Six months after Maria: A post-hurricane examination of mental health and associated risk factors in older Puerto Ricans.

Following Hurricanes Irma and Maria in September 2017, there were elevated rates of depression and suicide in Puerto Rico. This study evaluates mental health in older and elderly Puerto Ricans 6 months after the hurricanes and suggests strategies for improving future psychosocial responses. Patients attending clinics were evaluated for depression (Patient Health Questionnaire [PHQ-9]) and suicide risk (Ask Suicide-Screening Questions [ASQ]) and were surveyed about their perceived safety, designated as a proxy for anxiety. Used in conjunction, PHQ-9 and ASQ were found to identify a greater proportion of individuals experiencing adverse mental health effects than if each instrument was used in isolation. Patients were also surveyed about time to water and electricity restoration, and it was found that prolonged time to water restoration was associated with increased prevalence and severity of depression and decreased perceived safety. Based on collected patient data (n = 523), using multiple mental health screening tools for diagnosis, improving perceptions of home safety or anxiety, and prioritizing water restoration may reduce mental health sequelae in the elderly and enhance the effect of psychosocial responses following disasters.

Gene expression profiling in Helicobacter-induced MALT lymphoma with reference to antigen drive and protective immunization.

We have previously shown that long-term infection of BALB/c mice with gastric Helicobacter species results in the development of histopathological lesions that resemble those seen in patients diagnosed with gastric mucosa associated lymphoid tissue (MALT) lymphoma. This paper describes analysis of this disease at the molecular level through the use of microarray technology and immunohistochemical staining. We were able to monitor the genetic changes in the gastric mucosa characterized by distinct transcriptional signatures and correlate these with histological changes as the infection progressed from a chronic inflammatory infiltrate through to MALT lymphoma. This model system also enabled us to further dissect the role of antigen presentation and prophylactic immunization in the disease process. Antimicrobial therapy to eradicate the antigen correlated with significant reduction in pathology and major changes in the gene expression profile. Subsequent reintroduction of the antigen resulted in rapid tumor development which correlated with an increase in aggressively proliferating cells and changes in the cellular composition of the tumor. The response in vaccinated animals showed that the protected animals exhibited a strikingly different transcriptional profile compared to those of non-protected or control mice, indicating that the vaccination targeted the appropriate site leaving a long-lasting signature. The genes which were most significantly up-regulated included a number of adipocyte-specific factors, such as fat-cell specific cytokines and adipocyte surface markers. This study allowed for us to highlight the significance of antigen presentation in this disease and to hypothesis mechanisms associated with protective immunity.

Animal models of Helicobacter pylori infection and disease.

The acceptance of Helicobacter pylori as a major human pathogen has necessitated the development of animal models to help elucidate the pathogenic mechanisms of this bacterium and aid in the development of improved strategies for the treatment of gastric disease. Appropriate models, utilising a range of animal species, have been developed to examine factors such as the influence of host responses and bacterial factors in disease development and the success of new therapeutic regimens, including vaccination, to cure infection.

Atypical (dedifferentiated) chondrosarcoma or osteosarcoma with preponderant chondroblastic differentiation?

A bone tumor was detected in the distal right femur of a 15-year-old girl. The age of the patient, the localization, and the X-ray picture were in favor of an osteosarcoma. However, histology was consistent with a "highly differentiated chondrosarcoma with dedifferentiation and focal osteosarcomatous metaplasia". The tumor was resected with preservation of the limb. One year later the tumor recurred, and the leg was exarticulated. Histology was again of the same type, as was the case in a single lung metastasis taken out another half year later. Two series of chemotherapy according to an osteosarcoma protocol had no recognizable effect. An unambiguous diagnosis cannot yet be made.

[Treatment and prognosis in vertebral fractures in children and adolescents]. / Behandlung und Prognose von Wirbelfrakturen im Kindes- und Jugendalter

Twenty-six children and adolescents with a total of 65 vertebral fractures are reported. Sixteen patients could be followed up an average of 3 1/4 years after the accident. The questions of growth disturbance after vertebral body fractures and adequate treatment are chiefly considered. -Most of the fractures occurred in the midthoracic spine. As a rule they were serial fractures. -Fractures of the vertebral body with sagittal wedge deformity alone have a better prognosis than those with concomitant sagittal and frontal wedge deformities. Whereas those in the first group correct themselves partially or completely during subsequent growth, improvement in the wedge deformity was only observed in about one-third of the patients in the second group. When the end-plates were fractured, there was no correction and there was a lack in vertebral growth. Severe destruction of the cartilagenous plates and intervertebral discs led to a fusion of the corresponding segment. Increase in wedge deformity was observed twice. -Slight axial deviations of the intervertebral discs following vertebral body fractures are compensated for during growth in most cases. In comminuted fractures, the axial deviation persists but can be compensated for by the adjacent segments of the spine. In instable fractures, it can increase in spite of treatment in a Milwaukee corset. -No difference was found between the children treated with a hyperextension plaster corset and those treated functionally. On the basis of the results, the fracture types which should be treated functionally and those for which a plaster cast is recommended are indicated.

Primary chronic osteomyelitis.

The term primary chronic osteomyelitis covers a heterogeneous spectrum of clinical features that should be separated for therapeutic reasons. Unifocal manifestations should be distinguished from multifocal ones. While bacteria are often found in the first group, bacteriological investigations are usually negative in the second group. Additionally, multifocal forms often recur (chronic multifocal recurrent osteomyelitis), possess a long clinical course and may be combined with dermatological disorders (SAPHO syndrome). A biopsy is often necessary for tumor exclusion and obtaining material for bacteriology. Histology cannot differentiate between the respective forms of chronic osteomyelitis.

Guidelines in orthopaedic surgery. A first step.

Guidelines are systematically developed statements of the actual knowledge in order to assist doctors and patients by the decision of appropriate health care. Since 1998 the DGOT has published 22 well structured guidelines, 20 guidelines are under construction. The AWMF as the coordinator of guideline constructing of all scientific medical societies has published 629 guidelines since 1995. The publication of guidelines of the DGOT and the BVO is the first step for dissemination, nexts steps should be implementation und evaluation. Then it will be evident whether change in medical practice will occur.

[A new standard method for experimental for measuring cement coat strength in endoprosthesis implantation]. / Eine neue Standardmethode zur experimentellen Vermessung der Zementmantelstärke in der Endoprothetik.

The distribution of bone cement around an endoprosthesis influences its stability over the long term. We have developed a new method for the experimental measurement of the cement mantle thickness of an endoprosthesis. The use of this computer-aided procedure is described in a hip prosthesis. Transverse sections of a human femur containing a cemented stem were prepared, recorded with a CCD camera and the images fed into a computer. The image-processing software differentiated the metal and bone cement on the basis of the different colours. Radial lines were drawn from the calculated centre of gravity of the stem, and the cement thickness was measured automatically along these lines. In our experiment, the accuracy of the method was 0.2 mm. This method of measuring the thickness of the cement mantle is accurate, rapid and practical.

[Effect of integrated distance studs on cement thickness of implanted PE-acetabulum cups--experimental in vitro studies for improved cementing technique]. / Der Einfluss von integrierten Abstandhaltern auf die Dicke des Zementmantels bei implantierten PE-Hüftpfannen--Experimentelle In-vitro-Untersuchungen zur Verbesserung der Zementiertechnik.

Variations in cement thickness between PE cups and acetabular bone are biomechanically unfavourable, and may contribute to prosthetic loosening. Integrated distance studs should in the first instance, prevent local thinning of the cement. In an experimental study we compared the thickness of the cement mantel of implanted PE cups without such studs. In the case of cups with studs, significantly fewer areas of thin cement (0-1 mm) were found in comparison with cups with no studs. "Bald" areas of cement (0-0.2 mm) were virtually prevented by the studs. We are of the opinion that PE cups with integrated studs on the surface ensure a uniform cement thickness around the cup, as well as decreasing the risk of "bald" areas in the cement, thus reducing loosening.

[Simulator for migration processes and wear in the artificial hip acetabulum for radiologic measurement]. / Simulator für Wanderungsvorgänge und Abrieb bei künstlichen Hüftpfannen zur radiologischen Vermessung.

For assessing migration of cups, standard X-rays or stereo radiological images (SRI) are available. In addition, software is also available for measurements. The accuracies of the various systems are established statistically, in part combined with phantoms, and compared. To date, no known phantom is available for the simulation of acetabular cup migration with account being taken of the position of the pelvis in the X-ray beam. Such an appliance covering 8 different parameters has now been developed, the cup can be moved horizontally, vertically and in the loading direction. Angular accuracy is +/- 0.5 degree, and wear of a magnitude of 0.25 mm can be simulated. Two degree elevation of the pelvis, left or right, can be simulated. The position of the pelvis around the horizontal axis permits continuous variation. This appliance can simulate migratory movements of the acetabular cup within a pelvis, and wear within the cup. In addition, the spatial position of the pelvis can be varied. The X-ray images can be used to investigate the accuracy of evaluation strategies.

Urea, fluorofamide, and omeprazole treatments alter helicobacter colonization in the mouse gastric mucosa.

BACKGROUND: Helicobacter pylori is a causative agent of gastric and duodenal ulcers and gastric cancer. Its urease enzyme allows survival in acid conditions and drives bacterial intracellular metabolism. We aimed to investigate the role of urease in determining the intragastric distribution of Helicobacter species in vivo. MATERIALS AND METHODS: The C57BL/6 mouse model of gastritis was used for infection with Helicobacter felis (CS1) or H. pylori (SS1). Urease-modulating compounds urea and/or fluorofamide (urease inhibitor) were administered to mice over 7 days. Concurrent gastric acid inhibition by omeprazole was also examined. Bacterial distribution in the antrum, body, antrum/body, and body/cardia transitional zones was graded "blindly" by histologic evaluation. Bacterial colony counts on corresponding tissue were also conducted. RESULTS: Urease inhibition by fluorofamide decreased H. pylori survival in most gastric regions (p < .05); however, there were no marked changes to H. felis colonization after this treatment. There was a consistent trend for decreased antral colonization, and an increase in antrum/body transitional zone and body colonization with excess 5% or 6% (w/v) urea treatment. Significant reductions of both Helicobacter species were observed with the co-treatment of urea and fluorofamide (p < .05). Collateral treatment with omeprazole did not alter H. pylori colonization patterns caused by urea/fluorofamide. CONCLUSIONS: Urease perturbations affect colonization patterns of Helicobacter species. Combined urea and fluorofamide treatment reduced the density of both Helicobacter species in our infection model.