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Little is known about fusion times of the primary and secondary centers of ossification in the sacrum, particularly from dry bone observations. In this study, the timing of union of these centers was studied in a sample of modern Portuguese skeletons (90 females and 101 males) between the ages of 0 and 30 years, taken from the Lisbon documented skeletal collection. A three-stage scheme was used to assess fusion status between ossification centers as unfused, partially fused and completely fused. Posterior probability tables of age, given a certain stage of fusion, were calculated for most anatomical locations studied using both reference and uniform priors. Partial union of primary centers of ossification was observed from 1 to 8 years of age and partial union of secondary centers of ossification was observed from 15 to 21 years of age. The first primary centers of ossification to complete fusion are the neural arch with the centrum of the fifth sacral vertebrae and the last are the costal element with the centrum of the first sacral vertebra. The annular and sacroiliac epiphyses are the first, among the secondary centers of ossification observed, to complete fusion, after which the lateral margin fuses. This study offers information on timing of fusion of diverse locations in the developing sacrum useful for age estimation of complete or fragmented immature human skeletal remains and fills an important gap in the literature, by adding to previously published times of fusion of primary and secondary ossification centers in this sample. PMID:24227049
Cardoso, Hugo F V; Pereira, Vanessa; Rios, LuĒs
Secondary ossification center of transverse process: A bone-scan normal variant
This report describes the bone-scan appearance of significantly increased activity in a lumbar transverse process of a 15-year-old boy; we believe it represents a normal variant related to the secondary ossification center.
Richard M. Shore; G. Patrick Cain; Thomas V. Lloyd
Thyroid hormones (THs) are known to regulate endochondral ossification during skeletal development via acting directly in chondrocytes and osteoblasts. In this study, we focused on TH effects on the secondary ossification center (SOC) because the time of appearance of SOCs in several species coincides with the time when peak levels of TH are attained. Accordingly, micro-computed tomography (ĄCT) evaluation of femurs and tibias at day 21 in TH-deficient and control mice revealed that endochondral ossification of SOCs is severely compromised owing to TH deficiency and that TH treatment for 10 days completely rescued this phenotype. Staining of cartilage and bone in the epiphysis revealed that whereas all of the cartilage is converted into bone in the prepubertal control mice, this conversion failed to occur in the TH-deficient mice. Immunohistochemistry studies revealed that TH treatment of thyroid stimulating hormone receptor mutant (Tshr(-/-) ) mice induced expression of Indian hedgehog (Ihh) and Osx in type 2 collagen (Col2)-expressing chondrocytes in the SOC at day 7, which subsequently differentiate into type 10 collagen (Col10)/osteocalcin-expressing chondro/osteoblasts at day 10. Consistent with these data, treatment of tibia cultures from 3-day-old mice with 10 ng/mL TH increased expression of Osx, Col10, alkaline phosphatase (ALP), and osteocalcin in the epiphysis by sixfold to 60-fold. Furthermore, knockdown of the TH-induced increase in Osx expression using lentiviral small hairpin RNA (shRNA) significantly blocked TH-induced ALP and osteocalcin expression in chondrocytes. Treatment of chondrogenic cells with an Ihh inhibitor abolished chondro/osteoblast differentiation and SOC formation. Our findings indicate that TH regulates the SOC initiation and progression via differentiating chondrocytes into bone matrix-producing osteoblasts by stimulating Ihh and Osx expression in chondrocytes. ® 2014 American Society for Bone and Mineral Research. PMID:24753031
Xing, Weirong; Cheng, Shaohong; Wergedal, Jon; Mohan, Subburaman
Vascularization of primary and secondary ossification centres in the human growth plate
Background The switch from cartilage template to bone during endochondral ossification of the growth plate requires a dynamic and close interaction between cartilage and the developing vasculature. Vascular invasion of the primarily avascular hypertrophic chondrocyte zone brings chondroclasts, osteoblast- and endothelial precursor cells into future centres of ossification. Vascularization of human growth plates of polydactylic digits was studied by immunohistochemistry, confocal-laser-scanning-microscopy and RT-qPCR using markers specific for endothelial cells CD34 and CD31, smooth muscle cells ?-SMA, endothelial progenitor cells CD133, CXCR4, VEGFR-2 and mesenchymal progenitor cells CD90 and CD105. In addition, morphometric analysis was performed to quantify RUNX2+ and DLX5+ hypertrophic chondrocytes, RANK+ chondro- and osteoclasts, and CD133+ progenitors in different zones of the growth plate. Results New vessels in ossification centres were formed by sprouting of CD34+ endothelial cells that did not co-express the mature endothelial cell marker CD31. These immature vessels in the growth plate showed no abluminal coverage with ?-SMA+ smooth muscle cells, but in their close proximity single CD133+ precursor cells were found that did not express VEGFR-2, a marker for endothelial lineage commitment. In periosteum and in the perichondrial groove of Ranvier that harboured CD90+/CD105+ chondro-progenitors, in contrast, mature vessels were found stabilized by ?-SMA+ smooth muscle cells. Conclusion Vascularization of ossification centres of the growth plate was mediated by sprouting of capillaries coming from the bone collar or by intussusception rather than by de-novo vessel formation involving endothelial progenitor cells. Vascular invasion of the joint anlage was temporally delayed compared to the surrounding joint tissue. PMID:25164565
The early development and ossification of the human clavicle--an embryologic study.
Morphologic studies of the early development of the clavicle were carried out in 46 human embryos and fetuses ranging in age from 6 to 12 weeks. We confirmed that the clavicle is formed by two membranous primary ossification centers appearing by 6 weeks and fusing approximately 1 week later. Cartilage at both ends of the clavicle then develops. In time, the medial cartilaginous mass contributes more to the growth in length of the clavicle than the lateral cartilaginous mass. The spatial orientation of both ossification centers and the development of enchondral bone formation at the ends of the clavicle lead to its characteristic shape. Interestingly, the primary ossification centers contribute little to the growth in length. The junction of the two centers of ossification is situated between the lateral and middle third of the clavicle and, consequently, does not correspond to the site of congenital pseudarthrosis, which is located in the middle part of the clavicle. PMID:2402985
Ogata, S; Uhthoff, H K
Pouch-young of the opossum Didelphis albiventris were studied. They were removed from the marsupium at a crown-rump length (CRL) of 9.0 to 100.0 mm and submitted to differential staining of the bone and cartilage. Newborn D. albiventris of 9.0 to 10.0 mm CRL have a cartilaginous skeleton, with no macroscopic evidence of ossification. In 10.5 to 13.0 mm CRL pouch-young, ossification occurs in the bones surrounding the oral cavity, clavicle, ribs, cervical and thoracic vertebrae and thoracic limbs, structures necessary to ensure the survival and maintenance of the newborn in the marsupium. Ossification of most of the skull begins in 15.5 to 16.0 mm CRL pouch-young. The ossification in the pelvis and the pelvic limbs is observed at 18.0 mm CRL and in the sternum and the epipubic bone at 25.0 to 28.0 mm CRL. Most of the skeleton is ossified in 45.0 to 58.0 mm CRL pouch-young, except in the carpus, tarsus and epiphyses of the long bones where ossification occurs in 60.0 to 100.0 mm CRL pouch-young. In the skeleton of D. albiventris the omosternum, haemal arches, prepollex, prehallux and parafibula, are present. These are inconstant or absent elements in eutherian mammals. PMID:9587634
de Oliveira, C A; Nogueira, J C; Mahecha, G A
Collateral cartilage ossification of the distal phalanx in the Brazilian Jumper horse.
Collateral cartilage ossification of the distal phalanx in the Brazilian Jumper horse is a common finding. The objective of this study was to evaluate the prevalence and the degree of ossification of the collateral cartilages of the distal phalanx in Brazilian Jumper horses. In an analysis of 652 collateral cartilages from the front feet of 163 horses, 93% of these cartilages had collateral cartilage ossification (P < 0.005), and 7% of these cartilages did not have any type of ossification. In ossified cartilages, 86.4% had ossification beginning from the base, and 6.6% had a separate center of ossification. PMID:12375781
Melo e Silva, Sķrgio Ricardo A; Vulcano, Luiz Carlos
chp/pcor center for health policy/ center for primary care
chp/pcor center for health policy/ center for primary care and outcomes research center overview The Center for Health Policy and the Center for Primary Care and Outcomes Research offer innovative research that lays the foundation for better domestic and international health policy and health care
Ford, James
Occipital ossification of balaenopteroid mysticetes.
The bones of the posterior portion of the mammalian skull often exhibit incomplete ossification of the joints between the bones at the time of birth, with complete ossification at some point after birth. The sequence of ossification of these joints in mysticetes can be used to characterize the relative age in the calf and early juvenile ontogenetic stages. This study examined occipital joints ossification of 38 dry prepared neonate specimens in four mysticete species from two families (Eschrichtiidae: Eschrichtius robustus; Balaenopteridae: Balaenoptera acutorostrata, Balaenoptera physalus, and Megaptera novaeangliae). Each of the joints responsible for the fusion of the occiput were examined and rated for degree of ossification. The cranial ossification analysis indicates that E. robustus calves have open occipital joints until ~6 months of age and are born at a less mature stage than closely related balaenopterids. All of the species followed the same sequence of ossification: basioccipital/exoccipital joint, followed by the basioccipital/basisphenoid joint, and completed by the supraoccipital/exoccipital joint. PMID:21290612
Walsh, Breda M; Berta, Annalisa
Blast Injuries And Heterotopic Ossification.
National Technical Information Service (NTIS)
Heterotopic ossification (HO) is perhaps the single most significant obstacle to independence, functional mobility, and return to duty for combat- injured veterans of Operation Enduring Freedom and Operation Iraqi Freedom. Recent research into the cause(s...
B. K. Potter, J. A. Forsberg, K. A. Alfieri
Heterotopic Ossification in Postgastrectomy Scars.
National Technical Information Service (NTIS)
Experience in the roentgenological detection of heterotopic ossification in postgastrectomy cases indicates that it is not as rare a finding as previously thought. It is readily demonstrated on lateral and oblique roentgenograms. In all cases suspected of...
H. Nishitani
Community health centers as primary providers of health care
In their essay, Shelly Raymer Duncan and Cinthia L. Deye examine the experience of community health centers as primary providers\\u000a of health care. These centers provide quality health care for their clientele and operate in an efficient manner. The authors\\u000a argue that community health centers are a viable mechanism for the provision of comprehensive quality primary care for underserved\\u000a persons.
Shelly Raymer Duncan; Cinthia L. Deye
Background: Delayed fetal skeletal ossification is one of the known complications of maternal diabetes. Objective: The present study was designed to evaluate the protective role of petroleum ether extract of Cissus quadrangularis (PECQ) on diabetes-induced delayed fetal skeletal ossification. Materials and Methods: Female Wistar rats were rendered diabetic with streptozotocin (STZ, 40 mg/kg, intraperitonial) before mating. After confirmation of pregnancy, the pregnant rats were divided into three groups: normal control group, diabetic control group, and diabetic + CQ group. The diabetic + CQ group pregnant rats were treated with PECQ (500 mg/kg body weight) throughout their gestation period. Immediately after delivery, pups were collected from all three groups and processed for alizarin red S¢alcian blue staining in order to examine the pattern of skeletal ossification. Results: Fewer ossification centers and decreased extent of ossification of forelimb and hindlimb bones were observed in the neonatal pups of diabetic control group as compared to those in the normal control group. PECQ pretreatment significantly restored the ossification centers and improved the extent of ossification of forelimb and hindlimb bones in the neonatal pups of diabetic + CQ group as compared to those in the diabetic control group. Conclusions: The results suggested that PECQ treatment is effective against diabetes-induced delayed fetal skeletal ossification. However, further studies on the isolation and characterization of active constituents of PECQ, which can cross the placental barrier and are responsible for the bone anabolic activity are warranted. PMID:24812472
Sirasanagandla, Srinivasa Rao; Ranganath Pai, K. Sreedhara; Potu, Bhagath Kumar; Bhat, Kumar MR
A Peek...at Primary Learning Centers.
ERIC Educational Resources Information Center
Defining a learning center as a classroom area containing several learning stations where students may work independently with materials which teach, reinforce, or enrich their skills, this guide presents essential considerations for designing such a center. Among the items discussed are scheduling, time management techniques, and record keepingģ
Kessler, John
Heterotopic Ossification Following Combat-Related Trauma.
National Technical Information Service (NTIS)
The term heterotopic ossification refers to the aberrant formation of mature, lamellar bone in nonosseous tissue. Translated from its Greek (heteros and topos) and Latin (ossificatio) etymologic origins, heterotopic ossification can be literally defined a...
B. K. Potter, J. A. Forsberg, J. S. Hawksworth, K. N. Evans, T. A. Davis
Primary Care Practice Development: A Relationship-Centered Approach
PURPOSE Numerous primary care practice development efforts, many related to the patient-centered medical home (PCMH), are emerging across the United States with few guides available to inform them. This article presents a relation- ship-centered practice development approach to understand practice and to aid in fostering practice development to advance key attributes of primary care that include access to fi rst-contact
William L. Miller; Benjamin F. Crabtree; Paul A. Nutting; Kurt C. Stange; Carlos Roberto Jaķn
Heterotopic Ossification in Wartime Wounds.
National Technical Information Service (NTIS)
Heterotopic ossification (HO) refers to the formation of mature lamellar bone in nonosseous tissue. In the setting of high-energy wartime extremity wounds, HO is expected to complicate up to 64% of patients, has a predilection for the residual limbs of am...
B. K. Potter, J. A. Forsberg
Ossification of thoracic ligamenta flava
Although ligamentum flavum ossification (LFO) often occurs in normal persons, there are no reports of its detection on lateral chest radiographs made during screening examinations. Review of 1,744 consecutive lateral chest radiographs identified LFO in 6.2% of males and 4.8% of females. LFO occurred mainly at the intervertebral segments from T9-T10 through T12-L1. Most prevalent was the hook-shaped LFO, protruding inferoirly from the inferior facets into the projections of the intervertabral foramina. Though LFO can cause severe neurologic symptoms, none of the affected persons in this study reported such symptoms. LFO was first visualized radiographically when the subjects were 20-40 years old, and it may be a physiologic condition. The LFO in these cases existed independent of thoracic posterior longitudinal ligament ossification, diffuse idiopathic skeletal hyperostosis, and degenerative osteoarthritis.
Kudo, S.; Minoru, O.; Russell, W.J.
[Ossification of posterior longitudinal ligament].
Ossification of posterior longitudinal ligament (OPLL) is a hyperostotic disease of the spine associated with myelopathy which is occurred by an anterior compression to the spinal cord. OPLL was first reported by Key GA in 1838, and was previously considered specific to east Asian people, especially Japanese. However, now OPLL is recognized as a subtype of diffuse idiopathic skeletal hyperosteosis, which is detected in Europe and the United States. We discuss the etiology and natural history of OPLL in this review. PMID:24473355
Watanabe, Ryuichi; Miyamoto, Takeshi
Coracoclavicular and coracoacromial ligament calcification and ossification.
Thirty-six patients with calcification or ossification at or around the coracoclavicular and coracoacromial regions were analyzed with regard to type, location, and configuration of the deposits and related clinical history. Calcification or ossification in the coracoclavicular region resulted largely from trauma (36%) or renal failure (28%). Trauma patients may develop punctate calcification or ossification but do not develop the tumoral type of calcification. About 5% of the renal failure patients had coracoclavicular ligament calcifications, one-half of which were of the tumoral type. Renal failure patients may have punctate or tumoral calcifications but do not develop ossification. PMID:2112784
Chen, Y M; Bohrer, S P
Translational Research Overview Health Policy and Primary Care Research Center
Translational Research Overview Health Policy and Primary Care Research Center Effective and timely findings that leads to the improvement of care and the revi- sion of health care policy. #12;REFERENCES translation of research into health care practice is essential to the delivery of high quality care. Despite
Oliver, Douglas L.
Information Requested About Organ Donation in Primary Health Care Centers
Information provided by primary care workers about organ donation significantly affects the attitude of the general public. The objective of this study was to evaluate information about donation requested by the general public in health centers in an autonomous community (region) of Spain and to find out how many workers provided relevant information.
A. RĒos; C. Conesa; P. RamĒrez; J. Sßnchez; E. Sßnchez; F. Ramos; P. Parrilla
Women of Polygamous Marriages in Primary Health Care Centers
Clinical implications for working with polygamous families are discussed following a report of research among a sample of 126 Bedouin-Arab women from polygamous marriages who were being seen in primary health care centers. Of these, 94 were senior wives who were followed by another wife in the marriage, and 32 were junior wives, the most recent wife joining the marriage.
Alean Al-Krenawi
Endometrial ossification successfully treated by hysteroscopic resection
Background: Endometrial ossification is a rare condition. The common feature in most reported cases is a previous history of abortion and retention of fetal bones. Few cases of endometrial ossification can be explained by osseous metaplasia. Clinical presentation may include abnormal vaginal bleeding or discharge, dysmenorrhoea, pelvic pain, and secondary infertility. Hysterectomy or dilation and curettage have been the usual
Aureli Tornķ; Pere Jou; Rafael Pagano; Ignacio Sanchez; Jaume Ordi; Juan A. Vanrell
Heterotopic Ossification: An Unusual Presentation
Heterotopic ossification (HO) is usually seen after-trauma, following traumatic injuries, surgeries involving major joints, neurogenic injury, and burns; however, atraumatic cases have also been reported. HO tends to cause pain, swelling, and limitation of joint movements. HO has been reported in adults as well as in pediatric cases, however, our search in the English literature has not revealed a single case in the infratemporal region, especially in children of developing age, where HO tends to affect the development and growth of adjacent bones. We are reporting a case of HO in close proximity to TMJ affecting the development of mandible and maxilla. PMID:23346421
Patil, Satish G.; Siddiqua, Aaisha; Joshi, Udupi Krishna; Deshmukh, Pallavi K.; Patil, Bindu S.; Mangalgi, Anand
University of California Davis Center for Health Services Research in Primary Care
University of California Davis Center for Health Services Research in Primary Care FOURTH ANNUAL REPORT 1997-1998 The UCD Center for Health Services Research in Primary Care has now completed an initial
Carmichael, Owen
University of California Davis Center for Health Services Research in Primary Care
University of California Davis Center for Health Services Research in Primary Care SEVENTH ANNUAL REPORT 2000-2001 The UCD Center for Health Services Research in Primary Care has now completed six years
Carmichael, Owen
University of California Davis Center for Health Services Research in Primary Care
University of California Davis Center for Health Services Research in Primary Care SIXTH ANNUAL REPORT 1999-2000 The UCD Center for Health Services Research in Primary Care has now completed five years
Carmichael, Owen
Prevention and Treatment of Heterotopic Ossification.
National Technical Information Service (NTIS)
The factors contributing to heterotopic ossification (HO), the formation of bone in abnormal soft-tissue locations, are beginning to emerge, but very little is known about the microenvironmental conditions that promote this often devastating disease. Usin...
A. R. Davis, E. A. Olmsted-Davis, J. West, M. Heggeness, R. Olabisis
Diagnosis and Treatment of Heterotopic Ossification.
National Technical Information Service (NTIS)
We recently developed a model of heterotopic ossification (HO) that suggests blocking the initial response of the nerve could ultimately block this devastating problem before it occurs. Studies proposed in this application to identify and isolate osterix+...
A. R. Davis, E. A. Olmsted-Davis
University of California Davis Center for Health Services Research in Primary Care
University of California Davis Center for Health Services Research in Primary Care THIRD ANNUAL REPORT 1996-1997 The UCD Center for Health Services Research in Primary Care has now completed an initial Administrative Base Although the Center for Health Services Research in Primary Care is currently designated
Carmichael, Owen
The John D. Stoeckle Center for Primary Care Innovation Massachusetts General Hospital
2007 The John D. Stoeckle Center for Primary Care Innovation Massachusetts General Hospital 50.stoecklecenter.org reshaping primary care for a healthier future The John D. Stoeckle Center for PRIMARY CARE INNOVATION How You Can Help The need for outstanding primary care is great, and your charitable support
Mootha, Vamsi K.
Ossification of the Ligamentum Flavum
Ossification of the ligamentum flavum is a rare cause of thoracic myelopathy. It develops in East Asians more frequently than in people from other areas. The exact pathophysiology has not been elucidated yet; however, it largely depends on biomechanical alterations, especially changes in the tensile force. Because the spinal cord is compressed from the posterior side, the first and most common clinical manifestation is usually loss of functional gait and spastic paralysis, which develop as the spinal cord compression progresses. The choice of diagnostic imaging is T2 sagittal magnetic resonance imaging scanning. Whole spine scanning is mandatory to identify multiple areas of compression and any associated distal lumbar diseases. Fine computed tomography imaging is necessary to make a differential diagnosis and set up a precise surgical plan. Conservative treatment does not work in this disorder. Decompression surgery is the only option and prognosis after surgical treatment is better with this disorder than with other causes of thoracic myelopathy. The severity of preoperative symptoms and the time interval before surgical treatment are the most important prognostic factors. PMID:24596612
Lee, Song; Moon, Sang Ho; Boo, Kyung Hwan; Chang, Byung Kwon; Lee, Jae Il
Patient Centered Communication During Primary Care Visits for Depressive Symptoms
Background Patient Centered Communication (PCC) is associated with more appropriate treatment of depression in primary care. In part a function of patient presentation, little is known about other influences on PCC. We investigated whether PCC was also influenced by personality dispositions of primary care providers (PCPs), independent of patient presentation. Methods 46 PCPs completed personality scales from the NEO-Personality Inventory, Revised and provided care to 88 Standardized Patients (SPs) presenting with either major depression or adjustment disorder with comorbid musculoskeletal symptoms, either making or not making a medication request. Coders scored each visit using the Measure of Patient Centered Communication, assessing physiciansÆ ability to explore the patientÆs illness experience (component 1), understand the patientÆs psychosocial context (component 2), and involve the patient in collaborative discussions of treatment (component 3). Results Adjusting for physician demographics, training, and patient presentation, physicians who were more open to feelings explored the patientÆs experience of illness more (p = .05). More dutiful, or rule-bound physicians engaged in greater exploration of the patientÆs psychosocial and life circumstances (p = .04), but involved the patient less in treatment discussions (p = .03), as did physicians reporting more anxious vulnerability (p = .03). Physician demographics, training, and patient presentation explained 4-7% of variance in MPCC components, with personality explaining an additional 4-7% of the variance. Conclusion Understanding of personality dispositions which promote or detract from PCC may help medical educators better identify trainees of varying aptitude, addressing individual training needs in a tailored fashion. PMID:18665060
Chapman, Benjamin P.; Duberstein, Paul R.; Epstein, Ron; Fiscella, Kevin; Kravitz, Richard L.
Ossification sequence of the avian order anseriformes, with comparison to other precocial birds.
Ossification sequences are poorly known for most amniotes, and yet they represent an important source of morphogenetic, phylogenetic, and life history information. Here, the author describes the ossification sequences of three ducks, the Common Eider Somateria mollissima dresseri, the Pekin Duck Anas platyrhynchos, and the Muscovy Duck Cairina moschata. Sequence differences exist both within and among these species, but are generally minor. The Common Eider has the most ossified skeleton prior to hatching, contrary to what is expected in a subarctic migrant species. This may be attributed to a tradeoff between growth rate and locomotory performance. Growth rate is higher in hatchlings with more cartilaginous skeletons, but this may compromise locomotion. No major ossification sequence differences were observed in the craniofacial skeleton when compared with Galliformes, which suggests that the influence of adult morphology on ossification sequence might be relatively minor in many taxa. Galliformes and Anseriformes, while both highly ossified at hatching, differ in the location of their late-stage ossification centers. In Anseriformes, these are most often located in the appendicular skeleton, whereas in Galliformes they are in the thoracic region and form the ventilatory apparatus. PMID:18496857
Maxwell, Erin E
University of California, Davis Center for Health Services Research in Primary Care
University of California, Davis Center for Health Services Research in Primary Care 2005 ┬Ł 2006 for Health Services Research in Primary Care ANNUAL REPORT 2005-2006 The University of California Davis Center for Health Services Research in Primary Care has now completed twelve years of ongoing growth
Carmichael, Owen
University of California, Davis Center for Health Services Research in Primary Care
University of California, Davis Center for Health Services Research in Primary Care 2001 ┬Ł 2002 in Primary Care ANNUAL REPORT 2001-2002 The University of California Davis Center for Health Services Research in Primary Care has now completed seven years of continuing growth and development. During
Carmichael, Owen
University of California, Davis Center for Health Services Research in Primary Care
University of California, Davis Center for Health Services Research in Primary Care 2003 - 2004 Research in Primary Care ANNUAL REPORT 2003-2004 The University of California Davis Center for Health Services Research in Primary Care has now completed nine years of continuing growth and development
Carmichael, Owen
University of California, Davis Center for Health Services Research in Primary Care
University of California, Davis Center for Health Services Research in Primary Care 2004 ┬Ł 2005 for Health Services Research in Primary Care ANNUAL REPORT 2004-2005 The University of California Davis Center for Health Services Research in Primary Care has now completed eleven years of ongoing growth
Carmichael, Owen
University of California, Davis Center for Health Services Research in Primary Care
University of California, Davis Center for Health Services Research in Primary Care 2002 ┬Ł 2003 in Primary Care ANNUAL REPORT 2002-2003 The University of California Davis Center for Health Services Research in Primary Care has now completed eight years of continuing growth and development. During
Carmichael, Owen
University of California, Davis Center for Health Services Research in Primary Care
University of California, Davis Center for Health Services Research in Primary Care SECOND ANNUAL Davis Center for Health Services Research in Primary Care has generated much excitement within the School of Medicine and throughout the UCD Campus. In this short while, the Center has energized faculty
Carmichael, Owen
Diabetes in a primary care center among Spaniards and immigrants
Diabetes is a disease with different prevalence in different populations. Objectives The aim of the present study is to describe diabetic patients in a primary care center with regard to their geographic origin, and to determine the status of their disease. Methods A cross-sectional descriptive study, with data available from clinical records in South Tarrasa primary care center (Barcelona, Spain) in 2004. Results A total of 1215 diabetic patients with an average age of 65 years, 51% female, were included in the study. Regarding their origin, 97% were from Spain, 2% from Morocco, 0.8% from Latin America, and 0.2% from the rest of Europe. The average Hb1AC was 6.9%. In type 2 diabetic patients, treatment consisted of oral hypoglycemic agents (OHA) for 46.6%, only dietetic restrictions for 36.5%, OHA + insulin for 7.9%, and only insulin for 9%. In the age group 30-39 years, 0.7% of Moroccans suffer from diabetes versus 0.5% of Spaniards. The values in the 40-49 year group are 3.9% of Moroccans, 3% of Spaniards, and 2.1% of Latin Americans. The values in the 50-59 year group are 13.5% of Moroccans, 10.6% of Spaniards, and 7.7% of Latin Americans. The values in the 60-69 year group are 40% of Moroccans, 18.8% of Spaniards, and 44.5% of Latin Americans. The values in the 70-79 year group are 67% of Moroccans, 26% of Spaniards, and 50% of Latin Americans. The average Hb1AC was 6.3% in Latin Americans, 6.9% in Spaniards, and 8.1% in Moroccans. In type 1 diabetic patients, the average Hb1AC was 10.2% in Moroccans and 8% in Spaniards; while in type 2 diabetes, the average Hb1AC was 7.8% in Moroccans and 6.9% in Spaniards. Gestational diabetes was observed in 6.1% of the Spanish, 10.9% of the Moroccan and 4.2% of the Latin American women. Conclusions A higher prevalence of diabetes was detected in Moroccans than in patients from other countries. These patients present poor control of the disease.
Vilalta, Montserrat Roca; Castano Perez, Agueda; Lopez Moya, Charo; Lopez Olivares, Mercedes
Heterotopic Ossification of the Quadratus Lumborum Muscle
Heterotopic ossification is a benign process of mature laminar bone formation in the soft tissues. A synonymous term used to describe this pathology in muscle is myositis ossificans. The pathogenesis is unclear, but is likely multifactorial. The basic pathology is thought to be ectopic production of osseous tissue as part of a repair process in response to tissue injury. This report describes a case of heterotopic ossification of the quadratus lumborum muscle as an incidental finding. This case highlights that treatment is based on symptoms and conservative management might be appropriate for the asymptomatic patient. PMID:24967013
Alport, Brie; Horne, David; Burbridge, Brent
Heterotopic ossification of the quadratus lumborum muscle.
Heterotopic ossification is a benign process of mature laminar bone formation in the soft tissues. A synonymous term used to describe this pathology in muscle is myositis ossificans. The pathogenesis is unclear, but is likely multifactorial. The basic pathology is thought to be ectopic production of osseous tissue as part of a repair process in response to tissue injury. This report describes a case of heterotopic ossification of the quadratus lumborum muscle as an incidental finding. This case highlights that treatment is based on symptoms and conservative management might be appropriate for the asymptomatic patient. PMID:24967013
Alport, Brie; Horne, David; Burbridge, Brent
January 2008 The John D. Stoeckle Center for Primary Care Innovation Number 8 "Greetings and Salutations" News from the Frontlines of Primary Care Partners Creates Primary Care Task Force The PHS Task Force is charged with developing a Partners-wide strategy for primary care in the community. Chaired
Mootha, Vamsi K.
Magnetic resonance imaging of the clavicular ossification.
Assessment of the degree of ossification of the medial clavicular epiphyseal cartilage is of vital importance in forensic age diagnostics of living individuals aged more than 18 years. To date, reference studies on the assessment of clavicular ossification using imaging procedures only relate to conventional radiography and computed tomography (CT). In this study, magnetic resonance (MR) scans of 54 sternoclavicular joints of bodies aged between 6 and 40 years were evaluated prospectively. All of the examined medial clavicular epiphyseal cartilages permitted an assessment of the degree of ossification. Stage 2 was first observed at the age of 15.0 years, the earliest age at which stage 3 was observed was 16.9 years, and stage 4 was first observed at the age of 23.8 years. The observed age intervals of the respective degrees of ossification correspond to the known data from X-ray and CT scan examinations. The achieved results should be examined with a larger number of cases. A modified examination protocol is required for the MR examination of the medial clavicular epiphyseal cartilage for the purpose of forensic age diagnostics of living individuals. PMID:17437121
Schmidt, Sven; M³hler, Matthias; Schmeling, Andreas; Reisinger, Walter; Schulz, Ronald
[Posterior longitudinal ligament ossification: case report].
Posterior longitudinal ligament ossification of cervical spine is a rare condition among caucasians. A 42 years old japanese patient with progressive walking difficulty was diagnosed with this pathology by CT scan and MRI and treated surgically by an anterior approach with arthrodesis. Pathophysiology, racial prevalence, clinical picture, radiological characteristics and surgical approaches options are revised. PMID:16622577
Tella, Oswaldo Inßcio de; Herculano, Marco Antonio; Paiva Neto, Manoel Antonio; Faedo Neto, AtĒlio; Crosera, JoŃo Francisco
Regulation of Embryonic Endochondral Ossification by Smurf2
Smurf2 is an E3 ubiquitin ligase that targets TGF-? receptor activated Smad2 and Smad3 for the proteasome in primary articular chondrocytes, thus stimulating their hypertrophic differentiation. Comparatively, how Smurf2 functions in growth plate chondrocytes in a developing long bone is an open question. In this study, we measured the mRNA levels of endogenous Smurf2 and type X collagen in chick growth plate at different embryonic stages to monitor the correlation between the level of Smurf2 expression and chondrocyte maturational stage. We found that high levels of Smurf2 were associated with the differentiative and proliferative stages, while Smurf2 levels were thereafter decreased as the chondrocytes matured toward hypertrophy. In addition, we injected Smurf2-RCAS into chick wing buds at HH stage 20¢23 and examined how the ectopic overexpression of Smurf2 in condensing chondrogenic mesenchymeaffects the subsequent process of chondrocyte maturation and ossification during embryonic development. Histological analysis showed that overexpression of Smurf2 in a developing wing bud accelerated chondrocyte maturation and endochondral ossification, which may result from a decrease in TGF-? signaling in the infected chondrocytes with Smurf2-RCAS. PMID:18176945
Wu, Qiuqian; Wang, Meina; Zuscik, Michael J.; Chen, Di; O'Keefe, Regis J.; Rosier, Randy N.
Reconsidering the popularity of primary health centers in India: A case study from rural Maharashtra
Most evaluations of India's primary health care (PHC) program have been critical of the ways government primary health centers have been functioning. It has been commonly noted that utilization of health services is poor and community participation in the PHC outreach program low. Additionally, medical officers and health center staff are often accused of being negligent in their duties. In
Vinay R. Kamat
Age dependence of fusion of primary occipital sutures: a radiographic study
PurposeĀĀWhen linear lucency is present in the occipital bone on radiographs throughout childhood, differential diagnosis becomes important because some primary sutures are similar to fractures. The authors here chronicled the normal development of ossification centers, sutures, and synchondroses in the chondrocranium by radiographic examination.MethodsĀĀOne hundred and twenty-seven children, aged from newborns to 6Āyears and without any skull base deformities, were
Kuniaki Nakahara; Satoshi Utsuki; Satoru Shimizu; Hideo Iida; Yoshio Miyasaka; Hiroshi Takagi; Hidehiro Oka; Kiyotaka Fujii
New Pathways for Primary Care: An Update on Primary Care Programs From the Innovation Center at CMS
Those in practice find that the fee-for-service system does not adequately value the contributions made by primary care. The Center for Medicare and Medicaid Innovation (Innovation Center) was created by the Affordable Care Act to test new models of health care delivery to improve the quality of care while lowering costs. All programs coming out of the Innovation Center are tests of new payment and service delivery models. By changing both payment and delivery models and moving to a payment model that rewards physicians for quality of care instead of volume of care, we may be able to achieve the kind of health care patients want to receive and primary care physicians want to provide. PMID:22412007
Baron, Richard J.
Effect of arsenic in endochondral ossification of experimental animals.
Arsenic (As) toxicity is a global health problem affecting millions of people, the most toxic forms being Arsenites [As(III)] and Arsenates [As(V)]. Arsenic intoxication can occur through different exposure routes. The aim of the present work was to determine the effect of As on endochondral ossification and bone remodeling in experimental animals, by means of biochemical, histologic, and histomorphometric determinations. Sixteen male Wistar rats, 100g body weight (b.w.), were divided into two groups: experimental group (n=8), treated with 10mg/l of NaAsO(2) in their drinking water, receiving 0.21mg/kgb.w./day during 45 days; and control group (n=8) remained untreated. On day 45, blood samples were obtained by cardiac puncture to perform hematologic blood counts and biochemical determination. The animals were killed, the tibiae, femurs, kidneys and livers were resected, fixed in formalin and processed histologically. Tibia and femur sections were obtained and stained with H&E. The following histomorphometric parameters were determined on tibia and femur sections: bone volume (BV/TV), thickness of growth plate cartilage (GPC.Th) and thickness of hypertrophic zone (HpZ.Th). Biochemical determinations showed that experimental animals exhibited neutrophilia and a decrease in lymphocytes and monocytes. As levels were below 1 microg/dl in both groups. The femur sections of the experimental group showed (1) a statistically significant increase in total growth cartilage plate thickness (p<0.05) at the expense of the hypertrophic zone (p<0.05); (2) subchondral trabecular bone sealed to the growth plate with a non-significant increase in primary spongiosa bone volume. These results suggest that As alters endochondral ossification. PMID:19447590
Odstrcil, Ana Del Carmen Aybar; Carino, Silvia Norma; Ricci, Juan Carlos Diaz; Mandalunis, Patricia M¾nica
Nurse Managed Center: Access to Primary Health Care for Urban Native Americans
Urban Native Americans represent a small, diverse minority with unique health needs. The purposes of this descriptive retrospective study were to describe (a) the characteristics and primary health problems of urban Native Americans who receive primary health care at an urban nurse managed center (NMC) and (b) the nursing interventions provided at an urban NMC to urban Native Americans. A
Donna Felber Neff; Elizabeth S. Kinion; Christen Cardina
Distance from the Primary Health Center: A GIS method to study geographical access to health care
Aerial distance from the dependent Primary Health Center is a crude but objective measure of geographical accessibility to Primary Health care facilities. This report describes a method for calculation of distances between the PHC and the population it serves using the data available from the local health authorities and the Swedish Central Statistical Bureau. The Swedish annual population registration records
S. Kohli; K. Sahlķn; ┼. Sivertun; O. L÷fman; E. Trell; O. Wigertz
The Association of Low Back Pain with Obesity in One of the Primary Health Care Centers
Objective: The present study was designed to assess the association between low back pain and obesity in patients attending one of the primary health care centers. Methods: A case control study of patients attending Marka Medical Center (Amman Jordan) was conducted over 7 months (Jan-Jul 1998). All patients with low back pain were included as cases and an equal number
Mohammed Halalsheh; Mohammed Tarawneh; Ziad Mahadine
Ossification sequence and genetic patterning in the mouse axial skeleton.
We provide novel data on vertebral ontogeny in the mouse, the mammalian model-of-choice for developmental studies. Most previous studies on ossification sequences in mice have focused on pooled elements of the spine (cervicals, thoracics, lumbars, sacrals, and caudals). Here, we contribute data on ossification sequences in the neural arches and centra to provide a comparative basis upon which to evaluate mammalian diversity of the axial skeleton. In attempt to explain the ossification pattern observed, we compared our observations with the phenotype of Cdx over-expresser mice. We use high-resolution X-ray microtomography and clearing and staining techniques to quantify the precise sequential ossification pattern of the mouse spine. We show that micro-CT scans perform better in all cases whereas clearing and staining exhibit sensitivity to the presence of semi-opaque tissue. We observe that the centra of wild-type mice always ossify after neural arches and that the ossification of the neural arches proceeds from two loci. The ossification of the centra appears more complex, especially in the neck where ossification is delayed and does not just follow the order of the vertebrae along the anterior-posterior axis. Our findings also suggest that Cdx genes' expression levels may be involved in the delayed ossification in the neck centra. J. Exp. Zool. (Mol. Dev. Evol.) 322B: 631-642, 2014. ® 2014 Wiley Periodicals, Inc. PMID:25110855
Hautier, Lionel; Charles, Cyril; Asher, Robert J; Gaunt, Stephen J
'Duplication' of the clavicle or ossification in coracoclavicular ligament.
A case is presented in which plain films revealed a short band of ossification adjacent to the inferior aspect of the lateral part of the clavicle. CT findings indicated that the ossification was situated in the coracoclavicular ligament and was not a manifestation of clavicular 'duplication'. PMID:9125077
Schubert, F
Determinants of heterotopic ossification after total hip replacement surgery.
The ability of various pre- or peri-operative variables to determine the risk of developing moderate to severe heterotopic ossification (HO) six to twelve months after surgery was investigated among 407 patients undergoing elective total hip replacement (THR) surgery and allocated to placebo in a randomised controlled trial evaluating NSA IDs-based prophylaxis for HO. Overall, 11 (30%) of the 37 patients undergoing revision surgery developed moderate to severe HO compared with 58 (16%) of the 370 patients undergoing primary THR; odds ratio (OR) 2.3, 95% confidence interval (CI) 1.1 to 4.9. Among patients undergoing primary THR , mutually adjusted analysis of collected independent risk factors demonstrated that receiving a transfusion of red cells or having general as well as epidural or spinal anaesthesia present as indicators of increased risk for developing moderate to severe HO. Patients who have undergone revision surgery have a significantly increased risk of clinically relevant ectopic bone, while among patients who have undergone primary THR surgery, those with indicators of excessive surgical bleeding are also at increased risk of clinically relevant HO. PMID:19455501
Fransen, Marlene; Neal, Bruce; Cameron, Ian D; Crawford, Ross; Tregonning, Garnet; Winstanley, Julie; Norton, Robyn
[Isolated stapedius tendon ossification: a case report].
In this study, a case with bilateral isolated stapedius tendon ossification was reported, since it is a rare clinical condition. A 46-year-old female patient was admitted to our clinic with the complaint of bilateral hearing loss. Tympanic membrane was bilateral normal in color and appearance on otomicroscopic examination. Pure tone air bone gap was between 20-25 dB at 1 kHz and 4 kHz on audiogram bilaterally. Middle ear pressure was normal and stapedius reflex was negative bilaterally. Preoperative diagnosis was otosclerosis. Right exploratory tympanotomy was performed. Isolated stapedius tendon ossification was determined. Normal stapedius movement was achieved by cutting the tendon. Three months later, the same procedure was performed on the left ear. Pure tone air bone gap was bilateral 0 dB at 0.5 kHz, 1 kHz and 2 kHz, and 5-10 dB at 4 kHz on audiogram postoperatively. PMID:21417973
Ulk³, Ca?atay Han
Radiographic staging of ossification of the medial clavicular epiphysis.
Determination of the stage of ossification of the medial clavicular epiphysis is a crucial part of forensic age estimation when evaluating living subjects over 18 years of age. In the present study, we comparatively assessed conventional radiographs and computed tomography (CT) scans of sternoclavicular joints used to perform forensic age assessments in 57 individuals undergoing criminal proceedings. With CT, it was possible to determine the ossification stage of all clavicles studied. In the case of conventional radiography, reliable assessment of ossification stage was not possible in 15 out of 114 clavicles studied due to the superimposition of other structures. Regarding agreement between the methods, both radiography and CT produced identical staging results in 97 out of 99 clavicular epiphyses. In two cases, however, ossification was classified as stage 2 by CT and as stage 3 by conventional radiography. Regarding stages 4 and 5, both methods produced identical staging results in all cases. In forensic age estimation practice, it is necessary that conventional radiographic reference studies be used for ossification stage classification by conventional radiography and that CT reference studies be used for ossification stage classification by CT. Further studies in dead bodies of known age are required to issue a recommendation as to whether conventional radiography using obtained in three planes or CT is the method of choice for the assessment of clavicular ossification. PMID:17940787
Schulz, Ronald; M³hler, Matthias; Reisinger, Walter; Schmidt, Sven; Schmeling, Andreas
The Role of Matrix Gla Protein in Ossification and Recovery of the Avian Growth Plate
Extracellular matrix mineralization is an essential physiologic process in bone, teeth, and hypertrophic cartilage. Matrix Gla protein (MGP), an inhibitor of mineralization, is expressed by chondrocytes and vascular smooth muscle cells to inhibit calcification of those soft tissues. Tibial dyschondroplasia (TD), a skeletal abnormality apparent as a plug of non-vascularized, non-mineralized, white opaque cartilage in the tibial growth plate of avian species can serve as a good model for studying process and genes involved in matrix mineralization and calcification. In this work, we studied the involvement of MGP in the development of TD, as well as in the processes of spontaneous and induced recovery from this syndrome. First, we found that during normal bone development, MGP is expressed in specific time and locations, starting from wide-spread expression in the yet un-ossified diaphysis during embryonic development, to specific expression in hypertrophic chondrocytes adjacent to the chondro-osseous junction and the secondary ossification center just prior to calcification. In addition, we show that MGP is not expressed in the impaired TD lesion, however when the lesion begins to heal, it strongly express MGP prior to its calcification. Moreover, we show that when calcification is inhibited, a gap is formed between the expression zones of MGP and BMP2 and that this gap is closed during the healing process. To conclude, we suggest that MGP, directly or through interaction with BMP2, plays a role as ossification regulator that acts prior to ossification, rather then simple inhibitor. PMID:22787455
Dan, Harel; Simsa-Maziel, Stav; Reich, Adi; Sela-Donenfeld, Dalit; Monsonego-Ornan, Efrat
Primary cutaneous follicle center lymphoma responsive to interferon alfa-2a.
Follicular lymphoma is the most common type of primary cutaneous B-cell lymphomas with a predilection for the scalp, forehead, and trunk. Herein we report a case of primary cutaneous follicle center lymphoma on the scalp of 72-year-old female. The diagnosis was made histopathologically, confirming the presence of centrocytes and centroblasts. Complete resolution was achieved following administration of subcutaneous interferon ?-2a at a dose of 4.5 ū 10? IU three times weekly for 3 months. PMID:22016291
Kavala, Mukaddes; Zindanci, Ilkin; Sudogan, Sibel; Can, Burce; Turkoglu, Zafer; Kocaturk, Emek; Koc, Melek; Buyukbabani, Nesimi
Primary Health Care in Community Health Centers and Comparison with Office-Based Practice
We examine the roles of nurse practitioners (NPs), physician assistants (PAs), and nurse midwives (CNMs) in community health\\u000a centers (CHCs). We also compare primary care physicians in CHCs with office-based physicians. Estimates are from the National\\u000a Ambulatory Medical Care Survey, a nationally representative annual survey of nonfederal, office-based patient care physicians\\u000a and their visits. Analysis of primary care delivery in
Esther HingRoderick; Roderick S. Hooker; Jill J. Ashman
Primary Stenting of Subclavian and Innominate Artery Occlusive Disease: A Single CenterÆs Experience
Purpose: To review immediate and midterm results of primary stenting for innominate and subclavian artery occlusive lesions. Methods: Retrospective data were collected from 48 consecutive symptomatic patients (27 men and 21 women, median age 64 years) having 49 subclavian and innominate artery lesions treated with stenting. Of the patients 52% had concomitant ischemic heart disease, and 30% had carotid and\\/or
E. N. Brountzos; B. Petersen; C. Binkert; I. Panagiotou; J. A. Kaufman
Division Overview The primary goal of CDC's National Center for Environmental Health Division of Emergency and Environmental Health Services (EEHS) is to provide national leadership in the development of environmental and emergency public health policy and prevention programs to improve public health practice
SUMMARY. A pharmaceutical care program for dyslipidemic patients was designed, implemented, and assessed. The study was conducted during 32 weeks, at three Primary Health Care Centers. One hundred and forty two patients were selected. These patients were randomly assigned to intervention or control groups. Intervention group patients received care twice a month and were surveyed to assess their knowl- edge
Lorenzo A. VILLA; Ana M. VON CHRISMAR; Carlos OYARZ┌N; Paloma EUJEN═N; Maria E. FERN┴NDEZ; Marcela QUEZADA
Sustainable patient information network (SPaIN) for primary care health center in Indonesia
Sustainable patient information network for primary care health center is needed for Indonesia. There are many of remote, isolated or urban area, which causes transportation problems and telecommunication problems, for example: necessity of wireless infrastructure. The Internet and its free software is the main agent for this system combining with information and communication technology. We develop low speed communication system
I. T. Pambudi; T. Hayasaka; T. Tsubota; S. Wada; T. Yamaguchi
The purpose of this research is to measure the efficiency of trainings in the general principles of vaccine applications, the cold chain, and the adverse effects after vaccination for 51 employees (31 midwives and 20 nurses) working at primary health centers in Tuzla Health Group Region via test and retest method. The data collected through measurement of test scores before
Bahar Ta?ńio?ullari; Mithat Kiyak; I?ik Ūińek
Ultrasound studies on the time course of clavicular ossification
When preparing forensic age estimates for living subjects over 18Āyears of age, it is crucial to evaluate the stage of ossification\\u000a of the medial clavicular epiphysis. The establishment of radiation-free imaging techniques for assessment of clavicular ossification\\u000a would be desirable in order to reduce the radiation exposure associated with forensic age estimations. In the present study,\\u000a 84 right clavicles of
Ronald Schulz; Per Zwiesigk; Manfred Schiborr; Sven Schmidt; Andreas Schmeling
There are few studies that have addressed the effects of prenatal exposure of topiramate on ossification of the bones derived from the paraxial mesoderm. This study aimed to evaluate skeletal ossification of ribs and vertebrae in 20-day-old rat fetuses after maternal exposure to two therapeutic doses of topiramate. Three groups of Sprague-Dawley pregnant rats were used: control, topiramate 50 mg/kg/day and topiramate 100 mg/kg/day treated groups. Topiramate was administered by gavage from day 6-19 of gestation. Fetuses were collected on day 20 by caesarean section. Fetal bones were stained with alizarin red and ossification was assessed. Results showed significant delayed ossification of ribs and vertebrae in topiramate-exposed fetuses at both doses and the effects were not dose dependent. In all examined groups, there was a direct correlation between the fetal weight and the number of complete ossified vertebral centers. Also, there were significant increases in skeletal abnormalities, particularly in ribs in both treated groups when compared to the control group. In conclusion, therapeutic doses of topiramate should be taken cautiously during pregnancy as they lead to fetal growth restriction and increases abnormalities of axial skeleton in rat fetuses. PMID:22732801
Fadel, R A; Sequeira, R P; Abu-Hijleh, M F; Obeidat, M; Salem, A H A
Ultrasound studies on the time course of clavicular ossification.
When preparing forensic age estimates for living subjects over 18 years of age, it is crucial to evaluate the stage of ossification of the medial clavicular epiphysis. The establishment of radiation-free imaging techniques for assessment of clavicular ossification would be desirable in order to reduce the radiation exposure associated with forensic age estimations. In the present study, 84 right clavicles of test subjects 12-30 years of age were prospectively evaluated by means of ultrasound. Ossification stage classification was possible in 80 of the 84 medial clavicular epiphyses studied. In the remaining cases, stage classification was not possible due to the presence of developmental anomalies. The earliest ages at which the respective ossification stages were observed were 17.1 years for stage 2, 16.7 years for stage 3, and 22.5 years for stage 4. The age intervals observed for the ossification stages are consistent with the known data from radiological and computed tomography assessments. The present study results should be confirmed in a larger number of cases and with analysis of observer variability. Evaluation of medial clavicular epiphyseal ossification by ultrasound could ultimately be a rapid and economic non-ionizing diagnostic imaging procedure for forensic age estimation. PMID:18180940
Schulz, Ronald; Zwiesigk, Per; Schiborr, Manfred; Schmidt, Sven; Schmeling, Andreas
Raman spectroscopic analysis of combat-related heterotopic ossification development.
Over 60% of our severely combat-injured patient population develops radiographically apparent heterotopic ossification. Nearly a third of these require surgical excision of symptomatic lesions, a procedure that is fraught with complications, and delays or regresses functional rehabilitation in many cases. Unfortunately, for the combat injured, medical contraindications and logistical limitations limit widespread use of conventional means of primary prophylaxis. Better means of risk stratification are needed to both mitigate the risk of current means of primary prophylaxis as well as to evaluate novel preventive strategies currently in development. We asked whether Raman spectral changes, measured ex vivo, correlated with histologic evidence of the earliest signs of HO formation using tissue biopsies from the wounds of combat casualties. In doing so, we compared normal muscle tissue to injured muscle tissue, unmineralized HO tissue, and mineralized HO tissue. The Raman spectra of these tissues demonstrate clear differences in the amide I and amide III spectral regions of HO tissue compared to normal tissue, denoted by changes in the 1640/1445cm(-1)(p<0.01), and 1340/1270cm(-1) (p<0.01) band area ratios (BARs). Additionally, analysis of the bone mineral in HO by Raman spectroscopy appears capable of determining bone maturity by measuring both the 945/960cm(-1) and the 1070/1445cm(-1) BARs. Raman may therefore prove a useful, non-invasive, and early diagnostic modality to detect HO formation prior to it becoming evident clinically or radiographically. This technique could ostensibly be utilized as a non-invasive means to risk stratify individual wounds at a time thought to be amenable to various means of primary prophylaxis. PMID:24012700
Crane, Nicole J; Polfer, Elizabeth; Elster, Eric A; Potter, Benjamin K; Forsberg, Jonathan A
The decay of the excited primary electron donor P* in bacterial photosynthetic reaction centers (both membrane-bound and detergent-isolated) has been observed to be nonexponential on a time scale of some tens of picoseconds. Although the multipicosecond nonexponentiality of P* has been ascribed to heterogeneity in teh rate of primary electron transfer (PET), the decay kinetics can be interpreted equally well using homogeneous models. To address this ambiguity, we studied the decay of excited bacteriochlorophyll (Bchl) in the membrane-bound core antenna/reaction center complexes of wild-type and mutant reaction center strains of Rhodobacter capsulatus. Reaction centers isolated from these same strains display a range of multiexponentiality in primary charge separation. The mutant strains carry substitutions of amino acids residing near the monomeric Bchl on the active and/or inactive sides of the reaction center. Transient absorption measurements monitoring the Qy bleach of antenna Bchls require at least two exponential components to fit all decays. The wild type was fitted with equal-amplitude components whose lifetimes are 24 and 65 ps. The shortest-lived component is relatively insensitive to mutation, in contrast to the longer-lived component(s) whose amplitude and magnitude were dramatically perturbed by amino acid substitutions. Unlike the situation with isolated reaction centers, here the only kinetic models consistent with the data are those in which the primary electron-transfer rate constant is heterogeneous, suggesting at least two structural populations of RCs. PET in the population with the shortest-lived antenna decay causes the kinetics to be transfer-to-trap-limited, whereas the kinetics in the other population(s)--having longer-lived antenna decays--are limited by the rate of PET. Observation of both types of kinetic limitation within a single light-harvesting system is unexpected and complicates any discussion of the rate-limiting step of light energy utilization in photosynthesis. PMID:9289013
Laible, P D; Greenfield, S R; Wasielewski, M R; Hansen, D K; Pearlstein, R M
Economic Analysis of Requests for Laboratory Tests in Primary Health Care Centers
Introduction: Operation of the Primary health care center and Medical-biochemical laboratories depends on the number of performed laboratory tests. The number of unnecessary tests significantly affect the operation of health institutions. Material and methods: We analyzed the 1000 requests for laboratory tests at the Primary Health Care Centre in Gracanica from primary care units. Based on the requests for laboratory diagnostics advisable diagnoses from primary health care unit in the Primary Health Care Center (PHC) we made an economic analysis of the total required laboratory tests in the requests for laboratory diagnosis. Incorporating the economic analysis of laboratory tests in requests for laboratory diagnosis by doctors in primary health care (PHC) and the economic analysis of laboratory tests by the disease in primary health care. Results: The economic value of 5333 laboratory tests was 84 312 points (1 point is 0.80 KM). Of the total value of the index score requirements of GPs are 44, 1%, the requirement of family doctors account for 40% and requirements of other specialists make up 15, 9%.. Discussion: In the requests of the PHC units for laboratory tests are required all levels of services: urine, CBC, SE, glucose, bilirubine, ALT, AST, AF, CK, cholesterol, HDL chol., triglicerdes, creatinine, urea, uric acid, CRP, fibrinogen, calcium and phosphorus. The following requests are the most common laboratory tests: urine, CBC, blood glucose, cholesterol, triglycerides, aminotransferases, creatinine, urea. The doctors in family practice most often requested: blood glucose, urine, CBC, SE, TGL. , Chol., ALT, AST, creatinine and urea. General practitioners were demanding more cholesterol and triglycerides, and family medicine doctors were demanding less cholesterol and triglycerides and more often CRP, fibrinogen, ALT, AST, what from the level of economic cost analysis rises the issue whether this was justified? PMID:23322950
Zunic, Lejla
Numerous forecasts have predicted shortages of primary care providers, particularly in light of an expected increase in patient demand resulting from the Affordable Care Act. Yet these forecasts could be inaccurate because they generally do not allow for changes in the way primary care is delivered. We analyzed the impact of two emerging models of care--the patient-centered medical home and the nurse-managed health center--both of which use a provider mix that is richer in nurse practitioners and physician assistants than today's predominant models of care delivery. We found that projected physician shortages were substantially reduced in plausible scenarios that envisioned greater reliance on these new models, even without increases in the supply of physicians. Some less plausible scenarios even eliminated the shortage. All of these scenarios, however, may require additional changes, such as liberalized scope-of-practice laws; a larger supply of medical assistants, licensed practical nurses, and aides; and payment changes that reward providers for population health management. PMID:24191083
Auerbach, David I; Chen, Peggy G; Friedberg, Mark W; Reid, Rachel; Lau, Christopher; Buerhaus, Peter I; Mehrotra, Ateev
Congenital anomalies of the brain frequently correspond to cranial base anomalies, and a detailed description of morphology and individual variations in the developing cranial base is of clinical importance for diagnosing anomalies. Development of the human cranial base has been studied using dissection, computed tomography, and magnetic resonance imaging, each of which has advantages and disadvantages. We here examined development of the normal human fetal cranial base using bone staining, which allows for direct observation of the ossification centers and precise three-dimensional measurements. We observed alizarin red S-stained sphenoids and basiocciputs of 22 normal formalin-fixed human fetuses with crown-rump lengths (CRL) of 115-175 mm. We defined landmarks and measured sphenoids and basiocciputs using a fine caliper. Growth patterns of these ossifying bones were obtained, and we found similarities and differences among the growth patterns. We also observed individual variations in the ossification patterns, in particular, single- or double-ossification center patterns for the basisphenoid. The orbitosphenoid and basisphenoid widths and ratios of the widths to the total cranial base width were significantly different between the two pattern groups, whereas the other measurements and their ratios to the total cranial base did not differ between the groups. We measured the cerebrum and pons in different sets of 22 human fetuses with CRLs of 105-186 mm and found close relationships with the development of corresponding parts of the cranial base. The results contribute to the quantitative and qualitative information about the growth patterns and variations during human fetal cranial base development. PMID:21848997
Zhang, Qinghua; Wang, Hui; Udagawa, Jun; Otani, Hiroki
Patterns of drug use in the public sector primary health centers of Bhopal district
Objective To study drug use in public sector out-patient centers in Bhopal district, Madhya Pradesh Province, India. This study was\\u000a conducted as part of the provincial health DepartmentÆs efforts to develop a state drug policy. It was intended to inform\\u000a policy elements concerned with the promotion of rational drug use. Method Health facilities studied included the functioning 9 primary health
Ayesha De Costa; Shekhawat Bhartiya; Amani Eltayb; Sunil Nandeswar; Vinod K. Diwan
Radiotherapy of primary cutaneous follicle center lymphoma: case report and review of literature.
Primary cutaneous follicle center lymphoma is an indolent primary cutaneous B-cell lymphoma originating from the follicle center cells, composed of a combination of centrocytes (small and large cleaved cells) and centroblasts (large noncleaved cells) with a follicular, follicular/diffuse, or diffuse growth pattern. Lesions are mostly located on the head, neck and trunk. A case is presented of a 56-year-old male patient with primary cutaneous follicle center lymphoma, with lesions involving the skin of the back, shoulders, presternal area and right forearm. As the patient presented a disseminated cutaneous form of the disease that involved several anatomical regions, complete work-up was followed by superficial fractionated radiotherapy of eight fields in VI expositions, with total irradiation dose of 1400ĀcGy upon the following fields: right and left pectoral region, left and right shoulders, right suprascapular region, and proximal third of the right forearm. Total irradiation dose applied upon each field for the lesions located on the left and right side of the back was 1500ĀcGy. This therapy resulted in significant reduction of visible tumor. The patient was regularly followed up on outpatient basis for 12Āmonths of radiotherapy, being free from local recurrence and systemic spread of the disease. PMID:23786884
Ceovic, Romana; Jovanovic, Ivana; Kostovic, Kresimir; Rados, Jaka; Dotlic, Snjezana; Radman, Ivo; Kulisic, Sandra Marinovic; Loncaric, Davorin
FGF9 can induce endochondral ossification in cranial mesenchyme
Background The flat bones of the skull (i.e., the frontal and parietal bones) normally form through intramembranous ossification. At these sites cranial mesenchymal cells directly differentiate into osteoblasts without the formation of a cartilage intermediate. This type of ossification is distinct from endochondral ossification, a process that involves initial formation of cartilage and later replacement by bone. Results We have analyzed a line of transgenic mice that expresses FGF9, a member of the fibroblast growth factor family (FGF), in cranial mesenchymal cells. The parietal bones in these mice show a switch from intramembranous to endochondral ossification. Cranial cartilage precursors are induced to proliferate, then hypertrophy and are later replaced by bone. These changes are accompanied by upregulation of Sox9, Ihh, Col2a1, Col10a1 and downregulation of CbfaI and Osteocalcin. Fate mapping studies show that the cranial mesenchymal cells in the parietal region that show a switch in cell fate are likely to be derived from the mesoderm. Conclusion These results demonstrate that FGF9 expression is sufficient to convert the differentiation program of (at least a subset of) mesoderm-derived cranial mesenchyme cells from intramembranous to endochondral ossification. PMID:16504022
Govindarajan, Venkatesh; Overbeek, Paul A
[Sexual dimorphic patterns of ossificated costal cartilages in humans].
Ossification of costal cartilages is one of many changes reflecting their ageing. It is found only in a limited percentage of population and used to begin at various ages. Shape of these ossification changes is different in men and women. Due to heterogeneity of data in literature and scarce amount of information, we decided to evaluate the occurrence of costal cartilage ossifications in a sample of Czech population. Use of roentgenograms of ossification focuses was based on their contrast in x-rays. We have studied altogether 1044 X-rays archived by Department of Radiology at the Teaching Hospital in Hradec Krßov'e. This set comprised roentgenograms of both men and women in age range from 10 to 95 years. Ossification changes of costal cartilages were described on 18 roentgenograms from dissection material as well. These rtg pictures were taken from chest plates and costal cartilages which were obtained from Department of Anatomy and Department of Forensic Medicine at Faculty of Medicine in Hradec Krßlovķ. In this sample of Czech population we confirmed an occurrence of sexual dimorphism of ossified costal cartilages. Statistical evaluation revealed that beginning of these changes depends on the age and sex. PMID:16922163
Rejtarovß, Olga; SlĒzovß, Dßsa; Smoranc, Pavel; Rejtar, Pavel; Bukac, Josef
Pressure dependence of primary charge separation in a photosynthetic reaction center
NASA Astrophysics Data System (ADS)
Spectral hole burning is used to study the pressure dependence of the Q y absorption spectrum and primary charge separation kinetics of the D1-D2-cyt b 559 reaction center complex of photosystem II. The 4.2 K lifetime of P680 ?, the primary donor state, lengthens from 2.0 ps at 0.1 MPa to 7.0 ps at 267 MPa. Importantly, this effect is irreversible (plastic), in sharp contrast with the elastic effects of pressure on the low-temperature absorption and non-line-narrowed hole spectrum of P680. These observations and data which show that the electron-phonon coupling is weakly dependent on pressure, suggest a model that has the plastic behavior of charge separation kinetics due mainly to the pressure dependence of the energy of the acceptor state and of the variance of the P680 ?-acceptor energy gap stemming from structural heterogeneity. Nonadiabatic rate expressions, which take into account the distribution of energy gap values, are used to estimate the linear pressure shift of the acceptor state energy for both the superexchange and two-step mechanisms for primary charge separation. For both mechanisms shifts in the vicinity of 1 cm -1/MPa are required to explain the data, a value which is not unreasonable based on pressure dependent studies of other systems. The results point to the marriage of hole burning and high pressures as having considerable potential for the study of primary transport dynamics in reaction center and antenna complexes.
Chang, H.-C.; Jankowiak, R.; Reddy, N. R. S.; Small, G. J.
Penile ossification is very rare, with only a handful of histologically confirmed reported cases. The most common condition leading to penile ossification is PeyronieÆs disease. Other conditions, such as gout, end-stage renal disease, diabetes mellitus, hyperparathyroidism and local trauma, have also been associated with penile ossification. We report a unique case of near-complete penile ossification of the corporal bodies with histologic confirmation on pathologic review. Our report summarizes the literature regarding this rare entity. PMID:23671498
Yilmaz, Ibrahim Edhem; Barazani, Yagil; Tareen, Basir
Background and PurposeŚTo increase the proportion of ischemic stroke patients treated with thrombolytic therapy, the establishment of primary stroke centers in community hospitals has been advocated. We evaluated the use of thrombolytic therapy before and after institution of a primary stroke center in a community hospital. MethodsŚThe availability of an on-call stroke emergency response team was the only significant additional
Susan Unipan Lattimore; Julio Chalela; Lisa Davis; Thomas DeGraba; Mustapha Ezzeddine; Joseph Haymore; Paul Nyquist; Alison E. Baird; John Hallenbeck; Steven Warach
Ossification of the posterior longitudinal ligament: a case report
Ossification of the posterior longitudinal ligament (OPLL) has recently been recognized as a clinical entity. It is a rare condition, having a higher incidence in the Japanese population. It is characterized by hyperplasia of cartilage cells with eventual endochondral ossification of the posterior longitudinal ligament. The radiographic signs are characteristic and consist of a linear band of ossified tissue along the posterior margin of the vertebral body. OPLL can be associated with mild to serious neurological complications due to spinal cord or nerve root compression, or it may be asymptomatic. This paper reviews the radiological, clinical and therapeutic aspects of this rare condition. ImagesFigures 1 and 2Figures 3 and 4
Aker, PD; OÆConnor, SM; Mior, SA; Beauchemin, D
School-based health centers and the primary care physician: an opportunity for collaborative care.
Located throughout the country, SBHCs are an important resource for primary care physicians caring for children and adolescents. It is beneficial for primary care physicians to become familiar with school-based resources in their community. Information about SBHCs nationwide is available from the NASBHC [4,16] and The Center for Health and Health Care in Schools [3,7,12,15]. Partnering with SBHCs can have important benefits for your practice, including improved continuity of care, management of chronic dis-eases like asthma, opportunities for group and multidisciplinary interventions for overweight children, and access to SBHC mental health services. Specializing in adolescent issues, with the advantage of proximity, SBHC providers can be an invaluable asset in managing and helping to monitor your patients, especially when other community resources are limited or services are difficult to access. In our own centers, we are currently exploring ways to simplify ongoing routine communication with primary care providers. Consider discussing this opportunity for collaborative services with your patients and contacting your local SBHC to discuss how you would like to communicate and work together. PMID:16713764
Weinstein, Jamie
Background Each year, nearly 20 million Americans with alcohol or illicit drug dependence do not receive treatment. The Affordable Care Act and parity laws are expected to result in increased access to treatment through integration of substance use disorder (SUD) services with primary care. However, relatively little research exists on the integration of SUD services into primary care settings. Our goal was to assess SUD service integration in California primary care settings and to identify the practice and policy facilitators and barriers encountered by providers who have attempted to integrate these services. Methods Primary survey and qualitative interview data were collected from the population of federally qualified health centers (FQHCs) in five California counties known to be engaged in SUD integration efforts was surveyed. From among the organizations that responded to the survey (78% response rate), four were purposively sampled based on their level of integration. Interviews were conducted with management, staff, and patients (n?=?18) from these organizations to collect further qualitative information on the barriers and facilitators of integration. Results Compared to mental health services, there was a trend for SUD services to be less integrated with primary care, and SUD services were rated significantly less effective. The perceived difference in effectiveness appeared to be due to provider training. Policy suggestions included expanding the SUD workforce that can bill Medicaid, allowing same-day billing of two services, facilitating easier reimbursement for medications, developing the workforce, and increasing community SUD specialty care capacity. Conclusions Efforts to integrate SUD services with primary care face significant barriers, many of which arise at the policy level and are addressable. PMID:24679108
This study aimed to analyze the social-demographic, clinical and life habits characteristics of a diabetic population being treated in the primary level of a healthcare center. A total of 52 diabetic patients, enrolled, in 2006, in a Research and Extension Center linked to a University in Sao Paulo, participated in the study. The data were collected through interviews, using appropriated forms, after the patients consent. The results showed other illness associated to diabetes and an unsatisfactory metabolic control. These data can support health professionals' actions in order to effectively prevent and manage diabetes in the basic health services. The conclusion, in face of the obtained results, is that there is the need to develop courses to the health professionals of education in diabetes, aiming to meet the complexity of the care and progression of the disease in this clientele. PMID:17934583
Otero, Liudmila Miyar; Zanetti, Maria L·cia; Teixeira, Carla Regina de Souza
NASA Astrophysics Data System (ADS)
The primary dynamics of reaction centers from Rhodobacter sphaeroides at room temperature are studied at low excitation intensities and low excitation rates. Analysis based on singular value decomposition yields three time constants in the picosecond range (ca. 1.2 ps, 3.5 ps and 220 ps). The spectral and temporal signatures are fully consistent with the step-wise electron transfer model published previously, with a first electron transfer to the bacteriochlorophyll with a time constant of 3.5 ps and a second 1.2 ps transfer to the bacteriopheophytin. No indications for adiabatic electron transfer are found in the time range >0.5 ps.
Dominguez, Pablo Nahuel; Himmelstoss, Matthias; Michelmann, Jeff; Lehner, Florian Thomas; Gardiner, Alastair T.; Cogdell, Richard J.; Zinth, Wolfgang
Nutritional status of Palestinian children attending primary health care centers in Gaza
ObjectiveĀĀTo assess the nutritional status of Palestinian children less than two years old and the associated risk factors.\\u000a \\u000a \\u000a \\u000a MethodsĀĀThe study was descriptive cross-sectional of 102 children attending the main four primary health care centers in the Gaza\\u000a Strip during summer 2003. Data were collected through medical records and meeting interviews with childrenÆs mothers by face\\u000a to face. Questionnaire was subjected
Samir Radi; Tayser Abu Mourad; Christopher Papandreou
Energy transfer and the primary charge separation process are studied as a function of excitation wavelength in membrane-bound reaction centers of Rhodobacter sphaeroides in which the excitonically coupled bacteriochlorophyll homodimer is converted to a bacteriochlorophyll-bacteriopheophytin heterodimer, denoted D [Bylina, E. J., and Youvan, D. C. (1988) Proc. Natl. Acad. Sci. U.S. A. 85, 7226]. In the HM202L heterodimer reaction center, excitation of D using 880 nm excitation light results in a 43 ps decay of the excited heterodimer, D. The decay of D results for about 30% in the formation of the charge separated state D+QA- and for about 70% in a decay directly to the ground state. Upon excitation of the monomeric bacteriochlorophylls using 798 nm excitation light, approximately 60% of the excitation energy is transferred downhill to D, forming D. Clear evidence is obtained that the other 40% of the excitations results in the formation of D+QA- via the pathway BA --> BA+HA- --> D+HA- --> D+QA-. In the membrane-bound "reversed" heterodimer reaction center HL173L, the simplest interpretation of the transient absorption spectra following B excitation is that charge separation occurs solely via the slow D-driven route. However, since a bleach at 812 nm is associated with the spectrum of D in the HL173L reaction center, it cannot be excluded that a state including BB is involved in the charge separation process in this complex. PMID:10360952
van Brederode, M E; van Stokkum, I H; Katilius, E; van Mourik, F; Jones, M R; van Grondelle, R
Calcitonin treatment for intersternocostoclavicular ossification: clinical experience in two cases
Intersternocostoclavicular ossification is a benign arthro-osteitis of the upper anterior chest of unknown cause. Two patients with acute exacerbation of this disorder were successfully treated with intramuscular injections of an eel calcitonin analogue (40 units three times a week). Besides symptomatic relief of local pain and swelling, serial scintigrams showed quantitative improvement in radiophosphonate uptake. The rapid alleviation of pain
T Misaki; S Dokoh; E Mori
FGFR3 mutation causes abnormal membranous ossification in achondroplasia.
FGFR3 gain-of-function mutations lead to both chondrodysplasias and craniosynostoses. Achondroplasia (ACH), the most frequent dwarfism, is due to an FGFR3-activating mutation which results in impaired endochondral ossification. The effects of the mutation on membranous ossification are unknown. Fgfr3(Y367C/+) mice mimicking ACH and craniofacial analysis of patients with ACH and FGFR3-related craniosynostoses provide an opportunity to address this issue. Studying the calvaria and skull base, we observed abnormal cartilage and premature fusion of the synchondroses leading to modifications of foramen magnum shape and size in Fgfr3(Y367C/+) mice, ACH and FGFR3-related craniosynostoses patients. Partial premature fusion of the coronal sutures and non-ossified gaps in frontal bones were also present in Fgfr3(Y367C/+) mice and ACH patients. Our data provide strong support that not only endochondral ossification but also membranous ossification is severely affected in ACH. Demonstration of the impact of FGFR3 mutations on craniofacial development should initiate novel pharmacological and surgical therapeutic approaches. PMID:24419316
Di Rocco, Federico; Biosse Duplan, Martin; Heuzķ, Yann; Kaci, Nabil; Komla-Ebri, Davide; Munnich, Arnold; Mugniery, Emilie; Benoist-Lasselin, Catherine; Legeai-Mallet, Laurence
The Critical Role of the Epidermal Growth Factor Receptor in Endochondral Ossification
Loss of epidermal growth factor receptor (EGFR) activity in mice alters growth plate development, impairs endochondral ossification, and retards growth. However, the detailed mechanism by which EGFR regulates endochondral bone formation is unknown. Here, we show that administration of an EGFR-specific small molecule inhibitor, gefitinib, into 1-month-old rats for 7 days produced profound defects in long bone growth plate cartilage characterized by epiphyseal growth plate thickening and massive accumulation of hypertrophic chondrocytes. Immunostaining demonstrated that growth plate chondrocytes express EGFR but endothelial cells and osteoclasts show little to no expression. Gefitinib did not alter chondrocyte proliferation or differentiation and vascular invasion into the hypertrophic cartilage. However, osteoclast recruitment and differentiation at the chondro-osseous junction was attenuated due to decreased RANKL expression in the growth plate. Moreover, gefitinib treatment inhibited the expression of matrix metalloproteinases (MMP9, 13, and 14), increased the amount of collagen fibrils, and decreased degraded extracellular matrix products in the growth plate. In vitro, the EGFR ligand TGF? strongly stimulated RANKL, MMP9 and MMP13 expression and suppressed OPG expression in primary chondrocytes. In addition, a mouse model of cartilage-specific EGFR inactivation exhibited a similar phenotype of hypertrophic cartilage enlargement. Together, our data demonstrate that EGFR signaling supports osteoclastogenesis at the chondro-osseous junction and promotes chondrogenic expression of MMPs in the growth plate. Therefore, we conclude that EGFR signaling plays an essential role in the remodeling of growth plate cartilage extracellular matrix into bone during endochondral ossification. PMID:21887704
Zhang, Xianrong; Siclari, Valerie A.; Lan, Shenghui; Zhu, Ji; Koyama, Eiki; Dupuis, Holly L.; Enomoto-Iwamoto, Motomi; Beier, Frank; Qin, Ling
Luxury Primary Care, Academic Medical Centers, and the Erosion of Science and Professional Ethics
Medical schools and teaching hospitals have been hit particularly hard by the financial crisis affecting health care in the United States. To compete financially, many academic medical centers have recruited wealthy foreign patients and established luxury primary care clinics. At these clinics, patients are offered tests supported by little evidence of their clinical and/or cost effectiveness, which erodes the scientific underpinnings of medical practice. Given widespread disparities in health, wealth, and access to care, as well as growing cynicism and dissatisfaction with medicine among trainees, the promotion by these institutions of an overt, two-tiered system of care, which exacerbates inequities and injustice, erodes professional ethics. Academic medical centers should divert their intellectual and financial resources away from luxury primary care and toward more equitable and just programs designed to promote individual, community, and global health. The public and its legislators should, in turn, provide adequate funds to enable this. Ways for academic medicine to facilitate this largesse are discussed. PMID:14748866
Donohoe, Martin
Long-term evolution of an untreated primary cutaneous follicle center lymphoma of the scalp.
Among primary cutaneous B-cell lymphomas, follicle center lymphomas represent, according to the World Health Organization-European Organisation For Research and Treatment of Cancer classification, a subgroup with a favorable prognosis. We describe the case of a 45-year-old man who presented with large infiltrated tumors and nodules coalescing into a wide ulcerated plaque of the scalp, extending from the frontal to the occipital region. At the vertex, 2 large ulcerations were present, reaching the subcutaneous tissues and the underlying bone structures with osseus infiltration and erosion and consequent meningeal exposure. A left retroauricular lymphadenopathy was also present. Histology and immunohystochemistry diagnosed a relapse of primary cutaneous follicle center lymphoma with multilobated histomorphology and lymph node involvement. The histological picture was unchanged from the first sample of 1989. Due to a refusal to treatment, the lesion progressively grew until now. After 6 courses of chemotherapy (cyclophosphamide, vincristine, liposomal doxorubicin, prednisone-Rituximab), the tumor displayed an impressive complete regression with the persistence of a 4-cm occipital ulceration and underlying bone erosion. The adenopathy disappeared as well. This case gave us the opportunity to observe the natural development of the disease, leading to local mutilating and destroying lesions but with low tendency to systemic spread and an impressive response to chemotherapy. PMID:19915449
Fierro, Maria Teresa; Marenco, Federica; Novelli, Mauro; Fava, Paolo; Quaglino, Pietro; Bernengo, Maria Grazia
Background There has been an increase the acceptability and the number of the procedures via the radial approach. We present our experience pertaining to the clinical characteristics, procedural details and post procedural outcome of patients undergoing radial artery access, coronary angiographies over a period of 4 years at a primary care tertiary level center. Materials and methods A retrospective analysis of all the coronary artery procedures during the last 4 years was done and the various parameters related to these procedures noted. Results In 4195 procedures performed, success in radial artery procedures was achieved in 3975 (94.8%) procedures. The average puncture time and total procedure time was 9.5Ā+Ā3Āmin (min) and 15Ā+Ā2.5Āmin in the initial 500 patients, whereas the times taken in the final 695 patients were just 1.5Ā+Ā0.5Āmin and 3.0Ā+Ā1.5Āmin respectively. The total fluoroscopy time was not significantly different among the groups, when performed by an operator with training in the femoral route for angiography. Cardiology fellows needed more fluoroscopy time when mastering the radial route. Crossover of access sites was seen in 220 patients (5.2%). Conclusions After 100 procedures, radial access coronary angiographies take less than 4.5Āmin, with first attempt radial artery access and negligible complication rates. Prior experience of coronary angiography helps in the reduction of fluoroscopy time during the learning curve. PMID:24814110
Gokhroo, Rajendra K.; Kaushik, Satish K.; Padmanabhan, Deepak; Bisht, Devendra; Gupta, Sajal
Skeletal development in the African elephant and ossification timing in placental mammals
We provide here unique data on elephant skeletal ontogeny. We focus on the sequence of cranial and post-cranial ossification events during growth in the African elephant (Loxodonta africana). Previous analyses on ossification sequences in mammals have focused on monotremes, marsupials, boreoeutherian and xenarthran placentals. Here, we add data on ossification sequences in an afrotherian. We use two different methods to quantify sequence heterochrony: the sequence method and event-paring/Parsimov. Compared with other placentals, elephants show late ossifications of the basicranium, manual and pedal phalanges, and early ossifications of the ischium and metacarpals. Moreover, ossification in elephants starts very early and progresses rapidly. Specifically, the elephant exhibits the same percentage of bones showing an ossification centre at the end of the first third of its gestation period as the mouse and hamster have close to birth. Elephants show a number of features of their ossification patterns that differ from those of other placental mammals. The pattern of the initiation of the ossification evident in the African elephant underscores a possible correlation between the timing of ossification onset and gestation time throughout mammals. PMID:22298853
Hautier, Lionel; Stansfield, Fiona J.; Allen, W. R. Twink; Asher, Robert J.
The purpose of this research is to measure the efficiency of training in the general principles of vaccine applications, the cold chain, and the adverse effects after vaccination for 51 employees (31 midwives and 20 nurses) working at primary health centers in Tuzla Health Group Region via test and retest method. The data collected through measurement of test scores before and after training is analyzed via multiple comparison techniques such as general test scores, the scores of each training, the scores of previously trained subjects, and difference scores. Achievement scores after training were significantly high. Previous training did not reveal significant effects on the results. Having been trained before did not cause permanent influence. PMID:21678141
Tascio?ullari, Bahar; Kiyak, Mithat; Cicek, Isik
This study compares the implementation of community-based monitoring (CBM) in 45 primary health centers (PHCs) in the pilot phase in Maharashtra with the equal number of randomly selected PHCs not implementing CBM (non-CBM) from the same districts. Information was collected by teams from Community Medicine Departments by visiting selected PHCs. Establishment of monitoring committees and training of medical officers (MOs) had been completed as required but only 36.36% MOs were trained. Only 43.18% MOs received the facility report card. Most of the MOs (90.90%) attended Jansunwai and opined that it had increased community awareness and the barriers between the people and PHC staff were broken. There was no difference in fund utilization and meetings of Rugna Kalyan Samittees. Percentage of Institutional deliveries and women receiving Janani Suraksha Yojana benefits among home deliveries was more in the non-CBM group of PHCs. PMID:24748362
Doke, Prakash Prabhakarrao; Kulkarni, Ashok Purshottamrao; Lokare, Pushpa Omprakash; Tambe, Muralidhar; Shinde, Ratnendra R; Khamgaonkar, Mohan B
Could Ossification of the Achilles Tendon Have a Hereditary Component?
Ossification of the Achilles tendon (OTA) is an unusual clinical condition. It is characterized by the presence of an ossified mass within the fibrocartilaginous substance of the Achilles tendon. The etiology of the ossification of the Achilles tendon is unknown. Review of the literature suggests that its etiology is multifactorial. The major contributing factors are trauma and surgery with other minor causes such as systemic diseases, metabolic conditions, and infections. To our knowledge, no previous reports suggest any genetic/hereditary predisposition in OAT. We report 3 siblings who have OAT with no history of any of the aforementioned predisposing factors. Could OAT have a hereditary component as one of its etiologies? PMID:23738172
Cortbaoui, Chawki
Arginine methyltransferase CARM1/PRMT4 regulates endochondral ossification
Background Chondrogenesis and subsequent endochondral ossification are processes tightly regulated by the transcription factor Sox9 (SRY-related high mobility group-Box gene 9), but molecular mechanisms underlying this activity remain unclear. Here we report that coactivator-associated arginine methyltransferase 1 (CARM1) regulates chondrocyte proliferation via arginine methylation of Sox9. Results CARM1-null mice display delayed endochondral ossification and decreased chondrocyte proliferation. Conversely, cartilage development of CARM1 transgenic mice was accelerated. CARM1 specifically methylates Sox9 at its HMG domain in vivo and in vitro. Arg-methylation of Sox9 by CARM1 disrupts interaction of Sox9 with beta-catenin, regulating Cyclin D1 expression and cell cycle progression of chondrocytes. Conclusion These results establish a role for CARM1 as an important regulator of chondrocyte proliferation during embryogenesis. PMID:19725955
Ito, Tatsuo; Yadav, Neelu; Lee, Jaeho; Furumatsu, Takayuki; Yamashita, Satoshi; Yoshida, Kenji; Taniguchi, Noboru; Hashimoto, Megumi; Tsuchiya, Megumi; Ozaki, Toshifumi; Lotz, Martin; Bedford, Mark T; Asahara, Hiroshi
Primary cutaneous follicle center lymphoma in the setting of chronic lymphocytic leukemia.
Primary cutaneous malignancies arising in association with chronic lymphocytic leukemia (CLL) are notable for their atypical clinical and histological presentation. We report a 69-year-old man with a 17-year history of CLL who presented for evaluation of a well-defined red to violaceous nodule with a central depressed scar on the left lower extremity. Microscopic examination of a punch biopsy revealed an infiltrate of predominantly small lymphocytes with scattered large, atypical epithelioid cells. Immunohistochemical stains revealed diffuse positive staining of the lesional cells with CD20+ and bcl-6+ and focal positive staining with bcl-2+ (negative CD10 and CD23), findings which, in conjunction with the histology, were most compatible with a diagnosis of primary cutaneous follicle center lymphoma (PCFCL). A review of the clinical charts revealed several prior biopsies with varied diagnoses. In light of the most recent biopsy findings, all previous biopsies were re-reviewed and interpreted as PCFCL arising in the setting of CLL. Features contributing to the diagnostic conundrum in this case included an atypical clinical and histological presentation, lack of pertinent clinical history and multiple presentations at different institutions. PMID:21508570
Konda, S; Beckford, A; Demierre, M F; Mahalingam, M
Toward a strategy of patient-centered access to primary care.
Patient-centered access (PCA) to primary care services is rapidly becoming an imperative for efficiently delivering high-quality health care to patients. To enhance their PCA-related efforts, some medical practices and health systems have begun to use various tactics, including team-based care, satellite clinics, same-day and group appointments, greater use of physician assistants and nurse practitioners, and remote access to health services. However, few organizations are addressing the PCA imperative comprehensively by integrating these various tactics to develop an overall PCA management strategy. Successful integration means taking into account the changing competitive and reimbursement landscape in primary care, conducting an evidence-based assessment of the barriers and benefits of PCA implementation, and attending to the particular needs of the institution engaged in this important effort. This article provides a blueprint for creating a multifaceted but coordinated PCA strategy-one aimed squarely at making patient access a centerpiece of how health care is delivered. The case of a Wisconsin-based health system is used as an illustrative example of how other institutions might begin to conceive their fledgling PCA strategies without proposing it as a one-size-fits-all model. PMID:25199953
Berry, Leonard L; Beckham, Dan; Dettman, Amy; Mead, Robert
Primary immunodeficiency disorders include a variety of diseases that render patients more susceptible to infections. To determine the percentage of different primary immunodeficiency disorders diagnosed in the Children's Medical Center Hospital affiliated to Tehran University of Medical Sciences in Iran, we retrospectively reviewed the charts of the patients being referred to our hospital for immunologic evaluation of recurrent infections during a 20 year period. Among these patients, antibody deficiencies were the most frequent ones and were found in 52.6% of patients (n = 130). T-cell disorders, phagocytic disorders and complement deficiencies were found to be present in 24.69% (n = 61). 22.2% (n = 55) and 0.4% (n = 1) respectively. On the whole, common variable immunodeficiency was the most frequent disorder (n = 65), followed by ataxia telangiectasia (n = 39), X-linked agammaglobulinemia (n = 33), chronic granulomatous disease (n = 29) and selective IgA deficiency (n = 20). This study reveals that antibody deficiencies are the most common type of disorders as shown in other studies. A comparative study shows some differences between our results and other registries. This article also indicates that immunodeficiency disorders should be considered in patients with recurrent infections. PMID:16261953
Farhoudi, A; Aghamohammadi, A; Moin, M; Rezaei, N; Pourpak, Z; Movahedi, M; Gharagozlou, M; Amir Tahaei, S; MirSaeid Ghazi, B; Mahmoudi, M; Kouhi, A; Atarod, L; Ahmadi Afshar, A; Bazargan, N; Isaeian, A
Giant primary cutaneous spindle cell B-cell lymphoma of follicle center cell origin.
Spindle cell B-cell lymphoma is a rare morphologic variant of B-cell lymphoma that is generally associated with follicle center cell origin. It is typically found on the skin and presents as single nodule or plaque with a diameter of several centimeters. It is also characterized by abnormal spindle cells with elongated or spindle-shaped nuclei, and usually stained positive for Bcl-6 and negative for multiple myeloma oncogene 1 (MUM-1). In this report, we describe a giant primary cutaneous spindle cell B-cell lymphoma measured 20 cm ū 25 cm, substantially larger than all the previously reported cases. Histologic examination revealed that the neoplasm was mainly located in the dermis and subcutaneous fat, and had infiltrated into striated muscles of the patient's back. The neoplasm cells contained elongated or spindle-shaped nuclei. Immunohistochemistry results demonstrated that the neoplasm cells were stained positive for CD20, CD79, and Bcl-6, negative for Bcl-2 and MUM-1, and focally positive for CD5, CD10, CD31, and CD43. These results collectively indicated that the neoplasm was of follicle center cell origin. The neoplasm was excised and the patient was still alive without systemic involvement after 4 years of follow-up. PMID:20559117
Wang, Lei; Lv, Yajie; Wang, Xiaoxia; Wei, Kaijun; Zhang, Yanguo
Heterotopic ossification after acromioplasty and distal clavicle resection.
A retrospective review of acromioplasty and distal clavicle resections disclosed 40 cases in which postoperative ectopic bone formation caused recurrent shoulder impingement or acromioclavicular joint pain. Symptomatic lesions either encroached on the supraspinatus outlet or were located in the acromioclavicular interval and were large in size. The incidence of symptomatic heterotopic ossification occurring after acromioplasty or distal clavicle excision was 3.2% and was disproportionately seen in patients with chronic pulmonary diseases (p < 0.05). Heterotopic bone formation could not be correlated with the method of bone resection and occurred after both open and arthroscopic procedures. No evidence of bone remnants or calcific deposits was seen in 17 patients in whom postoperative radiographs were taken within 8 weeks of the operation. It thus appeared that the heterotopic bone formed de novo after the procedure. Twenty patients had repeat shoulder surgery to ameliorate symptoms; four of these had a second recurrence of postoperative heterotopic bone formation. Three of the four required a third procedure and had effective prophylaxis against heterotopic ossification. It is suggested that patients at risk (e.g., with a profile of hypertrophic pulmonary osteoarthropathy or active spondylitic arthropathy) be treated with prophylaxis for heterotopic ossification after acromioplasty and distal clavicle resections. PMID:7552676
Berg, E E; Ciullo, J V
Primary central nervous system lymphoma in immunocompetent individuals: a single center experience
Primary central nervous system lymphoma (PCNSL) is defined as the involvement of brain, leptomeninges, eyes or spinal cord by non-Hodgkin lymphoma. The role of various prognostic markers in predicting adverse outcome is debated. Objectives: To investigate the clinical and immunohistochemical findings of immunocompetent PCNSL cases (39 cases) diagnosed at the study center, and evaluate the influence of potential prognostic factors on overall survival (OS) of patients. Methods: Data regarding patient characteristics, neuroimaging, pathological and immunohistochemical features and follow-up were obtained from patient records. The influence of potential prognostic parameters on OS was investigated by log-rank test and Cox regression analysis. Results: Patients who received combined chemotherapy and radiotherapy had a significantly better OS when compared to chemotherapy alone. Other variables included in this study were not associated with a significant survival advantage. Conclusion: In this study, we failed to demonstrate a relationship between different clinicopathological variables and OS of patients. Prospective studies with large patient series are needed to investigate other potential prognostic factors. PMID:23696924
Aki, Hilal; Uzunaslan, Didem; Saygin, Caner; Batur, Sebnem; Tuzuner, Nukhet; Kafadar, Ali; Ongoren, Seniz; Oz, Buge
Objective. To study life styles and dietary behaviors among Saudi preschool children (1-5 years) attending primary health care centers (PHCCs) in Dammam and Qatif areas, eastern province, Saudi Arabia. Material and Methods. Cross-sectional study. Data were collected using structured, interviewer-filled questionnaire. Children and their mothers were encountered during their well-baby clinic visits. A total number of 300 preschool children and their mothers were interviewed during study period. Results. Unsatisfactory areas include smoking fathers (32%), smoking in front of children (11.3%), overweight and obesity among mothers (60.3%), noncompliance using seat belts for both parents (56.3%) and children (68%), children watching television (T.V) more than 2 hours (50%), adherence to exclusive breast feeding (only 20.7%), and late solid food introduction (65.3%). Frequent intake of unhealthy food items was 26%, 25%, and 24% for pizza, burger, and soft drinks. Unfortunately frequent intake of the following unhealthy food items was high: biscuits, deserts/chocolates, and chips which was 78%, 67%, and 72%, respectively. Conclusion. This study provides benchmark about the current situation. It provides health care workers and decision makers with important information that may help to improve health services. PMID:25114804
Darwish, Magdy A; Al-Saif, Ghadeer; Albahrani, Suha; Sabra, Amr A
Asthma is a common chronic disease. Due to difficulties in accessibility to the health care system, asthma affects severely to minorities. This study's objective is to describe the morbidity of asthma on a poor population and its modification after abolishing assistance barriers.Thirty-four asthma camps were carried out between May 2004 and May 2007. Patients' socioeconomic conditions, asthma history, and symptoms in the last month were determined during the camps. Patients received free medication and were invited to come to follow-up. Fifty-six children younger than 12 years old and 53 adults with persistent asthma were evaluated in 783 visits. The mean monthly income per capita was US $28.57.At baseline, 50% of children and 34.5% of adults received inhaled corticosteroids. After intervention, 92.7% children and 98.1% adults received inhaled corticosteroids. Treatment was associated with a significant reduction of daytime and nighttime symptoms, absences to school or work, and emergency room visits and admissions. Patients referred less interference and more control of their disease in their everyday life.Our results suggest that this population receives an insufficient treatment of its asthma severity. For such population, moving specialized assistance to the primary health care center resulted in a better control of their illness. PMID:23282848
Malbrßn, Eloisa; Rey, Graciela Laura; Malbrßn, Alejandro
Objective. To study life styles and dietary behaviors among Saudi preschool children (1¢5 years) attending primary health care centers (PHCCs) in Dammam and Qatif areas, eastern province, Saudi Arabia. Material and Methods. Cross-sectional study. Data were collected using structured, interviewer-filled questionnaire. Children and their mothers were encountered during their well-baby clinic visits. A total number of 300 preschool children and their mothers were interviewed during study period. Results. Unsatisfactory areas include smoking fathers (32%), smoking in front of children (11.3%), overweight and obesity among mothers (60.3%), noncompliance using seat belts for both parents (56.3%) and children (68%), children watching television (T.V) more than 2 hours (50%), adherence to exclusive breast feeding (only 20.7%), and late solid food introduction (65.3%). Frequent intake of unhealthy food items was 26%, 25%, and 24% for pizza, burger, and soft drinks. Unfortunately frequent intake of the following unhealthy food items was high: biscuits, deserts/chocolates, and chips which was 78%, 67%, and 72%, respectively. Conclusion. This study provides benchmark about the current situation. It provides health care workers and decision makers with important information that may help to improve health services. PMID:25114804
Darwish, Magdy A.; Al-Saif, Ghadeer; Albahrani, Suha; Sabra, Amr A.
IntroductionTo increase access to safe abortion in rural India, the feasibility and acceptability of mifepristone¢misoprostol abortion was assessed in a typical government run primary health center (PHC) in Nagpur district, Maharashtra State, that does not offer surgical abortion services and must refer off-site for emergency and backup services.
Shuchita Mundle; Batya Elul; Abhijeet Anand; Shveta Kalyanwala; Suresh Ughade
Primary antibody deficiencies (PADs) are a heterogeneous group of disorders, characterized by hypogammaglobulinemia and increased susceptibility to bacterial infections, leading to hospitalizations. This study was performed to determine the main infectious causes of hospital admissions in selective Iranian patients with PADs. Forty patients with PADs, who were admitted to the Infectious Ward of Children's Medical Center Hospital during a 14-year
Setareh Mamishi; Aiden Nasiri Eghbali; Nima Rezaei; Hassan Abolhassani; Nima Parvaneh; Asghar Aghamohammadi
ERIC Educational Resources Information Center
Childhood sexual abuse (CSA) is prevalent among women. Person-centered counseling (PCC) is an effective core therapeutic approach to use when treating women with this issue. This article provides (a) an overview of CSA, (b) an orientation to PCC, and (c) a case example illustrating the primary application of this approach.
Edwards, Nivischi N.; Lambie, Glenn W.
The objective of this study is to investigate the prevalence of abuse and neglect of the elderly aged 65 years and older, living with their relative in a primary health care center area and affecting factors. A descriptive study included 331 people aged 65 years. The most frequent type of abuse was psychological abuse and the least frequent was sexual
Aygul Kissal; Ay?e Be?er
Cross-sectional descriptive and correlation research, whose general objective was to find out about the perception of the violence phenomena in a primary health care center, in a district of the VIII Region in Chile, from the perspective of different categories of health employees. The universe were 62 workers. Data were collected through the questionnaire of Paravic et al., that was
TATIANA PARAVIC KLIJN; SANDRA VALENZUELA SUAZO; MėNICA BURGOS MORENO
The prevalence of cardiovascular diseases (CVD) has increased sharply in the developing countries and because Type 2 diabetic patients are at increased risk for CVD, we assessed CVD risk factors in newly diagnosed Type 2 diabetic patients presenting in a primary health care center in Trinidad. Fasting and 2 h postprandial blood samples were collected from 387 (269 females, 118
C. E. Ezenwaka; G. Davis
Objective: To identify the morbidity pattern according to age, gender and seasonal variation using the ICD cod- ing and the utilization of Primary Health Care (PHC) center services in a demographically defined community. Methods: The data collected from 2001-2003 was analyzed using the International Classification of Diseases - 10 (ICD-10) coding for identifying the morbidity patterns presenting at the PHC
Qudsia Anjum; Ejaz Alam; Raza Rizvi; Jawed Usman; Shazia Shaikh; Yousuf Ahmed
Contribution to the study of the development and ossification of human sternum.
We have studied the development of sternum in man. Complete microscopic series of sections through thorax of human embryos and fetuses from the second and third months of gestation served as the research material. Preparations were stained by Alcian blue and Mayer's haematoxyline, counterstained by eosine. We also had a set of macroscopic preparations of sterna and adjacent parts of ribs from fetuses of the fifth and sixth months of gestation. These specimens were stained by Alcian blue and by Alizarine and subsequently cleared by glycerine method. We have found that sternum develops by a fusion of sternal bars. Sternal bars develop from anterior bent parts of ribs, lying one over another like tiles. The newly formed sternum has different proportions in comparison to its definitive state. In all the cases its manubrium is wider and bigger, its xiphoid process is longer, in almost all the cases doubled or at least bifurcated. The sternocostal junctions are provided with interzones with the exception of the first rib. Its primordium continues into sternum without any border. Clavicle is connected with sternal anlage without any visible border and this interzone quickly develops as the primordia of the sternoclavicular articulation and the disc. In the medial part, there is a cartilaginous model which ossifies very early--as the first bone of the body. In young embryos from the end of the second month of gestation the clavicle and sternum show very different structures. Ossification of the sternum begins in the fifth month by developing a large number of very small centers of ossification which are not yet detectable by X-ray or CT.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7949403
Doskocil, M
Conserved relative timing of cranial ossification patterns in early mammalian evolution
SUMMARY We analyzed a comprehensive data set of ossification sequences including seven marsupial, 13 placental and seven sauropsid species. Data are provided for the first time for two major mammalian clades, Chiroptera and Soricidae, and for two rodent species; the published sequences of three species were improved with additional sampling. The relative timing of the onset of ossification in 17
Marcelo R. Sßnchez-Villagra; Anjali Goswami; Vera Weisbecker; Orin Mock; Shigeru Kuratanie
Neurogenic heterotopic ossification after a stroke: diagnostic and radiological challenges.
Heterotopic ossification (HO) is the aberrant formation of ectopic bone within the soft tissues, of which the aetiology is usually either traumatic or neurogenic. Neurogenic HO is a known but uncommon complication that occurs after a cerebral or spinal insult. The condition may present with a spectrum of symptoms and is often difficult to diagnose clinically. Although different imaging modalities have been used to diagnose HO, clinicians and radiologists may occasionally encounter radiological features of HO that may mimic other disease conditions. We herein report a rare case of neurogenic HO occurring in the non-paretic limb of a patient, and the diagnostic and radiological challenges encountered. PMID:25189310
Pek, C H; Lim, M C; Yong, R; Wong, H P
Background Hospital certification and recognition programs represent 2 independent but commonly used systems to distinguish hospitals, yet they have not been directly compared. This study assessed acute ischemic stroke quality of care measure conformity by hospitals receiving Primary Stroke Center (PSC) certification and those receiving the American Heart Association's Get With The Guidelines?Stroke (GWTG?Stroke) Performance Achievement Award (PAA) recognition. Methods and Results The patient and hospital characteristics as well as performance/quality measures for acute ischemic stroke from 1356 hospitals participating in the GWTG?Stroke Program 2010¢2012 were compared. Hospitals were classified as PAA+/PSC+ (hospitals n=410, patients n=169 302), PAA+/PSC? (n=415, n=129 454), PAA?/PSC+ (n=88, n=26 386), and PAA?/PSC? (n=443, n=75 565). A comprehensive set of stroke measures were compared with adjustment for patient and hospital characteristics. Patient characteristics were similar by PAA and PSC status but PAA?/PSC? hospitals were more likely to be smaller and nonteaching. Measure conformity was highest for PAA+/PSC+ and PAA+/PSC? hospitals, intermediate for PAA?/PSC+ hospitals, and lowest for PAA?/PSC? hospitals (all?or?none care measure 91.2%, 91.2%, 84.3%, and 76.9%, respectively). After adjustment for patient and hospital characteristics, PAA+/PSC+, PAA+/PSC?, and PAA?/PSC+ hospitals had 3.15 (95% CIs 2.86 to 3.47); 3.23 (2.93 to 3.56) and 1.72 (1.47 to 2.00), higher odds for providing all indicated stroke performance measures to patients compared with PAA?/PSC? hospitals. Conclusions While both PSC certification and GWTG?Stroke PAA recognition identified hospitals providing higher conformity with care measures for patients hospitalized with acute ischemic stroke, PAA recognition was a more robust identifier of hospitals with better performance. PMID:24125846
Fonarow, Gregg C.; Liang, Li; Smith, Eric E.; Reeves, Mathew J.; Saver, Jeffrey L.; Xian, Ying; Hernandez, Adrian F.; Peterson, Eric D.; Schwamm, Lee H.
Primary health care ideology is considered from the vantage point of health center field staff in South India and Sri Lanka. It is argued that professional and organizational role conflicts are fostered by primary health care inspired programs introduced without regard to the status and motivations of existing cadres of staff. Attention is focused on the health center as a
Mark A. Nichter
Objectives: The objective of this study was to evaluate the use of antibiotics in treating upper respiratory tract infections (URTIs) in primary health centers in Kuwait and investigate the extent to which antibiotic use follows international guidelines. SubjectsandMethods: A nationwide cross-sectional study was conducted with a sample size of 615 patients selected by using a multi-stage cluster sampling method. Of
Salem Ayyad; Abdullah Al-Owaisheer; Faisal Al-Banwan; Abdullah Al-Mejalli; Mumtaz Shukkur; Lukman Thalib
A sample of 852 Saudi women who attended the primary health care centers in Jeddah seeking medical care were examined. Obesity was defined as a value for the body mass index (kg\\/m2) ? 25.0. The prevalence of obesity in the examined sample was high (64.3%). Obesity was significantly related to age, marital status, parity, level of education, level of work,
Rufaida H. Khashoggi; Khalid A. Madani; Hassan I. Ghaznawy; Majdi A. Ali
The objective of this study was to assess the accuracy of x-ray film interpretation by nonradiologist physicians. This was a cross-sectional study based on data collected using a structured check-list from a sample of 863 x-ray films requested and interpreted by physicians working in the outpatient departments of Dammam Central Hospital, and in five primary health care centers in Dammam
Mohammed O. Basulaiman; Ahmed G. Elzubier
BACKGROUND: Safety and effectiveness of efficacious antiretroviral (ARV) regimens beyond single-dose nevirapine (sdNVP) for prevention of mother-to-child transmission (PMTCT) have been demonstrated in well-controlled clinical studies or in secondary- and tertiary-level facilities in developing countries. This paper reports on implementation of and factors associated with efficacious ARV regimens among HIV-positive pregnant women attending antenatal clinics in primary health centers (PHCs)
Justin Mandala; Kwasi Torpey; Prisca Kasonde; Mushota Kabaso; Rebecca Dirks; Chiho Suzuki; Catherine Thompson; Gloria Sangiwa; Ya Mukadi
mission-driven programs and innovative work with the primary care practices throughout the Massachusetts General Hospital (MGH) community. Education Stoeckle Center Seminars Primary care physicians (PCPs and improvements within primary care, and to educate providers about new methods and techniques to improve
Mootha, Vamsi K.
Integrating Education into Primary Care Quality and Cost Improvement at an Academic Medical Center
ERIC Educational Resources Information Center
Introduction: In 1996 the University of Michigan Health System created the Guidelines Utilization, Implementation, Development, and Evaluation Studies (GUIDES) unit to improve the quality and cost-effectiveness of primary care for common medical problems. GUIDES's primary functions are to oversee the development of evidence-based, practicalģ
Harrison, R. Van; Standiford, Connie J.; Green, Lee A.; Bernstein, Steven J.
Opinion of patients on accessibility of primary health care centers in Siauliai region
This article presents the data about the accessibility of primary health care in Siauliai region and about factors related to the patientsÆ perceived access to primary care. The survey was carried out in June 2004, in the context of a joint project of Kaunas University of Medicine and NIVEL, the Netherlands Institute of Health services research. Patients, treated in private
Z. Milasauskiene; I. Juodryte; I. Miseviciene; W. Boerma; R. Rezgiene
Background Heterotopic ossification (HO) is a rare and potentially detrimental complication of soft-tissue trauma, amputations, central nervous system injury (traumatic brain injuries, spinal cord lesions, tumors, encephalitis), vasculopathies, arthroplasties and burn injury, characterized by lamellar bone growth in non-osseous tissues such as the muscle and the joint capsule. Heterotopic ossification associated with encephalitis is rare and the occurrence of excessive, symptomatic heterotopic ossification around bilateral hips and bilateral knees is rarely described in the literature. Case presentation We present a 47-year-old man with heterotopic ossification in the bilateral hips and bilateral knees that prevented him from walking after being attacked by encephalitis as the case study. He developed severe pain and significantly impaired range of motion of bilateral hips and bilateral knees. Research so far revealed that the management of heterotopic ossification is controversial. After requiring revision surgery resection of heterotopic ossification, reconstruction of the medial collateral ligament and adjunctive pharmacotherapy of 200Āmg Celecoxib for 8Āweeks after operation, he regained mobility of his joints. On review of X-ray, there was no recurrence of HO and no loosening of rivets which were used in the reconstruction of medial collateral ligament. Conclusion Heterotopic ossification in the bilateral hip joints and bilateral knee joints associated with encephalitis have never been reported previously. Daily functions of heterotopic ossification patients can be hampered by pain, inflammation, reduced mobility, the loss of normal posture and other complications. Further studies of presumptive root causes, the early diagnosis, preventability and optimal therapeutic measures for heterotopic ossification following encephalitis are required. Different patient should be managed with different appropriated protocol based on the risk of individual patient and the institutional experience. PMID:25280472
Measuring and Improving Preventive Care for Patients With Diabetes in Primary Health Centers
Diabetes care among medically underserved patients is suboptimal. Few studies, however, have described successful strategies to improve diabetes care in these patient populations. To address this issue, 4 Montana community health centers and 1 urban Indian health center implemented quality improvement efforts along with an office-based electronic system for monitoring diabetes care. After a median of 17 months follow-up, preventive
Todd S. Harwell; Janet M. McDowall; Dorothy Gohdes; Steven D. Helgerson
Primary percutaneous coronary intervention (PPCI) is the preferred method of reperfusion for ST-segment elevation myocardial infarction (STEMI), if it can be performed in a timely manner by an experienced interventional cardiologist at a high volume STEMI Receiving Center. However, an estimated 50% of STEMI patients present to STEMI Referral Centers without PPCI capability. Transfer of STEMI patients for PPCI has been shown to improve outcomes as compared with fibrinolysis given at the presenting hospital. Nonetheless, transfer of STEMI patients for PPCI has not been used extensively in the United States and is associated with markedly prolonged transfer times. This study demonstrates that rapid transfer of STEMI patients from community hospitals without PPCI capability to a STEMI Receiving Center is both safe and feasible using a standardized protocol with an integrated transfer system. PMID:20802263
Baruch, Terrence; Rock, Alisa; Koenig, William J; Rokos, Ivan; French, William J
Ossification in the cephalic attachment of the ligamentum flavum: an anatomical and CT study
A review of 50 anatomical specimens and 100 routine CT scans of the chest and abdomen demonstrated that ossification in the cephalic attachment of the ligamentum flavum is a common anatomical finding, but not as common on CT. Examination of hospital charts and plain radiographs of 26 patients with such ossification suggests that it is probably a normal variant; there was no evidence that it is related to diffuse idiopathic skeletal hyperostosis (DISH) or inflammatory arthropathy. Marked ossification may cause or contribute to neurological symptoms.
Williams, D.M.; Gabrielsen, T.O.; Latack, J.T.; Martel, W.; Knake, J.E.
Intra-abdominal heterotopic ossification of the peritoneum following traumatic splenic rupture
Intra-abdominal heterotopic ossification is extremely rare with only approximately 30 cases having been reported. While most reported cases have involved the mesentery, ossification of the peritoneum is even rarer. The pathogenesis remains undetermined but is generally considered a reactive process in response to various stimuli. Histologically, it is composed of a peripheral area with bone formation and a central area of reactive hypercellular fibrous tissue. We report a rare case of intra-abdominal heterotopic ossification of the parietal peritoneum following traumatic splenic rupture. PMID:23248662
Ioannidis, Orestis; Sekouli, Argiro; Paraskevas, George; Kotronis, Anastasios; Chatzopoulos, Stavros; Papadimitriou, Nikolaos; Konstantara, Athina; Makrantonakis, Apostolos; Kakoutis, Emmanouil
Chondrogenesis and ossification of the lissamphibian pectoral girdle.
Knowledge of amphibian shoulder development is requisite for further understanding of gnathostome pectoral girdle evolution. Fish and amniotes share few pectoral girdle elements, but modern amphibians exhibit a unique combination of traits that bridge the morphological gap between these two groups. I analyzed patterns of chondrogenesis, ossification, and bone histology of the pectoral girdles of two anuran species (Xenopus laevis and Bombina orientalis) and two urodele species (Ambystoma mexicanum and Desmognathus aeneus) to provide new insight into the evolution of the tetrapod pectoral girdle. Comparisons reveal the following: 1) variation in the pattern of chondrogenesis among the anuran species analyzed correlates to variation in adult pectoral girdle morphology; 2) morphologically similar pectoral skeletons do not necessarily have similar patterns of bone histology; and 3) the urodele and anuran pectoral girdles included herein share a common morphology despite differences in patterns of chondrogenesis. PMID:17999401
Shearman, Rebecca M
Thoracic radiculopathy caused by ossification of the ligamentum flavum
Thoracic ossification of the ligamentum flavum (OLF) has been widely recognized as a main cause of thoracic myelopathy in Asia, particularly in Japan. However, thoracic OLF rarely causes radiculopathy. We report a rare case of thoracic radiculopathy caused by OLF. A 67-year-old male presented with a chief complaint of back pain radiating to the right of the abdomen. Neurological examination revealed mild sensory deficit at the right side of the abdomen at the T9¢10 level. Magnetic resonance imaging and computed tomography demonstrated OLF at the right T9¢10 level. Thoracic radiculopathy caused by OLF was suspected. Because conservative treatment was not effective to this lesion, surgical intervention was performed, and the pain disappeared immediately after the operation. Thoracic OLF rarely causes radiculopathy, but it should be considered as a differential diagnosis of thoracic radicular pain. When conservative treatment is not effective in this lesion, surgical treatment should be considered. PMID:23163624
Yabe, Yutaka; Honda, Masahito; Tohjo, Yuuichi; Nakajima, Souichi; Ando, Akira; Sonofuchi, Kazuaki; Itoi, Eiji
Family-centered Care Delivery: Comparing Models of Primary Care Service Delivery in Ontario .
??Family-centered care (FCC) focuses on considering the family in planning/implementing care and is associated with increased patient satisfaction. Little is known about factors that influenceģ (more)
Mayo-Bruinsma, Liesha
Primary and metastatic cardiac sarcomas: a 12-year experience at a German heart center
Background: Primary and metastatic cardiac sarcomas represent a heterogeneous group of rare neoplasms with varying clinical course and diverse histogenetic line of differentiation. To date, there exist no uniform guidelines for their surgical and/or oncological treatment. Methods: We evaluated retrospectively all patients undergoing cardiac surgery for primary or secondary cardiac sarcoma in the period 1999-2011 at the Erlangen Heart Centre to analyze their clinicopathological spectrum, treatment and outcome. Results: Five patients (3 women & 2 men; mean age: 46 years; range: 28-81 years) had primary cardiac sarcomas (6.7% of primary cardiac tumors) and 4 had cardiac metastasis from soft tissue sarcoma (1 case each of osteosarcoma, myxoid liposarcoma, alveolar soft part sarcoma and pleomorphic spindle cell sarcoma). Primary sarcomas were located in the left atrium (n=3), left ventricle (n=1) and right atrium (n=1). Histological types were myxosarcoma (3), pleomorphic undifferentiated sarcoma (1) and angiosarcoma (1). Four patients died at 2-64 months (mean, 24.5 months). Sarcoma metastasis to the heart developed at a mean of 109.5 months from initial diagnosis (range, 5-240 months). Three of them died of disease at a mean of 14 months after cardiac surgery and one is disease free 34 months after heart transplantation for metastasis. Conclusions: Primary and metastatic cardiac sarcomas are very heterogeneous in their histological appearance, clinical presentation and course of the disease. Radical surgery combined with chemoradiation is promising in patients with resectable disease and may significantly prolong survival. Cardiac transplantation represents an emerging strategy for patients with isolated unresectable cardiac involvement. PMID:23119110
Agaimy, Abbas; Rosch, Johannes; Weyand, Michael; Strecker, Thomas
Diffuse idiopathic skeletal hyperostosis (DISH) is a systemic condition leading to ossification of spinal ligaments and has\\u000a been shown to behave similarly to ankylosing spondylitis (AS) often leading to unstable hyperextension fractures. Currently,\\u000a no quantitative data are available on the spatial relationship between the bridging anterolateral ossification mass (ALOM)\\u000a and the vertebral body\\/intervertebral disc to explain the propensity in DISH
J. J. VerlaanL; L. A. Westerveld; J. W. van Keulen; R. L. A. W. Bleys; W. J. Dhert; J. A. van Herwaarden; F. L. Moll; F. C. Oner
Due to the requirement to minimise exposure to radiation, it is desirable to develop non-ionising imaging procedures for the\\u000a analysis of skeletal maturation for forensic age diagnostics in living individuals. The present pilot study analyses the applicability\\u000a of ultrasound examinations for the evaluation of apophyseal ossification of the iliac crest. With reference to the sonographic\\u000a staging of clavicular ossification, the
Sven Schmidt; Andreas Schmeling; Per Zwiesigk; Heidi Pfeiffer; Ronald Schulz
A case of heterotopic ossification (myositis ossificans) secondary to the central nervous system complications of acquired immune deficiency syndrome (AIDS) is reported. Because of the overwhelming suspicion of infection in this patient, this diagnosis was not considered until a gallium scan revealed the typical findings of heterotopic ossification. Because of the increasing utilization of gallium imaging in the AIDS population, every imaging specialist should be aware of this potential disorder.
Drane, W.E.; Tipler, B.M.
In the World Health Organization (WHO) 2008 classification 2 main types of primary cutaneous large B-cell lymphomas (PCLBCLs) are distinguished: primary cutaneous follicle center lymphoma (PCFCL) and primary cutaneous large B-cell lymphoma, leg type (PCBCL-LT). PCFCL has a 5-year overall survival rate of 95%, and PCBCL-LT of approximately 50%. Expression profiling studies have shown higher RNA expression of the IgM heavy chain in PCBCL-LT compared with PCFCL. To find out whether this difference could also be demonstrated at the protein level, we performed immunohistochemical staining for B-cell receptor heavy and light chains on skin biopsies from 53 patients with PCFCL and 40 patients with PCBCL-LT. All 40 cases of PCBCL-LT consistently showed cytoplasmic staining for IgM, in 18 of them with coexpression of IgD. In contrast, only 5 of the PCFCL cases showed cytoplasmic staining for IgM and/or IgD, including all 3 PCFCLs presenting on the leg. Hence, staining for IgM on paraffin-embedded sections seems to be an additional tool for differentiating between the 2 entities in clinical pathology practice. Analogous to other nodal and extranodal large B-cell lymphomas, expression of IgM in PCLBCL seems to be related to an activated B cell-like phenotype. Finally, the expression of IgM (and IgD) in this type of lymphoma might imply defective class switch recombination. PMID:20551823
Koens, Lianne; Vermeer, Maarten H; Willemze, Rein; Jansen, Patty M
The ossification of the pectoral girdle and wing skeleton of the quail (Coturnix coturnix japonica).
The onset of ossification centres of the pectoral girdle and wing skeleton of the quail (Coturnix coturnix japonica) has been studied in embryos and juvenile birds, which were sampled daily from the 4th day of incubation up to the 12th day after hatching. Specimens, which were cleared and were stained with Alcian Blue and Alizarin Red S, were examined at the stereomicroscope. The furcula ossified with intramembranous ossification at the 7th day of incubation. The first centres of perichondral ossification in the scapula and the coracoid bones were observed at the 7th day of incubation. In the humerus, radius and ulna, perichondral ossification was observed at the 6th day of incubation. The carpal bones were ossified between the 8th and 10th day of the post-hatching period. The 2nd metacarpal bone began to ossify at the 6th day of the post-hatching period, whereas the 3rd and 4th metacarpal bones were ossified at the 7th day of incubation. At the 9th day of incubation, ossification was observed in the 1st phalanx of the alular digit and in the phalanges of the major digit. The 2nd phalanx of the alular digit began to ossify at the 12th, whereas the phalanx of the minor digit at the 14th day of incubation. The data presented here provide useful baseline information on the normal sequential pattern of ossification in the pectoral girdle and wing skeleton in this species. PMID:21392085
Pourlis, A F; Antonopoulos, J
The ability to interpret experimental data is essential to understanding and participating in the process of scientific discovery. Reading primary research articles can be a frustrating experience for undergraduate biology students because they have very little experience interpreting data. To enhance their data interpretation skills, students used a template called ōFigure Factsö to assist them with primary literature¢based reading assignments in an advanced cellular neuroscience course. The Figure Facts template encourages students to adopt a data-centric approach, rather than a text-based approach, to understand research articles. Specifically, Figure Facts requires students to focus on the experimental data presented in each figure and identify specific conclusions that may be drawn from those results. Students who used Figure Facts for one semester increased the amount of time they spent examining figures in a primary research article, and regular exposure to primary literature was associated with improved student performance on a data interpretation skills test. Students reported decreased frustration associated with interpreting data figures, and their opinions of the Figure Facts template were overwhelmingly positive. In this paper, we present Figure Facts for others to adopt and adapt, with reflection on its implementation and effectiveness in improving undergraduate science education. PMID:23463227
Round, Jennifer E.; Campbell, A. Malcolm
Primary Stenting of Subclavian and Innominate Artery Occlusive Disease: A Single Center's Experience
Purpose: To review immediate and midterm results of primary stenting for innominate and subclavian artery occlusive lesions. Methods: Retrospective data were collected from 48 consecutive symptomatic patients (27 men and 21 women, median age 64 years) having 49 subclavian and innominate artery lesions treated with stenting. Of the patients 52% had concomitant ischemic heart disease, and 30% had carotid and\\/or
E. N. Brountzos; B. Petersen; C. Binkert; I. Panagiotou; J. A. Kaufman
The John D. Stoeckle Center for Primary Care Innovation Massachusetts General Hospital
personal doctor," or "My children's pediatrician said they need to exercise more," do you know what kind, general internist, pediatrician, or medicine-pediatrics doctor to be their primary care physician. Nurse get their vaccinations, treating sore throats and bladder infections, and doing school and annual
Mootha, Vamsi K.
Talking about the pain: A patient-centered study of low back pain in primary care
Despite considerable research, low back pain (LBP) often proves resistant to treatment. This study was designed to increase the understanding of low back pain through access to patients' perceptions, beliefs, illness behaviors and lived experiences. The findings are based on focus groups, individual interviews and participant observation conducted in primary care practices and community settings in three regions in Israel.
Jeffrey Borkan; Shmuel Reis; Doron Hermoni; Aya Biderman
in the role of the solvent, e.g. water, in promoting acid dissociation and in the hydrogen┬Łbond (HB) rearrangements which accompany it. Strong acids dissociate in water much too fast. Hence mixing cannot servePrimary events in photoacid dissociation Noam Agmon Department of Physical Chemistry and the Fritz
Agmon, Noam
Introduction: Assessment of patient satisfaction is a way to determine the quality of primary care. The outcomes of consultations include patient satisfaction, recall of the phy- sician's explanations and changes in the patients' concern about their symptoms. The aim of this study was to study the quality of consul- tation regarding its duration and outcomes in terms of enablement (satisfaction).
Mansoura Fawaz; S. Ismail
Structure and outcome evaluation of three primary health care centers in riyadh
Primary Health Care (PHC) is a relatively new concept in the health field. Its objective is to deliver integrated health services (curative and preventative). The Alma-Ata conference in 1978 urged countries to adopt the PHC approach to promote the health of all the people. Despite this world-wide acceptance of PHC, there is an observation that its impact is still relatively
Ahlam A. Mansour; Muneera H. Al-Osimy
A multicenter study of data collection and communication at primary health care centers
Health care delivery is information intensive. As computer applications make information available to the decision maker with speed and accuracy, informatics applications will strengthen the infrastructure. This paper is the second part of a multicenter systems analysis study to design a common application software to support primary health care focused on information flow. We present the questionnaire analysis and observations
K. Moidu; O. Wigertz; E. Trell
Clinical documentation and health information portability pose unique challenges in urban and rural areas of India. This article presents findings of a pilot study conducted in a primary health center in rural India. In this article, we focus on primary care in rural India and how a portable health record system could facilitate the availability of medical information at the point of care. We followed a geriatric cohort and a maternal cohort of 308 participants over a nine-month period. Physician encounters were entered into a web-based electronic health record. This information was made available to all study participants through a short messaging service (SMS). Additionally, 135 randomly selected participants from the cohort were issued a USB-based memory card that contained their detailed health records and could be viewed on most computers. The dual portability model implemented in the pilot study demonstrates the utility of the concept. PMID:25214819
Radhakrishna, Kedar; Goud, B. Ramakrishna; Kasthuri, Arvind; Waghmare, Abijeet; Raj, Tony
Primary cutaneous follicle center lymphoma (pcFCL) is an indolent type of primary cutaneous B-cell lymphoma (pcBCL) rarely disseminating to other organs. PcBCL with spindle-cell morphology has been described as a rare variant of pcFCL but the prognosis data of this variant is sparse. We report a rare case of spindle-cell pcFCL with CD20(+), CD79a(+), CD3(+), Bcl-6(+), Mum-1(-) and CD10(-) tumor cells that infiltrated the hepatic hilum, mimicking a Klatskin tumor. On the basis of the sparse published data on spindle-cell morphology of pcBCL, this growth pattern should elicit awareness of an increased risk of systemic involvement in the otherwise indolent pcFCL. PMID:23167279
Rozati, Sima; Kerl, Katrin; Kempf, Werner; Tinguely, Marianne; Zimmermann, Dieter R; Dummer, Reinhard; Cozzio, Antonio
Eleven Years of Primary Health Care Delivery in an Academic Nursing Center.
ERIC Educational Resources Information Center
Client visits to an academic community nursing center (n=25,495) were coded and analyzed. Results show expansion of nursing practice and services, strong case management, and management of illness care. The usefulness of computerized clinical documentation system and of the Lundeen conceptional model of community nursing care was demonstrated.ģ
Hildebrandt, Eugenie; Baisch, Mary Jo; Lundeen, Sally P.; Bell-Calvin, Jean; Kelber, Sheryl
One hundred Finnhorse cadaver front feet were measured and examined both radiographically and visually to report the incidence of various foot problems and their relationship to ossification of the cartilages of the foot. Ossification extending above the proximal border of the navicular bone and/or separate centres of ossification were found in 36 feet, and the lateral cartilages showed more ossification than the medial cartilages. The feet were generally broad with well developed frogs, but the long toe-low heel syndrome was a relatively common finding. Ossification of the cartilages correlated with the length of the heels but was not related to any clinically significant foot abnormalities such as contracted or under-run heels or signs of unequal weightbearing. Ossification of the cartilages did not seem to be either the cause or the result of general conformational adaptations of the front feet. PMID:9031863
Ruohoniemi, M; Raekallio, M; Tulamo, R M; Salonius, K
Spongiosa primary development: a biochemical hypothesis by Turing patterns formations.
We propose a biochemical model describing the formation of primary spongiosa architecture through a bioregulatory model by metalloproteinase 13 (MMP13) and vascular endothelial growth factor (VEGF). It is assumed that MMP13 regulates cartilage degradation and the VEGF allows vascularization and advances in the ossification front through the presence of osteoblasts. The coupling of this set of molecules is represented by reaction-diffusion equations with parameters in the Turing space, creating a stable spatiotemporal pattern that leads to the formation of the trabeculae present in the spongy tissue. Experimental evidence has shown that the MMP13 regulates VEGF formation, and it is assumed that VEGF negatively regulates MMP13 formation. Thus, the patterns obtained by ossification may represent the primary spongiosa formation during endochondral ossification. Moreover, for the numerical solution, we used the finite element method with the Newton-Raphson method to approximate partial differential nonlinear equations. Ossification patterns obtained may represent the primary spongiosa formation during endochondral ossification. PMID:23193429
L¾pez-Vaca, Oscar Rodrigo; Garz¾n-Alvarado, Diego Alexander
Although evidence of effectiveness is limited, care management based outside primary care practices or hospitals is receiving increased attention. The University of Michigan (UM) Complex Care Management Program (CCMP) provides care management for uninsured and underinsured, high-utilizing patients in multiple primary care practices. To inform development of optimal care management models, we describe the CCMP model and characteristics and health care utilization patterns of its patients. Of a consecutive series of 49 patients enrolled at CCMP in 2011, the mean (SD) age was 48 (+/- 14); 23 (47%) were women; and 29 (59%) were White. Twenty-eight (57%) had two or more chronic medical conditions, 39 (80%) had one or more psychiatric condition, 28 (57%) had a substance abuse disorder, and 11 (22%) were homeless. Through phone, e-mail, and face-to-face contact with patients and primary care providers (PCPs), care managers coordinated health and social services and facilitated access to medical and mental health care. Patients had a mean (SD) number of hospitalizations and emergency room (ER) visits in 6 months prior to enrollment of2.2 (2.5) and 4.2 (4.3), respectively, with a nonstatistically significant decrease in hospitalizations, hospital days, and emergency room visits in 6 months following enrollment in CCMP. Centralized care management support for primary care practices engages high-utilizing patients with complex medical and behavioral conditions in care management that would be difficult to provide through individual practices and may decrease health care utilization by these patients. PMID:24761538
Williams, Brent C; Paik, Jamie L; Haley, Laura L; Grammatico, Gina M
Solid Waste Processing Center Primary Opening Cells Systems, Equipment and Tools
This document addresses the remote systems and design integration aspects of the development of the Solid Waste Processing Center (SWPC), a facility to remotely open, sort, size reduce, and repackage mixed low-level waste (MLLW) and transuranic (TRU)/TRU mixed waste that is either contact-handled (CH) waste in large containers or remote-handled (RH) waste in various-sized packages.
Bailey, Sharon A.; Baker, Carl P.; Mullen, O Dennis; Valdez, Patrick LJ
OBJECTIVE: The efficacy for primary orthotopic liver transplantation of a new immunosuppressive agent, FK 506 (tacrolimus, Prograf, Fujisawa USA, Deerfield, IL), was determined. SUMMARY BACKGROUND DATA: After 3 years of preclinical research, a clinical trial of FK 506 for orthotopic liver transplantation was begun in February 1989, first as a rescue therapy for patients with intractable rejection with conventional immunosuppression, then as a primary drug. METHODS: Between August 1989 and December 1993, 1391 recipients (1188 adult and 203 pediatric) of primary liver allografts were treated with FK 506 from the outset. Results from these patients were analyzed and compared with those of 1212 historical control patients (971 adult and 241 pediatric) given cyclosporine-based immunosuppression. RESULTS: Actuarial survival at 4 years was 86.2% with FK 506 versus 65.5% with cyclosporine in the pediatric patients (p < 0.0000) and 71.4% versus 65.5% in the adults (p < 0.0005). The need for retransplantation was reduced significantly for FK 506 patients. Four-year graft survival was 77.0% with FK 506 versus 48.4% with cyclosporine in the pediatric patients (p < 0.0000), and 61.9% with FK 506 versus 51.4% with cyclosporine in the adult recipients (p < 0.0000). Regression analysis revealed that reduction in mortality or graft loss from uncontrollable rejection, sepsis, technical failure, and recurrent original liver disease were responsible for the improved results with FK 506 therapy. CONCLUSIONS: FK 506 is a potent and superior immunosuppressive agent for orthotopic liver transplantation. PMID:7522431
Todo, S; Fung, J J; Starzl, T E; Tzakis, A; Doyle, H; Abu-Elmagd, K; Jain, A; Selby, R; Bronsther, O; Marsh, W
A research agenda for adolescent-centered primary care in the United States.
Little attention has been given to how primary care can be transformed to better meet the needs of adolescents. To help generate the evidence needed, The National Alliance to Advance Adolescent Health convened an invitational conference in 2012 in Washington, DC. Participants from various disciplines identified a set of prioritized recommendations pertaining to 3 topics: increasing adolescent and parent engagement and self-care management; improving preventive care and identifying conditions early; and integrating physical, behavioral, and reproductive health services. This commentary includes the top three recommendations for each topic area and concludes with a brief examination of federal and private funding prospects. PMID:23972582
Fox, Harriette B; McManus, Margaret A; Irwin, Charles E; Kelleher, Kelly J; Peake, Ken
Low Primary Cesarean Rate and High VBAC Rate With Good Outcomes in an Amish Birthing Center
PURPOSE Recent national guidelines encourage a trial of labor after cesarean (TOLAC) as a means of increasing vaginal births after cesarean (VBACs) and decreasing the high US cesarean birth rate and its consequences (2010 National Institute of Health Consensus Statement and American College of Obstetricians and Gynecologists revised guideline). A birthing center serving Amish women in Southwestern Wisconsin offered an opportunity to look at the effects of local culture and practices that support vaginal birth and TOLAC. This study describes childbirth and perinatal outcomes during a 17-year period in LaFarge, Wisconsin. METHODS We undertook a retrospective analysis of the records of all women admitted to the birth center in labor. Main outcome measures include rates of cesarean deliveries, TOLAC and VBAC deliveries, and perinatal outcomes for 927 deliveries between 1993 and 2010. RESULT S The cesarean rate was 4% (35 of 927), the TOLAC rate was 100%, and the VBAC rate was 95% (88 of 92). There were no cases of uterine rupture and no maternal deaths. The neonatal death rate of 5.4 of 1,000 was comparable to that of Wisconsin (4.6 of 1,000) and the United States (4.5 of 1,000). CONCLUSIONS Both the culture of the population served and a number of factors relating to the management of labor at the birthing center have affected the rates of cesarean delivery and TOLAC. The results of the LaFarge Amish study support a low-technology approach to delivery where good outcomes are achieved with low cesarean and high VBAC rates. PMID:23149530
Deline, James; Varnes-Epstein, Lisa; Dresang, Lee T.; Gideonsen, Mark; Lynch, Laura; Frey, John J.
Under a program created by Congress in 1989, certain primary care treatment centers serving the medically and economically indigent can become Federally Qualified Health Centers (FQHCs). Recently enacted rules and regulations allow participants in the FQHC program to receive 100 percent reasonable cost reimbursement for Medicaid services and 80 percent for Medicare services. An all-inclusive annual cost report is the basis for determining reimbursement rates. The report factors in such expenses as physician and other healthcare and professional salaries and benefits, medical supplies, certain equipment depreciation, and overhead for facility and administrative costs. Both Medicaid and Medicare reimbursement is based on an encounter rate, and states employ various methodologies to determine the reimbursement level. In Illinois, for example, typical reimbursement for a qualified encounter ranges from $70 to $88. To obtain FQHC status, an organization must demonstrate community need, deliver the appropriate range of healthcare services, satisfy management and finance requirements, and function under a community-based governing board. In addition, an FQHC must provide primary healthcare by physicians and (where appropriate) midlevel practitioners; it must also offer its community diagnostic laboratory and x-ray services, preventive healthcare and dental care, case management, pharmacy services, and arrangements for emergency services. Because FQHCs must be freestanding facilities, establishing them can trigger a number of ancillary legal issues, such as those involved in forming a new corporation, complying with not-for-profit corporation regulations, applying for tax-exempt status, and applying for various property and sales tax exemptions. Hospitals that establish FQHCs must also be prepared to relinquish direct control over the delivery of primary care services. PMID:10124301
Fahey, T M; Gallitano, D G
Background Debate surrounds the nature of gender differences in rates of posttraumatic stress disorder (PTSD). Objective The goal of this study was to quantify and explore the reasons for gender differences in rates of PTSD in low income, primary care patients after the World Trade Center (WTC) attack of September 11, 2001. Methods A survey was conducted at a large primary care practice in New York City 7 to 16 months after the WTC attack. The study involved a systematic sample of primary care patients aged 18 to 70 years. The main outcome measures were the Life Events Checklist, the Posttraumatic Stress Disorder Checklist¢Civilian Version, and the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire, all administered by a bilingual research staff. Results A total of 3807 patients were approached at the primary care clinic. Of the 1347 who met eligibility criteria, 1157 (85.9%) consented to participate. After the addition of the WTC/PTSD supplement to the study, the total number of patients was 992, of whom 982 (99.0%) completed the survey. Both sexes had high rates of direct exposure to the WTC attack and high rates of lifetime exposure to stressful life events. Overall, females had lower rates of exposure to the attack compared with males (P < 0.05). Hispanic females had the highest rate of PTSD in the full sample. Gender differences in rates of PTSD were largely accounted for by differences in marital status and education. The rate of current major depressive disorder (MDD) was higher in females than in males (P < 0.001), and the reverse was true for substance abuse (P < 0.001). Gender differences for MDD and substance abuse persisted even after adjustments for demographic differences between the sexes. Conclusions The increased rate of PTSD in women attending a primary care clinic was mediated by their social and economic circumstances, such as living alone without a permanent relationship and with little education or income. The increased rate of MDD in women appeared to be less dependent on these circumstances. These findings have implications for the treatment of women with PTSD in primary care and for research on gender differences in rates of psychiatric disorders. PMID:16115602
Weissman, Myrna M.; Neria, Yuval; Das, Amar; Feder, Adriana; Blanco, Carlos; Lantigua, Rafael; Shea, Steven; Gross, Raz; Gameroff, Marc J.; Pilowsky, Daniel; Olfson, Mark
Treatment of heterotopic ossification through remote ATP hydrolysis.
Heterotopic ossification (HO) is the pathologic development of ectopic bone in soft tissues because of a local or systemic inflammatory insult, such as burn injury or trauma. In HO, mesenchymal stem cells (MSCs) are inappropriately activated to undergo osteogenic differentiation. Through the correlation of in vitro assays and in vivo studies (dorsal scald burn with Achilles tenotomy), we have shown that burn injury enhances the osteogenic potential of MSCs and causes ectopic endochondral heterotopic bone formation and functional contractures through bone morphogenetic protein-mediated canonical SMAD signaling. We further demonstrated a prevention strategy for HO through adenosine triphosphate (ATP) hydrolysis at the burn site using apyrase. Burn site apyrase treatment decreased ATP, increased adenosine 3',5'-monophosphate, and decreased phosphorylation of SMAD1/5/8 in MSCs in vitro. This ATP hydrolysis also decreased HO formation and mitigated functional impairment in vivo. Similarly, selective inhibition of SMAD1/5/8 phosphorylation with LDN-193189 decreased HO formation and increased range of motion at the injury site in our burn model in vivo. Our results suggest that burn injury-exacerbated HO formation can be treated through therapeutics that target burn site ATP hydrolysis and modulation of SMAD1/5/8 phosphorylation. PMID:25253675
Peterson, Jonathan R; De La Rosa, Sara; Eboda, Oluwatobi; Cilwa, Katherine E; Agarwal, Shailesh; Buchman, Steven R; Cederna, Paul S; Xi, Chuanwu; Morris, Michael D; Herndon, David N; Xiao, Wenzhong; Tompkins, Ronald G; Krebsbach, Paul H; Wang, Stewart C; Levi, Benjamin
A clinical perspective on common forms of acquired heterotopic ossification
The clinical courses of heterotopic ossification (HO) as a consequence of trauma and central nervous system insults have many similarities as well as dissimilarities. Detection is commonly noted at two months. The incidence of clinically significant HO is 10%-20%. Approximately 10% of the HO is massive and causes severe restriction in joint motion or ankylosis. The most common sign and symptom are decreased range of motion and pain. The locations are the proximal limbs and joints. Sites of HO about a joint may vary according to the etiology of the HO. Roentgenographic evolution of HO occurs during a six-month period in the majority of patients. Treatment modalities include diphosphonates, indomethacin, radiation, range of motion exercises, and surgical excision. Surgical timing differs according to etiology: traumatic HO may be resected at six months; spinal cord injury HO is excised at one year; and traumatic brain injury HO is removed at 1.5 years. A small number of patients have progression of HO with medicinal treatment and recurrence after resection. The patients seem recalcitrant to present treatment methods regardless of the HO etiology. 117 refs.
Garland, D.E. (Rancho Los Amigos Medical Center, Downey, CA (USA))
Substance P Signaling Mediates BMP Dependent Heterotopic Ossification
Heterotopic ossification (HO) is a disabling condition associated with neurologic injury, inflammation, and overactive BMP signaling. The inductive factors involved in lesion formation are unknown. We found that the expression of the neuro-inflammatory factor Substance P (SP) is dramatically increased in early lesional tissue in patients who have either fibrodysplasia ossificans progressiva (FOP) or acquired HO, and in three independent mouse models of HO. In Nse-BMP4, a mouse model of HO, robust HO forms in response to tissue injury; however null mutations of the preprotachykinin gene encoding SP prevent HO. Importantly, ablation of SP+ sensory neurons, treatment with an antagonist of SP receptor NK1r, deletion of NK1r gene, or genetic down-regulation of NK1r-expressing mast cells also profoundly inhibits injury-induced HO. These observations establish a potent neuro-inflammatory induction and amplification circuit for BMP-dependent HO lesion formation, and identify novel molecular targets for prevention of HO. PMID:21748788
Kan, Lixin; Lounev, Vitali Y; Pignolo, Robert J; Duan, Lishu; Liu, Yijie; Stock, Stuart R; McGuire, Tammy L; Lu, Bao; Gerard, Norma P; Shore, Eileen M; Kaplan, Frederick S; Kessler, John A
Primary CNS lymphoma (PCNSL) is a very uncommon disease in children, and usually treated by chemotherapy, combined with focal or craniospinal radiotherapy (RT). However, adverse effects of RT are a concern. We evaluated the outcomes of childhood PCNSL, treated with systemic and intrathecal chemotherapy, but without RT. For fifteen years, six patients among 175 of non-Hodgkin lymphoma were diagnosed as PCNSL in Seoul National University Children's Hospital and we analyzed their medical records retrospectively. Their male:female ratio was 5:1, and median age was 10.1 yr. The primary sites were the sellar area in three patients, parietal area in one, cerebellum in one, and multiple areas in one. Their pathologic diagnoses were diffuse large B-cell lymphoma in three patients, Burkitt lymphoma in two, and undifferentiated B-cell lymphoma in one. Five were treated with the LMB96 treatment protocol, and one was treated with the CCG-106B protocol. None had RT as a first-line treatment. One patient had a local relapse and received RT and salvage chemotherapy, without success. No patient had treatment-related mortality. Their estimated 5-yr event-free and overall survival rates were both 83.3%. In conclusion, PCNSL is a rare disease in childhood, but successfully treated by chemotherapy without RT. PMID:23166421
Yoon, Jong Hyung; Kang, Hyoung Jin; Kim, Hyery; Lee, Ji Won; Park, June Dong; Park, Kyung Duk; Ahn, Hyo Seop
Sarcoidois: is it only a mimicker of primary rheumatic disease? A single center experience
Background: Sarcoidosis is known as a T helper 1 lymphocyte (Th1-Ly) mediated disease which can imitate or sometimes accompany many primary rheumatic diseases. The purpose of this study is to share the clinical, demographic and laboratory data of patients presenting with rheumatologic manifestations and diagnosed with sarcoidosis. Methods: A total of 42 patients (10 men) were included in the study. The patients were admitted to the rheumatology outpatient clinic for the first time with different rheumatic complaints between November 2011 and May 2013 and were diagnosed with sarcoidosis after relevant tests. Clinical, demographic, laboratory, radiological and histological data of these patients were collected during the 18-month follow-up period and then analyzed. Results Mean patient age was 45.2 years (20¢70 years) and mean duration of disease was 3.5 years (1 month¢25 years). Evaluation of system and organ involvement revealed that 20 (47.6%) patients had erythema nodosum, 3 (7.1%) had uveitis, 1 (2.3%) had myositis, 1 (2.3%) had neurosarcoidosis, 32 (76.2%) had arthritis and 40 (95.2%) had arthralgia. Of the 32 patients with arthritis, 28 (87.5%) had involvement of the ankle, 3 (9.4%) had involvement of the knee and 1 (3.2%) had involvement of the wrist. No patient had cardiac involvement. Thoracic computed tomography scan showed stage 1, 2, 3 and 4 sarcoidosis in 12 (28.5%), 22 (52.4%), 4 (9.5%) and 4 (9.5%) patients, respectively. Histopathology of sarcoidosis was verified by endobronchial ultrasound, mediastinoscopy and skin and axillary biopsy of lymphadenopathies, which revealed noncaseating granulomas. Laboratory tests showed elevated serum angiotensin-converting enzyme in 15 (35.7%) patients, elevated serum calcium level in 6 (14.2%) patients and elevated serum 1,25-dihydroxyvitamin D concentrations in 2 (4.7%) patients. Serological tests showed antinuclear antibody positivity in 12 (28.5%) patients, rheumatoid factor positivity in 7 (16.6%) patients and anticyclic citrullinated antibody positivity in 2 (4.8%) patients. Conclusion: Sarcoidosis can imitate or accompany many primary rheumatic diseases. Sarcoidosis should be considered not simply as an imitator but as a primary rheumatic pathology mediated by Th1-Ly. New studies are warranted on this subject. PMID:24489610
Sever, Fidan; Sivrikoz, Oya Nermin; Orman, Mehmet
Primary Stenting of Subclavian and Innominate Artery Occlusive Disease: A Single Center's Experience
Purpose: To review immediate and midterm results of primary stenting for innominate and subclavian artery occlusive lesions. Methods: Retrospective data were collected from 48 consecutive symptomatic patients (27 men and 21 women, median age 64 years) having 49 subclavian and innominate artery lesions treated with stenting. Of the patients 52% had concomitant ischemic heart disease, and 30% had carotid and/or vertebral artery disease. Indication for treatment was vertebrobasilar insufficiency (VBI) in 16.6% of the patients; upper limb ischemia (ULI) in 31.3%; VBI and ULI in 12.5%; transient ischemic attack in 16.7%; angina in 12.5% before or after left internal mammary artery-to-coronary artery bypass grafting; and leg claudication in 10.4% before or after axillofemoral bypass grafting. Balloon-expandable stents were used in 44 lesions and self-expandable stents in 5 lesions. In total, 53 stents were placed in 48 patients. Results: Technical success was 96%, and clinical success 94%. We encountered four complications (two puncture site hematomas, one distal hand embolization and one transient cerebral ischemia). Two patients died within 30 days from other causes, and seven patients were lost to follow-up. Mean follow-up time was 16.7 months (range 0.3 to 68.2). Five patients had recurrent lesions treated by surgical (n = 2) or endovascular (n = 3) means. Cumulative primary patency rate was 91.7% and 77% at 12 and 24 months, respectively. Cumulative secondary patency rate was 96.5% and 91.7% at 12 and 24 months, respectively. Conclusion: Stenting of subclavian and innominate artery lesions resulted in immediate resolution of patients' symptoms with durable midterm effect and few complications in a larger patient group with serious comorbid conditions.
Brountzos, E. N., E-mail: firstname.lastname@example.com; Petersen, B.; Binkert, C.; Panagiotou, I.; Kaufman, J. A. [Oregon Health Sciences University, Dotter Interventional Institute (United States)
Chondrocyte-specific ablation of Osterix leads to impaired endochondral ossification
Highlights: Black-Right-Pointing-Pointer Conditional ablation of Osterix (Osx) in chondrocytes leads to skeletal defects. Black-Right-Pointing-Pointer Osx regulates chondrocyte differentiation and bone growth in growth plate chondrocytes. Black-Right-Pointing-Pointer Osx has an autonomous function in chondrocytes during endochondral ossification. -- Abstract: Osterix (Osx) is an essential transcription factor required for osteoblast differentiation during both intramembranous and endochondral ossification. Endochondral ossification, a process in which bone formation initiates from a cartilage intermediate, is crucial for skeletal development and growth. Osx is expressed in differentiating chondrocytes as well as osteoblasts during mouse development, but its role in chondrocytes has not been well studied. Here, the in vivo function of Osx in chondrocytes was examined in a chondrocyte-specific Osx conditional knockout model using Col2a1-Cre. Chondrocyte-specific Osx deficiency resulted in a weak and bent skeleton which was evident in newborn by radiographic analysis and skeletal preparation. To further understand the skeletal deformity of the chondrocyte-specific Osx conditional knockout, histological analysis was performed on developing long bones during embryogenesis. Hypertrophic chondrocytes were expanded, the formation of bone trabeculae and marrow cavities was remarkably delayed, and subsequent skeletal growth was reduced. The expression of several chondrocyte differentiation markers was reduced, indicating the impairment of chondrocyte differentiation and endochondral ossification in the chondrocyte-specific Osx conditional knockout. Taken together, Osx regulates chondrocyte differentiation and bone growth in growth plate chondrocytes, suggesting an autonomous function of Osx in chondrocytes during endochondral ossification.
Oh, Jung-Hoon [Department of Molecular Medicine, Cell and Matrix Research Institute, BK21 Medical Education Program for Human Resources, Kyungpook National University School of Medicine, Daegu (Korea, Republic of)] [Department of Molecular Medicine, Cell and Matrix Research Institute, BK21 Medical Education Program for Human Resources, Kyungpook National University School of Medicine, Daegu (Korea, Republic of); Park, Seung-Yoon [Department of Biochemistry, School of Medicine, Dongguk University, Gyeongju 780-714 (Korea, Republic of)] [Department of Biochemistry, School of Medicine, Dongguk University, Gyeongju 780-714 (Korea, Republic of); Crombrugghe, Benoit de [Department of Genetics, University of Texas, M.D. Anderson Cancer Center, Houston (United States)] [Department of Genetics, University of Texas, M.D. Anderson Cancer Center, Houston (United States); Kim, Jung-Eun, E-mail: firstname.lastname@example.com [Department of Molecular Medicine, Cell and Matrix Research Institute, BK21 Medical Education Program for Human Resources, Kyungpook National University School of Medicine, Daegu (Korea, Republic of)] [Department of Molecular Medicine, Cell and Matrix Research Institute, BK21 Medical Education Program for Human Resources, Kyungpook National University School of Medicine, Daegu (Korea, Republic of)
Fibrodysplasia ossificans progressiva (FOP) is a rare autosomal dominant disorder characterized by progressive heterotopic ossification. FOP is caused by a gain-of-function mutation in ACVR1 encoding the bone morphogenetic protein type II receptor, ACVR1/ALK2. The mutant receptor causes upregulation of a transcriptional factor, Id1. No therapy is available to prevent the progressive heterotopic ossification in FOP. In an effort to search for clinically applicable drugs for FOP, we screened 1,040 FDA-approved drugs for suppression of the Id1 promoter activated by the mutant ACVR1/ALK2 in C2C12 cells. We found that that two antianginal agents, fendiline hydrochloride and perhexiline maleate, suppressed the Id1 promoter in a dose-dependent manner. The drugs also suppressed the expression of native Id1 mRNA and alkaline phosphatase in a dose-dependent manner. Perhexiline but not fendiline downregulated phosphorylation of Smad 1/5/8 driven by bone morphogenetic protein (BMP)-2. We implanted crude BMPs in muscles of ddY mice and fed them fendiline or perhexiline for 30Ādays. Mice taking perhexiline showed a 38.0Ā% reduction in the volume of heterotopic ossification compared to controls, whereas mice taking fendiline showed a slight reduction of heterotopic ossification. Fendiline, perhexiline, and their possible derivatives are potentially applicable to clinical practice to prevent devastating heterotopic ossification in FOP. PMID:23011467
Yamamoto, Ryuichiro; Matsushita, Masaki; Kitoh, Hiroshi; Masuda, Akio; Ito, Mikako; Katagiri, Takenobu; Kawai, Tatsushi; Ishiguro, Naoki; Ohno, Kinji
Primary cutaneous follicle center lymphoma (PCFCL) is the most common cutaneous B cell lymphoma. It is most often indolent and responds well to rituximab. We present a case of transient rituximab-induced edematous lesions located exclusively on tumor papules in a patient treated for PCFCL. Based on this observation and on a review of the literature, we discuss the mechanism of this edematous reaction which does not seem to be allergic. Indeed, this focal reaction observed solely during the first infusion of rituximab is more likely linked with local cytokine release induced by B cell lysis in the skin. This reaction is neither unusual nor severe and should not lead to an interruption of rituximab. PMID:21986026
Brunet-Possenti, F; Franck, N; Tamburini, J; Jacobelli, S; Avril, M-F; Dupin, N
Care coordination is a core element of the Patient-Centered Medical Home and requires an effective, well educated nursing staff. A greater understanding of roles and tasks currently being carried out by nurses in primary care is needed to help practices determine how best to implement care coordination and transform into PCMHs. We conducted an observational study of primary care nursing in a Community Health Center by creating a classification schema for nursing responsibilities, directly observing and tracking nurses' work, and categorizing their activities. Ten nurses in eight different practice sites were observed for a total of 61 hours. The vast majority of nursing time was spent in vaccine and medication administration; telephone work; and charting and paper work, while only 15% of their time was spent in activity that was classified broadly as care coordination. Care coordination work appeared to be subsumed by other daily tasks, many of which could have been accomplished by other, lesser trained members of the health care team. Practices looking to implement care coordination need a detailed look at work flow, task assignments, and a critical assessment of staffing, adhering to the principal of each team member working to the highest level of his or her education and license. Care coordination represents a distinct responsibility that requires dedicated nursing time, separate from the day to day tasks in a busy practice. To fully support these new functions, reimbursement models are needed that support such non visit-based work and provide incentives to coordinate and manage complex cases, achieve improved clinical outcomes and enhance efficiency of the health system. This article describes our study methods, data collection, and analysis, results, and discussion about reorganizing nursing roles to promote care coordination. PMID:22686111
Anderson, Daren R; St Hilaire, Daniel; Flinter, Margaret
Background Parathyroid reoperations are challenging and achieving a cure requires multidisciplinary treatment team cooperation. The aims of this study were to summarize our experience in revision surgery for persistent (pHPT) or recurrent primary hyperparathyroidism (rHPT) and to explore factors underlying failure to cure at initial surgery. Material/Methods This was a retrospective cohort study of patients who underwent reoperations for pHPT or rHPT at a tertiary referral center. The database of parathyroid surgery was searched for eligible patients (treated in the years 2000¢2012). The primary outcome was the cure rate. All the patients were followed-up for at least 12 months postoperatively. Factors underlying failure to cure at initial surgery were reviewed based on hospital records. Results The study group comprised 88 patients (69 women, 19 men) operated on for persistent (n=57) or recurrent disease (n=31), who underwent 98 reoperations, including 26 (2.4%) patients first operated on at our institution, and 72 (81.8%) patients operated on elsewhere, but referred for revision surgery. A long-term cure was achieved in 83/88 patients (94.3%). The mean post-reoperation follow-up was 91.7 (12¢176) months. Missed hyperfunctioning parathyroid gland was found on reoperation in eutopic position in 49 (55.5%) patients, and in ectopic position in 39 (44.3%) patients, including 20 (22.7%) cases of cervical ectopy and 19 (21.6%) cases of mediastinal ectopy. Conclusions Multidisciplinary treatment team cooperation at a tertiary referral center, consisting of an accurate preoperative localization, expertise in parathyroid re-explorations, and correct use of intraoperative adjuncts, contribute to the high success rate of parathyroid reoperations. PMID:25201515
Nawrot, Ireneusz; Chudzinski, Witold; Ciacka, Tomasz; Barczynski, Marcin; Szmidt, Jacek
Primary cutaneous follicle center lymphoma (PCFCL) is the most frequent cutaneous B-cell lymphoma. A 62-year-old man presented with a solitary indolent subcutaneous nodule for 3 years duration, without other abnormalities. Histological examination showed lymphoproliferation with a nodular growth pattern characterized by fibrous collagen bands surrounding nodules. The nodules were composed of medium-sized centrocytes admixed with many large multilobulated and lacunar cells without eosinophils or granulomatous aspect. Hodgkin-like cells were CD30+, CD15+, PAX5+, OCT2+, BOB1+, MUM1+, Ki67+, Bcl6+ and focally CD20+ and EMA-, CD79a-, Bcl2- and CD10-. The medium-sized cells were CD20+, CD79a+, Bcl2+, Bcl6+ and CD10+, enmeshed in a network of CD21-positive follicular dendritic cells. Epstein-Barr virus detection was negative. Interphase fluorescence in situ hybridization showed the absence of BCL2 or BCL6 rearrangement. In such a case, the presence of Hodgkin-like cells intermixed with the tumor population may result in a pitfall diagnosis of classical Hodgkin lymphoma (CHL). Differential diagnoses to be ruled out are secondary or primary skin localization of rather CHL, or systemic follicular lymphoma. Several clinical, radiological, histological, immunohistochemical and molecular arguments indicated the diagnosis of PCFCL. To our knowledge, this is the first report of PCFCL with Hodgkin-like cells. PMID:25099172
Marie, Dilly; Houda, Ben-Rejeb; Bķatrice, Vergier; Matthieu, Feldis; Louis, Toty; Olivier, Nohra; Marie, Beylot-Barry; Audrey, Gros; Jean-Philippe, Merlio; Marie, Parrens
Postoperative Single-Fraction Radiation for Prevention of Heterotopic Ossification of the Elbow
Purpose: Heterotopic ossification (HO) about the elbow has been described after surgery, trauma, and burns. Even limited deposits can lead to significant functional deficits. Little data exist regarding outcomes of patients treated with radiation therapy (RT) after elbow surgery. We report here the Cleveland Clinic experience with single-fraction radiation following surgery to the elbow. The primary endpoint was the rate of new HO after RT. Secondary endpoints were range of motion, functional compromise, and toxicity. Methods and Materials: From May 1993 to July 2006, 36 patients underwent elbow surgery followed by single-fraction RT. Range of motion data were collected before and during surgery and at last follow-up. Radiographs were reviewed for persistent or new HO. Patient and treatment factors were analyzed for correlation with development of HO or functional compromise. Results: Median follow-up was 8.7 months, median age was 42 years, and 75% of patients were male. Twenty-six (72%) patients had HO prior to surgery. All patients had significant limitations in flexion/extension or pronation/supination at baseline. Thirty-one (86%) patients had prior elbow trauma, and 26 (72%) patients had prior surgery. RT was administered a median of 1 day postoperatively (range, 1-4 days). Thirty-four patients received 700 cGy, and 2 patients received 600 cGy. Three (8%) patients developed new HO after RT. All patients had improvement in range of motion from baseline. No patient or treatment factors were significantly associated with the development of HO or functional compromise. Conclusions: Single-fraction RT after surgery to the elbow is associated with favorable functional and radiographic outcomes.
Robinson, Clifford G. [Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio (United States); Polster, Joshua M. [Department of Radiology, Cleveland Clinic, Cleveland, Ohio (United States); Reddy, Chandana A. [Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio (United States); Lyons, Janice A. [Department of Radiation Oncology, UH Case Medical Center, Cleveland, Ohio (United States); Evans, Peter J.; Lawton, Jeffrey N. [Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio (United States); Graham, Thomas J. [Curtis National Hand Center, Baltimore, Maryland (United States); Suh, John H., E-mail: firstname.lastname@example.com [Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio (United States)
Reportedly, ossification of the posterior longitudinal ligament (OPLL) usually involves the cervical spine and often accompanies other ligamentous ossification such as diffuse idiopathic skeletal hyperostosis (DISH). It is considered serious because it sometimes causes severe radiculomyelopathy; however, the present study, based on a fixed population sample, revealed that OPLL of the thoracic spine is nearly always asymptomatic. The prevalence of thoracic OPLL was 0.6%, with three times as many women as men being affected, compared with cervical OPLL which occurs predominantly among men. No marked radiculomyelopathy was observed, nor definite evidence of neurological involvement due to thoracic OPLL. DISH was rare, especially among women.
Ono, M.; Russell, W.J.; Kudo, S.; Kuroiwa, Y.; Takamori, M.; Motomura, S.; Murakami, J.
Reportedly, ossification of the posterior longitudinal ligament (OPLL) usually involves the cervical spine and often accompanies other ligamentous ossification such as diffuse idiopathic skeletal hyperostosis (DISH). It is considered serious because it sometimes causes severe radiculomyelopathy; however, the present study, based on a fixed population sample, revealed that OPLL of the thoracic spine is nearly always asymptomatic. The prevalence of thoracic OPLL was 0.6% with three times as many women as men being affected, compared with cervical OPLL which occurs predominantly among men. No marked radiculomyelopathy was observed, nor definite evidence or neurological involvement due to thoracic OPLL. DISH was rare, especially among women.
Ono, M.; Russell, W.J.; Kudo, S.; Kuroiwa, Y.; Takamori, M.; Motomura, S.; Murakami, J.
Voriconazole-related periostitis has been increasingly described in the literature over the last several years as a recognizable disease entity, especially in lung transplant patients. This relationship should be considered when approaching immunosuppressed patients presenting with diffuse bone pain and imaging findings of periostitis. We present a case of voriconazole-associated periostitis, capsular and enthesial ossification and glenuhumeral capsulitis in a patient with a hematologic malignancy. To the authors' knowledge, soft tissue ossification associated with voriconazole has not been described in the radiology literature. PMID:24699891
Raghavan, Meera; Hayes, Alex
Insulin has been shown to stimulate bone formation, and there is a high incidence of obesity and disturbance in the glucose\\u000a metabolism of patients with paravertebral ligamentous ossification (PVLO). In an effort to clarify whether there is any alteration\\u000a in insulin status in PVLO patients, and whether such changes play any role in the development of PVLO, glucose metabolism\\u000a and
Yasuhiro Takeuchi; Toshio Matsumoto; Yoh Takuwa; Yuichi Hoshino; Takahide Kurokawa; Naohiko Shibuya; Etsuro Ogata
Obesity is a risk factor for ossification of the posterior longitudinal ligament (OPLL) of the spine, which is characterized\\u000a by heterotopic bone formation in the posterior longitudinal spinal ligament. Hyperleptinemia is a common feature of obese\\u000a people and leptin is believed to be an important factor in the pathogenesis of OPLL. However, the association between leptin\\u000a and bone metabolism and
Yoshikazu Ikeda; Arata Nakajima; Atsuomi Aiba; Masao Koda; Akihiko Okawa; Kazuhisa Takahashi; Masashi Yamazaki
ABSTRACT Background: Attracting physicians to rural areas has been a long-standing challenge in India. Government efforts to address the shortage of rural physicians include posting non-physician clinicians (NPCs) at primary health centers (PHCs) in select areas. Performance assessments of NPCs have typically focused on the technical quality of their care with little attention to the perspectives of patients. This study investigates patient views of physicians (Medical Officers) and NPCs in terms of patient satisfaction, perceived quality, and provider trust. NPCs include: Indian system of medicine physicians (AYUSH Medical Officers) and clinicians with 3 years of training, such as Rural Medical Assistants (RMAs). At PHCs without clinicians, paramedics provide clinical care, although they are not trained for this. Methods: PHCs in the state of Chhattisgarh were stratified by provider type: Medical Officer, AYUSH Medical Officer, RMA, or paramedic. PHCs were randomly sampled in each group. A total of 1,082 exiting patients were sampled from138 PHCs. Factor analysis was used to identify perceived quality domains. Multiple regression analysis was used to test for group differences. Results: Patients of Medical Officers and NPCs reported similar levels of satisfaction, trust, and perceived quality, with scores of 84% for Medical Officers, 80% for AYUSH Medical Officers, and 85% for RMAs. While there were no significant differences in these outcomes between these groups, scores for paramedical staff were significantly lower, at 73%. Conclusions: Physicians and NPCs performed similarly in terms of patient satisfaction, trust, and perceived quality. From a patient's perspective, this supports the use and scale up of NPCs in primary care settings in India. Leaving clinician posts vacant undermines public trust and quality perceptions of government health services.
Rao, Krishna D; Stierman, Elizabeth; Bhatnagar, Aarushi; Gupta, Garima; Gaffar, Abdul
Data on the relative sequence of ossification of postcranial elements for eight therian mammals (Myotis lucifugus, Homo sapiens, Rattus norvegicus, Mus musculus, Mesocricetus auratus, Cavia porcellus, Didelphis albiventris, and Sminthopsis macroura) and three outgroups (Chelydra serpentina, Alligator mississippiensis, and Lacerta vivipara) were taken from the literature. For each species, a matrix was constructed in which the relative timing of the onset of ossification in 24 elements was summarized. This resulted in 276 event pairs (characters) for each species. Thirty-three (33.3)% of the characters examined are uniform across all taxa, 16.3% are variable but uninformative in the phylogeny, and 50.4% potentially deliver diagnostic features for clades of two or more taxa. In all species examined, the clavicle is the first bone to appear. Placentalia is not unequivocally diagnosed by the state of any event pair, while Marsupialia has the largest amount of autapomorphies with 18. The acceleration in the timing of ossification of the scapula in relation to the hindlimb in marsupials is most probably causally correlated to movements after birth and during early phases of pre-weaning life. Marsupials are almost unique among amniotes in that the earliest onset of ossification of at least one element among carpals and among tarsals is simultaneous. Three parsimony analyses, each one with a different reptilian taxon as outgroup, were performed using event pairs as characters. In all cases, results were incongruent with the phylogeny of the studied taxa. PMID:12362432
SAnchez-Villagra, Marcelo R
This report describes a patient presenting with a spastic quadriplegia who was found to have both diffuse idiopathic skeletal hyperostosis (DISH) and ossification of the posterior longitudinal ligament (OPLL) in the cervical spine. There was a dramatic worsening of his symptoms during a myelogram examination of the neck. It is suggested that computed tomographic imaging of the neck is the
I D Griffiths; T P Fitzjohn
Homology of the palpebral and origin of supraorbital ossifications in ornithischian dinosaurs
in the ornithischian skull, including dermal ossifications associated with display or defence and the development for display and defence (Hopson 1975; Weishampel 1981a; Dodson 1996), and the development of narial sinuses (e of complex feeding mechanisms, may have led to the incorporation of the palpebral into the skull roof. h
The influence of slice thickness on assessment of clavicle ossification in forensic age diagnostics.
Computed tomography scans originally obtained to assess the ossification status of the medial clavicular epiphyses of 40 live subjects for forensic age estimation purposes were analysed. From the data acquired we reconstructed images with slice thicknesses of 1, 3, 5 and 7 mm, and based on the classification of stages by Schmeling et al. (Int J Legal Med 118:5-8, 2004), we determined the ossification stage for each reconstructed slice thickness, separately for both sides. Of the 80 clavicular epiphysial plates examined, seven displayed slice-thickness-dependent differences at certain ossification stages. In one case a slice thickness of 1 mm led to a different diagnosis of the ossification stage than a slice thickness of 3 mm, in three cases the diagnoses differed between the slice thicknesses of 3 and of 5 mm, and in another three cases, between 5 and 7 mm. We therefore conclude that for age estimation purposes, the slice thickness should be 1 mm to ensure maximum accuracy and diagnostic reliability. PMID:16012831
M³hler, Matthias; Schulz, Ronald; Schmidt, Sven; Schmeling, Andreas; Reisinger, Walter
Radiological assessment of the degree of ossification of the medial clavicular epiphyseal cartilage plays a vital part in forensic age diagnosis of living adolescents and young adults. A total of 873 plain chest radiographs requested by the staff medical officer for members of staff aged 16-30 at the University Hospital Charitķ were evaluated retrospectively. Of these X-rays 699 permitted an assessment of ossification of at least 1 side of the clavicle. In addition to the customary stages (1: non-ossified epiphysis, 2: discernible ossification centre, 3: partial fusion, 4: total fusion) a stage 5 was also defined, characterised by the disappearance of the epiphyseal scar following total fusion. The earliest age at which stage 3 was detected in either gender was 16 years. Stage 4 was first observed in women at 20 years and in men at 21 years. In both genders, the earliest observation of stage 5 was at 26 years. It was concluded that plain chest radiographs can essentially be used to assess clavicular ossification. In practice, if overlap in posterior-anterior views impedes evaluation, a lateral view should also be taken to facilitate age estimation. In forensic practice the reference values of the present paper should be applied. PMID:14534796
Schmeling, Andreas; Schulz, Ronald; Reisinger, Walter; M³hler, Matthias; Wernecke, Klaus-Dieter; Geserick, Gunther
We examined the fetal growth and development of the coypu (Myocastor coypus), a member of the Caviomorpha that produces extremely precocial young. Analyses of 69 fetuses derived from the latter half of the prenatal period (60¢125 days of gestation) focused on external feature growth and development, tooth eruption, and cranial ossification. There were four developmental stages based on morphological characteristics;
Keiko Sone; Kazuhiro Koyasu; Shuji Kobayashi; Sen-ichi Oda
Skeletogenic heterochronies have gained much attention in comparative developmental biology. The temporal appearance of mineralized individual bones in a species ¢ the species ossification sequence ¢ is an excellent marker in this kind of study. Several publications describe interspecific variation, but only very few detail intraspecific variation. In this study, we describe and analyze the temporal order of ossification of skeletal elements in the zebra finch, Taeniopygia guttata, the Japanese quail, Coturnix coturnix japonica, and the White Pekin duck, a domestic race of the mallard Anas platyrhynchos, and explore patterns of intraspecific variation in these events. The overall sequences were found to be conserved. In the duck, variability is present in the relative timing of ossification in the occipital, the basisphenoid and the otic regions of the skull and the phalanges in the postcranium. This variation appears generally in close temporal proximity. Comparison with previously published data shows differences in ossification sequence in the skull, the feet, and the pelvis in the duck, and especially the pelvis in the quail. This clearly documents variability among different breeds. PMID:21728797
Mitgutsch, Christian; Wimmer, Corinne; Sanchez-Villagra, Marcelo R.; Hahnloser, Richard; Schneider, Richard A.
Men and women returning from the wars in Afghanistan and Iraq face a multitude of difficulties while integrating back into civilian life, but the importance of their veteran status is often overlooked in primary care settings. Family physicians have the potential to be the first line of defense to ensure the well-being of veterans and their families because many will turn to nonmilitary and non-Veterans Affairs providers for health care needs. An awareness of the unique challenges faced by this population is critical to providing care. A patient-centered medical home orientation can help the family physician provide veterans and their families the care they need. Specific recommendations for family physicians include screening their patient population; providing timely care; treating the whole family; and integrating care from multiple disciplines and specialties, providing veterans and families with "one-stop shopping" care. An awareness of the unique challenges faced by veterans and their families translates into better overall outcomes for this population. PMID:21057073
Hinojosa, Ramon; Hinojosa, Melanie Sberna; Nelson, Karen; Nelson, David
Slow, ?50 ps, P* ? P(+)HA(-) electron transfer is observed in Rhodobacter capsulatus reaction centers (RCs) bearing the native Tyr residue at M208 and the single amino acid change of isoleucine at M204 to glutamic acid. The P* decay kinetics are unusually homogeneous (single exponential) at room temperature. Comparative solid-state NMR of [4'-(13)C]Tyr labeled wild-type and M204E RCs show that the chemical shift of Tyr M208 is significantly altered in the M204E mutant and in a manner consistent with formation of a hydrogen bond to the Tyr M208 hydroxyl group. Models based on RC crystal structure coordinates indicate that if such a hydrogen bond is formed between the Glu at M204 and the M208 Tyr hydroxyl group, the -OH would be oriented in a fashion expected (based on the calculations by Alden et al., J. Phys. Chem. 1996, 100, 16761-16770) to destabilize P(+)BA(-) in free energy. Alteration of the environment of Tyr M208 and BA by Glu M204 via this putative hydrogen bond has a powerful influence on primary charge separation. PMID:24902471
Saggu, Miguel; Carter, Brett; Zhou, Xiaoxue; Faries, Kaitlyn; Cegelski, Lynette; Holten, Dewey; Boxer, Steven G; Kirmaier, Christine
Latest Data Show Strong Fertility Center Offers Region's Best IVF Success Rates! The Society for Assisted Reproductive Technology (SART), the primary organization of professionals dedicated to the practice of assisted reproductive technologies (ART) in the United States, annually collects and publishes
Goldman, Steven A.
ABSTRACT Objectives: The study is to evaluate changes in microhardness of enamel after exposure to acidic center filled chewing gum on primary and permanent teeth. Methods: Thirty primary and 30 permanent molar extracted teeth were painted with acid resistant varnish except a small window over buccal surface. Teeth were divided into four groups according to type of teeth and type of chewing gum (Center fresh and Bubbaloo) (D1, P1, D2 and P2); each tooth was exposed to whole chewing gum mashed with 5 ml of artificial saliva for five minutes at room temperature twice a day for 5 days. After the exposure, teeth were stored in deionized water and submitted for microhardness tests. Results: Paired t-test and independent sample t-test were used for statistical analysis. A significant reduction in microhardness was found between exposed and unexposed areas in all groups. There was no statistically significant difference in reduction of microhardness to chewing gums, and between primary and permanent enamel. Conclusion: There is a definite reduction in microhardness in all groups exposed to chewing gums. Both the chewing gums are equally erosive; both permanent and primary teeth were affected. How to cite this article: Mudumba VL, Muppa R, Srinivas NCH, Kumar DM. Evaluation and Comparison of Changes in Microhardness of Primary and Permanent Enamel on Exposure to Acidic Center-filled Chewing Gum: An in vitro Study. Int J Clin Pediatr Dent 2014;7(1):24-29. PMID:25206233
Muppa, Radhika; Srinivas, NCH; Kumar, Duddu Mahesh
Ossification of the posterior longitudinal ligament (OPLL) is an important cause of cervical myelopathy that results from bony ossification of the cervical or thoracic posterior longitudinal ligament (PLL). It has been estimated that nearly 25% of patients with cervical myelopathy will have features of OPLL. Patients commonly present in their mid-40s or 50s with clinical evidence of myelopathy. On MR and CT imaging, this can be seen as areas of ossification that commonly coalesce behind the cervical vertebral bodies, leading to direct ventral compression of the cord. While MR imaging will commonly demonstrate associated changes in the soft tissue, CT scanning will better define areas of ossification. This can also provide the clinician with evidence of possible dural ossification. The surgical management of OPLL remains a challenge to spine surgeons. Surgical alternatives include anterior, posterior, or circumferential decompression and/or stabilization. Anterior cervical stabilization options include cervical corpectomy or multilevel anterior cervical corpectomy and fusion, while posterior stabilization approaches include instrumented or noninstrumented fusion or laminoplasty. Each of these approaches has distinct advantages and disadvantages. While anterior approaches may provide more direct decompression and best improve myelopathy scores, there is soft-tissue morbidity associated with the anterior approach. Posterior approaches, including laminectomy and fusion and laminoplasty, may be well tolerated in older patients. However, there often is associated axial neck pain and less improvement in myelopathy scores. In this review, the authors discuss the epidemiology, imaging findings, and clinical presentation of OPLL. The authors additionally discuss the merits of the different surgical techniques in the management of this challenging disease. PMID:21361748
Smith, Zachary A; Buchanan, Colin C; Raphael, Dan; Khoo, Larry T
This is a case of idiopathic pulmonary calcification and ossification in a 70 year old with long-standing diabetes and hypertension. Thirteen years prior to her demise, she was first noticed to have multiple calcific deposits in her lungs on a chest X-ray film. She had no risk factors for soft tissue calcification and ossification. Histology of tissue from autopsy showed intraparenchymal pulmonary calcification and ossification with marrow elements. Idiopathic pulmonary calcification and ossification is rare. At autopsy, she was also found to have had bilateral subarachnoid haemorrhage (SAH), a diagnosis missed during clinical evaluation. We highlight the pertinent details in our patient's management that could have helped to prevent a missed diagnosis of SAH. Even though SAH occurs most commonly following head trauma, the more familiar medical use of SAH is for non-traumatic SAH occurring following a ruptured cerebral aneurysm. This patient had notable risk factors for cerebral aneurysm formation but an aneurysm was not identified at autopsy. The location of the blood high on the cerebral convexities further suggests a traumatic origin rather than a ruptured aneurysm. Heterotopic calcification and ossification (HO) is known to occur in the setting of severe neurologic disorders such as traumatic brain injury but the fact that the lung calcification in our patient predated the brain injury by over 10 years makes it unlikely for the HO to have been due to the brain trauma. Other organ pathologies found at autopsy include chromophobe renal cell carcinoma, renal papillary necrosis, lymphocytic thyroiditis, and seborrheic keratosis. PMID:24391231
Odubanjo, M O; Abdulkareem, F B; Banjo, A; Ekwere, T E; Awelimobor, D I
The impact of recently passed health reform legislation may cause substantial changes in community health center (CHC) operations. The new legislation provides federal funding for center expansion, increased Medicaid enrollment, enhanced Medicare payments, training to increase primary care providers, and incentives to develop CHCs as accountable care organizations. Health reform could place CHCs in a vulnerable financial situation. Newly insured patients may seek care at private providers, whereas CHCs are left caring only for the uninsured. Thus, CHCs are unable to benefit from enhanced insurance payments needed to offset care given to the uninsured. Conversely, if CHCs participate in developing comprehensive care networks for low-income populations by strengthening referral networks, developing primary medical care homes and accountable care organizations, and investing in infrastructure, then health center medical care will be a desired option for the newly insured, and a robust safety-net system may result. PMID:23629032
Kulesher, Robert R
Radiology of postnatal skeletal development
Thirty-six manubriosternal composites from skeletally immature cadavers were examined morphologically and radiographically. Sternebral ossification followed certain patterns. The manubrium (first sternebra) usually had one primary ossification center and one or two smaller centers. These usually were caudad to the major center (longitudinally bifid). The second sternebra invariably had only one ossification center. The third and fourth sternebrae had latitudinal (right-left)
John A. Ogden; Gerald J. Conlogue; Mary L. Bronson; Pamela S. Jensen
Primary immunodeficiencies (PIDs) represent a large group of diseases that affect all age groups. Although PIDs have been recognized as rare diseases, there is epidemiological evidence suggesting that their real prevalence has been underestimated. We performed an evaluation of a series of 1,008 infants, children, adolescents and adults with well-defined PIDs from a single Brazilian center, regarding age at diagnosis, gender and PID category according to the International Union of Immunological Societies classification. Antibody deficiencies were the most common category in the whole series (61 %) for all age groups, with the exception of <2-year-old patients (only 15 %). In the >30-year-old group, antibody deficiencies comprised 84 % of the diagnoses, mostly consisting of common variable immunodeficiency, IgA deficiency and IgM deficiency. Combined immunodeficiencies represented the most frequent category in <2-years-old patients. Most congenital defects of phagocytes were identified in patients <5 -years of age, as were the diseases of immune dysregulation, with the exception of APECED. DiGeorge syndrome and ataxia-telangiectasia were the most frequent entities in the category of well-defined syndromes, which were mostly identified in patients <10-years of age. Males represented three-quarters and two-thirds of <2 -years-old and 2-5-years -old patients, respectively, whereas females predominated among the >30-year-old patients. Our data indicated that some PIDs were only detected at early ages, likely because affected patients do not survive long. In addition, our data pointed out that different strategies should be used to search for PIDs in infants and young children as compared to older patients. PMID:23354909
Carneiro-Sampaio, Magda; Moraes-Vasconcelos, Dewton; Kokron, Cristina M; Jacob, Cristina M A; Toledo-Barros, Myrthes; Dorna, Mayra B; Watanabe, LetĒcia A; Marinho, Ana Karolina B B; Castro, Ana Paula Moschione; Pastorino, Antonio C; Silva, Cl¾vis Artur A; Ferreira, MaurĒcio D; Rizzo, Luiz V; Kalil, Jorge E; Duarte, Alberto J S
Ventral premotor cortex (PMv) is widely accepted to exert an important influence over primary motor cortex (M1) when hand movements are made. Although study of these interactions has typically focused on their excitatory nature, given its strong connections with both ventral and opercular frontal regions, one feature of the influence of PMv over M1 may be inhibitory. Paired-pulse transcranial magnetic stimulation (ppTMS) was used to examine functional interactions between human PMv and M1 during the selection and reprogramming of a naturalistic goal-directed action. One of two cylinders was illuminated on each trial. It was then grasped and picked up. On some trials, however, subjects had to reprogram the action as the illuminated cylinder was switched off and the other illuminated simultaneously with reach initiation. At a neurophysiological level, the PMv paired-pulse effect (PPE) on M1 corticospinal activity was facilitatory after the initial target presentation and during movement initiation. When reprogramming was required, however, the PPE became strongly inhibitory. This context-dependent change from facilitation to inhibition occurred within 75 ms of the change of target. Behaviorally, PMv-M1 ppTMS disrupted reprogramming. Diffusion-weighted magnetic resonance image scans were taken of each subject. Intersubject differences in the facilitation-inhibition contrast of PMv-M1 interactions were correlated with fractional anisotropy of white-matter in ventral prefrontal, premotor, and intraparietal brain areas. These results suggest that a network of brain areas centered on PMv inhibits M1 corticospinal activity associated with undesired movements when action plans change. PMID:20107065
Buch, Ethan R; Mars, Rogier B; Boorman, Erie D; Rushworth, Matthew F S
Purpose: Heterotopic ossification (HO) is a frequent complication following total hip arthroplasty. This study was conducted to calculate the radiation dose to organs-at-risk and estimate the probability of cancer induction from radiotherapy for HO prophylaxis.Methods: Hip irradiation for HO with a 6 MV photon beam was simulated with the aid of a Monte Carlo model. A realistic humanoid phantom representing an average adult patient was implemented in Monte Carlo environment for dosimetric calculations. The average out-of-field radiation dose to stomach, liver, lung, prostate, bladder, thyroid, breast, uterus, and ovary was calculated. The organ-equivalent-dose to colon, that was partly included within the treatment field, was also determined. Organ dose calculations were carried out using three different field sizes. The dependence of organ doses upon the block insertion into primary beam for shielding colon and prosthesis was investigated. The lifetime attributable risk for cancer development was estimated using organ, age, and gender-specific risk coefficients.Results: For a typical target dose of 7 Gy, organ doses varied from 1.0 to 741.1 mGy by the field dimensions and organ location relative to the field edge. Blocked field irradiations resulted in a dose range of 1.4¢146.3 mGy. The most probable detriment from open field treatment of male patients was colon cancer with a high risk of 564.3 ū 10{sup ?5} to 837.4 ū 10{sup ?5} depending upon the organ dose magnitude and the patient's age. The corresponding colon cancer risk for female patients was (372.2¢541.0) ū 10{sup ?5}. The probability of bladder cancer development was more than 113.7 ū 10{sup ?5} and 110.3 ū 10{sup ?5} for males and females, respectively. The cancer risk range to other individual organs was reduced to (0.003¢68.5) ū 10{sup ?5}.Conclusions: The risk for cancer induction from radiation therapy for HO prophylaxis after total hip arthroplasty varies considerably by the treatment parameters, organ site in respect to treatment volume and patient's gender and age. The presented risk estimates may be useful in the follow-up studies of irradiated patients.
Mazonakis, Michalis; Berris, Theoharris; Damilakis, John [Department of Medical Physics, Faculty of Medicine, University of Crete, P.O. Box 2208, 71003 Iraklion, Crete (Greece)] [Department of Medical Physics, Faculty of Medicine, University of Crete, P.O. Box 2208, 71003 Iraklion, Crete (Greece); Lyraraki, Efrossyni [Department of Radiotherapy and Oncology, University Hospital of Iraklion, 71110 Iraklion, Crete (Greece)] [Department of Radiotherapy and Oncology, University Hospital of Iraklion, 71110 Iraklion, Crete (Greece)
A serial radiographic study was conducted on eight kori bustard (Ardeotis kori) and four white-bellied bustard (Eupodotis senegalensis) chicks to determine the pattern of long bone development and to establish radiographic standards for assessing skeletal maturity. The ossification pattern, appearance of secondary ossification centres, and epiphyseal fusion of the long bones in kori and white-bellied bustards were similar to those in houbara bustards (Chlamydotis undulata macqueenii), rufous-crested bustards (Eupodotis ruficrista), domestic fowl (Gallus gallus), house wrens (Troglodytes aedon aedon), racing pigeons (Columba livia). and barn owls (Tyto alba). Secondary ossification centres were present at the proximal and distal tibiotarsus, proximal tarsometatarsus and proximal metacarpal III. The ossification of long bones occurred earlier in female kori bustards compared with males. PMID:9839896
Naldo, J L; Samour, J H; Bailey, T A
To elucidate the normal development and growth of Mongolian gerbils, the timing and sequence of the appearance of ossification centres within foetuses were investigated. Average foetus body weight and tail length on the 15th day of pregnancy were found to be 0.042 g and 6.2 mm, respectively. For the 25th day of pregnancy, these measurements were 2.601 g and 29.4 mm, respectively. The body weight and tail length of foetuses increased significantly from the 20th day of pregnancy. Also, the first ossification centre of Mongolian gerbil foetuses appeared in the clavicle at the 17th day of pregnancy. The order in which ossification centres appeared in Mongolian gerbils resembles the pattern for rats and mice, except in some areas of the skull. Except for the clavicle, in which ossification centres appeared rather early, most ossification centres appeared in the last quarter of pregnancy. These results suggest that Mongolian gerbil foetal development is near completion by the last gestational stage. Also, ossification centres appear sooner in the skull and nasal bones than in other rodents. PMID:10652827
Yukawa, M; Hayashi, N; Takagi, K; Mochizuki, K
Although the Charcot arthropathy may be associated with serious complications, total knee arthroplasty (TKA) is the preferred choice of treatment by patients. This case report presents an 80-year-old man with intra-articular giant heterotopic ossification following loosening of femoral and tibial implants and femoral condylar fracture. He had undergone TKA because of Charcot neuropathy seven years ago and had been doing well since. Immediately after a left knee sprain, he became unable to walk. Because he had developed a skin ulcer on his left calf where methicillin-resistant Staphylococcus aureus was detected, we postponed revision surgery until the ulcer was completely healed. While waiting, intra-articular bony fragments grew larger and formed giant heterotopic ossified masses. Eventually, the patient underwent revision surgery, and two major ossified masses were carefully and successfully extirpated. It should be noted that intra-articular heterotopic giant ossification is a significant complication after TKA for neuropathic arthropathy. PMID:24151574
Tsuge, Shintaro; Aoki, Yasuchika; Sonobe, Masato; Shibata, Yoshifumi; Sasaki, Yu; Nakagawa, Koichi
Although the Charcot arthropathy may be associated with serious complications, total knee arthroplasty (TKA) is the preferred choice of treatment by patients. This case report presents an 80-year-old man with intra-articular giant heterotopic ossification following loosening of femoral and tibial implants and femoral condylar fracture. He had undergone TKA because of Charcot neuropathy seven years ago and had been doing well since. Immediately after a left knee sprain, he became unable to walk. Because he had developed a skin ulcer on his left calf where methicillin-resistant Staphylococcus aureus was detected, we postponed revision surgery until the ulcer was completely healed. While waiting, intra-articular bony fragments grew larger and formed giant heterotopic ossified masses. Eventually, the patient underwent revision surgery, and two major ossified masses were carefully and successfully extirpated. It should be noted that intra-articular heterotopic giant ossification is a significant complication after TKA for neuropathic arthropathy. PMID:24151574
Nakajima, Arata; Tsuge, Shintaro; Aoki, Yasuchika; Sonobe, Masato; Shibata, Yoshifumi; Sasaki, Yu; Nakagawa, Koichi
Abstract Heterotopic mesenteric ossification (HMO) is a rare disease that results in intra-abdominal ossification of unknown origin. An 88-year-old man developed an intestinal obstruction 2 weeks after undergoing an operation for a ruptured abdominal aortic aneurysm, resulting in intestinal obstructions those did not improved concervatively. During relaparotomy performed 30 days after the first operation, hard adhesions of the small intestine and mesentery were found; these adhesions were difficult to separate without damaging the serosa of the small intestine. We removed 240cm of the small intestine and performed a jejuno-ileo anastomosis. Microscopically, trabecular bone tissue had increased irregularly in the fat tissue of the nodules with fibrosis, which were partially lined with osteoblasts. Accordingly, we histopathologically diagnosed the patient as having HMO. The patient was treated with NSAIDs and cimetidine to prevent the recurrence of HMO. No signs of recurrence have occurred as of one year after the second operation. PMID:25058788
Honjo, Hiroaki; Kumagai, Youichi; Ishiguro, Toru; Imaizumi, Hideko; Ono, Tomojiro; Suzuki, Okihide; Ito, Tetsuya; Haga, Norihiro; Kuwabara, Kohki; Sobajima, Jun; Kumamoto, Kensuke; Ishibashi, Keiichiro; Baba, Hiroyuki; Sato, Osamu; Ishida, Hideyuki; Kuwano, Hiroyuki
Primary immunodeficiencies (PIDs) are rare diseases characterized by an increased susceptibility to infections. Early diagnosis and appropriate treatment are critical for reducing morbidity and mortality. Based on available data, the efficacy of antibiotic administration for the prophylaxis of infections remains uncertain, and recommendations supporting this practice are poor. The use of antimicrobial prophylaxis is mainly based on single institution-specific experience without controlled measurements of patient safety and quality health outcomes. To address this issue an Italian Network on Primary Immunodeficiencies (IPINet) has been set up in 1999 within the Italian Association of Pediatric Hematology and Oncology (AIEOP) to increase the awareness of these disorders among physicians. Further, diagnostic and treatment guideline recommendations have been established to standardize the best clinical assistance to all patients, including antibiotic prophylaxis, and for a national epidemiologic monitoring of PIDs. The aim of this review is not only to give a scientific update on the use of antimicrobial prophylaxis in selected congenital immunological disorders but also to draw a picture of this practice in the context of the Italian Primary Immunodeficiency Network (IPINet). Controlled multicenter studies are necessary to establish if, when and how you should start an efficacious antimicrobial prophylaxis. PMID:24382174
Moschese, V; Martire, B; Soresina, A; Chini, L; Graziani, S; Monteferrario, E; Bacchetta, R; Cancrini, C; Fiorilli, M; Gambineri, E; Pession, A; Pignata, C; Quinti, I; Rondelli, R; Rossi, P; Ugazio, A G; Plebani, A; Pietrogrande, M C
Primary gastric lymphomas are the most common extranodal non-Hodgkin's lymphomas and are divided into indolent (low grade) and aggressive (high grade) types. They are mainly the disease of middle age, with a male predominance reported by most of the studies. For several years, surgery played a central role in diagnosis, staging, and treatment of this entity, yet recently there has been a move away from a surgical approach to conservative treatment. To determine the role of surgery as the initial treatment modality, we performed this retrospective single-center research on 245 patients with primary gastric lymphoma who were treated according to our protocol between 1990 and 2003. The patients' characteristics, distribution of histological types, treatment results, and disease-specific survival were followed. According to the histology, 59.2% had diffuse large B-cell lymphoma (DLCL), 26.1% MALT lymphoma, 9.8% mixed lymphoma (indolent and aggressive at the same time), while other types were infrequent. In total, 161 patients (65.7%) were treated with surgical resection as the initial treatment, which was then followed or not by additional therapy (chemotherapy, chemotherapy and radiotherapy, radiotherapy) depending on the histological type of lymphoma and the extent of residual disease after surgery. In 84 patients (34.3%), the treatment approach was conservative. The selection of treatment (chemotherapy, chemotherapy and radiotherapy, radiotherapy or Helicobacter pylori eradication only) was based on the histological type of lymphoma, considering also the patients' physical condition. The disease-specific survival in the group of patients who underwent surgery was statistically significantly better than in patients who were treated conservatively (p=0.049). At 5 years, it was 96.9% for the group treated with surgery and 89.8% in patients treated conservatively. However, the results were biased, as the patients who were treated conservatively were either in a worse performance status or presented with a more extensive disease. Similarly, in the DLCL type the disease-specific survival was better in the surgically treated group (97.2%) than in the conservatively treated patients (89.2%). The difference was barely significant (p=0.046) and again the results have to be considered with caution due to the selection of patients in a worse performance status or with a more extensive disease for conservative treatment. In the MALT lymphoma and mixed lymphoma types, there were no differences in the disease-specific survival between both treatment groups. Regarding the statement that for conservative treatment patients were selected who were unsuitable for the resection on account of concomitant diseases or due to the fact that the process was inoperable, we believe that the conservative approach gives comparable outcomes to the approach including initial surgery. The existing evidence thus no longer justifies surgery as the standard initial treatment and preference should be given to conservative treatment approaches. PMID:16944146
Jezersek Novakovi?, Barbara; Vovk, Marjeta; Juznic Setina, Tanja
Summary 1.Mechanical and chemical sensitivity of the palatine nerve, ramus palatinus facialis, innervating the anterior palate of the puffer,Fugu pardalis, and their central projection to the primary taste center were investigated.2.Application of horseradish peroxidase (HRP) to the central cut end of the palatine nerve resulted in retrogradely labeled neurons in the geniculate ganglion but no such neurons in the trigeminal
Sadao Kiyohara; Iwao Hidaka; Junzoh Kitoh; Satoru Yamashita
Eight to 10% of children in Sweden have asthma. The majority of these children are followed and treated in primary health care centers (PHCs). Many studies show poor compliance to written guidelines [1,2]. The purpose of this study was to evaluate whether or not the method of interactive case-based education [3] combined with audit\\/feedback [4], leads to a better quality
Maria Ingemansson; Marina Jonsson; Gunilla Hedlin
Endochondral ossification in a case of progressive osseous heteroplasia in a young female child.
Progressive osseous heteroplasia (POH) (OMIM 166350) is a rare autosomal dominant condition, characterized by heterotopic ossification of the skin, subcutaneous fat, and deep connective tissue. This condition is distinct from Albright's hereditary osteodystrophy or McCune Albright syndrome (OMIM 103580) and fibrodysplasia ossificans progressiva (OMIM 135100). We present an unusual presentation of POH in a 7-year-old female child. The clinical features included a painful swelling on the left foot, with mechanical complaints. There was no congenital hallux valgus. Family anamnesis was positive in the father. There were subcutaneous ossifications of his left upper arm, right-sided thorax, and lateral side of the right ankle. The father did not allow any radiographs or further examinations. Radiographic examination of the patient revealed ossified subcutaneous plaques on the left foot, lumbar spine, and left scapulae. Additional blood samples were analyzed, revealing no pseudohypoparathyroidism. Sequence analysis of the gene associated with POH, the GNAS1 gene, revealed the heterozygote mutation c.565_568del, previously found in Albright's hereditary osteodystrophy. Histopathological examination of the subcutaneous ossification showed presence of chondrocyte clusters, a feature usually found in fibrodysplasia ossificans progressiva. The combination of the clinical features, the absence of pseudohypoparathyroidism, histology revealing chondrocyte clusters, and the specific GNAS mutation in this patient makes this a truly unusual presentation of POH. The findings in the described case might denote subdivisions of POH. The condition is associated with progressive superficial to deep ossification, progressive restriction of range of motion, and recurrence if excised. We hope to inform pediatricians and orthopedic surgeons to create more awareness of this disorder so that unnecessary treatments can be avoided and proper counseling offered. PMID:24626099
Schrander, Dirk E; Welting, Tim J; Caron, Marjolein M J; Schrander, Jaap J P; van Rhijn, Lodewijk W; K÷rver-Keularts, Inge; Schrander-Stumpel, Constance T R M
The developmental anatomy of the proximal femur is complex. In some mammals, including humans, the femoral head and greater trochanter emerge as separate ossification centres within a common chondroepiphysis and remain separate throughout ontogeny. In other species, these secondary centres coalesce within the chondroepiphysis to form a single osseous epiphysis much like the proximal humerus. These differences in femoral ontogeny have not been previously addressed, yet are critical to an understanding of femoral mineralization and architecture across a wide range of mammals and may have key implications for understanding and treating hip abnormalities in humans. We evaluated femora from 70 mammalian species and categorized each according to the presence of a æseparateÆ or æcoalescedÆ proximal epiphysis based on visual assessment. We found that ossification type varies widely among mammals: taxa in the æcoalescedÆ group include marsupials, artiodactyls, perissodactyls, bats, carnivores and several primates, while the æseparateÆ group includes hominoids, many rodents, tree shrews and several marine species. There was no clear relationship to body size, phylogeny or locomotion, but qualitative and quantitative differences between the groups suggest that ossification type may be primarily an artefact of femoral shape and neck length. As some osseous abnormalities of the human hip appear to mimic the normal morphology of species with coalesced epiphyses, these results may provide insight into the aetiology and treatment of human hip disorders such as femoroacetabular impingement and early-onset osteoarthritis. PMID:17331175
Serrat, Maria A; Reno, Philip L; McCollum, Melanie A; Meindl, Richard S; Lovejoy, C Owen
In contrast to nodal follicular lymphoma, limited data exist on genetic changes in primary cutaneous follicular lymphoma (primary cutaneous follicle center lymphoma according to WHO-EORTC). The detection rate of the BCL2 rearrangement, representing the characteristic t(14;18)(q32;q21) underlying follicular lymphoma, by polymerase chain reaction (PCR) has been reported to vary over a wide range (0%-41%), and only a few cases have been studied by molecular cytogenetic techniques such as fluorescence in situ hybridization (FISH). In this study, 27 primary cutaneous follicle center lymphomas were analyzed by FISH and the results compared with those obtained by PCR. FISH demonstrated translocations affecting the immunoglobulin heavy chain locus (IGH) in 14 of 27 cases (52%): a t(14;18)(q32;q21) involving BCL2 was found in 11 cases (41%), a t(3;14)(q27;q32) affecting BCL6 in 2 cases (7%), and in 1 case the partner gene of IGH could not be identified. Interestingly, PCR did not detect BCL2 rearrangement in any case. These data suggest that the t(14;18)(q32;q21) frequently occurs in primary cutaneous follicular lymphoma. The reason(s) why BCL2 rearrangements escape the detection by PCR is (are) not clear but could be due to BCL2 mutations, breakpoints outside the amplified DNA, or a high load of somatic mutations. PMID:16625101
Streubel, Berthold; Scheucher, Brigitte; Valencak, Julia; Huber, Daniela; Petzelbauer, Peter; Trautinger, Franz; Weihsengruber, Felix; Mannhalter, Christine; Cerroni, Lorenzo; Chott, Andreas
Thin-slice computed tomography provides the imaging modality of choice in analysing the ossification process of the medial\\u000a clavicular epiphysis for the purpose of forensic age diagnostics in the living in the course of criminal proceedings. The\\u000a classification of the ossification stages by Schmeling et al. compass the emergence of an epiphyseal ossification centre (stage\\u000a 2), the partial fusion of the
Manuel Kellinghaus; Ronald Schulz; Volker Vieth; Sven Schmidt; Heidi Pfeiffer; Andreas Schmeling
Aim: Certification of breast centers helps improve the quality of care but requires additional resources, particularly for documentation. There are currently no published data on the actual staff costs and financial resources required for such documentation. The aim of this study was to determine the time and resources required to document a patient with primary breast cancer from diagnosis to the end of follow-up, to establish a database for future strategic decisions. Material and Methods: All diagnostic and therapeutic procedures of patients with primary breast cancer were recorded at the University Breast Center of Franconia. All time points for documentation were evaluated using structured interviews. The times required to document a representative number of patients were determined and combined with the staff costs of the different professional groups, to calculate the financial resources required for documentation. Results: A total of 494 time points for documentation were identified. The study also identified 21 departments and 20 different professional groups involved in the documentation. The majority (54?%) of documentation was done by physicians. 62?% of all documentation involved outpatients. The results of different scenarios for the diagnosis, therapy and follow-up of breast cancer patients in a certified breast center showed that the time required for documentation can be as much as 105 hours, costing Ć?4135. Conclusion: This analysis shows the substantial staffing and financial costs required for documentation in certified centers. A multi-center study will be carried out to compare the costs for certified breast centers of varying sizes with the costs of non-certified care facilities. PMID:25221342
Lux, M. P.; Sell, C. S.; Fasching, P. A.; Seidl-Ertel, J.; Bani, M. R.; Schrauder, M. G.; Jud, S. M.; Loehberg, C. R.; Rauh, C.; Hartmann, A.; Schulz-Wendtland, R.; Strnad, V.; Beckmann, M. W.
Aim. To evaluate the technical success and patency rates following primary cutting balloon angioplasty for venous stenoses in native dialysis fistulas. Methods. Forty-one patients (26 men, 15 women; age range 26-82 years, average age 59 years) underwent 50 (repeat procedures in 9 patients) primary cutting balloon (PCB) angioplasty procedures in three institutions by three primary operators. The indication was primary stenosis in 21 patients, recurrent lesions in 15, and immature fistulas in 5. A PCB was used alone in 17 cases, but was followed by a larger standard balloon in 33 cases. Follow-up included ultrasound, flow analysis and urea reduction ratio, and ranged from 2 to 30 months (mean 14 months). Results. The technical success rate was 98%. All procedures were relatively painless. Two PCBs burst and 4 leaked, but without causing any morbidity. Nineteen fistulas were still working at last follow-up. Primary patency rates at 6, 12, and 24 months using Kaplan-Meier analysis were 88%, 73%, and 34%, respectively, and the primary assisted patencies were 90%, 75%, and 50%, respectively. Conclusion. PCB angioplasty has high technical success and low complication rates. The long-term patency rates are favorable for PCB angioplasty and compare favorably with other series.
Bhat, Rajesh [Ninewells Hospital, Department of Clinical Radiology (United Kingdom)], E-mail: email@example.com; McBride, Kieran [Queen Margaret Hospital (United Kingdom); Chakraverty, Sam; Vikram, Raghunandan; Severn, Alison [Ninewells Hospital, Department of Clinical Radiology (United Kingdom)
BACKGROUND: Fever is a common reason for attending primary health facilities in Vietnam. Response of health care providers to patients with fever commonly consists of making a presumptive diagnosis and proposing corresponding treatment. In Vietnam, where malaria was brought under control, viral infections, notably dengue, are the main causes of undifferentiated fever but they are often misdiagnosed and inappropriately treated
Hoang L Phuong; Tran TT Nga; Phan T Giao; Le Q Hung; Tran Q Binh; Nguyen V Nam; Nico Nagelkerke; Peter J de Vries
ERIC Educational Resources Information Center
Purpose: To assess, in the context of Primary Health Care (PHC), the effect of a psychological intervention in mental health among caregivers (CGs) of dependent relatives. Design and Methods: Randomized multicenter, controlled clinical trial. The 125 CGs included in the trial were receiving health care in PHC. Inclusion criteria: Identifyingģ
Rodriguez-Sanchez, Emiliano; Patino-Alonso, Maria C.; Mora-Simon, Sara; Gomez-Marcos, Manuel A.; Perez-Penaranda, Anibal; Losada-Baltar, Andres; Garcia-Ortiz, Luis
ERIC Educational Resources Information Center
This directory identifies 254 Community and Migrant Health Centers (C/MHC) and Health Care for the Homeless (HCH) programs in 10 regions of the United States that, in response to local requests and with mostly local resources, developed either school-based or school-linked health programs. Each listing provides information under the followingģ
Health Resources and Services Administration (DHHS/PHS), Rockville, MD. Bureau of Primary Health Care.
photosynthesis has, thus far, remained unexplored as reaction center chlorophyll a (Chl a) complexes have not yet. In green plants, there are two photochemical systems and two light reactions [6,7] . Light reaction II of the products oxidized by light reaction I. (Reviewed * Present address: Argonne National Laboratory, Chemistry
Objective To present a partnership-based and community-oriented approach designed to ease provider anxiety and facilitate the implementation of electronic health records (EHR) in resource-limited primary care settings. Materials and Methods The approach, referred to as partnership model, was developed and iteratively refined through the research team's previous work on implementing health information technology (HIT) in over 30 safety net practices. This paper uses two case studies to illustrate how the model was applied to help two nurse-managed health centers (NMHC), a particularly vulnerable primary care setting, implement EHR and get prepared to meet the meaningful use criteria. Results The strong focus of the model on continuous quality improvement led to eventual implementation success at both sites, despite difficulties encountered during the initial stages of the project. Discussion There has been a lack of research, particularly in resource-limited primary care settings, on strategies for abating provider anxiety and preparing them to manage complex changes associated with EHR uptake. The partnership model described in this paper may provide useful insights into the work shepherded by HIT regional extension centers dedicated to supporting resource-limited communities disproportionally affected by EHR adoption barriers. Conclusion NMHC, similar to other primary care settings, are often poorly resourced, understaffed, and lack the necessary expertise to deploy EHR and integrate its use into their day-to-day practice. This study demonstrates that implementation of EHR, a prerequisite to meaningful use, can be successfully achieved in this setting, and partnership efforts extending far beyond the initial software deployment stage may be the key. PMID:21828225
Dennehy, Patricia; White, Mary P; Hamilton, Andrew; Pohl, Joanne M; Tanner, Clare; Onifade, Tiffiani J
Sonographic assessment of the ossification of the medial clavicular epiphysis in 616 individuals.
Establishing radiation-free imaging methods for the assessment of clavicular ossification in forensic age determination is desirable as it reduces radiation exposure in living individuals. For this purpose the stage of ossification of the right medial clavicular epiphysis was determined prospectively using sonography in 309 male and 307 female healthy volunteers. The classification of stages according to Schulz et al. was used for this purpose. Stage 2 was first noticed at the age of 14.4 years in males, and at the age of 14.1 years in females. Stage 3 was first achieved by males at the age of 17.6 years and by females at the age of 17.4 years. Stage 4 first occurred in males at the age of 19.3 years and at the age of 18.9 years in females. The mean age for stage 1 was 13.6 years. The mean age of stage 2 ranged between 17.3 and 17.6 years. For stage 3 the mean age varied from 20.7 to 21.2 years, and for stage 4 from 23.3 to 23.5 years. It was concluded that sonographically determined stage 4 clavicular ossification provides evidence for the completion of the nineteenth year of life in males and the eighteenth year of life in females. In order to increase the reliability of age determination using this method it is recommended that findings be recorded by at least two experienced independent examiners who then reach a consensus. PMID:23615796
Schulz, Ronald; Schiborr, Manfred; Pfeiffer, Heidi; Schmidt, Sven; Schmeling, Andreas
The recently increased interest in studies on sequence heterochrony has uncovered developmental variation between species. However, how changes in developmental program are related to shifts in life-history parameters remains largely unsolved. Here we provide the most comprehensive data to date on postcranial ossification sequence of bats and compare them to various boreoeutherian mammals with different locomotive modes. Given that bats are equipped with an elongated manus, we expected to detect characteristic heterochronies particularly related to wing development. Although heterochronies related to wing development were confirmed as predicted, unexpected heterochronies regarding the pedal digits were also found. The timing of ossification onset of pedal phalanges is earlier than other mammals. Particularly, bats deviate from others in that pedal phalanges initiate ossification earlier than manual phalanges. It is known that the foot size of new born bats is close to that of adults, and that it takes several weeks to month until the wing is developed for flight. Given that the foot is required to be firm and stable enough at the time of birth to allow continued attachment to the mother and/or cave walls, we suggest that the accelerated development of the hind foot is linked to their unique life history. Since the forelimb is not mature enough for flight at birth and requires extended postnatal time to be large enough to be fully functional, we postulate that bats invest in earlier development of the hindlimb. We conclud that energy allocation trade-offs can play a significant role in shaping the evolution of development. J. Exp. Zool. (Mol. Dev. Evol.) 322B: 607-618, 2014. ® 2014 Wiley Periodicals, Inc. PMID:24863050
Koyabu, Daisuke; Son, Nguyen Truong
Recent reports have noted higher rates of heterotopic ossification (HO) with surface replacement arthroplasty (SRA) than with traditional total hip arthroplasty in the absence of postoperative HO prophylaxis. This study reports rates and grades of HO in 44 SRA patients with at least 1 year of follow-up. Heterotopic ossification prophylaxis was used in 32 (73%) of 44 cases. Heterotopic ossification prophylaxis consisted of radiotherapy (22/32), nonsteroidal anti-inflammatory drugs (8/32), or both (2/32). One case of clinically significant HO was documented in the no-prophylaxis group. This strategy of selective HO prophylaxis in patients felt by orthopedic surgeons to be at high risk of HO resulted in low rates of clinically relevant HO after SRA (1/44, 2.3%). Further study is needed to establish optimal selection criteria for HO prophylaxis after SRA. PMID:22245125
Kruser, Tim J.; Kozak, Kevin R.; Cannon, Donald M.; Platta, Christopher S.; Heiner, John P.; Illgen, Richard L.
A 50-year-old woman developed discomfort of oral cavity and dysarthria. Her tongue showed a slight left-deviation and atrophy in the left side in a month. Examination with X-p, CT, and MRI showed hypoplasia of the atlas and high cervical ossification of the posterior longitudinal ligament (OPLL) from C1 to C5. Thus, combination of congenital hypoplasia of the atlas and acquired high cervical OPLL reduced a function of hypoglossal nerve, which resulted in the palsy. In a case of unilateral hypoglossal palsy, a possible lesion of foramen magnum should be considered. PMID:12833884
Deguchi, Kentaro; Manabe, Yasuhiro; Takahashi, Koji; Ota, Taisei; Takamatsu, Kazuhiro; Ida, Kentaro; Ota, Kosuke; Abe, Koji
Background Primary testicular diffuse large B-cell lymphoma (DLBCL) is a rare but aggressive extranodal lymphoma, and its relapse in the central nervous system (CNS) is a major concern during treatment. Despite this, the role of intrathecal prophylaxis in primary testicular DLBCL remains controversial. Methods We retrospectively reviewed the medical records of 14 patients with primary testicular DLBCL diagnosed between November 2000 and June 2012, and analyzed the CNS relapse rate in patients treated without intrathecal prophylaxis. Survival curves were estimated using the Kaplan-Meier method. Results The median age at diagnosis was 57 years (range, 41-79 years). Unilateral testicular involvement was observed in 13 patients. Nine patients had stage I, 1 had stage II, and 4 had stage IV disease. The international prognostic index was low or low-intermediate risk in 12 patients and high-intermediate risk in 2 patients. Thirteen patients underwent orchiectomy. All the patients received systemic chemotherapy without intrathecal prophylaxis, and prophylactic radiotherapy was administered to the contralateral testis in 12 patients. The median follow-up period of surviving patients was 39 months (range, 10-139 months). Median overall survival was not reached and the median progression-free survival was 3.8 years. Four patients experienced relapse, but CNS relapse was observed in only one patient (7.1%) with stage IV disease, 27 months after a complete response. Conclusion Even without intrathecal prophylaxis, the rate of relapse in the CNS was lower in the Korean patients with primary testicular DLBCL compared to prior reports. PMID:25325036
Kim, Jeongseok; Yoon, Dok Hyun; Park, Inkeun; Kim, Shin; Park, Jung Sun; Lee, Sang-Wook; Huh, Jooryung; Park, Chan-Sik
ZDHHC13 is a member of DHHC-containing palmitoyl acyltransferases (PATs) family of enzymes. It functions by post-translationally adding 16-carbon palmitate to proteins through a thioester linkage. We have previously shown that mice carrying a recessive Zdhhc13 nonsense mutation causing a Zdhcc13 deficiency develop alopecia, amyloidosis and osteoporosis. Our goal was to investigate the pathogenic mechanism of osteoporosis in the context of this mutation in mice. Body size, skeletal structure and trabecular bone were similar in Zdhhc13 WT and mutant mice at birth. Growth retardation and delayed secondary ossification center formation were first observed at day 10 and at 4 weeks of age, disorganization in growth plate structure and osteoporosis became evident in mutant mice. Serial microCT from 4-20 week-olds revealed that Zdhhc13 mutant mice had reduced bone mineral density. Through co-immunoprecipitation and acyl-biotin exchange, MT1-MMP was identified as a direct substrate of ZDHHC13. In cells, reduction of MT1-MMP palmitoylation affected its subcellular distribution and was associated with decreased VEGF and osteocalcin expression in chondrocytes and osteoblasts. In Zdhhc13 mutant mice epiphysis where MT1-MMP was under palmitoylated, VEGF in hypertrophic chondrocytes and osteocalcin at the cartilage-bone interface were reduced based on immunohistochemical analyses. Our results suggest that Zdhhc13 is a novel regulator of postnatal skeletal development and bone mass acquisition. To our knowledge, these are the first data to suggest that ZDHHC13-mediated MT1-MMP palmitoylation is a key modulator of bone homeostasis. These data may provide novel insights into the role of palmitoylation in the pathogenesis of human osteoporosis. PMID:24637783
Song, I-Wen; Li, Wei-Ru; Chen, Li-Ying; Shen, Li-Fen; Liu, Kai-Ming; Yen, Jeffrey J. Y.; Chen, Yi-Ju; Chen, Yu-Ju; Kraus, Virginia Byers; Wu, Jer-Yuarn; Lee, M. T. Michael; Chen, Yuan-Tsong
This study reports the effectiveness of the Houston Parent-Child Development Center (PCDC) program for preventing behavior problems in young children. The PCDC is a 2-year, intensive parent-child education program for children ages 1-3 and their parents. Low-income Mexican American families were randomly assigned to program or control groups. A follow-up of the program 1-4years later, when children averaged 5Į years
Dale L. Johnson; James N. Breckenridge
Background: Osteoporosis is a serious public health. Since the majority of bone mass occurs during adolescence, primary prevention is important. Probably mother's participation in health education interventions leads to promote health behaviors in children. Aims: To assess a lifestyle modification intervention focused on mothers and students has an impact on osteoporosis preventive behaviors in adolescent girls. Materials and Methods: It is a randomized field trial in female high schools. 210 girls aged between 11 and 15 were randomly selected. Students in groups A and C and mothers in group B were selected Through the sampling frame. Our lifestyle modification was based on group based education in the public girlsÆ high schools. Subjects in the intervention groups participated in three educational sessions. StudentsÆ osteoporosis preventive behaviors were measured by using a lifestyle questionnaire consisting of items assessing nutrition, physical activity and sun exposure. Repeated measure ANOVA at baseline, 4 week, 2 months and 6 months and were used to analyze the data. Results: After 1 month, diet and sun exposure scores increased significantly (P < 0.001) but it was higher in group B compared with group A. (About diet P < 0.001 and sun exposure = 0. 001). After 6 months, diet and sun exposure status in the group A approximately decreased to baseline, while in group B, diet components were significantly different compared to baseline (P < 0.001). There was no change in physical activity. Conclusion: Osteoporosis prevention intervention of adolescent can be effective when parents or girls participate in training sessions, but education is associated with better outcomes when focused on mothers.
Ansari, Hourieh; Farajzadegan, Ziba; Hajigholami, Ali; Paknahad, Zamzam
In 2011 and 2012, 147 patients in urban United States Community Health Centers who misused drugs, but did not meet criteria for drug dependence, received a brief intervention as part of a National Institute on Drug Abuse-funded clinical trial of a screening and brief intervention protocol. Potential study participants were identified using the World Health Organization (WHO) Alcohol, Smoking, and Substance Involvement Screening Test. Data gathered during brief interventions were analyzed using grounded theory strategies to identify barriers patients believed inhibited drug use behavior change. Numerous perceived barriers to drug use behavior change were identified. Study implications and limitations are discussed. PMID:24354547
Padwa, Howard; Ni, Yu-Ming; Barth-Rogers, Yohanna; Arangua, Lisa; Andersen, Ronald; Gelberg, Lillian
A 32-year-old lady presented to our clinic with persistent painful restriction of her dominant forearm movements for three months after tension band wiring of olecranon. She had full elbow flexion and extension; however, her forearm rotations were restricted and painful. Investigations revealed prominent tips of the wire, eroding the radial tuberosity with heterotopic ossification between the radius and ulna. As there was no synostosis, the patient had implant exit. During surgery, before implant removal, examination under anaesthesia revealed a mechanical block of the rotation beyond 30░ on pronation and supination from neutral. However, after the removal of implant, the mechanical block eased off and with gentle manipulation, full pronation and supination were achieved. At the final follow-up at 6Āmonths, the patient had full pain-free forearm rotation with regression of heterotopic ossification. Our case report highlights the importance of intra-operative assessment of wire tips at full supination and pronation, and in patients with restricted forearm rotation, CT scan may be needed to assess the position of the hardware is essential as it can progress to synostosis. In cases with prominent hardware, removal of the implant may suffice if performed before the development of synostosis. PMID:25063222
Karthik, Karuppaiah; Tahmassebi, Ramon; Tavakkolizadeh, Adel; Compson, Jonathan
The use of spect/ct in the evaluation of heterotopic ossification in para/tetraplegics
Objective: To evaluate the stage of maturation and the metabolism of neurogenic heterotopic ossification by using SPECT/CT. Methods: A total of 12 medical records of patients with spinal cord injury, all of them classified according to the ASIA protocol (disability scale from the American Spinal Injury Association) in complete lesion (A) and partial lesions (B, C and D) and registered at the Laboratory of Biomechanics and Rehabilitation of the Locomotor System, were submitted to SPECT/CT evaluation. Results: Sixteen hips with heterotopic ossification observed in X-ray were studied and only two (12.5%) had high osteoblastic activity. Five hips showed medium activity, three (18.75%) low activity and six (37.5%) did not present any activity detected by SPECT/CT. Conclusion: SPECT/CT helps to determinate which patients have a greater risk of relapse after surgical resection, proving to be a useful imaging study in preoperative evaluation that can be used to determinate the postoperative prognosis of these patients. Level of Evidence III, Investigating a Diagnostic Test. PMID:24644413
Lima, Mauricio Coelho; Passarelli, Marcus Ceregati; Dario, Virgilio; Lebani, Bruno Rodrigues; Monteiro, Paulo Henrique Silva; Ramos, Celso Dario
The potential presence of developmental modules is studied in the urodele skull using several classical statistical methods that have not previously been used in this context. Principal component analysis (PCA) of ossification sequence data on 21 bones in 21 extant urodele species suggests the presence of up to four developmental modules, but examination of statistically significant correlations using phylogenetic independent contrasts (PIC) and correcting for multiple tests using the false discovery rate suggests the presence of only two modules of uneven size and of two bones that may not be part of these modules. Thus, PCA does not appear to be a reliable method to investigate modularity; direct investigation of statistically significant correlations using PIC or other phylogeny-informed methods is recommended. A binomial test of the distribution of significant correlations between characters shows significant heterogeneity, which suggests that modularity is indeed present in the data. A cluster analysis gives inconsistent results that apparently do not reflect developmental modules. The data include a phylogenetic signal, as shown by a permutation-based test with squared change parsimony, but this is detectable only when the whole matrix is analyzed, and a plot of the tree onto developmental space through Evolutionary PCA shows that homoplasy is pervasive. Evolutionary rates between characters vary about 90-fold. Canonical variates analyses suggest that obligatorily neotenic urodeles may be discriminated from other urodeles on the basis of cranial ossification sequence data. J. Exp. Zool. (Mol. Dev. Evol.) 322B: 567-585, 2014. ® 2014 Wiley Periodicals, Inc. PMID:24816835
Laurin, Michel
Activating transcription factor 4 (Atf4) is a leucine-zipper-containing protein of the cAMP response element-binding protein (CREB) family. Ablation of Atf4 (Atf4(-/-)) in mice leads to severe skeletal defects, including delayed ossification and low bone mass, short stature and short limbs. Atf4 is expressed in proliferative and prehypertrophic growth plate chondrocytes, suggesting an autonomous function of Atf4 in chondrocytes during endochondral ossification. In Atf4(-/-) growth plate, the typical columnar structure of proliferative chondrocytes is disturbed. The proliferative zone is shortened, whereas the hypertrophic zone is transiently expanded. The expression of Indian hedgehog (Ihh) is markedly decreased, whereas the expression of other chondrocyte marker genes, such as type II collagen (Col2a1), PTH/PTHrP receptor (Pth1r) and type X collagen (Col10a1), is normal. Furthermore, forced expression of Atf4 in chondrocytes induces endogenous Ihh mRNA, and Atf4 directly binds to the Ihh promoter and activates its transcription. Supporting these findings, reactivation of Hh signaling pharmacologically in mouse limb explants corrects the Atf4(-/-) chondrocyte proliferation and short limb phenotypes. This study thus identifies Atf4 as a novel transcriptional activator of Ihh in chondrocytes that paces longitudinal bone growth by controlling growth plate chondrocyte proliferation and differentiation. PMID:19906842
Wang, Weiguang; Lian, Na; Li, Lingzhen; Moss, Heather E; Wang, Weixi; Perrien, Daniel S; Elefteriou, Florent; Yang, Xiangli
In 2002, the British Columbia Ministry of Health and the British Columbia Medical Association (now Doctors of BC) came together to form the British Columbia General Practice Services Committee to bring about transformative change in primary care in British Columbia, Canada. This committeeÆs approach to primary care was to respond to an operational problemŚthe decline of family practice in British ColumbiaŚwith an operational solutionŚassist general practitioners to provide better care by introducing new incentive fees into the fee-for-service payment schedule, and by providing additional training to general practitioners. This may be referred to as a ōsoft powerö approach, which can be summarized in the abbreviation RISQ: focus on Relationships; provide Incentives for general practitioners to spend more time with their patients and provide guidelines-based care; Support general practitioners by developing learning modules to improve their practices; and, through the incentive payments and learning modules, provide better Quality care to patients and improved satisfaction to physicians. There are many similarities between the British Columbian approach to primary care and the US patient-centered medical home. PMID:24867550
MacCarthy, Dan; Hollander, Marcus J
In order to analyze the clinical features, approach and treatment of patients with acute primary headaches seen at the Clinics Hospital of the Federal University of UberlŌndia (HC-UFU) throughout 2005, the medical charts of 109 patients were evaluated through a standardized questionnaire as to age, gender, main diagnosis, characteristics of the headache attacks, diagnostic tests and treatment. Probable migraine was the most common type of primary headache (47.7%), followed by probable tension-type headache (37.6%), unspecified headache (11.9%), and headache not elsewhere classified (2.8%). As to characteristics of the crisis, the location of the pain was described in 86.2% of the patients. The most commonly used drugs for treatment of acute headache attacks were dipyrone (74.5%), tenoxicam (31.8%), diazepam (20.9%), dimenhydrate (10.9%), and metochlopramide (9.9%). The data collected are in agreement with those reported in literature. In most cases, treatment was not what is recommended by consensus or clinical studies with appropriate methodology. Therefore, we suggest the introduction of a specific acute headache management protocol which could facilitate the diagnosis, treatment and management of these patients. PMID:18345416
Ruiz Jr, Facundo Burgos; Santos, Mßrcia Silva; Siqueira, Helen Souto; Cotta, Ulisses Correa
Background In 2009, the Lebanese Ministry of Public Health (MOPH) launched the Primary Healthcare (PHC) accreditation program to improve quality across the continuum of care. The MOPH, with the support of Accreditation Canada, conducted the accreditation survey in 25 PHC centers in 2012. This paper aims to gain a better understanding of the impact of accreditation on quality of care as perceived by PHC staff members and directors; how accreditation affected staff and patient satisfaction; key enablers, challenges and strategies to improve implementation of accreditation in PHC. Methods The study was conducted in 25 PHC centers using a cross-sectional mixed methods approach; all staff members were surveyed using a self-administered questionnaire whereas semi-structured interviews were conducted with directors. Results The scales measuring Management and Leadership had the highest mean score followed by Accreditation Impact, Human Resource Utilization, and Customer Satisfaction. Regression analysis showed that Strategic Quality Planning, Customer Satisfaction and Staff Involvement were associated with a perception of higher Quality Results. Directors emphasized the benefits of accreditation with regards to documentation, reinforcement of quality standards, strengthened relationships between PHC centers and multiple stakeholders and improved staff and patient satisfaction. Challenges encountered included limited financial resources, poor infrastructure, and staff shortages. Conclusions To better respond to population health needs, accreditation is an important first step towards improving the quality of PHC delivery arrangement system. While there is a need to expand the implementation of accreditation to cover all PHC centers in Lebanon, considerations should be given to strengthening their financial arrangements as well. PMID:24568632
Dysregulated cell growth or differentiation due to mis- expression of developmental critical factors seems to be a decisive event in oncogenesis. As osteosarcomas are histologically defined by malignant osteoblasts pro- ducing an osteoid component, we prospected in pe- diatric osteosarcomas treated with OS94 protocol the genomic status of several genes implied in ossification processes. In 91 osteosarcoma cases, we focused
Natacha Entz-Werle; Thomas Lavaux; Nadia Metzger; Corinne Stoetzel; Christelle Lasthaus; Perrine Marec; Chantal Kalifa; Laurence Brugieres; HķlĶne Pacquement; Claudine Schmitt; Marie-Dominique Tabone; Jean-Claude Gentet; Patrick Lutz; Annie Babin; Pierre Oudet; Marie-Pierre Gaub; Fabienne Perrin-Schmitt
The hypotheses of relationships within Lari (gulls) are highly unstable, and depend on whether morphological or molecular data are examined. Developmental sequence data are thought to contain phylogenetic information, but have never been applied to the problem of avian systematics. In this article, we describe the ossification sequence of the Common Tern (Sterna hirundo), and compare the pattern observed to published descriptions of other Charadriiformes, specifically the Great Skua (Stercorariidae) and various species of gulls (Laridae). We use changes in ossification sequence to elucidate the relationship between these three taxa, using both qualitative and systematic approaches. The first analysis of the ossification sequence data does not support a close relationship between Stercorariidae and Laridae, as has been proposed in some morphological analyses; however it was unable to differentiate between a Laridae-Sternidae sister-group relationship or a Sternidae-Stercorariidae sister-group relationship. The second analysis was unable to differentiate between any topology, including a polytomy, for these taxa. These results highlight the potential for use of ossification sequence data in an evolutionary context but caution that analyses are highly dependent on sequence resolution and the taxonomic level of the data set. PMID:18570230
Maxwell, Erin E; Harrison, Luke B
Progressive osseous heteroplasia (POH) is a rare, disabling disease of heterotopic ossification (HO) that progresses from skin and subcutaneous tissues into deep skeletal muscle. POH occurs in the absence of multiple developmental features of Albright hereditary osteodystrophy (AHO) or hormone resistance, clinical manifestations that are also associated with GNAS inactivation. However, occasional patients with AHO and pseudohypoparathyroidism 1a/c (PHP1a/c; AHO features plus hormone resistance) have also been described who have progressive HO. This study was undertaken to define the diagnostic and mutational spectrum of POH and progressive disorders of HO, and to distinguish them from related disorders in which HO remains confined to the skin and subcutaneous tissues. We reviewed the charts of 111 individuals who had cutaneous and subcutaneous ossification. All patients were assessed for eight characteristics: age of onset of HO, presence and location of HO, depth of HO, type of HO, progression of HO, features of AHO, PTH resistance, and GNAS mutation analysis. We found, based on clinical criteria that POH and progressive HO syndromes are at the severe end of a phenotypic spectrum of GNAS-inactivating conditions associated with extra-skeletal ossification. While most individuals with superficial or progressive ossification had mutations in GNAS, there were no specific genotype-phenotype correlations that distinguished the more progressive forms of HO (e.g., POH) from the non-progressive forms (osteoma cutis, AHO, and PHP1a/c). PMID:18553568
Adegbite, N. S.; Xu, M.; Kaplan, F. S.; Shore, E. M.; Pignolo, R. J.
In patients who have fibrodysplasia ossificans progressiva, routine childhood diphtheria-tetanus-pertussis immunizations administered by intramuscular injection caused a significant risk of permanent heterotopic ossification at the site of injection ( p <10 \\\\-8 ), whereas measles-mumps-rubella immunizations administered by subcutaneous injection posed no significant risk. Intramuscular injections should be avoided, if possible, once a diagnosis of fibrodysplasia ossificans progressiva has been
Thomas F. Lanchoney; Randolph B. Cohen; David M. Rocke; Michael A. Zasloff; Frederick S. Kaplan
Interspecific comparisons suggest that a trade-off exists between development and somatic growth rate. We provide evidence for a trade-off between cranial ossification and growth rate within a single species, the pumpkinseed sunfish (Lepomis gibbosus). We compare fish derived from two populations known to differ in their somatic growth rates. Fish were hatched from eggs and maintained under common conditions. Juveniles
Jeffrey D. Arendt; David S. Wilson
Background The objectives of this paper are: (1) to study the feasibility and relative benefits of integrating the prevention of parent-to-child transmission (PPTCT) component of the National AIDS Control Program with the maternal and child health component of the National Rural Health Mission (NRHM) by offering HIV screening at the primary healthcare level; and (2) to estimate the incremental cost-effectiveness ratio to understand whether the costs are commensurate with the benefits. Methods The intervention included advocacy with political, administrative/health heads, and capacity building of health staff in Satara district, Maharashtra, India. The intervention also conducted biannual outreach activities at primary health centers (PHCs)/sub-centers (SCs); initiated facility-based integrated counseling and testing centers (FICTCs) at all round-the-clock PHCs; made the existing FICTCs functional and trained PHC nurses in HIV screening. All ōfunctionalö FICTCs were equipped to screen for HIV and trained staff provided counseling and conducted HIV testing as per the national protocol. Data were collected pre- and post- integration on the number of pregnant women screened for HIV, the number of functional FICTCs and intervention costs. Trend analyses on various outcome measures were conducted. Further, the incremental cost-effectiveness ratio per pregnant woman screened was calculated. Results An additional 27% of HIV-infected women were detected during the intervention period as the annual HIV screening increased from pre- to post-intervention (55% to 79%, p?0.001) among antenatal care (ANC) attendees under the NRHM. A greater increase in HIV screening was observed in PHCs/SCs. The proportions of functional FICTCs increased from 47% to 97% (p?0.001). Additionally, 93% of HIV-infected pregnant women were linked to anti-retroviral therapy centers; 92% of mother-baby pairs received Nevirapine; and 89% of exposed babies were enrolled for early infant diagnosis. The incremental cost-effectiveness ratio was estimated at INR 44 (less than 1 US$) per pregnant woman tested. Conclusions Integrating HIV screening with the broader Rural Health Mission is a promising opportunity to scale up the PPTCT program. However, advocacy, sensitization, capacity building and the judicious utilization of available resources are key to widening the reach of the PPTCT program in India and elsewhere. PMID:24670002
The complete amino acid sequence of Rhodoferax fermentans high-potential iron-sulfur protein (Hipip), which is known to be an efficient electron donor to the photosynthetic reaction center, has been determined using both N-terminal and C-terminal analyses. The sequence contains 75 residues, with 11 positive charges, 10 negative charges, and one histidine residue. The molecular mass of apo-Hipip, determined by electrospray ionization mass spectrometry, is 7849.64 Da. Multiple sequence alignment, based both on primary and tertiary structure information, reveals conservation of Tyr19 and Gly75 (Chromatium vinosum numbering) in addition to the four [Fe4S4]-bound cysteines. The Hipip from Rf. fermentans is most similar (57% similarity) to the Hipip from Rubrivivax gelatinosus, a photosynthetic bacterium belonging to the beta-1 subgroup of the proteobacteria. PMID:9119002
Van Driessche, G; Ciurli, S; Hochkoeppler, A; Van Beeumen, J J
Diffuse large B-cell infiltration of the skin includes mainly primary cutaneous follicle center lymphoma (PCFCL) with diffuse architecture and diffuse large B cell lymphoma (PCDLBCL), leg type. Differentiation of these lymphomas on morphology may be troublesome. Immunohistochemistry panel, including CD20, CD79a, bcl-6, bcl-2, MUM-1, FOX-P1 is mandatory. However, in minority of cases, these markers would not suffice. In order to search the value of another marker, IgM, 30 cases of PCFCL and 10 cases of PCDLBCL, leg type were included in the study. As suggested in a recent literature, our study denoted that expression of IgM was useful as an additional tool for differentiation. PMID:21700336
Demirkesen, Cuyan; T³z³ner, N³khet; Esen, Tu?ńe; Lebe, Banu; Ozkal, Sermin
Objective: The objective of this study was to determine the morbidity profile of patients being treated at the Primary Health Center, their distribution according to gender, and the seasonal trend of diseases. Materials and Methods: The study was done retrospectively using secondary data, over a period of 1 year from June 2007 to July 2008, at the OPD of the Primary Health Center at Patara in Kanpur District, India. The study was aimed to study the pattern of diseases according to the classification provided by the Government of India. The data were collected from the OPD registers of the consultant medical officer, and the diagnosis was classified into communicable diseases, nutritional and metabolic disorders, infectious diseases, obstetric complications, and other diseases including injuries. Results: A total of 6838 patients had been treated at the OPD, which included 2707 males and 4131 females. It was observed that, while communicable diseases constituted about half of the total burden of the diseases with skin infections being the commonest; the non-communicable diseases constituted about one-fifth of the total disease burden. Significant gender differences were evident in the prevalence of certain diseases such as worm infestation, acute respiratory tract infection, urinary tract infection, reproductive tract infection, chronic obstructive pulmonary disease, gastritis, arthritis/gout, falls/injuries/fractures, anemia, pyrexia of unknown origin, and snake bite. Most of the diseases were observed to have a seasonal variation, with the communicable and infectious diseases peaking in the monsoon months. Surprisingly, the non-communicable diseases such as gastritis and falls and injuries also showed a seasonal variation. Conclusion: Many diseases have a seasonal variation and the burden of these diseases could be reduced if we devise measures to detect the changes in their trend through the implementation of surveillance programs in this part of the world, as has been carried out in other countries. The knowledge of the burden of the diseases would also assist the health administrators in judicious allocation of the resources. PMID:24479013
Kumari, Ranjeeta; Nath, Bhola; Midha, Tanu; Vaswani, Narain D.; Lekhwani, Seema; Singh, Bhupendra
The stem cell niche of the Arabidopsis (Arabidopsis thaliana) primary root apical meristem is composed of the quiescent (or organizing) center surrounded by stem (initial) cells for the different tissues. Initial cells generate a population of transit-amplifying cells that undergo a limited number of cell divisions before elongating and differentiating. It is unclear whether these divisions occur stochastically or in an orderly manner. Using the thymidine analog 5-ethynyl-2'-deoxyuridine to monitor DNA replication of cells of Arabidopsis root meristems, we identified a pattern of two, four, and eight neighboring cells with synchronized replication along the cortical, epidermal, and endodermal cell files, suggested to be daughters, granddaughters, and great-granddaughters of the direct progeny of each stem cell. Markers of mitosis and cytokinesis were not present in the region closest to the transition zone where the cells start to elongate, suggesting that great-granddaughter cells switch synchronously from the mitotic cell cycle to endoreduplication. Mutations in the stem cell niche-expressed ASH1-RELATED3 (ASHR3) gene, encoding a SET-domain protein conferring histone H3 lysine-36 methylation, disrupted this pattern of coordinated DNA replication and cell division and increased the cell division rate in the quiescent center. E2Fa/E2Fb transcription factors controlling the G1-to-S-phase transition regulate ASHR3 expression and bind to the ASHR3 promoter, substantiating a role for ASHR3 in cell division control. The reduced length of the root apical meristem and primary root of the mutant ashr3-1 indicate that synchronization of replication and cell divisions is required for normal root growth and development. PMID:25034019
Kumpf, Robert; Thorstensen, Tage; Rahman, Mohummad Aminur; Heyman, Jefri; Nenseth, H Zeynep; Lammens, Tim; Herrmann, Ullrich; Swarup, Ranjan; Veiseth, Silje Veie; Emberland, Gitika; Bennett, Malcolm J; De Veylder, Lieven; Aalen, Reidunn B
Background/Aims The epidemiology of Chagas disease, until recently confined to areas of continental Latin America, has undergone considerable changes in recent decades due to migration to other parts of the world, including Spain. We studied the prevalence of Chagas disease in Latin American patients treated at a health center in Barcelona and evaluated its clinical phase. We make some recommendations for screening for the disease. Methodology/Principal Findings We performed an observational, cross-sectional prevalence study by means of an immunochromatographic test screening of all continental Latin American patients over the age of 14 years visiting the health centre from October 2007 to October 2009. The diagnosis was confirmed by serological methods: conventional in-house ELISA (cELISA), a commercial kit (rELISA) and ELISA using T cruzi lysate (Ortho-Clinical Diagnostics) (oELISA). Of 766 patients studied, 22 were diagnosed with T. cruzi infection, showing a prevalence of 2.87% (95% CI, 1.6¢4.12%). Of the infected patients, 45.45% men and 54.55% women, 21 were from Bolivia, showing a prevalence in the Bolivian subgroup (n?=?127) of 16.53% (95% CI, 9.6¢23.39%). All the infected patients were in a chronic phase of Chagas disease: 81% with the indeterminate form, 9.5% with the cardiac form and 9.5% with the cardiodigestive form. All patients infected with T. cruzi had heard of Chagas disease in their country of origin, 82% knew someone affected, and 77% had a significant history of living in adobe houses in rural areas. Conclusions We found a high prevalence of T. cruzi infection in immigrants from Bolivia. Detection of T. cruzi¢infected persons by screening programs in non-endemic countries would control non-vectorial transmission and would benefit the persons affected, public health and national health systems. PMID:21572511
Roca, Carme; Pinazo, Maria Jesus; Lopez-Chejade, Paolo; Bayo, Joan; Posada, Elizabeth; Lopez-Solana, Jordi; Gallego, Montserrat; Portus, Montserrat; Gascon, Joaquim
The primary electron donor (P) in the photosynthetic bacterial reaction center of Rhodobacter sphaeroides and Blastochloris viridis consists of a dimer of bacteriochlorophyll a and b cofactors, respectively. Its photoexcited triplet state in frozen solution has been investigated by time resolved ENDOR spectroscopy at 34 GHz. The observed ENDOR spectra for (3)P865 and (3)P960 are essentially the same, indicating very similar spin density distributions. Exceptions are the ethylidene groups unique to the bacteriochlorophyll b dimer in (3)P960. Strikingly, the observed hyperfine coupling constants of the ethylidene groups are larger than in the monomer, which speaks for an asymmetrically delocalized wave function over both monomer halves in the dimer. The latter observation corroborates previous findings of the spin density in the radical cation states P 865 (Ģ+) (Lendzian et al. in Biochim Biophys Acta 1183:139-160, 1993) and P 960 (Ģ+) (Lendzian et al. in Chem Phys Lett 148:377-385, 1988). As compared to the bacteriochlorophyll monomer, the hyperfine coupling constants of the methyl groups 2(1) and 12(1) are reduced by at least a factor of two, and quantitative analysis of these couplings gives rise to a ratio of approximately 3:1 for the spin density on the halves PL:PM. Our findings are discussed in light of the large difference in photosynthetic activity of the two branches of cofactors present in the bacterial reaction center proteins. PMID:23184403
Marchanka, Aliaksandr; Lubitz, Wolfgang; Plato, Martin; van Gastel, Maurice
Although the primary visual cortex (V1) is one of the most extensively studied areas of the primate brain, very little is known about how the far periphery of visual space is represented in this area. We characterized the physiological response properties of V1 neurons in anaesthetized marmoset monkeys, using high-contrast drifting gratings. Comparisons were made between cells with receptive fields located in three regions of V1, defined by eccentricity: central (3-5░), near peripheral (5-15░), and far peripheral (>50░). We found that orientation selectivity of individual cells was similar from the center to the far periphery. Nonetheless, the proportion of orientation-selective neurons was higher in central visual field representation than in the peripheral representations. In addition, there were similar proportions of cells representing all orientations, with the exception of the representation of the far periphery, where we detected a bias favoring near-horizontal orientations. The proportions of direction-selective cells were similar throughout V1. When the center/surround organization of the receptive fields was tested with gratings with varying diameters, we found that the population of neurons that was suppressed by large gratings was smaller in the far periphery, although the strength of suppression in these cells tended to be stronger. In addition, the ratio between the diameters of the excitatory centers and suppressive surrounds was similar across the entire visual field. These results suggest that, superimposed on the broad uniformity of V1, there are subtle physiological differences, which indicate that spatial information is processed differently in the central versus far peripheral visual fields. PMID:24160942
Yu, Hsin-Hao; Rosa, Marcello G P
Heterotopic ossification (HO) is a complication following total hip arthroplasty (THA) with traditional approaches. The direct anterior approach (DAA) has become a popular approach for THA; however, no study has evaluated HO formation following DAA THA. We examined the incidence of HO in a consecutive series of THA using the DAA in two separate hospitals. Standard preoperative radiographs were examined to determine the type of degenerative arthritis, and follow-up radiographs of at least 6months after surgery were evaluated for the presence and classification of HO. The overall incidence of HO after DAA THA in this study was 98/236, or 41.5%, which falls within the reported range from recent studies involving more traditional approaches to the hip. PMID:24957801
Tippets, Duane M; Zaryanov, Anton V; Vincent Burke, W; Patel, Preetesh D; Suarez, Juan C; Ely, Erin E; Figueroa, Nathania M
BMP-9 expression in human traumatic heterotopic ossification: a case report
Background Heterotopic ossification (HO) is defined as the abnormal formation of mature bone in soft tissue, notably skeletal muscle. The morbidity of HO in polytraumatized patients impacts the functional outcome, impairs rehabilitation, and increases costs due to subsequent surgical interventions. Case presentation We present the case of a 34-year-old African male who developed severe HO around his right hip 11 days after a major trauma. Immunohistochemical analyses of resected tissue revealed that several BMPs were expressed in the HO, including highly osteogenic BMP-9. Conclusions To the best of our knowledge, this is the first report of local BMP expression, notably BMP-9, in traumatic HO, and suggests that BMP-9, possibly through mrSCs, can contribute to HO formation in soft tissues when a suitable microenvironment is present. PMID:24330639
Heterotopic ossification (HO) is a benign condition of abnormal formation of bone in soft tissue. HO is frequently asymptomatic, though when it is more severe it typically manifests as decreased range of motion at a nearby joint. HO has been recognized to occur in three distinct contexts-trauma, neurologic injury, and genetic abnormalities. The etiology of HO is incompletely understood. A posited theory is that HO results from the presence of osteoprogenitor cells pathologically induced by an imbalance in local or systemic factors. Individuals at high risk for HO development frequently undergo prophylaxis to prevent HO formation. The two most commonly employed modalities for prophylaxis are nonsteroidal anti-inflammatory drugs and radiation therapy. This review discusses HO pathophysiology, clinical features, and the role of radiotherapy for prophylaxis.
Balboni, Tracy A. [Harvard Radiation Oncology Program, Brigham and Women's Hospital, Boston, MA (United States); Gobezie, Reuben [Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA (United States); Mamon, Harvey J. [Department of Radiation Oncology, Brigham and Women's Hospital, Boston, MA (United States)]. E-mail: email@example.com
Here we describe a 65-year-old Japanese man with chronic renal failure (CRF) and a large, dense, calcified abdominal mass. The patient had a history of proteinuria, which was diagnosed as focal glomerulosclerosis. This diagnosis was confirmed by renal biopsy in 2002, with worsening renal function by July 2005 when a large area of calcification was detected on abdominal radiography, which further increased in size on follow-up radiography in December 2006. The calcified mass was surgically resected and histopathologically diagnosed as myxoid-type liposarcoma composed of dedifferentiated, myxoid, and well-differentiated components with areas of osseous metaplasia. Soft tissue calcifications and ossifications are often benign, but malignant tumors should be considered when the calcified mass is retroperitoneal, occurs in a patient with no history of chronic infection, and is not located near a large joint or associated with administration of calcium carbonate or a vitamin D derivative. PMID:19882203
Okuda, Itsuko; Ubara, Yoshifumi; Okuda, Chikao; Fujii, Takeshi; Suwabe, Tatsuya; Kokubo, Takashi; Nakajima, Yasio; Hashimoto, Masaji
Heterotopic ossification (HO), the abnormal formation of true marrow-containing bone within extraskeletal soft tissues, is a serious bony disorder that may be either acquired or hereditary. We utilized an animal model of the genetic disorder fibrodysplasia ossificans progressiva to examine the cellular mechanisms underlying HO. We found that HO in these animals was triggered by soft tissue injuries and that the effects were mediated by macrophages. Spreading of HO beyond the initial injury site was mediated by an abnormal adaptive immune system. These observations suggest that dysregulation of local stem/progenitor cells could be a common cellular mechanism for typical HO irrespective of the signal initiating the bone formation. PMID:18832590
Kan, Lixin; Liu, Yijie; McGuire, Tammy L.; Berger, Diana M. Palila; Awatramani, Rajeshwar B.; Dymecki, Susan M.; Kessler, John A.
Anatomical variations of the stylohyoid apparatus are frequent. Two types can occur: an elongation of the stylohyoid ligament, from a long styloid process to a complete ossified structure connecting the skull base to the lesser horn of the hyoid bone, or the existence of supernumerary bones in the stylohyoid fibrous matrix, which sometimes resembles phalanges. These variations are in the majority of cases bilateral and symmetrical. The authors report the case of a 43-year-old male patient who presented with an unusual unilateral complete ossification of the stylohyoid apparatus, associated with vertebral and laryngeal calcifications. Original latest generation CT scan and three-dimensional MRI imagery are provided to illustrate this rare case. PMID:24964997
Hardy, Hubert; Guichard, Benjamin; Eliezer, Mickael; Choussy, Olivier; Pķron, Jean-Marc; Trost, Olivier
Ceratophryidae represent a monophyletic group of terrestrial and aquatic frogs inhabiting lowlands of South America where they are more diverse in semiarid environments of the Chaco region. Adult morphology of ceratophryids presents some features associated to terrestrial and fossorial life such as hyper-ossified skulls, spade feet for digging, among others. For anurans, different mineralized structures have been described in the integument as calcium reservoirs and related to the terrestrial life and water balance (e.g., the calcified layer and dermal ossifications). We describe the ontogeny of the integument in the three genera of ceratophryids (Chacophrys, Ceratophrys, and Lepidobatrachus) that inhabit in semiarid environments. Data obtained demonstrated the early acquisition of metamorphic transformations in the integument layers in larvae of Ceratophrys cranwelli and Lepidobatrachus spp. and a continuous increment in the thickness of them up to old postmetamorphic stages. The integument of ceratophryids develops calcium deposits as the calcified layer during postmetamorphic stages. Furthermore, dorsal shields are also present in adult stages independently of terrestrial versus aquatic lifestyles. While the calcified layer seems to be a feature of a fully developed integument, in which their layers have acquired the adult thickness, dorsal shields develop at premetamorphic stages in L. llanensis and postmetamorphic individuals of C. cranwelli. In ceratophryids, similar to other studied taxa (e.g., Brachycephalus spp.) dorsal shields develop via an intramembranous ossification in which the calcified layer does not precede its differentiation. Within anurans, the occurrence of dorsal shields in the monophyletic ceratophryids suggested a distinctive evolutionary history in the lineage. PMID:23074148
Quinzio, Silvia; Fabrezi, Marissa
Runx2 is a known master transcription factor for osteoblast differentiation, as well as an essential regulator for chondrocyte maturation. Recently, more and more data has shown that Runx2 regulates hypertrophic chondrocyte-specific type X collagen gene (Col10a1) expression in different species. However, how Runx2 regulation of Col10a1 expression impacts chondrocyte maturation, an essential step of endochondral bone formation, remains unknown. We have recently generated transgenic mice in which flag-tagged Runx2 was driven by a cell-specific Col10a1 control element. Significantly increased level of Runx2 and Col10a1 mRNA transcripts were detected in transgenic mouse limbs at both E17.5 (embryonic day 17.5) and P1 (postnatal day1) stages, suggesting an in vivo correlation of Runx2 and Col10a1 expression. Surprisingly, skeletal staining suggested delayed ossification in both the axial and the appendicular skeleton of transgenic mice from E14.5 until P6. Histological analysis showed elongated hypertrophic zones in transgenic mice, with less von Kossa and TUNEL staining in long bone sections at both E17.5 and P1 stages, suggesting defective mineralization due to delayed chondrocyte maturation or apoptosis. Indeed, we detected increased level of anti-apoptotic genes Bcl-2, Opn, and Sox9 in transgenic mice by real-time RT-PCR. Moreover, immunohistochemistry and Western blotting analysis also suggested increased Sox9 expression in hypertrophic chondrocytes of transgenic mice. Together, our data suggest that targeting Runx2 in hypertrophic chondrocytes upregulates expression of Col10a1 and other marker genes (such as Sox9 etc.). This will change the local matrix environment, delay chondrocyte maturation, reduce apoptosis and matrix mineralization, and eventually, lead to impaired endochondral ossification. PMID:22223437
Ding, Ming; Lu, Yaojuan; Abbassi, Sam; Li, Feifei; Li, Xin; Song, Yu; Geoffroy, Valerie; Im, Hee-Jeong; Zheng, Qiping
Background: The selection, neurodiagnostic evaluation, and surgical management of patients with cervical ossification of the posterior longitudinal ligament (OPLL) remain controversial. Whether for prophylaxis or treatment, the decision to perform anterior vs. posterior vs. circumferential cervical OPLL surgery is complex. MR and CT Documentation of OPLL: Together, MR and CT cervical studies best document the full extent of OPLL. While MR provides the optimal soft-tissue overview (e.g. hyperintense signals reflecting edema/myelomalacia in the cord), CT's directly demonstrate the ossification of OPLL often ōmissedö by MR (e.g. documents the single or double layer signs of dural penetration. Patient Selection: Patients with mild myelopathy/cord compression rarely require surgery, while those with moderate/severe myelopathy/cord compression often warrant anterior, posterior, or circumferential approaches. Operative Approaches: Anterior corpectomies/fusions, warranted in patients with OPLL and kyphosis/loss of lordosis, also increase the risks of cerebrospinal fluid (CSF) leaks (e.g. single/double layer sign), and vascular injuries (e.g. carotid, vertebral). Alternatively, with an adequate lordosis, posterior procedures (e.g. often with fusions), may provide adequate multilevel decompression while minimizing risk of anterior surgery. Occasionally, combined pathologies may warrant circumferential approaches. Anesthetic and Intraoperative Monitoring Protocols: The utility of awake nasotracheal fiberoptic intubation/awake positioning, intraoperative somatosensory/motor evoked potential, and electromyographic monitoring, and the requirement for total intravenous anesthesia (TIVA) for OPLL surgery is also discussed. Conclusion: Anterior, posterior, or circumferential surgery may be warranted to treat patients with cervical OPLL, and must be based on careful patient selection, and both MR and CT documentation of the full extent of OPLL. PMID:24843818
Epstein, Nancy E.
NASA Astrophysics Data System (ADS)
Using quantum-chemical methods, we have studied the role played by water molecules W-A and W-B that are bound by hydrogen bonds to accessory bacteriochlorophyll molecules B A and B B in the process of primary charge separation in the reaction center of Rhodobacter Sphaeroides. We have found that the occurrence of a rotational mode of the W-A molecule at 32 cm-1 and/or its harmonics in stimulated emission of an electron donor P* and the dynamics of population of the states P+B{/A -} and P+H{/A -} may be related to the structural heterogeneity of the reaction center and the existence of a conformation in which the W-A molecule is predominantly involved in one hydrogen bond (with B A). Based on the calculated redox potentials B A and P, it has been shown that the appearance of the W-A molecule in the reaction center reduces the energy of the P+B{/A -} state by ś600 cm-1. This is somewhat smaller than the influence of the amino-acid residue TyrM210 (ś870 cm-1) and correlates well with a substantial decrease in the electron transfer rate in mutant forms of reaction centers GM203L (which do not contain W-A molecules) and YM210F (in which TyrM210 is replaced with Phe). The data obtained allow us to suggest that rotation of the water molecule with a fixed position of its H atom that is involved in a hydrogen bond with the keto carbonyl group of B A is initiated due to the charge separation between the halves of special pair P and the formation of the state P{/A +}P{/B -}. The large effect of this rotation on the kinetics of population of the states P+B{/A -} and P+H{/A -} after the excitation of P is quite consistent with its influence on the energy of the state P+B{/A -}.
Ivashin, N. V.; Shchupak, E. E.
In a collection of 101 anatomical preparations of the human pelvis, ossification of the sacrotuberous ligament was found in 8 cases. In 7 of these, the ossification showed a characteristic intraligamentous morphology, with a broad-based origin at the ischial tuberosity and tapering off craniomedially. The length varied between 1.1 and 7.2 cm. The surface of the bone formations appeared fasciculated,
Andreas Prescher; Klaus Bohndorf
Castleman's disease (CD), diffuse idiopathic skeletal hyperostosis (DISH), and ossification of the posterior longitudinal\\u000a ligament of the spine (OPLL) are three different entities. Castleman's disease displaying a variety of calcifications in the\\u000a abdomen and\\/or pelvis has been reported in some papers. However, there were no reports suggesting an association between CD\\u000a and ossification\\/calcification in spine and joints. So far, there
Shu Kobayashi; Shigeki Momohara; Katsunori Ikari; Takeshi Mochizuki; Koichiro Kawamura; So Tsukahara; Kazumasa Nishimoto; Hiroshi Okamoto; Taisuke Tomatsu
Determination of the stage of ossification of the medial clavicular epiphysis is a crucial part of age estimation in criminal\\u000a proceedings when evaluating individuals with completed hand ossification. In order to ensure a maximum of accuracy in forensic\\u000a age estimation practise, it is recommended to perform thin-slice CT scans; but to date there exist no reference data on the\\u000a bone
Manuel Kellinghaus; Ronald Schulz; Volker Vieth; Sven Schmidt; Andreas Schmeling
An 85-year-old man presented with pain and numbness in the left buttock, and physical examination revealed an approximately 7 cm mass extending from the first to the third sacral vertebrae; biopsy of the mass led to the diagnosis of CD10-negative, BCL6-weakly positive, MUM1-positive, non-germinal center (non-GC) type diffuse large B-cell lymphoma (DLBCL). Furthermore, serological testing showed negative results for Epstein-Barr virus (EBV) infection, and fluorescence in situ hybridization (FISH) revealed a MYC translocation. Radiographs showed no remarkable osteolytic bone destruction, and the patient was staged with Stage IAE. After 8 cycles of rituximab therapy and 6 cycles of CHOP therapy, complete remission has been maintained until now, approximately 1 year after the treatment. Primary sacral lymphoma is very rare, with only 6 reported cases, including the present one. A review of the reported cases revealed that the disease predominantly affects elderly men, is usually non-GC-type DLBCL and stage IAE, measures approximately 2-7 cm in diameter in general, and does not show early recurrence after chemotherapy or chemoradiotherapy. There is no report in the literature yet of primary sacral DLBCL with MYC translocation, and this is the first case report. On the other hand, 35 cases of CD10-negative DLBCL with MYC translocation, including the present one, have been reported, and a review of the reported cases showed that the disease predominantly affects Asians, middle-aged or elderly men, shows positivity for either BCL6 or MUM1 and negativity for EBV, and has a high international prognostic index and poor prognosis. PMID:24040459
Shimada, Asami; Sugimoto, Kei-Ji; Wakabayashi, Mutsumi; Imai, Hidenori; Sekiguchi, Yasunobu; Nakamura, Noriko; Sawada, Tomohiro; Ota, Yasunori; Komatsu, Norio; Noguchi, Masaaki
Objectives On June 6th 2007, a tropical Cyclone Gonu striked the coastline of Oman. The purpose of this study is to compare number of patients and pattern of illnesses between disaster (June 2007) and peace times (June 2006/2008). Methods Descriptive comparative analysis of all patients who visited primary health centers in Wilayat AÆSeeb during the index days. Electronic database collected from the Health Centers (HC) were grouped into four groups; infection-related, trauma-related, acute non trauma-related, and miscellaneous group. Data were analyzed to find difference of patient influx and disease patterns between disaster and peace times. Results HC visits during the index days decreased from 9006 in 2006 to 8687 in 2007 then increased to 8786 in 2008. Neither between years variation nor between disaster and peace times difference was found to be statistically significant. The proportion of patient visited the HC due to infection-related illnesses changed from 30% in 2006, 31% in 2007, and 24% in 2008 (p<0.0001). The proportion of patients visited the HC due to trauma-related illnesses had changed from 4% in 2006, to 6.7% in 2007, and to 4.4% in 2008. (p<0.0001). Proportions for acute non trauma-related visits were 27% in 2006, 24% in 2007, and 23% in 2008 (p<0.0001). Miscellaneous group accounted for 38% in 2006, 37% in 2007, and 47% in 2008 (p<0.0001). Conclusion Tropical Cyclone Gonu caused statistically significant increase in percentages of infectious and trauma-related visits. The overall ratios of total visits did not differ from peace times. PMID:22043424
Alhinai, Mustafa Y.
Lamellar bone formation in an abnormal location is defined as heterotopic ossification. It commonly occurs around the hip joint and most often involves the abductor muscles. It is a benign condition; however, its etiology remains largely unknown. Most previously reported cases have been due to trauma or intramuscular hemorrhage. In this paper, we present a case of bilateral heterotopic ossification of the reflected head of rectus femoris muscle without antecedent trauma or any other known cause, as the first and unique case in the literature. She was treated by excision of the right symptomatic bony mass via a modified Smith-Petersen approach. Postoperatively, she received 75?mg indomethacin daily for six weeks. She was pain-free and obtained full range of motion 3 weeks after the first intervention. PMID:24804132
Tonbul, Murat; Ozen, Seyma; Tonbul, Ayse Tuba
Background Physical activity is an important aspect in the treatment of patients with chronic obstructive pulmonary disease or type-2 diabetes. A monitoring and feedback tool combined with guidance by a primary care provider might be a successful method to enhance the level of physical activity in these patients. As a prerequisite for useful technology, it is important to involve the end-users in the design process from an early stage. Objective The aim of this study was to investigate the user requirements for a tool to stimulate physical activity, embedded in primary care practice. The leading principle of this tool is to change behavior by self-monitoring, goal-setting, and feedback. Methods The research team collected qualitative data among 15 patients, 16 care professionals, and several experts. A prototype was developed in three stages. In stage 1, the literature was searched to identify end-users and context. In stage 2, the literature, experts and patient representatives were consulted to set up a use case with the general idea of the innovation. In stage 3, individual interviews and focus groups were held to identify the end-user requirements. Based on these requirements a prototype was built by the engineering team. Results The development process has led to a tool that generally meets the requirements of the end-users. A tri-axial activity sensor, worn on the hip, is connected by Bluetooth to a smartphone. In an app, quantitative feedback is given about the amount of activity and goals reached by means of graphical visualization, and an image shows a sun when the goal is reached. Overviews about activity per half an hour, per day, week, and month are provided. In the menu of the app and on a secured website, patients can enter information in individual sessions or read feedback messages generated by the system. The practice nurse can see the results of all patients on a secure webpage and can then discuss the results and set personalized goals in consultation with the patient. Conclusions This study demonstrates that a user-centered approach brings in valuable details (such as the requirements for feedback in activity minutes per day) to improve the fit between the user, technology, and the organization of care, which is important for the usability and acceptability of the tool. The tool embedded in primary care will be evaluated in a randomized controlled trial. PMID:25099556
Verwey, Renee; Spreeuwenberg, Marieke; Tange, Huibert; van der Weijden, Trudy; de Witte, Luc
A size series of 143 specimens of the Permo-Carboniferous temnospondyl Archegosaurus decheni from the Saar-Nahe Basin (south-west Germany), ranging in size from 18 to 280 mm skull length, can be interpreted as an extensive growth series. This study focuses on the reconstruction of ossification sequences and developmental patterns of skull, visceral skeleton, and postcranium in A. decheni. With respect to
Florian Witzmann
In light of recent studies showing successful transplantation of both bony and stromal elements by marrow transplantation, we report an unexpected phenomenon occurring in a canine radiation chimera. Nine hundred fifty-six days after a successful and uneventful DLA-matched marrow allograft, a dog suddenly died of respiratory failure. Autopsy revealed extensive ossification of the lungs with multiple sites of trilineage marrow engraftment. The entire complement of bony elements can apparently be allografted using marrow grafting techniques.
Sale, G.E.; Storb, R.
Fibrodysplasia ossificans progressiva is characterized by extensive ossification within muscle tissues, and its molecular pathogenesis is responsible for the constitutively activating mutation (R206H) of the bone morphogenetic protein type 1 receptor, activin-like kinase 2 (ALK2). In this study, we investigated the effects of implanting ALK2 (R206H)-transfected myoblastic C2C12 cells into nude mice on osteoclast formation during heterotopic ossification in muscle and subcutaneous tissues. The implantation of ALK2 (R206H)-transfected C2C12 cells with BMP-2 in nude mice induced robust heterotopic ossification with an increase in the formation of osteoclasts in muscle tissues but not in subcutaneous tissues. The implantation of ALK2 (R206H)-transfected C2C12 cells in muscle induced heterotopic ossification more effectively than that of empty vector-transfected cells. A co-culture of ALK2 (R206H)-transfected C2C12 cells as well as the conditioned medium from ALK2 (R206H)-transfected C2C12 cells enhanced osteoclast formation in Raw264.7 cells more effectively than those with empty vector-transfected cells. The transfection of ALK2 (R206H) into C2C12 cells elevated the expression of transforming growth factor (TGF)-?, whereas the inhibition of TGF-? signaling suppressed the enhanced formation of osteoclasts in the co-culture with ALK2 (R206H)-transfected C2C12 cells and their conditioned medium. In conclusion, this study demonstrated that the causal mutation transfection of fibrodysplasia ossificans progressiva in myoblasts enhanced the formation of osteoclasts from its precursor through TGF-? in muscle tissues. PMID:24798338
Yano, Masato; Kawao, Naoyuki; Okumoto, Katsumi; Tamura, Yukinori; Okada, Kiyotaka; Kaji, Hiroshi
Though sequences of formation and ossification of bony elements have been described for many taxa, controversy surrounds the formation of limb elements in turtles. Three hypotheses for patterns of formation of autopodial elements have been proposed, differing primarily in the origin of Distal Carpal/Tarsal 3, the digital arch, and Centrale 4. Patterns of formation and ossification of limb elements are described for Trachemys scripta. These patterns are compared to similar data for representatives of four families of turtles (Cheloniidae, Chelydridae, Emydidae, and Trionychidae). Hypotheses of limb formation are compared in the context of new and published data. Three species (Trachemys scripta, Chrysemys picta, and Chelydra serpentina) suggest that Distal Carpal 3 forms by branching from the ulnare, whereas Distal Carpal 3 may branch from Distal Carpal 4 in Macrochelys temminckii and Chelonia mydas; data from Graptemys nigrinoda, Apalone spinifera, and Eretmochelys imbricata did not provide evidence for the origin of Distal Carpal 3. Centrale 4 was not observed to branch from the ulnare and apparently arises by de-novo condensation. Distal Carpal 4 did not branch from Centrale 4 in any species. Until the developmental origins of Distal Carpal 3 and Centrale 4 are understood, interspecific variation in the origin of these elements remains, and may explain some of the observed differences. Trends of ossification in the fore- and hind limb autopodium also are summarized. Homology of elements in pedal Digit V is discussed, and we suggest that the hooked proximal element of this digit be recognized as Distal Tarsal 5. PMID:18624573
Sheil, Christopher A; Portik, Daniel
In the course of embryonic development skeletal elements form either through intramembranous or endochondral ossification. Wnt proteins play diverse roles during vertebrate skeletal development. Wnt16 is a key factor in developing long bones, but its exact role in craniofacial bone formation remains unclear. This study was initially undertaken to investigate the expression of Wnt16 during craniofacial bone development in mouse embryos. Wnt16 expression in the osteoid of calvaria, maxilla, and mandible started later than that of ALP and osteocalcin (OCN), but before mineralization of the craniofacial bones, suggesting that Wnt16 is involved in intramembranous ossification in the head. To confirm this, MC3T3-E1 cells were transfected with an adenovirus containing Wnt16 (Ad-Wnt16). Ad-Wnt16 cells showed decreased ALP activity and less mineralized nodule formations compared with control cells. In addition, the mRNA levels of osteogenic markers were reduced. Moreover, Wnt16 activated ?-catenin signaling in MC3T3-E1 cells at both transcription and protein levels as shown by a TOPflash luciferase reporter gene assay and western blot analysis. On the other hand, Wnt/?-catenin pathway blockade by Dickkopf 1 abrogated the suppression of mineralization by Wnt16. Our findings suggest that Wnt16 is involved in intramembranous ossification and suppresses osteoblast differentiation through the Wnt/?-catenin pathway. PMID:24037946
Jiang, Zheng; Von den Hoff, Johannes W; Torensma, Ruurd; Meng, Liuyan; Bian, Zhuan
Activation of Hedgehog signaling by loss of GNAS causes heterotopic ossification
Bone formation is exquisitely controlled in space and time. Heterotopic ossification (HO), the pathologic formation of extra-skeletal bone, occurs as a common complication of trauma or in genetic disorders and can be disabling and lethal. However, the underlying molecular mechanisms are largely unknown. Here we demonstrate that G?s restricts bone formation to the skeleton by inhibiting Hedgehog (Hh) signaling in mesenchymal progenitor cells. In progressive osseous heteroplasia (POH), a human disease caused by null mutations in GNAS that encodes G?s, HH signaling is upregulated in ectopic osteoblasts and progenitor cells. Ectopic Hh signaling is sufficient to induce HO, while Hh signaling inhibition blocks HO in animal models. As our previous work has shown that GNAS gain of function mutations upregulate WNT/?-Catenin signaling in fibrous dysplasia (FD), our findings identify G?s as a critical regulator of osteoblast differentiation by maintaining a balance between two key signaling pathways: Wnt/?-catenin and Hh. HH signaling inhibitors developed for cancer therapy may be repurposed to treat HO and other diseases caused by GNAS inactivation. PMID:24076664
Regard, Jean B.; Malhotra, Deepti; Gvozdenovic-Jeremic, Jelena; Josey, Michelle; Chen, Min; Weinstein, Lee S.; Lu, Jianming; Shore, Eileen M.; Kaplan, Frederick S.; Yang, Yingzi
Clock Genes Influence Gene Expression in Growth Plate and Endochondral Ossification in Mice*
We have previously shown transient promotion by parathyroid hormone of Period-1 (Per1) expression in cultured chondrocytes. Here we show the modulation by clock genes of chondrogenic differentiation through gene transactivation of the master regulator of chondrogenesis Indian hedgehog (IHH) in chondrocytes of the growth plate. Several clock genes were expressed with oscillatory rhythmicity in cultured chondrocytes and rib growth plate in mice, whereas chondrogenesis was markedly inhibited in stable transfectants of Per1 in chondrocytic ATDC5 cells and in rib growth plate chondrocytes from mice deficient of brain and muscle aryl hydrocarbon receptor nuclear translocator-like (BMAL1). Ihh promoter activity was regulated by different clock gene products, with clear circadian rhythmicity in expression profiles of Ihh in the growth plate. In BMAL1-null mice, a predominant decrease was seen in Ihh expression in the growth plate with a smaller body size than in wild-type mice. BMAL1 deficit led to disruption of the rhythmic expression profiles of both Per1 and Ihh in the growth plate. A clear rhythmicity was seen with Ihh expression in ATDC5 cells exposed to dexamethasone. In young mice defective of BMAL1 exclusively in chondrocytes, similar abnormalities were found in bone growth and Ihh expression. These results suggest that endochondral ossification is under the regulation of particular clock gene products expressed in chondrocytes during postnatal skeletogenesis through a mechanism relevant to the rhythmic Ihh expression. PMID:22936800
Takarada, Takeshi; Kodama, Ayumi; Hotta, Shogo; Mieda, Michihiro; Shimba, Shigeki; Hinoi, Eiichi; Yoneda, Yukio
Intradural herniation of a cervical disc is rare; less than 35 cases have been reported to date. A 52-year-old man with preexisting ossification of posterior longitudinal ligament developed severe neck pain with Lt hemiparesis while asleep. Neurological exam was consistent with Brown-Sķquard syndrome. Magnetic resonance images showed a C5-6 herniated disc that was adjacent to the ossified ligament and indenting the cord. The mass was surrounded by cerebrospinal fluid signal intensity margin, and caudally the ventral dura line appears divided into two, consistent with the ōY-signö described by Sasaji et al. Cord edema were noted. Because of preexisting canal stenosis and spinal cord at risk, a laminoplasty was performed, followed by an anterior C6 corpectomy. Spot-weld type adhesions of the posterior longitudinal ligament to the dura was noted, along with a longitudinal tear in the dura. An intradural extra-arachnoid fragment of herniated disc was removed. Clinical exam at 6 months after surgery revealed normal muscle strength but persistent mild paresthesias. It is difficult to make a definite diagnosis of intradural herniation preoperatively; however, the clinical findings and radiographic signs mentioned above are suggestive and should alert the surgeon to look for an intradural fragment. PMID:25295205
Wang, Dachuan; Wang, Haifeng; Shen, Wun-Jer
We evaluated the clinical results of posterior decompression with instrumented fusion (PDF) for thoracic myelopathy due to ossification of the posterior longitudinal ligament (OPLL). A total of 24 patients underwent PDF, and their surgical outcomes were evaluated by the Japanese Orthopaedic Association (JOA) scores (0-11 points) and by recovery rates calculated at 3, 6, 9 and 12 months after surgery and at a mean final follow-up of 4 years and 5 months. The mean JOA score before surgery was 3.7 points. Although transient paralysis occurred immediately after surgery in one patient (3.8%), all patients showed neurological recovery at the final follow-up with a mean JOA score of 8.0 points and a mean recovery rate of 58.1%. The mean recovery rate at 3, 6, 9 and 12 months after surgery was 36.7, 48.8, 54.0 and 56.8%, respectively. The median time point that the JOA score reached its peak value was 9 months after surgery. No patient chose additional anterior decompression surgery via thoracotomy. The present findings demonstrate that despite persistent anterior impingement of the spinal cord by residual OPLL, PDF can result in considerable neurological recovery with a low risk of postoperative paralysis. Since neurological recovery progresses slowly after PDF, we suggest that additional anterior decompression surgery is not desirable during the early stage of recovery. PMID:20049486
Yamazaki, Masashi; Okawa, Akihiko; Fujiyoshi, Takayuki; Furuya, Takeo; Koda, Masao
Heparan sulfate as a regulator of endochondral ossification and osteochondroma development.
Most elements of the vertebrate skeleton are formed by endochondral ossification. This process is initiated with mesenchymal cells that condense and differentiate into chondrocytes. These undergo several steps of differentiation from proliferating into hypertrophic chondrocytes, which are subsequently replaced by bone. Chondrocyte proliferation and differentiation are tightly controlled by a complex network of signaling molecules. During recent years, it has become increasingly clear that heparan sulfate (HS) carrying proteoglycans play a critical role in controlling the distribution and activity of these secreted factors. In this review we summarize the current understanding of the role of HS in regulating bone formation. In human, mutations in the HS synthetizing enzymes Ext1 and Ext2 induce the Multiple Osteochondroma syndrome, a skeletal disorder characterized by short stature and the formation of benign cartilage-capped tumors. We review the current insight into the origin of the disease and discuss its possible molecular basis. In addition, we summarize the existing insight into the role of HS as a regulator of signal propagation and signaling strength in the developing skeleton. PMID:24370655
Jochmann, Katja; Bachvarova, Velina; Vortkamp, Andrea
Most elements of the vertebrate skeleton are formed by endochondral ossification. This process is initiated with mesenchymal cells that condense and differentiate into chondrocytes. These undergo several steps of differentiation from proliferating into hypertrophic chondrocytes, which are subsequently replaced by bone. Chondrocyte proliferation and differentiation are tightly controlled by a complex network of signaling molecules. During recent years, it has become increasingly clear that heparan sulfate (HS) carrying proteoglycans play a critical role in controlling the distribution and activity of these secreted factors. In this review we summarize the current understanding of the role of HS in regulating bone formation. In human, mutations in the HS synthetizing enzymes Ext1 and Ext2 induce the Multiple Osteochondroma syndrome, a skeletal disorder characterized by short stature and the formation of benign cartilage-capped tumors. We review the current insight into the origin of the disease and discuss its possible molecular basis. In addition, we summarize the existing insight into the role of HS as a regulator of signal propagation and signaling strength in the developing skeleton. PMID:24726293
Jochmann, Katja; Bachvarova, Velina; Vortkamp, Andrea
NASA Astrophysics Data System (ADS)
Coherent components in the dynamics of decay of stimulated emission from the primary electron donor excited state P*, and of population of the product charge-separated states P+BA- and P+HA-, were studied in GM203L mutant reaction centers (RCs) of Rhodobacter (Rb.) sphaeroides by measuring oscillations in the kinetics of absorbance changes at 940 nm (P* stimulated emission region), 1020 nm ( BA- absorption region) and 760 nm (H A bleaching region). Absorbance changes were induced by excitation of P (870 nm) with 18 fs pulses at 90 K. In the GM203L mutant, replacement of Gly M203 by Leu results in exclusion of the crystallographically defined water molecule (HOH55) located close to the oxygen of the 13 1-keto carbonyl group of B A and to His M202, which provides the axial ligand to the Mg of the P B bacteriochlorophyll. The results of femtosecond measurements were compared with those obtained with Rb. sphaeroides R-26 RCs containing an intact water HOH55. The main consequences of the GM203L mutation were found to be as follows: (i) a low-frequency oscillation at 32 cm -1, which is characteristic of the HOH55-containing RCs, disappears from the kinetics of absorbance changes at 1020 and 760 nm in the mutant RC; (ii) electron transfer from P* to B A in the wild type RC was characterized by two time constants of 1.1 ps (80%) and 4.3 ps (20%), but in the GM203L mutant was characterized by a single time constant of 4.3 ps, demonstrating a slowing of primary charge separation. The previously postulated rotation of water HOH55 with a fundamental frequency of 32 cm -1, triggered by electron transfer from P* to B A, was confirmed by observation of an isotopic shift of the 32 cm -1 oscillation in the kinetics of P+BA- population in deuterated, pheophytin-modified RCs of Rb. sphaeroides R-26, by a factor of 1.6. These data are discussed in terms of the influence of water HOH55 on the energetics of the P??P+BA- reaction, and protein dynamic events that occur on the time scale of this reaction.
Yakovlev, Andrey G.; Jones, Michael R.; Potter, Jane A.; Fyfe, Paul K.; Vasilieva, Lyudmila G.; Shkuropatov, Anatoli Ya.; Shuvalov, Vladimir A.
Objective: Over the past 30 years, great strides have been made in the treatment of disseminated testicular tumors. Despite the low number of patients and the rarity of studies concerning primary advanced seminoma, the efficacy of chemotherapy is clear, mainly 3¢4-cisplatin-based chemotherapy. Aiming to contribute to the understanding and implementation of proper chemotherapeutic management in advanced seminoma patients, we retrospectively summarized our experience with 26 patients who were referred for platinum-based chemotherapy, post-orchiectomy to the Northern Israel Oncology Center between 1989 and 2010. Response rate, side effects, and long-term outcome were investigated. Methods: Before chemotherapy, meticulous staging was done, including tumor markers (B-human chorionic gonadotropin (B-HCG), alpha-fetoprotein (AFP), and lactic dehydrogenase (LDH)), and abdominal and pelvic computerized tomography (CT) scans were carried out. Results: All 26 treated patients achieved complete remission, clinically and symptomatically, with normalization of their CT scans. At a median follow-up of 120 months (range, 24¢268 months) all patients are alive, without evidence of recurrent disease. One patient whose disease recurred twice achieved a third complete remission following salvage treatment with high-dose chemotherapy and autologous peripheral stem cell transplantation. Another patient, who preferred surveillance, relapsed abdominally after 9 months but achieved long-standing complete remission with cisplatin-based chemotherapy. Both these patients are alive with no evidence of disease. Three patients recovered uneventfully from bleomycin-induced pneumonitis. Conclusions: Advanced seminoma is a highly curable disease using platinum-based chemotherapy. Our study confirms the efficacy and safety of cisplatin-based chemotherapy in the treatment of advanced seminoma. PMID:24498512
Stein, Moshe E.; Drumea, Karen; Charas, Tomer; Gershuny, Anthony; Ben-Yosef, Rahamim
Correlation between the ossification of nuchal ligament and clinical cervical disorders.
This is a correlation analysis between severity of the ossification of the nuchal ligament (ONL) and clinical cervical disorders including neck dysfunction, cervical malalignment, and morphologic changes of the cervical neural foramen (CNF). The clinical effects of ONL on active range of motion (AROM) of neck, cervical radiculopathy, abnormal cervical curvature, and the degree of CNF stenosis in patients with painful neck stiffness are investigated. Studies have investigated the predisposing factors to cervical dysfunction and degenerative disorders; however, few studies have examined the influence of the ONL on neck function and cervical spine. A total of 31 participants with painful neck stiffness were recruited. They accepted measurement of cervical AROM and serial cervical radiographs at anterior-posterior view, lateral view, and bilateral oblique views. Parameters of radiographs measurement included cervical lordotic curve, and cross-sectional areas (CSA) of the ONL and CNF (C2-C3, C4-C5, C5-C6, and C6-C7 levels). The ratio of CSA of the lower CNF (C4-C5, C5-C6, C6-C7) to CSA of the upper CNF (C2-C3) was used as a CNF stenosis ratio. The correlations of ONL size, neck symptoms, cervical AROM, lordotic curve, and CNF stenosis ratio were analyzed. More than half of all patients were positive in cervical root signs and prone to have larger ONL. Neck AROM of all participants was significantly below normal average in all directions, and a moderate negative association was found between the ONL CSA and AROM in flexion-extension. Most patients had moderate loss of cervical lordotic curve despite there being no significant correlation between ONL CSA and cervical curvature. Moreover, CNF stenosis ratio significantly negatively correlated with ONL CSA. Patients with larger ONL had more severe cervical radiculopathy, more stiffness in flexion-extension direction, more complex degenerative change of spine, and worse CNF stenosis. PMID:23089319
Tsai, Yu-Lin; Weng, Ming-Cheng; Chen, Tien-Wen; Hsieh, Yi-Lun; Chen, Chia-Hsin; Chen, Chia-Shin; Huang, Mao-Hsiung
Cervical radiculopathy of the C2-4 spinal nerves is a rare condition and is poorly documented in terms of clinical symptoms, hindering its detection during initial patient screening based on imaging diagnostics. The authors describe in detail the clinical symptoms and successful surgical treatment of a patient diagnosed with isolated C-4 radiculopathy. This 41-year-old man suffered from sleep disturbance because of pain behind the right ear, along the right clavicle, and at the back of his neck on the right side. The Jackson and Spurling tests were positive, with pain radiating to the area behind the patient's ear. Unlike in cases of radiculopathy involving the C5-8 spinal nerves, no loss of upper-extremity motor function was seen. Magnetic resonance imaging showed foraminal stenosis at the C3-4 level on the right side, and multiplanar reconstruction CT revealed a beak-type ossification of the posterior longitudinal ligament in the foraminal region at the same level. In the absence of intracranial lesions or spinal cord compressive lesions, the positive Jackson and Spurling tests and the C3-4 foraminal stenosis were indicative of isolated C-4 radiculopathy. Microscopic foraminotomy was performed at the C3-4 vertebral level and the ossified lesion was resected. The patient's symptoms completely resolved immediately after surgery. To the authors' knowledge, this report is the first to describe the symptomatic features of isolated C-4 radiculopathy, in a case in which the diagnosis has been confirmed by both radiological findings and surgical outcome. Based on this case study, the authors conclude that the characteristic symptoms of C-4 radiculopathy are the presence of pain behind the ear and in the clavicular region in the absence of upper-limb involvement. PMID:24654743
Katsumi, Keiichi; Yamazaki, Akiyoshi; Watanabe, Kei; Hirano, Toru; Ohashi, Masayuki; Endo, Naoto
Novel surgical technique for ossification of posterior longitudinal ligament in the thoracic spine.
Several surgical procedures have been developed to treat thoracic ossification of the posterior longitudinal ligament (OPLL). However, favorable surgical results are not always achieved, and consistent protocols and procedures for surgical treatment of thoracic OPLL have not been established. This technical note describes a novel technique to achieve anterior decompression via a single posterior approach. Three patients with a beak-type thoracic OPLL underwent surgery in which the authors' technique was used. Complete removal of the ossified PLL was achieved in all cases. With the patient in the prone position, the authors performed total resection of the posterior elements at the anterior decompression levels. This maneuver included not only laminectomies but also removal of the transverse processes and pedicles, which allowed space to be created bilaterally at the sides of the dural sac for the subsequent anterior decompression. The thoracic nerves at the levels of anterior decompression were ligated bilaterally and lifted up to manipulate the ossified ligament and the dural sac. An anterior decompression was then performed posteriorly. The PLL was floated without any difficulty. After exfoliation of the adhesions between the ossified ligament and the ventral aspect of the dural sac, the ossified PLL was removed. In every step of the anterior decompression, the space created in the bilateral sides of the dural sac allowed the surgeons to see the OPLL and anterolateral aspect of the dural sac directly and easily. After removal of the ossified PLL, posterior instrumented fusion was performed. This surgical procedure allows the surgeon to perform, safely and effectively, anterior decompression via a posterior approach for thoracic OPLL. PMID:23039177
Kato, Satoshi; Murakami, Hideki; Demura, Satoru; Yoshioka, Katsuhito; Hayashi, Hiroyuki; Tsuchiya, Hiroyuki
Purpose: Heterotopic ossification (HO), or abnormal bone formation, is a common sequela of total hip arthroplasty. This abnormal bone can impair joint function and must be surgically removed to restore mobility. HO can be prevented by postoperative nonsteroidal anti-inflammatory drug (NSAID) use or radiotherapy (RT). NSAIDs are associated with multiple toxicities, including gastrointestinal bleeding. Although RT has been shown to be more efficacious than NSAIDs at preventing HO, its cost-effectiveness has been questioned. Methods and Materials: We performed an analysis of the cost of postoperative RT to the hip compared with NSAID administration, taking into account the costs of surgery for HO formation, treatment-induced morbidity, and productivity loss from missed work. The costs of RT, surgical revision, and treatment of gastrointestinal bleeding were estimated using the 2007 Medicare Fee Schedule and inpatient diagnosis-related group codes. The cost of lost wages was estimated using the 2006 median salary data from the U.S. Census Bureau. Results: The cost of administering RT was estimated at $899 vs. $20 for NSAID use. After accounting for the additional costs associated with revision total hip arthroplasty and gastrointestinal bleeding, the corresponding estimated costs were $1,208 vs. $930. Conclusion: If the costs associated with treatment failure and treatment-induced morbidity are considered, the cost of NSAIDs approaches that of RT. Other NSAID morbidities and quality-of-life differences that are difficult to quantify add to the cost of NSAIDs. These considerations have led us to recommend RT as the preferred modality for use in prophylaxis against HO after total hip arthroplasty, even when the cost is considered.
Strauss, Jonathan B. [Department of Radiation Oncology, Rush University Medical Center, Chicago, IL (United States)], E-mail: firstname.lastname@example.com; Chen, Sea S.; Shah, Anand P.; Coon, Alan B. [Department of Radiation Oncology, Rush University Medical Center, Chicago, IL (United States); Dickler, Adam [Department of Radiation Oncology, Little Company of Mary Hospital, Evergreen Park, IL (United States)
Background Idiopathic arthrofibrosis occurs in 3-4% of patients who undergo total knee arthroplasty (TKA). However, little is known about the cellular or molecular changes involved in the onset or progression of this condition. To classify the histomorphologic changes and evaluate potential contributing factors, periarticular tissues from the knees of patients with arthrofibrosis were analyzed for fibroblast and mast cell proliferation, heterotopic ossification, cellular apoptosis, hypoxia and oxidative stress. Results The arthrofibrotic tissue was composed of dense fibroblastic regions, with limited vascularity along the outer edges. Within the fibrotic regions, elevated numbers of chymase/fibroblast growth factor (FGF)-expressing mast cells were observed. In addition, this region contained fibrocartilage and associated heterotopic ossification, which quantitatively correlated with decreased range of motion (stiffness). Fibrotic, fibrocartilage and ossified regions contained few terminal dUTP nick end labeling (TUNEL)-positive or apoptotic cells, despite positive immunostaining for lactate dehydrogenase (LDH)5, a marker of hypoxia, and nitrotyrosine, a marker for protein nitrosylation. LDH5 and nitrotyrosine were found in the same tissue areas, indicating that hypoxic areas within the tissue were associated with increased production of reactive oxygen and nitrogen species. Conclusions Taken together, we suggest that hypoxia-associated oxidative stress initiates mast cell proliferation and FGF secretion, spurring fibroblast proliferation and tissue fibrosis. Fibroblasts within this hypoxic environment undergo metaplastic transformation to fibrocartilage, followed by heterotopic ossification, resulting in increased joint stiffness. Thus, hypoxia and associated oxidative stress are potential therapeutic targets for fibrosis and metaplastic progression of idiopathic arthrofibrosis after TKA. PMID:20809936
We model the dynamics of energy transfer and primary charge separation in isolated photosystem II (PSII) reaction centers. Different exciton models with specific site energies of the six core pigments and two peripheral chlorophylls (Chls) in combination with different charge transfer schemes have been compared using a simultaneous fit of the absorption, linear dichroism, circular dichroism, steady-state fluorescence, transient absorption upon different excitation wavelengths, and time-resolved fluorescence. To obtain a quantitative fit of the data we use the modified Redfield theory, with the experimental spectral density including coupling to low-frequency phonons and 48 high-frequency vibrations. The best fit has been obtained with a model implying that the final charge separation occurs via an intermediate state with charge separation within the special pair (RP(1)). This state is weakly dipole-allowed, due to mixing with the exciton states, and can be populated directly or via 100-fs energy transfer from the core-pigments. The RP(1) and next two radical pairs with the electron transfer to the accessory Chl (RP(2)) and to the pheophytin (RP(3)) are characterized by increased electron-phonon coupling and energetic disorder. In the RP(3) state, the hole is delocalized within the special pair, with a predominant localization at the inactive-branch Chl. The intrinsic time constants of electron transfer between the three radical pairs vary from subpicoseconds to several picoseconds (depending on the realization of the disorder). The equilibration between RP(1) and RP(2) is reached within 5 ps at room temperature. During the 5-100-ps period the equilibrated core pigments and radical pairs RP(1) and RP(2) are slowly populated from peripheral chlorophylls and depopulated due to the formation of the third radical pair, RP(3). The effective time constant of the RP(3) formation is 7.5 ps. The calculated dynamics of the pheophytin absorption at 545 nm displays an instantaneous bleach (30% of the total amplitude) followed by a slow increase of the bleaching amplitude with time constants of 15 and 12 ps for blue (662 nm) and red (695 nm) excitation, respectively. PMID:15980183
Novoderezhkin, Vladimir I; Andrizhiyevskaya, Elena G; Dekker, Jan P; van Grondelle, Rienk
We model the dynamics of energy transfer and primary charge separation in isolated photosystem II (PSII) reaction centers. Different exciton models with specific site energies of the six core pigments and two peripheral chlorophylls (Chls) in combination with different charge transfer schemes have been compared using a simultaneous fit of the absorption, linear dichroism, circular dichroism, steady-state fluorescence, transient absorption upon different excitation wavelengths, and time-resolved fluorescence. To obtain a quantitative fit of the data we use the modified Redfield theory, with the experimental spectral density including coupling to low-frequency phonons and 48 high-frequency vibrations. The best fit has been obtained with a model implying that the final charge separation occurs via an intermediate state with charge separation within the special pair (RP1). This state is weakly dipole-allowed, due to mixing with the exciton states, and can be populated directly or via 100-fs energy transfer from the core-pigments. The RP1 and next two radical pairs with the electron transfer to the accessory Chl (RP2) and to the pheophytin (RP3) are characterized by increased electron-phonon coupling and energetic disorder. In the RP3 state, the hole is delocalized within the special pair, with a predominant localization at the inactive-branch Chl. The intrinsic time constants of electron transfer between the three radical pairs vary from subpicoseconds to several picoseconds (depending on the realization of the disorder). The equilibration between RP1 and RP2 is reached within 5 ps at room temperature. During the 5¢100-ps period the equilibrated core pigments and radical pairs RP1 and RP2 are slowly populated from peripheral chlorophylls and depopulated due to the formation of the third radical pair, RP3. The effective time constant of the RP3 formation is 7.5 ps. The calculated dynamics of the pheophytin absorption at 545 nm displays an instantaneous bleach (30% of the total amplitude) followed by a slow increase of the bleaching amplitude with time constants of 15 and 12 ps for blue (662 nm) and red (695 nm) excitation, respectively. PMID:15980183
Novoderezhkin, Vladimir I.; Andrizhiyevskaya, Elena G.; Dekker, Jan P.; van Grondelle, Rienk
Although primary antifungal prophylaxis (PAP) is routinely administered in patients with acute myeloid leukemia (AML) during remission-induction and consolidation chemotherapy, the impact of PAP on the incidence of invasive fungal infections (IFIs) is not well described. We retrospectively analyzed the incidence of IFIs in 152 patients with AML who had been admitted to a tertiary cancer center between August 2009 and March 2011 and received PAP within 120 days after first remission-induction chemotherapy. We excluded patients who had undergone stem cell transplantation. Patients received a PAP drug with anti-Aspergillus activity during 72% (7,660/10,572) of prophylaxis-days. The incidence of documented IFIs (definite or probable according to revised European Organization for Research and Treatment of Cancer [EORTC] criteria) was 2.0/1,000 prophylaxis-days (95% confidence interval [CI], 1.23 to 3.04). IFIs due to molds were more common than IFIs due to yeasts (1.5/1,000 prophylaxis-days versus 0.4/1,000 prophylaxis-days; P = 0.01). Echinocandin-based PAP (8.6 and 7.1/1,000 prophylaxis-days, respectively) was associated with higher rates of documented IFIs than anti-Aspergillus azoles (voriconazole or posaconazole) (2.4 and 1.1/1,000 prophylaxis-days, respectively) at both 42 days (P = 0.03) and 120 days (P < 0.0001) after first remission-induction chemotherapy. The incidence of overall (documented and presumed) IFIs (P < 0.001), documented IFIs (P < 0.01), and empirical antifungal therapies (P < 0.0001) was higher during the first 42 days than after day 42. Despite the broad use of PAP with anti-Aspergillus activity, IFIs, especially molds, remain a significant cause of morbidity and mortality in AML patients, predominantly during the remission-induction phase. Patients receiving echinocandin-based PAP experienced higher rates of IFIs than did those receiving anti-Aspergillus azoles. PMID:24277033
Mulanovich, Victor E.; Jiang, Y.; Lewis, Russell E.
Although primary antifungal prophylaxis (PAP) is routinely administered in patients with acute myeloid leukemia (AML) during remission-induction and consolidation chemotherapy, the impact of PAP on the incidence of invasive fungal infections (IFIs) is not well described. We retrospectively analyzed the incidence of IFIs in 152 patients with AML who had been admitted to a tertiary cancer center between August 2009 and March 2011 and received PAP within 120 days after first remission-induction chemotherapy. We excluded patients who had undergone stem cell transplantation. Patients received a PAP drug with anti-Aspergillus activity during 72% (7,660/10,572) of prophylaxis-days. The incidence of documented IFIs (definite or probable according to revised European Organization for Research and Treatment of Cancer [EORTC] criteria) was 2.0/1,000 prophylaxis-days (95% confidence interval [CI], 1.23 to 3.04). IFIs due to molds were more common than IFIs due to yeasts (1.5/1,000 prophylaxis-days versus 0.4/1,000 prophylaxis-days; P = 0.01). Echinocandin-based PAP (8.6 and 7.1/1,000 prophylaxis-days, respectively) was associated with higher rates of documented IFIs than anti-Aspergillus azoles (voriconazole or posaconazole) (2.4 and 1.1/1,000 prophylaxis-days, respectively) at both 42 days (P = 0.03) and 120 days (P < 0.0001) after first remission-induction chemotherapy. The incidence of overall (documented and presumed) IFIs (P < 0.001), documented IFIs (P < 0.01), and empirical antifungal therapies (P < 0.0001) was higher during the first 42 days than after day 42. Despite the broad use of PAP with anti-Aspergillus activity, IFIs, especially molds, remain a significant cause of morbidity and mortality in AML patients, predominantly during the remission-induction phase. Patients receiving echinocandin-based PAP experienced higher rates of IFIs than did those receiving anti-Aspergillus azoles. PMID:24277033
Gomes, Marisa Z R; Mulanovich, Victor E; Jiang, Y; Lewis, Russell E; Kontoyiannis, Dimitrios P
INTRODUCTION Symtomatic lumbar ligamantum flavum calcification is quite rare in the young age group. PRESENTATION OF CASE The authors report a case of young adult with diagnosis of lumbar spinal stenosis, presenting with leg pain and neurological deficits. Computerized tomography (CT) scan and magnetic resonance (MR) imaging studies revealed ossification of the ligamantum flavum as the causative factor of the disease and the patient recovered completely after the decompressive operation. DISCUSSION It is emphasized that attention should be given to this rare etiological factor of lumbar spinal stenosis. CONCLUSION Complete relief can be achieved with early and adequate surgery. PMID:23774332
Yilmaz, Murat; Kalemci, Orhan; Yilmaz, Hakan; Palaz, Necdet M.
The E2F family of transcription factors, in association with pocket protein family members, are important for regulating genes required for cellular proliferation. The most abundant E2F, E2F4, is implicated in maintaining the G0/G1 cell cycle state via transcriptional repression of genes that encode proteins required for S-phase progression. Here, we investigate E2F4's role in bone development using E2f4 germline mutant mice. We find that mutation of E2f4 impairs the formation of several bones that arise through intramembranous or endochondral ossification. The most severe defect occurred in the calvarial bones of the skull where we observed a striking delay in their ossification. In vivo and in vitro analyses established that E2F4 loss did not block the intrinsic differentiation potential of calvarial osteoblast progenitors. However, our data showed that E2f4 mutation elevated proliferation in the developing calvaria in vivo and it increased the endogenous pool of undifferentiated progenitor cells. These data suggest that E2F4 plays an important role in enabling osteoblast progenitors to exit the cell cycle and subsequently differentiate thereby contributing to the commitment of these cells to the bone lineage. PMID:20581455
Miller, Emily S; Berman, Seth D; Yuan, Tina L
The combination of radiotherapy and indomethacin for the prevention of heterotopic ossification (HO) in high-risk patients undergoing total hip arthroplasty (THA) has not been reported. The aim of the present study was to present the experience of our department with this combined therapeutic protocol. Fifty-four patients who underwent THA received a single dose of 7ĀGy of postoperative radiotherapy and 75Āmg of indomethacin for 15Ādays. Patients were analyzed for clinical and radiographical evidence of HO development at 1Āyear postoperatively. The overall radiographical incidence of HO was 20.4% (95% CI 10.6¢33.5%), while only 1 patient with clinically significant HO was seen. Patients with secondary arthritis due to congenital hip disease had a statistically significantly higher incidence of HO compared with those with osteoarthrosis. The clinical assessment with the Merle dÆAubignķ score showed that patients with radiographic documentation of HO had a lower mean score compared with those with no evidence of HO. No treatment-related side effects were seen. Combined radiotherapy and indomethacin was effective in preventing heterotopic ossification after total hip arthroplasty. The evaluation of this efficacy compared with radiotherapy or NSAIDs alone should be the future target of larger randomized designs. PMID:16482442
Pitouli, Evita J.; Tsekeris, Pericles G.; Papathanasopoulou, Vasiliki; Stafilas, Kosmas; Xenakis, Theodore H.
The authors retrospectively analyzed 629 CT images of patients aged between 15 and 30 years produced during multiple trauma diagnostics at the Unfallkrankenhaus Berlin. For the purposes of this study, the authors reliably determined the ossification status of the medial epiphysis of the clavicle in 556 cases, using the classification of stages by Schmeling et al. In both sexes, stage 2 was first noted at age 15. In male patients, the earliest occurrence of stage 3 was noted at age 17, in female patients at age 16. Stage 4 was first achieved by both sexes at age 21. Stage 5 was first noted in female patients at age 21 and in male patients at age 22, which is 4 or 5 years earlier than was observed by a comparable study using conventional radiographs. The partial-volume effect in computed tomography using the thick slice scanning mode was discussed as a possible explanation for this early visualization. The question of how slice thickness affects the age intervals between ossification stages identified by CT examinations should be examined in additional studies. PMID:15711799
Schulz, Ronald; M³hler, Matthias; Mutze, Sven; Schmidt, Sven; Reisinger, Walter; Schmeling, Andreas
Ossification of the posterior longitudinal ligament (OPLL) and ossification of the ligamentum flavum (OLF) have been recognized as causes of myelopathy due to thickening of the ligaments resulting in narrowing of the spinal canal and compression of the spinal cord. However, few studies have focused on predicting stress distribution under conditions of OPLL and OLF based on clinical aspects such as the relationship between level of stress and severity of neurologic symptoms because direct in vivo measurement of stress is very restrictive. In this study, a three-dimensional finite element model of the spinal cord in T12-L1 was developed based on MR images. The von-Mises stresses in the cord and the cross-sectional area of the cord were investigated for various grades and shapes of spinal cord compression in OPLL and OLF. Substantial increases in maximum stresses resulting in the manifestation of spinal cord symptoms occurred when the cross-sectional area was reduced by 30-40% at 60% compression of the antero-posterior diameter of the cord in OPLL and at 4mm compression in OLF. These results indicate that compression greater than these thresholds may induce spinal symptoms, which is consistent with clinical observations. PMID:23419995
Kim, Yoon Hyuk; Khuyagbaatar, Batbayar; Kim, Kyungsoo
Low-grade fibromyxoid sarcoma was first described more than 20 years ago. Subsequently, it was discovered to carry the recurrent chromosomal translocation t(7;16)(q33;p11) encoding a FUS-CREB3L2 fusion oncoprotein. Molecular tests for this pathognomonic gene fusion can confirm the identity of histologic variants (such as hyalinizing spindle cell tumor with giant rosettes) and suggest that some cases of sclerosing epithelioid fibrosarcoma may represent a high-grade version of this entity. We present a case of an ossifying tumor of the perineum that required an open biopsy and fluorescent in situ hybridization testing for FUS and CREB3L2 for diagnosis as a variant of low-grade fibromyxoid sarcoma. Subsequent excision revealed characteristic areas with collagen rosettes as well as foci of heterotopic ossification. Significant ossification, which is well documented in entities such as synovial sarcoma, ossifying fibromyxoid tumor, and extraskeletal osteosarcoma, has not been reported previously in low-grade fibromyxoid sarcoma. This case demonstrates the value of having a distinctive confirmatory molecular pathology test for diagnosis and expands our knowledge of the histologic variants possible in low-grade fibromyxoid sarcoma. PMID:21658743
Lee, Anna F; Yip, Stephen; Smith, Adam C; Hayes, Malcolm M; Nielsen, Torsten O; O'Connell, John X
National Technical Information Service (NTIS)
Modular high and medium voltage gas insulated electrical substations are being used by ENEL (Italian Electricity Board) to meet the specific needs of urban centers with special design and sizing constraints of a historical/architectural nature. This paper...
A. Bargigia, C. Boatto, A. Di Mario, N. Fava, S. Sciarra
Thin-slice computed tomography provides the imaging modality of choice in analysing the ossification process of the medial clavicular epiphysis for the purpose of forensic age diagnostics in the living in the course of criminal proceedings. The classification of the ossification stages by Schmeling et al. compass the emergence of an epiphyseal ossification centre (stage 2), the partial fusion of the epiphysis with the metaphysis (stage 3), the complete fusion of these osseous elements including a visible epiphyseal scar (stage 4), and the complete fusion without a visible epiphyseal scar (stage 5). In the present study, each of the ossification stages 2 and 3 was divided into an early, intermediate and late phase. The authors evaluated the thin-slice CT scans of 185 patients aged between 13 and 26 years. In all these cases, a stage 2 or 3 had been determined in a previous study. The late stage 3, which is characterized by a fusion between metaphysis and epiphysis completing more than two thirds of the former epiphyseal gap, first appeared at age 19 in both sexes. If a late stage 3 is found, it is therefore possible to substantiate that an individual has already reached the legally important age threshold of 18 years. PMID:20354711
Kellinghaus, Manuel; Schulz, Ronald; Vieth, Volker; Schmidt, Sven; Pfeiffer, Heidi; Schmeling, Andreas
The petro-occitpital fissure (POF) lies within a critical interface of cranial growth and development in the posterior cranial fossa. The relationships between skeletal and soft tissues make this region especially important for examining biomechanical and basic biologic forces that may mold the cranial base and contribute to significant clinicopathologies associated with the structures located near the POF. Therefore, this study investigates the POF in adults in both preserved human cadavers and dried crania in order to determine if developmental changes can be observed and, if so, their value in age assessment as a model system for describing normal morphogenesis of the POF. This study demonstrates that tissue within the POF undergoes characteristic changes in ossification with age, the onset of which is considerably later than that of other synchondroses of the cranial base. Statistically, there is a moderate to strong correlation between age and stage of ossification within the POF. Further, male crania were observed to reach greater degrees of ossification at a younger age than female crania and that individual asymmetry in ossification of the tissue within the POF was not uncommon. An understanding of the basic temporal biological processes of the POF may yield insight into the development of clinicopathologies in this region of the cranial base. PMID:15584035
In recent years, there has been a renewed interest in forensic sciences about forensic age estimation in living subjects by means of radiological methods. This research was conducted on digital thorax X-rays to test the usefulness of some radiological changes in the clavicle and first rib. The sample consisted in a total of 123 subjects of Spanish origin (61 men and 62 women; age range: 5-75 years). From all subjects, a thorax posterior-anterior radiograph was obtained in digital format. Scoring for fusion of medial epiphyses of the clavicle was carried out by Schmeling's system and ossification of the costal cartilage of the first rib by Michelson's system. Degree of ossification and epiphyseal fusion were analyzed in relation with known age and sex of these subjects. The results give a minimum age of >20 years for full fusion of the medial epiphysis of the clavicle (Stages 4 and 5). Concerning the first rib, all subjects with the final Stage 3 of ossification were above 25 years of age. These results suggest that the first rib ossification might become an additional method to the ones so far recommended for forensic age estimation in subjects around 21. New research would be desirable to confirm this suggestion. PMID:21155800
Garamendi, Pedro M; Landa, Maria I; Botella, Miguel C; Alemßn, Inmaculada
BACKGROUND: Although Primary Health Care (PHC) Teams are used to deal with prevention and treatment of sanitary problems in adults with chronic diseases, they usually have a lack of experience in development of psychotherapeutic interventions. However, these interventions are the ones that achieve better results to reduce symptomatology and improve emotional state of caregivers. The study aims to evaluate the
Emiliano RodrĒguez-Sßnchez; Sara Mora-Sim¾n; Nieves Porras-Santos; Maria C Patino-Alonso; Josķ I Recio-RodrĒguez; Concepci¾n Becerro-Mu±oz; Diana Pķrez-Arechaederra; Manuel A Gomez-Marcos; Luis Garcia-Ortiz
BACKGROUND: Mental distress is common in primary care and overrepresented among Human Immunodeficiency virus (HIV)-infected individuals, but access to effective treatment is limited, particularly in developing countries. Explanatory models (EM) are contextualised explanations of illnesses and treatments framed within a given society and are important in understanding an individual's perspective on the illness. Although individual variations are important in determining
Peter J Chipimo; Mary Tuba; Knut Fylkesnes
Only quinones with a 2-methoxy group can act simultaneously as the primary (QA) and secondary (QB) electron acceptors in photosynthetic reaction centers from Rhodobacter sphaeroides. (13)C hyperfine sublevel correlation measurements of the 2-methoxy in the semiquinone states, SQA and SQB, were compared with quantum mechanics calculations of the (13)C couplings as a function of the dihedral angle. X-ray structures support dihedral angle assignments corresponding to a redox potential gap (?Em) between QA and QB of ~180 mV. This is consistent with the failure of a ubiquinone analogue lacking the 2-methoxy to function as QB in mutant reaction centers with a ?Em of ?160-195 mV. PMID:24079813
Taguchi, Alexander T; Mattis, Aidas J; O'Malley, Patrick J; Dikanov, Sergei A; Wraight, Colin A
Only quinones with a 2-methoxy group can act simultaneously as the primary (QA) and secondary (QB) electron acceptors in photosynthetic reaction centers from Rb. sphaeroides. 13C HYSCORE measurements of the 2-methoxy in the semiquinone states, SQA and SQB, were compared with QM calculations of the 13C couplings as a function of dihedral angle. X-ray structures support dihedral angle assignments corresponding to a redox potential gap (?Em) between QA and QB of ~180 mV. This is consistent with the failure of a ubiquinone analog lacking the 2-methoxy to function as QB in mutant reaction centers with a ?Em ? 160¢195 mV. PMID:24079813
Taguchi, Alexander T.; Mattis, Aidas J.; O'Malley, Patrick J.; Dikanov, Sergei A.; Wraight, Colin A.
Background Students may encounter difficulties when they have to apply clinical skills trained in their pre-clinical studies in clerkships. Early clinical exposure in the pre-clinical phase has been recommended to reduce these transition problems. The aim of this study is to explore differences in students' experiences during the first clerkships between students exclusively trained in a skills laboratory and peers for whom part of their skills training was substituted by early clinical experiences (ECE). Methods Thirty pre-clinical students trained clinical skills exclusively in a skills laboratory; 30 peers received part of their skills training in PHC centers. Within half a year after commencing their clerkships all 60 students shared their experiences in focus group discussions (FGDs). Verbatim transcripts of FGDs were analyzed using Atlas-Ti software. Results Clerkship students who had participated in ECE in PHC centers felt better prepared to perform their clinical skills during the first clerkships than peers who had only practiced in a skills laboratory. ECE in PHC centers impacted positively in particular on studentsÆ confidence, clinical reasoning, and interpersonal communication. Conclusion In the Indonesian setting ECE in PHC centers reduce difficulties commonly encountered by medical students in the first clerkships. PMID:22640419
the cofactors that transfer electrons from the lumenal side to the stromal side of PSI. The two terminal electron acceptors FA and FB (4Fe-4S clusters) are coordi- nated by the PsaC subunit. Light energy absorbedElectron Transfer from Plastocyanin to the Photosystem I Reaction Center in Mutants with Increased
ERIC Educational Resources Information Center
This is a collection of recipes which children involved in early childhood education centers can prepare for their own consumption. The recipes were contributed by teachers in such schools based on their own successful experiences in using cooking as a learning experience for children to incorporate and integrate a number of intellectual tasks,ģ
Foster, Florence P.
A report on two homozygous twin girls affected by X linked hypophosphataemic rickets. They were examined due to short stature and genu varum of both tibias. They were treated with calcitriol and Joulie's solution, whereon it was observed that serum parathyroid hormone and phosphaturia decreased while phosphataemia increased. They underwent a tibial osteotomy (by means of the insertion of Kirchner needles) at 7.7?years of age for correction of genu varum and a normal consolidation was reached 1?month later. Nonetheless, height was percentile <1 after menarche, so both sisters asked for bone lengthening. Because of this, at 15?years of age femoral distraction was performed, but no bone callus was observed 14?months later. Consequently, they were treated with subcutaneous growth hormone, showing bone callus at 6?months. Finally, the external fixators were removed due to ossification in the lengthened segments. PMID:25115781
Ca±ete, Ram¾n; Caballero-Villarraso, Javier; Aguilar-Quintero, MarĒa; Vßzquez-Rueda, Fernando
The ontogenetic sequence of cranial osteogenesis through adulthood is described in samples of newts from completely metamorphosing and partially neotenic populations. Cranial ossification proceeds in the same sequence in both samples. Seven stages of cranial development are described on the basis of conspicuous events that occur during ontogeny. These include four larval stages, metamorphs, efts, and adults. Neotenic adults have skulls that are metamorphosed completely and indistinguishable from the skulls of non-neotenic adults. Neoteny in these newts does not involve the skull and is limited to the postmetamorphic retention of some gill structures and, thus, is termed "limited neoteny." The evolution of limited neoteny in newts as a correlated response to the inhibition of land-drive behavior is discussed. PMID:3735436
Reilly, S M
Background To investigate the imaging features of primary sarcomas of the great vessels in CT, MRI and 18?F-FDG PET/CT. Methods Thirteen patients with a primary sarcoma of the great vessels were retrospectively evaluated. All available images studies including F-18 FDG PET(/CT) (n?=?4), MDCT (n?=?12) and MRI (n?=?6) were evaluated and indicative image features of this rare tumor entity were identified. Results The median interval between the first imaging study and the final diagnosis was 11Āweeks (0¢12Āweeks). The most frequently observed imaging findings suggestive of malignant disease in patients with sarcomas of the pulmonary arteries were a large filling defect with vascular distension, unilaterality and a lack of improvement despite effective anticoagulation. In patients with aortic sarcomas we most frequently observed a pedunculated appearance and an atypical location of the filling defect. The F-18 FDG PET(/CT) examinations demonstrated an unequivocal hypermetabolism of the lesion in all cases (4/4). MRI proved lesion vascularization in 5/6 cases. Conclusion Intravascular unilateral or atypically located filling defects of the great vessels with vascular distension, a pedunculated shape and lack of improvement despite effective anticoagulation are suspicious for primary sarcoma on MDCT or MRI. MR perfusion techniques can add information on the nature of the lesion but the findings may be subtle and equivocal. F-18 FDG PET/CT may have a potential role in these patients and may be considered as part of the imaging workup. PMID:23924063
Treatment options for inoperable glioblastoma are limited. Low-dose-rate stereotactic iodine-125 brachytherapy (SBT) has been reported as an effective and low-risk treatment option for circumscribed low-grade gliomas and brain metastases. The present study evaluates this treatment approach for patients with inoperable glioblastoma. Between 1990 and 2012, 201 patients with histologically proven glioblastoma were treated with SBT (iodine-125 seeds; median cumulative surface dose, 60ĀGy; median dose-rate, 6ĀcGy/h; median gross-tumor-volume, 17Āml) either as primary treatment (nĀ=Ā103) or at recurrence (nĀ=Ā98). In addition to SBT, 90.3Ā% of patients in the primary treatment group received external boost radiotherapy (median dose, 25.2ĀGy). Adjuvant chemotherapy was added for 30.8Ā% of patients following SBT and consisted of temozolomide for the majority of cases (88.7Ā%). Procedure-related complications, clinical outcome, progression-free and overall survival (PFS, OS) were evaluated. Median follow-up was 9.8Āmonths. The procedure-related mortality was zero. During follow-up, transient and permanent procedure-related morbidity was observed in 7.5 and 2.0Ā%, respectively. Calculated from the time of SBT, median OS and PFS rates were 10.5 and 6.2Āmonths, with no significant differences among primary and recurrent tumors (11.1 vs.10.4Āmonths for OS and 6.2 vs. 5.9Āmonths for PFS). For OS, multivariate analysis revealed Karnofsky performance score, age, and adjuvant chemotherapy as independent prognostic factors (all pĀ<Ā0.01). Low-dose-rate SBT is a relatively safe and potentially effective local treatment option for patients with circumscribed inoperable glioblastoma initially or at recurrence. It deserves prospective validation since it may improve the outcome for a subset of patients with inoperable GBM. PMID:25151509
Kickingereder, Philipp; Hamisch, Christina; Suchorska, Bogdana; Galldiks, Norbert; Visser-Vandewalle, Veerle; Goldbrunner, Roland; Kocher, Martin; Treuer, Harald; Voges, Juergen; Ruge, Maximilian I
Ewing sarcoma/peripheral primitive neuroectodermal tumor (pPNET) is a rare primary tumor of the kidney with morphologic features similar to those of other primitive tumors. Previous studies have shown that these tumors frequently stain positively with immunostains against CD99 and FLI-1 and negatively with stains against WT-1, suggesting that these markers may be used for the distinction between Wilms tumor and pPNET. We present 30 cases of primary malignant neuroepithelial tumor with immunohistochemical profiles and reverse transcriptase polymerase chain reaction (RT-PCR) analysis and show that immunophenotypic overlap exists between Wilms tumor and pPNET. A subset of 30 neuroepithelial tumors from the National Wilms Tumor Study originally categorized as putative pPNETs of the kidney was stained with FLI-1, WT-1, and thyroid transcription factor-1. Bicolor fluorescence in situ hybridization studies were performed on 19 of the cases. Other data on these tumors were available from a previous study (Am J Surg Pathol 2001;25:133). Of 7 primary tumors that had the EWS/FLI-1 fusion transcript by RT-PCR, 6 exhibited strong immunopositivity for FLI-1. Nine that were negative by RT-PCR stained positively with the FLI-1 stain. Five fusion-negative cases stained with both FLI-1 and WT-1. Three fusion-negative cases were negative for FLI-1 but positive for WT-1. Five fusion-negative cases were negative for both FLI-1 and WT-1. Of the 30 cases, 29 were positive for CD99. Seven cases that were negative for the EWS-FLI-1 fusion by RT-PCR were positive by fluorescence in situ hybridization. All cases were negative for thyroid transcription factor-1. Reliance upon immunohistochemistry as the sole means of ancillary diagnosis in renal pPNET can lead to confusing results. We recommend molecular fusion studies for clarification of primitive renal tumors with unexpected immunophenotypic results. PMID:17134738
Ellison, Dale A; Parham, David M; Bridge, Julia; Beckwith, J Bruce
Primary syphilis; Secondary syphilis; Late syphilis; Tertiary syphilis ... their newborn (congenital syphilis). Syphilis has three stages: Primary syphilis Secondary syphilis Tertiary syphilis (the late phase ...
Background Preoperative patients' characteristics can predict the need for perioperative blood component transfusion in cardiac surgical operations. The aim of this prospective observational study is to identify perioperative patient characteristics predicting the need for allogeneic packed red blood cell (PRBC) transfusion in isolated primary coronary artery bypass grafting (CABG) operations. Patients and Methods 105 patients undergoing isolated, first-time CABG were reviewed for their preoperative variables and followed for intraoperative and postoperative data. Patients were 97 males and 8 females, with mean age 58.28 ▒ 10.97 years. Regression logistic analysis was used for identifying the strongest perioperative predictors of PRBC transfusion. Results PRBC transfusion was used in 71 patients (67.6%); 35 patients (33.3%) needed > 2 units and 14 (13.3%) of these needed > 4 units. Univariate analysis identified female gender, age > 65 years, body weight ? 70 Kg, BSA ? 1.75 m2, BMI ? 25, preoperative hemoglobin ? 13 gm/dL, preoperative hematocrit ? 40%, serum creatinine > 100 ?mol/L, Euro SCORE (standard/logistic) > 2, use of CPB, radial artery use, higher number of distal anastomoses, and postoperative chest tube drainage > 1000 mL as significant predictors. The strongest predictors using multivariate analysis were CPB use, hematocrit, body weight, and serum creatinine. Conclusion The predictors of PRBC transfusion after primary isolated CABG are use of CPB, hematocrit ? 40%, weight ? 70 Kg, and serum creatinine > 100 ?mol/L. This leads to better utilization of blood bank resources and cost-efficient targeted use of expensive blood conservation modalities. PMID:19422707
Elmistekawy, Elsayed M; Errett, Lee; Fawzy, Hosam F
NASA Astrophysics Data System (ADS)
The frozen solution electron paramagnetic resonance spectrum of the primary donor cation P + rad in reaction centers of site-directed mutants of Rhodobacter ( Rb.) sphaeroides has been obtained at a microwave frequency ?=360 GHz and a magnetic field B0=12.8 T. Due to the high Zeeman resolution of the powder pattern, all three principal components of the rhombic g-tensors at T=160 K could be determined with high accuracy. We compare spectra of the site-directed mutants, in which the axial ligand histidine M202 of the primary donor is replaced by glutamic acid (HE(M202)) or leucine (HL(M202)), with those of the strain R26, whose primary donor is similar to that of the wild type and only lacks the carotenoid. For HE(M202), this is the first determination of its g-tensor with the principal components gxx=2.00335(3), gyy=2.00236(2) and gzz=2.00191(2). While in R26 the primary donor is a bacteriochlorophyll a dimer, the HL(M202) and HE(M202) mutants have previously been shown to be bacteriochlorophyll:bacteriopheophytin heterodimers. Their g-tensor anisotropy ? g= gxx- gzz shows significant variations in opposite directions when compared with R26, with an increased anisotropy for HE(M202) and a decreased one for HL(M202). Calculations employing Density Functional Theory suggest that the observed shifts originate in different torsional angles of the acetyl group attached to the spin-carrying bacteriochlorophyll half L of the dimer.
Fuchs, Martin R.; Schnegg, Alexander; Plato, Martin; Schulz, Claudia; M³h, Frank; Lubitz, Wolfgang; M÷bius, Klaus
Background Only about one-third of eligible HIV/AIDS patients receive anti-retroviral treatment (ART). Decentralizing treatment is crucial to wider and more equitable access, but key obstacles are a shortage of trained healthcare workers (HCW) and challenges integrating HIV/AIDS care with other primary care. This report describes the development of a guideline and training program (PALM PLUS) designed to integrate HIV/AIDS care with other primary care in Malawi. PALM PLUS was adapted from PALSA PLUS, developed in South Africa, and targets middle-cadre HCWs (clinical officers, nurses, and medical assistants). We adapted it to align with Malawi's national treatment protocols, more varied healthcare workforce, and weaker health system infrastructure. Methods/Design The international research team included the developers of the PALSA PLUS program, key Malawi-based team members and personnel from national and district level Ministry of Health (MoH), professional associations, and an international non-governmental organization. The PALSA PLUS guideline was extensively revised based on Malawi national disease-specific guidelines. Advice and input was sought from local clinical experts, including middle-cadre personnel, as well as Malawi MoH personnel and representatives of Malawian professional associations. Results An integrated guideline adapted to Malawian protocols for adults with respiratory conditions, HIV/AIDS, tuberculosis, and other primary care conditions was developed. The training program was adapted to Malawi's health system and district-level supervision structure. PALM PLUS is currently being piloted in a cluster-randomized trial in health centers in Malawi (ISRCTN47805230). Discussion The PALM PLUS guideline and training intervention targets primary care middle-cadre HCWs with the objective of improving HCW satisfaction and retention, and the quality of patient care. Successful adaptations are feasible, even across health systems as different as those of South Africa and Malawi. PMID:21791048
NCIÆs 67 Designated Cancer Centers form a nationwide network for studying and controlling cancer. The Centers are the primary source of new discoveries into cancerÆs causes, prevention, diagnosis, and treatment.
BACKGROUNDCervical diffuse idiopathic skeletal hyperostosis (DISH) and ossification of the posterior longitudinal ligament (OPLL) rarely coexist in the North American population. Here, different surgical strategies were used to manage simultaneous DISH and OPLL resulting in dysphagia or myelopathy in two geriatric patients.METHODSA 74-year-old male with esophageal compression and dysphagia attributed to DISH, and cord compression with myelopathy due to OPLL,
Nancy E Epstein
In this study, both medial clavicular epiphyses of 77 men were evaluated by two researchers with a digital ultrasound system.\\u000a The degree of ossification was classified in four stages according to Schulz et al. (Int J Legal Med 122:55¢58, 17). Of the test persons over 21Āyears of age, stage 4 was found bilaterally in 25 (60%), while for five (12%)
Fabian Quirmbach; Frank Ramsthaler; Marcel A. Verhoff
Hand development in the European shrew Crocidura russula is described, based on the examination of a cleared and double-stained ontogenetic series and histological sections of a c. 20-day-old embryo and a neonate. In the embryo all carpal elements are still mesenchymal condensations, and there are three more elements than in the adult stage: the ælunatumÆ, which fuses with the scaphoid around birth; a centrale, which either fuses with another carpal element or just disappears later in ontogeny; and the anlage of an element that later fuses with the radius. Carpal arrangement in the neonate and the adult is the same. In order to compare the relative timing of the onset of ossification in forelimb bones in C. russula with that of other therians, we built up two matrices of events based on two sets of data and used the event-pair method. In the first analysis, ossification of forelimb elements in general was examined, including that of the humerus, radius, ulna, the first carpal and metacarpal to ossify, and the phalanges of the third digit. The second analysis included each carpal, humerus, radius, ulna, the first metacarpal and the first phalanx to ossify. Some characters (= event¢pairs) provide synapomorphies for some clades examined. There have been some shifts in the timing of ossification apparently not caused by ecological and/or environmental influences. In two species (Oryctolagus and Myotis), there is a tendency to start the ossification of the carpals relatively earlier than in all other species examined, the sauropsid outgroups included. PMID:15291793
Prochel, Jan; Vogel, Peter; Sanchez-Villagra, Marcelo R
Background Particle irradiation was established at the University of Heidelberg 2 years ago. To date, more than 400 patients have been treated including patients with primary brain tumors. In malignant glioma (WHO IV) patients, two clinical trials have been set up-one investigating the benefit of a carbon ion (18 GyE) vs. a proton boost (10 GyE) in addition to photon radiotherapy (50 Gy), the other one investigating reirradiation with escalating total dose schedules starting at 30 GyE. In atypical meningioma patients (WHO ░II), a carbon ion boost of 18 GyE is applied to macroscopic tumor residues following previous photon irradiation with 50 Gy. This study was set up in order to investigate toxicity and response after proton and carbon ion therapy for gliomas and meningiomas. Methods 33 patients with gliomas (n = 26) and meningiomas (n = 7) were treated with carbon ion (n = 26) and proton (n = 7) radiotherapy. In 22 patients, particle irradiation was combined with photon therapy. Temozolomide-based chemotherapy was combined with particle therapy in 17 patients with gliomas. Particle therapy as reirradiation was conducted in 7 patients. Target volume definition was based upon CT, MRI and PET imaging. Response was assessed by MRI examinations, and progression was diagnosed according to the Macdonald criteria. Toxicity was classified according to CTCAE v4.0. Results Treatment was completed and tolerated well in all patients. Toxicity was moderate and included fatigue (24.2%), intermittent cranial nerve symptoms (6%) and single episodes of seizures (6%). At first and second follow-up examinations, mean maximum tumor diameters had slightly decreased from 29.7 mm to 27.1 mm and 24.9 mm respectively. Nine glioma patients suffered from tumor relapse, among these 5 with infield relapses, causing death in 8 patients. There was no progression in any meningioma patient. Conclusions Particle radiotherapy is safe and feasible in patients with primary brain tumors. It is associated with little toxicity. A positive response of both gliomas and meningiomas, which is suggested in these preliminary data, must be evaluated in further clinical trials. PMID:22436135
The assessment of the ossification status of the medial clavicular epiphysis plays a decisive role in forensic age diagnostics to determine whether a person has completed his or her 18th or, respectively, 21st year of life. Currently, computed tomography is the gold standard method for age diagnostics of this kind. However, efforts are being made to establish non-ionizing methods, such as ultrasonography, predominantly, in an attempt to reduce the radiation exposure load of living persons. The present study is the first to score and to compare the ossification status of both medial clavicular epiphyses of the same subjects by sonography, computed tomography, and, in some of the cases, by macroscopy. Our study was conducted on five male corpses, ranging in age from 15.8-28.8 years. In the comparison of high-resolution sonography (frequency, 12-15 MHz) and thin slice computed tomography (slice thickness, 0.6 mm), performed separately for left and right clavicles, the results from these two methods differed in seven of ten cases. In six cases, the ossification stage of the medial clavicle, determined by sonography and classified according to Schulz et al. (2008), was scored higher than with computed tomography. In one case, it was rated lower. There was only one subject for whom both the sonographic and computed tomography findings agreed for both body sides. PMID:23820972
Gonsior, Michael; Ramsthaler, Frank; Gehl, Axel; Verhoff, Marcel A
Nowadays, due to the global increase in migration movements, forensic age estimation of living young adults has become an important focus of interest. Minors often have no identification documents providing their correct birth dates. Establishing the age of majority is therefore fundamental in order to determine whether juvenile penal systems or penal systems in force for adults are to be applied. Radiological examination of the clavicles is one of the methods recommended by the Study Group on Forensic Age Diagnostics. In this retrospective study, a sample of chest radiographs of 274 subjects, aged between 12 and 25Āyears, was studied according to Schmeling's method in order to examine the ossification of both medial clavicular epiphyses. All stage classifications were evaluated by five examiners. Intra- and inter-examiner reliability was analysed by Cohen's K statistic. Intra-examiner agreement was insufficient for two of the experts. Inter-examiner agreement, among the other three operators, was moderate (K?=?0.509). Study of reliability highlighted difficulties in interpretation, the need to select qualified personnel and choice of the best radiographic image in order to reduce any anatomic overlaps. Although ossification of the medial clavicular epiphyses is recommended to assess whether an individual has already reached the age of majority or not, these results suggested that it is very difficult to clearly identify the five stages of ossification by using conventional chest radiography. PMID:22968719
Cameriere, R; De Luca, S; De Angelis, D; Merelli, V; Giuliodori, A; Cingolani, M; Cattaneo, C; Ferrante, L
This study describes an outbreak of varicella, in a small town in the region of Puglia, Southern Italy, in the period between February¢March 2011. This outbreak presented the opportunity to assess varicella vaccine effectiveness and its determinants. The outbreak occurred in a small community in Puglia; parents of the children attending the schools of the community were contacted by telephone and information was gathered on current disease and varicella history. Varicella vaccination history was verified through the immunization registry of the Local Health Unit. Before the outbreak, immunization coverage was 86.6% of children attending preschool and 51.9% of children attending elementary school. In day care center where the outbreak was happened, the attack rate in vaccinated individuals was 32.1% and 80% in susceptible unvaccinated individuals. VE is therefore estimated as 59.9% (95% CI = 48.3¢69.8). In the elementary school the VE can be calculated as 69.2% (95% CI = 50.5¢88.1), since the attack rate in unvaccinated children was of 23.1% and in vaccinated of 7.1. The time between vaccination and the onset of the epidemic appears higher in children with a vaccine failure. The results of this study highlight the need for a reflection on the desirability of adopting a shorter schedule in Italy, with a minimum 1 mo interval between MMRV doses. PMID:23108354
Tafuri, Silvio; Martinelli, Domenico; Prato, Rosa; Germinario, Cinzia
This study describes an outbreak of varicella, in a small town in the region of Puglia, Southern Italy, in the period between February-March 2011. This outbreak presented the opportunity to assess varicella vaccine effectiveness and its determinants. The outbreak occurred in a small community in Puglia; parents of the children attending the schools of the community were contacted by telephone and information was gathered on current disease and varicella history. Varicella vaccination history was verified through the immunization registry of the Local Health Unit. Before the outbreak, immunization coverage was 86.6% of children attending preschool and 51.9% of children attending elementary school. In day care center where the outbreak was happened, the attack rate in vaccinated individuals was 32.1% and 80% in susceptible unvaccinated individuals. VE is therefore estimated as 59.9% (95% CI = 48.3-69.8). In the elementary school the VE can be calculated as 69.2% (95% CI = 50.5-88.1), since the attack rate in unvaccinated children was of 23.1% and in vaccinated of 7.1. The time between vaccination and the onset of the epidemic appears higher in children with a vaccine failure. The results of this study highlight the need for a reflection on the desirability of adopting a shorter schedule in Italy, with a minimum 1 mo interval between MMRV doses. PMID:23108354
Tafuri, Silvio; Martinelli, Domenico; Prato, Rosa; Germinario, Cinzia
The stem cell niche of the Arabidopsis (Arabidopsis thaliana) primary root apical meristem is composed of the quiescent (or organizing) center surrounded by stem (initial) cells for the different tissues. Initial cells generate a population of transit-amplifying cells that undergo a limited number of cell divisions before elongating and differentiating. It is unclear whether these divisions occur stochastically or in an orderly manner. Using the thymidine analog 5-ethynyl-2?-deoxyuridine to monitor DNA replication of cells of Arabidopsis root meristems, we identified a pattern of two, four, and eight neighboring cells with synchronized replication along the cortical, epidermal, and endodermal cell files, suggested to be daughters, granddaughters, and great-granddaughters of the direct progeny of each stem cell. Markers of mitosis and cytokinesis were not present in the region closest to the transition zone where the cells start to elongate, suggesting that great-granddaughter cells switch synchronously from the mitotic cell cycle to endoreduplication. Mutations in the stem cell niche-expressed ASH1-RELATED3 (ASHR3) gene, encoding a SET-domain protein conferring histone H3 lysine-36 methylation, disrupted this pattern of coordinated DNA replication and cell division and increased the cell division rate in the quiescent center. E2Fa/E2Fb transcription factors controlling the G1-to-S-phase transition regulate ASHR3 expression and bind to the ASHR3 promoter, substantiating a role for ASHR3 in cell division control. The reduced length of the root apical meristem and primary root of the mutant ashr3-1 indicate that synchronization of replication and cell divisions is required for normal root growth and development. PMID:25034019
Kumpf, Robert; Thorstensen, Tage; Rahman, Mohummad Aminur; Heyman, Jefri; Nenseth, H. Zeynep; Lammens, Tim; Herrmann, Ullrich; Swarup, Ranjan; Veiseth, Silje Veie; Emberland, Gitika; Bennett, Malcolm J.; De Veylder, Lieven; Aalen, Reidunn B.
Primary health care delivery in large urban centers may be shared between family physicians and specialists. This study examined screening and health promotion interventions by obstetrician-gynecologists as part of an annual examination of asymptomatic women. Procedures most closely linked to gynecological practice were performed most frequently. PMID:21229004
Yaffe, Mark J.; Toop, Jo-Ann
Primary Prevention of Hypertension
supplementation 10 Fish oil supplementation 10 Herbal or botanical dietary supplements 10 PRIMARY PREVENTION and Medicine Tulane University Health Sciences Center New Orleans, LA COCHAIR Jiang He, M.D., Ph.D. Associate Professor of Epidemiology and Medicine Department of Epidemiology Tulane University School of Public Health
Bandettini, Peter A.
75 FR 32797 - Health Center Program
Federal Register 2010, 2011, 2012, 2013
...Replacement Awards to Albany Area Primary Health Care, Inc...Center, Inc., to Albany Area Primary Health Care, Inc., to ensure the provision...letter of support from the local Primary Care Association. This...
Primary thrombocythemia is when the bone marrow is making too many platelets without a known cause. Platelets ... Primary thrombocythemia is caused by too much growth of a type of cell that is used to ...
Glypicans are a family of glycosylphosphatidylinositol (GPI)-anchored, membrane-bound heparan sulfate (HS) proteoglycans. Their biological roles are only partly understood, although it is assumed that they modulate the activity of HS-binding growth factors. The involvement of glypicans in developmental morphogenesis and growth regulation has been highlighted by Drosophila mutants and by a human overgrowth syndrome with multiple malformations caused by glypican 3 mutations (Simpson-Golabi-Behmel syndrome). We now report that autosomal-recessive omodysplasia, a genetic condition characterized by short-limbed short stature, craniofacial dysmorphism, and variable developmental delay, maps to chromosome 13 (13q31.1-q32.2) and is caused by point mutations or by larger genomic rearrangements in glypican 6 (GPC6). All mutations cause truncation of the GPC6 protein and abolish both the HS-binding site and the GPI-bearing membrane-associated domain, and thus loss of function is predicted. Expression studies in microdissected mouse growth plate revealed expression of Gpc6 in proliferative chondrocytes. Thus, GPC6 seems to have a previously unsuspected role in endochondral ossification and skeletal growth, and its functional abrogation results in a short-limb phenotype. PMID:19481194
Campos-Xavier, Ana Belinda; Martinet, Danielle; Bateman, John; Belluoccio, Dan; Rowley, Lynn; Tan, Tiong Yang; Baxova, Alica; Gustavson, Karl-Henrik; Borochowitz, Zvi U.; Innes, A. Micheil; Unger, Sheila; Beckmann, Jacques S.; Mittaz, Laureane; Ballhausen, Diana; Superti-Furga, Andrea; Savarirayan, Ravi; Bonafe, Luisa
Purpose: Radiation therapy (RT) is frequently administered to prevent heterotopic ossification (HO) after total hip arthroplasty (THA). The purpose of this study was to determine if there is an increased risk of HO after RT prophylaxis with shielding of the THA components. Methods and Materials: This is a retrospective analysis of THA patients undergoing RT prophylaxis of HO at Brigham and Women's Hospital between June 1994 and February 2004. Univariate and multivariate logistic regressions were used to assess the relationships of all variables to failure of RT prophylaxis. Results: A total of 137 patients were identified and 84 were eligible for analysis (61%). The median RT dose was 750 cGy in one fraction, and the median follow-up was 24 months. Eight of 40 unshielded patients (20%) developed any progression of HO compared with 21 of 44 shielded patients (48%) (p = 0.009). Brooker Grade III-IV HO developed in 5% of unshielded and 18% of shielded patients (p 0.08). Multivariate analysis revealed shielding (p = 0.02) and THA for prosthesis infection (p = 0.03) to be significant predictors of RT failure, with a trend toward an increasing risk of HO progression with age (p = 0.07). There was no significant difference in the prosthesis failure rates between shielded and unshielded patients. Conclusions: A significantly increased risk of failure of RT prophylaxis for HO was noted in those receiving shielding of the hip prosthesis. Shielding did not appear to reduce the risk of prosthesis failure.
Balboni, Tracy A. [Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA (United States); Gaccione, Peter [Biostatistics Consulting Service, Brigham and Women's Hospital, Boston, MA (United States); Gobezie, Reuben [Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA (United States); Mamon, Harvey J. [Department of Radiation Oncology, Brigham and Women's Hospital, Boston, MA (United States)]. E-mail: firstname.lastname@example.com
ERIC Educational Resources Information Center
Classroom areas organized into centers for specific study purposes are discussed. These centers are used for individual or small group work. The physical arrangement of the area used for a study center is described, including the organization of furniture, materials, and preferred locations. Suggestions are made for the management and stocking ofģ
Utah System Approach to Individualized Learning Project.
Cancer Centers Program - Cancer Centers
Cancer Centers Program - Cancer Centers Map of Cancer Centers Data Tables Benchmark Home > Cancer Centers Cancer Centers NCI-designated cancer centers are characterized by scientific excellence and the capability to integrate a diversity of
Objective Heterotopic ossification (HO) is a well-known complication after total hip replacement. But the occurrence rate by the time-course, clinical effect and risk factors of HO after total cervical disc replacement (TCDR) are not well described. The purpose of this study is to evaluate the occurrence rate by the time-course and risk factors for HO after TCDR with a ProDisc-C. Methods Thirty-two patients whom followed up more than one year after the TCDR are enrolled. Radiographic study was done at 12, 24 and 36 months after the TCDR and classified HO with McAfee classification. Segmental range of motion, preoperative existence of spondylosis, type of operation, disc space occupying ratio by artificial disc, surgical level are analyzed to identify the risk factors of HO. The visual analog scale and the neck disability index were evaluated preoperatively and at last follow-up time for clinical parameters. Results Eighteen patients (56%) showed HO at 12 months, 18 patients (86%) showed HO at 24 months and 6 patients (89%) showed HO at 36 months after the TCDR. Clinical significant HO(Grade 3 and 4) was shown in one patient (3%) at 12 months, 3 patients (14%) at 24 months and 5 patients (56%) at 36 months. Only post-operative follow-up period increases the risk of development clinical significant HO. All patients showed improvement of clinical parameters (p<0.005). Conclusion Incidence of HO is getting higher as time course progress. However, there are no relation between clinical outcome and radiologic change of ROM and the grade of HO. PMID:24757452
Cho, Yong-Hwan; Kim, Keun-Su
Diffuse idiopathic skeletal hyperostosis (DISH) is difficult to distinguish from various forms of inflammatory arthritis, including psoriatic arthritis (PsA), rheumatoid arthritis, and ankylosing spondylitis. A 67-year-old Japanese male had been treated for psoriasis vulgaris for 13 years. Numbness of his right arm and lower limbs and spinal stiffening had developed 7 years prior to his initial evaluation at our facility. He noticed pain mainly while exercising. There were symmetrical marginal syndesmophytes in the spine, from the thoracic vertebrae to the upper lumbar vertebrae, on radiological examinations. We therefore suspected DISH. Furthermore, ossifications of the posterior and anterior longitudinal ligaments were noted in the cervical spine. Laboratory examinations revealed a normal peripheral white blood cell count, serum C-reactive protein, and erythrocyte sedimentation rate, and he was negative for rheumatoid factor. We detected human leukocyte antigen B39 but not B27. All distal interphalangeal joints were swollen but without pain. X-ray imaging showed narrowing of the joint space, and the consolidation of the joint was recognized, but there was no new juxta-articular bone formation. Based on clinical and radiological findings, we concluded that he had DISH and not PsA. DISH was indicated by marked radiological features of the axial skeleton, particularly the thoracic spine, but may also have involved the peripheral joints. DISH is one of the entheseal disorders, and 10% of Japanese middle-aged and elderly men have DISH. Therefore, the differentiation of DISH from PsA is necessary in psoriasis patients with spinal involvement. PMID:20165950
Taniguchi, Tomonori; Maejima, Hideki; Watarai, Akira; Aki, Ryoichi; Katsuoka, Kensei
Delta like-1 (Dlk1)/preadipocyte factor-1 (Pref-1)/fetal antigen-1 (FA1) is a novel surface marker for embryonic chondroprogenitor cells undergoing lineage progression from proliferation to prehypertrophic stages. However, mechanisms mediating control of its expression during chondrogenesis are not known. Thus, we examined the effect of a number of signaling molecules and their inhibitors on Dlk1 expression during in vitro chondrogenic differentiation in mouse embryonic limb bud mesenchymal micromass cultures and mouse embryonic fibroblast (MEF) pellet cultures. Dlk1/Pref-1 was initially expressed during mesenchymal condensation and chondrocyte proliferation, in parallel with expression of Sox9 and Col2a1, and was downregulated upon the expression of Col10a1 by hypertrophic chondrocytes. Among a number of molecules that affected chondrogenesis, transforming growth factor-?1 (TGF-?1)-induced proliferation of chondroprogenitors was associated with decreased Dlk1 expression. This effect was abolished by TGF-? signaling inhibitor SB431542, suggesting regulation of Dlk1/FA1 by TGF-?1 signaling in chondrogenesis. TGF-?1-induced Smad phosphorylation and chondrogenesis were significantly increased in Dlk1(-/-) MEF, while they were blocked in Dlk1 overexpressing MEF, in comparison with wild-type MEF. Furthermore, overexpression of Dlk1 or addition of its secreted form FA1 dramatically inhibited TGF-?1-induced Smad reporter activity. In conclusion, our data identified Dlk1/FA1 as a downstream target of TGF-?1 signaling molecule that mediates its function in embryonic chondrogenesis. The crosstalk between TGF-?1 and Dlk1/FA1 was shown to promote early chondrogenesis during the embryonic endochondral ossification process. PMID:22102178
Taipaleenmõki, Hanna; Harkness, Linda; Chen, Li; Larsen, Kenneth H; Sõõmõnen, Anna-Marja; Kassem, Moustapha; Abdallah, Basem M
Human genetic disorders sharing the common feature of subcutaneous heterotopic ossification (HO) are caused by heterozygous inactivating mutations in GNAS, a gene encoding multiple transcripts including two stimulatory G-proteins, the ?-subunit of the stimulatory G-protein (Gs?) of adenylyl cyclase and the æextra-longö form of Gs?, XL?s. In one such disorder, progressive osseous heteroplasia (POH), bone formation initiates within subcutaneous fat before progressing to deeper tissues, suggesting that osteogenesis may involve abnormal differentiation of mesenchymal precursors that are present in adipose tissues. We determined by immunohistochemical analysis that GNAS protein expression is limited to Gs? in bone-lining cells and to Gs? and XL?s in osteocytes. By contrast, the GNAS proteins Gs?, XL?s, and NESP55 are detected in adipocytes and in adipose stroma. Although Gnas transcripts, as assessed by qRT-PCR, show no significant changes upon osteoblast differentiation of bone-derived precursor cells, the abundance of these transcripts is enhanced by osteoblast differentiation of adipose-derived mesenchymal progenitors. Using a mouse knockout model, we determined that heterozygous inactivation of Gnas (by disruption of the Gs?-specific exon 1) abrogates upregulation of multiple Gnas transcripts that normally occurs with osteoblast differentiation in wild-type adipose stromal cells. These transcriptional changes in Gnas+/? mice are accompanied by accelerated osteoblast differentiation of adipose stromal cells in vitro. In vivo, altered osteoblast differentiation in Gnas+/? mice manifests as subcutaneous HO by an intramembranous process. Taken together, these data suggest that Gnas is a key regulator of fate decisions in adipose-derived mesenchymal progenitor cells, specifically those that are involved in bone formation. PMID:21812029
Pignolo, Robert J.; Xu, Meiqi; Russell, Elizabeth; Richardson, Alec; Kaplan, Josef; Billings, Paul C.; Kaplan, Frederick S.; Shore, Eileen M.
Objectives Patients with cervical ossification of posterior longitudinal ligament (OPLL) are susceptible to cord injury, which often develops into myelopathic symptoms. However, little is known regarding the prognostic factors that are involved in minor trauma. We evaluated the relationship between minor trauma and neurological outcome of OPLL and investigated the prognostic factors with a focus on compressive factors and intramedullary signal intensity (SI). Methods A total of 74 patients with cervical myelopathy caused by OPLL at more than three-levels were treated with posterior decompression surgeries. We surveyed the space available for spinal cord (SAC), the severity of SI change on T2-weighted image, and diabetes mellitus (DM). The neurological outcome using Japanese Orthopedic Association (JOA) scale was assessed at admission and at 12-month follow-up. Results Among the variables tested, preoperative JOA score, severity of intramedullary SI, SAC, and DM were significantly related to neurological outcome. The mean preoperative JOA were 11.3▒1.9 for the 41 patients who did not have histories of trauma and 8.0▒3.1 for the 33 patients who had suffered minor traumas (p<0.05). However, there were no significant differences in the recovery ratios between those two groups. Conclusions Initial neurological status and high intramedullary SI in the preoperative phase were related to poorer postoperative outcomes. Moreover, the patients with no histories of DM and larger SACs exhibited better improvement than did the patients with DM and smaller SACs. Although the initial JOA scores were worse for the minor trauma patients than did those who had no trauma prior to surgery, minor trauma exerted no direct effects on the surgical outcomes. PMID:25328649
Choi, Jae Hyuk; Kim, Tae Hong; Shin, Hyung Shik; Hwang, Yong Soon; Park, Sang Keun
Background Mechanism of ossification of the posterior longitudinal ligament (OPLL) has not been elucidated clearly. Surgical decompression is usually necessary for the patients with neurological symptoms. Anterior decompression and resection of OPLL seems to be a radical surgical option, because the spinal cord is compressed from the anterior direction. Methods Among 229 patients who underwent ACF for OPLL between January 2001 and December 2007 in our hospital, a total of 133 patients responded to the invitation and made return visits, with a follow-up rate of 58.1%. For these patients, clinical data were collected from medical and operative records. Neurological status were evaluated by using the Japanese Orthopedic Association (JOA) scoring system. Radiological evaluations including C2-7 lordotic angle, sagittal vertical axis (SVA), occupying rate of OPLL, double-layer sign and high-intensity zone were obtained from all the patients. Complications and causes of revision surgery were also investigated. Correlations between the long-term surgical outcome and various prognostic factors were statistically analyzed. Findings Eighty-four males and forty-nine females completed the follow-up, with a mean age at operation of 56.8 years. The overall average JOA score significantly increased, with a mean recovery rate of 64.1%▒14.2%. The mean C2-7 lordotic angle and SVA were also significantly improved, and fusion rate was satisfactory. The incidence of complications was consistent to the previous reports and most of them were controllable by suitable treatments. Multiple regression analysis showed that number of corpectmies and preoperative JOA score were important predictors of surgical outcome. Conclusions ACF is a reliable and effective method for treating OPLL patients in terms of neurological recovery, maintenance of radiological parameters, fusion rate and complications. Number of corpectomies and preoperative JOA score are important predictors for the clinical outcome when this procedure is used. PMID:25000183
Liu, Yang; Yang, Haisong; Wang, Xinwei; Chen, Deyu
Determination of the stage of ossification of the medial clavicular epiphysis is a crucial part of age estimation in criminal proceedings when evaluating individuals with completed hand ossification. In order to ensure a maximum of accuracy in forensic age estimation practise, it is recommended to perform thin-slice CT scans; but to date there exist no reference data on the bone development of the region in question based on thin-slice computed tomography. In this retrospective study, the authors evaluated thin-slice multidetector CT images of 592 individuals aged between 10 and 35 years produced in the University Hospital of M³nster. The ossification status of the medial epiphysis of the clavicle could be reliably determined in 502 cases using the classification of stages by Schmeling et al. In male individuals, stage 2 was first noted at age 14, in female individuals at age 13. Stage 3 was first achieved by male individuals at age 17, by female individuals at age 16. The occurrence of stage 4 was first found in both sexes at the age of 21. In either sex, the earliest observation of stage 5 was at age 26. The findings are basically in line with those from the only CT-based study on the subject in question using the same classification of five stages, except from the fact that in the present study, stage 5 first occurs at age 26, which is 4 or 5 years later than what was found in the CT study using 7 mm slices in the majority of cases. This vast difference may be explained through the partial volume effect occurring with thick-slice CT images by a visual deception of the epiphyseal scar occurring with stage 4. PMID:20013127
Kellinghaus, Manuel; Schulz, Ronald; Vieth, Volker; Schmidt, Sven; Schmeling, Andreas
Primary Science Focus: Where's Primary?
ERIC Educational Resources Information Center
In this article, the author discusses the deliberate policy on the part of Primary Science Committee (PSC) to ensure that not only is primary science embedded in all aspects of the work of ASE but is seen to be there. She also describes the events for the 2010 Annual Conference. Over the coming months, PSC will continue to put much thought intoģ
Lawrence, Liz
Osteoblasts and osteocytes derive from the same precursors, and osteocytes are terminally differentiated osteoblasts. These two cell types are distinguishable by their morphology, localization and levels of expression of various bone cell-specific markers. In the present study on the chicken femur we investigated the properties of the mesenchymal cells within cartilage canals on their course into the secondary ossification centre (SOC). We examined several developmental stages after hatching by means of light microscopy, electron microscopy, immunohistochemistry and in situ hybridization. Cartilage canals appeared as extensions of the perichondrium into the developing distal epiphysis and they were arranged in a complex network. Within the epiphysis an SOC was formed and cartilage canals penetrated into it. In addition, they were successively incorporated into the SOC during its growth in the radial direction. Thus, the canals provided this centre with mesenchymal cells and vessels. It should be emphasized that regression of cartilage canals could never be observed in the growing bone. Outside the SOC the mesenchymal cells of the canals expressed type I collagen and periostin and thus these cells had the characteristics of preosteoblasts. Periostin was also expressed by numerous chondrocytes. Within the SOC the synthesis of periostin was down-regulated and the majority of osteoblasts were periostin negative. Furthermore, osteocytes did not secret this protein. Tissue-non-specific alkaline phosphatase (TNAP) staining was only detectable where matrix vesicles were present. These vesicles were found around the blind end of cartilage canals within the SOC where newly formed osteoid started to mineralize. The vesicles originated from osteoblasts as well as from late osteoblasts/preosteocytes and thus TNAP was only expressed by these cells. Our results provide evidence that the mesenchymal cells of cartilage canals express various bone cell-specific markers depending on their position. We suggest that these cells differentiate from preosteoblasts into osteocytes on their course into the SOC and consider that cartilage canals are essential for normal bone development within the epiphysis. Furthermore, we propose that the expression of periostin by preosteoblasts and several chondrocytes is required for adhesion of these cells to the extracellular matrix. PMID:16761972
Blumer, Michael J F; Schwarzer, Christoph; Perez, Maria Teresa; Konakci, Kadriye Zeynep; Fritsch, Helga
The Vermont Primary Care Workforce 2012 SNAPSHOT
The Vermont Primary Care Workforce 2012 SNAPSHOT wOrkfOrce SHOwS imPrOvemeNT buT SHOrTAge iN Adul improvement programming to Vermont's primary care practitioners and supports community health education. AHEC Area Health Education Centers Program was established in 1996 by the Office of Primary Care
Hayden, Nancy J.
NSDL National Science Digital Library
Started in 1960 by the U.S. Congress, the East-West Center's primary purpose is "to strengthen relations and understanding among the peoples and nations of Asia, the Pacific, and the United States." To accomplish this purpose, the Center serves as a functional hub for education, cooperative research, and scholarly dialogue. On their homepage, visitors can look over the latest news from scholars at the Center, look over a list of upcoming events sponsored by the Center, and also learn about some of their most recent publications. Academics visiting the site may wish to click on over to the "Research" area. Here they will find information on their primary areas of interest, which include population and health, environmental change, and politics and governance. Finally, visitors should look at their "Publications" area, as it includes free downloads, abstracts, and access to ordering information.
Germinal centers (GCs) are the sites of antigen-driven V(D)J gene hypermutation and selection necessary for the generation of high affinity memory B lymphocytes. Despite the antigen dependence of this reaction, injection of soluble antigen during an established primary immune response induces massive apoptotic death in GC B cells, but not in clonally related populations of nonfollicular B lymphoblasts and plasmacytes. Cell death in GCs occurs predominantly among light zone centrocytes, is antigen specific, and peaks within 4-8 h after injection. Antigen-induced programmed death does not involve cellular interactions mediated by CD40 ligand (CD40L) or Fas; disruption of GCs by antibody specific for CD40L was not driven by apoptosis and C57BL/6.lpr mice, though unable to express the Fas death trigger, remained fully susceptible to soluble antigen. Single injections of antigen did not significantly decrease GC numbers or average size, but repeated injections during an 18-h period resulted in fewer and substantially smaller GCs. As cell loss appeared most extensive in the light zone, decreased GC cellularity after prolonged exposure to soluble antigen implies that the Ig- centroblasts of the dark zone may require replenishment from light zone cells that have survived antigenic selection. GC cell death is avidity-dependent; oligovalent antigen induced relatively little apoptosis and GC B cells that survived long exposures to multivalent antigen expressed atypical VDJ rearrangements unlikely to encode high affinity antibody. Antigen- induced apoptotic death in GCs may represent a mechanism for the peripheral deletion of autoreactive B cell mutants much as the combinatorial repertoire of immature B lymphocytes is censored in the bone marrow. PMID:7500008
75 FR 53701 - Health Center Program
Federal Register 2010, 2011, 2012, 2013
...Saint Vincent's Catholic Medical Center of New York has filed for bankruptcy...requested that HRSA transfer the Health Center Program Section 330(h) funds...been engaged in the delivery of primary health care services in the local...
UNIVERSITY OF CALIFORNIA, DAVIS CENTER FOR HEALTH SERVICES RESEARCH IN PRIMARY CARE 1998 September 1, 1999 #12;University of California Davis Center for Health Services Research in Primary Care FIFTH ANNUAL REPORT 1998-1999 The UCD Center for Health Services Research in Primary Care has now
Carmichael, Owen
"Greetings and Salutations" News from the Frontlines of Primary Care
"Greetings and Salutations" News from the Frontlines of Primary Care May/June 2008 The John D. Stoeckle Center for Primary Care Innovation Number 9 GPIN Conference News Last month, the Stoeckle Center sent a group of MGH primary care practitioners to the 30th semi-annual conference of Group Practice
Mootha, Vamsi K.
... Performance VA Plans, Budget, & Performance VA Center for Innovation (VACI) Performance and Accountability Report Budget Submission Recovery ... Winter Sports Clinic Locations Hospitals & Clinics Vet Centers Regional Benefits Offices Regional Loan Centers Cemetery Locations Contact ...
NSDL National Science Digital Library
"A web resource for information about stroke care and research," the Internet Stroke Center provides updated stroke information for patients and families, as well as health care professionals. A nonprofit, educational service, the Internet Stroke Center is a product of the Stroke Center at Barnes-Jewish Hospital, Washington University Medical Center, and the Cerebrovascular Diseases Section of the Department of Neurology at Washington University School of Medicine in St. Louis. Dedicated to advancing the understanding of stroke research and clinical care, the Center's Web site also provides links to primary acute stroke facilities in St. Louis and Missouri, and a stroke trails directory that offers a select registry of clinical trials. All information provided on the site is obtained from "published accounts, meeting presentations, Internet searches, and direct correspondence."
Arkansas Water Resources Center
as a primary drinking water source and the Alluvial Aquifer is used for irrigation purposes. ChlorideArkansas Water Resources Center Submitted to the U.S. Geologcial Survey ANNUAL TECHNICAL REPORT FISCAL YEAR 2000 For The Period 03/01/00 ┬Ł 02/28/01 Publication No. MSC-280.2000 Arkansas Water Resources
Soerens, Thomas
-Defense Workshop Norfolk Karate Academy 814 West 45th St. Norfolk, VA, 7:30pm-9:30pm RSVP to firstname.lastname@example.com by 9 Karate Academy 814 West 45th St. Norfolk, VA, 1:00pm-3:00pm RSVP to firstname.lastname@example.com by 10/24 Big Blue & Activism Virginia Beach Room, Webb Center 12:30pm-1:30pm Self-Defense Workshop Norfolk Karate Academy 814
Background Pressure ulcers (PrUs) are ischemic wounds in the skin and underlying tissues caused by long-standing pressure force over an external bone or cartilaginous surface. PrUs are an important challenge for the overall health system because can prolong patient hospitalization and reduce quality of life. Moreover, 95% of PrUs are avoidable, suggesting they are caused by poor quality care assistance. PrUs are also costly, increasing national costs. For example, they represent about 5% of overall annual health expenses in Spain. Stages I and II PrUs have a combined prevalence of 65%. According main clinical guidelines, stage II PrUs (PrU-IIs) are usually treated by applying special dressings (polyurethane or hydrocolloid). However, little scientific evidence regarding their efficacy has been identified in scientific literature. Our aim is to assess the comparative efficacy of adhesive polyurethane foam and hydrocolloid dressings in the treatment of PrU-IIs in terms of healed ulcer after 8 weeks of follow-up. Methods/design This paper describes the development and evaluation protocol of a randomized clinical trial of two parallel treatment arms. A total of 820 patients with at least 1 PrU-II will be recruited from primary health care and home care centers. All patients will receive standardized healing procedures and preventive measures (e.g. positional changes and pressure-relieving support surfaces), following standardized procedures. The main outcome will be the percentage of wounds healed after 8Āweeks. Secondary outcomes will include cost-effectiveness, as evaluated by cost per healed ulcer and cost per treated patient and safety evaluated by adverse events. Discussion This trial will address the hypothesis that hydrocolloid dressings will heal at least 10% more stage II PrUs and be more cost-effective than polyurethane foam dressings after 8Āweeks. Trial registration This trial has been registered with controlled-trials number ISCRCTN57842461 and EudraCT 2012-003945-14. PMID:24359122
Primary (inborn) immunodeficiency is caused by gene defects that impact both the innate and the adaptive immune system. Individuals with an immunedeficiency primarily come to medical attention with recurrent infections. Most diagnoses are first made in childhood and include cellular immunodeficiency, defects of phagocyte function and other primary immunodeficiencies. Antibody deficiencies, particularly common variable immunodeficiency (CVID) and complement defects may, however, not become manifested until adulthood. A pathological susceptibility to infection in adults is defined as more than three infections per year that require treatment with antibiotics and last longer than 4 weeks each. Clinical clues for immunodeficiency are pathological susceptibility to infections and immune dysregulation. The former is characterized by frequent and severe infections with often unusual pathogens, localization, course and/or intensity. Immune dysregulation comprises granulomas, autoimmune diseases, recurrent fever/chronic inflammation, tendency to eczema, lymphoproliferation and chronic enteritis. There are evidence-based guidelines and consensus documents for the diagnosis and treatment of primary immunodeficiencies. Therapeutic approaches depend on the nature of the immune defect and range from immunoglobulin substitution for antibody deficiencies to bone marrow transplantation for severe cellular immune defects. PMID:23989691
Engelhardt, K R; Grimbacher, B; Niehues, T
20 UTHealthScienceCenter20 UTHealthScienceCenter Celebrating its first anniversary in June, Clinica
). As a community-based primary care clinic, Clinica Esperanza offers free primary care every Saturday primary care health center for the medically underserved. CCHS generously offered Clinica Esperanza
Cui, Yan
Cancer Centers Program - Cancer Centers List
Cancer Centers Program - Cancer Centers List Map of Cancer Centers Center Addresses(text file) Cancer Center Profiles Benchmark Data Home > Cancer Centers > Cancer Centers List Cancer Centers List View By: Name | State | State Map
Primary Teachers' Conceptions of Giftedness
ERIC Educational Resources Information Center
This article focuses on the first phase of a recent National Research Center on Giftedness and Talented (NRC/GT) project, which used survey research to target a disproportionate nationally stratified random sample of primary grade teachers about their beliefs and practices related to talent development in young children and their responses to caseģ
Moon, Tonya R.; Brighton, Catherine M.
9. VIEW SOUTHWEST OF PRIMARY REDUCING GEARS; NOTE BRAKE WHEEL AND PADS AT RIGHT CENTER BEHIND PRIMARY GEAR; MITER GEAR AT CENTER IS PART OF MECHANISM FOR MANUAL OPERATION OF BRIDGE; FLANGE FOR COUPLING THE NORTH AND SOUTH REDUCTION GEAR TRAINS IS AT CENTER OF PHOTOGRAPH BEHIND SOUTH PRIMARY REDUCTION GEAR - East Washington Avenue Bridge, Spanning Pequonnock River at East Washington Avenue, Bridgeport, Fairfield County, CT
42 CFR 411.175 - Basis for Medicare primary payments.
Code of Federal Regulations, 2013 CFR
42 Public Health 2 2013-10-01...Basis for Medicare primary payments. 411...411.175 Public Health CENTERS FOR MEDICARE & MEDICAID...SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES...Basis for Medicare primary payments....
42 CFR 411.175 - Basis for Medicare primary payments.
Code of Federal Regulations, 2010 CFR
42 Public Health 2 2010-10-01...Basis for Medicare primary payments. 411...411.175 Public Health CENTERS FOR MEDICARE & MEDICAID...SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES...Basis for Medicare primary payments....
42 CFR 411.175 - Basis for Medicare primary payments.
Code of Federal Regulations, 2011 CFR
42 Public Health 2 2011-10-01...Basis for Medicare primary payments. 411...411.175 Public Health CENTERS FOR MEDICARE & MEDICAID...SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES...Basis for Medicare primary payments....
42 CFR 411.175 - Basis for Medicare primary payments.
Code of Federal Regulations, 2012 CFR
42 Public Health 2 2012-10-01...Basis for Medicare primary payments. 411...411.175 Public Health CENTERS FOR MEDICARE & MEDICAID...SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES...Basis for Medicare primary payments....
In the murine spleen, germinal centers are the anatomic sites for antigen-driven hypermutation and selection of immunoglobulin (Ig) genes. To detail the kinetics of Ig mutation and selection, 178 VDJ sequences from 16 antigen-induced germinal centers were analyzed. Although germinal centers appeared by day 4, mutation was not observed in germinal center B cells until day 8 postimmunization; thereafter, point mutations favoring asymmetrical transversions accumulated until day 14. During this period, strong phenotypic selection on the mutant B lymphocytes was inferred from progressively biased distributions of mutations within the Ig variable region, the loss of crippling mutations, decreased relative clonal diversity, and increasingly restricted use of canonical gene segments. The period of most intense selection on germinal center B cell populations preceded significant levels of mutation and may represent a physiologically determined restriction on B cells permitted to enter the memory pathway. Noncanonical Ig genes recovered from germinal centers were mostly unmutated although they probably came from antigen-reactive cells. Together, these observations demonstrate that the germinal center microenvironment is rich and temporally complex but may not be constitutive for somatic hypermutation. PMID:8376935
PRIMARY CARE ASSOCIATE PROGRAM 2011-2013 PRIMARY PRECEPTOR MANUAL http://pcap.stanford.edu 1215 or Supplemental Preceptor PRIMARY PRECEPTOR/PRIMARY CARE ASSOCIATE PROGRAM RELATIONSHIP PRECEPTOR REQUIREMENTS: Thank you for your interest in precepting a student in the Primary Care Associate Program. Your services
Puglisi, Joseph
Primary hyperoxalurias (PH) are inborn errors in the metabolism of glyoxylate and oxalate. PH type 1, the most common form, is an autosomal recessive disorder caused by a deficiency of the liver-specific enzyme alanine, glyoxylate aminotransferase (AGT) resulting in overproduction and excessive urinary excretion of oxalate. Recurrent urolithiasis and nephrocalcinosis are the hallmarks of the disease. As glomerular filtration rate decreases due to progressive renal damage, oxalate accumulates leading to systemic oxalosis. Diagnosis is often delayed and is based on clinical and sonographic findings, urinary oxalate assessment, DNA analysis, and, if necessary, direct AGT activity measurement in liver biopsy tissue. Early initiation of conservative treatment, including high fluid intake, inhibitors of calcium oxalate crystallization, and pyridoxine in responsive cases, can help to maintain renal function in compliant subjects. In end-stage renal disease patients, the best outcomes have been achieved with combined liver-kidney transplantation which corrects the enzyme defect. PMID:21748001
Harambat, Jerome; Fargue, Sonia; Bacchetta, Justine; Acquaviva, Cecile; Cochat, Pierre
Cancer Centers Program - Cancer Centers List
Cancer Centers Program - Cancer Centers List Map of Cancer Centers Center Addresses(text file) Cancer Center Profiles Benchmark Data Home > Cancer Centers > Region Map Cancer Centers List View By: Name | State | State
Primary care perspectives on prostate cancer screening.
Although the effectiveness of prostate cancer screening is controversial, screening rates have risen dramatically among primary care providers in the United States. The authors' findings suggest more collaboration among primary care and specialty organizations, especially with respect to decision aid endorsement, is needed to achieve more discriminatory and patient-centered prostate cancer screening. PMID:21572298
Skolarus, Ted A; Holmes-Rovner, Margaret; Northouse, Laurel L; Fagerlin, Angela; Garlinghouse, Carol; Demers, Raymond Y; Rovner, David R; Darwish-Yassine, May; Wei, John T
Clinical features presented by a patient with primary macroglobulinemia over a four-year period included cachexia, weight loss, bleeding tendency, anemia, lymphadenopathy, hepatosplenomegaly and recurrent pulmonary bacterial infections. Immunoelectrophoresis demonstrated the presence of a ?2 macroglobulin which, on ultracentrifugation, was found to have a sedimentation constant of 14.9 S20, w; this macroglobulin constituted over 40% of the total serum protein. Postmortem findings included the typical ōnakedö lymphocyte infiltration of the reticuloendothelial system, with septic embolization from a terminal Gram-negative bacteremia, associated with a mesenteric vascular occlusion. A feature of particular interest was the antemortem appearance of gas in the portal venous system, shown on two abdominal scout radiographs taken one and two hours before death. The diagnostic significance of this rare radiologic sign is discussed. ImagesFig. 1Fig. 2Fig. 3Fig. 4Fig. 5Fig. 6Fig. 7Fig. 8Fig. 9Fig. 10Fig. 11Fig. 12Fig. 13Fig. 14Fig. 15 PMID:14226112
Edwards, A. M.; Costopoulous, L. B.; Bell, H. E.
Health Insurance & Patient-Centered Medical Homes
is health care directed by primary care providers offering family centered, culturally effective careHealth Insurance & Patient- Centered Medical Homes Office of Rural Health Area Health Education Center Advisory Board Meeting June 8, 2012 #12;2 Montana Commissioner of Securities and Insurance
Maxwell, Bruce D.
A case¢control study was conducted to examine the association between two single nucleotide polymorphisms (SNPs) in exon 2 of the bone morphogenetic protein-2 gene (BMP-2) and ossification of the posterior longitudinal ligament (OPLL), and to investigate whether SNPs of the Ser37Ala (T/G) and the Ser87Ser (A/G) in the BMP-2 gene are associated with genetic susceptibility to OPLL and its severity in Chinese subjects. The Ser87Ser (A/G) SNP has been implicated in bone mineral density (BMD) and increases the risk of OA in women. The Ser37Ala (T/G) SNP is associated with BMD and the rate of bone loss in osteoporosis and osteoporosis fractures. A total of 57 OPLL patients and 135 non-OPLL controls were studied. Radiographs of the cervical spine were analyzed to determine the presence and the severity of OPLL. The association of two SNPs with the occurrence and the extent of OPLL were statistically evaluated. There was a significant association between the Ser37Ala (T/G) polymorphism and the occurrence of OPLL in the cervical spine. However, no significant association was found between the Ser37Ala (T/G) polymorphism and the more number of ossified cervical vertebrae in OPLL patients. There was a significant association between the Ser87Ser (A/G) polymorphism and the more number of ossified cervical vertebrae in OPLL patients. However, there was no statistical difference between the Ser87Ser (A/G) SNP and the occurrence of OPLL in the cervical spine. In addition, the Ser87Ser (A/G) polymorphism in male patients and in female patients showed no statistical difference between cases and controls. The present results demonstrate that BMP-2 Gene is not only a factor associated with the occurrence of OPLL, but also a factor related to more extensive OPLL. The ōGö allele in the Ser37Ala (T/G) polymorphism is associated with the occurrence of OPLL, but not more extensive OPLL in the cervical spine. The ōGö allele in the Ser87Ser (A/G) polymorphism promotes the extent of OPLL, whereas the ōAö allele in the Ser87Ser (A/G) polymorphism restricts ectopic ossification in the cervical spine at least in Chinese subjects. PMID:18389292
Wang, Hao; Liu, Dongmei; Yang, Zhaohui; Tian, Baopeng; Li, Jie; Meng, Xianglong; Wang, Zhentian
Primary hyperoxaluria (PH) occurs due to an autosomal recessive hereditary disorder of the metabolism of glyoxylate, which causes excessive oxalate production. The most frequent and serious disorder is due to enzyme deficit of alanine-glyoxylate aminotransferase (PH type I) specific to hepatic peroxisome. As oxalate is not metabolised in humans and is excreted through the kidneys, the kidney is the first organ affected, causing recurrent lithiasis, nephrocalcinosis and early renal failure. With advance of renal failure, particularly in patients on haemodialysis (HD), calcium oxalate is massively deposited in tissues, which is known as oxalosis. Diagnosis is based on family history, the presence of urolithiasis and/or nephrocalcinosis, hyperoxaluria, oxalate deposits in tissue forming granulomas, molecular analysis of DNA and enzyme analysis if applicable. High diagnostic suspicion is required; therefore, unfortunately, in many cases it is diagnosed after its recurrence following kidney transplantation. Conservative management of this disease (high liquid intake, pyridoxine and crystallisation inhibitors) needs to be adopted early in order to delay kidney damage. Treatment by dialysis is ineffective in treating excess oxalate. After the kidney transplant, we normally observe a rapid appearance of oxalate deposits in the graft and the results of this technique are discouraging, with very few exceptions. Pre-emptive liver transplantation, or simultaneous liver and kidney transplants when there is already irreversible damage to the kidney, is the treatment of choice to treat the underlying disease and suppress oxalate overproduction. Given its condition as a rare disease and its genetic and clinical heterogeneity, it is not possible to gain evidence through randomised clinical trials. As a result, the recommendations are established by groups of experts based on publications of renowned scientific rigour. In this regard, a group of European experts (OxalEurope) has drawn up recommendations for diagnosis and treatment, which were published in 2012. PMID:24798559
Lorenzo, VĒctor; Torres, Armando; Salido, Eduardo
Hydrogen bonds are important in determining the structure and function of biomolecules. Of particular interest are hydrogen bonds to quinones, which play an important role in the bioenergetics of respiration and photosynthesis. In this work we investigated the hydrogen bonds to the two carbonyl oxygens of the semiquinone QA?? in the well-characterized reaction center from the photosynthetic bacterium Rhodobacter sphaeroides
M. Flores; R. Isaacson; E. Abresch; R. Calvo; W. Lubitz; G. Feher
NSDL National Science Digital Library
Use these links to learn more about primary and secondary sources. 1. Explore the links below to learn about primary and secondary sources. When you have finished, you should be able to: Tell the difference between primary and secondary sources. Give at least three examples of primary sources and three examples of secondary sources. Explain why primary sources are important in research. Examples of Primary Sources Examples of Primary and Secondary Sources on the Same Topic Genres/Formats of Primary Sources 2. ...
Bates, Albion M.
Data Center facilities, prevalent in many industries and institutions are essential to California's economy. Energy intensive data centers are crucial to California's industries, and many other institutions (such as universities) in the state, and they play an important role in the constantly evolving communications industry. To better understand the impact of the energy requirements and energy efficiency improvement potential in these facilities, the California Energy Commission's PIER Industrial Program initiated this project with two primary focus areas: First, to characterize current data center electricity use; and secondly, to develop a research ''roadmap'' defining and prioritizing possible future public interest research and deployment efforts that would improve energy efficiency. Although there are many opinions concerning the energy intensity of data centers and the aggregate effect on California's electrical power systems, there is very little publicly available information. Through this project, actual energy consumption at its end use was measured in a number of data centers. This benchmark data was documented in case study reports, along with site-specific energy efficiency recommendations. Additionally, other data center energy benchmarks were obtained through synergistic projects, prior PG&E studies, and industry contacts. In total, energy benchmarks for sixteen data centers were obtained. For this project, a broad definition of ''data center'' was adopted which included internet hosting, corporate, institutional, governmental, educational and other miscellaneous data centers. Typically these facilities require specialized infrastructure to provide high quality power and cooling for IT equipment. All of these data center types were considered in the development of an estimate of the total power consumption in California. Finally, a research ''roadmap'' was developed through extensive participation with data center professionals, examination of case study findings, and participation in data center industry meetings and workshops. Industry partners enthusiastically provided valuable insight into current practice, and helped to identify areas where additional public interest research could lead to significant efficiency improvement. This helped to define and prioritize the research agenda. The interaction involved industry representatives with expertise in all aspects of data center facilities, including specialized facility infrastructure systems and computing equipment. In addition to the input obtained through industry workshops, LBNL's participation in a three-day, comprehensive design ''charrette'' hosted by the Rocky Mountain Institute (RMI) yielded a number of innovative ideas for future research.
Tschudi, William; Xu, Tengfang; Sartor, Dale; Koomey, Jon; Nordman, Bruce; Sezgen, Osman
Heterotopic ossification (HO) is the abnormal formation of bone in soft tissue. Current diagnostics have low sensitivity or specificity to incremental progression of mineralization, especially at early time points. Without accurate and reliable early diagnosis and intervention, HO progression often results in incapacitating conditions of limited range of motion, nerve entrapment, and pain. We hypothesized that non-invasive near-infrared (NIR) optical imaging can detect HO at early time points and monitor heterotopic bone turnover longitudinally. C57BL6 mice received an Achilles tenotomy on their left hind limb in combination with a dorsal burn or sham procedure. A calcium-chelating tetracycline derivative (IRDye 680RD BoneTag) was injected bi-weekly and imaged via NIR to measure accumulative fluorescence for 11?wk and compared to in vivo microCT images. Percent retention of fluorescence was calculated longitudinally to assess temporal bone resorption. NIR detected HO as early as five days and revealed a temporal response in HO formation and turnover. MicroCT could not detect HO until 5?wk. Confocal microscopy confirmed fluorophore localization to areas of HO. These findings demonstrate the ability of a near-infrared optical imaging strategy to accurately and reliably detect and monitor HO in a murine model. ® 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 32:1416-1423, 2014. PMID:25087685
Perosky, Joseph E; Peterson, Jonathan R; Eboda, Owulatobi N; Morris, Michael D; Wang, Stewart C; Levi, Benjamin; Kozloff, Kenneth M
In this study, both medial clavicular epiphyses of 77 men were evaluated by two researchers with a digital ultrasound system. The degree of ossification was classified in four stages according to Schulz et al. (Int J Legal Med 122:55-58, 17). Of the test persons over 21 years of age, stage 4 was found bilaterally in 25 (60%), while for five (12%) stage 4 was found on only one side; 12 (28%) further subjects did not show stage 4 on either side, although nine were exactly 21 years old. For the subjects under 21 years of age, stage 4 was found bilaterally in three cases (8.5%), and in three additional cases stage 4 was found on one side. Particularly, the three cases in which stage 4 was diagnosed bilaterally before completion of the 21st year of age limit the value of the used examinatory technique. For these cases it would be interesting to know if parts of the epiphyseal plate that might have been obstructed from the view of the ultrasound transducer would have been visible with CT. PMID:19294404
Quirmbach, Fabian; Ramsthaler, Frank; Verhoff, Marcel A
Constitutional complex chromosomal rearrangements (CCRs) are considered rare cytogenetic events. Most apparently balanced CCRs are de novo and are usually found in patients with abnormal phenotypes. High-resolution techniques are unveiling genomic imbalances in a great percentage of these cases. In this paper, we report a patient with growth and developmental delay, dysmorphic features, nervous system anomalies (pachygyria, hypoplasia of the corpus callosum and cerebellum), a marked reduction in the ossification of the cranial vault, skull base sclerosis, and cardiopathy who presents a CCR with 9 breakpoints involving 4 chromosomes (3, 6, 8 and 14) and a 0.6-Mb deletion in 14q24.1. Although the only genomic imbalance revealed by the array technique was a deletion, the clinical phenotype of the patient most likely cannot be attributed exclusively to haploinsufficiency. Other events must also be considered, including the disruption of critical genes and position effects. A combination of several different investigative approaches (G-banding, FISH with different probes and SNP array techniques) was required to describe this CCR in full, suggesting that CCRs may be more frequent than initially thought. Additionally, we propose that a chain chromosome breakage mechanism may have occurred as a single rearrangement event resulting in this CCR. This study demonstrates the importance of applying different cytogenetic and molecular techniques to detect subtle rearrangements and to delineate the rearrangements at a more accurate level, providing a better understanding of the mechanisms involved in CCR formation and a better correlation with phenotype. PMID:23817307
Guilherme, R S; Cernach, M C S P; Sfakianakis, T E; Takeno, S S; Nardozza, L M M; Rossi, C; Bhatt, S S; Liehr, T; Melaragno, M I
Dental pulp stem cells (DPSCs), which arise from cranial neural crest cells, are multipotent, making them a candidate for use in tissue engineering that may be especially useful for craniofacial tissues. Costal chondrocytes (CCs) can be easily obtained and demonstrate higher initial cell yields and expansion than articular chondrocytes. CCs have been found to retain chondrogenic capacity that can effectively repair articular defects. In this study, human CCs were co-cultured with human DPSCs, and the results showed that the CCs were able to supply a chondro-inductive niche that promoted the DPSCs to undergo chondrogenic differentiation and to enhance the formation of cartilage. Although CCs alone could not prevent the mineralization of chondro-differentiated DPSCs, CCs combined with exogenous FGF9 were able to simultaneously promote the chondrogenesis of DPSCs and partially inhibit their mineralization. Furthermore, FGF9 may activate this inhibition by binding to FGFR3 and enhancing the phosphorylation of ERK1/2 in DPSCs. Our results strongly suggest that the co-culture of CCs and DPSCs combined with exogenous FGF9 can simultaneously enhance chondrogenesis and partially inhibit ossification in engineered cartilage. PMID:22841919
Dai, Jiewen; Wang, Jia; Lu, Jingting; Zou, Duohong; Sun, Hao; Dong, Yuefu; Yu, Hongbo; Zhang, Lei; Yang, Tong; Zhang, Xiuli; Wang, Xudong; Shen, Guofang
International Quilt Study Center
NSDL National Science Digital Library
The world has many great textile traditions, and the art and practice of quilt-making is certainly one of them. The International Quilt Study Center (IQSC) was founded in 1997 at the University of Nebraska-Lincoln with the kind assistance of Ardis and Robert James, who donated 900 quilts. Since then, the Center has grown to include research symposia, a graduate program in textile history, and numerous online resources. Visitors may want to search the quilt collection online through their helpful search engine. Users can search by primary pattern, quilt title, quilt maker, country of origin, and predominant technique. One very interesting feature of the site is the ├ó┬┬Quilt of the Month├ó┬┬ area, where visitors can learn about some of the Center├ó┬┬s most unique quilts, such as the Chicken Ribbons Quilt from 1913, which features blocks of blue, red, and white silver printed ribbons.
International Registry for Primary Hyperoxaluria
Background\\/Aims: Primary hyperoxaluria (PH) is an inherited disorder that causes calcium urolithiasis and renal failure. Due to its rarity, experience at most centers with this disease is limited. Methods: A secure, web-based, institutional review board\\/ethics committee and American Health Insurance Portability and Accountability Act (HIPAA)-compliant registry was developed to facilitate international contributions to a data base. To date 95 PH
John C. Lieske; Carla G. Monico; W. Scott Holmes; Erik J. Bergstralh; Jeffrey M. Slezak; Audrey L. Rohlinger; Julie B. Olson; Dawn S. Milliner
ERIC Educational Resources Information Center
The services of the Living Skills Center for the Visually Handicapped, a habilitative service for blind young adults, are described. It is explained that the Center houses its participants in their own apartments in a large complex and has served over 70 young people in 4 years. The evaluation section describes such assessment instruments as anģ
Canter, Patricia; And Others
Congenital pseudarthrosis of the clavicle: a histopathological study in five patients.
Congenital pseudarthrosis of the clavicle is usually situated on the right clavicle. Pathological data on pseudarthrosis are scant. The histological analysis of five cases treated by 'en bloc' surgical resection are reported. Enchondral ossification was observed on both sides of the resected pseudarthrosis in two cases. Less characteristic enchondral features were noted in three cases. These findings confirm that the pseudarthrosis is due to the failure of coalescence of the two primary ossification centers of the clavicle. PMID:15599233
Gomez-Brouchet, Anne; Sales de Gauzy, Jķr¶me; Accadbled, Franck; Abid, Aziz; Delisle, Marie Bernadette; Cahuzac, Jean-Philippe
Learning Centers for Child-Centered Classrooms. NEA Early Childhood Education Series.
ERIC Educational Resources Information Center
A learning center is a defined space where materials are organized in such a way that children learn without the teacher's constant direction. This book offers guidelines that will help preprimary and primary school teachers organize and manage learning centers in the classroom. Chapter 1 describes the advantages of using learning centers andģ
Pattillo, Janice; Vaughan, Elizabeth
of Chicago Patients Only Heartland Health Center ┬ŁTrilogy 1400 W. Greenleaf Avenue Chicago, IL 60626 *Primary* Statistical data provided by Heartland International Health Center: Rev. 01/09 Heartland International Health Center 3048 N. Wilton, 2nd Floor Chicago, Illinois 60657 http
Chisholm, Rex L.
Cancer Centers Program - Cancer Centers List
'╗┐ Cancer Centers Program - Cancer Centers List Map of Cancer Centers Data Tables Benchmark Home > Cancer Centers > Region Map Cancer Centers List View By: Name | State | State Map | Region Map Click on geographical
78 FR 42788 - School-Based Health Center Program
Federal Register 2010, 2011, 2012, 2013
...services at school-based health centers will continue. SUPPLEMENTARY...transfer the School-Based Health Center Capital Program funds to The...Kozar, Supervisory Public Health Analyst, Bureau of Primary Health Care, HRSA, 5600...
Primary Pulmonary Hypertension
... ENews Home > Lung Disease > Primary Pulmonary Hypertension Primary Pulmonary Hypertension Primary pulmonary hypertension (PPH) is a rare lung ... Lung Association also provides patients with information about pulmonary arterial hypertension (PAH). In-Depth Resources Symptoms, Diagnosis and Treatment ...
ASPSU Children's Center SMSU 126 (503) 725-2273
Testing Office is in 310 UCB. e Health Center enhances overall health and safety by providing primary with the Student Health Center for optimum care of PSU students. CAPS offers testing services as well; the TestingASPSU Children's Center SMSU 126 (503) 725-2273 e Children's Center located on the first floor
... Center Report IRB: Ethics & Human Research Special Publications Bioethics Forum blog Over 65 blog Health Care Cost Monitor blog Books and Monographs Bioethics Briefing Book Help with Hard Questions Research Current ...
Hyperaldosteronism - primary and secondary
... hormone aldosterone into the blood. Hyperaldosteronism can be primary or secondary. ... Primary hyperaldosteronism is due to a problem of the adrenal glands themselves, causing them to release too ...
The Rockefeller University Child and Family Center
\\Grade__________ Previous Child Care or School Experience ____________________________________________ I understandThe Rockefeller University Child and Family Center Application for Admission Name of Child_____________________________________________________________________ Telephone Number_____________________ Other Address _______________________________ Child's Primary Language
75 FR 2549 - Health Center Program
Federal Register 2010, 2011, 2012, 2013
...SUMMARY: The Health Resources and Services Administration...HRSA) will be transferring Health Center Program (section 330 of the Public Health Service Act) funds originally...the provision of critical primary health care services to...
78 FR 24756 - Health Center Program
Federal Register 2010, 2011, 2012, 2013
...SUMMARY: The Health Resources and Services Administration...HRSA) will be transferring Health Center Program (section 330 of the Public Health Service Act) funds originally...the provision of critical primary health care services to...
Primary Care Clinics (ōCOPCö) Clinic (participants/eligible) Castro-Mission Health Center (primary care clinics (ōhospital-basedö), (2) community-based, county- funded health centersPrimary Care clinics or ōCOPCö), and (3) local non-county-funded community health centers (
Kim, Yeuen; Chen, Alice Hm; Keith, Ellen; Yee, Hal F.; Kushel, Margot B.
National Pesticide Information Center
NSDL National Science Digital Library
The National Pesticide Information Center (NPIC) was created through a cooperative agreement between Oregon State University and the U.S. Environmental Protection Agency. Its primary function is to provide "objective, science-based information about pesticides and pesticide-related topics to enable people to make informed decisions about pesticides and their use." The site contains seven primary sections, including "General Information", "Technical Information", "Pest Control", and "Emergency". Most casual visitors to the site should click on over to the "General Information" area. In this section, they will find fact sheets and posters on pesticide safety, storage and disposal, and case studies. Of course, they shouldn't forget about the other areas of the site, particularly if they are interested in regulatory issues involving pesticides and emergency resources. Finally, the site also contains a search engine for those who know exactly what they need to find.
UC DAVIS CLINICAL & TRANSLATIONAL SCIENCE CENTER CLINICAL & TRANSLATIONAL SCIENCE CENTER and Translational Science CenterClinical and Translational Science Center June 24, 2011June 24, 2011 #12;UC DAVIS CLINICAL & TRANSLATIONAL SCIENCE CENTER UC DAVIS CLINICAL & TRANSLATIONAL SCIENCE CENTER Goals
Carmichael, Owen
NSDL National Science Digital Library
The CERT Coordination Center is part of the Software Engineering Institute at Carnegie Mellon University. Its primary function is to work with industry to identify and eliminate Internet security vulnerabilities. Additionally, the center analyzes business and personal software to find potentially dangerous flaws that could compromise the system, meaning that both corporate and home users can benefit from the information offered on the Web site. There are continual updates of security advisories, survivability guides, and fixes that can help prevent disasters or speed recovery from them. Step-by-step suggestions make finding and implementing an efficient security practice reasonably painless. A wide range of papers and presentations on Internet and computer security research are available for free download.
NSDL National Science Digital Library
"Challenger Center uses students' natural enthusiasm for space to create innovative learning experiences for imaginative young minds." After learning about the Challenger 51-L crew, users can find information about visits to the Challenger Learning Center Networks' forty six sites located across the Unites States, Canada, and the United Kingdom. Within the Teacher and Community Resources link, users can find student activities, professional development opportunities, community programs, and special events. Teachers can learn about Space Day 2004 on May 6th, where young students can take a journey to uncharted galaxies.
Predictions of the Space Environment Services Center
NASA Technical Reports Server (NTRS)
The types of users of the Space Environment Services Center are identified. All the data collected by the Center are listed and a short description of each primary index or activity summary is given. Each type of regularly produced forecast is described, along with the methods used to produce each prediction.
Heckman, G. R.
Primary gastric mantle cell lymphoma
Mantle cell lymphoma represents 2.5¢7% all of non Hodgkin's lymphomas. Stomach is the most common site of extranodal lymphoma. However, that is not the case with mantle cell lymphoma, which is extremely rare. We present a case of 71-year-old woman admitted to the Internal Clinic of the University Clinical Hospital Center Rijeka, because of stomach discomfort and melena. Endoscopy and computed tomography revealed a polyp in gastric antrum. Histopathologic, immunohistochemic and genetic methods were also performed and the results were consistent with primary gastric mantle cell lymphoma without periepigastric and/or local or distant abdominal lymph node involvement. PMID:22567215
Petranovic, Duska; Pilcic, Gorazd; Peitl, Milena; Cubranic, Aleksandar; Valkovic, Toni; Nacinovic, Antica Duletic; Lucin, Ksenija; Jonjic, Nives
Southern Rural Development Center
NSDL National Science Digital Library
Since John F. Kennedy and Lyndon Johnson declared war on rural poverty during their time in the White House, there has been an overriding concern with alleviating the persistently high levels of poverty in the American South. A number of organizations have developed to provide assistance to the region, and the Southern Rural Development Center (SRDC), located at Mississippi State University is one such entity. The center's mission statement reflects this sentiment, as it notes its primary directive is "to strengthen the capacity of the region's 29-land grant institutions to address critical contemporary development issues impacting the well-being of people and communities in the rural South." Visitors interested in these issues will find plenty to examine here, as they may elect to view a calendar of germane events (such as regional science conferences and the like), look over a list of their primary focus areas, learn about available funding opportunities, and download any number of policy publications and newsletters which date back to 1993.
The Center for Beam Physics is a multi-disciplinary research and development unit in the Accelerator and Fusion Research Division at Lawrence Berkeley Laboratory. At the heart of the Center`s mission is the fundamental quest for mechanisms of acceleration, radiation and focusing of energy. Dedicated to exploring the frontiers of the physics of (and with) particle and photon beams, its primary mission is to promote the science and technology of the production, manipulation, storage and control systems of charged particles and photons. The Center serves this mission via conceptual studies, theoretical and experimental research, design and development, institutional project involvement, external collaborations, association with industry and technology transfer. This roster provides a glimpse at the scientists, engineers, technical support, students, and administrative staff that make up this team and a flavor of their multifaceted activities during 1993.
Not Available
More than 40% of the medical center's patients come from outside the primary service area, defined as a 12-mile radius of the hospital. 78% of the Cancer Institute's patients are adults over 55, and 12% are African American.
Association of Mycoplasma Pneumoniae Infection with Primary Atypical Pneumonia.
National Technical Information Service (NTIS)
A controlled epidemiologic experiment was conducted at the Great Lakes Naval Training Center to measure the relationship of Mycoplasma pneumoniae infection and the syndrome of primary atypical pneumonia. Recruits admitted with pneumonia were matched with ...
J. P. Griffin, Y. E. Crawford
Quadtree-like pyramids have the advantage of re- sulting in a multiresolution representation where each pyramid node has four unambiguous parents. Such a centered topology guarantees a clearly defined up-projection of labels. This concept has been successfully and extensively used in applications of contour detection, object recognition and segmentation. Unfortu- nately, the quadtree-like type of pyramid has poor approximation powers because
Patrick Brigger; Frank M³ller; Klaus Illgner; Michael Unser
National Technical Information Service (NTIS)
The video presents reasons for and against going to another system of nursing care, the advantages and disadvantages of primary care, problems encountered and staffing patterns. It includes question and answer session. The primary audience is nurses.
NSDL National Science Digital Library
The Salvadori Center was established in New York City in 1976, when Professor Salvadori of Columbia University was challenged by the New York Academy of Sciences to improve the teaching of math and science in middle schools. Visitors can read the about the vision and values of the Salvadori Center in the "About Us" link, which explains that "[u]sing the urban landscape of buildings, tunnels, and bridges,...[it] introduces teachers to the wonder, beauty, and logic of architecture and engineering, who then share it with their students." The "Resource Center" tab near the top of the page has a link to the "Salvadori Curriculum," which has been created for Science, Social Studies, Language Arts, Art, and Math. Visitors will note that the inclusion of non-STEM subjects offers a well-rounded approach to learning that still addresses the STEM subjects. Examples of some of the lessons that are taught in the Language Arts curriculum include asking students to legally protect their new ergonomic chair design, invent or improve upon a product they currently use, and produce a radio program telling the story of a school building, from the building's point of view.
Federal Register 2010, 2011, 2012, 2013
...Certain Primary Care Physicians and Charges for Vaccine Administration Under the Vaccines for Children Program; Correction AGENCY: Centers...Certain Primary Care Physicians and Charges for Vaccine Administration under the Vaccines for...
42 CFR 411.206 - Basis for Medicare primary payments and limits on secondary payments.
Code of Federal Regulations, 2013 CFR
42 Public Health 2 2013-10-01...Basis for Medicare primary payments and limits...411.206 Public Health CENTERS FOR MEDICARE & MEDICAID...SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES...Basis for Medicare primary payments and...
42 CFR 411.206 - Basis for Medicare primary payments and limits on secondary payments.
Code of Federal Regulations, 2012 CFR
42 Public Health 2 2012-10-01...Basis for Medicare primary payments and limits...411.206 Public Health CENTERS FOR MEDICARE & MEDICAID...SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES...Basis for Medicare primary payments and...
42 CFR 411.206 - Basis for Medicare primary payments and limits on secondary payments.
Code of Federal Regulations, 2011 CFR
42 Public Health 2 2011-10-01...Basis for Medicare primary payments and limits...411.206 Public Health CENTERS FOR MEDICARE & MEDICAID...SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES...Basis for Medicare primary payments and...
The disclosure relates to the quantitation of a primary enzyme concentration by utilizing a substrate for the primary enzyme labeled with a second enzyme which is an indicator enzyme. Enzyme catalysis of the substrate occurs and results in release of the indicator enzyme in an amount directly proportional to the amount of primary enzyme present. By quantifying the free indicator enzyme one determines the amount of primary enzyme present.
Saunders, G.C.
Quality of primary health care in Saudi Arabia: a comprehensive review
Objectives. Little is known about the quality of primary care in Saudi Arabia, despite the central role of primary care centers in Saudi health strategy. This study presents an overview of quality of primary care in Saudi Arabia, and identifies factors impeding the achievement of quality, with the aim of determining how the quality of Saudi primary care could be
ERIC Educational Resources Information Center
Given the chorus of approval for primary care emanating from every party to the health reform debate, one might suppose that the future for primary physicians is bright. Yet this is far from certain. And when one looks to history and recognizes that primary care medicine has failed virtually every conceivable market test in recent years, itsģ
Alper, Philip R.
Investigating Primary Source Literacy
ERIC Educational Resources Information Center
Primary source research requires students to acquire specialized research skills. This paper presents results from a user study testing the effectiveness of a Web guide designed to convey the concepts behind "primary source literacy". The study also evaluated students' strengths and weaknesses when conducting primary source research. (Contains 3ģ
Archer, Joanne; Hanlon, Ann M.; Levine, Jennie A.
NASA Technical Reports Server (NTRS)
NASA's new Moderate-resolution Imaging Spectroradiometer (MODIS) allows scientists to gauge our planet's metabolism on an almost daily basis. GPP, gross primary production, is the technical term for plant photosynthesis. This composite image over the continental United States, acquired during the period March 26-April 10, 2000, shows regions where plants were more or less productive-i.e., where they 'inhaled' carbon dioxide and then used the carbon from photosynthesis to build new plant structures. This false-color image provides a map of how much carbon was absorbed out of the atmosphere and fixed within land vegetation. Areas colored blue show where plants used as much as 60 grams of carbon per square meter. Areas colored green and yellow indicate a range of anywhere from 40 to 20 grams of carbon absorbed per square meter. Red pixels show an absorption of less than 10 grams of carbon per square meter and white pixels (often areas covered by snow or masked as urban) show little or no absorption. This is one of a number of new measurements that MODIS provides to help scientists understand how the Earth's landscapes are changing over time. Scientists' goal is use of these GPP measurements to refine computer models to simulate how the land biosphere influences the natural cycles of water, carbon, and energy throughout the Earth system. The GPP will be an integral part of global carbon cycle source and sink analysis, an important aspect of Kyoto Protocol assessments. This image is the first of its kind from the MODIS instrument, which launched in December 1999 aboard the Terra spacecraft. MODIS began acquiring scientific data on February 24, 2000, when it first opened its aperture door. The MODIS instrument and Terra spacecraft are both managed by NASA's Goddard Space Flight Center, Greenbelt, MD. Image courtesy Steven Running, MODIS Land Group Member, University of Montana
The Impact of Primary Care: A Focused Review
Primary care serves as the cornerstone in a strong healthcare system. However, it has long been overlooked in the United States (USA), and an imbalance between specialty and primary care exists. The objective of this focused review paper is to identify research evidence on the value of primary care both in the USA and internationally, focusing on the importance of effective primary care services in delivering quality healthcare, improving health outcomes, and reducing disparities. Literature searches were performed in PubMed as well as ōsnowballingö based on the bibliographies of the retrieved articles. The areas reviewed included primary care definitions, primary care measurement, primary care practice, primary care and health, primary care and quality, primary care and cost, primary care and equity, primary care and health centers, and primary care and healthcare reform. In both developed and developing countries, primary care has been demonstrated to be associated with enhanced access to healthcare services, better health outcomes, and a decrease in hospitalization and use of emergency department visits. Primary care can also help counteract the negative impact of poor economic conditions on health. PMID:24278694
Shi, Leiyu
Chemical Hydrogen Storage Center Center of Excellence
Hydrogen Storage Center Center Objectives ┬Ę Identify, research, develop and validate the best chemicalChemical Hydrogen Storage Center Center of Excellence for Chemical Hydrogen Storage William Tumas proprietary or confidential information #12;2 Chemical Hydrogen Storage Center Overview Project Start Date: FY
Carver, Jeffrey C.
Center for Networked Center for Networked Computing
Center for Networked Computing Center for Networked Computing Adaptive Battery Charge email@example.com Presenter: Pouya Ostovari #12;Center for Networked Computing Center for Networked Computing Motivation for Networked Computing Center for Networked Computing Problem What is a good voltage threshold to trigger
Wu, Jie
The Future: Optimism or Ossification.
ERIC Educational Resources Information Center
This paper addresses the issues raised in a recent review of postcompulsory education and training in Victoria. In the interim report (April 2000) it is stated that employers found that the skills of new graduates appear to be most deficient in the areas of creativity, flair, problem solving, oral business communication, and interpersonal skills.ģ
Bottrell, Christine; Ling, Lorraine
Higher Education Center for Alcohol and Other Drug Prevention.
ERIC Educational Resources Information Center
This brochure describes the mission, approach, and services of the Higher Education Center for Alcohol and Other Drug Prevention. The Center is the nation's primary resource center for assisting higher education institutions in the development, implementation, and evaluation of alcohol and drug violence prevention policies and programs thatģ
Higher Education Center for Alcohol and Other Drug Prevention, Newton, MA.
Louisiana Forest Products Lab 1 Accidents in the Primary &
Louisiana Forest Products Lab 1 Accidents in the Primary & Secondary Forest Products Industry Center #12;Louisiana Forest Products Lab 2 Abitibi Paper Co. Camp 40 Thunder Bay, Ontario #12;Louisiana Forest Products Lab 3 Accidents in Forest Products Industry Accident Statistics Primary industry
Promoting Primary Education for Girls in Pakistan. CDIE Impact Evaluation.
ERIC Educational Resources Information Center
This report details a field study to evaluate the efforts of Pakistan's Primary Education Development Program (PED) to improve the access, equity, and quality of primary education in Pakistan, especially for rural girls. A 3-week visit was conducted in 1997 by a team from the United States Agency for International Development (USAID) Center forģ
Agency for International Development (IDCA), Washington, DC.
Why Mental Health Centers Should Not Do Home-Based Family Centered Services.
ERIC Educational Resources Information Center
Home Based Family Centered (HBFC) services give primary responsibility for evaluation, service planning, and counseling to the direct service in-home family therapist. In the mental health center (MHC), the psychiatrist may see a child once in the office and make a diagnosis and recommendation for the child, and sometimes for the parents. Also inģ
Leverington, John J.; Bryce, Marvin
Overview of Nurse Managed Health Centers Nurse Managed Health Centers (NMHC) are outpatient, primary care, college health care, school- based care, and occupational health, Pohl, et. al. (2010). A Nurse Managed Health Center can be independently operated, be based in a public school, or University
Firestone, Jeremy
The Sanford USD Medical Center is the largest tertiary hospital in South Dakota with nearly 500 beds. It serves as the primary teaching institution for the Sanford School of Medicine of the University of South Dakota. The Medical Center serves as a regional institution, with half of its patients coming from outside the immediate Sioux Falls community. The Sanford Cancer Center is the region's largest, treating more than 1,278 new patients in 2005.
Development and Validation of the Tibetan Primary Care Assessment Tool
Objective. To develop a primary care assessment tool in Tibetan area and assess the primary care quality among different healthcare settings. Methods. Primary care assessment tool-Tibetan version (PCAT-T) was developed to measure seven primary care domains. Data from a cross-sectional survey of 1386 patients was used to conduct validity and reliability analysis of PCAT-T. Analysis of variance was used to conduct comparison of primary care quality among different healthcare settings. Results. A 28-item PCAT-T was constructed which included seven multi-item scales and two single-item scales. All of multi-item scales achieved good internal consistency and item-total correlations. Scaling assumptions tests were well satisfied. The full range of possible scores was observed for all scales, except first contact and continuity. Compared with prefecture hospital (77.42) and county hospital (82.01), township health center achieved highest primary care quality total score (86.64). Conclusions. PCAT-T is a valid and reliable tool to measure patients' experience of primary care in the Tibet Autonomous Region. Township health center has the best primary care performance compared with other healthcare settings, and township health center should play a key role in providing primary care in Tibet. PMID:24967349
Yin, Aitian; Lai, Youwen
NSDL National Science Digital Library
A human is a complicated organism, and it is considered unethical to do many kinds of experiments on human subjects. For these reasons, biologists often use simpler 'model' organisms that are easy to keep and manipulate in the laboratory. Despite obvious differences, model organisms share with humans many key biochemical and physiological functions that have been conserved (maintained) by evolution. Each of the following model organisms has its advantages and disadvantages in different research applications. This tool allows you to examine the similarities between different systems by comparing the proteins they share and the proportion of DNA they have in common. Choose a gene from the drop-down menu and select the species you want to compare. Rolling over the images will give you a more detailed description of each model. Clicking on a gene├┬ó├┬├┬s name will take you to the National Center for Biological Information, where you can explore the latest relevant scientific literature.
Fan control centers are used extensively in cooling and heating applications to provide simple, low voltage control over the heating and cooling system as well as the fan operation and auxiliary circuit devices. The control consists of a low voltage transformer and a switching relay, which are designed to carry low voltage or line voltage to the load devices being controlled. Manufacturers of fan control relays offer a variety of controls with various voltage and switch contact arrangements available to suit many system applications. For this reason, consider the following factors when selecting a fan relay control: (1) Primary voltage of the transformer; (2) Secondary voltage of the transformer; (3) VA rating of the transformer; (4) Relay switching needs-double pole, double throw, single pole, single throw, single pole double throw; (5) Amperage rating of the relay contact-full load amperage or locked rotor amperage.
Puzio, H. [Sussex County Vocational Technical School, Sparta, NJ (United States)
Primary care research: barriers and opportunities.
A paucity of relevant scientific evidence limits the ability of the primary care disciplines to practice evidence-based medicine and to advocate for health care policy. Significant barriers to primary care research still exist, including difficulties in translating practice-based wisdom into methodologically sound research, the lack of a critical mass of researchers, a poorly developed research culture, and competing demands faced by investigators. In addition, the categorical nature of most available research funding is unfavorable for the generalist focus of primary care research. Efforts to advance primary care research will require support from health care organizations, dedicated federal and state funding sources, and foundations. In addition, there is a need to provide sophisticated methodological training for a small cadre of primary care researchers while increasing opportunities for a large number of clinicians to participate in research. Opportunities for transdisciplinary collaboration need to be increased, including the creation of primary care research centers. The development of a scientific basis for primary care practice will require policy advocacy, development of infrastructure, and creative and sustained individual effort. PMID:8606311
Stange, K C
An introduction to primary care and psychology.
The health care system in the United States has been less effective and more expensive than it needs to be, but the organizational and political will to address these shortcomings is beginning to emerge. These changes are particularly noticeable in primary care, at the heart of an improved health care system. The value of primary care turns on its comprehensiveness, which means that behavioral health care-health behavior change, mental health care, management of psychological symptoms and psychosocial distress, and attention to substance abuse-must be woven into the fabric of primary care practice. This integration is beginning to happen as psychologists and other behavioral health clinicians are incorporated as essential team members in the patient-centered medical home and other emerging models of primary care. This article introduces psychologists to the fundamental changes taking place in primary care and to the various roles that psychologists can play in the new health care system. We describe the extensive breadth and diversity of primary care by age, sex, setting, and type of clinical problem and the implications of this variety for the psychologist's role. This description is not simply a clinical exercise: Transformation of the primary care system also has policy, educational, and research dimensions. We describe how psychologists are essential to these functions as well. PMID:24820682
McDaniel, Susan H; deGruy, Frank V
Primary Photosynthetic Energy Conversion in Bacterial Reaction Centers
NASA Astrophysics Data System (ADS)
The development of human societies is strongly influenced by the available energetic resources. In a period where the limitations of conventional fossil energy carriers become as evident as the often uncontrollable dangers of nuclear energy, one has to reconsider regenerative energy resources. Here photovoltaic or photochemical use of solar energy is an important approach. Since the early days of evolution some two billion years ago, the dominant energetic input into the life system on earth occurs via the conversion of solar energy performed in photosynthetic organisms. The fossil energy carriers that we use and waste today have been produced by photosynthesis over millions of years. In the race for an extended and versatile use of solar energy, semiconductorbased photovoltaic devices have been developed. However, even after decades of intense engineering they cannot serve as a competitive alternative to fossil energy. Under these circumstances new alternatives are required. One line of scientific development may use the operational principles of photosynthesis since photosynthesis is still our main energy source. In this respect, we will present results on the basic concepts of energy conversion in photosynthetic bacteria, which could be used as a guideline to alternative light energy conversion systems.
Zinth, Wolfgang; Wachtveitl, J.
Paying primary health care centers for performance in Rwanda
Paying for performance (P4P) provides financial incentives for providers to increase the use and quality of care. P4P can affect health care by providing incentives for providers to put more effort into specific activities, and by increasing the amount of resources available to finance the delivery of services. This paper evaluates the impact of P4P on the use and quality
Paulin Basinga; Paul J. Gertler; Agnes Binagwaho; Agnes L. B. Soucat; Jennifer R. Sturdy; Christel M. J. Vermeersch
... Affairs VA ╗ Center for Women Veterans Center for Women Veterans 2014 Champions of Change On Tuesday, March ... Vets Women Veterans Outreach Center for Women Veterans Women Veterans Program Resources Home Center for Women Veterans ...
Composites technology for transport primary structure
NASA Technical Reports Server (NTRS)
The ACT contract activity being performed by the McDonnell Douglas Corporation is divided into two separate activities: one effort by Douglas Aircraft in Long Beach, California with a focus on Transport Primary Wing and Fuselage Structure, and the other effort by McDonnell Aircraft in St. Louis, Missouri with a focus on Advanced Combat Aircraft Center Wing-Fuselage Structure. This presentation is on the Douglas Aircraft Transport Structure portion of the ACT program called ICAPS - Innovative Composite Aircraft Primary Structure.
Chen, Victor; Hawley, Arthur; Klotzsche, Max; Markus, Alan; Palmer, Ray
Extending hospital to the primary care office.
Using a Centers for Medicare & Medicaid Services Innovation grant, Beth Israel Deaconess Medical Center in Boston launched a program to prevent readmissions. Care transition specialist nurses are assigned to six primary care practices and work with patients in the practice to which they are assigned. They meet patients in the hospital and follow them for 30 days after discharge. The program includes pharmacists who conduct medication reconciliation and work with patients on medication issues, and a social worker who is called in when patients have psychosocial needs. PMID:24923072
Center of mass or center of gravity
Each coordinate system has one, two or three axes and one center of its own. Each axis is called reference line and the point where they meet is its origin. The origin or the center is not the same in different systems. In some of coordinate systems origin is the center of gravity and in other systems is the center
N. F. Vaezi; A. Hajizadeh
STRONG FERTILITY CENTER Strong Fertility Center
STRONG FERTILITY CENTER Strong Fertility Center Women's Lifestyle Center The Women's Lifestyle with the improved lifestyle. Also, we work together with the Strong Fertility Center to coordinate your fertility fertility treatments. ┬Ę A complete nutritional consultation with our registered dietician, Tracy Cherry, RD
Goldman, Steven A.
NSDL National Science Digital Library
Created by an act of Congress in 1967, the Federal Judicial Center has served as a clearinghouse of information about the federal court system for four decades. While the Center is physically based in Washington, DC, their website brings information about the court system, its history, and its judges to any interested parties with access to the Internet. From their homepage, visitors can go straight to one of the primary sections, which include "Federal Judicial History", "Publications & Videos", and "Educational Programs & Materials". In the "Publications & Videos" area, visitors can use the search engine to look for specific items of interest, or they can also browse the archive's contents by subject or by date of publication. Recent additions have included the updated second edition of the copyright law statutes to the proceedings of a roundtable discussion on the use of technology to facilitate appearances in bankruptcy proceedings. For most visitors, the "Federal Judicial History" will be of greatest interest, as it contains biographies of federal judges since 1789, the histories of individual courts, and summaries of landmark decisions.
Composite Crew Module: Primary Structure
NASA Technical Reports Server (NTRS)
In January 2007, the NASA Administrator and Associate Administrator for the Exploration Systems Mission Directorate chartered the NASA Engineering and Safety Center to design, build, and test a full-scale crew module primary structure, using carbon fiber reinforced epoxy based composite materials. The overall goal of the Composite Crew Module project was to develop a team from the NASA family with hands-on experience in composite design, manufacturing, and testing in anticipation of future space exploration systems being made of composite materials. The CCM project was planned to run concurrently with the Orion project's baseline metallic design within the Constellation Program so that features could be compared and discussed without inducing risk to the overall Program. This report discusses the project management aspects of the project including team organization, decision making, independent technical reviews, and cost and schedule management approach.
Kirsch, Michael T.
Education research Primary Science
Education research Primary Science Survey Report December 2011 #12;Primary Science Survey Report, Wellcome Trust 1 Background In May 2009 Key Stage 2 science SATs (Standard Assessment Tests) were abolished fiasco might occur, where the results were delayed and their quality questioned. The loss of science SATs
Rambaut, Andrew
Using Primary Source Documents.
ERIC Educational Resources Information Center
Explores the use of primary sources when teaching about U.S. slavery. Includes primary sources from the Gilder Lehrman Documents Collection (New York Historical Society) to teach about the role of slaves in the Revolutionary War, such as a proclamation from Lord Dunmore offering freedom to slaves who joined his army. (CMK)
Mintz, Steven
Argumentation and Primary Science
ERIC Educational Resources Information Center
The importance of argumentation in science education is outlined and the relatively low level of argumentation typically observed in classrooms in the UK is noted, along with possible reasons for this. The research sets out to determine the extent to which primary school pupils engage in argumentation and to characterise their arguments in primaryģ
Naylor, S.; Keogh, B.; Downing, B.