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Abstract Desorption electrospray ionization (DESI) tandem mass spectrometry (MS) is used to assess mutation status of isocitrate dehydrogenase (IDH) in human gliomas. Due to the diffuse nature of gliomas, total gross resection is not normally achieved during surgery, leading to tumor recurrence. The mutation status of IDH has clinical significance due to better prognosis in IDH-mutant patients. The mutant IDH converts alpha-ketoglutaric acid (α-KG) into 2-hydroxyglutarate (2HG), which accumulates abnormally in cells. Immunohistochemical staining (IHC) and genetic testing, the gold standards, are incompatible with intraoperative applications but DESI tandem mass spectrometry (MS/MS) can be used to assess the mutation status of IDH enzyme from tissue intraoperatively. Here, on off-line evaluation is made of the performance of two different types of mass spectrometers in characterization of IDH mutation status. The intensity of 2HG is measured against glutamate (Glu), an intrinsic reference molecule, in both tandem MS measurements. In both cases using DESI clear separation between IDH-mutant (mut) and IDH-wildtype (wt) samples (p

IntroductionThe COVID-19 pandemic prompted healthcare professionals to implement service delivery adaptations to remain in compliance with safety regulations. Though many adaptations in service delivery were reported throughout the literature, a wide variety of terminology and definitions were used.MethodsTo address this, we conducted a PRISMA review to identify service delivery adaptations across behavioral healthcare services in the United States from March 2020 to May 2022 and to identify variations in terminology used to describe these adaptations. We identified 445 initial articles for our review across eight databases using predetermined keywords. Using a two-round screening process, authors used a team approach to identify the most appropriate articles for this review.ResultsOur results suggested that a total of 14 different terms were used to describe service modality changes, with the most frequent term being telehealth (63%). Each term found in our review and the frequency of use across identified articles is described in detail.DiscussionImplications of this review such as understanding modality changes during the COVID-19 pandemic and beyond are discussed. Our findings illustrate the importance of standardizing terminology to enhance communication and understanding among professionals.

Influenza affects millions of people every year. It causes a considerable amount of medical visits and hospitalisations as well as hundreds of thousands of deaths. Forecasting influenza prevalence with good accuracy can significantly help public health agencies to timely react to seasonal or novel strain epidemics. Although significant progress has been made, influenza forecasting remains a challenging modelling task. In this paper, we propose a methodological framework that improves over the state-of-the-art forecasting accuracy of influenza-like illness (ILI) rates in the United States. We achieve this by using Web search activity time series in conjunction with historical ILI rates as observations for training neural network (NN) architectures. The proposed models incorporate Bayesian layers to produce associated uncertainty intervals to their forecast estimates, positioning themselves as legitimate complementary solutions to more conventional approaches. The best performing NN, referred to as the iterative recurrent neural network (IRNN) architecture, reduces mean absolute error by 10.3% and improves skill by 17.1% on average in nowcasting and forecasting tasks across 4 consecutive flu seasons.

Abstract Background Lymphangioma is a rare diagnosis in adult patients and typically presents in early infancy. These tumors are a result of malformation of the lymphatic vessels and usually involve the head, neck, and axilla. Case presentation We report the case of a 28-year-old African female who recently immigrated from East Africa and presented to our surgical breast clinic with a large and rapidly growing left axillary mass. Initial history and evaluation were concerning for hydatid cyst; however, on surgical excision, gross appearance was consistent with cystic lymphangioma. Diagnosis was confirmed on pathology review. Conclusions Although lymphangiomas are typically found in young children, adults may develop these tumors in response to unknown triggers. Surgical excision is the preferred treatment.

Melt-spun Fe-based ribbons are widely used as the core of transformers and inductors due to their high flux density and low coercivity. However due to their high thickness (∼19 µm) these ribbons are prone to large eddy current losses at MHz frequencies. Despite low yield, ball milling has been widely used to break such ribbons down to thinner flakes to suppress the eddy current losses at high frequency. In this work, we demonstrated an optimized ball milling process with increased yield for flakes in the desired size range (2–4 µm). We have demonstrated that reducing pre milling annealing temperature from 450 to 350 °C increases the yield in desired size range from 2% to 5% and further increasing batch size from 10 to 20 g increases the yield to 21%. The coercivity of the milled flakes increases from 139 to 1352 A/m due to the ball milling process. A post-mill annealing at 350 °C in Ar atmosphere decreases the coercivity to 341 A/m. X-ray diffraction analysis showed no sign of crystallization during ball milling. The result presented here demonstrates an efficient approach to fabricate ultra-thin flakes out of soft magnetic ribbons for high-frequency applications.

Rural communities are noted as having poor health outcomes. Rural areas experience barriers to care primarily due to a lack of resources, including education, health insurance, transportation, and social support. Additionally, poor health outcomes are a consequence of poor health literacy skills. Community Health Workers (CHWs) are utilized as a resource to combat these issues. This study focused on a CHW led Self-Management Blood Pressure (SMBP) program offered through the University of Texas at Tyler Health Science Center. The goal of the program was to improve management of hypertension through awareness, education, navigation, advocacy, and resource assistance. The SMBP program included structured workshops and regular follow-up with participants including connections to community resources and social support. CHWs worked closely with physicians providing bi-directional feedback on referrals and engagement of communities through outreach events. Furthermore, CHWs aided to bridge cultural or linguistic gaps between service providers and community members. Data is provided indicating this CHW-led intervention played a significant role in improving hypertension through education of how to make lifestyle changes that impact overall health and quality of life. Participants gained knowledge encouraging them to create lifelong healthy habits, coping skills, stress management, self-care, and accountability. Through this innovative approach, participants thrived in the supportive and encouraging environment led by CHWs as well as improved their blood pressure management.

Background: The coronavirus disease-2019 (COVID-19) pandemic significantly affected management of cardiovascular disease around the world. The effect of the pandemic on volume of cardiovascular diagnostic procedures is not known. Objectives: This study sought to evaluate the effects of the early phase of the COVID-19 pandemic on cardiovascular diagnostic procedures and safety practices in Asia. Methods: The International Atomic Energy Agency conducted a worldwide survey to assess changes in cardiovascular procedure volume and safety practices caused by COVID-19. Testing volumes were reported for March 2020 and April 2020 and were compared to those from March 2019. Data from 180 centers across 33 Asian countries were grouped into 4 subregions for comparison. Results: Procedure volumes decreased by 47% from March 2019 to March 2020, showing recovery from March 2020 to April 2020 in Eastern Asia, particularly in China. The majority of centers cancelled outpatient activities and increased time per study. Practice changes included implementing physical distancing and restricting visitors. Although COVID testing was not commonly performed, it was conducted in one-third of facilities in Eastern Asia. The most severe reductions in procedure volumes were observed in lower-income countries, where volumes decreased 81% from March 2019 to April 2020. Conclusions: The COVID-19 pandemic in Asia caused significant reductions in cardiovascular diagnostic procedures, particularly in low-income countries. Further studies on effects of COVID-19 on cardiovascular outcomes and changes in care delivery are warranted.

We introduce an active, semisupervised algorithm that utilizes Bayesian experimental design to address the shortage of annotated images required to train and validate Artificial Intelligence (AI) models for lung cancer screening with computed tomography (CT) scans. Our approach incorporates active learning with semisupervised expectation maximization to emulate the human in the loop for additional ground truth labels to train, evaluate, and update the neural network models. Bayesian experimental design is used to intelligently identify which unlabeled samples need ground truth labels to enhance the model’s performance. We evaluate the proposed Active Semi-supervised Expectation Maximization for Computer aided diagnosis (CAD) tasks (ASEM-CAD) using three public CT scans datasets: the National Lung Screening Trial (NLST), the Lung Image Database Consortium (LIDC), and Kaggle Data Science Bowl 2017 for lung cancer classification using CT scans. ASEM-CAD can accurately classify suspicious lung nodules and lung cancer cases with an area under the curve (AUC) of 0.94 (Kaggle), 0.95 (NLST), and 0.88 (LIDC) with significantly fewer labeled images compared to a fully supervised model. This study addresses one of the significant challenges in early lung cancer screenings using low-dose computed tomography (LDCT) scans and is a valuable contribution towards the development and validation of deep learning algorithms for lung cancer screening and other diagnostic radiology examinations.

Abstract Growing interest in food quality and traceability by regulators as well as consumers demands advances in more rapid, versatile and cost-effective analytical methods. Milk, as most food matrices, is a heterogeneous mixture composed of metabolites, lipids and proteins. One of the major challenges is to have simultaneous, quantitative detection (profiling) of this panel of biomolecules to gather valuable information for assessing food quality, traceability and safety. Here, for milk analysis, atmospheric pressure matrix-assisted laser desorption/ionization employing homogenous liquid sample droplets was used on a Q-TOF mass analyzer. This method has the capability to produce multiply charged proteinaceous ions as well as highly informative profiles of singly charged lipids/metabolites. In two examples, this method is coupled with user-friendly machine-learning software. First, rapid speciation of milk (cow, goat, sheep and camel) is demonstrated with 100% classification accuracy. Second, the detection of cow milk as adulterant in goat milk is shown at concentrations as low as 5% with 92.5% sensitivity and 94.5% specificity.

We report a case of a 57-year-old woman with a history of multiple myeloma (MM) and light chain (AL) amyloidosis who presented due to worsening dyspnea on exertion. Her MM has been refractory to multiple chemotherapy regimens and two autologous bone marrow transplantation. Diagnostic evaluations including serum kappa and lambda chains, echocardiogram, pyrophosphate cardiac scan, and cardiac magnetic resonance were indicative of a progression to AL cardiomyopathy. Addition of daratumumab to her regimen appeared to ameliorate the progression of AL cardiomyopathy. However, it was stopped due to adverse effects of pancytopenia and allergic reactions including skin rash and hives. She was hospitalized for heart failure exacerbation and died approximately 2 months following the discontinuation of daratumumab. This case highlights the late presentation of AL cardiomyopathy in refractory MM.

Introduction: Early-stage liver fibrosis is potentially reversible, but difficult to diagnose. Clinical management would be enhanced by the development of a non-invasive imaging technique able to identify hepatic injury early, before end-stage fibrosis ensues. The analog of the amino acid proline, cis-4-[18F]fluoro-L-proline ([18F]fluoro-proline), which targets collagenogenesis in hepatic stellate cells (HSC), was used to detect fibrosis.Methods: Acute steatohepatitis was induced in experimental animals by liquid ethanol diet for 8 weeks, intra-gastric binge feedings every 10th day along with lipopolysaccharide (LPS) injection. The control animals received control diet for 8 weeks and an equivalent volume of saline on the same schedule as the acute steatohepatitis model. First, in vitro cellular experiments were carried out to assess [3H]proline uptake by HSC, hepatocytes and Kupffer cells derived from rats with acute steatohepatitis (n = 14) and controls (n = 14). Next, ex vivo liver experiments were done to investigate unlabeled proline-mediated collagen synthesis and its associated proline transporter expression in acute steatohepatitis (n = 5) and controls (n = 5). Last, in vivo dynamic and static [18F]fluoro-proline micro-PET/CT imaging was performed in animal models of acute steatohepatitis (n = 7) and control (n = 7) mice.Results: [3H]proline uptake was 5-fold higher in the HSCs of steatohepatitis rats than controls after incubation of up to 60 min. There was an excellent correlation between [3H]proline uptake and liver collagen expression (r-value > 0.90, p < 0.05). Subsequent liver tissue studies demonstrated 2–3-fold higher proline transporter expression in acute steatohepatitis animals than in controls, and proline-related collagen synthesis was blocked by this transporter inhibitor. In vivo micro-PET/CT studies with [18F]fluoro-proline showed 2–3-fold higher uptake in the livers of acute steatohepatitis mice than in controls. There was an excellent correlation between [18F]fluoro-proline uptake and liver collagen expression in the livers of acute steatohepatitis mice (r-value = 0.97, p < 0.001).Conclusion: [18F]fluoro-proline localizes in the liver and correlates with collagenogenesis in acute steatohepatitis with a signal intensity that is sufficiently high to allow imaging with micro-PET/CT. Thus, [18F]fluoro-proline could serve as a PET imaging biomarker for detecting early-stage liver fibrosis.

Background: The NLRP3 inflammasome has been recognized as one of the key components of innate immunity. Gain-of-function mutations in the exon 3 of NLRP3 gene have been implicated in inflammatory diseases suggesting the presence of functionally important sites in this region. Q703K (c.2107C>A, p.Gln703Lys, also known in the literature as Q705K) is a common variant of NLRP3, that has been considered to be both clinically unremarkable or disease-causing with a reduced penetrance.Objectives: We aimed to investigate the potential genetic impact of the NLRP3 variant Q703K in patients with recurrent fever presenting with two autoinflammatory diseases: PFAPA (periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis) and CAPS (cryopyrin-associated periodic syndrome), as well as with undefined autoinflammatory disease (uAID).Methods: This is an international multicentric observational retrospective study characterizing the clinical phenotype of patients presenting with recurrent fever suspected to be of auto-inflammatory origin and where the Q703K NLRP3 variant was found. Monocytes of parents of 6 Q703K+ PFAPA patients were studied and levels of pro-inflammatory cytokines produced by monocytes of Q703K+ and Q703K- parents have been compared by ELISA.Results: We report 42 patients with the Q703K NLRP3 genetic variant: 21 were PFAPA patients, 6 had a CAPS phenotype, and 15 had an uAID. The phenotypes of PFAPA, CAPS and uAID were quite similar between Q703K positive and negative patients with the exception of increased prevalence of pharyngitis in the Q703K positive CAPS population compared to the negative one. The in vitro production of IL-1β was not significantly different between Q703K+ and Q703K- monocytes from asymptomatic parents.Conclusion: The evidence we report in our study shows an increased prevalence of NLRP3 Q703K in patients with autoinflammatory diseases, suggesting an association between the Q703K variant and the risk of PFAPA, CAPS and uAID syndromes. However, we did not show a functional effect of this mutation on the inflammasome basal activity.

Abstract Background Treatments for localized prostate cancer present challenging tradeoffs in the face of uncertain treatment benefits. These options are best weighed in a process of shared decision-making with the patient’s healthcare team. Minority men experience disparities in prostate cancer outcomes, possibly due in part to a lack of optimal communication during treatment selection. Decision aids facilitate shared decision-making, improve knowledge of treatment options, may increase satisfaction with treatment choice, and likely facilitate long-term quality of life. Methods/design This study will compare the effect of two evidence-based decision aids on patient knowledge and on quality of life measured one year after treatment, oversampling minority men. One decision aid will be administered prior to specialist consultation, preparing patients for a treatment discussion. The other decision aid will be administered within the consultation to facilitate transparent, preference-sensitive, and evidence-informed deliberations. The study will utilize a four-arm, block-randomized design to test whether each decision aid alone (Arms 1 and 2) or in combination (Arm 3) can improve patient knowledge and quality of life compared to usual care (Arm 4). The study, funded by the National Cancer Institute’s Community Oncology Research Program (NCORP), will be deployed within select institutions that have demonstrated capacity to recruit minority populations into urologic oncology trials. Discussion Upon completion of the trial, we will have 1) tested the effectiveness of two evidence-based decision aids in enhancing patients’ knowledge of options for prostate cancer therapy and 2) estimated whether decision aids may improve patient quality of life one year after initial treatment choice. Trial registration Clinicaltrials.gov: NCT03103321. The trial registration date (on ClinicalTrials.gov) was April 6, 2017.

Objectives: This purpose of the study was to evaluate TAVR outcomes at low, intermediate and high volume institutions. Background: For the care of complex patients, volume-outcome effect is well described. The initial US TAVR experience was limited to a few centers of excellence. The impact of institutional volume on outcomes after TAVR has not been systematically studied. Methods: Within the Banner Health system, TAVR is performed at 3 institutions-a low volume, an intermediate volume and a high volume institution. 181 consecutive patients undergoing TAVR within these 3 institutions were the study cohort. To adjust for bias and confounders between the 3 groups, risk-adjusted multivariate logistic regression and propensity score analysis was performed. The primary endpoint was a composite of mortality, dialysis-dependent renal failure, cerebrovascular accident, need for new permanent pacemaker and readmission within 30 days. Results: The primary endpoint was reached in 38.8% of patients at the high volume institution and 76.2% of patients at the low volume institution (p 30, diabetes, hypertension, prior CAD, CKD and NYHA class III/IV heart failure. Conclusions: High-risk patients undergoing TAVR at a large volume institution have better 30-day outcomes compared to outcomes at intermediate and low volume centers.

Human modifications in response to erosion have altered the natural transport of sediment to and across the coastal zone, thereby potentially exacerbating the impacts of future erosive events. Using a combination of historical shoreline-change mapping, sediment sampling, three-dimensional beach surveys, and hydrodynamic modeling of nearshore and inlet processes, this study explored the feedbacks between periodic coastal erosion patterns and associated mitigation responses, focusing on the open-ocean and inner-inlet beaches of Plum Island and the Merrimack River Inlet, Massachusetts, United States. Installation of river-mouth jetties in the early 20th century stabilized the inlet, allowing residential development in northern Plum Island, but triggering successive, multi-decadal cycles of alternating beach erosion and accretion along the inner-inlet and oceanfront beaches. At a finer spatial scale, the formation and southerly migration of an erosion “hotspot” (a setback of the high-water line by ∼100 m) occurs regularly (every 25–40 years) in response to the refraction of northeast storm waves around the ebb-tidal delta. Growth of the delta progressively shifts the focus of storm wave energy further down-shore, replenishing updrift segments with sand through the detachment, landward migration, and shoreline-welding of swash bars. Monitoring recent hotspot migration (2008–2014) demonstrates erosion (>30,000 m3 of sand) along a 350-m section of beach in 6 months, followed by recovery, as the hotspot migrated further south. In response to these erosion cycles, local residents and governmental agencies attempted to protect shorefront properties with a variety of soft and hard structures. The latter have provided protection to some homes, but enhanced erosion elsewhere. Although the local community is in broad agreement about the need to plan for long-term coastal changes associated with sea-level rise and increased storminess, real-time responses have involved reactions mainly to short-term (

Background: Patients who undergo trans-catheter aortic valve replacement (TAVR) may have concomitant aortic aneurysms. We sought to clarify the incidence of aortic aneurysms and its impact on clinical outcomes among patients undergoing TAVR. Methods: We performed a retrospective analysis of patients with severe symptomatic aortic stenosis who underwent TAVR from January 2012 to June 2016. Multi-detector computer tomography (MDCT) was performed on all patients and images were reviewed to identify thoracic and abdominal aortic aneurysms (TAA and AAA). The incidence of vascular complications (VARC-2 definition), and in-hospital and 6-month major adverse cardiac events (MACE) defined as a composite of all-cause mortality, cardiac arrest, myocardial infarction, and stroke were recorded. Results: Among 232 patients included in the analysis, 22 patients (9.5%) had aortic aneurysms (11 had AAA, 8 had TAA, and 3 had both). Patients with aortic aneurysms had a higher, albeit statistically insignificant, rate of smoking history (63.6% vs. 42.9%, p = 0.062). Both groups of patient predominantly underwent TAVR via trans-femoral access (72.7% vs. 71.4%, p = 0.90). The incidence of vascular complications was similar between the two groups (9.1% vs. 10.5%, p = 1.0). Patients with aortic aneurysms had a similar in-hospital MACE (4.5% vs. 6.2%, p = 1.0) and 6-month MACE (9.1% vs. 9.0%, p = 1.0) compared to those without aneurysms. Conclusions: In our patient cohort, 9.5% of patients who underwent TAVR had concomitant aortic aneurysms. Patients with aortic aneurysms had similar incidence of vascular complications as well as in-hospital and 6-month MACE compared to those without. Keywords: Aortic aneurysms, Aortic stenosis, Trans-catheter aortic valve replacement

Minimal hepatic encephalopathy (MHE) is highly prevalent, observed in up to 80% of patients with liver dysfunction. Minimal hepatic encephalopathy is defined as hepatic encephalopathy with cognitive deficits and no grossly evident neurologic abnormalities. Clinical management may be delayed due to the lack of in vivo quantitative methods needed to reveal changes in brain neurobiochemical biomarkers. To gain insight into the development of alcoholic liver disease–induced neurological dysfunction (NDF), a mouse model of late-stage alcoholic liver fibrosis (LALF) was used to investigate changes in neurochemical levels in the thalamus and hippocampus that relate to behavioral changes. Proton magnetic resonance spectroscopy of the brain and behavioral testing were performed to determine neurochemical alterations and their relationships to behavioral changes in LALF. Glutamine levels were higher in both the thalamus and hippocampus of alcohol-treated mice than in controls. Thalamic levels of taurine and creatine were significantly diminished and strongly correlated with alcohol-induced behavioral changes. Chronic long-term alcohol consumption gives rise to advanced liver fibrosis, neurochemical changes in the nuclei, and behavioral changes which may be linked to NDF. Magnetic resonance spectroscopy represents a sensitive and noninvasive measurement of pathological alterations in the brain, which may provide insight into the pathogenesis underlying the development of MHE.

Postinfarct VSD (PIVSD) carries a grim prognosis. The mainstay of management has been surgical repair. The advent of septal occluder devices has offered an attractive alternative to surgical repair. Most PIVSD have serpiginous tracts with necrotic tissue, which makes assessing the defect challenging. 3D computer printing has become useful in preprocedure planning of complex surgical procedures in multiple subspecialties.

Preprocedural planning and advanced imaging is vital to achieve a consistent and high level of success for complex coronary chronic total occlusion (CTO) revascularization. Various practice patterns exist around the world when performing coronary artery CTO revascularization. This case report highlights a fusion of global practices in CTO intervention and integration of advanced imaging to achieve successful revascularization.

In Morris (2008) I presented in outline a new interpretation of the famous ‘substance argument’ in Wittgenstein’s Tractatus (Wittgenstein 1922). The account I presented there gave a distinctive view of Wittgenstein’s main concerns in the argument, but did not explain in detail how the argument works: how its steps are to be found in the text, and how it concludes. I remain convinced that the interpretation I proposed correctly identifies the main concerns which lie behind the argument. I return to the argument here in order to elaborate in fuller detail the relation between those concerns and the actual course of the text.

Redesigned instrumentation has become available for implantation of the Oxford Mobile Bearing Medial unicompartmental knee arthroplasty. To assess the benefit of these changes, we compared operative time of 200 Phase III and 176 Microplasty UKA done 2008-2011. An average time savings of 8.6 minutes was seen with the Microplasty design. Additionally, the standard deviation in operative times, minimum and maximum operatives were lower in knees in which Microplasty instrumentation was utilized. A 15% savings in operative time was seen with the new Microplasty instrumentation.

Jejunogastric intussusception is a rare event following gastrointestinal reconstruction. We present a case report in which jejunogastric intussuception was diagnosed in a child four years after a gastrectomy with jejunogastric reconstruction for duodenal duplication. Prompt diagnosis and emergent resection of any non-viable bowel, and revision to a Roux-En-Y anastomosis with or without pexy of the Roux limb to the colon or Y-limb mesentery appear to be the appropriate treatment for this clinical entity.

A six-year-old female goat was presented to the veterinary teaching hospital of the University of the West Indies with a history of progressive hind-limb paresis lasting two weeks. The doe developed a grade 6/6 holosystolic murmur during hospitalisation. Echocardiography revealed vegetative growths attached to cusps of the mitral and aortic valves. There was an accelerated aortic flow at 2.9 m/s and aortic insufficiency. The aortic vegetation was prolapsing into the left ventricle during diastole, causing it to contact the septal mitral valve leaflet. A diagnosis of mitral and aortic vegetative endocarditis, with a mitral kissing vegetation and mild aortic stenosis, was reached. The patient was placed on broad-spectrum antimicrobials. A short-term follow-up showed no resolution of clinical signs, and the animal eventually died. Post-mortem examination showed severe vegetative, fibrino-necrotic, aortic and mitral valve lesions. The goat also had a severe fibrino-suppurative mastitis. Histopathology confirmed the lesions to be vegetative endocarditis.

While considerable attention has been devoted to the personality traits of entrepreneurs, less attention has been given to their values, especially outside of a Western context. Values are instrumental in the decision to pursue entrepreneurship, and have implications for the entrepreneurʼs approach to creating and managing the venture. The role of values would seem especially relevant in the context of ethnic subcultures. Values traditionally associated with entrepreneurship, such as risk, individualism, competitiveness, wealth generation, and growth, may be more consistent with Western cultures, and may conflict with closely held values within various ethnic subcultures the world over. This article examines the values of entrepreneurs in two ethnic subcultures within South Africa. Findings are reported from interviews with cross-sectional samples of black and colored entrepreneurs. The results indicate entrepreneurs tend to embrace common values regardless of their individual ethnic heritage, but with different underlying patterns. In addition, the entrepreneurial path itself gives rise to certain shared values; and the overarching country culture has a strong influence on value orientations. Implications are drawn from the results, and suggestions made for ongoing research.

Background: Modular component options can assist the surgeon in addressing complex femoral reconstructions in total hip arthroplasty by allowing for customization of version control and proximal to distal sizing. We review the early clinical results of a single modular femoral revision system that offers 3 proximal body types, 5 distal stem geometries, and a wide range of offset, sizing and auxiliary options. Methods: A query of our practice’s arthroplasty registry revealed 60 patients (61 hips) who signed an IRB-approved general research consent allowing retrospective review, and underwent total hip arthroplasty performed with the modular femoral revision system between December 2009 and April 2012. There were 35 men (58%) and 25 women (42%). Mean age was 65.1 years (range, 35-94) and BMI was 31.3 kg.m2 (range, 14-53). Procedures were complex primary in 1 hip, conversion in 6 (10%), revision in 32 (53%), and two-staged exchange for infection in 22 (33%). Two-thirds of procedures included complete acetabular revision (n=40), while 31% (19) involved liner change only and 2 were isolated femoral revisions. Results: At an average follow-up of 1.5 years (maximum: 3.7 years) there have been no revisions or failures of the femoral component. Average Harris hip scores (0 to 100 possible) improved from 44.2 preoperatively to 66.0 at most recent evaluation, while the pain component (0 to 44 possible) improved from 15.8 to 31.2. Complications requiring surgical intervention included intraoperative periprosthetic femur fracture in one patient returned to the operating suite same day for open reduction internal fixation, which further required incision and debridement for superficial infection at 1 year postoperative; and two patients with dislocation and fracture of the greater trochanter treated with open reduction, revision of the head and liner, and application of cerclage cables, one of which required removal of a migrated claw 10 months later followed 2 weeks subsequently with incision and debridement for a non-healing wound. Postoperative radiographs were available for review for 59 THA in 58 patients. Analysis of the femoral component revealed satisfactory findings in 50 hips (85%) while 9 had radiographic changes that included bone deficit, osteolysis, or radiolucency in one or more zones. Conclusions: The early results of this modular femoral revision system are promising for the treatment of the deficient femur in complex primary and revision total hip arthroplasty. Patients with radiographic changes are advised to return for regular clinical and radiographic follow-up. Survival of the modular femoral component in this series was 100% at mean follow-up of 1.5 years and up to 3.7 years. While HHS clinical and pain scores were somewhat low at most recent evaluation, they were significantly improved over preoperative levels.

Background: The number of revision total knee arthroplasty (TKA) procedures is projected to rise dramatically over the next fifteen years. These procedures are technically more demanding than routine primary TKA. Modular component options can assist the surgeon in addressing complex reconstructions in TKA, providing customization to remedy bony deficits, deformity, malalignment and instability. We review the early clinical results of a modular revision system that offers full interchangeability enhanced with a wide array of options for augmentation, offset, and constraint as well as modular stems. Materials and Methods: A query of our practice’s arthroplasty registry revealed a consecutive series of 100 patients (101 knees) who signed an IRB-approved general research consent allowing retrospective review, and underwent total knee arthroplasty performed with the modular revision system between May 2011 and May 2012. Reconstruction constructs and components, demographic variables, pre and post-operative clinical variables, failure modes, and survivorship were analyzed. Results: At an average follow-up of 1 year (range, 0.1 to 2.2 years) there has been one aseptic failure for instability. One patient required incision and debridement of a non-healing wound. Three patients, all status-post reimplantation, failed secondary to recurrent infection, with one treated single-staged and the others undergoing another 2-staged exchange. Average ROM improved from 96.4° preoperatively to 104.8° at most recent evaluation. Average Knee Society clinical scores (0 to 100 possible) improved from 45.5 to 78.0, and function scores (0 to 100 possible) improved from 41.3 to 48.3. There have been no patient deaths during the follow-up period. Postoperative radiographs were available for review for 97 knees. Satisfactory position, fixation and alignment were observed in 92 (95%). Heterotopic ossification was observed at the lateral tibial aspect in 1 knee with CR lipped bearing. A stable radiolucency was observed around the tibial component of one knee. Minor radiolucencies were observed in femoral zones I and II and tibial zone 1 on lateral view of one knee, in tibial zones III and IV on AP view in one knee, and in tibial zone IV on AP view in one knee. Conclusion: The early results of this modular TKA revision system are promising for use in complex TKA, with only one aseptic failure observed. There has been substantial improvements in ROM and function in this cohort. Key words: Arthroplasty, Knee, Revision

El artículo no presenta resumen.