bluuebunny/crossref_metadata_2025 huggingface dataset:
Rheology and Processing of HDPE/Wood Flour Composites
Authors: Santi C. R. , Hage E. , Vlachopoulos J. , Correa C. A.
Published: August 2009

Rheological and mechanical properties of extruded wood plastic composites have been investigated for the purpose of providing a better understanding of processing conditions in profile extrusion for this novel class of thermoplastics composites. The basic formulations prepared for the study were comprised of 60 wt.% HDPE, with or without LLDPE-MAH as coupling agent, compounded with up to 40 wt.% of wood flour and lubricant. Capillary and rotational rheometers were employed to measure the rheological properties of the melt composite. A cooled die at the end of a single screw extruder was used for the extrusion of rectangular profiles having smooth surfaces and edges. Finite element flow simulation was used for the interpretation of the experimental data. Once extrusion steady conditions were achieved in the die, linear output was monitored and profile samples were cut for determination of flexural modulus and strength. The results showed that flexural properties can be influenced by many factors such as, coupling agents, lubricants, processing conditions, die pressure drop and cooling at the die. Linear speed of HDPE wood-plastic profile extrusion and end-use properties are strongly influenced by combination of these factors.
Water Assisted Injection Molding: A Review
Authors: Liu S.-J.
Published: August 2009

Water assisted injection molding technology has become one of the most important methods to manufacture hollow plastic parts in recent years, due to its light weight, relatively lower resin cost per part and faster cycle time. This report aims to present a review of the development and progress of the water assisted injection molding technology. The tooling used for the process is introduced. The interaction between the assisting water and the polymer melt during molding is discussed, and insight into the penetration behaviors of the fluid is summarized. In addition, comparisons have been made between the gas-assisted injection molding and water assisted injection molding processes.
Zinc Surfactant Effects on Improved Mechanical Properties of Silica-Filled Silicone Rubber/Natural Rubber Blends Using TESPD Coupling Agent
Authors: Dang T. T. Nga , Kim J. K. , Kim K.-J.
Published: August 2009

Zinc surfactant (ZS) is added into natural rubber (NR)/silica/TESPD (bis (triethoxysilyl propyl) disulfide) and silicone rubber (SR)/NR/silica/TESPD compounds and these compounds are vulcanized. The addition of the ZS shows significant improvements on mechanical properties on both compounds. It increases the torque maximum values of the compounds as well as the tan values, which is an indirect implication that the vibration isolation property is increased. It shows the presence of zinc ion in the ZS helps silane coupling with double bond in the rubber chain. This results in improved mechanical properties such as the modulus, tensile strength, elongation at break, and hardness.
A Two Years Study on Pregnant Women with Cardiac Disease in a Tertiary Care Centre
Authors: Sayeeda Syeda , Wahid Fatima , Begum Firoza , Zaman Mahboob Mustafa
Published: August 2009

Objective: To analyse the pregnant women with heart disease and to assess its influence on the fetomaternal outcome. Materials and methods: This observational study was carried out during the period from Jan 2006 to Sept 2007. Fifty pregnant women with cardiac diseases who were admitted in the Fetomaternal Medicine unit of the department of Obstetrics & Gynaecology in Bangabandhu Sheikh Mujib Medical University (BSMMU) were included in the study. Results: Rheumatic heart disease (n-37, 74%) with isolated mitral stenosis (28%) was the predominant cardiac problem among the study subjects while atrial septal defect (16%) was the most common form of congenital heart disease (n-13, 26%). Based on New York Heart Association (NYHA) functional classification, 40(80%) women were in class-I, 7(14%) were in class-II and 3(6%) were in class-III heart disease on presentation. The mean (±SD) gestational age at delivery was 37.50(±2.50) weeks and pregnancy duration was shortened in more advanced classes of heart disease. The rate of cesarean section (90%) was high in the study subjects. The rate of prematurity (55.5%) was high among class II and III and average birth weight of neonates were less among these two classes compared to class I (2.80±0.20 kg in Class-I, 2.30±0.26 in Class-II and 2.10±0.34 in Class-III). No baby was delivered stillborn and there was no neonatal death. Out of fifty, nine patients developed heart failure during the hospital stay. Duration of hospital stay was shorter in class-I (7.50±1.50) and was prolonged in more advanced classes of heart disease (9.50±1.56 in Class-II and 13.80±4.20 in Class-III). Two patients of the study subjects expired. Conclusion: Rheumatic heart disease was the predominant type of heart disease in pregnancy and most of the women were in class I on admission. The neonatal outcome was satisfactory. Two patients in the congenital heart disease group expired during the study period. Key words: Maternal, Fetal, Cardiac disease.   doi: 10.3329/bjog.v23i1.3050   Bangladesh J Obstet Gynaecol, 2008; Vol. 23(1) : 3-7
Effect of Site of Injection on Spread of Spinal Anaesthesia with Hyperbaric Bupivacaine
Authors: Karim MA , Banik Debasish , Huda Qumrul , Hye Abdul , Banik Debabrata , Begum Feroza
Published: August 2009

Spinal Anaesthesia during caesarean section is popular world wide. The aim of the study was the explore the efficacy of spinal Anaesthesia with hyperbaric bupivacaine at different intervertebral space in lower uterine caesarean section. Ninety unpremeditated patients (20-40 years) undergoing caesarean section were allocated randomly to receive 0.5% hyperbaric bupivacaine 2ml at the site of L2-3, L3-4 and L4-5 intervertebral space. Spinal injection was performed to all patients with a 25-gauge Quincke spinal needle. The onset time of analgesia at T10 and T6 was significantly faster and the level of analgesia at 5 and 10 min was significantly higher after injection at L2-3. But the maximum height (T4) of analgesia at 15 and 20 min after injection and the number of episodes of hypotension were not significantly different among the three groups. So we can conclude that onset of Analgesia is altered by the site of injection, but the overall analgesia level achieved remain unchanged. Key words: Spinal anaesthesia, hyperbaric bupivacane, site of injection, spread of anaesthesia.   doi: 10.3329/bjog.v23i1.3052  Bangladesh J Obstet Gynaecol, 2008; Vol. 23(1) : 15-19
Perinatal Outcome of Eclampsia in Dhaka Medical College Hospital
Authors: Alam Irin Parveen , Akhter Sayeba
Published: August 2009

Objectives: The study was done with the objective to find the perinatal outcome in eclampsia patients and also to find out preventable causes of perinatal mortality and morbidity which are related to eclampsia. Materials & methods: This was a cross sectional observational study carried out in the Eclampsia unit in the Department of Obstetrics and Gynaecology in Dhaka Medical College Hospital during the period from February 2001 to July 2001. Results: Three hundred patients were selected for study. Three hundred mother's delivered 311 babies (11 sets of twins). Perinatal death(PND) which included stillbirth (SB) and early neonatal death (END) was 29%; stillbirth rate was 158/1000 live birth and early neonatal death rate was 132/1000 live births; 71% babies were born healthy. Maternal and fetal conditions were assessed and its relation with perinatal outcome was analyzed. Convulsion delivery interval > 12 hours, diastolic BP > 110mm Hg and Proteinuria > 3+ had significant higher perinatal death. (P<0.001, <0.01 and <0.001, respectively). Seventy percent babies had low birth weight. Among the live born neonates (n=262) 27.5% had jaundice, 34.7% had no complication and 15.6% had early neonatal death. Pre-maturity was common cause of early perinatal death (54%) and 39% death was due to asphyxia. Conclusion: Still birth, prematurity and birth asphyxia are important causes of perinatal loss in eclampsia, so early referral of eclampsia patients, early resuscitative measures and good neonatal care can improve perinatal outcome.   doi: 10.3329/bjog.v23i1.3053   Bangladesh J Obstet Gynaecol, 2008; Vol. 23(1) : 20-24
Early Recurrent Inversion - A Case Report
Authors: Kabir Nazneen , Islam Ferdousi , Zannat Fatematul , Razzak Mollika
Published: August 2009

doi: 10.3329/bjog.v23i1.3056   Bangladesh J Obstet Gynaecol, 2008; Vol. 23(1) : 35-37
Educating for Local Development and Global Sustainability: An Overview in Spain
Authors: Murga-Menoyo María Angeles
Published: August 2009

The following are systematized examples, taken from the general panorama of activities currently being implemented in Spain, of significant experiences and formative strategies of local sustainable development. They correspond to three different intervention areas in education: different levels in the school system, adults training in competence and technical abilities, and community education. They offer a contextualized model of education intervention that contributes to ecological and environmental sustainability, social promotion and productive competitiveness. The experiences described permit, in many cases, changes of life styles and social customs, adjusting them to the requirements of sustainable development; in others, to form new generations for local sustainable development and global sustainability. Although procedures must vary to suit the particular features inherent in each such realm, it is the function of education to tackle first and foremost the training of the intellect, the education of emotions and moral personality, and the acquisition of professional skills.
Mitotic instability in resynthesized and natural polyploids of the genus Arabidopsis (Brassicaceae)
Authors: Wright Kirsten M. , Pires J. Chris , Madlung Andreas
Published: August 2009

Allopolyploids contain complete sets of chromosomes from two or more different progenitor species. Because allopolyploid hybridization can lead to speciation, allopolyploidy is an important mechanism in evolution. Meiotic instability in early‐generation allopolyploids contributes to high lethality, but less is known about mitotic fidelity in allopolyploids. We compared mitotic stability in resynthesized Arabidopsis suecica‐like neoallopolyploids with that in 13 natural lines of A. suecica (2n = 4x = 26). We used fluorescent in situ hybridization to distinguish the chromosomal contribution of each progenitor, A. thaliana (2n = 2x =10) and A. arenosa (2n = 4x = 32). Surprisingly, cells of the paternal parent A. arenosa had substantial aneuploidy, while cells of the maternal parent A. thaliana were more stable. Both natural and resynthesized allopolyploids had low to intermediate levels of aneuploidy. Our data suggest that polyploidy in Arabidopsis is correlated with aneuploidy, but varies in frequency by species. The chromosomal composition in aneuploid cells within individuals was variable, suggesting somatic mosaicisms of cell lineages, rather than the formation of distinct, stable cytotypes. Our results suggest that somatic aneuploidy can be tolerated in Arabidopsis polyploids, but there is no evidence that this type of aneuploidy leads to stable novel cytotypes.
The filifolium1 mutation perturbs shoot architecture in Zea mays (Poaceae)
Authors: Mellor E. Anne , Langdale Jane A.
Published: August 2009

Plant architecture is elaborated through the activity of shoot apical meristems (SAMs), which produce repeating units known as phytomers, that are comprised of leaf, node, internode, and axillary bud. Insight into how SAMs function and how individual phytomer components are related to each other can been obtained through characterization of recessive mutants with perturbed shoot development. In this study, we characterized a new mutant to further understand mechanisms underlying shoot development in maize. The filifolium1‐0 (ffm1‐0) mutants develop narrow leaves on dwarfed shoots. Shoot growth often terminates at the seedling stage from depletion of the SAM, but if plants survive to maturity they are invariably bushy. KN1‐like homeobox (KNOX) proteins are inappropriately regulated in mutant apices, adaxial identity is not specified in mutant leaves, and axillary meristems develop precociously. We propose that FFM1 acts to demarcate zones within the SAM so that appropriate fates can be conferred on cells within those zones by other factors. On the basis of the mutant phenotype, we also speculate about different relationships between phytomer components in maize and Arabidopsis.
Molecular evidence of reticulate evolution in the subgenus Plantago (Plantaginaceae)
Authors: Ishikawa Naoko , Yokoyama Jun , Tsukaya Hirokazu
Published: August 2009

Polyploidization is a frequent evolutionary event in plants that has a large influence on speciation and evolution of the genome. Molecular phylogenetic analyses of the taxonomically complex subgenus Plantago were conducted to elucidate intrasubgeneric phylogenetic relationships. A nuclear‐encoding single‐copy gene, SUC1 (1.0–1.8 kb), was sequenced in 24 taxa representing all five sections of the subgenus Plantago and two taxa from subgenus Coronopus as the outgroup. Fifteen known polyploids and one putative polyploid were sampled to examine polyploid origins and occurrence of reticulate evolution by cloning and sequence analysis of SUC1. Phylogenetic relationships were estimated using maximum parsimony, neighbor‐joining, and Bayesian analyses. For the first time, our analysis provides a highly resolved phylogenetic tree. Subgenus Plantago formed a well‐supported monophyletic clade. In contrast, alleles from polyploid species were scattered across the whole SUC1 phylogenetic tree, and some independent allopolyploids originated from hybridization between distant lineages. One reason for this taxonomic complexity can be attributed to reticulate evolution within the subgenus Plantago. Our results also suggest the possibility of two independent long‐distance dispersals between the northern and southern hemispheres.
Construction costs, payback times, and the leaf economics of carnivorous plants
Authors: Karagatzides Jim D. , Ellison Aaron M.
Published: August 2009

Understanding how different plant species and functional types “invest” carbon and nutrients is a major goal of plant ecologists. Two measures of such investments are “construction costs” (carbon needed to produce each gram of tissue) and associated “payback times” for photosynthesis to recover construction costs. These measurements integrate among traits used to assess leaf‐trait scaling relationships. Carnivorous plants are model systems for examining mechanisms of leaf‐trait coordination, but no studies have measured simultaneously construction costs of carnivorous traps and their photosynthetic rates to determine payback times of traps. We measured mass‐based construction costs (CCmass) and photosynthesis (Amass) for traps, leaves, roots, and rhizomes of 15 carnivorous plant species grown under greenhouse conditions. There were highly significant differences among species in CCmass for each structure. Mean CCmass of carnivorous traps (1.14 ± 0.24 g glucose/g dry mass) was significantly lower than CCmass of leaves of 267 noncarnivorous plant species (1.47 ± 0.17), but all carnivorous plants examined had very low Amass and thus, long payback times (495–1551 h). Our results provide the first clear estimates of the marginal benefits of botanical carnivory and place carnivorous plants at the “slow and tough” end of the universal spectrum of leaf traits.
Sensorineural Hearing Loss in Patients with Mixed Connective Tissue Disease: Immunological Markers and Cytokine Levels
Authors: HAJAS AGOTA , SZODORAY PETER , BARATH SANDOR , SIPKA SANDOR , REZES SZILARD , ZEHER MARGIT , SZIKLAI ISTVAN , SZEGEDI GYULA , BODOLAY EDIT
Published: August 2009

Objective.

To investigate the frequency of sensorineural hearing loss (SNHL) in patients with mixed connective tissue disease (MCTD).

Methods.

The study population consisted of 71 patients with MCTD (69 female; 2 male), with a mean age of 57.1 ± 7.9 years and a mean disease duration of 14.5 ± 8.0 years. All patients underwent audiological evaluation that included pure tone and speech audiometry. In addition, the systemic manifestations of the disease and drug therapy were recorded. All patients were tested for presence of autoantibodies. Fifty-one age-matched healthy subjects served as controls.

Results.

SNHL was found in 33 (46.4%) of the 71 patients with MCTD. There was no correlation between SNHL and age and disease duration. An association was found between Raynaud’s phenomenon (p < 0.03), secondary antiphospholipid syndrome (APS) (p < 0.05), and SNHL. MCTD patients with SNHL had higher serum levels of anti-U1RNP (p < 0.05), antiendothelial cell antibodies (p < 0.001), and IgG type anticardiolipin antibodies (p < 0.0001) than patients without SNHL. Serum levels of interferon-γ and tumor necrosis factor-α were increased in MCTD patients with SNHL compared to patients without SNHL. The absolute number of natural (CD4+CD25highFoxP+) regulatory T cells (Treg) was lower compared to patients without SNHL.

Conclusion.

In MCTD, SNHL is a specific organ manifestation and appears frequently. We have found that pathogenic autoantibodies, decreased levels of regulatory T cells, and overexpression of proinflammatory cytokines may play a role in the pathogenesis of immune mediated inner ear disorders in MCTD.
Voices of Experience: Reflections of Nurse Educators
Authors: Dattilo JoEllen , Brewer M. Kathleen , Streit Linda
Published: August 2009

Background:

Recent data reported by the American Association of Colleges of Nursing suggest that nursing education is experiencing a continued increase in applicants. However, because of a faculty shortage, many qualified students are denied enrollment. Strategies that would encourage individuals to consider a career in nursing education would somewhat alleviate applicant restrictions.

Methods:

A descriptive phenomenological study was conducted exploring experienced baccalaureate educators' perspectives. Questions were posed about their role experiences. Analysis was conducted with van Manen's procedural steps for examination.

Results:

Emergent themes were identified. These themes, reflective of the educators' experience, offer insight and guidance to novice educators striving for success.

Conclusion:

To alleviate the nursing shortage, increased efforts should be directed toward encouraging qualified individuals to pursue a career as a nurse educator and mentoring those who are novices. The wisdom gleaned from experienced nurse educators may help achieve these goals.

J Contin Educ Nurs
2009;40(8):367–370.
Effect of an Acute Care Geriatric Educational Program on Fall Rates and Nurse Work Satisfaction
Authors: Lange Jean , Wallace Meredith , Gerard Sally , Lovanio Kathleen , Fausty Nina , Rychlewicz Susie
Published: August 2009

Background:

A successful faculty-mentored geriatric nurse education program resulted from an acute care-academic partnership.

Purpose:

This study educated nurses in best geriatric nursing practices to enhance effective management of common geriatric problems as well as to improve nurse work satisfaction.

Methods:

Forty-seven nurses completed an online course in geriatric best practices.

Results:

Pre- and posttest comparisons showed a declining trend in the incidence of falls and improved satisfaction with autonomy, task requirements, and nurse-to-nurse interaction among participants. Units in which two or more participants achieved national certification had significantly lower fall rates 3 months after program completion. Participants who attained national certification also had significantly improved satisfaction with professional status.

Conclusion:

This partnership represents a replicable model that facilitated the advancement of evidence-based practice and enhanced nurses' knowledge of best practices in caring for older adults. Early evidence shows that these successes may improve patient outcomes.

J Contin Educ Nurs
2009;40(8):371–379.
Treating Ventricular Tachycardia
Authors: McDonough Marjorie
Published: August 2009

Ventricular tachycardia (VT) is a life–threatening cardiac dysrhythmia requiring emergency medical care. VT is readily recognized on the electrocardiogram. VT is usually caused by ischemic or structural heart disease, electrolyte disturbances, or the effects of drug therapy. Emergency treatment of VT follows the Advanced Cardiac Life Support (ACLS) algorithms for pulseless VT and stable and unstable VT with a pulse.

J Contin Educ Nurs
2009;40(8):342–343.
Situations in Which Questions Are Valuable
Authors: Kowalski Karren
Published: August 2009

This column discusses several situations in which questions are valuable.

J Contin Educ Nurs
2009;40(8):344–345.
Why Does the Randomized Clinical Trial Methodology So Often Mislead Clinical Decision Making?: Focus on Moderators and Mediators of Treatment
Authors: Kraemer Helena Chmura , Gibbons Robert D.
Published: August 2009

CME Educational Objectives

1.

Review moderators and mediators of treatment efficacy and effectiveness.

2.

Identify limitations of randomized clinical trials for generalizing to the population.

3.

Identify moderators and mediators for treatment-related effects.
Use of Isotretinoin for Acne Vulgaris
Authors: Merritt Bradley , Burkhart Craig N. , Morrell Dean S.
Published: August 2009

CME Educational Objectives

1.

Distinguish the mechanism of action of isotretinoin and its indications for use in the treatment of acne vulgaris.

2.

Analyze the side-effect profile of isotretinoin and the necessity for routine follow-up during therapy.

3.

Outline the evolution of current regulatory mechanisms in place for pregnancy prevention in patients taking isotretinoin.
Pediatric Infestations
Authors: Diamantis Stephanie A. , Morrell Dean S. , Burkhart Craig N.
Published: August 2009

CME Educational Objectives

1.

Define common treatment options for head lice, body lice, crab lice, and scabies.

2.

Outline the situations in which each of the above infestations may arise as well as how each infestation presents clinically.

3.

Demonstrate how to eradicate infestations using a combination of environmental decontamination, topical, and/or oral therapy.
Effect of Individualized Music on Agitation in Individuals with Dementia Who Live at Home
Authors: Park Heeok , Pringle Specht Janet K.
Published: August 2009

This pilot study investigated the effect of individualized music on agitation in individuals with dementia who live at home. Fifteen individuals listened to their preferred music for 30 minutes prior to peak agitation time, two times per week for 2 weeks, followed by no music intervention for 2 weeks. The process was repeated once. The findings showed that mean agitation levels were significantly lower while listening to music than before listening to the music. The findings of this pilot study suggest the importance of music intervention for individuals with dementia who live at home.
Total Hip Arthroplasty for Alcoholic Osteonecrosis of the Femoral Head
Authors: Yuan Brandon , Taunton Michael J. , Trousdale Robert T.
Published: August 2009

Osteonecrosis of the femoral head in the setting of alcohol abuse is a potential important cause of symptomatic hip disease in young patients. All cases of uncemented primary total hip arthroplasty (THA) with a primary operative diagnosis of osteonecrosis of the femoral head secondary to alcohol abuse treated at our institution from January 1990 to February 2002 were identified. Twenty-three patients with 28 hips were identified; all patients had advanced disease (subchondral collapse) that was unresponsive to conservative treatment modalities. Within 5 years of index THA, 2 patients were lost to follow-up, and 2 patients died from causes unrelated to their surgery. The remaining 19 patients underwent 24 THAs. Unilateral THA was performed in 14 patients, and bilateral THA was performed in 5 patients. Seventeen men and 2 women with an average age of 41.8 years (range, 30–59 years) at the time of THA were included in the study. The average duration to clinical follow-up was 7.6 years.

There was significant improvement in hip pain and hip function scores. Seven THAs were revised at a mean 6.7 years following index THA. Five- and 10-year implant survivorship free of revision was 96% and 64%, respectively (Kaplan-Meier Survivorship Analysis). The continued use of alcohol was associated with a slightly increased risk of failure (61% implant survivorship at 10 years in those with continued alcohol intake vs 75% 10-year survivorship in those without).
Quantification of Active ROM After Arthroscopic Bankart Repair With Rotator Interval Closure
Authors: Randelli Pietro , Arrigoni Paolo , Polli Luca , Cabitza Paolo , Denti Matteo
Published: August 2009

Several series report patients homogeneously treated using arthroscopic Bankart repair exclusively, or in some cases arthroscopic Bankart repair with rotator interval closure. Current international literature has few reports on arthroscopic Bankart repair with rotator interval closure procedures undertaken on a homogeneous series of patients. The purpose of this study was to evaluate the residual active range of motion (ROM) and clinical outcome in this patient population.

Fourteen patients affected by recurrent anterior instability were consecutively treated. Rowe, Walch-Duplay, and UCLA scores, as well as differences in active ROM of both shoulders (treated and contralateral), were recorded. A significant reduction in active external rotation was noted along the side of the arm (
P
<.001) and at 90° of abduction (
P
=.007). The average reduction was 12.14° and 7.21°, respectively, which represents 17.8% and 8% of the arc of motion of the opposite side in external rotation. No significant differences were found for flexion, abduction, and internal rotation. According to Walch-Duplay and Rowe scores, 71.4% and 85.7% of patients had excellent or good results.

Arthroscopic Bankart repair with rotator interval closure results in a reduction of external rotation and provides satisfactory stability results.
Adolescent Idiopathic Scoliosis and the Single-nucleotide Polymorphism of the Growth Hormone Receptor and IGF-1 Genes
Authors: Yang Yong , Wu Zhihong , Zhao Taimao , Wang Hai , Zhao Dong , Zhang Jianguo , Wang Yipeng , Ding Yaozhong , Qiu Guixing
Published: August 2009

The etiology of adolescent idiopathic scoliosis is undetermined despite years of research. A number of hypotheses have been postulated to explain its development, including growth abnormalities. The irregular expression of growth hormone and insulin-like growth factor-1 (IGF-1) may disturb hormone metabolism, result in a gross asymmetry, and promote the progress of adolescent idiopathic scoliosis. Initial association studies in complex diseases have demonstrated the power of candidate gene association. Prior to our study, 1 study in this field had a negative result. A replicable study is vital for reliability.

To determine the relationship of growth hormone receptor and IGF-1 genes with adolescent idiopathic scoliosis, a population-based association study was performed. Single nucleotide polymorphisms with potential function were selected from candidate genes and a distribution analysis was performed. A conclusion was made confirming the insufficiency of an association between adolescent idiopathic scoliosis and the single-nucleotide polymorphism of the growth hormone receptor and IGF-1 genes in Han Chinese.
Hip Resurfacing Using the Anterolateral Watson-Jones Approach in the Supine Position
Authors: Sandri Andrea , Regis Dario , Magnan Bruno , Luminari Elisa , Bartolozzi Pietro
Published: August 2009

Hip resurfacing is commonly performed using a posterior approach, although some authors have advocated damage to the vascular supply due to posterolateral capsulectomy as one of the possible causes of femoral neck fracture. The need to preserve blood supply has led to the use of an alternative surgical vascular-sparing procedure.

This article describes early clinical and radiological outcomes of hip resurfacing via an anterolateral Watson-Jones approach in the supine position. Twenty-eight hips in 26 patients with degenerative hip disease were evaluated retrospectively with a mean follow-up of 28 months (range, 12–61 months). The mean age at surgery was 58 years (range, 26–72 years). The average Harris Hip Score increased from 60 points preoperatively (range, 30–69 points) to 96 points at latest follow-up (range, 80–100 points). Complications included femoral neurapraxia and deep vein thrombosis in 1 patient, which both resolved. One hip required revision due to acetabular cup loosening 15 months postoperatively. No progressive radiolucencies, avascular necroses, or dislocations were observed. Heterotopic ossifications were detected in 3 hips. The absence of early femoral failures in our series may be related to careful patient selection and a proper surgical technique.

The anterolateral Watson-Jones approach in the supine position provides optimal exposure of the acetabulum and proximal femur, but a wide soft tissue release is always necessary. We preserve the posterolateral neck capsule to improve the chances of maintaining the blood supply to the femoral neck, even if no differences in clinical outcomes and complications are evident between the anterolateral and posterolateral approaches.
Closed Manipulation After Total Knee Arthroplasty: Outcome and Affecting Variables
Authors: Cates Hal E. , Schmidt John M.
Published: August 2009

Clinic records of 37 manipulations in 767 consecutive primary total knee arthroplasties (TKAs) were analyzed to identify any predictors of manipulation outcome. Factors studied were sex, age, body mass index, tibiofemoral alignment, surgical history, smoking history, range of motion before TKA and manipulation, intraoperative lateral release, implant design and manufacturer, and manipulation interval. Measures of outcome were gains in extension and flexion from manipulation and range of motion at 1-year follow-up.

Patients gained an average of 4° of extension and 22° of flexion after manipulation, resulting in average extension of 1° and average flexion of 105° at 1-year follow-up. Restored flexion was similar to that measured preoperatively. Manipulation was most effective in patients manipulated within 8 weeks, with full extension and <90° of flexion prior to manipulation, and those receiving a lateral release during arthroplasty.

Potential for benefit from manipulation appears to be reduced in patients with large flexion contractures but with adequate flexion. Patients with flexion contractures regained only approximately 80% of the extension they lacked before manipulation. Only 12 of 18 patients (67%) with flexion contractures regained full extension. Manipulation is successful at regaining flexion and restoring function for patients of all levels of flexion deficiency. At least 90° of flexion was regained in 20 of 23 patients (87%) who lacked it at manipulation.
Compound Osteosynthesis for Osteolyses and Pathological Fractures of the Proximal Femur
Authors: Kinkel Stefan , Stecher Jens , Gotterbarm Tobias , Bruckner Thomas , Holz Ulrich
Published: August 2009

Due to improved oncological therapeutic procedures with longer survival times, the stabilization of osteolyses and pathological fractures is gaining importance. The proximal femur is often affected by metastases. As femoral stability can be compromised by such bone lesions, stabilization as a palliative measure is indicated to restore function and relieve pain. Besides intramedullary osteosynthesis and endoprosthetic reconstruction, compound osteosynthesis is an alternative method for stabilization of the proximal femur.

Between 1994 and 2004, 34 compound osteosyntheses were performed for a tumor-caused lesion compromising mechanical stability of the proximal femur. Of those cases, 22 double-plate compound osteosyntheses and 12 single-plate compound osteosyntheses were performed for 9 pathological fractures and 25 osteolyses. Both techniques provided good primary stability. The average survival time after compound osteosynthesis was 14.2 months (range, 0–72 months). Double-plate compound osteosyntheses showed a lower mechanical failure rate than single-plate compound osteosyntheses (14.3% vs 33.3%) and a higher survival probability after 5 years (76.4% vs 38.6%). No surgical revision was required due to perioperative complications in any case.

We conclude that reliable stabilization of extensive osteolyses and pathological fractures of the proximal femur can be achieved with compound osteosynthesis. Our data suggest that double-plate compound osteosyntheses is a more favorable technique than single-plate compound osteosyntheses based on a lower rate of mechanical failure and higher survival probability.
Intra-articular Fragments in Acetabular Fracture–Dislocation
Authors: Pascarella Raffaele , Maresca Alessandra , Reggiani Leonardo Marchesini , Boriani Stefano
Published: August 2009

Acetabular fractures are often associated with dislocation of the femoral head. When the dislocation is reduced, ⩾1 fragments may remain inside the joint, especially in posterior dislocation. In this kind of dislocation, the fracture of the posterior wall of the acetabulum may be comminuted. The fragments attached to the joint capsule or free may remain between the femoral head and the acetabulum. During reduction, these fragments are dragged inside the joint. The presence of the fragments in the hip joint may prevent complete reduction of the dislocation. Surgery should be performed early to reduce the risk of aseptic necrosis of the femoral head. Sometimes the fragments derive from a fracture of the femoral head without involving the posterior wall. Fragments are difficult to detect by conventional radiography; therefore, computed tomography scans are always indicated in fracture-dislocations pre- and postoperatively to check that all intra-articular fragments have been removed and the fracture has been reduced. We observed 373 cases of acetabular fracture between January 1, 1997, and December 31, 2007. One hundred twenty-seven cases presented a dislocation: 5 anterior, 13 central, and 109 posterior. In 45 cases, after reduction of the dislocation, 2 anterior and 43 posterior intra-articular fragments were observed. Removing a loose body inside the joint is always necessary because movement causes damage of the cartilage and therefore an early arthritis. The strategy to remove and the approach differs according to the kind of dislocation observed.
Massive Wear and Metallosis of an Acetabular Cup System Presenting as Pseudodislocation
Authors: Sathappan Sathappan S. , Wee James , Ginat Daniel , Meere Patrick
Published: August 2009

In primary and revision total hip arthroplasty (THA), the acetabular component continues to pose greater challenges than the femoral component. Numerous factors lead to polyethylene wear, which subsequently affects primary THA survival. Progressive polyethylene wear is associated with the occurrence of osteolysis, especially overlying the acetabulum, which can lead to component loosening and subsequent revision.

Polyethylene failure usually manifests as massive liner wear up to the metal shell, fracture of the liner, or a combination of both. There is often a small amount of metallosis associated with this pathology. To our knowledge, massive wear of the acetabular metal shell, however, has not previously been reported in the literature.

This article describes a case of massive wear through a polyethylene liner and the acetabular metal shell of an Acetabular Cup System (DePuy, Leeds, United Kingdom) that presented as an apparent dislocation 13 years following the index operation. The pseudodislocation was intraoperatively found to be penetration of the femoral head through the acetabular shell. The acetabular component was consequently revised to a larger cementless cup. The femoral component was mechanically stable and required no revision.

Patients with long-standing Acetabular Cup System THA may experience acetabular metal shell wear-through phenomena presenting as a pseudodislocation, and this possibility should be taken into consideration during preoperative planning.
Symptomatic Fat Necrosis and Lipoatrophy of the Posterior Pelvis Following Trauma
Authors: Crawford Eileen A. , King Joseph J. , Fox Edward J. , Ogilvie Christian M.
Published: August 2009

Posttraumatic fat necrosis and lipoatrophy can occur in the subcutaneous fat following falls, blunt injury, surgery, and minor procedures or injections. While these processes have no inherent serious medical consequences, they occasionally require treatment due to severe or concerning symptoms.

Three patients (all women; average age, 47 years) who sustained blunt trauma to the pelvis and were diagnosed with posttraumatic fat necrosis or lipoatrophy were retrospectively identified from our orthopedic oncology records. All patients recalled blunt trauma to the posterior pelvis just prior to symptom onset; 2 patients fell down stairs and 1 fell from a bed. Chief symptoms were a painful mass, a painless mass, and chronic pain in the injured area. Magnetic resonance imaging (MRI) revealed atrophy of the subcutaneous fat in all cases and a small mass in 1 patient. A bright linear signal was seen on T2-weighted, fat-saturated images in 2 cases, likely representing scar tissue. One patient with chronic pain underwent surgery to provide better soft tissue coverage in the area of atrophic fat. The other 2 patients did not undergo surgical treatment: 1 was treated at a pain center for reflex sympathetic dystropy–type pain, and 1 remained pain free.

Blunt trauma with subsequent fat atrophy and necrosis manifests as a mass, a subcutaneous fat defect, and even as chronic pain. Characteristic MRI findings are often sufficient for diagnosis, but any indeterminate masses should be further evaluated to rule out aggressive or malignant neoplasms. Chronic unrelenting pain despite treatment may be related to posttraumatic reflex sympathetic dystropy–like symptoms.
Pseudoaneurysm of the Popliteal Artery Complicating Medial Opening Wedge High Tibial Osteotomy
Authors: Shenoy Pritom Mohan , Oh Hyung Keun , Choi Jun Young , Yoo Si Hoon , Han Seung Beom , Yoon Jung Ro , Koo Ja Sung , Nha Kyung Wook
Published: August 2009

The popliteal artery is vulnerable to injury during surgeries performed around the knee joint. Pseudoaneurysm of the popliteal artery following a high tibial osteotomy is rare. Few case reports describe the development of this complication after a lateral closing wedge high tibial osteotomy.

Our patient underwent an uneventful medial opening wedge high tibial osteotomy and autogenous bone grafting fixed with dual plating for medial osteoarthritis of the knee. The procedure was performed under tourniquet control, which was released only once after the wound closure. Postoperatively, the dressing was soaked, and a large volume of hemorrhagic collection was present in the suction drain. The patient experienced decreased sensation over the sole, which was successfully treated conservatively with medication. Other clinical parameters like motor function and distal pulses were normal. The patient was discharged after 2 weeks. Two days later, the patient presented with pain and numbness over the entire lower limb and a pulsatile swelling in the popliteal fossa. A femoral angiogram revealed a pseudoaneurysm arising from the popliteal artery just below the osteotomy site. Open vascular surgery with resection of the pseudoaneurysm and end-to-end anastomosis using contralateral saphenous vein interposition graft was performed. During the vascular surgery, a pinhead-sized tear was clearly identified on the anterior wall of the popliteal artery, which may have occurred while using the oscillating saw during opening wedge high tibial osteotomy. Careful placement of retractors around the osteotomy site during sawing and flexing the knee to displace the popliteal artery away are recommended to prevent this complication. To our knowledge, this is the first report of a popliteal artery pseudoaneurysm occurring after a medial opening wedge high tibial osteotomy.
No Superiority of Cemented Metal-on-Metal vs Metal-on-Polyethylene THA at 5-Year Follow-up
Authors: Zijlstra Wierd P. , Cheung John , Sietsma Maurits S. , van Raay Jos J.A.M. , Deutman Robert
Published: August 2009

A randomized controlled trial was performed to compare the cemented Stanmore metal-on-metal (Biomet, Warsaw, Indiana) total hip arthroplasty (THA; 102 hips) to the cemented Stanmore metal-on-polyethylene (Biomet) THA (98 hips). The primary outcome was clinical performance. Radiological performance, serum cobalt analysis, and prosthetic survival were secondary outcome measures. At a mean follow-up of 5.6 years, 5 patients were lost to follow-up, 18 died, and 4 were revised (3 metal-on-metal, 1 metal-on-polyethylene). Harris Hip Scores improved from 48 to 90 in the metal-on-metal patients (
P
<.001) and from 46 to 87 in the metal-on-polyethylene patients (
P
<.001). Oxford Hip Scores changed from 40 to 19 in the metal-on-metal group (
P
<.001) and from 40 to 18 in the metal-on-polyethylene group (
P
<.001). For both Harris and Oxford Hip Scores, there was no significant difference between the 2 groups. Five-year survival with revision for any reason was 97% (95% CI 93%–100%) in the metal-on-metal group and 99% (95% CI 97%–100%) in the metal-on-polyethylene group. All revisions were indicated for aseptic loosening (metal-on-metal: 3 cup revisions; metal-on-polyethylene: 1 total revision). At 5-year follow-up, cemented metal-on-metal THA showed no clinical superiority over metal-on-polyethylene THA.
Hip Stability in Primary Total Hip Arthroplasty Using an Anatomically Sized Femoral Head
Authors: Smit Milton J.
Published: August 2009

Dislocation after total hip arthroplasty (THA) remains a problem despite many advances in technique and prosthetic design over the 5 decades since the introduction of total joint replacement. This article reports the short-term results (1-year follow-up) of THA in 235 patients who received a large, anatomically sized femoral head (BFH Technology; Wright Medical Technology, Inc, Arlington, Tennessee) with modular necks for hip stability. The prosthesis allows a 6-mm differential between the size of the acetabular component and femoral head size. Patients also received a Conserve mono-block acetabular cup and a Profemur femoral stem (Wright Medical Technology, Inc) implanted without cement. Postoperative clinical evaluations included measurements of Harris Hip Scores and range of motion, along with assessments of pain and function and radiological evaluations. There were no complications (deep venous thrombosis, pulmonary embolism, infection, reoperations) and no dislocations. All clinical evaluations showed statistically significant improvement (
P
<.001) at 1-year follow-up, and radiographic evaluation has shown no evidence of osteolysis or implant loosening. This study indicates that using a large femoral head may reduce the incidence of dislocation and may enable early return to activities postoperatively. Future evaluations of this patient group will elicit longer-term follow-up data.

See full article online for commentary by Dr Roberto Binazzi.
Knowledge of Levels of Evidence Criteria in Orthopedic Residents
Authors: Wolf Jennifer Moriatis , Athwal George S. , Hoang Bang H. , Mehta Samir , Williams Allison E. , Owens Brett D.
Published: August 2009

The purpose of the levels of evidence system is to provide a framework for critical evaluation of orthopedic literature. This rating system is based on guidelines from the Oxford Centre for Evidence-Based Medicine and is currently in use in several orthopedic surgery journals. The purpose of this study was to investigate resident knowledge of the levels of evidence criteria used in classification of clinical articles. Thirty-eight residents from 5 orthopedic surgery training programs, from year-in-training 3 to 5, determined the levels of evidence rating of 10 blinded articles representing all levels of evidence types in the orthopedic literature. Residents were then provided with a levels of evidence information sheet and asked to re-rate each article. The mean percentage correct for the initial rating was 29.5% and for the posteducation rating was 41.3%, with significant improvement after levels of evidence education (
P
<.001). The year-intraining–3 group had the highest mean percentage correct for the average of both tests (46.7%) compared to year-in-training–4 (34.2%) and year-in-training–5 (25.4%). Residents were significantly more accurate in scoring therapeutic (41.1% correct pre–levels of evidence; 51.6% post–levels of evidence) than prognostic studies (6.6% correct pre–levels of evidence; 28.9% post–levels of evidence) (
P
<.001). Residents graded the level of evidence correctly in fewer than half the papers. These findings indicate that resident knowledge of levels of evidence criteria is limited and suggest a need for more education in this area.
Accuracy of Lag Screw Placement for the Dynamic Hip Screw and the Cephalomedullary Nail
Authors: Lindsey Ronald W. , Ahmed Sonya , Overturf Steven , Tan Alai , Gugala Zbigniew
Published: August 2009

The outcome of peritrochanteric fracture fixation is dependent on lag screw placement in the femoral head. The dynamic hip screw technique permits initial, independent lag screw placement, while the cephalomedullary nail dictates its positioning. The objective of this study was to compare the accuracy of lag screw placement for both implant types. A retrospective review of 200 consecutive patients with peritrochanteric fractures stabilized with a dynamic hip screw or cephalomedullary nail was performed. Postoperative biplanar radiographs were used to determine the lag screw tip-apex distance and femoral head zone placement. The study inclusion criteria were met by 137 patients (66 dynamic hip screw; 71 cephalomedullary nail). The patients included 56% women and 44% men with an average age of 73 years. The tip-apex distance and femoral head zone placement demonstrated no statistically significant difference between the 2 implant groups. The lag screw of a cephalomedullary nail was 3.25 times more likely placed in the antero-center zone compared to the dynamic hip screw, and this was statistically significant when compared to other zones. There was a trend toward a more favorable tip-apex distance in women for both implants. The accurate placement of the lag screw can be routinely achieved for both dynamic hip screw and cephalomedullary nail implants, and therefore should not a factor in the selection of these implants for adequate peritrochanteric fracture stabilization. These results represent the immediate postoperative setting, and a follow-up is warranted to establish their long-term clinical relevance.
Melorheostosis: Clinicopathological Features, Diagnosis, and Management
Authors: Jain Vijay Kumar , Arya Rajendra Kumar , Bharadwaj Minakshi , Kumar Satish
Published: August 2009

Educational Objectives

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

1.

Describe the natural history, clinical features, and differential diagnosis of melorheostosis.

2.

Recognize the histopathology characteristics of melorheostosis.

3.

Identify the imaging characteristics of melorheostosis on various imaging modalities.

4.

Analyze all available treatment options and prognoses for melorheostosis of bones.
Diabetic Myonecrosis of the Posterior Compartments of Both Thighs
Authors: Mamoun Ihsan , Sundaram Murali
Published: August 2009

The case:

A 25-year-old woman with poorly controlled type 1 diabetes presented with cough, pneumonia, and sepsis, which progressed to adult respiratory distress syndrome requiring ventilation. Two weeks after being admitted to the intensive care unit, she reported bilateral thigh pain. Creatine kinase levels were elevated.