有限元分析在骨科植入器械研发中的应用探讨

有限元分析方法目前常用于骨科植入器械设计和性能研究,但在运用的过程中还存在有限元分析方法使用不当、有限元分析的研究过程不完整、有限元分析模型缺少验证等问题。因此,本文结合企业研发资料情况,就如何提高有限元分析方法在骨科植入器械研发过程中的可靠性提出几点建议,以期为相关人员正确合理使用有限元分析方法提供参考。     

The effect of social media on patient acceptance of temporary anchorage devices:: A cross-cultural study

ObjectivesTo investigate the relationship between the use of social networking sites (SNSs) on patient perceptions, acceptance, and expectations of treatment using temporary anchorage devices (TADs) and to compare differences between patients from the United Kingdom and Brazil.Materials and MethodsCross-sectional questionnaires were administered to 39 participants at orthodontic practices in the United Kingdom and Brazil about patients'' use of SNSs, exposure to TADs on SNSs, and thoughts on extractions, jaw surgery, or TADs as treatment options.ResultsUK patients prefer for clinicians to have SNS profiles (P = .022). Most UK and Brazilian patients want to see their clinician''s work online (76.7%) and use SNSs to get information about treatment options (76.6%). There was a statistically significant difference in Brazilian patients'' acceptance of TADs as a treatment option compared with UK patients, particularly if it meant avoiding extractions (P = .002), avoiding jaw surgery (P = .004), or reducing treatment time (P = .010). Knowledge of TADs was greater in Brazilian patients (P < .001).ConclusionsPatients use SNSs to obtain information about treatments and prefer clinicians to have social media accounts. Patients exposed to TADs on SNSs are more likely to accept them as an orthodontic treatment option. UK patients have less knowledge of TADs and are therefore less sure to consider TADs as an option. Brazilian patients are more confident in considering the use of TADs. Clinicians should consider increasing their social media presence to accommodate patients'' expectations and acceptance of TADs.     

可穿戴设备在COPD患者中的应用进展

本文对可穿戴设备在COPD患者中的具体应用、应用效果及应用过程中存在的问题等进行综述,旨在为设计适合于COPD患者的可穿戴设备及其应用提供参考。     

我国辅助器具租赁服务相关政策研究

目的 梳理我国康复辅助器具租赁服务现状,归纳提出我国康复辅助器具租赁对策建议。方法 基于四维社会保障政策分析框架,采用主题检索与实地调研相结合的方式,总结我国康复辅助器具社区租赁部分试点地区的市场主体、配套制度、租赁产品、资金保障和专业人才。结果 我国康复辅助器具租赁服务还存在市场主体发展不充分、配套政策制度不完善、支付保障体系不健全、专业人员不充足、社会认可度不高等问题。结论 推进康复辅助器具租赁行业健康快速发展,要科学设置租赁产品,规范服务企业,积极培育市场主体,加大资金投入、人才培养和宣传推广力度。     

Atrial fibrillation with left bundle branch block and intermittent right axis deviation during acute myocardial infarction

A survey of the litterature was made to precise the characteristics of infectious endocarditis (IE) in the elderly as defined by the diagnostic criteria of Von Reyn. The IE presents at times with a fallacious symptomatology where fever and cardiac bruit are often lacking. With regard to the cardiac disease, there is an increase in the incidence of calcifying degenerative valvulopathy responsible for IE. On the bacteriological point of view, streptococcal infections are still predominent in etiologgy for endocarditis but opportunistic infections dues to other bacterial species are increasing in frequency. Lastly, on the therapeutical side, there is a new trend to reduce the proeminence of curative treatment with aminoglycoside agents in favor of the antibiotic prophylaxis.

The use of mobile devices as assistive technology in resource-limited environments: access for learners with visual impairments in Kenya

Purpose: In this paper, the authors explore the use of mobile devices as assistive technology for students with visual impairments in resource-limited environments. This paper provides initial data and analysis from an ongoing project in Kenya using tablet devices to provide access to education and independence for university students with visual impairments in Kenya. Method: The project is a design-based research project in which we have developed and are refining a theoretically grounded intervention – a model for developing communities of practice to support the use of mobile technology as an assistive technology. We are collecting data to assess the efficacy and improve the model as well as inform the literature that has guided the design of the intervention. Results: In examining the impact of the use of mobile devices for the students with visual impairments, we found that the devices provide the students with (a) access to education, (b) the means to participate in everyday life and (c) the opportunity to create a community of practice. Conclusions: Findings from this project suggest that communities of practice are both a viable and a valuable approach for facilitating the diffusion and support of mobile devices as assistive technology for students with visual impairments in resource-limited environments.

• Implications for Rehabilitation

• The use of mobile devices as assistive technology in resource-limited environments provides students with visual impairments access to education and enhanced means to participate in everyday life.

• Communities of practice are both a viable and a valuable approach for facilitating the diffusion and support of mobile devices as assistive technology for students with visual impairments in resource-limited environments.

• Providing access to assistive technology early and consistently throughout students’ schooling builds both their skill and confidence and also demonstrates the capabilities of people with visual impairments to the larger society.

     

Arthrodesis of proximal inter-phalangeal joint for hammertoe: intramedullary device options

Background

Proximal inter-phalangeal (PIP) joint arthrodesis today represents the standard treatment for structured hammertoes; however, recently, a lot of new intramedullary devices for the fixation of this arthrodesis have been introduced. The purpose of this work is to look at the currently available devices and to perform a review of the present literature.

Materials and methods

A literature search of PubMed/Medline and Google Scholar databases, considering works published up until September 2014 and using the keywords: hammertoe, arthrodesis, PIP joint, fusion, intramedullary devices, and K-wire, was performed. The published papers were included in the present study only if they met the following inclusion criteria: English articles, arthrodesis of PIP joints for hammertoes with new generation intramedullary devices, series with n > 10. Studies using absorbable pins or screws that are considered as another kind of fixation that involved more than one articulation, as well as comments, letters to the editor, or newsletters were excluded.

Results

Nine publications were included. Of the patients’ reports, 93–100 % were good or excellent concerning satisfaction. Radiological arthrodesis was achieved in 60.5–100 % of cases. Three of the publications compared the new devices with the K-wire. Of these three articles, two employed the traditional technique and one the buried technique. The AOFAS score, evaluated in three publications, showed a delta of 19, 45 and 58 points. Major complications, which required a secondary surgical revision, were between 0 and 8.6 %. The complications of the K-wire and the new devices were similar; also the reoperation rate was close to equal (maximal difference 2 %). On the other hand, these kinds of devices definitely have a higher price, compared to the K-wire.

Conclusion

The use of these new devices provides good results; however, their high price is currently a problem. For this reason, cost-benefit studies seem to be necessary to justify their use as standard treatment.

Level of evidence

Level III systematic review.     

Comparison of the Sliding and Femoral Head Rotation among Three Different Femoral Head Fixation Devices for Trochanteric Fractures

Background

Recently, various femoral head fixation devices (HFDs) for trochanteric fractures have become available. However, there are some cases in which femoral head rotation with excessive sliding of the HFD is observed and it is often followed by cutout. The purpose of this study is to compare the ability of the three types of HFDs to prevent femoral head rotation.

Methods

Between July 2005 and December 2009, 206 patients aged over 60 years with trochanteric fractures who had undergone surgical treatment using a short femoral nail in our institution were enrolled into the study. We used the gamma 3 nail (GMN) as the screw-type HFD in 66 cases, the gliding nail (GLN) as a non-cylindrical blade in 76 cases, and the proximal femoral nail antirotation (PFNA) as a cylindrical blade in 64 cases. The sliding length of HFDs and the occurrence of femoral head rotation were evaluated by assessing radiographs as the main outcome, and the results were compared among these devices.

Results

A comparison of the degree of sliding in the GMN group showed that femoral head rotation was observed significantly more frequently in cases with rotation. Further, it appeared that femoral head rotation occurred more frequently in comminuted fractures. However, no significant differences between the sliding lengths of the different HFDs were observed among three groups. Femoral head rotation was observed in 15 cases of GMN (22.7%), 0 case of GLN, and 5 case of PFNA (7.8%). Significant differences with regard to the occurrence of femoral head rotation were observed among the three groups. Furthermore, significant differences were also observed between GLN and PFNA with respect to the occurrence of femoral head rotation.

Conclusions

The ability to stabilize femoral head appears to be greater with blade-type materials than with screw-type materials. Furthermore, we believe that a non-cylindrical blade is preferable to a cylindrical blade for the surgical treatment of comminuted, unstable trochanteric fractures in order to prevent femoral head rotation and cut-out.