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Objective To illustrate the obstetrical outcome after B-Lynch sutures and ligation of the uterine arteries. Case A 26-year-old nulliparous woman. A caesarean section performed for obstructed labour was complicated by uterine atony. A B-Lynch uterine compression suture technique was used combined with ligation of the ascending branches of the uterine arteries. Before the subsequent fertility treatment, gel instillation sonography and power Doppler imaging showed a normal uterine cavity and restored myometrial vascularization. Subsequent caesarean section showed external adhesions on the anterior uterine serosa. A healthy baby of normal weight was delivered. There was focal placenta accreta; the underlying myometrium was strikingly thinner and prone to inversion. Discussion After B-Lynch sutures and ligation of the ascending branches of the uterine arteries, the pregnancy was subsequently uncomplicated. The potential association between B-Lynch sutures and placenta accreta or uterine inversion in a subsequent pregnancy has to be assessed in further studies. This case report illustrates how 3D gel instillation sonography is a valuable tool to evaluate the integrity of the uterine cavity., Highlights • 3D gel instillation sonography gives the best evaluation of the uterus after B-Lynch sutures have been used. • Normal fertility and pregnancy are possible after B-Lynch sutures have been used. • Normal fertility and pregnancy are possible after ligation of the uterine arteries. • B-Lynch sutures and ligation of the uterine arteries are useful in postpartum haemorrhage.

Supporting info item, per2092-sup-0002-Data_supplement_Appendix 2_figures for Using Indirect Measurement Tasks to Assess the Self–Concept of Personality: A Systematic Review and Meta–Analyses by De Cuyper K., De Houwer J., Vansteelandt K., Perugini M., Pieters G., Claes L. and Hermans D. in European Journal of Personality

Clinical studies do not allow a quantitative correlation between stability of fracture fixation and outcome of bone healing. This limits the biomechanical improvement of fracture fixation techniques. The most practical quantitative parameter to describe the stability of a fracture fixation is the stiffness. This can be determined for several types of fixation through biomechanical methods and in some clinical studies in vivo. By using numerical fracture healing models, it is now possible to use the tissue differentiation rules found in basic research to calculate optimal stiffness parameters for various fixation techniques. For a tibial fracture as an example the possibilities of a numerical fracture healing simulation have been demonstrated. The effects of the diameter of an intramedullary nail, type of fracture, fracture gap size and nail material on healing could be demonstrated. To circumvent complex and time consuming calculations for several fixations a map was calculated which shows the expected bone healing quality as a function of the axial stiffness and the shear stiffness of the fixation device. By comparing the stiffness of various fixation techniques with the stiffness map it becomes evident that the methods most often used (e.g. unreamed nail, plate and external fixator) have a low shear and/or rotational stiffness that is too low to achieve the optimal healing outcome. The high axial stiffness of plates next to the plate surface can lead to very low tissue strain directly adjacent to the plate and can delay the bone healing process at this location.

Introduction Pharmacist receive a lot of publicity for OTC products. Often one or more literature references are mentioned to support the advertising claims. Objective In this study we examine: [1) whether the advertising claim is consistent with what is stated in the literature references mentioned on the leaflet and [2] whether these literature references are trustworthy. Method Through 60 randomly selected community pharmacies, pharmacist-directed advertisements for OTC products I= medicines, medical devices, dietary supplements and parapharmacy) with at least one bibliographic reference, were collected. The literature references listed in these leaflets were assessed in terms of content [= is the claim consistent with the information in the reference) and technically [= evaluation of the quality of the references]. Results The 85 collected OTC advertisements made 214 claims that referred to 243 references. Of these, 128 references did not support the promotional claim. The remaining 84 references did support the corresponding claim. From 31 references no full text was obtained. Of the 84 supporting references 44 were of dubious quality. The remaining 40 references were found to be reliable. Conclusion This study shows that the literature references in advertising leaflets for OTC-products are not a reliable source of information on the advertised product. Pharmacists should deal critically with this information and should be encouraged to consult reliable scientific sources.

The dynamization of fracture fixation is a frequently used method to improve the fracture healing process; however, the term dynamization is used for different methods of altering the fixation of fractures during the bone healing process. The dynamization of intramedullary nail fixation by removing the interlocking screws is the most frequently applied method. This method can cause a telescopic movement between the nail and tubular bone that closes gaps in bony continuity and potentially compresses the fracture fragments. Experimental and clinical studies showed that this dynamization can accelerate the bone healing process. In particular dynamization may improve the outcome for fractures with residual fracture gaps following reduction but which allows support of the fragments. An alternative dynamization method involves decreasing the stiffness of the fracture fixation during the healing process. This method is used mainly with external fixation. In this procedure, stabilizing elements of the fixator are removed at some time during the treatment leading to greater flexibility of the fixation. Good results are reported for this method when the dynamization is performed in the late phase of the fracture healing process. If sufficient callus formation has taken place, callus bridging and maturation can be achieved. For reverse dynamization, which starts with a flexible fixation and is later stabilized, no significant advantages could be shown. The aim of fracture treatment should be stable fixation from the beginning. If the fracture fixation is unstable, it should be stabilized as soon as possible.

Trotz groser Fortschritte bei der Behandlung von Frakturen kommt es immer noch zu einer erheblichen Anzahl von verzogerten Knochenheilungen oder Pseudarthrosen. Fur solche Falle ist ein nichtinvasives Behandlungsverfahren, das ohne negative Nebenwirkungen die Knochenheilung beschleunigen kann, von grosem Vorteil. Seit ca. 60 Jahren wird niedrigenergetischer Ultraschall mit dieser Indikation eingesetzt. Dabei hat sich der niedrigdosierte speziell gepulste Ultraschall (low Intensity pulsed Ultrasound, LIPUS) klinisch als das dominierende Verfahren durchgesetzt.

Trichinellosis is an emerging parasitic zoonosis in North Vietnam. In this survey, hunted and farm-bred wild boars as well as synanthropic rats were sampled in two provinces of northwest Vietnam where outbreaks of trichinellosis have recently occurred. Evidence of Trichinella infection was studied by parasitological, serological and molecular methods. The results showed relatively low prevalence of Trichinella spiralis in hunted wild boars (2/62 (3.2%; 95% CI: 0.8- 4.8)) and rats (23/820 (2.8%; 95% CI: 13.7-32.3)). Parasite burdens in the muscle tissues were between 0.1 and 0.03 larvae/g, and 0.1 and 7 larvae/g in wild boars and rats, respectively. Seroprevalence in farm-bred wild boars was negative. The findings of Trichinella-infected rats in 7 of the 20 districts of Dien Bien and Son La provinces suggest that the parasite is circulating in these regions. These results indicate that the local population and health centers should be made aware of the risks of eating raw or undercooked meat dishes prepared from wild animals.

Clinical studies do not allow a quantitative correlation between stability of fracture fixation and outcome of bone healing. This limits the biomechanical improvement of fracture fixation techniques. The most practical quantitative parameter to describe the stability of a fracture fixation is the stiffness. This can be determined for several types of fixation through biomechanical methods and in some clinical studies in vivo. By using numerical fracture healing models, it is now possible to use the tissue differentiation rules found in basic research to calculate optimal stiffness parameters for various fixation techniques. For a tibial fracture as an example the possibilities of a numerical fracture healing simulation have been demonstrated. The effects of the diameter of an intramedullary nail, type of fracture, fracture gap size and nail material on healing could be demonstrated. To circumvent complex and time consuming calculations for several fixations a map was calculated which shows the expected bone healing quality as a function of the axial stiffness and the shear stiffness of the fixation device. By comparing the stiffness of various fixation techniques with the stiffness map it becomes evident that the methods most often used (e.g. unreamed nail, plate and external fixator) have a low shear and/or rotational stiffness that is too low to achieve the optimal healing outcome. The high axial stiffness of plates next to the plate surface can lead to very low tissue strain directly adjacent to the plate and can delay the bone healing process at this location.

It is undisputed that the stability of fracture fixation influences the fracture healing process; however, up until now the mechanical conditions which guide bone healing were unknown and it was therefore not possible to optimize the design of fracture fixation devices. This article presents how the stability of fracture fixation, interfragmentary movement and interfragmentary tissue strain depend on each other and how the mechanical environment influences the cellular processes in the healing tissue. A tissue transformation hypothesis is presented which was developed taking into consideration the results of animal experimental studies, cellular biomechanical investigations and numerical methods. This tissue differentiation hypothesis allows the prediction of bone healing by intramembranous and endochondral bone formation as a function of the local mechanical environment in the fracture healing zone. This allows the possibility for selection of a fracture fixation stability to achieve high-quality bone healing.

Objectives: The aim of this study was to determine the genetic defect in a 4-generational family with an epileptic disorder characterized by febrile and afebrile polymorphic seizures and mild to severe mental retardation by means of analyzing the neuronal voltage-gated sodium channel α-subunit gene SCN1A for mutations. Methods: A Bulgarian family was ascertained and clinically assessed, followed by mutation analysis of the SCN1A gene using direct sequencing to detect point mutations and multiplex amplicon quantification to identify copy number variations. Results: A microdeletion encompassing the entire SCN1A gene segregating with all affected members was identified in this family. Additional analysis showed that the unaffected father of the proband is mosaic for the deletion. So far, SCN1A deletions, predicted to lead to haploinsufficiency, are exclusively identified in isolated patients with Dravet or contiguous gene syndromes. Because of the severe phenotype, SCN1A deletion carriers are usually not able to live independently and start a family, and hence do not transmit the disease. Conclusions: We report an inherited SCN1A gene deletion not exclusively associated with Dravet syndrome. Moreover, our results demonstrate that SCN1A haploinsufficiency can cause a significant intrafamilial clinical variability including moderately affected to syndromal patients. The involvement of multiple genetic and environmental factors could be the basis of this difference in phenotype severity.

Summary Purpose: Mutations in the ATP1A2 gene have been described in families with familial hemiplegic migraine (FHM). FHM is a variant of migraine with aura characterized by the occurrence of hemiplegia during the aura. Within several FHM families, some patients also had epileptic seizures. In this study we tested the hypothesis that mutations in ATP1A2 may be common in patients presenting with epilepsy and migraine. Methods: We selected 20 families with epilepsy and migraine and performed mutation analysis of ATP1A2 in the probands by direct sequencing of all exons and splice-site junctions. Results: Novel ATP1A2 mutations were found in two of the 20 families (10%). The p.Gly900Arg mutation was present in a family with epilepsy and FHM, and the p.Cys702Tyr mutation occurred in a family with occipitotemporal epilepsy and migraine with and without visual aura. In the two families together, six mutation carriers had the combination of epilepsy and migraine, two had only epilepsy, and six had only migraine. Discussion: This study shows that a history of migraine and a family history of both epilepsy and migraine should be obtained in all patients presenting with epilepsy in the epilepsy clinic. It may be worthwhile to screen patients with a combination of epilepsy and migraine and a positive family history of either migraine or epilepsy for mutations in the ATP1A2 gene.

Objective: To map the disease-causing locus in a large Belgian family with occipitotemporal lobe epilepsy associated with migraine with visual aura and to describe the clinical, electrophysiologic, and imaging characteristics. Methods: DNA samples from 21 family members were obtained and an 8 cM density genome-wide scan was performed. The authors interviewed 21 individuals and performed interictal EEG in 14 and brain MRI in 13 individuals. Results: Nine at risk family members and one deceased individual had epilepsy with occipital and temporal lobe symptomatology, variable age at onset, usually good prognosis, no epileptic EEG features, and normal brain MRI. Five of the 10 patients had a history of migraine with aura (p = 0.0026). Seizures and migraine attacks occurred as separate episodes in all but one patient. Three patients described light flashes both as epileptic and migraine aura. Epilepsy and migraine started at the same age in three patients and remitted simultaneously in two. The epileptic phenotype had a dominant mode of inheritance with a reduced penetrance of 75%. A conclusive two-point lod score of 3.3 was obtained for marker D9S257 at recombination fraction zero. Haplotype analysis defined a candidate region of 9.95 cM (5.96 Mb) between markers GATA152H04 and D9S253 located at chromosome 9q21-q22 based upon recombinations in affected individuals. Conclusions: The clinical association in this family of occipitotemporal lobe epilepsy and migraine with visual aura and the conclusive linkage of the occipitotemporal lobe epilepsy/migraine with aura trait to a single locus suggests a common monogenic gene defect.

Mutations in the gene encoding the gamma2 subunit of the gamma-aminobutyric acid type A receptor (GABRG2) have been reported to cause childhood absence epilepsy (CAE), febrile seizures (FS), and generalized epilepsy with FS plus (GEFS+). The authors analyzed GABRG2 in 47 unrelated patients with CAE, FS, and GEFS+ and identified a novel mutation that cosegregated with FS. Electrophysiologic studies demonstrated altered current desensitization and reduced benzodiazepine enhancement in mutant receptors.

The aim of the present in vitro study was to investigate the effect of the crash pulse shape on the peak loading and the injury tolerance levels of the human neck. In a custom-made acceleration apparatus 12 human cadaveric cervical spine specimens, equipped with a dummy head, were subjected to a series of incremental side accelerations. While the duration of the acceleration pulse of the sled was kept constant at 120 ms, its shape was varied: Six specimens were loaded with a slowly increasing pulse, i.e. a low loading rate, the other six specimens with a fast increasing pulse, i.e. a high loading rate. The loading of the neck was quantified in terms of the peak linear and angular acceleration of the head, the peak shear force and bending moment of the lower neck and the peak translation between head and sled. The shape of the acceleration curve of the sled only seemed to influence the peak translation between head and sled but none of the other four parameters. The neck injury tolerance level for the angular acceleration of the head and for the bending moment of the lower neck was almost identical for both, the high and the low loading rate. In contrast, the injury tolerance level for the linear acceleration of the head and for the shear force of the lower neck was slightly higher for the low loading rate as compared to the high loading rate. For the translation between head and sled this difference was even statistically significant. Thus, if the shape of the crash pulse is not known, solely the peak bending moment of the lower neck and the peak angular acceleration of the head seem to be suitable predictors for the neck injury risk but not the peak shear force of the lower neck, the peak linear acceleration of the head and the translation between head and thorax.

Febrile seizures (FS) represent the most common seizure disorder in childhood and contribution of a genetic predisposition has been clearly proven. In some families FS is associated with a wide variety of afebrile seizures. Generalized epilepsy with febrile seizures plus (GEFS+) is a familial epilepsy syndrome with a spectrum of phenotypes including FS, atypical febrile seizures (FS+) and afebrile generalized and partial seizures. Mutations in the genes SCN1B, SCN1A and GABRG2 were identified in GEFS+ families. GEFS+ is genetically heterogeneous and mutations in these three genes were detected in only a minority of the families. We performed a 10 cM density genome-wide scan in a multigenerational family with febrile seizures and epilepsy and obtained a maximal multipoint LOD score of 3.12 with markers on chromosome 5q14.3-q23.1. Fine mapping and segregation analysis defined a genetic interval of approximately 33 cM between D5S2103 and D5S1975. This candidate region overlapped with a previously reported locus for febrile seizures (FEB4) in the Japanese population, in which MASS1 was proposed as disease gene. Mutation analysis of the exons and exon-intron boundaries of MASS1 in our family did not reveal a disease causing mutation. Our linkage data confirm for the first time that a locus on chromosome 5q14-q23 plays a role in idiopathic epilepsies. However, our mutation data is negative and do not support a role for MASS1 suggesting that another gene within or near the FEB4 locus might exist.

A retrospective epidemiological study ( n = 7,875) of neurologically expressed disorders (NED) in ruminants before the onset of the bovine spongiform encephalopathy epidemic (years studied, 1980 to 1997) was carried out in Belgium. The archives of all veterinary laboratories and rabies and transmissible spongiform encephalopathy (TSE) epidemiosurveillance networks were consulted. For all species, a significantly higher number of NED with virological causes (rabies) was reported south of the Sambre-Meuse Valley. During the period 1992 to 1997, for which the data were complete, (i) the predicted annual incidence of NED varied significantly as a function of species and area (higher numbers in areas where rabies was present) but was always above 100 cases per million, and (ii) the mean incidence of suspected TSE cases and, among them, those investigated by histopathological examination varied significantly as a function of species and area. The positive predictive value of a presumptive clinical diagnosis of NED ranged from 0.13 (game) to 0.63 (sheep). Knowledge of the positive predictive value permits the definition of a reference point before certain actions (e.g., awareness and training campaigns) are undertaken. It also shows the usefulness of a systematic necropsy or complementary laboratory tests to establish an etiological diagnosis. TSE analysis of a small, targeted historical sampling ( n = 48) permitted the confirmation of one case and uncovered another case of scrapie. The results of the present study help to develop and maintain the quality of the worldwide clinical epidemiological networks for TSE, especially in countries that in the past imported live animals, animal products, and feedstuffs from countries with TSE cases.

Whether injuries to the alar ligaments could be responsible for complaints of patients having whiplash injury in the upper cervical spine is still controversially discussed. It is known that these ligaments protect the upper cervical spine against excessive lateral bending and axial rotation movements. The objective of the present in vitro study was therefore to examine whether the alar ligaments or any other structures of the cervical spine are damaged in side collisions. In a specially designed acceleration apparatus, six human osteoligamentous cervical spine specimens were subjected to incremental 90 degrees side collisions from the right (1 g, 2 g, 3 g, etc.) until structural failure occurred. A damped pivot table accounted for the passive movements of the trunk during collision, and a dummy head (4.5 kg) ensured almost physiological loading of the specimens. For quantification of functional injuries, the three-dimensional flexibility of the specimens was tested in a spine tester before and after each acceleration. In all six specimens, structural failure always occurred in the lower cervical spine and always affected the facet joint capsules and the intervertebral discs. In four specimens, this damage occurred during the 2 g collision, while in the other two it occurred during the 3 g and 4 g collision, respectively. The flexibility mainly increased in the lower cervical spine (especially in lateral bending to both sides) and, to a minor extent, in axial rotation. In vitro low-speed side collisions caused functional and structural injury to discoligamentous structures of the lower cervical spine, but did not damage the alar ligaments. Since the effects of muscle forces were not taken into account, the present in vitro study reflects a worst-case scenario. Injury thresholds should therefore not be transferred to reality.

Severe myoclonic epilepsy of infancy (SMEI or Dravet syndrome) is a rare disorder occurring in young children often without a family history of a similar disorder. The earliest disease manifestations are usually fever-associated seizures. Later in life, patients display different types of afebrile seizures including myoclonic seizures. Arrest of psychomotor development occurs in the second year of life and most patients become ataxic. Patients are resistant to antiepileptic drug therapy. Recently, we described de novo mutations of the neuronal sodium channel alpha-subunit gene SCN1A in seven isolated SMEI patients. To investigate the contribution of SCN1A mutations to the etiology of SMEI, we examined nine additional SMEI patients. We observed eight coding and one noncoding mutation. In contrast to our previous study, most mutations are missense mutations clustering in the S4-S6 region of SCN1A. These findings demonstrate that de novo mutations in SCN1A are a major cause of isolated SMEI.

Une classification des troubles neurologiques ou a expression nerveuse susceptibles d'etre rencontres en Europe occidentale chez les bovins âges de 12 mois et plus a ete etablie selon l'etiologie, la frequence et les conditions d'apparition, l'âge et le type d'animaux concernes et les principaux signes cliniques observes. Les troubles a expression nerveuse ont ete classes selon les differents groupes de causes : biologiques, non biologiques et non specifiques ou inconnues. Le diagnostic differentiel des troubles a expression nerveuse est un element essentiel de l'epidemiosurveillance clinique de l'encephalopathie spongiforme bovine. Un nombre croissant d'etiologies est decrit dans la litterature scientifique. L'identification et la gestion centralisee des troubles neurologiques permettront, d'une part, de tenir compte de la variabilite inherente a la forme clinique developpee et a la demarche diagnostique de l'observateur et, d'autre part, d'identifier de nouveaux facteurs de risque permettant leur maitrise.

Severe myoclonic epilepsy of infancy (SMEI) is a rare disorder that occurs in isolated patients. The disease is characterized by generalized tonic, clonic, and tonic-clonic seizures that are initially induced by fever and begin during the first year of life. Later, patients also manifest other seizure types, including absence, myoclonic, andsimple and complex partial seizures. Psychomotor development stagnates around the second year of life. Missense mutations in the gene that codes for a neuronal voltage-gated sodium-channel α-subunit (SCN1A) were identified in families with generalized epilepsy with febrile seizures plus (GEFS+). GEFS+ is a mild type of epilepsy associated with febrile and afebrile seizures. Because both GEFS+ and SMEI involve fever-associated seizures, we screened seven unrelated patients with SMEI for mutations in SCN1A. We identified a mutation in each patient: four had frameshift mutations, one had a nonsense mutation, one had a splice-donor mutation, and one had a missense mutation. All mutations are de novo mutations and were not observed in 184 control chromosomes.

Fusion is the main goal in the surgical management of the injured and unstable spine. A wide variety of implants is available to enhance this. Our study was performed to evaluate the stabilising characteristics of several anterior, posterior and combined systems of fixation. Six thoracolumbar (T11 to L2) spines from 13-week-old calves were first tested intact. Then the vertebral body of T13 was removed and the defect replaced and supported by a wooden block to simulate bone grafting. Dorsal implants consisting of a Universal Spine System (USS) fracture system and an AO Fixateur interne (AOFI), and ventral implants comprising of a Kaneda Classic, a Kaneda SR, a prototype of the VentroFix single clamp/single rod construct (SC/SR) and the VentroFix single clamp/double rod construct (SC/DR) were first implanted individually to stabilise the removal of the vertebral body. Simulating the combined anteroposterior stabilisations, all ventral implants were combined with the AOFI. The range of motion (ROM) was measured under loads of up to 7.5 Nm. The load was applied in a custom-made spine tester in the three primary directions while measuring the intervertebral movements using a goniometric linkage system. The dorsal systems limited ROM in flexion below 0.9° and in extension between 3.3° and 3.6° (median values). The improved Kaneda System SR yielded a mean ROM of 1.8° in flexion and in extension. The median rotation found with the VentroFix (SC/DR) was 3.2° for flexion and 2.8° for extension. Reinforcement of the ventral constructs with a dorsal system reduced the ROM in flexion and extension in all cases to 0.4° and lower. In rotation, the median ROM of the anterior systems ranged from 2.7° to 5.1° and for the posterior systems from 3.9° to 5.7°, while the combinations provided a ROM of 1.2° to 1.9°. In lateral bending, the posterior implants restricted movement to 1.1°, whereas the anterior implants allowed up to 5.2°. The combined systems provided the highest stability at less than 0.6°. Our study revealed distinct differences between posterior and anterior approaches in all primary directions. Also, different stabilisation characteristics were found within the anterior and posterior groups. Combinations of these two approaches provided the highest stability in all directions.

The Behavioural Inhibition System/Behavioural Activation System Scale (BIS/BAS-Scales) developed by Carver and White 1 is a self-rating instrument to assess the dispositional sensitivity to punishment and reward. The present work aims to examine the factor structure of the German version of the BIS/BAS-Scales.In a large German population-based sample (n = 1881) the model fit of several factor models was tested by using confirmatory factor analyses.The best model fit was found for the 5-factor model with two BIS (anxiety, fear) and three BAS (drive, reward responsiveness, fun seeking) scales, whereas the BIS-fear, the BAS-reward responsiveness, and the BAS-fun seeking subscales showed low internal consistency. The BIS/BAS scales were negatively correlated with age, and women reported higher BIS subscale scores than men.Confirmatory factor analyses suggest a 5-factor model. However, due to the low internal reliability of some of the subscales the use of this model is questionable.

The present study investigated the clinical and functional outcome of calcaneal fractures. 14 patients were evaluated at a mean follow-up of 52 months. Two groups, group A with good and group B with poor calcaneal restoration were distinguished by Bohler's angle. Ten normal subjects were used for comparison. Clinical results were evaluated with a questionnaire, radiography and range of motion measurements. Plantar pressure patterns were recorded with a capacitive pressure distribution platform. A comparison of the injured and healthy foot of all patients revealed a load shift towards lateral foot regions. A comparison of the patient groups with the controls did not reveal more pronounced changes in the poorly restored group. The results demonstrate that a disturbance of foot function persists even after long healing.

In a controlled animal experiment we attempted to clarify the question of whether there is a stimulating effect of extracorporeal shock-waves on the repair process of fractured long bones. As a fracture model we used an osteotomy in the diaphysis of the ovine tibia and an external fixation device. Shock-wave treatment at two levels of intensity and with four different numbers of applied shocks was performed with an electromagnetic acoustic source. Healing of the osteotomized bone was evaluated by biomechanical and radiological investigations on the whole bone as well as on bone sections from areas of the fracture gap and the periosteal fracture callus. We found a non-significant tendency to deterioration of the fracture healing with increasing shock-wave intensities. The study of treatment parameters led neither to significantly different biomechanical outcomes nor to altered radiological results in comparison to the untreated control group. RELEVANCE:--While we cannot comment upon the effectiveness of extracorporeal shock-waves in the delayed treatment of fractures or pseudarthrosis, our results suggest that shock-waves have no beneficial effect in acute fracture repair.

The need to survey and compare in vitro investigations on the effect of extracorporeally generated pressure pulses demands precise description of experimental conditions. We determined the effect of water temperature on the pressure characteristics in and around the focus area of an electromagnetic type lithotripter. The peak pressure amplitude at the geometrical focus of the lens was reduced to 60% of the original peak pressure if water at room temperature was used instead of water with human body temperature. By decreasing the temperature of the lithotripter's internal water, we observed shifting of the focus point at a rate of 1.4 mm per degree. This dramatic reduction of the peak pressure and the shifting of the focus point resulting from changes in the acoustic and thermal parameters of the propagation medium and of the focusing device could lead to differences of up to 80% of peak pressure amplitude.

In ligament replacement cases where the artificial ligament has worn and partially or totally ruptured, the released wear particles have been associated with a chronic synovitis that inhibits integration of the ligament and contributes to the ultimate failure of the device. In this study, the biological response to ligament wear particles from nine different artificial ligaments was quantitatively evaluated in vivo. Wear particles, the majority of which were

A major problem in fracture treatment by external fixation is screw loosening, which often results in reduced stability and can lead to prolonged treatment. A load-carrying experiment was conducted to determine whether coating implants with bioactive hydroxyapatite (HA) increases screw stability. Twelve HA-coated ASIF screws with 3 different macroporosities were inserted in 12 sheep that had already been fitted with a 6-pin external fixator for the treatment of a tibial osteotomy. The same number of uncoated polished steel screws served as controls. Although initial stability was not different for HA-coated screws, average removal torque after a 9-week implantation period increased with increasing macroporosity of the HA coating (p < .002). Instability of some screws was accompanied by histologic findings of cartilagenous tissue and proliferation of periosteal callus. Near the threads in the tibial cortex and in the shaft area of the screw were seen large numbers of HA particles that had been sheared off during implantation as well as during screw removal because of high contact forces between the HA coating and bone. Particulate debris of HA particles as well as the release of small bone fragments during explanation is likely to be unavoidable since HA adherence to bone is greater than adherence to steel after several weeks of implantation.

Trichinellosis is an important emerging or re-emerging zoonotic disease in Southeast Asia. In Vietnam, data on trichinellosis are scarce. Therefore, the present study was designed to determine the seroprevalence of trichinellosis in the domestic lifecycle in two provinces of northwestern Vietnam, where recently isolated outbreaks of human trichinellosis occurred. Serum samples were obtained from 558 pigs, 125 dogs and 98 cats, transported on filter paper, and tested for Trichinella antibodies by ELISA and Western blot, using larval excretory–secretory (E/S) antigens. The overall seroprevalence of antibodies to Trichinella was 5.6%, 4% and 0% in pigs, dogs and cats, respectively. In pigs, positive cases were distributed in 8/20 districts of the two provinces. This study suggests that Trichinella spp. is circulating in the domestic life cycle in northwestern Vietnam. Further study is recommended to investigate the presence of Trichinella in a sylvatic cycle, and to identify the occurring Trichinella species.

Objective: KCNQ2 and KCNQ3 mutations are known to be responsible for benign familial neonatal seizures (BFNS). A few reports on patients with a KCNQ2 mutation with a more severe outcome exist, but a definite relationship has not been established. In this study we investigated whether KCNQ2/3 mutations are a frequent cause of epileptic encephalopathies with an early onset and whether a recognizable phenotype exists. Methods: We analyzed 80 patients with unexplained neonatal or early-infantile seizures and associated psychomotor retardation for KCNQ2 and KCNQ3 mutations. Clinical and imaging data were reviewed in detail. Results: We found 7 different heterozygous KCNQ2 mutations in 8 patients (8/ 80; 10%); 6 mutations arose de novo. One parent with a milder phenotype was mosaic for the mutation. No KCNQ3 mutations were found. The 8 patients had onset of intractable seizures in the first week of life with a prominent tonic component. Seizures generally resolved by age 3 years but the children had profound, or less frequently severe, intellectual disability with motor impairment. Electroencephalography (EEG) at onset showed a burst-suppression pattern or multifocal epileptiform activity. Early magnetic resonance imaging (MRI) of the brain showed characteristic hyperintensities in the basal ganglia and thalamus that later resolved. Interpretation: KCNQ2 mutations are found in a substantial proportion of patients with a neonatal epileptic encephalopathy with a potentially recognizable electroclinical and radiological phenotype. This suggests that KCNQ2 screening should be included in the diagnostic workup of refractory neonatal seizures of unknown origin. ANN NEUROL 2012; 71: 15-25

Thirty healthy subjects were studied to determine whether and how changes in walking speed affect plantar pressure distribution and hindfoot angular motion. A capacitive pressure distribution platform and an electrogoniometer on the subjects' hind foot were used for data collection. There was a significant increase in peak pressure under the heel and the medial part of the forefoot and a significant decrease under the midfoot and lateral forefoot with increasing walking speed. This effect of a medialization of the loading pattern seems closely related to a more pronounced pronation motion as indicated by increased eversion of the hindfoot. The results emphasize the need for monitoring and controlling walking speed when comparing the foot loading characteristics of different groups of subjects.