bluuebunny/crossref_metadata_2025 huggingface dataset:
A General Construction Method of Simultaneous Confounding in pn - Factorial Experiment
Authors: Jalil M.A.
Published: August 2012

A general construction method of simultaneous confounding in pn ( p is prime) factorial experiment is proposed. The concept of matrix method in the construction of factorial experiment with a single factorial effect confounded is used to develop the method. The procedure may be extended for the construction of simultaneous confounding of factorial experiment with three or more factorial effects confounded.DOI: http://dx.doi.org/10.3329/dujs.v60i2.11531 Dhaka Univ. J. Sci. 60(2): 265-270, 2012 (July)
Annealing Effects on the Properties of Chemically Deposited CdS Thin Films at Ambient Condition
Authors: Mustafa G. , Chowdhury M.R.I. , Saha D.K. , Hussain S. , Islam O.
Published: August 2012

Chemically-deposited CdS thin films have been investigated using various techniques to discuss annealing effects on the structural, morphological, optical and electrical properties of the films. It has been observed from XRD that the deposited layers are mainly consisting of CdS phase. After annealing, metastable cubic phase was transformed into stable hexagonal phase. The average grain sizes were found to increase and the lattice constant, micro-strain and dislocation density were found to decrease after annealing. Optical absorption measurements show that band gap is observed to be 2.42 eV for as deposited and be 2.27 eV upon heat treatment at 673 K for one hour in air. The conductivity of this film has been determined by I-V measurement and observed to increase with increase of temperature. The activation energy of electrical conductivity of this film is also determined.DOI: http://dx.doi.org/10.3329/dujs.v60i2.11536 Dhaka Univ. J. Sci. 60(2): 283-288, 2012 (July)
Traditional Practice vs. New Tools and Routines in Stroke Treatment
Authors: Nilsen Line Lundvoll , Solvoll Terje
Published: August 2012

In Norway, it is a national goal to provide more patients with thrombolytic treatment. A referring hospital and a specialist hospital have implemented videoconferencing (VC) equipment to share knowledge and discuss stroke patients, regarding thrombolytic treatment. VC has only been used four times within the 19 months that the service has been available. The objective in this article is to increase the understanding of the contradiction between the need for knowledge-sharing through VC technology, as well as the reasons for low frequency of use when discussing stroke patients. Semi-structured interviews were conducted with 13 professionals. The results illustrate how the technology per se is not the reason for the low frequency use. Health care is shaped by behavior, traditional rules, standards and division of labor. By using cultural historical activity theory (CHAT) as a framework, we illustrate the importance of understanding the historic way of performing an activity to be able to expand the treatment activity in the future.
Land Use Zoning at the County Level Based on a Multi-Objective Particle Swarm Optimization Algorithm: A Case Study from Yicheng, China
Authors: Liu Yaolin , Wang Hua , Ji Yingli , Liu Zhongqiu , Zhao Xiang
Published: August 2012

Comprehensive land-use planning (CLUP) at the county level in China must include land-use zoning. This is specifically stipulated by the China Land Management Law and aims to achieve strict control on the usages of land. The land-use zoning problem is treated as a multi-objective optimization problem (MOOP) in this article, which is different from the traditional treatment. A particle swarm optimization (PSO) based model is applied to the problem and is developed to maximize the attribute differences between land-use zones, the spatial compactness, the degree of spatial harmony and the ecological benefits of the land-use zones. This is subject to some constraints such as: the quantity limitations for varying land-use zones, regulations assigning land units to a certain land-use zone, and the stipulation of a minimum parcel area in a land-use zoning map. In addition, a crossover and mutation operator from a genetic algorithm is adopted to avoid the prematurity of PSO. The results obtained for Yicheng, a county in central China, using different objective weighting schemes, are compared and suggest that: (1) the fundamental demand for attribute difference between land-use zones leads to a mass of fragmentary land-use zones; (2) the spatial pattern of land-use zones is remarkably optimized when a weight is given to the sub-objectives of spatial compactness and the degree of spatial harmony, simultaneously, with a reduction of attribute difference between land-use zones; (3) when a weight is given to the sub-objective of ecological benefits of the land-use zones, the ecological benefits get a slight increase also at the expense of a reduction in attribute difference between land-use zones; (4) the pursuit of spatial harmony or spatial compactness may have a negative effect on each other; (5) an increase in the ecological benefits may improve the spatial compactness and spatial harmony of the land-use zones; (6) adjusting the weights assigned to each sub-objective can generate a corresponding optimal solution, with a different quantity structure and spatial pattern to satisfy the preference of the different decision makers; (7) the model proposed in this paper is capable of handling the land-use zoning problem, and the crossover and mutation operator can improve the performance of the model, but, nevertheless, leads to increased time consumption.
Constituents from Vigna vexillata and Their Anti-Inflammatory Activity
Authors: Leu Yann-Lii , Hwang Tsong-Long , Kuo Ping-Chung , Liou Kun-Pei , Huang Bow-Shin , Chen Guo-Feng
Published: August 2012

The seeds of Vigna genus are important food resources and there have already been many reports regarding their bioactivities. In our preliminary bioassay, the chloroform layer of methanol extracts of V. vexillata demonstrated significant anti-inflammatory bioactivity. Therefore, the present research is aimed to purify and identify the anti-inflammatory principles of V. vexillata. One new sterol (1) and two new isoflavones (2,3) were reported from the natural sources for the first time and their chemical structures were determined by the spectroscopic and mass spectrometric analyses. In addition, 37 known compounds were identified by comparison of their physical and spectroscopic data with those reported in the literature. Among the isolates, daidzein (23), abscisic acid (25), and quercetin (40) displayed the most significant inhibition of superoxide anion generation and elastase release.
Structural and Catalytic Differences between Two FADH2-Dependent Monooxygenases: 2,4,5-TCP 4-Monooxygenase (TftD) from Burkholderia cepacia AC1100 and 2,4,6-TCP 4-Monooxygenase (TcpA) from Cupriavidus necator JMP134
Authors: Hayes Robert P. , Webb Brian N. , Subramanian Arun Kumar , Nissen Mark , Popchock Andrew , Xun Luying , Kang ChulHee
Published: August 2012

2,4,5-TCP 4-monooxygenase (TftD) and 2,4,6-TCP 4-monooxygenase (TcpA) have been discovered in the biodegradation of 2,4,5-trichlorophenol (2,4,5-TCP) and 2,4,6-trichlorophenol (2,4,6-TCP). TcpA and TftD belong to the reduced flavin adenine dinucleotide (FADH2)-dependent monooxygenases and both use 2,4,6-TCP as a substrate; however, the two enzymes produce different end products. TftD catalyzes a typical monooxygenase reaction, while TcpA catalyzes a typical monooxygenase reaction followed by a hydrolytic dechlorination. We have previously reported the 3D structure of TftD and confirmed the catalytic residue, His289. Here we have determined the crystal structure of TcpA and investigated the apparent differences in specificity and catalysis between these two closely related monooxygenases through structural comparison. Our computational docking results suggest that Ala293 in TcpA (Ile292 in TftD) is possibly responsible for the differences in substrate specificity between the two monooxygenases. We have also identified that Arg101 in TcpA could provide inductive effects/charge stabilization during hydrolytic dechlorination. The collective information provides a fundamental understanding of the catalytic reaction mechanism and the parameters for substrate specificity. The information may provide guidance for designing bioremediation strategies for polychlorophenols, a major group of environmental pollutants.
Data Analysis Strategies for Protein Microarrays
Authors: Díez Paula , Dasilva Noelia , González-González María , Matarraz Sergio , Casado-Vela Juan , Orfao Alberto , Fuentes Manuel
Published: August 2012

Microarrays constitute a new platform which allows the discovery and characterization of proteins. According to different features, such as content, surface or detection system, there are many types of protein microarrays which can be applied for the identification of disease biomarkers and the characterization of protein expression patterns. However, the analysis and interpretation of the amount of information generated by microarrays remain a challenge. Further data analysis strategies are essential to obtain representative and reproducible results. Therefore, the experimental design is key, since the number of samples and dyes, among others aspects, would define the appropriate analysis method to be used. In this sense, several algorithms have been proposed so far to overcome analytical difficulties derived from fluorescence overlapping and/or background noise. Each kind of microarray is developed to fulfill a specific purpose. Therefore, the selection of appropriate analytical and data analysis strategies is crucial to achieve successful biological conclusions. In the present review, we focus on current algorithms and main strategies for data interpretation.
N-Substituted 5-Chloro-6-phenylpyridazin-3(2H)-ones: Synthesis, Insecticidal Activity Against Plutella xylostella (L.) and SAR Study
Authors: Wu Jian , Kang Shenghong , Yuan Qinkun , Luo Lijun , Ma Juan , Shi Qingcai , Yang Song
Published: August 2012

A series of N-substituted 5-chloro-6-phenylpyridazin-3(2H)-one derivatives were synthesized based on our previous work; all compounds were characterized by spectral data and tested for in vitro insecticidal activity against Plutella xylostella. The results showed that the synthesized pyridazin-3(2H)-one compounds possessed good insecticidal activities, especially the compounds 4b, 4d, and 4h which showed > 90% activity at 100 mg/L. The structure-activity relationships (SAR) for these compounds were also discussed.
A New Natural Lactone from Dimocarpus longan Lour. Seeds
Authors: Zheng Gongming , Wei Xiaoyi , Xu Liangxiong , Li Zhongjun , Liu Gangyong , Zhang Xiance
Published: August 2012

A new natural product named longanlactone was isolated from Dimocarpus longan Lour. seeds. Its structure was determined as 3-(2-acetyl-1H-pyrrol-1-yl)-5-(prop-2-yn-1-yl)dihydrofuran-2(3H)-one by spectroscopic methods and HRESIMS.
Rafts, Nanoparticles and Neural Disease
Authors: Gulati Vishal , Wallace Ron
Published: August 2012

This review examines the role of membrane rafts in neural disease as a rationale for drug targeting utilizing lipid-based nanoparticles. The article begins with an overview of methodological issues involving the existence, sizes, and lifetimes of rafts, and then examines raft function in the etiologies of three major neural diseases—epilepsy, Parkinson’s disease, and Alzheimer’s disease—selected as promising candidates for raft-based therapeutics. Raft-targeting drug delivery systems involving liposomes and solid lipid nanoparticles are then examined in detail.
A Wide Linear Range Eddy Current Displacement Sensor Equipped with Dual-Coil Probe Applied in the Magnetic Suspension Flywheel
Authors: Fang Jiancheng , Wen Tong
Published: August 2012

The Eddy Current Displacement Sensor (ECDS) is widely used in the Magnetic Suspension Flywheel (MSFW) to measure the tiny clearance between the rotor and the magnetic bearings. The linear range of the ECDS is determined by the diameter of its probe coil. Wide clearances must be measured in some new MSFWs recently designed for the different space missions, but the coil diameter is limited by some restrictions. In this paper, a multi-channel ECDS equipped with dual-coil probes is proposed to extend the linear range to satisfy the demands of such MSFWs. In order to determine the best configuration of the dual-coil probe, the quality factors of the potential types of the dual-coil probes, the induced eddy current and the magnetic intensity on the surface of the measuring object are compared with those of the conventional single-coil probe. The linear range of the ECDS equipped with the selected dual-coil probe is extended from 1.1 mm to 2.4 mm under the restrictions without adding any cost for additional compensation circuits or expensive coil materials. The effectiveness of the linear range extension ability and the dynamic response of the designed ECDS are confirmed by the testing and the applications in the MSFW.
An Integrative Architecture for a Sensor-Supported Trust Management System
Authors: Trček Denis
Published: August 2012

Trust plays a key role not only in e-worlds and emerging pervasive computing environments, but also already for millennia in human societies. Trust management solutions that have being around now for some fifteen years were primarily developed for the above mentioned cyber environments and they are typically focused on artificial agents, sensors, etc. However, this paper presents extensions of a new methodology together with architecture for trust management support that is focused on humans and human-like agents. With this methodology and architecture sensors play a crucial role. The architecture presents an already deployable tool for multi and interdisciplinary research in various areas where humans are involved. It provides new ways to obtain an insight into dynamics and evolution of such structures, not only in pervasive computing environments, but also in other important areas like management and decision making support.
Vision-Based Sensor for Early Detection of Periodical Defects in Web Materials
Authors: Bulnes Francisco G. , Usamentiaga Rubén , García Daniel F. , Molleda Julio
Published: August 2012

During the production of web materials such as plastic, textiles or metal, where there are rolls involved in the production process, periodically generated defects may occur. If one of these rolls has some kind of flaw, it can generate a defect on the material surface each time it completes a full turn. This can cause the generation of a large number of surface defects, greatly degrading the product quality. For this reason, it is necessary to have a system that can detect these situations as soon as possible. This paper presents a vision-based sensor for the early detection of this kind of defects. It can be adapted to be used in the inspection of any web material, even when the input data are very noisy. To assess its performance, the sensor system was used to detect periodical defects in hot steel strips. A total of 36 strips produced in ArcelorMittal Avilés factory were used for this purpose, 18 to determine the optimal configuration of the proposed sensor using a full-factorial experimental design and the other 18 to verify the validity of the results. Next, they were compared with those provided by a commercial system used worldwide, showing a clear improvement.
Development of a Plastic-Based Microfluidic Immunosensor Chip for Detection of H1N1 Influenza
Authors: Lee Kyoung G. , Lee Tae Jae , Jeong Soon Woo , Choi Ho Woon , Heo Nam Su , Park Jung Youn , Park Tae Jung , Lee Seok Jae
Published: August 2012

Lab-on-a-chip can provide convenient and accurate diagnosis tools. In this paper, a plastic-based microfluidic immunosensor chip for the diagnosis of swine flu (H1N1) was developed by immobilizing hemagglutinin antigen on a gold surface using a genetically engineered polypeptide. A fluorescent dye-labeled antibody (Ab) was used for quantifying the concentration of Ab in the immunosensor chip using a fluorescent technique. For increasing the detection efficiency and reducing the errors, three chambers and three microchannels were designed in one microfluidic chip. This protocol could be applied to the diagnosis of other infectious diseases in a microfluidic device.
Femoral Tunnel Drilling From the Anteromedial Portal Using the Figure-4 Position in ACL Reconstruction
Authors: George Michael S.
Published: August 2012

Creation of the femoral tunnel in anterior cruciate ligament (ACL) reconstruction via the anteromedial portal can reproducibly achieve femoral tunnel positioning at the center of the femoral ACL footprint. Anteromedial portal drilling requires knee hyperflexion, which is awkward to perform. Knee hyperflexion to 120° can easily be achieved in the figure-4 position for femoral tunnel drilling via the anteromedial portal. The leg is hyperflexed in the figure-4 position on a Mayo stand. The offset femoral guide, guidewire, and drill are placed at the femoral ACL footprint via the anteromedial portal to create the femoral tunnel.
Cloud-based Preoperative Planning for Total Hip Arthroplasty: A Study of Accuracy, Efficiency, and Compliance
Authors: Maratt Joseph D. , Srinivasan Ramesh C. , Dahl William J. , Schilling Peter L. , Urquhart Andrew G.
Published: August 2012

As digital radiography becomes more prevalent, several systems for digital preoperative planning have become available. The purpose of this study was to evaluate the accuracy and efficiency of an inexpensive, cloud-based digital templating system, which is comparable with acetate templating. However, cloud-based templating is substantially faster and more convenient than acetate templating or locally installed software. Although this is a practical solution for this particular medical application, regulatory changes are necessary before the tremendous advantages of cloud-based storage and computing can be realized in medical research and clinical practice.
Tibial Tubercle Avulsion Fractures in Adolescent Basketball Players
Authors: Jakoi Andre , Freidl Michael , Old Andrew , Javandel Mitra , Tom James , Realyvasquez Juan
Published: August 2012

Tibial tubercle avulsion fractures most commonly occur in adolescent boys and usually result from pushing off or landing while jumping. These fractures are relatively uncommon but can have a significant functional effect. The purpose of this study was to determine the long-term outcome with return to play in 8 adolescent basketball players with at least 4 years of postoperative reconditioning. Results with return to play at the preinjury level are favorable after treatment of acute tibial avulsion fractures in adolescent basketball players. Long-term outcome was excellent in all patients regardless of fracture type. Open reduction and internal fixation using 1 or 2 cancellous bone screws achieved union in all cases.
Comparison of Initial Nonoperative and Operative Management of Radial Nerve Palsy Associated With Acute Humeral Shaft Fractures
Authors: Liu Geng-yan , Zhang Chao-yue , Wu Hong-wei
Published: August 2012

Educational Objectives

As a result of reading this article, physicians should be able to:

1.

Become familiar with the available treatment approaches for radial nerve palsy associated with humeral shaft fractures.

2.

Understand the strengths and limitations of the current treatment approaches for radial nerve palsy associated with humeral shaft fractures.

3.

Become familiar with the available evidence regarding the effectiveness of operative and nonoperative treatment for radial nerve palsy associated with humeral shaft fractures.

4.

Understand when operative or nonoperative management of radial nerve palsy associated with humeral shaft fractures may be appropriate.
Revision Total Hip Arthroplasty in Jehovah’s Witnesses
Authors: Harwin Steven F. , Pivec Robert , Johnson Aaron J. , Naziri Qais , Mont Michael A.
Published: August 2012

Revision total hip arthroplasty (THA) is associated with greater blood loss than primary THA. Jehovah’s Witnesses will not accept transfusions of blood or blood products and are thus at an increased risk for complications due to perioperative anemia. The purpose of this study was to report the clinical outcomes, radiographic outcomes, morbidity, and mortality of Jehovah’s Witnesses who were medically optimized and underwent revision THA.

Databases from 2 institutions were reviewed to identify 10 patients (11 THAs) who were Jehovah’s Witnesses undergoing revision THA with a minimum 24-month follow-up. At most recent follow-up, all patients were doing well clinically, with Harris Hip Scores greater than 80 points. Radiographic evaluation demonstrated well-positioned components and no progressive radioluciencies. No major perioperative medical or surgical complications occurred in patients undergoing THA. Revision THA for aseptic causes results in good clinical outcomes in patients who are preoperatively optimized before undergoing surgery.
Repair of Pectoralis Major Ruptures: Single-surgeon Case Series
Authors: Garrigues Grant E. , Kraeutler Matthew J. , Gillespie Robert J. , O’Brien Daniel F. , Lazarus Mark D.
Published: August 2012

Rupture of the pectoralis major is an uncommon injury that can lead to pain, loss of strength, and cosmetic deformity. The purpose of this study was to analyze the outcome of pectoralis major repairs by a single surgeon.

Twenty-four patients who underwent pectoralis major repair by the senior author (M.D.L.) between May 2005 and March 2011 were retrospectively identified. Patients were assessed at least 6 months postoperatively with the use of various questionnaires, including the Penn Shoulder Score, American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment Form, and Single Assessment Numeric Evaluation (SANE). All patients were men with an injury to the sternal head of the pectoralis. Most (16/24; 67%) patients sustained the injury while bench or incline bench pressing. Nineteen (79%) patients were successfully contacted for follow-up. Of these, an average preinjury bench press of 318 lb (range, 145–525 lb) was restored to an average of 264 lb (range, 100–500 lb) at follow-up. Average preoperative Penn Shoulder Score was 60 points (range, 33–77 points), improving to 94 points (range, 64–100 points) at last follow-up (
P
=.011). Average postoperative ASES and SANE scores were 96 points (range, 60–100 points) and 93 points (range, 50–100 points), respectively. All but 1 patient were rated excellent (14/19; 74%) or good (4/19; 21%) by the Bak criteria.

Operative treatment of pectoralis major rupture yields high patient satisfaction and allows predictable return of comfort, range of motion, cosmesis, and overall limb strength, with a slightly less predictable return of maximum bench press strength.
Clinical Results of Treatment Using a Clavicular Hook Plate Versus a T-plate in Neer Type II Distal Clavicle Fractures
Authors: Tan Hong-Lve , Zhao Jin-Kun , Qian Chen , Shi Yan , Zhou Qi
Published: August 2012

AO clavicular hook plate fixation provides more rigid fixation and good bony union rates for Neer type II distal clavicular fractures. However, the hook may cause rotator cuff tears and subacromial impingement, which adversely affect the clinical results. T-plate fixation is another surgical method of treatment for unstable clavicle fractures, and its clinical efficacy has been demonstrated. The purpose of this study was to compare the clinical outcomes of AO clavicular hook plate and T-plate fixation for Neer type II distal clavicular fractures.

Forty-two patients with Neer type II fractures were divided into 2 groups. The hook plate group comprised 23 patients who underwent hook plate fixation, and the T-plate group comprised 19 patients who underwent distal radius volar locking T-plate fixation. Hook plates were removed 3 to 14 months postoperatively in 15 patients because of shoulder function limitations. All patients were evaluated postoperatively for shoulder pain, activities of daily living, range of motion, strength, and satisfaction according to the University of California, Los Angeles (UCLA) Shoulder rating scale. All fractures in the 2 groups achieved stable fixation and bony union. Both groups yielded similar outcomes with regard to shoulder strength and patient satisfaction (
P
=.207 and
P
=.398, respectively). Significant differences existed between the 2 groups in the mean scores of shoulder pain, activities of daily living, range of motion, and total UCLA score (
P
=.001,
P
=.011,
P
=.038, and
P
=.001, respectively). More patients (74%) in the hook plate group had mild to severe shoulder pain than in the T-plate group (16%). However, shoulder pain was relieved and function improved significantly after removal of the hook plate (
P
=.001).
Immediate Weight Bearing of Comminuted Supracondylar Femur Fractures Using Locked Plate Fixation
Authors: Granata Jaymes D. , Litsky Alan S. , Lustenberger David P. , Probe Robert A. , Ellis Thomas J.
Published: August 2012

Comminuted supracondylar femur fractures (AO-OTA 33A3) are commonly treated with locked plates. Weight bearing is generally restricted for 6 to 12 weeks until radiologic evidence exists of sufficient callous to support weight bearing. Recent clinical studies have reported high nonunion rates with distal femur locked plates. In an attempt to induce beneficial motion across the fracture site, some studies have recommended earlier weight bearing. The purpose of the current study was to determine the biomechanical feasibility of an immediate weight-bearing rehabilitation protocol to encourage healing of distal femur fractures treated with lateral locked plate fixation.

Sixteen fresh-frozen cadaveric femora were used for this study. A 2.5-cm supracondylar gap osteotomy was made. Ten-hole, 4.5-mm distal femur locking plates were used with a standardized screw configuration that maximized the working length. The specimens were placed in a servohydraulic testing machine and axially loaded (unidirectional) at 1 Hz for up to 200,000 cycles. Failure was defined as 1 cm of deformation of the construct. The staircase method was used to determine the fatigue limit of the construct. The fatigue limit was calculated to be 1329±106 N. No specimen failed through the non-locking diaphyseal screws. Plastic deformation, when present, occurred at the metaphyseal flare of the plate. The fatigue limit of the locked plate constructs equaled 1.9 times body weight for an average 70-kg patient over a simulated 10-week postoperative course. Given that distal femoral loads during gait have been estimated to be more than 2 times body weight, the data from this study do not support immediate full weight bearing.
Analysis of the Basic Science Section of the Orthopaedic In-Training Examination
Authors: Sheibani-Rad Shahin , Arnoczky Steven Paul , Walter Norman E.
Published: August 2012

Since 1963, the Orthopaedic In-Training Examination (OITE) has been administered to orthopedic residents to assess residents’ knowledge and measure the quality of teaching within individual programs. The OITE currently consists of 275 questions divided among 12 domains. This study analyzed all OITE basic science questions between 2006 and 2010. The following data were recorded: number of questions, question taxonomy, category of question, type of imaging modality, and recommended journal and book references. Between 2006 and 2010, the basic science section constituted 12.2% of the OITE. The assessment of taxonomy classification showed that recall-type questions were the most common, at 81.4%. Imaging modalities typically involved questions on radiographs and constituted 6.2% of the OITE basic science section. The majority of questions were basic science questions (eg, genetics, cell replication, and bone metabolism), with an average of 26.4 questions per year. The
Journal of Bone & Joint Surgery (American Volume)
and the American Academy of Orthopaedic Surgeons’
Orthopaedic Basic Science
were the most commonly and consistently cited journal and review book, respectively.

This study provides the first review of the question content and recommended references of the OITE basic science section. This information will provide orthopedic trainees, orthopedic residency programs, and the American Academy of Orthopaedic Surgeons Evaluation Committee valuable information related to improving residents’ knowledge and performance and optimizing basic science educational curricula.
Is the 22 Modifier Worth It?
Authors: Richman James H. , Mears Simon C. , Ain Michael C.
Published: August 2012

The 22 modifier is a Current Procedural Terminology code modifier that allows surgeons to receive additional reimbursement for complex procedures. The goal of this study was to evaluate the rate of, time to, and factors affecting reimbursement for 22-modifier cases filed by orthopedic surgeons.

The authors reviewed the charts and billing data of the 150 noncharity spine and total joint replacement cases filed with a 22 modifier at 1 academic institution from 2004 through 2011. Of those 150 cases, 63 (42%) were reimbursed at a rate higher than the fee schedule. For all 150 cases, the mean amount and mean percentage of additional reimbursement were −$86±$1966 (
P
=.7) and 5.5%±37% (
P
=.04), respectively. The mean reimbursement time for private and public payers was 138±126 days (
P
<.001) and 118±129 days (
P
<.001), respectively (standard time, 30 and 15 days, respectively). The mean present values of the amount and percentage received compared with the fee schedule were −$144±$1966 (
P
=.8) and 4.1%±37% (
P
=.09), respectively (discount rate, 5%). Anatomic variant was the only cited reason that increased the probability of additional reimbursement (
P
=.016). Citing that the case required additional time had no bearing on additional reimbursement. The authors conclude that additional reimbursement with the 22 modifier is inconsistent, has significant payment delays, and is not worth the effort for total joint replacement or spine surgery.
Backout of the Helical Blade of Proximal Femoral Nail Antirotation and Accompanying Fracture Nonunion
Authors: Niikura Takahiro , Lee Sang Yang , Matsumoto Tomoyuki , Fukui Tomoaki , Kawakami Yohei , Akisue Toshihiro , Kuroda Ryosuke , Kurosaka Masahiro
Published: August 2012

This article describes a case of backout of the helical blade, a rare complication of proximal femoral nail antirotation. A 31-year-old man had sustained a trochanteric fracture of his right femur. Fracture fixation using proximal femoral nail antirotation and autologous bone grafting 7 months later were performed at another hospital. However, bony union was not obtained, and the patient’s pain and limp persisted. Therefore, he presented to the current authors. A radiograph taken at presentation revealed backout of the helical blade and fracture nonunion. A radiograph taken 1 month later showed a more advanced backout of the helical blade. The authors performed exchange nailing supplemented with transplantation of peripheral blood CD34-positive cells and autologous bone grafting. The proximal femoral nail antirotation was revised to a long gamma 3 nail, and a U-lag screw was used to obtain better stability. The postoperative course was uneventful. The patient regained ambulation without pain or support at 12 weeks postoperatively. Radiographic bony union was completed 9 months postoperatively. At 1-year follow-up, he could run and stand on the previously injured leg and had returned to work.

Backout of the helical blade should be considered as a possible complication of proximal femoral nail antirotation. Incomplete fixation of the helical blade is the possible reason for backout. The use of a helical blade in young patients may cause difficulty in insertion and result in incomplete fixation.
Arthroscopically Assisted Percutaneous Fixation and Bone Grafting of a Glenoid Fossa Fracture Nonunion
Authors: Sears Benjamin W. , Lazarus Mark D.
Published: August 2012

Arthroscopy is commonly used for evaluating intra-articular fracture patterns and assessing postfixation reduction; however, the use of arthroscopy for the definitive treatment of articular fracture nonunion has not been reported. This article describes a case of symptomatic glenoid fossa fracture nonunion that was successfully treated with arthroscopically assisted percutaneous screw fixation and bone grafting.

A 48-year-old laborer sustained a glenoid fossa fracture following a fall from a height. An initial period of nonoperative management was attempted; however, the patient reported continued shoulder pain during his rehabilitation course. Imaging 5 months after injury showed no osseous union at the fracture. Using an arthroscopically assisted technique, percutaneous fixation and bone grafting of the nonunion with cancellous allograft was performed. Postoperatively, the patient progressed through a structured therapy program, and his pain improved. A computed tomography scan 4 months postoperatively showed osseous union at the fracture site.

To the authors’ knowledge, this is the first report in the literature of definitive arthroscopically assisted bone grafting and percutaneous fixation of a diarthrodial joint nonunion. Advantages of arthroscopic fixation of glenoid fossa fracture nonunion include avoiding potential axillary nerve injury and preserving the native subscapularis insertion, which may be important if subsequent procedures require access to the anterior access to the joint.
Isolated Ring Finger Flexor Digitorum Profundus Entrapment After Closed Reduction and Intramedullary Fixation of Both-bone Forearm Fracture
Authors: Song Daniel J. , Kennebrew Garry J. , Jex Jefferson W.
Published: August 2012

Flexor tendon entrapment after a pediatric forearm fracture is a rarely reported complication that is often diagnosed late. Flexor tendon entrapment is more frequently reported after distal forearm fractures, and possible etiologies include fibrosis secondary to hemorrhage at the fracture site and simple entrapment of the muscle belly.

This article describes a case of ring finger flexor digitorum profundus entrapment in a 12-year-old boy with a closed both-bone forearm fracture that was treated with closed reduction and intramedullary nail fixation. Preoperatively, the patient had full flexion and extension of all fingers. The entrapment was noted at the first postoperative follow-up when the patient could fully extend the ring finger proximal interphalangeal joint but was unable to concomitantly extend the metacarpal phalangeal joint. Magnetic resonance imaging and ultrasound were obtained to identify the entrapment site. Intraoperatively, a portion of the flexor digitorum profundus musculotendinous junction was entrapped in the fracture site. After release of the entrapment, the patient gained immediate passive range of motion. Subsequently, the hardware was removed, and the patient healed and regained full ring finger function.

To the authors’ knowledge, this is the only report of isolated ring finger flexor digitorum profundus entrapment after closed reduction and intramedullary fixation of a pediatric forearm fracture. The authors recommend vigilant physical examination of passive and active range of motion of all digital joints with the wrist in flexion and extension before and after bony manipulation.
Atraumatic Acute Carpal Tunnel Syndrome in a Patient Taking Dabigatran
Authors: Sibley Paul A. , Mandel Richard J.
Published: August 2012

Acute carpal tunnel syndrome is an uncommon diagnosis most often related to blunt trauma requiring immediate surgical decompression to avoid serious sequelae. Patients who present with bleeding-related acute carpal tunnel syndrome tend to have severe pain, rapid onset of swelling, and neurologic symptoms that appear early and progress rapidly secondary to mass effect. Acute carpal tunnel syndrome can occur in anticoagulated patients spontaneously or after minor trauma.

This article describes a case of a 57-year-old man with progressive pain and paresthesias in the median nerve distribution after reaching for a picture frame. He was taking dabigatran, a direct thrombin inhibitor, for atrial fibrillation. He developed acute carpal tunnel syndrome secondary to spontaneous bleeding into the carpal canal and flexor tenosynovium with hematoma formation requiring surgical decompression. He reported immediate pain relief postoperatively, had no further bleeding complications, and regained full median nerve function within 2 months.

Dabigatran has gained recent popularity for the treatment of atrial fibrillation. Unlike warfarin, its use does not involve regular laboratory monitoring or dose titration. The risks and benefits of dabigatran should be considered carefully by the prescriber, particularly in patients taking medications that may alter its metabolism. Aspirin and nonsteroidal anti-inflammatory drugs may have effects similar to dabigatran and may increase the risk of bleeding problems. Should acute carpal tunnel syndrome occur, the authors recommend prompt surgical decompression rather than conservative management. The modification of anticoagulant therapy should be considered on a case-by-case basis.
Ankle Fracture Following Hip Arthroscopy
Authors: Schiffman Eric D. , McCarthy Joseph C. , Kwon John Y.
Published: August 2012

This article describes a case of an ankle fracture following hip arthroscopy. A 58-year-old woman underwent hip arthroscopy for a labral tear. She was placed in a lateral decubitus position with her foot in a padded boot. Traction was maintained for approximately 30 minutes. She was instructed to bear weight as tolerated with crutches postoperatively. At 2-week follow-up, she reported ipsilateral ankle pain. Radiographs revealed a minimally displaced medial malleolus fracture. She was treated with a cast followed by a cam walker boot and successfully went on to complete union and resolution of her symptoms.

The following risk factors exist for ankle fracture after hip arthroscopy: history of ankle sprains, ligamentous laxity (more common in women), and small feet with large calves (more likely to become plantarflexed during traction). Distraction performed with the ankle rotated is also likely to place added stress on the medial or lateral ligamentous structures.

It is important to counsel patients preoperatively about the risk of ankle pain after hip arthroscopy, to be aware of the possibility of ankle pathology postoperatively, and to have a low threshold for ordering radiographs. Radiographs are warranted if patients continue to have ankle pain after 72 hours postoperatively.
Multicentric Epithelioid Angiosarcoma of Bone
Authors: Yang Zhengming , Tao Huimin , Ye Zhaoming , Yang Disheng
Published: August 2012

Bone epithelioid angiosarcoma is rare and generally shows positive immunostaining for epithelial markers. Multicentric bone epithelioid angiosarcoma is easily misdiagnosed as carcinoma, including metastatic carcinoma, multiple myeloma, and multiple lymphoma of bone.

This article describes a case of multicentric bone epithelioid angiosarcoma. The patient was first misdiagnosed as having metastatic carcinoma. Examination showed osteolytic lesions in the bilateral heels and the lower left humerus. The diagnosis was confirmed postoperatively and corrected after immunohistochemical analysis of the biopsy. The immunohistochemical analysis revealed that the tumor mass was strongly positive for CD31, factor VIII, vimentin, and neuron-specific enolase. The patient refused chemotherapy and died of lung metastasis 4 months postoperatively.

Most bone epithelioid angiosarcomas are immunopositive for epithelial markers (ie, keratin, cytokeratin, high-molecular-weight keratin, and epithelial membrane antigen), vascular endothelial markers (ie, CD31, CD34, and von Willebrand factor), and factor VIII–associated antigen. Bone epithelioid angiosarcoma shows a relatively high degree of malignancy. Patients often die of distant metastasis, including those found in the lung and lymph node tissue. A wide excision of epithelioid angiosarcoma should be performed during the operation of the primary tumor. A better understanding of the clinicopathologic features of this disease may help to clarify the confusion, provide better treatment, and improve the clinical prognosis.
LASIK Interface Complications: Etiology, Management, and Outcomes
Authors: Randleman J. Bradley , Shah Rupa D.
Published: August 2012

PURPOSE:

To describe the etiology, diagnosis, clinical course, and management of LASIK interface complications.

METHODS:

Literature review.

RESULTS:

Primary interface complications include infectious keratitis, diffuse lamellar keratitis, central toxic keratopathy, pressure-induced stromal keratopathy (PISK), and epithelial ingrowth. Infectious keratitis is most commonly caused by Methicillin-resistant
Staphylococcus aureus
(early onset) or atypical
Mycobacterium
(late onset) postoperatively, and immediate treatment includes flap lift and irrigation, cultures, and initiation of broad-spectrum topical antibiotics, with possible flap amputation for recalcitrant cases. Diffuse lamellar keratitis is a white blood cell infiltrate that appears within the first 5 days postoperatively and is acutely responsive to aggressive topical and oral steroid use in the early stages, but may require flap lift and irrigation to prevent flap necrosis if inflammation worsens. In contrast, PISK is caused by acute steroid response and resolves only with cessation of steroid use and intraocular pressure lowering. Without appropriate therapy PISK can result in severe optic nerve damage. Central toxic keratopathy mimics stage 4 diffuse lamellar keratitis, but occurs early in the postoperative period and is noninflammatory. Observation is the only effective treatment, and flap lift is usually not warranted. Epithelial ingrowth is easily distinguishable from other interface complications and may be self-limited or require flap lift to treat irregular astigmatism and prevent flap melt.

CONCLUSIONS:

Differentiating between interface entities is critical to rapid appropriate diagnosis, treatment, and ultimate visual outcome. Although initial presentations may overlap significantly, the conditions can be readily distinguished with close follow-up, and most complications can resolve without significant visual sequelae when treated appropriately.
Hypopyon Uveitis Following LASIK in a Patient With Ulcerative Colitis
Authors: Liu Margaret P. , Hwang Frank S. , Dunn J.P. , Stark Walter J. , Bower Kraig S.
Published: August 2012

PURPOSE:

To present a case of unilateral hypopyon uveitis that began 15 days after uneventful bilateral LASIK in a 24-year-old man with an undisclosed history of ulcerative colitis.

METHODS:

Case report.

RESULTS:

The hypopyon uveitis completely resolved after treatment with aggressive topical and oral steroid agents in combination with topical antibiotic coverage.

CONCLUSIONS:

Although rare, visually significant hypopyon uveitis may arise after LASIK in the setting of ulcerative colitis and positive human leukocyte antigen (HLA) B27. Early recognition and treatment can result in an excellent outcome. The exact relationship between hypopyon uveitis and LASIK is impossible to ascertain.
LASIK for Presbyopia Correction in Emmetropic Patients Using Aspheric Ablation Profiles and a Micro-monovision Protocol With the Carl Zeiss Meditec MEL 80 and VisuMax
Authors: Reinstein Dan Z. , Carp Glenn I. , Archer Timothy J. , Gobbe Marine
Published: August 2012

PURPOSE:

To evaluate the monocular and binocular visual outcomes of LASIK with an aspheric micro-mono-vision protocol in emmetropic patients with presbyopia.

METHODS:

A retrospective, noncomparative case series included 296 eyes from 148 consecutive emmetropic patients with presbyopia who were treated with LASIK-induced micro-monovision. The CRS-Master software was used to generate ablation profiles for the MEL 80 excimer laser (Carl Zeiss Meditec) and flaps were created using the VisuMax femtosecond laser (Carl Zeiss Meditec). The target refraction was plano for distance eyes (dominant eye) and between −1.00 and −1.88 diopters (D) for near eyes. Patients were followed for 1 year. Emmetropia was defined for inclusion as spherical equivalent refraction ⩾− 0.88 D, sphere ⩽+1.00 D, and cylinder ⩽1.25 D. Median patient age was 55 years (range: 44 to 65 years). Median follow-up was 12.9 months.

RESULTS:

Mean deviation from intended correction was +0.02±0.35 D, with 91% within ±0.50 D and 100% within ±1.00 D. Of distance eyes, 95% achieved uncorrected distance visual acuity (UDVA) of 20/20 or better and 100% achieved 20/32 or better. Binocularly, 98% of patients achieved UDVA of 20/20 or better and 100% achieved 20/32 or better; 96% achieved uncorrected near visual acuity of J2 and 99% could read J3 or better. No eyes lost 2 or more lines of corrected distance visual acuity. An average increase of 0.05 logMAR was noted in distance-corrected near visual acuity. A small increase occurred in mesopic contrast sensitivity (CSV-1000, VectorVision Inc) at 3 cycles per degree (cpd) (
P
=.016) and no change at 6, 12, or 18 cpd.

CONCLUSIONS:

This aspheric micro-monovision protocol was a well-tolerated and effective procedure for treating emmetropic patients with presbyopia.
A multi‐disciplinary approach to marine shallow geohazard assessment
Authors: Marsset B. , Thomas Y. , Sultan N. , Gaillot A. , Stephan Y.
Published: August 2012

Seismic velocities together with sediment/rock compaction models are of common use in the oil industry to predict reservoir pressures and to detect and identify any potential hazard associated with over‐pressured formations. Excess pore pressure is a key parameter for geohazard assessment, nevertheless this approach is very seldom applied to shallow offshore engineering as it requires expensive ground‐truth boreholes.

The simultaneous availability in the Bourcart‐Hérault canyon interfluve (Gulf of Lion – NW Mediterranean) of 1) geotechnical and sedimentological data (300 m boreholes) from the PROMESS project; 2) in situ pore pressure measurements; and 3) High Resolution (HR) seismic geophysical data showing the presence of active structures in relation to fluid circulation, allows the importance of a multi‐disciplinary approach to shallow geohazard assessment to be illustrated through a case study.

The velocity field obtained from HR seismic data is interpreted in light of the neighbouring boreholes and resulting velocity anomalies are translated in terms of fluid overpressure and free gas content. Additional in situ surface geotechnical measurements (piezometers) are then taken into account and the role of these parameters is discussed.
Inference of Self-Regulated Transcriptional Networks by Comparative Genomics
Authors: Cornish Joseph P. , Matthews Fialelei , Thomas Julien R. , Erill Ivan
Published: August 2012

The assumption of basic properties, like self-regulation, in simple transcriptional regulatory networks can be exploited to infer regulatory motifs from the growing amounts of genomic and meta-genomic data. These motifs can in principle be used to elucidate the nature and scope of transcriptional networks through comparative genomics. Here we assess the feasibility of this approach using the SOS regulatory network of Gram-positive bacteria as a test case. Using experimentally validated data, we show that the known regulatory motif can be inferred through the assumption of self-regulation. Furthermore, the inferred motif provides a more robust search pattern for comparative genomics than the experimental motifs defined in reference organisms. We take advantage of this robustness to generate a functional map of the SOS response in Gram-positive bacteria. Our results reveal definite differences in the composition of the LexA regulon between Firmicutes and Actinobacteria, and confirm that regulation of cell-division inhibition is a widespread characteristic of this network among Gram-positive bacteria.