[Growth modulation through hemiepiphysiodesis : Novel surgical techniques: risks and progress]. / Kniegelenksnahe Wachstumsmodulation durch Hemiepiphysiodese : Neue Operationstechniken: Fortschritte und Risiken.

The correction of angular deformities of the lower limb is a key task in paediatric orthopaedic surgery. The growth potential of the physis can be employed for the correction of these malalignments in childhood and adolescence. Hemiepiphysiodesis (HED) is a surgical technique used for growth modulation by permanent or temporary asymmetrical arrest of the growth plate. In permanent HED, exact timing of the procedure is mandatory to achieve optimal correction. Temporary HED through tension band devices such as two-hole-plates or flexible staples has been established as the treatment of choice for growth guidance with excellent results. Implant-associated complications have been significantly reduced through implant modifications. Several experimental procedures have the potential to achieve growth modulation even without the requirement of surgical intervention.

Outbreaks of Salmonella infections attributed to beef --United States, 1973-2011.

Non-typhoidal Salmonella is estimated to be the most common bacterial cause of foodborne illness in the United States, causing an estimated one million domestically acquired foodborne illnesses annually. Recent, large outbreaks have highlighted the importance of ground beef as an important source of multidrug-resistant Salmonella. We analysed the epidemiology of salmonellosis outbreaks that were attributed to beef in the United States reported to the Centers for Disease Control and Prevention (CDC) from 1973 to 2011. During 1973-2011, of the 1965 outbreaks of Salmonella where a food vehicle was implicated, 96 were attributed to beef, accounting for 3684 illnesses. We observed a shift in the type of beef implicated in salmonellosis outbreaks, from roast to ground beef. Delicatessen-style roast beef cooked in commercial processing establishments was the predominant type during the 1970s and early 1980s; regulations on cooking and processing essentially eliminated this problem by 1987. Ground beef emerged as an important vehicle in the 2000s; it was implicated in 17 (45%) of the 38 beef-attributed outbreaks reported during 2002-2011. Although this emergence was likely due in part to increased participation in CDC's PulseNet, which was established in 1996, and proactive decisions by the United States Department of Agriculture's Food Safety and Inspection Service, stronger measures are needed to decrease contamination of ground beef with Salmonella.

Obliquity-paced Pliocene West Antarctic ice sheet oscillations.

Thirty years after oxygen isotope records from microfossils deposited in ocean sediments confirmed the hypothesis that variations in the Earth's orbital geometry control the ice ages, fundamental questions remain over the response of the Antarctic ice sheets to orbital cycles. Furthermore, an understanding of the behaviour of the marine-based West Antarctic ice sheet (WAIS) during the 'warmer-than-present' early-Pliocene epoch ( approximately 5-3 Myr ago) is needed to better constrain the possible range of ice-sheet behaviour in the context of future global warming. Here we present a marine glacial record from the upper 600 m of the AND-1B sediment core recovered from beneath the northwest part of the Ross ice shelf by the ANDRILL programme and demonstrate well-dated, approximately 40-kyr cyclic variations in ice-sheet extent linked to cycles in insolation influenced by changes in the Earth's axial tilt (obliquity) during the Pliocene. Our data provide direct evidence for orbitally induced oscillations in the WAIS, which periodically collapsed, resulting in a switch from grounded ice, or ice shelves, to open waters in the Ross embayment when planetary temperatures were up to approximately 3 degrees C warmer than today and atmospheric CO(2) concentration was as high as approximately 400 p.p.m.v. (refs 5, 6). The evidence is consistent with a new ice-sheet/ice-shelf model that simulates fluctuations in Antarctic ice volume of up to +7 m in equivalent sea level associated with the loss of the WAIS and up to +3 m in equivalent sea level from the East Antarctic ice sheet, in response to ocean-induced melting paced by obliquity. During interglacial times, diatomaceous sediments indicate high surface-water productivity, minimal summer sea ice and air temperatures above freezing, suggesting an additional influence of surface melt under conditions of elevated CO(2).

Quantifying inter-individual anatomical variability in the subcortex using 7 T structural MRI.

Functional magnetic resonance imaging (MRI) data are usually registered into standard anatomical space. However, standard atlases, such as LPBA40, the Harvard-Oxford atlas, FreeSurfer, and the Jülich cytoarchitectonic maps all lack important detailed information about small subcortical structures like the substantia nigra and subthalamic nucleus. Here we introduce a new subcortical probabilistic atlas based on ultra-high resolution in-vivo anatomical imaging from 7 T MRI. The atlas includes six important but elusive subcortical nuclei: the striatum, the globus pallidus internal and external segment (GPi/e), the subthalamic nucleus, the substantia nigra, and the red nucleus. With a sample of 30 young subjects and carefully cross-validated delineation protocols, our atlas is able to capture the anatomical variability within healthy populations for each of the included structures at an unprecedented level of detail. All the generated probabilistic atlases are registered to MNI standard space and are publicly available.

Ice sheet-free West Antarctica during peak early Oligocene glaciation.

One of Earth's most fundamental climate shifts, the greenhouse-icehouse transition 34 million years ago, initiated Antarctic ice sheet buildup, influencing global climate until today. However, the extent of the ice sheet during the Early Oligocene Glacial Maximum (~33.7 to 33.2 million years ago) that immediately followed this transition-a critical knowledge gap for assessing feedbacks between permanently glaciated areas and early Cenozoic global climate reorganization-is uncertain. In this work, we present shallow-marine drilling data constraining earliest Oligocene environmental conditions on West Antarctica's Pacific margin-a key region for understanding Antarctic ice sheet evolution. These data indicate a cool-temperate environment with mild ocean and air temperatures that prevented West Antarctic Ice Sheet formation. Climate-ice sheet modeling corroborates a highly asymmetric Antarctic ice sheet, thereby revealing its differential regional response to past and future climatic change.

Fibula-Assisted Segment Transport (FAST) for Defect Reconstruction after Resection of Tibial Adamantinoma: Report of Two Treatments.

Intramedullary limb lengthening via lengthening nails has been performed for more than three decades to overcome leg length inequalities. Plate-assisted bone segment transport (PABST) has recently been described for the reconstruction of segmental bone defects. We modified this procedure by using the ipsilateral fibula as a "biological plate" and report on its technical particularities and application in the reconstructive treatment of adamantinomas of the tibia in two patients. Both patients were successfully treated by wide resection and reconstruction of the tibial bone via bone segment transport through an expandable intramedullary nail using the remaining ipsilateral fibula to provide stabilization and guidance. This procedure was titled "fibula-assisted segment transport" (FAST). This is a new and promising technique that allows an entirely biological reconstruction of large bone defects of the tibia.

Influence of diabetes on cardiac nitric oxide synthase expression and activity.

UNLABELLED: There is some evidence that the endothelium dependent vasodilatation of coronary arteries is impaired in both types of diabetes. The underlying mechanisms are not yet clear, in particular whether this defect is caused by a direct effect of diabetes on the activity and the expression of nitric oxide synthases (NOS) or indirectly by an enhanced inactivation of nitric oxide. METHODS: To study this question we determined the activity (conversion of L-arginine to citrulline) and the mRNAs encoding the isoforms of NOS (using polymerase chain reaction after reverse transcription of the mRNAs into cDNAs by reverse transcriptase) in hearts of streptozotocin diabetic rats and in rat heart endothelial cells (RHEC). The formation of reactive oxygen intermediates (ROI) was measured by the dichloro-dihydro-fluorescein method. RESULTS: The activity of total NOS and the amounts of mRNAs encoding ecNOS and iNOS were dependent on the duration of diabetes. After a diabetes duration of 4 to 6 weeks both the total activity as well as the mRNAs encoding ecNOS and iNOS were elevated. A reduction of NOS activity and the amounts of mRNAs of ecNOS and iNOS was only seen after a diabetes duration longer than 20 weeks, a time at which a loss of endothelium has been described. In RHEC, high glucose (22 mM) and H(2)O(2) (100 microM) were able to increase the mRNA encoding ecNOS, but not iNOS. This increase in ecNOS mRNA was inhibited by lipoic acid (1 microM). In addition, high glucose (22 and 30 mM) led to an enhanced formation of ROI and to activation of the transcription NF kappa B. CONCLUSION: These observations suggest that diabetes causes a temporary increase in NOS activity and ecNOS mRNA in the rat heart which is presumably the consequence of an enhanced oxidative stress exerted by hyperglycaemia. Together with previously published observations, our data suggest that the impairment of endothelium dependent vasodilatation in rat heart is not the consequence of a reduced activity and expression of NOS, but is caused by an enhanced inactivation of nitric oxide by ROI.

Diagnosis and classification of amyloidosis by an immuno-histological method.

Following the recent classification of amyloidosis by the amyloid proteins involved, we decided to approach its tissue diagnosis and chemical classification by an immunohistological method. Post-mortem tissue specimens from various organs of patients with primary and secondary amyloidosis were examined by the immunoperoxidase technique with specific antibodies against proteins AL and AA which respectively characterize primary and secondary amyloidosis. The major advantage of this technique is that it can be applied to formalin fixed, paraffin embedded tissues. The immunoperoxidase technique proved to be extremely sensitive for the detection of amyloid deposits. Moreover, the deposited proteins could be clearly characterized as AL or AA by the specific anti-sera. We therefore believe that the immunooperoxidase technique is extremely useful for the early tissue diagnosis and chemical classification of amyloidosis.

Fine structure of Sertoli and Leydig cells in azoospermic human testis.

Testicular biopsy specimens taken from seven patients with azoospermia were studied by electron microscopy. We considered the possibility of a relationship between the annulate lamellae in the Sertoli cells and azoospermia. In the Leydig cells, we observed intranuclear and intracytoplasmic paracrystalline inclusions and considered their relationship with the Reinke crystalloid.

PIP: Special attention was given to the ultrastructure of 2 organelles: the annulate lamellae in the Sertoli cells and the crystalloid structure visible in the Leydig cells. Materials studied were biopsy specimens from 7 31-41 year old cases of male infertility with azoospermia or severe oligospermia. All biopsy specimens were bilateral. By light microscopy tubular atrophy with fibrosis and thickening of the boundary layer was observed. changes in the tubuli were characterized by an arrest of spermatogenesis at the stage of priamry spermatocyte production. Hyperplasia of Sertoli cells was noted with many fat vacuoles in the cytoplasm. Scattered large Sertoli cells contained Reinke crystalloids. By electron microscopy, large and irregular Sertoli cells contained abundant intracytoplasmic organelles and a prominent nucleus. The subcellular structures of the cytoplasm were all observed to be present. A specific organelle, the annulate lamellae or lamellar body, was seen in tight correlation with other structures near the nucleus. Other structural details observed are noted. Photographic reproductions illustrate electron microscopic findings. Although the presence of paracrystalline material is not specific to priamry testicular failure, the prominence of this structure in azoospermic human testes could be an expression of some modifications in the male hormone metabolism. It is suggested that a local estrogenic hyperaction could be the cause of depressed spermatogenesis and thus lead to azoospermia.

The emphatic and pharyngeal sounds in Hebrew and in Arabic.

This study addresses physiological, acoustic, and linguistic issues in the production of the emphatic sounds [in text] and the pharyngeal sounds [in text]. Approximately 300 minutes of video recordings were obtained from nine Hebrew and Arabic speakers, using a fiberscope positioned in the upper pharynx and simultaneous audio recording through an external microphone. We also studied a cineradiographic film of three Arabic speakers. Results clearly show that all the emphatic sounds, when pronounced as such, share pharyngealization as a secondary articulation. A constriction is formed between the pharyngeal walls and the tip of the epiglottis, which tilts backwards. To a lesser degree, the lower part of the root of the tongue is also retracted. The data show that all the emphatic and pharyngeal sounds we studied are made with qualitatively the same pharyngeal constriction. However, the pharyngeal constriction is more extreme and less variable for the pharyngeal sounds, where it is the primary articulation, than for the emphatic sounds, where it is a secondary articulation. Because the same sort of pharyngealization is seen for all the emphatics, we use a common notational symbol, [in text], for all of them, including [in text] in place of /q/. We note that where pharyngeals and pharyngealized sounds were realized, the Hebrew and Arabic speakers produced them in essentially the same way.

Pulmonary adenocarcinoma in cattle / Adenocarcinoma pulmonar en bovinos

The Macroscopic, histological and immunohistochemical aspects of lung acinar adenocarcinoma and the presence of nodules in the abdominal cavity of an adult female bovine are reported. In the necropsy analysis samples were collected from the: lung, heart, spleen, liver, pancreas, kidney, uterus, intestine, brain, and from nodules found in the lung and abdominal cavity, which were routinely processed to be stained by hematoxylin-eosin and for an immunohistochemistry exam with the antibodies: cytokeratin (dilution 1:200 µL) and vimentin (dilution 1:1000 µL). The histopathological examination revealed neoplastic epithelial cells with acini formation. The immunohistochemical examination of the tumor cells showed positive marking for cytokeratin and the absence of marking for vimentin. According to anatomical, morphological, and histopathological findings, as well as the result of the immunohistochemical examination, the tumor was characterized as lung acinar adenocarcinoma.

Se relatan los aspectos macroscópicos, histológicos e inmunohistoquímicos de un adenocarcinoma acinar pulmonar y la presencia de nódulos en la cavidad abdominal en una hembra bovina adulta. En el análisis necroscópico fueron colectados fragmentos de: pulmón, corazón, bazo, hígado, páncreas, riñón, útero, intestino, encéfalo y de los nódulos hallados en pulmón y cavidad abdominal, los cuales fueron procesados rutinariamente para ser teñidos mediante Hematoxilina-Eosina y para examen inmunohistoquímico con los anticuerpos: citoqueratina (con dilución 1:200 µL) y vimentina (dilución 1:1000 µL). El examen histopatológico reveló células epiteliales neoplásicas con formación de acinos. El examen inmunohistoquímico de las células neoplásicas demostró marcación positiva para citoqueratina y ausencia de marcación para vimentina. De acuerdo con los hallazgos anatómicos, morfológicos, histopatológico, y el resultado del examen inmunohistoquímico, se logró caracterizar el tumor como adenocarcinoma acinar pulmonar.

Breastfeeding. Toward resolution of the unsatisfying birth experience.

The act of birth and the way that it is managed have great meaning for many women. What may appear to professionals as a routine or unremarkable delivery may be perceived by the mother as humiliating, mutilating, or dehumanizing. If the mother has an extremely negative perception of her birth experience, she will suffer a loss of self esteem, and it is more likely that she will have difficulty taking on the maternal role. A successful brestfeeding experience builds up a mothers' confidence and self esteem and facilitates acquisition of the maternal role. The problem with relying upon breastfeeding to determine or establish maternal identity is that failure or untimely termination may occur for a variety of reasons. Anticipatory guidance and emotional support are the primary approaches to be used in helping a mother to nurse her baby for as long as she wants.

Histochemical studies of human breast tumors: Activity of alkaline phosphatase, acid phosphatase and glucose-6-phosphate dehydrogenase.

Histochemical studies of human breast tumors were performed with particular emphasis on the activity of alkaline phosphatase (AIP), acid phosphatase (AcP) and glucose-6-phosphate dehydrogenase (G6PDH). Enzyme activities in benign and malignant lesions were compared. AIP was prominent in normal mammary epithelium, limited to the myoepithelial layer in benign tumors and was absent in cords of malignant cells. AcP activity was faintly detected in normal mammary epithelium, increased in canalicular epithelium of fibroadenomas and was marked in malignant cells. G6PDH exhibited marked activity in neoplastic epithelium and the stroma of nearly all carcinomas studied, whereas in benign tumors, G6PDH activity was strictly limited to the connective tissue. The study suggests a strong correlation between G6PDH activity and malignancy. The different results obtained by various workers in this field are critically reviewed, and discussed in the light of the results of the present study.

Demonstration of amyloid in murine and human secondary amyloidosis by the immunoperoxidase technique.

A specific rabbit anti-murine amyloid A protein (anti-AA) has been used in the immunoperoxidase (IP) technique for the detection of amyloid in formalin-fixed, paraffin-embedded, tissue obtained from amyloidotic mice and a post-mortem kidney specimen from a patient with amyloidosis secondary to osteomyelitis. Amyloidosis was induced in five out of 20 white mice by weekly intraperitoneal injections of complete Freund's adjuvant. Amyloid deposits were clearly demonstrated both by the Congo Red and by the IP techniques. The antibody against murine AA was found to be cross-reactive with human AA. These preliminary results suggest that the IP technique with the use of specific antibodies against the different amyloid proteins might be extremely useful for the histological dianosis and classification of amyloidosis.