Second Extensor Compartment Entrapment in an Adult Following Distal Radius Fracture.

Extensor tendon entrapment in the presence of distal radius fracture is a known but relatively uncommon complication. Single tendon or entire compartment entrapment has been described through the literature in youths and adults. However these findings generally are limited to a certain age demographic or are found on advanced imaging but are unable to be confirmed intraoperatively. We describe to our knowledge the first known description of second extensor compartment entrapment in an adult seen on computerized tomography scan and confirmed intraoperatively.

Are perceptions of climate change in Amazonian coastal communities influenced by socioeconomic and cultural factors?

Climate changes have become undisputed, as have their consequences for global ecosystems and mankind. The coastal areas are among the most affected areas on the planet due to their geographical location. The effects suffered by coastal areas can render the residing populations homeless, as well as compromise the continuity of the history and culture of these environments. The Marine Extractive Reserve of the city of Soure (coastal area of eastern Amazonia) stands out for housing populations that have developed an intimate relationship with nature and have knowledge that can explain people's perception of climate changes. In this context, this study investigated how local residents perceive climate change and its consequences considering different temporal and spatial scales. To this end, questionnaires were developed and applied using a 5-point Likert scale. Our results indicate that perception is shaped by socioeconomic and demographic factors, and that they are perceived on different time scales and geographic space. These findings reflect the awareness-raising efforts of the management body of this Conservation Unit and the local knowledge, derived from the relationship of the residents with the natural environment, which, together, provided the population with assertive information that favor a better understanding of this phenomenon.

Local perceptions do not follow rainfall trends: A case study in traditional Marajo island communities (eastern para state, BR).

The great current challenge for the conservation and use of natural resources refers to global climate change, because of its impacts felt in different intensities at global, regional, and local spatial scales. Within the system of environmental protection areas in Brazil, the extractive reserves ensure the sustainable use of natural resources by traditional populations, thus maintaining the cultural and biological aspects of a region. Such populations, being in close management of the surrounding environments, tend to perceive changes in ecological processes that many need for their livelihoods. The use of this perception of local populations in conjunction with academic research evidence has a high potential to allow a whole and systemic view of possible changes in natural phenomena. This study developed an integrated analysis of scientific evidence and local perceptions to understand the variation of precipitation in a community inserted in an extractive reserve in the eastern Amazon. We used 30 years of precipitation data from the Brazilian National Institute of Meteorology - INMET, the Southern Oscillation Index - SOI, and the Atlantic Meridional Mode Index - AMM. Furthermore, we applied a form to measure the population's perception of possible changes in rainfall cycles in the region. The meteorological data indicate that the region of the community has been presenting a rainfall reduction; however, people in the community do not perceive this trend. Although it is public knowledge that the global climate is undergoing changes, a fact noted after the integrating analysis of scientific evidence with local knowledge in Resexmar Soure is that the perceptions of traditional populations often focus on smaller temporal and spatial scale visions.

Choosing a future from a murky past: A generalization-based model of behavior.

Remembering the past appears critical in allowing organisms to detect order in an environment, and hence to behave in accordance with likely future events. Yet the shortcomings of remembering and perceiving typically mean that the remembered past differs from the actual past, and hence that behavior does not perfectly track the structure of the environment. Here, we outline how the process of generalization might be used to understand differences between what an organism does, and the structure of the past and potential structure of the environment. We explore how different sources of generalization - both from within the same stimulus situation, and from different stimulus situations - might be modeled quantitatively, and how predictions made by this modeling approach are supported by research. Finally, we discuss how generalization from multiple stimulus situations, longer-term experience, and from stimulus situations in the past that are not identical to the stimulus situation in the present, might contribute to our understanding of how an organism's experience translates into behavior.

Of fruits and fats: high-sugar diets restore fatty acid profiles in the white adipose tissue of captive dwarf lemurs.

Fat-storing hibernators rely on fatty acids from white adipose tissue (WAT) as an energy source to sustain hibernation. Whereas arctic and temperate hibernators preferentially recruit dietary polyunsaturated fatty acids (PUFAs), tropical hibernators can rely on monounsaturated fatty acids that produce fewer lipid peroxides during oxidation. Nevertheless, compositional data on WAT from tropical hibernators are scant and questions remain regarding fat recruitment and metabolism under different environmental conditions. We analyse fatty acid profiles from the WAT of captive dwarf lemurs (Cheirogaleus medius) subjected to high-sugar or high-fat diets during fattening and cold or warm conditions during hibernation. Dwarf lemurs fed high-sugar (compared to high-fat) diets displayed WAT profiles more comparable to wild lemurs that fatten on fruits and better depleted their fat reserves during hibernation. One PUFA, linoleic acid, remained elevated before hibernation, potentially lingering from the diets provisioned prior to fattening. That dwarf lemurs preferentially recruit the PUFA linoleic acid from diets that are naturally low in availability could explain the discrepancy between captive and wild lemurs' WAT. While demonstrating that minor dietary changes can produce major changes in seasonal fat deposition and depletion, our results highlight the complex role for PUFA metabolism in the ecology of tropical hibernators.

Bone penetration of intravenous flucloxacillin and gentamicin as antibiotic prophylaxis during total hip and knee arthroplasty.

AIMS: To investigate the bone penetration of intravenous antibiotic prophylaxis with flucloxacillin and gentamicin during hip and knee arthroplasty, and their efficacy against Staphylococcus (S.) aureus and S. epidermidis. PATIENTS AND METHODS: Bone samples from the femoral head, neck and acetabulum were collected from 18 patients undergoing total hip arthroplasty (THA) and from the femur and tibia in 21 patients during total knee arthroplasty (TKA). The concentration of both antibiotics in the samples was analysed using high performance liquid chromatography. Penetration was expressed as a percentage of venous blood concentration. The efficacy against common infecting organisms was measured against both the minimum inhibitory concentration 50, and the more stringent epidemiological cutoff value for resistance (ECOFF). RESULTS: The bone penetration of gentamicin was higher than flucloxacillin. Relative to ECOFF, flucloxacillin concentrations were effective against S. aureus and S. epidermidis in all THAs and 20 (95%) TKAs. Gentamicin concentrations were effective against S. epidermidis in all bone samples. Gentamicin was effective against S. aureus in 11 (61.1%) femoral neck samples in THA. Effective concentrations of gentamicin against S. aureus were only achieved in four (19%) femoral and six (29%) tibial samples in TKA. CONCLUSION: Flucloxacillin and gentamicin were found to penetrate bone during THA and TKA. Gentamicin was effective against S. epidermidis in both THA and TKA, while levels were subtherapeutic against S. aureus in most TKAs. Bone penetration of both antibiotics was less in TKA than THA, and may relate to the use of a tourniquet. Using this antibiotic combination, effective cover against the two common infective organisms was achieved in all THAs and all but one TKA. Cite this article: Bone Joint J 2017;99-B:358-64.

Healthcare use among preschool children attending GP-led urgent care centres: a descriptive, observational study.

OBJECTIVE: Urgent care centres' (UCCs) hours were developed with the aim of reducing inappropriate emergency department (ED) attendances in England. We aimed to examine the presenting complaint and outcomes of care in 2 general practitioner (GP)-led UCCs with extended opening times. DESIGN: Retrospective observational epidemiological study using routinely collected data. SETTING: 2 GP-led UCCs in London, colocated with a hospital ED. PARTICIPANTS: All children aged under 5 years, attending 2 GP-led UCCs over a 3-year period. OUTCOMES: Outcomes of care for the children including: primary diagnosis; registration status with a GP; destination following review within the UCC; and any medication prescribed. Comparison between GP-led UCC visit rates and routine general practices was also made. RESULTS: 3% (n=7747/282 947) of all attenders at the GP-led UCCs were children aged under 5 years. The most common reason for attendance was a respiratory illness (27%), followed by infectious illness (17%). 18% (n=1428) were either upper respiratory tract infections or viral infections. The majority (91%) of children attending were registered with a GP, and over two-thirds of attendances were 'out of hours'. Overall 79% were seen and discharged home. Preschool children were more likely to attend their GP (47.0 per 100) than a GP-led UCC (9.4 per 100; 95% CI 8.9 to 10.0). CONCLUSIONS: Two-thirds of preschool children attending GP-led UCCs do so out of hours, despite the majority being registered with a GP. The case mix is comparable with those presenting to an ED setting, with the majority managed exclusively by the GPs in the UCC before discharge home. Further work is required to understand the benefits of a GP-led urgent system in influencing future use of services especially emergency care.

SU-E-T-461: Fractionation Schedule Optimization for Lung Cancer Treatments Using Radiobiological and Dose Distribution Characteristics.

PURPOSE: Lung cancer radiotherapy treatments employ a wide variety of fractionation protocols. The choice among protocols mostly depends on the size of the target volume (GTV or ITV) and the volume of normal tissue receiving a critical dose. Rigorous mathematical criteria for normal tissue (NT) dose distributions were derived to determine the type of dose per fraction schedule that maximizes linear-quadratic tumor effect. METHODS: Selecting the individual doses per fraction that maximize a linear-quadratic effect in the tumor while constraining the normal tissue complication probability according to the Lyman-Kutcher-Burman model leads to an optimization problem. For time-independent parameters, the solution is always an equal dose per fraction schedule; depending on parameter values, two different class solutions are suggested: minimal number of fractions clinically realized with hypo-fractionation, or minimizing dose per fraction clinically realized with standard- or hyper-fractionation. The value of a single scale-free "bifurcation" number, derived from the DVH of the NT dose distribution suggests which solution is preferred for a given plan with respect to a given normal tissue. The clinical relevance of the bifurcation number in selecting fractionation schemes was tested for 30 patients previously treated for non-small-cell lung cancer according to various fractionation protocols. RESULTS: The bifurcation numbers for both lung and esophagus were a good classifier for the hypofractionated and the conventional fractionation groups. The variability of the numbers within patients of the conventional fractionation group was much smaller than the variability of the treated ITV volumes or the ITV to lung volume ratios. The prescribed fractionations were also consisted with the currently accepted alpha-beta values for tumor (10) and radiation-induced pneumonities in the lung (4). CONCLUSIONS: Model-based criteria such as the bifurcation number may replace the more empirical volume criteria to decide the optimal fractionation protocol once the dose distribution has been optimized.

Association of medication attitudes with non-persistence and non-compliance with medication to prevent fractures.

UNLABELLED: Our objective was to assess the association of self-reported non-persistence (stopping fracture-prevention medication for more than 1 month) and self-reported non-compliance (missing doses of prescribed medication) with perceived need for fracture-prevention medication, concerns regarding long-term harm from and/or dependence upon medications, and medication-use self-efficacy (confidence in one's ability to successfully take medication in the context of their daily life). INTRODUCTION: Non-persistence (stopping medication prematurely) and non-compliance (not taking medications at the prescribed times) with oral medications to prevent osteoporotic fractures is widespread and attenuates their fracture reduction benefit. METHODS: Cross-sectional survey and medical record review of 729 patients at a large multispecialty clinic in the United States prescribed an oral bisphosphonate between January 1, 2006 and March 31, 2007. RESULTS: Low perceived necessity for fracture-prevention medication was strongly associated with non-persistence independent of other predictors, but not with non-compliance. Concerns about medications were associated with non-persistence, but not with non-compliance. Low medication-use self-efficacy was associated with non-persistence and non-compliance. CONCLUSIONS: Non-persistence and non-compliance with oral bisphosphonate medication have different, albeit overlapping, sets of predictors. Low perceived necessity of fracture-prevention medication, high concerns about long-term safety of and dependence upon medication , and low medication-use self-efficacy all predict non-persistence with oral bisphosphonates, whereas low medication-use self-efficacy strongly predicts non-compliance with oral bisphosphonate medication. Assessment of and influence of these medication attitudes among patients at high risk of fracture are likely necessary to achieve better persistence and compliance with fracture-prevention therapies.

Sub-Tenon's anaesthesia versus topical anaesthesia for cataract surgery.

BACKGROUND: Local anaesthesia for cataract surgery can be provided by either sub-Tenon or topical anaesthesia. Although there is some work suggesting advantages to both techniques, there has been no recent systematic attempt to compare both techniques for all relevant outcomes. OBJECTIVES: To compare the effectiveness of topical anaesthesia (with or without the addition of intracameral local anaesthetic) and sub-Tenon's anaesthesia in providing pain relief during cataract surgery. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library, 2006, Issue 2); MEDLINE (1990 to July 2006); EMBASE (1990 to July 2006) and reference lists of articles. There were no constraints based on language or publication status. SELECTION CRITERIA: We included all randomized or quasi-randomized studies comparing sub-Tenon anaesthesia with topical anaesthesia for cataract surgery. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality and extracted data. We contacted study authors for additional information. We also collected adverse effects information from the trials. MAIN RESULTS: Seven studies involving 617 patients with 742 eyes operated on were examined. Five studies used unpaired data, with a single eye operated on; two studies used paired data with both eyes operated on. The surgical technique was clear corneal incision in five studies and scleral tunnel in two. The overall quality of the studies was not high, with one study triple blind (patient, surgeon and assessor blinded to treatment group) and three others single blind. The allocation of concealment and methods of randomization were only described in two studies. Three unpaired studies showed that sub-Tenon anaesthesia provided better intra-operative pain relief than topical anaesthesia (pooled weighted mean difference (fixed) 1.28, 95% CI 0.83to 1.72). The differences in the pain scores are not necessarily clinically significant although statistically significant. The differences are not large in magnitude and are skewed to the low end of the visual analogue scale but the studies are consistent throughout in reporting more pain in the topical anaesthesia group. This was also supported by the one paired study which showed that the mean pain score in the topical group was 1.13 (SD 1.57) compared with 0.57 (SD 1.28) in the sub-Tenon group (P < 0.001). Three of the studies used a 10-point visual analogue scale, while one used a novel 5-point scale. Further support was provided by other outcome measures. Sub-Tenon anaesthesia caused more chemosis and sub-conjunctival haemorrhage although this was purely aesthetic. The more serious complication of posterior capsule tear and vitreous loss occurred twice as much in the topical group than with sub-Tenon anaesthesia (4.3% versus 2.1%). AUTHORS' CONCLUSIONS: Sub-Tenon anaesthesia provides better pain relief than topical anaesthesia for cataract surgery.

Recombinant human acid [alpha]-glucosidase: major clinical benefits in infantile-onset Pompe disease.

BACKGROUND: Pompe disease is a progressive metabolic neuromuscular disorder resulting from deficiency of lysosomal acid alpha-glucosidase (GAA). Infantile-onset Pompe disease is characterized by cardiomyopathy, respiratory and skeletal muscle weakness, and early death. The safety and efficacy of recombinant human (rh) GAA were evaluated in 18 patients with rapidly progressing infantile-onset Pompe disease. METHODS: Patients were diagnosed at 6 months of age and younger and exhibited severe GAA deficiency and cardiomyopathy. Patients received IV infusions of rhGAA at 20 mg/kg (n = 9) or 40 mg/kg (n = 9) every other week. Analyses were performed 52 weeks after the last patient was randomized to treatment. RESULTS: All patients (100%) survived to 18 months of age. A Cox proportional hazards analysis demonstrated that treatment reduced the risk of death by 99%, reduced the risk of death or invasive ventilation by 92%, and reduced the risk of death or any type of ventilation by 88%, as compared to an untreated historical control group. There was no clear advantage of the 40-mg/kg dose with regard to efficacy. Eleven of the 18 patients experienced 164 infusion-associated reactions; all were mild or moderate in intensity. CONCLUSIONS: Recombinant human acid alpha-glucosidase is safe and effective for treatment of infantile-onset Pompe disease. Eleven patients experienced adverse events related to treatment, but none discontinued. The young age at which these patients initiated therapy may have contributed to their improved response compared to previous trials with recombinant human acid alpha-glucosidase in which patients were older.

Oral healthcare of clients with learning disability: changes following relocation from hospital to community.

OBJECTIVE: To investigate changes in the oral healthcare of adults with learning disability after transference from long stay hospital care to community-based care. SUBJECTS: Adults with learning disability who were former residents of a single long stay hospital and who had been resettled into the community during the period April 1995 to April 1998. DESIGN: Structured questionnaire with a covering letter sent to community-based carers. Hospital notes were reviewed to assess oral healthcare received as in-patients. RESULTS: There was a 68% response rate to the questionnaire from community-based carers with details obtained from 106 out of a possible 157 subjects. As residents in the hospital, all subjects were examined regularly by a dentist--yearly for edentulous and six-monthly for dentate individuals. However, attendance patterns were less regular as residents in the community. In the community, individuals were also less likely to receive operative dental treatment. Although oral hygiene regimes were generally on a daily basis only 37% of the subjects and/or their carers had received oral health education from dental professionals in the community. CONCLUSION: Changes from institutional living to community-based housing for adults with learning disability may be associated with changes in dental attendance and treatment patterns.

Down syndrome: lip lesions (angular stomatitis and fissures) and Candida albicans.

BACKGROUND: The incidence of angular cheilitis (angular stomatitis, perleche, commissural fissures) appears to be increased in people with Down syndrome (DS). Lip fissures are also (in our clinical impression) a fairly regular feature, yet this is scarcely mentioned in the literature. OBJECTIVES: To establish the incidence of angular cheilitis and lip fissures in a substantial group of patients with DS and to examine the relationship with Candida albicans. PATIENTS AND METHODS: The prevalence of orofacial soft tissue lesions was investigated in a group of 77 DS patients. Swabs were taken from lip lesions, palate and tongue and inoculated on Sabouraud's agar discs for the isolation of C. albicans, identified with commercially available kits. RESULTS: Lip fissures were seen in at least one-quarter of DS patients. Angular cheilitis was also found in a similar percentage. CONCLUSIONS: C. albicans was isolated from a substantial proportion of lesions tested, and was present more frequently than in those without lip lesions, but it is uncertain whether this represents cause or effect.

Quantitative proteomic analysis of mouse liver response to the peroxisome proliferator diethylhexylphthalate (DEHP).

Peroxisome proliferators (PPs) are a diverse group of chemicals that cause hepatic proliferation, suppression of apoptosis, peroxisome proliferation and liver tumours in rodents. The biochemical response to PPs involves changes in the expression of peroxisomal beta-oxidation enzymes and fatty acid transport proteins such as acyl-CoA oxidase and liver fatty acid binding protein. The response to PPs is mediated by the peroxisome proliferator-activated receptor alpha (PPARalpha) and the livers of PPARalpha-null transgenic mice do not develop tumours in response to PPs. In order to identify the molecular pathways underlying the adverse effects of PPs in rodent liver, we carried out two-dimensional differential gel electrophoresis to provide quantitative proteomic analyses of diethylhexylphthalate (DEHP)-treated wild-type or PPARalpha-null mouse livers. Since tumourigenesis is both PP- and PPARalpha-dependent, analyses were focused on these changes. Fifty-nine proteins were identified where altered expression was both PPARalpha- and PP-dependent. In addition, six proteins regulated by the deletion of PPARalpha were identified, possibly indicating an adaptive change in response to the loss of this receptor. The proteins that we identified as being regulated by PPARalpha are known to be involved in lipid metabolism pathways, but also in amino acid and carbohydrate metabolism, mitochondrial bioenergetics and in stress responses including several genes not previously reported to be regulated by PPARalpha. These data provide novel insights into the pathways utilised by PPs and may assist in the identification of early markers rodent nongenotoxic hepatocarcinogenesis.

Validation and development of fluorescence two-dimensional differential gel electrophoresis proteomics technology.

Fluorescence two-dimensional differential gel electrophoresis (2-D DIGE*) is a new development in protein detection for two-dimensional gels. Using mouse liver homogenates (control and paracetamol (N-acetyl-p-aminophenol, APAP)-treated), we have determined the quantitative variation in the 2-D DIGE process and established statistically valid thresholds for assigning quantitative changes between samples. Thresholds were dependent on normalised spot volume, ranged from approximately 1.2 fold for large volume spots to 3.5 fold for small volume spots and were not markedly affected by the particular cyanine dye combination or by multiple operators carrying out the dye labelling reaction. To minimise the thresholds, substantial user editing was required when using ImageMaster 2D-Elite software. The difference thresholds were applied to the test system and quantitative protein differences were determined using replicate gels of pool samples and single gels from multiple individual animals (control vs treated in each gel). Throughout, the differences revealed with a particular cyanine dye combination were mirrored almost without exception when the dye combination was reversed. Both pool and individual sample analyses provided unique data to the study. The inter-animal response variability in inbred mice was approximately nine times that contributed by the 2-D DIGE process. A number of the most frequently observed protein changes resulting from APAP-treatment were identified by mass spectrometry. Several of these can be rationalised based on available data on the mechanism of APAP hepatotoxicity but others cannot, indicating that proteomics can provide further insights into the biochemical basis of APAP toxicity.

Chromatographic separations as a prelude to two-dimensional electrophoresis in proteomics analysis.

Current methods of proteome analysis rely almost solely on two-dimensional polyacrylamide gel electrophoresis (2-D PAGE) followed by the excision of individual spots and protein identification using mass spectrometry (MS) and database searching. 2-D PAGE is denaturing in both dimensions and, thus, cannot indicate functional associations between individual proteins. Moreover, less abundant proteins are difficult to identify. To simplify the proteome, and explore functional associations, nondenaturing anion exchange column chromatography was used to separate a soluble protein extract from Escherichia coli. Successive fractions were then analysed using 2-D PAGE and selected spots from both the gels for the start material and the fractionated material were quantified and identified by peptide mass fingerprinting using a MALDI-TOF mass spectrometer. Enrichments of up to 13-fold were attained for individual protein spots and peptide mass fingerprints were of significantly higher quality after chromatographic separation. The marked anomalies between predicted p/and column elution position contrasted with the almost perfect correlation with migration distance on isoelectric focusing (IEF) and were explored further for basic proteins.