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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.

The effect of Neuromuscular Electrical Stimulation on children with Congenital Talipes Equinovarus following treatment with the Ponseti method

Gelfer, Yael January 2007 (has links)
Congenital Talipes Equinovarus (CTEV) or clubfoot is the commonest congenital orthopaedic condition with an incidence of 1.5 per 1000 in the UK. The usual treatment for CTEV is the Ponseti method, consisting ofserial manipulation and casting followed by immobilisation in a foot brace. Two main factors have an effect on treatment result: deformity relapse due to muscle imbalance, creating the need for surgery, and smaller ankle range ofmotion (ROM) and calf circumference (CC).This study investigated the practicality ofsurface neuromuscular electrical stimulation (NMES) as an 'active' intervention in infants with CTEV. The primary outcome measure was the potential to reduce relapse measured by the Pirani score and secondary outcome measures were increase ROM and calf circumference. An AlBA2 approach (Astimulation, B-non-stimulation), six weeks each phase, was used in a study and a control group each with eight feet. At each session evertor muscle activity, Pirani severity score and static measures were assessed. Usage and parent perception was assessed using a questionnaire. The compliance with the stimulation and the brace were monitored by diary cards. A separate study with normally developing feet (n=26) and clubfeet (n=14) was also undertaken to determine the repeatability ofthe static measures.

Development of methods for the attachment of soft-tissues to implants

Vayianos, Vassilis January 2013 (has links)
Surgeons performing revision hip joint operations are faced with a growing number of patients with extensive bone loss. This results in insufficient bone for the attachment of soft-ligamentous tissues which are important in maintaining normal joint function. The aim of this project was to develop methods for studying the attachment of soft-tissues to prosthetic implants with a view to tissue engineering the interface in vitro. Cells were isolated from the porcine medial collateral ligament (pMCL) and characterised by indirect immunofluorescent labelling using a panel of antibodies. Porcine MSCs isolated from femoral bone marrow were also characterised by fluorescent activated cell sorting and their capacity to undergo tri-lineage differentiation. The population of pMCL cells was a mixed population of fibroblasts/myofibroblasts and smooth muscle cells. The smooth muscle cells were removed from the population by magnetic activated cell sorting. The porcine anterior cruciate ligament (pACL) interface was characterised using histology and immunohistochemistry. The pACL interface was of a fibrocartilagenous nature, consisting of the ligament, uncalcified fibrocartilage, calcified fibrocartilage and bone. Segments of pMCL were cultured under a range of static conditions for 14 days and analysed for cell viability by the ATPlite-MTM assay and Live/Dead cell staining. The ligament tissue could not be viably maintained. Porcine patella tendon tissue was studied as an alternative and the results indicated that the patella tendon was 60 % viable after 14 days in organ culture. Titanium porous coated (Gription®, Porocoat® and Porocoat®/Gription®) and foam discs of different pore sizes were fabricated and characterised in terms of their ability to enable cell/tissue in-growth. To determine the pore size/volume porosity by microCT a novel method of metal suppression was developed and applied successfully. The biocompatibility of the discs was assessed using 3 types of cells and they were shown to be biocompatible. The pMCL fibroblasts and pMSCs were then seeded to the discs to determine the optimal cell/disc type in terms of in-growth and proliferation (ATPlite-M™ assay) over 21 days. There was significant ingrowth in the Porocoat® and Porocoat®/Gription® coated discs for both pMCL cells and MSCs. The methods developed and results of this study will enable future experiments to culture the ligament tissue in close contact with the optimum cell/disc scaffold type under strain in a cyclic tensile strain bioreactor (TenCell) in order to determine the effect of tensile strain on the attachment of the ligament to the scaffold and the formation of an interface like tissue.

Predicting walking following lower limb amputation

Sansam, Katherine Alice Julia January 2011 (has links)
Lower limb amputation is a common clinical problem with around 7,000 leg amputations occurring in the UK per year. This commonly results in impaired mobility, which may also influence an individual's quality of life and independence. However, it is difficult to predict walking ability with a prosthesis accurately. The objective of this thesis is to establish whether simple clinical tests can be used to predict walking outcome following lower limb amputation . A systematic literature review, performed to establish current knowledge regarding predictors of walking following lower limb amputation, found inconsistent results and variability in methodology making comparison difficult. Data were collected to ascertain the current clinical assessment practice and mobility outcome for lower limb amputees in Leeds. This indicated that only around one third of patients achieve independent walking with a prosthesis. A qualitative interview study was completed with clinicians experienced in amputee rehabilitation to explore in more depth the decision making processes that are used to determine whether a patient is supplied with a prosthesis and what components are prescribed. This identified four key themes, one of which was estimating outcome, emphasising the clinical importance of predicting walking outcome in amputee rehabilitation. The final section of the research took the form of an observational study looking at the predictive nature of simple clinical tests on walking outcome after prosthetic rehabilitation. Backward stepwise multiple linear regression analysis resulted in a model that was able to predict 59% of the variance in the timed up and go test and contained six predictor variables; age, gender, amputation level, presence of contracture, ability to stand on one leg and performance on the trail making test. If confirmed in a larger population and across multiple sites these simple tests could be used to improve estimation of walking outcome in the future.

Wear resistant alumina for artificial hip replacements

Rana, Amit January 2013 (has links)
No description available.

Subacromial impingement syndrome : a study using clinical, functional and electromyography assessments

Makki, Ahmed Taha January 2012 (has links)
Subacromial impingement syndrome (SIS) is the most common diagnosis made in patients with chronic shoulder pain, accounting for 44-65% of all complaints of shoulder pain. SIS is a clinical diagnosis describing a multifactorial pathology applied to a condition whose main clinical symptoms are anterior or anterior-lateral superior shoulder pain, associated with restricted elevation of the arm or when attempting overhead activities, but without specific clinical tests. This study uses a battery of clinical, functional and EMG investigations in well-defined patient and control groups, in order to identify and measure aberrations in shoulder movements common to patients with SIS, to establish the consequences for shoulder girdle control and ultimately to suggest which therapeutic strategies might be most successful.

Numerical modelling of the pelvis and acetabular construct following hip arthroplasty

Phillips, Andrew T. M. January 2005 (has links)
The study presents finite element models of the acetabular construct and the pelvis. Particular attention is given to investigating the behaviour of the acetabular construct following revision hip arthroplasty, carried out using the Slooff-Ling impaction grafting technique. Mechanical tests are carried out on bone graft, and constitutive models are developed to describe its non-linear elasto-plastic behaviour, for inclusion in finite element analyses. Impaction of bone graft was found to have a significant effect in reducing subsequent development of consolidation plastic strains. A novel approach for the inclusion of muscles and ligaments, in finite element analyses, to provide boundary conditions similar to those found in vivo is also presented. 2D analyses of the acetabular construct, following revision hip arthroplasty, carried out using impaction grafting, indicate that for idealised load cases, rotation of the acetabular cup increases, as the depth of the bone graft bed increases. This indicates that it is advantageous to use the largest practical diameter of acetabular cup. Results from 3D analyses of the hemi pelvis, following revision arthroplasty, indicate that different patterns of migration and rotation of the acetabular cup, within the bone graft bed are associated with different physiological activities. For example walking is seen to cause migration of the cup in the superior direction, and rotation of the cup in abduction. Results from 3D analyses of the pelvis indicate that the inclusion of muscles and ligaments, in place of fixed boundary conditions cause significant changes to the stress distribution observed in the cortical bone, but comparatively minor changes to the stresses in the trabecular bone, and bone graft in the acetabular region.

Effect of exercise and antioxidant supplementation on inflammation, muscle strength and physical function in post hip fracture females

Campbell, Frances Geraldine January 2013 (has links)
Skeletal muscle mass and function progressively decline with advancing age (sarcopenia), and this can result in frailty, loss of independence, representing a major cause of falls and fractures in aged populations (Aubertin-Leheudre, Lord, Khalil & Dionne, 2008; Sirola & Kroger, 2011; Maggio, Lauretani & Ceda, 2013). Exercise and antioxidant supplementation have been considered as therapeutic modalities to attenuate age associated inflammation and muscle wastage (Peterson, Rhea, Sen & Gordon, 2010; Cerrullo, Gambassi & Cesari, 2012). Despite a plethora of knowledge regarding the benefits of exercise and antioxidant supplementation in advancing age, the precise mechanisms as to how each stimulus reduces inflammation is not fully elucidated. It has been postulated however, that detailed examination of cell signalling pathways may provide further information into the biochemical and cellular changes evoking respective adaptations (Mathur & Pedersen, 2008; Pedersen & Febbraio, 2008). The principal aim of the work contained in this thesis, is to examine the effects of exercise and antioxidant supplementation on inflammation and gene expression in aged females.

DNA damage caused by cobalt chromium and ceramic orthopaedic wear debris across a model placental barrier : an in vitro study

Bhabra, Gev January 2013 (has links)
Metal-on-metal and ceramic-on-ceramic hip replacements generate low volumes of wear debris and have been used increasingly in younger, more physically demanding patients. Metal-on-metal implants generate micron-sized and nano-sized particles of cobalt chromium alloy (CoCr) and ions of cobalt (Co) and chromium (Cr). Ceramic-on-ceramic implants generate nanoparticles of alumina ceramic. There are concerns that the unique properties of metal nanoparticles may allow them access across cellular barriers to cause toxicity to privileged sites in the body. In 2010 the Medicines and Healthcare products Regulatory Agency published a report highlighting a specific concern regarding the potential toxicity of CoCr wear debris across a placenta to an unborn child in utero. Addressing this concern would not be possible using epidemiological studies, and differences in placental morphology prohibit simple extrapolation from animal models. We have therefore used an in vitro, dual chamber model to determine whether CoCr and ceramic wear debris can cause DNA damage to human fibroblasts separated from the debris by an intact cellular barrier. We have used a multilayered BeWo cell barrier that has similarities to the human placenta in vivo, and used the comet and y-H2AX assays to measure DNA damage. Co and Cr ions, CoCr micron-sized and nano-sized particles, and ceramic nanoparticles all caused DNA damage to human fibroblasts across the BeWo cell barrier. None of the exposures adversely affected the barrier permeability or integrity, and the metal was not transported across the barrier. Instead, these indirect effects were dependant on a mechanism involving intercellular and paracellular signalling through connexin 43 gap junctions and hemichannels. The threshold concentration at which Cr ions caused DNA damage was 5 parts per billion; a concentration equivalent to that found in the peripheral blood of some patients with well-functioning metal-on-metal hip replacements. The dose of CoCr and ceramic particles necessary to cause DNA damage across the barrier was high, and unlikely to be relevant in most patients with well-functioning implants.

Glycaemic control after pancreas transplantation

Eckoldt, Stephanie Martina January 2013 (has links)
Background: Pancreas transplantation is considered in patients with type 1 diabetes in whom usual medical management is not able to provide adequate glycaemic control or causes frequent severe episodes of hypoglycaemia. Benefits of transplantation in terms of correction of glycaemia (hyper- and hypoglycaemia) must be weighed carefully against risks associated with surgery and lifelong immunosuppression. Improved long-term graft survival would tip the risk-benefit balance in favour of transplantation. It is not clear what factors determine longterm metabolic graft function and there is currently no clinical measure to monitor graft function or identify dysfunction Methods: Glycaemic control, insulin secretion and insulin resistance was prospectively measured in patients awaiting pancreas and islet transplantation and in a cohort of pancreas transplant recipients (n=34) at 3 months after transplantation and yearly thereafter. Islet (n=2) transplant recipients were studied at 3 monthly intervals after transplantation. Results: Patients awaiting transplantation tend to be insulin sensitive. Pancreas transplantation normalises glycaemic control and restores insulin responses. Islet transplantation improves glycaemia to a lesser degree and partially restores insulin responses. Graft function appears to decline with time after transplantation with worsening glycaemia and gradual deterioration of insulin responses. A proportion of patients have clinical and sub-clinical abnormalities in glycaemic control, which may put them at risk of future decline in graft function. A fasting plasma glucose of > 5.5 mmol/L identifies patients who are at risk of future graft decline. In these patients a three-sample oral glucose tolerance test (OGTT) can confirm whether beta cell function is deteriorating. Conclusions: Although in the short term pancreas transplantation normalises glucose homeostasis, graft function declines over time. Fasting plasma glucose and OGTT are the easiest way of identifying graft dysfunction. Identification and further investigation of dysfunction may allow 'development of interventions to support graft function and prevent long-term decline.

Identifying risk and improving outcomes in major abdominal surgery

Davies, Simon James January 2012 (has links)
Dopexamine has been shown to reduce both mortality and morbidity in major surgery when it is utilised to increase perioperative oxygen delivery. A meta regression analysis of data from the dopexamine trials in major surgery has shown a significant improvement both in outcomes for low dose dopexamine (<1mcg/kg/min), however a meta-analysis of the same data showed no overall benefit, leaving an uncertainty as whether dopexamine confers an outcome benefit. The identification of high-risk patients is complex, however functional capacity has been shown to predict of outcomes after major surgery. Cardiopulmonary exercise testing (CPET) provides an objective measurement of cardiorespiratory fitness, and hence functional capacity, and a reduced oxygen uptake at the anaerobic threshold (AT) has been shown to confer a significant risk of mortality in patients undergoing major surgery. Measurement of outcomes after major abdominal surgery have focused on mortality, but the low incidence in elective surgery makes this a poor comparator. The Post Operative Morbidity Survey (PO MS) prospectively assesses shOli-term postoperative morbidity and may have clinical utility both as a core outcome measure in clinical trials. The oesphageal Doppler (ODM) is widely used to deliver goal directed therapy via stroke volume optimisation. New methods of stroke volume measurement are available with arterial waveform analysis, and fluid optimisation can be performed with measurements of preload responsiveness.

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