Traumatic labral avulsion from the stable rim: a constant pathology in displaced transverse acetabular fractures

Introduction: During the treatment of a malunited transverse acetabular fracture, a hitherto undescribed extended avulsion of the labrum from the stable acetabular fragment was found. Based on the labral pathomorphology present in this case, the hypothesis was put forward that traumatic acetabular labral avulsions are a constant phenomenon in transverse acetabular fractures. Patients and methods: Fourteen patients underwent capsulotomy and/or surgical dislocation of the involved hip to facilitate open reduction and internal fixation of transverse acetabular fractures. Results: In all cases, the labrum was partially or completely detached from the superior acetabular rim. In eight cases with bucket-handle tears of the labrum from the stable superior fragment, the injured portion was resected back to normal margins. In one case the labrum was avulsed with an attached piece of bone and was repaired by screw fixation. Small separations of the labrum from the underlying acetabular rim occurred at the level of the fractures in five cases with minor displacement and received no treatment. Conclusion: With displaced transverse acetabular fractures, consideration should be given to opening the joint at the time of open reduction and internal fixation to look for associated intracapsular injuries. An avulsed portion of the labrum should be left if stable and undamaged. If unstable and damaged, it is probably better resected and if unstable but intact and/or attached to a bony fragment, it should be repaire

Method and apparatus for electromagnetic powder deposition

The present invention provides a method for depositing powder particles on a substrate. The method comprises forming a planar plasma armature, accelerating the plasma armature, accelerating a column of gas with the plasma armature; and accelerating the powder particles with the column of gas. The present invention provides for a railgun, comprising first and second conducting rails, and first and second insulating rails. The insulating and conducting rails form a bore of the railgun. The first and second conducting rails are separated by the insulating rails. At least one of the rails has a port in the wall thereof, the port is adapted to introducing powder particles into the bore.Board of Regents, University of Texas Syste

Psychotherapy for suicidal patients with borderline personality disorder: an expert consensus review of common factors across five therapies

The objective was to review established literature on approaches to the psychotherapy of borderline personality disorder with specfic reference to suicide in order to determine if there were common factors across these efforts that would guide future teaching, practice and research. The publications from the proponents of five therapies for the treatment of suicidal behavior in individuals with borderline personality disorder (BPD), were reviewed and discussed by the members of the Group for the Advanced of Psychiatry, Psychotherapy Committee (GAPPC). Twenty nine published research and summary reports were reviewed of the specific treatments noted above along with two other reviews of common factors for this group of treatments. We used expert consensus as to the salient articles for review and the appropriate level of abstraction for the common factor definition. We formulated a definition of effectiveness and identified six common factors: 1) negotiation of a specific frame for treatment, 2) recognition and insistence on the patient’s responsibilities within the therapy, 3) provision to the therapist of a conceptual framework for understanding and intervening, 4) use of the therapeutic relationship to engage and address suicide, 5) prioritization of suicide as a topic to be actively addressed whenever it emerges, and 6) provision of support for the therapist in the form of supervision, consultation or peer support. We discuss common factors, their formulation, and implications for development and teaching of psychotherapeutic approaches specific to suicide in patients with borderline personality disorder and note that there should be greater attention in practice and education to these issues

Clinical and Genomic Risk to Guide the Use of Adjuvant Therapy for Breast Cancer

BACKGROUND The use of adjuvant chemotherapy in patients with breast cancer may be guided by clinicopathological factors and a score based on a 21-gene assay to determine the risk of recurrence. Whether the level of clinical risk of breast cancer recurrence adds prognostic information to the recurrence score is not known. METHODS We performed a prospective trial involving 9427 women with hormone-receptor–positive, human epidermal growth factor receptor 2–negative, axillary node–negative breast cancer, in whom an assay of 21 genes had been performed, and we classified the clinical risk of recurrence of breast cancer as low or high on the basis of the tumor size and histologic grade. The effect of clinical risk was evaluated by calculating hazard ratios for distant recurrence with the use of Cox proportional-hazards models. The initial endocrine therapy was tamoxifen alone in the majority of the premenopausal women who were 50 years of age or younger. RESULTS The level of clinical risk was prognostic of distant recurrence in women with an intermediate 21-gene recurrence score of 11 to 25 (on a scale of 0 to 100, with higher scores indicating a worse prognosis or a greater potential benefit from chemotherapy) who were randomly assigned to endocrine therapy (hazard ratio for the comparison of high vs. low clinical risk, 2.73; 95% confidence interval [CI], 1.93 to 3.87) or to chemotherapy plus endocrine (chemoendocrine) therapy (hazard ratio, 2.41; 95% CI, 1.66 to 3.48) and in women with a high recurrence score (a score of 26 to 100), all of whom were assigned to chemoendocrine therapy (hazard ratio, 3.17; 95% CI, 1.94 to 5.19). Among women who were 50 years of age or younger who had received endocrine therapy alone, the estimated (±SE) rate of distant recurrence at 9 years was less than 5% (≤1.8±0.9%) with a low recurrence score (a score of 0 to 10), irrespective of clinical risk, and 4.7±1.0% with an intermediate recurrence score and low clinical risk. In this age group, the estimated distant recurrence at 9 years exceeded 10% among women with a high clinical risk and an intermediate recurrence score who received endocrine therapy alone (12.3±2.4%) and among those with a high recurrence score who received chemoendocrine therapy (15.2±3.3%). CONCLUSIONS Clinical-risk stratification provided prognostic information that, when added to the 21-gene recurrence score, could be used to identify premenopausal women who could benefit from more effective therapy

Adjuvant Chemotherapy Guided by a 21-Gene Expression Assay in Breast Cancer

BACKGROUND The recurrence score based on the 21-gene breast cancer assay predicts chemotherapy benefit if it is high and a low risk of recurrence in the absence of chemotherapy if it is low; however, there is uncertainty about the benefit of chemotherapy for most patients, who have a midrange score. METHODS We performed a prospective trial involving 10,273 women with hormone-receptor–positive, human epidermal growth factor receptor 2 (HER2)–negative, axillary node–negative breast cancer. Of the 9719 eligible patients with follow-up information, 6711 (69%) had a midrange recurrence score of 11 to 25 and were randomly assigned to receive either chemoendocrine therapy or endocrine therapy alone. The trial was designed to show noninferiority of endocrine therapy alone for invasive disease–free survival (defined as freedom from invasive disease recurrence, second primary cancer, or death). RESULTS Endocrine therapy was noninferior to chemoendocrine therapy in the analysis of invasive disease–free survival (hazard ratio for invasive disease recurrence, second primary cancer, or death [endocrine vs. chemoendocrine therapy], 1.08; 95% confidence interval, 0.94 to 1.24; P=0.26). At 9 years, the two treatment groups had similar rates of invasive disease–free survival (83.3% in the endocrine-therapy group and 84.3% in the chemoendocrine-therapy group), freedom from disease recurrence at a distant site (94.5% and 95.0%) or at a distant or local–regional site (92.2% and 92.9%), and overall survival (93.9% and 93.8%). The chemotherapy benefit for invasive disease–free survival varied with the combination of recurrence score and age (P=0.004), with some benefit of chemotherapy found in women 50 years of age or younger with a recurrence score of 16 to 25. CONCLUSIONS Adjuvant endocrine therapy and chemoendocrine therapy had similar efficacy in women with hormone-receptor–positive, HER2-negative, axillary node–negative breast cancer who had a midrange 21-gene recurrence score, although some benefit of chemotherapy was found in some women 50 years of age or younger

Using RNA-Seq for gene identification, polymorphism detection and transcript profiling in two alfalfa genotypes with divergent cell wall composition in stems

<p>Abstract</p> <p>Background</p> <p>Alfalfa, [<it>Medicago sativa </it>(L.) sativa], a widely-grown perennial forage has potential for development as a cellulosic ethanol feedstock. However, the genomics of alfalfa, a non-model species, is still in its infancy. The recent advent of RNA-Seq, a massively parallel sequencing method for transcriptome analysis, provides an opportunity to expand the identification of alfalfa genes and polymorphisms, and conduct in-depth transcript profiling.</p> <p>Results</p> <p>Cell walls in stems of alfalfa genotype 708 have higher cellulose and lower lignin concentrations compared to cell walls in stems of genotype 773. Using the Illumina GA-II platform, a total of 198,861,304 expression sequence tags (ESTs, 76 bp in length) were generated from cDNA libraries derived from elongating stem (ES) and post-elongation stem (PES) internodes of 708 and 773. In addition, 341,984 ESTs were generated from ES and PES internodes of genotype 773 using the GS FLX Titanium platform. The first alfalfa (<it>Medicago sativa</it>) gene index (MSGI 1.0) was assembled using the Sanger ESTs available from GenBank, the GS FLX Titanium EST sequences, and the <it>de novo </it>assembled Illumina sequences. MSGI 1.0 contains 124,025 unique sequences including 22,729 tentative consensus sequences (TCs), 22,315 singletons and 78,981 pseudo-singletons. We identified a total of 1,294 simple sequence repeats (SSR) among the sequences in MSGI 1.0. In addition, a total of 10,826 single nucleotide polymorphisms (SNPs) were predicted between the two genotypes. Out of 55 SNPs randomly selected for experimental validation, 47 (85%) were polymorphic between the two genotypes. We also identified numerous allelic variations within each genotype. Digital gene expression analysis identified numerous candidate genes that may play a role in stem development as well as candidate genes that may contribute to the differences in cell wall composition in stems of the two genotypes.</p> <p>Conclusions</p> <p>Our results demonstrate that RNA-Seq can be successfully used for gene identification, polymorphism detection and transcript profiling in alfalfa, a non-model, allogamous, autotetraploid species. The alfalfa gene index assembled in this study, and the SNPs, SSRs and candidate genes identified can be used to improve alfalfa as a forage crop and cellulosic feedstock.</p

Prospective Validation of a 21-Gene Expression Assay in Breast Cancer

Prior studies with the use of a prospective–retrospective design including archival tumor samples have shown that gene-expression assays provide clinically useful prognostic information. However, a prospectively conducted study in a uniformly treated population provides the highest level of evidence supporting the clinical validity and usefulness of a biomarker

Southern Bound A Gulf Coast Journalist on Books, Writers, and Literary Pilgrimages of the Heart

Engaging and spirited, Southern Bound represents the critical art at its most accessible and will prove entertaining fare for anyone who loves the written word.Cover -- Title -- Copyright -- Contents -- List of Illustrations -- Foreword -- Acknowledgments -- Introduction: For the Love of Books -- The South -- Essence of the South Remains Hard to Define -- Slaves in the Family -- Ball's Book Strikes Personal Chord with Historian -- Rivers of History -- Bumper Crop of Poems Celebrates Life on the Land -- Faulkner's "Blood and Thunder" Novel Endures -- Oprah Makes Brave, Bold Choice with Faulkner -- Liuzzo Biographer Brings a Sense of Justice to Topic -- South Carolina's Charms Preserved in Encyclopedia -- Young Woman's Diaries Basis of Wonderful Book -- Painter Mary Whyte Shows Keen Eye for Laborers in Working South -- The Civil War -- Slaves' Memories Offer Harrowing Accounts of War -- LSU Press Revives Story of Army of Tennessee -- Lee's True Legacy beyond Latest Biographer -- Pelham's Valor Shines in Maxwell's Perfect Lion -- Eye of the Storm: Union Soldier's Illustrated Memoir Confirms Civil War Was Tragedy for All -- Co. Aytch a Direct Link to Army in Gray -- Chance Discovery Reveals Details of Mobile Campaign -- Chaffin Cuts Through to Clear View of Hunley -- Poetry Collection from out of the Blue and Gray -- Rosen Invigorates Civil War Setting -- The Gulf Coast Renaissance -- Year in Greece Yields Book for Native Mobilian -- Our Voice of Reason -- Author Finds Inspiration in Writer Eugene Walter -- Store Specializes in Antique Volumes -- Hollon's The God File Deserves National Attention -- Black Belt Chronicles Richly Deserve Recognition -- Mobile Native Knight a Fast-Rising Literary Star -- Breech a Violent, Dark Tale from Franklin -- Scully's In the Hope of Rising Again a Gem -- Chicken Dreaming Corn: Family Tales Spur Captivating Novel of Mobile -- Emotional Exploration of a Deplorable Event -- Groom Takes Big Step with Vicksburg -- Architecture -- How Did Our Gardens Grow? Famously, It SeemsMississippi's Victorian Treasures Get Their Due -- Alabama's Architecture Gets Some Overdue Respect -- William Faulkner and the Tangible Past: The Architecture of Yoknapatawpha -- Matrana Shows Pride and Ruin of Plantations -- Historian Upends Ideas on American Architecture -- Scholar-Town Houses Have Many Tales to Tell -- Legacy Presents a Detailed Look at Rayfield's Work -- Fallingwater Study Cuts Myths, Affirms Merits -- The Architect of America -- New Orleans Takes Shape in an Architect's Memoir -- Literary Pilgrimages -- Stumbling on a Fossil of a Southern Dinosaur -- McMurtry's Hometown a Paradise for Collectors -- Drama of Story Comes Alive in Monroeville -- A Night in the Library -- Finding Cahaba: New Book Rekindles Fascination with Alabama's First Capital -- Looking Past Midnight -- A Literary Ramble through Old New Orleans -- Oxford, Mississippi: A Literary Profile -- A Small City of Literary Giants: Greenville, Mississippi -- Visit to Library Is a Return to Childhood -- Images from the Literary Side of Paris, with a Personal Touch -- Walter-Inspired Dream an Affirmation of Creativity -- Classics and Old Favorites Revisited -- A Tale Worthy of the Centuries: Looking into Chapman's Iliad -- Plato's Ancient Words Inspire the Modern Mind -- Old Story, New Life: Heaney Makes Epic Worth the Wait -- Decline and Fall Stands Test of Time -- Last of the Mohicans Was First of Its Kind -- Omoo a Showcase for Melville's Lighter Side -- Slowly, Beautifully: That's How the Cookie Crumbles -- Revisiting a Classic at the Water's Edge -- Joseph Conrad's Typhoon Shows Power of Storm -- One Man's Trash Is Another Man's Pleasure -- Pride and Prejudice Run Deep in Memoir -- Old Soldier Sahib a Rare Chronicle of Bygone Empire -- Cather's Look Westward Broke New Literary Ground -- Shane Stands as Classic of Western GenreBook behind Classic Wayne Film Still Holds Up -- Pacific Battleground Is More Than a Memory -- The International Scene -- A Shadowed Friendship: Book Looks Back on Broken Bond between Two Powerful Writers -- Quirky Italian Novel Shines in Recent Reissue -- Just an adventurer": An Aid Worker's Strange Path -- Cuba in Mind Brings Island Near Enough to Touch -- Events Make Brick Lane a Timely Volume -- Long Way Gone a Tribute to Human Spirit -- My Forbidden Face Drives Home Sufferings of Women under Taliban -- Márquez Classic Still Rewards Reader's Effort -- Istanbul, Not Constantinople, Gets the Works from a Nobel-Winning Native Son -- Iconic AK47 Assault Rifle Subject of Far-Ranging Biography -- Controversy and Censorship -- Plagiarism Charges Pull Prize-Winner from Shelves -- Alexandria's Library Rises from the Ashes-but Fires Still Burn -- George and Lennie Feeling the Squeeze -- Proposed Book Ban Deserves Firm Rebuttal -- America Flap Puts Mississippi in Spotlight -- Writer Takes Clear-Eyed Look at Battle Flag's Past and Present -- Without Sanctuary Confronts an Ugly Past -- Poe Folks Perturbed by Graveyard Guest -- Breach of Faith Offers Incisive Critiques -- An Open Letter to Louisiana's Governor -- School's Switch Alarms Book Lovers -- Old Writings Preserve Sense of Beaches' Beauty -- Reading and Writing Life -- My First Gun Became a Boy's Rite of Passage -- The Reader: A Quieter Side of Michael Jackson -- Politics Aside, Spanish Opens Rich Literary Terrain -- In Changing Times, It's Hard to Turn the Page -- Southern Writers Save the Style for the Page -- Oscar Wilde: One Fine Figure of a Writer -- Everybody Has a Story, but Who Wants to Read It? -- Odd Fantasy Reveals Deep-Seated Desire -- Coleridge Tome More Than Equal to Georges -- Favorite Reading Spots Make Good Books Better -- Elysium -- Mentor's Passing Time for ReflectionMississippian's Deep Roots Yielded a Towering Legacy -- In Memoriam: Eudora Welty -- George Plimpton's Wit, Grace Will Be Missed -- Foote Takes His Place among Heavenly Host -- Norman Mailer Leaves Larger-Than-Life Legacy -- A Chess Board Warrior's Influence Remembered -- A Father's Reading List Holds Share of TreasuresEngaging and spirited, Southern Bound represents the critical art at its most accessible and will prove entertaining fare for anyone who loves the written word.Description based on publisher supplied metadata and other sources.Electronic reproduction. Ann Arbor, Michigan : ProQuest Ebook Central, YYYY. Available via World Wide Web. Access may be limited to ProQuest Ebook Central affiliated libraries