Surgical therapy of dens fracture

The use of Anderson/D'Alonso or Aebi/Nazarian classification of dens fractures is the basis for exact selection of therapy. The ventral screw-fixation of Anderson type-II-Fracture is today the common standard of treatment, especially in the elderly. The stabilisation of the fracture with maintenance of atlanto-axial rotation-function, the minimal rate of pseudarthrosis compared with conservative therapy, the minimal operation trauma and the immediate mobilisation with high patient comfort are decisive benefits of this method. Reposition of the fracture, visualisation in two planes and the use of adequate instruments are important conditions to get optimal operation results. In-vitro-experiments have shown that there is no difference of stability in one- or two-screw-technique. Flexion injuries with oblique fracture plane, insufficient stability after anterior screw fixation and typ-III-fractures are indications for dorsal, atlanto-axial screw fixation. The conservative treatment(HALO-vest) is recommended only in otherwise inoperable patients.     

Efficacy and safety of tramadol HCl in breakthrough musculoskeletal pain attributed to osteoarthritis

OBJECTIVE: To evaluate the efficacy of tramadol as adjunctive therapy in patients with musculoskeletal pain attributed to osteoarthritis (OA) who experienced breakthrough pain while taking a nonsteroidal antiinflammatory drug (NSAID). METHODS: This single center, parallel, placebo controlled, 2 phase study was conducted in adults who experienced breakthrough OA pain while undergoing stable NSAID therapy. In a 24 h open label phase, patients took 100 mg of tramadol followed by 50 mg every 6 h (total 250 mg) in addition to their daily NSAID regimen. Supplemental analgesics were prohibited. Patients who met entry criteria and were willing to continue therapy were randomized to a 13 day double blind phase of adjunctive therapy with tramadol (50-100 mg every 4-6 h as needed for pain) or placebo; NSAID therapy was continued. The primary efficacy endpoint was the time to exit from the study because of therapeutic failure (i.e., insufficient pain relief or an inability to perform activities of daily living). RESULTS: The time to exit from the study because of insufficient pain relief tended to be longer in the tramadol group (250 mg/day) compared with the placebo group (p = 0.066). At the end of the double blind phase, pain at rest was significantly less severe in tramadol treated patients (p = 0.046). In addition, severity of pain on motion tended to be less severe in tramadol treated patients (p = 0.059). General severity of current pain and ability to perform activities of daily living were not significantly different with tramadol or placebo. Patients' overall assessment of therapy (p = 0.022) and investigator's rating of global improvement (p = 0.004) were significantly better with tramadol than with placebo. CONCLUSION: Tramadol may have a role as adjunctive treatment for breakthrough pain in patients receiving NSAID therapy for musculoskeletal pain attributed to OA.     

Attenuated hematopoietic response to granulocyte-macrophage colony-stimulating factor in patients with acquired pulmonary alveolar proteinosis

The pathogenesis of acquired pulmonary alveolar proteinosis (PAP), a rare lung disease characterized by excessive surfactant accumulation within the alveolar space, remains obscure. Gene-targeted mice lacking the hematopoietic growth factor granulocyte-macrophage colony-stimulating factor (GM-CSF) or the signal-transducing beta-common chain of the GM-CSF receptor have impaired surfactant clearance and pulmonary pathology resembling human PAP. We therefore investigated the hematopoietic effects of GM-CSF in patients with PAP. The hematologic response of 5 infants with congenital PAP to 5 microgram/kg/d was of normal magnitude. By contrast, despite normal expression of GM-CSF receptor alpha- and beta-common chains on peripheral blood myelomonocytic cells (n = 6) and normal binding affinity of bone marrow mononuclear cells for GM-CSF (n = 3), each of the 12 patients with acquired PAP treated displayed impaired responses to GM-CSF; 5 microgram/kg/d produced only minor eosinophilia, and doses of 7.5 to 20 microgram/kg were required to induce >/=1.5-fold neutrophil increments in the 3 patients who underwent dose-escalation. However, neutrophilic responses to 5 microgram/kg granulocyte colony-stimulating factor (G-CSF) were normal (n = 4). In vitro, the proportion of hematopoietic progenitors responsive to GM-CSF (16.1% +/- 8.9%; P = .042) or interleukin-3 (IL-3; 19.3% +/- 7.7%; P = .063), both of which utilize the beta-common chain of the GM-CSF receptor complex, were reduced among patients with acquired PAP (n = 4) compared with normal bone marrow donor controls (47.2% +/- 25.9% and 40.9% +/- 18.6%, respectively). In the one individual who had complete resolution of lung disease during the period of study, this was temporally associated with correction of this defective in vitro response to GM-CSF and IL-3 on serial assessment. These data establish that patients with acquired PAP have an associated impaired responsiveness to GM-CSF that is potentially pathogenic in the development of their lung disease. Based on these observations, we propose a model of the pathogenesis of acquired PAP that suggests the disease arises as a consequence of an acquired clonal disorder within the hematopoietic progenitor cell compartment.     

Isolation of translactone-containing triterpenes with thrombin inhibitory activities from the leaves of Lantana camara

Methanolic extracts prepared from the leaves of Lantana camara have been found to inhibit human thrombin. An assay, in which thrombin activity is measured as a function of clot formation from fibrinogen, was used to guide the fractionation and purification of five principal active constituents (1-5), which were all characterized as 5,5-trans-fused cyclic lactone-containing euphane triterpenes.     

From Sultaniyeh to Tashkent Scrolls: Euclidean Constructions of Two Nine- and Twelve-Pointed Interlocking Star Polygon Designs

In this paper we will explore two nine- and twelvepointed Islamic star polygon patterns consisting of ??nearly regular?? nine-pointed, regular twelve-pointed and irregularly-shaped pentagonal star polygons. The two designs are similar in that they may both be classified mathematically as being p6m patterns with the major star polygons placed in identical locations within each layout; however, the structure of the major stars is quite different. Both of the patterns considered here are of Persian origin. The first design may be found as a repeat unit sketch of the Tashkent Scrolls, and exists as a Timurid-style stone inlay and mosaic tiling in India. The second pattern may be found as Plate 120 of Bourgoin??s Arabic Geometrical Pattern and Design and exists as a stucco/plasterwork ceiling in the Mausoleum of Sultan Oljaytu in Sultaniyeh, Iran, as well as numerous other locations across the Islamic world. Both patterns may be recreated via plausible Euclidean ??point-joining?? constructions (that is, using only the methods available to medieval artisans) in an attempt to ascertain how the original designers of these patterns may have determined the proportion and placement of the stars.     

Null values in nested relational databases

Summary The desire to extend the applicability of the relational model beyond traditional data-processing applications has stimulated interest in nested or non-first normal form relations in which the attributes of a relation can take on values which are sets or even relations themselves. In this paper, we study the role of null values in the nested relational model using an open world assumption. We extend the traditional theory and study the properties of extended operators for nested relations containing nulls. The no-information, unknown, and non-existent interpretation of nulls are discussed and the meaning of empty set is clarified. Finally, contrary to several previous results, we determine that the traditional axiomatization of functional and multivalued dependencies is valid in the presence of nulls.Currently with the Air Force Institute of Technology, AFIT/ENG, Wright-Patterson AFB, OH 45433, USAResearch partially supported by an IBM Faculty Development A ward and NSF grant DCR-8507224     

Comparison of mainline and alternate approaches to fusion energy

The tokamak and tandem mirror concepts are compared with alternate confinement concepts using the criteria established in DOE/ET-0047, An Evaluation of Alternate Magnetic Fusion Concepts 1977. The concepts are evaluated and rated in each of three broad categories: confidence in physics and technology, and reactor desirability. The STARFIRE and MARS reactors are used as a basis for comparing the mainline tokamak and tandem mirror concepts with the alternate concepts evaluated in DOE/ET-0047. Two recent alternate concepts, theohmically heated toroidal experiment (OHTE) and thecompact reversed field pinch reactor (CRFPR), are also evaluated. Results indicate that the physics of the mainline tokamaks and tandem mirrors is better understood than that of most alternate concepts. Both mainline concepts rank near the middle for technology requirements, and both rank near or at the bottom when compared with the reactor desirability of alternate concepts.     

The behavior of small fatigue cracks at notches in corrosive environments

The behavior of small cracks growing out of the roots of blunt notches in compact type specimens of an austenitic steel was characterized under fatigue loading in wet H ₂ plus air environment. The growth rates of cracks in the size range of 0.125 mm to 0.75 mm were up to two orders of magnitude higher than the rates expected for conventional cracks at equal stress intensity range, K. It was also observed that the small cracks grew at these fast rates only in corrosive environments when the loading frequency was 0.02 Hz or less. At a frequency of 10 Hz, the behavior was in agreement with the trend predicted for conventional size cracks.The above observations are rationalized in terms of the breakdown of the concept of a single parameter representation of the crack tip stress and strain field by K or in terms of differences in crack tip environments between small and long cracks for the same bulk environment. A simple engineering model is proposed which adequately represents the observed small crack growth behavior.

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Résumé On a procédé à la caractérisation, sous charges de fatigue en atmosphère humide de H ₂ et d'air, de petites fissures se développant à partir des racines d'entailles arrondies dans des éprouvettes compactes.Les vitesses de croissance des fissures d'une taille allant de 0,125 à 0,750 mm se sont révélé être de deux ordres de grandeur plus grandes que les vitesses prévues dans le cas de fissures conventionnelle, soumises aux mêmes variations de l'intensité de contrainte K. On a également observé que de petites fissures croissaient à ces grandes vitesses seulement dans des atmosphères corrosives, lorsque la fréquence de sollicitation était de 0,02 Hz ou moins. A la fréquence de 10 Hz, le comportement observé s'est trouvé en accord avec les tendances prévues pour des fissures de taille conventionnelle.Les observations ci-dessus sont rationnalisées en un élargissement du concept de représentation monoparamétrique par le facteur K du champ de contraintes et de dilatation à l'extrémité de la fissure, ou en termes des différences rencontrées dans l'environnement local de l'extrémité d'une fissure, selon que celle-ci est longue ou courte, et ce dans un même environnement global.On propose un modèle simple utilisable en pratique, pour représenter de manière adéquate le comportement à la croissance observé pour des petites fissures.

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Metallurgy Department