bluuebunny/crossref_metadata_2025 huggingface dataset:
TGF‐β1 calcium signaling increases α5 integrin expression in osteoblasts
Authors: Nesti Leon J. , Caterson E. J. , Wang Mark , Chang Richard , Chapovsky Felix , Hoek Jan B. , Tuan Rocky S.
Published: August 2002

TGF‐β1 is a potent osteoactive factor and exhibits a wide variety of effects on osteoblasts, most of which are mediated through receptor associated Smad proteins. We have recently reported a novel TGF‐β1 intracellular Ca2+ signaling pathway in osteoblasts, and found that this signaling is required for the TGF‐β1 mediated enhancement of osteoblast adhesion to substrate. Given that interaction between the extracellular matrix protein fibronectin and α5β1 integrin on the cell surface is principally responsible for osteoblast substrate adhesion, we examined here whether the TGF‐β1 stimulated Ca2+ signal is involved in this pathway. Our results show that, in primary human osteoblasts, the TGF‐β1 induced intracellular Ca2+ signal is responsible, in part, for the stimulation of expression of α5 integrin, but not of β1 integrin or fibronectin. Increased levels of α5 integrin protein and mRNA were seen as early as 12 h after TGF‐β1 treatment, but were inhibited by co‐treatment of cells with nifedipine, a selective L‐type Ca2+ channel blocker. TGF‐β1 treatment increased both fibronectin and β1 integrin protein production within 48 h, in a manner unaffected by co‐treatment with nifedipine.

Immunofluorescence observations revealed that TGF‐β1 treatment resulted in increased α5 integrin staining, and more prominent α5 integrin clustering, with increased co‐localization with the actin cytoskeleton, effects that were blocked by co‐treatment with nifedipine. The TGF‐β1 induced intracellular Ca2+ signal in human osteoblasts is thus an important mechanistic step in the regulation of α5 integrin expression, later contributing to enhanced cell adhesion.

© 2002 Orthopaedic Research Society. Published by Elsevier Science Ltd. All rights reserved.
Parathyroid hormone‐related peptide regulation of chick tibial growth plate chondrocyte maturation requires protein kinase A
Authors: Zuscik Michael J. , O'Keefe Regis J. , Gunter Thomas E. , Edward Puzas J. , Schwarz Edward M. , Rosier Randy N.
Published: August 2002

Regulation of phenotype in chick tibial growth plate chondrocytes (GPCs) by parathyroid hormone‐related peptide (PTHrP) is facilitated via signaling through three pathways: protein kinase A (PKA), protein kinase C (PKC) and inositol‐1.4.5‐trisphosphate‐induced Ca2+ transients. To establish the underlying signaling specificity for PTHrP‐regulation of chondrocyte maturation, we examined the separate involvement of each of these three pathways in the PTHrP regulation of key hallmarks of GPC phenotype: stimulation of proliferation and proteoglycan synthesis and reduction of alkaline phosphatase activity and type X collagen expression. Mimicking the PTHrP stimulation either of PKC with 1‐oleoyl 2‐acetyl glycerol or of a Ca2+ pulse with 65 mM KCl did not lead to PTHrP‐like effects on any of the four markers examined. Also, inhibition of PKC with myr‐ΨPKC or blockade of Ca2+ signals with an intracellular chelator did not inhibit PTHrP action. However, PKA activation with dibutyryl cAMP mimicked PTHrP and blockade of PTHrP stimulation of PKA with H‐89 inhibited the regulatory action of the factor. These data demonstrate that although activation of PKC or Ca2+ signals is not required, the cylic AMP‐dependent A kinase is required for PTHrP to regulate key hallmarks of GPC phenotype.

© 2002 Orthopaedic Research Society. Published by Elsevier Science Ltd. All rights reserved.
Healing of subfailure ligament injury: comparison between immature and mature ligaments in a rat model
Authors: Provenzano Paolo P. , Hayashi Kei , Kunz David N. , Markel Mark D. , Jr. Ray Vanderby
Published: August 2002

This study evaluated biomechanical properties of healing ligament following subfailure (grade II) injury by comparing young and mature animals in a rat lateral collateral ligament (LCL) model. One randomly selected LCL was stretched in situ using a custom designed device in eighteen young (21 days) and eighteen skeletally mature (8 months) male rats. Animals were euthanized at 0, 7, and 14 days post‐surgery, and ligament ultimate stress, strain at failure and laxity were determined (n = 6 pairs per group). At time 0 after introduction of stretch injury, ligament laxity was present in both groups. The mature rats had 54 ± 9% strength of the control while the immature rats had 58 ± 11% of the strength of the control, representing a consistent and significant injury. The immature and mature ligaments showed similar patterns of cellular damage post‐injury and had similar modes of mechanical failure. Ligament laxity decreased in each group as healing time increased, however ligament laxity did not completely recover in either group after 2 weeks of healing. After 7 and 14 days of healing, the mature rats, respectively, had only 63 ± 14% and 80 ± 8% strengths of the controls while the immature rats had 94 ± 6% and 94 ± 10%. Hence, mechanical data showed that immature animals recovered their strength after a grade II sprain at a faster rate than mature animals. However, ligament laxity was still present in both groups two weeks after the injury and was not completely removed by growth in the immature group. These findings are clinically relevant since joint laxity after injury is common, and these results may explain the presence of continued instability in a joint injured at a young age. Hence, this study, with a new injury model, showed differences in ligament healing associated with maturity and quantified the clinically observed persistance of ligament laxity.

© 2002 Orthopaedic Research Society. Published by Elsevier Science Ltd. All rights reserved.
Ontologies in the life sciences
Authors: McENTIRE ROBIN
Published: August 2002

This paper describes the need for ontologies in the life sciences, some work that has been done already on the development of ontologies and languages for the exchange of life sciences objects, some important problems in the field where ontologies provide critical benefit and some of the organisations that are facilitating this work.
How the semantic web will change KR: challenges and opportunities
for a new research agenda
Authors: VAN HARMELEN FRANK
Published: August 2002

Currently the Web is the largest available environment for the deployment of agents, and much work in agent research is driven by Web-based applications (Luke et al. (1997), Joachims et al. (1997), Bollacker et al. (1998), Doorenbos et al. (1997) are just some examples; see also the May 2000 special issue of the Artificial Intelligence Journal on intelligent internet systems, 118 (1–2)). However, such applications of agent technology are hampered by the
fact that the Web is not geared towards agent use, but is rather designed for human use. Current Web resources are lacking in explicit, machine-accessible descriptions of their contents; they are only fully accessible to agents with a competent grasp of English (i.e. limited to human agents only).
The future of seagrass meadows
Authors: Duarte Carlos M.
Published: August 2002

Seagrasses cover about 0.1–0.2% of the global ocean, and develop highly productive ecosystems which fulfil a key role in the coastal ecosystem. Widespread seagrass loss results from direct human impacts, including mechanical damage (by dredging, fishing, and anchoring), eutrophication, aquaculture, siltation, effects of coastal constructions, and food web alterations; and indirect human impacts, including negative effects of climate change (erosion by rising sea level, increased storms, increased ultraviolet irradiance), as well as from natural causes, such as cyclones and floods. The present review summarizes such threats and trends and considers likely changes to the 2025 time horizon. Present losses are expected to accelerate, particularly in South-east Asia and the Caribbean, as human pressure on the coastal zone grows. Positive human effects include increased legislation to protect seagrass, increased protection of coastal ecosystems, and enhanced efforts to monitor and restore the marine ecosystem. However, these positive effects are unlikely to balance the negative impacts, which are expected to be particularly prominent in developing tropical regions, where the capacity to implement conservation policies is limited. Uncertainties as to the present loss rate, derived from the paucity of coherent monitoring programmes, and the present inability to formulate reliable predictions as to the future rate of loss, represent a major barrier to the formulation of global conservation policies. Three key actions are needed to ensure the effective conservation of seagrass ecosystems: (1) the development of a coherent worldwide monitoring network, (2) the development of quantitative models predicting the responses of seagrasses to disturbance, and (3) the education of the public on the functions of seagrass meadows and the impacts of human activity.
Mating behaviour in the agile antechinus Antechinus agilis (Marsupialia: Dasyuridae)
Authors: Shimmin Glenn A. , Taggart David A. , Temple‐Smith Peter D.
Published: August 2002

Antechinus agilis mate within a 2–3 week, highly synchronized period each year, with copulation consisting of short bouts of thrusting interrupted by longer bouts of rest during which time the male remains mounted. In the laboratory, mating can last as long as 8–12 h without any break in intromission, with captive paired animals generally copulating once per day (Woolley, 1966a, b). The mating programme used in this study examines the effects on copulatory behaviour of changing: (1) timing of access relative to ovulation; (2) order of mating; (3) the delay between the first and second males' mating access. The total mount time was divided into quarters and the changes in behavioural patterns assessed by examining changes in the frequency of five key activities; thrusting, pelvic side‐to‐side movements, walking, female resistance, and dismounts. No significant differences were observed in the time from initial pairing to first mount regardless of mating order or time of mating, nor was the total time mounted significantly affected by mating order. Significant reductions in the total time mounted were evident, however, for those males mating closer to the time of ovulation. The behavioural strategies associated with copulation in A. agilis significantly enhance arguments for equality between males and females in determining overall mating strategies.
Hordes of mandrills (Mandrillus sphinx): extreme group size and seasonal male presence
Authors: Abernethy K. A. , White L. J. T. , Wickings E. J.
Published: August 2002

Mandrill Mandrillus sphinx hordes in the Lopé Reserve, Gabon, the approximate centre of the mandrill species range, were studied over 3 years from 1996 to 1999. Part of the study site included gallery forests within savanna areas, allowing observation of entire hordes, hitherto impossible in dense forest habitat. Horde size and composition (sex and age classes) were documented using exact records on video film whenever a horde or subgroup crossed an open space. Mean horde size was 620, and hordes of up to 845 individuals were documented, probably the largest stable group size found in any wild, unprovisioned primate population. Hordes were cohesive throughout the study period and did not seem to be aggregations of smaller units. Mandrill societies seem to be quite different from the baboon societies, to which they have been compared to date. Mature, breeding‐age males were not resident members of hordes, but entered at the onset of seasonal cycles in the females (as deduced by the presence of sexual tumescence) and emigrated once female sexual cycles ceased. The number of breeding males present in the horde at any one time is best explained by the number of sexually attractive females. It is postulated that the extreme coloration of males and strong sexual dimorphism in mandrills may have evolved through an enhanced need for competitive signals in a situation where no long‐term social bonds between breeding partners exist.
Parsing engineering and empirical robustness
Authors: BASILI ROBERTO , ZANZOTTO FABIO MASSIMO
Published: August 2002

Robustness has been traditionally stressed as a general desirable property of any computational model and system. The human NL interpretation device exhibits this property as
the ability to deal with odd sentences. However, the difficulties in a theoretical explanation
of robustness within the linguistic modelling suggested the adoption of an empirical notion.
In this paper, we propose an empirical definition of robustness based on the notion of
performance. Furthermore, a framework for controlling the parser robustness in the design
phase is presented. The control is achieved via the adoption of two principles: the modularisation, typical of the software engineering practice, and the availability of domain adaptable
components. The methodology has been adopted for the production of CHAOS, a pool of
syntactic modules, which has been used in real applications. This pool of modules enables
a large validation of the notion of empirical robustness, on the one side, and of the design
methodology, on the other side, over different corpora and two different languages (English
and Italian).
Robustness beyond shallowness: incremental deep
parsing
Authors: AÏT-MOKHTAR S. , CHANOD J.-P. , ROUX C.
Published: August 2002

Robustness is a key issue for natural language processing in general and parsing in particular,
and many approaches have been explored in the last decade for the design of robust parsing
systems. Among those approaches is shallow or partial parsing, which produces minimal and
incomplete syntactic structures, often in an incremental way. We argue that with a systematic
incremental methodology one can go beyond shallow parsing to deeper language analysis,
while preserving robustness. We describe a generic system based on such a methodology and
designed for building robust analyzers that tackle deeper linguistic phenomena than those
traditionally handled by the now widespread shallow parsers. The rule formalism allows the
recognition of n-ary linguistic relations between words or constituents on the basis of global
or local structural, topological and/or lexical conditions. It offers the advantage of accepting
various types of inputs, ranging from raw to chunked or constituent-marked texts, so for
instance it can be used to process existing annotated corpora, or to perform a deeper analysis
on the output of an existing shallow parser. It has been successfully used to build a deep
functional dependency parser, as well as for the task of co-reference resolution, in a modular
way.
Robust methods in analysis of
natural language data
Authors: BALLIM AFZAL , PALLOTTA VINCENZO
Published: August 2002

The automated analysis of natural language data has become a central issue in the
design of intelligent information systems. Processing unconstrained natural language
data is still considered as an AI-hard task. However, various analysis techniques have
been proposed to address specific aspects of natural language. In particular, recent
interest has been focused on providing approximate analysis techniques, assuming
that when perfect analysis is not possible, partial results may be still very useful.
Cerebrospinal fluid pseudocyst of the breast
Authors: Kalra Naveen , Mani NBS , Jain M , Sidhu R , Gulati M , Suri S
Published: August 2002

Cerebrospinal fluid pseudocyst of the breast is a rare complication of ventriculoperitoneal shunt placement. Two cases of cerebrospinal pseudocyst of the breast are reported here. The mammography and ultrasound findings in these two cases are described.
Effect of lansoprazole on histamine‐induced acid secretion in isolated rabbit parietal cells
Authors: LI Xiao Bo , QIAN Jia Ming , CHEN Yuan Jia , CHEN Yuan Fang
Published: August 2002

OBJECTIVE:  Lansoprazole (Takepron; Takeda) is extensively used in the treatment of acid‐related diseases. There are no prior studies of the effects of antisecretion drugs on parietal cells, but we recently developed a rabbit parietal cell model. This allowed us to compare the antisecretory effects of lansoprazole and cimetidine in vitro in the present study.

METHODS:  Parietal cells were isolated using cell elutriation and continuous density gradient centrifugation. The effect of cimetidine and lansoprazole on histamine‐induced acid secretion in rabbit parietal cells was investigated by measuring the accumulation of 14C‐aminopurine.

RESULTS:  The purity and viability of isolated parietal cells was >80 and 95%, respectively. Lansoprazole and cimetidine both significantly inhibited histamine‐stimulated acid secretion (10−4 mol/L), but the 50% inhibition concentration (IC50) of the two treatments was quite different. The IC50 of cimetidine was 3.70 × 10−5 mol/L, and that of lansoprazole was 9.59 × 10−8 mol/L.

CONCLUSIONS:  Lansoprazole is much more effective than cimetidine in the in vitro inhibition of histamine‐stimulated acid secretion in rabbit parietal cells. This study developed a model for the study of acid inhibition drugs.
Novel triple expression hybrid clone from human sources for the detection of M2 antibodies
Authors: JIANG Xiao Hua , ZHONG Ren Qian , FAN Lie Ying , HU Yin , LI Wen Wen , CAO Lu Ning , KONG Xian Tao
Published: August 2002

OBJECTIVE:  Primary biliary cirrhosis (PBC) or, more accurately, chronic non‐suppurative destructive cholangitis, is a chronic cholestatic liver disease that is considered to have an autoimmune basis. In most patients, PBC is characterized by the presence of M2 antibodies. The major autoantigens recognized by M2 antibodies are members of the 2‐oxo‐acid dehydro­genase complex, including pyruvate dehydrogenase complex E2 (PDC‐E2), branched chain 2‐oxo‐acid dehydrogenase complex E2 (BCOADC‐E2), 2‐oxo‐glutarate dehydrogenase complex E2 (OGDC‐E2), E1 subunits of the pyruvate dehydrogenase complex and protein X of the PDC. The aim of this study was to express the immunodominant epitopes of BCOADC‐E2, PDC‐E2 and OGDC‐E2 separately, to create a triple hybrid clone (designated as BPO) containing epitopes of three autoantigens, and to use BPO as a tool for the detection of M2 antibodies specific for primary biliary cirrhosis (PBC).

METHODS:  The cDNA fragments from human sources encoding the M2‐reactive
epitopes of BCOADC‐E2, PDC‐E2 and OGDC‐E2 were amplified using reverse transcription−polymerase
chain reaction with total RNA extracted from human peripheral mononuclear blood
cells. The fragments were cloned into pQE‐30 and then transferred
into plasmid Escherichia coli M15. Transformants were induced
by isopropylthio‐β‐d‐galactoside and confirmed with sodium dodecyl sulfate−polyacrylamide gel electrophoresis and western blotting.

RESULTS:  Four specific proteins produced from the transformants containing the fused plasmid were shown to have antigenic reactivity with PBC sera, but not with normal control sera.

CONCLUSIONS:  We succeeded in expressing three immunodominant epitopes and a hybrid clone, which can be used as a powerful and specific tool for the detection of M2‐specific autoantibodies in the diagnosis of PBC.
Structural characteristics of the cag pathogenicity island and its significance in the classification of Chinese strains of Helicobacter pylori
Authors: LIU Jiong , XU Guo Ming , LI Zhao Shen , TU Zhen Xing , NIE Shi Nan , HOU Peng , GONG Yan Fang , JI Xu Huai
Published: August 2002

OBJECTIVE:  To investigate the structural characteristics of the cag pathogenicity island (PAI) and its significance in the classification in Chinese strains of Helicobacter pylori.

METHODS:  In 107 H. pylori strains isolated from Chinese patients, cagA, cagI, cagII, the cagI−cagII junction and IS605 were studied by using the polymerase chain reaction.

RESULTS:  The positive rates in Chinese H. pylori strains were 95.3% for cag PAI, 92.5% for cagA, 86.9% for cagI and 66.4% for cagII. There was no statistical difference among H. pylori strains from chronic gastritis, peptic ulcers or gastric carcinoma in the detectable rate of cag PAI, cagA, cagI or cagII (P > 0.05). Of the cag PAI‐negative strains, four came from cases of chronic gastritis and one from a patient with cardiac cancer. The products of the cagI−cagII junction were found in only five strains. The continuous cag PAI was much more common in duodenal ulcers than in chronic gastritis (P < 0.01). The positive rates of cagI and cagII were markedly different in chronic gastritis (P < 0.05). One strain of H. pylori tested positive for cagA but negative for other regions of the cag PAI. IS605 was less common in duodenal ulcers than in chronic gastritis (P < 0.05). The amplified fragment of IS605 in one strain from a gastric carcinoma was approximately 1580 bp in size, which was much longer than that in other strains.

CONCLUSION:  Our results indicate that the cag PAI is very common in Chinese strains of H. pylori. The structural variety of the cag PAI might be related to the virulence of H. pylori. It is suggested that H. pylori may be classified into different virulence groups according to differences in the structure of the cag PAI.
Efficacy and Safety of Eletriptan 20 Mg, 40 Mg and 80 Mg in Japanese Migraineurs
Authors: Fukuuchi Yasuo
Published: August 2002

This prospective multicentre, double-blind, randomized, parallel-group, placebo-controlled trial evaluated the efficacy and safety of a single dose of eletriptan 20 mg, 40 mg and 80 mg in Japanese migraineurs. A total of 402 adult Japanese migraineurs were diagnosed using International Headache Society (IHS) criteria. At 2 h after a single dose, the headache response rates of eletriptan 20 mg, 40 mg, 80 mg and placebo were 64%, 67%, 76% and 51%, respectively, with all doses significantly superior to placebo ( P< 0.05). Eletriptan had a statistically significant dose response for headache relief and pain-free response at 2 h post-dose ( P = 0.0011 and P = 0.0291, respectively). Most all-causality adverse events were mild and there were no deaths or discontinuations. Saliva samples were used to assess serum eletriptan levels 2 h post-dose. Pharmaco-kinetic evaluations showed no clinically significant differences between Japanese and Western subjects. Eletriptan was shown to be efficacious, safe, and well tolerated in Japanese migraineurs.
General binocular disorders: prevalence in a clinic population
Authors: Lara Francisco , Cacho Pilar , García Ángel , Megías Ramón
Published: August 2002

The purpose of this paper was to study the prevalence of nonstrabismic accommodative and binocular dysfunctions in a clinical population. We examined 265 symptomatic patients who were chosen from an optometric clinic. We performed several tests to diagnose any form of refractive, accommodative or binocular dysfunction. Of the 265 subjects examined, 59 patients (22.3%) had some form of accommodative or binocular dysfunction and required not just the correction of the refractive error but a specific treatment for each of the problems diagnosed. The remaining subjects were classed as having refractive anomalies. The frequency of binocular dysfunctions was 12.9%, and 9.4% for accommodative anomalies. Convergence excess (4.5%) was more prevalent than convergence insufficiency (0.8%) and accommodative excess (6.4%) more prevalent than accommodative insufficiency (3%).
A prospective study of contact lens wear in diabetes mellitus
Authors: O'Donnell Clare , Efron Nathan , Boulton Andrew J. M.
Published: August 2002

A prospective, controlled, observer‐masked study was conducted to investigate the suitability of contact lenses for patients with diabetes mellitus. Forty diabetic patients and 40 non‐diabetic control subjects were fitted with soft hydrogel contact lenses to be worn on a daily wear basis for 12 months. The ocular response was assessed using slit lamp biomicroscopy, ultrasonic pachometry, corneal aesthesiometry and visual acuity measures. Compared to non‐diabetic subjects, diabetic patients displayed significantly reduced corneal transparency, variable vision and reduced comfort with the contact lenses(p<0.05). There were no significant differences between the two groups with respect to ocular hyperaemia, corneal staining, corneal thickness, corneal sensitivity or high contrast visual acuity. Contrary to previous reports, the response of the diabetic eye to contact lenses—as observed clinically—does not differ appreciably from that of the non‐diabetic eye. These results suggest that current generation daily wear soft contact lenses can be a viable mode of vision correction for diabetic patients.
Chronic Daily Headache in Children and Adolescents Presenting to Tertiary Headache Clinics
Authors: Koenig Matthew A. , Gladstein Jack , McCarter Robert J. , Hershey Andrew D. , Wasiewski Warren , The Pediatric Committee of the American Headache Society
Published: August 2002

Background.—Adults with chronic daily headache often describe a transformation from episodic migraine and partial retention of migrainous features. Although chronic daily headache has not been investigated as carefully in the pediatric population, one study showed a predominance of coexisting daily headache and episodic migraine, without a clear history of transformation.

Objective.—To identify the clinical features of chronic daily headache in children and adolescents, to evaluate the efficacy of current headache classification criteria, and to compare the features of coexistent daily and episodic headaches so as to determine whether they represent separate syndromes or different stages in the “transformation” process.

Design.—We surveyed 189 consecutive patients, 18 years of age or younger, who presented for initial evaluation of daily or near daily headache at one of 9 tertiary headache clinics. Data were collected in semistructured interviews employing a standard questionnaire and analyzed using Statistical Analysis Systems and Stata statistical software computer programs.

Results.—Of the patients enrolled, 70% were female and 87% were white. Mean age was 13.0 ± 3.1 years. Male gender was associated with a higher degree of reported disability. A family history of headache (typically migraine) was described in 79%. Use of nonsteroidal anti‐inflammatory drugs 5 days per week or more was reported by 44% of patients. The International Headache Society (IHS) criteria failed to classify 64% of patients and criteria proposed by Silberstein et al failed to classify 31% of patients. Participating physicians misclassified patients according to criteria of the IHS and Silberstein et al in one third of cases. Nearly one quarter of patients reported two separate headache types with distinguishing characteristics. “Baseline” headache was present 27.3 ± 4.1 days per month with a mean pain intensity of 5.9 ± 2.1 on a 10‐point scale. Superimposed episodic headache occurred 4.7 ± 3.8 days per month with a mean pain intensity of 8.4 ± 1.4, and was more often accompanied by other migrainous symptoms. After logistic regression to control for pain intensity, the only statistically significant difference between the two headache types was a lower prevalence of tension‐type head pain with the superimposed headache.

Conclusions.—Our data suggest that rather than having two coexistent headache types, children and adolescents with chronic daily headache have a single syndrome that, in many cases, will paroxysmally worsen and gather migrainous features.
Hemicrania Continua Responds to Cyclooxygenase‐2 Inhibitors
Authors: Peres Mario F.P. , Silberstein Stephen D.
Published: August 2002

Background.—Hemicrania continua is a primary headache disorder defined by its absolute responsiveness to indomethacin. We report the treatment response to two cyclooxygenase‐2 inhibitors, celecoxib and rofecoxib, in a series of patients with hemicrania continua.

Methods.—Fourteen patients were treated, 9 with rofecoxib and 5 with celecoxib.

Results.—Three patients in each group had a complete response to treatment.

Conclusion.—The cyclooxygenase‐2 inhibitors may represent an alternative to indomethacin in the treatment of hemicrania continua. Their mechanism of action for this potential indication is unknown.
Hip Fracture in the Older Patient: Reasons for Delay in Hospitalization and Timing of Surgical Repair
Authors: Orosz Gretchen M. , L Hannan Edward , Magaziner Jay , Koval Kenneth , Gilbert Marvin , Aufses Arthur , Straus Elton , Vespe Ellen , Siu Albert L.
Published: August 2002

OBJECTIVES: To quantify the interval between injury and hospitalization in older hip fracture patients, to quantify the time from hospital arrival to surgical repair of hip fracture, and to describe factors contributing to extended intervals between injury, hospitalization, and surgical repair of hip fracture.

DESIGN: Prospective cohort study.

SETTING: Four hospitals in the New York City metropolitan area.

PARTICIPANTS: Consecutive patients aged 50 and older admitted with diagnosis of hip fracture to these four hospitals between August 1997 and August 1998.

MEASUREMENTS: Time of injury, time of arrival to the emergency room, and time of surgery were recorded and used to calculate intervals between injury and hospital arrival and between hospital arrival and surgical repair.

RESULTS: Of the 571 patients enrolled, 99 (17%) arrived at the hospital more than 24 hours after injury. After hospital arrival, 17 (3%) patients did not have surgery, 166 (29%) had surgery within 24 hours of arrival, and 388 (68.0%) had surgery more than 24 hours after arrival (median 41 hours, range 25–584). For those patients who had surgery after 24 hours, 163 (29.4%) had surgery 25 to 36 hours after hospital arrival, 102 (18.4%) had surgery 37 to 48 hours after arrival, and 123 (22.2%) had surgery more than 48 hours after arrival. The primary reasons for delaying surgery more than 24 hours after hospital arrival were waiting for routine medical clearance (52%) and unavailability of the operating suite or surgeon (29%). Stabilization of associated medical conditions resulted in the lengthiest periods of delay.

CONCLUSION: A wait time of more than 24 hours from hospitalization to surgical repair of hip fracture in older patients is common. Some of this delay time is patient related and some occurs because of systems factors and may be avoidable. The extent to which surgical timing affects survival and functional recovery needs more detailed examination.
Prediction of Fracture in Nursing Home Residents
Authors: Girman Cynthia J. , Chandler Julie M. , Zimmerman Sheryl I. , Martin Allison R. , Hawkes William , Hebel J. Richard , Sloane Philip D. , Magaziner Jay
Published: August 2002

OBJECTIVES:TTo investigate cross‐validated methods of identifying patients at increased risk of fracture in nursing homes using readily available data.

DESIGN:Prospective cohort study with 18 months of follow‐up.

SETTING:Forty‐seven randomly selected nursing homes in Maryland.

PARTICIPANTS:One thousand four hundred twenty‐seven white female nursing home residents aged 65 and older were followed for fracture for 18 months after baseline assessment.

MEASUREMENTS:Fracture ascertained by physician note or x‐ray from chart abstraction; demographic and baseline data extracted from the Minimum Data Set (MDS).

RESULTS:Exploratory analyses on a random subset (67%) of the data (development sample) identified variables that might be important in predicting subsequent fracture and included variables for how the resident moved between locations in her room or adjacent corridor (mobility), age, weight, height, independence in eating and dressing, urinary incontinence, resistance to care, falls in the previous 6 months, a dementia score, and other activities of daily living. A simple scoring algorithm derived from a subset of these MDS variables showed good sensitivity (.70) but low specificity (.39) in the random validation sample.

CONCLUSION:A scoring algorithm developed in more than 1,400 white females from 47 nursing homes in the state of Maryland shows high sensitivity for identifying women at increased risk for fracture and may be useful in targeting fracture prevention programs.
Implementation of Consultative Geriatric Recommendations: The Role of Patient–Primary Care Physician Concordance
Authors: Maly Rose C. , Leake Barbara , Frank Janet C. , DiMatteo M. Robin , Reuben David B.
Published: August 2002

OBJECTIVES: To examine the effect on primary care physicians' implementation and their patients' adherence behaviors of patient‐physician concordance about recommended geriatric health care.

DESIGN: Case‐series, independent interviews of patients and their physicians about their perceptions of the patients' health and the comprehensive geriatric assessment (CGA).

SETTING: Community.

PARTICIPANTS: Community‐dwelling older patients (n = 111) who received consultative outpatient CGA and their primary care physicians.

MEASUREMENTS: Concordance variables were generated using physician and patient responses to 10 questions on health‐ and CGA‐related perceptions. An overall concordance score was generated by summing the total number of items on which patients and physicians agreed. Measures of the two dependent variables (physician implementation of and patient adherence to CGA recommendations) were by self‐report.

RESULTS: In multiple logistic regression analyses, overall concordance between patient and physician proved to be a significant and powerful predictor of physician implementation of (adjusted odds ratio (OR) = 2.7, 95% confidence interval (CI) = 1.6–4.6, P < .001) and patient adherence to (OR = 2.7, 95% CI = 1.7–4.2, P < .001) CGA recommendations, controlling for patient and physician gender and age, patients' functional status, duration of the patient‐physician relationship, and frequency of visits in the previous year. Further analysis revealed that mutual patient‐physician concordance on health‐related perceptions was a significant predictor of these outcomes, whereas individual patient or physician perceptions were not.

CONCLUSION: Concordance between older patients and their primary care physicians is a powerful predictor of physician implementation of and patient adherence to outpatient consultative CGA recommendations. Future research should focus on ways physicians can assess and negotiate patient‐physician agreement on geriatric healthcare recommendations.
The Effect of Culture‐Positive Influenza Type A on Resource Use and Adverse Events in Nursing Home Residents
Authors: Drinka Paul J. , Krause Peggy , Nest Lori , Dissing Margaret , Gravenstein Stefan , Goodman Brian M.
Published: August 2002

OBJECTIVES: To determine adverse clinical events and resource utilization associated with culture‐positive influenza A in nursing home residents.

DESIGN: A retrospective cohort study with cases and controls.

SETTING: Seven hundred twenty‐one–bed skilled nursing facility.

PARTICIPANTS: One hundred fifty‐four residents (21% of all residents) from whom influenza A was isolated during the 1997/98 season and matched controls.

MEASUREMENTS: Baseline parameters, staff interventions, diagnostic tests, and adverse events were recorded from 60 days before to 60 days after specimen collection. The difference between each individual's before and after measurements determined excess utilization secondary to influenza. Controls were studied to determine time series effects.

RESULTS: Baseline Minimum Data Set and nutritional parameters demonstrated significantly greater (P < .05) feeding dependency and lower serum albumin in the control group. Time series effects in the control group were negligible. Among cases, there were nine deaths within 30 days; among controls, there were four (χ2P = .26). Within 30 days of onset, an average excess of 18 notations by nursing staff, one phone call to the physician, and one to family was noted per case. In half of cases, a nonscheduled physician visit was required. There was a 20% excess in physician orders for oxygen and bronchodilators. Chest x‐rays were performed in half of the cases, and antibiotics were prescribed to half. Sixteen percent of cases had radiographic pneumonia, and 2% had congestive heart failure. The average cost for excess chest x‐rays, laboratory services, antimicrobials, ambulance calls, hospital days, and emergency room and physician visits was $943.44. This does not include efforts by nursing home staff who accommodate functional decline on‐site.

CONCLUSION: An unexpected finding was that there were more impaired individuals who were less likely to have influenza detected or less likely to acquire influenza in the control group than in the influenza group. The morbidity, mortality, excess staff effort, and measured expenditure justify efforts to prevent influenza.
Paroxysmal Finger Haematomas (Achenbach’s Syndrome) with Angiographic Abnormalities
Authors: ROBERTSON A. , LIDDINGTON M. I. , KAY S. P.
Published: August 2002

We present two cases of women with Achenbach’s syndrome (paroxysmal finger haematomas) with abnormal angiograms.
Digital Artery Damage Associated with Closed Crush Injuries
Authors: REAGAN D. S. , GRUNDBERG A. B. , REAGAN J. M.
Published: August 2002

This retrospective study describes closed finger crush injuries in seven patients (eight fingers) in which each finger sustained a loss of blood supply. Clinical findings included numbness, decreased two-point and sharp/dull sensation, cyanosis or pallor, and decreased capillary filling. Fractures, especially transverse fractures near the proximal interphalangeal joint or distal interphalangeal joint, were usually present and often showed longitudinal crush fracture lines. Exploration and revascularization were carried out in seven fingers, all of which survived. The only finger not explored progressed to necrosis and amputation. Crush injuries to the fingers, especially those associated with displaced fractures, should be carefully evaluated for symptoms and signs of ischaemia.
An Allograft Salvage Technique for Failure of the Darrach Procedure: A Report of Four Cases
Authors: SOTEREANOS D. G. , GÖBEL F. , VARDAKAS D. G. , SARRIS I.
Published: August 2002

We report on four patients with failed resections of the distal ulna causing instability and impingement, who were treated with a tendon allograft to stabilize and buffer the ulnar stump. In three of the four patients the outcome was excellent. We believe that this new technique holds promise as an alternative salvage procedure for the failed Darrach resection.
Proximal Interphalangeal Joint Instability: A Dynamic Technique for Stabilization
Authors: AHMED H. A. , GOLDIE B. S.
Published: August 2002

Chronic, disabling, proximal interphalangeal joint instability is difficult to treat. We describe a method of stabilizing an unstable proximal interphalangeal joint using an adaptation of the oblique retinacular ligament reconstruction.
Tendon Grafting for Multiple Extensor Tendon Ruptures of Fingers in Rheumatoid Hands
Authors: NAKAMURA S. , KATSUKI M.
Published: August 2002

We assessed the outcome of tendon grafting of multiple finger extensor tendon ruptures in 14 patients with rheumatoid arthritis. Extensor lags improved from a preoperative mean of 33° (range, 20°–65°) to a postoperative mean of 18° (range, 0–60°). However, loss of finger flexion was observed, with a mean postoperative fingertip to palm distance of 1.6 (range: 0–7.5) cm. Patient satisfaction correlated with the fingertip to palm distance, though not with the postoperative extensor lag. Because of the loss of finger flexion which was probably due to muscle contracture, we conclude that the results of tendon grafts in this situation are unsatisfactory.
The Role of Biofilm Formation in Percutaneous Kirschner-Wire Fixation of Radial Fractures
Authors: HARGREAVES D. G. , PAJKOS A. , DEVA A. K. , VICKERY K. , FILAN S. L. , TONKIN M. A.
Published: August 2002

This study examines the formation of bacterial biofilms on percutaneous wires used for fracture fixation. Twelve control (clinically uninfected) wires and ten infected wires were collected and examined using broth culture and scanning electron microscopy. Three of the 12 control wires grew Staphylococcus spp. with very low bacterial counts in their percutaneous portions. In the clinically infected wires, six wires in four subjects had positive cultures in their percutaneous portions and four of these also had positive cultures in their deep portions with much higher bacterial counts than the controls. In two patients (four wires) treated with antibiotics, cultures were negative except for the percutaneous portion of one wire. Scanning electron microscopy did not reveal bacterial biofilm formation, but biological deposit without bacteria was noted on most wires. During the 6 weeks of fracture fixation, some bacterial colonization of wires occurred, but bacteria did not form biofilms which may increase bacterial resistance to systemic antibiotics, cause implant loosening and act as a source of late infection.
Double Hand Transplantation: Functional Outcome after 18 Months
Authors: PIZA-KATZER H. , NINKOVIC M. , PECHLANER S. , GABL M. , NINKOVIC M. , HUSSL H.
Published: August 2002

In March 2000, we performed a double hand transplantation on a patient who had suffered traumatic hand amputations 6 years previously. The transplantations were both successful and, 18 months later, the patient has regained some complex hand functions and remarkably good tactile gnosis.
The Dynamic Radioulnar Convergence of the Darrach Procedure and the Ulnar Head Hemiresection Interposition Arthroplasty: A Biomechanical Study
Authors: SAUERBIER M. , FUJITA M. , HAHN M. E. , NEALE P. G. , BERGER R. A.
Published: August 2002

Resection of the entire ulnar head (Darrach operation) and the hemiresection interposition arthroplasty are common methods of treating the arthritic distal radioulnar joint (DRUJ). Biomechnical investigation about both of these procedures is lacking. The purpose of this study was to evaluate the dynamic effects of both the hemiresection interposition arthroplasty and the Darrach procedure on radioulnar convergence and dorsal–palmar displacement and to compare their biomechanical behaviours. With a dynamic computer-controlled testing device, cadaveric forearm rotation was performed with simultaneous loading of relevant muscles. Torque along the forearm axis was generated by simulated muscle action through pneumoactuators attached to relevant tendons while the wrist was constrained to prescribed ranges of motion. The instability of the radius relative to the ulna was evaluated using displacement data of digitized landmarks in an ulnar coordinate system. Seven fresh-frozen cadaver upper extremities were used. The Darrach resection created an extreme instability of the forearm with movement of the radius ulnarly. Anteroposterior translations in each loading condition could also be detected, but the magnitude of displacement was small and less predictable. The results of the hemiresection interposition arthroplasty demonstrated significantly less instability compared with the Darrach results.
Stage 3 KienbÖck’s Disease: Reconstruction of the Fractured Lunate using a Free Vascularized Iliac Bone Graft and External Fixation
Authors: GABL M. , LUTZ M. , REINHART Cl. , ZIMMERMANN R. , PECHLANER S. , HUSSL H. , RIEGER M.
Published: August 2002

Eighteen patients with stage 3 Kienböck’s disease were treated by débridement of the necrotic core of the lunate and implantation of a free vascularized corticocancellous iliac bone. The wrist was stabilized with an external fixator during healing. The efficiency of the procedure for restoring the structure of the fractured lunate, preventing carpal collapse and improving the clinical outcome was assessed at a mean follow-up of 5 years. The graft became incorporated in the lunate in 16 of the 18 patients and no fracture of the reconstructed lunate or carpal collapse occurred in these cases. The graft did not integrate and was resorbed in the other two patients.
Comparison of the Mechanical Properties of Polyglycolide-Trimethylene Carbonate (Maxon) and Polydioxanone Sutures (PDS2) used for Flexor Tendon Repair and Active Mobilization
Authors: WADA A. , KUBOTA H. , TAKETA M. , MIURA H. , IWAMOTO Y.
Published: August 2002

Thirty-six canine flexor digitorum profundus tendons were repaired using 5-0 polyglycolide-trimethylene carbonate monofilament (Maxon) or polydioxanone monofilament (PDS2). All the tendons healed without rupture or formation of gaps of more than 2 mm. Mechanically, all tendon repairs had sufficient tensile strength to enable active mobilization. Polyglycolide-trimethylene carbonate (Maxon) repairs were initially superior in gap and ultimate strength to polydioxanone (PDS2) repairs. However, the gap and ultimate tensile strength of polyglycolide-trimethylene carbonate (Maxon) repairs had decreased significantly at day 14, whereas polydioxanone (PDS2) repairs maintained their strength throughout the 28-day observation period.
The Re-Attachment of Tendon and Ligament Avulsions
Authors: GRANT I. , PANDYA A. , MAHAFFEY P. J.
Published: August 2002

This paper presents our experience of a new technique for the reattachment of tendons in the hand. A percutaneous Kirschner wire is fashioned into a hoop to support an intratendinous suture. This mechanism maintains continuous traction upon the avulsed tendon. The technique avoids extensive dissection of the fingertip and the direct application of pressure on the dorsal surface of the digit, which might cause skin breakdown.
Hand Exsanguination: Prospective Randomised Blind Study of an Established Versus a Modified Technique
Authors: HARRIS P. C. , SCOTT S. , EVANS R. A.
Published: August 2002

One hundred patients undergoing elective hand surgery were randomized to have their hands exsanguinated by either the Rhys-Davies exsanguinator alone or the Rhys-Davies exsanguinator supplemented by a 500 ml bag of intravenous fluid which was placed in the patient’s palm as the exsanguinator was rolled up the limb. The quality of the exsanguination was assessed by the surgeon using a pre-defined subjective scoring system. There were no significant differences in the exsanguination scores of the two treatment groups.
Increased Suture Embedment in Tendons: An Effective Method to Improve Repair Strength
Authors: WANG B. , TANG J. B.
Published: August 2002

We evaluated the effect of length of suture embedment within tendons on the tensile strength of repaired tendons. Thirty fresh pig flexor tendons were divided into three groups and subjected to repairs with the Halsted tendon sutures in which 1/3, 1/2, and 2/3 of the length of the longitudinal sutures was embedded within the tendons. The repaired tendons were pulled to complete failure by an Instron tensile testing machine. The 2 mm gap-formation force, ultimate strength, stiffness, and energy to failure were greatest when 2/3 of the suture length was embedded within the tendon. The results indicate that suture embedment is an important contributor to the tensile properties of the repair, and that increase in length of suture embedment is an effective way to strengthen tendon repairs.
Functional Benefit of Dupuytren’s Surgery
Authors: SINHA R. , CRESSWELL T. R. , MASON R. , CHAKRABARTI I.
Published: August 2002

The results of surgery for Dupuytren’s disease were prospectively assessed to see if there is a correlation between hand function, the degree of deformity and the post-operative result. A total of 42 patients were followed-up for 6 months. The mean flexion deformity was 81° pre-operatively and 32° post-operatively. The mean Sollerman score improved from 71 (out of 80) pre-operatively to 77 post-operatively. There was a significant correlation between the degree of deformity and the Sollerman score, and also between the improvement in deformity after surgery, and the Sollerman score. We conclude that hand function is worsened by increasing deformity in Dupuytren’s disease and improved by correction of the deformity.