TY - JOUR A1 - Alnemer, Momin Sami Mohammad A1 - Kotliar, Konstantin A1 - Neuhaus, Valentin A1 - Pape, Hans-Christoph A1 - Ciritsis, Bernhard D. T1 - Cost-effectiveness analysis of surgical proximal femur fracture prevention in elderly: a Markov cohort simulation model JF - Cost Effectiveness and Resource Allocation N2 - Background Hip fractures are a common and costly health problem, resulting in significant morbidity and mortality, as well as high costs for healthcare systems, especially for the elderly. Implementing surgical preventive strategies has the potential to improve the quality of life and reduce the burden on healthcare resources, particularly in the long term. However, there are currently limited guidelines for standardizing hip fracture prophylaxis practices. Methods This study used a cost-effectiveness analysis with a finite-state Markov model and cohort simulation to evaluate the primary and secondary surgical prevention of hip fractures in the elderly. Patients aged 60 to 90 years were simulated in two different models (A and B) to assess prevention at different levels. Model A assumed prophylaxis was performed during the fracture operation on the contralateral side, while Model B included individuals with high fracture risk factors. Costs were obtained from the Centers for Medicare & Medicaid Services, and transition probabilities and health state utilities were derived from available literature. The baseline assumption was a 10% reduction in fracture risk after prophylaxis. A sensitivity analysis was also conducted to assess the reliability and variability of the results. Results With a 10% fracture risk reduction, model A costs between $8,850 and $46,940 per quality-adjusted life-year ($/QALY). Additionally, it proved most cost-effective in the age range between 61 and 81 years. The sensitivity analysis established that a reduction of ≥ 2.8% is needed for prophylaxis to be definitely cost-effective. The cost-effectiveness at the secondary prevention level was most sensitive to the cost of the contralateral side’s prophylaxis, the patient’s age, and fracture treatment cost. For high-risk patients with no fracture history, the cost-effectiveness of a preventive strategy depends on their risk profile. In the baseline analysis, the incremental cost-effectiveness ratio at the primary prevention level varied between $11,000/QALY and $74,000/QALY, which is below the defined willingness to pay threshold. Conclusion Due to the high cost of hip fracture treatment and its increased morbidity, surgical prophylaxis strategies have demonstrated that they can significantly relieve the healthcare system. Various key assumptions facilitated the modeling, allowing for adequate room for uncertainty. Further research is needed to evaluate health-state-associated risks. KW - Hip fractures KW - Prevention KW - Geriatric KW - Cost-effectiveness KW - Prophylaxis Y1 - 2023 U6 - http://dx.doi.org/10.1186/s12962-023-00482-4 SN - 1478-7547 N1 - Corresponding author: Momin S. Alnemer IS - 21, Article number: 77 PB - Springer Nature ER - TY - JOUR A1 - Werfel, Stanislas A1 - Günthner, Roman A1 - Hapfelmeier, Alexander A1 - Hanssen, Henner A1 - Kotliar, Konstantin A1 - Heemann, Uwe A1 - Schmaderer, Christoph ED - Guzik, Tomasz J. T1 - Identification of cardiovascular high-risk groups from dynamic retinal vessel signals using untargeted machine learning JF - Cardiovascular Research N2 - Dynamic retinal vessel analysis (DVA) provides a non-invasive way to assess microvascular function in patients and potentially to improve predictions of individual cardiovascular (CV) risk. The aim of our study was to use untargeted machine learning on DVA in order to improve CV mortality prediction and identify corresponding response alterations. KW - Machine learning KW - Retinal vessels KW - Microcirculation KW - Haemodialysis KW - Myocardial infarction and cardiac death Y1 - 2022 U6 - http://dx.doi.org/10.1093/cvr/cvab040 SN - 0008-6363 VL - 118 IS - 2 SP - 612 EP - 621 PB - Oxford University Press CY - Oxford ER - TY - JOUR A1 - Malinowski, Daniel A1 - Fournier, Yvan A1 - Horbach, Andreas A1 - Frick, Michael A1 - Magliani, Mirko A1 - Kalverkamp, Sebastian A1 - Hildinger, Martin A1 - Spillner, Jan A1 - Behbahani, Mehdi A1 - Hima, Flutura T1 - Computational fluid dynamics analysis of endoluminal aortic perfusion JF - Perfusion N2 - Introduction: In peripheral percutaneous (VA) extracorporeal membrane oxygenation (ECMO) procedures the femoral arteries perfusion route has inherent disadvantages regarding poor upper body perfusion due to watershed. With the advent of new long flexible cannulas an advancement of the tip up to the ascending aorta has become feasible. To investigate the impact of such long endoluminal cannulas on upper body perfusion, a Computational Fluid Dynamics (CFD) study was performed considering different support levels and three cannula positions. Methods: An idealized literature-based- and a real patient proximal aortic geometry including an endoluminal cannula were constructed. The blood flow was considered continuous. Oxygen saturation was set to 80% for the blood coming from the heart and to 100% for the blood leaving the cannula. 50% and 90% venoarterial support levels from the total blood flow rate of 6 l/min were investigated for three different positions of the cannula in the aortic arch. Results: For both geometries, the placement of the cannula in the ascending aorta led to a superior oxygenation of all aortic blood vessels except for the left coronary artery. Cannula placements at the aortic arch and descending aorta could support supra-aortic arteries, but not the coronary arteries. All positions were able to support all branches with saturated blood at 90% flow volume. Conclusions: In accordance with clinical observations CFD analysis reveals, that retrograde advancement of a long endoluminal cannula can considerably improve the oxygenation of the upper body and lead to oxygen saturation distributions similar to those of a central cannulation. KW - computational fluid dynamics analysis KW - simulation KW - endoluminal KW - aortic perfusion KW - extracorporeal membrane oxygenation Y1 - 2022 U6 - http://dx.doi.org/10.1177/02676591221099809 SN - 1477-111X VL - 0 IS - 0 SP - 1 EP - 8 PB - Sage CY - London ER - TY - JOUR A1 - Lenz, Maximilian A1 - Kahmann, Stephanie Lucina A1 - Behbahani, Mehdi A1 - Pennig, Lenhard A1 - Hackl, Michael A1 - Leschinger, Tim A1 - Müller, Lars Peter A1 - Wegmann, Kilian T1 - Influence of rotator cuff preload on fracture configuration in proximal humerus fractures: a proof of concept for fracture simulation JF - Archives of Orthopaedic and Trauma Surgery N2 - Introduction In regard of surgical training, the reproducible simulation of life-like proximal humerus fractures in human cadaveric specimens is desirable. The aim of the present study was to develop a technique that allows simulation of realistic proximal humerus fractures and to analyse the influence of rotator cuff preload on the generated lesions in regards of fracture configuration. Materials and methods Ten cadaveric specimens (6 left, 4 right) were fractured using a custom-made drop-test bench, in two groups. Five specimens were fractured without rotator cuff preload, while the other five were fractured with the tendons of the rotator cuff preloaded with 2 kg each. The humeral shaft and the shortened scapula were potted. The humerus was positioned at 90° of abduction and 10° of internal rotation to simulate a fall on the elevated arm. In two specimens of each group, the emergence of the fractures was documented with high-speed video imaging. Pre-fracture radiographs were taken to evaluate the deltoid-tuberosity index as a measure of bone density. Post-fracture X-rays and CT scans were performed to define the exact fracture configurations. Neer’s classification was used to analyse the fractures. Results In all ten cadaveric specimens life-like proximal humerus fractures were achieved. Two III-part and three IV-part fractures resulted in each group. The preloading of the rotator cuff muscles had no further influence on the fracture configuration. High-speed videos of the fracture simulation revealed identical fracture mechanisms for both groups. We observed a two-step fracture mechanism, with initial impaction of the head segment against the glenoid followed by fracturing of the head and the tuberosities and then with further impaction of the shaft against the acromion, which lead to separation of the tuberosities. Conclusion A high energetic axial impulse can reliably induce realistic proximal humerus fractures in cadaveric specimens. The preload of the rotator cuff muscles had no influence on initial fracture configuration. Therefore, fracture simulation in the proximal humerus is less elaborate. Using the presented technique, pre-fractured specimens are available for real-life surgical education. KW - Proximal humerus fracture KW - Biomechanical simulation KW - Fracture configuration KW - Fracture simulation KW - Rotator cuff Y1 - 2022 U6 - http://dx.doi.org/10.1007/s00402-022-04471-9 SN - 1434-3916 PB - Springer CY - Berlin, Heidelberg ER - TY - JOUR A1 - Chloé, Radermacher A1 - Malyaran, Hanna A1 - Craveiro, Rogerio Bastos A1 - Peglow, Sarah A1 - Behbahani, Mehdi A1 - Pufe, Thomas A1 - Wolf, Michael A1 - Neuss, Sabine T1 - Mechanical loading on cementoblasts: a mini review JF - Osteologie N2 - Orthodontic treatments are concomitant with mechanical forces and thereby cause teeth movements. The applied forces are transmitted to the tooth root and the periodontal ligaments which is compressed on one side and tensed up on the other side. Indeed, strong forces can lead to tooth root resorption and the crown-to-tooth ratio is reduced with the potential for significant clinical impact. The cementum, which covers the tooth root, is a thin mineralized tissue of the periodontium that connects the periodontal ligament with the tooth and is build up by cementoblasts. The impact of tension and compression on these cells is investigated in several in vivo and in vitro studies demonstrating differences in protein expression and signaling pathways. In summary, osteogenic marker changes indicate that cyclic tensile forces support whereas static tension inhibits cementogenesis. Furthermore, cementogenesis experiences the same protein expression changes in static conditions as static tension, but cyclic compression leads to the exact opposite of cyclic tension. Consistent with marker expression changes, the singaling pathways of Wnt/ß-catenin and RANKL/OPG show that tissue compression leads to cementum degradation and tension forces to cementogenesis. However, the cementum, and in particular its cementoblasts, remain a research area which should be explored in more detail to understand the underlying mechanism of bone resorption and remodeling after orthodontic treatments. KW - Cementoblast KW - Compression KW - Tension KW - Mechanotransduction KW - Forces Y1 - 2022 U6 - http://dx.doi.org/10.1055/a-1826-0777 SN - 1019-1291 VL - 31 IS - 2 SP - 111 EP - 118 PB - Thieme CY - Stuttgart ER - TY - JOUR A1 - Uysal, Karya A1 - Creutz, Till A1 - Firat, Ipek Seda A1 - Artmann, Gerhard A1 - Teusch, Nicole A1 - Temiz Artmann, Aysegül T1 - Bio-functionalized ultra-thin, large-area and waterproof silicone membranes for biomechanical cellular loading and compliance experiments JF - Polymers N2 - Biocompatibility, flexibility and durability make polydimethylsiloxane (PDMS) membranes top candidates in biomedical applications. CellDrum technology uses large area, <10 µm thin membranes as mechanical stress sensors of thin cell layers. For this to be successful, the properties (thickness, temperature, dust, wrinkles, etc.) must be precisely controlled. The following parameters of membrane fabrication by means of the Floating-on-Water (FoW) method were investigated: (1) PDMS volume, (2) ambient temperature, (3) membrane deflection and (4) membrane mechanical compliance. Significant differences were found between all PDMS volumes and thicknesses tested (p < 0.01). They also differed from the calculated values. At room temperatures between 22 and 26 °C, significant differences in average thickness values were found, as well as a continuous decrease in thicknesses within a 4 °C temperature elevation. No correlation was found between the membrane thickness groups (between 3–4 µm) in terms of deflection and compliance. We successfully present a fabrication method for thin bio-functionalized membranes in conjunction with a four-step quality management system. The results highlight the importance of tight regulation of production parameters through quality control. The use of membranes described here could also become the basis for material testing on thin, viscous layers such as polymers, dyes and adhesives, which goes far beyond biological applications. Y1 - 2022 SN - 2073-4360 VL - 14 IS - 11 SP - 2213 PB - MDPI CY - Basel ER - TY - CHAP A1 - Tran, Ngoc Trinh A1 - Trinh, Tu Luc A1 - Dao, Ngoc Tien A1 - Giap, Van Tan A1 - Truong, Manh Khuyen A1 - Dinh, Thuy Ha A1 - Staat, Manfred T1 - Limit and shakedown analysis of structures under random strength T2 - Proceedings of (NACOME2022) The 11th National Conference on Mechanics, Vol. 1. Solid Mechanics, Rock Mechanics, Artificial Intelligence, Teaching and Training, Hanoi, December 2-3, 2022 N2 - Direct methods comprising limit and shakedown analysis is a branch of computational mechanics. It plays a significant role in mechanical and civil engineering design. The concept of direct method aims to determinate the ultimate load bearing capacity of structures beyond the elastic range. For practical problems, the direct methods lead to nonlinear convex optimization problems with a large number of variables and onstraints. If strength and loading are random quantities, the problem of shakedown analysis is considered as stochastic programming. This paper presents a method so called chance constrained programming, an effective method of stochastic programming, to solve shakedown analysis problem under random condition of strength. In this our investigation, the loading is deterministic, the strength is distributed as normal or lognormal variables. KW - Reliability of structures KW - Stochastic programming KW - Chance constrained programming KW - Shakedown analysis KW - Limit analysis Y1 - 2022 SN - 978-604-357-084-7 SP - 510 EP - 518 PB - Nha xuat ban Khoa hoc tu nhien va Cong nghe (Verlag Naturwissenschaft und Technik) CY - Hanoi ER - TY - JOUR A1 - Topçu, Murat A1 - Madabhushi, Gopal S.P. A1 - Staat, Manfred T1 - A generalized shear-lag theory for elastic stress transfer between matrix and fibres having a variable radius JF - International Journal of Solids and Structures N2 - A generalized shear-lag theory for fibres with variable radius is developed to analyse elastic fibre/matrix stress transfer. The theory accounts for the reinforcement of biological composites, such as soft tissue and bone tissue, as well as for the reinforcement of technical composite materials, such as fibre-reinforced polymers (FRP). The original shear-lag theory proposed by Cox in 1952 is generalized for fibres with variable radius and with symmetric and asymmetric ends. Analytical solutions are derived for the distribution of axial and interfacial shear stress in cylindrical and elliptical fibres, as well as conical and paraboloidal fibres with asymmetric ends. Additionally, the distribution of axial and interfacial shear stress for conical and paraboloidal fibres with symmetric ends are numerically predicted. The results are compared with solutions from axisymmetric finite element models. A parameter study is performed, to investigate the suitability of alternative fibre geometries for use in FRP. KW - Natural fibres KW - Polymer-matrix composites KW - Biocomposites KW - Stress concentrations KW - Finite element analysis Y1 - 2022 U6 - http://dx.doi.org/10.1016/j.ijsolstr.2022.111464 SN - 0020-7683 VL - 239–240 IS - Art. No. 111464 PB - Elsevier CY - New York, NY ER - TY - JOUR A1 - Mandekar, Swati A1 - Holland, Abigail A1 - Thielen, Moritz A1 - Behbahani, Mehdi A1 - Melnykowycz, Mark T1 - Advancing towards Ubiquitous EEG, Correlation of In-Ear EEG with Forehead EEG JF - Sensors N2 - Wearable EEG has gained popularity in recent years driven by promising uses outside of clinics and research. The ubiquitous application of continuous EEG requires unobtrusive form-factors that are easily acceptable by the end-users. In this progression, wearable EEG systems have been moving from full scalp to forehead and recently to the ear. The aim of this study is to demonstrate that emerging ear-EEG provides similar impedance and signal properties as established forehead EEG. EEG data using eyes-open and closed alpha paradigm were acquired from ten healthy subjects using generic earpieces fitted with three custom-made electrodes and a forehead electrode (at Fpx) after impedance analysis. Inter-subject variability in in-ear electrode impedance ranged from 20 kΩ to 25 kΩ at 10 Hz. Signal quality was comparable with an SNR of 6 for in-ear and 8 for forehead electrodes. Alpha attenuation was significant during the eyes-open condition in all in-ear electrodes, and it followed the structure of power spectral density plots of forehead electrodes, with the Pearson correlation coefficient of 0.92 between in-ear locations ELE (Left Ear Superior) and ERE (Right Ear Superior) and forehead locations, Fp1 and Fp2, respectively. The results indicate that in-ear EEG is an unobtrusive alternative in terms of impedance, signal properties and information content to established forehead EEG. KW - in-ear EEG KW - correlation KW - forehead EEG KW - impedance spectroscopy KW - biopotential electrodes Y1 - 2022 U6 - http://dx.doi.org/10.3390/s22041568 SN - 1424-8220 VL - 22 IS - 4 SP - 1 EP - 19 PB - MDPI CY - Basel ER - TY - JOUR A1 - Defosse, Jerome A1 - Kleinschmidt, Joris A1 - Schmutz, Axel A1 - Loop, Torsten A1 - Staat, Manfred A1 - Gatzweiler, Karl-Heinz A1 - Wappler, Frank A1 - Schieren, Mark T1 - Dental strain on maxillary incisors during tracheal intubation with double-lumen tubes and different laryngoscopy techniques - a blinded manikin study JF - Journal of Cardiothoracic and Vascular Anesthesia KW - anaesthetic complications KW - dental trauma KW - difficult airway KW - double-lumen tube intubation KW - videolaryngoscopy Y1 - 2022 U6 - http://dx.doi.org/10.1053/j.jvca.2022.02.017 SN - 1053-0770 VL - 36 IS - 8, Part B SP - 3021 EP - 3027 PB - Elsevier CY - New York, NY ER -