Objectives: Comparative analysis of functional results, complications, cosmesis, operative time and hospital stay between staged urethroplasty and single–stage on–lay island flap for proximal hypospadias.Materials and Methods: Non–randomised single observer study of two groups of patients over a 5–year period with proximal hypospadias. Group 1 had 17 patients (mean age 17.7±1.6 months) who underwent a staged urethroplasty. Urethral plate was tubularised
M. Samuel; S. Capps; A. Worth
Boys with undermasculinized external genital and/or 46,XY disorders of sex development (DSD) often receive masculinizing genitoplasty. Such procedures are done to correct ventral curvature of the phallus, reposition a proximally located urethral meatus, and cosmetically correct the appearance of labioscrotal folds. No studies to date have assessed if patients with a specific DSD diagnosis have worse outcomes for severe proximal hypospadias procedures or whether or not these patients require more extensive surgical maneuvers than severe proximal hypospadias patients without a specific DSD diagnosis. We retrospectively reviewed consecutive proximal hypospadias repairs performed at our institution from 1998 to 2010 and compared the anatomy, surgical technique required for repair, and outcomes in patients with and without a definitive DSD diagnosis. Boys with a specific DSD diagnosis do have significantly more atypical anatomy when undergoing proximal hypospadias masculinizing genitoplasties. They are more likely to require associated gonad procedures but do not have an increased risk of complications or number of surgeries when compared to other proximal hypospadias patients without a specific DSD diagnosis. The risk of complications is consistent with reports in the literature, and the mean number of procedures in this contemporary study is fewer than in historic reports. PMID:22778726
Palmer, Blake W; Reiner, William; Kropp, Brad P
PurposeTransverse island flaps of inner preputial skin have provided a reliable technique for the repair of proximal hypospadias. The flap may be used to create a neourethra by tubularizing the flap after urethral transection or applying the flap as an onlay patch onto an intact urethral plate. We retrospectively analyzed our experience with these 2 techniques to compare outcomes.
John S. Wiener; Richard W. Sutherland; David R. Roth; Edmond T. Jr. Gonzales
One-stage repair is a conventional treatment of hypospadias. If hypospadias is severe as in the scrotal type and perineal type, penile curvature sometimes cannot be corrected by dorsal midline plication alone. In addition to resection of the urethral plate, ventral grafting becomes necessary for insufficient skin and subcutaneous tissue. In recent years, there has been renewed interest in 2-stage repair for such severe cases and salvage of failed cases with scarring. In the present study, novel 2-stage urethroplasty was performed in 6 cases to repair severe proximal hypospadias which required resection of the urethral plate. This novel method consisted of a combination of a modified Bracka method using oral mucosal grafts and a modified Byars flap of the dorsal foreskin. Good results were obtained using this novel method. PMID:23759975
Mitsukawa, Nobuyuki; Saiga, Atsuomi; Akita, Shinsuke; Kubota, Yoshitaka; Kuriyama, Motone; Satoh, Kaneshige
Objective. The great possibility of variations in the clinical presentation of hypospadia, makes its therapy challenging. This has led to the development of a number of techniques for hypospadia repair. This article assesses past and present concepts and operative techniques with the aim of broadening our understanding of this malformation. Materials and Methods. The article not only reviews hypospadia in general with its development and clinical presentation as well as historical and current concepts in hypospadiologie on the basis of available literature, but it is also based on our own clinical experience in the repair of this malformation. Results and Conclusion. The fact that there are great variations in the presentation and extent of malformations existent makes every hypospadia individual and a proposal of a universal comprehensive algorithm for hypospadia repair difficult. The Snodgrass technique has found wide popularity for the repair of distal hypospadias. As far as proximal hypospadias are concerned, their repair is more challenging because it not only involves urethroplasty, but can also, in some cases, fulfil the dimensions of a complex genital reconstruction. Due to the development of modern operating materials and an improvement in current surgical techniques, there has been a significant decrease in the complication rates. Nonetheless, there still is room and, therefore, need for further improvement in this field.
Djakovic, N.; Nyarangi-Dix, J.; Ozturk, A.; Hohenfellner, M.
Objective. The great possibility of variations in the clinical presentation of hypospadia, makes its therapy challenging. This has led to the development of a number of techniques for hypospadia repair. This article assesses past and present concepts and operative techniques with the aim of broadening our understanding of this malformation. Materials and Methods. The article not only reviews hypospadia in general with its development and clinical presentation as well as historical and current concepts in hypospadiologie on the basis of available literature, but it is also based on our own clinical experience in the repair of this malformation. Results and Conclusion. The fact that there are great variations in the presentation and extent of malformations existent makes every hypospadia individual and a proposal of a universal comprehensive algorithm for hypospadia repair difficult. The Snodgrass technique has found wide popularity for the repair of distal hypospadias. As far as proximal hypospadias are concerned, their repair is more challenging because it not only involves urethroplasty, but can also, in some cases, fulfil the dimensions of a complex genital reconstruction. Due to the development of modern operating materials and an improvement in current surgical techniques, there has been a significant decrease in the complication rates. Nonetheless, there still is room and, therefore, need for further improvement in this field. PMID:18989369
Djakovic, N; Nyarangi-Dix, J; Ozturk, A; Hohenfellner, M
Reoperating an hypospadias requires a reconstructive strategy that considers the patient's disturbing symptoms, located on the urethra (stenosis, fistula, persistent hypospadias, urethral hair) as well as on cavernous bodies and penile skin. Though experience validates it, this global and gradual approach has been barely described. It takes up latest hypospadiology work through several steps: after urethroscopy, penis is freed from penile skin in order to treat first a potential residual curvature in four steps. Then, the urethral issue is fixed differently according to the state of the penile urethra. In addition, a buccal mucosal urethroplasty will be likely to be occurred, in one or two times. PMID:24090780
Boillot, B; Lebret, T
Background\\/Purpose: Secondary procedures to correct complications after hypospadias repair remain challenging especially for “hypospadias cripples”. The tubularized, incised plate urethroplasty was first introduced by Snodgrass for the repair of primary hypospadias in 1993. The authors used this procedure to correct the complications after hypospadias repair in patients who had no abundant local skin flaps to be used for a neourethra.Methods:
Chih-Chang Luo; Jer-Nan Lin
PurposeSince its introduction, the Snodgrass hypospadias repair has been applied to virtually all forms of hypospadias repair. However, fistula rates have still been reported to be as high as 5% from large center, multiple surgeon studies and 16% from smaller center studies. We report on the use of the Snodgrass repair in conjunction with routine use of a vascularized dartos
Earl Y. Cheng; Sreenivas N. Vemulapalli; Bradley P. Kropp; John C. Pope; Peter D. Furness; William E. Kaplan; D. Preston Smith
PurposeWe conducted a retrospective study of patients with strictures after hypospadias repair to identify factors contributing to the development of strictures and to attempt to define an optimal strategy for management.
BARRY P. DUEL; JULIA SPENCER BARTHOLD; RICARDO GONZALEZ
Context: Despite the abundance of techniques for the repair of Hypospadias, its problems still persist and a satisfactory design to correct the penile curvature with the formation of neourethra from the native urethral tissue or genital or extragenital tissues, with minimal postoperative complications has yet to evolve. Aim: Persisting with such an endeavor, a new technique for the repair of distal and midpenile hypospadias is described. Materials and Methods: The study has been done in 70 cases over the past 11 years. The “Forked-Flap” repair is a single stage method for the repair of such Hypospadias with chordee. It takes advantage of the rich vascular communication at the corona and capitalizes on the established reliability of the meatal based flip–flap. The repair achieves straightening of the curvature of the penis by complete excision of chordee tissue from the ventral surface of the penis beneath the urethral plate. The urethra is reconstructed using the native plate with forked flap extensions and genital tissue relying on the concept of meatal based flaps. Water proofing by dartos tissue and reinforcement by Nesbit's prepucial tissue transfer completes the one stage procedure. Statistical Analysis: An analysis of 70 cases of this single stage technique of repair of penile hypospadias with chordee, operated at 3 to 5 years of age over the past 11 years is presented. Results and Conclusion: The Forked Flap gives comparable and replicable results; except for a urethrocutaneous fistula rate of 4% no other complications were observed.
Chadha, Anil; Singh, Amitabh
Background\\/Purpose: The onlay island flap urethroplasty was first described in the repair of mid and distal penile hypospadias. Since then, this technique has been increasingly used in more severe cases of hypospadias, because of the complications of tubularized flaps, mainly megaurethra and proximal anastomotic strictures. The aim of this study was to compare the morbidity of these 2 techniques. Methods:
M. Castañón; E. Muñoz; R. Carrasco; J. Rodó; L. Morales
The treatment of hypospadias requires the release of chordee and the reconstruction of a new urethra to provide for a satisfactory sexual function and normal micturition. A technique is described in two stages. In the first stage a large dorsal apron flap of prepuce skin is developed by a pericoronal incision. The chordee is released well beyond the urethral opening.
J. M. Maes; D. T. Shaw
Hypospadias is one of the most common congenital malformations of the male genitalia. Severe cases present with associated curvature greater than 30° and the meatus opening proximally to the penoscrotal junction. The perioperative management of patients with primary severe hypospadias is variable. Systematic evaluation of the upper urinary tract and the search for enlarged prostatic utricles seem unnecessary in patients
Alaa El-Ghoneimi; Marco Castagnetti
on the nonsurgical aspects of hypospadias repair are reviewed and compared with the practices of surgeons in the UK, as assessed by a questionnaire. THE TIMING OF SURGERY Early practice guidelines from the American Academy of Pediatrics recommended that children with hypospadias should be operated on after 4 years of age (5). It was felt that the parental separation from
Christopher R. J. Woodhouse; Deborah Christie
Objectives. To review our results of patients who underwent repeat hypospadias surgery using local skin flaps with preservation of the urethral plate.Methods. We retrospectively reviewed the medical records of all patients who underwent a reoperative hypospadias repair using the urethral plate between 1988 and 1996. A total of 53 patients were identified who developed either a large fistula (47 patients)
Garrick R Simmons; Mark P Cain; Anthony J Casale; Michael A Keating; Mark C Adams; Richard C Rink
PurposeBoys in whom hypospadias was repaired by tubularized, incised plate urethroplasty were evaluated to determine whether dorsal incision of the urethral plate results in strictures of the neourethra.
This report documents our experience with primary and reoperative repair of anterior and middle hypospadias using the tubularized,\\u000a incised plate (TIP) urethroplasty (Snodgrass technique) and provides a detailed description of the operative procedure. A\\u000a total of 31 patients (27 primary; 4 reoperative) underwent TIP urethroplasty. The patients' age at primary of reoperative\\u000a hypospadias repair ranged from 5 months to 26
Alan B. Retik; Joseph G. Borer
PurposeIn select patients with hypospadias in whom genital skin is insufficient alternative tissues are needed for urethral reconstruction. Although skin and mucosal grafts may be used, they may increase hospitalization and morbidity. We explored the feasibility of using a bladder submucosal, collagen based inert matrix as a free graft substitute for urethral repair.
ANTHONY ATALA; LUIS GUZMAN; ALAN B. RETIK
PurposeWe compared surgical outcomes of stented and unstented Mathieu repairs in boys with primary distal hypospadias, and evaluated the efficacy and safety of caudal analgesia relative to other forms of analgesia (penile block and epidural analgesia).
Samuel Hakim; Paul A. Merguerian; Ronald Rabinowitz; Linda D. Shortliffe; Patrick H. McKenna
A systematic review was performed of publications relating to the results of urinary flow studies after hypospadias repair dating back to 1978, when what appears to be the first publication on this topic was found. The literature search was performed using the key words "hypospadias" combined with "urinary flow", "urine flow", "uroflow", "uroflowmetry", and "long-term". We also reviewed the abstracts and full-length articles cited in the reference list of selected articles. Criteria for inclusion in the present systematic review included descriptions of patient selection, surgical technique, the severity of disease (proximal vs distal), and the method used to determine uroflow, as well as a definition of urethral obstruction. In all, 339 article titles were found. Of these, 25 abstracts appeared relevant and the full text of these articles were reviewed, with 22 of the papers included in this review. Sixteen reports had appeared in the literature since 2001, compared with six between 1978 and 2000, suggesting an increasing interest in this topic. On the basis of the results of the present systematic review, we recommend that asymptomatic children operated on for hypospadias in infancy should have one flow study after toilet training, with that study repeated if the results are abnormal. It appears that early abnormal flows improve spontaneously, so that children operated on after toilet training who are asymptomatic should undergo their first uroflow measurement 1 year after surgery. Children with obstructed flow parameters or borderline flows should be followed until adulthood, until long-term follow up studies clarify the significance of abnormal flow parameters. Given the present findings, we anticipate that in the next two decades urologists will need to treat a number of men with strictures resulting from hypospadias repairs performed in childhood. PMID:21883491
González, Ricardo; Ludwikowski, Barbara M
AIM: To report outcome of technical modifications to minimize fistula after TIP procedure. PATIENTS AND METHODS: 369 boys presenting with distal hypospadias were divided into two groups. In group 1, 196 underwent the standard TIP procedure. In the 173 patients in group 2, several modifications were incorporated into the TIP repair: 1) the first proximal suture was U-shaped subepithelial, 2) dartos flap was created on ventral aspect of penis to cover the proximal suture, and 3) the midline release incision was done as a first step. Patients were monitored prospectively for fistulae, chordee, meatal position, stenosis, and evaluated postoperatively at regular intervals. RESULTS: 362 patients had a good cosmetic appearance with slit-shaped meatus. Urethrocutaneous fistula was seen in 9 (4.6%) in group 1 and 4 (2.3%) in group 2. Urinary streams were of good quality and without fistula in 187 in group 1 and 169 in group 2. Glans dehiscence was seen in 7 (4 in group 1 and 3 in group 2), meatal stenosis and new urethral stricture in 15 (6 in group 1 and 9 in group 2). Glanular appearance was excellent except in those 7 patients who had glans dehiscence, and the phallus was straight in all. CONCLUSION: The Snodgrass repair has revolutionized the treatment of hypospadias. These technical modifications combined with careful patient selection achieved a low fistula rate. PMID:23122925
Abdel-Hamid Mohamid El-Hawy, Mamdouh
Hypospadias is the most common anomaly in the male genital tract with an incidence of 0.8–8.2 per 1000 live male births. Routinely, hypospadias cases are repaired after one year of age, and it is recommended that a child with hypospadias not to be circumcised until hypospadias repair is completed. This study was conducted to determine whether or not circumcision prior to hypospadias repair increases the risk of complications. 30 circumcised patients and 30 persons without a history of circumcision and hypospadias were enrolled in this study and underwent surgery for hypospadias repair. The results of surgery compared between two groups. In the uncircumcised group, the mean durations of surgery and hospitalization were 55.61 ± 58.11?min and 3.17 ± 1.79 days. In circumcised group, the mean duration of surgery and hospitalization were 66.17 ± 33.65 minutes and 3.7 ± 1.62 days. There was no significant difference between these criteria and other complications of the two groups. This study shows that postoperative complications in circumcised distal hypospadias patients do not increase. Cosmetic and functional results were excellent. If there are failures in therapy and in case of postoperative complications, it is better to notice other factors such as infection.
Kazemi Rashed, Fahimeh; Gholizade, Rasool
PurposeArtificial erections are induced at hypospadias repair to prevent recurrent chordee. We describe the development and etiology of late onset recurrent chordee greater than 10 years after the initial surgery.
DAVID R. VANDERSTEEN; DOUGLAS A. HUSMANN
Twenty-one males underwent an interview, clinical investigation, and measurement of urine flow and residual volume 15–25 years after surgery. All had undergone reconstruction due to hypospadias, using a staged procedure, which was essentially that of Byars. In an overall subjective evaluation, 11 men said that their hypospadias had had appreciable consequences, in 3 cases related mainly to urination, and in
K. Olofsson; J. Oldbring; M. Becker; M. Åberg; H. Svensson
Introduction: Potential long-term sequelae of hypospadias and its surgical cor- rection include difficulties in voiding, sexual function, psychosexual adjust- ment and self-appraisal. These difficulties often evolve long after surgical repair as children grow to adulthood. Despite this, patient-driven data on long-term functional outcomes and satisfaction are limited, leaving the true success of hypospadias surgery essentially unknown. The aim of this
Chris C. Hoag; Geoff T. Gotto; Kevin B. Morrison; Gerald U. Coleman; Andrew E. MacNeily
Purpose: To evaluate the functional outcome in the form of urinary flow rates in asymptomatic children following uncomplicated tubularized incised plate urethroplasty (TIPU) hypospadias repair. Methods: We reviewed the records of children who underwent TIPU at our institution between April 1997 and September 2007 and included only asymptomatic toilet-trained children who had an uncomplicated postoperative course and had undergone uroflometry not less than 1 year postoperatively. Unfavourable voiding parameters were either a plateau curve, a peak flow below the 5th percentile range in nomogram or a post-void residual (PVR) more than 20% of the total functional capacity of the bladder. Uroflowmetry findings were analyzed against variables, including the surgeon, the severity of hypospadias, the presence of a hypoplastic urethra, the use of double layer closure, the performance of a spongioplasty and the use of a stent. Serial uroflowmetries, when available, were compared with respect to the initial flow study. Results: In total, 59 patients were eligible for the study. The mean age at surgery was 2.4 years. Hypospadias was distal penile in 50 (85%) and mid and proximal penile in 9 (15%). Mean follow-up was 3.3±2 (1–9.5) years. The uroflow curve was bell-shaped in 18 (30%), interrupted in 8 (14%), slightly flattened in 27 (46%) and plateau in 6 (10%). Flow rate nomograms revealed that 40 (68%) were above the 20th percentile, 10 (17%) were below the 5th percentile and 9 (15%) were between these ranges. PVR was >20% of the pre-void volume in 9 children (15%). No patient demonstrated all three unfavourable parameters together. The groups of children with unfavourable functional voiding parameters were compared to the children with favourable parameters specifically with respect to the possible predictors of outcome. Follow-up uroflometry in 17 patients showed improvement in the flow curve, flow rate and PVR with significant improvement of maximum urinary flow rate (Qmax) and PVR values. Conclusions: Asymptomatic, urodynamic abnormalities were observed in our study following uncomplicated TIPU repair. These abnormalities were not related to the variation of the technique among surgeons. Spontaneous improvement has been noted on serial flow studies.
Eassa, Waleed; Brzezinski, Alex; Capolicchio, J.P.; Jednak, Roman; El-Sherbiny, Mohamed
The author proposes a modification of one-stage urethral plastic repair with cross-over graft from the foreskin according to Duckett for correction of proximal hypospadias with malformation or absence of the free trunkal part of the penis in well developed foreskin. From 1996 to 2001 one-stage operations were made in 82 boys at the age of 8 months to 15 years. Expanding of the cavernous bodies with loss of the urethral platform and plastic repair of a long urethral area were performed in 69 patients. These cases were most difficult for correction. Only plastic repair was made in the rest 13 children as their cavernous body deformation had been corrected previously. One-stage surgery of the urethra with dissection of the chorda was conducted by Hodgson-III in 13 patients, by modified Hodgson-III technique in 29 and by Duckett in 5 patients. Plastic repair with diagonal deepithelized graft from the foreskin was tried in 22 patients with underdeveloped volar surface of the penis. The modification consisted in cutting out the diagonal graft from the foreskin entoderm, forming a tube of it with uninterrupted suture, creation of the graft vascular pedicle by skeletization and deepithelization of the skin of the foreskin ectoderm and partially of the penis trunk, creation of a wide anastomosis of the formed tube with external opening of the urethra isolated by edge incision, mobilization of the glans penis wings by longitudinal incisions and creation of meatus on the top of the glans penis, mobilization of the foreskin and penis trunk tunica dartos with its placing from the dorsal surface on the ventral at both sides of the cavernous bodies. The treatment outcomes were followed up from 6 months to 3.5 years. Complications (stenosis of the external urethral opening, urethral fistulas and stenosis of the anastomosis zone) were observed in 13 (18.84%) patients. The proposed modification reduced the number of complications up to 13.63%, improved cosmetic and functional results. PMID:12402780
Rudin, Iu E
Hypospadias is one of the most common congenital genital anomalies for which surgery early in life is indicated. The surgical treatment is changing progressively, often by repeating treatment strategies that have been used decades ago. Indeed, historically two-stage procedures were replaced by one-stage procedures and nowadays two-stage procedures gain new interest. The same for reconstructions using the urethral plate, which decades ago were based on the Thiersch Duplay principle. In the 1980s, preputial onlay flaps were most often used and today we see a new interest in the use of the urethral plate. The actual surgical approach to hypospadias is described and technical details are given.
Subramaniam, Ramnath; Spinoit, Anne Francoise; Hoebeke, Piet
PurposeIncision of the glanular urethral plate (the Snodgrass modification) permits tubularization of the neourethra in the Thiersch-Duplay fashion when anatomy would otherwise preclude a tension-free anastomosis and necessitate another operative technique for hypospadias repair. To take advantage of these cosmetic benefits without the potential morbidity associated with indwelling catheters, we performed a stent-free Thiersch-Duplay repair incorporating the Snodgrass modification.
Robert Eric Steckler; Mark R. Zaontz
. In his editorial to the first issue of Aesthetic Plastic Surgery in 1976, the Managing Editor, Dr. Blair Rogers lays special emphasis on the publication of papers and reports dealing with\\u000a the increasing role of Aesthetic Plastic Surgery as the final step in the overall rehabilitation of Reconstructive Surgery\\u000a patients. In genitourinary malformations—hypospadias and epispadias—without any doubt a satisfactory
Ulrich T. Hinderer
Background. Clonidine is used increasingly in paediatric anaesthetic practice to prolong the duration of action of caudal block with a local anaesthetic agent. Which route of administration of clonidine is the most beneficial remains unknown. We compared the effects of caudal and i.v. clonidine on postoperative analgesia produced by caudal bupivacaine after hypospadias repair. Methods. Forty-six children (ASA I or
T. G. Hansen; S. W. Henneberg; S. Walther-Larsen; J. Lund; M. Hansen
Nonsystemic review of the literature was done for timing of surgery, preoperative evaluation and plan, anesthesia, suture materials, magnification, tissue handling, stent and diversion problems, intra and postoperative care, dressing, and follow-up protocol. The best time for hypospadias repair is between 6 and 18 months. Preoperative evaluation in proximal hypospadias includes hormonal and radiological examination for intersex disorders, as well as for upper tract anomalies along with routine evaluation. General anesthesia is a rule but local blocks help in reducing the postoperative pain. Magnification, gentle tissue handling, use of microsurgical instruments, and appropriate-sized stent for adequate period help in improving the results. Hormonal stimulation is useful to improve growth and vascularity of urethral plate and decrease the severity of chordee in poorly developed urethral plate with severe curvature. Urethral plate preservation urethroplasty with spongioplasty is the procedure of choice in both proximal and distal hypospadias. Algorithms are proposed for management of hypospadias both with curvature and without curvature. Two-stage urethroplasty has its own indications. A good surgical outcome may be achieved following basic surgical principles of microsurgery, fine suture materials, choosing one or two-stage repair as appropriate, proper age of surgery, and with good postoperative care. Future of hypospadiology is bright with up coming newer modalities like laser shouldering, robotics, and tissue engineering.
AIM: To undertake an online survey of current hypospadias surgery practice among those specialists attending the IVth World Congress of the International Society for Hypospadias and Disorders of Sex Development (ISHID), 2011. MATERIALS AND METHODS: An online survey covering 22 separate questions relating to proximal and distal hypospadias surgery was set up, and all delegates registered for the conference were invited to complete this questionnaire anonymously. The data was analysed by three of the authors. RESULTS: A total of 162 delegates registered for the conference of whom 74% were paediatric surgeons, paediatric urologists, plastic surgeons and adult/adolescent urologists. 93 delegates completed the online survey, and most of them (57%) were from Europe. The majority of surgeons see over 20 new patients/year (90%) and perform primary hypospadias surgery in over 20 patients/year (76%). The tubularized incised plate (TIP) repair is the most frequent technique used for the management of distal hypospadias (59%); other techniques used included Mathieu, onlay and TIP with graft. A variety of techniques are used for proximal hypospadias, but nearly half of the respondents (49%) preferred a staged approach. Self reported complication rates for distal hypospadias surgery are favourable (less than 10%) for 78% of the respondents. However, proximal hypospadias complication rates are higher. CONCLUSIONS: With a majority of paediatric urologists and European delegates responding to our survey, the results suggest that there are differences in the management of proximal and distal hypospadias between surgeons, yet no differences were observed according to the region of their practice. Variations in long-term outcomes appear to be in keeping with the current literature. PMID:23683539
Steven, Lisa; Cherian, Abraham; Yankovic, Francisca; Mathur, Azad; Kulkarni, Milind; Cuckow, Peter
PurposeHypospadias is the most common congenital anomaly affecting the penis. Successful repair depends on an accurate understanding of anatomy. We compared the anatomy of hypospadiac and normal fetal penises.
LAURENCE S. BASKIN; ALI EROL; YING WU LI; GERALD R. CUNHA
In this study, we report a 3-year-old boy with severe scrotal hypospadias with Robertsonian translocation [45,XY,t(13q;14q)]. The patient was born at term with a low birth weight and hypospadias. There was no endocrinological abnormality. His father also has a balanced 13–14 Robertsonian translocation. Two-stage hypospadias repair was carried out. The presence of this chromosomal anomaly and hypospadias are unique to
Nizamettin Kilic; Emin Balkan; Halil Saglam; Tahsin Yakut; Hasan Dogruyol
Hypospadia is abnormal sex differentiation of the external genitalia with ventral and proximal displacement of the urethral orifice from its usual location on glans penis. Three prenatally diagnosed cases of hypospadia are presented and the major ultrasound findings of this entity are discussed. PMID:18642570
Markov, D; Bozhilov, D; Dimitrova, V; Sl?ncheva, B; Iar?kova, N
The buccal mucosa has begun to be used as a free graft in complex hypospadias repair gradually and successfully in recent years. However, there are limited experiences regarding use of the buccal mucosa in adult patients. In this study, the authors describe their experience using buccal mucosal grafts in hypospadias-crippled adult patients. Between March 1996 and February 2001, the buccal mucosa was used in 26 cases of complex hypospadias in which local penile skin was not present or it was insufficient for urethral repair. All patients were adults (age range, 17-24 y; average, 21 y). In these patients in whom penile skin was insufficient, urethral repair by buccal mucosa was planned, with the stipulation that at least 6 months had passed from the previous operation. The buccal mucosa has been applied to 23 patients alone and in combination with penile skin in three patients. After surgery, the patients were followed-up for 3 to 18 months (average, 12 mo). During the follow-up, fistula in the line of the proximal anastomosis, meatal stenosis, and the fistula together with meatal stenosis developed in nine (35%), four (15%), and two patients (7%), respectively. It is concluded that buccal mucosa is the free graft material that should be the first choice in complex hypospadias cases that are circumcised or undergo operation more than once and when the penile skin is not available. PMID:12671380
Sahin, Coskun; Seyhan, Tamer
The surgical technique for repair of acute proximal hamstring tears is relatively recent. Installation of the patient is critical. The approach is either vertical under the gluteal fold in case of a complete tear with tendon retraction of more than 6 cm, or horizontal in the gluteal fold for retraction of less than 6 cm or for partial tears. After identification and neurolysis of the sciatic nerve, transosseous tendon reinsertion is performed with three or four metal or resorbable suture anchors. A rigid brace keeping the leg at 30° of flexion is worn for few days, then replaced by an articulated knee brace for 45 days, which limits extension but allows full flexion. Rehabilitation is begun early. Thirty-four patients underwent surgery for acute proximal hamstring tear and received this treatment. All of the athletic patients were able to return to their pre-injury activities after a mean 5.7 ± 1.6 months (2.3-9.3 months). PMID:22926295
Lefevre, N; Bohu, Y; Klouche, S; Herman, S
To determine the role of uroflowmetry in the evaluation of the functional results of hypospadias repair we retrospectively reviewed the records of 32 patients who underwent hypospadias repair with urethral reconstruction (mean age 2.4 years and mean followup 3.6 years). Patients with a plateau pattern and a maximum flow rate 2 standard deviations below the mean for age, body surface
Jorge Tapia Garibay; Churphena Reid; Ricardo Gonzalez
Proximal type I endoleaks after endovascular abdominal aortic aneurysm repair (EVAR) are associated with a high risk of rupture. Risk factors for developing this complication are not fully elucidated. We aimed to define preoperative predictors for proximal type I endoleak and describe its clinical outcome. From a consecutive series of 257 patients who underwent EVAR, we selected 202 who had
Sergio M. Sampaio; Jean M. Panneton; Geza I. Mozes; James C. Andrews; Thomas C. Bower; Manju Karla; Audra A. Noel; Kenneth J. Cherry; Timothy Sullivan; Peter Gloviczki
Base excision repair (BER) is the major pathway for the repair of simple, non-bulky lesions in DNA that is initiated by a damage-specific DNA glycosylase. Several human DNA glycosylases exist that efficiently excise numerous types of lesions, although the close proximity of a single strand break (SSB) to a DNA adduct can have a profound effect on both BER and
Jason L. Parsons; Bradley D. Preston; Timothy R. O'Connor; Grigory L. Dianov
Epidemiological and genetic variables in hypospadias were analysed during the years 1978 to 1983 in a case control study of congenital malformations in the Emilia Romagna region of northern Italy. During the observation period, in a sample of 41 078 male newborns, 168 had hypospadias giving a prevalence at birth of 4.1 in 1000 males. Hypospadias was divided into three
E Calzolari; M R Contiero; E Roncarati; P L Mattiuz; S Volpato
Hamstring injuries are common forms of muscle strains in athletes but a complete rupture of a proximal hamstring origin is rare. Often there is a considerable delay in diagnosis and stringent treatment because of its rarity, difficulty in clinical diagnosis, and initial attempts of conservative care. We report two cases of acute complete rupture of the proximal hamstring tendons treated with early surgical repair. The diagnosis and treatment of this unusual injury are discussed.
Kwak, Ho Yoon; Choi, Yun Sun; Jang, Mun Suk
The proximal suture line is a vulnerable area after abdominal aortic aneurysm repairs. This area has been implicated in various postoperative complications, such as pseudoaneurysm formation, graft-enteric fistula, and suture line disruption. We present a technique that provides safe and adequate coverage of this suture line by using the aneurysm sac. This technique is derived from the z-plasty technique used
Aditya K. Kaza; Jeffrey T. Cope; John A. Kern; David C. Cassada; Stewart M. Long; Steven M. Fiser; Irving L. Kron; Curtis G. Tribble
Fracture of the proximal femur due to metastatic disease is a significant cause of morbidity and mortality among breast cancer patients. Prophylactic surgical fixation is advised for patients at risk of fracture and typically involves placement of an orthopaedic implant. We propose that some proximal femora with metastases can be repaired by removing the lesion and filling the resulting defect with bone cement (polymethylmethacrylate), a procedure that could be performed percutaneously without the use of hardware. We studied the strengths of 12 matched pairs of cadaveric proximal femora under single-limb stance loading. One femur from each pair remained intact, while a simulated metastatic lesion, measuring approximately 75% of the neck diameter, was burred into the neck of the contralateral femur. The defects were repaired using a procedure similar to the one proposed. Femoral strength was measured via mechanical testing to failure. The strengths of the repaired femora averaged 94.7% of the strength of their respective contralateral intact femur (standard deviation, 8.7%). These findings suggest that the proposed procedure may be useful for some patients with metastases in the femoral neck. If the proximal femur could be safely repaired using the proposed technique in place of conventional surgical fixation, the patient would benefit from a shorter and less invasive surgical procedure, less pain and discomfort, greatly reduced recovery time, and a shorter hospital stay-all at a much lower cost. PMID:16949854
Kaneko, Tadashi S; Skinner, Harry B; Keyak, Joyce H
Hypospadia is a frequent birth deformity consisting in fissure of the posterior (lower) wall of the urethra. Hypospadia is characterized by shortening of the urethra and ectopia of the external urethral opening. This deformity often occurs in women but is rarely diagnosed because physicians are not well-informed about female hypospadia. Classification of anatomic variants of female hypospadia proposed by the authors includes low vaginal ectopia of the external urethral opening; high vaginal ectopia of the external opening of the urethra; urovaginal (vesicovaginal) fusion of the neck of the urinary bladder with vagina accompanied with enuresis; urogenital sinus in females (ectopia of the external urethral opening in the urogenital sinus); any of the above variants of female hypospadia in combination with false or true hermaphroditism. All the variants of female hypospadia must be surgically corrected as transposition of the external opening of the urethra from the vagina on the perineum under the clitoris in chronic urethritis, cystitis and vulvovaginitis or as urethroplasty in enuresis. Hypospadia, urogenital sinus and hermaphroditism--three anomalies of human urogenital system--combine rather frequently. PMID:17722617
Derevianko, I M; Derevianko, T I; Ryzhkov, V V
OBJECTIVE: For acute type A dissection without an intimal tear in the arch, the optimal surgical strategy is unknown. The present study was designed to clarify the issue by comparing the early and late outcomes of proximal (PR) and extensive repair (ER). METHODS: From January 2002 to June 2010, 331 patients with acute type A dissection were treated surgically at our institute. Of these 331 patients, 197 were identified without an arch tear on the preoperative imaging examination and by intraoperative inspection. Of these 197 patients, 74 underwent proximal repair, including the aortic root, ascending aortic, or hemiarch repair, and 88 underwent extensive repair, including proximal repair, total arch replacement and a stented elephant trunk technique. The perioperative variables and late results were statistically analyzed. RESULTS: No significant difference was found in the rates of early mortality and morbidity between the 2 groups, despite the shorter duration of circulatory arrest in the PR group. During long-term follow-up (mean, 55.7 ± 33.1 months; maximum, 129), the overall survival rate in the whole cohort was 100%, 90.8%, and 71.1% at 1, 5, and 8 years, respectively. No difference was found in survival between the 2 groups (P > .05). However, complete thrombosis of the false lumen in the proximal descending aorta was achieved in 100% of the ER group and 24.6% of the PR group (P < .001). For patients with a patent false lumen in the PR group, distal anastomosis leakage and unclosed small intimal tears were identified in 53.3% and 35.6% patients, respectively. The reintervention rate was also lower in the ER group than in the PR group (4.9% vs 15.9%, P < .05) during follow-up. Moreover, the reintervention rate for patients with Marfan syndrome was 9.5% in the ER group and 38.5% in the PR group (P < .05). CONCLUSIONS: For patients with acute type A dissection without an intimal tear in the arch, extensive repair could promote the occlusion of distal false lumen and decrease the reintervention rate without increasing the operative risk. PMID:23778086
Zhang, Hao; Lang, Xilong; Lu, Fanglin; Song, Zhigang; Wang, Jun; Han, Lin; Xu, Zhiyun
Objective: To compare the psychosocial adaptation of boys with hypospadias after genital surgery to a community sample. Methods: Boys (6 to 10 years) with a history of hypospadias repair (n 175) were compared with a commu- nity sample (n 333) in a postal questionnaire survey using the Child Behavior Checklist. Results: Few significant differences between cases and controls emerged. Boys
David E. Sandberg; Heino F. L. Meyer-Bahlburg; Terry W. Hensle
Background: Hypospadias repair is a common pediatric operation. Several kinds of dressings are currently available, with their benefits and side effects. Aim: The aim of our study was to introduce a new method of dressing, by pouring several layers of cyanoacrylate (CA) glue as the dressing, in hypospadias surgery. Materials and Methods: Twenty out of the 61 patients with hypospadias, with a mean age of 13.5 months, were enrolled in this study. Forty-one had conventional dressing (pressure wrap dressing), while CA glue was used in 20 patients. CA glue was applied around the penis and its base four times and each time it took one minute to dry. All patients were followed postoperatively for two weeks and six to twelve months, for early and late complications, respectively. Results: One out of 20 developed wound hematoma, one had skin necrosis with infection, and edema was present in all. All these were easily diagnosed and managed rapidly. In the group treated with conventional methods, there were five infections, seven hematomas, all the patients in the group had edema and painful removal of the dressing, and 10 needed repeat dressing. Conclusions: CA glue is impermeable to urine and stool, and prevents edema and hematoma. Used in several layers, it is a good alternative dressing in hypospadias surgery.
Hosseini, Seyed Mohammad Vahid; Rasekhi, Ahmad Reza; Zarenezhad, Mohammad; Hedjazi, Arya
The aim of this study was to evaluate the healing capacity of proximal anterior cruciate ligament (ACL) ruptures following primary repair with and without a bioresorbable augmentation. The ACL was transected at the femoral origin in the right knee joint of 24 sheep. The ACL was repaired in eight sheep (group B) without, and in eight sheep (group C) with
M RICHTER; L DURSELEN; A IGNATIUS; F MISSLER; L CLAES; H KIEFER
We present herein a novel, combined, simultaneous open proximal and stent-graft distal repair for complex distal aortic arch aneurysms involving the descending aorta. In the first surgical step, the transverse arch is opened during selective antegrade cerebral perfusion, and a Dacron graft (DuPont, Wilmington, DE) is positioned down the descending aorta in an elephant trunk-like fashion with its proximal free margin sutured circumferentially to the aorta just distal to the left subclavian or left common carotid artery. With the graft serving as the new proximal landing zone, subsequent endovascular repair is performed antegrade during rewarming through the ascending aorta. PMID:19559261
Zierer, Andreas; Sanchez, Luis A; Moon, Marc R
Hypospadia is the most common congenital malformation of the urinary tract. It is a malformation with the opening of the urethra proximally from the usual site. The meatal opening can be anywhere alone the shaft of the penis, or in more severe forms, within the scrotum, or in the perineum. Consequently the hypospadias can be distal, medial and proximal. The proximal ones can be penoscrotal (PS), scrotal (SC) and perineal (PE). The cause of hypospadias is largely unknown; however, current epidemiology and laboratory studies have shed new light into the etiology of hypospadias. With recent advancements in molecular biology, microarray technology, it appears that hypospadias is potentially related to disrupted gene expression. Currently, the only available treatment is surgery. The aim of this study was to present our results of the surgical correction of hypospadias and methods used to answer the clinical dilemmas about the gender. Authors have used two methods for a surgical resolution of the hypospadia - one-step operation suggested by Snodgrass and two-step operation, employing free graft suggested by Bracka. Clinical dilemmas regarding the gender were answered using cytogenetic assessment through lymphocyte cultivation method, suggested by Seabright. The cytogenetic assessment was carried in 23 patients with proximal hypospadia (penoscrotal, scrotal and perineal). Characteristic male cariotype (46, XY) was found in 22 patients. In one patient, with scrotal hypospadia, we found the characteristic female cariotype. This patient had testicles. The patient with female cariotype had a TDG gene that determines the differentiation of the testicles. Although surgery remains the only therapy for the treatment of the hypospadias, better understanding of the molecular and hormonal mechanisms behind the diseases may contribute to the prevention and the decrease in the incidence of the malformation. Cytogenetic testing in patients with unclear gender is important in planning further treatment. PMID:19754479
Ahmeti, Hasan; Kolgeci, Selim; Arifi, Hysni; Jaha, Luan
The dictum, “There is nothing new in surgery not previously described”, is particularly true of hypospadias. The major significance of chordee was fully appreciated by Galen in the second century A. D. and then almost forgotten until Mettauer in 1842, all previous surgeons overstressing the position of the orifice. Mettauer recognised skin shortening as a cause of chordee, a fact
E. Durham Smith
The aim of this review is to summarize the various steps of the surgical procedures to treat a hypospadias. Hundreds of procedures have been described but most of them follow the same principles. They include correction of a ventral curvature, the urethroplasty itself and penile skin reconstruction. Most of the affected children may be treated with a one-stage procedure. Each
Y. Aigrain; A. Cheikhelard; H. Lottmann; S. Lortat-Jacob
Traumatic aortic injury represents 15% of motor vehicle related deaths with death occurring at the scene in 85% of the cases. Aortic disruptions usually occur at the isthmus in a transverse fashion with all three of the aortic layers being involved. Herein, we report the case of a 68-year old man with no prior medical history who was struck by a vehicle while riding his bicycle. The ruptured segment of aorta was resected circumferentially and interrupted horizontal mattress pledgeted prolene sutures were used to ensure full thickness aortic integrity of the proximal and distal aortic segments. The aorta was closed with a single-layer technique using 4/0 prolene suture. There were no postoperative complications and patient was discharged on Day 44. The case here discussed demonstrates a rare presentation of blunt aortic injury. The proximal ascending aorta is an unusual site of transection following blunt trauma with few reports in the literature. We were able to repair the aorta with direct suture, thus avoiding the use of artificial material. PMID:23838337
Harmouche, Majid; Slimani, Eric Karim; Heraudeau, Adeline; Verhoye, Jean-Philippe
127 new cases of hypospadia were treated in 1980-2002. A total of 348 operations including urethroplasty by Duplay and Cecil were made. 78 of the operations were followed by complications out of which 26 were corrected in the postoperative period and had no effect on the treatment results. The first stage of surgical correction of hypospadia (89 operations) brought complications in 13.48% cases. Recurrent distortion of the cavernous bodies was most typical complication at this stage. In most cases development of scarry deformation was due to inflammatory changes early after surgery. Derivatives of prednisolone proved effective in the treatment of hypertrophic scars. This complication correlated with skin plastic repair (longitudinal suturing or creation of oncoming triangular flaps) to correct the defect. The second stage of hypospadia surgery was urethroplasty made in 196 cases. It was accompanied with complications in 13.25 patients. Fistulas of newly-created urethra (11.73%) were the most typical and frequent complication. The number of postoperative complications varied greatly depending on the disease form and method of urethral reconstruction. Cecil urethroplasty brought complications in 7.94% cases. Efficacy of neurourethra creation by Duplay varied greatly depending on the length of the created neourethral portion and the number of local skin resources (8-33-83.33% complications). PMID:15199814
Romanov, D V; Korol'kova, I A
Aristolochic acid (AA), derived from plants of the Aristolochia genus, has been proven to be associated with aristolochic acid nephropathy (AAN) and urothelial cancer in AAN patients. In this study, we used toxicogenomic analysis to clarify the molecular mechanism of AA-induced cytotoxicity in normal human kidney proximal tubular (HK-2) cells, the target cells of AA. AA induced cytotoxic effects in a dose-dependent (10, 30, 90 microM for 24 h) and time-dependent manner (30 microM for 1, 3, 6, 12 and 24 h). The cells from those experiments were then used for microarray experiments in triplicate. Among the differentially expressed genes analyzed by Limma and Ingenuity Pathway Analysis software, we found that genes in DNA repair processes were the most significantly regulated by all AA treatments. Furthermore, response to DNA damage stimulus, apoptosis, and regulation of cell cycle, were also significantly regulated by AA treatment. Among the differentially expressed genes found in the dose-response and time-course studies that were involved in these biological processes, two up-regulated (GADD45B, NAIP), and six down-regulated genes (TP53, PARP1, OGG1, ERCC1, ERCC2, and MGMT) were con-firmed by quantitative real-time reverse transcription polymerase chain reaction (qRT-PCR). AA exposure also caused a down-regulation of the gene expression of anti-oxidant enzymes, such as superoxide dismutase, glutathione reductase, and glutathione peroxidase. Moreover, AA treatment led to increased frequency of DNA strand breaks, 8-hydroxydeoxyguanosine-positive nuclei, and micronuclei in a dose-dependent manner in HK-2 cells, possibly as a result of the inhibition of DNA repair. These data suggest that oxidative stress plays a role in the cytotoxicity of AA. In addition, our results provide insight into the involvement of down-regulation of DNA repair gene expression as a possible mechanism for AA-induced genotoxicity. PMID:20514455
Chen, Ya-Yin; Chung, Jing-Gung; Wu, Hsiu-Ching; Bau, Da-Tian; Wu, Kuen-Yuh; Kao, Shung-Te; Hsiang, Chien-Yun; Ho, Tin-Yun; Chiang, Su-Yin
Background: Aortic aneurysm affecting the arch and proximal descending thoracic aorta may require a two-stage repair, which includes proximal elephant trunk graft placement and completion of descending thoracic aortic repair. The combination of open surgery and endovascular grafting may improve the morbidity and mortality of the patient population at risk. Methods: Between February 2001 and March 2007, 258 patients underwent
Nobuyoshi Kawaharada; Yoshihiko Kurimoto; Toshiro Ito; Tetsuya Koyanagi; Akihiko Yamauchi; Masanori Nakamura; Nobuyuki Takagi; Tetsuya Higami
Hypospadias surgery has dramatically changed over the last 15 years with a new anatomical approach of the ventral penile anomalies and new techniques of repair. The description of the hypoplasia of the tissues forming the ventral aspect of the penis (ventral radius of the penis) beyond the division of the corpus spongiosum, and the concept of urethral plate are the two key-elements to select the most appropriate technique of reconstruction. These modern concepts and the various surgical techniques used are reported here with their results. PMID:11761703
Paparel, P; Mure, P Y; Margarian, M; Feyaerts, A; Mouriquand, P
So-called hypospadias cripples are a challenging group of patients who present with multiple previous repair operations with unsatisfactory functional and cosmetic results. Attempts at renewed correction can be carried out with various techniques and different materials and staged repair with buccal mucosa according to Bracka has shown good results. PMID:23982464
Riechardt, S; Isbarn, H; Dahlem, R; Fisch, M
BACKGROUND: Reports on increasing hypospadias trends are based on birth\\u000a defect registries, which are prone to inaccuracy. We assessed the\\u000a prevalence of hypospadias precisely, by prospective examination of all\\u000a newborns in Rotterdam over a 2-year period. METHODS: A total of 7292\\u000a consecutive male births were examined for the presence of hypospadias,\\u000a classified by severity. RESULTS: The frequency of hypospadias in
F. H. Pierik; A. Burdorf; J. M. Nijman; Muinck Keizer-Schrama de S. M. P. F; R. E. Juttmann; R. F. A. Weber
DNA double-strand breaks (DSBs) are a common form of cellular damage that can lead to cell death if not repaired promptly. Experimental systems have shown that DSB repair in eukaryotic cells is often imperfect and may result in the insertion of extra chromosomal DNA or the duplication of existing DNA at the breakpoint. These events are thought to be a
John K. Pace; Shurjo K. Sen; Mark A. Batzer; Cédric Feschotte
SUMMARY We examined whether hypospadias was associated with several aspects of the diet, including intake of animal products, intake of several nutrients and food groups related to a vegetarian diet and estrogen metabolism, and diet quality. The study included deliveries from 1997 to 2005 that were part of the National Birth Defects Prevention Study. Diet was assessed by food frequency questionnaire during maternal telephone interviews, and two diet quality indices were developed based on existing indices. Analyses included 1,250 cases with second or third degree hypospadias (urethra opened at the penile shaft, scrotum or perineum) and 3,118 male, liveborn, non-malformed controls. All odds ratios (ORs) and 95% confidence intervals (CI) were estimated from logistic regression models that included several potential confounders, including energy intake. Intake of animal products was not associated with hypospadias; e.g., the adjusted OR for any versus no intake of meat was 1.0 (95% CI 0.6, 1.6). Frequency of intake of meat or other animal products was also not associated with hypospadias, nor was intake of iron or several nutrients that are potentially related to estrogen metabolism. Diet quality was also not associated with hypospadias; the ORs for diet quality in the highest versus lowest quartile for the two diet quality indices were 1.0 (95% CI 0.6, 1.6) and 0.9 (95% CI 0.7, 1.1). In conclusion, this large study does not support an association of a vegetarian diet or worse diet quality with hypospadias.
Carmichael, Suzan L.; Ma, Chen; Feldkamp, Marcia L.; Munger, Ronald G.; Olney, Richard S.; Botto, Lorenzo D.; Shaw, Gary M.; Correa, Adolfo
Failure in repairing severe hypospadias complicated with fistula and cutaneous retraction is often associated with lack of subcutaneous tissue and skin providing protection to the neourethra. We report the results of treatment in 6 patients with scrotal hypospadias with severe deviation and scarce dorsal prepuce. A neourethra was created by the onlay technique applying an oral mucosa graft and preserving in all cases the dorsal preputial skin for the island cutaneous flap. All patients had hypospadias without previous repairs excepting one of them, who had had one first time hypospadias repair in other hospital. Patients age ranged between 2 years and 3 months, and 4 years (mean: 2 years and 9 months). In all cases, hypospadias was scrotal type with severe deviation and scarce dorsal prepuce. All patients had prior hormone stimulation with dehydrotestosterone 3%. Surgical repair was performed in one-stage. Urethroplasty included preservation of the urethral plate, oral mucosa graft to provide ventral coverage, and island cutaneous flap with the dorsal preputial skin. In all cases, the chord was dissected behind the urethral plate. In 3 patients a dorsal Nesbit plication was necessary to obtain a complete straighten penis. Results in all 6 cases were satisfactory. Only one patient had a small leakage at the previous neomeatus. The other five patients are asymptomatic. Follow-up ranges from 6 months to 2 years. We conclude that urethroplasty in association with a well vascularized island flap of dorsal preputial skin decrease the incidence of fistulae. In patients with severe hypospadias with scarce dorsal prepuce urethroplasty should be completed with oral mucosa grafts preserving dorsal preputial skin for the ventral cutaneous plasty. PMID:10570864
Castañón, M; Grande, C; Muñoz, M E; García, A; Morales, L
Knowledge of the formation of the normal male urethra may elucidate the etiology of hypospadias. We describe urethral formation in the mouse, show the similarities and relevance to human urethral development, and introduce the concept of the epithelial seam formation and remodeling during urethral formation. Three mechanisms may account for epithelial seam formation: (1) epithelial-mesenchymal transformation similar to that described
Laurence S. Baskin; Ali Erol; Priya Jegatheesan; Yingwu Li; Wenhui Liu; Gerald R. Cunha
DNA double-strand breaks (DSBs) are a common form of cellular damage that can lead to cell death if not repaired promptly. Experimental systems have shown that DSB repair in eukaryotic cells is often imperfect and may result in the insertion of extra chromosomal DNA or the duplication of existing DNA at the breakpoint. These events are thought to be a source of genomic instability and human diseases, but it is unclear whether they have contributed significantly to genome evolution. Here we developed an innovative computational pipeline that takes advantage of the repetitive structure of genomes to detect repair-mediated duplication events (RDs) that occurred in the germline and created insertions of at least 50 bp of genomic DNA. Using this pipeline we identified over 1,000 probable RDs in the human genome. Of these, 824 were intra-chromosomal, closely linked duplications of up to 619 bp bearing the hallmarks of the synthesis-dependent strand-annealing repair pathway. This mechanism has duplicated hundreds of sequences predicted to be functional in the human genome, including exons, UTRs, intron splice sites and transcription factor binding sites. Dating of the duplication events using comparative genomics and experimental validation revealed that the mechanism has operated continuously but with decreasing intensity throughout primate evolution. The mechanism has produced species-specific duplications in all primate species surveyed and is contributing to genomic variation among humans. Finally, we show that RDs have also occurred, albeit at a lower frequency, in non-primate mammals and other vertebrates, indicating that this mechanism has been an important force shaping vertebrate genome evolution. PMID:19424419
Pace, John K; Sen, Shurjo K; Batzer, Mark A; Feschotte, Cédric
Hypospadias is a frequent congenital malformation, which severity is connected to the spungiosum divergence. Biological and anatomical explorations are necessary, before the recourse to the surgeon, in posterior hypospadias, familal hypospadias, but also in any type of hypospadias associated with cryptorchidism, bifid scrotum, micropenis less than 20mm (full-term newborn), or any other anomaly (skeletal, renal, cardiac…). The "mini-puberty", occurring in the first 4-6 months of life, is a period of intense gonadotropic activity in male newborns. It allows an easy investigation of the testicular function in boys with hypospadias. Hormonal evaluation (testosterone, AMH) should be done the first day of life. Let us remind that a newborn with "hypospadias" and bilateral cryptorchidism must be considered, until proved otherwise, as a girl with congenital adrenal hyperplasia. PMID:23992834
A case control study of hypospadias was performed from 1979 to 1987 in Alsace, north-eastern France. A total of 176 out of 60 847 male infants had hypospadias giving a prevalence at birth of 2.89 per 1000 male newborns; 15.3% of all infants with hypospadias also had other malformations. Renal and urinary tract malformations were present in 37.0% of the
C Stoll; Y Alembik; M P Roth; B Dott
In a study designed to determine the best suture for use in hypospadias surgery, polydioxanone (PDS), chromic catgut, and polyglycolic acid (Dexon) were studied under similar conditions in the penile foreskin of 16 baboons. Gross and microscopic observations were made at intervals of six to forty-eight days. The wounds sutured with catgut were all healed by twenty-four days with complete suture resorption and no evidence of scar formation. Both polyglycolic acid and polydioxanone sutures showed delayed resorption, wound abscesses, and granulomas. Catgut remains the best available suture to use in the penile foreskin. Polyglycolic acid and polydioxanone sutures, because of their prolonged resorption and excess reaction, should not be used in hypospadias surgery. PMID:3107191
Bartone, F; Shore, N; Newland, J; King, L; DuPlessis, D
Objective To explore whether women who reported corticosteroid use during pregnancy were more likely to deliver an infant with hypospadias than women who did not. Study design The analysis encompassed data on deliveries with an estimated due date between 1997 and 2004 from the National Birth Defects Prevention Study, a large population-based, case-control study conducted in the United States. Included were 1165 cases of moderate to severe hypospadias and 3000 nonmalformed male controls. Results The mothers of 39 cases (3.3%) and 62 controls (2.1%) reported using a corticosteroid medication during the period extending from 4 weeks before conception to 14 weeks after conception. The odds ratio (OR) for any corticosteroid exposure versus no corticosteroid exposure was 1.6 (95% confidence interval [CI] = 1.1 to 2.5); after adjustment for maternal race/ethnicity, education, age, and study site, it was 1.3 (95% CI = 0.8 to 2.0). Analyses by route of administration and specific component suggest that elevated ORs occurred only for nasal spray/inhaled corticosteroids (OR = 1.5; 95% CI = 0.9 to 2.6). Conclusions Maternal use of corticosteroid medications was weakly associated with risk of hypospadias, but the association was negligible after adjustment for potential confounders.
Carmichael, Suzan L.; Ma, Chen; Werler, Martha M.; Olney, Richard S.; Shaw, Gary M.
A descriptive epidemiological study of simple hypospadias—that is, hypospadias without coexisting malformation outside the genital system—in a birth population of 46,927 singleton males and 1,013 twin males showed that the condition was significantly more common (P < 0·001) in uniovular twin males than in either singleton or binovular twin males. Also the temporal distribution of dates of conception had a
C. J. Roberts; S. Lloyd
Hypospadias is one of the most common congenital malformations. It is considered to be a mild form of the 46,XY disorders of sex development (DSD), but its precise etiology remains to be elucidated. Compromised androgen synthesis or effects can cause this frequent malformation, although the mutational analyses of the genes involved in androgen actions have identified abnormalities in only a very small portion of patients. The overwhelming majority of cases remain unexplained and hypospadias may be a highly heterogeneous condition subject to multiple genetic and environmental factors. We here review the recent advances in this field and discuss the potential interactions between the environment and genetics. PMID:21256920
Kalfa, N; Philibert, P; Baskin, L S; Sultan, C
A complex aetiological (epidemiological, teratological and genetic) study was made in 294 index patients with simple isolated hypospadias. The epidemiological study conducted by the help of personal interviews of the mothers revealed a higher frequency of index patients among children born between August and December, among twins, mainly monozygotic, and finally in the lower birth weight groups and among first-borns.
A. Czeizel; J. Tóth; Eve Erodi
Hypospadias is one of the most common congenital malformations. It is considered to be a mild form of the 46,XY disorders of sex development (DSD), but its precise etiology remains to be elucidated. Compromised androgen synthesis or effects can cause this frequent malformation, although the mutational analyses of the genes involved in androgen actions have identified abnormalities in only a
N. Kalfa; P. Philibert; L. S. Baskin; C. Sultan
Introduction: proximal perigraft endoleak (PPE) and graft migration are associated with significant morbidity and mortality. Objective data establishing correlation between neck anatomy and these complications are lacking. The aim of this study was to analyse the anatomy of the neck in order to find which variables were significantly associated with PPE and graft migration. Methods: one hundred and eighty-four patients
J-N Albertini; S Kalliafas; S Travis; SW Yusuf; JA Macierewicz; SC Whitaker; NM Elmarasy; BR Hopkinson
46,XY disorders of sex development (DSD) refer to a wide range of abnormal genitalia, including hypospadias, which affects approximately 0.5% of male newborns. We identified three different nonsense mutations of CXorf6 in individuals with hypospadias and found that its mouse homolog was specifically expressed in fetal Sertoli and Leydig cells around the critical period for sex development. These data imply that CXorf6 is a causative gene for hypospadias. PMID:17086185
Fukami, Maki; Wada, Yuka; Miyabayashi, Kanako; Nishino, Ichizo; Hasegawa, Tomonobu; Nordenskjöld, Agneta; Camerino, Giovanna; Kretz, Christine; Buj-Bello, Anna; Laporte, Jocelyn; Yamada, Gen; Morohashi, Ken-Ichirou; Ogata, Tsutomu
Objectives: To evaluate the effect of parenteral testosterone on penile length, preputial skin and side effects in patients with hypospadias. Materials and Methods: 23 patients with hypospadias were included in this study. An oily solution, each ml of which contained testosterone propionate 25 mg, and testosterone enanthate 110 mg, equivalent to 100 mg of testosterone was given deep intramuscularly 4, 3 and 2 weeks before reconstructive surgery at the dose of 2 mg/kg body weight. Increase in penile length, transverse preputial diameter, and diameter at the base of penis were noted. Basal testosterone levels were obtained before the institution of therapy and on the day of operation. In addition, side effect such as development of pubic hair and delay in bone age was noted. Results: Following parenteral testosterone administration, the mean increase in penile length, transverse preputial diameter and diameter at the base of penis was 1.35±0.40 cm (P<0.001), 1.40±0.47 cm (P<0.001), and 0.72±0.47 cm (P<0.001), respectively. Serum testosterone level after injection was well within normal range for that age. Minimal side effects were noted in form of development of fine pubic hair. Conclusion: We conclude that parenteral testosterone can be safely used to improve the surgical outcome of hypospadias repair.
Ahmad, Reyaz; Chana, Rajendra Singh; Ali, Syed Manazir; Khan, Shehtaj
Endocrine disruptors, such as environmental compounds with endocrine-altering properties, may cause hypospadias and cryptorchidism in several species, including humans. Anogenital distance is sexually dimorphic in many mammals, with males having longer anogenital distance on average than females. Animal models of proposed endocrine disruptors have associated prenatal exposure with hypospadias, cryptorchidism, and reduced anogenital distance. Human studies have correlated shorter anogenital distance to in utero exposure to putative endocrine disruptors. We review preliminary data suggesting that anogenital distance is reduced in boys with hypospadia and cryptorchidism. Hence, human hypospadias and cryptorchidism may be associated with reduced anogenital distance as a result of endocrine disruption. PMID:18419998
Hsieh, Michael H; Breyer, Benjamin N; Eisenberg, Michael L; Baskin, Laurence S
A 31-year-old man was referred for further management of a urethral stricture. He was a victim of a traffic accident and his urethral injury was associated with a pelvic bone fracture. He had previously undergone a suprapubic cystostomy only owing to his unstable general condition at another hospital. After 3 months of urethral injury, direct urethral anastomosis was attempted, but the surgery failed. An additional 4 failed internal urethrotomies were performed before the patient visited Chungbuk National University Hospital. Preoperative images revealed complete posterior urethral disruption, and the defect length was 4 cm. We performed a buccal mucosa tubal graft without anastomosis of the proximal urethra for a long segment posterior urethral defect. The Foley catheter was removed 3 weeks after the operation and the patient was able to void successfully. After 8 months, he had normal voiding function without urinary incontinence.
Min, Byung-Dal; Lee, Eui-Tai; Kim, Won-Tae; Kim, Yong-June; Lee, Sang Cheol; Kim, Wun-Jae
MAMLD1 (mastermind-like domain containing 1), previously known as CXorf6 (chromosome X open reading frame 6), has been shown to be a causative gene for hypospadias. This is primarily based on the identification of nonsense mutations (E124X, Q197X, and R653X), which undergo nonsense-mediated mRNA decay, in patients with penoscrotal hypospadias. Subsequent studies have shown that (1) the mouse homolog is transiently
Tsutomu Ogata; Jocelyn Laporte; Maki Fukami
Hypospadias is one of the most common congenital anomalies in the United States, occurring in approximately 1 in 250 newborns or roughly 1 in 125 live male births. It is the result of arrested development of the urethra, foreskin, and ventral surface of the penis where the urethral opening may be anywhere along the shaft, within the scrotum, or in the perineum. The only treatment is surgery. Thus, prevention is imperative. To accomplish this, it is necessary to determine the etiology of hypospadias, the majority of which have been classified as idiopathic. In this paper we briefly describe the normal development of the male external genitalia and review the prevalence, etiology, risk factors, and epidemiology of hypospadias. The majority of hypospadias are believed to have a multifactorial etiology, although a small percentage do result from single gene mutations. Recent findings suggest that some hypospadias could be the result of disrupted gene expression. Discoveries about the antiandrogenic mechanisms of action of some contemporary-use chemicals have provided new knowledge about the organization and development of the urogenital system and may provide additional insight into the etiology of hypospadias and direction for prevention.
Baskin, L S; Himes, K; Colborn, T
Purpose Despite extensive research, the molecular basis of hypospadias and anorectal malformations is poorly understood, likely due to a multifactorial basis. The incidence of hypospadias is increasing, thus making research in this area warranted and timely. This review presents recent molecular work broadening our understanding of these disorders. Materials and Methods A brief review of our recent work and the literature on the role of Eph/ephrin signaling in hypospadias and anorectal malformations is presented. Results Genetically engineered mice mutant for ephrin-B2 or EphB2;EphB3 manifest a variety of genitourinary and anorectal malformations. Approximately 40% of adult male heterozygous mice demonstrate perineal hypospadias. Although homozygous mice die soon after birth, 100% of homozygous males demonstrate high imperforate anus with urethral anomalies and 100% of homozygous females demonstrate persistent cloaca. Male mice compound homozygous for EphB2ki/ki;EphB3?/?/ also demonstrate hypospadias. Conclusions These mouse models provide compelling evidence of the role of B-class Eph/ephrin signaling in genitourinary/anorectal development and add to our mechanistic and molecular understanding of normal and abnormal embryonic development. As research on the B-class Ephs and ephrins continues, they will likely be shown to be molecular contributors to the multifactorial basis of hypospadias and anorectal malformations in humans as well.
Yucel, Selcuk; Dravis, Christopher; Garcia, Nilda; Henkemeyer, Mark; Baker, Linda A.
Purpose Adults with complications from previous hypospadias surgery experience various problems, including urethral stricture, persistent hypospadias and urethrocutaneous fistula. Innate deficiencies of the corpus spongiosum and multiple failed operations makes further management challenging. Materials and Methods We reviewed our prospective urethroplasty database of men who presented with complications of previous hypospadias surgery. Patients were included in study if they had greater than 6 months of followup. Our surgical management was defined as an initial success if there were no urethral complications. The overall success rate included men with the same result after additional treatment. Results A total of 50 men had followup greater than 6 months (median 89) and were included in study. These 50 patients presented with urethral stricture (36), urethrocutaneous fistula (12), persistent hypospadias (7), hair in the urethra (6) and severe penile chordee (7). Patients underwent a total of 74 urethroplasties, including stage 1 urethroplasty in 19, a penile skin flap in 11, stage 2 urethroplasty in 11, urethrocutaneous fistula closure in 9, permanent perineal urethrostomy in 6, excision and primary anastomosis in 6, a 1-stage buccal mucosa onlay in 4, tubularized plate urethroplasty in 3, combined techniques in 3 and chordee correction in 1. In 25 men (50%) treatment was initially successfully. Of the 25 men in whom surgery failed 18 underwent additional procedures, including 13 who were ultimately treated successfully for an overall 76% success rate (38 of 50). Conclusions Managing problems from previous hypospadias surgery is difficult with a high initial failure rate. Additional procedures are commonly needed.
Myers, Jeremy B.; McAninch, Jack W.; Erickson, Bradley A.; Breyer, Benjamin N.
Cryptorchidism and proximal hypospadia in a newborn are highly suspicious for an intersex disorder, and proper investigations should be planned immediately after birth. In some hypospadic patients, the presence of a palpable gonad in the scrotum may induce to assign the male sex, whereas the anatomy of internal and external genitalia could be extremely complex, requiring an accurate evaluation before any definitive attribution of gender. The authors present a case of an infant, referred to the hospital for surgical treatment of a proximal hypospadia, who showed ambiguous external genitalia, absence of the right gonad, a partially dysgenetic left testis, and presence of both müllerian and wolffian structures. Cytogenetic analysis detected a mosaicism with a cell line showing an isodicentric Yp chromosome and a second one, a 45, X chromosomal complement. Because the baby had been assigned previously to male gender, he underwent a staged masculinizing correction of the genital anomalies. The authors discuss the necessity of a careful evaluation of these patients at birth by a multispecialistic team, for appropriate sex assignment and for the assessment of the risk of neoplastic degeneration. PMID:12891509
Marrocco, G; Poscente, M; Majore, S; De Bernardo, C; Rinaldi, R; Del Porto, G; Storniello, G; Grammatico, P
Background Hypospadias is a congenital displacement of the urethral meatus in male newborns, being either an isolated defect at birth or a sign of sexual development disorders. The aim of this study was to assess the prevalence rate of hypospadias in different Districts of Italy, in order to make a comparison with other countries all over the world. Methods We reviewed all the newborns file records (years 2001–2004) in 15 Italian Hospitals. Results We found an overall hypospadias prevalence rate of 3.066 ± 0.99 per 1000 live births (82.48% mild hypospadias, 17.52% moderate-severe). In newborns Small for Gestational Age (birthweight < 10th percentile) of any gestational age the prevalence rate of hypospadias was 6.25 per 1000 live births. Performing multivariate logistic regression analysis for different degrees of hypospadias according to severity, being born SGA remained the only risk factor for moderate-severe hypospadias (p = 0.00898) but not for mild forms (p > 0.1). Conclusion In our sample the prevalence of hypospadias results as high as reported in previous European and American studies (3–4 per 1000 live births). Pathogenesis of isolated hypospadias is multifactorial (genetic, endocrine and environmental factors): however, the prevalence rate of hypospadias is higher in infants born small for gestational age than in newborns with normal birth weight.
Ghirri, Paolo; Scaramuzzo, Rosa T; Bertelloni, Silvano; Pardi, Daniela; Celandroni, Amerigo; Cocchi, Guido; Danieli, Roberto; De Santis, Luisa; Di Stefano, Maria C; Gerola, Orietta; Giuffre, Mario; Gragnani, Giuseppe S; Magnani, Cinzia; Meossi, Cristiano; Merusi, Ilaria; Sabatino, Giuseppe; Tumini, Stefano; Corsello, Giovanni; Boldrini, Antonio
PurposeHypospadias is a common urogenital malformation in boys. The etiology is unknown but genetic and environmental factors are involved. Because monozygotic twins have the same genetic constitution, we studied disease discordant twin pairs to evaluate environmental risk factors while controlling for genetic effects.
LOUISE FREDELL; PAUL LICHTENSTEIN; NANCY L. PEDERSEN; JAN SVENSSON; AGNETA NORDENSKJOLD
that can perturb normal male development. The fetus is especially sensitive to these chem- icals known as endocrine disruptors that can mimic or interfere with the natural hormones that control development. We provide a brief description of normal development of the male external genitalia and review the preva- lence, etiology, risk factors, and epidemiology of hypospadias. We also present evidence
Laurence S. Baskin; Katherine Himes; Theo Colborn
One of the most discussed subjects regarding anterior cruciate ligament (ACL) repair methods is femoral fixation. One of the materials often used for fixation in recent years is the EndoButton (Acufex Microsurgical, Mansfield, MA), which provides rapid and secure fixation. Although many reports about femoral fixation with EndoButton have been published, insufficient information is available on possible complications. We have
Servet Tunay; Erbil O?uz; Cemil Yildiz; Hüseyin Özkan; Vecihi Kirdemir
The purpose of our study was to biomechanically compare, under cyclic loading conditions, fracture site motion, humeral head collapse, and intra-articular hardware penetration in simulated 3-part osteoporotic proximal humeral fractures stabilized with 1 of 2 locking-plate constructs. We performed fixation on simulated 3-part proximal humeral fractures in 10 pairs of cadaveric osteoporotic humeri with a Hand Innovations S3 Proximal Humerus Plate (S3 plate) or an LCP Proximal Humerus Plate (LCP plate; 1 each for each pair). The specimens were potted, mounted on a materials testing machine, and subjected to 5000 cycles of abduction in the scapular plane, loading through the supraspinatus tendon. Interfragmentary displacement at 2 virtual points (the most medial aspect of the calcar and the most superior aspect of the osteotomy line between the greater tuberosity and humeral head) was measured using an optical tracking system. Humeral head rotation was also measured. We used a generalized linear latent and mixed model to check for an effect of cyclic loading and treatment on the parameters of interest (significance, P < .05). After cyclic loading, the S3 plate humeri showed significantly greater displacement of the greater tuberosity fragment and rotation of the humeral head and a trend (not a significant difference) toward greater displacement at the calcar. No hardware penetration was noted for either repair. Although the S3 plate repairs resulted in significantly more fracture site motion, it is unknown whether the magnitude of the motion is clinically significant.
Rose, David M.; Sutter, Edward G.; Mears, Simon C.; Gupta, Rohit R.; Belkoff, Stephen M.
This is a critical review of 376 patients with hypospadias that were treated by the first author. The techniques used were\\u000a a one-stage procedure for the correction of hypospadias without chordee (type I) and a two-stage procedure for hypospadias\\u000a with chordee (type II). Development of these techniques was based on several conjectures: (a) A curvature of the penis can\\u000a be
J. C. van der Meulen; J. F. A. van der Werff
This report outlines the case of a 3-year-old boy whose initial presentation was that of asymptomatic hypertension (lowest recording 148/90), found at preoperative check prior to stage 2-correction surgery for distal hypospadias. Upon diagnosis of true hypertension, an ultrasound of the child's renal tract showed evidence of marked hydronephrosis and calyceal dilatation. On the background of deteriorating renal function (Urea 25.5 and Creatinine 188), a Micturating Cystourethrogram was performed, demonstrating posterior urethral dilatation. With difficulties controlling blood pressure, the child was transferred to Urology care, where resection of a posterior urethral valve (PUV) was undertaken. Despite this, renal function deteriorated further and re-cystoscopy identified an anterior urethral valve (AUV), which was also resected. Renal function, although improved, remains poor and blood pressure is controlled with two anti-hypertensives. To the publisher's knowledge, the association between hypospadias, PUVs and AUVs is as yet undocumented.
Carvell, James; Mulik, Roopa
The kidney plays a fundamental role in maintaining body salt and fluid balance and blood pressure homeostasis through the actions of its proximal and distal tubular segments of nephrons. However, proximal tubules are well recognized to exert a more prominent role than distal counterparts. Proximal tubules are responsible for reabsorbing approximately 65% of filtered load and most, if not all, of filtered amino acids, glucose, solutes, and low molecular weight proteins. Proximal tubules also play a key role in regulating acid-base balance by reabsorbing approximately 80% of filtered bicarbonate. The purpose of this review article is to provide a comprehensive overview of new insights and perspectives into current understanding of proximal tubules of nephrons, with an emphasis on the ultrastructure, molecular biology, cellular and integrative physiology, and the underlying signaling transduction mechanisms. The review is divided into three closely related sections. The first section focuses on the classification of nephrons and recent perspectives on the potential role of nephron numbers in human health and diseases. The second section reviews recent research on the structural and biochemical basis of proximal tubular function. The final section provides a comprehensive overview of new insights and perspectives in the physiological regulation of proximal tubular transport by vasoactive hormones. In the latter section, attention is particularly paid to new insights and perspectives learnt from recent cloning of transporters, development of transgenic animals with knockout or knockin of a particular gene of interest, and mapping of signaling pathways using microarrays and/or physiological proteomic approaches. PMID:23897681
Zhuo, Jia L; Li, Xiao C
Objective The aim of this study was to determine prevalence and risk factors of hypospadias in newborn infants of a private hospital in Mashhad city located in northeast Iran. Methods All live birth deliveries in maternity hospital were enrolled from Oct 2006 to Sep 2008. All hypospadias cases were compared with the next male live births for possible risk factors. This study included only solitary hypospadias cases, those associated with other anomalies were excluded. Both parents were asked to fill out the same written questionnaires seperately. Data was analyzed by using SPSS. Findings During two years 6149 babies were born in our hospital; 25 cases (0.4%, 4 in1000 live births) of hypospadias were identified. Hypospadias occurred in 0.76% of male deliveries. Most cases of hypospadias were born in summer and winter was the season which least number. Positive family history (P=0.04) was regarded as a potential risk factor that was present in 44% of cases in hypospadias group. Iron supplement consumption in first trimester of pregnancy in control group was significantly more than in hypospadias group (P=0.001) and also usage of folic acid in control group before and in first trimester of pregnancy was taken more by mother in control group than in hypospadias group (P=0.049 and P=0.001 respectively). Conclusion Prevalence in this population was intermediate (4 in 1000 live births). Summer was the most epidemiology factor for occurring of hypospadias probably due to conception in cold season. Iron and folic acid supplementation may have preventive effect in hypospadias.
Mohammadzadeh, Ashraf; Farhat, Ahmadshah; Esmaieli, Habibollah; Shiranzaei, Soozan
Surgical correction of hypospadias is proposed to improve the aesthetic and functional quality of the penis. Hormone therapy preceding surgical correction is indicated to obtain better surgical conditions. However, there is divergence in the literature regarding the hormone therapy of choice, time of its use before surgery, appropriate dose, and route of application. To try to elucidate this matter, an electronic survey of the databases PubMed and Cochrane Central Library was conducted, limited to articles in English published since 1980. Search strategy identified 14 clinical trials that matched the inclusion criteria. Analysis was made in terms of study design, classification of hypospadias, association with chordee and cryptorchidism, type of hormone, route of application, dose and duration of treatment, penile length before and after hormone therapy, glans circumference before and after hormone therapy, adverse effects, and surgical complications. From the trials evaluated it was not possible to determine the ideal neoadjuvant treatment. A preference for use of testosterone was observed. Intramuscular administration seems to have fewer adverse effects than topical treatment. Side effects were seldom described, and treated patients were not followed on a long-term basis. The scarcity of randomized and controlled clinical trials regarding the topic impairs the establishment of a protocol. In conclusion, although preoperative hormone therapy is currently used before hypospadias surgery, its real benefit in terms of improvement of the penis and surgical results has not been defined. PMID:23602841
Netto, Jose Murillo B; P F Ferrarez, Carlos Eduardo; Schindler Leal, Anucha Andrade; Tucci, Silvio; Gomes, Carlos Augusto; Barroso, Ubirajara
Reports suggesting an increasing incidence of male genitourinary anomalies such as hypospadias, possibly related to environmental factors such as environmental estrogen-like compounds, have recently received considerable publicity. These reports are based on birth defects registry data, and there may be variation in the completeness of the registries used. We analyzed temporal trends in the prevalence of hypospadias in Finland to
Martti Aho; Anna-Maija Koivisto; Teuvo L. J. Tammela; Anssi Auvinen
PurposeHypospadias has no known single etiology but it has been linked to androgen insensitivity caused by mutations of the androgen receptor gene. The purpose of this study was to search for such mutations in cases of various degrees of isolated hypospadias to determine whether such an association exists and, if so, with any particular anatomical subgroup.
Richard W. Sutherland; John S. Wiener; Joseph P. Hicks; Marco Marcelli; Edmond T. Gonzales; David R. Roth; Dolores J. Lamb
We have evaluated the long-term functional and cosmetic results of the Snodgrass technique in the treatment of anterior and midpenile hypospadias. A total of 70 patients who presented in the period between 1997 and 2002 underwent the Snodgrass procedure for the treatment of hypospadias. Patients who had been operated on 2 or more years previously were recalled for evaluation. Of
Mesut Gürdal; Ali Tekin; Sinan Kireççi; Feridun ?engör
Urethral reconstruction following failed hypospadias repair or post-traumatic chronic stricture requires adequate amounts\\u000a of tissue. Many surgical techniques utilizing different types of biological tissues have been attempted: (a) vascularized\\u000a skin flaps from the prepuce, scrotum or penile shaft; (b) full-thickness free skin grafts; (c) vesical or buccal mucosa grafts;\\u000a (d) ureter; artery; vein and appendix tissue. More recently, biodegradable polymers
P. P. Parnigotto; M. T. Conconi; P. G. Gamba; P. Midrio
Background Hypospadias is a birth defect of the urethra in males, and a milder form of 46,XY disorder of sexual development (DSD). The disease is characterized by a ventrally placed urinary opening due to a premature fetal arrest of the urethra development. Moreover, the Androgen receptor (AR) gene has an essential role in the hormone-dependent stage of sexual development. In addition, longer AR polyglutamine repeat lengths encoded by CAG repeats are associated with lower transcriptional activity in vitro. In the present study, we aimed at investigating the role of the CAG repeat length in the AR gene in hypospadias cases as compared to the controls. Our study included 211 hypospadias and 208 controls of Caucasian origin. Methods We amplified the CAG repeat region with PCR, and calculated the difference in the mean CAG repeat length between the hypospadias and control group using the T-test for independent groups. Results We detected a significant increase of the CAG repeat length in the hypospadias cases when compared to the controls (contrast estimate: 2.29, 95% Confidence Interval (1.73-2.84); p-value: 0.001). In addition, the odds ratios between the hypospadias and controls revealed that the hypospadias cases are two to 3 times as likely to have longer CAG repeats than a shorter length for each repeat length investigated. Conclusions We have investigated the largest number of hypospadias cases with regards to the CAG repeat length, and we provide evidence that a higher number of the CAG repeat sequence in the AR gene have a clear effect on the risk of hypospadias in Caucasians.
Treatment for distal hypospadia was conducted in 148 children aged from 11 months to 14 years admitted to the urological department of the Syktyvkar Central Children's Hospital in 1998-2010. Operation MAGPI was made in 12 (8.8%) children, TIP--in 87 (61.8%), Mathieu--in 15 (11.0%), displacing urethroplasty--in 25 (18.4%). Preputial reconstruction was performed in 29 (21%) children: in 21 in displacing urethroplasty and in 8 in conduction of TIP operation. The number of complications in displacing urethroplasty and TIP is less than in MAGPI and Mathieu operations. Significantly less number of complications was seen only in comparison of TIP with MAGPI. Operations with preputial reconstruction had no such complications as urethral fistula, meatostenosis and separation of the glans penis. Two cases of partial preputial separation after the operation were observed. Thus, preputial reconstruction can be conducted in most children with distal hypospadia, the risk of postoperative complications being the same. PMID:22876640
Kagantsov, I M
Uroflowmetry is a non-invasive diagnostic method well accepted by children and uninfluenced by stress. It allows the study of natural urination and could significantly reduce the frequency of calibration and postoperative urethral dilation (invasive, poorly tolerated procedures) in hypospadias. However, the usefulness of uroflowmetry in children has been questioned. The aim of this study was: (1) to assess the repeatability of uroflowmetry and the objectiveness/reliability of the procedure in children; (2) to check whether uroflowmetry could replace urethral calibration for postoperative monitoring of patients with hypospadia. Preoperative and postoperative uroflowmetric investigations and urethral calibrations were performed in 54 boys aged 5-14 years (Table 1) forming the study group (GB) (360 uroflowmetric measurements in total). The results were compared with uroflowmetry results in 26 boys of the same age from the control group (GK) (102 measurements in total). To measure the rate at which urine passes through the urethra, the author constructed a simple apparatus (basing on the apparatus for adult patients used by Janosz) (Fig. 1). For urethral calibration, metal bougies manufactured by PennTM were used. Documentation consisted of data sheets which were next computer processed (Fig. 2). The preoperative and postoperative results of uroflowmetry (voiding time, total volume voided, average flow rate, maximal flow rate, voiding time for first 100 mL of urine, average flow rate during first 10 s) were compared for each patient. Next, the results in the study group were compared with age-matched controls (Tables 2-5, Fig. 3) and with urethral calibration values (Table 6; Fig. 9). 462 urination curves (360 from the studied group and 102 from the control group) were examined and 6 curve shapes were recognized (Fig. 4). Graphical analysis of individual urination curves in the study and control groups was done to evaluate the repeatability of the method (Fig. 5). Statistical and graphical analysis of 4 uroflowmetric parameters (average flow, maximal flow, voiding time for first 100 mL of urine, average flow rate during first 10 s) were compared with mean values and standard deviation in the age subgroups of the study and control groups (Fig. 6) and with urethral calibration values in the study group (Fig. 7). Correlation between maximal flow rate and urethral calibration after surgery was checked (Fig. 8). Maximal flow rate correlated with the corresponding urethral calibration value (Table 6; Fig. 9). The homogenous clinical material (boys with hypospadias) allowed the evaluation of the uroflowmeter as to precision and repeatability. The apparatus proved reliable and facilitated the preoperative evaluation and postoperative monitoring in hypospadias. The following conclusions were drawn: (1) Uroflowmetry is an objective, reliable and repeatable investigation in children; (2) Uroflowmetry could replace urethral calibration for postoperative monitoring of hypospadia patients. PMID:12514911
Objectives:? In hypospadia patients, the urethral plate and the underlying tissue were previously thought to be the main cause of penile curvature and, because of this, they used to be excised to correct the curvature. Currently, they are preserved as they are not thought to cause penile curvature anymore. The aim of the present histology study was to elucidate the characteristic structure of the tissue beneath the urethral plate. Methods:? The experimental group consisted of 27 hypospadiac patients with moderately severe penile curvature, who underwent one-stage urethroplasty after dividing the urethral plate. Excised tissues were observed under light microscopy and transmission electron microscopy (TEM). Furthermore, the presence of collagen subtypes I, III and IV was examined with immunohistochemical staining and western blotting. Results:? Light microscopy showed the existence of many massed and intertwined collagen fibers and vessels that resembled those of the cavernous sinus. TEM showed the existence of many collagen fibers, capillary vessels and other structures. Immunohistochemical staining showed collagen subtype I in the interfascicular space and collagen fibers were densely stained. Collagen subtype IV was found in the basement membrane of vessels, but collagen subtype III was not detected. The same results were obtained by western blotting. Conclusions:? The tissue beneath the urethral plate was considered to originate from the corpus spongiosum penis. The distribution of collagen subtypes suggests that the presence of the tissue might affect ventral penile curvature. Long-term follow up is required after one-stage hypospadias repair with preservation of the urethral plate and the underlying tissue. PMID:21332824
Hayashi, Yutaro; Mizuno, Kentaro; Kojima, Yoshiyuki; Moritoki, Yoshinobu; Nishio, Hidenori; Kato, Toshiki; Kurokawa, Satoshi; Kamisawa, Hideyuki; Kohri, Kenjiro
PurposeWe studied the degree of agreement between hypospadias patient and surgeon satisfaction with the cosmetic surgical result, and the relation between penile length, meatal position and patient satisfaction.
Marc A. M. Mureau; Froukje M. E. Slijper; A. Koos Slob; Frank C. Verhulst; Rien J. M. Nijman
Developmental delay/intellectual disabilities, speech disturbance, pre- and postnatal growth retardation, microcephaly, signs of ectodermal dysplasia, and genital malformations in males (hypospadias) represent the phenotypic core of the recent emerging 19q13.11 deletion syndrome. Using array-CGH for genome-wide screening we detected an interstitial deletion of chromosome band 19q13.11 in two patients exhibiting the recognizable pattern of malformations as described in other instances of this submicroscopic genomic imbalance. The deletion detected in our patients has been compared with previously reported cases leading to the refinement of the minimal overlapping region (MOR) for this microdeletion syndrome to 324?kb. This region encompasses five genes: four zinc finger (ZNF) genes belonging to the KRAB-ZNF subfamily (ZNF302, ZNF181, ZNF599, and ZNF30) and LOC400685. On the basis of our male patient 1 and on further six male cases of the literature, we also highlighted that larger 19q13.11 deletions including the Wilms tumor interacting protein (WTIP) gene, proximal to the MOR, results in hypospadias making this gene a possible candidate for this genital abnormality due to its well-known interaction with WT1. Although the mechanism underlying the phenotypic effects of copy number alterations involving KRAB-ZNF genes at 19q13.11 has not clearly been established, we suggest their haploinsufficiency as the most likely candidate for the phenotypic core of the 19q13.11 deletion syndrome. In addition, we hypothesized WTIP gene haploinsufficiency as responsible for hypospadias.
Gana, Simone; Veggiotti, Pierangelo; Sciacca, Giusy; Fedeli, Cristina; Bersano, Anna; Micieli, Giuseppe; Maghnie, Mohamad; Ciccone, Roberto; Rossi, Elena; Plunkett, Katie; Bi, Weimin; Sutton, Vernon R; Zuffardi, Orsetta
Urethrocutaneous fistula is a common complication after redo urethroplasty for hypospadias, or urethroplasty for patients with thin urethral plate. We modified Snodgrass' tubularized incised plate urethroplasty (STIPU) by stripping the most superficial skin from both sides of the U-shaped incision to expose more subcutaneous tissue along the suture line. Our modified STIPU would appear to be effective in preventing postoperative urethrocutaneous fistula formation in redo urethroplasty for hypospadias, and urethroplasty for patients with thin urethral plate. PMID:22868631
Yamataka, Atsuyuki; Shimotakahara, Akihiro; Koga, Hiroyuki; Miyano, Go; Lane, Geoffrey J; Cazares, Joel; Halibieke, Abudebieke; Okawada, Manabu
A proximity fuze system includes an optical ranging apparatus, a detonation circuit controlled by the optical ranging apparatus, and an explosive charge detonated by the detonation cirtcuit. The optical ranging apparatus includes a pulsed laser light source for generating target ranging light pulses and optical reference light pulses. A single lens directs ranging pulses to a target and collects reflected light from the target. An optical fiber bundle is used for delaying the optical reference pulses to correspond to a predetermined distance from the target. The optical ranging apparatus includes circuitry for providing a first signal depending upon the light pulses reflected from the target, a second signal depending upon the light pulses from the optical delay fiber bundle, and an output signal when the first and second signals coincide with each other. The output signal occurs when the distance from the target is equal to the predetermined distance form the target. Additional circuitry distinguishes pulses reflected from the target from background solar radiation.
Harrison, Thomas R. (Stockton, CA)
Introduction X-linked congenital adrenal hypoplasia is a rare developmental disorder of the human adrenal cortex and is caused by deletion or mutation of the dosage-sensitive sex reversal adrenal hypoplasia congenita critical region of the X chromosome, gene 1 (DAX-1) gene. Most affected children present with failure to thrive, salt wasting and hypoglycemic convulsions in the first months of life. Hypospadias affects approximately one in 250 live male births. Mutations in the mastermind-like domain-containing 1 (MAMLD1) gene have been implicated as one of the causes of hypospadias in children. To the best of our knowledge, an association between congenital adrenal hypoplasia due to a DAX-1 mutation and hypospadias due to mutation of the MAMLD1 gene has not previously been reported in the literature. Case presentation A 35-day-old male Egyptian baby was referred to our institution for the evaluation of a two-week history of recurrent vomiting associated with electrolyte imbalance. On examination, our patient was found to have hypotension and dehydration. A genital examination showed distal penile hypospadias with chordee and normal testes. He had hyponatremia, hyperkalemia, hypoglycemia and metabolic acidosis. Endocrinological investigations revealed low levels of cortisol, 17-hydroxyprogesterone and aldosterone, with a high level of adrenocorticotrophic hormone. A provisional diagnosis of congenital adrenal hypoplasia associated with hypospadias was made. A molecular genetics study confirmed the diagnosis of X-linked congenital adrenal hypoplasia due to DAX-1 mutations and hypospadias due to MAMLD1 mutation. He was started on hydrocortisone and fludrocortisone treatment. After three weeks of treatment, his symptoms improved and his blood sugar, sodium, potassium and cortisol levels normalized. Conclusions We report the case of an Egyptian baby with an association of congenital adrenal hypoplasia due to DAX-1 mutation and hypospadias due to MAMLD1 mutation. Early diagnosis of this association and determining its optimal treatment are vital in helping to avoid its fatal course.
Purpose Hypospadias is one of the most frequent genital malformations in the male newborn, and results from abnormal penile and urethral development. The etiology of hypospadias remains largely unknown despite intensive investigations. Fetal androgens have a crucial role in genital differentiation. Recent studies have suggested that molecular mechanisms that underlie the effects of androgens on the fetus may involve disruption of epigenetic programming of gene expression during development. We assessed whether epigenetic modification of DNA methylation is associated with hypospadias in a case-control study of 12 hypospadias and 8 control subjects. Materials and Methods Genome-wide DNA methylation profiling was performed on the study subjects using the Illumina Infinium® HumanMethylation450 Bead-Chip, which enables the direct investigation of methylation status of more than 485,000 individual CpG sites throughout the genome. The methylation level at each CpG site was compared between cases and controls using the t test and logistic regression. Results We identified 14 CpG sites that were associated with hypospadias with p <0.00001. These CpG sites were in or near the SCARB1, MYBPH, SORBS1, LAMA4, HOXD11, MYO1D, EGFL7, C10orf41, LMAN1L and SULF1 genes. Two CpG sites in SCARB1 and MYBPH genes remained statistically significant after correction for multiple testing (p = 2.61×10?09, pcorrected = 0.008; p = 3.06×10?08, pcorrected = 0.02, respectively). Conclusions To our knowledge this is the first study to investigate hypospadias using a unique and novel epigenetic approach. Our findings suggest DNA methylation patterns are useful in identifying new genes such as SCARB1 and MYBPH that may be involved in the etiology of hypospadias.
Choudhry, Shweta; Deshpande, Archana; Qiao, Liang; Beckman, Kenneth; Sen, Saunak; Baskin, Laurence S.
Hypospadias is one of the more frequently observed congenital malformations in the worldwide urologic pediatric practice and one of the reasons for repeated visits in this territory. In this respect a descriptive, observational and retrospective study was carried out in 108 children with diagnosis of hypospadias, who were attended in the Service of Urology of the Southern Children Hospital of
Manuel Pantoja Blanco; Edward Kofi Boache; Gilberto Rio Hidalgo; Oscar Luis; Sánchez Ramírez; Rafael Antonio; Camué Moya
BACKGROUND Animal models of endocrine dysfunction have associated male genital defects with reduced anogenital distance (AGD). Human studies have correlated shorter AGD with exposure to putative endocrine disruptors in the environment but have not examined AGD in hypospadiac boys. We measured AGD in boys with hypospadias and those with normal genitals. METHODS Data were collected prospectively on boys undergoing urologic procedures at the University of California San Francisco and the Children's Hospital of Oakland, CA, USA. Data included age, race, height, weight, BMI, urologic diagnoses and AGD. To minimize any potential effects of race on observed AGD, we examined only Caucasian boys. Differences between boys with hypospadias and those with normal genitals were examined through two-tailed Student's t-tests. RESULTS One hundred and nineteen Caucasian boys ranging in age from 4 to 86 months underwent AGD measurement, of which 42 and 77 were boys with normal genitals and hypospadias, respectively. The mean (±SD) AGD of boys with hypospadias was 67 ± 1.2 versus 73 ± 1 mm for boys with normal genitals (P = 0.002). In these age-unmatched patient groups, there were also differences in age, height and weight (P = 0.0001, 0.0002 and 0.0004, respectively). After age matching (all <2 years of age), boys with hypospadias (n= 26) still featured a shorter AGD than boys with normal genitals (n= 26; 62 ± 2 versus 68 ± 2 mm respectively, P = 0.033) but the differences in age, height and weight were no longer significant. CONCLUSIONS In humans, hypospadias may indeed be associated with reduced AGD. Additional studies are needed to corroborate these preliminary findings and to determine their etiology.
Hsieh, Michael H.; Eisenberg, Michael L.; Hittelman, Adam B.; Wilson, Jason M.; Tasian, Gregory E.; Baskin, Laurence S.
Biopsy of the skin, fascia and urethra was performed in 29 cases of urethroplasty for hypospadia in children and adults. The patients were divided into two groups: group 1 (n=14) with primary plastic urethra and group 2 (n=15) with secondary urethroplasty of hypospadia with complication. Tissue samples were examined microbiologically and morphologically. Focal infection of penile skin was found after iodopiron sterilization as well as contamination of the skin, fascia and urethra in all the patients of group 2. Nonclostridial anaerobes dominated among the bacteria. Microbiological investigations in groups 1 and 2 proved a great role of Bacteriodes fragilic in the development of penile tissue inflammation. PMID:21815457
Kogan, M I; Panchenko, S N; Nabokova, Iu A; Mitusov, V V; Shangichev, V A; Sizonov, V V
High blood lead levels have recently been documented in schoolchildren living in communities adjacent to boat-repair yards in southern Thailand. In this study, the spatial pattern of lead contamination of soil and household dust in an area surrounding several boat-repair yards is described, and household factors associated with elevated dust lead are identified. A cross-sectional spatial study was conducted in
Nipa Maharachpong; Alan Geater; Virasakdi Chongsuvivatwong
INTRODUCTION ZEB1 is overexpressed in patients with severe hypospadias. We examined the interaction between ZeB1 and the androgen receptor (AR) in vitro and the expression of AR in boys with hypospadias. RESULTS ZEB1 and AR colocalize to the nucleus. Estrogen upregulated ZEB1 and AR expression. Chromatin immunoprecipitation (ChIP) demonstrated that ZEB1 binds to an E-box sequence in the AR gene promoter. AR expression is higher in subjects with severe hypospadias than those with mild hypospadias and control subjects (P < 0.05). ZEB1 physically interacts with AR in human foreskin cells. DISCUSSION AR is overexpressed in patients with severe hypospadias. Environmental estrogenic compounds may increase the risk of hypospadias by facilitating the interaction between ZEB1 and AR. METHODS Hs68 cells, a fibroblast cell line derived from neonatal human foreskin, were exposed to 0, 10, and 100 nmol/l of estrogen, after which the cellular localization of ZEB1 and AR was assessed using immunocytochemistry. To determine if ZEB1 interacted with the AR gene, ChIP was performed using ZEB1 antibody and polymerase chain reaction (PCR) for AR. Second, AR expression was quantified using real-time PcR and western blot in normal subjects (n = 32), and subjects with mild (n = 16) and severe hypospadia (n = 16).
Qiao, Liang; Tasian, Gregory E.; Zhang, Haiyang; Cao, Mei; Ferretti, Max; Cunha, Gerald R.; Baskin, Laurence S.
Background: The etiologies of the male urogenital anomalies—cryptorchidism and hypospadias—are poorly understood. Given positive associations between chlordane isomers and testicular germ cell tumors, it is reasonable to assume that chlordanes might also be associated with other testicular dysgenesis syndrome disorders, namely cryptorchidism and hypospadias. Objective: To examine whether exposure to in utero chlordane is related to cryptorchidism and hypospadias, we evaluated levels of chlordane derivatives, trans-nonachlor and oxychlordane, among pregnant women enrolled in the Collaborative Perinatal Project (CPP). Methods: From 1959 to 1965, the CPP enrolled pregnant women at 12 U.S. medical centers. We analyzed serum trans-nonachlor and oxychlordane levels measured in third-trimester serum from the mothers of 217 sons with cryptorchidism, 197 sons with hypospadias, and 557 sons with neither condition. Adjusted odds ratios (ORs) and 95% confidence intervals were calculated using conditional logistic regression. Results: The quartile-specific ORs for cryptorchidism or hypospadias show no notable associations with trans-nonachlor or oxychlordane. Further, there were no significant trends with increasing quartile of maternal trans-nonachlor or oxychlordane level in either cryptorchidism or hypospadias (p-trend all > 0.45). Conclusions: The results do not support an association between chlordane levels and cryptorchidism or hypospadias. It is unlikely that current chlordane exposure is related to the development of either anomaly, given that serum chlordane levels at the time of sample collection, the early 1960s, were considerably higher than levels at present.
Longnecker, Matthew P.; Brock, John W.; Klebanoff, Mark A.; McGlynn, Katherine A.
High blood lead levels have recently been documented in schoolchildren living in communities adjacent to boat-repair yards in southern Thailand. In this study, the spatial pattern of lead contamination of soil and household dust in an area surrounding several boat-repair yards is described, and household factors associated with elevated dust lead are identified. A cross-sectional spatial study was conducted in a coastal residential area within a distance of 2 km from three major boat-repair yards situated on the east coast of peninsular Thailand. Household dust specimens were collected from an undisturbed position in the residences of children, aged 4-14 years, sampled randomly from all children living in the study area. Soil specimens were obtained from the interstices of a square grid, 70 x 70 m2, superimposed on the area. Geographic coordinates of residence and soil sampling positions were recorded and semivariograms and kriging used to contour the spatial distribution of lead in dust and soil. Environmental lead levels were also modeled in terms of direction and minimum distance from a boat-repair yard and, for household dust lead content, in terms of household variables, including occupation of household members in boat-repair work, type of house construction, and general cleanliness. Household dust and soil lead content ranged from 10 to 3025 mg/kg and from 1 to 7700 mg/kg, respectively. The distribution of soil lead peaked at the location of the boat-repair yards, but outside the yards the distribution was generally below 400 mg/kg and irregular. About 24% of household dust lead specimens were equal to or above 400 mg/kg, but showed significant decrease with increasing distance from the boat-repair yards, at rates of between 7% and 14% per 100 m. In houses where a family member was a worker in one of the major boatyards and in houses where occasional repair of small boats was undertaken, household dust lead levels were significantly elevated, by 65% (95% CI: 18-130%) and 31% (95% CI: 5-63%), respectively. Siting of boat-repair yards at a distance from residential areas and measures to reduce the spread of lead-containing dust are recommended to alleviate the problem of elevated household dust lead levels. PMID:16832871
Maharachpong, Nipa; Geater, Alan; Chongsuvivatwong, Virasakdi
The underlying reasons for the increasing occurrence of male reproductive diseases (MRD) such as hypospadias, cryptorchidism, and testicular cancer (TC) over the last decades are still unknown. It has been hypothesized that the risk of MRD is determined in utero and that pregnancy dietary intake could also affect MRD risk in the offspring. Various studies in animals reported that cocoa
Background: Reported rises in the prevalence of hypospadias and other abnormalities of the male reproductive system may be a result of exposure to endocrine disrupting chemicals. Aims: To analyse the relation between risk of hypospadias and maternal occupation, particularly with regard to exposure to potential endocrine disrupting chemicals (EDCs). Methods: Data (1980–96) from the National Congenital Anomaly System (NCAS) were used to analyse the proportion of all congenital anomaly cases (n = 35 962) which were notified with hypospadias (n = 3471) by occupational codes (348 individual job titles) and by categories of exposure to potential EDCs from a job exposure matrix. Results: Five individual occupations (of 348) showed nominally statistically significant excesses, none of which had possible or probable exposure to potential EDCs. Odds ratios for "possible" or "probable" compared to "unlikely" exposure to potential EDCs did not show statistically significant increases in any of the EDC categories after adjustment for social class of the mother and father, nor was there evidence of an upward trend in risk with likelihood of exposure. In the 1992–96 time period odds ratios were increased for hairdressers (the largest group exposed to potential EDCs) and for probable exposure to phthalates (of which hairdressers form the largest group) before social class adjustment. Conclusions: There was little evidence for a relation between risk of hypospadias and maternal occupation or occupational exposure to potential EDCs, but as the exposure classification was necessarily crude, these findings should be interpreted with caution.
Vrijheid, M; Armstrong, B; Dolk, H; van Tongeren, M; Botting, B
Hypospadias flap viability is determined most often by direct observation or injection of visual doses of fluorescein and observation with a Woods lamp. We support the use of a dermofluorometer and subvisual doses of fluorescein to measure tissue fluorescence in predicting flap viability. PMID:3723677
Walker, R D; Graham, B
Torre A. and Rallet A. (2005) Proximity and localization, Regional Studies39, 47- 59. The objective of this paper is to pave the way for an analysis of the relations between proximity and localization of activities and people, two notions that are often mistaken for one another. Our method consists in exploiting the semantic wealth of the notion of proximity. We
Andre Torre; Alain Rallet
The underlying reasons for the increasing occurrence of male reproductive diseases (MRD) such as hypospadias, cryptorchidism, and testicular cancer (TC) over the last decades are still unknown. It has been hypothesized that the risk of MRD is determined in utero and that pregnancy dietary intake could also affect MRD risk in the offspring. Various studies in animals reported that cocoa and theobromine, the main stimulant of cocoa, exert toxic effects on the testis, inducing testicular atrophy and impaired sperm quality. A correlation analysis was conducted to examine the possible role of cocoa consumption on the occurrence of selected MRD during the prenatal and early life period of cases. The incidence rates between 1998-2002 of TC in 18 countries obtained from Cancer Incidence in Five Continents were correlated with the average per-capita consumption of cocoa (kg/capita/year) (FAOSTAT-Database) in these countries from 1965 to 1980, i.e. the period corresponding to the early life of TC cases. In order to test the above correlation in the case of hypospadias, the mean prevalence at birth in 20 countries (1999-2003) with average per-capita consumption of cocoa in these countries in the same period corresponding to pregnancy were used. The consumption of cocoa in the period 1965-80, was most closely correlated with the incidence of TC in young adults (r=0.859; p<0.001). An analogous significant correlation was also observed between early cocoa consumption and the prevalence rates of hypospadias in the period 1999-2003 (r=0.760; p<0.001). Although the ecological approach used in this study cannot provide an answer on the causal relationship between consumption of cocoa in early life and TC and hypospadias, the results are suggestive and indicate the need of further analytic studies to investigate the role of individual exposure to cocoa, particularly during the prenatal and in early life of the patients. PMID:19440400
The underlying reasons for the increasing occurrence of male reproductive diseases (MRD) such as hypospadias, cryptorchidism, and testicular cancer (TC) over the last decades are still unknown. It has been hypothesized that the risk of MRD is determined in utero and that pregnancy dietary intake could also affect MRD risk in the offspring. Various studies in animals reported that cocoa and theobromine, the main stimulant of cocoa, exert toxic effects on the testis, inducing testicular atrophy and impaired sperm quality. A correlation analysis was conducted to examine the possible role of cocoa consumption on the occurrence of selected MRD during the prenatal and early life period of cases. The incidence rates between 1998–2002 of TC in 18 countries obtained from Cancer Incidence in Five Continents were correlated with the average per-capita consumption of cocoa (kg/capita/year) (FAOSTAT-Database) in these countries from 1965 to 1980, i.e. the period corresponding to the early life of TC cases. In order to test the above correlation in the case of hypospadias, the mean prevalence at birth in 20 countries (1999–2003) with average per-capita consumption of cocoa in these countries in the same period corresponding to pregnancy were used. The consumption of cocoa in the period 1965–80, was most closely correlated with the incidence of TC in young adults (r=0.859; p<0.001). An analogous significant correlation was also observed between early cocoa consumption and the prevalence rates of hypospadias in the period 1999–2003 (r=0.760; p<0.001). Although the ecological approach used in this study cannot provide an answer on the causal relationship between consumption of cocoa in early life and TC and hypospadias, the results are suggestive and indicate the need of further analytic studies to investigate the role of individual exposure to cocoa, particularly during the prenatal and in early life of the patients.
Credentials as a means of identifying individuals have traditionally been a photo badge and more recently, the coded credential. Another type of badge, the proximity credential, is making inroads in the personnel identification field. This badge can be read from a distance instead of being veiewed by a guard or inserted into a reading device. This report reviews proximity credentials, identifies the companies marketing or developing proximity credentials, and describes their respective credentials. 3 tabs.
Background Hypospadias is one of the most common urogenital congenital anomalies affecting baby boys. Prevalence estimates in Europe range from 4 to 24 per 10,000 births, depending on definition, with higher rates reported from the United States. Relatively little is known about potential risk factors, but a role for endocrine-disrupting chemicals (EDCs) has been proposed. Objective Our goal was to elucidate the risk of hypospadias associated with occupational exposure of the mother to endocrine-disruptor chemicals, use of folate supplementation during pregnancy, and vegetarianism. Design We designed a case–control study of 471 hypospadias cases referred to surgeons and 490 randomly selected birth controls, born 1 January 1997–30 September 1998 in southeast England. Telephone interviews of mothers elicited information on folate supplementation during pregnancy and vegetarianism. We used a job exposure matrix to classify occupational exposure. Results In multiple logistic regression analysis, there were increased risks for self-reported occupational exposure to hair spray [exposed vs. nonexposed, odds ratio (OR) = 2.39; 95% confidence interval (CI), 1.40–4.17] and phthalate exposure obtained by a job exposure matrix (OR = 3.12; 95% CI, 1.04–11.46). There was a significantly reduced risk of hypospadias associated with of folate use during the first 3 months of pregnancy (OR = 0.64; 95% CI, 0.44–0.93). Vegetarianism was not associated with hypospadias risk. Conclusions Excess risks of hypospadias associated with occupational exposures to phthalates and hair spray suggest that antiandrogenic EDCs may play a role in hypospadias. Folate supplementation in early pregnancy may be protective.
Ormond, Gillian; Nieuwenhuijsen, Mark J.; Nelson, Paul; Toledano, Mireille B.; Iszatt, Nina; Geneletti, Sara; Elliott, Paul
In humans and mice, mutations in Hoxa13 cause malformation of limb and genitourinary (GU) regions. In males, one of the most common GU malformations associated with loss of Hoxa13 function is hypospadia, a condition defined by the poor growth and closure of the urethra and glans penis. By examining early signaling in the developing mouse genital tubercle, we show that Hoxa13 is essential for normal expression of Fgf8 and Bmp7 in the urethral plate epithelium. In Hoxa13(GFP)-mutant mice, hypospadias occur as a result of the combined loss of Fgf8 and Bmp7 expression in the urethral plate epithelium, as well as the ectopic expression of noggin (Nog) in the flanking mesenchyme. In vitro supplementation with Fgf8 restored proliferation in homozygous mutants to wild-type levels, suggesting that Fgf8 is sufficient to direct early proliferation of the developing genital tubercle. However, the closure defects of the distal urethra and glans can be attributed to a loss of apoptosis in the urethra, which is consistent with reduced Bmp7 expression in this region. Mice mutant for Hoxa13 also exhibit changes in androgen receptor expression, providing a developmental link between Hoxa13-associated hypospadias and those produced by antagonists to androgen signaling. Finally, a novel role for Hoxa13 in the vascularization of the glans penis is also identified. PMID:12783783
Morgan, Emily A; Nguyen, Susan B; Scott, Virginia; Stadler, H Scott
Background Androgens are critical in male external genital development. Alterations in the androgen sensitivity pathway have been identified in severely undermasculinized boys, and mutations of the androgen receptor gene (AR) are usually found in partial or complete androgen insensitivity syndrome (AIS). Objective The aim of this study was to determine whether even the most minor forms of isolated hypospadias are associated with AR mutations and thus whether all types of hypospadias warrant molecular analysis of the AR. Materials and Methods Two hundred and ninety-two Caucasian children presenting with isolated hypospadias without micropenis or cryptorchidism and 345 controls were included prospectively. Mutational analysis of the AR through direct sequencing (exons 1–8) was performed. In silico and luciferase functional assays were performed for unreported variants. Results Five missense mutations of the AR were identified in 9 patients with glandular or penile anterior (n?=?5), penile midshaft (n?=?2) and penile posterior (n?=?2) hypospadias, i.e., 3%: p.Q58L (c.173A>T), 4 cases of p.P392S (c.1174C>T), 2 cases of p.A475V (c.1424C>T), p.D551H (c.1651G>C) and p.Q799E (c.2395C>G). None of these mutations was present in the control group. One mutation has never been reported to date (p.D551H). It was predicted to be damaging based on 6 in silico models, and in vitro functional studies confirmed the lowered transactivation function of the mutated protein. Three mutations have never been reported in patients with genital malformation but only in isolated infertility: p.Q58L, p.P392S, and p.A475V. It is notable that micropenis, a cardinal sign of AIS, was not present in any patient. Conclusion AR mutations may play a role in the cause of isolated hypospadias, even in the most minor forms. Identification of this underlying genetic alteration may be important for proper diagnosis and longer follow-up is necessary to find out if the mutations cause differences in sexual function and fertility later in life.
Kalfa, Nicolas; Philibert, Pascal; Werner, Ralf; Audran, Francoise; Bashamboo, Anu; Lehors, Helene; Haddad, Myriam; Guys, Jean Michel; Reynaud, Rachel; Alessandrini, Pierre; Wagner, Kathy; Kurzenne, Jean Yves; Bastiani, Florence; Breaud, Jean; Valla, Jean Stephane; Lacombe, Gerard Morisson; Orsini, Mattea; Daures, Jean-Pierre; Hiort, Olaf; Paris, Francoise; McElreavey, Kenneth; Sultan, Charles
Little is known on environmental risk factors for cryptorchidism and\\u000a hypospadias, which are among the most frequent congenital abnormalities.\\u000a The aim of our study was to identify risk factors for cryptorchidism and\\u000a hypospadias, with a focus on potential endocrine disruptors in parental\\u000a diet and occupation. In a case-control study nested within a cohort of\\u000a 8,698 male births, we compared 78
Frank H. Pierik; Alex Burdorf; James A. Deddens; Rikard E. Juttmann; Rob F. A. Weber
Endovascular repair of an abdominal aortic aneurysm (AAA) offers hope of improved outcomes in patients presenting with acute rupture. However, a high proportion of such patients have unfavorable proximal neck anatomy and are not suitable for treatment with conventional endografts. In this case report, the authors describe a successful endovascular repair of a ruptured AAA with very short and angulated proximal neck. PMID:19828584
Bellosta, Raffaello; Luzzani, Luca; Carugati, Claudio; Cossu, Luisa; Sarcina, Antonio
Objective: This study was undertaken to determine significant risk factors for proximal or distal reoperations after surgical correction of acute type A aortic dissection. Methods: Between 1980 and 2000, a total of 160 consecutive patients (mean age 57.5 ± 13.3 years, 126 men) underwent surgery for acute type A aortic dissection. Proximal repair was performed by means of ascending aorta
Matthias Kirsch; Céline Soustelle; Rémi Houël; Marie Line Hillion; Daniel Loisance
Hypospadia is an abnormal development of the corpus spongiosum, that involves cavernosa urethra, as a result of an inadequate fusion of the urethral folds. The incidence ranges from 0.2 to 4.1 per 1,000 live births. Among the markers of hypospadia, isolated ventral or lateral curvature of the penis associated with shortening are the most important markers and, in severe cases, can result in the classic “tulip sign.” The diagnosis of hypospadia is uncommon unless there is a routine of detailed analysis of fetal genitalia morphology. The prenatal diagnosis is of great importance for genetic counseling and allows better planning of postnatal treatment. The three-dimensional ultrasonography (3DUS) in rendering mode enables better comprehension of the pathology by parents, facilitating postnatal planning. We report a case of penoscrotal hypospadia diagnosed at 33 weeks of gestation, suspected due to the absence of testicles in the scrotum and difficulty of penis visualization. We emphasize the findings of 3DUS and its importance in the pathology compression by parents.
Rios, Livia Teresa Moreira; Araujo Junior, Edward; Nardozza, Luciano Marcondes Machado; Rolo, Liliam Cristine; Hatanaka, Alan Roberto; Moron, Antonio Fernandes; Martins, Marilia da Gloria
Hypospadia is an abnormal development of the corpus spongiosum, that involves cavernosa urethra, as a result of an inadequate fusion of the urethral folds. The incidence ranges from 0.2 to 4.1 per 1,000 live births. Among the markers of hypospadia, isolated ventral or lateral curvature of the penis associated with shortening are the most important markers and, in severe cases, can result in the classic "tulip sign." The diagnosis of hypospadia is uncommon unless there is a routine of detailed analysis of fetal genitalia morphology. The prenatal diagnosis is of great importance for genetic counseling and allows better planning of postnatal treatment. The three-dimensional ultrasonography (3DUS) in rendering mode enables better comprehension of the pathology by parents, facilitating postnatal planning. We report a case of penoscrotal hypospadia diagnosed at 33 weeks of gestation, suspected due to the absence of testicles in the scrotum and difficulty of penis visualization. We emphasize the findings of 3DUS and its importance in the pathology compression by parents. PMID:23304621
Rios, Lívia Teresa Moreira; Araujo Júnior, Edward; Nardozza, Luciano Marcondes Machado; Rolo, Liliam Cristine; Hatanaka, Alan Roberto; Moron, Antonio Fernandes; Martins, Marília da Glória
Authors present their experience with application of polyurethane foil dressing Bioclusive (Johnson and Johnson) in 36 boys surgical by treated for hypospadias. Authors emphasize very good results of treatment and the ease of keeping dressing in place. The polyurethane foil can be an alternative form of traditional dressings. PMID:9814120
Skrobisz, P; Miko?ajczyk, A; Fryc, D; Bilski, P
Retrospective analysis of results of the most frequently used methods of urethroplasty: urethroplasty using tubularized dissected urethral area (TIP), urethroplasty using tubularized dissected urethral area with inset the free flap of the foreskin (GTIP) and Mathieu surgery in patients with coronary, distal and middle hypospadias (in primary and recurrent surgery), was performed. From 2005 to 2010, 300 patients aged 7 months to 19 years underwent the surgery. There were no early postoperative complications in any patient, with the exception of early accidental removal of the catheter in 4 patients. Long-term results of one-stage correction of hypospadias were followed-up during period of 6 months to 4 years. Late complications included urethral fistula and stenosis. Analysis of the results of operations led to the conclusion that the TIP urethroplasty with Snodgrass modification can be performed as either primary or recurrent surgery in case of normal size of balanus and urethral area. However, in case of changes in the urethral area, scarring and small sizes of balanus, appropriate surgery is Mathieu operation. PMID:23662505
Rudin, Iu É; Marukhnenko, D V; Garmanova, T N; Sa?edov, K M
Background Environmental exposures to endocrine disrupting chemicals have been suggested as a risk factor for male genital abnormalities such as hypospadias. The aim of this case-control study was to investigate the association between fetal exposure to persistent organochlorine pollutants (POP) and the risk for hypospadias. Methodology/Principal Findings The Southern Sweden Maternity Cohort (SSMC) contains serum samples collected in early pregnancy among women in Southern Sweden. Linkages with the Medical Birth Register, the Malformation Register and the In-patient Register resulted in 390 SSMC mothers who had given birth to a boy with hypospadias in year 1986–2002 (mean 1995). For 237 of these (cases) sufficient amounts of serum for the chemical analyses were available. For each case, a control boy from the SSMC was randomly selected, matched for maternal age, birth year, parity and maternal smoking. PCB-153, p,p’-DDE and hexachlorbenzene (HCB) were used as biomarkers for POP exposure. The exposures were categorized into quartiles based on the distributions among the controls. There were no statistically significant trends between the a priori categorisation of the exposure variables and the risk for hypospadias. However, when the upper HCB quartile (>26 ng/ml) was compared to the other quartiles an odds ratio of 1.65 (95% CI 1.02 to 2.69) was obtained. p,p?-DDE levels above median (>1.0 ng/ml) compared to levels below 0.1 ng/ml gave an OR of 1.69 (95% CI 0.97 to 2.93). Conclusions The present study suggests that fetal exposure to HCB and p,p’-DDE may be a risk factor for hypospadias.
Rignell-Hydbom, Anna; Lindh, Christian H.; Dillner, Joakim; Jonsson, Bo A. G.; Rylander, Lars
Proximal ulna fractures are relatively common. They range in severity from a simple transverse olecranon fracture to a highly complex fracture dislocation involving a comminuted coronoid process. The anatomy, fracture pathology, treatment approach, and rehabilitation are presented in this article. PMID:19181239
Sahajpal, Deenesh; Wright, Thomas W
Discussion of models that have been developed to structure text documents for information retrieval focuses on XML and its proposed query language XQL. Considers efficiency of the query engine and shows that an already existing model, Proximal Nodes, can be used as an efficient query engine behind an XQL front-end. (Author/LRW)
Baeza-Yates, Ricardo; Navarro, Gonzalo
|This lab experiment illustrates the use of thermogravimetric analysis (TGA) to perform proximate analysis on a series of coal samples of different rank. Peat and coke are also examined. A total of four exercises are described. These are dry exercises as students interpret previously recorded scans. The weight percent moisture, volatile matter,…
Donahue, Craig J.; Rais, Elizabeth A.
Hypospadias (a urethral orifice located along the ventral side of the penis) and cryptorchidism (failure of the testes to descend into the scrotal sacs) are the 2 most common congenital malformations in males, affecting 0.3%-0.7% and 2%-4%, re- spectively, at birth. To study the association of CAG\\/GGN tri- nucleotide repeats in the androgen receptor gene with cryptorchi- dism and hypospadias
RAMIN RADPOUR; MINA REZAEE; ALI TAVASOLY; SANAZ SOLATI; AHMAD SALEKI
Our aim was to define the association between early onset intra-uterine growth restriction (IUGR) due to placental insufficiency and hypospadias in males. We prospectively studied a cohort of small-for-gestational age (SGA) male infants with hypospadias managed by a multidisciplinary team over a 5-year period. Thirty SGA male infants were diagnosed with hypospadias/abnormal genitalia after birth, and four of them were diagnosed antenatally. Five cases occurred in the smaller pair of discordant IUGR twins, where the larger co-twin had normal male genitalia. Serial ultrasounds demonstrated features of early-onset IUGR in all cases at a median gestational age of 21 weeks (range 14-31weeks). Twenty-one (70%) pregnancies were subsequently complicated by absent/reversed end-diastolic flow in the umbilical arteries indicating severe IUGR, and 17 (57%) women developed severe pre-eclampsia. There were 27 (90%) live births at a median gestational age of 31 weeks (range 27-37); 23 (77%) of the neonates had birth weights <3rd centile. All newborns had normal male karyotypes. In 62% (18/29) the hypospadias was severe. A correlation was found between the severity of the IUGR and the severity of hypospadias as significantly more infants with severe hypospadias were less than the 3rd centile compared to the mild-moderate hypospadias group: 94% (17/18) versus 55% (6/11), respectively (P = 0.02). In conclusion, SGA male newborns with hypospadias exhibit a high rate of early-onset severe IUGR due to placental insufficiency. Early placental development likely influences male external genitalia formation. Careful sonographic evaluation of the genitalia is advised when early-onset placentally mediated IUGR is found. PMID:20014131
Yinon, Yoav; Kingdom, John C P; Proctor, Leslie K; Kelly, Edmond N; Salle, Joao L Pippi; Wherrett, Diane; Keating, Sarah; Nevo, Ori; Chitayat, David
BackgroundMutations of the NR5A1 gene encoding steroidogenic factor-1 have been reported in association with a wide spectrum of 46,XY DSD (Disorder of Sex Development) phenotypes including severe forms of hypospadias.Methodology\\/Principal FindingsWe evaluated the frequency of NR5A1 gene mutations in a large series of patients presenting with 46,XY DSD and hypospadias. Based on their clinical presentation 77 patients were classified either
Slimane Allali; Jean-Baptiste Muller; Raja Brauner; Diana Lourenço; Radia Boudjenah; Vasiliki Karageorgou; Christine Trivin; Henri Lottmann; Stephen Lortat-Jacob; Claire Nihoul-Fékété; Olivier de Dreuzy; Ken McElreavey; Anu Bashamboo; Joerg Gromoll
A method for repair of amplitude and/or phase defects in lithographic masks. The method involves modifying or altering a portion of the absorber pattern on the surface of the mask blank proximate to the mask defect to compensate for the local disturbance (amplitude or phase) of the optical field due to the defect.
Sweeney, Donald W. (San Ramon, CA); Ray-Chaudhuri, Avijit K. (Livermore, CA)
Background: Advancements in minimally invasive surgery in neonates have allowed even the most complex neonatal procedures to be approached using these techniques. Methods: During a period of 15 months, 8 patients born with a proximal esophageal atresia and a distal tracheoesophageal fistula underwent repair thoracoscopically. Weights ranged from 2.1 to 3.4 kg and operating times ranged from 55 to 120
Steven S. Rothenberg
The proximal point methods have been widely used in the last decades to approximate the solutions of nonlinear equations associated with monotone operators. Inspired by the iterative procedure defined by B. Martinet (1970), R.T. Rockafellar introduced in 1976 the so-called proximal point algorithm (PPA) for a general maximal monotone operator. The sequence generated by this iterative method is weakly convergent under appropriate conditions, but not necessarily strongly convergent, as proved by O. Güler (1991). This fact explains the introduction of different modified versions of the PPA which generate strongly convergent sequences under appropriate conditions, including the contraction-PPA defined by H.K. Xu in 2002. Here we discuss Xu's modified PPA as well as some of its generalizations. Special attention is paid to the computational errors, in particular the original Rockafellar summability assumption is replaced by the condition that the error sequence converges to zero strongly.
Boikanyo, Oganeditse A.; Moro?anu, Gheorghe
As living beings that encounter every kind of traumatic event from paper cut to myocardial infarction, we must possess ways to heal damaged tissues. While some animals are able to regrow complete body parts following injury (such as the earthworm who grows a new head following bisection), humans are sadly incapable of such feats. Our means of recovery following tissue damage consists largely of repair rather than pure regeneration. Thousands of times in our lives, a meticulously scripted but unseen wound healing drama plays, with cells serving as actors, extracellular matrix as the setting and growth factors as the means of communication. This article briefly reviews the cells involved in tissue repair, their signaling and proliferation mechanisms and the function of the extracellular matrix, then presents the actors and script for the three acts of the tissue repair drama.
Background The 13q-deletion syndrome causes human congenital birth defects due to the loss of regions of one long arm of human chromosome 13. A distal critical region for severe genitourinary and anorectal birth defects in the region of 13q32.2-34 has been suggested; we sought to narrow this critical region. Methods From patients with karyotypes revealing haploinsufficiency for distal chromosome 13q and their parents, peripheral blood was obtained and lymphocytes were immortalized for DNA isolation. Genetic and molecular cytogenetic methods were used to map deletions. Patient and parental samples were genotyped with a panel of 20 microsatellite markers spanning 13q31.3 qter and deletions identified by loss of heterozygosity. Deletions were also mapped using a panel of 35 BAC clones from the same region as probes for fluorescence in-situ hybridization on patient lymphoblastoid metaphase preparations. The data were synthesized and a deletion map defining the critical region was generated. Results Eight patients with known deletions around 13q32qter and their parents were analyzed, and categorized into three groups: three patients with anorectal and genitourinary anomalies (hypospadias, penoscrotal transposition), four male patients without anorectal and genitourinary anomalies, and one XY patient with ambiguous genitalia without anorectal anomalies. We mapped the critical region for anorectal and genitourinary anomalies to a ?9.5-Mb interval of 13q33.3-q34 delineated by markers D13S280-D13S285; this spans ?8% of the chromosome and contains 20 annotated genes Conclusion The critical region of chromosome 13q mediating genitourinary/anorectal anomalies has been mapped, and will be narrowed by additional patients and further mapping. Identification of the gene(s) mediating these syndromic genitourinary defects should further our knowledge of molecular mediators of non-syndromic hypospadias, penoscrotal transposition and anorectal malformations.
Garcia, Nilda M.; Allgood, Jocelyn; Santos, Lane J.; Lonergan, D.; Batanian, J.R.; Henkemeyer, Mark; Bartsch, Oliver; Schultz, Roger A.; Zinn, Andrew R.; Baker, Linda A.
In this online math game from Cyberchase, sneaky Hacker has removed some of the tracks on the Trans-Cyberspace Railroad. Learners must repair the tracks so the Cybertrain can get back to Central Station. Learners add decimals and drag spare tracks to fill the missing spaces.
|This consortium-developed instructor's manual for small engine repair (with focus on outboard motors) consists of the following nine instructional units: electrical remote control assembly, mechanical remote control assembly, tilt assemblies, exhaust housing, propeller and trim tabs, cooling system, mechanical gearcase, electrical gearcase, and…
Background\\/PurposeThe effect of low-dose bisphenol A (BPA) exposure on human reproductive health is still controversial. To better understand the molecular basis of the effect of BPA on human reproductive health, a genome-wide screen was performed using human foreskin fibroblast cells (hFFCs) derived from child hypospadias (HS) patients to identify novel targets of low-dose BPA exposure.Methodology\\/Principal FindingsGene expression profiles of hFFCs
Xian-Yang Qin; Yoshiyuki Kojima; Kentaro Mizuno; Katsuhiko Ueoka; Koji Muroya; Mami Miyado; Hiroko Zaha; Hiromi Akanuma; Qin Zeng; Tomokazu Fukuda; Jun Yoshinaga; Junzo Yonemoto; Kenjiro Kohri; Yutaro Hayashi; Maki Fukami; Tsutomu Ogata; Hideko Sone
BACKGROUND: Wolf-Hirschhorn syndrome is caused by distal deletion of the short arm of chromosome 4 (4p-). We report a case in which intrauterine growth restriction, hypospadias and foot deformity were detected by prenatal ultrasound examination at 29 weeks of gestation. CASE PRESENTATION: A 31-year-old gravida 2 partus 1 woman was referred at 29 weeks' gestation with suspicion of intrauterine growth
Halil Aslan; Nilay Karaca; Seher Basaran; Hayri Ermis; Yavuz Ceylan
Disease spread in most biological populations requires the proximity of agents. In populations where the individuals have spatial mobility, the contact graph is generated by the “collision dynamics” of the agents, and thus the evolution of epidemics couples directly to the spatial dynamics of the population. We first briefly review the properties and the methodology of an agent-based simulation (EPISIMS) to model disease spread in realistic urban dynamic contact networks. Using the data generated by this simulation, we introduce the notion of dynamic proximity networks which takes into account the relevant time-scales for disease spread: contact duration, infectivity period, and rate of contact creation. This approach promises to be a good candidate for a unified treatment of epidemic types that are driven by agent collision dynamics. In particular, using a simple model, we show that it can account for the observed qualitative differences between the degree distributions of contact graphs of diseases with short infectivity period (such as air-transmitted diseases) or long infectivity periods (such as HIV).
Toroczkai, Zoltán; Guclu, Hasan
We propose the use of a commercial ultrasonic proximity sensor kit for profiling an altitude-varying surface by employing echosonography. The proximity sensor kit, two identical transducers together with its dedicated operating circuit, is used as a profiler for the construction of an image. Ultrasonic pulses are emitted from one of the transducers and received by the other. The time duration between the pulses allows us to determine the traveling distance of each pulse. In the experiment, the circuit is used with the addition of two copper wires for directing the outgoing and incoming signals to an oscilloscope. The time of flight of ultrasonic pulses can thus be determined. Square grids of 5 × 5 cm2 are made from fishing lines, forming pixels in the image. The grids are designed to hold the detection unit in place, about 30 cm above a flat surface. The surface to be imaged is constructed to be height varying and placed on the flat surface underneath the grids. Our result shows that an image of the profiled surface can be created by varying the location of the detection unit along the grid. We also investigate the deviation in relation to the time of flight of the ultrasonic pulse. Such an experiment should be valuable for conveying the concept of ultrasonic imaging to physical and medical science undergraduate students. Due to its simplicity, the setup could be made in any undergraduate laboratory relatively inexpensively and it requires no complex parts. The results illustrate the concept of echosonography.
Thaisiam, W.; Laithong, T.; Meekhun, S.; Chaiwathyothin, N.; Thanlarp, P.; Danworaphong, S.
Androgen action is exerted through the androgen receptor. The normal 46,XY genital virilization depends on androgen receptor gene expression, which is tissue specific, and requires normal androgen receptor mRNA levels in androgen sensitive tissues. Hypospadias is a frequent male genital abnormality, potentially related to reduced androgen sensitivity in genital tissues. The aim of this study was to compare, by quantitative real time PCR, the amount of androgen receptor mRNA in cells obtained from the urethral mucosa of patients with middle idiopathic hypospadias with the androgen receptor mRNA levels observed in control phimosis subjects with eutopic urethral opening. Prepubertal individuals were studied, including 41 controls and 17 hypospadias patients with mean (SD) ages of 4.7 (2.1) years and 4.0 (3.0) years, respectively. We observed significantly less androgen receptor mRNA in the urethral mucosa of patients with hypospadias than in the controls (p=0.002). The correlation between the level of androgen receptor mRNA expression and the penile size was almost statistically significant only in hypospadias patients (r=0.47; p=0.053). We also established the number of CAG repeats in exon 1 of the androgen receptor gene by GeneScan analysis. No significant difference was observed in the number of CAG repeats when patients and controls were compared. A negative correlation between the CAG repeats and penile size was detected in patients with hypospadias, but not in controls. Our data suggest that a critical lower level of androgen receptor mRNA expression could be a determining factor in the development of middle hypospadias. PMID:23386417
Silva, T S; Richeti, F; Cunha, D P P S; Amarante, A C M; de Souza Leão, J Q; Longui, C A
Most human pre-mRNAs are cis-spliced, removing introns and joining flanking exons of the same RNA molecule. However, splicing of exons present on separate pre-mRNA molecules can also occur. This trans-splicing reaction can be exploited by pre-trans-splicing molecules (PTMs), which are incapable of cis-splicing. PTM-mediated trans-splicing has been utilized to repair mutant RNAs as a novel approach to gene therapy. Herein we explore how the site of PTM expression influences trans-splicing activity. We stably inserted a PTM expression cassette into the genome of HEK293 cells, generating clonal lines with single, unique insertion sites. We analyzed trans-splicing to the gene where the PTM was integrated, as well as genes neighboring these loci. We observed some pre-mRNAs only serve as substrates for trans-splicing when they are expressed in immediate proximity to the PTM expression site. The need for PTMs to be in close proximity with pre-mRNAs to trans-splice with them is consistent with the observation that pre-mRNA cis-splicing occurs cotranscriptionally. Interestingly, we identified several cellular pre-mRNAs in one localized area that serve as trans-splicing substrates irrespective of the PTM expression site. Thus, we find multiple cellular pre-mRNAs require PTM expression in close proximity to trans-splice while others do not. PMID:18441053
Viles, Kristi D; Sullenger, Bruce A
Most human pre-mRNAs are cis-spliced, removing introns and joining flanking exons of the same RNA molecule. However, splicing of exons present on separate pre-mRNA molecules can also occur. This trans-splicing reaction can be exploited by pre-trans-splicing molecules (PTMs), which are incapable of cis-splicing. PTM-mediated trans-splicing has been utilized to repair mutant RNAs as a novel approach to gene therapy. Herein we explore how the site of PTM expression influences trans-splicing activity. We stably inserted a PTM expression cassette into the genome of HEK293 cells, generating clonal lines with single, unique insertion sites. We analyzed trans-splicing to the gene where the PTM was integrated, as well as genes neighboring these loci. We observed some pre-mRNAs only serve as substrates for trans-splicing when they are expressed in immediate proximity to the PTM expression site. The need for PTMs to be in close proximity with pre-mRNAs to trans-splice with them is consistent with the observation that pre-mRNA cis-splicing occurs cotranscriptionally. Interestingly, we identified several cellular pre-mRNAs in one localized area that serve as trans-splicing substrates irrespective of the PTM expression site. Thus, we find multiple cellular pre-mRNAs require PTM expression in close proximity to trans-splice while others do not.
Viles, Kristi D.; Sullenger, Bruce A.
Programmers and data structure designers are often forced to choose between alternative structures. In storing these structures, preserving logical adjacencies or “proximity” is usually an important consideration. The combinatorial problem of storing arrays as various kinds of list structures is examined. Embeddings of graphs are used to model the loss of proximity involved in such storage schemes, and an elementary
Richard A. DeMillo; Stanley C. Eisenstat; Richard J. Lipton
Sentime nt analysis seeks to characterize opinionated or evaluative aspects of natural language text thus helping people to discover valuable information from large amounts of unstructured data 111. In this paper we explore a new methodology for sentiment analysis called proximity-based sentiment analysis. We take a different approach, by considering a new set of features based on word proximities in
S. M. Shamimul Hasan; Donald A. Adjeroh
The two broad categories of deposited weld metal repair and fiber-reinforced composite repair technologies were reviewed for potential application for internal repair of gas transmission pipelines. Both are used to some extent for other applications and could be further developed for internal, local, structural repair of gas transmission pipelines. Preliminary test programs were developed for both deposited weld metal repairs and for fiber-reinforced composite repair. To date, all of the experimental work pertaining to the evaluation of potential repair methods has focused on fiber-reinforced composite repairs. Hydrostatic testing was also conducted on four pipeline sections with simulated corrosion damage: two with composite liners and two without.
Robin Gordon; Bill Bruce; Nancy Porter; Mike Sullivan; Chris Neary
We present prenatal diagnosis of a de novo distal deletion involving 5p(5p15.1?pter) using uncultured amniocytes in a pregnancy with cerebellar hypoplasia, hypospadias and facial dysmorphisms in the fetus. We discuss the genotype-phenotype correlation and the consequence of haploinsufficiency of CTNND2, SEMA5A, TERT, SRD5A1 and TPPP. We speculate that haploinsufficiency of SRD5A1 and TPPP may be responsible for hypospadias and cerebellar hypoplasia, respectively, in this case. PMID:23500598
Chen, Chih-Ping; Huang, Ming-Chao; Chen, Yi-Yung; Chern, Schu-Rern; Wu, Peih-Shan; Su, Jun-Wei; Town, Dai-Dyi; Wang, Wayseen
The two broad categories of fiber-reinforced composite liner repair and deposited weld metal repair technologies were reviewed and evaluated for potential application for internal repair of gas transmission pipelines. Both are used to some extent for other applications and could be further developed for internal, local, structural repair of gas transmission pipelines. Principal conclusions from a survey of natural gas
Bill Bruce; Nancy Porter; George Ritter; Matt Boring; Mark Lozev; Ian Harris; Bill Mohr; Dennis Harwig; Robin Gordon; Chris Neary; Mike Sullivan
The two broad categories of fiber-reinforced composite liner repair and deposited weld metal repair technologies were reviewed and evaluated for potential application for internal repair of gas transmission pipelines. Both are used to some extent for other applications and could be further developed for internal, local, structural repair of gas transmission pipelines. Principal conclusions from a survey of natural gas
Robin Gordon; Bill Bruce; Ian Harris; Dennis Harwig; George Ritter; Bill Mohr; Matt Boring; Nancy Porter; Mike Sullivan; Chris Neary
ome nerve injuries require repair in order to regain sen- sory or motor function. Although this article focuses pri- marily on trigeminal nerve (TN) injuries and repairs, the facts presented may apply to any peripheral nerve repair. The primary indications for nerve repair or grafting are 1) an injury or continuity defect in a nerve, as a result of trauma,
LARRY M. WOLFORD; EBER L. L. STEVAO
Background. Laser tissue repair usually relies on haemoderivate solders, based on serum albumin. These solders have intrinsic limitations that impair their widespread use, such as limited repair strength, high solubility, brittleness and viral transmission. Furthermore, the solder activation temperature (65-70 °C) can induce significant damage to tissue. In this study, a new laser-activated biomaterial for tissue repair was developed and tested in vitro and in vivo to overcome some of the shortcomings of traditional solders. Materials and Methods. Flexible and insoluble strips of chitosan adhesive (surface area ~34 mm2, thickness ~20 ?m) were developed and bonded on sheep intestine with a laser fluence and irradiance of 52 +/- 2 J/cm2 and ~15 W/cm2 respectively. The temperature between tissue and adhesive was measured using small thermocouples. The strength of repaired tissue was tested by a calibrated tensiometer. The adhesive was also bonded in vivo to the sciatic nerve of rats to assess the thermal damage induced by the laser (fluence = 65 +/- 11 J/cm2, irradiance = 15 W/cm2) four days post-operatively. Results. Chitosan adhesives successfully repaired intestine tissue, achieving a repair strength of 0.50 +/- 0.15 N (shear stress = 14.7 +/- 4.7 KPa, n=30) at a temperature of 60-65 °C. The laser caused demyelination of axons at the operated site; nevertheless, the myelinated axons retained their normal morphology proximally and distally.
Lauto, A.; Stoodley, M.; Avolio, A.; Foster, L. J. R.
Fractures of the proximal humerus are common injuries that are increasing in incidence as the population ages. These fractures are often treated nonsurgically; however, surgery is indicated if displacement, concurrent dislocation, or unacceptable alignment is present. Knowledge of the anatomic and physiologic characteristics of the proximal humerus and shoulder joint and familiarity with the available fixation elements will help surgeons make informed and patient-specific decisions regarding treatment. Reduction and internal fixation of proximal humeral fractures has expanding indications in comparison with arthroplasty, in part because of improvements in fixation technology and a better understanding of anatomy and physiology. The outcomes of proximal humeral fractures managed with percutaneous pinning, open reduction and locked-plate fixation, and intramedullary fixation are being actively investigated. PMID:23395021
Aaron, Daniel; Shatsky, Joshua; Paredes, Juan Carlos S; Jiang, Chunyan; Parsons, Bradford O; Flatow, Evan L
Hypospadias is a congenital malformation and a milder form of 46,XY disorder of sexual development (DSD). In the present study, we investigated 13 haplotype tagging single nucleotide polymorphisms (SNPs) covering the steroid-5-alpha reductase (SRD5A2) and androgen receptor(AR) gene region, respectively, in a cohort consisting of 260 individuals with mild hypospadias and 77 with severe disease, in addition to 471 healthy male controls. The investigated genes are known to have an important role in the hormone-dependent stage of sexual development. Our study revealed one novel marker located in the AR gene region (rs5919436; g.67024320C>G) to be significantly associated with an increased risk of severe hypospadias (adjusted p value: 0.02; odds ratio: 2.98). In concordance with this finding, we detected an association of a haplotype tagged by the minor allele of rs5919436 (adjusted p value: 0.04). We further detected no association between the investigated disease and the haplotype tagging polymorphisms covering the SRD5A2 gene, which is of importance considering the conflicting results reported previously. In conclusion, our data implicate that the AR rs5919436 (g.67024320C>G) polymorphism may act as a novel genetic marker for increased susceptibility to severe hypospadias in Caucasians. PMID:23571770
Adamovic, T; Thai, H T T; Liedén, A; Nordenskjöld, A
A study to assess the association between the prevalence of hypospadias and maternal occupa- tional exposure to potential endocrine-disrupting chemicals was carried out using data from the congenital anomaly register of the Office for National Statistics. The occupation of the mother is recorded in this register and to facilitate the assessment of maternal occupational exposure, a specific job-exposure matrix for
MARTIE VAN TONGEREN; MARK J. NIEUWENHUIJSEN; KERRY GARDINER; BEN ARMSTRONG; MARTINE VRIJHEID; HELEN DOLK; BEVERLY BOTTING
Disclosed is a rapid road repair vehicle capable of moving over a surface to be repaired at near normal posted traffic speeds to scan for and find at the high rate of speed, imperfections in the pavement surface, prepare the surface imperfection for repair by air pressure and vacuum cleaning, applying a correct amount of the correct patching material to effect the repair, smooth the resulting repaired surface, and catalog the location and quality of the repairs for maintenance records of the road surface. The rapid road repair vehicle can repair surface imperfections at lower cost, improved quality, at a higher rate of speed than was not heretofor possible, with significantly reduced exposure to safety and health hazards associated with this kind of road repair activities in the past. 2 figs.
Disclosed is a rapid road repair vehicle capable of moving over a surface to be repaired at near normal posted traffic speeds to scan for and find an the high rate of speed, imperfections in the pavement surface, prepare the surface imperfection for repair by air pressure and vacuum cleaning, applying a correct amount of the correct patching material to effect the repair, smooth the resulting repaired surface, and catalog the location and quality of the repairs for maintenance records of the road surface. The rapid road repair vehicle can repair surface imperfections at lower cost, improved quality, at a higher rate of speed than was was heretofor possible, with significantly reduced exposure to safety and health hazards associated with this kind of road repair activities in the past.
Mara, Leo M. (Livermore, CA)
When a superconductor is placed close to a non-superconducting metal, it can induce superconducting correlations in the metal , known as the `proximity effect'. Such behaviour modifies the density of states (DOS) in the normal metal and opens a minigap with an amplitude that can be controlled by changing the phase of the superconducting order parameter. Here, we exploit such behaviour to realize a new type of interferometer, the superconducting quantum interference proximity transistor (SQUIPT), for which the operation relies on the modulation with the magnetic field of the DOS of a proximized metal embedded in a superconducting loop. Even without optimizing its design, this device shows extremely low flux noise, down to ~10-5?0Hz-1/2 (?0~=2×10-15Wb is the flux quantum) and dissipation several orders of magnitude smaller than in conventional superconducting interferometers. With optimization, the SQUIPT could significantly increase the sensitivity with which small magnetic moments are detected.
Giazotto, Francesco; Peltonen, Joonas T.; Meschke, Matthias; Pekola, Jukka P.
Summary Primary rabbit kidney epithelial cell cultures can be obtained that express renal proximal tubule functions. Toward these ends, renal proximal tubules are purified from the rabbit kidney by the method of Brendel and Meezan. To summarize, each kidney is perfused with iron oxide, which becomes associated with glomeruli. The renal cortex is sliced and homogenized to liberate nephron segments. Renal proximal tubules and glomeruli are purified by sieving. The glomeruli, covered with iron oxide, are removed using a magnet. After a brief collagenase treatment (to disrupt basement membrane), the tubules are plated in hormonally defined serum-free medium supplemented with 5 ?g/mL bovine insulin, 5 ?g/mL human transferrin, and 5 × 10?8 M hydrocortisone. After 5–6 d of incubation, confluent monolayers are obtained that possess multicellular domes, indicative of their capacity for transepithelial solute transport.
Boschma R. A. (2005) Proximity and innovation: a critical assessment, Regional Studies39, 61-74. A key issue in economic geography is to determine the impact of geographical proximity on interactive learning and innovation. We argue that the importance of geographical proximity cannot be assessed in isolation, but should always be examined in relation to other dimensions of proximity that may provide
Hypospadias: a contemporary epidemiologic assessment 1 1 The opinions contained herein are those of the authors and are not to be construed as reflecting the views of the Army or the Department of Defense
Objectives.To determine whether the incidence of hypospadias is increasing and whether racial differences among patients are significant, we evaluated the current incidence of hypospadias and patient race in an equal-access healthcare system.Methods.We undertook a retrospective review of discharge records between 1990 and 1998 from 15 military treatment facilities to determine the total number of male live births and the number
Michael L Gallentine; Allen F Morey; Ian M Thompson
Hypersonic flows involving two or more bodies travelling in close proximity to one another are encountered in several important situations. The present work seeks to explore one aspect of the resulting flow problem by investigating the forces experienced by a secondary body when it is within the domain of influence of a primary body travelling at hypersonic speeds. An analytical
STUART J. L AURENCE; R. D EITERDING
Numerous commercial nuclear power plant sites have 2 to 3 reactors located together, and a group of Facilities with capabilities for fuel fabrication, a nuclear reactor, a storage area for spent fuel, and a maintenance area for contaminated equipment and radioactive waste storage are being designed and constructed in the US. The proximity of these facilities to each other provides
PURPOSE: This study was designed to critically analyze the outcome of sphincter repair and, if possible, to identify high-risk factors. METHODS: Clinical and physiologic assessment was made of all sphincter repairs (42 patients) performed in one unit by two surgeons during five years. RESULTS: Forty-two patients (10 men, 32 women) underwent sphincter repair. Only three of five men with anterior
N. Nikiteas; S. Korsgen; D. Kumar; M. R. B. Keighley
Students learn about how biomedical engineers aid doctors in repairing severely broken bones. They learn about using pins, plates, rods and screws to repair fractures. They do this by designing, creating and testing their own prototype devices to repair broken turkey bones.
Integrated Teaching and Learning Program, College of Engineering,
The Donner-Hanna Coke Plant of Buffalo, New York has four coke oven batteries, the oldest being put into operation in 1943. A description is given of a method of repair developed by the company to repair stack waste heat tunnels and coke oven walls using a firesuit that allowed a repairman to work inside these hot areas. The procedure for the repair of coke oven walls is discussed in detail. A high duty castable was found to simulate the qualities of coke oven silica brick. The repair technique is relatively low cost without the attendant loss of production entailed by other methods of oven repair. (CKK)
Kolvek, R.E.; Bronke, H.R.
Laser repair of liver using albumin is a promising method for treating liver trauma. Concentrated human serum albumin is applied to a liver laceration and then denatured using a laser. These repairs were pulled with a material tester to measure the ultimate strength of the laser repair. We show that the ultimate strength of the liver repairs tends to increase with delivered laser energy, that the mode of delivery (pulsed versus continuous) does not matter, that the repair strength correlates with the area of denatured albumin, and that strong welds cause about 1.5 mm of thermal damage.
Prahl, Scott A.; Denison, Tim; LaJoie, Elaine
The human meniscus is important for normal knee function and distributes loads, aids in joint lubrication, congruence, stability, and proprioception. Repair of appropriate meniscal tears is possible and several methods exist to accomplish this including suture repairs and device repairs. Clinical evidence suggests that meniscal repairs can result in acceptable healing rates although adverse events have been reported for some devices. New self-adjusting suture devices have facilitated the accurate and effective repair of the torn meniscus. Technique descriptions for these devices are presented. PMID:18004219
Barber, F Alan; McGarry, John E
To counteract the adverse effects of various DNA lesions, cells have evolved an array of diverse repair pathways to restore DNA structure and to coordinate repair with cell cycle regulation. Chromatin changes are an integral part of the DNA damage response, particularly with regard to the types of repair that involve assembly of large multiprotein complexes such as those involved in double strand break (DSB) repair and nucleotide excision repair (NER). A number of phosphorylation, acetylation, methylation, ubiquitylation and chromatin remodeling events modulate chromatin structure at the lesion site. These changes demarcate chromatin neighboring the lesion, afford accessibility and binding surfaces to repair factors and provide on-the-spot means to coordinate repair and damage signaling. Thus, the hierarchical assembly of repair factors at a double strand break is mostly due to their regulated interactions with posttranslational modifications of histones. A large number of chromatin remodelers are required at different stages of DSB repair and NER. Remodelers physically interact with proteins involved in repair processes, suggesting that chromatin remodeling is a requisite for repair factors to access the damaged site. Together, recent findings define the roles of histone post-translational modifications and chromatin remodeling in the DNA damage response and underscore possible differences in the requirements for these events in relation to the chromatin context. PMID:23085398
Gospodinov, Anastas; Herceg, Zdenko
DNA repair is a collection of several multienzyme, multistep processes keeping the cellular genome intact against genotoxic insults. One of these processes is base excision repair, which deals with the most ubiquitous lesions in DNA: oxidative base damage, alkylation, deamination, sites of base loss and single-strand breaks, etc. Individual enzymes acting in base excision repair have been identified. The recent years were marked with many advances in understanding of their structure and many interactions that make base excision repair a functional, versatile system. This review describes the current knowledge of structural biology and biochemistry of individual steps of base excision repair, several subpathways of the common base excision repair pathway, and interactions of the repair process with other cellular processes. PMID:18259689
Zharkov, D O
Malunion of a proximal humerus fracture is difficult to manage once bone union has been achieved in a wrong position. Malunion may be encountered after conservative treatment or internal fixation of fractures, and also around a joint prosthesis. The malunion can involve the greater and lesser tuberosities, humeral head, bicipital groove, or the entire epiphysis. The nature of the malunion must be precisely characterized. Malunion can affect bone structures and the articular surface; any resulting displacements must be carefully measured. Clinical assessments will help to evaluate the functional repercussions and determine the need for correction. Radiographic imaging and CT scan guide the treatment plan. Arthroscopic surgery (acromioplasty or tuberoplasty) can be used to treat biceps tenosynovitis or impingement syndrome in cases where full correction of the malunion is not required. Corrective surgery of a metaphyseal malunion is used to realign the proximal humeral into the proper position. Tuberosity osteotomy is the main predictor for a poor outcome following secondary arthroplasty. PMID:23333124
We report the case of a 2-week-old girl born at term (by vaginal delivery and without antenatal or perinatal events) who was referred as having "bilateral talipes and bilateral proximal symphalangism of little and ring fingers." The "talipes" was atypical with marked equinus and varus, but no cavus or adductus of the midfoot. Her mother had both symphalangism (absence of proximal interphalangeal joints) of middle, ring, and little fingers bilaterally and fixed pes planus with a rigid fixed hindfoot-and these deformities had also been present from birth. The maternal grandmother was similarly affected. However, the neonatal subject has an unaffected older sibling; maternal siblings are also unaffected. The three affected people did not have other obvious musculoskeletal abnormalities. Because of the coalitions, the child's atypical talipes was managed by a modified Kite's procedure. Symphalangism-coalition syndromes may be associated with conductive deafness because of fusion of the auditory ossicles. PMID:22294466
Shaw, Lauren; McCaul, Janet; Irwin, Greg J; Huntley, James S
Geography, economic, socio-political and language are considered to be factors that effect the level of research collaboration. However, to-date no technique has been developed to isolate the effect of geographical proximity from the other factors. This paper presents a methodology for specifically examining geographical effects on intra-national scientific collaboration. An investigation of intra-national university-university collaboration in Canada, Australia and the
J. S. Katz
A level detector or proximity detector for materials capable of sensing through plastic container walls or encapsulating materials is disclosed. Thus, it can be used in corrosive environments, as well as in a wide variety of applications. An antenna has a characteristic impedance which depends on the materials in proximity to the antenna. An RF oscillator, which includes the antenna and is based on a single transistor in a Colpitt`s configuration, produces an oscillating signal. A detector is coupled to the oscillator which signals changes in the oscillating signal caused by changes in the materials in proximity to the antenna. The oscillator is turned on and off at a pulse repetition frequency with a low duty cycle to conserve power. The antenna consists of a straight monopole about one-quarter wavelength long at the nominal frequency of the oscillator. The antenna may be horizontally disposed on a container and very accurately detects the fill level within the container as the material inside the container reaches the level of the antenna. 5 figs.
Objectives the aim of this study was to assess the relationship between patient factors, the anatomy of the proximal aneurysm neck; the type of endovascular graft; and the consequences of graft\\/neck size mismatch and the occurrence of proximal endoleak. Design multicentre clinical study. Materials of a total of 2194 patients, 2146 underwent successful endovascular repair of infra-renal abdominal aortic aneurysms
I. V. Mohan; R. J. F. Laheij; P. L. Harris
Objective: The anatomic and functional success of suspension of the vaginal cuff to the proximal uterosacral ligaments is described. Study Design: Forty-six women underwent vaginal site-specific repair of endopelvic fascia defects with suspension of the vaginal cuff to the proximal uterosacral ligaments for pelvic organ prolapse. Outcome measures included operative complications, pelvic organ prolapse quantitation, and assessment of pelvic floor
Matthew D. Barber; Anthony G. Visco; Alison C. Weidner; Cindy L. Amundsen; Richard C. Bump
The proximate composition and identification and quantification of polyphenolic compounds in dried cranberry pomace were determined. Proximate analysis was conducted based on AOAC methods for moisture, protein, fat, and ash. Total carbohydrates were determined by the difference method. Polyphenolic ...
Trauma to the popliteal artery is potentially dangerous, and limb loss may result, especially with delayed diagnosis. Three anatomic factors contribute to the seriousness of the outcome: proximity of the artery to bone, superficial position of the artery and consequent lack of protection, and frequent associated injury to associated collateral blood vessels. Diagnosis of injury to the popliteal artery rests on suspicion and vigilance; the Doppler transcutaneous flow detector and angiography are often useful aids to diagnosis. Methods of treatment that have been used include arterial repair, grafting and fasciotomy, together with management of associated injuries. The bypass principle of vascular reconstruction may improve overall results. Images FIG. 2
Miles, J. T.; de la Rocha, A. G.; Baird, R. J.
A surgical technique for the repair of complete epispadias, with emphasis on correction of the urethropenile deformity and attempt to restore normal anatomic relations has been presented. The epispadiac orifice is dissected and followed proximally to beyond the bladder neck, then brought out perineally between the bifurcated crura. The penis is denuded from its skin, then embedded in the scrotum, except for the glans penis which protrudes from the midscrotum. Penile skin is folded into a tube to be used later for urethral reconstruction. Excellent cosmetic and functional results are consistently obtained by this multi-stage technique. PMID:953420
Tanagho, E A
Idiopathic proximal hemimegacolon is a disorder characterized by bowel dilatation proximal to the splenic flexure. It is a very rare and therefore a poorly understood clinical entity. This report describes a case of idiopathic proximal hemimegacolon in a 44-year-old woman. The patient suffered from 2 episodes of constipation and bowel dilatation over 4 years and was successfully treated by medical therapy.
Noh, Jung Won; Son, Seo Young; Ok, Chang Soo; Lee, Gayeon; Min, Byung-Hoon
Cartilage repair is required in a number of orthopaedic conditions and rheumatic diseases. From a macroscopic viewpoint, the complete repair of an articular cartilage defect requires integration of opposing cartilage surfaces or the integration of repair tissue with the surrounding host cartilage. However, integrative cartilage repair does not occur readily or predictablyin vivo. Consideration of the ‘integrative cartilage repair process’,
Tabassum Ahsan; Robert L. Sah
What role do various kinds of proximity play in the current and projected development of peripheral areas? In summarizing and drawing conclusions from this special issue on proximity, this paper elaborates on two core notions of proximity, geographical and organizational. It presents a framework in which the relationship between geographical and organizational proximity is conceptualized in a way that is
Arnoud Lagendijk; Anne Lorentzen
This work proposes a 25 min-last thermogravimetric method as a tool to determine biomass sample's proximate analysis data (moisture, ash, volatile matter and fixed carbon contents) just by direct measure of weight changes on each sample's TG chart. Compared with international standards commonly used to that aim, TG is a faster and easier to develop technique. Obtained results were satisfactory, with AEE under 6% for moisture and volatile matter, close to 10% for fixed carbon determination and AAD of 1.6 points for ash content. PMID:23644064
García, Roberto; Pizarro, Consuelo; Lavín, Antonio G; Bueno, Julio L
Antethoracic jejunal esophageal reconstruction is an effective alternative method of repair and should be considered when difficulty is expected with the standard approaches. The primary difficulty with this mode of repair is related to the vascular supply of the jejunum. However, with careful evaluation and management of the pedicle, ischemia of the graft may be avoided. If vascularity appears less than optimal, the proximal anastomoses should be delayed and the graft placed in the subfascial tunnel. If the cervical jejunal portion becomes necrotic, this space may be bridged later with an isoperistaltically positioned free graft utilizing microvascular techniques. PMID:7223942
Sasaki, T M; McConnell, D B; Moseley, H S; Vetto, R M
Hypospadias, when the urethra opens on the ventral side of the penis, is a common malformation seen in about 3 per 1,000 male births. It is a complex disorder associated with genetic and environmental factors and can be part of genetic syndromes. Mowat-Wilson syndrome (MWS) is a multiple congenital anomaly syndrome characterized by a distinct facial phenotype, Hirschsprung disease, microcephaly and mental retardation. It is caused by mutations in the zinc finger homeo box 1B gene, ZFHX1B (SIP1). To date, 68 deletion/mutation-positive cases have been reported. Genitourinary anomalies are common in MWS. Here we report that hypospadias is common in males with this syndrome. In 39 patients where this information was available, hypospadias was present in 46% of patients (18/39). In the 3 Italian male cases reported here, hypospadias was always present. MWS should be considered by endocrinologists in patients with hypospadias associated with developmental delays/mental retardation, in particular in the presence of a distinct facial phenotype. PMID:15908750
Garavelli, L; Cerruti-Mainardi, P; Virdis, R; Pedori, S; Pastore, G; Godi, M; Provera, S; Rauch, A; Zweier, C; Zollino, M; Banchini, G; Longo, N; Mowat, D; Neri, G; Bernasconi, S
Hypersonic flows involving two or more bodies travelling in close proximity to one another are encountered in several important situations, both natural and man-made. The present work seeks to investigate one aspect of the resulting flow problem by exploring the forces experienced by a secondary body when it is within the domain of influence of a primary body travelling at hypersonic speeds. An analytical methodology based on the blast wave analogy is developed and used to predict the secondary force coefficients for simple geometries in both two and three dimensions. When the secondary body is entirely inside the primary shocked region, the nature of the lateral force coefficient is found to depend strongly on the relative size of the two bodies. For two spheres, the methodology predicts that the secondary body will experience an exclusively attractive lateral force if the secondary diameter is larger than one-sixth the primary diameter. The analytical results are compared with those from numerical simulations and reasonable agreement is observed if an appropriate normalization for the lateral displacement is used. Results from a series of experiments in the T5 hypervelocity shock tunnel are also presented and compared with perfect-gas numerical simulations, with good agreement. A new force-measurement technique for short-duration hypersonic facilities, enabling the experimental simulation of the proximal bodies problem, is described. This technique provides two independent means of measurement, and the agreement observed between the two gives a further degree of confidence in the results obtained.
Deiterding, Ralf [ORNL; Laurence, Stuart J [California Institute of Technology, Pasadena; Hornung, Hans G [California Institute of Technology, Pasadena
The paper provides a simple guide for carrying out preventive maintenance which will eliminate or greatly reduce the need for bicycle repair work. It also covers simple and not-so-simple repair techniques which will allow the reader to fix almost any faul...
From February 1982 through July 1987, the author studied 87 patients who had a total of 116 meniscus tears, 96 of which were repaired. Seventy patients (79 meniscus repairs) had postoperative followup ranging from 12 months to 5½ years (mean, 39 months). The patients' ages ranged from 14 to 51 years with a mean age of 22. The time from
Donald B. Miller
The repair of wounds is one of the most complex biological processes that occur during human life. After an injury, multiple biological pathways immediately become activated and are synchronized to respond. In human adults, the wound repair process commonly leads to a non-functioning mass of fibrotic tissue known as a scar. By contrast, early in gestation, injured fetal tissues can
Geoffrey C. Gurtner; Sabine Werner; Yann Barrandon; Michael T. Longaker
The management of patients with a failed rotator cuff repair is challenging. Revision arthroscopic repairs can be entertained in select patients when realistic outcomes are understood. Complete evaluation of the shoulder is needed to identify and treat potential confounding pain generators. The ability to determine if a recurrent tear is repairable is difficult, because there are no established criteria to make this determination. If a recurrent tear is found to be repairable, the results of the surgery are encouraging, although persistent limitations in shoulder function are common. Strategies to improve the rates of tendon healing should be used and include the use of stronger repair constructs, when possible, and implementation of a slower rehabilitation progression. PMID:23040555
Keener, Jay D
The two broad categories of fiber-reinforced composite liner repair and deposited weld metal repair technologies were reviewed and evaluated for potential application for internal repair of gas transmission pipelines. Both are used to some extent for other applications and could be further developed for internal, local, structural repair of gas transmission pipelines. Principal conclusions from a survey of natural gas transmission industry pipeline operators can be summarized in terms of the following performance requirements for internal repair: (1) Use of internal repair is most attractive for river crossings, under other bodies of water, in difficult soil conditions, under highways, under congested intersections, and under railway crossings. (2) Internal pipe repair offers a strong potential advantage to the high cost of horizontal direct drilling when a new bore must be created to solve a leak or other problem. (3) Typical travel distances can be divided into three distinct groups: up to 305 m (1,000 ft.); between 305 m and 610 m (1,000 ft. and 2,000 ft.); and beyond 914 m (3,000 ft.). All three groups require pig-based systems. A despooled umbilical system would suffice for the first two groups which represents 81% of survey respondents. The third group would require an onboard self-contained power unit for propulsion and welding/liner repair energy needs. (4) The most common size range for 80% to 90% of operators surveyed is 508 mm (20 in.) to 762 mm (30 in.), with 95% using 558.8 mm (22 in.) pipe. Evaluation trials were conducted on pipe sections with simulated corrosion damage repaired with glass fiber-reinforced composite liners, carbon fiber-reinforced composite liners, and weld deposition. Additional un-repaired pipe sections were evaluated in the virgin condition and with simulated damage. Hydrostatic failure pressures for pipe sections repaired with glass fiber-reinforced composite liner were only marginally greater than that of pipe sections without liners, indicating that this type of liner is only marginally effective at restoring the pressure containing capabilities of pipelines. Failure pressures for larger diameter pipe repaired with a semi-circular patch of carbon fiber-reinforced composite lines were also marginally greater than that of a pipe section with un-repaired simulated damage without a liner. These results indicate that fiber reinforced composite liners have the potential to increase the burst pressure of pipe sections with external damage Carbon fiber based liners are viewed as more promising than glass fiber based liners because of the potential for more closely matching the mechanical properties of steel. Pipe repaired with weld deposition failed at pressures lower than that of un-repaired pipe in both the virgin and damaged conditions, indicating that this repair technology is less effective at restoring the pressure containing capability of pipe than a carbon fiber-reinforced liner repair. Physical testing indicates that carbon fiber-reinforced liner repair is the most promising technology evaluated to-date. In lieu of a field installation on an abandoned pipeline, a preliminary nondestructive testing protocol is being developed to determine the success or failure of the fiber-reinforced liner pipeline repairs. Optimization and validation activities for carbon-fiber repair methods are ongoing.
Bill Bruce; Nancy Porter; George Ritter; Matt Boring; Mark Lozev; Ian Harris; Bill Mohr; Dennis Harwig; Robin Gordon; Chris Neary; Mike Sullivan
Isolated tracheoesophageal ("H-type") fistula is a relatively uncommon congenital anomaly that can be difficult to identify and, at times, challenging to repair. We present a very unusual case of an infant with 2 distinct H-type tracheoesophageal fistulas (TEFs) identified and repaired in 1 operation. A newborn male infant presented with coughing with feeds. Contrast esophagram demonstrated an intrathoracic H-type fistula without esophageal atresia. In the operating room, rigid bronchoscopy was performed, and a second TEF was identified in the cervical region. A separate balloon catheter was placed in each fistula. The intrathoracic fistula was repaired through a thoracotomy incision, and the more proximal fistula was repaired through a cervical incision. Each repair was uncomplicated, and recovery was uneventful. Double H-type tracheoesophageal appears to be extremely rare. This case underscores the importance of searching for a second fistula by bronchoscopy before undertaking definitive repair of a TEF. PMID:23164022
Endovascular aneurysm repair (EVAR) using stent grafts has shown to be an effective alternative to surgical repair in treating an abdominal aortic aneurysm (AAA). EVAR is associated with shorter hospital stays, less blood loss, shorter operating times, and lower early morbidity and mortality compared to open surgical repair, although EVAR required a higher reintervention rate during a longer follow-up period. However, short or severely an angulated infrarenal proximal aortic neck is considered unsuitable for EVAR. The chimney graft technique is a modified procedure based on the deployment of a covered or bare-metal stent parallel to the main aortic endograft within the aneurysm, thereby creating a conduit that runs outside the aortic main endograft to preserve flow to the aortic branches. In this case report, we present a 78-year-old patient with an AAA with a short and severely angulated proximal neck who was successfully treated by EVAR using the chimney graft technique.
Lee, Sangeun; Choi, Donghoon; Lee, Do-yun
The two broad categories of fiber-reinforced composite liner repair and deposited weld metal repair technologies were reviewed and evaluated for potential application for internal repair of gas transmission pipelines. Both are used to some extent for other applications and could be further developed for internal, local, structural repair of gas transmission pipelines. Principal conclusions from a survey of natural gas transmission industry pipeline operators can be summarized in terms of the following performance requirements for internal repair: (1) Use of internal repair is most attractive for river crossings, under other bodies of water, in difficult soil conditions, under highways, under congested intersections, and under railway crossings. (2) Internal pipe repair offers a strong potential advantage to the high cost of horizontal direct drilling when a new bore must be created to solve a leak or other problem. (3) Typical travel distances can be divided into three distinct groups: up to 305 m (1,000 ft.); between 305 m and 610 m (1,000 ft. and 2,000 ft.); and beyond 914 m (3,000 ft.). All three groups require pig-based systems. A despooled umbilical system would suffice for the first two groups which represents 81% of survey respondents. The third group would require an onboard self-contained power unit for propulsion and welding/liner repair energy needs. (4) The most common size range for 80% to 90% of operators surveyed is 508 mm (20 in.) to 762 mm (30 in.), with 95% using 558.8 mm (22 in.) pipe. Evaluation trials were conducted on pipe sections with simulated corrosion damage repaired with glass fiber-reinforced composite liners, carbon fiber-reinforced composite liners, and weld deposition. Additional un-repaired pipe sections were evaluated in the virgin condition and with simulated damage. Hydrostatic failure pressures for pipe sections repaired with glass fiber-reinforced composite liner were only marginally greater than that of pipe sections without liners, indicating that this type of liner is only marginally effective at restoring the pressure containing capabilities of pipelines. Failure pressures for larger diameter pipe repaired with a semi-circular patch of carbon fiber-reinforced composite lines were also marginally greater than that of a pipe section with un-repaired simulated damage without a liner. These results indicate that fiber reinforced composite liners have the potential to increase the burst pressure of pipe sections with external damage Carbon fiber based liners are viewed as more promising than glass fiber based liners because of the potential for more closely matching the mechanical properties of steel. Pipe repaired with weld deposition failed at pressures lower than that of un-repaired pipe in both the virgin and damaged conditions, indicating that this repair technology is less effective at restoring the pressure containing capability of pipe than a carbon fiber-reinforced liner repair. Physical testing indicates that carbon fiber-reinforced liner repair is the most promising technology evaluated to-date. The first round of optimization and validation activities for carbon-fiber repairs are complete. Development of a comprehensive test plan for this process is recommended for use in the field trial portion of this program.
Robin Gordon; Bill Bruce; Ian Harris; Dennis Harwig; George Ritter; Bill Mohr; Matt Boring; Nancy Porter; Mike Sullivan; Chris Neary
How living near environmental hazards contributes to poorer health and disproportionate health outcomes is an ongoing concern. We conducted a substantive review and critique of the literature regarding residential proximity to environmental hazards and adverse pregnancy outcomes, childhood cancer, cardiovascular and respiratory illnesses, end-stage renal disease, and diabetes. Several studies have found that living near hazardous wastes sites, industrial sites, cropland with pesticide applications, highly trafficked roads, nuclear power plants, and gas stations or repair shops is related to an increased risk of adverse health outcomes. Government agencies should consider these findings in establishing rules and permitting and enforcement procedures to reduce pollution from environmentally burdensome facilities and land uses. PMID:22028451
Brender, Jean D; Maantay, Juliana A; Chakraborty, Jayajit
Mismatch repair of palindromic loops in the presence or absence of single-base mismatches was investigated in wild-type and mismatch-binding defective mutant Chinese hamster ovary cells. Recombination intermediates with a maximum heteroduplex DNA (hDNA) region of 697 bp contained a centrally located, phenotypically silent 12-base palindromic loop mismatch, and/or five single-base mismatches. In wild-type cells, both loops and single-base mismatches were efficiently repaired (80-100%). When no other mismatches were present in hDNA, loops were retained with a 1.6-1.9:1 bias. However, this bias was eliminated when single-base mismatches were present, perhaps because single-base mismatches signal nick-directed repair. In the multiple marker crosses, most repair tracts were long and continuous, with preferential loss of markers in cis to proximal nicks, consistent with nicks directing most repair in this situation. However, approximately 25% of repair tracts were discontinuous as a result of loop-specific repair, or from segregation or short tract repair of single-base mismatches. In mutant cells, single-base mismatches were repaired less frequently, but the loop was still repaired efficiently and with bias toward loop retention, indicating that the defect in these cells does not affect loop-specific repair. Repair tracts in products from mutant cells showed a wide variety of mosaic patterns reflecting short regions of repair and segregation consistent with reduced nick-directed repair. In mutant cells, single-base mismatches were repaired more efficiently in the presence of the loop than in its absence, a likely consequence of corepair initiated at the loop.
Taghian, D G; Hough, H; Nickoloff, J A
The two broad categories of fiber-reinforced composite liner repair and deposited weld metal repair technologies were reviewed and evaluated for potential application for internal repair of gas transmission pipelines. Both are used to some extent for other applications and could be further developed for internal, local, structural repair of gas transmission pipelines. Principal conclusions from a survey of natural gas transmission industry pipeline operators can be summarized in terms of the following performance requirements for internal repair: (1) Use of internal repair is most attractive for river crossings, under other bodies of water, in difficult soil conditions, under highways, under congested intersections, and under railway. (2) Internal pipe repair offers a strong potential advantage to the high cost of horizontal direct drilling when a new bore must be created to solve a leak or other problem. (3) Typical travel distances can be divided into three distinct groups: up to 305 m (1,000 ft.); between 305 m and 610 m (1,000 ft. and 2,000 ft.); and beyond 914 m (3,000 ft.). All three groups require pig-based systems. A despooled umbilical system would suffice for the first two groups which represents 81% of survey respondents. The third group would require an onboard self-contained power unit for propulsion and welding/liner repair energy needs. (4) The most common size range for 80% to 90% of operators surveyed is 508 mm (20 in.) to 762 mm (30 in.), with 95% using 558.8 mm (22 in.) pipe. Evaluation trials were conducted on pipe sections with simulated corrosion damage repaired with glass fiber-reinforced composite liners, carbon fiber-reinforced composite liners, and weld deposition. Additional un-repaired pipe sections were evaluated in the virgin condition and with simulated damage. Hydrostatic failure pressures for pipe sections repaired with glass fiber-reinforced composite liner were only marginally greater than that of pipe sections without liners, indicating that this type of liner is only marginally effective at restoring the pressure containing capabilities of pipelines. Failure pressures for larger diameter pipe repaired with a semi-circular patch of carbon fiber-reinforced composite lines were also marginally greater than that of a pipe section with un-repaired simulated damage without a liner. These results indicate that fiber reinforced composite liners have the potential to increase the burst pressure of pipe sections with external damage Carbon fiber based liners are viewed as more promising than glass fiber based liners because of the potential for more closely matching the mechanical properties of steel. Pipe repaired with weld deposition failed at pressures lower than that of un-repaired pipe in both the virgin and damaged conditions, indicating that this repair technology is less effective at restoring the pressure containing capability of pipe than a carbon fiber-reinforced liner repair. Physical testing indicates that carbon fiber-reinforced liner repair is the most promising technology evaluated to-date. Development of a comprehensive test plan for this process is recommended for use in the field trial portion of this program.
Robin Gordon; Bill Bruce; Ian Harris; Dennis Harwig; George Ritter; Bill Mohr; Matt Boring; Nancy Porter; Mike Sullivan; Chris Neary
The advances in thoracic endovascular aortic repair (TEVAR) offer patients who are otherwise unsuitable for open surgery an alternative in treating their aortic arch pathologies. However, the adoption of TEVAR carries inherent complications unique to itself, notably the occurrence of Type A retrograde ascending aortic dissections, which can range from 1-3%. Several key technical considerations are must be heeded to minimize the risks of these complications. It is important to completely excise the primary entry tear through a careful and methodical approach. The proximal and distal reconstruction must be hemodynamically sound, with care taken to stabilize both the root and the distal aorta. Neuroprotection strategies, such as antegrade cerebral perfusion, should be utilized if the duration of circulatory arrest is anticipated to be greater than 30 minutes. This report details the operative techniques for the repair of retrograde aortic dissections following TEVAR. PMID:23977609
Desai, Nimesh D
We report a splint system for a protected mobilization program (termed dynamic treatment) of proximal phalangeal fractures. This program can be used for nonoperative treatment or after operative treatment. Intra-articular fractures of the proximal phalanx at the metacarpophalangeal joint were included. The custom-molded 2-component thermoplastic splint allows motion of the proximal and distal interphalangeal joints. It was developed to allow
T. Ebinger; N. Erhard; L. Kinzl; M. Mentzel
Disclosed are improvements to a rapid road repair vehicle comprising an improved cleaning device arrangement, two dispensing arrays for filling defects more rapidly and efficiently, an array of pre-heaters to heat the road way surface in order to help the repair material better bond to the repaired surface, a means for detecting, measuring, and computing the number, location and volume of each of the detected surface imperfection, and a computer means schema for controlling the operation of the plurality of vehicle subsystems. The improved vehicle is, therefore, better able to perform its intended function of filling surface imperfections while moving over those surfaces at near normal traffic speeds.
Redo surgery for residual distal dissection after the limited proximal aortic repair for Stanford type A acute aortic dissection remains challenging with some difficulties. In essence, redo aortic repair predominantly depends on the significantly dilated parts of the residual dissection. According to that, the strategy including median or lateral approach and 1 or 2 staged repair would be determined with careful consideration for patients' age and function of the vital organs such as brain, heart, lung, liver, and kidney. Generally, for relatively young and low-risk patients, an aggressive 1 stage repair of the entire arch to descending aorta through a left thoracotomy is feasible. Meanwhile, 2 stage repair is beneficial for elderly high-risk patients, which consists of the 1st total arch replacement with elephant trunk through a median sternotomy followed secondly by the open descending aortic repair through a lateral thoracotomy or recently-advanced less-invasive endovascular aortic repair. In the initial repair, more aggressive total arch replacement with elephant trunk or frozen elephant trunk might be another useful option to potentially prevent such troublesome behaviors of the residual dissecting aorta requiring redo surgery in the late stage. PMID:23917181
This report describes a series of tests to evaluate a system for rapidly repairing airfield pavement using polymer concrete (synthetic polymer plus aggregate), thermally cured by microwave power. The technique, developed by the Syracuse University Researc...
L. L. Boyko R. G. Sawyer
The two broad categories of deposited weld metal repair and fiber-reinforced composite liner repair technologies were reviewed for potential application for internal repair of gas transmission pipelines. Both are used to some extent for other applications and could be further developed for internal, local, structural repair of gas transmission pipelines. Preliminary test programs were developed for both deposited weld metal repair and for fiber-reinforced composite liner repair. Evaluation trials have been conducted using a modified fiber-reinforced composite liner provided by RolaTube and pipe sections without liners. All pipe section specimens failed in areas of simulated damage. Pipe sections containing fiber-reinforced composite liners failed at pressures marginally greater than the pipe sections without liners. The next step is to evaluate a liner material with a modulus of elasticity approximately 95% of the modulus of elasticity for steel. Preliminary welding parameters were developed for deposited weld metal repair in preparation of the receipt of Pacific Gas & Electric's internal pipeline welding repair system (that was designed specifically for 559 mm (22 in.) diameter pipe) and the receipt of 559 mm (22 in.) pipe sections from Panhandle Eastern. The next steps are to transfer welding parameters to the PG&E system and to pressure test repaired pipe sections to failure. A survey of pipeline operators was conducted to better understand the needs and performance requirements of the natural gas transmission industry regarding internal repair. Completed surveys contained the following principal conclusions: (1) Use of internal weld repair is most attractive for river crossings, under other bodies of water, in difficult soil conditions, under highways, under congested intersections, and under railway crossings. (2) Internal pipe repair offers a strong potential advantage to the high cost of horizontal direct drilling (HDD) when a new bore must be created to solve a leak or other problem. (3) Typical travel distances can be divided into three distinct groups: up to 305 m (1,000 ft.); between 305 m and 610 m (1,000 ft. and 2,000 ft.); and beyond 914 m (3,000 ft.). All three groups require pig-based systems. A despooled umbilical system would suffice for the first two groups which represents 81% of survey respondents. The third group would require an onboard self-contained power unit for propulsion and welding/liner repair energy needs. (4) Pipe diameter sizes range from 50.8 mm (2 in.) through 1,219.2 mm (48 in.). The most common size range for 80% to 90% of operators surveyed is 508 mm to 762 mm (20 in. to 30 in.), with 95% using 558.8 mm (22 in.) pipe. An evaluation of potential repair methods clearly indicates that the project should continue to focus on the development of a repair process involving the use of GMAW welding and on the development of a repair process involving the use of fiber-reinforced composite liners.
Robin Gordon; Bill Bruce; Ian Harris; Dennis Harwig; Nancy Porter; Mike Sullivan; Chris Neary
These two diagrams from SpaceTEC National Aerospace Technical Education Center show how to create a PVC foam core sandwich and perform structural scarf repair. The diagrams show the materials to use and the dimensions of each.
Because wound infection is a major cause of incisional hernia, the question posed is whether or not repairs of incisional hernias are at a higher risk for wound infection also. To answer this, we analyzed the incidence of wound infection after repair of incisional hernias during a 30 month period and compared it with the infection rate in all other clean procedures performed during the same period. All repairs of incisional hernias were performed upon patients with completely healed incisions without clinical signs of infection. Patients undergoing concomitant procedures upon the gastrointestinal tract were excluded. During the 30 month period, 995 clean operations were performed. In the 80 repairs of incisional hernias, there were 13 infections proved by culture, yielding an over-all infection rate of 16 per cent. In the remaining 915 clean procedures, there were 14 wound infections (1.5 per cent, p less than 0.0001). Of these 915 clean operations, 241 were repairs of inguinal hernias. Two infections occurred in this subgroup (0.8 per cent, p less than 0.0001, compared with repairs of incisional hernias). In patients undergoing repairs of incisional hernias with previously documented wound infections, 41 per cent had infected repairs. By comparison, only 12 per cent of patients without a prior infection had infections develop in the hernial repair (p less than 0.05). The infection rate for patients not receiving prophylactic antibiotics (21 per cent) was almost twice the rate for those receiving antibiotics (11 per cent), p = 0.07. We concluded that repair of incisional hernias has a significantly higher rate of infection than do other clean general surgical procedures. Herniorrhaphy of a wound that was previously infected is at a higher risk for reinfection, despite complete healing of the skin and absence of clinical signs of infection. Perioperative antibiotic prophylaxis may be indicated, but randomized studies are needed. For reporting and surveillance purposes, repairs of incisional hernias should not be classified as clean surgical procedures. PMID:2530641
Houck, J P; Rypins, E B; Sarfeh, I J; Juler, G L; Shimoda, K J
The author has, in the past, classified treatment methods for pain geometrically as point, line, two-dimensional, three-dimensional treatment and has used these over the years. However as a practitioner of western medicine, the author originally treated pain only directed at the painful site, and encountered cases where local treatment did not suffice. The author proved with SPECT and the Rand Phantom that treating the neck which is the midpoint of the brain, the center of the nervous system and the heart, the center of circulation, increased cerebral blood flow and also that laser emitted to neck will reach the spinal chord no matter from where on the neck the laser is emitted. From such research and 25 years of clinical experience, the author has created an anatomy based, systemic treatment method called the Proximal Priority Laser Therapy (PPLT) where not only the cerebral cortex, spinal chord and peripheral nerves are treated but also the tracts of blood vessels and lymph ducts are treated as well. Treatment method and cases are presented herein.
We propose a system for improving grasping using fingertip optical proximity sensors that allows us to perform online grasp adjustments to an initial grasp point without requiring premature object contact or regrasping strategies. We present novel optical proximity sensors that fit inside the fingertips of a Barrett Hand, and demonstrate their use alongside a probabilistic model for robustly combining sensor
Kaijen Hsiao; Paul Nangeroni; Manfred Huber; Ashutosh Saxena; Andrew Y. Ng
The inability to obtain proximal or distal seal continues to remain one of the main challenges of endovascular aneurysm repair. This is particularly relevant when endografts are used in patients with unsuitable proximal or distal landing zones. A variety of techniques can be used to achieve a seal in these difficult situations. Two specific techniques that can help intraoperatively to resolve the lack of adequate graft to aortic wall opposition are discussed in this article. These include the use of Palmaz stents for proximal seal and hypogastric snorkel for distal seal with internal iliac flow preservation. PMID:23062496
Kasirajan, Karthikeshwar; Gupta, Naren
ObjectiveMarfan syndrome patients with aortic root aneurysms undergo elective aortic root replacement to avoid the life-threatening outcomes of aortic dissection and emergency repair. The long-term implications of failed aortic surveillance leading to acute dissection and emergency repair are poorly defined. We compared the long-term clinical courses of Marfan syndrome patients who survive emergency versus elective proximal aortic surgery.
Howard K. Song; Mark Kindem; Joseph E. Bavaria; Harry C. Dietz; Dianna M. Milewicz; Richard B. Devereux; Kim A. Eagle; Cheryl L. Maslen; Barbara L. Kroner; Reed E. Pyeritz; Kathryn W. Holmes; Jonathan W. Weinsaft; Victor Menashe; William Ravekes; Scott A. LeMaire
Aortic insufficiency in patients with type A aortic dissection is commonly seen and, in most cases, is the consequence of commissural detachment. We report our method of aortic valve repair in which the valve commissure and detached intima are repaired by using a "T-shaped" polyester patch that fits well within the aortic root after removal of the clots in the proximal false lumen. The early results have proved this is an easy and effective way to repair valve commissural detachment and reconstruct the aortic root. PMID:23706453
Dong, Song-Bo; Zheng, Jun; Ma, Wei-Guo; Zhu, Jun-Ming; Liu, Yong-Min; Sun, Li-Zhong
The maintenance of genomic integrity in response to DNA damage is tightly linked to controlled changes in the damage-proximal chromatin environment. Many of the chromatin modifying enzymes involved in DNA repair depend on metabolic intermediates as cofactors, suggesting that changes in cellular metabolism can have direct consequences for repair efficiency and ultimately, genome stability. Here, we discuss how metabolites may contribute to DNA double-strand break repair, and how alterations in cellular metabolism associated with both aging and tumorigenesis may affect the integrity of our genomes.
Liu, Jinping; Kim, Jeongkyu; Oberdoerffer, Philipp
The suitability for endovascular aneurysm repair (EVAR) is determined primarily by abdominal aortic aneurysm (AAA) anatomy. For patients unsuitable for standard EVAR, due to proximal neck anatomy, fenestrated aortic stent-grafting (FEVAR) is a viable alternative to open repair surgery. Initially FEVAR stent-grafts were custom-made to fit the unique anatomical characteristics of each treated individual. This customization leads to production delays therefore excluding acute aneurysms from endovascular treatment. For patients in need for more urgent treatment, several alternatives have currently been developed. The aim of this review is to provide an overview on current developments and results in acute endovascular abdominal aortic aneurysm repair. PMID:23558653
Pol, R A; Tielliu, I F J; Zeebregts, C J
Renal proximal tubular damage and repair are hallmarks of acute kidney injury. Because glycogen synthase kinase-3? (GSK-3?) is an important cellular regulator of survival and proliferation, we determined its role during injury and recovery of proximal tubules in a mercuric chloride-induced nephrotoxic model of acute kidney injury. Renal proximal tubule-specific GSK-3? knockout mice exposed to mercuric chloride had improved survival and renal function compared to wild type mice. Apoptosis, measured by TUNEL staining, Bax activation, and caspase 3 cleavage were all reduced in the knockout mice. The restoration of renal structure, function, and cell proliferation was also accelerated in the GSK-3? knockout mice. This enhanced repair, evidenced by increased Ki-67 and BrdU staining, along with increased cyclin D1 and c-myc levels, was recapitulated by treatment of wild type mice with the small-molecule GSK-3 inhibitor TDZD-8 following injury. This confirmed that hastened repair in the knockout mice was not merely due to lower initial injury levels. Thus, inhibition of GSK-3? prior to nephrotoxic insult protects from renal injury. Such treatment after acute kidney injury may accelerate repair and regeneration.
Howard, Christiana; Tao, Shixin; Yang, Hai-Chun; Fogo, Agnes B; Woodgett, James R; Harris, Raymond C; Rao, Reena
Endovascular repair of the abdominal aortic aneurysm has been established as a successful alternative to open surgical repair, provided that the criteria necessary for such an approach are fulfilled. Anatomic criteria include suitable diameter, length, and angle of the aneurysm proximal neck. We present three cases in which patients were initially ineligible for endovascular repair because of unfavorable neck anatomy but in whom the use of aortic cuffs allowed for successful endograft placement and aneurysm exclusion.
Awan, Omer; Garcia, Mark; Awan, Yousaf; Gakhal, Mandip; Kim, Moonjohn; Iliescu, Bogdan; Siegel, Eliot
The authors of this study noticed that the elastic garters of below knee anti-embolism stockings (AES) were indenting the proximal calves of patients after application and feared this might be interrupting venous return. This was lower on one ward which had a rigorous standardized protocol for sizing and checking stockings. Hypotheses were that proximal indentation caused higher proximal than distal pressures (reverse gradients) and that by adopting the standardized protocol throughout the unit, proximal indentation could be reduced. Fifty-seven patients were recruited after total hip replacement (THR) or total knee replacement (TKR) in a regional orthopaedic centre. The authors implemented the standardized protocol for sizing stockings and measured the pressures under them. After implementation of the standardized protocol, proximal indentation fell from 53% to 19% (p<0.05), incorrectly sized stockings from 74% to 34% (p<0.05) and removal of stockings by patients from 32% to 0% (p<0.05). In total, 21% of patients had reverse gradients which occurred in 41% of legs with proximal indentation and 8% without. When reverse gradients or proximal indentation exist, AES may not be as effective and may be counterproductive. A standardized protocol of nursing practice is critical to optimizing AES after THR and TKR. More in-vivo research is needed on AES after hip and knee replacement. PMID:22241490
Thompson, Alice; Walter, Sophie; Brunton, Luke R; Pickering, Greg T; Mehendale, Sanchit; Smith, Alison J; Bannister, Gordon C
The goal of this study was to transect and immediately repair ventral roots, selected by their ability to stimulate bladder contraction, to assess the feasibility of bladder reinnervation in a canine model. Brain-derived neurotrophic factor (BDNF) was delivered via an osmotic pump (0.5 or 5 mg/mL) to a cuff surrounding the reanastomosis site to the two root bundles on one side. Electrodes were implanted bilaterally immediately proximal to the site of surgical reanastomosis. Results were compared to four root-intact, control animals that also received bilateral electrode implantation. At 6–12 months post-surgery, five of eight nerve transected and repaired animals showed increased pressure and bladder emptying during electrical stimulation of the repaired ventral roots contralateral to the BDNF delivery side. Nerve tracing studies one year postoperatively determined the repaired roots to be S1 and S2 and showed regrowth of axons from the spinal cord to nerve sites proximal to the repair site and to the bladder, and the presence of neurofilament-labeled axons growing across the ventral root repair site. In conclusion, transected ventral and dorsal roots in the sacral spine can be repaired and are capable of functionally reinnervating the urinary bladder. This feasibility study paves the way for future studies utilizing other more proximal motor nerves to bypass the transection site for bladder reinnervation.
RUGGIERI, MICHAEL R.; BRAVERMAN, ALAN S.; D'ANDREA, LINDA; SIMPKISS, BERNADETTE; KOZIN, SCOTT H.; PONTARI, MICHEL A.; BETZ, RANDALL; BARBE, MARY F.
Pseudoaneurysm after thoracic endovascular aortic repair (TEVAR) is very rare. We report a case of thoracic aortic pseudoaneurysms due to flares at the proximal end of a stent graft after TEVAR for ductal aneurysm. We describe a total aortic arch replacement in this case using a modified cuffed anastomosis technique with an elephant trunk procedure leaving the partial stent graft in situ.
Matsuo, Satoshi; Oda, Katsuhiko; Motoyoshi, Naotaka; Saiki, Yoshikatsu
We generalize the Proximity Force Theorem of J. Blocki et al. (Ann. Phys. (N. Y.) 105 (1977), 427) (valid for gently curved surfaces) to include surfaces that may have large curvatures (but are still characterized by small angles between relevant portions of the interacting surfaces). A general proof is given for the approximate concinuity of the proximity force when a gap configuration goes over into a crevice after contact. Simple and somewhat improved formulae are given for the universal proximity potential functions Phi and Phi-circumflex for gaps and crevices.
Blocki, J.; Swiatecki, W.J.
Patient. We report the case of a 20-year-old caucasian male with an Ewing's sarcoma in the left upper femur. After induction chemotherapy, he underwent resection of the left upper femur and insertion of a cemented proximal femoral replacement. Four years later, he presented with a solitary bone metastasis in the right upper femur. He underwent further chemotherapy followed by resection and endoprosthetic replacement of the other proximal femur. He remains disease free with excellent function almost a year after the second operation. Discussion. We believe this is the first reported case of bilateral proximal femoral endoprostheses.
Grimer, Robert J.
The mismatch repair (MMR) system detects non-Watson-Crick base pairs and strand misalignments arising during DNA replication and mediates their removal by catalyzing excision of the mispair-containing tract of nascent DNA and its error-free resynthesis. In this way, MMR improves the fidelity of replication by several orders of magnitude. It also addresses mispairs and strand misalignments arising during recombination and prevents synapses between nonidentical DNA sequences. Unsurprisingly, MMR malfunction brings about genomic instability that leads to cancer in mammals. But MMR proteins have recently been implicated also in other processes of DNA metabolism, such as DNA damage signaling, antibody diversification, and repair of interstrand cross-links and oxidative DNA damage, in which their functions remain to be elucidated. This article reviews the progress in our understanding of the mechanism of replication error repair made during the past decade. PMID:23545421
Base excision repair (BER) corrects DNA damage from oxidation, deamination and alkylation. Such base lesions cause little distortion to the DNA helix structure. BER is initiated by a DNA glycosylase that recognizes and removes the damaged base, leaving an abasic site that is further processed by short-patch repair or long-patch repair that largely uses different proteins to complete BER. At least 11 distinct mammalian DNA glycosylases are known, each recognizing a few related lesions, frequently with some overlap in specificities. Impressively, the damaged bases are rapidly identified in a vast excess of normal bases, without a supply of energy. BER protects against cancer, aging, and neurodegeneration and takes place both in nuclei and mitochondria. More recently, an important role of uracil-DNA glycosylase UNG2 in adaptive immunity was revealed. Furthermore, other DNA glycosylases may have important roles in epigenetics, thus expanding the repertoire of BER proteins. PMID:23545420
Krokan, Hans E; Bjørås, Magnar
During repair, many different matrix metalloproteinases are produced by multiple cell types residing in various compartments within the wound environment. This diversity of enzymes, coupled with discreet cellular expression, implies that different matrix metalloproteinases serve different functions, acting on a variety of substrates, during wound healing. With few exceptions, however, the actual function and spectrum of functions of matrix metalloproteinases in vivo is not known. Even with the advent of genetically defined animal models, few studies have rigorously addressed the substrates and role of matrix metalloproteinases in wound repair. Before we can understand the role of matrix metalloproteinases in ulceration and disease, we need to determine the function these enzymes serve in normal tissues and repair. PMID:10633001
Parks, W C
Meniscal repair devices not requiring accessory incisions are attractive. Many factors contribute to their clinical effectiveness including their biomechanical characteristics. This study compared several new meniscal repair devices with standard meniscal suture techniques. Using a porcine model, axis-of-insertion loads were applied to various meniscal sutures and repair devices. A single device or stitch was placed in a created meniscal tear and a load applied. Both loads and modes of failure were recorded. The load-to-failure data show stratification into 4 distinct statistical groups. Group A, 113 N for a double vertical stitch; group B, 80 N for a single vertical stitch; group C, 57 N for the BioStinger, 56 N for a horizontal mattress stitch, and 50 N for the T-Fix stitch; and group D, 33 N for the Meniscus Arrow (inserted by hand or gun), 32 N for the Clearfix screw, 31 N for the SDsorb staple, 30 N for the Mitek meniscal repair system, and 27 N for the Biomet staple. The failure mechanism varied. Sutures broke away from the knot. The Meniscus Arrow and BioStinger pulled through the inner rim with the crossbar intact. The Clearfix screw failed by multiple mechanisms, whereas 1 leg of the SDsorb staple always pulled out of the outer rim. The Mitek device usually failed by pullout from the inner rim. The Biomet staple always broke at the crosshead or just below it. Although the surgeon should be aware of the material properties of the repair technique chosen for a meniscal repair, this information is only an indication of device performance and may not correlate with clinical healing results. PMID:10976122
Barber, F A; Herbert, M A
The practice of proximal formative assessment - the continual, responsive attention to students' developing understanding as it is expressed in real time - depends on students' sharing their ideas with instructors and on teachers' attending to them. Rogerian psychology presents an account of the conditions under which proximal formative assessment may be promoted or inhibited: (1) Normal classroom conditions, characterized by evaluation and attention to learning targets, may present threats to students' sense of their own competence and value, causing them to conceal their ideas and reducing the potential for proximal formative assessment. (2) In contrast, discourse patterns characterized by positive anticipation and attention to learner ideas increase the potential for proximal formative assessment and promote self-directed learning. We present an analysis methodology based on these principles and demonstrate its utility for understanding episodes of university physics instruction.
Scherr, Rachel E.; Close, Hunter G.; Mckagan, Sarah B.
The proximity effects of superconducting multilayer films composed of different metals are considered. The relationship between the critical temperature of a superconducting multilayer film with strong heterogeneity and its geometric structure is given.
Xueyu, C.; Daole, Y.
Traditional measures of proximity all share three common weaknesses: (1) they are based upon ratio-level measurement of physical distance that may not correspond to 'psychological distance,' (2) they measure distance as a fixed rather than a variable quan...
P. R. Monge K. K. Kirste
Many pattern recognition tasks can be modeled as proximity searching. Here the common task is to quickly find all the elements\\u000a close to a given query without sequentially scanning a very large database.\\u000a \\u000a A recent shift in the searching paradigm has been established by using permutations instead of distances to predict proximity. Every object in the database record how the
Eric Sadit Tellez; Edgar Chávez; Antonio Camarena-ibarrola
The present study is concerned with concepts, techniques, and system requirements which would permit 'automated' proximity operations utilizing an unmanned vehicle such as the proposed Orbital Maneuvering Vehicle (OMV). Attention is given to proximity operations mission phases, tethered operations, operational control zones, operation control zone objectives, operational control zone definition, aspects of monitoring and tracking, the departure zone, the rendezvous zone, and coorbiting satellite zones.
Lineberry, E. C., Jr.
Objective Proximal radioulnar synostosis is a rare upper limb malformation. The elbow is first identifiable at 35 days (after conception),\\u000a at which stage the cartilaginous anlagen of the humerus, radius and ulna are continuous. Subsequently, longitudinal segmentation\\u000a produces separation of the distal radius and ulna. However, temporarily, the proximal ends are united and continue to share\\u000a a common perichondrium. We investigated the
Alison M. Elliott; Lisa Kibria; Martin H. Reed
A 41-year-old woman had a 15-year history of pain in her thighs and arms, which also became weaker, and a decrease in visual acuity. Her 35-year-old brother, their 38-year-old sister and their 64-year-old mother also had myalgia, myotonia and proximal muscle weakness, and the women also had cataracts. Additional examinations and tests led to a diagnosis of proximal myotonic myopathy
A. A. Tieleman; M. P. van der Velden; M. C. Visser; J. H. J. Wokke; H. Scheffer; B. G. M. van Engelen
The study of reciprocal altruism, or the exchange of goods and services between individuals, requires attention to both evolutionary\\u000a explanations and proximate mechanisms. Evolutionary explanations have been debated at length, but far less is known about\\u000a the proximate mechanisms of reciprocity. Our own research has focused on the immediate causes and contingencies underlying\\u000a services such as food sharing, grooming, and
Sarah F. Brosnan; Frans B. M. de Waal
We experimentally study the polarization dynamics (orientation and ellipticity) of near-infrared light transmitted through magneto-optical yttrium iron garnet isolator crystal pairs using a modified balanced detection scheme. When the pair separation is in the submillimeter range, we observed a proximity effect in which the saturation field is reduced by up to 20%. One-dimensional calculations suggest that the proximity effect originates from magnetostatic interactions between the dipole moments of the isolator crystals. PMID:19037456
Linzon, Y; Ferrera, M; Razzari, L; Pignolet, A; Morandotti, R
Damage recognition is a key initial step in DNA repair. A recent study puts to rest the debate of whether XPD helicase 'verifies' the appropriateness of the DNA damage to be mended by the nucleotide excision repair machinery. PMID:23391386
Experience from several recent spacecraft development programs, such as Space Station Freedom (SSF) and the Orbital Maneuvering Vehicle (OMV) has shown the need for factoring proximity operations considerations into the vehicle design process. Proximity operations, those orbital maneuvers and procedures which involve operation of two or more spacecraft at ranges of less than one nautical mile, are essential to the construction, servicing, and operation of complex spacecraft. Typical proximity operations considerations which drive spacecraft design may be broken into two broad categories; flight profile characteristics and concerns, and use of various spacecraft systems during proximity operations. Proximity operations flight profile concerns include the following: (1) relative approach/separation line; (2) relative orientation of the vehicles; (3) relative translational and rotational rates; (4) vehicle interaction, in the form of thruster plume impingement, mating or demating operations, or uncontrolled contact/collision; and (5) active vehicle piloting. Spacecraft systems used during proximity operations include the following: (1) sensors, such as radar, laser ranging devices, or optical ranging systems; (2) effector hardware, such as thrusters; (3) flight control software; and (4) mating hardware, needed for docking or berthing operations. A discussion of how these factors affect vehicle design follows, addressing both active and passive/cooperative vehicles.
Staas, Steven K.
Distraction osteogenesis has been advocated for treatment of the mandibular deformity in patients with hemifacial microsomia (HFM). During the active phase, the force of distraction pushes the distal segment of the mandible down, creating a distraction gap. Because of the abnormal temporomandibular joint anatomy in HFM patients, the proximal segment may not seat in the glenoid fossa and thus may be displaced with distraction. The purpose of this study was to determine the vector(s) of proximal segment movement during mandibular distraction using a semiburied device. Two investigators traced the immediate pre-and postdistraction panoramic radiographs of 12 HFM patients (mean age at operation = 8.4 years, mean distraction = 28 mm) who had mandibular distraction with a semiburied device. Radiographic analysis, based on a vertical maxillary reference line, measured change in condylar position with angular and linear measurements. Inter-rater reliability for the tracing and analysis was shown with a correlation coefficient between 0.89 and 0.99 for all measures. Based on the angular and linear measurements, 10 of the 12 patients had superior movement of the proximal segment with distraction. Sagittal movement of the proximal segment could not be judged adequately. This study was based on measurements made on panoramic radiographs. Direct measurements could not be made; thus, it was not possible to estimate proximal segment movement in millimeters or as a percentage of total movement. Further studies to document proximal segment movement using computed tomography scans may provide more quantitative data. PMID:12000889
Padwa, Bonnie L; Zaragoza, Sandra M; Sonis, Andrew L
Lockheed Martin Energy Research Corporation (LMERC) and Merritt Systems, Inc. (MSI) entered into a Cooperative Research and Development Agreement (CRADA) for the development and demonstration of a compact, modular proximity sensing system suitable for application to a wide class of manipulator systems operated in support of environmental restoration and waste management activities. In teleoperated modes, proximity sensing provides the manipulator operator continuous information regarding the proximity of the manipulator to objects in the workspace. In teleoperated and robotic modes, proximity sensing provides added safety through the implementation of active whole arm collision avoidance capabilities. Oak Ridge National Laboratory (ORNL), managed by LMERC for the United States Department of Energy (DOE), has developed an application specific integrated circuit (ASIC) design for the electronics required to support a modular whole arm proximity sensing system based on the use of capacitive sensors developed at Sandia National Laboratories. The use of ASIC technology greatly reduces the size of the electronics required to support the selected sensor types allowing deployment of many small sensor nodes over a large area of the manipulator surface to provide maximum sensor coverage. The ASIC design also provides a communication interface to support sensor commands from and sensor data transmission to a distributed processing system which allows modular implementation and operation of the sensor system. MSI is a commercial small business specializing in proximity sensing systems based upon infrared and acoustic sensors.
Haley, D.C. [Oak Ridge National Lab., TN (United States); Pigoski, T.M. [Merrit Systems, Inc. (United States)
Adverse birth outcomes are associated with exposure to air pollution during pregnancy. Road proximity is a simple, widely available metric for capturing local variation in exposure to traffic-related air pollution. We characterized maternal exposure to traffic-related air pollution during pregnancy using residential proximity to major roadways among 2004-2008 singleton births in NC. Controlling for maternal race, age, education, nativity, marital status, and tobacco use, and season of birth, parity, infant sex, and Census tract-level urbanization and income, we evaluated the association between road proximity and pregnancy outcomes using generalized linear mixed models with a random intercept for each Census tract. Birth weight, birth weight percentile for gestational age, gestational hypertension, and small-for-gestational age were not associated with road proximity; however, women residing within 250?m of a major roadway were at 3-5% increased odds of low birth weight, preterm birth, and late preterm birth compared with women residing beyond 250?m (P<0.05). Our analyses demonstrate an association between proximity to major roadways and pregnancy outcomes using a large sample. Road proximity may represent a relatively straightforward method for assessing maternal risk from exposure to traffic-related air pollution, with results offering guidance for studies that can more accurately characterize air pollution exposures. PMID:22805991
Miranda, Marie Lynn; Edwards, Sharon E; Chang, Howard H; Auten, Richard L
DNA is under constant attack from intracellular and external mutagens. Sites of DNA damage need to be pinpointed so that the DNA repair machinery can be mobilized to the proper location. The identification of damaged sites, recruitment of repair factors, and assembly of repair "factories" is orchestrated by posttranslational modifications (PTMs). These PTMs include phosphorylation, ubiquitination, sumoylation, acetylation, and methylation. Here we discuss recent data surrounding the roles of arginine and lysine methylation in DNA repair processes. PMID:17306845
Lake, Aimee N; Bedford, Mark T
|Designed to provide a model curriculum and guidelines, this manual presents tasks that were identified by employers, employees, and teachers as important in a postsecondary auto body repair curriculum. The tasks are divided into ten major component areas of instruction: metalworking and fiberglass, painting, frame and suspension, glass and trim,…
D'Armond, Jack; And Others
Cell wounding is a common event in the life of many cell types, and the capacity of the cell to repair day-to-day wear-and-tear injuries, as well as traumatic ones, is fundamental for maintaining tissue integrity. Cell wounding is most frequent in tissues exposed to high levels of stress. Survival of such plasma membrane disruptions requires rapid resealing to prevent the loss of cytosolic components, to block Ca2+ influx and to avoid cell death. In addition to patching the torn membrane, plasma membrane and cortical cytoskeleton remodeling are required to restore cell function. Although a general understanding of the cell wound repair process is in place, the underlying mechanisms of each step of this response are not yet known. We have developed a model to study single cell wound repair using the early Drosophila embryo. Our system combines genetics and live imaging tools, allowing us to dissect in vivo the dynamics of the single cell wound response. We have shown that cell wound repair in Drosophila requires the coordinated activities of plasma membrane and cytoskeleton components. Furthermore, we identified an unexpected role for E-cadherin as a link between the contractile actomyosin ring and the newly formed plasma membrane plug.
Abreu-Blanco, Maria Teresa; Verboon, Jeffrey M
This note considers a method, recently described by Dykstra, for augmenting existing data in response surface experiments. Examples are given to show how this relatively simple approach can be usefully applied, not only to design repair problems, but to situations in which the experimenter, after reviewing his initial results, decides to change his region of interest, his model, or both.
T. L. Hebble; T. J. Mitchell
Exposure of cells to UV light from the sun causes the formation of pyrimidine dimers in DNA that have the potential to lead to mutation and cancer. In humans, pyrimidine dimers are removed from the genome in the form of ~30 nt-long oligomers by concerted dual incisions. Though nearly 50 y of excision repair research has uncovered many details of UV photoproduct damage recognition and removal, the fate of the excised oligonucleotides and, in particular, the ultimate fate of the chemically very stable pyrimidine dimers remain unknown. Physiologically relevant UV doses introduce hundreds of thousands of pyrimidine dimers in diploid human cells, which are excised from the genome within ~24 h. Once removed from the genome, “where do all the dimers go?” In a recent study we addressed this question. Although our study did not determine the fate of the dimer itself, it revealed that the excised ~30-mer is released from the duplex in a tight complex with the transcription/repair factor TFIIH. This finding combined with recent reports that base and oligonucleotide products of the base and double-strand break repair pathways also make stable complexes with the cognate repair enzymes, and that these complexes activate the MAP kinase and checkpoint signaling pathways, respectively, raises the possibility that TFIIH-30-mer excision complexes may play a role in signaling reactions in response to UV damage.
Kemp, Michael G.; Sancar, Aziz
Injury to the ureter is a possible complication of laparoscopic surgery. Traditionally, it is repaired by laparotomy. During laparoscopic surgery for bilateral ovarian remnants in a 29-year-old woman, the left ureter was transected. The ureter was repaired by primary end-to-end anastomosis by laparoscopy. The patient recovered uneventfully, and postoperative intravenous puelogram confirmed the repair to be intact.
Paul K. Tulikangas; Jeffrey M. Goldberg; Inderbir S. Gill
This article discusses a systematic approach to the repair of cystoceles using interposition grafting. Surgeons' opinions vary regarding which graft is most appropriate as there are several varieties for mesh interposition. High-grade cystocele repair using the porcine dermis interposition graft is successful and associated with few complications. Cystocele repair is typically low grade and does not require additional surgery. PMID:21353079
Leu, Patrick B; Scarpero, Harriette M; Dmochowski, Roger R
Background/Purpose The effect of low-dose bisphenol A (BPA) exposure on human reproductive health is still controversial. To better understand the molecular basis of the effect of BPA on human reproductive health, a genome-wide screen was performed using human foreskin fibroblast cells (hFFCs) derived from child hypospadias (HS) patients to identify novel targets of low-dose BPA exposure. Methodology/Principal Findings Gene expression profiles of hFFCs were measured after exposure to 10 nM BPA, 0.01 nM 17?-estradiol (E2) or 1 nM 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) for 24 h. Differentially expressed genes were identified using an unpaired Student's t test with P value cut off at 0.05 and fold change of more than 1.2. These genes were selected for network generation and pathway analysis using Ingenuity Pathways Analysis, Pathway Express and KegArray. Seventy-one genes (42 downregulated and 29 upregulated) were identified as significantly differentially expressed in response to BPA, among which 43 genes were found to be affected exclusively by BPA compared with E2 and TCDD. Of particular interest, real-time PCR analysis revealed that the expression of matrix metallopeptidase 11 (MMP11), a well-known effector of development and normal physiology, was found to be inhibited by BPA (0.47-fold and 0.37-fold at 10 nM and 100 nM, respectively). Furthermore, study of hFFCs derived from HS and cryptorchidism (CO) patients (n?=?23 and 11, respectively) indicated that MMP11 expression was significantly lower in the HS group than in the CO group (0.25-fold, P?=?0.0027). Conclusions/Significance This present study suggests that an involvement of BPA in the etiology of HS might be associated with the downregulation of MMP11. Further study to elucidate the function of the novel target genes identified in this study during genital tubercle development might increase our knowledge of the effects of low-dose BPA exposure on human reproductive health.
Qin, Xian-Yang; Kojima, Yoshiyuki; Mizuno, Kentaro; Ueoka, Katsuhiko; Muroya, Koji; Miyado, Mami; Zaha, Hiroko; Akanuma, Hiromi; Zeng, Qin; Fukuda, Tomokazu; Yoshinaga, Jun; Yonemoto, Junzo; Kohri, Kenjiro; Hayashi, Yutaro; Fukami, Maki; Ogata, Tsutomu; Sone, Hideko
Treatment of endoleaks after thoracic endovascular repair remains challenging, particularly when the proximal landing zone is small and partly includes the origin of the neck vessels. We report a Type Ia endoleak, occurring after thoracic endovascular aneurysm repair, which was successfully treated with a novel uncovered nitinol stent. With this success, we were able to avoid a conventional surgery to treat the endoleak. PMID:23255527
Buz, Semih; Zipfel, Burkhart; D'Ancona, Guiseppe; Hetzer, Roland
Background: Bone-to-tendon healing in the shoulder can be unpredictable. Biologic augmentation, through the implementation of adult mesenchymal stem cells, may improve this healing process.Purpose: The purpose of this study was to (1) arthroscopically obtain bone marrow aspirates from the proximal humerus during rotator cuff repair, (2) purify and concentrate the connective tissue progenitor cells (CTPs) in the operating room efficiently,
Augustus D. Mazzocca; Mary Beth R. McCarthy; David M. Chowaniec; Mark P. Cote; Robert A. Arciero; Hicham Drissi
Proximal physeal fracture-separation of the clavicle is a very rare injury occurring in the adolescent and in the young adult which involves a contact loss with fracture between the clavicle and its cartilaginous ossification center similar in appearance to a sternoclavicular dislocation. The authors report an unusual case of a proximal physeal fracture-separation of the clavicle with avulsion of sternoclavicular periosteal and ligamentous structures without vasculonervous injury in a 16-year-old young person. A CT scan examination is essential. Surgical management consisted in costoclavicular ligament and periosteum reattachment associated with reduction of the fracture-separation and pin fixation.This repair demonstrated a successful outcome at 8-month follow-up. PMID:21435963
El Mekkaoui, M J; Sekkach, N; Bazeli, A; Faustin, J M
Cartilage repair is required in a number of orthopaedic conditions and rheumatic diseases. From a macroscopic viewpoint, the complete repair of an articular cartilage defect requires integration of opposing cartilage surfaces or the integration of repair tissue with the surrounding host cartilage. However, integrative cartilage repair does not occur readily or predictably in vivo. Consideration of the 'integrative cartilage repair process', at least in the relatively early stages, as the formation of a adhesive suggests several biomechanical approaches for characterizing the properties of the repair tissue. Both strength of materials and fracture mechanics approaches for characterizing adhesives have recently been applied to the study of integrative cartilage repair. Experimental configurations, such as the single-lap adhesive test, have been adapted to determine the strength of the biological repair that occurs between sections of bovine cartilage during explant culture, as well as the strength of adhesive materials that are applied to opposing cartilage surfaces. A variety of fracture mechanics test procedures, such as the (modified) single edge notch, 'T' peel, dynamic shear, and trouser tear tests, have been used to assess Mode I, II, and III fracture toughness values of normal articular cartilage and, in some cases, cartilaginous tissue undergoing integrative repair. The relationships between adhesive biomechanical properties and underlying cellular and molecular processes during integrative cartilage repair remain to be elucidated. The determination of such relationships may allow the design of tissue engineering procedures to stimulate integrative cartilage repair. PMID:10367013
Ahsan, T; Sah, R L
Modern meniscal repair incorporates multiple techniques and adjunctive measures. The classic inside-out repair remains the gold standard and is most appropriate for a bucket-handle type tear of the medial or lateral meniscus. The all-inside technique has gained in popularity recently and has outcomes that approach those of the inside-out repair with decreased morbidity but increased cost. The choice of this technique is most appropriate for small tears requiring few sutures to repair. Outside-in repair can also be employed and is preferred for anterior horn tears. Surgeons may use a hybrid technique that incorporates all techniques in some challenging cases. Meniscal debridement is used for degenerative tears that are not amenable to repair. Meniscal transplantation is an option for symptomatic meniscal deficiency in young, active patients. This article discusses the technical considerations for meniscal debridement, repair, and transplantation. PMID:21980876
Burns, Travis C; Giuliani, Jeffrey R; Svoboda, Steven J; Owens, Brett D
We report a 5-year-old girl with hypoplastic left heart syndrome who originally underwent a Norwood procedure with a Sano shunt. Subsequent procedures included a bidirectional Glenn and extracardiac Fontan with a Gore-Tex graft (W.L Gore and Associates, Flagstaff, AZ). The patient was found to have a heart murmur on a follow-up visit 3 years later. Echocardiography and computed tomography imaging showed an aneurysm of the proximal Sano anastomosis. The patient underwent successful surgical repair. PMID:22916755
ElZein, Chawki; Subramanian, Sujata; Roberson, David; Husayni, Tarek; Polimenakos, Anastasios; Ilbawi, Michel
|This paper presents arguments for the premise that, from an instructional point of view, the most effective environmental education program is one that provides for proximity congruency (direct interaction with the natural and man-made environment) as opposed to proximity incongruency. The author suggests that if the teacher is interested in…
Nucleotide excision repair (NER) has allowed bacteria to flourish in many different niches around the globe that inflict harsh environmental damage to their genetic material. NER is remarkable because of its diverse substrate repertoire, which differs greatly in chemical composition and structure. Recent advances in structural biology and single-molecule studies have given great insight into the structure and function of NER components. This ensemble of proteins orchestrates faithful removal of toxic DNA lesions through a multistep process. The damaged nucleotide is recognized by dynamic probing of the DNA structure that is then verified and marked for dual incisions followed by excision of the damage and surrounding nucleotides. The opposite DNA strand serves as a template for repair, which is completed after resynthesis and ligation. PMID:23457260
Kisker, Caroline; Kuper, Jochen; Van Houten, Bennett
The pathogenesis of prolapse and the requirements for a successful surgical outcome vary from one person to another. The importance of traditional risk factors is questionable, but failed previous repair is definitely an adverse prognosticator. An ideal operation should re-attach apical support to the pelvic skeleton, restore integrity within anterior and posterior suspensory hammocks and re-distribute some of the expulsive load back onto the pelvic diaphragm. Reasons for failure are best analysed by location; recurrence within the operated compartment should also be distinguished from recurrence in a different compartment. There is no all-encompassing secret to re-operating on recurrent prolapse. Success depends on sound strategic planning and using tactics to negate the greater technical difficulty and reduced collagen strength in women with prior operative failure. If an augmented repair is to be carried out, choice of biomaterials must reflect surgical objectives, movement dynamics and functional anatomy at the intended implantation site. PMID:21353645
Reid, Richard I
Eukaryotic mismatch repair (MMR) has been shown to require two different heterodimeric complexes of MutS-related proteins: MSH2–MSH3 and MSH2–MSH6. These two complexes have different mispair recognition properties and different abilities to support MMR. Alternative models have been proposed for how these MSH complexes function in MMR. Two different heterodimeric complexes of MutL-related proteins, MLH1–PMS1 (human PMS2) and MLH1–MLH3 (human PMS1)
Richard D Kolodner; Gerald T Marsischky
Occurrence of parastomal hernia is considered a near inevitable consequence of stoma formation, making their management a common clinical dilemma. This article reviews the outcomes of different surgical approaches for hernia repair and describes in detail the laparoscopic Sugarbaker technique, which has been shown to have lower recurrence rates than other methods. Also reviewed is the current literature on the impact of prophylactic mesh placement during ostomy formation. PMID:24035081
Shah, Nilay R; Craft, Randall O; Harold, Kristi L
Development and characterization of rabbit proximal tubular epithelial cell lines. We have isolated rabbit kidney proximal tubular epithelial cell lines. The selection was based on their ability to form confluent monolayers on porous supports and to maintain receptor-mediated signal transduction and ion transport, characteristic of the proximal tubule. The isolation method consisted of several steps: (1) superficial cortical proximal tubule
Michael F Romero; Janice G Douglas; Richard L Eckert; Ulrich Hopfer; James W Jacobberger
Collaboration and the exchange of knowledge are supposedly made easier by geographical proximity because of the tacit character of knowledge. Recently a number of scholars' criticised this view on geographical proximity as being oversimplified and argued that the precise role of geographical proximity for knowledge exchange and collaboration still remains unclear. This paper analyses the role of geographical proximity for
Roderik Ponds; Frank van Oort; Koen Frenken
The importance of geographical proximity for interaction and knowledge sharing has been discussed extensively in economic geography in recent years. There is increasing consensus that it is just one out of many types of proximities that might be relevant. We argue that proximity may be a crucial driver for agents to connect and exchange knowledge, but too much proximity between
Tom Broekel; Ron Boschma
The search for safe and effective means of herniorrhaphies has been ongoing for more than a century. Evidence strongly supports tension-free hernia repairs in most patients, which result in a 50% reduction in a ten-year cumulative rate of hernia recurrence compared with tissue repairs. Polypropylene mesh revolutionized the field approximately 50 years ago; however, limitations of traditional polypropylene mesh have fueled the research and development of other prosthetic and biologic mesh products. Newer polyester and expanded polytetrafluoroethylene (ePTFE) products are designed to improve pliability and reduce adhesiogenic potential. Combination meshes capitalize on the ideal properties of biomaterials by strategically positioning particular mesh surfaces to selectively impede or promote tissue ingrowth. The most recent improvement in mesh products is the introduction of "lightweight" meshes. In response to mounting evidence that the traditional formulations of polypropylene meshes are over-engineered, lightweight meshes were designed with less polypropylene per surface area. Future research may prove that most meshes used currently are "mechanical overkill," which may lead to a widespread use of lightweight meshes to provide a durable repair, minimize chronic mesh-related discomfort, and improve the overall quality of life of hernia patients. PMID:17429779
Novitsky, Yuri W; Harrell, Andrew G; Hope, William W; Kercher, Kent W; Heniford, B Todd
Proximity effect, in general, is a major concern for submicron lithography. There are two kinds of proximity effects -- global and local -- normally observed in the submicron lithography processes. Local proximity effect occurs as a result of interaction between adjacent patterns, in which elbow rounding and proximity effect between adjacent contact holes are two typical examples. Global proximity effect is a result of thin film interference of photoresist thickness variation over topography. The critical dimension variation between cell array and periphery patterns is a typical case. In this paper we discuss several process approaches to the solution of global proximity effect. An optimum process to minimize the global proximity effect is described.
Lee, Daniel H.; Chu, Ron
Delayed treatment of a quadriceps rupture is an infrequent but difficult situation. The fibrous degeneration and muscle retraction and subsequent hiatus present a challenging technical problem. A 54-year-old laborer with a 7-week quadriceps rupture was treated by a method that seems not to have been previously reported. At surgery there was a 9-cm gap that could not be approximated by either a Bunnell suture, or Codvilla lengthening of Scuderi inverted triangle. Repair was successfully accomplished by transposing the inner one-third of the patellar tendon. The tendon was split longitudinally and separated from the medial and lateral aspects in a distal to proximal direction with an osteoperiosteal flap. This was proximally sutured across the gap in the quadriceps mechanism. Eighteen months postoperatively there was no extension lag with knee range of motion of 0 degrees-125 degrees and good power. PMID:7371293
Chekofsky, K M; Spero, C R; Scott, W N
We present a case of Achilles tendon rupture in a 54-year-old man whilst rehabilitating following end-to-end open repair of an acute Achilles tendon rupture. Re-rupture following surgical repair of Achilles tendon is well known. This case however, is atypical as the second rupture occurred significantly proximal to the first rupture. To our knowledge this is the first time this has been described in the English literature. We have termed this incident a 'second rupture'. We describe the surgical technique used by the operating surgeon during open repair of this 'second rupture', involving a gastrocnemius flap turndown. This has lead to the patient making a good recovery, despite complications. This case report serves to inform surgeons of the existence of this type of Achilles tendon rupture, whilst considering possible aetiologies and suggesting a technique for repair of the injury. PMID:21549964
Rushton, P R P; Singh, A K; Deshmukh, R G
Background: The RapidLoc is an all-inside, self-adjusting, flexible meniscal repair device that combines a suture with an anchor component and, by using a reinforced sliding knot, allows for tightening to compress and hold the repaired meniscal segments. The purpose of this study was to evaluate the clinical success of the RapidLoc device. Methods: A prospective consecutive series of meniscal repairs
F. Alan Barber; David A. Coons; Michell Ruiz-Suarez
The finding of a double-chambered right ventricle (DCRV) is exceptionally rare as an isolated anomaly. It is a congenital cardiac anomaly in which the right ventricle is separated into two chambers, a proximal high-pressure chamber and a distal low-pressure chamber, by anomalous muscles or fibrous tissues in the right ventricular cavity. We report the case of a 6-year-old infant who was admitted for growth retardation. The patient was diagnosed with an isolated DCRV without any other associated congenital anomalies. The patient underwent a successful cardiac surgical procedure of enlargement repair; he was discharged in good clinical condition with a normal cardiac function. PMID:23860078
El Kouache, M; Babakhoya, A; Labib, S; El Madi, A; Atmani, S; Harandou, M; Abouabdilah, Y; Hida, M
Lateral reattachment of the rotator cuff and the more recent introduction of the double-row rotator cuff repair technique require adequate visualization to define the rotator cuff footprint and the greater tuberosity. In many cases extensive debridement in this area is required to remove the overlying subdeltoid bursa, which can impair visualization laterally on the proximal humerus. Inadequate visualization laterally may lead to improper placement of the lateral row of fixation, compromising the reduction and fixation of the repaired rotator cuff tendon. We describe a surgical technique used to improve lateral visualization of the proximal humerus for placement of lateral anchors during arthroscopic rotator cuff repair using a Foley catheter. The end of a 14F-diameter Foley catheter is cut just proximal to the balloon end. One to three catheters are introduced in the subacromial space through small anterolateral or posterolateral portals and inflated with 15 mL of air. Adequate distension of the subacromial space allows better visualization, triangulation of the arthroscopic instruments, and anatomic repair of the rotator cuff tendon. PMID:19664512
Kilinc, Alexandre S; Ebrahimzadeh, Mohammad H; Lafosse, Laurent
Abdominal aortic aneurysms (AAAs) are classified as juxtarenal if their proximal extent is next to the origin of the renal arteries but does not involve them. An AAA is suprarenal if it extends above at least one renal artery and ends below the celiac axis. Juxtarenal AAAs need inter-renal or suprarenal clamping, with the aortic reconstruction usually made at the infrarenal level. Aneurysms requiring suprarenal clamping, often supraceliac, and the reconstruction (direct attachment or bypass) of at least one renal artery, are often defined as suprarenal AAAs. Endovascular aortic repair (EVAR) is feasible in most of cases of infrarenal AAAs and has been shown to be as effective as open repair (OR) in reducing aneurysm-related mortality and perioperative mortality with shorter length of stay. However, the feasibility of standard EVAR with an on-label use of commercially available devices is limited in the juxtarenal aorta. In our series, approximately, 20% to 30% of patients with an AAA are considered not eligible for standard EVAR owing to their anatomy, and in the most of the cases are patients with juxtarenal AAAs. Fenestrated and branched endografts and newer "off the shelf" techniques (such as chimney, periscope, sandwich) have been recently described, all with the purpose of widening the therapeutic range of EVAR to the treatment of aneurysms with involvement of renal and visceral arteries. However, safety, efficacy, long-term results, and cost-effectiveness of these expensive techniques have still to be carefully assessed. For these reasons, the OR is currently still considered the gold standard for treatment of juxtarenal AAAs, reserving endovascular strategies mainly for high-risk patients having comorbidities or other contraindications for conventional repair. If compared to open repair of infrarenal AAAs, juxtarenal AAA OR is technically more complex and might require specific organ-protection strategies in order to minimize ischemia-reperfusion injury to kidneys and visceral organs. Because of the complexity of the surgical procedure and of the multiple clinical problems, an optimal operative strategy for the treatment of juxtarenal AAAs has not been established yet. The choice of the surgical access, clamping level, methods of organ protection and their impact on renal, respiratiry, cardiac and gastrointestinal morbidity are still debated issues. PMID:23443588
Chiesa, R; Tshomba, Y; Mascia, D; Rinaldi, E; Logaldo, D; Civilini, E
Meniscus injury is common in today's active society. Despite the frequent presentation of meniscus injury, the decision to repair or resect a torn meniscus is not always straightforward. Current repair techniques are effective in the peripheral vascularized meniscus, but their success is not dependable in the avascularized zone. Tissue engineering, a discipline that combines the technologies of cell culture and biodegradable scaffolds to deliver a cellular repair, may be one future answer to this problem. The concept of using cell-based repair for torn menisci could improve healing of lesions in the avascular zone and broadly expand the indication for repair rather than removal, obviating the need for meniscectomy. This article reviews current advances in the relatively new field of tissue engineering toward the development of a tissue-engineered meniscal repair technique. PMID:15742594
Adams, Samuel B; Randolph, Mark A; Gill, Thomas J
Triplot is used to portray the three-dimensional concepts--literate, proximate illiterate and secluded illiterate. Pictographic portrayal complemented with a method proposed to calculate distance between situations enhances comparison. Illustration with Indian data explains change over time, rural-urban divide, and social gap.
Proximal gastric vagotomy is nearing its twentieth year in clinical use as an operation for peptic ulcer disease. No other acid-reducing operation has undergone as much scrutiny or study. At this time, the evidence of such studies and long-term follow-up strongly supports the use of proximal gastric vagotomy as the treatment of choice for chronic duodenal ulcer in patients who have failed medical therapy. Its application in treating the complications of peptic ulcer disease, which recently have come to represent an increasingly greater percentage of all operations done for peptic ulcer disease, is well-tested. However, initial series suggest that it should probably occupy a prominent role in treating some of these complications, particularly in selected patients, in the future. The operation has the well-documented ability to reduce gastric acid production, not inhibit gastric bicarbonate production, and also minimally inhibit gastric motility. The combination of these physiologic results after proximal gastric vagotomy, along with preservation of the normal antropyloroduodenal mechanism of gastrointestinal control, serve to allow patients with proximal gastric vagotomy the improved benefits of significantly fewer severe gastrointestinal side effects than are seen after other operations for peptic ulcer disease. PMID:2644897
Schirmer, B D
23 years old male presented with inferolateral dislocation of proximal tibiofibular joint associated with popliteal artery and common peroneal nerve injury. The extension of the injury to involve the interosseus membrane up to the distal tibiofibular joint. The association of popliteal artery injury is not reported before to the best of our knowledge. PMID:23162155
Veerappa, Lokesh A; Gopalakrishna, Chetan
The goal of this study is to investigate the nonlinear dynamics of two ships in close proximity towing. The sway and yaw dynamics of both the leading and the trailing ships were included in the formulation. Previous studies were restricted to a linear ana...
The 'pocket formula' for the proximity potential is generalized for collisions of any two (equal or unequal) deformed nuclei, having any degree of (equal or unequal) orientations (from 0 deg. to 180 deg. ) in space. The method is applied to axially symmetric coplaner nuclei. The case of noncoplaner nuclei will be dealt with in a separate publication.
Gupta, Raj K.; Singh, Narinder; Manhas, Monika [Physics Department, Panjab University, Chandigarh-160014 (India)
A hierarchical rule based optical proximity effect correction approach is presented. The approach has been driven by maskmaking and production requirements to make OPC a practical problem solution. The model based rule generation is presented, as well as benchmark tests on different state-of- the-art test chips.
Anja Rosenbusch; Andrew C. Hourd; Casper A. Juffermans; Hartmut Kirsch; Frederic P. Lalanne; Wilhelm Maurer; Carmelo Romeo; Kurt Ronse; Patrick Schiavone; Michal Simecek; Olivier Toublan; John G. Watson; Wolfram Ziegler; Rainer Zimmermann
A hierarchical rule based optical proximity effect correction approach is presented. The approach has been driven by maskmaking and production requirements to make OPC a practical problem solution. The model based rule generation is presented, as well as benchmark tests on different state-of- the-art test chips.
Rosenbusch, Anja; Hourd, Andrew C.; Juffermans, Casper A.; Kirsch, Hartmut; Lalanne, Frederic P.; Maurer, Wilhelm; Romeo, Carmelo; Ronse, Kurt; Schiavone, Patrick; Simecek, Michal; Toublan, Olivier; Watson, John G.; Ziegler, Wolfram; Zimmermann, Rainer
Proceeding from assumptions about interests and costs, two basic questions about the relation of foreign military intervention and geographic proximity are examined: (1) whether various types of intervening countries usually send troops to distant or nearby states; (2) whether certain types of military intervention are more likely to occur near to or far from the intervener. Data on categories of
Frederic S. Pearson
As the critical dimensions required in mask making and direct write by electron beam lithography become ever smaller, correction for proximity effects becomes increasingly important. Furthermore, the problem is beset by the fact that only a positive energy dose can be applied with an electron beam. We discuss techniques such as chopping and dose shifting, which have been proposed to meet the positivity requirement. An alternative approach is to treat proximity correction as an optimization problem. Two such methods, local area dose correction and optimization using a regularizer proportional to the informational entropy of the solution, are compared. A notable feature of the regularized proximity correction is the ability to correct for forward scattering by the generation of a 'firewall' set back from the edge of a feature. As the forward scattering width increases, the firewall is set back farther from the feature edge. The regularized optimization algorithm is computationally time consuming using conventional techniques. However, the algorithm lends itself to a microelectronics integrated circuit coprocessor implementation, which could perform the optimization faster than even the fastest work stations. Scaling the circuit to larger number of pixels is best approached with a hybrid serial/parallel digital architecture that would correct for proximity effects over 108 pixels in about 1 h. This time can be reduced by simply adding additional coprocessors.
Marrian, Christie R.; Chang, Steven; Peckerar, Martin C.
As the critical dimensions required for masks and e-beam direct write become ever smaller, the correction of proximity effects becomes more necessary. Furthermore, the problem is beset by the fact that only a positive energy dose can be applied with the e-beam. We discuss here approaches such as chopping and dose shifting which have been proposed to meet the positivity requirement. An alternative approach is to treat proximity correction as an optimization problem. Two such methods, local area dose correction and optimization using a regularizer proportional to the informational entropy of the solution, are compared. A notable feature of the regularized proximity correction is the ability to correct for forward scattering by the generation of a 'firewall' set back from the edge of a feature. As the forward scattering width increases, the firewall is set back further from the feature edge. The regularized optimization algorithm is computationally time consuming using conventional techniques. However, the algorithm lends itself to a microelectronics integrated circuit coprocessor implementation which could perform the optimization much faster than even the fastest work stations. Scaling the circuit to larger number of pixels is best approached with a hybrid serial/parallel digital architecture which would correct for proximity effects over 108 pixels about one hour. This time can be reduced by simply adding additional coprocessors.
Marrian, Christie R.; Chang, S.; Peckerar, Martin C.
Problem statement: Dragon fruit (Hylecereus polyhizus ) is well known for the rich nutrient contents and it is commercially available worldwide for improving many health problems. Several studies show the proximity value of red pitaya frui ts but the nutrient composition of the stem has not been extensively studied. Approach: This study was carried out to measure the proximat e
Ruzainah Ali Jaafar; Ahmad Ridhwan; R. Vasudevan
Calciphylaxisisarareconditionaffectingpatientssuffering from end-stage renal failure, characterised by cutaneous ischaemia and necrosis. The management of calciphylaxis is challenging owing to the lack of optimal medical therapy, although parathyroidectomy has shown some benefit. We present a case of severe proximal calciphylaxis treated with a small dose of the calcimimetic 'Cinacalcet'.
Ismail A. Mohammed; Vashisht Sekar; Abdullah J. Bubtana; Sandip Mitra; Alastair J. Hutchison
In a review of more than 1000 patients with operatively managed abdominal trauma, eight patients with injuries to the proximal parts of the superior mesenteric artery or vein were identified: three with either a superior mesenteric artery or vein injury and two with combined superior mesenteric vessel injuries. All patients were in shock on arrival, and had associated abdominal injuries.
Ari K. Leppäniemi; Hannu O. Savolainen; Jarmo A. Salo; Pertti T. Aarnio
The use of the theoretical tools provided by proximity economics to address environmental questions, and the emergence of analyses revitalising the role of the spatial dimension in environmental problems, date from the late 1990s. This paper first aims to provide a review of the research conducted in this field and second to suggest some future research directions concerning the respective
André Torre; Bertrand Zuindeau
The AFM-technology has undergone tremendous development during the past decade. This review is devoted to the realization of piezoresistive sensors used in scanning probe microscopy at University of Kassel. It is expected that in the near future major technological breakthroughs in scanning proximal probe nanotools will allow for key scientific impact on analysis and synthesis of nanostructures. All the piezoresistive
Ivo W. Rangelow
The ideal management of complex proximal humeral fractures continues to be debatable. Evolution of proximal humeral fracture management, during the past decade, led to the implementation of many innovations in surgical treatment. Even though the pendulum of treatment seems to swing towards new trends such as locked plating, hemiarthroplasty remains a valid and reliable option that serves the patient's needs well. Hemiarthroplasty is indicated for complex proximal humeral fractures in elderly patients with poor bone stock and when internal fixation is difficult or unreliable. Hemiarthroplasty provides a better result when it is performed early post-injury. Stem height, retroversion and tuberosity positioning are technical aspects of utmost importance. Additionally reverse total shoulder arthroplasty is an alternative new modality that can be used as a primary solution in selected patients with proximal humeral fracture treatment. Failed hemiarthroplasty and fracture sequelae can be successfully managed with reverse total shoulder arthroplasty. Individual decision-making and tailored treatment that takes into consideration the personality of the fracture and the patient's characteristics should be used. PMID:19036360
Kontakis, George; Tosounidis, Theodoros; Galanakis, Ioannis; Megas, Panagiotis
Short abstract The empathy literature is characterized by debate regarding the nature of the phenomenon. We propose a unified theory of empathy, divided into ultimate and proximate levels, grounded in the emotional link between individuals. On an ultimate level, emotional linkage supports group alarm, vicariousness of emotions, mother-infant responsiveness, and the modeling of competitors and predators; these exist across species
Stephanie D. Preston
Most of our understanding of DNA repair mechanisms in human cells has come from the study of these processes in cultured fibroblasts. The unique properties of keratinocytes and their pattern of terminal differentiation led us to a comparative examination of their DNA repair properties. The relative repair capabilities of the basal cells and the differentiated epidermal keratinocytes as well as possible correlations of DNA repair capacity with respect to age of the donor have been examined. In addition, since portions of human skin are chronically exposed to sunlight, the repair response to ultraviolet (UV) irradiation (254 nm) when the cells are conditioned by chronic low-level UV irradiation has been assessed. The comparative studies of DNA repair in keratinocytes from infant and aged donors have revealed no significant age-related differences for repair of UV-induced damage to DNA. Sublethal UV conditioning of cells from infant skin had no appreciable effect on either the repair or normal replication response to higher, challenge doses of UVL. However, such conditioning resulted in attenuated repair in keratinocytes from adult skin after UV doses above 25 J/m2. In addition, a surprising enhancement in replication was seen in conditioned cells from adult following challenge UV doses.
Liu, S.C.; Parsons, S.; Hanawalt, P.C.
Abdominal aortic aneurysm repair has undergone a revolution since Volodos and Parodi described endoluminal repair in the early 1990s. Subsequent data from large registries have confirmed its efficacy. Randomised controlled trials have shown that although endoluminal repair may not be as cost effective as open repair, it can be performed with a lower mortality in patients fit for open repair.
M Davis; P R Taylor
Tendon connects muscle to bone and functions to transmit muscular forces across joints to stabilize or move those joints. Tendons in the foot and ankle are subject to enormous loads and consequently make up a substantial portion of the body's tendon injuries. Understanding the mechanisms of these injuries requires an understanding of the relative rates of muscle, tendon, osteotendinous junction, and myotendinous junction adaptation. This article provides the practitioner with an overview of tendon anatomy, physiology, healing, and repair and correlates didactic and clinical aspects so that practitioners can better treat patients and get them back to normal functioning as quickly and as close to anatomic and physiologic capabilities as possible. PMID:16213379
Platt, Marc A
Loss of experimental animals due to tendon repair failure results in the need for additional animals to complete the study. We designed a relief proximal to the flexor digitorum profundus (FDP) tendon repair site to serve as a “safety incision” to prevent repair site ruptures and maximize safety incision-to-suture strength. The FDP tendons were dissected in 24 canine forepaws. The 2nd and 5th tendons were lacerated at the proximal interphalangeal joint level and sutured using a modified Kessler technique and peripheral running suture. Tendon width was measured where the FDP tendon separates into each individual digit and a safety incision, equal to the 2nd and 5th tendon widths, was performed 3, 4, or 5 mm (Groups 1, 2, and 3) proximal to the separation. The tendons were pulled at a rate of 1 mm/s until either the “safety incision” ruptured or the repair failed. There was no gap formation at the repair site in Groups 1 and 2. However, all Group 3 tendons failed by repair site rupture with the safety incision intact. An adequate safety incision to protect repair gap and rupture and maintain tendon tension for the FDP animal model should be about 4 mm from where the FDP tendon separates.
Giambini, Hugo; Ikeda, Jun; Amadio, Peter C.; An, Kai-Nan; Zhao, Chunfeng
\\u000a In 1996 a conference was held in Europe to discuss the ramifications of a number of disturbing clinical observations relating\\u000a to male reproductive health. The rate of testicular cancer was noted to be increasing in many countries (Weybridge, 1995). Additionally these same countries were noted to have increasing problems with male infertility correlated with decreasing\\u000a sperm counts (Carlesen et al.,
George F. Steinhardt
Background Obesity is associated with glomerular hyperfiltration, increased proximal tubular sodium reabsorption, glomerular enlargement and renal hypertrophy. A single experimental study reported an increased glomerular urinary space in obese dogs. Whether proximal tubular volume is increased in obese subjects and whether their glomerular and tubular urinary spaces are enlarged is unknown. Objective To determine whether proximal tubules and glomerular and tubular urinary space are enlarged in obese subjects with proteinuria and glomerular hyperfiltration. Methods Kidney biopsies from 11 non-diabetic obese with proteinuria and 14 non-diabetic lean patients with a creatinine clearance above 50 ml/min and with mild or no interstitial fibrosis were retrospectively analyzed using morphometric methods. The cross-sectional area of the proximal tubular epithelium and lumen, the volume of the glomerular tuft and of Bowman’s space and the nuclei number per tubular profile were estimated. Results Creatinine clearance was higher in the obese than in the lean group (P=0.03). Proteinuria was similarly increased in both groups. Compared to the lean group, the obese group displayed a 104% higher glomerular tuft volume (P=0.001), a 94% higher Bowman’s space volume (P=0.003), a 33% higher cross-sectional area of the proximal tubular epithelium (P=0.02) and a 54% higher cross-sectional area of the proximal tubular lumen (P=0.01). The nuclei number per proximal tubular profile was similar in both groups, suggesting that the increase in tubular volume is due to hypertrophy and not to hyperplasia. Conclusions Obesity-related glomerular hyperfiltration is associated with proximal tubular epithelial hypertrophy and increased glomerular and tubular urinary space volume in subjects with proteinuria. The expanded glomerular and urinary space is probably a direct consequence of glomerular hyperfiltration. These effects may be involved in the pathogenesis of obesity-related renal disease.
Benchetrit, Sydney; Milo, Gai; Herman-Edelstein, Michal; Zingerman, Boris; Lev, Netta; Gafter, Uzi; Chagnac, Avry
The chimney technique in endovascular aortic aneurysm repair (Ch-EVAR) involves placement of a stent or stent-graft parallel to the main aortic stent-graft to extend the proximal or distal sealing zone while maintaining side branch patency. Ch-EVAR can facilitate endovascular repair of juxtarenal and aortic arch pathology using available standard aortic stent-grafts, therefore, eliminating the manufacturing delays required for customised fenestrated and branched stent-grafts. Several case series have demonstrated the feasibility of Ch-EVAR both in acute and elective cases with good early results. This review discusses indications, technique, and the current available clinical data on Ch-EVAR. PMID:23674274
Patel, Rakesh P; Katsargyris, Athanasios; Verhoeven, Eric L G; Adam, Donald J; Hardman, John A
Root tears are a subset of meniscal injuries that result in significant knee joint pathology. Occurring on either the medial or lateral side, root tears are defined as radial tears or avulsions of the posterior horn attachment to bone. After a root tear, there is a significant increase in tibio-femoral contact pressure concomitant with altered knee joint kinematics. Previous cadaver studies from our institution have shown that root repair of the medial meniscus is successful in restoring joint biomechanics to within normal limits. Indications for operative management of meniscal root tears include (1) a symptomatic medial meniscus root tear with minimal arthritis and having failed non-operative treatment, and (2) a lateral root tear in associated with an ACL tear. In this review, we describe diagnosis, imaging, patient selection, and arthroscopic surgical technique of medial and lateral meniscus root injuries. In addition we highlight the pearls of repair technique, associated complications, post-operative rehabilitation regimen, and expected outcomes. PMID:22555205
Vyas, Dharmesh; Harner, Christopher D
This paper describes British Airways experience with composite repairs since 1970. It includes the use of composite materials to repair metal structures such as Concorde wing leading edges and traces the repair of composite parts from Radomes starting in ...
K. B. Armstrong
Penile chordee, with and without hypospadias, is amenable to surgical correction. The Nesbit technique of dorsal plication of the ventral tunica albuginea is effective in correcting most cases of corporal disproportion. A hazard with this approach is the potential inclusion of the dorsal neurovascular bundle, with resultant erectile and sensory dysfunction. We developed a simple technique using the Freer elevator to isolate the neurovascular bundle prior to plication. This ensures that no injury occurs to the neurovascular bundle during plication. Since 1994, 37 boys with chordee have been repaired using this approach. Their ages at the time of operation ranged from 5 months to 28 years (mean 9 months). Following standard degloving of the penis, an incision through Buck's fascia is made lateral and parallel to the neurovascular bundle at the maximum level of the chordee. A similar incision is carried out on the contralateral side. A 4-mm-wide Freer elevator is positioned under Buck's fascia while hugging the tunica albuginea. The Freer elevator slides across the midline to the contralateral side, separating Buck's fascia and underlying layers from the tunica albuginea. Following isolation of the bundle, each corporal body is plicated by creating a longitudinal incision through the tunica albuginea, which then is closed transversely with a 5-0 polydioxanone suture. Buck's fascia subsequently is closed with an absorbable suture following confirmation of chordee correction. No complications have been encountered during a mean follow-up of 21 months (range 5-51 months). No patients have required reoperation for persistent chordee. We developed a technique that elevates the neurovascular bundle prior to plication, thereby ensuring no injury to this structure. We have successfully used this modified Nesbit technique since 1994 and have had no complications. Utilization of the Freer elevator adds an estimated 5 minutes to chordee correction compared to a standard plication lateral to the neurovascular bundles. Although long-term follow-up needs to be performed to confirm any erectile or sensory advantage, this approach should be considered whenever plication is to be performed. PMID:10708139
Dean, G E; Burno, D K; Zaontz, M R
|The curriculum guide was developed to serve as a statewide model for Virginia auto body repair programs. The guide is designed to 1,080 hours of instruction in eleven blocks: orientation, introduction, welding and cutting, techniques of shaping metal, body filler and fiberglass repairs, body and frame, removing and replacing damaged parts, basic…
Virginia Polytechnic Inst. and State Univ., Blacksburg. Dept. of Education.
The effects of intermittent work patterns and funding on the costs of ship repair and maintenance were modeled for the San Diego region in 2002 for Supervisor of Shipbuilding and Repair (SUPSHIP) San Diego. One of the shipyards that participated in the st...
M. McDevitt M. Zabarouskas J. Crook
This module is a comprehensive text on basic appliance repair, designed to prepare students for entry-level jobs in this growing field. Ensuring a firm grounding in electrical knowledge, the module contains 13 instructional units that cover the following topics: (1) major appliance repair orientation; (2) safety and first aid; (3) fundamentals of…
Smreker, Eugene; Calvert, King
Epithelioid sarcoma, first described by Enzinger in 1970, is a rare soft-tissue sarcoma typically presenting as a subcutaneous or deep dermal mass in distal portions of the extremities of adolescents and young adults. In 1997, Guillou et al. described a different type of epithelioid sarcoma, called proximal-type epithelioid sarcoma, which is found mostly in the pelvic and perineal regions and genital tracts of young to middle-aged adults. It is characterized by a proliferation of epithelioid-like cells with rhabdoid features and the absence of a granuloma-like pattern. In this paper we present a case of proximal-type epithelioid sarcoma with an aggressive clinical course, including distant metastasis and death nine months after diagnosis.
dos Santos, Luciana Mendes; Nogueira, Lisiane; Matsuo, Christiane Yuri; Talhari, Carolina; Santos, Monica
Centromere-near gain of copy number can be induced by intra- or inter-chromosomal rearrangements or by the presence of a small supernumerary marker chromosome (sSMC). Interestingly, partial trisomy to hexasomy of euchromatic material may be present in clinically healthy or affected individuals, depending on origin and size of chromosomal material involved. Here we report the known minimal sizes of all centromere-near, i.e., proximal auto-somal regions in humans, which are tolerated; over 100 Mb of coding DNA are comprised in these regions. Additionally, we have summarized the typical symptoms for nine proximal autosomal regions including genes obviously sensitive to copy numbers. Overall, studying the carriers of specific chromosomal imbalances using genomics-based medicine, combined with single cell analysis can provide the genotype-phenotype correlations and can also give hints where copy-number-sensitive genes are located in the human genome.
Hamid, AB; Weise, A; Voigt, M; Bucksch, M; Kosyakova, N; Liehr, T; Klein, E
Silicone implant arthroplasty (SIA) has been an effective alternative in the treatment of arthritic conditions of the proximal interphalangeal (PIP) joints since its introduction into surgical practice in the early 1960s. Patients with post-traumatic, degenerative, and rheumatoid arthritis all may be candidates for PIP joint SIA. The indications for SIA of the PIP joint include pain, limited joint mobility, and angular deformity of the joint with underlying articular destruction. Contraindications include ankylosis of the joint due to bony or soft-tissue restrictions, infection, inadequate soft-tissue support for coverage, absence of flexor and/or extensor tendon function, and considerable periarticular bone loss in the proximal and middle phalanges. Proximal interphalangeal joint SIA can be accomplished by dorsal, volar, or midaxial approaches. The dorsal approach has the advantages of relative technical ease, excellent visibility of the articular surfaces for preparation of the implant canals, access to the extensor mechanism for correction of central slip abnormalities, and preservation of the collateral ligaments. The surgical technique is outlined and includes handling of the extensor mechanism and central slip attachment, mobilization of the collateral ligaments, joint surface resection, preparation of the bony canals, implant sizing, implant insertion, and repair of the soft tissues. Pearls and pitfalls of the technique are outlined. Early postoperative mobilization with hand therapy is essential but must include protection of the repaired extensor apparatus. Complications include bony changes, implant failure, recurrent angular deviation or swan-neck deformity, particulate synovitis, and rarely, infection. Complications related to implant failure are most often managed with implant replacement or arthrodesis; those related to poor mobility, angular deformity and tendon imbalance, pain, or infection are managed by arthrodesis. Although SIA of the PIP joint has a relatively high degree of success when measured both subjectively and objectively, careful patient selection is important for achieving desirable results. PMID:17606076
Bickel, Kyle D
We report results using a novel 3 terminal device to study the influence of the superconducting proximity effect on the sheet resistance of the N-layer, Rs, as well as the junction conductance across the N-S boundary, Gc. When the N-layer is a degenerate semiconductor the changes in these quantities are large. In samples with large Gc, we find that the
Michael Vissers; Kevin Inderhees; Tim McArdle; Stephanie Law; Paul Goldbart; Laura Greene; Jim Eckstein
Temperature changes in the resting proximal human forearm have been studied non-invasively, using computer simulation. A procedure for spatial model generation, based on digitized slice data, has been applied. A mathematical model and a 3-D computer simulation program have been implemented. Heat transfer in the non-homogenous tissue was modeled with a well known bio-heat equation. The heat production by tissue
Roman Trobec; Matjaž Depolli
The proximity effect at superconductor-ferromagnet interfaces produces damped oscillatory behavior of the Cooper pair wave function within the ferromagnetic medium. This is analogous to the inhomogeneous superconductivity, predicted long ago by Fulde and Ferrell (P. Fulde and R. A. Ferrell, 1964, ``Superconductivity in a strong spin-exchange field,'' Phys. Rev. 135, A550-A563), and by Larkin and Ovchinnikov (A. I. Larkin and
A. I. Buzdin
Observed upper air soundings that occurred within 2 h and 167 km of derechos were collected and analyzed to document atmospheric stability and wind shear conditions associated with long-lived convective windstorms. Sixty-seven derechos, accompanied by 113 proximity soundings, were identified during the years 1983-93. Owing to the large variability of the synoptic-scale environments associated with derechos, each derecho was further
Jeffry S. Evans; Charles A. Doswell III
Wound repair on the cellular and multicellular levels is essential to the survival of complex organisms. In order to avoid further damage, prevent infection, and restore normal function, cells and tissues must rapidly seal and remodel the wounded area. The cytoskeleton is an important component of wound repair, needed for actomyosin contraction, recruitment of repair machineries, and cell migration. Recent use of model systems and high-resolution microscopy has provided new insight into molecular aspects of the cytoskeletal response during wound repair. Here we discuss the role of the cytoskeleton in single cell, embryonic, and adult repair, as well as the striking resemblance of these processes to normal developmental events and many diseases.
Abreu-Blanco, Maria Teresa; Watts, James J.; Verboon, Jeffrey M.; Parkhurst, Susan M.
Proximal myopathy presents as symmetrical weakness of proximal upper and/or lower limbs. There is a broad range of underlying causes including drugs, alcohol, thyroid disease, osteomalacia, idiopathic inflammatory myopathies (IIM), hereditary myopathies, malignancy, infections and sarcoidosis. Clinical assessment should aim to distinguish proximal myopathy from other conditions that can present similarly, identify patients who need prompt attention, like those with cardiac, respiratory or pharyngeal muscle involvement, and determine underlying cause of myopathy. Initial evaluation should include simple tests, like creatine kinase, thyroid function and (25)OH vitamin D levels, but further evaluation including neurophysiological studies, muscle imaging and muscle biopsy should be considered for patients in whom no toxic, metabolic or endocrine cause is found, and in those with clinical features suggestive of inflammatory or hereditary myopathy. Additionally, screening for malignancy and testing for anti-Jo1 antibody is indicated for selected patients with IIM. Management depends on underlying cause, and includes measures, such as removal of offending agent, correction of endocrine or metabolic problem, corticosteroids and immunosuppressive therapy for IIM, and physical therapy, rehabilitation and genetic counselling for muscular dystrophies. PMID:23596213
Suresh, Ernest; Wimalaratna, Sunil
Topological insulators (TIs) are bulk insulators that possess robust helical conducting states along their interfaces with conventional insulators. A tremendous research effort has recently been devoted to Tl-based heterostructures, in which conventional proximity effects give rise to a series of exotic physical phenomena. This paper reviews our recent studies on the potential existence of topological proximity effects at the interface between a topological insulator and a normal insulator or other topologically trivial systems. Using first-principles approaches, we have realized the tunability of the vertical location of the topological helical state via intriguing dual-proximity effects. To further elucidate the control parameters of this effect, we have used the graphene-based heterostructures as prototypical systems to reveal a more complete phase diagram. On the application side of the topological helical states, we have presented a catalysis example, where the topological helical state plays an essential role in facilitating surface reactions by serving as an effective electron bath. These discoveries lay the foundation for accurate manipulation of the real space properties of the topological helical state in TI-based heterostructures and pave the way for realization of the salient functionality of topological insulators in future device applications.
Li, Xiao-Guang; Zhang, Gu-Feng; Wu, Guang-Fen; Chen, Hua; Dimitrie, Culcer; Zhang, Zhen-Yu
Topological insulators (TI) are bulk insulators that possess robust chiral conducting states along their interfaces with normal insulators. A tremendous research effort has recently been devoted to TI-based heterostructures, in which conventional proximity effects give rise to many exotic physical phenomena. Here we establish the potential existence of ``topological proximity effect'' at the interface of a topological graphene nanoribbon (GNR) and a normal GNR. Specifically, we show that the location of the topological edge states exhibits versatile tunability as a function of the interface orientation, as well as the strengths of the interface coupling and spin-orbit coupling in the normal GNR. For zigzag and bearded GNRs, the topological edge state can be tuned to be either at the interface or outer edge of the normal ribbon. For armchair GNR, the potential location of the topological edge state can be further enriched to be at the edge of or within the normal ribbon, at the interface, or diving into the topological GNR. We also discuss potential experimental realization of the predicted topological proximity effects, which may pave the way for integrating the salient functionality of TI and graphene in future device applications.
Zhang, Gufeng; Li, Xiaoguang; Wu, Guangfen; Wang, Jie; Culcer, Dimitrie; Kaxiras, Efthimios; Zhang, Zhenyu
Involutional lower-eyelid entropion has three underlying correctable causes: eyelid laxity, overriding of the orbicularis oculi muscle, and attenuation of the lower-eyelid retractors. We describe a new technique for correcting this problem. A transconjunctival approach is used to advance or fortify the lower-eyelid retractors. The orbicularis oculi muscle can also be addressed through this approach. Combining this technique with lateral canthal resuspension anatomically corrects the entropion by addressing all three correctable causes. Transconjunctival blepharoplasty can also be performed in conjunction with this technique. Twenty-three eyelids of 18 patients successfully underwent this procedure. Six patients underwent simultaneous transconjunctival blepharoplasty. Follow-up ranged between 9 and 18 months. There were no postoperative recurrences, overcorrections, or lower-eyelid retraction. This approach yields a stable and definitive repair of involutional entropion with excellent postoperative cosmesis. PMID:8352697
Dresner, S C; Karesh, J W
Healthy skeletal muscle has a remarkable capacity for regeneration. Even at a mature age, muscle tissue can undergo a robust rebuilding process that involves the formation of new muscle cells and extracellular matrix and the re-establishment of vascular and neural networks. Understanding and reverse-engineering components of this process is essential for our ability to restore loss of muscle mass and function in cases where the natural ability of muscle for self-repair is exhausted or impaired. In this article, we will describe current approaches to restore the function of diseased or injured muscle through combined use of myogenic stem cells, biomaterials, and functional tissue-engineered muscle. Furthermore, we will discuss possibilities for expanding the future use of human cell sources toward the development of cell-based clinical therapies and in vitro models of human muscle disease. PMID:23711735
Juhas, Mark; Bursac, Nenad
Detroit Edison's St. Clair Power Plant (STCPP) Units 1 through 4 are 1950's vintage fossil fueled units with an average capacity of 163 megawatt per unit. Each unit had identical 2190 ton bunkers. The Unit No. 1 bunker had been experiencing noticeable exterior deterioration at the lower level internal support system. An internal bunker inspection revealed large deflections in the network of beams supporting the bunker side walls. A complete collapse of the internal support beams was imminent. Failure of these beams would have transferred the coal pressure loads to the bunker skin and external stiffeners which were not capable of sustaining the load and were also showing signs of distress. This paper presents the temporary repair installed immediately after inspection, the redesign of the lower internal support system and construction procedures involved in bringing the bunker back into operating condition.
Emmons, M.H.; Hoffman, M.G. (Detroit Edison Co., MI (United States))
Using the three versions of proximity potentials, namely proximity 1977, proximity 1988, and proximity 2000, we present a pocket formula for fusion barrier heights and positions. This was achieved by analyzing as many as 400 reactions with mass between 15 and 296. Our parametrized formula can reproduced the exact barrier heights and positions within an accuracy of +-1%. A comparison with the experimental data is also in good agreement.
Dutt, Ishwar; Puri, Rajeev K. [Department of Physics, Panjab University, Chandigarh 160014 (India)
This paper addresses the question of whether proximity is always necessary for interactive learning, as proposed by recent European innovation theory. Recent research has provided a refined conceptualization of proximity, but there is little empirically-based knowledge about the actual role that proximity plays in relationships intended to foster…
The geography of innovation has established itself as a central subject in economic geography. Geographical proximity to firms and organizations like universities is supposed to have a positive effect on a firmsâ€™ innovative performance. One of the reasons causing these positive agglomeration effects is the fact that collaboration is eased by geographical proximity. Although the role of proximity for collaboration
Frank Van Oort; Roderik Ponds; Koen Frenken
Medical sociologists hold that social conditions generate disparities across a host of health conditions through exposure to a variety of more proximate risk factors. Though distal and proximal causes jointly influence disease, the nature of risk accumulation may differ appreciably by the link of a proximal cause to the outcome in question. This paper employs a representative sample of over
Markus H. Schafer; Kenneth F. Ferraro
Chromobacterium violaceum is a Gram-negative beta-proteobacterium that inhabits a variety of ecosystems in tropical and subtropical regions, including the water and banks of the Negro River in the Brazilian Amazon. This bacterium has been the subject of extensive study over the last three decades, due to its biotechnological properties, including the characteristic violacein pigment, which has antimicrobial and anti-tumoral activities. C. violaceum promotes the solubilization of gold in a mercury-free process, and has been used in the synthesis of homopolyesters suitable for the production of biodegradable polymers. The complete genome sequence of this organism has been completed by the Brazilian National Genome Project Consortium. The aim of our group was to study the DNA repair genes in this organism, due to their importance in the maintenance of genomic integrity. We identified DNA repair genes involved in different pathways in C. violaceum through a similarity search against known sequences deposited in databases. The phylogenetic analyses were done using programs of the PHILYP package. This analysis revealed various metabolic pathways, including photoreactivation, base excision repair, nucleotide excision repair, mismatch repair, recombinational repair, and the SOS system. The similarity between the C. violaceum sequences and those of Neisserie miningitidis and Ralstonia solanacearum was greater than that between the C. violaceum and Escherichia coli sequences. The peculiarities found in the C. violaceum genome were the absence of LexA, some horizontal transfer events and a large number of repair genes involved with alkyl and oxidative DNA damage. PMID:15100997
Duarte, Fábio Teixeira; Carvalho, Fabíola Marques de; Bezerra e Silva, Uaska; Scortecci, Kátia Castanho; Blaha, Carlos Alfredo Galindo; Agnez-Lima, Lucymara Fassarella; Batistuzzo de Medeiros, Silvia Regina
...repair proficient and repair deficient bacteria: Ã¢Bacterial DNA damage or repair tests...repair proficient and repair deficient bacteria: âBacterial DNA damage or repair tests...growth inhibition of repair deficient bacteria in a set of repair proficient and...
...repair proficient and repair deficient bacteria: Ã¢Bacterial DNA damage or repair tests...repair proficient and repair deficient bacteria: âBacterial DNA damage or repair tests...growth inhibition of repair deficient bacteria in a set of repair proficient and...
The push toward smaller feature size at 193 nm exposure has been enabled by resolution enhancement techniques (RET) such as phase shifting technologies and optical proximity correction (OPC) which require more costly and time intensive resources to fabricate. This leads to a higher overall cost associated with each mask, making it more important than ever for the mask shop to fully utilize and improve its repair capabilities as the presence of defects on the final product is the major yield reducing factor. An increase in repair capability leads to a direct enhancement in repair yield which translates to an improvement in overall mask yield and a reduction in cycle time. The Carl Zeiss MeRiT® MG 45 provides numerous benefits over other techniques that can lead to an increase in repair yield. This paper focuses on methods utilizing the MeRiT® MG 45 that can be employed in a production environment in order to increase mask repair yield. The capability to perform multiple repairs at a single site without optical degradation enables defects that were not successfully repaired the first time to be corrected on a subsequent attempt. This not only provides operator mistakes and inexperience to be corrected for, but eliminates the need to hold up production in order to start a new mask which can cause a cascading effect down the line. Combining techniques to approach difficult partial height and combination defects that may have previously been classified as non-repairable is presented in an attempt to enable a wider range of defects to be repaired. Finally, these techniques are validated by investigating their impact in a production environment in order to increase overall mask yield and decrease cycle time.
Garetto, Anthony; Oster, Jens; Waiblinger, Markus; Edinger, Klaus
Bone healing after fracture occurs in a well-organized manner and involves a multitude of cell types, inflammatory cytokines, growth factors, prostaglandins, and certain vitamins. Some of the means by which alterations in these essential components affect bone repair are understood, whereas others still need to be delineated. Based on clinical experience and basic science research, certain clinical conditions have become associated with delays in bone repair after fracture. These conditions include chronic inflammation, diabetes, hypovitaminosis, aging, and polytrauma. This brief report reviews some of the ways by which these conditions have been shown to negatively influence bone repair. PMID:23047710
Borrelli, Joseph; Pape, Chris; Hak, David; Hsu, Joseph; Lin, Sheldon; Giannoudis, Peter; Lane, Joseph
Repair of scalp defects is often challenging, because without careful planning, excision of the defect may leave unsatisfactory cosmesis. Contemporary techniques in hair restoration surgery allow creation of natural and undetectable results, but these techniques are often unsuitable for repairing large scarred areas of hair loss. However, by using older techniques of scalp reduction and tissue expansion, excision of many large scarring defects can be accomplished. Combining older methods with modern hair restoration surgery permits the satisfactory treatment of many previously untreatable conditions. This article focuses on tissue expansion as an adjunct to repairing large scalp defects. PMID:24017990
Mangubat, E Antonio
Hybrid surgical and endovascular approaches such as open visceral vessel debranching and subsequent endovascular exclusion of thoracic abdominal aortic aneurysms (TAAA) represents a significant development in treatment of TAAAs. As compared to traditional endovascular aneurysm repair, hybrid repairs commonly have a higher rate of endoleak and other endograft-related complications. In this report, we present a 71 year-old man with significant comorbidities including chronic obstructive pulmonary disease, hypertension and prostate cancer. The patient after undergoing debranching of the thoracic arch followed by endograft repair of an arch aneurysm developed a proximal type I and type II endoleak fed by the previously ligated left subclavian artery. Despite coiling of the left subclavian artery and proximal extension of the endograft, a type I endoleak persisted. Several months after the left subclavian artery was coiled, a catheter was advanced through the coils and beyond the site of ligation directly into the aneurysmal sac. Once in the aneurysmal sac, multiple coils were deployed resulting in successful treatment of the type I endoleak. This report highlights the unique challenges in treating proximal descending thoracic aneurysms and represents the first report of the treatment of a type I endoleak with reaccess through a previously coiled vessel for deployment of embolics directly into the aneurysmal sac. PMID:19628521
Barnett, Brad P; Qazi, Umair; Perler, Bruce A; Malas, Mahmoud B
Injuries to the proximal interphalangeal joint are common but frequently missed. They are often overtreated by prolonged immobilization, resulting in stiffness, which may be permanent. The purpose of the present article is to briefly review the relevant anatomy and biomechanics, present an approach to physical examination and diagnosis, and propose a practical clinical classification. The treatment of the most severe injury – the intra-articular fracture dislocation – is controversial. The various treatment options are discussed, based on personal experience and a review of the literature. A list of relevant references is presented.
A 52-year-old Indian woman presented with a progressively increasing swelling and pain in the right elbow for the past eight months, which was not associated with trauma or constitutional symptoms. The patient was diagnosed to have Campanacci grade III giant cell tumour of the proximal radius, and was treated with above elbow amputation. The patient has not shown any recurrence after five years of follow-up. The case was reported because of its rarity and the unusual site of occurrence of the tumour. PMID:19960152
Singh, A P; Mahajan, S; Singh, A P
Platinum (Pt) metal, being nonmagnetic and with a strong spin-orbit coupling interaction, has been central in detecting the pure spin current and establishing most of the recent spin-based phenomena. Magnetotransport measurements, both electrical and thermal, conclusively show strong ferromagnetic characteristics in thin Pt films on the ferromagnetic insulator due to the magnetic proximity effects. The pure spin current phenomena measured by Pt, including the inverse spin Hall and the spin Seebeck effects, are thus contaminated and not exclusively established. PMID:23005323
Huang, S Y; Fan, X; Qu, D; Chen, Y P; Wang, W G; Wu, J; Chen, T Y; Xiao, J Q; Chien, C L
Urea transport in the proximal tubule is passive and is dependent on the epithelial permeability. The present study examined the maturation of urea permeability (P(urea)) in in vitro perfused proximal convoluted tubules (PCT) and basolateral membrane vesicles (BLMV) from rabbit renal cortex. Urea transport was lower in neonatal than adult PCT at both 37 and 25 degrees C. The PCT P(urea) was also lower in the neonates than the adults (37 degrees C: 45.4 +/- 10.8 vs. 88.5 +/- 15.2 x 10(-6) cm/s, P < 0.05; 25 degrees C: 28.5 +/- 6.9 vs. 55.3 +/- 10.4 x 10(-6) cm/s; P < 0.05). The activation energy for PCT P(urea) was not different between the neonatal and adult groups. BLMV P(urea) was determined by measuring vesicle shrinkage, due to efflux of urea, using a stop-flow instrument. Neonatal BLMV P(urea) was not different from adult BLMV P(urea) at 37 degrees C [1.14 +/- 0.05 x 10(-6) vs. 1.25 +/- 0.05 x 10(-6) cm/s; P = not significant (NS)] or 25 degrees C (0.94 +/- 0.06 vs. 1.05 +/- 0.10 x 10(-6) cm/s; P = NS). There was no effect of 250 microM phloretin, an inhibitor of the urea transporter, on P(urea) in either adult or neonatal BLMV. The activation energy for urea diffusion was also identical in the neonatal and adult BLMV. These findings in the BLMV are in contrast to the brush-border membrane vesicles (BBMV) where we have previously demonstrated that urea transport is lower in the neonate than the adult. Urea transport is lower in the neonatal proximal tubule than the adult. This is due to a lower rate of apical membrane urea transport, whereas basolateral urea transport is the same in neonates and adults. The lower P(urea) in neonatal proximal tubules may play a role in overall urea excretion and in developing and maintaining a high medullary urea concentration and thus in the ability to concentrate the urine during renal maturation. PMID:11353675
Quigley, R; Lisec, A; Baum, M
Background: Wound closure is accomplished in most cases of myelomeningocele (MMC) by undermining of the skin edges surrounding the defect. However, large defects cannot be closed reliably by this simple technique. Due to the technical challenge associated with large MMC, surgeons have devised different methods for repairing large defects. In this paper, we report our experience of managing large defects, which we believe bears a direct relationship to decrease the incidence of wound complications. Materials and Methods: Forty children with large MMCs underwent surgical repair and represent our experience. We recommend using all hairy skin around the defect as a way to decrease the tension on the edges of the wound and the possible subsequent necrosis. It is our experience that vertical incision on one or two flanks parallel to the midline can decrease the tension of the wound. Moreover, ventriculo-peritoneal shunting for children who developed hydrocephalus was performed simultaneously, which constitutes another recommendation for preventing fluid collection and build up of pressure on the wound. Results: Patients in this study were in the age range of 2 days to 8 years. The most common location of MMC was in the thoracolumbar area. All but four patients had severe weakness in lower extremities. We used as much hairy skin around the MMC sac as possible in all cases. Vertical incisions on one or both flanks and simultaneous shunt procedure were performed in 36 patients. We treated children with large MMC defects with acceptable tension-free closure. Nonetheless, three patients developed superficial skin infection and partial wound dehiscence, and they were managed conservatively. Conclusions: We recommend using all hairy skin around the MMC defect for closure of large defects. In cases that were expected to be at a higher risk to develop dehiscence release incisions on one or two flanks towards the fascia were found to be useful. Simultaneous ventriculo-peritoneal shunting is also recommended in this cohort of patients, according to our experience. These recommendations neither prolong the time of surgery nor increase the cost, but facilitate a successful closure.
Nejat, Farideh; Baradaran, Nima; Khashab, Mostafa EI
|From auto mechanic to HVAC technicians, many occupations require repair skills. For jobseekers with the right skills, there are many advantages to a repair career. Repair work provides millions of jobs throughout the United States. Wages are often higher than average. And in many occupations, the employment outlook is bright. Plus, most repair…
Torpey, Elka Maria
Repair and maintenance cost drives a large percentage of the lifetime cost of aircraft structures. Understanding repair issues can lead to a structure that significantly lowers the lifetime cost. Advanced composite materials, while offering the potential to increase aircraft capabilities with minimum weight, are more susceptible to repairable damage than conventional aircraft materials. Improved inspection and repair methods are required
Mary A. Mahler
This article presents a local LR error repair method that repairs syntax errors quickly by adoption of the A* algorithm that helps remove unproductive configurations. The new method also enhances the repair quality by adoption of a flexible edit strategy to support shifting symbols unrestrictedly, as well as inserting and deleting symbols, in order to repair invalid input strings. Experimental
Ik-Soon Kim; Kwangkeun Yi
With the development of hip joint preservation procedures, the use of hip arthroscopy has grown dramatically over the past decade. However, recent articles have reported cases of hip instability after hip arthroscopy. Little is known about the role of static and dynamic stabilizers on hip joint stability, but there are concerns that an extensile capsulotomy or capsulectomy, osteoplasty of the acetabulum and proximal femur, and labral detachment or debridement during hip arthroscopy could potentially compromise hip stability. The safety parameters for arthroscopic hip surgery have not yet been fully established, and techniques are being developed for labral refixation and capsular repair after arthroscopic treatment of femoroacetabular impingement in an attempt to decrease the chance of iatrogenic hip instability or microinstability. The surgical technique presented in this article may provide anatomic repair of both the labrum and capsule using a double-loaded suture anchor technique. We believe that this technique increases both operative efficiency and the strength of the overall repair, which may minimize the risk of iatrogenic hip instability after hip arthroscopy. PMID:23766998
Slikker, William; Van Thiel, Geoffrey S; Chahal, Jaskarndip; Nho, Shane J
|The course helps students determine types of repairs, compute repair sizes, and complete the repair through surface protection. Course content includes goals, specific objectives, protection of metals, repairs to metal skin, and honeycomb structure repair. A bibliography and post-test are appended. A prerequisite for this course is mastery of the…
Dade County Public Schools, Miami, FL.
Background Recently, array-comparative genomic hybridization (aCGH) platforms have significantly improved the resolution of chromosomal analysis allowing the identification of genomic copy number gains and losses smaller than 5?Mb. Here we report on a young man with unexplained severe mental retardation, autism spectrum disorder, congenital malformations comprising hypospadia and omphalocele, and episodes of high blood pressure. An?~?6?Mb interstitial deletion that includes the causative genes is identified by oligonucleotide-based aCGH. Results Our index case exhibited a de novo chromosomal abnormality at 2q22 [del(2)(q22.1q22.3)dn] which was not visible at the 550 haploid band level. The deleted region includes eight genes: HNMT, SPOPL, NXPH2, LOC64702, LRP1B, KYNU, ARHGAP15 and GTDC1. Discussion aCGH revealed an?~?6?Mb deletion in 2q22.1 to 2q22.3 in an as-yet unique clinical case associated with intellectual disability, congenital malformations and autism spectrum disorder. Interestingly, the deletion is co-localized with a fragile site (FRA2K), which could be involved in the formation of this chromosomal aberration. Further studies are needed to determine if deletions of 2q22.1 to 2q22.3 define a new microdeletion syndrome.
It is well known that the endocrine-disrupting chemical (EDC) dibutylphthalate (DBP) inhibits testosterone synthesis and can lead to feminisation in male laboratory animals. Moreover, it has long been speculated that human exposure would result in the similar effects, but this is difficult to study because specific human exposure cohorts are rare. We report increases in the incidences of hypospadias (p<0.05), cryptorchidism (p<0.05) and breast cancer (p<0.05) in the children of New Zealand soldiers who served in Malaya (1948-1960) and were exposed to DBP applied daily to their clothing as an acaricide to prevent tick-transmitted bush typhus. In addition, we modelled absorption of DBP from the soldiers' clothing and using published data for skin absorption, and calculated a large theoretical absorbed dose of 64 mg/kg body weight/day which is similar to DBP's lowest observed adverse effect level (LOAEL) of 50 mg/kg body weight/day and thus indicates a biological effect is possible. This is the first report of a multigenerational developmental effect following DBP exposure in human males. PMID:22864157
Carran, Matthew; Shaw, Ian C
Objective: The objective was to analyze the short- and long-term results of patients with previous tricuspid valve repair who had valve dysfunction and required cardiac reoperations. Methods: Between 1976 and 2002, 74 patients with a mean age of 53.8 12.2 years underwent valve reoperations for dysfunction of previous tricuspid valve repair. Mitral and tricuspid lesions were diagnosed in 40 patients
José M. Bernal; Dieter Morales; Carmen Revuelta; Javier Llorca; Jesús Gutiérrez-Morlote; José M. Revuelta
Twenty-seven patients who had sphincter repair by one surgeon over the last ten years were reviewed. Previous surgery, childbirth,\\u000a and perineal trauma were the most common causes. Twelve patients had been treated previously using an anal continence device\\u000a (N=6), postanal repair (N=5), and rectopexy (N=1). A covering colostomy was used in ten patients. At the initial operation\\u000a only 7 patients
Kazuhiko Yoshioka; Michael R. B. Keighley
Homologous recombination (HR) is crucial for genetic exchange and accurate repair of DNA double-strand breaks and is pivotal for genome integrity. HR uses homologous sequences for repair, but how homology search, the exploration of the genome for homologous DNA sequences, is conducted in the nucleus remains poorly understood. Here, we use time-resolved chromatin immunoprecipitations of repair proteins to monitor homology search in vivo. We found that homology search proceeds by a probing mechanism, which commences around the break and samples preferentially on the broken chromosome. However, elements thought to instruct chromosome loops mediate homology search shortcuts, and centromeres, which cluster within the nucleus, may facilitate homology search on other chromosomes. Our study thus reveals crucial parameters for homology search in vivo and emphasizes the importance of linear distance, chromosome architecture, and proximity for recombination efficiency. PMID:23523370
Renkawitz, Jörg; Lademann, Claudio A; Kalocsay, Marian; Jentsch, Stefan
Background. Peripheral nerve injury treatment options are limited to primary nerve repair, nerve grafting, and tendon transfers. In this case, a large suitable donor site was easily accessible and delayed grafting was indicative of poor prognosis. Case Description. A 25-year-old soldier presented to a military hospital in Afghanistan following a roadside bomb attack. The patient had a medial shrapnel wound in the bicipital groove with a cool pulseless hand and catastrophic lower extremity injuries. Bilateral above-the-knee amputations (AKAs) and exploration of the medial shrapnel wound were undertaken. A 7?cm traumatic defect in the median nerve was repaired with interpositional sciatic nerve graft harvested from the AKA. Conclusion. Recovery of motor function after nerve grafting is dependent on motor axons reinnervating target muscles, making proximal nerve injuries problematic. We identify a potential nerve harvest site in patients with lower extremity amputations in need of long segment nerve repairs.
Ragel, Brian T.; Park, Gregory C.; Brevard, Sid
Background. Peripheral nerve injury treatment options are limited to primary nerve repair, nerve grafting, and tendon transfers. In this case, a large suitable donor site was easily accessible and delayed grafting was indicative of poor prognosis. Case Description. A 25-year-old soldier presented to a military hospital in Afghanistan following a roadside bomb attack. The patient had a medial shrapnel wound in the bicipital groove with a cool pulseless hand and catastrophic lower extremity injuries. Bilateral above-the-knee amputations (AKAs) and exploration of the medial shrapnel wound were undertaken. A 7?cm traumatic defect in the median nerve was repaired with interpositional sciatic nerve graft harvested from the AKA. Conclusion. Recovery of motor function after nerve grafting is dependent on motor axons reinnervating target muscles, making proximal nerve injuries problematic. We identify a potential nerve harvest site in patients with lower extremity amputations in need of long segment nerve repairs. PMID:22084742
Ragel, Brian T; Park, Gregory C; Brevard, Sid
We present the case of Achilles tendon rupture in a 54-year-old man while rehabilitating after end-to-end open repair of an acute Achilles tendon rupture. Re-rupture after surgical repair of Achilles tendon is well known. The present case, however, is atypical, because the second rupture occurred significantly proximal to the first rupture. To our knowledge, this is the first time this has been described in English language studies. We have termed this incident a fresh rupture. A gastrocnemius turndown flap was used to repair the fresh rupture, which led to a satisfactory recovery. This case report serves to inform surgeons of the existence of this type of Achilles tendon rupture, while considering the possible etiologies and suggesting a technique that has been shown to be successful in the present case. PMID:22055493
Rushton, Paul R P; Singh, Alok K; Deshmukh, Rajiv G
From May 1999 to April 2002, we treated 14 patients with subtrochanteric femoral fractures and seven patients with ipsilateral fractures of the femoral neck and shaft using a second-generation cephalomedullary interlocked nail. Patients mean age was 36 (20-60) years, and 19 fractures were caused by high-energy trauma. Four patients had associated injuries. The average follow-up was 23 (16-30) months. Per-operatively, we had problems in locating the entry portal in four patients, and one nail was driven through the inter-condylar notch. All fractures except two united. One patient had non-union of the femoral neck and one of both neck and shaft. One patient united with shortening of more than 1.5 cm and varus angulation at the fracture site. Two patients had loosening and backing out of the proximal screw. The second-generation cephalomedullary nail is a suitable treatment option for proximal femoral fractures, but it requires a high degree of accuracy and technical expertise. PMID:15647914
Kakkar, Rahul; Kumar, S; Singh, A K
Regulation of bacterial gene networks by small non-coding RNAs (sRNAs) requires base pairing with messenger RNA (mRNA) targets, which is facilitated by Hfq protein. Hfq is recruited to sRNAs and mRNAs through U-rich- and A-rich-binding sites, respectively, but their distance from the sRNA–mRNA complementary region varies widely among different genes. To determine whether distance and binding orientation affect Hfq’s chaperone function, we engineered ‘toy’ RNAs containing strong Hfq-binding sites at defined distances from the complementary target site. We show that RNA annealing is fastest when the distal face of Hfq binds an A-rich sequence immediately 3? of the target. This recruitment advantage is lost when Hfq binds >20?nt away from the target, but is partially restored by secondary structure that shortens this distance. Although recruitment through Hfq’s distal face accelerates RNA annealing, tight binding of six Us to Hfq’s proximal face inhibits annealing. Finally, we show that ectopic A-rich motifs dramatically accelerate base pairing between DsrA sRNA and a minimal rpoS mRNA in the presence of Hfq, demonstrating that proximity and orientation predict the activity of Hfq on long RNAs.
Panja, Subrata; Woodson, Sarah A.
We report results using a novel 3 terminal device structure that provides two independent resistance measurements that we use to examine the influence of the superconducting proximity effect on both the transport properties of the thin film N layer by quantifying its sheet resistance, Rs, as well as independently measuring the junction conductance across the N-S boundary, Gc. When the N layer is a degenerate semiconductor the changes in these quantities are large. Gc increases much more than the factor of 2 that Andreev Reflection or BTK theory predicts, and both Gc and Rs exhibit reentrance as temperature decreases. We interpret these effects as being due to a transition between a phase fluctuating and phase stiff proximity effect in the N layer. This manifests itself by moving the N-S electrical boundary into the semiconductor, increasing Gc, while simultaneously removing volume available to normal transport forcing the measured Rs to increase. This work was supported by the DOE BES at the F. Seitz Materials Research Laboratory at the University of Illinois, Urbana.
Vissers, Michael; Flexner, Soren; Welander, Paul; Inderhees, Kevin; McArdle, Tim; Eckstein, Jim
Normal motion of the proximal interphalangeal joint requires bony support, intact articular surfaces, unimpeded tendon gliding, and uncompromised integrity of the collateral ligaments and volar plate. Deficiency in any one of these structural requirements can lead to a loss of finger joint motion and decreased hand function. Once finger extension is lost, options include nonsurgical or surgical treatment. Nonsurgical treatment such as splinting or serial casting should be tried before attempting surgical intervention. When severe flexion deformity exists or the vascular status of the finger has been compromised, arthrodesis or amputation should be undertaken instead of procedures to regain motion. Surgical options for regaining motion include external fixators and open surgical release. Although they can lead to improved extension at the proximal interphalangeal joint, external fixators carry a risk of reduced finger flexion and pin site infection. Most clinical series of patients who have undergone surgical release document improvement in flexion contracture between 25 degrees to 30 degrees and a shift of the flexion/extension arc into a more functional range. Close follow-up after surgery is warranted, with frequent physical therapy and splinting. PMID:16959890
Hogan, Christopher J; Nunley, James A
The continuing decline in fertility despite a contraction in contraceptive use in Peninsular Malaysia since the mid-1980s has triggered considerable interest in the reasons behind this phenomenon, such as increase in abortion, sterility, and out-of-wedlock pregnancy. Fertility decline has been attributed to rapid socioeconomic development, which can only influence fertility through the intermediate variables. Application of vital statistics, population census, and survey data of Peninsular Malaysia on Bongaarts's model vindicates that marriage postponement and contraceptive use are the 2 most important proximate determinants of fertility, but the effects are not uniform across the ethnic groups. For instance, the predicted total fertility rate for Chinese and Malays are 2.9 and 1.6, respectively, compared with the observed level of 3.0 and 1.9. Postpartum infecundability and abortion also play a part in explaining ethnic fertility differentials. The fertility inhibiting effects of these proximate determinants have significant implications on reproductive health and future population growth. PMID:21490114
Tey, Nai Peng; Ng, Sor Tho; Yew, Siew Yong
OBJECTIVE—To examine autonomic function as assessed by heart rate variability in patients 10 or more years after repair of tetralogy of Fallot, and to relate this to cardiac structure, function, and electrocardiographic indices.?METHODS—Heart rate variability was measured by standard time domain techniques on a 24 hour Holter ECG in 28 patients, aged 12 to 34 years (mean 19.5), who had undergone repair of tetralogy of Fallot at least 10 years previously. Echocardiography was performed to assess left ventricular size and function, right ventricular size and pressure, and any proximal pulmonary arterial stenosis. Right ventricular function was evaluated by radionuclide scan. QRS duration, QT interval, and QT dispersion were measured on a standard 12 lead ECG. Measurements of heart rate variability were compared with values from 28 age matched healthy controls (mean age 19.9 years). Interrelations between variables were assessed using Pearson correlation coefficients and stepwise regression analysis.?RESULTS—Heart rate variability was reduced, compared with values for age matched normal controls, in 12 of the 28 patients. Reduced heart rate variability was associated with increased age, increased right ventricular size and pressure, and widening of the QRS complex.?CONCLUSIONS—Reduced heart rate variability is a feature following repair of tetralogy of Fallot. It is associated with increasing age, impaired right ventricular haemodynamics, and widening of the QRS complex. Under these circumstances, reduced heart rate variability may be a marker for deteriorating right ventricular function. Increased QRS duration has been identified as a risk factor for sudden death following repair of tetralogy of Fallot, and impaired cardiac autonomic control may be one of the mechanisms involved.???Keywords: tetralogy of Fallot; heart rate variability; right ventricular function; congenital heart disease
McLeod, K; Hillis, W; Houston, A; Wilson, N; Trainer, A; Neilson, J; Doig, W
This study aimed to represent the recent trends in the nationwide incidence of cryptorchidism and hypospadias in Korea, and to determine whether there is evidence of spatial heterogeneity in the incidence. The incidence was calculated as the number of newly diagnosed patients (males) during the first 4 years after a live birth in a population, nationally and regionally (a non-industrialized area (Chuncheon) and petrochemical estates (Yeocheon and Ulsan)), between 2000 and 2005. The data (numerator) for new patients were acquired from the National Health Insurance Review Agency, and the data (denominator) for the resident registration population were from the National Statistical Office. Between 2000 and 2005, the national incidence of cryptorchidism and hypospadias had an increased tendency from 5.01 to 17.43 per 10 000 persons and from 1.40 to 3.28 per 10 000 persons, respectively. The incidence of cryptorchidism was significantly higher in Yeocheon (throughout the study period) and in Ulsan (2001, 2002, 2004 and 2005) than the national incidence, whereas the incidence in Chuncheon was significantly lower in 2001 and 2002. It was difficult to compare the rates of hypospadias yearly and regionally because of the small number of cases. In conclusion, the incidence of cryptorchidism has recently increased in Korea. The petrochemical estates, Yeocheon and Ulsan, had a significantly higher incidence of cyptorchidism than the national incidence, which suggests that further study is needed to obtain a more precise estimation of the trends in the incidence of the anomalies and to confirm the association between petrochemicals and the anomalies.
Chul Kim, Sae; Kyoung Kwon, Su; Pyo Hong, Yeon
Perilunate dislocations are rare injuries of the wrist and complete dislocation of the lunate is also rare. There is controversy in literature regarding the optimal management of such injuries. Complete lunate enucleation is associated with high rate of osteonecrosis of lunate thus wrist arthrodesis or proximal row carpectomy has been advocated as primary treatment for such injuries. We report a case of transradial styloid complete palmar lunate enucleation in a 25-year-old male patient who sustained injury to the left wrist due to fall on outstretched hand. Carpal row salvage surgery initially by closed reduction and wrist distractor application followed by open reduction and internal fixation with K-wires along with ligamentous repair resulted in restoration of normal wrist anatomy and good functional outcome. As many of these injuries are missed on initial presentation and outcome is poor for missed injuries, prompt diagnosis and early surgical management to restore vascularity of lunate is recommended. PMID:24103828
Jaiswal, Atin; Kachchhap, Naiman-Deepak; Tanwar, Yashwant-S; Habib, Masood; Kumar, Birendra
We have studied the proximity effect in bilayers of thin films of iridium covered by gold. By varying the thicknesses of the iridium and gold layers, we achieved critical temperatures as low as 33 mK. The critical temperature of the bilayers is lower than predicted by the theory of the Gennes-Werthamer (1964), but adding a free parameter to the theory allows good agreement. The transitions of the bilayers typically had widths of a few mK, with the narrowest reaching 0.2 mK, and were always steeper than those of pure iridium films evaporated simultaneously. Such bilayers can be used as superconducting phase transition thermometers in cryogenic particle detectors.
Nagel, U.; Nowak, A.; Gebauer, H.-J.; Colling, P.; Cooper, S.; Dummer, D.; Ferger, P.; Frank, M.; Igalson, J.; Nucciotti, A.
Proteins are continuously affected by various intrinsic and extrinsic factors. Damaged proteins influence several intracellular pathways and result in different disorders and diseases. Aggregation of damaged proteins depends on the balance between their generation and their reversal or elimination by protein repair systems and degradation, respectively. With regard to protein repair, only few repair mechanisms have been evidenced including the reduction of methionine sulfoxide residues by the methionine sulfoxide reductases, the conversion of isoaspartyl residues to L-aspartate by L-isoaspartate methyl transferase and deglycation by phosphorylation of protein-bound fructosamine by fructosamine-3-kinase. Protein degradation is orchestrated by two major proteolytic systems, namely the lysosome and the proteasome. Alteration of the function for both systems has been involved in all aspects of cellular metabolic networks linked to either normal or pathological processes. Given the importance of protein repair and degradation, great effort has recently been made regarding the modulation of these systems in various physiological conditions such as aging, as well as in diseases. Genetic modulation has produced promising results in the area of protein repair enzymes but there are not yet any identified potent inhibitors, and, to our knowledge, only one activating compound has been reported so far. In contrast, different drugs as well as natural compounds that interfere with proteolysis have been identified and/or developed resulting in homeostatic maintenance and/or the delay of disease progression. PMID:23107776
Chondrogianni, Niki; Petropoulos, Isabelle; Grimm, Stefanie; Georgila, Konstantina; Catalgol, Betul; Friguet, Bertrand; Grune, Tilman; Gonos, Efstathios S
We report our retrospective experience in the treatment of infective tricuspid endocarditis with valve repair. From January 1981 through January 1999, 238 cases of infective endocarditis were seen at our institution, with tricuspid involvement in 19 cases. Tricuspid valve repair was performed in 9 patients whose valves had infective lesions involving a single leaflet. One goal of the repair was to avoid implanting any prosthetic material. At surgery, the posterior leaflet was completely excised and annuloplasty was performed in 4 patients. Wide quadrangular resection of the anterior leaflet and De Vega annuloplasty were performed in the other 5 patients. All patients had a good postoperative recovery. Postoperative echocardiography showed no tricuspid regurgitation in 4 patients, mild regurgitation in 3, and moderate in 2. Follow-up ranged from 21 to 155 months (mean, 47.56 ± 50 [SD] months). Two late deaths occurred: one, 2 months postoperatively (sudden death), and the other, 108 months postoperatively (lung carcinoma). Late postoperative echocardiography showed no tricuspid regurgitation in 4 patients, mild in 2, and moderate in 2. No recurrent infection was observed. Tricuspid valve repair rather than valvulectomy or replacement is indicated in cases of right-sided endocarditis with single-leaflet involvement. Tricuspid repair enables eradication of the infection without implantation of prosthetic material.
Carozza, Antonio; Renzulli, Attilio; De Feo, Marisa; Ismeno, Gennaro; Corte, Alessandro Della; Dialetto, Giovanni; Cotrufo, Maurizio
OBJECTIVE: Kommerell diverticulum carries the risk of rupture or dissection if left untreated. Various methods of repair have been described, and options have recently expanded to include the hybrid approach. This study describes hybrid repair techniques for Kommerell diverticulum and assesses outcomes. METHODS: Between 2005 and 2010, a total of 10 patients underwent hybrid repair of Kommerell diverticulum (3 right-sided arches) by elephant trunk with endovascular completion (n = 4), frozen elephant trunk (n = 3), or stent grafting with cervical debranching (n = 3). Mean age at procedure was 57 ± 25.5 years. Subclavian artery revascularization was performed preoperatively (n = 4), intraoperatively (n = 3), or postoperatively (n = 3), either as carotid-to-subclavian bypass (n = 7; n = 3 bilateral) or originating from the ascending aorta (n = 3). Data were obtained from the prospectively collected database and chart review. RESULTS: There was no in-hospital mortality, nor were there any cases of respiratory or renal failure. There were no cases of paraplegia, but there was 1 stroke. Two patients had type 2 endoleaks develop; 1 required subclavian coil embolization. Mean hospital stay was 8.73 ± 4 days. After repair, there were no ruptures, no significant growth, and all patients remain free of symptoms. CONCLUSIONS: Hybrid repair is a safe and effective surgical treatment option for Kommerell diverticulum. Selection of the specific type of intervention is based on patient anatomy and comorbid conditions. PMID:23535153
Idrees, Jahanzaib; Keshavamurthy, Suresh; Subramanian, Sreekumar; Clair, Daniel G; Svensson, Lars G; Roselli, Eric E
Repair and maintenance cost drives a large percentage of the lifetime cost of aircraft structures. Understanding repair issues can lead to a structure that significantly lowers the lifetime cost. Advanced composite materials, while offering the potential to increase aircraft capabilities with minimum weight, are more susceptible to repairable damage than conventional aircraft materials. Improved inspection and repair methods are required to ensure structural integrity and aircraft readiness in the existing operational environment. Many of today's innovative composite designs may result in aircraft structures that are unreasonably difficult to repair. As a first step, technical issues associated with bonded composite repair of composite structures were investigated. An extensive literature review identified many areas where real world composite repairs are being used successfully. An electronic database was developed summarizing the publications found during the literature review. The database includes publication, experimental test results and analytical results of advanced composite bonded repairs. The current analysis of repair does not account for the variations that exist in repair. To facilitate the analysis, a finite element interface was developed to provide analysts with a tool that would create complete finite element models of repaired structures efficiently and in a 3-dimensional view. The finite element models created by the developed interface were successfully correlated to test data for accuracy of the results. Parametric studies were performed using the interface to evaluate effects of repair variables. Thermal impact of repair on the repair panel is one area lacking attention in the repair literature. To understand the impact of heat and thermal gradients of the repair, an analytical investigation was performed to evaluate. the parameters affected by heat. For a solid laminate, the temperature at the adhesive bondline was investigated. The primary focus is on sandwich panels where heat transfer is known to impact the repair process. The internal pressure from the heat of the repair process and moisture trapped in honeycomb structure was evaluated and shown to produce sufficient pressure to disbond the facesheet from the core.
Mahler, Mary A.
Limb development requires the formation of a proximal-distal axis perpendicular to the main anterior-posterior and dorsal-ventral body axes. The secreted signalling proteins Decapentaplegic and Wingless act in a concentration-dependent manner to organize the proximal-distal axis. Discrete domains of proximal-distal gene expression are defined by different thresholds of Decapentaplegic and Wingless activities. Subsequent modulation of the relative sizes of these domains
Thomas Lecuit; Stephen M. Cohen
Detailed information is given concerning the types of coatings failures that are amenable to repair and materials and methods effective in making them. Coatings failure types are analyzed, and recommended surface preparation for several types of failure are described in detail. Consequences of improper surface preparation are emphasized. Precautions necessary for selection of materials and for application methods effective in applying coatings over old coatings are presented in detail. Characteristics and causes are given for pinpoint rusting, delamination, chalking, and undercutting by rust. Characteristics and causes of gas and liquid blisters are described and methods of repairing coating underneath them are detailed. Special attention is given to repairs on galvanizing and inorganic zinc-loaded coatings and the correct procedures of surface preparation and overcoating. Importance of time after start of failure to begin recoating is emphasized.
When the sun damages the skin, it also impairs the DNA. The DNA repair system is needed to maintain the genetic integrity of the epidermis. Defects in DNA repair (eg, xeroderma pigmentosum) commonly result in skin cancer. Sun-screens are important for preventing sun damage, but inadequate application by consumers is common, and protection against DNA damage is incomplete. The human population varies widely in its formation and response to DNA damage. Sequencing of individuals' DNA repair genes has revealed unexpected diversity, and some polymorphisms may be related to skin cancer risk. DNA damage has been linked to immune suppression in humans, and variations in this immune response also are linked to cancer risk. PMID:14533826
Yarosh, Daniel B
Purpose To objectify the influence of the atherosclerotic burden in the proximal landing zone on the development of endoleaks after\\u000a endovascular abdominal aortic aneurysm repair (EVAR) or thoracic endovascular aneurysm repair (TEVAR) using objective aortic calcium scoring (ACS).\\u000a \\u000a \\u000a \\u000a \\u000a Materials and Methods This retrospective observation study included 267 patients who received an aortic endograft between 1997 and 2010 and for\\u000a whom preoperative computed
Johannes Petersen; Bernhard Glodny
A region-specific ENU mutagenesis screen was conducted to elucidate the functional content of proximal mouse Chr 5. We used the visibly marked, recessive, lethal inversion Rump White (Rw) as a balancer in a three-generation breeding scheme to identify recessive mutations within the ?50 megabases spanned by Rw. A total of 1003 pedigrees were produced, representing the largest inversion screen performed in mice. Test-class animals, homozygous for the ENU-mutagenized proximal Chr 5 and visibly distinguishable from nonhomozygous littermates, were screened for fertility, hearing, vestibular function, DNA repair, behavior, and dysmorphology. Lethals were identifiable by failure to derive test-class animals within a pedigree. Embryonic lethal mutations (total of 34) were overwhelmingly the largest class of mutants recovered. We characterized them with respect to the time of embryonic death, revealing that most act at midgestation (8.5–10.5) or sooner. To position the mutations within the Rw region and to guide allelism tests, we performed complementation analyses with a set of new and existing chromosomal deletions, as well as standard recombinational mapping on a subset of the mutations. By pooling the data from this and other region-specific mutagenesis projects, we calculate that the mouse genome contains ?3479–4825 embryonic lethal genes, or about 13.7%–19% of all genes.
Wilson, Lawriston; Ching, Yung-Hao; Farias, Michael; Hartford, Suzanne A.; Howell, Gareth; Shao, Hongguang; Bucan, Maja; Schimenti, John C.
Endovascular repair of infrarenal abdominal aortic aneurysms (EVARs) has revolutionized the treatment of aortic aneurysms, with over half of elective abdominal aortic aneurysm repairs performed endoluminally each year. Since the first endografts were placed two decades ago, many changes have been made in graft design, operative technique, and management of complications. This paper summarizes modern endovascular grafts, considerations in preoperative planning, and EVAR techniques. Specific areas that are addressed include endograft selection, arterial access, sheath delivery, aortic branch management, graft deployment, intravascular ultrasonography, pressure sensors, management of endoleaks and compressed limbs, and exit strategies.
Phade, Sachin V.; Garcia-Toca, Manuel; Kibbe, Melina R.
Self-rated degree of femininity and masculinity across development were evaluated for 40 adults affected by 46,XY disorders of sex development (DSDs) who presented at birth with a small phallus and perineoscrotal hypospadias, raised either male (n = 22) or female (n = 18). Most participants were confirmed or presumed to be affected by partial androgen insensitivity syndrome (n = 14), partial gonadal dysgenesis (n = 11), or were considered to have a poorly defined case of 46,XY DSD including ambiguous external genitalia (n = 15). Participants retrospectively evaluated their degree of masculinity and femininity during their childhood, adolescence, adulthood, and in the past 12 months of filling out a questionnaire pertaining to their psychosexual development. Participants raised male reported more masculinity than those raised female due to an increase in masculinization during adolescence and adulthood. Participants raised male also reported less femininity than those raised female throughout development. Participants raised female reported more femininity than those raised male due to an increase in feminization during adolescence and adulthood. Participants raised female also reported less masculinity than those raised male throughout development. These data support the proposition that some aspects of gender role (GR), such as masculinity and femininity, are capable of proceeding along female- or male-typic patterns depending on sex of rearing among individuals affected by specific types of 46,XY DSD. Furthermore, regardless of male or female rearing, GR increasingly corresponds with assigned sex as individuals proceed through sexual maturity and into adulthood. These results are consistent with the idea that socialization/learning contributes to GR development in humans in addition to data from others demonstrating endocrine influences. PMID:18780596
Pappas, Kara B; Wisniewski, Amy B; Migeon, Claude J
Thoracic endovascular aneurysm repair (TEVAR) has gained wide acceptance because of its minimal invasiveness and effectiveness for thoracic aortic aneurysms. However, the endovascular technique alone is often not applicable to arch aneurysms due to their anatomical complexity, such as aortic curve and presense of neck branches. The development of branched stent graft that allows total endovascular approach has been slow. Therefore open surgical technique is still needed to obtain an adequate landing zone. Prior total arch replacement with elephant trunk and debranching neck vessels including partial debranching such as carotid-carotid crossover bypass, and total debranching from the ascending aorta were able to create a suitable proximal landing zone. Chimney technique using covered stent for the neck vessels is also effective for arch aneurysms. Here, we report the strategies of TEVAR for aortic arch aneurysms. PMID:21229676
Suzuki, Toshiaki; Sumi, Makoto; Kanaoka, Yuji; Ohki, Takao
One of twelve individualized courses included in an automotive repair curriculum, this course covers theory and construction, inspection diagnoses, and service and overhaul of automotive engines. The course is comprised of five units: (1) Fundamentals of Four-Cycle Engines, (2) Engine Construction, (3) Valve Train, (4) Lubricating Systems, and (5)…
Schramm, C.; Osland, Walt
Background Coarctation of the aorta is a discrete stenosis of the proximal thoracic aorta. The common clinical pattern is congestive heart failure in infancy. Treatment methods include balloon angioplasty and surgical repair in this age group. Percutaneous balloon angioplasty is a less invasive method for the repair of discrete coarctation but remains controversial as a primary treatment strategy for a native coarctation. This study aimed to compare the effectiveness and outcome of balloon angioplasty and surgical repair in coarctation infants younger than 1 year old. Methods This retrospective study evaluated the results of the two methods in 167 patients younger than one year old admitted into a tertiary heart center pediatric ward with the diagnosis of coarctation of the aorta: Balloon angioplasty was done for 55 and surgical repair for 112 infants. Patients with previous interventions were not included in this study. Results Primary results revealed no significant difference in the effectiveness of the two methods (p value = 0.0601). While the rate of recurrent coarctation was significantly lower in the surgery group [19 (17%) vs. 11 (20%), p value = 0.0470], the mortality rate was lower in the balloon angioplasty method [5 (5.5%) vs. 13 (11.6%), p value = 0.039]. Our multivariate logistic regression model, however, showed no statistically significant difference (p value = 0.120). Conclusion Because of the incidence of re-coarctation, balloon angioplasty compared with surgical repair did not confer an improved outcome for our infants’ coarctation.
Alaei, Fariba; Moghadam, Mohammad Yousef Arabi; Mortaezaian, Hojat; Alaei, Mastaneh; Bakhshandeh, Hooman
The sequence of repair of structures in macroreplantation surgery is important, since it has a direct influence on ischaemia time, blood loss and technical accuracy. Different sequences have been recommended in the literature. A uniform order of repair was used in a series of macroreplants, performing the arterial repair at the end of the procedure. A total of 341 parts were replanted in 249 patients. Of these, 28 cases (27 patients) were amputations proximal to the wrist. The sequence of repair was temporary catheter arterial shunt for 10-15 minutes, debridement, bone, musculotendons, veins and dorsal skin, nerves, arteries and volar skin. Fasciotomies were performed only if primary ischaemia time had been over 6 hours. A 100% survival rate was achieved. Primary ischaemia time was less than 6 hours in all cases but two. Fasciotomy was performed only in these two patients. Infection rate was 10% (three cases). Soft-tissue necrosis requiring free flap coverage occurred in four cases (14%). In these complicated cases (24%), salvage rate was 100%. Mean operative time was 240 minutes. Functional results according to Chen's criteria were grade I in six cases, grade II in nine, grade III in 13, and no patients with grade IV. Temporary catheter arterial perfusion reduces ischaemia time and permits an artery-last sequence. This may reduce blood loss, permits an accurate repair of non-vascular structures, and shortens operative time. PMID:18650139
Cavadas, Pedro C; Landín, Luis; Ibáñez, Javier
Background: Ipsilateral fractures of the proximal femur and femoral shaft are extremely uncommon injuries which occur in young adults who sustain a high energy trauma. A variety of management modalities have been tried to treat this complex fracture pattern ranging from conservative approach to recently introduced reconstruction nails. All these approaches have their own difficulties. We studied the outcome of long proximal femoral nail (LPFN) in the management of concomitant ipsilateral fracture of the proximal femur and femoral shaft. Materials and Methods: We analysed the prospective data of 36 consecutive patients who had sustained a high energy trauma (30 closed fractures and 6 open shaft fractures) who had concomitant ipsilateral fractures of the femoral shaft associated with proximal femur fractures treated with LPFN between December 2005 and December 2011. The mean age was 39 years (range 28-64 years). Twenty nine males and seven females were enrolled for this study. Results: The patients were followed up at three, six, twelve, and eighteen months. The mean healing time for the neck fractures was 4.8 months and for the shaft fractures was 6.2 months. The greater trochanter was splintered and widened in two cases which eventually consolidated. Two patients had superficial infection, two patients had lateral migration of the screws with coxa vara which was due to severe osteoporosis detected during the followup. We had two cases of nonunion of shaft fracture and one case of nonunion of neck fracture. Two cases of avascular necrosis of femoral head were detected after 2 years of followup. No cases of implant failure were noted. Limb shortening of less than 2 cms was noted in four of our patients. The functional assessment system of Friedman and Wyman was used for evaluating the results. In our series 59.9% (n = 23) were rated as good, 30.6% (n = 11) as fair, and 5.5% (n = 2) as poor. Conclusion: Long PFN is a reliable option for concomitant ipsilateral diaphyseal and proximal femur fractures.
Gadegone, WM; Lokhande, Vijayanand; Salphale, Yogesh; Ramteke, Alankar
Despite having almost identical origins and similar perfusion pressures, the flow-velocity waveforms in the left and right coronary arteries are strikingly different. We hypothesized that pressure differences originating from the distal (microcirculatory) bed would account for the differences in the flow-velocity waveform. We used wave intensity analysis to separate and quantify proximal- and distal-originating pressures to study the differences in velocity waveforms. In 20 subjects with unobstructed coronary arteries, sensor-tipped intra-arterial wires were used to measure simultaneous pressure and Doppler velocity in the proximal left main stem (LMS) and proximal right coronary artery (RCA). Proximal- and distal-originating waves were separated using wave intensity analysis, and differences in waves were examined in relation to structural and anatomic differences between the two arteries. Diastolic flow velocity was lower in the RCA than in the LMS (35.1 ± 21.4 vs. 56.4 ± 32.5 cm/s, P < 0.002), and, consequently, the diastolic-to-systolic ratio of peak flow velocity in the RCA was significantly less than in the LMS (1.00 ± 0.32 vs. 1.79 ± 0.48, P < 0.001). This was due to a lower distal-originating suction wave (8.2 ± 6.6 × 103 vs. 16.0 ± 12.2 × 103 W·m?2·s?1, P < 0.01). The suction wave in the LMS correlated positively with left ventricular pressure (r = 0.6, P < 0.01) and in the RCA with estimated right ventricular systolic pressure (r = 0.7, P = 0.05) but not with the respective diameter in these arteries. In contrast to the LMS, where coronary flow velocity was predominantly diastolic, in the proximal RCA coronary flow velocity was similar in systole and diastole. This difference was due to a smaller distal-originating suction wave in the RCA, which can be explained by differences in elastance and pressure generated between right and left ventricles.
Hadjiloizou, Nearchos; Davies, Justin E.; Malik, Iqbal S.; Aguado-Sierra, Jazmin; Willson, Keith; Foale, Rodney A.; Parker, Kim H.; Hughes, Alun D.; Francis, Darrel P.; Mayet, Jamil
...or ensuring that the seal flush is operating at design pressure and temperature. First attempt at repair for valves includes...i) Repair requires replacing the existing seal design with a new system that the owner or operator...
Tracheoesophageal fistula and esophageal atresia repair is surgery to repair two birth defects in your esophagus and trachea. ... not connect with the lower esophagus and stomach. Tracheoesophageal fistula (TEF) is a connection between the upper part ...
The leak testing, reporting and vacuum leak repair techniques of the MFTF yin-yang number one magnet system, the world's largest superconducting magnet system, are discussed. Based on this experience, techniques will be developed for testing and repairing...
T. A. Kozman
Fatigue tests were performed on large-scale models of ship structural components. Cracks that formed in these test specimens were repaired using various techniques and the residual fatigue lives of these repairs were then determined by continuing the test...
The meeting, titled ''DNA Repair and Mutagenesis: Mechanism, Control, and Biological Consequences'', was designed to bring together the various sub-disciplines that collectively comprise the field of DNA Repair and Mutagenesis. The keynote address was titled ''Mutability Doth Play Her Cruel Sports to Many Men's Decay: Variations on the Theme of Translesion Synthesis.'' Sessions were held on the following themes: Excision repair of DNA damage; Transcription and DNA excision repair; UmuC/DinB/Rev1/Rad30 superfamily of DNA polymerases; Cellular responses to DNA damage, checkpoints, and damage tolerance; Repair of mismatched bases, mutation; Genome-instability, and hypermutation; Repair of strand breaks; Replicational fidelity, and Late-breaking developments; Repair and mutation in challenging environments; and Defects in DNA repair: consequences for human disease and aging.
Walker, Graham C.
Formation of DNA interstrand crosslinks (ICLs) in chromosomal DNA imposes acute obstruction of all essential DNA functions. For nearly a century, bifunctional alkylators, also known as DNA crosslinkers, have been an important class of cancer chemotherapeutic regimens. The mechanisms of ICL repair remains largely elusive. Here, we review a eukaryotic mutagenic ICL repair pathway discovered by work from several laboratories. This repair pathway, alternatively termed recombination-independent ICL repair, involves the incision activities of the nucleotide excision repair (NER) mechanism and lesion bypass polymerase(s). Repair of the ICL is initiated by dual incisions flanking the ICL on one strand of the double helix; the resulting gap is filled in by lesion bypass polymerases. The remaining lesion is subsequently removed by a second round of NER reaction. The mutagenic repair of ICL likely interacts with other cellular mechanisms such as the Fanconi anemia pathway and recombinational repair of ICLs. These aspects will also be discussed.
Shen, Xi; Li, Lei
Guidelines are established in the report for evaluation and repair of damaged steel bridge members. Included in the guidelines are inspection of damage, assessment of damage, selection of repair method, and repair of damage. Included in methods of repair ...
G. O. Shanafelt W. B. Horn
This paper presents the final results of the performances of the High Resolution Standard Proximity Sensor developed under a GSTP contract for ESA/ESTEC. The HRSPS is a general purpose displacement measuring system developed with the aim to replace the multitude of customised sensors used so far in scanning and pointing mechanisms. It will become the European standard nano-measuring system qualified for space mechanisms operating in closed loop control. The HRSPS offers either two independent single or a differential output(s) offering a resolution of 1 nanometer. Three different HRSPS covering three measuring ranges have been developed. This paper presents the test results and the final confirmation of the performances of the HRSPS. The majority of sensor designs available industrially and in the launcher field are not readily suitable for high reliability space / satellite applications. The HRSPS manufactured can be supplied in either high reliability FM's for satellites and also FM's for microgravity / ISS applications requiring Mil 883B/C type of components. The paper will present the first applications for microgravity and satellite applications.
Aeby, Hans-Peter; Blaser, Roger; Mancini, Nicolas; Mivelaz, Marcel; Perriard, Jacques
In patients with unilateral proximal femoral focal deficiency, the leg length inequality is almost always greater than five inches at skeletal maturity. Consequently, prosthetic management should be planned before the patient walks. A standard plan of treatment of the patient with unilateral PFFD is not possible at this time, primarily because of the varying percentage of femur missing and the controversy of management of the hip in patients with type A or B deformity. However, we found that ankle disarticulation with Syme flap closure combined with arthrodesis of the knee is a reasonable plan in many patients with unilateral PFFD. This allows correction of the knee and hip flexion contractures and gives the patient a functional, cosmetic stump. By the time he begins school, he is functioning as an above-knee amputee. This is not an undesirable goal, as one of us (E.G.R.) recently examined an above-knee amputee, a Captain in the United States Army, who continued his hobby of sky diving. PMID:424795
Richardson, E G; Rambach, B E
A histologically normal insertion site does not regenerate following rotator cuff tendon-to-bone repair, which is likely due\\u000a to abnormal or insufficient gene expression and\\/or cell differentiation at the repair site. Techniques to manipulate the biologic\\u000a events following tendon repair may improve healing. We used a sheep infraspinatus repair model to evaluate the effect of osteoinductive\\u000a growth factors and BMP-12 on
David Kovacevic; Scott A. Rodeo
Rotator cuff repair techniques continue to evolve in an effort to improve repair biomechanics, maximize the biologic environment for tendon healing, and ultimately improve patient outcomes. The arthroscopic transosseous-equivalent technique was developed to replicate the favorable tendon-bone contact area for healing seen in open transosseous tunnel repair. In this technical note and accompanying video, we present our all-arthroscopic transosseous-equivalent rotator cuff repair technique with a focus on technical pearls.
Lavery, Kyle P.; Rasmussen, Jeffrey F.; Dhawan, Aman
Although the Achilles tendon is the strongest in the body, it also is the most often ruptured. Achilles tendon rupture most often occurs during sports activities in middle-aged men. Operative repair of a ruptured Achilles tendon can be accomplished with a variety of techniques, ranging from open repair, to minimally invasive technique, to endoscopic-assisted repair. This article focuses on open repair of acute Achilles tendon rupture. Surgical techniques, rehabilitation protocol, and the authors' preferred method are described. PMID:19857843
Rosenzweig, Seth; Azar, Frederick M
This paper examines and discusses past, present and future considerations of self-repairing products. Descriptive terms are carefully defined for seven possible degrees of self-repair. Basic design requirements to achieve the fourth and fifth degrees of self-repair are described. Reliability enhancing, endurance and life considerations of the various degrees of self-repair are reviewed. Current work being performed in the broad field
Richard R. Landers
The two broad categories of fiber-reinforced composite liner repair and deposited weld metal repair technologies were reviewed and evaluated for potential application for internal repair of gas transmission pipelines. Both are used to some extent for other applications and could be further developed for internal, local, structural repair of gas transmission pipelines. Evaluation trials were conducted on pipe sections with
The aim of this study was to investigate, if the simulated proximity level of an anthropomorphic conversational agent and the affective contents in the agent's speech influence the subjects' affective experiences. Eight subjects were exposed to messages given by the agent using synthetic speech. The agent character's simulated proximity level (intimate, personal, social, and public) and the affective contents of
Timo Partala; Veikko Surakka; Jussi Lahti
An intussusception of the small intestine in association with a long tube usually occurs in the vicinity of the mercury-filled bag and can be visualized radiographically by instilling barium directly into the tube. On rare occasions, an intussusception develops in the proximal jejunum and is difficult to recognize. We report the fifth and sixth cases of a proximal jejunal intussusception
Steven R. Peskin; R. Eugene Langevin; Peter A. Banks
In this study, we introduce and study a proximity-based fuzzy clustering. As the name stipulates, in this mode of clustering, a structure “discovery” in the data is realized in an unsupervised manner and becomes augmented by a certain auxiliary supervision mechanism. The supervision mechanism introduced in this algorithm is realized via a number of proximity “hints” (constraints) that specify an
Witold Pedrycz; Vincenzo Loia; Sabrina Senatore
Five patients with stress fractures of the proximal tibia adjacent to an arthritic knee joint were treated by resurfacing arthroplasty with intramedullary fixation of the fracture. All five fractures healed and limb realignment was achieved. The literature concerning proximal tibial stress structures in relation to the arthritic knee and the management of this condition is reviewed.
M. P. W. Tomlinson; I. M. Dingwall; H. Phillips
Using perfusion techniques in single proximal tubule segments of rat kidney, the relationship between net sodium movement and active transport of ions, as measured by the short-circuit method, has been studied. In addition, the role of the colloid-osmotic pressure gradient in proximal transtubular fluid and sodium movement has been considered. Furthermore, the limiting concen- tration gradient against which sodium movement
GERHARD GIEBISCH; RUTH M. KLOSE; GERHARD MALNIC; W. JAMES SULLIVAN; ERICH E. WINDHAGER
Spatial data mining recently emerges from a number of real applications, such as realestate marketing, urban planning, weather forecasting, medical image analysis, road traffic accident analysis, etc. It demands for efficient solutions for many new, expensive, and complicated problems. In this paper, we investigate a proximity matching problem among clusters and features. The investigation involves proximity relationship measurement between clusters
Xuemin Lin; Xiaomei Zhou; Chengfei Liu
Empirical evidence tends to show that regional development occurs only in certain places. Therefore, one can ask the central question of the role of physical proximity in economic development processes. Economists try to answer this question through the concept of externalities, but this does not explain why certain externalities are linked with physical proximity. In this paper the author tries
Intralysosomal digestion of lysozyme in renal proximal tubule cells. This investigation was carried out to determine the ability of lysosomes in intact proximal tubule cells to digest absorbed protein. Lysozyme labeled with 125I was injected i.v. into rats and renal cortical slices removed after one hour. The slices were incubated in vitro for up to two hours. The location of
Erik Ilsø Christensen; Arvid B Maunsbach
Background & Aims: Low doses of erythromycin induce antral contractions and accelerate gastric emptying. However, the effect of erythromycin on the proximal stomach remains unknown. The aim of this study was to assess the effect and mechanism(s) of action of erythromycin on proximal gastric tone in humans. Methods: Gastric tone was measured using an electronic barostat in two groups of
Stanislas Bruley des Varannes; Véronique Parys; Alain Ropert; Jean Alain Chayvialle; Claude Rozé; Jean Paul Galmiche
...RCCM using radio waves or a cable. Moving...Virginia Mine Safety Technology Task Force (Task...including shuttle cars, scoops, belt...proximity detection technology to underground mobile...RCCMs and shuttle cars. In your experience...proximity warning technology. Include any...
This paper proposes a nanorobotic fiber fabrication method which uses proximal probes to draw polymer fibers down to few hundred nanometers in diameter and several hundred micrometers in length. Using proximal probes such as Atomic Force Microscope (AFM) and Scanning Tunneling Microscope (STM) or glass micropipettes, liquid polymers dissolved in a solvent are drawn. During drawing, the solvent evaporates in
Amrinder Singh Nain; Cristina Amon; Metin Sitti
We proposea proximity-based access control scheme forimplantable medical devices (IMDs). Ourscheme is based onultrasonic distance- bounding and enables an implanted medical device to grant access to its resources only to those devices that are in its close proxim- ity. We demonstrate the feasibility of our approach through tests in an emulated patient environment. We show that, although im- planted, IMDs
Kasper Bonne Rasmussen; Claude Castelluccia; Thomas S. Heydt-benjamin; Srdjan Capkun
This study examines direct and indirect impacts of antismoking media messages on adolescents' smoking attitudes and intentions to smoke. Elaborating on the influence of presumed influence model, this study incorporates the moderating role of peer proximity (i.e., proximal versus distal peers). Analyzing direct effects in a survey of 1,687 middle school students, we find that antismoking media messages have unexpected
Hye-Jin Paek; Albert C. Gunther
This paper investigates the problems of the large beam divergence angle and short detection range in the launch system of laser proximity fuze. By analyzing the factors of measuring distance in laser proximity fuze, combined with characteristics of laser's far-field divergence angle, and according to aspheric optical design theory, we carry out image processing and simulation of laser spot by
Lin Gan; He Zhang; Xiang-jin Zhang
For four years up to December 1987, 190 patients (median age 73 years) with proximal malignant biliary obstruction were treated by endoscopic endoprosthesis insertion. Altogether 101 had cholangiocarcinoma, 21 gall bladder carcinoma, 20 local spread of pancreatic carcinoma, and 48 metastatic malignancy. Fifty eight patients had type I, 54 type II, and 78 type III proximal biliary strictures (Bismuth classification).
A A Polydorou; S R Cairns; J F Dowsett; A R Hatfield; P R Salmon; P B Cotton; R C Russell
Many firms rely on external organizations to acquire knowledge that is useful for developing creative new products and reducing the time needed to bring these products to market. Cluster theory suggests that this knowledge is often obtained from organizations located in close geographic proximity. Specifically, proximity is assumed to fos- ter heightened face-to-face communication, strengthened relational ties, increased knowledge acquisition,
Shankar Ganesan; Alan J. Malter; Aric Rindfleisch
In spite of increasing global flows of ideas, capital, goods and labor, recent research in urban economics and economic geography suggests that geographical proximity between innovators may be important to technological innovation. Many authors also claim that the rise of a knowledge-based economy and changes in the organization of the innovation process have actually increased the value of such proximity
Jung Won Sonn
The biceps brachii is a unique muscle with 2 proximal tendons and a single distal tendon. Although these tendons are part of the same muscle, they have significantly different functions. It is hypothesized that the long head of the biceps acts as a pain generator in the shoulder, though the biomechanical function is still under debate. Conversely, the distal biceps tendon is the major supinator of the forearm and serves a secondary flexor. As such, injuries to these tendons must be evaluated independently. Biceps brachii ruptures most often occur in middle-aged men following a traumatic event. Injuries to the long head of the biceps are primarily treated nonoperatively with adequate results. Injuries of distal tendon occur less often, but are receiving significant attention in the literature in regard to treatment options. Surgical repair of distal biceps ruptures is indicated in patients who want to restore supination strength and endurance. It is unclear which operative technique is superior, although the most recent data suggest increased strength of the cortical button repair. This article provides a comprehensive review of both proximal and distal biceps brachii ruptures in addition to our treatment algorithm. PMID:20631471
Geaney, Lauren E; Mazzocca, Augustus D
The objective of this contract is the assimilation and development of a compatible set of techniques which can be used to design and construct self-repairing digital systems. The objectives of this phase of the contract were to perform studies in the area...
H. S. Fitzhugh C. G. Masters W. C. Roberson
The arthroscopic operation for repair of full-thickness rotator cuff tears is successful and has the advantages ofglenohumeral joint inspection, treatment of intra-articular lesions, smaller incisions, no deltoid detachment, less soft tissue dissection, less pain, and more rapid rehabilitation. However, these advantages must be balanced against the technical difficulty of the method, which limits its application to surgeons skilled in both
Gary M. Gartsman
Joint injuries are a major concern for horses used in athletic and recreational sports. Spontaneous cartilage repair diminishes as horses reach maturity, and surgical measures have been developed to bolster these meager intrinsic responses. Local debridement, joint lavage, and marrow stimulation techniques provide improved symptomatic therapy that may last several years. Subchondral drilling (forage) has largely been superseded by microfracture
Alan J. Nixon
Endovascular repair is an established modality of treatment for abdominal aortic aneurysms. It is therefore reasonable to expect its application to other less common aneurysmal conditions, including isolated iliac and popliteal artery aneurysms (PAA). There are, however, essential differences between aortic aneurysms and peripheral aneurysms: smaller arterial caliber, mobility of the arterial segment, associated occlusive disease, and devices that have not been specifically designed for peripheral applications. Due to these differences, results obtained in abdominal aortic aneurysms cannot be extrapolated to peripheral aneurysms. The attraction of the endovascular repair for PAA is its minimally invasive nature. The literature, however, provides only case reports, case series and small cohorts, and one small randomized, controlled trial. A cumulative summary of these studies provides the clinician with information upon which to base the choice of treatment on a specific patient. Endovascular repair for PAA with suitable anatomy and good run-off can be considered safe, and medium term results appear comparable with those of open repair. PMID:20045613
Cina, Claudio S
|This competency-based curriculum guide for teachers addresses the skills a technician will need to service microwave ovens and to provide customer relations to help retain the customer's confidence in the product and trust in the service company that performs the repair. The guide begins with a task analysis, listing 20 cognitive tasks and 5…
The Canadian hernioplasty is the modern equivalent of the original Bassini operation. Most of the criticism of the repair is unjustified, even the fact that the repair does not address the femoral canal. The incidence of the femoral type of recurrence that typically occurs in the first year was only 0.14% among the 4,366 primary Canadian hernioplasties performed by one surgeon in the years 1970 to 1987. There were a total of 58 recurrences for a raw recurrence rate of 1.3%. About half of the recurrences were considered to be failures of the hernioplasty, and the remaining ones were attributable to continued deterioration of the patient's tissues. This huge experience of one surgeon demonstrates that recurrence rates, to a great extent, depend on the skills of the surgeon. Recurrence rates decrease as a surgeon's experience with the procedure increases. It also demonstrates the importance of technique and how a minor change in the method of beginning the continuous suture reduced suture tension and eliminated the well-known pubic tubercle type of recurrence seen after all hernioplasties. The recurrence rate for 639 recurrent and rerecurrent hernias repaired by Canadian hernioplasty was 7.2%. This rate is unsatisfactory, and a preperitoneal repair with a polyester prosthesis is preferred for these difficult problems. A local agent neutralized with sodium bicarbonate is the anesthetic of choice, and simultaneous left and right hernioplasties with the patient going home the same day as the procedure are now commonplace. PMID:2815796
Wantz, G E
This competency-based curriculum guide for teachers addresses the skills a technician will need to service microwave ovens and to provide customer relations to help retain the customer's confidence in the product and trust in the service company that performs the repair. The guide begins with a task analysis, listing 20 cognitive tasks and 5…
Deficient repair of ubiquitous errors in the genome risks faulty transcription or replication. Its direct and indirect phenotypic consequences are rare, complex, dementing, lethal disorders of children with inadequately understood overlapping genotypes and variable severity. Mutations of CSA or CSB responsible for impaired transcription-coupled repair cause Cockayne syndrome (CS). Its characteristics are (1) profound growth deficiency affecting all tissues, including the brain, (2) premature aging marked by cachexia, vascular disease, exocrine deficiency, and osteopenia, but not cancer, and (3) a selective degenerative disorder of central and peripheral myelin and by neuronal loss in the retina and inner ear, and in the cerebellum and basal ganglia where it is associated with calcification. Xeroderma pigmentosum (XP) can arise from mutations of at least eight genes involved in global genomic repair. Severe XPA and XPC cause innumerable carcinomas and melanomas in light-exposed eyes and skin, and enhanced risk of visceral cancers. XPA and XPD and others can cause childhood XP neurological disease with widespread neuronal loss, axonal sensorimotor neuropathy, and dwarfing. Four genes, including XPD, can cause trichothiodystrophy (TTD) with sulfur-deficient, brittle, tiger-tail hair, and growth and developmental inadequacy. CSB or XPD can cause the severe congenital cerebro-oculofacioskeletal (COFS) CS-like syndrome with joint contractures, cataracts, and early death. Three XP genes can also cause XP/CS complex. Much more needs to be learned about these and other disorders of DNA repair to enable prevention and treatment. PMID:23622385
In most adult epithelia the process of replacing damaged or dead cells is maintained through the presence of stem\\/progenitor cells, which allow epithelial tissues to be repaired following injury. Existing evidence strongly supports the presence of stem cells in the adult kidney. Indeed, recent findings provide evidence in favour of a role for intrinsic renal cells and against a physiological
Paola Romagnani; Raghu Kalluri
Surgical repair of tricuspid atresia has been carried out in three patients; two of these operations have been successful. A new surgical procedure has been used which transmits the whole vena caval blood to the lungs, while only oxygenated blood returns to the left heart. The right atrium is, in this way, `ventriclized', to direct the inferior vena caval blood
F. Fontan; E. Baudet
Arthroscopic rotator cuff repairs using titanium-alloy suture anchors are a new treatment option for active patients with shoulder injuries. Shoulder arthroscopy and arthroscopic repair procedures are alternative treatments to traditional open surgical procedures for Bankart lesions and rotator cuff tears. Distinct advantages of arthroscopic repair techniques include decreased patient tissue trauma and morbidity rates and shortened recovery and rehabilitation periods.
Lee Anna Farrall
Purpose: The clinical results of a single surgeon’s experience with Meniscus Arrows (Bionx, Blue Bell, PA) for meniscal repair are reviewed and reported to determine the safety and efficacy of this device. Type of Study: Consecutive sample. Methods: Over a 3-year period, the senior author has used only Meniscus Arrows for all meniscal repairs. All patients who underwent meniscal repair
Timothy S. Petsche; Harlan Selesnick; Adam Rochman
DNA repair is crucial to the integrity of the human genome since mammalian cells are continuously exposed to different chemical and physical genotoxic agents. To counteract the lesions induced by these agents, organisms have developed a number of highly conserved repair mechanisms involving numerous protein complexes grouped in several different repair pathways. The importance of studying the individual capacity to
Vanessa Valdiglesias; Eduardo Pásaro; Josefina Méndez; Blanca Laffon
A current explanation for development of chronic renal injury is the imbalance between injurious mechanism and regenerative repair. The possibility that stem cells contribute to the repair of glomerular and tubular damage is of great interest for basic and translational research. Endogenous bone marrow-derived stem cells have been implicated in the repair of renal tissue, although the lineage of stem
Benedetta Bussolati; Peter Viktor Hauser; Raquel Carvalhosa; Giovanni Camussi
The GERRY scheduling and rescheduling system being applied to coordinate Space Shuttle ground processing is described. The system uses constraint-based iterative repair, a technique that starts with a complete but possibly flawed schedule and iteratively improves it by using constraint knowledge within repair heuristics. The tradeoff between the informedness and the computational cost of several repair heuristics is explored. It
Monte Zweben; Eugene Davis; Brian Daun; Michael J. Deale
Ancient pottery repair has become a topic of growing interest to scholars of Greek and Roman pottery. This particular area of study is part of a larger one devoted to the diverse types of pottery reuse in classical antiquity. Quantification of ancient repairs remains a fundamental problem, however, and periods of intensified use of repaired pottery have been difficult to
Pia Guldager Bilde; Søren Handberg
Atherosclerosis is a chronic inflammatory process and progresses through characteristic morphologic stages. We have shown previously that chronically injecting bone-marrow-derived vascular progenitor cells can effect arterial repair. This repair capacity depends on the age of the injected marrow cells, suggesting a progressive decline in progenitor cell function. We hypothesized that the progression of atherosclerosis coincides with the deteriorating repair capacity
Ravi Karra; Sreekanth Vemullapalli; Chunming Dong; Edward E. Herderick; Xiaohua Song; Kathy Slosek; Joseph R. Nevins; Mike West; Pascal J. Goldschmidt-Clermont; David Seo
|Standardized curricula are provided for two courses for the secondary vocational education program in Mississippi: automotive body repair I and II. The nine units in automotive body repair I are as follows: introduction; related information; basic tool usage and safety; body and frame construction; basic sheet metal repair; preparing for…
Mississippi State Dept. of Education, Jackson. Office of Vocational, Technical and Adult Education.
Lasers have come into wide use for the repair of liquid crystal (LCD), electroluminescent (EL) and plasma flat panel displays. As displays have become larger, more complex and thus increasingly more expensive, repair also has become indispensable. Laser repaid equipment can perform either as on-line production machinery or in a failure analysis role. Most of these repairs have been subtractive,
Rodney L. Waters; Floyd R. Pothoven
Cleft palate affects almost every function of the face except vision. Today a child born with cleft palate with or without cleft lip should not be considered as unfortunate, because surgical repair of cleft palate has reached a highly satisfactory level. However for an average cleft surgeon palatoplasty remains an enigma. The surgery differs from centre to centre and surgeon to surgeon. However there is general agreement that palatoplasty (soft palate at least) should be performed between 6-12 months of age. Basically there are three groups of palatoplasty techniques. One is for hard palate repair, second for soft palate repair and the third based on the surgical schedule. Hard palate repair techniques are Veau-Wardill-Kilner V-Y, von Langenbeck, two-flap, Aleveolar extension palatoplasty, vomer flap, raw area free palatoplasty etc. The soft palate techniques are intravelar veloplasty, double opposing Z-plasty, radical muscle dissection, primary pharyngeal flap etc. And the protocol based techniques are Schweckendiek's, Malek's, whole in one, modified schedule with palatoplasty before lip repair etc. One should also know the effect of each technique on maxillofacial growth and speech. The ideal technique of palatoplasty is the one which gives perfect speech without affecting the maxillofacial growth and hearing. The techniques are still evolving because we are yet to design an ideal one. It is always good to know all the techniques and variations so that one can choose whichever gives the best result in one's hands. A large number of techniques are available in literature, and also every surgeon incorporates his own modification to make it a variation. However there are some basic techniques, which are described in details which are used in various centres. Some of the important variations are also described.
A 32-year-old man with Marfan syndrome presented with enlarging, asymptomatic bilateral subclavian artery aneurysms. He has an extensive surgical history including aortic arch and descending thoracic aorta replacement. The L aneurysm was treated first with an L carotid-vertebral artery vein bypass, aneurysm debranching, and stent-graft repair of aneurysm via the L brachial artery approach. The R aneurysm was treated by placing a stent graft from the proximal R common carotid artery across the R subclavian artery origin and landing in the prosthetic innominate bypass graft via an L common carotid artery conduit. An aneurysm debranching and R carotid-subclavian artery bypass completed the procedure. A proximal type I endoleak was detected in the R aneurysm sac on follow-up computed tomography angiography. This was treated with sternotomy, aorta to L common carotid artery bypass, stent graft removal, and oversewing of the R subclavian artery origin. The patient recovered uneventfully. Subclavian artery aneurysms are rarely diagnosed in patients with Marfan disease. Although durability remains unproven, hybrid repair should be considered in patients with subclavian artery aneurysms, to minimize the morbidity commonly associated with open repair. PMID:19631504
Bowman, Jonathan N; Ellozy, Sharif H; Plestis, Konstadinos; Marin, Michael L; Faries, Peter L
The purpose of this study was to determine what proportion of patients with an abdominal aortic aneurysm (AAA) would be eligible for endovascular aneurysm repair (EVAR) and to examine the major determinants for suitability of EVAR with the currently available indications. We retrospectively reviewed 3-D reconstructed computed tomography angiography of 88 patients with an atherosclerotic AAA who underwent open repair or EVAR between October 2003 and October 2010 at the Cardiovascular Center, Seoul National University Bundang Hospital. Of the 88 patients, 71 (80.7%) were treated with open repair and 17 (19.3%) were treated with EVAR. The rate of minor complications, postprocedural intensive care unit stay, and total hospital stay were significantly lower in the EVAR group. When the suitability of EVAR was reevaluated using morphologic criteria, a total of 33 (37.5%) patients were considered eligible for EVAR. Multivariate analysis revealed that proximal neck length, proximal neck angle, and aneurismal sac size were independent determinants for suitability of EVAR. Taking into account the increased clinical experience and the availability of new devices, EVAR would be applicable in about 40% of atherosclerotic AAA cases in this series of Korean patients. Accurate identification of candidates for EVAR by detailed preoperative evaluation, especially for morphologic characteristics, is essential. PMID:22258719
Lee, Joo Myung; Lim, Cheong; Youn, Tae-Jin; Chun, Eun Ju; Choi, Sang-Il; Cho, Young-Seok; Cho, Goo-Yeong; Chae, In-Ho; Park, Kay-Hyun; Choi, Dong-Ju
The clinical success of stem cell therapy for myocardial repair hinges on a better understanding of cardiac fate mechanisms. We have identified small molecules involved in cardiac fate by screening a chemical library for activators of the signature gene Nkx2.5, using a luciferase knockin bacterial artificial chromosome (BAC) in mouse P19CL6 pluripotent stem cells. We describe a family of sulfonyl-hydrazone (Shz) small molecules that can trigger cardiac mRNA and protein expression in a variety of embryonic and adult stem/progenitor cells, including human mobilized peripheral blood mononuclear cells (M-PBMCs). Small-molecule-enhanced M-PBMCs engrafted into the rat heart in proximity to an experimental injury improved cardiac function better than control cells. Recovery of cardiac function correlated with persistence of viable human cells, expressing human-specific cardiac mRNAs and proteins. Shz small molecules are promising starting points for drugs to promote myocardial repair/regeneration by activating cardiac differentiation in M-PBMCs. PMID:18420817
Sadek, Hesham; Hannack, Britta; Choe, Elizabeth; Wang, Jessica; Latif, Shuaib; Garry, Mary G; Garry, Daniel J; Longgood, Jamie; Frantz, Doug E; Olson, Eric N; Hsieh, Jenny; Schneider, Jay W
Defect repair is a key component in fabricating a defect- free mask. Focused ion beam repair has been successfully used for x-ray masks. To repair an opaque defect the ion beam is used to mill away the excess absorber while clear defect repair requires beam assisted deposition of Au. Current x-ray mask repair tools specify edge placement accuracy of +/- 25 mask nm. However, the effects of non- ideal repairs on printed resist have not been investigated, and the tolerance of such errors have not been specified. In this study, reported defect printing was tracked and resists edge placement accuracy was measured to evaluate the non- ideal repair effects. In the opaque defect repair case, we observed inside the 'repair box', repaired mask errors such as sloped walls, remaining absorber and re-deposition outside the box and found that these errors shift the printed resist pattern edge toward the inside of the box. In the clear defect repair case, the deposited gold is typically extended out of the defined box by sloped side- wall and the printed resist pattern edge is shifted toward the outside of the box. These non-ideal repairs systematically affect resist pattern edge placement. An x- ray lithography simulation tool was used to analyze these effects. Preliminary by adjusting the 'repair box' size and etch/deposition time, the effects of non-ideal repair can be eliminated. Programmed defects were created on a mask and repairs were performed, evaluated and optimized with actual x-ray exposures.
Chen, Zheng; Nash, Steven C.; Krasnoperova, Azalia A.; Wasik, Chet
Limb salvage surgery for malignant tumours of proximal humerus is an operative challenge, where the surgeon has to preserve elbow and hand functions and retain shoulder stability with as much function as possible. We treated 14 consecutive patients with primary malignant or isolated metastasis of proximal humerus with surgical resection and reconstruction by nail cement spacer. There were 8 females and 6 males, with a mean age of 28.92 years (range 16-51 years) and a mean follow-up of 30.14 months (range 12-52 months). The diagnosis was osteosarcoma in 8 patients, chondrosarcoma in 4 patients and metastasis from thyroid and breast carcinoma in 1 patient each. One of our patients had radial nerve neuropraxia, 1 developed inferior subluxation and 3 developed distant metastasis. Two patients died of disease and one developed local recurrence leading to forequarter amputation, leaving a total of 11 patients with functional extremities for assessment at the time of final follow-up which was done using the Musculoskeletal Tumour Society (MSTS) score. Though we were able to preserve the elbow, wrist and hand functions in all patients, the abductor mechanism, deltoid muscle and axillary nerve were not salvageable in any of cases. The mean MSTS score at the time of final follow-up was 19.09. Thus, proximal humeral reconstruction using nail cement spacer is a technical simple, cost-effective and reproducible procedure which makes it a reliable option in subset of patients where the functions around the shoulder cannot be preserved despite costlier prosthesis. PMID:23925868
Kundu, Zile Singh; Gogna, Paritosh; Gupta, Vinay; Kamboj, Pradeep; Singla, Rohit; Sangwan, Sukhbir Singh
Research at the interface between biomolecules and inorganic nanocrystals has resulted in a great number of new discoveries. In part this arises from the synergistic duality of the system: biomolecules may act as self-assembly agents for organizing inorganic nanocrystals into functional materials; alternatively, nanocrystals may act as microscopic or spectroscopic labels for elucidating the behavior of complex biomolecular systems. However, success in either of these functions relies heavily uponthe ability to control the conjugation and assembly processes.In the work presented here, we first design a branched DNA scaffold which allows hybridization of DNA-nanocrystal monoconjugates to form discrete assemblies. Importantly, the asymmetry of the branched scaffold allows the formation of asymmetric2assemblies of nanocrystals. In the context of a self-assembled device, this can be considered a step toward the ability to engineer functionally distinct inputs and outputs.Next we develop an anion-exchange high performance liquid chromatography purification method which allows large gold nanocrystals attached to single strands of very short DNA to be purified. When two such complementary conjugates are hybridized, the large nanocrystals are brought into close proximity, allowing their plasmon resonances to couple. Such plasmon-coupled constructs are of interest both as optical interconnects for nanoscale devices and as `plasmon ruler? biomolecular probes.We then present an enzymatic ligation strategy for creating multi-nanoparticle building blocks for self-assembly. In constructing a nanoscale device, such a strategy would allow pre-assembly and purification of components; these constructs can also act as multi-label probes of single-stranded DNA conformational dynamics. Finally we demonstrate a simple proof-of-concept of a nanoparticle analog of the polymerase chain reaction.
Claridge, Shelley A
Distal airway epithelium is widely believed to secrete ions and liquid into the airspace, although this process has never been demonstrated in intact small airways. To determine the characteristics of active ion transport in distal airway epithelium, the effects of selective inhibitors of active Na+ absorption and Cl- secretion on the bioelectric properties of intact proximal bronchiolar epithelium were evaluated. Large bronchioles (450-1,200 microns outside diameter, 1.5-5.0 mm length) were excised from 4- to 8-wk-old pigs, cannulated with glass microcannulas, and perfused. Transepithelial potential difference (PD), short-circuit current (Isc), and resistance (Rm) were measured by cable analysis. In 14 tissues, resting PD, Isc, and Rm were -3.4 +/- 0.4 mV (lumen negative), 19.6 +/- 4.7 microA/cm2, and 255 +/- 50 omega.m2, respectively. The conductive Na+ channel blocker amiloride (10 microM) significantly (P < 0.05) reduced PD and Isc by 37 and 41% and significantly increased Rm by 23% in seven tissues. Subsequent bumetanide (10 microM), a blocker of active Cl- secretion through inhibition of Na(+)-K(+)-2Cl- cotransport, significantly reduced the amiloride-insensitive PD and Isc by 41 and 50%, whereas Rm significantly increased 15%. Because amiloride is known to induce Cl- secretion, the order of drug addition was reversed to determine the fractional contribution of active Cl- secretion to the resting PD, Isc, and Rm. In seven different bronchioles, bumetanide did not significantly affect PD, Isc, or Rm.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8048545
Ballard, S T; Taylor, A E
Background: Endovascular aneurysm repair has gained widespread acceptance, and there has been a significant increase in the number of aneurysms treated with stent grafts. However, the endovascular technique alone is often not appropriate for anatomically complex aneurysms involving the neck branches. We used the TAG stent for thoracic aortic aneurysms (TAA), and report our initial results. Patients and Results: We deployed 80 TAG stents in 65 patients electively treated with TAA between June 2006 and June 2008. Thoracic endovascular aneurysm repair (TEVAR) was performed in 45 cases of descending aortic aneurysm with no morbidity or mortality. A combination of open surgery and TEVAR was performed in 11 out of 20 cases with aneurysms of the aortic arch. The prior total arch replacement and elephant trunk procedure was performed in 3 cases with dilated ascending aorta, total debranching from ascending aorta with sternotomy in 5, and carotid-carotid artery crossover bypass in 3 cases. Meanwhile, TEVAR with coverage of the left subclavian artery was performed in the remaining 9 distal arch cases. In 3 cases with extremely short necks, a 0.018” guide wire was inserted percutaneously in a retrograde manner through the common carotid artery (CCA) into the ascending aorta to place the stent graft in close proximity to the CCA (wire protection). In 1 of these 3 cases, the TAG stent was deployed through the CCA, and the 0.018” guide wire was used to deliver a balloon-expandable stent in order to restore the patency of the CCA. In arch and distal arch aneurysm cases, perioperative mortality and the incidence of stroke were both 5.0%; dissection of the ascending aorta was seen in one case (5.0%). Conclusion: As treatment for descending aortic aneurysms, TEVAR can replace conventional open repair. However, TEVAR for arch aneurysms has some problems, and further improvement is necessary. (English Translation of Jpn J Vasc Surg 2010; 19: 547-555.)
Kanaoka, Yuji; Ohki, Takao; Toya, Naoki; Ishida, Atsushi; Tachihara, Hiromasa; Hirayama, Shigeki; Kurosaw