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Background: Adolescent idiopathic scoliosis, in which obvious curves are visible in radiographic images, is also seen in combination with lumps in the back. These lumps contribute to inclination, which can be measured by a scoliometer. To the authors' knowledge, there are no previous formulas combining thoracic and lumbar scoliometer values simultaneously to predict thoracic and lumbar Cobb angles, respectively. This study aimed to create more accurate two-parameter mathematical formulas for predicting thoracic and lumbar Cobb angles., Methods: Between Dec. 2012 and Jan. 2013, patients diagnosed with idiopathic scoliosis in an outpatient clinic were enrolled. The maximal trunk rotations at the thoracic and lumbar regions were recorded with a scoliometer. Right asymmetry hump was deemed positive (+), and left asymmetry hump was deemed negative (-). The Cobb angles were measured with a Picture Archiving and Communication System. Statistical analysis included Pearson's correlation coefficient, multivariate regression and Bland-Atman analysis., Results: One-hundred and one patients were enrolled in our study. The average thoracic curve (TC) was 23.3 ± 1.8°, while the average lumbar curve (LC) was - 23.3 ± 1.4°. The thoracic inclination (TI) and lumbar inclination (LI) were 4.5 ± 0.7 and - 5.9 ± 0.6, respectively. The one-parameter formula for the thoracic curve was TC = 2.0 TI + 14.3 (r = 0.813); for the lumbar curve, it was LC = 0.9 LI - 16.9 (r = 0.409). By multivariate regression, the two-parameter formulas for the thoracic and lumbar curves were TC = 2.6 TI - 1.4 LI (r = 0.931) and LC = - 1.5 TI + 2.0 LI (r = 0.874), respectively. The two-parameter formulas were more accurate than the one-parameter formulas., Conclusions: Based on the results of these two-parameter formulas for thoracic and lumbar curves, the Cobb angles can be predicted more accurately by the readings of the scoliometer. Physicians and other healthcare practitioners can thus evaluate patients with scoliosis more precisely than before with a scoliometer.

Background: Of the proposed animal interbody fusion models, rat caudal discs have gained popularity in disc research due to their strong resemblance to human discs with respect to geometry, composition and mechanical properties. The purpose of this study is to demonstrate an efficient, repeatable and easily accessible animal model of interbody fusion for future research into mechanical testing and graft materials., Methods: Twelve 12-week-old female Sprague-Dawley (SD) rats underwent caudal interbody fusion of the third and fourth coccygeal vertebrae of the tail. Serial radiological evaluation, and histological evaluation and manual palpation after sacrifice were performed to assess the fusion quality. Mechanical testing of functional units (FUs) of non-operated and operated segments was compared using a three-point bending test., Results: At postoperative 12 weeks, callus formation was observed at the fusion sites in all rats, with the mean radiological evaluations of 2.75/3 according to the Bransford classification. Newly formed bone tissue was also observed in all rats with the mean histological score of 5.85/7, according to the Emery grading system. No palpable gaps and obvious change of bending stiffness was observed in the operated segments. The mean bending stiffness of the FUs was statistically higher than that of the control FUs (26.57 ± 6.71 N/mm vs. 12.45 ± 3.21 N/mm, p < 0.01)., Conclusion: The rat caudal disc interbody fusion model proved to be an efficient, repeatable and easily accessible model. Future research into adjuvant treatments like growth factor injection and alternative fusion materials under conditions of osteoporosis using this model would be worthwhile., (Copyright © 2017 Chang Gung University. Published by Elsevier B.V. All rights reserved.)

Osteoporosis is a bone disease that afflicts millions of people around the world, and a variety of spinal integrity issues, such as degenerative spinal stenosis and spondylolisthesis, are frequently concomitant with osteoporosis and are sometimes treated with spinal interbody fusion surgery. Previous studies have demonstrated the efficacy of strontium ranelate (SrR) treatment of osteoporosis in improving bone strength, promoting bone remodeling, and reducing the risk of fractures, but its effects on interbody fusion surgery have not been adequately investigated. SrR-treated rats subjected to interbody fusion surgery exhibited significantly higher lumbar vertebral bone mineral density after 12 weeks of treatment than rats subjected to the same surgery but not treated with SrR. Furthermore, histological and radiographic assessments showed that a greater amount of newly formed bone tissue was present and that better fusion union occurred in the SrR-treated rats than in the untreated rats. Taken together, these results show significant differences in bone mineral density, PINP level, histological score, SrR content and mechanical testing, which demonstrate a relatively moderate effect of SrR treatment on bone strength and remodeling in the specific context of recovery after an interbody fusion surgery, and suggest the potential of SrR treatment as an effective adjunct to spinal interbody fusion surgery for human patients., Competing Interests: The authors have declared that no competing interests exist.

Antibiotic-loaded bone cement (ALBC) is widely used in orthopaedic surgery for both prevention and treatment of infection. Little is known about the effect of different brand combinations of antibiotic and bone cement on the elution profile and mechanical strength of ALBC. Standardized specimens that consisted of one of the 4 brands of bone cement and one of the 3 brands of vancomycin were fashioned, producing 12 combinations of ALBC. Two dosages of vancomycin in 40g bone cement were used to represent the high (4g vancomycin) and low (1g vancomycin) dose groups. Concentrations of vancomycin elution from ALBC was measured for up to 336 hours. The ultimate compression strength was tested at axial compression using a material testing machine before and after elution. In both high-dose and low-dose groups, Lyo-Vancin in PALACOS bone cement resulted in the highest cumulative elution and Vanco in Simplex P bone cement resulted in the lowest elution (458% and 65% higher in high- and low-dose groups, respectively). The mechanical strength was not significantly compromised in all groups with low dose vancomycin (range: 70.31 ± 2.74 MPa to 87.28 ± 8.26MPa after elution). However, with the addition of high dose vancomycin, there was a mixed amount of reduction in the ultimate compression strength after cement aging, ranging from 5% (Vanco in Simplex P, 81.10 ± 0.48 MPa after elution) to 38% (Sterile vancomycin in CMW, 60.94 ± 5.74 MPa after elution). We concluded that the selection of brands of vancomycin and bone cement has a great impact on the release efficacy and mechanical strength of ALBC., Competing Interests: The authors have declared that no competing interests exist.

Purpose: Distal femur fractures adjacent to total knee arthroplasty are a rare yet complex problem. Recently, extramedullary locking plate and retrograde intramedullary nail fixations have become popular options, but the complication rates associated with these procedures are 15-20 %. Modified fixations were assessed in an effort to reduce complications from unstable periprosthetic fractures., Methods: Using experimental and finite element methods, this study compared the construct behaviours of a locking plate, a retrograde intramedullary nail, and their modifications (a spiral-blade supplemented in an intramedullary nail or a locking plate/allograft hybrid) when subjected to various fracture types, locations, loading conditions, and bony strength. The implanted models were used to assess construct stiffness, fracture micromotion, and implant stress under different osteoporotic conditions. Finally, we collected 40 cases for radiological analysis to indicate the appropriate procedure for treating periprosthetic fractures following total knee arthroplasty., Results: Regardless of the fracture type, femoral constructs fixed with a conventional or spiral-blade supplemented intramedullary nail exhibited higher axial but lower torsional stiffness than those fixed with a locking plate. Torsional deformation occurred if the lower-positioned fracture had no medial support. The locking plate/allograft construct exhibited the highest stiffness and the least micromotion. A review of 40 clinical cases confirmed the above findings regarding the locking plate/allograft construct., Conclusion: The spiral-blade supplement of retrograde intramedullary nail and locking plate/allograft modified constructs significantly stabilizes the unstable fractured gaps. The locking plate/allograft is recommended for the periprosthetic fractures with deficient bone stock and severe osteoporosis to improve alignment and healing potentials.

Polymethylmethacrylate (PMMA) bone cement is a popular bone void filler for vertebroplasty. However, the use of PMMA has some drawbacks, including the material's excessive stiffness, exothermic polymerization, and short handling time. This study aimed to create an ideal modified bone cement to solve the above-mentioned problems. Modified bone cements were prepared by combining PMMA with three different volume fractions of castor oil (5%, 10%, and 15%). The peak polymerization temperatures, times to achieve the peak polymerization temperature, porosities, densities, modulus and maximum compression strengths of standard (without castor oil), and modified cements were investigated following storage at ambient temperature (22°C) or under precooling conditions (3°C). Six specimens were tested in each group of the aforementioned parameters. Increasing castor oil content and precooling treatment effectively decreased the peak polymerization temperatures and increased the duration to achieve the peak polymerization temperature ( P < 0.05). Furthermore, the mechanical properties of the material, including density, modulus, and maximum compression strength, decreased with increasing castor oil content. However, preparation temperature (room temperature versus precooling) had no significant effect ( P > 0.05) on these mechanical properties. In conclusion, the addition of castor oil to PMMA followed by precooling created an ideal modified bone cement with a low modulus, low polymerization temperature, and long handling time, enhancing its applicability and safety for vertebroplasty.

Expansive pedicle screws significantly improve fixation strength in osteoporotic spines. However, the previous literature does not adequately address the effects of the number of lengthwise slits and the extent of screw expansion on the strength of the bone/screw interface when expansive screws are used with or without cement augmentation. Herein, four designs for expansive pedicle screws with different numbers of lengthwise slits and different screw expansion levels were evaluated. Synthetic bones simulating severe osteoporosis were used to provide a comparative platform for each screw design. The prepared specimens were then tested for axial pullout failure. Regardless of screw design, screws with cement augmentation demonstrated significantly higher pullout strength than pedicle screws without cement augmentation (p < 0.001). For screws without cement augmentation, solid screws exhibited the lowest pullout strength compared to the four expansive groups (p < 0.01). No significant differences in pullout strength were observed between the expansive screws with different designs (p > 0.05). Taken together, our results show that pedicle screws combined with cement augmentation may greatly increase screw fixation regardless of screws with or without expansion. An increase in both the number of slits and the extent of screw expansion had little impact on the screw-anchoring strength. Cement augmentation is the most influential factor for improving screw pullout strength.

Background: Acetabular reinforcement devices (ARDs) are frequently used as load-sharing devices to allow allograft incorporation in revision hip arthroplasty with massive acetabular bone loss. The key to a successful reconstruction is robust fixation of the device to the host acetabulum. Interlocking fixation is expected to improve the initial stability of the postoperative construct. However, all commercially available ARDs are designed with non-locking fixation. This study investigates the efficacy of standard ARDs modified with locking screw mechanisms for improving stability in acetabular reconstruction., Methods: Three types of ARDs were examined to evaluate the postoperative compression and angular stability: i) standard commercial ARDs, ii) standard ARDs modified with monoaxial and iii) standard ARDs modified with polyaxial locking screw mechanisms. All ARDs were implanted into osteomized synthetic pelvis with pelvic discontinuity. Axial compression and torsion tests were then performed using a servohydraulic material testing machine that measured load (angle) versus displacement (torque). Initial stability was compared among the groups., Results: Equipping ARDs with interlocking mechanisms effectively improved the initial stability at the device/bone interface compared to standard non-locked ARDs. In both compression and torsion experiments, the monoaxial interlocking construct demonstrated the highest construct stiffness (672.6 ± 84.1 N/mm in compression and 13.3 ± 1.0 N · m/degree in torsion), whereas the non-locked construct had the lowest construct stiffness (381.4 ± 117.2 N/mm in compression and 6.9 ± 2.1 N · m/degree in torsion) (P < 0.05)., Conclusions: Our study demonstrates the potential benefit of adding a locking mechanism to an ARD. Polyaxial ARDs provide the surgeon with more flexibility in placing the screws at the cost of reduced mechanical performance. This in vitro study provides a preliminary evaluation of biomechanical performance for ARDs with or without interlocking mechanisms, actual clinical trial deserves to be further investigated in future studies.

Unlabelled: An absolutely convincing technique of anterior transfer of the tibialis posterior (TP) tendon for treating drop foot has not been developed. Thirty-seven consecutive adult patients with drop foot owing to deep peroneal nerve injury were treated with bone-to-bone TP tendon transfer. The TP tendon with a small bony attachment was procured from the undersurface of the navicula and then transferred through a tunnel of the interosseous membrane. The navicular attachment was implanted in the tunnel of the navicula or intermediate cuneiform. Cancellous bone graft procured from the distal tibial metaphysis was packed into the tunnel inlet. Side-to-side tendon suturing was performed between the TP tendon and tibialis anterior tendon. Thirty-one patients were followed for a mean of 2.8 years (range, 1.2-4.8 years), and all achieved satisfactory outcome for the ankle. All patients achieved a normal gait after one year and at the latest follow-up., Conclusions: The described technique may provide a high success rate. This surgical technique is not complex, and complications are few.

Background: Due to the advantages of its bone-conserving nature, hip resurface arthroplasty (HRA) has recently gained the interest of orthopedic surgeons for the treatment of young and active patients who have osteonerosis of the femoral head. However, in long-term follow-up studies after HRA, narrowing of the femoral neck has often been found, which may lead to fracture. This phenomenon has been attributed to the stress alteration (stress shielding). Studies addressing the effects of necrotic size and the orientation of the implant on stress alterations are lacking., Methods: Computed tomography images of a standard composite femur were used to create a three-dimensional finite-element (FE) intact femur model. Based on the intact model, FE models simulating four different levels of necrotic regions (0°, 60°, 100°, 115°) and three different implant insertion angles (varus 10°, neutral, valgus 10°) were created. The von Mises stress distributions and the displacement of the stem tip of each model were analyzed and compared for loading conditions that simulated a single-legged stance., Results: Stress shielding occurred at the femoral neck after HRA. More severe stress shielding and an increased displacement of the stem tip were found for femoral heads that had a wider necrotic lesion. From a biomechanics perspective, the results were consistent with clinical evidence of femoral neck narrowing after HRA. In addition, a varus orientation of the implant resulted in a larger displacement of the stem tip, which could lead to an increased risk of implant loosening., Conclusions: A femoral head with a wide necrotic lesion combined with a varus orientation of the prosthesis increases the risk of femoral neck narrowing and implant loosening following HRA.

Objectives: The objective of this study was to compare the elution characteristics, antimicrobial activity and mechanical properties of antibiotic-loaded bone cement (ALBC) loaded with powdered antibiotic, powdered antibiotic with inert filler (xylitol), or liquid antibiotic, particularly focusing on vancomycin and amphotericin B., Methods: Cement specimens loaded with 2 g of vancomycin or amphotericin B powder (powder group), 2 g of antibiotic powder and 2 g of xylitol (xylitol group) or 12 ml of antibiotic solution containing 2 g of antibiotic (liquid group) were tested., Results: Vancomycin elution was enhanced by 234% in the liquid group and by 12% in the xylitol group compared with the powder group. Amphotericin B elution was enhanced by 265% in the liquid group and by 65% in the xylitol group compared with the powder group. Based on the disk-diffusion assay, the eluate samples of vancomycin-loaded ALBC of the liquid group exhibited a significantly larger inhibitory zone than samples of the powder or the xylitol group. Regarding the ALBCs loaded with amphotericin B, only the eluate samples of the liquid group exhibited a clear inhibitory zone, which was not observed in either the xylitol or the powder groups. The ultimate compressive strength was significantly reduced in specimens containing liquid antibiotics., Conclusions: Adding vancomycin or amphotericin B antibiotic powder in distilled water before mixing with bone cement can significantly improve the efficiency of antibiotic release than can loading ALBC with the same dose of antibiotic powder. This simple and effective method for preparation of ALBCs can significantly improve the efficiency of antibiotic release in ALBCs. Cite this article: Bone Joint Res 2014;3:246-51., (©2014 The British Editorial Society of Bone & Joint Surgery.)

Background: The biomechanical performance of the hooks and screws in spinal posterior instrumentation is not well-characterized. Screw-bone interface failure at the uppermost and lowermost vertebrae is not uncommon. Some have advocated for the use of supplement hooks to prevent screw loosening. However, studies describing methods for combined hook and screw systems that fully address the benefits of these systems are lacking. Thus, the choice of which implant to use in a given case is often based solely on a surgeon's experience instead of on the biomechanical features and advantages of each device., Methods: We conducted a biomechanical comparison of devices instrumented with different combinations of hooks and screws. Thirty-six fresh low thoracic porcine spines were assigned to three groups (12 per group) according to the configuration used for of fixation: (1) pedicle screw; (2) lamina hook and (3) combination of pedicle screw and lamina hook. Axial pullout tests backward on transverse plane in the direction normal to the rods were performed using a material testing machine and a specially designed grip with self-aligned function., Results: The pullout force for the pedicle screws group was significantly greater than for the hooks and the combination (p < 0.05). However, no significant difference was found between the hooks and the combination (p > 0.05)., Conclusions: Pedicle screws achieve the maximal pullout strength for spinal posterior instrumentation.

Objectives: The objective of this study is to determine an optimal antibiotic-loaded bone cement (ALBC) for infection prophylaxis in total joint arthroplasty (TJA)., Methods: We evaluated the antibacterial effects of polymethylmethacrylate (PMMA) bone cements loaded with vancomycin, teicoplanin, ceftazidime, imipenem, piperacillin, gentamicin, and tobramycin against methicillin-sensitive Staphylococcus aureus (MSSA), methicillin-resistant Staph. aureus (MRSA), coagulase-negative staphylococci (CoNS), Escherichia coli, Pseudomonas aeruginosa, and Klebsiella pneumoniae. Standardised cement specimens made from 40 g PMMA loaded with 1 g antibiotics were tested for elution characteristics, antibacterial activities, and compressive strength in vitro., Results: The ALBC containing gentamicin provided a much longer duration of antibiotic release than those containing other antibiotic. Imipenem-loading on the cement had a significant adverse effect on the compressive strength of the ALBC, which made it insufficient for use in prosthesis fixation. All of the tested antibiotics maintained their antibacterial properties after being mixed with PMMA. The gentamicin-loaded ALBC provided a broad antibacterial spectrum against all the test organisms and had the greatest duration of antibacterial activity against MSSA, CoNS, P. aeruginosa and E. coli., Conclusion: When considering the use of ALBC as infection prophylaxis in TJA, gentamicin-loaded ALBC may be a very effective choice. Cite this article: Bone Joint Res 2013;2:220-6.

This paper introduces a simple yet effective shape analysis mechanism for geometry processing. Unlike traditional shape analysis techniques which compute descriptors per surface point up to certain neighborhoods, we introduce a shape analysis framework in which the descriptors are based on pairs of surface points. Such a pairwise analysis approach leads to a new class of shape descriptors that are more global, discriminative, and can effectively capture the variations in the underlying geometry. Specifically, we introduce new shape descriptors based on the isocurves of harmonic functions whose global maximum and minimum occur at the point pair. We show that these shape descriptors can infer shape structures and consistently lead to simpler and more efficient algorithms than the state-of-the-art methods for three applications: intrinsic reflectional symmetry axis computation, matching shape extremities, and simultaneous surface segmentation and skeletonization.

Background: Polymethylmethacrylate (PMMA) is commonly used for clinical applications. However, the short handling time increases the probability of a surgeon missing the crucial period in which the cement maintains its ideal viscosity for a successful injection. The aim of this article was to illustrate the effects a reduction in temperature would have on the cement handling time during percutaneous vertebroplasty., Methods: The injectability of bone cement was assessed using a cement compressor. By twisting the compressor, the piston transmits its axial load to the plunger, which then pumps the bone cement out. The experiments were categorized based on the different types of hypothermic manipulation that were used. In group I (room temperature, sham group), the syringes were kept at 22°C after mixing the bone cement. In group 2 (precooling the bone cement and the container), the PMMA powder and liquid, as well as the beaker, spatula, and syringe, were stored in the refrigerator (4°C) overnight before mixing. In group 3 (ice bath cooling), the syringes were immediately submerged in ice water after mixing the bone cement at room temperature., Results: The average liquid time, paste time, and handling time were 5.1 ± 0.7, 3.4 ± 0.3, and 8.5 ± 0.8 min, respectively, for group 1; 9.4 ± 1.1, 5.8 ± 0.5, and 15.2 ± 1.2 min, respectively, for group 2; and 83.8 ± 5.2, 28.8 ± 6.9, and 112.5 ± 11.3 min, respectively, for group 3. The liquid and paste times could be increased through different cooling methods. In addition, the liquid time (i.e. waiting time) for ice bath cooling was longer than for that of the precooling method (p < 0.05)., Conclusions: Both precooling (i.e. lowering the initial temperature) and ice bath cooling (i.e. lowering the surrounding temperature) can effectively slow polymerization. Precooling is easy for clinical applications, while ice bath cooling might be more suitable for multiple-level vertebroplasty. Clinicians can take advantage of the improved injectability without any increased cost.

Various types of video can be captured with fisheye lenses; their wide field of view is particularly suited to surveillance video. However, fisheye lenses introduce distortion, and this changes as objects in the scene move, making fisheye video difficult to interpret. Current still fisheye image correction methods are either limited to small angles of view, or are strongly content dependent, and therefore unsuitable for processing video streams. We present an efficient and robust scheme for fisheye video correction, which minimizes time-varying distortion and preserves salient content in a coherent manner. Our optimization process is controlled by user annotation, and takes into account a wide set of measures addressing different aspects of natural scene appearance. Each is represented as a quadratic term in an energy minimization problem, leading to a closed-form solution via a sparse linear system. We illustrate our method with a range of examples, demonstrating coherent natural-looking video output. The visual quality of individual frames is comparable to those produced by state-of-the-art methods for fisheye still photograph correction.

Recessive congenital methemoglobinemia (RCM) is a very rare disorder caused by NADH-cytochrome b5 reductase (cb5r) deficiency. Two distinct clinical forms, types I and II, caused by cb5r deficiency have been recognized. In type I, the enzyme deficiency is restricted only to erythrocytes with cyanosis being the only major symptom. In contrast, in type II, the enzyme deficiency is generalized to all tissues and associated with neurological impairment, mental and growth retardation and reduced life expectancy, in addition to cyanosis. Recently, we conducted a study on an 11-year-old boy with cb5r deficiency type I. The mutational analysis of the CYB5R3 gene revealed that the boy is homozygous for L72P mutation. Surprisingly, his mother is heterozygous for this L72P mutant, but not his father. Thirteen microsatellite markers of chromosome 22 were selected to analyze the origins of the patient's chromosome 22. The result showed that both of the chromosome 22(s) of this patient came from the maternal side (uniparental heterodisomy of chromosome 22 with segmental isodisomy). This is the first case report of a patient with cb5r deficiency type I resulting from uniparental disomy and also discloses an alternate mechanism whereby this enzymatic disorder can be derived from a single parent., (Crown Copyright © 2012. Published by Elsevier Inc. All rights reserved.)

This paper presents a very easy-to-use interactive tool, which we call dot scissor, for mesh segmentation. The user's effort is reduced to placing only a single click where a cut is desired. Such a simple interface is made possible by a directional search strategy supported by a concavity-aware harmonic field and a robust voting scheme that selects the best isoline as the cut. With a concavity-aware weighting scheme, the harmonic fields gather dense isolines along concave regions which are natural boundaries of semantic components. The voting scheme relies on an isoline-face scoring mechanism that considers both shape geometry and user intent. We show by extensive experiments and quantitative analysis that our tool advances the state-of-the-art segmentation methods in both simplicity of use and segmentation quality.

This paper presents a simple and efficient automatic mesh segmentation algorithm that solely exploits the shape concavity information. The method locates concave creases and seams using a set of concavity-sensitive scalar fields. These fields are computed by solving a Laplacian system with a novel concavity-sensitive weighting scheme. Isolines sampled from the concavity-aware fields naturally gather at concave seams, serving as good cutting boundary candidates. In addition, the fields provide sufficient information allowing efficient evaluation of the candidate cuts. We perform a summarization of all field gradient magnitudes to define a score for each isoline and employ a score-based greedy algorithm to select the best cuts. Extensive experiments and quantitative analysis have shown that the quality of our segmentations are better than or comparable with existing state-of-the-art more complex approaches.

Because standard femoral supracondylar nails have certain disadvantages, they are often replaced by traditional femoral or tibial locked nails. The purpose of this study was to make a biomechanical comparison between both types of traditional locked nails to determine which technique was more suitable for treating unstable femoral supracondylar fractures. Fourteen left Sawbones femurs (Pacific Research Laboratories, Vashon, Washington) were osteotomized in the femoral supracondylar area. One centimeter of the medial cortex in the proximal fragment was obliquely removed to simulate an unstable fracture without shortening. Seven specimens were treated with traditional retrograde dynamic femoral locked nails, and the other 7 with traditional retrograde dynamic tibial locked nails. All specimens were tested with a servohydraulic materials testing machine to compare their relative stability. Static compression, dynamic cyclic compression, and static compression to failure were tested. An extensometer was used to measure the displacement of fragments. Displacement between the fragments increased following the increment in loads in both nails. The load-displacement curve was nearly linear up to 1000 N for both nails. The femoral nail had a greater stiffness compared with the tibial nail at 100 and 200 N (P=.02 and P=.04, respectively) in static compression and at 700 to 1000 N (P=.01 in each case) in dynamic cyclic compression, as well as larger loads in static compression to failure (8663 vs 7547 N, respectively; P<.001). Clinically, a traditional femoral locked nail may be more suitable to replace a standard femoral supracondylar nail in a retrograde fashion to treat an unstable femoral supracondylar fracture., (Copyright 2012, SLACK Incorporated.)

Background: As an X-linked genetic disorder, Fabry disease was first thought to affect males only, and females were generally considered to be asymptomatic carriers. However, recent research suggests that female carriers of Fabry disease may still develop vital organ damage causing severe morbidity and mortality. In the previous newborn screening, from 299,007 newborns, we identified a total of 20 different Fabry mutations and 121 newborns with Fabry mutations. However, we found that most female carriers are not detected by enzyme assays., Methods: A streamlined method for high resolution melting (HRM) analysis was designed to screen for GLA gene mutations using a same PCR and melting program. Primer sets were designed to cover the 7 exons and the Chinese common intronic mutation, IVS4+919G>A of GLA gene., Results: The HRM analysis was successful in identifying heterozygous and hemizygous patients with the 20 surveyed mutations. We were also successful in using this method to test dry blood spots of newborns afflicted with Fabry mutations without having to determine DNA concentration before PCR amplification., Conclusion: The results of this study show that HRM could be a reliable and sensitive method for use in the rapid screening of females for GLA mutations., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Decoupling local geometric features from the spatial location of a mesh is crucial for feature-preserving mesh denoising. This paper focuses on first order features, i.e., facet normals, and presents a simple yet effective anisotropic mesh denoising framework via normal field denoising. Unlike previous denoising methods based on normal filtering, which process normals defined on the Gauss sphere, our method considers normals as a surface signal defined over the original mesh. This allows the design of a novel bilateral normal filter that depends on both spatial distance and signal distance. Our bilateral filter is a more natural extension of the elegant bilateral filter for image denoising than those used in previous bilateral mesh denoising methods. Besides applying this bilateral normal filter in a local, iterative scheme, as common in most of previous works, we present for the first time a global, noniterative scheme for an isotropic denoising. We show that the former scheme is faster and more effective for denoising extremely noisy meshes while the latter scheme is more robust to irregular surface sampling. We demonstrate that both our feature-preserving schemes generally produce visually and numerically better denoising results than previous methods, especially at challenging regions with sharp features or irregular sampling., (© 2011 IEEE)

Background: Percutaneous vertebroplasty by injecting PMMA bone cement into the fractured vertebrae has been widely accepted in treatment of spinal compression fracture. However, the exothermic polymerization of bone cement may cause osseous or neural tissue injury. This study is thus designed to evaluate the potential risk of thermal damage in percutaneous vertebroplasty., Method: Twelve porcine vertebrae were immersed in 37°C saline for the experiment. In the first stage of the study, vertebroplasty without cement leakage (control group, n = 6) was simulated. The anterior cortex, foramen, posterior cortex and the center of the vertebral body were selected for temperature measurement. Parameters including peak temperature and duration above 45°C were recorded. In the second stage, a model (n = 6) simulating bone cement leaking into the spinal canal was designed. The methods for temperature measurement were identical to those used in the first stage., Results: In Stage 1 of the study (vertebroplasty of the porcine vertebral body in the absence of cement leakage), the average maximal temperature at the anterior cortex was 42.4 ± 2.2°C; at the neural foramen 39.5 ± 2.1°C; at the posterior cortex 40.0 ± 2.5°C and at the vertebral center, 68.1 ± 3.4°C. The average time interval above 45°C was 0 seconds at the anterior cortex; at the neural foramen, 0 seconds; at the posterior cortex, 0 seconds and at the vertebral center, 223 seconds. Thus, except at the core of the bone cement, temperatures around the vertebral body did not exceed 45°C. In Stage 2 of the study (cement leakage model), the average maximal temperature at the anterior cortex was 42.7 ± 2.4°C; at the neural foramen, 41.1 ± 0.4°C; at the posterior cortex, 59.1 ± 7.6°C and at the vertebral center, 77.3 ± 5.7°C. The average time interval above 45°C at the anterior cortex was 0 seconds; at the neural foramen, 0 seconds; at the posterior cortex, 329.3 seconds and at the vertebral center, 393.2 seconds. Based on these results, temperatures exceeded 45°C at the posterior cortex and at the vertebral center., Conclusions: The results indicated that, for bone cement confined within the vertebra, curing temperatures do not directly cause thermal injury to the nearby soft tissue. If bone cement leaks into the spinal canal, the exothermic reaction at the posterior cortex might result in thermal injury to the neural tissue.

Background: Pedicle screws with PMMA cement augmentation have been shown to significantly improve the fixation strength in a severely osteoporotic spine. However, the efficacy of screw fixation for different cement augmentation techniques, namely solid screws with retrograde cement pre-filling versus cannulated screws with cement injection through perforation, remains unknown. This study aimed to determine the difference in pullout strength between conical and cylindrical screws based on the aforementioned cement augmentation techniques. The potential loss of fixation upon partial screw removal after screw insertion was also examined., Method: The Taguchi method with an L8 array was employed to determine the significance of design factors. Conical and cylindrical pedicle screws with solid or cannulated designs were installed using two different screw augmentation techniques: solid screws with retrograde cement pre-filling and cannulated screws with cement injection through perforation. Uniform synthetic bones (test block) simulating severe osteoporosis were used to provide a platform for each screw design and cement augmentation technique. Pedicle screws at full insertion and after a 360-degree back-out from full insertion were then tested for axial pullout failure using a mechanical testing machine., Results: The results revealed the following 1) Regardless of the screw outer geometry (conical or cylindrical), solid screws with retrograde cement pre-filling exhibited significantly higher pullout strength than did cannulated screws with cement injection through perforation (p = 0.0129 for conical screws; p = 0.005 for cylindrical screws). 2) For a given cement augmentation technique (screws without cement augmentation, cannulated screws with cement injection or solid screws with cement pre-filling), no significant difference in pullout strength was found between conical and cylindrical screws (p >0.05). 3) Cement infiltration into the open cell of the test block led to the formation of a cement/bone composite structure. Observations of the failed specimens indicated that failure occurred at the composite/bone interface, whereas the composite remained well bonded to the screws. This result implies that the screw/composite interfacial strength was much higher than the composite/bone interfacial strength. 4) The back-out of the screw by 360 degrees from full insertion did not decrease the pullout strength in any of the studied cases. 5) Generally, larger standard deviations were found for the screw back-out cases, implying that the results of full insertion cases are more repeatable than those of the back-out cases., Conclusions: Solid screws with retrograde cement pre-filling offer improved initial fixation strength when compared to that of cannulated screws with cement injection through perforation for both the conically and cylindrically shaped screw. Our results also suggest that the fixation screws can be backed out by 360 degrees for intra-operative adjustment without the loss of fixation strength.

Antibiotic-loaded bone cement is widely used to treat musculoskeletal infections. Here we tested whether the curing temperature affected pore size of the cement and antibiotic release. Bone cement containing vancomycin was cured at 3 temperatures (50, 25 and 0°C). The solidified vancomycin-loaded cement was stored for 1-week at 25 and 5°C and then assayed for antibiotic release. We found that a significantly higher proportion of vancomycin was released from cement cured at 0°C versus that cured at 50°C, and that lower storage temperature also increased antibiotic release.

Despite a wide range of available sources for bone repair, significant limitations persist. To bioengineer bone, we have previously transferred adenovirus-mediated human BMP-2 gene into autologous bone marrow stromal cells (MSC). We have successfully repaired large, full thickness, cranial defects using this approach. We report now the effectiveness of various hydrogels as the scaffold for this type of bone regeneration, comparing specifically alginate with Type I collagen. Cultured MSC of miniature swine were infected with BMP-2 or beta-gal adenovirus 7 days before implantation. These cells were mixed with alginate, ultrapure alginate, alginate-RGD, or type I collagen to fabricate the MSC/biomaterial constructs. The results of cranial bone regeneration were assessed by gross examination, histology, 3D CT, and biomechanical tests at 6 weeks and 3 months after implantation. We found that the BMP-2 MSC/collagen type I construct, but not the beta-gal control, effectively achieved nearly complete repair of the cranial defects. No bone regeneration was observed with the other hydrogels. Biomechanical testing showed that the new bone strength was very close and only slightly inferior to that of normal cranial bone. Controlling for the integration of stem cells and ex vivo gene transfer, the alginate scaffolds has a significant negative impact on the success of the construct. Our study demonstrates better bone regeneration by collagen type I over alginate. This may have therapeutic implications for tissue engineered bone repair., ((c) 2010 Wiley Periodicals, Inc.)

Adsorption behaviors of phosphate on the desert particulates of inflow Yellow River were investigated in natural water (river water and sea water) and the experimental data was fitted by both the improved Langmuir and Freundlich isotherm adsorption models. The results show that (1) With more clear physical meaning and more reasonable fitting parameters, the improved Langmuir isotherm adsorption model is much better for describing phosphate adsorption on the desert particulates than the improved Freundlich isotherm adsorption model; (2) The maximum phosphorus (P) adsorption capacity Qmac is in the range of 41.322-357.143 mg x kg(-1), which is the biggest in Y2 (Juyanhai Lake particulates). There is remarkable positive correlation between Qmax and organic matter of the particulates (Y1-Y5); (3) Except for Y1 (Badain Jaran Desert particulates), the EPC0 (zero equilibrium P concentration) of the particulates are higher than the concentration of P in corresponding water. The EPC0 of P adsorption on Y1 in Yellow River is lower than P concentration in corresponding water (0.010 mg x L(-1) < 0.053 mg x L(-1)), while the EPC0 of P adsorption on Y1 in Bohai Sea water is higher than the P concentration in their corresponding water (0.109 mg x L(-1) > 0.074 mg x L(-1)), which shows that Y1 adsorbs P from the water of the Yellow River, then it releases its NAP (native adsorbed exchangeable phosphorus) into Bohai Seawater. However, in the process of the P exchange between other desert particulates and their corresponding water, only desorption phenomenon were observed, which means all other desert particulates release P to their corresponding water; (4) The adsorption isotherms of phosphate on the desert particulates of inflow Yellow River are cross-axis-type with over 0.00, a new cross-axis-type adsorption-desorption model, which provide a better explanation for adsorption characteristics of P and for the dual role of natural particulates.

Background: Septic arthritis in native hip joints is a rare but serious condition in adult patients. Prompt aggressive surgical and medical treatment is a challenge, and the outcomes after delayed management can be devastating. This article reports the findings of treatment of recalcitrant cases using a standardized protocol., Methods: Fourteen consecutive patients (15 hips) were treated with two-stage total hip arthroplasty (THA) for septic arthritis of the hip joint over a 6-year period. All patients underwent resection arthroplasty and implantation of an antibiotic-loaded articulating spacer in the first stage, short-term systemic antibiotic therapy during the interim period, and subsequent THA without bone cement in the second stage., Results: One patient required additional debridement and spacer reinsertion before THA. The mean interim period was 12.9 weeks (range, 6-31 weeks). After an average follow-up period of 42.5 months (range, 25-72 months) after THA, there was no evidence of recurrent infection or loosening of the prostheses in any patient. The average Merle D'Aubigne and Postel hip score improved from 9.3 (range, 5-15) to 13.5 (range, 12-16) between stages and to 16.7 (range, 15-18) at the latest follow-up., Conclusions: Two-stage uncemented THA is a reliable treatment option for adult patients with recalcitrant septic hips. If an antibiotic-loaded interim spacer is used, routine, prolonged systemic antibiotic therapy may not be necessary.

Management of massive segmental bone defects remains a challenging clinical problem and bone marrow-derived mesenchymal stem cells (BMSCs) hold promise for bone regeneration. To explore whether BMSCs engineered by baculovirus (an emerging gene delivery vector) can heal large bone defects, New Zealand White (NZW) rabbit BMSCs were transduced with the BMP2-expressing baculovirus or VEGF-expressing baculovirus, and co-implanted into critical-sized (10mm) femoral segmental defects in NZW rabbits. X-ray analysis revealed that the baculovirus-engineered BMSCs not only bridged the defects at as early as week 2, but also healed the defects in 100% of rabbits (13/13) at week 4. The osteogenic metabolism, as monitored by positron emission tomography (PET) also suggested the completion of bone healing at week 8. When compared with other control groups, the BMP2/VEGF-expressing BMSCs remarkably enhanced the segmental bone repair and mechanical properties, as evidenced by micro-computed tomography (microCT), histochemical staining and biomechanical testing. The ameliorated bone healing concurred with the augmented angiogenesis. These data demonstrated, that BMSCs engineered to express BMP2 and VEGF accelerate the repair of large femoral bone defects and improve the quality of the regenerated bone, which paves an avenue to utilizing baculovirus as a vector for BMSCs modification and regenerative medicine., (Copyright 2010 Elsevier Ltd. All rights reserved.)

Background: To stabilize the femoral head in ipsilateral femoral neck and shaft fractures, one cannulated screw was supplemented in front of the reconstruction interlocking nail (recon nail)., Methods: Twenty-eight left sawbone femurs were divided into two groups. The 14 femurs in each group were osteotomized with subcapital or transcervical fractures. The shafts of all femurs were also osteotomized, and 1cm of the distal segmental cortex was excised. Next, all the fractures were treated with static recon nails to concomitantly stabilize both femoral neck and shaft fractures. Additionally, seven subcapital fractures and seven transcervical fractures were supplemented with one cannulated screw in front of the recon nails. All specimens were tested with a Material Testing System machine to investigate the relative stability during uniaxial cyclic compression., Findings: The subcapital and transcervical fractures supplemented with one cannulated screw could bear more loads than those without screw supplementation (P<0.01 and P<0.01, respectively at any testing interval). Moreover, in the case of the subcapital fractures, the single supplemented cannulated screw could reduce the displacement at 500 N by 24% (P< 0.001). On the other hand, in the case of the transcervical fractures, one supplemented cannulated screw could reduce the displacement at 500 N by 4% (P=0.003)., Interpretation: From the biomechanical viewpoint, the subcapital fractures in combined fractures are recommended to supplement with one cannulated screw in front of the recon nails to eliminate complications associated with stabilization.

Background: Pedicle screw fixation in a severely osteoporotic spine remains a challenge for orthopedic surgeons. The previous literature does not adequately address the effects of radial holes for cannulated screws with cement injection and pilot hole tapping on the bone/screw interfacial strength., Methods: Specially designed cannulated pedicle screws, with or without radial holes, were installed in tapped and untapped pilot holes and then injected with cement. A uniform synthetic bone (test block) was used to provide a platform for each screw design. Specimens with inserted screws were then tested for axial pullout failure., Findings: (1) Cannulated screws with cement augmentation significantly increased the pullout strength in comparison to solid screws. Additionally, the amount of cement exuded from the cannulated screws increased with an increasing number of radial holes, leading to an increase in the average ultimate pullout strength for cannulated screws with a large number of radial holes. (2) Radiological examination indicated that the cement was exuded from the most proximal holes at the very beginning of its flow path, whereas no cement exudation was found at the remaining distal holes. (3) Cement exudation from the holes of cannulated screws into the open cell of the test block led to a composite (cement/bone) structure at the area of cement exudation. Observations of the failed specimens indicated that failure occurred at the composite/bone interface, while the composite was well bonded to the screws. This implies that the screw/composite interfacial strength was much higher than the composite/bone interfacial strength. (4) Tapping pilot holes decreased the pullout strength of the screws. Generally, larger standard deviations were found for the tapped cases, implying that untapped cases results are more repeatable than tapped cases results., Interpretation: Cannulated pedicle screws with radial holes combined with PMMA cement augmentation but without tapping may be a viable clinical option for achieving fixation in severely osteoporotic bone.

Background: Numerous proposed surgical techniques have had minimal success in managing greater trochanter overgrowth secondary to retarded growth of the femoral capital epiphysis. For reconstruction of residual hip deformities, a novel type of proximal femur L-osteotomy was performed with satisfactory results. Although the clinical outcome was good, the biomechanical characteristics of the femur after such an osteotomy have not been clearly elucidated. Therefore, this study presents a three dimensional finite element analysis designed to understand the mechanical characteristics of the femur after the L-osteotomy., Methods: A patient with left hip dysplasia was recruited as the study model for L-osteotomy. The normal right hip was used as a reference for performing the corrective surgery. Four FEA models were constructed using different numbers of fixation screws but the same osteotomy lengths together with four FEA models with the same number of fixation screws but different osteotomy lengths. The von Mises stress distributions and femoral head displacements were analyzed and compared., Results: The results revealed the following: 1). The fixation devices (plate and screws) sustained most of the external loading, and the peak value of von Mises stress on the fixation screws decreased with an increasing number of screws. 2). Additional screws are more beneficial on the proximal segment than on the distal segment for improving the stability of the postoperative femur. 3). The extent of osteotomy should be limited because local stress might be concentrated in the femoral neck region with increasing length of the L-osteotomy., Conclusion: Additional screw placement on the proximal segment improves stability in the postoperative femur. The cobra-type plate with additional screw holes in the proximal area might improve the effectiveness of L-osteotomies.

We present a novel knowledge-based system to automatically convert real-life engineering drawings to content-oriented high-level descriptions. The proposed method essentially turns the complex interpretation process into two parts: knowledge representation and knowledge-based interpretation. We propose a new hierarchical descriptor-based knowledge representation method to organize the various types of engineering objects and their complex high-level relations. The descriptors are defined using an Extended Backus Naur Form (EBNF), facilitating modification and maintenance. When interpreting a set of related engineering drawings, the knowledge-based interpretation system first constructs an EBNF-tree from the knowledge representation file, then searches for potential engineering objects guided by a depth-first order of the nodes in the EBNF-tree. Experimental results and comparisons with other interpretation systems demonstrate that our knowledge-based system is accurate and robust for high-level interpretation of complex real-life engineering projects.

Autologous vascularized bone grafts, allografts, and biocompatible artificial bone substitutes each have their shortcomings. Bones regenerated using recombinant human bone morphogenetic proteins, demineralized bone powder, or combinations of these are generally small and do not meet the need. The current trend is to use tissue engineering approaches with bone marrow mesenchymal stem cells (MSCs) to generate bones of a desired size and shape. A suspension of osteogenically induced MSCs (CD11a-, CD29+, CD44+) was added to 2% alginate, gelled by mixing this combination with calcium sulfate (CaSO(4) 0.2 g/mL), and injected into the subcutaneous pocket in the dorsal aspect of nude mice. Cells of various concentrations (0, 10, 50, and 70 million/mL) were used. These implanted constructs were harvested at predetermined times up to 30 weeks for histology. The doubling time of bovine MSCs is 3.75 +/- 1.96 days and the proliferation is rapid. Histological evaluation revealed signs of endochondrosis with woven bone deposition. The equilibrium modulus increased with time in vivo, though less than that of normal tissue. Implants seeded with 70 million cells/mL for 6 months resulted in the best formation of equilibrium modulus. This approach has several advantages: (i) obtaining MSCs is associated with low donor morbidity; (ii) MSCs proliferate rapidly in vitro, and a large number of viable cells can be obtained; and (iii) the MSC/alginate constructs can develop into bone-like nodules with high cell viability. Such a system may be useful in large-scale production of bony implants or in the repair of bony defects. The fact that endochondral bone formation led to woven bone suggests its potential feasibility in regional cell therapy.

This study investigated the use of liquid gentamicin, a much less costly antibiotic (<1/20 the price of tobramycin) with a broad antimicrobial spectrum, alone and in combination with vancomycin in bone cement. Standardized cement specimens loaded with 480 mg of liquid gentamicin, 4 g of powdered vancomycin, or both antibiotics were tested for elution characteristics, bioactivity, compressive strength, and porosity. Vancomycin elution was enhanced by 146% with the addition of gentamicin liquid, and gentamicin elution was enhanced by 45% when combined with vancomycin. Bioassay confirmed the bactericidal activity of the released antibiotics. Adding liquid gentamicin increased porosity, whereas adding vancomycin did not. Compressive strength decreased by 13%, 37%, and 45% in specimens containing vancomycin, liquid gentamicin, and both antibiotics, respectively. Despite inferior mechanical properties, the temporary nature of cement beads and spacers makes the liquid gentamicin-vancomycin mixture a potentially more cost-effective regimen in bone cement to treat musculoskeletal infections.

The need to examine and manipulate large surface models is commonly found in many science, engineering, and medical applications. On a desktop monitor, however, seeing the whole model in detail is not possible. In this paper, we present a new, interactive Focus+Context method for visualizing large surface models. Our method, based on an energy optimization model, allows the user to magnify an area of interest to see it in detail while deforming the rest of the area without perceivable distortion. The rest of the surface area is essentially shrunk to use as little of the screen space as possible in order to keep the entire model displayed on screen. We demonstrate the efficacy and robustness of our method with a variety of models.

Replacing the conventional pyrazole 5-aryl substituent of 1 (SR141716A) with the 2-thienyl moiety appended with an appropriate alkynyl unit, a novel class of 5-(5-alkynyl-2-thienyl)pyrazole derivatives, behaving as highly potent CB1 receptor antagonists with good CB1/2 selectivity, was discovered, many of which, as typified by compound 18, showed significant weight reduction in diet-induced obese mouse model, thus pharmacologically validating that the bioisosteric replacement described above is viable. Also encouraging was the finding that a subtle structural modification of the newly developed series could result in a distinct difference in the intrinsic property, as demonstrated by compounds 12 (NA) and its methylated structural isomers 15 (PA) and 18 (IA). Moreover, current structure-activity relationship studies revealed that around the pyrazole 5-position of 1, a deep and flat crevice surrounded by a sequence of hydrophobic/aromatic residues as indicated by the CB1-receptor homology model might exist in the binding site.

Hip resurfacing arthroplasty has become an attractive treatment option for young, active patients with femoral head necrosis. However, little information is available about the potential thermal damage to the remaining femoral head when a cemented component is used. We used an experimental model to measure the temperature profile at the cement-bone interface during hip resurfacing. We compared four simulated lesion sizes-15, 25, 33, and 50%-of the femoral head, and a control group with no cystic lesion. Temperatures were measured with the specimens in a 37 degrees C saline bath or with copious pulsed lavage. With specimens tested in the bath, peak temperatures were higher, and durations of temperatures above 50 degrees C were longer, in femoral heads with necrotic lesions (88.8 +/- 7.5 degrees C; 17.6 +/- 1.1 min for a 15% lesion; 96.2 +/- 7.2 degrees C; 22.86 +/- 1.3 min for a 25% lesion; 99.7 (c) 200 +/- 9.4 degrees C; 28.6 +/- 2.0 min for a 33% lesion; and 97.2 +/- 4.2 degrees C; 35.6 +/- 2.4 min for a 50% lesion) than those in the control group (65.8 +/- 4.9 degrees C; 10.0 +/- 1.3 min). The larger the cement-filled cysts, the longer the temperatures remained above 50 degrees C. Although copious lavage reduced the temperature profile in each group, the temperatures remained above 50 degrees C for 7 to 17 min in specimens with necrotic cysts. The measured temperatures during surface replacement are sufficiently high in magnitude and long in duration to cause thermal damage to the remaining bone in femoral heads with preexisting necrotic lesions. Hip resurfacing for femoral head necrosis should be performed with caution., ((c) 2008 Orthopaedic Research Society)

Cyclooxygenase (COX)-2 inhibitors are known to be used as chemopreventative agents against certain malignancies. Thus far, there has been very limited information on whether COX-2 inhibitors protect against chronic narrow-band UVB (NB-UVB)-induced immunosuppression. The present study investigated the effect of nonselective and specific COX-2 inhibitors, indomethacin and celecoxib, on epidermal Ia+ Langerhans cells (LCs) and Thy-1+ dendritic epidermal T cells (DETCs) in mice irradiated with NB-UVB. Sixty female BALB/c mice were divided randomly into the control group (sham) and the experimental groups (irradiated with NB-UVB for 17 weeks, further divided into five groups according to the diets containing different concentrations of either COX-2 inhibitors). Alterations in the density and morphology of epidermal Ia+ LCs and Thy-1+ DETCs in mice were documented using fluorescence microscopy. Chronic NB-UVB irradiation substantially decreased the density and altered the morphology of the epidermal Ia+ LCs and Thy-1+ DETCs in control mice. The dietary supplementation of both COX-2 inhibitors displayed a dosage-dependent protective effect on the murine dendritic cells irradiated by NB-UVB. In conclusion, COX-2 inhibitors protected against chronic NB-UVB-induced density and morphologic changes in epidermal Ia+ LCs and Thy-1+ DETCs in mice.

This paper presents a novel basis function, called spherical piecewise constant basis function (SPCBF), for precomputed radiance transfer. SPCBFs have several desirable properties: rotatability, ability to represent all-frequency signals, and support for efficient multiple product. By smartly partitioning the illumination sphere into a set of subregions, and associating each subregion with an SPCBF valued 1 inside the region and 0 elsewhere, we precompute the light coefficients using the resulting SPCBFs. Efficient rotation of the light representation in SPCBFs is achieved by rotating the domain of SPCBFs. We run-time approximate the BRDF and visibility coefficients using the set of SPCBFs for light, possibly rotated, through fast lookup of summed-area-table (SAT) and visibility distance table (VDT), respectively. SPCBFs enable new effects such as object rotation in all-frequency rendering of dynamic scenes and on-the-fly BRDF editing under rotating environment lighting. With graphics hardware acceleration, our method achieves real-time frame rates.

A novel class of (5-(pent-1-enyl)thiophen-2-yl)pyrazole antagonists was discovered, many of which exhibited potent CB1 activity and good CB1/2 selectivity, suggesting that along with a 1,3-transposition of the carbonyl of the pyrazole 3-carboxamide, bioisosteric replacement of the conventional pyrazole 5-aryl group with a thienyl ring substituted with an appropriate alkenyl moiety is viable.

We radiographically measured the bipolar cup position to analyze the direction of joint force acting on the bipolar cup. The abduction angle of the bipolar cup was measured in each radiograph taken immediately and at six 12 weeks and yearly after the operation. Radiographs in patients with weight bearing were also investigated. The results indicated that the abduction angle of the bipolar cup was 24.1 degrees +/- 11.2 degrees immediate postoperatively and was 16.2 degrees +/- 5.1 degrees at 6 weeks, 16.1 degrees +/- 5.1 degrees at 3 months, and 16.2 degrees +/- 5.1 degrees at 1 year. The cup abduction angles with weight bearing were not different from those without weight bearing and were 15.9 degrees +/- 4.9 degrees , 16.2 degrees +/- 4.4 degrees , and 16.1 degrees +/- 4.7 degrees on the supine, double-legged stance, and single-legged stance radiographs, respectively. Because the position of the bipolar cup reflects the direction of loads pivoting on it, the direction of the joint force in the frontal plane acting on the bipolar prosthesis is about 16 degrees to vertical.

Introduction: The load tolerance of conventional plate treatment for bicondylar tibial plateau fractures with the buttress and the tension band positions was compared from biomechanical viewpoints., Materials and Methods: Fourteen left synthetic tibiae divided into two groups were tested. T-plates in the buttress group were placed on the medial tibial subcondyle and T-plates in the tension band group were placed on the lateral tibial subcondyle. All specimens were evaluated with a Material Testing System (MTS) machine. A linear variance displacement transducer gauge was placed on the medial tibial subcondyle. The anatomic axis of the synthetic femur and the tibia was maintained at 6 degrees varus in the frontal plane. The MTS actuator was set to increase displacement at 3 mm/min. All specimens were evaluated to failure. The relative motion and the ultimate failure load (UFL) between both groups were compared., Results: The buttress group had significantly less displacement than the tension band group following the incrementally increased loading (p < 0.001). At failure, the buttress group also had a higher UFL (p < 0.001) and less displacement (p = 0.009) than the tension band group., Conclusion: All medial tibial condylar fragments achieved improved stabilization from the medial aspect of the proximal tibia by conventional plates. When conventional plates cannot be placed medially due to skin ailments, lateral placement of conventional plates may have the insufficient stability. Protected weight bearing should be followed strictly.

Background: The prospect for success in the efficacy of osteotomy for precollapse stage of femoral head osteonecrosis depends on the ability to predict reliably the stress changes derived from specific osteotomies. A three-dimensional finite-element analysis was thus designed to compute necrotic femoral head stress changes with different extent of necrocrosis that accompany anterior or posterior rotational osteotomies., Method: Computed tomography images of a standard composite femur were used to create the three-dimensional finite-element intact femur model. Based on the intact model, 27 models simulating three different levels of necrotic region together with nine different rotational osteotomies were created. The von Mises stress distributions of each model were analyzed and compared for a loading condition simulating single-legged stance., Findings: (1) The stress reduction in anterior rotational osteotomy is more effective as compared to that of the posterior rotational osteotomy for various necrotic lesion sizes. (2) Von Mises stress on the necrotic zone decreased with increasing rotational angle. The decreasing rate was higher for the femoral head with a narrow lesion. (3) Femoral head with a wider necrotic lesion had a higher risk for developing collapse due to high local stress on the surface of necrotic region; whereas the necrotic region tended to expand in size instead of collapse for femoral head with a narrow lesion due to high local stress on the interface between necrotic region and healthy bone., Interpretation: Transtrochanteric rotational osteotomy is a technically demanding procedure and associated with high complication risks, a more scrupulous planning including the finite-element analysis should be considered before doing surgery in clinical subjects.

Preheating of the femoral stem in total hip arthroplasty improves the cement-prosthesis bond by decreasing the interfacial porosity. The main concern, however, is the potential thermal osteonecrosis because of an increased polymerization temperature. In this study, the effects of femoral canal precooling on the characteristics of the cement-stem interface were evaluated in an experimental model for three test conditions: precooling of the femoral canal, preheating of the stem (44 degrees C), and a control in which stems were inserted at room temperature without thermal manipulation of the implant, cement, or bone. Compared to the control group, precooling of the femoral canal and preheating of the stem had similar effects on the cement-stem interface, with greater interfacial shear strength and a reduced porosity. Femoral canal precooling also produced a lower temperature at the cement-bone interface. No difference was found in the ultimate compressive strength of bone cement for the three preparation conditions. Based on this laboratory model, precooling of the femoral canal could improve shear strength and porosity at the stem-cement interface, minimize thermal injury, and maintain the mechanical strength of the cement.

Recently, differential information as local intrinsic feature descriptors has been used for mesh editing. Given certain user input as constraints, a deformed mesh is reconstructed by minimizing the changes in the differential information. Since the differential information is encoded in a global coordinate system, it must somehow be transformed to fit the orientations of details in the deformed surface, otherwise distortion will appear. We observe that visually pleasing deformed meshes should preserve both local parameterization and geometry details. We propose to encode these two types of information in the dual mesh domain due to the simplicity of the neighborhood structure of dual mesh vertices. Both sets of information are nondirectional and nonlinearly dependent on the vertex positions. Thus, we present a novel editing framework that iteratively updates both the primal vertex positions and the dual Laplacian coordinates to progressively reduce distortion in parametrization and geometry. Unlike previous related work, our method can produce visually pleasing deformations with simple user interaction, requiring only the handle positions, not local frames at the handles.

Background: Despite that a mid-third simple transverse femoral shaft fracture has been traditionally treated with an unlocked reamed intramedullary nail, recently a static locked reamed intramedullary nail has been favored by some orthopedists to avoid missing extended fracture lines. A prospective comparison of both nails was conducted to investigate the superiority between the nails from biomechanical viewpoints., Methods: Seven pairs of fresh healthy cadaver femora underwent mid-third transverse osteotomy. Consequently, all seven left femora were stabilized using Kuntscher nails and all seven right femora, static Russell-Taylor locked nails. Finally, all 14 femora were tested using a Material Testing System (MTS) machine to investigate the sustained mechanical loads, the maximal failure load, and the relative fragment displacement., Results: The locked nails produced the larger mechanical loads (p = 0.02). The unlocked nails had the larger fragment displacement (p = 0.02) and the higher maximal failure load (6090 verse 5590 newtons, p = 0.02). All tests ended due to basal neck oblique fractures., Conclusions: Biomechanically, an unlocked nail, being a load-sharing device, is superior to a static locked nail, being a load-bearing device, in the treatment of a mid-third simple transverse femoral shaft fracture. Clinically, careful investigation of the fracture types and adequate selection of the nail type should be performed in treating these types of fractures.

Eight fresh porcine lumbar spines received a posterior instrumentation at L4-L5 using pedicle screw-rod system. Each specimen was tested utilizing laminectomies of varying extent. Group A (Integrity) preserved the spinous process and interspinous ligament; Group B (Partial laminectomy) removed the inferior portion of L4 spinous process and preserved the interspinous ligament of L3-L4; Group C (Complete laminectomy) removed the entire L4 spinous process. Hydraulic testing machine was used to generate an increasing moment up to 8400 N mm in flexion and extension. The intervertebral displacement on the superior adjacent disc between L3-L4 was measured using an extensometer. Under extension, no significant difference in the intervertebral displacement was observed among three different models of laminectomy. However, under flexion, the intervertebral displacement on adjacent disc with complete laminectomy was statistically larger than those of integrity and partial laminectomies (P=0.000976 and P=0.0363, respectively). No difference was found between integrity and partial laminectomy groups (P>0.05). This study implies that an instrumented spine with integrity of posterior complex is less likely to develop adjacent instability than a spine with destruction of the anchoring point for supraspinous ligament.

The new pyridyl imidazolidinone derivative, 1-[5-(4'-chlorobiphenyl-4-yloxy)-3-methylpentyl]-3-pyridin-4-yl-imidazolidin-2-one (+/-)-1a, was synthesized and found to have an excellent antiviral activity against EV71 (IC50 = 0.009 microM). Therefore, both the enantiomers, (S)-(+)-1a and (R)-(-)-1a, have been prepared starting from readily available monomethyl (R)-3-methylglutarate (7) as a useful chiral building block and their antiviral activity was evaluated in a plaque reduction assay. Interestingly, we observed that the enantiomer (S)-(+)-1a was 10-fold more active against enterovirus71 (EV71) (IC50 = 0.003 microM) than the corresponding enantiomer (R)-(-)-1a (IC50 = 0.033 microM). Similar results were found against all five strains (1743, 2086, 2231, 4643, and BrCr) of EV71 tested. This demonstrated that the absolute configuration of the chiral carbon atom at the 3-position of the alkyl linker considerably influenced the anti-EV71 activity of these pyridyl imidazolidinones.