bluuebunny/crossref_metadata_2025 huggingface dataset:
Transvaginal mesh in repair of pelvic organs prolapse as a minimally invasive surgical procedure
Authors: Argirovic Rajka , Berisavac Milica , Likic-Ladjevic Ivana , Kadija Sasa , Boskovic Vladimir , Zizic Vojislav
Published: July 2011

Background/Aim. Prolapse of genital organs with or without urinary stress
incontinention is the most often health problem in the elderly female
population tending to increase with ageing. The aim of this study was to
assess the perioperative complications and short-term outcomes of prolaps
repair using transvaginal polypropylene mesh (Prolift system, Gynecare,
Ethicon, USA). Methods. A retrospective study was conducted evaluating 96
women from September 2006 to January 2010 who undewent vaginal repair with
implatation of a soft mesh manufactured by Gynecare, Ethicon, USA. Results.
All the patients had a stage 3 or stage 4 prolapse according to the POP-Q
system of ICS. Total mesh was used in 12 (13%) patients isolated anterior
mesh in 52 (54%) patients and isolated posterior mesh in 32 (33%) patients.
We reported one intra-operative bladder injury and no other serious
complications. At 3 months, all 96 patients were available for follow-up.
Vaginal erosion occured in 9 (9.3%) patients, shrinkage of mesh in 6 (6.2%)
patients and de novo urinary incontinence in 5 (5.2%) patients. Failure rate
was 6.25% (recurrent prolapse stage 3 or 4 even asymptomatic). Conclusion.
Our study suggests that transvaginal polypropylene mesh applied with a
tensionfree technique is a safe and effective method with low intraoperative
complications and low morbidity rates. However, some complications are
serious and require highly specialised management.
Evaluation of the risk malignancy index diagnostic value in patients with adnexal masses
Authors: Terzic Milan , Dotlic Jelena , Likic-Ladjevic Ivana , Atanackovic Jasmina , Ladjevic Nebojsa
Published: July 2011

Background/Aim. Ovarian cancer is the leading cause of death from gynecologic
malignancies. Risk of malignancy index (RMI) is recommended in assessment of
patients with adnexal masses. The aim of this study was to verify the
effectiveness of the RMI in the discrimination between benign lesions and
malignant adnexal masses in clinical practice. Methods. Ultrasounds were
performed for all the patients and menopausal status, CA125 level and
calculated RMI were defined. All the patients were divided into 3 groups
depending on RMI (< 25, 25-200, > 200). After operations all adnexal masses
were analyzed histopathologically (HP) and then sensitivity, specificity and
predictive value of RMI were calculated. Results. Out of a total of 81
patients involved benign tumor had 51 (62.96%) and malignant 30 (37.04%) of
the patients. The average value of CA125 in the group of patients with benign
adnexal masses was 68.3 U/mL and in the group of patients with malignant
adnexal masses it was 581.95 U/mL. In the group of patients with benign
adnexal masses the average RMI was 284.9 and in the group of patients with
malignant adnexal masses RMI was 469.2. All the results showed a positive
correlation between both HP categories and RMI categories. The more malignant
HP result produced higher RMI and the cut off value was RMI = 200.
Sensitivity of RMI was 83.33%, specificity was 94.12%, positive predictive
value was 89.29% and negative predictive value was 90.57%. Conclusion. Our
study showed that RMI is very reliable in differentiation benign from
malignant adnexal masses.
Correlation analysis of craniomandibular index and gothic arch tracing in patients with craniomandibular disorders
Authors: Todic Jelena , Lazic Dragoslav , Radosavljevic Radiovoje
Published: July 2011

Background/Aim. Complex etiology and symptomatology of craniomandibular
dysfunction make the diagnosing and therapy of this disorder more difficult.
The aim of this work was to assess the value of clinical and instrumental
functional analyses in diagnosing of this type of disorders. Methods. In this
study 200 subjects were examined, 15 with temporomandibular joint disorder.
They were subjected to clinical functional analysis (Fricton-Shiffman) and
instrumental functional analysis by using the method of gothic arch. The
parameters of the gothic arch records were analyzed and subsequently compared
among the subjects of the observed groups. Results. In the examined group of
the population 7.5% of them were with craniomandibular dysfunction. The most
frequent symptoms were sound in temporomandibular joint, painful sensitivity
of the muscles on palpation and lateral turning of the lower jaw while
opening the mouth. By analyzing the gothic arch records and comparing the
obtained values between the observed groups it was assessed that: lateral and
protrusion movements, lateral amplitude and the size of gothic arch were much
bigger in the healthy subjects, and latero-lateral asymmetry was larger in
the sick subjects. Latero-lateral dislocation of apex was recorded only in
the sick subjects with average values of 0.22 ? 0.130 mm. The correlation
between the values of Fricton-Shiffman craniomandibular index and the
parameters of the gothic arch records and latero-lateral amplitude and
dislocation of apex records were established by correlative statistical
analysis. Conclusion. Functional analysis of orofacial system and
instrumental analysis of lower jaw movements (gothic arch method) can be
recommended as precise and simple methods in diagnosing craniomandibular
dysfunctions.
Splenic artery pseudoaneurysm as a complication of pancreatic pseudocyst
Authors: Mickovic Sasa , Mitrovic Miroslav , Stankovic Nebojsa , Bezmarevic Mihailo , Jovanovic Milan , Mirkovic Darko , Tufegdzic Ivana , Nikolic-Mickovic Irena
Published: July 2011

Introduction. Pancreatic pseudocyst presented as pseudoaneurysm of the
splenic artery is a potential serious complication in patients with chronic
pancreatitis. Case report. A 42-year-old male patient with a long-standing
evolution of chronic pancreatitis and 8-year long evolution of pancreas
pseudocyst was referred to the Military Medical Academy, Belgrade due to
worsening of the general condition. At admission, the patient was cachectic,
febrile, and had the increased values of amylases in urine and sedimentation
(SE). After clinical and diagnostic examination: laboratory assessment,
esophagogastroduodenoscopy (EGDS), ultrasonography (US), endoscopic
ultrasonography (EUS), multislice computed scanner (MSCT) angiography,
pseudoaneurysm was found caused by the conversion of pseudocyst on the basis
of chronic pancreatitis. The patient was operated on after founding
pancreatic pseudocyst, which caused erosion of the splenic artery and their
mutual communication. Postoperative course was duly preceded without
complications with one year follow-up. Conclusion. Angiography is the most
reliable and the safest method for diagnosing hemorrhagic pseudocysts when
they clinically present as pseudoaneurysms. A potentially dangerous
complication in the presented case was treated surgically with excellent
postoperative results.
Group a streptococcal cellulitis in the early puerperium
Authors: Nikolic Branka , Mitrovic Ana , Dragojevic-Dikic Svetlana , Rakic Snezana , Cakic Zlatica , Saranovic Milena , Sikimic Milan
Published: July 2011

Introduction. Infectious diseases caused by Streptococcus pyogenes, a member
of the group A Streptococci (GAS) are among the most common life threatening
ones. Patients with GAS infections have a poor survival rate. Cellulitis is a
severe invasive GAS infection and the most common clinical presentation of
the disease associated with more deaths than it can be seen in other GAS
infections. According to the literature data, most cases of GAS toxic shock
syndrome are developed in the puerperium. However, there are two main
problems with GAS infection in early puerperium and this case report is aimed
at reminding on them. The first problem is an absence of awareness that it
can be postpartal invasive GAS infection before the microbiology laboratory
confirms it, and the second one is that we have little knowledge about GAS
infection, in general. Case report. A 32- year-old healthy woman, gravida 1,
para 1, was hospitalized three days after vaginal delivery with a 38-hour
history of fever, pain in the left leg (under the knee), and head injury
after short period of conscious lost. Clinical picture of GAS infection was
cellulites. Group A Streptoccocus pyogenes was isolated in vaginal culture.
Rapid antibiotic and supportive treatment stopped development of
streptococcal toxic shock syndrome (STSS) and potential multiorganic failure.
Signs and symptoms of the infection lasted 25 days, and complete recovery of
the patient almost 50 days. Conclusion. In all women in childbed with a
history of fever early after delivery, vaginal and cervical culture specimens
should be taken as soon as possible. Early recognition of GAS infection in
early puerperium and prompt initiation of antimicrobial drug and supportive
therapy can prevent development of STSS and lethal outcome.
Surgical time and severity of postoperative pain in dogs undergoing laparoscopic ovariectomy with one, two, or three instrument cannulas
Authors: Case J. Brad , Marvel Sarah J. , Boscan Pedro , Monnet Eric L.
Published: July 2011

Objective—To determine whether number of instrument cannulas is associated with surgical time or severity of postoperative pain in dogs undergoing laparoscopic ovariectomy.

Design—Randomized clinical trial.

Animals—18 healthy dogs.

Procedures—Dogs were randomly assigned to undergo laparoscopic ovariectomy with 1, 2, or 3 instrument cannulas. Surgical time and intraoperative and postoperative complications were recorded. Severity of pain was monitored 2, 4, 8, 12, and 24 hours after surgery by means of pain scoring with a modified Melbourne Pain Scale and palpation of surgical sites with variably sized von Frey filaments. Owner-assessed postoperative comfort was also evaluated.

Results—Surgical time was significantly longer with 1 cannula (mean ± SD, 29.7 ± 5.6 minutes) than with 2 cannulas (18.2 ± 4.4 minutes) or 3 cannulas (19.3 ± 3.4 minutes). Intraoperative complications included splenic puncture (2 dogs), pedicle hemorrhage (1 dog), and SC emphysema (1 dog); complication rates were not significantly different among groups. Total pain score was significantly lower for dogs with 2 cannulas than for dogs with 3 cannulas; total pain score for dogs with 1 cannula did not differ significantly from scores for dogs with 2 cannulas or 3 cannulas. Owner assessments of postoperative comfort and number of days pain medications were administered did not differ among groups.

Conclusions and Clinical Relevance—Results suggested that laparoscopic ovariectomy with 2 instrument cannulas, rather than with 1, resulted in shorter surgical times without increasing severity of postoperative pain.
Use of a nitinol stent to palliate a colorectal neoplastic obstruction in a dog
Authors: Culp William T. N. , MacPhail Catriona M. , Perry James A. , Jensen Tracey D.
Published: July 2011

Case Description—A 12-year-old castrated male Labrador Retriever was evaluated for clinical signs associated with colorectal obstruction.

Clinical Findings—The dog had a 2-week history of tenesmus and hematochezia. On rectal examination, an annular colorectal mass was palpable extending orad into the pelvic canal. The original diagnosis of the colorectal mass was a mucosal adenoma. The dog was maintained on a low-residue diet and fecal softeners for a period of 13 months after initial diagnosis. At that time, medical management was no longer effective.

Treatment and Outcome—Placement of a colonic stent was chosen to palliate the clinical signs associated with colorectal obstruction. By use of fluoroscopic and colonoscopic guidance, a nitinol stent was placed intraluminally to open the obstructed region. Placement of the stent resulted in improvement of clinical signs, although tenesmus and obstipation occurred periodically after stent placement. At 212 days after stent placement, the patient had extensive improvement in clinical signs with minimal complications; however, clinical signs became severe at 238 days after stent placement, and the dog was euthanized. Histologic evaluation of the rectal tumor from samples obtained during necropsy revealed that the tumor had undergone malignant transformation to a carcinoma in situ.

Clinical Relevance—A stent was successfully placed in the colon and rectum to relieve obstruction associated with a tumor originally diagnosed as a benign neoplasm. Placement of colorectal stents may be an option for the palliation of colorectal obstruction secondary to neoplastic disease; however, clinical signs may persist, and continuation of medical management may be necessary.
A category Ψ-density topology
Authors: Wilczyński Władysław , Wojdowski Wojciech
Published: July 2011

Ψ-density point of a Lebesgue measurable set was introduced by Taylor in [Taylor S.J., On strengthening the Lebesgue Density Theorem, Fund. Math., 1958, 46, 305–315] and [Taylor S.J., An alternative form of Egoroff’s theorem, Fund. Math., 1960, 48, 169–174] as an answer to a problem posed by Ulam. We present a category analogue of the notion and of the Ψ-density topology. We define a category analogue of the Ψ-density point of the set A at a point x as the Ψ-density point at x of the regular open representation of A.
Method of Power System Suistanable Development Optimization in Liberalized Market Conditions
Authors: Turcik M. , Oleinikova I. , Krishans Z.
Published: July 2011

Method of Power System Suistanable Development Optimization in Liberalized Market Conditions

The paper is focused on the development of the Baltic Sea region taking into account the new EU energy policy. The authors elucidate the current situation and the power system infrastructure projects of the region. For the economic analysis and optimization of the development plans a method is proposed that takes into account the outlooks for upcoming 20-50 years and the initial information uncertainty. The method makes possible estimation of the technically-economic state, including market conditions, for a given power system.
Regulating genetically modified food: Policy trajectories, political culture, and risk perceptions in the U.S., Canada, and EU
Authors: Wohlers Anton E.
Published: July 2011

This paper examines whether national differences in political culture add an explanatory dimension to the formulation of policy in the area of biotechnology, especially with respect to genetically modified food. The analysis links the formulation of protective regulatory policies governing genetically modified food to both country and region-specific differences in uncertainty tolerance levels and risk perceptions in the United States, Canada, and European Union. Based on polling data and document analysis, the findings illustrate that these differences matter. Following a mostly opportunistic risk perception within an environment of high tolerance for uncertainty, policymakers in the United States and Canada modified existing regulatory frameworks that govern genetically modified food in their respective countries. In contrast, the mostly cautious perception of new food technologies and low tolerance for uncertainty among European Union member states has contributed to the creation of elaborate and stringent regulatory policies governing genetically modified food.
Modeling Answer Changes on Test Items
Authors: van der Linden Wim J. , Jeon Minjeong
Published: July 2011

The probability of test takers changing answers upon review of their initial choices is modeled. The primary purpose of the model is to check erasures on answer sheets recorded by an optical scanner for numbers and patterns that may be indicative of irregular behavior, such as teachers or school administrators changing answer sheets after their students have finished the test or test takers communicating with each other about their initial responses. A statistical test based on the number of erasures is derived from the model. Besides, it is shown how to analyze the residuals under the model to check for suspicious patterns of erasures. The use of the two procedures is illustrated for an empirical data set from a large-scale assessment. The robustness of the model with respect to less than optimal opportunities for regular test takers to review their responses is investigated.
Epidemiology and Outcomes of Acute Achilles Tendon Rupture with Operative or Nonoperative Treatment Using an Identical Functional Bracing Protocol
Authors: Gwynne-Jones David P. , Sims Martyn
Published: July 2011

Background:

This study reports on the demographics of acute Achilles tendon rupture in our region and compares the results of a selective approach to operative and nonoperative treatment using an identical rehabilitation program with functional bracing.

Materials and Methods:

A consecutive series of 363 patients, aged 15 to 60 years, treated over 8.5 years by either open operative repair (143) or nonoperatively (220) were compared with respect to demographics, re-rupture rate, and major wound complication.

Results:

There was an almost equal number of males (159) and females (152) up to age 50 years but males comprised 73% of patients aged 51 to 60 years. Netball was the most common cause of injury and explains the relatively high incidence in females. In the 143 patients treated surgically there were two re-ruptures (1.4%) and two reop-erations for wound complications (1.4%). In the 220 patients treated nonoperatively there were 19 re-ruptures (8.6%), 13 of 113 males (11.5%) and six of 107 females (5.6%). There was a significantly lower re-rupture rate, and reoperation rate in the surgical group ( p < 0.05). In the nonoperative group there was a significantly lower rate of re-rupture in patients over 40 (six of 119) (4.1%) compared with those 40 years and under (13 of 99, 13.1%) and between females over 40 when compared with males 40 years and under.

Conclusion:

In our region there is a high incidence of Achilles tendon rupture among women due to netball and results in a younger age of injury than previously reported. Our results support surgery in patients less than 40 years, particularly males, if there are no contraindications. Functional bracing as part of nonoperative treatment can result in low re-rupture rates in patients over 40, especially in females. Level of Evidence: III, Retrospective Comparative Study
Functional Outcome of Matrix-Associated Autologous Chondrocyte Implantation in the Ankle
Authors: Dixon Sean , Harvey Leigh , Baddour Edward , Janes Greg , Hardisty Gerard
Published: July 2011

Background:

The technique of Matrix-associated autologous chondrocyte implantation (MACI) is well established with satisfactory outcomes up to 5 years in the knee. Fewer series describe the outcomes of this technique in the ankle. We present the functional outcomes of the technique for a single surgeon series in a general hospital setting.

Materials and Methods:

Twenty-seven patients, mean age 41, were reviewed at 3.7 (range, 1 to 5) years. Patients were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scale, Tegener activity score and University of California lower extremity activity scale. MRI findings were also reviewed.

Results:

While most patients report a significant improvement in symptoms with full return to activities of daily living, 36% of those under 40 and 78% of those over 40 reported restricted recreational activity. Of the patients under 40 years of age, 86% were able to run compared with 23% of those over 40. Of patients over 40, 64% continued to have moderate or severe pain.

Conclusion:

Careful preoperative counseling is required for patients of all ages regarding likely outcomes. In patients over 40, the procedure is unlikely to give good pain relief and alternative options should be considered. Level of Evidence: IV, Case Series
Osteochondral Autograft Transplantation for Acute Osteochondral Fractures Associated with an Ankle Fracture
Authors: Liu Wanjun , Liu Fang , Zhao Wen , Kim Jaehon M. , Wang Zhenghai , Vrahas Mark S.
Published: July 2011

Background:

Osteochondral fractures of the talar dome (OCFT) are frequently associated with ankle fractures. Controversy exists regarding the treatment of acute Grade III and IV OCFT. Osteochondral autograft transplantation (OAT) is a possible operative solution.

Materials and Methods:

We performed OAT in 16 patients with acute Grade III or IV OCFT. There were ten males and six females with the average age of 33.9 (range, 18 to 49) years. The average period of followup was 36.3 (range, 21 to 48) months. OCFT was identified, and clinically determined to be Grade III or IV using radiographs and intraoperative assessment. Seven patients were Grade III, nine patients were Grade IV OCFT. The OAT consisted of two sequential procedures: 1) harvesting of osteochondral autograft cylinder from the nonweightbearing surface of the ipsilateral knee, and 2) implanting the donor graft into the talar defect with press-fit technique. Single cylinder transplantation or a mosaicplasty was used. The outcome was determined by the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, the simplified symptomatology evaluation, plain radiography and MRI.

Results:

The mean size of the osteochonral fracture defects was 84.1 (range, 50 to 125) mm2, and the mean depth was 2.5 (range, 1 to 5) mm. The mean AOFAS score was 95.4 (range, 86 to 100) points postoperatively. At the latest followup, there was no radiographic evidence of post-traumatic arthritis. Based on the MRI of all patients, 93.7% of the osteochondral grafts showed bony integration and articular congruity of the talar dome.

Conclusion:

OAT was shown to be an effective treatment with excellent clinical outcome and imaging evidence of graft integration.
Effect of a Steel Toe Cap on Forefoot Injury Pattern in a Cadaveric Model
Authors: Kwon John Y. , Campbell John T. , Myerson Mark S. , Jeng Cliff L.
Published: July 2011

Background:

Crush injuries to the foot are a common workplace injury and a significant source of morbidity, disability and lost wages. Many regulatory bodies including the Occupational Safety and Health Administration (OSHA) recommend the use of safety shoes in certain occupations to help protect against these occupational hazards. However there remains controversy and paucity of published data regarding the protection afforded by a steel toe cap in regards to clinical injury pattern. This study looks to investigates the protective influence of a steel toe cap on crush injuries of the forefoot.

Materials and Methods:

Five non-osteoporotic paired cadaver lower extremities were appropriately fitted to a standard work boot. One foot of each pair was fitted into a steel toe capped boot (designated “ST” group) while the other foot was fitted into an identical version of the work boot but without the protective steel toe cap (designated “NST” group). Each foot was crushed using a custom designed rig with a load of 150 lb dropped from a calibrated height of 3 feet to the forefoot. X-rays were obtained to assess fracture location & comminution and stress fluoroscopy was used to assess for any ligamentous Lisfranc injury.

Results:

The NST group averaged 8.2 fractured bones per foot while the ST group averaged 3.6 fractured bones per foot ( p = 0.001). The NST group demonstrated significantly more metatarsal fractures (3.2 fractures/foot) versus the ST group (one fracture/foot) ( p= 0.020). The NST group demonstrated significantly more proximal phalanx fractures (4.2 fractures/foot) compared to the ST group (2.6 fractures/foot) ( p= 0.035). Middle and distal phalanx fractures were not significantly different between the two groups. A higher percentage of the bones fractured were deemed comminuted in the NST group (53.6%) versus the ST group (38.8%) although this did not reach statistical significance.

Conclusion:

This study demonstrated that the steel toe affords protective advantages in crush injuries to the foot in limiting the number and severity of metatarsal and proximal phalanx fractures. However the steel toe does not fully protect the forefoot from injury.

Clinical Relevance:

Crush injuries to the foot are a common workplace injury. Strict adherence to workplace safety standards may limit the severity of crush injuries to the foot and additional safety measures such as metatarsal guards should be considered when appropriate.
Valgus Deformity of the Great Toe Interphalangeal Joint Treated by Reversed Sliding Osteotomy of the Proximal Phalanx: A Case Report
Authors: Kubo Maya , Miyamoto Wataru , Takao Masato , Yasui Youichi , Innami Ken , Matsushita Takashi
Published: July 2011

Level of Evidence: V, Expert Opinion
The Fate of Syndesmotic Screws
Authors: Stuart Kyle , Panchbhavi Vinod K.
Published: July 2011

Background:

A standard protocol for the management of syndesmosis injuries has yet to be established. Debate persists regarding number of screws, screw diameter, number of cortices purchased, and the need for and timing of screw removal. The purpose of this study was to identify factors related to screw fixation that may lead to the ultimate failure of syndesmosis fixation defined as a loss of reduction of the syndesmosis, screw breakage, screw loosening, or widening of the medial clear space.

Materials and Methods:

A retrospective assessment of 137 consecutive patients who underwent open reduction and internal fixation of the distal tibiofibular joint at a single institution from 2004 to 2008 was performed. Clinical and radiographic data were recorded regarding problems with questionable clinical significance (number of syndesmotic screws, number of cortices, screw diameter, screw location, hardware failure) and loss of syndesmosis reduction. A series of Fisher's exact tests were used to evaluate outcomes. A p value of 0.05 defined as significant.

Results:

The 3.5-mm diameter screws were statistically more likely to break than 4- or 4.5-mm screws, but there was no difference in frequency of loss of reduction of the syndesmosis as a function of screw diameter; however, a power study revealed an n value of 1656 would be required to show a significant difference.

Conclusion:

Screw diameter may have an effect on screw breakage but clinical significance of hardware failure itself is unknown including whether or not it results in a loss of reduction or failure of syndesmotic fixation. Level of Evidence: III, Retrospective Comparative Study
Augmented Tendon Achilles Repair Using a Tissue Reinforcement Scaffold: A Biomechanical Study
Authors: Giza Eric , Frizzell Lauren , Farac Randall , Williams Joel , Kim Sunny
Published: July 2011

Background:

Missed or chronic Achilles tendon ruptures may have muscle atrophy and tendon retraction resulting in a defect that must be augmented with endogenous or exogenous materials. The Artelon® Tissue Reinforcement (ATR) scaffold is a readily available synthetic degradable poly(urethane urea) material used to augment tendon repair. The objective of this study was to compare human cadaveric Achilles tendon repairs with and without ATR.

Materials and Methods:

Eighteen fresh frozen human cadaver limbs were dissected and the tendon transected 2 cm proximal to the calcaneal insertion. The control group of nine specimens was repaired with sutures, while the experimental group was repaired with sutures and reinforced with a tubularized patch of ATR. Specimens were tested for ultimate load to failure in an Instron machine after preloading to 10 N followed by cyclic loading for 20 cycles from 2 to 30 N.

Results:

The ultimate load to failure in the control group was a mean of 248.1 N ± 19.6 (202 to 293 at 95% CI) versus 370.4 N ± 25.2 (312 to 428 at 95% CI) in the ATR group. The ultimate load to failure was 370.4 ± 25.2 N (312 to 428 at 95% CI) and 248.1 ± 19.6 N (202 to 293 at 95% CI) in the experimental and control groups, respectively (p = 0.0015). Creep of the ATR augmented group was 2.0 ± 0.5 mm, compared to 3.1 ± 1.1 mm for the control group (p = 0.026).

Conclusion:

ATR provided a statistically significant improvement in load to failure when compared to control specimens in a cadaver model.

Clinical Relevance:

This finding may allow for development of more aggressive rehabilitation techniques following chronic Achilles tendon repairs.
Talar Neck Fracture after Tibiotalar Arthrodesis: Case Report
Authors: Kwon John Y. , Myerson Mark S.
Published: July 2011

Level of Evidence: V, Expert Opinion
Fixation of Maximal Shift Scarf Osteotomy with Inside-Out Plating: Technique Tip
Authors: Bouaicha Samy , Moor Beat K. , Bohnert Laurent , Gautier Emanuel , Lottenbach Marc
Published: July 2011

Level of Evidence: V, Expert Opinion
Calcific Tendinitis of the Peroneus Longus: Case Report
Authors: Klammer Georg , Iselin Lukas D. , Bonel Harald M. , Weber Martin
Published: July 2011

Level of Evidence: V, Expert Opinion
Syndactyly with Hallux Valgus: A Case Report
Authors: Rambani Rohit , Elnaggar Mohamed , Sturdee Simon
Published: July 2011

Level of Evidence: V, Expert Opinion
Metformin in the Management of Clomiphene Resistant Polycystic Ovarian Syndrome
Authors: Omole-Ohonsi Abiodun , Nwokedi Emmanuel
Published: July 2011

DOI: http://dx.doi.org/10.3126/njog.v5i1.5056 NJOG 2010 Jul-Aug; 5(1): 21-25
Correlation of Serum Bile Acids with Liver Enzymes and Perinatal and Maternal Outcome in Cholestasis in Pregnancy
Authors: Kaur Satinder , Huria Anju , Kaur Jasbinder , Kumar Pradip
Published: July 2011

DOI: http://dx.doi.org/10.3126/njog.v5i1.5058 NJOG 2010 Jul-Aug; 5(1): 32-36
Role of Clusterin in the Female Reproductive System
Authors: Shrestha Eliza , Yang Yue-bo , Li Xiao-Mao
Published: July 2011

DOI: http://dx.doi.org/10.3126/njog.v5i2.5069 NJOG 2010 Nov-Dec; 5(2): 3-7
Low Birthweight Infants in Twin Gestations
Authors: Onyiriuka Alphonsus N
Published: July 2011

DOI: http://dx.doi.org/10.3126/njog.v5i2.5075 NJOG 2010 Nov-Dec; 5(2): 26-31
Splenectomy at Caesarean: Management of Intractable ITP during Pregnancy
Authors: Sharma Paban , Acharya Paras , Shah Jaya Narayan , Amatya Rosani
Published: July 2011

DOI: http://dx.doi.org/10.3126/njog.v5i2.5082NJOG 2010 Nov-Dec; 5(2): 52-54
A critical evaluation of cystic features in primary glioblastoma as a prognostic factor for survival
Authors: Kaur Gurvinder , Bloch Orin , Jian Brian J. , Kaur Rajwant , Sughrue Michael E. , Aghi Manish K. , McDermott Michael W. , Berger Mitchel S. , Chang Susan M. , Parsa Andrew T.
Published: July 2011

Object

The presence of cystic features in glioblastoma (GBM) has been described as a favorable prognostic factor. The aim of this study was to determine the survival outcome in patients undergoing surgery for newly diagnosed primary GBM with a large cystic component as compared with a large cohort of patients with noncystic GBM, while controlling for well-characterized prognostic factors.

Methods

A retrospective review of 354 consecutive patients treated with resection of primary GBM was performed using medical records and imaging information obtained at the University of California, San Francisco from 2005 to 2009. Within this cohort, 37 patients with large cysts (≥ 50% of tumor) were identified. Clinical presentations and surgical outcomes were statistically compared between the cystic and noncystic patients.

Results

There were no statistically significant differences in clinical presentation between groups, including differences in age, sex, presenting symptoms, tumor location, or preoperative functional status, with the exception of tumor size, which was marginally larger in the cystic group. Surgical outcomes, including extent of resection and postoperative functional status, were equivalent. The median actuarial survival for the patients with cystic GBM was 17.0 months (95% CI 12.6–21.3 months), and the median survival for patients with noncystic GBM was 15.9 months (95% CI 14.6–17.2 months). There was no significant between-groups difference in survival (p = 0.99, log-rank test). A Cox multivariate regression model was constructed, which identified only age and extent of resection as independent predictors of survival. The presence of a cyst was not a statistically significant prognostic factor.

Conclusions

This study, comprising the largest series of cases of primary cystic GBM reported in the literature to date, demonstrates that the presence of a large cyst in patients with GBM does not significantly affect overall survival as compared with survival in patients without a cyst. Preoperative discussions with patients with GBM should focus on validated prognostic factors. The presence of cystic features does not confer a survival advantage.
Expression of carbonic anhydrase IX in craniopharyngiomas
Authors: Proescholdt Martin , Merrill Marsha , Stoerr Eva-Maria , Lohmeier Annette , Dietmaier Wolfgang , Brawanski Alexander
Published: July 2011

Object

In craniopharyngiomas, cystic growth causes pressure on vital structures of the adjacent brain, leading to significant morbidity. However, the molecular pathogenesis of this cyst formation remains unknown. Carbonic anhydrase IX (CA IX) is a tumor-associated, hypoxia-inducible enzyme, which can cause fluid production and development of cysts. The authors investigated CA IX expression in craniopharyngiomas and its correlation with the extent of cyst formation. In addition, the major pathways of CA IX regulation, hypoxia and p53 mutation, were analyzed.

Methods

Expression of CA IX was analyzed in 20 craniopharyngioma patients by means of in situ hybridization and immunohistochemistry. Preoperative imaging was used to quantify cyst volume. To analyze putative hypoxic induction of CA IX, immunohistochemical staining for HIF-1α and VEGF was performed. Since p53 negatively regulates CA IX expression, we also analyzed the tumors for p53 mutation by direct sequencing.

Results

Significant CA IX was found in 85% of the 20 cases. The extent of CA IX expression was significantly correlated with cyst volume. HIF-1α expression was largely absent in all tissue samples, whereas moderate VEGF expression was present in a subset of cases but without correlation to cyst volume. No p53 mutation was found in any of the analyzed tumors.

Conclusions

Carbonic anhydrase IX, which is virtually absent in normal brain, is significantly upregulated in craniopharyngiomas and shows a significant association with cyst size. The mechanisms of regulation remain unknown, since neither hypoxia nor p53 appears to play a role. These results indicate that inhibition of CA IX may be a potential target for the adjuvant treatment in patients with cystic craniopharyngiomas.
Intraoperative, full-rotation, three-dimensional image (O-arm)–based navigation system for cervical pedicle screw insertion
Authors: Ishikawa Yoshimoto , Kanemura Tokumi , Yoshida Go , Matsumoto Akiyuki , Ito Zenya , Tauchi Ryoji , Muramoto Akio , Ohno Shuichiro , Nishimura Yusuke
Published: July 2011

Object

The aim of this study was to retrospectively evaluate the reliability and accuracy of cervical pedicle screw (CPS) placement using an intraoperative, full-rotation, 3D image (O-arm)–based navigation system and to assess the advantages and disadvantages of the system.

Methods

The study involved 21 consecutive patients undergoing posterior stabilization surgery of the cervical spine between April and December 2009. The patients, in whom 108 CPSs had been inserted, underwent screw placement based on intraoperative 3D imaging and navigation using the O-arm system. Cervical pedicle screw positions were classified into 4 grades, according to pedicle-wall perforations, by using postoperative CT.

Results

Of the 108 CPSs, 96 (88.9%) were classified as Grade 0 (no perforation), 9 (8.3%) as Grade 1 (perforations < 2 mm, CPS exposed, and < 50% of screw diameter outside the pedicle), and 3 (2.8%) as Grade 2 (perforations between ≥ 2 and < 4 mm, CPS breached the pedicle wall, and > 50% of screw diameter outside the pedicle). No screw was classified as Grade 3 (perforation > 4 mm, complete perforation). No neurovascular complications occurred because of CPS placement.

Conclusions

The O-arm offers high-resolution 2D or 3D images, facilitates accurate and safe CPS insertion with high-quality navigation, and provides other substantial benefits for cervical spinal instrumentation. Even with current optimized technology, however, CPS perforation cannot be completely prevented, with 8.3% instances of minor violations, which do not cause significant complications, and 2.8% instances of major pedicle violations, which may cause catastrophic complications. Therefore, a combination of intraoperative 3D image–based navigation with other techniques may result in more accurate CPS placement.
A simple and updated pneumatic method for uniaxial ice compression in the laboratory: experimental settings and creep test results on glacier ice
Authors: Samyn D. , Dierckx M. , Remy J.-P. , Goossens T. , Tison J.-L.
Published: July 2011

Creep tests provide invaluable data to better understand the physical properties of ice under various conditions. We describe here a simple, updated pneumatic apparatus for experimental studies of ice rheological properties. The apparatus is designed to perform two simultaneous compression creep tests either in a cold room or in atmospheric conditions when coupled to an external cooling circulator. We present results from calibration tests of the apparatus and provide new data from creep tests performed on temperate glacier ice samples. These calibration and creep results show that the apparatus is able to provide fast and reliable mechanical ice characterization. The secondary creep rates measured in this study range between 1.59 × 10−8 s−1 (at 0.21 MPa) and 4.38 × 10−7 s−1 (at 0.71 MPa) at −10°C for quasi-isotropic ice, which is consistent with former standard published data. The corresponding mean parameter, A, is 5.20 × 10−16 s−1 kPa−3, which also compares well with the range of reported other studies.
Mountain permafrost: development and challenges of a young research field
Authors: Haeberli Wilfried , Noetzli Jeannette , Arenson Lukas , Delaloye Reynald , Gärtner-Roer Isabelle , Gruber Stephan , Isaksen Ketil , Kneisel Christof , Krautblatter Michael , Phillips Marcia
Published: July 2011

An overview is given of the relatively short history, important issues and primary challenges of research on permafrost in cold mountain regions. The systematic application of diverse approaches and technologies contributes to a rapidly growing knowledge base about the existence, characteristics and evolution in time of perennially frozen ground at high altitudes and on steep slopes. These approaches and technologies include (1) drilling, borehole measurement, geophysical sounding, photogrammetry, laser altimetry, GPS/SAR surveying, and miniature temperature data logging in remote areas that are often difficult to access, (2) laboratory investigations (e.g. rheology and stability of ice-rock mixtures), (3) analyses of digital terrain information, (4) numerical simulations (e.g. subsurface thermal conditions under complex topography) and (5) spatial models (e.g. distribution of permafrost where surface and microclimatic conditions are highly variable spatially). A sound knowledge base and improved understanding of governing processes are urgently needed to deal effectively with the consequences of climate change on the evolution of mountain landscapes and, especially, of steep mountain slope hazards as the stabilizing permafrost warms and degrades. Interactions between glaciers and permafrost in cold mountain regions have so far received comparatively little attention and need more systematic investigation.
Nanotechnology-Based Detection and Targeted Therapy in Cancer: Nano-Bio Paradigms and Applications
Authors: Mousa Shaker A. , Bharali Dhruba J.
Published: July 2011

The application of nanotechnology to biomedicine, particularly in cancer diagnosis and treatment, promises to have a profound impact on healthcare. The exploitation of the unique properties of nano-sized particles for cancer therapeutics is most popularly known as nanomedicine. The goals of this review are to discuss the current state of nanomedicine in the field of cancer detection and the subsequent application of nanotechnology to treatment. Current cancer detection methods rely on the patient contacting their provider when they feel ill, or relying on non-specific screening methods, which unfortunately often result in cancers being detected only after it is too late for effective treatment. Cancer treatment paradigms mainly rely on whole body treatment with chemotherapy agents, exposing the patient to medications that non-specifically kill rapidly dividing cells, leading to debilitating side effects. In addition, the use of toxic organic solvents/excipients can hamper the further effectiveness of the anticancer drug. Nanomedicine has the potential to increase the specificity of treatment of cancer cells while leaving healthy cells intact through the use of novel nanoparticles. This review discusses the use of nanoparticles such as quantum dots, nanoshells, nanocrystals, nanocells, and dendrimers for the detection and treatment of cancer. Future directions and perspectives of this cutting-edge technology are also discussed.
The Existence of Perfect Equilibrium in Discontinuous Games
Authors: Carbonell-Nicolau Oriol
Published: July 2011

We prove the existence of a trembling-hand perfect equilibrium within a class of compact, metric, and possibly discontinuous games. Our conditions for existence are easily verified in a variety of economic games.
Enhanced Anti-Tumoral Activity of Methotrexate-Human Serum Albumin Conjugated Nanoparticles by Targeting with Luteinizing Hormone-Releasing Hormone (LHRH) Peptide
Authors: Taheri Azade , Dinarvand Rassoul , Atyabi Fatemeh , Ahadi Fatemeh , Nouri Farank Salman , Ghahremani Mohammad Hossein , Ostad Seyed Nasser , Borougeni Atefeh Taheri , Mansoori Pooria
Published: July 2011

Active targeting could increase the efficacy of anticancer drugs. Methotrexate-human serum albumin (MTX-HSA) conjugates, functionalized by luteinizing hormone-releasing hormone (LHRH) as targeting moieties, with the aim of specifically targeting the cancer cells, were prepared. Owing to the high expression of LHRH receptors in many cancer cells as compared to normal cells, LHRH was used as the targeting ligand in this study. LHRH was conjugated to MTX-HSA nanoparticles via a cross-linker. Three types of LHRH targeted nanoparticles with a mean particle size between 120–138 nm were prepared. The cytotoxicity of LHRH targeted and non-targeted nanoparticles were determined on the LHRH positive and negative cell lines. The internalization of the targeted and non-targeted nanoparticles in LHRH receptor positive and negative cells was investigated using flow cytometry analysis and fluorescence microscopy. The cytotoxicity of the LHRH targeted nanoparticles on the LHRH receptor positive cells were significantly more than non-targeted nanoparticles. LHRH targeted nanoparticles were also internalized by LHRH receptor positive cells significantly more than non-targeted nanoparticles. There were no significant differences between the uptake of targeted and non-targeted nanoparticles to the LHRH receptor negative cells. The active targeting procedure using LHRH targeted MTX-HSA nanoparticles could increase the anti-tumoral activity of MTX.
Electroformation of Giant Vesicles on a Polymer Mesh
Authors: Okumura Yukihisa , Sugiyama Takuya
Published: July 2011

Electroformation of cell-sized lipid membrane vesicles (giant vesicles, GVs) from egg yolk phosphatidylcholine under applied electric voltage was examined on a substrate of a polymer mesh placed between two planar indium tin oxide coated glass electrodes. Under appropriate conditions, GVs were formed in good yield on meshes of various polymer materials, namely, hydrophobic poly(propylene), poly(ethylene terephthalate), a carbon fiber/nylon composite, and relatively hydrophilic nylon. Arranging threads in a mesh structure with appropriate openings improved GV formation compared to simply increasing the number of threads. For optimal electroformation of GVs, the size and shape of a mesh opening were crucial. With a too large opening, GV formation deteriorated. When the sides of an opening were partially missing, GV formation did not occur efficiently. With an adequate opening, a deposited lipid solution could fill the opening, and a relatively uniform lipid deposit formed on the surface of threads after evaporation of the solvent. This could supply a sufficient amount of lipids to the opening and also prevent a lipid deposit from becoming too thick for electroformation. As a result, good GV formation was often observed in openings filled with swelled lipid.
The Use of Response Surface Methodology to Optimize the Ultrasound-Assisted Extraction of Five Anthraquinones from Rheum palmatum L.
Authors: Zhao Li-Chun , Liang Jian , Li Wei , Cheng Kun-Mu , Xia Xianghua , Deng Xin , Yang Geng-Liang
Published: July 2011

In this paper, ultrasound-assisted extraction (UAE) was applied to the extraction of anthraquinones (aloe-emodin, rhein, emodin, chrysophanol and physcion) from Rheum palmatum L. The five anthraquinones were quantified and analyzed by high performance liquid chromatography coupled with UV detection (HPLC-UV). The extraction solvent, extraction temperature and extraction time parameters, the three main factors for UAE, were optimized with response surface methodology (RSM) to obtain the highest extraction efficiency. The optimal conditions were the use of 84% methanol as solvent, an extraction time of 33 min and an extraction temperature of 67 °C. Under these optimal conditions, the experimental values agreed closely with the predicted values. The analysis of variance indicated a high goodness of model fit and the success of RSM method for optimizing anthraquinones extraction in Rheum palmatum L.
In Mesopore Protein Digestion: A New Forthcoming Strategy in Proteomics
Authors: Savino Rocco , Casadonte Francesca , Terracciano Rosa
Published: July 2011

The conventional protocols for in solution or in gel protein digestion require many steps and long reaction times. The use of trypsin immobilized onto solid supports has recently captured the attention of many research groups, because these systems can speed-up protein digestion significantly. The utilization of new materials such as mesoporous silica as supports, in which enzyme and substrate are dramatically concentrated and confined in the nanospace, offers new opportunities to reduce the complexity of proteomics workflows. An overview of the procedures for in situ proteolysis of single proteins or complex protein mixtures is reported, with a special focus on porous materials used as catalysts. The challenging efforts for designing such systems aimed at mimicking the biochemistry of living cells are reviewed. Potentials, limitations and challenges of this branch of enzyme catalysis, which we indicate as in mesopore digestion, are discussed, in relation to its suitability for high-speed and high-throughput proteomics.
Mechanical Properties and Adhesion of a Micro Structured Polymer Blend
Authors: Cappella Brunero
Published: July 2011

A 50:50 blend of polystyrene (PS) and poly(n-butyl methacrylate) (PnBMA) has been characterized with an Atomic Force Microscope (AFM) in Tapping Mode and with force-distance curves. The polymer solution has been spin-coated on a glass slide. PnBMA builds a uniform film on the glass substrate with a thickness of @200 nm. On top of it, the PS builds an approximately 100 nm thick film. The PS-film undergoes dewetting, leading to the formation of holes surrounded by about 2 µm large rims. In those regions of the sample, where the distance between the holes is larger than about 4 µm, light depressions in the PS film can be observed. Topography, dissipated energy, adhesion, stiffness and elastic modulus have been measured on these three regions (PnBMA, PS in the rims and PS in the depressions). The two polymers can be distinguished in all images, since PnBMA has a higher adhesion and a smaller stiffness than PS, and hence a higher dissipated energy. Moreover, the polystyrene in the depressions shows a very high adhesion (approximately as high as PnBMA) and its stiffness is intermediate between that of PnBMA and that of PS in the rims. This is attributed to higher mobility of the PS chains in the depressions, which are precursors of new holes.