Transposition of the apophysis of the greater trochanter for reconstruction of the femoral head after septic hip arthritis in children: 4 children followed for more than 15 years

Background and purpose Total necrosis of the femoral head after infection in children during their first months of life gives a dislocated hip with severe leg shortening. A new femoral head can be achieved with subtrochanteric osteotomy and transposition of the apophysis of the greater trochanter into the acetabulum. Previous reports have dealt with short-term results (up to 12 years). Here I present some results of this procedure 15–24 years after operation. Patients and methods 4 children aged 1–6 years with complete necrosis of the femoral head were operated on with transposition of the greater trochanter. Secondary shelf plasty was performed later in 1 child, distal femoral epiphysiodesis in another, and femoral bone lengthening in 1 child. The mean follow-up period was 19 (15–24) years. Results A new femoral head developed in all hips. 2 of them had a spherical head with a good acetabular cover, and without any osteoarthritis except for slight reduction of cartilage height. These hips were painless, with a mobility that allowed good walking function after 16 and 24 years, respectively. In the other 2 patients, in which there was a severe acetabular dysplasia at the primary operation, the new femoral head was somewhat flattened; painful osteoarthritis led to hip replacement 15 and 21 years after trochanter arthroplasty. Even these patients had a relatively good walking function until the last couple of years before hip replacement. Maximum leg length discrepancy was 7 cm. Interpretation Trochanter arthroplasty with subtrochanteric osteotomy in total femoral head necrosis after septic arthritis in children may give satisfactory long-term results provided adequate acetabular cover is obtained. Although the method cannot provide a normal hip, it can contribute to less length discrepancy, less pain, improved gait, and more favorable conditions for later hip replacement

Methods for the Study of Marine Biodiversity

Recognition of the threats to biodiversity and its importance to society has led to calls for globally coordinated sampling of trends in marine ecosystems. As a step to defining such efforts, we review current methods of collecting and managing marine biodiversity data. A fundamental component of marine biodiversity is knowing what, where, and when species are present. However, monitoring methods are invariably biased in what taxa, ecological guilds, and body sizes they collect. In addition, the data need to be placed, and/or mapped, into an environmental context. Thus a suite of methods will be needed to encompass representative components of biodiversity in an ecosystem. Some sampling methods can damage habitat and kill species, including unnecessary bycatch. Less destructive alternatives are preferable, especially in conservation areas, such as photography, hydrophones, tagging, acoustics, artificial substrata, light-traps, hook and line, and live-traps. Here we highlight examples of operational international sampling programmes and data management infrastructures, notably the Continuous Plankton Recorder, Reef Life Survey, and detection of Harmful Algal Blooms and MarineGEO. Data management infrastructures include the World Register of Marine Species for species nomenclature and attributes, the Ocean Biogeographic Information System for distribution data, Marine Regions for maps, and Global Marine Environmental Datasets for global environmental data. Existing national sampling programmes, such as fishery trawl surveys and intertidal surveys, may provide a global perspective if their data can be integrated to provide useful information. Less utilised and emerging sampling methods, such as artificial substrata, light-traps, microfossils and eDNA also hold promise for sampling the less studied components of biodiversity. All of these initiatives need to develop international standards and protocols, and long-term plans for their governance and support.published_or_final_versio

Prognostic and Mechanistic Potential of Progesterone Sulfates in Intrahepatic Cholestasis of Pregnancy and Pruritus Gravidarum

A challenge in obstetrics is to distinguish pathological symptoms from those associated with normal changes of pregnancy, typified by the need to differentiate whether gestational pruritus of the skin is an early symptom of intrahepatic cholestasis of pregnancy (ICP) or due to benign pruritus gravidarum. ICP is characterized by raised serum bile acids and complicated by spontaneous preterm labor and stillbirth. A biomarker for ICP would be invaluable for early diagnosis and treatment and to enable its differentiation from other maternal diseases. Three progesterone sulfate compounds, whose concentrations have not previously been studied, were newly synthesized and assayed in the serum of three groups of ICP patients and found to be significantly higher in ICP at 9-15 weeks of gestation and prior to symptom onset (group 1 cases/samples: ICP n = 35/80, uncomplicated pregnancy = 29/100), demonstrating that all three progesterone sulfates are prognostic for ICP. Concentrations of progesterone sulfates were associated with itch severity and, in combination with autotaxin, distinguished pregnant women with itch that would subsequently develop ICP from pruritus gravidarum (group 2: ICP n = 41, pruritus gravidarum n = 14). In a third group of first-trimester samples all progesterone sulfates were significantly elevated in serum from low-risk asymptomatic women who subsequently developed ICP (ICP/uncomplicated pregnancy n = 54/51). Finally, we show mechanistically that progesterone sulfates mediate itch by evoking a Tgr5-dependent scratch response in mice. Conclusion: Our discovery that sulfated progesterone metabolites are a prognostic indicator for ICP will help predict onset of ICP and distinguish it from benign pruritus gravidarum, enabling targeted obstetric care to a high-risk population. Delineation of a progesterone sulfate-TGR5 pruritus axis identifies a therapeutic target for itch management in ICP

A change in the optical polarization associated with a gamma-ray flare in the blazar 3C 279

It is widely accepted that strong and variable radiation detected over all accessible energy bands in a number of active galaxies arises from a relativistic, Doppler-boosted jet pointing close to our line of sight. The size of the emitting zone and the location of this region relative to the central supermassive black hole are, however, poorly known, with estimates ranging from light-hours to a light-year or more. Here we report the coincidence of a gamma-ray flare with a dramatic change of optical polarization angle. This provides evidence for co-spatiality of optical and gamma-ray emission regions and indicates a highly ordered jet magnetic field. The results also require a non-axisymmetric structure of the emission zone, implying a curved trajectory for the emitting material within the jet, with the dissipation region located at a considerable distance from the black hole, at about 10^5 gravitational radii.Comment: Published in Nature issued on 18 February 2010. Corresponding authors: Masaaki Hayashida and Greg Madejsk

Localization and potential role of matrix metalloproteinase-1 and tissue inhibitors of metalloproteinase-1 and -2 in different phases of bronchopulmonary dysplasia

Bronchopulmonary dysplasia (BPD) can evolve in prematurely born infants who require mechanical ventilation because of hyaline membrane disease (HMD). The development of BPD can be divided in an acute, a regenerative, a transitional, and a chronic phase. During these different phases, extensive remodeling of the lung parenchyma with re-epithelialization of the alveoli and formation of fibrosis occurs. Matrix metalloproteinase-1 (MMP-1) is an enzyme that is involved in re-epithelialization processes, and dysregulation of MMP-1 activity contributes to fibrosis. Localization of MMP-1 and its inhibitors, tissue inhibitor of metalloproteinase (TIMP)-1 and TIMP-2, were investigated in lung tissue obtained from infants who died during different phases of BPD development. In all studied cases (n = 50) type-II pneumocytes were found to be immunoreactive for MMP-1, TIMP-1, and TIMP-2. During the acute and regenerative phase of BPD, type-II pneumocytes re-epithelialize the injured alveoli. This may suggest that MMP-1 and its inhibitors, expressed by type-II pneumocytes, play a role in the re-epithelialization process after acute lung injury. Although MMP-1 staining intensity remained constant in type-II pneumocytes during BPD development, TIMP-1 increased during the chronic fibrotic phase. This relative elevation of TIMP-1 compared with MMP-1 is indicative for reduced collagenolytic activity by type-II pneumocytes in chronic BPD and may contribute to fibrosis. Fibrotic foci in chronic BPD contained fibroblasts immunoreactive for MMP-1 and TIMP-1 and -2. This may indicate that decreased collagen turnover by fibroblasts contributes to fibrosis in BPD development

The implementation of a translational study involving a primary care based behavioral program to improve blood pressure control: The HTN-IMPROVE study protocol (01295)

<p>Abstract</p> <p>Background</p> <p>Despite the impact of hypertension and widely accepted target values for blood pressure (BP), interventions to improve BP control have had limited success.</p> <p>Objectives</p> <p>We describe the design of a 'translational' study that examines the implementation, impact, sustainability, and cost of an evidence-based nurse-delivered tailored behavioral self-management intervention to improve BP control as it moves from a research context to healthcare delivery. The study addresses four specific aims: assess the implementation of an evidence-based behavioral self-management intervention to improve BP levels; evaluate the clinical impact of the intervention as it is implemented; assess organizational factors associated with the sustainability of the intervention; and assess the cost of implementing and sustaining the intervention.</p> <p>Methods</p> <p>The project involves three geographically diverse VA intervention facilities and nine control sites. We first conduct an evaluation of barriers and facilitators for implementing the intervention at intervention sites. We examine the impact of the intervention by comparing 12-month pre/post changes in BP control between patients in intervention sites versus patients in the matched control sites. Next, we examine the sustainability of the intervention and organizational factors facilitating or hindering the sustained implementation. Finally, we examine the costs of intervention implementation. Key outcomes are acceptability and costs of the program, as well as changes in BP. Outcomes will be assessed using mixed methods (<it>e.g</it>., qualitative analyses--pattern matching; quantitative methods--linear mixed models).</p> <p>Discussion</p> <p>The study results will provide information about the challenges and costs to implement and sustain the intervention, and what clinical impact can be expected.</p

A Single Session of Virtual Reality Improved Tiredness, Shortness of Breath, Anxiety, Depression and Well-Being in Hospitalized Individuals with COVID-19: A Randomized Clinical Trial

Background: In 2020, the world was surprised by the spread and mass contamination of the new Coronavirus (COVID-19). COVID-19 produces symptoms ranging from a common cold to severe symptoms that can lead to death. Several strategies have been implemented to improve the well-being of patients during their hospitalization, and virtual reality (VR) has been used. However, whether patients hospitalized for COVID-19 can benefit from this intervention remains unclear. Therefore, this study aimed to investigate whether VR contributes to the control of pain symptoms, the sensation of dyspnea, perception of well-being, anxiety, and depression in patients hospitalized with COVID-19. Methods: A randomized, double-blind clinical trial was designed. Patients underwent a single session of VR and usual care. The experimental group (n = 22) received VR content to promote relaxation, distraction, and stress relief, whereas the control group (n = 22) received non-specific VR content. Results: The experimental group reported a significant decrease in tiredness, shortness of breath, anxiety, and an increase in the feeling of well-being, whereas the control group showed improvement only in the tiredness and anxiety. Conclusions: VR is a resource that may improve the symptoms of tiredness, shortness of breath, anxiety, and depression in patients hospitalized with COVID-19. Future studies should investigate the effect of multiple VR sessions on individuals with COVID-19

LCA applied to perennial cropping systems: a review focused on the farm stage

International audienc