Estudio biomecánico comparativo de dos configuraciones de tornillos cementados en una fractura simulada de húmero proximal fijada con placa y tornillos bloqueados / Comparative biomechanical study of two configurations of cemented screws in a simulated proximal humerus fracture fixed with locking plate

Introducción: La utilización de tornillos cementados en la fijación interna de fracturas de húmero proximal con placas bloqueadas parece mejorar la estabilidad del implante y disminuir las complicaciones asociadas al fracaso de síntesis. Sin embargo, la combinación óptima de tornillos cementados se desconoce. El objetivo de este estudio fue analizar la estabilidad relativa de dos configuraciones de tornillos cementados sometidos a una fuerza de compresión axial en una fractura simulada de húmero proximal. Material y métodos: Se realizó una osteotomía del cuello quirúrgico en cinco pares de húmeros embalsamados con una edad media de 74 años (rango 46-93), fijados con una placa de acero inoxidable con tornillos bloqueados. En cada par de húmeros, en el húmero derecho se cementaron los tornillos A y E, y en el lado contralateral se cementaron los tornillos B y D. Cada espécimen fue testado inicialmente mediante una carga cíclica de compresión axial durante 6.000 ciclos para evaluar el movimiento interfragmentario (estudio dinámico). Al final de la prueba, los especímenes se sometieron a una carga de compresión axial progresiva para medir la rigidez de la construcción (estudio estático). Resultados: No se encontraron diferencias estadísticamente significativas en la movilidad interfragmentaria entre las dos configuraciones de tornillos cementados en el estudio dinámico (p=0,463). Cuando se sometieron a rotura, los especímenes con tornillos cementados en las hileras B y D presentaron una carga de rotura mayor (2218N vs. 2105, p=0,901) y una mayor rigidez (125N/mm vs. 106N/mm, p=0,672); sin embargo, ninguna de estas diferencias fue estadísticamente significativa. Conclusiones: La configuración de los tornillos cementados utilizadas en este estudio no influyen en la estabilidad del implante cuando se aplica una carga cíclica de baja energía. La cementación de los tornillos de las hileras B y D proporciona una resistencia similar a la cementación de los tornillos...(AU)

Introduction: Screw tip augmentation with bone cement for fixation of osteoporotic proximal humerus fractures seems to improve stability and to decrease the rate of complications related to implant failure. However, the optimal augmentation combinations are unknown. The aim of this study was to assess the relative stability of two augmentations combinations under axial compression load in a simulated proximal humerus fractures fixed with locking plate. Material and methods: A surgical neck osteotomy was created in five pairs of embalmed humeri with a mean age of 74 years (range 46–93 years), secured with a stainless-steel locking-compression plate. In each pair of humeri, on the right humerus were cemented the screws A and E, and in the contralateral side were cemented screws B and D of the locking plate. The specimens were first tested cyclically in axial compression for 6,000 cycles to evaluate interfragmentary motion (dynamic study). At the end of the cycling test, the specimens were loaded in compression force simulating varus bending with increasing load magnitude until failure of the construct (static study). Results: There were no significant differences in interfragmentary motion between the two configurations of cemented screws in the dynamic study (p=0.463). When tested to failure, the configuration of cemented screws in lines B and D demonstrated higher compression load to failure (2218N vs. 2105, p=0.901) and higher stiffness (125N/mm vs. 106N/mm, p=0.672). However, no statistically significant differences were reported in any of these variables. Conclusions: In simulated proximal humerus fractures, the configuration of the cemented screws does not influence the implant stability when a low-energy cyclical load is applied. Cementing the screws in rows B and D provides similar strength to the previously proposed cemented screws configuration and could avoid complications observed in clinical studies.(AU)

[Translated article] Comparative biomechanical study of two configurations of cemented screws in a simulated proximal humerus fracture fixed with locking plate / Estudio biomecánico comparativo de 2 configuraciones de tornillos cementados en una fractura simulada de húmero proximal fijada con placa y tornillos bloqueados

Introducción: La utilización de tornillos cementados en la fijación interna de fracturas de húmero proximal con placas bloqueadas parece mejorar la estabilidad del implante y disminuir las complicaciones asociadas al fracaso de síntesis. Sin embargo, la combinación óptima de tornillos cementados se desconoce. El objetivo de este estudio fue analizar la estabilidad relativa de dos configuraciones de tornillos cementados sometidos a una fuerza de compresión axial en una fractura simulada de húmero proximal. Material y métodos: Se realizó una osteotomía del cuello quirúrgico en cinco pares de húmeros embalsamados con una edad media de 74 años (rango 46-93), fijados con una placa de acero inoxidable con tornillos bloqueados. En cada par de húmeros, en el húmero derecho se cementaron los tornillos A y E, y en el lado contralateral se cementaron los tornillos B y D. Cada espécimen fue testado inicialmente mediante una carga cíclica de compresión axial durante 6.000 ciclos para evaluar el movimiento interfragmentario (estudio dinámico). Al final de la prueba, los especímenes se sometieron a una carga de compresión axial progresiva para medir la rigidez de la construcción (estudio estático). Resultados: No se encontraron diferencias estadísticamente significativas en la movilidad interfragmentaria entre las dos configuraciones de tornillos cementados en el estudio dinámico (p=0,463). Cuando se sometieron a rotura, los especímenes con tornillos cementados en las hileras B y D presentaron una carga de rotura mayor (2218N vs. 2105, p=0,901) y una mayor rigidez (125N/mm vs. 106N/mm, p=0,672); sin embargo, ninguna de estas diferencias fue estadísticamente significativa. Conclusiones: La configuración de los tornillos cementados utilizadas en este estudio no influyen en la estabilidad del implante cuando se aplica una carga cíclica de baja energía. La cementación de los tornillos de las hileras B y D proporciona una resistencia similar a la cementación de los tornillos...(AU)

Introduction: Screw tip augmentation with bone cement for fixation of osteoporotic proximal humerus fractures seems to improve stability and to decrease the rate of complications related to implant failure. However, the optimal augmentation combinations are unknown. The aim of this study was to assess the relative stability of two augmentations combinations under axial compression load in a simulated proximal humerus fractures fixed with locking plate. Material and methods: A surgical neck osteotomy was created in five pairs of embalmed humeri with a mean age of 74 years (range 46–93 years), secured with a stainless-steel locking-compression plate. In each pair of humeri, on the right humerus were cemented the screws A and E, and in the contralateral side were cemented screws B and D of the locking plate. The specimens were first tested cyclically in axial compression for 6,000 cycles to evaluate interfragmentary motion (dynamic study). At the end of the cycling test, the specimens were loaded in compression force simulating varus bending with increasing load magnitude until failure of the construct (static study). Results: There were no significant differences in interfragmentary motion between the two configurations of cemented screws in the dynamic study (p=0.463). When tested to failure, the configuration of cemented screws in lines B and D demonstrated higher compression load to failure (2218N vs. 2105, p=0.901) and higher stiffness (125N/mm vs. 106N/mm, p=0.672). However, no statistically significant differences were reported in any of these variables. Conclusions: In simulated proximal humerus fractures, the configuration of the cemented screws does not influence the implant stability when a low-energy cyclical load is applied. Cementing the screws in rows B and D provides similar strength to the previously proposed cemented screws configuration and could avoid complications observed in clinical studies.(AU)

[Translated article] Comparative biomechanical study of two configurations of cemented screws in a simulated proximal humerus fracture fixed with locking plate.

INTRODUCTION: Screw tip augmentation with bone cement for fixation of osteoporotic proximal humerus fractures seems to improve stability and to decrease the rate of complications related to implant failure. However, the optimal augmentation combinations are unknown. The aim of this study was to assess the relative stability of two augmentations combinations under axial compression load in a simulated proximal humerus fractures fixed with locking plate. MATERIAL AND METHODS: A surgical neck osteotomy was created in five pairs of embalmed humeri with a mean age of 74 years (range 46-93 years), secured with a stainless-steel locking-compression plate. In each pair of humeri, on the right humerus were cemented the screws A and E, and in the contralateral side were cemented screws B and D of the locking plate. The specimens were first tested cyclically in axial compression for 6000 cycles to evaluate interfragmentary motion (dynamic study). At the end of the cycling test, the specimens were loaded in compression force simulating varus bending with increasing load magnitude until failure of the construct (static study). RESULTS: There were no significant differences in interfragmentary motion between the two configurations of cemented screws in the dynamic study (p=0.463). When tested to failure, the configuration of cemented screws in lines B and D demonstrated higher compression load to failure (2218N vs. 2105, p=0.901) and higher stiffness (125N/mm vs. 106N/mm, p=0.672). However, no statistically significant differences were reported in any of these variables. CONCLUSIONS: In simulated proximal humerus fractures, the configuration of the cemented screws does not influence the implant stability when a low-energy cyclical load is applied. Cementing the screws in rows B and D provides similar strength to the previously proposed cemented screws configuration and could avoid complications observed in clinical studies.

Comparative biomechanical study of two configurations of cemented screws in a simulated proximal humerus fracture fixed with locking plate. / Estudio biomecánico comparativo de dos configuraciones de tornillos cementados en una fractura simulada de húmero proximal fijada con placa y tornillos bloqueados.

INTRODUCTION: Screw tip augmentation with bone cement for fixation of osteoporotic proximal humerus fractures seems to improve stability and to decrease the rate of complications related to implant failure. However, the optimal augmentation combinations are unknown. The aim of this study was to assess the relative stability of two augmentations combinations under axial compression load in a simulated proximal humerus fractures fixed with locking plate. MATERIAL AND METHODS: A surgical neck osteotomy was created in five pairs of embalmed humeri with a mean age of 74 years (range 46-93 years), secured with a stainless-steel locking-compression plate. In each pair of humeri, on the right humerus were cemented the screws A and E, and in the contralateral side were cemented screws B and D of the locking plate. The specimens were first tested cyclically in axial compression for 6,000 cycles to evaluate interfragmentary motion (dynamic study). At the end of the cycling test, the specimens were loaded in compression force simulating varus bending with increasing load magnitude until failure of the construct (static study). RESULTS: There were no significant differences in interfragmentary motion between the two configurations of cemented screws in the dynamic study (p=0.463). When tested to failure, the configuration of cemented screws in lines B and D demonstrated higher compression load to failure (2218N vs. 2105, p=0.901) and higher stiffness (125N/mm vs. 106N/mm, p=0.672). However, no statistically significant differences were reported in any of these variables. CONCLUSIONS: In simulated proximal humerus fractures, the configuration of the cemented screws does not influence the implant stability when a low-energy cyclical load is applied. Cementing the screws in rows B and D provides similar strength to the previously proposed cemented screws configuration and could avoid complications observed in clinical studies.

Glycan distribution and density in native skin's stratum corneum.

BACKGROUND: The glycosylation of proteins on the surface of corneocytes is believed to play an important role in cellular adhesion in the stratum corneum (SC) of human skin. Mapping with accuracy the localization of glycans on the surface of corneocytes through traditional methods of immunohistochemistry and electron microscopy remains a challenging task as both approaches lack enough resolution or need to be performed in high vacuum conditions. MATERIALS AND METHODS: We used an advanced mode of atomic force microscope (AFM), with simultaneous topography and recognition imaging to investigate the distribution of glycans on native (no chemical preparation) stripped samples of human SC. The AFM cantilever tips were functionalized with anti-heparan sulfate antibody and the lectin wheat germ agglutinin (WGA) which binds specifically to N-acetyl glucosamine and sialic acid. RESULTS: From the recognition imaging, we observed the presence of the sulfated glycosaminoglycan, heparan sulfate, and the glycans recognized by WGA on the surface of SC corneocytes in their native state. These glycans were found associated with bead-like domains which represent corneodesmosomes in the SC layers. Glycan density was calculated to be ~1200 molecules/µm2 in lower layers of SC compared to an important decrease, (~106 molecules/µm2 ) closer to the surface due probably to corneodesmosome degradation. CONCLUSION: Glycan spatial distribution and degradation is first observed on the surface of SC in native conditions and at high resolution. The method used can be extended to precisely localize the presence of other macromolecules on the surface of skin or other tissues where the maintenance of its native state is required.

Surfactant-polymer interactions: molecular architecture does matter.

Polymer-surfactant mixtures are found in many industrial formulations, and hence there is a significant interest in understanding, at a molecular level, how the self-assembly of surfactant is affected by oppositely-charged polyelectrolytes (PEs). We use self-consistent field modeling and show that the modes of interaction of PEs strongly depend on the architecture of the PE on the segmental level. Hydrophilic cationic PEs with their charge proximal to the linear backbone are expected to bind electrostatically to the outsides of the coronas of the spherical micelles of anionic surfactants, such as sodium laureth sulphate (SLES). As a result, the surfactant aggregation number increases, but at the same time the colloidal stability deteriorates, due to bridging of the PEs between micelles. PEs with their charge somewhat displaced from the backbone by way of short hydrophobic spacers, are expected to be present inside a micelle at the core-corona boundary. In this case the aggregation number decreases, yet the colloidal stability is retained. Hence, SLES tends to remove hydrophilic PEs from an aqueous solution, whereas it solubilizes more hydrophobic ones. The binding isotherm shows that the uptake of PEs remains typically below charge compensation and in this case the spherical micelle topology remains the preferred state.

Impacto del autocuidado y manejo terapéutico en la utilización de los recursos sanitarios urgentes por pacientes crónicos: estudio de cohortes / Impact of self-management of therapy on use of emergency health care services by patients with chronic diseases: a cohort study

OBJETIVOS: Determinar si el manejo ineficaz del régimen terapéutico (MIRT) en pacientes crónicos que acuden a urgencias es un predictor de mayor utilización de los recursos sanitarios y de peor calidad de vida. MÉTODO: Estudio de cohortes prospectivas. En 2007 se formaron dos cohortes prospectivas en función de su adherencia o no al tratamiento y fueron seguidas durante 12 meses para evaluar la calidad de vida, la adherencia y el uso de recursos sanitarios. RESULTADOS: De los 302 pacientes incluidos, 167 presentaban MIRT (55,29%). El perfil del paciente era un varón, con hipertensión arterial, polimedicado con baja adherencia terapéutica. El riesgo de reingreso era casi 4 veces mayor en los pacientes expuestos a los 12 meses (OR 3,72, IC al 95%: 2,19-6,32; p < 0,0001), evaluados con la herramienta DecaMIRT. Estos pacientes con baja adherencia presentaban una reducción significativa de su calidad de vida superior a 5 puntos (IC 95% 2,60-7,258; p < 0,05), si se comparaban con la cohorte no expuesta. CONCLUSIONES: El manejo efectivo del régimen terapéutico está asociado con la calidad de vida y con el uso que los pacientes crónicos hacen de los recursos sanitarios

OBJECTIVE: To determine whether ineffective management of therapeutic regimen is a predictor of frequent use of health care resources and poor quality of life in patients with chronic illnesses. METHODS: Prospective cohort study. Two cohorts were formed in 2007 on the basis of presence or absence of ineffective management. The patients were evaluated for 12 months to assess quality of life, adherence to therapy, and use of health care resources. RESULTS: Of 302 patients included, 167 (55.29%) were in the ineffective-management cohort. In addition to poor adherence to therapy, such patients tended to be men, hypertensive, and on several medications. The risk of readmission in this cohort was nearly 4-fold higher during the 12-month period (odds ratio, 3.72; 95% CI, 2.19-6.32; P<.0001) according to a 10-item scale (DecaMIRT). The patients with low adherence to therapy had quality of life scores that were significantly lower by a mean of more than 5 points (95% CI, 2.60-7.258; P<.05). CONCLUSIONS: In patients with chronic diseases, effective management of therapeutic regimen is associated with quality of life and a different pattern of use of health care resources. The DecaMIRT scale proved valid for measuring adherence to therapy and can help improve how persons with chronic diseases are attended in the emergency department

Chronological ageing of human hair keratin fibres.

Examination of very long hair (length > 2.4 m) using a large range of evaluation methods including physical, chemical, biochemical and microscopic techniques has enabled to attain a detailed understanding of natural ageing of human hair keratin fibres. Scrutinizing hair that has undergone little or no oxidative aggression--because of the absence of action of chemical agents such as bleaching or dyeing--from the root to the tip shows the deterioration process, which gradually takes place from the outside to the inside of the hair shaft: first, a progressive abrasion of the cuticle, whilst the cortex structure remains unaltered, is evidenced along a length of roughly 1 m onwards together with constant shine, hydrophobicity and friction characteristics. Further along the fibre, a significant damage to cuticle scales occurs, which correlates well with ceramides and 18-Methyl Eicosanoic Acid (18-MEA) decline, and progressive decrease in keratin-associated protein content. Most physical descriptors of mechanical and optical properties decay significantly. This detailed description of natural ageing of human hair fibres by a fine analysis of hair components and physical parameters in relationship with cosmetic characteristics provides a time-dependent 'damage scale' of human hair, which may help in designing new targeted hair care formulations.

Formulation, characterization, and efficacy of an adenosine-containing dissolvable film for a localized anti-wrinkle effect.

A water-dissolvable film was developed to topically deliver adenosine for a localized anti-wrinkle effect. The polymers used to produce the film were cellulose derivatives. An aqueous mixture of the film components was made, coated on a liner, and then dried to form a solid film. No preservatives were added and the film was shown to be stable over time. The film quickly dissolves in water to form a uniform layer at the surface of the skin, as shown by scanning electron microscopy. The film layer can still be visualized on the wrinkle six hours after being applied on the skin. A randomized, placebo-controlled, investigator-blind study was conducted in female volunteers to assess the efficacy of the 1% adenosine-containing dissolvable film. After three weeks and eight weeks, a twice daily application led to a significant decrease in the skin roughness parameters as observed using fast optical in vivo topometry (FOITS). These results demonstrate that water-dissolvable films may be used as novel, preservative-free, cosmetic delivery systems.

Investigation of dyed human hair fibres using apertureless near-field scanning optical microscopy.

We present the first studies of dyed human hair fibres performed with an apertureless scanning near-field optical microscope. Samples consisted of 5-microm-thick cross-sections, the hair fibres being bleached and then dyed before being cut. Hair dyed with two molecular probes diffusing deep inside the fibre or mainly spreading at its periphery were investigated at a wavelength of 655 nm. An optical resolution of about 50 nm was achieved, well below the diffraction limit; the images exhibited different optical contrasts in the cuticle region, depending on the nature of the dye. Our results suggest that the dye that remains confined at the hair periphery is mainly located at its surface and in the endocuticle.

In vitro photodynamic activity of kryptocyanine.

The photophysical properties of 1,1'-diethyl-4,4'-carbocyanine chloride (kryptocyanine) have been measured in methanol solution and for the dye bound to human serum albumin, incorporated in neutral micelles and after incubation with leukemia cells. In all cases, it is found that formation of the triplet state of the dye occurs with low efficiency and that illumination of the dye under aerobic conditions does not produce significant yields of O2(1 delta g). Instead, the only efficient photoprocess involves rapid internal conversion from the first excited singlet state to the ground state, probably via isomerization of the polymethine sequence. These findings are discussed with respect to the demonstrated ability of kryptocyanine to photodestroy leukemic cells.