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.

Design of Instructional Videos for People with Autism Who Want to Learn About Grocery Store Work: A Community, Business, Educational and Health Partnership

To facilitate the integration of people with autism into the food industry labour market, this cross sectoral project aimed to design, validate and test instructional videos to concretely demonstrate various tasks in the grocery store, and to probe interest and assess knowledge about these tasks. Results are the delivery of 21 instructional videos validated for individuals with autism and 21 for mentors in grocery.

Availability and Quality of Web Resources for Parents of Children With Disability: Content Analysis and Usability Study

BACKGROUND

The internet is a valuable resource for parents of typical children, who are looking for information about their children's growth and development and how to boost them. However, for parents of children with special needs, especially for non-English-speaking parents, there are anecdotal reports stating that specific and accurate information is not available on the internet.

OBJECTIVE

This study aims to describe the type of information available on the internet for French-speaking parents of children with disability as well as assess the quality of the information collected.

METHODS

We carried out a search of the existing relevant websites targeted at parents of children with disability. We used a validated instrument to extract structural, textual, and visual characteristics of these websites and evaluate their usability.

RESULTS

In all, 42 websites were analyzed; of these, the information had been validated by a trustworthy source in only 18 (43%) websites. Networking opportunities for parents were available in only 7 (17%) websites. Most websites provided information related to autism spectrum disorder (20/42, 42%) and learning disabilities (19/42, 45%), and only a few websites discussed other disability types such as behavorial disorders and developmental language disorders (4/42, 10% each). Community, social, and civic life (9/42, 22%); domestic life (12/42, 29%); and mobility (15/42, 36%) were the less frequently covered topics. With regard to the usability evaluation, 22 of the 42 (52%) websites received a global score <70%, whereas 20 (48%) scored ≥70.

CONCLUSIONS

Although the internet is an infinite source of information, it is not necessarily actionable for parents of children with disability. Some information remains difficult to find online, and networking opportunities with other parents dealing with similar challenges are scarce.

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

The pore diameter (depth) of the periodically corrugated h-BN monolayer (“nanomesh”) can be tuned allyoing Au into the Rh(111) surface.

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)

CeO₂ films were prepared evaporating Ce on Cu(111) in O₂ gas; a nearly perfect wetting could be achieved at p_O2 = 5 × 10⁻⁷ mbar.

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.

Percutaneous video choledochoscopic treatment of retained biliary stones via dilated T-tube tract

BACKGROUND

Retained biliary stones is a common clinical problem in patients after surgery for complicated gallstone disease. When postoperative endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy are unsuccessful, several percutaneous procedures for stone removal can be applied as alternatives to relaparotomy. These procedures are performed either under fluoroscopic control or with the use of choledochoscopy, but it is also possible to combine these methods.

METHODS

Since 1994, we have used the percutaneous video choledochoscopic technique for the removal of difficult retained biliary stones via dilated T-tube tract in 17 patients, applying the technique of percutaneous stone extraction used in urology. While waiting for the T-tube tract to mature and after the removal of the T-tube, the dilatation of its tract was 26-30 Fr. Stone removal was carried out using a flexible video choledochoscope and a rigid renoscope under fluoroscopic control, with the aid of Dormia baskets, rigid forceps, and high-pressure irrigation.

RESULTS

We performed 23 operative procedures, and the clearance of the biliary ducts was successful in all cases. There were no major complications or deaths.

CONCLUSION

Percutaneous video choledochoscopic-assisted removal of large retained biliary stones via the T-tube tract is a highly effective and safe procedure. Its advantages over other procedures include the ability to visualize the stones and noncalculous filling defects; it also guarantees that the stones can be removed under visual video endoscopic control. It has no problems related to tract or stone size.

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

Au is stabilized on titanate nanowires partially in positively charged gold form and also as Au clusters. Au loaded nanotubes loose their tubular morphology and are readily transformed into anatase. On the other hand, gold stabilizes the layered structure of titanate nanowires.

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.

Formation of Rh-Au core-shell nanoparticles on TiO2(110) surface studied by STM and LEIS

Rh-Au core-shell nanoparticles were fabricated on TiO(2)(110) surface by physical vapor deposition (PVD) of Rh followed by exposure of Au at elevated sample temperature (500 K). The morphology of the bimetallic particles was checked by scanning tunneling microscopy (STM). The chemical composition of the particles was characterized by low energy ion scattering (LEIS) method. It was shown that the "seeding + growing" method described previously for growth of monometallic particles in narrow size distribution (Berko, A. et al. J. Catal. 1999, 182, 511) can also be applied for fabrication of bimetallic nanoparticles. The large mean free path of surface diffusion of gold on the oxide support makes the accumulation of Au possible exclusively on the Rh seeds formed in the first step of the procedure. By performing careful STM and LEIS experiments, it was proven that, for appropriate Au and Rh coverages, the postdeposited Au completely and uniformly covers the Rh nanoparticles.

Demonstration of HTLV-Related Pro viral DNA Sequences and Antibodies Reactive with HTLV Internal Proteins in an Hungarian Patient with Sézary Syndrome

DNA sequences distantly related to the proviral DNA of HTLV-I were found in the leukemic cells of a Hungarian patient suffering from Sézary syndrome. Serum samples from the patient contained antibodies reactive with the internal core polypeptides of HTLV-I and HTLV-II, but not with the env gene encoded type-specific HTLV antigens. The husband and daughter of the patient also had antibodies of the same specificity. These findings suggest the presence of a virus distantly related to HTLV-I and HTLV-II.

Surgical treatment of oesophageal perforation

Several options–but choose wisely

Non-invasive estimation of hepatic blood perfusion from H2 15O PET images using tissue-derived arterial and portal input functions

PURPOSE

The liver is perfused through the portal vein and the hepatic artery. When its perfusion is assessed using positron emission tomography (PET) and (15)O-labeled water (H(2) (15)O), calculations require a dual blood input function (DIF), i.e., arterial and portal blood activity curves. The former can be generally obtained invasively, but blood withdrawal from the portal vein is not feasible in humans. The aim of the present study was to develop a new technique to estimate quantitative liver perfusion from H(2) (15)O PET images with a completely non-invasive approach.

METHODS

We studied normal pigs (n=14) in which arterial and portal blood tracer concentrations and Doppler ultrasonography flow rates were determined invasively to serve as reference measurements. Our technique consisted of using model DIF to create tissue model function and the latter method to simultaneously fit multiple liver time-activity curves from images. The parameters obtained reproduced the DIF. Simulation studies were performed to examine the magnitude of potential biases in the flow values and to optimize the extraction of multiple tissue curves from the image.

RESULTS

The simulation showed that the error associated with assumed parameters was <10%, and the optimal number of tissue curves was between 10 and 20. The estimated DIFs were well reproduced against the measured ones. In addition, the calculated liver perfusion values were not different between the methods and showed a tight correlation (r=0.90).

CONCLUSION

In conclusion, our results demonstrate that DIF can be estimated directly from tissue curves obtained through H(2) (15)O PET imaging. This suggests the possibility to enable completely non-invasive technique to assess liver perfusion in patho-physiological studies.

Comparison of the degenerative changes in weight-bearing joints following cementing or grafting techniques in giant cell tumour patients: medium-term results

The aim of this retrospective study was to compare and assess the effect of bone grafting and cementing techniques--two common applications used in the treatment of subchondral giant cell tumours of bone (GCTs)--on the development of degenerative changes in the weight-bearing joints of the lower extremity. Eighty patients were included in this follow-up study, 44 of whom underwent curettage followed by bone grafting, and 36 who had curettage followed by cementation. At the 24-month post-operative examination, significantly less degenerative change was found in patients with bone cement than in those with bone grafting. At the 50-month and later (range: 50-148 months) post-operative examination, however, no significant differences were found between the two groups, indicating that there was a significant acceleration of degenerative changes in the cemented group after the 24-month follow-up.

Adult movements of newly introduced alien Diabrotica virgifera virgifera (Coleoptera: Chrysomelidae) from non-host habitats

Mark-release-recapture experiments were undertaken in order to investigate the movement of adult Diabrotica virgifera virgifera LeConte from accidental introduction points towards suitable habitats, such as its host plant, Zea mays L. In Hungary in 2003 and 2004, nine mark-release-recapture experiments were carried out in a grass steppe area and lucerne field, in which two small maize fields (10x10 m) had been planted 300 m distant from the central release point. After each release of 5500 to 6000 marked D. v. virgifera, beetle recaptures were recorded three times using non-baited yellow sticky traps placed on 30, 105, 205 and 305 m radii around the release point. In seven out of 15 recapture periods (47%), beetle populations showed no directional movements, and their movements towards any particular habitat cannot be predicted. During five recapture periods (33%), beetle populations showed a uni-directional movement, and in three cases (20%) a bi-directional movement was observed. In 10 out of 15 recapture periods (67%), the released populations moved in a direction that was comparable with the mean wind direction during these periods; thus, beetle movements were slightly correlated with wind direction. On average over sites and years, beetles were not preferentially moving towards the two small maize fields (located 300 m from the release point) compared to other directions. However, beetles moved significantly more frequently in the direction of naturally-occurring maize fields within a radius of 1500 m than towards other habitats. Beetles stayed more frequently within flowering lucerne fields out to a radius of 300 and 600 m than in non-flowering lucerne or other habitats. On average, 2.8% (SD 3.2) of all recaptured beetles arrived in one of the two small maize fields located 300 m from their release point indicating that there is a high risk of a founder population establishing. Habitat management cannot be suggested as a means of preventing the beetle's initial dispersal because movement was usually non-directional, and alternative food plants were used prior to reaching maize.