bluuebunny/crossref_metadata_2025 huggingface dataset:
A normatização do cuidar da criança menor de um ano: estudo dos significados atribuídos pelos profissionais do Programa Saúde da Família (PSF)
Authors: Vasconcelos Eliane Nóbrega , Silveira Maria de Fátima Araújo da , Eulálio Maria do Carmo , Medeiros Paula Frassinetti Vasconcelos
Published: August 2009

O PSF foi implantado como uma estratégia de mudança e reordenamento do modelo assistencial, visando a superar a fragmentação do cuidado e, para tanto, propõe um atendimento integral, de qualidade e, sobretudo, humanizado. Este trabalho teve por objetivo identificar como vem sendo cuidada a criança menor de um ano pelos profissionais do PSF. O estudo tem abordagem qualitativa e os dados foram produzidos no contexto de quatro oficinas de sensibilização e criatividade, cujo conteúdo gravado foi transformado em corpus de discursos, e registros da observação participante, submetidos à análise de conteúdo. Os resultados demonstraram que o cuidado ao menor de um ano tem sido majoritariamente normativo, as UBSF pesquisadas não possuem ambiente e instrumental adequado para o atendimento de crianças, a formação acadêmica dos profissionais é inadequada e estes não têm recebido capacitação continuada para atuação nesta faixa etária. Há, ainda, enormes dificuldades no enfrentamento das questões sociais e culturais e nos encaminhamentos para procedimentos de média e alta complexidade. No entanto, os profissionais consideram o trabalho dinâmico e desafiador e, com as suas ações, muito têm contribuído para a saúde das crianças cuidadas.
Perfil sociossanitário e estilo de vida de hipertensos e/ou diabéticos, usuários do Programa de Saúde da Família no município de Teixeiras, MG
Authors: Cotta Rosângela Minardi Mitre , Batista Kelly Cristina Siqueira , Reis Roberta Sena , Souza Gisele Adriana de , Dias Glauce , Castro Fátima Aparecida Ferreira de , Alfenas Rita de Cássia Gonçalves
Published: August 2009

O objetivo deste estudo foi traçar o perfil sociossanitário e estilo de vida da população hipertensa e/ou diabética do município de Teixeiras (MG). Foram realizadas entrevistas semi-estruturadas nos domicílios de hipertensos e/ou diabéticos cadastrados no Programa de Saúde da Família de Teixeiras (MG), selecionados aleatoriamente. Foram entrevistados 150 hipertensos (10,33% da população hipertensa) e 30 diabéticos (15% da população diabética), havendo uma predominância de indivíduos idosos (idade média=63,59 + 13,12 anos), do sexo feminino (74,4%), de baixa escolaridade (40,9% de analfabetismo) e de baixa renda (mediana de 0,5 salário mínimo). O tratamento destas morbidades foi basicamente medicamentoso (96,6%); houve uma elevada prevalência do sedentarismo (67,4%). Além disso, houve um grande consumo per capita diário de açúcar (153g + 110,66g), sal (18g + 21,26g) e óleo (60g + 43,23g). Os resultados obtidos apontam para a importância de intervenções multiprofissionais, por meio do Programa de Saúde da Família, com o objetivo de promover a adoção de hábitos e estilos de vida saudáveis, prevenir complicações dessas doenças e proporcionar melhoria da qualidade de vida.
Análise da fluoretação da água de abastecimento público da zona urbana do município de Campo Grande (MS)
Authors: Bellé Bruno Luiz Lessa , Lacerda Valéria Rodrigues de , Carli Alessandro Diogo De , Zafalon Edílson José , Pereira Paulo Zárate
Published: August 2009

O presente estudo teve por objetivo analisar a concentração de fluoreto na água que flui das torneiras da zona urbana do município de Campo Grande (MS). Para tanto, foram coletadas amostras de água de 21 escolas situadas nos sete subdistritos da cidade, em três oportunidades diferentes para análise do teor de fluoreto, determinada pelo método do eletrodo específico (medidor de fluoreto combinado Orion 9609 BN, acoplado a um potenciômetro digital EA-940 da Orion). Os resultados mostraram que 63,5% das amostras coletadas apresentaram níveis aceitáveis (entre 0,6 a 0,8 ppm) de fluoreto e 36,5%, níveis inaceitáveis. Em relação à condição dos locais de coleta, 76,2% foram consideradas adequadas e 23,8%, inadequadas.
Disponibilidade de energia e nutrientes nos domicílios: o contraste entre as regiões Norte e Sul do Brasil
Authors: Enes Carla Cristina , Silva Marina Vieira da
Published: August 2009

Com o objetivo de analisar a disponibilidade domiciliar de energia, a participação relativa dos macronutrientes no Valor Energético Total (VET) e a contribuição dos diferentes grupos de alimentos na energia disponível nos domicílios das regiões Norte e Sul do país, segundo o rendimento mensal familiar, foi proposto o presente estudo. Utilizou-se para a elaboração das análises os microdados da Pesquisa de Orçamentos Familiares - 2002/2003 realizada pelo Instituto Brasileiro de Geografia e Estatística (IBGE). Para as análises nutricionais, utilizou-se o software Virtual Nutri. O teste de regressão linear múltipla foi aplicado para analisar o efeito dos rendimentos sobre a disponibilidade de energia e nutrientes. Verificou-se uma relação inversa entre a participação dos carboidratos no VET e a renda. A contribuição dos lipídios para o VET apresentou tendência de crescimento, de acordo com o aumento da renda. Quanto à participação dos distintos grupos de alimentos no VET, destaca-se a reduzida contribuição energética das frutas, verduras e legumes para praticamente a totalidade dos grupamentos familiares. Foram identificadas indesejáveis contribuições (consideradas excessivas) dos doces, açúcares e refrigerantes para o VET disponível para as famílias de ambas as regiões estudadas.
Novos possíveis para a militância no campo da Saúde: a afirmação de desvios nos encontros entre trabalhadores, gestores e usuários do SUS
Authors: Oliveira Gustavo Nunes de , Pena Ricardo Sparapan , Amorim Simone Cristina de , Carvalho Sergio Resende , Azevedo Bruno Mariani de Souza , Martins Anderson Luiz Barbosa , Guerra Maíra Barros
Published: August 2009

Os autores tecem considerações sobre a militância no campo da saúde, em especial na defesa do Sistema Único de Saúde (SUS), enquanto uma política pública universal. Após apontar algumas estratégias desta militância, o texto discute o centralismo e o caráter identitário dessas práticas. Destacam e problematizam quatro formas de centralismo: do "bem comum" em suas representações; o procedimento como oferta de tecnologias de saúde; do usuário e as concepções sobre suas necessidades/demandas; e da proteção inadvertida da vida. Propõem, como alternativa, uma nova militância no SUS, como prática intensiva e produzida no encontro, na dimensão relacional, entre gestores, trabalhadores e usuários.
A morte de Ivan Ilitch, de Leon Tolstói: elementos para se pensar as múltiplas dimensões da gestão do cuidado
Authors: Cecilio Luiz Carlos de Oliveira
Published: August 2009

O autor se utiliza do conto A morte de Ivan Ilitch, de Leon Tolstói, para explorar o tema das múltiplas dimensões da gestão do cuidado em saúde (profissional, organizacional e sistêmica), apontando para a imanência e complementaridade que guardam entre si. Mesmo reconhecendo não haver uma hierarquia entre essas três dimensões, focaliza a discussão na dimensão profissional - onde se dá o encontro profissional-usuário - destacando como ela tem sido o território preferencial para as estratégias de gerenciamento pautadas pela busca de uma crescente racionalidade, previsibilidade e controle das práticas de saúde, hoje, seja no setor público, seja no setor da saúde suplementar. Aponta para o risco de que programas de "qualificação" e "humanização" do atendimento possam estar contribuindo para a instrumentalização e excessiva formalização do encontro trabalhador-usuário, dificultando ainda mais, senão impossibilitando, encontros verdadeiramente cuidadores como o relatado por Tolstói em seu conto.
Gestão participativa e corresponsabilidade em saúde: limites e possibilidades no âmbito da Estratégia de Saúde da Família
Authors: Trad Leny Alves Bomfim , Esperidião Monique Azevedo
Published: August 2009

De acordo com a Política Nacional de Humanização do SUS - HumanizaSUS - a gestão participativa implica o envolvimento dos trabalhadores da saúde, gestores e usuários em um pacto de corresponsabilidade baseado em contratos e compromissos com o sistema de saúde. Este artigo discute limites e possibilidades de incorporação da gestão participativa e incorporação do princípio da corresponsabilidade no âmbito da Estratégia Saúde da Família (ESF). Foi desenvolvido um estudo de casos múltiplos, integrando estratégias qualitativas (dominante) e quantitativas, no qual se privilegiou a percepção de profissionais e usuários. Foram contemplados seis municípios da Bahia, Sergipe e Ceará. Evidenciou-se que o processo de participação social e a incorporação do princípio da corresponsabilidade no escopo da gestão e atenção na ESF é bastante incipiente. Constatou-se que a participação cidadã não é incentivada pelos profissionais e que muitos usuários assumem uma atitude de gratidão diante dos serviços recebidos.
Humanização em Unidade de Terapia Intensiva Adulto (UTI): compreensões da equipe de enfermagem
Authors: Costa Silvio Cruz , Figueiredo Maria Renita Burg , Schaurich Diego
Published: August 2009

Trata-se de estudo descritivo de abordagem qualitativa cujo objetivo foi compreender como os profissionais da enfermagem (enfermeiros e técnicos) percebem a política de humanização no cenário de uma UTI e sua importância nesse processo. Foi desenvolvido em uma instituição privada no município de Porto Alegre/RS, com 18 participantes. A coleta dos dados ocorreu por meio de entrevista estruturada. Da análise emergiram aspectos referentes a elementos e características que definem a humanização, bem como questões facilitadoras e dificultadoras presentes no processo. Conclui-se que a empatia, o respeito e a valorização constituem elementos fundamentais e que o profissional de enfermagem acredita fazer a diferença no processo de humanizar, com vistas a melhorar as práticas de cuidado baseadas na ética, no diálogo e na autonomia do paciente, de sua família e da própria equipe.
A Política Nacional de Humanização como política que se faz no processo de trabalho em saúde
Authors: Santos Filho Serafim Barbosa , Barros Maria Elizabeth Barros de , Gomes Rafael da Silveira
Published: August 2009

Este artigo tem como objetivo realizar um exercício analítico do modo de fazer da Política Nacional de Humanização (PNH) sobre a função apoio institucional, com base em diferentes dispositivos, diretrizes e princípios. O texto está dividido em três partes: na primeira, traz reflexões acerca da concepção de humano e humanismo que fundamenta as análises; a segunda busca ampliar o debate sobre a indissociabilidade entre atenção e gestão e o modo de fazer apoio institucional; a terceira aborda a indissociabilidade entre a produção de serviços e produção de sujeitos, e encaminha a discussão dessas três partes que se desdobram em outros planos de análise. Ressalta, em todo o texto, a aposta na inclusão dos diferentes sujeitos e na análise e gestão coletiva dos processos de trabalho como estratégia para criar desestabilizações produtivas e práticas de humanização dos serviços de Saúde.
Os coletivos da Política Nacional de Humanização (PNH): a cogestão em ato
Authors: Mori Maria Elizabeth , Oliveira Olga Vânia Matoso de
Published: August 2009

O texto propõe descrever o processo de constituição dos diferentes arranjos de funcionamento interno da Política Nacional de Humanização desde a sua criação, em 2003, e caracterizar os coletivos como instâncias de cogestão. A cogestão é uma diretriz estruturante da PNH e a experimentação revela disputas de saber, de poder e tensionamentos interpessoais e intergrupais. O exercício da coanálise, da codecisão e da corresponsabilização é base do trabalho em saúde, processo que busca reformular os modos de gestão tradicional.
A rede como estratégia metodológica da Política Nacional de Humanização: a experiência de um hospital universitário
Authors: Falk Maria Lúcia Rodrigues , Ramos Márcia Ziebell , Salgueiro Jennifer Braathen
Published: August 2009

Este estudo enfoca a rede de contatos como estratégia metodológica da Política Nacional de Humanização (PNH). Trata-se de um relato de experiência, instituído no Hospital de Clínicas de Porto Alegre (HCPA), que buscou identificar as ações de humanização suscitadas pela formação da Rede de Contatos no âmbito da instituição. O Grupo de Trabalho de Humanização do HCPA procurou estruturar uma Rede que abrangesse o maior número possível de áreas no hospital, iniciando um trabalho de sensibilização dentro dos setores e buscando promover ações convergentes com as propostas pela PNH. Observou-se que, desde 2005 até agora, várias ações humanizadoras aconteceram nas diversas áreas envolvidas, demonstrando que o dispositivo das redes é ferramental precioso para a instituição, pois oferece indicadores para a PNH e favorece a inter-relação entre os diferentes atores que buscam, para além das dificuldades de um cotidiano hospitalar, a promoção de outros modos de fazer em saúde.
Forecasting Injector/Producer Relationships From Production and Injection Rates Using an Extended Kalman Filter
Authors: Liu Feilong , Mendel Jerry M. , Nejad Amir Mohammad
Published: August 2009

This paper presents an adaptive method, using an extended Kalman filter (EKF), to forecast the injector/producer relationships (IPRs) between multiple injectors and a single producer on the basis of measured production and injection rates.

For this method, we used a very simple parametric model, one with two parameters per injector, so that, if a producer depends upon N injectors, our model contains exactly 2N parameters. The EKF is used to adaptively estimate the 2N parameters, from which the IPR between each injector and a producer is then estimated.

This approach was tested on synthetic, reservoir simulation, and real data. The tests for synthetic data used Monte-Carlo simulations; the tests for reservoir simulation data used blind data that were generated by a reservoir simulator; and, the tests for real data used data from a Chevron oil field. Test results on synthetic and reservoir simulation data demonstrate the feasibility of the EKF method, and test results on the real data match other field indications about the IPRs between injectors and a producer. All results confirm that this EKF method may provide a good way to infer and track the IPRs and may provide better insight about the IPRs.
The Effects of Assistive Technology on Students with Disabilities
Authors: Sze Susan
Published: August 2009

The purpose of this article is to analyze assistive technology literature for students with disabilities. The literature search rendered N = 57 literature and n = 17 manuscripts were identified in the special education technology field studies. Each source was evaluated according to the following criteria: types of disability, learning objectives and tasks, types of assistive devices available, application, and competency in matching the assistive technology with a specific disability. Results show: 1) research in this field tends to be limited to faculty development and need assessment focus; 2) technological interventions appeared scattered, vague, incomprehensive and non-specific; and 3) pre-service teachers' comfort level of assistive technology in an inclusive classroom remain low. An updated list of various type of AT suggesting teachers to match each technological tool to a specific disability is summarized in Table 1 and it is also included in this study.
Pulsed Infrared Roasting of Groundnuts and its Quality
Authors: Kumar Sanjeet , Debnath Sukumar , Hebbar Umesh H
Published: August 2009

The application of high intensity, pulsed infrared radiation for roasting of groundnuts is attempted and the product quality is compared with that of the conventionally roasted samples. Product qualities such as lightness (color), compressive strength (texture) and free fatty acid content are analyzed for different combinations of roasting duration (4-12 min) and temperature (160-200°C), selected based on central composite rotatable design (CCRD). Pulsed infrared roasting at 178-188°C for 6.8-9.2 min resulted in optimum product quality in terms of color, texture and free fatty acid content. The other parameters such as oil and moisture content, peroxide value and sensory characteristics of roasted nuts are also evaluated for the select temperature-duration combinations. The oil yield increased marginally with roasting duration and temperature. Peroxide number, an indicator of the stability of fat, did not vary during infrared roasting. Groundnuts processed at 180°C for 8 min scored high in terms of sensory attributes. Infrared roasting resulted in better product quality as compared to drum and sand roasting.
The Cost of Primary Care Doctors
Authors: Glied Sherry , Prabhu Ashwin G , Edelman Norman
Published: August 2009

Research Objective: This study offers a novel approach to workforce planning in the physician market. Rather than projecting the future demand for physician services, a human capital model is used to estimate the societal cost of producing a physician service. The socially optimal workforce is one at which (at optimal practice scale), the societal cost of producing a physician service is equal to the societal benefit obtained from the service.Study Design: Physician human capital consists of two components: the underlying human capital (productivity) of those who become physicians and the job-specific investments (physician training) added to this underlying capital. The value of physicians' underlying human capital is estimated using a regression analysis of the National Longitudinal Sample of Youth (NLSY). For those in the survey who did not go on to become doctors, income over time is modeled as a function of a rich set of variables measured in youth, including family background, educational attainment and a range of high-school level performance tests. This equation is then used to forecast an age-earnings profile for doctors based on the characteristics in youth of those NLSY cohort participants who subsequently became doctors. Next, published estimates are used to measure the total cost (wherever paid) of investments in physician training. Combining these estimates, the social cost per primary care physician provided visit and Medicare relative value unit (RVU) is determined.Principal Findings: Physicians are drawn from the highest performing group of high school students. The earnings of comparable students who do not become doctors and the predicted earnings of would be doctors are substantially above the population mean. The opportunity cost of physician human capital is thus very high. The estimated societal cost per primary care physician visit is substantially higher than the average co-payment. The societal cost per primary care physician provided RVU is generally higher than the current Medicare compensation rate per RVU. The private return to primary care physician training is relatively low, in the range of 7-9%.Conclusions: At current levels of supply, the marginal social costs of primary care visits appear to be equal to or greater than marginal social benefits of many primary care services. In considering expansions of primary care capacity, it may be efficient to increase the use of complementary, lower-skilled practitioners.
Quantum counterparts of three-dimensional real Lie algebras over harmonic oscillator
Authors: Paal Eugen , Virkepu Jüri
Published: August 2009

Operadic Lax representations for the harmonic oscillator are used to construct the quantum counterparts of three-dimensional (3D) real Lie algebras in Bianchi classification. The Jacobi operators of the quantum algebras are found.
The Archaeology of the Tolbooth, Broad Street, Stirling
Authors: Will Bob , Addyman Tom
Published: August 2009

Between December 1999 and May 2000, a series of archaeological excavations and an architectural survey were undertaken in and around the Tolbooth in Stirling prior to the complete renovation of the building. The excavations uncovered information relating to the initial construction of the Tolbooth and to subsequent phases of rebuilding, repair and extension. They also uncovered evidence for the use of the site prior to its construction. Several stone-built foundations were discovered that relate to medieval tenements on the site, while metalworking remains suggest industrial activity to the rear of the tenements. In addition, historical records refer to executed prisoners being buried within the confines of the Tolbooth, and a burial was recovered from beneath the floor of the building.
Radial Basis Function Cascade Correlation Networks
Authors: Lu Weiying , Harrington Peter de  B.
Published: August 2009

A cascade correlation learning architecture has been devised for the first time for radial basis function processing units. The proposed algorithm was evaluated with two synthetic data sets and two chemical data sets by comparison with six other standard classifiers. The ability to detect a novel class and an imbalanced class were demonstrated with synthetic data. In the chemical data sets, the growth regions of Italian olive oils were identified by their fatty acid profiles; mass spectra of polychlorobiphenyl compounds were classified by chlorine number. The prediction results by bootstrap Latin partition indicate that the proposed neural network is useful for pattern recognition.
Vibrational Spectra Study of the Interactions Between Keggin Heteropolyanions and Amino Acids
Authors: Bamoharram Fatemeh F.
Published: August 2009

A study of the effects of the interactions with amino acids on the vibrational spectra of Keggin heteropolyanions (NanH3-n[XM12O40]n-; n = 0,1,2,3; X = PV, SiIV, M = WVI, MoVI) has been performed. Interactions occurred for all of the studied compounds leading to changes and splits in the stretching frequencies. Depending on the amino acid type, the IR bands for interbridge stretchings (M-Ob-M) and terminal stretchings (M-Od) were affected.
A molecular phylogeny and classification of Bignoniaceae
Authors: Olmstead Richard G. , Zjhra Michelle L. , Lohmann Lúcia G. , Grose Susan O. , Eckert Andrew J.
Published: August 2009

Bignoniaceae are woody, trees, shrubs, and lianas found in all tropical floras of the world with lesser representation in temperate regions. Phylogenetic analyses of chloroplast sequences (rbcL, ndhF, trnL‐F) were undertaken to infer evolutionary relationships in Bignoniaceae and to revise its classification. Eight clades are recognized as tribes (Bignonieae, Catalpeae, Coleeae, Crescentieae, Jacarandeae, Oroxyleae, Tecomeae, Tourrettieae); additional inclusive clades are named informally. Jacarandeae and Catalpeae are resurrected; the former is sister to the rest of the family, and the latter occupies an unresolved position within the “core” Bignoniaceae. Tribe Eccremocarpeae is included in Tourrettieae. Past classifications recognized a large Tecomeae, but this tribe is paraphyletic with respect to all other tribes. Here Tecomeae are reduced to a clade of approximately 12 genera with a worldwide distribution in both temperate and tropical ecosystems. Two large clades, Bignonieae and Crescentiina, account for over 80% of the species in the family. Coleeae and Crescentieae are each included in larger clades, the Paleotropical alliance and Tabebuia alliance, respectively; each alliance includes a grade of taxa assigned to the traditional Tecomeae. Parsimony inference suggests that the family originated in the neotropics, with at least five dispersal events leading to the Old World representatives.
Treatment of Alopecia Areata in Children
Authors: Mukherjee Niyati , Burkhart Craig N. , Morrell Dean S.
Published: August 2009

CME Educational Objectives

1.

Describe the proposed etiologies for alopecia areata in children and young adults.

2.

Review the commonly employed treatment options for alopecia areata and the quality of the evidence supporting these modalities.

3.

Determine when a “watch-and-wait” approach to management of alopecia areata is most appropriate.
Prenatal Genetic Testing
Authors: Dolan Siobhan M.
Published: August 2009

CME Educational Objectives

1.

Describe the currently available prenatal screening and diagnostic tests for Down syndrome.

2.

Recognize the autosomal recessive conditions for which carrier testing is available and determine how these should be offered to women during the preconception and prenatal period.

3.

Identify the appropriate use of genetic services during the preconception and prenatal period.
Using Microarray-based Molecular Cytogenetic Methods to Identify Chromosome Abnormalities
Authors: Shaffer Lisa G. , Bejjani Bassem A.
Published: August 2009

CME Educational Objectives

1.

Differentiate between traditional banding methods and molecular cytogenetic techniques for chromosome analysis.

2.

Demonstrate the benefits and limitations to microarray-based methods for chromosome analysis.

3.

Interpret differences in detection rates between traditional chromosome analysis and microarray-based cytogenetics for the identification of chromosome abnormalities in children.
Lumbar Disk Replacement Failures: Review of 29 Patients and Rationale for Revision
Authors: Rosen Charles , Kiester P. Douglas , Lee Thay Q.
Published: August 2009

The Charité III (DePuy Spine, Inc, Raynham, Massachusetts) and ProDisc II (Synthes Spine, West Chester, Pennsylvania) artificial disk replacements were approved for use by the United States Food and Drug Administration in October 2004 and January 2006, respectively. The purpose of this study was to retrospectively review 29 patients receiving either disk replacement who presented with complications to the University of California Irvine Spine Center. Specifically, patient outcome data from the Oswestry Disability Index (ODI) and the SF-36 were analyzed. The probable sources of pain were determined based on diagnostic facet and nerve root injections, single photon emission computed tomography bone scans, computed tomography scans, magnetic resonance imaging scans, flexion extension radiographs, patient history, and physical examination and direct surgical observation when possible. Results suggested that the main source of pain is facet degeneration and fractures in this area due to flawed biomechanics of disk replacement design. Oswestry Disability Index and SF-36 scores exhibited marked disability with a large improvement in all scores after revision surgery. This difference was statistically significant for the ODI and the SF-36 MCS (mental), but not for the SF-36 PCS (physical). A successful outcome in the revised patients was achieved completely in the majority, and only partially in some, by a solid fusion after meticulous and complete facet excision and correction of the segmental deformity.
Treatment of Bicondylar Tibia Plateau Fractures Using Locked Plating Versus External Fixation
Authors: Krupp Ryan J. , Malkani Arthur L. , Roberts Craig S. , Seligson David , Crawford Charles H. , Smith Langan
Published: August 2009

Bicondylar tibial plateau fractures can be difficult to treat due to the extent of articular cartilage, metaphyseal bone, and soft tissue injury. The purpose of this study was to compare the outcomes of open reduction and locked plating vs fine-wire external fixation of 58 consecutive bicondylar tibial plateau fractures at a level I trauma center. All bicondylar tibial plateau fractures were classified as Schatzker V/VI or AO/OTA type 41C. Twenty-eight patients in one group were treated using a locked plating system, and 30 patients in another group were treated with a hybrid or circular external fixation frame. The 2 groups were similar demographically. When compared with external fixation, locked plating was associated with a decreased time to union (5.9 vs 7.4 months), decreased incidence of articular malunion (7% vs 40%;
P
=.003), decreased knee stiffness (4% vs 13%), and decreased overall complications (27% vs 48%). The Schatzker VI subgroup accounted for 25 of the 27 complications (93%) in the locked plating group and 40 of the 48 complications (83%) in the external fixation group. We reserve the use of external fixation devices in the treatment of tibial plateau fractures to span the fracture site until the patient is amenable to definitive fixation with locked plating.
Partial Humeral Head Resurfacing and Latarjet Coracoid Transfer for Treatment of Recurrent Anterior Glenohumeral Instability
Authors: Moros Chris , Ahmad Christopher S.
Published: August 2009

Bone deficiencies of either the humeral head or glenoid fossa may cause recurrent shoulder instability following soft tissue stabilization procedures. The engaging Hill-Sachs lesion, a major risk factor for instability, has been identified in a majority of patients with recurrent anterior instability. Guidance for surgical management of large humeral head deficiency presents few available options, with even fewer clinical data to support any one technique. Anteroinferior glenoid deficiency has also been a well-documented source of recurrent instability. The Latarjet coracoid transfer procedure corrects the glenoid defect by restoring the architecture of the inferior rim. Although coracoid transfer addresses containment on the glenoid, a concomitant large humeral head defect is at risk for engagement on the corrected glenoid. This article describes a case of a 50-year-old man presenting with recurrent right shoulder dislocations status post-open stabilization procedure 10 years prior. Radiologic evaluation demonstrated a large Hill-Sachs lesion with adjacent chondral derangement and a nonunion bony Bankart lesion.

The Arthrosurface HemiCap humeral head resurfacing prosthesis (Arthrosurface Inc, Franklin, Massachusetts) was used to address the Hill-Sachs lesion with a Latarjet coracoid transfer procedure. We were unable to identify examples in the literature of the HemiCap used in the correction of a Hill-Sachs lesion for recurrent anterior instability. The HemiCap prosthesis has the benefit of correcting the Hill-Sachs lesion and adjacent chondral defect while preserving uninvolved articular surface. The combination of surgical interventions produced a successful result.
A Rare Wrist Injury: Simultaneous Fractures of the Hamate Body and Scaphoid Waist
Authors: Yalcinkaya Merter , Azar Nikola , Dogan Ahmet
Published: August 2009

Hamate fractures, which are classified as fractures of the body or the hook, are rare, representing only 2% to 4% of carpal fractures. Hamate body fractures can occur as isolated injuries, but in a high-energy trauma, associated carpal bone fractures or carpal disruption can be seen. Hamate fractures can be easily underdiagnosed. Pain in the ulnar side of the palm and swelling of the wrist after a wrist injury should alert the physician. Anteroposterior and lateral radiographs of the wrist may not always be adequate for the diagnosis. Computed tomography should be used to explain the pain in the wrist and to investigate any associating osseous pathologies. This article describes a case of a rare wrist injury: a fracture of the hamate body and a simultaneous fracture of the scaphoid waist treated nonoperatively. To our knowledge, there is only 1 case report in the literature in which the fracture of the hamate body accompanies the fracture of the distal pole of the scaphoid.
Intramuscular Lipoma of the Supraspinatus Causing Impingement Syndrome
Authors: Ferrari Louis , Haynes Paul , Mack Jonathan , DiFelice Gregory S.
Published: August 2009

Impingement syndrome is a common ailment of the shoulder, particularly in individuals who perform repetitive overhead activities, such as athletes and laborers. Patients typically report progressive shoulder pain often exacerbated by flexion and abduction and may demonstrate a classic painful arc of motion. This article describes a case of a 45-year-old man with signs and symptoms consistent with impingement syndrome. Workup revealed a well-circumscribed, homogeneous lesion within the supraspinatus muscle on magnetic resonance imaging. The patient underwent uncomplicated marginal excision of the mass with a final diagnosis of benign lipoma. Lipomas represent one of the most common soft tissue tumors, although there are no reports of an intramuscular supraspinatous lipoma causing impingement syndrome. In our case, there were no findings on history, physical examination, or radiographs that would place neoplasm high on a differential. Magnetic resonance imaging provided the crucial information necessary to narrow the differential diagnosis and formulate a preoperative plan. Marginal resection of the mass was curative in this patient, as he remained pain free and regained excellent motion postoperatively.
Atraumatic Bilateral Femur Fracture in Long-Term Bisphosphonate Use
Authors: Goddard Maria S. , Reid Kristoff R. , Johnston James C. , Khanuja Harpal S.
Published: August 2009

Postmenopausal women with osteoporosis are commonly treated with the bisphosphonate class of medications, one of the most frequently prescribed medications in the United States. In the past 4 years, reports have been published implying that long-term bisphosphonate therapy could be linked to atraumatic femoral diaphyseal fractures.

This article presents a case of a 67-year-old woman who presented with an atraumatic right femur fracture. She had a medical history notable for use of the bisphosphonate alendronate for 16 years before being switched to ibandronate for 1 year before presentation. She had sustained a similar fracture on the contralateral side 3 years previously.

This case report, in addition to a review of the literature, shows that use of the bisphosphonate class of medications for an extended period of time may result in an increased susceptibility to atraumatic femoral diaphyseal fractures. Some studies have suggested that the reason may be the mechanism of action of bisphosphonates, resulting in decreased bone turnover and remodeling. Studies have not shown if the entire class of medications produce a similar result, but patients who have been treated with any bisphosphonate for an extended period of time should be considered at risk. In patients who have already sustained a femoral diaphyseal fracture, imaging of the contralateral side should be performed to identify cortical thickening as an early sign of fracture risk. Patients should also be questioned about thigh pain.
Distal Femur Defects Reconstructed With Polymethylmethacrylate and Internal Fixation Devices: A Biomechanical Study
Authors: Uglialoro Anthony D. , Maceroli Michael , Beebe Kathleen S. , Benevenia Joseph , Patterson Francis R.
Published: August 2009

Benign aggressive distal femur tumors are treated with curettage, adjuvant phenol or argon, and polymethylmethacrylate (PMMA) packing. For large defects, an internal fixation device is added to reduce the fracture risk. The purpose of this study is to compare the strength of locking plates to other fixation devices for stabilization of these defects.

Lateral condyle defects in young, fresh frozen femurs were packed with PMMA and augmented by internal fixation. Three groups of 4 matched pairs of femurs were organized for the following comparisons: (1) stacked Steinmann pins vs crossed screws; (2) stacked pins vs locking plates; and (3) crossed screws vs locking plates. Specimens were subjected to axial load-to-failure testing on an MTS machine.

There was no difference in load-to-failure strength (
P
=.177) using Steinmann pins or crossed screws. Locking plate constructs were stronger (
P
=.028) than Steinmann pin constructs. Locking plate constructs were also stronger (
P
<.001) than crossed-screw constructs. Steinmann pin constructs failed with severe intra-articular fractures; crossed screw constructs failed with bulging of the defects, articular impaction, and minimal fracture propagation. Locking plate constructs failed with extra-articular spiral shaft fractures.
Antibiotic Cement Screw for Postoperative Infection After Gamma Nailing
Authors: Noda Mitsuaki , Saegusa Yasuhiro , Takakura Yoshiyuki , Kuroda Ryosuke , Doita Minoru
Published: August 2009

Few articles describe the management of postoperative infection occurring after the use of an intramedullary nail in the treatment of femoral intertrochanteric fractures. Implant removal is frequently selected for postoperative infection control, especially in chronic cases. However, removal of the intramedullary nail causes a high rate of femoral neck fractures, challenging surgeons to prevent such fractures with few guidelines for how this can be done.

This article presents 2 cases of postoperative infection following intramedullary nail implant in elderly women. After removal of the infected implant and meticulous debridement, an antibiotic cement screw (a cannulated screw enveloped with antibiotic-impregnated bone cement) was inserted from the lag screw hole into the femoral head. At the latest follow-up (mean, 18 months postoperatively), neither femoral neck fracture nor infection had occurred in either patient.

The antibiotic cement screw is expected to provide stability and prevent fracture at the femoral neck region, and its more intimate contact with the medullary canal allows a higher concentration of local antibiotics than intravenous application. The antibiotic cement screw is recommended especially for infection after gamma nailing.

We also introduce a simple, reproducible method for constructing an antibiotic cement screw large enough to fit the lag screw hole using bone cement, cannulated screw, antibiotics, and a chest tube.
Foxp3-Deficient Regulatory T Cells Do Not Revert into Conventional Effector CD4+ T Cells but Constitute a Unique Cell Subset
Authors: Kuczma Michal , Podolsky Robert , Garge Nikhil , Daniely Danielle , Pacholczyk Rafal , Ignatowicz Leszek , Kraj Piotr
Published: August 2009

Homeostasis in the immune system is maintained by specialized regulatory CD4+ T cells (Treg) expressing transcription factor Foxp3. According to the current paradigm, high-affinity interactions between TCRs and class II MHC-peptide complexes in thymus “instruct” developing thymocytes to up-regulate Foxp3 and become Treg cells. However, the loss or down-regulation of Foxp3 does not disrupt the development of Treg cells but abrogates their suppressor function. In this study, we show that Foxp3-deficient Treg cells in scurfy mice harboring a null mutation of the Foxp3 gene retained cellular features of Treg cells including in vitro anergy, impaired production of inflammatory cytokines, and dependence on exogenous IL-2 for proliferation and homeostatic expansion. Foxp3-deficient Treg cells expressed a low level of activation markers, did not expand relative to other CD4+ T cells, and produced IL-4 and immunomodulatory cytokines IL-10 and TGF-β when stimulated. Global gene expression profiling revealed significant similarities between Treg cells expressing and lacking Foxp3. These results argue that Foxp3 deficiency alone does not convert Treg cells into conventional effector CD4+ T cells but rather these cells constitute a distinct cell subset with unique features.
Alveolar Macrophages and Lung Dendritic Cells Sense RNA and Drive Mucosal IgA Responses
Authors: Bessa Juliana , Jegerlehner Andrea , Hinton Heather J. , Pumpens Paul , Saudan Philippe , Schneider Pascal , Bachmann Martin F.
Published: August 2009

The mechanisms regulating systemic and mucosal IgA responses in the respiratory tract are incompletely understood. Using virus-like particles loaded with single-stranded RNA as a ligand for TLR7, we found that systemic vs mucosal IgA responses in mice were differently regulated. Systemic IgA responses following s.c. immunization were T cell independent and did not require TACI or TGFβ, whereas mucosal IgA production was dependent on Th cells, TACI, and TGFβ. Strikingly, both responses required TLR7 signaling, but systemic IgA depended upon TLR7 signaling directly to B cells whereas mucosal IgA required TLR7 signaling to lung dendritic cells and alveolar macrophages. Our data show that IgA switching is controlled differently according to the cell type receiving TLR signals. This knowledge should facilitate the development of IgA-inducing vaccines.
ERK and Not p38 Pathway Is Required for IL-12 Restoration of T Cell IL-2 and IFN-γ in a Rodent Model of Alcohol Intoxication and Burn Injury
Authors: Li Xiaoling , Chaudry Irshad H. , Choudhry Mashkoor A.
Published: August 2009

Previous studies from our laboratory have shown that acute alcohol/ethanol (EtOH) intoxication combined with burn injury suppresses T cell IL-2 and IFN-γ production by inhibiting p38 and ERK activation. Because IL-12 plays a major role in Th1 differentiation and IFN-γ production, we examined whether diminished IL-2 and IFN-γ production after EtOH plus burn injury resulted from a decrease in IL-12. Furthermore, we investigated whether IL-12 utilizes the p38/ERK pathway to modulate T cell IL-2 and IFN-γ production after EtOH and burn injury. Male rats (∼250 g) were gavaged with 5 ml of 20% EtOH 4 h before ∼12.5% total body surface area burn or sham injury. Rats were sacrificed on day 1 after injury, and mesenteric lymph node T cells were isolated. T cells were stimulated with anti-CD3 in the absence or presence of rIL-12 (10 ng/ml) for 5 min and lysed. Lysates were analyzed for p38/ERK protein and phosphorylation levels using specific Abs and Western blot. In some experiments, T cells were cultured for 48 h with or without the inhibitors of p38 (10 μM SB203580/SB202190) or ERK (50 μM PD98059) to delineate the role of p38 and ERK in IL-12-mediated restoration of IL-2 and IFN-γ. Our findings indicate that IL-12 normalizes both p38 and ERK activation in T cells, but the results obtained using p38 and ERK inhibitors indicate that the restoration of ERK plays a predominant role in IL-12-mediated restoration of T cell IL-2 and IFN-γ production after EtOH and burn injury.
Immune Suppressive Activity and Lack of T Helper Differentiation Are Differentially Regulated in Natural Regulatory T Cells
Authors: Zeng Wei-ping , Chang Chawnshang , Lai Jiann-jyh
Published: August 2009

The mechanism for controlling Th cytokine expression in natural regulatory T (nTreg) cells is unclear. Here, it was found that under polarizing conditions Foxp3 did not affect Th1 cell, partially inhibited Th17 cell, but greatly inhibited Th2 cell differentiation of conventional CD4 T cells. Under the polarizing conditions, nTreg cells failed to differentiate into Th2 and Th17 cells, but differentiated into IFN-γ-producing cells. Such Foxp3-transduced CD4 T cells and nTreg cells expressed T-bet, GATA-3, or retinoic acid-related orphan receptor (ROR)γt, and retroviral GATA-3 and RORγt could not induce Th2 and Th17 differentiation from nTreg cells. However, regardless of their cytokine profiles, the Foxp3-transduced CD4 T cells and nTreg cells remained immune suppressive. These results suggested that it is possible to convert pathogenic Th cells to Treg-like cells for therapeutic application. In conclusion, our studies show that Foxp3 is sufficient for immune suppression, whereas the inhibition of cytokine expression requires additional mechanisms.
SHIP Represses the Generation of IL-3-Induced M2 Macrophages by Inhibiting IL-4 Production from Basophils
Authors: Kuroda Etsushi , Ho Victor , Ruschmann Jens , Antignano Frann , Hamilton Melisa , Rauh Michael J. , Antov Andrey , Flavell Richard A. , Sly Laura M. , Krystal Gerald
Published: August 2009

There is a great deal of interest in determining what regulates the generation of classically activated (M1) vs alternatively activated (M2) macrophages (Mφs) because of the opposing effects that these two Mφ subsets have on tumor progression. We show herein that IL-3 and, to a lesser extent, GM-CSF skew murine Mφ progenitors toward an M2 phenotype, especially in the absence of SHIP. Specifically, the addition of these cytokines, with or without M-CSF, to adherence- or lineage-depleted (Lin−) SHIP−/− bone marrow (BM) cells induces high levels of the M2 markers, arginase I, and Ym1 in the resulting mature Mφs. These in vitro-derived mature Mφs also display other M2 characteristics, including an inability to enhance anti-CD3-stimulated splenic T cell secretion of IFN-γ and low IL-12 and high IL-10 production in response to LPS. Not surprisingly, given that IL-3 and GM-CSF utilize STAT5 to trigger many downstream signaling pathways, this M2 phenotype is suppressed when STAT5−/− BM cells are used. Unexpectedly, however, this M2 phenotype is also suppressed when STAT6−/− BM cells are used, suggesting that IL-4- or IL-13-induced signaling might be involved. Consistent with this, we found that IL-3 and GM-CSF stimulate the production of IL-4, especially from SHIP−/− Lin− BM cells, and that neutralizing anti-IL-4 Abs block IL-3-induced M2 skewing. Moreover, we found that basophil progenitors within the Lin− BM are responsible for this IL-3- and GM-CSF-induced IL-4 production, and that SHIP represses M2 skewing not by preventing skewing within Mφs themselves but by inhibiting IL-4 production from basophils.
XBP-1-Deficient Plasmablasts Show Normal Protein Folding but Altered Glycosylation and Lipid Synthesis
Authors: McGehee Annette M. , Dougan Stephanie K. , Klemm Elizabeth J. , Shui Guanghou , Park Boyoun , Kim You-Me , Watson Nicki , Wenk Markus R. , Ploegh Hidde L. , Hu Chih-Chi Andrew
Published: August 2009

The accumulation of misfolded secreted IgM in the endoplasmic reticulum (ER) of X-box binding protein 1 (XBP-1)-deficient B cells has been held responsible for the inability of such cells to yield plasma cells, through the failure to mount a proper unfolded protein response. LPS-stimulated B cells incapable of secreting IgM still activate the XBP-1 axis normally, as follows: XBP-1 is turned on by cues that trigger differentiation and not in response to accumulation of unfolded IgM, but the impact of XBP-1 deficiency on glycoprotein folding and assembly has not been explored. The lack of XBP-1 compromised neither the formation of functional hen egg lysozyme-specific IgM nor the secretion of free κ-chains. Although XBP-1 deficiency affects the synthesis of some ER chaperones, including protein disulfide isomerase, their steady state levels do not drop below the threshold required for proper assembly and maturation of the Igα/Igβ heterodimer and MHC molecules. Intracellular transport and surface display of integral membrane proteins are unaffected by XBP-1 deficiency. Given the fact that we failed to observe any defects in folding of a variety of glycoproteins, we looked for other means to explain the requirement for XBP-1 in plasma cell development. We observed significantly reduced levels of phosphatidylcholine, sphingomyelin, and phosphatidylinositol in total membranes of XBP-1-deficient B cells, and reduced ER content. Terminal N-linked glycosylation of IgM and class I MHC was altered in these cells. XBP-1 hence has important roles beyond folding proteins in the ER.
TLR3-Stimulated Dendritic Cells Up-regulate B7-H1 Expression and Influence the Magnitude of CD8 T Cell Responses to Tumor Vaccination
Authors: Pulko Vesna , Liu Xin , Krco Christopher J. , Harris Kimberley J. , Frigola Xavier , Kwon Eugene D. , Dong Haidong
Published: August 2009

Agonists of TLR have been explored as vaccine adjuvants for tumor immunotherapy. However, their immunological consequences are not fully understood. Although TLR signaling increases the functional potential of dendritic cells (DCs) for priming T cells, coinduction of potentially negative immunoregulatory capacities may impair effector T cell generation. We examined the expression and function of B7 family costimulatory molecules on DCs after activation with the TLR3 agonist, polyinosinic:polycytidylic acid. We demonstrated that polyinosinic:polycytidylic acid consistently up-regulated both B7-2 and B7-H1 molecules on resident, migratory DCs from spleen and lymph nodes. Depletion or blockade of B7-H1 on activated DCs increased the magnitude of effector CD8 T cell expansion. DC-based or protein-based tumor vaccines, in combination with B7-H1 blockade, induced strong effector CD8 T cell responses, resulting in protective immunity against newly established tumors. Our studies suggest that TLR3 signaling has the potential to up-regulate both positive and negative coregulatory molecules on APCs. Selective blockade of negative regulatory molecules in combination with TLR3 agonist may be an effective strategy for increasing the efficacy of tumor vaccines.