[Status quo of screening for hip dysplasia]. / Status quo Hüftdysplasiescreening.

Since the first description of the ultrasound examination of the infant hip by Graf in 1980 this technique has impressively demonstrated that it lives up to its promise very well. In the implementation of hip ultrasound in the German pediatric guidelines it was hoped that it would improve the sensitivity and specificity of the early detection of dislocated and dysplastic joints in comparison to a general clinical hip screening. Furthermore, it has been repeatedly shown that general newborn hip ultrasound screening according to Graf can significantly reduce not only the treatment rate but also the invasiveness. Consequentially, the cost of treatment as well as the rate of late presenting developmental dysplasia of the hip (DDH) can also be significantly reduced. Despite those proven merits the meaningfulness of general hip ultrasound screening in infancy is still questioned, especially in the Anglo-American world. This article reviews how this misconception came about.

[Are 55 cents always better value than 90 cents for venous thromboembolism prophylaxis? Comparison of three low-molecular-weight heparins with regard to economics and guideline compliance]. / Sind bei der venösen Thrombembolieprophylaxe 55 Cent immer günstiger als 90 Cent? - Vergleich von 3 niedermolekularen Heparinen hinsichtlich Wirtschaftlichkeit und Leitlinien-Compliance.

BACKGROUND: Four low-molecular-weight heparins with different dosage regimens are allowed for venous thromboembolism prophylaxis in patients with a high risk of thromboembolism in Germany. If comparison is made purely on the basis of drug costs, multi-dose vials are the favourable solution. We try to answer the question whether the choice of low-molecular-weight heparin influences the compliance with the S2 guideline "Inpatient and outpatient thromboembolism prophylaxis in surgery and perioperative medicine." Beyond that we ask if multi-dose administration is superior to the pre-filled syringe when total costs are calculated on the basis of procedure and technical application. PATIENTS AND METHODS: After training the nursing and medical staff in guideline-compliant implementation of thromboembolism prophylaxis with pre-filled certoparin safety syringes (03/09-05/09) or nadroparin (06/09-08/09) and enoxaparin (02/10-04/10) from multi-dose vials, we calculated the total costs on the basis of procedure and technical application. Furthermore, the satisfaction of the nursing staff was interrogated and the proportion of non-guideline-compliant prescriptions was determinated prospectively on the basis of a total of 388 patient files. RESULTS: When total costs are calculated on the basis of procedure and technical application, the costs for nadroparin are 1.16 €/0.3 mL, 1.30 €/0.4 mL and 1.58 €/0.6 mL, for enoxaparin 1.04 €/20 and 1.42 €/40, and for certoparin 1.25 €/pre-filled safety syringe. The pre-filled certoparin safety syringe made a very good overall impression on the nursing staff (versus sufficient for nadroparin and enoxaparin). Guideline-compliance was achieved in 100 % with body weight- and risk-independent certoparin, in 79.4 % with risk-adapted enoxaparin, and in 66.4 % with body weight- and risk-dependent nadroparin. CONCLUSION: The complexity of the dosage regimen of a low-molecular-weight heparin has a decisive influence on guideline-compliance. By calculating total costs on the basis of procedure and technical application multi-dose vials only offer a price advantage in patients with a low or moderate risk of thromboembolism compared with pre-filled safety syringes in the venous thromboembolism prophylaxis of orthopaedic and trauma surgery patients.

Support vector machine classification based on correlation prototypes applied to bone age assessment.

Bone age assessment (BAA) on hand radiographs is a frequent and time consuming task in radiology. We present a method for (semi)automatic BAA which is done in several steps: (i) extract 14 epiphyseal regions from the radiographs, (ii) for each region, retain image features using the IRMA framework, (iii) use these features to build a classifier model (training phase), (iv) evaluate performance on cross validation schemes (testing phase), (v) classify unknown hand images (application phase). In this paper, we combine a support vector machine (SVM) with cross-correlation to a prototype image for each class. These prototypes are obtained choosing one random hand per class. A systematic evaluation is presented comparing nominal- and real-valued SVM with k nearest neighbor (kNN) classification on 1,097 hand radiographs of 30 diagnostic classes (0 19 years). Mean error in age prediction is 1.0 and 0.83 years for 5-NN and SVM, respectively. Accuracy of nominal- and real-valued SVM based on 6 prominent regions (prototypes) is 91.57% and 96.16%, respectively, for accepting about two years age range.

[Comparison of treatment results of idiopathic and non-idiopathic congenital clubfoot : prospective evaluation of the Ponseti therapy]. / Vergleich der Behandlungsergebnisse bei kongenitalen idiopathischen und nichtidiopathischen Klumpfüßen : Prospektive Evaluation der Ponseti-Therapie.

BACKGROUND: Clubfoot deformity is one of the most common congenital musculoskeletal deformities and occurs in newborns with different neuromuscular diseases. To date the Ponseti method is the gold standard for the treatment of idiopathic clubfeet but not for non-idiopathic clubfeet which are associated with neuromuscular diseases. The results of the treatment for congenital idiopathic and non-idiopathic clubfeet according to Ponseti performed in our department since 2004 were compared concerning results and relapse surgery with particular reference to the compliance of the parents concerning the use of an abduction splint. PATIENTS AND METHODS: A total of 101 children (28 female and 73 male) with 159 clubfeet were treated with the Ponseti method and included in this prospective non-randomized cohort study. Of these children 27 with 48 affected feet suffered from neuromuscular diseases which are associated with clubfoot deformity, such as myelomeningocele (n=4), arthrogryposis (n=9) and various other syndromes (n=14). The degree of the deformity was evaluated with the Pirani score initially, after casting and at follow-up. Parents were asked at follow-up to state subjectively how compliant they were with the abduction splint treatment. The necessity of surgical treatment of relapses was recorded. Statistical analysis was performed applying χ(2) and Kruskal-Wallis tests for the comparison of idiopathic and non-idiopathic clubfeet. RESULTS: The average period of follow-up was 36 month (range 6-75 months) and non-idiopathic clubfeet were initially significantly more severely deformed according to the Pirani-score (p=0.013). Treatment of non-idiopathic clubfeet was started significantly later than that of idiopathic clubfeet (p=0.003) and took significantly longer (p <0.001). A correlation between the initiation of casting and the duration of casting was not found (p=0.399). At the end of the casting period no significant differences were found between correction of idiopathic and non-idiopathic clubfeet with respect to the Pirani score (p=0.8). The mean score after casting was 0.1 in both groups. At mid-term follow-up the score increased in both groups but stayed below 0.5 with non-idiopathic clubfeet showing a significantly higher score than idiopathic clubfeet (p=0.014). Relapse surgery was necessary in 11% of the patients. No significant difference in the revision rate was found between the two groups (p=0.331) and peritalar release was not necessary in either group. The rate of revisions correlated with the compliance concerning the use of the abduction splint (p <0.001). Only 61% of the parents stated that they adhered strictly to the abduction splint treatment recommendations with no significant difference between the groups (p=0.398). CONCLUSION: This study shows good initial results after Ponseti treatment for idiopathic as well as non-idiopathic clubfeet. Based on the good functional results all clubfeet should initially be treated with the Ponseti method regardless of the etiology.

[Do German-speaking paediatric orthopaedic surgeons agree on diagnostics and treatment of the neonatal hip?]. / Diagnostik und Therapie der Säuglingshüfte - sind sich die deutschsprachigen Kinderorthopäden einig?

BACKGROUND: Ultrasound examination of the neonatal hip has been an integral part of the German programme for the "early detection of disease in childhood" since 01.01.1996. The aim of this study is to determine if any consensus exists among German-speaking paediatric orthopaedic specialists concerning diagnosis and treatment of the neonatal hip 15 years after legal implementation of hip ultrasound screening by the Graf technique. MATERIALS AND METHODS: A questionnaire was sent to all members of the German speaking Association of Paediatric Orthopaedic Surgeons (Vereinigung für Kinderorthopädie - VKO). The query included questions concerning education and field of activity of the member as well as information on the diagnostics of neonatal hip with regard to examiner, technical equipment, and type of screening. In addition, four cases were presented with clinical history, clinical findings, and rateable Graf sonogram (case 1: 3 days old ♀, type D; case 2: 2 days old ♀, type IV; case 3: 4 weeks old ♀, type II a; case 4: 4 months old ♀, type III a) and a treatment recommendation was requested for each case. RESULTS: 78 of 179 contactable VKO members participated in this survey. 75.6 % of the participants are specialists with additional qualification in paediatric orthopaedic surgery. 68 % of the participants work in a hospital. As stated by 61.5 % of the participants the ultrasound examination of the neonatal hip is primarily done by orthopaedic surgeons. One participant stated that the examination is performed primarily by medical-technical assistants. The majority of participants use a 7.5-MHz linear transducer for ultrasound examination, a positioning device according to Graf and a foot switch as technical equipment. State-of-the-art equipment as recommended by Graf including in addition to the above mentioned an upright image display and a transducer guiding arm system is available to only 21.8 % of the participating VKO members. 23 of 50 participants stated that a general screening is performed at their institution where all newborns get an ultrasound examination within the first week of life regardless of medical history and clinical findings. Therapeutic recommendations for the first case (type D hip) were in 15.4 % wait and check by some colleagues, supplemented by double diapering. 56.4 % would use a flexion-abduction splint and 26.9 % would perform reduction with consecutive retention. To treat case 2 (type IV hip) 3.8 % of participants suggest a flexion-abduction splint and 88.5 % reduction and retention. Concerning the type of reduction the participants do not agree. Pavlik harness as well as closed reduction under anaesthesia or without anaesthesia is recommended. In case 3 (type II a hip) 67.9 % of the colleagues suggest to wait and check, some with supplementary double diapering. 25.6 % suggest a flexion-abduction splint. One colleague would prescribe a Pavlik harness. In case 4 (type III a hip) 14.1 % of the participants suggest a flexion-abduction splint, 80.8 % reduction and retention as described before with disagreement concerning the preferred type of reduction. On combining the therapeutic suggestions for all four cases, 66 % of the participants recommend a type of treatment that is concordant with Graf's guidelines. CONCLUSION: Despite the existence of clear recommendations the German-speaking paediatric orthopaedic surgeons are quite discordant concerning diagnostics and treatment of the neonatal hip. Uncertainty particularly concerning the evaluation of sonograms of physiologically immature and dysplastic-unstable hips bears the risk of overtreatment as well as of delayed diagnosis of hip dysplasia.

[Reduction of unstable and dislocated hips applying the Tübingen hip flexion splint?]. / Die Tübinger Hüftbeugeschiene als Repositionsorthese?

BACKGROUND: The indication for the use of the Tübingen hip flexion splint is a dysplastic hip without instability. According to current knowledge dysplastic unstable or dislocated hips should be treated with a stable retention device such as a modified Fettweis cast. The aim of this study was to evaluate the treatment effect of the Tübingen hip flexion splint when applied to dysplastic unstable hips (type IIc unstable according to the classification of Graf) and dislocated hips (types D, III and IV according to the classification of Graf) within the first week of life. PATIENTS AND METHODS: All newborns with an unstable hip type IIc or worse detected by ultrasound in the first week of life were treated with a Tübingen hip flexion splint. A prospective cohort trial was performed between November 2007 and December 2010. The initial hip type according to the ultrasound classification of Graf, the start and the duration of treatment with the Tübingen hip flexion splint as well as the rate of success were evaluated. Due to the small number of patients non-parametric tests were used for statistical analysis. RESULTS: A total of 50 dysplastic unstable or dislocated hips in 42 newborns were treated with the Tübingen hip flexion splint. The distribution of pathological hip types was 6 type IIc unstable, 33 type D, 10 type III and 1 type IV. Therapy was started on average on day 3.5 (range 1-8 days) of life and 49 out of 50 hips were successfully treated with the Tübingen hip flexion splint. Solely the type IV hip could not be reduced in the Tübingen hip flexion splint. Thus 98% of the dysplastic unstable or dislocated hips were successfully converted into type I hips with an α-angle of more than 64° in the splint. The mean time for achieving an α-angle ≥ 64° was 51.6 ± 18.9 days (range 21-87 days). No statistically significant relationship was found between the duration of therapy and the time when treatment was started, early or late within the first week of life (p = 0.152). Furthermore, no correlation was detected between the duration of therapy and the initial hip type determined by ultrasound (p = 0.886). In all successfully treated cases therapy could be discontinued during the exponential part of Tschauner's maturation curve of hip development. CONCLUSION: When recognized within the first week of life dysplastic unstable hips (type IIc unstable according to the classification of Graf) and dislocated hips with a cranially dislocated cartilage roof (types D and III according to the classification of Graf) can be successfully treated with the Tübingen hip flexion splint provided that the parents show good compliance concerning the treatment regimen.

[Locking plates for osteosyntheses of corrective osteotomies in paediatric orthopaedic and neuroorthopaedic patients]. / Winkelstabile Implantate zur Osteosynthese nach Korrekturosteotomien in der Kinder- und Neuroorthopädie.

BACKGROUND: Modern locking plates are widely used for the treatment of adult orthopaedic and trauma patients. Sporadic descriptions of their advantages now exist for paediatric trauma patients. Publications concerning their implantation in paediatric orthopaedic and neuroorthopaedic patients are still scarce even though it is well known that the compliance of children and adolescents is limited and that rapid mobilisation is essential for patients with disorders of neurological origin or bone metabolism to avoid developmental setbacks and perioperative fractures. PATIENTS AND METHODS: The principle of the locking plate system also described as internal fixateur is based on the thread bolting of the screwheads within the plate. This results in high initial stability and thus high initial loading capacity. Furthermore, it is possible to preserve soft tissue and periosteum which leads to less impaired biological bone healing. Between February 2008 and March 2010 locking plates were used for osteosynthesis in our department in 16 paediatric patients with 20 corrective osteotomies. All patients suffered from either neurological disorders or diseases with alteration of the bone metabolism. The outcome was analysed concerning safety, complications, practicability, mobilisation, consolidation of the osteotomy, loss of correction, as well as complications with the removal of the implants. RESULTS: Seven of the treated patients suffered from neurological disorders such as cerebral palsy or spina bifida, 9 patients had diseases with local or systemic alteration of their bone metabolism such as vitamin D deficiency and phosphate diabetes. The average age of the patients at the time of surgery was 11.18 (5-18) years. Implant-associated complications were not seen in this patient group, especially no implant failures. Mobilisation was achieved without cast treatment with at least partial weight-bearing within the first postoperative week in most cases. Loss of correction or problems with implant removal did not occur. 18 of the 20 osteotomy sites were completely healed at the 12 week follow-up. CONCLUSION: Locking plates are a safe and effective treatment device not only for adult trauma patients but also for the treatment of children and adolescents. When stabilisation of corrective osteotomies is performed with locking plates especially young patients benefit from this technique since mobilisation can be started earlier as compared to the use of non-angle stable plates or wires and cast immobilisation becomes unneccessary. The surgeon needs to know the range of products to pick the best implant regarding the growing skeleton's special anatomy. When choosing implants for patients with reduced bone density or impaired motor abilities as in cerebral palsy, spina bifida, and other systemic disorders, locking plates have to be taken into account to facilitate mobilisation and to avoid setbacks in motor development as well as pressure ulcers from casts. Clinical studies have to evaluate if early mobilisation combined with shorter inpatient treatment and less time and cost consuming postoperative physiotherapy or rehabilitation justify the use of the more expensive locking plates for the treatment of otherwise healthy patients.

Innate immunity and HIV-1 infection.

HIV-1 is predominantly transmitted through mucosal tissues, targeting CD4(+)CCR5(+) T cells, 50% of which are destroyed within 2 weeks of infection. Conventional vaccination strategies have so far failed to prevent HIV-1 infection. Neither antibodies nor cytotoxic lymphocytes are capable of mounting a sufficiently rapid immune response to prevent early destruction of these cells. However, innate immunity is an early-response system, largely independent of prior encounter with a pathogen. Innate immunity can be classified into cellular, extracellular, and intracellular components, each of which is exemplified in this review by γδ T cells, CC chemokines, and APOBEC3G, respectively. First, γδ T cells are found predominantly in mucosal tissues and produce cytokines, CC chemokines, and antiviral factors. Second, the CC chemokines CCL-3, CCL-4, and CCL-5 can be upregulated by immunization of macaques with SIVgp120 and gag p27, and these can bind and downmodulate CCR5, thereby inhibiting HIV-1 entry into the host cells. Third, APOBEC3G is generated and maintained following rectal mucosal immunization in rhesus macaques for over 17 weeks, and the innate anti-SIV factor is generated by CD4(+)CD95(+)CCR7(-) effector memory T cells. Thus, innate anti-HIV-1 or SIV immunity can be linked with immune memory, mediated by CD4(+) T cells generating APOBEC3G. The multiple innate functions may mount an early anti-HIV-1 response and either prevent viral transmission or contain the virus until an effective adaptive immune response develops.

Adhesion measurements on the attachment devices of the jumping spider Evarcha arcuata.

The feet of the jumping spider Evarcha arcuata attach to rough substrates using tarsal claws. On smooth surfaces, however, attachment is achieved by means of a claw tuft, the scopula. All eight feet bear a tarsal scopula, which is equipped with setae, these again being covered by numerous setules. In E. arcuata, an estimated 624,000 setules, with a mean contact area of 1.7 x 10(5) nm(2), are present. The spider's entire contact area thus totals 1.06 x 10(11) nm(2). Adhesion to the substrate does not depend on the secretion of an adhesive fluid. Analysis via atomic force microscopy (AFM) shows that a single setule can produce an adhesive force (F(a)) of 38.12 nN perpendicular to a surface. Consequently, at a total F(a) of 2.38 x 10(-2) N and a mean body mass of 15.1 mg, a safety factor (SF; F(a)/F(m), where F(m) is weight) of 160 is achieved. Tenacity (tau(n); F(a)/A, where A is area of contact) amounts to 2.24 x 10(5) N m(-2).

[Chronic recurrent multifocal osteomyelitis]. / Chronisch rekurrierende multifokale Osteomyelitis. Kasuistik einer 25-jährigen Patientin mit sternospondylärem Befall.

Chronic recurrent multifocal osteomyelitis (CRMO) is a rare, inflammatory, skeletal disease of unknown origin, which mainly affects children and adolescents in terms of cleido-spondylo-metaphysal skeletal inflammation. Only 10% of the patients are older than 20 years. To date, only about 200 cases have been reported in the literature. In the course of the disease, the initial radiological signs are osteolysis followed by sclerosis and hyperostosis in the end stage. The histological investigations reveal chronic inflammatory infiltrates with lymphocytes and hyperostosis. Although the prognosis of CRMO, to our current understanding, is self limiting, serious complications have been reported such as pathological fractures and compression fractures of the spine. A recently recommended therapy scheme is based on the administration of azithromycin combined with calcitonin. We present the case of a 25 year old female patient who has suffered from CRMO for 1.5 years with the cervical spine and the manubrium sterni being affected. The current state of diagnosis, therapy, and prognostic outlook of this rare disease are discussed.

Mouse pre-immunocytes as non-proliferating multipotent precursors of macrophages, interferon-producing cells, CD8alpha(+) and CD8alpha(-) dendritic cells.

In this study we characterize in mouse bone marrow and peripheral blood a homogeneous cell subset expressing Ly6C, CD31 and CD11c, that can give rise to multiple cell types involved in the immune response. Under the aegis of M-CSF or GM-CSF these cells rapidly differentiate without division to either macrophages or immature dendritic cells, which can be further induced to mature by LPS stimulation. In fetal thymic organ cultures the same cells generate both CD8alpha(+) and CD8alpha(-) dendritic cells in comparable proportion as found in normal thymus. The Ly6C(+), CD31(+) and CD11c(+) cells express not only TLR2 and TLR4, which are characteristic of myeloid dendritic cells, but also TLR7 and TLR9, which conversely are characteristic of human interferon-producing cells. Moreover, following stimulation with influenza virus, they rapidly express high levels of IFN-alpha mRNA. Finally these precursors are increased in bone marrow and peripheral blood during systemic inflammation. These cells are defined as "pre-immunocytes" to underline the fact that they serve in a flexible fashion multiple, and often divergent, functions required for the immune response to pathogens.

The VpreB protein of the surrogate light-chain can pair with some mu heavy-chains in the absence of the lambda 5 protein.

Nineteen different mu heavy-chains, seven of them not capable of forming a pre B cell receptor were expressed in Drosophila melanogaster Schneider cells together with either VpreB1, VpreB2, lambda5, or the complete surrogate light-chain to study their interactions in the formation of the pre B cell receptor. The lambda5 protein alone was unable to bind properly to any of the mu heavy-chains, while the VpreB proteins alone formed complexes with five of the mu heavy-chains. All mu heavy-chains incapable of forming a pre B cell receptor with surrogate light-chain were also incapable of complex formation with VpreB. The possible role of the VpreB/mu heavy-chain in allelic exclusion of the heavy-chain locus during B cell development is discussed.

Repertoire selection by pre-B-cell receptors and B-cell receptors, and genetic control of B-cell development from immature to mature B cells.

During B-cell development the surrogate light (SL) chain is selectively expressed in progenitor and precursor B cells during the developmental stages of D(H) to J(H) and V(H) to D(H)J(H) rearrangements. Approximately half of all muH chains produced by these rearrangements cannot pair with SL chains and cannot form a pre-B-cell receptor (pre-BCR). A spectrum of affinities between VpreB and individual V(H) domains generates preB cells with pre-BCR of different fitness which, in turn, determines the extent of the pre-B II-cell proliferation and the fidelity of allelic exclusion of the H chain locus. Once pre-BCR is expressed, SL chain expression is turned off. As pre-B II cells proliferate, SL is diluted out, thus limiting pre-BCR formation. As a consequence, pre-B II cells stop proliferating, become small and resting and begin to rearrange the L chain loci. Multiple rearrangements of the kappaL chain alleles are often detected in wild-type small pre-B II cells. Around 20% of the muH chain-expressing small pre-B II cells also express L chains but do not display the Ig on the surface. Hence, it is likely that not all L chains originally generated in resting pre-B II cells can pair with the muH chain previously present in that cell. The best fitting ones are selected preferentially to generate sIg+ B cells. Furthermore, the transition of immature B cells from the bone marrow to spleen and their development to mature cells appear as two separate steps controlled by different genes.

Nearest neighbor classification in 3D protein databases.

In molecular databases, structural classification is a basic task that can be successfully approached by nearest neighbor methods. The underlying similarity models consider spatial properties such as shape and extension as well as thematic attributes. We introduce 3D shape histograms as an intuitive and powerful approach to model similarity for solid objects such as molecules. Errors of measurement, sampling, and numerical rounding may result in small displacements of atomic coordinates. These effects may be handled by using quadratic form distance functions. An efficient processing of similarity queries based on quadratic forms is supported by a filter-refinement architecture. Experiments on our 3D protein database demonstrate the high classification accuracy of more than 90% and the good performance of the technique.

Activated murine B lymphocytes and dendritic cells produce a novel CC chemokine which acts selectively on activated T cells.

Genes were isolated using the suppression subtractive hybridization method by stimulation of pro/pre B cells with anti-CD40 and interleukin (IL)-4 to mature S mu-Sepsilon-switched cells. One of the strongly upregulated genes encodes a novel murine CC chemokine we have named ABCD-1. The ABCD-1 gene has three exons separated by 1. 2- and 2.7-kb introns. It gives rise to a 2.2-kb transcript containing an open reading frame of 276 nucleotides. Two polyadenylation sites are used, giving rise to cDNAs with either 1550 or 1850 bp of 3' untranslated regions. The open reading frame encodes a 24 amino acid-long leader peptide and a 68 amino acid-long mature protein with a predicted molecular mass of 7.8 kD. ABCD-1 mRNA is found in highest quantities in activated splenic B lymphocytes and dendritic cells. Little chemokine mRNA is present in lung, in unstimulated splenic cells, in thymocytes, and in lymph node cells. No ABCD-1 mRNA is detected in bone marrow, liver, kidney, or brain, in peritoneal exudate cells as well as in the majority of all unstimulated B lineage cells tested. It is also undetectable in Concanavalin A-activated/IL-2-restimulated splenic T cells, and in bone marrow-derived IL-2-induced natural killer cells and IL-3-activated macrophages. Recombinant ABCD-1 revealed a concentration-dependent and specific migration of activated splenic T lymphoblasts in chemotaxis assays. FACS(R) analyses of migrated cells showed no preferential difference in migration of CD4(+) versus CD8(+) T cell blasts. Murine as well as human T cells responded to ABCD-1. Freshly isolated cells from bone marrow, thymus, spleen, and lymph node, IL-2-activated NK cells, and LPS-stimulated splenic cells, all did not show any chemotactic response. Thus, ABCD-1 is the first chemokine produced in large amounts by activated B cells and acting selectively on activated T lymphocytes. Therefore, ABCD-1 is expected to play an important role in the collaboration of dendritic cells and B lymphocytes with T cells in immune responses.

Specific labelling of cell wall proteins by biotinylation. Identification of four covalently linked O-mannosylated proteins of Saccharomyces cerevisiae.

Intact Saccharomyces cerevisiae cells were biotinylated with the non-permeable sulfosuccinimidyl-6-(biotinamido) hexanoate reagent. Twenty specifically labelled cell wall proteins would be extracted and visualized on SDS gels via streptavidin/horseradish peroxidase. Nine cell wall proteins were released by SDS extraction under reducing conditions and were designated Scw1-9p for (soluble cell wall proteins); five proteins were released from SDS-extracted cell walls by laminarinase (Ccw1-5p for covalently linked cell wall proteins) and six with mild (30 mM-NaOH, 4 degrees C, 14 h) alkali treatment (Ccw6-11p). N-terminal sequences of the Ccw proteins 6, 7, 8 and 11 showed that these cell wall proteins are members of the PIR gene family (predicted proteins with internal repeats), CCW6 being identical to PIR1 and CCW8 to PIR3. Single gene disruptions of all four genes did not yield a phenotype. In the CCW11 disruption the Ccw11p as well as the laminarinase-extracted Ccw5 protein was missing. The new cell wall proteins are O-mannosylated, contain a Kex2 processing site, but no C-terminal GPI anchor sequence.

Pediatric injury resulting from family violence.

OBJECTIVE: Children who live in violent households are at risk for emotional and physical injury. Although recent research has addressed the emotional impact of witnessing family violence, no study has addressed the inadvertent physical injuries that result to children who witness family violence. The objective of this study was to describe the causes, types, and patterns of pediatric injuries resulting from family violence. METHODS: We reviewed the medical records of 139 children who presented to the emergency department with injuries resulting from domestic violence for demographic information, mechanism of injury, type, location, and severity of injury, treatment, and disposition. RESULTS: Children who were injured during domestic violence ranged in age from 2 weeks to 17 years. Although the mean age of the children identified was 5 years, 48% of the children were younger than 2 years. Although the most common dyad involved in the fight was the mother and father (57% of cases), extended family members and nonrelated adults were involved in almost one third of the cases. The most common mechanism of injury was a direct hit (36%). Of the injured children who were younger than 2 years, 59% were injured while being held by parents. Thirty-nine percent of the children were injured during attempts to intervene in fights. The majority of injuries were to the head (25%), face (19%), and eyes (18%). Young children sustained more head and facial injuries than older children, who had disproportionately more extremity trauma. Medical intervention was indicated in 43% of patients, of which 9% required hospital admission and 2% required surgical or intensive care intervention. Of the 91% of children discharged from the emergency department, 73% returned home, and 27% went to alternative homes. CONCLUSIONS: Children sustain a wide range of physical injuries from family violence. Because the majority of injuries are minor, specific inquiry into the causes of all pediatric injuries may help further identify children living among family violence.

Long-term outcome in infants with the shaking-impact syndrome.

Nonaccidental injury accounts for nearly one quarter of all hospital admissions for head injury in infancy, and is associated with significant morbidity and mortality. Long-term outcome in survivors, however, has been incompletely studied. In this series, 84 infants 2 years of age and younger with the shaking-impact syndrome consecutively admitted to a single hospital between 1978 and 1988 were identified. A questionnaire detailing current medical, developmental, and behavioral status was developed, and attempts were made to locate the 62 children surviving the acute injury. Family instability and strict confidentiality restrictions precluded locating the majority of children, but 14 children with demographic and injury characteristics similar to those of the overall group were contacted at an average of 9 years after injury. Seven children were severely disabled or vegetative, 2 were moderately disabled, and 5 had a good outcome. Of the latter group, 3 had repeated grades and/or required tutoring. Acute factors associated with poor outcome included unresponsiveness on admission, need for intubation, age less than 6 months, and bilateral or unilateral diffuse hypodensity on CT scan. All children with bilateral diffuse hypodensity and loss of gray-white differentiation on CT scan remained blind, retarded, nonverbal, and nonambulatory in spite of aggressive medical and surgical management. This study suggests that the majority of children surviving the shaking-impact syndrome suffer major permanent morbidity, and that acute factors predicting long-term outcome may help guide aggressiveness of care.