bluuebunny/crossref_metadata_2025 huggingface dataset:
Articular Surface Replacement of the hip: a prospective single-surgeon series
Authors: Jameson S. S. , Langton D. J. , Nargol A. V. F.
Published: January 2010

We present the early clinical and radiological results of Articular Surface Replacement (ASR) resurfacings in 214 hips (192 patients) with a mean follow-up of 43 months (30 to 57). The mean age of the patients was 56 years (28 to 74) and 85 hips (40%) were in 78 women.

The mean Harris hip score improved from 52 (11 to 81) to 95 (27 to 100) at two years and the mean University of California, Los Angeles activity score from 3.9 (1 to 10) to 7.4 (2 to 10) in the same period. Narrowing of the neck (to a maximum of 9%) was noted in 124 of 209 hips (60%). There were 12 revisions (5.6%) involving four (1.9%) early fractures of the femoral neck and two (0.9%) episodes of collapse of the femoral head secondary to avascular necrosis. Six patients (2.8%) had failure related to metal wear debris. The overall survival for our series was 93% (95% confidence interval 80 to 98) and 89% (95% confidence interval 82 to 96) for hips with acetabular components smaller than 56 mm in diameter.

The ASR implant has a lower diametrical clearance and a subhemispherical acetabular component when compared with other more frequently implanted metal-on-metal hip resurfacings. These changes may contribute to the higher failure rate than in other series, compared with other designs. Given our poor results with the small components we are no longer implanting the smaller size.
Early failure of metal-on-metal bearings in hip resurfacing and large-diameter total hip replacement
Authors: Langton D. J. , Jameson S. S. , Joyce T. J. , Hallab N. J. , Natu S. , Nargol A. V. F.
Published: January 2010

Early failure associated with adverse reactions to metal debris is an emerging problem after hip resurfacing but the exact mechanism is unclear. We analysed our entire series of 660 metal-on-metal resurfacings (Articular Surface Replacement (ASR) and Birmingham Hip Resurfacing (BHR)) and large-bearing ASR total hip replacements, to establish associations with metal debris-related failures. Clinical and radiological outcomes, metal ion levels, explant studies and lymphocyte transformation tests were performed. A total of 17 patients (3.4%) were identified (all ASR bearings) with adverse reactions to metal debris, for which revision was required. This group had significantly smaller components, significantly higher acetabular component anteversion, and significantly higher whole concentrations of blood and joint chromium and cobalt ions than asymptomatic patients did (all p < 0.001). Post-revision lymphocyte transformation tests on this group showed no reactivity to chromium or cobalt ions. Explants from these revisions had greater surface wear than retrievals for uncomplicated fractures. The absence of adverse reactions to metal debris in patients with well-positioned implants usually implies high component wear.

Surgeons must consider implant design, expected component size and acetabular component positioning in order to reduce early failures when performing large-bearing metal-on-metal hip resurfacing and replacement.
Ruptured aneurysm of the common iliac artery as a cause of unilateral hip pain
Authors: Siau K. , Singh A. , Awon K. , Kelly A. , Chester J. F.
Published: January 2010

Rupture of an aneurysm of the common iliac artery is a rare cause of pain in the hip. We describe an elderly hypertensive patient with an aneurysmal rupture of the left common iliac artery who presented with unilateral hip pain masquerading as septic arthritis.
Management of fractures of the pedicle after instrumentation with transpedicular screws
Authors: Lattig F. , Fekete T. F. , Jeszenszky D.
Published: January 2010

Fracture of a pedicle is a rare complication of spinal instrumentation using pedicular screws, but it can lead to instability and pain and may necessitate extension of the fusion. Osteosynthesis of the fractured pedicle by cerclage-wire fixation and augmentation of the screw fixation by vertebroplasty or temporary elongation of the fixation, allows stabilisation without sacrifice of the adjacent healthy segment. We describe three patients who developed a fracture of the pedicle in the most caudal instrumented vertebra early after lumbar spinal fusion.

During revision surgery the pedicles were reduced and secured by a soft cerclage wire bilaterally. Fusion was obtained at the site of the primary instrumentation and healing of the pedicles was achieved. Cerclage wiring of the fractured pedicle seems to be safe and avoids permanent extension of the fusion without the sacrifice of an otherwise healthy segment.
The use of a biodegradable mesh plate to augment grafting of an acetabular defect
Authors: Väänänen P. , Pajamäki I. , Paakkala A. , Nurmi J. T. , Pajamäki J.
Published: January 2010

We used a biodegradable mesh to convert an acetabular defect into a contained defect in six patients at total hip replacement. Their mean age was 61 years (46 to 69). The mean follow-up was 32 months (19 to 50). Before clinical use, the strength retention and hydrolytic in vitro degradation properties of the implants were studied in the laboratory over a two-year period. A successful clinical outcome was determined by the radiological findings and the Harris hip score.

All the patients had a satisfactory outcome and no mechanical failures or other complications were observed. No protrusion of any of the impacted grafts was observed beyond the mesh. According to our preliminary laboratory and clinical results the biodegradable mesh is suitable for augmenting uncontained acetabular defects in which the primary stability of the implanted acetabular component is provided by the host bone. In the case of defects of the acetabular floor this new application provides a safe method of preventing graft material from protruding excessively into the pelvis and the mesh seems to tolerate bone-impaction grafting in selected patients with primary and revision total hip replacement.
What is the role of lateral retinacular release?
Authors: Clifton R. , Ng C. Y. , Nutton R. W.
Published: January 2010

We have reviewed the literature to establish the role of lateral retinacular release in the management of disorders of the extensor apparatus of the knee. The scientific evidence for intervention is explored and reports on outcome are discussed.
The Avon patellofemoral joint replacement
Authors: Odumenya M. , Costa M. L. , Parsons N. , Achten J. , Dhillon M. , Krikler S. J.
Published: January 2010

Between May 1998 and May 2007 we carried out 50 Avon patellofemoral joint replacements in 32 patients with isolated patellofemoral osteoarthritis.

There were no revisions in the first five years, giving a cumulative survival of 100% for those with a minimum follow-up of five years. The mean follow-up was 5.3 years (2.1 to 10.2). The median Oxford knee score was 30.5 (interquartile range 22.25 to 42.25). In patients with bilateral replacements the median Euroqol General health score was 50 which was significantly lower than that of 75 in those with a unilateral replacement (p = 0.047). The main complication was progression of disease, which was identified radiologically in 11 knees (22%). This highlights the need for accurate selection of patients. Our findings suggest that the Avon prosthesis survives well and gives a satisfactory functional outcome in the medium term.
A new musculoskeletal curriculum
Authors: Williams S. C. , Gulihar A. , Dias J. J. , Harper W. M.
Published: January 2010

This study assessed whether undergraduate performance improved following the introduction in 2006 of a musculoskeletal teaching programme lasting for seven weeks. Different methods were used to deliver knowledge and skills in trauma and orthopaedic surgery, rheumatology and allied specialties. The programme combined four main elements: traditional firm-based teaching, weekly plenary sessions, a task-based workbook and additional specialist clinics. The block of 139 students who attended in its first year were assessed using a multiple choice question examination just before their final examinations in 2008. They showed a 6% improvement in performance over a control group of 130 students assessed in 2005 before the programme had commenced. There was no difference in performance between the students assessed in 2005 and a second group of 46 students from 2008 who did not attend the new teaching programme. Performance was improved by providing more focused musculoskeletal training using available resources, as well as increasing the length of the programme.
The process of orthognathic care in an NHS region
Authors: Parbatani R , Williams AC , Ireland AJ , Sandy JR
Published: December 2009

INTRODUCTION

The aim of this study was to evaluate, within an NHS region, the process of care and the standard of record for orthognathic patients.

PATIENTS AND METHODS

A retrospective analysis of the medical records of 372 patients who underwent orthognathic surgery 1 January 1995 and 31 April 2000 in the South West Region of the UK.

RESULTS

Most patients underwent joint orthodontic and maxillofacial planning and had third molars extracted under general anaesthesia prior to orthognathic surgery. There was a significant difference in the median operation times and length of stay for bimaxillary surgery (4 h/4 days) compared with single jaw surgery (2 h/3 days; P < 0.001). Just over 15% of patients required removal of internal fixation plates after surgery, with nearly 90% of these requiring a further episode of general anaesthesia. The level of record keeping and patient review was variable with no regional standardisation.

CONCLUSIONS

This study is evidence of a generally acceptable standard in the process of care, which was found to follow international and national practices. However, at the time of the study there was no regional protocol for patient records or patient review, highlighting the need for the establishment of a regional database.
The incidence of epidural abscess following epidural analgesia in open abdominal aortic aneurysm repair
Authors: Wallace David , Bright Elizabeth , London N J M
Published: December 2009

INTRODUCTION

Complications of epidural catheterisation can cause significant morbidity. Epidural abscess following epidural catheterisation is rare and the reported incidence is variable. The purpose of this study was to review the incidence of epidural abscess in patients undergoing open abdominal aortic aneurysm (AAA) repair.

PATIENTS AND METHODS

A retrospective case note review of all patients having open AAA repair over a 5-year period.

RESULTS

A total of 415 patients underwent open AAA repair between January 2003 and March 2008. Of these, 290 were elective procedures and 125 were for ruptured aneurysms. Six patients underwent postoperative magnetic resonance imaging of the spine for clinical suspicion of an epidural abscess. Two of these (0.48%) had confirmed epidural abscess and two superficial infection at the epidural site.

CONCLUSIONS

The incidence of epidural abscess following epidural analgesia in patients undergoing open AAA repair within our department was 0.48%. Although a rare complication, epidural abscess can cause significant morbidity. Epidural abscesses rarely develop before the third postoperative day.
The impact of Improving Outcomes Guidance on the management and outcomes of patients with carcinoma of the penis
Authors: Bayles Andrew C , Sethia Krishna K
Published: December 2009

INTRODUCTION

The Improving Outcomes Guidance (IOG) for patients with carcinoma of the penis states that treatment should be provided supraregionally to populations of 4 million or greater who treat over 25 cases of penis cancer each year. This study assesses the impact of this guidance on the management and outcomes of patients with the disease in our region.

PATIENTS AND METHODS

We retrospectively compared the records of 44 patients with carcinoma of the penis treated in our institution between 1969 and 1990 with 101 patients treated between 2002 and 2006, i.e. after supraregional centralisation of the service.

RESULTS

There was no significant change in the stage or grade of the tumours. However, the results show that, in modern times, there was a significant increase in the amount of penis-preserving and nodal surgery as well as a fall in mortality. The improved survival is greatest in patients with poorly-differentiated disease who may, therefore, have benefited from aggressive nodal surgery.

CONCLUSIONS

The centralisation of surgery for carcinoma of the penis results in improved outcomes both in terms of preservation and improved survival and this supports the IOG guidance.
Postoperative management after loop ileostomy closure: are we keeping patients in hospital too long?
Authors: Baraza W , Wild J , Barber W , Brown S
Published: December 2009

INTRODUCTION

Recent studies have shown that closure of loop ileostomy can be performed in the day-case setting, reducing the length and cost of hospitalisation. By analysing our patients who have undergone reversal, we aimed to determine the length of hospital stay and potential factors behind stays beyond 24 h.

PATIENTS AND METHODS

A database of patients undergoing closure of loop ileostomy at one colorectal unit was examined. The times taken to discharge, morbidity and re-admission rates were recorded.

RESULTS

Eighty patients underwent reversal of ileostomy between January 2001 and January 2006. Median age was 63 years (range, 22–81 years). The median length of stay was 4 days (range, 2–32 days). The median length of stay in patients without complications was 4 days. Many appeared able to be discharged earlier. Seventy-two patients (90%) were able to tolerate a solid diet within 48 h and 54 (67.5%) had bowel function within 3 days. Six patients went home before bowel function; none of these were re-admitted. Twenty patients (25%) developed complications, which included wound infection (8%), small bowel obstruction/ileus (6%), enterocutaneous fistula (1%), anastomotic leak (1%), and late abdominal wall abscess (1%). Of the patients, 16% stayed longer than 5 days despite having no postoperative complications.

CONCLUSIONS

The majority of patients undergoing loop ileostomy reversal at our institution can be discharged earlier than they are at present. Support in the community and the implementation of modified UK day-case surgery protocols are suggested to help shorten patients' length of stay.
Appendiceal faecaliths are associated with right iliac fossa pain
Authors: Grimes Caris , Chin Diana , Bailey Catherine , Gergely Szabolcs , Harris Adrian
Published: December 2009

INTRODUCTION

There is debate over whether a normal-looking appendix should be removed at diagnostic laparoscopy performed for right iliac fossa (RIF) pain. Faecaliths are associated with appendicitis. This study assessed whether there was an association between the removal of normal appendices containing faecaliths and improvement of symptoms.

PATIENTS AND METHODS

Analysis of the histology database for all appendicectomies during 2003–2007 with normal histology, noting presence of a faecalith. Retrospective study using a telephone questionnaire for frequency/duration of pre-operative symptoms, postoperative symptom recurrence, re-admission rates and complications. The faecalith-positive (f+) group was compared to a similar control group of patients who had a normal appendix removed which did not contain a faecalith (f−).

RESULTS

Out of 203 appendicectomies performed with normal histology, 26 (13%) were f+. Of these, 21 responded to the questionnaire. Thirty-one consecutive patients with normal histology and no faecalith were identified. A similar proportion in each group presented with three or more episodes of pain prior to appendicectomy (38% f+; 39% control). Only one (5%) of the f+ patients had recurring symptoms after the operation, compared with 14 (48%) of the control group (P = 0.0016). Only one (5%) of the f+ patients underwent further investigations, compared with 11 (36%) of the control group (P < 0.02). None of the f+ patients were re-admitted, compared to 19% of the control population. There were no significant postoperative complications in either group.

CONCLUSIONS

Appendiceal faecaliths may be a cause of right iliac fossa pain in the absence of obvious appendiceal inflammation. In this study, the policy of routine removal of a normal-looking appendix at laparoscopy in the absence of any other obvious pathology appeared to be an effective treatment for recurrent symptoms in those cases with a faecalith. Further studies are needed to assess this putative association.
Changing management of suspected appendicitis in the laparoscopic era
Authors: Akbar Fayyaz , Yousuf Mansoor , Morgan Richard J , Maw Andrew
Published: December 2009

INTRODUCTION

The aims of this study were to examine the trends in performance of open and laparoscopic appendicectomy at a district general hospital, and to compare the diagnostic outcomes in the two patient groups.

PATIENTS AND METHODS

Data were collected prospectively from patients undergoing an open or laparoscopic procedure for cted appendicitis in an 8-year period between January 2000 and December 2007.

RESULTS

A total of 1700 patients (873 women, 827 men) with a median age of 24 years underwent surgery for suspected appendicitis in the study period. There were 1357 patients (group A) who underwent an open procedure for presumed appendicitis (610 women and 747 men [F:M ratio, 1:1.2]). There were 343 patients (group B) who underwent laparoscopy with or without laparoscopic appendicectomy (82 men and 261 women [F:M ratio, 1:0.31]). Over the study period, there was an increasing trend towards the performance of laparoscopic procedures for suspected appendicitis, increasing from 4% to 39% of the total per year. In group A, 1172 (86%) patients had appendicular pathology, while the appendix was normal histologi-cally in 178 (13%). Other pathologies were diagnosed intra-operatively in 1%. In group B, 193 patients (56%) had appendicular pathology while in 150 (44%) the appendix was normal. In the subgroup with a normal appendix, 56 patients (37%) had another cause for their symptoms identified.

CONCLUSIONS

Laparoscopic appendicectomy is increasingly being performed. Laparoscopy is often used as a diagnostic tool in general surgical patients, particularly women, with lower abdominal pain. In effect, these patients are undergoing diagnostic laparoscopy, with or without appendicectomy. This has resulted in a lower positive appendicectomy rate, but a higher yield of diagnoses other than appendicitis, in the laparoscopic group. Overall appendicectomy rates, however, have remained unchanged.
Early results of whole femoral head allograft with articular cartilage for acetabular impaction grafting in revision hip replacements
Authors: Subramanian Sivaraman , Jain Kaushik D , Sreekumar Ramakutty , Fox Una , Hemmady Mukesh , Hodgkinson John
Published: December 2009

INTRODUCTION

Extensive bone loss associated with revision hip surgery is a significant orthopaedic challenge. Acetabular reconstruction with the use of impaction bone grafting and a cemented polyethylene cup is a reliable and durable technique in revision situations with cavitatory acetabular bone defects. Some use cancellous graft alone whilst others morselise the whole femoral head after removal of articular cartilage. This paper asks, if it really necessary to use pure cancellous graft?

PATIENTS AND METHODS

Forty-two acetabular revisions using impacted morselised bone graft without removal of articular cartilage and a cemented cup were studied retrospectively. The mean follow-up was 3 years (range, 2–5.6 years). Clinical and radiographic assessment was made using the Oxford hip score, Hodgkinson's criteria (1988) for socket loosening and the Gie classification (1993) for evaluation of allograft consolidation and remodelling.

RESULTS

Forty (95%) sockets were considered radiologically stable (type 0, 1, 2 demarcations) and two (5%) sockets were radiologically loose (Type 3 demarcation). There was no socket migration in our series. Twenty-seven(64%) cases showed good trabecular remodelling (grade 3). Twelve (29%) cases showed trabecular incorporation (grade 2). Only three (7%) cases showed poor allograft incorporation (grade 1). Average pre-operative Oxford hip score was 41 and postoperative hip score was 27. There have been no socket re-revisions (100% survival) at an average of 3 years.

CONCLUSIONS

Early radiological and clinical survival results with retaining articular cartilage of femoral head allografts are similar and comparable to other major studies for acetabular impaction bone grafting in revisions. Minimal loss of allograft mass is 40% in obtaining pure cancellous graft. When there is a limited supply and demand of allograft, saving up to 40% of the material is a valuable and cost-effective use of scarce resources.
Cervicomastoidfacial versus modified facelift incision for parotid surgery: a patient feedback comparison
Authors: Wasson Joseph , Karim Haider , Yeo Justin , Panesar Jaan
Published: December 2009

INTRODUCTION

Traditionally, the cervicomastoidfacial (CMF) incision is used to excise benign tumours of the parotid gland. The rhytidectomy or modified facelift (MF) incision allows an alternative approach which leaves no visible neck scar. The objective of this study was to establish the frequency of each surgical approach used and identify any difference in complication and patient satisfaction between the two incisions for benign conditions of the parotid gland.

PATIENTS AND METHODS

A retrospective analysis of 101 case notes for patients who underwent parotidectomy by both ENT and maxillofacial departments between January 2006 and February 2008 was undertaken. All histologically confirmed cases of malignancy were excluded. For each incision, immediate postoperative complications were obtained from the notes. A postal patient outcome evaluation questionnaire sought information regarding persistent and late complications as well as a visual analogue scar satisfaction score for both incisions.

RESULTS

Overall, 79 parotidectomies were included (59 CMF incisions, 20 MF incisions). Of CMF incisions, 34% suffered facial weakness immediately postoperatively versus 20% of MF incisions. Of CMF incisions, 4% suffered postoperative haematomas versus none following MF incisions. In the study cohort, 47 (60%) responded to the postal feedback questionnaire (33 CMF versus 14 MF respondents). Information regarding immediate and late postoperative ipsilateral facial paraesthe-sia and gustatory sweating was obtained. Mean visual analogue scar satisfaction scores were 9.4 for CMF incisions and 8.9 for MF incisions.

CONCLUSIONS

Immediate and late complications for CMF and MF approaches for benign disease parotidectomy were comparable, but scar satisfaction following MF incision was not greater than CMF incisions.
The impact of the two-week wait rule on the diagnosis and management of bladder cancer in a single UK institution
Authors: Blick Christopher , Bailey David , Haldar Neil , Bdesha Amarjit , Kelleher John , Muneer Asif
Published: December 2009

INTRODUCTION

The objective of this study was to investigate the impact of the 2-week wait rule on patient waiting times for the diagnosis and treatment of bladder cancer.

PATIENTS AND METHODS

Data reporting the waiting times from diagnosis to treatment for 100 consecutive patients newly diagnosed with bladder cancer immediately before and after the implementation of the 2-week wait rule were compared. The data were collected both prospectively and retrospectively from cancer multidisciplinary team meeting files and patient records. Various steps of the patient pathway were analysed including waiting times from referral to consultation as well as time to investigation and first treatment. Data were also analysed based upon tumour stage/grade and whether referrals were made on an urgent or routine basis.

RESULTS

One hundred newly diagnosed patients with bladder cancer in each group covered a period of 4–5 years (1997–2001 and 2001–2006). Following the introduction of the 2-week wait rule, there was a 47.6% reduction in the time from referral to first consultation with a specialist (42 days vs 22 days; P < 0.001). The time between first investigation and treatment has not reduced significantly. We also found that, despite the introduction of the 2-week wait rule, only 42% of the patients were diagnosed with bladder cancer using this pathway. Patients referred as ‘routine’ waited longer to be seen in hospital although there was no significant delay in receiving treatment.

CONCLUSIONS

The introduction of the 2-week wait rule has significantly reduced the time patients with bladder cancer wait for their first consultation with a specialist. However, there is no significant change in the time between first consultation and treatment.
Critical appraisal of subjective outcome measures used in the assessment of shoulder disability
Authors: Desai Aravind S , Dramis Asterios , Hearnden Anthony J
Published: December 2009

INTRODUCTION

Objective measures can be impractical in some settings, because they are time consuming and require face-to-face contact. More recently, there is an increasing trend towards the use of subjective outcome measures. Hence, in this article, five common subjective shoulder outcome measures are critically appraised in terms of their development, validity, relia-lity, responsiveness and clinical application.

MATERIALS AND METHODS

Following an extensive literature search, five common shoulder patient-based scores were identified: Disability of Arm, Shoulder and Hand (DASH), Oxford Shoulder Score (OSS), Shoulder Disability Questionnaire (SDQ-UK), Shoulder Pain and Disability Index (SPADI), and the Shoulder Rating Questionnaire (SRQ). These questionnaires were then critically appraised in terms of their development process, validity, reliability, responsiveness, and clinical application.

RESULTS

The SDQ-UK has shown good construct validity but there is no data available regarding internal consistency, reliability and responsiveness. The SPADI has good internal consistency, fair reliability with adequate criterion and construct validity. The DASH has shown to have good construct validity, excellent test–re-test reliability and responsiveness to change. The OSS has good sensitivity, validity and responsiveness. Though SRQ has good internal consistency, its reproducibility and responsiveness are poor.

CONCLUSIONS

Based on this critical appraisal, the DASH received the best ratings for its clinimetric properties followed by the OSS.
Mixed-sex wards – a surgeon's view
Authors: Butler Christopher M
Published: December 2009

When I started my medical training nearly 40 years ago life in NHS hospitals seemed so much simpler. General surgeons performed most of the surgery and were managed by their secretaries; nurses nursed; and wards were designated 'male or female surgical'. The wards were overseen by the gimlet eyes of the ward sister and hospital matron. These formidable ladies would have had apoplexy at the sight of or even the thought of a man in the female surgical ward or vice versa.
The import of the impact factor: fallacies of citation-dependent scientometry
Authors: Kumar M
Published: December 2009

Scientific research needs to be 'measured' for many reasons. First, it gives an indication of the quantitative output of research and thereby the productivity of a scientist. This is used by universities and research organisations to take decisions regarding continuation of tenure, promotion, salary and further funding of research by the scientist. It is used by librarians to decide on the type of journals that need priority. It is used by committees granting prizes and awards to the scientists based on the merit of research. For a long time there was no objective method of measuring scientific research and it is probably true that there are no satisfactory methods even today.
Combining Biochemical and Ultrasonographic Markers in Predicting Preeclampsia: A Systematic Review
Authors: Giguère Yves , Charland Marc , Bujold Emmanuel , Bernard Nathalie , Grenier Sonya , Rousseau François , Lafond Julie , Légaré France , Forest Jean-Claude
Published: January 2010

Background: Early identification of pregnant women at risk for preeclampsia is a priority to implement preventive measures. Some biochemical and ultrasonographic parameters have shown promising predictive performance, but so far there is no clinically validated screening procedure.

Content: Using a series of keywords, we reviewed electronic databases (Medline, Embase, all records to May 2009) reporting the performance of biological and ultrasonographic markers to predict preeclampsia, both single markers and combinations of markers. We analyzed the data according to gestational age and risk levels of the studied populations. We evaluated the methodological quality of included publications using QUADAS (quality assessment of diagnostic accuracy studies). We identified 37 relevant studies that assessed 71 different combinations of biochemical and ultrasonographic markers. Most studies were performed during the second trimester on small-scale high-risk populations with few cases of preeclampsia. Combinations of markers generally led to an increase in sensitivity and/or specificity compared with single markers. In low-risk populations, combinations including placental protein 13 (PP13), pregnancy-associated plasma protein A (PAPP-A), a disintegrin and metalloprotease-12 (ADAM12), activin A, or inhibin A measured in first or early second trimester and uterine artery Doppler in second trimester appear promising (sensitivity 60%–80%, specificity >80%). In high-risk populations, the combination of PP13 and pulsatility index in first trimester showed 90% sensitivity and 90% specificity in a single study limited to severe preeclampsia.

Summary: Combinations of biochemical and ultrasonographic markers improved the performance of early prediction of preeclampsia. From a perspective of integrative medicine, large population-based studies evaluating algorithms combining multiple markers are needed, if screening approaches are to be eventually implemented.
Origins of microfossil bonebeds: insights from the Upper Cretaceous Judith River Formation of north-central Montana
Authors: Rogers Raymond R. , Brady Mara E.
Published: January 2010

Microfossil bonebeds are multi-individual accumulations of disarticulated and dissociated vertebrate hardparts dominated by elements in the millimeter to centimeter size range (≤75% of bioclasts ≤5 cm maximum dimension). Modes of accumulation are often difficult to decipher from reports in the literature, although predatory (scatological) and fluvial/hydraulic origins are typically proposed. We studied the sedimentology and taphonomy of 27 microfossil bonebeds in the Campanian Judith River Formation of Montana in order to reconstruct formative histories. Sixteen of the bonebeds examined are hosted by fine-grained facies that accumulated in low-energy aquatic settings (pond/lake microfossil bonebeds). Eleven of the bonebeds are embedded in sandstones that accumulated in ancient fluvial settings (channel-hosted microfossil bonebeds). In lieu of invoking separate pathways to accumulation based on facies distinctions, we present a model that links the accumulation of bioclasts in the two facies. We propose that vertebrate material initially accumulates to fossiliferous levels in ponds/lakes and is later reworked and redeposited as channel-hosted assemblages. This interpretation is grounded in reasonable expectations of lacustrine and fluvial depositional systems and supported by taphonomic data. Moreover, it is consistent with faunal data that indicate that channel-hosted assemblages and pond/lake assemblages are similar with regard to presence/absence and rank-order abundance of taxa.

This revised model of bonebed formation has significant implications for studies of vertebrate paleoecology that hinge on analyses of faunal data recovered from vertebrate microfossil assemblages. Pond/lake microfossil bonebeds in the Judith River record are preserved in situ at the scale of the local paleoenvironment, with no indication of postmortem transport into or out of the life habitat. Moreover, they are time-averaged samples of their source communities, which increases the likelihood of capturing both ecologically abundant species and more rare or transient members of the paleocommunity. These attributes make pond/lake microfossil bonebeds excellent targets for paleoecological studies that seek to reconstruct overall community membership and structure. In contrast, channel-hosted microfossil bonebeds in the Judith River record are out of place from a paleoenvironmental perspective because they are reworked from preexisting pond/lake assemblages and redeposited in younger channel facies. However, despite a history of exhumation and redeposition, channel-hosted microfossil bonebeds are preserved in relatively close spatial proximity to original source beds. This taphonomic reconstruction is counter to the commonly held view that microfossil bonebeds are biased samples that have experienced long-distance transport and significant hydrodynamic sorting.
Seasonal Losses of Dissolved Organic Carbon and Total Dissolved Solids from Rice Production Systems in Northern California
Authors: Ruark Matthew D. , Linquist Bruce A. , Six Johan , van Kessel Chris , Greer Chris A. , Mutters Randall G. , Hill James E.
Published: January 2010

Water quality concerns have arisen related to rice (Oryza sativa L.) field drain water, which has the potential to contribute large amounts of dissolved organic carbon (DOC) and total dissolved solids (TDS) to the Sacramento River. Field‐scale losses of DOC or TDS have yet to be quantified. The objectives of this study were to evaluate the seasonal concentrations of DOC and TDS in rice field drain water and irrigation canals, quantify seasonal fluxes and flow‐weighted (FW) concentrations of DOC and TDS, and determine the main drivers of DOC and TDS fluxes. Two rice fields with different straw management practices (incorporation vs. burning) were monitored at each of four locations in the Sacramento Valley. Fluxes of DOC ranged from 3.7 to 34.6 kg ha−1 during the growing season (GS) and from 0 to 202 kg ha−1 during the winter season (WS). Straw management had a significant interaction effect with season, as the greatest DOC concentrations were observed during winter flooding of straw incorporated fields. Fluxes and concentrations of TDS were not significantly affected by either straw management or season. Total seasonal water flux accounted for 90 and 88% of the variability in DOC flux during the GS and WS, respectively. Peak DOC concentrations occurred at the onset of drainflow; therefore, changes in irrigation management may reduce peak DOC concentrations and thereby DOC losses. However, the timing of peak DOC concentrations from rice fields suggest that rice field drainage water is not the cause of peak DOC concentrations in the Sacramento River.
Pulmonary Dendritic Cells in Lungs of Preterm Infants: Neglected Participants in Bronchopulmonary Dysplasia?
Authors: De Paepe Monique E. , Hanley L. Corey , Lacourse Zacharie , Pasquariello Terese , Mao Quanfu
Published: January 2010

Preterm infants are at risk for bronchopulmonary dysplasia (BPD), a chronic lung disease characterized by disrupted alveolar remodeling and microvascular dysangiogenesis. The pathogenesis of BPD is multifactorial, with contributions from antenatal and/or postnatal infection and inflammation. The potential role of dendritic cells, critical immune regulatory cells with potent angiogenic activities, remains undetermined. We studied the prevalence and topography of dendritic cells in postmortem lungs of short- and long-term ventilated preterm infants born between 23 and 29 weeks in gestation. Controls were age-matched infants who had lived less than 12 hours. Dendritic cells were identified by anti-DC-SIGN immunohistochemistry and were co-localized with endothelial and smooth muscle cells by double immunofluorescence. Lungs of early and late control infants without evidence of antenatal infection contained scattered DC-SIGN-positive dendritic cells in the peripheral lung parenchyma. Lungs of early control infants with a history of chorioamnionitis/antenatal infection and lungs of short- or long-term ventilated preterm infants showed a dramatic (more than 3-fold) increase in dendritic cells. Double labeling highlighted a close association between dendritic cells and small- or medium-sized pulmonary vessels. In conclusion, we demonstrated that dendritic cells are an integral component of normal postcanalicular lung development. Antenatal infection and ventilation/BPD are associated with significant pulmonary recruitment of dendritic cells. The recently described angiogenic effects of dendritic cells and their intimate association with the pulmonary microvasculature indicate that dendritic cells may participate in BPD-associated dysangiogenesis. Elucidation of the role of this immunovascular axis may lead to novel therapeutic approaches to BPD.
Evaluation of early cellular influences of bone morphogenetic proteins 12 and 2 on equine superficial digital flexor tenocytes and bone marrow–derived mesenchymal stem cells in vitro
Authors: Murray Shannon J. , Santangelo Kelly S. , Bertone Alicia L.
Published: January 2010

Objective—To evaluate early cellular influences of bone morphogenetic protein (BMP)12 and BMP2 on equine superficial digital flexor tenocytes (SDFTNs) and equine bone marrow–derived mesenchymal stem cells (BMDMSCs).

Animals—9 adult clinically normal horses.

Procedures—BMDMSCs and SDFTNs were cultured in monolayer, either untreated or transduced with adenovirus encoding green fluorescent protein, adenovirus encoding BMP12, or adenovirus encoding BMP2. Cytomorphologic, cytochemical, immunocytochemical, and reverse transcriptase–quantitative PCR (RT-qPCR) analyses were performed on days 3 and 6. Genetic profiling for effects of BMP12 was evaluated by use of an equine gene expression microarray on day 6.

Results—BMDMSCs and SDFTNs had high BMP12 gene expression and remained viable and healthy for at least 6 days. Type l collagen immunocytochemical staining for SDFTNs and tenocyte-like morphology for SDFTNs and BMDMSCs were greatest in BMP12 cells. Cartilage oligomeric matrix protein, as determined via RT-qPCR assay, and chondroitin sulfate, as determined via gene expression microarray analysis, were upregulated relative to control groups in SDFTN-BMP12 cells. The BMDMSCs and SDFTNs became mineralized with BMP2, but not BMP12. Superficial digital flexor tenocytes responded to BMP12 with upregulation of genes relevant to tendon healing and without mineralization as seen with BMP2.

Conclusions and Clinical Relevance—Targeted equine SDFTNs may respond to BMP12 with improved tenocyte morphology and without mineralization, as seen with BMP2. Bone marrow–derived mesenchymal stem cells may be able to serve as a cell delivery method for BMP12.
Evaluation of a real-time, continuous monitor of glucose concentration in healthy dogs during anesthesia
Authors: Bilicki Kerry L. , Schermerhorn Thomas , Klocke Emily E. , McMurphy Rose M. , Roush James K.
Published: January 2010

Objective—To evaluate the accuracy of a real-time, continuous glucose monitoring system (CGMS) in healthy dogs undergoing anesthesia for elective ovariohysterectomy or orchiectomy.

Animals—10 healthy dogs undergoing routine elective surgery.

Procedures—A CGMS was placed and used to obtain calculated glucose measurements before, during, and after anesthesia in each dog. Periodically, CGMS measurements were compared with concurrent measurements of glucose concentration in peripheral venous blood obtained with a portable chemistry analyzer (PCA).

Results—CGMS-calculated glucose measurements were significantly different from PCA blood glucose measurements during most of the anesthetic period. The CGMS values differed from PCA values by > 20% in 54 of 126 (42.9%) paired measurements obtained during the anesthetic period. Hypoglycemia was evident in CGMS measurements 25 of 126 (19.8%) times during anesthesia. By comparison, only 1 incident of hypoglycemia was detected with the PCA during the same period.

Conclusions and Clinical Relevance—Use of the CGMS for routine monitoring of interstitial glucose concentration as an indicator of blood glucose concentration during anesthesia cannot be recommended. Additional investigation is necessary to elucidate the cause of discrepancy between CGMS results and PCA data during anesthesia.
Evaluation of the safety of spinosad and milbemycin 5-oxime orally administered to Collies with the MDR1 gene mutation
Authors: Sherman Jeffrey G. , Paul Allan J. , Firkins Lawrence D.
Published: January 2010

Objective—To determine whether signs of avermectin (AVM)-milbemycin (MB) toxicosis would be evident in AVM-MB–sensitive Collies after treatment with an experimental formulation of spinosad alone or spinosad combined with MB 5-oxime (MBO) at doses up to 5 and 10 times the MBO maximum label dose.

Animals—20 adult Collies homozygous or heterozygous for the MDR1 gene mutation that had signs of toxicosis after oral administration of ivermectin.

Procedures—On the basis of AVM-MB sensitivity score, each dog was assigned in a randomized block design to 1 of 5 treatment groups (control group, 300 mg of spinosad/kg [5 times maximum label dose], 180 mg of spinosad/kg with 3 mg of MBO/kg [3 times maximum MBO label dose], 300 mg of spinosad/kg with 5 mg of MBO/kg, and 300 mg of spinosad/kg with 10 mg of MBO/kg). Treatments were administered orally as a sequence of single doses during 5 consecutive days. After a 28-day washout period, treatment sequences were repeated. Posttreatment observation and scoring by blinded observers were conducted to specifically include neurologic abnormalities typical of AVM-MB toxicosis, such as signs of depression, ataxia, mydriasis, and hypersalivation.

Results—No signs of AVM-MB toxicosis were attributed to treatment in any dog during the study.

Conclusions and Clinical Relevance—Results indicated that oral administration of spinosad at 300 mg/kg alone or in combination with MBO at doses up to 10 mg/kg did not cause signs of AVM-MB toxicosis in AVM-MB–sensitive dogs with the MDR1 gene mutation.
Effect of changes in number of doses and anatomic location for administration of an Escherichia coli bacterin on serum IgG1 and IgG2 concentrations in dairy cows
Authors: Erskine Ronald J. , Brockett Anne R. , Beeching Nicole D. , Hull Robert W. , Bartlett Paul C.
Published: January 2010

Objective—To determine effects of injection site on antibody response to J5 Escherichia coli bacterin.

Animals—28 adult Holstein cows.

Procedures—Cows were randomly assigned as control cattle (n=4cows), not administered J5 E coli bacterin; 3X (8), administered 3 doses of bacterin SC in the left side of the neck; 5XN (8), administered 5 doses of bacterin SC in the left side of the neck; or 5XSR (8), administered 5 doses of bacterin SC sequentially in the left side of the neck, right side of the neck, right side of the thorax, left side of the thorax, and left side of the neck. Blood samples were collected from the cows to determine anti-J5 E coli IgG1 and IgG2 concentrations.

Results—Vaccinated cows had higher mean serum anti-J5 E coli IgG1 concentrations than did control cows. The 5XN and 5XSR cows had higher mean serum anti-J5 E coli IgG1 concentrations than did 3X cows. Additionally, 5XSR cows had higher mean serum anti-J5 E coli IgG1 concentrations than did 5XN cows. Vaccinated cows had higher mean serum anti-J5 E coli IgG2 concentrations than did control cows. The 5XN and 5XSR cows had higher mean serum anti-J5 E coli IgG2 concentrations than did 3X cows. The 5XSR cows had higher mean serum anti-J5 E coli IgG2 concentrations than did all other groups at 84 days after the fifth vaccination.

Conclusions and Clinical Relevance—Sequential doses of core-antigen bacterins administered at different anatomic locations may improve antibody response in dairy cattle.
Evaluation of segmental dorsolumbar epidural analgesia with ketamine hydrochloride administered by use of nonstyletted multiple-port catheters via the caudal approach in cattle
Authors: DeRossi Rafael , Ruzzon Rafael H. S. , Verde-Selva Alexandre B. , Bertoni Rodrigo A.
Published: January 2010

Objective—To evaluate use of nonstyletted multiple-port catheters for epidural administration of ketamine hydrochloride via the caudal approach to induce analgesia of the paralumbar fossa (flank) in cattle.

Animals—6 healthy bulls.

Procedures—1 week before experiments began, a multiple-port catheter was inserted by use of a Tuohy needle in all cattle via the caudal approach (between the first and second coccygeal vertebrae); the tip was threaded approximately 48 cm cranial into the dorsolumbar region. Each bull was administered ketamine (0.3, 0.5, or 0.7 mg/kg) at time 0. Heart rate, blood pressures, respiratory rate, rectal temperature, analgesia, sedation, and ataxia were determined before treatment (baseline [time 0]); at 5, 10, 15, 30, 45, 60, 75, and 90 minutes; and every 30 minutes thereafter until end of analgesia.

Results—All multiple-port catheters were threaded with negligible resistance into the dorsolumbar region in all bulls. All doses of ketamine were effective for inducing analgesia of the flank region of bulls in a standing position. Total analgesia time was dose dependent (35, 50, and 80 minutes for 0.3, 0.5, and 0.7 mg/kg, respectively). All doses of ketamine induced mild or moderate ataxia. Heart rate changes were within acceptable limits.

Conclusions and Clinical Relevance—Segmental dorsolumbar epidural analgesia with ketamine administered via multiple-port catheters by use of the caudal approach in cattle was feasible, and the cattle remained standing with minimal adverse effects. Further studies are necessary to determine whether this technique provides optimal conditions to allow surgery in standing cattle.
Effects of hypercapnia, hypocapnia, and hyperoxemia on blood oxygenation level–dependent signal intensity determined by use of susceptibility-weighted magnetic resonance imaging in isoflurane-anesthetized dogs
Authors: Rioja Eva , Kerr Carolyn L. , McDonell Wayne N. , Dobson Howard , Konyer Norman B. , Poma Roberto , Noseworthy Michael D.
Published: January 2010

Objective—To assess the effects of alterations in PaCO2 and PaO2 on blood oxygenation level–dependent (BOLD) signal intensity determined by use of susceptibility-weighted magnetic resonance imaging in brains of isoflurane-anesthetized dogs.

Animals—6 healthy dogs.

Procedures—In each dog, anesthesia was induced with propofol (6 to 8 mg/kg, IV) and maintained with isoflurane (1.7%) and atracurium (0.2 mg/kg, IV, q 30 min). During 1 magnetic resonance imaging session in each dog, targeted values of PaCO2 (20, 40, or 80 mm Hg) and PaO2 (100 or 500 mm Hg) were combined to establish 6 experimental conditions, including a control condition (PaCO2, 40 mm Hg; PaO2, 100 mm Hg). Dogs were randomly assigned to different sequences of conditions. Each condition was established for a period of ≥ 5 minutes before susceptibility-weighted imaging was performed. Signal intensity was measured in 6 regions of interest in the brain, and data were analyzed by use of an ANCOVA and post hoc Tukey-Kramer adjustments.

Results—Compared with control condition findings, BOLD signal intensity did not differ significantly in any region of interest. However, signal intensities in the thalamus and diencephalic gray matter decreased significantly during both hypocapnic conditions, compared with all other conditions except for the control condition.

Conclusions and Clinical Relevance—In isoflurane-anesthetized dogs, certain regions of gray matter appeared to have greater cerebrovascular responses to changes in PaCO2 and PaO2 than did others. Both PaO2 and PaCO2 should be controlled during magnetic resonance imaging procedures that involve BOLD signaling and taken into account when interpreting findings.