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1

Leptin increases growth of primary ossification centers in fetal mice  

PubMed Central

The effect of peripheral leptin on fetal primary ossification centers during the early phases of bone histogenesis was investigated by administration of leptin to pregnant mice. Fourteen pregnant mice were divided into two groups. The treated pregnant group was subcutaneously injected in the intrascapular region with supraphysiologic doses (2 mg kg?1) of leptin (Vinci Biochem, Firenze, Italy) in a volume of 0.1 mL per 10 g body weight, at the 7th, 9th and 11th day of gestation. The control group was treated with physiological solution in the same manner and same times as the treated group. The new-born mice were killed 1 day after birth and the primary ossification centers were stained with Alizarin Red S after diaphanizing the soft tissues in 1% potassium hydroxide. The development of both endochondral and intramembranous ossification centers was morphometrically analysed in long bones. The results showed that the ossification centers of mice born by mothers treated with leptin grow more rapidly in both length and cross-sectional area compared with mice born by the untreated mothers. As the development of long bones depends on endochondral ossification occurring at proximal and distal epiphyseal plates as well as on intramembranous ossification along the periosteal surface, it appears that leptin activates the differentiation and proliferation of both chondrocytes and osteoblasts. The role of leptin as a growth factor of cartilage and bone is discussed in the light of the data reported in the literature.

Bertoni, Laura; Ferretti, Marzia; Cavani, Francesco; Zavatti, Manuela; Resca, Elisa; Benelli, Augusta; Palumbo, Carla

2009-01-01

2

Leptin increases growth of primary ossification centers in fetal mice.  

PubMed

The effect of peripheral leptin on fetal primary ossification centers during the early phases of bone histogenesis was investigated by administration of leptin to pregnant mice. Fourteen pregnant mice were divided into two groups. The treated pregnant group was subcutaneously injected in the intrascapular region with supraphysiologic doses (2 mg kg(-1)) of leptin (Vinci Biochem, Firenze, Italy) in a volume of 0.1 mL per 10 g body weight, at the 7th, 9th and 11th day of gestation. The control group was treated with physiological solution in the same manner and same times as the treated group. The new-born mice were killed 1 day after birth and the primary ossification centers were stained with Alizarin Red S after diaphanizing the soft tissues in 1% potassium hydroxide. The development of both endochondral and intramembranous ossification centers was morphometrically analysed in long bones. The results showed that the ossification centers of mice born by mothers treated with leptin grow more rapidly in both length and cross-sectional area compared with mice born by the untreated mothers. As the development of long bones depends on endochondral ossification occurring at proximal and distal epiphyseal plates as well as on intramembranous ossification along the periosteal surface, it appears that leptin activates the differentiation and proliferation of both chondrocytes and osteoblasts. The role of leptin as a growth factor of cartilage and bone is discussed in the light of the data reported in the literature. PMID:19682137

Bertoni, Laura; Ferretti, Marzia; Cavani, Francesco; Zavatti, Manuela; Resca, Elisa; Benelli, Augusta; Palumbo, Carla

2009-11-01

3

Bilateral osteochondrosis of the primary patellar ossification centers in a young athlete: a case report.  

PubMed

: Osteochondroses are a group of idiopathic self-limited conditions seen in skeletally immature individuals. The term describes disturbances in endochondral ossification affecting either the primary or secondary ossification centers. Osteochondrosis of the tarsal navicular was first described by Köhler in 1908; the eponym "Köhler's disease" is commonly used to refer to this condition. In his original paper, Köhler also described one instance of an osteochondrosis of the primary patellar ossification center, a clinical entity that has since rarely been reported. We present a case of isolated bilateral "Köhler's disease of the patellae" in an approximately 7-year-old male athlete demonstrated clinically and radiographically by both plain radiographs and magnetic resonance imaging. PMID:23797161

Dharamsi, Aisha S; Carl, Rebecca L

2014-01-01

4

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

PubMed

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

2014-02-01

5

Apparent primary ossification of the menisci in a dog.  

PubMed

A 2-year-old Collie was examined after it developed acute lameness in the right hind limb. Palpation of the right stifle elicited signs of pain, but a cranial drawer sign could not be elicited during palpation of the joint. Radiography revealed mineralized opacities in the craniolateral and caudal portions of the right stifle joint. Exploratory arthrotomy of the right stifle joint revealed a firm mass in the cranial horn of the lateral meniscus, which was characterized as osseous metaplasia in the cranial and caudal menisceal horns on histologic examination. Other abnormalities were not identified during surgery. Results of histologic examination, radiologic evidence, and observations during exploratory surgery supported a diagnosis of primary lateral meniscal ossification of the right stifle joint. Radiographs were obtained of the contralateral stifle joint when the dog was clinically normal (5 weeks after arthrotomy), and mineralized opacities were found in the lateral meniscus of this limb as well. Clinical signs may not be associated with primary intrameniscal ossification initially; type and location of ossification may affect likelihood and severity of clinical signs and secondary joint damage. Initial treatment for menisceal ossification is conservative (anti-inflammatory medications) unless there is a concurrent pathologic process that requires surgical repair. PMID:9638188

Weber, N A

1998-06-15

6

[Long-term functional outcomes of periprosthetic ossification post-total primary and revision hip arthroplasty].  

PubMed

Authors present long-term functional outcomes of acquired peri-prosthetic ossifications complicating primary and revision hip arthroplasty. Aim of the paper was realized based on clinical material of 1995-2005, 142 patients was included to the study, 64 (45.1%) men and 78 (54.9%) women aged between 44-75 years (average 62 years) with periprosthetic ossifications after primary and revision hip arthroplasty done through the posterolateral surgical approach. Observation period was between 1-6 years (average 3 years). Study group of 142 patients made up 67.3% of all periprosthetic ossification diagnosed in during the analyzed period. Pharmacological and radiological pre and postoperative prophylaxis of periprosthetic ossifications was not done in this group. Clinical material was divided into three age groups and according to type of implants creating the study group. Diagnosed ossifications were classified according to Brooker classes. Evaluation of obtained outcomes was done basing on Harris criterions and compared to outcomes obtained in control group, which was separated from existeding Clinic data base. Control group made up 142 patients without periprosthetic ossifications, 64 (45.1%) men and 78 (54.9%) women aged between 37-78 years (average 66 years), observation period between 1-3 years (average 2 years). PMID:18669104

Jurczak, Piotr; Golec, Edward; Nowak, Sebastian; Golec, Joanna; Szczygie?, Elzbieta

2008-01-01

7

Peculiar structures of the blood vessels forming the secondary ossification center in the rat femoral heads  

Microsoft Academic Search

To investigate the development of the blood vessels forming the secondary ossification center in the femoral heads of growing rats, we observed the specimens of the proximal femurs having vascular casts using both an optical and a scanning electron microscopy (SEM). Histologically, the vascular invasion occurred from the lateral part of the cartilaginous epiphysis, prior to the appearance of the

T. Hirano; M. E. Rabbi; K. Taguchi; K. Iwasaki

1994-01-01

8

Congenital os odontoideum arising from the secondary ossification center without prior fracture.  

PubMed

The etiology of os odontoideum has been debated in the literature since the condition was initially described. The authors present the case of a 4-year-old girl who was found to have an os odontoideum with atlantoaxial instability after a motor vehicle collision. Imaging performed 3 years earlier demonstrated an incompletely ossified, cartilaginous, orthotopic os separated from the body of the odontoid process at the level of the secondary ossification center with a short odontoid process. This case presents the earliest imaging demonstration of the presence of a congenital orthotopic os odontoideum at the secondary ossification center. The authors review the pertinent literature and propose that the etiology of os odontoideum is multifactorial and related to the embryology and vascular supply to the odontoid process. PMID:23039156

McHugh, Brian J; Grant, Ryan A; Zupon, Alyssa B; DiLuna, Michael L

2012-12-01

9

New patterns of the growing L3 vertebra and its 3 ossification centers in human fetuses - a CT, digital, and statistical study  

PubMed Central

Background This study describes reference data for L3 vertebra and its 3 ossification centers at varying gestational ages. Material/Methods Using CT, digital-image analysis and statistics, the growth of L3 vertebra and its 3 ossification centers in 55 spontaneously aborted human fetuses aged 17–30 weeks was examined. Results Neither sex nor right-left significant differences were found. The height and transverse and sagittal diameters of the L3 vertebral body increased logarithmically. Its cross-sectional area followed linearly, whereas its volume increased parabolically. The transverse and sagittal diameters of the ossification center of the L3 vertebral body varied logarithmically, but its cross-sectional area and volume grew linearly. The ossification center-to-vertebral body volume ratio gradually declined with age. The neural ossification centers increased logarithmically in length and width, and proportionately in cross-sectional area and volume. Conclusions With no sex differences, the growth dynamics of the L3 vertebral body follow logarithmically in height, sagittal and transverse diameters, linearly (in cross-sectional area), and parabolically (in volume). The growth dynamics of the 3 ossification centers of the L3 vertebra follow logarithmically in transverse and sagittal diameters, and linearly (in cross-sectional area and volume). The age-specific reference intervals of the L3 vertebra and its 3 ossification centers present the normative values of clinical importance in the diagnosis of congenital spinal defects.

Szpinda, Michal; Baumgart, Mariusz; Szpinda, Anna; WoYniak, Alina; Mila-Kierzenkowska, Celestyna

2013-01-01

10

BMP2 induces segment-specific skeletal regeneration from digit and limb amputations by establishing a new endochondral ossification center  

PubMed Central

Bone morphogenetic proteins (BMPs) are required for bone development, the repair of damage skeletal tissue, and the regeneration of the mouse digit tip. Previously we showed that BMP treatment can induce a regeneration response in mouse digits amputated at a proximal level of the terminal phalangeal element (P3) (Yu et al., 2010). In this study, we show that the regeneration-inductive ability of BMP2 extends to amputations at the level of the second phalangeal element (P2) of neonatal digits, and the hindlimb of adult limbs. In these models the induced regenerative response is restricted in a segment-specific manner, thus amputated skeletal elements regenerate distally patterned skeletal structures but does not form joints or more distal skeletal elements. Studies on P2 amputations indicate that BMP2-induced regeneration is associated with a localized proliferative response and the transient expression of established digit blastema marker genes. This is followed by the formation of a new endochondral ossification center at the distal end of the bone stump. The endochondral ossification center contains proliferating chondrocytes that establish a distal proliferative zone and differentiate proximally into hypertrophic chondrocytes. Skeletal regeneration occurs from proximal to distal with the appearance of osteoblasts that differentiate in continuity with the amputated stump. Using the polarity of the endochondral ossification centers induced by BMP2 at two different amputation levels, we show that BMP2 activates a level-dependent regenerative response indicative of a positional information network. In summary, our studies provide evidence that BMP2 induces the regeneration of mammalian limb structures by stimulating a new endochondral ossification center that utilizes an existing network of positional information to regulate patterning during skeletal regeneration.

Yu, Ling; Han, Manjong; Yan, Mingquan; Lee, Jangwoo; Muneoka, Ken

2012-01-01

11

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.

2013-01-01

12

Fetal spine ossification: the gender and individual differences illustrated by ultrasonography.  

PubMed

The spatial and temporal pattern of manifestation of ossification nuclei of the spinal column in fetal life have been well established by histologic and radiologic studies. Sonographic evaluation of the fetal spine depends on visualization of the ossification centers, but the sequence of development of ossification centers in the vertebral column obtained by embryologists and sonographers and radiology are conflicting. We carried out a longitudinal study to establish the ultrasonographic appearance and timing of development of primary ossification centers of the fetal spine in the first and second trimesters of pregnancy. A total of 80 mothers were evaluated during their pregnancy with two echographic controls; in the first trimester, the spine length was measured and, in the second trimester of pregnancy, the timing of ossification of the bodies and neural arches of sacral vertebrae and the difference in appearance between the female and male genders were evaluated. Spinal length measurements obtained in the first trimester and percentage of detection of sacral vertebral structures increased progressively with a regular pattern in relation to gestational age. Spinal length at first ultrasound examination was slightly correlated with time of appearance of sacral bodies and arches. Ossification timing was significantly earlier in females than in males. The study has attempted to improve our understanding of the sonographic detection of the spinal ossification. Data presented give some further information on the stages of appearance of sacral vertebrae body centers during intrauterine development. Differences between genders and interindividual variations in ossification timing were observed at a very early stage of development. This could be of value when fetal growth is evaluated. Moreover, further knowledge of spinal development may be useful for early diagnosis of spinal abnormalities and for fetal biometrics. PMID:15936488

Vignolo, M; Ginocchio, G; Parodi, A; Torrisi, C; Pistorio, A; Venturini, P L; Aicardi, G; De Biasio, P

2005-06-01

13

Heterotopic ossification: a review  

Microsoft Academic Search

Heterotopic ossification is the formation of bone in the soft tissues. Soft tissue bone deposition may range from the minimal and inconsequential to massive and clinically significant. In some clinical settings it is a predictable finding with an unpredictable course and in other settings it may be diagnostically confounding. Heterotopic ossification may be encountered in clinically disparate disease processes and

E. F. McCarthy; M. Sundaram

2005-01-01

14

Heterotopic ossification revisited.  

PubMed

Heterotopic ossification is the abnormal formation of mature lamellar bone within extraskeletal soft tissues where bone does not exist. Heterotopic ossification has been classified into posttraumatic, nontraumatic or neurogenic, and myositis ossificans progressiva or fibrodysplasia ossificans progressive. The pathophysiology is unknown. Anatomically, heterotopic ossification occurs outside the joint capsule without disrupting it. The new bone can be contiguous with the skeleton but generally does not involve the periosteum. Three-phase technetium-99m (99mTc) methylene diphosphonate bone scan is the most sensitive imaging modality for early detection and assessing the maturity of heterotopic ossification. Nonsurgical treatment with indomethacin and radiation therapy is appropriate for prophylaxis or early treatment of heterotopic ossification. Although bisphosphonates are effective prophylaxis if initiated shortly after the trauma, mineralization of the bone matrix resumes after drug discontinuation. During the acute inflammatory stage, the patient should rest the involved joint in a functional position; once acute inflammatory signs subside, passive range of motion exercises and continued mobilization are indicated. Surgical indications for excision of heterotopic ossification include improvement of function, standing posture, sitting or ambulation, independent dressing, feeding and hygiene, and repeated pressure sores from underlying bone mass. The optimal timing of surgery has been suggested to be a delay of 12 to 18 months until radiographic evidence of heterotopic ossification maturation and maximal recovery after neurological injury. The ideal candidate for surgical treatment before 18 months should have no joint pain or swelling, a normal alkaline phosphatase level, and 3-phase bone scan indicating mature heterotopic ossification. PMID:21410128

Mavrogenis, Andreas F; Soucacos, Panayotis N; Papagelopoulos, Panayiotis J

2011-03-01

15

A Peek...at Primary Learning Centers.  

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 essential considerations for designing such a center. Among the items discussed are scheduling, time management techniques, and record keeping…

Kessler, John

16

Calcification and Ossification  

Microsoft Academic Search

\\u000a \\u000a \\u000a \\u000a \\u000a \\u000a • \\u000a \\u000a \\u000a \\u000a Cutaneous calcification or ossification is the result of a disruption of the normal calcium regulatory pathway in the skin\\u000a by local or systemic events.\\u000a \\u000a \\u000a \\u000a \\u000a \\u000a • \\u000a \\u000a \\u000a \\u000a Calcifying disorders of the skin can be divided into four groups: dystrophic calcinosis secondary to localized or diffuse\\u000a tissue alterations; metastatic calcinosis, including calciphylaxis, due to impaired calcium-phosphate metabolism; idiopathic\\u000a calcinosis, and iatrogenic calcinosis.

Maxime Battistella; Bernard Cribier

17

Nurse practitioner center expands access to primary care.  

PubMed

In response to a need for increased patient access to primary care services in an area with a shortage of primary care physicians, not-for-profit Oconee Memorial Hospital, Seneca, South Carolina, opened a primary care center staffed solely by nurse practitioners. In addition to reducing the number of patients using the hospital's emergency room for nonurgent care, the center has improved patients' access to primary care services, strengthened the community's primary care base, and helped the hospital's managed care network win contracts. PMID:10164873

Olmsted, K L; DeMint, S

1997-02-01

18

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.

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

2014-01-01

19

Women of Polygamous Marriages in Primary Health Care Centers  

Microsoft Academic Search

Clinical implications for working with polygamous families are discussed following a report of research among a sample of 126 Bedouin-Arab women from polygamous marriages who were being seen in primary health care centers. Of these, 94 were senior wives who were followed by another wife in the marriage, and 32 were junior wives, the most recent wife joining the marriage.

Alean Al-Krenawi

1999-01-01

20

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.

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

2010-01-01

21

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.

2013-01-01

22

Heterotopic ossification induced by hypoxia in a retrosternal gastric tube following transhiatal oesophagectomy.  

PubMed Central

A 71 year old man underwent retrosternal gastric tube reconstruction following transhiatal oesophagectomy for squamous cell carcinoma. On the second post-operative day, the patient developed a cardiac arythmia with secondary hypotension followed by hypoxaemia necessitating artificial ventilation. Two weeks after surgery, endoscopy revealed massive necrosis of the proximal segment of the gastric tube extending from the anastomosis in the neck to the watershed area. Three weeks later, the patient died and a necropsy was performed. Macroscopic evaluation of the gastric tube revealed a sharply demarcated and fully ossificated proximal segment. Heterotopic ossification was present on histological examination. This condition has only been described in conjunction with primary or metastatic gastric adenocarcinoma. The location of the ossification and the presence of temporary systemic hypoxia suggest that the latter was the main factor responsible for the ossificative response. Images

Buscher, H C; van Lanschot, J J; Mulder, A H; Tilanus, H W

1995-01-01

23

The role of morphogens in endochondral ossification  

Microsoft Academic Search

The formation of bone occurs normally by one of two developmental processes: intramembranous or endochondral ossification. Endochondral ossification occurs in the morphogenesis of the limb buds and growth plates, and in the regeneration of bone following injury (fracture callus). Two classes of diffusible morphogen-like molecules (MLMs) involved in limb development are the bone morphogenetic proteins (BMPs) and retinoic acid (RA).

John T. Campbell; Frederick S. Kaplan

1992-01-01

24

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.

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

2012-01-01

25

Heterotopic Ossification in Orthopaedic Trauma  

PubMed Central

Heterotopic ossification (HO) can be defined as the pathological formation of bone in extra-skeletal tissues. There has been a substantial amount of recent research on the pathophysiology, prophylaxis and treatment of HO and traumatic conditions associated with the development of HO. This research has advanced our understanding of this disease and helped to clarify evidence-based approaches to both the prophylaxis and treatment of HO. This article reviews the literature on these topics with a focus on their application in orthopaedic trauma.

Nauth, Aaron; Giles, Erica; Potter, Benjamin K.; Nesti, Leon J.; O'Brien, Frederick P.; Bosse, Michael J.; Anglen, Jeffrey O.; Mehta, Samir; Ahn, Jaimo; Miclau, Theodore; Schemitsch, Emil H.

2012-01-01

26

Heterotopic ossification in a colorectal carcinoma.  

PubMed

A 48 years old man presented with subacute intestinal obstruction resulting from an intraluminal colorectal mass. He underwent partial colectomy. Histological diagnosis of mucinous adenocarcinoma with focal areas of heterotopic ossification was made. Although the presence of heterotopic ossification has no known prognostic implication in colorectal carcinoma, however, it is important that both radiologist and pathologist be aware of this phenomenon as distinct from carcinosarcoma that has poorer prognosis. From the available literature reviewed and to the best of our knowledge, this is the first reported case of mucinous colorectal carcinoma with heterotopic ossification in Saudi Arabia. PMID:22015126

Badmos, Kabir Bolarinwa; Seada, Laila Salah; Faraj, Abdelfattah Abueisha

2011-10-01

27

Primary charge separation in isolated photosystem II reaction centers  

SciTech Connect

Primary charge-separation in isolated bacterial reaction center (RC) complex occurs in 2.8 ps at room temperature and 0.7--1.2 ps at 10 K. Because of similarities between the bacterial and photosystem II (PSII) RCs, it has been of considerable interest to obtain analogous charge-separation rates in the higher plant system. Our previous femtosecond transient absorption studies used PSII RC material stabilized with PEG or by exchanging dodecyl maltoside (DM) for Triton in the isolation procedure. These materials gave charge-separation 1/e times of 3.0 [plus minus] 0.6 ps at 4[degree]C and 1.4[plus minus] 0.2 ps at 15 K based on the risetime of transient absorption kinetics at 820 nm. These values were thought to represent the time required for formation of the P680[sup +]-Pheo[sup [minus

Seibert, M.; Toon, S. (National Renewable Energy Lab., Golden, CO (United States)); Govindjee (Illinois Univ., Urbana, IL (United States)); O'Neil, M.P.; Wasielewski, M.R. (Argonne National Lab., IL (United States))

1992-08-24

28

Pediatric blood pressure: ethnic comparisons in a primary care center.  

PubMed

This study reviews the blood pressure (BP) determinations previously recorded in a primary care center serving a low socioeconomic population and compares the systolic blood pressure (SBP) and diastolic blood pressure (DBP) distributions within the clinic population among the three major ethnic groups represented, and also between this clinic population and a recently reported standard population (Task Force for Blood Pressure Control in Children, NHLBI). The study group consisted of 2810 children 3-17 years of age, of whom 49.2% were of Spanish surname, 23.4% black, and 27.4% white. As a standard clinic procedure, BP readings were obtained from the right arm with the subject seated. Comparisons of the average SBP by 3-year age groups, by sex, within the clinic population showed that blacks had higher SBPs than children with Spanish surnames or whites in all of the five male subgroups and in four of the five female subgroups. Black males had higher DBPs than Spanish or whites in four of the five subgroups; black females had higher DBPs in three of the five subgroups. In comparison with the standard population, the overall 95th percentile values for both SBP and DBP were lower. The prevalence of readings above the 95th percentile values reported for the standard population over all age groups was as follows: SBP, 1.53%; DBP, 1.60%; and both SBP and DBP, 0.57%. Proportionately, elevated readings were most common among blacks and least common among whites. However, these differences between ethnic groups could be accounted for statistically, to a great extent, by adjusting for height and weight, since blacks were the tallest and heaviest of the three groups. These results suggest that, even in childhood, blacks presenting at a primary care center have higher BPs than Spanish or whites, but that this differences is largely related to body size. PMID:7203603

Gutgesell, M; Terrell, G; Labarthe, D

1981-01-01

29

[Endometrial ossification: a report of four cases and literature review].  

PubMed

Endometrial ossification is a rare endometrial pathology. Its predisposing factors include history of uterine curettage to metabolic abnormalities. It usually presents in patients with secondary infertility and history of first trimester pregnancy loss, accompanied by severe dysmenorrhea and dyspareunia. The diagnosis is suspected by OB-GYN history and USG findings, therapeutic strategies range from D&C to hysterectomy, we propose diagnosis and management by hysteroscopy in order to preserve future fertility and minimize uterine damage. A review of four cases during 1985-2004 from a large assisted reproduction center in Mexico City is presented. PMID:17547092

Nevarez Bernal, Roberto; Vilchis Nava, Pablo; Kably Ambe, Alberto

2007-03-01

30

Hysteroscopic diagnosis and treatment of endocervical ossification: a case report.  

PubMed

We describe a case of osseous metaplasia into the cervical canal in a 41-year-old woman. The patient had a history of primary infertility, pelvic pain, chronic endocervicitis, and bone formation in the upper third of the cervical canal. After antibiotic therapy, we removed bone fragments by operative hysteroscopy using grasping forceps. The fragments were completely removed with no evidence of recurrence at 1-year follow-up. Chronic endocervicitis may cause endocervical ossification and should be ruled out before surgical removal of bone fragments in order to ensure definitive resolution and prevent recurrence. PMID:15904621

Cicinelli, Ettore; Stanziano, Antonio; Parisi, Carlo; Marinaccio, Marco; Causio, Franco

2005-01-01

31

Primary charge separation in isolated photosystem II reaction centers  

SciTech Connect

Primary charge-separation in isolated bacterial reaction center (RC) complex occurs in 2.8 ps at room temperature and 0.7--1.2 ps at 10 K. Because of similarities between the bacterial and photosystem II (PSII) RCs, it has been of considerable interest to obtain analogous charge-separation rates in the higher plant system. Our previous femtosecond transient absorption studies used PSII RC material stabilized with PEG or by exchanging dodecyl maltoside (DM) for Triton in the isolation procedure. These materials gave charge-separation 1/e times of 3.0 {plus_minus} 0.6 ps at 4{degree}C and 1.4{plus_minus} 0.2 ps at 15 K based on the risetime of transient absorption kinetics at 820 nm. These values were thought to represent the time required for formation of the P680{sup +}-Pheo{sup {minus}} state. Recent results of Hastings et al. obtained at high data acquisition rates and low flash intensities, suggest that the Pheo{sup {minus}} state may form more slowly. In light of this work, we have carried out additional time domain studies of both electron transport and energy transfer phenomena in stabilized DM PSII RCs at room temperature. We used a 1-kHz repetition rate femtosecond transient absorption spectrometer with a 200 fs instrumental time resolution and compared the results with those obtained by others using frequency domain hole-burning techniques.

Seibert, M.; Toon, S. [National Renewable Energy Lab., Golden, CO (United States); Govindjee [Illinois Univ., Urbana, IL (United States); O`Neil, M.P.; Wasielewski, M.R. [Argonne National Lab., IL (United States)

1992-08-24

32

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.

Alport, Brie; Horne, David; Burbridge, Brent

2014-01-01

33

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

2009-01-01

34

Regulation of Embryonic Endochondral Ossification by Smurf2  

PubMed Central

Smurf2 is an E3 ubiquitin ligase that targets TGF-? receptor activated Smad2 and Smad3 for the proteasome in primary articular chondrocytes, thus stimulating their hypertrophic differentiation. Comparatively, how Smurf2 functions in growth plate chondrocytes in a developing long bone is an open question. In this study, we measured the mRNA levels of endogenous Smurf2 and type X collagen in chick growth plate at different embryonic stages to monitor the correlation between the level of Smurf2 expression and chondrocyte maturational stage. We found that high levels of Smurf2 were associated with the differentiative and proliferative stages, while Smurf2 levels were thereafter decreased as the chondrocytes matured toward hypertrophy. In addition, we injected Smurf2-RCAS into chick wing buds at HH stage 20–23 and examined how the ectopic overexpression of Smurf2 in condensing chondrogenic mesenchymeaffects the subsequent process of chondrocyte maturation and ossification during embryonic development. Histological analysis showed that overexpression of Smurf2 in a developing wing bud accelerated chondrocyte maturation and endochondral ossification, which may result from a decrease in TGF-? signaling in the infected chondrocytes with Smurf2-RCAS.

Wu, Qiuqian; Wang, Meina; Zuscik, Michael J.; Chen, Di; O'Keefe, Regis J.; Rosier, Randy N.

2009-01-01

35

Histology of epiphyseal cartilage calcification and endochondral ossification.  

PubMed

Cartilage calcification is carried out by chondrocytes as they hypertrophy and begin to secrete matrix vesicles. Calcification initiates when calcium phosphates appear inside these matrix vesicles, forming hydroxyapatite crystals that eventually break through the membrane to form calcifying globules, as in bone calcification. However, the extracellular environment in cartilage is different from that in bone: cartilage is abundant in proteoglycans but contains a small amount of osteopontin. Hypertrophic chondrocytes secrete vesicles in the cartilaginous matrix of intercolumnar septae only, forming well-calcified longitudinal septae and poorly-calcified transverse partitions. Such pattern of vesicle deposition permits the invasion of endothelial cells, which infiltrate into cartilage and induce migration of osteogenic and osteoclastic cells. Osteoclasts resorb the excess of calcified globules in the partitions, shaping calcified cartilage cores paralleling the longitudinal axis of long bones. After the formation of these calcified cartilage cores, endochondral ossification involves a series of well-defined events in which osteogenic cells deposit new bone onto the cartilage core and form primary trabecules. This review presents the histology of epiphyseal cartilage calcification and endochondral ossification. PMID:22202021

Amizuka, Norio; Hasegawa, Tomoka; Oda, Kimimitsu; Luiz de Freitas, Paulo Henrique; Hoshi, Kazuto; Li, Minqi; Ozawa, Hidehiro

2012-01-01

36

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.

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

2005-01-01

37

The Primary Cilium as a Complex Signaling Center  

PubMed Central

Respect for the primary cilium has undergone a remarkable renaissance over the past decade, and it is now thought to be an essential regulator of numerous signaling pathways. The primary cilium’s functions range from the movement of cells and fluid, to sensory inputs involved with olfaction and photoreception. Disruption of cilia function is involved in multiple human syndromes collectively called ‘ciliopathies’. The cilium’s activities are mediated by targeting of receptors, channels, and their downstream effector proteins to the ciliary or basal body compartment. These combined properties of the cilium make it a critical organelle facilitating the interactions between the cell and its environment. Here we review many of the recent advances contributing to the ascendancy of the primary cilium and how the extraordinary complexity of this organelle inevitably assures many more exciting future discoveries.

Berbari, Nicolas F.; O'Connor, Amber K.; Haycraft, Courtney J.; Yoder, Bradley K.

2010-01-01

38

Ossification and midline shape changes of the human fetal cranial base.  

PubMed

An appreciation of ontogenetic changes to the cranial base is important for understanding the evolution of modern human skull form. Using geometric morphometric techniques, this study explores midline shape variations of the basicranium and midface during human prenatal ontogeny. In particular, the analysis sets out to explore shape variations associated with endochondral ossification and to reassess shape variations previously observed on the basis of angular measures.Fifty-four formalin-preserved human fetuses were imaged using high-resolution MRI. Coordinates for 10 landmarks defining the midline basicranium and midface were acquired and areas of ossification in the midline basioccipital, basisphenoid, and presphenoid cartilages were measured as percentages of overall cranial base area. The results show shape variations with increasing fetal size that are consistent with cranial base retroflexion, anterior facial projection and dorsal facial rotation. These growth variations are centered on the midsphenoid area and are associated with disproportionate variations of sphenoid height and length. Small but significant correlations were observed between ossification of the presphenoid cartilage and components of shape that described, among other variations, sphenoid shortening. While ossification cannot be directly linked with the shape variations observed, it seems likely that bone formation plays a role in modulating the influence of other factors on the fetal cranial base. PMID:14669239

Jeffery, Nathan; Spoor, Fred

2004-01-01

39

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.

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

2012-01-01

40

Giant cranionasal and cystic-solid craniopharyngioma associated with extensive bone erosion and ossification.  

PubMed

Craniopharyngioma (CP), a rare benign and slow-growing epithelial tumor, is mainly located within the sellar/parasellar region. Primary CP involving the nasal cavity and the sellar region with extensive erosion of the skull base and ossification simultaneity has not been described previously. The authors report a 23-year-old man who presented to our institute with complaints of repeated nasal cavity bloodshed, liquid flow, and progressive visual loss. A neuroimaging examination showed a giant cranionasal and cystic-solid CP extending from the suprasellar region to the nasopharynx with inhomogeneous enhancement, which is associated with extensive erosion of the skull base and ossification. The patient underwent a transsphenoidal surgery to resect the nasopharyngeal component of CP and a subfrontal craniotomy with a total removal of intracranial component by grinding 3 months later. A histopathologic examination revealed characteristic features of adamantinomatous CP associated with ossification. The current study demonstrates that CP can exhibit cranionasal growth pattern and arise from residue of craniopharyngeal duct. Extensive erosion of the skull base, calcification, and ossification can present in tumor simultaneity. A 2-stage stratagem is important for its total removal because of the peculiar hardness. Postsurgical course is unevenly and should be dealt with carefully. PMID:23851734

Chen, Haifeng; Zhou, Liangxue; Luo, Linli; Jiang, Su; Guo, Gang; You, Chao

2013-07-01

41

Heterotopic ossification of the abdominal wall  

PubMed Central

INTRODUCTION Heterotopic ossification is a rare, benign condition which occurs when bone develops in tissues that do not normally ossify. PRESENTATION OF CASE We herein report the case of a 73-year-old gentleman who underwent a laparotomy for a large splenic flexure tumour considered unresectable at initial intervention. Following delivery of chemotherapy, he was referred for a second opinion and the tumour with adjacent structures was removed at a subsequent laparotomy. A segment of abnormal hard tissue present in the abdominal wall was also excised. Histopathology revealed metaplastic bone deposition. DISCUSSION Heterotopic ossification may occur at various sites and is a recognised but exceedingly infrequent sequela of abdominal surgery. CONCLUSION This case highlights clinical, aetiological and histopathological features of this rare finding.

Hogan, Niamh M.; Caffrey, Emer; Curran, Stephanie; Sheehan, Margaret; Joyce, Myles R.

2012-01-01

42

Marker Mode Structure in the Primary Donor State of Bacterial Reaction Centers.  

National Technical Information Service (NTIS)

Underlying structure for the primary donor absorption profiles of isolated reaction centers Rhodopseudomonas viridis and Rhodobacter sphaeroides (P960 and P870) has recently been uncovered by transient hole burning experiments. A Franck-Condon progression...

P. Lyle G. J. Small T. J. DiMagno J. R. Norris

1992-01-01

43

New Pathways for Primary Care: An Update on Primary Care Programs From the Innovation Center at CMS  

PubMed Central

Those in practice find that the fee-for-service system does not adequately value the contributions made by primary care. The Center for Medicare and Medicaid Innovation (Innovation Center) was created by the Affordable Care Act to test new models of health care delivery to improve the quality of care while lowering costs. All programs coming out of the Innovation Center are tests of new payment and service delivery models. By changing both payment and delivery models and moving to a payment model that rewards physicians for quality of care instead of volume of care, we may be able to achieve the kind of health care patients want to receive and primary care physicians want to provide.

Baron, Richard J.

2012-01-01

44

The role of vascular endothelial growth factor in ossification.  

PubMed

Osteogenesis and angiogenesis are two closely correlated processes during bone growth, development, remodelling and repair.Vascular endothelial growth factor (VEGF) is an essential mediator during the process of angiogenesis. Based on an extensive literature search, which was carried out using the PubMed database and the keywords of osteogenesis, VEGF, endochondral ossification and intramembranous ossification, this manuscript reviews the role of VEGF in ossification, with emphasis on its effect in endochondral and intramembranous ossification. Osteogenesis and angiogenesis are closely correlated processes. VEGF acts as an essential mediator during these processes. It not only functions in bone angiogenesis but also in various aspects of bone development. PMID:22722639

Yang, Yan-Qi; Tan, Ying-Ying; Wong, Ricky; Wenden, Alex; Zhang, Lin-Kun; Rabie, A Bakr M

2012-06-01

45

The role of vascular endothelial growth factor in ossification  

PubMed Central

Osteogenesis and angiogenesis are two closely correlated processes during bone growth, development, remodelling and repair. Vascular endothelial growth factor (VEGF) is an essential mediator during the process of angiogenesis. Based on an extensive literature search, which was carried out using the PubMed database and the keywords of osteogenesis, VEGF, endochondral ossification and intramembranous ossification, this manuscript reviews the role of VEGF in ossification, with emphasis on its effect in endochondral and intramembranous ossification. Osteogenesis and angiogenesis are closely correlated processes. VEGF acts as an essential mediator during these processes. It not only functions in bone angiogenesis but also in various aspects of bone development.

Yang, Yan-Qi; Tan, Ying-Ying; Wong, Ricky; Wenden, Alex; Zhang, Lin-Kun; Rabie, A Bakr M

2012-01-01

46

Primary Care Screening of Depression and Treatment Engagement in a University Health Center: A Retrospective Analysis  

ERIC Educational Resources Information Center

Objectives: This retrospective study analyzed a primary care depression screening initiative in a large urban university health center. Depression detection, treatment status, and engagement data are presented. Participants: Participants were 3,713 graduate and undergraduate students who presented consecutively for primary care services between…

Klein, Michael C.; Ciotoli, Carlo; Chung, Henry

2011-01-01

47

Primary Trait Analysis to Assess a Learner-Centered, Upper-Level Mathematics Course  

ERIC Educational Resources Information Center

This study presents a primary trait analysis of a learner-centered, discrete mathematics course based on student-to-student instruction. The authors developed a scoring rubric for the primary traits: conceptual knowledge, procedural knowledge, application of understanding, and mathematical communication skills. Eleven students took an exam…

Alsardary, Salar; Pontiggia, Laura; Hamid, Mohammed; Blumberg, Phyllis

2011-01-01

48

Observation of a bacteriochlorophyll anion radical during the primary charge separation in a reaction center  

Microsoft Academic Search

The primary light-induced charge separation in reaction Centers of Rkfobacter sphueroides was investigated with femtosecond time resolution. The absorption changes in the time range 100 fs to 1 ns observed after direct excitation of the primary donor P at 860 mn could only be explained by a kinetic model which uses three time constants. This fmding supports the following reaction

W. Holzapfel; U. Finkele; W. Kaiser; D. Oesterhelt; H. Scheer; H. U. Stilz; W. Zinth

1989-01-01

49

Heterotopic ossification in Dupuytren's disease: clinical and histological significance.  

PubMed

We report the case of an 82-year-old man who underwent fasciectomy for a severe Dupuytren's contracture, during which an ossified lesion was encountered within the contracture and surrounding the neurovascular bundle. The abnormal tissue was removed with difficulty and heterotopic ossification was confirmed histologically. We believe this is the first report of heterotopic ossification in Dupuytren's disease. PMID:22161933

Sadideen, H; Athanasou, N; Ashmore, A; McNab, I

2011-12-01

50

Animal Models of Typical Heterotopic Ossification  

PubMed Central

Heterotopic ossification (HO) is the formation of marrow-containing bone outside of the normal skeleton. Acquired HO following traumatic events is a common and costly clinical complication. In contrast, hereditary HO is rarer, progressive, and life-threatening. Substantial effort has been directed towards understanding the mechanisms underlying HO and finding efficient treatments. However, one crucial limiting factor has been the lack of relevant animal models. This article reviews the major currently available animal models, summarizes some of the insights gained from these studies, and discusses the potential future challenges and directions in HO research.

Kan, Lixin; Kessler, John A.

2011-01-01

51

Hyaluronan turnover and hypoxic brown adipocytic differentiation are co-localized with ossification in calcified human aortic valves  

PubMed Central

The calcification process in aortic stenosis has garnered considerable interest but only limited investigation into selected signaling pathways. This study investigated mechanisms related to hypoxia, hyaluronan homeostasis, brown adipocytic differentiation, and ossification within calcified valves. Surgically explanted calcified aortic valves (n=14) were immunostained for markers relevant to these mechanisms and evaluated in the center (NodCtr) and edge (NodEdge) of the calcified nodule (NodCtr), tissue directly surrounding nodule (NodSurr); center and tissue surrounding small “prenodules” (PreNod, PreNodSurr); and normal fibrosa layer (CollFibr). Pearson correlations were determined between staining intensities of markers within regions. Ossification markers primarily localized to NodCtr and NodEdge, along with markers related to hyaluronan turnover and hypoxia. Markers of brown adipocytic differentiation were frequently co-localized with markers of hypoxia. In NodCtr and NodSurr, brown fat and ossification markers correlated with hyaluronidase-1, whereas these markers, as well as hypoxia, correlated with hyaluronan synthases in NodEdge. The protein product of tumor necrosis factor-? stimulated gene-6 strongly correlated with ossification markers and hyaluronidase in the regions surrounding the nodules (NodSurr, PreNodSurr). In conclusion, this study suggests roles for hyaluronan homeostasis and the promotion of hypoxia by cells demonstrating brown fat markers in calcific aortic valve disease.

Stephens, Elizabeth H.; Saltarrelli, Jerome G.; Balaoing, Liezl R.; Baggett, L. Scott; Nandi, Indrajit; Anderson, Kristin M.; Morrisett, Joel D.; Reardon, Michael J.; Simpson, Melanie A.; Weigel, Paul H.; Olmsted-Davis, Elizabeth A.; Davis, Alan R.; Grande-Allen, K. Jane

2012-01-01

52

Prevalence of heterotopic ossification in cemented versus noncemented total hip joint replacement in patients with osteoarthrosis: a randomized clinical trial  

PubMed Central

Objective To determine the prevalence of heterotopic bone formation in cemented versus noncemented total hip joint replacement. Design A prospective randomized controlled trial. Follow-up ranged from 2 to 6 years (mean 4 years). Setting A university hospital. Patients Two hundred and twenty-six patients who had primary or secondary osteoarthrosis of the hip were stratified according to type of fixation, surgeon and age. Patients were randomized within strata: 112 received noncemented total hip prostheses and 114 received cemented prostheses. The 2 groups were similar with respect to age and sex. Intervention Primary total hip arthroplasty. A cemented (methylmethacrylate) or noncemented prosthesis was inserted by a lateral surgical approach. Main outcome measure The Brooker classification was used to grade heterotopic bone formation from postoperative radiographs. Results Overall, 148 (66%) hips had no heterotopic ossification, 56 (25%) were Brooker class I, 14 (6%) were class II, 8 (3%) were class III and none were class IV. In the noncemented group of patients, 76 (68%) hips had no heterotopic ossification, 25 (22%) were Brooker class I, 7 (6%) were class II, 4 (4%) were class III and none were class IV. In the cemented group of patients, 72 (63%) hips had no heterotopic ossification, 31 (27%) hips were Brooker class I, 7 (6%) were class II, 4 (4%) were class III and none were class IV. Conclusion There was no significant difference in the prevalence of heterotopic ossification between cemented and noncemented total hip replacements in patients with osteoarthrosis.

Nayak, K. Naresh K.; Mulliken, Brian; Rorabeck, Cecil H.; Bourne, Robert B.; Woolfrey, Michael R.

1997-01-01

53

Sustainable patient information network (SPaIN) for primary care health center in Indonesia  

Microsoft Academic Search

Sustainable patient information network for primary care health center is needed for Indonesia. There are many of remote, isolated or urban area, which causes transportation problems and telecommunication problems, for example: necessity of wireless infrastructure. The Internet and its free software is the main agent for this system combining with information and communication technology. We develop low speed communication system

I. T. Pambudi; T. Hayasaka; T. Tsubota; S. Wada; T. Yamaguchi

2003-01-01

54

The National Area Health Education Center Program and Primary Care Residency Training.  

ERIC Educational Resources Information Center

As part of its mission to increase the availability of primary care providers in rural and other underserved areas of the country, the national Area Health Education Center Program has developed new rural-focused initiatives, including expanded student experiences in underserved areas, rural-track residencies, and telehealth links to rural…

Bacon, Thomas J.

2000-01-01

55

The Role of Matrix Gla Protein in Ossification and Recovery of the Avian Growth Plate  

PubMed Central

Extracellular matrix mineralization is an essential physiologic process in bone, teeth, and hypertrophic cartilage. Matrix Gla protein (MGP), an inhibitor of mineralization, is expressed by chondrocytes and vascular smooth muscle cells to inhibit calcification of those soft tissues. Tibial dyschondroplasia (TD), a skeletal abnormality apparent as a plug of non-vascularized, non-mineralized, white opaque cartilage in the tibial growth plate of avian species can serve as a good model for studying process and genes involved in matrix mineralization and calcification. In this work, we studied the involvement of MGP in the development of TD, as well as in the processes of spontaneous and induced recovery from this syndrome. First, we found that during normal bone development, MGP is expressed in specific time and locations, starting from wide-spread expression in the yet un-ossified diaphysis during embryonic development, to specific expression in hypertrophic chondrocytes adjacent to the chondro-osseous junction and the secondary ossification center just prior to calcification. In addition, we show that MGP is not expressed in the impaired TD lesion, however when the lesion begins to heal, it strongly express MGP prior to its calcification. Moreover, we show that when calcification is inhibited, a gap is formed between the expression zones of MGP and BMP2 and that this gap is closed during the healing process. To conclude, we suggest that MGP, directly or through interaction with BMP2, plays a role as ossification regulator that acts prior to ossification, rather then simple inhibitor.

Dan, Harel; Simsa-Maziel, Stav; Reich, Adi; Sela-Donenfeld, Dalit; Monsonego-Ornan, Efrat

2012-01-01

56

Prophylaxis of heterotopic ossification - an updated review  

PubMed Central

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 effects to the patient. Recently there have been several studies attempting to identify new aspects of the etiology of heterotopic bone formation and introduce new prophylactic modalities with increased efficacy and fewer side effects. For this review, we selectively retrieved articles from Medline published from 1958–2008 on the prophylaxis of HO with the aim of assisting readers in quickly grasping the current status of research and clinical aspects of HO prophylaxis.

Baird, Evan O; Kang, Qian K

2009-01-01

57

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

PubMed

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

2011-01-01

58

Metaplastic ossification of a cervical sialocoele in a dog.  

PubMed

Metaplastic ossification of a long-standing cervical sialocoele was identified in a 2-year-old male Hellenic Hound dog. Diagnosis was based upon history, clinical findings, paracentesis and histopathology. Trauma or chronic inflammation of the mandibular gland/duct complex were the most probable causes of the ossification. Surgical excision of the ossified mass, as well as of mandibular and sublingual salivary glands/ducts of the affected side, resulted in clinical remission. PMID:16035182

Prassinos, N N; Tontis, D K; Adamama-Moraitou, K k; Galatos, A D; Siochu, A

2005-07-01

59

Luxury Primary Care, Academic Medical Centers, and the Erosion of Science and Professional Ethics  

PubMed Central

Medical schools and teaching hospitals have been hit particularly hard by the financial crisis affecting health care in the United States. To compete financially, many academic medical centers have recruited wealthy foreign patients and established luxury primary care clinics. At these clinics, patients are offered tests supported by little evidence of their clinical and/or cost effectiveness, which erodes the scientific underpinnings of medical practice. Given widespread disparities in health, wealth, and access to care, as well as growing cynicism and dissatisfaction with medicine among trainees, the promotion by these institutions of an overt, two-tiered system of care, which exacerbates inequities and injustice, erodes professional ethics. Academic medical centers should divert their intellectual and financial resources away from luxury primary care and toward more equitable and just programs designed to promote individual, community, and global health. The public and its legislators should, in turn, provide adequate funds to enable this. Ways for academic medicine to facilitate this largesse are discussed.

Donohoe, Martin

2004-01-01

60

Economic Analysis of Requests for Laboratory Tests in Primary Health Care Centers  

PubMed Central

Introduction: Operation of the Primary health care center and Medical-biochemical laboratories depends on the number of performed laboratory tests. The number of unnecessary tests significantly affect the operation of health institutions. Material and methods: We analyzed the 1000 requests for laboratory tests at the Primary Health Care Centre in Gracanica from primary care units. Based on the requests for laboratory diagnostics advisable diagnoses from primary health care unit in the Primary Health Care Center (PHC) we made an economic analysis of the total required laboratory tests in the requests for laboratory diagnosis. Incorporating the economic analysis of laboratory tests in requests for laboratory diagnosis by doctors in primary health care (PHC) and the economic analysis of laboratory tests by the disease in primary health care. Results: The economic value of 5333 laboratory tests was 84 312 points (1 point is 0.80 KM). Of the total value of the index score requirements of GPs are 44, 1%, the requirement of family doctors account for 40% and requirements of other specialists make up 15, 9%.. Discussion: In the requests of the PHC units for laboratory tests are required all levels of services: urine, CBC, SE, glucose, bilirubine, ALT, AST, AF, CK, cholesterol, HDL chol., triglicerdes, creatinine, urea, uric acid, CRP, fibrinogen, calcium and phosphorus. The following requests are the most common laboratory tests: urine, CBC, blood glucose, cholesterol, triglycerides, aminotransferases, creatinine, urea. The doctors in family practice most often requested: blood glucose, urine, CBC, SE, TGL. , Chol., ALT, AST, creatinine and urea. General practitioners were demanding more cholesterol and triglycerides, and family medicine doctors were demanding less cholesterol and triglycerides and more often CRP, fibrinogen, ALT, AST, what from the level of economic cost analysis rises the issue whether this was justified?

Zunic, Lejla

2012-01-01

61

Temperature dependence of the primary electron transfer reaction in pigment-modified bacterial reaction centers  

Microsoft Academic Search

The initial electron transfer steps in pigment modified reaction centers, where bacteriopheophytin is replaced by plant pheophytin (R26.Phe-a RCs) have been investigated over a wide temperature range by femtosecond time-resolved spectroscopy. The experimental data obtained in the maximum of the bacteriochlorophyll anion band at 1020 nm show the existence of a high and long-lived population of the primary acceptor P+BA-

Heinz Huber; Michaela Meyer; Hugo Scheer; Wolfgang Zinth; Josef Wachtveitl

1998-01-01

62

Raman spectroscopic analysis of combat-related heterotopic ossification development.  

PubMed

Over 60% of our severely combat-injured patient population develops radiographically apparent heterotopic ossification. Nearly a third of these require surgical excision of symptomatic lesions, a procedure that is fraught with complications, and delays or regresses functional rehabilitation in many cases. Unfortunately, for the combat injured, medical contraindications and logistical limitations limit widespread use of conventional means of primary prophylaxis. Better means of risk stratification are needed to both mitigate the risk of current means of primary prophylaxis as well as to evaluate novel preventive strategies currently in development. We asked whether Raman spectral changes, measured ex vivo, correlated with histologic evidence of the earliest signs of HO formation using tissue biopsies from the wounds of combat casualties. In doing so, we compared normal muscle tissue to injured muscle tissue, unmineralized HO tissue, and mineralized HO tissue. The Raman spectra of these tissues demonstrate clear differences in the amide I and amide III spectral regions of HO tissue compared to normal tissue, denoted by changes in the 1640/1445cm(-1)(p<0.01), and 1340/1270cm(-1) (p<0.01) band area ratios (BARs). Additionally, analysis of the bone mineral in HO by Raman spectroscopy appears capable of determining bone maturity by measuring both the 945/960cm(-1) and the 1070/1445cm(-1) BARs. Raman may therefore prove a useful, non-invasive, and early diagnostic modality to detect HO formation prior to it becoming evident clinically or radiographically. This technique could ostensibly be utilized as a non-invasive means to risk stratify individual wounds at a time thought to be amenable to various means of primary prophylaxis. PMID:24012700

Crane, Nicole J; Polfer, Elizabeth; Elster, Eric A; Potter, Benjamin K; Forsberg, Jonathan A

2013-12-01

63

Radiotherapy of primary cutaneous follicle center lymphoma: case report and review of literature  

PubMed Central

Primary cutaneous follicle center lymphoma is an indolent primary cutaneous B-cell lymphoma originating from the follicle center cells, composed of a combination of centrocytes (small and large cleaved cells) and centroblasts (large noncleaved cells) with a follicular, follicular/diffuse, or diffuse growth pattern. Lesions are mostly located on the head, neck and trunk. A case is presented of a 56-year-old male patient with primary cutaneous follicle center lymphoma, with lesions involving the skin of the back, shoulders, presternal area and right forearm. As the patient presented a disseminated cutaneous form of the disease that involved several anatomical regions, complete work-up was followed by superficial fractionated radiotherapy of eight fields in VI expositions, with total irradiation dose of 1400 cGy upon the following fields: right and left pectoral region, left and right shoulders, right suprascapular region, and proximal third of the right forearm. Total irradiation dose applied upon each field for the lesions located on the left and right side of the back was 1500 cGy. This therapy resulted in significant reduction of visible tumor. The patient was regularly followed up on outpatient basis for 12 months of radiotherapy, being free from local recurrence and systemic spread of the disease.

2013-01-01

64

Assessments for measuring patient-centered cultural sensitivity in community-based primary care clinics.  

PubMed Central

OBJECTIVE: To develop and test the reliability of three race/ethnicity-specific forms of the pilot Tucker-Culturally Sensitive Health Care Inventory (T-CUSHCI) for use by patients at community-based primary care centers to evaluate the level of patient-centered cultural sensitivity perceived in the health care that they experience. METHODS: This research involved two studies using independent samples of primary care patients. In study 1, mostly low-income African-American, Hispanic and non-Hispanic white American patients (N=221) rated the importance of specific provider and office staff behaviors and attitudes, and center policies and physical environment characteristics that were earlier identified in previous focus groups as characteristics of patient-centered culturally sensitive healthcare. In study 2, three pilot race/ethnicity-specific T-CUSHCI patient forms were constructed from the items rated as at least important in study 1. Mostly low-income African-American and non-Hispanic white American patients (N=180) provided data to determine the reliability of the T-CUSHCI patient form for their racial/ethnic group. RESULTS: The pilot T-CUSHCI-African-American patient form and the pilot T-CUSHCI-non-Hispanic white American patient form were found to have Cronbach's alpha coefficients ranging from 0.71-0.96 and six-month test-retest and split-half reliabilities ranging from 0.92-0.99. CONCLUSION: The pilot T-CUSHCI patient forms (one each for African Americans, Hispanics and non-Hispanic whites) should be further tested using a national sample of patients. In the interim, these inventory forms can be used as clinical tools to obtain patient feedback for providing "individualized" patient-centered culturally sensitive healthcare.

Tucker, Carolyn M.; Mirsu-Paun, Anca; Van den Berg, Jacob J.; Ferdinand, Lisa; Jones, Jessica D.; Curry, Robert W.; Rooks, Larry G.; Walter, Todd J.; Beato, Cristina

2007-01-01

65

Implementing Quality Improvement in Small, Autonomous Primary Care Practices: Implications for the Patient Centered Medical Home  

PubMed Central

Background Implementing improvement programs to enhance quality of care within primary care clinics is complex, with limited practical guidance available to help practices during the process. Understanding how improvement strategies can be implemented in primary care is timely given the recent national movement towards transforming primary care into patient-centered medical homes (PCMH). This study examined practice members’ perceptions of the opportunities and challenges associated with implementing changes in their practice. Methods Semi-structured interviews were conducted with a purposive sample of 56 individuals working in 16 small, community-based primary care practices. The interview consisted of open-ended questions focused on participants’ perceptions of: (1) practice vision, (2) perceived need for practice improvement, and (3) barriers that hinder practice improvement. The interviews were conducted at the participating clinics and were tape-recorded, transcribed, and content analyzed. Results Content analysis identified two main domains for practice improvement related to: (1) the process of care, and (2) patients’ involvement in their disease management. Examples of desired process of care changes included improvement in patient tracking/follow-up system, standardization of processes of care, and overall clinic documentations. Changes related to the patients’ involvement in their care included improving (a) health education, and (b) self care management. Among the internal barriers were: staff readiness for change, poor communication, and relationship difficulties among team members. External barriers were: insurance regulations, finances and patient health literacy. Practice Implications Transforming their practices to more patient-centered models of care will be a priority for primary care providers. Identifying opportunities and challenges associated with implementing change is critical for successful improvement programs. Successful strategy for enhancing the adoption and uptake of PCMH elements should leverage areas of concordance between practice members’ perceived needs and planned improvement efforts.

Arar, Nedal H.; Noel, Polly H.; Leykum, Luci; Zeber, John E.; Romero, Raquel; Parchman, Michael L.

2012-01-01

66

Primary acceptor in bacterial photosynthesis: obligatory role of ubiquinone in photoactive reaction centers of Rhodopseudomonas spheroides.  

PubMed Central

Reaction centers were found to bind two ubiquinones, both of which could be removed by o-phenanthroline and the detergent lauryldimethylamine oxide. One ubiquinone was more easily removed than the other. The low-temperature light-induced optical and electron paramagnetic resonance (EPR) changes were eliminated and restored upon removal and readdition of ubiquinone and were quantitatively correlated with the amount of tightly bound ubiquinone. We, therefore, conclude that this ubiquinone plays an obligatory role in the primary photochemistry. The easily removed ubiquinone is thought to be the secondary electron acceptor. The low-temperature charge recombination kinetics, as well as the optical and EPR spectra, were the same for untreated reaction centers and for those reconstituted with ubiquinone. This indicates that extraction and reconstitution were accomplished without altering the conformation of the active site. Reaction centers reconstituted with other quinones also showed restored photochemical activity, although they exhibited changes in their low-temperature recombination kinetics and light-induced (g = 1.8) EPR signal is interpreted in terms of a magnetically coupled ubiquinone--Fe2+ acceptor complex. A possible role of iron is to facilitate electron transfer between the primary and secondary ubiquinones.

Okamura, M Y; Isaacson, R A; Feher, G

1975-01-01

67

Diffuse pulmonary ossification and spontaneous pneumothorax in a pilot: a case report.  

PubMed

A 51-year-old pilot with spontaneous pneumothorax, emphysema, and multiple horny ossification in the lung is reported. The literature concerning diffuse pulmonary ossification is reviewed and aeromedical implications are discussed. PMID:3090992

Ekholdt, P F; Oppedal, B R; Arva, P

1986-07-01

68

"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.

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

2013-01-01

69

Primary reactions in photosynthetic reaction centers of Rhodobacter sphaeroides - Time constants of the initial electron transfer  

NASA Astrophysics Data System (ADS)

The primary dynamics of reaction centers from Rhodobacter sphaeroides at room temperature are studied at low excitation intensities and low excitation rates. Analysis based on singular value decomposition yields three time constants in the picosecond range (ca. 1.2 ps, 3.5 ps and 220 ps). The spectral and temporal signatures are fully consistent with the step-wise electron transfer model published previously, with a first electron transfer to the bacteriochlorophyll with a time constant of 3.5 ps and a second 1.2 ps transfer to the bacteriopheophytin. No indications for adiabatic electron transfer are found in the time range >0.5 ps.

Dominguez, Pablo Nahuel; Himmelstoss, Matthias; Michelmann, Jeff; Lehner, Florian Thomas; Gardiner, Alastair T.; Cogdell, Richard J.; Zinth, Wolfgang

2014-05-01

70

Two-dimensional free energy surfaces for primary electron transfer in a photosynthetic reaction center  

NASA Astrophysics Data System (ADS)

Two-dimensional free energy surfaces for primary electron transfer in a bacterial photosynthetic reaction center are constructed from the MD simulation results by Warshel et al. [J. Photochem. Photobiol. A: Chem 82 (1994) 123] on the same system by choosing the reaction coordinates appropriately. The activation energies for the direct and sequential electron transfer are calculated using these surfaces. One needs these two-dimensional free energy surfaces to analyze the dynamical solvent effect on the competition between the direct and sequential electron transfer properly, although this effect has so far been analyzed by using one-dimensional free energy curves.

Fushiki, M.; Tachiya, M.

1996-06-01

71

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.

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

2013-01-01

72

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.

2014-01-01

73

Ossification of the Achilles tendon: a case report.  

PubMed

Ossification of the Achilles tendon is a rare condition. We recently treated a patient with ossification of bilateral Achilles tendons. The patient was a 50 year old male whose chief complaint was discomfort around the Achilles tendon. He had a previous history of treatment of bilateral club feet. On the roentgenograms, the length of the bony mass in the Achilles tendon was 5.5 cm on the right side and 1.5 cm on the left side. The left side was treated by surgical removal of a bony mass and suture of the tendon. Microscopic examination of the extirpated specimen revealed bone formation through enchondral and intramembranous ossification in the Achilles tendon. PMID:7981796

Hatori, M; Kita, A; Hashimoto, Y; Watanabe, N; Sakurai, M

1994-01-01

74

A single center multioperator initial experience of 4195 patients at a primary radial intervention program in a tertiary level center  

PubMed Central

Background There has been an increase the acceptability and the number of the procedures via the radial approach. We present our experience pertaining to the clinical characteristics, procedural details and post procedural outcome of patients undergoing radial artery access, coronary angiographies over a period of 4 years at a primary care tertiary level center. Materials and methods A retrospective analysis of all the coronary artery procedures during the last 4 years was done and the various parameters related to these procedures noted. Results In 4195 procedures performed, success in radial artery procedures was achieved in 3975 (94.8%) procedures. The average puncture time and total procedure time was 9.5 + 3 min (min) and 15 + 2.5 min in the initial 500 patients, whereas the times taken in the final 695 patients were just 1.5 + 0.5 min and 3.0 + 1.5 min respectively. The total fluoroscopy time was not significantly different among the groups, when performed by an operator with training in the femoral route for angiography. Cardiology fellows needed more fluoroscopy time when mastering the radial route. Crossover of access sites was seen in 220 patients (5.2%). Conclusions After 100 procedures, radial access coronary angiographies take less than 4.5 min, with first attempt radial artery access and negligible complication rates. Prior experience of coronary angiography helps in the reduction of fluoroscopy time during the learning curve.

Gokhroo, Rajendra K.; Kaushik, Satish K.; Padmanabhan, Deepak; Bisht, Devendra; Gupta, Sajal

2014-01-01

75

BMP type I receptor inhibition reduces heterotopic ossification  

PubMed Central

Fibrodysplasia ossificans progressiva (FOP) is a congenital disorder of progressive and widespread postnatal ossification of soft tissues1–4 and is without known effective treatments. Affected individuals harbor conserved mutations in the ACVR1 gene that are thought to cause constitutive activation of the bone morphogenetic protein (BMP) type I receptor, activin receptor-like kinase-2 (ALK2)5. Here we show that intramuscular expression in the mouse of an inducible transgene encoding constitutively active ALK2 (caALK2), resulting from a glutamine to aspartic acid change at amino acid position 207, leads to ectopic endochondral bone formation, joint fusion and functional impairment, thus phenocopying key aspects of human FOP. A selective inhibitor of BMP type I receptor kinases, LDN-193189 (ref. 6), inhibits activation of the BMP signaling effectors SMAD1, SMAD5 and SMAD8 in tissues expressing caALK2 induced by adenovirus specifying Cre (Ad.Cre). This treatment resulted in a reduction in ectopic ossification and functional impairment. In contrast to localized induction of caALK2 by Ad.Cre (which entails inflammation), global postnatal expression of caALK2 (induced without the use of Ad.Cre and thus without inflammation) does not lead to ectopic ossification. However, if in this context an inflammatory stimulus was provided with a control adenovirus, ectopic bone formation was induced. Like LDN-193189, corticosteroid treatment inhibits ossification in Ad.Cre-injected mutant mice, suggesting caALK2 expression and an inflammatory milieu are both required for the development of ectopic ossification in this model. These results support the role of dysregulated ALK2 kinase activity in the pathogenesis of FOP and suggest that small molecule inhibition of BMP type I receptor activity may be useful in treating FOP and heterotopic ossification syndromes associated with excessive BMP signaling.

Yu, Paul B; Deng, Donna Y; Lai, Carol S; Hong, Charles C; Cuny, Gregory D; Bouxsein, Mary L; Hong, Deborah W; McManus, Patrick M; Katagiri, Takenobu; Sachidanandan, Chetana; Kamiya, Nobuhiro; Fukuda, Tomokazu; Mishina, Yuji; Peterson, Randall T; Bloch, Kenneth D

2010-01-01

76

Ossification of the posterior longitudinal ligament: a case report  

PubMed Central

Ossification of the posterior longitudinal ligament (OPLL) has recently been recognized as a clinical entity. It is a rare condition, having a higher incidence in the Japanese population. It is characterized by hyperplasia of cartilage cells with eventual endochondral ossification of the posterior longitudinal ligament. The radiographic signs are characteristic and consist of a linear band of ossified tissue along the posterior margin of the vertebral body. OPLL can be associated with mild to serious neurological complications due to spinal cord or nerve root compression, or it may be asymptomatic. This paper reviews the radiological, clinical and therapeutic aspects of this rare condition. ImagesFigures 1 and 2Figures 3 and 4

Aker, PD; O'Connor, SM; Mior, SA; Beauchemin, D

1989-01-01

77

Could Ossification of the Achilles Tendon Have a Hereditary Component?  

PubMed Central

Ossification of the Achilles tendon (OTA) is an unusual clinical condition. It is characterized by the presence of an ossified mass within the fibrocartilaginous substance of the Achilles tendon. The etiology of the ossification of the Achilles tendon is unknown. Review of the literature suggests that its etiology is multifactorial. The major contributing factors are trauma and surgery with other minor causes such as systemic diseases, metabolic conditions, and infections. To our knowledge, no previous reports suggest any genetic/hereditary predisposition in OAT. We report 3 siblings who have OAT with no history of any of the aforementioned predisposing factors. Could OAT have a hereditary component as one of its etiologies?

Cortbaoui, Chawki

2013-01-01

78

The Effect of Training in Primary Health Care Centers on Medical Students' Clinical Skills  

PubMed Central

Medical students' effective clinical skills training are an important goal of any medical school. When adequate, graduate doctors will have sufficient skills to consult a patient by taking proper history and conducting appropriate physical examination. The question under scrutiny is the optimal place for providing such training. Since the aim is to graduate general physicians, many literatures highlighted the importance of implementing such training in the primary health care centers. A special clinical skills training program was developed for the Year 4 pre-clerkship medical students of the Arabian Gulf University during the academic year 2011-2012. It was important for these students to acquire certain skills before transferring to the clerkship phase where they deal directly with patients. For the 130 students involved in this study, a self-assessment and clinical exam were conducted at the beginning and end of the program. The study showed that students benefited greatly from this training program with significant differences between their preexisting known skills and clinical skills acquired by the end of the program. Primary care centers are ideal places for optimal training because of small group training setting that is one tutor to two students and of the advantage that students face real patient environment.

Abdullatif Alnasir, Faisal; Jaradat, Ahmed Abdel-Karim

2013-01-01

79

Comparison of Fall Risk Education Methods for Primary Prevention with Community-Dwelling Older Adults in a Senior Center Setting  

Microsoft Academic Search

Purpose: The purpose of this study was to determine which of 2 primary prevention education programs was more effective in increasing knowledge and prompting behavior change to reduce fall risks among community-dwelling older adults who attended Senior Centers. Methods: A convenience sample (N=69) was recruited at 4 local senior centers to com- pare 2 fall risk education methods. Subjects were

Renée M. Hakim; Aileen Roginski; Jason Walker

80

Acceptability of quality reporting and pay for performance among primary health centers in Lebanon.  

PubMed

Primary health care (PHC) is emphasized as the cornerstone of any health care system. Enhancing PHC performance is considered a strategy to enhance effective and equitable access to care. This study assesses the acceptability of and factors associated with quality reporting among PHC centers (PHCCs) in Lebanon. The managers of 132 Lebanese Ministry of Health PHCCs were surveyed using a cross-sectional design. Managers' willingness to report quality, participate in comparative quality assessments, and endorse pay-for-performance schemes was evaluated. Collected data were matched to the infrastructural characteristics and services database. Seventy-six percent of managers responded to the questionnaire, 93 percent of whom were willing to report clinical performance. Most expressed strong support for peer-performance comparison and pay-for-performance schemes. Willingness to report was negatively associated with the religious affiliation of centers and presence of health care facilities in the catchment area and favorably associated with use of information systems and the size of population served. The great willingness of PHCC managers to employ quality-enhancing initiatives flags a policy priority for PHC stakeholders to strengthen PHCC infrastructure and to enable reporting in an easy, standardized, and systematic way. Enhancing equity necessitates education and empowerment of managers in remote areas and those managing religiously affiliated centers. PMID:24397238

Saleh, Shadi S; Alameddine, Mohamad S; Natafgi, Nabil M

2013-01-01

81

Primary light-energy conversion in tetrameric chlorophyll structure of photosystem II and bacterial reaction centers: I. A review  

Microsoft Academic Search

The purpose of the review is to show that the tetrameric (bacterio)chlorophyll ((B)Chl) structures in reaction centers of\\u000a photosystem II (PSII) of green plants and in bacterial reaction centers (BRCs) are similar and play a key role in the primary\\u000a charge separation. The Stark effect measurements on PSII reaction centers have revealed an increased dipole moment for the\\u000a transition at

Ravil A. Khatypov; Anton Yu. Khmelnitskiy; Maria M. Leonova; Lyudmila G. Vasilieva; Vladimir A. Shuvalov

2008-01-01

82

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

PubMed

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

2013-12-01

83

Primary Diffuse Large B-Cell Lymphoma of the Oral Cavity: Germinal Center Classification  

PubMed Central

Primary lymphomas of the oral cavity are rare and the most frequent type is diffuse large B-cell lymphoma (DLBCL). Recently, several reports have highlighted the value of classifying DLBCL into prognostically important subgroups, namely germinal center B-cell like (GCB) and non-germinal center B-cell like (non-GCB) lymphomas based on gene expression profiles and by immunohistochemical expression of CD10, BCL6 and MUM-1. GCB lymphomas tend to exhibit a better prognosis than non-GCB lymphomas. Studies validating this classification have been done for DLBCL of the breast, CNS, testes and GI tract. Therefore we undertook this study to examine if primary oral DLBCLs reflect this trend. We identified 13 cases (age range 38–91 years) from our archives dating from 2003–09. IHC was performed using antibodies against germinal center markers (CD10, BCL6), activated B-cell markers (MUM1, BCL2) and Ki-67 (proliferation marker). Cases were sub-classified as GCB subgroup if CD10 and/or BCL6 were positive and MUM-1, was negative and as non-GCB subgroup if CD10 was negative and MUM-1 was positive. Immunoreactivity was noted in 2/13 cases for CD10, in 12/13 for BCL6, in 8/13 for MUM-1, and in 6/13 for BCL2. Therefore, 8/13 (58%) were sub-classified as non-GCB DLBCLs and 5/13 (42%) as GCB subgroup. All tumors showed frequent labeling with Ki-67 (range 40–95%). Four of the 8 patients with non-GCB subgroup succumbed to their disease, with the mean survival rate of 16 months. Two patients in this group are alive, one with no evidence of disease and another with disease. No information was available for the other 3 patients in this group. Four of the 5 patients in the GCB subgroup were alive with no evidence of disease and one patient succumbed to complications of therapy and recurrent disease after 18 months. In conclusion, our analysis shows that primary oral DLBCL predominantly belongs to the non-GCB subgroup, which tends to exhibit a poorer prognosis. These findings could allow pathologists to provide a more accurate insight into the potential aggressive behavior and poorer prognosis of these lymphomas.

Chehal, Hardeep K.; Cohen, Donald M.; Al-Quran, Samer Z.

2010-01-01

84

Patterns of ossification in southern versus northern placental mammals.  

PubMed

Consensus on placental mammal phylogeny is fairly recent compared to that for vertebrates as a whole. A stable phylogenetic hypothesis enables investigation into the possibility that placental clades differ from one another in terms of their development. Here, we focus on the sequence of skeletal ossification as a possible source of developmental distinctiveness in "northern" (Laurasiatheria and Euarchontoglires) versus "southern" (Afrotheria and Xenarthra) placental clades. We contribute data on cranial and postcranial ossification events during growth in Afrotheria, including elephants, hyraxes, golden moles, tenrecs, sengis, and aardvarks. We use three different techniques to quantify sequence heterochrony: continuous method, sequence-ANOVA (analysis of variance) and event-paring/Parsimov. We show that afrotherians significantly differ from other placentals by an early ossification of the orbitosphenoid and caudal vertebrae. Our analysis also suggests that both southern placental groups show a greater degree of developmental variability; however, they rarely seem to vary in the same direction, especially regarding the shifts that differ statistically. The latter observation is inconsistent with the Atlantogenata hypothesis in which afrotherians are considered as the sister clade of xenarthrans. Interestingly, ancestral nodes for Laurasiatheria and Euarchontoglires show very similar trends and our results suggest that developmental homogeneity in some ossification sequences may be restricted to northern placental mammals (Boreoeutheria). PMID:23815655

Hautier, Lionel; Bennett, Nigel C; Viljoen, Hermien; Howard, Lauren; Milinkovitch, Michel C; Tzika, Athanasia C; Goswami, Anjali; Asher, Robert J

2013-07-01

85

The emergence of mechanoregulated endochondral ossification in evolution.  

PubMed

The differentiation of skeletal tissue phenotypes is partly regulated by mechanical forces. This mechanoregulatory aspect of tissue differentiation has been the subject of many experimental and computational investigations. However, little is known about what factors promoted the emergence of mechanoregulated tissue differentiation in evolution, even though mechanoregulated tissue differentiation, for example during development or healing of adult bone, is crucial for vertebrate phylogeny. In this paper, we use a computational framework to test the hypothesis that the emergence of mechanosensitive genes that trigger endochondral ossification in evolution will stabilise in the population and create a variable mechanoregulated response, if the endochondral ossification process enhances fitness for survival. The model combines an evolutionary algorithm that considers genetic change with a mechanoregulated fracture healing model in which the fitness of animals in a population is determined by their ability to heal their bones. The simulations show that, with the emergence of mechanosensitive genes through evolution enabling skeletal cells to modulate their synthetic activities, novel differentiation pathways such as endochondral ossification could have emerged, which when favoured by natural selection is maintained in a population. Furthermore, the model predicts that evolutionary forces do not lead to a single optimal mechanoregulated response but that the capacity of endochondral ossification exists with variability in a population. The simulations correspond with many existing findings about the mechanosensitivity of skeletal tissues in current animal populations, therefore indicating that this kind of multi-level models could be used in future population based simulations of tissue differentiation. PMID:23261239

Khayyeri, Hanifeh; Prendergast, Patrick J

2013-02-22

86

Minimally invasive pectus excavatum repair: migration of bar and ossification.  

PubMed

Minimally invasive repair of pectus excavatum is an effective treatment option, with satisfactory results. Nevertheless, complications may occur during bar removal. We describe the case of a 16-year-old boy operated on for pectus excavatum with the Nuss procedure, who developed bar migration into the rib, with ossification, making its removal very difficult. PMID:23430431

Giacomo, Tiziano De; Diso, Daniele; Francioni, Federico; Anile, Marco; Venuta, Federico

2013-02-01

87

Interface between intramembranous and endochondral ossification in human foetuses.  

PubMed

In the head and neck of human mid-term foetuses, the interface between areas of endochondral ossification and adjacent membranous (intramembranous) ossification is extensive. Using 8 foetal heads at 15-16 weeks, we have demonstrated differences in the matrices and composite cells between these 2 ossification processes, especially in the occipital squama and pterygoid process. Aggrecan-positive cartilage was shown to be invaded by a primitive bony matrix that was negative for aggrecan. At the interface, the periosteum was continuous with the perichondrium without any clear demarcation, but tenascin-c expression was restricted to the periosteum. In contrast, the interface between the epiphysis and shaft of the femur showed no clear localisation of tenascin-c. Versican expression tended to be restricted to the perichondrium. In the pterygoid process, the density of CD34-positive vessels was much higher in endochondral than in membranous ossification. The membranous part of the occipital was considered most likely to contribute to growth of the skull to accommodate the increased volume of the brain, while the membranous part of the pterygoid process seemed to be suitable for extreme flattening under pressure from the pterygoid muscles. PMID:24902099

Hayashi, S; Kim, J H; Hwang, S E; Shibata, S; Fujimiya, M; Murakami, G; Cho, B H

2014-05-01

88

FGFR3 mutation causes abnormal membranous ossification in achondroplasia.  

PubMed

FGFR3 gain-of-function mutations lead to both chondrodysplasias and craniosynostoses. Achondroplasia (ACH), the most frequent dwarfism, is due to an FGFR3-activating mutation which results in impaired endochondral ossification. The effects of the mutation on membranous ossification are unknown. Fgfr3(Y367C/+) mice mimicking ACH and craniofacial analysis of patients with ACH and FGFR3-related craniosynostoses provide an opportunity to address this issue. Studying the calvaria and skull base, we observed abnormal cartilage and premature fusion of the synchondroses leading to modifications of foramen magnum shape and size in Fgfr3(Y367C/+) mice, ACH and FGFR3-related craniosynostoses patients. Partial premature fusion of the coronal sutures and non-ossified gaps in frontal bones were also present in Fgfr3(Y367C/+) mice and ACH patients. Our data provide strong support that not only endochondral ossification but also membranous ossification is severely affected in ACH. Demonstration of the impact of FGFR3 mutations on craniofacial development should initiate novel pharmacological and surgical therapeutic approaches. PMID:24419316

Di Rocco, Federico; Biosse Duplan, Martin; Heuzé, Yann; Kaci, Nabil; Komla-Ebri, Davide; Munnich, Arnold; Mugniery, Emilie; Benoist-Lasselin, Catherine; Legeai-Mallet, Laurence

2014-06-01

89

The Incidence of Heterotopic Ossification After Hip Arthroscopy  

Microsoft Academic Search

Background: Minimally invasive techniques to treat femoroacetabular impingement (FAI), snapping hip syndrome, and peritrochanteric space disorder (PSD) were developed to reduce complications and recovery time. Although a multitude of studies have reported on the incidence of heterotopic ossification (HO) after open procedures of the hip, there is little known about the rate of HO after hip arthroscopy.Hypotheses: The incidence of

Asheesh Bedi; Robert M. Zbeda; Vinicius F. Bueno; Brian Downie; Mark Dolan; Bryan T. Kelly

2012-01-01

90

Ossification of the infraspinatus tendon-bursa in 13 dogs  

Microsoft Academic Search

Ossification of the infraspinatus tendon-bursa was diagnosed in 13 labrador retrievers, 12 of which were lame in one thoracic limb and the other in both. They ranged in age from 28 to 121 months (mean 69·4 months). The lameness developed gradually and was progressive in 11 of the 14 affected joints. Scapular muscle atrophy and signs of pain on direct

W. M. McKee; C. Macias; C. May; E. J. Scurrell

2007-01-01

91

Prescribing pattern of interns in a primary health center in India  

PubMed Central

Background: Prescription is the written order of the physician which is conveyed to the patient. Rational prescription writing is a skill which should be mastered at the earliest. Internship is the period where undergraduate medical education can be consolidated through continued learning under the direct supervision of teachers. The attitude of interns toward rational drug use is of utmost importance. The present study aimed to explore the prescribing pattern of interns in a primary health center in India. Materials and Methods: A cross-sectional study was conducted for a period of 2 months (June 1 2010-July 30 2010) in a primary health center attached to a medical college in India. The main outcome measure was to assess rationality of prescribing pattern of interns was measured as per World Health Organization enlisted prescribing indicators. Data analysis was done by using descriptive and inferential statistical methods: Frequencies, percentage, and mean standard deviation. Results: A total of 1968 drugs were prescribed in 760 prescriptions analyzed with an average of 2.58 drugs per prescription. Analgesic was the most commonly prescribed drug (25.78%) followed by antibiotics (22.1%), drugs used for gastrointestinal symptom (15.78%), multivitamins (11.84%), anti-malarials (8.35%), antihistaminics (6.25%), and hematinics (5.36%). Regarding prescribing indicators, in 435 prescriptions (22.4%), antibiotics were advised. A total of 688 (34.97%) drugs were prescribed by generic name, while the percentage of drugs prescribed from essential drug list of India was 58.47%. Injectables were prescribed in 89 prescriptions (4.49%). Conclusion: The present study shows that irrational prescribing practices are common among interns of the institute. The art of rational prescribing should be taught to them by medical teachers who are adequately trained in rational drug use.

Banerjee, Indranil; Bhadury, Tania

2014-01-01

92

Distribution of primary immunodeficiency disorders diagnosed in the Children's Medical Center in Iran.  

PubMed

Primary immunodeficiency disorders include a variety of diseases that render patients more susceptible to infections. To determine the percentage of different primary immunodeficiency disorders diagnosed in the Children's Medical Center Hospital affiliated to Tehran University of Medical Sciences in Iran, we retrospectively reviewed the charts of the patients being referred to our hospital for immunologic evaluation of recurrent infections during a 20 year period. Among these patients, antibody deficiencies were the most frequent ones and were found in 52.6% of patients (n = 130). T-cell disorders, phagocytic disorders and complement deficiencies were found to be present in 24.69% (n = 61). 22.2% (n = 55) and 0.4% (n = 1) respectively. On the whole, common variable immunodeficiency was the most frequent disorder (n = 65), followed by ataxia telangiectasia (n = 39), X-linked agammaglobulinemia (n = 33), chronic granulomatous disease (n = 29) and selective IgA deficiency (n = 20). This study reveals that antibody deficiencies are the most common type of disorders as shown in other studies. A comparative study shows some differences between our results and other registries. This article also indicates that immunodeficiency disorders should be considered in patients with recurrent infections. PMID:16261953

Farhoudi, A; Aghamohammadi, A; Moin, M; Rezaei, N; Pourpak, Z; Movahedi, M; Gharagozlou, M; Amir Tahaei, S; MirSaeid Ghazi, B; Mahmoudi, M; Kouhi, A; Atarod, L; Ahmadi Afshar, A; Bazargan, N; Isaeian, A

2005-01-01

93

Partnering urban academic medical centers and rural primary care clinicians to provide complex chronic disease care.  

PubMed

Many of the estimated thirty-two million Americans expected to gain coverage under the Affordable Care Act are likely to have high levels of unmet need because of various chronic illnesses and to live in areas that are already underserved. In New Mexico an innovative new model of health care education and delivery known as Project ECHO (Extension for Community Healthcare Outcomes) provides high-quality primary and specialty care to a comparable population. Using state-of-the-art telehealth technology and case-based learning, Project ECHO enables specialists at the University of New Mexico Health Sciences Center to partner with primary care clinicians in underserved areas to deliver complex specialty care to patients with hepatitis C, asthma, diabetes, HIV/AIDS, pediatric obesity, chronic pain, substance use disorders, rheumatoid arthritis, cardiovascular conditions, and mental illness. As of March 2011, 298 Project ECHO teams across New Mexico have collaborated on more than 10,000 specialty care consultations for hepatitis C and other chronic diseases. PMID:21596757

Arora, Sanjeev; Kalishman, Summers; Dion, Denise; Som, Dara; Thornton, Karla; Bankhurst, Arthur; Boyle, Jeanne; Harkins, Michelle; Moseley, Kathleen; Murata, Glen; Komaramy, Miriam; Katzman, Joanna; Colleran, Kathleen; Deming, Paulina; Yutzy, Sean

2011-06-01

94

Reducing disparities in access to primary care and patient satisfaction with care: the role of health centers.  

PubMed

This paper examined disparities in access to and satisfaction with primary care among patients of different racial/ethnic groups and insurance coverage, in health centers and the nation overall. Data came from the 2009 Health Center Patient Survey and 2009 Medical Expenditure Panel Survey. Study outcomes included usual source of care, type of usual source of care, satisfaction with provider office hours, and satisfaction with overall care. Health center patients were more racially and ethnically diverse than national patients, and health center patients were more likely than national patients to be uninsured or publicly insured. No significant health care disparities in access to care existed among patients from different racial/ethnic and insurance groups among health centers, unlike low-income patients nationwide or the U.S. population in general. Additional focus on the uninsured, in health centers and other health care settings nationwide, is needed to enhance satisfaction with care among these patients. PMID:23377717

Shi, Leiyu; Lebrun-Harris, Lydie A; Daly, Charles A; Sharma, Ravi; Sripipatana, Alek; Hayashi, A Seiji; Ngo-Metzger, Quyen

2013-02-01

95

[At the Savar center, primary health care (PHC) evolves with the health conditions].  

PubMed

A war hospital installed close to the front by a group of young Bangladeshi doctors during the 1971 war of liberation from Pakistan was the origin of the new "Gonoshasthaya Kendra" (GK), or people's health center, 40 km north of Dhaka in Savar. At the new center, as in the hospital, trained paramedics furnish basic health care for the population. The center at Savar was applying the principles of primary health care 6 years before they were recognized at the Alma Ata conference. Today, GK has integrated programs to fight poverty into its health activities, with educational, nutrition, and employment programs. The paramedics have a long training course, working under the supervision of a senior paramedic for a year and receiving theoretical training in the evenings. They do not become senior paramedics for several years. The work of the paramedics is oriented toward health education, prevention, and demoepidemiologic surveillance and registration. Each paramedic is responsible for 2 or 3 villages with about 3 thousand inhabitants. The paramedics visit and motivate the population, register births and deaths, identify and care for pregnant women, and vaccinate children and pregnant women. They provide health and nutrition education, treat diarrhea and instruct mothers in use of oral rehydration therapy, and provide family planning information and supplies. Persons in need are referred to "clinic days" held regularly in the larger villages. The paramedics maintain records for each family which allow calculation of vital rates and epidemiologic data. In the region of Savar served by the paramedics, the rates of general mortality and infant mortality are 12/1000 and 85/1000 respectively, vs. 17 and 124/1000 in Bangladesh as a whole. The GK has a new goal of reducing infant mortality to 60/1000. The paramedics have been taught to recognize 2 new symptoms, convulsions and respiratory distress, and to refer infants showing these symptoms to doctors. The GK doctors believe that reducing infant mortality below 60/1000 will require improving the physical condition of mothers by delaying the age at 1st birth, providing education for girls, and improving the nutrition of women. A recent study shows certain limitations in the role of the paramedics. Demand for their services is somewhat limited by their purely preventive role, and they feel undervalued because of their low pay. Their attrition rate is high, and they now sign 3-year contracts at the outset of training. The center is studying the possibility of allowing junior paramedics to prescribe antibiotics to increase demand for their services and improve their professional image. PMID:12282818

Chirac, P

1989-01-01

96

Skeletal development in the African elephant and ossification timing in placental mammals.  

PubMed

We provide here unique data on elephant skeletal ontogeny. We focus on the sequence of cranial and post-cranial ossification events during growth in the African elephant (Loxodonta africana). Previous analyses on ossification sequences in mammals have focused on monotremes, marsupials, boreoeutherian and xenarthran placentals. Here, we add data on ossification sequences in an afrotherian. We use two different methods to quantify sequence heterochrony: the sequence method and event-paring/Parsimov. Compared with other placentals, elephants show late ossifications of the basicranium, manual and pedal phalanges, and early ossifications of the ischium and metacarpals. Moreover, ossification in elephants starts very early and progresses rapidly. Specifically, the elephant exhibits the same percentage of bones showing an ossification centre at the end of the first third of its gestation period as the mouse and hamster have close to birth. Elephants show a number of features of their ossification patterns that differ from those of other placental mammals. The pattern of the initiation of the ossification evident in the African elephant underscores a possible correlation between the timing of ossification onset and gestation time throughout mammals. PMID:22298853

Hautier, Lionel; Stansfield, Fiona J; Allen, W R Twink; Asher, Robert J

2012-06-01

97

Skeletal development in the African elephant and ossification timing in placental mammals  

PubMed Central

We provide here unique data on elephant skeletal ontogeny. We focus on the sequence of cranial and post-cranial ossification events during growth in the African elephant (Loxodonta africana). Previous analyses on ossification sequences in mammals have focused on monotremes, marsupials, boreoeutherian and xenarthran placentals. Here, we add data on ossification sequences in an afrotherian. We use two different methods to quantify sequence heterochrony: the sequence method and event-paring/Parsimov. Compared with other placentals, elephants show late ossifications of the basicranium, manual and pedal phalanges, and early ossifications of the ischium and metacarpals. Moreover, ossification in elephants starts very early and progresses rapidly. Specifically, the elephant exhibits the same percentage of bones showing an ossification centre at the end of the first third of its gestation period as the mouse and hamster have close to birth. Elephants show a number of features of their ossification patterns that differ from those of other placental mammals. The pattern of the initiation of the ossification evident in the African elephant underscores a possible correlation between the timing of ossification onset and gestation time throughout mammals.

Hautier, Lionel; Stansfield, Fiona J.; Allen, W. R. Twink; Asher, Robert J.

2012-01-01

98

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.

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

2012-01-01

99

Outcomes after ischemic stroke for hospitals with and without Joint Commission-certified primary stroke centers  

PubMed Central

Background: The Joint Commission (JC) began certifying primary stroke centers (PSCs) in the United States in 2003. We assessed whether 30-day risk-standardized mortality (RSMR) and readmission (RSRR) rates differed between hospitals with and without JC-certified PSCs in 2006. Methods: The study cohort included all fee-for-service Medicare beneficiaries ?65 years old discharged with a primary diagnosis of ischemic stroke (International Classification of Diseases, ninth revision, Clinical Modification 433, 434, 436) in 2006. Hierarchical linear regression models calculated hospital-level RSMRs and RSRRs, adjusting for patient demographics, comorbid conditions, and hospital referral region. Hospitals were categorized as being higher than, no different from, or lower than the national average. Results: There were 310,381 ischemic stroke discharges from 315 JC-certified PSC and 4,231 noncertified hospitals. Mean overall 30-day RSMR and RSRR were 10.9% ± 1.7% and 12.5% ± 1.4%, respectively. The RSMRs of hospitals with JC-certified PSCs were lower than in noncertified hospitals (10.7% ± 1.7% vs 11.0% ± 1.7%), but the RSRRs were comparable (12.5% ± 1.3% vs 12.4% ± 1.7%). Almost half of JC-certified PSC hospitals had RSMRs lower than the national average compared with 19% of noncertified hospitals, but 13% of JC-certified PSC hospitals had lower RSRRs vs 15% of noncertified hospitals. Conclusions: Hospitals with JC-certified PSCs had lower RSMRs compared with noncertified hospitals in 2006; however, differences were small. Readmission rates were similar between the 2 groups. PSC certification generally identified better-performing hospitals for mortality outcomes, but some hospitals with certified PSCs may have high RSMRs and RSRRs whereas some hospitals without PSCs have low rates. Unmeasured factors may contribute to this heterogeneity.

Jones, S.B.; Wang, Y.; Watanabe, E.; Leifheit-Limson, E.; Goldstein, L.B.

2011-01-01

100

The role of endothelial-mesenchymal transition in heterotopic ossification  

PubMed Central

Heterotopic ossification (HO) is a process by which bone forms in soft tissues, in response to injury, inflammation or genetic disease. This usually occurs by initial cartilage formation, followed by endochondral ossification. A rare disease called Fibrodysplasia Ossificans Progressiva (FOP) allows this mechanism to be induced by a combination of genetic mutation and acute inflammatory responses. FOP patients experience progressive HO throughout their lifetime and form an ectopic skeleton. Recent studies on FOP have suggested that heterotopic cartilage and bone is of endothelial origin. Vascular endothelial cells differentiate into skeletal cells through a mesenchymal stem cell intermediate that is generated by endothelial-mesenchymal transition (EndMT). Local inflammatory signals and/or other changes in the tissue microenvironment mediate the differentiation of endothelial-derived mesenchymal stem cells into chondrocytes and osteoblasts to induce HO. Here we discuss the current evidence for the endothelial contribution to heterotopic bone formation.

Medici, Damian; Olsen, Bjorn R.

2012-01-01

101

The role of endothelial-mesenchymal transition in heterotopic ossification.  

PubMed

Heterotopic ossification (HO) is a process by which bone forms in soft tissues, in response to injury, inflammation, or genetic disease. This usually occurs by initial cartilage formation, followed by endochondral ossification. A rare disease called fibrodysplasia ossificans progressiva (FOP) allows this mechanism to be induced by a combination of genetic mutation and acute inflammatory responses. FOP patients experience progressive HO throughout their lifetime and form an ectopic skeleton. Recent studies on FOP have suggested that heterotopic cartilage and bone is of endothelial origin. Vascular endothelial cells differentiate into skeletal cells through a mesenchymal stem cell intermediate that is generated by endothelial-mesenchymal transition (EndMT). Local inflammatory signals and/or other changes in the tissue microenvironment mediate the differentiation of endothelial-derived mesenchymal stem cells into chondrocytes and osteoblasts to induce HO. We discuss the current evidence for the endothelial contribution to heterotopic bone formation. PMID:22806925

Medici, Damian; Olsen, Bjorn R

2012-08-01

102

Impaired endochondral ossification and angiogenesis in mice deficient in membrane-type matrix metalloproteinase I  

PubMed Central

Membrane-type matrix metalloproteinase I (MT1-MMP)-deficient mice were found to have severe defects in skeletal development and angiogenesis. The craniofacial, axial, and appendicular skeletons were severely affected, leading to a short and domed skull, marked deceleration of postnatal growth, and death by 3 wk of age. Shortening of bones is a consequence of decreased chondrocyte proliferation in the proliferative zone of the growth plates. Defective vascular invasion of cartilage leads to enlargement of hypertrophic zones of growth plates and delayed formation of secondary ossification centers in long bones. In an in vivo corneal angiogenesis assay, null mice did not have angiogenic response to implanted FGF-2, suggesting that the defect in angiogenesis is not restricted to cartilage alone. In tissues from null mice, activation of latent matrix metalloproteinase 2 was deficient, suggesting that MT1-MMP is essential for its activation in vivo.

Zhou, Zhongjun; Apte, Suneel S.; Soininen, Raija; Cao, Renhai; Baaklini, George Y.; Rauser, Richard W.; Wang, Jianming; Cao, Yihai; Tryggvason, Karl

2000-01-01

103

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: anamariainforme@hotmail.com [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)

2013-01-15

104

Primary electron donor(s) in isolated reaction center of photosystem II from Chlamydomonas reinhardtii.  

PubMed

Isolated reaction centers (RCs) from wild-type Chlamydomonas (C.) reinhardtii of Photosystem II (PSII), at different levels of intactness, were studied to provide more insight into the nature of the charge-separation (CS) pathway(s). We argue that previously studied D1/D2/Cytb559 complexes (referred to as RC680), with ChlD1 serving as the primary electron donor, contain destabilized D1 and D2 polypeptides and, as a result, do not provide a representative model system for the intact RC within the PSII core. The shapes of nonresonant transient hole-burned (HB) spectra obtained for more intact RCs (referred to as RC684) are very similar to P(+)QA(-) - PQA absorbance difference and triplet minus singlet spectra measured in PSII core complexes from Synechocystis PCC 6803 [Schlodder et al. Philos. Trans. R. Soc. London, Ser. B2008, 363, 1197]. We show that in the RC684 complexes, both PD1 and ChlD1 may serve as primary electron donors, leading to two different charge separation pathways. Resonant HB spectra cannot distinguish the CS times corresponding to different paths, but it is likely that the zero-phonon holes (ZPHs) observed in the 680-685 nm region (corresponding to CS times of ?1.4-4.4 ps) reveal the ChlD1 pathway; conversely, the observation of charge-transfer (CT) state(s) in RC684 (in the 686-695 nm range) and the absence of ZPHs at ?B > 685 nm likely stem from the PD1 pathway, for which CS could be faster than 1 ps. This is consistent with the finding of Krausz et al. [Photochem. Photobiol. Sci.2005, 4, 744] that CS in intact PSII core complexes can be initiated at low temperatures with fairly long-wavelength excitation. The lack of a clear shift of HB spectra as a function of excitation wavelength within the red-tail of the absorption (i.e., 686-695 nm) and the absence of ZPHs suggest that the lowest-energy CT state is largely homogeneously broadened. On the other hand, in usually studied destabilized RCs, that is, RC680, for which CT states have never been experimentally observed, ChlD1 is the most likely electron donor. PMID:22462595

Acharya, Khem; Zazubovich, Valter; Reppert, Mike; Jankowiak, Ryszard

2012-04-26

105

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.

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.

2013-01-01

106

Commentary on Gurewich et Al, "comparative performance of community health centers and other usual sources of primary care": community health centers: valuable partners for state medicaid programs.  

PubMed

Community health centers are well positioned to bring needed primary care to populations experiencing the most acute health disparities. Health centers already care for 1 in 7 Medicaid beneficiaries and 1 in 5 low-income, uninsured individuals. And they generate $24 billion in annual savings to the entire health care system, including $6 billion for Medicaid programs. Health center patients are distinctly different from patients of other providers, and successfully meet the challenges associated with serving those who have special needs that require more time and resources to address. For this reason, health centers provide a much more comprehensive array of services, both health care and services that facilitate access to care, compared to private practice physicians. With more beneficiaries joining the Medicaid rolls under health reform, and the limited number of providers available to serve the most complex, hard-to-reach, and underserved patients, health centers will play an increasingly important partnership role with state Medicaid programs. Continued investments are necessary to effectively serve at-risk patients. PMID:21914998

Proser, Michelle; Camacho, Jose E; Edraos, Patricia; Stangis, Amanda

2011-01-01

107

The development of centres of ossification of bones forming elbow joints in young swine.  

PubMed Central

Epiphyseal centres of ossification in the bones forming the elbow joints of pigs between one day and 15 weeks of age were examined radiographically, macroscopically, mesoscopically and microscopically. Thoracic limbs from 39 pigs were perfused with India ink or silicone rubber injection compound and the bones were dissected free of soft tissues. The humerus, ulna and radius were fixed in formalin or ethyl alcohol and then cleared by the modified Spalteholz technique. Bones were radiographed, examined grossly, and then cut into slabs for mesoscopical evaluation. Foci considered to be calcifying within cartilaginous anlage were selected for microscopical examination. It was concluded that the epiphyseal centre of ossification develops at different times in different sites in the bones forming the elbow joint. Centres of ossification are initiated when foci of chondrocytes adjacent to one side of a cartilage canal undergo hypertrophy and the inter-territorial matrix becomes calcified. Osteogenesis then proceeds in the calcified focus, presumably with osteoprogenitor cells that originate within the cartilage canals. Subsequently, each epiphyseal centre of ossification enlarges by one of two methods. Firstly, the layer of cartilage adjacent to the centre undergoes endochondral ossification, thus allowing for the circumferential growth of the epiphyseal centre of ossification. Secondly, foci of calcification develop adjacent to the ends of cartilage canals near the epiphyseal centre of ossification and eventually the focus of calcification coalesces with the developing epiphyseal centre of ossification, thus establishing a new ossification front. Endochondral ossification continues at the periphery of the mass of bone. Mesoscopical examination is more useful than radiographical evaluation for identifying small foci of calcification which precede epiphyseal centres of ossification. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6 Fig. 7 Fig. 8

Visco, D M; Hill, M A; Van Sickle, D C; Kincaid, S A

1990-01-01

108

Three modes of ossification during distraction osteogenesis in the rat.  

PubMed

We developed a rat model of limb lengthening to study the basic mechanism of distraction osteogenesis, using a small monolateral external fixator. In 11-week-old male rats we performed a subperiosteal osteotomy in the midshaft of the femur with distraction at 0.25 mm every 12 hours from seven days after operation. Radiological and histological examinations showed a growth zone of constant thickness in the middle of the lengthened segment, with formation of new bone at its proximal and distal ends. Osteogenic cells were arranged longitudinally along the tension vector showing the origin and the fate of individual cells in a single section. Typical endochondral bone formation was prominent in the early stage of distraction, but intramembraneous bone formation became the predominant mechanism of ossification at later stages. We also showed a third mechanism of ossification, 'transchondroid bone formation'. Chondroid bone, a tissue intermediate between bone and cartilage, was formed directly by chondrocyte-like cells, with transition from fibrous tissue to bone occurring gradually and consecutively without capillary invasion. In situ hybridisation using digoxigenin-11-UTP-labelled complementary RNAs showed that the chondroid bone cells temporarily expressed type-II collagen mRNA. They did not show the classical morphological characteristics of chondrocytes, but were assumed to be young chondrocytes undergoing further differentiation into bone-forming cells. We found at least three different modes of ossification during bone lengthening by distraction osteogenesis. We believe that this is the first report of such a rat model, and have shown the validity of in situ hybridisation techniques for the study of the cellular and molecular mechanisms involved in distraction osteogenesis. PMID:9331045

Yasui, N; Sato, M; Ochi, T; Kimura, T; Kawahata, H; Kitamura, Y; Nomura, S

1997-09-01

109

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.

2006-01-01

110

Primary centers and secondary concentrations of tectonic activity through time in the western hemisphere of Mars  

USGS Publications Warehouse

Five main stages of radial and concentric structures formed around Tharsis from the Noachian through the Amazonian as determined by geologic mapping of 24,452 structures within the stratigraphic framework of Mars and by testing their radial and concentric orientations. Tectonic activity peaked in the Noachian (stage 1) around the largest center, Claritas, an elongate center extending more than 20?? in latitude and defined by about half of the total grabens which are concentrated in the Syria Planum, Thaumasia, and Tempe Terra regions. During the Late Noachian and Early Hesperian (stage 2), extensional structures formed along the length of present-day Valles Marineris and in Thaumasia (with a secondary concentration near Warrego Vallis) radial to a region just to the south of the central margin of Valles Marineris. Early Hesperian (stage 3) radial grabens in Pavonis, Syria, Ulysses, and Tempe Terra and somewhat concentric wrinkle ridges in Lunae and Solis Plana and in Thaumasia, Sirenum, Memnonia, and Amazonis are centered northwest of Syria with secondary centers at Thaumasia, Tempe Terra, Ulysses Fossae, and western Valles Marineris. Late Hesperian/Early Amazonian (stage 4) structures around Alba Patera, the northeast trending alignment of Tharsis Montes, and Olympus Mons appears centered on Alba Patera. Stage 5 structures (Middle-Late Amazonian) represent the last pulse of Tharsis-related activity and are found around the large shield volcanoes and are centered near Pavonis Mons. Tectonic activity around Tharsis began in the Noachian and generally decreased through geologic time to the Amazonian. Statistically significant radial distributions of structures formed during each stage, centered at different locations within the higher elevations of Tharsis. Secondary centers of radial structures during many of the stages appear related to previously identified local magmatic centers that formed at different times and locations throughout Tharsis. Copyright 2001 by the American Geophysical Union.

Anderson, R. C.; Dohm, J. M.; Golombek, M. P.; Haldemann, A. F. C.; Franklin, B. J.; Tanaka, K. L.; Lias, J.; Peer, B.

2001-01-01

111

Retroviral expression in a patient who has paraarticular ossification.  

PubMed

Reverse transcriptase activity is reported in the mononuclear blood cells isolated from a patient in whom paraarticular ossification developed after surgery for an aneurysmal bone cyst. The enzyme was purified to apparent homogeneity by chromatography before being characterized biochemically for its template specificity and ionic requirement. The enzyme was able to transcribe poly(rA).(dT)12-18 very efficiently in the presence of Mn++ ions. Viral particles were observed in the HuT-78 cell line, cocultured with the mononuclear cells of the patient. No viral particles were observed in HuT-78 cells before the coculture. The patient was found seronegative for HIV-1, HIV-2, and HTLV-1. These results suggest that a new retrovirus infecting mononuclear blood cells may be involved in the development of ectopic ossification. This hypothesis is strengthened by the previous finding of a retrovirus in the mononuclear blood cells of a patient with benign osteopetrosis, and by the fact that HTLV-1 infected T-lymphocytes acquire the ability to secrete factors responsible for the lytic bone lesions observed in the patients. A family of human bone diseases that reflect T-cell dysfunction(s) and are caused by lymphotropic viruses may exist. PMID:7543835

Bringuier, A F; Labat, M L

1995-04-01

112

Early Presentation of Heterotopic Ossification Mimicking Pyomyositis - Two Case Reports -  

PubMed Central

Early diagnosis and treatment of heterotopic ossification (HO) is essential to the prevention of complications. It is difficult to diagnose HO in its initial phase because non-specific clinical manifestations, laboratory findings and imaging findings of immature HO may mimic other diseases such as cellulitis, osteomyelitis, thrombophlebitis, deep vein thrombosis and local infection with abscess. We experienced two cases of HO, which were misdiagnosed as pyomyositis at first by clinical signs and MRI findings indicating the deep infection; the extensive intramuscular ossification appeared later on. We observed an increase of C-reactive protein and creatine kinase followed by the elevation of alkaline phosphatase with abnormal triphasic bone scan. The trajectory of these biomarkers was analyzed to get more insight into the early stages of HO along with the imaging findings. Although our cases cannot be generalized as typical of immature HO, they clearly demonstrate that the change of specific biomarkers with a careful history taking and physical examination should be noted to detect HO as early as possible while avoiding confusion with other mimicking conditions.

Choi, Yoon-Hee; Kim, Kyoung-Eun; Lim, Sung-Hoon

2012-01-01

113

An improvement in the appointment scheduling in primary health care centers using data mining.  

PubMed

An optimal resource management in health care centers implies the use of an appropriate timetabling scheme to schedule appointments. Timetables of health centers are usually divided into time slots whose duration is equal to time required for clinical attendance. However doctors perform a series of tasks that are not always clinical in nature: issuing prescriptions or prescribing sick leave certificates. In this sense the time spent in attending a clinical or an administrative matter is different. This last required less time to attend the patient. This study is focused in the administrative task. A predictive model is generated to provide daily information on how many patients will go to the health center for an administrative issue. The accuracy of the model is less than 4,6 % absolute error and the improvement in scheduling appointments is a time saving of 21,73 %. PMID:24964781

Cubillas, Juan José; Ramos, M Isabel; Feito, Francisco R; Ureña, Tomás

2014-08-01

114

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

2003-01-01

115

The Ossification of the Pelvic Girdle and Leg Skeleton of the Quail (Coturnix coturnix japonica).  

PubMed

The onset of ossification centres of the pelvic girdle and leg skeleton of the quail in embryos and juvenile birds were studied. Specimens, which were cleared and were stained with Alcian Blue and Alizarin Red S, were examined at the stereomicroscope. The ilium and the pubis began to ossify at the 8th day (E8), whereas the ischium at E9. Perichondral ossification was observed at E6 in the femur, tibia and fibula. A secondary ossification centre was detected in the proximal epiphysis of the tibiotarsus at the 15th post-hatching day (P15). The patella began to ossify at P30. Regarding the tarsal bones tibiale, pre-tibiale and fibulare, ossification was observed at the E15, E12 and E16, respectively. The metatarsals II, III, IV ossified at E7, whereas the metatarsal I at E11. The centres of ossification of the 1st phalanges of all digits were observed at E9. At the same day, the ossification centres of the 2nd phalanx of digits II and III as well as the 3rd phalanx of digit III appeared. At E10, ossification was observed in the 2nd phalanx of digit I, in the 3rd phalanx of digit II and in the 2nd and 3rd phalanx of digit IV. In the 4th phalanx of digit III and in the terminal phalanges of digit IV, ossification was observed at E11. The data presented here provide useful baseline information on the normal sequential pattern of ossification in the pelvic girdle and leg skeleton in this species. PMID:23834034

Pourlis, A F; Antonopoulos, J

2014-08-01

116

Incidence of Heterotopic Ossification after Surface and Conventional Total Hip Arthroplasty: A Comparative Study Using Anterolateral Approach and Indomethacin Prophylaxis  

PubMed Central

The incidence and severity of heterotopic ossification (HO) in two homogeneous groups of patients that received surface replacement arthroplasty (SRA) and conventional total hip arthroplasty (THA) were evaluated retrospectively. Thirty-nine patients undergoing 42 hip resurfacing procedures and 41 primary cementless THAs through an anterolateral approach received a 10-day course of 150?mg/die of indomethacin postoperatively. The median surgical time was 190 minutes and 156 minutes, respectively (P < 0.003). At a minimum 1-year followup, the development of HO was assessed on standard X-ray using Brooker grading. Ectopic bone formation was detected in five cases (11.9%, two Brooker grade I and three grade II) in the SRA group and in 14 hips (34.1%, 12 grade I and two grade II) treated with conventional THA, but the difference was not significant (P < 0.11). No clinically relevant periprosthetic ossification (Brooker III or IV) occurred in both groups. Although the difference was not statistically significant, the incidence of HO after SRA was lower than conventional THA. More extensive soft tissue trauma, bone debris, and longer operative time in hip resurfacing are not likely to be absolute risk factors for HO. Further investigations including larger patient populations are needed to confirm these findings.

Sandri, Andrea; Sambugaro, Elena

2013-01-01

117

Figure Facts: Encouraging Undergraduates to Take a Data-Centered Approach to Reading Primary Literature  

PubMed Central

The ability to interpret experimental data is essential to understanding and participating in the process of scientific discovery. Reading primary research articles can be a frustrating experience for undergraduate biology students because they have very little experience interpreting data. To enhance their data interpretation skills, students used a template called “Figure Facts” to assist them with primary literature–based reading assignments in an advanced cellular neuroscience course. The Figure Facts template encourages students to adopt a data-centric approach, rather than a text-based approach, to understand research articles. Specifically, Figure Facts requires students to focus on the experimental data presented in each figure and identify specific conclusions that may be drawn from those results. Students who used Figure Facts for one semester increased the amount of time they spent examining figures in a primary research article, and regular exposure to primary literature was associated with improved student performance on a data interpretation skills test. Students reported decreased frustration associated with interpreting data figures, and their opinions of the Figure Facts template were overwhelmingly positive. In this paper, we present Figure Facts for others to adopt and adapt, with reflection on its implementation and effectiveness in improving undergraduate science education.

Round, Jennifer E.; Campbell, A. Malcolm

2013-01-01

118

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))

1994-09-29

119

Ossification in the cephalic attachment of the ligamentum flavum: an anatomical and CT study  

SciTech Connect

A review of 50 anatomical specimens and 100 routine CT scans of the chest and abdomen demonstrated that ossification in the cephalic attachment of the ligamentum flavum is a common anatomical finding, but not as common on CT. Examination of hospital charts and plain radiographs of 26 patients with such ossification suggests that it is probably a normal variant; there was no evidence that it is related to diffuse idiopathic skeletal hyperostosis (DISH) or inflammatory arthropathy. Marked ossification may cause or contribute to neurological symptoms.

Williams, D.M.; Gabrielsen, T.O.; Latack, J.T.; Martel, W.; Knake, J.E.

1984-02-01

120

QUALITY OF HEALTH EDUCATION POSTERS IN PRIMARY HEALTH CARE CENTERS IN AL-KHOBAR TOWN, EASTERN PROVINCE  

PubMed Central

Background: Health Education (HE) is vital to each of the seven other central ele-ments of Public Health Care (PHC). HE must be carefully planned and implemented. A crucial part of HE is planning, production and placement of effective HE posters. Objective: Assess the quality of health education posters in Al-Khobar PHC centers. Methods: A cross-sectional study of a sample of 138 HE posters in three PHC centers in Al-Khobar was conducted. The quality of posters in relation to set criteria was measured using a data sheet and scoring system developed by the investigator. Results: The health education subjects displayed were among the common health problems in Saudi Arabia in 134 (97.1 %) of the posters.More than one-third (34.8%) had been displayed for more than one year. In 74 (53.6%) of the posters, the source of scientific information was unknown. The assessment showed that 109 (79%) posters were of optimal quality. Conclusion: The study showed that the health education posters in PHC centers in Al-Khobar were relatively satisfactory, though they did not fulfill some of the required criteria. Health education posters should be included in the assessment of health education programs in primary health care centers.

Al-Sowielem, Latifa S.

2001-01-01

121

Spindle-cell variant of primary cutaneous follicle center lymphoma spreading to the hepatobiliary tree, mimicking Klatskin tumor.  

PubMed

Primary cutaneous follicle center lymphoma (pcFCL) is an indolent type of primary cutaneous B-cell lymphoma (pcBCL) rarely disseminating to other organs. PcBCL with spindle-cell morphology has been described as a rare variant of pcFCL but the prognosis data of this variant is sparse. We report a rare case of spindle-cell pcFCL with CD20(+), CD79a(+), CD3(+), Bcl-6(+), Mum-1(-) and CD10(-) tumor cells that infiltrated the hepatic hilum, mimicking a Klatskin tumor. On the basis of the sparse published data on spindle-cell morphology of pcBCL, this growth pattern should elicit awareness of an increased risk of systemic involvement in the otherwise indolent pcFCL. PMID:23167279

Rozati, Sima; Kerl, Katrin; Kempf, Werner; Tinguely, Marianne; Zimmermann, Dieter R; Dummer, Reinhard; Cozzio, Antonio

2013-01-01

122

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 EpicTM 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

2006-06-01

123

[Anconeus arthroplasty: a salvage procedure in recurrent heterotopic ossification].  

PubMed

Anconeus interpositional arthroplasty has been used in the treatment of radiocapitellar and radioulnar joint problems occurring after trauma. We performed anconeus interposition arthroplasty in a 31-year-old male patient who developed heterotopic ossification (HTO) in the elbow following surgical treatment of an isolated radial neck fracture. Treatment with implant removal and excision of the radial head resulted in recurrent HTO and a stiff elbow. The patient underwent excision of the heterotrophic new bone and mobilization of the proximal radius. The anconeus muscle was mobilized and interposed between the proximal radius and ulna. Sixteen months after the operation, forearm rotation, elbow flexion and extension increased by 80 degrees , 45 degrees , and 60 degrees , respectively. Control X-rays showed maintenance of the radiohumeral gap without any signs of HTO. PMID:19293618

Seyahi, Aksel; Atalar, Ata Can; Demirhan, Mehmet

2009-01-01

124

Thoracic radiculopathy caused by ossification of the ligamentum flavum  

PubMed Central

Thoracic ossification of the ligamentum flavum (OLF) has been widely recognized as a main cause of thoracic myelopathy in Asia, particularly in Japan. However, thoracic OLF rarely causes radiculopathy. We report a rare case of thoracic radiculopathy caused by OLF. A 67-year-old male presented with a chief complaint of back pain radiating to the right of the abdomen. Neurological examination revealed mild sensory deficit at the right side of the abdomen at the T9–10 level. Magnetic resonance imaging and computed tomography demonstrated OLF at the right T9–10 level. Thoracic radiculopathy caused by OLF was suspected. Because conservative treatment was not effective to this lesion, surgical intervention was performed, and the pain disappeared immediately after the operation. Thoracic OLF rarely causes radiculopathy, but it should be considered as a differential diagnosis of thoracic radicular pain. When conservative treatment is not effective in this lesion, surgical treatment should be considered.

Yabe, Yutaka; Honda, Masahito; Tohjo, Yuuichi; Nakajima, Souichi; Ando, Akira; Sonofuchi, Kazuaki; Itoi, Eiji

2013-01-01

125

Heterotopic ossification of the elbows in a major petrol burn.  

PubMed

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

2012-01-01

126

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

2006-04-17

127

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

PubMed

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

2014-01-01

128

Characterization, Outcome, and Prognosis in 273 Patients with Primary Sclerosing Cholangitis: A Single Center Study  

Microsoft Academic Search

OBJECTIVES:Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease with varying severity and progression. This study describes the natural history of PSC patients and evaluates the prognostic significance of clinical, biochemical, and cholangiographic findings constructing a novel prognostic model.METHODS:A population of 273 German PSC patients was studied with a median follow-up time of 76 months (range 1–280 months). Survival

Jens J. W. Tischendorf; Hartmut Hecker; Martin Krüger; Michael P. Manns; Peter N. Meier

2007-01-01

129

Thirty patients with primary plasma cell leukemia: a single center experience  

Microsoft Academic Search

The primary plasma cell leukemia (PCL) is a rare aggressive plasma cell dyscrasia. We investigated its clinical and laboratory\\u000a aspects in a large series of patients. Among 934 consecutive patients with multiple myeloma (MM), registered between 1978\\u000a and 2004 in a single institution, 30 patients [M\\/F: 22\\/8; median age (yr): 60, range: 36–79] with PCL (3.1%) were diagnosed.\\u000a Retrospective analysis

Milica ?olovi?; Gradimir Jankovi?; Nada Suvajdži?; Nataša Mili?; Vesna ?or?evi?; Snežana Jankovi?

2008-01-01

130

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.

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

2012-01-01

131

Heterotopic ossification in metastatic colorectal carcinoma: case report with morphoproteomic insights into the histogenesis.  

PubMed

A case of metastatic colorectal carcinoma with heterotopic ossification is described. Objective Morphoproteomic analysis was performed to help define the histogenesis of the heterotopic ossification in this context. Design Immunohistochemical stains for Gli2, ?-SMA, SPARC (osteonectin), and nestin were performed and the expression level (chromogenic signal intensity) and subcellular compartmentalization of these protein analytes were assessed in the tumor cells vis-à-vis the companionate stromal cells and osteoblasts in a morphoproteomic application. Results This analysis revealed that the heterotopic ossification is more likely the result of pluripotent stromal cells that undergo differentiation to form osteoblasts rather than the tumor cells undergoing osseous metaplasia. Conclusion Morphoproteomics provides evidence that the histogenesis of heterotopic ossification in this case of metastatic colon cancer is from the stromal cells in the tumoral microenvironment. PMID:24695482

Huang, Richard Sheng Poe; Brown, Robert E; Buryanek, Jamie

2014-01-01

132

Ultrasound as the primary imaging method in the diagnosis of hip dysplasia in children aged < 2 years.  

PubMed

The aims of this study were to evaluate the usefulness of ultrasonography as the primary imaging method for hip joints and to establish the limits of normal variation of ultrasound measurements. Five hundred sixty-six children aged 1-23 months who had been referred for clinical suspicion of developmental dysplasia of the hip (DDH) were examined. In the youngest infants, the percentage cover of the cartilaginous femoral head by the bony acetabular roof (femoral head cover, FHC) was measured. When the ossification center had appeared, the cover was measured indirectly by the distance from the lateral tangent to the ossification center to the lateral acetabular rim (lateral head distance, LHD). The FHC of normal hips increased with age; the lower normal limit (mean -2 SD) was 46% in the youngest infants and 52% at age 4-5 months. The LHD also increased with age; the upper normal limit (mean +2 SD) was 3 mm in patients aged < 1 year of age and 4 mm in the oldest patients. Radiographs were obtained when ultrasound examination showed pathological hips and the radiographic findings were in good accordance with the ultrasound findings. Ultrasonography based on measurements of the cover of the femoral head represents a rapid and reliable technique for evaluation of hips in children in their first and second year of life. If ultrasonography is used as the primary imaging method, radiography can be omitted in approximately 95% of patients referred for clinical suspicion of DDH, because their hip joints are normal. PMID:8811543

Terjesen, T

1996-01-01

133

Ossification of the posterior atlantoaxial membrane associated with an os odontoideum: a case report.  

PubMed

We report a case of ossification of the posterior atlantoaxial membrane associated with an os odontoideum in a 46-year-old woman. She developed myelopathy following a minor motor vehicle accident. The patient underwent posterior atlantoaxial arthrodesis and resection of the ossified lesion and recovered uneventfully. Long-standing atlantoaxial instability might have played a role in ectopic ossification of the posterior atlantoaxial membrane. PMID:22184181

Ohya, Junichi; Chikuda, Hirotaka; Sugita, Shurei; Ono, Takashi; Oshima, Yasushi; Takeshita, Katsushi; Kawaguchi, Hiroshi; Nakamura, Kozo

2011-12-01

134

Oxidized low-density lipoprotein and ?-glycerophosphate synergistically induce endothelial progenitor cell ossification  

Microsoft Academic Search

Aim:To investigate the ability of ox-LDL to induce ossification of endothelial progenitor cells (EPCs) in vitro and explored whether oxidative stress, especially hypoxia inducible factor-1? (HIF-1?) and reactive oxygen species (ROS), participate in the ossific process.Methods:Rat bone marrow-derived endothelial progenitor cells (BMEPCs) were cultured in endothelial growth medium supplemented with VEGF (40 ng\\/mL) and bFGF (10 ng\\/mL). The cells were

Li Liu; Zhi-zhong Liu; Hui Chen; Guo-jun Zhang; Yu-hua Kong; Xi-xiong Kang

2011-01-01

135

The influence of pregnancy on heterotopic ossification post-displaced acetabular fractures surgical repair.  

PubMed

Pregnancy is associated with maternal bone mineral density loss and modulation of calcium metabolism. We hypothesized that pregnancy may decrease the risk of heterotopic ossification (HO) after trauma. This is a single-institution, University of Mississippi Medical Center, retrospective study investigating the effect of pregnancy on the incidence HO after surgical repair (SR) of displaced acetabular fractures. Between January 1998 and 2010, 257 non-pregnant women (Group A) and 16 pregnant women (Group B) were identified. All the non-pregnant women received radiation therapy (RT) ± indomethacin. None of the pregnant women in group B received any prophylaxis. After a median follow-up of 6.6 years the incidence of HO in all patients was 27% (75/273). In Group A, non-pregnant, women who received RT ± indomethacin, 29% developed HO; HO risk was 0.4. In Group B, 16 pregnant patients, only one developed HO (6%); HO risk was 0.06. Thus, the risk of HO appears to be nearly six-fold higher in non-pregnant women despite prophylactic RT ± indomethacin. Our data suggest that pregnancy may be associated with a reduced risk of HO after SR of displaced acetabular fractures. Further analysis with a larger pregnant patient sample is necessary to confirm this finding. PMID:23335247

Mourad, Waleed F; Packianathan, Satya; Shourbaji, Rania A; Jennelle, Richard; Yang, Claus Chunli; Mobit, Paul; Zhang, Zhen; Khan, Majid A; Graves, Mathew; Russell, George; Vijayakumar, Srinivasan

2013-06-01

136

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.

Pape, Kathryn A.; Jenkins, Marc K.

2012-01-01

137

Heterotopic ossification in the reaming tract of a percutaneous antegrade femoral nail: a case report  

PubMed Central

Introduction Heterotopic ossification is a rare complication of musculoskeletal injuries, characterized by bone growth in soft tissues. Percutaneous antegrade intramedullary nailing represents the ‘gold standard’ for the treatment of femur shaft fractures. Minor bone growth is frequently seen around the proximal end of reamed femoral nails (so-called ‘callus caps’), which are asymptomatic and lack a therapeutic implication. The occurrence of excessive, symptomatic heterotopic ossification around the entry site of an antegrade femoral nail is rarely described in the literature. Case presentation We present the case of a 28-year-old Caucasian woman who developed extensive heterotopic ossification around the reaming seeds of a reamed femoral nail. She developed severe pain and significantly impaired range of motion of the hip joint, requiring revision surgery for heterotopic ossification resection and adjunctive local irradiation. She recovered full function of the hip and remained asymptomatic at her two-year follow-up appointment. Conclusions Severe heterotopic ossification represents a rare but potentially detrimental complication after percutaneous femoral nailing of femur shaft fractures. Diligent care during the reaming procedure, including placement of a trocar to protect from osteogenic seeding of the soft tissues, may help decrease the risk of developing heterotopic ossification after reamed antegrade femoral nailing.

2013-01-01

138

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.

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

2013-01-01

139

Gender Differences in Posttraumatic Stress Disorder Among Primary Care Patients After the World Trade Center Attack of September 11, 2001  

PubMed Central

Background Debate surrounds the nature of gender differences in rates of posttraumatic stress disorder (PTSD). Objective The goal of this study was to quantify and explore the reasons for gender differences in rates of PTSD in low income, primary care patients after the World Trade Center (WTC) attack of September 11, 2001. Methods A survey was conducted at a large primary care practice in New York City 7 to 16 months after the WTC attack. The study involved a systematic sample of primary care patients aged 18 to 70 years. The main outcome measures were the Life Events Checklist, the Posttraumatic Stress Disorder Checklist–Civilian Version, and the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire, all administered by a bilingual research staff. Results A total of 3807 patients were approached at the primary care clinic. Of the 1347 who met eligibility criteria, 1157 (85.9%) consented to participate. After the addition of the WTC/PTSD supplement to the study, the total number of patients was 992, of whom 982 (99.0%) completed the survey. Both sexes had high rates of direct exposure to the WTC attack and high rates of lifetime exposure to stressful life events. Overall, females had lower rates of exposure to the attack compared with males (P < 0.05). Hispanic females had the highest rate of PTSD in the full sample. Gender differences in rates of PTSD were largely accounted for by differences in marital status and education. The rate of current major depressive disorder (MDD) was higher in females than in males (P < 0.001), and the reverse was true for substance abuse (P < 0.001). Gender differences for MDD and substance abuse persisted even after adjustments for demographic differences between the sexes. Conclusions The increased rate of PTSD in women attending a primary care clinic was mediated by their social and economic circumstances, such as living alone without a permanent relationship and with little education or income. The increased rate of MDD in women appeared to be less dependent on these circumstances. These findings have implications for the treatment of women with PTSD in primary care and for research on gender differences in rates of psychiatric disorders.

Weissman, Myrna M.; Neria, Yuval; Das, Amar; Feder, Adriana; Blanco, Carlos; Lantigua, Rafael; Shea, Steven; Gross, Raz; Gameroff, Marc J.; Pilowsky, Daniel; Olfson, Mark

2013-01-01

140

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.

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

2013-01-01

141

Primary B-cell CNS lymphoma clinicopathologic and treatment outcomes in 89 patients from a single tertiary care center.  

PubMed

Primary central nervous system lymphoma (PCNSL) is a rare aggressive variant of diffuse large B-cell lymphoma with a poor prognosis and no defined optimal therapeutic strategies. Our aim was to compare the role of intrathecal chemotherapy with current high-dose methotrexate (HDMTX) treatments. Clinicopathologic characteristics, therapy, and outcomes of patients with PCNSL at Moffitt Cancer Center were reviewed in 89 patients identified over an 11-year period. Patients treated initially with HDMTX-based therapy showed improved overall and progression-free survival, with no improvement shown with added radiation or intrathecal therapy. Age and performance status were also important prognostic indicators. Our conclusion is that initial therapy in PCNSL should include an HDMTX backbone. The use of intrathecal chemotherapy or radiation therapy initially likely does not improve outcomes. Future multicenter phase III clinical trials are needed to better establish the superior initial treatment in PCNSL. PMID:24584873

Dalia, Samir; Forsyth, Peter; Chavez, Julio; Price, Samantha; Shah, Bijal; Bello, Celeste; Sokol, Lubomir; Pan, Edward; Sotomayor, Eduardo; Lee, Ji-Hyun; Fisher, Kate; Jaglal, Michael

2014-04-01

142

Primary care nursing role and care coordination: an observational study of nursing work in a community health center.  

PubMed

Care coordination is a core element of the Patient-Centered Medical Home and requires an effective, well educated nursing staff. A greater understanding of roles and tasks currently being carried out by nurses in primary care is needed to help practices determine how best to implement care coordination and transform into PCMHs. We conducted an observational study of primary care nursing in a Community Health Center by creating a classification schema for nursing responsibilities, directly observing and tracking nurses' work, and categorizing their activities. Ten nurses in eight different practice sites were observed for a total of 61 hours. The vast majority of nursing time was spent in vaccine and medication administration; telephone work; and charting and paper work, while only 15% of their time was spent in activity that was classified broadly as care coordination. Care coordination work appeared to be subsumed by other daily tasks, many of which could have been accomplished by other, lesser trained members of the health care team. Practices looking to implement care coordination need a detailed look at work flow, task assignments, and a critical assessment of staffing, adhering to the principal of each team member working to the highest level of his or her education and license. Care coordination represents a distinct responsibility that requires dedicated nursing time, separate from the day to day tasks in a busy practice. To fully support these new functions, reimbursement models are needed that support such non visit-based work and provide incentives to coordinate and manage complex cases, achieve improved clinical outcomes and enhance efficiency of the health system. This article describes our study methods, data collection, and analysis, results, and discussion about reorganizing nursing roles to promote care coordination. PMID:22686111

Anderson, Daren R; St Hilaire, Daniel; Flinter, Margaret

2012-05-01

143

Evaluating factors affecting the implementation of evidence based medicine in primary healthcare centers in Dubai  

PubMed Central

Objectives To assess the current evidence based medicine (EBM) knowledge, attitude and perceptions of physicians at Dubai Primary Health Care Sector (PHCS). Further to evaluate barrier and facilitator factors toward implementing the EBM practice. Methodology A cross-sectional study, at Dubai PHCS, UAE between June and August 2010. The survey was composed of two phases. The first phase was a self administrated questionnaire employed for data collection and the second phase was qualitative method, which was in the form of individual interviews. Statistical Package for Social Sciences (SPSS) was used for data analysis. Results In total 48 participants responded to the survey questionnaire and 13 responded to individual interviews. The response rate was 70.0%. Mean age was 42.18 (SD 10.46). The majority were females (64.6%). The physicians who attended EBM courses reported 70.30% using EBM and showed statistical significance (p = 0.002) from those who did not attend the EBM courses. 65.0% believe that 50–75% of the patients are capable of participating in clinical decision while 71.8% disagreed that the concept of EBM is not applicable to their culture. In addition they showed significance (p = 0.03) between physician beliefs with regard to patient capacity to take decision. About 67.0% of the family physicians were knowledgeable and followed systematic review as the strongest evidence. They had no access to the EBM resources (37.0%) and had no time to practice the EBM (38.0%). Nearly 40.0% interviewees reported lack of encouragement to attend EBM courses. EBM activities (22.0%) and active audit (18.0%) were top rated facilitating factors. Conclusions EBM is not fully utilized by indefinite physicians in the Dubai PHC sector. Factors associated with non-utilization of EBM in the PHCS are lack of encouragement to attend EBM courses, senior physicians resist adoption of EBM, lack of time and insufficient dissemination process for implementing the clinical guideline.

Albarrak, Ahmed I.; Ali Abbdulrahim, Suhair Aqil; Mohammed, Rafiuddin

2013-01-01

144

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))

1991-02-01

145

Ossification of the Posterior Longitudinal Ligament: A Review of Literature  

PubMed Central

Ossification of the posterior longitudinal ligament (OPLL) is most commonly found in men, in the elderly, and in Asian patients. The disease can start with mild or no symptoms, but some patients progress slowly to develop symptoms of myelopathy. An accurate diagnosis through the use plain radiograph, computed tomography, and magnetic resonance imaging findings is very important to monitor the development of symptoms and to make decisions regarding a treatment plan. When symptoms are mild and non-progressive, conservative treatments and periodic observations are good enough, but once symptoms of myelopathy are present and neurologic symptoms are progressive, the treatment of choice is surgery to relieve spinal cord compression. Surgical management of OPLL continues to be controversial. Each surgical technique has some advantages and disadvantages, and the choice of operation should be decided carefully with various considerations. The patient's neurological condition, location and extent of pathology, cervical kyphosis, presence or absence of accompanied instability, and the individual surgeon's experience must be an important factors that should be considered before surgery.

Choi, Byung-Wan; Chang, Han

2011-01-01

146

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.

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

2013-01-01

147

Primary homologies of the circumorbital bones of snakes.  

PubMed

Some snakes have two circumorbital ossifications that in the current literature are usually referred to as the postorbital and supraorbital. We review the arguments that have been proposed to justify this interpretation and provide counter-arguments that reject those conjectures of primary homology based on the observation of 32 species of lizards and 81 species of snakes (both extant and fossil). We present similarity arguments, both topological and structural, for reinterpretation of the primary homologies of the dorsal and posterior orbital ossifications of snakes. Applying the test of similarity, we conclude that the posterior orbital ossification of snakes is topologically consistent as the homolog of the lacertilian jugal, and that the dorsal orbital ossification present in some snakes (e.g., pythons, Loxocemus, and Calabaria) is the homolog of the lacertilian postfrontal. We therefore propose that the terms postorbital and supraorbital should be abandoned as reference language for the circumorbital bones of snakes, and be replaced with the terms jugal and postfrontal, respectively. The primary homology claim for the snake "postorbital" fails the test of similarity, while the term "supraorbital" is an unnecessary and inaccurate application of the concept of a neomorphic ossification, for an element that passes the test of similarity as a postfrontal. This reinterpretation of the circumorbital bones of snakes is bound to have important repercussions for future phylogenetic analyses and consequently for our understanding of the origin and evolution of snakes. PMID:23630161

Palci, Alessandro; Caldwell, Michael W

2013-09-01

148

Clinically applicable antianginal agents suppress osteoblastic transformation of myogenic cells and heterotopic ossifications in mice.  

PubMed

Fibrodysplasia ossificans progressiva (FOP) is a rare autosomal dominant disorder characterized by progressive heterotopic ossification. FOP is caused by a gain-of-function mutation in ACVR1 encoding the bone morphogenetic protein type II receptor, ACVR1/ALK2. The mutant receptor causes upregulation of a transcriptional factor, Id1. No therapy is available to prevent the progressive heterotopic ossification in FOP. In an effort to search for clinically applicable drugs for FOP, we screened 1,040 FDA-approved drugs for suppression of the Id1 promoter activated by the mutant ACVR1/ALK2 in C2C12 cells. We found that that two antianginal agents, fendiline hydrochloride and perhexiline maleate, suppressed the Id1 promoter in a dose-dependent manner. The drugs also suppressed the expression of native Id1 mRNA and alkaline phosphatase in a dose-dependent manner. Perhexiline but not fendiline downregulated phosphorylation of Smad 1/5/8 driven by bone morphogenetic protein (BMP)-2. We implanted crude BMPs in muscles of ddY mice and fed them fendiline or perhexiline for 30 days. Mice taking perhexiline showed a 38.0 % reduction in the volume of heterotopic ossification compared to controls, whereas mice taking fendiline showed a slight reduction of heterotopic ossification. Fendiline, perhexiline, and their possible derivatives are potentially applicable to clinical practice to prevent devastating heterotopic ossification in FOP. PMID:23011467

Yamamoto, Ryuichiro; Matsushita, Masaki; Kitoh, Hiroshi; Masuda, Akio; Ito, Mikako; Katagiri, Takenobu; Kawai, Tatsushi; Ishiguro, Naoki; Ohno, Kinji

2013-01-01

149

Patellar tendon ossification after anterior cruciate ligament reconstruction using bone - patellar tendon - bone autograft  

PubMed Central

Background Among the various complications described in literature, the patellar tendon ossification is an uncommon occurrence in anterior cruciate ligament (ACL) reconstruction using bone – patellar tendon – bone graft (BPTB). The heterotopic ossification is linked to knee traumatism, intramedullary nailing of the tibia and after partial patellectomy, but only two cases of this event linked to ACL surgery have been reported in literature. Case presentation We present a case of a 42-year-old Caucasian man affected by symptomatic extended heterotopic ossification of patellar tendon after 20 months from ACL reconstruction using BPTB. The clinical diagnosis was confirmed by Ultrasound, X-Ray and Computed Tomography studies, blood tests were performed to exclude metabolic diseases then the surgical removal of the lesion was performed. After three years from surgery, the patient did not report femoro-patellar pain, there was not range of motion limitation and the clinical-radiological examinations resulted negative. Conclusion The surgical removal of the ossifications followed by anti-inflammatory therapy, seems to be useful in order to relieve pain and to prevent relapses. Moreover, a thorough cleaning of the patellar tendon may reveal useful, in order to prevent bone fragments remain inside it and to reduce patellar tendon heterotopic ossification risk.

2013-01-01

150

National Committee for Quality Assurance (NCQA) Patient-Centered Medical Home (PCMH) Recognition Is Suboptimal Even Among Innovative Primary Care Practices.  

PubMed

The National Committee for Quality Assurance (NCQA) has promoted patient-centered medical home (PCMH) recognition among primary care practices since 2008 as a standard indicator of which practices have transformed into medical homes. A 40% PCMH adoption rate among a large national cohort of identified practices with innovative staffing (n = 131) calls into question whether the NCQA recognition process is truly transformative and patient-centered or simply another certificate to hang on the wall. PMID:24808108

Hahn, Karissa A; Gonzalez, Martha M; Etz, Rebecca S; Crabtree, Benjamin F

2014-01-01

151

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: Waleed246@gmail.com [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)

2012-04-01

152

Outcomes of the oldest patients with primary CNS lymphoma treated at Memorial Sloan-Kettering Cancer Center  

PubMed Central

Up to 20% of all primary CNS lymphoma (PCNLS) patients are aged 80 years or older, yet data are limited on how best to treat this rapidly growing population. Despite demographic pressures and the proven efficacy of methotrexate (MTX)-based regimens, automatic de-escalation of care based on age is standard practice outside of tertiary care centers. We performed a retrospective review of all PCNSL patients aged 80 years or older treated at Memorial Sloan-Kettering Cancer Center from 1993 to 2011. Demographic and clinical variables were evaluated as predictors of survival by multivariate analysis. Twenty-three of 24 patients were treated with chemotherapy (92% with high-dose MTX, typically in combination with vincristine and procarbazine). One patient received ocular radiation alone for disease limited to the eyes. Response to treatment was noted in 62.5% of patients; 9 (37.5%) had refractory disease. Median overall survival was 7.9 months (95% confidence interval [CI]: 5.8–53), and median progression-free survival was 6.5 months (95% CI: 4.4–29.5). Two-year survival rate was 33%; 3-year survival rate was 17%. Three patients lived more than 4 years postdiagnosis. Most patients tolerated therapy well, and despite low baseline creatinine clearance, no significant renal toxicity was noted. Response status and deep brain involvement were identified as the most important predictors of survival. Multidrug regimens containing high-dose MTX are feasible and efficacious among the oldest patients, particularly those who achieve a complete response by their fifth treatment cycle. Aggressive therapy should be offered to select patients irrespective of advanced age.

Welch, Mary R.; Omuro, Antonio; DeAngelis, Lisa M.

2012-01-01

153

Randomised primary health center based interventions to improve the diagnosis and treatment of undifferentiated fever and dengue in Vietnam  

PubMed Central

Background Fever is a common reason for attending primary health facilities in Vietnam. Response of health care providers to patients with fever commonly consists of making a presumptive diagnosis and proposing corresponding treatment. In Vietnam, where malaria was brought under control, viral infections, notably dengue, are the main causes of undifferentiated fever but they are often misdiagnosed and inappropriately treated with antibiotics. This study investigate if educating primary health center (PHC) staff or introducing rapid diagnostic tests (RDTs) improve diagnostic resolution and accuracy for acute undifferentiated fever (AUF) and reduce prescription of antibiotics and costs for patients. Methods In a PHC randomized intervention study in southern Vietnam, the presumptive diagnoses for AUF patients were recorded and confirmed by serology on paired (acute and convalescence) sera. After one year, PHCs were randomized to four intervention arms: training on infectious diseases (A), the provision of RDTs (B), the combination (AB) and control (C). The intervention lasted from 2002 until 2006. Results The frequency of the non-etiologic diagnosis "undifferentiated fever" decreased in group AB, and - with some delay- also in group B. The diagnosis "dengue" increased in group AB, but only temporarily, although dengue was the most common cause of fever. A correct diagnosis for dengue initially increased in groups AB and B but only for AB this was sustained. Antibiotics prescriptions increased in group C. During intervention it initially declined in AB with a tendency to increase afterwards; in B it gradually declined. There was a substantial increase of patients' costs in B. Conclusions The introduction of RDTs for infectious diseases such as dengue, through free market principles, does improve the quality of the diagnosis and decreases the prescription of antibiotics at the PHC level. However, the effect is more sustainable in combination with training; without it RDTs lead to an excess of costs.

2010-01-01

154

Association of the human NPPS gene with ossification of the posterior longitudinal ligament of the spine (OPLL)  

Microsoft Academic Search

OPLL (ossification of the posterior longitudinal ligament of the spine) is a common form of human myelopathy with a prevalence\\u000a of as much as 4% in a variety of ethnic groups. To clarify the genetic factors that predispose to OPLL, we have studied ttw (tiptoe walking), a mouse model that presents ectopic ossification of the spinal ligaments similar to OPLL

Isao Nakamura; Shiro Ikegawa; Akihiko Okawa; Shin’ya Okuda; Y. Koshizuka; Hiroshi Kawaguchi; Kozo Nakamura; Tsunemaro Koyama; Sumio Goto; Junya Toguchida; Mutsumi Matsushita; Takahiro Ochi; Kunio Takaoka; Y. Nakamura

1999-01-01

155

COX-2 inhibitors for the prevention of heterotopic ossification after THA.  

PubMed

Nonsteroidal anti-inflammatory drugs (NSAIDs) may prevent heterotopic ossification after total hip arthroplasty (THA). Cyclooxygenase 2 (COX-2) inhibitors may minimize side effects. The goal of this review was to compare the effectiveness and side effects of the perioperative use of selective COX-2 inhibitors with those of conventional NSAIDs in patients undergoing THA. We followed the systematic reviews' updated methods of the Cochrane Collaboration Back Review Group and searched MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials. We identified all randomized controlled trials until April 2009 enrolling THA patients and comparing COX-2 inhibitors to NSAIDs. We assessed their methodological quality and extracted data. Five randomized controlled trials were included. Prevention of heterotopic ossification and side effects with COX-2 inhibitors were significant in 2 studies. Discontinuation for side effects was not significant. COX-2 inhibitors do not prevent heterotopic ossification after THA significantly better than conventional NSAIDs, while they are advantageous regarding side effects. PMID:21661680

Vasileiadis, George I; Sioutis, Ioannis C; Mavrogenis, Andreas F; Vlasis, Konstantinos; Babis, George C; Papagelopoulos, Panayiotis J

2011-06-01

156

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)

2010-08-01

157

Barriers and Facilitators to Implementing Primary Stroke Center Policy in the United States: Results From 4 Case Study States  

PubMed Central

Objectives. We identified barriers and facilitators to the state-level implementation of primary stroke center (PSC) policies, which encourage the certification or designation of specialized stroke treatment facilities and may address concerns such as transportation bypass, telemedicine, and treatment protocols. Methods. We studied the experiences of 4 states (Florida, Massachusetts, New Mexico, and New York) selected from the 18 states that had enacted PSC policies or were actively considering doing so. We conducted semistructured interviews during fieldwork in each case study state. Results. Our results showed that system fragmentation, gaps in human and financial resources, and complexity at the interorganizational and operational levels are common barriers and that policy champions, stakeholder support and communication, and operational adaptation are essential facilitators in the adoption and implementation of PSC policies. Conclusions. The identification of barriers and facilitators reveals the contextual elements that can help or hinder policy implementation and may be useful in informing policy formulation and implementation in other jurisdictions. Proactively identifying jurisdictional challenges and opportunities may help facilitate the policy process for PSC designation and allow jurisdictions to develop more effective stroke systems of care.

Slade, Catherine P.; Brewer, Gene A.; Gase, Lauren N.

2011-01-01

158

Putative Hydrogen Bond to Tyrosine M208 in Photosynthetic Reaction Centers from Rhodobacter capsulatus Significantly Slows Primary Charge Separation.  

PubMed

Slow, ?50 ps, P* ? P(+)HA(-) electron transfer is observed in Rhodobacter capsulatus reaction centers (RCs) bearing the native Tyr residue at M208 and the single amino acid change of isoleucine at M204 to glutamic acid. The P* decay kinetics are unusually homogeneous (single exponential) at room temperature. Comparative solid-state NMR of [4'-(13)C]Tyr labeled wild-type and M204E RCs show that the chemical shift of Tyr M208 is significantly altered in the M204E mutant and in a manner consistent with formation of a hydrogen bond to the Tyr M208 hydroxyl group. Models based on RC crystal structure coordinates indicate that if such a hydrogen bond is formed between the Glu at M204 and the M208 Tyr hydroxyl group, the -OH would be oriented in a fashion expected (based on the calculations by Alden et al., J. Phys. Chem. 1996, 100, 16761-16770) to destabilize P(+)BA(-) in free energy. Alteration of the environment of Tyr M208 and BA by Glu M204 via this putative hydrogen bond has a powerful influence on primary charge separation. PMID:24902471

Saggu, Miguel; Carter, Brett; Zhou, Xiaoxue; Faries, Kaitlyn; Cegelski, Lynette; Holten, Dewey; Boxer, Steven G; Kirmaier, Christine

2014-06-19

159

Voriconazole-associated soft tissue ossification: an undescribed cause of glenohumeral joint capsulitis.  

PubMed

Voriconazole-related periostitis has been increasingly described in the literature over the last several years as a recognizable disease entity, especially in lung transplant patients. This relationship should be considered when approaching immunosuppressed patients presenting with diffuse bone pain and imaging findings of periostitis. We present a case of voriconazole-associated periostitis, capsular and enthesial ossification and glenuhumeral capsulitis in a patient with a hematologic malignancy. To the authors' knowledge, soft tissue ossification associated with voriconazole has not been described in the radiology literature. PMID:24699891

Raghavan, Meera; Hayes, Alex

2014-09-01

160

Two Programs for Primary Care Practitioners: Family Medicine Training in an Affiliated University Hospital Program and Primary Care Graduate Training in an Urban Private Medical Center  

ERIC Educational Resources Information Center

Eugene Farley describes the University of Rochester and Highland Hospital Family Medicine Program for teaching of primary care internists, primary care pediatricians, and family doctors. Thomas Piemme presents the George Washington University School of Medicine alternative, a 2-year program in an ambulatory setting leading to broad eligibility in…

Farley, Eugene S.; Piemme, Thomas E.

1975-01-01

161

Primary Cutaneous Follicle Center Cell Lymphomas and Large B Cell Lymphomas of the Leg Descend from Germinal Center Cells. A Single Cell Polymerase Chain Reaction Analysis  

Microsoft Academic Search

Primary cutaneous B cell lymphomas are defined as non-Hodgkin lymphomas that occur in the skin without extracutaneous involvement for 6 mo after diagnosis. They are characterized by a less aggressive course and better prognosis than their nodal counterparts. According to the European Organization for Research and Treatment of Cancer classification, the major subentities of primary cutaneous B cell lymphoma are

Sylke Gellrich; Sascha Rutz; Sven Golembowski; Claudia Jacobs; Malgorzata von Zimmermann; Pamela Lorenz; Heike Audring; Marcus Muche; Wolfram Sterry; Sigbert Jahn

2001-01-01

162

Clinical features and treatment outcomes of 14 cases of primary ovarian non-Hodgkin's lymphoma: a single-center experience.  

PubMed

To analyze the clinical characteristics, results of treatment, and prognostic factors of patients diagnosed as primary ovarian non-Hodgkin's lymphoma (PONHL). Fourteen cases of PONHL treated in Fudan University Cancer Center during a 10-year period were retrospectively reviewed, and the clinical data of the patients were analyzed for correlation between KPS, clinical stage, tumor size, IPI, ovary involvement, treatment and prognosis. The median age was 45 years, and thirteen patients were diagnosed of diffuse large B-cell lymphoma and one patient lymphoblastic lymphoma. Four patients were stage IE, three stage IIE, and seven stage IVE. The median tumor size was 8 cm (range, 4.0-15.0 cm). The median overall survival (OS) of the 14 patients was 23.0 months (range 11.5-71.2 months). Thirty-six percentage of patients with bilateral ovary involvement had a shorter survival time than those with unilateral ovary involvement (median OS: 19.0 vs. 37.2 months, P=0.014). The OS of Stage IVE was worse than stage IE and stage IIE (median OS: 18.75 vs. 37.5 months, P=0.047). Patients with IPI>2 had worse prognosis than those with IPI?2 (median OS: 19.0 vs. 42.1 months, P=0.03). PONHL patient with larger tumor mass had worse prognosis (median OS: 19.1 vs. 37.2 months, P=0.019). R-CHOP regimens had a tendency to improve the OS but was not shown to be statistically significant (median OS: 22.4 vs. 37.2 months, P=0.436). The management of PONHL should be based on multi-modality treatment including surgery and chemotherapy. The significant prognostic factors of survival are tumor size, Ann Arbor staging, and IPI. PMID:20509008

Zhao, Xiao-Ying; Hong, Xiao-Nan; Cao, Jun-Ning; Leaw, Shiang-Jiin; Guo, Ye; Li, Zi-Ting; Chang, Jian-Hua

2011-12-01

163

Impact of the Primary Care Initiative on the Pediatric Department at the National Naval Medical Center: A Descriptive Analysis.  

National Technical Information Service (NTIS)

In 1997 TRICARE, Region I, the National Capital Area, will begin enrolling beneficiaries into TRICARE Prime. Beneficiaries will be assigned to 'Primary Care Managers', at the primary care sites, based on the zip code of their residence. This enrollment pr...

S. L. Griffitts

1995-01-01

164

Thoracic Posterior Longitudinal Ligament Ossification in a Fixed Population; Longitudinal Radiological Observations.  

National Technical Information Service (NTIS)

All lateral chest radiographs of 34 persons with posterior longitudinal ligament ossification (PLLO) in the thoracic spine were reviewed for date of its onset and its progress. These observations spanned as long as 18 years. Upper mid-thoracic PLLO first ...

M. Ono W. J. Russell S. Kudo

1984-01-01

165

Posterior approaches in the management of cervical spondylosis and ossification of the posterior longitudinal ligament  

Microsoft Academic Search

BACKGROUNDIf the cervical lordotic curvature has been well preserved, spondylostenosis or ossification of the posterior longitudinal ligament, with or without instability, may be approached posteriorly in selected older patients (over 65 years of age). Posterior surgical alternatives include the laminectomy with or without fusion, or laminoplasty. However, in younger patients or in geriatric patients with predominantly anterior disease with kyphosis,

Nancy Epstein

2002-01-01

166

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.

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

2011-01-01

167

The Influence of Heterotopic Ossification on Functional Status of Hip Joint Following Total Hip Arthroplasty  

Microsoft Academic Search

Purpose: The functional failure induced by heterotopic ossification (HO) following total hip arthroplasty (THA) was analyzed and correlated to the radiologic failure. Patients and Methods: From July 1997 to July 2001, 315 patients (345 hips) received THA indicated by a hypertrophic osteoarthritis of higher degree (Kellgren grade III, IV). All patients were irradiated prophylactically for prevention of HO on the

Fabian Pohl; Julia Seufert; Annette Tauscher; Harald Lehmann; Hans-Werner Springorum; Michael Flentje; Oliver Koelbl

2005-01-01

168

Chondrocyte-specific ablation of Osterix leads to impaired endochondral ossification  

PubMed Central

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; Park, Seung-Yoon; de Crombrugghe, Benoit; Kim, Jung-Eun

2014-01-01

169

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

PubMed

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. PMID:6435921

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

1984-10-01

170

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.

1984-10-01

171

Endometrial ossification: a cause of secondary infertility. Report of two cases.  

PubMed

Two cases of endometrial ossification with secondary infertility are reported; pelvic ultrasonography suggested an intrauterine foreign body in one case. Hysteroscopy was necessary to make the correct diagnosis and to remove the bony fragments from the two cases. One patient conceived naturally after the bony fragments were removed. PMID:8178874

Marcus, S F; Bhattacharya, J; Williams, G; Brinsden, P; Hamou, J

1994-05-01

172

Does Immobilization and Pressure Bearing of a Joint Result in Ossification in an Animal Experiment .  

National Technical Information Service (NTIS)

In an animal experiment the complete immobilization and a pressure bearing applied in doses results in a progressive joint-change which leads to an ossification of the joint if the experiment is extended up to 6 months and the compression on the joint has...

H. Stuerz K. Walcher

1974-01-01

173

Bone marrow blood vessel ossification and "microvascular dead space" in rat and human long bone.  

PubMed

Severe calcification of the bone microvascular network was observed in rats, whereby the bone marrow blood vessels appeared ossified. This study sought to characterize the magnitude of ossification in relation to patent blood vessels and adipocyte content in femoral diaphyses. Additionally, this study confirmed the presence of ossified vessels in patients with arteriosclerotic vascular disease and peripheral vascular disease and cellulitis. Young (4-6month; n=8) and old (22-24month; n=8) male Fischer-344 rats were perfused with barium sulfate to visualize patent bone marrow blood vessels. Femoral shafts were processed for bone histomorphometry to quantify ossified (Goldner's Trichrome) and calcified (Alizarin Red) vessels. Adipocyte content was also determined. Additional femora (n=5/age group) were scanned via ?CT to quantify microvascular ossification. Bone marrow blood vessels from the rats and the human patients were also isolated and examined via microscopy. Ossified vessels (rats and humans) had osteocyte lacunae on the vessel surfaces and "normal" vessels were transitioning into bone. The volume of ossified vessels was 4800% higher (p<0.05) in the old vs. young rats. Calcified and ossified vessel volumes per tissue volume and calcified vessel volume per patent vessel volume were augmented (p<0.05) 262%, 375% and 263%, respectively, in the old vs. young rats. Ossified and patent vessel number was higher (171%) and lower (40%), respectively, in the old vs. young rats. Finally, adipocyte volume per patent vessel volume was higher (86%) with age. This study is the first to report ossification of bone marrow blood vessels in rats and humans. Ossification presumably results in "microvascular dead space" in regard to loss of patency and vasomotor function as opposed to necrosis. Progression of bone microvascular ossification may provide the common link associated with age-related changes in bone and bone marrow. The clinical implications may be evident in the difficulties treating bone disease in the elderly. PMID:24680721

Prisby, Rhonda D

2014-07-01

174

A higher frequency of lumbar ossification of the posterior longitudinal ligament in elderly in an outpatient clinic in Japan  

PubMed Central

Purpose Little is known about the prevalence and epidemiological characteristics of lumbar ossification of the posterior longitudinal ligament (OPLL). We analyzed the rate of lumbar OPLL in an outpatient unit where primary care physicians are working in Japan, to better understand the epidemiological characteristics of the disease. Methods We analyzed consecutive, first-time visiting outpatients who received abdominal and pelvic computed tomography (CT) scan at the Department of General Medicine, Asahikawa Medical University Hospital, Japan, between April 2009 and March 2012. Each parameter such as age, sex, and clinical presentation was investigated. Results Out of 393 patients who underwent abdominal and pelvic CT scan, 33 (8.4%) were diagnosed as lumbar OPLL. When compared with patients without lumbar OPLL (n = 360), there was no significant difference in gender, body mass index (BMI), presence of hypertension, diabetes mellitus or hyperlipidemia, and smoking habit, while the age in patients with lumbar OPLL was significantly higher. Conclusion These results suggest for the first time that lumbar OPLL is frequently observed in elderly people in the primary care setting, in Japan.

Okumura, Toshikatsu; Ohhira, Masumi; Kumei, Shima; Nozu, Tsukasa

2013-01-01

175

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

1979-01-01

176

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.

Singh, Mukesh P

2013-01-01

177

2D ESEEM of the [sup 15]N-labeled radical cations of bacteriochlorophyll a and of the primary donor in reaction centers of Rhodobacter sphaeroides  

Microsoft Academic Search

The radical cations of [[sup 15]N]bacteriochlorophyll a and of the primary donor P[sub 865] in [sup 15]N-labeled reaction centers of Rhodobacter spaeroides R-26.1 were investigated in frozen solutions using two-dimensional ESEEM methods. Both three-pulse (stimulated echo) and four-pulse (HYSCORE) sequences were employed to avoid ambiguities in data analysis. Computer simulations of the experimental powder spectra were performed, yielding a complete

H. Kaess; J. Rautter; B. Boenigk; W. Lubitz; P. Hoefer

1995-01-01

178

Multipotent progenitors resident in the skeletal muscle interstitium exhibit robust BMP-dependent osteogenic activity and mediate heterotopic ossification  

PubMed Central

Heterotopic ossification is a debilitating condition that can result from traumatic injury, surgery, or genetic disease. We investigated the cellular origins of heterotopic skeletogenesis in the mouse using lineage tracing and bioassays of heterotopic ossification based on intramuscular transplantation. We identify, characterize and purify a tissue-resident stem/progenitor cell population that exhibits robust osteogenic potential and represents a major cell-of-origin for heterotopic ossification. These progenitors reside in the interstitium of skeletal muscle and other tissues, and are distinct from the endothelium, which does not exhibit osteogenic activity in response to BMP2 stimulation. Intramuscular transplantation together with clonal analysis in culture revealed that these progenitors are multipotent, exhibiting the capacity for both BMP-dependent skeletogenic differentiation and spontaneous adipogenic differentiation. Identifying the cells-of-origin responsible for heterotopic ossification provides a potential therapeutic target to treat, mitigate or prevent this disabling condition.

Wosczyna, Michael N.; Biswas, Arpita A.; Cogswell, Catherine A.; Goldhamer, David J.

2012-01-01

179

Anti-infective prophylaxis for primary immunodeficiencies: what is done in Italian Primary Immunodeficiency Network centers (IPINet) and review of the literature.  

PubMed

Primary immunodeficiencies (PIDs) are rare diseases characterized by an increased susceptibility to infections. Early diagnosis and appropriate treatment are critical for reducing morbidity and mortality. Based on available data, the efficacy of antibiotic administration for the prophylaxis of infections remains uncertain, and recommendations supporting this practice are poor. The use of antimicrobial prophylaxis is mainly based on single institution-specific experience without controlled measurements of patient safety and quality health outcomes. To address this issue an Italian Network on Primary Immunodeficiencies (IPINet) has been set up in 1999 within the Italian Association of Pediatric Hematology and Oncology (AIEOP) to increase the awareness of these disorders among physicians. Further, diagnostic and treatment guideline recommendations have been established to standardize the best clinical assistance to all patients, including antibiotic prophylaxis, and for a national epidemiologic monitoring of PIDs. The aim of this review is not only to give a scientific update on the use of antimicrobial prophylaxis in selected congenital immunological disorders but also to draw a picture of this practice in the context of the Italian Primary Immunodeficiency Network (IPINet). Controlled multicenter studies are necessary to establish if, when and how you should start an efficacious antimicrobial prophylaxis. PMID:24382174

Moschese, V; Martire, B; Soresina, A; Chini, L; Graziani, S; Monteferrario, E; Bacchetta, R; Cancrini, C; Fiorilli, M; Gambineri, E; Pession, A; Pignata, C; Quinti, I; Rondelli, R; Rossi, P; Ugazio, A G; Plebani, A; Pietrogrande, M C

2013-01-01

180

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)

2013-10-15

181

Determination of the primary charge separation rate in isolated photosystem II reaction centers with 500-fs time resolution  

Microsoft Academic Search

The authors have measured directly the rate of formation of the oxidized chlorophyll a electron donor (P680+) and the reduced electron acceptor pheophytin a⁻ (Pheoa⁻) following excitation of isolated spinach photosystem II reaction centers at 4°C. The reaction-center complex consists of Dâ, Dâ, and cytochrome b-559 proteins and was prepared by a procedure that stabilizes the protein complex. Transient absorption

M. R. Wasielewski; D. G. Johnson; M. Seibert; Govindjee

1989-01-01

182

Craniosynostosis of Coronal Suture in Twist1+/? Mice Occurs Through Endochondral Ossification Recapitulating the Physiological Closure of Posterior Frontal Suture  

PubMed Central

Craniosynostosis, the premature closure of cranial suture, is a pathologic condition that affects 1/2000 live births. Saethre-Chotzen syndrome is a genetic condition characterized by craniosynostosis. The Saethre-Chotzen syndrome, which is defined by loss-of-function mutations in the TWIST gene, is the second most prevalent craniosynostosis. Although much of the genetics and phenotypes in craniosynostosis syndromes is understood, less is known about the underlying ossification mechanism during suture closure. We have previously demonstrated that physiological closure of the posterior frontal suture occurs through endochondral ossification. Moreover, we revealed that antagonizing canonical Wnt-signaling in the sagittal suture leads to endochondral ossification of the suture mesenchyme and sagittal synostosis, presumably by inhibiting Twist1. Classic Saethre-Chotzen syndrome is characterized by coronal synostosis, and the haploinsufficient Twist1+/? mice represents a suitable model for studying this syndrome. Thus, we seeked to understand the underlying ossification process in coronal craniosynostosis in Twist1+/? mice. Our data indicate that coronal suture closure in Twist1+/? mice occurs between postnatal day 9 and 13 by endochondral ossification, as shown by histology, gene expression analysis, and immunohistochemistry. In conclusion, this study reveals that coronal craniosynostosis in Twist1+/? mice occurs through endochondral ossification. Moreover, it suggests that haploinsufficiency of Twist1 gene, a target of canonical Wnt-signaling, and inhibitor of chondrogenesis, mimics conditions of inactive canonical Wnt-signaling leading to craniosynostosis.

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

2011-01-01

183

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

PubMed

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

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

2013-01-01

184

The roles of inflammatory cytokines in the pathogenesis of ossification of ligamentum flavum  

PubMed Central

Ossification of Ligamentum Flavum (OLF) is associated with serious neurologic symptoms including thoracic myelopathy and spinal stenosis. The pathogenesis of thoracic OLF is mainly due to the localized mechanical stress on the ligament induced enchondral ossification. However, despite numerous epidemiological and basic science studies, the mechanism of this process remains unclear. Studies have suggested that inflammatory cytokines, such as IL-6, TNF-?, seem to play a crucial role in OLF. In this review, we summarise the mechanistic information on the roles of inflammation cytokines in OLF and discuss about several therapeutic methods for OLF. Further studies on the role of cytokines in OLF should provide important insights into the designation of therapeutic strategies in preventing human spinal stenosis caused by OLF.

Ren, Liang; Hu, Hongtao; Sun, Xianze; Li, Feng; Zhou, Jimmy Jianheng; Wang, Yuan Min

2013-01-01

185

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.

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

2013-01-01

186

Transforming Primary Care Practices in a Hawai'i Island Clinic: Obtaining Patient Perceptions on Patient Centered Medical Home  

PubMed Central

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.

Hunt, Susan B

2012-01-01

187

Creating Rigidly Stabilized Fractures for Assessing Intramembranous Ossification, Distraction Osteogenesis, or Healing of Critical Sized Defects  

PubMed Central

Assessing modes of skeletal repair is essential for developing therapies to be used clinically to treat fractures. Mechanical stability plays a large role in healing of bone injuries. In the worst-case scenario mechanical instability can lead to delayed or non-union in humans. However, motion can also stimulate the healing process. In fractures that have motion cartilage forms to stabilize the fracture bone ends, and this cartilage is gradually replaced by bone through recapitulation of the developmental process of endochondral ossification. In contrast, if a bone fracture is rigidly stabilized bone forms directly via intramembranous ossification. Clinically, both endochondral and intramembranous ossification occur simultaneously. To effectively replicate this process investigators insert a pin into the medullary canal of the fractured bone as described by Bonnarens4. This experimental method provides excellent lateral stability while allowing rotational instability to persist. However, our understanding of the mechanisms that regulate these two distinct processes can also be enhanced by experimentally isolating each of these processes. We have developed a stabilization protocol that provides rotational and lateral stabilization. In this model, intramembranous ossification is the only mode of healing that is observed, and healing parameters can be compared among different strains of genetically modified mice 5-7, after application of bioactive molecules 8,9, after altering physiological parameters of healing 10, after modifying the amount or time of stabilization 11, after distraction osteogenesis 12, after creation of a non-union 13, or after creation of a critical sized defect. Here, we illustrate how to apply the modified Ilizarov fixators for studying tibial fracture healing and distraction osteogenesis in mice.

Yu, Yan-yiu; Bahney, Chelsea; Hu, Diane; Marcucio, Ralph S.; Miclau,, Theodore

2012-01-01

188

[Bilateral ankylosing paraarticular ossifications of the hip joint with involvement of the sciatic nerve].  

PubMed

In December 1997 a 48 year-old man was treated by resection of the bilateral paraarticular ankylosing ossifications that developed after 6 weeks of unconsciousness after necrotic pancreatitis. The ossifications on the posterior part of the hip joint involved a highly separated sciatic nerve. There was a bilateral osseous ankylosis of the hip joint and total denervation of sciatic nerve. In April 1999 the ossifications on the right side were removed. The splitted sciatic nerve was in two osseous channels. The head of the femur was vital and immediately following the operation, flexion of the hip joint was possible to 90 degrees. The same procedure was performed on the left hip joint in October 1999. In April 2000, a re-occurance of the paraarticular ossification on the ventral part of the right hip joint was removed from an ilioinquinal approach. In June 2002 the patient was able to stand and walk without crutches. ROM of the knee joints improved bilaterally to 120 degrees of flexion. The flexion of the right hip joint is 70 degrees and in the left hip is 80 degrees. 3 years after decompression of both sciatic nerves involved in heterotopic bone established significant reinervation. The motor function of the proximal femoral muscles and the function of the tibial nerve was renewed. Complete motor denervation syndrom persists in common peroneal nerve. Sensitive inervation was renewed as in n. tibialis as in common peroneal nerve except acral parts of the foot a toes. Concerning function of the sciatic nerves, the overall results can be assessed as partially succesfull because of partial denervation syndrome of sciatic nerves. In definite clinical improvement the recovery of the neurologic status is very important besides the mechanical improvement of range of motion of the hip joint. PMID:15600127

St?drý, V; Zv?rina, E; Chomiak, J

2004-01-01

189

Endochondral ossification in a case of progressive osseous heteroplasia in a young female child.  

PubMed

Progressive osseous heteroplasia (POH) (OMIM 166350) is a rare autosomal dominant condition, characterized by heterotopic ossification of the skin, subcutaneous fat, and deep connective tissue. This condition is distinct from Albright's hereditary osteodystrophy or McCune Albright syndrome (OMIM 103580) and fibrodysplasia ossificans progressiva (OMIM 135100). We present an unusual presentation of POH in a 7-year-old female child. The clinical features included a painful swelling on the left foot, with mechanical complaints. There was no congenital hallux valgus. Family anamnesis was positive in the father. There were subcutaneous ossifications of his left upper arm, right-sided thorax, and lateral side of the right ankle. The father did not allow any radiographs or further examinations. Radiographic examination of the patient revealed ossified subcutaneous plaques on the left foot, lumbar spine, and left scapulae. Additional blood samples were analyzed, revealing no pseudohypoparathyroidism. Sequence analysis of the gene associated with POH, the GNAS1 gene, revealed the heterozygote mutation c.565_568del, previously found in Albright's hereditary osteodystrophy. Histopathological examination of the subcutaneous ossification showed presence of chondrocyte clusters, a feature usually found in fibrodysplasia ossificans progressiva. The combination of the clinical features, the absence of pseudohypoparathyroidism, histology revealing chondrocyte clusters, and the specific GNAS mutation in this patient makes this a truly unusual presentation of POH. The findings in the described case might denote subdivisions of POH. The condition is associated with progressive superficial to deep ossification, progressive restriction of range of motion, and recurrence if excised. We hope to inform pediatricians and orthopedic surgeons to create more awareness of this disorder so that unnecessary treatments can be avoided and proper counseling offered. PMID:24626099

Schrander, Dirk E; Welting, Tim J; Caron, Marjolein M J; Schrander, Jaap J P; van Rhijn, Lodewijk W; Körver-Keularts, Inge; Schrander-Stumpel, Constance T R M

2014-09-01

190

Absence of endochondral ossification and craniosynostosis in posterior frontal cranial sutures of Axin2(-/-) mice.  

PubMed

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

2013-01-01

191

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.

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

2013-01-01

192

Stage-Specific Secretion of HMGB1 in Cartilage Regulates Endochondral Ossification? †  

PubMed Central

High mobility group box 1 protein (HMGB1) is a chromatin protein that has a dual function as a nuclear factor and as an extracellular factor. Extracellular HMGB1 released by damaged cells acts as a chemoattractant, as well as a proinflammatory cytokine, suggesting that HMGB1 is tightly connected to the process of tissue organization. However, the role of HMGB1 in bone and cartilage that undergo remodeling during embryogenesis, tissue repair, and disease is largely unknown. We show here that the stage-specific secretion of HMGB1 in cartilage regulates endochondral ossification. We analyzed the skeletal development of Hmgb1?/? mice during embryogenesis and found that endochondral ossification is significantly impaired due to the delay of cartilage invasion by osteoclasts, osteoblasts, and blood vessels. Immunohistochemical analysis revealed that HMGB1 protein accumulated in the cytosol of hypertrophic chondrocytes at growth plates, and its extracellular release from the chondrocytes was verified by organ culture. Furthermore, we demonstrated that the chondrocyte-secreted HMGB1 functions as a chemoattractant for osteoclasts and osteoblasts, as well as for endothelial cells, further supporting the conclusion that Hmgb1?/? mice are defective in cell invasion. Collectively, these findings suggest that HMGB1 released from differentiating chondrocytes acts, at least in part, as a regulator of endochondral ossification during osteogenesis.

Taniguchi, Noboru; Yoshida, Kenji; Ito, Tatsuo; Tsuda, Masanao; Mishima, Yasunori; Furumatsu, Takayuki; Ronfani, Lorenza; Abeyama, Kazuhiro; Kawahara, Ko-ichi; Komiya, Setsuro; Maruyama, Ikuro; Lotz, Martin; Bianchi, Marco E.; Asahara, Hiroshi

2007-01-01

193

Genome-Wide Analyses of Gene Expression during Mouse Endochondral Ossification  

PubMed Central

Background Endochondral ossification is a complex process involving a series of events that are initiated by the establishment of a chondrogenic template and culminate in its replacement through the coordinated activity of osteoblasts, osteoclasts and endothelial cells. Comprehensive analyses of in vivo gene expression profiles during these processes are essential to obtain a complete understanding of the regulatory mechanisms involved. Methodology/Principal Findings To address these issues, we completed a microarray screen of three zones derived from manually segmented embryonic mouse tibiae. Classification of genes differentially expressed between each respective zone, functional categorization as well as characterization of gene expression patterns, cytogenetic loci, signaling pathways and functional motifs both confirmed reported data and provided novel insights into endochondral ossification. Parallel comparisons of the microdissected tibiae data set with our previously completed micromass culture screen further corroborated the suitability of micromass cultures for modeling gene expression in chondrocyte development. The micromass culture system demonstrated striking similarities to the in vivo microdissected tibiae screen; however, the micromass system was unable to accurately distinguish gene expression differences in the hypertrophic and mineralized zones of the tibia. Conclusions/Significance These studies allow us to better understand gene expression patterns in the growth plate and endochondral bones and provide an important technical resource for comparison of gene expression in diseased or experimentally-manipulated cartilages. Ultimately, this work will help to define the genomic context in which genes are expressed in long bones and to understand physiological and pathological ossification.

James, Claudine G.; Stanton, Lee-Anne; Agoston, Hanga; Ulici, Veronica; Underhill, T. Michael; Beier, Frank

2010-01-01

194

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.

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

2007-01-01

195

School Health Primary Care Programs in Community and Migrant Health Centers and Health Care for the Homeless Projects. Directory.  

ERIC Educational Resources Information Center

This directory identifies 254 Community and Migrant Health Centers (C/MHC) and Health Care for the Homeless (HCH) programs in 10 regions of the United States that, in response to local requests and with mostly local resources, developed either school-based or school-linked health programs. Each listing provides information under the following…

Health Resources and Services Administration (DHHS/PHS), Rockville, MD. Bureau of Primary Health Care.

196

Randomised primary health center based interventions to improve the diagnosis and treatment of undifferentiated fever and dengue in Vietnam  

Microsoft Academic Search

BACKGROUND: Fever is a common reason for attending primary health facilities in Vietnam. Response of health care providers to patients with fever commonly consists of making a presumptive diagnosis and proposing corresponding treatment. In Vietnam, where malaria was brought under control, viral infections, notably dengue, are the main causes of undifferentiated fever but they are often misdiagnosed and inappropriately treated

Hoang L Phuong; Tran TT Nga; Phan T Giao; Le Q Hung; Tran Q Binh; Nguyen V Nam; Nico Nagelkerke; Peter J de Vries

2010-01-01

197

Primary School, School-Based Decision Making, Family Resource/Youth Services Centers. First Year Reports to the Prichard Committee.  

ERIC Educational Resources Information Center

These three reports by national consultants assess first year progress in implementing state mandated educational reforms in Kentucky. First, "The Status of Primary School Reform in Kentucky and Its Implications," by James Rath, Lilian Katz, and John Fanning, reports on site visits to 14 public schools to assess progress in implementing the…

Raths, James; And Others

198

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

2013-01-01

199

Correlation of paramagnetic states and molecular structure in bacterial photosynthetic reaction centers: the symmetry of the primary electron donor in Rhodopseudomonas viridis and Rhodobacter sphaeroides R-26.  

PubMed Central

The orientation of the principal axes of the primary electron donor triplet state measured in single crystals of photosynthetic reaction centers is compared to the x-ray structures of the bacteria Rhodobacter (Rb.) sphaeroides R-26 and Rhodopseudomonas (Rps.) viridis. The primary donor of Rps. viridis is significantly different from that of Rb. sphaeroides. The measured directions of the axes indicate that triplet excitation is almost completely localized on the L-subunit half of the dimer in Rps. viridis but is more symmetrically distributed (approximately 63% on the L half of the special pair and approximately 37% on the M half) on the dimeric donor in Rb. sphaeroides R-26. The large reduction of the zero field splitting parameters relative to monomeric bacteriochlorophyll triplet in vitro suggests significant participation of asymmetrical charge transfer electronic configurations in the special pair triplet state of both organisms (approximately 23% in Rps. viridis and approximately 13% in Rb. sphaeroides).

Norris, J R; Budil, D E; Gast, P; Chang, C H; el-Kabbani, O; Schiffer, M

1989-01-01

200

Patient-centered perspectives on the access to educational opportunities specific to lifestyle modification in men at risk for primary or secondary prostate cancer.  

PubMed

Educating men at risk for primary or secondary prostate cancer on lifestyle modification may help prevent the development of the disease, reduce the risk of recurrence in those treated for cancer, and slow the progression of active disease. To date, substantial literature on male patient attitudes towards risk modification does not exist. In this project, we evaluate the attitudes and educational needs of men at high-risk for primary or secondary prostate cancer to assess the need for a dedicated clinic focused on education and prevention. Two clinic nurses administered surveys to 76 male patients seen at the University Kansas Cancer Center (KUCC) and Urology clinics. Survey responses showed the patients' perspectives and desire for more support and education regarding late effects of treatment, management of risk, and lifestyle modification. Findings from this survey inspired the establishment of the Burns & McDonnell High-Risk Prostate Cancer Prevention Program at KUCC. PMID:24214853

Diggett, Bethany; Holzbeierlein, Jeffrey; Klemp, Jennifer; Glennon, Cathy; Hamilton-Reeves, Jill M

2014-06-01

201

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

SciTech Connect

Transient absorption measurements of the pheophytin a anion band and Qx band bleach region using preferential excitation of P680 are performed on isolated photosystem II reaction centers to determine the effective rate constant for charge separtion. A novel analysis of the Qx band bleach region explicity takes the changing background into account in order to directly measure the rate of growth of the bleach. Both spectral regions reveal biphasic kinetics, with a ca. (8 ps)-1 rate constant for the faster component, and a ca. (50 ps)-1 rate constant for the slower component. We propose that the fster component corresponds to the effective rate constant for charge separation from within the equilibrated reaction center core and provides a lower limit for the intrinsic rate constant for charge separation. The slower component corresponds to charge separation that is limited by slow energy transfer from a long-wavelength accessory chlorophyll a.

Greenfield, S. R.; Seibert, M.; Govindjee; Wasielewski, M. R.

1997-03-27

202

The Houston parent—child development center and the primary prevention of behavior problems in young children  

Microsoft Academic Search

This study reports the effectiveness of the Houston Parent-Child Development Center (PCDC) program for preventing behavior problems in young children. The PCDC is a 2-year, intensive parent-child education program for children ages 1-3 and their parents. Low-income Mexican American families were randomly assigned to program or control groups. A follow-up of the program 1-4years later, when children averaged 5½ years

Dale L. Johnson; James N. Breckenridge

1982-01-01

203

Primary Care DirectConnect: How the Marriage of Call Center Technology and the EMR Brought Dramatic Results--A Service Quality Improvement Study  

PubMed Central

Of the key Health Plan patient satisfaction measures used in Kaiser Permanente Colorado, ease of contacting the physician's office with a medical question was consistently rated as the lowest quarterly patient satisfaction measure. Furthermore, medical office staff had become dissatisfied with their inability to contact patients who had previously left messages. In addition to the shear volume of messages, the return calls were often unanswered, leading to subsequent attempts to reach patients, creating additional work for medical office staff. DirectConnect—the project name for a system and set of processes focused on improving patient satisfaction with the ability to contact Primary Care delivery teams by telephone—focuses on isolating medical advice calls from the other types of calls handled by the centralized Call Center. The system identifies the patient using his/her unique electronic medical record number, then automatically routes medical advice calls directly to the appropriate Primary Care Physician (PCP) or staff. The clinician may then evaluate and respond to the patient's need quickly, thus managing more of their panel's requests in real time. How is DirectConnect different from simply having the patient contact their PCP's office directly? The primary difference is “one-number” convenience that allows all patients to dial one number to access their PCP's team. In addition, calls are routed to various staff as available to reduce long telephone queues and wait times. The DirectConnect system has resulted in statistically significant improvement in key service quality measures. Patient satisfaction improved from a pre-implementation nine quarter mean of 55.9% to a post-implementation 12 quarter mean of 70.2%. Fourteen percent to 17% of all Primary Care calls are now handled by the patient's home medical office team, creating a 54% improvement in the centralized Call Center's speed of answering calls in the first quarter post implementation—making no additions to medical office staffing levels. The efficiencies gained by directly connecting medical advice-seeking patients with their Primary Care team resulted in an estimated savings of 198 and 247 cumulative hours per week in unnecessary telephone work for Call Center and medical office staff regionwide.

Bowman, Brent; Smith, Scott

2010-01-01

204

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.

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

2014-01-01

205

Modulation of the free energy of the primary quinone acceptor (QA) in reaction centers from Rhodobacter sphaeroides: contributions from the protein and protein-lipid(cardiolipin) interactions.  

PubMed

The redox midpoint potential (E(m)) of Q(A), the primary quinone of bacterial reaction centers, is substantially modulated by the protein environment. Quite subtle mutations in the Q(A) binding site, e.g., at residues M218, M252 and M265, cause significant increases in the equilibrium constant for electron transfer to Q(B), which indicate relative lowering of the E(m) of Q(A). However, reports of functional linkage between the Q(A) and Q(B) sites make it difficult to partition such effects between Q(A) and Q(B) from purely relative changes. We report here measurements on the yield of delayed fluorescence emission from the primary donor (P) accompanying the thermally activated charge recombination of P(+)Q(A)(-) to form the excited singlet state of the primary donor, P*. The results show that for mutations of the Q(A) site residues, Met(M218) and Ile(M265), essentially all the substantial thermodynamic effect is localized at Q(A), with no evidence for a significant effect of these residues on the properties of Q(B) or the mutual influence (linkage) of Q(A) and Q(B). We also report a significant lowering of the E(m) of Q(A) by the native lipid, cardiolipin, which brings the E(m) in isolated reaction centers more in line with that seen in native membrane vesicles (chromatophores). Possible origins of this effect are discussed in the context of the Q(A) binding site structure. PMID:15100021

Rinyu, Laszlo; Martin, Erik W; Takahashi, Eiji; Maróti, Péter; Wraight, Colin A

2004-04-12

206

Dissemination and adoption of the advanced primary care model in the Maryland multi-payer patient centered medical home program.  

PubMed

The Maryland Learning Collaborative together with the Maryland Multi-Payer Program transformed 52 medical practices into patient-centered medical homes (PCMH). The Maryland Learning Collaborative developed an Internet-based 14-question Likert scale survey to assess the impact of the PCMH model on practices and providers, concerning how this new method is affecting patient care and outcomes. The survey was sent to 339 practitioners and 52 care management teams at 18 months into the program. Sixty-seven survey results were received and analyzed. After 18 months of participation in the PCMH initiative, participants demonstrated a better understanding of the PCMH initiative, improved patient access to care, improved care coordination, and increased health information technology optimization (p > .001). The findings from the survey evaluation suggest that practice participation in the Maryland Multi-Payer Program has enhanced access to care, influenced patient outcomes, improved care coordination, and increased use of health information technology. PMID:24583492

Khanna, Niharika; Shaya, Fadia; Chirikov, Viktor; Steffen, Ben; Sharp, David

2014-02-01

207

Slow dissociation of a charged ligand: analysis of the primary quinone Q(A) site of photosynthetic bacterial reaction centers.  

PubMed

Reaction centers (RCs) are integral membrane proteins that undergo a series of electron transfer reactions during the process of photosynthesis. In the Q(A) site of RCs from Rhodobacter sphaeroides, ubiquinone-10 is reduced, by a single electron transfer, to its semiquinone. The neutral quinone and anionic semiquinone have similar affinities, which is required for correct in situ reaction thermodynamics. A previous study showed that despite similar affinities, anionic quinones associate and dissociate from the Q(A) site at rates ?10(4) times slower than neutral quinones indicating that anionic quinones encounter larger binding barriers (Madeo, J.; Gunner, M. R. Modeling binding kinetics at the Q(A) site in bacterial reaction centers. Biochemistry 2005, 44, 10994-11004). The present study investigates these barriers computationally, using steered molecular dynamics (SMD) to model the unbinding of neutral ground state ubiquinone (UQ) and its reduced anionic semiquinone (SQ(-)) from the Q(A) site. In agreement with experiment, the SMD unbinding barrier for SQ(-) is larger than for UQ. Multi Conformational Continuum Electrostatics (MCCE), used here to calculate the binding energy, shows that SQ(-) and UQ have comparable affinities. In the Q(A) site, there are stronger binding interactions for SQ(-) compared to UQ, especially electrostatic attraction to a bound non-heme Fe(2+). These interactions compensate for the higher SQ(-) desolvation penalty, allowing both redox states to have similar affinities. These additional interactions also increase the dissociation barrier for SQ(-) relative to UQ. Thus, the slower SQ(-) dissociation rate is a direct physical consequence of the additional binding interactions required to achieve a Q(A) site affinity similar to that of UQ. By a similar mechanism, the slower association rate is caused by stronger interactions between SQ(-) and the polar solvent. Thus, stronger interactions for both the unbound and bound states of charged and highly polar ligands can slow their binding kinetics without a conformational gate. Implications of this for other systems are discussed. PMID:21863833

Madeo, Jennifer; Mihajlovic, Maja; Lazaridis, Themis; Gunner, M R

2011-11-01

208

Osteogenic lineage commitment of mesenchymal stem cells from patients with ossification of the posterior longitudinal ligament.  

PubMed

Ectopic bone formation is thought to be responsible for ossification of the posterior longitudinal ligament of the spine (OPLL). Mesenchymal stem cells (MSCs) were isolated from spinal ligaments and shown to play a key role in the process of ectopic ossification. The purpose of this study was to explore the capacity of these MSCs to undergo lineage commitment and to assess the gene expression changes between these committed and uncommitted MSCs between OPLL and non-OPLL patients. Spinal ligament-derived cells were obtained from OPLL patients or patients with cervical spondylotic myelopathy (non-ossified) for comparison (n=8 in each group). MSCs from the two patient cohorts were evaluated for changes in colony forming ability; osteogenic, adipogenic and chondrogenic differentiation potential; and changes in gene expression following induction with lineage-specific conditions. We show that the osteogenic differentiation potential was significantly higher in MSCs from OPLL patients than in those from non-OPLL patients. In addition, alkaline phosphatase activity and several osteogenic-related genes expressions (bone morphogenetic protein 2, runt-related transcription factor 2 and alkaline phosphatase) were significantly higher in the OPLL group than in the non-OPLL group. However, single cell cloning efficiency, adipogenic and chondrogenic differentiation, and the expression of adipogenic and chondrogenic-related genes were equivalent between MSCs harvested from OPLL and non-OPLL patient samples. These findings suggest an increase in the osteogenic differentiation potential of MSCs from OPLL patients and that this propensity toward the osteogenic lineage may be a causal factor in the ossification in these ligaments. PMID:24361881

Harada, Yoshifumi; Furukawa, Ken-Ichi; Asari, Toru; Chin, Shunfu; Ono, Atsushi; Tanaka, Toshihiro; Mizukami, Hiroki; Murakami, Manabu; Yagihashi, Soroku; Motomura, Shigeru; Ishibashi, Yasuyuki

2014-01-17

209

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

PubMed

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

2014-01-01

210

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.

MacCarthy, Dan; Hollander, Marcus J

2014-01-01

211

Low rates of heterotopic ossification after resurfacing hip arthroplasty with use of prophylactic radiotherapy in select patients.  

PubMed

Recent reports have noted higher rates of heterotopic ossification (HO) with surface replacement arthroplasty (SRA) than with traditional total hip arthroplasty in the absence of postoperative HO prophylaxis. This study reports rates and grades of HO in 44 SRA patients with at least 1 year of follow-up. Heterotopic ossification prophylaxis was used in 32 (73%) of 44 cases. Heterotopic ossification prophylaxis consisted of radiotherapy (22/32), nonsteroidal anti-inflammatory drugs (8/32), or both (2/32). One case of clinically significant HO was documented in the no-prophylaxis group. This strategy of selective HO prophylaxis in patients felt by orthopedic surgeons to be at high risk of HO resulted in low rates of clinically relevant HO after SRA (1/44, 2.3%). Further study is needed to establish optimal selection criteria for HO prophylaxis after SRA. PMID:22245125

Kruser, Tim J; Kozak, Kevin R; Cannon, Donald M; Platta, Christopher S; Heiner, John P; Illgen, Richard L

2012-08-01

212

Vascular pedicle ossification of free fibular flap: is it a rare phenomenon? Is it possible to avoid this risk?  

PubMed

Free fibula flap is the most common free tissue transfer for maxillary and mandibular reconstructions. The distal part of the harvested bone is transferred, while the proximal part is removed by sub-periosteum dissection. The vascularized periosteum attached to the vascular pedicle has osteogenic potential. 61 patients reconstructed with free fibula flaps were divided in 2 groups: 41 flaps performed with a standard technique and 20 flaps performed by dissecting the periosteum from the pedicle. Patients were followed up with orthopantomography and CT scan at 6, 12, 18 and 24 months after surgery. The minimum follow-up time was 18 months. With retrospective analysis of the first group we diagnosed 7 pedicle ossifications on 41 reconstructions (17%). In the second group, no pedicle ossification was observed (p < 0.05). The dissection of periosteum from the vascular pedicle of free fibula flaps avoids the risk of ossification. PMID:24227895

Tarsitano, A; Sgarzani, R; Betti, E; Oranges, C M; Contedini, F; Cipriani, R; Marchetti, C

2013-10-01

213

Heterotopic ossification following traumatic brain injury and spinal cord injury: insight into the etiology and pathophysiology.  

PubMed

Neurogenic heterotopic ossification (HO) is the ectopic formation of lamellar bone in non-osseous tissues following traumatic brain or spinal cord injury. The associated complications affect greatly their quality of life. This fact has shifted the focus of scientific effort towards the investigation and understanding of related risk factors and the pathophysiological mechanisms. Recent advancements include the investigation for genetic predisposition and association various biomarkers. In the present article we will analyze the current concepts on this topic, based on clinical and physiological evidence and we will discuss the potential areas for future research on this field. PMID:23196266

Sakellariou, V I; Grigoriou, E; Mavrogenis, A F; Soucacos, P N; Papagelopoulos, P J

2012-12-01

214

[Ossification of the stylohyoid chain in computerized tomography--Eagle syndrome].  

PubMed

The computed tomographic morphology of a typical Eagle syndrome is presented on the basis of a case history. In a 40-year old male patient [correction of female] presenting with bilateral tinnitus, globus hystericus, and increasing hoarseness computed tomography revealed bilateral ossification of the stylohyoid ligament. The incidence of stylalgia is very low in comparison to the occurrence of a elongated styloid process or an ossified stylohyoid ligament. However, in cases of unexplained complaints in the head and neck region it should be considered in the differential diagnosis as it has therapeutic consequences. PMID:9467028

Lugmayr, H; Krennmair, G; Lenglinger, F

1997-11-01

215

Genetics of Ossification of the Posterior Longitudinal Ligament of the Spine: A Mini Review  

PubMed Central

Ossification of the posterior longitudinal ligament of the spine (OPLL) is a common disease in aging populations and sometimes results in serious neurological problems due to compression of the spinal cord and nerve roots. OPLL is a multi-factorial (polygenic) disease controlled by genetic and environmental factors. Studies searching for the genetic component of OPLL, using linkage and association analyses, are in progress and several susceptibility genes have been reported. This paper reviews the recent progress in the genetic study of OPLL and comments on its future task.

2014-01-01

216

Hematopoietic Cell Transplantation for Primary Plasma Cell Leukemia: Results from the Center for International Blood and Marrow Transplant Research  

PubMed Central

There is limited data on hematopoietic cell transplantation (HCT) in primary plasma cell leukemia (pPCL), an aggressive plasma cell disorder. We report outcomes of 147 patients with pPCL receiving autologous (n=97) or allogeneic (n=50) HCT within 18 months after diagnosis between 1995 and 2006. Median age was 56 years and 48 years for autologous HCT and allogeneic HCT respectively. Progression-free survival (PFS) at 3 years was 34% (95% CI, 23%-46%) in the autologous group and 20% (95% CI, 10%-34%) in the allogeneic group. Cumulative incidence of relapse at 3 years was 61% (95% CI, 48%-72%) in the autologous group and 38% (95% CI, 25%-53%) in the allogeneic group. Overall survival (OS) at 3 years was 64% (95% CI, 52%-75%) in the autologous group and 39% (95% CI, 26%-54%) in the allogeneic group. Non-relapse mortality (NRM) at 3 years was 5% (95% CI, 1-11%) in the autologous group and 41% (95% CI, 28%-56%) in the allogeneic group. The encouraging OS after autologous HCT, establishes the safety and feasibility of this consolidative treatment option after initial induction therapy for pPCL. Allogeneic HCT, although associated with a significantly lower relapse rate, carries a much higher risk of NRM and no overall survival benefit.

Mahindra, Anuj; Kalaycio, Matt E.; Vela-Ojeda, Jorge; Vesole, David H.; Zhang, Mei-Jie; Li, Peigang; Berenson, James R.; Bird, Jennifer M.; Dispenzieri, Angela; Gajewski, James L.; Gale, Robert P.; Holmberg, Leona; Kumar, Shaji; Kyle, Robert A.; Lazarus, Hillard M.; Lonial, Sagar; Mikhael, Joseph; Milone, Gustavo A.; Munker, Reinhold; Nath, Rajneesh; Saccaro, Steven; To, L Bik; Vogl, Dan T.; Wirk, Baldeep; Hari, Parameswaran

2011-01-01

217

Development and pilot testing of HIV screening program integration within public/primary health centers providing antenatal care services in Maharashtra, India  

PubMed Central

Background The objectives of this paper are: (1) to study the feasibility and relative benefits of integrating the prevention of parent-to-child transmission (PPTCT) component of the National AIDS Control Program with the maternal and child health component of the National Rural Health Mission (NRHM) by offering HIV screening at the primary healthcare level; and (2) to estimate the incremental cost-effectiveness ratio to understand whether the costs are commensurate with the benefits. Methods The intervention included advocacy with political, administrative/health heads, and capacity building of health staff in Satara district, Maharashtra, India. The intervention also conducted biannual outreach activities at primary health centers (PHCs)/sub-centers (SCs); initiated facility-based integrated counseling and testing centers (FICTCs) at all round-the-clock PHCs; made the existing FICTCs functional and trained PHC nurses in HIV screening. All “functional” FICTCs were equipped to screen for HIV and trained staff provided counseling and conducted HIV testing as per the national protocol. Data were collected pre- and post- integration on the number of pregnant women screened for HIV, the number of functional FICTCs and intervention costs. Trend analyses on various outcome measures were conducted. Further, the incremental cost-effectiveness ratio per pregnant woman screened was calculated. Results An additional 27% of HIV-infected women were detected during the intervention period as the annual HIV screening increased from pre- to post-intervention (55% to 79%, p?centers; 92% of mother-baby pairs received Nevirapine; and 89% of exposed babies were enrolled for early infant diagnosis. The incremental cost-effectiveness ratio was estimated at INR 44 (less than 1 US$) per pregnant woman tested. Conclusions Integrating HIV screening with the broader Rural Health Mission is a promising opportunity to scale up the PPTCT program. However, advocacy, sensitization, capacity building and the judicious utilization of available resources are key to widening the reach of the PPTCT program in India and elsewhere.

2014-01-01

218

Potential prescription patterns and errors in elderly adult patients attending public primary health care centers in Mexico City  

PubMed Central

Introduction Six out of every 10 elderly persons live in developing countries. Objective To analyze and assess the drug prescription patterns and errors in elderly outpatients attending public health care centers in Mexico City, Mexico. Materials and methods A descriptive and retrospective study was conducted in 2007. Fourteen hundred prescriptions were analyzed. Prescriptions of ambulatory adults aged >70 years who were residents of Mexico City for at least two years were included. Prescription errors were divided into two groups: (1) administrative and legal, and (2) pharmacotherapeutic. In group 2, we analyzed drug dose strength, administration route, frequency of drug administration, treatment length, potential drug–drug interactions, and contraindications. Variables were classified as correct or incorrect based on clinical literature. Variables for each drug were dichotomized as correct (0) or incorrect (1). A Prescription Index (PI) was calculated by considering each drug on the prescription. SPSS statistical software was used to process the collected data (95% confidence interval; p <0.05). Results The drug prescription pattern in elderly outpatients shows that 12 drugs account for 70.72% (2880) of prescribed drugs. The most prescribed drugs presented potential pharmacotherapeutic errors (as defined in the present study). Acetylsalicylic acid–captopril was the most common potential interaction (not clinically assessed). Potential prescription error was high (53% of total prescriptions). Most of the prescription errors were due to omissions of dosage, administration route, and length of treatment and may potentially cause harm to the elderly outpatients. Conclusions A high number of potential prescription errors were found, mainly due to omissions. The drug prescription pattern of the study population is mainly constituted by 12 drugs. The results indicate that prescription quality depends on the number of prescribed drugs per prescription (p < 0.000).

Corona-Rojo, Jose Antonio; Altagracia-Martinez, Marina; Kravzov-Jinich, Jaime; Vazquez-Cervantes, Laura; Perez-Montoya, Edilberto; Rubio-Poo, Consuelo

2009-01-01

219

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.

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

2014-01-01

220

Structural studies of the primary donor cation radical P870+· in reaction centers of Rhodospirillum rubrum by electron-nuclear double resonance in solution  

PubMed Central

The light-induced cation radical of the primary electron donor, P870+·, in photosynthetic reaction centers from Rhodospirillum rubrum G-9, has been investigated by electron-nuclear double resonance (ENDOR) in liquid aqueous solution. The measured hyperfine coupling constants are assigned to specific molecular positions by partial deuteration. Comparison with the bacteriochlorophyll a cation radical shows different reduction factors of the individual coupling constants deviating from the value 2.0 reported in earlier investigations in frozen solutions. The average of the coupling constants is, however, reduced by a factor very close to 2.0. EPR simulations using the ENDOR coupling constants support a dimer model for P870+· with C2 symmetry, where the two macrocycles are close enough to form a supermolecular orbital resulting in a different distribution of the unpaired electron, compared with the monomeric bacteriochlorophyll a cation radical. Molecular orbital calculations were used to obtain structural information about this dimer.

Lubitz, W.; Lendzian, F.; Scheer, H.; Gottstein, J.; Plato, M.; Mobius, K.

1984-01-01

221

15N electron nuclear double resonance of the primary donor cation radical P+.865 in reaction centers of Rhodopseudomonas sphaeroides: additional evidence for the dimer model.  

PubMed Central

Four 15N hyperfine coupling constants, including signs, have been measured by electron nuclear double resonance (ENDOR) and electron nuclear nuclear triple resonance (TRIPLE) for the bacteriochlorophyll a radical cation, BChla+., in vitro and for the light-induced primary donor radical cation, P+.865, in reaction centers of Rhodopseudomonas sphaeroides R-26. A comparison of the data shows that the hyperfine coupling constants have the same sign in both radicals and are, on the average, smaller by a factor of 2 in P+.865. These results provide additional evidence that P+.865 is a bacteriochlorophyll dimer and are in contradiction with the monomer structure of P+.865 recently proposed by O'Malley and Babcock. The reduction factors of the individual 15N couplings, together with the evidence from proton ENDOR data and molecular orbital calculations, indicate a dimer structure in which only two rings (either I and I or III and III) of the bacteriochlorophyll macrocycles overlap.

Lubitz, W; Isaacson, R A; Abresch, E C; Feher, G

1984-01-01

222

The use of spect/ct in the evaluation of heterotopic ossification in para/tetraplegics  

PubMed Central

Objective: To evaluate the stage of maturation and the metabolism of neurogenic heterotopic ossification by using SPECT/CT. Methods: A total of 12 medical records of patients with spinal cord injury, all of them classified according to the ASIA protocol (disability scale from the American Spinal Injury Association) in complete lesion (A) and partial lesions (B, C and D) and registered at the Laboratory of Biomechanics and Rehabilitation of the Locomotor System, were submitted to SPECT/CT evaluation. Results: Sixteen hips with heterotopic ossification observed in X-ray were studied and only two (12.5%) had high osteoblastic activity. Five hips showed medium activity, three (18.75%) low activity and six (37.5%) did not present any activity detected by SPECT/CT. Conclusion: SPECT/CT helps to determinate which patients have a greater risk of relapse after surgical resection, proving to be a useful imaging study in preoperative evaluation that can be used to determinate the postoperative prognosis of these patients. Level of Evidence III, Investigating a Diagnostic Test.

Lima, Mauricio Coelho; Passarelli, Marcus Ceregati; Dario, Virgilio; Lebani, Bruno Rodrigues; Monteiro, Paulo Henrique Silva; Ramos, Celso Dario

2014-01-01

223

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.

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

2013-01-01

224

Heterotopic ossification around the hip with intramedullary nailing of the femur.  

PubMed

Heterotopic ossification (HO) at the proximal end of a reamed intramedullary femoral nail is a complication of the procedure. Kuntscher stated that these "callus caps" were due to the prominence of the nail above the greater trochanter. A study of patients undergoing locked intramedullary nailing of the femur to assess subsequent development of heterotopic ossification at the proximal end of the implant was done. The purpose was to study the clinical significance of the ectopic bone and identify etiologic factors of bone formation. This group consisted of 59 patients with 60 locked intramedullary nails who were reviewed after prospective clinical and radiologic followup. Ectopic bone around the proximal end of the nail was classified with respect to quantity and clinical importance. A number of parameters were evaluated and a multifactorial analysis was performed. There were 52 males and seven females. Heterotopic bone was graded as: none--32%; minimal--20%, mild--28%; moderate--15%; and severe--5%. There was a positive correlation between bone formation and head injury, Injury Severity Score, and ventilator and ICU days. Prominence of the nail was not significant. PMID:3137364

Marks, P H; Paley, D; Kellam, J F

1988-08-01

225

Factors contributing to non-compliance among diabetics attending primary health centers in the Al Hasa district of Saudi Arabia  

PubMed Central

Purpose: The purpose of the study was to measure the rate of non-compliance and the factors contributing to non-compliance among the diabetic patients in the Al Hasa region of Saudi Arabia. Materials and Methods: A cross-sectional survey was conducted in the Al Hasa region during the period of June 2010 to June 2011. Random sampling was carried out for the selection of 535 diabetic patients from three chronic disease centers in different parts of Al Hasa. The data were collected by means of interviewing questionnaires and file records. Any patient who had been prescribed optimum treatment and was properly advised on diet and exercise for his / her diabetes, but did not follow the medical advice, with Hb1AC of more than 7% at the time of interview, was considered as non-compliant. Results: The overall prevalence of therapeutic non-compliance of the participants was 67.9% (n = 318, 95% CI 63.59 – 72.02%). The non-compliance of males (69.34%) was higher than females (65.45%, P = .003). The non-compliance among the urban participants was significantly higher than (71.04 vs. 60.15%, P = .023) in the rural participants. There was a statistically significant difference in the prevalence rate of non-compliance among the participants with different levels of education. Factors found to be significantly associated with non-compliance on bi-variate analysis were: female gender (OR = 1.90, CI =1.32-4.57),level of education (Illiteracy) (OR = 5.27, CI = 4.63 – 7.19), urban population (OR =5.22, CI= 3.65 – 8.22), irregularity of the follow-up (OR = 8.41, CI = 4.90 – 11.92), non-adherence to drug prescription (OR = 4.55 , CI = 3.54 – 5.56), non-adherence to exercise regimen (OR = 5.55, CI = 4.2 6 – 6.), insulin (OR = 1.29, CI = .71 – 1.87), and insulin with oral Metformin (OR = 1.20, CI = .65 – 1.75). Conclusion: The findings indicate that there is a high rate of non-compliance among the diabetes patients in the Al Hasa region of Saudi Arabia and there is a definite need for improvement in the healthcare system, health education, and training of diabetic patients.

Khan, Ataur R.; Al-Abdul Lateef, Zaki N.; Al Aithan, Mohammad A.; Bu-Khamseen, Montaser A.; Ibrahim, Ibrahim Al; Khan, Shabbir A.

2012-01-01

226

Evidence that Ala M260 is hydrogen-bonded to the reduced primary acceptor quinone Q A-. in reaction centers of Rb. sphaeroides  

NASA Astrophysics Data System (ADS)

The binding of the primary quinone anion radical Q A-. in reaction centers (Rcs) of Rhodobacter (Rb.) sphaeroides species was investigated with electron spin echo envelope modulation (ESEEM). The ESEEM spectra, at two microwave frequencies, of Zn-substituted RCs of Rb. sphaeroides R26 showed interactions of the unpaired electron of Q A-. with two nitrogen nuclei in the protein matrix. From an analysis of the experimental data the nitrogen nuclear quadrupole resonance parameters were determined: e2qQ/ h = 1.52 MHz, ? = 0.82 and e2qQ/ h = 3.04 MHz, ? = 0.66, which are assigned to the 14N ?(1)?N group of His M219 and the peptide 14N of Ala M260. The ESEEM spectrum of Q A-. in reaction centers of the Rb. sphaeroides mutant W(M252)Y shows that the nitrogen of Trp M252 is not interacting with Q A-., that of the mutant H(M266)C shows that manipulating the Fe binding site strongly affects the Q A-binding site.

Spoyalov, A. P.; Hulsebosch, R. J.; Shochat, S.; Gast, P.; Hoff, A. J.

1996-12-01

227

Heterotopic ossification of the knee joint in intensive care unit patients: early diagnosis with magnetic resonance imaging  

Microsoft Academic Search

INTRODUCTION: Heterotopic ossification (HO) is the formation of bone in soft tissues. The purpose of the present study was to evaluate the magnetic resonance imaging (MRI) findings on clinical suspicion of HO in the knee joint of patients hospitalised in the intensive care unit (ICU). METHODS: This was a case series of 11 patients requiring prolonged ventilation in the ICU

Maria I Argyropoulou; Eleonora Kostandi; Paraskevi Kosta; Anastasia K Zikou; Dimitra Kastani; Efi Galiatsou; Athanassios Kitsakos; George Nakos

2006-01-01

228

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.

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

2007-01-01

229

Osterix Regulates Calcification and Degradation of Chondrogenic Matrices through Matrix Metalloproteinase 13 (MMP13) Expression in Association with Transcription Factor Runx2 during Endochondral Ossification*  

PubMed Central

Endochondral ossification is temporally and spatially regulated by several critical transcription factors, including Sox9, Runx2, and Runx3. Although the molecular mechanisms that control the late stages of endochondral ossification (e.g. calcification) are physiologically and pathologically important, these precise regulatory mechanisms remain unclear. Here, we demonstrate that Osterix is an essential transcription factor for endochondral ossification that functions downstream of Runx2. The global and conditional Osterix-deficient mice studied here exhibited a defect of cartilage-matrix ossification and matrix vesicle formation. Importantly, Osterix deficiencies caused the arrest of endochondral ossification at the hypertrophic stage. Microarray analysis revealed that matrix metallopeptidase 13 (MMP13) is an important target of Osterix. We also showed that there exists a physical interaction between Osterix and Runx2 and that these proteins function cooperatively to induce MMP13 during chondrocyte differentiation. Most interestingly, the introduction of MMP13 stimulated the calcification of matrices in Osterix-deficient mouse limb bud cells. Our results demonstrated that Osterix was essential to endochondral ossification and revealed that the physical and functional interaction between Osterix and Runx2 were necessary for the induction of MMP13 during endochondral ossification.

Nishimura, Riko; Wakabayashi, Makoto; Hata, Kenji; Matsubara, Takuma; Honma, Shiho; Wakisaka, Satoshi; Kiyonari, Hiroshi; Shioi, Go; Yamaguchi, Akira; Tsumaki, Noriyuki; Akiyama, Haruhiko; Yoneda, Toshiyuki

2012-01-01

230

Mechanism by which a single water molecule affects primary charge separation kinetics in a bacterial photosynthetic reaction center of Rhodobacter sphaeroides  

NASA Astrophysics Data System (ADS)

Using quantum-chemical methods, we have studied the role played by water molecules W-A and W-B that are bound by hydrogen bonds to accessory bacteriochlorophyll molecules B A and B B in the process of primary charge separation in the reaction center of Rhodobacter Sphaeroides. We have found that the occurrence of a rotational mode of the W-A molecule at 32 cm-1 and/or its harmonics in stimulated emission of an electron donor P* and the dynamics of population of the states P+B{/A -} and P+H{/A -} may be related to the structural heterogeneity of the reaction center and the existence of a conformation in which the W-A molecule is predominantly involved in one hydrogen bond (with B A). Based on the calculated redox potentials B A and P, it has been shown that the appearance of the W-A molecule in the reaction center reduces the energy of the P+B{/A -} state by ˜600 cm-1. This is somewhat smaller than the influence of the amino-acid residue TyrM210 (˜870 cm-1) and correlates well with a substantial decrease in the electron transfer rate in mutant forms of reaction centers GM203L (which do not contain W-A molecules) and YM210F (in which TyrM210 is replaced with Phe). The data obtained allow us to suggest that rotation of the water molecule with a fixed position of its H atom that is involved in a hydrogen bond with the keto carbonyl group of B A is initiated due to the charge separation between the halves of special pair P and the formation of the state P{/A +}P{/B -}. The large effect of this rotation on the kinetics of population of the states P+B{/A -} and P+H{/A -} after the excitation of P is quite consistent with its influence on the energy of the state P+B{/A -}.

Ivashin, N. V.; Shchupak, E. E.

2012-11-01

231

Site-directed mutations near the L-subunit D-helix of the purple bacterial reaction center: a partial model for the primary donor of photosystem II.  

PubMed

We have engineered a photosynthetically competent mutant of the purple non-sulfur bacterium Rhodobacter capsulatus which seeks to mimic the behavior of the primary electron donor (P) of the plant photosystem II (PS II) reaction center (RC). To construct this mutant (denoted D1-ILMH), four residues in the bacterial L subunit were mutagenized, such that an 11-residue segment was made identical to the analogous segment from the D1 subunit of PS II. The electronic properties of the bacteriochlorophyll (Bchl) dimer which constitutes the primary donor are substantially altered by these modifications, to the degree that the dimer becomes functionally much more "monomeric". The changes include (1) an increase in the values of the zero-field splitting (ZFS) parameters, as measured by electron paramagnetic resonance (EPR), for the spin-polarized triplet state, 3P, from /D/ = 185 x 10(-4) cm(-1) and /E/ = 31 x 10(-4) cm(-1) in wild-type (WT) chromatophore membranes to /D/ = 200 x 10(-4) cm(-1) and /E/ = 44 x 10(-4) cm(-1) in the mutant and (2) an increase in the EPR line width of the oxidized state, P+, from 0.97 mT in WT to 1.09 mT in D1-ILMH RCs. However, unlike the PS II primary donor (P680), the orientation of 3P in the D1-ILMH mutant is the same as in WT bacteria and does not display the unusual orientation found for PS II. And whereas the redox couple P/P+ has a very high midpoint potential in PS II, P/P+ in the D1-ILMH mutant has a lower midpoint (90 mV more negative) than in WT Rb. capsulatus. In addition, Raman measurements indicate that the hydrogen bond between HisL168 and the C2 acetyl carbonyl oxygen of the Bchl on the active electron transfer pathway (P(A)) is absent in the mutant, due to the fact that HisL168 in the WT sequence has been replaced by a leucine in D1-ILMH. However, the Raman data also reveal the presence of a new hydrogen bond in the D1-ILMH RCs, between the C9 keto carbonyl oxygen of P(A) and an unknown hydrogen-bond donor. Thus, although the protein environment around one of the Bchls of the special pair is significantly changed in D1-ILMH, the chimeric RC does not, as a result of these changes, have a primary donor that is oriented like the one in PS II. PMID:9047318

Coleman, W J; Mattioli, T A; Youvan, D C; Rutherford, A W

1997-02-25

232

Racial and ethnic differences in primary, unscheduled cesarean deliveries among low-risk primiparous women at an academic medical center: a retrospective cohort study  

PubMed Central

Background Cesarean sections are the most common surgical procedure for women in the United States. Of the over 4 million births a year, one in three are now delivered in this manner and the risk adjusted prevalence rates appear to vary by race and ethnicity. However, data from individual studies provides limited or contradictory information on race and ethnicity as an independent predictor of delivery mode, precluding accurate generalizations. This study sought to assess the extent to which primary, unscheduled cesarean deliveries and their indications vary by race/ethnicity in one academic medical center. Methods A retrospective, cross-sectional cohort study was conducted of 4,483 nulliparous women with term, singleton, and vertex presentation deliveries at a major academic medical center between 2006–2011. Cases with medical conditions, risk factors, or pregnancy complications that can contribute to increased cesarean risk or contraindicate vaginal birth were excluded. Multinomial logistic regression analysis was used to evaluate differences in delivery mode and caesarean indications among racial and ethnic groups. Results The overall rate of cesarean delivery in our cohort was 16.7%. Compared to White women, Black and Asian women had higher rates of cesarean delivery than spontaneous vaginal delivery, (adjusted odds ratio {AOR}: 1.43; 95% CI: 1.07, 1.91, and AOR: 1.49; 95% CI: 1.02, 2.17, respectively). Black women were also more likely, compared to White women, to undergo cesarean for fetal distress and indications diagnosed in the first stage as compared to the second stage of labor. Conclusions Racial and ethnic differences in delivery mode and indications for cesareans exist among low-risk nulliparas at our institution. These differences may be best explained by examining the variation in clinical decisions that indicate fetal distress and failure to progress at the hospital-level.

2013-01-01

233

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: hmamon@partners.org

2006-08-01

234

Fibrodysplasia ossificans progressiva in a Maine Coon cat with prominent ossification in dorsal muscle.  

PubMed

A one-year and six-month-old female Maine Coon cat presented with skin problems and paravertebral induration with a history of seven months. Survey radiographs and computed tomography revealed prominent calcifications in both sides of cervical, thoracic and lumbar vertebrae and soft tissue in femoral regions, below knee regions and in brachial regions. Histopathological findings from muscle biopsy samples showed connective tissue proliferation around adjacent skeletal muscle, cartilage formation and endochondral ossification. On the basis of these findings, this feline patient was diagnosed with fibrodysplasia ossificans progressiva (FOP). The most prominent signs observed in this FOP case were significant calcifications of dorsal muscle and presentation of cutaneous signs at the early stage. PMID:20046034

Yabuzoe, Atsushi; Yokoi, Shin-ichi; Sekiguchi, Maiko; Momoi, Yasuyuki; Ide, Kaori; Nishifuji, Koji; Iwasaki, Toshiroh

2009-12-01

235

Ossification of vascular pedicle in fibular free flaps: a report of four cases.  

PubMed

The fibular free flap is the most widely used flap for jaw reconstruction. Flap contouring requires removal of bone excess in the proximal segment by a subperiosteal dissection, preserving vascular connections between the pedicle and the bone and leaving well vascularized periosteum attached to the vascular pedicle. Among about 100 reconstructions with fibular flaps, 4 cases were observed of abnormal ossification along the vascular pedicle. Periosteum preserves its osteogenic capability after transposition, especially in a revascularized flap; this characteristic, together with the direct contact with the bone, allows the possibility of new bone formation along the pedicle. It would appear necessary to change the technique of reducing fibular excess, with removal of periosteum together with the bone, in order to avoid the complication described. PMID:18372160

Autelitano, L; Colletti, G; Bazzacchi, R; Biglioli, F

2008-07-01

236

BMP-9 expression in human traumatic heterotopic ossification: a case report  

PubMed Central

Background Heterotopic ossification (HO) is defined as the abnormal formation of mature bone in soft tissue, notably skeletal muscle. The morbidity of HO in polytraumatized patients impacts the functional outcome, impairs rehabilitation, and increases costs due to subsequent surgical interventions. Case presentation We present the case of a 34-year-old African male who developed severe HO around his right hip 11 days after a major trauma. Immunohistochemical analyses of resected tissue revealed that several BMPs were expressed in the HO, including highly osteogenic BMP-9. Conclusions To the best of our knowledge, this is the first report of local BMP expression, notably BMP-9, in traumatic HO, and suggests that BMP-9, possibly through mrSCs, can contribute to HO formation in soft tissues when a suitable microenvironment is present.

2013-01-01

237

Ontogenetic and structural variation of mineralizations and ossifications in the integument within ceratophryid frogs (anura, Ceratophryidae).  

PubMed

Ceratophryidae represent a monophyletic group of terrestrial and aquatic frogs inhabiting lowlands of South America where they are more diverse in semiarid environments of the Chaco region. Adult morphology of ceratophryids presents some features associated to terrestrial and fossorial life such as hyper-ossified skulls, spade feet for digging, among others. For anurans, different mineralized structures have been described in the integument as calcium reservoirs and related to the terrestrial life and water balance (e.g., the calcified layer and dermal ossifications). We describe the ontogeny of the integument in the three genera of ceratophryids (Chacophrys, Ceratophrys, and Lepidobatrachus) that inhabit in semiarid environments. Data obtained demonstrated the early acquisition of metamorphic transformations in the integument layers in larvae of Ceratophrys cranwelli and Lepidobatrachus spp. and a continuous increment in the thickness of them up to old postmetamorphic stages. The integument of ceratophryids develops calcium deposits as the calcified layer during postmetamorphic stages. Furthermore, dorsal shields are also present in adult stages independently of terrestrial versus aquatic lifestyles. While the calcified layer seems to be a feature of a fully developed integument, in which their layers have acquired the adult thickness, dorsal shields develop at premetamorphic stages in L. llanensis and postmetamorphic individuals of C. cranwelli. In ceratophryids, similar to other studied taxa (e.g., Brachycephalus spp.) dorsal shields develop via an intramembranous ossification in which the calcified layer does not precede its differentiation. Within anurans, the occurrence of dorsal shields in the monophyletic ceratophryids suggested a distinctive evolutionary history in the lineage. PMID:23074148

Quinzio, Silvia; Fabrezi, Marissa

2012-12-01

238

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.

Epstein, Nancy E.

2014-01-01

239

Lim mineralization protein is involved in the premature calvarial ossification in sporadic craniosynostoses.  

PubMed

Sporadic mono-sutural craniosynostosis represents a highly prevalent regional bone disorder, where a single cranial suture undergoes premature ossification due to a generally unclear etiopathogenesis. The LIM mineralization protein (LMP) was recently described as an efficient osteogenic molecule involved in osteoblast differentiation, expressed in calvarial tissues upon corticosteroid-osteogenic induction and used as a potent inducer of bone formation in several animal models. In this study, calvarial cells isolated from both prematurely fused and physiologically patent sutures of children with sporadic craniosynostosis, were used as an in vitro paradigmatic model for the study of the molecular events involved in calvarial osteogenesis, focusing on the possible role of the LMP-related osteogenic signaling. Calvarial cells isolated from both patent and fused sutures expressed a mesenchymal-like immunophenotype. Cells isolated from fused sutures displayed an increased osteogenic potential, being able to undergo spontaneous mineralization and premature response to osteogenic induction, leading to in vitro bone nodule formation. The expression of LMP and its target genes (bone morphogenetic protein-2, osteocalcin and Runt-related transcription factor 2) was significantly up-regulated in cells derived from the fused sutures. Upon silencing the expression of LMP in fused suture-derived cells, the osteogenic potential along with the expression of osteo-specific transcription factors decreased, restoring the "physiologic" cell behavior. These results suggested that: 1. mesenchymal cells residing in fused sutures display a constitutionally active osteogenic disposition leading to the premature suture ossification; 2. the molecular basis of the overactive osteogenic process may at least in part involve a deregulation of the LMP-related pathway in calvarial cells. PMID:22982077

Lattanzi, Wanda; Barba, Marta; Novegno, Federica; Massimi, Luca; Tesori, Valentina; Tamburrini, Gianpiero; Galgano, Salvatore; Bernardini, Camilla; Caldarelli, Massimo; Michetti, Fabrizio; Di Rocco, Concezio

2013-01-01

240

Efficacy and safety of rituximab treatment in early primary Sj?gren'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.

2013-01-01

241

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.

2005-12-01

242

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 ClinicalTrials.gov Identifier NCT01177696

2010-01-01

243

Critical roles of the guanylyl cyclase B receptor in endochondral ossification and development of female reproductive organs  

PubMed Central

Guanylyl cyclase B is the receptor for a small peptide (C-type natriuretic peptide) produced locally in many different tissues. To unravel the functions of the receptor, we generated mice lacking guanylyl cyclase B through gene targeting. Expression of the receptor mRNA in tissues such as bone and female reproductive organs was evident, and significant phenotypes associated with each of these tissues were apparent in null mice. A dramatic impairment of endochondral ossification and an attenuation of longitudinal vertebra or limb-bone growth were seen in null animals. C-type natriuretic peptide-dependent increases of guanylyl cyclase B activity, but not basal enzyme activity, appeared to be required for the progression of endochondral ossification. Female mice were infertile, but male mice were not. This result was due to the failure of the female reproductive tract to develop. Thus, the guanylyl cyclase B receptor is critical for the development of both bone and female reproductive organs.

Tamura, Naohisa; Doolittle, Lynda K.; Hammer, Robert E.; Shelton, John M.; Richardson, James A.; Garbers, David L.

2004-01-01

244

Bilateral Simultaneous Heterotopic Ossification of the Reflected Head of Rectus Femoris Muscle: A Case Report and Review of the Literature  

PubMed Central

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.

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

2014-01-01

245

Bilateral diffuse pulmonary ectopic ossification after marrow allograft in a dog. Evidence for allotransplantation of hemopoietic and mesenchymal stem cells  

SciTech Connect

In light of recent studies showing successful transplantation of both bony and stromal elements by marrow transplantation, we report an unexpected phenomenon occurring in a canine radiation chimera. Nine hundred fifty-six days after a successful and uneventful DLA-matched marrow allograft, a dog suddenly died of respiratory failure. Autopsy revealed extensive ossification of the lungs with multiple sites of trilineage marrow engraftment. The entire complement of bony elements can apparently be allografted using marrow grafting techniques.

Sale, G.E.; Storb, R.

1983-11-01

246

Variation and timing of the cranial ossification sequence of the oriental fire-bellied toad,Bombina orientalis (Amphibia, Discoglossidae)  

Microsoft Academic Search

The sequence of appearance of the 17 different skull bones in the oriental fire-bellied toad, Bombina orientalis, is described. Data are based primarily on samples of ten or 11 laboratory-reared specimens of each of 11 Gosner developmental stages (36-46) representing middle through late meta- morphosis. Ossification commences as early as stage 37 (hind limb with all five toes distinct), but

James Hanken; Brian K. Hall

1984-01-01

247

Relationship between the oxidation potential and electron spin density of the primary electron donor in reaction centers from Rhodobacter?sphaeroides  

PubMed Central

The primary electron donor in bacterial reaction centers is a dimer of bacteriochlorophyll a molecules, labeled L or M based on their proximity to the symmetry-related protein subunits. The electronic structure of the bacteriochlorophyll dimer was probed by introducing small systematic variations in the bacteriochlorophyll–protein interactions by a series of site-directed mutations that replaced residue Leu M160 with histidine, tyrosine, glutamic acid, glutamine, aspartic acid, asparagine, lysine, and serine. The midpoint potentials for oxidation of the dimer in the mutants showed an almost continuous increase up to ?60 mV compared with wild type. The spin density distribution of the unpaired electron in the cation radical state of the dimer was determined by electron–nuclear–nuclear triple resonance spectroscopy in solution. The ratio of the spin density on the L side of the dimer to the M side varied from ?2:1 to ?5:1 in the mutants compared with ?2:1 for wild type. The correlation between the midpoint potential and spin density distribution was described using a simple molecular orbital model, in which the major effect of the mutations is assumed to be a change in the energy of the M half of the dimer, providing estimates for the coupling and energy levels of the orbitals in the dimer. These results demonstrate that the midpoint potential can be fine-tuned by electrostatic interactions with amino acids near the dimer and show that the properties of the electronic structure of a donor or acceptor in a protein complex can be directly related to functional properties such as the oxidation–reduction midpoint potential.

Artz, K.; Williams, J. C.; Allen, J. P.; Lendzian, F.; Rautter, J.; Lubitz, W.

1997-01-01

248

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.

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

2014-01-01

249

Mast cells and hypoxia drive tissue metaplasia and heterotopic ossification in idiopathic arthrofibrosis after total knee arthroplasty  

PubMed Central

Background Idiopathic arthrofibrosis occurs in 3-4% of patients who undergo total knee arthroplasty (TKA). However, little is known about the cellular or molecular changes involved in the onset or progression of this condition. To classify the histomorphologic changes and evaluate potential contributing factors, periarticular tissues from the knees of patients with arthrofibrosis were analyzed for fibroblast and mast cell proliferation, heterotopic ossification, cellular apoptosis, hypoxia and oxidative stress. Results The arthrofibrotic tissue was composed of dense fibroblastic regions, with limited vascularity along the outer edges. Within the fibrotic regions, elevated numbers of chymase/fibroblast growth factor (FGF)-expressing mast cells were observed. In addition, this region contained fibrocartilage and associated heterotopic ossification, which quantitatively correlated with decreased range of motion (stiffness). Fibrotic, fibrocartilage and ossified regions contained few terminal dUTP nick end labeling (TUNEL)-positive or apoptotic cells, despite positive immunostaining for lactate dehydrogenase (LDH)5, a marker of hypoxia, and nitrotyrosine, a marker for protein nitrosylation. LDH5 and nitrotyrosine were found in the same tissue areas, indicating that hypoxic areas within the tissue were associated with increased production of reactive oxygen and nitrogen species. Conclusions Taken together, we suggest that hypoxia-associated oxidative stress initiates mast cell proliferation and FGF secretion, spurring fibroblast proliferation and tissue fibrosis. Fibroblasts within this hypoxic environment undergo metaplastic transformation to fibrocartilage, followed by heterotopic ossification, resulting in increased joint stiffness. Thus, hypoxia and associated oxidative stress are potential therapeutic targets for fibrosis and metaplastic progression of idiopathic arthrofibrosis after TKA.

2010-01-01

250

Immature muscular tissue differentiation into bone-like tissue by bone morphogenetic proteins in vitro, with ossification potential in vivo.  

PubMed

The objective of this study was to induce bone formation from immature muscular tissue (IMT) in vitro, using bone morphogenetic proteins (BMPs) as a cytokine source and an expanded polytetrafluoroethylene (ePTFE) scaffold. In addition, cultured IMTs were implanted subcutaneously into Sprague-Dawley (SD) rats to determine their in vivo ossification potential. BMPs, extracted from bovine cortical bones, were applied to embryonic SD rat IMT cultures, before 2 weeks culture on ePTFE scaffolds. Osteoblast-like cells and osteoid tissues were partially identified by hematoxylin-eosin staining 2 weeks after culture. Collagen type I (Col-I), osteopontin (OP), and osteocalcin (OC) were detected in the osteoid tissues by immunohistochemical staining. OC gene expression remained low, but OP and Col-I were upregulated during the culture period. In vivo implanted IMTs showed slight radiopacity 1 week after implantation and strong radiopacity 2 and 3 weeks after implantation. One week after implantation, migration of numerous capillaries was observed and ossification was detected after 2 weeks by histological observation. These results suggest that IMTs are able to differentiate into bone-like tissue in vitro, with an ossification potential after implantation in vivo. © 2013 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 102A: 3112-3121, 2014. PMID:24115406

Hayashi, Tatsuhide; Kobayashi, Syuichiro; Asakura, Masaki; Kawase, Mayu; Ueno, Atsuko; Uematsu, Yasuaki; Kawai, Tatsushi

2014-09-01

251

Osteolytic bone metastasis is hampered by impinging on the interplay among autophagy, anoikis and ossification  

PubMed Central

Here we show that the fate of osteolytic bone metastasis depends on the balance among autophagy, anoikis resistance and ossification, and that the hepatocyte growth factor (HGF) signaling pathway seems to have an important role in orchestrating bone colonization. These findings are consistent with the pathophysiology of bone metastasis that is influenced by the cross-talk of supportive and neoplastic cells through molecular signaling networks. We adopted the strategy to target metastasis and stroma with the use of adenovirally expressed NK4 (AdNK4) and Dasatinib to block HGF/Met axis and Src activity. In human bone metastatic 1833 cells, HGF conferred anoikis resistance via Akt and Src activities and HIF-1? induction, leading to Bim isoforms degradation. When Src and Met activities were inhibited with Dasatinib, the Bim isoforms accumulated conferring anoikis sensitivity. The proviability effect of HGF, under low-nutrient stress condition, was related to a faster autophagy deactivation with respect to HGF plus Dasatinib. In the 1833 xenograft model, AdNK4 switched metastasis vasculature to blood lacunae, increasing HIF-1? in metastasis. The combination of AdNK4 plus Dasatinib gave the most relevant results for mice survival, and the following molecular and cellular changes were found to be responsible. In bone metastasis, we observed a hypoxic condition – marked by HIF-1? – and an autophagy failure – marked by p62 without Beclin-1. Then, osteolytic bone metastases were largely prevented, because of autophagy failure in metastasis and ossification in bone marrow, with osteocalcin deposition. The abnormal repair process was triggered by the dysfunctional autophagy/anoikis interplay. In conclusion, the concomitant blockade of HGF/Met axis and Src activity seemed to induce HIF-1? in metastasis, whereas the bone marrow hypoxic response was reduced. As a consequence, anoikis resistance might be hampered favoring, instead, autophagy failure and neoformation of woven bone trabeculae. Mice survival was, therefore, prolonged by overcoming an escape strategy adopted by metastatic cells by disruption of tumor–stroma coevolution, showing the importance of autophagy inhibition for the therapy of bone metastasis.

Maroni, P; Bendinelli, P; Matteucci, E; Locatelli, A; Nakamura, T; Scita, G; Desiderio, M A

2014-01-01

252

Skeletal ossification impairment in Nile Tilapia (Oreochromis niloticus) after exposure to lead acetate.  

PubMed

Heavy metal pollution represents a serious problem facing many of the aquatic organisms. Lead is one of the most toxic elements found in many industrial effluents which are metabolized inside bodies and can cause skeletal deformities by impairing developmental processes and bone formation. This study was undertaken to determine the LC50 of Pb-acetate and detect the effect of 1/10 LC50 exposure on fingerlings of Nile Tilapia (Oreochromis niloticus). Modern and accurate diagnostic methods were used; Scanning Electron Microscopy (SEM) of gills, plain X-ray and Energy-dispersive X-ray Spectroscopy (EDX) of the spinal column to explain the elemental analysis. The results indicated that the 96 h LC50 of lead acetate was 146.8 mg L(-1). SEM showed a distinct degeneration in gill filaments and pavement cells with increasing of mucus secretion after lead exposure. X-ray revealed slight dorsal spinal curvature. EDX analysis of the spinal column of treated fish showed decrease in calcium and phosphorus weight percents, on the other hand Pb appeared in treated fish but not in control ones. Finally this study can spot a light on the dangerous effects of lead toxicity in developing of fish and impairment of their skeletal ossification which may lead to skeletal deformities. PMID:24171258

Hassanain, Mohey A; Abbas, Wafaa T; Ibrahim, Taghreed B

2012-08-01

253

Activation of Hedgehog signaling by loss of GNAS causes heterotopic ossification  

PubMed Central

Bone formation is exquisitely controlled in space and time. Heterotopic ossification (HO), the pathologic formation of extra-skeletal bone, occurs as a common complication of trauma or in genetic disorders and can be disabling and lethal. However, the underlying molecular mechanisms are largely unknown. Here we demonstrate that G?s restricts bone formation to the skeleton by inhibiting Hedgehog (Hh) signaling in mesenchymal progenitor cells. In progressive osseous heteroplasia (POH), a human disease caused by null mutations in GNAS that encodes G?s, HH signaling is upregulated in ectopic osteoblasts and progenitor cells. Ectopic Hh signaling is sufficient to induce HO, while Hh signaling inhibition blocks HO in animal models. As our previous work has shown that GNAS gain of function mutations upregulate WNT/?-Catenin signaling in fibrous dysplasia (FD), our findings identify G?s as a critical regulator of osteoblast differentiation by maintaining a balance between two key signaling pathways: Wnt/?-catenin and Hh. HH signaling inhibitors developed for cancer therapy may be repurposed to treat HO and other diseases caused by GNAS inactivation.

Regard, Jean B.; Malhotra, Deepti; Gvozdenovic-Jeremic, Jelena; Josey, Michelle; Chen, Min; Weinstein, Lee S.; Lu, Jianming; Shore, Eileen M.; Kaplan, Frederick S.; Yang, Yingzi

2014-01-01

254

Ossification defects detected in CT scans represent early osteochondrosis in the distal femur of piglets.  

PubMed

The purpose of the current study was to validate the use of CT for selection against osteochondrosis in pigs by calculating positive predictive value and comparing it to the positive predictive value of macroscopic evaluation, using histological examination as the reference standard. Eighteen male, hereditarily osteochondrosis-predisposed piglets underwent terminal examination at biweekly intervals from the ages of 82-180 days old, including CT scanning, macroscopic, and histological evaluation of the left distal femur. Areas of ischemic chondronecrosis (osteochondrosis) were confirmed in histological sections from 44/56 macroscopically suspected lesions, resulting in a positive predictive value of 79% (95% CI: 67-84%). Suspected lesions, that is; focal, radiolucent defects in the ossification front in CT scans corresponded to areas of ischemic chondronecrosis in 36/36 histologically examined lesions, resulting in a positive predictive value of 100% (95% CI: 90-100%). CT was superior to macroscopic evaluation for diagnosis of early stages of osteochondrosis in the distal femur of piglets. The current histologically validated observations can potentially be extrapolated to diagnostic monitoring of juvenile osteochondritis dissecans in children, or to animal models of human juvenile articular cartilage injury and repair. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 32:1014-1023, 2014. PMID:24740876

Olstad, Kristin; Kongsro, Jørgen; Grindflek, Eli; Dolvik, Nils Ivar

2014-08-01

255

Papillary thyroid carcinoma with heterotopic ossification is a special subtype with extensive progression.  

PubMed

An immunohistochemical study was conducted of 108 papillary carcinoma cases, including 48 cases with intratumoral heterotopic ossification (IHO). In 48 cases, papillary carcinoma with IHO was accompanied by nodular fibrosis. Cases of papillary carcinoma with IHO or nodular fibrosis showed higher incidences of lymph node metastasis, multifocal lesions, and extrathyroidal invasion than those without IHO and nodular fibrosis. A higher number of stromal myofibroblasts was observed in papillary carcinoma with IHO or nodular fibrosis than in that without fibrosis. Expression of both basic fibroblast growth factor (bFGF) and bone morphogenetic protein (BMP)-2 was the highest in papillary carcinoma with IHO. Papillary carcinoma with IHO showed higher vascular invasion and higher numbers of capillaries expressing nestin, which is associated with high expression of vascular endothelial growth factor (VEGF). Papillary carcinoma with IHO is a unique subtype with extensive progression including frequent lymph node metastasis, multifocality, and invasive behavior. Papillary carcinoma with IHO was correlated with expression of bFGF, BMP-2, and VEGF in the carcinoma cells, leading to neovascularization. PMID:23596110

Takeda, Masahiko; Mikami, Tetuo; Numata, Yoshiko; Okamoto, Makito; Okayasu, Isao

2013-05-01

256

The iliac crest in forensic age diagnostics: evaluation of the apophyseal ossification in conventional radiography.  

PubMed

Due to the increasing significance of forensic age estimations in the age of globalisation, novel radiographic criteria besides clavicles and hand bones may provide additional certainty for forensic age expertises. The present study analyses the suitability of the iliac crest apophysis by means of 643 pelvic radiographs of patients between 10 and 30 years of age. Retrospective assessments were carried out according to the forensically established classification and sub-classification systems modified after Kreitner et al. (Rofo 166(6):481-486, 1997) and Kellinghaus et al. (Int J Legal Med 124(4):321-325, 2010). The basic ossification stages range from 1 to 4, and the sub-stages of stage 2 and 3 range from a to c. While stage 3c was first achieved at the age of 15 by both sexes, stage 4 was first observed in females at the age of 16 and in males at the age of 17. This indicates the possibility of a valid diagnosis of both the age of 14 and the age of 16 years which represent legally relevant age thresholds in numerous countries. Applied as targeted radiography on the iliac crest, the exposure to radiation would range between other radiographic techniques recently applied. Therefore, the iliac crest apophysis appears principally suitable as novel possible criterion for forensic age estimation in the living. However, for the establishment of the iliac crest apophysis in routine diagnostics, further studies are needed focussing on the comparison of different grading systems and different radiological techniques. PMID:23052440

Wittschieber, Daniel; Vieth, Volker; Domnick, Christoph; Pfeiffer, Heidi; Schmeling, Andreas

2013-03-01

257

Mice lacking tartrate-resistant acid phosphatase (Acp 5) have disrupted endochondral ossification and mild osteopetrosis.  

PubMed

Mature osteoclasts specifically express the purple, band 5 isozyme (Acp 5) of tartrate-resistant acid phosphatase, a binuclear metalloenzyme that can generate reactive oxygen species. The function of Acp 5 was investigated by targeted disruption of the gene in mice. Animals homozygous for the null Acp 5 allele had progressive foreshortening and deformity of the long bones and axial skeleton but apparently normal tooth eruption and skull plate development, indicating a rôle for Acp 5 in endochondral ossification. Histomorphometry and mineralization density analysis of backscattered electron imaging revealed widened and disorganized epiphyseal growth plates with delayed mineralization of cartilage in 6- to 8-week-old mutant mice. The membrane bones of the skull showed increased density at all ages examined, indicating defective osteoclastic bone turnover. Increased mineralization density was observed in the long bones of older animals which showed modelling deformities at their extremities: heterozygotes and homozygous Acp 5 mutant mice had tissue that was more mineralized and occupied a greater proportion of the bone in all regions. Thus the findings reflect a mild osteopetrosis due to an intrinsic defect of osteoclastic modelling activity that was confirmed in the resorption pit assay in vitro. We conclude that this bifunctional metalloprotein of the osteoclast is required for normal mineralization of cartilage in developing bones; it also maintains integrity and turnover of the adult skeleton by a critical contribution to bone matrix resorption. PMID:8898228

Hayman, A R; Jones, S J; Boyde, A; Foster, D; Colledge, W H; Carlton, M B; Evans, M J; Cox, T M

1996-10-01

258

BMP-9-induced muscle heterotopic ossification requires changes to the skeletal muscle microenvironment.  

PubMed

Heterotopic ossification (HO) is defined as the formation of bone inside soft tissue. Symptoms include joint stiffness, swelling, and pain. Apart from the inherited form, the common traumatic form generally occurs at sites of injury in damaged muscles and is often associated with brain injury. We investigated bone morphogenetic protein 9 (BMP-9), which possesses a strong osteoinductive capacity, for its involvement in muscle HO physiopathology. We found that BMP-9 had an osteoinductive influence on mouse muscle resident stromal cells by increasing their alkaline phosphatase activity and bone-specific marker expression. Interestingly, BMP-9 induced HO only in damaged muscle, whereas BMP-2 promoted HO in skeletal muscle regardless of its state. The addition of the soluble form of the ALK1 protein (the BMP-9 receptor) significantly inhibited the osteoinductive potential of BMP-9 in cells and HO in damaged muscles. BMP-9 thus should be considered a candidate for involvement in HO physiopathology, with its activity depending on the skeletal muscle microenvironment. PMID:21611960

Leblanc, Elisabeth; Trensz, Frédéric; Haroun, Sonia; Drouin, Geneviève; Bergeron, Eric; Penton, Christopher M; Montanaro, Federica; Roux, Sophie; Faucheux, Nathalie; Grenier, Guillaume

2011-06-01

259

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: a.al-mamgani@erasmusmc.nl [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)

2012-09-01

260

Total Delay in Treatment among Smear Positive Pulmonary Tuberculosis Patients in Five Primary Health Centers, Southern Ethiopia: A Cross Sectional Study  

PubMed Central

Introduction The global burden of Tuberculosis (TB) remains enormous. Delay in TB diagnosis may lead to a higher infectious pool in the community and a more advanced disease state at presentation increasing the risk of mortality. This study is conducted to determine the total delay before treatment among smear positive Pulmonary Tuberculosis (PTB) patients. Methods A health institution based cross sectional study was conducted in five primary health centers in southern Ethiopia from June to December 2012. A total of 328 smear positive PTB patients were enrolled in the study. A structured and pre-tested questionnaire was used. Median patient, diagnostic, and treatment delays were calculated to determine the total delay. Multiple logistic regression analysis was used to identify factors associated with total delay. Results The median patient, diagnostic, treatment and total delays measured in days were 30 (IQR 20.2, 60), 7 (IQR: 3, 14), 3 (IQR: 1, 4) and 45 (IQR: 34.5, 69.5) days respectively. Patients for whom treatment was not initiated within 45 days of onset of symptom(s) (total delay) constituted 49% of the study participants (59.5% among males and 39.2% among females; P<0.001). Total delay was found to be associated with: being female [AOR ?=?0.34, 95% CI: 0.18–0.62], having attended tertiary level education [AOR ?=?0.11, 95% CI: 0.02–0.55], perceived severity of stigma during the current TB disease course [AOR?=?2. 18, 95% CI: 1.07, 4.42] and living in houses with higher family size [AOR?=?0.26, 95% CI: 0.11, 0.61]. Conclusion Total delay in treatment of TB is still high in the study area. Patient's sex, perceived stigma, educational status and family size are significantly contributing for total delay. Therefore, a concerted effort should be taken in order to improve health seeking behavior of the community on TB and to reduce delays from seeking care after experiencing TB symptoms.

Asefa, Anteneh; Teshome, Wondu

2014-01-01

261

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.

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

2005-01-01

262

Highlights of Workshop on Primary Nursing Care - Southeastern Regional Medical Education Center, Birmingham, Alabama, Held on March 7-8, 1977.  

National Technical Information Service (NTIS)

In this workshop, primary nursing care is explored as an alternative to team nursing. In primary care, a single nurse assumes the principal role of nursing a patient through the stay in the health care facility, establishing and maintaining a supportive r...

1977-01-01

263

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: Jonathan_Strauss@rush.edu; 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)

2008-08-01

264

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

PubMed

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

2014-05-01

265

Bone lengthening osteogenesis, a combination of intramembranous and endochondral ossification: an experimental study in sheep  

PubMed Central

We evaluated the morphological features of the newly formed tissue in an experimental model of tibial callotasis lengthening on 24 lambs, aged from 2 to 3 months at the time of operation. A unilateral external fixator prototype Monotube Triax® (Stryker Howmedica Osteonics, New Jersey) was applied to the left tibia. A percutaneous osteotomy was performed in a minimally traumatic manner using a chisel. Lengthening was started 7 days after surgery and was continued to 30 mm. The 24 animals were randomly divided into three groups of 8 animals each: in Group 1, lengthening took place at a rate of 1 mm/day for 30 days; in Group 2, at a rate of 2 mm/day for 15 days; in Group 3, at a rate of 3 mm/day for 10 days. In each group, 4 animals were killed 2 weeks after end of lengthening, and the other 4 animals at 4 weeks after end of lengthening. To assess bony formation in the distraction area, radiographs were taken every 2 weeks from the day of surgery. To study the process of vascularization, we used Spalteholz’s technique. After killing, the tibia of each animal was harvested, and sections were stained with hematoxylin and eosin, Masson’s trichrome, and Safranin-O. Immunohistochemistry was performed, using specific antibodies to detect collagens I and II, S100 protein, and fibronectin. A combination of intramembranous and endochondral ossification occurred together at the site of distraction. Our study provides a detailed structural characterization of the newly formed tissue in an experimental model of tibial lengthening in sheep and may be useful for further investigations on callotasis.

Forriol, Francisco; Denaro, Luca; Longo, Umile Giuseppe; Taira, Hirofumi; Denaro, Vincenzo

2010-01-01

266

Lumbar spinal stenosis in a young individual as a result of ligamantum flavum ossification: A case report  

PubMed Central

INTRODUCTION Symtomatic lumbar ligamantum flavum calcification is quite rare in the young age group. PRESENTATION OF CASE The authors report a case of young adult with diagnosis of lumbar spinal stenosis, presenting with leg pain and neurological deficits. Computerized tomography (CT) scan and magnetic resonance (MR) imaging studies revealed ossification of the ligamantum flavum as the causative factor of the disease and the patient recovered completely after the decompressive operation. DISCUSSION It is emphasized that attention should be given to this rare etiological factor of lumbar spinal stenosis. CONCLUSION Complete relief can be achieved with early and adequate surgery.

Yilmaz, Murat; Kalemci, Orhan; Yilmaz, Hakan; Palaz, Necdet M.

2013-01-01

267

Angiomatosis and ectopic ossification in the dog myocardium after intramyocardial implantation of autologous bone marrow mononuclears in experimental coronary disease.  

PubMed

Disseminated ossification of the myocardium and severe angiomatosis were detected in sites of implantation of unseparated bone marrow mononuclear fraction cells in dogs with experimental chronic coronary disease. Minor immunocytochemical differences in cells of the mononuclear fraction adhering and not adhering to plastic were found. Significant differences in the expression of mRNA of chondro-osteogenesis genes (aggrecan, lumican, and osteopontin) in adherent and nonadherent cells were detected. The expression of aggrecan gene mRNA was 3-fold lower, of lumican gene 6-fold, and of osteopontin gene 11-fold lower in nonadherent cells compared to adherent fraction. PMID:19907760

Larionov, P M; Sergeevichev, D S; Chernyavskii, A M; Novruzov, R B; Lushnikova, E L; Subbotin, D V; Karas'kov, A M; Nepomnyashchikh, L M

2009-05-01

268

[Reperfusion therapy for patients with an acute myocardial infarct with ST-segment elevation: fibrinolysis versus transport to a cardiac center for primary angioplasty].  

PubMed

Although fibrinolytic therapy for acute myocardial infarction is widely used and can be administered prior to hospitalisation, it is only successful in restoring full early coronary patency in about 60% of patients and has a 0.5% to 1% risk of severe side effects. Primary percutaneous coronary angioplasty carried out as an alternative to fibrinolysis avoids the risk of fibrinolytic therapy and restores patency in nearly 90% of cases. Data from randomised trials of primary angioplasty versus fibrinolytic therapy in acute myocardial infarction reveal that angioplasty results in a significant reduction in mortality. Furthermore, primary angioplasty can be improved by means of a new pre-angioplasty drug therapy (so-called facilitated primary angioplasty). Transport to a cardiac centre for primary angioplasty (of which there are 14 in the Netherlands) is feasible and safe. Although the time to treatment is delayed by a further 90 minutes, it tends to save lives and prevent strokes and it also significantly reduces the incidence of reinfarction. Interestingly, the time gained to treatment with prehospital fibrinolytic therapy compared to in-hospital therapy gave an outcome similar to that found upon comparing transport and primary angioplasty. Rescue procedures (angioplasty) within 24 hours are necessary in about 30% of patients who are initially treated with lytic therapy. These results support prehospital triage for fibrinolysis or transport to a cardiac centre, where early angioplasty can be performed if clinically indicated. A trial to determine the policy of choice is at present being conducted in the Netherlands. PMID:14587140

Verheugt, F W; Lamfers, E J; Aengevaeren, W R

2003-10-11

269

Intensity-Modulated Radiotherapy for Cervical Node Squamous Cell Carcinoma Metastases From Unknown Head-and-Neck Primary Site: M. D. Anderson Cancer Center Outcomes and Patterns of Failure  

SciTech Connect

Purpose: Conventional therapy for cervical node squamous cell carcinoma metastases from an unknown primary can cause considerable toxicity owing to the volume of tissues to be irradiated. In the present study, hypothesizing that using intensity-modulated radiotherapy (IMRT) would provide effective treatment with minimal toxicity, we reviewed the outcomes and patterns of failure for head-and-neck unknown primary cancer at a single tertiary cancer center. Methods and Materials: We retrospectively reviewed the records of 52 patients who had undergone IMRT for an unknown primary at M.D. Anderson Cancer Center between 1998 and 2005. The patient and treatment characteristics were extracted and the survival rates calculated using the Kaplan-Meier method. Results: Of the 52 patients, 5 presented with Stage N1, 11 with Stage N2a, 23 with Stage N2b, 6 with Stage N2c, 4 with Stage N3, and 3 with Stage Nx disease. A total of 26 patients had undergone neck dissection, 13 before and 13 after IMRT; 14 patients had undergone excisional biopsy and presented for IMRT without evidence of disease. Finally, 14 patients had received systemic chemotherapy. All patients underwent IMRT to targets on both sides of the neck and pharyngeal axis. The median follow-up time for the surviving patients was 3.7 years. The 5-year actuarial rate of primary mucosal tumor control and regional control was 98% and 94%, respectively. Only 3 patients developed distant metastasis with locoregional control. The 5-year actuarial disease-free and overall survival rate was 88% and 89%, respectively. The most severe toxicity was Grade 3 dysphagia/esophageal stricture, experienced by 2 patients. Conclusion: The results of our study have shown that IMRT can produce excellent outcomes for patients who present with cervical node squamous cell carcinoma metastases from an unknown head-and-neck primary tumor. Severe late complications were uncommon.

Frank, Steven J., E-mail: sjfrank@mdanderson.or [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Rosenthal, David I.; Petsuksiri, Janjira; Ang, K. Kian; Morrison, William H. [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Weber, Randal S. [Department of Head and Neck Surgery, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Glisson, Bonnie S. [Department of Thoracic /Head and Neck Medical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Chao, K.S. Clifford; Schwartz, David L.; Chronowski, Gregory M. [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); El-Naggar, Adel K. [Department of Pathology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Garden, Adam S. [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)

2010-11-15

270

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

Cancer.gov

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.

271

Cancer Centers Program - Cancer Centers  

Cancer.gov

Cancer Centers Program - Cancer Centers Map of Cancer Centers Data Tables Benchmark Home > Cancer Centers Cancer Centers NCI-designated cancer centers are characterized by scientific excellence and the capability to integrate a diversity of

272

Tuning cofactor redox potentials: the 2-methoxy dihedral angle generates a redox potential difference of >160 mV between the primary (Q(A)) and secondary (Q(B)) quinones of the bacterial photosynthetic reaction center.  

PubMed

Only quinones with a 2-methoxy group can act simultaneously as the primary (QA) and secondary (QB) electron acceptors in photosynthetic reaction centers from Rhodobacter sphaeroides. (13)C hyperfine sublevel correlation measurements of the 2-methoxy in the semiquinone states, SQA and SQB, were compared with quantum mechanics calculations of the (13)C couplings as a function of the dihedral angle. X-ray structures support dihedral angle assignments corresponding to a redox potential gap (?Em) between QA and QB of ~180 mV. This is consistent with the failure of a ubiquinone analogue lacking the 2-methoxy to function as QB in mutant reaction centers with a ?Em of ?160-195 mV. PMID:24079813

Taguchi, Alexander T; Mattis, Aidas J; O'Malley, Patrick J; Dikanov, Sergei A; Wraight, Colin A

2013-10-15

273

Refined cytogenetic-risk categorization for overall and leukemia-free survival in primary myelofibrosis: a single center study of 433 patients  

Microsoft Academic Search

We have previously identified sole +9, 13q- or 20q-, as ‘favorable’ and sole +8 or complex karyotype as ‘unfavorable’ cytogenetic abnormalities in primary myelofibrosis (PMF). In this study of 433 PMF patients, we describe additional sole abnormalities with favorable (chromosome 1 translocations\\/duplications) or unfavorable (?7\\/7q-) prognosis and also show that other sole or two abnormalities that do not include i(17q),

D Caramazza; K H Begna; N Gangat; R Vaidya; S Siragusa; D L Van Dyke; C Hanson; A Pardanani; A Tefferi

2011-01-01

274

Assessing Age-Related Ossification of the Petro-Occipital Fissure: Laying the Foundation for Understanding the Clinicopathologies of the Cranial Base  

PubMed Central

The petro-occitpital fissure (POF) lies within a critical interface of cranial growth and development in the posterior cranial fossa. The relationships between skeletal and soft tissues make this region especially important for examining biomechanical and basic biologic forces that may mold the cranial base and contribute to significant clinicopathologies associated with the structures located near the POF. Therefore, this study investigates the POF in adults in both preserved human cadavers and dried crania in order to determine if developmental changes can be observed and, if so, their value in age assessment as a model system for describing normal morphogenesis of the POF. This study demonstrates that tissue within the POF undergoes characteristic changes in ossification with age, the onset of which is considerably later than that of other synchondroses of the cranial base. Statistically, there is a moderate to strong correlation between age and stage of ossification within the POF. Further, male crania were observed to reach greater degrees of ossification at a younger age than female crania and that individual asymmetry in ossification of the tissue within the POF was not uncommon. An understanding of the basic temporal biological processes of the POF may yield insight into the development of clinicopathologies in this region of the cranial base.

BALBONI, ARMAND L.; ESTENSON, THOMAS L.; REIDENBERG, JOY S.; BERGEMANN, ANDREW D.; LAITMAN, JEFFREY T.

2005-01-01

275

Prevention of heterotopic ossification in cases of hypertrophic osteoarthritis submitted to total hip arthroplasty. Etidronate or Indomethacin?  

PubMed

We present a study comparing etidronate or indomethacin for the prevention of heterotopic ossification after total hip arthroplasty in patients with hypertrophic osteoarthritis. 52 patients were divided in two groups. Group A (26 patients) received etidronate (20 mg/kg/day for 12 weeks) and Group B (26 patients) indomethacin 75 mg/day for 2 weeks. Mean follow up was 36 months (range, 18 to 50 months). The incidence of side effects was 15.4% in group A and 30.8% in group B (p=0.324). At 6 months there was no statistically significant difference in terms of clinical (p=0.532) and radiographic evaluation between the two groups (p=0.303). However, the cost of etidronate which may be as much as six times more expensive than that of indomethacin could not justify its routine prophylactic use. PMID:20516633

Vasileiadis, G I; Sakellariou, V I; Kelekis, A; Galanos, A; Soucacos, P N; Papagelopoulos, P J; Babis, G C

2010-06-01

276

Postoperative Bowel Perforation due to Heterotopic Ossification (Myositis Ossificans Traumatica): A Case Report and Review of the Literature  

PubMed Central

Heterotopic ossification (HO) is the ectopic development of normal bone within soft tissue that can occur after traumatic injury. It is uncommon and may be missed or misdiagnosed, which can lead to complications. We report the case of an 84-year-old male with a previous history of a laparotomy who underwent resection of an intra-abdominal tumor through a midline incision. On postoperative day six, the patient was taken to the operating room, as succus was draining from the incision. Upon re-exploration, sharp bone-like material was found in the wound directly adjacent to an enterotomy. Pathology confirmed mature lamellar bone and the diagnosis of HO. This is the first report of postoperative intestinal perforation secondary to HO in a midline wound. We report this case to encourage accurate reporting of HO and its morbidity and complications for the benefit of appropriate surgical planning and epidemiologic tracking of outcomes.

Lao, Victoria Valinluck; Lao, Oliver B.; Figueredo, Edgar

2011-01-01

277

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).

Epstein, Nancy E.

2014-01-01

278

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

PubMed

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

2014-01-01

279

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.

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

2009-01-01

280

Conceptual models for Mental Distress among HIV-infected and uninfected individuals: A contribution to clinical practice and research in primary-health-care centers in Zambia  

PubMed Central

Background Mental distress is common in primary care and overrepresented among Human Immunodeficiency virus (HIV)-infected individuals, but access to effective treatment is limited, particularly in developing countries. Explanatory models (EM) are contextualised explanations of illnesses and treatments framed within a given society and are important in understanding an individual's perspective on the illness. Although individual variations are important in determining help-seeking and treatment behaviour patterns, the ability to cope with an illness and quality of life, the role of explanatory models in shaping treatment preferences is undervalued. The aim was to identify explanatory models employed by HIV-infected and uninfected individuals and to compare them with those employed by local health care providers. Furthermore, we aimed to build a theoretical model linking the perception of mental distress to treatment preferences and coping mechanisms. Methods Qualitative investigation nested in a cross-sectional validation study of 28 (male and female) attendees at four primary care clinics in Lusaka, Zambia, between December 2008 and May 2009. Consecutive clinic attendees were sampled on random days and conceptual models of mental distress were examined, using semi-structured interviews, in order to develop a taxonomic model in which each category was associated with a unique pattern of symptoms, treatment preferences and coping strategies. Results Mental distress was expressed primarily as somatic complaints including headaches, perturbed sleep and autonomic symptoms. Economic difficulties and interpersonal relationship problems were the most common causal models among uninfected individuals. Newly diagnosed HIV patients presented with a high degree of hopelessness and did not value seeking help for their symptoms. Patients not receiving anti-retroviral drugs (ARV) questioned their effectiveness and were equivocal about seeking help. Individuals receiving ARV were best adjusted to their status, expressed hope and valued counseling and support groups. Health care providers reported that 40% of mental distress cases were due to HIV infection. Conclusions Patient models concerning mental distress are critical to treatment-seeking decisions and coping mechanisms. Mental health interventions should be further researched and prioritized for HIV-infected individuals.

2011-01-01

281

Substance Use Among HIV-Infected Patients Engaged in Primary Care in the United States: Findings From the Centers for AIDS Research Network of Integrated Clinical Systems Cohort  

PubMed Central

Objectives. The purpose of this study was to better understand substance use behaviors and deleterious health consequences among individuals with HIV. Methods. We examined a multicenter cohort of HIV-infected patients (n?=?3413) receiving care in 4 US cities (Seattle, Birmingham, San Diego, Boston) between December 2005 and April 2010 in the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS). We used generalized estimating equations to model specific substance use outcomes. Results. Overall, 24% of patients reported recent use of marijuana; 9% reported amphetamine use, 9% reported crack–cocaine use, 2% reported opiate use, 3.8% reported injection drug use, and 10.3% reported polydrug use. In adjusted multivariable models, those who reported unprotected anal sex had higher odds of marijuana, amphetamine, injection drug, and polydrug use. An increased number of distinct vaginal sexual partners was associated with polydrug and crack–cocaine use. Nonadherence to antiretroviral therapy was associated with the use of all substances other than marijuana. Conclusions. The co-occurrence of substance use, unprotected intercourse, and medication nonadherence could attenuate the public health benefits of test, treat, and link to care strategies. Prevention programs are needed that address these coprevalent conditions.

Reisner, Sari L.; Grasso, Chris; Crane, Heidi M.; Safren, Steven A.; Kitahata, Mari M.; Schumacher, Joseph E.; Mathews, W. Christopher; Mayer, Kenneth H.

2013-01-01

282

Vaccine effectiveness evaluation during a varicella outbreak among children of primary schools and day-care centers in a region which adopted UMV  

PubMed Central

This study describes an outbreak of varicella, in a small town in the region of Puglia, Southern Italy, in the period between February–March 2011. This outbreak presented the opportunity to assess varicella vaccine effectiveness and its determinants. The outbreak occurred in a small community in Puglia; parents of the children attending the schools of the community were contacted by telephone and information was gathered on current disease and varicella history. Varicella vaccination history was verified through the immunization registry of the Local Health Unit. Before the outbreak, immunization coverage was 86.6% of children attending preschool and 51.9% of children attending elementary school. In day care center where the outbreak was happened, the attack rate in vaccinated individuals was 32.1% and 80% in susceptible unvaccinated individuals. VE is therefore estimated as 59.9% (95% CI = 48.3–69.8). In the elementary school the VE can be calculated as 69.2% (95% CI = 50.5–88.1), since the attack rate in unvaccinated children was of 23.1% and in vaccinated of 7.1. The time between vaccination and the onset of the epidemic appears higher in children with a vaccine failure. The results of this study highlight the need for a reflection on the desirability of adopting a shorter schedule in Italy, with a minimum 1 mo interval between MMRV doses.

Tafuri, Silvio; Martinelli, Domenico; Prato, Rosa; Germinario, Cinzia

2013-01-01

283

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.

2014-01-01

284

An AIDS information center.  

PubMed

Because busy members of the health care team are confronted with a plethora of articles and information on AIDS, the Health Sciences Library at the University of Alabama has developed a current awareness information center on AIDS. The materials in the center can be easily accessed by patrons. Books and audiovisuals are included in the center; however, the primary emphasis is on accessing articles in journals to which the library subscribes and the journals which have granted blanket photocopy permission. The planning and organization of the center are described. PMID:10295658

Doughty, B P; Russell, L R

1989-01-01

285

Primary Aldosteronism  

MedlinePLUS

... ABOUT OUR SITE › Primary Aldosteronism Share: Fact Sheet Primary Aldosteronism March 2012 Download PDFs English Espanol Editors ... MD, FRCP William Young, MD, MSc What is primary aldosteronism? Primary aldosteronism (PA) is a type of ...

286

Sub-picosecond dynamics of excited state of primary electron donor in reaction centers of Rhodopseudomonas viridis as revealed by hole burning at 1.7K broad and narrow holes.  

PubMed

Within the QF band of the primary electron donor (P), the spectra of absorbance changes due to the formation of a state of P+QA- (QA is the primary quinone) at 1.7K in Rhodopseudomonas viridis reaction centers excited at 1014 nm have been shown to involve two spectral features characterized by: (i) a progression of broad (170-190 cm-1) Gaussian vibronic bands (S-factor = 1.4) separated by 150 cm-1 and (ii) a 'narrow' structure near 1014 nm, characterized by 0-0 transition at 1014 nm with a width of approximately 50 cm-1 and 0-1 transition at 1000 nm with the width of approximately 100 cm-1, and S-factor = 0.9. The width of 50 cm-1 can be related to either zero-phonon hole (ZPH) width or the structure involving phonon wings and ZPH being unresolved. Since dichroic value (approximately 0.37) is unvarying over the P band, the vibrations involved are totally symmetric. The ZPH (width of approximately 3 cm-1) and phonon wings (frequency of approximately 30 cm-1) are resolved within the P band near 1014 nm when the spectrum of delta A due to the formation of bacteriopheophytinL- is measured at 1.7K. PMID:2060638

Ganago, A O; Shkuropatov AYa; Shuvalov, V A

1991-06-24

287

Role of endochondral ossification of articular cartilage and functional adaptation of the subchondral plate in the development of fatigue microcracking of joints  

Microsoft Academic Search

The mechanisms that regulate functional adaptation of the articular ends of long bones are poorly understood. However, endochondral ossification of articular cartilage and modeling\\/remodeling of the subchondral plate and epiphyseal trabeculae are important components of the adaptive response. We performed a histologic study of the distal end of the third metacarpal\\/metatarsal bone of Thoroughbreds after bones were bulk-stained in basic

P. Muir; J. McCarthy; C. L. Radtke; M. D. Markel; E. M. Santschi; M. C. Scollay; V. L. Kalscheur

2006-01-01

288

Low temperature pulsed EPR study at 34 GHz of the triplet states of the primary electron donor P865 and the carotenoid in native and mutant bacterial reaction centers of Rhodobacter sphaeroides†  

PubMed Central

The photosynthetic charge separation in bacterial reaction centers occurs predominantly along one of two nearly symmetric branches of cofactors. Low temperature EPR spectra of the triplet states of the chlorophyll and carotenoid pigments in the reaction center of Rb. sphaeroides R-26.1, 2.4.1 and two double mutants GD(M203)/AW(M260) and LH(M214)/AW(M260) have been recorded at 34 GHz to investigate the relative activities of the ‘A’ and ‘B’ branches. The triplet states are found to derive from radical pair and intersystem crossing mechanisms and the rates of formation are anisotropic. The former mechanism is operative for Rb. sphaeroides R-26.1, 2.4.1 and mutant GD(M203)/AW(M260) and indicates that A-branch charge separation proceeds at temperatures down to 10 K. The latter mechanism, derived from the spin polarization and operative for mutant LH(M214)/AW(M260) indicates that no long-lived radical pairs are formed upon direct excitation of the primary donor and that virtually no charge separation at the B-branch occurs at low temperatures. When the temperature is raised above 30 K, B-branch charge separation is observed, which is at most 1% of A-branch charge separation. B-branch radical pair formation can be induced at 10 K with low yield by direct excitation of the bacteriopheophytin of the B-branch at 590 nm. The formation of a carotenoid triplet state is observed. The rate of formation depends on the orientation of the reaction center in the magnetic field and is caused by a magnetic field dependence of the oscillation frequency by which the singlet and triplet radical pair precursor states interchange. Combination of these findings with literature data provides strong evidence that the thermally activated transfer step on the B-branch occurs between the primary donor, P865, and the accessory bacteriochlorophyll, whereas this step is barrierless down to 10 K along the A-branch.

Marchanka, Aliaksandr; Paddock, Mark; Lubitz, Wolfgang; van Gastel, Maurice

2008-01-01

289

Double-level cervical total disc replacement for adjacent segment disease: is it a useful treatment? Description of late onset heterotopic ossification and review of the literature.  

PubMed

We report a rare case of double-level adjacent segment disease (ASD), occurring ten years later an anterior cervical discectomy (ACD) without fusion, treated by cervical arthroplasty, highlighting the outcome at long-term follow-up and focusing on heterotopic ossification. In 1995 a 25-year-old man satisfactorily underwent ACD at C4/C5. At that time MRI also showed signs of degenerative disc disease (DDD) at C3/C4 and C5/C6. Ten years later, a new MRI scan showed a large C3/C4 and a smaller C5/C6 soft disc hernia together with spondylotic changes at the level above and below the site of the first surgery. At C4/C5 imaging revealed a kyphotic stable "pseudoarthrosis" with anterior bridging osteophyte. The patient underwent double-level arthroplasty with ProDisc-C. Clinical and radiological outcome was satisfactory. 3 and 5 years after surgery, X-rays and CT scan documented the progressive development of heterotopic ossification, with gradual reduction of range of motion. A late onset heterotopic ossification can neutralize the theoretical advantages of cervical arthroplasty, which should be considered an effective surgical option only in selected cases. ACDF and restoration of normal lordosis can be a viable alternative in cervical revision surgery, as motion preservation can not be always mantained for a long time. PMID:24825036

Barbagallo, G M V; Certo, F; Visocchi, M; Sciacca, G; Albanese, V

2014-01-01

290

Cancer Centers  

Cancer.gov

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

291

East-West Center  

NSDL National Science Digital Library

Started in 1960 by the U.S. Congress, the East-West Center's primary purpose is "to strengthen relations and understanding among the peoples and nations of Asia, the Pacific, and the United States." To accomplish this purpose, the Center serves as a functional hub for education, cooperative research, and scholarly dialogue. On their homepage, visitors can look over the latest news from scholars at the Center, look over a list of upcoming events sponsored by the Center, and also learn about some of their most recent publications. Academics visiting the site may wish to click on over to the "Research" area. Here they will find information on their primary areas of interest, which include population and health, environmental change, and politics and governance. Finally, visitors should look at their "Publications" area, as it includes free downloads, abstracts, and access to ordering information.

292

Increased bone mineral density in patients with ossification of the ligamentum flavum: a case-control study.  

PubMed

The present study investigated the bone mineral density (BMD) and the prevalence of osteoporosis in an ossification of the ligamentum flavum (OLF) patient group and a matched control group. We also investigated the correlation of BMD with the number of spine levels exhibiting OLF. From January 1999 to August 2012, 120 patients with spinal OLF underwent dual-energy X-ray absorptiometry at our institute, and 102 of those were included in our study. Control group members were age, sex, and body mass index (BMI) matched to OLF group members on a 1:1 basis. Age, sex, and BMI were similar in the OLF and control groups. BMDs of the OLF and control groups were significantly different in the lumbar spine (mean T-scores: -0.2 ± 1.5 and -0.7 ± 1.5, respectively; p = 0.03). The prevalences of osteopenia and osteoporosis tended to be lower in the OLF group (28.3% and 4.0%, respectively) than those in the control group (31.3% and 9.1%, respectively); however, the differences were not statistically significant (p = 0.41). A significant positive correlation was detected between the lumbar spine BMD and the number of spine levels exhibiting OLF (p = 0.03). PMID:23726874

Sohn, Seil; Yoon, Ji Won; Chung, Chun Kee

2014-01-01

293

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: hmamon@partners.org

2007-04-01

294

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

PubMed

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

2014-09-01

295

The ALX4 homeobox gene is mutated in patients with ossification defects of the skull (foramina parietalia permagna, OMIM 168500)  

PubMed Central

Foramina parietalia permagna (FPP) (OMIM 168500) is caused by ossification defects in the parietal bones. Recently, it was shown that loss of function mutations in the MSX2 homeobox gene on chromosome 5 are responsible for the presence of these lesions in some FPP patients. However, the absence of MSX2 mutations in some of the FPP patients analysed and the presence of FPP associated with chromosome 11p deletions in DEFECT 11 (OMIM 601224) patients or associated with Saethre-Chotzen syndrome suggests genetic heterogeneity for this disorder. Starting from a BAC/P1/cosmid contig of the DEFECT 11 region on chromosome 11, we have now isolated the ALX4 gene, a previously unidentified member of the ALX homeobox gene family in humans. Mutation analysis of the ALX4 gene in three unrelated FPP families without the MSX2 mutation identified mutations in two families, indicating that mutations in ALX4 could be responsible for these skull defects and suggesting further genetic heterogeneity of FPP.???Keywords: ALX4; FPP; DEFECT 11

Wuyts, W.; Cleiren, E.; Homfray, T.; Rasore-Quartino, A.; Vanhoenacker, F.; Van Hul, W.

2000-01-01

296

Primary Syphilis  

MedlinePLUS

newsletter | contact Share | Primary Syphilis Information for adults A A A This image displays a painless ulcer with a red base, typical of primary syphilis. Overview Primary syphilis is a disease caused ...

297

Dynamics of the excited state of the primary electron donor in reaction centers of Rhodopseudomonas viridis as revealed by hole burning at 1.7K. Different conformational states.  

PubMed

The spectra of absorbance changes (delta A) due to the formation of P+Q- (P, primary electron donor, Q, primary quinone acceptor) at 1.7K in Rhodopseudomonas viridis reaction centers (RCs) excited at 1014 nm has been shown to include, besides a progression of broad (170-190 cm-1) Gaussian vibronic bands separated by 150 cm-1, a 'narrow' structure near 1014 nm which can be simulated by a Lorentian zero-phonon hole (ZPH) and Lorentian one-mode (26.8 cm-1) phonon wings. The widths of ZPH of approximately 17 cm-1 for delta A reflecting the formation of P+Q- decaying in the ms time domain and of 6.8 +/- 0.4 cm-1 for P+Q- decaying in the min time domain at 1.7K, seems to correspond to different conformations of RCs with a relaxation time of P* of approximately 0.6 ps (in agreement with measurements in this time domain) and 1.6 +/- 0.1 ps, respectively. The comparison of the spectra of delta A in the region of the BL band for slow (min) and fast (ms) decaying components suggests a different mutual arrangement of P and BL for different conformations of RCs. It is assumed that the broad and narrow structures of the P band reflect the transitions to two configurations with different P-protein interactions. 'Narrow' structure of delta A spectrum with essentially the same phonon wings and ZPH (width of 3.8 +/- 0.4 cm-1) was observed within the P band when HL was photoreduced at 1.7K. PMID:1879522

Shkuropatov AYa; Ganago, A O; Shuvalov, V A

1991-08-01

298

Immune and inflammatory responses in TNF alpha-deficient mice: a critical requirement for TNF alpha in the formation of primary B cell follicles, follicular dendritic cell networks and germinal centers, and in the maturation of the humoral immune response  

PubMed Central

To investigate the role of TNF alpha in the development of in vivo immune response we have generated TNF alpha-deficient mice by gene targeting. Homozygous mutant mice are viable and fertile, develop lymph nodes and Peyer's patches and show no apparent phenotypic abnormalities, indicating that TNF alpha is not required for normal mouse development. In the absence of TNF alpha mice readily succumb to L. monocytogenes infections and show reduced contact hypersensitivity responses. Furthermore, TNF alpha knockout mice are resistant to the systemic toxicity of LPS upon D-galactosamine sensitization, yet they remain sensitive to high doses of LPS alone. Most interestingly, TNF alpha knockout mice completely lack splenic primary B cell follicles and cannot form organized follicular dendritic cell (FDC) networks and germinal centers. However, despite the absence of B cell follicles, Ig class-switching can still occur, yet deregulated humoral immune responses against either thymus-dependent (TD) or thymus-independent (TI) antigens are observed. Complementation of TNF alpha functioning by the expression of either human or murine TNF alpha transgenes is sufficient to reconstitute these defects, establishing a physiological role for TNF alpha in regulating the development and organization of splenic follicular architecture and in the maturation of the humoral immune response.

1996-01-01

299

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."

1997-01-01

300

The Infant Development Center.  

ERIC Educational Resources Information Center

Reported are services provided to developmentally or behaviorally disturbed children (0-to-3-years-old) and their parents by the Infant Development Center (IDC) in Mission, Kansas. Outlined is information such as the IDC's primary activities (infant developmental stimulation and parental training and support), secondary activities (such as…

Birr, Jack

301

The Pupil Appraisal Center.  

ERIC Educational Resources Information Center

The primary purpose of the Pupil Appraisal Center (PAC) is to promote teacher education by providing teachers and students direct experience in resolving behavioral disorders and learning problems. PAC provides specialized teacher training in counseling, reading, hearing, speech, and language development and provides service to area schools for…

Wilborn, Bobbie; Gentile, Lance M.

302

Surgical Results and Prognostic Factors of Anterior Cervical Corpectomy and Fusion for Ossification of the Posterior Longitudinal Ligament  

PubMed Central

Background Mechanism of ossification of the posterior longitudinal ligament (OPLL) has not been elucidated clearly. Surgical decompression is usually necessary for the patients with neurological symptoms. Anterior decompression and resection of OPLL seems to be a radical surgical option, because the spinal cord is compressed from the anterior direction. Methods Among 229 patients who underwent ACF for OPLL between January 2001 and December 2007 in our hospital, a total of 133 patients responded to the invitation and made return visits, with a follow-up rate of 58.1%. For these patients, clinical data were collected from medical and operative records. Neurological status were evaluated by using the Japanese Orthopedic Association (JOA) scoring system. Radiological evaluations including C2-7 lordotic angle, sagittal vertical axis (SVA), occupying rate of OPLL, double-layer sign and high-intensity zone were obtained from all the patients. Complications and causes of revision surgery were also investigated. Correlations between the long-term surgical outcome and various prognostic factors were statistically analyzed. Findings Eighty-four males and forty-nine females completed the follow-up, with a mean age at operation of 56.8 years. The overall average JOA score significantly increased, with a mean recovery rate of 64.1%±14.2%. The mean C2-7 lordotic angle and SVA were also significantly improved, and fusion rate was satisfactory. The incidence of complications was consistent to the previous reports and most of them were controllable by suitable treatments. Multiple regression analysis showed that number of corpectmies and preoperative JOA score were important predictors of surgical outcome. Conclusions ACF is a reliable and effective method for treating OPLL patients in terms of neurological recovery, maintenance of radiological parameters, fusion rate and complications. Number of corpectomies and preoperative JOA score are important predictors for the clinical outcome when this procedure is used.

Liu, Yang; Yang, Haisong; Wang, Xinwei; Chen, Deyu

2014-01-01

303

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

PubMed

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

2014-01-01

304

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.

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

2014-01-01

305

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: Waleed246@gmail.com [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)

2012-03-01

306

Evaluation of tail biopsy collection in laboratory mice (Mus musculus): vertebral ossification, DNA quantity, and acute behavioral responses.  

PubMed

A preferred method to genotype genetically engineered mice is through collection of distal tail tissue (tail biopsy) followed by DNA isolation. Currently, general or local anesthesia (or both) is recommended for biopsy after 3 wk of age, the time after which tail vertebrae are considered to be ossified. Our objective was to rigorously evaluate vertebral development, DNA content, and acute behavioral responses at different ages by harvesting tail biopsies of different lengths. We evaluated laboratory mice from 5 inbred strains and 1 outbred stock at each of 12 ages (3 to 42 d of age). Biopsies of 5-, 10-, and 15-mm lengths were obtained. Vertebrae were graded according to level of ossification by using complementary modalities of high-resolution microradiography, microcomputed tomography, and histology. Vertebral development progressed at different rates among the strains, with mature tail vertebrae containing endplates detectable in the tail of some strains by 10 d of age. Within the distal 2 mm of tail, end plates were not identified before 21 d of age. DNA yield (DNA weight/tissue weight) was greatest from the 5-mm biopsy harvest. Acute behavioral responses to biopsy varied by age and strain, and these differences were associated with vertebral maturation. Vertebral development progressed most rapidly in C57BL/6 mice, which also demonstrated the highest response rate to biopsy, whereas BALB/c mice had slower vertebral development and were less responsive. These findings support the collection of minimal lengths of tail tissue from mice at ages younger than 17 d, unless anesthesia or analgesia is provided. PMID:19049247

Hankenson, F Claire; Garzel, Laura M; Fischer, David D; Nolan, Bonnie; Hankenson, Kurt D

2008-11-01

307

Heterotopic Ossification after Cervical Arthroplasty with ProDisc-C: Time Course Radiographic Follow-up over 3 years  

PubMed Central

Objective Heterotopic ossification (HO) is a well-known complication after total hip replacement. But the occurrence rate by the time-course, clinical effect and risk factors of HO after total cervical disc replacement (TCDR) are not well described. The purpose of this study is to evaluate the occurrence rate by the time-course and risk factors for HO after TCDR with a ProDisc-C. Methods Thirty-two patients whom followed up more than one year after the TCDR are enrolled. Radiographic study was done at 12, 24 and 36 months after the TCDR and classified HO with McAfee classification. Segmental range of motion, preoperative existence of spondylosis, type of operation, disc space occupying ratio by artificial disc, surgical level are analyzed to identify the risk factors of HO. The visual analog scale and the neck disability index were evaluated preoperatively and at last follow-up time for clinical parameters. Results Eighteen patients (56%) showed HO at 12 months, 18 patients (86%) showed HO at 24 months and 6 patients (89%) showed HO at 36 months after the TCDR. Clinical significant HO(Grade 3 and 4) was shown in one patient (3%) at 12 months, 3 patients (14%) at 24 months and 5 patients (56%) at 36 months. Only post-operative follow-up period increases the risk of development clinical significant HO. All patients showed improvement of clinical parameters (p<0.005). Conclusion Incidence of HO is getting higher as time course progress. However, there are no relation between clinical outcome and radiologic change of ROM and the grade of HO.

Cho, Yong-Hwan; Kim, Keun-Su

2013-01-01

308

Hastings Center  

MedlinePLUS

... Feedback Home Publications The Hastings Center Report IRB: Ethics & Human Research Special Publications Bioethics Forum blog Over ... Media Alerts Hastings Center Report Press Kit IRB: Ethics & Human Research Press Kit Logos & Photos About Mission ...

309

In situ studies of the primary immune response to (4-hydroxy-3- nitrophenyl)acetyl. IV. Affinity-dependent, antigen-driven B cell apoptosis in germinal centers as a mechanism for maintaining self- tolerance  

PubMed Central

Germinal centers (GCs) are the sites of antigen-driven V(D)J gene hypermutation and selection necessary for the generation of high affinity memory B lymphocytes. Despite the antigen dependence of this reaction, injection of soluble antigen during an established primary immune response induces massive apoptotic death in GC B cells, but not in clonally related populations of nonfollicular B lymphoblasts and plasmacytes. Cell death in GCs occurs predominantly among light zone centrocytes, is antigen specific, and peaks within 4-8 h after injection. Antigen-induced programmed death does not involve cellular interactions mediated by CD40 ligand (CD40L) or Fas; disruption of GCs by antibody specific for CD40L was not driven by apoptosis and C57BL/6.lpr mice, though unable to express the Fas death trigger, remained fully susceptible to soluble antigen. Single injections of antigen did not significantly decrease GC numbers or average size, but repeated injections during an 18-h period resulted in fewer and substantially smaller GCs. As cell loss appeared most extensive in the light zone, decreased GC cellularity after prolonged exposure to soluble antigen implies that the Ig- centroblasts of the dark zone may require replenishment from light zone cells that have survived antigenic selection. GC cell death is avidity-dependent; oligovalent antigen induced relatively little apoptosis and GC B cells that survived long exposures to multivalent antigen expressed atypical VDJ rearrangements unlikely to encode high affinity antibody. Antigen- induced apoptotic death in GCs may represent a mechanism for the peripheral deletion of autoreactive B cell mutants much as the combinatorial repertoire of immature B lymphocytes is censored in the bone marrow.

1995-01-01

310

Primary thrombocythemia  

MedlinePLUS

Primary thrombocythemia is when the bone marrow is making too many platelets without a known cause. Platelets ... Primary thrombocythemia is caused by too much growth of a type of cell that is used to ...

311

Primary events of photosynthesis  

SciTech Connect

The primary events of photosynthesis are those photophysical and photochemical events that occur immediately after absorption of a photon by the photosynthetic pigments. The primary events include the migration of singlet excitons among the antenna pigments, exciton trapping by the reaction center, and a sequence of several electron transfer steps that leads to the formation of a stable electron-hole separation. All of the primary events occur within protein complexes which include chlorophylls, carotenoids, quinones, and various other transfer components. These complexes are called photosystems. Photosystems reside in a special photosynthetic membrane in organisms such as algae, higher plants, purple photosynthetic bacteria, and green photosynthetic bacteria. In this manuscript the primary events of photosynthesis are summarized with particular attention to the principles that they might hold for the design of molecular electronic devices.

Shipman, L.L.

1981-01-01

312

Identification and location of bone-forming cells within cartilage canals on their course into the secondary ossification centre  

PubMed Central

Osteoblasts and osteocytes derive from the same precursors, and osteocytes are terminally differentiated osteoblasts. These two cell types are distinguishable by their morphology, localization and levels of expression of various bone cell-specific markers. In the present study on the chicken femur we investigated the properties of the mesenchymal cells within cartilage canals on their course into the secondary ossification centre (SOC). We examined several developmental stages after hatching by means of light microscopy, electron microscopy, immunohistochemistry and in situ hybridization. Cartilage canals appeared as extensions of the perichondrium into the developing distal epiphysis and they were arranged in a complex network. Within the epiphysis an SOC was formed and cartilage canals penetrated into it. In addition, they were successively incorporated into the SOC during its growth in the radial direction. Thus, the canals provided this centre with mesenchymal cells and vessels. It should be emphasized that regression of cartilage canals could never be observed in the growing bone. Outside the SOC the mesenchymal cells of the canals expressed type I collagen and periostin and thus these cells had the characteristics of preosteoblasts. Periostin was also expressed by numerous chondrocytes. Within the SOC the synthesis of periostin was down-regulated and the majority of osteoblasts were periostin negative. Furthermore, osteocytes did not secret this protein. Tissue-non-specific alkaline phosphatase (TNAP) staining was only detectable where matrix vesicles were present. These vesicles were found around the blind end of cartilage canals within the SOC where newly formed osteoid started to mineralize. The vesicles originated from osteoblasts as well as from late osteoblasts/preosteocytes and thus TNAP was only expressed by these cells. Our results provide evidence that the mesenchymal cells of cartilage canals express various bone cell-specific markers depending on their position. We suggest that these cells differentiate from preosteoblasts into osteocytes on their course into the SOC and consider that cartilage canals are essential for normal bone development within the epiphysis. Furthermore, we propose that the expression of periostin by preosteoblasts and several chondrocytes is required for adhesion of these cells to the extracellular matrix.

Blumer, Michael J F; Schwarzer, Christoph; Perez, Maria Teresa; Konakci, Kadriye Zeynep; Fritsch, Helga

2006-01-01

313

76 FR 61103 - Medicare Program; Comprehensive Primary Care Initiative  

Federal Register 2010, 2011, 2012, 2013

...Medicare Program; Comprehensive Primary Care Initiative AGENCY: Centers for...participate in the Comprehensive Primary Care initiative (CPC), a multipayer model designed to improve primary care. DATES: Letter of Intent...

2011-10-03

314

Cancer Centers Program - Cancer Centers List  

Cancer.gov

Cancer Centers Program - Cancer Centers List Map of Cancer Centers Cancer Center Profiles Benchmark Data Home > Cancer Centers > State Map Map of Cancer Centers View By: Name | State | State Map | Region

315

78 FR 55731 - Health Workforce Research Center Cooperative Agreement Program  

Federal Register 2010, 2011, 2012, 2013

...workers in community health centers, health IT, and telehealth. The other focuses primarily on primary care, including competencies for primary care teams, temporal shifts between primary and specialty practice over time, and flexibility in...

2013-09-11

316

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.

2013-01-01

317

Senior Centers  

Microsoft Academic Search

This study explores the diversity of programs and services offered by senior centers in New York State, and identifies factors that may impact on the levels of participation among the elderly. Two hundred nineteen (n = 219) senior centers, recreation clubs, nutrition sites, and local Area Agencies of Aging in New York State were surveyed and comprise the study population.

Manoj P. Pardasani

2004-01-01

318

Senior Centers  

Microsoft Academic Search

This article explores the degree of influence of the racial and linguistic characteristics of staff and the availability of culturally diverse programs on the level of minority elder participation in senior centers. Two hundred twenty senior centers, recreation clubs, nutrition sites, and local Area Agencies of Aging in New York State were surveyed and comprise the study population. The impact

Manoj P. Pardasani

2004-01-01

319

Primary Hyperparathyroidism  

MedlinePLUS

... PHPT. Rarely, parathyroid cancer causes PHPT. What is PRiMaRY hYPERPaRathYROiDisM? The body’s parathyroid glands—four pea-sized glands in the neck—produce parathyroid hormone (PTH). Primary hyperparathyroidism (PHPT) is a condition in which an ...

320

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.

1993-01-01

321

Nanobiotechnology Center  

NSDL National Science Digital Library

Established in 2000 at Cornell University as a science and technology center, the Nanobiotechnology Center works to inform the general public and interested scholars about this growing area of human inquiry. This field of nanotechnology applies the tools and processes of nanofabrication to advance research in life sciences. On their website visitors can look over their programs, workshops, or read some of their working papers and research documents. The Research section contains a basic primer on their ongoing research projects, which includes long-term investigations into bimolecular devices and nanoscale cell biology. Moving on, the Publications area contains some nice research summary slides, annual reports, and the Center's newsletter.

322

Primary Science Focus: Where's Primary?  

ERIC Educational Resources Information Center

In this article, the author discusses the deliberate policy on the part of Primary Science Committee (PSC) to ensure that not only is primary science embedded in all aspects of the work of ASE but is seen to be there. She also describes the events for the 2010 Annual Conference. Over the coming months, PSC will continue to put much thought into…

Lawrence, Liz

2009-01-01

323

Primary Education or Primary Schooling?  

ERIC Educational Resources Information Center

There may be forces at work that recently have created barriers and restrictions within primary education. Indeed it could be argued that those forces have reduced the children's education to a more rigid and limiting primary schooling. This article explores the influence of target setting and testing, literacy and numeracy hours, American and…

Campbell, Robin

2005-01-01

324

Posterior decompression with transforaminal interbody fusion for thoracic myelopathy due to ossification of the posterior longitudinal ligament and the ligamentum flavum at the same level.  

PubMed

Our objective was to evaluate the clinical efficacy and feasibility of posterior decompression with transforaminal thoracic interbody fusion (PTTIF) for thoracic myelopathy caused by ossification of the ligamentum flavum (OLF) and ossification of the posterior longitudinal ligament (OPLL) at the same level. Between March 2004 and December 2008, 13 patients (five men and eight women, average age: 56years, range: 39-72years) who underwent PTTIF for concurrent OLF and OPLL were studied retrospectively. The clinical efficacy, operative time, blood loss, sagittal alignment and complications were investigated. Cerebrospinal fluid leakage occurred in three patients, all of whom healed well after repair. One patient developed a urinary tract infection and one developed a wound infection, but both were cured with appropriate antibiotic therapy. Neurological symptom deterioration occurred in one patient, but she returned to her preoperative baseline after completing methylprednisolone therapy. After an average 36.8months follow up, the mean Japanese Orthopaedic Association (JOA) score significantly increased from 4.3±1.3 preoperatively to 7.2±1.8 at 3months after the operation and 8.5±1.7 at the final follow-up (P<0.01), with an overall recovery rate of 63.2±21.8%. Postoperative imaging demonstrated an improvement in the local kyphosis (P<0.01), and as of the final follow up no cases of spinal instability or instrument loosening had occurred. We conclude that PTTIF provides satisfactory neurological recovery and stabilises the thoracic fusion through a single posterior approach. However, this procedure is not complication free and demands advanced technical expertise on the part of practitioners, particularly to avoid catastrophic spinal cord injuries. PMID:23313526

Liu, Fa-Jing; Chai, Yi; Shen, Yong; Xu, Jia-Xin; Du, Wei; Zhang, Peng

2013-04-01

325

Nurse managed occupational health centers: an overview.  

PubMed

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

1997-10-01

326

Nanobiotechnology Center  

NSDL National Science Digital Library

Established in January 2000, the Nanobiotechnology Center (NBTC) is a consortium of several major universities that is headed by Cornell University. Despite being so new, the NBTC has already made many important advances in this area of research. This brochure starts with a good introduction to the principles and uses of nanobiotechnology, and then gives a brief synopsis of the center's work. Some of the research programs described in this document are Selective Molecular Filtration, Bioselective Surfaces, and Molecular Motors. The NBTC Web site has even more information, including research papers and educational materials. Lesson plans for grade school teachers are also provided to let students learn about this exciting science.

2000-01-01

327

Primary Preceptors  

Microsoft Academic Search

The goal of our Primary Care Residency is to develop leaders in pharmaceutical care for ambulatory patients. Continuity of care in an interdisciplinary team environment is a major focus of the residency. The resident will be responsible for pharmacotherapy decisions, patient counseling, and monitoring of drug therapy to optimize therapeutic outcomes. Projects, clinical research, staff education, presentations, and publications are

Betsy Bryant; Robb Malone; Tim Ives

328

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.

1997-01-01

329

Challenger Center  

NSDL National Science Digital Library

The Challenger Center was founded by family members of the Challenger 51-L crew to continue the crew's educational mission to use students' natural enthusiasm for space to create innovative learning experiences. Teacher and community resources are available in the form of clip art, student activities, teacher workshops, electronic fieldtrips, and classroom programs pertaining to comets, Mars, the Moon, shuttles, the solar system, the international space station, and general space science.

330

Salvadori Center  

NSDL National Science Digital Library

The Salvadori Center was established in New York City in 1976, when Professor Salvadori of Columbia University was challenged by the New York Academy of Sciences to improve the teaching of math and science in middle schools. Visitors can read the about the vision and values of the Salvadori Center in the "About Us" link, which explains that "[u]sing the urban landscape of buildings, tunnels, and bridges,...[it] introduces teachers to the wonder, beauty, and logic of architecture and engineering, who then share it with their students." The "Resource Center" tab near the top of the page has a link to the "Salvadori Curriculum," which has been created for Science, Social Studies, Language Arts, Art, and Math. Visitors will note that the inclusion of non-STEM subjects offers a well-rounded approach to learning that still addresses the STEM subjects. Examples of some of the lessons that are taught in the Language Arts curriculum include asking students to legally protect their new ergonomic chair design, invent or improve upon a product they currently use, and produce a radio program telling the story of a school building, from the building's point of view.

2012-01-13

331

Primary Documents  

NSDL National Science Digital Library

This is a place to find primary documents in American history. This is a great website to find pictures and other images of historical figures and events. They can be used by anybody without fear of breaking copyright laws. Images of American Political History This website is not limited to the Federalist Papers. It is a great website to find historical documents. Federalist Papers This website is great ...

Revelli, Mr.

2006-11-13

332

National Centers for Career and Technical Education Annual Report, 2000.  

ERIC Educational Resources Information Center

The National Research Center for Career and Technical Education and the National Dissemination Center for Career and Technical Education were established at the University of Minnesota and The Ohio State University, respectively, in 1999. The centers operate as a consortium with primary and associate partners. Through the centers, the partners…

National Dissemination Center for Career and Technical Education, Columbus, OH.

333

76 FR 1441 - Health Center Program  

Federal Register 2010, 2011, 2012, 2013

...demonstrated record of compliance with Health Center Program statutory and regulatory...the ARRA Increased Demand for Services and ARRA Capital Improvement Project funds will ensure that critical primary health care services continue and remain...

2011-01-10

334

Community Health Centers: Providers, Patients, and Content of Care  

MedlinePLUS

... 40 years, community health centers (CHCs) have provided primary care and behavioral and mental health services in medically ... 72%) and PAs (72%) served as the patient's primary care provider more frequently than NPs (58%). Table 1. ...

335

[Primary aldosteronism].  

PubMed

The syndrome of primary aldosteronism is caused either by an aldosterone-producing adenoma or by idiopathic bilateral adrenal hyperplasia. Hypokalemic hypertension is the leading symptome of the disease. Diagnosis is by the combination of abnormally high and non-suppressible aldosterone values with undetectable or low renin values unresponsive to postural changes or salt restriction. Patients with aldosterone-producing adenoma normally show a fall in plasma aldosterone in response to posture and ACTH-dependent circadian rhythm of aldosterone, whereas bilateral hyperplasia is characterized by postural increases in plasma aldosterone and an ACTH-independent diurnal aldosterone rhythm. These creteria serve to differentiate between adenoma and hyperplasia. An aldosterone-producing adenoma can be localized by veinography, determination of aldosterone concentration in both adrenal veins and by 131I-cholesterol scintigraphy. In our hands the determination of aldosterone in blood from both adrenal veins is the most efficient procedure. In interpreting the results, however, rhythmic and sudden changes in adrenal hormone secretion should be considered. In cases where no adrenal venous blood is obtained, 131I-cholesterol scintigraphy may be used to localize adenoma. In patients with aldosterone-producing adenomas unilateral adrenalectomy should be performed, whereas patients with idiopathic bilateral hyperplasia should receive antihypertensive therapy. As rare instances of primary aldosteronism, a case of aldosterone-producing carcinoma of the adrenal cortex and a case of presumably unilateral adrenal hyperplasia are reported. PMID:1265463

Vetter, W; Vetter, H; Nussberger, J; Witassek, F; Beckerhoff, R; Pouliadis, G; Braun, K P; Sobbe, A; Furrer, J; Siegenthaler, W

1976-04-01

336

CHOP followed by involved field radiotherapy for localized primary gastric diffuse large B-cell lymphoma: results of a multi center phase II study and quality of life evaluation.  

PubMed

We aimed to define the role of cyclophosphamide, vincristine, doxorubicin, prednisone (CHOP) followed by involved field radiotherapy (IFRT) for treating localized primary gastric diffuse large B-cell lymphoma (DLBCL). Newly diagnosed patients with localized primary gastric DLBCL were to receive four cycles of CHOP followed by IFRT of 40.0 Gy. At 1 year after the completion of treatment, patients filled out the EORTC Quality of Life Questionnaire specified for stomach cancer (QLQ-C30-STO22). Fifty evaluable patients (25 men, 25 women) were included. The median age was 54.5 years (range, 21 - 73 years. The overall response rate to the CHOP was 94% (95% confidence interval [CI], 87 - 100) in the intent-to-treat population. Forty-one of the 50 patients (82%; 95% CI, 71 - 93) achieved complete remission (CR). After the completion of radiotherapy, five patients who were in PR following chemotherapy eventually attained CR. The overall complete response rate was thus 92% (95% confidence interval, 84 - 99). With a median follow-up period of 30 months, the 2-year progression-free and overall survival rate was 92% and 92%, respectively. The gastric function was well preserved with negligible stomach-related symptoms at 1 year after the completion of treatment. This organ-preserving combined treatment is highly effective and well tolerated for the patients with localized gastric DLBCL. PMID:16923554

Park, Yeon Hee; Lee, Se-Hoon; Kim, Won Seog; Bang, Soo-Mee; Ryoo, Baek-Yeol; Yang, Sung Hyun; Lee, Seung-Sook; Kim, Mi Sook; Kim, Kihyun; Park, Keon Woo; Im, Do Hyoung; Kang, Jung Hun; Lee, Jeeyun; Ko, Young H; Ahn, Yong Chan; Lim, Do Hoon; Park, Keunchil

2006-07-01

337

Phosphate is a specific signal for ATDC5 chondrocyte maturation and apoptosis-associated mineralization: possible implication of apoptosis in the regulation of endochondral ossification  

PubMed Central

During endochondral ossification, regulation of chondrocyte maturation governs the growth of the cartilage plate. The role of inorganic phosphate (Pi), whose levels strongly increase in the hypertrophic zone of the growth plate, on chondrocyte maturation has not yet been deciphered. Using the chondrogenic ATDC5 cells, we investigated the effects of Pi on cell maturation and on mineralization of the extracellular matrix. Pi induces matrix mineralization identical to that observed in growth plate cartilage and increases expression of the hypertrophic marker, collagen X. When calcium concentration is slightly increased (like in cartilage growth plate), Pi also stimulates apoptosis of differentiated ATDC5 cells, with a decrease in Bcl-2/Bax mRNA ratio, DNA fragmentation, characteristic morphological features and caspase-3 activation. All these effects are dependent on Pi entry into cells through sodium-dependent transporters. Finally, inhibition of apoptosis with ZVAD-fmk reduces Pi-induced mineralization. These findings suggest that Pi regulates chondrocyte maturation and apoptosis, which, in turn, controls skeletal development.

Magne, David; Bluteau, Gilles; Faucheux, Corinne; Palmer, Gaby; Vignes-Colombeix, Caroline; Pilet, Paul; Rouillon, Thierry; Caverzasio, Joseph; Weiss, Pierre; Daculsi, Guy; Guicheux, Jerome

2003-01-01

338

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.

NISHIDA, NORIHIRO; KANCHIKU, TSUKASA; KATO, YOSHIHIKO; IMAJO, YASUAKI; YOSHIDA, YUICHIRO; KAWANO, SYUNICHI; TAGUCHI, TOSHIHIKO

2014-01-01

339

Cameriere's approach modified for pelvic radiographs: a novel method to assess apophyseal iliac crest ossification for the purpose of forensic age diagnostics.  

PubMed

According to a modified method originally developed by Cameriere et al. (Int J Legal Med 120:143-146, 2006; J Forensic Sci 52:1151-1155, 2007; Forensic Sci Int 174:59-62, 2008; Forensic Sci Int 174:178-181, 2008; Forensic Sci Int 193:128.e1-128.e6, 2009), the suitability of the iliac crest apophysis (ICA) for the purpose of forensic age estimation in living individuals was investigated by means of area measurements in 643 pelvic radiographs of patients aged between 10 and 30 years. The area of the ossification centre(s) of the iliac crest and the area of the iliac wing (IW) were determined by manual segmentation. In 116 cases, area measurements were possible. ICA/IW ratios were calculated and used for regression analyses, yielding different regression equations. Depending on sex, pelvic side and ratio considered, R (2) ranged between 0.20 and 0.38 and the standard error of the estimate, between 1.91 and 2.00 years. No statistical significant differences were found between the right and the left pelvic sides. In conclusion, this method is potentially applicable for forensic age estimation in living individuals. However, further studies under more standardised conditions and with higher case numbers are needed in order to decide whether the iliac crest apophysis might become suitable for routine age diagnostics. PMID:23420261

Wittschieber, Daniel; Vieth, Volker; Wierer, Traugott; Pfeiffer, Heidi; Schmeling, Andreas

2013-07-01

340

Joint Interdisciplinary Earth Science Information Center.  

National Technical Information Service (NTIS)

The report spans the three year period beginning in June of 2001 and ending June of 2004. Joint Interdisciplinary Earth Science Information Center's (JIESIC) primary purpose has been to carry out research in support of the Global Change Data Center and ot...

M. Kafatos

2004-01-01

341

Predictions of the Space Environment Services Center  

NASA Technical Reports Server (NTRS)

The types of users of the Space Environment Services Center are identified. All the data collected by the Center are listed and a short description of each primary index or activity summary is given. Each type of regularly produced forecast is described, along with the methods used to produce each prediction.

Heckman, G. R.

1979-01-01

342

Can Third Graders Make Learning Centers?  

ERIC Educational Resources Information Center

The article describes the Tuscaloosa County class for 16 primary gifted students in Northport, Alabama. It is explained that the students designed learning centers based on their own interests. Outlined is the sequential plan developed for researching and developing the learning centers. (SBH)

Alexander, Frances

1979-01-01

343

Extreme ultraviolet explorer science operation center  

Microsoft Academic Search

The Extreme Ultraviolet Explorer (EUVE) Science Operations Center (ESOC) is a satellite payload operations center for the Extreme Ultraviolet Explorer project, located on the Berkeley campus of the University of California. The ESOC has the primary responsibility for commanding the EUVE telescopes and monitoring their telemetry. The ESOC is one of a very few university based satellite operations facilities operating

G. S. Wong; F. A. Kronberg; H. D. Meriwether; L. S. Wong; C. L. Grassi

1993-01-01

344

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

1994-05-01

345

Extreme Ultraviolet Explorer Science Operation Center  

NASA Technical Reports Server (NTRS)

The EUVE Science Operations Center (ESOC) is a satellite payload operations center for the Extreme Ultraviolet Explorer project, located on the Berkeley campus of the University of California. The ESOC has the primary responsibility for commanding the EUVE telescopes and monitoring their telemetry. The ESOC is one of a very few university-based satellite operations facilities operating with NASA. This article describes the history, operation, and advantages of the ESOC as an on-campus operations center.

Wong, G. S.; Kronberg, F. A.; Meriwether, H. D.; Wong, L. S.; Grassi, C. L.

1993-01-01

346

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 geneâÃÂÃÂs name will take you to the National Center for Biological Information, where you can explore the latest relevant scientific literature.

2009-04-14

347

Primary Hyperoxaluria  

PubMed Central

Primary hyperoxalurias (PH) are inborn errors in the metabolism of glyoxylate and oxalate. PH type 1, the most common form, is an autosomal recessive disorder caused by a deficiency of the liver-specific enzyme alanine, glyoxylate aminotransferase (AGT) resulting in overproduction and excessive urinary excretion of oxalate. Recurrent urolithiasis and nephrocalcinosis are the hallmarks of the disease. As glomerular filtration rate decreases due to progressive renal damage, oxalate accumulates leading to systemic oxalosis. Diagnosis is often delayed and is based on clinical and sonographic findings, urinary oxalate assessment, DNA analysis, and, if necessary, direct AGT activity measurement in liver biopsy tissue. Early initiation of conservative treatment, including high fluid intake, inhibitors of calcium oxalate crystallization, and pyridoxine in responsive cases, can help to maintain renal function in compliant subjects. In end-stage renal disease patients, the best outcomes have been achieved with combined liver-kidney transplantation which corrects the enzyme defect.

Harambat, Jerome; Fargue, Sonia; Bacchetta, Justine; Acquaviva, Cecile; Cochat, Pierre

2011-01-01

348

Primary care psychiatry in Italy.  

PubMed

In Italy, the importance of integrating primary care and mental health has only recently been grasped. Several reasons may explain this delay: a) until 2005, primary care physicians worked individually instead of in group practices, without any functional network or structured contacts with colleagues; b) community mental health centers with multiprofessional teams were well structured and widespread in several regions but focused on people with severe and persistent mental disorders; and c) specific national government health policies were lacking. Only two regions have implemented explicit policies on this issue. The "G. Leggieri" program started by the Emilia-Romagna region health government in 1999 aims to coordinate unsolicited bottom-up cooperation initiatives developing since the 1980s. In Liguria, a regional work group was established in 2010 to boost the strategic role of collaborative programs between primary care and mental health services. This article describes the most innovative experiences relating to primary care psychiatry in Italy. PMID:24840088

Berardi, Domenico; Ferrannini, Luigi; Menchetti, Marco; Vaggi, Marco

2014-06-01

349

Protein-Cofactor Interactions in Bacterial Reaction Centers from Rhodobacter sphaeroides R-26: I. Identification of the ENDOR Lines Associated with the Hydrogen Bonds to the Primary Quinone QA??  

PubMed Central

Hydrogen bonds are important in determining the structure and function of biomolecules. Of particular interest are hydrogen bonds to quinones, which play an important role in the bioenergetics of respiration and photosynthesis. In this work we investigated the hydrogen bonds to the two carbonyl oxygens of the semiquinone \\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\setlength{\\oddsidemargin}{-69pt} \\begin{document} \\begin{equation*}{\\mathrm{Q}}_{{\\mathrm{A}}}^{{\\cdot}-}\\end{equation*}\\end{document} in the well-characterized reaction center from the photosynthetic bacterium Rhodobacter sphaeroides R-26. We used electron paramagnetic resonance and electron nuclear double resonance techniques at 35 GHz at a temperature of 80 K. The goal of this study was to identify and assign sets of 1H-ENDOR lines to protons hydrogen bonded to each of the two oxygens. This was accomplished by preferentially exchanging the hydrogen bond on one of the oxygens with deuterium while concomitantly monitoring the changes in the amplitudes of the 1H-ENDOR lines. The preferential deuteration of one of the oxygens was made possible by the different 1H ? 2H exchange times of the protons bonded to the two oxygens. The assignment of the 1H-ENDOR lines sets the stage for the determination of the geometries of the H-bonds by a detailed field selection ENDOR study to be presented in a future article.

Flores, M.; Isaacson, R.; Abresch, E.; Calvo, R.; Lubitz, W.; Feher, G.

2006-01-01

350

Congenital pseudarthrosis of the clavicle: a histopathological study in five patients.  

PubMed

Congenital pseudarthrosis of the clavicle is usually situated on the right clavicle. Pathological data on pseudarthrosis are scant. The histological analysis of five cases treated by 'en bloc' surgical resection are reported. Enchondral ossification was observed on both sides of the resected pseudarthrosis in two cases. Less characteristic enchondral features were noted in three cases. These findings confirm that the pseudarthrosis is due to the failure of coalescence of the two primary ossification centers of the clavicle. PMID:15599233

Gomez-Brouchet, Anne; Sales de Gauzy, Jérôme; Accadbled, Franck; Abid, Aziz; Delisle, Marie Bernadette; Cahuzac, Jean-Philippe

2004-11-01

351

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

1995-01-01

352

NCI Community Cancer Centers Program - Pilot Site Profile - St. Joseph Medical Center, Towson, Maryland  

Cancer.gov

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.

353

Primary hyperoxaluria.  

PubMed

Primary hyperoxaluria (PH) occurs due to an autosomal recessive hereditary disorder of the metabolism of glyoxylate, which causes excessive oxalate production. The most frequent and serious disorder is due to enzyme deficit of alanine-glyoxylate aminotransferase (PH type I) specific to hepatic peroxisome. As oxalate is not metabolised in humans and is excreted through the kidneys, the kidney is the first organ affected, causing recurrent lithiasis, nephrocalcinosis and early renal failure. With advance of renal failure, particularly in patients on haemodialysis (HD), calcium oxalate is massively deposited in tissues, which is known as oxalosis. Diagnosis is based on family history, the presence of urolithiasis and/or nephrocalcinosis, hyperoxaluria, oxalate deposits in tissue forming granulomas, molecular analysis of DNA and enzyme analysis if applicable. High diagnostic suspicion is required; therefore, unfortunately, in many cases it is diagnosed after its recurrence following kidney transplantation. Conservative management of this disease (high liquid intake, pyridoxine and crystallisation inhibitors) needs to be adopted early in order to delay kidney damage. Treatment by dialysis is ineffective in treating excess oxalate. After the kidney transplant, we normally observe a rapid appearance of oxalate deposits in the graft and the results of this technique are discouraging, with very few exceptions. Pre-emptive liver transplantation, or simultaneous liver and kidney transplants when there is already irreversible damage to the kidney, is the treatment of choice to treat the underlying disease and suppress oxalate overproduction. Given its condition as a rare disease and its genetic and clinical heterogeneity, it is not possible to gain evidence through randomised clinical trials. As a result, the recommendations are established by groups of experts based on publications of renowned scientific rigour. In this regard, a group of European experts (OxalEurope) has drawn up recommendations for diagnosis and treatment, which were published in 2012. PMID:24798559

Lorenzo, Víctor; Torres, Armando; Salido, Eduardo

2014-05-21

354

Fibrodysplasia ossificans progressiva: middle-age onset of heterotopic ossification from a unique missense mutation (c.974G>C, p.G325A) in ACVR1.  

PubMed

Fibrodysplasia ossificans progressiva (FOP) is the rare mendelian disease characterized by congenital malformation of the great toes preceding heterotopic ossification (HO) and caused by heterozygous activating mutation of the ACVR1 gene, which encodes the ALK2 receptor for bone morphogenetic proteins. Early adult life is the latest reported presentation for the HO of FOP. The patient of our report first developed HO from FOP at 47 years of age. She had congenital hallux valgus deformity but despite various traumas was previously well. HO began several months after a brief, seemingly viral, illness. Sudden and progressive pain, redness, warmth, and swelling appeared over a scapula. Computed tomography was remarkable for asymmetrical thickening of muscles and fascial planes. At first, the significance of the great toe abnormalities went unrecognized elsewhere, and biopsy for suspected inflammatory fasciitis revealed proliferating fibroblasts with scattered inflammatory cells. Prednisone improved her symptoms but, when tapered, swellings developed on her chest, posterior thorax, and flank, and FOP was diagnosed. Methylprednisolone, methotrexate, and alendronate seemed to help her symptoms, but the lesions worsened and HO appeared and rapidly progressed. Mutation analysis of the ACVR1 gene revealed heterozygosity for a unique missense defect (c.974G>C, p.G325A) that predicted a conservative (mild) amino acid change within the kinase domain of ALK2. Hence, HO in FOP can be delayed until middle-age, and perhaps provoked by a viral illness. Nevertheless, progression of HO can then be rapid despite bisphosphonate and high-dose immunosuppressive therapy. Possibly, our patient's late-onset HO reflects her mild alteration of ALK2 or some protective and therapeutically useful genetic, epigenetic, or nongenetic factor. Recognition of presymptomatic individuals or late-onset HO in FOP should have these patients avoid traumas, treatments, and maybe viral illnesses that can initiate or exacerbate the HO. If the diagnosis of FOP is unclear, ACVR1 mutation analysis is available at certified laboratories. PMID:22131272

Whyte, Michael P; Wenkert, Deborah; Demertzis, Jennifer L; DiCarlo, Edward F; Westenberg, Erica; Mumm, Steven

2012-03-01

355

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.

356

Mid-America Earthquake Center  

NSDL National Science Digital Library

Understanding earthquakes is a complex process, and the Mid-Americ Earthquake Center is one of three national earthquake engineering research centers set up to work on a variety of approaches to a broad set of related scientific concerns. Based at the University of Illinois at Urbana-Champaign, the Center consists of a consortium of nine core institutions and is funded by the National Science Foundation. The Center's primary work is within four areas, including information technology and consequence-based risk management frameworks. Recognizing that they serve a broad range of visitors to their website, the Center has established a number of informative introductions on their homepage for the general public, potential industry partners, members of the press, and K-12 educators. While a number of visitors may be interested in their technical reports and software packages, most visitors will want to look over the graduate and undergraduate teaching modules, which will be of great use to educators in the engineering and geophysical sciences and their students. Additionally, the Center's site provides access to a number of informative webcasts, including presentations on seismic performances of bridges.

357

Primary Sclerosing Cholangitis  

MedlinePLUS

... List of Topics and Titles : Primary Sclerosing Cholangitis Primary Sclerosing Cholangitis On this page: What is primary ... Hope through Research For More Information What is primary sclerosing cholangitis (PSC)? PSC is a disease that ...

358

Primary Lateral Sclerosis  

MedlinePLUS

NINDS Primary Lateral Sclerosis Information Page Table of Contents (click to jump to sections) What is Primary Lateral Sclerosis? ... is being done? Clinical Trials Organizations What is Primary Lateral Sclerosis? Primary lateral sclerosis (PLS) is a ...

359

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.

360

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. ...

Bates, Albion M.

2010-01-23

361

Environmental drift in health center dental practice management.  

PubMed

Federally qualified health centers, FQHCs, face a number of challenges providing low-cost health services and meeting their primary mission of being available to all users regardless of their ability to pay. In effect, health centers must provide services that border on free to minimal revenue-generating potential. This is especially challenging for health centers providing dental services that are often more costly on a case-by-case visit encounter than primary care services.. PMID:19831007

Russell, Bob

2009-05-01

362

Carbon Dioxide Information Analysis Center and World Data Center for Atmospheric Trace Gases Fiscal Year 2000 Annual Report.  

National Technical Information Service (NTIS)

The Carbon Dioxide Information Analysis Center (CDIAC), which includes the World Data Center (WDC) for Atmospheric Trace Gases, is the primary global change data and information analysis center of the U.S. Department of Energy (DOE). More than just an arc...

R. M. Cushman

2001-01-01

363

Technology Transfer Center | Competitive Service Center  

Cancer.gov

The Technology Transfer Center (TTC) is a designated Competitive Service Center (CSC) for technology transfer to other NIH Institutes and Centers (ICs). The CSC at TTC offers a range of services and works with each client IC to determine the IC's unique technology transfer needs.

364

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.

365

Belfer Center for Science and International Affairs  

NSDL National Science Digital Library

The Belfer Center for Science and International Affairs at Harvard was originally founded in 1973 by Paul Doty, when its original gaol was to revive serious analysis of nuclear dangers and arms control. In 1997, the Center was re-endowed, and its primary mission became "to provide leadership in advancing policy-relevant knowledge about the international security and other critical issues where science, technology, and international affairs intersect." Within the Center, there are five main research programs, including international security, intrastate conflict, and Russia and the Caspian. From their home page, visitors can read opinion and editorials penned by people working at the Center, and find out about upcoming talks and conferences sponsored or hosted by the Center. Also, visitors can visit the Publications section of the site to read discussion papers and other scholarship written by scholars and fellows associated with the Center.

366

Center for International Development at Harvard University  

NSDL National Science Digital Library

Established in 1998 by the Harvard Institute for International Development and the Kennedy School of Government, the Center for International Development (CID) is Harvard's primary center for research on sustainable international development. The CID is currently headed by Professor Dani Rodrik, who provides oversight and direction for the Center. On the site, visitors can learn about upcoming international development conferences sponsored by the Center, read about the various persons working at the Center, learn about various research programs, along with reading various reports associated with each area of inquiry. The site also contains a host of links to online research data sets for persons working in the field of international development, and to the Center's working papers and special reports. Some of the more compelling working papers address the situation of sustainable development in sub-Saharan Africa and the rise and fall of the Indonesian economy.

367

Fireworks Information Center  

MedlinePLUS

... Safety Education / Safety Education Centers En Español Fireworks Information Center This is an information center on fireworks ... Put Safety First This Fourth of July Fireworks Information What are consumer fireworks and where are they ...

368

Choosing a Transplant Center  

MedlinePLUS

... and foundation partners Global transplant network Donor centers Recruitment centers International donor centers Cord blood banks Cooperative ... information Annual report Funding patient assistance Funding donor recruitment Careers Working with us Our accomplishments & recognition Career ...

369

Transplant Center Directory  

MedlinePLUS

... and foundation partners Global transplant network Donor centers Recruitment centers International donor centers Cord blood banks Cooperative ... information Annual report Funding patient assistance Funding donor recruitment Careers Working with us Our accomplishments & recognition Career ...

370

Arizona Cancer Center  

Cancer.gov

The Arizona Cancer Center (AZCC) was founded in 1976 as a division of the University of Arizona’s College of Medicine and became an NCI-designated cancer center in 1978. It received Comprehensive Cancer Center status in 1990.

371

The Watergate Learning Center  

ERIC Educational Resources Information Center

The Watergate Learning Center, recently opened by Sterling Learning Center in Washington, D. C., blueprints the plan established by Sterling and Marriott Hotels for a national chain of learning centers with much the same facilities. (EB)

Training in Business and Industry, 1971

1971-01-01

372

Molecular Basis for the Photosynthetic Primary Process  

PubMed Central

In this paper, the molecular details for the primary reaction in photosynthesis are deduced from several recent critical experimental observations. A symmetrical structure is proposed for the basic unit of the reaction center in plant photosynthesis. A mathematical consequence of the symmetrical arrangement is the creation of an anomalously long-lived trap state, which makes possible the summation of a reaction-center triplet excitation and an antenna chlorophyll singlet excitation to bring the photoactive chlorophylls to a charge-transfer state prior to entering into a primary photochemical reaction.

Fong, Francis K.

1974-01-01

373

Primary charge separation in mutant reaction centers of Rhodobacter capsulatus  

Microsoft Academic Search

Excited-state decays of the special pair of Rhodobacter capsulatus and 10 mutants as a function of temperature are presented. The mutations are at the symmetry-related sites L181 and M208. All the decays are nonexponential, although the degree of nonexponentially depends strongly on the mutant and the temperature. We correlated the changes in decay time with mutation-induced changes in the redox

Yiwei Jia; M. Du; G. R. Fleming; T. J. DiMagno; C. K. Chan; M. Schiffer; Z. Wang; J. R. Norris; M. S. Popov; D. K. Hanson

1993-01-01

374

Dryden Flight Research Center  

NASA Technical Reports Server (NTRS)

This content is for a DFRC Center Overview Poster for the 2011 TFAWS (Thermal & Fluids Analysis Workshop). The LaRC personnel running it gave each center POC the template to fill out, and send back so their graphics personnel could use a center aerial photo (or two) and the content to generate the poster (that way each center has the same template, etc.).

Kostyk, Chris

2011-01-01

375

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.

1990-01-01

376

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

377

Primary cardiac valve tumors.  

PubMed

To assess the prevalence, characteristics, and outcome of surgical treatment of primary cardiac valve tumors in a single center, we reviewed our experience in 6 women and 1 man, aged 49 to 76 years (mean, 64.7 years) who presented between 1999 and 2006. In one patient, the diagnosis of cardiac valve tumor was made incidentally on transesophageal echocardiography during aortocoronary bypass surgery. The others had clinical symptoms: angina or myocardial infarction in 3, congestive heart failure in 2, dyspnea and cerebrovascular ischemia in 1 patient each. Four of the 7 tumors were benign, and 3 were malignant. All patients survived the operation and recovered uneventfully. Midterm follow-up was available in all patients. Two patients with malignant tumors were considered unsuitable for adjuvant therapy by the oncologist; both died during follow-up from local tumor recurrence. All 5 survivors were categorized at the last follow-up as functional class I, with normal exercise tolerance. Excellent early and midterm surgical results can be obtained in patients with benign cardiac valve tumors, but the prognosis for those with a malignant tumor is poor. PMID:20519288

Georghiou, Georgios P; Vidne, Bernardo A; Sahar, Gideon; Sharoni, Erez; Fuks, Avi; Porat, Eyal

2010-06-01

378

Albert Einstein Cancer Center  

Cancer.gov

The Albert Einstein College of Medicine at Yeshiva University was founded in 1955. In 1971, the Albert Einstein Cancer Center (AECC) was established at the medical school and in 1972, AECC became an NCI-designated Cancer Center. AECC is located in the Chanin Research Institute. The Center’s imaging facility, new mouse facilities, and expanded research programs are housed in the newly opened Price Center for Genetic and Translational Medicine.

379

RSF Data Center Tour  

ScienceCinema

The Data Center in the Research Support Facility on the campus of the U.S. Department of Energy's National Renewable Energy Laboratory (NREL) marks a significant accomplishment in its ultra-efficiency. Data centers by nature are very energy intensive. The RSF Data Center was designed to use 80% less energy than NREL's old data center, which had been in use for the last 30 years. This tour takes you through the data center highlighting its energy saving techniques.

380

RSF Data Center Tour  

SciTech Connect

The Data Center in the Research Support Facility on the campus of the U.S. Department of Energy's National Renewable Energy Laboratory (NREL) marks a significant accomplishment in its ultra-efficiency. Data centers by nature are very energy intensive. The RSF Data Center was designed to use 80% less energy than NREL's old data center, which had been in use for the last 30 years. This tour takes you through the data center highlighting its energy saving techniques.

Powers, Chuck

2011-01-01

381

Masonic Cancer Center  

Cancer.gov

The Masonic Cancer Center was founded in 1991 as the University of Minnesota Cancer Center and received its NCI designation in 1998. It was renamed the Masonic Cancer Center (MCC) in 2008. The Center combines population sciences, basic research, and translational cancer care with community outreach and educational activities. The Center facilitates the research of its members, fosters multidisciplinary approaches to cancer, provides infrastructure support for cancer research, and develops new methods and strategies to reduce cancer incidence and mortality.

382

Center of Gravity, Center of Mass, Centroids  

Microsoft Academic Search

In this chapter, definitions of the center of gravity and the center of mass are given. It is shown how to determine the centroids\\u000a of bodies, areas and lines. Various examples demonstrate how to apply the definitions to practical problems.

Dietmar Gross; Werner Hauger; Jörg Schröder; Wolfgang A. Wall; Nimal Rajapakse

383

Organisation of Prevention in Primary Health Care.  

ERIC Educational Resources Information Center

This report examines the possiblities of increasing the amount of preventive work being carried out by primary care workers in European communities. Before making practical recommendations about promoting prevention, an analysis is presented of the main present day problems. These center on the environment (not only physical but also social and…

Council of Europe, Strasbourg (France).

384

Primary neuroendocrine tumors of the thymus  

Microsoft Academic Search

Primary neuroendocrine tumors of the thymus are highly aggressive tumors that rarely occur. A little more than 200 cases have been reported, many of which were single case reports. Only a few articles contained modest series from single centers for analysis. A review of 157 cases collected from the major series reported to-date show a clinical pattern with male preponderance

Rabih Chaer; Malek G Massad; Alexander Evans; Norman J Snow; Alexander S Geha

2002-01-01

385

Primary Neuroendocrine Tumors of the Thymus  

Microsoft Academic Search

Primary neuroendocrine tumors of the thymus are highly aggressive tumors that rarely occur. A little more than 200 cases have been reported, many of which were single case reports. Only a few articles contained modest series from single centers for analysis. A review of 157 cases collected from the major series reported to-date show a clinical pattern with male preponderance

Rabih Chaer; Malek G. Massad; Alexander Evans; Norman J. Snow; Alexander S. Geha

386

Computational Center for Studies of Plasma Microturbulence  

SciTech Connect

The Maryland Computational Center for Studies of Microturbulence (CCSM) was one component of a larger, multi-institutional Plasma Microturbulence Project, funded through what eventually became DOE's Scientific Discovery Through Advanced Computing Program. The primary focus of research in CCSM was to develop, deploy, maintain, and utilize kinetic simulation techniques, especially the gyrokinetic code called GS2.

William Dorland

2006-10-11

387

University of Texas Health Science Center, Houston  

Cancer.gov

The primary project is to focus upon translation of imaging agents and devices developed at The Baylor College of Medicine (BCM) and translated in Phase I studies at The Michael E. DeBakey Veterans Administration Medical Center (MEDVAMC) as well as at Ben Taub General Hospital (BTGH).

388

Harvard Education and Research Center, Final Progress Report July 1, 1993 - June 30, 1998.  

National Technical Information Service (NTIS)

The Harvard Educational Resource Center for Occupational Safety and Health (renamed Harvard Education and Research Center in 1997) holds as its primary objective the training of leaders in occupational medicine, industrial hygiene, occupational-health nur...

A. Backus C. Love D. C. Christiani H. Hu L. Fitzgerald P. M. Adams S. Rudnick T. J. Smith

1999-01-01

389

Comparative study of reaction centers from purple photosynthetic bacteria: Isolation and optical spectroscopy  

Microsoft Academic Search

Reaction centers from two species of purple bacteria, Rhodospirillum rubrum and Rhodospirillum centenum, have been characterized and compared to reaction centers from Rhodobacter sphaeroides and Rhodobacter capsulatus. The reaction centers purified from these four species can be divided into two classes according to the spectral characteristics of the primary donor. Reaction centers from one class have a donor optical band

S. Wang; S. Lin; X. Lin; N. W. Woodbury; J. P. Allen

1994-01-01

390

Patient Telephone Appointment System for High Volume Primary Care Sites.  

National Technical Information Service (NTIS)

The purpose of this research is to design a patient telephone appointment system for use in the Naval Medical Center San Diego's high volume Primary Care sites, which will reduce variation and ensure efficient, timely, convenient, and appropriate access t...

F. M. Worthington

2000-01-01

391

8. VIEW FROM NORTHWEST OF CONDENSATE STORAGE TANK (LEFT), PRIMARY ...  

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

8. VIEW FROM NORTHWEST OF CONDENSATE STORAGE TANK (LEFT), PRIMARY WATER STORAGE TANK (CENTER), CANAL WATER STORAGE TANK (RIGHT) (LOCATIONS E,F,D) - Shippingport Atomic Power Station, On Ohio River, 25 miles Northwest of Pittsburgh, Shippingport, Beaver County, PA

392

Scientific and Engineering Leaders of the Naval Surface Warfare Center.  

National Technical Information Service (NTIS)

This directory will introduce you to the top scientific and engineering leaders of the Naval Surface Warfare Center. It is divided into three sections, each representing a primary area of leadership. The sections contain photographs and brief resumes of t...

1988-01-01

393

Presearch Data Conditioning in the Kepler Science Operations Center Pipeline.  

National Technical Information Service (NTIS)

We describe the Presearch Data Conditioning (PDC) software component and its context in the Kepler Science Operations Center (SOC) pipeline. The primary tasks of this component are to correct systematic and other errors, remove excess flux due to aperture...

F. Girouard H. Chandrasekaran J. D. Twicken J. M. Jenkins J. P. Gunter T. C. Klaus

2010-01-01

394

Chinese Communist Party: A Strategic Center of Gravity Analysis.  

National Technical Information Service (NTIS)

A strategic center of gravity analysis of the Chinese Communist Party (CCP) reveals four mutually-supporting critical capabilities that provide the Party's primary capacity to maintain dominant power and authority in China. However, a major deficiency ass...

J. J. Abernethy

2012-01-01

395

University of Colorado Cancer Center  

Cancer.gov

The University of Colorado Cancer Center was founded and became an NCI-designated cancer center in 1988. CU Cancer Center became a comprehensive cancer center in 1997. The Center is headquartered on the Anschutz Medical Campus in Aurora.

396

Crib Information Center  

MedlinePLUS

... Safety Education / Safety Education Centers En Español Crib Information Center Learn How to Put Your Baby to ... Privacy Policy Budget & Performance Open Government Freedom of Information (FOIA) Inspector General No Fear Act Data USA. ...

397

Science Centers for All.  

ERIC Educational Resources Information Center

Discusses the merits of science learning centers as a tool for teachers to encourage positive interaction among students of different backgrounds and ability levels. Describes the success of science centers through work with children and preservice teachers. (Author/KHR)

Irwin, Leslie; Nucci, Christine; Beckett, E. Carol

2003-01-01

398

Undergraduate Research Centers (URC)  

NSF Publications Database

... Research Centers (URC) Synopsis of Program: The Undergraduate Research Center (URC) Program seeks ... nation?s research enterprise. The research underlying an URC should provide exposure to research of ...

399

Undergraduate Research Centers  

NSF Publications Database

... Research Centers (URC) Synopsis of Program: This pilot program of Undergraduate Research Centers ... research to include first- and second-year college students; and (2) to enhance the research ...

400

Science Centers for All  

NSDL National Science Digital Library

University professors suggest ways to bridge gaps among diverse learners--of different cultural, socioeconomic, physiological, and linguistic backgrounds--through the use of science centers in the classroom. Includes ideas for setting up science centers and celebrating diversity.

Nucci, Christine; Beckett, E. C.; Irwin, Leslie

2003-02-01

401

National Wildlife Research Center.  

National Technical Information Service (NTIS)

The National Wildlife Research Center (NWRC) is the Federal institution devoted to resolving problems caused by the interaction of wild animals and society. The Center applies scientific expertise to the development of practical methods to resolve these p...

2001-01-01

402

UAB Comprehensive Cancer Center  

Cancer.gov

Established in 1971, the University of Alabama at Birmingham Comprehensive Cancer Center (UAB), received its NCI designation in the same year. The Center has grown to include a membership of more than 330 physicians and researchers.

403

ACTS data center  

NASA Technical Reports Server (NTRS)

Viewgraphs on ACTS Data Center status report are included. Topics covered include: ACTS Data Center Functions; data flow overview; PPD flow; RAW data flow; data compression; PPD distribution; RAW Data Archival; PPD Audit; and data analysis.

Syed, Ali; Vogel, Wolfhard J.

1993-01-01

404

Regional Instrumentation Centers.  

ERIC Educational Resources Information Center

Focuses on the activities of regional instrumentation centers that utilize the state-of-the-art instruments and methodology in basic scientific research. The emphasis is on the centers involved in mass spectroscopy, magnetic resonance spectroscopy, lasers, and accelerators. (SA)

Cromie, William J.

1980-01-01

405

The Calculator Information Center.  

ERIC Educational Resources Information Center

The functions of the center include preparing annotated bibliographies, research listings, and information bulletins. The address of the center and a bibliography for instruction with hand-held calculators, K-12, are given. (MP)

Calculators/Computers Magazine, 1978

1978-01-01

406

Center for Alternative Fuels  

NSDL National Science Digital Library

The success of the HEV programs under this grant prompted Macomb to launch this resource, the Center for Alternative Fuels. The center holds forums in which academic and industry experts discuss the technical and societal impact of alternative fuels.

2009-12-21

407

National Farm Medicine Center  

MedlinePLUS

Farm Medicine, Rural Health & Safety National Farm Medicine Center Established in 1981 in response to occupational health problems seen in farm patients coming to Marshfield Clinic, the National Farm Medicine Center ...

408

Disability Statistics Center  

MedlinePLUS

... can help ease this problem. Highlights of the DSC study's findings: The lack in hours of needed ... long-term care. Center for Personal Assistance Services DSC researchers have key roles in the new Center ...

409

Tornadoes: A Center Approach.  

ERIC Educational Resources Information Center

Information is given on how to put together a learning center. Discusses information and activity packets for a complete learning center on tornadoes including objectives, directions, materials, photographs of physical arrangements, and posttest. (DC)

Christman-Rothlein, Liz; Meinbach, Anita M.

1981-01-01

410

Abramson Cancer Center  

Cancer.gov

In 1973, the University of Pennsylvania established a cancer center to serve as the focus and stimulus for all cancer-related activities at the University. In 1974, it was designated as a comprehensive cancer center by NCI and in 2002, it was renamed the Abramson Cancer Center of the University of Pennsylvania. The mission of the Center is the eradication of cancer as a cause of human disease and suffering.

411

Connection: Schwartz Center Rounds at Massachusetts General Hospital Cancer Center  

PubMed Central

Shortly before his death in 1995, Kenneth B. Schwartz, a cancer patient at Massachusetts General Hospital, founded the Kenneth B. Schwartz Center®, a nonprofit organization dedicated to supporting and advancing compassionate health care. The Center sponsors Schwartz Rounds®, a multidisciplinary forum in which doctors, nurses, chaplains, social workers, and oth