Finally, bromodeoxyuridine incorporation experiments confirm that a small fraction of interneurons located in the aCC are generated during the early postnatal period. These results altogether reveal that at postnatal ages, the dorsal white matter contains a pool of interneuron precursors that divide and migrate into the aCC.

Combined theoretical and experimental study on the adsorption of methanol on the ZnO(1010) surface.

The structure, dynamics, and energetics of methanol adlayers on the nonpolar ZnO(1010) surface have been studied by He-atom diffraction (HAS), high-resolution electron energy loss spectroscopy (HREELS), thermal desorption spectroscopy (TDS), and density functional calculations. The experimental and theoretical data consistently show that at temperatures below 357 K methanol forms an ordered adlayer with a (2 × 1) periodicity and a coverage of one monolayer in which half of the methanol molecules are dissociated. The ordering of the methanol molecules is governed by repulsive interactions between the methyl groups of the methanol molecules. This repulsive interaction is also responsible for the formation of a second, low-density phase at higher temperatures with half monolayer coverage of undissociated methanol which is stable up to 440 K.

Location of glutamatergic/aspartatergic neurons projecting to the hypothalamic ventromedial nucleus studied by autoradiography of retrogradely transported [³H]D-aspartate.

The hypothalamic ventromedial nucleus is a prominent cell group, which is involved in the control of feeding, sexual behavior and cardiovascular function as well as having other functions. The nucleus receives inputs from various forebrain structures and has a dense glutamatergic innervation. The aim of the present investigations was to reveal the location of glutamatergic neurons in the telencephalon and diencephalon projecting to this hypothalamic cell group. [(3)H]d-aspartate retrograde autoradiography was used injecting the tracer into the ventromedial nucleus. We detected radiolabeled neurons in telencephalic structures including the lateral septum, bed nucleus of the stria terminalis and the amygdala, and in various diencephalic regions, such as the medial preoptic area, hypothalamic paraventricular nucleus, periventricular nucleus, anterior hypothalamic area, ventral premamillary nucleus, thalamic paraventricular and parataenial nuclei and in the hypothalamic ventromedial nucleus itself. Our observations are the first data on the location of glutamatergic neurons terminating in the hypothalamic ventromedial nucleus. The findings indicate that glutamatergic innervation of the ventromedial nucleus is very complex.

Cardiomyocyte apoptosis after cardioplegic ischemia: comparison to unprotected regional ischemia-reperfusion.

BACKGROUND: Cardiomyocyte apoptosis might contribute to left ventricular (LV) dysfunction following cardiac surgery. Magnetic resonance imaging is considered the most accurate method of determining LV function. We compared apoptosis (by terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling, TUNEL, staining and detection of caspase 3 activation) and LV function after regional ischemia-reperfusion (I-R) and global cardioplegic ischemia. METHODS: Pigs were randomized to undergo regional myocardial I-R for 20 + 20 min, global myocardial ischemia with cardiopulmonary bypass (CPB) for 40 min or CPB without ischemia (control), followed by 274 min of reperfusion. RESULTS: Compared with the control group, the number of TUNEL-positive cardiomyocytes was higher in the global ischemia group with CPB (0.024 ± 0.014%; p = 0.02) and further increased in areas of unprotected regional I-R (0.444 ± 0.562%; p = 0.003, vs. control). Myocytes with active caspase 3 were detected after global and regional ischemia. The global ejection fraction did not differ between CPB and regional I-R groups. CONCLUSIONS: The use of cardioplegia and CPB efficiently protects the heart from global I-R-induced cardiomyocyte apoptosis during open heart surgery.

A mathematical model of exposure of non-target Lepidoptera to Bt-maize pollen expressing Cry1Ab within Europe.

Genetically modified (GM) maize MON810 expresses a Cry1Ab insecticidal protein, derived from Bacillus thuringiensis (Bt), toxic to lepidopteran target pests such as Ostrinia nubilalis. An environmental risk to non-target Lepidoptera from this GM crop is exposure to harmful amounts of Bt-containing pollen deposited on host plants in or near MON810 fields. An 11-parameter mathematical model analysed exposure of larvae of three non-target species: the butterflies Inachis io (L.), Vanessa atalanta (L.) and moth Plutella xylostella (L.), in 11 representative maize cultivation regions in four European countries. A mortality-dose relationship was integrated with a dose-distance relationship to estimate mortality both within the maize MON810 crop and within the field margin at varying distances from the crop edge. Mortality estimates were adjusted to allow for physical effects; the lack of temporal coincidence between the susceptible larval stage concerned and the period over which maize MON810 pollen is shed; and seven further parameters concerned with maize agronomy and host-plant ecology. Sublethal effects were estimated and allowance made for aggregated pollen deposition. Estimated environmental impact was low: in all regions, the calculated mortality rate for worst-case scenarios was less than one individual in every 1572 for the butterflies and one in 392 for the moth.