bluuebunny/crossref_metadata_2025 huggingface dataset:
A Classroom-Based Antecedent Intervention Reduces Obsessive-Repetitive Behavior in an Adolescent With Autism
Authors: Sigafoos Jeff , Green Vanessa A. , Payne Donna , O'Reilly Mark F. , Lancioni Giulio E.
Published: January 2009

Obsessive-repetitive behavior is a core feature of autism and represented the presenting complaint for Robert, a 15-year-old boy with autism. Robert's constant rearrangement of objects interfered with his participation in classroom activities, and this behavior was successfully reduced by providing structured opportunities to select and use preferred leisure activities. Provision of structured leisure opportunities could be conceptualized as an antecedent intervention that includes differential reinforcement of incompatible behavior. Although the treatment was generally successful, follow-up data indicated that long-term maintenance could be lacking. This treatment can be recommended given that it appears to be efficacious for applied settings, relatively benign, and easy to implement.
Differential Diagnoses and Treatment of Behavioral Disturbances Associated With Landau—Kleffner Syndrome The Case of T. R
Authors: Anderson Shawanda W. , Jackson Chauncey R.
Published: January 2009

This case report detailed the process of differential diagnosis and course of treatment for a 9-year-old male with Landau—Kleffner syndrome (LKS). He presented to a long-term inpatient psychiatric facility with primary complaints of physical aggression, property destruction, non-compliance, poor academic performance, and developmental regression. He had no history of seizures. Subsequent to several diagnoses and admits to the hospital, a neuropsychological evaluation was conducted. Findings revealed primary deficits in language (receptive and expressive). Observations during functional analysis indicated the possibility of seizure activity. EEG (electroencephalograph) confirmed this contention. The diagnosis of LKS was given and behavioral therapy was successfully used to extinguish the maladaptive behaviors associated with LKS. This complex case illustrated the necessity and utility of neuropsychological assessment, especially in cases where alternate diagnoses are feasible and also served as an informative case example of possible behavioral manifestations that can occur with LKS, and how to treat such.
The Value of Graded Exercise Testing in Today's World
Authors: Visich Paul S.
Published: January 2009

With the continued high prevalence of coronary artery disease in our country, the need for diagnostic testing for myocardial ischemia will continue to be a high priority. Many advances have been made in the field of diagnostic testing for myocardial ischemia, but the combination of graded exercise testing (GXT) with 12-lead electrocardiogram (with or without nuclear perfusion imaging or echocardiography) continues to be the initial noninvasive test most accepted in the medical field. However, it is imperative that the patient is able and willing to give a good physical effort to increase the sensitivity in detecting disease. In addition to using GXT for diagnostic purposes, the GXT is also beneficial in respect to determining long-term prognosis, assessing therapeutic interventions, and assessing one's functional capacity for the purpose of determining appropriate and safe exercise training.
SHIP prevents lipopolysaccharide from triggering an antiviral response in mice
Authors: Sly Laura M. , Hamilton Melisa J. , Kuroda Etsushi , Ho Victor W. , Antignano Frann L. , Omeis Stephanie L. , van Netten-Thomas Christina J. , Wong Dana , Brugger Hayley K. , Williams Olusegun , Feldman Morris E. , Houseman Benjamin T. , Fiedler Dorothea , Shokat Kevan M. , Krystal Gerald
Published: January 2009

Gram-negative bacterial infections, unlike viral infections, do not typically protect against subsequent viral infections. This is puzzling given that lipopolysaccharide (LPS) and double-stranded (ds) RNA both activate the TIR domain–containing adaptor-inducing interferon β (TRIF) pathway and, thus, are both capable of eliciting an antiviral response by stimulating type I interferon (IFN) production. We demonstrate herein that SH2-containing inositol-5′-phosphatase (SHIP) protein levels are dramatically increased in murine macrophages via the MyD88-dependent pathway, by up-regulating autocrine-acting transforming growth factor-β (TGFβ). The increased SHIP then mediates, via inhibition of the phosphatidylinositol-3-kinase (PI3K) pathway, cytosine-phosphate-guanosine (CPG)– and LPS-induced tolerance and cross-tolerance and restrains IFN-β production induced by a subsequent exposure to LPS or dsRNA. Intriguingly, we found, using isoform-specific PI3K inhibitors, that LPS- or cytosine-phosphate-guanosine-induced interleukin-6 (IL-6) is positively regulated by p110α, -γ, and -δ but negatively regulated by p110β. This may explain some of the controversy concerning the role of PI3K in Toll-like receptor–induced cytokine production. Consistent with our in vitro findings, SHIP−/− mice overproduce IFN-β in response to LPS, and this leads to antiviral hypothermia. Thus, up-regulation of SHIP in response to Gram-negative bacterial infections probably explains the inability of such infections to protect against subsequent viral infections.
CXCR4 inhibitor AMD3100 disrupts the interaction of multiple myeloma cells with the bone marrow microenvironment and enhances their sensitivity to therapy
Authors: Azab Abdel Kareem , Runnels Judith M. , Pitsillides Costas , Moreau Anne-Sophie , Azab Feda , Leleu Xavier , Jia Xiaoying , Wright Renee , Ospina Beatriz , Carlson Alicia L. , Alt Clemens , Burwick Nicholas , Roccaro Aldo M. , Ngo Hai T. , Farag Mena , Melhem Molly R. , Sacco Antonio , Munshi Nikhil C. , Hideshima Teru , Rollins Barrett J. , Anderson Kenneth C. , Kung Andrew L. , Lin Charles P. , Ghobrial Irene M.
Published: January 2009

The interaction of multiple myeloma (MM) cells with their microenvironment in the bone marrow (BM) provides a protective environment and resistance to therapeutic agents. We hypothesized that disruption of the interaction of MM cells with their BM milieu would lead to their sensitization to therapeutic agents such as bortezomib, melphalan, doxorubicin, and dexamethasone. We report that the CXCR4 inhibitor AMD3100 induces disruption of the interaction of MM cells with the BM reflected by mobilization of MM cells into the circulation in vivo, with kinetics that differed from that of hematopoietic stem cells. AMD3100 enhanced sensitivity of MM cell to multiple therapeutic agents in vitro by disrupting adhesion of MM cells to bone marrow stromal cells (BMSCs). Moreover, AMD3100 increased mobilization of MM cells to the circulation in vivo, increased the ratio of apoptotic circulating MM cells, and enhanced the tumor reduction induced by bortezomib. Mechanistically, AMD3100 significantly inhibited Akt phosphorylation and enhanced poly(ADP-ribose) polymerase (PARP) cleavage as a result of bortezomib, in the presence of BMSCs in coculture. These experiments provide a proof of concept for the use of agents that disrupt interaction with the microenvironment for enhancement of efficacy of cytotoxic agents in cancer therapy.
Store-and-forward telemedicine for doctors working in remote areas
Authors: Bonnardot Laurent , Rainis Roberto
Published: January 2009

For doctors working in remote areas, access to medical specialists is crucial in order to provide patients with the best possible health care. Telemedicine is now widely used to obtain second opinions from consultants and is a mainstay of the organization of health care in Antarctica. Taking advantage of our extreme geographical isolation on a polar station, we tested the possibilities for obtaining specialist advice by telemedicine based on email. Two virtual case reports with one question each were sent to six correspondents: two non-governmental organizations (NGOs), two personal acquaintances and two institutions. Initial email replies were received between 13 hours and 7 days later. There were three kinds of reply: well argued and well adapted to our situation (one NGO); argued but not well adapted to our situation (one NGO, one acquaintance and one institution); and a short reply without argument (one acquaintance). Contacting personal acquaintances was not as reliable as we had expected. The best support was provided by one of the NGOs whose efficiency was based on the use of an automatic message-handling system and a team of specialists well trained in giving advice to isolated doctors. This NGO demonstrated how a store-and-forward telemedicine system can be efficient and reliable; the study also highlighted some limitations in other methods of obtaining specialist advice.
Clinical photography
Authors: Jakowenko Janelle
Published: January 2009

Digital cameras, when used correctly, can provide the basis for telemedicine services. The increasing sophistication of digital cameras, combined with the improved speed and availability of the Internet, make them an instrument that every health-care professional should be familiar with. Taking satisfactory images of patients requires clinical photography skills. Photographing charts, monitors, X-ray films and specimens also requires expertise. Image capture using digital cameras is often done with insufficient attention, which can lead to inaccurate study results. The procedures in clinical photography should not vary from camera to camera, or from country to country. Taking a photograph should be a standardised process. There are seven main scenarios in clinical photography and health professionals who use cameras should be familiar with all of them. Obtaining informed consent prior to photography should be a normal part of the clinical photography routine.
A framework for the design of user-centred teleconsulting systems
Authors: Esser Priscilla E , Goossens Richard HM
Published: January 2009

Telemedicine projects often fail to grow beyond the pilot phase of implementation. As well as the usual barriers such as reimbursement and legislation, user acceptance of telemedicine technologies is essential. From a design-perspective, it can be hypothesized that a user-centred design approach is missing in the development of telemedicine systems. We have mapped the underlying theoretical dimensions relevant to teleconsultations. An existing framework describing teleconsultations was used as the basis for the study. The perspectives that were taken to complement this framework were: (a) doctor–patient communication; (b) technology-mediated communication; and (c) technology acceptance. A literature search found 303, 42 and 409 articles in the three areas, respectively. Abstract assessment indicated 8, 5 and 6 papers for full text evaluation. Theoretical models were retrieved for each perspective and elements were clustered to form a new framework. The findings suggest the importance of instrumental and affective communication behaviours of participants in a teleconsultation. On the same level of importance are the perceptions formed by the participants on effectiveness, efficiency and ‘affectiveness’ of the telemedicine system. The framework has the potential to contribute to design methodology by providing a practical tool that can be used by design professionals to consider the user at every stage of the design process, even when the context is complex and unfamiliar to the designer.
Limitations in the routine use of telepsychiatry
Authors: Hailey David , Ohinmaa Arto , Roine Risto
Published: January 2009

Telepsychiatry is well established in many countries, but there is still little information about its use in routine health care. We reviewed the literature for information on the use of telepsychiatry in mental health services. From 1033 publications identified in the literature search and through references from a separate project, 16 studies or descriptions of the routine use of telepsychiatry services were selected for further review. Eleven of these articles dealt primarily with videoconferencing and five with telephone- based services. Clinical use of videoconferencing in the programmes described by the reviewed papers was modest, with an average of 16 consultations per month. Three of the telephone-based services had large numbers of clients. The papers we reviewed gave limited consideration to the healthcare systems in which telepsychiatry was provided and to the use of conventional mental health services. Telepsychiatry appears to still be a niche technology in many health systems. A lack of champions for the technology and reimbursement problems may contribute to the limited use of this area of telemedicine.
Videophones for intensive case management of psychiatric outpatients
Authors: Nieves J Edwin , Godleski Linda S , Stack Kathleen M , Zinanni Tracy
Published: January 2009

When visiting patients with serious mental illness at their homes, case managers carried a portable videophone. This was used to access the hospital clinical team via the home telephone line, when an acute clinical need arose in addressing questions related to medication management and treatment planning; travel was therefore avoided. In an acceptability study lasting 12 months, 24 patients received the supplemental videophone mental health service and 19 of them completed a satisfaction survey. Only one patient was not satisfied with the videophone treatment, while 74% of them were very satisfied. Specific areas of satisfaction concerned the savings of time and travel, assistance with medication questions and increased involvement in treatment. No patient reported any difficulty in using the equipment. Staff members were enthusiastic about the decrease in travel time and there were no complaints about the videophone process or encounters. During the study, 135 h of the case manager's time was saved by using the videophone for urgent access visits, equivalent to a saving of $4000 in salary costs. In addition, the patients saved 135 h in travel time. We believe that there are other potential uses of videophones for seriously mentally ill patients, including discharge planning, intensive post-discharge monitoring and transition to community life.
Economic evaluation of a store-and-forward teledermatology system for skin cancer patients
Authors: Moreno-Ramirez David , Ferrandiz Lara , Ruiz-de-Casas Andres , Nieto-Garcia Adoracion , Moreno-Alvarez Pedro , Galdeano Rafael , Camacho Francisco M
Published: January 2009

We conducted an economic analysis of a store-and-forward teledermatology system for the routine triage of skin cancer patients. A cost-identification, cost-effectiveness and sensitivity analysis under a societal perspective was used to compare teledermatology with the conventional care alternative. In the period March 2004 to July 2005, a total of 2009 teledermatology referrals were managed from 12 Primary Care Centres (PCCs) of the public health system. The unit cost was of €79.78 per patient in teledermatology, and €129.37 per patient in conventional care ( P < 0.005), with an incremental cost of €49.59 per patient in favour of teledermatology. The cost ratio between teledermatology and conventional care was 1.6. There was a significant inverse relation between the unit cost in each participating PCC and the number of teleconsultations transmitted from them ( P < 0.001). Teledermatology resulted in a more cost-effective, or dominant, methodology. In a public health system equipped with an intranet, the routine use of teledermatology in skin cancer clinics is a cost-effective method of managing referrals.
Protective Effect of Total Carotenoid and Lycopene Intake on the Risk of Hip Fracture: A 17-Year Follow-Up From the Framingham Osteoporosis Study
Authors: Sahni Shivani , Hannan Marian T , Blumberg Jeffrey , Cupples L Adrienne , Kiel Douglas P , Tucker Katherine L
Published: January 2009

In vitro and in vivo studies suggest that carotenoids may inhibit bone resorption, yet no previous study has examined individual carotenoid intake (other than β-carotene) and the risk of fracture. We evaluated associations of total and individual carotenoid intake (α-carotene, β-carotene, β-cryptoxanthin, lycopene, lutein + zeaxanthin) with incident hip fracture and nonvertebral osteoporotic fracture. Three hundred seventy men and 576 women (mean age, 75 ± 5 yr) from the Framingham Osteoporosis Study completed a food frequency questionnaire (FFQ) in 1988–1989 and were followed for hip fracture until 2005 and nonvertebral fracture until 2003. Tertiles of carotenoid intake were created from estimates obtained using the Willett FFQ adjusting for total energy (residual method). HRs were estimated using Cox-proportional hazards regression, adjusting for sex, age, body mass index, height, total energy, calcium and vitamin D intake, physical activity, alcohol, smoking, multivitamin use, and current estrogen use. A total of 100 hip fractures occurred over 17 yr of follow-up. Subjects in the highest tertile of total carotenoid intake had lower risk of hip fracture (p = 0.02). Subjects with higher lycopene intake had lower risk of hip fracture (p = 0.01) and nonvertebral fracture (p = 0.02). A weak protective trend was observed for total β-carotene for hip fracture alone, but associations did not reach statistical significance (p = 0.10). No significant associations were observed with α-carotene, β-cryptoxanthin, or lutein + zeaxanthin. These results suggest a protective role of several carotenoids for bone health in older adults.
Osmolarity and Intracellular Calcium Regulate Aquaporin2 Expression Through TonEBP in Nucleus Pulposus Cells of the Intervertebral Disc
Authors: Gajghate Sachin , Hiyama Akihiko , Shah Monica , Sakai Daisuke , Anderson D Greg , Shapiro Irving M , Risbud Makarand V
Published: January 2009

The goal of this study was to examine the expression and regulation of aquaporin2 (AQP2), a tonicity-sensitive water channel in nucleus pulposus cells of the intervertebral disc. We found that AQP2 protein was expressed in vivo in both rat and human discs. We determined whether AQP2 promoter expression was regulated by osmolarity in a tonicity enhancer binding protein (TonEBP)-dependent manner. When TonEBP was suppressed under hypertonic conditions or overexpressed under isotonic conditions, AQP2 promoter activity was correspondingly inhibited or induced. The role of TonEBP in controlling AQP2 expression was confirmed using mouse embryonic fibroblasts (MEFs) derived from TonEBP-null mice. We studied whether calcium in addition to osmolarity played a role in regulation of AQP2 in nucleus pulposus cells. We also determined whether both TonEBP and calcineurin–nuclear factor of activated T cells (NFAT) signaling contributed to ionomycin, a calcium ionophore, mediated induction of AQP2. Co-transfection of AQP2 reporter with calcineurin (CnA/B) and/or NFAT1–4 vectors suggested that this pathway did not control AQP2 promoter activity in nucleus pulposus cells. These findings were also validated using MEFs from TonEBP, fibroblasts from CnAα- and CnAβ-null mice, and mutant TonE reporter constructs. Results of these studies suggest that, in nucleus pulposus cells, osmotic pressure and calcium modulate AQP2 expression through TonEBP and are independent of the calcineurin–NFAT pathway. Because calcium flux reflects a change in applied stress, the possibility exists that NFAT5/TonEBP modulate not just water balance in the disc but also accommodate applied biomechanical forces.
Vitamin D and parathyroid hormone: a tool to determine assay specific cutoff values for vitamin D1
Authors: Thierfelder Wulf , Roth Heinz J. , Laussmann Detlef , Pientka Ludger , Schumacher Jochen , Schulz Jörg , Scheidt-Nave Christa
Published: January 2009

Abstract>

Vitamin D has been attributed a role in the pathogenesis of various chronic diseases. Vitamin D status is best assessed by measuring serum 25-hydroxyvitamin D(25[OH]D). Serum 25(OH)D concentrations far above the deficiency threshold for skeletal health may be suboptimal with respect to long-term health consequences. No final consensus has so far been reached regarding an appropriate cutoff value. Diagnostic work-up in the clinical setting as well as the interpretation of scientific evidence are hampered by a lack of standardization in 25(OH)D assays. The present study compares quantification of serum 25(OH)D by means of three different assays: an in-house high-performance liquid chromatograph (HPLC)-method, and two chemiluminescence immunoassays (CLI) from different manufacturers (DiaSorin, Nichols). In addition, serum intact parathyroid hormone (iPTH) was measured using two different methods (CLI, DiaSorin; electrochemiluminescence immunoassay [ECL], Roche). Based on the inverse relationship between vitamin D and PTH in the regulation of serum calcium, receiver operating characteristic (ROC) analyses were used to determine assay specific serum 25(OH)D cutoff values that distinguished at best between normal and elevated serum iPTH according to the manufacturers given reference ranges. Obtained cutoff values identified varied from 22.9 μg/L for the HPLC method to 19.5μg/L for the CLI (Nichols) and to 14.4 μg/L for the CLI (DiaSorin), respectively. While these values need to be considered as warning thresholds, they fall within published reference limits for the investigated 25(OH)D assays. Serum iPTH-based cutoff values for serum 25(OH)D are not apt to substitute for assay-specific reference limits for the various long-term adverse health outcomes that may be linked to vitamin D insufficiency.
Budd-Chiari syndrome and portal venous thrombosis – relevance of the JAK2 mutation as new risk marker1
Authors: Roskos Martin
Published: January 2009

Abstract>

A myeloproliferative disorder is the main risk factor for portal venous thrombosis or Budd-Chiari syndrome. Other significant factors are hereditary or acquired prothrombotic states and different liver diseases. Approximately 25% of thromboses occur without an indication of possible etiology. However, some patients show signs of myeloproliferative disorders on bone marrow morphology. The identification of the Janus kinase V617F mutation, which was first described in 2005, allows new insights into both the pathobiochemistry and pathophysiology of this disease, and a substantial improvement of the diagnostics at least to some of the myeloproliferative disorders. A retrospective study of clinical trials of patients with Budd-Chiari syndrome or portal venous thrombosis showed that patients with thrombosis predefined as idiopathic carried the V617F mutation at a high percentage rate and, furthermore, that a part of this patients group developed a myeloproliferative disorder after the thrombotic event.
Interleukin 6, procalcitonin and CRP levels during first increase of fever in intensive care patients1
Authors: Fraunberger Peter , Holler Ernst , Parhofer Klaus G. , Walli Autar K. , Seidel Dietrich
Published: January 2009

Serum levels of interleukin 6 (IL-6), procalcitonin (PCT), and C-reactive protein (CRP) were measured in 38 critically ill patients immediately after an increase in body temperature above 38.3°C. Ten healthy controls were also included for comparison. The onset of fever was accompanied by elevated circulating levels of all the 3 markers in comparison to healthy control subjects. However, only IL-6 levels were significantly higher (p<0.05) in nonsurvivors compared with survivors. Sensitivity, specificity, positive, and negative predictive values for survival were higher for IL-6 in comparison to levels of PCT and CRP. Areas under receiver characteristic operating curves revealed the highest area under the curve for IL-6 compared to PCT and CRP. These data suggest that IL-6 rather than PCT or CRP may be an early predictor of prognosis and mortality in patients with the onset of fever.
Treatment of Osteochondritis Dissecans of the Ankle with Hyaluronic Acid Injections: A Prospective Study
Authors: Mei-Dan Omer , Maoz Guy , Swartzon Michael , Onel Erol , Kish Beni , Nyska Meir , Mann Gideon
Published: January 2009

Background:

No studies have evaluated the efficacy of hyaluronic acid (HA) in reducing pain caused by osteochondritis dissecans (OCD) of the ankle. We report our initial results with this treatment.

Materials and Methods:

Fifteen subjects aged 18 to 60 treated for OCD of the talus were followed for 26 weeks, in a pre- and post-treatment repeated measurements design, after receiving three weekly injections of intra-articular HA. The efficacy of HA injections in reducing pain and improving function was assessed at each visit and adverse events were recorded. Efficacy was evaluated by comparing scores determined using a Visual Analog Scale for pain, stiffness and function over time with baseline values. In addition, frequency of symptoms and global function over time were assessed using questionnaires and the AOFAS Ankle-Hindfoot Scale. Data analysis was made using ANCOVA models and paired t-tests. All statistical tests were based on an alpha level of 0.05.

Results:

The majority of subjects were male (60%) and had Grade 3 lesions (60%). Mean VAS scores, reported on a scale from 1 (e.g., no pain) to 10 (e.g., worst pain) decreased for pain (5.6 to 3.2), stiffness (5.1 to 2.9), and function (5.9 to 3.3) from baseline to week 26. Subjective global function scores, reported on a scale from 0 to 100 (with 100 representing healthy, pre-injury function), improved on average from 57.3 at baseline to 74.3 by week 26. All of these results were statistically significant, as was the decrease in frequency of pain reported by subjects at the end of the study.

Conclusion:

OCD of the ankle treated with intra-articular injections of HA caused a decrease in pain scores and increase in global functioning over a short period of time (within 12 weeks) which then lasted for more than 6 months with minimal adverse events.
Functional Outcome after Surgical Reconstruction of Posterior Tibial Tendon Insufficiency in Patients under 50 Years
Authors: Tellisi Nazzar , Lobo M. , O'Malley Martin , Kennedy John G. , Elliott Andrew J. , Deland Jonathan T.
Published: January 2009

Background:

Procedures utilized to address the flatfoot in this study included medializing calcaneal osteotomy, posterior tibial tendon reconstruction with flexor digitorum longus tendon transfer, and in patients with more severe deformity, lateral column lengthening. We evaluated patients age 50 and less at the time of surgery, who underwent surgical reconstruction for Stage 2 posterior tibial tendon dysfunction. Pre- and postoperative activity levels were evaluated to assess the effect of surgical reconstruction in the younger patient.

Materials and Method:

Thirty-four feet in 30 patients (11 male, 19 female) with an average age of 41.2 (range, 17 to 50) years had surgery between 1997 and 2004. All feet were examined at an average followup of 44.5 (range, 24 to 65) months and were evaluated with the American-Orthopaedic-Foot and Ankle Society (AOFAS) Hindfoot-Score and SF-36 score.

Results:

The average preoperative AOFAS-Score was 53.1 ± 14.5 points and 83.2 ± 12.2 points at final postoperative followup. The mean improvement was 29.5. The difference between the preoperative and postoperative AOFAS score was significant ( p < 0.0001) using a two-tailed t-test. The difference in the AOFAS pain and alignment subscales was also significant ( p < 0.0001). The function subscale improvement was also significant ( p = 0.018). The mean physical function component of the postoperative SF-36 score was 79.2. A correlation was found between the SF-36 physical component score and the post operative AOFAS score ( r2 = 0.754).

Conclusion:

While some lateral discomfort or pain occurred in patients with or without a lateral column lengthening, the posterior tibial tendon reconstruction utilizing medial calcaneal displacement osteotomy with flexor digitorum longus transfer and a lateral column lengthening with more deformity was successful in the higher-functioning, younger patients.
Ankle Fractures in the Elderly: Initial and Long-Term Outcomes
Authors: Anderson Sarah A. , Li Xinning , Franklin Patricia , Wixted John J.
Published: January 2009

Background:

Surgical management of ankle fractures will be an increasing part of the orthopaedic practice for aging adults. To date, there are few studies comparing outcomes after ankle fracture surgery between patients over and under 65 years. The purpose of this study was to evaluate short- and long-term outcomes after surgical treatment of isolated malleolar fractures in both the elderly and non-elderly population.

Materials and Methods:

Charts and radiographs were reviewed for 25 patients over age 65 and 46 patients under age 65 who underwent operative treatment of an ankle fracture during a 2-year period. Postoperative complications and need for placement in a skilled nursing facility following discharge were noted. The SF-36 and the Olerud and Molander Ankle Score were completed. Mean duration of followup in patients greater than 65 was 27 months and 24 months for patients less than or equal to 65 years.

Results:

Patients over 65 had a higher number of postoperative complications (40% vs. 11%, p < 0.007), and required nursing home placement more frequently than patients under 65 ( p < 0.0001). At long-term followup, the data showed no significant difference in patient reported physical outcomes.

Conclusion:

Early postoperative outcomes after operative fixation of ankle fractures suggest significantly worse outcomes for patients over age 65. However, long-term function in the elderly was comparable to patients under age 65 in this sample. The elderly population had a significantly better mental composite score than the non-elderly.
Subtalar Distraction Arthrodesis through a Posterior Approach
Authors: DeOrio James K. , Leaseburg J. Thaddeus , Shapiro Shane A.
Published: January 2009

Background:

Subtalar arthrodesis is a common procedure for treating subtalar arthrosis. An isolated lateral incision can be used as an approach to subtalar fusion alone. However, it can be a difficult approach for correction of varus or valgus hindfoot deformities through the subtalar joint; especially if it involves distraction to correct calcaneal alignment. Less commonly, two-incision or single-incision medial approaches also have been described, but distraction and angular correction can still be difficult. We present an alternative method, using a posterior Achilles tendon-splitting procedure, that gives excellent subtalar exposure and the ability to obtain distraction with angular correction and bone grafting.

Materials and Methods:

Six consecutive patients underwent subtalar fusion with a posterior approach. Both varus and valgus deformities secondary to trauma, tendon insufficiency, or congenital deformities were corrected. Distraction was accomplished with laminar spreaders, and fixation was obtained with two 7.3-mm partially threaded cannulated screws. All patients were followed until fusion, and clinical and radiographic results were recorded. No other concomitant procedures were performed.

Results:

Fusion was observed radiographically in all patients by 3 months postoperatively. No serious wound complications occurred. Correction to slightly valgus alignment (for varus deformity) or neutral alignment (for valgus deformity) was obtained without collapse of autologous bone graft. Talocalcaneal height and all angular measurements were significantly increased (all p < 0.05).

Conclusion:

The posterior approach for distraction arthrodesis is an alternative to the standard lateral approach technique. It allows safe exposure with the ability to distract while also correcting varus or valgus deformity of the subtalar joint.
Primary Isolated Subtalar Arthrodesis: Outcome after 2 to 5 Years Followup
Authors: Diezi Christian , Favre Philippe , Vienne Patrick
Published: January 2009

Background:

Favorable to excellent clinical results have been reported for isolated subtalar joint arthrodesis. Pedobarography after subtalar bone-block distraction arthrodesis have demonstrated a more laterally shifted gait line. However pedobarographic measurements after primary in-situ isolated subtalar arthrodesis have not been reported. This is the first study considering this.

Materials and Methods:

Physical examination, AOFAS Hindfoot score, full weightbearing anterior/posterior and lateral radiographs were assessed in 15 feet. Peak pressures, ground reaction force and force distribution at foot-flat and push-off were measured.

Results:

Average AOFAS-Score significantly improved. Subjective satisfaction was high. Non-union was found in 1 foot (7%), screws were removed in 4 of the 15 feet (27%). One new asymptomatic arthritic talonavicular joint was found. The pressure and force distributions under the operated and contralateral foot showed a different pattern compared to a normal foot. Ground reaction force under both the operated and contralateral feet were lower than a normal foot.

Discussion:

This study found good clinical, subjective and radiographic results matching that of the reported literature. However, pedobarographic assessment suggests that great functional differences still remain when compared to a normal foot. Subtalar arthrodesis may induce an abnormal gait pattern by preventing compensation of axial rotation of the tibia. This is also reflected in the unaffected side, which may indicate an effort in the general locomotor control to keep a symmetrical gait pattern. This finally alters the pressure and force distribution under both feet. Nevertheless, subtalar arthrodesis is considered a valuable treatment for various isolated subtalar disorders.
Analysis of Modified Oblique Keller Procedure for Severe Hallux Rigidus
Authors: Akgun Rahmi Can , Sahin Orcun , Demirors Huseyin , Tuncay Ismail Cengiz
Published: January 2009

Background:

Several procedures have been described for treating hallux rigidus, but all have limitations. The purpose of this study is to evaluate the clinical and radiologic results of a modified oblique Keller procedure for treating hallux rigidus.

Materials and Methods:

Eleven patients (13 feet) with Grade III or IV hallux rigidus were treated by modified oblique Keller procedure. Average age was 64.7 years and followup was 27.2 months. Outcomes including range of motion (ROM) of first metatarsophalengeal joint, complications, American Orthopaedic Foot and Ankle Society (AOFAS) scores, satisfaction, osteophyte recurrence, osteonecrosis, and shortening were analyzed. Preoperative and postoperative values were statistically compared.

Results:

Mean preoperative and postoperative ROMs were 6.5 degrees and 51.9 degrees, respectively ( p < 0.005). Two feet had numbness on the dorsum of the first toe. Transfer metatarsalgia occurred in one patient. Mean preoperative and postoperative AOFAS scores were 29.1 points and 93.6 points, respectively ( p < 0.005). All patients had good or excellent results. There was no recurrence of the dorsal osteophyte. One patient had radiographic mottling of the first metatarsal head. Average preoperative and postoperative first toe length was 124.3 mm and 123.1 mm, respectively.

Conclusion:

This technique was a good treatment alternative for patients with end-stage hallux rigidus. It was a safe and reliable procedure that preserved range of motion and has good outcomes.
Equivalent Correction in Scarf and Chevron Osteotomy in Moderate and Severe Hallux Valgus: A Randomized Controlled Trial
Authors: Deenik Axel , van Mameren Henk , de Visser Enrico , de Waal Malefijt Maarten , Draijer Frits , de Bie Rob
Published: January 2009

Background:

Chevron osteotomy is a widely accepted osteotomy for correction of hallux valgus. 18 Algorithms were developed to overcome the limitations of distal osteotomies. Scarf osteotomy has become popular as a versatile procedure that should be able to correct most cases of acquired hallux valgus. The purpose of this study was to evaluate whether patients with moderate or severe hallux valgus have better correction with a scarf osteotomy as compared to chevron osteotomy.

Materials and Methods:

After informed consent, 136 feet in 115 patients were randomized to 66 scarf and 70 chevron osteotomies. Deformities of patients were classified as mild, moderate and severe according to IMA, and both groups were compared with independent t-tests. The results were measured using radiographic HVA, IMA and DMAA measurements.

Results:

There were no statistical differences in HVA, IMA and DMAA between scarf and chevron osteotomy in mild to moderate hallux valgus. In severe hallux valgus, chevron osteotomy corrected HVA better than scarf osteotomy, although this group consisted of twelve patients only. Five patients in the chevron group and seven in the scarf group developed recurrent subluxation of the metatarsophalangeal joint.

Conclusion:

In patients with moderate and severe hallux valgus, the results of chevron osteotomy were at least as effective as a scarf osteotomy. Recurrent subluxation of the first metatatarsophalangeal joint was the main cause for insufficient correction. We favor the chevron osteotomy because it is less invasive, without sacrificing correction of HVA and IMA.
A New Option for Intramedullary Fixation of Jones Fractures: The Charlotte™ Carolina™ Jones Fracture System
Authors: Nunley James A. , Glisson Richard R.
Published: January 2009

Background:

A number of different screws are used for Jones fracture fixation in cases in which hastened healing is desirable or nonoperative treatment has failed. None of them were designed for this application, and consequently there is a lack of continuity in screw configuration and sizing that can force the use of a screw that is not optimally size-matched to the metatarsal. This can be particularly problematic in high-demand patients such as athletes, in whom screw fixation failure is more likely to occur. Application-specific screws available in graduated sizes are now an option. This study was designed to compare the bending fatigue resistance of the new screws with that of clinically-proven contemporary Jones fracture fixation screws. The results may provide a basis for judging the probability of successful screw performance relative to the other established screw options.

Materials and Methods:

Bending fatigue resistance of the smallest-diameter Wright Medical Technologies Charlotte™ Carolina™ screw was compared to that of three commonly used contemporary screws. Cyclic three-point bending was applied to the screw shafts for 2,000,000 cycles or until 5 mm of deflection occurred. Four to six samples of each screw were tested.

Results:

The number of load cycles withstood by the new screws greatly exceeded the number of cycles tolerated by Acutrak 4/5 screws, Synthes 4.5-mm malleolar screws, and Synthes 4.5 mm cannulated screws.

Conclusion:

The fatigue resistance of the smallest-diameter Charlotte™ Carolina™ screw exceeds that of other contemporary screws known to possess sufficient strength for Jones fracture fixation.

Clinical Relevance:

It is likely that this system of graduated-size screws may be implemented for treatment of acute Jones fractures without concern for device failure. Patients may benefit from more accurate matching of the screw size to the fractured metatarsal
Cross-Cultural Adaptation and Validation of the Foot Function Index for Use in German-Speaking Patients with Foot Complaints
Authors: Naal Florian D. , Impellizzeri Franco M. , Huber Martin , Rippstein Pascal F.
Published: January 2009

Background:

The purpose of this study was to cross-culturally adapt the Foot Function Index (FFI) for use in German-speaking patients with foot complaints.

Materials and Methods:

The FFI was adapted for the German language according to the recommended forward/backward translation protocol. The following metric properties were assessed in 53 consecutive patients (mean age, 57.2 years; 39 women) undergoing foot surgery at our department: feasibility, reliability (intraclass correlation coefficient ICC), internal consistency (Cronbach's alpha, CA), and construct validity (correlation with the Short Form (SF-36), a VAS assessing pain, a VAS assessing function, and the University of California at Los Angeles (UCLA) activity scale.

Results:

The German FFI (FFI-D) comprised 18 items separated into a pain and a disability subscale. Completion of the FFI-D was feasible. The reliability and the internal consistency were both excellent with an ICC of 0.98 and a CA of 0.97 for the total score. We found moderate to high correlations between the FFI-D and the physical related SF-36 domains ( r = −;0.43 to −;0.80), the VAS pain ( r = 0.81), the VAS function ( r = 0.77), and the UCLA ( r = −0.52). Correlation coefficients between the FFI-D and the mental health related SF-36 domains were significantly lower ( r = −0.08 to −0.32; p < 0.01), indicating divergent validity.

Conclusion:

The German version of the FFI is a reliable and valid questionnaire for the self-assessment of pain and disability in German-speaking patients with foot complaints.
Percutaneous Stabilization of Traumatic Peroneal Tendon Dislocation
Authors: Summers Hobie , Kramer Patricia Ann , Benirschke Stephen K.
Published: January 2009

Level of Evidence: V, Expert Opinion
Gastrocnemius Apneourosis Recession: A Modified Technique
Authors: Tellisi Nazzar , Elliott Andrew J.
Published: January 2009

Level of Evidence: V, Expert Opinion
Computer Assisted Surgery (CAS) Guided Arthrodesis of the Foot and Ankle: An Analysis of Accuracy in 100 Cases
Authors: Richter Martinus , Zech Stefan
Published: January 2009

Background:

Computer Assisted Surgery (CAS) has shown the potential to increase the accuracy of surgical procedures in different fields of orthopedic surgery. The clinical experiences of 100 cases with CAS guided arthrodeses were evaluated.

Materials and Methods:

Two navigation systems were used (VectorVision/Navivision, Brainlab). Patients with unilateral foot and/or ankle correction arthrodesis from January 1st, 2005 to March 31st, 2008 were included. The correction was planned on the basis of clinical findings, radiographs and computer tomography. Time spent, accuracy, and problems that occurred with CAS guidance were analyzed. The accuracy was assessed by intraoperative three-dimensional imaging with ISO-C 3D or ARCADIS-3D (Siemens). The deviation from the achieved correction in comparison with the planned correction was analyzed.

Results:

One hundred patients were included (ankle, n = 19; subtalar, n = 23; ankle and subtalar, n = 12; midfoot/tarsometatarsal (TMT), n = 28, others, n = 18). The average time needed for preparation was 356 seconds (5 minutes, 56 seconds) (range, 4 to 30 minutes), the correction took an average of 28 (range, 12 to 140) seconds. The CAS system encountered malfunctions in 3 procedures (3%). In the remaining cases, all the achieved corrections were within a maximum deviation of 2 degrees/mm when compared to the planned correction ( p < 0.05).

Conclusion:

With CAS guidance for the correction of deformities of the foot and ankle, a surgeon can achieve a high degree of accuracy with a rapid correction. The high accuracy may lead to improved clinical outcomes. Level of Evidence: IV, Retrospective Case Series
3D Imaging (ARCADIS)-Based Computer Assisted Surgery (CAS) Guided Retrograde Drilling in Osteochondritis Dissecans of the Talus
Authors: Richter Martinus , Zech Stefan
Published: January 2009

Level of Evidence: V, Expert Opinion
3D Imaging (ARCADIS)-Based Computer Assisted Surgery (CAS) for Nail Placement in Combined Ankle and Subtalar Fusion
Authors: Richter Martinus , Zech Stefan , Bay Raymund
Published: January 2009

Level of Evidence: V, Expert Opinion
Treatment of Macrodactyly in the Adult Foot: A Case Report
Authors: Ahn Jae-Hoon , Choy Won-Sik , Kim Ha-Yong , Lee Sang-Ki , Lee Seung-Hun
Published: January 2009

Level of Evidence: V, Case Report
Anatomic Reconstruction of a Chronically Unstable Calcaneocuboid Joint with Augmented Extensor Digitorum Brevis Muscle Flap: A New Method
Authors: Hirschmann Michael T. , Friederich Niklaus F. , Müller Claude
Published: January 2009

Level of Evidence: V, Expert Opinion
Trends in Percutaneous Coronary Interventions in New South Wales, Australia
Authors: Weerasinghe Daminda P. , Yusuf Farhat , Parr Nicholas J.
Published: January 2009

This is the first detailed study on percutaneous coronary intervention (PCI) in New South Wales (NSW), Australia. Hospital data for PCIs carried out between 1 July 1990 and 30 June 2002 are analysed. The study explores trends in PCI rates by selected socio-demographic factors, the utilisation of angioplasties vis-a-vis stents, emergency admissions, and selected coexisting conditions which determine the disease status of PCI patients. Logistic regression models are used to study the medical conditions that require both PCI and coronary artery bypass graft (CABG). The PCI rate has grown rapidly at 12.1% per annum, with a particularly rapid increase for persons aged 75+. The rate of multiple stent utilisation increased at 4.6% per annum. Pacific-born and Middle-Eastern-born patients are more than twice as likely as the Australian-born to have diabetes. Factors affecting failure of PCI requiring CABG include perforation and multi-vessel disease. PCI services in public hospitals need to be increased to facilitate the availability of these procedures to all segments of the population, as do targeted community-level programmes to educate high-risk groups in the control of heart diseases.
Determination of Mineral Content in Methanolic Safflower (Carthamus tinctorius L.) Seed Extract and Its Effect on Osteoblast Markers
Authors: Lee Young Seok , Choi Chang Won , Kim Jae Jin , Ganapathi Andy , Udayakumar Rajangam , Kim Sei Chang
Published: January 2009

Safflower (Carthamus tinctorius L.) seeds are used as a folk medicine to enhance bone formation or to prevent osteoporosis in Korea. Therefore, the methanolic extract of safflower seeds (MESS) containing high mineral content, such as calcium (Ca), potassium (K) and phosphorous (P), was evaluated for the role on osteoblast (Ob) markers of Sprague-Dawley rats. In serum of 3 to 11 weeks (wks) old rats, both osteocalcin (OC) content and bone-specific alkaline phosphatase (B-ALP) activity increased to their maximum levels in 4-7 wks. Hence, 3 wks old rats were selected for 8 wks oral treatment of MESS, resulted in the significant increase of Ob markers in serum such as OC content (4-8 wks), B-ALP activity (1-2 wks) and insulin-like growth factor I (IGF-I) level (1 wk), and the growth parameter such as the length of femur (2-8 wks) and tibia (4 wks). On the basis of Pearson’s correlation coefficient, there were a moderate correlation between OC and B-ALP at 8 wks, a low correlation between OC and IGF-I at 1, 4 and 8 wks, a moderate correlation between OC and femur length at 1, 2 and 8 wks, and a moderate correlations between OC and tibia length at 1 and 8 wks of MESS-treated groups. The result reveals that the changes of OC correlated at low to moderate level with the changes of B-ALP activity, IGF-I content and femur and tibia length in the MESS-treatment period. On the other hand, there were a strong correlation between IGF-I and femur length at 2 wks and moderate correlation between IGF-I and tibia length at 1, 2 and 8 wks of MESS-treated groups. Therefore, the effect of MESS on bone formation likely appears to be mediated by IGF-I at the early stage of treatment.
Vitamin B6: A Long Known Compound of Surprising Complexity
Authors: Mooney Sutton , Leuendorf Jan-Erik , Hendrickson Christopher , Hellmann Hanjo
Published: January 2009

In recent years vitamin B6 has become a focus of research describing the compound’s critical function in cellular metabolism and stress response. For many years the sole function of vitamin B6 was considered to be that of an enzymatic cofactor. However, recently it became clear that it is also a potent antioxidant that effectively quenches reactive oxygen species and is thus of high importance for cellular well-being. In view of the recent findings, the current review takes a look back and summarizes the discovery of vitamin B6 and the elucidation of its structure and biosynthetic pathways. It provides a detailed overview on vitamin B6 both as a cofactor and a protective compound. Besides these general characteristics of the vitamin, the review also outlines the current literature on vitamin B6 derivatives and elaborates on recent findings that provide new insights into transport and catabolism of the compound and on its impact on human health.