IntroductionLag screw cutout is one of the most commonly reported complications following intramedullary nail fixation of intertrochanteric femur fractures. However, its occurrence can be minimized by a well-positioned implant, with a short Tip-to-Apex Distance (TAD). Computer-assisted navigation systems provide surgeons with the ability to track screw placement in real-time. This could allow for improved lag screw placement and potentially reduce radiation exposure to the patient and surgeon.MethodsBetween Oct 2014 and Jan 2016, patients with intertrochanteric femur fractures being treated with intramedullary nail fixation by one of three fellowship-trained orthopaedic traumatologists were enrolled. Inclusion criteria were low-energy mechanism of injury and fracture class 31-A1/A2. Open fractures and patients with multiple injuries to the lower extremity were excluded. Patients were randomly assigned to computer-assisted navigation or a conventional fluoroscopic technique for lag screw placement. The primary outcomes were TAD, measured by postoperative anteroposterior and lateral x-rays by an independent reviewer, and radiation exposure measured in seconds of fluoroscopy time. Surgical time was also recorded.Results50 patients were randomized, 26 to the computer-assisted navigation group and 24 to the control group. The mean manually-measured TAD in the computer-assisted navigation group was 14.1 mm ± 3.2 and in the control group was 14.9 mm ± 3.0 (p = 0.394). There was no difference between groups in total radiation time (navigation: 58.8 s ± 23.6, control: 56.5 s ± 28.5, p = 0.337) or radiation time during lag screw placement (navigation: 19.4 s ± 8.8, control: 18.8 s ± 8.0, p = 0.522). The surgical time was significantly longer in the computer-assisted navigation group with a mean surgical time of 45.8 min ± 9.8 compared to 38.4 min ± 9.3 in the control group (p = 0.009).ConclusionsComputer-assisted navigation consistently produced excellent TADs, however it was not significantly better than conventional methods when done by fellowship-trained orthopaedic traumatologists. Surgeons with a lower volume trauma practice could potentially benefit from computer-assisted navigation to obtain better TAD. 相似文献
The purpose of this study was to determine whether the response AC/A ratio could be altered when the subject's interpupillary distance (IPD) was optically halved. We measured the changes in the AC/A ratio for 10 subjects after using the optical device for 30 min. Accommodative response was measured using a Canon R-1 optometer, and vergence response was measured with an ASL 210 Eye Movement Monitor. The average AC/A ratios were 1.20+/-0.35 (SD) (MA/D) and 0.84+/-0.39 (MA/D) before and after wearing the device, respectively. The decrease in AC/A ratio was statistically significant (p=0.01). This was mainly caused by a reduction in the slope of the accommodative vergence. The results of this study suggest that the AC/A ratio can be decreased if an IPD-narrowing device is used. A possible application of this mechanism in the study of myopia is discussed. 相似文献
Purpose: To use the time-dependent linear-quadratic model, both in the standard form and in a form modified to incorporate intertumor heterogeneity, in a reanalysis of 4 datasets for larynx tumor control, to provide more representative and direct estimates of the lag period, the time factor (λ/), and the clonogen population inactivation dose ([lnk]/).
Methods and Materials: The data comprised 2,225 patients treated in Edinburgh (UK), Glasgow (UK), Manchester (UK), or Toronto (Canada), with tumor control assessed after at least 2 years. Heterogeneity in each series was taken into account using the coefficient of variation (CV) of the clonogen radiosensitivity (). Maximum likelihood techniques were used to provide best estimates of the parameters, and also direct estimation of the more stable parameter ratios of interest.
Results: The use of different heterogeneity factors for the different series allowed common dose/time parameters to be fitted across all four series in a way not possible using the standard model, enabling the inherent effect of heterogeneity in flattening dose-response curves and in reducing time factors to be separated from the underlying more-representative values. Radiosensitivity CVs were calculated to be 30% (Edinburgh), 36% (Glasgow), 40% (Manchester), and 71% (Toronto). The lag phase was 32 days (95% CL 20–38 days) which was longer than the value of 23 days (11–36 days) deduced using the standard model without the heterogeneity parameter. The time factor was 1.2 (0.8–2.2) Gy/day, again greater than the value of 0.80 (0.54–1.41) Gy/day derived using the standard model. Similar larger time factors and longer lag periods could be reproduced using the standard model either by using a parameterization based on parameter ratios, or by omitting the discordant Toronto data and refitting just the data from the three UK centers.
Conclusion: It was concluded that the heterogeneity model provides a better representation of the time factor for tumor control when data are analyzed comprising different stages of disease treated at different centers. The model allows different amounts of heterogeneity in different series, which tend to flatten dose-responses curves and reduce time factors, to be taken in to account. Also, direct maximum likelihood estimates can be made of the lag period, the time factor (λ/), and the fractionation sensitivity (β/), as well as the clonogen population inactivation dose (lnk)/. Values of these parameter ratios are more robust and stable than the individual parameter values. The results of the present analysis using a total of 2,225 patients from four centers indicate that the average lag period may be somewhat longer and the average time factor somewhat greater (and the 95% confidence limits of the time factor exclude previous estimates), than the values deduced previously using simpler models and more diverse multi-center datasets. 相似文献
Summary
Background Gastric emptying of non-nutrient liquids usually lacks the presence of an initial delay phase (lag phase), and so it has
been considered to be monoexponential with an initial rapid phase followed by a slower emptying phase. However a lag phase
in the gastric emptying of liquids can be found if there is a high caloric density in the liquid meal. Aims of the study To characterise with stable isotopes the presence of a lag phase in the gastric emptying of non-sold meals. Methods Healthy volunteers ingested a low caloric liquid meal (345 KJ/200 mL) (LCLM), a high caloric liquid meal (1135 KJ/180 mL)
(HCLM) or a semisolid meal (1403 KJ/500 mL) (SSM). Test meals were labelled with 13C-acetate. Breath samples were collected for 13>CO2 measurement and data were fitted to a power exponential function. Results Non-solid meals can have different behaviour related to the initial emptying. The presence of a lag phase in the gastric
emptying of liquids was not masked by the processing of the tracer previous to its detection in breath. While the LCLM and
SSM showed a rapid initial emptying phase (no lag phase), the HCLM has an initial slow emptying phase. The slower gastric
emptying of the HCLM compared to the SSM was related to the presence of a lag phase in the gastric emptying of the HCLM. Conclusions The 13C-acetate breath test is very accurate to identify and study the lag phase if present of liquid meals. 相似文献
Objective To compare the visual performance of accommodative IOLS and that of multifocal IOLs implantation after phacoemulsification. Methods A total of 40 eyes from 30 patients undergoing phacoemulsification received intraocular lens based on the principle of voluntary. Ten eyes from 20 patients who had implantation of Tetraflex accommodative intraocular lens were randomized into group 1. Thirty eyes from 20 patients who had implantation of +3.0 aspheric ReSTOR multifocal intraocular lens were randomized into group 2. Main outcome measures included best corrected distance visual acuity, distance corrected near vision, near point, intermediate vision, and the accommodation amplitude. All the clinical data were obtained at 6months postoperatively. Results No patients had undergone any complications. At 6 months postoperatively,best corrected distance visual acuity were similar between the groupl and group2 (-0.23± 0.09LogMAR versus-0.14 ± 0.08LogMAR, P =0.085). Distance corrected near vision were similar between the two groups (J3/40cm versusJ1/35cm, P =0.035). Subjective near point were similar between the two groups [(39± 10) cm versus (35± 9) cm F=0.065, P=0.80]. The accommodation amplitude were similar between the two groups [(1.94± 0.13)D versus (2.08± 0.63)D, P =0.093]. The defocus line showed a double-peak in group 2 and single peak in group 1 which declined at intermediate distance. Conclusions Both accommodative IOLs and multifocal IOLs can correct presbyopia effectively after operation. It is best to prefer the proper IOLs for patients. 相似文献