bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of cold compression therapy on postoperative pain, swelling, range of motion, and lameness after tibial plateau leveling osteotomy in dogs
Authors: Drygas Kevin A. , McClure Scott R. , Goring Robert L. , Pozzi Antonio , Robertson Sheilah A. , Wang Chong
Published: May 2011

Objective—To evaluate the effect of cold compression therapy (CCT) on postoperative pain, lameness, range of motion of the stifle joint, and swelling following tibial plateau leveling osteotomy (TPLO) in dogs.

Design—Randomized, blinded, placebo-controlled clinical trial.

Animals—34 client-owned dogs with unilateral deficiency of a cranial cruciate ligament undergoing TPLO.

Procedures—Dogs were assigned to 2 groups. Group 1 (n = 17 dogs) received CCT in the 24-hour period following TPLO. Group 2 (n = 17 dogs) received no CCT. Degree of lameness, range of motion, and circumference of the stifle joint were measured before surgery and 1,14, and 28 days after surgery. A modified composite Glasgow pain scale, visual analogue scale, and pain threshold score were used to evaluate signs of pain before surgery and 1,14, and 28 days after surgery. Logistic regression and linear regression analysis were used to compare the measured variables.

Results—No complications were observed, and all dogs tolerated CCT. Use of CCT resulted in lower values for the visual analogue scale and Glasgow pain scale and lower pain threshold scores; lower lameness scores; less swelling; and an increased range of motion 24 hours after surgery. At 14 days after surgery, there were no significant differences between groups. At 28 days after surgery, too few data sets were available for comparison.

Conclusions and Clinical Relevance—CCT decreased signs of pain, swelling, and lameness and increased stifle joint range of motion in dogs during the first 24 hours after TPLO.
Effect of eyelid manipulation and manual jugular compression on intraocular pressure measurement in dogs
Authors: Klein Heidi E. , Krohne Sheryl G. , Moore George E. , Mohamed Ahmed S. , Stiles Jean
Published: May 2011

Objective—To determine the effect of eyelid manipulation and manual jugular compression on intraocular pressure (IOP) measurement in clinically normal dogs.

Design—Randomized clinical trial.

Animals—30 dogs (57 eyes) without diseases or medications that affect IOP.

Procedures—An applanation tonometer was used to measure IOP during eyelid manipulation or jugular compression. Six manipulations were used in each eye, including minimal eyelid manipulation, maximal dorsoventral extension of the eyelids, lateral eyelid extension, manual compression of the ipsilateral jugular vein, manual compression of both jugular veins, and lateral eyelid extension with manual compression of both jugular veins. Skull type and position of globe in the orbit were recorded.

Results—The 2 manipulations that caused the greatest significant increase in mean IOP were lateral eyelid extension with compression of both jugular veins (difference from baseline IOP, 17.6 mm Hg; 95% confidence interval [CI], 15.7 to 19.5 mm Hg) and lateral eyelid extension alone (16.5 mm Hg; 95% CI, 14.6 to 18.4 mm Hg). Dorsoventral eyelid extension (6.42 mm Hg; 95% CI, 4.5 to 8.3 mm Hg) and compression of both jugular veins alone (3.0 mm Hg; 95% CI, 1.1 to 5.0 mm Hg) significantly increased mean IOP, compared with baseline. Compression of the ipsilateral jugular vein increased mean IOP (0.3 mm Hg; 95% CI, −1.6 to 2.2 mm Hg) from baseline, but not significantly.

Conclusions and Clinical Relevance—Traction on the eyelids or pressure on both jugular veins can significantly increase IOP values as measured by use of applanation tonometry in clinically normal dogs.
Incidence of and risk factors for seizures after myelography performed with iohexol in dogs: 503 cases (2002–2004)
Authors: da Costa Ronaldo C. , Parent Joane M. , Dobson Howard
Published: May 2011

Objective—To establish the incidence of and risk factors for seizures following myelography performed with iohexol in dogs.

Design—Retrospective case series.

Animals—503 dogs.

Procedures—Medical records were searched for dogs that underwent myelography between April 2002 and December 2004. Data extracted included body weight, breed, age, sex, volume and dose of iohexol, site of injections, location of lesion, duration of anesthesia, surgical procedures immediately after myelography, use of acepromazine, and presence or absence of seizures.

Results—15 (3%) dogs had postmyelographic seizures. Risk factors significantly associated with seizures were size of dogs (large dogs were 35.35 times as likely to have seizures as were small dogs), location of contrast medium injection (dogs in which iohexol was injected into the cerebellomedullary cistern were 7.4 times as likely to have seizures as were dogs in which iohexol was injected into the lumbar cistern), location of lesion (dogs with lesions at the level of the cervical portion of the vertebral column were 4.65 times as likely to develop seizures as were dogs with lesions in other regions), and total volume of iohexol. Mean ± SD total volume of iohexol was 11.73 ± 5.52 mL (median, 10.5 mL [range, 3.0 to 21.0 mL]) for dogs that had seizures and 4.57 ± 4.13 mL (median, 3.5 mL [range, 0.75 to 45.0 mL]) for those that did not.

Conclusions and Clinical Relevance—Large-breed dogs with cervical lesions and large volumes of iohexol injected into the cerebellomedullary cistern had the highest risk of seizures. The use of contrast medium volumes > 8 mL in large dogs should be avoided, with preference given to injections into the lumbar cistern.
Anaphylactoid reaction in a heartworm-infected dog undergoing lung lobectomy
Authors: Carter Jennifer E. , Chanoit Guillaume , Kata Cheryl
Published: May 2011

Case Description—A 7-year-old 23-kg (50.6-lb) spayed female Border Collie with a history of heartworm disease was evaluated for respiratory distress.

Clinical Findings—Computed tomography of the thorax revealed possible pulmonary bullae or blebs, and on the basis of these findings, a tentative diagnosis of bullous emphysema was made.

Treatment and Outcome—Exploratory median sternotomy revealed gross pathological lesions in the right caudal lung lobe; the most peripheral portion appeared discolored (pale pink), and a clear line of demarcation was observed. Upon excision of the affected lung lobe, a worm segment was noticed both on the remaining stump of the lung lobe in the dog and in the removed lobe. At this time, the dog had an anaphylactoid reaction. The reaction was successfully treated with fluid therapy, antihistamines, and corticosteroids. Lung lobectomy of the right caudal lobe resulted in clinical resolution of the bilateral pneumothorax. However, during the postoperative period, the dog developed a hemothorax and was returned to surgery. As no obvious cause for the hemothorax was seen at the second surgery, the dog was treated for a potential coagulopathy with fresh frozen plasma, which provided clinical resolution of the hemothorax. Parasitological examination of the worm segment confirmed a Dirofilaria immitis infection. The dog was discharged 5 days after surgery and treated with doxycycline for 30 days and monthly administration of heartworm preventative was prescribed.

Clinical Relevance—Heartworm infection should be a differential diagnosis in dogs with spontaneous pneumothorax. Anaphylactoid reactions associated with accidental dissection of adult heartworms should be managed with treatment aimed at cardiovascular stabilization.
α-Melanocyte—stimulating hormone and adrenocorticotropin concentrations in response to thyrotropin-releasing hormone and comparison with adrenocorticotropin concentration after domperidone administration in healthy horses and horses with pituitary pars intermedia dysfunction
Authors: Beech Jill , McFarlane Dianne , Lindborg Sue , Sojka Janice E. , Boston Raymond C.
Published: May 2011

Objective—To compare endogenous ACTH and α-melanocyte-stimulating hormone (α-MSH) concentrations after administration of thyrotropin-releasing hormone (TRH) and to compare ACTH concentrations after TRH administration with those following domperidone administration in healthy horses and horses with pituitary pars intermedia dysfunction (PPID).

Design—Prospective case series.

Animals—69 clinically normal horses and 47 horses with or suspected to have PPID.

Procedures—ACTH concentrations were measured during 108 TRH stimulation tests in 88 horses, and α-MSH concentrations were measured during 56 TRH stimulation tests in 50 horses. In 28 of these horses, ACTH concentrations after domperidone administration were measured and test results were compared. The pituitary gland was histologically examined in all horses that were euthanatized.

Results—ACTH and α-MSH concentrations increased in all horses afterTRH administration, with a greater and more prolonged increase in horses with PPID. Percentage increase was significantly greater for α-MSH concentration than for ACTH concentration. The change in ACTH concentration after domperidone administration was less consistent in differentiating clinically normal horses from those with PPID than was the response to TRH.

Conclusions and Clinical Relevance—Results suggested that ACTH concentration in response to TRH administration was useful for the diagnosis of PPID in horses and appeared more accurate than response to domperidone administration. Use of an α-MSH concentration ≥ 30 or 50 pmol/L did not appear superior to use of an ACTH concentration ≥ 36 pg/mL for the diagnosis of PPID, either before or 30 minutes after TRH administration.
Racing prognosis after cumulative stress-induced injury of the distal portion of the third metacarpal and third metatarsal bones in Thoroughbred racehorses: 55 cases (2000–2009)
Authors: Tull Travis M. , Bramlage Lawrence R.
Published: May 2011

Objective—To evaluate the diagnostic features, results of free-choice exercise treatment, prognosis, and postinjury racing performance of Thoroughbred racehorses with cumulative stress-induced bone injury (CSBI) of the distal portion of the third metacarpal and third metatarsal bones (MC3/MT3).

Design—Retrospective case series.

Animals—55 Thoroughbred racehorses with CSBI of the distal portion of MC3/MT3.

Procedures—Data on signalment, history, and radiographic, scintigraphic, and lameness examination findings were reviewed. Horses with lameness localized to the distal portion of MC3/MT3, and that did not have concurrent lameness but did have radiographic and nuclear scintigraphic changes consistent with CSBI, were included in the study. Information on pre-and postinjury racing performance was acquired from race records.

Results—Mean age was 3.2 years (median, 3 years [range, 2 to 6 years]). Ninety-five percent (52/55) of horses with CSBI raced after injury. Males were more commonly affected (75% [41/55]) than were females (25% [14/55]; odds ratio, 3.99 [95% confidence interval, 2.17 to 7.34]). There was no significant difference in postinjury total earnings, compared with total earnings before injury; horses had significantly more starts and less earnings per start after injury. Median time to first start after injury was 194 days. Of 45 horses that raced before and after injury, 31 % (14/45) had an increase in racing class, 31 % (14/45) had no change in class, and 38% (17/45) had a decrease in class.

Conclusions and Clinical Relevance—Thoroughbred racehorses with CSBI of the distal portion of MC3/MT3 treated with free-choice exercise had a favorable prognosis with no appreciable decrease in class or performance.
Associations between prebreeding serum micronutrient concentrations and pregnancy outcome in beef cows
Authors: Van De Weyer Leanne M. , Hendrick Steve H. , Waldner Cheryl L.
Published: May 2011

Objective—To determine associations between serum concentrations of copper, molybdenum, selenium, vitamin A, and vitamin E measured in beef cows at the start of the community pasture breeding season and pregnancy status at the end of the season.

Design—Prospective cohort study.

Animals—771 beef cows from 39 cow-calf herds.

Procedures—Serum micronutrient concentrations were measured in samples collected from cows on arrival at 5 different community pastures in Saskatchewan, Canada, in May 2008. Cows were palpated transrectally to determine pregnancy status in October 2008. Herd owners and professional herd managers were surveyed to collect individual data for cows (age, calving date, and history of exposure to bulls before the start of the breeding season) and information on herd and breeding management. Associations between animal-, herd-, and pasture-level variables and pregnancy status were examined.

Results—Serum concentrations of selenium, molybdenum, vitamin A, and vitamin E were not associated with pregnancy status after accounting for prebreeding body condition score, age, and calving-to-breeding interval. Serum copper concentrations were more commonly assessed as below adequate than were other micronutrients. Decreased serum copper concentrations were associated with increased odds of nonpregnancy in cows < 10 years of age.

Conclusions and Clinical Relevance—Prebreeding micronutrient supplementation programs should be carefully managed in herds with poor reproductive performance in areas known to be copper deficient, and evaluation of serum copper concentrations from a subset of cows should be considered before the start of the breeding season.
Onset of diarrhea and pyrexia and time to detection of Salmonella enterica subsp enterica in feces in experimental studies of cattle, horses, goats, and sheep after infection per os
Authors: Aceto Helen , Miller Stephanie A. , Smith Gary
Published: May 2011

Objective—To determine time to first detection of Salmonella organisms in feces of animals after experimental infection PO and times to onset of diarrhea and pyrexia to evaluate a common method for identifying nosocomial infections on the basis of time of admission and onset of clinical signs (ie, the 3-day criterion).

Design—Meta-analysis.

Sample Population—Cattle, horses, goats, and sheep experimentally infected PO with Salmonella enterica subsp enterica.

Procedures—Online databases were searched for published reports describing results of experimental infection of cattle, horses, goats, and sheep PO with salmonellae. Time to detection of organisms in feces as well as to onset of diarrhea and pyrexia was noted. Analysis of covariance was used to examine relationships among these variables, host species and age, and Salmonella serovar and magnitude of infecting dose.

Results—Forty-three studies met the criteria for inclusion. Time to detection of salmonellae in feces ranged from 0.5 to 4 days. Times to onset of diarrhea and pyrexia ranged from 0.33 to 11 days and from 0.27 to 5 days, respectively. Time to onset of diarrhea was related to host age and Salmonella serovar. No other associations were identified.

Conclusions and Clinical Relevance—Time to detection of salmonellae in feces is unreliable for identifying hospital-acquired infections; a 3-day criterion will misidentify hospital- versus community-acquired infections. Relying on clinical indices such as times to onset of diarrhea and pyrexia to trigger fecal sampling for detection of Salmonella infection will increase the risk of environmental contamination and nosocomial spread because animals may begin shedding organisms in feces several days prior.
Examination of operational dynamics of radiant ceiling panel
Authors: Dudkiewicz Edyta , Jadwiszczak Piotr , Jeżowiecki Janusz
Published: May 2011

Radiant ceiling panels can be used in large-volume halls, e.g. vehicle repair shops and markets, to heat the entire or specific zones of the enclosed space. The system with radiant panels may be of small water capacity when just one or several units are installed over selected zones to provide additional heating. Depending on dimensions of radiant ceiling panel, its mounting mode and the temperature of its feeding medium, various thermal conditions are created under such panel. Thermal effects are also affected by the mode of thermal or cooling power control and dynamics of such control for an individual radiant panel or a set of panels. The dynamics of attainable radiant ceiling panel capacity was investigated and used as the grounds to determine general requirements for time-domain automatic control programs and those for operation of the controllers. The results presented from the examinations carried out for water radiators are not intended to delineate the requirements for all automatic control loops for water radiators; they are aimed at attracting attention to issues to be considered when preparing the algorithm of automatic control in particular situations.
The Demographic Aspect of Contemporary Urban Processes (The Case of Portugal)
Authors: Litwińska Elżbieta
Published: May 2011

The Demographic Aspect of Contemporary Urban Processes (The Case of Portugal)

In the last decades in most European countries urbanization can be observed, characterized by a tendency towards expansion of big cities into their environs with a decreasing number of inhabitants living in urban cores (urban sprawl). The result is networked, poly-centric forms of concentration. These new structures are the result of the changes in the organization of the production process, the increasing role of the service and information based economy and the growing mobility of the population.

The aim of this paper is to present the demographic aspect of urban processes in Portugal, in the country as well as in the Lisbon Metropolita Area.
Inner-City Transformations after Socialism. Findings from Interviews with New Residents of Pre-War Tenement Houses in Gdańsk
Authors: Grabkowska Maja
Published: May 2011

Inner-City Transformations after Socialism. Findings from Interviews with New Residents of Pre-War Tenement Houses in Gdańsk

Issues of intense suburbanization and urban sprawl have been the most discussed threads in the recent debate on urban development in Poland. Meanwhile, in numerous cities of Western Europe signs of inner-city revival have been observed and investigated. Led by demographic and lifestyle changes alike, such reurbanization trends are found to be closely related to household transformations. Results of undertaken studies indicate that residential preferences of non-traditional households, such as singles, cohabitations, childless couples or flatsharers, gravitate to inner-city living. The aim of this paper is to reveal similar tendencies in a postsocialist city, using the example of Gdańsk. Presented results of statistical and qualitative data analyses point towards confirmation of incipient reurbanization, although with several distinctions following from the postsocialist context.
An illustrated textbook Ear, Nose and Throat Head and Neck Surgery
Authors: Guragain R
Published: May 2011

DOI: 10.3126/njenthns.v1i1.4739 Nepalese J ENT Head Neck Surg Vol.1 No.1 (2010) p.36
Complications of axial lumbar interbody fusion
Authors: Lindley Emily M. , McCullough Matthew A. , Burger Evalina L. , Brown Courtney W. , Patel Vikas V.
Published: May 2011

Object

Axial lumbar interbody fusion (AxiaLIF) is a novel minimally invasive approach for fusion of L4–5 and L5–S1. This technique uses the presacral space for percutaneous access to the anterior sacrum. The AxiaLIF procedure has the potential to decrease patient recovery time, length of hospital stay, and overall occurrence of surgical complications. It can be used alone or in combination with minimally invasive or traditional open fusion procedures. The purpose of this study was to evaluate complications of the AxiaLIF procedure at the authors' institutions.

Methods

Patients who underwent AxiaLIF surgery between October 2005 and June 2009 at the authors' institutions were identified. The authors retrospectively reviewed these patients' charts, including operative reports and postoperative medical records, to determine what complications were encountered.

Results

A total of 68 patients underwent AxiaLIF surgery, with an average follow-up time of 34 months. Sixteen patients (23.5%) experienced a total of 18 complications (26.5%); this group included 8 men and 8 women (mean age 52.1 years). These complications included pseudarthrosis (8.8%), superficial infection (5.9%), sacral fracture (2.9%), pelvic hematoma (2.9%), failure of wound closure (1.5%), transient nerve root irritation (1.5%), and rectal perforation (2.9%).

Conclusions

The complication rate associated with AxiaLIF in the present study was relatively low (26.5%). The most common complications were superficial infection and pseudarthrosis. There were 2 cases of rectal perforation associated with AxiaLIF; one case was found intraoperatively and the other presented 4 days postoperatively. Both patients underwent emergency repair by a general surgeon and had no long-term sequelae as a result of the rectal injuries. It is important for surgeons to be aware of the potential for these complications. Many of these complications can probably be avoided with proper patient selection and operative planning. Preoperative MR imaging, a detailed patient physical examination and history, full bowel preparation, and the use of live fluoroscopy can all help to prevent complications with AxiaLIF surgery.
A Managed Case of Ruptured Heterotopic Pregnancy
Authors: Akhter Rowshan , Siddiqua Shahmima , Ara Arjuman , Bhuiyan Syeda Nurjahan
Published: May 2011

Key words: heterotropic pregnancy; ectopic pregnancy; assisted reproductive techniqueDOI: 10.3329/jcmcta.v21i1.7685 Journal of Chittagong Medical College Teachers' Association 2010: 21(1):77-79
Wegener's Granulomatosis: Case Report
Authors: Dutta Pradip Kumar , Jabed Sayed Md , Huda Md Nurul , Das Saibal , Islam Md Manirul , Chowdhury Dipen , Islam Md Shariful , Arjumand Merina , Uddin Rabiul Alam Md Erfan
Published: May 2011

DOI: 10.3329/jcmcta.v21i1.7686 Journal of Chittagong Medical College Teachers' Association 2010: 21(1):80-82
Epidermal Growth Factor Receptor (EGFR) Crosstalks in Liver Cancer
Authors: Berasain Carmen , Ujue Latasa María , Urtasun Raquel , Goñi Saioa , Elizalde María , Garcia-Irigoyen Oihane , Azcona María , Prieto Jesús , Ávila Matías A.
Published: May 2011

Hepatocarcinogenesis is a complex multistep process in which many different molecular pathways have been implicated. Hepatocellular carcinoma (HCC) is refractory to conventional chemotherapeutic agents, and the new targeted therapies are meeting with limited success. Interreceptor crosstalk and the positive feedback between different signaling systems are emerging as mechanisms of targeted therapy resistance. The identification of such interactions is therefore of particular relevance to improve therapeutic efficacy. Among the different signaling pathways activated in hepatocarcinogenesis the epidermal growth factor receptor (EGFR) system plays a prominent role, being recognized as a “signaling hub” where different extracellular growth and survival signals converge. EGFR can be transactivated in response to multiple heterologous ligands through the physical interaction with multiple receptors, the activity of intracellular kinases or the shedding of EGFR-ligands. In this article we review the crosstalk between the EGFR and other signaling pathways that could be relevant to liver cancer development and treatment.
A Reverse Transcriptase-Dependent Mechanism Is Essential for Murine Preimplantation Development
Authors: Sciamanna Ilaria , Vitullo Patrizia , Curatolo Angela , Spadafora Corrado
Published: May 2011

LINE-1 (Long Interspersed Nuclear elements) and HERVs (Human Endogenous Retroviruses) are two families of retrotransposons which together account for about 28% of the human genome. Genes harbored within LINE-1 and HERV retrotransposons, particularly that encoding the reverse transcriptase (RT) enzyme, are generally expressed at low levels in differentiated cells, but their expression is up-regulated in embryonic tissues and transformed cells. Here we review evidence indicating that the LINE-1-encoded RT plays regulatory roles in early embryonic development. Indeed, antisense-mediated inhibition of expression of a highly expressed LINE-1 family in mouse zygotes caused developmental arrest at the two- or four-cell embryo stages. Development is also arrested when the embryo endogenous RT activity is pharmacologically inhibited by nevirapine, an RT inhibitor currently employed in AIDS treatment. The arrest of embryonic development is irreversible even after RT inhibition is removed and it is associated with subverted gene expression profiles. These data indicate an early requirement for LINE-1-encoded RT to support early developmental progression. Consistent with this, recent findings indicate that a reverse transcription wave is triggered in the zygote a few hours after fertilization and is propagated at least through the first two rounds of cell division. On the whole these findings suggest that reverse transcription is strictly required in early embryos as a key component of a novel RT-dependent mechanism that regulated the proper unfolding of the developmental program.
Chemical Composition, Antioxidant and Antimicrobial Activity of Pericarpium Citri Reticulatae Essential Oil
Authors: Gao Bei , Chen Yulong , Zhang Mingwei , Xu Yujuan , Pan Siyi
Published: May 2011

The chemical composition, antioxidant and antimicrobial activity of Pericarpium Citri Reticulatae (PCR) essential oil obtained using an improved Clevenger type apparatus were studied. Among the five different PCRs examined the highest yield of essential oil was found in Chachi 2004 (harvested and stored in 2004) and the lowest in Chachi 2008 (harvested and stored in 2008). Fifty three different volatile compounds were determined, including terpenic hydrocarbons, alcohols, aldehydes, ketones and esters. D-limonene, one of terpenes, was the major constituent in PCR. The antioxidant capacity of PCR essential oil varied considerably with the duration of storage time, and the oil from Chachi 1994 has the strongest ferric-reducing antioxidant power. In addition, the essential oil possessed varying degrees of antimicrobial activity against Gram-positive bacteria (Staphylococcus aureus, Bacillus subtilis, Bacillus cereus), except Streptococcus faecalis, while had no effect on Gram-negative bacteria (Escherichia coli, Enterobacter cloacae).
FRCA: A Fuzzy Relevance-Based Cluster Head Selection Algorithm for Wireless Mobile Ad-Hoc Sensor Networks
Authors: Lee Chongdeuk , Jeong Taegwon
Published: May 2011

Clustering is an important mechanism that efficiently provides information for mobile nodes and improves the processing capacity of routing, bandwidth allocation, and resource management and sharing. Clustering algorithms can be based on such criteria as the battery power of nodes, mobility, network size, distance, speed and direction. Above all, in order to achieve good clustering performance, overhead should be minimized, allowing mobile nodes to join and leave without perturbing the membership of the cluster while preserving current cluster structure as much as possible. This paper proposes a Fuzzy Relevance-based Cluster head selection Algorithm (FRCA) to solve problems found in existing wireless mobile ad hoc sensor networks, such as the node distribution found in dynamic properties due to mobility and flat structures and disturbance of the cluster formation. The proposed mechanism uses fuzzy relevance to select the cluster head for clustering in wireless mobile ad hoc sensor networks. In the simulation implemented on the NS-2 simulator, the proposed FRCA is compared with algorithms such as the Cluster-based Routing Protocol (CBRP), the Weighted-based Adaptive Clustering Algorithm (WACA), and the Scenario-based Clustering Algorithm for Mobile ad hoc networks (SCAM). The simulation results showed that the proposed FRCA achieves better performance than that of the other existing mechanisms.
Diversity and dynamics of plant genome size: An example of polysomaty from a cytogenetic study of Tahitian vanilla (Vanilla ×tahitensis, Orchidaceae)
Authors: Lepers‐Andrzejewski Sandra , Siljak‐Yakovlev Sonja , Brown Spencer C. , Wong Maurice , Dron Michel
Published: May 2011

• Premise of the study: Abnormal mitotic behavior with somatic aneuploidy and partial endoreplication were previously reported for the first time in the plant kingdom in Vanilla planifolia. Because vanilla plants are vegetatively propagated, such abnormalities have been transmitted. This study aimed to determine whether mitotic abnormalities also occur in Vanilla hybrid or are suppressed by sexual reproduction.

• Methods: Twenty‐eight accessions of Vanilla ×tahitensis, one V. planifolia, and hybrid V. planifolia × V. ×tahitensis were analyzed by chromosome counts, cytometry, and fluorescent in situ hybridization of 18S–5.8S–26S rDNA.

• Key results: In a single root meristem of V. ×tahitensis, chromosome number varied from 22 to 31 in diploids (mean 2C = 5.23 pg), 31 to 41 in triploids (2C = 7.82 pg) and 43 to 60 in tetraploids (2C = 10.27 pg). Morphological diversity is apparently related to ploidy changes. Aneuploidy and partial (asymmetrical) endoreduplication were observed in root meristems of both V. ×tahitensis and the hybrid V. planifolia × V. ×tahitensis, but pollen grains had the euploid chromosome number (n = 15 in diploids).

• Conclusions: Genome irregularities may be transmitted not only during vegetative propagation but also by sexual reproduction in Vanilla. However, there must be a complex regulation of genome size and organization between the aneuploidy in somatic tissues and subsequently euploid gametic tissue. This is a novel example of polysomaty with developmentally regulated partial endoreplication.
Persistence with Anti-Tumor Necrosis Factor Therapies in Patients with Rheumatoid Arthritis: Observations from the RADIUS Registry
Authors: MARKENSON JOSEPH A. , GIBOFSKY ALLAN , PALMER WILLIAM R. , KEYSTONE EDWARD C. , SCHIFF MICHAEL H. , FENG JINGYUAN , BAUMGARTNER SCOTT W.
Published: May 2011

Objective.

To evaluate persistence with anti-tumor necrosis factor (TNF) therapy and predictors of discontinuation in patients with rheumatoid arthritis (RA).

Methods.

This retrospective analysis used data from RADIUS 1, a 5-year observational registry of patients with RA, to determine time to first- and second-course discontinuation of etanercept, infliximab, and adalimumab. First-course therapy was defined as first exposure to anti-TNF therapy, and second-course therapy was defined as exposure to anti-TNF therapy after the first discontinuation. Kaplan-Meier survival analysis was used to assess persistence, log-rank tests were used to compare therapies, and Cox proportional hazards models were used to assess potential predictors of treatment discontinuation.

Results.

This analysis included 2418 patients. Mean persistence rates were similar among treatments [first-course: etanercept, 51%; infliximab, 48%; adalimumab, 48% (followup was 54 weeks for etanercept and infliximab and 42 weeks for adalimumab); second-course: 56%, 50%, 46%, respectively (followup was 36 weeks for etanercept and infliximab and 30 weeks for adalimumab)]. Discontinuations of first-course therapy due to ineffectiveness were similar among treatments (etanercept, 19%; infliximab, 19%; adalimumab, 20%) and discontinuations due to adverse events were significantly (p = 0.0006) lower for etanercept than for infliximab (etanercept, 14%; infliximab, 22%; adalimumab, 17%). Predictors from univariable analysis of first- or second-course therapy discontinuation included increased comorbidities (etanercept), female sex (infliximab), Clinical Disease Activity Index > 22 (infliximab), and a Stanford Health Assessment Questionnaire score > 0.5 (adalimumab).

Conclusion.

In this population, first- and second-course persistence was similar among anti-TNF therapies. First-course discontinuation due to adverse events was lower with etanercept compared with infliximab.
Febuxostat in Gout: Serum Urate Response in Uric Acid Overproducers and Underexcretors
Authors: GOLDFARB DAVID S. , MacDONALD PATRICIA A. , HUNT BARBARA , GUNAWARDHANA LHANOO
Published: May 2011

Objective.

Hyperuricemia of gout can arise due to either overproduction or underexcretion of uric acid. Not all available urate-lowering therapies are equally effective and safe for use in patients with renal disease. The objective of this post-hoc analysis was to determine the effectiveness of the xanthine oxidase inhibitor febuxostat in reducing serum urate (sUA) levels in gouty patients who were either overproducers or underexcretors.

Methods.

Gouty subjects 18 to 85 years of age with sUA ≥ 8.0 mg/dl at baseline were enrolled in a Phase 2, 28-day, multicenter, randomized, double-blind, placebo-controlled trial and randomized to receive febuxostat 40 mg, 80 mg, or 120 mg daily, or placebo. The primary efficacy endpoint was the proportion of subjects with sUA < 6.0 mg/dl at Day 28. Secondary efficacy endpoints included percentage reductions in sUA and urinary uric acid (uUA) from baseline to Day 28.

Results.

Of the 153 subjects, 118 (77%) were underexcretors (uUA ≤ 800 mg/24 h) and 32 (21%) were overproducers (uUA > 800 mg/24 h); baseline uUA data were missing for 3 subjects. Treatment with febuxostat led to the majority of subjects achieving sUA < 6.0 mg/dl at Day 28. Treatment with any dose of febuxostat led to significantly greater percentage reductions in uUA than that observed in the placebo group, for both underexcretors and overproducers.

Conclusion.

Febuxostat is a highly efficacious urate-lowering therapy in patients with gout regardless of overproduction or underexcretion status.
Arthritis Increases the Risk for Fractures — Results from the Women’s Health Initiative
Authors: WRIGHT NICOLE C. , WALITT BRIAN T. , EATON CHARLES B. , CHEN ZHAO ,   the Women’s Health Initiative Investigators
Published: May 2011

Objective.

To examine the relationship between arthritis and fracture.

Methods.

Women were classified into 3 self-reported groups at baseline: no arthritis (n = 83,295), osteoarthritis (OA; n = 63,402), and rheumatoid arthritis (RA; n = 960). Incident fractures were self-reported throughout followup. Age-adjusted fracture rates by arthritis category were generated, and the Cox proportional hazards model was used to test the association between arthritis and fracture.

Results.

After an average of 7.80 years, 24,137 total fractures were reported including 2559 self-reported clinical spinal fractures and 1698 adjudicated hip fractures. For each fracture type, age-adjusted fracture rates were highest in the RA group and lowest in the nonarthritic group. After adjustment for several covariates, report of arthritis was associated with increased risk for spine, hip, and any clinical fractures. Compared to the nonarthritis group, the risk of sustaining any clinical fracture in the OA group was HR 1.09 (95% CI 1.05, 1.13; p < 0.001) and HR 1.49 (95% CI 1.26, 1.75; p < 0.001) in the RA group. The risk of sustaining a hip fracture was not statistically increased in the OA group (HR 1.11; 95% CI 0.98, 1.25; p = 0.122) compared to the nonarthritis group; however, the risk of hip fracture increased significantly (HR 3.03; 95% CI 2.03, 4.51; p < 0.001) in the RA group compared to the nonarthritis group.

Conclusion.

The increase in fracture risk confirms the importance of fracture prevention in patients with RA and OA.
Posterior Reversible Encephalopathy Syndrome in Systemic Lupus Erythematosus
Authors: VARAPRASAD IRLAPATI RAJENDRA , AGRAWAL SUMEET , PRABU VADIVELMURUGAN NAGASUBRAMANI NAGA , RAJASEKHAR LIZA , KANIKANNAN MEENA ANGAMUTHU , NARSIMULU GUMDAL
Published: May 2011

Objective.

To study the clinical profile of posterior reversible encephalopathy syndrome (PRES) in patients with systemic lupus erythematosus (SLE) and analyze the risk factors and outcomes associated with it.

Methods.

We identified patients with SLE and PRES from January 2006 to October 2010. Data were collected on demographic details, lupus characteristics, PRES-related features, laboratory abnormalities, treatment details, and outcomes.

Results.

We studied 13 patients (all female) ages 14–37 years (median 23 yrs; 4 were aged < 18 yrs with juvenile SLE). Duration of lupus ranged from 1.5 to 36 months (median 6 mo). Six patients had PRES as a part of their initial presentation of lupus. All had active lupus and hypertension; 9 had nephritis. Four patients were on treatment with cyclophosphamide therapy when they developed PRES. Antihypertensives and antiepileptics were the mainstay of treatment along with supportive care. Immunosuppressive therapy was guided by lupus-related major organ manifestations. Two patients had focal neurological deficits; one had persistent hemiparesis at followup. One patient died.

Conclusion.

PRES occurs in young lupus patients and in the early part of the disease. Focal deficits are not uncommon. It can be the presenting manifestation of lupus. Management is predominantly symptomatic. Immunosuppression is directed by other major organ manifestations. Early diagnosis and appropriate management is productive.
Time to Treatment for New Patients with Rheumatoid Arthritis in a Major Metropolitan City
Authors: JAMAL SHAHIN , ALIBHAI SHABBIR M.H. , BADLEY ELIZABETH M. , BOMBARDIER CLAIRE
Published: May 2011

Objective.

To determine the proportion of patients with rheumatoid arthritis (RA) seen by rheumatologists and treated with disease-modifying antirheumatic drugs (DMARD) within 3 months of symptom onset, to determine where treatment delays occur, and to identify contributing factors.

Methods.

A retrospective cohort study in which adult patients with RA, diagnosed between January 1, 2003, and May 31, 2006, were recruited from rheumatologists’ offices to participate in a telephone survey and chart review. The percentage treated with DMARD within 3 months of symptom onset was determined, along with median times for delay. Factors contributing to the delay were explored using multivariable logistic regression.

Results.

Our study included 204 patients. Within 3 months of symptoms, 22.6% (95% CI 16.8%, 28.3%) received DMARD and within 6 months, 47.6% (95% CI 40.7%, 54.4%). The median time from symptom onset to DMARD was 6.4 months [interquartile range (IQR) 3.3, 12.0] with a median time from RA diagnosis by a rheumatologist to DMARD of 0.0 months (IQR 0.0, 1.0). Higher baseline swollen joint counts resulted in earlier treatment. Age, sex, education, comorbidity, rheumatologist practice type, and years since the physician’s graduation did not affect time to treatment.

Conclusion.

Fewer than 25% of patients referred to rheumatologists were treated within 3 months of symptom onset. Identification of inflammatory arthritis and referral to rheumatologists are the key factors in timely care, because once patients are seen there is no delay to treatment. Future resources should be focused on development and evaluation of interventions to facilitate rapid triage, referral, and assessment by a rheumatologist.
Anti-Fibrillarin Antibody in African American Patients with Systemic Sclerosis: Immunogenetics, Clinical Features, and Survival Analysis
Authors: SHARIF ROOZBEH , FRITZLER MARVIN J. , MAYES MAUREEN D. , GONZALEZ EMILIO B. , McNEARNEY TERRY A. , DRAEGER HILDA , BARON MURRAY ,   the Canadian Scleroderma Research Group, FURST DANIEL E. , KHANNA DINESH K. , DEL JUNCO DEBORAH J. , MOLITOR JERRY A. , SCHIOPU ELENA , PHILLIPS KRISTINE , SEIBOLD JAMES R. , SILVER RICHARD M. , SIMMS ROBERT W. ,   GENISOS Study Group, PERRY MARILYN , ROJO CARLOS , CHARLES JULIO , ZHOU XIAODONG , AGARWAL SANDEEP K. , REVEILLE JOHN D. , ASSASSI SHERVIN , ARNETT FRANK C.
Published: May 2011

Objective.

Anti-U3-RNP, or anti-fibrillarin antibodies (AFA), are detected more frequently among African American (AA) patients with systemic sclerosis (SSc) compared to other ethnic groups and are associated with distinct clinical features. We examined the immunogenetic, clinical, and survival correlates of AFA in a large group of AA patients with SSc.

Methods.

Overall, 278 AA patients with SSc and 328 unaffected AA controls were enrolled from 3 North American cohorts. Clinical features, autoantibody profile, and HLA class II genotyping were determined. To compare clinical manifestations, relevant clinical features were adjusted for disease duration. Cox proportional hazards regression was used to determine the effect of AFA on survival.

Results.

Fifty (18.5%) AA patients had AFA. After Bonferroni correction, HLA-DRB1*08:04 was associated with AFA, compared to unaffected AA controls (OR 11.5, p < 0.0001) and AFA-negative SSc patients (OR 5.2, p = 0.0002). AFA-positive AA patients had younger age of disease onset, higher frequency of digital ulcers, diarrhea, pericarditis, higher Medsger perivascular and lower Medsger lung severity indices (p = 0.004, p = 0.014, p = 0.019, p = 0.092, p = 0.006, and p = 0.016, respectively). After adjustment for age at enrollment, AFA-positive patients did not have different survival compared to patients without AFA (p = 0.493).

Conclusion.

Our findings demonstrate strong association between AFA and HLA-DRB1*08:04 allele in AA patients with SSc. AA SSc patients with AFA had younger age of onset, higher frequency of digital ulcers, pericarditis and severe lower gastrointestinal involvement, but less severe lung involvement compared to AA patients without AFA. Presence of AFA did not change survival.
Suivre une règle. Wittgenstein entre Aristote et Lejeune-Dirichlet
Authors: Dumoncel Jean-Claude
Published: May 2011

Résumé Selon Wittgenstein « la théorie des ensembles part du concept de fonction défini par Dirichlet ». Cette remarque généalogique n’est pas seulement décisive dans la philosophie des mathématiques de Wittgenstein. Le concept de « fonction arbitraire » dû à Dirichlet, en effet, qui étend d’abord la notion de fonction au-delà des mathématiques , en rend de surcroît la règle variable et finit même par se placer au-dessus des lois . Le rôle que Wittgenstein accorde à Dirichlet définit donc un précédent éclairant pour les thèses paradoxales qu’il soutient au sujet des règles, même si le cas des fonctions mathématiques y forme une exception. Ainsi, c’est toute la question de la règle qui est à repenser à partir des possibilités ouvertes par Dirichlet. Dans le commentaire de Kripke, en particulier, l’interprétation sceptique peut être évitée en isolant un noyau dur qui explicite et corrobore la lecture proposée ici.
Suspected Nonaccidental Trauma and Femoral Shaft Fractures in Children
Authors: Shrader M. Wade , Bernat Nicholas M. , Segal Lee S.
Published: May 2011

The question of suspected nonaccidental trauma as a possible cause of injury for femoral shaft fractures in children is a troubling but common issue facing orthopedic surgeons. The purpose of this study is to analyze femoral shaft fractures at a major pediatric level I trauma center in a large metropolitan area over a 5-year period to determine the incidence of suspected nonaccidental trauma and the risk factors associated with that diagnosis. This study is a retrospective review of all children younger than 5 years at a large trauma center in a southwestern metropolitan area who presented with a femoral shaft fracture. Patient charts were reviewed to determine demographics, mechanism of injury, and fracture type. Referrals to social work and Child Protective Services were also reviewed to determine an overall incidence of suspected nonaccidental trauma.

Over the 5-year study period, 137 patients presented to our institution with a femoral shaft fracture. Mean patient age at the time of injury was 2.2 years (range, 1 month to 4 years). Overall, 43 patients with a mean age of 1.8 years were determined to have injuries suspicious of nonaccidental trauma and were referred to Child Protective Services, giving an overall incidence of 31%. Age younger than 1 year was a highly significant risk factor for suspected nonaccidental trauma. Of the 20 children younger than 1 year, 18 (90%) were referred to Child Protective Services, comprising 42% of those children suspicious of nonaccidental trauma. The presence of either Medicaid or no insurance was a highly statistically significant risk factor for suspected nonaccidental trauma.
Operative Versus Nonoperative Management of Pipkin Type-II Fractures Associated with Posterior Hip Dislocation
Authors: Chen Zhi-wen , Zhai Wen-liang , Ding Zhen-qi , Lian Ke-jian , Kang Liang-qi , Guo Lin-xin , Liu Hui , Lin Bin
Published: May 2011

Little has been written on randomized, controlled studies of operative versus nonoperative management of Pipkin type-II fractures associated with posterior dislocation of the hip. It is difficult to validate the optimal management of these fractures. The goals of this study were to (1) evaluate the results of conservative and surgical treatment for Pipkin type-II fractures associated with posterior dislocation of the hip and supply the optimal management for these fractures and (2) identify whether the Smith-Petersen approach is a safe and reliable surgical approach for Pipkin type-II fractures.

Twenty-four patients were randomly divided into 2 groups: the conservative group (n=12) was treated by closed reduction, and the surgical group (n=12) was treated by primary open reduction internal fixation (ORIF) by bioabsorbable screws via a Smith-Petersen approach. Minimum follow-up was 24 months. Functional outcome was measured using the Thompson and Epstein score and the d’Aubigné-Postel score. Heterotopic ossification was classified based on the Brooker classification. The outcome of the conservative group was worse than that of the surgical group (
P
=.037). Two patients in the conservative group needed joint replacement for avascular necrosis of the femoral head. Heterotopic ossification was found in 6 patients (1 patient in the conservative group and 5 in the surgical group).

Primary ORIF by bioabsorbable screws via a Smith-Petersen approach is an effective treatment for Pipkin type-II fractures associated with posterior dislocation.
Application of Locking Plate in Long-Bone Atrophic Nonunion Following External Fixation
Authors: Sun Si-guo , Zhang Yong , Zheng Lian-he , Li Jun , Fan De-gang , Ma Bao-an
Published: May 2011

The treatment of atrophic fracture nonunion continues to represent a therapeutic challenge. Large segmental osteopenia is often seen in patients who received uniplanar or hybrid external fixators as the definitive method of fixation for high-energy fractures, and this adds more difficulties to the treatment of fracture nonunion. This retrospective study was designed to assess the outcome of locking compression plating with autologous bone grafting in patients with long-bone atrophic nonunion following external fixation.

From January 2004 to December 2009, a series of consecutive patients with atrophic nonunion of the long bone following external fixation were treated with this method in our institution. The clinical outcomes and complications of these patients were retrospectively analyzed. Twenty-seven patients with 28 fracture nonunions were involved in this study. Mean follow-up was 14.2±3.4 months. Bony union was achieved in all 27 patients within a mean 18.6±4.8 weeks after revision surgery. Two patients developed superficial wound infections. No deep infections were found, and no implant failure was seen. Three patients reported minor pain in the donor site of the bone graft, and no other donor site complications were found.

Revision osteosynthesis of long-bone atrophic nonunion following external fixation by locking compression plating with autologous iliac crest bone grafting represents a safe and efficacious modality for the treatment of these challenging conditions.