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Chronology of fusion of the primary and secondary ossification centers in the human sacrum and age estimation in child and adolescent skeletons.  


Little is known about fusion times of the primary and secondary centers of ossification in the sacrum, particularly from dry bone observations. In this study, the timing of union of these centers was studied in a sample of modern Portuguese skeletons (90 females and 101 males) between the ages of 0 and 30 years, taken from the Lisbon documented skeletal collection. A three-stage scheme was used to assess fusion status between ossification centers as unfused, partially fused and completely fused. Posterior probability tables of age, given a certain stage of fusion, were calculated for most anatomical locations studied using both reference and uniform priors. Partial union of primary centers of ossification was observed from 1 to 8 years of age and partial union of secondary centers of ossification was observed from 15 to 21 years of age. The first primary centers of ossification to complete fusion are the neural arch with the centrum of the fifth sacral vertebrae and the last are the costal element with the centrum of the first sacral vertebra. The annular and sacroiliac epiphyses are the first, among the secondary centers of ossification observed, to complete fusion, after which the lateral margin fuses. This study offers information on timing of fusion of diverse locations in the developing sacrum useful for age estimation of complete or fragmented immature human skeletal remains and fills an important gap in the literature, by adding to previously published times of fusion of primary and secondary ossification centers in this sample. PMID:24227049

Cardoso, Hugo F V; Pereira, Vanessa; Rios, Luís



Primary Cervical Leiomyoma with Remarkable Calcification and Ossification  

PubMed Central

We encountered a patient with primary cervical leiomyoma with remarkable calcification and ossification. A 68-year-old man presenting with induration and swelling of the left submandibular region was found to have nodular lesions with calcifications in the left submandibular region and the upper mediastinum on CT. Fine needle aspiration biopsies (FNAB) of the left submandibular lesion revealed no malignancy. Resection was performed for definitive diagnosis and treatment. The resected specimen contained a solid tumor, which was markedly calcified and ossified on the cut surface. Histopathological examination showed proliferating spindle cells in a tangled and crossed arrangement. Immunohistochemically, the spindle cells were stained intensely with ?-SMA and h-caldesmon, consistent with smooth muscle cells. These findings led to a definitive diagnosis of leiomyoma with calcification and ossification. This is extremely rare and the preoperative differentiation from other tumors of the head and neck was very difficult. By resection of the submandibular tumor, both definitive diagnosis of leiomyoma by histopathological and immunohistochemical analyses and treatment could be carried out. However, as the tumor in the upper mediastinum was most likely to be leiomyoma with calcification, he did not wish to undergo its biopsy and resection immediately. We have continued the follow-up. PMID:24711950

Yamanishi, Takahiro; Sakamoto, Kaname; Watanabe, Hiroyuki; Yonaga, Takaaki; Katoh, Ryohei; Masuyama, Keisuke



Multipurpose contrast enhancement on epiphyseal plates and ossification centers for bone age assessment  

PubMed Central

Background The high variations of background luminance, low contrast and excessively enhanced contrast of hand bone radiograph often impede the bone age assessment rating system in evaluating the degree of epiphyseal plates and ossification centers development. The Global Histogram equalization (GHE) has been the most frequently adopted image contrast enhancement technique but the performance is not satisfying. A brightness and detail preserving histogram equalization method with good contrast enhancement effect has been a goal of much recent research in histogram equalization. Nevertheless, producing a well-balanced histogram equalized radiograph in terms of its brightness preservation, detail preservation and contrast enhancement is deemed to be a daunting task. Method In this paper, we propose a novel framework of histogram equalization with the aim of taking several desirable properties into account, namely the Multipurpose Beta Optimized Bi-Histogram Equalization (MBOBHE). This method performs the histogram optimization separately in both sub-histograms after the segmentation of histogram using an optimized separating point determined based on the regularization function constituted by three components. The result is then assessed by the qualitative and quantitative analysis to evaluate the essential aspects of histogram equalized image using a total of 160 hand radiographs that are implemented in testing and analyses which are acquired from hand bone online database. Result From the qualitative analysis, we found that basic bi-histogram equalizations are not capable of displaying the small features in image due to incorrect selection of separating point by focusing on only certain metric without considering the contrast enhancement and detail preservation. From the quantitative analysis, we found that MBOBHE correlates well with human visual perception, and this improvement shortens the evaluation time taken by inspector in assessing the bone age. Conclusions The proposed MBOBHE outperforms other existing methods regarding comprehensive performance of histogram equalization. All the features which are pertinent to bone age assessment are more protruding relative to other methods; this has shorten the required evaluation time in manual bone age assessment using TW method. While the accuracy remains unaffected or slightly better than using unprocessed original image. The holistic properties in terms of brightness preservation, detail preservation and contrast enhancement are simultaneous taken into consideration and thus the visual effect is contributive to manual inspection. PMID:23565999



Glucocerebrosidase deficiency in zebrafish affects primary bone ossification through increased oxidative stress and reduced Wnt/?-catenin signaling.  


Loss of lysosomal glucocerebrosidase (GBA1) function is responsible for several organ defects, including skeletal abnormalities in type 1 Gaucher disease (GD). Enhanced bone resorption by infiltrating macrophages has been proposed to lead to major bone defects. However, while more recent evidences support the hypothesis that osteoblastic bone formation is impaired, a clear pathogenetic mechanism has not been depicted yet. Here, by combining different molecular approaches, we show that Gba1 loss of function in zebrafish is associated with defective canonical Wnt signaling, impaired osteoblast differentiation and reduced bone mineralization. We also provide evidence that increased reactive oxygen species production precedes the Wnt signaling impairment, which can be reversed upon human GBA1 overexpression. Type 1 GD patient fibroblasts similarly exhibit reduced Wnt signaling activity, as a consequence of increased ?-catenin degradation. Our results support a novel model in which a primary defect in canonical Wnt signaling antecedes bone defects in type 1 GD. PMID:25326392

Zancan, Ilaria; Bellesso, Stefania; Costa, Roberto; Salvalaio, Marika; Stroppiano, Marina; Hammond, Chrissy; Argenton, Francesco; Filocamo, Mirella; Moro, Enrico



Heterotopic ossification: A review  

Microsoft Academic Search

Heterotopic ossification is defined as the presence of lamellar bone at locations where bone normally does not exist. The condition must be distinguished from metastatic calcifications, which mainly occur in hypercalcaemia, and dystrophic calcifications in tumours. It is a frequent complication following central nervous system disorders (brain injuries, tumours, encephalitis, spinal cord lesions), multiple injuries, hip surgery and burns. In

Luc Vanden Bossche; Guy Vanderstraeten



Protective effect of Cissus quadrangularis Linn. on diabetes induced delayed fetal skeletal ossification  

PubMed Central

Background: Delayed fetal skeletal ossification is one of the known complications of maternal diabetes. Objective: The present study was designed to evaluate the protective role of petroleum ether extract of Cissus quadrangularis (PECQ) on diabetes-induced delayed fetal skeletal ossification. Materials and Methods: Female Wistar rats were rendered diabetic with streptozotocin (STZ, 40 mg/kg, intraperitonial) before mating. After confirmation of pregnancy, the pregnant rats were divided into three groups: normal control group, diabetic control group, and diabetic + CQ group. The diabetic + CQ group pregnant rats were treated with PECQ (500 mg/kg body weight) throughout their gestation period. Immediately after delivery, pups were collected from all three groups and processed for alizarin red S–alcian blue staining in order to examine the pattern of skeletal ossification. Results: Fewer ossification centers and decreased extent of ossification of forelimb and hindlimb bones were observed in the neonatal pups of diabetic control group as compared to those in the normal control group. PECQ pretreatment significantly restored the ossification centers and improved the extent of ossification of forelimb and hindlimb bones in the neonatal pups of diabetic + CQ group as compared to those in the diabetic control group. Conclusions: The results suggested that PECQ treatment is effective against diabetes-induced delayed fetal skeletal ossification. However, further studies on the isolation and characterization of active constituents of PECQ, which can cross the placental barrier and are responsible for the bone anabolic activity are warranted. PMID:24812472

Sirasanagandla, Srinivasa Rao; Ranganath Pai, K. Sreedhara; Potu, Bhagath Kumar; Bhat, Kumar MR



NASA. Johnson Space Center primary battery applications  

NASA Technical Reports Server (NTRS)

The role of the Power Branch/EP5 of JSC in primary battery applications is to support those JSC organizations having direct application responsibility with trade studies, battery selection recommendations, and with development, qualification, and provisioning of primary batteries. Battery subsystem management is provided. Payload hazard report preparation is supported, as is the review and comment of such reports for the JSC Payload Safety Panel, who approves the flight safety for all Orbiter payloads. JSC battery users are provided with safety analysis and test support to achieve safety approval. Finally, it is the responsibility of the Power Branch to define and maintain battery safety requirement documentation for JSC.

Bragg, Bob J.



Heterotopic Ossification: An Unusual Presentation  

PubMed Central

Heterotopic ossification (HO) is usually seen after-trauma, following traumatic injuries, surgeries involving major joints, neurogenic injury, and burns; however, atraumatic cases have also been reported. HO tends to cause pain, swelling, and limitation of joint movements. HO has been reported in adults as well as in pediatric cases, however, our search in the English literature has not revealed a single case in the infratemporal region, especially in children of developing age, where HO tends to affect the development and growth of adjacent bones. We are reporting a case of HO in close proximity to TMJ affecting the development of mandible and maxilla. PMID:23346421

Patil, Satish G.; Siddiqua, Aaisha; Joshi, Udupi Krishna; Deshmukh, Pallavi K.; Patil, Bindu S.; Mangalgi, Anand



The Patient-Centered Medical Home: transforming primary care.  


The Patient-Centered Medical Home (PCMH) is a new care model that reorganizes primary care to improve access, coordination, quality, satisfaction, and comprehensive patient-centered care. Nurse practitioners should understand the PCMH concept, appraise the evidence, and become leaders in this transformation. PMID:22430928

Schram, Andrea Parsons



Regulation of endochondral ossification by transcription factors.  


Endochondral ossification is very unique and complex biological event which is associated with skeletal development and tissue partnering. Genetic studies and gene-targeting approaches identified several transcription factors that play important roles in endochondral ossification. These transcription factors sequentially and harmoniously regulate each step of endochondral ossification, and consequently maintain the spatio-temporal control of the program. Importantly, these transcription factors form large protein complex to control chromatin remodeling, histone modification, transcription and splicing steps during endochondral ossification. It is also important to understand how these transcription factors regulate expression of their target genes. Biochemical and molecular cloning techniques largely contributed to identification of the components of the transcriptional complex and the target genes. Most recently, importance of endoplasmic reticulum (ER) stress in endochondral ossification has been reported. A transcription factor, BBF2H7, functions as an ER stress sensor in chondrocytes through regulation of appropriate secretion of chondrogenic matrices. We would like to discuss how the transcription factors regulate endochondral ossification. PMID:22652803

Nishimura, Riko; Hata, Kenji; Ono, Koichiro; Amano, Katsuhiko; Takigawa, Yoko; Wakabayashi, Makoto; Takashima, Rikako; Yoneda, Toshiyuki



Primary processes in plant photosynthesis: photosystem I reaction center  

Microsoft Academic Search

The photosystem I (PSI) pigment-protein complex of plants converts light energy into a transmembrane charge separation, which ultimately leads to the reduction of carbon dioxide. Recent studies on the dynamics of primary energy transfer, charge separation, and following electron transfer of the reaction center (RC) of the PSI prepared from spinach are reviewed. The main results of femtosecond transient absorption

Keitaro Yoshihara; Shigeichi Kumazaki



Primary Care Practice Development: A Relationship-Centered Approach  

PubMed Central

PURPOSE Numerous primary care practice development efforts, many related to the patient-centered medical home (PCMH), are emerging across the United States with few guides available to inform them. This article presents a relationship-centered practice development approach to understand practice and to aid in fostering practice development to advance key attributes of primary care that include access to first-contact care, comprehensive care, coordination of care, and a personal relationship over time. METHODS Informed by complexity theory and relational theories of organizational learning, we built on discoveries from the American Academy of Family Physicians’ National Demonstration Project (NDP) and 15 years of research to understand and improve primary care practice. RESULTS Primary care practices can fruitfully be understood as complex adaptive systems consisting of a core (a practice’s key resources, organizational structure, and functional processes), adaptive reserve (practice features that enhance resilience, such as relationships), and attentiveness to the local environment. The effectiveness of these attributes represents the practice’s internal capability. With adequate motivation, healthy, thriving practices advance along a pathway of slow, continuous developmental change with occasional rapid periods of transformation as they evolve better fits with their environment. Practice development is enhanced through systematically using strategies that involve setting direction and boundaries, implementing sensing systems, focusing on creative tensions, and fostering learning conversations. CONCLUSIONS Successful practice development begins with changes that strengthen practices’ core, build adaptive reserve, and expand attentiveness to the local environment. Development progresses toward transformation through enhancing primary care attributes. PMID:20530396

Miller, William L.; Crabtree, Benjamin F.; Nutting, Paul A.; Stange, Kurt C.; Jaén, Carlos Roberto



Primary and Comprehensive Stroke Centers: History, Value and Certification Criteria  

PubMed Central

In the United States (US) stroke care has undergone a remarkable transformation in the past decades at several levels. At the clinical level, randomized trials have paved the way for many new stroke preventives, and recently, several new mechanical clot retrieval devices for acute stroke treatment have been cleared for use in practice by the US Federal Drug Administration. Furthermore, in the mid 1990s we witnessed regulatory approval of intravenous recombinant tissue plasminogen activator for administration in acute ischemic stroke. In the domain of organization of medical care and delivery of health services, stroke has transitioned from a disease dominated by neurologic consultation services only to one managed by vascular neurologists in geographical stroke units, stroke teams and care pathways, primary stroke center certification according to The Joint Commission, and most recently comprehensive stroke center designation under the aegis of The Joint Commission. Many organizations in the US have been involved to enhance stroke care. To name a few, the American Heart Association/American Stroke Association, Brain Attack Coalition, and National Stroke Association have been on the forefront of this movement. Additionally, governmental initiatives by the US Centers for Disease Control and Prevention and legislative initiatives such as the Paul Coverdell National Acute Stroke Registry program have paved the way to focus on stroke prevention, acute treatment and quality improvement. In this invited review, we discuss a brief history of organized stroke care in the United States, evidence to support the value of primary and comprehensive stroke centers, and the certification criteria and process to become a primary or comprehensive stroke center. PMID:24324943



Heterotopic Ossification of the Quadratus Lumborum Muscle  

PubMed Central

Heterotopic ossification is a benign process of mature laminar bone formation in the soft tissues. A synonymous term used to describe this pathology in muscle is myositis ossificans. The pathogenesis is unclear, but is likely multifactorial. The basic pathology is thought to be ectopic production of osseous tissue as part of a repair process in response to tissue injury. This report describes a case of heterotopic ossification of the quadratus lumborum muscle as an incidental finding. This case highlights that treatment is based on symptoms and conservative management might be appropriate for the asymptomatic patient. PMID:24967013

Alport, Brie; Horne, David; Burbridge, Brent



Pilomatricoma of the arm with extensive ossification.  


Pilomatricoma is a benign skin tumor derived from the hair follicle, usually located in the head and neck and presenting in the first two decades of life. Clinically it most commonly presents as a hard, mobile, well circumscribed nodule. Microscopically it is characterized by the presence of shadow cells and may show calcification, while extensive ossification is rare. Surgical removal is the treatment of choice, as the recurrence rate is very low. We present a rare case of late regressive pilomatricoma of the arm in a 33 year old female which presented with extensive ossification. PMID:20439187

Ioannidis, O; Stavrakis, T; Cheva, A; Papadimitriou, N; Kotronis, A; Kakoutis, E; Makrantonakis, N



Endochondral ossification model system: designed cell fate of human epiphyseal chondrocytes during long-term implantation.  


The aim of this study is to establish a recapitulation system of human endochondral ossification as a paradigm of developmental engineering. Chondrocytes were isolated from the epiphyseal cartilage of the supernumerary digits of infants with polydactyly. In vivo studies showed that implanted chondrocytes exhibited cartilaginous regeneration over a short period of time and subsequent endochondral ossification with a marrow cavity. Tracing studies revealed that cells of donor origin at the periphery of the cartilage migrated into the center of the cartilage and transformed into osteoblasts, adipocytes, and endothelial cells. Bone marrow was formed through anastomosis with the recipient endothelial system at 13 weeks, and from the migration of recipient hematopoietic cells at 50 weeks. This study provides a human endochondral ossification model system with transdifferentiation of the donor cells at the periphery of the cartilage. J. Cell. Physiol. 230: 1376-1388, 2015. © 2015 Wiley Periodicals, Inc., A Wiley Company. PMID:25640995

Nasu, Michiyo; Takayama, Shinichiro; Umezawa, Akihiro



Diffuse pulmonary ossification in permanent vegetative state.  


Diffuse pulmonary ossification (DPO) is a rare condition characterized by diffuse metaplastic bone formation in the lungs. Two patterns have been described: dendriform, with a coral-like network of bone spiculae along the alveolar septa; and nodular, with lobulated fragments in the alveolar spaces. Dendriform DPO is frequently associated with chronic pulmonary pathologies. We present here the first case of DPO associated with a long-lasting vegetative state. Micro-computed tomography (MicroCT) was applied to analyze the distribution of pulmonary ossification in volumes of lung samples. It showed a mean volume percentage of ossification of 0.79% and 3-D reconstructions permitted to reveal the branching pattern and internal cavities of some ossifications. The occurrence of DPO in a persistent vegetative state (PVS) may be favored by recurrent pulmonary infections, due to aspiration and immunological defects, and respiratory instability, due to brain damage and the fact of being bedridden. Fibrotic reactions probably represent a preliminary step in bone formation. Further studies could examine the incidence and clinical significance of DPO in subjects in PVS or patients who are bedridden for other reasons. MicroCT may facilitate analysis of more case histories, with greater sensitivity with respect to classic microscopic analyses. PMID:25406490

Porzionato, Andrea; Macchi, Veronica; Da Broi, Ugo; Giraudo, Chiara; Miotto, Diego; Rodriguez, Daniele; Moreschi, Carlo; De Caro, Raffaele



Prophylaxis of heterotopic ossification – an updated review  

Microsoft Academic Search

Heterotopic ossification (HO) is defined as the process by which trabecular bone forms outside of the skeletal structure, occupying space in soft tissue where it does not normally exist. The current popular prophylactic treatment modalities include non-steroidal anti-inflammatory drugs (NSAIDs) and radiation therapy, although the literature remains inconclusive as to which is superior. Additionally, both treatments can lead to adverse

Evan O Baird; Qian K Kang



Ossification in the human calcaneus: a model for spatial bone development and ossification  

PubMed Central

Perichondral bone, the circumferential grooves of Ranvier and cartilage canals are features of endochondral bone development. Cartilage canals containing connective tissue and blood vessels are found in the epiphysis of long bones and in cartilaginous anlagen of small and irregular bones. The pattern of cartilage canals seems to be integral to bone development and ossification. The canals may be concerned with the nourishment of large masses of cartilage, but neither their role in the formation of ossification centres nor their interaction with the circumferential grooves of Ranvier has been established. The relationships between cartilage canals, perichondral bone and the ossification centre were studied in the calcaneus of 9 to 38-wk-old human fetuses, by use of epoxy resin embedding, three-dimensional computer reconstructions and immunhistochemistry on paraffin sections. We found that cartilage canals are regularly arranged in shells surrounding the ossification centre. Whereas most of the shell canals might be involved in the nourishment of the cartilage, the inner shell is directly connected with the perichondral ossification groove of Ranvier and with large vessels from outside. In this way the inner shell canal imports extracellular matrix, cells and vessels into the cartilage. With the so-called communicating canals it is also connected to the endochondral ossification centre to which it delivers extracellular matrix, cells and vessels. The communicating canals can be considered as inverted ‘internal’ ossification grooves. They seem to be responsible for both build up intramembranous osteoid and for the direction of growth and thereby for orientation of the ossication centre. PMID:11760892




Effect of alendronate on endochondral ossification in mandibular condyles of growing rats  

PubMed Central

The replacement of the calcified cartilage by bone tissue during the endochondral ossification of the mandibular condyle is dependent of the resorbing activity of osteoclats. After partial resorption, calcified cartilage septa are covered by a primary bone matrix secreted by osteoblasts. Osteoadherin (OSAD) is a small proteoglycan present in bone matrix but absent in cartilage during the endochondral ossification. The aim of this study was to analyze the effect of alendronate, a drug known to inhibit bone resorption by osteoclasts, on the endochondral ossification of the mandibular condyle of young rats, by evaluating the distribution of osteoclasts and the presence of OSAD in the bone matrix deposited. Wistar newborn rats (n=45) received daily injections of alendronate (n=27) or sterile saline solution as control (n=18) from the day of birth until the ages of 4, 14 and 30 days. At the days mentioned, the mandibular condyles were collected and processed for transmission electron microscopy analysis. Specimens were also submitted to tartrate resistant acid phosphatase (TRAP) histochemistry and ultrastructural immunodetection of OSAD. Alendronate treatment did not impede the recruitment and fusion of osteoclasts at the ossification zone during condyle growth, but they presented inactivated phenotype. The trabeculae at the ossification area consisted of cartilage matrix covered by a layer of primary bone matrix that was immunopositive to OSAD at all time points studied. Apparently, alendronate impeded the removal of calcified cartilage and maturation of bone trabeculae in the mandibular ramus, while in controls they occurred normally. These findings highlight for giving attention to the potential side-effects of bisphosphonates administered to young patients once it may represent a risk of disturbing maxillofacial development. PMID:22688305

Bradaschia-Correa, V.; Barrence, F.A.C.; Ferreira, L.B.; Massa, L.F.; Arana-Chavez, V.E.



Patient Centered Communication During Primary Care Visits for Depressive Symptoms  

PubMed Central

Background Patient Centered Communication (PCC) is associated with more appropriate treatment of depression in primary care. In part a function of patient presentation, little is known about other influences on PCC. We investigated whether PCC was also influenced by personality dispositions of primary care providers (PCPs), independent of patient presentation. Methods 46 PCPs completed personality scales from the NEO-Personality Inventory, Revised and provided care to 88 Standardized Patients (SPs) presenting with either major depression or adjustment disorder with comorbid musculoskeletal symptoms, either making or not making a medication request. Coders scored each visit using the Measure of Patient Centered Communication, assessing physicians’ ability to explore the patient’s illness experience (component 1), understand the patient’s psychosocial context (component 2), and involve the patient in collaborative discussions of treatment (component 3). Results Adjusting for physician demographics, training, and patient presentation, physicians who were more open to feelings explored the patient’s experience of illness more (p = .05). More dutiful, or rule-bound physicians engaged in greater exploration of the patient’s psychosocial and life circumstances (p = .04), but involved the patient less in treatment discussions (p = .03), as did physicians reporting more anxious vulnerability (p = .03). Physician demographics, training, and patient presentation explained 4-7% of variance in MPCC components, with personality explaining an additional 4-7% of the variance. Conclusion Understanding of personality dispositions which promote or detract from PCC may help medical educators better identify trainees of varying aptitude, addressing individual training needs in a tailored fashion. PMID:18665060

Chapman, Benjamin P.; Duberstein, Paul R.; Epstein, Ron; Fiscella, Kevin; Kravitz, Richard L.



[The nucleus of ossification in kidney calculus].  


The presence of bone tissue in renal stones has been described for a long time. Two cases of heterotopic ossification are reported in this study. Stone analysis was performed by stereoscopic microscopy, infrared spectrophotometry and fine slice petrographic section and polarized light microscopy. This last technique revealed the existence of osteocytic filling defects inside the stones, an unquestionable sign of mineralized bone tissue. PMID:8687168

Alcover, J; Fernàndez-Conde, M; Carretero, P



Outcome Determinants of Stroke in a Brazilian Primary Stroke Center  

PubMed Central

Background. Stroke mortality in Brazil is one of the highest among Western countries. Nonetheless, stroke outcome determinants are still poorly known in this country. In this study we evaluate outcome determinants of stroke in a primary stroke center in São Paulo, Brazil. Methods. We evaluated demographic, clinical, and outcome data of patients with ischemic stroke (IS), transient ischemic attack (TIA), and intracerebral hemorrhage (ICH) admitted at “Hospital Paulistano,” São Paulo, Brazil. In-hospital mortality and functional outcome determinants were assessed. Univariate and binary logistic regression analysis were performed. Results. Three hundred forty-one patients were included in the study, 52.2% being male with 66.8 ± 15.7 years. The stroke type distribution was IS: 59.2%, TIA: 29.6%, and ICH: 11.1%. ICH was associated with greater severity and poorer functional outcome. The determinants of poorer functional outcome were higher NIHSS, lower Glasgow score, and lower oxygen saturation level. The most important mortality determinant was the presence of visual symptoms. Conclusions. The stroke mortality and stroke outcome determinants found in the present study do not remarkably differ from studies carried out in developed countries. Stroke prognosis studies are crucial to better understand the high burden of stroke in Brazil. PMID:25580352

Kuster, Gustavo W.; Dutra, Lívia A.; Brasil, Israel P.; Pacheco, Evelyn P.; Arruda, Márcio A. C.; Volcov, Cristiane; Domingues, Renan B.



Heterotopic ossification in spinal cord-injured patients.  


Therapy programs during the development of heterotopic ossification in spinal cord injury range widely from complete rest to aggressive exercise programs. The literature is confusing by its multiplicity of recommendations because the basic etiology and pathophysiology are unknown and because some basic differences exist between traumatic myositis ossificans and heterotopic ossification associated with severe neurological impairments. Prospective heterotopic ossification roentgenographic (x-ray) surveys of the hips, knees, shoulders, and elbows were made on 250 consecutive spinal cord-injured patients. Those who had x-ray evidence of early or immature heterotopic ossification or who developed early clinical signs of possible heterotopic ossification were treated with an aggressive program of passive progressive range of motion exercises. Several patients who developed bilateral heterotopic ossification had one side used as their own control. Follow-up x-ray studies and range of motion evaluation suggest that an aggressive range of motion exercise program is indicated for patients who are developing or have heterotopic ossification. There is no evidence that exercise increases inflammation with subsequent ossification, and it frequently causes a pseudarthrosis, permitting adequate functional range of motion. PMID:806274

Stover, S L; Hataway, C J; Zeiger, H E



Heterotopic Ossifications in a Mouse Model of Albright Hereditary Osteodystrophy  

Microsoft Academic Search

Albright hereditary osteodystrophy (AHO) is characterized by short stature, brachydactyly, and often heterotopic ossifications that are typically subcutaneous. Subcutaneous ossifications (SCO) cause considerable morbidity in AHO with no effective treatment. AHO is caused by heterozygous inactivating mutations in those GNAS exons encoding the ?-subunit of the stimulatory G protein (G?s). When inherited maternally, these mutations are associated with obesity, cognitive

David L. Huso; Sarah Edie; Michael A. Levine; William Schwindinger; Yingli Wang; Harald Jüppner; Emily L. Germain-Lee; Frank Beier



Patient centered primary care is associated with patient hypertension medication adherence  

Microsoft Academic Search

There is increasing evidence that patient centered care, including communication skills, is an essential component to chronic\\u000a illness care. Our aim was to evaluate patient centered primary care as a determinant of medication adherence. We mailed 1,341\\u000a veterans with hypertension the Short Form Primary Care Assessment Survey (PCAS) which measures elements of patient centered\\u000a primary care. We prospectively collected each

Christianne L. Roumie; Robert Greevy; Kenneth A. Wallston; Tom A. Elasy; Lisa Kaltenbach; Kristen Kotter; Robert S. Dittus; Theodore Speroff


Primary charge-recombination in an artificial photosynthetic reaction center  

PubMed Central

Photoinduced primary charge-separation and charge-recombination are characterized by a combination of time-resolved optical and EPR measurements of a fullerene-porphyrin-linked triad that undergoes fast, stepwise charge-separation processes. The electronic coupling for the energy-wasting charge recombination is evaluated from the singlet-triplet electronic energy gap in the short-lived, primary charge-separated state. The electronic coupling is found to be smaller by ?40% than that for the primary charge-separation. This inhibition of the electronic interaction for the charge-recombination to excited triplet state largely results from a symmetry-broken electronic structure modulated by configuration interaction between 3(b1u,b3g) and 3(au, b3g) electronic states of the free-base porphyrin. PMID:16014413

Kobori, Yasuhiro; Yamauchi, Seigo; Akiyama, Kimio; Tero-Kubota, Shozo; Imahori, Hiroshi; Fukuzumi, Shunichi; Norris, James R.



The Primary Cilium: A Signaling Center During Vertebrate Development  

PubMed Central

The primary cilium has recently stepped into the spotlight, as a flood of data demonstrate that this organelle has crucial roles in vertebrate development and human genetic diseases. Cilia are required for the response to developmental signals, and evidence is accumulating that the primary cilium is specialized for Hedgehog (Hh) signal transduction. Formation of cilia, in turn, is regulated by other signaling pathways, possibly including the planar cell polarity pathway. The cilium therefore represents a nexus for signaling pathways during development. The connections between cilia and developmental signaling have begun to clarify the basis of human diseases associated with ciliary dysfunction. PMID:20395968

Goetz, Sarah C.



A Treasure Chest of Primary Learning Center Ideas.  

ERIC Educational Resources Information Center

Defining a learning center as a classroom area containing several learning stations where students may work independently with materials which teach, reinforce, or enrich their skills, this guide presents a number of ideas for use in the visual motivation display area of such a center. Suggestions for displays for the various teaching stations are…

Kessler, Margaret; Kessler, John


Elbow heterotopic ossification in head-trauma patients: diagnosis and treatment.  


Heterotopic ossification is a disorder characterized histologically and radiographically by normal bone formation in soft tissues that normally have no ossification properties. In severe head-trauma patients, a high incidence of heterotopic ossification occurs. The diagnosis of this pathology in these patients often is difficult for residual neurological damage. The etiology of heterotopic ossification following head trauma is unknown. Similarities have been found between heterotopic ossification and myositis ossificans, a hereditary autosomal dominant disease. PMID:12083577

de Palma, Luigi; Rapali, Stefano; Paladini, Paolo; Ventura, Angelo



ADAM17 Controls Endochondral Ossification by Regulating Terminal Differentiation of Chondrocytes  

PubMed Central

Endochondral ossification is a highly regulated process that relies on properly orchestrated cell-cell interactions in the developing growth plate. This study is focused on understanding the role of a crucial regulator of cell-cell interactions, the membrane-anchored metalloproteinase ADAM17, in endochondral ossification. ADAM17 releases growth factors, cytokines, and other membrane proteins from cells and is essential for epidermal growth factor receptor (EGFR) signaling and for processing tumor necrosis factor alpha. Here, we report that mice lacking ADAM17 in chondrocytes (A17?Ch) have a significantly expanded zone of hypertrophic chondrocytes in the growth plate and retarded growth of long bones. This abnormality is caused by an accumulation of the most terminally differentiated type of chondrocytes that produces a calcified matrix. Inactivation of ADAM17 in osteoclasts or endothelial cells does not affect the zone of hypertrophic chondrocytes, suggesting that the main role of ADAM17 in the growth plate is in chondrocytes. This notion is further supported by in vitro experiments showing enhanced hypertrophic differentiation of primary chondrocytes lacking Adam17. The enlarged zone of hypertrophic chondrocytes in A17?Ch mice resembles that described in mice with mutant EGFR signaling or lack of its ligand transforming growth factor ? (TGF?), suggesting that ADAM17 regulates terminal differentiation of chondrocytes during endochondral ossification by activating the TGF?/EGFR signaling axis. PMID:23732913

Hall, Katherine C.; Hill, Daniel; Otero, Miguel; Plumb, Darren A.; Froemel, Dara; Dragomir, Cecilia L.; Maretzky, Thorsten; Boskey, Adele; Crawford, Howard C.; Selleri, Licia; Goldring, Mary B.



Molecular and cellular mechanisms of heterotopic ossification  

PubMed Central

Summary Heterotopic ossification (HO) is a debilitating condition in which cartilage and bone forms in soft tissues such as muscle, tendon, and ligament causing immobility. This process is induced by inflammation associated with traumatic injury. In an extremely rare genetic disorder called fibrodysplasia ossificans progessiva (FOP), a combination of inflammation associated with minor soft tissue injuries and a hereditary genetic mutation causes massive HO that progressively worsens throughout the patients’ lifetime leading to the formation of an ectopic skeleton. An activating mutation in the BMP type I receptor ALK2 has been shown to contribute to the heterotopic lesions in FOP patients, yet recent studies have shown that other events are required to stimulate HO including activation of sensory neurons, mast cell degranulation, lymphocyte infiltration, skeletal myocyte cell death, and endothelial-mesenchymal transition (EndMT). In this review, we discuss the recent evidence and mechanistic data that describe the cellular and molecular mechanisms that give rise to heterotopic bone. PMID:24796520

Ramirez, Diana M.; Ramirez, Melissa R.; Reginato, Anthony M.; Medici, Damian



The immunological contribution to heterotopic ossification disorders.  


The formation of bone outside the endogenous skeleton is a significant clinical event, rendering affected individuals with immobility and a diminished quality of life. This bone, termed heterotopic ossification (HO), can appear in patients following invasive surgeries and traumatic injuries, as well as progressively manifest in several congenital disorders. A unifying feature of both genetic and nongenetic episodes of HO is immune system involvement at the early stages of disease. Activation of the immune system sets the stage for the downstream anabolic events that eventually result in ectopic bone formation, rendering the immune system a particularly appealing site of early therapeutic intervention for optimal management of disease. In this review, we will discuss the immunological contributions to HO disorders, with specific focus on contributing cell types, signaling pathways, relevant in vivo animal models, and potential therapeutic targets. PMID:25687936

Convente, Michael R; Wang, Haitao; Pignolo, Robert J; Kaplan, Frederick S; Shore, Eileen M



Quantitative Analyses of Pediatric Cervical Spine Ossification Patterns Using Computed Tomography  

PubMed Central

The objective of the present study was to quantify ossification processes of the human pediatric cervical spine. Computed tomography images were obtained from a high resolution scanner according to clinical protocols. Bone window images were used to identify the presence of the primary synchondroses of the atlas, axis, and C3 vertebrae in 101 children. Principles of logistic regression were used to determine probability distributions as a function of subject age for each synchondrosis for each vertebra. The mean and 95% upper and 95% lower confidence intervals are given for each dataset delineating probability curves. Posterior ossifications preceded bilateral anterior closures of the synchondroses in all vertebrae. However, ossifications occurred at different ages. Logistic regression results for closures of different synchondrosis indicated p-values of <0.001 for the atlas, ranging from 0.002 to <0.001 for the axis, and 0.021 to 0.005 for the C3 vertebra. Fifty percent probability of three, two, and one synchondroses occurred at 2.53, 6.97, and 7.57 years of age for the atlas; 3.59, 4.74, and 5.7 years of age for the axis; and 1.28, 2.22, and 3.17 years of age for the third cervical vertebrae, respectively. Ossifications occurring at different ages indicate non-uniform maturations of bone growth/strength. They provide an anatomical rationale to reexamine dummies, scaling processes, and injury metrics for improved understanding of pediatric neck injuries PMID:22105393

Yoganandan, Narayan; Pintar, Frank A.; Lew, Sean M.; Rao, Raj D.; Rangarajan, Nagarajan



Quantitative analyses of pediatric cervical spine ossification patterns using computed tomography.  


The objective of the present study was to quantify ossification processes of the human pediatric cervical spine. Computed tomography images were obtained from a high resolution scanner according to clinical protocols. Bone window images were used to identify the presence of the primary synchondroses of the atlas, axis, and C3 vertebrae in 101 children. Principles of logistic regression were used to determine probability distributions as a function of subject age for each synchondrosis for each vertebra. The mean and 95% upper and 95% lower confidence intervals are given for each dataset delineating probability curves. Posterior ossifications preceded bilateral anterior closures of the synchondroses in all vertebrae. However, ossifications occurred at different ages. Logistic regression results for closures of different synchondrosis indicated p-values of <0.001 for the atlas, ranging from 0.002 to <0.001 for the axis, and 0.021 to 0.005 for the C3 vertebra. Fifty percent probability of three, two, and one synchondroses occurred at 2.53, 6.97, and 7.57 years of age for the atlas; 3.59, 4.74, and 5.7 years of age for the axis; and 1.28, 2.22, and 3.17 years of age for the third cervical vertebrae, respectively. Ossifications occurring at different ages indicate non-uniform maturations of bone growth/strength. They provide an anatomical rationale to reexamine dummies, scaling processes, and injury metrics for improved understanding of pediatric neck injuries. PMID:22105393

Yoganandan, Narayan; Pintar, Frank A; Lew, Sean M; Rao, Raj D; Rangarajan, Nagarajan



Dendriform pulmonary ossification in patient with rare earth pneumoconiosis  

PubMed Central

The case history is presented of a patient with pathologically proven dendriform pulmonary ossification and rare earth pneumoconiosis confirmed by analytical transmission electron microscopy. This is thought to be the first report of this association. PMID:16061714

Yoon, H; Moon, H; Park, S; Song, J; Lim, Y; Kohyama, N



Primary Electron Transfer in Membrane-Bound Reaction Centers with Mutations at the M210 Position  

E-print Network

Primary Electron Transfer in Membrane-Bound Reaction Centers with Mutations at the M210 Position L, 1995; In Final Form: January 9, 1996X The kinetics of primary electron transfer in membrane state was examined, leading to the conclusion that a distribution in the driving force (G) for electron

van Stokkum, Ivo


The Association of Low Back Pain with Obesity in One of the Primary Health Care Centers  

Microsoft Academic Search

Objective: The present study was designed to assess the association between low back pain and obesity in patients attending one of the primary health care centers. Methods: A case control study of patients attending Marka Medical Center (Amman Jordan) was conducted over 7 months (Jan-Jul 1998). All patients with low back pain were included as cases and an equal number

Mohammed Halalsheh; Mohammed Tarawneh; Ziad Mahadine


Penile ossification: A traumatic event or evolutionary throwback? Case report and review of the literature  

PubMed Central

Penile ossification is very rare, with only a handful of histologically confirmed reported cases. The most common condition leading to penile ossification is Peyronie’s disease. Other conditions, such as gout, end-stage renal disease, diabetes mellitus, hyperparathyroidism and local trauma, have also been associated with penile ossification. We report a unique case of near-complete penile ossification of the corporal bodies with histologic confirmation on pathologic review. Our report summarizes the literature regarding this rare entity. PMID:23671498

Yilmaz, Ibrahim Edhem; Barazani, Yagil; Tareen, Basir



Penile ossification: A traumatic event or evolutionary throwback? Case report and review of the literature.  


Penile ossification is very rare, with only a handful of histologically confirmed reported cases. The most common condition leading to penile ossification is Peyronie's disease. Other conditions, such as gout, end-stage renal disease, diabetes mellitus, hyperparathyroidism and local trauma, have also been associated with penile ossification. We report a unique case of near-complete penile ossification of the corporal bodies with histologic confirmation on pathologic review. Our report summarizes the literature regarding this rare entity. PMID:23671498

Yilmaz, Ibrahim Edhem; Barazani, Yagil; Tareen, Basir



Progressive Relapse of Ligamentum Flavum Ossification Following Decompressive Surgery  

PubMed Central

Thoracic ossification of the ligamentum flavum (T-OLF) is a relatively rare spinal disorder that generally requires surgical intervention, due to its progressive nature and the poor response to conservative therapy. The prevalence of OLF has been reported at 3.8%-26%, which is similar to that of cervical ossification of the posterior longitudinal ligament (OPLL). The progression of OPLL after cervical laminoplasty for the treatment of OPLL is often shown in long-term follow-up. However, there have been no reports on the progression of OLF following surgery. We report a case of thoracic myelopathy secondary to the progressive relapse of OLF following laminectomy. PMID:25558329

Ando, Kei; Ito, Zenya; Kobayashi, Kazuyoshi; Ukai, Junichi; Muramoto, Akio; Shinjo, Ryuichi; Matsumoto, Tomohiro; Nakashima, Hiroaki; Ishiguro, Naoki



Osteochondrosis of the accessory ossification centre of the medial malleolus.  


We report a case of a painful accessory ossification centre of the medial malleolus in an 11-year-old girl who was not involved in sports activities. The patient was treated conservatively, with complete clinical and radiographic healing of the medial malleolus 6 months after the first presentation. We ruled out the uncommon pathological conditions causing chronic pain in the medial malleolus during skeletal growth, such as traction apophysitis of the medial malleolus, osteochondrosis, osteochondritis or avascular necrosis of the distal tibial epiphysis. We speculate that this painful condition may be classified as an osteochondrosis of the accessory ossification centre of the medial malleolus. PMID:25438106

Farsetti, Pasquale; Dragoni, Massimiliano; Potenza, Vito; Caterini, Roberto



Monotreme ossification sequences and the riddle of mammalian skeletal development.  


The developmental differences between marsupials, placentals, and monotremes are thought to be reflected in differing patterns of postcranial development and diversity. However, developmental polarities remain obscured by the rarity of monotreme data. Here, I present the first postcranial ossification sequences of the monotreme echidna and platypus, and compare these with published data from other mammals and amniotes. Strikingly, monotreme stylopodia (humerus, femur) ossify after the more distal zeugopodia (radius/ulna, tibia/fibula), resembling only the European mole among all amniotes assessed. European moles also share extreme humeral adaptations to rotation digging and/or swimming with monotremes, suggesting a causal relationship between adaptation and ossification heterochrony. Late femoral ossification with respect to tibia/fibula in monotremes and moles points toward developmental integration of the serially homologous fore- and hindlimb bones. Monotreme cervical ribs and coracoids ossify later than in most amniotes but are similarly timed as homologous ossifications in therians, where they are lost as independent bones. This loss may have been facilitated by a developmental delay of coracoids and cervical ribs at the base of mammals. The monotreme sequence, although highly derived, resembles placentals more than marsupials. Thus, marsupial postcranial development, and potentially related diversity constraints, may not represent the ancestral mammalian condition. PMID:21521190

Weisbecker, Vera



Spinal dural ossification causing neurological signs in a cat.  


A six-year-old Ragdoll cat underwent examination due to a six-month history of slowly progressive gait abnormalities. The cat presented with an ambulatory tetraparesis with a neurological examination indicating a C1-T2 myelopathy. Radiographs of the spine showed a radiopaque irregular line ventrally in the vertebral canal dorsal to vertebral bodies C3-C5. In this area, magnetic resonance imaging revealed an intradural extramedullary/extradural lesion compressing the spinal cord. The spinal cord was surgically decompressed. The cause of the spinal cord compression was dural ossification, a diagnosis confirmed by histopathological examination of the surgically dissected sample of dura mater. The cat gradually improved after the procedure and was ambulating better than prior to the surgery. The cat's locomotion later worsened again due to ossified plaques in the dura causing spinal cord compression on the same cervical area as before. Oral prednisolone treatment provided temporary remission. Ten months after surgery, the cat was euthanized due to severe worsening of gait abnormalities, non-ambulatory tetraparesis. Necropsy confirmed spinal cord compression and secondary degenerative changes in the spinal cord on cervical and lumbar areas caused by dural ossification. To our knowledge, this is the first report of spinal dural ossification in a cat. The reported cat showed neurological signs associated with these dural changes. Dural ossification should be considered in the differential diagnosis of compressive spinal cord disorders in cats. PMID:23777582

Antila, Johanna M; Jeserevics, Janis; Rakauskas, Mindaugas; Anttila, Marjukka; Cizinauskas, Sigitas



Antenna excited state decay kinetics establish primary electron transfer in reaction centers as heterogeneous.  


The decay of the excited primary electron donor P* in bacterial photosynthetic reaction centers (both membrane-bound and detergent-isolated) has been observed to be nonexponential on a time scale of some tens of picoseconds. Although the multipicosecond nonexponentiality of P* has been ascribed to heterogeneity in teh rate of primary electron transfer (PET), the decay kinetics can be interpreted equally well using homogeneous models. To address this ambiguity, we studied the decay of excited bacteriochlorophyll (Bchl) in the membrane-bound core antenna/reaction center complexes of wild-type and mutant reaction center strains of Rhodobacter capsulatus. Reaction centers isolated from these same strains display a range of multiexponentiality in primary charge separation. The mutant strains carry substitutions of amino acids residing near the monomeric Bchl on the active and/or inactive sides of the reaction center. Transient absorption measurements monitoring the Qy bleach of antenna Bchls require at least two exponential components to fit all decays. The wild type was fitted with equal-amplitude components whose lifetimes are 24 and 65 ps. The shortest-lived component is relatively insensitive to mutation, in contrast to the longer-lived component(s) whose amplitude and magnitude were dramatically perturbed by amino acid substitutions. Unlike the situation with isolated reaction centers, here the only kinetic models consistent with the data are those in which the primary electron-transfer rate constant is heterogeneous, suggesting at least two structural populations of RCs. PET in the population with the shortest-lived antenna decay causes the kinetics to be transfer-to-trap-limited, whereas the kinetics in the other population(s)--having longer-lived antenna decays--are limited by the rate of PET. Observation of both types of kinetic limitation within a single light-harvesting system is unexpected and complicates any discussion of the rate-limiting step of light energy utilization in photosynthesis. PMID:9289013

Laible, P D; Greenfield, S R; Wasielewski, M R; Hansen, D K; Pearlstein, R M



Primary photosynthesis in reaction centers containing four different types of electron acceptors at site H A  

NASA Astrophysics Data System (ADS)

Femtosecond spectroscopy is used to study the primary electron transfer reactions in photosynthetic reaction centers, where the chromophore at the secondary acceptor site is changed from bacteriopheophytin a via 3-vinyl-bacteriopheophytin a and 3-acetyl-pheophytin a to pheophytin a. Pronounced changes in the primary electron transfer reactions are observed which are directly related to the redox potential of the different chromophores and the corresponding changes in free energy of the first intermediates. The reaction dynamics do not primarily correlate with the changes in absorption spectra.

Huber, H.; Meyer, M.; Nägele, T.; Hartl, I.; Scheer, H.; Zinth, W.; Wachtveitl, J.



Discrepancy in Diagnosis of Primary Myelofibrosis between Referral and Tertiary Care Centers  

PubMed Central

Primary myelofibrosis (PMF) is myeloproliferative neoplasm whose diagnosis is based on a combination of clinical and pathology criteria. We evaluated 560 consecutive patients who were diagnosed with PMF upon a referral to our center and evaluated the frequency of and reasons for diagnostic discordance. Discordance in the diagnosis was found in 70 (12.5%) patients. Discordant cases had a significantly lower grade of bone marrow fibrosis (grade 0–1), more likely to be JAK2V617F-mutation negative, and have no peripheral blood blasts, possibly explaining the difficulty in making a proper diagnosis and underscoring the need for a complete evaluation at a tertiary center. PMID:24284333

Yi, Cecilia Arana; Jeyakumar, Ghayathri; Medina, Pedro; Cortes, Jorge; Pierce, Sherry; Bueso-Ramos, Carlos; Kantarjian, Hagop; Verstovsek, Srdan



Radionuclide assessment of heterotopic ossification in spinal cord injury patients  

SciTech Connect

Whole body /sup 99m/T-pyrophosphate bone scans were obtained and correlated with skeletal radiographs for detection of heterotopic ossification in 135 spinal injury patients. There were 40 patients with recent injury (less than 6 months) and 95 with injury of over 6 months duration. Heterotopic new bone was detected on the bone scan in 33.7% of 95 patients with spinal cord injuries of more than 6 months duration and 30% of 40 patients with injuries of less than 6 months. The radionuclide scan was found to be useful in detection of heterotopic ossification at its early stage and in its differentiation from other complications in spinal cord injury patients.

Prakash, V.



[Diffuse pulmonary ossifications with mortal consequences. A case report].  


Dendriform pulmonary ossification (DPO) represents a relatively frequent form of diffuse pulmonary and mostly clinically inapparent bone formation of unknown etiology. An association with other pulmonary diseases, particularly pulmonary interstitial fibrosis, has been suggested. Here we report a female patient with a 15-year history of DPO whereby at the age of 48 an X-ray of the thorax first revealed findings suggestive of pulmonary fibrosis. For 9 years the patient suffered from chronic progressive ventilation disorder and after a further 3 years open lung biopsy revealed DPO in conjunction with interstitial fibrosis. After a history of progressive respiratory failure the patient suddenly died of cardiac arrhythmia along with deteriorated cor pulmonale at the age of 71. Autopsy revealed an almost complete ossification of the lungs with an increasing gradient from apex to base. In contrast to previous reports, the DPO of our patient was life-limiting. PMID:12673500

Reinehr, M; Rittinger, M; Müller-Wening, D; Wagner, T; Gabelmann, A; Möller, P; Scheil, Stefanie



Extensive heterotopic ossification in patient with tubercular meningitis  

PubMed Central

Tubercular meningitis is a severe form of central nervous system tuberculosis with high morbidity and mortality. Apart from neurological deficits, musculoskeletal involvement is also seen in very few cases in the form of heterotopic ossification around immobile joints. A 35-year-old male case of tubercular meningitis with left hemiparesis presented with multiple joint restriction of range of motion. On clinical examination, palpable firm masses around multiple joints with painful restriction of movements were seen. X-ray films of multiple joints revealed heterotopic ossification over left shoulder, hip and knee joint with bony ankylosis of left hip and soft tissue contractures. Very few reports have been published in the literature for association of heterotopic ossification with tubercular meningitis with such extensive joint involvement which compels us to report this clinical association of tubercular meningitis. This report is intended to create caution among physicians and other caregivers for this debilitating complication of tubercular meningitis and in face of high prevalence of tuberculosis and tubercular meningitis, employ methods to prevent and treat. PMID:25540549

Sharma, Vijai Prakash; Yadav, Ganesh; Gupta, Anil Kumar; Kumar, Dileep



Integration of substance use disorder services with primary care: health center surveys and qualitative interviews  

PubMed Central

Background Each year, nearly 20 million Americans with alcohol or illicit drug dependence do not receive treatment. The Affordable Care Act and parity laws are expected to result in increased access to treatment through integration of substance use disorder (SUD) services with primary care. However, relatively little research exists on the integration of SUD services into primary care settings. Our goal was to assess SUD service integration in California primary care settings and to identify the practice and policy facilitators and barriers encountered by providers who have attempted to integrate these services. Methods Primary survey and qualitative interview data were collected from the population of federally qualified health centers (FQHCs) in five California counties known to be engaged in SUD integration efforts was surveyed. From among the organizations that responded to the survey (78% response rate), four were purposively sampled based on their level of integration. Interviews were conducted with management, staff, and patients (n?=?18) from these organizations to collect further qualitative information on the barriers and facilitators of integration. Results Compared to mental health services, there was a trend for SUD services to be less integrated with primary care, and SUD services were rated significantly less effective. The perceived difference in effectiveness appeared to be due to provider training. Policy suggestions included expanding the SUD workforce that can bill Medicaid, allowing same-day billing of two services, facilitating easier reimbursement for medications, developing the workforce, and increasing community SUD specialty care capacity. Conclusions Efforts to integrate SUD services with primary care face significant barriers, many of which arise at the policy level and are addressable. PMID:24679108



Advancing Educational Continuity in Primary Care Residencies: An Opportunity for Patient-Centered Medical Homes.  


Continuity of care is a core value of patients and primary care physicians, yet in graduate medical education (GME), creating effective clinical teaching environments that emphasize continuity poses challenges. In this Perspective, the authors review three dimensions of continuity for patient care-informational, longitudinal, and interpersonal-and propose analogous dimensions describing continuity for learning that address both residents learning from patient care and supervisors and interprofessional team members supporting residents' competency development. The authors review primary care GME reform efforts through the lens of continuity, including the growing body of evidence that highlights the importance of longitudinal continuity between learners and supervisors for making competency judgments. The authors consider the challenges that primary care residency programs face in the wake of practice transformation to patient-centered medical home models and make recommendations to maximize the opportunity that these practice models provide. First, educators, researchers, and policy makers must be more precise with terms describing various dimensions of continuity. Second, research should prioritize developing assessments that enable the study of the impact of interpersonal continuity on clinical outcomes for patients and learning outcomes for residents. Third, residency programs should establish program structures that provide informational and longitudinal continuity to enable the development of interpersonal continuity for care and learning. Fourth, these educational models and continuity assessments should extend to the level of the interprofessional team. Fifth, policy leaders should develop a meaningful recognition process that rewards academic practices for training the primary care workforce. PMID:25470307

Bowen, Judith L; Hirsh, David; Aagaard, Eva; Kaminetzky, Catherine P; Smith, Marie; Hardman, Joseph; Chheda, Shobhina G



Food insecure families: description of access and barriers to food from one pediatric primary care center.  


Despite evidence that food insecurity negatively impacts child health, health care providers play little role in addressing the issue. To inform potential primary care interventions, we sought to assess a range of challenges faced by food insecure (FI) families coming to an urban, pediatric primary care setting. A cross-sectional study was performed at a hospital-based, urban, academic pediatric primary care clinic that serves as a medical home for approximately 15,000 patients with 35,000 annual visits. Subjects included a convenience sample of caregivers of children presenting for either well child or ill care over a 4 months period in 2012. A self-administered survey assessed household food security status, shopping habits, transportation access, budgeting priorities, and perceptions about nutrition access in one's community. Bivariate analyses between food security status and these characteristics were performed using Chi square statistics or Fisher's exact test. The survey was completed by 199 caregivers. Approximately 33% of families were FI; 93% received food-related governmental assistance. FI families were more likely to obtain food from a corner/convenience store, utilize food banks, require transportation other than a household car, and prioritize paying bills before purchasing food. FI families perceived less access to healthy, affordable foods within their community. Thus, FI families may face unique barriers to accessing food. Knowledge of these barriers could allow clinicians to tailor in-clinic screening and create family-centered interventions. PMID:23852328

DeMartini, Tori L; Beck, Andrew F; Kahn, Robert S; Klein, Melissa D



Heterotopic ossifications in a mouse model of albright hereditary osteodystrophy.  


Albright hereditary osteodystrophy (AHO) is characterized by short stature, brachydactyly, and often heterotopic ossifications that are typically subcutaneous. Subcutaneous ossifications (SCO) cause considerable morbidity in AHO with no effective treatment. AHO is caused by heterozygous inactivating mutations in those GNAS exons encoding the ?-subunit of the stimulatory G protein (G?(s)). When inherited maternally, these mutations are associated with obesity, cognitive impairment, and resistance to certain hormones that mediate their actions through G protein-coupled receptors, a condition termed pseudohypoparathyroidism type 1a (PHP1a). When inherited paternally, GNAS mutations cause only AHO but not hormonal resistance, termed pseudopseudohypoparathyroidism (PPHP). Mice with targeted disruption of exon 1 of Gnas (Gnas(E1-/+)) replicate human PHP1a or PPHP phenotypically and hormonally. However, SCO have not yet been reported in Gnas(E1+/-) mice, at least not those that had been analyzed by us up to 3 months of age. Here we now show that Gnas(E1-/+) animals develop SCO over time. The ossified lesions increase in number and size and are uniformly detected in adult mice by one year of age. They are located in both the dermis, often in perifollicular areas, and the subcutis. These lesions are particularly prominent in skin prone to injury or pressure. The SCO comprise mature bone with evidence of mineral deposition and bone marrow elements. Superficial localization was confirmed by radiographic and computerized tomographic imaging. In situ hybridization of SCO lesions were positive for both osteonectin and osteopontin. Notably, the ossifications were much more extensive in males than females. Because Gnas(E1-/+) mice develop SCO features that are similar to those observed in AHO patients, these animals provide a model system suitable for investigating pathogenic mechanisms involved in SCO formation and for developing novel therapeutics for heterotopic bone formation. Moreover, these mice provide a model with which to investigate the regulatory mechanisms of bone formation. PMID:21747923

Huso, David L; Edie, Sarah; Levine, Michael A; Schwindinger, William; Wang, Yingli; Jüppner, Harald; Germain-Lee, Emily L



Heterotopic Ossifications in a Mouse Model of Albright Hereditary Osteodystrophy  

PubMed Central

Albright hereditary osteodystrophy (AHO) is characterized by short stature, brachydactyly, and often heterotopic ossifications that are typically subcutaneous. Subcutaneous ossifications (SCO) cause considerable morbidity in AHO with no effective treatment. AHO is caused by heterozygous inactivating mutations in those GNAS exons encoding the ?-subunit of the stimulatory G protein (G?s). When inherited maternally, these mutations are associated with obesity, cognitive impairment, and resistance to certain hormones that mediate their actions through G protein-coupled receptors, a condition termed pseudohypoparathyroidism type 1a (PHP1a). When inherited paternally, GNAS mutations cause only AHO but not hormonal resistance, termed pseudopseudohypoparathyroidism (PPHP). Mice with targeted disruption of exon 1 of Gnas (GnasE1?/+) replicate human PHP1a or PPHP phenotypically and hormonally. However, SCO have not yet been reported in GnasE1+/? mice, at least not those that had been analyzed by us up to 3 months of age. Here we now show that GnasE1?/+ animals develop SCO over time. The ossified lesions increase in number and size and are uniformly detected in adult mice by one year of age. They are located in both the dermis, often in perifollicular areas, and the subcutis. These lesions are particularly prominent in skin prone to injury or pressure. The SCO comprise mature bone with evidence of mineral deposition and bone marrow elements. Superficial localization was confirmed by radiographic and computerized tomographic imaging. In situ hybridization of SCO lesions were positive for both osteonectin and osteopontin. Notably, the ossifications were much more extensive in males than females. Because GnasE1?/+ mice develop SCO features that are similar to those observed in AHO patients, these animals provide a model system suitable for investigating pathogenic mechanisms involved in SCO formation and for developing novel therapeutics for heterotopic bone formation. Moreover, these mice provide a model with which to investigate the regulatory mechanisms of bone formation. PMID:21747923

Huso, David L.; Edie, Sarah; Levine, Michael A.; Schwindinger, William; Wang, Yingli; Jüppner, Harald; Germain-Lee, Emily L.



Bilateral ossification of the auricles: an unusual entity and review of the literature  

Microsoft Academic Search

BACKGROUND: True ossification of the auricle with cartilage replacement by bone, is a very rare clinical entity and can result in an entirely rigid auricle. CASE PRESENTATION: We present a rare case of bilateral ossification of the auricles in a 75-years old man with profound progressive rigidity of both auricles. His main complaint was a mild discomfort during resting making

Nicholas S Mastronikolis; Peter Zampakis; Christina Kalogeropoulou; Theodoros Stathas; Vassiliki Siabi; Eleni Geropoulou; Panos D Goumas



Homology of the palpebral and origin of supraorbital ossifications in ornithischian dinosaurs  

E-print Network

Homology of the palpebral and origin of supraorbital ossifications in ornithischian dinosaurs and origin of supraor- bital ossifications in ornithischian dinosaurs. Lethaia, 10.1111/j.1502 dinosaurs and its presence is considered a synapomorphy of the clade. By contrast, other ornithischians lack


Synostosis between pubic bones due to neurogenic, heterotopic ossification.  


Neurogenic, heterotopic ossification is characterised by the formation of new, extraosseous (ectopic) bone in soft tissue in patients with neurological disorders. A 33-year-old female, who was born with spina bifida, paraplegia, and diastasis of symphysis pubis, had indwelling urethral catheter drainage and was using oxybutynin bladder instillations. She was prescribed diuretic for swelling of feet, which aggravated bypassing of catheter. Hence, suprapubic cystostomy was performed. Despite anticholinergic therapy, there was chronic urine leak around the suprapubic catheter and per urethra. Therefore, the urethra was mobilised and closed. After closure of the urethra, there was no urine leak from the urethra, but urine leak persisted around the suprapubic catheter. Cystogram confirmed the presence of a Foley balloon inside the bladder; there was no urinary fistula. The Foley balloon ruptured frequently, leading to extrusion of the Foley catheter. X-ray of abdomen showed heterotopic bone formation bridging the gap across diastasis of symphysis pubis. CT of pelvis revealed heterotopic bone lying in close proximity to the balloon of the Foley catheter; the sharp edge of heterotopic bone probably acted like a saw and led to frequent rupture of the balloon of the Foley catheter. Unique features of this case are: (1) temporal relationship of heterotopic bone formation to suprapubic cystostomy and chronic urine leak; (2) occurrence of heterotopic ossification in pubic region; (3) complications of heterotopic bone formation viz. frequent rupture of the balloon of the Foley catheter by the irregular margin of heterotopic bone and difficulty in insertion of suprapubic catheter because the heterotopic bone encroached on the suprapubic track; (4) synostosis between pubic bones as a result of heterotopic ossification.. Common aetiological factors for neurogenic, heterotopic ossification, such as forceful manipulation, trauma, or spasticity, were absent in this patient. Since heterotopic bone formation was observed in the pubic region after suprapubic cystostomy and chronic urine leak, it is possible that risk factors related to the urinary tract might have played a role in heterotopic bone formation, which resulted in synostosis between pubic bones. PMID:17619722

Vaidyanathan, Subramanian; Hughes, Peter L; Soni, Bakul M



Experimental model of heterotopic ossification in Wistar rats  

PubMed Central

Heterotopic ossification (HO) is a metaplastic biological process in which there is newly formed bone in soft tissues adjacent to large joints, resulting in joint mobility deficit. In order to determine which treatment techniques are more appropriate for such condition, experimental models of induced heterotopic bone formation have been proposed using heterologous demineralized bone matrix implants and bone morphogenetic protein and other tissues. The objective of the present experimental study was to identify a reliable protocol to induce HO in Wistar rats, based on autologous bone marrow (BM) implantation, comparing 3 different BM volumes and based on literature evidence of this HO induction model in larger laboratory animals. Twelve male Wistar albino rats weighing 350/390?g were used. The animals were anesthetized for blood sampling before HO induction in order to quantify serum alkaline phosphatase (ALP). HO was induced by BM implantation in both quadriceps muscles of these animals, experimental group (EG). Thirty-five days after the induction, another blood sample was collected for ALP determination. The results showed a weight gain in the EG and no significant difference in ALP levels when comparing the periods before and after induction. Qualitative histological analysis confirmed the occurrence of heterotopic ossification in all 12 EG rats. In conclusion, the HO induction model was effective when 0.35?mL autologous BM was applied to the quadriceps of Wistar rats. PMID:22473322

Zotz, T.G.G.; de Paula, J.B.; Moser, A.D.L.



Prenatal cranial ossification of the humpback whale (Megaptera novaeangliae).  


Being descendants of small terrestrial ungulate mammals, whales underwent enormous transformations during their evolutionary history, that is, extensive changes in anatomy, physiology, and behavior were evolved during secondary adaptations to life in water. However, still only little is known about whale ontogenetic development, which help to identify the timing and sequence of critical evolutionary events, such as modification of the cetacean ear. This is particularly true for baleen whales (Mysticeti), the group including the humpback whale Megaptera novaeangliae. We use high-resolution X-ray computed tomography to reinvestigate humpback whale fetuses from the Kükenthal collection at the Museum für Naturkunde, Berlin, thus, extending historic descriptions of their skeletogenesis and providing for the first time sequences of cranial ossification for this species. Principally, the ossification sequence of prenatal Megaptera follows a typical mammalian pattern with the anterior dermal bones being the first ossifying elements in the skull, starting with the dentary. In contrast to other mammals, the ectotympanic bone ossifies at an early stage. Alveolar structure can be observed in both the maxillae and dentaries in these early prenatal specimens but evidence for teeth is lacking. Although the possibility of obtaining new embryological material is unlikely due to conservation issues, our study shows that reexamination of existing specimens employing new technologies still holds promise for filling gaps in our knowledge of whale evolution and ontogeny. J. Morphol. 276:564-582, 2015. © 2015 Wiley Periodicals, Inc. PMID:25728778

Hampe, Oliver; Franke, Helena; Hipsley, Christy A; Kardjilov, Nikolay; Müller, Johannes



Quality of Antenatal Care in Primary Health Care Centers of Bangladesh  

PubMed Central

Objective: To find out the quality of ANC in the Upazila Health Complexes (PHC centres) of Bangladesh. Materials and methods: This cross sectional study was done in purposively selected three upazilas among the clients receiving antenatal care (ANC). Data were collected with questionnaire cum checklist in the context of two aspects of quality issues, namely assessment of physical arrangements for ANC (input) and services rendered by the providers (process). Results: The mean age of respondents was 24.6±4.5 years. Majority of the respondents were with primary level education (60.3%). About half (52.8%) of the families had monthly income ranging from 3000-5000 taka (38-64 US$). Nearly half (48.9%) had no child, little more than one third (42.3%) were primigravida and 528 (57.7%) were multigravida. Out of 528 multigravid respondents 360 (68.2%) took ANC in their previous pregnancy whereas 168 (31.8%) did not take ANC Pregnancy outcome was found to be associated with receiving ANC (?2=73.599; p=0.000). Respondents receiving ANC had more good pregnancy outcome. The mean waiting time for receiving ANC was 0.77±.49 hours. Out of the 13 centers, only 3 (23.1%) have sufficient instruments to render ANC services. Findings showed that where the modes of ANC service delivery in the ANC centers are fairly satisfactory. Though some of the points of standard operation procedures (SOPs) on ANC are not covered by some ANC centers, those were not considered necessary. But, regarding the physical facilities available for rendering ANC services, it is seen that facilities are not quite satisfactory. Number of doctors and nurses are not very satisfactory. One of the centers under this study has no doctor, where ANC services are given by nurses. Conclusion: It can be concluded that the ANC services at the primary health care level is not adequate in Bangladesh. To ensure further improvement of the quality of ANC services, instruments used in logistics and supplies should be enhanced. PMID:25530770

Mansur, Ahmed M. S. A.; Rezaul, Karim M.; Mahmudul, Hoque. M.; S, Chowdhury



Etiology of primary ovarian insufficiency in a series young girls presenting at a pediatric endocrinology center.  


The cause of the primary ovarian insufficiency (POI) remains unknown in the majority of cases. A retrospective study was carried out in 17 girls with POI and normal 46,XX karyotype evaluated before 20 years of age. The etiology of POI was determined in eight girls (group 1) and remained idiopathic in nine girls (group 2). In group 1, five patients had a medical history: cerebellar ataxia due to congenital disorder of glycosylation (CDG) 1 in three cases, mitochondrial disease in one case, and autoimmune deficiencies in one case. The diagnosis of POI was made on pubertal delay or primary amenorrhea in these five patients, whilst the others presented with clitoral hypertrophy at birth or short stature and pubertal delay in two cases with NR5A1 mutation or with short stature and learning difficulties in one case with mitochondrial disease. In group 2, associated diseases were arthrogryposis malformative, gut, and bladder malformations and kidney failure or parieto-occipital tumor. The genes tested (NR5A1, BMP15, GDF9, and NOBOX) showed no mutation. Conclusions: The frequency of defined etiologies (47 %) is high. This is probably because of the recruitment of the cases at the pediatric center, where other somatic anomalies can lead to the accurate determination of the etiology. PMID:25425520

Brauner, Raja; Pierrepont, Sophie; Bignon-Topalovic, Joelle; McElreavey, Ken; Bashamboo, Anu



Creating cross-racial primary care relationships in a nurse-managed center.  


Culturally incompetent communication patterns with providers influence the health disparities of African Americans. Limited knowledge exists on cross-racial nurse practitioner nurse-patient relationships (NP-NPRs). The purpose of this paper is to describe how NPs and patients in cross-racial relationships developed primary care relationships in one nurse managed center (NMC). A qualitative design incorporated a social constructivist paradigm and the methodology of Interpretive Interactionism. Twenty cross-racial NP-patient dyads (White NPs and Black patients) participated in individual 1 to 3-hour audiotaped interviews regarding their ongoing relationships and the impact of the NMC. The analysis uncovered a rich description of the relationship processes from the initial meeting to its current state. Multiple themes for each phase, as well as, four typologies of primary care cross-racial NP-NPRs are described. Significant relationship work was needed by both partners to overcome communication misunderstandings, contextual aspects of cross-racial interactions and other overt and covert perceptions. PMID:15689143

Benkert, Ramona; Pohl, Joanne M; Coleman-Burns, Patricia



[Assessment of quality of vaccine storage and conservation in primary health care centers].  


This is an evaluative study of the quality of vaccine storage and conservation in primary health care centers (PHC) in the mid-west region of the state of Minas Gerais. Dimensions, structures and processes were the criteria used to measure the level of quality in 261 vaccine storage and conservation units in over 55 municipalities in the area. Quality levels were defined by means of a scoring system with different weighted scores attributed to indicators for each dimension being rated. Categories for quality levels were then defined as: "adequate," "inadequate" and "critical." Pearson's chi-square test was used to verify the correlation between quality level and population size and adherence to the Unified Health System. It was observed that vaccine storage and conservation quality levels were inadequate in 59.3% and critical in 26.9% of these facilities. Small municipalities that are registered for Full Primary Health Care Management featured the worst vaccine storage facilities. Vaccine conservation supervision, which spans a series of activities present in nursing praxis, indicates the need to train human resources, monitor and assess work processes and conduct further studies in the field. PMID:25184594

Oliveira, Valéria Conceição de; Gallardo, Maria Del Pilar Serrano; Arcêncio, Ricardo Alexandre; Gontijo, Tarcísio Laerte; Pinto, Ione Carvalho



Toward a strategy of patient-centered access to primary care.  


Patient-centered access (PCA) to primary care services is rapidly becoming an imperative for efficiently delivering high-quality health care to patients. To enhance their PCA-related efforts, some medical practices and health systems have begun to use various tactics, including team-based care, satellite clinics, same-day and group appointments, greater use of physician assistants and nurse practitioners, and remote access to health services. However, few organizations are addressing the PCA imperative comprehensively by integrating these various tactics to develop an overall PCA management strategy. Successful integration means taking into account the changing competitive and reimbursement landscape in primary care, conducting an evidence-based assessment of the barriers and benefits of PCA implementation, and attending to the particular needs of the institution engaged in this important effort. This article provides a blueprint for creating a multifaceted but coordinated PCA strategy-one aimed squarely at making patient access a centerpiece of how health care is delivered. The case of a Wisconsin-based health system is used as an illustrative example of how other institutions might begin to conceive their fledgling PCA strategies without proposing it as a one-size-fits-all model. PMID:25199953

Berry, Leonard L; Beckham, Dan; Dettman, Amy; Mead, Robert



Diabatic surfaces and the pathway for primary electron transfer in a photosynthetic reaction center  

SciTech Connect

We have performed molecular dynamics simulations for two different models of a photosynthetic reaction center (Rps.viridis) to examine the diabatic surfaces governing the primary charge separation after photoexcitation. We include the electrostatic energy of the entire proteic complex and also account for the energies of the electronic states of chromophores as computed by semiempirical quantum theory. The statistics we have acquired from our dynamics trajectories is sufficient to contrast the behaviors of the two models, to deduce the effect of crystallization water, and to measure the size of nonlinear response on the pertinent diabetic surfaces. Further, with the perspective we develop, we are able to juxtapose the active and inactive branches of the reaction center. By renormalizing our computed diabetic surfaces with a physically reasonable value for the high-frequency dielectric response of the system, the simulation results can be brought into accord with experimental observations of the thermodynamic driving force for the primary electron transfer. With no further adjustment, we find that the diabatic surfaces for the excited special pair state, SP*, and the charge-separated state SP[sup +]-BPL intersect with essentially no activation barrier. Here, BPL refers to the bacteriopheophytin on the L branch. In contrast, the SP* and SP[sup +]-BPM-surfaces intersect in the normal region with an activation barrier and an endothermic thermodynamic driving force. A related observation is that we find fluctuations in the pertinent energy gaps to be significantly smaller on the active L branch than they are on the inactive M branch. We also examine the surfaces associated with moving charge to the accessory bacteriochlorophylls, BCL and BCM. We find that these surfaces lies at energies far above SP*. 41 refs., 11 figs., 3 tabs.

Marchi, M. (Univ. of California, Berkeley (United States) Universite Paris-Sud (France)); Gehlen, J.N.; Chandler, D. (Univ. of California, Berkeley (United States)); Newton, M. (Brookhaven National Lab., Upton, NY (United States))



Direct Measurement of the Effective Rate Constant for Primary Charge Separation in Isolated Photosystem II Reaction Centers  

E-print Network

are performed on isolated photosystem II reaction centers to determine the effective rate constant for chargeLETTERS Direct Measurement of the Effective Rate Constant for Primary Charge Separation in Isolated Photosystem II Reaction Centers Scott R. Greenfield, Michael Seibert, Govindjee,§ and Michael R. Wasielewski

Govindjee "Gov"


"Dot COM", a nuclear transit center for the primary piRNA pathway in Drosophila.  


The piRNA pathway protects genomes by silencing mobile elements. Despite advances in understanding the processing events that generate piRNAs for silencing, little is known about how primary transcripts are transported from their genomic clusters to their processing centers. Using a model of the Drosophila COM/flamenco locus in ovarian somatic cells, we identified a prominent nuclear structure called Dot COM, which is enriched in long transcripts from piRNA clusters but located far from their transcription sites. Remarkably, transcripts from multiple clusters accumulate at Dot COM, which is often juxtaposed with Yb-bodies, the cytoplasmic processing centers for cluster transcripts. Genetic evidence suggests that the accumulation of precursor transcripts at Dot COM represents one of the most upstream events in the piRNA pathway. Our results provide new insights into the initial steps of the piRNA pathway, and open up a new research area important for a complete understanding of this conserved pathway. PMID:24039799

Dennis, Cynthia; Zanni, Vanessa; Brasset, Emilie; Eymery, Angeline; Zhang, Liang; Mteirek, Rana; Jensen, Silke; Rong, Yikang S; Vaury, Chantal



“Dot COM”, a Nuclear Transit Center for the Primary piRNA Pathway in Drosophila  

PubMed Central

The piRNA pathway protects genomes by silencing mobile elements. Despite advances in understanding the processing events that generate piRNAs for silencing, little is known about how primary transcripts are transported from their genomic clusters to their processing centers. Using a model of the Drosophila COM/flamenco locus in ovarian somatic cells, we identified a prominent nuclear structure called Dot COM, which is enriched in long transcripts from piRNA clusters but located far from their transcription sites. Remarkably, transcripts from multiple clusters accumulate at Dot COM, which is often juxtaposed with Yb-bodies, the cytoplasmic processing centers for cluster transcripts. Genetic evidence suggests that the accumulation of precursor transcripts at Dot COM represents one of the most upstream events in the piRNA pathway. Our results provide new insights into the initial steps of the piRNA pathway, and open up a new research area important for a complete understanding of this conserved pathway. PMID:24039799

Brasset, Emilie; Eymery, Angeline; Zhang, Liang; Mteirek, Rana; Jensen, Silke; Rong, Yikang S.; Vaury, Chantal



Primary care compensation at an academic medical center: a model for the mixed-payer environment.  


The authors' academic medical center, Brigham and Women's Hospital, Boston, Massachusetts, developed a primary care physician (PCP) salary incentive program for employed academic physicians. This program, first implemented in 1999, was needed to meet the financial imperatives placed on the institution by managed care and the Balanced Budget Act of 1997; its goal was to create a set of incentives for PCPs that is consistent with the mission of the academic center and helps motivate and reward PCP's work. The program sought to simultaneously increase productivity while optimizing resource utilization in a mixed-payer environment. The salary incentive program uses work relative-value units (wRVUs) as the measure of productivity. In addition to productivity-derived base pay, bonus incentives are added for efficient medical management, quality of care, teaching, and seniority. The authors report that there was significant concern from several members of the physician staff before the plan was implemented; they felt that the institution's PCPs were already operating at maximum clinical capacity. However, after the first year of operation of this plan, there was an overall 20% increase in PCP productivity. Increases were observed in all PCP subgroups when stratified by professional experience, clinical time commitment, and practice location. The authors conclude that the program has succeeded in giving incentives for academic PCPs to achieve under the growing demands for revenue self-sufficiency, managed care performance, quality of care, and academic commitment. PMID:11448822

Sussman, A J; Fairchild, D G; Coblyn, J; Brennan, T A



Acquired heterotopic ossification in hips and knees following encephalitis: case report and literature review  

PubMed Central

Background Heterotopic ossification (HO) is a rare and potentially detrimental complication of soft-tissue trauma, amputations, central nervous system injury (traumatic brain injuries, spinal cord lesions, tumors, encephalitis), vasculopathies, arthroplasties and burn injury, characterized by lamellar bone growth in non-osseous tissues such as the muscle and the joint capsule. Heterotopic ossification associated with encephalitis is rare and the occurrence of excessive, symptomatic heterotopic ossification around bilateral hips and bilateral knees is rarely described in the literature. Case presentation We present a 47-year-old man with heterotopic ossification in the bilateral hips and bilateral knees that prevented him from walking after being attacked by encephalitis as the case study. He developed severe pain and significantly impaired range of motion of bilateral hips and bilateral knees. Research so far revealed that the management of heterotopic ossification is controversial. After requiring revision surgery resection of heterotopic ossification, reconstruction of the medial collateral ligament and adjunctive pharmacotherapy of 200 mg Celecoxib for 8 weeks after operation, he regained mobility of his joints. On review of X-ray, there was no recurrence of HO and no loosening of rivets which were used in the reconstruction of medial collateral ligament. Conclusion Heterotopic ossification in the bilateral hip joints and bilateral knee joints associated with encephalitis have never been reported previously. Daily functions of heterotopic ossification patients can be hampered by pain, inflammation, reduced mobility, the loss of normal posture and other complications. Further studies of presumptive root causes, the early diagnosis, preventability and optimal therapeutic measures for heterotopic ossification following encephalitis are required. Different patient should be managed with different appropriated protocol based on the risk of individual patient and the institutional experience. PMID:25280472



Intra-abdominal heterotopic ossification of the peritoneum following traumatic splenic rupture  

PubMed Central

Intra-abdominal heterotopic ossification is extremely rare with only approximately 30 cases having been reported. While most reported cases have involved the mesentery, ossification of the peritoneum is even rarer. The pathogenesis remains undetermined but is generally considered a reactive process in response to various stimuli. Histologically, it is composed of a peripheral area with bone formation and a central area of reactive hypercellular fibrous tissue. We report a rare case of intra-abdominal heterotopic ossification of the parietal peritoneum following traumatic splenic rupture. PMID:23248662

Ioannidis, Orestis; Sekouli, Argiro; Paraskevas, George; Kotronis, Anastasios; Chatzopoulos, Stavros; Papadimitriou, Nikolaos; Konstantara, Athina; Makrantonakis, Apostolos; Kakoutis, Emmanouil



Severe soft tissue ossification in a southern right whale Eubalaena australis.  


The carcass of a stranded southern right whale Eubalaena australis, discovered on the coast of Golfo Nuevo in Península Valdés, Argentina, exhibited extensive orthotopic and heterotopic ossification, osteochondroma-like lesions, and early degenerative joint disease. Extensive soft tissue ossification led to ankylosis of the axial skeleton in a pattern that, in many respects, appeared more similar to a disabling human genetic disorder, fibrodysplasia ossificans progressiva (FOP), than to more common skeletal system diseases in cetaceans and other species. This is the first reported case of a FOP-like condition in a marine mammal and raises important questions about conserved mechanisms of orthotopic and heterotopic ossification in this clade. PMID:23269389

La Sala, Luciano F; Pozzi, Luciana M; McAloose, Denise; Kaplan, Frederick S; Shore, Eileen M; Kompanje, Erwin J O; Sidor, Inga F; Musmeci, Luciana; Uhart, Marcela M



Severe soft tissue ossification in a southern right whale Eubalaena australis  

PubMed Central

The carcass of a stranded southern right whale Eubalaena australis, discovered on the coast of Golfo Nuevo in Península Valdés, Argentina, exhibited extensive orthotopic and heterotopic ossification, osteochondroma-like lesions, and early degenerative joint disease. Extensive soft tissue ossification led to ankylosis of the axial skeleton in a pattern that, in many respects, appeared more similar to a disabling human genetic disorder, fibrodysplasia ossificans progressiva (FOP), than to more common skeletal system diseases in cetaceans and other species. This is the first reported case of a FOP-like condition in a marine mammal and raises important questions about conserved mechanisms of orthotopic and heterotopic ossification in this clade. PMID:23269389

Sala, Luciano F. La; Pozzi, Luciana M.; McAloose, Denise; Kaplan, Frederick S.; Shore, Eileen M.; Kompanje, Erwin J. O.; Sidor, Inga F.; Musmeci, Luciana; Uhart, Marcela M.



Journey toward a Patient-Centered Medical Home: Readiness for Change in Primary Care Practices  

PubMed Central

Context: Information is limited regarding the readiness of primary care practices to make the transformational changes necessary to implement the patient-centered medical home (PCMH) model. Using comparative, qualitative data, we provide practical guidelines for assessing and increasing readiness for PCMH implementation. Methods: We used a comparative case study design to assess primary care practices' readiness for PCMH implementation in sixteen practices from twelve different physician organizations in Michigan. Two major components of organizational readiness, motivation and capability, were assessed. We interviewed eight practice teams with higher PCMH scores and eight with lower PCMH scores, along with the leaders of the physician organizations of these practices, yielding sixty-six semistructured interviews. Findings: The respondents from the higher and lower PCMH scoring practices reported different motivations and capabilities for pursuing PCMH. Their motivations pertained to the perceived value of PCMH, financial incentives, understanding of specific PCMH requirements, and overall commitment to change. Capabilities that were discussed included the time demands of implementation, the difficulty of changing patients' behavior, and the challenges of adopting health information technology. Enhancing the implementation of PCMH within practices included taking an incremental approach, using data, building a team and defining roles of its members, and meeting regularly to discuss the implementation. The respondents valued external organizational support, regardless of its source. Conclusions: The respondents from the higher and lower PCMH scoring practices commented on similar aspects of readiness—motivation and capability—but offered very different views of them. Our findings suggest the importance of understanding practice perceptions of the motivations for PCMH and the capability to undertake change. While this study identified some initial approaches that physician organizations and practices have used to prepare for practice redesign, we need much more information about their effectiveness. PMID:21933274

Wise, Christopher G; Alexander, Jeffrey A; Green, Lee A; Cohen, Genna R; Koster, Christina R



Uniportal video assisted thoracoscopic lobectomy: primary experience from an Eastern center  

PubMed Central

Background Uniportal video-assisted thoracoscopic surgery (VATS) lobectomy is an emerging technique for the surgical resection of non-small cell lung cancer (NSCLC). Besides its wide debates on safety and efficacy throughout the world, there were few report on uniportal VATS from the Eastern countries. In this article, we summarized our primary experience on uniportal VATS lobectomy in an Eastern center. Methods From October 2013 till February 2014, 54 consecutive uniportal VATS lobectomy were performed in the Department of Thoracic Surgery, Zhongshan Hospital of Fudan University. Patients’ clinical features and operative details were recorded. Post-operatively, the morbidity and mortality were recorded to analyze the safety and efficacy of uniportal VATS lobectomy for NSCLCs. Results Among the 54 planned uniportal VATS lobectomy, there was one conversion to mini-thoracotomy due to lymph node sticking. Extra ports were required in two patients. The uniportal VATS lobectomy was achieved in 51 out of 54 patients (94.4%). The average operation duration was 122.2±37.5 min (90-160 min). The average volume of estimated blood loss during the operation was 88.8±47.1 mL (50-200 mL). The mean chest tube duration and hospital stay were 3.2±1.9 days and 4.6±2.0 days, respectively. There was no postoperative mortality in this study. Two patients suffered from prolonged air leakage (5 and 7 days), and one atrial fibrillation was observed in this cohort. Conclusions Based on our primary experience, uniportal VATS lobectomy is a safe and effective procedure for the surgical resection of NSCLCs. The surgical refinements and instrumental improvements would facilitate the technique. Further studies based on larger population are required to determine its benefits towards patients with NSCLCs. PMID:25589969

Feng, Mingxiang; Shen, Yaxing; Wang, Hao; Liu, Yi; Wang, Qun



Heterotopic ossification of the elbows in a major petrol burn  

PubMed Central

A case of a young man who developed heterotopic ossification (HO) in his elbows following an accident where he sustained petrol burns to over 60% of his body. His injuries necessitated intubation, escharotomies and a protracted intensive care unit stay that was complicated by septicaemia. Several weeks after the injury, he was diagnosed with HO in his right elbow, followed by the left elbow a week later. He was commenced on an non-steroidal anti-inflammatory drug, a long-term course of a bisphosphonate and regular physiotherapy. He is now waiting for the HO bone to mature before having definitive excision of his lesions in 12-18 months time. PMID:22927269

Zaman, Shahriar Raj



Hdac-mediated control of endochondral and intramembranous ossification.  


Histone deacetylases (Hdacs) remove acetyl groups (CH3CO-) from ?-amino groups in lysine residues within histones and other proteins. This posttranslational (de) modification alters protein stability, protein-protein interactions, and chromatin structure. Hdac activity plays important roles in the development of all organs and tissues, including the mineralized skeleton. Bone is a dynamic tissue that forms and regenerates by two processes: endochondral and intramembranous ossification. Chondrocytes and osteoblasts are responsible for producing the extracellular matrices of skeletal tissues. Several Hdacs contribute to the molecular pathways and chromatin changes that regulate tissue-specific gene expression during chondrocyte and osteoblast specification, maturation, and terminal differentiation. In this review, we summarize the roles of class I and class II Hdacs in chondrocytes and osteoblasts. The effects of small molecule Hdac inhibitors on the skeleton are also discussed. PMID:22077150

Bradley, Elizabeth W; McGee-Lawrence, Meghan E; Westendorf, Jennifer J



Management of neck metastases of unknown primary origin united in two European centers.  


Combined analysis of diagnostic and therapeutic management of neck metastases of carcinoma of unknown primary origin ('true CUP') in two European tertiary referral centers (University Medical Centers of Maastricht, NL and Cologne, D) to contribute to the ongoing discussion on management in CUP. Retrospective analysis of 29 (Maastricht) and 22 (Cologne) true cervical CUP syndrome patients (squamous cell carcinoma). The diagnostic and therapeutic approaches were correlated with clinical follow-up data and HPV status. In total, 48 out of 51 true CUP patients received postsurgical adjuvant radiotherapy. In eight patients from Cologne, this was combined with concomitant platin-based chemotherapy. Neither in Cologne nor in Maastricht, radiotherapy of the pharyngeal mucosa was commonly performed (n = 6, 12.5 %) The percentage of patients who were irradiated ipsilaterally or bilaterally did not differ between both institutes (N = 21/27 in Maastricht vs. 11/21 in Cologne), nor did the 5-year overall survival differ significantly. Oncogenic HPV was only found in 4 out of 51 CUPs (7, 8 %). Therefore, no relation with overall and recurrence-free survival could be detected. No occult primary tumors were revealed during follow-up despite de-escalation of therapy by abandoning irradiation of the pharyngeal mucosa in both institutes. There were no significant differences between ipsilateral and bilaterally irradiated patients regarding overall and recurrence-free survival. The occurrence of distant metastases was more often noticed in ipsilaterally treated patients as compared to bilaterally radiated patients (8 vs. 2, p = 0.099). Those patients all had been classified N2b or higher. International guidelines still are not unified and there is an urgent need for a consented therapeutic regimen. Comparison of two international strategies on the management of CUP patients is presented and further research is recommended regarding the role of radiotherapy of the pharyngeal axis, the value of unilateral and bilateral radiotherapy and the role of concomitant or induction chemotherapy in CUP patients, particularly in N2b or higher-staged neck disease. The prevalence and role of HPV in true CUP after thorough diagnostic work-up seem limited in our case series, particularly when compared to the role in oropharyngeal carcinomas. PMID:24615648

Straetmans, Jos; Vent, Julia; Lacko, Martin; Speel, Ernst-Jan; Huebbers, Christian; Semrau, Robert; Hoebers, Frank; Mujagic, Zlatan; Klussmann, Jens-Peter; Preuss, Simon F; Kremer, Bernd



Dynamic 3D culture: Models of chondrogenesis and endochondral ossification.  


The formation of cartilage from stem cells during development is a complex process which is regulated by both local growth factors and biomechanical cues, and results in the differentiation of chondrocytes into a range of subtypes in specific regions of the tissue. In fetal development cartilage also acts as a precursor scaffold for many bones, and mineralization of this cartilaginous bone precursor occurs through the process of endochondral ossification. In the endochondral formation of bones during fetal development the interplay between cell signalling, growth factors, and biomechanics regulates the formation of load bearing bone, in addition to the joint capsule containing articular cartilage and synovium, generating complex, functional joints from a single precursor anlagen. These joint tissues are subsequently prone to degeneration in adult life and have poor regenerative capabilities, and so understanding how they are created during development may provide useful insights into therapies for diseases, such as osteoarthritis, and restoring bone and cartilage lost in adulthood. Of particular interest is how these tissues regenerate in the mechanically dynamic environment of a living joint, and so experiments performed using 3D models of cartilage development and endochondral ossification are proving insightful. In this review, we discuss some of the interesting models of cartilage development, such as the chick femur which can be observed in ovo, or isolated at a specific developmental stage and cultured organotypically in vitro. Biomaterial and hydrogel-based strategies which have emerged from regenerative medicine are also covered, allowing researchers to make informed choices on the characteristics of the materials used for both original research and clinical translation. In all of these models, we illustrate the essential importance of mechanical forces and mechanotransduction as a regulator of cell behavior and ultimate structural function in cartilage. Birth Defects Research (Part C) 105:19-33, 2015. © 2015 Wiley Periodicals, Inc. PMID:25777047

Foster, Nicola C; Henstock, James R; Reinwald, Yvonne; El Haj, Alicia J



Clinical risk factors for primary graft dysfunction in a low-volume lung transplantation center.  


Primary graft dysfunction (PGD) is a severe acute lung injury syndrome following lung transplantation. Previous studies of clinical risk factors, including a multicenter prospective cohort trial, have identified a number of recipient, donor, and operative variables related to Grade 3 PGD. The aim of this study was to validate these risk factors in a lung transplantation center with a low volume of procedures. We conducted a retrospective cohort study of 45 consecutive lung transplantations performed between January 2011 and September 2013. PGD was defined according to the International Society for Heart and Lung Transplantation grading scale. Risk factors were evaluated independently and the significant confounders entered into multivariable logistic regression models. The overall incidence of Grade 3 PGD was 35.5% at T24, 17.7% at T48, and 15.5% at T72. The following risk factors were associated with Grade 3 PGD at the indicated time points: recipient female gender at T24 (P=.034), mixed diagnoses at T72 (P=.047), ECMO bridge-to-lung transplantation at T24 (P=.0004) and at T48 (P=.038), donor causes of death different from stroke and trauma at T24 (P=.019) and T72 (P=.014), blood transfusions during surgery at T24 (P=.001), intraoperative venoarterial ECMO T24 (P<.0001). Multivariate analysis at T24 identified recipient female gender and intraoperative venoarterial ECMO as risk factors (P=.010 and P=.018, respectively). This study demonstrated that risk factors for severe PGD in a low-volume center were similar to international reports in prevalence and type. ECMO bridge-to-lung transplantation emerged as a risk factor previously underestimated. PMID:25242781

Nosotti, M; Palleschi, A; Rosso, L; Tosi, D; Mendogni, P; Righi, I; Montoli, M; Crotti, S; Russo, R



Lifestyle and Dietary Behaviors among Saudi Preschool Children Attending Primary Health Care Centers, Eastern Saudi Arabia.  


Objective. To study life styles and dietary behaviors among Saudi preschool children (1-5 years) attending primary health care centers (PHCCs) in Dammam and Qatif areas, eastern province, Saudi Arabia. Material and Methods. Cross-sectional study. Data were collected using structured, interviewer-filled questionnaire. Children and their mothers were encountered during their well-baby clinic visits. A total number of 300 preschool children and their mothers were interviewed during study period. Results. Unsatisfactory areas include smoking fathers (32%), smoking in front of children (11.3%), overweight and obesity among mothers (60.3%), noncompliance using seat belts for both parents (56.3%) and children (68%), children watching television (T.V) more than 2 hours (50%), adherence to exclusive breast feeding (only 20.7%), and late solid food introduction (65.3%). Frequent intake of unhealthy food items was 26%, 25%, and 24% for pizza, burger, and soft drinks. Unfortunately frequent intake of the following unhealthy food items was high: biscuits, deserts/chocolates, and chips which was 78%, 67%, and 72%, respectively. Conclusion. This study provides benchmark about the current situation. It provides health care workers and decision makers with important information that may help to improve health services. PMID:25114804

Darwish, Magdy A; Al-Saif, Ghadeer; Albahrani, Suha; Sabra, Amr A



Water access and attendance for diarrhea in primary health care centers, Gaza strip.  


Water access and sanitation has worsened in Gaza strip since the conflict between Israel and Palestine in January 2009. This study aimed to investigate the relationship between attendance for diarrhea to a Primary Health Care Center (PHCC) in Gaza strip and several potential risk factors including water access. A matched case control study with prospective data record was performed. Cases were patients attending a PHCC for diarrhea, and controls were patients attending for any other cause with no diarrhea within the previous three months or since birth. We matched 133 cases and 133 controls, for date of inclusion, age, gender. All patients attended PHCC and were included in January/February 2010. A stool analysis for bacteria and parasites was performed for cases. Of the 266 patients, 62% (166) have to buy water from a private provider. In multivariate analysis, four variables were independently predictive of diarrhea: public water access (OR: 0.046; 95% CI: 0.005-0.454; P=0.0083), poultry or rabbits at home, and presence of cooker at home. A bacterial cause was found in 5.5% (7) and Giardia duodenalis in 20% (26). Treatments did not comply with WHO recommendations. Efforts should be made to improve water access and to implement guidelines for a better management of diarrhea in Gaza strip. PMID:21803391

Abouteir, A; El Yaagoubi, F; Bioh-Johnson, I; Kamel, A; Godard, N; Cormerais, L; Robin, F; Lesens, O



Maternal satisfaction about childhood immunization in primary health care center, Egypt  

PubMed Central

Introduction Childhood immunization is considered to be among the most effective preventive services, and is therefore critical to monitor and evaluate. One prior study reported an association between parental satisfactions with pediatric care and up-to-date immunization at 24 months independent of maternal age, race, and education. In addition to promoting appropriate utilization, satisfaction may increase engagement in the health care process. Health system factors included inconvenient clinic hours, dates or locations, waiting lines, and conflicting information. The inconvenience of clinic hours dates of immunization clinics, and locations of clinics were reported by 75% of the parents. Methods A cross section study was conducted on three hundred and thirty five mothers chosen from PHCC participating in the study by providing information on satisfaction about the program and their knowledge about vaccination Results Inappropriate knowledge was reported by most of mothers (84.8%). And 95.2% of mothers were satisfied with childhood immunization services in primary healthcare center, compared to 4.8% who were unsatisfied with them. Conclusion This study shows that there was no statistically significant relation between maternal satisfaction with childhood immunization services and knowledge score, while in most satisfaction surveys information giving was an important need and this represent that client needs are changing, and priorities from client's perspectives are also changing, so on- going monitoring of client satisfaction is the safeguard to improve quality of care. PMID:25419295

El Gammal, Hanan Abbas Abdo Abdel Rahman



The Learners' Perceptions Survey—Primary Care: Assessing Resident Perceptions of Internal Medicine Continuity Clinics and Patient-Centered Care  

PubMed Central

Background In 2010, the Department of Veterans Affairs (VA) implemented a national patient-centered care initiative that organized primary care into interdisciplinary teams of health care professionals to provide patient-centered, continuous, and coordinated care. Objective We assessed the discriminate validity of the Learners' Perceptions Survey—Primary Care (LPS-PC), a tool designed to measure residents' perceptions about their primary and patient-centered care experiences. Methods Between October 2010 and June 2011, the LPS-PC was administered to Loma Linda University Medical Center internal medicine residents assigned to continuity clinics at the VA Loma Linda Healthcare System (VALLHCS), a university setting, or the county hospital. Adjusted differences in satisfaction ratings across settings and over domains (patient- and family-centered care, faculty and preceptors, learning, clinical, work and physical environments, and personal experience) were computed using a generalized linear model. Results Our response rate was 86% (77 of 90). Residents were more satisfied with patient- and family-centered care at the VALLHCS than at either the university or county (P < .001). However, faculty and preceptors (odds ratio [OR] ?=? 1.53), physical (OR ?=? 1.29), and learning (OR ?=? 1.28) environments had more impact on overall resident satisfaction than patient- and family-centered care (OR ?=? 1.08). Conclusions The LPS-PC demonstrated discriminate validity to assess residents' perceptions of their patient-centered clinical training experience across outpatient primary care settings at an internal medicine residency program. The largest difference in scores was the patient- and family-centered care domain, in which residents rated the VALLHCS much higher than the university or county sites. PMID:24455006

Byrne, John M.; Chang, Barbara K.; Gilman, Stuart C.; Keitz, Sheri A.; Kaminetzky, Catherine P.; Aron, David C.; Baz, Sam; Cannon, Grant W.; Zeiss, Robert A.; Holland, Gloria J.; Kashner, T. Michael



Heterotopic ossification causing proximal radioulnar synostosis after insertion of a radial head prosthesis.  


A rare case of radioulnar synostosis following placement of a metal radial head replacement is described and a review of treatment options for heterotopic ossification in the vicinity of the elbow is presented. PMID:16753242

Bimmel, R; van Riet, R P; Sys, J



Vessel formation is induced prior to the appearance of cartilage in BMP-2-mediated heterotopic ossification  

Technology Transfer Automated Retrieval System (TEKTRAN)

Heterotopic ossification (HO), or endochondral bone formation at nonskeletal sites, often results from traumatic injury and can lead to devastating consequences. Alternatively, the ability to harness this phenomenon would greatly enhance current orthopedic tools for treating segmental bone defects. ...


Development of a nude mouse model for the study of antlerogenesis--mechanism of tissue interactions and ossification pathway.  


In a previous study (Li et al., 2001. J Exp Zool 290:18-30) a nude mouse model was established to investigate deer antler development. In that study we found nude mice could support the singularly implanted antlerogenic periosteum (AP) to form pedicle-like, but not antler-like, bony protuberances. To further develop the model and at the same time to use the updated model for the investigation of antler formation, three experiments were carried out in this study. The results showed that (1) antler-like protuberances were successfully induced on the nude mouse heads via subcutaneous co-transplantation of AP and deer skin, and subsequent exposure through wounding of the deer xenografts; (2) deer skin epidermis and its attached half thickness of dermis were sufficient to interact with the AP, and the interactions were capable of transforming adult scalp skin into velvet; (3) the putative initial inductive molecules were primarily derived from the AP cellular layer, rather than fibrous layer; (4) initiation of the ossification center in the avascular cartilage of each mouse "antler" took place via metaplasia, rather than classical endochondral ossification. Further research is required to identify means for effective stimulation of calcification of the "mouse antlers" in order to create the opportunity to investigate antler regeneration using the nude mouse model. Overall, the nude mouse model, once further developed, has the potential to become a powerful tool to study underlying mechanism of antlerogenesis and organogenesis/regeneration in general. PMID:19051317

Li, Chunyi; Gao, Xiuhua; Yang, Fuhe; Martin, Shirley K; Haines, Stephen R; Deng, Xuming; Schofield, John; Stanton, Jo-Ann L



Primary Care and Public Health Activities in Select US Health Centers: Documenting Successes, Barriers, and Lessons Learned  

PubMed Central

Objectives. We examined primary care and public health activities among federally funded health centers, to better understand their successes, the barriers encountered, and the lessons learned. Methods. We used qualitative and quantitative methods to collect data from 9 health centers, stratified by administrative division, urban–rural location, and race/ethnicity of patients served. Descriptive data on patient and institutional characteristics came from the Uniform Data System, which collects data from all health centers annually. We administered questionnaires and conducted phone interviews with key informants. Results. Health centers performed well on primary care coordination and community orientation scales and reported conducting many essential public health activities. We identified specific needs for integrating primary care and public health: (1) more funding for collaborations and for addressing the social determinants of health, (2) strong leadership to champion collaborations, (3) trust building among partners, with shared missions and clear expectations of responsibilities, and (4) alignment and standardization of data collection, analysis, and exchange. Conclusions. Lessons learned from health centers should inform strategies to better integrate public health with primary care. PMID:22690975

Shi, Leiyu; Chowdhury, Joya; Sripipatana, Alek; Zhu, Jinsheng; Sharma, Ravi; Hayashi, A. Seiji; Daly, Charles A.; Tomoyasu, Naomi; Nair, Suma; Ngo-Metzger, Quyen



[Updates on ossification of posterior longitudinal ligament. Ossification front of posterior longitudinal ligament and cellular biological assessment of chronic mechanical compressed spinal cord].  


Mechanisms of ossification processes, pathological changes, and treatment/assessment of myelopathy symptoms because of ossification of the posterior longitudinal ligament (OPLL) remain obscure. Enchondral ossification process of OPLL was closely associated with degenerative changes of elastic fibers and cartilage formation, together with the appearance of metaplastic hypertrophic cartilage cells and neovascularization. There are differences in expression degrees of cytokines and transcription factors between mixed and localized OPLL. While the chronic compressed spinal cord may have plasticity ; the use of stem cell implants, supplementation of neurotrophic factors, in addition to surgical treatment, may bring a better clinical outcome,encouraging the development of these basic research studies. Assessment using new imaging techniques needs to determine the affected level and judge the severity of symptoms. PMID:19794256

Uchida, Kenzo; Nakajima, Hideaki; Yayama, Takafumi; Sato, Ryuichiro; Baba, Hisatoshi



Nonsteroid anti-inflammatory drugs prevent the recurrence of heterotopic ossification after excision  

Microsoft Academic Search

The prophylactic effect of nonsteroid anti-inflammatory drugs on the recurrence of high-grade periarticular heterotopic ossification after resection was studied in ten patients operated on for loosening of one or both components of a cemented total hip prosthesis. These drugs, given at a standard dosage for 1–3 weeks after surgery, prevented the recurrence of heterotopic ossification. In some patients the range

B. Sodemann; P.-E. Persson; O. S. Nilsson



The inhibition effects of insulin on BMP2-induced muscle heterotopic ossification.  


Bone morphogenetic proteins (BMPs) play an important role in regulating osteoblastic differentiation and bone formation. But the diffuse of BMPs into muscle tissues around bone injury sites often leads to heterotopic ossification, which has been regarded as one of major side-effects of BMP implementation in bone defect patients. It raises great demands for exploring effective methods that preventing BMP-induced heterotopic ossification while not interrupting the osteoinductive activity of BMPs for in situ bone defect repair. Here we found insulin, a positive regulator for bone regeneration, inhibited BMP2-induced muscle heterotopic ossification by suppressing the expression of bone transcription factor Osterix. By analyzing downstream molecules of insulin pathway, we found AKT/mTOR/GSK3 signaling was responsible for the inhibition of insulin on BMP2-induced ossification, and GSK3 inhibitor SB216763 attenuated BMP2-induced muscle heterotopic ossification. The data might shed light on developing effective clinical therapy for inhibiting muscle heterotopic ossification when BMPs were used bone defect repair. PMID:25132600

Zhang, Jing; Zhao, Yannan; Hou, Xianglin; Chen, Bing; Xiao, Zhifeng; Han, Jin; Shi, Chunying; Liu, Jianzhou; Miao, Qi; Dai, Jianwu



Concurrent ossification of posterior longitudinal ligament and ossification of ligamentum flavum in the thoracic spine demonstrated by SPECT/CT imaging.  


A 44-year-old man with rectal cancer underwent bone scintigraphy to assess osseous lesions for lower extremity numbness and ambulatory difficulty. Whole-body bone scan showed increased tracer accumulation in the mid thoracic spine. Then SPECT combined with diagnostic CT was performed to further evaluate this doubtful hot spot. According to the images of SPECT/CT, the radiotracer uptake at the site of the T7 to T8 thoracic vertebra was confirmed to be simultaneous ossification of posterior longitudinal ligament complicated with ossification of the ligamentum flavum in the thoracic spine by pathology. PMID:25608144

Yin, Hongyan; Shi, Hongcheng



Assessment of medical waste management at a primary health-care center in Sao Paulo, Brazil  

SciTech Connect

Highlights: Black-Right-Pointing-Pointer Assessment of medical waste management at health-care center before/after intervention. Black-Right-Pointing-Pointer Qualitative and quantitative results of medical waste management plan are presented. Black-Right-Pointing-Pointer Adjustments to comply with regulation were adopted and reduction of waste was observed. Black-Right-Pointing-Pointer The method applied could be useful for similar establishments. - Abstract: According to the Brazilian law, implementation of a Medical Waste Management Plan (MWMP) in health-care units is mandatory, but as far as we know evaluation of such implementation has not taken place yet. The purpose of the present study is to evaluate the improvements deriving from the implementation of a MWMP in a Primary Health-care Center (PHC) located in the city of Sao Paulo, Brazil. The method proposed for evaluation compares the first situation prevailing at this PHC with the situation 1 year after implementation of the MWMP, thus allowing verification of the evolution of the PHC performance. For prior and post-diagnosis, the method was based on: (1) application of a tool (check list) which considered all legal requirements in force; (2) quantification of solid waste subdivided into three categories: infectious waste and sharp devices, recyclable materials and non-recyclable waste; and (3) identification of non-conformity practices. Lack of knowledge on the pertinent legislation by health workers has contributed to non-conformity instances. The legal requirements in force in Brazil today gave origin to a tool (check list) which was utilized in the management of medical waste at the health-care unit studied. This tool resulted into an adequate and simple instrument, required a low investment, allowed collecting data to feed indicators and also conquered the participation of the unit whole staff. Several non-conformities identified in the first diagnosis could be corrected by the instrument utilized. Total waste generation increased 9.8%, but it was possible to reduce the volume of non-recyclable materials (11%) and increase the volume of recyclable materials (4%). It was also possible to segregate organic waste (7%), which was forwarded for production of compost. The rate of infectious waste generation in critical areas decreased from 0.021 to 0.018 kg/procedure. Many improvements have been observed, and now the PHC complies with most of legal requirements, offers periodic training and better biosafety conditions to workers, has reduced the volume of waste sent to sanitary landfills, and has introduced indicators for monitoring its own performance. This evaluation method might subsidize the creation and evaluation of medical waste management plans in similar heath institutions.

Moreira, A.M.M., E-mail: [Department of Environmental Health, School of Public Health, University of Sao Paulo, Avenida Doutor Arnaldo 715, Sao Paulo 01246-904 (Brazil); Guenther, W.M.R. [Department of Environmental Health, School of Public Health, University of Sao Paulo, Avenida Doutor Arnaldo 715, Sao Paulo 01246-904 (Brazil)



The retention of health human resources in primary healthcare centers in Lebanon: a national survey  

PubMed Central

Background Critical shortages of health human resources (HHR), associated with high turnover rates, have been a concern in many countries around the globe. Of particular interest is the effect of such a trend on the primary healthcare (PHC) sector; considered a cornerstone in any effective healthcare system. This study is a rare attempt to investigate PHC HHR work characteristics, level of burnout and likelihood to quit as well as the factors significantly associated with staff retention at PHC centers in Lebanon. Methods A cross-sectional design was utilized to survey all health providers at 81 PHC centers dispersed in all districts of Lebanon. The questionnaire consisted of four sections: socio-demographic/ professional background, organizational/institutional characteristics, likelihood to quit and level of professional burnout (using the Maslach-Burnout Inventory). A total of 755 providers completed the questionnaire (60.5% response rate). Bivariate analyses and multinomial logistic regression were used to determine factors associated with likelihood to quit. Results Two out of five respondents indicated likelihood to quit their jobs within the next 1–3 years and an additional 13.4% were not sure about quitting. The top three reasons behind likelihood to quit were poor salary (54.4%), better job opportunities outside the country (35.1%) and lack of professional development (33.7%). A U-shaped relationship was observed between age and likelihood to quit. Regression analysis revealed that high levels of burnout, lower level of education and low tenure were all associated with increased likelihood to quit. Conclusions The study findings reflect an unstable workforce and are not conducive to supporting an expanded role for PHC in the Lebanese healthcare system. While strategies aiming at improving staff retention would be important to develop and implement for all PHC HHR; targeted retention initiatives should focus on the young-new recruits and allied health professionals. Particular attention should be dedicated to enhancing providers’ role satisfaction and sense of job security. Such initiatives are of pivotal importance to stabilize the workforce and ensure its longevity. PMID:23173905



Comparison of Performance Achievement Award Recognition With Primary Stroke Center Certification for Acute Ischemic Stroke Care  

PubMed Central

Background Hospital certification and recognition programs represent 2 independent but commonly used systems to distinguish hospitals, yet they have not been directly compared. This study assessed acute ischemic stroke quality of care measure conformity by hospitals receiving Primary Stroke Center (PSC) certification and those receiving the American Heart Association's Get With The Guidelines?Stroke (GWTG?Stroke) Performance Achievement Award (PAA) recognition. Methods and Results The patient and hospital characteristics as well as performance/quality measures for acute ischemic stroke from 1356 hospitals participating in the GWTG?Stroke Program 2010–2012 were compared. Hospitals were classified as PAA+/PSC+ (hospitals n=410, patients n=169 302), PAA+/PSC? (n=415, n=129 454), PAA?/PSC+ (n=88, n=26 386), and PAA?/PSC? (n=443, n=75 565). A comprehensive set of stroke measures were compared with adjustment for patient and hospital characteristics. Patient characteristics were similar by PAA and PSC status but PAA?/PSC? hospitals were more likely to be smaller and nonteaching. Measure conformity was highest for PAA+/PSC+ and PAA+/PSC? hospitals, intermediate for PAA?/PSC+ hospitals, and lowest for PAA?/PSC? hospitals (all?or?none care measure 91.2%, 91.2%, 84.3%, and 76.9%, respectively). After adjustment for patient and hospital characteristics, PAA+/PSC+, PAA+/PSC?, and PAA?/PSC+ hospitals had 3.15 (95% CIs 2.86 to 3.47); 3.23 (2.93 to 3.56) and 1.72 (1.47 to 2.00), higher odds for providing all indicated stroke performance measures to patients compared with PAA?/PSC? hospitals. Conclusions While both PSC certification and GWTG?Stroke PAA recognition identified hospitals providing higher conformity with care measures for patients hospitalized with acute ischemic stroke, PAA recognition was a more robust identifier of hospitals with better performance. PMID:24125846

Fonarow, Gregg C.; Liang, Li; Smith, Eric E.; Reeves, Mathew J.; Saver, Jeffrey L.; Xian, Ying; Hernandez, Adrian F.; Peterson, Eric D.; Schwamm, Lee H.



Extrahepatic malignancies in primary biliary cirrhosis: a comparative study at two European centers.  


Limited information and divergent results are available on the prevalence/incidence, survival, and risk factors for developing extrahepatic malignancies (EMs) in primary biliary cirrhosis (PBC). The aim of the study was to analyze the epidemiology and survival rates for EM in PBC patients. The study was conducted on two series of patients followed up at two European centers (361 in Padova, Italy, and 397 in Barcelona, Spain) for a mean 7.7?±?7 and 12.2?±?7 years, respectively. The cancer incidence was compared with the standardized incidence ratios (SIRs) calculated using the Cancer Registry of the Veneto Region (Italy) and the Cancer Registry of Tarragona (Spain). Seventy-two patients developed EM. The prevalence of cases was similar in Padova (9.7 %) and Barcelona (9.4 %). The overall cancer incidence was similar to the expected incidence for the general population in the same geographical area (SIR?=?1.2), and so was the crude EM rate (855.01 vs 652.86 per 100,000 patient-years, respectively, RR?=?1.3). Logistic regression analysis showed that advanced histological stage and extrahepatic autoimmune diseases were significantly associated with the onset of EM. Survival was similar for PBC patients with and without EM (p?=?n.s.), and actual survival was similar to the one predicted by the Mayo model. The incidence of EM in PBC patients was found similar in Italy and Spain and no different from that of the general population. Advanced histological stage and extrahepatic autoimmune disease were risk factors significantly associated with EM developing in PBC. The onset of cancer in PBC patients does not influence the natural history of their liver disease. PMID:25205363

Floreani, Annarosa; Spinazzè, Alice; Caballeria, Llorenc; Reig, Ana; Cazzagon, Nora; Franceschet, Irene; Buja, Alessandra; Furlan, Patrizia; Harada, Kenichi; Leung, Patrick Sc; Gershwin, M Eric; Pares, Albert



The Impact of Patient-Centered Narrative Interviewing on the Perceptions of Primary Care Clinicians: a Pilot Evaluation  

Microsoft Academic Search

In this project, psychiatric nurses were trained in patient-centered narrative interviewing approaches and placed in a variety of healthcare sites and conditions to function as consultants. Primary care clinicians (PCCs) in those sites selected patients that each clinician felt was frustrating or difficult and arranged for the consultant to interview them. The consultants then presented patient information to the PCC,

Michael James Terry



The Role of Community Health Centers in Delivering Primary Care to the Underserved Experiences of the Uninsured and Medicaid Insured  

Microsoft Academic Search

Community health centers (CHCs) have long served an important safety-net health- care delivery role for vulnerable populations. Federal efforts to expand CHCs, while potentially reducing the Federal budget for Medicaid, raise concern about how Medicaid and uninsured pa- tients of CHCs will continue to fare. To examine the primary care experiences of uninsured and Medicaid CHC patients and compare their

Leiyu Shi; Gregory D. Stevens


A Person-Centered Counseling Approach as a Primary Therapeutic Support for Women with a History of Childhood Sexual Abuse  

ERIC Educational Resources Information Center

Childhood sexual abuse (CSA) is prevalent among women. Person-centered counseling (PCC) is an effective core therapeutic approach to use when treating women with this issue. This article provides (a) an overview of CSA, (b) an orientation to PCC, and (c) a case example illustrating the primary application of this approach.

Edwards, Nivischi N.; Lambie, Glenn W.



Integrating Education into Primary Care Quality and Cost Improvement at an Academic Medical Center  

ERIC Educational Resources Information Center

Introduction: In 1996 the University of Michigan Health System created the Guidelines Utilization, Implementation, Development, and Evaluation Studies (GUIDES) unit to improve the quality and cost-effectiveness of primary care for common medical problems. GUIDES's primary functions are to oversee the development of evidence-based, practical…

Harrison, R. Van; Standiford, Connie J.; Green, Lee A.; Bernstein, Steven J.



Substance P Signaling Mediates BMP Dependent Heterotopic Ossification  

PubMed Central

Heterotopic ossification (HO) is a disabling condition associated with neurologic injury, inflammation, and overactive BMP signaling. The inductive factors involved in lesion formation are unknown. We found that the expression of the neuro-inflammatory factor Substance P (SP) is dramatically increased in early lesional tissue in patients who have either fibrodysplasia ossificans progressiva (FOP) or acquired HO, and in three independent mouse models of HO. In Nse-BMP4, a mouse model of HO, robust HO forms in response to tissue injury; however null mutations of the preprotachykinin gene encoding SP prevent HO. Importantly, ablation of SP+ sensory neurons, treatment with an antagonist of SP receptor NK1r, deletion of NK1r gene, or genetic down-regulation of NK1r-expressing mast cells also profoundly inhibits injury-induced HO. These observations establish a potent neuro-inflammatory induction and amplification circuit for BMP-dependent HO lesion formation, and identify novel molecular targets for prevention of HO. PMID:21748788

Kan, Lixin; Lounev, Vitali Y; Pignolo, Robert J; Duan, Lishu; Liu, Yijie; Stock, Stuart R; McGuire, Tammy L; Lu, Bao; Gerard, Norma P; Shore, Eileen M; Kaplan, Frederick S; Kessler, John A



Intramembranous ossification of scleral ossicles in Chelydra serpentina.  


Scleral ossicles are present in many reptiles, including turtles and birds. In both groups the sclerotic ring situated in the eye is composed of a number of imbricating scleral ossicles or plates. Despite this gross morphological similarity, Andrews (1996. An endochondral rather than a dermal origin for scleral ossicles in Cryptodiran turtles. J. Herpetol. 30, 257-260) reported that the scleral ossicles of turtles develop endochondrally unlike those in birds, which develop intramembranously after a complex epithelial-mesenchymal inductive event. This study re-explores one of the species examined by Andrews in order to determine the mode of ossification of scleral ossicles in turtles. A growth series of Chelydra serpentina embryos, including the stages examined by Andrews, were examined by staining separately for cartilage and bone. Results clearly contradict Andrews (1996) and show that the scleral ossicles of Chelydra serpentina develop similarly to those in birds. That is, they develop intramembranously without a cartilage precursor and are likely induced by transient scleral papillae. The sequence of scleral papillae development is broadly similar, but the papillae themselves are not as distinct as those seen in chicken embryos. This study has important consequences for understanding the homology of scleral ossicles among tetrapods. PMID:16377163

Franz-Odendaal, Tamara A



PIXE study of the kinetics of biomaterials ossification  

NASA Astrophysics Data System (ADS)

Biomaterials are frequently implanted in bones. This implantation is followed by a phenomenon of ossification. The purpose of this work was to study the time evolution of the gradient of characteristic atomic element's concentrations in the bone, the implant and the bone-implant interface. We have studied two types of neutral biomaterials: pure synthetic hydroxyapatite and porite's asteroid coral. The animal implantations have been made on sheep of the same age and sex having received the same basic diet. The implantations have been made in the cortical femur. On both sides of the implant, at the same distance, two screws were placed to allow further determination of the position of the implant. The PIXE method is particularly suitable here because of the possibility to analyze directly the samples without any preparation and to choose easily the dimensions of beam used for the gradient study. The X-rays have been detected with an ultra LEGe instead of the usual Si(Li) device to avoid the Si escape peak associated with the K ? X-ray of calcium, the major constituent of bone. This peak is particularly disturbing here because its energy corresponds to the K ? line of phosphorus, an important constituent of bone. The results of these determinations are presented and discussed.

Weber, G.; Robaye, G.; Braye, F.; Oudadesse, H.; Irigaray, J. L.



A clinical perspective on common forms of acquired heterotopic ossification  

SciTech Connect

The clinical courses of heterotopic ossification (HO) as a consequence of trauma and central nervous system insults have many similarities as well as dissimilarities. Detection is commonly noted at two months. The incidence of clinically significant HO is 10%-20%. Approximately 10% of the HO is massive and causes severe restriction in joint motion or ankylosis. The most common sign and symptom are decreased range of motion and pain. The locations are the proximal limbs and joints. Sites of HO about a joint may vary according to the etiology of the HO. Roentgenographic evolution of HO occurs during a six-month period in the majority of patients. Treatment modalities include diphosphonates, indomethacin, radiation, range of motion exercises, and surgical excision. Surgical timing differs according to etiology: traumatic HO may be resected at six months; spinal cord injury HO is excised at one year; and traumatic brain injury HO is removed at 1.5 years. A small number of patients have progression of HO with medicinal treatment and recurrence after resection. The patients seem recalcitrant to present treatment methods regardless of the HO etiology. 117 refs.

Garland, D.E. (Rancho Los Amigos Medical Center, Downey, CA (USA))



Treatment of heterotopic ossification through remote ATP hydrolysis  

PubMed Central

Heterotopic ossification (HO) is the pathologic development of ectopic bone in soft tissues because of a local or systemic inflammatory insult, such as burn injury or trauma. In HO, mesenchymal stem cells (MSCs) are inappropriately activated to undergo osteogenic differentiation. Through the correlation of in vitro assays and in vivo studies (dorsal scald burn with Achilles tenotomy), we have shown that burn injury enhances the osteogenic potential of MSCs and causes ectopic endochondral heterotopic bone formation and functional contractures through bone morphogenetic protein–mediated canonical SMAD signaling. We further demonstrated a prevention strategy for HO through adenosine triphosphate (ATP) hydrolysis at the burn site using apyrase. Burn site apyrase treatment decreased ATP, increased adenosine 3?,5?-monophosphate, and decreased phosphorylation of SMAD1/5/8 in MSCs in vitro. This ATP hydrolysis also decreased HO formation and mitigated functional impairment in vivo. Similarly, selective inhibition of SMAD1/5/8 phosphorylation with LDN-193189 decreased HO formation and increased range of motion at the injury site in our burn model in vivo. Our results suggest that burn injury–exacerbated HO formation can be treated through therapeutics that target burn site ATP hydrolysis and modulation of SMAD1/5/8 phosphorylation. PMID:25253675

Peterson, Jonathan R.; De La Rosa, Sara; Eboda, Oluwatobi; Cilwa, Katherine E.; Agarwal, Shailesh; Buchman, Steven R.; Cederna, Paul S.; Xi, Chuanwu; Morris, Michael D.; Herndon, David N.; Xiao, Wenzhong; Tompkins, Ronald G.; Krebsbach, Paul H.; Wang, Stewart C.; Levi, Benjamin



Heterotopic ossification as a complication of toxic epidermal necrolysis.  


The development of heterotopic ossification (HO) as a complication of toxic epidermal necrolysis (TEN) has not been previously reported. TEN, also known as Lyell's syndrome, is a rare but serious skin disorder that typically occurs after the administration of drugs, especially sulfonamides, barbiturates, phenytoin, and nonsteroidal anti-inflammatory agents. TEN is characterized by the development of large fluid-filled bullae with separation of large sheets of skin. Complications of TEN can include extensive denudation of skin with dehydration and electrolyte abnormalities, gastrointestinal hemorrhage, acute tubular necrosis, secondary infection of denuded skin, pneumonia, bacterial conjunctivitis, keratitis, and septic infarcts of internal organs. We report a case of HO in a patient with TEN after treatment with trimethoprim-sulfamethoxazole. A 49-year-old man developed an erythematous rash, bullae, fever, and extensive skin loss consistent with a diagnosis of TEN. He was intubated for complications of TEN (pneumonia) and maintained on bed rest for several weeks. In addition, he developed HO that resulted in multiple joint contractures. He was treated with aggressive range of motion by physical therapy, surgical resection of the HO followed by radiation to both elbows, right hip, and right knee. Postoperative outpatient rehabilitation enabled improved function in his mobility and activities of daily living. HO is known to occur after spinal cord and brain injuries and burns. It has not been reported to occur after TEN. Our experience with this case suggests that HO may merit inclusion into the list of complications of TEN. PMID:9228883

Gibson, C J; Poduri, K R



To Study the Incidence of Heterotopic Ossification After Anterior Cruciate Ligament Reconstruction  

PubMed Central

Introduction: Previous studies have enumerated the advantages of an arthroscopic Anterior Cruciate Ligament (ACL) reconstruction with the use of a Bone Patellar Tendon Bone (BPTB) graft. Complications are extremely rare in such surgeries and one such known complication, which is an extra-articular heterotophic ossification at the femoral tunnel site, is rarely seen only in few patients. Aim: To evaluate the incidence of heterotrophic ossifications at the femoral tunnel site and the efficacy of the preventive measures which were undertaken, in patients who had undergone ACL reconstructions with the use of bone patellar tendon bone grafts. Material and Methods: A total of 285 patients who had ACL tears within a duration of six years, were evaluated prospectively for the incidence of heterotrophic ossifications after they underwent arthroscopic reconstructions with the use of bone patellar tendon bone grafts by the double incision technique. The effect of the efficacy of various preventive measures on the incidence of the heterotophic ossifications post surgery was also studied. Results: The observed incidence of the heterotophic ossifications was 2.58% in patients whom preventive measures were not used. In contrast, an incidence of 1.54% of similar complications was recorded, after preventive measures were undertaken. Our results showed that heterotophic ossifications after arthroscopic reconstructions with the use of bone patellar tendon bone grafts were a rare complication and that their incidence could be further reduced if preventive measures were taken. Conclusion: The heterotophic ossification is a rare complication after an ACL reconstruction is done with the use of a bone patellar tendon bone graft by the double incision technique. Its incidence reduces significantly after preventive measures are undertaken. PMID:23814735

Bhandary, Bhaskara; Shetty, Sudeep; Bangera, Vinay V.; R., Yogaprakash; Kassim, Mohammed Shabir; Alva, Karan; Bhandary, Sudarshan



Spongiosa Primary Development: A Biochemical Hypothesis by Turing Patterns Formations  

PubMed Central

We propose a biochemical model describing the formation of primary spongiosa architecture through a bioregulatory model by metalloproteinase 13 (MMP13) and vascular endothelial growth factor (VEGF). It is assumed that MMP13 regulates cartilage degradation and the VEGF allows vascularization and advances in the ossification front through the presence of osteoblasts. The coupling of this set of molecules is represented by reaction-diffusion equations with parameters in the Turing space, creating a stable spatiotemporal pattern that leads to the formation of the trabeculae present in the spongy tissue. Experimental evidence has shown that the MMP13 regulates VEGF formation, and it is assumed that VEGF negatively regulates MMP13 formation. Thus, the patterns obtained by ossification may represent the primary spongiosa formation during endochondral ossification. Moreover, for the numerical solution, we used the finite element method with the Newton-Raphson method to approximate partial differential nonlinear equations. Ossification patterns obtained may represent the primary spongiosa formation during endochondral ossification. PMID:23193429

López-Vaca, Oscar Rodrigo; Garzón-Alvarado, Diego Alexander



The primary cilium as a cellular signaling center: lessons from disease  

PubMed Central

Genetic diseases known as ciliopathies have recently entered the limelight, placing new importance on a previously mysterious organelle: the primary cilium. Mutations affecting the primary cilium in both humans and animal models can lead to a plethora of distinct phenotypes including retinal degeneration, kidney cysts, and brain malformations. New findings are quickly lending insight into the functions of this cellular extension that seems to be especially important in modulation of subcellular signaling cascades at various stages of development and adult homeostasis. PMID:19477114

Lancaster, Madeline A; Gleeson, Joseph G



Chondrocyte-specific ablation of Osterix leads to impaired endochondral ossification  

SciTech Connect

Highlights: Black-Right-Pointing-Pointer Conditional ablation of Osterix (Osx) in chondrocytes leads to skeletal defects. Black-Right-Pointing-Pointer Osx regulates chondrocyte differentiation and bone growth in growth plate chondrocytes. Black-Right-Pointing-Pointer Osx has an autonomous function in chondrocytes during endochondral ossification. -- Abstract: Osterix (Osx) is an essential transcription factor required for osteoblast differentiation during both intramembranous and endochondral ossification. Endochondral ossification, a process in which bone formation initiates from a cartilage intermediate, is crucial for skeletal development and growth. Osx is expressed in differentiating chondrocytes as well as osteoblasts during mouse development, but its role in chondrocytes has not been well studied. Here, the in vivo function of Osx in chondrocytes was examined in a chondrocyte-specific Osx conditional knockout model using Col2a1-Cre. Chondrocyte-specific Osx deficiency resulted in a weak and bent skeleton which was evident in newborn by radiographic analysis and skeletal preparation. To further understand the skeletal deformity of the chondrocyte-specific Osx conditional knockout, histological analysis was performed on developing long bones during embryogenesis. Hypertrophic chondrocytes were expanded, the formation of bone trabeculae and marrow cavities was remarkably delayed, and subsequent skeletal growth was reduced. The expression of several chondrocyte differentiation markers was reduced, indicating the impairment of chondrocyte differentiation and endochondral ossification in the chondrocyte-specific Osx conditional knockout. Taken together, Osx regulates chondrocyte differentiation and bone growth in growth plate chondrocytes, suggesting an autonomous function of Osx in chondrocytes during endochondral ossification.

Oh, Jung-Hoon [Department of Molecular Medicine, Cell and Matrix Research Institute, BK21 Medical Education Program for Human Resources, Kyungpook National University School of Medicine, Daegu (Korea, Republic of)] [Department of Molecular Medicine, Cell and Matrix Research Institute, BK21 Medical Education Program for Human Resources, Kyungpook National University School of Medicine, Daegu (Korea, Republic of); Park, Seung-Yoon [Department of Biochemistry, School of Medicine, Dongguk University, Gyeongju 780-714 (Korea, Republic of)] [Department of Biochemistry, School of Medicine, Dongguk University, Gyeongju 780-714 (Korea, Republic of); Crombrugghe, Benoit de [Department of Genetics, University of Texas, M.D. Anderson Cancer Center, Houston (United States)] [Department of Genetics, University of Texas, M.D. Anderson Cancer Center, Houston (United States); Kim, Jung-Eun, E-mail: [Department of Molecular Medicine, Cell and Matrix Research Institute, BK21 Medical Education Program for Human Resources, Kyungpook National University School of Medicine, Daegu (Korea, Republic of)] [Department of Molecular Medicine, Cell and Matrix Research Institute, BK21 Medical Education Program for Human Resources, Kyungpook National University School of Medicine, Daegu (Korea, Republic of)



Contemporary issues in primary amenorrhea: An experience from a Tertiary Care Center  

PubMed Central

Introduction: Amenorrhea is classified as primary if menstrual bleeding has never occurred in the absence of hormonal treatment. The clinical significance of a lack of regular menstrual cycles extends beyond reproductive concerns. Episodes of amenorrhea as short as 90 day may have implications for bone and cardiovascular health. Aims and Objective: To evaluate all patients presenting with primary amenorrhea in the Endocrinology OPD of Gauhati Medical College and Hospital. Materials and Methods: A total of 14 patients presenting to the Endocrinology OPD from March 2010 to May 2012 with a history of primary amenorrhea were included in the study. All patients were subjected to a detailed history, a thorough clinical examination, and relevant biochemical, hormonal, and radiological investigations. Result: In our study, the average age of presentation was 17.23 ± 4.2 years. Out of the 14 patients presenting with primary amenorrhea, 5 patients (35.71%) were found to have Turner?s syndrome, 2 (14.28%) had XX (pure) gonadal dysgenesis, 2 (14.28%) patients had XY gonadal dysgenesis (Swyer syndrome), 2 (14.28%) patients had Müllerian agenesis, 2 (14.28%) patients had hypothalamic amenorrhea, and 1 (7.14%) patient was found to have multiple pituitary hormone deficiency. Conclusion: In concordance with other studies, Turner?s syndrome, Müllerian agenesis, and gonadal dysgenesis are the commonest causes of primary amenorrhea in our study. However, in contrast to certain Western reports, primary amenorrhea rather than short stature remains the commonest cause for seeking medical evaluation in patients with Turner?s syndrome. PMID:23565439

Bhuyan, Ashok Krishna; Sarma, Dipti; Saikia, Uma Kaimal



The Impact of Body Mass Index on Heterotopic Ossification  

SciTech Connect

Purpose: To analyze the impact of different body mass index (BMI) as a surrogate marker for heterotopic ossification (HO) in patients who underwent surgical repair (SR) for displaced acetabular fractures (DAF) followed by radiation therapy (RT). Methods and Materials: This is a single-institution retrospective study of 395 patients. All patients underwent SR for DAF followed by RT {+-} indomethacin. All patients received postoperative RT, 7 Gy, within 72 h. The patients were separated into four groups based on their BMI: <18.5, 18.5-24.9, 25-29.9, and >30. The end point of this study was to evaluate the efficacy of RT {+-} indomethacin in preventing HO in patients with different BMI. Results: Analysis of BMI showed an increasing incidence of HO with increasing BMI: <18.5, (0%) 0/6 patients; 18.5-24.9 (6%), 6 of 105 patients developed HO; 25-29.9 (19%), 22 of 117; >30 (31%), 51 of 167. Chi-square and multivariate logistic regression analysis showed that the correlation between odds of HO and BMI is significant, p < 0.0001. As the BMI increased, the risk of HO and Brooker Classes 3, 4 HO increased. The risk of developing HO is 1.0 Multiplication-Sign (10%) more likely among those with higher BMI compared with those with lower BMI. For a one-unit increase in BMI the log odds of HO increases by 1.0, 95% CI (1.06-1.14). Chi-square test shows no significant difference among all other factors and HO (e.g., indomethacin, race, gender). Conclusions: Despite similar surgical treatment and prophylactic measures (RT {+-} indomethacin), the risk of HO appears to significantly increase in patients with higher BMI after DAF. Higher single-fraction doses or multiple fractions and/or combination therapy with nonsteroidal inflammatory drugs may be of greater benefit to these patients.

Mourad, Waleed Fouad, E-mail: [Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, MS (United States); Department of Radiation Oncology, Beth Israel Medical Center, New York, NY (Israel); Department of Radiation Oncology, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY (United States); Packianathan, Satya [Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, MS (United States); Shourbaji, Rania A. [Department of Epidemiology and Biostatistics, Jackson State University, Jackson, MS (United States); Zhang Zhen; Graves, Mathew [Department of Orthopedic Surgery, University of Mississippi Medical Center, Jackson, MS (United States); Khan, Majid A. [Department of Radiology, University of Mississippi Medical Center, Jackson, MS (United States); Baird, Michael C. [Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, MS (United States); Russell, George [Department of Orthopedic Surgery, University of Mississippi Medical Center, Jackson, MS (United States); Vijayakumar, Srinivasan [Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, MS (United States)



Talking about the pain: A patient-centered study of low back pain in primary care  

Microsoft Academic Search

Despite considerable research, low back pain (LBP) often proves resistant to treatment. This study was designed to increase the understanding of low back pain through access to patients' perceptions, beliefs, illness behaviors and lived experiences. The findings are based on focus groups, individual interviews and participant observation conducted in primary care practices and community settings in three regions in Israel.

Jeffrey Borkan; Shmuel Reis; Doron Hermoni; Aya Biderman



Dissipative three-state system and the primary electron transfer in the bacterial photosynthetic reaction center  

SciTech Connect

The mechanism of the ultrafast primary charge separation process in bacterial photosynthesis has been examined with a general dissipative three-state tight-binding model. Using real-time path integrals, the transient populations of the three electronic states (BChl[sub 2]*BChlBPh, BChl[sub 2][sup +]BChl[sup [minus

Egger, R.; Mak, C.H. (Univ. of Southern California, Los Angeles, CA (United States))



"You reap what you sow"--a case of heterotopic ossification within a fasciocutaneous radial forearm free flap reconstruction.  


Heterotopic ossification is the formation of new bone outside of the skeleton. We describe a previously unreported case of heterotopic ossification occurring within a fasciocutaneous radial forearm free flap for reconstruction following tongue squamous cell carcinoma resection. Although this is a benign condition, it is important to consider and exclude a neoplastic recurrence. PMID:23433474

Gangidi, S R; Courtney, D



Radiographic monitoring of the ossification of long bones in kori ( Ardeotis kori) and white-bellied ( Eupodotis senegalensis) bustards  

Microsoft Academic Search

A serial radiographic study was conducted on eight kori bustard (Ardeotis kori) and four white-bellied bustard (Eupodotis senegalensis) chicks to determine the pattern of long bone development and to establish radiographic standards for assessing skeletal maturity. The ossification pattern, appearance of secondary ossification centres, and epiphyseal fusion of the long bones in kori and white-bellied bustards were similar to those

J. L. Naldo; J. H. Samour; T. A. Bailey



Functional outcome after excision of heterotopic ossification about the knee in ICU patients  

PubMed Central

The objective of this study was to evaluate the degree of improvement in the range of movement in the knee joint, sitting ability, and overall ambulation in patients with heterotopic ossification of the knee joint who underwent surgical excision of ectopic bone. Between 1999 and 2006, 14 patients (23 joints) with significant heterotopic ossification of the knee joint that required surgery were evaluated. We compared the range of movement in the knee joint, sitting ability, and overall ambulation in the preoperative and postoperative periods using the Fuller and Keenan classification systems. Range of movement increased in 82% of cases (19 knee joints). Sitting ability improved in 13 patients (93%). Postoperatively, ambulation in eight patients (57%) was remarkably superior. In conclusion, resection of heterotopic ossification may significantly improve the range of movement in the knee joint, sitting ability, and overall ambulation. PMID:18641984

Lykissas, M. G.; Kalos, N.; Paschos, N.; Beris, A. E.; Georgoulis, A. D.; Xenakis, T. A.



Does the epiphyseal cartilage of the long bones have one or two ossification fronts?  


Epiphyseal cartilage is hyaline cartilage tissue with a gelatinous texture, and it is responsible for the longitudinal growth of the long bones in birds and mammals. It is located between the epiphysis and the diaphysis. Epiphyseal cartilage also is called a growth plate or physis. It is protected by three bone components: the epiphysis, the bone bar of the perichondrial ring and the metaphysis. The epiphysis, which lies over the epiphyseal cartilage in the form a cupola, contains a juxtaposed bone plate that is near the epiphyseal cartilage and is in direct contact with the epiphyseal side of the epiphyseal cartilage. The germinal zone corresponds to a group of cells called chondrocytes. These chondrocytes belong to a group of chondral cells, which are distributed in rows and columns; this architecture is commonly known as a growth plate. The growth plate is responsible for endochondral bone growth. The aim of this study was to elucidate the causal relationship between the juxtaposed bone plate and epiphyseal cartilage in mammals. Our hypothesis is that cells from the germinal zone of the epiphyseal side of the epiphyseal cartilage are involved in forming a second ossification front that is responsible for the origin of the juxtaposed bone plate. We report the following: (a) The juxtaposed bone plate has a morphology and function that differs from that of the epiphyseal trabeculae; (b) on the epiphyseal edge of the epiphyseal cartilage, a new ossification front starts on the chondrocytes of the germinal area, which forms the juxtaposed bone plate. This ossification front is formed by chondrocytes from the germinal zone through a process of mineralisation and ossification, and (c) the process of mineralisation and ossification has a certain morphological analogy to the process of ossification in the metaphyseal cartilage of amphibians and differs from the endochondral ossification process in the metaphyseal side of the growth plate. The close relationship between the juxtaposed bone plate and the epiphyseal cartilage, in which the chondrocytes that migrate from the germinal area play an important role in the mineralisation and ossification process of the juxtaposed bone plate, supports the hypothesis of a new ossification front in the epiphyseal layer of the epiphyseal plate. This hypothesis has several implications: (a) epiphyseal cartilage is a morphological entity with two different ossification fronts and two different functions, (b) epiphyseal cartilage may be a morphological structure with three parts: perichondrial ring, metaphyseal ossification front or growth plate, and epiphyseal ossification front, (c) all disease (traumatic or dysplastic) that affects some of these parts can have an impact on the morphology of the epiphyseal region of the bone, (d) there is a certain analogy between metaphyseal cartilage in amphibians and mammalian epiphyseal cartilage, although the former is not responsible for bone growth, (e) comparative histological and anatomy studies are also warranted, to shed light on the phylogenetic study of epiphyseal cartilage throughout the changes that occur in the animal species. PMID:23953967

Delgado-Martos, María Jesús; Touza Fernández, Alberto; Canillas, Fernando; Quintana-Villamandos, Begoña; Santos del Riego, Sergio; Delgado-Martos, Emilio; Martos-Rodriguez, Antonia; Delgado-Baeza, Emilio



Bilateral ossification of the auricles: an unusual entity and review of the literature  

PubMed Central

Background True ossification of the auricle with cartilage replacement by bone, is a very rare clinical entity and can result in an entirely rigid auricle. Case presentation We present a rare case of bilateral ossification of the auricles in a 75-years old man with profound progressive rigidity of both auricles. His main complaint was a mild discomfort during resting making sleeping unpleasant without any other serious symptoms. His medical history was significant for predisposing factors for this condition such as, Addison's disease and diabetes mellitus. Excisional biopsy was performed confirming the ossified nature of the auricles. Further treatment deemed unnecessary in our case due to his mild clinical picture. Conclusion True auricular ossification is a quite rare clinical entity with unclear pathogenesis and one should have in mind that there is always the possibility of a serious co-existed disease like endocrinopathy. PMID:19796391

Mastronikolis, Nicholas S; Zampakis, Peter; Kalogeropoulou, Christina; Stathas, Theodoros; Siabi, Vassiliki; Geropoulou, Eleni; Goumas, Panos D



University of California, Davis Center for Health Services Research in Primary Care  

E-print Network

Azari, Ph.D. Core Faculty, Asst. Director for Division of Statistics Quantitative Methods Ed Callahan-time administrative assistant I (Christine Harlan). In addition, Dr. Rahman Azari was the Center's part-time core

Carmichael, Owen


Troublesome Heterotopic Ossification after Central Nervous System Damage: A Survey of 570 Surgeries  

PubMed Central

Background Heterotopic ossification (HO) is a frequent complication after central nervous system (CNS) damage but has seldom been studied. We aimed to investigate features of HO for the first time in a large sample and the rate of early recurrence of HO in terms of the time of surgery. Methodology/Principal Findings We retrospectively analyzed data from an anonymous prospective survey of patients undergoing surgery between May 1993 and November 2009 in our institution for troublesome HO related to acquired neurological disease. Demographic and HO characteristics and neurological etiologies were recorded. For 357 consecutive patients, we collected data on 539 first surgeries for HO (129 surgeries for multiple sites). During the follow-up, recurrences requiring another surgery appeared in 31 cases (5.8% [31/539]; 95% confidence interval [CI]: 3.8%–7.8%; 27 patients). Most HO requiring surgery occurred after traumatic brain injury (199 patients [55.7%]), then spinal cord injury (86 [24.0%]), stroke (42 [11.8%]) and cerebral anoxia (30 [8.6%]). The hip was the primary site of HO (328 [60.9%]), then the elbow (115 [21.3%]), knee (77 [14.3%]) and shoulder (19 [3.5%]). For all patients, 181 of the surgeries were performed within the first year after the CNS damage, without recurrence of HO. Recurrence was not associated with etiology (p?=?0.46), sex (p?=?1.00), age at CNS damage (p?=?0.2), multisite localization (p?=?0.34), or delay to surgery (p?=?0.7). Conclusions/Significance In patients with CNS damage, troublesome HO and recurrence occurs most frequently after traumatic brain injury and appears frequently in the hip and elbow. Early surgery for HO is not a factor of recurrence. PMID:21304993

Genêt, François; Jourdan, Claire; Schnitzler, Alexis; Lautridou, Christine; Guillemot, Didier; Judet, Thierry; Poiraudeau, Serge; Denormandie, Philippe



Postoperative Single-Fraction Radiation for Prevention of Heterotopic Ossification of the Elbow  

SciTech Connect

Purpose: Heterotopic ossification (HO) about the elbow has been described after surgery, trauma, and burns. Even limited deposits can lead to significant functional deficits. Little data exist regarding outcomes of patients treated with radiation therapy (RT) after elbow surgery. We report here the Cleveland Clinic experience with single-fraction radiation following surgery to the elbow. The primary endpoint was the rate of new HO after RT. Secondary endpoints were range of motion, functional compromise, and toxicity. Methods and Materials: From May 1993 to July 2006, 36 patients underwent elbow surgery followed by single-fraction RT. Range of motion data were collected before and during surgery and at last follow-up. Radiographs were reviewed for persistent or new HO. Patient and treatment factors were analyzed for correlation with development of HO or functional compromise. Results: Median follow-up was 8.7 months, median age was 42 years, and 75% of patients were male. Twenty-six (72%) patients had HO prior to surgery. All patients had significant limitations in flexion/extension or pronation/supination at baseline. Thirty-one (86%) patients had prior elbow trauma, and 26 (72%) patients had prior surgery. RT was administered a median of 1 day postoperatively (range, 1-4 days). Thirty-four patients received 700 cGy, and 2 patients received 600 cGy. Three (8%) patients developed new HO after RT. All patients had improvement in range of motion from baseline. No patient or treatment factors were significantly associated with the development of HO or functional compromise. Conclusions: Single-fraction RT after surgery to the elbow is associated with favorable functional and radiographic outcomes.

Robinson, Clifford G. [Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio (United States); Polster, Joshua M. [Department of Radiology, Cleveland Clinic, Cleveland, Ohio (United States); Reddy, Chandana A. [Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio (United States); Lyons, Janice A. [Department of Radiation Oncology, UH Case Medical Center, Cleveland, Ohio (United States); Evans, Peter J.; Lawton, Jeffrey N. [Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio (United States); Graham, Thomas J. [Curtis National Hand Center, Baltimore, Maryland (United States); Suh, John H., E-mail: suhj@ccf.or [Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio (United States)



Centralized care management support for "high utilizers" in primary care practices at an academic medical center.  


Although evidence of effectiveness is limited, care management based outside primary care practices or hospitals is receiving increased attention. The University of Michigan (UM) Complex Care Management Program (CCMP) provides care management for uninsured and underinsured, high-utilizing patients in multiple primary care practices. To inform development of optimal care management models, we describe the CCMP model and characteristics and health care utilization patterns of its patients. Of a consecutive series of 49 patients enrolled at CCMP in 2011, the mean (SD) age was 48 (+/- 14); 23 (47%) were women; and 29 (59%) were White. Twenty-eight (57%) had two or more chronic medical conditions, 39 (80%) had one or more psychiatric condition, 28 (57%) had a substance abuse disorder, and 11 (22%) were homeless. Through phone, e-mail, and face-to-face contact with patients and primary care providers (PCPs), care managers coordinated health and social services and facilitated access to medical and mental health care. Patients had a mean (SD) number of hospitalizations and emergency room (ER) visits in 6 months prior to enrollment of2.2 (2.5) and 4.2 (4.3), respectively, with a nonstatistically significant decrease in hospitalizations, hospital days, and emergency room visits in 6 months following enrollment in CCMP. Centralized care management support for primary care practices engages high-utilizing patients with complex medical and behavioral conditions in care management that would be difficult to provide through individual practices and may decrease health care utilization by these patients. PMID:24761538

Williams, Brent C; Paik, Jamie L; Haley, Laura L; Grammatico, Gina M



Heterotopic mineralization (ossification or calcification) in tendinopathy or following surgical tendon trauma  

PubMed Central

Heterotopic tendon mineralization (ossification or calcification), which may be a feature of tendinopathy or which may develop following surgical trauma (repair or graft harvest), has not received much attention. The purpose of this article is to review the prevalence, mechanisms and consequences of heterotopic tendon mineralization and to identify the gaps in our current understanding. We focus on endochondral heterotopic ossification and draw on knowledge of the mechanisms of this process in other tissues and conditions. Finally, we introduce a novel murine Achilles tendon needle injury model, which will enable us to further study the mechanisms and biomechanical consequences of tendon mineralization. PMID:22974213

O'Brien, Etienne J O; Frank, Cyril B; Shrive, Nigel G; Hallgrímsson, Benedikt; Hart, David A



Organizational Scope of Practice: Assessing the Primary Care and Public Health Activities of Health Centers and Health Departments in Iowa.  


Abstract The objective was to understand how Federally Qualified Health Centers (FQHCs) and local health departments (LHDs) address their shared mission of improving population health by determining the scope of primary care and public health activities each provides in their community. A brief mail survey was designed and fielded among executive directors at all 14 FQHCs in Iowa, and 13 LHDs in Iowa representing counties with and without an FQHC. This survey contained a mixture of questions adapted from previously validated primary care and public health survey instruments. Using survey responses, each FQHC and LHD was given 2 scores (each ranging from 0-100) measuring the extent of their primary care and public health activities, respectively. The overall response rate was 85.2%; the response rate was 78.6% within FQHCs and 91.7% within LHDs. Overall, FQHCs had higher scores (73.8%) compared to LHDs (27.3%) on total primary care services, while both LHDs (79.3%) and FQHCs (70.9%) performed particularly well on public health services. FQHCs and LHDs in Iowa address a variety of public health and primary care issues, including but not limited to screening for chronic diseases, nutrition counseling, immunizations, and behavioral health. However, FQHCs provide a higher amount of primary care services and nearly as many public health services when compared to LHDs. In a value-based health care delivery system, integrating to improve population health is a wise strategy to maximize efficiency, but this will require maximizing coordination and minimizing duplication of services across different types of safety net providers. (Population Health Management 20xx;xx:xxx-xxx). PMID:25187990

Wright, Brad; Ugwi, Patience; Nice, Andrew J



Pediatric echocardiograms performed at primary centers: Diagnostic errors and missing links!  

PubMed Central

Aim: The present study was undertaken to assess the accuracy of pediatric echocardiograms done at non-tertiary centers and to evaluate the relationship of inaccurate interpretations with age, echocardiogram performer and complexity of congenital heart disease (CHD). Materials and Methods: The echocardiogram reports of 182 consecutive children with CHD (5 days-16 years) who were evaluated at a non-tertiary center and subsequently referred to our center were reviewed. Age of the child at echocardiogram, echocardiogram performer and complexity of CHD were noted. These reports were compared with echocardiogram done at our center. Discrepancies were noted and categorized. To assess our own error rate, we compared our echocardiogram reports with the findings obtained during surgery (n = 172), CT scan (n = 9) or cardiac catheterization reports (n = 1). Results: Most of the children at the non-tertiary center (92%) underwent echocardiogram by personnel other than a pediatric cardiologist. Overall, diagnostic errors were found in 69/182 (38%) children. Moderate and major discrepancies affecting the final management were found in 42/182 (23%) children. Discrepancies were higher when the echocardiogram was done by personnel other than pediatric cardiologist (P < 0.01) and with moderate and high complexity lesions (P = 0.0001). There was no significant difference in proportion of these discrepancies in children ? 1 year vs. >1 year of age. Conclusions: A significant number of pediatric echocardiograms done at non-tertiary centers had discrepancies that affected the management of these children. More discrepancies were seen when the echocardiogram performer was not a pediatric cardiologist and with complex CHD. PMID:25684883

Saraf, Rahul P; Suresh, PV; Maheshwari, Sunita; Shah, Sejal S



Screening, diagnosis, treatment, and management of hepatitis C: a novel, comprehensive, online resource center for primary care providers and specialists.  


Current initiatives focusing on hepatitis C (HCV) screening and diagnosis, together with the advent of oral interferon (IFN)-free treatment regimens have prompted Elsevier Multimedia Publishing and the American Journal of Medicine (AJM) to develop a novel, comprehensive, online Resource Center dedicated to providing both primary care providers and specialists with the latest information on the screening, diagnosis, treatment, and management of HCV. To date, only 25% of infected patients have been diagnosed and only 5% cured. With the Centers for Disease Control and Prevention (CDC) and the US Prevention Services Task Force (USPSTF) recommendation of one-time screening for all individuals born between 1945 and 1965, and the availability of safe and effective therapy, it is anticipated that primary care providers and community practices will become increasingly responsible for the screening, diagnosis, and management of infected patients, as well as providing access to care by specialists when needed. The AJM Hepatitis C Resource Center site will have two major channels; one channel tailored to specifically address the needs of internal medicine physicians and other primary care providers, and one channel tailored to address the needs of specialists including hepatologists, gastroenterologists, and infectious disease specialists. Systematic surveys of these clinician audiences are being conducted by Elsevier to assess educational gaps, and ensure that the content of each channel of the Resource Center satisfies the needs of the intended audiences. In a recent Elsevier survey of primary care physicians (PCPs) who had screened and/or participated in the care of patients with HCV within 6 months of participating in the survey, 60% of PCPs stated that they were not very confident or only somewhat confident about screening patients for chronic HCV infection. A recent Elsevier survey of specialists revealed low levels of satisfaction with the treatment options available in 2013, with "no therapy" being selected for up to 38% of patients. This survey also showed that experience with newly-approved options for HCV including IFN-free regimens is currently limited, but the likelihood that a variety of patient types will be treated with these options is high. This provides an impetus for educational opportunities focusing on optimizing treatments for the different HCV genotypes and for patients with comorbidities. Further results of the PCP and specialist surveys will be published on the Resource Center. Each channel of the Resource Center will be comprised of a variety of specific communication elements, which are open to sponsorship, and include roundtable panel discussions, case studies, and direct links to relevant original research, review articles, and guidelines. All Resource Center components are peer-reviewed for publication on the Resource Center by the AJM Editorial Office and the Resource Center Guest Editor, Edward Lebovics, MD. The AJM Hepatitis C Resource Center will be accessible from the AJM online home page ( and will be launched immediately prior to the American Association for the Study of Liver Diseases (AASLD) Liver Meeting to be held from November 7 to 11, 2014 in Boston, Massachusetts. PMID:25308624

Lebovics, Edward; Czobor, Klara



Eleven Years of Primary Health Care Delivery in an Academic Nursing Center.  

ERIC Educational Resources Information Center

Client visits to an academic community nursing center (n=25,495) were coded and analyzed. Results show expansion of nursing practice and services, strong case management, and management of illness care. The usefulness of computerized clinical documentation system and of the Lundeen conceptional model of community nursing care was demonstrated.…

Hildebrandt, Eugenie; Baisch, Mary Jo; Lundeen, Sally P.; Bell-Calvin, Jean; Kelber, Sheryl



Automated Driving: Shifting the Primary Task from the Center to the  

E-print Network

driver assistance systems (ADAS), the car is also able to automatically keep a certain speed such as speech or freehand gestures allow the driver to perform tertiary tasks non-visually while keeping the driving task in the center of attention. This trend will eventually lead towards fully automated driving


Electronic Health Records and Information Portability: A Pilot Study in a Rural Primary Healthcare Center in India  

PubMed Central

Clinical documentation and health information portability pose unique challenges in urban and rural areas of India. This article presents findings of a pilot study conducted in a primary health center in rural India. In this article, we focus on primary care in rural India and how a portable health record system could facilitate the availability of medical information at the point of care. We followed a geriatric cohort and a maternal cohort of 308 participants over a nine-month period. Physician encounters were entered into a web-based electronic health record. This information was made available to all study participants through a short messaging service (SMS). Additionally, 135 randomly selected participants from the cohort were issued a USB-based memory card that contained their detailed health records and could be viewed on most computers. The dual portability model implemented in the pilot study demonstrates the utility of the concept. PMID:25214819

Radhakrishna, Kedar; Goud, B. Ramakrishna; Kasthuri, Arvind; Waghmare, Abijeet; Raj, Tony



Engaging Primary Care Patients to Use a Patient-Centered Personal Health Record  

PubMed Central

PURPOSE Health care leaders encourage clinicians to offer portals that enable patients to access personal health records, but implementation has been a challenge. Although large integrated health systems have promoted use through costly advertising campaigns, other implementation methods are needed for small to medium-sized practices where most patients receive their care. METHODS We conducted a mixed methods assessment of a proactive implementation strategy for a patient portal (an interactive preventive health record [IPHR]) offered by 8 primary care practices. The practices implemented a series of learning collaboratives with practice champions and redesigned workflow to integrate portal use into care. Practice implementation strategies, portal use, and factors influencing use were assessed prospectively. RESULTS A proactive and customized implementation strategy designed by practices resulted in 25.6% of patients using the IPHR, with the rate increasing 1.0% per month over 31 months. Fully 23.5% of IPHR users signed up within 1 day of their office visit. Older patients and patients with comorbidities were more likely to use the IPHR, but blacks and Hispanics were less likely. Older age diminished as a factor after adjusting for comorbidities. Implementation by practice varied considerably (from 22.1% to 27.9%, P <.001) based on clinician characteristics and workflow innovations adopted by practices to enhance uptake. CONCLUSIONS By directly engaging patients to use a portal and supporting practices to integrate use into care, primary care practices can match or potentially surpass the usage rates achieved by large health systems. PMID:25354405

Krist, Alex H.; Woolf, Steven H.; Bello, Ghalib A.; Sabo, Roy T.; Longo, Daniel R.; Kashiri, Paulette; Etz, Rebecca S.; Loomis, John; Rothemich, Stephen F.; Peele, J. Eric; Cohn, Jeffrey



A single-center study of hematopoietic stem cell transplantation for primary immune deficiencies (PIDD).  


PIDD are rare inherited disorders that can result in life-threatening infections. Allogeneic HSCT is the only cure for many primary immune deficiencies; however, the specific diseases and optimal type(s) of transplants are not clear. This study compares transplant outcomes in a large cohort with a relatively uniform pre- and post-transplant management strategies. We conducted a retrospective analysis of 39 pediatric patients who underwent HSCT for SCID (n?=?25) or other immune deficiencies (n?=?14) from 1986 to 2010. A structured case report form was used to collect clinical information. The outcomes of survival, immune reconstitution, engraftment, incidence of GvHD and IVIG dependency were tabulated. Overall survival rates were 88% for SCID and 86% for other primary immune deficiencies, which are high compared to other historical series. No single variable was associated with mortality. Immunoglobulin dependence occurred only in patients who had X-linked SCID and a parental donor haploidentical transplant. Because of improved supportive care and use of alternative donors and conditioning regimens, HSCT has become an acceptable option for an increasing number of PIDD subtypes not previously transplanted with high frequency. This study encourages greater use of transplantation. PMID:22093026

Dinardo, Laura; Brown, Valerie; Perez, Elena; Bunin, Nancy; Sullivan, Kathleen E



Primary electron-transfer dynamics in modified bacterial reaction centers containing pheophytin-a instead of bacteriopheophytin-a  

NASA Astrophysics Data System (ADS)

Primary electron transfer was studied in modified reaction centers of Rhodobacter sphaeroides R26.1, in which both bacteriopheophytin-a molecules were replaced by pheophytin-a to more than 90%. The absorption spectrum of the modified reaction centers shows a new Q y band at 674 nm, while the Q y absorption of bacteriopheophytin-a at 760 nm in native reaction centers is not present. The bands assigned to the monomeric bacteriochlorophylls show a slight blue shift (3 nm) and small but distinct changes in the circular dichroism spectra. Subpicosecond absorption spectroscopy reveals that the electron transfer kinetics in modified reaction centers are different from the kinetics in native samples. The accessory bacteriochlorophyll anion can be directly observed in the spectral region around 1000 nm. A detailed analysis of the data suggests that the modification raised the energy of the radical pair state P +H A-, leading to a long-lived P +B A- population of 30%. Relative to P 7 the free energy levels of the intermediates are -450 cm -1 (P +B A- and -630 cm -1 (P +H A-) in the modified reaction centers. Based on these calculations, a simplified electron transfer model is presented.

Schmidt, S.; Arlt, T.; Hamm, P.; Huber, H.; Nägele, T.; Wachtveitl, J.; Zinth, W.; Meyer, M.; Scheer, H.



Flight tests of a hybrid-centered integrated 3D perspective-view primary flight display  

NASA Astrophysics Data System (ADS)

This paper describes flight tests of a Honeywell Synthetic Vision System (SVS) prototype operating in a hybrid-centered mode on a Primus Epic TM large format display. This novel hybrid mode effectively resolves some cognitive and perceptual human factors issues associated with traditional heading-up or track-up display modes. By integrating synthetic 3D perspective view with advanced Head-Up Display (HUD) symbology in this mode, the test results demonstrate that the hybrid display mode provides clear indications of current track and crab conditions, and is effective in overcoming flight guidance symbology collision and resultant ambiguity. The hybrid-centering SVS display concept is shown to be effective in all phases of flight and is particularly valuable during landing operations with a strong cross-wind. The recorded flight test data from Honeywell's prototype SVS concept at Reno, Nevada on board Honeywell Citation V aircraft will be discussed.

He, Gang; Feyereisen, Thea; Wilson, Blake; Wyatt, Sandy; Engels, Jary



Sarcoidois: is it only a mimicker of primary rheumatic disease? A single center experience  

PubMed Central

Background: Sarcoidosis is known as a T helper 1 lymphocyte (Th1-Ly) mediated disease which can imitate or sometimes accompany many primary rheumatic diseases. The purpose of this study is to share the clinical, demographic and laboratory data of patients presenting with rheumatologic manifestations and diagnosed with sarcoidosis. Methods: A total of 42 patients (10 men) were included in the study. The patients were admitted to the rheumatology outpatient clinic for the first time with different rheumatic complaints between November 2011 and May 2013 and were diagnosed with sarcoidosis after relevant tests. Clinical, demographic, laboratory, radiological and histological data of these patients were collected during the 18-month follow-up period and then analyzed. Results Mean patient age was 45.2 years (20–70 years) and mean duration of disease was 3.5 years (1 month–25 years). Evaluation of system and organ involvement revealed that 20 (47.6%) patients had erythema nodosum, 3 (7.1%) had uveitis, 1 (2.3%) had myositis, 1 (2.3%) had neurosarcoidosis, 32 (76.2%) had arthritis and 40 (95.2%) had arthralgia. Of the 32 patients with arthritis, 28 (87.5%) had involvement of the ankle, 3 (9.4%) had involvement of the knee and 1 (3.2%) had involvement of the wrist. No patient had cardiac involvement. Thoracic computed tomography scan showed stage 1, 2, 3 and 4 sarcoidosis in 12 (28.5%), 22 (52.4%), 4 (9.5%) and 4 (9.5%) patients, respectively. Histopathology of sarcoidosis was verified by endobronchial ultrasound, mediastinoscopy and skin and axillary biopsy of lymphadenopathies, which revealed noncaseating granulomas. Laboratory tests showed elevated serum angiotensin-converting enzyme in 15 (35.7%) patients, elevated serum calcium level in 6 (14.2%) patients and elevated serum 1,25-dihydroxyvitamin D concentrations in 2 (4.7%) patients. Serological tests showed antinuclear antibody positivity in 12 (28.5%) patients, rheumatoid factor positivity in 7 (16.6%) patients and anticyclic citrullinated antibody positivity in 2 (4.8%) patients. Conclusion: Sarcoidosis can imitate or accompany many primary rheumatic diseases. Sarcoidosis should be considered not simply as an imitator but as a primary rheumatic pathology mediated by Th1-Ly. New studies are warranted on this subject. PMID:24489610

Sever, Fidan; Sivrikoz, Oya Nermin; Orman, Mehmet



Solid Waste Processing Center Primary Opening Cells Systems, Equipment and Tools  

SciTech Connect

This document addresses the remote systems and design integration aspects of the development of the Solid Waste Processing Center (SWPC), a facility to remotely open, sort, size reduce, and repackage mixed low-level waste (MLLW) and transuranic (TRU)/TRU mixed waste that is either contact-handled (CH) waste in large containers or remote-handled (RH) waste in various-sized packages.

Bailey, Sharon A.; Baker, Carl P.; Mullen, O Dennis; Valdez, Patrick LJ



Primary Stenting of Subclavian and Innominate Artery Occlusive Disease: A Single Center's Experience  

SciTech Connect

Purpose: To review immediate and midterm results of primary stenting for innominate and subclavian artery occlusive lesions. Methods: Retrospective data were collected from 48 consecutive symptomatic patients (27 men and 21 women, median age 64 years) having 49 subclavian and innominate artery lesions treated with stenting. Of the patients 52% had concomitant ischemic heart disease, and 30% had carotid and/or vertebral artery disease. Indication for treatment was vertebrobasilar insufficiency (VBI) in 16.6% of the patients; upper limb ischemia (ULI) in 31.3%; VBI and ULI in 12.5%; transient ischemic attack in 16.7%; angina in 12.5% before or after left internal mammary artery-to-coronary artery bypass grafting; and leg claudication in 10.4% before or after axillofemoral bypass grafting. Balloon-expandable stents were used in 44 lesions and self-expandable stents in 5 lesions. In total, 53 stents were placed in 48 patients. Results: Technical success was 96%, and clinical success 94%. We encountered four complications (two puncture site hematomas, one distal hand embolization and one transient cerebral ischemia). Two patients died within 30 days from other causes, and seven patients were lost to follow-up. Mean follow-up time was 16.7 months (range 0.3 to 68.2). Five patients had recurrent lesions treated by surgical (n = 2) or endovascular (n = 3) means. Cumulative primary patency rate was 91.7% and 77% at 12 and 24 months, respectively. Cumulative secondary patency rate was 96.5% and 91.7% at 12 and 24 months, respectively. Conclusion: Stenting of subclavian and innominate artery lesions resulted in immediate resolution of patients' symptoms with durable midterm effect and few complications in a larger patient group with serious comorbid conditions.

Brountzos, E. N., E-mail: platanos@hol.qr; Petersen, B.; Binkert, C.; Panagiotou, I.; Kaufman, J. A. [Oregon Health Sciences University, Dotter Interventional Institute (United States)



Head co-ossification, phragmosis and defence in the casque-headed tree frog Corythomantis greeningi  

Microsoft Academic Search

Some anurans have a peculiar casqued head with the skin co-ossified with the underlying bones. This type of skull usually is associated with phragmosis, a protective behaviour in which the animal enters a hole and closes it with the head. Although co-ossification of the head in lissamphibians frequently has been associated with water economy, recent studies of Corythomantis greeningi, a

C. Jared; M. M. Antoniazzi; C. A. Navas; E. Katchburian; E. Freymüller; D. V. Tambourgi; M. T. Rodrigues



Ossification of the external ear: a case report and review of the literature  

Microsoft Academic Search

A rare case of idiopathic bilateral ossification of the auricular cartilage and cartilage of the external ear canal is reported. The hardening and thickening of the external ear canals with subsequent narrowing and impaired exposure resulted in symptomatic hearing loss because of the recurrent impediment of inspissated cerumen, the removal of which finally became impossible. Surgical resection of the cartilage

Johannes J. Manni; Lysandra C. M. Berénos-Riley



Developing a Quantitative Measurement System for Assessing Heterotopic Ossification and Monitoring the Bioelectric Metrics  

E-print Network

ossification (HO), a frequent problem following blast injuries for returning service members. Osseointegration technology offers an advantage for individuals with significant HO and poor socket tolerance by using direct skeletal attachment and the bioelectric effects of HO were evaluated using finite element analysis in 11

Utah, University of


Comparative patterns of postcranial ontogeny in therian mammals: an analysis of relative timing of ossification events.  


Data on the relative sequence of ossification of postcranial elements for eight therian mammals (Myotis lucifugus, Homo sapiens, Rattus norvegicus, Mus musculus, Mesocricetus auratus, Cavia porcellus, Didelphis albiventris, and Sminthopsis macroura) and three outgroups (Chelydra serpentina, Alligator mississippiensis, and Lacerta vivipara) were taken from the literature. For each species, a matrix was constructed in which the relative timing of the onset of ossification in 24 elements was summarized. This resulted in 276 event pairs (characters) for each species. Thirty-three (33.3)% of the characters examined are uniform across all taxa, 16.3% are variable but uninformative in the phylogeny, and 50.4% potentially deliver diagnostic features for clades of two or more taxa. In all species examined, the clavicle is the first bone to appear. Placentalia is not unequivocally diagnosed by the state of any event pair, while Marsupialia has the largest amount of autapomorphies with 18. The acceleration in the timing of ossification of the scapula in relation to the hindlimb in marsupials is most probably causally correlated to movements after birth and during early phases of pre-weaning life. Marsupials are almost unique among amniotes in that the earliest onset of ossification of at least one element among carpals and among tarsals is simultaneous. Three parsimony analyses, each one with a different reptilian taxon as outgroup, were performed using event pairs as characters. In all cases, results were incongruent with the phylogeny of the studied taxa. PMID:12362432

SAnchez-Villagra, Marcelo R



Timing of Ossification in Duck, Quail, and Zebra Finch: Intraspecific Variation, Heterochronies, and Life History Evolution  

PubMed Central

Skeletogenic heterochronies have gained much attention in comparative developmental biology. The temporal appearance of mineralized individual bones in a species – the species ossification sequence – is an excellent marker in this kind of study. Several publications describe interspecific variation, but only very few detail intraspecific variation. In this study, we describe and analyze the temporal order of ossification of skeletal elements in the zebra finch, Taeniopygia guttata, the Japanese quail, Coturnix coturnix japonica, and the White Pekin duck, a domestic race of the mallard Anas platyrhynchos, and explore patterns of intraspecific variation in these events. The overall sequences were found to be conserved. In the duck, variability is present in the relative timing of ossification in the occipital, the basisphenoid and the otic regions of the skull and the phalanges in the postcranium. This variation appears generally in close temporal proximity. Comparison with previously published data shows differences in ossification sequence in the skull, the feet, and the pelvis in the duck, and especially the pelvis in the quail. This clearly documents variability among different breeds. PMID:21728797

Mitgutsch, Christian; Wimmer, Corinne; Sánchez-Villagra, Marcelo R.; Hahnloser, Richard; Schneider, Richard A.



Diffuse pulmonary ossification detected by bone scanning with Tc-99m hydroxymethylene diphosphate  

SciTech Connect

Diffuse pulmonary ossification (DPO) is a rare pathologic finding of heterotropic bone formation within the lungs. It has been associated with mitral stenosis, chronic left ventricular failure, interstitial fibrosis, metastatic breast cancer, pulmonary amyloidosis, histoplasmosis, and chronic busulfan therapy. This patient represents a case associated with Placidyl use.

Saks, D.A.; McClees, E.C.; Fajman, W.A.; Hollinger, W.M.; Gilman, M.J.



Low Primary Cesarean Rate and High VBAC Rate With Good Outcomes in an Amish Birthing Center  

PubMed Central

PURPOSE Recent national guidelines encourage a trial of labor after cesarean (TOLAC) as a means of increasing vaginal births after cesarean (VBACs) and decreasing the high US cesarean birth rate and its consequences (2010 National Institute of Health Consensus Statement and American College of Obstetricians and Gynecologists revised guideline). A birthing center serving Amish women in Southwestern Wisconsin offered an opportunity to look at the effects of local culture and practices that support vaginal birth and TOLAC. This study describes childbirth and perinatal outcomes during a 17-year period in LaFarge, Wisconsin. METHODS We undertook a retrospective analysis of the records of all women admitted to the birth center in labor. Main outcome measures include rates of cesarean deliveries, TOLAC and VBAC deliveries, and perinatal outcomes for 927 deliveries between 1993 and 2010. RESULT S The cesarean rate was 4% (35 of 927), the TOLAC rate was 100%, and the VBAC rate was 95% (88 of 92). There were no cases of uterine rupture and no maternal deaths. The neonatal death rate of 5.4 of 1,000 was comparable to that of Wisconsin (4.6 of 1,000) and the United States (4.5 of 1,000). CONCLUSIONS Both the culture of the population served and a number of factors relating to the management of labor at the birthing center have affected the rates of cesarean delivery and TOLAC. The results of the LaFarge Amish study support a low-technology approach to delivery where good outcomes are achieved with low cesarean and high VBAC rates. PMID:23149530

Deline, James; Varnes-Epstein, Lisa; Dresang, Lee T.; Gideonsen, Mark; Lynch, Laura; Frey, John J.



Changes in the Degree of Patient Expectations for Patient-Centered Care in a Primary Care Setting  

PubMed Central

Background To date, the medical environment has been undergoing continual changes. It is therefore imperative that clinicians recognize the changing trends in the degree of patient expectations for patient-centered care. We conducted this study to examine changes in the degree of patient expectations for patient-centered care and the related socio-demographic factors in a primary care setting over a 5-year period. Methods We evaluated patients' attitudes toward patient-centered care using the Patient-Practitioner Orientation Scale, which provides 'sharing' and 'caring' scores. The study included 359 and 468 patients in phase I (March-July, 2005) and II (March-July, 2010). We also examined the relationship of their changes to their socio-demographic factors. Results In phase II, as compared with phase I, the 'sharing' score was higher (3.67 ± 0.68 vs. 3.82 ± 0.44; P < 0.001) and 'caring' one was lower (4.01 ± 0.57 vs. 3.67 ± 0.58; P = 0.001). Further, 'sharing' and 'caring' scores were associated with age, monthly income, education level, marital status, and the functional health status of patients. Conclusion These results would be of help for providing patient-centered care for patients because it makes clinicians are aware of the degree to which patients' expect it.

Choi, Chang-Jin; Hwang, Sun-Wook



Access of primary and secondary literature by health personnel in an academic health center: implications for open access*  

PubMed Central

Purpose: The research sought to ascertain the types and quantity of research evidence accessed by health personnel through PubMed and UpToDate in a university medical center over the course of a year in order to better estimate the impact that increasing levels of open access to biomedical research can be expected to have on clinical practice in the years ahead. Methods: Web log data were gathered from the 5,042 health personnel working in the Stanford University Hospitals (SUH) during 2011. Data were analyzed for access to the primary literature (abstracts and full-text) through PubMed and UpToDate and to the secondary literature, represented by UpToDate (research summaries), to establish the frequency and nature of literature consulted. Results: In 2011, SUH health personnel accessed 81,851 primary literature articles and visited UpToDate 110,336 times. Almost a third of the articles (24,529) accessed were reviews. Twenty percent (16,187) of the articles viewed were published in 2011. Conclusion: When it is available, health personnel in a clinical care setting frequently access the primary literature. While further studies are needed, this preliminary finding speaks to the value of the National Institutes of Health public access policy and the need for medical librarians and educators to prepare health personnel for increasing public access to medical research. PMID:23930091

Steinberg, Ryan M.; Moorhead, Laura; O'Brien, Bridget; Willinsky, John



Adherence to the Mediterranean dietary pattern and personality in patients attending a primary health center.  


Personality influences lifestyle behaviors, and particularly dietary behavior. The possible association of personality with adherence to the Mediterranean diet pattern (MDP) has not been reported. The objective of this study was to analyze the possible association of personality traits with adherence to the MDP, controlling for sociodemographic variables, presence of chronic illnesses, minor psychiatric morbidity, body mass index (BMI), daily smoking, and physical activity. This cross-sectional study included 206 patients, age 18 to 65 years, recruited at a primary health service in Granada, Spain, during 2007 to 2008. The participants answered a questionnaire, including sociodemographic characteristics, data on personality, and MDP. Personality was measured by the Temperament and Character Inventory (TCI-125). Adherence to MDP was measured using the validated 14-point Mediterranean Diet Adherence Screener (MEDAS). MEDAS score was directly associated with the character dimension of self-directedness, age, and minor psychiatric morbidity score; and inversely with marital status (widowed, separated, or divorced) and BMI. Because highly self-directed individuals may respond better to diet advice, consideration of personality may prove helpful in the design of interventions to enhance the adherence to MDP. To improve the adherence to MDP in interventions with patients with low self-directedness, more intensive professional support and counseling with tailored messages about the health benefits of MDP may be indicated. PMID:22709815

Jurado, Dolores; Burgos-Garrido, Emilia; Diaz, Francisco J; Martínez-Ortega, José M; Gurpegui, Manuel



Cyclin?dependent kinase inhibitor p21 does not impact embryonic endochondral ossification in mice.  


Endochondral ossification at the growth plate is regulated by a number of factors and hormones. The cyclin?dependent kinase inhibitor p21 has been identified as a cell cycle regulator and its expression has been reported to be essential for endochondral ossification in vitro. However, to the best of our knowledge, the function of p21 in endochondral ossification has not been evaluated in vivo. Therefore, the aim of this study was to investigate the function of p21 in embryonic endochondral ossification in vivo. Wild?type (WT) and p21 knockout (KO) pregnant heterozygous mice were sacrificed on embryonic days E13.5, E15.5 and E18.5. Sagittal histological sections of the forearms of the embryos were collected and stained with Safranin O and 5?bromo?2'?deoxyuridine (BrdU). Additionally, the expression levels of cyclin D1, type II collagen, type X collagen, Sox9, and p16 were examined using immunohistochemistry, and the expression levels of p27 were examined using immunofluorescence. Safranin O staining revealed no structural change between the cartilage tissues of the WT and p21KO mice at any time point. Type II collagen was expressed ubiquitously, while type X collagen was only expressed in the hypertrophic zone of the cartilage tissues. No differences in the levels of Sox9 expression were observed between the two groups at any time point. The levels of cyclin D1 expression and BrdU uptake were higher in the E13.5 cartilage tissue compared with those observed in the embryonic cartilage tissue at subsequent time points. Expression of p16 and p27 was ubiquitous throughout the tissue sections. These results indicate that p21 may not be essential for embryonic endochondral ossification in articular cartilage of mice and that other signaling networks may compensate for p21 deletion. PMID:25376471

Chinzei, Nobuaki; Hayashi, Shinya; Hashimoto, Shingo; Kanzaki, Noriyuki; Iwasa, Kenjiro; Sakata, Shuhei; Kihara, Shinsuke; Fujishiro, Takaaki; Kuroda, Ryosuke; Kurosaka, Masahiro



A germinal center-independent pathway generates unswitched memory B cells early in the primary response.  


Memory B cells can be produced from the classical germinal center (GC) pathway or a less understood GC-independent route. We used antigen-based cell enrichment to assess the relative contributions of these pathways to the polyclonal memory B cell pool. We identified a CD38(+) GL7(+) B cell precursor population that differentiated directly into IgM(+) or isotype-switched (sw) Ig(+) memory B cells in a GC-independent fashion in response to strong CD40 stimulation. Alternatively, CD38(+) GL7(+) B cell precursors had the potential to become Bcl-6(+) GC cells that then generated primarily swIg(+) memory B cells. These results demonstrate that early IgM(+) and swIg(+) memory B cells are products of a GC-independent pathway, whereas later switched Ig(+) memory B cells are products of GC cells. PMID:22370719

Taylor, Justin J; Pape, Kathryn A; Jenkins, Marc K



A germinal center–independent pathway generates unswitched memory B cells early in the primary response  

PubMed Central

Memory B cells can be produced from the classical germinal center (GC) pathway or a less understood GC-independent route. We used antigen-based cell enrichment to assess the relative contributions of these pathways to the polyclonal memory B cell pool. We identified a CD38+ GL7+ B cell precursor population that differentiated directly into IgM+ or isotype-switched (sw) Ig+ memory B cells in a GC-independent fashion in response to strong CD40 stimulation. Alternatively, CD38+ GL7+ B cell precursors had the potential to become Bcl-6+ GC cells that then generated primarily swIg+ memory B cells. These results demonstrate that early IgM+ and swIg+ memory B cells are products of a GC-independent pathway, whereas later switched Ig+ memory B cells are products of GC cells. PMID:22370719

Pape, Kathryn A.; Jenkins, Marc K.



Primary care program improves reimbursement. The Federally Qualified Health Center program helps hospitals improve services to the medically indigent.  


Under a program created by Congress in 1989, certain primary care treatment centers serving the medically and economically indigent can become Federally Qualified Health Centers (FQHCs). Recently enacted rules and regulations allow participants in the FQHC program to receive 100 percent reasonable cost reimbursement for Medicaid services and 80 percent for Medicare services. An all-inclusive annual cost report is the basis for determining reimbursement rates. The report factors in such expenses as physician and other healthcare and professional salaries and benefits, medical supplies, certain equipment depreciation, and overhead for facility and administrative costs. Both Medicaid and Medicare reimbursement is based on an encounter rate, and states employ various methodologies to determine the reimbursement level. In Illinois, for example, typical reimbursement for a qualified encounter ranges from $70 to $88. To obtain FQHC status, an organization must demonstrate community need, deliver the appropriate range of healthcare services, satisfy management and finance requirements, and function under a community-based governing board. In addition, an FQHC must provide primary healthcare by physicians and (where appropriate) midlevel practitioners; it must also offer its community diagnostic laboratory and x-ray services, preventive healthcare and dental care, case management, pharmacy services, and arrangements for emergency services. Because FQHCs must be freestanding facilities, establishing them can trigger a number of ancillary legal issues, such as those involved in forming a new corporation, complying with not-for-profit corporation regulations, applying for tax-exempt status, and applying for various property and sales tax exemptions. Hospitals that establish FQHCs must also be prepared to relinquish direct control over the delivery of primary care services. PMID:10124301

Fahey, T M; Gallitano, D G



Assessment of general characteristics of patients with primary metastatic breast carcinoma: single center experience  

PubMed Central

Introduction Breast cancer (BC) is a heterogeneous disease. Several subgroups have been identified, according to the clinical presentation and radiographic, pathological, biological, and molecular characteristics of the tumor. Intrinsic genetic heterogeneity may be responsible for these differences. To date, little is known about the clinical features and outcome of patients with primary metastatic BC (PMBC) defined as those presenting with stage IV disease. Material and methods Between September 2007 and May 2011, BC patients who were admitted to a clinic were assessed. Patients with PMBC were included in this retrospective analysis. The patients’ demographic characteristics, treatment schedules, and survival data were recorded. Results Of 2478 BC patients, 102 (4.1%) with PMBC were included in the analysis. The median age of the patients was 50 (26–90) years. Only four patients (3.9%) had previously undergone mammography. The median progression-free survival (PFS) and overall survival (OS) were 30 and 66 months, respectively. The PFS and OS were unaffected by age, menopausal status, ECOG, histology, or tumor grade. Both PFS and OS were affected by HR status (log rank p = 0.006, log rank p = 0.04), HER2 status (p = 0.001, p = 0.005), site of metastasis (p = 0.01, p = 0.04), radiotherapy (p = 0.04, OS p = 0.03), and bisphosphonate treatment (p = 0.02, p = 0.006). PFS was greater in the hormone therapy group (43 months, p = 0.03) while OS was greater in the patients that received chemotherapy (76 months, p = 0.01). Conclusions Mammography should be given greater emphasis, considering its importance in the prevention of PMBC. As a treatment option for bone and soft tissue metastatic PMBC patients, hormone therapy should be effective as a first-line treatment. PMID:24596535

Budakoglu, Burcin; Turker, ?brahim; Helvaci, Kaan; Sonmez, Ozlem Uysal; Aktas, Gulali; Arslan, Ulku Yalcintas; Oksuzoglu, Omur Berna Cakmak



Family centered approach in primary health care: experience from an urban area of mangalore, India.  


Introduction. "Health for All" still eludes public health experts despite many approaches to prevent disease and promote health among urban poor. Several key illness factors lie beyond the conventional healthcare boundaries. Objective. To examine the effectiveness of family centered approach (FCA) in addressing health and related issues in an urban area of Mangalore, India. Method. A longitudinal study was conducted in Bengre, an outreach centre of Mangalore from June 2011 to November 2013. Family folders were created with pertinent details. Demand generation and health education activities were conducted through two female community health link workers. An FCA package was implemented by medical and nursing interns, under supervision, to address the priority issues. Effect was assessed by comparing their practices and service utilization before and after the study. Results. About 809 families participated in this study. Social, cultural, and religious factors were responsible for viciousness of malaria and maternal and child health issues. FCA improved their perceptions and practices towards health and related issues. Significant (P < 0.05) and sustained hike in service utilization was evident. Conclusion. FCA exposes key illness factors beyond the conventional care, eases need based healthcare implementation, and provides feasible and enduring solutions. Community involvement makes it more practicable. PMID:25695098

Shivalli, Siddharudha; Majra, J P; Akshaya, K M; Qadiri, Ghulam Jeelani



Wavelength and intensity dependent primary photochemistry of isolated Photosystem II reaction centers at 5°C  

NASA Astrophysics Data System (ADS)

The long wavelength absorption band of the isolated Photosystem II reaction center was directly excited at five wavelengths between 655 and 689 nm to study the effects of excitation wavelength and intensity on both excitation energy transfer and charge separation processes. Subpicosecond transient absorption measurements were made monitoring principally the bleach of the pheophytin a Q x band at 544 nm. At all pump wavelengths, the kinetics require three exponentials (1-3, 10-25 and 50-100 ps) to be fit properly. The pump energy was varied by a factor of twenty-five (40-1000 nJ), with no apparent effect on either the rates or the amplitude ratios of the three components, although clear evidence of nonlinear behavior was observed at the higher excitation energies. The dependence of both the rates and amplitude ratios of the three components upon pump wavelength will be discussed in terms of excitation energy transfer occurring on a 30 ps timescale. Selective excitation into the short and long-wavelength sides of the composite Q y band give identical transient spectra at 500 ps, indicating near-unity efficiency of excitation energy transfer. At 1 ps, the spectra are quite different, calling into question the extent of ultrafast (˜ 100 fs) excitation energy transfer. The time after the excitation pulse at which the transient crosses ?A = 0 was found to be a highly sensitive measure of both the excitation energy and the identity of the pigment pool that had been excited.

Greenfield, Scott R.; Seibert, Michael; Govindjee; Wasielewski, Michael R.



Family Centered Approach in Primary Health Care: Experience from an Urban Area of Mangalore, India  

PubMed Central

Introduction. “Health for All” still eludes public health experts despite many approaches to prevent disease and promote health among urban poor. Several key illness factors lie beyond the conventional healthcare boundaries. Objective. To examine the effectiveness of family centered approach (FCA) in addressing health and related issues in an urban area of Mangalore, India. Method. A longitudinal study was conducted in Bengre, an outreach centre of Mangalore from June 2011 to November 2013. Family folders were created with pertinent details. Demand generation and health education activities were conducted through two female community health link workers. An FCA package was implemented by medical and nursing interns, under supervision, to address the priority issues. Effect was assessed by comparing their practices and service utilization before and after the study. Results. About 809 families participated in this study. Social, cultural, and religious factors were responsible for viciousness of malaria and maternal and child health issues. FCA improved their perceptions and practices towards health and related issues. Significant (P < 0.05) and sustained hike in service utilization was evident. Conclusion. FCA exposes key illness factors beyond the conventional care, eases need based healthcare implementation, and provides feasible and enduring solutions. Community involvement makes it more practicable. PMID:25695098

Majra, J. P.; Akshaya, K. M.; Qadiri, Ghulam Jeelani



The Use and Implementation of Interactive Writing as an Instructional Method for Primary Teachers in Texas Educational Service Center Region 2  

ERIC Educational Resources Information Center

This doctoral study investigated the use and implementation of interactive writing as an instructional method for primary teachers in Texas Educational Service Center Region 2. The descriptive study involved 152 survey respondents and eight interview participants. The primary instrument was a questionnaire (Interactive Writing Survey) that…

Fabela, Rachelle M.



Radiographic monitoring of the ossification of long bones in kori (Ardeotis kori) and white-bellied (Eupodotis senegalensis) bustards.  


A serial radiographic study was conducted on eight kori bustard (Ardeotis kori) and four white-bellied bustard (Eupodotis senegalensis) chicks to determine the pattern of long bone development and to establish radiographic standards for assessing skeletal maturity. The ossification pattern, appearance of secondary ossification centres, and epiphyseal fusion of the long bones in kori and white-bellied bustards were similar to those in houbara bustards (Chlamydotis undulata macqueenii), rufous-crested bustards (Eupodotis ruficrista), domestic fowl (Gallus gallus), house wrens (Troglodytes aedon aedon), racing pigeons (Columba livia). and barn owls (Tyto alba). Secondary ossification centres were present at the proximal and distal tibiotarsus, proximal tarsometatarsus and proximal metacarpal III. The ossification of long bones occurred earlier in female kori bustards compared with males. PMID:9839896

Naldo, J L; Samour, J H; Bailey, T A



Cervical Ossification of Posterior Longitudinal Ligament in X-Linked Hypophosphatemic Rickets Revealing Homogeneously Increased Vertebral Bone Density  

PubMed Central

There is no report that describes in detail the radiological and intraoperative findings of rickets with symptomatic cervical ossification of the posterior longitudinal ligament. Here, we describe a case of X-linked hypophosphatemic rickets with cervical ossification of the posterior longitudinal ligament presenting unique radiological and intraoperative findings. The patient presented progressive tetraparesis. Magnetic resonance imaging studies revealed severe cervical spinal cord compression caused by ossification of the posterior longitudinal ligament. Computed tomography scans revealed homogeneously increased vertebral bone density. An expansive laminoplasty was performed. At surgery, homogeneously hard lamina bone was burdened in drilling and opening of the laminae. The patient's neurological symptoms were improved postoperatively. Bony fusion of the hinges occurred postoperatively. Therefore, expansive laminoplasty could be performed for symptomatic cervical ossification of the posterior longitudinal ligament with X-linked hypophosphatemic rickets. However, unusual bone characters should be taken into consideration for careful operation during surgery. PMID:25705343

Mizuno, Masaki; Kuraishi, Keita; Suzuki, Hidenori



Cancer risk estimates from radiation therapy for heterotopic ossification prophylaxis after total hip arthroplasty  

SciTech Connect

Purpose: Heterotopic ossification (HO) is a frequent complication following total hip arthroplasty. This study was conducted to calculate the radiation dose to organs-at-risk and estimate the probability of cancer induction from radiotherapy for HO prophylaxis.Methods: Hip irradiation for HO with a 6 MV photon beam was simulated with the aid of a Monte Carlo model. A realistic humanoid phantom representing an average adult patient was implemented in Monte Carlo environment for dosimetric calculations. The average out-of-field radiation dose to stomach, liver, lung, prostate, bladder, thyroid, breast, uterus, and ovary was calculated. The organ-equivalent-dose to colon, that was partly included within the treatment field, was also determined. Organ dose calculations were carried out using three different field sizes. The dependence of organ doses upon the block insertion into primary beam for shielding colon and prosthesis was investigated. The lifetime attributable risk for cancer development was estimated using organ, age, and gender-specific risk coefficients.Results: For a typical target dose of 7 Gy, organ doses varied from 1.0 to 741.1 mGy by the field dimensions and organ location relative to the field edge. Blocked field irradiations resulted in a dose range of 1.4–146.3 mGy. The most probable detriment from open field treatment of male patients was colon cancer with a high risk of 564.3 × 10{sup ?5} to 837.4 × 10{sup ?5} depending upon the organ dose magnitude and the patient's age. The corresponding colon cancer risk for female patients was (372.2–541.0) × 10{sup ?5}. The probability of bladder cancer development was more than 113.7 × 10{sup ?5} and 110.3 × 10{sup ?5} for males and females, respectively. The cancer risk range to other individual organs was reduced to (0.003–68.5) × 10{sup ?5}.Conclusions: The risk for cancer induction from radiation therapy for HO prophylaxis after total hip arthroplasty varies considerably by the treatment parameters, organ site in respect to treatment volume and patient's gender and age. The presented risk estimates may be useful in the follow-up studies of irradiated patients.

Mazonakis, Michalis; Berris, Theoharris; Damilakis, John [Department of Medical Physics, Faculty of Medicine, University of Crete, P.O. Box 2208, 71003 Iraklion, Crete (Greece)] [Department of Medical Physics, Faculty of Medicine, University of Crete, P.O. Box 2208, 71003 Iraklion, Crete (Greece); Lyraraki, Efrossyni [Department of Radiotherapy and Oncology, University Hospital of Iraklion, 71110 Iraklion, Crete (Greece)] [Department of Radiotherapy and Oncology, University Hospital of Iraklion, 71110 Iraklion, Crete (Greece)



Primary cutaneous follicle center lymphoma with Hodgkin and Reed-Sternberg-like cells: a new histopathologic variant.  


Primary cutaneous follicle center lymphoma (PCFCL) is the most frequent cutaneous B-cell lymphoma. A 62-year-old man presented with a solitary indolent subcutaneous nodule for 3 years duration, without other abnormalities. Histological examination showed lymphoproliferation with a nodular growth pattern characterized by fibrous collagen bands surrounding nodules. The nodules were composed of medium-sized centrocytes admixed with many large multilobulated and lacunar cells without eosinophils or granulomatous aspect. Hodgkin-like cells were CD30+, CD15+, PAX5+, OCT2+, BOB1+, MUM1+, Ki67+, Bcl6+ and focally CD20+ and EMA-, CD79a-, Bcl2- and CD10-. The medium-sized cells were CD20+, CD79a+, Bcl2+, Bcl6+ and CD10+, enmeshed in a network of CD21-positive follicular dendritic cells. Epstein-Barr virus detection was negative. Interphase fluorescence in situ hybridization showed the absence of BCL2 or BCL6 rearrangement. In such a case, the presence of Hodgkin-like cells intermixed with the tumor population may result in a pitfall diagnosis of classical Hodgkin lymphoma (CHL). Differential diagnoses to be ruled out are secondary or primary skin localization of rather CHL, or systemic follicular lymphoma. Several clinical, radiological, histological, immunohistochemical and molecular arguments indicated the diagnosis of PCFCL. To our knowledge, this is the first report of PCFCL with Hodgkin-like cells. PMID:25099172

Marie, Dilly; Houda, Ben-Rejeb; Béatrice, Vergier; Matthieu, Feldis; Louis, Toty; Olivier, Nohra; Marie, Beylot-Barry; Audrey, Gros; Jean-Philippe, Merlio; Marie, Parrens



Patient-Centered Care: The Influence of Patient and Resident Physician Gender and Gender Concordance in Primary Care  

PubMed Central

Abstract Background Patient-centered care (PCC) is thought to significantly influence the process of care and its outcomes and has been identified as part of a comprehensive strategy for improving our nation's healthcare delivery system. Patient and physician gender, as well as gender concordance, may influence the provision of PCC. Methods Patients (315 women, 194 men) were randomized to care by primary care resident physicians (48 women, 57 men). Sociodemographic information, history of health risk behaviors (tobacco use, alcoholism, and obesity), and self-reported global pain and health status were collected before the first visit. That visit and subsequent patient visits to the primary care physician (PCP) were videotaped during the year-long study period. PCC was measured by coding all videotapes using a modified version of the Davis Observation Code. Results No significant gender differences in PCC were found between the male and female patients; however, female physicians provided increased PCC to their patients. The greatest amount of PCC was seen in the female patient-female physician gender dyad. Regression analyses, controlling for other patient variables, confirmed that female concordant dyads were associated with a greater amount of PCC. There was no significant relationship for the male patient-male physician concordance (vs. disconcordance). Conclusions These findings highlight the influence of gender in the process of care and provision of PCC. Gender concordance in female patient-female physician dyads demonstrated significantly more PCC. Further research in other clinical settings using other measures of PCC is needed. A public mandate to provide care that is patient-centered has implications for medical education. PMID:22150099

Azari, Rahman



Reoperations for Persistent or Recurrent Primary Hyperparathyroidism: Results of a Retrospective Cohort Study at a Tertiary Referral Center  

PubMed Central

Background Parathyroid reoperations are challenging and achieving a cure requires multidisciplinary treatment team cooperation. The aims of this study were to summarize our experience in revision surgery for persistent (pHPT) or recurrent primary hyperparathyroidism (rHPT) and to explore factors underlying failure to cure at initial surgery. Material/Methods This was a retrospective cohort study of patients who underwent reoperations for pHPT or rHPT at a tertiary referral center. The database of parathyroid surgery was searched for eligible patients (treated in the years 2000–2012). The primary outcome was the cure rate. All the patients were followed-up for at least 12 months postoperatively. Factors underlying failure to cure at initial surgery were reviewed based on hospital records. Results The study group comprised 88 patients (69 women, 19 men) operated on for persistent (n=57) or recurrent disease (n=31), who underwent 98 reoperations, including 26 (2.4%) patients first operated on at our institution, and 72 (81.8%) patients operated on elsewhere, but referred for revision surgery. A long-term cure was achieved in 83/88 patients (94.3%). The mean post-reoperation follow-up was 91.7 (12–176) months. Missed hyperfunctioning parathyroid gland was found on reoperation in eutopic position in 49 (55.5%) patients, and in ectopic position in 39 (44.3%) patients, including 20 (22.7%) cases of cervical ectopy and 19 (21.6%) cases of mediastinal ectopy. Conclusions Multidisciplinary treatment team cooperation at a tertiary referral center, consisting of an accurate preoperative localization, expertise in parathyroid re-explorations, and correct use of intraoperative adjuncts, contribute to the high success rate of parathyroid reoperations. PMID:25201515

Nawrot, Ireneusz; Chudzi?ski, Witold; Ci??ka, Tomasz; Barczy?ski, Marcin; Szmidt, Jacek



Intra-Articular Giant Heterotopic Ossification following Total Knee Arthroplasty for Charcot Arthropathy  

PubMed Central

Although the Charcot arthropathy may be associated with serious complications, total knee arthroplasty (TKA) is the preferred choice of treatment by patients. This case report presents an 80-year-old man with intra-articular giant heterotopic ossification following loosening of femoral and tibial implants and femoral condylar fracture. He had undergone TKA because of Charcot neuropathy seven years ago and had been doing well since. Immediately after a left knee sprain, he became unable to walk. Because he had developed a skin ulcer on his left calf where methicillin-resistant Staphylococcus aureus was detected, we postponed revision surgery until the ulcer was completely healed. While waiting, intra-articular bony fragments grew larger and formed giant heterotopic ossified masses. Eventually, the patient underwent revision surgery, and two major ossified masses were carefully and successfully extirpated. It should be noted that intra-articular heterotopic giant ossification is a significant complication after TKA for neuropathic arthropathy. PMID:24151574

Tsuge, Shintaro; Aoki, Yasuchika; Sonobe, Masato; Shibata, Yoshifumi; Sasaki, Yu; Nakagawa, Koichi



Pycnodysostosis with Multi-Segmental Spinal Canal Stenosis due to Ossification of the Yellow Ligament  

PubMed Central

Pycnodysostosis is an autosomal recessive disorder characterized by osteosclerosis, small stature, acro-osteolysis of the distal phalanges, loss of the mandibular angle, separated cranial sutures with open fontanels, and frequent fractures. One identified cause of the disease is reduced activity of the cysteine protease cathepsin K. A 48-year-old woman with a history of frequent fractures presented with a severe gait disturbance. Radiography, computed tomography, magnetic resonance imaging, and gene analysis were performed. Physical examination revealed open fontanels, and radiographs showed increased bone density. DNA sequence analysis revealed a deletion mutation of the cathepsin K gene. We diagnosed pycnodysostosis based on these findings. The magnetic resonance and computed tomography images demonstrated multilevel spinal canal stenosis due to ossification of the yellow ligament. We performed a laminectomy, and the patient's neurological signs and symptoms improved. To our knowledge, this is the first case of pycnodysostosis with ossification of the yellow ligament.

Kanaya, Koichi; Murata, Yasuaki; Kato, Yoshiharu



Primary Cutting Balloon Angioplasty for Treatment of Venous Stenoses in Native Hemodialysis Fistulas: Long-Term Results from Three Centers  

Microsoft Academic Search

Aim. To evaluate the technical success and patency rates following primary cutting balloon angioplasty for venous stenoses in native dialysis fistulas. Methods. Forty-one patients (26 men, 15 women; age range 26-82 years, average age 59 years) underwent 50 (repeat procedures in 9 patients) primary cutting balloon (PCB) angioplasty procedures in three institutions by three primary operators. The indication was primary

Rajesh Bhat; Kieran McBride; Sam Chakraverty; Raghunandan Vikram; Alison Severn



[Calcification and ossification of the posterior and longitudinal ligament of the cervical spine(author's transl)].  


Three patients with calcification or ossification of the posterior longitudinal ligament of the cervical spine are described. This abnormality is very common in Japan. Descriptions from non-Japanese sources vary considerably. The practical significance of this abnormality consists of narrowing of the spinal canal, which may result in a myelopathy. Two of our patients are Chinese, the third was a white Dutchman. PMID:125690

Orth, J O



Absence of Endochondral Ossification and Craniosynostosis in Posterior Frontal Cranial Sutures of Axin2?/? Mice  

PubMed Central

During the first month of life, the murine posterior-frontal suture (PF) of the cranial vault closes through endochondral ossification, while other sutures remain patent. These processes are tightly regulated by canonical Wnt signaling. Low levels of active canonical Wnt signaling enable endochondral ossification and therefore PF-suture closure, whereas constitutive activation of canonical Wnt causes PF-suture patency. We therefore sought to test this concept with a knockout mouse model. PF-sutures of Axin2?/? mice, which resemble a state of constantly activated canonical Wnt signaling, were investigated during the physiological time course of PF-suture closure and compared in detail with wild type littermates. Histological analysis revealed that the architecture in Axin2?/? PF-sutures was significantly altered in comparison to wild type. The distance between the endocranial layers was dramatically increased and suture closure was significantly delayed. Moreover, physiological endochondral ossification did not occur, rather an ectopic cartilage appeared between the endocranial and ectocranial bone layers at P7 which eventually involutes at P13. Quantitative PCR analysis showed the lack of Col10?1 upregulation in Axin2?/? PF-suture. Immunohistochemistry and gene expression analysis also revealed high levels of type II collagen as compared to type I collagen and absence of Mmp-9 in the cartilage of Axin2?/? PF-suture. Moreover, TUNEL staining showed a high percentage of apoptotic chondrocytes in Axin2?/? PF-sutures at P9 and P11 as compared to wild type. These data indicated that Axin2?/? PF-sutures lack physiological endochondral ossification, contain ectopic cartilage and display delayed suture closure. PMID:23936395

Behr, Björn; Longaker, Michael T.; Quarto, Natalina



Runx2 regulates endochondral ossification through control of chondrocyte proliferation and differentiation.  


Synthesis of cartilage by chondrocytes is an obligatory step for endochondral ossification. Global deletion of the Runx2 gene results in complete failure of the ossification process, but the underlying cellular and molecular mechanisms are not fully known. Here, we elucidated Runx2 regulatory control distinctive to chondrocyte and cartilage tissue by generating Runx2 exon 8 floxed mice. Deletion of Runx2 gene in chondrocytes caused failure of endochondral ossification and lethality at birth. The limbs of Runx2(?E8/?E8) mice were devoid of mature chondrocytes, vasculature, and marrow. We demonstrate that the C-terminus of Runx2 drives its biological activity. Importantly, nuclear import and DNA binding functions of Runx2 are insufficient for chondrogenesis. Molecular studies revealed that despite normal levels of Sox9 and PTHrP, chondrocyte differentiation and cartilage growth are disrupted in Runx2(?E8/?E8) mice. Loss of Runx2 in chondrocytes also impaired osteoprotegerin-receptor activator of NF-?B ligand (OPG-RANKL) signaling and chondroclast development. Dwarfism observed in Runx2 mutants was associated with the near absence of proliferative zone in the growth plates. Finally, we show Runx2 directly regulates a unique set of cell cycle genes, Gpr132, Sfn, c-Myb, and Cyclin A1, to control proliferative capacity of chondrocyte. Thus, Runx2 is obligatory for both proliferation and differentiation of chondrocytes. PMID:24862038

Chen, Haiyan; Ghori-Javed, Farah Y; Rashid, Harunur; Adhami, Mitra D; Serra, Rosa; Gutierrez, Soraya E; Javed, Amjad



Variation in mammalian proximal femoral development: comparative analysis of two distinct ossification patterns  

PubMed Central

The developmental anatomy of the proximal femur is complex. In some mammals, including humans, the femoral head and greater trochanter emerge as separate ossification centres within a common chondroepiphysis and remain separate throughout ontogeny. In other species, these secondary centres coalesce within the chondroepiphysis to form a single osseous epiphysis much like the proximal humerus. These differences in femoral ontogeny have not been previously addressed, yet are critical to an understanding of femoral mineralization and architecture across a wide range of mammals and may have key implications for understanding and treating hip abnormalities in humans. We evaluated femora from 70 mammalian species and categorized each according to the presence of a ‘separate’ or ‘coalesced’ proximal epiphysis based on visual assessment. We found that ossification type varies widely among mammals: taxa in the ‘coalesced’ group include marsupials, artiodactyls, perissodactyls, bats, carnivores and several primates, while the ‘separate’ group includes hominoids, many rodents, tree shrews and several marine species. There was no clear relationship to body size, phylogeny or locomotion, but qualitative and quantitative differences between the groups suggest that ossification type may be primarily an artefact of femoral shape and neck length. As some osseous abnormalities of the human hip appear to mimic the normal morphology of species with coalesced epiphyses, these results may provide insight into the aetiology and treatment of human hip disorders such as femoroacetabular impingement and early-onset osteoarthritis. PMID:17331175

Serrat, Maria A; Reno, Philip L; McCollum, Melanie A; Meindl, Richard S; Lovejoy, C Owen



Making Pregnancy Safer—Birth Preparedness and Complication Readiness Study Among Antenatal Women Attendees of A Primary Health Center, Delhi  

PubMed Central

Background: Every pregnancy is a joyful moment for all mothers who dream of a safe pregnancy and a healthy baby. However, every pregnant woman faces the risk of sudden, unpredictable complications that could end in death or injury to herself or to her infant. Birth preparedness and complication readiness (BPACR) is a strategy that encourages pregnant women, their families, and communities to effectively plan for births and deal with emergencies, if they occur. It is a key component of globally accepted safe motherhood programs. Objectives: The objective of our study was to assess the status of BPACR among pregnant women and to study the socio-demographic factors affecting BPACR. Materials and Methods: We conducted a facility-based cross-sectional study among 417 antenatal attendees at a primary health center, Palam, New Delhi from January to April 2012. Knowledge about danger signs, planning for transport, place, and delivery by skilled birth attendant, financial management, and outcome were assessed. BPACR index was calculated. Results: Our study revealed that the BPACR index was very low (41%) although the preparedness level was high. Majority (81.1%) had identified a skilled attendant at birth for delivery. Nearly half of the women (48.9%) had saved money for delivery and 44.1% women had also identified a mode of transportation for the delivery. However, only 179 (42.9%) women were aware about early registration of pregnancy. Only one-third (33.1%) of women knew about four or more antenatal visits during pregnancy. Overall, only 27.8% women knew about any one danger sign of pregnancy. Conclusion: The level of awareness regarding BPACR was very low (41%). Efforts should be targeted to increase the awareness regarding components of BPACR among pregnant women and their families at the Primary Health Center (PHC) as well as at the community level. This will indeed go a long way in reducing morbidity as well as mortality in pregnant women, thus enabling us to reach the millennium development goal.

Acharya, Anita Shankar; Kaur, Ravneet; Prasuna, Josyula Gnana; Rasheed, Nazish



Terminal phalangeal accessory ossification center of the thumb: an additional radiographic finding in Larsen syndrome  

Microsoft Academic Search

Larsen syndrome is an autosomal-dominant disorder characterized by multiple joint dislocations, vertebral anomalies and dysmorphic facies. Both autosomal-dominant and autosomal-recessive forms of the disorder have been proposed. Individuals with autosomal-dominant Larsen syndrome have characteristic “cylindrical-shape” thumbs caused by broad, shortened phalanges. Autosomal-dominant Larsen syndrome results from heterozygosity for mutations in filamin B, a cytoskeletal protein involved in multicellular processes. We

Yasemin Alanay; Gulen Eda Utine; Ralph S. Lachman; Deborah Krakow; Ergul Tuncbilek



Radiology of postnatal skeletal development  

Microsoft Academic Search

Thirty-six manubriosternal composites from skeletally immature cadavers were examined morphologically and radiographically. Sternebral ossification followed certain patterns. The manubrium (first sternebra) usually had one primary ossification center and one or two smaller centers. These usually were caudad to the major center (longitudinally bifid). The second sternebra invariably had only one ossification center. The third and fourth sternebrae had latitudinal (right-left)

John A. Ogden; Gerald J. Conlogue; Mary L. Bronson; Pamela S. Jensen



Evaluation and Comparison of Changes in Microhardness of Primary and Permanent Enamel on Exposure to Acidic Center-filled Chewing Gum: An in vitro Study  

PubMed Central

ABSTRACT Objectives: The study is to evaluate changes in microhardness of enamel after exposure to acidic center filled chewing gum on primary and permanent teeth. Methods: Thirty primary and 30 permanent molar extracted teeth were painted with acid resistant varnish except a small window over buccal surface. Teeth were divided into four groups according to type of teeth and type of chewing gum (Center fresh and Bubbaloo) (D1, P1, D2 and P2); each tooth was exposed to whole chewing gum mashed with 5 ml of artificial saliva for five minutes at room temperature twice a day for 5 days. After the exposure, teeth were stored in deionized water and submitted for microhardness tests. Results: Paired t-test and independent sample t-test were used for statistical analysis. A significant reduction in microhardness was found between exposed and unexposed areas in all groups. There was no statistically significant difference in reduction of microhardness to chewing gums, and between primary and permanent enamel. Conclusion: There is a definite reduction in microhardness in all groups exposed to chewing gums. Both the chewing gums are equally erosive; both permanent and primary teeth were affected. How to cite this article: Mudumba VL, Muppa R, Srinivas NCH, Kumar DM. Evaluation and Comparison of Changes in Microhardness of Primary and Permanent Enamel on Exposure to Acidic Center-filled Chewing Gum: An in vitro Study. Int J Clin Pediatr Dent 2014;7(1):24-29. PMID:25206233

Muppa, Radhika; Srinivas, NCH; Kumar, Duddu Mahesh



Efficacy and safety of rituximab treatment in early primary Sjögren's syndrome: a prospective, multi-center, follow-up study  

PubMed Central

Introduction Primary Sjögren’s syndrome (pSS) is an autoimmune disorder affecting exocrine glands; however, a subgroup of pSS patients experience systemic extra-glandular involvement leading to a worsening of disease prognosis. Current therapeutic options are mainly empiric and often translated by other autoimmune diseases. In the last few years growing evidence suggests that B-cell depletion by rituximab (RTX) is effective also in pSS. Patients with early active disease appear to be those who could benefit the most from RTX. The aim of this study was to investigate the efficacy and safety of RTX in comparison to disease modifying anti-rheumatic drugs (DMARDs) in early active pSS patients. Methods Forty-one patients with early pSS and active disease (EULAR Sjogren’s syndrome disease activity index, ESSDAI???6) were enrolled in the study. Patients were treated with either RTX or DMARDs in two different Rheumatology centers and followed up for 120 weeks. Clinical assessment was performed by ESSDAI every 12 weeks up to week 120 and by self-reported global disease activity pain, sicca symptoms and fatigue on visual analogic scales, unstimulated saliva flow and Schirmer’s I test at week 12, 24, 48, 72, 96, and 120. Laboratory assessment was performed every 12 weeks to week 120. Two labial minor salivary gland (MSG) biopsies were obtained from all patients at the time of inclusion in the study and at week 120. Results Our study demonstrated that RTX treatment results in a faster and more pronounced decrease of ESSDAI and other clinical parameters compared to DMARDs treatment. No adverse events were reported in the two groups. We also observed that RTX is able to reduce glandular infiltrate, interfere with B/T compartmentalization and consequently with the formation of ectopic lymphoid structures and germinal center-like structures in pSS-MSGs. Conclusions To our knowledge, this is the first study performed in a large cohort of early active pSS patients for a period of 120 weeks. We showed that RTX is a safe and effective agent to be employed in pSS patients with systemic, extra-glandular involvement. Furthermore, our data on pSS-MSGs provide additional biological basis to employ RTX in this disease. PMID:24286296



Heterodimeric versus homodimeric structure of the primary electron donor in Rhodobacter sphaeroides reaction centers genetically modified at position M202.  


Using light-induced Fourier-transform infrared (FTIR) difference spectroscopy of the photo-oxidation of the primary donor (P) in chromatophores from Rhodobacter sphaeroides, we examined a series of site-directed mutants with His M202 changed to Gly, Ser, Cys, Asn or Glu in order to assess the ability of these side chains to ligate the Mg atom of one of the two bacteriochlorophylls (BChl) constituting P. In the P+QA-/PQA FTIR difference spectra of the mutants HG(M202), HS(M202), HC(M202) and HN(M202), the presence of a specific electronic transition at approximately 2650-2750 cm-1 as well as of associated vibrational (phase-phonon) bands at approximately 1560, 1480 and 1290 cm-1 demonstrate that these mutants contain a BChl/BChl homodimer like that in native reaction centers with the charge on P+ shared between the two coupled BChl. In contrast, the absence of all of these bands in HE(M202) shows that this mutant contains a BChl/bacteriopheophytin heterodimer with the charge localized on the single BChl, as previously determined for the mutant HL(M202). Furthermore, the spectra of the heterodimers HE(M202) and HL(M202) are very similar in the 4000-1200 cm-1 IR range. Perturbations of the 10a-ester and 9-keto carbonyl modes for both the P and P+ states are observed in the homodimer mutants reflecting slight variations in the conformation and/or in position of P. These perturbations are likely to be due to a repositioning of the dimer in the new protein cavity generated by the mutation. PMID:10818789

Nabedryk, E; Schulz, C; Müh, F; Lubitz, W; Breton, J



Primary Cutting Balloon Angioplasty for Treatment of Venous Stenoses in Native Hemodialysis Fistulas: Long-Term Results from Three Centers  

Microsoft Academic Search

Aim  To evaluate the technical success and patency rates following primary cutting balloon angioplasty for venous stenoses in native\\u000a dialysis fistulas.\\u000a \\u000a \\u000a \\u000a Methods  Forty-one patients (26 men, 15 women; age range 26–82 years, average age 59 years) underwent 50 (repeat procedures in 9 patients)\\u000a primary cutting balloon (PCB) angioplasty procedures in three institutions by three primary operators. The indication was\\u000a primary stenosis in

Rajesh Bhat; Kieran McBride; Sam Chakraverty; Raghunandan Vikram; Alison Severn



Patterns of postcranial ossification and sequence heterochrony in bats: life histories and developmental trade-offs.  


The recently increased interest in studies on sequence heterochrony has uncovered developmental variation between species. However, how changes in developmental program are related to shifts in life-history parameters remains largely unsolved. Here we provide the most comprehensive data to date on postcranial ossification sequence of bats and compare them to various boreoeutherian mammals with different locomotive modes. Given that bats are equipped with an elongated manus, we expected to detect characteristic heterochronies particularly related to wing development. Although heterochronies related to wing development were confirmed as predicted, unexpected heterochronies regarding the pedal digits were also found. The timing of ossification onset of pedal phalanges is earlier than other mammals. Particularly, bats deviate from others in that pedal phalanges initiate ossification earlier than manual phalanges. It is known that the foot size of new born bats is close to that of adults, and that it takes several weeks to month until the wing is developed for flight. Given that the foot is required to be firm and stable enough at the time of birth to allow continued attachment to the mother and/or cave walls, we suggest that the accelerated development of the hind foot is linked to their unique life history. Since the forelimb is not mature enough for flight at birth and requires extended postnatal time to be large enough to be fully functional, we postulate that bats invest in earlier development of the hindlimb. We conclud that energy allocation trade-offs can play a significant role in shaping the evolution of development. PMID:24863050

Koyabu, Daisuke; Son, Nguyen Truong



Heterotopic ossification and cubital tunnel syndrome in traumatic brain injury: Ultrasound 'sees' both.  


Reported here is a 50-year-old man with cubital tunnel syndrome due to heterotopic ossification after traumatic braininjury. Herein, underscoring the role of ultrasonographic evaluations in the diagnosis of our patient, we suggest that ultrasono-graphic imaging can be a useful first-line diagnostic method for the possibility of HO and its complications. Further, due to itshigh spatial resolution, lack of radiation and easy applicability, we imply that US seems to overweigh in the daily practice ofrehabilitation physicians. PMID:25159289

Kara, Murat; Yalç?n, Süha; Yenigün, Didem; Tiftik, Tülay; Malas, Fevziye Ünsal; Özçakar, Levent



Prophylactic radiotherapy against heterotopic ossification following internal fixation of acetabular fractures: a comparative estimate of risk  

E-print Network

surgery and RT of 9% compared to 18% for indometacin [6], and 4% versus 11% [8] have been reported. Sixteen patients who did not receive prophylaxis all developed HO, 38% with grade III or IV [8]. In a meta-analysis based on 5 prospective studies... Oncol Biol Phys. 1997; 39(5): 961–6. 6. Moore KD, Goss K, Anglen JO. Indometacin versus radiation therapy for prophylaxis against heterotopic ossification in acetabular fractures: a randomised, prospective study. J Bone Joint Surg Br. 1998; 80...

Burnet, N. G.; Nasr, P.; Yip, G.; Scaife, J. E.; House, T.; Thomas, S. J.; Harris, F.; Owen, P. J.; Hull, P.



L5 radiculopathy caused by ossification of the ligamentum flavum: a case report.  


We describe a case of ossification of the ligamentum flavum in the thoracolumbar junction presenting as an L5 radiculopathy. Magnetic resonance imaging revealed a hypodense lesion on T2-weighted image at the T10-T12 level causing the right dural sac compression, and electrodiagnostic findings were compatible with the right L5 radiculopathy. The location and cause of the compression were confirmed by a surgery. The clinical findings and electrodiagnostic features of such lesions located at the thoracolumbar spinal junction are discussed. PMID:15224816

Kim, Dai-Youl; Paik, Nam-Jong; Han, Tai Ryoon



Genomic study of ossification of the posterior longitudinal ligament of the spine  

PubMed Central

Ossification of the posterior longitudinal ligament of the spine (OPLL) is a common disease after the middle age. OPLL frequently causes serious neurological problems due to compression of the spinal cord and/or nerve roots. OPLL occurs in patients with monogenic metabolic diseases including rickets/osteomalacia and hypoparathyroidism; however most of OPLL is idiopathic and is considered as a multi-factorial (polygenic) disease influenced by genetic and environmental factors. Genomic studies for the genetic factors of OPLL have been conducted, mainly in Japan, including linkage and association studies. This paper reviews the recent progress in the genomic study of OPLL and comments on its future direction. PMID:25504229




Indacaterol therapy in moderate-to-severe chronic obstructive pulmonary disease: findings from a single-center primary care cohort  

PubMed Central

Background Once-daily long-acting ?2-agonists (LABAs) are an important treatment option, either alone or in combination with other inhaled long-acting bronchodilators in the management of chronic obstructive pulmonary disease (COPD). Aims/objectives To audit the effectiveness of indacaterol as maintenance therapy in patients with moderate-to-severe COPD (Global initiative for chronic Obstructive Lung Disease [GOLD] stage II/III). Methods This was a single-center audit of a primary care COPD cohort comprising all patients treated with indacaterol following treatment escalation (as per National Institute for Health and Care Excellence guidelines) or failure with other therapies. The sample was restricted to patients treated for a minimum of 12 months with indacaterol, for whom preswitching and follow-up spirometry as well as exacerbation frequency data were available (GOLD spirometry guidelines). Pulmonary function was assessed by spirometry (recorded as forced expiratory volume in 1 second [FEV1] expressed as percentage predicted). Relevant self-reported qualitative information was recorded in descriptive terms for quality of life (QoL) assessment. Results A total of 15 patients met the audit inclusion criteria (66.6% male, mean age 64.9±7.7 years). COPD disease duration ranged from 1 to 22 years; 93% had GOLD stage II or III COPD. Follow-up ranged in duration from 12 to 27 months. Indacaterol was associated with a significant reduction in exacerbation frequency compared with the 12 months prior to initiation (P=0.02). In those patients who experienced three or more exacerbations/year, mean exacerbation rate fell from 5.43±1.07 to 2.43±0.2 after 12 months treatment with indacaterol (P=0.02). A reduction in dyspnea was noted in 53% of patients. Similarly, improvements in exercise tolerance and well-being were self-reported in 67% and 93%, respectively. Conclusion Indacaterol was found to be an effective LABA as an escalation or switch medication in patients with moderate-to-severe COPD. Indacaterol was effective both as monotherapy and in combination with a long-acting muscarinic antagonist. Switching to indacaterol from a LABA/inhaled corticosteroid fixed-combination inhaler significantly reduced the number of acute exacerbations and also improved self-reported QoL. PMID:24353411

Singh, Mukesh P



Prevention of mother-to-child transmission of HIV in Zambia: implementing efficacious ARV regimens in primary health centers  

PubMed Central

Background Safety and effectiveness of efficacious antiretroviral (ARV) regimens beyond single-dose nevirapine (sdNVP) for prevention of mother-to-child transmission (PMTCT) have been demonstrated in well-controlled clinical studies or in secondary- and tertiary-level facilities in developing countries. This paper reports on implementation of and factors associated with efficacious ARV regimens among HIV-positive pregnant women attending antenatal clinics in primary health centers (PHCs) in Zambia. Methods Blood sample taken for CD4 cell count, availability of CD4 count results, type of ARV prophylaxis for mothers, and additional PMTCT service data were collected for HIV-positive pregnant women and newborns who attended 60 PHCs between April 2007 and March 2008. Results Of 14,815 HIV-positive pregnant women registered in the 60 PHCs, 2,528 (17.1%) had their CD4 cells counted; of those, 1,680 (66.5%) had CD4 count results available at PHCs; of those, 796 (47.4%) had CD4 count ? 350 cells/mm3 and thus were eligible for combination antiretroviral treatment (cART); and of those, 581 (73.0%) were initiated on cART. The proportion of HIV-positive pregnant women whose blood sample was collected for CD4 cell count was positively associated with (1) blood-draw for CD4 count occurring on the same day as determination of HIV-positive status; (2) CD4 results sent back to the health facilities within seven days; (3) facilities without providers trained to offer ART; and (4) urban location of PHC. Initiation of cART among HIV-positive pregnant women was associated with the PHC's capacity to provide care and antiretroviral treatment services. Overall, of the 14,815 HIV-positive pregnant women registered, 10,015 were initiated on any type of ARV regimen: 581 on cART, 3,041 on short course double ARV regimen, and 6,393 on sdNVP. Conclusion Efficacious ARV regimens beyond sdNVP can be implemented in resource-constrained PHCs. The majority (73.0%) of women identified eligible for ART were initiated on cART; however, a minority (11.3%) of HIV-positive pregnant women were assessed for CD4 count and had their test results available. Factors associated with implementation of more efficacious ARV regimens include timing of blood-draw for CD4 count and capacity to initiate cART onsite where PMTCT services were being offered. PMID:19712454



Surgical treatment for ossification of the posterior longitudinal ligament in the cervical spine.  


Although classically associated with patients of East Asian origin, ossification of the posterior longitudinal ligament (OPLL) may cause myelopathy in patients of any ethnic origin. Degeneration of the PLL is followed by endochondral ossification, resulting in spinal cord compression. Specific genetic polymorphisms and medical comorbidities have been implicated in the development of OPLL. Patients should be evaluated with a full history and neurologic examination, along with cervical radiographs. Advanced imaging with CT and MRI allows three-dimensional evaluation of OPLL. Minimally symptomatic patients can be treated nonsurgically, but patients with myelopathy or severe stenosis are best treated with surgical decompression. OPLL can be treated via an anterior (ie, corpectomy and fusion) or posterior (ie, laminectomy and fusion or laminoplasty) approach, or both. The optimal approach is dictated by the classification and extent of OPLL, cervical spine sagittal alignment, severity of stenosis, and history of previous surgery. Anterior surgery is associated with superior outcomes when OPLL occupies >50% to 60% of the canal, despite increased technical difficulty and higher complication rates. Posterior surgery is technically easier and allows decompression of the entire cervical spine, but patients may experience late deterioration because of disease progression. PMID:24966248

An, Howard S; Al-Shihabi, Laith; Kurd, Mark



CASE REPORT An Unusual Case of Abdominal Compartment Syndrome Following Resection of Extensive Posttraumatic Mesenteric Ossification  

PubMed Central

Introduction: Heterotopic mesenteric ossification is an extremely rare condition, which often follows trauma and is frequently symptomatic. To date, there are no reports in the literature of abdominal compartment syndrome occurring after surgical resection of mesenteric calcification. The present report documents an unusual case of compartment syndrome complicating resection of extensive mesenteric calcification despite abdominal closure with the components-separation technique. Method: A 48-year-old man undergoing components-separation technique for posttraumatic laparostomy hernia repair (ileostomy reversal and sigmoid stricture correction) was found to have extensive heterotopic mesenteric calcification, which needed resection. Results: Resection of the mesenteric calcification was complicated by intraoperative hemorrhage and unplanned small bowel resection. Later the patient developed secondary hemorrhage leading to an abdominal compartment syndrome, which was successfully treated by decompression, hemostasis, and Permacol-assisted laparotomy wound closure. The patient remains symptom-free more than 2 years after surgery. Discussion: The case herein reported gives an account of the rare occurrence of abdominal compartment syndrome following resection of posttraumatic ectopic mesenteric ossifications. It is highly unusual in that it occurred because of “secondary hemorrhage” and despite abdominal closure with the components-separation technique, which had been undertaken precisely to prevent compartment syndrome with direct closure. It therefore highlights the need for continued clinical vigilance in complex posttraumatic cases. PMID:23573333

Nabulyato, William M.; Alsahiem, Hebah; Hall, Nigel R.; Malata, Charles M.



Primary Cutting Balloon Angioplasty for Treatment of Venous Stenoses in Native Hemodialysis Fistulas: Long-Term Results from Three Centers  

SciTech Connect

Aim. To evaluate the technical success and patency rates following primary cutting balloon angioplasty for venous stenoses in native dialysis fistulas. Methods. Forty-one patients (26 men, 15 women; age range 26-82 years, average age 59 years) underwent 50 (repeat procedures in 9 patients) primary cutting balloon (PCB) angioplasty procedures in three institutions by three primary operators. The indication was primary stenosis in 21 patients, recurrent lesions in 15, and immature fistulas in 5. A PCB was used alone in 17 cases, but was followed by a larger standard balloon in 33 cases. Follow-up included ultrasound, flow analysis and urea reduction ratio, and ranged from 2 to 30 months (mean 14 months). Results. The technical success rate was 98%. All procedures were relatively painless. Two PCBs burst and 4 leaked, but without causing any morbidity. Nineteen fistulas were still working at last follow-up. Primary patency rates at 6, 12, and 24 months using Kaplan-Meier analysis were 88%, 73%, and 34%, respectively, and the primary assisted patencies were 90%, 75%, and 50%, respectively. Conclusion. PCB angioplasty has high technical success and low complication rates. The long-term patency rates are favorable for PCB angioplasty and compare favorably with other series.

Bhat, Rajesh [Ninewells Hospital, Department of Clinical Radiology (United Kingdom)], E-mail:; McBride, Kieran [Queen Margaret Hospital (United Kingdom); Chakraverty, Sam; Vikram, Raghunandan; Severn, Alison [Ninewells Hospital, Department of Clinical Radiology (United Kingdom)



Palmitoyl Acyltransferase, Zdhhc13, Facilitates Bone Mass Acquisition by Regulating Postnatal Epiphyseal Development and Endochondral Ossification: A Mouse Model  

PubMed Central

ZDHHC13 is a member of DHHC-containing palmitoyl acyltransferases (PATs) family of enzymes. It functions by post-translationally adding 16-carbon palmitate to proteins through a thioester linkage. We have previously shown that mice carrying a recessive Zdhhc13 nonsense mutation causing a Zdhcc13 deficiency develop alopecia, amyloidosis and osteoporosis. Our goal was to investigate the pathogenic mechanism of osteoporosis in the context of this mutation in mice. Body size, skeletal structure and trabecular bone were similar in Zdhhc13 WT and mutant mice at birth. Growth retardation and delayed secondary ossification center formation were first observed at day 10 and at 4 weeks of age, disorganization in growth plate structure and osteoporosis became evident in mutant mice. Serial microCT from 4-20 week-olds revealed that Zdhhc13 mutant mice had reduced bone mineral density. Through co-immunoprecipitation and acyl-biotin exchange, MT1-MMP was identified as a direct substrate of ZDHHC13. In cells, reduction of MT1-MMP palmitoylation affected its subcellular distribution and was associated with decreased VEGF and osteocalcin expression in chondrocytes and osteoblasts. In Zdhhc13 mutant mice epiphysis where MT1-MMP was under palmitoylated, VEGF in hypertrophic chondrocytes and osteocalcin at the cartilage-bone interface were reduced based on immunohistochemical analyses. Our results suggest that Zdhhc13 is a novel regulator of postnatal skeletal development and bone mass acquisition. To our knowledge, these are the first data to suggest that ZDHHC13-mediated MT1-MMP palmitoylation is a key modulator of bone homeostasis. These data may provide novel insights into the role of palmitoylation in the pathogenesis of human osteoporosis. PMID:24637783

Song, I-Wen; Li, Wei-Ru; Chen, Li-Ying; Shen, Li-Fen; Liu, Kai-Ming; Yen, Jeffrey J. Y.; Chen, Yi-Ju; Chen, Yu-Ju; Kraus, Virginia Byers; Wu, Jer-Yuarn; Lee, M. T. Michael; Chen, Yuan-Tsong



Involvement of MET \\/ TWIST \\/ APC Combination or the Potential Role of Ossification Factors in Pediatric High-Grade Osteosarcoma Oncogenesis  

Microsoft Academic Search

Dysregulated cell growth or differentiation due to mis- expression of developmental critical factors seems to be a decisive event in oncogenesis. As osteosarcomas are histologically defined by malignant osteoblasts pro- ducing an osteoid component, we prospected in pe- diatric osteosarcomas treated with OS94 protocol the genomic status of several genes implied in ossification processes. In 91 osteosarcoma cases, we focused

Natacha Entz-Werle; Thomas Lavaux; Nadia Metzger; Corinne Stoetzel; Christelle Lasthaus; Perrine Marec; Chantal Kalifa; Laurence Brugieres; Hélène Pacquement; Claudine Schmitt; Marie-Dominique Tabone; Jean-Claude Gentet; Patrick Lutz; Annie Babin; Pierre Oudet; Marie-Pierre Gaub; Fabienne Perrin-Schmitt



Ossification sequence of the common tern (Sterna hirundo) and its implications for the interrelationships of the Lari (Aves, Charadriiformes).  


The hypotheses of relationships within Lari (gulls) are highly unstable, and depend on whether morphological or molecular data are examined. Developmental sequence data are thought to contain phylogenetic information, but have never been applied to the problem of avian systematics. In this article, we describe the ossification sequence of the Common Tern (Sterna hirundo), and compare the pattern observed to published descriptions of other Charadriiformes, specifically the Great Skua (Stercorariidae) and various species of gulls (Laridae). We use changes in ossification sequence to elucidate the relationship between these three taxa, using both qualitative and systematic approaches. The first analysis of the ossification sequence data does not support a close relationship between Stercorariidae and Laridae, as has been proposed in some morphological analyses; however it was unable to differentiate between a Laridae-Sternidae sister-group relationship or a Sternidae-Stercorariidae sister-group relationship. The second analysis was unable to differentiate between any topology, including a polytomy, for these taxa. These results highlight the potential for use of ossification sequence data in an evolutionary context but caution that analyses are highly dependent on sequence resolution and the taxonomic level of the data set. PMID:18570230

Maxwell, Erin E; Harrison, Luke B



Chronic cystitis with ossification of the bladder wall in a 6-month-old German shepherd dog  

PubMed Central

Ossification of the bladder wall, detected radiographically as a nonhomogeneous radiopaque area in the cranioventral part of the bladder in a puppy, is reported. We speculate that chronic inflammation due to the presence of uroliths in the lumen may have stimulated a metaplastic transformation of the cells. PMID:17966335

Zotti, Alessandro; Fant, Pierluigi; De Zan, Gabrita; Mollo, Antonio; Busetto, Roberto



Mechanical sensitivity of the facial nerve fibers innervating the anterior palate of the puffer, Fugu pardalis , and their central projection to the primary taste center  

Microsoft Academic Search

Summary 1.Mechanical and chemical sensitivity of the palatine nerve, ramus palatinus facialis, innervating the anterior palate of the puffer,Fugu pardalis, and their central projection to the primary taste center were investigated.2.Application of horseradish peroxidase (HRP) to the central cut end of the palatine nerve resulted in retrogradely labeled neurons in the geniculate ganglion but no such neurons in the trigeminal

Sadao Kiyohara; Iwao Hidaka; Junzoh Kitoh; Satoru Yamashita



Patient-Centered Approach to Building Problem Solving Skills Among Older Primary Care Patients: Problems Identified and Resolved  

Microsoft Academic Search

This article describes problems identified by older primary care patients enrolled in Problem Solving Therapy (PST), and explores factors associated with successful problem resolution. PST patients received 1 to 8, 45-min sessions with a social worker. Patients identified problems in their lives and directed the focus of subsequent sessions as consistent with the steps of PST. The 107 patients identified

Susan Enguidanos; Alexis Coulourides Kogan; Bronwyn Keefe; Scott Miyake Geron; Lynne Katz



Effects of a Psychological Intervention in a Primary Health Care Center for Caregivers of Dependent Relatives: A Randomized Trial  

ERIC Educational Resources Information Center

Purpose: To assess, in the context of Primary Health Care (PHC), the effect of a psychological intervention in mental health among caregivers (CGs) of dependent relatives. Design and Methods: Randomized multicenter, controlled clinical trial. The 125 CGs included in the trial were receiving health care in PHC. Inclusion criteria: Identifying…

Rodriguez-Sanchez, Emiliano; Patino-Alonso, Maria C.; Mora-Simon, Sara; Gomez-Marcos, Manuel A.; Perez-Penaranda, Anibal; Losada-Baltar, Andres; Garcia-Ortiz, Luis



Quantitative analysis of the anterolateral ossification mass in diffuse idiopathic skeletal hyperostosis of the thoracic spine.  


Diffuse idiopathic skeletal hyperostosis (DISH) is a systemic condition leading to ossification of spinal ligaments and has been shown to behave similarly to ankylosing spondylitis (AS) often leading to unstable hyperextension fractures. Currently, no quantitative data are available on the spatial relationship between the bridging anterolateral ossification mass (ALOM) and the vertebral body/intervertebral disc to explain the propensity in DISH to fracture through the vertebral body instead of through the intervertebral disc as more often seen in AS. Furthermore, no reasonable explanation is available for the typical flowing wax morphology observed in DISH. In the current study, a quantitative analysis of computed tomography (CT) data from human cadaveric specimens with DISH was performed to better understand the newly formed osseous structures and fracture biomechanics. Additionally, the results were verified using computed tomography angiography data from ten patients with DISH and ten controls. Transverse CT images were analyzed to obtain ALOM area and centroid angle relative to the anteroposterior axis; intervertebral disc and adjacent cranial and caudal levels. The ALOM area at the mid-vertebral body level averaged 57.9 ± 50.0 mm(2); at the mid-intervertebral disc space level it averaged 246.4 ± 95.9 mm(2). The mean ALOM area at the adjacent level caudal to the mid-vertebral body level was 169.6 ± 81.3 mm(2); at the adjacent cranial level, it was 161.7 ± 78.2 mm(2). The main finding was the significant difference between mean ALOM area at the mid-vertebral body level and other three levels (p < 0.0001). The subsequent verification study showed the presence of vertebral segmental arteries at the mid-vertebral body level in nearly all images irrespective of the presence of DISH. A larger area of ALOM seemed associated with increased counter-clockwise rotation (away from the aorta) of the centroid relative to the anteroposterior axis. The results from the present study suggest a predisposition for fractures through the vertebral body and a role for the arterial system in the inhibition of soft tissue ossification. PMID:21340711

Verlaan, J J; Westerveld, L A; van Keulen, J W; Bleys, R L A W; Dhert, W J; van Herwaarden, J A; Moll, F L; Oner, F C



Detailed examination of cartilage formation and endochondral ossification using human mesenchymal stem cells.  


1. Cartilage formation is one of the most complex processes in biology. The aim of the present study was to produce a simplified in vitro system to resolve its complexities. 2. Human mesenchymal stem cells (hMSC) were maintained in alginate beads with a chondrogenesis-induction medium containing 10 ng/mL transforming growth factor (TGF)-beta3. 3. At days 0, 2, 4, 8, 12, 16 and 19 of culture, we examined the cells using a light microscope and a transmission electron microscope. We also evaluated the cells using immunocryo-ultramicrotomy. 4. The present study demonstrated that hMSC produced numerous extracellular matrices containing abnormal collagen fibres following their exposure to a chondrogenesis-induction medium in alginate beads. At this time, calcification was detected by alizarin red staining and electron-dense particles, composed of hydroxyapatite, appeared in both the cytoplasm and the extracellular spaces. 5. In addition immunocryo-ultramicrotomy revealed that collagen type II, type X and proteoglycan were prominent and that osteocalcin was detectable at day 2. During 8-16 days of culture, collagen type X maintained its strong expression and the expression of osteocalcin increased markedly. In contrast, the expression of collagen type II and proteoglycan decreased with time. 6. These findings demonstrate that hMSC rapidly differentiate into chondrocytes expressing collagen type II and proteoglycan. 7. The expression of collagen type II and proteoglycan then dropped and the activity of collagen type X was the same as before (4-8 days). As a result, the cells developed into the next cell type, so-called hypertrophic chondrocytes. Finally, both osteocalcin activity and the calcification of cell bodies and extracellular matrices became evident, indicating endochondral ossification. Thus, we conclude that hMSC rapidly differentiate into chondrocytes, followed by the development of hypertrophic chondrocytes. Endochondral ossification is the final form in this culture. 8. The findings of the present study indicate that our three-dimensional culture is a convenient in vitro model for the investigation of the regulatory mechanisms of cartilage formation and endochondral ossification. PMID:16026516

Ichinose, Shizuko; Yamagata, Kazuo; Sekiya, Ichiro; Muneta, Takeshi; Tagami, Motoki



Influence of Access, Anticoagulant, and Bleeding Definition on Outcomes of Primary Percutaneous Coronary Intervention: Early Experience of an US Academic Center.  


Background?We aimed to carry out comparison of different bleeding avoidance strategies in doing primary percutaneous coronary intervention (PPCI) using either radial or femoral as access of choice and either bivalirudin or unfractionated heparin as anticoagulant of choice. In this analysis, we analyzed the influence of major bleeding definition on bleeding outcomes as well. Methods?We did a retrospective analysis of 139 patients with ST-segment elevation myocardial infarction (STEMI) who had PPCI in our academic center from January 2010 till October 2013. The primary outcome at 30 days was a composite of death from any cause or stent thrombosis or non-coronary artery bypass grafting (CABG) related major bleeding (CathPCI Registry definition) and secondary outcomes were individual components of primary outcome and the hospital length of stay. Results?There was no significant difference among different access/anticoagulant combinations with regards to primary outcome (22% in radial/bivalirudin vs. 5% in radial/heparin vs. 17% in femoral/bivalirudin vs. 28% in femoral/heparin group; p?=?0.2) as well as its individual components except the hospital length of stay (2.56 vs. 3 vs. 3.97 vs. 4.4 days each; p?center observational study doing PPCI did not show any superiority of one bleeding avoidance strategy over others with regard to primary outcome and its individual components except the hospital length of stay. It also shows the importance of bleeding definition on bleeding outcomes. PMID:25780323

Bheemarasetti, M K; Shawar, S; Chithri, S; Khalife, W I; Rangasetty, U M; Fujise, K; Gilani, S A



Patient-centered approach to building problem solving skills among older primary care patients: problems identified and resolved.  


This article describes problems identified by older primary care patients enrolled in Problem Solving Therapy (PST), and explores factors associated with successful problem resolution. PST patients received 1 to 8, 45-min sessions with a social worker. Patients identified problems in their lives and directed the focus of subsequent sessions as consistent with the steps of PST. The 107 patients identified 568 problems, 59% of which were resolved. Most commonly identified problems included health related issues such as need for exercise or weight loss activities, medical care and medical equipment needs, home and garden maintenance, and gathering information on their medical condition. Problems identified by patients were 2.2 times more likely to be solved than those identified by a health care professional. Using PST in primary care may facilitate patients in addressing key health and wellness issues. PMID:21462059

Enguidanos, Susan; Coulourides Kogan, Alexis; Keefe, Bronwyn; Geron, Scott Miyake; Katz, Lynne



Heterotopic ossification: Pathophysiology, clinical features, and the role of radiotherapy for prophylaxis  

SciTech Connect

Heterotopic ossification (HO) is a benign condition of abnormal formation of bone in soft tissue. HO is frequently asymptomatic, though when it is more severe it typically manifests as decreased range of motion at a nearby joint. HO has been recognized to occur in three distinct contexts-trauma, neurologic injury, and genetic abnormalities. The etiology of HO is incompletely understood. A posited theory is that HO results from the presence of osteoprogenitor cells pathologically induced by an imbalance in local or systemic factors. Individuals at high risk for HO development frequently undergo prophylaxis to prevent HO formation. The two most commonly employed modalities for prophylaxis are nonsteroidal anti-inflammatory drugs and radiation therapy. This review discusses HO pathophysiology, clinical features, and the role of radiotherapy for prophylaxis.

Balboni, Tracy A. [Harvard Radiation Oncology Program, Brigham and Women's Hospital, Boston, MA (United States); Gobezie, Reuben [Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA (United States); Mamon, Harvey J. [Department of Radiation Oncology, Brigham and Women's Hospital, Boston, MA (United States)]. E-mail:



Incidence of heterotopic ossification in direct anterior total hip arthroplasty: a retrospective radiographic review.  


Heterotopic ossification (HO) is a complication following total hip arthroplasty (THA) with traditional approaches. The direct anterior approach (DAA) has become a popular approach for THA; however, no study has evaluated HO formation following DAA THA. We examined the incidence of HO in a consecutive series of THA using the DAA in two separate hospitals. Standard preoperative radiographs were examined to determine the type of degenerative arthritis, and follow-up radiographs of at least 6 months after surgery were evaluated for the presence and classification of HO. The overall incidence of HO after DAA THA in this study was 98/236, or 41.5%, which falls within the reported range from recent studies involving more traditional approaches to the hip. PMID:24957801

Tippets, Duane M; Zaryanov, Anton V; Burke, W Vincent; Patel, Preetesh D; Suarez, Juan C; Ely, Erin E; Figueroa, Nathania M



Transforming primary care practices in a Hawai'i Island clinic: obtaining patient perceptions on patient centered medical home.  


Health care access is a significant problem for residents of Hawai'i Island who are experiencing a healthcare provider shortage crisis. Many residents must travel far for routine medical care, and in some cases to other islands. Hamakua Health Center, Inc., which operates from two clinical sites (Honokaa and Kapaau), is transitioning towards a Patient-Centered Medical Home care model. Through focus groups, a qualitative study was completed to obtain patient perceptions on Patient-Centered Medical Home. The Hamakua and Kohala Family Health Center staff were asked to recommend a list of patients from their respective health centers for focus group participation. In this sample (N=18), 67% of participants were female of various ethnicities. The participants' mean age was 62.2 (SD =14.3) years. Questions asked by the moderator were based on the American College of Providers' Patient-Centered Medical Home Assessment Tool. The three universal themes generated by the focus groups included quality care, provider and health services accessibility, and communication and coordination. Health information technology was a topic that was explored in the focus groups, and encompasses all three themes. Communication is regarded as a key to receiving quality care. Participants suggested having a rotation of specialists flown-in regularly from O'ahu to improve care quality. Technology is appreciated as it can streamline the information exchange process, and increase the patient's access to health services. There is unanimous concern regarding confidentiality and privacy. It is imperative that the health centers keep patients informed as they make their transition. PMID:23115754

Takane, Alain K; Hunt, Susan B



Time and Resources Needed to Document Patients with Breast Cancer from Primary Diagnosis to Follow-up – Results of a Single-center Study  

PubMed Central

Aim: Certification of breast centers helps improve the quality of care but requires additional resources, particularly for documentation. There are currently no published data on the actual staff costs and financial resources required for such documentation. The aim of this study was to determine the time and resources required to document a patient with primary breast cancer from diagnosis to the end of follow-up, to establish a database for future strategic decisions. Material and Methods: All diagnostic and therapeutic procedures of patients with primary breast cancer were recorded at the University Breast Center of Franconia. All time points for documentation were evaluated using structured interviews. The times required to document a representative number of patients were determined and combined with the staff costs of the different professional groups, to calculate the financial resources required for documentation. Results: A total of 494 time points for documentation were identified. The study also identified 21 departments and 20 different professional groups involved in the documentation. The majority (54?%) of documentation was done by physicians. 62?% of all documentation involved outpatients. The results of different scenarios for the diagnosis, therapy and follow-up of breast cancer patients in a certified breast center showed that the time required for documentation can be as much as 105 hours, costing €?4135. Conclusion: This analysis shows the substantial staffing and financial costs required for documentation in certified centers. A multi-center study will be carried out to compare the costs for certified breast centers of varying sizes with the costs of non-certified care facilities. PMID:25221342

Lux, M. P.; Sell, C. S.; Fasching, P. A.; Seidl-Ertel, J.; Bani, M. R.; Schrauder, M. G.; Jud, S. M.; Loehberg, C. R.; Rauh, C.; Hartmann, A.; Schulz-Wendtland, R.; Strnad, V.; Beckmann, M. W.



Cervical surgery for ossification of the posterior longitudinal ligament: One spine surgeon's perspective  

PubMed Central

Background: The selection, neurodiagnostic evaluation, and surgical management of patients with cervical ossification of the posterior longitudinal ligament (OPLL) remain controversial. Whether for prophylaxis or treatment, the decision to perform anterior vs. posterior vs. circumferential cervical OPLL surgery is complex. MR and CT Documentation of OPLL: Together, MR and CT cervical studies best document the full extent of OPLL. While MR provides the optimal soft-tissue overview (e.g. hyperintense signals reflecting edema/myelomalacia in the cord), CT's directly demonstrate the ossification of OPLL often “missed” by MR (e.g. documents the single or double layer signs of dural penetration. Patient Selection: Patients with mild myelopathy/cord compression rarely require surgery, while those with moderate/severe myelopathy/cord compression often warrant anterior, posterior, or circumferential approaches. Operative Approaches: Anterior corpectomies/fusions, warranted in patients with OPLL and kyphosis/loss of lordosis, also increase the risks of cerebrospinal fluid (CSF) leaks (e.g. single/double layer sign), and vascular injuries (e.g. carotid, vertebral). Alternatively, with an adequate lordosis, posterior procedures (e.g. often with fusions), may provide adequate multilevel decompression while minimizing risk of anterior surgery. Occasionally, combined pathologies may warrant circumferential approaches. Anesthetic and Intraoperative Monitoring Protocols: The utility of awake nasotracheal fiberoptic intubation/awake positioning, intraoperative somatosensory/motor evoked potential, and electromyographic monitoring, and the requirement for total intravenous anesthesia (TIVA) for OPLL surgery is also discussed. Conclusion: Anterior, posterior, or circumferential surgery may be warranted to treat patients with cervical OPLL, and must be based on careful patient selection, and both MR and CT documentation of the full extent of OPLL. PMID:24843818

Epstein, Nancy E.



A randomized field trial for the primary prevention of osteoporosis among adolescent females: Comparison of two methods, mother centered and daughter centered  

PubMed Central

Background: Osteoporosis is a serious public health. Since the majority of bone mass occurs during adolescence, primary prevention is important. Probably mother's participation in health education interventions leads to promote health behaviors in children. Aims: To assess a lifestyle modification intervention focused on mothers and students has an impact on osteoporosis preventive behaviors in adolescent girls. Materials and Methods: It is a randomized field trial in female high schools. 210 girls aged between 11 and 15 were randomly selected. Students in groups A and C and mothers in group B were selected Through the sampling frame. Our lifestyle modification was based on group based education in the public girls’ high schools. Subjects in the intervention groups participated in three educational sessions. Students’ osteoporosis preventive behaviors were measured by using a lifestyle questionnaire consisting of items assessing nutrition, physical activity and sun exposure. Repeated measure ANOVA at baseline, 4 week, 2 months and 6 months and were used to analyze the data. Results: After 1 month, diet and sun exposure scores increased significantly (P < 0.001) but it was higher in group B compared with group A. (About diet P < 0.001 and sun exposure = 0. 001). After 6 months, diet and sun exposure status in the group A approximately decreased to baseline, while in group B, diet components were significantly different compared to baseline (P < 0.001). There was no change in physical activity. Conclusion: Osteoporosis prevention intervention of adolescent can be effective when parents or girls participate in training sessions, but education is associated with better outcomes when focused on mothers. PMID:25422660

Ansari, Hourieh; Farajzadegan, Ziba; Hajigholami, Ali; Paknahad, Zamzam



Evaluation of Frequency of Four Common Nasal Anatomical Deformities in Primary Rhinoplasty in A Tehran Plastic Surgery Center  

PubMed Central

BACKGROUND In rhinoplasty, functional and cosmetic problems including imbalance between the nasal subunits and face are aimed to be corrected. So there is a need for careful preoperative evaluation and treatment of these patients. According to functional and aesthetic effects of these variables in rhinoplasty, evaluation of the frequency with focus to diagnostic methods was undertaken. METHODS In a descriptive study, 100 volunteer patients for primary rhinoplasty were enrolled. After history taking, nasal examination, desirable paraclinical work up and photography taking, presence of 4 anatomical variants was evaluated on the base of definition about normal and abnormal characteristic of organ. RESULTS Twenty nine male and 71 female patients underwent primary rhinoplasty. Open rhinoplasty was done in 85 and the close technique in 15 patients. 77% of patients had at least one of four anatomical nasal variations. The most common anomaly was alar cartilage malposition (51%) and frequency of others was low radix (36%), inadequate tip projection (35%) and middle vault collapse (15%). Frequency of low radix in male patients was 2.5 times more than females. CONCLUSON Success in rhinoplasty needs careful nasal analysis and evaluation. As at least one of four anatomical nasal variations is diagnosed before surgery, the correction has an important role on the outcome. As frequency of middle vault narrowing was low, a definitive diagnosis of alar cartilage malpositioning seems necessary in surgical exploration. Needs for correction and methods of treatment of variants can be based on dynamic interplay between nasal subunits. PMID:25489536

Eskandarlou, Mehdi; Motamed, Sadrollahe



A partnership model for implementing electronic health records in resource-limited primary care settings: experiences from two nurse-managed health centers  

PubMed Central

Objective To present a partnership-based and community-oriented approach designed to ease provider anxiety and facilitate the implementation of electronic health records (EHR) in resource-limited primary care settings. Materials and Methods The approach, referred to as partnership model, was developed and iteratively refined through the research team's previous work on implementing health information technology (HIT) in over 30 safety net practices. This paper uses two case studies to illustrate how the model was applied to help two nurse-managed health centers (NMHC), a particularly vulnerable primary care setting, implement EHR and get prepared to meet the meaningful use criteria. Results The strong focus of the model on continuous quality improvement led to eventual implementation success at both sites, despite difficulties encountered during the initial stages of the project. Discussion There has been a lack of research, particularly in resource-limited primary care settings, on strategies for abating provider anxiety and preparing them to manage complex changes associated with EHR uptake. The partnership model described in this paper may provide useful insights into the work shepherded by HIT regional extension centers dedicated to supporting resource-limited communities disproportionally affected by EHR adoption barriers. Conclusion NMHC, similar to other primary care settings, are often poorly resourced, understaffed, and lack the necessary expertise to deploy EHR and integrate its use into their day-to-day practice. This study demonstrates that implementation of EHR, a prerequisite to meaningful use, can be successfully achieved in this setting, and partnership efforts extending far beyond the initial software deployment stage may be the key. PMID:21828225

Dennehy, Patricia; White, Mary P; Hamilton, Andrew; Pohl, Joanne M; Tanner, Clare; Onifade, Tiffiani J



Intensity modulated radiotherapy (IMRT) combined with concurrent but not adjuvant chemotherapy in primary nasopharyngeal cancer – a retrospective single center analysis  

PubMed Central

Background We report our experience in 49 consecutive patients with nasopharyngeal carcinoma who were treated by Intensity-modulated radiation therapy (IMRT) combined with simultaneous but not adjuvant chemotherapy (CHT). Methods The medical records of 49 patients with histologically proven primary nasopharygeal carcinoma treated with IMRT and concurrent platin-based CHT (predominantly cisplatin weekly) were retrospectively reviewed. The majority of patients showed advanced clinical stages (stage III/IV:72%) with undifferentiated histology (82%). IMRT was performed in step-and-shoot technique using an integrated boost concept in 84%. In this concept, the boost volume covered the primary tumor and involved nodes with doses of 66–70.4 Gy (single dose 2.2 Gy). Uninvolved regional nodal areas were covered with doses of 54–59.4 Gy (median single dose 1.8 Gy). At least one parotid gland was spared. None of the patients received adjuvant CHT. Results The median follow-up for the entire cohort was 48 months. Radiation therapy was completed without interruption in all patients and 76% of the patients received at least 80% of the scheduled CHT. Four local recurrences have been observed, transferring into 1-, 3-, and 5-year Local Control (LC) rates of 98%, 90% and 90%. One patient developed an isolated regional nodal recurrence, resulting in 1-, 3-, and 5-year Regional Control (RC) rates of 98%. All locoregional failures were located inside the radiation fields. Distant metastases were found in six patients, transferring into 1-, 3, and 5-year Distant Control (DC) rates of 92%, 86% and 86%. Progression free survival (PFS) rates after 1, 3 and 5 years were 86%, 70% and 69% and 1-, 3- and 5-year Overall Survival (OS) rates were 96%, 82% and 79%. Acute toxicity???grade III mainly consisted of dysphagia (32%), leukopenia (24%), stomatitis (16%), infection (8%) and nausea (8%). Severe late toxicity (grade III) was documented in 18% of the patients, mainly as xerostomia (10%). Conclusion Concurrent chemoradiation without the addition of adjuvant chemotherapy cycles using IMRT with an integrated boost concept yielded good disease control and overall survival in patients suffering from primary nasopharyngeal cancer with acceptable acute side effects and limited rates of late toxicity. PMID:23347410



Barriers to Drug Use Behavior Change Among Primary Care Patients in Urban United States Community Health Centers  

PubMed Central

In 2011 and 2012, 147 patients in urban United States Community Health Centers who misused drugs, but did not meet criteria for drug dependence, received a brief intervention as part of a National Institute on Drug Abuse-funded clinical trial of a screening and brief intervention protocol. Potential study participants were identified using the World Health Organization (WHO) Alcohol, Smoking, and Substance Involvement Screening Test. Data gathered during brief interventions were analyzed using grounded theory strategies to identify barriers patients believed inhibited drug use behavior change. Numerous perceived barriers to drug use behavior change were identified. Study implications and limitations are discussed. PMID:24354547

Padwa, Howard; Ni, Yu-Ming; Barth-Rogers, Yohanna; Arangua, Lisa; Andersen, Ronald; Gelberg, Lillian



Bilateral simultaneous heterotopic ossification of the reflected head of rectus femoris muscle: a case report and review of the literature.  


Lamellar bone formation in an abnormal location is defined as heterotopic ossification. It commonly occurs around the hip joint and most often involves the abductor muscles. It is a benign condition; however, its etiology remains largely unknown. Most previously reported cases have been due to trauma or intramuscular hemorrhage. In this paper, we present a case of bilateral heterotopic ossification of the reflected head of rectus femoris muscle without antecedent trauma or any other known cause, as the first and unique case in the literature. She was treated by excision of the right symptomatic bony mass via a modified Smith-Petersen approach. Postoperatively, she received 75?mg indomethacin daily for six weeks. She was pain-free and obtained full range of motion 3 weeks after the first intervention. PMID:24804132

Tonbul, Murat; Ozen, Seyma; Tonbul, Ayse Tuba



Ossification and increased bone mineral density with zoledronic acid in a patient with lung adenocarcinoma: A case report  

PubMed Central

Cases of ossification and increased bone mineral density (BMD) at sites of bone metastasis following zoledronic acid (ZA) treatment have not been reported. The current study presents the case of a 65-year-old patient with lung adenocarcinoma and bone metastases in the lumbar vertebrae and femurs. Ossification and an increase in BMD at the metastatic sites was achieved following treatment with ZA and irradiation of the bone metastatic sites. The patient was able to maintain a normal lifestyle for over two years, despite the bone metastases. Therefore, as treatment with ZA was demonstrated to improve patient quality of life, physicians should consider this treatment strategy, particularly for the treatment of metastasis in weight-bearing bones. PMID:25187837




RISQy Business (Relationships, Incentives, Supports, and Quality): Evolution of the British Columbia Model of Primary Care (Patient-Centered Medical Home)  

PubMed Central

In 2002, the British Columbia Ministry of Health and the British Columbia Medical Association (now Doctors of BC) came together to form the British Columbia General Practice Services Committee to bring about transformative change in primary care in British Columbia, Canada. This committee’s approach to primary care was to respond to an operational problem—the decline of family practice in British Columbia—with an operational solution—assist general practitioners to provide better care by introducing new incentive fees into the fee-for-service payment schedule, and by providing additional training to general practitioners. This may be referred to as a “soft power” approach, which can be summarized in the abbreviation RISQ: focus on Relationships; provide Incentives for general practitioners to spend more time with their patients and provide guidelines-based care; Support general practitioners by developing learning modules to improve their practices; and, through the incentive payments and learning modules, provide better Quality care to patients and improved satisfaction to physicians. There are many similarities between the British Columbian approach to primary care and the US patient-centered medical home. PMID:24867550

MacCarthy, Dan; Hollander, Marcus J



Formation and ossification of limb elements in Trachemys scripta and a discussion of autopodial elements in turtles.  


Though sequences of formation and ossification of bony elements have been described for many taxa, controversy surrounds the formation of limb elements in turtles. Three hypotheses for patterns of formation of autopodial elements have been proposed, differing primarily in the origin of Distal Carpal/Tarsal 3, the digital arch, and Centrale 4. Patterns of formation and ossification of limb elements are described for Trachemys scripta. These patterns are compared to similar data for representatives of four families of turtles (Cheloniidae, Chelydridae, Emydidae, and Trionychidae). Hypotheses of limb formation are compared in the context of new and published data. Three species (Trachemys scripta, Chrysemys picta, and Chelydra serpentina) suggest that Distal Carpal 3 forms by branching from the ulnare, whereas Distal Carpal 3 may branch from Distal Carpal 4 in Macrochelys temminckii and Chelonia mydas; data from Graptemys nigrinoda, Apalone spinifera, and Eretmochelys imbricata did not provide evidence for the origin of Distal Carpal 3. Centrale 4 was not observed to branch from the ulnare and apparently arises by de-novo condensation. Distal Carpal 4 did not branch from Centrale 4 in any species. Until the developmental origins of Distal Carpal 3 and Centrale 4 are understood, interspecific variation in the origin of these elements remains, and may explain some of the observed differences. Trends of ossification in the fore- and hind limb autopodium also are summarized. Homology of elements in pedal Digit V is discussed, and we suggest that the hooked proximal element of this digit be recognized as Distal Tarsal 5. PMID:18624573

Sheil, Christopher A; Portik, Daniel



Significance of ossificated ungular cartilages regarding the performance of cold-blooded trotters.  


BackgroundOssification of the ungular cartilages (OUC) in the foot of horses has been studied for more than 100 years. There is a high heritability of this condition but its clinical relevance has remained questionable. Nevertheless, modern equine orthopedic literature ranks OUC as one of top 10 causes of lameness in cold-blooded trotters and stallions of these breeds are excluded from breeding if they have more than mild levels of side bones. Cold-blooded trotters have been used for racing for many decades and official sports data have been available since 1923. A decreased performance is often the only obvious clinical sign noticed by trainers and owners motivating them to seek professional help from veterinarians and farriers. By comparing various performance parameters in Swedish-Norwegian cold-blooded trotters without and with different grades of OUC, we aimed to determine the clinical relevance of ossified hoof cartilages in a population of high-performance horses.Front hooves from 649 Swedish-Norwegian cold-blooded trotters were evaluated radiologically regarding OUC. Breeding index and official sports data originating from strict protocols kept by groups of officials in trotting associations was used for comparison of performance of these horses that together had competed in more than 23,000 races between 1973 and 2009. Generalized linear mixed models were used for the statistical analyses. The response variable was modeled using ordinal logistic models with a multinomial distribution and a cumulative logit link function. The horse was used as a random factor.ResultsSignificant effects of gender on performance were demonstrated, but no correlations were found between different positions nor grades of ossified ungular cartilage and number of starts, running pace, race winnings, number of races completed in a regular gait.ConclusionsOssification of the ungular cartilages does not cause decreased performance in cold-blooded trotters and is therefore most likely not a cause of clinical or subclinical lameness in this breed. Results from this study can assist equine professionals in evaluating and interpreting the clinical relevance of radiological findings on ossified hoof cartilage among heavy and high-performing horses. PMID:25344341

Hedenström, Ulf O; Wattle, Ove S



IDA-FLAG regimen for the therapy of primary refractory and relapse acute leukemia: a single-center experience.  


We evaluated efficacy and toxicity profiles of fludarabine, Ara-C, idarubicin, and G-CSF (Ida-FLAG) combination chemotherapy in 56 refractory and/or relapsed acute leukemia patients. Patients were treated with fludarabine phosphate 25 mg/m2/d (d1-5), Ara-C 2 g/m2/d (d1-5), idarubicin 12 mg/m2/d (d1-3), G-CSF was given subcutaneously from sixth day until absolute neutrophil count (ANC) >500/microL. One third of the acute myeloblastic leukemia (AML) and 45% of acute lymphoblastic leukemia (ALL) cases were primary refractory disease. In AML patients, complete remission (CR) was achieved in 15 cases (53.6%). One case showed partial remission (PR) (3.6%) and 12 cases (42.8%) had resistant to this regimen (RD). Grade IV hematologic toxicity occurred in all AML cases. Leukocyte recovery time was 16 days. Nonhematologic complications were mild to moderate nausea, vomiting, and mucositis and could be controlled by routine measures. Stem cell transplantation was performed in 5 patients and all achieved CR, 2 autologous and 3 allogeneic. In ALL patients, CR and PR were obtained in 8 (42.2%) and 2 (10.5%) of 22 cases; disease was resistant to Ida-FLAG in 9 (47.3%) cases. Grade IV hematologic toxicity occurred in all ALL cases. Leukocyte recovery time was 17 days. Nonhematologic toxicity consisted of nausea, vomiting, and mucositis and could be controlled by supportive therapy. Autologous transplantation was performed in 1 patient, but relapse disease occurred after 5 weeks. There was no correlation between response rate and leukemia subtype (AML versus ALL), leukocyte count, age, sex, disease status (de novo versus secondary), and RFS (early versus late relapse) (P > 0.05). Median survival was 16 weeks in all cases (22 weeks in AML versus 13 weeks). At present, only 3 patients are alive and 2 of these are in continuous remission. The rest of the patients died. In conclusion, Ida-FLAG is a good choice in cases with refractory/relapsing acute leukemia for salvage chemotherapy. High efficacy and a low-toxicity profile are preferable properties of this regimen, and this regimen has been found to be useful for cytoreduction, especially in candidates for allo-SCT. PMID:16988532

Yavuz, Sinan; Paydas, Semra; Disel, Umut; Sahin, Berksoy



545?Global Prevalence and Types of Autoimmune Diseases Found in Children with Primary Immunodeficiencies; A Single-Center Experience  

PubMed Central

Background Autoimmune manifestations in primary immunodeficiencies (PIDs) are not uncommon, and they are more frequently observed in defects affecting lymphocytes and their regulatory mechanisms. There is a wide variability in prevalence, ranging from immune defects in which autoimmunity defines the syndrome, others with a very high prevalence of autoimmune manifestations, defects with a moderate prevalence, and those in which autoimmunity is rather an exception than the rule. Objective We aimed to determine the prevalence of autoimmunity in children with PIDs from our hospital, to delineate their clinical features. Methods An internal register was consulted to identify autoimmune diseases in our patients with PIDs. Their clinical files were then reviewed for diagnostic workup, age of presentation and outcome. Results We identified a prevalence of 18.8% (47 out of 250 patients, 68.1% male patient), within a period of 40 years (1970–2010), with autoimmune manifestations in the context of PID. Of which most are still alive: 35 (74.5%); lost to follow-up: 3 (6.4%), Dead: 9. Known or probable consanguinity was reported in 25.4%, 36.2% had a positive family history. 12.8% also had an allergic disease; none had cancer. The most frequent AI type was Systemic Autoimmune disease (11 case, 23%), followed by Organ-specific autoimmunity (15 cases, 32%), cytopenias (8 cases, 17%), and just antibodies (6 cases, 13%). Other than Autoimmune lymphoproliferative syndrome (ALPS), in which autoimmunity is a case-defining feature, the group of well defined (Hyper-IgE Syndrome (HIES), and Wiskott-Aldrich Syndrome (WAS)) were the PIDs with more cases of autoimmune disease, followed by phagocytosis deficiencies and antibody deficiency. Discussion The overall prevalence of autoimmune disease is relatively high PID syndromes such as ALPS, moderate levels in HIES, WAS and defects of phagocytosis and antibody interestingly. Interestingly, most of our patients with HIES have an autosomal-recessive pattern of inheritance and no identified mutational diagnosis; nearly all of our patients with CGD are receiving chronic subcutaneous therapy with human recombinant interferon gamma. Regular follow-up visits are justified for surveillance for complications and frequent treatment adjustments, given the delicate balance between immunosuppression and infection prophylaxis that is required in the care of these patients.

Ramírez Vázquez, María Guadalupe; Lugo-Reyes, Saul; Marco Antonio, Yamazaki-Nakashimada; Espinosa Rosales, Francisco Javier; Espinosa Padilla, Sara Elva



Chagas Disease among the Latin American Adult Population Attending in a Primary Care Center in Barcelona, Spain  

PubMed Central

Background/Aims The epidemiology of Chagas disease, until recently confined to areas of continental Latin America, has undergone considerable changes in recent decades due to migration to other parts of the world, including Spain. We studied the prevalence of Chagas disease in Latin American patients treated at a health center in Barcelona and evaluated its clinical phase. We make some recommendations for screening for the disease. Methodology/Principal Findings We performed an observational, cross-sectional prevalence study by means of an immunochromatographic test screening of all continental Latin American patients over the age of 14 years visiting the health centre from October 2007 to October 2009. The diagnosis was confirmed by serological methods: conventional in-house ELISA (cELISA), a commercial kit (rELISA) and ELISA using T cruzi lysate (Ortho-Clinical Diagnostics) (oELISA). Of 766 patients studied, 22 were diagnosed with T. cruzi infection, showing a prevalence of 2.87% (95% CI, 1.6–4.12%). Of the infected patients, 45.45% men and 54.55% women, 21 were from Bolivia, showing a prevalence in the Bolivian subgroup (n?=?127) of 16.53% (95% CI, 9.6–23.39%). All the infected patients were in a chronic phase of Chagas disease: 81% with the indeterminate form, 9.5% with the cardiac form and 9.5% with the cardiodigestive form. All patients infected with T. cruzi had heard of Chagas disease in their country of origin, 82% knew someone affected, and 77% had a significant history of living in adobe houses in rural areas. Conclusions We found a high prevalence of T. cruzi infection in immigrants from Bolivia. Detection of T. cruzi–infected persons by screening programs in non-endemic countries would control non-vectorial transmission and would benefit the persons affected, public health and national health systems. PMID:21572511

Roca, Carme; Pinazo, María Jesús; López-Chejade, Paolo; Bayó, Joan; Posada, Elizabeth; López-Solana, Jordi; Gállego, Montserrat; Portús, Montserrat; Gascón, Joaquim



Management of pelvic heterotopic ossification post-myocutaneous flap reconstruction of a sacral pressure ulcer  

PubMed Central

Heterotopic ossification (HO) is a process whereby lamellar bone forms in the soft tissues surrounding a joint. The most common type of HO is traumatic myositis ossificans, which develops following traumatic injuries, burns or arthroplasty. A variety of other forms of HO also exist, such as those associated with central nervous system injury and systemic forms that can manifest at other joints simultaneously. Clinically, patients can present with decreased range of motion, pressure ulcers, nerve compression, swelling, pain or asymptomatically. Symptomatic patients are most commonly treated with surgical debridement of the affected heterotopic deposits. Spinal dysraphism (SD) is a term describing a wide range of congenital malformations of the neural tube, ranging from spina bifida occulta to the more severe form, myelomeningocele. The cause of SD is multifactorial and has been associated with chromosomal disorders, teratogenic exposure and folate deficiency. Many patients with SD experience neuropathy below the affected neurological level, making them particularly susceptible to pressure ulcers. If these ulcers are severe and do not respond to conservative therapy, they often require surgical debridement and flap reconstruction – a clinical scenario that rarely results in HO. The present article describes a case involving a patient with pelvic HO following myocutaneous flap reconstruction of a pressure ulcer. The patient was successfully treated with oral bisphosphonate and aggressive physiotherapy. PMID:22654535

McInnes, Colin W; Reynolds, Richard AK; Arneja, Jugpal S



Expression of IL-5 alters bone metabolism and induces ossification of the spleen in transgenic mice  

PubMed Central

We have developed a transgenic mouse line, NJ.1638, which expresses high levels of IL-5 from T cells, with profound hematological consequences. Eosinophils comprise more than 60% of circulating white blood cells in these animals, with the total peripheral white blood cell counts increasing more than 40-fold relative to wild-type littermates. This extraordinary proliferative capacity is sustained by expanded sites of extramedullary hematopoiesis and is accompanied by multifocal, ectopic bone formation in the spleen. Histology of the splenic nodules revealed the presence of osteoid matrices and osteocytes trapped within mineralized trabecular plates. In addition, polarized light microscopy of calcified tissue sections revealed both woven bone and areas of organized lamellar bone. Morphometric assessments demonstrated that both the growth and mineralization of splenic bone occurred at rates nearly an order of magnitude higher than in skeletal bone. Skeletal bone metabolic parameters were also perturbed. We also observed heterotopic ossification of the spleen and perturbation of skeletal bone homeostasis following adoptive engraftment of transgenic marrow to wild-type recipients. These data suggest that IL-5 overexpression mediates bone formation through the mobilization of marrow-derived osteogenic progenitors and/or the inhibition of recruited osteoclasts. PMID:11306598

Macias, MiMi P.; Fitzpatrick, Lorraine A.; Brenneise, Ina; McGarry, Michael P.; Lee, James J.; Lee, Nancy A.



Hypomorphic mutation in mouse Nppc gene causes retarded bone growth due to impaired endochondral ossification  

SciTech Connect

Long bone abnormality (lbab/lbab) is a spontaneous mutant mouse characterized by dwarfism with shorter long bones. A missense mutation was reported in the Nppc gene, which encodes C-type natriuretic peptide (CNP), but it has not been confirmed whether this mutation is responsible for the dwarf phenotype. To verify that the mutation causes the dwarfism of lbab/lbab mice, we first investigated the effect of CNP in lbab/lbab mice. By transgenic rescue with chondrocyte-specific expression of CNP, the dwarf phenotype in lbab/lbab mice was completely compensated. Next, we revealed that CNP derived from the lbab allele retained only slight activity to induce cGMP production through its receptor. Histological analysis showed that both proliferative and hypertrophic zones of chondrocytes in the growth plate of lbab/lbab mice were markedly reduced. Our results demonstrate that lbab/lbab mice have a hypomorphic mutation in the Nppc gene that is responsible for dwarfism caused by impaired endochondral ossification.

Tsuji, Takehito [Graduate School of Natural Science and Technology, Okayama University, Tsushima-naka, Okayama 700-8530 (Japan)], E-mail:; Kondo, Eri; Yasoda, Akihiro [Department of Medicine and Clinical Science, Kyoto University Graduate School of Medicine, Kyoto 606-8507 (Japan); Inamoto, Masataka; Kiyosu, Chiyo [Graduate School of Natural Science and Technology, Okayama University, Tsushima-naka, Okayama 700-8530 (Japan); Nakao, Kazuwa [Department of Medicine and Clinical Science, Kyoto University Graduate School of Medicine, Kyoto 606-8507 (Japan); Kunieda, Tetsuo [Graduate School of Natural Science and Technology, Okayama University, Tsushima-naka, Okayama 700-8530 (Japan)



Clock Genes Influence Gene Expression in Growth Plate and Endochondral Ossification in Mice*  

PubMed Central

We have previously shown transient promotion by parathyroid hormone of Period-1 (Per1) expression in cultured chondrocytes. Here we show the modulation by clock genes of chondrogenic differentiation through gene transactivation of the master regulator of chondrogenesis Indian hedgehog (IHH) in chondrocytes of the growth plate. Several clock genes were expressed with oscillatory rhythmicity in cultured chondrocytes and rib growth plate in mice, whereas chondrogenesis was markedly inhibited in stable transfectants of Per1 in chondrocytic ATDC5 cells and in rib growth plate chondrocytes from mice deficient of brain and muscle aryl hydrocarbon receptor nuclear translocator-like (BMAL1). Ihh promoter activity was regulated by different clock gene products, with clear circadian rhythmicity in expression profiles of Ihh in the growth plate. In BMAL1-null mice, a predominant decrease was seen in Ihh expression in the growth plate with a smaller body size than in wild-type mice. BMAL1 deficit led to disruption of the rhythmic expression profiles of both Per1 and Ihh in the growth plate. A clear rhythmicity was seen with Ihh expression in ATDC5 cells exposed to dexamethasone. In young mice defective of BMAL1 exclusively in chondrocytes, similar abnormalities were found in bone growth and Ihh expression. These results suggest that endochondral ossification is under the regulation of particular clock gene products expressed in chondrocytes during postnatal skeletogenesis through a mechanism relevant to the rhythmic Ihh expression. PMID:22936800

Takarada, Takeshi; Kodama, Ayumi; Hotta, Shogo; Mieda, Michihiro; Shimba, Shigeki; Hinoi, Eiichi; Yoneda, Yukio



Prevalence and Correlates of Depressive Symptoms and Resiliency among African American Women in a Community-Based Primary Health Care Center  

PubMed Central

The purpose of this cross-sectional pilot study was to determine the prevalence and correlates of depressive symptoms and resiliency among 290 African American women (AAW) in a community-based primary health care center. Descriptive statistics, Pearson product-moment correlation, and logistic regression analyses were conducted. Findings indicate that depressive symptoms are experienced by 49% of the participants, while 10% indicated a history of suicidal ideation. Participants had moderately high resiliency scores that had a statistically significant inverse relationship with depressive symptoms. This suggests that resiliency is potentially a protective factor for depressive symptoms. Depressive symptoms were positively correlated with participants’ diagnosis of at least one chronic disease. The strongest predictors of depressive symptoms were previous diagnoses of a mental health condition and unemployment. This study identifies risk and potential protective factors for depression among a clinic sample of AAW. PMID:24241263

Holden, Kisha B.; Bradford, L. Dianne; Hall, Stephanie P.; Belton, Allyson S.



The impact of accreditation of primary healthcare centers: successes, challenges and policy implications as perceived by healthcare providers and directors in Lebanon  

PubMed Central

Background In 2009, the Lebanese Ministry of Public Health (MOPH) launched the Primary Healthcare (PHC) accreditation program to improve quality across the continuum of care. The MOPH, with the support of Accreditation Canada, conducted the accreditation survey in 25 PHC centers in 2012. This paper aims to gain a better understanding of the impact of accreditation on quality of care as perceived by PHC staff members and directors; how accreditation affected staff and patient satisfaction; key enablers, challenges and strategies to improve implementation of accreditation in PHC. Methods The study was conducted in 25 PHC centers using a cross-sectional mixed methods approach; all staff members were surveyed using a self-administered questionnaire whereas semi-structured interviews were conducted with directors. Results The scales measuring Management and Leadership had the highest mean score followed by Accreditation Impact, Human Resource Utilization, and Customer Satisfaction. Regression analysis showed that Strategic Quality Planning, Customer Satisfaction and Staff Involvement were associated with a perception of higher Quality Results. Directors emphasized the benefits of accreditation with regards to documentation, reinforcement of quality standards, strengthened relationships between PHC centers and multiple stakeholders and improved staff and patient satisfaction. Challenges encountered included limited financial resources, poor infrastructure, and staff shortages. Conclusions To better respond to population health needs, accreditation is an important first step towards improving the quality of PHC delivery arrangement system. While there is a need to expand the implementation of accreditation to cover all PHC centers in Lebanon, considerations should be given to strengthening their financial arrangements as well. PMID:24568632



Comparative ENDOR study at 34 GHz of the triplet state of the primary donor in bacterial reaction centers of Rb. sphaeroides and Bl. viridis.  


The primary electron donor (P) in the photosynthetic bacterial reaction center of Rhodobacter sphaeroides and Blastochloris viridis consists of a dimer of bacteriochlorophyll a and b cofactors, respectively. Its photoexcited triplet state in frozen solution has been investigated by time resolved ENDOR spectroscopy at 34 GHz. The observed ENDOR spectra for (3)P865 and (3)P960 are essentially the same, indicating very similar spin density distributions. Exceptions are the ethylidene groups unique to the bacteriochlorophyll b dimer in (3)P960. Strikingly, the observed hyperfine coupling constants of the ethylidene groups are larger than in the monomer, which speaks for an asymmetrically delocalized wave function over both monomer halves in the dimer. The latter observation corroborates previous findings of the spin density in the radical cation states P 865 (•+) (Lendzian et al. in Biochim Biophys Acta 1183:139-160, 1993) and P 960 (•+) (Lendzian et al. in Chem Phys Lett 148:377-385, 1988). As compared to the bacteriochlorophyll monomer, the hyperfine coupling constants of the methyl groups 2(1) and 12(1) are reduced by at least a factor of two, and quantitative analysis of these couplings gives rise to a ratio of approximately 3:1 for the spin density on the halves PL:PM. Our findings are discussed in light of the large difference in photosynthetic activity of the two branches of cofactors present in the bacterial reaction center proteins. PMID:23184403

Marchanka, Aliaksandr; Lubitz, Wolfgang; Plato, Martin; van Gastel, Maurice



Inhalant abuse of 1,1-difluoroethane (DFE) leading to heterotopic ossification: a case report  

PubMed Central

Background Heterotopic ossification (HO) is the formation of mature, lamellar bone within soft tissues other than the periosteum. There are three recognized etiologies of HO: traumatic, neurogenic, and genetic. Presently, there are no definitively documented causal factors of HO. The following factors are presumed to place a patient at higher risk: 60 years of age or older, male, previous HO, hypertrophic osteoarthritis, ankylosing spondylitis, diffuse idiopathic skeletal hyperostosis, prior hip surgery, and surgical risk factors. Case presentation A 33-year-old male, involved in a motor vehicle crash, sustained an irreducible acetabulum fracture/dislocation, displaced proximal humerus fracture, and an impacted pilon fracture. During the time of injury, he was intoxicated from inhaling the aerosol propellant used in "dust spray" cans (1,1-difluoroethane, C2H4F2). Radiographs identified rapid pathologic bone formation about the proximal humeral metaphysis, proximal femur, elbow, and soft tissue several months following the initial injury. Discussion The patient did not have any genetic disorders that could have attributed to the bone formation but had some risk factors (male, fracture with dislocation). Surgically, the recommended precautions were followed to decrease the chance of HO. Although the patient did not have neurogenic injuries, the difluoroethane in dusting spray can cause damage to the central nervous system. Signals may have been mixed causing the patient's body to produce bone instead of tissue to strengthen the injured area. Conclusion What is unusual in this case is the rate at which the pathological bone formation appeared, which was long outside the 4–6 week window in which HO starts to appear. The authors are not certain as to the cause of this rapid formation but suspect that the patient's continued abuse of inhaled aerosol propellants may be the culprit. PMID:18973696

Little, Jill; Hileman, Barbara; Ziran, Bruce H



The characteristic clinical symptoms of C-4 radiculopathy caused by ossification of the posterior longitudinal ligament.  


Cervical radiculopathy of the C2-4 spinal nerves is a rare condition and is poorly documented in terms of clinical symptoms, hindering its detection during initial patient screening based on imaging diagnostics. The authors describe in detail the clinical symptoms and successful surgical treatment of a patient diagnosed with isolated C-4 radiculopathy. This 41-year-old man suffered from sleep disturbance because of pain behind the right ear, along the right clavicle, and at the back of his neck on the right side. The Jackson and Spurling tests were positive, with pain radiating to the area behind the patient's ear. Unlike in cases of radiculopathy involving the C5-8 spinal nerves, no loss of upper-extremity motor function was seen. Magnetic resonance imaging showed foraminal stenosis at the C3-4 level on the right side, and multiplanar reconstruction CT revealed a beak-type ossification of the posterior longitudinal ligament in the foraminal region at the same level. In the absence of intracranial lesions or spinal cord compressive lesions, the positive Jackson and Spurling tests and the C3-4 foraminal stenosis were indicative of isolated C-4 radiculopathy. Microscopic foraminotomy was performed at the C3-4 vertebral level and the ossified lesion was resected. The patient's symptoms completely resolved immediately after surgery. To the authors' knowledge, this report is the first to describe the symptomatic features of isolated C-4 radiculopathy, in a case in which the diagnosis has been confirmed by both radiological findings and surgical outcome. Based on this case study, the authors conclude that the characteristic symptoms of C-4 radiculopathy are the presence of pain behind the ear and in the clavicular region in the absence of upper-limb involvement. PMID:24654743

Katsumi, Keiichi; Yamazaki, Akiyoshi; Watanabe, Kei; Hirano, Toru; Ohashi, Masayuki; Endo, Naoto



Ossification of the suprascapular ligament: A risk factor for suprascapular nerve compression?  

PubMed Central

Introduction: Entrapment of the suprascapular nerve at the suprascapular notch may be due to an ossified suprascapular ligament. The present study was conducted in order to investigate the incidence of this anomaly and to analyze the resultant bony foramen (foramen scapula) for gross nerve compression. Materials and Methods: We evaluated 104 human scapulae from 52 adult skeletons for the presence of complete ossification of the suprascapular ligament. When an ossified suprascapular ligament was identified, the diameter of the resultant foramen was measured. Also, the suprascapular regions of 50 adult cadavers (100 sides) were dissected. When an ossified suprascapular ligament was identified, the spinati musculature was evaluated for gross atrophy and the diameters of the resultant foramen scapulae and the suprascapular nerve were measured. Immunohistochemical analysis of the nerve was also performed. Results: For dry scapular specimens, 5.7% were found to have an ossified suprascapular ligament. The mean diameter of these resultant foramina was 2.6 mm. For cadavers, an ossified suprascapular ligament was identified in 5% of sides. Sections of the suprascapular nerve at the foramen scapulae ranged from 2 to 2.8 mm in diameter. In all cadaveric samples, the suprascapular nerve was grossly compressed (~10-20%) at this site. All nerves demonstrated histologic signs of neural degeneration distal to the site of compression. The presence of these foramina in male cadavers and on right sides was statistically significant. Conclusions: Based on our study, even in the absence of symptoms, gross compression of the suprascapular nerve exists in cases of an ossified suprascapular ligament. Asymptomatic patients with an ossified suprascapular ligament may warrant additional testing such as electromyography. PMID:23858291

Tubbs, R. Shane; Nechtman, Carl; D’Antoni, Anthony V.; Shoja, Mohammadali M.; Mortazavi, Martin M.; Loukas, Marios; Rozzelle, Curtis J.; Spinner, Robert J.



Cost of Radiotherapy Versus NSAID Administration for Prevention of Heterotopic Ossification After Total Hip Arthroplasty  

SciTech Connect

Purpose: Heterotopic ossification (HO), or abnormal bone formation, is a common sequela of total hip arthroplasty. This abnormal bone can impair joint function and must be surgically removed to restore mobility. HO can be prevented by postoperative nonsteroidal anti-inflammatory drug (NSAID) use or radiotherapy (RT). NSAIDs are associated with multiple toxicities, including gastrointestinal bleeding. Although RT has been shown to be more efficacious than NSAIDs at preventing HO, its cost-effectiveness has been questioned. Methods and Materials: We performed an analysis of the cost of postoperative RT to the hip compared with NSAID administration, taking into account the costs of surgery for HO formation, treatment-induced morbidity, and productivity loss from missed work. The costs of RT, surgical revision, and treatment of gastrointestinal bleeding were estimated using the 2007 Medicare Fee Schedule and inpatient diagnosis-related group codes. The cost of lost wages was estimated using the 2006 median salary data from the U.S. Census Bureau. Results: The cost of administering RT was estimated at $899 vs. $20 for NSAID use. After accounting for the additional costs associated with revision total hip arthroplasty and gastrointestinal bleeding, the corresponding estimated costs were $1,208 vs. $930. Conclusion: If the costs associated with treatment failure and treatment-induced morbidity are considered, the cost of NSAIDs approaches that of RT. Other NSAID morbidities and quality-of-life differences that are difficult to quantify add to the cost of NSAIDs. These considerations have led us to recommend RT as the preferred modality for use in prophylaxis against HO after total hip arthroplasty, even when the cost is considered.

Strauss, Jonathan B. [Department of Radiation Oncology, Rush University Medical Center, Chicago, IL (United States)], E-mail:; Chen, Sea S.; Shah, Anand P.; Coon, Alan B. [Department of Radiation Oncology, Rush University Medical Center, Chicago, IL (United States); Dickler, Adam [Department of Radiation Oncology, Little Company of Mary Hospital, Evergreen Park, IL (United States)



Association between alendronate, serum alkaline phosphatase level, and heterotopic ossification in individuals with spinal cord injury.  


Context/objective Only sparse evidence exists regarding the effectiveness of oral alendronate (ALN) in the prevention of heterotopic ossification (HO) in patients with spinal cord injury (SCI). The objective of this study is to investigate the protective effect of oral ALN intake on the appearance of HO in patients with SCI. Study design Retrospective database review. Setting A Spinal Cord Unit at a Rehabilitation Hospital. Participants Two hundred and ninety-nine patients with SCI during acute inpatient rehabilitation. Interventions Administration of oral ALN. Outcome measures The incidence of HO during rehabilitation was compared between patients with SCI receiving oral ALN (n = 125) and patients with SCI not receiving oral ALN (n = 174). The association between HO and/or ALN intake with HO risk factors and biochemical markers of bone metabolism were also explored. Results HO developed in 19 male patients (6.35%), however there was no significant difference in the incidence of HO in patients receiving oral ALN or not. The mean odds ratio of not developing versus developing HO given ALN exposure was 0.8. Significant correlation was found between abnormal serum alkaline phosphatase (ALP) levels and HO appearance (P < 0.001) as well as normal serum ALP and ALN intake (P < 0.05). Conclusion Even though there was no direct prevention of HO in patients with SCI by oral ALN intake, abnormal serum ALP was found more frequently in patients with HO development and without oral ALN intake. This evidence could suggest that ALN may play a role in preventing HO, especially in patients with acute SCI with increasing levels of serum ALP. PMID:24820653

Ploumis, Avraam; Donovan, Jayne M; Olurinde, Mobolaji O; Clark, Dana M; Wu, Jason C; Sohn, Douglas J; O'Connor, Kevin C



Heterotopic Ossification around the Knee after Internal Fixation of a Complex Tibial Plateau Fracture Combined with the Use of Demineralized Bone Matrix (DBM): A Case Report  

PubMed Central

Demineralized bone matrix has been successfully commercialized as an alternative bone graft material that not only can function as filler but also as an osteoinductive graft. Numerous studies have confirmed its beneficial use in clinical practice. Heterotopic ossification after internal fixation combined with the use of demineralized bone matrix has not been widely reported. In this paper we describe a 39 year old male who sustained a complex articular fracture that developed clinically significant heterotopic ossification after internal fixation with added demineralized bone matrix. Although we cannot be sure that there is a cause-and-effect relation between demineralized bone matrix and the excessive heterotopic ossification seen in our patient, it seems that some caution in using demineralised bone matrix in similar cases is warranted. Also, given the known inter- and intraproduct variability, the risks and benefits of these products should be carefully weighed. PMID:25692153

Nota, Sjoerd P.F.T.; Kloen, Peter



Acute closed traumatic sciatic nerve injury: a complication of heterotopic ossification and prominence of the femoral nail: a case report.  


The report of a 27-years-old man with presence of heterotopic ossification (HO) after femoral nailing 7years ago who developed foot drop afterfalling to the ground on his buttocks. Radiographs revealed a prominence ofthefemoral nail with HO in his right hip. EMG confirmedperoneal nerve injury ofthe hip region. Femoral nail and the HO were removed and external neurolysis was performed. At 9 months after surgery, he had not regain motor power thus posterior tibialis tendon transfer was performed to restore ankle dorsiflexion. Finally, at 2 years follow-up, he could ambulate well but did not regained sensation, extensor digitorum communis and peroneal muscle function. PMID:25518317

Niempoog, Sunyarn; Chumchuen, Sukanis



ENDOR studies of the primary donor cation radical in mutant reaction centers of Rhodobacter sphaeroides with altered hydrogen-bond interactions.  


The electronic structure of the cation radical of the primary electron donor was investigated in genetically modified reaction centers of Rhodobacter sphaeroides. The site-directed mutations were designed to add or remove hydrogen bonds between the conjugated carbonyl groups of the primary donor, a bacteriochlorophyll dimer, and histidine residues of the protein and were introduced at the symmetry-related sites L168 His-->Phe, HF(L168), and M197 Phe-->His, FH(M197), near the 2-acetyl groups of the dimer and at sites M160 Leu-->His, LH(M160), and L131 Leu-->His, LH(L131), in the vicinity of the 9-keto carbonyls of the dimer. The single mutants and a complete set of double mutants were studied using EPR, ENDOR, and TRIPLE resonance spectroscopy. The changes in the hydrogen bond situation of the primary donor were accompanied by changes in the dimer oxidation midpoint potential, ranging from 410 to 710 mV in the investigated mutants [Lin, X., Murchison, H. A., Nagarajan, V., Parson, W. W., Williams, J. C. & Allen, J. P. (1994) Proc. Natl. Acad. Sci. U.S.A. 91, 10265-10269]. It was found that the addition or removal of a hydrogen bond causes large shifts of the spin density between the two halves of the dimer. Measurements on double mutants showed that the unpaired electron can be gradually shifted from a localization on the L-half of the dimer to a localization on the M-half, depending on the hydrogen bond situation. As a control, the effects of the different hydrogen bonds on P.+ in the mutant HL(M202), which contains a BChlL-BPheM heterodimer as the primary donor with localized spin on the BChl aL [Bylina, E. J., & Youvan, D. C. (1988) Proc. Natl. Acad. Sci. U.S.A. 85, 7226-7230; Schenck, C. C., Gaul, D., Steffen M., Boxer S. G., McDowell L., Kirmaier C., & Holten D. (1990) in Reaction Centers of Photosynthetic Bacteria (Michel-Beyerle M. E., Ed.) pp 229-238, Springer, Berlin] were studied. In this mutant only small local changes of the spin densities (< or = 10%) in the vicinity of the hydrogen bonds were observed. The effects of the introduced hydrogen bonds on the spin density distribution of the dimer in the mutants are discussed in terms of different orbital energies of the two BChl a moieties which are directly influenced by hydrogen bond formation. The observed changes of the spin density distribution for the double mutants are additive with respect to the single mutations.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:7794927

Rautter, J; Lendzian, F; Schulz, C; Fetsch, A; Kuhn, M; Lin, X; Williams, J C; Allen, J P; Lubitz, W



Peripheral organ doses from radiotherapy for heterotopic ossification of non-hip joints: is there a risk for radiation-induced malignancies?  


Radiotherapy, used for heterotopic ossification (HO) management, may increase radiation risk to patients. This study aimed to determine the peripheral dose to radiosensitive organs and the associated cancer risks due to radiotherapy of HO in common non-hip joints. A Monte Carlo model of a medical linear accelerator combined with a mathematical phantom representing an average adult patient were employed to simulate radiotherapy for HO with standard AP and PA fields in the regions of shoulder, elbow and knee. Radiation dose to all out-of-field radiosensitive organs defined by the International Commission on Radiological Protection was calculated. Cancer induction risk was estimated using organ-specific risk coefficients. Organ dose change with increased field dimensions was also evaluated. Radiation therapy for HO with a 7 Gy target dose in the sites of shoulder, elbow and knee, resulted in the following equivalent organ dose ranges of 0.85-62 mSv, 0.28-1.6 mSv and 0.04-1.6 mSv, respectively. Respective ranges for cancer risk were 0-5.1, 0-0.6 and 0-1.3 cases per 10(4) persons. Increasing the field size caused an average increase of peripheral doses by 15-20%. Individual organ dose increase depends upon the primary treatment site and the distance between organ of interest and treatment volume. Relatively increased risks of more than 1 case per 10,000 patients were found for skin, breast and thyroid malignancies after treatment in the region of shoulder and for skin cancer following elbow irradiation. The estimated risk for inducing any other malignant disease ranges from negligible to low. PMID:24084192

Berris, Theocharis; Mazonakis, Michalis; Kachris, Stefanos; Damilakis, John



The Development of a Mobile Monitoring and Feedback Tool to Stimulate Physical Activity of People With a Chronic Disease in Primary Care: A User-Centered Design  

PubMed Central

Background Physical activity is an important aspect in the treatment of patients with chronic obstructive pulmonary disease or type-2 diabetes. A monitoring and feedback tool combined with guidance by a primary care provider might be a successful method to enhance the level of physical activity in these patients. As a prerequisite for useful technology, it is important to involve the end-users in the design process from an early stage. Objective The aim of this study was to investigate the user requirements for a tool to stimulate physical activity, embedded in primary care practice. The leading principle of this tool is to change behavior by self-monitoring, goal-setting, and feedback. Methods The research team collected qualitative data among 15 patients, 16 care professionals, and several experts. A prototype was developed in three stages. In stage 1, the literature was searched to identify end-users and context. In stage 2, the literature, experts and patient representatives were consulted to set up a use case with the general idea of the innovation. In stage 3, individual interviews and focus groups were held to identify the end-user requirements. Based on these requirements a prototype was built by the engineering team. Results The development process has led to a tool that generally meets the requirements of the end-users. A tri-axial activity sensor, worn on the hip, is connected by Bluetooth to a smartphone. In an app, quantitative feedback is given about the amount of activity and goals reached by means of graphical visualization, and an image shows a sun when the goal is reached. Overviews about activity per half an hour, per day, week, and month are provided. In the menu of the app and on a secured website, patients can enter information in individual sessions or read feedback messages generated by the system. The practice nurse can see the results of all patients on a secure webpage and can then discuss the results and set personalized goals in consultation with the patient. Conclusions This study demonstrates that a user-centered approach brings in valuable details (such as the requirements for feedback in activity minutes per day) to improve the fit between the user, technology, and the organization of care, which is important for the usability and acceptability of the tool. The tool embedded in primary care will be evaluated in a randomized controlled trial. PMID:25099556

Verwey, Renée; Spreeuwenberg, Marieke; Tange, Huibert; van der Weijden, Trudy; de Witte, Luc



The electronic structure of the primary electron donor of reaction centers of purple bacteria at atomic resolution as observed by photo-CIDNP 13C NMR  

PubMed Central

Composed of the two bacteriochlorophyll cofactors, PL and PM, the special pair functions as the primary electron donor in bacterial reaction centers of purple bacteria of Rhodobacter sphaeroides. Under light absorption, an electron is transferred to a bacteriopheophytin and a radical pair is produced. The occurrence of the radical pair is linked to the production of enhanced nuclear polarization called photochemically induced dynamic nuclear polarization (photo-CIDNP). This effect can be used to study the electronic structure of the special pair at atomic resolution by detection of the strongly enhanced nuclear polarization with laser-flash photo-CIDNP magic-angle spinning NMR on the carotenoid-less mutant R26. In the electronic ground state, PL is strongly disturbed, carrying a slightly negative charge. In the radical cation state, the ratio of total electron spin densities between PL and PM is 2:1, although it is 2.5:1 for the pyrrole carbons, 2.2:1 for all porphyrinic carbons, and 4:1 for the pyrrole nitrogen. It is shown that the symmetry break between the electronic structures in the electronic ground state and in the radical cation state is an intrinsic property of the special pair supermolecule, which is particularly attributable to a modification of the structure of PL. The significant difference in electron density distribution between the ground and radical cation states is explained by an electric polarization effect of the nearby histidine. PMID:20018724

Daviso, Eugenio; Prakash, Shipra; Alia, A.; Gast, Peter; Neugebauer, Johannes; Jeschke, Gunnar; Matysik, Jörg



A 240 GHz high-field transient EPR study of the primary donor triplet state g-tensor in photosynthetic reaction centers of Rhodobacter sphaeroides R-26.  

NASA Astrophysics Data System (ADS)

We report time-resolved 240 GHz EPR spectra of the primary donor triplet state ^3P from photosynthetic reaction centers of Rhodobacter sphaeroides R26.1 as a function of temperature in the range 10-230K. The data allow the determination of the principal g-tensor values and the principal axes directions of the ^3P g-tensor with respect to its zero-field axes. The g-tensor measured at 240 GHz differs appreciably from previous measurements of ^3P at lower frequencies and also differs from that of the cation radical state P^+, which has previously been characterized at high frequencies. In contrast to P^+, the ^3P state exhibits significant temperature dependence in its g-tensor, particularly in the direction of the principal axes. The ^3P yield anisotropy first observed by Boxer and coworkers at high field using photoselection methods is also evident in the high-field EPR spectrum as a significant variation of intensity across the spectrum. This variation is analyzed in terms of a radical pair and a yield ratio model.

van Tol, Johan; Budil, David; Zeng, Ronghui; Frank, Harry; Deal, Amanda



Malignancies after hematopoietic cell transplantation for primary immune deficiencies: a report from the Center for International Blood and Marrow Transplant Research  

PubMed Central

We describe the incidence of malignancy in patients with primary immunodeficiency disorders (PIDD) following hematopoietic cell transplantation (HCT). From the Center for International Blood and Marrow Transplant Research, 2266 PIDD patients who had undergone allogeneic HCT between 1968 and 2003 were identified. Patient, disease and transplant factors for development of malignancy were examined and pathology reports for reported malignancies reviewed independently by a pathologist for confirmation. The incidence of malignancy was highest for Wiskott-Aldrich syndrome (3.3%) with an overall incidence of 2.3% for PIDD. Post-HCT malignancy was confirmed for 52 of 63 reported cases. Forty-five of 52 patients developed a lymphoproliferative disorder (PTLD) at a median of 3 months post-HCT. Of these, 26 had received T-cell depleted (TCD) bone marrow. Three patients who developed myelodysplastic syndrome had received TCD marrow and total body irradiation. Three patients developed a solid tumor. Patients with PIDD are at a relatively low risk of developing malignancies post-HCT compared to their historical risk of cancer. The most frequent malignancy or lymphoproliferative disorder was early-onset PTLD. As in other HCT recipients, TCD appears to correlate with PTLD development. Our results lend support to the hypothesis that immune reconstitution in PIDD following HCT leads to a decrease in cancer risk. PMID:21658461

Kamani, Naynesh R.; Kumar, Shimareet; Hassebroek, Anna; Eapen, Mary; LeRademacher, Jennifer; Casper, James; Cowan, Morton; de Toledo, José Sánchez; Ferster, Alina; Szabolcs, Paul; Wingard, John R.; Horwitz, Edwin; Filipovich, Alexandra H.



Spanish adaptation of the NDSS (Nicotine Dependence Syndrome Scale) and assessment of nicotine-dependent individuals at primary care health centers in Spain.  


The availability of adequate instruments for the assessment of nicotine dependence is an important factor that is relevant in the area of tobacco addiction. In this study, we present a Spanish validation of the Nicotine Dependence Syndrome Scale (NDSS) (Shiffman, Waters, & Hickcox, 2004). The sample was composed ofpatients, all daily smokers, who visited their General Practitioner (GP) at five Primary Health Care Centers in different cities of Spain (N = 637). The results indicated adequate reliability for the general factor that assesses nicotine dependence (NDSS-Total) (Cronbach's alpha = .76). Factor analysis confirms the five factors of the original validation: Drive, Continuity, Stereotypy, Priority, and Tolerance. It must be noted that reliability is adequate for the first, and moderate or low for the rest. The NDSS-T and its scales correlate significantly with the Fagerström Test for Nicotine Dependence (FTND), with the nicotine dependence criteria of the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) as assessed through the Structured Clinical Interview for DSM-IV (SCID), with carbon monoxide levels in expired air (CO), and with the number of cigarettes smoked. The ROC curve indicates that the NDSS-T has a score of .79 which is under the curve (.69 for the FTND), thus the prediction of nicotine dependence is adequate. We conclude that this instrument is useful (in terms of its total score NDSS-T) for assessing nicotine dependence for Spanish smokers (in Spain), as has been found in other countries, language groups, and cultures. PMID:20977042

Becoña, Elisardo; López, Ana; Fernández del Río, Elena; Míguez, Ma Carmen; Castro, Josefina



The WHO/PEPFAR collaboration to prepare an operations manual for HIV prevention, care, and treatment at primary health centers in high-prevalence, resource-constrained settings: defining laboratory services.  


The expansion of HIV/AIDS care and treatment in resource-constrained countries, especially in sub-Saharan Africa, has generally developed in a top-down manner. Further expansion will involve primary health centers where human and other resources are limited. This article describes the World Health Organization/President's Emergency Plan for AIDS Relief collaboration formed to help scale up HIV services in primary health centers in high-prevalence, resource-constrained settings. It reviews the contents of the Operations Manual developed, with emphasis on the Laboratory Services chapter, which discusses essential laboratory services, both at the center and the district hospital level, laboratory safety, laboratory testing, specimen transport, how to set up a laboratory, human resources, equipment maintenance, training materials, and references. The chapter provides specific information on essential tests and generic job aids for them. It also includes annexes containing a list of laboratory supplies for the health center and sample forms. PMID:19461098

Spira, Thomas; Lindegren, Mary Lou; Ferris, Robert; Habiyambere, Vincent; Ellerbrock, Tedd



Primary charge separation between P* and B A: Electron-transfer pathways in native and mutant GM203L bacterial reaction centers  

NASA Astrophysics Data System (ADS)

Coherent components in the dynamics of decay of stimulated emission from the primary electron donor excited state P*, and of population of the product charge-separated states P+BA- and P+HA-, were studied in GM203L mutant reaction centers (RCs) of Rhodobacter (Rb.) sphaeroides by measuring oscillations in the kinetics of absorbance changes at 940 nm (P* stimulated emission region), 1020 nm ( BA- absorption region) and 760 nm (H A bleaching region). Absorbance changes were induced by excitation of P (870 nm) with 18 fs pulses at 90 K. In the GM203L mutant, replacement of Gly M203 by Leu results in exclusion of the crystallographically defined water molecule (HOH55) located close to the oxygen of the 13 1-keto carbonyl group of B A and to His M202, which provides the axial ligand to the Mg of the P B bacteriochlorophyll. The results of femtosecond measurements were compared with those obtained with Rb. sphaeroides R-26 RCs containing an intact water HOH55. The main consequences of the GM203L mutation were found to be as follows: (i) a low-frequency oscillation at 32 cm -1, which is characteristic of the HOH55-containing RCs, disappears from the kinetics of absorbance changes at 1020 and 760 nm in the mutant RC; (ii) electron transfer from P* to B A in the wild type RC was characterized by two time constants of 1.1 ps (80%) and 4.3 ps (20%), but in the GM203L mutant was characterized by a single time constant of 4.3 ps, demonstrating a slowing of primary charge separation. The previously postulated rotation of water HOH55 with a fundamental frequency of 32 cm -1, triggered by electron transfer from P* to B A, was confirmed by observation of an isotopic shift of the 32 cm -1 oscillation in the kinetics of P+BA- population in deuterated, pheophytin-modified RCs of Rb. sphaeroides R-26, by a factor of 1.6. These data are discussed in terms of the influence of water HOH55 on the energetics of the P??P+BA- reaction, and protein dynamic events that occur on the time scale of this reaction.

Yakovlev, Andrey G.; Jones, Michael R.; Potter, Jane A.; Fyfe, Paul K.; Vasilieva, Lyudmila G.; Shkuropatov, Anatoli Ya.; Shuvalov, Vladimir A.



Effectiveness of an intervention in groups of family caregivers of dependent patients for their application in primary health centers. Study protocol  

PubMed Central

Background Although Primary Health Care (PHC) Teams are used to deal with prevention and treatment of sanitary problems in adults with chronic diseases, they usually have a lack of experience in development of psychotherapeutic interventions. However, these interventions are the ones that achieve better results to reduce symptomatology and improve emotional state of caregivers. The study aims to evaluate the effectiveness of an intervention of psychotherapy in improving the mental health and Quality of life of caregivers. This intervention is based on theoretical approaches to care adjusted to cognitive theory, in order to be applied in primary health care centres. Methods/Design This is multicentre clinical trials study, randomized in two parallel groups, carry out in two PHC, Study population: 150 caregivers will be included by consecutive sampling and they will be randomized the half to experimental group and the other half to control group. They provide mostly all the assistance to care-dependent familiars receiving attention in PHC Centers. Measurements: Each caregiver will be evaluated on a personal interview. The caregivers' assessment protocol: 1) Assessment of different socio-demographic related to care, and caregiver's personal situation. 2)Care-dependent individuals will also be assessed by Barthel Index and Pfeiffer Questionnaire (SPMSQ). 3)Change in caregivers will be the principal measure: family function (Family APGAR Questionnaire), burden short questionnaire (Short Zarit Burden Interview), quality of life (Ruiz & Baca: 1993 Questionnaire), the Duke-UNK Functional Social Support Questionnaire, the General Health Questionnaire-12, and changes in Dysfunctional Thoughts about caring. 4) Intervention implementation measures will also be assessed. Intervention: A psychotherapeutic intervention will be 8 sessions of 90 minutes in groups. This intervention has been initially developed for family caregivers of patients with dementia. Discussion Psychotherapeutic interventions have been proved to obtain better results to reduce symptomatology and improve emotional state of caregivers. Moreover, this intervention has been proved to be effective in a different setting other than PHC, and was developed by professionals of Mental Health. If we found that this intervention is effective in PHC and with our professionals, it would be an important instrument to offer to caregivers of care-dependent patients. Trial Registration Identifier NCT01177696 PMID:20849630



Selenium deficiency and fulvic acid supplementation induces fibrosis of cartilage and disturbs subchondral ossification in knee joints of mice: An animal model study of Kashin-Beck disease  

Microsoft Academic Search

Kashin-Beck disease is an acquired, chronic and degenerative osteoarticular disorder. Selenium deficiency and fulvic acid in drinking water have been implicated in the cause of this disease. Pathologically, chondronecrosis of the growth plate and articular cartilage and subconsequent disturbance of ossification were observed in the joints. In this animal model study, mice were fed with a selenium deficient diet and

Chunlin Yang; Eduard Wolf; Kerstin Röser; Günter Delling; Peter K. Müller



Platinum-based Chemotherapy in Primary Advanced Seminoma—a Retrospective Analysis: Treatment Results at the Northern Israel Oncology Center (1989–2010)  

PubMed Central

Objective: Over the past 30 years, great strides have been made in the treatment of disseminated testicular tumors. Despite the low number of patients and the rarity of studies concerning primary advanced seminoma, the efficacy of chemotherapy is clear, mainly 3–4-cisplatin-based chemotherapy. Aiming to contribute to the understanding and implementation of proper chemotherapeutic management in advanced seminoma patients, we retrospectively summarized our experience with 26 patients who were referred for platinum-based chemotherapy, post-orchiectomy to the Northern Israel Oncology Center between 1989 and 2010. Response rate, side effects, and long-term outcome were investigated. Methods: Before chemotherapy, meticulous staging was done, including tumor markers (B-human chorionic gonadotropin (B-HCG), alpha-fetoprotein (AFP), and lactic dehydrogenase (LDH)), and abdominal and pelvic computerized tomography (CT) scans were carried out. Results: All 26 treated patients achieved complete remission, clinically and symptomatically, with normalization of their CT scans. At a median follow-up of 120 months (range, 24–268 months) all patients are alive, without evidence of recurrent disease. One patient whose disease recurred twice achieved a third complete remission following salvage treatment with high-dose chemotherapy and autologous peripheral stem cell transplantation. Another patient, who preferred surveillance, relapsed abdominally after 9 months but achieved long-standing complete remission with cisplatin-based chemotherapy. Both these patients are alive with no evidence of disease. Three patients recovered uneventfully from bleomycin-induced pneumonitis. Conclusions: Advanced seminoma is a highly curable disease using platinum-based chemotherapy. Our study confirms the efficacy and safety of cisplatin-based chemotherapy in the treatment of advanced seminoma. PMID:24498512

Stein, Moshe E.; Drumea, Karen; Charas, Tomer; Gershuny, Anthony; Ben-Yosef, Rahamim



Fibrodysplasia Ossificans Progressiva, a Heritable Disorder of Severe Heterotopic Ossification, Maps to Human Chromosome 4q27-31  

PubMed Central

Summary Fibrodysplasia ossificans progressiva (FOP) is a severely disabling, autosomal-dominant disorder of connective tissue and is characterized by postnatal progressive heterotopic ossification of muscle, tendon, ligament, and fascia and by congenital malformation of the great toes. To identify the chromosomal location of the FOP gene, we conducted a genomewide linkage analysis, using four affected families with a total of 14 informative meioses. Male-to-male transmission of the FOP phenotype excluded X-linked inheritance. Highly polymorphic microsatellite markers covering all human autosomes were amplified by use of PCR. The FOP phenotype is linked to markers located in the 4q27-31 region (LOD score 3.10 at recombination fraction 0). Crossover events localize the putative FOP gene within a 36-cM interval bordered proximally by D4S1625 and distally by D4S2417. This interval contains at least one gene involved in the bone morphogenetic protein–signaling pathway. PMID:10631143

Feldman, George; Li, Ming; Martin, Shelden; Urbanek, Margrit; Urtizberea, J. Andoni; Fardeau, Michel; LeMerrer, Martine; Connor, J. Michael; Triffitt, James; Smith, Roger; Muenke, Maximilian; Kaplan, Frederick S.; Shore, Eileen M.



What you need to know about ossification of the posterior longitudinal ligament to optimize cervical spine surgery: A review  

PubMed Central

What are the risks, benefits, alternatives, and pitfalls for operating on cervical ossification of the posterior longitudinal ligament (OPLL)? To successfully diagnose OPLL, it is important to obtain Magnetic Resonance Images (MR). These studies, particularly the T2 weighted images, provide the best soft-tissue documentation of cord/root compression and intrinsic cord abnormalities (e.g. edema vs. myelomalacia) on sagittal, axial, and coronal views. Obtaining Computed Tomographic (CT) scans is also critical as they best demonstrate early OPLL, or hypertrophied posterior longitudinal ligament (HPLL: hypo-isodense with punctate ossification) or classic (frankly ossified) OPLL (hyperdense). Furthermore, CT scans reveal the “single layer” and “double layer” signs indicative of OPLL penetrating the dura. Documenting the full extent of OPLL with both MR and CT dictates whether anterior, posterior, or circumferential surgery is warranted. An adequate cervical lordosis allows for posterior cervical approaches (e.g. lamionplasty, laminectomy/fusion), which may facilitate addressing multiple levels while avoiding the risks of anterior procedures. However, without lordosis and with significant kyphosis, anterior surgery may be indicated. Rarely, this requires single/multilevel anterior cervical diskectomy/fusion (ACDF), as this approach typically fails to address retrovertebral OPLL; single or multilevel corpectomies are usually warranted. In short, successful OPLL surgery relies on careful patient selection (e.g. assess comorbidities), accurate MR/CT documentation of OPLL, and limiting the pros, cons, and complications of these complex procedures by choosing the optimal surgical approach. Performing OPLL surgery requires stringent anesthetic (awake intubation/positioning) and also the following intraoperative monitoring protocols: Somatosensory evoked potentials (SSEP), motor evoked potentials (MEP), and electromyography (EMG). PMID:24843819

Epstein, Nancy E.



Pathways and Timescales of Primary Charge Separation in the Photosystem II Reaction Center as Revealed by a Simultaneous Fit of Time-Resolved Fluorescence and Transient Absorption  

PubMed Central

We model the dynamics of energy transfer and primary charge separation in isolated photosystem II (PSII) reaction centers. Different exciton models with specific site energies of the six core pigments and two peripheral chlorophylls (Chls) in combination with different charge transfer schemes have been compared using a simultaneous fit of the absorption, linear dichroism, circular dichroism, steady-state fluorescence, transient absorption upon different excitation wavelengths, and time-resolved fluorescence. To obtain a quantitative fit of the data we use the modified Redfield theory, with the experimental spectral density including coupling to low-frequency phonons and 48 high-frequency vibrations. The best fit has been obtained with a model implying that the final charge separation occurs via an intermediate state with charge separation within the special pair (RP1). This state is weakly dipole-allowed, due to mixing with the exciton states, and can be populated directly or via 100-fs energy transfer from the core-pigments. The RP1 and next two radical pairs with the electron transfer to the accessory Chl (RP2) and to the pheophytin (RP3) are characterized by increased electron-phonon coupling and energetic disorder. In the RP3 state, the hole is delocalized within the special pair, with a predominant localization at the inactive-branch Chl. The intrinsic time constants of electron transfer between the three radical pairs vary from subpicoseconds to several picoseconds (depending on the realization of the disorder). The equilibration between RP1 and RP2 is reached within 5 ps at room temperature. During the 5–100-ps period the equilibrated core pigments and radical pairs RP1 and RP2 are slowly populated from peripheral chlorophylls and depopulated due to the formation of the third radical pair, RP3. The effective time constant of the RP3 formation is 7.5 ps. The calculated dynamics of the pheophytin absorption at 545 nm displays an instantaneous bleach (30% of the total amplitude) followed by a slow increase of the bleaching amplitude with time constants of 15 and 12 ps for blue (662 nm) and red (695 nm) excitation, respectively. PMID:15980183

Novoderezhkin, Vladimir I.; Andrizhiyevskaya, Elena G.; Dekker, Jan P.; van Grondelle, Rienk



Long-term Outcomes and Quality of Life of 186 Patients With Primary Parotid Carcinoma Treated With Surgery and Radiotherapy at the Daniel den Hoed Cancer Center  

SciTech Connect

Purpose: To assess the outcomes, toxicity, and quality of life (QOL) of patients with primary parotid carcinoma treated with surgery and postoperative radiotherapy at the Daniel den Hoed Cancer Center. Methods and Materials: Between 1995 and 2010, 186 patients with parotid carcinoma were treated with parotidectomy with or without neck dissection, followed by radiotherapy. Elective nodal irradiation (ENI) was applied to high-risk, node-negative disease. End points were locoregional control (LRC), disease-free survival (DFS), cause-specific survival (CSS), and overall survival (OS), late toxicity, and QOL. Results: After a median follow-up of 58 months (range, 4-172 months), the 5-year Kaplan-Meier estimates for LRC, DFS, CSS, and OS were 89%, 83%, 80%, and 68%, respectively. Forty-five events were reported: 24 distant metastases (DM) and 21 locoregional failures (LRF). Event-free survival rates by histological types were 89%, 78%, 76%, 74%, and 70% for acinic cell, mucoepidermoid, adenoid cystic, adenocarcinoma, and squamous cell carcinoma, respectively. More LRF were reported in patients with squamous cell and high-grade mucoepidermoid carcinoma (21% and 19%, respectively) than in patients with other histological types (p = 0.04) and more DM in patients with adenoid cystic and adenocarcinoma (20% and 19%, respectively) than in patients with other types (p = 0.03). None of the high-risk node-negative patients who received ENI developed regional failure. On multivariate analysis, T stage, N stage, grade, and presence of perineural invasion and facial paralysis correlated significantly with DFS. The 5-year cumulative incidence of grade {>=}2 late toxicity was 8%. QOL scores deteriorate during and shortly after treatment but returned in almost all scales to baseline scores within 6 months. Conclusions: Of the entire group, surgery and postoperative radiotherapy resulted in excellent outcomes with minimal side effects and preservation of good QOL scores. However, in view of the pattern of failures observed in this study, the role of adjuvant systemic or targeted therapy in patients at high risk of DM should be investigated in prospective trials.

Al-Mamgani, Abrahim, E-mail: [Department of Radiation Oncology, Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam (Netherlands)] [Department of Radiation Oncology, Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam (Netherlands); Rooij, Peter van [Department of Biostatistics, Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam (Netherlands)] [Department of Biostatistics, Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam (Netherlands); Verduijn, Gerda M. [Department of Radiation Oncology, Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam (Netherlands)] [Department of Radiation Oncology, Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam (Netherlands); Meeuwis, Cees A. [Department of Otorhinolaryngology, Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam (Netherlands)] [Department of Otorhinolaryngology, Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam (Netherlands); Levendag, Peter C. [Department of Radiation Oncology, Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam (Netherlands)] [Department of Radiation Oncology, Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam (Netherlands)



Incidence Density of Invasive Fungal Infections during Primary Antifungal Prophylaxis in Newly Diagnosed Acute Myeloid Leukemia Patients in a Tertiary Cancer Center, 2009 to 2011  

PubMed Central

Although primary antifungal prophylaxis (PAP) is routinely administered in patients with acute myeloid leukemia (AML) during remission-induction and consolidation chemotherapy, the impact of PAP on the incidence of invasive fungal infections (IFIs) is not well described. We retrospectively analyzed the incidence of IFIs in 152 patients with AML who had been admitted to a tertiary cancer center between August 2009 and March 2011 and received PAP within 120 days after first remission-induction chemotherapy. We excluded patients who had undergone stem cell transplantation. Patients received a PAP drug with anti-Aspergillus activity during 72% (7,660/10,572) of prophylaxis-days. The incidence of documented IFIs (definite or probable according to revised European Organization for Research and Treatment of Cancer [EORTC] criteria) was 2.0/1,000 prophylaxis-days (95% confidence interval [CI], 1.23 to 3.04). IFIs due to molds were more common than IFIs due to yeasts (1.5/1,000 prophylaxis-days versus 0.4/1,000 prophylaxis-days; P = 0.01). Echinocandin-based PAP (8.6 and 7.1/1,000 prophylaxis-days, respectively) was associated with higher rates of documented IFIs than anti-Aspergillus azoles (voriconazole or posaconazole) (2.4 and 1.1/1,000 prophylaxis-days, respectively) at both 42 days (P = 0.03) and 120 days (P < 0.0001) after first remission-induction chemotherapy. The incidence of overall (documented and presumed) IFIs (P < 0.001), documented IFIs (P < 0.01), and empirical antifungal therapies (P < 0.0001) was higher during the first 42 days than after day 42. Despite the broad use of PAP with anti-Aspergillus activity, IFIs, especially molds, remain a significant cause of morbidity and mortality in AML patients, predominantly during the remission-induction phase. Patients receiving echinocandin-based PAP experienced higher rates of IFIs than did those receiving anti-Aspergillus azoles. PMID:24277033

Mulanovich, Victor E.; Jiang, Y.; Lewis, Russell E.



Primary bone tumors of the spine revisited: A 10-year single-center experience of the management and outcome in a neurosurgical department  

PubMed Central

Objective: To report a large clinical series of primary bone tumors of the spine (PBTS) and review the current concepts of management. Materials and Methods: We retrospectively analyzed a clinical series of PBTS treated over the last decade (2004-2014) in the spine unit of a large European tertiary care center. Every PBTS was identified from an electronic medical-record system. Analysis comprised medical records and clinical imaging. Overall survival and outcome was measured using the Glasgow Outcome Scale (GOS) at six weeks, six months and one year postoperatively. Surgical management and adjuvant/neoadjuvant strategies were analyzed. A thorough review of the current literature was performed. Results: A total of 79 patients were included. Of these, 44 (55.7%) were male. The age ranged from 9 to 90 years (mean 55), and most patients were adults (93.6%). Local pain was the most common symptom and was present in 91.1% of the patients. The majority of the tumors occurred in the thoracic spine (52 patients, 65.8%). Overall 86% (68 patients) of PBTS were classified as malignant and at the time of diagnosis, 7 patients (8.9%) presented with non-spinal metastasis. The most common histologic types were hematopoietic tumors (72.2%), followed by chondrogenic ones (12.7%). Within hematopoietic tumors, plasmacytoma was the most frequent type (49 patients, 62%). In 12 patients (15.2%) recurrences were seen during the follow-up period. Overall mean survival of benign PBTS was 100%, malignant non-hematopoietic PBTS 50% and, malignant hematopoietic PBTS 84% at one year, respectively. At six weeks and one year after the initial surgery, 79% and 54% of the patients presented a GOS >3, respectively. Conclusion: PBTS were almost exclusively seen in adults. Malignant tumors were markedly more frequent than benign tumors, with hematopoietic tumors being the most common type. For PBTS, early surgery is important in order to restore spinal stability and decompress the spinal cord. This allows pain reduction and prevention of neurological deficits.

Munoz-Bendix, Christopher; Slotty, Phillip Jorg; Ahmadi, Sebastian Alexander; Bostelmann, Richard; Steiger, Hans-Jakob; Cornelius, Jan Frederick



Latest Data Show Strong Fertility Center Offers Region's Best IVF Success Rates! The Society for Assisted Reproductive Technology (SART), the primary organization of  

E-print Network

Latest Data Show Strong Fertility Center Offers Region's Best IVF Success Rates! The Society Fertility Center surpasses the national average for IVF in women under 35 years of age. Over 51% of embryo transfers in women under age 35 resulted in live births. In fact, Strong Fertility Center's IVF success

Goldman, Steven A.


Electron Transfer from Plastocyanin to the Photosystem I Reaction Center in Mutants with Increased Potential of the Primary Donor in Chlamydomonas  

E-print Network

Electron Transfer from Plastocyanin to the Photosystem I Reaction Center in Mutants with Increased between transmembrane helices i and j of PsaA and PsaB. The photosynthetic electron transfer chain for light harvesting and electron transfer (2, 3). The reaction center core is formed by two homologous


Hand development and sequence of ossification in the forelimb of the European shrew Crocidura russula (Soricidae) and comparisons across therian mammals  

PubMed Central

Hand development in the European shrew Crocidura russula is described, based on the examination of a cleared and double-stained ontogenetic series and histological sections of a c. 20-day-old embryo and a neonate. In the embryo all carpal elements are still mesenchymal condensations, and there are three more elements than in the adult stage: the ‘lunatum’, which fuses with the scaphoid around birth; a centrale, which either fuses with another carpal element or just disappears later in ontogeny; and the anlage of an element that later fuses with the radius. Carpal arrangement in the neonate and the adult is the same. In order to compare the relative timing of the onset of ossification in forelimb bones in C. russula with that of other therians, we built up two matrices of events based on two sets of data and used the event-pair method. In the first analysis, ossification of forelimb elements in general was examined, including that of the humerus, radius, ulna, the first carpal and metacarpal to ossify, and the phalanges of the third digit. The second analysis included each carpal, humerus, radius, ulna, the first metacarpal and the first phalanx to ossify. Some characters (= event–pairs) provide synapomorphies for some clades examined. There have been some shifts in the timing of ossification apparently not caused by ecological and/or environmental influences. In two species (Oryctolagus and Myotis), there is a tendency to start the ossification of the carpals relatively earlier than in all other species examined, the sauropsid outgroups included. PMID:15291793

Prochel, Jan; Vogel, Peter; Sánchez-Villagra, Marcelo R



Hand development and sequence of ossification in the forelimb of the European shrew Crocidura russula (Soricidae) and comparisons across therian mammals.  


Hand development in the European shrew Crocidura russula is described, based on the examination of a cleared and double-stained ontogenetic series and histological sections of a c. 20-day-old embryo and a neonate. In the embryo all carpal elements are still mesenchymal condensations, and there are three more elements than in the adult stage: the 'lunatum', which fuses with the scaphoid around birth; a centrale, which either fuses with another carpal element or just disappears later in ontogeny; and the anlage of an element that later fuses with the radius. Carpal arrangement in the neonate and the adult is the same. In order to compare the relative timing of the onset of ossification in forelimb bones in C. russula with that of other therians, we built up two matrices of events based on two sets of data and used the event-pair method. In the first analysis, ossification of forelimb elements in general was examined, including that of the humerus, radius, ulna, the first carpal and metacarpal to ossify, and the phalanges of the third digit. The second analysis included each carpal, humerus, radius, ulna, the first metacarpal and the first phalanx to ossify. Some characters (= event-pairs) provide synapomorphies for some clades examined. There have been some shifts in the timing of ossification apparently not caused by ecological and/or environmental influences. In two species (Oryctolagus and Myotis), there is a tendency to start the ossification of the carpals relatively earlier than in all other species examined, the sauropsid outgroups included. PMID:15291793

Prochel, Jan; Vogel, Peter; Sánchez-Villagra, Marcelo R



Do intramedullary spinal cord changes in signal intensity on MRI affect surgical opportunity and approach for cervical myelopathy due to ossification of the posterior longitudinal ligament?  

Microsoft Academic Search

Some controversy still exists over the optimal treatment time and the surgical approach for cervical myelopathy due to ossification\\u000a of the posterior longitudinal ligament (OPLL). The aim of the current study was first to analyze the effect of intramedullary\\u000a spinal cord changes in signal intensity (hyperintensity on T2-weighted imaging and hypointensity on T1-weighted imaging) on\\u000a magnetic resonance imaging (MRI) on

Qizhi SunHongwei; Hongwei Hu; Ying Zhang; Yang Li; Linwei Chen; Huajiang Chen; Wen Yuan


Acceptable outcome following resection of bilateral large popliteal space heterotopic ossification masses in a spinal cord injured patient: a case report  

PubMed Central

Spinal cord injury is a well-known predisposing factor for development of heterotopic ossification around the joints especially hip and elbow. Heterotopic ossification about the knee is usually located medially, laterally or anteriorly; besides, the knee is generally fixed in flexion. There are only a few reports of heterotopic bone formation at the posterior aspect of the knee (popliteal space) and fixation of both knees in extension; so, there is little experience in operative management of such a problem. Here, we present a 39-years old paraplegic man who was referred to us five years after trauma with a request of above knee amputation due to sever impairment of his life style and adaptive capacity for daily living because of difficulties in using wheelchair. The principle reason for the impairment was fixed full extension of both knees as the result of bilateral large heterotopic ossification masses in popliteal fossae. The bony masses were surgically resected with acceptable outcome. The anatomic position of the ossified masses as well as ankylosis of both knees in full extension, and the acceptable functional outcome of surgery which was done after a long period of five years following injury makes this case unique. PMID:20569483



Imaging features of primary Sarcomas of the great vessels in CT, MRI and PET/CT: a single-center experience  

PubMed Central

Background To investigate the imaging features of primary sarcomas of the great vessels in CT, MRI and 18?F-FDG PET/CT. Methods Thirteen patients with a primary sarcoma of the great vessels were retrospectively evaluated. All available images studies including F-18 FDG PET(/CT) (n?=?4), MDCT (n?=?12) and MRI (n?=?6) were evaluated and indicative image features of this rare tumor entity were identified. Results The median interval between the first imaging study and the final diagnosis was 11 weeks (0–12 weeks). The most frequently observed imaging findings suggestive of malignant disease in patients with sarcomas of the pulmonary arteries were a large filling defect with vascular distension, unilaterality and a lack of improvement despite effective anticoagulation. In patients with aortic sarcomas we most frequently observed a pedunculated appearance and an atypical location of the filling defect. The F-18 FDG PET(/CT) examinations demonstrated an unequivocal hypermetabolism of the lesion in all cases (4/4). MRI proved lesion vascularization in 5/6 cases. Conclusion Intravascular unilateral or atypically located filling defects of the great vessels with vascular distension, a pedunculated shape and lack of improvement despite effective anticoagulation are suspicious for primary sarcoma on MDCT or MRI. MR perfusion techniques can add information on the nature of the lesion but the findings may be subtle and equivocal. F-18 FDG PET/CT may have a potential role in these patients and may be considered as part of the imaging workup. PMID:23924063



Ossification of the sesamoid bone at the base of the first finger in Czech boys and girls.  


Ossification of the sesamoid bone of the first finger was studied in left hand-and-wrist X-rays of 296 Czech boys and 272 girls 9 to 15 years old using data collected between 1962 and 1966. The logit and the YES or NO methods were used in treating the data. A sesamoid bone, clearly visible to the naked eye, was considered as positive and when it was not yet visible, as negative. The sesamoid bone was developed in 50 per cent of boys at the age of 13.6 years and in 50 per cent of girls at the age of 11.2 years. This stage preceded the age at onset of menarche in Czech girls by 1.9 years. Boys showed a greater variability (SD = 1.4) than girls (SD = 0.8). Both sexes with clearly visible (ossified) sesamoid bones in their first fingers showed to be, on the average, taller and heavier in comparison with the Czech standard and with those boys and girls of corresponding ages without the sesamoid bone. In contrast to the still continuing secular trend in stature in Czech youths, the age of menarche remained in the last cca 30 years unchanged. In view of the close link between bone age and onset of menarche which remained unchanged for the past 30 years, we may consider our finding as still applicable to present-day adolescents. PMID:9457411

Prokopec, M; Pfeiferová, K; Josífko, M



Defective Endochondral Ossification-Derived Matrix and Bone Cells Alter the Lymphopoietic Niche in Collagen X Mouse Models  

PubMed Central

Despite the appreciated interdependence of skeletal and hematopoietic development, the cell and matrix components of the hematopoietic niche remain to be fully defined. Utilizing mice with disrupted function of collagen X (ColX), a major hypertrophic cartilage matrix protein associated with endochondral ossification, our data identified a cytokine defect in trabecular bone cells at the chondro-osseous hematopoietic niche as a cause for aberrant B lymphopoiesis in these mice. Specifically, analysis of ColX transgenic and null mouse chondro-osseous regions via micro-computed tomography revealed an altered trabecular bone environment. Additionally, cocultures with hematopoietic and chondro-osseous cell types highlighted impaired hematopoietic support by ColX transgenic and null mouse derived trabecular bone cells. Further, cytokine arrays with conditioned media from the trabecular osteoblast cocultures suggested an aberrant hematopoietic cytokine milieu within the chondro-osseous niche of the ColX deficient mice. Accordingly, B lymphopoiesis was rescued in the ColX mouse derived trabecular osteoblast cocultures with interlukin-7, stem cell factor, and stromal derived factor-1 supplementation. Moreover, B cell development was restored in vivo after injections of interlukin-7. These data support our hypothesis that endrochondrally-derived trabecular bone cells and matrix constituents provide cytokine-rich niches for hematopoiesis. Furthermore, this study contributes to the emerging concept that niche defects may underlie certain immuno-osseous and hematopoietic disorders. PMID:23656481

Sweeney, Elizabeth; Roberts, Douglas; Lin, Angela; Guldberg, Robert



Defective endochondral ossification-derived matrix and bone cells alter the lymphopoietic niche in collagen X mouse models.  


Despite the appreciated interdependence of skeletal and hematopoietic development, the cell and matrix components of the hematopoietic niche remain to be fully defined. Utilizing mice with disrupted function of collagen X (ColX), a major hypertrophic cartilage matrix protein associated with endochondral ossification, our data identified a cytokine defect in trabecular bone cells at the chondro-osseous hematopoietic niche as a cause for aberrant B lymphopoiesis in these mice. Specifically, analysis of ColX transgenic and null mouse chondro-osseous regions via micro-computed tomography revealed an altered trabecular bone environment. Additionally, cocultures with hematopoietic and chondro-osseous cell types highlighted impaired hematopoietic support by ColX transgenic and null mouse derived trabecular bone cells. Further, cytokine arrays with conditioned media from the trabecular osteoblast cocultures suggested an aberrant hematopoietic cytokine milieu within the chondro-osseous niche of the ColX deficient mice. Accordingly, B lymphopoiesis was rescued in the ColX mouse derived trabecular osteoblast cocultures with interlukin-7, stem cell factor, and stromal derived factor-1 supplementation. Moreover, B cell development was restored in vivo after injections of interlukin-7. These data support our hypothesis that endrochondrally-derived trabecular bone cells and matrix constituents provide cytokine-rich niches for hematopoiesis. Furthermore, this study contributes to the emerging concept that niche defects may underlie certain immuno-osseous and hematopoietic disorders. PMID:23656481

Sweeney, Elizabeth; Roberts, Douglas; Lin, Angela; Guldberg, Robert; Jacenko, Olena



Hatching, growth, ion accumulation, and skeletal ossification of brook trout (Salvelinus fontinalis) alevins in acidic soft waters  

USGS Publications Warehouse

Brook trout eyed eggs and subsequent alevins were exposed to pH 5.0, 6.5, and 7.0 in soft reconstituted water and to pH 8.2 in hard well water for up to 72 d. Hatching was delayed and hatching success reduced (p K+ > Cl- during yolk absorption and early exogenous feeding. Whole-body monovalent ion concentrations were reduced for short periods during yolk absorption in alevins exposed to pH 6.5 and throughout most of the experiment for those exposed to pH 5.0. Whole-body Mg2+ concentrations were not affected by treatment pH and remained near their median hatch level throughout the exposure. The whole-body concentration of Ca2+ was reduced in fish exposed to pH 5.0, particularly near the end of the experiment. Calcium accumulation in fish was influenced by the interaction of pH and time at pH 5.0 but not at the other pH levels. Alevins exposed to pH 5.0 experienced delayed ossification of skeletal structures associated with feeding, respiration, and locomotion that usually persisted for up to 10 d. The detection of skeletal abnormalities early in life might aid in identifying fish populations at risk in acidified waters.

Steingraeber, M.T.; Gingerich, W.H.



Bone regeneration in a massive rat femur defect through endochondral ossification achieved with chondrogenically differentiated MSCs in a degradable scaffold.  


Mesenchymal stem cells (MSCs) are multipotent cells capable of proliferating and differentiating into several lineages. In regenerative medicine, their potential as a resource for tissue-replacement therapy is receiving much attention. However, transplanting MSCs to repair larger bone defects in animal models has so far proved disappointing. Here we report on the healing of both critical-sized (5 mm) and massive (15 mm) full-thickness femur defects in rats by implanting a uniquely fabricated PLGA scaffold seeded with MSCs pre-differentiated in vitro into cartilage-forming chondrocytes (MSC-DCs). This strategy closely mimics endochondral ossification, the process by which long bones develop in nature. It is thought that because the transplanted MSC-DCs induced natural bone formation, the defect size was not critical to the outcome. Crucially, after 8 weeks the mean biomechanical strength of femora with the massive 15 mm implant reached 75% that of a normal rat femur, while in the case of 5 mm implants there was no significant difference. Successful healing was also highly reproducible, with bone union occurring in all treated animals examined radiologically 8 or 16 weeks after surgery. PMID:24952976

Harada, Noriko; Watanabe, Yoshinobu; Sato, Kenji; Abe, Satoshi; Yamanaka, Katsuyuki; Sakai, Yuhiro; Kaneko, Tadashi; Matsushita, Takashi



Shielding of the Hip Prosthesis During Radiation Therapy for Heterotopic Ossification is Associated with Increased Failure of Prophylaxis  

SciTech Connect

Purpose: Radiation therapy (RT) is frequently administered to prevent heterotopic ossification (HO) after total hip arthroplasty (THA). The purpose of this study was to determine if there is an increased risk of HO after RT prophylaxis with shielding of the THA components. Methods and Materials: This is a retrospective analysis of THA patients undergoing RT prophylaxis of HO at Brigham and Women's Hospital between June 1994 and February 2004. Univariate and multivariate logistic regressions were used to assess the relationships of all variables to failure of RT prophylaxis. Results: A total of 137 patients were identified and 84 were eligible for analysis (61%). The median RT dose was 750 cGy in one fraction, and the median follow-up was 24 months. Eight of 40 unshielded patients (20%) developed any progression of HO compared with 21 of 44 shielded patients (48%) (p = 0.009). Brooker Grade III-IV HO developed in 5% of unshielded and 18% of shielded patients (p 0.08). Multivariate analysis revealed shielding (p = 0.02) and THA for prosthesis infection (p = 0.03) to be significant predictors of RT failure, with a trend toward an increasing risk of HO progression with age (p = 0.07). There was no significant difference in the prosthesis failure rates between shielded and unshielded patients. Conclusions: A significantly increased risk of failure of RT prophylaxis for HO was noted in those receiving shielding of the hip prosthesis. Shielding did not appear to reduce the risk of prosthesis failure.

Balboni, Tracy A. [Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA (United States); Gaccione, Peter [Biostatistics Consulting Service, Brigham and Women's Hospital, Boston, MA (United States); Gobezie, Reuben [Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA (United States); Mamon, Harvey J. [Department of Radiation Oncology, Brigham and Women's Hospital, Boston, MA (United States)]. E-mail:



Feeling labeled, judged, lectured, and rejected by family and friends over depression: Cautionary results for primary care clinicians from a multi-centered, qualitative study  

PubMed Central

Background Family and friends may help patients seek out and engage in depression care. However, patients’ social networks can also undermine depression treatment and recovery. In an effort to improve depression care in primary care settings, we sought to identify, categorize, and alert primary care clinicians to depression-related messages that patients hear from friends and family that patients perceive as unhelpful or detrimental. Methods We conducted 15 focus groups in 3 cities. Participants (n?=?116) with a personal history or knowledge of depression responded to open-ended questions about depression, including self-perceived barriers to care-seeking. Focus group conversations were audio-recorded and analyzed using iterative qualitative analysis. Results Four themes emerged related to negatively-received depression messages delivered by family and friends. Specifically, participants perceived these messages as making them feel labeled, judged, lectured to, and rejected by family and friends when discussing depression. Some participants also expressed their interpretation of their families’ motivations for delivering the messages and described how hearing these messages affected depression care. Conclusions The richness of our results reflects the complexity of communication within depression sufferers’ social networks around this stigmatized issue. To leverage patients’ social support networks effectively in depression care, primary care clinicians should be aware of both the potentially beneficial and detrimental aspects of social support. Specifically, clinicians should consider using open-ended queries into patients’ experiences with discussing depression with family and friends as an initial step in the process. An open-ended approach may avoid future emotional trauma or stigmatization and assist patients in overcoming self-imposed barriers to depression discussion, symptom disclosure, treatment adherence and follow-up care. PMID:22747989



Interchangeability of Quinvaxem during primary vaccination schedules: results from a phase IV, single-blind, randomized, controlled, single-center, non-inferiority study.  


Combination vaccines against diphtheria, tetanus and pertussis (DTP) represent the core of childhood vaccination programs. Quinvaxem, a fully-liquid, pentavalent combination vaccine containing inactivated hepatitis B (HepB), Haemophilus influenzae type b (Hib) and whole-cell pertussis (wP) antigens, and tetanus and diphtheria toxoids, has been shown to be suitable for boosting children primed in infancy with another DTwP-HepB-Hib vaccine. This single-blind, randomized, controlled study was designed to demonstrate non-inferiority of a primary vaccination course (6-10-14 week schedule) of Tritanrix HB+Hib (first dose) and Quinvaxem (second/third doses) versus three doses of Quinvaxem with respect to the seroprotection/seroconversion rates for all antigens one month after vaccination course completion. Four hundred healthy subjects eligible for the local Expanded Program on Immunization were enrolled and equally randomized to the two treatment regimens. All subjects achieved seroprotection for tetanus and Hib, all except one for diphtheria, and all except two achieved seroconversion against Bordetella pertussis. Seroprotection against hepatitis B was achieved by 97.4% of Tritanrix HB+Hib followed by Quinvaxem and 94.9% of Quinvaxem subjects. Therefore, one month after vaccination course completion, seroprotection rates (seroconversion rate for B. pertussis) of Tritanrix HB+Hib followed by Quinvaxem were non-inferior to those elicited by Quinvaxem only, thus meeting the primary objective. Adverse events were comparable between the groups and were in line with the safety profile of the vaccines. The switch of vaccine had no apparent effect on safety endpoints. Our results support the use of Quinvaxem interchangeably with Tritanrix HB+Hib in a primary vaccination course and provides further evidence for the interchangeability of pentavalent vaccines (Clinical registry: NCT01357720). PMID:24176498

Capeding, Maria Rosario Z; Jica, Corina; Macura-Biegun, Anna; Rauscher, Martina; Alberto, Edison



Adventures in Cooking: A Collection of Recipes for Use in Nursery Schools, Day Care Centers, Head Start Programs, Kindergartens, and Primary Classrooms.  

ERIC Educational Resources Information Center

This is a collection of recipes which children involved in early childhood education centers can prepare for their own consumption. The recipes were contributed by teachers in such schools based on their own successful experiences in using cooking as a learning experience for children to incorporate and integrate a number of intellectual tasks,…

Foster, Florence P.


Increasing Participation by African Americans in NCI-Designated Cancer Center Colorectal Trials by Involving Primary Care Physicians |

An academic cancer center developed a partnership with a national organization of African-American physicians with the goal of engaging community physicians and encouraging them to refer patients to clinical trials. Although the program focused on colorectal cancer and related trials, the insights gained may be useful for engaging referring physicians for other types of trials as well.


Single-center experience on renal transplantation in primary focal and segmental glomerulosclerosis using hematopoietic stem cell transplantation in thymus, bone marrow, portal and peripheral circulation.  


Recurrence of primary focal segmental glomerulosclerosis (FSGS) is an important cause of graft loss after renal transplantation (RTx). We report our experience in 34 patients with primary FSGS who underwent RTx between April 1999 and June 2009, using hematopoietic stem cell transplantation (HSCT). They belonged to four groups: group 1 (n = 12) received high-dose HSCT in periphery, thymus, bone-marrow, and portal circulation with low-dose non-myeloablative conditioning; group 2 (n = 7) was modified with HSCT without marrow/thymic infusion; and group 3 (n = 3) received HSCT and proteasome inhibitor Bortezomib replacing conditioning. Group 4 (n = 12), were controls who opted for RTx under standard triple-drug immunosuppression. Patient/donor demographics were comparable in all. No recurrence was noted in group 1 with mean follow-up of 8.1 years, whereas 28.6% of group 2, 33.3% of group 3, and 36.4% of group 4 had recurrence over mean follow-up of 2.6, 1.1, and 6.5 years, respectively. Mean serum creatinine was 1.62, 1.69, 1.41, and 1.73 mg%, respectively. Rejections were noted in 41.7%, 28.6%, 0%, and 45.5% grafts, respectively. Groups 1 and 4 had 25% patient loss each, group 2 had 28.6% loss, and no loss was observed in group 3. Graft loss was noted in 33.3% in group 1, 14.3% in group 2, nil in group 3, and 16.7% in the last group. Recurrent FSGS was prevented in RTx with HSCT in thymic, marrow infusion under low-dose non-myeloablative conditioning compared to controls and Bortezomib group, thus suggesting potential role of central tolerance in FSGS. PMID:23354186

Vanikar, Aruna V; Trivedi, Hargovind L; Shah, Pankaj R; Kanodia, Kamal V; Patel, Rashmi D; Modi, Pranjal R; Dave, Shruti D; Singhai, Atin M; Shah, Veena R; Trivedi, Varsha B; Shankar, V



Predictors of packed red cell transfusion after isolated primary coronary artery bypass grafting – The experience of a single cardiac center: A prospective observational study  

PubMed Central

Background Preoperative patients' characteristics can predict the need for perioperative blood component transfusion in cardiac surgical operations. The aim of this prospective observational study is to identify perioperative patient characteristics predicting the need for allogeneic packed red blood cell (PRBC) transfusion in isolated primary coronary artery bypass grafting (CABG) operations. Patients and Methods 105 patients undergoing isolated, first-time CABG were reviewed for their preoperative variables and followed for intraoperative and postoperative data. Patients were 97 males and 8 females, with mean age 58.28 ± 10.97 years. Regression logistic analysis was used for identifying the strongest perioperative predictors of PRBC transfusion. Results PRBC transfusion was used in 71 patients (67.6%); 35 patients (33.3%) needed > 2 units and 14 (13.3%) of these needed > 4 units. Univariate analysis identified female gender, age > 65 years, body weight ? 70 Kg, BSA ? 1.75 m2, BMI ? 25, preoperative hemoglobin ? 13 gm/dL, preoperative hematocrit ? 40%, serum creatinine > 100 ?mol/L, Euro SCORE (standard/logistic) > 2, use of CPB, radial artery use, higher number of distal anastomoses, and postoperative chest tube drainage > 1000 mL as significant predictors. The strongest predictors using multivariate analysis were CPB use, hematocrit, body weight, and serum creatinine. Conclusion The predictors of PRBC transfusion after primary isolated CABG are use of CPB, hematocrit ? 40%, weight ? 70 Kg, and serum creatinine > 100 ?mol/L. This leads to better utilization of blood bank resources and cost-efficient targeted use of expensive blood conservation modalities. PMID:19422707

Elmistekawy, Elsayed M; Errett, Lee; Fawzy, Hosam F



Does Intramedullary Signal Intensity on MRI Affect the Surgical Outcomes of Patients with Ossification of Posterior Longitudinal Ligament?  

PubMed Central

Objectives Patients with cervical ossification of posterior longitudinal ligament (OPLL) are susceptible to cord injury, which often develops into myelopathic symptoms. However, little is known regarding the prognostic factors that are involved in minor trauma. We evaluated the relationship between minor trauma and neurological outcome of OPLL and investigated the prognostic factors with a focus on compressive factors and intramedullary signal intensity (SI). Methods A total of 74 patients with cervical myelopathy caused by OPLL at more than three-levels were treated with posterior decompression surgeries. We surveyed the space available for spinal cord (SAC), the severity of SI change on T2-weighted image, and diabetes mellitus (DM). The neurological outcome using Japanese Orthopedic Association (JOA) scale was assessed at admission and at 12-month follow-up. Results Among the variables tested, preoperative JOA score, severity of intramedullary SI, SAC, and DM were significantly related to neurological outcome. The mean preoperative JOA were 11.3±1.9 for the 41 patients who did not have histories of trauma and 8.0±3.1 for the 33 patients who had suffered minor traumas (p<0.05). However, there were no significant differences in the recovery ratios between those two groups. Conclusions Initial neurological status and high intramedullary SI in the preoperative phase were related to poorer postoperative outcomes. Moreover, the patients with no histories of DM and larger SACs exhibited better improvement than did the patients with DM and smaller SACs. Although the initial JOA scores were worse for the minor trauma patients than did those who had no trauma prior to surgery, minor trauma exerted no direct effects on the surgical outcomes. PMID:25328649

Choi, Jae Hyuk; Kim, Tae Hong; Shin, Hyung Shik; Hwang, Yong Soon; Park, Sang Keun



The crosstalk between transforming growth factor-?1 and delta like-1 mediates early chondrogenesis during embryonic endochondral ossification.  


Delta like-1 (Dlk1)/preadipocyte factor-1 (Pref-1)/fetal antigen-1 (FA1) is a novel surface marker for embryonic chondroprogenitor cells undergoing lineage progression from proliferation to prehypertrophic stages. However, mechanisms mediating control of its expression during chondrogenesis are not known. Thus, we examined the effect of a number of signaling molecules and their inhibitors on Dlk1 expression during in vitro chondrogenic differentiation in mouse embryonic limb bud mesenchymal micromass cultures and mouse embryonic fibroblast (MEF) pellet cultures. Dlk1/Pref-1 was initially expressed during mesenchymal condensation and chondrocyte proliferation, in parallel with expression of Sox9 and Col2a1, and was downregulated upon the expression of Col10a1 by hypertrophic chondrocytes. Among a number of molecules that affected chondrogenesis, transforming growth factor-?1 (TGF-?1)-induced proliferation of chondroprogenitors was associated with decreased Dlk1 expression. This effect was abolished by TGF-? signaling inhibitor SB431542, suggesting regulation of Dlk1/FA1 by TGF-?1 signaling in chondrogenesis. TGF-?1-induced Smad phosphorylation and chondrogenesis were significantly increased in Dlk1(-/-) MEF, while they were blocked in Dlk1 overexpressing MEF, in comparison with wild-type MEF. Furthermore, overexpression of Dlk1 or addition of its secreted form FA1 dramatically inhibited TGF-?1-induced Smad reporter activity. In conclusion, our data identified Dlk1/FA1 as a downstream target of TGF-?1 signaling molecule that mediates its function in embryonic chondrogenesis. The crosstalk between TGF-?1 and Dlk1/FA1 was shown to promote early chondrogenesis during the embryonic endochondral ossification process. PMID:22102178

Taipaleenmäki, Hanna; Harkness, Linda; Chen, Li; Larsen, Kenneth H; Säämänen, Anna-Marja; Kassem, Moustapha; Abdallah, Basem M



Tunica albuginea allograft: a new model of LaPeyronie's disease with penile curvature and subtunical ossification  

PubMed Central

The pathophysiology of LaPeyronie's disease (PD) is considered to be multifactorial, involving genetic predisposition, trauma, inflammation and altered wound healing. However, these factors have not yet been validated using animal models. In this study, we have presented a new model obtained by tunica albuginea allograft. A total of 40, 16-week-old male rats were used. Of these, 8 rats served as controls and underwent a 10 × 2-mm-wide tunical excision with subsequent autografting, whereas the remaining 32 underwent the same excision with grafting of the defect with another rat's tunica. Morphological and functional testing was performed at 1, 3, 7 and 12 weeks after grafting. Intracavernous pressure, the degree of penile curvature and elastic fiber length were evaluated for comparison between the allograft and control groups. The tissues were obtained for histological examination. The penile curvature was significantly greater in the allografted rats as compared with the control rats. The erectile function was maintained in all rats, except in those assessed at 12 weeks. The elastin fiber length was decreased in the allografted tunica as compared to control. SMAD2 expression was detected in the inner part of the allograft, and both collagen-II- and osteocalcin-positive cells were also noted. Tunica albuginea (TA) allograft in rats is an excellent model of PD. The persistence of curvature beyond 12 weeks and the presence of ossification in the inner layer of the TA were similar to those observed in men with PD. Validation studies using this animal model would aid understanding of the PD pathophysiology for effective therapeutic interventions. PMID:24759578

Ferretti, Ludovic; Fandel, Thomas M; Qiu, Xuefeng; Zhang, Haiyang; Orabi, Hazem; Wu, Alex K; Banie, Lia; Wang, Guifang; Lin, Guiting; Lin, Ching-Shwun; Lue, Tom F



A Prolonged Time Interval Between Trauma and Prophylactic Radiation Therapy Significantly Increases the Risk of Heterotopic Ossification  

SciTech Connect

Purpose: To ascertain whether the time from injury to prophylactic radiation therapy (RT) influences the rate of heterotopic ossification (HO) after operative treatment of displaced acetabular fractures. Methods and Materials: This is a single-institution, retrospective analysis of patients referred for RT for the prevention of HO. Between January 2000 and January 2009, 585 patients with displaced acetabular fractures were treated surgically followed by RT for HO prevention. We analyzed the effect of time from injury on prevention of HO by RT. In all patients, 700 cGy was prescribed in a single fraction and delivered within 72 hours postsurgery. The patients were stratified into five groups according to time interval (in days) from the date of their accident to the date of RT: Groups A {<=}3, B {<=}7, C {<=}14, D {<=}21, and E >21days. Results: Of the 585 patients with displaced acetabular fractures treated with RT, (18%) 106 patients developed HO within the irradiated field. The risk of HO after RT increased from 10% for RT delivered {<=}3 days to 92% for treatment delivered >21 days after the initial injury. Wilcoxon test showed a significant correlation between the risk of HO and the length of time from injury to RT (p < 0.0001). Chi-square test and multiple logistic regression analysis showed no significant association between all other factors and the risk of HO (race, gender, cause and type of fracture, surgical approach, or the use of indomethacin). Conclusions: Our data suggest that there is higher incidence and risk of HO if prophylactic RT is significantly delayed after a displaced acetabular fracture. Thus, RT should be administered as early as clinically possible after the trauma. Patients undergoing RT >3 weeks from their displaced acetabular fracture should be informed of the higher risk (>90%) of developing HO despite prophylaxis.

Mourad, Waleed F., E-mail: [Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, MS (United States); Department of Radiation Oncology, Beth Israel Medical Center, New York, NY (Israel); Packianathan, Satyaseelan [Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, MS (United States); Shourbaji, Rania A. [Department of Epidemiology and Biostatistics, Jackson State University, Jackson, MS (United States); Zhang Zhen; Graves, Mathew [Department of Orthopedic Surgery, University of Mississippi Medical Center, Jackson, MS (United States); Khan, Majid A. [Department of Radiology, University of Mississippi Medical Center, Jackson, MS (United States); Baird, Michael C. [Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, MS (United States); Russell, George [Department of Orthopedic Surgery, University of Mississippi Medical Center, Jackson, MS (United States); Vijayakumar, Srinivasan [Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, MS (United States)



A study on knowledge, attitude, and practice towards premarital carrier screening among adults attending primary healthcare centers in a region in Oman  

PubMed Central

Background Despite that hereditary diseases are widespread among the Arab population due to high rates of consanguineous marriages, research regarding community awareness towards premarital carrier screening in some countries such as Oman, is extremely scarce. This study aimed to investigate knowledge and attitude towards premarital carrier screening (PMCS) in Oman. Methods A cross-sectional study was conducted using a self-administered questionnaire which was distributed to 400 Omani adults aged 20–35 who attended primary healthcare institutions at the South Batinah Governorate in Oman. Results The majority of the participants (84.5%) believed that PMCS was necessary, and about half of them (49.5%) supported the view of making PMCS compulsory. On the contrary, approximately one third (30.5%) of the participants reported that they were not in favor of taking the blood screening test. Overall, unwillingness to perform pre-marital testing was associated with female gender, younger age, being single, less education, and increased income. Conclusion Despite the relatively high level of knowledge, about one third of the participants were still reluctant to carry out premarital testing. Such attitude calls for immediate need for community-based campaigns to encourage the public to do premarital testing. PMID:24742222



The 12 item w.h.o.d.a.s. As primary self report outcome measure in a correctional community treatment center for dually diagnosed patients.  


The World Health Organization Disability Assessment Scale (WHODAS) is suggested as a measure of impairment in DSM-5. The measurement of impaired functioning is crucial in the rehabilitation of dually diagnosed, addiction and mental health, patients. This study is the first to look at the use of the 12 item self report WHODAS as the primary outcome in a community correctional treatment facility for dually diagnosed patients.100 (55 male; 73 white, 25 black, 2 hispanic) former inmates, age 36.1 ± 11.1, with psychiatric and addiction diagnoses were treated in an integrated program. The 12 item WHODAS was completed by the patients during the initial evaluation and repeated an average of 11.1 ± 2.7 weeks later. The Clinical Global Impression-Severity Scale (CGI) was completed at the same time by the psychiatrist, independently of the WHODAS. At initial assessment, the CGI showed moderate severity and the WHODAS showed severe disability. CGI and WHODAS were significantly correlated (R 0.48, p < 0.0001). After three months of treatment, both measures improved: CGI with 46 % and WHODAS with 49 %. The CGI showed mild severity and the WHODAS moderate disability. The change in CGI was correlated with the change in WHODAS (R 0.57, p < 0.0001). The WHODAS appears sensitive to clinical improvement related to shortterm treatment of a highly co-morbid dual diagnosis population. PMID:25262006

Bastiaens, Leo; Galus, James; Goodlin, Michael



Association of bone morphogenetic protein-2 gene polymorphisms with susceptibility to ossification of the posterior longitudinal ligament of the spine and its severity in Chinese patients  

Microsoft Academic Search

A case–control study was conducted to examine the association between two single nucleotide polymorphisms (SNPs) in exon 2\\u000a of the bone morphogenetic protein-2 gene (BMP-2) and ossification of the posterior longitudinal ligament (OPLL), and to investigate\\u000a whether SNPs of the Ser37Ala (T\\/G) and the Ser87Ser (A\\/G) in the BMP-2 gene are associated with genetic susceptibility to\\u000a OPLL and its severity

Hao Wang; Dongmei Liu; Zhaohui Yang; Baopeng Tian; Jie Li; Xianglong Meng; Zhentian Wang; Hui Yang; Xin Lin



The primary donor cation P + rad in photosynthetic reaction centers of site-directed mutants of Rhodobacter sphaeroides: g-tensor shifts revealed by high-field EPR at 360 GHz/12.8 T  

NASA Astrophysics Data System (ADS)

The frozen solution electron paramagnetic resonance spectrum of the primary donor cation P + rad in reaction centers of site-directed mutants of Rhodobacter ( Rb.) sphaeroides has been obtained at a microwave frequency ?=360 GHz and a magnetic field B0=12.8 T. Due to the high Zeeman resolution of the powder pattern, all three principal components of the rhombic g-tensors at T=160 K could be determined with high accuracy. We compare spectra of the site-directed mutants, in which the axial ligand histidine M202 of the primary donor is replaced by glutamic acid (HE(M202)) or leucine (HL(M202)), with those of the strain R26, whose primary donor is similar to that of the wild type and only lacks the carotenoid. For HE(M202), this is the first determination of its g-tensor with the principal components gxx=2.00335(3), gyy=2.00236(2) and gzz=2.00191(2). While in R26 the primary donor is a bacteriochlorophyll a dimer, the HL(M202) and HE(M202) mutants have previously been shown to be bacteriochlorophyll:bacteriopheophytin heterodimers. Their g-tensor anisotropy ? g= gxx- gzz shows significant variations in opposite directions when compared with R26, with an increased anisotropy for HE(M202) and a decreased one for HL(M202). Calculations employing Density Functional Theory suggest that the observed shifts originate in different torsional angles of the acetyl group attached to the spin-carrying bacteriochlorophyll half L of the dimer.

Fuchs, Martin R.; Schnegg, Alexander; Plato, Martin; Schulz, Claudia; Müh, Frank; Lubitz, Wolfgang; Möbius, Klaus



Efficacy and safety of tirofiban-supported primary percutaneous coronary intervention in patients pretreated with 600 mg clopidogrel: results of propensity analysis using the Clinical Center of Serbia STEMI Register  

PubMed Central

Background: Studies with platelet glycoprotein IIb/IIIa receptor inhibitors (GPIs) showed conflicting results in primary percutaneous coronary intervention (PPCI) patients who were pretreated with 600 mg clopidogrel. We sought to investigate the short- and long-term efficacy and safety of the periprocedural administration of tirofiban in a largest Serbian PPCI centre. Methods: We analysed 2995 consecutive PPCI patients enrolled in the Clinical Center of Serbia STEMI Register, between February 2007 and March 2012. All patients were pretreated with 600 mg clopidogrel and 300 mg aspirin. Major adverse cardiovascular events, comprising all-cause death, nonfatal infarction, nonfatal stroke, and ischaemia-driven target vessel revascularization, was the primary efficacy end point. TIMI major bleeding was the key safety end point. Results: Analyses drawn from the propensity-matched sample showed improved primary efficacy end point in the tirofiban group at 30-day (OR 0.72, 95% CI 0.53–0.97) and at 1-year (OR 0.74, 95% CI 0.57–0.96) follow up. Moreover, tirofiban group had a significantly lower 30-day all-cause mortality (secondary end point; OR 0.63, 95% CI 0.40–0.90), compared with patients who were not administered tirofiban. At 1 year, a trend towards a lower all-cause mortality was observed in the tirofiban group (OR 0.74, 95% CI 0.53–1.04). No differences were found with respect to the TIMI major bleeding during the follow-up period. Conclusions: Tirofiban administered with PPCI, following 600 mg clopidogrel pretreatment, improved primary efficacy outcome at 30 days and at 1 year follow up without an increase in major bleeding. PMID:24562804

Savic, Lidija; Lasica, Ratko; Krljanac, Gordana; Asanin, Milika; Brdar, Natasa; Djuricic, Nemanja; Marinkovic, Jelena; Perunicic, Jovan



The ASH1-RELATED3 SET-Domain Protein Controls Cell Division Competence of the Meristem and the Quiescent Center of the Arabidopsis Primary Root1[W][OPEN  

PubMed Central

The stem cell niche of the Arabidopsis (Arabidopsis thaliana) primary root apical meristem is composed of the quiescent (or organizing) center surrounded by stem (initial) cells for the different tissues. Initial cells generate a population of transit-amplifying cells that undergo a limited number of cell divisions before elongating and differentiating. It is unclear whether these divisions occur stochastically or in an orderly manner. Using the thymidine analog 5-ethynyl-2?-deoxyuridine to monitor DNA replication of cells of Arabidopsis root meristems, we identified a pattern of two, four, and eight neighboring cells with synchronized replication along the cortical, epidermal, and endodermal cell files, suggested to be daughters, granddaughters, and great-granddaughters of the direct progeny of each stem cell. Markers of mitosis and cytokinesis were not present in the region closest to the transition zone where the cells start to elongate, suggesting that great-granddaughter cells switch synchronously from the mitotic cell cycle to endoreduplication. Mutations in the stem cell niche-expressed ASH1-RELATED3 (ASHR3) gene, encoding a SET-domain protein conferring histone H3 lysine-36 methylation, disrupted this pattern of coordinated DNA replication and cell division and increased the cell division rate in the quiescent center. E2Fa/E2Fb transcription factors controlling the G1-to-S-phase transition regulate ASHR3 expression and bind to the ASHR3 promoter, substantiating a role for ASHR3 in cell division control. The reduced length of the root apical meristem and primary root of the mutant ashr3-1 indicate that synchronization of replication and cell divisions is required for normal root growth and development. PMID:25034019

Kumpf, Robert; Thorstensen, Tage; Rahman, Mohummad Aminur; Heyman, Jefri; Nenseth, H. Zeynep; Lammens, Tim; Herrmann, Ullrich; Swarup, Ranjan; Veiseth, Silje Veie; Emberland, Gitika; Bennett, Malcolm J.; De Veylder, Lieven; Aalen, Reidunn B.



[Primary hyperchylomicronemia].  


Primary hyperchylomicronemia is characterized by a marked hypertriglyceridemia due to an increase in chylomicrons, which may cause acute pancreatitis and eruptive xanthomas. This entity includes familial lipoprotein lipase (LPL) deficiency, familial apolipoprotein C-II deficiency, primary type V hyperlipoproteinemia, and idiopathic hyperchylomicronemia. Idiopathic hyperchylomicronemia is caused by an LPL inhibitor or autoantibody against LPL. More recently, patients with primary hyperchylomicronemia caused by mutations in the gene for glycosylphosphatidylinositol-anchored high density lipoprotein-binding protein 1(GPIHBP1) or lipase maturation factor 1(LMF1). For the treatment of primary hyperchylomicronemia, a strict restriction of dietary fat is essential to avoid acute pancreatitis. PMID:24205717

Yamashita, Shizuya



Tibiofibular syndesmosis and ossification. Case report: Sequelae of ankle sprain in an adolescent football player 1 1 Selected Topics: Emergency Radiology is coordinated by Jack Keene, MD, of the Emergency Treatment Associates, Poughkeepsie, New York  

Microsoft Academic Search

Heterotopic ossification development within the interosseous membrane of the ankle is an uncommon occurrence after routine ankle sprains. We present a case of a high school football player who sustained a syndesmosis ankle sprain. After 4 weeks, he continued to have pain, swelling, and range of motion restriction despite being treated with cryotherapy, NSAIDs, supportive taping, and progressive rehabilitation. The

Michael A Kennedy; Andrew E Sama; Mitch Sigman



Amenorrhea - primary  


... signs of puberty. Being born with incompletely formed genital or pelvic organs can lead to primary amenorrhea. ... the following conditions: Congenital defects of the upper genital system (uterus, hymen, and other structures inside the ...


Primary Myelofibrosis  


... a disease in which abnormal blood cells and fibers build up inside the bone marrow. The bone ... blood cells , and platelets ) and a web of fibers that support the blood-forming tissues. In primary ...


Primary Hyperparathyroidism  


... of calcium into the blood, causing blood calcium levels to rise above normal. The loss of calcium from bones ... that leads to dehydration can cause blood calcium levels to rise further in someone with primary hyperparathyroidism. People with ...


Ossification du ligament de Hoffa: évolution finale de la maladie de Hoffa (à propos d'un cas avec revue de la littérature)  

PubMed Central

La responsabilité de la bourse graisseuse sous rotulienne dans certains dérangements internes du genou est connue depuis les observations originales rapportées par Hoffa en 1904. En peropératoire, Hoffa retrouvait une frange graisseuse qui occupait l'interligne articulaire, dont l'ablation faisait disparaître les symptômes. Depuis cette date, peu de publications ont été consacrées à la maladie de Hoffa, et à notre connaissance, aucune grande série n'a été publiée récemment dans la littérature. Ce travail comprend une revue bibliographiqe associée à l’étude des différents aspects sémiologiques, étiopathogéniques et thérapeutiques de ce type d'affection, en rapportant un cas d'ossification du ligament de Hoffa qui ne serait en fait que l’évolution finale de la maladie.

Boukhris, Jalal; Boussouga, Mostapha; Benchakroune, Mohammed; Jaafar, Abdelouahab; Chagar, Belkacem



Prevalence of neurogenic heterotopic ossification in traumatic head- and spinal-injured patients admitted to a tertiary referral hospital in australia.  


A study was undertaken to investigate the prevalence of neurogenic heterotopic ossification (NHO) in patients with traumatic brain injury (TBI) or traumatic spinal cord injury (TSCI) admitted to nonspecialized units. Methods consisted of a retrospective audit of patients, using the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Australian Modification (ICD-10-AM) coding system, admitted to The Townsville Hospital with TBI/TSCI between July 1, 2006, and December 31, 2012. Fifty-eight patients with length of stay of 60 days or longer were admitted to The Townsville Hospital with TBI/TSCI over this period with mean age of 60 years (range, 31-87 years); 55 were TBI and 3 were TSCI patients. Three thousand one hundred fourteen TBI/TSCI patients with length of stay of less than 60 days and mean age of 43 years (range, 18-93 years) were also identified (2903 were TBI and 211 were TSCI patients). Overall, none had a diagnosis of NHO; 6 patients, identified by the ICD-10-AM codes, with a diagnosis of heterotopic ossification did not have an associated TBI/TSCI. Findings of 0% of NHO prevalence in TSCI/TBI patients admitted to the large tertiary referral hospital suggest that NHO may have been missed, possibly because of the TSCI/TBI ICD-10-AM codes, not being specifically designed for documentation of the TBI/TSCI complications. If NHO remains undiagnosed in nonspecialized units because of the method of coding, it may increase functional limitation in already compromised individuals. PMID:25627855

Reznik, Jacqueline E; Biros, Erik; Milanese, Steve; Gordon, Susan; Lamont, Anthony C; Galea, Mary P



Primary hyperparathyroidism  

Microsoft Academic Search

Opinion statement  Treatment of primary hyperparathyroidism depends on a clear diagnosis based on biochemical confirmation. Most patients have\\u000a an elevated serum total or ionized calcium level in association with an elevated or inappropriate serum intact parathyroid\\u000a hormone level. The serum calcium level can be lowered by hydration and by a variety of pharmacologic agents. However, none\\u000a of these agents is effective

Robert Udelsman



A multi-center, randomized, clinical trial comparing adhesive polyurethane foam dressing and adhesive hydrocolloid dressing in patients with grade II pressure ulcers in primary care and nursing homes  

PubMed Central

Background Pressure ulcers (PrUs) are ischemic wounds in the skin and underlying tissues caused by long-standing pressure force over an external bone or cartilaginous surface. PrUs are an important challenge for the overall health system because can prolong patient hospitalization and reduce quality of life. Moreover, 95% of PrUs are avoidable, suggesting they are caused by poor quality care assistance. PrUs are also costly, increasing national costs. For example, they represent about 5% of overall annual health expenses in Spain. Stages I and II PrUs have a combined prevalence of 65%. According main clinical guidelines, stage II PrUs (PrU-IIs) are usually treated by applying special dressings (polyurethane or hydrocolloid). However, little scientific evidence regarding their efficacy has been identified in scientific literature. Our aim is to assess the comparative efficacy of adhesive polyurethane foam and hydrocolloid dressings in the treatment of PrU-IIs in terms of healed ulcer after 8 weeks of follow-up. Methods/design This paper describes the development and evaluation protocol of a randomized clinical trial of two parallel treatment arms. A total of 820 patients with at least 1 PrU-II will be recruited from primary health care and home care centers. All patients will receive standardized healing procedures and preventive measures (e.g. positional changes and pressure-relieving support surfaces), following standardized procedures. The main outcome will be the percentage of wounds healed after 8 weeks. Secondary outcomes will include cost-effectiveness, as evaluated by cost per healed ulcer and cost per treated patient and safety evaluated by adverse events. Discussion This trial will address the hypothesis that hydrocolloid dressings will heal at least 10% more stage II PrUs and be more cost-effective than polyurethane foam dressings after 8 weeks. Trial registration This trial has been registered with controlled-trials number ISCRCTN57842461 and EudraCT 2012-003945-14. PMID:24359122



Career Center Career Center  

E-print Network

Library Career Center Events R easons to get an internship 1. Test drive different career options 2. Gain Take Ten (Mon-Fri 11am-4pm) career consulting hours or make an individual appointment with a counselor the most of the experience. Look at the tips below to learn how to maximize your expereince. Career

Stanford, Kyle


Biomechanical analysis of cervical myelopathy due to ossification of the posterior longitudinal ligament: Effects of posterior decompression and kyphosis following decompression  

PubMed Central

Cervical ossification of the posterior longitudinal ligament (OPLL) results in myelopathy. Conservative treatment is usually ineffective, thus, surgical treatment is required. One of the reasons for the poor surgical outcome following laminoplasty for cervical OPLL is kyphosis. In the present study, a 3-dimensional finite element method (3D-FEM) was used to analyze the stress distribution in preoperative, posterior decompression and kyphosis models of OPLL. The 3D-FEM spinal cord model established in this study consisted of gray and white matter, as well as pia mater. For the preoperative model, 30% anterior static compression was applied to OPLL. For the posterior decompression model, the lamina was shifted backwards and for the kyphosis model, the spinal cord was studied at 10, 20, 30, 40 and 50° kyphosis. In the preoperative model, high stress distributions were observed in the spinal cord. In the posterior decompression model, stresses were lower than those observed in the preoperative model. In the kyphosis model, an increase in the angle of kyphosis resulted in augmented stress on the spinal cord. Therefore, the results of the present study indicated that posterior decompression was effective, but stress distribution increased with the progression of kyphosis. In cases where kyphosis progresses following surgery, detailed follow-ups are required in case the symptoms worsen. PMID:24940393




A Newly Developed Robot Suit Hybrid Assistive Limb Facilitated Walking Rehabilitation after Spinal Surgery for Thoracic Ossification of the Posterior Longitudinal Ligament: A Case Report  

PubMed Central

Most patients with thoracic ossification of the posterior longitudinal ligament (OPLL) exhibit delayed recovery of gait dysfunction after spinal injury. The hybrid assistive limb (HAL) is a new robot suit controlling knee and hip joint motion by detecting very weak bioelectric signals on the surface of the skin. This study is to report the feasibility and benefits of patient-assistive HAL walking rehabilitation for facilitating locomotor function after spinal surgery. The patient was a 60-year-old woman with thoracic OPLL, and her motor and sensory paralyses did not improve after spinal surgery, indicating severe impairment in the paretic legs. The subject underwent 6 HAL sessions per week for 8 weeks, consisting of a standing and sitting exercise and walking on the ground with HAL. Clinical outcomes were evaluated before and after HAL training and 1 year after surgery. The subject improved considerably as a result of HAL training. Subsequently, her walking ability recovered rapidly, and she was able to walk unaided six months after surgery. This case study suggests that HAL training is a feasible and effective option to facilitating locomotor function and the early HAL training with physiotherapy may enhance motor recovery of patients with residual paralysis after surgery. PMID:24369516

Ijiri, Kosei; Matsuda, Fumiyo; Tominaga, Hiroyuki; Biwa, Takanori; Yone, Kazunori; Sankai, Yoshiyuki



The Insertion/Deletion Polymorphism of Angiotensin I Converting Enzyme Gene is Associated With Ossification of the Posterior Longitudinal Ligament in the Korean Population  

PubMed Central

Objective To determine whether ACE insertion/deletion (I/D) polymorphism is associated with the ossification of the posterior longitudinal ligament (OPLL) of the spine in the Korean population. Methods A case-control study was conducted to investigate the association between I/D polymorphism of the angiotensin I converting enzyme (peptidyl-dipeptidase A) 1 (ACE) gene and OPLL. The 95 OPLL patients and 274 control subjects were recruited. Polymerase chain reaction for the genotyping of ACE I/D polymorphism was performed. The difference between the OPLL patients and the control subjects was compared using the contingency ?2 test and the logistic regression analysis. For statistical analysis, SPSS, SNPStats, SNPAnalyzer, and Helixtree programs were used. Results The genotype and allele frequencies of ACE I/D polymorphism showed significant differences between the OPLL patients and the control subjects (genotype, p<0.001; allele, p=0.009). The frequencies of D/D genotype and D allele in the OPLL group were higher than those in the control group. In logistic regression analysis, ACE I/D polymorphism was associated with OPLL (dominant model; p=0.002; odd ratio, 2.20; 95% confidence interval, 1.33-3.65). Conclusion These results suggest that the deletion polymorphism of the ACE gene may be a risk factor for the development of OPLL in the Korean population. PMID:24639919

Kim, Dong Hwan; Yun, Dong Hwan; Kim, Hee-Sang; Min, Seong Ki; Yoo, Seung Don; Lee, Kyu Hoon; Kim, Ki-Tack; Jo, Dae Jean; Kim, Su Kang; Chung, Joo-Ho; Ban, Ju Yeon



Expansion of murine periosteal progenitor cells with fibroblast growth factor 2 reveals an intrinsic endochondral ossification program mediated by bone morphogenetic protein 2.  


The preservation of the bone-forming potential of skeletal progenitor cells during their ex vivo expansion remains one of the major challenges for cell-based bone regeneration strategies. We report that expansion of murine periosteal cells in the presence of FGF2, a signal present during the early stages of fracture healing, is necessary and sufficient to maintain their ability to organize in vivo into a cartilage template which gives rise to mature bone. Implantation of FGF2-primed cells in a large bone defect in mice resulted in complete healing, demonstrating the feasibility of using this approach for bone tissue engineering purposes. Mechanistically, the enhanced endochondral ossification potential of FGF2-expanded periosteal cells is predominantly driven by an increased production of BMP2 and is additionally linked to an improved preservation of skeletal progenitor cells in the cultures. This characteristic is unique for periosteal cells, as FGF2-primed bone marrow stromal cells formed significantly less bone and progressed exclusively through the intramembranous pathway, revealing essential differences between both cell pools. Taken together, our findings provide insight in the molecular regulation of fracture repair by identifying a unique interaction between periosteal cells and FGF2. These insights may promote the development of cell-based therapeutic strategies for bone regeneration which are independent of the in vivo use of growth factors, thus limiting undesired side effects. PMID:24989687

van Gastel, Nick; Stegen, Steve; Stockmans, Ingrid; Moermans, Karen; Schrooten, Jan; Graf, Daniel; Luyten, Frank P; Carmeliet, Geert



Examination of ossification of the distal radial epiphysis using magnetic resonance imaging. New insights for age estimation in young footballers in FIFA tournaments.  


Alongside a variety of clinical and forensic issues, age determination in living persons also plays a decisive role in the field of professional sport. Only methods of determining skeletal age which do not expose individuals to ionizing radiation are suitable for this purpose. The present study examines whether MRI diagnosis of the distal radial epiphysis can be utilised to monitor internationally relevant age limits in professional football. The wrist area of 152 male footballers aged 18 to 22years belonging to regional clubs was prospectively examined using MRI. The ossification stage of the distal radial epiphysis was subsequently determined on the basis of established criteria used in determining the maturity of the medial clavicular epiphysis. For the first time, we ascertained evidence of an increase in the prevalence of the phenomenon of threefold linear stratification (hypointense line, hyperintense line, and hypointense line) in the representation of the fused epiphyseal plate of the radius using magnetic resonance imaging with increasing chronological age. Within our study population, test persons with an ossified epiphyseal plate without any verifiable epiphyseal scar were not represented. The presumably high minimum age of entry into this final stage of development (>22years) must be verified in the course of further studies. According to the results of the present study, the fused epiphyseal plate of the distal radius provides potential maturation criteria which appear suitable for reliable monitoring of all relevant age limits in international football with the aid of magnetic resonance imaging. PMID:25754000

Schmidt, S; Vieth, V; Timme, M; Dvorak, J; Schmeling, A



Primary hyperparathyroidism.  


11 cases of primary hyperparathyroidism were seen during 1975-1988. Follow up has varied from 1-10 years. Renal disease in the form of renal calculi and nephro-calcinosis was observed in nine cases (81.8%). Two presented in chronic renal failure and required dialysis. Bone disease was found radiologically in six patients (54.5%); two had bone cysts in multiple bones while all six had subperiosteal bone erosion. Hypertension was found in three patients (27.3%). Proximal myopathy was observed in two cases (18.1%). One patient each presented with hypercalcaemic crisis, chondrocalcinosis and acute pancreatitis. The calcification of blood vessels and cornea was seen in two cases. PMID:2380135

Gupta, M M



Women's Center Women's Center  

E-print Network

-Defense Workshop Norfolk Karate Academy 814 West 45th St. Norfolk, VA, 7:30pm-9:30pm RSVP to by 9 Karate Academy 814 West 45th St. Norfolk, VA, 1:00pm-3:00pm RSVP to by 10/24 Big Blue & Activism Virginia Beach Room, Webb Center 12:30pm-1:30pm Self-Defense Workshop Norfolk Karate Academy 814



Microsoft Academic Search

The integration of the ICTs is one of the current objectives of many school centers. We consider that the systematizing starting from the design and development of specific curricular projects, as well as the preparation of the scenario are key factors for the success. We describe in this article an experience in this respect in a center of infantile and

José Luis Lázaro Cantabrana; Mercè Gisbert Cervera



Primary and Secondary Sources  

NSDL National Science Digital Library

Use these links to learn more about primary and secondary sources. 1. Explore the links below to learn about primary and secondary sources. When you have finished, you should be able to: Tell the difference between primary and secondary sources. Give at least three examples of primary sources and three examples of secondary sources. Explain why primary sources are important in research. Examples of Primary Sources Examples of Primary and Secondary Sources on the Same Topic Genres/Formats of Primary Sources 2. ...

Albion Middle School Library--Mrs. Bates



Selected case from the Arkadi M. Rywlin international pathology slide series: diffuse dendriform pulmonary ossification: report of 2 cases with review of the literature.  


Two cases of diffuse dendriform pulmonary ossification (DPO) are presented, one of the secondary type and the other of the idiopathic type. Case 1 was an adult female patient who underwent thoracic surgery to remove a posterior mediastinal bronchogenic cyst, which was discovered on a computed tomography scan performed after an episode of pneumonia when traction bronchiectasis with interstitial lung disease/fibrosis was also suspected in the lungs. Histologic examination performed on the resected lung tissue revealed numerous scattered small osseous spicules on a background of intense interstitial inflammation and fibrosis, leading to further clinical and laboratory investigations and the final diagnosis of DPO secondary to lung involvement by scleroderma. Case 2 was an adult male patient who underwent thoracoscopic exploration after a computed tomography scan, which revealed traction bronchiectasis with linear thickening of the interstitial lung tissue. Histologic examination of the lung tissue specimen revealed numerous osseous spicules in the absence of interstitial septal inflammation. Noteworthy in this case were also some nodules of collagenized tissue similar to those seen in the lungs of patients affected by Ehlers-Danlos syndrome. The absence of any clinical sign or symptoms related to Ehlers-Danlos syndrome attest to the nonspecificity of these pulmonary fibrous nodules. No case of DPO secondary to scleroderma has been reported in the literature so far, although around half of the patients with scleroderma manifest pulmonary diseases. Idiopathic DPO is even rarer, usually discovered postmortem, with only 20 cases diagnosed in life with lung biopsies taken by open surgery or through a thoracoscopic approach. DPO is often misdiagnosed radiologically as bronchiectasis and/or interstitial lung disease/fibrosis. PMID:25461781

Bisceglia, Michele; Chiaramonte, Antonio; Panniello, Gaetano; Tucci, Antonio; Orcioni, Giulio Fraternali; Colby, Thomas V



In situ studies of the primary immune response to (4-hydroxy-3- nitrophenyl)acetyl. III. The kinetics of V region mutation and selection in germinal center B cells  

PubMed Central

In the murine spleen, germinal centers are the anatomic sites for antigen-driven hypermutation and selection of immunoglobulin (Ig) genes. To detail the kinetics of Ig mutation and selection, 178 VDJ sequences from 16 antigen-induced germinal centers were analyzed. Although germinal centers appeared by day 4, mutation was not observed in germinal center B cells until day 8 postimmunization; thereafter, point mutations favoring asymmetrical transversions accumulated until day 14. During this period, strong phenotypic selection on the mutant B lymphocytes was inferred from progressively biased distributions of mutations within the Ig variable region, the loss of crippling mutations, decreased relative clonal diversity, and increasingly restricted use of canonical gene segments. The period of most intense selection on germinal center B cell populations preceded significant levels of mutation and may represent a physiologically determined restriction on B cells permitted to enter the memory pathway. Noncanonical Ig genes recovered from germinal centers were mostly unmutated although they probably came from antigen-reactive cells. Together, these observations demonstrate that the germinal center microenvironment is rich and temporally complex but may not be constitutive for somatic hypermutation. PMID:8376935



Cancer Centers

CANCER CENTERS Cancer Centers serves as a resource to bring together a highly trained group of scientists and physicians; patients and their families; and financial and other resources to combat cancer. Cancer centers allow scientists and physicians


Primary ciliary dyskinesia.  


Primary ciliary dyskinesia (PCD) is an autosomal recessive disorder of cilia structure, function, and biogenesis leading to chronic infections of the respiratory tract, fertility problems, and disorders of organ laterality. The diagnosis can be challenging, using traditional tools such as characteristic clinical features, ciliary function, and ultrastructural defects and newer screening tools such as nasal nitric oxide levels and genetic testing add to the diagnostic algorithm. There are 32 known PCD-causing genes, and in the future, comprehensive genetic testing may screen young infants before developing symptoms, thus improving survival. Therapies include surveillance of pulmonary function and microbiology, in addition to airway clearance, antibiotics, and early referral to bronchiectasis centers. As with cystic fibrosis (CF), standardized care at specialized centers using a multidisciplinary approach likely improves outcomes. In conjunction with the CF foundation, the PCD foundation, with experienced investigators and clinicians, is developing a network of PCD clinical centers to coordinate the effort in North America and Europe. As the network grows, clinical care and knowledge will improve. PMID:25826585

Lobo, Jason; Zariwala, Maimoona A; Noone, Peadar G



Internet Stroke Center  

NSDL National Science Digital Library

"A web resource for information about stroke care and research," the Internet Stroke Center provides updated stroke information for patients and families, as well as health care professionals. A nonprofit, educational service, the Internet Stroke Center is a product of the Stroke Center at Barnes-Jewish Hospital, Washington University Medical Center, and the Cerebrovascular Diseases Section of the Department of Neurology at Washington University School of Medicine in St. Louis. Dedicated to advancing the understanding of stroke research and clinical care, the Center's Web site also provides links to primary acute stroke facilities in St. Louis and Missouri, and a stroke trails directory that offers a select registry of clinical trials. All information provided on the site is obtained from "published accounts, meeting presentations, Internet searches, and direct correspondence."


Simon Wiesenthal Center: Multimedia Learning Center Online  

NSDL National Science Digital Library

The Simon Wiesenthal Center has done the Web-browsing public a great service by placing this extremely comprehensive and authoritative multimedia archive online. Online since 1999, the Multimedia Learning Center provides access to some of the past virtual exhibits sponsored by the Center's Museum of Tolerance (including a fine one dedicated to Polish Jews), a host of teacher's resources, and a helpful frequently-asked-questions area. The FAQ area may be most helpful for students, as it contains an interactive glossary of the Holocaust, a timeline of the Holocaust, and answers to 36 commonly asked questions about the Holocaust. The special collections area of the site contains a number of relevant primary documents related to the Holocaust, though it should be noted that the majority of them are available only in German and Hebrew.


Depressive disorders in primary care  

Microsoft Academic Search

OBJECTIVES: To assess the relative prevalence of subsyndromal depression (SubD) and major depression (MDD) in primary care patients and\\u000a describe their associated functional impairments, and to define the operating characteristics of a short depression screen\\u000a (SDS).\\u000a \\u000a \\u000a SETTING: Three primary care clinics: a university-affiliated Veterans Affairs clinic, a county general internal medicine clinic, and\\u000a a community health center.\\u000a \\u000a \\u000a \\u000a \\u000a SUBJECTS: Randomly selected

John W. Williams; Caroline A. Kerber; Cynthia D. Mulrow; Anna Medina; Christine Aguilar



The Impact of Preoperative Hip Heterotopic Ossification Extent on Recurrence in Patients with Head and Spinal Cord Injury: A Case Control Study  

PubMed Central

Background The preoperative Heterotopic Ossification (HO) extent is usually one of the main used criteria to predict the recurrence before excision. Brooker et al built a radiologic scale to assess this pre operative extent around the hip. The aim of this study is to investigate the relationship between the recurrence risk after hip HO excision in Traumatic Brain Injury (TBI) and Spinal Cord Injury (SCI) patients and the preoperative extent of HO. Methodology/Principal Findings A case control study including TBI or SCI patients following surgery for troublesome hip HO with (case, n?=?19) or without (control, n?=?76) recurrence. Matching criteria were: sex, pathology (SCI or TBI) and age at the time of surgery (+/?4.5 years). For each etiology (TBI and SCI), the residual cognitive and functional status (Garland classification), the preoperative extent (Brooker status), the modified radiological and functional status (GCG-BD classification), HO localization, side, mean age at the CNS damage, mean delay for the first HO surgery, and for the case series, the mean operative delay for recurrence after the first surgical intervention were noted. Conclusions/Significance The median delay for first HO surgery was 38.6 months (range 4.5 to 414.5;) for the case subgroup and 17.6 months (range 5.7 to 339.6) for the control group. No significant link was found between recurrence and operative delay (p?=?0.51); the location around the joint (0.07); the Brooker (p?=?0.52) or GCG-BD status (p?=?0.79). Including all the matching factors, no significant relationship was found between the recurrence HO risk and the preoperative extent of troublesome hip HO using Brooker status (OR?=?1.56(95% CI: 0.47–5.19)) or GCG-BD status (OR class 3 versus 2?=?0.67(95% CI: 0.11–4.24) and OR class 4 versus 2?=?0.79(95%CI: 0.09–6.91)). Until the pathophysiology of HO development is understood, it will be difficult to create tools which can predict HO recurrence. PMID:21853078

Genêt, François; Jourdan, Claire; Lautridou, Christine; Chehensse, Clément; Minooee, Kambiz; Denormandie, Philippe; Schnitzler, Alexis



Triangle Centers  

NSDL National Science Digital Library

A listing, with description and illustration, of 20th-century triangle centers (including: Schiffler Point, Exeter Point, Parry Point, congruent isoscelizers point, Yff Center of Congruence, isoperimetric point and equal detour point, Ajima-Malfatti Points, Apollonius Point, Morley Centers, Hofstadter Points, and equal parallelians points) and some classical triangle centers (including: centroid, incenter, circumcenter, orthocenter, Fermat Point, nine-point center, symmedian (or Lemoine) point, Gergonne point, Nagel point, Mittenpunkt, Spieker center, Feuerbach point, isodynamic points, and Napoleon points), as well as other references (to print works) and a list of journals that frequently publish items of interest to triangle geometers.

Kimberling, Clark, 1942-


Knight Law Center Eugene, Oregon  

E-print Network

and on the fourth floor roof. Air handler supply and return fans are all controlled by #12;| ASHRAE Level One Energy the requirement of an ASHRAE Level I energy audit of the Knight Law Center. SYSTEMS NARRATIVE Air Distribution and Ventilation Systems: The Knight Law Center uses a VAV air distribution system supplied by four primary air

Oregon, University of



Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey



Precision Joining Center  

NASA Technical Reports Server (NTRS)

The establishment of a Precision Joining Center (PJC) is proposed. The PJC will be a cooperatively operated center with participation from U.S. private industry, the Colorado School of Mines, and various government agencies, including the Department of Energy's Nuclear Weapons Complex (NWC). The PJC's primary mission will be as a training center for advanced joining technologies. This will accomplish the following objectives: (1) it will provide an effective mechanism to transfer joining technology from the NWC to private industry; (2) it will provide a center for testing new joining processes for the NWC and private industry; and (3) it will provide highly trained personnel to support advance joining processes for the NWC and private industry.

Powell, John W.



The Future: Optimism or Ossification.  

ERIC Educational Resources Information Center

This paper addresses the issues raised in a recent review of postcompulsory education and training in Victoria. In the interim report (April 2000) it is stated that employers found that the skills of new graduates appear to be most deficient in the areas of creativity, flair, problem solving, oral business communication, and interpersonal skills.…

Bottrell, Christine; Ling, Lorraine


High-field EPR on the primary electron donor cation radical in single crystals of heterodimer mutant reaction centers of photosynthetic bacteria — first characterization of the G-tensor  

NASA Astrophysics Data System (ADS)

First high-field/high-frequency (95 GHz) EPR experiments on the cation radical of the primary electron donor (D) in single crystals of the HL (M202) heterodimer mutant of the photosynthetic bacterium Rhodobacter sphaeroides are reported. The measurements have been performed in order to determine the electronic G-tensor of D + in the mutant and to compare it to the G-tensor of D + in wild type (R-26). In the heterodimer mutant of the two bacteriochlorophyll (BCHl) molecules constituting D in R-26 is replaced by a bacteriopheophytin. In D 2+ of the mutant the unpaired electron is localized on the BChl, thus, its G-tensor should reflect monomer properties, whereas in D + of R-26 the unpaired electron is delocalized over the two BChl molecules. The preliminary results reported here show that directions of the principal axes of the G-tensor of D + in HL (M202) are similar to those of R-26 investigated previously. Possible origins of this result are discussed.

Huber, M.; Törring, J. T.



Skills Center.  

ERIC Educational Resources Information Center

The services of the Living Skills Center for the Visually Handicapped, a habilitative service for blind young adults, are described. It is explained that the Center houses its participants in their own apartments in a large complex and has served over 70 young people in 4 years. The evaluation section describes such assessment instruments as an…

Canter, Patricia; And Others


Primary mesenteric hydatid cyst  

PubMed Central

Hydatid disease mostly caused by Echinococcus granulosus is a common parasitic infestation of the liver. Most common sites are liver (70%) and lungs (25%). Intraperitoneal hydatid cyst is found in 13% and it is usually secondary to rupture of primary hepatic cyst. Primary intraperitoeal hydatid cyst is rare (2%). Primary hydatid cyst in mesentery is very rare. In this article, the author presents a case of primary mesenteric hydatid cyst with chronic pain in lower abdomen. PMID:22778458

Kushwaha, Jitendra Kumar; Gupta, Rajni; Mohanti, Satyabrot; Kumar, Surender



Primary enzyme quantitation  


The disclosure relates to the quantitation of a primary enzyme concentration by utilizing a substrate for the primary enzyme labeled with a second enzyme which is an indicator enzyme. Enzyme catalysis of the substrate occurs and results in release of the indicator enzyme in an amount directly proportional to the amount of primary enzyme present. By quantifying the free indicator enzyme one determines the amount of primary enzyme present.

Saunders, G.C.



Primary Prevention of Hypertension  

E-print Network

Primary Prevention of Hypertension: Clinical and Public Health Advisory from the National High NIH PUBLICATION NO. 02-5076 NOVEMBER 2002 Primary Prevention of Hypertension: Clinical and Public LIFETIME BURDEN OF ELEVATED BLOOD PRESSURE 3 APPROACHES TO PRIMARY PREVENTION OF HYPERTENSION 4 Population

Bandettini, Peter A.


Investigating Primary Source Literacy  

ERIC Educational Resources Information Center

Primary source research requires students to acquire specialized research skills. This paper presents results from a user study testing the effectiveness of a Web guide designed to convey the concepts behind "primary source literacy". The study also evaluated students' strengths and weaknesses when conducting primary source research. (Contains 3…

Archer, Joanne; Hanlon, Ann M.; Levine, Jennie A.



Hastings Center  


... Center Report IRB: Ethics & Human Research Special Publications Bioethics Forum blog Over 65 blog Health Care Cost Monitor blog Books and Monographs Bioethics Briefing Book Help with Hard Questions Research Current ...


Energy efficient data centers  

SciTech Connect

Data Center facilities, prevalent in many industries and institutions are essential to California's economy. Energy intensive data centers are crucial to California's industries, and many other institutions (such as universities) in the state, and they play an important role in the constantly evolving communications industry. To better understand the impact of the energy requirements and energy efficiency improvement potential in these facilities, the California Energy Commission's PIER Industrial Program initiated this project with two primary focus areas: First, to characterize current data center electricity use; and secondly, to develop a research ''roadmap'' defining and prioritizing possible future public interest research and deployment efforts that would improve energy efficiency. Although there are many opinions concerning the energy intensity of data centers and the aggregate effect on California's electrical power systems, there is very little publicly available information. Through this project, actual energy consumption at its end use was measured in a number of data centers. This benchmark data was documented in case study reports, along with site-specific energy efficiency recommendations. Additionally, other data center energy benchmarks were obtained through synergistic projects, prior PG&E studies, and industry contacts. In total, energy benchmarks for sixteen data centers were obtained. For this project, a broad definition of ''data center'' was adopted which included internet hosting, corporate, institutional, governmental, educational and other miscellaneous data centers. Typically these facilities require specialized infrastructure to provide high quality power and cooling for IT equipment. All of these data center types were considered in the development of an estimate of the total power consumption in California. Finally, a research ''roadmap'' was developed through extensive participation with data center professionals, examination of case study findings, and participation in data center industry meetings and workshops. Industry partners enthusiastically provided valuable insight into current practice, and helped to identify areas where additional public interest research could lead to significant efficiency improvement. This helped to define and prioritize the research agenda. The interaction involved industry representatives with expertise in all aspects of data center facilities, including specialized facility infrastructure systems and computing equipment. In addition to the input obtained through industry workshops, LBNL's participation in a three-day, comprehensive design ''charrette'' hosted by the Rocky Mountain Institute (RMI) yielded a number of innovative ideas for future research.

Tschudi, William; Xu, Tengfang; Sartor, Dale; Koomey, Jon; Nordman, Bruce; Sezgen, Osman



Primary care: can it solve employers' health care dilemma?  


Employers are beginning to recognize that investing in the primary care foundation of the health care system may help address their problems of rising health care costs and uneven quality. Primary care faces a crisis as a growing number of U.S. medical graduates are avoiding primary care careers because of relatively low reimbursement and an unsatisfying work life. Yet a strong primary care sector has been associated with reduced health care costs and improved quality. Through the Patient-Centered Primary Care Collaborative and other efforts, some large employers are engaged in initiatives to strengthen primary care. PMID:18180490

Sepulveda, Martin-J; Bodenheimer, Thomas; Grundy, Paul



Challenger Center  

NSDL National Science Digital Library

"Challenger Center uses students' natural enthusiasm for space to create innovative learning experiences for imaginative young minds." After learning about the Challenger 51-L crew, users can find information about visits to the Challenger Learning Center Networks' forty six sites located across the Unites States, Canada, and the United Kingdom. Within the Teacher and Community Resources link, users can find student activities, professional development opportunities, community programs, and special events. Teachers can learn about Space Day 2004 on May 6th, where young students can take a journey to uncharted galaxies.


TRACE Center  

NSDL National Science Digital Library

Trace Center Mission Statement - To prevent the barriers and capitalize on the opportunities presented by current and emerging information and telecommunication technologies, in order to create a world that is as accessible and usable as possible for as many people as possible.


Gross Primary Productivity  

NASA Technical Reports Server (NTRS)

NASA's new Moderate-resolution Imaging Spectroradiometer (MODIS) allows scientists to gauge our planet's metabolism on an almost daily basis. GPP, gross primary production, is the technical term for plant photosynthesis. This composite image over the continental United States, acquired during the period March 26-April 10, 2000, shows regions where plants were more or less productive-i.e., where they 'inhaled' carbon dioxide and then used the carbon from photosynthesis to build new plant structures. This false-color image provides a map of how much carbon was absorbed out of the atmosphere and fixed within land vegetation. Areas colored blue show where plants used as much as 60 grams of carbon per square meter. Areas colored green and yellow indicate a range of anywhere from 40 to 20 grams of carbon absorbed per square meter. Red pixels show an absorption of less than 10 grams of carbon per square meter and white pixels (often areas covered by snow or masked as urban) show little or no absorption. This is one of a number of new measurements that MODIS provides to help scientists understand how the Earth's landscapes are changing over time. Scientists' goal is use of these GPP measurements to refine computer models to simulate how the land biosphere influences the natural cycles of water, carbon, and energy throughout the Earth system. The GPP will be an integral part of global carbon cycle source and sink analysis, an important aspect of Kyoto Protocol assessments. This image is the first of its kind from the MODIS instrument, which launched in December 1999 aboard the Terra spacecraft. MODIS began acquiring scientific data on February 24, 2000, when it first opened its aperture door. The MODIS instrument and Terra spacecraft are both managed by NASA's Goddard Space Flight Center, Greenbelt, MD. Image courtesy Steven Running, MODIS Land Group Member, University of Montana



Implications for Academic Health Centers  

Microsoft Academic Search

Background: The United States has achieved dramatic improvements in overall health and life expectancy, largely due to initia- tives in public health, health promotion and disease prevention. Academic health centers have played a major role in this effort, given their mission of engaging in research, educating health professionals, providing primary and specialty medical services, and caring for the poor and




CERT Coordination Center  

NSDL National Science Digital Library

The CERT Coordination Center is part of the Software Engineering Institute at Carnegie Mellon University. Its primary function is to work with industry to identify and eliminate Internet security vulnerabilities. Additionally, the center analyzes business and personal software to find potentially dangerous flaws that could compromise the system, meaning that both corporate and home users can benefit from the information offered on the Web site. There are continual updates of security advisories, survivability guides, and fixes that can help prevent disasters or speed recovery from them. Step-by-step suggestions make finding and implementing an efficient security practice reasonably painless. A wide range of papers and presentations on Internet and computer security research are available for free download.


The Impact of Primary Care: A Focused Review  

PubMed Central

Primary care serves as the cornerstone in a strong healthcare system. However, it has long been overlooked in the United States (USA), and an imbalance between specialty and primary care exists. The objective of this focused review paper is to identify research evidence on the value of primary care both in the USA and internationally, focusing on the importance of effective primary care services in delivering quality healthcare, improving health outcomes, and reducing disparities. Literature searches were performed in PubMed as well as “snowballing” based on the bibliographies of the retrieved articles. The areas reviewed included primary care definitions, primary care measurement, primary care practice, primary care and health, primary care and quality, primary care and cost, primary care and equity, primary care and health centers, and primary care and healthcare reform. In both developed and developing countries, primary care has been demonstrated to be associated with enhanced access to healthcare services, better health outcomes, and a decrease in hospitalization and use of emergency department visits. Primary care can also help counteract the negative impact of poor economic conditions on health. PMID:24278694

Shi, Leiyu



Nurse managed occupational health centers: an overview.  


1. Nurse managed centers provide clients with direct access to professional nursing care. 2. Lillian Wald, Mary Breckenridge, and Margaret Sanger established nurse managed centers at the beginning of this century. 3. Primary, secondary, and tertiary prevention programs and services are based on the mission, outcomes, staffing, and financing of the occupational health center. 4. Essential parameters for comprehensively evaluating an occupational health nurse managed center include, client outcomes, client satisfaction, and cost-benefit. PMID:9384001

Wachs, J E



Mackinac Center  

NSDL National Science Digital Library

Based in Midland, Michigan, the Mackinac Center for Public Policy is a "nonpartisan research and educational institute dedicated to improving the quality of life for all Michigan citizens by promoting sound solutions to state and local policy questions." Visitors to their website can read their blog, check out some of their publications, and also learn about some of their key topical interests. Most of their work focuses on economic policy matters, and visitors can get a sense of their viewpoints by clicking on the "Periodicals & Projects" area. The "In the Spotlight" area includes recent items of note, and recently they have featured pieces on charter schools, tax credits, and distance learning. Visitors are also encouraged to sign up to receive the Center's email updates and other materials.


Translational Research Overview Health Policy and Primary Care Research Center  

E-print Network

for effective dissemination and adoption of evidence-based guidelines, new technologies, practice redesign a substantial literature establishing the evidence base of effective clinical care, and a growing body of work, adoption and sustainability (in the real world of practice), on the effective implementation of evidence

Oliver, Douglas L.


Primary Photosynthetic Energy Conversion in Bacterial Reaction Centers  

NASA Astrophysics Data System (ADS)

The development of human societies is strongly influenced by the available energetic resources. In a period where the limitations of conventional fossil energy carriers become as evident as the often uncontrollable dangers of nuclear energy, one has to reconsider regenerative energy resources. Here photovoltaic or photochemical use of solar energy is an important approach. Since the early days of evolution some two billion years ago, the dominant energetic input into the life system on earth occurs via the conversion of solar energy performed in photosynthetic organisms. The fossil energy carriers that we use and waste today have been produced by photosynthesis over millions of years. In the race for an extended and versatile use of solar energy, semiconductorbased photovoltaic devices have been developed. However, even after decades of intense engineering they cannot serve as a competitive alternative to fossil energy. Under these circumstances new alternatives are required. One line of scientific development may use the operational principles of photosynthesis since photosynthesis is still our main energy source. In this respect, we will present results on the basic concepts of energy conversion in photosynthetic bacteria, which could be used as a guideline to alternative light energy conversion systems.

Zinth, Wolfgang; Wachtveitl, J.


Southern Rural Development Center  

NSDL National Science Digital Library

Since John F. Kennedy and Lyndon Johnson declared war on rural poverty during their time in the White House, there has been an overriding concern with alleviating the persistently high levels of poverty in the American South. A number of organizations have developed to provide assistance to the region, and the Southern Rural Development Center (SRDC), located at Mississippi State University is one such entity. The center's mission statement reflects this sentiment, as it notes its primary directive is "to strengthen the capacity of the region's 29-land grant institutions to address critical contemporary development issues impacting the well-being of people and communities in the rural South." Visitors interested in these issues will find plenty to examine here, as they may elect to view a calendar of germane events (such as regional science conferences and the like), look over a list of their primary focus areas, learn about available funding opportunities, and download any number of policy publications and newsletters which date back to 1993.


Developing primary health care  

Microsoft Academic Search

Primary health care is best provided by a primary health care team of general practitioners, community nurses, and other staff working together from good premises and looking after the population registered with the practice. It encourages personal and continuing care of patients and good communication among the members of the team. Efforts should be made to foster this model of

B Jarman; J Cumberlege



Primary Science Focus  

ERIC Educational Resources Information Center

Liz Lawrence has recently finished her term as Chair of Primary Science Committee (PSC). She is one of the 41 hub leaders who have led and mentored 192 schools across England and British Forces' schools in Germany, to achieve the first ever nationally recognised awards to celebrate excellence in primary science. In this article, the author writes…

Turner, Jane



Primary gastric Hodgkin's lymphoma  

Microsoft Academic Search

BACKGROUND: Primary Hodgkin's disease of the stomach is an extremely rare entity. Nearly all cases of primary gastric lymphoma are of the non-Hodgkin's variety. Diagnoses in such cases are difficult due to considerable histological similarities between the 2 disease entities. CASE PRESENTATION: We report the case of a 77 year old lady with a 1 year history of weight loss

Fahad S Hossain; Yashwant Koak; Farrukh H Khan



Education research Primary Science  

E-print Network

Education research Primary Science Survey Report December 2011 #12;Primary Science Survey Report, Wellcome Trust 1 Background In May 2009 Key Stage 2 science SATs (Standard Assessment Tests) were abolished fiasco might occur, where the results were delayed and their quality questioned. The loss of science SATs

Rambaut, Andrew


Using Primary Source Documents.  

ERIC Educational Resources Information Center

Explores the use of primary sources when teaching about U.S. slavery. Includes primary sources from the Gilder Lehrman Documents Collection (New York Historical Society) to teach about the role of slaves in the Revolutionary War, such as a proclamation from Lord Dunmore offering freedom to slaves who joined his army. (CMK)

Mintz, Steven




Located in the foothills of the Wasatch Mountains, Primary Children's Hospital is the children's hospital for Utah, Idaho, Wyoming, Nevada, and Montana. Our 289-bed hospital is equipped and staffed to care for children with complex illness and injury. Primary Children's is owned by Intermountain Healthcare and is the pediatric specialty teaching hospital for the University Of Utah School of Medicine.


Primary electron acceptors in plant photosynthesis  

Microsoft Academic Search

Results of electron spin resonance and electron nuclear double resonance are presented which establish that in subchloroplast fragments enriched in photosystem II reaction centers, the trapped primary electron acceptor exhibits magnetic characteristics very similar to those of the monomeric anion radical of pheophytin A (Pheo) in vitro. In addition the mid-point potential and the optical changes that accompany the reduction

J. Fajer; M. S. Davis; A. Forman; V. V. Klimov; E. Dolan; B. Ke



Primary Productivity: Marine Adaptation  

NSDL National Science Digital Library

This activity is designed to give students a better understanding of the concept of primary productivity and to have them use one or more methods to calculate primary productivity. Students will have also been introduced to the concepts of marine primary productivity, net productivity vs. gross productivity, and the importance of comparing dry weight versus wet weight. Marine primary producers are usually not plants as we typically think about them, but rather seaweeds or single cell algae. The classic example of a marine primary producer is a marine diatom. In this experiment students use marine diatoms to measure primary productivity. Real-time data from several sources may be used to increase understanding of this topic. Students will discover that although often ignored in the classroom, the marine environment produces 32 percent of the world's primary productivity on 71 percent of the Earth's surface area. Although this is far less than the 68 percent from the continental surfaces (29 percent of the Earth's surface area), this productivity is still very important.

Angela Morrow


University of Tennessee Health Science Center College of Nursing  

E-print Network

1 University of Tennessee Health Science Center College of Nursing Doctor of Nursing Practice CENTER COLLEGE OF NURSING PRECEPTOR GUIDE Primary Care Pediatric Nurse Practitioner Concentration TABLE..................................................................................................................................14 Honing Assessment Skills

Cui, Yan


Model Center  

NSDL National Science Digital Library

A human is a complicated organism, and it is considered unethical to do many kinds of experiments on human subjects. For these reasons, biologists often use simpler 'model' organisms that are easy to keep and manipulate in the laboratory. Despite obvious differences, model organisms share with humans many key biochemical and physiological functions that have been conserved (maintained) by evolution. Each of the following model organisms has its advantages and disadvantages in different research applications. This tool allows you to examine the similarities between different systems by comparing the proteins they share and the proportion of DNA they have in common. Choose a gene from the drop-down menu and select the species you want to compare. Rolling over the images will give you a more detailed description of each model. Clicking on a gene�s name will take you to the National Center for Biological Information, where you can explore the latest relevant scientific literature.



A compound heterozygote SLC26A2 mutation resulting in robin sequence, mild limbs shortness, accelerated carpal ossification, and multiple epiphysial dysplasia in two Brazilian sisters. A new intermediate phenotype between diastrophic dysplasia and recessive multiple epiphyseal dysplasia.  


Mutations in solute carrier family 26 (sulfate transporter), member 2 (SLC26A2) gene result in a spectrum of autosomal recessive chondrodysplasias that range from the mildest recessive form of multiple epiphysial dysplasia (rMED) through the most common diastrophic dysplasia (DTD) to lethal atelosteogenesis type II and achondrogenesis IB. The clinical variability has been ascribed to quantitative effect of mutations of the sulfate transporter activity. Here we describe two Brazilian sisters, born to healthy and non consanguineous parents, with Robin sequence, mild shortening of upper and lower limbs, brachymetacarpalia/tarsalia, additional and accelerated carpal ossification, marked genu valgum, and multiple epiphysial dysplasia. This phenotype was intermediate between DTD and rMED, and both girls have a compound heterozygous mutations for the SLC26A2, a Finnish founder mutation (c.-26 + 2T>C), and R279W. This combination of mutations has been observed in individuals with different phenotypes, including DTD, DTD variant, and rMED. The distinct phenotype of our cases reinforces the hypothesis that other factors may be influencing the phenotype as previously suggested. PMID:23840040

Zechi-Ceide, Roseli Maria; Moura, Priscila Padilha; Raskin, Salmo; Richieri-Costa, Antonio; Guion-Almeida, Maria Leine



Primary biliary cirrhosis  


... Saunders Elsevier; 2011:chap 158. Angulo P, Lindor KD. Primary biliary cirrhosis. In: Feldman M, Friedman LS, ... Clin Liver Dis . 2008;12:277-288. Lindor KD, Gershwin ME, Poupon R, Kaplan M, et al. ...


Primary Gonorrhea Infection  


newsletter | contact Share | Gonorrhea, Primary Infection Information for adults A A A Gonorrhea in a male is typically displayed as a discharge from ... be displayed, as seen in this image. Overview Gonorrhea is a sexually transmitted disease caused by the ...


Primary infertility (image)  


Primary infertility is a term used to describe a couple that has never been able to conceive a pregnancy ... to do so through unprotected intercourse. Causes of infertility include a wide range of physical as well ...


Staging Primary CNS Lymphoma  


... normal cells than chemotherapy or radiation therapy do. Monoclonal antibody therapy is one type of targeted therapy being studied in the treatment of primary CNS lymphoma. Monoclonal antibody therapy is a cancer treatment that uses antibodies made ...


Parenthood after Primary Infertility.  

ERIC Educational Resources Information Center

Reviews the literature on the experience of parenting after primary infertility and describes construction and initial testing of an instrument for assessing characteristics of this understudied population. (Contains 52 references and 4 tables.) (GCP)

Frances-Fischer, Jana E.; Lightsey, Owen Richard, Jr.



Ocean Primary Productivity Study  

NSDL National Science Digital Library

This site offers datasets of primary productivity measurements, computer source code, input data fields, and ocean productivity estimates for modeling purposes, as well as information on the activities of the NASA-sponsored Ocean Primary Productivity Working Group (OPPWG), which has been conducting round-robin algorithm testing exercises to compare the performance of various productivity models with the intent of establishing a NASA resident "consensus" algorithm for the routine generation of ocean productivity maps.


Primary sclerosing cholangitis  

Microsoft Academic Search

Opinion statement  There is no proven medical therapy for primary sclerosing cholangitis. The goal of management should be treatment of symptoms\\u000a and complications of cholestasis, as well as attempts at treating the underlying disease process. In addition, efforts should\\u000a be made to recognize and treat or prevent the known complications of primary sclerosing cholangitis, such as fat-soluble vitamin\\u000a deficiency, osteopenia, dominant

Young-Mee Lee; David J. Kim



Primary liver cancer  

Microsoft Academic Search

Liver cancer, whether primary or secondary, is one of the most difficult to treat among malignant solid tumors, with a miserable\\u000a prognosis. In view of the relative lack of exciting progress in the management of metastatic liver cancer in recent years\\u000a this lecture necessarily concerns primary liver cancer, particularly hepatocellular carcinoma (HCC). Time permits coverage\\u000a of only several important aspects

Kunio Okuda



STUDENT HEALTH CENTER Office of the Director  

E-print Network

STUDENT HEALTH CENTER Office of the Director Dear Purdue Parent and Student: On behalf of the Purdue University Student Health Center (PUSH) staff, welcome to Purdue University. PUSH is your primary immunization requirements have been met. Required and recommended vaccines are available at the Student Health

Holland, Jeffrey


Dementia consults: Predictors of compliance by primary care physicians  

Microsoft Academic Search

This study was designed to determine rates of primary care physician compliance with recommendations made by physician-consultants at an Alzheimer's disease center. A mail survey was sent to primary care physicians, who were asked to indicate which recommendations had been implemented and to select reasons for lack of adherence. The response rate was 53 percent (49\\/92). Some 83 percent of

Carol Ann Podgorski; Benjamin D. Lanning; Cynthia J. Casaceli; Andrea L. Nardi; Christopher Cox



Electron diffraction from the primary wall of cotton fibers  

Microsoft Academic Search

Summary Electron diffraction patterns have been obtained from selected areas of disencrusted microfibrils isolated from the primary cell wall of cotton fibers. The resultant fiber diagram has the same meridional repeat distance as a corresponding pattern of secondary wall microfibrils but differs markedly in the equatorial reflections. The primary wall diagram displays only two strong equatorial reflections centered at 0.570

H. Chanzy; K. Imada; R. Vuong



NCI Community Cancer Centers Program - Pilot Site Profile - St. Joseph Medical Center, Towson, Maryland

More than 40% of the medical center's patients come from outside the primary service area, defined as a 12-mile radius of the hospital. 78% of the Cancer Institute's patients are adults over 55, and 12% are African American.


A computational model of clavicle bone formation: a mechano-biochemical hypothesis.  


Clavicle development arises from mesenchymal cells condensed as a cord extending from the acromion towards the sternal primordium. First two primary ossification centers form, extending to develop the body of the clavicle through intramembranous ossification. However, at its ends this same bone also displays endochondral ossification. So how can the clavicle be formed by both types of ossification? Developmental events associated with clavicle formation have mainly used histological studies as supporting evidence. Nonetheless, mechanisms of biological events such as molecular and mechanical effects remain to be determined. The objective of this work was to provide a mathematical explanation of embryological events based on two serial phases: first formation of an ossified matrix by intramembranous ossification based on three factors: systemic, local biochemical, and mechanical factors. After this initial phase expansion of the ossified matrix follows with mesenchymal cell differentiation into chondrocytes for posterior endochondral ossification. Our model provides strong evidence for clavicle formation integrating molecules and mechanical stimuli through partial differentiation equations using finite element analysis. PMID:24444803

Garzon-Alvarado, Diego A; Gutiérrez, María Lucía; Calixto, Luis Fernando



Center for Beam Physics, 1993  

SciTech Connect

The Center for Beam Physics is a multi-disciplinary research and development unit in the Accelerator and Fusion Research Division at Lawrence Berkeley Laboratory. At the heart of the Center`s mission is the fundamental quest for mechanisms of acceleration, radiation and focusing of energy. Dedicated to exploring the frontiers of the physics of (and with) particle and photon beams, its primary mission is to promote the science and technology of the production, manipulation, storage and control systems of charged particles and photons. The Center serves this mission via conceptual studies, theoretical and experimental research, design and development, institutional project involvement, external collaborations, association with industry and technology transfer. This roster provides a glimpse at the scientists, engineers, technical support, students, and administrative staff that make up this team and a flavor of their multifaceted activities during 1993.

Not Available



Army Geospatial Center  

NSDL National Science Digital Library

Based in Virginia, the primary mission of the Army Geospatial Center (AGC) is "to coordinate, integrate, and synchronize geospatial information requirements and standards across the Army." On the home page, visitors can learn about the AGC's ongoing initiatives via the How Can We Help You area. Here visitors can learn about different thematic projects dealing with civil works, terrain, imagery, and hydrology. Moving along, visitors can use the AGC Publications area to look through engineering manuals and reports. Some of the most intriguing works here are "Geographic Profiling Military Capabilities" and "El Nino-Its Far-Reaching Environment Effects on Army Tactical Decision Aids." Those persons interested in joining the AGC may wish to look over the Careers area. Additionally, the Press Room section features several dozen fact sheets which cover cultural mapping initiatives and electronic charting for navigation.


Development and Validation of the Tibetan Primary Care Assessment Tool  

PubMed Central

Objective. To develop a primary care assessment tool in Tibetan area and assess the primary care quality among different healthcare settings. Methods. Primary care assessment tool-Tibetan version (PCAT-T) was developed to measure seven primary care domains. Data from a cross-sectional survey of 1386 patients was used to conduct validity and reliability analysis of PCAT-T. Analysis of variance was used to conduct comparison of primary care quality among different healthcare settings. Results. A 28-item PCAT-T was constructed which included seven multi-item scales and two single-item scales. All of multi-item scales achieved good internal consistency and item-total correlations. Scaling assumptions tests were well satisfied. The full range of possible scores was observed for all scales, except first contact and continuity. Compared with prefecture hospital (77.42) and county hospital (82.01), township health center achieved highest primary care quality total score (86.64). Conclusions. PCAT-T is a valid and reliable tool to measure patients' experience of primary care in the Tibet Autonomous Region. Township health center has the best primary care performance compared with other healthcare settings, and township health center should play a key role in providing primary care in Tibet. PMID:24967349

Yin, Aitian; Lai, Youwen



Composite Crew Module: Primary Structure  

NASA Technical Reports Server (NTRS)

In January 2007, the NASA Administrator and Associate Administrator for the Exploration Systems Mission Directorate chartered the NASA Engineering and Safety Center to design, build, and test a full-scale crew module primary structure, using carbon fiber reinforced epoxy based composite materials. The overall goal of the Composite Crew Module project was to develop a team from the NASA family with hands-on experience in composite design, manufacturing, and testing in anticipation of future space exploration systems being made of composite materials. The CCM project was planned to run concurrently with the Orion project's baseline metallic design within the Constellation Program so that features could be compared and discussed without inducing risk to the overall Program. This report discusses the project management aspects of the project including team organization, decision making, independent technical reviews, and cost and schedule management approach.

Kirsch, Michael T.



University of California, Davis Center for Healthcare Policy and Research  

E-print Network

;University of California Davis Center for Health Services Research in Primary Care ANNUAL REPORT 2007-2008 The University of California Davis Center for Health Services Research in Primary Care has now completed fourteen the University of California research community and externally. Careful self-analysis and development of our

Carmichael, Owen


Primary lymphoma of the brain  


Brain lymphoma; Cerebral lymphoma; Primary lymphoma of the central nervous system; Lymphoma - brain ... The cause of primary brain lymphoma is not known. Patients who have a weakened immune system are at high risk of primary lymphoma of the ...


Trafficking in and to the primary cilium  

PubMed Central

Polarized vesicle trafficking is mediated by small GTPase proteins, such as Rabs and Arls/Arfs. These proteins have essential roles in maintaining normal cellular function, in part, through regulating intracellular trafficking. Moreover, these families of proteins have recently been implicated in the formation and function of the primary cilium. The primary cilium, which is found on almost every cell type in vertebrates, is an organelle that protrudes from the surface of the cell and functions as a signaling center. Interestingly, it has recently been linked to a variety of human diseases, collectively referred to as ciliopathies. The primary cilium has an exceptionally high density of receptors on its membrane that are important for sensing and transducing extracellular stimuli. Moreover, the primary cilium serves as a separate cellular compartment from the cytosol, providing for unique spatial and temporal regulation of signaling molecules to initiate downstream events. Thus, functional primary cilia are essential for normal signal transduction. Rabs and Arls/Arfs play critical roles in early cilia formation but are also needed for maintenance of ciliary function through their coordination with intraflagellar transport (IFT), a specialized trafficking system in primary cilia. IFT in cilia is pivotal for the proper movement of proteins into and out of this highly regulated organelle. In this review article, we explore the involvement of polarized vesicular trafficking in cilia formation and function, and discuss how defects in these processes could subsequently lead to the abnormalities observed in ciliopathies. PMID:23351793



Plume primary smoke  

NASA Astrophysics Data System (ADS)

The exhaust from a solid propellant rocket motor usually contains condensed species. These particles, also called 'Primary Smoke', are often prejudicial to missile detectability and to the guidance system. To avoid operational problems it is necessary to know and quantify the effects of particles on all aspects of missile deployment. A brief description of the origin of the primary smoke is given. It continues with details of the interaction between particles and light as function of both particles and light properties (nature, size, wavelength, etc). The effects of particles on plume visibility, attenuation of an optical beam propagated through the plume and the contribution of particles on optical signatures of the plume are also described. Finally, various methods used in NATO countries to quantify the primary smoke effects are discussed.

Chastenet, J. C.



Primary leptomeningeal lymphoma  

PubMed Central

Objective: To evaluate clinical presentation, optimal diagnostic evaluation and treatment, and outcome in primary leptomeningeal lymphoma, a rare form of primary CNS lymphoma without parenchymal or systemic involvement. Methods: The International Primary CNS Lymphoma Collaborative Group, a multidisciplinary group of physicians with a particular interest in primary CNS lymphoma, retrospectively identified cases of lymphoma isolated to the leptomeninges as diagnosed by CSF cytology, flow cytometry, or biopsy, without systemic or parenchymal brain/spinal cord lymphoma or immunodeficiency. Results: Forty-eight patients were identified, with median age at diagnosis of 51 years and median Eastern Cooperative Oncology Group performance status of 2. Presenting symptoms were multifocal in 68%. Leptomeningeal enhancement was seen in 74% and CSF profile was abnormal in all cases. CSF cytology detected malignant lymphocytes in 67%. Flow cytometry identified monoclonal population in 80%, as did receptor gene rearrangement studies in 71%. Sixty-two percent had B-cell lymphoma, 19% T-cell, and 19% unclassified. Treatment varied and included fractionated radiotherapy (36%), systemic chemotherapy (78%), and intra-CSF chemotherapy (66%), with 66% receiving ?2 modalities. Seventy-one percent had a favorable clinical response; ultimately, 44% received salvage treatment. Median overall survival was 24 months, with 11 patients still alive at 50 months follow-up. Conclusion: Primary leptomeningeal lymphoma is a rare form of primary CNS lymphoma. Patients usually present with multifocal symptoms, with evidence of leptomeningeal enhancement and diagnostic CSF analysis. Although treatment is highly variable, patients have a better prognosis than previously reported and a subset may be cured. PMID:24107866

Taylor, Jennie W.; Flanagan, Eoin P.; O'Neill, Brian P.; Siegal, Tali; Omuro, Antonio; DeAngelis, Lisa; Baehring, Joachim; Nishikawa, Ryo; Pinto, Fernando; Chamberlain, Marc; Hoang-Xuan, Khe; Gonzalez-Aguilar, Alberto; Batchelor, Tracy; Blay, Jean-Yves; Korfel, Agnieszka; Betensky, Rebecca A.; Lopes, Maria-Beatriz S.



Center for Networked Center for Networked Computing  

E-print Network

Center for Networked Computing Center for Networked Computing Adaptive Battery Charge Scheduling.wu} Presenter: Pouya Ostovari #12;Center for Networked Computing Center for Networked Computing Motivation for Networked Computing Center for Networked Computing Problem What is a good voltage threshold to trigger

Wu, Jie


Chemical Hydrogen Storage Center Center of Excellence  

E-print Network

Chemical Hydrogen Storage Center Center of Excellence for Chemical Hydrogen Storage William Tumas proprietary or confidential information #12;2 Chemical Hydrogen Storage Center Overview Project Start Date: FY Barriers Addressed #12;3 Chemical Hydrogen Storage Center Chemical Hydrogen Storage Center National

Carver, Jeffrey C.


Federal Judicial Center  

NSDL National Science Digital Library

Created by an act of Congress in 1967, the Federal Judicial Center has served as a clearinghouse of information about the federal court system for four decades. While the Center is physically based in Washington, DC, their website brings information about the court system, its history, and its judges to any interested parties with access to the Internet. From their homepage, visitors can go straight to one of the primary sections, which include "Federal Judicial History", "Publications & Videos", and "Educational Programs & Materials". In the "Publications & Videos" area, visitors can use the search engine to look for specific items of interest, or they can also browse the archive's contents by subject or by date of publication. Recent additions have included the updated second edition of the copyright law statutes to the proceedings of a roundtable discussion on the use of technology to facilitate appearances in bankruptcy proceedings. For most visitors, the "Federal Judicial History" will be of greatest interest, as it contains biographies of federal judges since 1789, the histories of individual courts, and summaries of landmark decisions.


Philosophy in Primary Schools?  

ERIC Educational Resources Information Center

The article is a critical discussion of the aims behind the teaching of philosophy in British primary schools. It begins by reviewing the recent Special Issue of the "Journal of Philosophy of Education" Vol 45 Issue 2 2011 on "Philosophy for Children in Transition", so as to see what light this might throw on the topic just mentioned. The result…

White, John



Primary ectopic frontotemporal craniopharyngioma  

PubMed Central

Introduction Primary ectopic craniopharyngiomas have only rarely been reported. Craniopharyngiomas involve usually the sellar and suprasellar region, but can be originated from cell remnants of the obliterated craniopharyngeal duct or metaplastic change of andenohypophyseal cells. We present the first case of a primary ectopic frontotemporal craniopharyngioma. Presentation of case A 35-year old woman presented with a one-year history of headache and diplopia. MRI showed a large frontotemporal cystic lesion. Tumor resection was performed with a keyhole endoscopic frontal lateral approach. The pathological features showed an adamantinomatous craniopharyngioma with a cholesterol granuloma reaction. Discussion There have been reported different localizations for primary ectopic craniopharyngioma. Our case presented a lobulated frontotemporal cystic mass formed by a dense eosinophilic proteinaceous material dystrophic calcifications and cholesterol crystals, with epithelial remnants. No tumor regrowth was observed in the magnetic resonance image 27 months postoperatively. Conclusion Primary ectopic craniopharyngioma is a rare entity with a pathogenesis that remains uncertain. This is an unusual anatomic location associated with unique clinical findings. PMID:25725331

Ortega-Porcayo, Luis Alberto; Ponce-Gómez, Juan Antonio; Martínez-Moreno, Mauricio; Portocarrero-Ortíz, Lesly; Tena-Suck, Martha Lilia; Gómez-Amador, Juan Luis



Primary localized cutaneous amyloidosis.  


A 61-year-old man presented for evaluation of a bruise-like lesion of the right knee. He was found to have an ill-defined, light brown patch with focal areas of dark red and brown. The histopathologic diagnosis was consistent with amyloidosis. Further subtyping showed that the amyloid protein was AL (?). A systemic evaluation failed to show internal involvement. Amyloidosis comprises a spectrum of diseases, which range from systemic to localized cutaneous types, and is characterized by the extracellular deposition of amyloidosis protein as beta-pleated sheets. The forms of amyloidosis are differentiated by the specific types of protein-derived amyloidosis fibers. Both nodular and primary systemic amyloidosis can present as nodules on the skin owing to deposition of AL type amyloid protein. Primary systemic amyloidosis, which carries a poorer prognosis than does nodular amyloidosis, also may give rise to ecchymoses and many other cutaneous and extracutaneous findings. Histopathologic features are similar in both cases and involve the deposition of amorphous, eosinophilic material in the dermis. Nodular amyloidosis may progress to primary systemic disease in up to 50% of cases. Because our patient had no systemic involvement and the lesions did not appear nodular in nature, the patient was given a diagnosis of primary localized AL cutaneous amyloidosis. Routine follow-up for this patient is necessary to detect any potential disease progression. PMID:24365002

Terushkin, Vitaly; Boyd, Kevin P; Patel, Rishi R; McLellan, Beth



Primary Premier for Belfast  

ERIC Educational Resources Information Center

The author talks about the Association for Science Education (ASE) Primary Science Committee's (PSC) March 2009 meeting which was held in Belfast as guests of ASE Northern Ireland. To mark the auspicious occasion of a body that usually meets four times a year in the Hatfield HQ crossing the Irish Sea to be hosted by its Celtic cousins, a Lord…

McAlister, Peter



Primary production: Marine ecosystems  

Microsoft Academic Search

The seas occupy the greater part (70%) of the earth's surface, but their total net primary production is less than that of the land. Depletion of nutrients in the lighted surface waters is responsible for low productivities of most of the open ocean; higher productivities occur in coastal waters and areas of upwelling. A recent estimate of total production for

John S. Bunt



Models for Primary Eye Care Services in India  

PubMed Central

Blindness and visual impairment continues to be a major public health problem in India. Availability and easy access to primary eye care services is essential for elimination of avoidable blindness. ‘Vision 2020: The Right to Sight - India’ envisaged the need for establishing primary eye care units named vision centers for every 50,000 population in the country by the year 2020. The government of India has given priority to develop vision centers at the level of community health centers and primary health centers under the ‘National Program for Control of Blindness’. NGOs and the private sector have also initiated some models for primary eye care services. In the current situation, an integrated health care system with primary eye care promoted by government of India is apparently the best answer. This model is both cost effective and practical for the prevention and control of blindness among the underprivileged population. Other models functioning with the newer technology of tele-ophthalmology or mobile clinics also add to the positive outcome in providing primary eye care services. This review highlights the strengths and weaknesses of various models presently functioning in the country with the idea of providing useful inputs for eye care providers and enabling them to identify and adopt an appropriate model for primary eye care services.

Misra, Vasundhra; Vashist, Praveen; Malhotra, Sumit; Gupta, Sanjeev K.



History of Primary Immunodeficiency Diseases in Iran  

PubMed Central

Pediatric immunology came into sight in the second half of 20th century, when pediatricians and basic immunologists began to give attention to diagnosis and treatment of children with primary immunodeficiency diseases (PIDs). Understanding the genetic and mechanistic basis of PIDs provides unique insight into the functioning of the immune system. By progress in basic and clinical immunology, many infrastructural organizations and academic centers have been established in many countries worldwide to focus on training and research on the immune system and related disorders. Along with progress in basic and clinical immunology in the world, pediatric immunology had a good progress in Iran during the last 33-year period. Now, patients with PIDs can benefit from multidisciplinary comprehensive care, which is provided by clinical immunologists in collaboration with other specialists. Patients with history of recurrent and/or chronic infections suggestive of PIDs are evaluated by standard and research-based testing and receive appropriate treatment. The progress in PIDs can be described in three periods. Development of training program for clinical fellowship in allergy and immunology, multidisciplinary and international collaborative projects, primary immunodeficiency diseases textbooks, meetings on immunodeficiency disorders, improvement in diagnosis and treatment, and construction of Iranian primary immunodeficiency association, Students' research group for immunodeficiencies, Iranian primary immunodeficiency registry, and the immunological societies and centers were the main activities on PIDs during these years. In this article, we review the growth of modern pediatric immunology and PIDs status in Iran. PMID:23056678

Aghamohammadi, Asghar; Moin, Mostafa; Rezaei, Nima



Assessing & Developing Primary Care for Children: Reforms in Health Systems.  

ERIC Educational Resources Information Center

This publication is a compilation of papers presented at an April 1994 workshop sponsored by the National Center for Education in Maternal and Child Health and the Bureau-funded Johns Hopkins Child and Adolescent Health Policy Center (CAHPC). The papers are as follows: (1) "Defining the Issues and Planning for Change: Health Care Systems, Primary…

Grason, Holly Allen, Ed.; Guyer, Bernard, Ed.



Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey



Nurturing Second Graders' Literacy and Language Development through Child-Centered versus Curriculum-Centered Experiences.  

ERIC Educational Resources Information Center

A practicum was designed and implemented to foster 24 second graders' literacy and language development via child-centered as opposed to curriculum-centered experiences. The primary goal was to improve students' quality and quantity of writing by allowing extra time, much exposure to more and various non-basal literature, hands-on activities, and…

Esch, Gwendolyn C.



E-print Network

SHC STUDENT WELLNESS CENTER Student Health Center 4505 Maryland Parkway Account No. Box 453020 Las, the Student Wellness Center (Student Counseling and Psychological Services and Student Health Center), its HEALTH INFORMATION (For purposes other than treatment, payment or health care operations) It may take 5

Hemmers, Oliver


Primary axillary hydatid cyst.  


Echinococcosis (hydatid disease) is a zoonosis caused by the larval stage of Echinococcus granulosus (or Taenia echinococcus). The adult form of the parasite lives in the gut of the dog, while the intermediate hosts, where the tapeworm develops to larval stage are cats, cattle, pigs and humans(considered to be accidental intermediate hosts). The parasite has a worldwide distribution, but the endemic areas are Canada and Alaska, Australia, New Zealand, South America and the Mediterranean region. Hydatid cyst can grow many years before the symptoms and clinical signs appear. The liver and the lungs are the most affected organs, but primary location of the hydatid disease in the axilla is extremely rare. In our country we did not find any records of axillary hydatid disease, while the literature contains only 12 cases of axillary location. We present the case of a woman, 60 years old, with a primary axillary location of hydatid cyst, who underwent a total cystectomy. PMID:25149625

Mercu?, D; Andri?oiu, A; Tra?c?, Et; Silo?i, C; Resceanu, A; Mercu?, R



Redefining primary headaches.  


In the light of the pathophysiologic knowledge acquired in the recent years, a tentative redefinition is now possible of some types of headache until now defined as idiopathic, and indistinctly described as primary headaches. Cluster headache and trigeminal neuralgia are known examples of diseases classified as primary, which are, in contrast, well-defined diseases to be distinguished from headaches without any recognized anatomic site of lesion or pathogenesis. Another still debated condition, chronic migraine, is proposed here as the consequence of "processes" to be ascribed to mechanisms activated by other comorbid conditions. The observations supporting the possibility that allodynia represents the implicit process leading to pain progression, which occurs in some migraineurs, are discussed. PMID:19415416

Bonavita, V; De Simone, R



Primary immunodeficiencies: 2009 update  

PubMed Central

More than 50 years after Ogdeon Bruton’s discovery of congenital agammaglobulinemia, human primary immunodeficiencies (PIDs) continue to unravel novel molecular and cellular mechanisms that govern development and function of the human immune system. This report provides the updated classification of PIDs, that has been compiled by the International Union of Immunological Societies (IUIS) Expert Committee of Primary Immunodeficiencies after its biannual meeting, in Dublin (Ireland) in June 2009. Since the appearance of the last classification in 2007, novel forms of PID have been discovered, and additional pathophysiology mechanisms that account for PID in humans have been unraveled. Careful analysis and prompt recognition of these disorders is essential to prompt effective forms of treatment and thus to improve survival and quality of life in patients affected with PIDs. PMID:20004777

Notarangelo, Luigi D.; Fischer, Alain; Geha, Raif. S.; Casanova, Jean-Laurent; Chapel, Helen; Conley, Mary Ellen; Cunningham-Rundles, Charlotte; Etzioni, Amos; Hammartröm, Lennart; Nonoyama, Shigeaki; Ochs, Hans D.; Puck, Jennifer; Roifman, Chaim; Seger, Reinhard; Wedgwood, Josiah



Pathophysiology of primary headaches  

Microsoft Academic Search

The cerebral circulation is innervated by sympathetic, parasympathetic, and sensory nerves, which store a considerable number\\u000a of neurotransmitters. The role of these has been evaluated in primary headaches. A clear association between head pain and\\u000a the release of calcitonin gene-related peptide was demonstrated. In cluster headache and in a case of chronic paroxysmal headache\\u000a there was in addition the release

Lars Edvinsson



Primary Myxedema Heart Disease  

PubMed Central

A case of primary myxedema heart disease in an 84-year-old man is presented. His history and physical examination were typical of myxedema. Electrocardiographic changes showing generalized low voltage, nonspecific S-T segment and T-wave changes, and nodal rhythm are characteristic of the disease. The patient showed remarkable improvement after oral liothyronine (Cytomel) therapy. ImagesFigure 1Figure 2Figure 3Figure 4 PMID:722831

Thomas, John; Mills, Kelly B.; Grisham, Daniel W.



Primary Colors of Pigment  

NSDL National Science Digital Library

In this laboratory activity, students create secondary colors by mixing primary colors. Food coloring, test tubes, and a test tube stand are used. The activity is composed of a student handout with directions and a data sheet. The resource is part of the teacher's guide accompanying the video, NASA Why Files: The Case of the Mysterious Red Light. Lesson objectives supported by the video, additional resources, teaching tips and an answer sheet are included in the teacher's guide.



Mechanobiology of Primary Cilia  

Microsoft Academic Search

\\u000a Within many mechanosensitive tissues and organs such as vascular endothelium, renal and liver epithelium, and bone, the cells\\u000a residing within them are exposed to fluid flow. The process by which flow-induced mechanical loads are sensed by these cells\\u000a and transduced into a biochemical signal is mostly unknown. The primary cilium is a rod-like, microtubule-based structure\\u000a that projects from the cell

Ronald Y. Kwon; David A. Hoey; Christopher R. Jacobs


Chiral Primary Amine Catalysis  

Microsoft Academic Search

\\u000a Aminocatalysis is a versatile catalytic motif for both nature and organocatalysis. While Nature’s aminoenzymes, e.g. Type\\u000a I aldolase and decarboxylase, normally employ the primary amine group of lysine residue for catalysis, disproportionate emphasis\\u000a has been placed on chiral secondary amines in organocatalysis due to the observed low activity in the initial attempt. Recently,\\u000a there have been numerous exciting discoveries about

Liujuan Chen; Sanzhong Luo


Multiple Primary Cancer Monograph

To identify groups of cancer survivors that are at increased risk for multiple primary cancers, Radiation Epidemiology Branch (REB) investigators led a collaborative effort to provide the first comprehensive population-based analysis of the risk of subsequent cancer in the U.S. The 500-page monograph utilized data from nine cancer registries participating in the Surveillance, Epidemiology, and End Results (SEER) Program from 1973 to 2000.


Primary Sclerosing Cholangitis  

Microsoft Academic Search

\\u000a Primary sclerosing cholangitis (PSC) is a chronic liver condition which may affect both intra and extrahepatic biliary tree.\\u000a Etiology of PSC remains to be fully elucidated but genetic, autoimmune, inflammatory and possibly infective factors could\\u000a all contribute to its development. More than two-thirds of patients are males and the most commonly associated condition is\\u000a an inflammatory bowel disease which occurs

Piotr Milkiewicz; Ewa Wunsch


Anxiety in primary care  

Microsoft Academic Search

Anxiety disorders are common within primary care (PC) settings and are associated with patient functional impairment, distress,\\u000a and high utilization of medical care services. Data from PC settings indicate that detection of anxiety disorders is low.\\u000a Furthermore, adequate psychosocial and pharmacologic treatment of anxiety disorders in accordance with empirically validated\\u000a guidelines remains low in PC. When patients do receive treatment

Kristen Hope Demertzis; Michelle G. Craske



Primary production: Terrestrial ecosystems  

Microsoft Academic Search

The history of growth in understanding of primary productivity and in making estimates of biosphere production is reviewed. Two approaches to estimation of land production are discussed. Production may first be estimated by mean values for ecosystem types and the areas of these. A total production of 100×10\\u000a9 tons\\/year is thus estimated for the continents, making up 29% of

Helmut Lieth



Primary adrenal lymphoma.  


Primary non-Hodgkin's lymphoma of the adrenal gland is rare. We report the case of a 56-year-old patient suffering from B symptoms. The CT scan showed a bilateral adrenal mass without any lymph nodes. Scan-guided biopsies led to the diagnosis of diffuse large B-cell lymphoma. The medullar biopsy eliminated a secondary lymphoma. The patient was treated by immunochemotherapy with a complete response before autologous stem cell transplantation. PMID:25035679

Kacem, Karima; Zriba, Sami; Lakhal, Raihane Ben; Bouteraa, Walid; Aissaoui, Lamia; Amor, Ramzi Ben; Abdennebi, Yosr Ben; Ali, Zaher Belhadj; Abid, Hela Ben; Meddeb, Balkis



Primary Adrenal Lymphoma  

PubMed Central

Primary non-Hodgkin’s lymphoma of the adrenal gland is rare. We report the case of a 56-year-old patient suffering from B symptoms. The CT scan showed a bilateral adrenal mass without any lymph nodes. Scan-guided biopsies led to the diagnosis of diffuse large B-cell lymphoma. The medullar biopsy eliminated a secondary lymphoma. The patient was treated by immunochemotherapy with a complete response before autologous stem cell transplantation. PMID:25035679

Kacem, Karima; Zriba, Sami; Lakhal, Raihane Ben; Bouteraa, Walid; Aissaoui, Lamia; Amor, Ramzi Ben; Abdennebi, Yosr Ben; Ali, Zaher Belhadj; Abid, Hela Ben; Meddeb, Balkis



Primary care for refugees.  


Over the past decade, at least 600,000 refugees from more than 60 different countries have been resettled in the United States. The personal history of a refugee is often marked by physical and emotional trauma. Although refugees come from many different countries and cultures, their shared pattern of experiences allows for some generalizations to be made about their health care needs and challenges. Before being accepted for resettlement in the United States, all refugees must pass an overseas medical screening examination, the purpose of which is to identify conditions that could result in ineligibility for admission to the United States. Primary care physicians have the opportunity to care for members of this unique population once they resettle. Refugees present to primary care physicians with a variety of health problems, including musculoskeletal and pain issues, mental and social health problems, infectious diseases, and longstanding undiagnosed chronic illnesses. Important infectious diseases to consider in the symptomatic patient include tuberculosis, parasites, and malaria. Health maintenance and immunizations should also be addressed. Language barriers, cross-cultural medicine issues, and low levels of health literacy provide additional challenges to caring for this population. The purpose of this article is to provide primary care physicians with a guide to some of the common issues that arise when caring for refugee patients. PMID:21322519

Eckstein, Barbara



Primary aldosteronism in pregnancy.  


We describe a case of primary aldosteronism secondary to bilateral adrenal hyperplasia in three subsequent pregnancies. The disease was diagnosed soon after the first pregnancy, which ended in a miscarriage, and was treated pharmacologically with spironolactone. Because spironolactone is contraindicated in pregnancy, while the hypotensive effects of methyldopa, hydralazine, labetalol, diazoxide and nifedipine were unsatisfactory, in the second (since week 14) and third (since week 6) pregnancy, she received amiloride. This agent, administered at a daily dose of 10-15 mg, effectively controlled blood pressure, reversed hypokalaemia, and led to an increase in plasma renin activity. The course of both pregnancies was uneventful and ultrasonography performed during each visit revealed normal foetal development without growth retardation. Both pregnancies ended in giving birth to healthy children. Our report shows that each case of treatment-resistant hypertension in pregnancy requires assessment for the presence of primary aldosteronism, and that amiloride seems to be a safe and effective agent in the non-surgical treatment of this disorder in pregnant women with primary aldosteronism. PMID:22712170

Krysiak, R; Samborek, M; Stojko, R



Assessing primary care in Croatia: could it be moved forward?  


It is well known that countries with strong primary care achieve better health outcomes at lower costs. Therefore, the effort of World Health Organization in promoting primary care as a basic principal of successful health care system is an ongoing process. Although Croatia was recognized as a country with primary care orientation due to the development of health centers and introduction of specialist training of general practitioners, it seems that many health care reforms aimed at better organization of health institutions and decreasing of health care costs did not result with higher primary care orientation. By application of the Primary Care Score instrument in 2014 (Croatia received 11.2 out of 20 possible points), and international comparison performed in 2002, it was concluded that among the eighteen OECD countries Croatia could be categorized as an "intermediate primary care country", obtaining the scores just a bit above the average. PMID:25643520

Keglevi?, Mladenka Vrci?; Kova?i?, Luka; Pavlekovi?, Gordana



Vascular ossification – calcification in metabolic syndrome, type 2 diabetes mellitus, chronic kidney disease, and calciphylaxis – calcific uremic arteriolopathy: the emerging role of sodium thiosulfate  

PubMed Central

Background Vascular calcification is associated with metabolic syndrome, diabetes, hypertension, atherosclerosis, chronic kidney disease, and end stage renal disease. Each of the above contributes to an accelerated and premature demise primarily due to cardiovascular disease. The above conditions are associated with multiple metabolic toxicities resulting in an increase in reactive oxygen species to the arterial vessel wall, which results in a response to injury wound healing (remodeling). The endothelium seems to be at the very center of these disease processes, acting as the first line of defense against these multiple metabolic toxicities and the first to encounter their damaging effects to the arterial vessel wall. Results The pathobiomolecular mechanisms of vascular calcification are presented in order to provide the clinician – researcher a database of knowledge to assist in the clinical management of these high-risk patients and examine newer therapies. Calciphylaxis is associated with medial arteriolar vascular calcification and results in ischemic subcutaneous necrosis with vulnerable skin ulcerations and high mortality. Recently, this clinical syndrome (once thought to be rare) is presenting with increasing frequency. Consequently, newer therapeutic modalities need to be explored. Intravenous sodium thiosulfate is currently used as an antidote for the treatment of cyanide poisioning and prevention of toxicities of cisplatin cancer therapies. It is used as a food and medicinal preservative and topically used as an antifungal medication. Conclusion A discussion of sodium thiosulfate's dual role as a potent antioxidant and chelator of calcium is presented in order to better understand its role as an emerging novel therapy for the clinical syndrome of calciphylaxis and its complications. PMID:15777477

Hayden, Melvin R; Tyagi, Suresh C; Kolb, Lisa; Sowers, James R; Khanna, Ramesh



NCI Community Cancer Centers Program - Pilot Site Profile - Sanford USD Medical Center, Sioux Falls, South Dakota

The Sanford USD Medical Center is the largest tertiary hospital in South Dakota with nearly 500 beds. It serves as the primary teaching institution for the Sanford School of Medicine of the University of South Dakota. The Medical Center serves as a regional institution, with half of its patients coming from outside the immediate Sioux Falls community. The Sanford Cancer Center is the region's largest, treating more than 1,278 new patients in 2005.


Pennsylvania Water Resources Research Center Annual Technical Report  

E-print Network

Pennsylvania Water Resources Research Center Annual Technical Report FY 2013 Pennsylvania Water Resources Research Center Annual Technical Report FY 2013 1 #12;Introduction The Pennsylvania Water of the Pennsylvania State University, the primary land-grant University within Pennsylvania. The Center resides


[Primary adrenocortical micronodular dysplasia].  


Two girls (11 and 13 years old) with Cushing's syndrome due to primary adrenocortical micronodular dysplasia (PAMD) are presented. High plasma cortisol concentrations, elevated urinary free cortisol and 17-ketogenic steroids excretion, in addition to low or normal plasma adrenocorticotropic hormone (ACTH) levels pointed towards independent adrenal cortisol hypersecretion. In both girls bilateral adrenalectomy was performed, followed by replacement therapy with glucocorticoids and mineralocorticoids. Pathohistological findings of otherwise enlarged adrenal glands, showed characteristic small nodules measuring 1-2 mm, composed of cells resembling those of zona fasciculata, with abundant, clear cytoplasm. Our younger patient fulfilled the criteria of "Carney complex", because beside PAMD she has had the lentigines. PMID:10377697

Dumi?, M; Ille, J; Batinica, S; Caci?, M; Cvitanovi?, M; Marinovi?, B; Plavsi?, V; Lukenda, M; Radica, A



[Malignant primary intrathoracic histiocytofibroma].  


Malignant primary intrathoracic fibrous histiocytoma (MFH) is a rare tumour: since it was first described in 1979, hardly more than 80 cases have been published. We present a large MFH which had started in the pleura and was intrathoracic. The tumour was typical, being comprised of malignant fibroblastic and histiocytoid cells in storiform arrangement. It was revealed by spinal bone metastases which multiplied over the whole skeleton in spite of chemotherapy. The patient died of cerebral metastasis developed 8 months after the onset of the disease. The cases found in the literature are gathered together and commented. PMID:1338999

Natali, F; Fesselet, J; Jancovici, R; Pons, F; Schill, H; Genero-Gygax, M L; Vaylet, F; Allard, P



Primary pulmonary hypertension  

Microsoft Academic Search

SUMMARY Toevaluate theeffects ofprostacyclin (prostaglandin 12) on pulmonary vascular tonein primary pulmonary hypertension (PPH), we performed right-heart catheterization on sevenpatients with PPHandmadehemodynamic measurements before andafter infusing incremental doses ofprostacyclin. In maximaldoses of2-12ng\\/kg\\/min (mean5.7± 3.1ng\\/kg\\/min), prostacyclin reduced mean pulmonary arterial pressurefrom62± 15to55± 16mm Hg(p< 0.05) andtotal pulmonary resistance from17.1 8.7to9.7+ 5.9units (p< 0.005), andincreased cardiac output from4.22 ± 1.64to6.57 ± 2.041\\/min




Primary Productivity: Grass  

NSDL National Science Digital Library

In this activity students will use grass plants grown over a one week period in the classroom to calculate productivity rates using two methods of collection. At the end of this lab students will understand the concept of primary productivity and will have used one or more methods to calculate it. They will have also been introduced to the concepts of standing biomass, net productivity versus gross productivity, and the importance of comparing dry weight versus wet weight. This activity has an accompanying teacher site with hints and more information. There are also links to several other sites with more information on this topic.

Angela Morrow


Primary cilium: an elaborate structure that blocks cell division?  


A primary cilium is a microtubule-based membranous protrusion found in almost all cell types. A primary cilium has a "9+0" axoneme that distinguishes this ancient organelle from the canonical motile "9+2" cilium. A primary cilium is the sensory center of the cell that regulates cell proliferation and embryonic development. The primary ciliary pocket is a specialized endocytic membrane domain in the basal region. The basal body of a primary cilium exists as a form of the centriole during interphase of the cell cycle. Although conventional thinking suggests that the cell cycle regulates centrosomal changes, recent studies suggest the opposite, that is, centrosomal changes regulate the cell cycle. In this regard, centrosomal kinase Aurora kinase A (AurA), Polo-like kinase 1 (Plk1), and NIMA related Kinase (Nek or Nrk) propel cell cycle progression by promoting primary cilia disassembly which indicates a non-mitotic function. However, the persistence of primary cilia during spermatocyte division challenges the dominate idea of the incompatibility of primary cilia and cell division. In this review, we demonstrate the detailed structure of primary cilia and discuss the relationship between primary cilia disassembly and cell cycle progression on the background of various mitotic kinases. PMID:24971504

Ke, Yi-Ni; Yang, Wan-Xi



A study of satisfaction among primary health care patients in Saudi Arabia  

Microsoft Academic Search

Primary Health Care is essential health care based on delivering integrated health services (curative and preventive). The Kingdom of Saudi Arabia adopted this approach in 1980, and by the year 1987 the Ministry of Health had established 1477 Primary Health Care centers. The expansion in Primary Health Care created a need for various types of evaluation. Theorists recommended the study

Ahlam A. Mansour; Muneera H. Al-Osimy



Primary Care Providers' Perceptions of and Experiences with an Integrated Healthcare Model  

ERIC Educational Resources Information Center

Objective and Participants: The authors examined the experiences of primary care providers participating in an integrated healthcare service between mental health and primary care in a university health center. In this program, behavioral health providers work collaboratively with primary care providers in the treatment of students. Participants…

Westheimer, Joshua M.; Steinley-Bumgarner, Michelle; Brownson, Chris



Primary Prevention of Child Abuse.  

ERIC Educational Resources Information Center

Discusses primary prevention of child abuse, child injury, substance abuse with children and adolescents, and school maladjustment. Describes methods of prevention research with children, action approaches to primary prevention, and a school-based divorce intervention program. (MCF)

Rosenberg, Mindy S.; Reppucci, N. Dickon



National space test centers - Lewis Research Center Facilities  

NASA Technical Reports Server (NTRS)

The Lewis Research Center, NASA, presently has a number of test facilities that constitute a significant national space test resource. It is expected this capability will continue to find wide application in work involving this country's future in space. Testing from basic research to applied technology, to systems development, to ground support will be performed, supporting such activities as Space Station Freedom, the Space Exploration Initiative, Mission to Planet Earth, and many others. The major space test facilities at both Cleveland and Lewis' Plum Brook Station are described. Primary emphasis is on space propulsion facilities; other facilities of importance in space power and microgravity are also included.

Roskilly, Ronald R.



Primary CNS Lymphoma  

PubMed Central

Primary CNS Lymphoma (PCNSL) accounts for 3% of all primary brain tumors with a median age at onset of about 62 years. In the vast majority of cases, PCNSL presents as unifocal or multifocal enhancing lesions on MRI, frequently adjacent to the ventricles. Stereotactic biopsy is the diagnostic procedure of choice revealing high-grade malignant non-Hodgkin's B-cell lymphoma in more than 90% of cases. Therapy is not evidence based. When eligible, patients should be included in clinical trials. In patients younger than 60 years cure is the aim. Polychemotherapy based on high-dose methotrexate (MTX) or alternatively high-dose chemotherapy with autologous stem cell rescue should be offered to patients eligible for this regimens. For patients over 60 years of age no curative regimen with acceptable toxicity has yet been established. An MTX-based chemotherapy, for example, in combination with temozolomide, is recommended. The role of radiotherapy as part of the initial treatment is not established; however, the combination of radiotherapy with MTX-based chemotherapy potentially leads to severe long-term neurotoxic sequelae. Therefore, radiotherapy as part of the initial therapy is not recommended by the author outside clinical trials. At relapse or in cases of refractory disease, patients will frequently benefit of salvage therapy, which depends on the initial treatment. PMID:21180644



Primary Malignant Rhabdoid Melanoma  

PubMed Central

Melanoma with rhabdoid features is an uncommon variant of malignant melanoma. Here, we describe a rare case of primary rhabdoid malignant melanoma. A 54-year-old man presented with a black tumor measuring 3×4 cm on the right forearm. Histologic sections showed a tumor mass with rhabdoid features composed entirely of polygonal neoplastic cells with eccentric nuclei, prominent nucleoli, and large hyaline cytoplasmic inclusions. The tumor cells were immunoreactive with HMB-45, S100, Fontana-Masson silver and vimentin, and negative for smooth muscle actin, CD68, CD34, CD99, synaptophysin, desmin, and PAS. The differential diagnosis for this tumor included malignant peripheral nerve sheath tumor, malignant peripheral neuroectodermal tumor and rhabdomyosarcoma. The patient was treated with a wide excision and a local skin graft. The excised tumor was entirely composed of rhabdoid tumor cells. No recurrence or metastasis was evident 4 months after removal. This article is relevant to rare cases of primary malignant melanomas showing rhabdoid tumor cells over the entire excised lesion. PMID:22148039

Chung, Bo Young; Ahn, In Su; Cho, Soo Ick; Kim, Hye One; Kim, Kwang Ho; Park, Chun Wook



Primary malignant rhabdoid melanoma.  


Melanoma with rhabdoid features is an uncommon variant of malignant melanoma. Here, we describe a rare case of primary rhabdoid malignant melanoma. A 54-year-old man presented with a black tumor measuring 3×4 cm on the right forearm. Histologic sections showed a tumor mass with rhabdoid features composed entirely of polygonal neoplastic cells with eccentric nuclei, prominent nucleoli, and large hyaline cytoplasmic inclusions. The tumor cells were immunoreactive with HMB-45, S100, Fontana-Masson silver and vimentin, and negative for smooth muscle actin, CD68, CD34, CD99, synaptophysin, desmin, and PAS. The differential diagnosis for this tumor included malignant peripheral nerve sheath tumor, malignant peripheral neuroectodermal tumor and rhabdomyosarcoma. The patient was treated with a wide excision and a local skin graft. The excised tumor was entirely composed of rhabdoid tumor cells. No recurrence or metastasis was evident 4 months after removal. This article is relevant to rare cases of primary malignant melanomas showing rhabdoid tumor cells over the entire excised lesion. PMID:22148039

Chung, Bo Young; Ahn, In Su; Cho, Soo Ick; Kim, Hye One; Kim, Kwang Ho; Park, Chun Wook; Lee, Cheol Heon



[Normocalcemic primary hyperparathyroidism].  


This report shows our conclusions on the clinical, biochemical and densitometry characteristics of 35 normocalcemic primary hyperparathyroidism (PHPT) patients. This condition is defined by a high level of intact parathyroid hormone (iPTHI) with persistently normal serum and ionized calcium in the absence of secondary hyperparathyroidism. Our selection consisted of 30 women (90%) and 5 men (10%). The control group of 55 hypercalcemic patients with primary hyperparathyroidism included 51 women (93%) and 4 men (7%). The average age at diagnosis of normocalcemic PHPT was 61.4 ± 11.7 years and 56.4 ± 11.3 years in hypercalcemic PHPT. Besides the expected differences in serum calcium, ionized calcium, phosphorus and 24 h urinary calcium, we found no significant changes in other biochemical variables, and no differences in densitometry evaluations such as the presence of osteopenia or osteoporosis and the number of fractures in the two types of PHPT. But there was a significant difference in the presence of renal lithiasis between normocalcemic PHPT (11.4%) and clasic PHPT (49.1%) p < 0.0005, to some extent associated to the presence of hypercalciuria in classic PHPT. Two of the 35 patients with normocalcemic PHPT became classic hypercalcemic PHPT over a 4 year follow-up period. Our findings support the hypothesis that the normocalcemic PHPT could be an early stage of the classic PHPT, both having similar clinical effects to metabolic renal and bone levels. PMID:25555006

Spivacow, Francisco R; Sapag Durán, Ana; Zanchetta, María B



Angiogenesis in primary hyperparathyroidism.  


Angiogenesis can be described as a formation of new vessels from the existing microvasculature and is a process of great importance to the tumor development. Parathyroid tissue can trigger spontaneous induction of angiogenesis in vitro and in vivo models in a vascular endothelial growth factor (VEGF)-dependent manner. Autotransplantated parathyroid tissue after thyroidectomy is able to form new vasculature and produce parathormone, maintaining calcium homeostasis. A great amount of factors contributes to the process of new vessel formation in primary hyperparathyroidism, such as VEGF, transforming growth factor ?, and angiopoietins. Studies demonstrated that markers for angiogenesis can be useful in distinguishing between parathyroid hyperplasia and neoplasia, due to the increased angiogenesis in parathyroid proliferative lesions compared with parathyroid adenomas. These factors include, inter alia, VEGF, VEGFR2, CD105, and fibroblast growth factor-2. Although these differences appear promising in the differential diagnosis, there is an overlap between benign and malignant parathyroid lesions and there is no definite cutoff value. Loss of heterozygosity and comparative genomic hybridization studies revealed chromosomal regions frequently altered in parathyroid tumorigenesis at 9p21, 1p21-22, 1p35-36, and 11q13. Therefore, immunohistochemistry and genetic testing should be an additional diagnostic marker in combination with the traditional criteria. A better understanding of angiogenesis in primary hyperparathyroidism could result in more precise assessment of diagnosis and more effective treatment, especially in those cases, in which the commonly used parameters are insufficient. PMID:25648902

Segiet, Oliwia Anna; Michalski, Marek; Brzozowa-Zasada, Marlena; Piecuch, Adam; ?aba, Ma?gorzata; Helewski, Krzysztof; Gabriel, Andrzej; Wojnicz, Romuald



Primary cutaneous small vessel vasculitis  

Microsoft Academic Search

Opinion statement  Disorders associated with cutaneous vasculitis include numerous well-described etiologies. Primary cutaneous vasculitis limits\\u000a discussion to primary leukocytoclastic vasculitis, essential mixed cryoglobulinemia, urticarial vasculitis, Henoch-Schönlein\\u000a purpura, and erythema elevatum diutinum. Although the therapeutics for these disorders are based on limited data, we attempt\\u000a to construct a consensus opinion on the management of primary cutaneous vasculitis. Therapy of primary cutaneous vasculitis

James P. Russell; Roger H. Weenig



National Cancer Institute | Technology Transfer Center

The first-of-its-kind, the Breast Cancer Startup Challenge, an international university student-based startup competition, was launched by the National Cancer Institute's Technology Transfer Center in partnership with the non-profit organizations Avon Foundation and the Center for Advancing Innovation. The primary goals of this challenge were to accelerate the process of bringing emerging technologies from the NCI Intramural Research Program to market and stimulate the creation of start-up businesses around NCI’s discoveries.


Properties of inactive Photosystem II centers  

Microsoft Academic Search

A fraction (usually in the range of 10–25%) of PS II centers is unable to transfer electrons from the primary quinone acceptor QA to the secondary acceptor QB. These centers are inactive with respect to O2 evolution since their reopening after photochemical charge separation to the S2OA- state involves predominantly a back reaction to S1QA in the few seconds time

Jérôme Lavergne; Edlira Leci



Center for Global Development  

NSDL National Science Digital Library

A number of think-tanks and related organizations have sprung up in recent years with the intent of researching various development initiatives around the world. Founded in 2001, the Center for Global Development is just such an organization, and they are primarily concerned with offering â??â?¦.practical, creative solutions to the challenges that global interdependence poses to the developing countries, starting with debt.â? So far, they have assembled an impressive list of research fellows and partners, a fact that is apparent upon visiting their homepage. Visitors would do well to start by looking through their â??Initiativesâ? area, which offers brief introduction to their primary thematic areas of interest, which include debt relief and population dynamics. Along with this area, a nice complement is the section dedicated to providing access to their publications, which include working papers on infrastructure development in Africa and corruption and governance in public health care systems. Rounding out the site are areas where visitors can sign up to receive email updates and sections dedicated to their in-house blogs. [KMG


Goddard Space Flight Center- Visitor Center  

NSDL National Science Digital Library

The homepage of the Visitor Center at Goddard Space Flight Center provides access to a variety of information about the history, missions, and upcoming events at the center. Users can find information on public exhibits, educational resources, and programs on space and Earth science and technology.


Professional Issues for Primary Teachers  

ERIC Educational Resources Information Center

This book is intended to be a contribution to raising the awareness of primary teachers and trainee teachers as to what is involved in all the different professional dimensions of their work in schools. The book deals with the key professional issues in primary teaching that are addressed in primary teacher training courses. The book aims to…

Browne, Ann, Ed.; Haylock, Derek, Ed.