bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of rainwater harvesting on centralized urban water supply systems
Authors: Grandet C. , Binning P. J. , Mikkelsen P. S. , Blanchet F.
Published: September 2010

The potential effect of widespread rainwater harvesting practices on mains water demand and quality management are investigated for three different types of urban areas characterized by different roof area to water demand ratios. Two rainfall patterns are considered with similar average annual depths but very different temporal distributions. Supply reliability and the extent of reliance on the public distribution system are identified as suitable performance indicators for mains water infrastructure. A uniform temporal distribution of rainfall in an oceanic climate like that of Dinard, Northern France, yielded supply reliabilities close to 100% for reasonable tank sizes (0.065 m3/m2 of roof area in Dinard compared with 0.262 m3/m2 in Nice with a RWSO of 30% for a detached house). However, the collection and use of rainfall results in a permanent decrease in mains water demand leading to an increase in water age in the distribution network. Investigations carried on a real network showed that water age is greatly affected when rainwater supplies more than 30% of the overall water demand. In urban water utilities planning, rainwater supply systems may however be profitable for the community if they enable the deferment of requirements for new mains water infrastructure.
The Value of Clinical Criteria in Identifying Patients with X-Linked Alport Syndrome
Authors: Hanson Helen , Storey Helen , Pagan Judith , Flinter Frances
Published: October 2010

Background and objectives

Alport syndrome (AS) is a predominantly X-linked hereditary nephritis associated with high-tone, sensorineural deafness and characteristic eye signs. Clinical diagnostic criteria were defined in 1988. Most cases result from mutations in the X-linked collagen gene COL4A5, with mutations in the autosomal genes COL4A3 and COL4A4 on chromosome 2 accounting for the rest. Mutation analysis of COL4A5 with a combination of sequencing and multiplex ligation-dependent probe amplification has been available for several years. The objective of this study was to determine the utility of clinical diagnostic criteria in identifying patients likely to have a COL4A5 mutation.

Design, setting, participants, & measurements

Clinical information was available on 206 patients whose DNA was received for testing between 1994 and June 2008; predictive tests for a known familial mutation, samples from duplicate family members, and incompletely screened samples were excluded. One hundred and twenty-eight patients (62.1%) had a pathogenic COL4A5 mutation.

Results

The mutation detection rate in families fulfilling zero, one, two, three, or four diagnostic criteria was 0%, 18%, 64%, 89%, and 81%, respectively. Sixty-seven percent of patients with COL4A5 mutations meeting only two diagnostic criteria had not had a complete clinical assessment. In two thirds of families meeting four diagnostic criteria without an identified COL4A5 mutation, autosomal inheritance was confirmed or suspected.

Conclusions

The authors recommend COL4A5 analysis in any patient meeting at least two clinical diagnostic criteria. COL4A3 and COL4A4 analysis should be considered if a COL4A5 mutation is not detected and primarily if autosomal inheritance is suspected.
Vaginismus: A Review of the Literature on the Classification/Diagnosis, Etiology and Treatment
Authors: Lahaie Marie-Andrée , Boyer Stéphanie C , Amsel Rhonda , Khalifé Samir , Binik Yitzchak M
Published: October 2010

Vaginismus is currently defined as an involuntary vaginal muscle spasm interfering with sexual intercourse that is relatively easy to diagnose and treat. As a result, there has been a lack of research interest with very few well-controlled diagnostic, etiological or treatment outcome studies. Interestingly, the few empirical studies that have been conducted on vaginismus do not support the view that it is easily diagnosed or treated and have shed little light on potential etiology. A review of the literature on the classification/diagnosis, etiology and treatment of vaginismus will be presented with a focus on the latest empirical findings. This article suggests that vaginismus cannot be easily differentiated from dyspareunia and should be treated from a multidisciplinary point of view.
Updated checklist of Albanian aquatic beetles with first localities of some species of Hydradephaga, Hydrophiloidea and Byrrhoidea (Coleoptera)
Authors: Przewoźny Marek , Jaskuła Radomir , Grabowski Michał
Published: September 2010

New records of 34 aquatic beetle species from Albania are presented. Seventeen species are recorded for the first time from this country, including 3 species of Haliplidae, 6 of Dytiscidae, 6 of Hydrophilidae and 2 of Dryopidae. Coelostoma hispanicum (Küst.) is confirmed to occur in an area east of the Mediterranean Sea. An updated checklist of Albanian aquatic Coleoptera is also provided. The list counts 125 species belonging to 11 families. There are 3 species of Gyrinidae, 9 of Haliplidae, 1 of Noteridae, 44 of Dytiscidae, 4 of Helophoridae, 1 of Hydrochidae, 21 of Hydrophilidae, 33 of Hydraenidae, 5 of Elmidae, 3 of Dryopidae, and 1 of Limnichidae.
The effect of catchment area management on biogenic element concentrations in the water of small ponds
Authors: Szyperek Urszula
Published: September 2010

The aim of this study, conducted during the 1997-2001 period in the Olsztyn Lakeland, was to determine the effect of soil type and land use in the catchment areas of small ponds, on the concentrations of nitrogen and phosphorus compounds, as well as calcium and potassium, in water. The concentrations of all the nutrients (except for nitrite ions) in the water of small ponds were found to be significantly correlated with the soil type dominating in the catchment area. The domination of loamy sands in the catchment areas of small ponds caused an increase in the concentrations of nitrates, phosphorus and potassium, while the domination of light silty loam caused an increase the calcium content of the water. The highest and lowest concentrations of phosphorus compounds and potassium were recorded in water from small ponds located in agricultural (arable land - AL, fallow - FA) and afforested catchments, respectively.
Functioning conditions of small basinbogs in Wielkopolski National Park
Authors: Klimaszyk Piotr
Published: September 2010

Functioning conditions of small basinbogs in Wielkopolski National Park

The hydrological and geochemical aspects of the functioning and evolution of two small peatbogs located in Wielkopolska National Park were studied. The investigated peatlands are isolated from the influence of catchment ground waters. The main source of water supply is precipitation and surface run-off from the wooded catchment. Physical and chemical properties of the peatland waters are determined by hydrological conditions. Acid water reaction and low concentration of dissolved minerals suggest the peatlands should be classified as ombrotrophic high peatbogs.

High concentrations of nutrients (especially phosphorus) were found in the peat waters. However, the bioavailability of the phosphorus is strongly limited due to the presence of humic substances and the low pH of the water. Statistical analysis revealed that the peatlands studied were chemically similar.
Issues in the protection of small river valleys: the example of the Kulawa River valley (northwest Poland)
Authors: Prajs Bożena , Antkowiak Wojciech
Published: September 2010

This paper presents the results of research relating to the vegetation of the Kulawa River valley and its flow lakes - Głuche Duże, Głuche Małe, and Sieczonek.

Transformations observed in the flora examined were the result of two overlapping factors:

1. anthropogenic factors - among others, a high phosphorus content in the waters of the river and in nutrients accumulating in the lakes;

2. natural factors, such as a reduced level of subsoil waters.

In the protection of river valleys, it is important to diagnose all threats. The diagnosis should be based not only on an evaluation of water quality, but also on the state of the whole environment of the valley.
First report on fertility after allogeneic uterus transplantation
Authors: Díaz‐García César , Akhi Shamima N. , Wallin Ann , Pellicer Antonio , Brännström Mats
Published: September 2010

Uterus transplantation may become the first available treatment for uterine factor infertility, which is due to the absence or malfunction of the uterus. Here we describe for the first time pregnancy after allogeneic uterus transplantation, as a proof of concept of uterine function in a transplanted uterus in a standardized animal model (rat) under immunosuppression.
Is there a role for BLADE acquisition in T2-weighted breast MRI?
Authors: Ozcan Umit Aksoy , Dincer Alp , Yildiz M. Erdem , Cinko Murat , Cizmeli M. Olcay
Published: October 2010

Background: Standard T2-weighted (T2W) magnetic resonance imaging (MRI) is a necessary component of routine breast MRI. However, breast MRI suffers from minor subject movements, which degrade the image quality. BLADE acquisition MRI is a promising motion degradation method currently used in brain imaging.

Purpose: To compare T2W BLADE acquisition breast MR images with routine T2W images in the evaluation of motion artifacts and overall image quality.

Material and Methods: MRI was performed with a 1.5 T system on 25 volunteers and 25 consecutive patients with identical imaging parameters for both MRI sequences (TR 5240 ms, TE 112–108 ms, acquisition 1, spatial resolution 0.9×0.9× 4 mm). Motion and flow artifacts and pectoral muscle and lesion contour delineations were assessed. Signal to noise ratios (SNRs) of images and contrast to noise ratios (CNRs) of the incidental lesions were calculated. The results were evaluated with the Wilcoxon signed-ranks test.

Results: Of the 50 patients, 44 were included in the analysis (mean age 42.1 years). Motion artifacts were prominent in 48% cases on routine T2W and in only 2% of BLADE cases. The SNR values of BLADE images were significantly higher than routine T2W ( P<0.05). Pectoral muscle contours were better assessed on BLADE in all cases. Sequence performances were similar in flow artifacts, CNR values, and contour delineation of incidental lesions. The readers chose BLADE sequence MRI in 25 cases and found the overall performance of sequences equal in 19 cases. None of the readers preferred routine T2W to BLADE.

Conclusion: The performance of BLADE is superior to routine T2W images in eliminating motion artifacts, provides better SNRs, shows detailed pectoral muscle contours, and may be the sequence of choice.
Capsule of parotid gland tumor: evaluation by 3.0 T magnetic resonance imaging using surface coils
Authors: Ishibashi Mana , Fujii Shinya , Kawamoto Katsuyuki , Nishihara Keisuke , Matsusue Eiji , Kodani Kazuhiko , Kaminou Toshio , Ogawa Toshihide
Published: October 2010

Background: Magnetic resonance (MR) imaging of parotid gland tumors has been widely reported, although few reports have evaluated the capsule of parotid gland tumors in detail.

Purpose: To evaluate the diagnostic usefulness of 3.0 T MR imaging with surface coils for detection of the parotid gland tumor capsule, and to clarify the characteristics of the capsules.

Material and Methods: Seventy-eight patients with parotid gland tumors (63 benign and 15 malignant) were evaluated. Axial and coronal T2-weighted and contrast-enhanced T1-weighted images were obtained using a 3.0 T MR scanner with 70 mm surface coils. It was retrospectively assessed whether each parotid gland tumor was completely surrounded by a capsule. The capsule was classified as regular or irregular in terms of capsular thickness, and as none, mildly, or strongly enhancing in terms of contrast enhancement. Visual interpretations were compared with histopathological findings to evaluate the diagnostic ability of MR imaging to detect parotid gland tumor capsules. Statistical evaluation was conducted concerning the presence of capsules, capsular irregularity, and the difference in contrast enhancement between benign and malignant tumors, and that between pleomorphic adenomas and Warthin's tumors.

Results: Capsules completely surrounding the tumor on MR imaging yielded a sensitivity of 87.7% (50/57), specificity of 90.5% (19/21), and accuracy of 88.5% (69/78). Benign tumors had a capsule completely surrounding the tumor significantly more often than malignant tumors ( P = 0.009). Concerning capsular irregularity, malignant tumors tended to have more irregular capsules than benign tumors, although there were no significant differences. The capsules of malignant tumors enhanced significantly more strongly than those of benign tumors ( P = 0.018).

Conclusion: 3.0 T MR imaging using surface coils could correctly depict parotid gland tumor capsules in most cases. Most benign and some malignant tumors had capsules completely surrounding the tumors. Malignancy should be considered in tumors with irregular and strongly enhancing capsules.
Computer-aided detection system applied to full-field digital mammograms
Authors: Bolivar Alfonso Vega , Gomez Sonia Sánchez , Merino Paula , Alonso-Bartolomé Pilar , Garcia Estrella Ortega , Cacho Pedro Muñoz , Hoffmeister Jeffrey W.
Published: October 2010

Background: Although mammography remains the mainstay for breast cancer screening, it is an imperfect examination with a sensitivity of 75–92% for breast cancer. Computer-aided detection (CAD) has been developed to improve mammographic detection of breast cancer.

Purpose: To retrospectively estimate CAD sensitivity and false-positive rate with full-field digital mammograms (FFDMs).

Material and Methods: CAD was used to evaluate 151 cases of ductal carcinoma in situ (DCIS) ( n=48) and invasive breast cancer ( n=103) detected with FFDM. Retrospectively, CAD sensitivity was estimated based on breast density, mammographic presentation, histopathology type, and lesion size. CAD false-positive rate was estimated with screening FFDMs from 200 women.

Results: CAD detected 93% (141/151) of cancer cases: 97% (28/29) in fatty breasts, 94% (81/86) in breasts containing scattered fibroglandular densities, 90% (28/31) in heterogeneously dense breasts, and 80% (4/5) in extremely dense breasts. CAD detected 98% (54/55) of cancers manifesting as calcifications, 89% (74/83) as masses, and 100% (13/13) as mixed masses and calcifications. CAD detected 92% (73/79) of invasive ductal carcinomas, 89% (8/9) of invasive lobular carcinomas, 93% (14/15) of other invasive carcinomas, and 96% (46/48) of DCIS. CAD sensitivity for cancers 1–10 mm was 87% (47/54); 11–20 mm, 99% (70/71); 21–30 mm, 86% (12/14); and larger than 30 mm, 100% (12/12). The CAD false-positive rate was 2.5 marks per case.

Conclusion: CAD with FFDM showed a high sensitivity in identifying cancers manifesting as calcifications or masses. CAD sensitivity was maintained in small lesions (1–20 mm) and invasive lobular carcinomas, which have lower mammographic sensitivity.
Comprehensive Field Study of Fuel Use and Emissions of Nonroad Diesel Construction Equipment
Authors: Frey H. Christopher , Rasdorf William , Lewis Phil
Published: October 2010

Limited field data are available for analyses of fuel use and emissions of nonroad diesel construction equipment. This paper summarizes the results of field research that used a portable emissions monitoring system to collect fuel use and emissions data from eight backhoes, six bulldozers, three excavators, four generators, six motor graders, three off-road trucks, one skid-steer loader, three track loaders, and five wheel loaders while they performed various duty cycles. These tests produced approximately 119 h of field data for petroleum diesel and approximately 48 h for B20 biodiesel. Engine attribute data including horsepower, displacement, model year, engine tier, and engine load were collected to determine these factors’ influence on fuel use rates and emission rates of nitrogen oxides, hydrocarbons, carbon monoxide, carbon dioxide, and opacity. Mass per time fuel use rates were developed for each item of equipment, as were mass per time and mass per fuel used emission rates for each pollutant. For petroleum diesel, fuel use and emission rates of each pollutant were found to increase with engine displacement, horsepower, and load and to decrease with model year and engine tier. The results were qualitatively similar for B20 biodiesel. Fuel-based emission rates were found to have less variability and less sensitivity to engine size and load than time-based emission rates. Where possible, development of emission inventories based on fuel consumed, rather than time of activity, is preferred.
Subaxial sagittal alignment and adjacent-segment degeneration after atlantoaxial fixation performed using C-1 lateral mass and C-2 pedicle screws or transarticular screws
Authors: Yoshida Go , Kamiya Mituhiro , Yoshihara Hisatake , Kanemura Tokumi , Kato Fumihiko , Yukawa Yasutugu , Ito Keigo , Matsuyama Yukihiro , Sakai Yoshihito
Published: October 2010

Object

The purpose of this study was to evaluate the effect of a fixed atlantoaxial angle on subaxial sagittal alignment, and that of atlantoaxial fixation on adjacent-segment motion and degeneration.

Methods

The authors retrospectively reviewed 65 patients in whom atlantoaxial instability was treated with atlantoaxial fixation by C-1 lateral mass and C-2 pedicle screw fixation (30 patients, Goel-Harms [GH] group) or a combination of transarticular screw fixation and posterior wiring (35 patients, Magerl-Brooks [MB] group). Angles of Oc–C1, C1–2, C2–3, and C2–7 were determined based on an upright lateral radiograph in flexion, neutral, and extension positions. The range of motion (ROM) at Oc–C1 and C2–3 was also determined. All patients were examined before and 2 years after surgery.

Results

The mean preoperative atlantoaxial angles in the GH and MB groups were 20.9 ± 8.3° and 18.3 ± 7.2°, respectively, and the mean postoperative atlantoaxial angles in the same groups were 23.5 ± 5.6° and 29.7 ± 6.3°, respectively, with a statistically significant difference between the 2 groups (p < 0.05). The mean preoperative angles of C2–7 in the GH and MB groups were 15.4 ± 7.8° and 13.7 ± 9.5°, respectively, and after surgery, the angles were 11.8 ± 12° and 2.48 ± 12°, respectively, with a statistically significant difference between the 2 groups (p < 0.05). The postoperative angle of C1–2 showed a negative correlation with the extent of change observed in the C2–7 angle preand postoperatively in each of these 2 surgical procedures. The Oc–C1 ROM increased after surgery in both groups, but the difference was not statistically significant (p = 0.38). The C2–3 ROM decreased after surgery in both groups, and the difference was statistically significant (p < 0.05).

Conclusions

Atlantoaxial fixation in a hyperlordotic position produced kyphotic sagittal alignment after surgery in both GH and MB groups. Reduction of the atlantoaxial joint can be easily achieved through screw fixation at an optimal angle, thereby ameliorating the risk for subsequent subaxial kyphosis. Degeneration of lower adjacent segments appeared to be less with this procedure compared with using a combination of transarticular screw fixation and posterior wiring.
Influence of low glucose supply on the regulation of gene expression by nucleus pulposus cells and their responsiveness to mechanical loading
Authors: Rinkler Christina , Heuer Frank , Pedro Maria Teresa , Mauer Uwe Max , Ignatius Anita , Neidlinger-Wilke Cornelia
Published: October 2010

Object

Environmental alterations resulting in a decrease in the nutrient supply have been associated with intervertebral disc (IVD) degeneration, particularly of the nucleus pulposus (NP). The goal of the present study was to examine the hypothesis that glucose deprivation alters the metabolism of NP cells and their responsiveness to mechanical loading. A possible interaction of glucose supply and hydrostatic pressure (HP) with gene expression by NP cells has not been investigated.

Methods

The influence of glucose supply (physiological concentration: 5 mM, reduction: 0 or 0.5 mM) and cyclic HP loading (2.5 MPa, 0.1 Hz, 30 minutes) on bovine and human NP cell matrix turnover was analyzed by quantitative real-time reverse transcriptase–polymerase chain reaction. Glucose-dependent effects on cell viability were determined by trypan blue exclusion. A glycosaminoglycan (GAG) assay was performed to determine nutritional effects on the protein level.

Results

Glucose reduction resulted in significant downregulations (p < 0.05) of aggrecan, collagen-I, and collagen-II gene expression by bovine NP cells. Exemplary human donors also displayed a similar trend for aggrecan and collagen-II, whereas matrix metalloproteinases (MMPs) tended to be upregulated under glucose deprivation. After HP loading, human NP cells showed individual upregulations of collagen-I and collagen-II expression, while MMP expression tended to be downregulated under glucose reduction relative to a normal glucose supply. Cell viability decreased with glucose deprivation. The GAG content was similar in all groups at Day 1, whereas at Day 3 there was a significant increase under physiological conditions.

Conclusions

Glucose deprivation strongly affected NP cell metabolism. The effects of an altered glucose supply on gene expression were more pronounced than the mechanically induced effects. Data in this study demonstrate that the glucose environment is more critical for disc cell metabolism than mechanical loads. In individual human donors, however, adequate mechanical stimuli might have a beneficial effect on matrix turnover during IVD degeneration.
Anterior transsternal approach for a lesion in the upper thoracic vertebral body
Authors: Zengming Xiao , Maolin He , Xinli Zhan , Qianfen Chen
Published: October 2010

Object

Access to the upper thoracic vertebrae has been hampered by numerous anatomical structures and is further impaired by the transition from cervical lordosis to thoracic kyphosis. Therefore, the authors endeavored to study an anterior transsternal approach for upper thoracic disease (T1–4).

Methods

Fifty-four patients with upper thoracic disease underwent anterior decompression and fusion with sternotomy. Ages in the 33 men and 21 women ranged from 37 to 69 years (average 49 years). Before surgery, there were 7 patients with Frankel Grade B function, 17 with Grade C, 21 with Grade D, and 9 with Grade E. For a T-1 and T-2 lesion, the authors used “inside window of the brachiocephalic artery”: the brachiocephalic artery and right arteria carotis communis were retracted to the right, and the tracheoesophageal sheath was retracted to left. For a T-3 and T-4 lesion, the authors used the “outside window of the brachiocephalic artery”: the trachea, esophagus, and brachiocephalic artery were retracted to the left, the proximal portion of the right innominate vein was retracted to the right, and the left innominate vein was retracted inferolaterally. The patients were followed up for 24–48 months.

Results

The surgery was successful. The operation time was 120–150 minutes, and bleeding during the operation was 300–800 ml. After surgery, pain resolved in all patients, and improvement in motor deficits was noted in those who had presented with radiculopathy or myelopathy. Postoperative histological examinations showed that 33 patients had tuberculosis, 14 had metastatic neoplasm, 5 had eosinophilic granuloma, and 2 had traumatic fracture. Four patients died of systemic metastatic cancer between 10 and 21 months after surgery. There was no serious approach-related postoperative complication and no breakage of screws or failure of the internal fixation during follow-up.

Conclusions

Upper thoracic vertebrae can be exposed with sternotomy. This approach can provide excellent access to a lesion.
Cordotomy for patients with thoracic malignant astrocytoma
Authors: Nakamura Masaya , Tsuji Osahiko , Fujiyoshi Kanehiro , Watanabe Kota , Tsuji Takashi , Ishii Ken , Matsumoto Morio , Toyama Yoshiaki , Chiba Kazuhiro
Published: October 2010

Object

The optimal management of malignant astrocytomas remains controversial, and the prognosis of these lesions has been dismal regardless of the administered treatment. In this study the authors investigated the surgical outcomes of cordotomy in patients with thoracic malignant astrocytomas to determine the effectiveness of this procedure.

Methods

Cordotomy was performed in 5 patients with glioblastoma multiforme (GBM) and 2 with anaplastic astrocytoma (AA). A Kaplan-Meier survival analysis was performed, and the associations of the resection level with survival and postoperative complications were retrospectively examined.

Results

Cordotomy was performed in a single stage in 2 patients with GBM and in 2 stages in 3 patients with GBM and 2 patients with AA. In the 2 patients with GBM, cordotomy was performed 2 and 3 weeks after a partial tumor resection. In the 2 patients with AA, the initial treatment consisted of partial tumor resection and subtotal resection combined with radiotherapy, and rostral tumor growth and progressive paralysis necessitated cordotomy 2 and 28 months later. One patient with a secondary GBM underwent cordotomy; the GBM developed 1 year after subtotal resection and radiotherapy for a WHO Grade II astrocytoma. Four patients died 4, 5, 24, and 42 months after the initial operation due to CSF dissemination, and 3 patients (2 with GBM and 1 with AA) remain alive (16, 39, and 71 months). No metastasis to any other organs was noted.

Conclusions

One-stage cordotomy should be indicated for patients with thoracic GBM or AA presenting with complete paraplegia preoperatively. In patients with thoracic GBM, even if paralysis is incomplete, cordotomy should be performed before the tumor disseminates through the CSF. Radical resection should be attempted in patients with AA and incomplete paralysis. If the tumor persists, radiotherapy and chemotherapy are indicated, and cordotomy should be reserved for lesions growing progressively after such second-line treatments.
Immunogenicity of osteogenic protein 1: results from a prospective, randomized, controlled, multicenter pivotal study of uninstrumented lumbar posterolateral fusion
Authors: Hwang Chang Ju , Vaccaro Alexander R. , Hong Joseph , Lawrence James P. , Fischgrund Jeffrey S. , Alaoui-Ismaili Moulay Hicham , Falb Dean
Published: October 2010

Object

The aim in this study was to detect and quantify antibody responses against recombinant human osteogenic protein 1 (OP-1) and to compare these responses to patient clinical outcomes and safety information.

Methods

A controlled, open-label, randomized, prospective, multicenter pivotal study was performed in which patients with single-level Grade I or II degenerative lumbar spondylolisthesis (Meyerding classification) and spinal stenosis underwent decompression and uninstrumented posterolateral spinal arthrodesis. Three hundred thirty-six patients were randomized in a 2:1 fashion to receive either OP-1 Putty or autogenous iliac crest bone graft. Patients were evaluated at regular postoperative intervals for radiographic results, clinical outcomes, and safety parameters for more than 36 months. Serum samples were collected over this period and evaluated for the presence of anti–OP-1 antibodies and neutralizing activity by using a battery of in vitro binding assays (including enzyme-linked immunosorbent assay [ELISA]) and cell-based bioassays, respectively.

Results

Antibodies were predominantly seen in the OP-1–treated patients, although some responses were recorded preoperatively and in patients receiving autograft alone. Antibody production peaked in the 6-week to 3-month postoperative time frame and diminished thereafter. Neutralizing antibodies (Nabs) were detected at 1 time point at least in 25.6% of the patients treated with OP-1 Putty, but were not found in any patient following the 24-month postoperative time period. A single autograft patient (1.2%) also presented with OP-1 Nabs. An anti–OP-1 antibody status did not correlate with any measure of patient outcomes or adverse events.

Conclusions

Recombinant human OP-1 (bone morphogenetic protein 7), like many recombinant human proteins, induces an immune response following its use as a bone graft alternative. This response was transient and diminished over time, and there was no statistical evidence to suggest an association between Nab status and any of the efficacy or safety criteria that were examined.
Effectiveness of a clinical pathway for patients with cerebrospinal fluid shunt malfunction
Authors: Chern Joshua J. , Macias Charles G. , Jea Andrew , Curry Daniel J. , Luerssen Thomas G. , Whitehead William E.
Published: October 2010

Object

Patients with CSF shunts often present to the emergency department (ED) with suspected shunt malfunction. Timely assessment and treatment are important factors affecting patient outcomes. A protocol was implemented at a tertiary children's hospital ED to expedite the care of these patients. This study evaluated the effectiveness of this protocol.

Methods

The protocol assigned all patients with CSF shunts into 1 of 3 pathways. If a patient presented with altered mental status, the Cushing triad, acute focal neurological deficit, ongoing seizure activity, or severe dehydration due to emesis, an ED physician was immediately notified (emergency pathway). If a patient presented with emesis, headache, increasing frequency of seizure, or parental concern for shunt malfunction, the patient entered the expedited pathway, and imaging studies were ordered prior to physician evaluation. All other patients entered the default pathway, in which a physician would evaluate the patient before deciding on further workup. Outcomes of interest included measures of timeliness in the ED and clinical outcomes. Comparisons were made between preprotocol and protocol periods and among the 3 pathways.

Results

The total time to complete both ED physician evaluation and to initiate imaging studies was significantly shorter in the protocol period than in the preprotocol period (104 vs 147 minutes). Similar time saving over the 2 processes was demonstrated comparing expedited and default pathways during the protocol period (95 vs 134 minutes, a 29% difference). Clinically, more patients underwent surgery in the expedited pathway than the default pathway (36% vs 17%), and patients in the expedited pathway had a shorter hospital stay (3.4 ± 0.9 days vs 5.7 ± 4.0 days; p = 0.02).

Conclusions

An ED-based protocol helped identify patients at risk for shunt failure early in the triage process and shortened the assessment process prior to neurosurgical intervention. Improving the timeliness of care for patients with shunt failure is important because morbidity and mortality associated with shunt failure are time dependent.
Postoperative imaging surveillance in pediatric pilocytic astrocytomas
Authors: Dorward Ian G. , Luo Jingqin , Perry Arie , Gutmann David H. , Mansur David B. , Rubin Joshua B. , Leonard Jeffrey R.
Published: October 2010

Object

Currently there is no consensus regarding the frequency of neuroimaging following gross-total resection (GTR) of pilocytic astrocytoma (PA) in children. Whereas several reports recommend no postoperative imaging, one study proposed surveillance MR imaging studies to detect delayed recurrences.

Methods

The records of 40 consecutive pediatric patients who underwent GTR of infratentorial PAs were examined. All had follow-up duration of ≥ 2 years. Patients underwent early (< 48 hours) postoperative MR imaging, followed by surveillance imaging at 3–6 months, 1 year, and variably thereafter. The classification of GTR was based on a lack of nodular enhancement on early postoperative MR imaging. Demographic, clinical, and pathological variables were analyzed with respect to recurrence status. Univariate and multivariate analyses were performed to evaluate the association between pathological variables and recurrence-free survival (RFS).

Results

Of 13 patients demonstrating new nodular enhancement on MR imaging at 3–6 months, the disease progressed in 10, with a median time to recurrence of 6.4 months (range 2–48.2 months). At last follow-up, 29 patients had no recurrence, whereas in 1 additional patient the tumor recurred at 48 months, despite the absence of a new contrast-enhancing nodule at 3–6 months (for a total of 11 patients with recurrence). No demographic variable was associated with recurrence. Nodular enhancement on MR imaging at 3–6 months was significantly associated with recurrence in both univariate (p < 0.0001) and multivariate (p = 0.0015) analyses. Among the pathological variables, a high Ki 67 labeling index (LI) was similarly significantly associated with RFS in both univariate (p = 0.0016) and multivariate (p = 0.034) analyses. Multivariate models that significantly predicted RFS included a risk score incorporating Ki 67 LI and CD68 positivity (p = 0.0022), and a similar risk score combining high Ki 67 LI with the presence of nodular enhancement on initial surveillance MR imaging (p < 0.0001).

Conclusions

Surveillance MR imaging at 3–6 months after resection predicts tumor recurrence following GTR. One patient suffered delayed recurrence, arguing against a “no imaging” philosophy. The data also highlight the pathological variables that can help categorize patients into groups with high or low risk for recurrence. Larger series are needed to confirm these associations.
Improvement of obstructive sleep apneas caused by hydrocephalus associated with Chiari malformation Type II following surgery
Authors: Luigetti Marco , Losurdo Anna , Dittoni Serena , Testani Elisa , Colicchio Salvatore , Gnoni Valentina , Farina Benedetto , Scarano Emanuele , Zampino Giuseppe , Mariotti Paolo , Rendeli Claudia , Di Rocco Concezio , Massimi Luca , Marca Giacomo Della
Published: October 2010

Chiari malformation (CM) is the downward herniation of the caudal part of the cerebellum and/or medulla oblongata into the spinal canal. It can alter several neurological functions, including respiratory control and upper airway motility, and can be the cause of sleep-disordered breathing (SDB). The authors describe a 6-year-old boy affected by CM Type II associated with myelomeningocele who showed symptoms indicative of severe airway obstruction during sleep. Polysomnography revealed severe obstructive sleep apnea syndrome (OSAS). Magnetic resonance imaging demonstrated herniation of the cerebellar tonsils and diffuse ventricular dilation with a large pseudocystic formation in the third ventricle. Surgical marsupialization of the cystic wall was performed, associated with ventriculocystostomy and endoscopic replacement of the ventricular catheter. Polysomnography repeated 2 months after surgery revealed a striking improvement in the sleep-related respiratory pattern. The pathogenesis of OSAS was probably referable to a combination of CM and elevated intracranial pressure. However, the striking improvement of symptoms after ventriculoatrial shunt placement suggested that hydrocephalus plays a major role in this condition. Assessment and effective treatment of SDB is crucial in the care of patients with CM.
Microfibrillar collagen hemostat–induced necrotizing granulomatous inflammation developing after craniotomy: a pediatric case series
Authors: Apel-Sarid Liat , Cochrane Doug D. , Steinbok Paul , Byrne Angela T. , Dunham Christopher
Published: October 2010

Object

Microfibrillar collagen hemostat (MCH; trade name Avitene) is a partially water-insoluble acid salt of purified bovine corium collagen. This agent has been widely used to control hemorrhage at surgery, and especially during pediatric neurosurgeries at the authors' institution. Despite its effectiveness, rare case reports detailing adverse inflammatory reactions to MCH have been documented. Based primarily on MR imaging, postoperative reactions have most commonly elicited clinical differential diagnoses of tumor recurrence or abscess. According to the literature, MCH induces a very characteristic mixed inflammatory response that is rich in eosinophils; in light of these observations, many authors have suggested an allergy-based pathogenesis.

Methods

The authors retrospectively reviewed 3 pediatric neurosurgical cases treated at their institution, wherein a common histomorphological inflammatory reaction to MCH was elicited at the site of prior craniotomy.

Results

Case 1 is that of a 10-year-old girl whose diagnosis was a right temporal lobe ganglioglioma, classified as WHO Grade I. Case 2 is that of a 9-year-old boy whose diagnosis was a left parietal lobe anaplastic ependymoma, classified as WHO Grade III. Finally, Case 3 is that of a 15-year-old girl whose diagnosis was focal cortical dysplasia Type IIA affecting the left occipital lobe. Each patient presented with new or recurrent seizures 5–6 weeks after the initial resection. The postsurgical reactions incited by MCH mimicked the radiological appearance of either an abscess (Cases 2 and 3) or recurrent tumor (Case 1). Histologically, the mixed inflammatory infiltrate was typified by the presence of MCH-centric necrotizing granulomas that were surrounded by a palisade of macrophages and often several eosinophils.

Conclusions

The findings are in keeping with previous case reports describing the clinicopathological features of adverse reactions occurring due to MCH. Based on the authors' observations, the possibility of an idiopathic inflammatory reaction to MCH should be considered when either seizures, a typical radiological appearance (that is, consistent with tumor recurrence or abscess formation), or both arise shortly after initial surgery. A conservative treatment approach to this type of inflammatory lesion appears to be the most appropriate management strategy.
Predicting who will benefit from endoscopic third ventriculostomy compared with shunt insertion in childhood hydrocephalus using the ETV Success Score
Authors: Kulkarni Abhaya V. , Drake James M. , Kestle John R. W. , Mallucci Conor L. , Sgouros Spyros , Constantini Shlomi
Published: October 2010

Object

The authors recently developed and internally validated the ETV Success Score (ETVSS)—a simplified means of predicting the 6-month success rate of endoscopic third ventriculostomy (ETV) for a child with hydrocephalus, based on age, etiology of hydrocephalus, and presence of a previous shunt. A high ETVSS predicts a high chance of early ETV success. In this paper, they assess the clinical utility of the ETVSS by determining whether long-term survival outcomes for ETV versus shunt insertion are different within strata of ETVSS (low, moderate, and high scores).

Methods

A multicenter, international cohort of children (≤ 19 years old) with newly diagnosed hydrocephalus treated with either ETV (489 patients) or shunt insertion (720 patients) was analyzed. The ETVSS was calculated for all patients. Survival analyses with time-dependent modeling of the hazard ratios were performed.

Results

For the High-ETVSS Group (255 ETV-treated patients, 117 shunt-treated patients), ETV appeared to have a lower risk of failure right from the early postoperative phase and became more favorable with time. For the Moderate-ETVSS Group (172 ETV-treated patients, 245 shunt-treated patients), ETV appeared to have a higher initial failure rate, but after about 3 months the instantaneous risk of ETV failure became slightly lower than shunt failure (that is, the hazard ratio became < 1). For the Low-ETVSS Group (62 ETV-treated patients, 358 shunt-treated patients), the early risk of ETV failure was much higher than the risk of shunt failure, but the instantaneous risk of ETV failure became lower than the risk of shunt failure at about 6 months following surgery (the hazard ratio became < 1).

Conclusions

Across all ETVSS strata, the risk of ETV failure becomes progressively lower compared with the risk of shunt failure with increasing time from the surgery. In the best ETV candidates (ETVSS ≥ 80), however, the risk of ETV failure is lower than the risk of shunt failure very soon after surgery, while for less-than-ideal ETV candidates (ETVSS ≤ 70), the risk of ETV failure is initially higher than the risk of shunt failure and only becomes lower after 3–6 months from surgery. These results need to be confirmed by larger, prospective, and preferably randomized studies.
Recherches sur la « comedia » Los Moriscos de Hornachos
Authors: Pelorson Jean-Marc
Published: September 2010

A principios de este siglo, editó la hispanista norteamericana G. B. Bourland la comedia Los moriscos de Hornachos, mostrando poco entusiasmo por una obra que, en efecto, parece tener escaso valor literario. Sin embargo, el presente artículo pone de realce algunas características originales de dicha comedia que pueden ofrecer interés así para los historiadores de la expulsión de los Moriscos como para los especialistas de la comedia en el Siglo de Oro : primero, llama la atención la rica y precisa documentación que supone el que la comedia cite, a cada paso, lugares, personas, hechos, sentencias judiciales cuya autenticidad comprueban los varios testimonios escritos, coetáneos o posteriores, de que hoy disponemos sobre las circunstancias de la expulsión de los Moriscos de Hornachos (1609-1610). Se da el caso de que la información del dramaturgo resulta más amplia que la de los más minuciosos historiadores contemporáneos (Bleda, Guadalajara). Se trata, pues de una información de primera mano. En segundo lugar, la comedia lleva a la escena a personajes históricos, como Juan de Pina, López Madera, Francisco de Contreras, insistiendo sobre conflictos que surgieron, al parecer, entre los letrados encargados de procesar y expulsar a los Moriscos y algunos consejeros de Estado. Esta polémica, y el carácter alusivo del diálogo sugieren que la comedia fue escrita para leída o representada ante un público selecto de amigos de López Madera, devotos de Santiago, del Padre Seráfico, de la Virgen de los Remedios patrona de Hornachos, etc.. Aunque el artículo no tiene por objetivo principal el discutir la atribución de la comedia, se demuestra que, pese a lo que Bourland opinó, el autor no pudo ser el canónigo valenciano Tárrega, aduciéndose algunos argumentos en favor de la atribución, si no al mismo Lope de Vega, por lo menos a algún que otro dramaturgo de la Corte, y de la escuela de Lope.
Judío y confeso
Authors: Díaz Ramón
Published: September 2010

El nombre Juda -Yehudah- (de donde procede judío -yehudi-, y cuya etimología verdadera no se conoce) se interpreta en la Biblia como : « el que es alabado ; a quien se reconoce o confiesa ». En sentido pasivo, pues. En España, judío vino a coincidir, por razón de los conversos, con confeso. Covarrubias, tratando de probar e ilustrar esa identidad, alega que en hebreo judío significa « el que confiesa ». Un sentido activo, que se acomodaba a las circunstancias del judío de la época, pero alejado de la tradición. Américo Castro, recientemente, ha afirmado tal identidad como válida para todos los tiempos. Se apoya en Covarrubias e interpreta judío también activamente, pero con una inflexión distinta : « el que alaba o reconoce » (a Dios o a la ley).
Dos notas sobre el Libro de Apolonio
Authors: Devoto Daniel
Published: September 2010

señala el particular interés de esta versión de la historia de Apolonio de Tiro para el estudio del vocabulario musical medieval español, y partiendo de la consideración sistemática de ese aspecto del poema (valor y concepto de la música ; el repertorio vocal ; la ejecución musical) muestra la pertinencia de sus notaciones relativas a la afinación de los instrumentos y a la ejecución monódica y aun polifónica, y propone acepciones más precisas para algunos de los términos menos felizmente explicados : laude, responso, debailadas, doblas. — La segunda nota — « La corona del rey Apolonio » — trata de mostrar que un pasaje que Marden consideró corrompido es, por el contrario, capital para la comprensión de las relaciones entre las jerarquías sociales y la práctica artística y, por ello mismo, esencial para la comprensión cabal del carácter del protagonista del Libro.
Polarización erótica medieval y estructura del Libro de Buen Amor
Authors: Paiewonsky Conde E.
Published: September 2010

Après avoir analysé quelques concepts théologiques extraits du texte, l'essai établit une polarisation structurale — de l'époque et de l'œuvre de Juan Ruiz; puis il explique cette polarisation comme un mécanisme entre l'éros charnel (« amor loco ») et l'éros spirituel (« buen amor ») comme une clef de la nature extrême de la vie et du « je » autobiographique du livre.
Amadís de Galia
Authors: Devoto Daniel
Published: September 2010

Pour combler une lacune bibliographique — description incomplète des exemplaires de VAmadis (texte et traductions) conservés dans les bibliothèques parisiennes, et dont l'inexactitude se reflète dans la Bibliografía de Simón Díaz et dans le catalogue préliminaire de l'édition de Place — on signale nombre d'exemplaires non consignés et mainte édition inconnue des différentes parties du roman.
Réalités « gitanes » et faits littéraires
Authors: Laffranque Marie
Published: September 2010

Plus encore qu'au xvie et au xvnie siècle, les hommes des sociétés « occidentales » s'interrogent à la fois sur l'avenir de leur culture commune et sur celles, radicalement différentes, qu'ils découvrent à leurs côtés. Réalités « gitanes » et œuvres qui s'en inspirent conduisent ainsi critiques et chercheurs en sciences humaines vers des études qui, à leur corps défendant, peuvent menacer les groupes mêmes auxquels elles s'appliquent et qu'elles font connaître à quelque degré.
Les étrangers dans les régions de Tucumán et Potosí (1607-1610)
Authors: Lavallé Bernard
Published: September 2010

A partir de dos documentos administrativos del Archivio General de Indias, este artículo estudia concretamente la población extranjera del Tucumán y de Potosí a comienzos del xvn. Se analizan sucesivamente el origen geográfico, las actividades, la riqueza, la fecha y el lugar de llegada a América, etc..
Cortázar y el superrealismo
Authors: Valbuena Briones A.J.
Published: September 2010

Julio Cortázar ha obtenido muchas de sus ideas para la elaboración y estructura de sus novelas en las doctrinas del superrealismo. Especialmente ha utilizado los Manifiestos de Bretón para inspirarse en sus procedimientos estilísticos en busca de un entendimiento mas profundo de la realidad elusiva. Los experimentos lingüísticos llevados a cabo en los años veinte han sido decisivos para la creación de diversas técnicas empleadas por el autor argentino. El concepto filosófico de la correlación de realidad y fantasía como el instrumento apropiado para revelar la complejidad del ser humano es fundamental para la comprensión de su aventura conceptual. Incluso el desarrollo de personajes tan distintivos como son Persio y la Maga han sido sugeridos por ejemplos superrealistas. El estudio demuestra la riqueza y el intrincamiento del estilo de este autor contemporáneo.
Michelet y la historia de España
Authors: Sanz V.
Published: September 2010

Les jugements défavorables de Michelet sur l'Espagne et les Espagnols tiennent davantage à l'imagination puissante et à la vive sensibilité de l'historien qu'à une hispanophobie profonde.
Sebastián de Horozco y los Hegas
Authors: Weiner Jack
Published: September 2010

Entre el converso Sebastián de Horozco y sus dos hijos Juan de Horozco y Covarrubias y Sebastián de Covarrubias y Horozco, había antagonismos familiares. En parte estos conflictos surgían porque como conversos no podían ocupar puestos que exigían limpieza de sangre. La amargura de los Horozco se intensifica aun cuando otros deudos — en particular los Hegas — por ser tenidos como cristianos viejos, podían disfrutar de todas las ventajas de su estado social.