Treatment of Metaphyseal Defects in Plated Proximal Humerus Fractures with a New Augmentation Technique-A Biomechanical Cadaveric Study.

Background and Objectives: Unstable proximal humerus fractures (PHFs) with metaphyseal defects-weakening the osteosynthesis construct-are challenging to treat. A new augmentation technique of plated complex PHFs with metaphyseal defects was recently introduced in the clinical practice. This biomechanical study aimed to analyze the stability of plated unstable PHFs augmented via implementation of this technique versus no augmentation. Materials and Methods: Three-part AO/OTA 11-B1.1 unstable PHFs with metaphyseal defects were created in sixteen paired human cadaveric humeri (average donor age 76 years, range 66-92 years), pairwise assigned to two groups for locked plate fixation with identical implant configuration. In one of the groups, six-milliliter polymethylmethacrylate bone cement with medium viscosity (seven minutes after mixing) was placed manually through the lateral window in the defect of the humerus head after its anatomical reduction to the shaft and prior to the anatomical reduction of the greater tuberosity fragment. All specimens were tested biomechanically in a 25° adduction, applying progressively increasing cyclic loading at 2 Hz until failure. Interfragmentary movements were monitored by motion tracking and X-ray imaging. Results: Initial stiffness was not significantly different between the groups, p = 0.467. Varus deformation of the humerus head fragment, fracture displacement at the medial humerus head aspect, and proximal screw migration and cut-out were significantly smaller in the augmented group after 2000, 4000, 6000, 8000 and 10,000 cycles, p ≤ 0.019. Cycles to 5° varus deformation of the humerus head fragment-set as a clinically relevant failure criterion-and failure load were significantly higher in the augmented group, p = 0.018. Conclusions: From a biomechanical standpoint, augmentation with polymethylmethacrylate bone cement placed in the metaphyseal humerus head defect of plated unstable PHFs considerably enhances fixation stability and can reduce the risk of postoperative complications.

Intercriteria Analysis to Diagnose the Reasons for Increased Fouling in a Commercial Ebullated Bed Vacuum Residue Hydrocracker.

The intercriteria analysis developed on the base of intuitionistic fuzziness and index matrices was applied to evaluate processing data of the LUKOIL Neftohim Burgas H-Oil ebullated bed vacuum residue hydrocracker with the aim of revealing the reasons for increased fouling registered during the 3rd cycle of the H-Oil hydrocracker. It was found that when the ratio of the ΔT of the 1st reactor to the ΔT of the 2nd reactor gets lower than 2.0, an excessive H-Oil equipment fouling occurs. The fouling was also found to be favored by processing of lower Conradson carbon content vacuum residual oils and increased throughput and depressed by increasing the dosage of the HCAT nanodispersed catalyst. The fouling in the atmospheric tower bottom section is facilitated by a lower aromatic content in the atmospheric tower bottom product. The addition of FCC slurry oil not only increases aromatic content but also dissolves some of the asphaltenes in the atmospheric residual hydrocracked oil and decreases its colloidal instability index. The fouling in the vacuum tower bottom section is facilitated by a higher saturate content in the VTB. Surprisingly, it was found that the asphaltene content in the VTB depresses the fouling rate. No relation was found of the sediment content in the hydrocracked residual oils measured by hot filtration tests and by the centrifuge method to the equipment fouling of the H-Oil hydrocracker.

Power frequency spectrum analysis of surface EMG signals of upper limb muscles during elbow flexion - A comparison between healthy subjects and stroke survivors.

After a stroke, motor units stop working properly and large, fast-twitch units are more frequently affected. Their impaired functions can be investigated during dynamic tasks using electromyographic (EMG) signal analysis. The aim of this paper is to investigate changes in the parameters of the power/frequency function during elbow flexion between affected, non-affected, and healthy muscles. Fifteen healthy subjects and ten stroke survivors participated in the experiments. Electromyographic data from 6 muscles of the upper limbs during elbow flexion were filtered and normalized to the amplitudes of EMG signals during maximal isometric tasks. The moments when motion started and when the flexion angle reached its maximal value were found. Equal intervals of 0.3407 s were defined between these two moments and one additional interval before the start of the flexion (first one) was supplemented. For each of these intervals the power/frequency function of EMG signals was calculated. The mean (MNF) and median frequencies (MDF), the maximal power (MPw) and the area under the power function (APw) were calculated. MNF was always higher than MDF. A significant decrease in these frequencies was found in only three post-stroke survivors. The frequencies in the first time interval were nearly always the highest among all intervals. The maximal power was nearly zero during first time interval and increased during the next ones. The largest values of MPw and APw were found for the flexor muscles and they increased for the muscles of the affected arm compared to the non-affected one of stroke survivors.