bluuebunny/crossref_metadata_2025 huggingface dataset:
New mechanisms involved in paternal 20q disomy associated with pseudohypoparathyroidism
Authors: Fernández-Rebollo Eduardo , Lecumberri Beatriz , Garin Intza , Arroyo Javier , Bernal-Chico Ana , Goñi Fernando , Orduña Rosa , _ _ , Castaño Luis , Pérez de Nanclares Guiomar
Published: September 2010

Purpose

Type I pseudohypoparathyroidism (PHP-I) can be subclassified into Ia and Ib, depending on the presence or absence of Albright's hereditary osteodystrophy's phenotype, diminished α-subunit of the stimulatory G protein (Gsα) activity and multihormonal resistance. Whereas PHP-Ia is mainly associated with heterozygous inactivating mutations in Gsα-coding exons ofGNAS, PHP-Ib is caused by imprinting defects ofGNAS. To date, just one patient with PHP and complete paternal uniparental disomy (UPD) has been described.

We sought to identify the underlining molecular defect in twenty patients with parathyroid hormone resistance, hypocalcemia and hyperphosphatemia, and abnormal methylation pattern at GNAS locus.

Methods

Microsatellite typing and comparative genome hybridization were performed for proband and parents.

Results

We describe four patients with partial paternal UPD of chromosome 20 involving pat20qUPD in one case, from 20q13.13-qter in two cases, and pat20p heterodisomy plus interstitial 20q isodisomy in one patient.

Conclusions

These observations demonstrate that mitotic recombination of chromosome 20 can also give rise to UPD and PHP, a situation similar to other imprinting disorders, such as Beckwith–Wiedemann syndrome or neonatal diabetes.
Remodelling at the maternal–fetal interface: relevance to human pregnancy disorders
Authors: Cartwright Judith E , Fraser Rupsha , Leslie Karin , Wallace Alison E , James Joanna L
Published: September 2010

In human pregnancy, successful placentation and remodelling of the uterine vasculature require the integration of a number of stages, which are crucial for a healthy pregnancy. As the demands of the developing fetus for nutrients and oxygen increase, the capacity of the maternal blood vessels to supply this must be altered radically, with deficiencies in this process implicated in a number of dangerous pregnancy complications. The complex signalling networks that regulate these tightly co-ordinated events are becoming clearer as more studies of early pregnancy are performed. It is the aim of this review to draw together our knowledge of events that occur to facilitate a successful pregnancy ranging from the preparation for implantation, through the invasion and differentiation of the trophoblast and the regulation of these processes by other cells within the decidual environment, to the active role that the trophoblast and maternal immune cells play in facilitating the remodelling of the uterine spiral arteries. The events involved in a healthy pregnancy will then be compared to aberrant placentation and remodelling, which are characteristics of many pregnancy disorders, and recent advances in detection of abnormal placental development will also be discussed.
Helmet Versus Active Repositioning for Plagiocephaly: A Three-Dimensional Analysis
Authors: Lipira Angelo B. , Gordon Shayna , Darvann Tron A. , Hermann Nuno V. , Van Pelt Andrea E. , Naidoo Sybill D. , Govier Daniel , Kane Alex A.
Published: September 2010

BACKGROUND AND PURPOSE:

Orthotic helmets and active repositioning are the most common treatments for deformational plagiocephaly (DP). Existing evidence is not sufficient to objectively inform decisions between these options. A three-dimensional (3D), whole-head asymmetry analysis was used to rigorously compare outcomes of these 2 treatment methods.

PATIENTS AND METHODS:

Whole-head 3D surface scans of 70 infants with DP were captured before and after treatment by using stereophotogrammetric imaging technology. Helmeted (n = 35) and nonhelmeted/actively repositioned (n = 35) infants were matched for severity of initial deformity. Surfaces were spatially registered to a symmetric template, which was deformed to achieve detailed right-to-left point correspondence for every point on the head surface. A ratiometric asymmetry value was calculated for each point relative to its contralateral counterpart. Maximum and mean asymmetry values were determined. Change in mean and maximum asymmetry with treatment was the basis for group comparison.

RESULTS:

The helmeted group had a larger reduction than the repositioned group in both maximum (4.0% vs 2.5%; P = .02) and mean asymmetry (0.9% vs 0.5%; P = .02). The greatest difference was localized to the occipital region.

CONCLUSIONS:

Whole-head 3D asymmetry analysis is capable of rigorously quantifying the relative efficacy of the 2 common treatments of DP. Orthotic helmets provide statistically superior improvement in head symmetry compared with active repositioning immediately after therapy. Additional studies are needed to (1) establish the clinical significance of these quantitative differences in outcome, (2) define what constitutes pathologic head asymmetry, and (3) determine whether superiority of orthotic treatment lasts as the child matures.
Stimulant-Responsive and Stimulant-Refractory Aggressive Behavior Among Children With ADHD
Authors: Blader Joseph C. , Pliszka Steven R. , Jensen Peter S. , Schooler Nina R. , Kafantaris Vivian
Published: September 2010

OBJECTIVES:

The objective of this study was to examine factors that are associated with aggression that is responsive versus refractory to individualized optimization of stimulant monotherapy among children with attention-deficit/hyperactivity disorder (ADHD).

METHODS:

Children who were aged 6 to 13 years and had ADHD, either oppositional defiant disorder or conduct disorder, significant aggressive behavior, and a history of insufficient response to stimulants completed an open stimulant monotherapy optimization protocol. Stimulant titration with weekly assessments of behavior and tolerability identified an optimal regimen for each child. Families also received behavioral therapy. Parents completed the Retrospective-Modified Overt Aggression Scale (R-MOAS) at each visit. Children were classified as having stimulant-refractory aggression on the basis of R-MOAS ratings and clinician judgment. Differences that pertained to treatment, demographic, and psychopathology between groups with stimulant monotherapy–responsive and –refractory aggression were evaluated.

RESULTS:

Aggression among 32 (49.3%) of 65 children was reduced sufficiently after stimulant dosage adjustment and behavioral therapy to preclude adjunctive medication. Those who responded to stimulant monotherapy were more likely to benefit from the protocol's methylphenidate preparation (once-daily, triphasic release), showed a trend for lower average dosages, and received fewer behavioral therapy sessions than did children with stimulant-refractory aggression. Boys, especially those with higher ratings of baseline aggression and of depressive and manic symptoms, more often exhibited stimulant-refractory aggression.

CONCLUSIONS:

Among children whose aggressive behavior develops in the context of ADHD and of oppositional defiant disorder or conduct disorder, and who had insufficient response to previous stimulant treatment in routine clinical care, systematic, well-monitored titration of stimulant monotherapy often culminates in reduced aggression that averts the need for additional agents.
Unilateral Frontosphenoidal Craniosynostosis with Achondroplasia: A Case Report
Authors: Hubbard Bradley A. , Gorski Jerome L. , Muzaffar Arshad R.
Published: September 2010

Isolated, premature fusion of the frontosphenoidal suture is rare. This report describes an unusual combination of frontosphenoidal craniosynostosis and achondroplasia. Although craniosynostosis is known to occur in allelic conditions such as thanatophoric dysplasia, craniosynostosis in individuals with achondroplasia is exceedingly rare. Due to the distracting diagnosis of achondroplasia or inadequate knowledge of craniosynostosis, the abnormal head shape was initially treated by other physicians with helmet molding. Plastic surgery consultation was obtained at 2 years of age and surgical care was provided. An acceptable head shape was obtained, but the delay in appropriate evaluation was disconcerting. To our knowledge this is the first reported case of isolated frontosphenoidal craniosynostosis associated with achondroplasia.
Coupled deformation–flow analysis for methane hydrate extraction
Authors: KLAR A. , SOGA K. , NG M.Y.A.
Published: September 2010

Methane hydrate is estimated to be present in substantial amounts below deep sea floors. Particular scientific and engineering interests that encourage studies of mechanical behaviour of methane hydrate soils include submarine geohazards, such as the initiation of marine landslides through hydrate dissociation, wellbore stability and estimation of future gas production from wells. To study these problems, a formulation of a multi-physics model of methane hydrate flow coupled to soil deformation is developed. By assuming deformable porous media (soil matrix) that accommodate non-movable but dissociable hydrate, a two-phase flow formulation of water and methane gas is suggested according to Darcy's law and capillary pressure law. A single-phase elastic–perfectly plastic constitutive model for hydrate soil sediments, based on the concept of effective stress, is developed to account for the effect of hydrate saturation on mechanical strength and stiffness. The formulation is incorporated into the explicit scheme of finite-difference code FLAC by solving three boundary value problems in parallel. The code is used to simulate the behaviour of horizontal unsupported and supported wells in hydrate-bearing sediments under different in situ stress conditions during methane hydrate extraction. Axial force, bending moment and well displacements were compared for supported and unsupported wells.
Structural response of RC wide beams under low-rate and impact loading
Authors: Abbas A.A. , Pullen A.D. , Cotsovos D.M.
Published: September 2010

This paper summarises the test data obtained from an experimental investigation of reinforced concrete (RC) wide beams, which can also be described as one-way slabs, under low-rate (static) and high-rate (impact) concentrated loading applied at their mid-span. The aim of the work was to investigate key aspects of structural response such as the load–deformation behaviour, crack patterns, strength and failure modes of these basic structural elements under varying levels of loading rate. Three 125 mm thick specimens were studied and they measured 1800 mm long and 360 mm wide. They were simply supported at a span of 1600 mm. One specimen was tested under static loading, and the other two were subjected to impact loading using a drop weight. For both load rates investigated, measurements included strains, deflections and support reactions. Additional measurements for the impact test included accelerations and the use of a high-speed, high-resolution video camera to record the whole test. Digital photography was also used for the low-rate test. The use of digital photography and video recording has proved to be a valuable source of data to validate the readings of the more conventional instrumentation and also to give insight into transient features of the impact test such as crack patterns, particularly those which opened and closed during the test. The comparison between the low-rate and impact behaviour has helped further the understanding of the structural response of RC structures under varying rates of loading.
Existence of multiple periodic solutions for a class of first-order neutral differential equations
Authors: Guo Chengjun , O’Regan Donal , Agarwal Ravi
Published: September 2010

In this paper we establish three different existence results for periodic
solutions for a class of first-order neutral differential equations. The
first one is based on a generalized version of the Poincar?-Birkhoff fixed
point theorem where we establish conditions on f which guarantee that a
first-order neutral differential equations has infinitely many periodic
solutions. The second one is based on Mawhin?s continuation theorem and the
third one is based on Krasnoselskii fixed point theorem.
Ultrasonographyin diagnosis of thoracic diseases
Authors: Stevic Ruza , Jakovic Radoslav , Masulovic Dragan , Nagorni-Obradovic Ljudmila , Mujovic Natasa , Jovanovic Dragana
Published: September 2010

Introduction. Chest sonography was used until recently mainly for diagnosis of pleural diseases. High resolution ultrasound machines enable ultrasound application not only in pleural diseases detection, but in diagnosing peripheral lung and mediastinal lesions. Ultrasonography can define the origin and structure of the lesion of thoracic wall, pleural and peripheral lung lesions and mediastinal lesions. Pleural lesions. Ultrasonography is very useful in diagnosing pleural effusion and distinguishing pleural fluid and pleural thickening. This method can also differentiate transudate from exudates and tumor mass from pleural thickening. Lung lesions. Ultrasonography can reveal the cause of white hemithorax differentiating pleural effusion from large tumor mass or atelectasis. Peripheral pulmonary lesions, extending into visceral pleura can be visualized by ultrasonography and differentiation solid tumor from inflammation is possible. Mediastinal lesions. Computerized tomography and magnetic resonance are methods of choice in diagnosing mediastinal diseases. Ultrasonography is useful in distinguishing normal thymus from tumor mass and for ultras onographyguided biopsy. Conclusion. Ultrasonography is a very useful second line method in diagnosis of chest disease. The advantages of this method include bed side availability, absence of radiation, and guided aspiration of fluid-filled areas and solid tumors.
Perinatal outcome of growth restricted fetus with absent end diastolic umbilical blood flow: Case report
Authors: Tasic Marija , Lilic Vekoslav , Milosevic Jelena , Stefanovic Milan , Antic Vladimir
Published: September 2010

Introduction. Absent or reversed end-diastolic blood flow in the umbilical artery is usually associated with poor perinatal outcome and high perinatal mortality rate. Case report. We present the case of a pregnant woman with absent end-diastolic blood flow in the umbilical artery in the 27th week of pregnancy with initial restriction of fetal growth. All though it was more and more obvious that the fetal growth was hindered, the Doppler, cardiotocographic and biophysical parameters did not get any worse as the pregnancy developed. The full fetal maturation was reached after the intense monitoring of the fetal condition and the pregnancy was terminated in the 37lh week by elective Cesarean section. Conclusion. The basic purpose of prenatal fetal monitoring in the situation of hindered fetal growth with chronic hypoxia is to predict the phase of decompensation and to terminate pregnancy before it is developed. The major problem is in great individual variations at the moment of development of decompensation phase, so the major obstetric aim in the monitoring of the fetus hindered in growth is to determine the optimal time and way of delivery.
X-ray and neutron imaging – Complementary techniques for materials science and engineering
Authors: Banhart John , Borbély András , Dzieciol Krzysztof , Garcia-Moreno Francisco , Manke Ingo , Kardjilov Nikolay , Kaysser-Pyzalla Anke Rita , Strobl Markus , Treimer Wolfgang
Published: September 2010

Using X-ray and neutron radiography and tomography, images of material and component inhomogeneities and their development with time can be obtained. Due to their non-destructiveness and non-invasive nature both methods give insight into the function of devices and their decay processes. Fundamentals of X-ray and neutron radiography and tomography are briefly outlined, examples for both techniques are given, their complementarities are highlighted and emerging techniques and frontiers are discussed.
Fast in-situ X-ray micro tomography characterisation of microstructural evolution and strain-induced damage in alloys at various temperatures
Authors: Suéry Michel , Adrien Jérôme , Landron Caroline , Terzi Sofiane , Maire Eric , Salvo Luc , Blandin Jean-Jacques
Published: September 2010

Fast in-situ X-ray tomography has been used at ESRF Grenoble to characterise the microstructural evolution and the formation of strain-induced damage in various materials during different thermomechanical treatments. Materials are both light alloys (Al and Mg based alloys) and steels. The thermomechanical treatments include tensile deformation both in the solid state at room and high temperatures and in the semi-solid state together with thermal treatments above the solidus temperature. Melting and solidification of Al-alloys are also considered in this paper.
Synthesis and characterization of nanostructured Cu/ZnO/Al2O3 from lyotropic liquid crystalline templates
Authors: Wang Xiaodong , Guo Ruijie , Sun Yuan
Published: September 2010

The hexagonal lyotropic liquid crystalline phases of nonionic surfactants AEO-9 were used to template directly the fabrication of nanostructured Cu/ZnO/Al2O3 oxides. The reaction between metal precursors and alkaline reacting substance dissolved within the aqueous domains of the liquid crystalline templates generated nanostructured oxides. Low-angle X-ray diffraction and transmission election microscopy characterization reveals the product as a hexagonal array of cylindrical pores with pore-to-pore separation of ca. 6.3 nm. Possessing ordered nanochannels, Cu/ZnO/Al2O3 oxides could find more potential application in catalysis.
Thermo-kinetic computer simulation of differential scanning calorimetry curves of AlMgSi alloys
Authors: Falahati A. , Povoden-Karadeniz E. , Lang P. , Warczok P. , Kozeschnik E.
Published: September 2010

The microstructure evolution in heat-treatable Al-alloys is characterized by a complex sequence of precipitation processes. These can be either endothermic or exothermic in nature and they can be investigated by thermal analysis. The individual peaks identified in a differential scanning calorimetry (DSC) analysis can be correlated to the nucleation, growth and dissolution of certain types of precipitates. Simultaneously, these data can also be obtained by thermo-kinetic simulation based on models implemented, for instance, in the software MatCalc. The simulations make use of information stored in thermodynamic databases, including stable and metastable phases. In the present work, a thermo-kinetic computational analysis of Al–Mg–Si DSC curves is carried out. The comparison with experimentally observed DSC signals for precipitation and dissolution of metastable GP-zones, β″, β′, as well as stable β-Mg2Si and Si precipitates provides a quantitative insight into the kinetics and sequence of precipitation during DSC probing. The combination of thermo-kinetic and experimental DSC analysis offers new possibilities in interpretation of DSC peaks with multiple metastable phases. In the present paper, we discuss the linking of the simulated precipitation sequence with the measured DSC signal. In addition, with the proposed methodology, a consistent set of parameters to describe the non-equilibrium kinetic parameters of a specific alloy system can be obtained, which can substantially aid in alloy and process development.
Congestive Heart Failure: Redefining Health Care and Nursing
Authors: DeFelice Patricia , Masucci Mary , McLoughlin Judith , Salvatore Stephanie , Shane Margery , Wong Dina
Published: September 2010

This column describes an effective disease management program for congestive heart failure.
Don’t Ignore that Call for Posters!
Authors: McCulloch Brenda
Published: September 2010

Participating in a conference poster session is an effective way to share information about clinical practice. This column offers some practical tips to help with the process of developing a visually appealing and informative poster.
A 32-year-old Woman with Major Depressive Disorder, Pathological Skin Picking, and Trichotillomania
Authors: Asemota Babatunde
Published: September 2010

CME Educational Objectives

1.

Review the dysfunction of glutamate neurotransmission in some psychiatric disorders.

2.

Discuss the neurobiology of pathological skin picking and trichotillomania.

3.

Discuss the potential use of memantine augmentation in patients with pathological skin picking and trichotillomania.
Risk Factors for and Results of Late or Delayed Amputation Following Combat-Related Extremity Injuries
Authors: Helgeson Melvin D. , Potter Benjamin K. , Burns Travis C. , Hayda Roman A. , Gajewski Donald A.
Published: September 2010

We studied patients with combat-related injuries that required delayed amputation at least 4 months after the initial injury due to dysfunction, persistent pain, and patient desires. Late amputations were performed 22 times in 22 patients (21 men, 1 woman) since 2003. Fourteen patients underwent transtibial amputation, 5 transfemoral amputations, 1 knee disarticulation, and 2 transradial amputations. The primary indications for late amputation were neurologic dysfunction in 6 patients, persistent or recurrent infection in 6, neurogenic pain in 3, non-neurogenic pain in 5, and a globally poor functional result in 2. Sixteen of 22 patients reported multiple indications for electing to undergo amputation, with an average of 2.1 specific indications per patient. At final clinical follow-up an average of 13 months after amputation, all patients reported subjectively improved function and reported that they would undergo amputation again under similar circumstances.

When medically and functionally practicable, every effort is given to limb salvage following severe combat-related extremity injuries. There is no single risk factor that increases the likelihood of delayed amputation, but the combination of complex pain symptoms with neurologic dysfunction appears to increase the risk, particularly if the initial insult is a severe hindfoot injury or distal tibia fracture. With appropriately selected and counseled patients, elective late amputation results in a high degree of patient satisfaction and subjectively improved function.
Unicompartmental and Total Knee Arthroplasty in the Over 70 Population
Authors: Fisher David A. , Dalury David F. , Adams Mary Jo , Shipps Melanie R. , Davis Kenneth
Published: September 2010

This retrospective study compares the short-term outcomes of small-incision unicompartmental knee arthroplasty (41 patients) with standard total knee arthroplasty (TKA) (50 patients) in 91 consecutive patients older than 70 years. Knee Society Scores and range of motion (ROM) were assessed preoperatively, at 6 weeks and 6 months, and through a minimum of 2 years. Postoperative comparisons included blood loss, transfusions, narcotic consumption, length of hospital stay, and complications.

While Knee Scores and ROM were similar preoperatively, both were better in the unicompartmental group at each postoperative time interval. Patients with unicompartmental replacements had a much quicker return of function and discontinuation of pain medication. Blood loss was significantly more for the TKA group, as was the need for blood transfusion. None of the unicompartmental patients required transfusion. Narcotic use and length of hospital stay were also significantly less for the unicompartmental group. The overall rate of postoperative medical and surgical complications was similar for the 2 groups, with 1 major complication in each. Overall, the physiologic impact of unicompartmental knee arthroplasty was much less than TKA in this older patient population and resulted in a faster recovery.
Effectiveness of External Rotation Immobilization in Highly Active Young Men with Traumatic Primary Anterior Shoulder Dislocation or Subluxation
Authors: Tanaka Yoshitaka , Okamura Kenji , Imai Tomohito
Published: September 2010

We treated 15 highly active young men (16 shoulders) with traumatic primary anterior shoulder dislocation or subluxation using 3-week external rotation immobilization. Fourteen patients (14 shoulders) were members of the Self-Defense Force and the other patient (2 shoulders) was a high school student who played club-level rugby. Average patient age at the time of the primary injury was 21.3 years (range, 17–26 years). Magnetic resonance imaging (MRI) was performed on 14 of 16 shoulders after the 3-week external rotation immobilization and showed that the anteroinferior labrum was reduced on the glenoid rim in 11 shoulders but remained medially displaced on the glenoid neck in 3 shoulders. Five shoulders, including these 3 shoulders, underwent arthroscopic Bankart repair after 3-week external rotation immobilization. Eleven shoulders continued nonoperative treatment after the immobilization. Four of 11 shoulders had no recurrence of symptoms for >2 years, and these patients were able to return to their preinjury activities. However, 7 shoulders experienced recurrence within 2 years.

We concluded that external rotation immobilization may not be as effective as mentioned previously in highly active young men with primary traumatic anterior shoulder dislocation or subluxation. Whether a patient has instability symptom recurrence after external rotation immobilization depends on more than the fact that the anteroinferior labrum is not reduced on MRI.
Effect of Preoperative Exercise on Postoperative Mobility in Obese Total Joint Replacement Patients
Authors: Robbins Claire E. , Bono James V. , Ward Daniel M. , Barry Marilyn T. , Doren Janice , McNinch Amanda
Published: September 2010

There has been a significant increase in obesity in the United States over the past 20 years. Reports in the literature identify the association of obesity-related osteoarthritis and the likelihood of future total hip arthroplasty (THA) and total knee arthroplasty (TKA) in this patient population. However, little is known about the effect of preoperative exercise on immediate postoperative mobility and discharge disposition in obese total joint replacement patients. The purpose of this study was to examine the effect of preoperative exercise in the obese total joint replacement patient on early postoperative mobility and discharge disposition.

We retrospectively reviewed a consecutive series of patients with a body mass index (BMI) ≥30 kg/m
2
who underwent primary total joint replacement surgery from June 2005 through October 2005 at 1 institution. Two hundred seven patients met the inclusion criteria. Sixty-five patients performed self-reported preoperative exercise, defined as physical activity deemed above and beyond that of activities of daily living. Fewer exercise patients, 6.8%, required the assistance of ≥2 caregivers for mobility on postoperative day 1 vs 17.4% for nonexercisers. Fifty-four percent of patients participating in preoperative exercise were discharged home vs 46% who did not participate in exercise. A preoperative exercise program can improve postoperative functional mobility and increase the likelihood of discharge home in total joint replacement patients with a BMI of ≥30 kg/m
2
.
The Transverse Acetabular Ligament: Optimizing Version
Authors: Beverland David
Published: September 2010

In total hip arthroplasty (THA), excessive retroversion is associated with posterior instability, anterior impingement, and resultant groin pain. Excessive anteversion can lead to anterior instability and posterior impingement. The transverse acetabular ligament straddles the inferior limit of the bony acetabulum. It is a strong load-bearing structure and, in the normal hip, in association with the labrum, provides part of the load-bearing surface for the femoral head. It is our hypothesis that the transverse acetabular ligament defines normal version for the acetabulum. In Belfast, we found that using the transverse acetabular ligament helped reduce our primary dislocation rate from 3.7% to 1%. The key is good intraoperative exposure. A grading of 1 to 4 was based on 1000 consecutive cases: (1) normal transverse acetabular ligament easily visible on exposure of the acetabulum, 49%; (2) covered by soft tissue, 35.1%—cleared by blunt dissection; (3) covered by osteophytes, 15.6%—cleared using an acetabular reamer; (4) no transverse acetabular ligament identified, 0.3%. As can be seen, the transverse acetabular ligament is only immediately visible in 49% of cases. In the other 51%, soft tissue or bone must be cleared to define the ligament. The advantages of the transverse acetabular ligament are many. It is independent of patient positioning. The cup version can be individualized by the patient. The surgeon can avoid estimating version angle of 15° to 20° intraoperatively. It is easy to teach and consistently present. It is valuable in minimally invasive surgery. Using the transverse acetabular ligament provides an acceptable dislocation rate with the posterior approach. If the cup is cradled by the transverse acetabular ligament, it helps restore acetabular joint center. However, the transverse acetabular ligament does not help with inclination. We recommend 35° of operative inclination when using the posterior approach.
Component Malposition in Hip Resurfacing
Authors: Brooks Peter
Published: September 2010

Component malposition in hip resurfacing can cause early failure through the 2 main failure modes: femoral neck fracture and wear-related failures. The femoral component should be aligned in slight valgus with no notching of the superior femoral neck. Varus placement and notching are strongly correlated with early femoral neck fracture. We have developed special mushroom templates to assist with accurate femoral component sizing and positioning. Issues related to radiographic magnification, ruler measurements, and plastic overlay templates are avoided. Acetabular component malposition can result in wear-related failures. The geometry of most resurfacing sockets is such that the wall is thinner at the rim than at the apex. This is done to improve range of motion before impingement and results in the bearing having less coverage and a higher inclination than one would expect from the radiograph. Surgeons should therefore aim for a lower inclination than they would with total hip replacement. Acetabular anteversion, if excessive, can reduce the available contact area, and lead to edge wear and subluxation. Dysplasia, which is more common in women, can also result in excessive femoral anteversion. Taken together, the combined acetabular and femoral anteversion should not exceed 45°. Pseudotumors have been reported adjacent to metal-on-metal bearings. These reports point out that pseudotumors are often associated with component malposition. It is thought that edge wear due to malposition results in excessive metal debris, which is locally toxic. Proper component position is necessary for the short- and long-term success of hip resurfacing.
Cementless Tibial Fixation in TKA: A Second Coming
Authors: Callaghan John J. , Liu Steve S.
Published: September 2010

Cemented total knee arthroplasty (TKA), using mechanically sound components such as the total condylar system (Johnson & Johnson, New Brunswick, New Jersey), have been performed for >25 years. Long-term follow-up studies have shown excellent durability. In 1 series with a minimum 20-year follow-up, the revision rate for aseptic loosening was 3.5%. More contemporary prostheses, such as the low contact stress rotating platform (DePuy, Warsaw, Indiana) and Kinematic Knee systems (Howmedica, Rutherford, New Jersey), have demonstrated minimal loosening at 20-year follow-up. In a minimum 20-year follow-up of a rotating platform TKA, the revision rate for aseptic loosening was 0%. In a minimum 15-year follow-up of kinematic cruciate-retaining TKA, the revision rate for aseptic loosening was 1.8%. Cemented fixation is durable and forgiving. It can accommodate defects in bone as well as imperfect cuts that are not uncommon, even in the best of hands. It can interdigitate into soft and hard bone. With the development of modular tibial trays with better locking mechanisms and less abrasive surfaces, as well as the development of more wear-resistant polyethylene (gamma irradiated in an inert environment and crosslinked polyethylene), the osteolysis that developed around first generation modular components should be markedly less with newer designs. It is for these reasons that cement should remain the fixation of choice in TKA.
Wound Healing in Total Joint Arthroplasty
Authors: Jones Richard E.
Published: September 2010

Obtaining primary wound healing in total joint arthroplasty is essential to a good result. Wound healing problems can occur and the consequences can be devastating. Determination of the host healing capacity can be useful in predicting complications. Cierney and Mader classified patients as type A, no healing compromises; and type B, systemic or local healing compromising factors present. Local factors include traumatic arthritis, multiple previous incisions, extensive scarring, lymphedema, poor vascular perfusion. Systemic compromising factors include diabetes, rheumatic diseases, renal or liver disease, immunocompromise, steroids, smoking, and poor nutrition. In high-risk patients, the surgeon should encourage positive choices such as smoking cessation and nutritional supplementation to elevate the total lymphocyte count and total albumin.

Careful planning of incisions, particularly in patients with scarring or multiple previous operations, is productive. Around the knee the vascular viability is better in the medial flap. Thus, use the most lateral previous incision, do minimal undermining, and handle tissue meticulously. We perform all potentially complicated total knee arthroplasties without tourniquet to enhance blood flow and tissue viability. The use of perioperative anticoagulation will increase wound problems.

If wound drainage or healing problems occur, immediate action is required. Deep sepsis can be ruled out with a joint aspiration and cell count (>2000), differential (>50% polys), and negative culture and sensitivity. All hematomas should be evacuated and necrosis or dehiscence should be managed by debridement to obtain a live wound.
Subcapital Fractures: In the Bucket or On Top of the Neck?
Authors: Kyle Richard F.
Published: September 2010

Femoral neck fractures have a 30% reoperation rate when internally fixed. To reduce the reoperation rate, the surgeon must accurately decide which fractures are best fixed and which fractures require a prosthesis. The literature supports the fact that nondisplaced fractures should be internally fixed. Fractures in patients physiologically younger than 65 years should also be fixed if they have no comorbidities. The most important factors in reducing failure rate of fixation are patient selection and anatomic reduction. A femoral neck fracture left in varus is doomed to failure and reoperation.

Femoral neck fractures that are displaced in patients older than 65 years require a decision-making algorithm to decide how they should be treated. In the physiologically active patient older than 65 years, internal fixation may be considered. In most patients older than 65 years, prosthetic replacement should be considered. Nursing home patients and patients with comorbidities who are not expected to live longer than 6 to 7 years should receive a hemiarthroplasty. Studies show a high reoperation rate if the patient with hemiarthroplasty survives more than 6 or 7 years.

In the active elderly with little or no comorbidities, a total hip replacement should be considered. This is not only cost effective but provides the best pain relief of any of the treatment options for displaced femoral neck fractures. Treatment of femoral neck fractures remains a challenge, but the surgeon must develop an algorithm to select proper treatment options for the patient. The decision-making process is always shared with the patient.
Dual Mobility for Chronic Hip Instability: A Solution Option
Authors: Stulberg S. David
Published: September 2010

A dual-mobility acetabular component consists of a large, fixed, porous-coated acetabular component and a bipolar femoral component. These components are often called tripolar components. This configuration provides a stable, well-fixed implant platform against bone and 2 articular interfaces, a large polyethylene surface directly apposed to the highly polished metal shell, and a standard sized (28 mm, 32 mm) femoral head captured within polyethylene.

The dual-mobility cup was designed to reduce the incidence of dislocations in patients at increased risk of instability (eg, patients undergoing revision). The cup appears to offer a safe, effective, durable solution to hip instability. The concept has extensive laboratory and clinical support. Although the long-term durability of dual-mobility cups, particularly in young, active, large patients, is not known, the tested wear rates of the dual-mobility design with the current generation of highly cross-linked polyethylene are significantly lower than any previously reported wear rates. The recently released anatomic dual-mobility cup seeks to reduce the potential for iliopsoas impingement while retaining the stability and wear characteristics of the original dual-mobility design.
Use of Catheters in the Postoperative Patient
Authors: Swenson Jeffrey D.
Published: September 2010

Continuous peripheral nerve block has been shown to be superior to traditional opioid-based analgesia in terms of improved analgesia with reduced sedation, nausea, pruritis, and hospital stay. Because of its safety and efficacy, continuous peripheral nerve block has broad application in ambulatory and pediatric patients. Techniques for continuous peripheral nerve block have advanced significantly in the past decade, particularly as a result of affordable, high-resolution ultrasound equipment that permits rapid and successful administration and results in reduced procedure-related pain, lower dose requirements, and fewer vascular punctures. Continuous peripheral nerve block is associated with some limitations, including infection, neurologic injury, local anesthetic toxicity, and patient falls. The benefits of continuous peripheral nerve block are becoming increasingly relevant in the ambulatory surgery setting where more complex procedures are being performed on an outpatient basis.
Pain Management in Total Joint Arthroplasty: A Historical Review
Authors: Horlocker Terese T.
Published: September 2010

Patients undergoing total hip and knee arthroplasty experience substantial and sustained postoperative pain. Inadequate analgesia may impede recovery and delay hospital discharge. Traditionally, postoperative analgesia following arthroplasty was provided by intravenous patient-controlled analgesia or epidural analgesia, but each technique has distinct advantages and disadvantages. Recently, peripheral nerve blockade of the lumbosacral plexus has emerged as an alternative analgesic approach. An increasing number of studies have reported multimodal analgesia featuring unilateral peripheral block provide pain relief and functional outcomes similar to that of continuous epidural and superior to systemic analgesia but with fewer side effects. This review discusses the indications, benefits, and side effects associated with conventional and innovative analgesic approaches to facilitate rehabilitation and improve outcome following total joint arthroplasty.
Long-Term Monitoring of Age-Related Macular Degeneration with Preferential Hyperacuity Perimetry
Authors: Stur Michael , Manor Yair
Published: September 2010

Background and Objective:

To estimate the efficacy and usability of preferential hyper-acuity perimetry (PHP) for monitoring patients with high-risk intermediate age-related macular degeneration (AMD).

Patients and Methods:

A long-term, observational, prospective case series of patients with intermediate AMD who underwent fluorescein angiography at recruitment. Eyes were examined every 3 months with PHP, visual acuity, and biomicroscopy. Optical coherence tomography (OCT) imaging was performed when PHP was outside normal limits. In case of suspected findings in OCT, fluorescein angiography was also performed. Patients diagnosed as having choroidal neovascularization (CNV) were offered anti-vascular endothelial growth factor therapy.

Results:

Twenty-six eyes (25 patients) were monitored for a mean follow-up period of 600 days. Of the 172 PHP tests done by these 26 eyes with intermediate AMD, 158 were within normal limits yielding a false-positive rate of 8.1%. Three of 4 eyes that converted to CNV had PHP test results outside normal limits before or on the day of diagnosis.

Conclusion:

PHP is useful for detecting CNV in regularly monitored eyes with intermediate AMD while maintaining a low false-positive rate.
Fan filmmaking and copyright in a global world: "Warhammer 40,000" fan films and the case of "Damnatus"
Authors: Walliss John
Published: September 2010

The last decade has witnessed a proliferation, both online and off-line, of films produced by amateurs inspired by mainstream films, TV shows, and novels. As with much other fan production, fan films exist in, at best, a legally gray area since they are produced by amateurs, rather than by the media companies that own the copyrights to the films and novels that provide both their inspiration and settings. I examine the phenomenon of fan filmmaking, focusing on films produced by fans of the Warhammer 40,000 (W40K) tabletop battle game. In particular, I examine the case of Damnatus: The Enemy Within (Damnatus: Feind Im Innern, 2005), a German-made fan film set in the W40K universe, which was banned from release by the game's rights holder, the UK company Games Workshop, in 2007. Damnatus offers an interesting case study in both the ongoing struggle between rights holders and textual poachers and the tensions that can exist between different legal understandings of copyright in an increasingly globalized world.
"May the journey continue": "Earth 2" fan fiction, or Filling in gaps to revive a canceled series
Authors: Musiani Francesca
Published: September 2010

This essay explores writing practices in a fan community having to give life to a story deprived of an "official" version: the television series Earth 2. I argue that fan fiction writing for this prematurely canceled series exhibits peculiar features in comparison to fan writing for established series: for example, temporality, choice of protagonists, character pairings, and challenges to the original conception(s) of the series. Writing fan fiction for a canceled series is not about creating alternatives to an existing story, but about filling in gaps; it brings to light the ways in which fan fiction deals with closure. I take as a case study Earth 2, a series aired by NBC in the United States in 1994–95, whose first and only season ended in a cliffhanger episode hinting that a mysterious ailment had struck the main and most popular character. Shortly afterward, a significant number of Earth 2 Web sites, online conventions, and especially fan stories started developing; they explored what could have happened next and bore nostalgic but combative mottoes and titles such as "May the Journey Continue." I explore the specific features of Earth 2 fan fiction production and sharing by analyzing the main Earth 2 fan fiction archives on the Web and the responses to my email interviews of fan writers. Exemplars of the Earth 2 case are compared to those of other science fiction TV series, both prematurely canceled (Firefly, Space: Above and Beyond) and long-lived (Babylon 5, Star Trek: Deep Space 9).
Becky is my hero: The power of laughter and disruption in "Supernatural"
Authors: Fathallah Judith May
Published: September 2010

Interpreted through Mikhail Bakhtin's theories of resistant laughter, the fan insert character of Becky from Supernatural can be read as an invitation to appropriate the narrative for their own pleasure. However, outsiders to the fan community may not recognize that Becky's depiction is hyperbolic and may thus read the character as a damaging stereotype.
"This isn't something I can fake": Reactions to "Glee"'s representations of disability
Authors: Kociemba David
Published: September 2010

Angered by how Glee's creators depict the character of Artie giving up on his dreams of being a dancer, I demonstrate the show's ignorance of integrated dance and wheelchair ballroom dance. A review of other responses reveals widespread criticism by disability studies scholars. However, the fan communities generally are unaware of what is missing, engrossed in shipping and music appreciation debates.
Modelling the Role of Dietary Habits and Eating Behaviours on the Development of Acute Coronary Syndrome or Stroke: Aims, Design, and Validation Properties of a Case-Control Study
Authors: Kastorini Christina-Maria , Milionis Haralampos J. , Goudevenos John A. , Panagiotakos Demosthenes B.
Published: September 2010

In this paper the methodology and procedures of a case-control study that will be developed for assessing the role of dietary habits and eating behaviours on the development of acute coronary syndrome and stroke is presented. Based on statistical power calculations, 1000 participants will be enrolled; of them, 250 will be consecutive patients with a first acute coronary event, 250 consecutive patients with a first ischaemic stroke, and 500 population-based healthy subjects (controls), age and sex matched to the cases. Socio-demographic, clinical, dietary, psychological, and other lifestyle characteristics will be measured. Dietary habits and eating behaviours will be evaluated with a special questionnaire that has been developed for the study.
Role of imaging in female infertility [Dr. K.M. Rai Memorial Oration Award]
Authors: Rastogi Rajul
Published: September 2010

Infertility in females is multifactorial in origin. Though hysterolaparoscopy is the gold-standard investigation, USG is usually the first-line investigation. MRI has expanded the usefulness of imaging in female infertility. This pictorial essay reviews the role of imaging in the evaluation of female infertility.
Case report: Acute calcific discitis with intravertebral disc herniation in the dorsolumbar spine
Authors: Mittal Puneet , Saggar Kavita , Sandhu Parambir , Gupta Kamini
Published: September 2010

Acute calcific discitis is a rare but well-known condition of unknown etiology. In symptomatic cases, the most common site is the cervical spine. We describe the CT scan and MRI findings in a symptomatic patient, with a lesion in the dorsolumbar spine.