Catastrophic failure of an uncemented acetabular component due to high wear and osteolysisAn analysis of 154 Omnifit prostheses with mean 6-year follow-up

Background?The purposes of this study were (1) to evaluate the wear pattern of the hydroxyapatite-coated “Dual Radius” Omnifit cup, (2) to investigate whether wear is correlated to any demographic or prosthesis-related factors, and (3) to describe micromotion of both the cup and the stem.Patients and methods?154 hips were implanted between 1990 and 1996 and followed for an average of 6 years. Wear was measured according to the “Charnley-duo” method and, in 79 hips, with radiostereometry (RSA). RSA was also used to evaluate micromotion. We analyzed the femoral heads using scanning electron microscopy, energy dispersive X-ray spectroscopy and an atomic force microscope.Result?66 cups were revised and had a mean annual wear of 0.32?mm compared to 0.12?mm in hips not revised. Osteolytic processes were observed in 35 hips but at revision osteolysis was present in 51 cases. 43/66 sockets were loose. Micromotion evaluated by RSA, weight, age, side, size of cup, screws, polyethylene thickness or shelf-life of the polyethylene did not correlate to wear, whereas male gender did.Interpretation?It is still unclear why about half of our cases had an abnormal wear rate. Annual wear exceeding 0.2?mm is prognostic of late failure and should be considered a warning sign.     

Untreated congenital and posttraumatic high dislocation of the hip treated by replacement in adult age22 hips in 16 patients followed for 18 years

Between 1993 and 2001, we replaced 22 hips in 16 patients with high dislocation of the hip. All but 1 case was due to congenital dislocation. In all cases the femur was osteotomized below the lesser trochanter and a straight uncemented stem inserted in the medullary canal. The acetabular prostheses were inserted at the site of the original acetabulum, usually after augmenting the acetabular rim by using the medial half of the resected proximal femur. The lateral part of the proximal femur with the intact attachment of the gluteus medius muscle was transposed and fixed to the femoral diaphysis thereby restoring direction of muscle pull. The HHS score increased from a median value of 42 points preoperatively to a median of 86 points after median 25 months of follow-up. Limp, which before surgery was severe in all cases, was less marked or had disappeared at follow-up. The legs had been lengthened median 2.5 (1.0–4.5) cm. No postoperative infections occurred. Palsy or loss of sensory function was not observed in any patient. Dislocation was the commonest complication. It occurred in 3 hips, 2 of which had to be revised to ensure stability.     

Therapists’ therapies: The relation between training therapy and patient change in long-term psychotherapy and psychoanalysis

Abstract

Patients’ development across stages in long-term psychodynamic psychotherapy or psychoanalysis was studied in relation to various parameters of their therapists’ training, or personal, therapies. The change variable was symptom distress, the General Symptom Index, according to the Symptom Checklist-90. A series of latent class regression analyses revealed that one class of therapists (16% of the sample) whose patients had the least change in treatment, and in fact had nonsignificant deterioration, was significantly overrepresented by psychotherapists with long psychoanalyses for their training therapies. Alternative interpretations of the findings are discussed.

Zusammenfassung

Die Therapien der Therapeuten: Die Beziehung zwischen Therapeutentraining und der Veränderungen der Patienten bei Langzeitpsychotherapie und Psychoanalyse

Entwicklung der Patienten in verschiedenen Stadien von Langzeittherapie oder Psychoanalyse wurde in Beziehung gesetzt zu verschiedenen Parametern der Ausbildung ihrer Therapeuten bzw. deren persönlicher Therapien. Die Veränderungsvariable war der Symptomstress entsprechend dem allgemeinen Symptomindex nach der Symptomcheckliste-90. Eine Reihe von Regression Analysen mit latenten Klassen zeigte eine Klasse von Therapeuten auf (16% der Stichprobe), deren Patienten die geringsten Veränderungen aber auch keine Verschlechterung aufwiesen. In dieser Klasse waren Psychotherapeuten mit langen Lehranalysen überrepräsentiert. Es werden auch alternative Interpretationen dieser Ergebnisse diskutiert.

Résumé

Les thérapies des thérapeutes?: la relation entre la thérapie didactique et le changement chez le patient dans la psychothérapie et psychanalyse de longue durée

Le développement des patients à travers les phases de psychothérapies psychodynamiques ou de psychanalyses de longue durée était étudié en relation à divers paramètres de la thérapie personnelle ou didactique de leurs thérapeutes. La variable de changement était la détresse symptomatique, le General Symptom Index selon la Symptom Checklist-90. Une série d'analyses par la régression par classe latente a révélé qu'une classe de thérapeutes (16% de l’échantillon) dont les patients avaient changé le moins voire se détérioraient de façon non significative était surreprésentée de façon significative par des psychothérapeutes ayant eu de longues psychanalyses comme thérapies didactiques. Des interprétations alternatives des résultats sont discutées.

Resumen

Terapia de terapeutas. La relación entre el tratamiento didáctico y el cambio del paciente en psicoterapia y psicoanálisis a largo plazo

Se estudió el desarrollo de los pacientes a través de etapas en psicoterapia psicodinámica o psicoanálisis a largo plazo, en relación con diversos parámetros del entrenamiento de sus terapeutas o terapias personales. La variable de cambio fue un síntoma de distrés, del ïndice General de Síntomas, de acuerdo con el Symptom Checklist-90. Una serie de análisis de regresión de clase latente reveló que una clase de terapeutas (16% de la muestra), cuyos pacientes habían experimentado el cambio menor en el tratamiento y que, de hecho, no tuvieron deterioro significativo, estuvo significativamente sobrerrepresentada por psicoterapias con psicoanálisis largos en sus terapias didácticas. Se debate sobre interpretaciones alternativas de los hallazgos.

Resumo

As terapias dos terapêutas: A relação entre terapia de treino e a mudança do paciente em psicoterapia de longo prazo e psicanálise

Foi estudada a relação entre o desenvolvimento dos pacientes ao longo dos estádios da psicoterapia psicodinâmica de longo prazo ou psicanálise e os vários parâmetros da terapia, de treino ou pessoal, dos seus terapeutas. A variável de mudança foi a sintomatologia psicopatológica, o Índice de Perturbação Geral da Lista de Sintomas de Derrogatis (SCL-90). Uma série de análises de regressão ( La Lent Class Regression) revelou que um grupo de terapeutas (16% da amostra), cujos pacientes tiveram as menores mudanças no tratamento e sem deterioração significativa, estava significativamente sobre-representados por psicoterapeutas com longa experiência de psicanálise para as suas terapias de treino. Serão discutidas interpretações alternativas para os resultados.

     

A 5-year retrospective study of survival of zirconia single crowns fitted in a private clinical setting

ObjectivesThe aim of this report was to evaluate the 5-year clinical performance and survival of zirconia (NobelProcera?) single crowns.MethodsAll patients treated with porcelain-veneered zirconia single crowns in a private practice during the period October 2004 to November 2005 were included. The records were scrutinized for clinical data. Information was available for 162 patients and 205 crowns.ResultsMost crowns (78%) were placed on premolars and molars. Out of the 143 crowns that were followed for 5 years, 126 (88%) did not have any complications. Of those with complications, the most common were: extraction of abutment tooth (7; 3%), loss of retention (15; 7%), need of endodontic treatment (9; 4%) and porcelain veneer fracture (6; 3%). No zirconia cores fractured. In total 19 restorations (9%) were recorded as failures: abutment tooth extraction (7), remake of crown due to lost retention (6), veneer fracture (4), persistent pain (1) and caries (1). The 5-year cumulative survival rate (CSR) was 88.8%.ConclusionsAccording to the present 5-year results zirconia crowns (NobelProcera?) are a promising prosthodontic alternative also in the premolar and molar regions. Out of the 143 crowns followed for 5 years, 126 (88%) did not have any complications. However, 9% of the restorations were judged as failures. Further studies are necessary to evaluate the long-term success.     

Rapid Restoration of Vascularity and Oxygenation in Mouse and Human Islets Transplanted to Omentum May Contribute to Their Superior Function Compared to Intraportally Transplanted Islets

Transplantation of islets into the liver confers several site‐specific challenges, including a delayed vascularization and prevailing hypoxia. The greater omentum has in several experimental studies been suggested as an alternative implantation site for clinical use, but there has been no direct functional comparison to the liver. In this experimental study in mice, we characterized the engraftment of mouse and human islets in the omentum and compared engraftment and functional outcome with those in the intraportal site. The vascularization and innervation of the islets transplanted into the omentum were restored within the first month by paralleled ingrowth of capillaries and nerves. The hypoxic conditions in the islets early posttransplantation were transient and restricted to the first days. Newly formed blood vessels were fully functional, and the blood perfusion and oxygenation of the islets became similar to that of endogenous islets. Furthermore, islet grafts in the omentum showed at 1 month posttransplantation functional superiority to intraportally transplanted grafts. We conclude that in contrast to the liver the omentum provides excellent engraftment conditions for transplanted islets. Future studies in humans will be of great interest to investigate the capability of this site to also harbor larger grafts without interfering with islet functionality.     

The presence of inhibitory RNA elements in the late 3'-untranslated region is a conserved property of human papillomaviruses

Here we have tested the inhibitory activity of the late untranslated region (UTR) of nine different human papillomavirus (HPV) types representing three different genera and six different species. These HPVs include both low-risk and high-risk types. We found that the late UTR of the various HPVs all displayed inhibitory activity, although they inhibited gene expression to various extent. The late UTR from the two distantly related HPV types 1 and 16, which are two different species that belong to different genera, each interacted with a 55 kDa protein. This protein cross-linked specifically to both HPV-1 and HPV-16 late UTR, although it bound more strongly to HPV-16 than to HPV-1, which correlated with the higher inhibitory activity of the HPV-16 late UTR. Mutagenesis experiments revealed that inactivation of two UGUUUGU motifs in the HPV-16 late UTR or two UAUUUAU motifs in the HPV-1 late UTR resulted in loss of binding of p55. In summary, these results demonstrate that the presence inhibitory elements encoding PuU(3-5)Pu-motifs in the HPV late UTR is a conserved property of different HPV types, species and genera, and suggest that these elements play an important role in the viral life cycle.