The sinus tarsi approach in displaced intra-articular calcaneal fractures: a systematic review

Purpose: Although open reduction and internal fixation is currently considered the gold standard in surgical treatment of displaced intra-articular calcaneal fractures, various different approaches exist including the limited lateral approach. The aim of this systematic review was to combine the results of studies using the sinus tarsi approach, which is the most frequently applied limited lateral approach. Method: A literature search in the electronic databases of the Cochrane Library and Pubmed Medline, between January 1st 2000 to December 1st 2010, was conducted to identify studies in which the sinus tarsi approach or a modified sinus tarsi approach was utilized for the treatment of displaced intra-articular calcaneal fractures. The methodological quality of the included studies was assessed using the Coleman methodology score. Results: A total of eight case series reporting on 256 patients with 271 calcaneal fractures was identified. Overall good to excellent outcome was reached in three-quarters of all patients. An average complication rate of minor wound complications of 4.1% was reported and major wound complications in 0.7%. The need for a secondary subtalar arthrodesis occurred at an average rate of 4.3%. The average Coleman methodology score was 56.8 (range 39-72) points. Conclusion: The results, i.e. functional outcome and complication rates, of the sinus tarsi approach compare similarly or favourably to the extended lateral approach. Therefore, in the process of tailoring the best treatment modality to the right patient and the right fracture type, the sinus tarsi approach might be a valuable asset

Upregulation of the cell-cycle regulator RGC-32 in Epstein-Barr virus-immortalized cells

Epstein-Barr virus (EBV) is implicated in the pathogenesis of multiple human tumours of lymphoid and epithelial origin. The virus infects and immortalizes B cells establishing a persistent latent infection characterized by varying patterns of EBV latent gene expression (latency 0, I, II and III). The CDK1 activator, Response Gene to Complement-32 (RGC-32, C13ORF15), is overexpressed in colon, breast and ovarian cancer tissues and we have detected selective high-level RGC-32 protein expression in EBV-immortalized latency III cells. Significantly, we show that overexpression of RGC-32 in B cells is sufficient to disrupt G2 cell-cycle arrest consistent with activation of CDK1, implicating RGC-32 in the EBV transformation process. Surprisingly, RGC-32 mRNA is expressed at high levels in latency I Burkitt's lymphoma (BL) cells and in some EBV-negative BL cell-lines, although RGC-32 protein expression is not detectable. We show that RGC-32 mRNA expression is elevated in latency I cells due to transcriptional activation by high levels of the differentially expressed RUNX1c transcription factor. We found that proteosomal degradation or blocked cytoplasmic export of the RGC-32 message were not responsible for the lack of RGC-32 protein expression in latency I cells. Significantly, analysis of the ribosomal association of the RGC-32 mRNA in latency I and latency III cells revealed that RGC-32 transcripts were associated with multiple ribosomes in both cell-types implicating post-initiation translational repression mechanisms in the block to RGC-32 protein production in latency I cells. In summary, our results are the first to demonstrate RGC-32 protein upregulation in cells transformed by a human tumour virus and to identify post-initiation translational mechanisms as an expression control point for this key cell-cycle regulator

Demographics of extra-articular calcaneal fractures: Including a review of the literature on treatment and outcome

Introduction: Extra-articular calcaneal fractures represent 25-40% of all calcaneal fractures and an even higher percentage of up to 60% is seen in children. A disproportionately small part of the literature on calcaneal fractures involves the extra-articular type. The aim of this study was to investigate the incidence of extra-articular calcaneal fractures in a Level 1 trauma centre, define the distribution of the various types of fractures and compare patient demographics between extra- and intra-articular calcaneal fractures. In addition the literature was reviewed for the most common types of extra-articular calcaneal fractures with regard to incidence, treatment and clinical outcome. Methods: The radiological records between 2003 and 2005 were reviewed for intra- and extra-articular calcaneal fractures. Patient gender-distribution and age were compared. A literature search was conducted for the treatment of extra-articular calcaneal fractures. Results: In this 3-year study period a total of 49 patients with 50 extra-articular calcaneal fractures and 91 patients with 101 intra-articular fractures were identified. The median age for the first group was 32.7 years, and for the second group 40.3 years; P = 0.04. Male predominance was significantly less pronounced for extra-articular (63%) compared with intra-articular fractures (79%; P = 0.04). Conclusion: One-third of all calcaneal fractures are extra-articular. Significant differences exist between the intra- and extra-articular groups, in terms of lower age and male-female ratio. The literature study shows inconsistencies in treatment options, but most extra-articular fractures are well manageable conservatively

Stem cell dynamics and pretumor progression in the intestinal tract

Colorectal carcinogenesis is a process that follows a stepwise cascade that goes from the normal to an invisible pretumor stage ultimately leading to grossly visible tumor progression. During pretumor progression, an increasing accumulation of genetic alterations occurs, by definition without visible manifestations. It is generally thought that stem cells in the crypt base are responsible for this initiation of colorectal cancer progression because they are the origin of the differentiated epithelial cells that occupy the crypt. Furthermore, they are characterized by a long life span that enables them to acquire these cumulative mutations. Recent studies visualized the dynamics of stem cells both in vitro and in vivo. Translating this work into clinical applications will contribute to the evaluation of patients’ predisposition for colorectal carcinogenesis and may help in the design of preventive measures for high-risk groups. In this review, we outline the progress made in the research into tracing stem cell dynamics. Further, we highlight the importance and potential clinical value of tracing stem cell dynamics in pretumor progression

Brand advocacy in the frontline:how does it affect customer satisfaction?

\u3cp\u3ePurpose: Many organizations expect their service engineers, or frontline employees (FLEs), to behave as brand advocates by engaging in favorable communication about the brand and its offerings toward customers. However, this approach is not without risk as customers may be disappointed or even frustrated with brand advocacy behavior in many service encounters. The purpose of this paper is to study the impact of FLEs’ brand advocacy on customer satisfaction with the service encounter, and identify the conditions under which the effects are detrimental. This paper specifically considers service issue severity and product newness as contingency conditions. Design/methodology/approach: Building on social identification theory, the paper builds a conceptual model, which is empirically tested using a data set that matches data from service engineers, customers, and archival records from the after-sales service department of a globally operating business-to-business print and document management solutions provider. Findings: This paper finds that brand advocacy behavior harms customer satisfaction especially in service encounters that involve simple service issues (e.g. maintenance) for products that are new to the market. Fortunately, brand identification can compensate this negative effect under many service conditions. While the joint effect of brand identification and advocacy is most beneficial for severe service issues of new products, no effect on customer satisfaction was found for established products. Practical implications: This paper identifies those service situations in which brand advocacy is advisable and guides managers toward achieving more favorable customer evaluations. Originality/value: Past research has considered several FLE branding activities in the frontline but the effects of brand advocacy have not been isolated. In addition, most studies have assumed the effects of employee brand-related behaviors on customer satisfaction to be universally positive rather than negative and focused on antecedents and not on moderators and consequences.\u3c/p\u3

Why did they do it? How customers’ self-service technology introduction attributions affect the customer-provider relationship

\u3cp\u3ePurpose – Customers often think that innovations, such as self-service technologies (SSTs), are introduced by service providers to cut costs rather than extend customer service levels. The purpose of this paper is to investigate how customers use such attributions to adjust their perceptions of relational value. Design/methodology/approach – Drawing on attribution and relationship marketing theories, this study proposes a conceptual model that includes benefit and cost attributions, their antecedents, and consequences. Survey data came from customers of a supermarket that recently introduced self-scanning technology. Findings – Attributions mediate the impact of SST performance on relational value. This value is highest for customers with high-benefit and low-cost attributions; customers with low-benefit and low-cost attributions exhibit detrimental effects on the exchange relationship with the firm. Characterized by low self-efficacy, low education, and low spending, these latter customers appear ambivalent and possibly confused about the provider’s motives for introducing SST. Practical implications – This research has important implications for service managers responsible for communicating technological innovations to customers. A clear reason for the introduction should be provided, to stimulate customers’ attribution and prevent ambivalence among those with low self-efficacy and low education. Originality/value – Most SST research focusses on adoption, non-adoption, and disadoption. The more subtle responses by customers facing a new SST and the consequences for the customer-provider exchange relationship, as addressed herein, have been left largely unexplored.\u3c/p\u3

Innovation in the frontline: Exploring the relationship between role conflict, ideas for improvement, and employee service performance

\u3cp\u3eAlthough practitioners and scholars recognize that frontline employees' (FLEs') performance may improve rather than suffer from role conflict, research has yet to show how firms can manage this complex process. This study proposes that employees' ideas for improvement are a crucial mediator in role conflict's positive influence on FLEs' service performance. A conditional process model was tested in two empirical studies with multisource data. Results show that role conflict positively influences service performance through the employee's ideas for improvement. Role conflict also has a direct negative effect on performance. Detailed moderating analyses, using a floodlight approach, show that role conflict's total effect on service performance is positive only when an employee's learning orientation and the manager's level of encouragement for improvement are aligned. In other cases role conflict does not affect, or can even seriously impair FLEs' service performance. This study is the first to demonstrate empirically how, and under what conditions, role conflict can lead to performance enhancement of FLEs. Our findings help marketing managers to leverage role conflict for service innovation and to serve customers better.\u3c/p\u3

Disentangling the effects of role stress on service performance : the role of frontline employees' ideas for improvement

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