The Ilizarov external fixation frame in compression arthrodesis of large, weight bearing joints

Solid bony fusion of large joints affected with active chronic infections, is still the most effective surgical solution to establish a useful function of the affected limb. Even with extensive peri-articular bone loss and severe deformities, arthrodesis in a functional position can provide effective stability. The reported fusion rates in such patients are not encouraging however, and secondary amputations have been reported. Compression arthrodesis using an Ilizarov external fixation frame was performed for 17 destroyed feet (14 tibiotalar and 3 subtalar joints) and 6 badly disrupted knees in a series of 20 patients. Evaluation of the results was based on the clinical and radiological joint alignment, achievement of fusion, presence or absence of infection, and functional outcome. One patient after knee joint arthrodesis was lost to follow-up, and two knees had developed a clinically stable fibrous union. Solid fusion was obtained in all other joints. All joints were in anatomical alignment and the patients were fully functional at the time of review. Our experience of using the Ilizarov fixation frame for achieving joint fusion is very rewarding. The results reported hereby justify the further use of this hybrid frame as an effective mechanical method to achieve bony joint fusion without bone grafts, and to ensure a low failure rate.     

Intraosseous vascular access in the treatment of chemical warfare casualties assessed by advanced simulation: proposed alteration of treatment protocol

Current treatment protocols for chemical warfare casualties assume no IV access during the early treatment stages. Time constraints in mass casualty scenarios, impaired manual dexterity of medical personnel wearing protective gear, and victims' complex clinical presentations render standard IV access techniques impractical. A newly developed spring-driven, trigger-operated intraosseous infusion device may offer an effective solution. Sophisticated simulators were developed and used to mimic scenarios of chemical warfare casualties for assessing the feasibility of intraosseous infusion delivery. We evaluated the clinical performance of medical teams in full protective gear. The success rate in intraosseous insertion, time to completion of treatment goals, and outcome were measured in a simulated setting. Medical teams from major hospitals in Israel, designated for emergency response in a real chemical warfare mass casualty scenario, were trained in a simulated setting. All 94 participating physicians were supplied with conventional treatment modalities: only the 64 study group physicians received intraosseous devices. The simulated survival rate was 73.4% for the study group and 3.3% for the controls (P < 0.001). Treatment goals were achieved within 3.5 min (range, 1-9 min) in the study group and within >10 min for controls (P < 0.001), and the complication rate for intraosseous use was 13.8%. Personnel satisfaction with the intraosseous device was unanimous and high. New-generation intraosseous infusions have great potential value in the early treatment stages of chemical warfare casualties. IMPLICATIONS: In a chemical warfare mass casualty scenario, the protective gear worn by medical personnel, the time constraints, and the casualties' medical condition impose limitations on the establishment of IV access during early treatment of the victims. A spring-driven, trigger-operated intraosseous infusion delivery system may offer an effective solution.     

Case report: pregnancy outcome following ICSI of oocytes with abnormal cytoplasm and zona pellucida

A couple with unexplained infertility was referred for routine IVF and ICSI treatment. Ovulation was induced by the GnRH analogue protocol combined with HMG and HCG. Preparation of denuded oocytes revealed a major disorder of the zona pellucida and abnormal oocytes. During preparation of ova for ICSI, 15 retrieved oocytes were denuded, 14 of which underwent ICSI treatment. Four of the oocytes collapsed and the remaining 10 appeared to have irregular, fragile zona pellucida. Nevertheless, following ICSI, seven low-quality embryos developed, three of which were transferred into the uterus. Two implantations were achieved, but only one embryo resulted in an uneventful pregnancy and delivery by Caesarean section of a normal female neonate with an Apgar score of 10. It is hypothesized that infertility was due to the abnormal oocyte structure and abnormal zona pellucida, which prevented natural conception. This condition was successfully resolved by the ICSI procedure.     

Young infants' morbidity and exposure to fine particles in a region with two power plants

This study investigated the effect of fine particulate matter (PM2.5) in ambient air on hospital admissions and emergency room (ER) visits among young children (0-3 yr) residing in 4 communities in southern Israel, within an area 5-25 km from the 2 power plants, which operate within 25 km of each other. Daily records of hospitalizations and ER visits for respiratory diseases at the 3 hospitals serving the region were examined for 9 mo, October 1, 2000-June 30, 2001. Mean PM2.5 concentrations for the four communities ranged from 11.6 to 28.1 microg/m3. Time series analysis revealed a statistically significant association (p < 0.05) between the numbers of hospitalizations and ER visits for respiratory symptoms and concentrations of PM2.5. This effect was evaluated for 0-3 lag days, directly, and for interactions with temperatures and seasonal parameters. The respiratory health of young children may be affected by 24 hr concentrations of PM2.5 < 60 microg/m3, the threshold proposed by both Israel and the United States.     

AR-A014418, a selective GSK-3 inhibitor, produces antidepressant-like effects in the forced swim test

The mechanism by which lithium exerts either its anti-manic or antidepressant effects remains to be fully elucidated. Although lithium inhibits the enzyme glycogen synthase kinase-3 (GSK-3) at concentrations that are relevant for treatment of bipolar disorder, it is unclear whether GSK-3-related mechanisms are responsible for its therapeutic effects in the treatment of this disease. We report that AR-A014418 (a selective GSK-3 inhibitor) induces behavioural changes that are consistent with the effects of antidepressant medications. Subacute intraperitoneal injections of AR-A014418 reduced immobility time in rats exposed to the forced swim test, a well-established model for antidepressant efficacy. In addition, the specificity of this effect is supported by our finding that AR-A014418 decreased spontaneous as well as amphetamine-induced activity. Taken together, these data support the hypothesis that lithium may exert its antidepressant effects through inhibition of GSK-3, and that novel small-molecule GSK-3 inhibitors may be useful for the treatment of bipolar disorder and depression.     

Changes in the auditory nerve brainstem evoked responses in a case of maple syrup urine disease

Maple syrup urine disease (MSUD) is a rare metabolic disease due to deficiency in the enzyme that breaks down branched chain amino acids. Lack of the enzyme causes accumulation of these amino acids and, if untreated, causes severe neurological damage. A case study of a 10-day old female infant, born after 40 weeks' gestation with a birthweight of 2740 g with MSUD hospitalized in the acute stage with respiratory failure and severe brain oedema is described. As part of the neurological evaluation, auditory nerve brainstem evoked response testing was conducted and revealed bilateral presence of the first wave from the auditory nerve, with no later brainstem waves. Over the course of days when her condition improved following dialysis treatment and a diet to reach balanced levels of branched chain amino acids, the later brainstem waves appeared on one side, and several weeks later they were also observed on the other side. The possible mechanisms of the reversibility of the appearance of brainstem waves in this case are discussed.     

Cochlear activation at low sound intensities by a fluid pathway

In order to assess the mechanisms responsible for cochlear activation at low sound intensities, a semi-circular canal was fenestrated in fat sand rats, and in other experiments a hole was made in the bone over the scala vestibuli of the first turn of the guinea-pig cochlea. Such holes, which expose the cochlear fluids to air, provide a sound pathway out of the cochlea which is of lower impedance than that through the round window. This should attenuate the pressure difference across the cochlear partition and thereby reduce the driving force for the base-to-apex traveling wave along the basilar membrane. The thresholds of the auditory nerve brainstem evoked responses (ABR) and of the cochlear microphonic potentials were not affected in the fenestration experiments. In addition, holes in the scala vestibuli of the first turn did not cause ABR threshold elevations. These results contribute further evidence that at low sound intensities the outer hair cells are probably not activated by a base-to-apex traveling wave along the basilar membrane. Instead it is possible that they are excited directly by the alternating condensation/rarefaction fluid pressures induced by the vibrations of the stapes footplate. The activated outer hair cells would then cause the localized basilar membrane movement.     

Predicting molecular interactions in silico: II. Protein-protein and protein-drug docking

This article reviews the docking field starting from basic docking algorithms and describing the latest advances. We present the algorithmic framework and classify the state of-the-art methods. We point out the bottlenecks of the methods, like flexibility, absence of absolute scoring functions and explain what types of information can potentially be added to improve the results.