bluuebunny/crossref_metadata_2025 huggingface dataset:
Simulated Response of the Arctic Freshwater Budget to Extreme NAO Wind Forcing
Authors: Condron Alan , Winsor Peter , Hill Chris , Menemenlis Dimitris
Published: December 2008

The authors investigate the response of the Arctic Ocean freshwater budget to changes in the North Atlantic Oscillation (NAO) using a regional-ocean configuration of the Massachusetts Institute of Technology GCM (MITgcm) and carry out several different 10-yr and 30-yr integrations. At 1/6° (∼18 km) resolution the model resolves the major Arctic transport pathways, including Bering Strait and the Canadian Archipelago. Two main calculations are performed by repeating the wind fields of two contrasting NAO years in each run for the extreme negative and positive NAO phases of 1969 and 1989, respectively. These calculations are compared both with a control run and the compiled observationally based freshwater budget estimate of Serreze et al.

The results show a clear response in the Arctic freshwater budget to NAO forcing, that is, repeat NAO negative wind forcing results in virtually all freshwater being retained in the Arctic, with the bulk of the freshwater content being pooled in the Beaufort gyre. In contrast, repeat NAO positive forcing accelerates the export of freshwater out of the Arctic to the North Atlantic, primarily via Fram Strait (∼900 km3 yr−1) and the Canadian Archipelago (∼500 km3 yr−1), with a total loss in freshwater storage of ∼13 000 km3 (15%) after 10 yr. The large increase in freshwater export through the Canadian Archipelago highlights the important role that this gateway plays in redistributing the freshwater of the Arctic to subpolar seas, by providing a direct pathway from the Arctic basin to the Labrador Sea, Gulf Stream system, and Atlantic Ocean.

The authors discuss the sensitivity of the Arctic Ocean to long-term fixed extreme NAO states and show that the freshwater content of the Arctic is able to be restored to initial values from a depleted freshwater state after ∼20 yr.
Demographic Change and the Housing Market: Evidence from a Comparison of Scotland and England
Authors: Levin Eric , Montagnoli Alberto , Wright Robert E.
Published: December 2008

This paper examines the impact of demographic change on the housing market. More specifically, a difference-in-differences methodology is used to explore the effect of population decline and population ageing on house prices in Scotland and England/Wales. The analysis suggests that population decline and population ageing put downward pressure on prices. Therefore, the long-run trend of rising real house prices can not be assumed to continue into the future, particularly in Scotland.
Internal Impingement of the Shoulder
Authors: Heyworth Benton E. , Williams Riley J.
Published: December 2008

Internal impingement of the shoulder is a pathologic condition characterized by excessive or repetitive contact of the greater tuberosity of the humeral head with the posterosuperior aspect of the glenoid when the arm is abducted and externally rotated. This arm positioning leads to rotator cuff and glenoid labrum impingement by the bony structures of the glenohumeral joint. Although some degree of contact between these structures occurs under normal conditions, to date most of the orthopaedic literature has focused on internal impingement as a disease state that affects overhead athletes and is characterized by the development of articular-sided rotator cuff tears and posterosuperior labral lesions. The precise cause of these impingement lesions remains unclear. However, it is believed that varying degrees of glenohumeral instability, posterior capsular contracture, and scapular dyskinesis may play a role in the development of symptomatic internal impingement. The purpose of this article is to review the pathomechanics, clinical complaints, physical examination findings, and imaging findings that are associated with internal impingement. The results of treatment will be reviewed, and a diagnostic and therapeutic algorithm for the management of internal impingement is presented.
Arthroscopic Treatment of Triangular Fibrocartilage Wrist Injuries in the Athlete
Authors: McAdams Timothy R. , Swan Justin , Yao Jeffrey
Published: December 2008

Background

Triangular fibrocartilage (TFC) injuries are an increasingly recognized cause of ulnar-sided wrist pain and can be particularly disabling in the competitive athlete. Previous studies show that arthroscopic debridement or repair can improve symptoms, but the results of arthroscopic treatment of TFC injuries in high-level athletes have not yet been reported.

Hypothesis

Arthroscopic debridement or repair of wrist TFC injury will allow a high rate of return to full function in the elite athlete.

Study Design

Case series; Level of evidence, 4.

Methods

Between 2001 and 2005, 16 competitive athletes (mean age, 23.4 years) with wrist TFC injuries underwent arthroscopic surgery. Repair was performed in unstable tears, and all others underwent debridement alone. Presurgery and post-surgery mini-DASH (Disabilities of the Arm, Shoulder, and Hand) scores were recorded for each athlete through medical record review and clinical evaluation. The mean duration of follow-up was 32.8 months (range, 24-51 months).

Results

The TFC was repaired in 11 (68.8%) and debrided in 5 (31.3%) patients. The tear was ulnar-sided in 12 (75%), radial-sided in 2 (12.5%), combined radial-ulnar in 1, and central-sided in 1 patient. Mean mini-DASH scores improved from 47.3 (range, 25-65.9) to 0 (all patients) (P =. 002), and the mean mini-DASH sports module improved from 79.7 (range, 68.8-100) to 1.95 (range, 0-18.8) (P =. 002). Return to play averaged 3.3 months (range, 3-7 months). Associated conditions in the 2 patients unable to return to play at 3 months were distal radioulnar joint (DRUJ) instability with ulnar-carpal abutment (n = 1) and extensor carpi ulnaris (ECU) tendinosis (n = 1).

Conclusion

Arthroscopic debridement or repair of wrist TFC injury provides predictable pain relief and return to play in competitive athletes. Return to play may be delayed in athletes with concomitant ulnar-sided wrist injuries.
Macronuclear genome structure of the ciliate Nyctotherus ovalis: Single-gene chromosomes and tiny introns
Authors: Ricard Guénola , de Graaf Rob M , Dutilh Bas E , Duarte I , van Alen Theo A , van Hoek Angela HAM , Boxma Brigitte , van der Staay Georg WM , Moon-van der Staay Seung Yeo , Chang Wei-Jen , Landweber Laura F , Hackstein Johannes HP , Huynen Martijn A
Published: December 2008

Background

Nyctotherus ovalis is a single-celled eukaryote that has hydrogen-producing mitochondria and lives in the hindgut of cockroaches. Like all members of the ciliate taxon, it has two types of nuclei, a micronucleus and a macronucleus. N. ovalis generates its macronuclear chromosomes by forming polytene chromosomes that subsequently develop into macronuclear chromosomes by DNA elimination and rearrangement.

Results

We examined the structure of these gene-sized macronuclear chromosomes in N. ovalis. We determined the telomeres, subtelomeric regions, UTRs, coding regions and introns by sequencing a large set of macronuclear DNA sequences (4,242) and cDNAs (5,484) and comparing them with each other. The telomeres consist of repeats CCC(AAAACCCC)n, similar to those in spirotrichous ciliates such as Euplotes, Sterkiella (Oxytricha) and Stylonychia. Per sequenced chromosome we found evidence for either a single protein-coding gene, a single tRNA, or the complete ribosomal RNAs cluster. Hence the chromosomes appear to encode single transcripts. In the short subtelomeric regions we identified a few overrepresented motifs that could be involved in gene regulation, but there is no consensus polyadenylation site. The introns are short (21–29 nucleotides), and a significant fraction (1/3) of the tiny introns is conserved in the distantly related ciliate Paramecium tetraurelia. As has been observed in P. tetraurelia, the N. ovalis introns tend to contain in-frame stop codons or have a length that is not dividable by three. This pattern causes premature termination of mRNA translation in the event of intron retention, and potentially degradation of unspliced mRNAs by the nonsense-mediated mRNA decay pathway.

Conclusion

The combination of short leaders, tiny introns and single genes leads to very minimal macronuclear chromosomes. The smallest we identified contained only 150 nucleotides.
Heat shock cognate protein 70 contributes to Brucella invasion into trophoblast giant cells that cause infectious abortion
Authors: Watanabe Kenta , Tachibana Masato , Tanaka Satoshi , Furuoka Hidefumi , Horiuchi Motohiro , Suzuki Hiroshi , Watarai Masahisa
Published: December 2008

Background

The cell tropism ofBrucella abortus, a causative agent of brucellosis and facultative intracellular pathogen, in the placenta is thought to be a key event of infectious abortion, although the molecular mechanism for this is largely unknown. There is a higher degree of bacterial colonization in the placenta than in other organs and many bacteria are detected in trophoblast giant (TG) cells in the placenta. In the present study, we investigated mechanism ofB. abortusinvasion into TG cells.

Results

We observed internalization and intracellular growth ofB. abortusin cultured TG cells. A monoclonal antibody that inhibits bacterial internalization was isolated and this reacted with heat shock cognate protein 70 (Hsc70). Depletion and over expression of Hsc70 in TG cells inhibited and promoted bacterial internalization, respectively. IFN-γ receptor was expressed in TG cells and IFN-γ treatment enhanced the uptake of bacteria by TG cells. Administering the anti-Hsc70 antibody to pregnant mice served to prevent infectious abortion.

Conclusion

B. abortusinfection of TG cells in placenta is mediated by Hsc70, and that such infection leads to infectious abortion.
Uptake and intra-inclusion accumulation of exogenous immunoglobulin by Chlamydia-infected cells
Authors: Pollack David V , Croteau Nancy L , Stuart Elizabeth S
Published: December 2008

Background

Obligate intracellular pathogens belonging to the Chlamydiaceae family possess a number of mechanisms by which to manipulate the host cell and surrounding environment. Such capabilities include the inhibition of apoptosis, down-regulation of major histocompatability complex (MHC) and CD1/d gene expression, and the acquisition of host-synthesized nutrients. It is also documented that a limited number of host-derived macromolecules such as β-catenin and sphingomyelin accumulate within the inclusion.

Results

This report provides evidence that immunoglobulin, inherently present in the extracellular environment in vivo and in vitro, enters infected cells and accumulates within the chlamydial inclusion. Using epi-fluorescent and confocal microscopy, this selective uptake of Ig is shown to occur among human leukocytes in vivo as well as cells cultured in vitro. These findings were confirmed by detection of IgG in the lysate of infected cells by western blot hybridization. Sequestered antibodies appear to be present during the entire course of the chlamydial developmental cycle and are distributed throughout this compartment. IgG pre-labeled with fluorescein, when added to the supernatant of infected cell cultures, was also imported and readily visualized. Accumulation of these molecules within the inclusion and the failure of bovine serum albumin or F(ab')2 fragments to accumulate in a similar manner suggests the process of entry is specific for intact IgG molecules and not a result of pinocytosis, diffusion, or any other mass endocytic event.

Conclusion

Sequestration of a host cell-derived protein within the chlamydial inclusion, although unexpected, is not an unprecedented occurrence. However, selective accumulation of an exogenous host protein, such as extracellular IgG, has not been previously reported in connection with chlamydial infections. The selectivity of this process may indicate that this uptake plays an important role in pathogen physiology or virulence during infection and the phenomenon itself may give rise to novel diagnostic and therapeutic approaches.
Buthionine sulfoximine sensitizes antihormone-resistant human breast cancer cells to estrogen-induced apoptosis
Authors: Lewis-Wambi Joan S , Kim Helen R , Wambi Chris , Patel Roshani , Pyle Jennifer R , Klein-Szanto Andres J , Jordan V Craig
Published: December 2008

Introduction

Estrogen deprivation using aromatase inhibitors is one of the standard treatments for postmenopausal women with estrogen receptor (ER)-positive breast cancer. However, one of the consequences of prolonged estrogen suppression is acquired drug resistance. Our group is interested in studying antihormone resistance and has previously reported the development of an estrogen deprived human breast cancer cell line, MCF-7:5C, which undergoes apoptosis in the presence of estradiol. In contrast, another estrogen deprived cell line, MCF-7:2A, appears to have elevated levels of glutathione (GSH) and is resistant to estradiol-induced apoptosis. In the present study, we evaluated whether buthionine sulfoximine (BSO), a potent inhibitor of glutathione (GSH) synthesis, is capable of sensitizing antihormone resistant MCF-7:2A cells to estradiol-induced apoptosis.

Methods

Estrogen deprived MCF-7:2A cells were treated with 1 nM 17β-estradiol (E2), 100 μM BSO, or 1 nM E2 + 100 μM BSO combination in vitro, and the effects of these agents on cell growth and apoptosis were evaluated by DNA quantitation assay and annexin V and terminal deoxynucleotidyl transferase dUTP nick end-labeling (TUNEL) staining. The in vitro results of the MCF-7:2A cell line were further confirmed in vivo in a mouse xenograft model.

Results

Exposure of MCF-7:2A cells to 1 nM E2 plus 100 μM BSO combination for 48 to 96 h produced a sevenfold increase in apoptosis whereas the individual treatments had no significant effect on growth. Induction of apoptosis by the combination treatment of E2 plus BSO was evidenced by changes in Bcl-2 and Bax expression. The combination treatment also markedly increased phosphorylated c-Jun N-terminal kinase (JNK) levels in MCF-7:2A cells and blockade of the JNK pathway attenuated the apoptotic effect of E2 plus BSO. Our in vitro findings corroborated in vivo data from a mouse xenograft model in which daily administration of BSO either as a single agent or in combination with E2 significantly reduced tumor growth of MCF-7:2A cells.

Conclusions

Our data indicates that GSH participates in retarding apoptosis in antihormone-resistant human breast cancer cells and that depletion of this molecule by BSO may be critical in predisposing resistant cells to E2-induced apoptotic cell death. We suggest that these data may form the basis of improving therapeutic strategies for the treatment of antihormone resistant ER-positive breast cancer.
Cognitive–behavioural therapy v. usual care in recurrent depression
Authors: Conradi Henk Jan , de Jonge Peter , Ormel Johan
Published: November 2008

We examined in a primary care sample whether acute-phase cognitive–behavioural therapy (CBT) would be more effective than usual care for patients with multiple prior episodes of depression. Depression outcome was based on a 3-monthly administered Beck Depression Inventory (BDI) during a 2-year follow-up. We confirmed that in patients with four or more prior episodes, CBT outperformed usual care by four points on the BDI, but not in patients with three or fewer prior episodes. Subsequent analyses suggested that CBT may be able to tackle cognitive problems related to rumination in patients with recurrent depression.
Early intervention for adolescents with borderline personality disorder using cognitive analytic therapy: randomised controlled trial
Authors: Chanen Andrew M. , Jackson Henry J. , McCutcheon Louise K. , Jovev Martina , Dudgeon Paul , Yuen Hok Pan , Germano Dominic , Nistico Helen , McDougall Emma , Weinstein Caroline , Clarkson Verity , McGorry Patrick D.
Published: November 2008

Background

No accepted intervention exists for borderline personality disorder presenting in adolescence.

Aims

To compare the effectiveness of up to 24 sessions of cognitive analytic therapy (CAT) or manualised good clinical care (GCC) in addition to a comprehensive service model of care.

Method

In a randomised controlled trial, CAT and GCC were compared in out-patients aged 15–18 years who fulfilled two to nine of the DSM–IV criteria for borderline personality disorder. We predicted that, compared with the GCC group, the CAT group would show greater reductions in psychopathology and parasuicidal behaviour and greater improvement in global functioning over 24 months.

Results

Eighty-six patients were randomised and 78 (CAT n=41; GCC n=37) provided follow-up data. There was no significant difference between the outcomes of the treatment groups at 24 months on the pre-chosen measures but there was some evidence that patients allocated to CAT improved more rapidly. No adverse effect was shown with either treatment.

Conclusions

Both CAT and GCC are effective in reducing externalising psychopathology in teenagers with sub-syndromal or full-syndrome bipolar personality disorder. Larger studies are required to determine the specific value of CAT in this population.
Pregnancy loss and psychiatric disorders in young women: an Australian birth cohort study
Authors: Dingle Kaeleen , Alati Rosa , Clavarino Alexandra , Najman Jake M. , Williams Gail M.
Published: November 2008

Background

Recent evidence has linked induced abortion with later adverse psychiatric outcomes in young women.

Aims

To examine whether abortion or miscarriage are associated with subsequent psychiatric and substance use disorders.

Method

A sample (n=1223) of women from a cohort born between 1981 and 1984 in Australia were assessed at 21 years for psychiatric and substance use disorders and lifetime pregnancy histories.

Results

Young women reporting a pregnancy loss had nearly three times the odds of experiencing a lifetime illicit drug disorder (excluding cannabis): abortion odds ratio (OR)=3.6 (95% CI 2.0–6.7) and miscarriage OR=2.6 (95% CI 1.2–5.4). Abortion was associated with alcohol use disorder (OR=2.1, 95% CI 1.3–3.5) and 12-month depression (OR=1.9, 95% CI 1.1–3.1).

Conclusions

These findings add to the growing body of evidence suggesting that pregnancy loss per se, whether abortion or miscarriage, increases the risk of a range of substance use disorders and affective disorders in young women.
Abortion and mental health disorders: evidence from a 30-year longitudinal study
Authors: Fergusson David M. , Horwood L. John , Boden Joseph M.
Published: November 2008

Background

Research on the links between abortion and mental health has been limited by design problems and relatively weak evidence.

Aims

To examine the links between pregnancy outcomes and mental health outcomes.

Method

Data were gathered on the pregnancy and mental health history of a birth cohort of over 500 women studied to the age of 30.

Results

After adjustment for confounding, abortion was associated with a small increase in the risk of mental disorders; women who had had abortions had rates of mental disorder that were about 30% higher. There were no consistent associations between other pregnancy outcomes and mental health. Estimates of attributable risk indicated that exposure to abortion accounted for 1.5% to 5.5% of the overall rate of mental disorders.

Conclusions

The evidence is consistent with the view that abortion may be associated with a small increase in risk of mental disorders. Other pregnancy outcomes were not related to increased risk of mental health problems.
Invited commentaries on… Abortion and mental health disorders
Authors: Casey Patricia , Oates Margaret , Jones Ian , Cantwell Roch
Published: November 2008

The finding that induced abortion is a risk factor for subsequent psychiatric disorder in some women raises important clinical and training issues for psychiatrists. It also highlights the necessity for developing evidence-based interventions for these women. P.C. / Evidence suggesting a modest increase in mental health problems after abortion does not support the prominence of psychiatric issues in the abortion debate, which is primarily moral and ethical not psychiatric or scientific. M.O. et al.
Phospholipase Cγ2 is necessary for separation of blood and lymphatic vasculature in mice
Authors: Ichise Hirotake , Ichise Taeko , Ohtani Osamu , Yoshida Nobuaki
Published: December 2008

The lymphatic vasculature originates from the blood vasculature through a mechanism relying on Prox1 expression and VEGFC signalling, and is separated and kept separate from the blood vasculature in a Syk- and SLP76-dependent manner. However, the mechanism by which lymphatic vessels are separated from blood vessels is not known. To gain an understanding of the vascular partitioning, we searched for the affected gene in a spontaneous mouse mutant exhibiting blood-filled lymphatic vessels, and identified a null mutation of the Plcg2 gene, which encodes phospholipase Cγ2 (PLCγ2),by positional candidate cloning. The blood-lymph shunt observed in PLCγ2-null mice was due to aberrant separation of blood and lymphatic vessels. A similar phenotype was observed in lethally irradiated wild-type mice reconstituted with PLCγ2-null bone marrow cells. These findings indicate that PLCγ2 plays an essential role in initiating and maintaining the separation of the blood and lymphatic vasculature.
Disc calibration for digital templating in hip replacement
Authors: Kulkarni A. , Partington P. , Kelly D. , Muller S.
Published: November 2008

Digital radiography is becoming widespread. Accurate pre-operative templating of digital images of the hip traditionally involves positioning a calibration object at its centre. This can be difficult and cause embarrassment. We have devised a method whereby a planar disc placed on the radiographic cassette accounts for the expected magnification. Initial examination of 50 pelvic CT scans showed a mean hip centre distance of 117 mm (79 to 142) above the gluteal skin. Further calculations predicted that a disc of 37.17 mm diameter, placed on the cassette, would appear identical to a 30 mm sphere placed at the level of the centre of the hip as requested by our templating software. We assessed accuracy and reproducibility by ‘reverse calibration’ of 20 radiographs taken three months after hip replacement using simultaneous sphere and disc methods, and a further 20 with a precision disc of accurate size. Even when variations in patient size were ignored, the disc proved more accurate and reliable than the sphere.

The technique is reliable, robust, cost effective and acceptable to patients and radiographers. It can easily be used in any radiography department after a few simple calculations and manufacture of appropriately-sized discs.
Minimally-invasive treatment of three- and four-part fractures of the proximal humerus in elderly patients
Authors: Bogner R. , Hübner C. , Matis N. , Auffarth A. , Lederer S. , Resch H.
Published: November 2008

The surgical treatment of three- and four-part fractures of the proximal humerus in osteoporotic bone is difficult and there is no consensus as to which technique leads to the best outcome in elderly patients. Between 1998 and 2004 we treated 76 patients aged over 70 years with three- or four-part fractures by percutaneous reduction and internal fixation using the Humerusblock.

A displacement of the tuberosity of > 5 mm and an angulation of > 30° of the head fragment were the indications for surgery.

Of the patients 50 (51 fractures) were available for follow-up after a mean of 33.8 months (5.8 to 81). The absolute, age-related and side-related Constant scores were recorded. Of the 51 fractures, 46 (90.2%) healed primarily. Re-displacement of fragments or migration of Kirschner wires was seen in five cases. Necrosis of the humeral head developed in four patients. In three patients a secondary arthroplasty had to be performed, in two because of re-displacement and in one for necrosis of the head. There was one case of deep infection which required a further operation and one of delayed healing.

The mean Constant score of the patients with a three-part fracture was 61.2 points (35 to 87) which was 84.9% of the score for the non-injured arm. In four-part fractures it was 49.5 points (18 to 87) or 68.5% of the score for the non-injured arm.

The Humerusblock technique can provide a comfortable and mobile shoulder in elderly patients and is a satisfactory alternative to replacement and traditional techniques of internal fixation.
Limited open reduction and internal fixation of displaced intra-articular fractures of the calcaneum
Authors: Weber M. , Lehmann O. , Sägesser D. , Krause F.
Published: November 2008

The extended lateral L-shaped approach for the treatment of displaced intra-articular fractures of the calcaneum may be complicated by wound infection, haematoma, dehiscence and injury to the sural nerve. In an effort to reduce the risk of problems with wound healing a technique was developed that combined open reduction and fixation of the joint fragments and of the anterior process with percutaneous reduction and screw fixation of the tuberosity. A group of 24 patients with unilateral isolated closed Sanders type II and III fractures was treated using this technique and compared to a similar group of 26 patients managed by the extended approach and lateral plating. The operation was significantly shorter (p < 0.001) in the first group, but more minor secondary procedures and removal of heel screws were necessary. There were no wound complications in this group, whereas four minor complications occurred in the second group. The accuracy and maintenance of reduction, and ultimate function were equivalent.
Total knee replacements in a patient with the Morquio syndrome
Authors: Atinga M. , Hamer A. J.
Published: November 2008

The Morquio syndrome is a rare disorder which presents with a number of musculoskeletal problems. The literature describing total knee replacement in these patients is sparse. We describe the management of a patient with bilateral instability and pain in the knees using bilateral constrained knee replacements, and followed up for five years with pre- and postoperative knee scores. We highlight the difficulties encountered and discuss the end results.
European validation of the Vancouver classification of periprosthetic proximal femoral fractures
Authors: Rayan F. , Dodd M. , Haddad F. S.
Published: November 2008

The Vancouver classification has been shown by its developers to be a valid and reliable method for categorising the configuration of periprosthetic proximal femoral fractures and for planning their management. We have re-validated this classification system independently using the radiographs of 30 patients with periprosthetic fractures. These were reviewed by six experienced consultant orthopaedic surgeons, six trainee surgeons and six medical students in order to assess intra- and interobserver reliability and reproducibility. Each observer read the radiographs on two separate occasions. The results were subjected to weighted kappa statistical analysis.

The respective kappa values for interobserver agreement were 0.72 and 0.74 for consultants, 0.68 and 0.70 for trainees on the first and second readings of the radiographs and 0.61 for medical students. The intra-observer agreement for the consultants was 0.64 and 0.67, for the trainees 0.61 and 0.64, and for the medical students 0.59 and 0.60 for the first and second readings, respectively. The validity of the classification was studied by comparing the pre-operative radiological findings within B subgroups with the operative findings. This revealed agreement for 77% of these type-B fractures, with a kappa value of 0.67.

Our data confirm the reliability and reproducibility of this classification system in a European setting and for inexperienced staff. This is a reliable system which can be used by non-experts, between centres and across continents.
One stage uncemented revision of infected total hip replacement using cancellous allograft bone impregnated with antibiotics
Authors: Winkler H. , Stoiber A. , Kaudela K. , Winter F. , Menschik F.
Published: November 2008

Infection of a total hip replacement (THR) requires component removal and thorough local debridement. Usually, long-term antibiotic treatment in conjunction with a two-stage revision is required. This may take several months. One-stage revision using antibiotic-loaded cement has not gained widespread use, although the clinical and economic advantages are obvious. Allograft bone may be impregnated with high levels of antibiotics, and in revision of infected THR, act as a carrier providing a sustained high local concentration.

We performed 37 one-stage revision of infected THRs, without the use of cement. There were three hips which required further revision because of recurrent infection, the remaining 34 hips (92%) stayed free from infection and stable at a mean follow-up of 4.4 years (2 to 8). No adverse effects were identified. Incorporation of bone graft was comparable with unimpregnated grafts.

Antibiotic-impregnated allograft bone may enable reconstruction of bone stock, insertion of an uncemented implant and control of infection in a single operation in revision THR for infection.
A trabecular metal tibial component in total knee replacement in patients younger than 60 years
Authors: Henricson A. , Linder L. , Nilsson K. G.
Published: November 2008

We compared the performance of uncemented trabecular metal tibial components in total knee replacement with that of cemented tibial components in patients younger than 60 years over two years using radiostereophotogrammetric analysis (RSA). A total of 22 consecutive patients (mean age 53 years, 33 to 59, 26 knees) received an uncemented NexGen trabecular metal cruciate-retaining monobloc tibial component and 19 (mean 53 years, 44 to 59, 21 knees) a cemented NexGen Option cruciate-retaining modular tibial component.

All the trabecular metal components migrated during the initial three months and then stabilised. The exception was external rotation, which did not stabilise until 12 months. Unlike conventional metal-backed implants which displayed a tilting migration comprising subsidence and lift-off from the tibial tray, most of the trabecular metal components showed subsidence only, probably due to the elasticity of the implant.

This pattern of subsidence is regarded as being beneficial for uncemented fixation.
New insights into function of the growth plate
Authors: Bush P. G. , Hall A. C. , Macnicol M. F.
Published: November 2008

The mammalian growth plate is a complex structure which is essential for the elongation of long bones. However, an understanding of how the growth plate functions at the cellular level is lacking. This review, summarises the factors involved in growth-plate regulation, its failure and the consequence of injury. We also describe some of the cellular mechanisms which underpin the increase in volume of the growth-plate chondrocyte which is the major determinant of the rate and extent of bone lengthening. We show how living in situ chondrocytes can be imaged using 2-photon laser scanning microscopy to provide a quantitative analysis of their volume. This approach should give better understanding of the cellular control of bone growth in both healthy and failed growth plates.
The use of a vascularised periosteal patch onlay graft in the management of nonunion of the proximal scaphoid
Authors: Thompson N. W. , Kapoor A. , Thomas J. , Hayton M. J.
Published: November 2008

We describe the use of a vascularised periosteal patch onlay graft based on the 1,2 intercompartmental supraretinacular artery in the management of 11 patients (ten men, one woman) with chronic nonunion involving the proximal third of the scaphoid. The mean age of the patients was 31 years (21 to 45) with the dominant hand affected in eight. Six of the patients were smokers and three had undergone previous surgery to the scaphoid. All of the proximal fragments were avascular. The presence of union was assessed using longitudinal axis CT.

Only three patients progressed to union of the scaphoid and four required a salvage operation for a symptomatic nonunion. The remaining four patients with a persistent nonunion are asymptomatic with low pain scores, good grip strength and a functional range of wrist movement.

Although this technique has potential technical advantages over vascularised pedicled bone grafting, the rate of union has been disappointing and we do not recommend it as a method of treatment.
Bone formation in a carbonate-substituted hydroxyapatite implant is inhibited by zoledronate
Authors: Spence G. , Phillips S. , Campion C. , Brooks R. , Rushton N.
Published: November 2008

Carbonate-substituted hydroxyapatite (CHA) is more osteoconductive and more resorbable than hydroxyapatite (HA), but the underlying mode of its action is unclear. We hypothesised that increased resorption of the ceramic by osteoclasts might subsequently upregulate osteoblasts by a coupling mechanism, and sought to test this in a large animal model.

Defects were created in both the lateral femoral condyles of 12 adult sheep. Six were implanted with CHA granules bilaterally, and six with HA. Six of the animals in each group received the bisphosphonate zoledronate (0.05 mg/kg), which inhibits the function of osteoclasts, intra-operatively.

After six weeks bony ingrowth was greater in the CHA implants than in HA, but not in the animals given zoledronate. Functional osteoclasts are necessary for the enhanced osteoconduction seen in CHA compared with HA.
Heterotopic ossification after the use of commercially available recombinant human bone morphogenetic proteins in four patients
Authors: Axelrad T. W. , Steen B. , Lowenberg D. W. , Creevy W. R. , Einhorn T. A.
Published: November 2008

Heterotopic ossification occurring after the use of commercially available bone morphogenetic proteins has not been widely reported. We describe four cases of heterotopic ossification in patients treated with either recombinant bone morphogenetic protein 2 or recombinant bone morphogenetic protein 7. We found that while some patients were asymptomatic, heterotopic ossification which had occurred around a joint often required operative excision with good results.
Early outcome of hip arthroscopy for femoroacetabular impingement
Authors: Bardakos N. V. , Vasconcelos J. C. , Villar R. N.
Published: November 2008

There is a known association between femoroacetabular impingement and osteoarthritis of the hip. What is not known is whether arthroscopic excision of an impingement lesion can significantly improve a patient’s symptoms.

This study compares the results of hip arthroscopy for cam-type femoracetabular impingement in two groups of patients at one year. The study group comprised 24 patients (24 hips) with cam-type femoroacetabular impingement who underwent arthroscopic debridement with excision of their impingement lesion (osteoplasty). The control group comprised 47 patients (47 hips) who had arthroscopic debridement without excision of the impingement lesion. In both groups, the presence of femoroacetabular impingement was confirmed on pre-operative plain radiographs. The modified Harris hip score was used for evaluation pre-operatively and at one-year. Non-parametric tests were used for statistical analysis.

A tendency towards a higher median post-operative modified Harris hip score was observed in the study group compared with the control group (83 vs 77, p = 0.11). There was a significantly higher proportion of patients in the osteoplasty group with excellent/good results compared with the controls (83% vs 60%, p = 0.043). Additional symptomatic improvement may be obtained after hip arthroscopy for femoroacetabular impingement by the inclusion of femoral osteoplasty.
Midterm survival of a contemporary modular total knee replacement
Authors: Dalury D. F. , Barrett W. P. , Mason J. B. , Goldstein W. M. , Murphy J. A. , Roche M. W.
Published: November 2008

This retrospective study evaluated the midterm clinical and radiographic outcomes of a second-generation total knee replacement system. In a multicentre consecutive series of 1512 patients, 1970 knees were treated with the PFC Sigma knee system (Depuy, Warsaw, Indiana). The patients were reviewed for functional outcome, and underwent independent radiographic evaluation at a mean follow-up of 7.3 years (5 to 10). A total of 40 knees (2%) required revision, 17 (0.9%) for infection. The incidence of osteolysis was 2.2%. The ten-year survival with revision for any cause other than infection as the endpoint was 97.2% (95% CI 95.4 to 99.1).

The PFC Sigma knee system appears to provide excellent results in the medium term.
Cemented total hip replacement for primary osteoarthritis in patients aged 55 years or older
Authors: Mäkelä K. , Eskelinen A. , Pulkkinen P. , Paavolainen P. , Remes V.
Published: November 2008

We have analysed from the Finnish Arthroplasty Register the long-term survivorship of the 12 most commonly-used cemented implants between 1980 and 2005 in patients aged 55 years or older with osteoarthritis.

Only two designs of femoral component, the Exeter Universal and the Müller Straight femoral component had a survivorship of over 95% at ten years with revision for aseptic loosening as the endpoint. At 15 years of the femoral and acetabular component combinations, only the Exeter Universal/Exeter All-poly implant had a survival rate of over 90% with revision for aseptic loosening as the endpoint. In the subgroup of patients aged between 55 and 64 years, survivorship overall was less than 90% at ten years.

The variation in the long-term rates of survival of different cemented hip implants was considerable in patients aged 55 years or older. In those aged between 55 and 64 years, none of the cemented prostheses studied yielded excellent long-term survival rates (≥ 90% at 15 years).
Health-care quality registers
Authors: Ranstam J. , Wagner P. , Robertsson O. , Lidgren L.
Published: November 2008

Public disclosure of outcome-orientated ranking of hospitals is becoming increasingly popular and is routinely used by Swedish health-care authorities. Whereas uncertainty about an outcome is usually presented with 95% confidence intervals, ranking’s based on the same outcome are typically presented without any concern for bias or statistical precision. In order to study the effect of incomplete registration of re-operation on hospital ranking we performed a simulation study using published data on the two-year risk of re-operation after total hip replacement.

This showed that whereas minor registration incompleteness has little effect on the observed risk of revision, it can lead to major errors in the ranking of hospitals. We doubt whether a level of data entry sufficient to generate a correct ranking can be achieved, and recommend that when ranking hospitals, the uncertainties about data quality and random events should be clearly described as an integral part of the results.
Osteotomies around the knee
Authors: Brinkman J.-M. , Lobenhoffer P. , Agneskirchner J. D. , Staubli A. E. , Wymenga A. B. , van Heerwaarden R. J.
Published: November 2008

New developments in osteotomy techniques and methods of fixation have caused a revival of interest of osteotomies around the knee. The current consensus on the indications, patient selection and the factors influencing the outcome after high tibial osteotomy is presented. This paper highlights recent research aimed at joint pressure redistribution, fixation stability and bone healing that has led to improved surgical techniques and a decrease of post-operative time to full weight-bearing.
Medial transport of the fibula using the Ilizarov device for reconstruction of a massive defect of the tibia in two children
Authors: Shiha A. E. , Khalifa A. R. H. , Assaghir Y. M. , Kenawey M. O.
Published: November 2008

We present two children with massive defects of the tibia and an associated active infection who were treated by medial transport of the fibula using the Ilizarov device. The first child had chronic discharging osteomyelitis which affected the whole tibial shaft. The second had sustained bilateral grade-IIIB open tibial fractures in a motor-car accident. The first child was followed up for three years and the second for two years. Both achieved solid union between the proximal and distal stumps of the tibia and the fibula, with hypertrophy of the fibula. The first child had a normal range of movement at the knee, ankle and foot but there was shortening of 1.5 cm. The second had persistent anterior angulation at the proximal tibiofibular junction and the ankle was stiff in equinus.
Evidence of lower risk tolerance among public sector employees in their personal financial matters
Authors: Roszkowski Michael J. , Grable John E.
Published: December 2008

Critics claim that excessive risk avoidance is characteristic of public sector workers. To test this contention, the financial risk tolerance scores of public sector and private sector employees who had used financial planning services were compared on a financial risk tolerance scale. Public sector employees scored lower on financial risk tolerance relative to private sector employees. Differences remained even after controlling for other variables linked to risk tolerance.
Sustaining self‐regulatory efficacy and psychological outcome expectations for postnatal exercise: Effects of a group‐mediated cognitive behavioural intervention
Authors: Cramp A. G. , Brawley L. R.
Published: December 2008

Objective. The objective of the current investigation was to examine if the effects of a group‐mediated cognitive behavioural counselling plus exercise intervention were superior to the effects of a standard exercise care condition on postnatal mothers' self‐regulatory efficacy (SRE), outcome expectations (OEs) and self‐directed physical activity (PA).

Design. The design of the study consisted of two intervention conditions; group‐mediated cognitive behavioural counselling plus exercise (GMCB) and standard exercise (SE). Each condition consisted of two phases; a 4‐week supervised, centre‐based intensive exercise training phase followed by a 4‐week home‐based phase.

Methods. Participants were 57 postnatal women randomly assigned to conditions (SE: N = 31; GMCB: N = 26). Measures of SRE and OEs were assessed prior to and following the centre‐based aspect of the intervention. Physical activity was measured following the intensive exercise training phase as well as the home‐based phase.

Results. GMCB participants' SRE and OEs were sustained during the intervention whereas those of SE participants declined. GMCB participants also reported significantly greater time spent engaging in self‐directed PA at the conclusion of the intensive and home‐based phases. Mediation analysis revealed that SRE partially mediated the relationship between intervention condition and post home‐based PA as confirmed by a significant sobel test.

Conclusions. These findings suggest that a theory‐based GMCB counselling plus exercise intervention is superior to the SE condition in sustaining SRE and OEs, and in promoting greater self‐directed PA. SRE partially mediated the relationship between intervention condition and post home‐based PA supporting the targeting of that variable for change as part of the intervention.
Genetics and Deafness: Implications for Education and Life Care of Deaf Students
Authors: Schein Jerome D. , Miller Maurice H.
Published: November 2008

The severity of deafness can obscure the presence of other disabilities that may accompany genetic anomalies, such as occur in Alport and Usher syndromes. Recent advances in genetics have heightened attention to various disabilities and dysfunctions that may coexist with deafness. Failure to recognize these additional disabilities when they occur can misguide educational planning; may open the afflicted deaf person to failure to identify, diagnose, and manage potentially serious health conditions; and in some instances may even lead to loss of life. Of the many genetic conditions that have been identified, a few examples are cited to illustrate the need to inform parents, educators, and other care-givers about the importance of obtaining genetic information.
HIV/AIDS Knowledge and Health-Related Attitudes and Behaviors Among Deaf and Hearing Adolescents in Southern Brazil
Authors: Bisol Cláudia Alquati , Sperb Tania Mara , Brewer Toye H. , Kato Sérgio Kakuta , Shor-Posner Gail
Published: November 2008

HIV/AIDS knowledge and health-related attitudes and behaviors among deaf and hearing adolescents in southern Brazil are described. Forty-two deaf students attending a special nonresidential public school for the deaf and 50 hearing students attending a regular public school, ages 15–21 years, answered a computer-assisted questionnaire. (There was simultaneous video translation of questions to Brazilian Sign Language.) A branched decision-tree structure was used to determine level of sexual experience and hearing status. Deaf participants scored lower on HIV/AIDS knowledge, demonstrating a need to improve school-based instruction and develop campaigns tailored to this group’s requirements. Though the hearing students reported more sexual activity than the deaf students, no other significant differences were found in health-related attitudes and behaviors. Two findings of concern are the high rate of sexual abuse reported by deaf participants and the large number of deaf adolescents reporting having a friend with AIDS.
How Effectively Are We Preparing Teacher Educators in Special Education?: The Case of Deaf Education
Authors: Schirmer Barbara R.
Published: November 2008

The study assessed how well the field of teacher education in special education is preparing the next generation of teacher educators to be stewards of the discipline by exploring the particular case of deaf education. Assuming that preparing doctoral graduates who are able to conduct valuable and quality research requires mentoring by faculty who conduct such research, the study examined the scholarly productivity of 127 teacher educators in deaf education at U.S. postsecondary institutions. Results showed that most had published relatively little during the past 6 years, greater than half had published relatively little over the course of their careers, and less than half of their dissertations had been published. If this case study of one special education field is representative of the others, it suggests that special education needs to broaden the dialogue to address not only the shortages but the quality of faculty.
Leadership Style in the Deaf Community: An Exploratory Case Study of a University President
Authors: Kamm-Larew Deborah , Stanford Jevetta , Greene Robert , Heacox Christopher , Hodge Warren
Published: November 2008

A qualitative mini-case study of I. King Jordan and his leadership style explores the influence of a transformational leader on Gallaudet University and the Deaf community. The study features a template-style semistructured interview with Jordan regarding his perceptions of leadership and his personal insights. The study highlights the attributes of transformational leadership and encourages further research into leadership as a tool for change in the Deaf community and the disability rights movement. This exploration of the leadership style of Gallaudet’s first Deaf president is especially timely; the study was conducted between Jordan’s retirement announcement and the Gallaudet Board of Trustees’ decision to rescind an offer to his announced successor to become the university’s next president. That tumultuous transition accentuated the disconnect between Jordan’s transformational, charismatic leadership style, which affected generations of the Deaf community, and his followers’ dissatisfaction with his management and successor planning.