bluuebunny/crossref_metadata_2025 huggingface dataset:
One-stage major spine deformity correction surgery: comparison between groups with and without additional neurosurgical intervention, with more than 24 months of follow-up
Authors: Murans Girts , Gustavsson Bengt , Saraste Helena
Published: December 2010

Object

Early-onset, nonidiopathic spine deformities are frequently caused by intraspinal anomalies necessitating both neurosurgical and orthopedic intervention. The clinical tradition at most treatment units is to perform neurosurgical and orthopedic procedures separately. Sometimes the deformity correction surgery is also done in stages, which leads to several periods of hospitalization, increased use of health care resources, and a long rehabilitation time for the patient. The purpose of this project was to perform an outcome survey for major spine surgery in high-risk patients, and to analyze whether an additional neurosurgical intervention during the same session increased the risk of complications.

Methods

A consecutive series of 81 patients with major rigid spine deformities treated by the same orthopedic surgeon was analyzed. In 24 of 81 cases there were additional intraspinal pathological entities indicating a neurosurgical procedure. All cases were divided into 2 groups: one with anterior-posterior surgery and also neurosurgery, and the other with anterior-posterior surgery but without neurosurgery. The result variables for the group comparisons were as follows: clinical and radiographic outcome, operating time, length of intensive care and hospital stay, relative blood loss, and occurrence of complications or adverse events. Groups were similar in terms of sex, size of spinal curve, and surgical procedures, but different in terms of diagnosis (there were more patients with myelomeningocele in the group treated with both anterior-posterior surgery and neurosurgery) and patient age (the group with both anterior-posterior surgery and neurosurgery was younger).

Results

An additional neurosurgical procedure combined with fusion surgery did not increase the complication rate or use of resources compared with fusion surgery alone, except in the length of operating time. The mean correction of the spinal curve was 56.7%, and the mean correction of the pelvic obliquity was 74.7%. The loss of correction was 3° on average. A more than 10° progression was seen in 9 cases. There were no deaths, and there were no neurological complications or surgery-related deterioration of ambulatory function. There were 10 complications that altered the planned postoperative course, including 5 infections.

Conclusions

One-stage major spine surgery, even when neurosurgery is included, is safe and does not increase the risk of complications. The increase in hospital and ICU stays is marginal.
Biomechanics of polyaryletherketone rod composites and titanium rods for posterior lumbosacral instrumentation
Authors: Bruner Harlan J. , Guan Yabo , Yoganandan Narayan , Pintar Frank A. , Maiman Dennis J. , Slivka Michael A.
Published: December 2010

Object

Interest is increasing in the development of polyaryletherketone (PAEK) implants for posterior lumbar fusion. Due to their inherent physical properties, including radiolucency and the ability to customize stiffness with carbon fiber reinforcement, they may be more advantageous than traditional instrumentation materials. Customization of these materials may allow for the development of a system that is stiff enough to promote fusion, yet flexible enough to avoid instrumentation failure. To understand the feasibility of using such materials in posterior lumbosacral instrumentation, biomechanical performances were compared in pure moment and combined loadings between two different PAEK composite rods and titanium rods.

Methods

Four human cadaver L3–S1 segments were subjected to pure moment and combined (compressionflexion and compression-extension) loadings as intact specimens, and after L-4 laminectomy with complete L4–5 facetectomy. Pedicle screw/rod fixation constructs were placed from L-4 to S-1, and retested with titanium, pure poly(aryl-ether-ether-ketone) (PEEK), and carbon fiber reinforced PEEK (CFRP) rods. Reflective markers were fixed to each spinal segment. The range of motion data for the L3–S1 column and L4–5 surgical level were obtained using a digital 6-camera system. Four prewired strain gauges were glued to each rod at the level of the L-4 screw and were placed 90° apart along the axial plane of the rod to record local strain data in the combined loading mode. Biomechanical data were analyzed using the ANOVA techniques.

Results

In pure moment, when compared with intact specimens, each rod material similarly restricted motion in each mode of bending, except axial rotation (p < 0.05). When compared with postfacetectomy specimens, each rod material similarly restricted motion (p < 0.05) in all bending modes. In combined loading, rod stiffness was similar for each material. Rod strain was the least in the titanium construct, intermediate in the CFRP construct, and maximal in the pure PEEK construct.

Conclusions

Pure PEEK and CFRP rods confer equal stiffness and resistance to motion in lumbosacral instrumentation when compared with titanium constructs in single-cycle loading. The carbon fiber reinforcement reduces strain when compared with pure PEEK in single-cycle loading. These biomechanical responses, combined with its radiolucency, suggest that the CFRP may have an advantage over both titanium and pure PEEK rods as a material for use in posterior lumbosacral instrumentation. Benchtop fatigue testing of the CFRP constructs is needed for further examination of their responses under multicycle loading.
Health care reform 2009–2010: a neurosurgeon's perspective
Authors: Tippett Troy M.
Published: December 2010

Organized neurosurgery through its Washington Committee developed a number of principles against which all health care reform legislation was measured, and none of the bills were acceptable. The American Association of Neurological Surgeons/Congress of Neurological Surgeons (AANS/CNS) worked through multiple venues to modify or reject the legislation. In the author's view, the American Medical Association (AMA) supported the bills because its board of trustees was too focused on eliminating the sustainable growth rate, or SGR. Physicians failed to shape the health care debate. The leadership of many medical organizations was not prepared for the debate. Many had no experience in this arena and thus were too willing to let lobbyists dictate their position. In the future there are 3 things organized neurosurgery must do: be prepared, never give in, and stick with their principles. Organized neurosurgery must be prepared by developing leaders that have experience in the full spectrum of organized medicine. Neurosurgeons must not count on others, and because the specialty is small all must be involved. Neurosurgeons must never give in. Organized neurosurgery started 2009 with little support for its positions but by the end of the debate had convinced many other organizations, representing almost 500,000 physicians, to take their position. From an organizational point of view, neurosurgeons should now do 3 things: 1) reform or reject the AMA; 2) develop a real surgical coalition; and 3) change the current political environment. Neurosurgeons must also follow their principles. In the author's opinion the most important principles are: health care as a responsibility, medical liability reform, and the right to privately contract. In the United Kingdom and Germany, where health care is considered a right rather than a responsibility, bureaucratic entities determine whether you have the right to health care just as the Independent Payment Advisory Board, established under the new health care reform law in the US, will soon limit by rationing of health care under the guise of cutting costs. If, however, health care is a responsibility not a right, the obligation is shifted from society to the individual. It puts the patient and the doctor in charge. It is a far better mechanism to control costs and preserve quality without rationing. It becomes our obligation to have health care, and it puts us in charge of our destiny. Proven liability reform was not included in the health care legislation despite the fact that up to $200 billion per year is spent on defensive medicine. Another and possibly the most important principle ignored in the legislation is the right for a patient and his/her physician to privately contract under Medicare without penalty.
Perioperative epidural steroids for lumbar spine surgery in degenerative spinal disease
Authors: Ranguis Sebastian Carlos , Li Dianna , Webster Angela Claire
Published: December 2010

Object

This systematic review assesses the efficacy of epidural steroids on adults undergoing lumbar spine surgery for degenerative spinal disease.

Methods

The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Embase databases were searched for relevant articles. Search terms included “laminectomy,” “discectomy,” and “steroid.” Randomized and quasi-randomized controlled trials of adults undergoing lumbar spinal surgery for degenerative spinal disease were included. The main outcomes were pain, quality of life, total analgesic agent consumption, postoperative length of hospital stay, the ability to return to full-time work, and adverse events.

Results

Twelve trials (involving 1053 patients) were included. Epidural steroids reduced back pain at 12–24 hours postoperatively (standardized mean difference [SMD] –1.26, 95% CI –2.35 to –0.0.18, p = 0.02), and radicular pain at 1 week postoperatively (SMD –0.71, 95% CI –1.19 to –0.24, p = 0.003) and 1–2 months postoperatively (SMD –2.14, 95% CI –3.47 to –0.81, p = 0.002). Epidural steroids decreased postoperative consumption of analgesic agents (SMD –0.38, 95% CI –0.62 to –0.14, p = 0.002), length of stay (SMD –0.95, 95% CI –1.62 to –0.27, p = 0.006) and the risk of not returning to full-time work at 1 year (relative risk of 0.27, 95% CI 0.13–0.57, p = 0.0006). There was no significant difference in quality of life or in adverse events.

Conclusions

There is evidence that epidural steroids decrease pain in the short term and shorten length of stay in adults undergoing lumbar spinal surgery for degenerative spinal disease. Most of the evidence comes from studies without validated outcomes and that selectively report positive results. More research is required before establishing perioperative epidural steroids as an effective adjunct to surgery for reducing pain in the long term.
Twenty-year outcome in young adults with childhood hydrocephalus: assessment of surgical outcome, work participation, and health-related quality of life
Authors: Paulsen A. Henriette , Lundar Tryggve , Lindegaard Karl-Fredrik
Published: December 2010

Object

Shunting of CSF is one of the most commonly performed operations in the pediatric neurosurgeon's repertoire. The 1st decade after initial shunt insertion has been addressed in several previous reports. The goals of the authors' study, therefore, were to determine 20-year outcomes in young adults with childhood hydrocephalus and to assess their health-related quality of life (HRQOL).

Methods

Patients younger than 15 years of age, in whom a first-time shunt insertion was performed for hydrocephalus in the calendar years 1985–1988, were included in a retrospective study on surgical morbidity, mortality rates, academic achievement, and/or work participation. Information concerning perceived health and functional status was assessed using the 36-Item Short Form Health Survey (SF-36) and Barthel Index, which were completed by patients still alive by September 1, 2009.

Results

Overall, 138 patients participated, no patient being lost to follow-up. For the 20-year period, the overall mortality rate was 21.7%. The mortality rate was not significantly higher in the 1st decade after initial shunt insertion than in the 2nd decade (p = 0.10). Ten percent of the patients surviving still live with their primary shunt in place, whereas 81% required at least one revision, and among these individual the mean number of revisions was 4.2 (median 3, range 0–26). There was a significantly higher revision rate during the 1st decade after initial shunt insertion compared with the 2nd decade (p = 0.027). The majority of patients live lives comparable with those of their peers. At follow-up, 56% were employed in open-market jobs or were still students, 23% had sheltered employment, and 21% were unemployed. The HRQOL was slightly lower in the hydrocephalic cohort than in the normative population. A significant difference was found in 2 of 8 SF-36 domains—Physical Functioning and General Health.

Conclusions

During the 20-year follow-up period, 81% of the patients required at least one revision of the CSF shunt. The mortality rate was high: 24 patients died in the 1st decade and 6 died in the 2nd decade after implantation of the initial shunt. In total, 4 deaths (2.9%) were due to shunt failure. Shunt placement to treat childhood hydrocephalus has a substantial effect on social functioning in later life, although perceived health was positively found to be better than expected in young adults with hydrocephalus.
Pathological findings of fusiform dilation of the internal carotid artery following radical dissection of a craniopharyngioma
Authors: Nagata Takashi , Goto Takeo , Ichinose Tsutomu , Mitsuhashi Yutaka , Tsuyuguchi Naohiro , Ohata Kenji
Published: December 2010

Fusiform dilation of the internal carotid artery (FDICA) after radical resection of a suprasellar craniopharyngioma has been reported. To the authors' knowledge, however, fatal conditions associated with FDICA have not been reported and pathological findings have not been obtained. The authors performed biopsy sampling of the wall of an FDICA for histopathological evaluation and found hyperplastic adventitia. This pathological result strongly supports conclusions from previous reports that FDICA has a low risk of rupture.
Chronic emesis due to compression of the area postrema by the posterior inferior cerebellar artery: resolution following microvascular decompression
Authors: Mortazavi Martin M. , Tubbs R. Shane , Harmon Daniel , Oakes W. Jerry
Published: December 2010

Chronic emesis may result from a variety of causes. To the authors' knowledge, compression of the area postrema by regional vessels resulting in chronic emesis has not been reported.

The authors report on a child who presented with chronic medically intractable emesis and significant weight loss requiring jejunostomy feeding. Surgical exploration of the posterior cranial fossa found unilateral compression of the area postrema by the posterior inferior cerebellar artery. Microvascular decompression resulted in postoperative and long-term resolution of the patient's emesis.

Although apparently very rare, irritation of the area postrema from the posterior inferior cerebellar artery with resultant medically intractable chronic emesis may occur. Therefore, the clinician should be aware of this potential etiology when dealing with such patients.
Association of Hyperlipidaemia with Diabetic Retinopathy
Authors: Faruque GM , Ahsan K , Anisuddin AIM
Published: December 2010

Context: Diabetic retinopathy is a major cause of ocular morbidity among the diabetic patient. The aim of this study is to establish that hyperlipidaemia contributes to the development of diabetic retinopathy.Method: A cross sectional observational Study of 140 consecutive patients of Non insulin dependent diabetis mellitus more then 05 years were included in the study.Results: 140 NIDDM paticnts and 50 non diabetic control persons. were included in the study. In this study mean serum total cholesterol was 272.33 mg / dl, 187.70 mg /dl and 132.56 mg /dl respectively. Among the 3 study groups, 58.9% was diabetic retinopathy patients, 56% patients without retinopathy and 54% in non- diabetic controls. Visual acuity was 0.34, 0.08 and 0.06 respectively.Conclusion: This study suggests that diabetic retiopathy patients need assessment of serum lipids and they may need lipid-lowering agent to halt the progression of diabetic retinopathy and also to protect the patients from systemic morbidity of hyperlipidaemia. Key words: Hyperlipidaemia; Diabetic Retinopathy DOI: 10.3329/jdmc.v17i2.6584J Dhaka Med Coll. 2008; 17(2) : 62-66
Clinical and Investigation Profile of Subacute Sclerosing Panencephatitis (SSPE): An Analysis of Twenty Cases
Authors: Saha NC , Sultana N , Mollah MAH , Yasmin L , Anwar S
Published: December 2010

Objective: To identify common clinical features, sociodemographic characteristics and laboratory parameters of diagnosed cases of Subacute Sclerosing Panencephalitis.Design: Cross sectional descriptive type of study.Setting: Department of Paediatrics, Dhaka Medical College Hospital.Study period: January 2006 to December 2008.Subjects: Twenty clinically diagnosed patients of SSPE.Results: The mean age at presentation was 8 years. Male: Female ratio was 19:1. Most of the patients came from lower socio-economic group (70%). Forty five percent had history of primary measles infection and seventy percent were vaccinated against measles. Most common presenting features were fall to ground (95%), cognitive decline (85%), myoclonic seizures (80%), altered speech (70%), gait disturbance (60%), personality changes (55%), dysphagia (50%) and less commonly blindness (20%). EEG showed abnormal findings in 100% of patients who underwent this test. Measles specific IgG antibody in CSF was positive in 90% cases. Neuroimaging findings were abnormal in 43% cases.Conclusion: The diagnosis of SSPE should be considered in children presenting with deteriorating milestones of development especially cognition and behavior, fall to ground along with myoclonic jerks in an endemic country for measles infection. Investigations like CSF and serum antibody to measles virus and characteristic EEG changes may help further in the diagnosis. Key words: SSPE; Myoclonic jerks; Milestones regression; Measles antibody; EEG. DOI: 10.3329/jdmc.v17i2.6586J Dhaka Med Coll. 2008; 17(2) : 72-77
Study of Proportional and Absolute Volume of Placental Parenchyma and Non-Parenchyma Between Normal Pregnant and Preeclamptic Women
Authors: Kishwara S , Nurunnabi ASM , Begum M , Ahmed R , Ara S
Published: December 2010

Context: The changes in volume of the placenta and its internal components are evident in different maternal diseases like preeclampsia. Postnatal examination of the placenta is an important method for assessing maternal and fetal condition in antenatal and perinatal periods and enriching practical knowledge.Study design: Cross-sectional descriptive type.Place and period of study: Department of Anatomy, Dhaka Medical College, Dhaka from August 2005 to June 2006.Materials & Methods: 54 human placentae from Bangladeshi women were collected from the Department of Obstetrics & Gynaecology of Dhaka Medical College Hospital and Sir Salimullah Medical College Hospital, of which 27 from normal uncomplicated pregnancies (control group) and another 27 from pregnancies complicated by preeclampsia (study group) where the patients were normotensive previously.Results: Both the proportional and absolute volume of placental parenchyma were found lower in preeclamptic women than those of normal pregnant women (P<0.001). But only in the absolute volume of non-parenchyma of the placenta, there was difference in between two groups (P<0.001), no difference found in relative volume (P>0.50). Key words: placenta; volume; parenchyma; non-parenchyma; preeclampsia. DOI: 10.3329/jdmc.v17i2.6587J Dhaka Med Coll. 2008; 17(2) : 78-82
Prevalence of Malaria Parasites Among Blood Donors in Selected Hospitals of Dhaka City
Authors: Hoque MM , Islam MA , Begum HA , Rahman M , Rahman SM , Al Mamun MA , Chowdhury FS , Hossain MA
Published: December 2010

Blood serves as a vehicle for transmission of blood-borne pathogens and transfusion-associated malaria is a potentially serious complication. The present study was conducted to determine the prevalence of Malaria parasites in blood donors. Total of 400 blood donors were selected from Transfusion Medicine Department of two teaching institutes, Bangabandhu Sheikh Mujib Medical University (BSMMU) and National Institute of Diseases of Chest and Hospital (NIDCH), Dhaka between the period of 1st January and 30th April 2003. The blood samples were examined under microscope by thick film in the laboratory of Institute of Epidemiology, Disease Control & Research (IEDCR), Dhaka. The socio-demographic characteristics of the study subjects show that 304 (76%) blood donors were males and 96 (24%) of them were females. The malaria parasites were found in 3 (0.76%) donors out of 400 donors. From 400 donors, 52 (13%) donors had the history of residence/ travel in malaria zone and 348 (87%) had no such history. The 8 (15%) out of 52 who had the history of residence/ travel in malaria zone had previous history of malaria and had taken anti-malarial drug. It can be concluded from the present study that there is some risk of transmission of malaria parasites in blood transfusion among the voluntary and professional blood donors in Bangladesh. Key words: Malaria parasites; Blood donors; Thick film. DOI: 10.3329/jdmc.v17i2.6590J Dhaka Med Coll. 2008; 17(2) : 94-97
Closed Reduction and Percutaneous Kirschner Wire Fixation Combined with Plaster Cast versus Conventional Plaster Cast immobilization in the Treatment of Colles' Fracture  A Prospective Randomized Comparative Study
Authors: Uzzaman KS , Awal KA , Alam MK
Published: December 2010

Purpo'e: To evaluate functional & anatomical results of the Colles’ fracture treated by two methods- i) Closed reduction & precutaneous kirschner wire (K- wire) fixation combined with plaster cast & ii) Conventional plaster cast immobilization after closed reduction.Methods: A randomized prospective comparative study was done from July 2003 to June 2005 on 52 patient with Colles' fracture in NITOR, Dhaka. 12 patients lost from follow up. Twenty patient (20) in each group were finally available for evaluation. The group treated by closed reduction & percutaneous K-wire fixation combined with plaster cast- designated as "Arm A" & another group treated conventionally by plaster cast only designated by "Arm-B". Male Female ratio was 1:3, Age range was 35 to 70 years (Mean age 52.5 years) Distribution of limbs side involvement almost equal. Mode of injuries were domestic fall & RTA (4:1) According to AO classification fracture were in both groups- A2 = 13, A3 = 10, C1 = 6, C2 = 8 & C3 = 3 (Total- 40). Follow up period was 6-14 months (mean = 6 month)Results: Union time for most of the fractures was 6-8 weeks. At final follow up Satisfactory Anatomical end results of percutuneous fixation group (Arm-A) were 80% and in conventional plaster cast group (Arm-B) were 35%. (P<0.01). Satisfactory functional end results in Arm-A group were 70% and in Arm-B group were 30% (P<0.01) Complications seen much more in conventional group (Arm-B) than percutaneous K-wire fixation group (Arm-B). Sarmiento & Latta’s criteria was used to evaluate the progress.Conclusion: The coventional plaster cast method for treatment of colles’ fracture usually can't maintain radial length & angulation in many instances and results significant anatomical difficultly and functional disability. On the other hand after close reduction additional fixation in the form of percutaneous crossed K-wire can maintain the reduction till bony union & prevent late collapse at fracture site & provides better result. Key Words: Colles' fracture; closed reduction; Plaster cast & Kirschner wire (K-wire) fixationDOI: 10.3329/jdmc.v17i2.6591J Dhaka Med Coll. 2008; 17(2) : 98-105
Clinico-Epidemiological Pattern of Poisoning in A Tertiary Level Hospital
Authors: Howlader MAR , Sardar MH , Amin MR , Morshed MG , Islam MS , Uddin MZ , Azhar MA
Published: December 2010

Poisoning is a common medico-social problem in our country causing around 300,000 episodes and around 2000 death per year. The number of poisoning cases is increasing in our country day by day. The common pattern of poisoning in our country is suicidal, homicidal/criminal and accidental. The incidence, nature, etiology, age group affected and the outcome of poisoning in our country is different from that of the western world. A prospective descriptive study of poisoning cases in Sir Salimullah Medical College and Mitford Hospital was attempted in 2004.Among 100 cases, age of the cases ranged from 15-65 years. Sixty four percent were male. Around 68 percent cases were found businessman, 48% were from low-income group and Fifty three percent cases were educated up to secondary level.Among male patients 57.81% of poisoning caused by suspected sedative poisoning (transport related poison), 28.12% by organophophorous, 3.12% by copper sulphate, 4.98 by benzodiazepines (attempted suicide), 4.98% by Acid and 1.56% by kerosene. Among female patients 41.66% of poisoning caused by organophosphorous compounds, 19.44% by rat killer, 11.11% by copper sulphate, 8.33% by benzodiazepines, 5.55% by acid, 5.55% by savlon, 5.55% by herpic and 2.77% by phenol.Transport related poisoning by short acting sedative-hypnotics for the purpose of hijacking the belongings of the travelers and agrochemicals-organophosphorous compounds for suicidal purpose are the most common poisoning in our country. The pattern and magnitude of poisoning are thus multidimensional and demanding multi-sectoral approach for facing the problem. The comprehensive patient care can improve the poisoning case management in our country. DOI: 10.3329/jdmc.v17i2.6593J Dhaka Med Coll. 2008; 17(2) : 111-115
New Kinds of Land Conflict in Urban Cameroon: the Case of the ‘landless’ Indigenous Peoples in Yaoundé
Authors: Socpa Antoin
Published: December 2010

The land disputes in Cameroon that are best known are between groups of local (indigenous) populations and people originating from elsewhere (incomers). This situation is fairly common in the cosmopolitan towns of Douala and Yaoundé. The purpose of this article is not to revisit these types of conflict, but rather to explore conflicts over land between the indigenous populations and the state. This new kind of opposition demonstrates that it is not only the incoming populations who are dispossessing indigenous people of their land. In fact, in various and more effective ways, the state is playing a significant part in the expropriation of indigenous land heritage. This process may be witnessed in urban housing developments, as well as in areas set aside for public utility, or those that are too dangerous to be developed (slopes, piedmonts and marshlands). Through its policy of urbanization, the state is seemingly contributing to producing ‘landless indigenous people’ in much the same way as and probably more effectively than the incomers. This article reviews the historical processes of land expropriation from the time of the colonial state, analysing the grievances of indigenous people faced with this situation, as well as the strategies they have developed in an effort to take back control of their lost lands.
The World's First Biometric Money: Ghana's E-Zwich and the Contemporary Influence of South African Biometrics
Authors: Breckenridge Keith
Published: December 2010

In January 2008 the Ghanaian Central Bank announced that it had introduced a new centralized mechanism for the settlement of transactions between the Ghanaian banks. This interbank switch, as it was called, was purchased from, and managed by, the South African company Net 1 UEPS, and it had a unique central organizing principle. The switch was indexed biometrically, using a key derived from the ten fingerprints of account holders. This new interbank switch and a smartcard encoded in the same way has equipped Ghana with the world's first biometric money supply. This article is an effort to explain the development and significance of this biometric money, which Ghanaians call the e-Zwich. It traces the way in which biometric registration in Ghana (as in other African countries) has leaked from the mundane, difficult, and mostly unrewarding, task of civil registration into the more properly remunerated domain of monetary transactions. Viewed in the light of the rich historical anthropology of money in West Africa, what is at stake in Ghana may be much more significant than any of the current participants fully realize. Perhaps the most interesting finding of this study is that the e-Zwich system might actually succeed.
Control of Mechanical Properties of Thermoplastic Polyurethane Elastomers by Restriction of Crystallization of Soft Segment
Authors: Kojio Ken , Furukawa Mutsuhisa , Nonaka Yoshiteru , Nakamura Sadaharu
Published: December 2010

Mechanical properties of thermoplastic polyurethane elastomers based on either polyether or polycarbonate (PC)-glycols, 4,4’-dipheylmethane diisocyanate (1,1’-methylenebis(4-isocyanatobenzene)), 1,4-butanediol, were controlled by restriction of crystallization of polymer glycols. For the polyether glycol based-polyurethane elastomers (PUEs), poly(oxytetramethylene) glycol (PTMG), and PTMG incorporating dimethyl groups (PTG-X) and methyl side groups (PTG-L) were employed as a polymer glycol. For the PC-glycol, the randomly copolymerized PC-glycols with hexamethylene (C6) and tetramethylene (C4) units between carbonate groups with various composition ratios (C4/C6 = 0/100, 50/50, 70/30 and 90/10) were employed. The degree of microphase separation and mechanical properties of both the PUEs were investigated using differential scanning calorimetry, dynamic viscoelastic property measurements and tensile testing. Mechanical properties could be controlled by changing the molar ratio of two different monomer components.
Effects of Conventional Heating on the Stability of Major Olive Oil Phenolic Compounds by Tandem Mass Spectrometry and Isotope Dilution Assay
Authors: Attya Mohamed , Benabdelkamel Hicham , Perri Enzo , Russo Anna , Sindona Giovanni
Published: December 2010

The quality of olive oils is sensorially tested by accurate and well established methods. It enables the classification of the pressed oils into the classes of extra virgin oil, virgin oil and lampant oil. Nonetheless, it would be convenient to have analytical methods for screening oils or supporting sensorial analysis using a reliable independent approach based on exploitation of mass spectrometric methodologies. A number of methods have been proposed to evaluate deficiencies of extra virgin olive oils resulting from inappropriate technological treatments, such as high or low temperature deodoration, and home cooking processes. The quality and nutraceutical value of extra virgin olive oil (EVOO) can be related to the antioxidant property of its phenolic compounds. Olive oil is a source of at least 30 phenolic compounds, such as oleuropein, oleocanthal, hydroxytyrosol, and tyrosol, all acting as strong antioxidants, radical scavengers and NSAI-like drugs. We now report the efficacy of MRM tandem mass spectrometry, assisted by the isotope dilution assay, in the evaluation of the thermal stability of selected active principles of extra virgin olive oil.
A Simplified Liquid Chromatography-Mass Spectrometry Assay for Artesunate and Dihydroartemisinin, Its Metabolite, in Human Plasma
Authors: Teja-Isavadharm Paktiya , Siriyanonda Duangsuda , Siripokasupkul Raveewan , Apinan Roongnapa , Chanarat Nitima , Lim Apassorn , Wannaying Srisombat , Saunders David , Fukuda Mark M. , Miller Robert S. , Weina Peter J. , Meléndez Victor
Published: December 2010

Artesunate (AS) is a potent antimalarial that is used worldwide for the treatment of malaria. A simple method with a total run time of 12 min was developed and validated for the quantification of AS and dihydroartemisinin (DHA), its active metabolite, in human (heparinized) plasma based on one-step protein precipitation in acetonitrile using artemisinin (ARN) as an internal standard, followed by liquid chromatography with a single quadrupole mass spectrometry system connected to a C18 column. Peak area ratio responses were fitted to the 2nd-order curve type, polynomial equation with weighting (1/concentration) over a quantification range between 3.20/5.33–3,000/5,000 nM (1.23/1.52–1153/1422 ng/mL) of AS/DHA showing linearity with very good correlation (r2 > 0.999). Single ion recordings of 5 µL injections of plasma extracts allowed for limits of detection of 1.02 nM (0.39 ng/mL) for AS and 0.44 nM (0.13 ng/mL) for DHA. The inter-assay and intra-assay accuracy and precision of the method was very good with an inaccuracy of ±12.4% and coefficients of variation of ≤10.7% at all tested concentrations. The recovery of the analytes from plasma was ≥95%. Other commonly used antimalarials including mefloquine, quinine, and chloroquine, did not interfere with the analysis. Post-preparative tests over 24 h in an autosampler (10 °C) showed that the DHA response was only 2.1% of AS from auto-hydrolysis, and β-DHA was the major, stable epimer that was used for quantification of DHA. In contrast, α-DHA increased steadily up to 600%. Artesunate and DHA in plasma were stable through three freeze/thaw cycles for up to 6 h at room temperature and up to one year at -80 °C.
The Duke University Religion Index (DUREL): A Five-Item Measure for Use in Epidemological Studies
Authors: Koenig Harold G. , Büssing Arndt
Published: December 2010

There is need for a brief measure of religiosity that can be included in epidemiological surveys to examine relationships between religion and health outcomes. The Duke University Religion Index (DUREL) is a five-item measure of religious involvement, and was developed for use in large cross-sectional and longitudinal observational studies. The instrument assesses the three major dimensions of religiosity that were identified during a consensus meeting sponsored by the National Institute on Aging. Those three dimensions are organizational religious activity, non-organizational religious activity, and intrinsic religiosity (or subjective religiosity). The DUREL measures each of these dimensions by a separate “subscale”, and correlations with health outcomes should be analyzed by subscale in separate models. The overall scale has high test-retest reliability (intra-class correlation = 0.91), high internal consistence (Cronbach’s alpha’s = 0.78–0.91), high convergent validity with other measures of religiosity (r’s = 0.71–0.86), and the factor structure of the DUREL has now been demonstrated and confirmed in separate samples by other independent investigative teams. The DUREL has been used in over 100 published studies conducted throughout the world and is available in 10 languages.
Magnetic coupling mechanisms in particle/thin film composite systems
Authors: Confalonieri Giovanni A Badini , Szary Philipp , Mishra Durgamadhab , Benitez Maria J , Feyen Mathias , Lu An Hui , Agudo Leonardo , Eggeler Gunther , Petracic Oleg , Zabel Hartmut
Published: December 2010

Magnetic γ-Fe2O3 nanoparticles with a mean diameter of 20 nm and size distribution of 7% were chemically synthesized and spin-coated on top of a Si-substrate. As a result, the particles self-assembled into a monolayer with hexagonal close-packed order. Subsequently, the nanoparticle array was coated with a Co layer of 20 nm thickness. The magnetic properties of this composite nanoparticle/thin film system were investigated by magnetometry and related to high-resolution transmission electron microscopy studies. Herein three systems were compared: i.e. a reference sample with only the particle monolayer, a composite system where the particle array was ion-milled prior to the deposition of a thin Co film on top, and a similar composite system but without ion-milling. The nanoparticle array showed a collective super-spin behavior due to dipolar interparticle coupling. In the composite system, we observed a decoupling into two nanoparticle subsystems. In the ion-milled system, the nanoparticle layer served as a magnetic flux guide as observed by magnetic force microscopy. Moreover, an exchange bias effect was found, which is likely to be due to oxygen exchange between the iron oxide and the Co layer, and thus forming of an antiferromagnetic CoO layer at the γ-Fe2O3/Co interface.
The Role of HLA-B27 in Spondyloarthritis
Authors: TAUROG JOEL D.
Published: December 2010

This article summarizes the proceedings of a one-day international workshop held in July 2009 on the role of HLA-B27 in the pathogenesis of ankylosing spondylitis (AS) and related disorders. HLA-B27 is found in about 90% of patients with AS, with an odds ratio of about 100, but the mechanism underlying this association is not known. There are currently 3 major mechanistic hypotheses for this association: (1) T cell recognition of one or more B27 presented peptides; (2) B27 heavy-chain misfolding that induces an unfolded protein response; and (3) innate immune recognition of cell-surface expressed B27 heavy-chain dimers. None of these hypotheses accounts for the tissue specificity of the inflammation characteristic of AS. These hypotheses were discussed in the context of known epidemiologic, biochemical, structural, and immunologic differences among HLA-B27 subtypes; data from the HLA-B27 transgenic rat model of spondyloarthritis; the growing list of other genes that have been found to be associated with AS; and other data on the pathogenesis of spondyloarthritis. Proposed directions for future research include expanded efforts to define similarities and differences among the B27 subtypes; further development of animal models; identifying the interactions of B27 with the products of other genes associated with AS; and continued investigation into the pathogenesis of spondyloarthritis.
Eosinophilic Fasciitis: A Rare Skin Sclerosis
Authors: Servy Amandine , Clérici Thierry , Malines Caroline , Le Parc Jean-Marie , Côté Jean-François
Published: December 2010

Eosinophilic fasciitis (Schulman's syndrome) is a rare disease with specific clinical symptoms such as the groove sign which facilitate diagnosis. We report a typical case of eosinophilic fasciitis in an otherwise healthy 49-year-old man who presented with “prayer and groove signs”. Histological analysis showed sclerosis and eosinophilic infiltration of the fascia. The patient was successfully treated with systemic corticotherapy and Cyclosporine. A short review of the clinicopathological features of the lesions is presented.
Adrenal incidentalomas: a simple guide to a disease of modern technology
Authors: Ghosh S , Jones M , Swaminathan K
Published: December 2010

Incidentally discovered adrenal masses (adrenal incidentalomas) found during radiological procedures are a by-product of modern-day medicine. Incidental findings of such adrenal masses pose uncertainties and dilemmas in evaluation and management. There is a paucity of comprehensive guidelines from professional societies, and current recommendations (based on expert opinions and the US National Institutes of Health statement, 2002) are open to debate with regards to cost and clinical benefit. We report two patients with ‘adrenal incidentalomas’ with different outcomes during the course of evaluation. We conclude with a simple guide to the evaluation and management of such masses based on the available literature.
Observations regarding historical accounts of pneumococcal diseases due to serotypes 1 and 3
Authors: Inverarity DJ , Diggle MA
Published: December 2010

Surveillance of the serotypes causing invasive pneumococcal diseases in the UK has indicated increasing incidence of serotype 1- and serotype 3-related disease in recent years. The introduction of a pneumococcal conjugate vaccine to the paediatric vaccination schedule in 2006, which did not cover these serotypes, has been regarded as a contributing factor. Serotypes 1 and 3 were perhaps the most extensively studied pneumococcal serotypes in the early twentieth century when pneumococcal serotyping began. Such historical observations are pertinent to our understanding of contemporary disease manifestations for these serotypes as many parallels can be seen between their behaviour in the early twentieth century and the early twenty-first century. There are many relevant lessons to be learned from these pre-antibiotic era descriptions and the observations of our predecessors.
Improving outcomes in older people undergoing elective surgery
Authors: Dhesi J
Published: December 2010

Older people have much to gain from surgery, but pose a significant challenge not only in emergency surgery but also in elective surgery. Despite significant progress in the care of older surgical patients, they remain more likely to ‘fail’ pre-assessment and have higher rates of post-operative complications than younger people. The evidence suggests that this is a consequence of agerelated increases in co-morbidities and reduction in physiological reserve. Numerous studies have demonstrated improvements in outcome when individual co-morbidities are appropriately assessed and optimised. However, current models of care do not allow for the translation of this evidence into routine clinical practice, particularly in those with complex co-morbidities and functional dependence. This article explores the reasons for poor outcome in older people and describes an alternative model of care for the older elective surgical patient.
Non-surgical treatment for early prostate cancer
Authors: Law AB , McLaren DB
Published: December 2010

Prostate cancer incidence is rising due to the ageing population and increased public and doctor awareness. The role of screening is still not clear due to the large number of asymptomatic men who would need to be screened and treated to prevent one death. Discussion of all treatment options should be undertaken, with the patient having the opportunity to meet a clinical oncologist and urological surgeon. Treatment options include active surveillance, external beam radiotherapy, brachytherapy and surgery. Low-dose rate brachytherapy involves the permanent insertion of radioactive seeds (half-life 60 days) under ultrasound guidance. It is a good option for many men as impotence and incontinence rates are lower than for surgery and it has reduced hospital costs and time off work and high rates of relapse-free survival (90–95% in low-risk disease). External beam radiotherapy offers a good treatment for men with more locally advanced disease and men who do not want to undergo an anaesthetic. New developments allow higher doses of radiotherapy to be given with reduced relapse rates and reduced toxicity to neighbouring structures such as bowel and bladder. High-dose rate brachytherapy involves the temporary insertion of applicators into the prostate so that a high energy source can temporarily be fed into different positions in the prostate, ensuring a high dose to the prostate gland but minimising dose to the bladder and bowel. It can be used as monotherapy or in combination with external beam radiotherapy.
Composition of semi-volatile organic compounds in the urban atmosphere of Singapore: influence of biomass burning
Authors: He J. , Zielinska B. , Balasubramanian R.
Published: December 2010

Abstract. An intensive field study was conducted in the urban atmosphere of Singapore to investigate the composition of organic compounds in both gaseous and particulate phases during the period of August to early November 2006. 17 atmospheric samples were collected. These samples were subjected to accelerated solvent extraction with a mixture of dichloromethane and acetone and separated into functional group fractions for analyses by GC/MS. Over 180 organic compounds belonging to three major fractions (n-alkanes, polycyclic aromatic hydrocarbons – PAHs, and polar organic compounds – POCs) were identified and quantified. The characteristics and abundance of the n-alkanes, PAHs, mono and dicarboxylic acids, methoxylated phenols and other POCs were determined. The composition of these organic compounds fluctuated temporally with most of them being relatively higher in October than those in other months of the sampling period. 3-D backward air mass trajectory analyses together with the carbon preference index (CPI), molecular diagnostic ratios and molecular markers were used to investigate the origin of organic species measured in this study. Based on these diagnostic tools, the increased abundance of atmospheric organic species during October could be attributed to the occurrence of regional smoke haze episodes due to biomass burning in Indonesia. Among the POCs investigated, phthalic acid and cis-pinonic acid were abundant during October 2006. These two acids showed strong linear relationships with maximum daily ozone concentrations throughout the entire sampling period. This correlation with ozone suggested that the secondary aerosol constituents such as phthalic and cis-pinonic acids were probably formed through O3-induced photochemical transformation.
Dry deposition of reactive nitrogen to European ecosystems: a comparison of inferential models across the NitroEurope network
Authors: Flechard C. R. , Nemitz E. , Smith R. I. , Fowler D. , Vermeulen A. T. , Bleeker A. , Erisman J. W. , Simpson D. , Zhang L. , Tang Y. S. , Sutton M. A.
Published: December 2010

Abstract. Inferential models have long been used to determine pollutant dry deposition to ecosystems from measurements of air concentrations and as part of national and regional atmospheric chemistry and transport models, and yet models still suffer very large uncertainties. An inferential network of 55 sites throughout Europe for atmospheric reactive nitrogen (Nr) was established in 2007, providing ambient concentrations of gaseous NH3, NO2, HNO3 and HONO and aerosol NH4+ and NO3− as part of the NitroEurope Integrated Project. Network results providing modelled inorganic Nr dry deposition to the 55 monitoring sites are presented, using four existing dry deposition routines, revealing inter-model differences and providing ensemble average deposition estimates. Dry deposition is generally largest over forests in regions with large ambient NH3 concentrations, exceeding 30–40 kg N ha−1 yr−1 over parts of The Netherlands and Belgium, while some remote forests in Scandinavia receive less than 2 kg N ha−1 yr−1. Turbulent Nr deposition to short vegetation ecosystems is generally smaller than to forests due to reduced turbulent exchange, but also because NH3 inputs to fertilised, agricultural systems is limited by the presence of a substantial NH3 source in the vegetation, leading to periods of emission as well as deposition. Differences between models reach a factor 2–3 and are often greater than differences between monitoring sites. For soluble Nr gases such as NH3 and HNO3, non-stomatal pathways are responsible for most of the annual uptake over many surfaces, especially the non-agricultural land uses, but parameterisations of the sink strength vary considerably among models. For aerosol NH4+ and NO3−, discrepancies between theoretical models and field flux measurements lead to much uncertainty in dry deposition rates for fine particles (0.1–0.5 μm). The validation of inferential models at the ecosystem scale is best achieved by comparison with direct long-term micrometeorological Nr flux measurements, but too few such datasets are available, especially for HNO3 and aerosol NH4+ and NO3−.