[Post-traumatic necrosis of the humeral head-Endoprosthesis or joint preservation]. / Posttraumatische Humeruskopfnekrose ­ Endoprothese oder Gelenkerhalt.

BACKGROUND: Humerus fractures play a major role in daily clinical routine, and subsequent osteonecrosis is common after osteosyntheses. OBJECTIVES: The current paper highlights the incidence and cause of osteonecrosis after proximal humerus fractures, with respect to presentation of anatomy and risk factors. METHODS: Display of the literature and therapy options for humerus fracture and subsequent necrosis. RESULTS: Humerus fractures are the seventh most frequent fractures in humans. The complication rate is 40%, and the described rate of necrosis is up to 34%. Accordingly, the surgical revision rate is at 19% according to recent literature. CONCLUSION: The treatment of humerus head fracture must consider numerous variables. The individual type of fracture and the current individual situation of the patient must be included in the process of choosing the right treatment. Modern implants with screw locking features should be used, and for certain circumstances the direct implantation of a prosthesis should be considered. Thereby the expectations of the patient with respect to the postoperative activity level play a major role.

Views of South African biomedical research ethics committee members on their own ethics review outcomes

Background. Current research ethics guidelines and legislation provide research ethics committees (RECs) with the prerogative to review and approve the ethical acceptability of human research before commencement. However, individual REC members' views on the ethical issues identified behind closed doors remain largely empirically unexplored. Objective. To investigate the views and perceptions of South African biomedical REC members on their own aggregated ethics review outcomes. Methods. Semi-structured interviews were conducted with nine REC members from two different institutions in South Africa. Results. All respondents concurred with the prioritisation of informed consent in the review outcomes, emphasising the importance of the use of simple and understandable language for participants. Respondents also discussed lack of scientific validity as a common problem when reviewing proposals. Interestingly, while the majority of respondents reiterated the common view that scientifically invalid research is unethical, some REC members believed that there was an overemphasis on evaluation of scientific validity, and that it was not within the remit of RECs to review the scientific quality of proposed studies. The REC members felt that HIV and tuberculosis research had high social value, because it addresses national and regional public health priorities. For this reason, there was no concern expressed that a high proportion of research proposals involved HIV and TB. Conclusion. Although most respondents found the aggregated results unsurprising, there was some disagreement with the ranked review outcomes, with a minority of respondents arguing that scientific validity was overemphasised. These findings have potential training and practice implications for RECs and researchers. The study findings call for further studies to validate such findings in other RECs

Research ethics committees in a tight spot: Approving consent strategies for child research that are prima facie illegal but are ethical in terms of national guidelines.

It is an internationally accepted principle that ethics norms should be applied and enforced in research with humans through ethics review by research ethics committees (RECs). This places RECs at the very heart of the system for protecting participants and enforcing their rights. In the South African ethical-legal framework for child research, there are divergent approaches to consent. That is, section 71 of the National Health Act (No. 61 of 2003) (NHA) requires mandatory parental consent for child research, and limits the authority for proxy consent to parents and legal guardians. However, national ethics guidelines authorised by section 72 of the NHA and issued by the National Health Research Ethics Council (NHREC) acting in terms of its mandate (National Department of Health, 2015) allow a more nuanced approach - i.e. self-consent by older adolescents, provided certain conditions are met, and consent by a range of parental substitutes where there are no available parents or legal guardians. We have argued elsewhere that the consent approach in section 71 is inappropriately restrictive and are of the view that the consent approach endorsed in national ethics guidelines is more defensible. An REC that elects to approve a consent strategy allowable in ethics guidelines is effectively electing to not follow section 71, which raises the question of what the consequences might be for that REC. This article examines the legal liability of RECs through three 'threads' of accountability: the NHREC, the institutions hosting RECs, and the courts. We conclude that: (i) if an REC approves a child protocol with consent strategies allowable in terms of national ethics guidelinesbut not in terms of section 71, it is unlikely that the NHREC would discipline the REC in the face of a complaint - provided the REC acted within national ethics guidelines issued by the NHREC in terms of the latter's section 72 mandate to set national norms and standards; (ii) if an REC approves a consent approach allowed for in ethics guidance, it is also unlikely that the host institution would discipline the REC in the face of a complaint - especially if the institution is aware of the REC's explicit decision to follow national ethics guidelines that are authorised by section 72 of the NHA; and (iii) an REC could only be sued by a participant in terms of the law of delict (and be liable for damages) if several demanding components are proven, such as that the harm suffered by the participant resulted directly from the REC's actions in approving a particular consent strategy for that research. Furthermore, the court may well look to national ethics guidelines in making determinations about whether an REC's conduct was wrongful for the purposes of liability in civil law. RECs are protected from being collectively liable by insurance taken out by their host institutions. We make a series of recommendations to address this issue.

Protection of human participants in health research - a comparison of some US Federal Regulations and South African Research Ethics guidelines.

In response to criticism of ethical review of a South African clinical trial, we contrast aspects of the United States Common Rule with South African research ethics requirements. In the USA the Common Rule does not apply to all health research and allows many exemptions from ethics review and waivers of informed consent. At a structural level research ethics review in South Africa is in many cases equivalent to the US institutional review board (IRB) and Office for Human Research Protections (OHRP) oversight system, is wider reaching, and has no exclusions.

'Even if they ask you to stand by a tree all day, you will have to do it (laughter)...!': community voices on the notion and practice of informed consent for biomedical research in developing countries.

Ethical dilemmas in biomedical research, especially in vulnerable populations, often spark heated debate. Despite recommendations and guidelines, many issues remain controversial, including the relevance, prioritisation and application of individual voluntary informed consent in non-Western settings. The voices of the people likely to be the subjects of research have been notably absent from the debate. We held discussions with groups of community members living in the rural study area of a large research unit in Kenya. Discussions were facilitated by three research study vignettes outlining one field-based and two hospital-based studies being planned or taking place at the time. In addition to gathering general views about the aims and activities of the research unit, questions focused on whether consent should be sought for studies, and if so from whom (chiefs, elders, men/women, children), and on ascertaining whether there are any special concerns about the physical act of signing consent forms. The findings revealed the community's difficulty in distinguishing research from clinical investigations conducted in clinical settings. There was a spectrum of views regarding perceived appropriateness of consent procedures, in part because of difficulty in disentangling clinical from research aims, and because of other challenges to applying consent in practice. Debates between community members highlight the inadequacy of simplistic assumptions about community members' views on informed consent, and the complexity of incorporating lay opinions into biomedical research. Failure to appreciate these issues risks exaggerating differences between settings, and underestimating the time and resources required to ensure meaningful community involvement in research processes. Ultimately, it risks inadequately responding to the needs and values of those on whom the success of most biomedical research depends. Although compliance with community views does not necessarily make the research more ethical, it is argued that community opinions on local issues and practices should inform ethical decision-making in health research.

Provision of HIV treatment in HIV preventive vaccine trials: a developing country perspective.

HIV treatment for participants who become infected during HIV vaccine trials has been the focus of ethical controversy. The obligations of sponsors to ensure that participants have access to antiretrovirals have been a particular focus of this debate. This paper presents three arguments that have been made in this regard, and some of their limitations, in anticipation of HIV vaccine trials in South Africa. The first argument is that HIV risk behaviour increases in such trials, and HIV infection can be viewed as a research-related injury, justifying sponsor provision of treatment on grounds of compensation for harm. We conclude that risk-behaviour studies to date do not show general increases in risk behaviour that could constitute the basis for a general obligation. Participation may well adversely impact on risk behaviour for some individuals, and conceivably this could be demonstrated. This argument may, therefore, have merit at the individual level; however, it seems a weak platform from which to argue that sponsors should treat all HIV infections acquired during trials. The second argument is that treatment should be provided based on distributive justice. We conclude that traditional concepts of "distributive justice" in research appear limited in justifying obligations of sponsors to ensure access to antiretrovirals. Further, using research initiatives to reduce global health care inequities is controversial, and even proponents may disagree about the fairest use of finite resources. The third argument is that sponsors should ensure antiretroviral access on grounds of beneficence; namely, the maxim that if one can do something beneficial without sacrificing anything of comparable significance, it ought to be done. Thus, sponsors should provide more interventions than those minimally required to conduct the research. However, beneficence may demand levels of altruism that exceeds what is reasonable. While the latter arguments may provide stronger justifications than the first, it is difficult to use these arguments to establish that sponsor provision of antiretrovirals to infected individuals is obligatory.

Acculturation and eating disorder symptomatology in Black men and women.

OBJECTIVE: We assessed the prevalence of eating disorder symptoms in Black South African men and also explored their possible links with acculturation. METHOD: The Eating Disorders Inventory (EDI) and the South African Acculturation Scale (SAAS) were administered to a sample of undergraduate students consisting of 50 Black women, 50 Black men and 50 White men. RESULTS: The Black men had significantly higher scores than the White men on the psychological subscales of the EDI and higher than cut-off scores on perfectionism, interpersonal distrust and maturity fears subscales. There were marginal racial differences in the average acculturation scores, whereas gender appeared to have a variable effect on acculturation attitudes. Specific acculturation strategies were found to be differentially associated with the EDI subscales. The association between acculturation and eating disorder symptoms in Black men was significantly higher than that in White men. DISCUSSION: Our results indicate that there is a higher prevalence of eating disorder pathology in Black men than in White men. This lends support to the possible association between acculturation and eating disorders, and challenges the assumption that non-Western individuals--and Black men in particular--are protected from body image disturbances and disordered eating patterns.

Non-fatal suicidal behaviour in women--the role of spousal substance abuse and marital violence.

OBJECTIVE: To investigate the precipitants of non-fatal suicidal behaviour in women using a gender-based comparison. DESIGN: A retrospective analysis of case records. Data were analysed using chi-square tests of significance. SUBJECTS: One hundred men and 100 women admitted for non-fatal suicidal behaviour at a general hospital. OUTCOME MEASURES: Subjects' biographical details and self reports of precipitating factors such as marital conflict, spousal extramarital affairs, alcohol abuse and marital violence. RESULTS: Significantly more married women than men cited spousal extramarital affairs, spousal alcohol abuse and marital violence as precipitants of their self-destructive behaviours. CONCLUSION: The findings emphasise the role of spousal behaviour and resultant stress in precipitating non-fatal suicidal behaviour in women. Preventive efforts must focus on the psychological, social and economic empowerment of women.

Purification and properties of hydroquinone hydroxylase, a FAD-dependent monooxygenase involved in the catabolism of 4-hydroxybenzoate in Candida parapsilosis CBS604.

The ascomycetous yeast Candida parapsilosis CBS604 catabolizes 4-hydroxybenzoate through the initial formation of hydroquinone (1, 4-dihydroxybenzene). High levels of hydroquinone hydroxylase activity are induced when the yeast is grown on either 4-hydroxybenzoate, 2,4-dihydroxybenzoate, 1,3-dihydroxybenzene or 1, 4-dihydroxybenzene as the sole carbon source. The monooxygenase constitutes up to 5% of the total amount of protein and is purified to apparent homogeneity in three chromatographic steps. Hydroquinone hydroxylase from C. parapsilosis is a homodimer of about 150 kDa with each 76-kDa subunit containing a tightly noncovalently bound FAD. The flavin prosthetic group is quantitatively resolved from the protein at neutral pH in the presence of chaotropic salts. The apoenzyme is dimeric and readily reconstituted with FAD. Hydroquinone hydroxylase from C. parapsilosis catalyzes the ortho-hydroxylation of a wide range of monocyclic phenols with the stoichiometric consumption of NADPH and oxygen. With most aromatic substrates, no uncoupling of hydroxylation occurs. Hydroxylation of monofluorinated phenols is highly regiospecific with a preference for C6 hydroxylation. Binding of phenol highly stimulates the rate of flavin reduction by NADPH. At pH 7.6, 25 degrees C, this step does not limit the rate of overall catalysis. During purification, hydroquinone hydroxylase is susceptible towards limited proteolysis. Proteolytic cleavage does not influence the enzyme dimeric nature but results in relatively stable protein fragments of 55, 43, 35 and 22 kDa. N-Terminal peptide sequence analysis revealed the presence of two nick sites and showed that hydroquinone hydroxylase from C. parapsilosis is structurally related to phenol hydroxylase from Trichosporon cutaneum. The implications of these findings for the catalytic mechanism of hydroquinone hydroxylase are discussed.

Induction of immune responses and molecular cloning of the heavy chain antibody repertoire of Lama glama.

Functional heavy chain immunoglobulins have, so far, only been found in camels and llamas. Antigen-specific fragments of these heavy chain IgGs (V(HH)) are of great interest in biotechnology because they are very stable and can be produced at high level by the yeast Saccharomyces cerevisiae. The work described in this paper was conducted to determine whether llamas (Lama glama) are a practical source of antigen-specific V(HH) fragments. Llamas were immunised with various types of antigens and the antibody responses were examined during the course of immunisation. Both, conventional and heavy chain IgG antibodies were produced in response to each of the antigens. The heavy chain IgG repertoire displayed a recognition pattern different to that of conventional llama IgGs, resulting in the expansion of the accessible epitope repertoire. Llamas have a lower proportion of heavy chain IgG antibodies in their serum than have camels. To enable the specific and efficient isolation of V(HH) genes from peripheral blood B-cells, the long and short-hinge sequences of Lama glama heavy chain IgGs were determined, revealing the presence of a novel subclass of short-hinge heavy chain IgG. Long and short-hinge specific PCR primers were designed to be used in the construction of llama V(HH) libraries. We conclude that, using the techniques described, antigen-specific V(HH) antibody fragments are readily accessible from the llama, thus providing highly valuable binding molecules for a variety of applications.

Ethical issues in HIV vaccine trials in South Africa.

In this review we describe the ethical issues central to local and international debates about HIV vaccine trials. These issues include the physiological and psycho-social risks of trial participation, the preventative interventions to be provided to participants, access to treatment for participants who seroconvert, access to an effective vaccine after the trial, the role of placebo-controlled trials, and obtaining informed consent.

Hybrid affinity chromatography of alpha-galactosidase from Verbascum thapsus L.

Purification of alpha-galactosidase from the roots of Verbascum thapsus L. was difficult to achieve using conventional methods due to the presence of coloured contaminants. A newly developed procedure, hybrid affinity chromatography, which was based on a mixed matrix separation procedure, using a substrate analogue and an immobilized metal affinity matrix as ligands, respectively, allowed the purification of this enzyme with good recovery. The method should be applicable to other proteins as well.

Women in cultural transition: suicidal behavior in South African Indian women.

Young South African Indian women are a population with relatively high rates of suicidal behavior. This article presents three illustrative case studies of nonfatal suicidal behavior by South African Indian women. The cases are discussed in relation to a review of epidemiological, historical, and sociocultural perspectives on South African Indian women. It is argued that suicidal behaviors in this group can be understood in the context of sociocultural transition. Transitional tensions between traditional Indian culture and Westernization have an impact on traditional gendered power relations and generate conflicts that have intrapsychic and interpersonal consequences for women and for men. These in turn may have adverse effects on marital functioning, quality of life, and specific aspects of emotional functioning, which have been identified as precursors of suicidal behavior. The case studies are discussed with reference to gender narratives. Implications for prevention, intervention, and future research are discussed.

Recent stressors and family satisfaction in suicidal adolescents in South Africa.

A study of 40 adolescents who had engaged in suicidal behaviours showed that 77.5% of them reported conflict with their parents in the few hours before the event. Significantly more suicidal subjects than controls experienced family conflict, problems at school and problems with boy/girlfriends during the preceding 6 months. The suicidal subjects also expressed significantly lower levels of family satisfaction than the controls. The results support the view that suicidal adolescents are dissatisfied with their family functioning and use suicidal behaviour as a means of communicating their distress.

Family dynamics, hopelessness and psychiatric disturbance in parasuicidal adolescents.

OBJECTIVE: Adolescent parasuicide has often has been associated with family disturbance, hopelessness and psychiatric disturbance, but little empirical work has been done to verify these clinical impressions. METHOD: The present study compares matched groups of hospitalised parasuicidal adolescents, non-psychiatric medically hospitalised adolescents and a control group on measures of family disturbance, hopelessness and psychopathology. RESULTS: The findings reveal significantly higher levels of family disturbance, hopelessness and depressive symptoms in the parasuicidal group. CONCLUSIONS: The results suggest that prevention and treatment of adolescent parasuicide should focus on both individual and family dynamics.

Molecular characterization of FrpB, the 70-kilodalton iron-regulated outer membrane protein of Neisseria meningitidis.

The structural gene encoding the 70-kDa outer membrane protein FrpB of Neisseria meningitidis was cloned and sequenced. A mutant lacking FrpB was constructed. No difference in iron utilization between the mutant and the parental strain was observed. A minor effect of the mutation on serum resistance was observed. A topology model for FrpB in the outer membrane is proposed.

Psychological intervention, spontaneous remission, hopelessness, and psychiatric disturbance in adolescent parasuicides.

A study of 40 Indian adolescent parasuicides in South Africa showed that these subjects have significantly higher levels of hopelessness and psychiatric disturbance than nonsuicidal controls. Approximately half the parasuicides received psychological intervention. Posttesting at 6 months revealed that the treated subjects improved significantly on measures of hopelessness and psychiatric disturbance. The untreated subjects showed no significant reduction in hopelessness although they improved significantly on ratings of psychiatric disturbance. The results are discussed with possible explanations and recommendations.

Rescue expectations and hopelessness in adolescent parasuicides.

The study examined 40 adolescent parasuicides' reports of whether they expected to be rescued following parasuicide gestures. Measures of hopelessness were also assessed. 45% of these Indian South Africans reported that they expected to be rescued while the rest did not. There was no significant sex difference in expectation of rescue. There was also no significant difference between hopelessness scores of those expecting rescue and those not expecting rescue; however, the latter had a mean hopelessness score above the cut-off score suggested as predictive of subsequent suicide.

Cloning and nucleotide sequence of the alpha-galactosidase cDNA from Cyamopsis tetragonoloba (guar).

Polyadenylated mRNA was purified from the aleurone cells of Cyamopsis tetragonoloba (guar) seeds germinated for 18 h and used for the construction of a cDNA library. Clones with the alpha-galactosidase encoding gene were identified using oligo-nucleotide mixed probes based on the NH2 terminal amino acid sequence and on the sequence of an internal peptide. The nucleotide sequence of the cDNA clone showed that the enzyme is synthesized as a precursor with a 47 amino acid NH2 terminal extension. This pre-sequence most likely functions to target the protein outside the aleurone cells into the endosperm. Based upon structural features, it is proposed to divide the precursor into a pre-(signal sequence) part and a glycosylated pro-part comparable with those of the yeast mat A/alpha factor and killer factor. A comparison of the derived amino acid sequence of this alpha-galactosidase from plant origin revealed significant stretches of homology with respect to the amino acid sequences of the enzymes from Saccharomyces cerevisiae and from human origin but only to a minor extent compared with the alpha-galactosidase from Escherichia coli.

Reducing house-dust mites by vacuuming.

Two types of nozzles were compared for efficiency in extracting dust and house-dust mites from textile floor-coverings. From 21 homes, 2 m2 from the wall-to-wall floor-covering in the bedrooms were vacuumed. On 1-m2 the non-motorized nozzle was used, on the other 1-m2 a motorized nozzle was used. Before this sampling both test surfaces were vacuumed using the non-motorized nozzle in order to assess the mite numbers at the beginning of the experiment. The motorized nozzle appeared to be significantly more effective in extracting dust; however, for the mites no such difference could be noted.