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Background

Obesity has been associated with varying adverse outcomes related to total knee arthroplasty (TKA) and has long been associated with various mechanical complications. Computational modeling holds promise for investigating biomechanical aberrations related to TKA in obese patients. However, basic anthropometric information regarding the shape of the lower extremity in obese patients is lacking. We, therefore, developed a method to determine lower extremity shape both generally and subject specific as a function of body mass index (BMI) and sex.

Methods

A unique set of 4 radiographs (knee anteroposterior/lateral; EOS long-leg alignment anteroposterior/lateral) were reviewed for patients with BMI exceeding 30 kg/m2 before undergoing TKA. Soft tissue thickness in both the coronal and sagittal planes, including anterior adipose tissue thickness overlying the tibial tubercle and patella, was measured. Elliptical parameters were then determined for any distance along the lower extremity. Additional measurements were obtained, including prepatellar thickness and pretubercular thickness and anteroposterior and mediolateral dimensions of the proximal tibia. A total of 232 obese subjects were analyzed.

Results

Girth increased as a function of BMI. Anterior prepatellar and pretubercular subcutaneous fat thickness in females exceeded that in males for all values of BMI. Wide variation was seen with regard to overall patterns of adiposity among same-sex subjects with similar BMI. Proximal tibial osseous dimensions did not demonstrate an association with BMI; however, males were found to have deeper and wider tibias compared with females.

Conclusions

BMI and sex influence lower extremity shape. The prediction algorithms developed here holds implications for future biomechanical studies of TKA in obese patients.  相似文献   
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The use of point-of-care ultrasound in trauma provides diagnostic clarity and routinely influences management. A scanning protocol known as the Focused Assessment with Sonography in Trauma (FAST) has been widely adopted by trauma providers of all specialties. The FAST exam addresses a broad array of pathologic conditions capable of causing instability, including hemoperitoneum, hemopericardium, hemothorax, and pneumothorax. The exam is an integral component to the primary assessment of injured patients and an iconic application of point-of-care ultrasound.This review article aims to summarize the application of the FAST exam with special consideration, where relevant, to anesthesiologists. The scope of the FAST exam, technical considerations, and clinical decision-making in trauma are explored.  相似文献   
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Schneider  F.  Schulz  C. M.  May  M.  Schneider  G.  Jacob  M.  Mutlak  H.  Pawlik  M.  Zoller  M.  Kretzschmar  M.  Koch  C.  Kees  M. G.  Burger  M.  Lebentrau  S.  Novotny  A.  Hübler  M.  Koch  T.  Heim  M. 《Der Anaesthesist》2020,69(3):162-169
Die Anaesthesiologie - Vor dem Hintergrund einer stetig zunehmenden Gesundheitsgefährdung durch multiresistente Erreger spielt neben der Bevölkerungsaufklärung, der Fachkenntnis und...  相似文献   
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Convection-based renal replacement therapies (RRTs) have the potential to improve patient outcomes when compared to diffusion-based RRT such as hemodialysis (HD), but have limited clearance rates. We propose and characterize multipoint dilution hemofiltration (MPD-HF), a purely convective blood purification technology which removes the fundamental filtration limit associated with convective RRT resulting in clearance rates on par with HD. In MPD-HF, filtration of liquid and solutes occurs along the length of the hollow fibers that convey the blood, and substitution fluid is pushed into the fibers at multiple points along their length. Since multiple filtration and dilution steps are contained within one pass of the blood through the hollow fiber, the fraction of fluid that can be filtered may be increased to allow a high clearance rate that removes a wide range of toxins. In vitro tests yielded an average steady-state filtrate fraction of 68%, exceeding commercial HDF cartridge filtrate fractions by a factor of approximately 3. The molecular weights of molecules cleared spans up to the cutoff of 66 kDa for albumin.  相似文献   
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