Does the DVR(®) plate restore bony anatomy following distal radius fractures?

INTRODUCTION: Fractures of the distal radius are common. Malreduced fractures are associated with residual functional deficiency. There has been a trend over the last few years for using fixed angle volar locking plates to surgically stabilise this injury. Our unit uses the DVR(®) plate (DePuy, Warsaw, IN, US). Nevertheless, it is unknown whether the normal bony anatomy is recreated or merely restored to acceptable limits with its usage. The aim of this study was to evaluate the reduction achieved compared with an uninjured population and pre-existing quoted 'normal' values. Furthermore, we wanted to identify the percentage of cases that were reduced to acceptable limits, and determine whether the grade of the surgeon and fracture type was a confounding influence on this reduction. METHODS: A retrospective review of the 3-month postoperative radiography of 48 eligible patients who underwent open reduction and internal fixation of a distal radius fracture with a DVR(®) plate was undertaken. RESULTS: Volar tilt, radial length and inclination were different to quoted normal values (p<0.01). Despite this, these parameters fell within acceptable limits in 46 cases; this was not influenced by fracture type or grade of operating surgeon. CONCLUSIONS: The DVR(®) plate restores the bony anatomy to within acceptable limits in the majority of patients who have sustained a fracture of the distal radius although of all parameters investigated, the widest variability is seen in volar tilt.

Case series: 2q33.1 microdeletion syndrome--further delineation of the phenotype.

Recurrent deletions of 2q32q33 have recently been reported as a new microdeletion syndrome, clinical features of which include significant learning difficulties, growth retardation, dysmorphic features, thin and sparse hair, feeding difficulties, and cleft or high palate. Haploinsufficiency of one gene within the deleted region, SATB2, has been suggested to be responsible for most of the features of the syndrome. This article describes seven previously unreported patients with deletions at 2q33.1, all partially overlapping the previously described critical region for the 2q33.1 microdeletion syndrome. The deletions ranged in size from 35 kb to 10.4 Mb, with the smallest deletion entirely within the SATB2 gene. Patients demonstrated significant developmental delay and challenging behaviour, a particular behavioural phenotype that seems to be emerging with more reported patients with this condition. One patient in this cohort has a deletion entirely within SATB2 and has a cleft palate, whereas several patients with larger deletions have a high arched palate. In addition, one other patient has significant orthopaedic problems with ligamentous laxity. Interestingly, this patient has a deletion that lies just distal to SATB2. The orthopaedic problems have not been reported previously and are possibly an additional feature of this syndrome. Overall, this report provides further evidence that the SATB2 gene is the critical gene in this microdeletion syndrome. In addition, because the individuals in this study range in age from 3-19 years, these patients will help define the natural progression of the phenotype in patients with this microdeletion.

A comparison of fusion, trapeziectomy and silastic replacement for the treatment of osteoarthritis of the trapeziometacarpal joint.

This retrospective study compares three of surgical treatments for osteoarthritis of the trapeziometacarpal joint of the thumb. We assessed the outcomes of a total of 83 operations at a follow-up of between 1 and 5 years. The types of treatment were, fusion of the carpometacarpal joint (36 operations), excision of the trapezium with or without a sling ligament reconstruction (25 operations), and silastic trapezial replacement (22 operations). Assessments included patient satisfaction, pain measurement, range of movement, tip and key pinch, and complication rates. There were no significant differences between the clinical outcome of the treatments, though there was higher rate of complications and reoperation in the fusion group.

Spirituality, culture, and cancer care.

OBJECTIVES: To explore the inter-relatedness of culture and spirituality in the context of cancer caregiving and to provide suggestions for improving clinical practice. DATA SOURCES: Research reports and theoretical and clinical papers from nursing and medicine. CONCLUSION: Understanding spiritual-cultural influences that affect responses to cancer are essential if a nurse is to provide effective care. Research has documented spiritual-cultural aspects of cancer prevention and screening, living and coping with cancer, and dying with cancer. This research suggests that African American and Hispanic cancer patients are more religious, recognize more spiritual needs, and benefit more from religious coping strategies, than do white Americans. IMPLICATIONS FOR NURSING PRACTICE: Strategies proposed for increasing a nurse's effectiveness while caring for clients with diverse spiritual-cultural beliefs and behaviors include: increasing awareness of personal spiritual-cultural values and beliefs, gaining knowledge about diverse religious traditions, and negotiation with clients when values and beliefs that compromise care conflict.

Cloning, purification and characterization of the 6-phospho-3-hexulose isomerase YckF from Bacillus subtilis.

The enzyme 6-phospho-3-hexulose isomerase (YckF) from Bacillus subtilis has been prepared and crystallized in a form suitable for X-ray crystallographic analysis. Crystals were grown by the hanging-drop method at 291 K using polyethylene glycol 2000 monomethylether as precipitant. They diffract beyond 1.7 A using an in-house Cu Kalpha source and belong to either space group P6(5)22 or P6(1)22, with unit-cell parameters a = b = 72.4, c = 241.2 A, and have two molecules of YckF in the asymmetric unit.

The application of real-time PCR to the identification, detection and quantification of Pyrenophora species in barley seed.

Summary A real-time quantitative PCR technique has been used to develop a rapid and sensitive seed health test for Pyrenophora spp. on barley seed. Using the fluorescent reporter dye SYBR Green I for real-time detection of PCR amplification, pathogen DNA extracted from infected seed can be quantified to the picogram level. The amount of Pyrenophora DNA extracted from seed samples of an artificial infection level gradient, constructed by mixing infected and uninfected seed, correlated with good agreement (r = 0.931) to percentage infection levels of the same samples measured by agar plate testing. In addition, a correlation of r = 0.883 was obtained between the two testing methods for naturally infected seed, ranging from 0% to 89% infection. Samples could be quantified to below the 2% voluntary threshold required for deciding on seed treatment. The proposed test was performed in three parts: (i) quantification of Pyrenophora spp. infection using Pyrenophora-specific PCR primers; (ii) test of any negative samples from (i) with barley-specific PCR primers to check the DNA extraction process; (iii) test of positive samples from (i) for the presence of Pyrenophora graminea using P. graminea-specific PCR primers. All PCRs were performed in the LightCycler instrument allowing each PCR run and analysis to be completed within 30 min. With the current daily receipt of samples (batches up to 16) the test can be completed in 8 h, compared to 7 days for the traditional agar plate test.

Scorpion ARMS primers for SNP real-time PCR detection and quantification of Pyrenophora teres.

summary We have developed a quantitative PCR detection method that can be used to determine the seed infection levels of Pyrenophora teres, a seed-borne fungal pathogen of barley. This method uses Scorpion Amplified Refractory Mutation System (ARMS) technology with real-time PCR detection. Scorpion ARMS primers were designed and optimized such that a single nucleotide base mismatch in the primer sequence could distinguish P. teres from P. graminea, a closely related seed-borne pathogen of barley. It is necessary to distinguish between these two agriculturally important pathogens since different disease management decisions are made, based on the presence and level of infection measured for each. The advance in development of sensitive and specific fluorescent probes has enabled the current PCR test to detect Pyrenophora spp. pathogenic on barley to be enhanced with the advantage that it can now specifically detect P. teres in a single reaction, whilst previously, two reactions were required to discriminate P. teres from P. graminea.

Derivation of predicted No-effect concentrations for lindane, 3, 4-dichloroaniline, atrazine, and copper.

Environmental risk assessment is a key feature of regulations controlling the placing of new, and the maintenance of existing, chemicals products in the market place. For example, European Commission Directive 93/67/EC on Risk Assessment for New Notified Substances and Commission Regulation (EC) No. 1488/94 on Risk Assessment for Existing Substances requires that risk assessments be carried out for new and existing substances in the European Community. The process of environmental risk assessment seeks to determine the balance of probability of species and communities being damaged by chemical releases. The process relies upon a valid estimation of a predicted environmental concentration (PEC) in relevant environmental compartments and a predicted no effect concentration (PNEC) below which the organisms present in that compartment are unlikely to be significantly affected. If the PEC exceeds the PNEC there is a potential for damaging effects to occur. This article focuses on the determination of PNECs for risk assessment. Methods for determining a PNEC described in OECD Monograph 26 (1989, Report of the OECD Workshop on Ecological Effect Assessment, Paris, France, have been applied to data derived for the four chemicals lindane, 3,4-dichloroaniline, atrazine, and copper in a series of collaborative research projects funded by the European Commission.

Transformation of tragedy among women surviving breast cancer.

PURPOSE/OBJECTIVES: To describe the process of how women with breast cancer attribute positive meaning to their illness. DESIGN: Descriptive, qualitative. SETTING: Major metropolitan area in the southwestern United States. SAMPLE: Twenty-four women diagnosed with breast cancer within the past two years. METHODS: Data collected during semistructured interviews were coded and analyzed using Grounded Theory techniques. MAIN RESEARCH VARIABLES: Process and outcomes of ascribing positive meanings to cancer. FINDINGS: The author observed a basic social-psychospiritual process of transforming personal tragedy. This process involved phases labeled as encountering darkness, converting darkness, encountering light, and reflecting light. CONCLUSIONS: Varying degrees of positive meaning can be attributed to breast cancer. Encountering the darkness and moving through the other phases are normal and adaptive. IMPLICATIONS FOR NURSING PRACTICE: Recognizing that positive meanings are independent of questions of causality but that encountering the darkness is necessary for transformation can help patients and nurses to face tragedy. Future research should seek to understand why some patients get "stuck" encountering or converting darkness.

Development of methods for evaluating toxicity to freshwater ecosystems.

This article presents a summary of a collaborative research program involving five European research groups, that was partly funded by the European Commission under its Environmental Research Program. The objective of the program was to develop aquatic toxicity tests that could be used to obtain data for inclusion at Level 2 of the Risk Evaluation Scheme for the Notification of Substances as required by the 7th Amendment to EC Directive 79/831/EEC. Currently only a very limited number of test methods have been described that can be used for this purpose and these are based on an even smaller number of test species. Tests based upon algae (Chlamydomonas reinhardi, Scenedesmus subspicatus, and Euglena gracilis), protozoa (Tetrahymena pyriformis), rotifera (Brachionus calyciflorus), crustacea (Gammarus pulex), and diptera (Chironomus riparius) were developed. The tests encompassed a range of end points and were evaluated against four reference chemicals: lindane, 3, 4-dichloroaniline (DCA), atrazine, and copper. The capacity of the tests to identify concentrations that are chronically toxic in the field was addressed by comparing the effects threshold concentrations determined in the laboratory tests with those determined for similar and/or related species and end points in stream and pond mesocosm studies. The lowest no-observed-effect concentrations (NOEC), EC(x), or LC(x) values obtained for lindane, atrazine, and copper were comparable with the lowest values obtained in the mesocosms. The lowest chronic NOEC determined for DCA using the laboratory tests was approximately 200 times higher than the lowest NOEC in the mesocosms.

Vacuum-assisted lancing of the forearm: an effective and less painful approach to blood glucose monitoring.

A vacuum-lancet device was applied to the forearm for the purpose of obtaining capillary blood samples for glucose monitoring with minimal pain. In four clinical trials, a total of 215 individuals aged 12-77 years were tested four times using standard conditions and four times with either a different depth of lancing, different brand of lancet or a larger-sized device. The volume of blood collected using one-half atmosphere of vacuum in 40 sec was measured. The sensation and visual appearance of each lancet puncture on the forearm was recorded. Glucose was measured in forearm and in conventional fingerstick blood samples. The distribution of volumes was skewed to higher values with median values for each trial in the range of 3-10 microL. Ninety-five percent of the lancet sticks were judged as less painful than a fingerstick. Redness and bruising around the lanced sites were noted in some patients but disappeared within a few days. Overall correlation of the forearm versus fingerstick glucose values was 0.96. The vacuum-lancet device was very successful in obtaining capillary blood samples for glucose testing in a relatively painless manner. Incorporation of a glucose measuring system into the device might improve testing compliance among those who fear pain or the sight of blood.

Spiritual conflicts associated with praying about cancer.

A secondary analysis of data from a study designed to describe how persons use prayer to cope with cancer is presented in this paper to illuminate the spiritual conflicts that can be experienced among persons with cancer. Employing phenomenological methods, 30 persons from various phases of the cancer experience and religious backgrounds, were interviewed in depth about why, when, and how they prayed, as well as what they prayed about and the outcomes they expected. The secondary analysis revealed that many of these informants had hesitancies about petitionary prayers for particular things, a cure, or for themselves. They also indicated questions about theodicy and the meaning of having cancer, the nature of God, and acknowledged 'unanswered' prayer. Several described an inner conflict about releasing control to God. A few referred to bargaining with God, and a few doubted their personal spirituality and worth, if they were praying correctly, and if prayer was efficacious.

Predictors of oncology and hospice nurses' spiritual care perspectives and practices.

The purpose of this study was to identify factors that predict nurses' spiritual care perspectives and practices and compare these perspectives and practices between nurses in two subspecialties. The sample included 181 oncology nurses and 638 hospice nurses who completed the Spiritual Care Perspectives Survey and a demographic form by mail. The hospice nurses surveyed used traditional spiritual care interventions more frequently and held more positive perspectives regarding spiritual caregiving than oncology nurses. However, what determined spiritual care practices and perspectives most was the spirituality of the nurse. Nurses must continue to explore how their personal spirituality contributes to their caregiving.

The influence of fresh water pollutants and interaction with Asellus aquaticus (L.) on the feeding activity of Gammarus pulex (L.).

The feeding response of juvenile amphipod Gammarus pulex (L.) was investigated following exposure to freshwater pollutants. The method employed is nondestructive, provides a rapid indication of the status of groups of individuals, and is based on a time-response analysis of the consumption of the eggs of Artemia salina and the determination of median feeding times or FT50s. The feeding activity of juvenile G. pulex was found to be a sensitive response criterion for use in assessing the sublethal toxicity of copper, lindane, and 3,4-dichloroaniline (3,4-DCA). Reductions in gammarid feeding activity were identified following 96 hours exposure at 12.1 microg/L copper or 8.4 microg/L lindane and 240 hours exposure at 918 microg/L 3,4-DCA. However, a significant increase was observed in the feeding rate of gammarids that had been exposed for 240 h at 0.09 microg/L lindane in comparison with control values. The increase in feeding rate may be interpreted as a possible stimulatory effect associated with the toxicant action of lindane. Increases in gammarid feeding activity were not determined during the experiments conducted with either copper or 3,4-DCA. A sustained reduction in G. pulex feeding rates may cause growth inhibition and impaired reproduction which have previously been identified as sublethal responses of other freshwater organisms exposed to comparable concentrations of lindane, 3,4-DCA, or copper. The feeding bioassay was also used as a tool in an investigation of species interactions in toxicant systems. The feeding responses of G. pulex, which had been maintained in the presence of Asellus aquaticus (as interacting pairs) and exposed to a range of concentrations of lindane or 3,4-DCA, were recorded and compared. The findings illustrate the complex nature of test systems that integrate the stresses of toxicant and competition. In the lindane test system a reduction in gammarid feeding activity was observed following a 96-h exposure with A. aquaticus at 3.8 and 6.0 microg/L lindane (mean measured concentrations). After a 240-h exposure period a decrease in feeding rate was recorded only for gammarids that had been exposed to 6.5 microg/L lindane, however exposure to very low concentrations of lindane (0.1 and 0.9 microg/L) resulted in a significant increase in gammarid feeding activity. In the experiment conducted with 3,4-DCA the calculation of median feeding times or FT50s of gammarids that had been exposed for 96 and 240 h in the toxicant treatment groups with A. aquaticus was largely precluded (in most groups less than 50% of the A. salina eggs were eaten). However, control group FT50 values were determined on each occasion the bioassay was performed, indicating that a substantial reduction in gammarid feeding activity had occurred in the majority of the 3,4-DCA treatment groups.

The story behind the story: the use of storytelling in spiritual caregiving.

OBJECTIVES: To briefly discuss the nature and function of stories that patients tell, and offer practical tips on how to listen and make sense of these stories. DATA SOURCES: Books and articles from disciplines in the humanities and health care professions. CONCLUSION: Stories are a medium for assessment and intervention in areas that essentially reflect an individual's spirituality. IMPLICATIONS FOR NURSING PRACTICE: Encouraging storytelling is an intervention nurses can use to promote spiritual health. Suggestions for eliciting and analyzing stories are offered.

Natural inactivation of a common HLA allele (A*2402) has occurred on at least three separate occasions.

HLA-A*2402 is common and widely distributed in human populations. Several individuals were identified who type genotypically for A*2402, but are serologically null for the HLA-A24 Ag. Sequencing and transfection of genomic DNA fragments containing null and wild-type A*2402 alleles, and the related A*2301 allele, revealed three different null alleles (A*2409N, A*2411N, and A*2402(low)), each of which differs from A*2402 by a single nucleotide change within the 6.7-kb sequence. The A*2301 and A*2402 sequences differ by no substitutions additional to those previously determined for the 1.1-kb cDNA. In exon 4, A*2409N has an in-frame stop codon, while A*2411N has a nucleotide insertion that alters the reading frame, causing premature termination. A*2402(low) has a nucleotide substitution near the splice acceptor site for intron 2 that impairs the production of correctly spliced mRNA. For A*2409N and A*2411N, mRNA is undetectable by Northern analysis, whereas A*2402(low) produces a low level of mRNA and a concomitant amount of normal A*2402 protein at the cell surface. The protein expressed from the A*2402(low) allele is sufficient to stimulate an alloreactive T cell response. On a background of unexpected sequence homogeneity, the single nucleotide changes in the A*2409N, A*2411, and A*2402(low) alleles have dramatic effects upon gene expression and are of likely importance for HLA matching in clinical transplantation. Segregation of at least three independently inactivated A*2402 alleles in human populations raises the possibility that loss of A*2402 may be the result of natural selection.

A scanning electron microscope investigation of the effects of pollutants on the hepatopancreatic ceca of Gammarus pulex (L.).

Scanning electron microscope studies were performed on the peripheral muscle network (myoepithelium) of the hepatopancreatic ceca of Gammarus pulex (L.) exposed to lindane, copper, or 3, 4-dichloroaniline (3,4-DCA) for a 24-hr period. The structural integrity of the myoepithelium of gammarids from control and test treatments was assessed using semiquantitative techniques. The lowest observed effect concentrations for structural changes were determined as 29.8 microg liter-1 lindane, 55 microg liter-1 copper, and 8.7 mg liter-1 3,4-DCA. The sensitivity of the bioassay and the significance of the morphological changes observed in the hepatopancreatic ceca of G. pulex are discussed.