Current indications for open Kuntscher nailing of femoral shaft fractures

We retrospectively reviewed 32 patients with fractures of the femoral shaft treated with open Kuntscher nailing. All fractures were simple transverse, short oblique or Winquist-Hensen type I and 11 comminuted diaphyseal fractures. Average operating time was 45 minutes (35 to 55 minutes). Patients were discharged from the hospital within 7 days of surgery. All fractures healed within 12-14 weeks and the union rate was 100%. One patient developed superficial wound infection. Two nails were too long proximally and two nails protruded into the knee joints. There were no rotational deformities nor shortening. One patient had limited knee flexion (less than 60o) and one fracture united in 8o varus. We concluded that open Kuntscher nailing is still indicated in the following situations: in hospitals with no traction table and image intensifier, in obese patients, in Grade I and II compound fractures, in polytrauma patients, in irreducible fractures and in patients with vascular injuries.Keywords: Kuntscher nail, intramedullary nail, femoral fractur

Measuring physical activity levels in people with mild cognitive impairment or mild dementia

Measuring physical activity (PA) in people with mild cognitive impairment (MCI) or dementia can be difficult. The aim was to investigate the validity and acceptability of three different PA measurement methods.The mixed-method analysis included 49 participants with MCI or dementia who completed a daily calendar recording PA, the International Physical Activity Questionnaire (IPAQ), the LASA Physical Activity Questionnaire and wore a Misfit Shine accelerometer. The quantitative analysis showed equal completion rates for the IPAQ questionnaire and the accelerometer but a lower completion rate for the calendar. Correlations between outcome measures were moderate or strong. The qualitative analysis indicated that all measures were acceptable, though help to complete the calendars or fasten the accelerometers was required for some participants. The study supported the validity of these methods for people with MCI and mild dementia. Using accelerometers and completing calendars might increase motivation to be active for some people

Agriculture Irrigation and Water Use

The 17 Western States, plus Arkansas, Florida, and Louisiana, account for 91 percent of all U.S. irrigated acreage, with the Western States alone contributing over 85 percent. This report integrates data on the distribution, characteristics, uses, and management of water resources from a wide variety of data sources. The report includes charts and tables on water use in irrigation; farm data comparing selected characteristics of irrigated and nonirrigated farms; and data on water application systems, sources of water, pump energy expenses by energy type, values of irrigated and nonirrigated land, and cash rents

Effect of bath ionic strength on adhesion and tribological properties of pure nickel and nickel composite coatings

The effect of electrolytic chemical concentration on wear-resistant, corrosion-resistant, adhesion and wettability properties of pure nickel and nickel-alumina composite coatings has been investigated in this paper. Coatings were electroplated over steel substrates under constant pulse conditions using pulse electrodeposition technique. Corrosion-resistant results show that the anti-corrosion properties are increasing with medium concentration both for pure nickel and nickel-alumina composite coating. For anti-wear properties the medium concentration showed increasing trend in case of pure nickel coatings but decreased in nickel-alumina composite coatings. In composite coating the higher and low concentrations of electrolyte showed the higher wear resistance properties. Furthermore, the influence of electrolyte concentration on changing surface morphologies, mechanical, wettability and adhesion properties have been investigated and reported here. Surface morphologies of the coatings were examined using scanning electron microscopy and energy-dispersive spectroscopy. Surface mapping and wear analyses were conducted through 3D white light interferometry

Sepsis-induced long-term immune paralysis – results of a descriptive, explorative study

Background: Long-lasting impairment of the immune system is believed to be the underlying reason for delayed deaths after surviving sepsis. We tested the hypothesis of persisting changes to the immune system in survivors of sepsis for the first time. Methods: In our prospective, cross-sectional pilot study, eight former patients who survived catecholamine-dependent sepsis and eight control individuals matched for age, sex, diabetes and renal insufficiency were enrolled. Each participant completed a questionnaire concerning morbidities, medications and infection history. Peripheral blood was collected for determination of i) immune cell subsets (CD4+, CD8+ T cells; CD25+ CD127- regulatory T cells; CD14+ monocytes), ii) cell surface receptor expression (PD-1, BTLA, TLR2, TLR4, TLR5, Dectin-1, PD-1 L), iii) HLA-DR expression, and iv) cytokine secretion (IL-6, IL10, TNF-α, IFN-γ) of whole blood stimulated with either α-CD3/28, LPS or zymosan. Results: After surviving sepsis, former patients presented with increased numbers of clinical apparent infections, including those typically associated with an impaired immune system. Standard inflammatory markers indicated a low-level inflammatory situation in former sepsis patients. CD8+ cell surface receptor as well as monocytic HLA-DR density measurements showed no major differences between the groups, while CD4+ T cells tended towards two opposed mechanisms of negative immune cell regulation via PD-1 and BTLA. Moreover, the post-sepsis group showed alterations in monocyte surface expression of distinct pattern recognition receptors; most pronouncedly seen in a decrease of TLR5 expression. Cytokine secretion in response to important activators of both the innate (LPS, zymosan) and the adaptive immune system (α-CD3/28) seemed to be weakened in former septic patients. Conclusions: Cytokine secretion as a reaction to different activators of the immune system seemed to be comprehensively impaired in survivors of sepsis. Among others, this could be based on trends in the downregulation of distinct cell surface receptors. Based on our results, the conduct of larger validation studies seems feasible, aiming to characterize alterations and to find potential therapeutic targets to engage

Conditional Deletion of Sost in MSC‐derived lineages Identifies Specific Cell Type Contributions to Bone Mass and B Cell Development

Sclerostin (Sost) is a negative regulator of bone formation and blocking its function via antibodies has shown great therapeutic promise by increasing both bone mass in humans and animal models. Sclerostin deletion in Sost knockout mice (Sost‐/‐) causes high bone mass (HBM) similar to Sclerosteosis patients. Sost‐/‐ mice have been shown to display an up to 300% increase in bone volume/total volume (BV/TV), relative to aged matched controls, and it has been postulated that the main source of skeletal Sclerostin is the osteocyte. To understand the cell‐type specific contributions to the HBM phenotype described in Sost‐/‐ mice, as well as to address the endocrine and paracrine mode of action of sclerostin, we examined the skeletal phenotypes of conditional Sost loss‐of‐function (SostiCOIN/iCOIN) mice with specific deletions in (1) the limb mesenchyme (Prx1‐Cre; targets osteoprogenitors and their progeny); (2) mid‐stage osteoblasts and their progenitors (Col1‐Cre); (3) mature osteocytes (Dmp1‐Cre) and (4) hypertrophic chondrocytes and their progenitors (ColX‐Cre). All conditional alleles resulted in significant increases in bone mass in trabecular bone in both the femur and lumbar vertebrae, but only Prx1‐Cre deletion fully recapitulated the amplitude of the HBM phenotype in the appendicular skeleton and the B cell defect described in the global knockout. Despite wildtype expression of Sost in the axial skeleton of Prx1‐Cre deleted mice, these mice also had a significant increase in bone mass in the vertebrae, but the Sclerostin released in circulation by the axial skeleton did not affect bone parameters in the appendicular skeleton. Also, both Col1 and Dmp1 deletion resulted in a similar 80% significant increase in trabecular bone mass, but only Col1 and Prx1 deletion resulted in a significant increase in cortical thickness. We conclude that several cell types within the Prx1‐osteoprogenitor derived lineages contribute significant amounts of Sclerostin protein to the paracrine pool of Sost, in bone

Vhl deficiency in osteocytes produces high bone mass and hematopoietic defects

Tissue oxygen (O2) levels vary during development and disease; adaptations to decreased O2 (hypoxia) are mediated by hypoxia-inducible factor (HIF) transcription factors. HIFs are active in the skeleton, and stabilizing HIF-α isoforms cause high bone mass (HBM) phenotypes. A fundamental limitation of previous studies examining the obligate role for HIF-α isoforms in the skeleton involves the persistence of gene deletion as osteolineage cells differentiate into osteocytes. Because osteocytes orchestrate skeletal development and homeostasis, we evaluated the influence of Vhl or Hif1a disruption in osteocytes. Osteocytic Vhl deletion caused HBM phenotype, but Hif1a was dispensable in osteocytes. Vhl cKO mice revealed enhanced canonical Wnt signaling. B cell development was reduced while myelopoiesis increased in osteocytic Vhl cKO, revealing a novel influence of Vhl/HIF-α function in osteocytes on maintenance of bone microarchitecture via canonical Wnt signaling and effects on hematopoiesis

Quantitative morphometry of renal biopsies prior to cyclosporine in nephrotic syndrome

Use of cyclosporine (CsA) in the management of children with steroid-resistant (SRNS) and steroid-dependent (SDNS) nephrotic syndrome has become increasingly popular in recent years. Although most children receive a renal biopsy prior to initiation of CsA, the relationship between initial renal histology and the subsequent clinical response to CsA is not known. We analyzed the correlation between pre-CsA segmental and global glomerular scarring and interstitial fibrosis and the subsequent response to CsA in 23 children (5.6±1.0 years, Mean±SEM) with SDNS ( n =8) and SRNS ( n =15) treated with CsA for 24.2±3.8 months and followed for 28.0±4.1 months. Complete remission was obtained in 78% of patients within 67.6±16 days, while 18% had a partial response and 4% no response. Quantitative histological analysis revealed a trend toward partial rather than complete response with increasing segmental glomerular ( P =0.13), global glomerular ( P =0.05), and interstitial ( P =0.08) scarring, and among patients with minimal change nephrotic syndrome versus IgM nephropathy versus focal segmental glomerulosclerosis. Among complete responders, linear regression analyses revealed no correlation between time to response and pre-CsA glomerular or interstitial scarring. We conclude that increased glomerular or interstitial scarring on a pre-CsA renal biopsy tends to correlate with a partial, rather than complete, response to CsA in childhood nephrotic syndrome.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/42297/1/467-12-9-737_80120737.pd