Limited open reduction and Ilizarov external fixation in the treatment of distal tibial fractures

The authors reviewed 31 distal tibial fractures (16 involving the tibial plafond) treated with Ilizarov external fixation. The study population was composed of 19 males and 12 females, with an average age of 54. The fractures were classified according to the AO classification: A1 (3), A2 (6), A3 (6), C1 (2), C2 (8), C3 (6). There were six open injuries. In 14 pilon cases, open reduction of the intra-articular fragments and bone grafting via a limited incision was performed. Clinical follow-up averaged 28 months (range 18-42). All but one fracture united with an average healing time of 13.9 weeks. Nearly all patients with AO type A fracture had excellent or good functional scores. The 14 cases of AO C2 and C3 group had five (38%) good results, five (38%) fair results and three (24%) poor results. This method yielded results comparable with previous studies using open reduction and internal fixation. Twenty-nine percent of the patients had pin track infection, which remained the most important complication of this method. © 2003 Elsevier Ltd. All rights reserved.postprin

An umbrella review of adverse effects associated with antipsychotic medications: the need for complementary study designs

Antipsychotic medications are widely prescribed in psychotic illnesses and other mental disorders. Effectiveness is well-established, particularly for reducing symptoms such as delusions and hallucinations, but can be impacted by tolerability. Adverse effects are wide-ranging, and vary between antipsychotics, which is clinically important. This umbrella review aimed to comprehensively summarise the extent and quality of evidence for adverse effects associated with antipsychotic use in people with mental disorders. We included 32 meta-analyses of randomised trials and observational studies. The overall robustness of reported associations was considered in terms of review quality, heterogeneity, excess significance bias, and prediction intervals. Using this approach, endocrine and metabolic, movement-related, and sedation and sleep problems were the clinical domains with strongest evidence. The overall quality of included meta-analyses was low, and individual adverse effects were not typically examined in meta-analyses of both randomised trials and observational study designs. Future reviews should focus on adhering to methodological guidelines, consider the complementary strengths of different study designs, and integrate clinically relevant information on absolute rates and severity of adverse effects

Lower Bounds for Bruss' Odds Problem with Multiple Stoppings

We give asymptotic lower bounds of the value for Bruss' optimal stopping problem with multiple stopping chances. It interestingly consists of the asymptotic threshold values in the optimal multiple stopping strategy. Another interesting implication of the result is that the asymptotic value for each secretary problem with multiple stoppings is in fact a typical lower bound in a much more general class of multiple stopping problems as modifications of odds problem.Comment: 41 pages, 4 figure

Updated clinical recommendations for the use of tibolone in Asian women

Tibolone, which is indicated for the relief of climacteric symptoms and the prevention of osteoporosis in postmenopausal women, has a tissue-specific mode of action different to that of conventional hormone replacement therapy (HRT). A large proportion of Asian postmenopausal women experience symptoms that most frequently include musculoskeletal pain, insomnia, forgetfulness, hot flushes and sexual dysfunction, and there is a need to address their specific requirements. Recent studies show that, in comparison to HRT, tibolone is as effective in alleviating menopausal symptoms and preventing bone loss, has a greater positive effect on sexual dysfunction and is associated with less vaginal bleeding, but it is rarely mentioned in guidelines for menopausal treatment. Levels of awareness amongst women about treatments for menopausal symptoms vary between Asian countries but, even in countries where awareness is high, HRT usage is much lower than in the West. To provide a practical approach to the use of tibolone in Asian postmenopausal women, a panel of experts in the management of menopause from 11 Asia Pacific countries has developed recommendations for its use, based on the evidence from clinical studies published since 2005. However, as much of the clinical data reviewed are from international studies, the recommendations and the treatment algorithm presented here are widely applicable

Testing Identifiable Kernel P Systems Using an X-machine Approach

This paper presents a testing approach for kernel P systems (kP systems), based on the X-machine testing framework and the concept of cover automaton. The testing methodology ensures that the implementation conforms the speci cations, under certain conditions, such as the identi ably concept in the context of kernel P systems

Synchronizing heuristics for weakly connected automata with various topologies

Since the problem of finding a shortest synchronizing sequence for an automaton is known to be NP-hard, heuristics algorithms are used to find synchronizing sequences. There are several heuristic algorithms in the literature for this purpose. However, even the most efficient heuristic algorithm in the literature has a quadratic complexity in terms of the number of states of the automaton, and therefore can only scale up to a couple of thousands of states. It was also shown before that if an automaton is not strongly connected, then these heuristic algorithms can be used on each strongly connected component separately. This approach speeds up these heuristic algorithms and allows them to scale to much larger number of states easily. In this paper, we investigate the effect of the topology of the automaton on the performance increase obtained by these heuristic algorithms. To this end, we consider various topologies and provide an extensive experimental study on the performance increase obtained on the existing heuristic algorithms. Depending on the size and the number of components, we obtain speed-up values as high as 10000x and more

Electronic transitions of iron in almandine-composition glass to 91 GPa

Valence and spin states of Fe were investigated in a glass of almandine (Fe$_3$Al$_2$Si$_3$O$_{12}$) composition to 91 GPa by X-ray emission spectroscopy and energy- and time-domain synchrotron Mössbauer spectroscopy in the diamond-anvil cell. Changes in optical properties, total spin moment and Mössbauer parameters all occur predominantly between 1 bar and ~30 GPa. Over this pressure range, the glass changes from translucent brown to opaque and black. The total spin moment of the glass derived from X-ray emission spectroscopy decreases by ~20%. The complementary Mössbauer spectroscopy approaches reveal consistent changes in sites corresponding to 80–90% Fe$^{2+}$ and 10–20% Fe$^{3+}$. The high-spin Fe$^{2+}$ doublet exhibits a continuous decrease in isomer shift and increase in line width and asymmetry. A high-spin Fe$^{3+}$ doublet with quadrupole splitting of ~1.2 mm/s is replaced by a doublet with quadrupole splitting of ~1.9 mm/s, a value higher than all previous measurements of high-spin Fe$^{3+}$ and consistent with low-spin Fe$^{3+}$. These observations suggest that Fe$^{3+}$ in the glass undergoes a continual transition from a high-spin to a low-spin state between 1 bar and ~30 GPa. Almandine glass is not expected to undergo any abrupt transitions in electronic state at deep mantle pressures.National Science FoundationThis is the author accepted manuscript. The final version is available from the Mineralogical Society of America via http://dx.doi.org/10.2138/am-2016-560

X-Machine Based Testing for Cloud Services

In this article we present a tool designed for cloud service testing, able to generate test cases from a formal specification of the service, in form of a deterministic stream X-machine (DSXM) model. The paper summarizes the theoretical foundations of X-machine based testing and illustrates the usage of the developed tool on some examples. It shows in detail how the specification should be written, which are the design for test conditions it should satisfy, in order to assure the generation of high quality test suites for the cloud service

Rnf12—A Jack of All Trades in X Inactivation?

International audiencePlacental mammals compensate the dosage imbalance of X-linked genes between males (XY) and females (XX) by silencing one randomly chosen X chromosome in females. This process is initiated during early embryonic development and can be recapitulated during differentiation of murine embryonic stem cells (mESCs). X chromosome inactivation (XCI) is initiated by up-regulation of a non-coding RNA on the future inactive X chromosome, named Xist, which lies within a large complex locus, called the X inactivation center (Xic). Subsequently, Xist RNA induces silencing of the entire chromosome in cis. Although central to the XCI process, the molecular mechanisms underlying Xist's regulation still remain to be deciphered. In particular, it is unclear (1) how the up-regulation of Xist is triggered at the onset of differentiation, (2) why this is restricted to female cells, and (3) why one allele and not the other is affected? Although each aspect could in principle be controlled by distinct factors and sequence elements, one protein has recently been proposed to regulate Xist at all three levels: the E3 ubiquitin ligase Rnf12/Rlim. The X-linked Rnf12 gene acts as a dose-dependent activator of Xist, which is expressed at elevated levels in female relative to male cells and is up-regulated during differentiation. Two recent studies shed further light on the precise role of Rnf12 in XCI