bluuebunny/crossref_metadata_2025 huggingface dataset:
US AND DOPPLER-GUIDED SURGICAL TREATMENT BASED ON IMMUNOHISTOCHEMICAL FINDINGS IN MIDPORTION ACHILLES TENDINOPATHY SHOWS GOOD CLINICAL RESULTS AND FAST RETURN TO ACTIVITY
Authors: Alfredson H , Andersson G , Backman L , Bagge J , Danielson P , Forsgren S
Published: May 2013

Introduction

Treatment of midportion Achilles tendinopathy has been known to be difficult. Recent ultrasound(US) and Doppler(CD) findings (high blood flow outside ventral tendon), together with results of immunohistochemical analyses (marked presence of blood vessels accompanied by nerve fascicles in the ventral peritendinous tissue) have led to new treatment approaches like sclerosing polidocanol injections, where US and CD-guided injections in the region with high blood flow and nerves outside the tendon have shown good results. However, for satisfying pain relief multiple injection treatments were often needed. Therefore, based on the same principles as for the sclerosing injections, a more radical and one stage mini-surgical procedure has been invented.

Methods

107 patients (66 men, 41 women), mean age 43 years (range 24–77), with tendinosis in 125 Achilles tendons were, in local anaesthesia, treated with a US+CD-guided new surgical approach outside the ventral tendon. Pain during tendon loading activity (VAS) and satisfaction with treatment, were evaluated.

Results

Before surgery,the mean VAS was 77.Aftersurgery (follow up mean 18 months, range 6–33) the mean VAS was 2 in 111 tendons (89%) from satisfied patients back in full Achilles tendon loading activity.

Conclusions

US+CD-guided scraping/tenolysis in the region with rich vascularity and innervation outside the ventral tendon shows good short term clinical results in midportion Achilles tendinopathy.
CHRONIC DISTAL BICEPS TENDON RUPTURE: RETROSPECTIVE REVIEW OF OUTOCOMES OF A NOVEL TECHNIQUE OF RECONSTRUCTION WITH TENDON GRAFT
Authors: Goetz T , Okada M , Scott A , Pike J
Published: May 2013

Introduction

The biceps brachii muscle is the primary forearm supinator and a secondary elbow flexor. The pathophysiology of distal tendon ruptures is still unclear. Patients with chronic rupture presenting 4–6 weeks after the original injury often due to mis-diagnosis or neglect have been, until recently treated non-operatively. The chronic case of biceps tendon rupture poses a surgical challenge due the retraction of the muscle and scarring or resorption of the tendon that may make it impossible to reattach primarily. A novel technique of reconstruction using tendon graft has been developed by the author. The study aims to measure subjective and objective outcomes of reconstruction with this technique.

Methods

This is a retrospective review of nine patients (mean age 47±10) treated with tendon reconstruction an average of 17 months following injury. Patients were evaluated and graded for bicep contour, range of motion, Mayo Elbow Performance Index (MEPI) and for bilateral elbow flexion and supination torque on a Biodex System 4 Pro dynamometer. Patient reported outcome questionnaires were also collected.

Results

The mean Disabilities of the Arm, Shoulder, and Hand score (DASH), American Shoulder and Elbow Society score (ASES), and Mayo Elbow Performance Index (MEPI) were 11±10, 91±10, and 88±14 respectively. Eighty of nine subjects were somewhat or very satisfied with the reconstruction. Biceps contour was 4.7 cm above the antecubital fossa on the operative side versus 3.9 cm on the nonoperative side. No statistically different strength discrepancies were noted between the operative and nonoperative sides when comparing isometric supination strength (p=0.42) and flexion strength (p=0.17), as well as peak supination torque at 90 degrees of elbow flexion (p=0.09).

Discussion

Reconstruction of chronic distal biceps tendon rupture with tendon graft resulted in low patient-reported disability and high patient satisfaction.

No statistically different values in isokinetic supination and elbow flexion strength were noted between operative and nonoperative sides.

No loss of ROM was noted as a result of the reconstruction.
SIMULTANEOUS BILATERAL RUPTURE OF ACHILLES TENDON ASYMPTOMATIC POSTENDINOPATHY
Authors: Martínez L Á , Vicente I G , Contreras E A , Jaramillo C R , Jaén T F
Published: May 2013

Introduction

Rupture of Achilles tendon is the most common among those taking place in the lower extremities, being twice as common in men than in women between 30–50 years old and usually caused while doing sport. There are some risk factors such as age or chronic treatments based on corticosteroids or antibiotics when belonging to Quinolones group.

Spontaneous bilateral rupture of the Achilles tendon is much more infrequent, being almost exceptional in young and healthy patients without known pathological conditions.

Method

In relation to a specific clinical case, a medical history review was developed: personal history, diagnosis, treatment and progress.

Result

Asthmatic 45 year old male occasionally undergoing medical treatment with inhaled corticosteroids. Previously asymptomatic. Training athletics in the morning and handball in the afternoon. After the first 10 min of the match notices a bilateral acute pain when starting to run, showing ruptures of both Achilles tendons confirmed by MRI scan.

Treatment: surgical open-to-end suture reinforced with inverted taenia (see figure 1 below).

Development: 3 weeks immobilisation without setting foot, 3 weeks Walker boot, partial setting foot and rehabilitation, medical discharge after 6 months without complications.

Discussion

Simultaneous and spontaneous rupture of bilateral Achilles tendons in patients without pathological factors is really unusual. 25% of the healthy population above 30 years of age has degenerative structural changes in the Achilles tendon that increase the risk of rupture depending on the patient's activity level.

Both percutaneous and open surgical treatments on young and active patients provide an appropriate alternative. The open surgical treatment allows the possibility of tendon reinforcement techniques and a more complete visualisation of the damage.

The postsurgical rehabilitation management is an important factor for biomechanic tendon recovery alsoallowing the restart of patient's activities as soon as possible.

Figure 1

Appearance of Achilles tendon before (left) and after (right) surgical repair.
FUNCTIONAL RECOVERY AND RE-INTRODUCTION TO SPORT, AFTER REPAIR OF DISTAL BICEPS TEAR BY TWO-INCISION TECHNIQUE MAYO
Authors: León R A F , Ibañez E I , Mont R N , Jaen T F
Published: May 2013

Introduction

Three percent of all biceps tendon ruptures occur at the distal aspect, the rupture typically occuring in middle aged males after an eccentric extension load is applied to the elbow. Rupture of distal biceps tendon was once thought to be an uncommon injury, but an increase in athletic activities in middle age may account for its increase in incidence. There is an increased frequency of tendon rupture associated with use of statins and smoke.

Patients usually complain of a sudden and painful tearing sensation in the anterocubital region, with a palpable defect. Biceps squeeze test, hook test and Popeye sign are useful to the diagnosis. Testing images from MRI and ultrasound may be helpful to diagnose. Early anatomic re-attachment is the goal, no operative treatment typically results in loss of flexion and supination strength and endurance.

The objective of this study is the evaluation of the functional outcome and sport re-introduction in patients operated on for rupture of distal biceps tendon after rehabilitation.

Methods

A retrospective study was done with 12 patients with a mean age of 46.41 years, who suffered biceps distal tendon tear treated by early surgery with the two incision of Mayo technique. Rehabilitation treatment was performed and functional outcomes were assessed from the sixth month of the intervention, using the Mayo Elbow Score (MES). The range of movement was measured by manual goniometer, and the force with medical research council scale.

Results

Two of our 12 patients were taking statin, and three of them were smokers. The time from the break until surgery was 9.5 days on average, arrested by maintaining a splint for 5 weeks. Patients needed an average of 6 weeks of rehabilitation. Functional outcome showed a mean 95.11/100 with MES, at 6 months after surgery, which was considered excellent, with a range of motion that averaged 140°±15° and a muscular balance average of 4+/5, compared with the healthy arm. The reintroduction to usual sport was 88.9% at 10 month after surgery.

Discussion

Early repair of distal biceps tear followed by a rehabilitation treatment allows a good functional recovery and reintroduction to the sport.
SHORT- AND LONG-TERM OUTCOMES OF ELECTROLYSIS PERCUTANEOUS INTRATISSUE (EPI) IN CHRONIC LATERAL ELBOW EPICONDYLITIS
Authors: Valera-Garrido F , Minaya-Muñoz F , Sánchez-Ibáñez J M , Medina-Mirapeix F , Polidori F
Published: May 2013

Introduction

Chronic lateral elbow epicondylitis is a tendinosis with angiofibroblastic degeneration of the wrist extensors' origin. Electrolysis Percutaneous Intratissue (EPI) is a minimally invasive technique that involves the application of a galvanic current with an acupuncture needle in the soft tissue to initiate a local inflammatory process allowing phagocytosis and repair of the affected tissue. The aim of the study was evaluate the effectiveness of the EPI in chronic epicondylitis lateral.

Methods

Design:Cases series.

Setting.MVClinic Physiotherapy.

Subjects:

Inclusion criteriawere clinically diagnosed lateral epicondylitis (based on symptoms, site of tenderness, and pain elicited with resisted active extension of the wrist in pronation and elbow extension), onset of symptoms (equal to or more than 3 months), no previous local injections (eg. cortisone), no cervicoarthrosis C5–C6, no rheumatic disorder, no history of trauma, and no signs of posterior interosseous nerve entrapment.

Outcome measures.

Sonographic assessment, pain was evaluated using a visual analogue scale (VAS), algometry, and functional status was evaluated by completion of the DASH and Cozen´s test and Thomson´s test which were recorded at base line and at the end of treatment, at 6w and 6m post-treatment.

Intervention.

All patients received Electrolysis Percutaneous Intratissue (EPI)-one treatment session per week. At home, a simple programme of stretching and eccentric loading exercises to be performed on an individual basis twice every day.

No cortisone or non-steroidal anti-inflammatories were prescribed during follow-up. For pain relief only, oral paracetamol and ice therapy were used.

Results

36 subjects were included in the study, 52.8% men (47.2% women) with a mean age of 38 years. 80.5% of subjects reached a complete response after four sessions of EPI with a VAS<2, 86.2% negative Cozen´s test and Thomson´s test, and algometry values changed very significantly from 7.9 kg of pressure on the lateral epicondyle to 29.3 kg. DASH questionnaire showed significant changes, the mean score in the total of 36 subjects was 37.4 points, which means that there was an improvement of over 40% in functional capacity. Sonographic assessment showed change in the structure of the tendon, or hypoechoic region (long term outcomes, no short outcomes) and neovascularization (short outcomes).

Discussion

The combined programme of EPI, more eccentric exercise and stretching is an effective treatment for chronic elbow lateral epicondylitis.

Limitations of the study.

The main limitation is the absence of a control group to compare the results obtained with a placebo or another intervention. In scientific literature, there are no similar studies as the technique has been recently developed. The next step is to launch a pilot study to validate the results.
DOES THE TENDINOPATHIC PATELLAR TENDON NORMALISE, ACCORDING TO ULTRASOUND FINDINGS, AFTER TREATMENT WITH SCLEROSING INJECTIONS OR ARTHROSCOPIC SHAVING? A LONG TERM FOLLOW-UP (3–5 YEARS)
Authors: Sunding K , Willberg L , Niklasson U , Werner S
Published: May 2013

Introduction

Treatment of patellar tendinopathy/jumper's knee with ultrasound-guided sclerosing injections and arthroscopic shaving has shown good clinical results, but patients treated with the one-stage procedure arthroscopic shaving had a faster return to full activity, less pain and were more satisfied with the treatment result at follow-up approximately 1 year after end of treatment.1 There are studies suggesting that tendon structure in a tendinotic, chronic painful tendon does not sonographically normalise after successful treatment. However those results are based on a relatively short term follow up.

Methods

We have evaluated patellar tendons according to a routine ultrasound examination protocol for chronic painful patellar tendons/proximal patellar tendinopathy, 3 to 5 years after treatment with sclerosing injections (n=19) or arthroscopic shaving (n=25). Tendon thickness was measured and tendon structure and the amount of neovascularization was evaluated and scored, to be compared with corresponding values at baseline and at the 1 year follow-up. Self-reported pain during rest and patellar tendon loading activity, and patient satisfaction with the result of the treatment was registered on a visual analogue scale (VAS).

Results

At the 3–5 years follow-up, preliminary results showed that tendon structure seemed to improve, and the neovascularisation was reduced, in both groups. There was a trend towards a decrease in antero-posterior thickness of the proximal part of the patellar tendon in patients treated with arthroscopic shaving, but not for tendons treated with sclerosing injections. There were no differences in VAS score at rest and during activity between the two treatment groups or in VAS score for satisfaction with treatment.

Discussion

Treatment of patellar tendinopathy/jumper's knee with ultrasound and colour Doppler-guided sclerosing injections and arthroscopic shaving showed remaining good clinical results after 3–5 years for both methods. Treatment with sclerosing injections requires multiple injections with 6–8 weeks in between, but in the 3–5 years perspective seems to reach the same result in terms of ultrasound findings and self-reported pain (VAS) as treatment with the one-stage procedure arthroscopic shaving. This is in contrast to the results at 1 year follow-up where the surgical method showed better results in all evaluated variables. One remaining difference between the two treatments was that only the surgical method showed a decrease in antero-posterior thickness. In fact tendon thickness in the group treated with sclerosing injections were increased at the 1 year follow-up, while now 3–5 years after treatment the thickness seems to be back at the same level as at baseline, before treatment.
STEM CELL THERAPY FOR TENDINOPATHY: LESSONS FROM A LARGE ANIMAL MODEL
Authors: Smith R K W
Published: May 2013

Introduction

Tendon disorders compromise pain-free activity and often progress to chronic pain with a major impact on quality of life. Achilles tendinopathy (AT) is particularly common with many proposed therapies. However, apart from eccentric loading exercises, none have been shown to be more effective than placebo.1 Even the recent popular use of platelet-rich plasma has shown poor efficacy.2 3 There is therefore a clear need for new effective non-surgical treatments. Mesenchymal stem cells (MSCs) offer the potential for tendon regeneration and improved functional outcome via either direct or paracrine effects. We have therefore investigated the efficacy of bone marrow-derived MSCs (BM-MSCs) implanted into naturally-occurring over-strain injury of the equine superficial digital flexor tendon (SDFT), a commonly-injured weight-bearing tendon with many similarities to human AT. We hypothesised that autologous implanted MSCs would survive in the tendon and induce normalisation of the tendon matrix and reduce re-injury rates.

Methods

Labelling MSCs with technetium99m linked to HMPAO enabled non-invasive monitoring of cell fate in clinical cases (n=13). This revealed high initial cell loss (∼75% over 24 h). Longer term labelling with a fluorescent cytoplasmic dye showed the retention of small numbers of labelled cells for up to 5 months, similar to that reported for shorter term studies.4 5

Results

In a controlled experimental study of naturally-occurring SDFT injuries (n=12), MSC-treated tendons had greater elasticity, reduced cross-sectional area, and cellularity, improved organisational scores, and lower GAG content compared to saline-treated tendons, although not all parameters were statistically significant.

In 113 treated racehorses, the re-injury percentage was 27.4%, which was significantly less than published for racehorses treated in other ways (p<0.05 vs 56% 6; p<0.01 vs 50% 7).

These findings in a large animal model of naturally-occurring tendinopathy provide supportive evidence for the efficacy and safety for the use of MSCs for the treatment of tendinopathy in humans.
GENE EXPRESSION IN TENOCYTES SUGGESTS DEGNERATIVE TENDON TEARS ATTEMPT TO HEAL
Authors: Fearon A M , Cook J L , Smith P , Scott A
Published: May 2013

Introduction

The breakdown of the extracellular matrix (ECM) is well recognised in tendinopathy and likely the cause of degenerative tendon tears. Tendinopathy and degenerative tears can be hard and expensive to treat. Understanding the cellular processes that lead to ECM breakdown will likely lead to improved treatments. With this in mind, the gene transcript profile for extracellular matrix remodelling of tendon specimens from people with greater trochanteric pain syndrome (GTPS) and associated gluteal tendon tears were compared to an age and sex matched reference group.

Methods

Tendon specimens were collected from six participants undergoing gluteal tendon reconstruction for long standing (mean duration=41 months) GTPS, and four participants from an age-matched reference group (REF) of hip OA patients asymptomatic for GTPS. Specimens were collected using sterile technique and were stored at −80°C. RNA was isolated via laser capture micro-dissection (LCM) of areas of tendon that typified tendon rather than para-tendon or vessels within the specimen—identified using light microscopy and H&E staining. Specimens were tested using the SABiosciences array (PAHS-013). Immunohistochemistry was used to confirm the site of a subset of the expressed genes.

Results

We report on gene regulation changes of at least five fold that were seen in the GTPS group compared to the REF group. Genes involved in extracellular matrix modelling were both up regulated (MMP7) and down regulated (MMP3). The following cell adhesion genes were up regulated: ITGAV, NCAM1, ITGAM, while ITG3 was down regulated. The following genes involved in ECM synthesis were up regulated (LAMC1, COL1A1, COL5A1, Col6A1), while ADMATS1, LAMB3, VTN were down regulated.

Conclusions

This paper presents a novel method of tissue specimen selection (LCM), reducing the likelihood of RNA contamination from cells other than tenocytes. Further, these results suggest that there is increased cell activity and collagen production indicating that the tendon is continuing to actively remodel despite prolonged tissue damage. This supports the role of appropriate advice regarding tendon loading and compression, exercises to strengthen the musclo-tendinous unit, and ongoing support to patients. Recovery from tendinopathy may be possible—even in longstanding cases.
INCREASED LEVELS OF APOPTOSIS AND P53 IN PARTIAL-THICKNESS SUPRASPINATUS TENDON TEARS
Authors: Lundgreen K , Lian Ø , Scott A , Engebretsen L
Published: May 2013

Introduction

The role of apoptosis in the progression of rotator cuff tendinopathy is poorly understood. The primary aim of this study was to quantify the amount of apoptosis in supraspinatus tendons presenting partial-thickness tears and matched intact subscapularis tendons.

Methods

9 partially torn supraspinatus tendons and matched intact subscapularis tendons were biopsied and compared to 10 reference subscapularis tendon samples. Immunohistochemistry was used to assess apoptotic cells (activated caspase-3; Asp175), proliferation (Ki67) and p53 (M7001), a key protein involved in regulating cell death. The Bonar scale was used to evaluate tendon degeneration.

Results

The partially torn supraspinatus tendons and matched subscapularis tendons demonstrated a significant increase in the density of apoptotic cells and p53 expression. The Bonar score revealed significant tendon degeneration in the partially torn supraspinatus tendon compared to both matched and reference subscapularis tendon. The number of proliferating tendon cells was higher in the partially torn supraspinatus than in the matched or reference subscapularis tendons.

Discussion

The presence of increased apoptosis and p53 in partial-thickness tears of the supraspinatus tendon is accompanied by features of both degeneration as well as ongoing repair. Apoptosis may be a relatively early feature in the continuum of rotator cuff tendinopathy.
ECCENTRIC EXERCISES COMBINED WITH ELECTRICAL STIMULATION IN THE TREATMENT OF JUMPER'S KNEE: A STUDY ON SIX HIGH LEVEL JUMPING ATHLETES
Authors: Basas García A , Lorenzo A , Gómez-Ruano M A , Fernández Jaén T , Álvarez Rey G
Published: May 2013

Introduction

Treatment of patellar tendinopathy (PT)/Jumper's knee (JK) is known to be difficult, and there is no treatment of choice. This work analyses the development of a protocol using eccentric exercises and electrical stimulation, both using maximum tendon loading, to treat elite athletes suffering from Jumper's knee.

Methods

Six high level jumping athletes with chronic painful PT/JK completed a 6-month treatment/training programme using eccentric exercises and electrical stimulation. The protocol was done12 weeks in the winter pre-season and 10 weeks in the summer pre-season, for all together 36 months. Pain during patellar tendon loading activity was evaluated on a VAS, before the first session and then every 6 months.

Results

The VAS average fell significantly when the initial measurement is compared with those at 18, 24 and 48 months (p<0.01). There were no significant differences between the other comparisons, although they always improved when the protocol was followed and worsened following interruption of the latter (p>0.05).

Discussion

In a small group of high level jumping athletes with chronic painful PT/JK, eccentric exercises combined with electrical stimulation showed promising clinical results with significant pain reduction during tendon loading activity.
TENDONS: TIME TO REVISIT INFLAMMATION?
Authors: Rees J D , Stride M , Scott A
Published: May 2013

It is currently widely accepted that chronic tendinopathy is caused by a degenerative process devoid of inflammation. Current treatment strategies have focused on physical treatments including eccentric exercises, peritendinous injections of blood or blood products and interruption of painful stimuli. Results have been at best moderately good and at worst a failure.

The evidence for degeneration alone as the cause of tendinopathy is surprisingly weak. There is compelling evidence that inflammation is a key component of chronic tendinopathy. Newer anti-inflammatory modalities provide alternative potential opportunities in treating chronic tendinopathies and should be explored further.
Engaging all doctors in continuous quality improvement: a structured, supported programme for first-year doctors across a training deanery in England
Authors: Bethune Rob , Soo Eleanor , Woodhead Patricia , Van Hamel Clare , Watson Joanne
Published: May 2013

The structure of postgraduate medical training rightly puts enormous emphasis on gathering clinical experience and constantly updating knowledge of relevant medical research to use in practice. At most, this can be contrasted with the slight emphasis on clinical leadership and acquiring the skills to effect change and improve the quality of care. Doctors play central roles in orchestrating the clinical management of patients across multiple settings within the healthcare system. They also routinely encounter the many problems within the systems that they work, affecting their own practices as well as those of other healthcare professionals. They thus represent a tremendous resource for identifying solutions to these problems and playing leadership roles in implementing them. However, physician training programs focus almost entirely on the knowledge and skills to manage clinical problems, with almost no training in skills related to healthcare management or effective quality improvement. In this article, we describe one attempt to improve this situation. In four hospitals in the Severn Deanery in the Southwest of England, first-year doctors carry out a structured and supported quality improvement project of their choice throughout their first year of training. To date, 30 such projects have been or are being run. This has significant benefits for both the trusts they are working for as well as for their own professional development. We describe the successes, difficulties and future of this programme.
Management of long bone fractures in cattle
Authors: Mulon Pierre‐Yves
Published: May 2013

Fractures are encountered on a regular basis in large animal practice and managing them poses a challenge in the field. Cattle are excellent orthopaedic patients: they have great bone healing properties, most tolerate limb immobilisation well and they rarely suffer from contralateral limb disorders. However, the decision between treatment and euthanasia depends on the economic or genetic value of the animal, the cost of the treatment and the prognosis associated with the particular fracture. Treatment choices vary between stall rest, external coaptation, external fixation and open reduction with internal fixation, depending on the type of fracture and the bone involved. This article describes the different treatment options for common fractures encountered in cattle.
Lung cancer in never-smokers. Does smoking history matter in the era of molecular diagnostics and targeted therapy?
Authors: Ou Sai-Hong Ignatius
Published: May 2013

Lung cancer in never-smokers was recognised as a distinct clinical entity around the mid-2000s because these patients tended to be Asian women and diagnosed at a younger age with a preponderance of adenocarcinoma and better survival outcome despite a more advanced stage of presentation. It was soon discovered that lung cancer in never-smokers had a higher prevalence of activatingEGFRmutations and we tend to classify lung cancer by smoking status for screening purpose. With the discoveries of many actionable driver mutations such as activatingEGFRmutations andALKrearrangement in adenocarcinoma of the lung we have switched to classifying non-small cell lung cancer into different individual molecular subgroups based on the presence of a dominant driver mutation. Although many actionable driver mutations are found in never-smokers with adenocarcinoma, this review will summarise that a substantial proportion of patients with these actionable driver mutations had a previous smoking history. Alternatively among the driver mutations that are associated with smoking history, a fair amount of these patients were never-smokers. Thus smoking status should not be used as a screen strategy for identifying driver mutations in clinical practice. Finally smoking history may have predictive and/or prognostic significance within individual molecular subgroups and identifying the difference according to smoking history may help optimise future targeted therapy.
Tracking of cardiovascular risk factors across generations: family linkage within the population-based HUNT study, Norway
Authors: Vik Kirsti L , Romundstad Pål , Nilsen Tom IL
Published: May 2013

Background

Parent-offspring studies have shown that cardiovascular risk factors cluster within families. However, most studies have assessed the offspring cardiovascular risk factor level at a young age, and whether an association persists into the offspring's adult life is less clear. This study linked information between parents and their adult offspring to investigate the intergenerational association of anthropometric measures, blood pressure, blood lipid levels and physical activity.

Methods

The study population consisted of parent and adult offspring pairs (11 931 fathers–sons, 12 563 fathers–daughters, 15 626 mothers–sons and 16 449 mothers–daughters) who participated in the second and third cross-sectional waves of the Nord-Trøndelag Health Study (HUNT 2, 1995–1997 and HUNT 3, 2006–2008). A general linear model and logistic regression were used to estimate the association between the parent and offspring risk factor levels.

Results

All continuously measured cardiovascular risk factors under study showed a statistically significant positive association between parents and offspring, except the waist-hip ratio. Adjusted coefficients from linear regression ranged from 0.09 (95% CI 0.07 to 0.11) for waist circumference to 0.29 (95% CI 0.27 to 0.32) for body weight. Moreover, offspring were two to three times more likely to be obese, have a high cholesterol level, or hypertension when comparing extreme categories of the corresponding parental risk factor level. Physically active parents had a lower risk of having physically inactive offspring.

Conclusions

The results suggested that cardiovascular risk factors track across generations and persist into the offspring's adult life.
Effect of triangular corrugated beds on the hydraulic jump characteristics
Authors: Samadi-Boroujeni H. , Ghazali M. , Gorbani B. , Nafchi R. Fattahi
Published: May 2013

In this study, the hydraulic jump characteristics were studied experimentally over six triangular corrugated beds in a rectangular cross section flume. A total number of 42 tests were carried out for Froude numbers 6.1 to 13.1 in low stage of jump. In all tests, the main characteristics of hydraulic jump were measured. The results showed that the corrugated bed caused the conjugate depths of the jump and the hydraulic jump length to be reduced by 25% and 54.7%, respectively, compared to those of smooth bed. The obtained shear stress coefficient for corrugated bed is about 8.5 times of that for smooth bed. The effect of the relative corrugation heights on the jump characteristics was not found to be significant. Finally, results obtained from this study showed that the effect of the shape was almost insignificant. Furthermore, no specific corrugated sheet could be chosen to simultaneously reduce the tailwater depth and the jump length.
Empirical models for forecasting changes in the phenology of ice cover for Canadian lakes
Authors: Shuter B.J. , Minns C.K. , Fung S.R.
Published: May 2013

In situ and remote-sensed data on freeze-up and break-up dates for lakes spread over much of Canada were used to develop and validate simple regression models linking lake ice phenology to climatic conditions and lake morphometry. The primary variables affecting fall freeze-up dates were the fall date when 30-day smoothed air temperatures reached 0 °C and lake mean depth; the primary variables affecting spring break-up date were the spring date when 30-day smoothed air temperatures reached 0 °C, solar elevation on that date, and the number of days over winter when 30-day smoothed air temperatures were <0 °C. These models were used to project potential impacts of climate change on ice phenology across Canada; by 2055 (under the Intergovernmental Panel on Climate Change Special Report on Emissions Scenarios (IPCC SRES) A2 emissions scenario), freeze-up dates were projected to be an average of 10 days later. Break-up dates were projected to be from 0 to 16 days earlier, with greater changes occurring at higher latitudes. These projections were similar to those independently derived using a mechanistic ice phenology model.
The occurrence of subtilase-cytotoxin-encoding genes in environmental Escherichia coli isolated from a Northern California estuary
Authors: Pereira Maria das Graças C. , Byrne Barbara A. , Nguyen Trân B.H. , Lewis David J. , Atwill E. Robert
Published: May 2013

The presence of subtilase-cytotoxin-encoding genes was determined in 397 environmental Escherichia coli strains isolated from water, suspended solids, and sediments sampled from different hydrological and environmental conditions in a California estuary. A total of 7 strains (1.76%) were found to harbor subtilase-cytotoxin-encoding genes. Using primers targeting subA only, we generated PCR amplicons from 2 strains; while using primers targeting the 3′ end of SubA downstream to the 5′ end of SubB, amplicons of 232 bp were generated from 5 additional strains. The 556 bp subA sequences were almost identical to that in the subtilase-cytotoxin-positive strain ED 591 (98%), while subAB sequences of 2 non-Shiga-toxigenic strains revealed 100% similarity with the Shiga-toxigenic E. coli O113:H21 strain 98NK2 that was isolated from an outbreak of hemolytic uremic syndrome. Additionally, the serogroup O113:H21 was present in this collection of environmental E. coli, and it was found to harbor stx2d, hra1 that encodes the heat resistant agglutinin 1, and a subAB sequence similar to that in the non-Shiga-toxigenic E. coli subtilase cytotoxin strain ED 591. To further understand potential health risks posed by strains encoding SubAB, future epidemiological studies should consider screening isolates for subAB regardless of the presence of Shiga-toxin-encoding genes.
Crossing the phantom divide line from a generalized time-dependent Hubble parameter and its dynamical evolution a la Riccati
Authors: El-Nabulsi Rami Ahmad
Published: May 2013

We introduce the notion of a “generalized time-dependent Hubble parameter” for the case of Friedmann–Robertson–Walker cosmology. We obtain a Riccati differential equation for the Hubble parameter, H, and it was observed that the effective equation of state in our framework can cross the phantom divide line as supported by recent astrophysical observations. In addition, the model is able to evolve without initial singularity.
CHI-SQUARE SIMULATION OF THE CIR PROCESS AND THE HESTON MODEL
Authors: MALHAM SIMON J. A. , WIESE ANKE
Published: May 2013

The transition probability of a Cox–Ingersoll–Ross process can be represented by a non-central chi-square density. First, we establish a new representation for the central chi-square density based on sums of powers of generalized Gaussian random variables. Second, we show that Marsaglia's polar method extends to this distribution, providing a simple, exact, robust and efficient acceptance–rejection method for generalized Gaussian sampling and thus central chi-square sampling. Third, we derive a simple, high-accuracy, robust and efficient direct inversion method for generalized Gaussian sampling based on the Beasley–Springer–Moro method. Indeed the accuracy of the approximation to the inverse cumulative distribution function is to the tenth decimal place. We then apply our methods to non-central chi-square variance sampling in the Heston model. We focus on the case when the number of degrees of freedom is small and the zero boundary is attracting and attainable, typical in foreign exchange markets. Using the additivity property of the chi-square distribution, our methods apply in all parameter regimes.
VIBRATION AND BUCKLING ANALYSIS OF LAMINATED SANDWICH PLATE HAVING SOFT CORE
Authors: KHANDELWAL RAVI PRAKASH , CHAKRABARTI ANUPAM , BHARGAVA PRADEEP
Published: May 2013

Free vibration and buckling of laminated sandwich plate having soft core is studied by using an efficient C0 continuous finite element (FE) model based on higher-order zigzag theory (HOZT). In this theory, the in-plane displacement field for both the face sheets and the core is obtained by superposing a global cubically varying displacement field on a zigzag linearly varying displacement field with a different slope in each layer. The transverse displacement is assumed to be quadratic within the core while it remains constant in the faces beyond the core. The proposed model satisfies the condition of transverse shear stress continuity at the layer interfaces and the zero transverse shear stress condition at the top and bottom of the plate. The nodal field variables are chosen in an efficient manner to overcome the problem of C1 continuity requirement of the transverse displacement. Numerical examples on free vibration and buckling covering different geometric and material features of laminated composite and sandwich plates are presented. Many new results are also presented which should be useful for future research.
SINGLE PHOTON REFLECTION AND TRANSMISSION IN OPTOMECHANICAL SYSTEM
Authors: KHAN M. A. , HOU S. C. , FAROOQ K. , YI X. X.
Published: May 2013

Cavity Optomechanical system is speedily approaching the regime where the radiation pressure of a single photon displaces the moving mirror. In this paper, we consider a cavity optomechanical system where the cavity field is driven by an external field. In the limit of weak mirror-cavity couplings, we calculate analytically the reflection and transmission rates for cavity field and discuss the effects of mirror-cavity coupling on reflection and transmission.
SELECTING AND ALLOCATING REPACKAGING TECHNOLOGY FOR UNIT-DOSE MEDICATIONS IN HOSPITAL PHARMACIES
Authors: PAZOUR JENNIFER A. , ROOT SARAH E. , MELLER RUSSELL D. , THOMAS LISA M. , MASON SCOTT J.
Published: May 2013

To increase patient safety and support bedside-point-of-care medication administration, millions of unit-dose medications are dispensed in hospitals and health systems daily. Because not all medications are available in unit-dose form directly from the manufacturer, hospitals must repackage medications in unit-dose form themselves. We develop a mathematical model that simultaneously determines which level of technology is warranted and how each medication that is not delivered to the pharmacy in unit-dose form should be repackaged subject to multiple constraints. This model has been integrated into a free Excel-based tool available to pharmacy directors. We test our model with data based on small, medium, and large hospitals and conduct sensitivity analyses to gain further insight. We illustrate how the results from our model can aid in incorporating qualitative aspects into technology selection. Our results show that a semi-automated repackaging system is the most economical technology alternative for most hospital pharmacy in-house repackaging operations. This result, however, is sensitive to the number of unit-dose medications to repackage and the available labor.
AUTOMATION IN HEALTHCARE INTERNAL LOGISTICS: A CASE STUDY ON PRACTICE AND POTENTIAL
Authors: GRANLUND ANNA , WIKTORSSON MAGNUS
Published: May 2013

The current demographic development puts even greater demands on the healthcare sector which is already struggling with scarce resources and constant pressure of cost reductions. This paper, through multiple case studies, aims to describe how automation of hospital internal logistics can be a tool in improving efficiency. The results include several potential implementations for patient transports, waste handling and small goods transports. However, organizational issues as lack of ownership and a strategic view render difficulties and need to be dealt with. The authors conclude that transfer of knowledge and technology used in the manufacturing industry would be beneficial.
C-Nucleophilic substitution in tetrachlorophthalonitrile — An approach to some new hexadecasubstituted phthalocyanines
Authors: Negrimovsky Vladimir , Volkov Konstantin , Suponitsky Kyrill , Lukyanets Evgeny
Published: May 2013

Reaction of tetrachlorophthalonitrile with some C -nucleophiles was studied. Only one chlorine atom was substituted regioselectively in the position 4 of benzene ring with diethyl malonate and malononitrile; no reaction occurred in case of bulkier diethyl ethylmalonate and ethylmalononitrile. In case of dimedone the domino substitution of two chlorine atoms, first with C -nucleophile followed by enolate O -nucleophile led to the mixture of two dibenzofuran derivatives. Remaining chlorine aroms n malonate and dibenzofuran derivatives were substituted with thiols, but in malononitrile derivative high acidity of methine proton led to the formation of stable carbanion under basic conditions that prevents further substitution. Hexadecasubstituted zinc phthalocyanines were synthesized from some new phthalonitriles.
BENDING OF FGM PLATES BY A SIMPLIFIED FOUR-UNKNOWN SHEAR AND NORMAL DEFORMATIONS THEORY
Authors: ZENKOUR ASHRAF M.
Published: May 2013

The bending response of FGM plates is presented based upon a simplified shear and normal deformations theory. The present simplified theory is accounted for an adequate distribution of transverse shear strains through the plate thickness and tangential stress-free on the plate surfaces. The effect of transverse normal strain is also included. The number of unknown functions involved here is only four as against six in case of other shear and normal deformations theories. The principle of virtual work is employed to derive the governing equations. A comparison with the corresponding results is made to check the accuracy and efficiency of the present theory. Additional results for all stresses are investigated through-the-thickness of the FGM plate.
FINITE VORONOI DECOMPOSITIONS OF INFINITE VERTEX TRANSITIVE GRAPHS
Authors: FINUCANE HILARY
Published: May 2013

In this paper, we consider the Voronoi decompositions of an arbitrary infinite vertex-transitive graph G. In particular, we are interested in the following question: what is the largest number of Voronoi cells that must be infinite, given sufficiently (but finitely) many Voronoi sites which are sufficiently far from each other? We call this number the survival number s(G). The survival number of a graph has an alternative characterization in terms of the number of balls of radius r-1 required to cover a sphere of radius r.

The survival number is not a quasi-isometry invariant, but it remains open whether finiteness of s(G) is. We show that all vertex-transitive graphs with polynomial growth have finite s(G); vertex-transitive graphs with infinitely many ends have infinite s(G); the lamplighter graph LL(Z), which has exponential growth, has finite s(G); and the lamplighter graph LL(Z2), which is Liouville, has infinite s(G).
Characterizing discontinuities in naturally fractured outcrop analogues and rock core: the need to consider fracture development over geological time
Authors: Hencher S. R.
Published: May 2013

This paper reviews aspects of the procedures for characterizing rock masses from outcrop mapping and core logging. It is argued that current definitions of discontinuities and joints are too simple and too coarse to deal adequately with the range of geological features that are found in the field and that range from open fractures through to incipient joint traces. A generic approach is proposed that differentiates between discontinuities on the basis of relative tensile strength compared to the intact parent rock. Examples are provided of how fracture frequency and extent vary with degree of weathering and erosion, and it is suggested that the concept of dynamic development of geological discontinuities needs to be appreciated by geotechnical engineers and structural geologists when analysing fracture networks. This concept has major implications for the use of rock mass classifications to zone the rock mass into engineering units.
Cardiovascular Magnetic Resonance: Deeper Insights Through Bioengineering
Authors: Young A.A. , Prince J.L.
Published: May 2013

Heart disease is the main cause of morbidity and mortality worldwide, with coronary artery disease, diabetes, and obesity being major contributing factors. Cardiovascular magnetic resonance (CMR) can provide a wealth of quantitative information on the performance of the heart, without risk to the patient. Quantitative analyses of these data can substantially augment the diagnostic quality of CMR examinations and can lead to more effective characterization of disease and quantification of treatment benefit. This review provides an overview of the current state of the art in CMR with particular regard to the quantification of motion, both microscopic and macroscopic, and the application of bioengineering analysis for the evaluation of cardiac mechanics. We discuss the current clinical practice and the likely advances in the next 5–10 years, as well as the ways in which clinical examinations can be augmented by bioengineering analysis of strain, compliance, and stress.
Exploring Neural Cell Dynamics with Digital Holographic Microscopy
Authors: Marquet P. , Depeursinge C. , Magistretti P.J.
Published: May 2013

In this review, we summarize how the new concept of digital optics applied to the field of holographic microscopy has allowed the development of a reliable and flexible digital holographic quantitative phase microscopy (DH-QPM) technique at the nanoscale particularly suitable for cell imaging. Particular emphasis is placed on the original biological information provided by the quantitative phase signal. We present the most relevant DH-QPM applications in the field of cell biology, including automated cell counts, recognition, classification, three-dimensional tracking, discrimination between physiological and pathophysiological states, and the study of cell membrane fluctuations at the nanoscale. In the last part, original results show how DH-QPM can address two important issues in the field of neurobiology, namely, multiple-site optical recording of neuronal activity and noninvasive visualization of dendritic spine dynamics resulting from a full digital holographic microscopy tomographic approach.
Cellular Assays for Drug Discovery in Genetic Disorders of Intracellular Trafficking
Authors: De Matteis Maria Antonietta , Vicinanza Mariella , Venditti Rossella , Wilson Cathal
Published: May 2013

Intracellular membrane trafficking is essential for organelle biogenesis, structure, and function; the exchange of material between organelles; and communication between the cell and its external environment. Genetic disorders affecting intracellular trafficking can lead to a variety of human diseases, but specific therapies for these diseases are notably lacking. In this article, we focus on how current knowledge about genetic disorders that affect intracellular trafficking can be used to develop strategies for cell-based assays in order to identify drugs using high-content screening approaches.
X Chromosome Inactivation and Epigenetic Responses to Cellular Reprogramming
Authors: Lessing Derek , Lee Jeannie T.
Published: May 2013

Reprogramming somatic cells to derive induced pluripotent stem cells (iPSCs) has provided a new method to model disease and holds great promise for regenerative medicine. Although genetically identical to their donor somatic cells, iPSCs undergo substantial changes in the epigenetic landscape during reprogramming. One such epigenetic process, X chromosome inactivation (XCI), has recently been shown to vary widely in human female iPSCs and embryonic stem cells (ESCs). XCI is a form of dosage compensation whose chief regulator is the noncoding RNA Xist. In mouse iPSCs and ESCs, Xist expression and XCI strictly correlate with the pluripotent state, but no such correlation exists in humans. Lack of XIST expression in human cells is linked to reduced developmental potential and an altered transcriptional profile, including upregulation of genes associated with cancer, which has therefore led to concerns about the safety of pluripotent stem cells for use in regenerative medicine. In this review, we describe how different states of XIST expression define three classes of female human pluripotent stem cells and explore progress in discovering the reasons for these variations and how they might be countered.