Chronic instability of the anterior tibiofibular syndesmosis of the ankle. Arthroscopic findings and results of anatomical reconstruction

<p>Abstract</p> <p>Background</p> <p>The arthroscopic findings in patients with chronic anterior syndesmotic instability that need reconstructive surgery have never been described extensively.</p> <p>Methods</p> <p>In 12 patients the clinical suspicion of chronic instability of the syndesmosis was confirmed during arthroscopy of the ankle. All findings during the arthroscopy were scored. Anatomical reconstruction of the anterior tibiofibular syndesmosis was performed in all patients. The AOFAS score was assessed to evaluate the result of the reconstruction. At an average of 43 months after the reconstruction all patients were seen for follow-up.</p> <p>Results</p> <p>The syndesmosis being easily accessible for the 3 mm transverse end of probe which could be rotated around its longitudinal axis in all cases during arthroscopy of the ankle joint, confirmed the diagnosis. Cartilage damage was seen in 8 ankles, of which in 7 patients the damage was situated at the medial side of the ankle joint. The intraarticular part of anterior tibiofibular ligament was visibly damaged in 5 patients. Synovitis was seen in all but one ankle joint. After surgical reconstruction the AOFAS score improved from an average of 72 pre-operatively to 92 post-operatively.</p> <p>Conclusions</p> <p>To confirm the clinical suspicion, the final diagnosis of chronic instability of the anterior syndesmosis can be made during arthroscopy of the ankle. Cartilage damage to the medial side of the tibiotalar joint is often seen and might be the result of syndesmotic instability. Good results are achieved by anatomic reconstruction of the anterior syndesmosis, and all patients in this study would undergo the surgery again if necessary.</p

Leergangevaluatie: de Curvo-strategie in de praktijk

Leergangevaluatie staat in de literatuur bekend als een moeilijke en tijdrovende aangelegenheid. Aan het nut hiervan wordt vaak getwijfeld. Hebben evaluatie-experts er al de grootste moeite mee, nog moeilijker wordt het wanneer de evaluatie wordt uigevoerd door schoolteams binnen de context van een school. Deze ‘tour de force’ is met behulp van de Curvo-strategie uitgevoerd in vier projecten. Het ging hierbij om schoolteams die, met steun van interne en/of externe begeleiders, zelf hun leergangen evalueerden. Deze projecten zijn uitgevoerd in een MAVO/LBO-scholengemeenschap, een Kleuterschool en een Nieuwe Leraren Opleiding. In dit artikel presenteren we de opzet en resultaten van het empirisch onderzoek naar het functioneren van de Curvo-strategie in deze projecten. Centraal staat hierbij de vraag: Is de Curvo-strategie uitvoerbaar, effectief en efficiënt bij het structureren van het proces van leergangevaluatie? De resultaten van dit onderzoek geven aan dat de Curvo-strategie deze krachtproef redelijk heeft doorstaan in drie van de vier projecten. De strategie bleek een belangrijk hulpmiddel bij het evalueren in de praktijk. Een grondige bezinning op enkele uitgangspunten en vooronderstellingen achter de deelstrategie is echter gewenst. De deelstrategie kan op verschillende punten worden verbeterd, waardoor de waardevolle elementen nog beter tot hun recht komen

Tetrahydrouridine Inhibits Cell Proliferation through Cell Cycle Regulation Regardless of Cytidine Deaminase Expression Levels

Tetrahydrouridine (THU) is a well characterized and potent inhibitor of cytidine deaminase (CDA). Highly expressed CDA catalyzes and inactivates cytidine analogues, ultimately contributing to increased gemcitabine resistance. Therefore, a combination therapy of THU and gemcitabine is considered to be a potential and promising treatment for tumors with highly expressed CDA. In this study, we found that THU has an alternative mechanism for inhibiting cell growth which is independent of CDA expression. Three different carcinoma cell lines (MIAPaCa-2, H441, and H1299) exhibited decreased cell proliferation after sole administration of THU, while being unaffected by knocking down CDA. To investigate the mechanism of THU-induced cell growth inhibition, cell cycle analysis using flow cytometry was performed. This analysis revealed that THU caused an increased rate of G1-phase occurrence while S-phase occurrence was diminished. Similarly, Ki-67 staining further supported that THU reduces cell proliferation. We also found that THU regulates cell cycle progression at the G1/S checkpoint by suppressing E2F1. As a result, a combination regimen of THU and gemcitabine might be a more effective therapy than previously believed for pancreatic carcinoma since THU works as a CDA inhibitor, as well as an inhibitor of cell growth in some types of pancreatic carcinoma cells

Thermal and behavioural responses of moose to chemical immobilisation from a helicopter

Instrumentation and sample collection for wildlife research and management may require chemical immobilisation of animals, which may entail physiological and behavioural effects on them. It is therefore important to evaluate the immobilisation protocols to reduce the risk of mortality and morbidity of the handled animals and their populations. Using a multi-sensor approach, we assessed the short-term (< 10 days) thermal and behavioural responses of 10 adult female moose (Alces alces) equipped with ruminal temperature loggers and GPS collars with accelerometers to helicopter-based chemical immobilisations. We investigated the body temperature (T-b), movement rates, and resting time before, during, and after recapture. Chemical immobilisations on average increased maximum T-b by 0.71 degrees C during the capture day, and imposed longer travel distances during the capture day and the two following days (3.8 and 1.8 km, respectively), compared to a 10-day reference period before the immobilisation. The probability of resting was 5-6% lower on the capture day and the two following days compared to the reference period, and females with offspring had a higher probability of resting than females without. Maximum T-b, movement rate, and resting time returned to pre-capture levels on an individual level 2 h, 3 days, and 3 days after the immobilisation, respectively. Chemical immobilisation of moose from a helicopter increases the energy expenditure deduced through movement and T-b rise lasting for hours to days. Ecological and physiological studies aimed at inferring general patterns may encounter bias if including sensor and tracking data from tagged animals without accounting for potential post-capture effects

Prediction of early recurrence after surgery for liver tumor (ERASL): an international validation of the ERASL risk models

Background This study aimed to assess the performance of the pre- and postoperative early recurrence after surgery for liver tumor (ERASL) models at external validation. Prediction of early hepatocellular carcinoma (HCC) recurrence after resection is important for individualized surgical management. Recently, the preoperative (ERASL-pre) and postoperative (ERASL-post) risk models were proposed based on patients from Hong Kong. These models showed good performance although they have not been validated to date by an independent research group. Methods This international cohort study included 279 patients from the Netherlands and 392 patients from Japan. The patients underwent first-time resection and showed a diagnosis of HCC on pathology. Performance was assessed according to discrimination (concordance [C] statistic) and calibration (correspondence between observed and predicted risk) with recalibration in a Weibull model. Results The discriminatory power of both models was lower in the Netherlands than in Japan (C statistic, 0.57 [95% confidence interval {CI} 0.52-0.62] vs 0.69 [95% CI 0.65-0.73] for the ERASL-pre model and 0.62 [95% CI 0.57-0.67] vs 0.70 [95% CI 0.66-0.74] for the ERASL-post model), whereas their prognostic profiles were similar. The predictions of the ERASL models were systematically too optimistic for both cohorts. Recalibrated ERASL models improved local applicability for both cohorts. Conclusions The discrimination of ERASL models was poorer for the Western patients than for the Japanese patients, who showed good performance. Recalibration of the models was performed, which improved the accuracy of predictions. However, in general, a model that explains the East-West difference or one tailored to Western patients still needs to be developed.Analysis and support of clinical decision makingDevelopment and application of statistical models for medical scientific researc

Detection of Squamous Cell Carcinoma and Corresponding Biomarkers Using Optical Spectroscopy

1) Investigate the use of optical reflectance spectroscopy to differentiate malignant and non-malignant tissues in head and neck lesions; 2) Characterize corresponding oxygen tissue biomarkers that are associated with pathologic diagnosi

On the interplay between hypothermia and reproduction in a high arctic ungulate

For free-ranging animals living in seasonal environments, hypometabolism (lowered metabolic rate) and hypothermia (lowered body temperature) can be effective physiological strategies to conserve energy when forage resources are low. To what extent such strategies are adopted by large mammals living under extreme conditions, as those encountered in the high Arctic, is largely unknown, especially for species where the gestation period overlaps with the period of lowest resource availability (i.e. winter). Here we investigated for the first time the level to which high arctic muskoxen (Ovibos moschatus) adopt hypothermia and tested the hypothesis that individual plasticity in the use of hypothermia depends on reproductive status. We measured core body temperature over most of the gestation period in both free-ranging muskox females in Greenland and captive female muskoxen in Alaska. We found divergent overwintering strategies according to reproductive status, where pregnant females maintained stable body temperatures during winter, while non-pregnant females exhibited a temporary decrease in their winter body temperature. These results show that muskox females use hypothermia during periods of resource scarcity, but also that the use of this strategy may be limited to non-reproducing females. Our findings suggest a trade-of between metabolically driven energy conservation during winter and sustaining foetal growth, which may also apply to other large herbivores living in highly seasonal environments elsewhere.publishedVersio

Praktijkervaringen met waterberging en natuur in een beekdal : achtergrondrapport : Beerze

Hoofddoel van het pilotprogramma is waterbeheerders, terreinbeherende instanties en provincies te ondersteunen in hun activiteiten een koppeling tot stand te brengen tussen waterberging en - buffering en natuurbehoud en -ontwikkeling. Eén van de geselecteerde pilots uit het pilotprogramma ligt langs de Beerze. De Beerze is representatief voor de huidige situatie in veel Brabantse beekdalen: er is sprake van een waterkwantiteitsprobleem, en (tijdelijke) berging van het beekwater in natuurgebieden stuit op problemen, vooral vanwege de (eutrofe) waterkwaliteit. Tegelijkertijd speelt verdroging van natuurgebieden een rol. De pilot Beerze ligt in het traject Logtse Baan - Logtse Velden - Smalbroeken. De onderzoeksperiode van deze pilot besloeg 2004 tot medio 200

Human mass balance study of the novel anticancer agent ixabepilone using accelerator mass spectrometry

Ixabepilone (BMS-247550) is a semi-synthetic, microtubule stabilizing epothilone B analogue which is more potent than taxanes and has displayed activity in taxane-resistant patients. The human plasma pharmacokinetics of ixabepilone have been described. However, the excretory pathways and contribution of metabolism to ixabepilone elimination have not been determined. To investigate the elimination pathways of ixabepilone we initiated a mass balance study in cancer patients. Due to autoradiolysis, ixabepilone proved to be very unstable when labeled with conventional [14C]-levels (100 μCi in a typical human radio-tracer study). This necessitated the use of much lower levels of [14C]-labeling and an ultra-sensitive detection method, Accelerator Mass Spectrometry (AMS). Eight patients with advanced cancer (3 males, 5 females; median age 54.5 y; performance status 0–2) received an intravenous dose of 70 mg, 80 nCi of [14C]ixabepilone over 3 h. Plasma, urine and faeces were collected up to 7 days after administration and total radioactivity (TRA) was determined using AMS. Ixabepilone in plasma and urine was quantitated using a validated LC-MS/MS method. Mean recovery of ixabepilone-derived radioactivity was 77.3% of dose. Fecal excretion was 52.2% and urinary excretion was 25.1%. Only a minor part of TRA is accounted for by unchanged ixabepilone in both plasma and urine, which indicates that metabolism is a major elimination mechanism for this drug. Future studies should focus on structural elucidation of ixabepilone metabolites and characterization of their activities