Search

This study ‘Demand for and experiences with financial products and services’ describes and discusses the results of a survey to provide a first insight into the financial services that the smallholder farmers from climate smart villages use and to explore how these are related to climate smart agricultural technologies & practices. The study is one of three preliminary studies of a multi-year international research project (2016-2022) on ‘Business models, incentives and innovative finance for scaling climate smart agriculture (CSA)’. The knowledge and insights developed are used to further support ongoing and emerging climate smart projects in which CCAFS is involved. A survey was conducted to identify smallholder farmers and the small to medium enterprises (in different stages of the value chain) and their demand for and experiences with financial products and services. There were 148 respondents from 24 villages from Latin America, West Africa, East Africa, Southeast Asia and South Asia. The targeted number of female respondents (50%) was nog met in all regions, for example in India where the role of female farmers in irrigated agriculture would be limited. A limitation to the results is that in different regions a different number of villages was involved, making it more difficult to generalise results. Sometimes it would prove challenging to make conclusions about the reasoning behind the answers. The study is about adoption climate smart agriculture, but does not define the extent of adoption. ..

Summary Body weight is determined via both metabolic and hedonic mechanisms. Metabolic regulation of body weight centres around the ‘body weight set point’, which is programmed by energy balance circuitry in the hypothalamus and other specific brain regions. The metabolic body weight set point has a genetic basis, but exposure to an obesogenic environment may elicit allostatic responses and upward drift of the set point, leading to a higher maintained body weight. However, an elevated steady‐state body weight may also be achieved without an alteration of the metabolic set point, via sustained hedonic over‐eating, which is governed by the reward system of the brain and can override homeostatic metabolic signals. While hedonic signals are potent influences in determining food intake, metabolic regulation involves the active control of both food intake and energy expenditure. When overweight is due to elevation of the metabolic set point (‘metabolic obesity’), energy expenditure theoretically falls onto the standard energy–mass regression line. In contrast, when a steady‐state weight is above the metabolic set point due to hedonic over‐eating (‘hedonic obesity’), a persistent compensatory increase in energy expenditure per unit metabolic mass may be demonstrable. Recognition of the two types of obesity may lead to more effective treatment and prevention of obesity.

In The Origin and Meaning of Ekklēsia in the Early Jesus Movement, Ralph J. Korner examines the use of ekklēsia in the context of Greco-Roman and Jewish associations, Greek Imperial poleis, Roman Imperial ideology, and early Jewish and Christ-follower literary works.

In The Origin and Meaning of Ekklēsia in the Early Jesus Movement, Ralph J. Korner examines the use of ekklēsia in the context of Greco-Roman and Jewish associations, Greek Imperial poleis, Roman Imperial ideology, and early Jewish and Christ-follower literary works.

In The Origin and Meaning of Ekklēsia in the Early Jesus Movement, Ralph J. Korner examines the use of ekklēsia in the context of Greco-Roman and Jewish associations, Greek Imperial poleis, Roman Imperial ideology, and early Jewish and Christ-follower literary works.

In The Origin and Meaning of Ekklēsia in the Early Jesus Movement, Ralph J. Korner examines the use of ekklēsia in the context of Greco-Roman and Jewish associations, Greek Imperial poleis, Roman Imperial ideology, and early Jewish and Christ-follower literary works.

In The Origin and Meaning of Ekklēsia in the Early Jesus Movement, Ralph J. Korner examines the use of ekklēsia in the context of Greco-Roman and Jewish associations, Greek Imperial poleis, Roman Imperial ideology, and early Jewish and Christ-follower literary works.

In The Origin and Meaning of Ekklēsia in the Early Jesus Movement, Ralph J. Korner examines the use of ekklēsia in the context of Greco-Roman and Jewish associations, Greek Imperial poleis, Roman Imperial ideology, and early Jewish and Christ-follower literary works.

In The Origin and Meaning of Ekklēsia in the Early Jesus Movement, Ralph J. Korner examines the use of ekklēsia in the context of Greco-Roman and Jewish associations, Greek Imperial poleis, Roman Imperial ideology, and early Jewish and Christ-follower literary works.

In The Origin and Meaning of Ekklēsia in the Early Jesus Movement, Ralph J. Korner examines the use of ekklēsia in the context of Greco-Roman and Jewish associations, Greek Imperial poleis, Roman Imperial ideology, and early Jewish and Christ-follower literary works.

In The Origin and Meaning of Ekklēsia in the Early Jesus Movement, Ralph J. Korner examines the use of ekklēsia in the context of Greco-Roman and Jewish associations, Greek Imperial poleis, Roman Imperial ideology, and early Jewish and Christ-follower literary works.

In The Origin and Meaning of Ekklēsia in the Early Jesus Movement, Ralph J. Korner examines the use of ekklēsia in the context of Greco-Roman and Jewish associations, Greek Imperial poleis, Roman Imperial ideology, and early Jewish and Christ-follower literary works.

Objectives: Two 90-degree configurations of locking reconstruction plates with different numbers of screws in the distal ulnar column segment of distal extra-articular humeral fractures with metaphyseal comminution (A3) were biomechanically investigated. Methods: Eight pairs of fresh-frozen human humeri were used. For paired comparison, the humeri were divided into 2 randomized groups. In both groups, double-plate osteosyntheses with locking reconstruction plates were performed in 90-degree configurations. In group 1, the posteriorly placed radial column plate exceeded the capitellum and the ulnar column plate extended into the ulnar sulcus. The ulnar plate was molded around the medial epicondyle and fixed with 3 short angular stable screws distally. In group 2, the posteriorly placed radial column plate was applied analogous to group 1. The locking reconstruction plate placed on the ulnar column was used reaching to the ulnar epicondyle, fixed with 1 long, angular, stable screw in the distal fragment. Stiffness testing for axial load and bending in static and cyclic tests were performed. In static test mode, a load was applied with a frequency of 0.1 Hz. For cyclic loading conditions, a load was applied at 1 Hz for 5000 cycles. Results: All tested specimens adequately resisted simulated physiologic loading conditions with no failure. Comparable stiffness values for axial load (P = 0.161) and significant lower stiffness values for bending (P = 0.017) in group 2 under static bending conditions were found. Considering cyclic loading conditions, no significant alterations in stiffness in each group under axial load occurred. In bending conditions, stiffness values for group 2 were significantly lower than that for group 1 (P = 0.036). Conclusions: Under static and cyclic bending conditions, stiffness in group 2 was significantly lower than that in group 1. Nevertheless, both implant configurations showed no failure of the constructs. Based on these data, when applying locked plates in the clinical setting, more than 1 locked screw applied into the distal ulnar column of the articular segment is recommended.

One major barrier to osteosynthesis in distal humeral fractures is poor bone quality. This study was an attempt to measure the bone quality in the distal humerus.We measured the distribution of total bone mineral density (BMD), trabecular BMD (tBMD), and cortical thickness (CTh) in the distal humerus using peripheral quantitive computed tomography. Four slices in the infracondylar, supracondylar, and distal disphyseal regions of 25 human cadaver humeri were investigated.Total BMD decreased continuously from the distal diaphysis to the trochlea. Within the infracondylar region, the capitellum was the region of lowest tBMD and CTh (P.001). Measurements in anterior regions were higher than in most others (P.001). The tBMD of the medial column in the infracondylar and supracondylar regions was 31% and 36% higher vs the lateral column (P.001). The medial column had an average 22% higher CTh in the supracondylar and 38% higher CTh in distal diaphyseal regions vs the lateral sides (P.001).Distal humeral bone properties vary widely, providing stronger bone stock on the medial side. This may improve understanding of implant failure and techniques in surgical treatment.

This study examined the association of comorbidities, healthcare service use, and costs for diabetes patients with and without painful diabetic peripheral neuropathy (pDPN).This was a retrospective, cohort analysis of data from members of a health maintenance organization. Patients with pDPN identified from a previously validated algorithm that was based on inclusion ICD-9 diagnosis codes consistent with signs and symptoms of peripheral neuropathy, as well as ICD-9 diagnosis codes to exclude non-diabetic etiologies. These subjects were matched 2 : 1 to patients without pDPN on age (+/-4 years), gender, and HbA(1c) stratum (7%, 7-9%, and9%) based on median HbA(1c) measured in 2002. Administrative data associated with outpatient and hospital-based care for the year 2003 were used to estimate healthcare service utilization and costs. Chi-square, univariate, and multivariate regression analyses were employed to estimate the variation in healthcare service utilization and costs.After applying inclusion and exclusion criteria, 1543 patients with pPDN were matched to 3069 patients without pDPN among prevalent diabetes cases. Patients with pDPN had significantly higher prevalence of comorbidities, including twice as many limb infections and nearly ten-fold greater limb amputations, and had consistently higher healthcare service utilization and costs across categories of care. The likelihood of any hospital admission for pDPN patients was more than 2.5-fold higher relative to patients without pDPN, and the excess cost associated with pDPN was estimated to be almost $6000 for the calendar year.The presence of pDPN in patients with diabetes was associated with significantly greater comorbidity, greater healthcare service utilization, and higher costs. While this study is limited to the direct medical care costs borne by the health plan, given the association of comorbidities and cost for patients with pDPN, further investigation is needed to determine if management approaches that are effective across chronic illnesses may prove to be beneficial for high cost diabetes patients.

Internal fixation of fractures of the proximal humerus needs a high stability of fixation to avoid secondary loss of fixation. This is especially important in osteoporotic bone. In an experimental study, the biomechanical properties of the angle-fixed Philos plate (internal fixator) and a double-plate osteosynthesis using two one-third tubular plates were assessed. The fracture model was an unstable three-part fracture (AO type B2). Eight pairs of human cadaveric humeri were submitted to axial load and torque. In the first part of the study, it was assessed to which degree the original stiffness of the humeri could be restored after the osteotomy by the osteosynthesis procedure. Subsequently, subsidence during 200 cycles of axial loading and torque was analysed. During axial loading, the Philos plate was significantly stiffer and showed less irreversible deformation. Two double-plate fixations, but none of the Philos plate osteosynthesis, failed. During torsion, there were no significant differences between the two implants. From the biomechanical point of view, the angle-fixed Philos plate represents the implant of choice for the surgical fixation of highly unstable three-part fractures of the proximal humerus, as the internal fixator system is characterised by superior biomechanical properties.

There is a pressing need to make patient safety research more relevant to clinicians and decisionmakers. The RE-AIM framework of Reach, Effectiveness, Adoption, Implementation and Maintenance is one approach investigators can use to assess a study’s potential for translation from research to clinical practice. In this paper, we show how the RE-AIM approach is being used to evaluate a pharmacy alert intervention designed to detect and correct medication prescribing errors for all patients prescribed medications in a large health maintenance organization (HMO). In the REAIM framework, Reach is assessed by calculating the participation rate and evaluating the degree to which the patients enrolled in the study are representative of the larger patient population (i.e., the “representativeness” of the sample). Effectiveness is assessed across multiple dimensions. Medication errors are the primary outcome. Other outcomes include prescriber, pharmacist and patient satisfaction; measures of unintended consequences (e.g., false-positive alerts), and potential negative impacts (e.g., repeat patient visits to the pharmacy). Adoption is measured by calculating the participation rates of the pharmacies and pharmacists approached to participate in the project. Representativeness is assessed by comparing the characteristics of pharmacies and pharmacists that participate to those that do not. Implementation is assessed as the degree to which intervention components are delivered as intended. Measures of technical performance include the validity of alerts and system reliability. Measures of pharmacist performance include completeness of progress documentation and adherence to alert recommendations. Maintenance is assessed as the sustainability of the intervention’s impact during the study (at three, six, nine and 12 months), and at one year after its completion. Investigators interested in promoting the translation of their research and conducting “practical clinical trials” should consider external and internal validity issues. This paper describes one approach to the collection and reporting on measures of generalizability that are of interest to clinicians and decisionmakers.

Background: There are few contemporary estimates of prevalence rates for inflammatory bowel disease (IBD) in diverse North American communities. Methods: We estimated the period prevalence of IBD for January 1, 1999, through June 30, 2001, among 1.8 million randomly sampled members of nine integrated healthcare organizations in the US using computerized diagnoses and outpatient pharmaceutical dispensing. We also assessed the positive predictive value (PPV) and sensitivities of 1) the case-finding algorithm, and 2) the 30-month sampling period using medical chart review and linkage to a 78-month dataset, respectively. Results: The PPV of the case-finding algorithm was 81% (95% confidence interval [CI], 78–87) and 84% (95% CI, 79–89) in two different organizations. In both, the sensitivity of the optimal algorithm, compared with the most inclusive, exceeded 90%. The sensitivity of the 30-month sampling period compared with 78 months was 61% (95% CI, 57–64) in one organization. Applying a slightly more sensitive case-finding algorithm, the average period prevalence of IBD across the nine organizations, standardized to the age- and gender-distribution of the US population, 2000 census, was 388 cases (95% CI, 378–397) per 100,000 persons (range 209–784 per 100,000; average follow-up 26 months). The prevalence of Crohn's disease, ulcerative colitis, and unspecified IBD was 129, 191, and 69 per 100,000, respectively. Conclusions: The observed average prevalence was similar to prevalence proportions reported for other North American populations (369–408 per 100,000). Additional research is needed to understand differences in the occurrence of IBD among diverse populations as well as practice variation in diagnosis and treatment of IBD. (Inflamm Bowel Dis 2007)

BACKGROUND: Although rates of survival for women with breast cancer have improved, the survival disparity between African American and white women in the United States has increased. PURPOSE: To determine whether this survival disparity persists in an insured population with access to medical care. METHODS: In this retrospective cohort study, we extracted data from the tumor registries of six nonprofit, integrated health care delivery systems affiliated with the Cancer Research Network and assessed the survival of African American (n = 2276) and white (n = 18 879) female enrollees who were diagnosed with invasive breast cancer from January 1, 1993, through December 31, 1998. Cox proportional hazards regression was used to estimate the death rate among African American women relative to that of white women after adjustment for potential explanatory factors including stage at diagnosis, tumor characteristics, and treatment. RESULTS: Five-year survival was lower for African American women (73.8%) than for white women (81.6%). African American women were less likely to have tumor characteristics with good prognosis. Controlling for age at diagnosis, stage, grade, tumor size, and estrogen and progesterone receptor status, the adjusted hazard rate ratio for African American women was 1.34 (95% confidence interval = 1.22 to 1.46). Similar risks were found among women ages 20-49 and 50 and older. Controlling for treatment slightly lowered the hazard rate ratio to 1.31 (95% confidence interval = 1.20 to 1.43). CONCLUSIONS: Among women with invasive breast cancer, being insured and having access to medical care does not eliminate the survival disparity for African American women.

In order to assess the influence of eight different sterilisation and disinfection methods for bone allografts on adhesion, proliferation, and differentiation of human bone marrow stromal cells (BMSC), cells were grown in culture and then plated onto pieces of human bone allografts. Following processing methods were tested: autoclavation (AUT), low-temperature-plasma sterilisation of demineralised allografts (D-LTP), ethylene oxide sterilisation (EtO), fresh frozen bone (FFB), 80 degrees C-thermodisinfection (80 degrees C), gamma-irradiation (Gamma), chemical solvent disinfection (CSD), and Barrycidal-disinfection (BAR). The seeding efficiency was determined after one hour to detect the number of attached cells before mitosis started. The cell viability was determined after 3, 7, and 21 days. Tests to confirm the osteoblastic differentiation included histochemical alkaline phosphatase staining and RT-PCR for osteocalcin. Human BMSC showed greatest attachment affinities for D-LTP-, 80 degrees C-, and CSD-allografts, whereas less cells were found attached to AUT-, EtO-, FFB-, Gamma-, and BAR-probes. Cell viability assays at day 3 revealed highest proliferation rates within the FFB- and 80 degrees C-groups, whereas after 21 days most viable cells were found in D-LTP-, 80 degrees C-, CSD-, and Gamma-groups. BAR-treatment showed a considerably toxic effect and therefore was excluded from all further experiments. Highest AP-activity and gene expression of osteocalcin were detected in the D-LTP-group in comparison with all other groups. In summary, our results demonstrate that cell adhesion, final population, and function of BMSC are influenced by different disinfection and sterilisation methods. Therefore, processing-related alterations of BMSC-function may be important for the success of bone grafting. The experimental setup used in the present work may be useful for further optimisation of bone allograft processing.

Frakturen des Capitulum humeri sind selten. Trotz adaquater traumatologischer Therapie kommt es haufig zu Bewegungseinschrankungen, avaskularen Nekrosen des Frakturfragments und neurologischen Storungen (Traumatisierung von Nn. radialis, medianus und cutaneus antebrachii lateralis). Ziel der vorliegenden retrospektiven Studie war es unter Berucksichtigung dieser Komplikationen kurz- und mittelfristige Ergebnisse von Capitulumfrakturen Typ I nach Bryan und Morrey, die uber einen ventralen Zugang nach Henry mit Doppelschraubenosteosynthese versorgt wurden, zu untersuchen.

The ulnar coronoid is an important stabilizer of the elbow joint. The morphology of the coronoid fracture in association with a dislocation of the elbow joint correlates with the risk of persistent instability. Fractures involving more than 50% of the coronoid are unstable and require surgical fixation. This is especially the case when the distal insertion of the medial collateral ligament is involved in the fracture pattern. Instability is also seen in smaller lesions of the coronoid when there is an associated fracture of the radial head. The surgical approach depends upon the fracture morphology and the type of associated injuries. Transosseous fixation as well as ante- or retrograde screw fixation are viable alternatives.

Monteggia fractures are rare injuries. Early recognition is crucial in order to achieve good functional results. In the presented review paper it is pointed out that any fracture or angulation of the ulna should thoroughly be checked for any incomplete or complete dislocation of the radial head. Adequate clinical examination and radiologic evaluation are mandatory. The aim of treatment must be repositioning and retention of the radial head and restoration of the ulnar alignment. During the last years, surgical treatment has become more important for achieving good functional results and foar avoiding secondary corrective surgery. For the majority of acute Monteggia lesions, immediate repositioning maneuvers with surgical stabilization of the ulna (elastic nailing techniques) under general anesthesia are indicated. Cast immobilization is of short duration; physical therapy is normally not necessary. Treatment of missed Monteggia lesions or chronic radial head dislocations is more difficult. Nevertheless, newer surgical techniques for secondary operative correction of ulnar malalignment are promising.

The use of hip- and shoulder arthroplasty in elderly patients for grossly displaced intraarticular fractures is being more and more accepted. Total elbow replacement (TER) has not been considered as an option for the treatment of extensively comminuted fractures of the distal humerus because surgeons feel the outcome is not predictable after TER generally. On the basis of a Medline literature research of this issue and the documented results based on the improvement of the designs of the implants, operative technique and the selection of patients, TER has a definite role in the treatment of some fractures of the distal humerus. We retrospectively reviewed forty-nine acute distal humeral fractures in forty-eight patients who were treated with total elbow arthroplasty as the primary option. The average age of the patients was sixty-seven years. Forty-three fractures were followed for at least two years (average duration of follow-up seven years). According to the AO classification, five fractures were type A, five were type B, and thirty-three were type C. The average flexion arc was 24 degrees to 131 degrees and the Mayo elbow performance score averaged 93 points. Thirty-two of the forty-nine elbows had neither a complication nor any further surgery from the time of the index arthroplasty to the most recent follow-up evaluation. Ten additional procedures, including five revision arthroplasties, were required in nine elbows. When osteosynthesis is not considered to be feasible, especially in patients who are physiologically older and place lower demands on the joint, total elbow arthroplasty can be considered, when strict inclusion criteria are observed.

Aim: In our retrospective study we evaluated short- and midterm results of open reduction and internal fixation via the anterior Henry approach of type 1 capitellar fractures. Method: 7 patients were examined 10-65 months after surgical treatment clinically and radiological. In all patients the Morrey score was assessed. Results: 5 patients had excellent or good results in the Morrey Score. All fractures were consolidated. 2 patients developed an arthrosis. Conclusion: Open reduction and internal fixation via the Henry approach is a suitable option for surgical treatment for type 1 capitellar fractures.

Frakturen der proximalen Ulna in Kom-bination mit einer proximalen radioulna-ren Dissoziation und Luxation des Radi-uskopfchens werden seit Bado [, 2] nach ihrem Erstbeschreiber Giovanni Batista Monteggia, 762–85, [2] als „Monteg-gia-Frakturen“ bezeichnet. Mit einer In-zidenz von 2–5% der Frakturen des proxi-malen Unterarms treten sie vergleichswei-se selten auf [7]. Trotz des verbesserten biomechanischen Verstandnisses und der Fortschritte in der operativen Frak-turversorgung sind Komplikationen, Re-visionseingriffe und unbefriedigende funktionelle Ergebnisse nach Monteggia- frakturen nach wie vor haufig [7, 20, 26, 37, 40]. In der Literatur existieren bis-her kaum grosere Studien, die sich aus-schlieslich mit diesem Verletzungsmus-ter und dem therapeutischen Konzept beim Erwachsenen beschaftigen. Auser-dem sind kritische Analysen der Ursa-chen unbefriedigender funktioneller Er-gebnisse nach Monteggia-Frakturen sel-ten zu finden. Zudem wurden in der Ver-gangenheit haufiger die Ergebnisse nach Monteggia-Frakturen im Erwachsenenal-ter mit denen im Kindesalter zusammen-gefasst [2, 8, 9, 39], obwohl weder Frak-turformen, Behandlungsgrundsatze und Prognose ubereinstimmen [36].

Distal humerus fractures in adults are treated by open reduction and internal fixation, which produces good results in the majority of patients. However, in elderly patients or in cases with metaphyseal comminution, stable fracture fixation still remains problematic. Anatomical joint reconstruction and primary stable osteosynthesis are often particularly difficult to achieve in this group of patients since poor bone mineral quality is frequently encountered. Consequently, longer immobilization is necessary, which is known to negatively influence functional outcome. Over the past few years, double-plate osteosynthesis techniques using different configurations have become the treatment of choice. Nevertheless, complications due to inappropriate primary stability and/or implant failure have been described. Investigations on whether the recently introduced Locking Compression Plates (LCPs) could enhance primary stability are rare. On the basis of clinical and biomechanical experiences, the authors consider LCPs a helpful tool for increasing primary stability in osteosynthesis of distal humerus fractures. LCPs might be of substantial advantage in patients with diminished bone mineral quality or in the presence of metaphyseal comminution.

Im Zeitraum von 10/96 bis 01/99 wurde bei insgesamt 29 Patienten (16 Frauen, 13 Manner; Alter Median 56,Spannweite 22–86 Jahre) mit lateralen Tibiakopffrakturen (5 B1-, 13 B2- und 11 B3-Frakturen nach der AO-Klassifikation) eine Osteosynthese in Form einer arthroskopisch, radiologisch gestutzten Reposition mit perkutaner Verschraubung (16-mal) oder einer offenen Reposition und Plattenosteosynthese (13-mal) durchgefuhrt. Das Patientenkollektiv bestand aus: 15 Patienten (7 Frauen, 8 Manner;Alter Median 41,Spannweite 22–86 Jahre), die von 10/96 bis 12/97 retrospektiv erfasst und nach median 11 Monaten (9–22) klinisch und radiologisch nachuntersucht werden konnten. 14 Patienten (9 Frauen,5 Manner;Alter Median 56,Spannweite 27–84 Jahre) wurden von 01/98 bis 01/99 prospektiv erfasst und nach 6 Monaten nachuntersucht. Die Impressionszone wurde insgesamt 11-mal mit autologer Spongiosa und 9-mal mit einem resorbierbaren Knochenzement (Norian SRS) augmentiert. In 9 Fallen war wegen des geringen Defektes bzw. eines Spaltbruchs keine Augmentation erforderlich. Im Lysholm-Score und im rontgenologischen Ergebnis zeigten sich in allen Gruppen uberwiegend gute bis sehr gute Ergebnisse ohne Unterschiede bezuglich der Augmentationsformen. In der Norian SRS-Gruppe war die Dauer der Teilbelastung sowie die Behandlungsdauer deutlich kurzer.Nach den bisherigen Erfahrungen eignet sich der injizierbare neue Knochenzement aufgrund der gunstigen Applikationsform und der hohen Primarstabilitat zur Augmentation bei Impressions- bzw. Impressions-/Depressionsfrakturen.

The University Health System Consortium (UHC) represents a strategic alliance of 169 academic health centers and associated institutions engaged in knowledge sharing and idea-generation. The use of the Internet as a tool in the delivery of UHC's products and services has increased dramatically over the past year and will continue to increase during the foreseeable future. This paper examines the current state of UHC-member institution driven tools and services that utilize the Web as a fundamental component in their delivery. The evolution of knowledge management at UHC, its management information and reporting tools, and expansion of e-commerce provide real world examples of Internet use in health care delivery and management. Health care workers are using these Web-based tools to help manage rising costs and optimize patient outcomes. Policy, technical, and organizational issues must be resolved to facilitate rapid adoption of Internet applications.

Purpose: To evaluate age- and gender-related mechanical properties and bone mineral density (BMD) of the proximal humerus at different levels and regions. Materials and Methods: Mechanical indentation testing, DXA, QCT, pQCT and the radiogrammetry (Cortical Index, CI) were carried out in 70 freshly harvested humeri from 46 human cadavers (23 females, 23-males; median age 70.5 years). Results: In the female group, a high correlation between age and BMD was found (p = 0.62 to -0.70, p

The case of a 27-year-old overhead athlete with chronic shoulder pain because of an isolated subscapularis tear without trauma is described. Arthroscopy has proven to be the appropriate method for detailed visualisation of the injury and facilitates the operative planning. Furthermore, arthroscopy closes the problem of a "diagnostic gap". In the presented case, the results at the two year follow-up are excellent. The authors conclude that an operative approach is also justified in non-traumatic isolated ruptures of the subscapularis muscle.

Einleitung: Die Verminderung postoperativer Schmerzen gehort nach wie vor zu den essentiellen Aufgaben einer adaquaten chirurgischen Patientenversorgung. Methoden: In eine prospektive, randomisierte, doppelblinde Vergleichsstudie wurden uber einen Einjahreszeitraum 118 Patienten (67 Manner/51 Frauen; Alter median: 43 Jahre, min. 18; max. 74) eingeschlossen. Es erfolgte eine Einteilung in 2 Gruppen. In der Verumgruppe wurde intraoperativ eine Wundinstillation mit Ropivacain vorgenommen, in der Kontrollgruppe nicht. Schmerzintensitat, Analgetikaverbrauch und Patientenzufriedenheit wurden postoperativ ermittelt. Bei 10 Patienten wurden die Plasmaspiegel bestimmt. Ergebnisse: Durch das Verfahren werden postoperative Schmerzen sowie Schmerzmittelbedarf signifikant verringert. Die Zufriedenheit der Patienten mit der postoperativen Schmerzbehandlung ist groser als in der Kontrollgruppe. Es wurden keine potentiell toxischen Ropivacain-Plasmaspiegel gemessen. Schlussfolgerungen: Durch die beschriebene Methode kann der Chirurg zur signifikanten Verringerung postoperativer Schmerzen und des Analgetikabedarfs beitragen. Weiterhin kann eine grosere Patientenzufriedenheit erreicht werden. Mit Komplikationen als Folge toxischer Plasmaspiegel ist nicht zu rechnen.

Im Zeitraum zwischen 4/1997 und 10/1999 wurden 31 Patienten mit dislozierten proximalen Humerusfrakturen mit einer gekreuzten Schraubenosteosynthese operativ versorgt. Bei diesem Operationsverfahren werden 2–3 Kleinfragmentschrauben uber einen deltoidopektoralen Zugang vom Schaftfragment aus uberkreuzend ventral und dorsal im Humeruskopf platziert. Bei den 2-Segmentfrakturen wird zusatzlich eine Zuggurtung angelegt, bei den 3-Segmentfrakturen das Tub. majus zusatzlich mit 2 Schrauben fixiert. 21 Patienten (14 w, 7 m, Altersmedian 62 Jahre, 18–86) konnten nach einem medianen Follow-up von 18 Monaten (10–29) klinisch und radiologisch nachuntersucht werden. Dabei handelte es sich um 10 2-Segment- und 11 3-Segmentfrakturen. Die Ergebnisse im Constant-Score ergaben bei 15 Frakturen sehr gute und gute Ergebnisse, in 3 Fallen befriedigende und bei 3 Patienten schlechte Ergebnisse (1-mal 2-Segment-, 2-mal 3-Segmentfrakturen). Die Komplikationsrate lag bei 29% (3 Patienten mit fruhzeitiger Schraubenentfernung wegen Kopfperforation, 2 mit sekundarer Prothesenimplantation bei Humeruskopfnekrose und 1 mit Redislokation der Fraktur). Die gekreuzte Schraubenosteosynthese stellt eine Alternative bei der Versorgung dislozierter proximaler Humerusfrakturen dar und ermoglicht eine fruhfunktionelle Nachbehandlung.

First traumatic anterior shoulder dislocation still remains a topic of controvery regarding the factors which have an impact on the functional result and the development of chronic instability. In the presented study, criteria influencing the recurrence rate and the final outcome after conservative treatment are assessed. Material and Methods: Between January 1989 and March 1997, 175 patients were treated conservatively. In 91 patients, a clinical and radiologic follow-up was obtained using a retrospective study design. In all patients, adequate trauma was found. Two groups were formed according to the patients' age (PY30: patients aged 30 years and younger, n = 45; PO30: patients older than 30 years, n = 46). For clinical assessment, the Rowe score was used. Bilateral shoulder ultrasaound and X-rays of the involved shoulder were obtained for radiologic evaluation. Results: The recurrence rate was 89% in the PY30 group and 26% in the PO30 group (p < 0.05). A relationship between the immobilization period and the recurrence rate could not be found (p = 0.8). According to the Rowe score, excellent or good results were achieved in 19 patients of PY30 (42%) and in 29 patients of PO30 group (63%). However, main criteria significantly influencing the recurrence rate are the patients' age and activity level. Additionally, the presence of a Hill-Sachs lesion, glenohumeral subluxation or rotator cuff tears is important to the development of chronic instability. Conclusion: The results of the presented study indicate the high risk of chronic instability in young and active patients following primary conservative treatment.

Between 11/1989 and 6/1998 52 patients (10 m., 42 f., age median 72 years, 31-88) with proximal humeral fractures have been treated by conservative means (angulation of humeral head > 45 degrees and/or shaft displacement > 1 cm and displacement of greater tuberosity > 0.5 cm). In 37 patients (71%, 31 f., 6 m., age median 75 years, 36-88) a clinical and radiological follow-up could be obtained after median 20 months (3-93). According to the Neer-classification, subcapital 2-part fractures were found in 19 cases and 3-part fractures in 12 cases. 4-part fractures were diagnosed in 6 cases. By using the Constant-Score, the final result was scored "excellent" in 10 patients and "good" in 13 patients. In 7 patients each the results achieved were "moderate" or "poor". The underlying cause for the poor results was primarily due to persisting painful impairment in range of motion and loss of strength. Radiologically, persisting axial deviation was present in 23 cases, arthrosis in 14 patients and humeral head necrosis in 8 patients. Most commonly, poor functional and radiological results occurred in 4-part fractures. However, conservative therapy of displaced 2-part and 3-part fractures is a considerable therapeutical option since the final results are predominantly good. In contrast, due to the poor results after conservative therapy 4-part fractures should be treated surgically.

Das Ellbogengelenk ist aufgrund seiner zentralen Lage aus funktionellen Gesichtspunkten als das bedeutendste Gelenk der oberen Extremitat anzusehen. Knocherne und ligamentare Verletzungen im Bereich des proximalen Unterarms konfrontieren den behandelnden Arzt mit einer Anzahl von diagnostischen und therapeutischen Problemen. Posttraumatische Zustande am Ellbogengelenk, die mit chronischer Schmerzsymtomatik und Bewegungseinschrankungen einhergehen, mindern zwangslaufig die Gebrauchsfahigkeit des gesamten Arms. Es besteht heute kaum noch ein Zweifel daran, dass in der Mehrzahl der Falle eine primare definitive osteosynthetische Versorgung mit exakter Rekonstruktion der Gelenkflache fur ein befriedigendes Resultat ebenso unverzichtbar ist wie ein fruhzeitiger Beginn physiotherapeutischer Ubungsmasnahmen. Mit zunehmendem Verstandnis der anatomischen und biomechanischen Besonderheiten des proximalen Unterarms vollzog sich in den letzten Dekaden ein entscheidender Wandel der therapeutischen Grundsatze, deren aktueller Stand in der vorliegenden Arbeit unter Berucksichtigung der relevanten Literatur vorgestellt wird.

L'A. etudie les implications structurelles de trois conventions litteraires : le referent espace/temps, la formule meta tauta eidon et ses variantes, la formule kai eidon. Il utilise l'expression episode visionnaire comme classification litteraire d'un texte visionnaire identifie a travers un referent espace/temps. La formule meta tauta eidon est utilisee pour identifier des visions majeures, la formule kai eidon pour des visions mineures. Les apocalypses de IV Esdras et II Baruch temoigne d'un usage de ces trois conventions plus raffine que I Henoch et Daniel. Les trois conventions litteraires dans l'Apocalypse de Jean donne une structure pour les textes de visions.

The case of an 39-year-old man is presented, who sustained a bilateral locked fracture dislocation of the shoulders occurring during an epileptic seizure. Radiographs demonstrated a compression-fracture of the anteromedial aspect of the humeral head bilaterally (reversed Hill-Sachs-lesions). Additionally, fractures of the lesser and greater tuberosity were diagnosed at the right site. Open reduction and internal fixation was performed in both shoulders within 12 hours. 6 months later the patient has no complaints with a free range of motion. Diagnostics, treatment and result are discussed in context with the literature.

Between January 1989 and March 1997, 175 patients with traumatic shoulder dislocation were treated by conservative means (median age 41 years, 39 F, 136 M). In 78 patients (17 F, 61 M) a clinical and radiological follow up (median 50 months, range 6-106) could be obtained. Additionally, a diagnostic ultrasound was carried out in all patients. The recurrence rate in the group younger than 30 years (G 30; n = 43) it was 21% (P 30, 29 patients (67%). In 17% of cases, a glenohumeral arthrosis was diagnosed be radiological means. 18% had radiological signs of a previous fracture of the greater tuberosity. Hill-Sachs lesions were identified in 19% of cases. Rotator cuff tears were diagnosed in 9% by ultrasound. No relationship between the duration of immobilization and the recurrence rate was found (P = 0.95). The recurrence rate following primary shoulder dislocation depends primarily on the patients' age.

We present the crystal structure and biophysical characterization of a human V(L) [variable domain immunoglobulin (Ig) light chain] single-domain intrabody that binds to the huntingtin (Htt) protein and has been engineered for antigen recognition in the absence of its intradomain disulfide bond, otherwise conserved in the Ig fold. Analytical ultracentrifugation demonstrated that the αHtt-V(L) 12.3 domain is a stable monomer under physiological conditions even at concentrations >20 μM. Using peptide SPOT arrays, we identified the minimal binding epitope to be EKLMKAFESLKSFQ, comprising the N-terminal residues 5-18 of Htt and including the first residue of the poly-Gln stretch. X-ray structural analysis of αHtt-V(L) both as apo protein and in the presence of the epitope peptide revealed several interesting insights: first, the role of mutations acquired during the combinatorial selection process of the αHtt-V(L) 12.3 domain-initially starting from a single-chain Fv fragment-that are responsible for its stability as an individually soluble Ig domain, also lacking the disulfide bridge, and second, a previously unknown mode of antigen recognition, revealing a novel paratope. The Htt epitope peptide adopts a purely α-helical structure in the complex with αHtt-V(L) and is bound at the base of the complementarity-determining regions (CDRs) at the concave β-sheet that normally gives rise to the interface between the V(L) domain and its paired V(H) (variable domain Ig heavy chain) domain, while only few interactions with CDR-L1 and CDR-L3 are formed. Notably, this noncanonical mode of antigen binding may occur more widely in the area of in vitro selected antibody fragments, including other Ig-like scaffolds, possibly even if a V(H) domain is present.

OBJECTIVE AND METHODS: Given the profound weight loss after gastric banding and bypass we compared fat compartmentalization by whole body magnetic resonance imaging in women and men after these procedures to two groups of non-surgical controls who were either matched for age, weight and height or were of lower body mass index (BMI). RESULT: In women post-surgery (n=17; BMI 31.7 kg/m(2)) there was lower visceral adipose tissue (VAT) (1.4 vs 2.5 kg; P0.01) compared with matched controls (n=59; BMI 32.1 kg/m(2)). In contrast, VAT (5.3 vs 5.4 kg) was nearly identical in men post-surgery (n=10; BMI 34.1 kg/m(2)) compared with matched controls (n=10; BMI 32.1 kg/m(2)) even though the degree of weight reduction was not significantly different from women (27.4 vs 32.6%). Furthermore, VAT when adjusted for total adipose tissue (TAT) was 43% less in women post-surgery (1.2 vs 2.1 kg; P=0.03) than in controls with lower BMI (25.1 kg/m(2)). After adjustment for TAT, subcutaneous adipose tissue in women post-surgery was significantly greater than matched controls (35.1 vs 34.2 kg; P=0.03). There was a significant negative correlation of VAT and the degree of weight loss in women (r=-0.57; P=0.018) but this relationship was not significant in men (r=-0.39; P=0.27). Skeletal muscle was lower in both sexes compared with matched controls (women, 21.8 vs 23.1 kg; men, 32.5 vs 35.5 kg). CONCLUSION: Prospective studies are necessary to confirm if there is a sexual dimorphism in the effects of bariatric surgery on body composition.