Tibial Tuberosity Transposition Fixation with a Locking Plate during Medial Patellar Luxation Surgery: An Ex Vivo Mechanical Study

2021 ◽  
Author(s):  
Esa V. Eskelinen ◽  
Ari P. Suhonen ◽  
Juha V. Virolainen ◽  
William D. Liska
Keyword(s):  
Phase I ◽  
Phase Ii ◽  
Locking Plate ◽  
Ex Vivo ◽  
Tibial Tuberosity ◽  
Tension Band ◽  
Patellar Ligament ◽  
Raccoon Dog ◽  
Tension Band Wire ◽  
Lower Load

Abstract Objectives The purpose of this study was to compare the load at failure, stiffness and mode of failure between three types of tibial tuberosity transposition fixation techniques: (a) pin and figure-8 tension band wire (Pin-TBW), (b) locking plate with pin and a tension band wire (Plate-Pin-TBW) and (c) locking plate with a pin (Plate-Pin). Methods Six pairs of raccoon dog cadaveric tibiae were tested in Phase I Pin-TBW versus Plate-Pin-TBW and seven pairs in Phase II Plate-Pin-TBW versus Plate-Pin. One limb of each pair was randomly assigned to one of two groups for each phase. A tensile force was applied to the patellar ligament until construct failure. Results Pin-TBW (342N ± 54.7N) failed at a lower load than Plate-Pin-TBW (469N ± 77.3N), p = 0.00748, with all Pin-TBW failing by fracture and the majority of Plate-Pin-TBW failing by rupture of patellar ligament. Pin-TBW group Phase I, normalized with Plate-Pin-TBW Phase I, failed at a lower load than Plate-Pin group Phase II, normalized with Plate-Pin-TBW Phase II, p = 0.00467. There was no significant difference in mean load at failure, stiffness or mode at failure between the groups in the Phase II study. Clinical Significance Although ex vivo mechanical testing does not replicate the postoperative live dog or cat, these results demonstrate lower construct strength of the Pin-TBW construct compared with the Plate-Pin construct in the raccoon dog cadaver model.

Combined Tibial Plateau Levelling Osteotomy and Tibial Tuberosity Transposition: An Ex Vivo Mechanical Study

2018 ◽  
Vol 31 (02) ◽  
pp. 124-130
Author(s):  
Ryan Birks ◽  
Michael Kowaleski
Keyword(s):  
Phase I ◽  
Phase Ii ◽  
Tibial Plateau ◽  
Ex Vivo ◽  
Tensile Force ◽  
Tibial Tuberosity ◽  
Patellar Ligament ◽  
Fixation Failure ◽  
Significant Difference ◽  
Mode Of Failure

Objectives The purpose of this study is to compare the load at failure and mode of failure between (1) tibial plateau levelling osteotomy (TPLO) and combined TPLO and tibial tuberosity transposition (TPLO-TTT) (Phase I) and (2) TPLO-TTT and tibial tuberosity transposition (TTT) (Phase II). Methods Seven pairs of cadaveric tibiae were tested in each of the Phase I (TPLO vs. TPLO-TTT) and Phase II (TPLO-TTT vs. TTT) experiments. One limb of each pair was randomly assigned to one of two groups for each experimental phase. A tensile force was applied to the patellar ligament until construct failure occurred. Results There was a significant difference in mean load at failure between TPLO (2092.8 N) and TPLO-TTT (1067.8 N), p = 0.004. All TPLO constructs failed by fracture of the tibial crest. The TPLO-TTT constructs failed by cranial displacement of the distal tibial crest. Additionally, the tibial plateau was displaced in the majority of limbs. There was a significant difference in mean load at failure between TPLO-TTT (1157.6 N) and TTT (1394.0 N), p = 0.025. The TTT constructs demonstrated a similar mode of failure as TPLO-TTT. Clinical Significance Although ex vivo mechanical testing does not replicate the postoperative clinical scenario, these results demonstrate reduced construct strength of the combined TPLO-TTT technique compared with TPLO or TTT alone. When performing TPLO-TTT, meticulous technique and implants of adequate strength must be employed to create a robust construct and minimize postoperative tibial crest fixation failure.

A Cadaveric Evaluation of Pin and Tension Band Configuration Strength for Tibial Tuberosity Osteotomy Fixation

2019 ◽  
Vol 33 (01) ◽  
pp. 009-014 ◽  
Author(s):  
Amy N. Zide ◽  
Stephen C. Jones ◽  
Alan S. Litsky ◽  
Nina R. Kieves
Keyword(s):  
Tensile Force ◽  
Tibial Tuberosity ◽  
Tension Band ◽  
Patellar Ligament ◽  
Tension Band Wire ◽  
Significant Strength ◽  
Significant Difference ◽  
Mode Of Failure ◽  
Vertically Aligned ◽  
And Control

Abstract Objective The purpose of this study was to compare the load at failure and mode of failure of four constructs used to stabilize a tibial tuberosity osteotomy, including two vertically aligned pins (V), two horizontally aligned pins (H), two vertically aligned pins with a tension band wire (V-TB) and two horizontally aligned pins with a tension band wire (H-TB). Study Design Eighteen pairs of cadaveric tibiae were randomized to receive a TB or no TB. One limb was randomized to be in the H or V group. The contralateral limb was then assigned to the opposite configuration. One pair of limbs was used as a control. A tensile force was applied to the patellar ligament until construct failure. Results There was no significant difference between the mean load at failure of the H (595 N) and V (556 N) groups or between H-TB (1032 N) and V-TB groups (1034 N) (p = 0.487 and p = 0.238, respectively). The TB constructs were significantly stronger than the pin only constructs (p < 0.001). The mode of failure was similar for the pin only constructs, regardless of pin orientation. The TB constructs and control tibias failed at similar loads, most commonly by patellar ligament rupture. Conclusion The use of vertically aligned pins versus horizontally aligned pins does not affect construct strength. These results support the placement of pins in a vertically or horizontally aligned fashion. When performing a tibial tuberosity osteotomy, the addition of a TB adds significant strength to the construct.

scholarly journals Analysis of the ex-vivo transformation of semen, saliva and urine as they dry out using ATR-FTIR spectroscopy and chemometric approach

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Tanurup Das ◽  
Abhimanyu Harshey ◽  
Ankit Srivastava ◽  
Kriti Nigam ◽  
Vijay Kumar Yadav ◽  
...  
Keyword(s):  
Phase I ◽  
Phase Ii ◽  
Ex Vivo ◽  
Body Fluids ◽  
Biochemical Changes ◽  
Partial Least Square ◽  
The Body ◽  
Slow Phase ◽  
Time Since Deposition ◽  
Dry Out

AbstractThe ex-vivo biochemical changes of different body fluids also referred as aging of fluids are potential marker for the estimation of Time since deposition. Infrared spectroscopy has great potential to reveal the biochemical changes in these fluids as previously reported by several researchers. The present study is focused to analyze the spectral changes in the ATR-FTIR spectra of three body fluids, commonly encountered in violent crimes i.e., semen, saliva, and urine as they dry out. The whole analytical timeline is divided into relatively slow phase I due to the major contribution of water and faster Phase II due to significant evaporation of water. Two spectral regions i.e., 3200–3400 cm−1 and 1600–1000 cm−1 are the major contributors to the spectra of these fluids. Several peaks in the spectral region between 1600 and 1000 cm−1 showed highly significant regression equation with a higher coefficient of determination values in Phase II in contrary to the slow passing Phase I. Principal component and Partial Least Square Regression analysis are the two chemometric tool used to estimate the time since deposition of the aforesaid fluids as they dry out. Additionally, this study potentially estimates the time since deposition of an offense from the aging of the body fluids at the early stages after its occurrence as well as works as the precursor for further studies on an extended timeframe.

Tibial tuberosity transposition-advancement for lateralization of the tibial tuberosity: An ex vivo canine study

2014 ◽  
Vol 27 (04) ◽  
pp. 271-276 ◽  
Author(s):  
N. Bertollo ◽  
W. Walsh ◽  
K. Voss ◽  
M. Newman
Keyword(s):  
Computed Tomography ◽  
Cyclic Loading ◽  
Tibial Plateau ◽  
Ex Vivo ◽  
Peak Load ◽  
Tibial Tuberosity ◽  
Tension Band ◽  
Tension Band Wiring ◽  
Load To Failure ◽  
Canine Study

SummaryObjectives: To evaluate the degree of lateralization achievable and strength of tibial tuberosity transposition and advancement (TTTA) relative to pin and tension band wiring (PTBW) for lateral tibial tuberosity transposition.Methods: Six pairs of cadaveric tibiae were used. Tibial tuberosity position was determined with computed tomography (CT); bones were then randomly assigned into TTTA and PTBW groups. The PTBW group had a tibial tuberosity osteotomy and fixation with pin and tension band wiring. The TTTA group had a tibial tuberosity advancement performed with lateralization of the tibial tuberosity by 50% of cage depth, using spacers on the cranial cage screw. Postoperative CT images showed lateralization and craniocaudal deviation. Single axial distractive loading was applied to the patella at 90° to the tibial plateau, and peak load, energy, and stiffness were calculated.Results: There were significant differences in lateralization (PTBW: 67.92 ± 5.1 %; TTTA: 88.51 ± 5.5 %) (p = 0.0173) and craniocaudal deviation (PTBW: –8.30 ± 1.4 %; TTTA: 6.83 ± 0.6) (p = 0.0001). There were no significant differences in peak load to failure (N) (PTBW: 1448 ± 121; TTTA: 1597 ± 43) (p = 0.4541), energy to failure (N/mm) (PTBW: 15013 ± 2719; TTTA: 17314 ± 887) (p = 0.646), or stiffness (N/mm)(PTBW: 102.8 ± 4.7; TTTA: 92.9 ± 4.8) (p = 0.2716).Clinical significance: The TTTA was more effective at lateralization of the tibial tuberosity, and of comparable strength to PTBW. Greater support of the osteotomized fragment with TTTA may resist cyclic loading, and requires evaluation.

Phase I Dose-Escalation Trial of Checkpoint Kinase 1 Inhibitor MK-8776 As Monotherapy and in Combination With Gemcitabine in Patients With Advanced Solid Tumors

2015 ◽  
Vol 33 (9) ◽  
pp. 1060-1066 ◽  
Author(s):  
Adil I. Daud ◽  
Michelle T. Ashworth ◽  
Jonathan Strosberg ◽  
Jonathan W. Goldman ◽  
David Mendelson ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Phase I ◽  
Phase Ii ◽  
Ex Vivo ◽  
Dose Intensity ◽  
Median Number ◽  
Qtc Prolongation ◽  
Checkpoint Kinase ◽  
Checkpoint Kinase 1 ◽  
Recommended Phase Ii Dose

Purpose We determined the safety, pharmacokinetics, pharmacodynamics, and recommended phase II dose of MK-8776 (SCH 900776), a potent, selective checkpoint kinase 1 (Chk1) inhibitor, as monotherapy and in combination with gemcitabine in a first-in-human phase I clinical trial in patients with advanced solid tumor malignancies. Patients and Methods Forty-three patients were treated by intravenous infusion with MK-8776 at seven dose levels ranging from 10 to 150 mg/m2 as monotherapy and then in combination with gemcitabine 800 mg/m2 (part A, n = 26) or gemcitabine 1,000 mg/m2 (part B, n = 17). Forty percent of patients had three or more prior treatment regimens, and one third of patients had previously received gemcitabine. Results As monotherapy, MK-8776 was well tolerated, with QTc prolongation (19%), nausea (16%), fatigue (14%), and constipation (14%) as the most frequent adverse effects. Combination therapy demonstrated a higher frequency of adverse effects, predominantly fatigue (63%), nausea (44%), decreased appetite (37%), thrombocytopenia (32%), and neutropenia (24%), as well as dose-related, transient QTc prolongation (17%). The median number of doses of MK-8776 administered was five doses, with relative dose-intensity of 0.96. Bioactivity was assessed by γ-H2AX ex vivo assay. Of 30 patients evaluable for response, two showed partial response, and 13 exhibited stable disease. Conclusion MK-8776 was well tolerated as monotherapy and in combination with gemcitabine. Early evidence of clinical efficacy was observed. The recommended phase II dose is MK-8776 200 mg plus gemcitabine 1,000 mg/m2 on days 1 and 8 of a 21-day cycle.

scholarly journals Outcome of Inferior Patellar Pole Avulsion Fractures

2016 ◽  
Vol 4 (2) ◽  
pp. 84
Author(s):  
Ruban Raj Joshi ◽  
Rajeev Dwivedi ◽  
Subin Byanjankar ◽  
Rahul Shrestha
Keyword(s):  
Internal Fixation ◽  
Hospital Stay ◽  
Open Reduction ◽  
Tension Band ◽  
Tension Band Wiring ◽  
Patellar Ligament ◽  
Suture Repair ◽  
Avulsion Fractures ◽  
Inferior Pole ◽  
Tension Band Wire

Introduction: The optimal treatment for inferior pole patella avulsion fractures has still been a topic of debate. The options include (a) internal fixation of the pole fragment and (b) resection of the avulsed fragment and repair of the patellar ligament to the patella. We present the comparative outcomes for patients with displaced inferior pole patella treated by resection and transosseous Ethibond® Krackow suture repair of patellar ligament with open reduction and internal fixation with modified tension band wiring and circumferential wiring.   Methods: During a three year period between August 2013 and September 2016, twenty consecutive patients with distal pole fractures of the patella were prospectively enrolled in this study. These patients were divided into two groups. Group-T patients were treated with open reduction and internal fixation with modified tension band wire and  group-R patients by resection of the avulsed fragment and reattachment of the patellar ligament to the patella with #5 Ethibond®. Data entry and analysis was done by using SPSS version 20. Anatomical and functional outcome were compared.   Results: Consecutive 20 patients were treated either with resection lower patellar pole (n=10) or with open reduction internal fixation with tension band wiring (n=10). Demographics were matched in two groups. Group-T required a longer hospital stay (U=13.5, p=0.005). Complications were seen more often in Goup-T compared to Group-R (p=0.005). Group-R had better scores (Bostman score U=6, p=0.001; SFMA U=7.5, p=0.001) and range of movement (p<0.05).   Conclusion: Resection of the avulsed fragment and reattachment of the patellar ligament to the patella had better outcome according to the Bostman and SFMA dysfunction score, shorter hospital stay, and less complications as compared to open reduction and internal fixation with tension band wire and circumferential wiring.

scholarly journals Analysis of the Ex-vivo transformation of Semen, Saliva and Urine as they dry out using ATR-FTIR spectroscopy and chemometric Approach

2021 ◽  
Author(s):  
Tanurup Das ◽  
Abhimanyu Harshey ◽  
Ankit Srivast ◽  
Kriti Nigam ◽  
Vijay Yadav ◽  
...  
Keyword(s):  
Phase I ◽  
Phase Ii ◽  
Ex Vivo ◽  
Body Fluids ◽  
Biochemical Changes ◽  
Partial Least Square ◽  
Least Square ◽  
Slow Phase ◽  
Potential Marker ◽  
Dry Out

Abstract The ex-vivo biochemical changes of different body fluids are potential marker for the estimation of TSD. Infrared spectroscopy has great potential to reveal the biochemical changes in these fluids as previously reported by several researchers. Present study is focused to analyze the spectral changes in the ATR-FTIR spectra of three body fluids, commonly encountered in violent crimes i.e., Semen, Saliva and Urine as they dry out. The whole analytical timeline is divided into relatively slow phase I due to major contribution of water and faster Phase II due significant evaporation of water. Two spectral regions i.e., 3200-3400 cm-1 and 1600-1000 cm-1 are the major contributor to the spectra of these fluids. Several peaks in the spectral region between 1600-1000 cm-1 showed highly significant regression equation with higher coefficient of determination values in the Phase II in contrary to the slow passing Phase I. Principal component and Partial Least Square Regression analysis are the two chemometric tool used to estimate the TSD of the aforesaid fluids as they dry out. This study potentially estimates the TSD of an offence at the early stages after is occurrence as well as work as the precursor for further studies on extended timeframe.

Immunotherapy of Hormone-Refractory Prostate Cancer With Antigen-Loaded Dendritic Cells

2000 ◽  
Vol 18 (23) ◽  
pp. 3894-3903 ◽  
Author(s):  
Eric J. Small ◽  
Paige Fratesi ◽  
David M. Reese ◽  
George Strang ◽  
Reiner Laus ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Dendritic Cells ◽  
Immune Responses ◽  
Fusion Protein ◽  
Phase I ◽  
Phase Ii ◽  
Ex Vivo ◽  
Hormone Refractory Prostate Cancer ◽  
Tissue Antigen ◽  
Hormone Refractory

PURPOSE: Provenge (Dendreon Corp, Seattle, WA) is an immunotherapy product consisting of autologous dendritic cells loaded ex vivo with a recombinant fusion protein consisting of prostatic acid phosphatase (PAP) linked to granulocyte-macrophage colony-stimulating factor. Sequential phase I and phase II trials were performed to determine the safety and efficacy of Provenge and to assess its capacity to break immune tolerance to the normal tissue antigen PAP. PATIENTS AND METHODS: All patients had hormone-refractory prostate cancer. Dendritic-cell precursors were harvested by leukapheresis in weeks 0, 4, 8, and 24, loaded ex vivo with antigen for 2 days, and then infused intravenously over 30 minutes. Phase I patients received increasing doses of Provenge, and phase II patients received all the Provenge that could be prepared from a leukapheresis product. RESULTS: Patients tolerated treatment well. Fever, the most common adverse event, occurred after 15 infusions (14.7%). All patients developed immune responses to the recombinant fusion protein used to prepare Provenge, and 38% developed immune responses to PAP. Three patients had a more than 50% decline in prostate-specific antigen (PSA) level, and another three patients had 25% to 49% decreases in PSA. The time to disease progression correlated with development of an immune response to PAP and with the dose of dendritic cells received. CONCLUSION: Provenge is a novel immunotherapy agent that is safe and breaks tolerance to the tissue antigen PAP. Preliminary evidence for clinical efficacy warrants further exploration.

scholarly journals Long-Term Follow-Up of Mesothelioma Patients Treated with Dendritic Cell Therapy in Three Phase I/II Trials

Vaccines ◽  
2021 ◽  
Vol 9 (5) ◽  
pp. 525
Author(s):  
Daphne W. Dumoulin ◽  
Robin Cornelissen ◽  
Koen Bezemer ◽  
Sara J. Baart ◽  
Joachim G. J. V. Aerts
Keyword(s):  
Phase I ◽  
Phase Ii ◽  
Survival Data ◽  
Ex Vivo ◽  
Tumor Cell Line ◽  
Autologous Tumor ◽  
Term Survival ◽  
Long Term Survival ◽  
Three Phase

Background: Malignant pleural mesothelioma (MPM) is a fatal neoplasm with, if untreated, poor survival of approximately nine months from diagnosis. Until recently, phase II–III immunotherapy trials did not show any significant benefit. The lack of immunotherapy efficacy can be explained by the fact that mesothelioma is a tumor with an “immune desert” phenotype, meaning a non-inflamed tumor characterized by low T-cell infiltration. By administration of DCs, which were ex-vivo cultured, exposed to (tumor-associated) antigens, and subsequently activated, this “immune desert” phenotype might be turned into an “inflamed” phenotype. Three phase I/II studies have been performed and published using activated DCs, which support this concept. We here report on the long-term survival of patients treated with DCs in three phase I/II studies. Methods: Survival data of the phase I/II trials using DC therapy in MPM patients were obtained and subsequently analyzed. In the first two trials, DCs were loaded with autologous tumor lysate. In the third trial, DCs were loaded with allogeneic mesothelioma tumor cell line lysate. Results: In the three studies combined, 29 patients with MPM were treated with DC vaccination between 2006 and 2015. At data cut-off, the median OS was 27 months (95% CI: 21–47 months). OS at 2 years was 55.2% (95% CI: 39.7–76.6%), and OS at 5 years was 20.7% (95% CI: 10.1–42.2%). Conclusions: The long-term survival of DC therapy in MPM in these three trials is promising, which is the basis for the randomized phase II/III DENIM study. This DENIM study is currently enrolling, and the results of which have to be awaited for definite conclusions.

scholarly journals Evaluating Wire Configurations for Tension Band Constructs using a Canine Greater Trochanteric Osteotomy Model

2018 ◽  
Author(s):  
Elizabeth Thompson ◽  
Amir K. Robe ◽  
Simon C. Roe ◽  
Jacqueline H. Cole
Keyword(s):  
Failure Load ◽  
Ex Vivo ◽  
Tension Band ◽  
Tension Band Wiring ◽  
Stable Configuration ◽  
Trochanteric Osteotomy ◽  
Initial Tension ◽  
Residual Tension ◽  
Tension Band Wire ◽  
Highly Correlated

Objective: To investigate the stability of four tension band wiring configurations alone without the contributions of K-wire stabilization. Study design: ex vivo experimentalSample population: Sixty-four tension band wiring constructsMethods: Four tension band configurations were applied to a metal trochanteric osteotomy model based on a canine femur: figure-of-eight with one twist (OT), figure-of-eight with two twists (TT), dual interlocking single loop (DISL), and double loop (DL). Configurations were mechanically tested under both monotonic loading (n = 8 per configuration) and incremental cyclic loading (n = 8 per configuration). Initial tension after tying, residual tension remaining after each cycle, and failure load at 2 mm of displacement (considered equivalent to clinical failure) were recorded. Results: The initial tension and the load to 2 mm of displacement was lower for OT wires compared to TT wires. The DL was the strongest and most stable configuration, generating greater initial tension, maintaining a greater percentage of residual tension under incremental cyclic loads, and resisting higher load before failure at 2 mm. Failure load was highly correlated with initial tension. Conclusion: This model enabled evaluation of tension band wire configuration independent of the fixation pin portion of the construct. Wire configurations that can be tightened to a greater tension during tying, like the DL, are better able to resist the tensile loads experienced by the construct. Clinical impact: In clinical situations where high tensile loads are expected, a tighter, more secure tension band wire configuration may be warranted.

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