bluuebunny/crossref_metadata_2025_split huggingface dataset:
Structural vulnerability, reliability and risk
Authors: Blockley D I , Agarwal J , Pinto J T , Woodman N J 
Published: October 2002

AbstractA system is robust if it can withstand arbitrary damage. There are many practical ways to design in robustness, but there is as yet no accepted theory of robustness. Reliability theory is a useful tool for examining the probability of failure for a pre‐defined type of loading; however low‐probability–high‐consequence events may be missed. One insight into the lack of robustness is gained by identifying how a system is vulnerable. A system that is vulnerable in any one way is not robust. Like robustness, vulnerability has been defined differently in different contexts. The purpose of this paper is not to argue for particular definitions of robustness, vulnerability or risk, but rather to review a ‘theory of structural vulnerability’ developed by the authors and to show how it can be used in practice to improve the robustness of a system. The theory is one of form and connectivity. The purpose is to identify weak links within a structure as vulnerable failure scenarios. These can then be used with the probability of actions causing them to produce a measure of structural reliability and risk.
Buckling of the steel component of a composite member caused by shrinkage and creep of the concrete component
Authors: Vrcelj Z , Bradford M A , Uy B , Wright H D 
Published: October 2002

AbstractThe effects of shrinkage and creep in conventional reinforced and prestressed concrete members are quite well understood, and the effects of these time‐varying characteristics of the concrete component on the deflections of composite beams and columns have received a good deal of attention in recent years. However, creep and shrinkage effects may cause a redistribution of internal actions within a composite member, which increases significantly the compression within the steel component, and that may therefore lead to considerations of the possible buckling instability of the steel component. This paper reviews the research work that been documented only quite recently, which has been undertaken on the potential for composite structures using a thin external skin with a concrete infill to buckle locally, and the possible instabilities that may arise in the negative moment region of a continuous composite beam, due to the shrinkage and creep of the concrete. This paper also puts the possibilities of these instabilities into a practical perspective, indicating where this unique type of steel buckling may need to be a design consideration in the most efficient use of steel–concrete composite construction.
Adrenal Involvement in Multiple Endocrine Neoplasia Type 1
Authors: Langer Peter , Cupisti Kenko , Bartsch Detlef K. , Nies Christoph , Goretzki Peter E. , Rothmund Matthias , Röher Hans D. 
Published: October 2002

Adrenal lesions belong to the spectrum of multiple endocrine neoplasia type 1 (MEN‐1) syndrome. However, the prevalence of adrenal involvement, the characteristics, and the clinical management of adrenal lesions have not yet been clearly defined. A total of 66 patients with confirmed MEN1
germline mutations and 1 additional patient with typical manifestations in three organ systems were monitored in a regular screening program that included evaluation of the adrenals (median follow‐up 96 months;
range 12 to 300 months). Age at the diagnosis of MEN‐1 and of adrenal tumors and the clinical characteristics, genotype, treatment, and follow‐up of adrenal disease were analyzed. Adrenal lesions were identified in 18 of 67 (26.8%) MEN‐1 patients and were diagnosed 5
years later than MEN‐1. The median tumor diameter at diagnosis was 3.0
cm (range 1.2–15.0 cm), with most tumors being 3 cm or smaller. Eight patients had bilateral tumors. Ten patients had nonfunctional benign tumors, three had benign adrenal Cushing syndrome, and one patient had a pheochromocytoma. Four patients developed adrenocortical carcinomas
(ACCs), three of which were functional. Nine adrenalectomies and one subtotal adrenalectomy were performed in six patients. Three patients with ACC died owing to the tumor. Patients with mutations in exons 2 and 10 developed adrenal tumors significantly more often than patients with other mutations
(p <0.01). Adrenal tumors are a common feature of MEN‐1 but occur later in the course of the disease. The lesions are often small and nonfunctional and can therefore be managed by close surveillance; others have significant malignant potential and should be considered for surgery when they are 3 cm or larger.
Locally Applied Granulocyte‐macrophage Colony‐stimulating Factor Improves the Impaired Bowel Anastomoses in Rats with Long‐term Corticosteroid Treatment
Authors: Dinc Soykan , Alagol Haluk , Gulcelik Mehmet Ali , Ozbirecikli Bulent , Kuru Bekir , Renda Nurten , Ustun Huseyin 
Published: October 2002

Inflammation is an essential component of the first phase of anastomotic wound healing, and it is suppressed by corticosteroids. The anti‐inflammatory effect of corticosteroids is largely responsible for the impairment of wound healing in bowel anastomosis. It has been reported that local application of granulocyte‐macrophage colony‐stimulating factor (GM‐CSF) improves the healing process in dermal wounds. In the present study, we investigated the effects of locally injected GM‐CSF on anastomotic wound healing in long‐term corticosteroid treated rats. Eighty male Sprague‐Dawley rats were randomized into four groups. 1: control, 2: steroid, 3:
steroid + local GM‐CSF, 4: steroid + systemic GM‐CSF. In groups 2, 3, and 4, methylprednisolone (5 mg/kg) was injected IM daily for 14 days. After 14 days, following anesthesia and laparotomy,
colonic anastomosis was performed 3 cm away from the peritoneal reflection. In group 3, 50 mg GM‐CSF was injected into the perianastomotic area. In group 4, 50 mg GM‐CSF was applied subcutaneously. On postoperative day 3, repeat laparotomies were performed and bursting pressures, hydroxyproline levels, and histopathology examinations were studied. The mean values of bursting pressures and hydroxyproline levels in group 3, treated with steroid + local GM‐CSF, were significantly higher than that of the group 2 and group 4 values. In the histopathology examination, the mean score of group 3 was significantly higher than that of groups 2 and 4.
Our study indicates that local application of GM‐CSF significantly improves the impaired anastomotic wound healing in rats treated with long‐term corticosteroid.
Modified Technique of Percutaneous Dilational Tracheostomy in 600 Cases
Authors: Leptidis Geogios , Papanicolaou Spyros , Athanassiadi Kalliopi , Zogby Houssein , Iordanidou Olga , Katsaris Georgios 
Published: October 2002

Tracheostomy is frequently required for the treatment of critically ill patients to prevent the complications with prolonged translaryngeal intubation. It may facilitate airway suctioning and improve patient comfort during the process of weaning.
The purpose of the study was to introduce a new modified technique for percutaneous dilational tracheostomy (MPDT) and assess its advantages.
From November 1997 through December 2000, a series of 600 patients (350
men, 250 women; mean age 44.5 years) underwent MPDT in our department.
The technique we used is a combination of the Seldinger and Schachner techniques with an incision of 2 to 3 cm between the cricoid cartilage and the notch. Using a small automatic retractor, the thyroid muscles were dissected with the help of a curved mosquito clamp. This gave us the opportunity to control the isthmus and offered the possibility of ligation when the thyroid was large, providing a good operative field directly on the trachea. Hence we avoided traumatizing the isthmus,
which is the main source of hemorrhage during this procedure. The mean operating time was 4.5 minutes. The morbidity rate was 0.04%. One patient developed a subcutaneous emphysema and in three cases we had to ligate the external jugular vein. The surgical incision was completely healed within 3 to 4 days after removing the tracheostoma. No tracheal stenoses were observed during the follow‐up. MPDT is a safe, applicable technique that can be performed quickly even by a nonsurgeon in the intensive care unit and emergency department, with a low risk of complications because there is a direct view of the trachea and minimal trauma.
Sternal Fractures: Retrospective Analysis of 100 Cases
Authors: Athanassiadi Kalliopi , Gerazounis Michalis , Moustardas Marios , Metaxas Efstathios 
Published: October 2002

Isolated sternal fractures are seen with increasing frequency in road accidents, especially since the introduction of seatbelt legislation. The medical records of all our patients who were treated with a diagnosis of sternal fracture (SF)
over the past two decades were retrospectively reviewed to determine the incidence, morbidity, and mortality of this entity. Between 1984
and 1998, 100 consecutive patients were admitted to the Department of Surge Surgery, General Hospital of Nikea‐Piraeus, Greece, for SF. There were 72 men and 28 women ranging in age between 17 and 84 years.
Sixty‐seven patients sustained an isolated SF and the remaining 33 had a SF in combination with multiple injuries such as flail chest (n = 19), head injury (n = 18), limb fractures (n = 10), spinal fractures
(n = 4), hear contusion (n = 1),
hemo‐pneumothorax (n = 9), pneumothorax (n = 6), hemomediastinum (n = 5), and pericarditis (n = 2), among others. All patients with a radiological diagnosis were admitted for cardiac monitoring for at least 24 hours. Electrocardiogram (ECG), determinations of cardiac enzyme levels such as lactic dehydrogenase, creatine kinase, and creatine kinase‐MB, and evaluation by a cardiologist were routinely performed. An echocardiogram was performed as indicated by the cardiologist. Seven patients underwent operation, two for abdominal bleeding, two for chest wall and sternal stabilization, two for open pneumothorax, and one for massive hemothorax. Eight of our patients needed ventilatory support. Four of them died from respiratory insufficiency, myocardial infarction, and heart and lung contusion.
Although an isolated SF carries a good prognosis, careful evaluation and clinical observation are essential.
Indications and Results of Liver Transplantation in Patients with Neuroendocrine Tumors
Authors: Olausson Michael , Friman Styrbjörn , Cahlin Christian , Nilsson Ola , Jansson Svante , Wängberg Bo , Ahlman Håkan 
Published: October 2002

Metastases from neuroendocrine (NE)
tumors of the gastrointestinal tract, carcinoids, and endocrine pancreatic tumors (EPTs) can be confined to the liver for long periods and may exhibit slow growth. When considering liver transplantation
(LTx) for patients with NE tumors, the expected results with conventional treatment must be weighed against the risk of LTx and immunosuppression. The following indications for LTx may be considered for patients with metastatic NE tumors limited to the liver: (1) tumors not accessible to curative surgery or major tumor reduction; (2) tumors not responding to medical or interventional treatment; and (3) tumors causing life‐threatening hormonal symptoms. We excluded patients with poorly differentiated NE carcinoma or well differentiated NE carcinoma with a high proliferation index (Ki 67 > 10%). Over 4 years
(1997–2001) we have performed transplants in nine patients (five with EPTs, four with carcinoids) with a mean ± SEM follow‐up of
22 ± 5 months (range 4–45 months). Seven patients underwent orthotopic LTx and two multivisceral LTx. Eight patients are alive, six without clinical evidence of disease. Four patients developed recurrent tumors 9 to 36 months after LTx; two were detected at an early stage and underwent resection with curative intent. One patient with multivisceral Tx died after 4 months of posttransplant lymphoproliferative disease without tumor recurrence. In selected series LTx can offer good control of hormonal symptoms, a relatively long disease‐free interval, and in individual cases potential cure.
Intrapartum cardiotocography and fetal pulse oximetry in assessing fetal hypoxia
Authors: Leszczynska‐Gorzelak B , Poniedzialek‐Czajkowska E , Oleszczuk J 
Published: October 2002

AbstractObjectives: A retrospective analysis of short‐term variability (STV), a cardiotocography (CTG) parameter, in relation to fetal blood saturation values (FSpO2) obtained by fetal pulse oximetry. Methods: The study included 26 healthy pregnant women monitored continuously during delivery with both cardiotocography and fetal pulse oximetry. Results: Lower FSpO2 values were observed in the group showing STV levels ≤6.0 ms in the 1st stage of labor (44.7±3.46% vs. 49.2±1.8%), but this result was not statistically significant. In the 2nd stage of labor, FSpO2 values in the group with STV levels ≤6.0 ms were significantly lower than those with STV levels >6.0 ms (34.4±2.9% vs. 43±7.2%; P<0.001). A positive correlation was found between STV levels ≤6.0 ms and mean FSpO2 values in the 2nd stage of labor. Conclusions: 1. A significant relationship was observed between short‐term variability in the cardiotocographic records and fetal blood saturation levels in the 2nd stage of labor. 2. Fetal pulse oximetry can be valuable in assessing fetal wellbeing, especially when CTG records are abnormal.
Outcome of pregnancy with severe liver disease
Authors: Tank P.D. , Nadanwar Y.S. , Mayadeo N.M. 
Published: October 2002

AbstractObjectives: To study the incidence, presentation, and outcome of patients with severe liver disease in an urban Indian population. Method: 26 patients with severe liver disease were identified in the study period of one year at a teaching tertiary care institute in Mumbai. Investigations included bedside Bleeding and Clotting Time (BT/CT), coagulation profiles and liver and renal function tests. Management was directed towards initial stabilization followed by early delivery in an intensive care setting. Result: 80.71% of the patients had HELLP (Hemolysis, Elevated Liver enzymes, Low Platelets) syndrome. The remaining were cases of acute fulminant hepatitis and acute fatty liver of pregnancy. The most consistent finding was thrombocytopenia (88.46%). Disseminated Intravascular Coagulopathy (DIC) was the most common complication (65%). BT/CT were 100% sensitive for the diagnosis of DIC. Maternal and perinatal mortality were 42.3% and 61.5% respectively. Conclusion: Intensive care facilities and an early diagnosis are essential for the management of mothers with severe liver disease. Prognosis is poor for patients with fulminant hepatitis and acute fatty liver. Screening for DIC is a must. Delay in recovery of biochemical parameters may indicate atypical disease. Patient education is essential at discharge.
Growth of the fetal lens and orbit
Authors: Dilmen G , Köktener A , Turhan N.Ö , Tez S 
Published: October 2002

AbstractObjectives: To present normal lens and orbital measurement ranges by gestational age. Methods: Three hundred and thirty‐five women with uneventful pregnancies were evaluated from the 15th to the 40th week of gestation. Lens and orbital measurements were added to routine biometric measurements for normal fetuses. Results: A strong linear correlation was observed between gestational age (GA) and lens diameter (R2=0.89; P<0.0001), circumference (R2=0.89; P<0.0001), and surface (R2=0.90; P<0.0001). A linear correlation was also found between GA and orbital diameter (R2=0.92; P<0.0001), circumference (R2=0.92; P<0.0001) and surface (R2=0.95; P<0.0001). A linear growth function was observed between biparietal diameter and both lens diameter (R2=0.90; P<0.0001) and orbital diameter (R2=0.94; P<0.0001). Conclusions: Lens and orbital measurements provide normative data for fetal growth and development. These data may be also helpful in detecting fetal ocular anomalies.
Integrated product development practices and competitive capabilities: the effects of uncertainty, equivocality, and platform strategy
Authors: Koufteros Xenophon A. , Vonderembse Mark A. , Doll William J. 
Published: October 2002

AbstractProduct development occurs more frequently as product life cycles shrink and new product offerings expand. In this high‐change and complex environment, firms face high levels of uncertainty and equivocality, and in response, they seek integrative structural mechanisms. In these organizations, product development is characterized by the use of heavyweight product development managers, concurrent engineering, and computer usage. These mechanisms give product development efforts the senior leadership to overcome resistance, the ability to integrate and coordinate activities, the access to relevant information, and the ability to process it effectively. This research describes a framework for product development practices, and it discusses relations among these variables as well as important performance variables (product innovation, quality, premium pricing, and profitability). Based on responses from 244 manufacturing firms, the study suggests that heavyweight product development managers drive the application of concurrent engineering and computer use. Computer use has a significant and positive impact on product innovation, and concurrent engineering has a positive effect on quality. Product innovation also seems to have an influence on quality. Both quality and product innovation have a significant and positive impact on premium pricing, which, in turn, influences profitability. The extent to which a firm uses a product platform strategy seems to be an important contextual variable that affects the nature of the relationships among product development practices and competitive capabilities. Firms operating in uncertain or equivocal environments appear to adopt higher levels of integrated product development practices than firms operating in low uncertainty or low equivocality environments.
Low frequency EMF regulates chondrocyte differentiation and expression of matrix proteins
Authors: McK. Ciombor Deborah , Lester Gayle , Aaron Roy K. , Neame Peter , Caterson Bruce 
Published: October 2002

AbstractThis study describes the enhancement of chondrogenic differentiation in endochondral ossification by extremely low frequency pulsed electric/magnetic fields (EMFs). The demineralized bone matrix (DBM)‐induced endochondral ossification model was used to examine the effects of EMF stimulation. [35S]‐Sulfate and [3H]‐thymidine incorporation and glycosaminoglycan (GAG) content were determined by standard methods. Proteoglycan (PG) and GAG molecular size and composition were determined by gel chromatography and sequential enzyme digestion. Immunohistochemical and Western blot analysis of PGs were done with antibodies 2B6, 3B3, 2D3 and 5D4. Northern analysis of total RNA extracts was performed for aggrecan, and type II collagen. All data was compared for significance by Student's t‐ or analysis of variance (ANOVA)‐tests.The EMF field accelerated chondrogenesis as evidenced by an increase in: (1) 35SO4 incorporation and GAG content, (2) the number of chondrocytes at day 8 of development, (3) the volumetric density of cartilage and (4) the extent of immunostaining for 3B3 and 5D4. No differences in DNA content or [3H]‐thymidine incorporation were observed between control and stimulated ossicles, suggesting the absence of enhanced cell proliferation or recruitment as a mechanism for the acceleration. PG and GAG molecular sizes and GAG chemical composition were similar in stimulated and control ossicles, indicating that stimulation resulted in an accelerated synthesis of normal cartilage molecules. The increased expression of PG and type II collagen mRNA as well as a greater immunoreactivity of 3B3 and 504 suggest an increase in the rate of differentiation of chondrocytes and enhanced phenotypic maturation.© 2002 Orthopaedic Research Society. Published by Elsevier Science Ltd. All rights reserved.
Biomechanical regulation of type I collagen gene expression in ACLs in organ culture
Authors: Hsieh Adam H. , Sah Robert L. , Sung K.‐L. Paul 
Published: October 2002

AbstractIn this study, an ex vivo organ culture system that allows the application of controlled loads to the anterior cruciate ligament (ACL) was designed and used to characterize the influence of a step input in mechanical load on gene expression. A procedure for isolating bone–ACL–bone (B–ACL–B) complexes from rat knees was developed. After harvest and 24 hour culture, B–ACL–B complexes exhibited percentages of viability similar to that in intact ACLs (∼90%). Application of a physiologically relevant load of 5 N (superimposed on a 1 N tare load) resulted in changes in levels of mRNA encoding type I collagen. While levels of type I collagen mRNA significantly increased 32 ± 13% (mean ± standard errors of the mean (SEM)) over controls within the first hour of loading, levels decreased significantly to 44 ± 9% of control after 2 h. Displacements induced by the 5 N load were measured by video dimensional analysis. Calculated axial strains of 0.141 ± 0.034 were achieved rapidly during the first hour and remained essentially unchanged thereafter. These results demonstrate the feasibility of maintaining ligaments in organ culture and illustrate the time course expression of type I collagen following the application of a mechanical load. © 2002 Orthopaedic Research Society. Published by Elsevier Science Ltd. All rights reserved.
The effects of graft width and graft laxity on the outcome of caprine anterior cruciate ligament reconstruction
Authors: Cummings J. F. , Grood E. S. , Levy M. S. , Korvick D. L. , Wyatt R. , Noyes F. R. 
Published: October 2002

AbstractWe studied how initial graft size and initial graft laxity affected the biomechanics of anterior cruciate ligament (ACL) reconstruction at six months. Sixteen goats had bilateral reconstructions staged eight weeks apart. Autografts 4 and 7 mm wide were taken from the central patellar tendon (PT). Lax grafts were created by adding 4 mm slack to the graft before fixing. We reconstructed each joint using a combination of width and laxity treatments. Both factors were changed for the contralateral joint and all combinations appeared with equal frequency. At six months we measured the joint extension limit, anterior–posterior (AP) translation, and osteoarthritic changes. The grafts were then tested to failure to determine their mechanical properties. After six months the difference in initial treatments had disappeared: there was no difference in graft cross‐section due to the different initial widths and there was no difference in joint AP translation due to the initial graft laxity. We did observe that wide grafts were associated with a block to extension, decreased joint AP translation, and increased articular cartilage damage and osteophyte formation. While AP translation was reduced, it was correlated with decreased extension, possibly indicating an increase in scar tissue formation rather than a more functional graft. Neither graft width nor graft laxity produced differences in any graft mechanical properties. This suggests that the use of larger grafts to prevent increased AP translation has undesirable complications. Ultimately, we conclude that neither of these surgical treatments strongly affects the biomechanical result of caprine ACL reconstruction. © 2002 Orthopaedic Research Society. Published by Elsevier Science Ltd. All rights reserved.