bluuebunny/crossref_metadata_2025 huggingface dataset:
Multidisciplinary activities in a community mental health service: relationship to Health of the Nation Outcome Scale scores and diagnosis
Authors: Meagher David , O'Brien Sinead , Pullela Ananth , Oshun Anthony , Brosnan Pat
Published: April 2009

Aims and Method

Multidisciplinary activities of community mental health teams in Ireland are understudied. We explored symptom profile and multidisciplinary team contacts in a complete sector population (n= 504).

Results

The frequency of attendance was greater in individuals with severe mental illness (P<0.001) and correlated with total Health of the Nation Outcome Scale (HoNOS) scores (P<0.001) and with the sub-scales for social disability (P<0.001) and symptoms (P<0.01). Sixty-two per cent of individuals were receiving shared care and were more likely to have severe mental illness (P<0.001) and higher total HoNOS scores (P<0.001). Frequency of attendance correlated with total HoNOS scores and subscale scores for social impairment and symptoms.

Clinical Implications

Frequency of service attendance and activities of multidisciplinary team members vary with symptom profile of service attenders but are focused towards individuals with more severe illness and greater problems identified by the HoNOS.
Psychological therapies, older people and human rights
Authors: Hilton Claire
Published: April 2009

Additional funding has recently been made available by the government for the treatment of anxiety and depression. However, this is targeted towards people of working age, to reduce expenditure on incapacity benefit. That older people with the same mental illnesses do not receive equitable access to psychological therapies contradicts other recent government recommendations. Economic data appears to hugely influence provision of services for this group of users, but is this appropriate and humane? the Human Rights Act 1998 (Chapter 42) has been largely ignored in the provision of mental health services for older people, and the centrality of this legislation needs further consideration.
Developing a child and adolescent mental health service in a low-income country: a global partnership model
Authors: Tareen Amina , Mirza Ilyas , Minhas Ayesha , Minhas Fareed , Rahman Atif
Published: April 2009

Aims and Method

To develop a child and adolescent mental health service in a low-income country. This was a collaborative effort involving governmental and non-governmental organisations in the UK and Pakistan, where a training clinic was established.

Results

We assessed and treated 169 children and adolescents. A team of mental health professionals was trained, including one consultant psychiatrist; the consultant psychiatrist is now leading the clinic. Links were further developed with healthcare, social care and educational organisations, as well as efforts made to engage the public in relation to child and adolescent mental health.

Clinical Implications

Our development highlights a model of research collaboration and service development which may be sustainable in low-income settings. Such initiatives need support from a variety of organisations. There is a need to consider whether there should be a formal funding mechanism to support the Royal College of Psychiatrists Senior Volunteer Programme.
The Mental Health Act 1983 and incapacity: what general hospital doctors know
Authors: Richards Felicity , Dale Jenny
Published: April 2009

Aims and Method

A questionnaire survey of general hospital doctors was conducted before and after a 1h training intervention. Baseline levels of knowledge and confidence regarding the use of section 5(2) of the Mental Health Act 1983 and assessment and management of incapacitated patients were determined. Following a training intervention, improvements in these areas were established.

Results

Eighteen doctors participated. Confidence in assessing capacity and the knowledge of treatment under common law and section 5(2) were low at baseline. Improvements were seen following the training intervention, with four knowledge items relating to section 5(2) achieving statistically significant improvements.

Clinical Implications

Simple training interventions delivered by psychiatrists may be an effective way of improving the knowledge and confidence of general hospital doctors.
Effect of the 2004 tsunami on suicide rates in Sri Lanka
Authors: Rodrigo Asiri , McQuillin Andrew , Pimm Jonathan
Published: April 2009

Aims and Method

To investigate the effect of the 2004 tsunami on suicide rates in Sri Lanka. the number of suicides in the 2 years prior to and 1 year after the tsunami were considered for the study. Data from districts affected by the tsunami were compared with those from unaffected districts.

Results

No significant differences were found between the number of suicides before and following the disaster or between areas affected and unaffected by the tsunami.

Clinical Implications

Worldwise, the impact of disasters upon suicide rates is variable. It is possible that the tsunami failed to have any profound effect on societal forces affecting suicide rates in Sri Lanka.
Improving access to psychological therapies for all adults
Authors: Ghosh Pradip
Published: April 2009

New psychological services are about to roll out across England. the National Institute for Health and Clinical Excellence clinical guidelines have led to government investment in the Improving Access to Psychological Therapies (IAPT) programme. New IAPT services should cut waiting times for psychological treatment of depression and anxiety disorders from months to days. They are intended to be available for all adults on the basis of need rather than age. It is not currently illegal for patients to be discriminated against by the National Health Service (NHS) because of their age. the government intends to introduce new legislation against age discrimination in the provision of goods, facilities and services by the NHS. Further investment and service development will be needed to counter existing age-related inequalities in mental health services
Neither Necessary nor Sufficient
Authors: Marsh John
Published: April 2009

This article discusses the origins and political effects of university-affiliated, college-accredited community education programs for low-income adults. While useful in their efforts to share the academic resources of the humanities with those otherwise deprived, such programs thrive on and perpetuate the myth that education—not economic policies—will reduce or eliminate poverty.
Working Alone Together
Authors: Hendricks Bill
Published: April 2009

This article explores the dialectic between autonomy and mutuality within postsecondary composition programs. Grounded in a case study of writing instruction at a small, unionized, public university, the article argues that while broad workplace democracy and economic security are clearly desirable for communities of college composition teachers, their efficacy is seriously compromised absent sustained commitments to intellectual restlessness, professional deliberation, and collective action.
Extracellular matrix modifications at fertilization: regulation of dityrosine crosslinking by transamidation
Authors: Wong Julian L. , Wessel Gary M.
Published: April 2009

Fertilization is accompanied by the construction of an extracellular matrix that protects the new zygote. In sea urchins, this structure is built from glycoproteins residing at the egg surface and in secretory vesicles at the egg cortex. Four enzymatic activities are required for the transformation of these proteins into the mechanically and chemically resilient fertilization envelope: proteolysis, transamidation, NADPH-dependent oxidation and peroxidation. Here, we identify the Strongylocentrotus purpuratusenzymes responsible for the formation of ϵ(γ-glutamyl)lysine crosslinks (transamidation). We find that these two transglutaminases are activated by local acidification and act on specific substrates within the fertilization envelope (including ovoperoxidase, rendezvin and SFE9). Surprisingly, these enzymes also regulate dityrosine crosslinking both by direct conjugation of ovoperoxidase and by modulating hydrogen peroxide production. Together, these results emphasize how transglutaminases can coordinate the activities of other enzymes during extracellular matrix transmogrifications.
Mechanical control of global cell behaviour during dorsal closure inDrosophila
Authors: Gorfinkiel Nicole , Blanchard Guy B. , Adams Richard J. , Martinez Arias Alfonso
Published: April 2009

Halfway through embryonic development, the epidermis of Drosophilaexhibits a gap at the dorsal side covered by an extraembryonic epithelium, the amnioserosa (AS). Dorsal closure (DC) is the process whereby interactions between the two epithelia establish epidermal continuity. Although genetic and biomechanical analysis have identified the AS as a force-generating tissue, we do not know how individual cell behaviours are transformed into tissue movements. To approach this question we have applied a novel image-analysis method to measure strain rates in local domains of cells and performed a kinematic analysis of DC. Our study reveals spatial and temporal differences in the rate of apical constriction of AS cells. We find a slow phase of DC,during which apical contraction of cells at the posterior end predominates,and a subsequent fast phase, during which all the cells engage in the contraction, which correlates with the zippering process. There is a radial gradient of AS apical contraction, with marginal cells contracting earlier than more centrally located cells. We have applied this analysis to the study of mutant situations and associated a particular genotype with quantitative and reproducible changes in the rate of cell contraction and hence in the overall rate of the process. Our mutant analysis reveals the contribution of mechanical elements to the rate and pattern of DC.
FOXD3 regulates the lineage switch between neural crest-derived glial cells and pigment cells by repressing MITF through a non-canonical mechanism
Authors: Thomas Aaron J. , Erickson Carol A.
Published: April 2009

The first neural crest cells to emigrate from the neural tube are specified as neurons and glial cells and are subsequently followed by melanocytes of the skin. We wished to understand how this fate switch is controlled. The transcriptional repressor FOXD3 is expressed exclusively in the neural/glial precursors and MITF is expressed only in melanoblasts. Moreover, FOXD3 represses melanogenesis. Here we show that avian MITF expression begins very early during melanoblast migration and that loss of MITF in melanoblasts causes them to transdifferentiate to a glial phenotype. Ectopic expression of FOXD3 represses MITF in cultured neural crest cells and in B16-F10 melanoma cells. We also show that FOXD3 does not bind directly to the MITFpromoter, but instead interacts with the transcriptional activator PAX3 to prevent the binding of PAX3 to the MITF promoter. Overexpression of PAX3 is sufficient to rescue MITF expression from FOXD3-mediated repression. We conclude that FOXD3 controls the lineage choice between neural/glial and pigment cells by repressing MITF during the early phase of neural crest migration.
The tetraspanin Tm4sf3 is localized to the ventral pancreas and regulates fusion of the dorsal and ventral pancreatic buds
Authors: Jarikji Zeina , Horb Lori Dawn , Shariff Farhana , Mandato Craig A. , Cho Ken W. Y. , Horb Marko E.
Published: April 2009

During embryogenesis, the pancreas develops from separate dorsal and ventral buds, which fuse to form the mature pancreas. Little is known about the functional differences between these two buds or the relative contribution of cells derived from each region to the pancreas after fusion. To follow the fate of dorsal or ventral bud derived cells in the pancreas after fusion, we produced chimeric Elas-GFP transgenic/wild-type embryos in which either dorsal or ventral pancreatic bud cells expressed GFP. We found that ventral pancreatic cells migrate extensively into the dorsal pancreas after fusion,whereas the converse does not occur. Moreover, we found that annular pancreatic tissue is composed exclusively of ventral pancreas-derived cells. To identify ventral pancreas-specific genes that may play a role in pancreatic bud fusion, we isolated individual dorsal and ventral pancreatic buds, prior to fusion, from NF38/39 Xenopus laevis tadpoles and compared their gene expression profiles (NF refers to the specific stage of Xenopusdevelopment). As a result of this screen, we have identified several new ventral pancreas-specific genes, all of which are expressed in the same location within the ventral pancreas at the junction where the two ventral pancreatic buds fuse. Morpholino-mediated knockdown of one of these ventral-specific genes, transmembrane 4 superfamily member 3(tm4sf3), inhibited dorsal-ventral pancreatic bud fusion, as well as acinar cell differentiation. Conversely, overexpression of tm4sf3promoted development of annular pancreas. Our results are the first to define molecular and behavioral differences between the dorsal and ventral pancreas,and suggest an unexpected role for the ventral pancreas in pancreatic bud fusion.
Caenorhabditis elegans as an emerging model for studying the basic biology of obesity
Authors: Jones Kevin T. , Ashrafi Kaveh
Published: April 2009

The health problem of obesity and its related disorders highlights the need for understanding the components and pathways that regulate lipid metabolism. Because energy balance is maintained by a complex regulatory network, the use of a powerful genetic model like C. elegans can complement studies on mammalian physiology by offering new opportunities to identify genes and dissect complicated regulatory circuits. Many of the components that are central to governing human metabolism are conserved in the worm. Although the study of lipid metabolism in C. elegans is still relatively young, much progress has already been made in tracing out genetic pathways that regulate fat storage and in developing assays to explore different aspects of metabolic regulation and food sensation. This model system holds great promise for helping tease apart the complicated network of genes that maintain a proper energy balance.
The stratified syncytium of the vertebrate lens
Authors: Shi Yanrong , Barton Kelly , De Maria Alicia , Petrash J. Mark , Shiels Alan , Bassnett Steven
Published: April 2009

The fusion of cells to generate syncytial tissues is a crucial event in the development of many organisms. In the lens of the vertebrate eye, proteins and other macromolecules diffuse from cell to cell via the large molecule diffusion pathway (LMDP). We used the tamoxifen-induced expression of GFP to investigate the nature and role of the LMDP in living, intact lenses. Our data indicate that the LMPD preferentially connects cells lying within a stratum of the lens cortex and that formation of the LMPD depends on the expression of Lim2, a claudin-like molecule. The conduits for intercellular protein exchange are most likely regions of partial cellular fusion, which are commonly observed in wild-type lenses but rare or absent in Lim2-deficient lenses. The observation that lens tissue constitutes a stratified syncytium has implications for the transparency, refractive function and pathophysiology of the tissue.
Persisting muscle atrophy two years after replacement of the hip
Authors: Rasch A. , Byström A. H. , Dalén N. , Martinez-Carranza N. , Berg H. E.
Published: April 2009

Muscle atrophy has been demonstrated in patients suffering from osteoarthritis of the hip, but little is known about muscular recovery after total hip replacement (THR). A total of 20 patients with unilateral osteoarthritis of the hip were assessed before, six months and two years after THR. The cross-sectional area and radiological density of the muscles of the hip, thigh, calf and back were measured using CT. We hypothesised that the muscles would not recover fully after operation.

After two years comparison of the limb with the THR with the healthy limb showed that there was such a reduction in the cross-sectional area in iliopsoas (7.0%; p = 0.006) and the hip adductors (8.4%, p = 0.003) and in the radiological density in gluteus maximus (10.1 Hounsfield units; p < 0.001), gluteus medius/minimus (5.6 Hounsfield units; p = 0.011), iliopsoas (3.9 Hounsfield units; p < 0.001) and the adductors (2.4 Hounsfield units; p = 0.022).

Thus, there was persistent muscle atrophy in muscles acting about the hip two years after THR. We suggest that an earlier operation or a more intensive rehabilitation may reverse these changes.
Pronator teres transfer to correct pronation deformity of the forearm after an obstetrical brachial plexus injury
Authors: Amrani A. , Dendane M. A. , El Alami Z. F.
Published: April 2009

A pronation deformity of the forearm following an obstetric brachial plexus injury causes functional and cosmetic disability. We evaluated the results of pronator teres transfer to correct their deformity in 14 children treated over a period of four years. The mean age at surgery was 7.6 years (5 to 15). The indication for surgery in each case was impairment of active supination in a forearm that could be passively supinated provided that there was no medial contracture of the shoulder and normal function of the hand. The median follow-up was 20.4 months (8 to 42). No patient was lost to follow-up. Qualitative results were also assessed. The median active supination improved from 5° (0° to 10°) to 75° (70° to 80°) with no loss of pronation.

A passively correctible pronation contracture can be corrected safely and effectively by the transfer of pronator teres.
Oral rivaroxaban for the prevention of symptomatic venous thromboembolism after elective hip and knee replacement
Authors: Eriksson B. I. , Kakkar A. K. , Turpie A. G. G. , Gent M. , Bandel T.-J. , Homering M. , Misselwitz F. , Lassen M. R.
Published: April 2009

A once-daily dose of rivaroxaban 10 mg, an oral, direct Factor Xa inhibitor, was compared with enoxaparin 40 mg subcutaneously once daily for prevention of venous thromboembolism in three studies of patients undergoing elective hip and knee replacement (RECORD programme).

A pooled analysis of data from these studies (n = 9581) showed that rivaroxaban was more effective than enoxaparin in reducing the incidence of the composite of symptomatic venous thromboembolism and all-cause mortality at two weeks (0.4% vs 0.8%, respectively, odds ratio 0.44; 95% confidence interval 0.23 to 0.79; p = 0.005), and at the end of the planned medication period (0.5% vs 1.3%, respectively; odds ratio 0.38; 95% confidence interval 0.22 to 0.62; p < 0.001). The rate of major bleeding was similar at two weeks (0.2% for both) and at the end of the planned medication period (0.3% vs 0.2%).

Rivaroxaban started six to eight hours after surgery was more effective than enoxaparin started the previous evening in preventing symptomatic venous thromboembolism and all-cause mortality, without increasing major bleeding.
Subtalar and talonavicular arthrodesis through a single medial approach for the correction of severe planovalgus deformity
Authors: Knupp M. , Schuh R. , Stufkens S. A. S. , Bolliger L. , Hintermann B.
Published: April 2009

We describe a retrospective review of the clinical and radiological parameters of 32 feet in 30 patients (10 men and 20 women) who underwent correction for malalignment of the hindfoot with a modified double arthrodesis through a medial approach. The mean follow-up was 21 months (13 to 37). Fusion was achieved in all feet at a mean of 13 weeks (6 to 30). Apart from the calcaneal pitch angle, all angular measurements improved significantly after surgery. Primary wound healing occurred without complications.

The isolated medial approach to the subtalar and talonavicular joints allows good visualisation which facilitated the reduction and positioning of the joints. It was also associated with fewer problems with wound healing than the standard lateral approach.
An in vitro study of the strain distribution in human femora with anatomical and customised femoral stems
Authors: Østbyhaug P. O. , Klaksvik J. , Romundstad P. , Aamodt A.
Published: April 2009

Hydroxyapatite-coated standard anatomical and customised femoral stems are designed to transmit load to the metaphyseal part of the proximal femur in order to avoid stress shielding and to reduce resorption of bone. In a randomised in vitro study, we compared the changes in the pattern of cortical strain after the insertion of hydroxyapatite-coated standard anatomical and customised stems in 12 pairs of human cadaver femora. A hip simulator reproduced the physiological loads on the proximal femur in single-leg stance and stair-climbing. The cortical strains were measured before and after the insertion of the stems.

Significantly higher strain shielding was seen in Gruen zones 7, 6, 5, 3 and 2 after the insertion of the anatomical stem compared with the customised stem. For the anatomical stem, the hoop strains on the femur also indicated that the load was transferred to the cortical bone at the lower metaphyseal or upper diaphyseal part of the proximal femur.

The customised stem induced a strain pattern more similar to that of the intact femur than the standard, anatomical stem.
A common reference frame for describing rotation of the distal femur
Authors: Victor J. , Van Doninck D. , Labey L. , Van Glabbeek F. , Parizel P. , Bellemans J.
Published: April 2009

The understanding of rotational alignment of the distal femur is essential in total knee replacement to ensure that there is correct placement of the femoral component. Many reference axes have been described, but there is still disagreement about their value and mutual angular relationship. Our aim was to validate a geometrically-defined reference axis against which the surface-derived axes could be compared in the axial plane. A total of 12 cadaver specimens underwent CT after rigid fixation of optical tracking devices to the femur and the tibia. Three-dimensional reconstructions were made to determine the anatomical surface points and geometrical references. The spatial relationships between the femur and tibia in full extension and in 90° of flexion were examined by an optical infrared tracking system.

After co-ordinate transformation of the described anatomical points and geometrical references, the projection of the relevant axes in the axial plane of the femur were mathematically achieved. Inter- and intra-observer variability in the three-dimensional CT reconstructions revealed angular errors ranging from 0.16° to 1.15° for all axes except for the trochlear axis which had an interobserver error of 2°. With the knees in full extension, the femoral transverse axis, connecting the centres of the best matching spheres of the femoral condyles, almost coincided with the tibial transverse axis (mean difference −0.8°, sd 2.05). At 90° of flexion, this femoral transverse axis was orthogonal to the tibial mechanical axis (mean difference −0.77°, sd 4.08). Of all the surface-derived axes, the surgical transepicondylar axis had the closest relationship to the femoral transverse axis after projection on to the axial plane of the femur (mean difference 0.21°, sd 1.77). The posterior condylar line was the most consistent axis (range −2.96° to −0.28°, sd 0.77) and the trochlear anteroposterior axis the least consistent axis (range −10.62° to +11.67°, sd 6.12). The orientation of both the posterior condylar line and the trochlear anteroposterior axis (p = 0.001) showed a trend towards internal rotation with valgus coronal alignment.
Articular cartilage tissue engineering
Authors: Getgood A. , Brooks R. , Fortier L. , Rushton N.
Published: April 2009

Articular cartilage repair remains a challenge to surgeons and basic scientists. The field of tissue engineering allows the simultaneous use of material scaffolds, cells and signalling molecules to attempt to modulate the regenerative tissue. This review summarises the research that has been undertaken to date using this approach, with a particular emphasis on those techniques that have been introduced into clinical practice, via in vitro and preclinical studies.
Experimental results of combining bisphosphonates with allograft in a rat model
Authors: Agholme F. , Aspenberg P.
Published: April 2009

Soaking bone grafts in a bisphosphonate solution before implantation can prevent their resorption and increase the local bone density in rats and humans. However, recent studies suggest that pre-treatment of allografts with bisphosphonate can prevent bone ingrowth into impaction grafts. We tested the hypothesis that excessive amounts of bisphosphonate would also cause a negative response in less dense grafts. We used a model where non-impacted metaphyseal bone grafts were randomised into three groups with either no bisphosphonate, alendronate followed by rinsing, and alendronate without subsequent rinsing, and inserted into bone chambers in rats. The specimens were evaluated histologically at one week, and by histomorphometry and radiology at four weeks. At four weeks, both bisphosphonate groups showed an increase in the total bone content, increased newly formed bone, and higher radiodensity than the controls. In spite of being implanted in a chamber with a limited opportunity to diffuse, even an excessive amount of bisphosphonate improved the outcome. We suggest that the negative results seen by others could be due to the combination of densely compacted bone and a bisphosphonate.

We suggest that bisphosphonates are likely to have a negative influence where resorption is a prerequisite to create space for new bone ingrowth.
Nerve reconstruction in patients with obstetric brachial plexus injury results in worsening of glenohumeral deformity
Authors: Nath R. K. , Liu X.
Published: April 2009

Whereas a general trend in the management of obstetric brachial plexus injuries has been nerve reconstruction in patients without spontaneous recovery of biceps function by three to six months of age, many recent studies suggest this may be unnecessary. In this study, the severity of glenohumeral dysplasia and shoulder function and strength in two groups of matched patients with a C5-6 lesion at a mean age of seven years (2.7 to 13.3) were investigated. One group (23 patients) underwent nerve reconstruction and secondary operations, and the other (52 patients) underwent only secondary operations for similar initial clinical presentations. In the patients with nerve reconstruction shoulder function did not improve and they developed more severe shoulder deformities (posterior subluxation, glenoid version and scapular elevation) and required a mean of 2.4 times as many operations as patients without nerve reconstruction.

This study suggests that less invasive management, addressing the muscle and bone complications, is a more effective approach. Nerve reconstruction should be reserved for those less common cases where the C5 and C6 nerve roots will not recover.
Intra-articular injection versus portal infiltration of 0.5% bupivacaine following arthroscopy of the knee
Authors: Townshend D. , Emmerson K. , Jones S. , Partington P. , Muller S.
Published: April 2009

The administration of intra-articular local anaesthetic is common following arthroscopy of the knee. However, recent evidence has suggested that bupivacaine may be harmful to articular cartilage. This study aimed to establish whether infiltration of bupivacaine around the portals is as effective as intra-articular injection.

We randomised 137 patients to receive either 20 ml 0.5% bupivacaine introduced into the joint (group 1) or 20 ml 0.5% bupivacaine infiltrated only around the portals (group 2) following arthroscopy. A visual analogue scale was administered one hour post-operatively to assess pain relief. Both patients and observers were blinded to the treatment group. A power calculation was performed.

The mean visual analogue score was 3.24 (sd 2.20) in group I and 3.04 (sd 2.31) in group 2. This difference was not statistically significant (p = 0.62).

Infiltration of bupivacaine around the portals had an equivalent effect on pain scores at one hour, and we would therefore recommend this technique to avoid the possible chondrotoxic effect of intra-articular bupivacaine.
Calcaneogenesis
Authors: Brinker M. R. , Loncarich D. P. , Melissinos E. G. , O’Connor D. P.
Published: April 2009

We report a case in which Ilizarov distraction osteogenesis was used to lengthen the portion of calcaneum that remained after a radical debridement for osteomyelitis. The patient was able to walk normally in unmodified shoes at the end of his treatment.
The incidence of fatal pulmonary embolism after primary hip and knee replacement in a consecutive series of 4253 patients
Authors: Cusick L. A. , Beverland D. E.
Published: April 2009

We studied 4253 patients undergoing primary joint replacement between November 2002 and November 2007, of whom 4060 received aspirin only as chemical prophylaxis; 46 were mistakenly given low molecular weight heparin initially, which was stopped and changed to aspirin; 136 received no chemoprophylaxis and 11 patients received warfarin because of a previous history of pulmonary embolism. We identified the rate of clinical thromboembolism before and after discharge, and the mortality from pulmonary embolism at 90 days. The overall death rate was 0.31% (13 of 4253) and the rate of fatal pulmonary embolism was 0.07% (3 of 4253).

Our data suggest that fatal pulmonary embolism is not common following elective primary joint replacement, and with modern surgical practice elective hip and knee replacement should no longer be considered high-risk procedures.
Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement
Authors: Allen D. , Beaulé P. E. , Ramadan O. , Doucette S.
Published: April 2009

Femoroacetabular impingement is a cause of hip pain in adults and is potentially a precursor of osteoarthritis. Our aim in this study was to determine the prevalence of bilateral deformity in patients with symptomatic cam-type femoroacetabular impingement as well as the presence of associated acetabular abnormalities and hip pain. We included all patients aged 55 years or less seen by the senior author for hip pain, with at least one anteroposterior and lateral pelvic radiograph available. All patients with dysplasia and/or arthritis were excluded. A total of 113 patients with a symptomatic cam-impingement deformity of at least one hip was evaluated. There were 82 men and 31 women with a mean age of 37.9 years (16 to 55).

Bilateral cam-type deformity was present in 88 patients (77.8%) while only 23 of those (26.1%) had bilateral hip pain. Painful hips had a statistically significant higher mean alpha angle than asymptomatic hips (69.9° vs 63.1°, p < 0.001). Hips with an alpha angle of more than 60° had an odds ratio of being painful of 2.59 (95% confidence interval 1.32 to 5.08, p = 0.006) compared with those with an alpha angle of less than 60°. Of the 201 hips with a cam-impingement deformity 42% (84) also had a pincer deformity.

Most patients with cam-type femoroacetabular impingement had bilateral deformities and there was an associated acetabular deformity in 84 of 201 patients (42%). This information is important in order to define the natural history of these deformities, and to determine treatment.
Neonatal foot deformities and their relationship to developmental dysplasia of the hip
Authors: Paton R. W. , Choudry Q.
Published: April 2009

In a prospective study over 11 years we assessed the relationship between neonatal deformities of the foot and the presence of ultrasonographic developmental dysplasia of the hip (DDH). Between 1 January 1996 and 31 December 2006, 614 infants with deformities of the foot were referred for clinical and ultrasonographic evaluation. There were 436 cases of postural talipes equinovarus deformity (TEV), 60 of fixed congenital talipes equinovarus (CTEV), 93 of congenital talipes calcaneovalgus (CTCV) and 25 of metatarsus adductus.

The overall risk of ultrasonographic dysplasia or instability was 1:27 in postural TEV, 1:8.6 in CTEV, 1:5.2 in CTCV and 1:25 in metatarsus adductus.

The risk of type-IV instability of the hip or irreducible dislocation was 1:436 (0.2%) in postural TEV, 1:15.4 (6.5%) in CTCV and 1:25 (4%) in metatarsus adductus. There were no cases of hip instability (type IV) or of irreducible dislocation in the CTEV group.

Routine screening for DDH in cases of postural TEV and CTEV is no longer advocated. The former is poorly defined, leading to the over-diagnosis of a possibly spurious condition. Ultrasonographic imaging and surveillance of hips in infants with CTCV and possibly those with metatarsus adductus should continue.
Delayed operative management of fractures of the scapula
Authors: Herrera D. A. , Anavian J. , Tarkin I. S. , Armitage B. A. , Schroder L. K. , Cole P. A.
Published: April 2009

Between 1998 and 2007, 22 patients with fractures of the scapula had operative treatment more than three weeks after injury. The indications for operation included displaced intra-articular fractures, medialisation of the glenohumeral joint, angular deformity, or displaced double lesions of the superior shoulder suspensory complex.

Radiological and functional outcomes were obtained for 16 of 22 patients. Disabilities of the Arm, Shoulder, Hand (DASH) and Short form-36 scores were collected for 14 patients who were operated on after March 2002. The mean delay from injury to surgery was 30 days (21 to 57). The mean follow-up was for 27 months (12 to 72). At the last review the mean DASH score was 14 (0 to 41). Of the 16 patients with follow-up, 13 returned to their previous employment and recreational activities without restrictions. No wound complications, infection or nonunion occurred.

Malunion of the scapula can be prevented by surgical treatment of fractures in patients with delayed presentation. Surgery is safe, effective, and gives acceptable functional results.
Outcome after primary and secondary replacement for subcapital fracture of the hip in 10 264 patients
Authors: Leonardsson O. , Rogmark C. , Kärrholm J. , åkesson K. , Garellick G.
Published: April 2009

Between 1999 and 2005, 10 264 patients who had undergone total hip replacement (THR) for subcapital fracture of the hip were compared with 76 520 in whom THR had been performed for other reasons. All the cases were identified through the Swedish Hip Arthroplasty Register. The THRs performed as primary treatment for fracture were also compared with those done after failure of internal fixation.

After seven years the rate of revision was higher in THR after fracture (4.4% vs 2.9%). Dislocation and periprosthetic fracture were the most common causes of revision. The risk was higher in men than in women. The type of femoral component and the surgical approach influenced the risk. After correction for gender, type of component and the surgical approach the revision rates were similar in the primary and secondary fracture THR groups.

Total hip replacement is therefore a safe method for both the primary and secondary management of fracture of the hip.
Unsuccessful Article 14 Submissions to the Specialist Register for Trauma and Orthopaedic Surgery
Authors: Gray J , Arnander M , Ricketts D
Published: April 2009

It is a legal requirement that all NHS consultants have their names entered on the General Medical Council (GMC)'s specialist register. Entry to the register can be obtained by two routes. The first is to obtain a Certificate of Completion of Training (CCT) in a recognised specialty training programme approved by the Postgraduate Medical Education and Training Board (PMETB). The second is by obtaining a Certificate of Eligibility for Specialist Registration (CESR) by the article 14 process.
Oral surgery – an assured future
Authors: McArdle Louis
Published: April 2009

Oral and maxillofacial surgery (OMFS) has undergone a major transformation over the last two decades. This has resulted in the redefining of OMFS as a medical specialty and the categorisation of oral surgery as a dental specialty. Oral surgery includes dentoalveolar surgery, orthodontic surgery, intraoral soft tissue surgery, management of diseases of the jaws and oral implantology. OMFS also includes these areas of practice but has tended to focus on the management of more complex conditions such as orofacial malignancy and cleft-lip and palate surgery. Salivary gland disease, orthognathic surgery and facial trauma, although within the remit of OMFS, also fall within the extended competencies of the oral surgery curriculum and as such, will be part of the practice of some oral surgeons.
TAIP from the Trainer's Perspective
Authors: Cheng Leo
Published: April 2009

The two-day theoretical and interactive Training and Assessment in Practice (TAIP) course is organised by The Royal College of Surgeons of England. It aims to equip trainers with new assessment tools that allow standardisation of assessing trainees' performance in the workplace and early identification of failing trainees. This new work-based system became essential with the reality of Modernising Medical Careers and the European Working Time Directive. The course convenor is an experienced education and training consultant, Hayley Allan, and she has a team of enthusiastic consultant surgeons, including Stella Vig.
Commissioning surgical services
Authors: Abrams Paul
Published: April 2009

The College has been working with the strategic health authorities (SHAs) in the West Midlands and the South West to foster a collaborative approach to commissioning and improving the quality of local surgical services. This is being driven by the new College directors for professional affairs (DPAs) who are actively engaging with primary care trusts (PCTs) and commissioners by hosting strategic joint College–SHA meetings to present the evidence base for reconfiguring local surgical services. This report describes a recent meeting in Taunton.
Developing an e-portfolio
Authors: Steel Claire , Towell Elaine
Published: April 2009

Revalidation is going to require surgeons to produce large amounts of varied information. All surgeons will have to show that they are still fit to practise. The College has been working to minimise the extra information surgeons need to collect and this is reflected in the standards we are drafting. But the revalidation process must be robust and must be seen to be robust. Therefore, if asked, surgeons need to provide information that shows they are working to or above the expected standards. Experience of current consultant appraisals (and revalidation will be based on an enhanced form of appraisal) shows that surgeons produce large bundles of paper that are difficult to analyse and discuss. It is for this reason that the College is developing a comprehensive personal e-portfolio for fellows and members.
Rhetoric or reality? Cross-sector policy implementation at the UK governmen Department for International Development
Authors: Bovill Catherine
Published: April 2009

International development discourse emphasises collaboration, partnerships and crosssectoral approaches, but to what extent is cross-sector policy implemented in practice? This article presents findings from research into cross-sector policy implementation at the Department for International Development (DFID) in the UK and Nepal. Discussion focuses on examining and explaining the contradictory nature of the data gathered and a possible model of cross-sectoral engagement is presented in response to the findings. In conclusion, DFID was found to have made some significant attempts to implement cross-sectoral policies but, for a number of reasons, DFID's cross-sector policies have not been fully implemented.
Temporal perspective and parental intention to accept the human papillomavirus vaccination for their daughter
Authors: Morison Linda A. , Cozzolino Philip J. , Orbell Sheina
Published: April 2009

Objective

A school‐based vaccination programme to prevent infection with the human papillomavirus (HPV), the virus that causes cervical cancer, began in October 2008 in England. The present study evaluated the role of temporal perspective in the formation of attitudes and intentions towards the vaccine.

Design

A cross‐sectional correlational survey of 245 parents of 11–12‐year‐old girls.

Methods

Parents read a passage about the HPV vaccine containing information about benefits and concerns parents might have about the vaccine. They then completed a thought listing task and measures of attitude, vaccine efficacy, anticipated regret, intention, and consideration of future consequences.

Results

Parents with higher consideration of future consequences generated more positive relative to negative thoughts, held more positive attitudes, higher response efficacy, reported higher anticipated regret about not vaccinating their daughters and held more positive intentions. Mediation analyses suggested that the influence of thoughts generated on intention to vaccinate was partially mediated by attitude, perceived vaccine efficacy, and anticipated regret if the vaccine were not taken up.

Conclusion

Messages emphasizing efficacy of vaccination and anticipated regret are likely to promote vaccination uptake.
Hepcidin as a Predictor of Response to Epoetin Therapy in Anemic Cancer Patients
Authors: Ukarma Lidia , Johannes Hélène , Beyer Ulrich , Zaug Michel , Osterwalder Bruno , Scherhag Armin
Published: April 2009

Background: Hepcidin is thought to be the central regulator of iron metabolism. Iron deficiency is associated with low hepcidin concentrations, and anemia in patients with cancer is associated with high concentrations of hepcidin.

Study objectives: Our main objective was to assess the potential role of hepcidin for predicting response to epoetin therapy in anemic cancer patients. We also aimed to identify a cutoff value for hepcidin as a potential predictive marker for response to epoetin therapy.

Methods: Using data from 525 anemic cancer patients enrolled in 5 studies, we assessed serum hepcidin concentrations in 408 of these patients at baseline and analyzed pooled data from the 408 patients. The analysis population was separated into 2 categories using a threshold hepcidin concentration of 13 nmol/L: low hepcidin (<13 nmol/L) and high hepcidin (≥13 nmol/L).

Results: A significantly higher percentage of responders (defined as hemoglobin increase ≥10 g/L or ≥20 g/L from baseline) was observed in the low hepcidin group compared with the high hepcidin group (P = 0.04 for ≥10 g/L increase and P = 0.009 for ≥20 g/L from baseline). There was also a statistically significant difference between the 2 groups for hematopoietic response (hemoglobin rise at least once ≥20 g/L from baseline or at least once ≥120 g/L) to epoetin therapy (P = 0.0004).

Conclusions: The results of this analysis suggest a potential role of hepcidin serum concentrations in predicting the response to epoetin therapy.
Book Reviews
Authors: Blakeley Georgina , Menezes Alison Ribeiro de , Stephenson Paul
Published: April 2009

Making Spaniards. Primo de Rivera and the Nationalization of the Masses, 192330, Alejandro Quiroga (2007) Basingstoke: Palgrave Macmillan, 234 pp., ISBN-13 978-0-230-01968-3 (hbk), 45.00

The Spanish Civil War, Andy Durgan (2007) Houndmills and New York,
Palgrave Macmillan, xx + 156 pp., ISBN 9781403995162 (pbk), 14.99

The Impact of the Spanish Civil War on Britain War, Loss and Memory, Tom Buchanan (2007) Sussex Academic Press: Eastbourne, x + 267 pp., ISBN 1-84519-126-9 (hbk), 49.95; ISBN 1-84519-127-7 (pbk), 16.95
AβPP/APLP2 Family of Kunitz Serine Proteinase Inhibitors Regulate Cerebral Thrombosis
Authors: Xu Feng , Previti Mary Lou , Nieman Marvin T. , Davis Judianne , Schmaier Alvin H. , Van Nostrand William E.
Published: April 2009

The amyloid β-protein precursor (AβPP) is best recognized as the precursor to the Aβ peptide that accumulates in the brains of patients with Alzheimer's disease, but less is known about its physiological functions. Isoforms of AβPP that contain a Kunitz-type serine proteinase inhibitor (KPI) domain are expressed in brain and, outside the CNS, in circulating blood platelets. Recently, we showed that KPI-containing forms of AβPP regulates cerebral thrombosisin vivo(Xu et al., 2005, 2007). Amyloid precursor like protein-2 (APLP2), a closely related homolog to AβPP, also possesses a highly conserved KPI domain. Virtually nothing is known of its function. Here, we show that APLP2 also regulates cerebral thrombosis risk. Recombinant purified KPI domains of AβPP and APLP2 both inhibit the plasma clottingin vitro. In a carotid artery thrombosis model, both AβPP−/−and APLP2−/−mice exhibit similar significantly shorter times to vessel occlusion compared with wild-type mice indicating a prothrombotic phenotype. Similarly, in an experimental model of intracerebral hemorrhage, both AβPP−/−and APLP2−/−mice produce significantly smaller hematomas with reduced brain hemoglobin content compared with wild-type mice. Together, these results indicate that AβPP and APLP2 share overlapping anticoagulant functions with regard to regulating thrombosis after cerebral vascular injury.
α9 Integrin Promotes Neurite Outgrowth on Tenascin-C and Enhances Sensory Axon Regeneration
Authors: Andrews Melissa R. , Czvitkovich Stefan , Dassie Elisa , Vogelaar Christina F. , Faissner Andreas , Blits Bas , Gage Fred H. , ffrench-Constant Charles , Fawcett James W.
Published: April 2009

Damaged CNS axons are prevented from regenerating by an environment containing many inhibitory factors. They also lack an integrin that interacts with tenascin-C, the main extracellular matrix glycoprotein of the CNS, which is upregulated after injury. The α9β1 integrin heterodimer is a receptor for the nonalternatively spliced region of tenascin-C, but the α9 subunit is absent in adult neurons. In this study, we show that PC12 cells and adult rat dorsal root ganglion (DRG) neurons do not extend neurites on tenascin-C. However, after forced expression of α9 integrin, extensive neurite outgrowth from PC12 cells and adult rat DRG neurons occurs. Moreover, both DRG neurons and PC12 cells secrete tenascin-C, enabling α9-transfected cells to grow axons on tissue culture plastic. Using adeno-associated viruses to express α9 integrinin vivoin DRGs, we examined axonal regeneration after cervical dorsal rhizotomy or dorsal column crush in the adult rat. After rhizotomy, significantly more dorsal root axons regrew into the dorsal root entry zone at 6 weeks after injury in α9 integrin-expressing animals than in green fluorescent protein (GFP) controls. Similarly, after a dorsal column crush injury, there was significantly more axonal growth into the lesion site compared with GFP controls at 6 weeks after injury. Behavioral analysis after spinal cord injury revealed that both experimental and control groups had an increased withdrawal latency in response to mechanical stimulation when compared with sham controls; however, in response to heat stimulation, normal withdrawal latencies returned after α9 integrin treatment but remained elevated in control groups.