bluuebunny/crossref_metadata_2025 huggingface dataset:
Maxillary Sinus Augmentation by the Crestal Core Elevation Technique
Authors: Kolerman Roni , Moses Ofer , Artzi Zvi , Barnea Eytan , Tal Haim
Published: August 2010

Background: The crestal core elevation (CCE) technique is reportedly a less invasive procedure than the lateral window elevation technique. We retrospectively evaluated long‐term outcomes of CCE procedures over an 11‐year time period.

Methods: Core preparations were made after extractions of 57 upper molars in 45 patients. Extraction sites were drilled with a calibrated trephine bur to an estimated distance of 1 mm from the sinus membrane. The trephined interradicular bone and underlying sinus membrane were imploded into the sinus. The surgical crater and residual extraction socket were filled with deproteinized bovine bone mineral or freeze‐dried bone allograft, stabilized, and protected with an absorbable collagen membrane and fully covered with coronally positioned flaps. Implants were placed 4 months later. Success was defined if ≥9 mm available bone height was available. Where the available bone height varied between 7 and 9 mm, implant placement was complemented using the bone‐added osteotome sinus floor elevation technique; those sites were defined as a “partial success.”

Results: The CCE technique was successful in 31 (68.9%) out of 45 sites, and partially successful in six (13.3%) out of 45 sites. Eight sites failed (17.8%). Surgical failures were caused by core detachment resulting in large tears of the sinus membrane. Implants placed in successful sites presented a 100% survival rate during the study duration.

Conclusions: CCE implemented simultaneously with molar extractions provided therapeutic benefits and clinical limitations. The subsequent implant placement using CCE revealed an excellent survival rate in the study population evaluated.
Role of Smoking and Type 2 Diabetes in the Immunobalance of Advanced Chronic Periodontitis
Authors: Duarte Poliana M. , Santos Vanessa R. , dos Santos Fernanda A. , de Lima Pereira Sanivia A. , Rodrigues Denise B.R. , Napimoga Marcelo H.
Published: August 2010

Background: This study evaluates the tissue levels of interleukin (IL)‐17+, IL‐15+, Foxp3+ cells, fibrosis, and plasma B‐cell infiltration in sites with chronic periodontitis in smokers and subjects with type 2 diabetes.

Methods: Gingival biopsies were harvested from the following groups: systemically and periodontally healthy subjects (healthy group, n = 10); non‐smokers and subjects with advanced periodontitis and without diabetes (non‐risk factor/periodontitis group, n = 10); heavy smokers with advanced periodontitis and without diabetes (smoking/periodontitis group, ≥20 cigarettes per day for at least the past 5 years, n = 10); and non‐smoking poorly controlled subjects with diabetes (glycated hemoglobin levels ≥9%) with advanced periodontitis (diabetes mellitus/periodontitis group [DMP], n = 10). The number of IL‐17+, IL‐15+, and Foxp3+ cells was analyzed by immunohistochemistry, whereas the amount of fibrosis and plasma B‐cell infiltration in gingival tissue was analyzed by histomorphometry.

Results: The number of Foxp3+ cells was significantly higher in the periodontitis groups compared to the healthy group (P <0.05). The DMP group presented higher levels of Foxp3+ cells than other periodontitis groups (P <0.05). The levels of IL‐15+ and IL‐17+ cells and the amount of fibrosis were higher in the DMP group than in the other groups (P <0.05). There was a trend for a decreased B‐cell infiltration in the DMP group (P >0.05). There was a slightly significant negative correlation between B‐cell infiltration and the amount of fibrosis (P <0.05).

Conclusion: Upregulation of IL‐17+, IL‐15+, and Foxp3+ cells and increased amounts of fibrosis were observed in chronic periodontitis sites in subjects with type 2 diabetes, suggesting that periodontitis development in these subjects may be influenced by the T helper 17/T regulatory axis.
Demineralization Removes Residual Alendronate in Allograft Bone Procured From Donors With a History of Bisphosphonate Use
Authors: Hunter Shawn A. , Orheim Robert , Sazon Mia , Newman Helen , Woll Judith E. , Bergevin Michael
Published: August 2010

Background: Bisphosphonate‐associated osteonecrosis (BON) of the jaw is a growing concern in the dental community, but the possible presence of residual bisphosphonates in demineralized allograft bone from bisphosphonate‐using tissue donors and the clinical implications of using such bone are unclear. The objectives of this study are to determine whether alendronate remained in demineralized bone matrix (DBM) procured from donors with a documented history of oral bisphosphonate use and to examine whether the demineralization process removes alendronate from allograft bone.

Methods: A gas chromatography–mass spectrometry method was developed and validated to quantify residual alendronate in allograft bone. Alendronate levels in DBM procured from tissue donors with a history of oral bisphosphonate use were compared to alendronate levels in DBM procured from donors without a history of bisphosphonate use. In addition, mineralized and demineralized bone was soaked in alendronate at concentrations of 0.002, 2.0, and 2,000 ng/mg bone and analyzed to examine the effect of the demineralization process.

Results: Residual alendronate was not detected in the DBM from either group, nor was it detected in any of the DBM samples soaked in alendronate solutions. Soaked mineralized bone contained measureable alendronate, but the substance was removed by demineralization.

Conclusions: The demineralization process effectively removed residual alendronate from allograft bone. These results may relieve anxieties regarding the use of DBM in dental patients because it is unlikely to trigger BON of the jaw.
Retrospective Evaluation of Crestal Bone Changes Around Implants With Reduced Abutment Diameter Placed Non‐Submerged and at Subcrestal Positions: The Effect of Bone Grafting at Implant Placement
Authors: Koutouzis Theofilos , Fetner Michael , Fetner Alan , Lundgren Tord
Published: August 2010

Background: There is limited information regarding the effect of grafting of the osteotomy after subcrestal implant placement. The primary aim of this study is to retrospectively evaluate the effect of bone grafting of the defect between the bone crest and the coronal aspect of implants with reduced abutment diameter placed non‐submerged and at subcrestal positions.

Methods: Records of 50 consecutive patients treated with subcrestally placed dental implants grafted with a xenograft (Group A) and 50 consecutive patients with subcrestally placed dental implants without any grafting material (Group B) were reviewed. For each implant, the radiographs after placement were compared to images from the last follow‐up visit and evaluated regarding the following: 1) degree of subcrestal positioning of the implant, 2) changes of marginal hard‐tissue height over time, and 3) whether marginal hard‐tissue could be detected on the implant platform at the follow‐up visit.

Results: The mean marginal loss of hard tissues was 0.11 ± 0.30 mm for Group A and 0.08 ± 0.22 mm for Group B. Sixty‐nine percent of the implants in Group A and 77% of the implants in Group B demonstrated hard tissue on the implant platform. There were no statistically significant differences between the groups regarding marginal peri‐implant hard‐tissue loss.

Conclusion: The present study fails to demonstrate that grafting of the remaining osseous wound defect between the bone crest and the coronal aspect of the implant has a positive effect on marginal peri‐implant hard‐tissue changes.
Application of MUSLE for the prediction of phosphorus losses
Authors: Noor Hamze , Mirnia Seyed Khalagh , Fazli Somaye , Raisi Mohamad bagher , Vafakhah Mahdi
Published: August 2010

Soil erosion in forestlands affects not only land productivity but also the water body down stream. The Universal Soil Loss Equation (USLE) has been applied broadly for the prediction of soil loss from upland fields. However, there are few reports concerning the prediction of nutrient (P) losses based on the USLE and its versions. The present study was conducted to evaluate the applicability of the deterministic model Modified Universal Soil Loss Equation (MUSLE) to estimation of phosphorus losses in the Kojor forest watershed, northern Iran. The model was tested and calibrated using accurate continuous P loss data collected during seven storm events in 2008. Results of the original model simulations for storm-wise P loss did not match the observed data, while the revised version of the model could imitate the observed values well. The results of the study approved the efficient application of the revised MUSLE in estimating storm-wise P losses in the study area with a high level of agreement of beyond 93%, an acceptable estimation error of some 35%.
Quantifying the magnitude of the impact of climate change and human activity on runoff decline in Mian River Basin, China
Authors: Fan Jing , Tian Fei , Yang Yonghui , Han Shumin , Qiu Guoyu
Published: August 2010

Runoff in North China has been dramatically declining in recent decades. Although climate change and human activity have been recognized as the primary driving factors, the magnitude of impact of each of the above factors on runoff decline is still not entirely clear. In this study, Mian River Basin (a watershed that is heavily influenced by human activity) was used as a proxy to quantify the contributions of human and climate to runoff decline in North China. SWAT (Soil and Water Assessment Tool) model was used to isolate the possible impacts of man and climate. SWAT simulations suggest that while climate change accounts for only 23.89% of total decline in mean annual runoff, human activity accounts for the larger 76.11% in the basin. The gap between the simulated and measured runoff has been widening since 1978, which can only be explained in terms of increasing human activity in the region. Furthermore, comparisons of similar annual precipitation in 3 dry-years and 3 wet-years representing hydrological processes in the 1970s, 1980s, and 1990s were used to isolate the magnitude of runoff decline under similar annual precipitations. The results clearly show that human activity, rather than climate, is the main driving factor of runoff decline in the basin.
Rainwater harvesting potentials for drought mitigation in Iran
Authors: Tabatabaee J. , Han M. Y.
Published: August 2010

In order to evaluate the potential of rainwater harvesting (RWH) for mitigating water scarcity in a semi-arid zone of the country (Mashhad-Iran), three typical RWH systems were installed and monitored. The first system consists of 5,000 m2 natural ground catchment which was leveled and covered with plastic sheets allowing for maximum possible runoff generation. Surface runoff was conducted into a 500 m3 ground reservoir via a series of draining ditches and an end collection channel. The water collected from a plastic covered catchment was used for irrigation of dryland wheat cultivation. According to the result of two years measurements, grain yield was almost doubled in irrigated plots when compared to conventional rainfed cultivation. In the second RWH system, runoff generated from about 2 ha asphaltic road and parking was diverted into a 1,200 m3 ground reservoir. The results of 2 years measurement for reservoir inflow and outflow indicated that runoff generated during rainy season was sufficient to produce necessary water for irrigating 900 planted fruit trees during successive dry seasons. The last experiment reported here is about a 40 m2 roof area which was connected to a plastic tank for runoff measurement. The conclusion was that the proposed RWH system can produce enough water for building's toilets' flashes and other sanitary purposes so that the potable water could be saved considerably. In general, the results of three rainwater harvesting experiments showed the importance of using rainwater for compensating the effect of water shortages which is repeatedly occurring due to the effect of current climate change and ever increasing water utilization for drinking and food production.
Ammonium removal from aqueous solution by zeolite X synthesized from halloysite mineral
Authors: Zhao Yafei , Zhang Bing , Zhang Xiang , Wang Jinhua , Liu Jindun , Chen Rongfeng
Published: August 2010

Zeolite X was successfully synthesized from natural halloysite mineral by hydrothermal method. The synthesized zeolite X was characterized by XRD, SEM, TEM and HRTEM. The characterization indicated that zeolite X had high crystallinity together with symmetrical and uniform pore channels. Ammonium (NH4+) adsorption properties of zeolite X were studied using batch experiments. The results revealed that high initial concentration and low temperature favored NH4+ adsorption on zeolite X. Both Langmuir and Freundlich isotherms fit well with the equilibrium data. Kinetic studies showed that the adsorption followed pseudo-second-order model. Intra-particle diffusion analysis demonstrated that NH4+ diffused quickly among the particles at the initial 20 min of the adsorption process, and then the diffusion slowed down and stabilized. Thermodynamic parameters such as change in free energy (ΔG0), enthalpy (ΔH0) and entropy (ΔS0) indicated that the adsorption was spontaneous and exothermic at ambient conditions. The reusable ability of zeolite X was also evaluated. Due to its low cost, high adsorption capacity and fast adsorption rate, zeolite X synthesized from halloysite could be used as an effective and environmental-friendly adsorbent for NH4+ removal.
Abatement efficiency and controlling strategy of a cylindrical and a conical fluidized bed flocculator
Authors: Zhou D. , Dong S. , Zhang F.
Published: August 2010

The aggregation efficiency of colloidal kaolin particles by the turbulence caused by random movement of silica gel beads in a cylindrical (CFB) and an 8° conical fluidized bed (TFB) was studied in this paper, focusing on the control strategies of these novel processes. The abatement efficiencies as a function of the Camp number, velocity gradient (G) and flocculation time (T) were exploited. In general, the abatement efficiency tended to be improved with the increase of Camp number (in the study range of this work: Camp number lower than 8058 and 5639 in CFB and TFB, respectively). However, the efficiency was relatively low and sensitive to the Camp number as G was more than 186 s−1 in CFB and 178 s−1 in TFB, respectively. Whereas, increasing flocculation time clearly contributed to the improvement of the abatement efficiency, which is considered to be an effective strategy to enhance the treatment ability. Velocity gradient and flocculation time could be controlled by means of superficial liquid velocity and properties of packing particles. It should be noted that the backmixing in the TFB caused formed flocs to break and thus lower abatement efficiencies were found in the TFB than those in the CFB.
An integrated system for wastewater COD characterization and a case study
Authors: Lu P. , Zhang X. , Zhang D.
Published: August 2010

The guidelines of Activated Sludge Model (ASM) can make the use of modeling more straightforward and systematical. Therefore, this paper aims to develop a guideline for wastewater COD characterization. Four physical-chemical methods were compared experimentally for wastewater characterization in this paper and flocculation + 0.45 μm membrane filtration combining respirometry was selected to determine soluble inert COD. Simultaneous determination of readily and slowly biodegradable COD through respirometric measurement of raw wastewater was proved feasible. In addition, two methods were evaluated to determine heterotrophic biomass. In light of these investigations, an integrated system for characterizing wastewater COD fractions defined in ASM1 was proposed and then applied to characterize influent COD of a treatment plant. By following this guideline, a detailed and practical COD characterization can be obtained. Moreover, this study could also provide an example for the development of more widely accepted guidelines.
Towards a generic rainfall-runoff model for green roofs
Authors: Kasmin H. , Stovin V. R. , Hathway E. A.
Published: August 2010

A simple conceptual model for green roof hydrological processes is shown to reproduce monitored data, both during a storm event, and over a longer continuous simulation period. The model comprises a substrate moisture storage component and a transient storage component. Storage within the substrate represents the roof's overall stormwater retention capacity (or initial losses). Following a storm event the retention capacity is restored by evapotranspiration (ET). However, standard methods for quantifying ET do not exist. Monthly ET values are identified using four different approaches: analysis of storm event antecedent dry weather period and initial losses data; calibration of the ET parameter in a continuous simulation model; use of the Thornthwaite ET formula; and direct laboratory measurement of evaporation. There appears to be potential to adapt the Thornthwaite ET formula to provide monthly ET estimates from local temperature data. The development of a standardized laboratory test for ET will enable differences resulting from substrate characteristics to be quantified.
The ecological impact of membrane-based extraction of phenolic compounds – a life cycle assessment study
Authors: Bayer C. , Follmann M. , Melin T. , Wintgens T. , Larsson K. , Almemark M.
Published: August 2010

Many phenolic compounds show high boiling points, low molecular weights, moderate polarities or high toxicities. Therefore, conventional wastewater treatment is limited or expensive. Recycling of the separated compounds is often not possible. But, if liquid-liquid reactive extraction is linked to a non-porous membrane, some or all of the above mentioned limitations may be overcome. The key element is a composite membrane with a dense, hydrophobic top layer which avoids the mixing of the two aqueous fluid streams. The dilute phenol stream is one of them, the other is caustic soda as stripping solvent. Since the basics of this technology have been discussed before, the scope of this study is to facilitate process implementation and integration. To this end, a life cycle assessment framework is used to identify the optimal equipment size for the treatment of wastewater that may, for example, originate from the production of polycarbonate. Limiting for this application is not the environmental performance though, but most likely process economics.
Oxidation and coagulation of humic substances by potassium ferrate
Authors: Graham N. J. D. , Khoi T. T. , Jiang J.-Q.
Published: August 2010

Ferrate (FeO42−) is believed to have a dual role in water treatment, both as oxidant and coagulant. Few studies have considered the coagulation effect in detail, mainly because of the difficulty of separating the oxidation and coagulation effects. This paper summarises some preliminary results from laboratory-based experiments that are investigating the coagulation reaction dynamically via a PDA instrument, between ferrate and humic acid (HA) at different doses and pH values, and comparing the observations with the use of ferric chloride. The PDA output gives a comparative measure of the rate of floc growth and the magnitude of floc formation. The results of the tests show some significant differences in the pattern of behaviour between ferrate and ferric chloride. At pH 5 the chemical dose range (as Fe) corresponding to HA coagulation was much broader for ferrate than ferric chloride, and the optimal Fe dose was greater. Ferrate oxidation appears to increase the hydrophilic and electronegative nature of the HA leading to an extended region of charge neutralisation. A consequence of the ferrate oxidation is that the extent of HA removal was slightly lower (∼5%) than with ferric chloride. At pH 7, in the sweep flocculation domain, ferrate achieved much greater floc formation than ferric chloride, but a substantially lower degree of HA removal.
Modelling the catchment-scale environmental impacts of wastewater treatment in an urban sewage system for CO2 emission assessment
Authors: Mouri Goro , Oki Taikan
Published: August 2010

Water shortages and water pollution are a global problem. Increases in population can have further acute effects on water cycles and on the availability of water resources. Thus, wastewater management plays an important role in mitigating negative impacts on natural ecosystems and human environments and is an important area of research. In this study, we modelled catchment-scale hydrology, including water balances, rainfall, contamination, and urban wastewater treatment. The entire water resource system of a basin, including a forest catchment and an urban city area, was evaluated synthetically from a spatial distribution perspective with respect to water quantity and quality; the Life Cycle Assessment (LCA) technique was applied to optimize wastewater treatment management with the aim of improving water quality and reducing CO2 emissions. A numerical model was developed to predict the water cycle and contamination in the catchment and city; the effect of a wastewater treatment system on the urban region was evaluated; pollution loads were evaluated quantitatively; and the effects of excluding rainwater from the treatment system during flooding and of urban rainwater control on water quality were examined. Analysis indicated that controlling the amount of rainwater inflow to a wastewater treatment plant (WWTP) in an urban area with a combined sewer system has a large impact on reducing CO2 emissions because of the load reduction on the urban sewage system.
Determination of metoprolol in pure and pharmaceutical dosage forms by spectrofluorometry and high performance liquid chromatography
Authors: Yilmaz Bilal , Meral Kadem , Asci Ali , Organer Yavuz
Published: August 2010

In this study, a new and rapid spectrofluorometry and high performance liquid
chromatography (HPLC) methods were developed for determination of metoprolol
in pure and pharmaceutical dosage forms. The solvent system, wavelength of
detection and chromatographic conditions were optimized in order to maximize
the sensitivity of both the proposed methods. The linearity was established
over the concentration range of 50-4000 ng ml-1 for spectrofluorometry and
5.0-300 ng ml-1 for HPLC methods. The intra- and inter-day relative standard
deviation (RSD) was less than 4.14 and 3.86% for spectrofluorometry and HPLC,
respectively. Limit of quantitation was determined as 30 and 5.0 ng ml-1 for
spectrofluorometry and HPLC, respectively. No interference was found from
tablet excipients at the selected assay conditions. The methods were applied
for the quality control of commercial metoprolol dosage forms to quantify the
drug and to check the formulation content uniformity.
Perforation of a malignant ovarian tumor into the recto‐sigmoid colon
Authors: Bats Anne‐Sophie , Rockall Andrea G. , Singh Naveena , Reznek Rodney H. , Jeyarajah Arjun
Published: August 2010

Ovarian cancer often presents at an advanced stage, but tends to be an intra‐peritoneal disease that respects peritoneal planes. Thus, colo‐rectal perforation of the tumor is an extremely rare presentation. The surgical treatment of malignant colo‐ovarian fistula should include complete cyto‐reduction at the same time as the treatment of the fistula. However, prognosis remains poor, because of the advanced stage of neoplasia. We report the case of a patient with an ovarian malignant tumor perforating into the recto‐sigmoid colon. CT scan was the cornerstone of the radiological diagnosis. We managed to perform a complete cyto‐reduction, including an en‐bloc resection of the uterus, the mass, adnexa and recto‐sigmoid with removal of the associated pelvic abscess.
Isolated Fallopian tube torsion: a series of six cases
Authors: Wong Sze‐Wai A. , Suen Sik‐Hung S. , Lao Terence , Chung Kwok‐Hung T.
Published: August 2010

Isolated Fallopian tube torsion is a rare gynecological cause of acute lower abdominal pain. Currently, there are no pathognomonic symptoms, clinical findings, imaging or laboratory characteristics for this condition, and the diagnosis can rarely be made before operation. We have identified six cases of isolated Fallopian tube torsion treated over a period of 3 years. It was observed that acute onset of abdominal pain with gastrointestinal symptoms can be the initial presenting features. Clinical and laboratory findings included positive peritoneal signs, fever, tachycardia and leucocytosis. Most of the women had preoperative ultrasound showing tubular adnexal masses of heterogeneous echogenicity with cystic component and the presence of free fluid. In contrast to the belief that isolated Fallopian tube torsion is more common in the right side, in five of our cases it occurred in the left side.
Methotrexate‐based bilateral uterine arterial chemoembolization for treatment of cesarean scar pregnancy
Authors: Liang Fengbing , He Jing
Published: August 2010

We have evaluated the efficacy of methotrexate‐based bilateral uterine arterial chemoembolization for treating cesarean scar pregnancy (CSP) in 52 women between January 2005 and December 2009. Ten patients experienced massive vaginal hemorrhage after a misdiagnosis and subsequent curettage. Bleeding in these patients was reduced after chemoembolization. Dilation and curettage was not done in five of these patients because ultrasound scanning showed sparse or no blood flow in the previous gestational sac area. The five remaining patients, along with additional 42 patients who were diagnosed with CSP, underwent ultrasound‐guided dilation and curettage within 24–48 hours following chemoembolization. Patients tolerated the procedure well and only mild bleeding occurred. The positive clinical outcomes in these patients support the use of bilateral uterine artery chemoembolization for the treatment of CSP.
Medical students learning the pelvic examination: evaluation of a clinical patient model
Authors: Wånggren Kjell , Pettersson Gunilla , Gemzell‐Danielsson Kristina
Published: August 2010

Objective. To evaluate a clinical patient (CP) model for training in pelvic examination. Design. Prospective clinical study. Population. Students attending the course in obstetrics and gynecology and patients at Karolinska University Hospital, Stockholm, Sweden. Main outcome measures. Feelings, attitudes and skills of medical students and ratings from CPs in connection to training in the pelvic examination. Methods. Each student participated in two training sessions at an outpatient clinic. The student participants answered questionnaires after each clinical session to measure different aspects of experiencing distress and to themselves rate the technical performance of the examination as well as the interaction with the CP. The CP answered questions about the examination, communication, information provided by the student and how they felt about participating in a teaching session. Results. The students rated their own performance high including both interpersonal communication and the technical examination. It was felt that the teacher as well as the CP gave good support and guidance. The CPs rated interpersonal communication skills by the students high. The teaching session was regarded as important and useful by both students and CPs. Conclusions. We recommend the use of this type of training sessions where students are allowed to work more independently and train in the role as a doctor under supervision of the teacher.
Foot Function After Fusion of the First Metatarsophalangeal Joint
Authors: Doeselaar Dimitri J. van , Heesterbeek Petra J.C. , Louwerens Jan Willem K. , Swierstra Bart A.
Published: August 2010

Background: We measured with a validated score the operative outcome in patients without concomitant foot surgery who underwent fusion of the first metatarsophalangeal (MTP) joint for hallux rigidus (HR) and hallux valgus (HV). We also examined whether there is a correlation between foot function and hallux position to try to formulate an optimum fusion angle. Materials and Methods: Between 2002 and 2005, a consecutive series of 62 patients underwent crossed screw fusion of the first MTP joint (27 HR and 35 HV) without concomitant surgery of the same or contralateral foot or had previous surgery of the same foot. Foot function was measured by the Dutch Foot Function Index (FFI) pre- and postoperatively. Hallux valgus and dorsiflexion angles were measured on standing radiographs before operation and at followup. Results: Postoperatively the median hallux valgus angle was 14 (range, −2 to 33) degrees and the median dorsiflexion angle was 23 (range, 7 to 45) degrees. The median FFI score improved from 38 (range, 0 to 80) to 8 (range, 0 to 59) ( p < 0.001). The FFI score was not different between the HV and HR groups. There was no correlation between postoperative foot function, dorsiflexion angles and hallux valgus angles. Conclusion: Fusion of the first MTP joint in HR and HV results in improved function according to the validated FFI. There was no significant correlation between foot function and hallux position. This could be due to the fact that the desired position of the hallux was most often achieved.

Level of Evidence: II, Prospective Comparative Study
Scarf Osteotomy for Correction of Tailor's Bunion: Mid- to Long-Term Followup
Authors: Maher Anthony J. , Kilmartin Timothy E.
Published: August 2010

Background: The purpose of the study was to evaluate the increased correction possible with a mid shaft rotational osteotomy with the stability and ease of fixation associated with a scarf osteotomy. Materials and Methods: Between September 1999 and September 2006, 63 patients underwent operative repair of 77 Tailor's bunion deformities. Twenty eight patients (36 feet) were available for a final review (nine males and 19 females). A further seven patients (nine feet) completed a questionnaire. The mean followup period for the 28 patients reviewed in clinic was 6.5 years, (79.5 months; SD, 22). Results: Eighty-six percent were completely satisfied, 11.4% were satisfied with reservations and 3% were dissatisfied. Ninety-one percent considered themselves better than before their surgery while 8.6% felt they were no better. Ninety-one percent of patients said they would undergo surgery under the same conditions again. Preoperatively, the mean 4–5 intermetatarsal angle measured on weightbearing X-rays was 9.9 degrees (SD, 2.2), the mean postoperative intermetatarsal angle was 5.7 degrees (SD, 2.0). The mean preoperative AOFAS score was 44.1 (SD, 14.5) and the mean postoperative score at 6-month review was 91.8 (SD, 20.2). The AOFAS score at final review was 88.1 (SD, 11.6). Conclusion: The rotational scarf osteotomy was a reliable procedure for the correction of Tailor's bunion deformities. The osteotomy allowed for early mobilization and had few associated complications. The rotational scarf osteotomy facilitated correction of the intermetatarsal angle while maintaining excellent sagittal and transverse plane stability.

Level of Evidence: IV, Case Series
Insertional Achilles Tendinopathy Management: A Systematic Review
Authors: Kearney Rebecca , Costa Matthew L.
Published: August 2010

Background: Achilles tendinopathy is a common problem and its management remains controversial. However, many clinicians consider that the sub-group of patients with insertional Achilles tendinopathy are even more difficult to manage. The aim of this systematic review was to review evidence for interventions specific to insertional Achilles tendinopathy. Materials & Methods: Medline and the Cochrane library were searched using a pre-defined search strategy. All study designs were included except case studies, narrative reviews, technical notes and letters/personal opinion. The results were evaluated independently by two reviewers and assessed against the inclusion/exclusion criteria. All included articles were assessed for methodological quality and study characteristics were extracted into a table. Results: One hundred eighteen articles were identified through the search strategy, of which 11 met the eligibility criteria. Six studies evaluated operative techniques following failed conservative management and five evaluated conservative interventions only. The overall level of evidence was limited to case series evaluations and one randomized controlled trial. Conclusion: There is a consensus that conservative methods should be used before operative interventions. Current evidence for conservative treatment favors eccentric loading and shock wave therapy, although there is limited evidence by which to judge their effectiveness. Evaluation of operative interventions has been mostly retrospective and remains inconclusive.

Level of Evidence: III, Systematic Review of Level III and IV Studies
The Strength of Achilles Tendon Repair: A Comparison of Three Suture Techniques in Human Cadaver Tendons
Authors: McCoy Brett W. , Haddad Steven L.
Published: August 2010

Background: A previous study suggests the double Krackow suture (locking-loop) weave technique is nearly twice as strong as the single Bunnell or single Kessler suture repair techniques. Our hypothesis was that the strength of different repair techniques would be comparable if a similar number of suture strands cross the repair site. Materials and Methods: Twenty-four fresh-frozen human cadaver Achilles tendons were used to test maximum strength of three suture techniques (double Bunnell, double Kessler, and double Krackow). The simulated ruptures were created in the midsubstance of the Achilles tendon, five centimeters proximal to its calcaneal insertion. All repairs were performed with No. 2 polyester (Mersilene, Ethicon, Sommerville, NJ) nonabsorbable suture in standard fashion for each technique, with four strands crossing the repair site. The tendons were then anchored to a materials testing machine (Instron, Canton, MA) through a calcaneal pin distally and a modified soft tissue clamp proximally. Tendons were loaded with continuous tension at a head speed of 0.85 cm/s. Results: All repairs failed at the site of the suture knots, none pulling out through the substance of the tendon. A one-way analysis of variance was performed on the maximum force at failure of each repair technique. No statistically significant difference was noted between the double Krackow weave (199.9 ± 20 N), the double Bunnell weave (196.2 ± 45 N), and the double Kessler weave (166.9 ± 51 N). Conclusion: We found that in a laboratory model of cadaveric Achilles tendon repairs there was no significant difference in strength between the Krackow, Bunnell, and Kessler suture techniques, when each was performed with a double suture weave. Clinical Relevance: This is a cadaveric study that attempts to simulate the clinical parameters of Achilles tendon ruptures, repairs, and repair failures to examine the strength of different repair techniques.
Metatarsal Giant Cell Tumor in Adolescents
Authors: Bibbo Christopher
Published: August 2010

Level of Evidence: V, Expert Opinion
Neglected Sever's Disease as a Cause of Calcaneal Apophyseal Avulsion Fracture: Case Report
Authors: Lee Kyung Tai , Young Ki Won , Park Young Uk , Park Shin Yi , Kim Ki Chun
Published: August 2010

Level of Evidence; V, Expert Opinion
Securing Fluid Resources for Geothermal Projects in a World of Water Scarcity
Authors: Callison Kathleen
Published: August 2010

Water in some form plays a critical role in geothermal projects, given current technology. This paper explores inconsistencies in treatment of water and geothermal resources at the federal and state levels, and discusses legal and practical issues the developer should consider, relating to use of water, geothermal resources, and alternative sources of water supply. The developer is urged to incorporate water resource planning into project planning beginning at the project feasibility stage, and to seek creative solutions, possibly in cooperation with key stakeholders in the project area, to secure needed fluid resources.
Do Questions Reflecting Indoor Air Pollutant Exposure from a Questionnaire Predict Direct Measure of Exposure in Owner-Occupied Houses?
Authors: Loo C.K. Jennifer , Foty Richard G. , Wheeler Amanda J. , Miller J. David , Evans Greg , Stieb David M. , Dell Sharon D.
Published: August 2010

Home characteristic questions are used in epidemiological studies and clinical settings to assess potentially harmful exposures in the home. The objective of this study was to determine whether questionnaire-reported home characteristics can predict directly measured pollutants. Sixty home inspections were conducted on a subsample of the 2006 population-based Toronto Child Health Evaluation Questionnaire. Indoor/outdoor air and settled dust samples were analyzed. Mean Fel d 1 was higher (p < 0.0001) in homes with a cat (450.58 µg/g) versus without (22.28 µg/g). Mean indoor NO2 was higher (p = 0.003) in homes with gas stoves (14.98 ppb) versus without (8.31 ppb). Self-reported musty odours predicted higher glucan levels (10554.37 µg/g versus 6308.58 µg/g, p = 0.0077). Der f 1 was predicted by the home’s age, but not by reports of carpets, and was higher in homes with mean relative humidity > 50% (61.30 µg/g, versus 6.24 µg/g, p = 0.002). Self-reported presence of a cat, a gas stove, musty odours, mice, and the home’s age and indoor relative humidity over 50% predicted measured indoor levels of cat allergens, NO2, fungal glucan, mouse allergens and dust mite allergens, respectively. These results are helpful for understanding the significance of indoor exposures ascertained by self-reporting in large epidemiological studies and also in the clinical setting.
Dendritic Cell Regulation by Cannabinoid-Based Drugs
Authors: Svensson Mattias , Chen Puran , Hammarfjord Oscar
Published: August 2010

Cannabinoid pharmacology has made important advances in recent years after the cannabinoid system was discovered. Studies in experimental models and in humans have produced promising results using cannabinoid-based drugs for the treatment of obesity and cancer, as well as neuroinflammatory and chronic inflammatory diseases. Moreover, as we discuss here, additional studies also indicates that these drugs have immunosuppressive and anti-inflammatory properties including modulation of immune cell function. Thus, manipulation of the endocannabinoid system in vivo may provide novel therapeutic strategies against inflammatory disorders. At least two types of cannabinoid receptors, cannabinoid 1 and cannabinoid 2 receptors are expressed on immune cells such as dendritic cells (DC). Dendritic cells are recognized for their critical role in initiating and maintaining immune responses. Therefore, DC are potential targets for cannabinoid-mediated modulation. Here, we review the effects of cannabinoids on DC and provide some perspective concerning the therapeutic potential of cannabinoids for the treatment of human diseases involving aberrant inflammatory processes.
An analytical perspective on the Fellowship Narrative of Genesis 18:1–15
Authors: Keun Ahn Sang , Venter Pieter M.
Published: August 2010

The narrative in Genesis 18:1–15 deals with God’s visit to Abraham at Mamre. The general tendency in the interpretation of this narrative is to focus on Abraham’s hospitality. It is usually interpreted as an example of his righteousness, in line with Hebrews 13:2, or with the test motive of the Greek myth of the birth of Orion. These interpretations, however, seem to be in conflict with the narrator’s own theological views.This study, therefore, attempts to explore the view point of the author of the Fellowship Narrative (Gn 18:1–15) within the context of the larger Abraham narrative (Gn 11:27–25:11). The method used for the investigation is mainly that of narrative criticism. Attention is paid to the narrator’s various literary skills: ‘linking structure with preceding episode’ (Gn 18:1a), the ‘sandwiched structure’ of the larger context (Gn 18:1–21:7), the unique plot sequence, as well as repeated clue words and phrases (such as ‘laugh’, ‘Sarah’ and ‘this time next year’). These literary aspects are used by the narrator to depict the faithfulness of the Lord who fulfils what he promised. The conclusion of this study overturns the traditional interpretations of the Fellowship Narrative.
Apolipoprotein E gene polymorphism and total serum cholesterol level in Iranian population
Authors: Bazzaz JT , Nazari M , Nazem H , Amiri P , Fakhrzadeh H , Heshmat R , Abbaszadeh S , Amoli MM
Published: August 2010

Background:

Apolipoprotein E (APOE) is known as a major regulator of blood lipid levels in humans. A number of APOE gene allelic variants have been reported including E2, E3 and E4. Recent studies suggested a role for APOE in obesity and increased Body Mass Index (BMI) and plasma lipid levels in obese children.

Aim:

The aim of this study was to examine the association between APOE genetic variants and the BMI and lipid profile in an Iranian cohort. Setting and Design: Samples were obtained from subjects who participated in a study based on the WHO-designed MONICA (multinational monitoring of trends and determinants in cardiovascular disease) study for coronary artery disease risk assessment in Zone 17 of Tehran. The study was approved by the local ethical committee. Informed consent was obtained from all subjects included in this study. Materials and Methods: Subjects (n=320) were recruited. The level of triglyceride (TG) and total serum cholesterol was tested for all subjects in this study. Genotyping for APOE was carried using polymerase chain reaction-Restriction fragment length polymorphism (PCR-RFLP)technique.

Statistical Analysis:

Levels of significance were determined using contingency tables by either Chi-square or Fisher exact analysis using the STATA (v8) software. The analysis of regression and significance of differences for level of cholesterol and TG was established by one-way analysis of variance followed by Dunnett post hoc multiple comparison tests using SPSS software Version 11.5.

Results:

The frequency of allele E2 was significantly higher in patients with total serum cholesterol level <200 mg/dl (P 0.01 OR 2.1 95% CI 1.1-4.2).

Conclusion:

The association found in this study between allele E2 and lower total cholesterol level had been reported in previous studies. We have also observed that the frequency of genotype E2/E3 and E2/E4 was significantly higher in patients with normal total serum cholesterol level compared to patients with abnormal cholesterol (P=0.003 OR 2.4 95% CI; 1.3-4.6). Our data needs to be repeated in a larger population with more information for serum LDL and HDL levels and their subgroups.
Paradoxical embolism causing stroke and migraine
Authors: Nightingale S , Ray GS
Published: August 2010

This case report describes a lady who underwent investigations as a part of a clinical study. A 32-year-old woman with a history of episodes of severe migraine with aura, deep vein thrombosis and recurrent epistaxis, presented with two episodes of stroke with no particular cause evident on routine investigations. A contrast echocardiogram demonstrated a patent foramen ovale (PFO). She was found to be positive for the Factor V Leiden mutation. The PFO was closed percutaneously. However, a substantial right to left shunt of 14% persisted. Pulmonary angiography revealed multiple arterio-venous malformations (AVMs) and she was diagnosed with hereditary hemorrhagic telangiectasia. The AVMs were embolized and she has had no further cerebral events. Interestingly, her episodes of 'migraine' have also improved dramatically following the closure of the PFO and the embolization of the AVMs. This case demonstrates the complex relationship between right to left shunts, cryptogenic stroke and migraine.
Takotsubo cardiomyopathy presenting as postoperative atrial fibrillation
Authors: Shah NR , Wallis W
Published: August 2010

Takotsubo cardiomyopathy (TC) is a condition which was first acknowledged in Japan and is characterized by a reversible systolic dysfunction of the apical or mid segments of the left ventricle. Typically affecting women in the post-menopausal population, it is triggered by intense emotional, physical or medical stress. Also known as apical ballooning syndrome or stress cardiomyopathy, TC derives its name from the left ventricular angiographic appearance of a 'Takotsubo', literally translated as an 'octopus fishing trap' in Japanese. Patients often describe chest pain, have ischemic electrocardiogram (ECG) changes and positive cardiac enzymes mimicking an acute coronary syndrome. Obstructive coronary artery disease is excluded with prompt cardiac catheterization. We present the case of a 78-year-old lady, post gynecological surgery, presenting with palpitations and ECG confirming fast atrial fibrillation. Despite spontaneous cardioversion, she went on to develop ECG changes and cardiac enzyme elevations suggestive of an acute myocardial infarction. Cardiac catheterization was performed and confirmed the diagnosis of TC. It highlights an atypical presentation of TC, which can present initially as an arrhythmia in the postoperative phase as a consequence of the supraphysiological effects of elevated circulating plasma catecholamines. It reiterates the importance of prompt diagnosis and treatment to prevent cardiac decompensation in a condition poorly understood.
Maternal indicators and obstetric outcome in the north Indian population
Authors: Kumar A , Chaudhary K , Prasad S
Published: August 2010

Background:

Understanding the effect of maternal parameters on obstetric outcome has public health importance because these indicators are associated with infant health and survival and influence development and health in later life.

Aim:

To determine the effects of various maternal indicators on pregnancy outcome in north-Indian women. Settings and Design: A prospective study of all consecutive women with singleton pregnancy, who were registered in the first two months of pregnancy and delivered in the hospital.

Materials and Methods:

Maternal indicators such as age, height, prepregnancy weight, body mass index (BMI), hemoglobin and parity were correlated with pregnancy outcome. The women with a medical disorder or complication that developed during the course of pregnancy were excluded.

Results:

A total of 2027 women were analyzed. Maternal height, weight, BMI and parity had a positive significant correlation with birth weight of the newborn (r=0.081, P value < 0.001, r=0.148, P value <0.001, r = 0.121, P value < 0.001 and r = 0.099, P value < 0.001, respectively). Maternal height, weight and period of gestation were significant indicators for low birth weight on multivariate logistic regression. The rate of preterm delivery was significantly higher in women with hemoglobin < 7 g% and women with parity >3. The chances of caesarian section increased significantly with increase in maternal height, weight and BMI.

Conclusions:

A prepregnancy weight of more than 40 kg, BMI of more than 19.8 and hemoglobin of at least 7g% or more favor good obstetric outcome.