bluuebunny/crossref_metadata_2025 huggingface dataset:
C. elegansSUR-6/PR55 cooperates with LET-92/protein phosphatase 2A and promotes Raf activity independently of inhibitory Akt phosphorylation sites
Authors: Kao Gautam , Tuck Simon , Baillie David , Sundaram Meera V.
Published: January 2004

Protein phosphatase 2A (PP2A) can both positively and negatively influence the Ras/Raf/MEK/ERK signaling pathway, but its relevant substrates are largely unknown. In C. elegans, the PR55/B regulatory subunit of PP2A, which is encoded by sur-6, positively regulates Ras-mediated vulval induction and acts at a step between Ras and Raf. We show that the catalytic subunit (C) of PP2A, which is encoded by let-92, also positively regulates vulval induction. Therefore SUR-6/PR55 and LET-92/PP2A-C probably act together to dephosphorylate a Ras pathway substrate. PP2A has been proposed to activate the Raf kinase by removing inhibitory phosphates from Ser259 from Raf-1 or from equivalent Akt phosphorylation sites in other Raf family members. However, we find that mutant forms of C. elegansLIN-45 RAF that lack these sites still require sur-6. Therefore,SUR-6 must influence Raf activity via a different mechanism. SUR-6 and KSR(kinase suppressor of Ras) function at a similar step in Raf activation but our genetic analysis suggests that KSR activity is intact in sur-6mutants. We identify the kinase PAR-1 as a negative regulator of vulval induction and show that it acts in opposition to SUR-6 and KSR-1. In addition to their roles in Ras signaling, SUR-6/PR55 and LET-92/PP2A-C cooperate to control mitotic progression during early embryogenesis.
Original Paper: Assays for thyroid-stimulating hormone using dried blood spotted filter paper specimens to screen for hypothyroidism in older children and adults
Authors: Hofman L F , Foley T P , Henry J J , Naylor E W
Published: January 2004

Objective: Symptoms of hypothyroidism in adults can be mistaken for medical and psychiatric diseases, as well as for general signs of ageing such as weakness, lethargy and fatigue. The incidence of hypothyroidism is many-fold higher in adults than in newborn children. The latter have been routinely screened for the condition using filter paper dried blood spots (DBS) for nearly three decades but this cost-effective screening technique has only recently been applied to adults. This study was undertaken to show that DBS testing in adults and older children is an accurate way to screen for hypothyroidism.

Methods: Serum and DBS specimens were collected from adults and children. Assays were run on both specimens and the results correlated. In addition 972 specimens were collected from adults at community centres and nursing homes. Follow-up studies were performed on patients with positive results.

Results: The correlation coefficient for 118 matched serum and DBS specimens was 0.99. Thyroid-stimulating hormone (TSH) values were elevated in 50 of the 972 adults from nursing homes and community centres. Thirteen of these individuals were on thyroid medication and 28 had either high serum TSH or high thyroglobulin (TgAb) or thyroid peroxidase (TPOAb) antibody levels.

Conclusions: Individuals can be screened for hypothyroidism by collecting finger stick DBS specimens at community centres, nursing homes and other locations which can be mailed by regular postal service to a central laboratory for accurate and inexpensive testing.
Original Paper: Hereditary haemochromatosis and hepatocellular carcinoma in males: a strategy for estimating the potential for primary prevention
Authors: Haddow J E , Palomaki G E , McClain M , Craig W
Published: January 2004

Objectives: Homozygosity for the C282Y mutation of the HFE gene is the main cause of iron overload in hereditary haemochromatosis. This study calculated the number of hepatocellular carcinoma cases among a cohort of white males that could be attributed to C282Y homozygosity. A better understanding of the extent of potentially preventable mortality arising from this cancer might help with decision making about the feasibility of population screening.

Methods: We combined information from published life tables, age-specific cancer rates and DNA studies of archived liver biopsy specimens to calculate the number of cases of hepatocellular carcinoma that might occur during the lifetime of a cohort of 1,000,000 men, including a subgroup of 5000 C282Y homozygotes.

Results: Hepatocellular carcinoma was estimated to occur in 2673 men in the cohort (1:374); 267 of these cases were in the subgroup of 5000 C282Y homozygotes (1:17). If these 267 cases were prevented, the remaining lifetime risk among all males would be 1:416. The relative risk for this cancer in C282Y homozygotes is 23.

Conclusions: There continues to be uncertainty about the efficacy of screening for haemochromatosis. Hepatocellular carcinoma is the most readily quantifiable serious health problem attributable to this source. Further confirmatory DNA (C282Y) studies would be helpful in larger, unbiased sets of archived biopsy specimens, as a way to confirm the present estimate. Any strategy designed to prevent attributable liver cancer is likely to prevent other serious problems from haemochromatosis as well.
Short Report: Performance of the recommendations of a British advisory group for screening for chlamydia in a sample of women in general practice
Authors: Verhoeven V , Avonts D , Meheus A , Ieven M , Goossens H , van Royen P
Published: January 2004

In this study the performance of the guidelines produced by the British Chief Medical Officer's expert advisory group for selective screening for Chlamydia trachomatis was evaluated. The guidelines were applied to a sample of 777 women in general practice in Antwerp, Belgium. The accuracy of the screening/testing recommendations was suboptimal. The model detected 90% of infections but failed to identify a high-risk population; the population to be screened was reduced by only 21%. The focus on young age as the most important determinant for screening was not appropriate. More attention should be paid to risky sexual behaviour.
Original Paper: Contribution of clinical breast examination to mammography screening in the early detection of breast cancer
Authors: Bancej C , Decker K , Chiarelli A , Harrison M , Turner D , Brisson J
Published: January 2004

Objectives: As the benefit of clinical breast examination (CBE) over that of screening mammography alone in reducing breast cancer mortality is uncertain, it is informative to monitor its contribution to interim measures of effectiveness of a screening programme. Here, the contribution of CBE to screening mammography in the early detection of breast cancer was evaluated.

Setting: Four Canadian organised breast cancer screening programmes.

Methods: Women aged 50-69 receiving dual screening (CBE and mammography) (n=300,303) between 1996 and 1998 were followed up between screen and diagnosis. Outcomes assessed by mode of detection (CBE alone, mammography alone, or both CBE and mammography) included referral rate, positive predictive value, pathological features of tumours (size, nodal status, morphology), and cancer detection rates overall and for small cancers (≤10 mm or node-negative). Heterogeneity in findings across programmes was also assessed.

Results: On first versus subsequent screen, CBE alone resulted in 28.5-36.7% of referrals, and 4.6-5.9% of cancers compared with 52.6-60.1% of referrals and 60.0-64.3% of cancers for mammography alone. Among cancers detected by CBE, 83.6-88.6% were also detected by mammography, whereas for mammographically detected cancers only 31.7-37.2% were also detected by CBE. On average, CBE increased the rate of detection of small invasive cancers by 2-6% over rates if mammography was the sole detection method. Without CBE, programmes would be missing three cancers for every 10,000 screens and 3-10 small invasive cancers in every 100,000 screens.

Conclusions: Inclusion of CBE in an organised programme contributes minimally to early detection.
Original Paper: A likelihood ratio approach to meta-analysis of diagnostic studies
Authors: Stengel D , Bauwens K , Sehouli J , Ekkernkamp A , Porzsolt F
Published: January 2004

Objective: To develop a clinically and methodologically sound approach to diagnostic meta-analysis.

Methods: Two-step model was used involving four fictitious sets of 10 studies each with varying sensitivity and specificity; this was followed by the application of the method to data from a published systematic review of emergency ultrasound. Multidimensional test characteristics (relating to the detection or exclusion of the condition of interest) were described by likelihood ratio scatterplots and pooled likelihood ratios. Likelihood ratios summarise the ability of a test to revise the prior probability of disease. They can be summarised by established fixed-effects and random-effects methods.

Results: Likelihood ratios precisely describe both directions of test performance. By plotting positive against negative likelihood ratios, together with their 95% confidence intervals, a multidimensional forest plot is obtained that can be interpreted in analogy to therapeutic meta-analyses. There are accepted threshold values of positive and negative likelihood ratios (i.e. 10.0 and 0.1) to recommend a test for clinical use. In the matrix space, distinct test characteristics can even be assessed by eyeballing. With regard to data from the real meta-analysis, the suggested high discriminatory power of ultrasound was only partially qualified by likelihood ratios. The positive value confirms the reliability of a positive scan, whereas the negative value questions a normal sonogram.

Conclusions: A full characterisation of test performance requires multidimensional effect measures. Likelihood ratios are recommended descriptors of the two dimensions of diagnostic research evidence and provide a convenient means to visualise and to communicate results as weighted summary estimates of a diagnostic meta-analysis.
A pilot study of 'fast track' antenatal screening for haemoglobinopathies
Authors: Wright J , Rati N , Kennefick A , Cobley A , McKweon C , Wood A
Published: January 2004

The NHS Plan launched in 2000 advocated a linked antenatal and neonatal screening programme for haemoglobinopathies. Currently screening practices vary widely across the UK and patient sampling is generally performed in a hospital setting. The process is flawed and frequently fails to provide accurate and timely information. In this study we demonstrate that organisational changes can improve the efficiency and quality of screening. The primary care screening process described here has increased partner testing rates and allowed early identification of at risk couples.
Testing for toxoplasmosis in pregnancy: a study of the routines in primary antenatal care
Authors: Eskild Anne , Fallås Dahl Gunn , Melby Kjetil K. , Nesheim Britt-Ingjerd
Published: January 2004

Objectives: The question of benefit of screening for antibodies against Toxoplasma gondii in pregnancy to prevent impairment in the infant has not been settled. Despite this, it is believed that such testing is common. The aim of this study was to describe the test routines and to identify factors associated with testing in primary antenatal care.

Setting: Ulleval University Hospital, Oslo, Norway.

Methods: All women who gave birth at Ulleval University Hospital, Oslo, Norway, in May 2000 were included. The number of antibody tests during pregnancy was obtained from the patient registry at the department of microbiology at the same hospital.

Results: 81% (361/446) had been tested for antibodies against Toxoplasma gondii during pregnancy. Women attending primary antenatal care at a specialist in obstetrics and gynaecology were most likely to be tested. Among women with no signs of prior toxoplasmosis, 35% (110/317) were tested only once.

Discussion: The majority of pregnant women are being tested for toxoplasmosis even though such testing has no documented preventive effect and has not been recommended.
Neonatal birth parameters of positive newborns at PKU screening as predictors of false-positive and positive results at recall-testing
Authors: Zaffanello Marco , Zamboni Giorgio , Maffeis Claudio , Tatò Luciano
Published: January 2004

Objectives: To investigate the predictive role that neonatal birth parameters of positive newborns at phenylketonuria (PKU) screening have on false-positive and positive results. We reviewed 195 newborns (115 males and 80 females) that had false-positive results between 1998 and 2001. A total of 4386 randomly selected neonates (2191 males and 2195 females) who tested normal at the first investigation in the same period, were used as negative-controls. A total of 38 PKU neonates (17 males and 21 females) diagnosed between 1990 and 2001 were used as positive-controls.

Methods: Phenylalanine concentration was measured with a fluorometric multitask plate counter Wallac 1420 VICTOR F (Perkin Elmer, Finland) and the fluorescent ninhydrine method (EG&G Wallac neonatal phenylalanine kit) using a recall cut-off level >120 μmol/l (2 mg/dl) of phenylalanine on dried blood spots. A multivariate logistic regression analysis was performed to evaluate the predictive role that body parameters (sex, gestational age, parity, weight, length and head circumference) of positive newborns at PKU screening had on false-positive and positive results at recall PKU tests.

Results: The risk of false-positive results is higher (~48%) in females than in males. Moreover, for each 100g of body weight reduction, the risk of false positive is around 4.2% higher. The risk of confirmation increased by 39% per week of gestational age.

Conclusions: In conclusion, our results suggest that preterm or low-birth-weight neonates recalled at the first investigation are more likely to be due to false-positives, whereas the risk of confirmation is higher in at-term neonates. By implication, the phenylalanine cut-off value for premature or low-body-weight infants could be higher.
The burden of prevention: downstream consequences of Pap smear testing in the elderly
Authors: Sirovich B E , Gottlieb D J , Fisher E S
Published: January 2004

Context: Although cervical cancer is an unusual cause of death among women 65 and older, most elderly women in the US report continuing to undergo periodic Pap smear screening.

Objective: To describe the incidence of Pap smears and downstream testing among elderly women.

Setting: Claims-based analysis of female Medicare enrollees age 65 and older.

Methods: Using three years of Medicare Part B 5% Files (1995-1997), we differentiated between women undergoing screening Pap smears and those undergoing Pap smears for surveillance of previous abnormalities or Pap smear follow-up. We determined the proportion of elderly women undergoing Pap smear testing and rates of downstream testing and procedures after an initial Pap smear.

Results: Four million female Medicare beneficiaries over 65 years underwent Pap smear testing between 1995 and 1997, representing 25% of the eligible population. After adjusting for underbilling for Pap smears under Medicare, 43% of women over 65 are estimated to have undergone Pap smear testing during the 3-year period. The large majority (90%) of Pap smears were for screening, while 10% were done for surveillance or follow-up. For every 1000 women with a screening Pap smear, 39 had at least one downstream intervention within eight months of the initial Pap smear, including seven women who underwent colposcopy and two women who had other surgical procedures. Rates of downstream interventions were considerably higher for women undergoing Pap smear follow-up (302 per 1000 with at least one downstream intervention), and surveillance of previous abnormalities (209 per 1000 with a downstream intervention).

Conclusion: Cervical cancer screening is widespread among elderly American women, and follow-up testing is not uncommon, particularly among the ten percent of women who appear to be in a cycle of repeated testing. This substantial volume of testing occurs despite the rarity of cervical cancer deaths and unknown benefits of screening in this age group.
A Live Baby or Your Money Back: The Marketing of In Vitro Fertilization Procedures
Authors: Schmittlein David C. , Morrison Donald G.
Published: January 2004

Many clinics that offer in vitro fertilization (IVF) have begun to market the following options to couples: (1) an a la carte program where the couple pays $7,500 per attempt regardless of the outcome; or (2) a money-back-guarantee program where the couple pays a $15,000 fee that covers up to three attempts, however, if after three cycles there is no live-birth delivery, then the full $15,000 is refunded.

We assess the a la carte versus the money-back-guarantee programs, and find the surprising result that the money-back-guarantee program appears (for the patients) to be “too good to be true.” That is, the money-back guarantee yields a substantial negative expected profit per couple for the clinics. More importantly from the patients' perspective, the money-back guarantee is the better option for all couples with less than 0.5 success probability per cycle. Virtually all traditional IVF patients have had per-cycle success probabilities below 0.5.

A detailed analysis of the key variables—i.e., success rate per attempt, heterogeneity of couples' rates of success, individual couples' “learning” on successive attempts, and cost to the clinic per attempt—shows that these money-back guarantees are unprofitable for the clinics. Since presumably clinics are not in business to lose money, the standard analysis must be missing something major. We suggest that the marketing of money-back guarantees is inducing couples who would previously have used—successfully—other less invasive procedures with fewer side effects and less risk of multiple births to decide to proceed directly to IVF, and that this scenario makes the money-back guarantees profitable for the clinics.

The implications of earlier use of IVF are then considered from an overall public policy point of view. Just as mothers everywhere tell their children, “When something looks too good to be true, then it is too good to be true!”
Good Reasons Sell: Reason-Based Choice Among Group and Individual Investors in the Stock Market
Authors: Barber Brad M. , Heath Chip , Odean Terrance
Published: January 2004

In this paper, we compare the investment decisions of groups (stock clubs) and individuals. Both individuals and clubs are more likely to purchase stocks that are associated with good reasons (e.g., a company that is featured on a list of most-admired companies). However, stock clubs favor such stocks more than individuals, despite the fact that such reasons do not improve performance. We describe why social dynamics may make good reasons more important for groups than individuals.
Measuring Imputed Cost in the Semiconductor Equipment Supply Chain
Authors: Cohen Morris A. , Ho Teck H. , Ren Z. Justin , Terwiesch Christian
Published: January 2004

We consider the order-fulfillment process of a supplier producing a customized capital good, such as production equipment, commercial aircraft, medical devices, or defense systems. As is common in these industries, prior to receiving a firm purchase order from the customer, the supplier receives a series of shared forecasts, which are called “soft orders.” Facing a stochastic internal manufacturing lead time, the supplier must decide at what time to begin the fulfillment of the order. This decision requires a trade-off between starting too early, leading to potential holding or cancellation costs, and starting too late, leading to potential delay costs. We collect detailed data of shared forecasts, actual purchase orders, production lead times, and delivery dates for a supplier-buyer dyad in the semiconductor equipment supply chain. Under the assumption that the supplier acts rationally, optimally balancing the cancellation, holding, and delay costs, we are able to estimate the corresponding imputed cost parameters based on the observed data. Our estimation results reveal that the supplier perceives the cost of cancellation to be about two times higher and the holding costs to be about three times higher than the delay cost. In other words, the supplier is very conservative when commencing the order fulfillment, which undermines the effectiveness of the overall forecast-sharing mechanism.
Contracts in Offshore Software Development: An Empirical Analysis
Authors: Gopal Anandasivam , Sivaramakrishnan Konduru , Krishnan M. S. , Mukhopadhyay Tridas
Published: January 2004

We study the determinants of contract choice in offshore software development projects and examine how the choice of contract and other factors in the project affect project profits accruing to the software vendor. Using data collected on 93 offshore projects from a leading Indian software vendor, we provide evidence that specific vendor-, client-, and project-related characteristics such as requirement uncertainty, project team size, and resource shortage significantly explain contract choice in these projects. Our analysis suggests that contract choice significantly determines project profit. Additionally, some ex ante vendor-, client-, and project-related characteristics known at the time of choosing the contract continue to significantly influence project profits after controlling for contract choice. We also provide evidence to show that project duration and team size affect project profits.
Safeguarding Interorganizational Performance and Continuity Under Ex Post Opportunism
Authors: Jap Sandy D. , Anderson Erin
Published: January 2004

Opportunism is a central construct in exchange theory. Economists contend that despite the firm's best efforts to erect governance structures that reduce opportunism and preserve outcomes, there is always some opportunism that remains once the transaction is in place. Despite this, there are few studies that systematically investigate the safeguarding efficacy of relationship attributes in the presence of such ex post opportunism. In this research, we develop a theoretical framework and provide a longitudinal test of the ability of various relationship safeguards to preserve performance outcomes and future expectations given varying levels of ex post opportunism in the relationship. Our survey results from over 300 buyers and suppliers indicates that given lower levels of opportunism, bilateral idiosyncratic investments and interpersonal trust enhance performance outcomes and future expectations, while goal congruence has no discernable effect. However, at higher levels of opportunism, goal congruence becomes a more powerful safeguard, while interpersonal trust becomes less effective. Bilateral idiosyncratic investments continue to preserve performance outcomes and future expectations even at higher levels of opportunism. Implications for the long-term management of interorganizational alliances are discussed.
Social Networks in Organizational Emergence: The University Spinout Phenomenon
Authors: Nicolaou Nicos , Birley Sue
Published: January 2004

This paper aims to ascertain the influence of social networks in the university spinout phenomenon. With respect to the instrumental role of social networks, it adopts a content contingency perspective pertaining to the role of closure and structural holes, and examines the interaction between relational and structural embeddedness in the academics' network structure. With respect to spinout outcomes, this paper distinguishes between academic exodus and stasis, and differentiates between types of spinouts based on the degree of involvement of the key academics. It also examines networks at the team level of analysis and submits that team-level structural differences exist between the different spinout structures.
An Interactive Evolutionary Metaheuristic for Multiobjective Combinatorial Optimization
Authors: Phelps Selcen (Pamuk) , Köksalan Murat
Published: January 2004

We propose an evolutionary metaheuristic for multiobjective combinatorial optimization problems that interacts with the decision maker (DM) to guide the search effort toward his or her preferred solutions. Solutions are presented to the DM, whose pairwise comparisons are then used to estimate the desirability or fitness of newly generated solutions. The evolutionary algorithm comprising the skeleton of the metaheuristic makes use of selection strategies specifically designed to address the multiobjective nature of the problem. Interactions with the DM are triggered by a probabilistic evaluation of estimated fitnesses, while memory structures with indifference thresholds restrict the presentation of solutions resembling those that have already been rejected. The algorithm has been tested on a number of random instances of the Multiobjective Knapsack Problem (MOKP) and the Multiobjective Spanning Tree Problem (MOST). Simulation results indicate that the algorithm requires only a small number of comparisons to be made for satisfactory solutions to be found.
Resource Allocation in Multisite Service Systems with Intersite Customer Flows
Authors: Chao Xiuli , Liu Liming , Zheng Shaohui
Published: January 2004

Motivated by a project in health-care management, we study the resource allocation problem in multisite service systems with intersite customer flows. We aim at providing insights to and guidelines for resource allocation in these service systems when some service criterion, such as average waiting time, loss rate, or blocking probability, is a major concern. We develop analytical optimization models and from them we obtain the explicit optimal allocation policy. Our results demonstrate that the optimal resource allocation solution exhibits a structure of “one large and many small.”
A Comment on “Price-Endings When Prices Signal Quality”
Authors: Shoemaker Robert , Mitra Debanjan , Chen Yuxin , Essegaier Skander
Published: January 2004

Stiving (2000) proposes an interesting model to explain price-endings. His analysis shows that even when customer demand increases at 9-ending price points, certain firms that use high prices to signal quality are more likely to set those prices at round numbers. This comment raises two issues about the model. First, it appears that the original paper imposes a condition that has the effect of eliminating a broad range of legitimate separating equilibria from the analyses. Second, it appears that the original model does not include constraints to ensure that the demand for each market segment will be nonnegative. When these constraints on demand are included, one obtains different aggregate demand curves, which leads to different equilibrium prices. Using the revised model and analysis, we find that 71% of the prices end in 9 and only 12% in 0. This contrasts with only 3% ending in 9 and 58% ending in 0 for the original study. Therefore, 9-endings still prevail even though high prices can be used by firms to signal high quality.
Reply to “A Comment on ‘Price-Endings When Prices Signal Quality’”
Authors: Stiving Mark
Published: January 2004

Although the comment provides some additional insight, it in no way diminishes the contribution of the original paper. That paper is the first and only theoretical explanation for why firms behave as though they use round prices to signal quality. Further, the paper provides empirical evidence in support of this explanation.
Pro-inflammatory and anti-inflammatory circulating cytokines and periprosthetic osteolysis
Authors: Fiorito S. , Magrini L. , Goalard C.
Published: January 2004

We investigated the circulating levels of the main cytokines involved in bone resorption (IL-1β, IL-6, TNF-α), prostaglandins (PGE2) and metalloproteases (MMP-1), as possible early markers of osteolysis, in the serum of eight patients with periprosthetic osteolysis and ten patients without osteolysis. All had received a cementless hip prosthesis (ABG-1). We also assessed the serum levels of IL-11 and TGF-β anti-inflammatory cytokines exerting protective effect on bone resorption. The mean serum levels of IL-1β, IL-6, TNF-α, TGF-β, MMP-1, and PGE2 in patients with periprosthetic osteolysis did not differ significantly from those of patients without osteolysis or from those of normal controls. IL-11 serum levels were not detectable at all in any of the patients, while they were detected within normal reference values in the control subjects (significant inverse correlation).

We believe that circulating cytokines cannot be regarded as markers of osteolysis, a condition characterised by a local inflammation without systemic signs of inflammation. On the contrary, the undetectable levels of IL-11 in implanted patients could provide evidence for a lack of balance between pro- and anti-inflammatory cytokines in these patients.
Imbalance of RANKL/RANK/OPG system in interface tissue in loosening of total hip replacement
Authors: Mandelin J. , Li T.-F. , Liljeström M. , Kroon M. E. , Hanemaaijer R. , Santavirta S. , Konttinen Y. T.
Published: January 2004

In the differentiation of osteoclasts the differentiation factor (RANKL) interacts with the receptor activator of NF-κB (RANK) in a direct cell-to-cell contact between osteoblast and (pre)osteoclast. This is inhibited by soluble osteoprotegerin (OPG). The mRNA levels of both RANKL (p < 0.01) and RANK (p < 0.05) were high in peri-implant tissue and RANKL+ and RANK+ cells were found in such tissue. Double labelling also disclosed soluble RANKL bound to RANK+ cells. We were unable to stimulate fibroblasts to express RANKL in vitro, but monocyte activation with LPS gave a fivefold increase in RANK mRNA levels. In contrast to RANKL and RANK expression in peri-implant tissue, expression of OPG was restricted to vascular endothelium. Endothelial cell OPG mRNA levels were regulated by TNF-α and VEGF, but not by hypoxia. It is concluded that activated cells in the interface tissue overproduce both RANKL and RANK and they can interact without interference by OPG.
Acetabular revision in total hip replacement with a press-fit cup
Authors: Elke R. , Berli B. , Wagner A. , Morscher E. W.
Published: January 2004

The need for supplementary screw fixation in acetabular revisions is still widely debated. We carried out 439 acetabular revisions over an eight-year period. In 171 hips with contained or small segmental defects, the Morscher press-fit cup was used. These revisions were followed prospectively. No screws were used for additional fixation.

A total of 123 hips with a mean follow-up of 7.4 years (5 to 10.5) were available for clinical and radiological review. There was no further revision of a press-fit cup for aseptic loosening. Radiological assessment revealed osteolysis in three hips. Of the original 171 hips there was cranial and medial migration of up to 6 mm at two years in 44 (26%). No further migration was seen after the second post-operative year. Acetabular revision without screws is possible with excellent medium-term results in well selected patients.
COMPRESSION OF THE SCIATIC NERVE BY WEAR DEBRIS FOLLOWING TOTAL HIP REPLACEMENT: A REPORT OF THREE CASES
Authors: Crawford J. R. , Van Rensburg L. , Marx C.
Published: January 2004

Pain in the distribution of the sciatic nerve is common in the elderly. In the presence of a long-standing joint replacement, consideration should be given as to whether compression might be due to an extraspinal cause. We present three women, in whom a mass of wear debris from a previous total hip replacement caused compression of the sciatic nerve posterior to the hip. The symptoms were relieved immediately following operation.
Arthroplasty of the elbow in haemophilia
Authors: Chapman-Sheath P. J. , Giangrande P. , Carr A. J.
Published: January 2004

Total elbow replacement can be a valuable option for the treatment of the elbow in haemophilia where there are associated arthropathic changes. We describe the outcome of seven elbow replacements in five consecutive patients with severe haemophilia A (native factor levels < 1%) at a mean of 42 months (25 to 65) after operation. All the patients had excellent relief of pain and improvement in function. One failure was due to infection in an immunocompromised patient with both HIV and Hepatitis C antibodies who was on anti-retroviral chemotherapy. The implant was revised at 30 months in a one-stage procedure and showed no evidence of loosening or infection 35 months later.
Closed reduction and percutaneous fixation of supracondylar fracture of the humerus and ipsilateral fracture of the forearm in children
Authors: Tabak Y. , Çelebi L. , Murath H. H. , Yağmurlu M. F. , Aktekin C. N. , Biçimoglu A.
Published: January 2004

We treated 22 children with a supracondylar fracture of the humerus and an ipsilateral fracture of the forearm by closed reduction and percutaneous fixation. There were four Gartland type-II and 18 Gartland type-III supracondylar fractures of the humerus. There were fractures of both bones of the forearm in 16 and of the radius in six. Both the supracondylar and the distal forearm fractures were treated by closed reduction and percutaneous fixation. The mean follow-up time was 38.6 months.

At the latest follow-up there were 21 excellent or good results and one fair result. There were no cases of delayed union, nonunion or malunion. Five nerve injuries were diagnosed on admission and all recovered spontaneously within eight weeks. No patient developed a compartment syndrome.
Surgical treatment of symptomatic osteochondroma
Authors: Bottner F. , Rodl R. , Kordish I. , Winkelmann W. , Gosheger G. , Lindner N.
Published: January 2004

Our aim was to investigate the outcome of excision of osteochondromas. Between 1994 and 1998, 92 symptomatic osteochondromas in 86 patients were excised. There were 40 women and 46 men with a mean age of 20 years (3 to 62). Of these, 56 had a solitary osteochondroma and 30 had multiple hereditary tumours. The presenting symptoms were pain (79.1%), swelling (23.3%), reduced range of movement (19.8%), cosmetic abnormalities (17.4%), and bursitis (12.8%). The most common site (37.6%) was around the knee.

Four patients had major complications (4.7%) including one intra-operative fracture of the femoral neck and three nerve palsies which resolved after decompression. Six patients had minor complications. Overall, 93.4% of the preoperative symptoms resolved after excision of the tumours. Excision is a successful form of treatment for symptomatic osteochondromas with a low morbidity.
Separate vertical wiring for the fixation of comminuted fractures of the inferior pole of the patella
Authors: Yang K. H. , Byun Y. S.
Published: January 2004

Comminuted and displaced fractures of the inferior pole of the patella are not easy to reduce and it is difficult to fix the fragments soundly enough to allow early movement of the knee. We have evaluated the clinical effectiveness of the separate vertical wiring technique in acute comminuted fractures of the inferior pole of the patella. A biomechanical study was also performed using ten pairs of embalmed cadaver knees. A four-part fracture was made on the inferior pole of the patella and fixed by two separate vertical wires on one side and two pull-out sutures after partial patellectomy on the other.

The ultimate load to failure in the first group was significantly higher than in the second (250.1± 109.7 N v 69.7 ± 18.9 N, p< 0.002), as was the stiffness (279.9 ± 76.4 N/mm v 23.2 ± 11.4 N/mm, p< 0.001).

The separate wire technique was used in 25 patients with comminuted fractures of the inferior pole of the patella who were followed up for a mean period of 22 months (10 to 50). All the fractures healed at a mean of seven weeks (6 to 10). No breakage of a wire or infection occurred. The mean grading at the final follow-up was 29.5 points (27 to 30) using the Böstman method. This technique preserved the length of the patella, fixed the comminuted fragments of the inferior pole and avoided long-term immobilisation of the knee.
Levator scapulae and rhomboid transfer for paralysis of trapezius
Authors: Romero J. , Gerber C.
Published: January 2004

Spinal accessory nerve palsy leads to painful disability of the shoulder, carrying an uncertain prognosis. We reviewed the long-term outcome in 16 patients who were treated for pain, weakness of active elevation and asymmetry of the shoulder and the neck due to chronic paralysis of the trapezius muscle, as a result of nerve palsy. Of four patients who were treated conservatively, none regained satisfactory function, although two became pain-free. The other 12 patients were treated operatively with transfer of the levator scapulae to the acromion and the rhomboid muscles to the infraspinatus fossa (the Eden-Lange procedure). At a mean follow-up of 32 years, the clinical outcome of the operatively treated patients was excellent in nine, fair in two, and poor in one patient, as determined by the Constant score. Pain was adequately relieved in 11 and overhead function was restored in nine patients. Pre-operative electromyography had been carried out in four patients. In two, who eventually had a poor outcome, a concomitant long thoracic and dorsal scapular nerve lesion had been present.

The Eden-Lange procedure gives very satisfactory long-term results for the treatment of isolated paralysis of trapezius. In the presence of an additional serratus anterior palsy or weak rhomboid muscles, the procedure is less successful in restoring shoulder function.
The extensile rectus snip exposure in revision of total knee arthroplasty
Authors: Meek R. M. D. , Greidanus N. V. , McGraw R. W. , Masri B. A.
Published: January 2004

Revision of a total knee arthroplasty may require an extensile approach to permit a satisfactory exposure without compromising the attachment of the patellar tendon. It has been assumed that a rectus snip is a relatively benign form of release, but the effect of using this approach on function, pain and patient satisfaction is not known.

From January 1997 to December 1999, 107 patients who underwent revision of total knee arthroplasty were followed up at a minimum of two years (mean 40.5 months) and assessed by the Oxford Hip Score, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Short-Form (SF)-12 and patient satisfaction. Co-morbidity, surgical exposure, the Hospital for Special Surgery (HSS) knee scores and the range of movement were also used. A standard medial parapatellar approach was used in 57 patients and the rectus snip in 50. The two groups were equivalent for age, sex and co-morbidity scores. The WOMAC function, pain, stiffness and satisfaction scores demonstrated no statistical difference. The use of a rectus snip as an extensile procedure has no effect on outcome.
Acid-etched microtexture for enhancement of bone growth into porous-coated implants
Authors: Hacking S. A. , Harvey E. J. , Tanzer M. , Krygier J. J. , Bobyn J. D.
Published: January 2004

We designed an in vivo study to determine if the superimposition of a microtexture on the surface of sintered titanium beads affected the extent of bone ingrowth. Cylindrical titanium intramedullary implants were coated with titanium beads to form a porous finish using commercial sintering techniques. A control group of implants was left in the as-sintered condition. The test group was etched in a boiling acidic solution to create an irregular surface over the entire porous coating. Six experimental dogs underwent simultaneous bilateral femoral intramedullary implantation of a control implant and an acid etched implant. At 12 weeks, the implants were harvested in situ and the femora processed for undecalcified, histological examination. Eight transverse serial sections for each implant were analysed by backscattered electron microscopy and the extent of bone ingrowth was quantified by computer-aided image analysis. The extent of bone ingrowth into the control implants was 15.8% while the extent of bone ingrowth into the etched implants was 25.3%, a difference of 60% that was statistically significant.

These results are consistent with other research that documents the positive effect of microtextured surfaces on bone formation at an implant surface. The acid etching process developed for this study represents a simple method for enhancing the potential of commonly available porous coatings for biological fixation.
High-sensitivity analysis of serum C-reactive protein in young patients with lumbar disc herniation
Authors: Sugimori K. , Kawaguchi Y. , Morita M. , Kitajima I. , Kimura T.
Published: January 2004

We measured the serum concentration of C-reactive protein (CRP) by a high-sensitive method in patients with lumbar disc herniation. There were 48 patients in the study group and 53 normal controls. The level and type of herniation were evaluated. The clinical data including the neurological findings, the angle of straight leg raising and post-operative recovery as measured by the Japanese Orthopaedic Association (JOA) score, were recorded. The high-sensitive CRP (hs-CRP) was measured by an ultrasensitive latex-enhanced immunoassay. The mean hs-CRP concentration was 0.056 ± 0.076 mg/dl in the patient group and 0.017 ± 0.021 mg/dl in the control group. The difference was statistically significant (p = 0.006). There was no other correlation between the hs-CRP concentration and the level and type of herniation, or the pre-operative clinical data. A positive correlation was found between the concentration of hs-CRP before operation and the JOA score after. Those with a higher concentration of hs-CRP before operation showed a poorer recovery after. The significantly high concentration of serum hs-CRP might indicate a systemic inflammatory response to impingement of the nerve root caused by disc herniation and might be a predictor of recovery after operation.
Primary Dental Care: Time to Revise the Definition?
Authors: Morris John , White Deborah , Bradnock Gill
Published: January 2004

There have been several definitions of primary dental care over the last 20 years and while each was written to reflect the requirements of the time, most provide a conflicting description. This paper examines past definitions of primary dental care in the context of recent developments in UK dentistry and critically describes possible new definitions.
Management of the Impacted or Displaced Maxillary Canine
Authors: Kidner Giles , Noar Joe , Evans Robert D
Published: January 2004

The maxillary canine is commonly displaced or impacted. Monitoring the normal development of the dentition is important to identify and treat potential problems and hence minimise the need for later, more complex therapy. This paper discusses some problems that may occur and the subsequent treatment of these problems, by illustration with five case reports.
The Provision of Occlusal Splints in Primary Dental Care
Authors: Patel Kalpesh , Hemmings Kenneth W , Vaughan Simon
Published: January 2004

Occlusal splints (Michigan splints, night/bite guards or bite-raising appliances) can be an effective, inexpensive and reversible treatment for a wide range of dental problems.

Objective

The aim of this study was to analyse retrospectively the provision of occlusal splint (‘Michigan’ type) in general dental practice, following a prescription by a restorative dental consultant.

Method

One hundred patients were recruited from consultant clinics in a department of conservative dentistry during 1995 and 1996. All patients were prescribed a maxillary, full-coverage, heat-cured, acrylic-resin splint (Michigan splint) as part of a treatment plan. An explanatory letter and questionnaire were sent to all patients and to their referring general dental practitioner in 1997 and 1998.

Results

A response rate of 79% was achieved in obtaining completed questionnaires from both patients and general dental practitioners. Of respondents 43% (34/79) received an occlusal splint of some form. A small proportion of the respondents (16.5% [13/79]) received a Michigan splint as prescribed. Irrespective of the type of appliance provided, most patients (82% [28/34]) found them helpful. Of those who did not receive an occlusal splint, 38% (17/45) of patients felt financial implications deterred them from obtaining an appliance. Other common reasons for non-provision included: patients felt that symptoms had improved (18% [8/45]) and patients did not agree with treatment (18% [8/45]). The general dental practitioners had similar opinions to their patients.

Discussion

These findings raise some serious doubts on the efficacy of consultant clinic advice in the prescription of occlusal splints in general dental practice. The financial and educational issues raised by this study will need to be addressed to improve service provision.

Conclusion

The results of this study indicate that 16.5% of patient respondents prescribed a Michigan splint at a consultant clinic received such an appliance in general dental practice.
Primary Dental Care in Japan: Organisation, Management and Delivery
Authors: Thakrar Sneha
Published: January 2004

The Japanese system of business management and work ethic has been the envy of many in the Western world and many have visited the country to study the methods employed for success. As winner of the Faculty of General Dental Practitioners (UK)'s Stafford-Miller Travelling Scholarship, I spent four weeks in Japan visiting various dental institutions and examining general dental practice.1
An Evaluation of Powder-free Gloves in General Dental Practice
Authors: Brunton Paul A , Abidia Randa , Macfarlane Tatiana V , Wilson Nairn HF
Published: January 2004

Purpose of study

To evaluate the suitability of two non-sterile, powder-free gloves for routine use in general dental practice.

Basic procedures

Randomly allocated blind evaluation of two powder-free gloves by five dentists and five dental nurses in general dental practice. Each dentist and dental nurse were allocated a four-day supply of two unnamed powder-free gloves. Following glove usage a questionnaire sought their views regarding ease of donning, operator comfort, puncture and tear resistance, and tactile sensitivity. Details of procedure undertaken, time of wear and puncture and tear formation for the dentists’ gloves were also recorded. The dentists’ gloves were retained and subsequently tested for punctures and tears.

Main findings

In terms of ease of donning, operator discomfort, tear resistance and tactile sensitivity neither glove was ideal, however one glove was rated higher than the other. Overall, the dentists noticed only half of the punctures and tears detected in the laboratory. One glove was more prone to punctures with the other glove more liable to tear. Time worn in excess of 20 minutes and endodontic procedures were associated with a higher incidence of punctures.

Principal conclusions

The two powder-free gloves evaluated in this study would appear not to be suitable for routine use in general dental practice. Further developments are required before powder-free gloves of the type evaluated can be expected to receive widespread acceptance for routine use by dentists and dental nurses in general dental practice.
A General Systems Approach to Suicide Prevention: Lessons from Cardiac Prevention and Control
Authors: Sanddal Nels D. , Sanddal Teri L. , Berman Alan L. , Silverman Morton M.
Published: January 2004

The pathology of cardiac disease includes genetic, physical, biochemical, psychological, social, and environmental vectors. Factors contributing to suicide have been identified in these same areas. Survival from an acute cardiac event requires a systematized and multisectoral response. Communities that do not have systematized response capabilities to acute cardiac events have poorer survival outcomes. Suicide prevention and control may also be responsive to an integrated community response system. This paper examines the development of a community cardiac care model, explores potential parallels for a community suicide prevention and control model, and outlines a general systems theory framework for a suicide prevention and control system.