Management of open olecranon fractures using clamp-cum-compressor device

Background:

Open fractures of olecranon are not a rare occurrence in patients with road traffic accidents particularly motor bike riders who don''t use elbow guards. Definitive treatment has to be delayed in many till the wound heals. The present study was conducted to evaluate the results of open fractures of olecranon using clamp-cum-compressor device.

Materials and Methods:

Seventeen patients between the ages of 20 and 45 years of open olecranon fractures reported 5-20 days after injury were treated using an indigenous clamp-cum-compressor. All fractures were Mayo type II-A, i.e., displaced, stable and noncomminuted. Four patients had Gustilo-Anderson grade I and 13 had Gustilo-Anderson grade II open fractures. The patients with transverse or short oblique fractures were included in the study. The apparatus was applied under regional anesthesia after thorough washing and debridement of wounds with few loose sutures applied wherever needed. The wounds healed within 2-4 weeks and fractures united within 8-10 weeks. The elbow was mobilized with apparatus still in place. The results were evaluated by MayoElbow performance score.

Results:

We achieved excellent results in twelve patients, good in four and poor in one patient, who reported late, hooks of the apparatus were cut through the proximal fragment, leading to union of fracture in elongation and restricted elbow movements.

Conclusion:

The apparatus was found to be quite useful in transverse and short oblique fractures with contamination or infection, where internal fixation has to be delayed or avoided.     

Neighborhood community characteristics associated with HIV disease outcomes in a cohort of urban women living with HIV

Recent studies have found geographic variations in immune and viral human immunodeficiency virus (HIV) disease outcomes associated with census measures of neighborhood poverty and segregation. Although readily available, such aggregate census measures are not based on health behavior models and provide limited information regarding neighborhood effect pathways. In contrast, survey-based measures can capture specific aspects of neighborhood disadvantage that may better inform community-based interventions. Therefore, the aim of this study is to assess the measurement validity of multi-dimensional survey measures of neighborhood disorder compared with census measures as predictors of HIV outcomes in a cohort of 197 low-income women in a major metropolitan area. The multi-dimensional survey measures were related to each other and to census measures of concentrated poverty and racial segregation, but not so highly correlated as to be uniform. We found notable variation between community areas in women’s CD4 levels but there was no corresponding geographic variance in viral load, and relationships between community area measures and viral load disappeared after adjustment for individual characteristics, including HIV treatment adherence. In multilevel models adjusting for individual characteristics including substance use, depression, and HIV treatment adherence, one survey measure of neighborhood disadvantage (poor-quality built environment) and one census measure (racial segregation) were significantly associated with greater likelihood of CD4?p?相似文献   

The malignant cells in a Lennert's lymphoma are T lymphocytes with a mature helper surface phenotype. A multiparameter flow cytometric analysis

The flow cytometric analysis of DNA content in cells obtained from a case of Lennert's lymphoma demonstrated the presence of a discrete hypotetraploid cell population. Correlated multiparameter analysis of DNA, light scatter, and surface antigens by flow cytometry showed that the hypotetraploid cells were intermediate to large cells expressing T11, T3, and T4 antigens and lacking B1 and T8 antigens. These findings suggest that Lennert's lymphoma represents a malignant neoplasm of T- helper lymphocytes.     

Pathogenesis of B cell lymphoma in a patient with AIDS

Lymphoma occurs at increased frequency in patients with the acquired immunodeficiency syndrome (AIDS). We studied, using serologic and molecular techniques, one such lymphoma for (a) evidence of infection with human T lymphotropic virus, type III (HTLV-III), and Epstein-Barr virus (EBV), (b) monoclonal rearrangement of immunoglobulin and T cell receptor genes, and (c) rearrangement of the c-myc oncogene. Immunoglobulin and T cell receptor gene studies demonstrated that the tumor was of monoclonal B cell origin. Similar to cases of Burkitt's lymphoma unrelated to AIDS, there were DNA sequences in the lymphoma that hybridized to EBV-specific probes and demonstrated evidence of c- myc rearrangement. HTLV-III sequences were not detected in the malignant B cells. The pathogenesis of some B cell neoplasms in patients with the syndrome may involve transformation by EBV and deregulation of oncogene expression without direct infection of the malignant B cells by HTLV-III.     

Comparison of mutagenesis by O6-methyl- and O6-ethylguanine and O4- methylthymine in Escherichia coli using double-stranded and gapped plasmids

To compare mutagenesis by O6-methylguanine (m6G), O4-methylthymine (m4T) and O6-ethylguanine (e6G), and assess their genotoxicity in Escherichia coli, double-stranded and gapped plasmids were constructed containing a single m6G, e6G or m4T in the initiation codon (ATG) of a lacZ' gene. Modified base induced mutations were scored by the loss of lacZ' activity on X-gal-containing media resulting in formation of white or sectored (mutant) rather than blue (non-mutant) colonies. Genotoxicity experiments with gapped plasmids containing the modified bases indicated that m4T produced a greater number of bacterial colonies than m6G or e6G. m4T was more mutagenic (45% mutant colonies) than m6G (6%) or e6G (11%) in repair competent (w.t.) E. coli when incorporated in double-stranded plasmids. In gapped plasmids, m4T produced 99% mutant colonies (as was observed previously for e6G) in both w.t. E. coli or E. coli deficient in both O6-alkylguanine-DNA alkyltransferases as well as methylation-directed mismatch repair (ada(- )-ogt(-)-mutS[-]). m6G in gapped plasmids produced 62% mutant colonies in w.t. E. coli, but this percentage increased to 94% in the ada(-)- ogt(-)-mutS(-) strain. In double-stranded plasmids both m4T and m6G produced very similar distributions of mutant and non-mutant colonies in the ada(-)-ogt(-)-mutS(-) strain. These observations led to the conclusion that differences in the mutagenicity of m6G and m4T in w.t. E. coli were a result of preferential repair of m6G compared to m4T by alkyltransferase and mismatch repair mechanisms, and did not reflect differences in their respective coding efficiency or their inherent obstructiveness to DNA synthesis as was observed with e6G. The combination of alkyltransferase and mismatch repair was concluded to be primarily responsible for the apparent genotoxicity of m6G compared to m4T in double-stranded plasmids.      

右胸小切口在心内直视手术中的应用

0　引言　我院自 1997- 0 8/ 1998- 12 ,对先天性心脏病 ,风湿性心瓣膜病患者应用右胸小切口和心脏不停跳法等微创技术在体外循环下完成心内直视手术 40例 ,全部获得成功 .1　对象和方法　全组 40 (男 12 ,女 2 8)例 ,年龄 2～ 31岁 ,平均 10 .5岁 .先天性心脏畸形包括房间隔缺损 14例 ,室间隔缺损 2 2例 ,部分型房室管畸形 1例 ,合并畸形有肺动脉瓣狭窄 ,右室流出道狭窄 ,部分肺静脉畸形引流各 1例 .风湿性心脏病3例 ,均为二尖瓣狭窄 ,其中 2例直视成形 ,1例换瓣 .所有病例均全麻 ,气管插管 ,右乳房下弧形切口 37例 ,右腋下直切口3例 .切口…     

Occupational chemical exposures in pregnancy and fetal growth: evidence from the Born in Bradford Study

ObjectivesThis prospective birth cohort study evaluated the effect of occupational exposure to endocrine disrupting chemicals (EDC) during pregnancy on inadequate fetal growth as measured by small-for-gestational age (SGA) and inadequate fetal growth measured by percentage of optimal birth weight (POBW). The study also identified the maternal characteristics associated with an increased risk of exposure to EDC.MethodsWe studied 4142 pregnant women who were in paid employment during pregnancy and participated in a population-based, prospective 2007–2011 birth cohort study, the Born in Bradford Study, with an estimated participation of 80%. Job titles were coded at 26–28 weeks’ gestation at a 4-digit level according to 353 unit groups in the 2000 UK Standard Occupational Classification. They were then linked to expert judgment on exposure to each of ten EDC groups as assessed through a job exposure matrix (JEM). We performed generalized estimation equation modelling by a modified Poisson regression to assess the risk of POBW and SGA associated with an increased risk of chemical exposures.ResultsThe frequency of POBW<85 significantly increased for mothers exposed to pesticides [adjusted risk ratio (RR_adj) 3.72, 95% confidence interval (CI) 1.40–9.91] and phthalates (RR_adj 3.71, 95% CI 1.62–8.51). There was a 5-fold increase risk of SGA for mothers exposed to pesticides (RR_adj 5.45, 95% CI 1.59–18.62). Veterinary nurses and horticultural trades were most frequently associated with exposure to pesticides while hairdressers, beauticians, and printing machine minders were associated with phthalates.ConclusionMaternal occupational exposure to estimated concentrations of pesticides and phthalates is associated with impaired fetal growth.     

How to schedule night shift work in order to reduce health and safety risks

Objectives:This discussion paper aims to provide scientifically based recommendations on night shift schedules, including consecutive shifts, shift intervals and duration of shifts, which may reduce health and safety risks. Short-term physiological effects in terms of circadian disruption, inadequate sleep duration and quality, and fatigue were considered as possible links between night shift work and selected health and safety risks, namely, cancer, cardio-metabolic disease, injuries, and pregnancy-related outcomes.Method:In early 2020, 15 experienced shift work researchers participated in a workshop where they identified relevant scientific literature within their main research area.Results:Knowledge gaps and possible recommendations were discussed based on the current evidence. The consensus was that schedules which reduce circadian disruption may reduce cancer risk, particularly for breast cancer, and schedules that optimize sleep and reduce fatigue may reduce the occurrence of injuries. This is generally achieved with fewer consecutive night shifts, sufficient shift intervals, and shorter night shift duration.Conclusions:Based on the limited, existing literature, we recommend that in order to reduce the risk of injuries and possibly breast cancer, night shift schedules have: (i) ≤3 consecutive night shifts; (ii) shift intervals of ≥11 hours; and (iii) ≤9 hours shift duration. In special cases – eg, oil rigs and other isolated workplaces with better possibilities to adapt to daytime sleep – additional or other recommendations may apply. Finally, to reduce risk of miscarriage, pregnant women should not work more than one night shift in a week.