A modified direct lateral approach in total hip arthroplasty: a comprehensive review

A retrospective review of 770 consecutive primary total hip arthroplasties was conducted to determine the complications and utility of a modified direct lateral approach, which involves elevation of the anterior one-third of the gluteus medius and vastus lateralis in continuity. In 640 patients, 712 total hip arthroplasties were followed up for a minimum of 2 years (maximum 6.5 years, average 3.6 years). Two prosthetic dislocations occurred in the follow-up period, for a prevalence of instability of 0.3%. A moderate or severe limp was present in 10% of all patients at 2-year follow-up and in 4% of a subgroup of patients with only unilateral osteoarthritis of the hip (Charnley A). Severe heterotopic ossification (Brooker grade III or IV) developed in fewer than 3% of hips and was functionally limiting in only seven patients. Four sciatic nerve palsies occurred. Surgical exposure has been excellent through this approach, without the need for extensile measures, such as a trochanteric osteotomy. The duration of surgery has been considered acceptable, and the position of the components considered excellent while using this approach. From this review, it was concluded that this modified direct lateral approach has greatly diminished the potentially devastating complication of postoperative instability and is associated with an acceptable level and severity of limp and heterotopic ossification. The approach provides excellent exposure in primary total hip arthroplasty to allow accurate placement of components in an efficient manner.     

Effect of acute hypoxia on metabolism and ventilation in awake piglets

We studied the effect of acute sustained hypoxia on ventilation (VE) and oxygen consumption (VO2) over one hour during quiet wakefulness in young (6 days) and older (6 weeks) piglets in thermoneutral conditions during baseline, moderate hypoxia (PaO2 approximately 45 mmHg), and severe hypoxia (PaO2 approximately 30 mmHg). During severe hypoxia, ventilation and pH increased while PaCO2 decreased in both age groups. Blood gas changes (decreases PACO2, increases pH), but not ventilatory changes, were greater in the older piglets (P < 0.05). VO2 decreased similarly (-30%) while VE/VO2 rose over 160% in both age groups. During moderate hypoxia, changes in blood gas, VE, and VO2 were in a similar direction, but smaller in magnitude. We conclude that: (1) changes in blood gases and VO2 are amplified by maturation and severity of hypoxia and (2) blood gas changes are greater in older vs young piglets despite similar ventilatory responses suggesting maturational differences in CO2 production or dead space ventilation.     

Diagnosis and treatment planning of hypodivergent skeletal pattern with clockwise occlusal plane rotation

Diagnostic treatment planning of Class III malocclusion is complicated due to the interaction of development, timing, dental pattern, and skeletal relationships. Historically, the treatment of adult Class III malocclusions has tended to be seen primarily as cases of mandibular prognathism. As diagnostic acumen and surgical skills improve and merge, orthodontic and surgical treatment plans for Class III malocclusions have become more common. Class III malocclusions now tend to be described in terms of mandibular prognathism, horizontal maxillary hypoplasia, maxillary vertical hypoplasia, and mandibular dentoalveolar retrusion. The purpose of this paper is to present a combined surgical-orthodontic treatment approach involving clockwise rotation of the occlusal plane for treatment of hypodivergent Class III skeletal pattern and dental malocclusion.     

Signal compression based on models of human perception

The notion of perceptual coding, which is based on the concept of distortion masking by the signal being compressed, is developed. Progress in this field as a result of advances in classical coding theory, modeling of human perception, and digital signal processing, is described. It is proposed that fundamental limits in the science can be expressed by the semiquantitative concepts of perceptual entropy and the perceptual distortion-rate function, and current compression technology is examined in that framework. Problems and future research directions are summarized     

The measurement of low temperatures

Temperature measurement is almost always ancillary to some other measurement in bulk liquid handling and may therefore be added as something of an after-thought. Care over some features of the installation, however, is essential if good temperature measurements are to be made. This paper attempts to draw attention to some of the points to be considered and to give some examples of actual applications.Some fundamental concepts are common to all types of temperature measurement, and these are discussed briefly.     

A newly identified polymorphism in the apolipoprotein E enhancer gene region is associated with Alzheimer's disease and strongly with the epsilon 4 allele

Apolipoprotein E allele 4 (apoE epsilon 4) is a major risk factor for late-onset AD. Inheritance of this allele is associated with an earlier age of onset of dementia in individuals with AD. It is unknown whether other polymorphisms in the apoE gene may influence the effect of apoE epsilon 4 on AD. We screened portions of the promoter enhancer element and of the apoE receptor binding domain for other polymorphisms that could affect risk of AD. In particular, a C/G polymorphism at position +113 of the apoE mRNA in the apoE intron 1 enhancer element (IE1) has been recently identified. We found no other polymorphisms. We studied the relationship of the two alleles of the IE1 polymorphism with AD and found an apparent association between IE1 G and AD (n = 94; p = 0.0515). However, the IE1 G allele is also closely associated with apoE epsilon 4 (p < 0.0001). When the presence of apoE epsilon 4 is covaried, the association between the IE1 G allele and AD is no longer statistically significant (odds ratio = 1.29, 95% confidence interval: 0.44, 3.78). In contrast, epsilon 4 is still highly associated with AD when IE1 G is controlled for (odds ratio = 5.91, 95% confidence interval: 3.29, 10.63). Furthermore, there is no significant association between the age of onset of dementia and the inheritance of the G allele. We believe that the apparent association between IE1 G and AD is a consequence of the association between the epsilon 4 and IE1 G alleles.     

Sensory nerve recording for closed-loop control to restore motor functions

A method is developed for using neural recordings to control functional electrical stimulation (FES) to nerves and muscles. Experiments were done in chronic cats with a goal of designing a rule-based controller to generate rhythmic movements of the ankle joint during treadmill locomotion. Neural signals from the tibial and superficial peroneal nerves were recorded with cuff electrodes and processed simultaneously with muscular signals from ankle flexors and extensors in the cat's hind limb. Cuff electrodes are an effective method for long-term chronic recording in peripheral nerves without causing discomfort or damage to the nerve. For real-time operation we designed a low-noise amplifier with a blanking circuit to minimize stimulation artifacts. We used threshold detection to design a simple rule-based control and compared its output to the pattern determined using adaptive neural networks. Both the threshold detection and adaptive networks are robust enough to accommodate the variability in neural recordings. The adaptive logic network used for this study is effective in mapping transfer functions and therefore applicable for determination of gait invariants to be used for closed-loop control in an FES system. Simple rule-bases will probably be chosen for initial applications to human patients. However, more complex FES applications require more complex rule-bases and better mapping of continuous neural recordings and muscular activity. Adaptive neural networks have promise for these more complex applications.