bluuebunny/crossref_metadata_2025 huggingface dataset:
PAR-3 mediates the initial clustering and apical localization of junction and polarity proteins duringC. elegansintestinal epithelial cell polarization
Authors: Achilleos Annita , Wehman Ann M. , Nance Jeremy
Published: April 2010

The apicobasal polarity of epithelial cells is critical for organ morphogenesis and function, and loss of polarity can promote tumorigenesis. Most epithelial cells form when precursor cells receive a polarization cue, develop distinct apical and basolateral domains and assemble junctions near their apical surface. The scaffolding protein PAR-3 regulates epithelial cell polarity, but its cellular role in the transition from precursor cell to polarized epithelial cell has not been determined in vivo. Here, we use a targeted protein-degradation strategy to remove PAR-3 from C. elegans embryos and examine its cellular role as intestinal precursor cells become polarized epithelial cells. At initial stages of polarization, PAR-3 accumulates in cortical foci that contain E-cadherin, other adherens junction proteins, and the polarity proteins PAR-6 and PKC-3. Using live imaging, we show that PAR-3 foci move apically and cluster, and that PAR-3 is required to assemble E-cadherin into foci and for foci to accumulate at the apical surface. We propose that PAR-3 facilitates polarization by promoting the initial clustering of junction and polarity proteins that then travel and accumulate apically. Unexpectedly, superficial epidermal cells form apical junctions in the absence of PAR-3, and we show that PAR-6 has a PAR-3-independent role in these cells to promote apical junction maturation. These findings indicate that PAR-3 and PAR-6 function sequentially to position and mature apical junctions, and that the requirement for PAR-3 can vary in different types of epithelial cells.
Drosophilafly straight by fixating objects in the face of expanding optic flow
Authors: Reiser Michael B. , Dickinson Michael H.
Published: April 2010

Flies, like all animals that depend on vision to navigate through the world, must integrate the optic flow created by self-motion with the images generated by prominent features in their environment. Although much is known about the responses of Drosophila melanogaster to rotating flow fields, their reactions to the more complex patterns of motion that occur as they translate through the world are not well understood. In the present study we explore the interactions between two visual reflexes in Drosophila: object fixation and expansion avoidance. As a fly flies forward, it encounters an expanding visual flow field. However, recent results have demonstrated that Drosophila strongly turn away from patterns of expansion. Given the strength of this reflex, it is difficult to explain how flies make forward progress through a visual landscape. This paradox is partially resolved by the finding reported here that when undergoing flight directed towards a conspicuous object, Drosophila will tolerate a level of expansion that would otherwise induce avoidance. This navigation strategy allows flies to fly straight when orienting towards prominent visual features.
Mutation of theDrosophilavesicular GABA transporter disrupts visual figure detection
Authors: Fei Hao , Chow Dawnis M. , Chen Audrey , Romero-Calderón Rafael , Ong Wei S. , Ackerson Larry C. , Maidment Nigel T. , Simpson Julie H. , Frye Mark A. , Krantz David E.
Published: April 2010

The role of gamma amino butyric acid (GABA) release and inhibitory neurotransmission in regulating most behaviors remains unclear. The vesicular GABA transporter (VGAT) is required for the storage of GABA in synaptic vesicles and provides a potentially useful probe for inhibitory circuits. However, specific pharmacologic agents for VGAT are not available, and VGAT knockout mice are embryonically lethal, thus precluding behavioral studies. We have identified the Drosophila ortholog of the vesicular GABA transporter gene (which we refer to as dVGAT), immunocytologically mapped dVGAT protein expression in the larva and adult and characterized a dVGATminos mutant allele. dVGAT is embryonically lethal and we do not detect residual dVGAT expression, suggesting that it is either a strong hypomorph or a null. To investigate the function of VGAT and GABA signaling in adult visual flight behavior, we have selectively rescued the dVGAT mutant during development. We show that reduced GABA release does not compromise the active optomotor control of wide-field pattern motion. Conversely, reduced dVGAT expression disrupts normal object tracking and figure–ground discrimination. These results demonstrate that visual behaviors are segregated by the level of GABA signaling in flies, and more generally establish dVGAT as a model to study the contribution of GABA release to other complex behaviors.
Minimum viewing angle for visually guided ground speed control in bumblebees
Authors: Baird Emily , Kornfeldt Torill , Dacke Marie
Published: April 2010

To control flight, flying insects extract information from the pattern of visual motion generated during flight, known as optic flow. To regulate their ground speed, insects such as honeybees and Drosophila hold the rate of optic flow in the axial direction (front-to-back) constant. A consequence of this strategy is that its performance varies with the minimum viewing angle (the deviation from the frontal direction of the longitudinal axis of the insect) at which changes in axial optic flow are detected. The greater this angle, the later changes in the rate of optic flow, caused by changes in the density of the environment, will be detected. The aim of the present study is to examine the mechanisms of ground speed control in bumblebees and to identify the extent of the visual range over which optic flow for ground speed control is measured. Bumblebees were trained to fly through an experimental tunnel consisting of parallel vertical walls. Flights were recorded when (1) the distance between the tunnel walls was either 15 or 30 cm, (2) the visual texture on the tunnel walls provided either strong or weak optic flow cues and (3) the distance between the walls changed abruptly halfway along the tunnel's length. The results reveal that bumblebees regulate ground speed using optic flow cues and that changes in the rate of optic flow are detected at a minimum viewing angle of 23–30 deg., with a visual field that extends to approximately 155 deg. By measuring optic flow over a visual field that has a low minimum viewing angle, bumblebees are able to detect and respond to changes in the proximity of the environment well before they are encountered.
Mast cell population in the frog brain: distribution and influence of thyroid status
Authors: Monteforte Rossella , Pinelli Claudia , Santillo Alessandra , Rastogi Rakesh K. , Polese Gianluca , Baccari Gabriella Chieffi
Published: April 2010

In the developing frog brain, the majority of mast cells (MC) are distributed in the pia mater, and some immature MC are located adjacent to the blood capillaries in and around the neuropil. In the adult brain, MC are more numerous than in pre- and pro-metamorphic tadpoles; they are mainly located within the pia mater and are particularly numerous in the choroid plexuses. Many MC are found within the brain ventricles juxtaposed to the ependymal lining. MC are rarely observed in the brain parenchyma. In the adult brain, MC number is much higher than in the brain of post-metamorphic froglets. In the latter, MC number is nearly 2-fold over that found in the pre-metamorphic brain. Treatment of pre- and pro-metamorphic tadpoles with 3,5,3′-triiodothyronine (T3) and thyroxine (T4) stimulates overall larval development but does not induce a significant change in MC population within the brain. By contrast, treatment with 6-n-propyl-2-thiouracil (PTU) delays larval development and leads to a significant numerical increase of brain MC. In the adult, PTU treatment also has a similar effect whereas hypophysectomy causes a drastic decrease of MC population. The negative effects of hypophysectomy are successfully counteracted by a two-week replacement therapy with homologous pars distalis homogenate. In the adult frog, MC population seems to be refractory to thyroid hormone treatment. The present study on frog brain suggests that pituitary–thyroid axis may be involved in the regulation of MC frequency.
Carotenoid-based coloration predicts resistance to oxidative damage during immune challenge
Authors: Pérez-Rodríguez Lorenzo , Mougeot Francois , Alonso-Alvarez Carlos
Published: April 2010

Many animal ornaments may have evolved as signals advertising the quality of the bearer. The honesty of the information content of these signals would rely on the costs associated with their expression, these being relatively greater for low-quality than for high-quality individuals. Given the physiological functions of carotenoids, carotenoid-based ornaments could indicate individual immunocompetence, and possibly the ability to mount an immune response at a lower cost. We evaluated whether the red carotenoid-based coloration of male red-legged partridges (Alectoris rufa) predicts the capacity of the individual to counteract the oxidative stress generated by a cell-mediated immune response. Individuals were subcutaneously injected with phytohaemagglutinin (PHA) or phosphate buffer solution (PBS) as a control. We found that eye ring pigmentation predicted the change in the amount of peroxidized lipids (TBARS) in blood after the PHA-induced inflammatory challenge. The degree of pigmentation of this carotenoid-based ornament was also negatively related to individual changes in γ-glutamyl transferase (GGT), another biomarker of oxidative stress involved in antioxidant metabolism (i.e. glutathione recycling). However, changes in circulating carotenoids did not significantly explain changes in lipid peroxidation or GGT levels, suggesting that the higher resistance to oxidative stress of those individuals with more pigmented eye rings was not directly mediated by their greater circulating levels of carotenoids. Our results indicate that carotenoid-based coloration can predict not only immune responsiveness (more coloured males mount greater responses) but also an individual's ability to counter the oxidative stress generated during immune challenge (more coloured males experience less oxidative damage when mounting an immune response).
Parental behavior in pythons is responsive to both the hydric and thermal dynamics of the nest
Authors: Stahlschmidt Zachary , DeNardo Dale F.
Published: April 2010

Parental behavior contributes to the success of a diverse array of taxa, and female-only nest attendance is particularly widespread. Python egg-brooding behavior is an intriguing example of female-only nest attendance because it significantly influences several critical developmental variables, namely embryonic predation, hydration, respiration and temperature. During brooding, females predominately adopt a tightly coiled posture that reduces the exchange of heat, water vapor, O2 and CO2 between the nest and clutch environment, which benefits egg water balance at the cost of respiration. To determine the plasticity of this important behavior, we manipulated nest temperature and humidity while monitoring nest–clutch thermal, hydric and respiratory relationships to test the hypothesis that female Children's pythons (Antaresia childreni) modify their egg-brooding behavior due to an interaction between environmental thermal and hydric conditions. During moderate and high nest humidity treatments (23 and 32 g m−3 H2O, respectively), females spent more time coiling tightly when the nest was cooling than when it was warming, which benefited clutch temperature. However, brooding females in low-humidity nest environments (13 g m−3 H2O) showed a high frequency of tight coiling even when the nest was warming; thus, nest temperature and humidity had an interactive effect on egg-brooding behavior in support of our hypothesis. Our results also suggest that certain egg-brooding behaviors (i.e. postural adjustments) are more energetically costly to females than other behaviors (i.e. tight coiling). In sum, we provide empirical support for the adaptive plasticity of python egg-brooding behavior, which offers insight into the general significance of female-only nest attendance in animals.
The spatial frequency tuning of optic-flow-dependent behaviors in the bumblebee Bombus impatiens
Authors: Dyhr Jonathan P. , Higgins Charles M.
Published: April 2010

Insects use visual estimates of flight speed for a variety of behaviors, including visual navigation, odometry, grazing landings and flight speed control, but the neuronal mechanisms underlying speed detection remain unknown. Although many models and theories have been proposed for how the brain extracts the angular speed of the retinal image, termed optic flow, we lack the detailed electrophysiological and behavioral data necessary to conclusively support any one model. One key property by which different models of motion detection can be differentiated is their spatiotemporal frequency tuning. Numerous studies have suggested that optic-flow-dependent behaviors are largely insensitive to the spatial frequency of a visual stimulus, but they have sampled only a narrow range of spatial frequencies, have not always used narrowband stimuli, and have yielded slightly different results between studies based on the behaviors being investigated. In this study, we present a detailed analysis of the spatial frequency dependence of the centering response in the bumblebee Bombus impatiens using sinusoidal and square wave patterns.
Ethnic and social inequalities in women's experience of maternity care in England: results of a national survey
Authors: Raleigh VS , Hussey D , Seccombe I , Hallt K
Published: April 2010

Summary

Objective

To examine ethnic and social inequalities in women's experience of maternity care in England.

Design

A 2007 national survey of women (16 years or over) about their experience of maternity care. Multiple logistic regression analysis, controlling for several maternal characteristics, was used to examine inequalities by ethnicity, partner status and education.

Setting

Sample of records of 149 NHS acute trusts and two primary care trusts (PCTs) providing maternity services in England.

Results

A total of 26,325 women responded to the survey (response rate 59%). Ethnic minority women were more likely than White British women to access services late, not have a scan by 20 weeks, and experience complications during pregnancy and birth. They were more likely to initiate breastfeeding and say they were treated with respect and dignity. Single women responded more negatively to almost all questions than women with a husband/partner. They were less likely to access care within 12 weeks of pregnancy (OR 0.45, 95% CI 0.39–0.52), have a scan at 20 weeks (OR 0.49, 95% CI 0.39–0.63), attend NHS antenatal classes (OR 0.56, 95% CI 0.49–0.65), have a postnatal check-up (OR 0.67, 95% CI 0.60–0.75), and initiate breastfeeding (OR 0.57, 95% CI 0.51–0.62), and were more likely to experience complications. Women completing education at 19+ years were more likely to access services early (OR 1.21, 95% CI 1.04–1.40), attend antenatal classes (OR 1.48, 95% CI 1.31–1.67), have a postnatal check-up (OR 1.19, 95% CI 1.07–1.32) and initiate breastfeeding (OR 3.88, 95% CI 3.56–4.22) than those completing education at 16 years or younger, and were less likely to experience complications.

Conclusions

Ethnic minority women, single mothers, and those with an earlier age at completing education access maternity services late, have poorer outcomes, and report poorer experiences across some – though not all – dimensions of maternity care. Ethnic differences were absent or inconsistent between groups for some aspects of care. We recommend these findings are used by commissioners, trusts and healthcare professionals to inform improvements in maternity services for high-risk groups and reduce inequalities.
Structure and RNA recognition by the snRNA and snoRNA transport factor PHAX
Authors: Mourão André , Varrot Annabelle , Mackereth Cameron D. , Cusack Stephen , Sattler Michael
Published: April 2010

Small nuclear and small nucleolar RNAs (snRNAs and snoRNAs) are critical components of snRNPs and snoRNPs and play an essential role in the maturation of, respectively, mRNAs and rRNAs within the nucleus of eukaryotic cells. Complex and specific pathways exist for the assembly of snRNPs and snoRNPs, involving, for instance, nucleocytoplasmic transport of snRNAs and intranuclear transport between compartments of snoRNAs. The phosphorylated adaptor for nuclear export (PHAX) is required for nuclear export of snRNAs in metazoans and also involved in the intranuclear transport of snoRNAs to Cajal bodies. PHAX contains a conserved single-stranded nucleic acid binding domain (RNA_GG_bind domain) with no sequence homology with any other known RNA-binding module. Here, we report NMR and X-ray crystallography studies that elucidate the structural basis for RNA recognition by the PHAX RNA-binding domain (PHAX-RBD). The crystal structure of the RNA_GG_bind domain from the parasite Cryptosporidium parvum (Cp RBD) forms well-folded dimers in solution in the absence of any ligand. The human PHAX-RBD is monomeric and only adopts a tertiary fold upon RNA binding. The PHAX-RBD represents a novel helical fold and binds single-stranded RNA with micromolar affinity without sequence specificity. RNA recognition by human PHAX-RBD is consistent with mutational analysis that affects RNA binding and PHAX-mediated nuclear export. Our data suggest that the PHAX-RBD mediates auxiliary RNA contacts with the snRNA and snoRNA substrates that are required for transport and/or substrate release.
The influence of malrotation of the femoral component in total knee replacement on the mechanics of patellofemoral contact during gait
Authors: Verlinden C. , Uvin P. , Labey L. , Luyckx J. P. , Bellemans J. , Vandenneucker H.
Published: April 2010

Malrotation of the femoral component is a cause of patellofemoral maltracking after total knee arthroplasty. Its precise effect on the patellofemoral mechanics has not been well quantified. We have developed an in vitro method to measure the influence of patellar maltracking on contact. Maltracking was induced by progressively rotating the femoral component either internally or externally. The contact mechanics were analysed using Tekscan. The results showed that excessive malrotation of the femoral component, both internally and externally, had a significant influence on the mechanics of contact. The contact area decreased with progressive maltracking, with a concomitant increase in contact pressure. The amount of contact area that carries more than the yield stress of ultra-high molecular weight polyethylene significantly increases with progressive maltracking. It is likely that the elevated pressures noted in malrotation could cause accelerated and excessive wear of the patellar button.
Long-term survival of the Souter-Strathclyde total elbow replacement in patients with rheumatoid arthritis
Authors: Ikävalko M. , Tiihonen R. , Skyttä E. T. , Belt E. A.
Published: April 2010

Between 1982 and 1997, 403 consecutive patients (522 elbows) with rheumatoid arthritis underwent Souter-Strathclyde total elbow replacement. By the end of 2007, there had been 66 revisions for aseptic loosening in 60 patients. The mean time of follow-up was 10.6 years (0 to 25) The survival rates at five-, ten, 15 and 19 years were 96% (95%, confidence interval (CI) 95 to 98), 89% (95% CI 86 to 92), 83% (95% CI 78 to 87), and 77% (95% CI 69 to 85), respectively. The small and medium-sized short-stemmed primary humeral components had a 5.6-fold and 3.6-fold risk of revision for aseptic loosening respectively, compared to the medium-sized long-stemmed component. The small and medium-sized all-polyethylene ulnar components had respectively a 28.2-fold and 8.4-fold risk of revision for aseptic loosening, compared to the metal-backed ulnar components.

The use of retentive ulnar components was not associated with an increased risk of aseptic loosening compared to non-retentive implants.
Classification of the morphology of the acromioclavicular joint using cadaveric and radiological analysis
Authors: Colegate-Stone T. , Allom R. , Singh R. , Elias D. A. , Standring S. , Sinha J.
Published: April 2010

The aim of this study was to establish a classification system for the acromioclavicular joint using cadaveric dissection and radiological analyses of both reformatted computed tomographic scans and conventional radiographs centred on the joint. This classification should be useful for planning arthroscopic procedures or introducing a needle and in prospective studies of biomechanical stresses across the joint which may be associated with the development of joint pathology.

We have demonstrated three main three-dimensional morphological groups namely flat, oblique and curved, on both cadaveric examination and radiological assessment. These groups were recognised in both the coronal and axial planes and were independent of age.
Early results of the Acclaim total elbow replacement in patients with primary osteoarthritis
Authors: Naqui S. Z. , Rajpura A. , Nuttall D. , Prasad P. , Trail I. A.
Published: April 2010

This is a retrospective review of the results of the Acclaim total elbow replacement in 11 older patients aged ≥ 65 years with primary osteoarthritis of the elbow, with a mean follow-up of 57.6 months (30 to 86.4).

Significant reductions in pain and improvement in range of movement and function were recorded. Radiological review revealed two patients with 1 mm lucencies in a single zone, and one patient with 1 mm lucencies in two zones. No components required revision. There were no deep infections, dislocations or mechanical failures. Complications included one intra-operative medial condylar fracture and one post-operative transient ulnar neuropathy, which resolved.

This study demonstrates that the Acclaim prosthesis provides good symptomatic relief and improvement of function in patients with primary osteoarthritis, with low rates of loosening or other complications. This prosthesis can therefore be considered for patients aged ≥ 65 years with primary osteoarthritis of the elbow.
Impaction grafting of the acetabulum with a mixture of frozen, ground irradiated bone graft and porous synthetic bone substitute (Apapore 60)
Authors: McNamara I. , Deshpande S. , Porteous M.
Published: April 2010

The clinical and radiological results of 50 consecutive acetabular reconstructions in 48 patients using impaction grafting have been retrospectively reviewed. A 1:1 mixture of frozen, ground irradiated bone graft and Apapore 60, a synthetic bone graft substitute, was used in all cases. There were 13 complex primary and 37 revision procedures with a mean follow-up of five years (3.4 to 7.6). The clinical survival rate was 100%, with improvements in the mean Harris Hip Scores for pain and function. Radiologically, 30 acetabular grafts showed evidence of incorporation, ten had radiolucent lines and two acetabular components migrated initially before stabilising.

Acetabular reconstruction in both primary and revision surgery using a 1:1 mixture of frozen, ground, irriadiated bone and Apapore 60 appears to be a reliable method of managing acetabular defects. Longer follow-up will be required to establish whether this technique is as effective as using fresh-frozen allograft.
Failure of metal radial head replacement
Authors: van Riet R. P. , Sanchez-Sotelo J. , Morrey B. F.
Published: April 2010

There is little information available at present regarding the mechanisms of failure of modern metallic radial head implants. Between 1998 and 2008, 44 consecutive patients (47 elbows) underwent removal of a failed metallic radial head replacement. In 13 patients (13 elbows) the initial operation had been undertaken within one week of a fracture of the radial head, at one to six weeks in seven patients (seven elbows) and more than six weeks (mean of 2.5 years (2 to 65 months)) in 22 patients (25 elbows). In the remaining two elbows the replacement was inserted for non-traumatic reasons. The most common indication for further surgery was painful loosening (31 elbows). Revision was undertaken for stiffness in 18 elbows, instability in nine, and deep infection in two. There were signs of over-lengthening of the radius in 11 elbows. Degenerative changes were found in all but one. Only three loose implants had been fixed with cement. Instability was not identified in any of the bipolar implants.
The Trabecular Metal Monoblock acetabular component in patients with high congenital hip dislocation
Authors: Macheras G. A. , Kateros K. , Koutsostathis S. D. , Tsakotos G. , Galanakos S. , Papadakis S. A.
Published: April 2010

Between November 1997 and December 2000 we performed 27 total hip replacements in 22 patients with high congenital dislocation of the hip using porous tantalum monoblock acetabular components implanted in the true acetabular bed. Clinical and radiological evaluation was performed at regular intervals for a mean of 10.2 years (8.5 to 12). The mean Harris Hip Score improved from 48.3 (15 to 65) pre-operatively to 89.5 (56 to 100) at the final follow-up. The mean Oxford Hip Score was 49.5 (35 to 59) pre-operatively and decreased to 21.2 (12 to 48) at one year and 15.2 (10 to 28) at final follow-up. Migration of the acetabular component was assessed with the EBRA software system. There was a mean migration of 0.68 mm (0.49 to 0.8) in the first year and a mean 0.89 mm (0.6 to 0.98) in the second year, after excluding one initial excessive migration. No revision was necessary for any reason, no acetabular component became loose, and no radiolucent lines were observed at the final follow-up.

The porous tantalum monoblock acetabular component is an implant offering adequate initial stability in conjunction with a modulus of elasticity and porosity close to that of cancellous bone. It favours bone ingrowth, leading to good mid-term results.
Survival analysis in total joint replacement
Authors: Fennema P. , Lubsen J.
Published: April 2010

Survival analysis is an important tool for assessing the outcome of total joint replacement. The Kaplan-Meier method is used to estimate the incidence of revision of a prosthesis over time, but does not account appropriately for competing events which preclude revision. In the presence of competing death, this method will lead to statistical bias and the curve will lose its interpretability. A valid comparison of survival results between studies using the method is impossible without accounting for different rates of competing events. An alternative and easily applicable approach, the cumulative incidence of competing risk, is proposed. Using three simulated data sets and realistic data from a cohort of 406 consecutive cementless total hip prostheses, followed up for a minimum of ten years, both approaches were compared and the magnitude of potential bias was highlighted. The Kaplan-Meier method overestimated the incidence of revision by almost 4% (60% relative difference) in the simulations and more than 1% (31.3% relative difference) in the realistic data set. The cumulative incidence of competing risk approach allows for appropriate accounting of competing risk and, as such, offers an improved ability to compare survival results across studies.
Comparison of standard and gender-specific posterior-cruciate-retaining high-flexion total knee replacements
Authors: Kim Y.-H. , Choi Y. , Kim J.-S.
Published: April 2010

We undertook a study in which 138 female patients with a mean age of 71.2 years (51 to 82) received a standard NexGen CR-flex prosthesis in one knee and a gender-specific NexGen CR-flex prosthesis in the other. The mean follow-up period was 3.25 years (3.1 to 3.5). The aspect ratios of the standard and gender-specific prostheses were compared with that of the distal femur.

The mean post-operative Knee Society knee scores were 94 (70 to 100) and 93 (70 to 100) points and the function scores were 83 (60 to 100) and 84 (60 to 100) points for the standard implants and the gender-specific designs, respectively. The mean post-operative Western Ontario and McMaster Universities score was 26.4 points (0 to 76). Patient satisfaction, the radiological results and the complication rates were similar in the two groups. In those with a standard prosthesis, the femoral component was closely matched in 80 knees (58.0%), overhung in 14 (10.1%) and undercovered the bone in 44 (31.9%). In those with a gender-specific prosthesis, it was closely matched in 15 knees (10.9%) and undercovered the bone in 123 (89.1%).

Since we found no significant differences between the two groups with regard to the clinical and radiological results, patient satisfaction or complication rate, the goal of the design of the gender-specific CR-flex prosthesis to improve the outcome was not achieved in our patients.
Developing guidelines for venous thromboembolism for The National Institute for Clinical Excellence
Authors: Treasure T. , Chong L.-Y. , Sharpin C. , Wonderling D. , Head K. , Hill J.
Published: April 2010

Following the publication in 2007 of the guidelines from the National Institute for Health and Clinical Excellence (NICE) for prophylaxis against venous thromboembolism (VTE) for patients undergoing surgery, concerns were raised by British orthopaedic surgeons as to the appropriateness of the recommendations for their clinical practice. In order to address these concerns NICE and the British Orthopaedic Association agreed to engage a representative panel of orthopaedic surgeons in the process of developing expanded VTE guidelines applicable to all patients admitted to hospital. The functions of this panel were to review the evidence and to consider the applicability and implications in orthopaedic practice in order to advise the main Guideline Development Group in framing recommendations.

The panel considered both direct and indirect evidence of the safety and efficacy, the cost-effectiveness of prophylaxis and its implication in clinical practice for orthopaedic patients. We describe the process of selection of the orthopaedic panel, the evidence considered and the contribution of the panel to the latest guidelines from NICE on the prophylaxis against VTE, published in January 2010.
Infection-free surgery: how to improve hand-hygiene compliance and eradicate methicillin-resistant Staphylococcus aureus from surgical wards
Authors: Davis CR
Published: April 2010

INTRODUCTION

Healthcare-associated infections cost the UK National Health Service £1 billion per annum. Poor hand hygiene is the main route of transmission for methicillin-resistant Staphylococcus aureus (MRSA), leading to increased mortality and morbidity for infected patients. This study aims to quantify MRSA infection rates and compliance of alcohol gel application at the entrance to a surgical ward and assess how a simple intervention affects compliance.

SUBJECTS AND METHODS

Compliance was assessed via a discretely positioned close-surveillance camera at the ward entrance, ootage was reviewed to monitor compliance of all persons entering the ward over a 12-month period.

RESULTS

For the initial 6 months, mean alcohol gel compliance was 24% for all persons entering the ward. After this period, a conspicuous strip of bright red tape was positioned along the corridor approaching the ward entrance. The red line continued up the wall to an arrow head pointing to the two alcohol gel dispensers on the wall. Mean compliance over the subsequent 6 months significantly improved to 62% (P< 0.0001). Compliance improved for all persons entering the ward as follows (before – after, significance): doctors (0% – 54%, P< 0.01); nurses (24% – 75%, P< 0.05); porters (21% – 67%, P< 0.05); visitors (35% – 68%, P< 0.01); patients (23% – 44%, P > 0.05). There were two cases of MRSA bacteraemia in the initial 6 months and no cases in the following 6 months with the red line in situ.

CONCLUSIONS

This study demonstrates how a simple intervention significantly improves hand-hygiene compliance with associated eradication of MRSA.
Soft tissue management of children's open tibial fractures – a review of seventy children over twenty years
Authors: Rao P , Schaverien MV , Stewart KJ
Published: April 2010

INTRODUCTION

The management of open tibial fractures in children represents a unique reconstructive challenge. The aim of the study was to evaluate the management of paediatric open tibial fractures with particular regard to soft tissue management.

PATIENTS AND METHODS

A retrospective case-note analysis was performed for all children presenting with an open tibial fracture at a single institution over a 20-year period for 1985 to 2005.

RESULTS

Seventy children were reviewed of whom 41 were males and 29 females. Overall, 91% (n = 64) of children suffered their injury as a result of a vehicle-related injury. The severity of the fracture with respect to the Gustilo classification was: Grade I, 42% (n = 29); Grade II, 24% (n = 17); Grade III, 34% (n = 24; 7 Grade 3a, 16 Grade 3b, 1 Grade 3c). The majority of children were treated with external fixation and conservative measures, with a mean hospital in-patient stay of 13.3 days. Soft tissue cover was provided by plastic surgeons in 31% of all cases. Four cases of superficial wound infection occurred (6%), one case of osteomyelitis and one case of flap failure. The limb salvage was greater than 98%.

CONCLUSIONS

In this series, complications were associated with delayed involvement of plastic surgeons. Retrospective analysis has shown a decreased incidence of open tibial fractures which is reported in similar studies. Gustilo grade was found to correlate with length of hospital admission and plastic surgery intervention. We advocate, when feasible, the use of local fas-ciocutaneous flaps (such as distally based fasciocutaneous and adipofascial flaps), which showed a low complication rate in children.
Law and medical ethics in organ transplantation surgery
Authors: Woodcock Tom , Wheeler Robert
Published: April 2010

This article in the series describes how UK law and medical ethics have evolved to accommodate developments in organ transplantation surgery. August committees have formulated definitions of the point of death of the person which are compatible with the lawful procurement of functioning vital organs from cadavers. Some of the complexities of dead donor rules are examined. Live donors are a major source of kidneys and the laws that protect them are considered. Financial inducements and other incentives to donate erode the noble concept of altruism, but should they be unlawful?
The operative management of gallstone ileus
Authors: Ravikumar Reena , Williams J Graham
Published: April 2010

INTRODUCTION

Gallstone ileus is an uncommon entity, which accounts for 1–4% of all presentations to hospital with small bowel obstruction and for up to 25% of all cases in patients over 65 years of age. Despite medical advances over the last 350 years, gallstone ileus is still associated with high rates of morbidity and mortality. The management of gallstone ileus remains controversial. Whilst open surgery has been the mainstay of treatment, more recently other approaches have been employed, including laparoscopic surgery and lithotripsy. However, controversy persists primarily in relation to the extent of surgery performed.

MATERIALS AND METHODS

A literature review was performed in an attempt to discover the optimal surgical treatment of gallstone ileus, particularly the timing of biliary surgery. Published articles were identified from the medical literature by electronic searches of Pubmed and Ovid Medline databases, using the search terms ‘gallstone ileus’, ‘gallstone/intestinal obstruction’ and ‘gallstone/bowel obstruction’. The related articles function of the search engines was also used to maximise the number of articles identified. Relevant articles were retrieved and additional articles were identified from the references cited in these articles.

RESULTS AND CONCLUSIONS

The literature on gallstone ileus is composed entirely of retrospective analysis of small numbers of patients accumulated over many years. The question as to whether one stage or interval biliary surgery should be performed remains unanswered and it is unlikely that further case series will help decision making in the management of gallstone ileus. Whilst many authors conclude that enterolithotomy alone is the best option in most patients, a one-stage procedure should be considered for low-risk patients.
More Trainees and Less Operative Exposure: A Quantitative Analysis of Training Opportunities for Junior Surgical Trainees
Authors: Toll EC , Davis CR
Published: April 2010

The evolution of postgraduate medical education in the UK continues to influence the quality of surgical training. Many reforms over the last three decades have affected training, including the Calman reforms, Modernising Medical Careers (MMC) and the European Working Time Directive (EWTD). The net effect of these changes is a reduction in working hours and shorter total training time for surgical trainees. Compounded by increasing subspecialisation, centralisation of surgical services and surgeon-specific data reporting, there may be fewer operative opportunities for surgical trainees.
Establishing a Professional Affairs Board in Wales
Authors: Ferguson Colin
Published: April 2010

Establishing a professional affairs board (PAB) will be different in each of the regions of the UK but presents particular challenges in Wales. The NHS is very important to the Welsh Assembly Government (WAG). It has its own Department of Health; Minister; Director General, Health and Social Services; Chief Medical Officer; Medical Director; and the panoply of government.
Strong foundations
Authors: Black John
Published: April 2010

Medical Education England, the body set up in response to the Tooke report and of which I am a member, has commissioned Professor John Collins, formerly Director of Education at the Royal Australasian College of Surgeons and a fellow of this College, to carry out a review of the foundation programme. The change from two six-month house jobs to a two-year programme of usually four-month attachments was the first step in the disastrous Modernising Medical Careers (MMC) initiative, which fell apart in 2007 after the Medical Training Application Service fiasco. We are told that the foundation programme has been a success and indeed it has not attracted the opprobrium and subsequent rejection by the profession that the rest of the MMC initiative did.
Remnants of a 35-year-old ventriculo-atrial shunt presenting as orofacial pain
Authors: Chiu GA , Nisar K , Shetty S , Baldwin AJ
Published: April 2010

A 36-year-old man presented to his general dental practitioner with pain in the right jaw and neck. This was initially treated as a dento-alveolar abscess. Three days later, he presented to the oral and maxillofacial unit with neck swelling to the right side. An ultrasound confirmed the swelling was due to thrombosis associated with remnants of a ventriculo-atrial (VA) shunt in the right internal jugular vein. This had been placed during the patient’s infancy and apparently removed at the age of 8 years. The patient was treated conservatively with warfarin and Coamoxyclav. The patient made a full recovery and was placed on long-term anticoagulant therapy. The introduction of cerebral spinal fluid shunt procedures for the treatment of hydrocephalus has resulted in a reduction in the mortality rate from 80% to 15–20%. Various thrombo-embolic complications have been described with VA shunts. A thorough medical history is absolutely essential in order to identify uncommon causes of common presentations.
A massive left paraduodenal fossa hernia as an unusual cause of small bowel obstruction
Authors: Virich George , Davies Ward
Published: April 2010

We present our experience in diagnosing and treating a case of a massive left paraduodenal fossa hernia, containing over 30% of the small bowel, presenting with a history of recurrent incomplete small bowel obstruction.
Giant inguinoscrotal hernia presenting with acute renal failure: a case report and review of literature
Authors: Goonetilleke Kolitha , McIlroy Brendon
Published: April 2010

We present a case of a giant inguinoscrotal hernia. The patient presented with acute renal failure secondary to obstructive uropathy caused by a large inguinoscrotal hernia. It was treated by reduction of its contents through a right transverse abdominal incision below the arcuate line. The hernial sac contained loops of small bowel along with its mesentery, appendix, caecum and ascending colon. The defect was repaired using Marlex mesh.
A review of problems following insertion of biliary stents illustrated by an unusual complication
Authors: Bagul Atul , Pollard Cristina , Dennison Ashley R
Published: April 2010

Introduction

The management of obstructive jaundice resulting from both benign and malignant causes relies heavily on minimally invasive techniques and particularly with the insertion of biliary endoprostheses. Migration of these biliary stents is a well-documented problem and can result in a variety of complications including perforation, intra-abdominal sepsis, fistulae formation, obstruction and appendicitis.

Methods

A literature search was performed using PubMed examining case reports, published abstracts and reviews to date (2009). In addition, we report a left groin abscess as a previously unreported complication following migration of a biliary endoprosthesis.

Findings

Stent migration can lead to serious complications and produce significant morbidity and mortality. Symptomatic patients especially those with other co-morbid abdominal pathologies such as colonic diverticulae, parastomal hernia or abdominal hernias may be at an increased risk of perforation especially when straight plastic stents are used.
A retropharyngeal multinodular goitre
Authors: Lakhani R , Nijjar R , Fishman JM , Jefferis AF
Published: April 2010

Thyroid goitre usually presents as a mid-line lump in the neck with or without compressive symptoms. More commonly, the goitre can extend inferiorly into the mediastinum resulting in a retrosternal goitre. We present an unusual case of goiterous enlargement of the thyroid gland into the retropharyngeal space presenting as a retropharyngeal mass.
Critical Tensions in Talk About Brain Injury
Authors: Ferguson Alison
Published: April 2010

This article presents an introduction to some potential applications of a critical discourse perspective to the field of traumatic brain injury. Critical Discourse Analysis (CDA) examines spoken and written texts as a means to understand the two-way relationship between discourse and cultural context. CDA is particularly interested in how language use reflects and creates power relationships between those involved in the communication. In order to illustrate this perspective, this paper discusses a purposively selected set of written texts about brain injury from a range of institutional contexts: a scholarly journal article, a submission to government from an advocacy group, the home web page of a support group, a newspaper article from the general media, and personal letters written by people with traumatic brain injury. The analysis involved investigation of key linguistic features reflecting the experiential, interpersonal and textual aspects of these texts. Three main lines of tension between competing discourses emerged from an examination. Tension emerged within each text between medical vs. lay terminology, and this was seen as reflecting the widespread power of the scientific paradigm. Tension was apparent between problem talk vs. positive talk. Talk about the problems associated with brain injury forms an essential component when seeking support, and yet talk about positive outcomes forms an essential component when describing the rehabilitation journey. There were also competing discourses in terms of the focus of the talk, between person centredness vs. other centredness. The methodology of CDA is proposed as a tool for reflective clinical practice at both an individual and professional level, as it provides a systematic means to examine health professionals' interactions and promotes the development of a critical understanding of the cultural ideologies and institutions in which practice is located.
Novel Approach Towards Calculation of Averaged Activation Energy Based on Arrhenius Plot for Predicting the Effect of Temperature on Chloride Induced Corrosion of Steel in Concrete
Authors: Hussain Raja Rizwan , Ishida Tetsuya
Published: April 2010

Reinforced concrete structures exposed to aggressive environments such as severe chloride attack coupled with high temperature suffer from accelerated corrosion. The objective of this paper is to model and verify the effect of temperature on chloride induced corrosion potential and corrosion rate of steel in concrete by incorporating a novel approach towards calculation of averaged activation energy based on Arrhenius plot. This paper presents a semiempirical corrosion modeling approach which obeys the basic corrosion science laws and is also verified by the experimentation involving a wide range of chloride and temperature variations (0 %–10 % total chlorides and 20–60°C temperatures). The modeling task has been incorporated by the use of a concrete durability model developed by our research group at the University of Tokyo as a computational platform on which the coupled temperature-chloride induced corrosion throughout the life of reinforced concrete structures is examined in both space and time domains.
Gigacycle Fatigue Properties of Bearing Steels
Authors: Bathias Claude
Published: April 2010

The concept of a fatigue limit at 106 cycles that was introduced by Wohler in 1850 seems nowadays to be the wrong magnitude when considering the fatigue life of modern industrial applications such as automotive engines that run typically billions of cycles. The necessity to increase performances in terms of lifetime and safety in steel fabricated products remains an issue, although testing is becoming more time consuming and costly with current design products. It is the aim of our research to develop better understanding of fatigue properties of steels in the gigacycle domain. One way to approach this is to use a piezoelectric fatigue testing system working at ultrasonic frequency. This paper will describe the research done on several 52100 steels coming from Europe (NF100C6) and Japan (SUJ2). Different heat treatments have been applied to obtain different microstructures: Martensite and bainite with and without residual austenite. The fatigue tests, up to 1011 cycles, have been carried out using piezoelectric machines working at 20 and 30 kHz under tension-compression, tension-tension, and torsion only. A set of specimens has been tested also with a circular notch to observe the effect of stress concentration. Finally the thermal dissipation during testing has been determined using an infrared camera. It is confirmed that the influence of inclusions is a key problem.