Ankle fusion in a high risk population: an assessment of nonunion risk factors.

Between July 1992 and April 1996, 88 ankle fusions were performed at our institution. Sixty-seven of these had adequate follow-up for evaluation for union of the fusion, including adequate records and/or radiographs. The average age of patients was 43 years. There were 37 men and 24 women. The charts were reviewed to determine what level of trauma had resulted in posttraumatic arthritis (low energy, high energy, or open fracture). Alcohol use, drug abuse, diabetes, peripheral vascular disease, psychiatric history, smoking, or technical problems were also assessed. A chi-square analysis was used to evaluate the statistical significance. Nineteen of sixty-seven ankle fusions progressed to nonunion (28%). Eighty-five percent of the patients had posttraumatic arthritis. Among 17 patients with a history of open trauma, nine patients developed a nonunion (P < 0.03). A trend toward significance was noted for patients who were smokers, drank alcohol, had diabetes, had a psychiatric disorder, or used illegal drugs. Even with current techniques, this study demonstrates that a high risk population in a trauma center is at risk for nonunion after an ankle fusion caused by multiple risk factors, including a history of open trauma, tobacco use, alcohol use, illegal drug use, a history of psychiatric disorders, or diabetes.     

Factors associated with parental grief reaction following pediatric acquired brain injury

ABSTRACT

The present study investigated factors associated with parental grief reaction (PGR) following pediatric acquired brain injury (ABI), and compared PGR to the one exhibited following child death. Fifty-seven parents of 51 children (aged 3–18) whose ABI occurred 1–14 years before participation, completed the multi-scale Two-Track Bereavement Questionnaire; a socio-demographic questionnaire; and a scale assessing perceived behavioural changes in the child. Results from regression analysis indicated that time since injury had no impact on parents’ grief other than having an adverse impact on their overall coping and functioning; A higher amount of weekly caring hours predicted only a greater traumatic perception of the loss; Older children’s ages but mostly greater parental-perceived behavioural changes, predicted greater PGR on most scales. PGR was compared with the pre-existing data of bereaved parents who completed the same grief questionnaire. Although grief response patterns and intensity were similar in both groups, significant differences were found on scales assessing the continuing bond with the child: relational active grief, close and positive relationship, and conflictual relationship. Our findings indicate that parental grief is multi-dimensional following pediatric ABI and illuminate the interplay between elements characterizing parents’ nonfinite vs. finite loss experience.     

Multiple origins of obligate nematode and insect symbionts by a clade of bacteria closely related to plant pathogens

Obligate symbioses involving intracellular bacteria have transformed eukaryotic life, from providing aerobic respiration and photosynthesis to enabling colonization of previously inaccessible niches, such as feeding on xylem and phloem, and surviving in deep-sea hydrothermal vents. A major challenge in the study of obligate symbioses is to understand how they arise. Because the best studied obligate symbioses are ancient, it is especially challenging to identify early or intermediate stages. Here we report the discovery of a nascent obligate symbiosis in Howardula aoronymphium, a well-studied nematode parasite of Drosophila flies. We have found that H. aoronymphium and its sister species harbor a maternally inherited intracellular bacterial symbiont. We never find the symbiont in nematode-free flies, and virtually all nematodes in the field and the laboratory are infected. Treating nematodes with antibiotics causes a severe reduction in fly infection success. The association is recent, as more distantly related insect-parasitic tylenchid nematodes do not host these endosymbionts. We also report that the Howardula nematode symbiont is a member of a widespread monophyletic group of invertebrate host-associated microbes that has independently given rise to at least four obligate symbioses, one in nematodes and three in insects, and that is sister to Pectobacterium, a lineage of plant pathogenic bacteria. Comparative genomic analysis of this group, which we name Candidatus Symbiopectobacterium, shows signatures of genome erosion characteristic of early stages of symbiosis, with the Howardula symbiont’s genome containing over a thousand predicted pseudogenes, comprising a third of its genome.

Intimate symbioses involving intracellular bacteria have transformed eukaryotic life (1, 2), with mitochondria and chloroplasts as canonical examples. More recent, yet still ancient, acquisitions of obligate bacterial intracellular endosymbionts have enabled colonization and radiation by animals into previously inaccessible niches, such as feeding on plant sap and animal blood (3), and surviving in deep-sea hydrothermal vents (4). Among the most difficult questions to resolve in the study of obligate symbiosis are how do obligate symbioses evolve, and where do obligate symbionts come from? This is particularly challenging because most of the obligate symbioses that have been studied are ancient, making it extremely difficult to identify early or intermediate stages.One of the most common ways to acquire an obligate symbiont is via symbiont replacement (5). As a result of a lifestyle shaped by genetic drift, vertically transmitted obligate symbionts follow a syndrome of accumulation of deleterious mutations, leading to genome degradation and reduction (6). A common pattern is that they are replaced by other less broken symbionts that may then renew the cycle of genomic degradation (7). Here the symbiont, which is often descended from common facultative symbionts or parasites (8, 9), is fitted into an established and well-functioning symbiosis (i.e., with a “symbiont-experienced” host). For example, the symbiont Sodalis has independently given rise to numerous obligate nutritional symbioses in blood-feeding flies and lice, sap-feeding mealybugs, spittlebugs, hoppers, and grain-feeding weevils (9).Less studied are young obligate symbioses in host lineages that did not already house obligate symbionts (i.e., “symbiont-naive” hosts) (10). Some of the best known examples originate through host manipulation by the symbiont via addiction or reproductive control. Addiction or dependence may be a common route for obligate symbiosis (11), and one of the most famous examples occurred in the laboratory, on the timescale of years, where strains of Amoeba evolved to become entirely dependent on intracellular symbionts (12). Many maternally inherited symbionts of terrestrial arthropods induce parthenogenetic (i.e., all female) reproduction in their hosts (13); accumulation of deleterious mutations in genes required for sexual reproduction will result in hosts that are unable to reproduce if cured of their symbiont (14). However, despite advances in microbial surveys, there are still few examples of young obligate symbioses that result in novel host functions. One intriguing example involves spheroid bodies, nitrogen-fixing organelles found in rhopalodiacean diatoms, that originated from a single acquisition of a cyanobacterial symbiont as recently as ∼12 Mya (15, 16).Here we report the discovery of a nascent obligate symbiosis in Howardula aoronymphium, a well-studied nematode parasite of Drosophila (17), most recently in the context of a defensive symbiosis. A common host species, Drosophila neotestacea, harbors a strain of the facultative inherited symbiont Spiroplasma that protects it against nematode-induced sterility (18). The protection provided by Spiroplasma is so strong that symbiont-infected flies are spreading across North America and replacing their uninfected counterparts (19). Surprisingly, we have found that H. aoronymphium itself harbors an intracellular bacterial symbiont that is related to Pectobacterium, a well-studied group of plant pathogens often vectored by insects. We also report that the nematode symbiont, which we name Candidatus Symbiopectobacterium (and hereafter Symbiopectobacterium), is a member of a widespread lineage of invertebrate symbionts that has independently given rise to at least four obligate symbioses, one in nematodes and three in insects, representing an exciting model for the study of obligate symbiosis.     

Sonographic assessment of the lower uterine segment during active labor in women with or without a uterine scar – a prospective study

Objectives: No study thus far has evaluated the LUS thickness in active labor. In this study, we endeavored to assess the LUS during active labor.

Methods: Using transabdominal sonography in the mid-sagittal position with a full urinary bladder, the thickness of the LUS was measured during active labor phase in women with or without a history of a previous cesarean section.

Results: A total of 28 women with a previous cesarean delivery were compared to 29 women without a history of uterine surgery. The median LUS was significantly thinner in women with a uterine scar both during (4 versus 5?mm, p?=?.001) and between contractions (5 versus 7?mm, p?=?.011). Paired comparison of LUS thickness between and during contractions within each group showed that thinning of LUS during contraction was significant for both the previous CS group (p?p?Conclusions: In this study, we characterized for the first time the LUS during active labor. We found that LUS was significantly thinner in women after a previous CS and that the LUS was significantly thinner during contraction.     

Correlation between clinical fetal head station and sonographic angle of progression during the second stage of labor

Purpose: To investigate the correlation between the angle of progression and the clinical fetal head station (FHS) during the second stage of labor, and to build reference range.

Materials and methods: A prospective, observational study was conducted. Women carrying singleton term pregnancies were enrolled during the second stage of labor. FHS was assessed manually by a senior obstetrician, while the angle of progression (AOP) was assessed by transperineal ultrasound (TPU). Both examiners were blinded to each others results. The correlation between the sonographic AOP and the clinical FHS was analyzed.

Results: Seventy patients comprised the study group. Clinical FHS demonstrated an excellent correlation with the sonographic measurement of AOP (Pearson’s Correlation 0.642, p?2?=?0.423, p?Conclusions: Our results demonstrate a significant correlation between the clinical FHS and the TPU measured AOP. These standardized sonographic values may serve the obstetrician as a reliable, objective auxiliary tool for the evaluation of the FHS during the second stage of labor.     

Management strategies of the interaction between direct oral anticoagulant and drug-metabolizing enzyme inducers

Journal of Thrombosis and Thrombolysis - Little is known regarding the management of direct oral anticoagulants (DOACs) in patients with enzyme-inducing drugs (EID). The use of EID may lead to...