Evaluation of Radiological and Functional Outcome of Intra-articular Proximal Tibia Plateau Fracture Treated with Plating.

Introduction: Proximal tibial plateau fractures are one of the major problems in orthopaedic surgery and are associated with high complication rates. Intra-articular proximal tibia plateau fractures represent approximately 1% of fractures in adults. Various modalities of proximal tibial plateau fracture management have been considered, ranging from simple external fixators in impending compartment syndrome to periarticular proximal tibia plates and inter-locking nails with poller screws. Purpose of this study is to determine clinical outcomes of proximal tibial plateau fractures treated with plate. Materials and methods: We did this study of proximal tibial plateau fracture according to Schatzker's classification treated with proximal tibial periarticular plates in 53 patients prospectively admitted at the author's institute from June 2018 to May 2020 with follow-up period of 6 months. Results: In our study, the average knee score was 89.30 (ranging from 79 to 93) and functional knee score was 97.92 (ranging from 75 to 100). Fifty-one (51) patients (96.23%) showed excellent results and 2 patients (3.77%) showed good results according to Knee Society Score, which suggest that internal fixation of proximal tibia plateau fracture with plating provides better results. Out of 53 patients, 9 patients had post-operative complications. Average radiological union was seen at 14 weeks. Conclusion: Locking compression plate in proximal tibia plateau fractures act as a good biological fixation provide stable fixation, articular reduction and limb alignment even in difficult fracture situations. Fixation of proximal tibia plateau fractures with plate gives excellent to good knee society score, with satisfactory functional and radiological outcome.

Techniques and results of palate fistula repair following palatoplasty: a 234-case multicenter study. / Técnicas y resultados de reparación de fístulas palatinas pospalatoplastia: estudio multicéntrico de 234 casos.

INTRODUCTION: Palate fistula is the most frequent complication following palatoplasty. The objectives of this study were: to describe the most widely used repair techniques; to study results and recurrence rate; to analyze potentially predictive recurrence variables; and to assess whether a specific technique is superior according to fistula size and location. MATERIALS AND METHODS: Retrospective study of patients undergoing palate fistula repair in 7 healthcare facilities from 2008 to 2018. All facilities had at least 20 new cases of cleft lift and palate annually (range: 20-80), with a fistula incidence of 14% (range: 1.5-20%). Minimum follow-up was 1 year. 8 variables were collected for statistical analysis purposes. RESULTS: 234 fistula patients underwent surgery. Most fistulas occurred in complete bilateral cleft lift and palate (Veau type IV). The most frequent location was the hard palate (Pittsburgh types IV and V (63.2%)), and fistulas were mostly large (42.1%) and medium (39.5%). The most frequent repair technique was re-palatoplasty (34.2%). Recurrence rate was 22%. The multivariate analysis demonstrated more recurrences in re-palatoplasty repaired type III fistulas in patients over 3 years old. CONCLUSION: A tendency towards using flap repair in large hard palate fistulas, re-palatoplasty in medium hard palate and soft and hard palate junction fistulas, and local flaps or re-palatoplasty in small fistulas at any location was observed. However, it could not be statistically demonstrated whether a specific repair technique was superior in different clinical situations.

INTRODUCCION: La fístula palatina es la complicación más frecuente tras una palatoplastia. Los objetivos de este estudio fueron: describir las técnicas de reparación más frecuentemente empleadas; estudiar los resultados y la tasa de recidiva; analizar posibles variables predictivas de recidiva y valorar la posible superioridad de una determinada técnica según el tamaño y la localización de la fístula. MATERIAL Y METODO: Estudio retrospectivo de pacientes operados de fístulas palatinas desde 2008 hasta 2018 en 7 centros. Todos operaban al menos 20 casos nuevos de fisuras labiopalatinas al año (rango 20-80) con una incidencia de fístulas de 14% (rango: 1,5-20%). El seguimiento mínimo fue de 1 año. Se recogieron 8 variables para el análisis estadístico. RESULTADOS: Se operaron 234 pacientes con fístulas. La mayoría ocurrieron en fisuras labiopalatinas bilateral completa (tipo IV de Veau). La localización más frecuente fue el paladar duro (tipos IV y V de Pittsburgh (63,2%) y la mayoría fueron grandes (42,1%) y medianas (39,5%). La técnica de reparación más frecuente fue la repalatoplastia (34,2%). La tasa de recidiva fue del 22%. El análisis multivariante mostró más recidivas en fístulas tipo III reparadas con repalatoplastia, en mayores de 3 años. CONCLUSION: Se observó una tendencia a utilizar más reparación con colgajo en fístulas grandes del paladar duro, repalatoplastia en fístulas medianas de paladar duro y de la unión, y colgajos locales o repalatoplastia en fístulas pequeñas en cualquier localización, pero no se pudo demostrar estadísticamente la superioridad de una técnica reparadora concreta en diferentes situaciones clínicas.

Cervical ribs: a common variant overlooked in CT imaging.

BACKGROUND AND PURPOSE: Cervical ribs are congenital variants that are known to cause TOS or brachial plexopathy in up to 10% of the affected individuals. We investigated how often cervical ribs are present on cervical spine CT scans to determine the incidence in humans and the percentage of reported cervical ribs. MATERIALS AND METHODS: Cervical spine CT scans and the reports of 3404 consecutive adult patients were retrospectively reviewed to determine the presence of cervical ribs and whether they had been reported. RESULTS: Cervical ribs were found in 2.0% (67/3404) of the population. Of the 67 patients with cervical ribs, 27 (40.3%) had bilateral ribs. The prevalence of cervical ribs in women was twice that in men, 2.8% (39/1414) versus 1.4% (28/1990). Although African Americans accounted for 50.1% (1706/3404) and whites, 41.2% (1402/3404) of the patient population, African Americans were 70.1% (47/67) of patients with cervical ribs, whereas whites were 26.9% (18/67). Radiologists commented on 25.5% (24/94) of the cervical ribs in 25.4% (27/67) of patients. CONCLUSIONS: The prevalence of cervical ribs in the human population has been a source of uncertainty due to the degree of difficulty that comes in detecting this often subtle congenital variation. In our sample, the prevalence was 2.0% of patients. Our study determined that cervical ribs are underreported in patients undergoing cervical spine CT. Given the potential clinical implications of these anatomic variants, neuroradiologists must be more meticulous in identifying cervical ribs when reviewing cervical spine CT scans.

Contrast-enhanced angiographic cone-beam CT of cerebrovascular stents: experimental optimization and clinical application.

BACKGROUND AND PURPOSE: With modern imaging techniques, visualization of neurovascular stents remains challenging. We present a method for contrast-enhanced C-arm CBCT that provides detailed and simultaneous visualization of neurovascular stents and host arteries. MATERIALS AND METHODS: CBCT was performed with a rotational angiography system by acquiring 620 projection frames over a 200° arc at 80 kVp and a total of 260 mAs. A superselective intra-arterial contrast injection protocol was optimized in swine experiments and implemented in 57 clinical examinations. High-resolution 3D reconstructions were evaluated by 3 blinded interventional neuroradiologists. Reviewers rated the images by answering questions related to both the quality of the stent and artery visualization and the clinical utility of the images. Raw agreement statistics, ICC, and κ statistics were computed for the questionnaire results. RESULTS: Of 57 clinical evaluations, 5 were not evaluated due to the use of large balloon-mounted stents (n = 4) and a failed contrast injection (n = 1). In 50 of 52 evaluated examinations, the reviewers agreed that simultaneous stent and vessel visualization was of diagnostic quality. There was strong agreement that stent-vessel wall apposition could be assessed (κ = 0.79). CBCT detected contrast filling defects (κ = 0.85) and vascular calcification (κ = 0.68). Artifacts resulting from the aneurysm coil mass impaired the delineation of adjacent structures (κ = 0.72). CONCLUSIONS: We have developed a technique that enables simultaneous clinically useful imaging of neurovascular stents and their host arteries that is unobtainable with other current imaging modalities. Further improvements are required to reduce artifacts from large coil masses due to x-ray scattering.

In vitro controlled release of colon targeted mesalamine from compritol ATO 888 based matrix tablets using factorial design.

A controlled release matrix formulation for mesalamine was designed and developed to achieve a 24 h release profile. Using compritol 888 ATO (glyceryl behenate) as an inert matrix-forming agent to control the release of mesalamine, formulation granules containing the solid dispersions were investigated. Pectin, a polysaccharide, was used as bacterial dependent polymer for colon targeting. The matrix tablets for these formulations were prepared by direct compression and their in vitro release tests were carried out. A 3(2) full factorial design was used for optimization by taking the amounts of glyceryl behenate (X(1)) and pectin (X(2)) as independent variables and percentage drug released at 2 (Q(2)), 16 (Q(16)) and 24 (Q(24)) h as dependent variables. Drug release from the matrix tablets formulations lasted for over 24 h. Images of the tablet surface and cross-section were characterized by scanning electron microscopy to show the formed pores and channels in the matrices. These may provide the release pathway for the inner embedded drugs. The co-mixing of polysaccharide pectin, into the waxy matrices played a meaningful role in targeting the tablets to colon. The drug release from the novel formulation may be attributed to the diffusion-controlled mechanism. The results of the full factorial design indicated that an optimum amount of compritol ATO 888 and a high amount of pectin favors the colon targeting and controlled release of mesalamine from dosage form.

Tablet formulation studies on an oxcarbazepine-beta cyclodextrin binary system.

Oxcarbazepine is a poorly water-soluble (0.083 mg/ml) anti-epileptic drug according to the BCS system (class II) and its dissolution is rate-limiting step for its absorption. The objective of this work was to develop tablet formulations of oxcarbazepine-beta-cyclodextrin (OX-beta-CD) binary systems. Three types of binary systems--physical mixtures, kneaded systems, and coevaporated systems--were studied. Phase solubility studies indicated 1:1 M complexation of oxcarbazepine with beta-cyclodextrin. Drug-beta-CD binary systems were prepared at 1:1 molar ratios and used in formulation studies. The dissolution properties of OX-beta-CD KS (kneaded system, 100.10% drug release in 15 min) were superior than those of the other binary system and pure oxcarbazepine. The tablet formulations containing drug-beta-CD binary systems prepared by wet granulation and direct compression showed superior dissolution properties when compared with the formulations of the corresponding pure drug formulations. Tablet formulations containing drug-beta-CD binary systems prepared by the kneading method showed good dissolution properties (100% drug release in 15 min in direct compression method and 99.9% drug release in 20 min in wet granulation method). Overall, the dissolution properties of tablet formulations prepared by the direct compression method were superior to those of tablets prepared by the wet granulation method. Accelerated stability studies on some selected tablet formulations were also conducted by keeping the samples at 40 +/- 2 degrees C and 75% relative humidity. There were no statistical differences in the percentage of drug dissolved at 15 and 20 min between fresh and stored samples at the different time points (P < 0.05). Drug content also remained within acceptable limits. Thus, drug-beta-CD binary systems are useful in developing tablet formulations of oxcarbazepine with improved dissolution properties.

Prevalence and impact of migraine and probable migraine in a health plan.

BACKGROUND: A large number of headache sufferers with features of migraine fail to meet criteria for strict migraine (SM; migraine with or without aura) but do meet criteria for probable migraine (PM). OBJECTIVES: To estimate the prevalence of PM, to compare the epidemiologic profiles of SM and PM, and to assess the disability and impact on the health-related quality of life (HRQoL) of these patients. METHODS: Computer-assisted telephone interviews in a sample recruited from a mixed model health maintenance organization were used. SM, PM, and control subjects were identified. Also assessed were demographic features, disability, HRQoL, and depression. RESULTS: The 1-year prevalence for SM was 14.7% (19.2% in women and 6.6% in men); for PM, it was 14.6% (15.9% in women, 12.6% in men). Most subjects with PM (82%) did not meet the associated symptom criteria for migraine. HRQoL was reduced in the PM, SM, and all migraine (AM; SM and PM pooled together) groups compared with controls. The proportion of subjects with high disability was elevated in PM (13%), SM (31%), and AM (22%) groups vs controls (3.7%; p < 0.0001). CONCLUSIONS: Within a health plan, probable migraine is a prevalent form of migraine, with symptom and epidemiologic profiles that overlap with strict migraine. Although strict migraine prevalence was consistent with previous studies, a probable migraine prevalence higher than previously reported was found, perhaps reflecting a difference between health plan and population samples.

The glucocorticoid paradox of caloric restriction in slowing brain aging.

Glucocorticoids have a bimodal effect on cognition, hippocampal pyramidal neurons and long-term potentiation (LTP). Transient increases in glucocorticoids improve performance at spatial memory tasks and facilitate synaptic efficacy, depending on the context. On the other hand, long-term elevations of glucocorticoids are associated with decreased cognitive performance, attenuated synaptic efficacy and neuronal atrophy. Elevation of glucocorticoids during aging is also associated with mild cognitive impairment and hippocampal atrophy. Caloric restriction (CR), a dietary manipulation which extends life-span in rodents, also increases free plasma corticosterone. Recent data suggests that CR attenuates many brain aging changes and increases resistance of neurons to toxins and injury. Thus, a paradox may be considered: if CR causes chronic elevation of glucocorticoids, and if glucocorticoids can increase the risk of neurodegeneration, how can CR be neuroprotective. We suggest that the neuroprotective effects of CR outweigh the deleterious effects of glucocorticoids. The neuroprotective effects of CR that are discussed here include decreased plasma glucose, attenuated free radical generation, alterations of the vasculature, increased expression of heat shock proteins and neurotrophic factors, and attenuation of age-related glial activation.

Non-aqueous emulsions: hydrocarbon-formamide systems.

There are few reports in the literature on formulation of non-aqueous emulsions. This study was designed to evaluate some design criteria for such systems. Formamide is the closest polar solvent that has the ability to replace water in emulsification when employing established non-ionic surfactants as stabilisers. For the majority of studies, linear alkanes (C6-C16) were dispersed in formamide as the continuous phase were stabilised with polysorbate 20. Initial studies involved gentle emulsification and observing mean globule size. The mean globule size varied in a non-linear fashion with alkyl chain length, the minimum being between C10 and C12. Sonication for 30 s led to smaller differences in the mean globule size. The effect of various parameters such as surfactant concentration and solvophilicity of the surfactant was observed. The surface activities of polysorbate 20, 40, 60 and 80 in formamide and critical micellar concentrations were determined. The latter were several orders of magnitude higher in formamide than in water, and the areas per molecule larger. The addition of water to the dodecane formamide systems did not destabilise the emulsion. Release of the model drug dehydroepiandrosterone from dodecane in formamide emulsions was studied in distilled water, the rate of release being dependent on the volume fraction of dodecane.

Neuregulin-1 and human epidermal growth factor receptors 2 and 3 play a role in human lung development in vitro.

The human epidermal growth factor receptor (HER) family consists of four distinct receptors: HER1 (epidermal growth factor receptor), HER2, HER3, and HER4. Their specific activating ligands are collectively known as neuregulins (NRG). We hypothesized that one member of the NRG family, NRG-1, and the HER family would play a role in fetal lung development. To test this hypothesis, we defined NRG-1 and HER gene expression in mid-trimester human fetal lung tissue. HER2 and HER3 messenger RNA and protein were detected in the fetal lung, but HER4 expression was not detected. Immunohistochemical staining of fetal lung tissue localized HER2 and HER3 protein to the developing lung epithelium. NRG-1 expression was not found in freshly isolated human fetal lung, but it was observed in fetal lung explants after 2 d of explant culture. Immunohistochemistry of cultured human fetal lung explants revealed that NRG-1 protein was also expressed in pulmonary epithelial cells. Exposing human fetal lung to recombinant NRG-1 activated the HER receptor complex as measured by approximately 4-fold increases in receptor phosphotyrosine content. In addition, NRG-1 increased explant epithelial cell volume density approximately 2-fold (P < 0. 03); increased epithelial cell proliferation approximately 2-fold, as determined by bromodeoxyuridine labeling (P = 0.002); and reduced surfactant protein-A (SP-A) levels by 53% (P < 0.05). These data are consistent with an autocrine regulatory process mediated by NRG-1 activation of HER2/HER3 heterodimers expressed on developing human fetal lung epithelial cells. Receptor activation results in increased lung epithelial cell proliferation and volume density, and decreased SP-A production, a marker of type II pneumocyte differentiation.

Detection and mapping of quantitative trait loci for haloperidol-induced catalepsy in a C57BL/6J x DBA/2J F2 intercross.

A genomewide scan was conducted to detect quantitative trait loci (QTLs) for haloperidol-induced catalepsy in a C57BL/6J (B6) x DBA/2J (D2) F2 intercross (N = 678). Significant QTLs (LOD, > 4.3) were detected on chromosomes 1 and 9. The relative position of the QTL on chromosome 1 is similar to open-field activity QTLs previously identified by Flint et al. (1995) and Gershenfeld et al. (1997). Given the broad confidence intervals for these QTLs, such associations must be viewed cautiously. However, these data are consistent with the report of Kline et al. (1998), who found a significant genetic associations between catalepsy and open-field activity. The QTL interval on chromosome 9 stretched from approximately 25 to 55 cM; this region contains numerous candidate genes, including Drd2, Ncam, Acat1, and Htr1b. The data also suggest the presence of a second QTL on chromosome 9 (LOD, > 3.5) in the proximal region of the chromosome. Potential candidate genes in this region include Penk2 and Gria4. Overall, these data support our previous observation (Kanes et al., 1996) that for the B6 x D2 genotypes, one or more polymorphisms on chromosome 9 are associated with the variance in haloperidol response.

Psychosocial development of urban children (below 2 years) using culture appropriate indicators of development.

Six hundred essentially normal children 15 days-2 years were randomly assessed for their nutritional and developmental status. Measurement of the mid-upper-arm circumference using the Jellife's technique was employed for a quick nutritional survey. For developmental assessment, the WHO suggested culture appropriate psychosocial Basic Test Battery was used. Shakir's classification of the results did not reveal any malnutrition. Analysis of the data revealed 'at par' performances in Gross Motor, Hearing and Self Help skills and delays in Vision and Fine Motor, Language and Concept Skills. Social skills were particularly advanced.

Culture appropriate indicators for monitoring growth and development of urban and rural children below 6 years.

In this cross sectional study, 2000 apparently normal children aged 0-6 years (1200 urban and 800 rural), were nutritionally and developmentally assessed and their environment scrutinized for possible risk factors. Measurement of mid upper arm circumference (MUAC) using standard techniques revealed malnutrition in 44% of the rural and 24% of the urban children especially in the 2-6 years of age group. Culture appropriate indicators of psycho-social development picked up gross delays in gross motor (GM), vision and fine motor (V&FM) and language skills. Self help, concept hearing (SHCH) skills were recorded as normal while social skills were advanced particularly in the 0-2 years old urban group. By the use of the family protocols, low socio-economic status, malnutrition and 9 other risks factors have been generated for the urban group. No risk factor could be identified for the rural group. Better income emerged as the only real protective factor for the sample showing a direct positive relationship with the 45 skills tested, especially in the 2-6 years age group. Nineteen developmental skills were identified as powerful predictors of development. A prototype home based screening record was constructed for monitoring of growth and development which can be even used by minimally trained primary care worker.

Phenobarbital and sulfonylurea-inducible operons encoding herbicide metabolizing cytochromes P-450 in Streptomyces griseolus.

We have identified the promoters for two inducible genes, in Streptomyces griseolus, that encode herbicide-metabolizing cytochromes P-450. They are in the class of promoters that have -35 and -10 sequences similar to those used in Escherichia coli by RNA polymerase E sigma 70. Transcription from either promoter was shown to be induced by sulfonylurea (chlorimuron ethyl) or phenobarbital. Mapping of mRNA showed that each cytochrome P450-encoding gene was transcribed on a separate multicistronic mRNA that encodes cytochrome P-450 (suaC or subC), ferredoxin (suaB or subB) and at least one other open reading frame. An inducible, site-specific DNA-binding activity was identified that bound to two similar 8-bp inverted repeat sequences within or near the sua promoter (suaP). A noninducible DNA-binding activity, distinct from that which bound to suaP, was found that bound to an 11-bp inverted repeat at the sub transcription start point.

Training of non-professional health workers in a simple technique of developmental screening of infants and young children.

Twenty Anganwadi Workers were trained for developmental screening of infants and young children (6 weeks to 2 yrs) and their results compared with that of a trained medical practitioner. The screening tool used was the Woodside System of screening. A reference test (Gesell's Developmental Schedules) was given to 56.5% of the sample. The tester/tester reliability worked out on 50% of the testers was comparable. The results of the tester/author reliability worked out on 150 children were statistically comparable. A high level of proficiency of the workers was retained throughout the study through constant supervision and cross check by the author. The successful training of insufficiently used paramedical manpower for decreasing cost of medical care and improving utilization of the health delivery system is highlighted.

Trial of a screening technique of the developmental assessment of infants and young children (6 weeks-2 years).

Six hundred and nineteen infants and young children from the slums of Jabalpur City were screened by twenty trained paramedical workers using the Woodside Screening Technique. A second screen was given by the author within three days of the first screen on 350 (56.5%) children. The tester/author agreement was 97%. The results of the Woodside Screening Technique were validated against the standard Gesell's Schedules. The specificity and sensitivity rates of 88 and 83%, respectively were better than the original Denver Developmental Screening Test (77% each). Over referral rates which vary between 10-28% were comparable to the original Denver Developmental Screening Test. The under referral rate was 24%. All children tested belonged to the deprived sections of society, having weights below 50th centile of Harvard Standards. Inspite of this 74% of children scored above and at par on the Gesell's Developmental Schedule, only 11% children showing any developmental abnormality. The need to eliminate the cultural bias from the test and draw a new threshold line to separate questionable cases from abnormal ones is highlighted. Recommendations and specific modifications of the Woodside Screening Technique are suggested.

Changing trends in mortality and morbidity in a teaching hospital in central India.

A comparison of mortality and morbidity pattern of hospital admissions of children under 14 years during 1966-68 and 1977-81 has been made. Annual admission rate has increased from 1515 to 2515, which is in proportion to the population increase of 3 lacs from 1966 to 1981. Recently more than 70% were discharged within a week as against 52% during 1966-68, indicating a faster turnover and a need for more beds. Protein energy malnutrition, infections and diarrhoea with dehydration were main killers. The pattern of mortality and morbidity has not much changed from 1966 to 81 but mortality rates at all ages have considerably declined in recent years (neonatal, post neonatal, preschool and school). Measures to decline it further have been discussed. The data should be of interest to those engaged in planning health strategies and to teachers in defining priorities in Medical education.

PIP: A comparison of mortality and morbidity patterns of hospital admissions for children under age 14 between 1966-68 and 1977-81 has been made. Annual admission rate has increased from 1515 to 2515, which is in proportion to the population increase of 3 lacs from 1966-81. Recently, more than 70% were discharged within 1 week as compared to 51% during 1966-68, indicating a faster turnover and a need for more beds. Protein energy malnutrition, infections, and diarrhea with dehydration were the main causes of death. The pattern of mortality and morbidity has not changed much from 1966-81, but mortality rates at all ages have declined considerably in recent years (neonatal, postneonatal, preschool and school-age). Measures to decrease it even further have been discusses. the data should be of interest to those engaged in planning health strategies and to teachers in order to help define priorities in medical education.