bluuebunny/crossref_metadata_2025 huggingface dataset:
Water Security and Services in the Caribbean
Authors: Cashman Adrian
Published: May 2014

The efficient management of water resources and services continues to be a concern in many of the small island states of the Caribbean. There are growing concerns over the ability of governments in the region to ensure the good management and provision of water without jeopardizing economic growth and the maintenance of social well-being. This paper provides an overview of the major factors influencing the water security facing the Caribbean Region and how the emerging concerns are being addressed. The key challenges and vulnerabilities may be summarized as lack of data and barriers to making available what information there is. Forward planning has been largely neglected and is symptomatic of a lack of appreciation of the need for having national water policies. In this respect Jamaica’s development of a national master water plan serves as a good example of what is needed. Water service providers have to be efficient, well managed and allowed to do their job. This means that they have to be on a sound financial footing. The challenge is to find the balance between appropriate political and regulatory oversight and the autonomy of water managers and service providers.
Effect of natal and colonised host species on female host acceptance and male joining behaviour of the mountain pine beetle (Coleoptera: Curculionidae) using pine and spruce
Authors: McKee Fraser R. , Huber Dezene P.W. , Lindgren B. Staffan , Hodgkinson Robert S. , Aukema Brian H.
Published: April 2014

The mountain pine beetle, Dendroctonus ponderosae Hopkins (Coleoptera: Curculionidae), outbreak in British Columbia and Alberta, Canada, currently extends over 18.3 million ha of pine forest. The principal host of the insect is lodgepole pine, Pinus contorta var. latifolia Englemann (Pineaceae) although it is a generalist herbivore on pines. Mountain pine beetles do not typically colonise spruce. However, during the current outbreak, several instances of mountain pine beetle attack on interior hybrid spruce, Picea glauca (Moench) Voss×Picea engelmannii Parry ex. Engelmann (Pinaceae) have been noted in areas where severe lodgepole pine mortality has occurred. Occasionally, beetle reproduction within spruce has been successful. Reproductive behaviours of mountain pine beetles reared from pine and spruce, such as female host acceptance and male joining behaviour, were studied on bolts of pine and spruce in laboratory bioassays. Females more readily accepted spruce host material relative to pine. Females that developed in spruce had higher rates of host acceptance of both pine and spruce host material than females that had developed in pine. We interpret these latter results with caution, however, as inference is partially restricted by sourcing viable insects from one spruce in this study. Implications of these findings to the concepts of host adaptation and population dynamics of this eruptive herbivore are discussed.
Check MAIT
Authors: Gapin Laurent
Published: May 2014

The evolutionary conservation of T lymphocyte subsets bearing αβ TCRs using invariant α-chains is indicative of unique and important functions. Among these T lymphocytes, NKT cells that express an invariant TCRα-chain and recognize lipid Ags presented by the nonclassical MHC class I molecule CD1d are probably the most studied. However, a new population of evolutionarily conserved T cells with another invariant TCRα rearrangement was recently characterized. These cells, which are very abundant in humans, tend to reside in mucosal tissues and, therefore, were named mucosal-associated invariant T (MAIT) cells. Until recently, little was known about MAIT cells; however, several recent advances in our understanding of MAIT cell characteristics and functions secure their upcoming rise to fame in the immunology field and in clinical practice.
ICAM-1: Isoforms and Phenotypes
Authors: Ramos Theresa N. , Bullard Daniel C. , Barnum Scott R.
Published: May 2014

ICAM-1 plays an important role in leukocyte trafficking, immunological synapse formation, and numerous cellular immune responses. Although considered a single glycoprotein, there are multiple membrane-bound and soluble ICAM-1 isoforms that arise from alternative splicing and proteolytic cleavage during inflammatory responses. The function and expression of these isoforms on various cell types are poorly understood. In the generation of ICAM-1–deficient mice, two isoform-deficient ICAM-1 mutants were inadvertently produced as a result of alternative splicing. These mice, along with true ICAM-1–deficient mice and newly generated ICAM-1–transgenic mice, have provided the opportunity to begin examining the role of ICAM-1 isoforms (singly or in combination) in various disease settings. In this review, we highlight the sharply contrasting disease phenotypes using ICAM-1 isoform mutant mice. These studies demonstrate that ICAM-1 immunobiology is highly complex but that individual isoforms, aside from the full-length molecule, make significant contributions to disease development and pathogenesis.
Waves of mission amongst South African Baptists
Authors: Henry Desmond , Niemandt Cornelius J.P.
Published: April 2014

Baptists in South Africa have developed along lines similar to other denominations of their day (e.g. the Dutch Reformed Church). However, there are six distinct waves of development within Baptist history in South Africa (including an emerging wave) that showcase the growth, development, digressions, limitations and transformation that has taken place in the Baptist denomination in South Africa. These waves are a tremendous help to the Baptist Union of Southern Africa (BUSA) as they seek to be faithful witnesses in the 21st century and beyond. It has become clear: If BUSA is to succeed within the emerging wave of mission and development, it will need a new, updated map to guide them where many have not been before � or BUSA could simply fade into irrelevance in South Africa, impacting other movements and denominations in turn.
Microsurgical training model for residents to approach to the orbit and the optic nerve in fresh cadaveric sheep cranium
Authors: Altunrende M. Emre , Hamamcioglu Mustafa Kemal , Hicdonmez Tufan , Akcakaya Mehmet Osman , Birgili Baris , Cobanoglu Sebahattin
Published: April 2014

Background: Neurosurgery and ophthalmology residents need many years to improve microsurgical skills. Laboratory training models are very important for developing surgical skills before clinical application of microsurgery. A simple simulation model is needed for residents to learn how to handle microsurgical instruments and to perform safe dissection of intracranial or intraorbital nerves, vessels, and other structures. Materials and Methods: The simulation material consists of a one-year-old fresh cadaveric sheep cranium. Two parts (Part 1 and Part 2) were designed to approach structures of the orbit. Part 1 consisted of a 2-step approach to dissect intraorbital structures, and Part 2 consisted of a 3-step approach to dissect the optic nerve intracranially. Results: The model simulates standard microsurgical techniques using a variety of approaches to structures in and around the orbit and the optic nerve. Conclusions: This laboratory training model enables trainees to gain experience with an operating microscope, microsurgical instruments and orbital structures.
Supratentorial primitive neuroectodermal tumor presenting with intracranial hemorrhage in adult
Authors: Abuzayed Bashar , Khreisat Wiam , Maaiah William , Agailat Saoud
Published: April 2014

A 24-year-old female patient presented with complaints of nausea, vomiting and of loss of consciousness lasted for 15 minutes with left sided weakness. Neuroradiological evaluation revealed a hemorrhagic mass lesion in the right frontal lobe. The patient was operated and intraoperative findings showed a cortical-subcortical hematoma including hemorrhagic and disrupted tissue with a pathologic purple tissue on the periphery of the hematoma. Postoperative course was uneventful and postoperative histopathological examination revealed primitive neuroectodermal tumor. The patient was then referred to medical and radiation oncology clinics for further evaluation and treatment.
A Case of Human Leukocyte Antigen (HLA) B27-Positive Intestinal Behçet's Disease with Crohn's Disease-Like Anal Fistulas
Authors: Kobashigawa Tsuyoshi , Nanke Yuki , Takazoe Masakazu , Iihara Kuniko , Yamanaka Hisashi , Kotake Shigeru
Published: April 2014

A 49-year-old male was admitted to our hospital with complaints of perianal pain, bloody stool, and high-grade fever due to perianal abscess. Drainage was carried out; however, the patient's complaints worsened, and biopsy findings of colonoscopy showed ulcerative colitis-like lesions. The patient was diagnosed as having Behçet's disease with intestinal involvement, did not have HLA-B51, but did have HLA-B27. We describe a case of Behcet's disease with colitis, making a differential diagnosis of inflammatory bowel disease difficult.
Quantification of hydroxyacetone and glycolaldehyde using chemical ionization mass spectrometry
Authors: Clair J. M. St. , Spencer K. M. , Beaver M. R. , Crounse J. D. , Paulot F. , Wennberg P. O.
Published: April 2014

Chemical ionization mass spectrometry (CIMS) enables online, rapid, in situ detection and quantification of hydroxyacetone and glycolaldehyde. Two different CIMS approaches are demonstrated employing the strengths of single quadrupole mass spectrometry and triple quadrupole (tandem) mass spectrometry. Both methods are generally capable of the measurement of hydroxyacetone, an analyte with known but minimal isobaric interferences. Tandem mass spectrometry provides direct separation of the isobaric compounds glycolaldehyde and acetic acid using distinct, collision-induced dissociation daughter ions. The single quadrupole CIMS measurement of glycolaldehyde was demonstrated during the ARCTAS-CARB (Arctic Research of the Composition of the Troposphere from Aircraft and Satellites - California Air Resources Board) 2008 campaign, while triple quadrupole CIMS measurements of glycolaldehyde and hydroxyacetone were demonstrated during the BEARPEX (Biosphere Effects on Aerosols and Photochemistry Experiment) 2009 campaign. Enhancement ratios of glycolaldehyde in ambient biomass-burning plumes are reported for the ARCTAS-CARB campaign. BEARPEX observations are compared to simple photochemical box model predictions of biogenic volatile organic compound oxidation at the site.
Relationship between Amazon biomass burning aerosols and rainfall over the La Plata Basin
Authors: Camponogara G. , Silva Dias M. A. F. , Carrió G. G.
Published: May 2014

Abstract. High aerosol loads are discharged into the atmosphere by biomass burning in the Amazon and central Brazil during the dry season. These particles can interact with clouds as cloud condensation nuclei (CCN) changing cloud microphysics and radiative properties and, thereby, affecting the radiative budget of the region. Furthermore, the biomass burning aerosols can be transported by the low-level jet (LLJ) to the La Plata Basin, where many mesoscale convective systems (MCS) are observed during spring and summer. This work proposes to investigate whether the aerosols from biomass burning may affect the MCS in terms of rainfall over the La Plata Basin during spring. Aerosol effects are very difficult to isolate because convective clouds are very sensitive to small environment disturbances; for that reason, detailed analyses using different techniques are used. The binplot, 2-D histograms and combined empirical orthogonal function (EOF) methods are used to identify certain environmental conditions with the possible effects of aerosol loading. Reanalysis 2, TRMM-3B42 and AERONET data are used from 1999 up to 2012 during September–December. The results show that there are two patterns associated with rainfall–aerosol interaction in the La Plata Basin: one in which the dynamic conditions are more important than aerosols to generation of rain; and a second one where the aerosol particles have a more important role in rain formation, acting mainly to suppress rainfall over the La Plata Basin. However, these results need further investigation to strengthen conclusions, especially because there are limitations and uncertainties in the methodology and data set used.
Observation and analysis of speciated atmospheric mercury in Shangri-la, Tibetan Plateau, China
Authors: Zhang H. , Fu X. W. , Lin C.-J. , Wang X. , Feng X. B.
Published: May 2014

Abstract. This study reports the speciated concentration and the potential sources of atmospheric mercury measured at the Shangri-La Atmosphere Watch Regional Station (SAWRS), a pristine high-altitude site (3580 m a.s.l.) in Tibetan Plateau, China. The total gaseous mercury (TGM, defined as the sum of Gaseous Elemental Mercury, GEM, and gaseous oxidized mercury, GOM), GOM and particulate-bound mercury (PBM) were monitored from November 2009 to November 2010 to investigate the characteristics and atmospheric transport of mercury influenced by the Indian summer monsoon (ISM) and westerlies. The mean concentrations of TGM, PBM and GOM were 2.55 ± 0.73 ng m−3, 37.78 ± 31.35 pg m−3 and 7.90 ± 7.89 ng m−3. A notable seasonal pattern was observed with higher TGM concentrations in the beginning and end of the ISM. High TGM concentrations were associated with the transport of dry air that carried regional anthropogenic emissions from both domestic and foreign sources. The low PBM and GOM level was attributed to the deposition and wet scavenging during the ISM period. Backward trajectory analysis of air masses associated with TGM levels suggested that both the ISM and westerlies can carry Hg emitted in Burma, Bengal bay and north India to the SAWRS.
An inverse modelling approach for frequency response correction of capacitive humidity sensors in ABL research with small unmanned aircraft
Authors: Wildmann N. , Kaufmann F. , Bange J.
Published: May 2014

Abstract. The measurement of water-vapour concentration in the atmosphere is an ongoing challenge in environmental research. Satisfactory solutions are present for ground-based meteorological stations and measurements of mean values. However, advanced research of thermodynamic processes also aloft, above the surface layer and especially in the atmospheric boundary layer (ABL), requires the resolution of small-scale turbulence. Sophisticated optical instruments are used in airborne meteorology with manned aircraft to achieve the necessary fast response measurements in the order of 1 Hz (e.g. LiCor 7500). Since these instruments are too large and heavy for the application on the promising platforms of small remotely piloted aircraft (RPA), a method is presented in this study, that enhances small capacitive humidity sensors to be able to resolve turbulent eddies in the order of 10 m. For this purpose a physical and dynamical model of such a sensor is described and inverted in order to restore original water vapour fluctuations from sensor measurements. Examples of flight measurements show how the method can be used to correct vertical profiles and resolve turbulence spectra up to about 3 Hz.
Deriving a per-field land use and land cover map in an agricultural mosaic catchment
Authors: Seo B. , Bogner C. , Poppenborg P. , Martin E. , Hoffmeister M. , Jun M. , Koellner T. , Reineking B. , Shope C. L. , Tenhunen J.
Published: April 2014

Abstract. Detailed data on land use and land cover constitutes important information for Earth system models, environmental monitoring and ecosystem services research. Global land cover products are evolving rapidly, however, there is still a lack of information particularly for heterogeneous agricultural landscapes. We censused land use and land cover field by field in an agricultural mosaic catchment Haean, South Korea. We recorded the land cover types with additional information on agricultural practice and make this data available at the public repository Pangaea (doi:10.1594/PANGAEA.823677). In this paper we introduce the data, its collection and the post-processing protocol. During the studied period, a large portion of dry fields was converted to perennial crops. A comparison between our dataset and MODIS Land Cover Type (MCD12Q1) suggested that the MODIS product was restricted in this area since it does not distinguish irrigated fields from general croplands. In addition, linear landscape elements such as water bodies were not detected in the MODIS product due to its coarse spatial resolution. The data presented here can be useful for earth science and ecosystem services research.
Multiple knickpoints in an alluvial river generated by a single instantaneous drop in base level: experimental investigation
Authors: Cantelli A. , Muto T.
Published: May 2014

Abstract. Knickpoints often form in bedrock rivers in response to base-level lowering. These knickpoints can migrate upstream without dissipating. In the case of alluvial rivers, an impulsive lowering of base level due to, for example, a fault associated with an earthquake or dam removal commonly produces smooth, upstream-progressing degradation; the knickpoint associated with suddenly lowered base level quickly dissipates. Here, however, we use experiments to demonstrate that under conditions of Froude-supercritical flow over an alluvial bed, an instantaneous drop in base level can lead to the formation of upstream-migrating knickpoints that do not dissipate. The base-level fall can generate a single knickpoint, or multiple knickpoints. Multiple knickpoints take the form of cyclic steps, that is, trains of upstream-migrating bedforms, each bounded by a hydraulic jump upstream and downstream. In our experiments, trains of knickpoints were transient, eventually migrating out of the alluvial reach as the bed evolved to a new equilibrium state regulated with lowered base level. Thus the allogenic perturbation of base-level fall can trigger the autogenic generation of multiple knickpoints which are sustained until the alluvial reach recovers a graded state.
Seismic vulnerability and risk assessment of Kolkata City, India
Authors: Nath S. K. , Adhikari M. D. , Devaraj N. , Maiti S. K.
Published: April 2014

Abstract. The city of Kolkata is one of the most urbanized and densely populated regions in the world, which is a major industrial and commercial hub of the Eastern and Northeastern region of India. In order to classify the seismic risk zones of Kolkata we used seismic hazard exposures on the vulnerability components namely, landuse/landcover, population density, building typology, age and height. We microzoned seismic hazard of the City by integrating seismological, geological and geotechnical themes in GIS which in turn is integrated with the vulnerability components in a logic-tree framework to estimate both the socio-economic and structural risk of the City. In both the risk maps, three broad zones have been demarcated as "severe", "high" and "moderate". There had also been a risk-free zone in the City. The damage distribution in the City due to the 1934 Bihar-Nepal Earthquake of Mw 8.1 well matches with the risk regime. The design horizontal seismic coefficients for the City have been worked out for all the predominant periods which indicate suitability of "A", "B" and "C" type of structures. The cumulative damage probabilities in terms of "slight", "moderate", "extensive" and "complete" have also been assessed for the significant four model building types viz. RM2L, RM2M, URML and URMM for each structural seismic risk zone in the City. Both the Seismic Hazard and Risk maps are expected to play vital roles in the earthquake inflicted disaster mitigation and management of the city of Kolkata.
System Design Model for Versatile Outbreak Surveillance
Authors: Chaudet Hervé , Delon François , Texier Gaëtan , Meynard Jean-Baptiste , Pellegrin Liliane , Deparis Xavier
Published: May 2014

Unlike usual surveillance systems, the ASTER system must provide a unified monitoring of several military populations exposed to different biological and chemical threats, and the surveillance of each population must be tailored to meet its specific risk profile. For coping with these requirements, we have developed a formal surveillance system model we have used for designing the system architecture and the webservices collaborations. The system currently covers populations in desertic areas as well as in Amazonian Forest. This versatility allowed a quick and easy system tailoring for the recent French Deployments in Jordanian Refugees Camps or in Mali.
Technical Challenges of Syndromic Surveillance System Deployment in a Health Information Exchange
Authors: Silva Julio C. , Cox Charles , Rumoro Dino P. , Shah Shital C. , Hallock Marilyn M. , Gibbs Gillian S. , Trenholme Gordon M. , Waddell Michael J.
Published: May 2014

This session describes the technical process, challenges, and lessons learned in scaling up from a local to regional syndromic surveillance system using the MetroChicago Health Information Exchange (HIE) and GUARDIAN collaborative initiative.
The ALERT Algorithm: How to Simply Define a Period of Elevated Disease Incidence
Authors: Reich Nicholas G. , Cummings Derek , Zorn Johns Hopkins Bloomberg School of Public , Nyquist Ann-Christine , Perl Trish M. , Radonovich Lew J.
Published: May 2014

Despite the number of infections, hospitalizations, and deaths from influenza each year, developing the ability to predict the timing of these outbreaks has remained elusive. We have developed the Above Local Elevated Respiratory illness Threshold (ALERT) algorithm to help public health practitioners develop simple rules to define a period of increased disease incidence in a given location. The ALERT algorithm defines a period of elevated disease incidence in a community or hospital that systematically collects surveillance data on a particular disease. By defining this period of increased risk, the ALERT algorithm enables fast response to emerging outbreaks in healthcare settings.
Utilization of Emergency Department Data for Drug Overdose Surveillance in North Carolina
Authors: Harmon Katherine J. , Proescholdbell Scott , Marshall Steve , Waller Anna
Published: May 2014

The United States is in the midst of a drug overdose epidemic, primarily due to opioid analgesics. Emergency department data are an important source of morbidity data for public health surveillance. This population-based study will describe visits to North Carolina emergency departments for drug, and more specifically, opioid overdoses.
Validation of Analytic Methods for Combining Evidence Sources in Biosurveillance
Authors: Burkom Howard , Elbert Yevgeniy , Ramac-Thomas Liane , Cuellar Christopher
Published: May 2014

To manage an increasingly complex data environment, a fusion module based on Bayesian networks (BN) was developed for the Dept. of Defense (DoD) Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE).  Subsequent efforts have produced a full fusion-enabled version of ESSENCE for beta testing and further upgrades. The current presentation describes advances to formalize the network training, calibrate the component alerting algorithms and decision nodes together, and implement a validation strategy. A cross-validation strategy produced consistent threshold combinations yielding 88% sensitivity from reported events, a 10-15% improvement over the original demonstration module.
Imaging of Sub-retinal Pigment Epithelial Linear Structures in Patients with Age-Related Macular Degeneration
Authors: Inoue Maiko , Arakawa Akira , Yamane Shin , Kadonosono Kazuaki
Published: April 2014

Purpose

To evaluate hyperreflective linear structures (HLS), as assessed using spectral-domain optical coherence tomography (SD-OCT), identified under the retinal pigment epithelium (RPE) in patients with age-related macular degeneration (AMD).

Methods

This retrospective observational case study was conducted on 427 eyes of 408 consecutive patients who were scheduled to undergo anti-vascular endothelial growth factor (anti-VEGF) therapy for AMD. Patients with HLS under the RPE were investigated based on the SD-OCT findings at baseline or during the follow-up period. The associations between HLS and the lesion subtypes, localization in SD-OCT, clinical findings, and structural change after anti-VEGF treatment were also investigated.

Results

HLS were identified in 18 eyes of 16 patients. From the eyes with HLS, 12 eyes (66.7%) were diagnosed with retinal angiomatous proliferation (RAP), 4 eyes (22.2%) were diagnosed with occult choroidal neovascularization, and the remaining 2 eyes (11.1%) were diagnosed with polypoidal choroidal vasculopathy. HLS were multifocal and exhibited multilocalization under the RPE in all the eyes. Although it was difficult to identify these structures in the clinical findings at baseline, crystalline deposits correlated with the linear bands were observed during the follow-up period in 16 eyes (88.9%). After the anti-VEGF treatments, the HLS remained between the Bruch membrane and RPE or combined with the fibrovascular component.

Conclusions

HLS are rare SD-OCT findings found in patients with AMD, found in only 4.2% of the patients examined in this study. HLS were found especially in RAP lesions.
The Cementless Spotorno stem in THA: 10 year results
Authors: Yamasaki Takuma , Yasunaga Yuji , Mori Ryo , Hamanishi Michio , Shoji Takeshi , Ochi Mitsuo
Published: April 2014

Background

The clinical results of total hip arthroplasty (THA) with a cementless prosthesis have been constantly improving due to progress in the area of stem design and surface finish. Cementless Spotorno stem (CLS stem; Zimmer, Warsaw, USA) is a double-tapered rectangular straight stem. The purpose of this study is to investigate the mean 10 year results of CLS stem and to evaluate the press-fit stability of CLS stem.

Methods

One hundred and eighty-six consecutive patients (194 hips) were evaluated at more than five years after THA using CLS stems. The mean follow-up period was 111 months. The radiographic stability of the femoral stem was determined by Engh's criteria. The ascertained period of spot welds was noted by Gruen zones on the femoral side. The presence of stress shielding, and subsidence was also evaluated.

Results

A stable stem with bony on growth was identified in all cases. The mean period of expression of spot welds was 10.8 months in zone 2, 9.9 months in zone 3, 8.5 months in zone 5, and 8.8 months in zone 6. Stress shielding of more than grade 2 was observed in only three hips, which was non-progressive at one year after surgery. Subsidence of more than 2 mm was not observed in any of the hips.

Conclusions

Excellent stability of CLS stem has been maintained without abnormal bone reaction at the proximal femur. CLS stem is considered to achieve not only press-fit stability at trochanteric and subtrochanteric level, but bony fixation by osseointegration within one year after THA.
Periacetabular Osteotomy: Sporting, Social and Sexual Activity 9-12 Years Post Surgery
Authors: Klit Jakob , Hartig-Andreasen Charlotte , Jacobsen Steffen , Søballe Kjeld , Troelsen Anders
Published: April 2014

Hip joint survivorship and functional outcome are traditional outcome measures applied after periacetabular osteotomy (PAO). Younger adults however have greater demands and expectations on the function of their hip joints and these demands are not expressed using traditional outcome assessment tools. The main purpose of this study was to explore alternative functional and quality of life measure after PAO.

A cross sectional survey of preserved hip joints following PAO was performed. Fifty-two patients (68 hips), mean age 41 years (range 24-67), returned a questionnaire examining satisfaction, willingness to repeat surgery, quality of life, abilities in social activities, sports and sex-life, pain, limp, and stability of the hip.

Median satisfaction was 5 (range 1-5) and 44 of 49 patients were willing to repeat surgery. Significant improvements were seen in quality of life, ability to do sports, participate in social activities and sex-life (p values <0.001) (although sex-life for males (p = 0.102)). Traditional outcomes (pain, stability and limp) showed significant improvements (p<0.001). Lasting improvements in patients’ sex life, social life and ability to do sports nine to 12 years following PAO were reported. Such factors are important measures of outcome in a younger adult cohort.
Prevention of Venous Thromboembolic Events following Femoroacetabular Osteoplasty: Aspirin is Enough for Most
Authors: Tischler Eric H. , Ponzio Danielle Y. , Diaz-Ledezma Claudio , Parvizi Javad
Published: April 2014

Background

As hip-preservation surgery is performed in a particularly young and active group of patients, the knowledge accrued in the fields of hip arthroplasty and hip fracture care regarding postoperative thromboprophylaxis cannot be extrapolated to this patient population. Recommendations based on the evidence for each particular surgical procedure and population is desirable. For these reasons, the purpose of our study is to describe the rate of clinically relevant venous thromboembolism (VTE) and anticoagulation-related complications observed in patients undergoing hip-preservation surgery through mini-open femoracetabular osteoplasty (FAO) with a formal postoperative thromboprophylaxis protocol of aspirin dosing.

Methods

A prospective case series of 407 consecutive FAO procedures in 375 patients of mean age 34.5 ± 11.1 years (range 15–62 years) were followed six weeks postoperatively to document the presence of clinically relevant VTE as well as major bleeding events, as defined by the most recent American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. All patients were given aspirin 325 mg by mouth daily for two to four weeks.

Results

There was one case of distal DVT in a 31-year-old male with no specific risk factors. No cases of pulmonary embolism were observed. There were no major bleeding events or reoperations due to postsurgical haematoma. There were no deaths. The crude incidence of clinically relevant VTE was 1 per 407 procedures (0.25%).

Conclusion

Aspirin is a safe and effective modality to provide thromboprophylaxis in patients undergoing hip-preservation surgery. The rate of VTE that we observed is, thus far, the lowest in comparison to other published series of hip preservation surgery that specifically focused on this complication.
Risedronate does not Enhance Fixation or BMD in Revision Cups: Randomised Study with Three Years follow-up
Authors: Saari Tuuli M. , Digas Georgios , Kärrholm Johan N.
Published: April 2014

Background

Bisphosphonates may improve implant fixation by inhibition of bone resorption and stimulation of osteoblasts by up regulation of BMP-2. However, there are few clinical studies in this area.

Questions/purpose

Does treatment with oral bisphosphonates improve implant fixation and bone remodelling around the acetabular component after revision arthroplasty with or without use of morselised allograft?

Patients and methods

Fifty-three patients received university pharmacy blinded medication for three months: 5 mg risedronate or placebo one dosage and 1 g calcium carbonate and 800IE cholecalciferol per day. Forty-one patients were operated upon with revision of the cup. The revisions were performed with an uncemented (Trilogy, Zimmer, Warsaw, USA) or a cemented (Ogee, Depuy Int, England) cup. Radiostereometric analysis was obtained within one week after the operation, at three and six months, and after one, two and three years to study cup migration. Bone mineral density was measured postoperatively, at six months, one and two years, using DEXA. The presence and extension of radiolucent lines and graft remodelling were studied on conventional radiography.

Results

The risendronate group revealed less anterior-posterior rotation at 6 months. We found no significant differences in migration at three years, change in bone mineral density, or graft remodelling and radiolucent lines formation between groups.

Conclusions

We could not demonstrate any beneficial effects of oral administration of risedronate on the fixation, bone mineral density or bone remodelling of revision cups using various amount of bone graft.
Prospective Five-Year Subsidence Analysis of a Cementless Fully Hydroxyapatite-Coated Femoral Hip Arthroplasty Component
Authors: Clauss Martin , Van Der Straeten Catherine , Goossens Marc
Published: April 2014

Early subsidence >1.5 mm is considered to be a predictive factor for later aseptic loosening of the femoral component following total hip arthroplasty (THA). The aim of this study was to assess five-year subsidence rates of the cementless hydroxyapatite-coated twinSys® stem (Mathys Ltd., Bettlach, Switzerland).

This prospective single-surgeon series examined consecutive patients receiving a twinSys® stem at Maria Middelares Hospital, Belgium. Patients aged >85 years or unable to come to follow-up were excluded. Subsidence was assessed using Ein Bild Roentgen Analyse – Femoral Component Analysis (EBRA-FCA). Additional clinical and radiographic assessments were performed. Follow-ups were prospectively scheduled at two, five, 12, 24, and 60 months.

In total, 218 THA (211 patients) were included. At five years, mean subsidence was 0.66 mm (95% CI: 0.43-0.90). Of the 211 patients, 95.2% had an excellent or good Harris Hip Score. There were few radiological changes. Kaplan-Meier analysis indicated five-year stem survival to be 98.4% (95% CI: 97.6-100%).

Subsidence levels of the twinSys® femoral stem throughout the five years of follow-up were substantially lower than the 1.5 mm level predictive of aseptic loosening. This was reflected in the high five-year survival rate.
The influence of triple pelvic osteotomy on birth canal size
Authors: Schwarz Ondřej , Chomiak Jiří , Dungl Pavel , Burian Michal
Published: April 2014

Introduction

The aim of this study was to investigate the influence of triple pelvic osteotomy on the internal pelvic dimensions and thus on the potential for normal vaginal delivery.

Methods

Data were acquired by processing fixed anatomical specimens of 19 female pelves with maintained sacrotuberous and sacrospinous ligaments after unilateral and bilateral osteotomy, respectively. The specimens were measured and x-ray images and photographs were taken.

Results

The dimensions in the plane of the pelvic inlet and the plane of the greatest pelvic dimension after unilateral osteotomy increased in 51%, remained unchanged in 34% and in 15% of cases they decreased. The most critical locations for the passage of fetus decreased in average from 0.016 cm in distantia interspinalis in the plane of the least pelvic dimension to 0.695 cm in distantia intertuberositas in the plane of the pelvic outlet. After bilateral osteotomy are decreases more significant from 0.226 cm (2.05%) to 1.00 cm (9.51%). Decreases we observed in the monitored dimensions were not so big in comparison to other published studies.

Conclusion

Results of this study confirm our hypothesis that unilateral triple pelvic osteotomy does not significantly narrow the bony birth canal and so it does not impede the ability to deliver per vias naturales in female patients with this surgical procedure in anamnesis. After bilateral triple osteotomy we would rather recommend Caesarean section.
A seven- to 14-year follow-up study of bipolar hip arthroplasty in the treatment of osteonecrosis of the femoral head
Authors: Gągała Jacek , Tarczyńska Marta , Gaweda Krzysztof
Published: April 2014

Introduction

Bipolar hip arthroplasty (BHA) in the treatment of Ficat stage III osteonecrosis of the femoral head (ONFH) has theoretical advantages over total hip replacement (THR) in that it preserves the natural acetabulum and uses an implant that allows better stability and larger range of movement. The purpose of this study was to evaluate the clinical and radiological outcomes of BHA with uncemented ingrowth stems in the treatment of ONFH.

Material and methods

Thirty-nine hips in 34 patients (two women and 32 men) with a mean age at the time of surgery of 45.31 years (range 30–66 years) operated between 1998 and 2005 were examined in a retrospective evaluation. Mean follow-up was 9.5 years (range 3–14 years). Patients were evaluated with the Harris hip score (HHS). Kaplan-Meier survivorship was calculated to examine the revision rate. Radiographic analysis included evaluation of bipolar head migration, radiolucent lines around the stem and osteolysis in the acetabulum and the femur.

Results

Evaluation of clinical results revealed an increase in HHS from 28 points preoperatively to 88.6 points at the most recent follow-up. Radiographic evaluation showed bipolar head migration in 3 hips (7.7%). Survival rate of BHA, with revision THR defined as the endpoint, was 92.31% at ten years (CI 95%). All implanted uncemented stems were stable without any radiographic signs of loosening or osteolysis.

Conclusions

The results of the present study show that implantation of BHA with uncemented ingrowth stem in Ficat stage III is still justified.
Regional variability in the rates of total hip replacement in Spain
Authors: Padilla-Eguiluz Norma G. , García-Rey Eduardo , Cordero-Ampuero Jose , Gómez-Barrena Enrique
Published: April 2014

The role of economic resources, distribution of providers, and demography may explain part of the variability found in hip arthroplasty in international surveys. We aimed to investigate the influence of ageing index, health budget, and density of orthopaedic surgeons in the regional variability of the primary and revision THR rate in Spain, where regions decide on the allocation of their health budget.

Inpatient database of hip procedures for years 1997 to 2011 was obtained from the Spanish Ministry of Health, segregated for each of the 17 regional health services in Spain. Crude and adjusted rates (direct method with total Spanish population per year) were calculated and used as dependent variables. Ageing index, Health Expenditure of Gross Domestic Product (GDP), and number of orthopaedic surgeons per region were used as independent variables. Negative binomial regression analysis model and Poisson regression were calculated to estimate the risk contribution of the ecological variables.

A total of 425,914 hip procedures, with 367,489 primary (mean crude rate = 124 × 105 inhabitants/year) and 58,425 revision hips (21 × 105 inhabitants/year) were included in the analysis. Regional variability was higher than expected in THR in Spain, despite a universal coverage health system in which equity may be challenged in the administration of hip arthroplasty. This was found particularly for primary THR. When hip replacement rates were adjusted for sex and age, the regional ageing index, the density of orthopaedic surgeons and the regional health budget could only partially explain risk ratio changes.
Salter innominate osteotomy in the treatment of late presentation Perthes disease
Authors: Yavuz Umut , Demir Bilal , Yildirim Timur , Beng Kubilay , Karakas Eyup Salahattin
Published: April 2014

Purpose

The aim of this study was to evaluate the clinical and radiological results of patients presenting older than eight years and treated with Salter osteotomy for Perthes disease.

Method

Seventeen patients (18 hips) with late presentation of Perthes disease treated with Salter osteotomy. Sixteen males were identified. The average age of patients was 8.8 years (range 8-12). Preoperation radiographs were analysed for lateral pillar staging, centre-periphery (CP) angle, Sharp acetabular index, acetabular depth index, acetabular covering percentage and Cross-over sign. Final follow-up radiograph were classified using modified Stulberg grade.

Results

The average follow-up of the patients was 78 months (range 40-104). During the surgery, seven hips were found to be lateral pillar grade B, three hips grade B/C and 8 hips grade C. In the final examination, 10 hips were evaluated as good (Stulberg 1 or 2), seven as medium (Stulberg 3) and one as bad (Stulberg 4). There was shortening in four patients who were all either Stulberg stage 3 or 4. A meaningful difference was detected between the pre-operation and post-operation radiographic values, regardless of the surgical staging. However, no statistical difference was found between the patients in Stulberg stage 3 or 4 and stage 1 or 2 for radiographic variables.

Conclusion

Salter osteotomy can be used to treat older patients with lateral pillar stage B, B/C and C at presentation.
Comparison of Refobacin Bone Cement and Palacos with Gentamicin in total hip arthroplasty: an RSA study with two years follow-up
Authors: Olerud Fredrik , Olsson Christer , Flivik Gunnar
Published: April 2014

Previous experience has demonstrated the importance of testing new bone cement in vivo before widespread clinical use. We performed a consecutive, radiostereometric (RSA) study comparing Refobacin Bone Cement (RBC) to the well proven Palacos with Gentamicin (PWG). According to the manufacturer of RBC it has the equivalent characteristics as PWG, and in vitro tests show good results. The purpose of this study was to evaluate whether RBC is safe to use in clinical practice for total hip arthroplasty (THA). Two consecutive series of patients with primary osteoarthritis received a THA using a highly polished, collarless, tapered stem with a hollow centralizer. The study comprises 21 hips with RBC and 30 with PWG. The patients were followed up for two years with repeated RSA examinations and clinical outcome questionnaires SF-12 and WOMAC. There were no statistically significant migratory differences between the groups. The mean subsidence after two years was 1.28 mm and 1.40 mm, and the mean retroversion was 1.03° and 0.99°, for the RBC and the PWG groups respectively. Almost all migration occurred in the interface between the stem and the cement. The WOMAC and SF12 clinical scores did not reveal any clinical differences between the groups. We conclude that, as previous in vitro tests indicate, RBC performs as well as PWG and seems to be safe to use in clinical practice for THA.
Single tranexamic acid dose to reduce perioperative morbidity in primary total hip replacement: a randomised clinical trial
Authors: Hourlier Hervé , Fennema Peter
Published: April 2014

Introduction

Although prophylactic tranexamic acid (TXA) is a safe, low-cost option to reduce bleeding in patients undergoing total hip replacement (THR), its optimal dose and duration is unknown. We compared the safety and effectiveness of TXA given as either a single injection or continuous infusion in THR patients, hypothesising that a second TXA dose would not offer any clinical advantages over the single injection.

Materials and methods

One hundred and sixty-four patients undergoing unilateral THR were randomised. Exclusion criteria were history of thromboembolic events (TE), epilepsy, thrombophilia, and severe chronic renal failure. Patients received either a single dose of 30 mg/kg TXA on induction of surgery (one shot [OS] group), or a loading dose of 10 mg/kg TXA followed two hours later by a continuous infusion of 2 mg/kg per hour for 20 hours (one day [OD] group). The primary outcome was blood loss (BL) calculated from haematocrit levels. Secondary outcomes were mortality and TE events within 90 days postoperatively.

Results

All patients completed treatment, with none lost to follow-up. Mean BL was 1107 ± 508 ml in Group OS and 1047 ± 442 ml in Group OD (p = 0.43). No patients were transfused prior to Day 10 postoperatively. At final follow-up, no patients had died, and there were no occurrences of major TE.

Conclusion

The 30 mg/kg TXA single shot was as safe as continuous infusion. As it is also less cumbersome, we recommend it as part of routine care in THR patients.
Comparison of mechanoreceptor quantities in hip joints of developmental dysplasia of the hip patients with normal hips
Authors: Desteli Engin Eren , Gülman Ali Birol , Imren Yunus , Kaymaz Figen
Published: April 2014

Background

Joint mechanoreceptors are afferent neural elements involved in pain sensation and tactile sense.

Questions/purposes

We aimed to detect the free nerve endings (FNE) and other types of mechanoreceptors and to compare their quantities in human hip joint capsule (HJC) and ligamentum capitis femoris (LCF) of babies with developmantal dysplasia of hip (DDH) and intrauterine ex foetuses (control group) to find out whether there is an increase in the amount of mechanoreceptors in hip joint due to the occured anatomical chages.

Patients and methods

We took 15 LCF and HJC biopsies from 15 patients undergoing hip surgery for DDH, and 15 HJC and LCFs from intrauterine ex fetuses. Total of 60 specimens were investigated. The mean age of the babies was 10.3 months (6-18 months) at the time of surgery. Full thickness 1 × 1 cm HJC and LCF portions were taken as biopsy specimens. An immunohistochemical technique was performed for neurogenic protein S-100 and examined under light microscopy.

Results

FNEs were detected in all four different tissues (type IVa). Other types of mechanoreceptors (Type I-II and III) were not detected in any of the specimens. The positive rates of FNE staining in the control group were % 2.60 ± 1.24 for the LCF and % 2.67 ± 1.11 for the HJC respectively and FNE staining in the DDH group were found to be % 2.67 ± 1.11 for the LCF and % 2.73 ± 1.16 for the HJC. We did not find a statistically significant difference in number of FNEs between the specimens of the DDH group and the control group (p>0.05), also there was no statistically significant difference in number of FNEs between the HJC and LCF within each group (p>0.05).

Conclusion

Our results suggest that the number of FNEs does not increase in HJC and LCF of DDH patients even though LCF hypertrophy and capsular elongation occurs.
Proximal femoral reconstruction after aseptic loosening following proximal femoral replacement for Ewing sarcoma: a case report with one-year follow-up
Authors: Schoof Benjamin , Jakobs Oliver , Gehrke Thorsten , Gebauer Matthias
Published: April 2014

We report the case of a 30-year-old patient initially treated for a proximal femoral Ewing's sarcoma when 12 years old. Index treatment comprised tumour resection and total hip arthroplasty. Two years later revision for aseptic loosening was performed. Subsequently, six further surgical revisons were performed for varying causes. At the age of 23 years the proximal femur was resected and a proximal femoral endoprosthesis implanted.

Eighteen years after initial diagnosis the patient presented with recurrent aseptc loosening. Both the proximal femur and acetabulum were reconstructed. For acetabular reconstruction a structural allograft and a tantalum cup were utilised. Reconstruction of the femur utilsed extensive wire mesh and circlage wiring with impaction bone allograft into which a femoral stem was implanted.

At one-year follow-up the patient was pain free, had no evidence of infection with satisfactory radiographs and no evidence of implant loosening. This is the first case reporting an extended proximal femoral reconstruction with a wire mesh in combination with impaction bone grafting in an aseptic loosened proximal femoral replacement following Ewing's Sarcoma.