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1.
Sibanda N Copley LP Lewsey JD Borroff M Gregg P MacGregor AJ Pickford M Porter M Tucker K van der Meulen JH;Steering Committee of the National Joint Registry 《PLoS medicine》2008,5(9):e179
Background
Hip and knee replacement are some of the most frequently performed surgical procedures in the world. Resurfacing of the hip and unicondylar knee replacement are increasingly being used. There is relatively little evidence on their performance. To study performance of joint replacement in England, we investigated revision rates in the first 3 y after hip or knee replacement according to prosthesis type.Methods and Findings
We linked records of the National Joint Registry for England and Wales and the Hospital Episode Statistics for patients with a primary hip or knee replacement in the National Health Service in England between April 2003 and September 2006. Hospital Episode Statistics records of succeeding admissions were used to identify revisions for any reason. 76,576 patients with a primary hip replacement and 80,697 with a primary knee replacement were included (51% of all primary hip and knee replacements done in the English National Health Service). In hip patients, 3-y revision rates were 0.9% (95% confidence interval [CI] 0.8%–1.1%) with cemented, 2.0% (1.7%–2.3%) with cementless, 1.5% (1.1%–2.0% CI) with “hybrid” prostheses, and 2.6% (2.1%–3.1%) with hip resurfacing (p < 0.0001). Revision rates after hip resurfacing were increased especially in women. In knee patients, 3-y revision rates were 1.4% (1.2%–1.5% CI) with cemented, 1.5% (1.1%–2.1% CI) with cementless, and 2.8% (1.8%–4.5% CI) with unicondylar prostheses (p < 0.0001). Revision rates after knee replacement strongly decreased with age.Interpretation
Overall, about one in 75 patients needed a revision of their prosthesis within 3 y. On the basis of our data, consideration should be given to using hip resurfacing only in male patients and unicondylar knee replacement only in elderly patients. 相似文献2.
Background
There is a lack of evidence on the effectiveness or cost-effectiveness of alternative brands of prosthesis for total knee replacement (TKR). We compared patient-reported outcomes, revision rates, and costs, and estimated the relative cost-effectiveness of five frequently used cemented brands of unconstrained prostheses with fixed bearings (PFC Sigma, AGC Biomet, Nexgen, Genesis 2, and Triathlon).Methods
We used data from three national databases for patients who had a TKR between 2003 and 2012, to estimate the effect of prosthesis brand on post-operative quality of life (QOL) (EQ-5D-3L) in 53 126 patients at six months. We compared TKR revision rates by brand over 10 years for 239 945 patients. We used a fully probabilistic Markov model to estimate lifetime costs and quality-adjusted life years (QALYs), incremental cost effectiveness ratios (ICERs), and the probability that each prosthesis brand is the most cost effective at alternative thresholds of willingness-to-pay for a QALY gain.Findings
Revision rates were lowest with the Nexgen and PFC Sigma (2.5% after 10 years in 70-year-old women). Average lifetime costs were lowest with the AGC Biomet (£9 538); mean post-operative QOL was highest with the Nexgen, which was the most cost-effective brand across all patient subgroups. For example, for 70-year-old men and women, the ICERs for the Nexgen compared to the AGC Biomet were £2 300 per QALY. At realistic cost per QALY thresholds (£10 000 to £30 000), the probabilities that the Nexgen is the most cost-effective brand are about 98%. These results were robust to alternative modelling assumptions.Conclusions
AGC Biomet prostheses are the least costly cemented unconstrained fixed brand for TKR but Nexgen prostheses lead to improved patient outcomes, at low additional cost. These results suggest that Nexgen should be considered as a first choice prosthesis for patients with osteoarthritis who require a TKR. 相似文献3.
A. S. Dickinson 《Biomechanics and modeling in mechanobiology》2016,15(1):181-194
Bone morphology and density changes are commonly observed following joint replacement, may contribute to the risks of implant loosening and periprosthetic fracture and reduce the available bone stock for revision surgery. This study was presented in the ‘Bone and Cartilage Mechanobiology across the scales’ WCCM symposium to review the development of remodelling prediction methods and to demonstrate simulation of adaptive bone remodelling around hip replacement femoral components, incorporating intrinsic (prosthesis) and extrinsic (activity and loading) factors. An iterative bone remodelling process was applied to finite element models of a femur implanted with a cementless total hip replacement (THR) and a hip resurfacing implant. Previously developed for a cemented THR implant, this modified process enabled the influence of pre- to post-operative changes in patient activity and joint loading to be evaluated. A control algorithm used identical pre- and post-operative conditions, and the predicted extents and temporal trends of remodelling were measured by generating virtual X-rays and DXA scans. The modified process improved qualitative and quantitative remodelling predictions for both the cementless THR and resurfacing implants, but demonstrated the sensitivity to DXA scan region definition and appropriate implant–bone position and sizing. Predicted remodelling in the intact femur in response to changed activity and loading demonstrated that in this simplified model, although the influence of the extrinsic effects were important, the mechanics of implantation were dominant. This study supports the application of predictive bone remodelling as one element in the range of physical and computational studies, which should be conducted in the preclinical evaluation of new prostheses. 相似文献
4.
Stefan Kinkel Jan Nadorf Jan Dennis Graage Eike Jakubowitz Jan Philippe Kretzer 《PloS one》2015,10(6)
Purpose
Fixation of proximal femoral megaprostheses is achieved in the diaphyseal isthmus. We hypothesized that after extended bone resection including the proximal part of the isthmus a reduced length of fixation will affect the stability and fixation characteristics of these megaprostheses. The aim of this study was to analyze in a validated sawbone model with extended proximal femoral defects which types of implants have sufficient primary stability to allow osteointegration and to describe their fixation characteristics.Methods
Four different cementless megaprostheses were implanted into 16 Sawbones with an AAOS type III defect after resection 11cm below the lesser trochanter involving the proximal isthmus. To determine the primary implant stability relative micromotions between bone and implant were measured in relation to a cyclic torque of 7Nm applied on the longitudinal axis of the implant. We determined the fixation characteristics of the different implant designs by comparing these relative micromotions along the longitudinal stem axis.Results
In the tested sawbones all studied implants showed sufficient primary stability to admit bone integration with relative micromotions below 150µm after adapting our results to physiologic hip joint loadings. Different fixation characteristics of the megaprostheses were determined, which could be explained by their differing design and fixation concepts.Conclusions
Cementless megaprostheses of different designs seem to provide sufficient primary stability to bridge proximal femoral defects if the diaphyseal isthmus is partially preserved. In our sawbone model the different implant fixation patterns can be related to their stem designs. No evidence can be provided to favor one of the studied implants in this setting. However, femoral morphology is variable and in different isthmus configurations specific implant designs might be appropriate to achieve the most favorable primary stability, which enables bone integration and consequently long term implant stability. 相似文献5.
Alexander Tsertsvadze Amy Grove Karoline Freeman Rachel Court Samantha Johnson Martin Connock Aileen Clarke Paul Sutcliffe 《PloS one》2014,9(7)
Background
Evolvements in the design, fixation methods, size, and bearing surface of implants for total hip replacement (THR) have led to a variety of options for healthcare professionals to consider. The need to determine the most optimal combinations of THR implant is warranted. This systematic review evaluated the clinical effectiveness of different types of THR used for the treatment of end stage arthritis of the hip.Methods
A comprehensive literature search was undertaken in major health databases. Randomised controlled trials (RCTs) and systematic reviews published from 2008 onwards comparing different types of primary THR in patients with end stage arthritis of the hip were included.Results
Fourteen RCTs and five systematic reviews were included. Patients experienced significant post-THR improvements in Harris Hip scores, but this did not differ between impact types. There was a reduced risk of implant dislocation after receiving a larger femoral head size (36 mm vs. 28 mm; RR = 0.17, 95% CI: 0.04, 0.78) or cemented cup (vs. cementless cup; pooled odds ratio: 0.34, 95% CI: 0.13, 0.89). Recipients of cross-linked vs. conventional polyethylene cup liners experienced reduced femoral head penetration and revision. There was no impact of femoral stem fixation and cup shell design on implant survival rates. Evidence on mortality and complications (aseptic loosening, femoral fracture) was inconclusive.Conclusions
The majority of evidence was inconclusive due to poor reporting, missing data, or uncertainty in treatment estimates. The findings warrant cautious interpretation given the risk of bias (blinding, attrition), methodological limitations (small sample size, low event counts, short follow-up), and poor reporting. Long-term pragmatic RCTs are needed to allow for more definitive conclusions. Authors are encouraged to specify the minimal clinically important difference and power calculation for their primary outcome(s) as well CONSORT, PRISMA and STROBE guidelines to ensure better reporting and more reliable production and assessment of evidence. 相似文献6.
Kerryl E. Piper Marta Fernandez-Sampedro Kathryn E. Steckelberg Jayawant N. Mandrekar Melissa J. Karau James M. Steckelberg Elie F. Berbari Douglas R. Osmon Arlen D. Hanssen David G. Lewallen Robert H. Cofield John W. Sperling Joaquin Sanchez-Sotelo Paul M. Huddleston Mark B. Dekutoski Michael Yaszemski Bradford Currier Robin Patel 《PloS one》2010,5(2)
Background
C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) have been shown to be useful for diagnosis of prosthetic hip and knee infection. Little information is available on CRP and ESR in patients undergoing revision or resection of shoulder arthroplasties or spine implants.Methods/Results
We analyzed preoperative CRP and ESR in 636 subjects who underwent knee (n = 297), hip (n = 221) or shoulder (n = 64) arthroplasty, or spine implant (n = 54) removal. A standardized definition of orthopedic implant-associated infection was applied. Receiver operating curve analysis was used to determine ideal cutoff values for differentiating infected from non-infected cases. ESR was significantly different in subjects with aseptic failure infection of knee (median 11 and 53.5 mm/h, respectively, p = <0.0001) and hip (median 11 and 30 mm/h, respectively, p = <0.0001) arthroplasties and spine implants (median 10 and 48.5 mm/h, respectively, p = 0.0033), but not shoulder arthroplasties (median 10 and 9 mm/h, respectively, p = 0.9883). Optimized ESR cutoffs for knee, hip and shoulder arthroplasties and spine implants were 19, 13, 26, and 45 mm/h, respectively. Using these cutoffs, sensitivity and specificity to detect infection were 89 and 74% for knee, 82 and 60% for hip, and 32 and 93% for shoulder arthroplasties, and 57 and 90% for spine implants. CRP was significantly different in subjects with aseptic failure and infection of knee (median 4 and 51 mg/l, respectively, p<0.0001), hip (median 3 and 18 mg/l, respectively, p<0.0001), and shoulder (median 3 and 10 mg/l, respectively, p = 0.01) arthroplasties, and spine implants (median 3 and 20 mg/l, respectively, p = 0.0011). Optimized CRP cutoffs for knee, hip, and shoulder arthroplasties, and spine implants were 14.5, 10.3, 7, and 4.6 mg/l, respectively. Using these cutoffs, sensitivity and specificity to detect infection were 79 and 88% for knee, 74 and 79% for hip, and 63 and 73% for shoulder arthroplasties, and 79 and 68% for spine implants.Conclusion
CRP and ESR have poor sensitivity for the diagnosis of shoulder implant infection. A CRP of 4.6 mg/l had a sensitivity of 79 and a specificity of 68% to detect infection of spine implants. 相似文献7.
Kazuya Doi Hiroshi Oue Koji Morita Shiho Kajihara Takayasu Kubo Katsunori Koretake Vittoria Perrotti Giovanna Iezzi Adriano Piattelli Yasumasa Akagawa 《PloS one》2012,7(11)
Background
Dental implant has been successfully used to replace missing teeth. However, in some clinical situations, implant placement may be difficult because of a large bone defect. We designed novel complex biomaterial to simultaneously restore bone and place implant. This complex was incorporated implant into interconnected porous calcium hydroxyapatite (IP-CHA). We then tested this Implant/IP-CHA complex and evaluated its effect on subsequent bone regeneration and implant stability in vivo.Methodology/Principal Findings
A cylinder-type IP-CHA was used in this study. After forming inside of the cylinder, an implant was placed inside to fabricate the Implant/IP-CHA complex. This complex was then placed into the prepared bone socket in the femur of four beagle-Labrador hybrid dogs. As a control, implants were placed directly into the femur without any bone substrate. Bone sockets were allowed to heal for 2, 3 and 6 months and implant stability quotients (ISQ) were measured. Finally, tissue blocks containing the Implant/IP-CHA complexes were harvested. Specimens were processed for histology and stained with toluidine blue and bone implant contact (BIC) was measured. The ISQs of complex groups was 77.8±2.9 in the 6-month, 72.0±5.7 in the 3-month and 47.4±11.0 in the 2-month. There was no significant difference between the 3- or 6-month complex groups and implant control groups. In the 2-month group, connective tissue, including capillary angiogenesis, was predominant around the implants, although newly formed bone could also be observed. While, in the 3 and 6-month groups, newly formed bone could be seen in contact to most of the implant surface. The BICs of complex groups was 2.18±3.77 in the 2-month, 44.03±29.58 in the 3-month, and 51.23±8.25 in the 6-month. Significant difference was detected between the 2 and 6-month.Conclusions/Significance
Within the results of this study, the IP-CHA/implant complex might be able to achieve both bone reconstruction and implant stability. 相似文献8.
Malte N. Bongers Christoph Schabel Christoph Thomas Rainer Raupach Mike Notohamiprodjo Konstantin Nikolaou Fabian Bamberg 《PloS one》2015,10(11)
Purpose
To compare and combine dual-energy based and iterative metal artefact reduction on hip prosthesis and dental implants in CT.Material and Methods
A total of 46 patients (women:50%,mean age:63±15years) with dental implants or hip prostheses (n = 30/20) were included and examined with a second-generation Dual Source Scanner. 120kV equivalent mixed-images were derived from reconstructions of the 100/Sn140kV source images using no metal artefact reduction (NOMAR) and iterative metal artefact reduction (IMAR). We then generated monoenergetic extrapolations at 130keV from source images without IMAR (DEMAR) or from source images with IMAR, (IMAR+DEMAR). The degree of metal artefact was quantified for NOMAR, IMAR, DEMAR and IMAR+DEMAR using a Fourier-based method and subjectively rated on a five point Likert scale by two independent readers.Results
In subjects with hip prosthesis, DEMAR and IMAR resulted in significantly reduced artefacts compared to standard reconstructions (33% vs. 56%; for DEMAR and IMAR; respectively, p<0.005), but the degree of artefact reduction was significantly higher for IMAR (all p<0.005). In contrast, in subjects with dental implants only IMAR showed a significant reduction of artefacts whereas DEMAR did not (71%, vs. 8% p<0.01 and p = 0.1; respectively). Furthermore, the combination of IMAR with DEMAR resulted in additionally reduced artefacts (Hip prosthesis: 47%, dental implants 18%; both p<0.0001).Conclusion
IMAR allows for significantly higher reduction of metal artefacts caused by hip prostheses and dental implants, compared to a dual energy based method. The combination of DE-source images with IMAR and subsequent monoenergetic extrapolation provides an incremental benefit compared to both single methods. 相似文献9.
10.
Setor K. Kunutsor Michael R. Whitehouse Ashley W. Blom Andrew D. Beswick INFORM Team 《PloS one》2015,10(9)
Background
The two-stage revision strategy has been claimed as being the “gold standard” for treating prosthetic joint infection. The one-stage revision strategy remains an attractive alternative option; however, its effectiveness in comparison to the two-stage strategy remains uncertain.Objective
To compare the effectiveness of one- and two-stage revision strategies in treating prosthetic hip infection, using re-infection as an outcome.Design
Systematic review and meta-analysis.Data Sources
MEDLINE, EMBASE, Web of Science, Cochrane Library, manual search of bibliographies to March 2015, and email contact with investigators.Study Selection
Cohort studies (prospective or retrospective) conducted in generally unselected patients with prosthetic hip infection treated exclusively by one- or two-stage revision and with re-infection outcomes reported within two years of revision. No clinical trials were identified.Review Methods
Data were extracted by two independent investigators and a consensus was reached with involvement of a third. Rates of re-infection from 38 one-stage studies (2,536 participants) and 60 two-stage studies (3,288 participants) were aggregated using random-effect models after arcsine transformation, and were grouped by study and population level characteristics.Results
In one-stage studies, the rate (95% confidence intervals) of re-infection was 8.2% (6.0–10.8). The corresponding re-infection rate after two-stage revision was 7.9% (6.2–9.7). Re-infection rates remained generally similar when grouped by several study and population level characteristics. There was no strong evidence of publication bias among contributing studies.Conclusion
Evidence from aggregate published data suggest similar re-infection rates after one- or two-stage revision among unselected patients. More detailed analyses under a broader range of circumstances and exploration of other sources of heterogeneity will require collaborative pooling of individual participant data.Systematic Review Registration
PROSPERO 2015: CRD42015016559 相似文献11.
Rodolfo Mastropasqua Lisa Toto Enrico Borrelli Luca Di Antonio Chiara De Nicola Alessandra Mastrocola Marta Di Nicola Paolo Carpineto 《PloS one》2015,10(12)
Background
To investigate changes in macular morphology and function after an intravitreal dexamethasone implant for diabetic macular edema (DME).Methods
Twenty-seven eyes in 27 treatment-naive patients affected by DME were treated with intravitreal Ozurdex® injections (IVOI) and followed up 12 months to evaluate morphological and functional changes by means of best-corrected visual acuity (BCVA), microperimetry (MP1), multifocal electroretinography (mfERG), pattern electroretinography (PERG) and spectral domain optical coherence tomography (SD-OCT).Results
Both BCVA and retinal sensitivity improved significantly at one month after the IVOI (p = 0.031 and p<0.0001, respectively). After five months, the improvement of BCVA remained statistically significant compared with baseline values (p = 0.022); retinal sensitivity improvement was statistically significant for up to four months after the IVOI (p = 0.059). Moreover, central macular thickness significantly decreased for up to four months. Interestingly, PERG and mfERG values did not change significantly for up to four months post-IVOI, but then began to worsen.Conclusions
In eyes with DME, intravitreal dexamethasone implant determined morphological and functional improvement as soon as one month and for up to four months after the treatment. 相似文献12.
Objectives
To estimate the annual cost to patients, the health service and society of infectious intestinal disease (IID) from Campylobacter, norovirus and rotavirus.Design
Secondary data analysis.Setting
The United Kingdom population, 2008–9.Main outcome measures
Cases and frequency of health services usage due to these three pathogens; associated healthcare costs; direct, out-of-pocket expenses; indirect costs to patients and caregivers.Results
The median estimated costs to patients and the health service at 2008–9 prices were: Campylobacter £50 million (95% CI: £33m–£75m), norovirus £81 million (95% CI: £63m–£106m), rotavirus £25m (95% CI: £18m–£35m). The costs per case were approximately £30 for norovirus and rotavirus, and £85 for Campylobacter. This was mostly borne by patients and caregivers through lost income or out-of-pocket expenditure. The cost of Campylobacter-related Guillain-Barré syndrome hospitalisation was £1.26 million (95% CI: £0.4m–£4.2m).Conclusions
Norovirus causes greater economic burden than Campylobacter and rotavirus combined. Efforts to control IID must prioritise norovirus. For Campylobacter, estimated costs should be considered in the context of expenditure to control this pathogen in agriculture, food production and retail. Our estimates, prior to routine rotavirus immunisation in the UK, provide a baseline vaccine cost-effectiveness analyses. 相似文献13.
Nicholas M. Bernthal Alexandra I. Stavrakis Fabrizio Billi John S. Cho Thomas J. Kremen Scott I. Simon Ambrose L. Cheung Gerald A. Finerman Jay R. Lieberman John S. Adams Lloyd S. Miller 《PloS one》2010,5(9)
Background
Post-arthroplasty infections represent a devastating complication of total joint replacement surgery, resulting in multiple reoperations, prolonged antibiotic use, extended disability and worse clinical outcomes. As the number of arthroplasties in the U.S. will exceed 3.8 million surgeries per year by 2030, the number of post-arthroplasty infections is projected to increase to over 266,000 infections annually. The treatment of these infections will exhaust healthcare resources and dramatically increase medical costs.Methodology/Principal Findings
To evaluate novel preventative therapeutic strategies against post-arthroplasty infections, a mouse model was developed in which a bioluminescent Staphylococcus aureus strain was inoculated into a knee joint containing an orthopaedic implant and advanced in vivo imaging was used to measure the bacterial burden in real-time. Mice inoculated with 5×103 and 5×104 CFUs developed increased bacterial counts with marked swelling of the affected leg, consistent with an acute joint infection. In contrast, mice inoculated with 5×102 CFUs developed a low-grade infection, resembling a more chronic infection. Ex vivo bacterial counts highly correlated with in vivo bioluminescence signals and EGFP-neutrophil fluorescence of LysEGFP mice was used to measure the infection-induced inflammation. Furthermore, biofilm formation on the implants was visualized at 7 and 14 postoperative days by variable-pressure scanning electron microscopy (VP-SEM). Using this model, a minocycline/rifampin-impregnated bioresorbable polymer implant coating was effective in reducing the infection, decreasing inflammation and preventing biofilm formation.Conclusions/Significance
Taken together, this mouse model may represent an alternative pre-clinical screening tool to evaluate novel in vivo therapeutic strategies before studies in larger animals and in human subjects. Furthermore, the antibiotic-polymer implant coating evaluated in this study was clinically effective, suggesting the potential for this strategy as a therapeutic intervention to combat post-arthroplasty infections. 相似文献14.
Arief Lalmohamed Alexander J. MacGregor Frank de Vries Hubertus G. M. Leufkens Tjeerd P. van Staa 《PloS one》2013,8(7)
Background
There are concerns that metal-on-metal hip implants may cause cancer. The objective of this study was to evaluate patterns and timing of risk of cancer in patients with metal-on-metal total hip replacements (THR).Methods
In a linkage study between the English National Joint Registry (NJR) and the Clinical Practice Research Datalink (CPRD), we selected all THR surgeries (NJR) between 2003 and 2010 (n = 11,540). THR patients were stratified by type of bearing surface. Patients were followed up for cancer and Poisson regression was used to derive adjusted relative rates (RR).Results
The risk of cancer was similar in patients with hip resurfacing (RR 0.69; 95% Confidence Interval [CI] 0.39–1.22) or other types of bearing surfaces (RR 0.96; 95% CI 0.64–1.43) compared to individuals with stemmed metal-on-metal THR. The pattern of cancer risk over time did not support a detrimental effect of metal hip implants. There was substantial confounding: patients with metal-on-metal THRs used fewer drugs and had less comorbidity.Conclusions
Metal-on-metal THRs were not associated with an increased risk of cancer. There were substantial baseline differences between the different hip implants, indicating possibility of confounding in the comparisons between different types of THR implants. 相似文献15.
Luis Gracia Elena Ibarz Sergio Puértolas José Cegoñino Fernando López-Prats Juan J Panisello Antonio Herrera 《Biomedical engineering online》2010,9(1):22
Background
A hip replacement with a cemented or cementless femoral stem produces an effect on the bone called adaptive remodelling, attributable to mechanical and biological factors. All of the cementless prostheses designs try to achieve an optimal load transfer in order to avoid stress-shielding, which produces an osteopenia. 相似文献16.
Jean-Christian Borel Pascale Roux-Lombard Renaud Tamisier Claire Arnaud Denis Monneret Nathalie Arnol Jean-Philippe Baguet Patrick Levy Jean-Louis Pepin 《PloS one》2009,4(8)
Background
Obesity hypoventilation syndrome (OHS) is associated with increased cardiovascular morbidity. What moderate chronic hypoventilation adds to obesity on systemic inflammation and endothelial dysfunction remains unknown.Question
To compare inflammatory status and endothelial function in OHS versus eucapnic obese patients.Methodology
14 OHS and 39 eucapnic obese patients matched for BMI and age were compared. Diurnal blood gazes, overnight polysomnography and endothelial function, measured by reactive hyperemia peripheral arterial tonometry (RH-PAT), were assessed. Inflammatory (Leptin, RANTES, MCP-1, IL-6, IL-8, TNFα, Resistin) and anti-inflammatory (adiponectin, IL-1Ra) cytokines were measured by multiplex beads immunoassays.Principal Findings
OHS exhibited a higher PaCO2, a lower forced vital capacity (FVC) and tended to have a lower PaO2 than eucapnic obese patients. HS-CRP, RANTES levels and glycated haemoglobin (HbA1c) were significantly increased in OHS (respectively 11.1±10.9 vs. 5.7±5.5 mg.l−1 for HS-CRP, 55.9±55.3 vs 23.3±15.8 ng/ml for RANTES and 7.3±4.3 vs 6.1±1.7 for HbA1c). Serum adiponectin was reduced in OHS (7606±2977 vs 13660±7854 ng/ml). Endothelial function was significantly more impaired in OHS (RH-PAT index: 0.22±0.06 vs 0.51±0.11).Conclusions
Compared to eucapnic obesity, OHS is associated with a specific increase in the pro-atherosclerotic RANTES chemokine, a decrease in the anti-inflammatory adipokine adiponectin and impaired endothelial function. These three conditions are known to be strongly associated with an increased cardiovascular risk.Trial Registration
ClinicalTrials.gov NCT00603096相似文献17.
Andreas Buechner Karl-Heinz Dyballa Phillipp Hehrmann Stefan Fredelake Thomas Lenarz 《PloS one》2014,9(4)
Objective
To investigate the performance of monaural and binaural beamforming technology with an additional noise reduction algorithm, in cochlear implant recipients.Method
This experimental study was conducted as a single subject repeated measures design within a large German cochlear implant centre. Twelve experienced users of an Advanced Bionics HiRes90K or CII implant with a Harmony speech processor were enrolled. The cochlear implant processor of each subject was connected to one of two bilaterally placed state-of-the-art hearing aids (Phonak Ambra) providing three alternative directional processing options: an omnidirectional setting, an adaptive monaural beamformer, and a binaural beamformer. A further noise reduction algorithm (ClearVoice) was applied to the signal on the cochlear implant processor itself. The speech signal was presented from 0° and speech shaped noise presented from loudspeakers placed at ±70°, ±135° and 180°. The Oldenburg sentence test was used to determine the signal-to-noise ratio at which subjects scored 50% correct.Results
Both the adaptive and binaural beamformer were significantly better than the omnidirectional condition (5.3 dB±1.2 dB and 7.1 dB±1.6 dB (p<0.001) respectively). The best score was achieved with the binaural beamformer in combination with the ClearVoice noise reduction algorithm, with a significant improvement in SRT of 7.9 dB±2.4 dB (p<0.001) over the omnidirectional alone condition.Conclusions
The study showed that the binaural beamformer implemented in the Phonak Ambra hearing aid could be used in conjunction with a Harmony speech processor to produce substantial average improvements in SRT of 7.1 dB. The monaural, adaptive beamformer provided an averaged SRT improvement of 5.3 dB. 相似文献18.
Albrecht Hartmann Franziska Hannemann J?rg Lützner Andreas Seidler Hans Drexler Klaus-Peter Günther Jochen Schmitt 《PloS one》2013,8(8)
Introduction
The use of metal-on-metal (MoM) total hip arthroplasty (THA) increased in the last decades. A release of metal products (i.e. particles, ions, metallo-organic compounds) in these implants may cause local and/or systemic adverse reactions. Metal ion concentrations in body fluids are surrogate measures of metal exposure.Objective
To systematically summarize and critically appraise published studies concerning metal ion concentrations after MoM THA.Methods
Systematic review of clinical trials (RCTs) and epidemiological studies with assessment of metal ion levels (cobalt, chromium, titanium, nickel, molybdenum) in body fluids after implantation of metalliferous hip replacements. Systematic search in PubMed and Embase in January 2012 supplemented by hand search. Standardized abstraction of pre- and postoperative metal ion concentrations stratified by type of bearing (primary explanatory factor), patient characteristics as well as study quality characteristics (secondary explanatory factors).Results
Overall, 104 studies (11 RCTs, 93 epidemiological studies) totaling 9.957 patients with measurement of metal ions in body fluids were identified and analyzed. Consistently, median metal ion concentrations were persistently elevated after implantation of MoM-bearings in all investigated mediums (whole blood, serum, plasma, erythrocytes, urine) irrespective of patient characteristics and study characteristics. In several studies very high serum cobalt concentrations above 50 µg/L were measured (detection limit typically 0.3 µg/L). Highest metal ion concentrations were observed after treatment with stemmed large-head MoM-implants and hip resurfacing arthroplasty.Discussion
Due to the risk of local and systemic accumulation of metallic products after treatment with MoM-bearing, risk and benefits should be carefully balanced preoperatively. The authors support a proposed „time out“ for stemmed large-head MoM-THA and recommend a restricted indication for hip resurfacing arthroplasty. Patients with implanted MoM-bearing should receive regular and standardized monitoring of metal ion concentrations. Further research is indicated especially with regard to potential systemic reactions due to accumulation of metal products. 相似文献19.
Fumiyo Nakagawa Alec Miners Colette J. Smith Ruth Simmons Rebecca K. Lodwick Valentina Cambiano Jens D. Lundgren Valerie Delpech Andrew N. Phillips 《PloS one》2015,10(4)
Objective
Estimates of healthcare costs associated with HIV infection would provide valuable insight for evaluating the cost-effectiveness of possible prevention interventions. We evaluate the additional lifetime healthcare cost incurred due to living with HIV.Methods
We used a stochastic computer simulation model to project the distribution of lifetime outcomes and costs of men-who-have-sex-with-men (MSM) infected with HIV in 2013 aged 30, over 10,000 simulations. We assumed a resource-rich setting with no loss to follow-up, and that standards and costs of healthcare management remain as now.Results
Based on a median (interquartile range) life expectancy of 71.5 (45.0–81.5) years for MSM in such a setting, the estimated mean lifetime cost of treating one person was £360,800 ($567,000 or €480,000). With 3.5% discounting, it was £185,200 ($291,000 or €246,000). The largest proportion (68%) of these costs was attributed to antiretroviral drugs. If patented drugs are replaced by generic versions (at 20% cost of patented prices), estimated mean lifetime costs reduced to £179,000 ($281,000 or €238,000) and £101,200 ($158,900 or €134,600) discounted.Conclusions
If 3,000 MSM had been infected in 2013, then future lifetime costs relating to HIV care is likely to be in excess of £1 billion. It is imperative for investment into prevention programmes to be continued or scaled-up in settings with good access to HIV care services. Costs would be reduced considerably with use of generic antiretroviral drugs. 相似文献20.