Modeling the Role of Epitaxial Grain Structure of the Prior ß Phase and Associated Fiber Texture on the Strength Characteristics of Ti-6Al-4V Produced via Additive Manufacturing.

Due to the rapid cooling and directional heat flow inherent in metal-based additive manufacturing, Ti-6Al-4V results in epitaxial grain growth and a fiber texture of the prior ß phase. While Ti-6Al-4V produced via powder bed, electron beam melted processing can exhibit a range of strength characteristics, recent studies have shown superior strength properties, compared to similar orientations, of conventional plate material (AMS 4911) across a range of elevated temperatures (204 to 371 °C). To investigate this phenomenon, a series of crystal plasticity models was developed for the representative grain structures of Ti-6Al-4V to rationalize if the columnar, fiber texture produced by additive manufacturing (AM) was sufficient to explain the observed strength attributes. As a first step towards understanding this behavior, the grain structure was characterized via electron backscattering diffraction for AM material taken from four specimens (with different build directions), as well as material taken from baseline plate material (along and transverse to the rolling direction), and the resulting microstructures were modeled via a crystal plasticity framework. As expected, the results showed the AM material accounting for only the α grain structure was stronger in the vertical builds and weaker in the horizontal builds compared to the conventional plate counterparts. This suggested that grain morphology and α grain orientation alone provided some information about the relative strengths, but did not explain the overall trends observed from the experiments. To account for the role of texture, the characterized α phase was converted, via variant selection, to its prior ß phase for use in the simulations. The results showed that each simulation of the AM prior ß phase exhibited a higher strength compared to the baseline plate material, except for one specimen (horizontally built), which had large colonies of soft microtextured regions for the prior ß structure. This suggests that some variability was experienced (as anticipated), but the texture (especially of the prior ß macrozones) was a key contributor for the unusually high strength observed of the AM Ti-6Al-4V material.

Preoperative screening and intervention for mild anemia with low iron stores in elective hip and knee arthroplasty.

BACKGROUND: Preoperative anemia in patients undergoing elective hip and knee arthroplasty is associated with increased postoperative morbidity and mortality, red blood cell (RBC) transfusion, and length of stay (LOS). The aim of this study was to assess the effect of optimizing hemoglobin (Hb) levels before elective primary hip and knee arthroplasty. STUDY DESIGN AND METHODS: This is a prospective comparative cohort study of patients who underwent elective hip and knee arthroplasty before (control) and after (intervention) the launch of a Hb optimization program. Patients with anemia followed an agreed upon algorithm dependent on their medical history and blood variables taken on listing for surgery. The primary outcome for this study was the requirement for allogenic RBC transfusion. Secondary outcomes included hospital LOS, admission to critical care, readmission, medical complications, incidence of thromboembolic events, mortality, and costs. RESULTS: A total of 1814 control patients operated between February 2012 and February 2013 were compared to 1622 intervention patients operated between February 2013 and May 2014. In the intervention group transfusion was significantly reduced (108 [6%] vs. 63 [4.1%], p = 0.005) as well as readmission (81 [4.5%] vs. 48 [2.3%], p= 0.020) and critical care admission (23 [1.3%] vs. 9 [0.5%], p = 0.030). LOS was significantly reduced from 3.9 days to 3.6 days (p = 0.017). The saving for the cohort was £263,000 ($342,000). CONCLUSIONS: Algorithm-led preoperative anemia screening and management in elective arthroplasty was associated with reduced RBC transfusion, readmission, critical care admission, LOS, and costs.

Colorectal cancer population screening programs worldwide in 2016: An update.

Colorectal cancer (CRC) is the third most commonly diagnosed cancer in the world. The incidence and mortality show wide geographical variations. Screening is recommended to reduce both incidence and mortality. However, there are significant differences among studies in implementation strategies and detection. This review aimed to present the results and strategies of different screening programs worldwide. We reviewed the literature on national and international screening programs published in PubMed, on web pages, and in clinical guidelines. CRC Screening programs are currently underway in most European countries, Canada, specific regions in North and South America, Asia, and Oceania. The most extensive screening strategies were based on fecal occult blood testing, and more recently, the fecal immunochemical test (FIT). Participation in screening has varied greatly among different programs. The Netherlands showed the highest participation rate (68.2%) and some areas of Canada showed the lowest (16%). Participation rates were highest among women and in programs that used the FIT test. Men exhibited the greatest number of positive results. The FIT test has been the most widely used screening program worldwide. The advent of this test has increased participation rates and the detection of positive results.

Treatment of chronic anterior locked glenohumeral dislocation with hemiarthroplasty.

Restoring good shoulder function in an active patient with a chronic anterior locked dislocation of the glenohumeral joint can be challenging. This case report describes a 58-year-old active patient who presented with a very late missed locked anterior dislocation of the glenohumeral joint. He had coexisting large bony defects in the anterior glenoid and humeral head with resultant loss of motion and pain secondary to glenohumeral arthrosis. He underwent a humeral hemiarthroplasty, glenoid structural bone grafting, glenoid biological resurfacing and reinforcement of anterior capsule with the graft jacket to achieve a pain-free, stable, mobile joint with good range of movements and function. The clinical decision-making process and the surgical technique used in the management of this difficult condition are discussed.

Drug-related problems in prescribed medicines in Germany at the time of dispensing.

BACKGROUND: Drug-related problems (DRPs) can have an important impact on the effectiveness and safety of pharmacotherapy. In Germany, the frequency of DRPs in prescribed medicines in ambulatory care is not yet known. Objective To quantify DRPs in prescribed medicines identified by community pharmacists (CPs) at the time the medicine is dispensed. SETTING: German CPs in four different regions. METHOD: We invited CPs to document one hundred consecutive patients presenting prescriptions using a standardized documentation form. For each patient, person- and medication-related as well as identified DRP-related data were documented. Data were transcribed electronically, coded if necessary, checked for validity, and analyzed. MAIN OUTCOME MEASURE: Nature and frequency of DRPs. RESULTS: In total, 143 CPs documented 14,231 patients with 24,422 prescribed drugs and identified DRPs in 2,556 patients (18.0%). Analyses resulted in 0.23 DRPs per patient and 0.13 DRPs per prescribed medicine. Four DRPs were responsible for almost 70% of all DRPs: Potential drug-drug interaction (22.9%), dose not known to patient (21.7%), patient insecure due to generic substitution (13.5%), and insufficient patient knowledge of correct drug use (10.9%). If a patient's drug file was kept in the pharmacy, specific types of DRPs were detected more frequently e.g., drug-drug interactions (p < 0.001). Interventions primarily comprised counselling, monitoring, and changing drug or instructions for use. The prescribing physician was contacted in 28% of DRPs resulting in a change of these prescriptions in 50% of the cases. Overall and according to the pharmacists, more than 90% of the DRPs detected were partially (10.4%) or completely (85.4%) solved. CONCLUSION: We quantified DRPs in prescribed medicines in daily ambulatory care practice in Germany. When filling a prescription, in nearly 20% of the patients relevant DRPs were revealed. According to the pharmacists, the majority could be partially or completely solved during the encounter at the pharmacy. Keeping a patient's drug file including patient specific data may facilitate the detection of DRPs and shall, therefore, be offered to patients more often.

Clinical and histopathological factors affecting failed sentinel node localization in axillary staging for breast cancer.

BACKGROUND: Sentinel lymph node biopsy (SLNB) has become the standard of care in axillary staging of clinically node-negative breast cancer patients. AIMS: To analyze reasons for failure of SLN localization by means of a multivariate analysis of clinical and histopathological factors. METHODS: We performed a review of 164 consecutive breast cancer patients who underwent SLNB. A superficial injection technique was used. RESULTS: 9/164 patients failed to show nodes. In 7/9 patients no evidence of radioactivity or blue dye was observed. Age and nodal status were the only statistically significant factors (p < 0.05). For every unit increase in age there was a 9% reduced chance of failed SLN localization. Patients with negative nodal status have 90% reduced risk of failed sentinel node localization than patients with macro or extra capsular nodal invasion. DISCUSSION: The results suggest that altered lymphatic dynamics secondary to tumour burden may play a role in failed sentinel node localization. We showed that in all failed localizations the radiocolloid persisted around the injection site, showing limited local diffusion only. While clinical and histopathological data may provide some clues as to why sentinel node localization fails, we further hypothesize that integrity of peri-areolar lymphatics is important for successful localization.

Surgery for breast cancer in the elderly--how relevant?

Studies suggest that elderly women receive less aggressive treatment, experience higher disease progression and mortality from breast cancer. We report on an experience of 256 consecutive cases of symptomatic breast cancer in a population of over 75 years of age. 142/256 patients underwent surgical intervention in the form of breast conserving surgery or mastectomy, 114/256 did not. Mean follow up was 6.4 years. Our results show a statistically significant association between surgery and survival (p = 0.05, CI 0.00046-0.19641) and a strong statistically significant association between surgery and disease progression/recurrence (p = 0.001, CI 0.08713-0.03145). Women treated conservatively are significantly less fit hence suffering high cancer unrelated mortality; as a consequence they suffer higher disease related progression and mortality. In our study surgical treatment with adjuvant endocrine and/or radiotherapy was associated with a statistically significant advantage in terms of disease related mortality and local disease control.