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Background Several short-stemmed press-fit humeral components have been developed in recent years for anatomic total shoulder arthroplasty (TSA) as well as reverse shoulder arthroplasty (RSA). Varying radiographic outcomes have been reported, with some studies reporting concerning rates of aseptic loosening. This study analyzed the radiographic findings of a press-fit convertible short-stemmed humeral component in both TSA and RSA. Methods There were 150 anatomic TSAs (group 1) and 77 RSAs (group 2) analyzed radiographically at a minimum follow-up of 2 years postoperatively. Plain radiographs were reviewed for stem loosening, alignment, signs of stress shielding, and the filling ratio. Results At final follow-up, 49% of group 1 and 65% of group 2 had no evidence for radiographic changes. In those with radiographic changes, low bone adaptions were found in 83% and high adaptions in 17% in both groups. Larger stem sizes with higher filling ratios were associated with high radiographic adaptions in both groups (P = .02). The overall filling ratios were higher in group 2 (P = .002). Cortical contact of the stem led to higher bone adaptions (P = .014). Conclusions The short humeral component analyzed in this study showed encouraging survival rates without aseptic loosening. Radiographic changes are associated with a higher filling ratio and cortical contact of the stem. Surgeons should aim to achieve fixation with the minimal required canal filling to minimize radiographic changes with the uncemented humeral component used in this study.

Background: The radiological phenomenon of subsidence following the implantation of uncemented short-stem reverse prostheses (USSP) has not yet been described. The purpose of this study was to describe the rate and potential risk factors for subsidence. We hypothesized that subsidence may be a frequent finding and that a subsidence of &gt, 5 mm (mm) is associated with an inferior clinical outcome. Methods: A total of 139 patients with an average age of 73 &plusmn, 9 years were included. The clinical and radiological outcome was evaluated at a minimum follow-up (FU) of 12 months. Results: No humeral component loosening was present at a mean FU of 18 (range, 12&ndash, 51) months. Mean Constant Score (CS) and Subjective Shoulder Value (SSV) improved significantly from 34.3 &plusmn, 18.0 points and 37.0 &plusmn, 19.5% preoperatively to 72.2 &plusmn, 13.4 points and 80.3 &plusmn, 16.5% at final FU (p &lt, 0.001). The average subsidence of the USSP was 1.4 &plusmn, 3.7 mm. Subsidence of &gt, 5 mm was present in 15 patients (11%). No association between a subsidence &gt, 5 mm and CS or SSV was found (p = 0.456, p = 0.527). However, a subsidence of &gt, 5 mm resulted in lower strength at final FU (p = 0.022). Complications occurred in six cases (4.2%), and the revision rate was 3.5% (five cases). Conclusions: Although subsidence of USSP is a frequent radiographic finding it is not associated with loosening of the component or a decrease in the clinical outcome at short term FU. Level of evidence: Level 4, retrospective study.

The aim of the study was to evaluate the short-term clinical results of anatomic total shoulder arthroplasty with a short-stem prosthesis in primary osteoarthritis.65 shoulders with a mean age of 70 years (range 47-85 years) were available for minimum follow-up of 24 months. Clinical outcome was determined by range of motion, Constant score (CS) age and sex-adjusted Constant score (CS%), and subjective shoulder value (SSV). The influence of six different factors (high bone adaptations, age 65 years, female gender, dominant side, atrophy of the supraspinatus tendon ≥ grade 2, glenoid type B2/B3) on the clinical outcome was assessed.At mean follow-up of 37 months (range 24-58 months), the CS improved from 36 ± 8 to 75 ± 12 (p 0.001). The shoulder flexion (100° ± 21° to 159° ± 19°) as well as the external rotation (3° ± 11° to 43° ± 18°) improved significantly (p 0.001). Three complications were noted (transient neuropraxia of the radial nerve, subjective instability, hematoma with superficial wound infection) leading to one revision surgery (wound debridement). No stem loosening was observed. High bone adaptation was present in 19 out of 65 shoulders (29%). The clinical outcome was not influenced by high bone adaptations (p ≥ 0.095). Age 65 years (n = 44) and female gender (n = 38) were associated with worse clinical outcome (p ≤ 0.043).In the short term, the clinical results of this anatomical short-stem shoulder prosthesis are encouraging. A low prevalence of high bone adaptations was found without any influence on the clinical outcome and stem loosening was not observed.

This study analyzed the radiographic results of a cemented all-polyethylene keeled glenoid component available in different sizes and multiple backside radiuses of curvature.The study group consisted of 118 cases (114 patients). There were 63 women and 51 men. Mean age at the time of arthroplasty was 68 years (range, 51-85 years). True anterior-posterior radiographs obtained postoperatively and at the final follow-up were analyzed for implant seating and the occurrence of radiolucent lines. Glenoid morphology and fatty infiltration of the rotator cuff muscles were examined using computed tomography scans. Mean follow-up was 38 months (range, 24-70 months).The mean radiolucent line score after surgery was 0.54 points (range, 0-3 points), and 90% had no or only 1 radiolucent line. At the final follow-up, the mean score was 1.06 points (range, 0-3 points), and 74% had no or only 1 radiolucent line. The score increased significantly over time (P .001). No component was at risk for loosening. No correlation was found between patient age, sex, hand dominance, glenoid morphology, or fatty infiltration of the rotator cuff muscles and the occurrence of radiolucent lines.In the short-term, the glenoid component analyzed in this study showed promising radiographic results, with a low number of radiolucent lines without failure. However, the mean radiolucent line score increased significantly over time, and long-term observations are necessary to confirm a possible advantage compared with older component designs.

Introduction Preoperative 3D planning programs for anatomic (TSA) and reverse total shoulder arthroplasty (RSA) allow the analysis of glenohumeral joint pathoanatomy and templating for implant size selection and placement. The aim of this multicenter study was to compare the preoperative glenoid implant type and size planned to the final glenoid implant type and size used intraoperatively. Methods Two hundred patients (100 TSA and 100 RSA) with a mean age of 72 years who had undergone preoperative planning and subsequent shoulder arthroplasty (100 TSA and 100 RSA) were included. All preoperative plans were saved and were analyzed for arthroplasty type (TSA vs. RSA), implant type (augment vs. nonaugment), and size (ie, polyethylene size, polyethylene radius of curvature, glenoid baseplate diameter, baseplate post length, and baseplate lateralization). The preoperative plan was available during surgery and was compared to the final implants inserted by the surgeon. Results There were no intraoperative conversions of TSA to RSA or vice versa. In patients planned for a TSA, complete concordance between the preoperative plan and final implant selection was 85%. A complete mismatch for TSA glenoid size, backside radius of curvature, and augmentation occurred in 2%. For RSA, complete concordance was found in 90% of cases. A complete mismatch for implant type, size, post length, and glenosphere size occurred in 3%. Conclusion A high concordance was found between preoperative 3D planning implant selection and the glenoid component inserted at surgery for TSA and RSA. This high concordance may assist with surgical preparedness, implant stocks, and possibly future implant production.

Shorter humeral reverse total shoulder arthroplasty (RTSA) stems may reduce stress shielding, however, potentially carry the risk of varus/valgus malalignment. This radiographic study’s purpose was to measure the incidence of stem malalignment and thus the realized neck-shaft angle (NSA). The hypothesis was that malalignment of the stem is a frequent postoperative radiographic finding. Radiographs of an uncemented curved short stem RTSA with a 145° NSA were reviewed. The study group included 124 cases at a mean age of 74 (range 48–91) years. The humeral stem axis was measured and defined as neutral if the value fell within ± 5° of the longitudinal humeral axis. Angular values > 5° were defined as malaligned in valgus or varus. The filling ratio of the implant within the humeral shaft was measured at the level of the metaphysis (FRmet) and diaphysis (FRdia). The average humeral stem axis angle was 4 ± 3° valgus, corresponding to a true mean NSA of 149 ± 3°. Stem axis was neutral in 73% (n = 90) of implants. Of the 34 malaligned implants, 82% (n = 28) were in valgus (NSA = 153 ± 2°) and 18% (n = 6) in varus (NSA = 139 ± 1°). The average FRmet and FRdia were 0.68 ± 0.11 and 0.72 ± 0.11, respectively. A low positive association was found between stem diameter and filling ratios (r = 0.39; p 5° malaligned. The majority of malaligned components (86%) were implanted in valgus, corresponding to an NSA of > 150°. As such, surgeons must be aware that shorter and smaller stems may lead to axial malalignment influencing the true SA. Level IV, retrospective study.

Background Knowledge about the clinical spectrum of lung disease caused by variations in the ATP binding cassette subfamily A member 3 (ABCA3) gene is limited. Here we describe genotype-phenotype correlations in a European cohort. Methods We retrospectively analysed baseline and outcome characteristics of 40 patients with two disease-causing ABCA3 mutations collected between 2001 and 2015. Results Of 22 homozygous (15 male) and 18 compound heterozygous patients (3 male), 37 presented with neonatal respiratory distress syndrome as term babies. At follow-up, two major phenotypes are documented: patients with (1) early lethal mutations subdivided into (1a) dying within the first 6 months or (1b) before the age of 5 years, and (2) patients with prolonged survival into childhood, adolescence or adulthood. Patients with null/null mutations predicting complete ABCA3 deficiency died within the 1st weeks to months of life, while those with null/other or other/other mutations had a more variable presentation and outcome. Treatment with exogenous surfactant, systemic steroids, hydroxychloroquine and whole lung lavages had apparent but many times transient effects in individual subjects. Conclusions Overall long-term (>5 years) survival of subjects with two disease-causing ABCA3 mutations was

The ABCA3 gene encodes a lipid transporter in type II pneumocytes critical for survival and normal respiratory function. The frequent ABCA3 variant R288K increases the risk for neonatal respiratory distress syndrome among term and late preterm neonates, but its role in children’s interstitial lung disease has not been studied in detail. In a retrospective cohort study of 228 children with interstitial lung disease related to the alveolar surfactant system, the frequency of R288K was assessed and the phenotype of patients carrying a single R288K variant further characterized by clinical course, lung histology, computed tomography and bronchoalveolar lavage phosphatidylcholine PC 32:0. Cell lines stably transfected with ABCA3-R288K were analyzed for intracellular transcription, processing and targeting of the protein. ABCA3 function was assessed by detoxification assay of doxorubicin, and the induction and volume of lamellar bodies. We found nine children with interstitial lung disease carrying a heterozygous R288K variant, a frequency significantly higher than in the general Caucasian population. All identified patients had neonatal respiratory insufficiency, recovered and developed chronic interstitial lung disease with intermittent exacerbations during early childhood. In vitro analysis showed normal transcription, processing, and targeting of ABCA3-R288K, but impaired detoxification function and smaller lamellar bodies. We propose that the R288K variant can underlie interstitial lung disease in childhood due to reduced function of ABCA3, demonstrated by decelerated detoxification of doxorubicin, reduced PC 32:0 content and decreased lamellar body volume.

BACKGROUND: Children's interstitial lung diseases (chlLD) comprise a broad spectrum of diseases. Besides the genetically defined surfactant dysfunction disorders, most entities pathologically involve the alveolar surfactant region, possibly affecting the surfactant proteins SP-B and SP-C. Therefore, our objective was to determine the value of quantitation of SP-B and SP-C levels in bronchoalveolar lavage fluid (BALF) for the diagnosis of chlLD. METHODS: Levels of SP-B and SP-C in BALF from 302 children with chlLD and in controls were quantified using western blotting. In a subset, single-nucleotide polymorphisms (SNPs) in the SFTPC promoter were genotyped by direct sequencing. RESULTS: While a lack of dimeric SP-B was found only in the sole subject with hereditary SP-B deficiency, low or absent SP-C was observed not only in surfactant dysfunction disorders but also in patients with other diffuse parenchymal lung diseases pathogenetically related to the alveolar surfactant region. Genetic analysis of the SFTPC promoter showed association of a single SNP with SP-C level. CONCLUSION: SP-B levels may be used for screening for SP-B deficiency, while low SP-C levels may point out diseases caused by mutations in TTF1, SFTPC, ABCA3, and likely in other genes involved in surfactant metabolism that remain to be identified. We conclude that measurement of levels of SP-B and SP-C was useful for the differential diagnosis of chlLD, and for the precise molecular diagnosis, sequencing of the genes is necessary.

Designing shuttles that help transit riders complete the last mile of their trip (from a transit station or stop to their destination) plays an important role in leveraging rail capacity and growing a regional transit market. Unavailable or imprecise data have made it difficult to conduct effective design for shuttle routes on the basis of a defined potential market. This study developed a methodology for determining the size and location of the untapped market of commuters who drove long distances for work but could have made the same trip with commuter rail and last-mile shuttle service. The analysis was conducted with U.S. Census Longitudinal Employer–Household Dynamics data, a relatively new public data set of statewide workplace and residence pairs at the census block level. As a case study, the analysis was applied to the potential for last-mile shuttle connections between employment and 14 FrontRunner commuter rail stations outside downtown Salt Lake City, Utah. For the shuttle market to be captured, the workplace and residence pairs in this methodology were selected on the basis of three criteria: ( a) a residence within the FrontRunner park-and-ride shed, ( b) a workplace within 2 mi of a FrontRunner station, and ( c) an overall trip distance of 15 mi or greater. The study identified stations with the highest number of trips that met all three criteria and designed shuttle routes on the basis of the associated employment locations. Although this analysis focused on nontraditional commuting patterns, the same methodology would be useful for many other analyses of commuter markets.

Introduction: ABCA3 is a lipid transporter expressed in alveolar type II pneumocytes. It is involved in the transport of phospholipids into lamellar bodies (LBs) and is therefore essential for the assembly of pulmonary surfactant and LB biogenesis. Mutations in the ABCA3 gene display a common genetic cause for respiratory distress syndrome in newborns and interstitial lung disease in children. Aim: As ABCA3 shares several features with CFTR (ABCC7), small molecules that are able to correct mutated CFTR proteins were tested for ABCA3 mutations. Methods: A549 cells stably expressing HA-tagged wildtype ABCA3 or variants Q215K, M760R, A1046E, K1388N, or G1421R, were treated with a range of different correctors to identify molecules that are able to restore ABCA3 processing and function. Cells were analyzed in regard to ABCA3 protein pattern in Western blotting and immunofluorescence. Activity of corrected ABCA3 protein was quantified using a lipid transport assay with TopFluor-conjugated phosphatidylcholine. Results: Two of the tested correctors restored processing of all ABCA3 variants except for M760R and led to a WT-like appearance of mutated protein in Western blotting and immunofluorescence. Lipid transport into ABCA3-HA-positive vesicles was increased by corrector treatment for WT ABCA3 and all variants except for M760R. Conclusion: The identification of molecules with the ability to correct processing and function of mutated ABCA3 proteins are an important step towards the development of drugs for the treatment of children suffering from respiratory distress syndrome or interstitial lung disease.

Fault-hiding control reconfiguration aims at hiding a fault from the nominal controller while the reconfigured closed-loop system possesses admissible behaviour. The necessary degrees of freedom are created by placing a reconfiguration block between nominal controller and faulty plant. We aim at a guaranteed non-conflicting, complete and controllable behaviour of the self-reconfiguring closed-loop system, in particular for an arbitrary solution to the nominal control problem. Thereby, the nominal controller design and the design of the reconfiguration block are completely decoupled. This is desirable from a practical perspective, since in this way additional fault-tolerant control capabilities can be retrofit to an existing control system. In this paper, we propose a self-reconfiguring control architecture, state our reconfiguration problem in terms of finite languages and address the synthesis of discrete event dynamic reconfiguration blocks. To illustrate our results, we provide a running example.

Fault-tolerant control systems with discrete-event dynamics allow for differing sets of design requirements, that specify the system's behaviour during nominal operation and in the case of component degradation or component malfunction. This paper is concerned with the design of fault-tolerant control algorithms for discrete event systems in the framework of supervisory control theory. Its main contribution is a modelling framework that describes the evolution of systems which are potentially subject to faults. These models are called fault-accommodating models. Within this context, the occurrence of faults is modelled by means of unobservable and uncontrollable events. Hence, the design problem of fault-tolerant controllers is transformed to a supervisory control problem under partial observation. Consequently, there is no need for explicitly diagnosing the occurrence of faults and relaxed diagnosability conditions are applied. Finally, the paper provides extensive examples in order to illustrate the application of all derived methodological results. All computations needed for controller design and system analysis were implemented using a freely available software toolbox.

This paper addresses abstraction-based supervisory control for plant and specification behaviours that are not necessarily ω-closed, i.e. plant behaviours that exhibit eventuality properties and specifications that impose eventuality properties on the closed loop. Technically, the core idea is to combine results from previous work on abstraction-based supervision of input-output behaviours with results on supervisory control of ω-languages. As our main result, we identify a controllability condition for the plant, that ensures a nonblocking closed-loop behaviour with a controller that has been obtained for a plant abstraction.

The paper presents the results of cooperative work done by three different research institutions. The cooperation concluded in a large field experiment with six heterogeneous unmanned ground vehicles (UGVs) and unmanned aerial vehicles (UAVs). It is shown, that it is possible to do reconnaissance and surveillance, namely detection of pedestrians and vehicles, with an autonomous multi-robot system under real world conditions. The participants were all using different robotic middlewares and interfaces to the graphical user interface. Hence, it has been agreed to use common interfaces and standards for communication. The Robot Operating System (ROS) is used as a communication layer, supported by commercially available 3G mobile radio communication for large operating distances. A standardized markup language has been used for the description of tasks and feedback from the robots to the control station. Moreover, the applied UGV control strategies and the implemented approach for detection, tracking and classification are presented. The concluding field test showed that it is possible to realize a multi-robot system of dynamic size, and that such teams are well-suited to perform reconnaissance and surveillance without constant observation by a human operator.

Path integration is a primary means of navigation for a number of animals. We present a model which performs path integration with a neural network. This model is based on a neural structure called a sinusoidal array, which allows an efficient representation of vector information with neurons. We show that exact path integration can easily be achieved by a neural network. Thus deviations from the direct home trajectory, found previously in experiments with ants, can not be explained by computational limitations of the nervous system. Instead we suggest that the observed deviations are caused by a strategy to simplify landmark navigation.

Based on a real-life problem, the target group selection for a bank's database marketing campaign, we will examine the capacity of Neuro-Fuzzy Systems (NFS) for Data Mining. NFS promise to combine the benefits of both fuzzy systems and neural networks, and are thus able to learn IF-THEN-rules, which are easy to interpret, from data. However, they often need extensive preprocessing efforts, especially concerning the imputation of missing values and the selection of relevant attributes and cases. In this paper we will demonstrate innovative solutions for various pre- and postprocessing tasks as well as the results from the NEFCLASS Neuro-Fuzzy software package.

Data Mining Algorithms extract patterns from large amounts of data. But these patterns will yield knowledge only if they are interesting, i.e. valid, new, potentially useful, and understandable. Unfortunately, during pattern search most Data Mining Algorithms focus on validity only, which also holds true for Neuro-Fuzzy Systems. In this Paper we introduce a method to enhance the interestingness of a rule base as a whole. In the first step, we aggregate the rule base through amalgamation of adjacent rules and eliminiation of redundant attributes. Supplementing this rather technical approach, we next sort rules with regard to their performance, as measured by their evidence. Finally, we compute reduced evidences, which penalize rules that are very similar to rules with a higher evidence. Rules sorted on reduced evidence are fed into an integrated rulebrowser, to allow for manual rule selection according to personal and situation-dependent preference. This method was applied successfully to two real-life classification problems, the target group selection for a retail bank, and fault diagnosis for a large car manufacturer. Explicit reference is taken to the NEFCLASS algorithm, but the procedure is easily generalized to other systems.