text:
The purpose of this study was to investigate sex differences in resected distal femoral morphology in Chinese osteoarthritic knees.
The study included 130 osteoarthritic knees in 65 men and 65 women in China. None had anterior femoral osteophyte or serious patellar femoral joint degeneration. The following were measured using computed tomography and analyzed to identify morphological differences according to sex in the resected distal femurs: anterior lateral condylar height (ALCH), anterior medial condylar height (AMCH), and mediolateral (ML) and anteroposterior (AP) dimensions. The ML/AP aspect ratio was calculated.
The average ALCH and AMCH were 8.2±1.8 mm, 3.1±1.5 mm for men and 7.4±1.7 mm, 3.6±1.5 mm for women. There were significant differences between men and women in ALCH values (P = 0.014) but not in AMCH values (P = 0.09). Women had smaller ML/AP aspect ratios than men for a given AP dimension. This indicated that the femoral ML dimension of a prosthesis with a given AP dimension may have overhang in women.
This study suggested that sex differences should be taken into account in the design of femoral prosthesis for Chinese men and women.
Citation: Yang B, Yu J-K, Zheng Z-Z, Lu Z-H, Zhang J-Y (2014) Comparative Study of Sex Differences in Distal Femur Morphology in Osteoarthritic Knees in a Chinese Population. PLoS ONE 9(2): e89394. doi:10.1371/journal.pone.0089394
Editor: Gwendolen Reilly, Kroto Research Institute, United Kingdom
Received: September 11, 2013; Accepted: January 20, 2014; Published: February 19, 2014
Copyright: © 2014 Yang et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: This research was funded by the Sino-Germany Cooperation Project of the Department of International Cooperation of the Ministry of Science and Technology of china (No. 2011DFA31340); the science and technology plan projects of Beijing (No. Z131100005213004); Instrument Research Project of the National Natural Science Foundation (No. 81327001). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
To achieve a successful outcome during total knee arthroplasty (TKA) and to reduce complications, it is important that the size and shape of the knee prosthesis matches the morphology of the resected knee [1], [2]. Many studies have shown striking sex differences in distal femoral morphology, and these differences have prompted the design of female-specific femoral components with narrower femoral condyles, thinner anterior flanges, and increased trochlear groove angles that provide a better fit for the anatomical variances in women's knees [3]–[5]. Compared with standard femoral components, female-specific femoral components can reduce the mediolateral overhang in women undergoing TKA [6], [7]. However, it is not known whether use of female-specific femoral components results in better clinical outcomes in women. Some researchers support using sex-specific femoral components [3], [8], whereas others express doubts that the use of such components is necessary [9]–[11].
Morphological differences have also been reported among some populations that differ in terms of ethnicity. Specifically, Asian populations have different femoral dimensions and morphology than Western populations [12], [13]. However, most currently available commercial knee prostheses are designed based on anthropometric data from Caucasian knees; such prostheses do not necessarily provide the best fit in Asian populations. For instance, with currently used TKA implants, the femoral component tends to show mediolateral overhang [1], [14] or poor clinical results for TKAs performed in Asian populations [15]. These findings, along with the increasing use of TKA in Asian countries [16], [17], indicated that it is critical to investigate knee morphology in Asian populations.
Furthermore, most knees undergoing TKA are different from healthy knees, suggesting that the prosthetic design should be based on the data from diseased knees [18]. Our previous study found that in Chinese subjects with osteoarthritis, the proximal tibias of men and women had the same AP and different ML dimensions; this resulted in a higher ML/AP aspect ratio in men compared to women [19]. Because osteoarthritis affects the shape of the knee, the present study investigated sex differences in the geometric features of the distal femur in Chinese osteoarthritic knees using three-dimensional computed tomography (CT).
Materials and Methods
This study was approved by the institutional review board at the Peking University Third Hospital. Prior to the start of the study, all study subjects gave written informed consent. A total of 130 osteoarthritic knees from 65 Chinese men and 65 Chinese women were included in the study. The mean subject age was 61.4±8.3 years for men and 61.6±7.7 years for women. The mean height was 169.3±4.2 cm for men and 160.0±5.4 cm for women. Patients were excluded if they had a history of femoral fracture or congenital anomaly, if they had diseases that could affect the normal formation of the knee joint, or if the knee had a varus or valgus deformity greater than 15°.
CT Imaging
A CT scan of each knee was performed using a helical CT scanner (120 kVp, 200 mA, Somatom Sensation 16, Siemens Healthcare, Germany). The patient was placed supine with the knee in a full extended position on the scanner with the patella facing towards the ceiling. The scanning procedure acquired 1-mm CT slices (image size, 512×512 pixels). The CT images were retrieved on the CT workstation (Syngo CT workplace, Germany), and the femur was segmented to construct three-dimensional bone models.
Using the CT images, a line that connected the center of the femoral head to the center of the distal femur notch was defined as the femoral mechanical axis. A line connecting the medial sulcus of the medial epicondyle and the lateral epicondylar prominence was defined as the surgical transepicondylar axis (STEA). A line connecting the middle point of the femoral shaft to the entry point of the intramedullary guide rod (10 mm above the roof of the intercondylar fossa) was defined as the simulated intramedullary guide rod. The distal femur was cut passed the STEA and perpendicular to the femoral mechanical axis with 9 mm above the lowest point of the medial femoral condyle (Figure 1A). The anterior condyle was cut parallel to the simulated intramedullary guide rod without notching the anterior cortex (Figure 1B). The femoral mediolateral (ML) dimension was defined as the longest ML length of the distal cut femur surface; this line paralleled the STEA. The anteroposterior (AP) dimensions were defined as the longest line drawn perpendicular to the ML line between the most posterior condylar and the anterior trochlear point from the lateral condyle of the femur. The anterior lateral condylar height (ALCH) and the anterior medial condylar height (AMCH) were defined as the maximum thicknesses of the anterior cut at the lateral and medial condyles, respectively (Figure 1C). The femoral aspect ratio of the ML dimension to the AP dimension (ML/AP) was calculated.
(A) A coronal CT image of a femur. The red line indicates the distal femur cut line. (B) A sagittal CT image of a femur. The red line indicates the anterior condyle cut line, which is flush with the anterior femoral cortex. (C) An axial CT image shows the measurement parameters for the distal femur. The red line indicates the anterior condyle cut line.
Statistical Analysis
SPSS software version 18.0 (SPSS, Chicago, IL) was used for statistical analysis. The mean and standard deviation of the measured dimensions were calculated. For independent samples, the student's t-test was used to determine the significance of differences between values for men and women. Linear regression analysis was used to determine correlations for the femur ML and AP dimensions. The differences were considered significant when P<0.05.
The average ALCH was 8.2±1.8 mm for men and 7.4±1.7 mm for women. There was a significant difference between men and women with regard to ALCH (P = .014). The average AMCH was 3.1±1.5 mm for men and 3.6±1.5 mm for women (P = 0.09). The average ML and AP dimensions and ML/AP aspect ratios were significantly lower in women than in men (P<0.05; Table 1).
There was a significant positive correlation between the ML and AP dimensions in both men and women, with the ML dimension increasing as the AP dimension increased. The line fitted to the data for women lies below the one of men, showing that women generally have a smaller ML dimension than men for a given AP dimension, i.e. men have wider knees than women (Figure 2).
The ML/AP aspect ratios for the distal femur showed a progressive decline with increasing AP dimension in both men and women. The fitted line for women lies below that of men, showing that women generally have smaller ML/AP ratios than men for a given AP dimension (Figure 3).
Researchers continue to debate whether it is necessary to design and use sex-specific femoral components based on anatomic differences in the morphology of the distal femur in men and women [8], [9]. Here we analyzed morphological differences in the distal femurs of 130 Chinese osteoarthritic knees based on simulated intraoperative bone cuts in three-dimensional CT images. The ALCH and the ML and AP dimensions of the resected distal femurs were significantly smaller in women than in men, while the AMCH values did not differ significantly according to sex. In addition, there was a significant sex difference in the ML/AP aspect ratio, with women generally having smaller ML/AP aspect ratios and narrower distal femurs than men.
Several researchers have studied the ML and AP dimensions of the distal femur in Asian populations. Lim et al. [20] used MRI to show that femoral ML and AP dimensions were 81.5±5.7 mm and 59.0±4.0 mm in men and 76.7±3.7 mm and 58.4±3.1 mm in women in a Korean population. Yue et al. [12] studied knees using CT imaging in a Chinese population and reported values of 82.6±3.6 mm and 65.0±2.8 mm in men and 72.8±2.6 mm and 58.8±2.5 mm in women. Notably, these studies looked at femur morphology in healthy knees. Such data may not suitable for guiding implant design because most knees undergoing TKA are deformed and sometimes differed dramatically from healthy knees. Instead, prosthetic designs should be based on data from diseased knees [18]. In this study, we measured osteoarthritic knees that were candidates for TKA; these data better reflect the morphology of patients seeking TKA and should thus be more useful for designing well-fitting components.
The difference in the distal femoral condyle ML/AP aspect ratio is one of the reasons for designing a sex-specific femoral implant. Our results and those of previous studies demonstrated that osteoarthritic women have narrower distal femurs and smaller ML/AP ratios than men [21], [5]. Hitt et al. measured 337 knees of TKA patients (209 women and 128 men) and found that with the use of standard femoral components there tended to be overhang in women compared to men [2]. Clarke et al. [7] reported that with standard femoral prostheses, the incidence of femoral component ML overhang in women was 17% compared with 0% in men. The overhang rate decreased in women when a female-specific femoral component was used. Guy et al. [6] measured the intraoperative anatomy of the distal femur in 100 knees of TKA patients (50 men and 50 women) and compared these measurements with the geometries of standard and female-specific femoral components. They found that with the use of standard femoral components, there was an overhang greater than 3 mm at the anterior flange width in 48% (24/50) of women and in the anterior medial-lateral width in 58% (29/50) of women. In contrast, only 6% (3/50) of women had any measurable medial-lateral component overhang greater than 2 mm when female-specific femoral implants were used. However, none of these studies quantified the clinical effects of the overhang.
Optimal design of femoral TKA components is critical for obtaining ideal coverage of the resected femur surface to allow for best function. We found that the distal femurs of women have smaller ML dimensions and aspect ratios than those of men for the same AP dimension. This means that for a prosthesis with a given AP dimension, the femoral ML dimension may overhang in women. Overhang can cause pain and soft tissue irritation, which is related to undesirable clinical outcomes [22]. Consequently, taking sex differences into consideration when designing sex-specific femoral components could decrease ML overhang and thereby achieve successful clinical outcomes.
Anterior condylar height is another issue that should be considered when designing sex-specific femoral components. Many studies have examined the sex differences of femoral morphology in Caucasians population. Poilvache et al. [21] measured TKA patients intraoperatively and found that the knees of women have smaller ALCHs and AMCHs than those of men. Conley et al. reported the similar results using CT imaging [3], [23]. Fehring et al. measured the anterior condylar height of men and women by MRI and found a significant difference in AMCH but no difference in ALCH [24]. Our results showed a significant difference between the sexes with regard to ALCH but not AMCH. Differences in different studies may be explained by anatomic variations according to ethnicity. Indeed, some studies have demonstrated differences in the shape and size of the knee in populations that differ in terms of ethnicity by three-dimensional CT or MRI images [25], [12]. In this study, we measured distal femur morphology of 130 Chinese osteoarthritic knees by three-dimensional CT images, and the morphology differed from that Caucasians. It is not known whether these differences are clinically relevant. Those in favor of sex-specific knee components posit that use of standard implants in women may overstuff the patellofemoral joint, leading to anterior knee pain and limited range of motion [3], [26], [8]. In contrast, others claim that the differences are small and not clinically important [27], [28]. Based on our study and the recent literature, sex differences in anterior condylar height do exist, but there is no clear clinical evidence concerning the effect of these differences on TKA.
Recent studies have reported substantial ethnic differences in distal femur morphology [12], [25]. In particular, Asian populations have been found to have smaller and narrower distal femurs than Caucasian populations [12], [13]. However, most TKA components that are currently in use were designed based on data from Caucasian populations. Some studies have looked at the fit of current femoral implant systems in Chinese, Korean, and Thai populations and found that implants tend to have overhangs in these Asian populations [1], [20], [29]. In terms of clinical results, Iorio et al. reported that Asian patients had significantly less postoperative range of motion and a higher revision rate after primary TKA than white patients [15]. These suggested ethnic differences should be taken into account when designing TKA components suitable for use in Asian populations.
One limitation of the present study is that we could not directly compare the morphology of the distal femur in Chinese and Caucasian populations. The depth of the distal femur resection affects the sizing of the resected surface. During the TKA procedures, the suitable depth of the distal femur resection varies on individual length of the femur. Another limitation is that the cutting depth in our study at a constant thickness of 9 mm above the lowest point of the medial femoral condyle. This should be noted when interpreting the results.
In conclusion, the present study found that Chinese women with osteoarthritic knees generally had smaller ALCHs and narrower ML dimension in their distal femurs compared to their male counterparts. The results suggested that in terms of prosthesis design, sex differences should be taken into account to design components that better match the natural geometry of femurs in men and women. Further study is needed to determine whether sex-specific component design leads to better clinical outcomes in TKA patients.
Author Contributions
Conceived and designed the experiments: JKY ZZZ. Performed the experiments: BY ZHL. Analyzed the data: BY. Contributed reagents/materials/analysis tools: JKY JYZ. Wrote the paper: BY JKY.
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- 17. Kim HA, Kim S, Seo YI, Choi HJ, Seong SC, et al. (2008) The epidemiology of total knee replacement in South Korea: national registry data. Rheumatology 47: 88–91. doi: 10.1093/rheumatology/kem308
- 18. Cheng KC, ChenYL, Ye ML, Chun HH (1999) A new approach of designing the tibial baseplate of total knee prostheses. Clin Biomech 14: 112–117. doi: 10.1016/s0268-0033(98)00054-0
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- 26. Bong MR, DiCesare PE (2004) Stiffness after total knee arthroplasty. J Am Acad Orthop Surg 12: 164–171.
- 27. Mihalko W, Fishkin Z, Krakow K (2006) Patellofemoral overstuff and its relationship to flexion after total knee arthroplasty. Clin Orthop Relat Res 449: 283–287. doi: 10.1097/01.blo.0000218756.89439.06
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|456 posts found
SOE Everquest Next: Landmark stream archive from yesterday. LOTS of great stuff in here, questions, and GAMEPLAY! 11/13/2013
General Discussion « Landmark
Originally posted by ropenice
I've always worded it this way
Landmark is a full-fledged MMO. It's a glorified Minecraft with more possibilities. You aren't going to see the character progression/etc that Next will have. You can partake in any theme you want. Sci-fi, Western, Greece, etc. There will even be a Norrath part I believe. SOE also said the AI/etc that is being used in Next will be worked through in Landmark. So Landmark is almost serving like a beta for Everquest Next in a lot of ways.
Next is a full-fledged MMORPG. It's the next Norrath Everquest MMORPG. If you dont like anything about Minecraft, you can still like Everquest Next. If you dont like anything about Minecraft, you probably won't like Landmark. Even though they did say if you aren't a builder, there is still lots of things for you to do in Landmark.
SOE Everquest Next: Landmark stream archive from yesterday. LOTS of great stuff in here, questions, and GAMEPLAY! 11/13/2013
General Discussion « Landmark
To be honest, this might have been better than SOE Live.
I admittingly am more excited for Everquest: Next than I am Landmark, but I'm starting to see what Landmark can be: A fully player created MMO. There will be combat, there will be monsters, you can create your own dungeons if you wish.
While I am much more excited for Everquest Next, I am definitely going to partake in Landmark until then.
I finally get that they want to dominate the "Minecraft" crowd and the MMORPG crowd.
Landmark can be a glorified, much better Minecraft.
Everquest Next can change the MMORPG genre.
Very informative stream!!
Lets share extra keys!
General Discussion « WildStar
If anyone has a spare one and they're feeling generous, feel free to message it to me :) Longtime MMORPG player. If not, that's fine too!
John Smedley: We intend to start alpha and beta before the placeholder dates
General Discussion « EverQuest Next
Early access to EQNL - 28/2/2014
General Discussion « EverQuest Next
choosing not to do rally call.
General Discussion « EverQuest Next
Originally posted by DMKano
What if there are evil rallying calls? Like stealing from a certain town or something? Which can help them be a Necro/Shadow Knight, but doesnt fully damage the world.
Will they keep updating with new rallying calls? It'd be a shame if one server "maxes" out the Rallying Calls EQN had planned out and just have to wait for an expansion or something because they worked together so quickly
Poll - Since the reveal has your excitement and interest in the game increased, decreased or stayed the same?
General Discussion « EverQuest Next
It lowered for me. I didnt really walk out of the EQN reveal creaming my pants or jaw dropping like TenTonHammer and MMORPG claimed I would.
I liked what I heard, but, there are two things hindering me having any hype right now
1: i'm not interested in playing Everquest Next: Landmark. I assume they want us to play that for a year or two, but I'm not interested in that
2: The biggest one -- No release date for Everquest Next. I thought SOE kept saying they were farther ahead than we all realized. I thought the point of blackboxing the game was to drop the info, then release months after. But at this point I'd be surprised if the game released before Christmas 2014, and I can't just stay hyped for a game that will be a year+ off. Got more important things to worry about and other games to get hyped about that will actually come out soon/before 2015.
What if they put the PvP Ruleset to a public vote
General Discussion « EverQuest Next
I dont know if the type of PvP is going to be voted on. Georgeson smiled when asked about PvP and said they can do a lot with what they have and will talk about it later. To me that doesnt just sound like "yeah pvp or pve server" or "/duels yeah those are in"
The reason why Everquest players are so upset...
General Discussion « EverQuest Next
Originally posted by BearKnight
League of Legends is one of (if not the) most popular game in the world right now, and it's also one of the most competitive game. Being available to casual and competitive doesnt mean its a casual game.
No Raids/Endgame..
General Discussion « EverQuest Next
Originally posted by dejoblue
I was there, brotha man. It was awesome. But I heard recently servers had to grind the living hell out of dailies to unlock new content and everyone hated it because dailies got boring by the time WOTLK hit.
This game has too many unresolved issues.
General Discussion « EverQuest Next
Originally posted by lizardbones
I still think the biggest blunder was not capitalizing on ESO's delay. I thought ESO's delay and Smedley tricking me/others into thinking the game was gonna come out this year (The whole 'you'll get your hands on a version of the game this year and we dont mean a beta' quote) was a prime opportunity.
To me, all it is are ideas. Ideas that maybe Summer 2015 will actually be able to be played. I dont get why they were in a Blackbox if they arent even close to releasing, anyone who likes their ideas can steal them and the game won't be out for a year or 2.
Additionally: A lot of people (AKA, WildStar's hype) want a game just like WoW in a new setting. I don't always understand why "WoW clone" is a negative term. Sure, even I might be a little tired of those style of games, but I totally understand why people enjoy never feeling like they've beaten the game. They always have new raids to look forward to.
No Raids/Endgame..
General Discussion « EverQuest Next
Originally posted by Manakar
I think WoW recently had "Server Events" where pretty much everyone had to do the new expansions/patches dailies to unlock new stuff.
my goodness, the flaming was unreal. If SOE is even thinking about having it something boring like that (Which is a real possibility) the game will go down the crapper real quick
No Raids/Endgame..
General Discussion « EverQuest Next
I feel like World Events fade though. Like, you do a FATE on FFXIV:ARR and the first couple times you're like "Hey! Cool!" and then by the 3rd time you're already mindlessly facerolling while watching tv just to get your xp.
I feel like Elder Scrolls Online is making a big mistake relying on their PvP zone (Cyrodill) because I dont think that is going to hold players over for long. 100 v 100 might be fun the first time with that pretty much being their end-game, by time #75 it'll be stale and boring and "That's it? Nothing else to look forward to?"
People don't like feeling like they've beat a game. You know that feeling in a single player game where you know you're in the middle of it and dont want it to end, and as it gets closer to the end, it's bittersweet? That's how these type of MMOs go. People dont want to feel like they're getting to the end, and I just dont get how Cyrodill in PvP or these Rallying Calls in EQN can hold people over for a year+.
Has it sunk in yet? We get to destroy everything
General Discussion « EverQuest Next
I'm excited to play this game in 2016 when its close to releasing
Georgeson confirms Landmark-EQN crossover building and PVP
General Discussion « EverQuest Next
Originally posted by DSWBeef
There is no way this will be full loot FFA PvP. If you lost your gear, wouldn't you lose all of your horizontal progression they are preaching? And tier-ing up to advance yourself?
I dont think they'd go that route.
Anyone notice how giddy Georgeson was when asked about PvP?
General Discussion « EverQuest Next
Do you think they're going to drop a bombshell closer to release about PvP?
It makes me think PvP isn't just going to be /duel or BG's/Arenas.
Smart AI breaks the need for Trinity
General Discussion « EverQuest Next
But this isn't chess. AI eventually becomes predictable in video games. There will be a way to exploit the AI. The people who grind the game will find it out, and anyone struggling could look online and figure out the trick. "Oh, if you stand in this formation, they wont go for the casters, etc"
And the winner is....................... EQNext Landmarks
General Discussion « EverQuest Next
But what about a player like me who isnt really interested in playing Minecraft? I want to play the actual game. I'm supposed to dink around in EQN Landmark for a year, maybe two? They didnt even sniff a hint of when the real game is coming out, and the game looked very unpolished. Not nearly as close to being ready as they were teasing. If anything I didnt imagine they were this far behind the way they were talking.
Did SOE accomplish their goal of changing the MMORPG genre upon their reveal?
General Discussion « EverQuest Next
I feel like I could say half-yes, but the fact the game could be 2 years away when I thought it might be 4 months away really dampered any good things they said. I thought the point of being in a black box was because the game was close to being done, and SOE kept saying they are further along than people imagined.. Apparently they meant "we arent as far along as you might imagine"
So, what's your answer?
What is your biggest disappointment about EQNext
General Discussion « EverQuest Next
The fact I tricked myself because of a Smedley quote/SOE saying how far along the game was that I honestly believed the game could release around Christmas time
At this point I'd expect the game in 2015, and the way SOE was talking I thought 2013 was very realistic.
I can't stay hyped for 2 years straight for a game. I was hyped because I thought the game was close.
ESO and EQN are competing to see which game can postpone the longest.


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The CW came to TCA this morning to announce it had bought a barbershop competition series hosted by Cedric the Entertainer, a magician reality series hosted by Penn & Teller, and a four-hour event series about the Holy Grail.
Barber Battle visits different barbershops across the country in each of its 10 episodes. The most talented barbers will compete to showcase their artistry — from portraits to landmarks to ballparks — on someone''s head. Judges, locations and contestants will be announced later. Cedric exec produces along with Mark Efman ("Charlemagne & Friends," "A&E Biographies").
On each of the nine episodes of Penn & Teller: Fool Us, aspiring magicians are invited to perform their best trick. Anyone who succeeds in fooling Penn & Teller wins the right to perform with them at their show at the Rio Hotel & Casino in Las Vegas. A live studio audience and viewers watch along with Penn & Teller as they try to figure out the secrets. Penn & Teller see the trick only once and have to try to work it out immediately. British television and radio personality Jonathan Ross ("Friday Night With Jonathan Ross") serves as host. Penn & Teller: Fool Us is created and produced by 117 Productions and September Films (part of DCD Media) for ITV, with executive producers Peter Adam Golden and Andrew Golder, David Green and Peter Davey.
Meanwhile, the network has acquired Labyrinth, the four-hour event series that jumps back and forth between modern and medieval France as it follows the lives of two women separated by centuries but united in their search for the Holy Grail. The project, filmed on-location in the medieval town of Carcassonne in southwest France and Cape Town, South Africa, stars John Hurt, Sebastian Stan, Jessica Brown-Findlay and Tom Felton. It's based on the best-selling 2005 novel by Kate Mosse, adapted by Adrian Hodges ("Primeval," "My Week With Marilyn"). It's produced by Tandem Communications ("Crossing Lines, World Without End," "The Pillars Of The Earth") and Film Afrika Worldwide ("Dark Tide," "Endgame"), in association with Scott Free Films ("The Good Wife, "The Andromeda Strain") and Universal Production Partners.
In Carcassonne, in the year 1209, 17-year-old Alaïs (Brown-Findlay"), is given a mysterious book by her father, who claims it contains the secret of the true Grail. Alaïs realizes that her destiny lies in keeping the secret of the labyrinth safe. Eight centuries later, at an archeological dig in the French Pyrenees, a young volunteer named Alice Tanner (Kirby") discovers two skeletons in a forgotten cave. Puzzled by the labyrinth symbol carved into the rock, she realizes she's disturbed something that was meant to remain hidden. Somehow, a link to a horrific past –and Alice''s own past – has been revealed.
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Residency in Anatomic & Clinical Pathology at Lenox Hill Hospital
About us
The Department of Pathology and Laboratory Medicine offers a flexible four year training program leading to board certification in anatomic pathology, clinical pathology or combined anatomic pathology and clinical pathology. These programs are tailored for individuals interested in an academic career in pathology, in the subspecialty practice of pathology, or in general community practice.
The anatomic pathology program consists of training in general surgical pathology, which includes specimens from the skin, brain, lung, breast, pancreas, bone and soft tissue, genitourinary and endocrine; and hematopathology training that focuses on bone marrow, the lymph nodes and flow cytometry. The department also has a robust autopsy service residents rotate through every month.
The department analyzes approximately 23,000 surgical specimens annually with about 1,500 frozen sections each year.
The clinical pathology core program provides training in blood banking, clinical chemistry, cytogenetics, microbiology, virology, parasitology, toxicology, and molecular pathology. Residents are expected to participate in interdepartmental tumor boards, as well as daily intradepartmental conferences and weekly didactic conferences in anatomic and clinical pathology.
The Pathology program offers eight pathology residents close supervision in a supportive atmosphere and exposure to a wide variety of complex surgical specimens and clinical testing. Residents have the opportunity to participate in translational research; support is provided for presentation of research projects (papers, posters, etc) at national meetings. Trainees also participate in various hospital committees and have the opportunity and support to participate in regional and national professional committees as well.
Application Process
Applicants interested in the Pathology training program at Lenox Hill Hospital should apply using the Association of American College (AAMC) electronic residency application service (ERAS), which allows applications beginning Sept. 1.
The deadline for applications is Dec. 1.
Essential application information includes:
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- Curriculum vitae
- USMLE or COMLEX transcript
- Medical school transcript
- Personal statement
- Three (3) letters of recommendation
- ECFMG Status Report, if applicable
We participate in the NRMP, the "match." Candidates must be graduates of approved medical schools in the United States or Canada. Foreign medical graduates must possess an ECFMG (Education Commission for Foreign Medical Graduates) certificate and valid visa by the July 1 start date of the residency training. Lenox Hill Hospital does not initially sponsor H1 visas. Only those individuals on J-1 visas are accepted into the program.
Lenox Hill Hospital is a 652-bed acute care facility located in the Upper East Side of Manhattan. The Department of Pathology is affiliated with Hofstra University, where residents rotate in pediatric pathology and cytopathology. Lenox Hill Hospital has merged with Manhattan Eye, Ear & Throat Hospital, an internationally recognized hospital in ophthalmology, otolaryngology and plastic surgery.
Housing is available for single and married house staff in Lenox Hill Hospital maintained apartments. All residents are covered under Lenox Hill Hospital benefits, which include professional liability insurance, hospitalization and uniforms. The hospital's prime location offers easy access to all major museums, boutiques, restaurants, concert halls, the opera house and Central Park.
Please address all inquiries to the Residency Coordinator:
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- Chairman - Approved by the Jan 14 Med Board of Pathology, Lenox Hill Hospital
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Technically Incorrect: Some of Hertz's NeverLost systems now have cameras and mics -- which the company claims it doesn't intend to use at this time.
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EconStor Collection: Economics: The Open-Access, Open-Assessment E-Journal - Journal Articles http://hdl.handle.net/10419/6 The Collection's search engine Search the Channel search http://www.econstor.eu/simple-search Costs of trade and self-selection into exporting and importing: The case of Turkish manufacturing firms http://hdl.handle.net/10419/110371 Title: Costs of trade and self-selection into exporting and importing: The case of Turkish manufacturing firms

Authors: Dalgic, Basak; Fazlioglu, Burcu; Gasiorek, Michael

Abstract: This paper focuses on self-selection into trade by exporting and importing firms, and on the presence of differential variable and sunk costs between exporters and importers across different categories of imports. The authors use a rich and recent dataset for Turkish manufacturing firms for the period 2003 - 2010. This allows them to provide a comprehensive analysis of firm heterogeneity and the connection between firm-level performance and international trade. They provide evidence on the remarkable heterogeneity across firms where only-importers (importers) perform better than only-exporters (exporters). The authors detect a self-selection effect for both importing and exporting firms with a stronger effect for importers. The results suggest that the nature of sunk costs varies between importing and exporting activities with importers facing higher sunk costs. Tariffs represent a potentially important source of variation in the variable costs of trading. When taking the tariffs faced by firms into account, the authors find that the self-selection effect associated with sunk costs is still present but greatly reduced with a smaller reduction for importers compared to exporters. The inner structure of pyramid and capital structure: Evidence from China http://hdl.handle.net/10419/110256 Title: The inner structure of pyramid and capital structure: Evidence from China

Authors: Su, Kun

Abstract: This paper examines the effects of the pyramid inner ownership structure of companies on capital structure in an emerging market economy country. The author uses firm-level panel data of Chinese listed companies to analyze the effects of the inner structure of pyramid on capital structure, and the differences in those effects between regions with different institutional environments. The results indicate that the longer the layers of a pyramid structure, the stronger its "leverage effect", as well as the ultimate owner's motivation to expand debt financing. Thus the layers of pyramid structure have a significantly positive effect on capital structure. However, the chains within a pyramid structure have no significant effect on capital structure. Compared with regions with poor institutional environment, in regions with a better institutional environment the effect of the layers of pyramid structure on capital structure becomes smaller. What have economists been doing for the last 50 years? A text analysis of published academic research from 1960-2010 http://hdl.handle.net/10419/110191 Title: What have economists been doing for the last 50 years? A text analysis of published academic research from 1960-2010

Authors: Kosnik, Lea-Rachel

Abstract: This paper presents the results of a text based exploratory study of over 20,000 academic articles published in seven top research journals from 1960 - 2010. The goal is to investigate the general research foci of economists over the last fifty years, how (if at all) they have changed over time, and what trends (if any) can be discerned from a broad body of the top academic research in the field. Of the 19 JEL-code based fields studied in the literature, most have retained a constant level of attention over the time period of this study, however, a notable exception is that of macroeconomics which has undergone a significantly diminishing level of research attention in the last couple of decades, across all the journals under study; at the same time, the "microfoundations" of macroeconomic papers appears to be increasing. Other results on co-authorship trends and depth of research articles are also presented. Discounting, beyond utilitarianism http://hdl.handle.net/10419/109674 Title: Discounting, beyond utilitarianism

Authors: Fleurbaey, Marc; Zuber, Stéphane

Abstract: Discounted utilitarianism and the Ramsey equation prevail in the debate on the discount rate on consumption. The utility discount rate is assumed to be constant and to reflect either the uncertainty about the existence of future generations or a pure preference for the present. The authors question the unique status of discounted utilitarianism and discuss the implications of alternative criteria addressing the key issues of equity in risky situations and variable population. To do so, they introduce a class of intertemporal social objectives, named Expected Prioritarian Equally Distributed Equivalent (EPEDE) criteria. The class is more flexible than discounted utilitarianism in terms of population ethics and it disentangles risk aversion and inequality aversion. The authors show that these social objectives imply interesting modifications of the Ramsey formula, and shed new light on Weitzman's "dismal theorem".


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Handmade and vintage lovelies for you, your home and for gifts.
We are currently in the process of creating lots of new products for this shop. We hope to start adding these soon, so please keep checking by clicking on the Browse shop link on the left.
19th May 2015 - a lavender pillow, a rose pillow and a hand embroidered brooch have been added.
We use new and vintage fabrics, lace, linens, buttons etc to create our unique pillows, hearts, brooches, collages, pincushions etc.


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plays with this mix of players fighting game, choose the one you like and kick like crazy.
plays with this mix of players fighting game, choose the one you like and kick like crazy.
remember this classic fights, fight with your rival and recalled the old days
pang playing machines, destroy all balls and spend all the screens until the end
fandejuegos here, the best pang flash. destroy all the balls you can before they kill you.
Help ghosts get to their graves with the help of the mouse, but beware! with the evil witch who will do anything to avoid it.
Play this classic machine, grab your gun and kill all the enemies you see down the street.
Play this second part of the classic metal slug, very entertaining and addictive.
tetri a new version of the game, giving a new style and reformer. play it and see that you will not regret.
a new game of pinball in a soccer field where you have to sneak the ball into the opposite goal to win a huge prize. interacts with the arrow keys to hit the ball
Play classic pinball game based in the jungle. press the space bar to throw the ball and the arrow keys to hit the ball
New delivery of tetris, you will be doing lines, not to fill the entire screen of parts.


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Scottish League Cup draw: Big sides get home draws
PETERHEAD will be Mark Warburton's first competitive opponents at Ibrox after the League Two side were handed an away game against Rangers in the Scottish League Cup first round.Scotsman.com » 7h
PETERHEAD will be Mark Warburton's first competitive opponents at Ibrox after the League Two side were handed an away game against Rangers in the Scottish League Cup first round.Scotsman.com » 7h
Rangers will host Peterhead in the first round of the Scottish League Cup while Hearts and Hibernian were also handed home ties.SkySports.com » 7h
Hearts, Hibernian and Rangers are all given home ties in the draw for the first round of the Scottish League Cup.BBC Sport » 7h
Hibernian have completed the signing of former Ross County and Inverness Caledonian Thistle goalkeeper Antonio Reguero.SkySports.com » 7h
Hibernian sign their second goalkeeper in a week with the capture of Antonio Reguero on a one-year deal.BBC Sport » 10h
Attacking duo Bob McHugh and Paul Heffernan will travel with Falkirk to their training camp in Ireland this week looking to secure contracts after making 45-minute appearances against Queen's Park in a 5-0 closed-door win.Scotsman.com » 15h
FORMER Hibernian and Celtic striker Derek Riordan has signalled his availability to potential employers as he seeks a club for the new season.Scotsman.com » 1d
Queen of the South sign Callum Tapping after the former Hearts midfielder rejects a new deal with Brechin.BBC Sport » 1d
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text: Really good local food at reasonable prices. BEST espetada we had in Madeira - quality of the beef was excellent, melt in the mouth and cooked exactly to our liking. Also excellent polenta and sweet potato. Definitely recommended for trying out local Madeiran specialitiesVisted twice - first time... read more


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Q&A: Zipcar founder Robin Chase on open source and the collaboration economy
Robin Chase is a transportation entrepreneur known for founding the transportation related companies such as Zipcar, Buzzcar and Veniam. She wears many hats and is an inspiration to women all around the globe. She is also a strong supporter of Open Source and Open Collaborative technologies. She recently authored a book called Peers Inc: How People and Platforms Are Inventing the Collaborative Economy and Reinventing Capitalism. Chase will be delivering a keynote at the upcoming LinuxCon event.
Learn OpenStack with Linux Foundation Instructor Tim Serewicz
When Tim Serewicz started teaching Linux system administration classes at IBM, his boss thought Linux was "just a fad." Serewicz has since made a full-time career out of teaching admins the latest technologies in the ever-evolving and growing Linux ecosystem. He has taught at IBM, Sun Microsystems, Oracle, and Red Hat and now teaches OpenStack and Linux performance and tuning courses for Linux Foundation Training.
BQ Aquaris E5: An Ubuntu Edition Phone that severely disappoints
I can't begin to tell you how saddened I am that I've had to write this. I wanted the Ubuntu Phone to completely blow me away and pull me from the Android platform with ease and grace. Instead, it solidified my opinion that jumping into the ring with Android and Apple is a fight that most aren't really ready to take up. Please, Canonical, go back to the drawing board and return with a UI that makes sense... or simply return all of your focus on what you do best and leave the mobile platform to Google and Apple.
Samsung Sells a Million Tizen Phones as Mozilla Rethinks Firefox OS
On June 29, Samsung announced that since January, it has sold over one million units of its Tizen-based Samsung Z1 smartphones in India, Bangladesh, and Sri Lanka. According to Reuters, Samsung will "launch several more Tizen smartphones at varying prices." The Reuters report, which did not mention a timetable, was based on a tip from an undisclosed source. The story also cited a Counterpoint study that estimated the Z1 to be the best-selling smartphone in Bangladesh in Q1 2015.
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Growing up in eastern Oklahoma, and especially in LeFlore County, I was blessed to see great high school football teams. Spiro, Heavener, Poteau and Panama were all great, and I would see them all yearly. However, since Talihina is on the other side of the county, I had a hard time fully understanding and apperciating just how good the Golden Tigers were, also.
Over the years, the Razorbacks continued to be in the upper echelon in their classification, and they made numerous deep runs into the playoffs.
WISTER ŌĆö Just 48 hours after meeting to decide the consolation championship of the Red Oak Eagle Classic, the Howe Lions and the Wister Wildcats met again, this time in a doubleheader on Monday.
By the time the late news aired, the Wildcats finally ended the twinbill with a sweep of the Lions.
After taking the first game 6-1, the ŌĆśCats outlasted the Lions 12-11 in a marathon Game 2.
Cameron 12, McCurtain 0; Cameron 11, McCurtain 0: In Cameron, the Yellowjackets were too much for the Bulldogs.
BEGGS ŌĆö The Panama Lady Razorbacks softball team went 3-1 last weekend in the Beggs Festival. Panama beat the defending state champion Davenport 4-3, Checotah 7-2 and Mounds 8-0. However, the Lady ŌĆÖBacks fell 11-3 to Mannford.


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7 banks sue Lynn, Worcester over foreclosure rules - 0 Comments
WORCESTER, Mass. — Seven Massachusetts banks have filed a lawsuit alleging that the cities of Lynn and Worcester exceeded their authority in enacting foreclosure regulations in the aftermath of the housing bust.
The suit filed this week in U.S. District Court in Worcester says only the state can set rules governing foreclosure proceedings, and allowing communities to set their own rules can make for a confusing and conflicting patchwork across the state.
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iTunes 11 Finally Available For Download
Posted: 11/30/2012 - At long last, iTunes 11 is finally available for download.
Posted: 11/30/2012 - At long last, iTunes 11 is finally available for download.
Posted: 11/30/2012 - Things are slowly turning around. After another +.500 week that saw the Texans squeak out a nail biter that all but eliminated the Lions from the playoffs, and the Cowboys disappoint all of their fans again, the playoff picture is finally starting to clear up.
Updated: 11/30/2012 - ndeed 2012 will be a year that will forever remain in the memories of Texas A&M fans. From a new conference to perhaps the first ever freshman Heisman Trophy winner, the Aggies made themselves known not only to College Station but to the entire world of college football.
Posted: 11/30/2012 - Don't miss this week's cutest animal video. It's amazing.
Updated: 11/30/2012 - Good or bad, Johnny Football songs all the talk on YouTube.
Updated: 11/29/2012 - Practiced and practiced "Gangnam Style," but still can't pull off those dance moves? Well now you can thanks to JibJab!
Updated: 11/29/2012 - Former President George H.W. Bush has been hospitalized in Houston since the day after Thanksgiving.
Posted: 11/29/2012 - NEW YORK — An 80-foot Norway spruce that made it through Superstorm Sandy was transformed into a beacon of shimmering glory Wednesday when New York City Mayor Michael Bloomberg and others turned its lights on at Rockefeller Center.
Updated: 11/29/2012 - Politico's Arena asks: Mitt Romney is scheduled to have lunch with President Obama today at the White House
Updated: 11/29/2012 - NEW YORK — A tourist's snapshot of a New York City police officer giving new boots to a barefoot homeless man in Times Square has created an online sensation.
Posted: 11/29/2012 - This is the first time for me to have ever read anything by Gillian Flynn, but after finishing the book I can guarantee you it will not be the last!
Posted: 11/29/2012 - (CNN) -- If you are in Missouri or Arizona, check your lottery tickets. You could be filthy rich.
Updated: 11/29/2012 - It's Thirsty Thursday y'all! Thanksgiving has passed but Christmas is on the horizon!
Posted: 11/29/2012 - Lindsay Lohan was ARRESTED at 4 AM Thursday in New York City for allegedly punching a woman at a New York City nightclub
Updated: 11/29/2012 - Here are some tips to be able to still enjoy your favorite hot holiday drinks while not drinking your recommended daily calorie intake!
Updated: 12/01/2012 - Just because we love you, we combined two of everyone's favorite things... LOLing and Johnny Manziel.
Posted: 11/28/2012 - "That '70s Show" star Lisa Robin Kelly has been arrested AGAIN -- this time the 42-year-old was busted for assaulting a man in North Carolina ... TMZ has learned.
Posted: 11/28/2012 - BP has been barred from doing new business with the United States government for misdeeds during the 2010 Gulf of Mexico rig disaster and oil spill, the Environmental Protection Agency said Wednesday.
Posted: 11/28/2012 - Yoselyn Ortega, the nanny charged with first-degree murder for allegedly killing the two young children she cared for, faced a Manhattan Supreme Court Justice Tuesday morning – and entered a plea of not guilty.
Posted: 11/28/2012 - Glenn Beck might want to stick to his day job.
Posted: 11/28/2012 - Ivanka Trump has a message for those who think she and her siblings are embarrassed by their father Donald Trump's Obama rants: Kiss off.
Posted: 11/28/2012 - Ben Savage and Danielle Fishel – who starred as the fictional couple on the '90s hit series Boy Meets World – are reuniting to reprise their roles on the pilot of Girl Meets World.
Posted: 11/28/2012 - A Cowboys fan has created a petition on the White House's website to have Jerry Jones removed as the team's owner and general manager
Updated: 11/28/2012 - Halle Berry's ex, Gabriel Aubry, will not spend time in the slammer for his Thanksgiving brawl with Oliver Martínez, the beauty's fiancé.
Posted: 11/28/2012 - 'Downton Abbey' creator to produce new drama with NBC, Universal TV


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Hester On Orton: Hes Trying to Come Back This Week
Posted by mouthpiece on Nov. 04, 2008
Break celebrates 4th of July the American Way: by laying the smack down on ...
With the 4th of July around the corner, we celebrate the most kick-ass USA ...
Dude, are you drunk AND high? Or are you just being PRANKED?!
Posted by mouthpiece on Nov. 04, 2008


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America is Ready: Counties across the nation prepare for the freedom to marry
Postedon Jun 18, 2015 at 11:00 am
As we await the United States Supreme Court's ruling on the question of the freedom to marry, counties are preparing for the possibility that their marriage bans may be struck down as a result of the decision.
VIDEO: Panel for 'Limited Partnership' doc featuring marriage movement pioneers
Postedon Jun 15, 2015 at 04:00 pm
This spring, Freedom to Marry has been proud to serve as a Community Partner for screenings of Limited Partnership, a new documentary debuting tonight, June 15, on PBS.
Looking back on the 48th anniversary of 'Loving v. Virginia' SCOTUS decision
Postedon Jun 12, 2015 at 10:00 am
Today, June 12, marks the 48th anniversary of the United States Supreme Court's decision on Love v. Virginia, a landmark ruling that declared bans on interracial marriage in the United States unconstitutional.
Couples show the Supreme Court just how long they've been waiting for the freedom to marry
Postedon Jun 11, 2015 at 10:30 am
Same-sex couples across the country have been waiting for years -- sometimes decades -- for the freedom to marry nationwide.
MOMENTUM: Arkansas Judge affirms marriages of over 500 same-sex couples
Postedon Jun 09, 2015 at 04:15 pm
Today, June 10, Pulaski County Judge Wendell Griffen ruled in favor of respecting the marriages of the over 500 same-sex couples who were married in the "window" of the freedom to marry in Arkansas in 2014.
First same-sex couples marry in Guam
Postedon Jun 09, 2015 at 09:30 am
Today, Tuesday, June 9, the first marriages between same-sex couples began in Guam, following a ruling last week that struck down the U.S. territory's marriage ban.
Victory: Judge strikes down Guam's marriage ban
Postedon Jun 05, 2015 at 08:40 am
Today, June 5, a federal judge in Guam struck down the U.S. territory's ban on marriage between same-sex couples.
Familia es Familia releases TV ad showing Latino support for freedom to marry
Postedon Jun 04, 2015 at 12:30 pm
Today, June 4, Familia es Familia released a television ad that highlights Latino support for the freedom to marry nationwide.
Freedom to Marry and Equality Florida launch ad calling for marriage nationwide
Postedon Jun 03, 2015 at 02:40 pm
Today, Equality Florida, in partnership with Freedom to Marry, released a television ad arguing for marriage for all loving, committed couples.
In live debate, supermajority agrees: The Constitution requires the freedom to marry
Postedon Jun 03, 2015 at 10:30 am
Last night, Freedom to Marry president and founder Evan Wolfson, alongside law professor and author Kenji Yoshino, debated so-called National Organization for Marriage chairman John Eastman and Sherif Gergis before a live audience on the question of the freedom to marry on Intelligence Squared U.S.


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Ronald Driggers, Editor-in-Chief
Hyeonsoo Chang, Young L. Kim, Ali Hassan, and Peter J. Fitzgerald
Hyeonsoo Chang,1,* Young L. Kim,2 Ali Hassan,3 and Peter J. Fitzgerald1
1Center for Cardiovascular Technology, School of Medicine, Stanford University, 300 Pasteur Drive, Room H3554, Stanford, California 94305, USA
2Weldon School of Biomedical Engineering, Purdue University, 206 S. Martin Jischke Drive, West Lafayette, Indiana 47907, USA
3Catharos Medical Systems, Inc., 548 Division Street, Campbell, California 95008, USA
*Corresponding author: email@example.com
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VALPARAISO, Ind. (AP) -- Mike English scored 26 points and
Carlton Aaron added 20 to lead Missouri-Kansas City to an 84-78
victory over Valparaiso in the Mid-Continent Conference on
UMKC (5-7, 4-0) took the lead for good at 57-55 on Aaron's
jumper with 13:44 remaining and built its advantage to as much as
eight points several times the rest of the way. It was the 15th
lead change of the game.
Valparaiso (6-10, 2-2) narrowed the margin to three points,
76-73, with 2:14 remaining on Ron Howard's jump shot, but Brandon
Temple immediately responded with his fourth 3-pointer in as many
attempts for the game, and the host Crusaders never came closer
than four points the rest of the game. The Kangaroos made 5-of-9
free throws in the time remaining to seal the victory.
UMKC shot 58 percent from the field for the game, including
16-of-27 in the second half. English, who had 18 points at
halftime, and Aaron led the marksmanship, making 9-of-14 and
10-of-15 field goals respectively.
Dan Oppland led Valparaiso with 24 points, but had only a single
point in the second half, when UMKC held him to three field goal
attempts and he missed all three. Howard finished with 22 points.
Temple finished with 16 points for UMKC and Quinton Day added


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Most Beautiful 2008
Beautiful at Every Age
From Rihanna (at 20) to Michelle Pfeiffer (50 and fabulous!), these stars prove that real beauty is timeless. By Karen J. Quan
Credit: BRIAN ZAK/GAMMA
Updated: Monday Apr 28, 2008 | 06:00 AM EDT
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- Matt Bomer's Reaction to Channing Tatum's Bromantic Compliments: 'I Blushed'


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Registration takes less than 1 minute.
The ocean carrier's new China East Coast Express 2 will connect ports in China and Southeast Asia with the United States East Coast via the Suez Canal.
The Federal Maritime Commission said its detailed monitoring of the Maersk-MSC alliance in the east-west liner trades has "raised no red flags."
French ocean carrier increased container volumes 10.8 percent compared to first quarter 2014.
Total shipments and total revenues for third party logistics providers both fell in first quarter 2015 compared to fourth quarter 2014, according to a recent benchmarking report from the Transportation Intermediaries Association.
Daseke, Inc., an open-deck and specialty transportation company, announced it would merge with Charleston, S.C.-based Bulldog Hiway Express.
A recent survey of professional truck drivers found 60 percent of respondents indicated that road conditions in the United States have gotten worse since they began driving.