La prothèse à pivot "GSB"

Résumé L'étude porte sur une série de 50 prothèses totales de genou GSB implantées entre 1981 et 1988 au Centre de Traumatologie et d'Orthopédie de Strasbourg. Cette prothèse entre dans la catégorie des prothèses à charnières cimentées, mais son pivot semi rigide diminue efficacement les contraintes exercées sur le ciment. Les résultats sont conformes à ceux retrouvés dans la littérature concernant les prothèses à charnière. L'accent a été mis plus particulièrement sur les complications spécifiques à ce type d'arthroplastie : infections, fractures, complications rotuliennes. Cependant le caractère semi rigide de la GSB a permis la disparition presque totale des descellements qui compliquaient d'ordinaire les prothèses à charnière. La prothèse GSB nous semble donc supérieure aux autres modèles de prothèse à charnière.     

Innovations in quality

To strengthen their operations many hospitals have embraced total quality management (TQM) strategies used by companies throughout the world. California Hospitals examines how some of these hospitals have used TQM to improve clinical outcomes, cut costs, boost staff morale and increase patient satisfaction.     

Synthetic Evolution of a Supramolecular Harpooning Mechanism to Immobilize Vesicles at Antifouling Interfaces

The immobilization of vesicles has been conceptualized as a method to functionalize biointerfaces. However, the preservation of their integrity post immobilization remains a considerable challenge. Interfacial interactions can cause vesicle rupture upon close surface contact and non-specific protein adsorption impairing surface functions. To date, immobilization of vesicles has relied solely on either entrapment or prior modification of vesicles, both of which require laborious preparation and limit their applications. This work develops a bioinspired strategy to pin vesicles without prior modification while preserving their intact shape. This work introduces antifouling diblock copolymers and ultrathin surface-attached hydrogels containing a brush-like interface consisting of a bottle brush copolymer of N-(2-hydroxypropyl) methacrylamide (HPMA) and N-(3-methacrylamidopropyl)-N,N-dimethyldodecan-1-aminiumiodide (C12+). The presence of positive charges generates an attractive force that pulls vesicles toward the surface. At the surface, the amphiphilic properties of the combs facilitate their insertion into the membrane, mimicking the harpooning mechanism observed in antimicrobial peptides. Importantly, the antifouling poly(HPMA) backdrop serves to safeguard the vesicles by preventing deformation and breakage. Using a combination of thermodynamic analysis, surface plasmon resonance, and confocal laser scanning microscopy, this work demonstrates the efficiency of this biomimetic system to capture vesicles while maintaining an antifouling interface necessary for bioapplications.     

Using adverse events in health-care quality improvement: results from a British acute hospital

Adverse event monitoring is a problem-oriented approach to clinical audit and health-care quality improvement, which was developed and has been widely used in the USA. Briefly explores the technique itself and its evolution. Presents experience gained from the widespread use of the approach in a British acute hospital, and results from one specialty--ophthalmology. Suggests that the study of adverse events in patient care can produce significant improvements in patients' care, that it is particularly suited to some specialties, and that it should be used alongside other techniques in hospital clinical audit programmes. Concludes that, as the demand for quality-monitoring information from purchasers and within providers grows, adverse event monitoring may become one of the key techniques for quality assessment and improvement.     

Nutritional modulation of aging in nonhuman primates

Caloric restriction (CR), undernutrition without malnutrition, remains the only experimental paradigm that has been shown consistently to extend lifespan and slow aging in short-lived species. Decades of research, mostly in laboratory rodents, have shown that CR consistently extends lifespan, reduces or delays the onset of many age-related diseases and slows aging in many physiological systems. In recent years gerontologists interested in CR have focused on two unanswered questions. 1) What is the relevance of this nutritional paradigm to human aging? and 2) What biological mechanism(s) underlie the diverse effects of CR leading to a retardation of aging and disease?. To address the question of human relevance, researchers in the Intramural Research Program of the National Institute on Aging began a study of CR in nonhuman primates in the late 1980s. In addition to assessing the effects of CR on aging in primates, a major focus of this work relates to possible metabolic mechanisms of CR. A subsequent study at the University of Wisconsin Madison was initiated in the early 1990s. Certain aspects of experimental design differ between these two important ongoing investigations, but generally these studies compliment each other in many ways and have begun to provide much important data regarding the effects of CR in primates. Emerging data from these studies strongly support that physiological responses to CR in monkeys parallel the extensive findings reported in rodents. Lifespan data will not be available for several years, however, the remarkable consistency with rodent studies, in which lifespan extension is documented extensively, strengthens the possibility that CR will also extend lifespan in primates, perhaps including humans. This review summarizes the major findings from the primate CR studies after over a decade of research in this model.     

Type of screw does not influence holding power in the femoral head: a cadaver study with shearing test

We studied the holding power during cut-out tests of 4 different screw fixation devices of the femoral head, correlated to head size and bone density, on 48 paired deep frozen proximal femurs of fresh gross specimens. We found no significant effect of the device on the holding power. There was a significantly higher maximal load at failure in large and dense heads. It seems then unnecessary to advocate more sophisticated but also more expensive devices to fix femoral neck fractures.     

Genetic defects of human brain development

This review focuses on malformations of the central nervous system that have a genetic etiology. One can view each malformation as giving us unique details on a map entitled "how to make a human brain." The gene(s) that cause each malformation are being identified, allowing discovery of their specific role in neurodevelopment, and defining a "road" on the map. The malformation is then the developmental consequence of "taking a wrong turn." Assimilation of complementary data from other species with human malformation phenotype and genotype is revealing just how wonderful and complex the neurodevelopment map is. Here we highlight recent research on brain malformations and how this is illuminating the map of normal human brain formation.     

Epidemiology of equine upper respiratory tract disease on standardbred racetracks.

The outbreaks of upper respiratory tract infections in horses at Standardbred racetracks were investigated over a three year period. The most serious epidemics of respiratory disease occurred in the winter and spring seasons. Both influenza viruses and equine herpesvirus 1 were shown to be present in the horse population. The herpesvirus was associated with respiratory disease particularly in the winter but the equine influenza viruses apparently were responsible for the major epidemics of respiratory disease at these tracks. Younger horses, two or three years of age, were particularly susceptible to upper respiratory disease and showed the greatest rate of seroconversion to influenza viruses. Major outbreaks of respiratory disease occurred when the proportion of young horses which had not previously been exposed to epidemics of respiratory disease reached 30 to 40% of the population at the track. Most horses over four years of age appeared to develop resistance to the infections.     

Refraction as a basis for screening children for squint and amblyopia.

+2-00 to +2-75 dioptres of spherical hypermetropia in the more emmetropic of a pair of eyes is significantly associated with esotropia (P less than 0-001) and the presence of amblyopia (P less than 0-01). Anisometropia is not significantly associated with esotropia (P = 0-31) unless there is spherical hypermetropia of +2-00 dioptres or more in the more emmetropic eye (P less than 0-001). Hypermetropic anisometropia of +1-00 DS or +1-00 D.Cyl. is associated with the presence of amblyopia (P less than 0-001). In the absence of esotropia there is also a significant association between the amount of anisometropia and the initial depth of amblyopia (P less than 0-01). The additional presence of esotropia increases the depth of amblyopia further (P less than 0-05) but not the incidence of amblyopia (P greater than 0-30). The level of significance of the association of refractive errors with squint/amblyopia was itself significantly higher (P less than 0-01) than that between a family history of squint or "lazy eye" on the one hand and squint and/or amblyopia on the other hand. 72 +/- 3% of all cases of esotropia and/or amblyopia in this sample of children had a refractive error of +2-00 DS or more spherical hypermetropia in the more emmetropic eye, or +1-00 D. or more spherical or cylindrical anisometropia. Since there is a close association between the refraction and how, when, and whether a child presents with squint and/or amblyopia, it would seem reasonable to reconsider refraction as a basis for screening young children for visual defects.