Höft- och knäprotesoperationer är idag en vanlig operation vid artros i höft- och knäled. Trotsminutiösa infektionsförebyggande förberedelser inför operationen drabbas ändå en delpatienter av postoperativa infektioner. Vid ortopedisk proteskirurgi är postoperativainfektioner ett direkt hot mot den nya inopererade leden och kan leda till långabehandlingstider som påverkar patientens livskvalitet under lång tid. Syftet med studien var att utforska patienters möjlighet till delaktighet i tidig upptäckt avpostoperativ infektion utifrån given information vid operation för höft- eller knäprotes. Semi-strukturerade intervjuer genomfördes med tio patienter med diagnostiserad postoperativinfektion efter höft- eller knäprotesoperation. Transkriberade intervjuer analyserades medinnehållsanalys. Journaler granskades för att beskriva patientens tidigare sjukdomar. Resultatet visade att första tecknen på infektion kan beskrivas med temat: Vad är normalt ochvad är inte normalt. Två kategorier beskriver patienternas Möjlighet till delaktighet ochHinder till delaktighet i det infektionsförebyggande arbete före, under och efter operation. Det handlade om hur patienten hade förstått eller inte förstått given information, vilketkategoriserades som subkategorier. Personcentrerad vård kan vara ett redskap för att stärka patienternas förutsättningar tilldelaktighet och ökar möjligheterna för att förhindra att vårdskador så som postoperativainfektioner uppstår. / Surgery with prosthetic joint replacement of the hip and knee in patients with osteoarthritis is a common procedure. Despite meticulous preparation prior to surgery, surgical site infections develop in some patients. A surgical site infection is a direct threat to the new implanted joint and can lead to long treatments that affect quality of life over time. The aim of this study was to explore patients´ participation in early detection of a surgical site infection based on the information given in conjunction to surgery for hip and knee replacement. Semi structured interviews were conducted with ten patients diagnosed with surgical site infection after hip or knee replacement surgery. Transcribed interviews were analyzed using content analysis. Medical records were reviewed to describe the patients´ comorbidity. The result showed that the first signs of infection can be described with the theme; What is normal and what is not normal? Two categories describe patients´ Possibility of participation and Barriers to participation in infection prevention before and after surgery. It was all about How the patient had understood or not understood the given information which was categorized as subcategories. Person-centered care can be a tool that enables patients´ possibilities to participate in their care and increases the possibilities to prevent adverse events such as surgical site infections.

Apesar dos pesquisadores afirmarem que os materiais odontológicos restauradores, devido às suas diferentes propriedades mecânicas, influenciam na transmissão da carga para os tecidos de suporte, não foi encontrada comprovação científica concludente. Os trabalhos de análise da distribuição da carga oclusal com diferentes materiais de reconstrução protética não são concordantes em seus resultados. Assim, diante da importância da seleção de materiais restauradores protéticos no prognóstico da reabilitação oral, este trabalho se propôs a estudar a influência de coroas protéticas metalo-cerâmica e de resina, cimentadas no canino, na transmissão de tensões para o tecido ósseo em mandíbulas frescas de cães, utilizando o método de interferometria holográfica de dupla exposição. Seis hemi-mandíbulas frescas de cães da espécie Canis familiares foram fixadas em um dispositivo para garantir a invariabilidade da força aplicada durante o experimento. Uma carga de 0,98 N foi aplicada sobre as coroas, seguindo o longo eixo do dente. Pelo método de interferometria holográfica, foram obtidos 12 hologramas, 6 para cada grupo de amostras. As coroas metalo-cerâmicas apresentaram maior deslocamento, com movimento de intrusão no alvéolo, em relação às de resina. Os microdeslocamentos resultantes nas hemimandíbulas demonstraram comportamentos semelhantes de deflexão, porém, não foram encontradas diferenças estatisticamente significantes na distribuição das tensões ao osso, com relação aos dois tipos de coroas consideradas, demonstrando a influência da presença do ligamento periodontal. / Although researches assert that restoring dental material, due to their different mechanical properties, influences at load transmission to support tissues, it was not find any conclusive scientific evidence. Researches with finite element, implants and different prosthetic reconstruction material do not have an agreement in terms of results. So, considering the importance of prosthetic restoring material selection on oral rehabilitate prognosis, this assignment studied the influence of metaloceramic and resin prosthetics crowns, cemented on canine, during stress transmission to bony tissue of post-mortem dog mandibles, using double exposure holographic interferometry method. Three fresh mandibles were split into 6 hemi-mandibles, which were fixed in a proper device in order to assure the same applied force during the whole experiment. A 0,98 N load was applied to the crowns, following the long axis of the tooth. It was collect 12 holograms, 6 for each sample group. Metaloceramic crowns presented larger intrusion micromovement in the alveolus, comparing that of resin ones. The resulting micromovings in the hemimandibles presented similar deflecting behaviour. However, significant statistical differences on bone tension distribution have not been found, concerning the two types of previously referred crowns, demonstrating the influence of periodontal ligament.

Um dos maiores desafios da Implantodontia é manter a osseointegração e a saúde dos tecidos peri-implantares após a instalação da prótese. Para que uma reabilitação sobre implantes tenha longevidade é necessário que se realize a manutenção da saúde dos tecidos peri-implantares. Existe uma relação direta entre o acúmulo de biofilme e a presença da inflamação desses tecidos, denominada mucosite. Essa condição pode evoluir para uma peri-implantite. A proposta deste estudo foi encontrar uma solução preventiva às doenças peri-implantares, através do controle do biofilme. Avaliou-se a ação antibacteriana de três tipos de revestimentos nanoestruturados com prata aplicados à superfície de discos de titânio frente a cepas de microrganismos peri-implanto-patogênicos. Após determinado o melhor revestimento, analisou-se, também, se a quantidade de prata (3 ou 6 camadas) melhorava sua ação antimicrobiana. Foram confeccionados discos de titânio divididos em 4 grupos: titânio sem deposição (controle), titânio com deposição de solução coloidais de prata e sílica (Si02), titânio com deposição de solução coloidal hidrotermalizada de prata e dióxido de titânio (TiAg) e titânio com deposição de solução hidrotermalizada somente com dióxido de titânio (TiAa). Testou se a efetividade da atividade antimicrobiana dos revestimentos estudados por meio da contagem das colônias bacterianas, encontradas na superfície das placas de ágar sangue. Para permitir uma contagem correta do crescimento das colônias, realizou se diluição seriada e, após incubação a 37°C em anaerobiose, a contagem do número de colônias e, posteriormente, o cálculo das unidades formadoras de colônia (UFC/mL). Após determinação do melhor revestimento, foram desenvolvidos biofilmes monoespécie sobre discos de titânio com 3 e 6 camadas do revestimento SiO2, além dos grupos controle positivo (C.positivo) e negativo (C.negativo), utilizando as cepas Streptococcus gordonii. A atividade microbiana nos biofilmes foi determinada pelo método de XTT. Utilizou-se três discos de cada grupo por teste (triplicata) e realizado a leitura em espectrofotômetro à 450 nm e 492 nm. Os resultados obtidos com cepa de A. actinomycetemcomitans, apresentaram diferença estatística (p<= 0,01) entre o grupo controle (branco) e os grupos teste. Observou-se um maior número de bactérias A.a na superfície branca quando comparado com as superfícies nanoestruturadas com prata, sendo que o grupo SiO2 foi o que apresentou melhor resultado. Notou-se, também, que houve uma maior quantidade da bactéria P.gingivalis na superfície dos discos brancos quando comparado com os grupos com revestimentos nanoestruturados com prata. As bactérias S.aureus e F.nucleatum , porém, não apresentaram redução nos discos com filmes nanoestruturados quando comparados ao disco sem revestimento. Os discos com 6 camadas do revestimento SiO2 apresentaram eficiência semelhante a clorexidina 0,12%, na redução do biofilme da S.gordonii. Conclui-se que os revestimentos nanoestruturados com partículas de prata foram efetivos na redução de UFC/ml das bactérias A. actinomycetemcomitans e P.gingivalis, com o melhor resultado observado com revestimento SiO2. A concentração da prata interferiu positivamente nos resultados com a bactéria S.gordonii. / One of implantology\'s major challenge is to maintain the osseointegration and health of the peri-implant tissues after the installation of the prosthesis. To ensure implant rehabilitation\'s longevity it is necessary to maintain the health of the peri-implant tissues. There is a direct relationship between the accumulation of biofilm and the presence of inflammation of these tissues, called mucositis. This condition can progress to peri-implantitis. The purpose of this study was to find a preventive solution to peri-implant diseases through biofilm control. For this, the antibacterial action against strains of peri-implant-pathogenic of three types of nanostructured coatings with silver applied to the surface of titanium discs microorganisms was evaluated. After determining the best coating, it was also analyzed whether the amount of silver (3 or 6 layers) improved its antimicrobial action. Titanium disks were divided into 4 groups: titanium without deposition (control), titanium with deposition of colloidal solution of silver and silica (SiO2), titanium with deposition of colloidal hydrothermalized solution of silver and titanium dioxide (TiAg) and titanium with deposition of a hydrothermal solution only with titanium dioxide (TiAa). The effectiveness of the coatings was tested by counting the bacterial colonies found on the surface of the blood agar plates. In order to allow a correct colony count, a serial dilution was performed and, after incubation at 37 ° C in anaerobiosis, counting the number of colonies and, later, calculating the colony forming units (CFU / mL). After determination of the best coating, monospecies biofilms were prepared on 3 and 6 layer titanium discs of the SiO2 coating, in addition to the positive control (C.positive) and negative (negative) groups, using Streptococcus gordonii strains. The microbial activity in biofilms was determined by the XTT method. Three disks of each group were used per test (triplicate) and the spectrophotometer read at 450 nm and 492 nm. The results obtained with A. actinomycetemcomitans strain presented a statistical difference (p<=0.01) between the control group (blank) and the test groups. A higher number of A.a bacteria was observed on the blank surface when compared to the nanostructured surfaces with silver, and the SiO2 group showed the best results. It was also noted that there was a greater amount of P.gingivalis bacteria on the surface of the blank discs when compared to the groups with nanostructured coatings with silver. The bacteria S. aureus and F. nucleatum, however, did not present reduction in the discs with nanostructured films when compared to the disc without coating. The 6- layer discs of the SiO2 coating presented similar efficiency to 0.12% chlorhexidine in reducing the S. gordonii biofilm. We concluded that nanostructured coatings with silver particles were effective in reducing CFU/ml of A. actinomycetemcomitans and P.gingivalis bacteria and the best result was observed with SiO2 coating. The concentration of silver interfered positively decreasing S.gordonii bacteria number.

No description available.

Prosthetic joint infection (PJI) is an emergent concern given the wide usage of prosthetic joints in old and young population to assist with activities of daily living. While the public health burden of PJI appears to be relatively low compared with other potentially fatal infections such as blood stream infections, PJI is associated with excess morbidity and steep healthcare costs. Appropriate and timely diagnosis and management are crucial in preventing poor clinical outcomes and restoring adequate function in patients with PJI. There is lack of studies using robust epidemiologic methods to evaluate effectiveness of existing treatment protocols for PJI. We conducted retrospective studies using the Veterans Affairs (VA) database using data from 123 VA hospitals between 2003 and 2012. We also abstracted clinical data from VA medical records to achieve the objectives of this research. The effectiveness of an antibiotic — rifampin and a surgical management – exchange arthroplasty was assessed in separate studies. These treatments were adjudicated based on their effectiveness in prevention of PJI recurrence and two-year postoperative mortality, respectively. Seven hundred thirty-one of the 2838 patients with first episode of PJI were treated with surgery and medical management for Staphylococcus aureus PJI and were retained in the thesis dataset. In the first study, we compared 300 patients treated with rifampin for the first 42 days of treatment period to 364 patients treated with antibiotics other than rifampin during the 42 days (unexposed). Overall, 255 patients (38.4%) were observed to have a treatment failure defined as recurrence of S. aureus PJI with or without a repeat surgery or death in the 90 days after surgery for the PJI. The rifampin-treated and unexposed groups did not differ on time to treatment failure (p=0.92). It was noted that patients treated with a less invasive surgery that resulted in retention of the infection prosthesis with removal of infected tissue and rifampin treatment had lower risk for treatment failure compared to patients with similar surgery but not treated with rifampin (HR=0.79, 95%CI 0.52-1.20). We also observed that patients who had surgery for removal of the infected prosthesis and were treated with rifampin had significantly greater risk for treatment failure compared to those treated with the prosthesis removal surgery but no rifampin. In our second study we further analyzed this research question in depth using advanced epidemiologic methods to attenuate any bias in our previous findings. We noted that the groups did not differ in their risk for treatment failure after matching patients on their probability of receiving rifampin treatment (HR=1.08, 95%CI 0.71-1.65). In addition, we observed that patients whose treatment decision with rifampin was determined by the rifampin prescription rate in the treating facility substantially benefited with use of rifampin antibiotic for S. aureus PJI. In the third study we assessed the effectiveness of a surgery — exchange arthroplasty (involves removal of infected prosthesis and insertion of new prosthesis) to reduce the risk of death two years after surgery in a sample of 566 S. aureus PJI patients. Patients with this procedure were compared to patients treated with retention of their infected prosthesis and removal of infected tissue (DAIR). Overall, 90 patients (15.9%) died in the 2 years after surgery. Of these, 14 (9.9%) died after exchange surgery while 76 (17.9%) died after the DAIR procedure. We observed that the exchange surgery reduced the risk for death by almost 60% compared to the DAIR (OR=0.42, 95%CI 0.19-0.89). In conclusion, epidemiological studies conducted as part of this thesis identified considerable burden of treatment failure (38.4%) and all-cause mortality (15.9%) among veterans treated for S. aureus PJI. Rifampin combination antibiotic regimen was not observed to be effective in reducing the burden of the infection, in comparison to other antibiotics. Exchange arthroplasty reduced the risk for death in old veteran patients compared to a less invasive but potentially life-threatening procedure such as DAIR. Choice of treatment should be made on a case-by-case basis for patients with S. aureus PJI after thorough consideration of patient characteristics.

Currently there are nearly 2 million people living with limb loss in the United States [1]. Many of these individuals are either transtibial (below knee) or transfemoral (above knee) amputees and require an ankle-foot prosthesis for basic mobility. While there are an abundance of options available for individuals who require an ankle-foot prosthesis, these options fail to mimic an intact ankle when it comes to key evaluation criteria such as range of motion, push-off force, and roll over shape. The roll over shape is created by plotting the center of pressure during a step in a shank-based coordinate system. To address the need for a prosthesis that effectively replaces the ankle's contribution to an able-bodied gait, a biomimetic approach is taken in the design the Compliant & Articulating Prosthetic Ankle (CAPA) foot. The passive CAPA foot consists of four components connected by torsion springs representing the Phalanges, Metatarsal bones, Talus, and Calcaneus. Biomimetic functionality is exhibited by CAPA foot with regards to the roll over shape and a linear relationship between moment exerted and ankle angle, distinguishing the CAPA foot from other ankle-foot prostheses. A mathematical model of the CAPA foot is created to determine the roll over shape a specific CAPA foot geometry would produce and support eventual customization of the 3D printed components. The mathematical model is used to optimize the design to two distinctly different roll over shapes, one with a rocker radius closer to that of the Talus bone and the other closer to the energetically advantageous value of 0.3 times leg length [2, 3]. Compliant and stiff versions of the two CAPA feet were compared to a conventional Solid Articulating Cushioned Heel (SACH) foot and a passive dynamic response foot (Renegade® AT produced by Freedom Innovations). Ten able bodied subjects walked on the Computer Assisted Rehabilitation Environment normally, and then with a transfemoral prosthetic simulator. The study was separated into two experiments. For the second experiment (subjects 6-10), the versions of the CAPA foot had pretension in the dorsiflexion springs. Overall the ankle angles and sagittal plane ground reaction forces of the CAPA foot better mimicked an intact ankle-foot than the existing passive ankle-foot prostheses. Added pretension increased the sagittal plane ground reaction forces and roll over shape radius of curvature and arc length. Nine out of ten participants preferred the CAPA foot and there was a statistical significant difference (F=14.2, p<0.01) between the difficulty level rating given for trials with the CAPA foot versus the existing ankle-foot prostheses. The mathematical model is found to be capable of accurately predicting experimental roll over shape trends and the concept of roll over shape based design is demonstrated. Successful aspects of the CAPA foot can be applied to other ankle-foot prosthesis. The CAPA foot could provide a passive, cheap, and personalizable ankle-foot prosthesis that improves mobility the quality of life for individual’s lacking an intact ankle.

<p>Different prosthetic groups containing a trialkylstannyl- and an electrophilic group have been synthesised and labelled with the accelerator produced ⁷⁶Br (T_1/2=16 h) through oxidative bromination. The labelled prosthetic groups were conjugated to amino-containing macromolecules such as proteins and 5´-modified oligonucleotides.</p><p><i>N</i>-Succinimidyl 4-[⁷⁶Br]bromobenzoate <b>14 </b>was synthesised in 65 % radio-chemical yield and was conjugated to 5´-hexylamino-modified phosphodiester and phosphorothioate oligonucleotides in 12-19 % isolated radiochemical yield. The stability of the ⁷⁶Br-oligonucleotide-conjugates <i>in vivo</i> in rats was investigated. No degradation from the 5´-end, resulting in labelled, low molecular weight compounds was detected. Compound <b>14</b> has also been used for labelling of different proteins in 23-61% radiochemical yield.</p><p><i>N</i>-Succinimidyl-5-[⁷⁶Br]bromo-3-pyridinecarboxylate <b>17</b> and methyl-4-[⁷⁶Br]bromo-benzimidate <b>15 </b>were synthesised from the corresponding trimethylstannyl-compound in 25% and 40 % yield respectively. Compounds <b>14 </b>and <b>17</b> were conjugated to ε-Boc-octreotide in 55 and 50% isolated radiochemical yield respectively after microwave heating. Compound <b>15</b> did not react with octreotide under the conditions investigated. The two ⁷⁶Br-labelled octreotide derivatives showed different lipophilicity and different binding-properties to tissue from meningiomas.</p><p>Hyaluronic acid, a polysaccharide, was modified with tyramine and labelled by oxidative bromination using ⁷⁶Br in 10% radiochemical yield.</p><p>The generator produced ⁶⁸Ga (T_1/2=68 min) was used to label octreotide and oligonucleotides modified with the metal chelating group 1,4,7,10-tetraazacyclo-dodecane-1,4,7,10-tetraacetic acid (DOTA). ⁶⁸Ga-DOTA-octreotide was isolated in 65% radiochemical yield and a phosphorothioated ⁶⁸Ga-DOTA-oligonucleotide was isolated in 35% radio-chemical yield after 30 min synthesis time.</p><p>Compound<b> 14 </b>was reacted with 3-aminomethylbenzylamine to give compound <b>18</b>. The specific radioactivity<b> </b>of<b> 18 </b>was determined to be 36 GBq/µmol by measuring the ratio between the mass-peaks for the ⁷⁶Br and ⁷⁹Br-compounds using packed-capillary LC-MS.</p>

Different prosthetic groups containing a trialkylstannyl- and an electrophilic group have been synthesised and labelled with the accelerator produced 76Br (T1/2=16 h) through oxidative bromination. The labelled prosthetic groups were conjugated to amino-containing macromolecules such as proteins and 5´-modified oligonucleotides. N-Succinimidyl 4-[76Br]bromobenzoate <b>14 </b>was synthesised in 65 % radio-chemical yield and was conjugated to 5´-hexylamino-modified phosphodiester and phosphorothioate oligonucleotides in 12-19 % isolated radiochemical yield. The stability of the 76Br-oligonucleotide-conjugates in vivo in rats was investigated. No degradation from the 5´-end, resulting in labelled, low molecular weight compounds was detected. Compound <b>14</b> has also been used for labelling of different proteins in 23-61% radiochemical yield. N-Succinimidyl-5-[76Br]bromo-3-pyridinecarboxylate <b>17</b> and methyl-4-[76Br]bromo-benzimidate <b>15 </b>were synthesised from the corresponding trimethylstannyl-compound in 25% and 40 % yield respectively. Compounds <b>14 </b>and <b>17</b> were conjugated to ε-Boc-octreotide in 55 and 50% isolated radiochemical yield respectively after microwave heating. Compound <b>15</b> did not react with octreotide under the conditions investigated. The two 76Br-labelled octreotide derivatives showed different lipophilicity and different binding-properties to tissue from meningiomas. Hyaluronic acid, a polysaccharide, was modified with tyramine and labelled by oxidative bromination using 76Br in 10% radiochemical yield. The generator produced 68Ga (T1/2=68 min) was used to label octreotide and oligonucleotides modified with the metal chelating group 1,4,7,10-tetraazacyclo-dodecane-1,4,7,10-tetraacetic acid (DOTA). 68Ga-DOTA-octreotide was isolated in 65% radiochemical yield and a phosphorothioated 68Ga-DOTA-oligonucleotide was isolated in 35% radio-chemical yield after 30 min synthesis time. Compound<b> 14 </b>was reacted with 3-aminomethylbenzylamine to give compound <b>18</b>. The specific radioactivity<b> </b>of<b> 18 </b>was determined to be 36 GBq/µmol by measuring the ratio between the mass-peaks for the 76Br and 79Br-compounds using packed-capillary LC-MS.

The loss of a hand or arm is a devastating life event that results in many months of healing and challenging rehabilitation. Technology has allowed the development of an electronic replacement for a lost limb but similar advancements in therapy have not occurred. The situation is made more challenging because people with amputations often do not live near specialized rehabilitation centres. As a result, delays in therapy can worsen common complications like nerve pain and joint stiffness. For children born without a limb, poor compliance with the use of their prosthesis leads to delays in therapy and may affect their development. In many parts of the world, amputation rehabilitation does not exist. Fortunately, we live in an age where advances in technology and engineering can help solve these problems. Virtual reality creates a simulated world or environment through computer animation much like what is seen in modern video games. An experienced team of rehabilitation doctors, therapists, engineers and computer scientists are required to realize a system such as this. A person with an amputation will be taught to control objects in the virtual world by wearing a modified electronic prosthesis. Using computers, it will be possible to analyze his or her movements within the virtual world and improve the wearer's skills. The goals of this system include making the system portable and internet compatible so that people living in remote areas can also receive therapy. The novel approach of using virtual reality to rehabilitate people with upper limb amputations will help them return to normal activities by providing modern and appropriate rehabilitation, reducing medical complications, improving motivation (via gaming modules), advancing health care technology and reducing health care costs. The use of virtual reality technology in the field of amputee rehabilitation is in its earliest stages of development world wide. A virtual environment (VE) will facilitate the early rehabilitation of a patient before they are clinically ready to be fitted with an actual prosthesis. In order to create a successful virtual reality rehabilitation system such as this, an accurate method of tracking the arm in real-time is necessary. A linear displacement sensor and a microelectromechanical system (MEMS) inertial measurement unit (IMU) were used to create a device for capturing the motion of a user's movement with the intent that the data provided by the device be used along with a VE as a virtual rehabilitation tool for new upper extremity amputation patients. This thesis focuses on the design and testing of this motion capture device in order to determine the suitability of current commercially available sensing components as used in this system. Success will be defined by the delivery of accurate position and orientation data from the device so that that data can be used in a virtual environment. Test results show that with current MEMS sensors, the error introduced by double integrating acceleration data is too significant to make an IMU an acceptable choice for position tracking. However, the device designed here has proven to be an excellent cable emulator, and would be well suited if used as an orientation tracker.

Rupture of the anterior cruciate ligament (ACL) is a relatively common sports-related injury for which the current treatment is reconstruction with an autograft or allograft. Drawbacks associated with each of the current options would make a prosthetic alternative advantageous, however, artificial ligaments are not widely used, having failed due to lack of biocompatibility and mechanical insufficiencies. To develop the next-generation prosthetic ACL, design control principles were applied including specification of comprehensive design inputs, risk analysis, and verification testing. A design was proposed utilizing polyvinyl alcohol and ultrahigh molecular weight polyethylene, selected for good biocompatibility and mechanical strength and stiffness suitable for ACL replacement. A biomimetic fibrous rope pattern was designed for the intra-articular ligament section of the prosthetic that produced a close match the static tensile behavior of the native ACL and which also demonstrated good resistance to fatigue and creep. A calcium phosphate coating was recommended for the sections of the device lying within the bone tunnel to increase the rate of osseointegration. The proposed design was then evaluated in a computational simulation to assess functional restoration and the effects of installation parameters such as tension and tunnel orientation on knee kinematics. The encouraging results of preclinical verification testing support further in vivo evaluation of the proposed design.