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ABSTRACTIntroductionWith the introduction and continuous improvement in operative fracture fixation, even the most severe bone fractures can be treated with a high rate of successful healing. However, healing complications can occur and when healing fails over prolonged time, the outcome is termed a fracture non-union. Non-union is generally believed to develop due to inadequate fixation, underlying host-related factors, or infection. Despite the advancements in fracture fixation and infection management, there is still a clear need for earlier diagnosis, improved prediction of healing outcomes and innovation in the treatment of non-union.Areas coveredThis review provides a detailed description of non-union from a clinical perspective, including the state of the art in diagnosis, treatment, and currently available biomaterials and orthobiologics.Subsequently, recent translational development from the biological, mechanical, and infection research fields are presented, including the latest in smart implants, osteoinductive materials, and in silicomodeling.Expert opinionThe first challenge for future innovations is to refine and to identify new clinical factors for the proper definition, diagnosis, and treatment of non-union. However, integration of invitro, invivo, and in silicoresearch will enable a comprehensive understanding of non-union causes and correlations, leading to the development of more effective treatments.

To describe the diagnosis and management of a 49-year-old woman with multiple sclerosis (MS) developing a progressive hemiparesis and expanding MRI lesion suspicious of progressive multifocal leukoencephalopathy (PML) 19 months after starting natalizumab.

With substantial progress made toward polio eradication, developing the appropriate strategy for discontinuing global oral poliovirus vaccine (OPV) after global eradication becomes increasingly important. At issue is the theoretical risk of independent circulation of potentially virulent OPV-derived strains. Because Cuba uses OPV only in mass campaigns, it represents an ideal site to assess vaccine-derived poliovirus persistence.

The movement of sediments in sewers has been widely recognised as being strongly linked with poor sewer flow quality. Currently, empirically calibrated transport capacity relationships are used to estimate the movement of in-sewer sediments. The majority of these relationships were developed and calibrated with laboratory data sets that used uniformly sized granular sediment. In many combined sewers, there are both organic and inorganic sediments. The fine-grained organic sediments are thought to be able to develop considerable cohesive strength under certain conditions. This paper describes the results from laboratory experiments in which the erosion of non-homogeneous in-pipe sediment deposits was investigated. The types of sediment mixtures used ensured that a range of cohesive deposit strengths was developed. The measured bed load and suspended load were compared with transport capacity relationships currently used for sewer design. Significant divergence between the transport capacity predictions and experimental observations was discovered. It was seen that it is unwise to model in-sewer deposits as homogeneous and granular and that it is important to take into account the impact of deposit cohesion.

Presents a Kappan Special Report on crack cocaine and children. A social epidemic; No social boundaries; Damage to the children; A question of definitions; More. INSET: The story of Kahlil; Ten recommendations for educators, by R.C....

During the course of a stay lasting several years in Montpellier, France, for the study of the phytosociology of rock crevices, the author was also able to study the geographical distribution, and phytosociology of the extremely rare species Ferula glauca DC. After a short introduction to the history, nomenclature and morphology of Ferula, the results of the research on the distribution of the species, with special emphasis on the sites found in the Bas-Languedoc area, are summarized in the form of a map. The accompanying vegetation is also described, and as will be shown, a series of consistently associated species and their peculiar ecologies, allow the description of a new association designated the Brachypodio-Feruletum glaucae. This association is analyzed in a table with 23 separate vegetation samples. Aside from the presence of Ferula glauca the association can be recognized by the presence of the characteristic species Narcissus dubius (Spain and Southern France), the eumediterranean Melilotus elegans and Urospermum picroides. Finally, the different life forms of the association are described and several observations on Ferula glauca are discussed.

Although poliomyelitis due to wild-virus infection has virtually disappeared from Romania, with no cases having been documented between 1984 and 1989, vaccine-associated paralytic poliomyelitis has been reported at very high rates for over two decades. In November 1990, to decrease the risk of vaccine-associated paralytic poliomyelitis, oral poliovirus vaccine produced in Romania was replaced by imported oral vaccine made by a Western European manufacturer. To better quantify the risk of vaccine-associated paralytic poliomyelitis and the impact of the change in vaccine manufacturer, the authors reviewed clinical, epidemiologic, and laboratory data on poliomyelitis cases that occurred in Romania from 1984 to 1992. Poliovirus isolates were characterized at the US Centers for Disease Control and Prevention. During the period 1984-1992, 132 confirmed cases of paralytic poliomyelitis were reported in Romania, of which 13 were classified as wild-virus-associated, 93 as vaccine-associated, and 26 as "of unknown origin." Wild type 1 poliovirus was isolated during 1990-1992 from nine of 13 (69%) cases in an outbreak that occurred primarily among undervaccinated gypsy children. Vaccine-associated cases were epidemiologically and virologically distinct from wild-virus cases. Of the 93 vaccine-associated cases, 45 children were recipients and 48 were contacts. The overall risk of vaccine-associated paralytic poliomyelitis in Romania (1 case per 183,000 doses of oral poliovirus vaccine distributed) was 14-fold higher than the risk in the United States. The risks of recipient vaccine-associated paralytic poliomyelitis related to the first dose of oral vaccine were similar for Romanian and imported vaccine (1 case per 95,000 doses and 1 case per 65,000 doses, respectively), as were the total risks of vaccine-associated paralytic poliomyelitis. These findings definitively demonstrate a substantially elevated risk of vaccine-associated paralytic poliomyelitis in Romania which was not affected by a change in oral poliovirus vaccine manufacturer.

Reported tetanus cases and tetanus deaths have declined substantially since widespread implementation of tetanus immunization. However, preventable morbidity and mortality continue to occur. During 1979-1984, 74-95 cases of tetanus were reported annually to the Centers for Disease Control (CDC) and 20-31 deaths were reported annually by the National Center for Health Statistics (NCHS). To evaluate further the health impact of tetanus, the authors assessed the completeness of national tetanus mortality data. They reviewed tetanus case report forms received at CDC from the states and NCHS multiple-cause-of-death tapes for 1979-1984. CDC reports recorded 129 deaths and NCHS mortality tapes 197 deaths. Year of death, state, age, and sex were used to match CDC and NCHS deaths, identifying 78 deaths reported to both sources. Using the methodology of Chandra Sekar and Deming, the authors estimated the actual number of tetanus deaths for 1979-1984 to be 326 (95% confidence interval 291-361). Based on this estimate, the completeness of reporting to CDC was 40%, to NCHS 60%, and to the combined systems 76%. To evaluate the reasons for underreporting, the authors contacted 14 states that had reported greater than or equal to 10 cases of tetanus to CDC during 1979-1984 to obtain death certificates for all tetanus deaths and additional information on all tetanus cases. Thirteen states submitted 108 death certificates for review. Coding and other systematic errors did not explain the low reporting efficiency. Failure to list tetanus as a cause of death on the death certificate was the primary reason for nonreporting of tetanus deaths to NCHS. These results suggest that NCHS tetanus mortality data may not be as complete as previously assumed and that tetanus mortality, and probably morbidity, are higher than previous reports have indicated.

Given the demonstrated efficacy of vitamin A supplements in reducing childhood mortality, health officials now have to decide whether it would be efficient to target the supplements to high risk children. Decisions about targeting are complex because they depend on a number of factors; the degree of clustering of preventable deaths, the cost of the intervention, the side-effects of the intervention, the cost of identifying the high risk group, and the accuracy of the 'diagnosis' of risk. A cost-effectiveness analysis was used in the Philippines to examine whether vitamin A supplements should be given universally to all children 6-59 months, targeted broadly to children suffering from mild, moderate, or severe malnutrition, or targeted narrowly to pre-schoolers with moderate and severe malnutrition. The first year average cost of the universal approach was US$67.21 per death averted compared to $144.12 and $257.20 for the broad and narrow targeting approaches respectively. When subjected to sensitivity analysis the conclusion about the most cost-effective strategy was robust to changes in underlying assumptions such as the efficacy of supplements, clustering of deaths, and toxicity. Targeting vitamin A supplements to high risk children is not an efficient use of resources. Based on the results of this cost-effectiveness analysis and a consideration of alternate strategies, it is apparent that vitamin A, like immunization, should be provided to all pre-schoolers in the developing world. Issues about targeting public health interventions can usefully be addressed by cost-effectiveness analysis.

Although zygospore (mature zygote) formation in P. blakeslleeanus occurs in liquid glucoseglutamate medium, morphological observations are made more easily when cultures are grown on 1-mm-thick agar medium. Zygophores (sexually differentiated hyphae) develop prior to physical contact in crosses of (plus) and (minus) wild types. Zygophores interlock upon contact and then undergo six successive morphological changes to become a zygospore. Mutants with abnormal carotene synthesis exhibit aberrant sexual behavior. Some zygospores do form in crosses of carA mutants and wild types. Only paired zygophores form in crosses of wild type(plus) with car-42(minus), a beta-carotene-accumulating mutant. Zygophores form only on (minus) in crosses of wild type(plus) with carB(minus), carR(minus), carAcarR(minus), and carBcarR(minus) mutants, and only on (plus) in crosses of car-43(plus) with wild type(minus), car-42(minus), and carA(minus) mutants. Zygophores do not form in crosses of car-43(plus) with carB(minus), carR(minus), carAcarR(minus), and carBcarR(minus) mutants. These observations demonstrate that each mating type makes a chemical messenger that stimulates zygophore development in the opposite mating type.

A group of sedentary middle‐aged men (N=15) completed a 6‐week exercise program that involved two 6‐minute daily exercise bouts of running‐in‐place. Total body weight, skinfold thickness and serum triglyceride levels were not altered by this mild exercise program. However, increases in the subjects' work capacity and decreases in systolic blood pressure and heart rate for a given work load were observed. The results of measuring systolic time intervals by a noninvasive technique suggested that myocardial contractility at rest had increased after the 6‐week period. These results indicate that a beneficial adaptation of cardiovascular function can occur in sedentary middle‐aged men in response to a mild form of activity that can be accomplished with a minimum of time, inconvenience and facilities. In addition, the use of noninvasive techniques in measuring systolic time intervals appears to be a useful means of evaluating changes in cardiovascular function induced by exercise training.

Combined mating type cultures of Phycomyces blakesleeanus accumulate 41 mg of trisporic acids/l of medium, of which 30% is trisporic acid E. The methyl ester of trisporic acid E exhibits the same zygophore -inducing activity in bioassays with P. blakesleeanus and Mucor mucedo as does the pheromone methyl trisporate C. The structure of methyl trisporate E is 1,5-dimethyl-2-hydroxyl-4-oxo-6-(2'-hydroxyl-6'- methylocta -5',7'-d ien-8'-yl) -5-cyclohexene-1-carboxylic acid methyl ester.

Ohne Zusammenfassung:

The first result of the production of kaonic nuclei by the (K-, n) reaction is presented. The spectra strongly indicate that the antikaon nuclear potential is strongly attractive which seem to contradict to many theoretical predictions. It suggests that the so-called kaon condensation is taking place in the core of neutron stars.