bluuebunny/crossref_metadata_2025 huggingface dataset:
Expanded phenotypically stable chondrocytes persist in the repair tissue and contribute to cartilage matrix formation and structural integration in a goat model of autologous chondrocyte implantation
Authors: Dell'Accio Francesco , Vanlauwe Johan , Bellemans Johan , Neys Johan , De Bari Cosimo , Luyten Frank P.
Published: December 2002

Autologous chondrocyte implantation (ACI) is an established technique to repair joint surface defects. Although there is some indirect evidence that the expanded chondrocytes are required to achieve proper healing, the role they play in the repair process is not clear yet. To monitor the persistence and the phenotype of the injected chondrocytes in the repair tissue (RT) we have optimized a fluorescent labeling protocol for articular chondrocytes, which allows cell tracking in vivo for up to 14 weeks, using the fluorescent dye PKH26. We have combined in vivo cell tracking, with the immune‐detection of collagen type II protein in a goat model of ACI. Our data indicate that the implanted cells can persist for at least 14 weeks in the defects, can participate in the integration with the surrounding tissues, and become structural part of the RT, rich in collagen type II and sulfated proteoglycans. Albeit with a small number of samples, our data provide proof of principal that the implanted chondrocytes can contribute to structural cartilage repair in a goat model of ACI.

© 2002 Orthopaedic Research Society. Published by Elsevier Science Ltd. All rights reserved.
MicroCT evaluation of normal and osteoarthritic bone structure in human knee specimens
Authors: Patel Vikas , Issever Ahi Sema , Burghardt Andrew , Laib Andres , Ries Michael , Majumdar Sharmila
Published: December 2002

Although trabecular bone structure has been evaluated, variation with knee compartment and depth from joint surface is not completely understood. Cadaver knees were evaluated with microcomputed tomography analysis for these variations. Objective differences were compared between: medial vs. lateral compartments; femoral vs. tibial bone; and normal vs. arthritic knees. Depth dependent changes in the parameters were observed for the first 6 mm of the cores in normal knees: BV/TV, Tb.N and Conn.D gradually decrease, while Tb.Sp and SMI increase. In the first 6 mm of the normal tibia BV/TV, Tb.N, and Tb.Th are greater than in the femur on both the medial and lateral compartments while Tb.Sp, SMI, and Conn.D are lower. The medial compartment values for BV/TV, Tb.N, Tb.Th and Conn.D are generally greater than for the lateral in both the femur and tibia while Tb.Sp and SMI are lower. In comparison of normal vs. arthritic knees significant differences are observed in the first 6 mm of the medial tibia. With arthritis BV/TV and Tb.Th are lower, while SMI and Tb.Sp are higher. Tb.N and Conn.D show no statistically significant difference. The bone structure variations are, thus, most prominent in the first 6 mm of depth and medial compartment bone is generally more structurally sound than lateral. Severely arthritic bone changes are most prominent in the medial compartment of the tibia and bone structure is less sound in severe arthritis.

© 2002 Orthopaedic Research Society. Published by Elsevier Science Ltd. All rights reserved.
Quantification of expression levels of cellular differentiation markers does not support a general shift in the cellular phenotype of osteoarthritic chondrocytes
Authors: Gebhard Pia Margarethe , Gehrsitz Angelika , Bau Brigitte , Söder Stephan , Eger Wolfgang , Aigner Thomas
Published: December 2002

Many studies have shown increased anabolic activity in osteoarthritic cartilage and have suggested changes in the cellular phenotypes of articular chondrocytes. Most of these studies relied on non‐quantitative technologies, which did not allow the estimation of the relative importance of the different differentiation phenomena. In the present study, we developed and used quantitative PCR assays for collagen types I, II(total), IIA, III, and X as marker genes indicating cellular synthetic activity (collagen type II) as well as differentiation pattern of chondrocytes (collagen types I, IIA, III, and X) and quantified these genes in normal, early degenerative, and late stage osteoarthritic cartilage in parallel.

At first sight, our results confirmed previously published data showing hardly any expression of collagen genes in normal and significantly enhanced expression in osteoarthritic cartilage. This included collagen types II, III, and IIA, but also collagen types I(α1) and X. However, if one considers the ratios of the various markers of chondrocytic differentiation in comparison to collagen type II, the main synthetic product of differentiated chondrocytes, no shift in the cellular phenotype was detectable. In fact, expression ratios remained constant or were even decreased in osteoarthritic cartilage.

Our results confirm that normal adult human articular chondrocytes display hardly any expression activity of the collagen types investigated, whereas osteoarthritic chondrocytes show very increased synthetic activity. The largely unchanged ratios of collagen subtypes investigated indicate that no general shift in the cellular phenotype does occur in osteoarthritic cartilage as suggested by previous investigations.

© 2002 Orthopaedic Research Society. Published by Elsevier Science Ltd. All rights reserved.
A novel two‐step method for the formation of tissue‐engineered cartilage by mature bovine chondrocytes: The alginate‐recovered‐chondrocyte (ARC) method
Authors: Masuda Koichi , Sah Robert L. , Hejna Michael J. , Thonar Eugene J.‐M. A.
Published: December 2002

Most attempts to tissue‐engineer cartilage have involved seeding of cultured cells into a biological or synthetic scaffold. We have developed a novel two‐step culture approach that makes possible the in vitro formation of cartilaginous‐like tissue by mature adult bovine chondrocytes without the aid of a synthetic matrix. The first step consists of culturing chondrocytes under conditions that maintain their rounded shape and their molecular phenotype as assessed by type II collagen and aggrecan production. This step was accomplished by culturing the isolated chondrocytes in alginate beads until the cells have reestablished a proteoglycan‐rich cell‐associated matrix (CM). The second step consists of culturing the cells with their CM, after recovery from the beads, on a tissue culture insert with a porous membrane. In this study, young adult bovine articular chondrocytes were cultured in alginate beads in the presence of 10% or 20% fetal bovine serum (FBS). After 7 days of culture, the alginate beads were dissolved by incubating the beads for 20 min in sodium citrate buffer, a calcium chelator. Following a brief centrifugation, the cells with their CM were recovered, resuspended in medium containing 10% or 20% FBS and seeded onto a tissue culture insert. After 1 week of culture on the insert, the individual cells with their CM progressively became incorporated into a mass of cartilaginous tissue. Culture with 20% FBS resulted in the best formation of tissues. These tissues, easily recovered from the insert, were then subjected to biochemical and histological analyses. The biochemical results showed that the chondrocytes remain phenotypically stable in the tissues. The de novo tissue has a relatively high ratio of PG/collagen. Histological examination of the tissue revealed it contained a cartilage‐like matrix strongly stained with toluidine blue. This scaffold‐free system appears ideal to study, in vitro, the development of transplantable cartilaginous tissue.

© 2002 Orthopaedic Research Society. Published by Elsevier Science Ltd. All rights reserved.
A Conceptual Model of Weight Loss and Weight Regain: An Intervention for Change
Authors: Wysoker Amy
Published: December 2002

Obesity is considered one of the most prevalent health problems in the United States. The controversy surrounding the causes of obesity and its incidence of illness as well as the less-than-promising statistics for long-term weight loss raise questions about present treatment modalities. Statistics indicate that the majority of persons who lose weight regain the weight within 1 to 5 years. Statistics also indicate that 95% of the participants in weight loss programs are women. Based on the findings of a qualitative study, Wysoker developed a model of weight loss and weight regain. The model offers a framework for treatment and includes three different approaches: (a) one can lose weight and keep it off; (b) it may be impossible to lose weight and keep it off; and (c) women will continue to try to lose weight, despite the long history of losing weight and gaining the lost weight back.
Integrating Psychiatric Nursing into a Baccalaureate Nursing Curriculum
Authors: Perese Eris F.
Published: December 2002

Integrated nursing curricula are believed to carry the risk of diluting psychiatric nursing content and limiting nursing students’ opportunities to gain skills in providing care for patients with psychiatric disorders, especially patients with severe mental illnesses. Also, there is fear that integrating psychiatric nursing into more broad nursing content will reduce students’ interest in graduate psychiatric nursing study and thus endanger the specialty of psychiatric nursing. This report of a restructured baccalaureate nursing program that adopted the premise of holism—mental and physical health as united—presents a different view. Psychiatric nursing content was incorporated into classroom instruction over four semesters and, with the nursing theory of modeling and role-modeling as a guide, clinical experiences were planned for all students in primary, rehabilitative, or acute care settings. Psychiatric nursing did not disappear, as had been feared. It emerged less stigmatized, more accepted by the nonpsychiatric faculty, and enthusiastically received by the students.
Autologous and MHC class I–negative allogeneic tumor cells secreting IL-12 together cure disseminated A20 lymphoma
Authors: Curti Antonio , Parenza Mariella , Colombo Mario P.
Published: December 2002

Cytokine gene-modified tumor cells have increased immunogenicity and retain the antigenic repertoire of a particular neoplasia. However, practical concerns have led to an increased interest in allogeneic gene-transduced bystander cells as a broader source of cytokines for autologous tumor cell–based vaccines. Here, we show that allogeneic B78H1 major histocompatibility complex (MHC) class I–negative and –positive (H-2Kb– and Db-transfected) cells induced cytotoxic T lymphocytes (CTLs) and protection in BALB/c mice at comparable levels in response to a challenge with C26 (H-2d) colon carcinoma cells sharing the tumor-associated antigen envelope glycoprotein 70 (env-gp70) with both cell lines. Class I–negative B78H1 cells transduced to express interleukin-12 (IL-12) and mixed with autologous A20 tumor cells led to eradication of preestablished A20 lymphoma in 50% or 100% of treated mice after 3 or 4 vaccinations, respectively, whereas A20 cells alone or mixed with nontransduced B78H1 cured none or 50% of mice after 3 or 4 vaccinations, respectively. Immunization with the IL-12–producing bystander cell line increased tumor-specific proliferation and type 1 cytokine production by CD4+ T cells. By contrast, CD4 T-cell function appeared impaired after immunization with A20 cells alone or mixed with B78H1 cells. Indeed, only CD4+ T cells from IL-12–treated mice could be restimulated with anti-OX40 monoclonal antibody (mAb) in place of a fourth cellular boost. Moreover, the IL-12–based tumor vaccine induced expansion of tumor-specific interferon-γ (IFN-γ)–producing CD8+ T cells. These results are clinically relevant for the development of feasible IL-12 cancer vaccines based on engineered class I–negative bystander cells.
The national maternal mortality study of Egypt 1992–1993
Authors: Kassas M. , Hefni M. , Hanafi A. , Campbell O.
Published: December 2002

The study was designed as a population‐based sample of all maternal deaths over a one‐year period in 21 governorates. A sample of 7487 deceased women of reproductive age was selected. During pregnancy, delivery, or in the puerperium, there were 825 772 maternal deaths and 53 from incidental causes. Of the maternal deaths, 69.5% were due to direct obstetric causes while 26.9 and 3.6% were due to indirect and unknown causes, respectively. The national maternal mortality ratio was 174 maternal deaths per 100 000 live births.
Birth control counseling for HIV seropositive pregnant women
Authors: Piya‐Anant M. , Atisook R. , Ratananikom P.
Published: December 2002

Testing for HIV antibody at the antenatal clinic in Siriraj Hospital started on 1 July 1991. It was found that the percentage of HIV seropositive pregnant women rapidly increased from 1.2% in 1992 to 1.9% in 1993. During those 2 years, 487 seropositive women were admitted for delivery or abortion; 23.8% were adolescents and 47.0%, young adults. Prevention of HIV transmission from mother‐to‐baby was birth control; 95 women (19.5%) chose to abort their pregnancy. After termination of all pregnancies by abortion or delivery, 83% requested sterilization, 12.9% accepted Norplant, 1.8% the pill and only 2.3% refused anything at all. Condoms were used regularly for prevention of HIV infection by 29.4% of men although Thai men generally do not accept them for birth control. Seropositive Norplant users had more bleeding than general Norplant users but treatments were the same.
Nerve conduction and microanatomy in the rabbit sciatic nerve after gradual limb lengthening–distraction neurogenesis
Authors: Yokota Atsushi , Doi Munekazu , Ohtsuka Hisashi , Abe Muneaki
Published: December 2002

To clarify how the peripheral nerve adapts to elongation during gradual limb lengthening, electrophysiological and histomorphometric examinations were performed on the sciatic nerves in 18 rabbits. External fixators were used to lengthen the right femora by 30 mm (30%), at a daily rate of 0.5 mm (Group 1) or 2.0 mm (Group 2). Examinations were performed immediately after the limb lengthening procedure. Electrophysiologically, mild conduction slowing was observed in Group 1; a conduction block was evident in Group 2. Histologically, the mean diameter of myelinated fibers was unchanged in Group 1, but a significantly decreased diameter was observed in Group 2. Electron microscopy revealed that mild degenerative change of unmyelinated axons occurred sporadically in two cases in Group 2, but neither group showed evidence of thinning of myelin sheath of myelinated fibers. The mean internodal length (between nodes of Ranvier) of teased fibers was 1216 ± 295 μm in the control contralateral side, 1484 ± 347 μm in Group 1, and 1467 ± 322 μm in Group 2. Thus the internodes were lengthened by 22.1% (Group 1) and 20.7% (Group 2) in comparison with those of the controls. Straightening of the geometry of paranodal myelin sheath was significantly correlated with the rate of distraction. These results indicate that myelinated nerve fibers adapt to gradual elongation by lengthening each Schwann cell body, not by proliferation of Schwann cells.

© 2002 Orthopaedic Research Society. Published by Elsevier Science Ltd. All rights reserved.
Two distinct cellular mechanisms of osteoclast formation and bone resorption in periprosthetic osteolysis
Authors: Sabokbar A. , Kudo O. , Athanasou N. A.
Published: December 2002

Purpose: TNFα and IL‐1α are proinflammatory cytokines that are abundant in periprosthetic tissues. These cytokines stimulate bone resorption and have recently been shown to directly induce osteoclast formation in mouse marrow cultures. We examined whether TNFα and IL‐1α can directly induce osteoclast formation from human arthroplasty‐derived (CD14+) macrophages by a mechanism independent of RANKL‐induced osteoclastogenesis.

Methods: TNFα and M‐CSF (±IL‐1α) were added to cultures of magnetically sorted (CD14+) and unsorted (CD14+/CD14−14) cells isolated from the pseudomembrane of loosened hip arthroplasties. Osteoprotegerin (OPG), RANK:Fc and antibodies to TNF receptors (p55 and p75) were added to these cultures to distinguish the pathway of osteoclastogenesis. Osteoclast differentiation was assessed by expression of tartrate‐resistant acid phosphatase (TRAP), vitronectin receptor (VNR) and lacunar resorption.

Results: The addition of TNFα (±IL‐1α) resulted in differentiation of CD14+ macrophages into TRAP+ and VNR+ multinucleated cells capable of extensive lacunar resorption. Both OPG and RANK:Fc (which inhibit RANKL‐induced osteoclastogenesis) did not block osteoclastogenesis. The addition of antibodies directed against the p55 receptor subunit of TNF resulted in significant inhibition of osteoclast formation and lacunar resorption.

Conclusions: Our results indicate that, in the presence of M‐CSF, TNFα is sufficient for inducing human osteoclast differentiation from arthroplasty macrophages and that TNFα acts synergistically with IL‐1α to stimulate lacunar resorption. This process is distinct from the RANK/RANKL signalling pathway and is likely to operate in periprosthetic tissues when there is heavy wear particle deposition and cytokine production.

© 2002 Orthopaedic Research Society. Published by Elsevier Science Ltd. All rights reserved.
Limbal Stem Cells in Health and Disease
Authors: Sangwan Virender S.
Published: December 2002

Stem cells are present in all self-reviewing tissues and have unique properties. The ocular surface is made up of two distinct types of epithelial cells, constituting the conjunctival and the corneal epithelia. These epithelia are stratified, squamous and non-keratinized. Although anatomically continuous with each other at the corneoscleral limbus, the two cell phenotypes represent quite distinct subpopulations. The stem cells for the cornea are located at the limbus. The microenvironment of the limbus is considered to be important in maintaining stemness of the stem cells. They also act as a “barrier” to conjunctival epithelial cells and prevent them from migrating on to the corneal surface. In certain pathologic conditions, however, the limbal stem cells may be destroyed partially or completely resulting in varying degrees of stem cell deficiency with its characteristic clinical features. These include “conjunctivalization” of the cornea with vascularization, appearance of goblet cells, and an irregular and unstable epithelium. The stem cell deficiency can be managed with auto or allotransplantation of these cells. With the latter option, systemic immunosuppression is required. The stem cells can be expanded ex vivo on a processed human amniotic membrane and transplanted back to ocular surface with stem cell deficiency without the need of immunosuppression.
Rethinking the role of the risk approach and antenatal care in maternal mortality reduction
Authors: Yuster E.A.
Published: December 2002

In developing countries where most women are not delivered in health facilities, screening for obstetric risk is neither a cost‐effective nor efficient strategy for maternal mortality reduction. Antenatal care can contribute to preventing such deaths when used for identifying early obstetric complications, educating women to identify obstetric danger signs, and motivating them and their families to seek appropriate referral care.
Emergency obstetric care: measuring availability and monitoring progress
Authors: Nirupam S. , Yuster E.A.
Published: December 2002

To reduce maternal deaths substantially, the facilities for Emergency Obstetric Care (EOC) must exist, be accessible, be utilized by complicated cases and be successful. Accordingly, a new set of indicators, viz., number of functional EOC facilities, geographic bed distribution within a district, proportion of expected births and expected complications managed at these units, and case fatality rate for complicated cases, were assessed in ten districts drawn from ten major states of India. The paper discusses the findings and some of the problems of data collection and interpretation. In general, maldistribution of beds within the district, low levels of cesarean section rates and, sometimes, high case fatality point to a need for an improvement in availability, distribution and quality of EOC. Similarly, low institutional birth rate and much lower than expected number of complications reaching the facilities point to the need for encouraging families to use them. Changes in these indicators over time will help gauge improvements in provision and utilization of EOC. The study findings and methodology are serving as an important element for developing a monitoring system for EOC under Safe Motherhood in India.
Levels and determinants of maternal morbidity: results from a community‐based study in southern India
Authors: Bhatia J.C.
Published: December 2002

This analysis is based on detailed interviews with 3600 rural and urban women in southern India. They were younger than 35 and had at least one child less than 5 years of age. Each woman was questioned by a trained female interviewer and asked about problems she had encountered during the last pregnancy. Approximately two‐fifths (41%) reported at least one morbid condition associated with that event. About one‐fifth (18%) had had at least one problem during the antenatal period and delivery and another 23% indicated problems during the postpartum. Surgical interventions were made in 13.1% of all deliveries. However, if we consider only those taking place in hospital, more than one‐third (34.2%) were delivered surgically. The relationship between socioeconomic and demographic factors and reported maternal morbidity has been examined by using multivariate statistical techniques. The policy implications of the study are discussed.
An in vivo model of degenerative disc disease
Authors: Norcross Jason P. , Lester Gayle E. , Weinhold Paul , Dahners Laurence E.
Published: December 2002

Although the precise etiology of low back pain is disputed, degeneration of the intervertebral disc is believed to play an important role. Many animal models have been described which reproduce the changes found in degenerative disc disease, but none allow for efficient, large‐scale testing of purported therapeutic agents. The purpose of this study was to develop a simple animal model resembling degenerative disc disease using the intervertebral discs found in the tails of rats. The proximal two intervertebral discs in the tails of 20 rats were injected with either chondroitinase ABC or control (phosphate buffered saline, PBS). The tails were harvested at 2 weeks, and measurements were made of intervertebral disc height (measured radiographically and histologically), biomechanics (stiffness, hysteresis, and residual deformation), and histologic appearance. Treatment with chondroitinase ABC resulted in a significant loss in intervertebral disc height (radiographic intervertebral disc height, p < 0.001; histologic intervertebral disc height, p < 0.001) and significant increases in all biomechanical parameters (stiffness, p < 0.001; hysteresis, p < 0.006; residual deformation, p < 0.004) compared to PBS controls. Intervertebral discs treated with chondroitinase ABC had significantly lower histologic grades for each grading category (nucleus pulposus (NP), annulus fibrosus, and proteoglycan staining) compared to controls. The results of injury with chondroitinase ABC were similar to the findings in degenerative disc disease: reduced intervertebral disc height, diminished proteoglycan content, loss of NP cells, and increased stiffness of the disc. Thus, the model appears to be a reasonable tool for the preliminary in vivo evaluation of proposed treatments for degenerative disc disease.

© 2002 Orthopaedic Research Society. Published by Elsevier Science Ltd. All rights reserved.
Undersulfation of proteoglycans and proteins alter C6 glioma cells proliferation, adhesion and extracellular matrix organization
Authors: Mendes de Aguiar Claudia B.N. , Garcez Ricardo Castilho , Alvarez‐Silva Marcio , Trentin Andréa Gonçalves
Published: December 2002

Proteoglycans are considered to be important molecule in cell–microenvironment interactions. They are overexpressed in neoplastic cells modifying their growth and migration in hosts. In this work we verified that undersulfation of proteoglycans and other sulfated molecules, induced by sodium chlorate treatment, inhibited C6 glioma cells proliferation in a dose‐dependent way. This effect was restored by the addition of exogenous heparin. We could not detect significant cell mortality in our culture condition. The treatment also impaired in a dose‐dependent manner, C6 cell adhesion to extracellular matrix (ECM) proteins (collagen IV, laminin and fibronectin). In addition, sodium chlorate treatment altered C6 glioma cell morphology, from the fibroblast‐like to a more rounded one. This effect was accompanied by increased synthesis of fibronectin and alterations in its extracellular network organization. However, we could not observe modifications on laminin organization and synthesis. The results suggest an important connection between sulfation degree with important tumor functions, such as proliferation and adhesion. We suggest that proteoglycans may modulate the glioma microenvironment network during tumor cell progression and invasion.
The Lipid Layer: The Outer Surface of the Ocular Surface Tear Film
Authors: McCulley James P. , Shine Ward E.
Published: December 2002

The outer layer of the tear film—the lipid layer—has numerous functions. It is a composite monolayer composed of a polar phase with surfactant properties and a nonpolar phase. In order to achieve an effective lipid layer, the nonpolar phase, which retards water vapor transmission, is dependent on a properly structured polar phase. Additionally, this composite lipid layer must maintain its integrity during a blink. The phases of the lipid layer depend on both lipid type as well as fatty acid and alcohol composition for functionality. Surprisingly, the importance of the composition of the aqueous layer of the tear film in proper structuring of the lipid layer has not been recognized. Finally, lipid layer abnormalities and their relationship to ocular disease are beginning to be clarified.
Amniotic Membrane Transplantation for Ocular Surface Reconstruction
Authors: Tseng S.C.G.
Published: December 2002

The use of amniotic membrane (or amnion) for transplantation as graft in ocular surface reconstruction is reviewed. This technique has become widespread because of the availability of the amnion, convenience and ease of use, and high and reproducible success rates. The mechanisms of action of the transplantation are varied and include the prolongation and clonogenic maintenance of epithelial progenitor cells, promotion of goblet and non-goblet cell differentiation, exclusion of inflammatory cells with anti-protease activities, suppression of Transforming Growth Factor β signaling and myoblast differentiation of normal fibroblasts. The observed clinical effects include facilitation of epithelialization, maintenance of normal phenotypes, and reduction of inflammation, vascularization and scarring. Amniotic membrane transplantation is being increasingly used as graft for various conjunctival and corneal diseases and as a patch in cases of chemical and thermal burns, refractory and recalcitrant keratitis, and most recently as an excellent substrate for expanding epithelial stem cells ex vivo.
MERCURY AND RADIOACTIVE WASTE DISPOSAL IN SWEDEN: POLITICAL HANDLING AT THE LOCAL LEVEL
Authors: UGGLA YLVA
Published: December 2002

The paper analyses the political handling of mercury and radioactive waste disposal at the local level, and includes a case study of a Swedish community where there is a conflict concerning a planned deep repository of mercury. The analysis is based on two contrasting lines of planning theory, the trajectory of rational planning and the trajectory of communicative planning. In politics and planning on environmental matters, the Environmental Impact Assessment (EIA) is a means of involving various actors in consultation. EIA refers both to a document that provides the basis for decisions and a working process, which can be seen as an endeavour to integrate the divergent trajectories of planning. Experiences from mercury and radioactive waste disposal, however, show a bias towards rational planning, giving scientific and technological expertise precedence to define the issue at stake. Likewise, the process of policy implementation shows a course with weak political commitment at the national as well as the local level of government.
ASSESSING ENVIRONMENTAL IMPACTS DURING NATURAL DISASTER: THE DEVELOPMENT OF A RAPID ENVIRONMENTAL ASSESSMENT METHODOLOGY
Authors: KELLY CHARLES
Published: December 2002

The linkages between disaster and environmental damage are recognized as important to predicting, preventing and mitigating the impact of disasters. Environmental Impact Assessment (EIA) procedures are well developed for non-ndisaster situations. However, they are conceptually and operationally inappropriate for use in disaster conditions, particularly in the first 120 days after the disaster has begun. The paper provides a conceptual overview of the requirements for an environmental impact assessment procedure appropriate for disaster conditions. These requirements are captured in guidelines for a Rapid Environmental Impact Assessment (REA) for use in disasters. The REA guides the collection and assessment of a wide range of factors which can indicate: (1) the negative impacts of a disaster on the environment, (2) the impacts of environmental conditions on the magnitude of a disaster and, (3) the positive or negative impacts of relief efforts on environmental conditions. The REA also provides a foundation for recovery program EIAs, thus improving the overall post disaster recovery process. The REA is designed primarily for relief cadres, but is also expected to be usable as an assessment tool with disaster victims. The paper discusses the field testing of the REA under actual disaster conditions.
Kinetics of minimal residual disease and chimerism in patients with chronic myeloid leukemia after nonmyeloablative conditioning and allogeneic stem cell transplantation
Authors: Uzunel Mehmet , Mattsson Jonas , Brune Mats , Johansson Jan-Erik , Aschan Johan , Ringdén Olle
Published: December 2002

The kinetics of minimal residual disease (MRD) and chimerism were studied in 15 patients with chronic myeloid leukemia (CML) receiving nonmyeloablative stem cell transplantation (NST) and in 10 patients receiving conventional stem cell transplantation (CST). All NST patients showed T-cell mixed chimerism (MC) while granulocyte and B-cell MC occurred in 80% and 60% of the NST patients, respectively. In CST patients, T-cell MC was detected in 5 patients, of whom 3 were mixed only during the first month. MRD was detected in all NST patients. During the first 3 months the median BCR-ABL/ABL ratio was 0.2% in NST patients compared with 0.01% in CST patients (P < .01). However, 12 months after transplantation, the percentage of reverse transcriptase–polymerase chain reaction (RT-PCR)–positive patients was 20% in NST patients and 50% in CST patients. In conclusion, molecular remission can be induced in most patients after NST, albeit with different kinetics from CST.
Unmet need in family planning in South Asia Region
Authors: Kapoor I.
Published: December 2002

Today's population in South Asia is estimated at 1.2 billion. With an average annual growth of 2%, it increases by more than 24 million people each year, the highest increment in the world. Despite recent improvements in the contraceptive prevalence rate, all countries in the region experience high levels of unmet need for contraception, Several of the region's characteristics have a bearing on the challenge of promoting and providing family planning services: women's status is particularly low; the persistence of son preference results in higher female than male mortality at all ages; the young age structure means an increasing number of people entering childbearing ages. Being predominantly rural, the region experiences shortages of trained health personnel as well as major problems of accessibility to basic health services.
Family planning in Sub‐Saharan Africa: present status and future strategies
Authors: Arkutu A.
Published: December 2002

Africa lags behind the rest of the developing world in most demographic, health and economic indicators of social development, but some progress has been made in contraceptive prevalence and fertility decline. Many challenges remain for governments on that continent to meet the basic reproductive health needs of their rapidly growing populations. With the sustained support of the international community, there is reason to be hopeful.
Severe anemia of pregnancy, recent experience
Authors: Sarin A.R.
Published: December 2002

We undertook this study to determine the current prevalence of anemia in pregnancy and its impact on maternal and perinatal mortality and morbidity, and to suggest ways to make the anemia prevention programs more effective. The incidence of pregnancy anemia was determined by a population‐based survey (1990–1994) of rural and urban areas using a cluster sample design. Mortality and morbidity data were gathered from our own hospital records (1982–1994). The survey data showed that 86.1% of pregnant women (n = 4752) were anemic (Hb < 11 g/dl); 56.0% had severe anemia (Hb < 7 g/dl); and 1.9% were decompensated (Hb < 4 g/dl). The hospital‐based analysis revealed that severe anemia contributed to 34.5% of all maternal deaths (case fatality ratio = 1769). Hypertensive disorders were found in 28.2% of severe anemia cases. The incidence of preterm labor was 31.2% in these cases and the birthweight 2.23 ± 1.13 kg (mean ± SD), while perinatal mortality was 65 compared to overall rates of 7.9%, 2.78 ± 1.32 kg and 46, respectively. We conclude that severe anemia of pregnancy is still rampant and its adverse consequences remain unabated. The risk‐care approach is advocated as an alternative strategy.
Antenatal risk screening and scoring: a new look
Authors: Fortney J.A.
Published: December 2002

At the individual level, risk assessment is fundamental to antenatal care. But at the program level, there are real difficulties associated with it, of which the most important is the false negatives — women with no (or few) risk factors who experience complications. This paper evaluates several commonly used indicators of risk in terms of both maternal (cephalopelvic disproportion) and fetal (low birthweight/prematurity) outcomes. The literature shows that obstetric history is a better measure of risk than so‐called demographic variables like age and parity. When assessing the utility of a risk factor, Us sensitivity must be evaluated against the likelihood of false negatives. If risk assessment is practiced effectively, it must include a means of ensuring prompt treatment for low risk women with (unexpected) complications.
Neonatal tetanus: review of progress
Authors: Gasse F.
Published: December 2002

The target set for elimination of neonatal tetanus (NT) is less than one case par 1000 live births in every district of the world. NT will then be considered to have been removed as a major public health problem and fewer than 150 000 cases are expected to occur annually worldwide if the achievements are maintained. It is estimated for 1993 that over 700 000 neonatal deaths due to tetanus were in fact prevented by maternal immunization and clean delivery practices. About 480 000 (70%) of them were averted in only three countries: India, Bangladesh and Indonesia. Meanwhile, 91 others already have an estimated NT rate below 1 per 1000 live births nationwide. Of these, 50 countries may already have achieved the target in each of their districts. According to 1993 estimates half a million newborn deaths due to tetanus are still occurring worldwide, 80% of them in 12 countries. Out of 14 others where NT remains a major public health problem, 12 are in the African Region. Together, these 26 countries contribute 90% of the global incidence of NT. By 1995, major strides towards the elimination of NT can be made by using the high risk approach and immunization, including organizing Days of Tranquility where necessary. But for this to be accomplished, there must be sufficient political commitment and financial support of some US$ 30 million to carry out the program in the 26 priority countries.
A 5‐year study of maternal mortality in Faisalabad City Pakistan
Authors: Bashir A. , Aleem M. , Mustansar M.
Published: December 2002

A 5‐year study (1989–1993) of 215 maternal deaths in Faisalabad (third largest city of Pakistan) is presented. There were 276 717 live births recorded by the Municipal Corporation during that period, giving a maternal mortality of 0.77/1000 live births. These deaths included 88 (40.9%) in teaching hospitals, 70 (32.6%) at home and 57 (26.5%) in private hospitals. The main causes of maternal death were postpartum hemorrhage, 50 (23.3%), followed by pregnancy induced hypertension/eclampsia and non‐obstetric causes, 34 (15.8%) each. The study reveals that traditional birth attendant (TBA) training/refresher courses, intensive community education, antenatal checkup in local areas, free obstetric flying squad service, better linkage between formal and informal health services, home maternal death condolence camps and improvement of obstetric care in hospital, offered free for deserving cases have played major roles in reducing maternal mortality.
The Mother‐Baby Package: an approach to implementing safe motherhood
Authors: Mehta S.
Published: December 2002

The basic objectives of the Mother‐Baby Package are neither new nor controversial — they are considered the ‘four pillars’ of Safe Motherhood: (1) family planning — to ensure that individuals and couples have the information and services to plan and space pregnancies; (2) antenatal care — to ensure that complications of pregnancy are detected as early as possible and treated appropriately; (3) clean/safe delivery — to ensure that all birth attendants have the knowledge, siwills and equipment to perform a clean and safe delivery; (4) essential obstetric care — to ensure that essential care is made available to all women who need it. Complications during pregnancy and childbirth affect not only the women but their newborns as well. The woman and the fetus, the mother and the neonate, should be seen as a dyad — two units treated as one. Poorly managed pregnancies and/or deliveries and/or inadequate care of neonates during the first critical hours of life account for significant numbers of perinatal and neonatal deaths. Each intervention of the Package can be appropriately applied at community, health center and hospital levels. Only by providing this continuum of care from the community through to the referral hospital will significant impact on mortality be achieved. The goals of the Package are, by the year 2000, to reduce maternal mortality by half and neonatal and perinatal mortality by 30–40% of 1990 levels.
HIV, STD and their current impact on reproductive health: the need for control of sexually transmitted diseases
Authors: van Dam C.J.
Published: December 2002

STD and HIV are the second most important cause of Disability Adjusted Life Years lost in women in the developing world. Reasons for this are multiple, and include their higher vulnerability for STD and HIV, poor health care seeking behavior and lack of accessible and acceptable services. There is considerable synergism between family welfare services and STD programs: complications and sequelae of STD affect the reproductive tract and child health and survival; reproductive and child health and survival are the focus of family welfare programs. Family welfare services are thus well positioned to incorporate STD and HIV prevention and control measures. This is feasible, although practical and logistical problems need to be addressed. Where indicated, pilot integration projects can assess the cost‐effectiveness and outcome of such programs.
Maternal mortality: national versus hospital situation
Authors: Bhuiyan A.B. , Hussain F.
Published: December 2002

A retrospective analysis of the causes of maternal mortality in two academic hospitals of Dhaka city over a 2‐year period was carried out and compared with national figures. These are the country's chief referral institutions, where only the critically ill are admitted. Currently, the national maternal mortality ratio (MMR) is 5.6/1000 live births, while in Dhaka Medical College Hospital the case fatality ratios (CFR) were 24.4 and 17.2 in 1992 and 1993, respectively. In Mitford Hospital the CFR was 11.1 and 5.4/1000 live births, during the same periods. The most common cause of maternal death at the national level was postpartum hemorrhage and at medical college hospitals it was eclampsia. If we can strengthen emergency obstetric care at all levels, we can reduce maternal mortality bolh at the national level and at the referral hospitals.
Natural sex selection for safe motherhood and as a solution for population control
Authors: Hingorani V. , Shroff G.
Published: December 2002

For Safe Motherhood wanted children should be of desired sex. As Y sperm have a shorter life span and migrate faster, if coitus occurs before ovulation, sperm must wait in the tube for the ovum to arrive. By the time the ovum arrives, Y sperm have died and X sperm fertilize the ovum, resulting in a baby girl. If coitus takes place after ovulation when the ovum is waiting in the tube, the faster migrating Y sperm fertilize the ovum resulting in a baby boy. Eighty women wishing to test this hypothesis by basal body temperature and ultrasound were recruited. Correct results have so far been obtained in 97%. This theory can be used for Safe Motherhood, for population control and to eliminate sex‐linked genetic disorders. It can also prevent both female feticide and infanticide in some cultures.
Rapid new bone tissue remodeling during distraction osteogenesis is associated with apoptosis
Authors: Li Gang , Dickson Glenn R. , Marsh David R. , Simpson Hamish
Published: December 2002

During the process of distraction osteogenesis new bone forms and undergoes rapid remodeling. Apoptosis may be one of the regulatory mechanisms governing the removal of the redundant callus during distraction osteogenesis. A rabbit tibial lengthening model was used and lengthened at 0.7 mm/day for 3 weeks. The regenerating tissues from the distraction gap were examined for apoptotic changes by transmission electron microscopy (TEM) and the terminal deoxynucleotidyl transferase‐mediated dUTP‐biotin nick end‐labeling (TUNEL) method. Osteoclastic bone resorption activities were demonstrated by tartrate resistant acid phosphatase (TRAP) staining. The apoptotic cells were mainly present in the transitional regions between the fibrous tissue and the new bone in the mineralization front, and close to or on the new bone surfaces near the center of the regenerate. The TUNEL labeling was greatly reduced in the mature bone near the osteotomied bone ends. TEM examination confirmed the presence of cells with apoptotic changes at various regions of the regenerate. TRAP staining revealed that osteoclastic bone resorption activities in the regenerate were in a similar pattern of distribution to those of the TUNEL labeling. The localization of apoptotic cells at the different regions of the regenerate, accompanied by the osteoclast activities, suggest that apoptosis is closely related to bone formation and remodeling during distraction osteogenesis.

© 2002 Orthopaedic Research Society. Published by Elsevier Science Ltd. All rights reserved.
Gliding properties of the long head of the biceps brachii
Authors: Heers G. , O'Driscoll S. W. , Halder A. M. , Zhao C. , Mura N. , Berglund L. J. , Zobitz M. E. , An K.‐N.
Published: December 2002

To elucidate the role of mechanical forces that resist motion of the long head of the biceps brachii, the gliding resistance of the tendon during abduction and adduction was measured. Nine human cadaveric glenohumeral joints were obtained (mean age 68 years, range 47–84). A testing device was developed to simulate glenohumeral abduction and adduction motion. Gliding resistance was calculated as the force differential on the proximal and distal ends of the biceps brachii at five glenohumeral angles (15°, 30°, 45°, 60° and 75°).

The average gliding resistance in abduction at 15°, 30°, 45°, 60° and 75° for a 4.9 N load was 0.41, 0.40, 0.36, 0.32 and 0.28 N, respectively. At these same angles, but during adduction motion, the force on the proximal tendon end was either identical or less than the distal tendon end (p > 0.46) indicating a lack of resistance and even a phenomena of „negative”︁ resistance in which some other force overcame the friction. The difference in gliding resistance between abduction and adduction was significant (p < 0.05).

The results indicate that forces opposing biceps tendon gliding are more complicated than simply due to friction. Tendon deformation inside the bicipital groove produces a direction‐dependent effect due to a mechanism of elastic recoil. Understanding forces that are absorbed by the tendon during active motion may provide insight into pathological changes that develop inside and around the tendon.

© 2002 Orthopaedic Research Society. Published by Elsevier Science Ltd. All rights reserved.
Biomechanical effects of medial–lateral tibial tunnel placement in posterior cruciate ligament reconstruction
Authors: Markolf Keith L. , McAllister David R. , Young Charles R. , McWilliams Justin , Oakes Daniel A.
Published: December 2002

With most posterior cruciate (PCL) reconstruction techniques, the distal end of the graft is fixed within a tibial bone tunnel. Although a surgical goal is to locate this tunnel at the center of the PCL's tibial footprint, errors in medial–lateral tunnel placement of the tibial drill guide are possible because the position of the tip of the guide relative to the PCL's tibial footprint can be difficult to visualize from the standard arthroscopy portals. This study was designed to measure changes in knee laxity and graft forces resulting from mal‐position of the tibial tunnel medial and lateral to the center of the PCL's tibial insertion. Bone–patellar tendon–bone allografts were inserted into three separate tibial tunnels drilled into each of 10 fresh‐frozen knee specimens. Drilling the tibial tunnel 5 mm medial or lateral to the center of the PCL's tibial footprint had no significant effect on knee laxities: the graft pretension necessary to restore normal laxity at 90° of knee flexion (laxity match pretension) with the medial tunnel was 13.8 N (29%) greater than with the central tunnel. During passive knee flexion–extension, graft forces with the medial tibial tunnel were significantly higher than those with the central tunnel for flexion angles greater than 65° while graft forces with the central tibial tunnel were not significantly different than those with the lateral tibial tunnel. Graft forces with medial and lateral tunnels were not significantly different from those with a central tunnel for 100 N applied posterior tibial force, 5 N m applied varus and valgus moment, and 5 N m applied internal and external tibial torque. With the exception of slightly higher graft forces recorded with the medial tunnel beyond 65° of passive knee flexion, errors in medial–lateral placement of the tibial tunnel would not appear to have important effects on the biomechanical characteristics of the reconstructed knee.

© 2002 Orthopaedic Research Society. Published by Elsevier Science Ltd. All rights reserved.