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Many pediatric patients with severe scoliosis requiring surgery have baseline anemia. Pediatric scoliosis fusion surgery is associated with perioperative blood loss requiring transfusion. As such, many patients in this surgical population could benefit from a perioperative blood conservation program.Here we present a narrative review of perioperative blood conservation strategies for pediatric scoliosis surgery involving nurses, transfusion medicine physicians, anesthesiologists, surgeons, dieticians, perfusionists and neurophysiologists spanning the pre-, intra- and postoperative phases of care.The review highlights how perioperative blood conservation strategies, have the potential to minimize exposures to exogenous blood products. Further, we describe a relevant example of blood conservation related to the care of a Jehovah's Witness patient undergoing staged scoliosis repair. Lastly, we outline areas which would benefit from clinical studies to further elucidate perioperative blood conservation interventions and their outcomes relevant to pediatric scoliosis surgery patients.Interdisciplinary communication and meticulous blood conservation strategies are proving to be a means of reducing if not eliminating the need for allogeneic blood products for surgical correction of pediatric scoliosis.

Adenosine plays a role in the energy supply of cells and provokes differential, hormone-like functions in circulating cells and various tissues. Its release is importantly regulated by oxygen tension. This renders adenosine and its kinetics interesting to investigate in humans subjected to low oxygen conditions. Especially for space exploration scenarios, hypoxic conditions – together with reduced gravity - represent two foreseen living conditions when planning manned long-duration space missions or planetary habitats. The PlanHab study investigated microgravity through inactivity in bed rest and normobaric hypoxia to examine their independent or combined effect on adenosine and its kinetics. Healthy male subjects (n = 14) completed three 21-day interventions: hypoxic bed rest (HBR); hypoxic ambulatory confinement (HAMB); normoxic bed rest (NBR). The interventions were separated by 4 months. Our hypothesis of a hypoxia-triggered increase in adenosine was confirmed in HAMB but unexpectedly also in NBR. However, the highest adenosine levels were noted following HBR. Furthermore, the percentage of hemolysis was elevated in HBR whereas endothelial integrity markers stayed low in all three interventions. In summary, these data suggest that neocytolysis accounts for these effects while we could reduce evidence for microcirculatory changes.

Immobilization and hypoxemia are conditions often seen in patients suffering from severe heart insufficiency or primary pulmonary diseases (e.g. fibrosis, emphysema). In future planned long-duration and exploration class space missions (including habitats on the moon and Mars), healthy individuals will encounter such a combination of reduced physical activity and oxygen tension by way of technical reasons and the reduced gravitational forces. These overall unconventional extraterrestrial conditions can result in yet unknown consequences for the regulation of stress-permissive, psycho-neuroendocrine responses, which warrant appropriate measures in order to mitigate foreseeable risks. The Planetary Habitat Simulation Study (PlanHab) investigated these two space-related conditions: bed rest as model of reduced gravity and normobaric hypoxia, with the aim of examining their influence on psycho-neuroendocrine responses. We hypothesized that both conditions independently increase measures of psychological stress and enhance neuroendocrine markers of stress, and that these effects would be exacerbated by combined treatment. The cross-over study composed of three interventions (NBR, normobaric normoxic horizontal bed rest; HBR, normobaric hypoxic horizontal bed rest; HAMB, normobaric hypoxic ambulatory confinement) with 14 male subjects during three sequential campaigns separated by 4 months. The psychological state was determined through three questionnaires and principal neuroendocrine responses were evaluated by measuring cortisol in saliva, catecholamine in urine, and endocannabinoids in blood. The results revealed no effects after 3 weeks of normobaric hypoxia on psycho-neuroendocrine responses. Conversely, bed rest induced neuroendocrine alterations that were not influenced by hypoxia.

A detailed understanding of the CSF dynamics is essential for testing and evaluation of intrathecal drug delivery. Preclinical work using large-animal models (e.g., monkeys, dogs and sheep) has great utility for defining spinal drug distribution/pharmacokinetics and provide an important tool for defining safety. In this study, we investigated the impact of catheter implantation in the sub-dural space on CSF flow dynamics in Cynomolgus monkeys. Magnetic resonance imaging (MRI) was performed before and after catheter implantation to quantify the differences based on catheter placement location in the cervical compared to the lumbar spine. Several geometric and hydrodynamic parameters were calculated based on the 3D segmentation and flow analysis. Hagen-Poiseuille equation was used to investigate the impact of catheter implantation on flow reduction and hydraulic resistance. A linear mixed-effects model was used in this study to investigate if there is a statistically significant difference between cervical and lumbar implantation, or between two MRI time points. Results showed that geometric parameters did not change statistically across MRI measurement time points and did not depend on catheter location. However, catheter insertion did have a significant impact on the hydrodynamic parameters and the effect was greater with the cervical implantation. CSF flow rate decreased up to 54.7% when the catheter located in the cervical region. The maximum flow rate reduction in the lumbar implantation group was 21%. Overall, lumbar catheter implantation disrupted CSF dynamics to a lesser degree than cervical catheter implantation and this effect remained up to two weeks post-catheter implantation

Recent advancements have been made toward understanding the diagnostic and therapeutic potential of cerebrospinal fluid (CSF) and related hydrodynamics. Increased understanding of CSF dynamics may lead to improved detection of central nervous system (CNS) diseases and optimized delivery of CSF based CNS therapeutics, with many proposed therapeutics hoping to successfully treat or cure debilitating neurological conditions. Before significant strides can be made toward the research and development of interventions designed for human use, additional research must be carried out with representative subjects such as non-human primates (NHP). This study presents a geometric and hydrodynamic characterization of CSF in eight cynomolgus monkeys (Macaca fascicularis) at baseline and two-week follow-up. Results showed that CSF flow along the entire spine was laminar with a Reynolds number ranging up to 80 and average Womersley number ranging from 4.1-7.7. Maximum CSF flow rate occurred ~25 mm caudal to the foramen magnum. Peak CSF flow rate ranged from 0.3-0.6 ml/s at the C3-C4 level. Geometric analysis indicated that average intrathecal CSF volume below the foramen magnum was 7.4 ml. The average surface area of the spinal cord and dura was 44.7 and 66.7 cm2 respectively. Subarachnoid space cross-sectional area and hydraulic diameter ranged from 7-75 mm2 and 2-3.7 mm, respectively. Stroke volume had the greatest value of 0.14 ml at an axial location corresponding to C3-C4.

Objectives The use of adjuvants in regional anesthesia has increased. However, there are knowledge gaps pertaining to 1) in vivo local tissue effects of these adjuvants; and 2) chemical compatibility and solubility of these drugs in solution with each other and with local anesthetics. This study addresses these gaps in knowledge. Design In vivo rat safety/toxicopathology study and analytical chemistry study. Setting Collaborating Good Laboratory Practice laboratories under the direction of the university-based principal investigator. Methods Single-injection formulations of clonidine, buprenorphine, and dexamethasone were combined with either bupivacaine or midazolam, and were administered to groups of rats. Post-injection behavior was monitored to assess changes related to the block. A continuous infusion of bupivacaine, clonidine, and dexamethasone was administered to another group of rats, and behavioral effects were recorded. After 15 days, rats were sacrificed and their nerves/dorsal root ganglia were examined by the pathologist. Samples of combined drug solutions were processed at an analytical chemistry laboratory for compatibility, solubility, and stability. Results Each of the single-injection formulations produced reversible sensory and/or motor block. None of the study drugs caused damage to any of the nerve segments or related tissue. The text describes the concentrations at which compatibility and solubility of the combined drug solutions were achieved. Conclusions Four-drug single-injection formulations are described that 1) had compatible and stable concentrations in solution; and 2) produced reversible nerve block without causing long-term motor or sensory deficits or damage to sciatic nerves/dorsal root ganglia.

A detailed quantification and understanding of cerebrospinal fluid (CSF) dynamics may improve detection and treatment of central nervous system (CNS) diseases and help optimize CSF system-based delivery of CNS therapeutics. This study presents a computational fluid dynamics (CFD) model that utilizes a nonuniform moving boundary approach to accurately reproduce the nonuniform distribution of CSF flow along the spinal subarachnoid space (SAS) of a single cynomolgus monkey. A magnetic resonance imaging (MRI) protocol was developed and applied to quantify subject-specific CSF space geometry and flow and define the CFD domain and boundary conditions. An algorithm was implemented to reproduce the axial distribution of unsteady CSF flow by nonuniform deformation of the dura surface. Results showed that maximum difference between the MRI measurements and CFD simulation of CSF flow rates was

Ketones 2 (MSDC-0160) and 3 (MSDC-0602) had been selected for clinical development, however their initial syntheses were considered suboptimal for application deep into clinical trials. Difficulties ranging from the nature of the starting material, alcohol oxidation problems, epoxide opening regioisomeric issues, and endgame ketone redox problems had been encountered. Direct ketone introduction/maintenance was desired for maximum efficiency and convergence was found to be critically dependent upon the acidity of the nucleophilic species (13, 18) and the use of pre- or post-alkylative oximino-ether/oxime protection (vide infra). Improvements in overall yield for the syntheses of 2 (MSDC-0160) and 3 (MSDC-0602) from 20% (2) and 31% (3) respectively, to 44% (2) and 59% (3) were realized.

Zusammenfassung Nach intravenoser Applikation von Sulfamethylphenazol beim Pferde wurden der Blutspiegel und die Konzentration in der Synovialflussigkeit der Sprunggelenke untersucht. Sulfamethylphenazol zeichnet sich durch langanhaltende hohe Blutspiegel aus. Bereits nach einer Stunde ist es in hoher Konzentration in der Synovia nachweisbar. Nach 24 Stunden liegt die Konzentration in der Synovia noch hoher als im Blut. Mit einer Dosierung von 100 mg/kg Korpergewicht am ersten Tage und je 50 mg/kg Korpergewicht am 2. und 3. Tage, kann man im Blut und in der Synovia einen therapeutischen Blutspiegel von etwa 5 mg% uber 84 Stunden aufrecht erhalten. Summary The concentration of sulphamethylphenazol in blood and synovial fluid after intravenous injection in the horse In a series of 15 horses the blood level of sulphamethylphenazol remained high for a long period after intravenous injection. A high level was reached in the synovia within one hour of injection and after 24 hours the level was higher than in the blood. At a dosage of 100 mg/kg. bodyweight on the first day and 50 mg/kg. on the second and third days it was possible to obtain a therapeutic level in the synovia and the blood of about 5 mg% throughout 84 hours. Resume Concentration du sulfamethylphenazol dans le sang et la synovie du cheval traite par voie intraveineuse Apres l'injection intraveineuse de sulfamethylphenazol a quinze chevaux, on en recherchait la teneur dans le sang et le liquide synovial du jarret. Une particularite du sulfamethylphenazol est de se maintenir de faĉon prolongee et a un taux eleve, dans le sang. Il peut etre decele, apres une heure deja et en forte concentration dans la synovie. Apres 24 heures, la synovie en contient plus que le sang. En procedant a l'administration de 100 mg par kg de poids de l'animal le premier jour, suivie de celle de 50 mg/kg le 2eme puis le3eme jour, on obtient aussi bien dans le sang que dans la synovie un taux therapeutique d'environ 5 mg% qui dure au dela de 84 heures. Resumen La concentracion de sulfametilfenazol en la sangre y en la sinovia tras la aplicacion intravenosa en el caballo Tras la administracion endovenosa de sulfametilfenazol en el caballo se analizo el nivel sanguineo y la concentracion en el liquido sinovial de los corvejones. El sulfametilfenazol se caracteriza por elevados dinteles sanguineos de larga duracion. Incluso al cabo de una hora se puede identificar en suprema concentracion en la sinovia. Transcurridas 24 horas, la concentracion en la sinovia es superior a la de la sangre. Con una dosificacion de 100 mg/kg de peso vivo en el primer dia y 50 mg/kg de peso vivo cada vez en el segundo y tercer dia puede mantenerse en sangre y en la sinovia un nivel sanguineo terapeutico de unos 5 mg% a lo largo de 84 horas.

Zusammenfassung Bei Trabrennpferden tritt eine Erkrankung auf, die von den Tierbesitzern als “Sauerwerden” bezeichnet wird, und die durch die fast ausschliesliche Haferfutterung bedingt ist. Sie ausert sich in Fresunlust und Mudigkeit und ist nur durch langere Umstellung in der Futterung zu heilen. Um den schadlichen Einflus der Haferfutterung zu untersuchen, wurden drei Versuchspferde ausschlieslich mit Hafer gefuttert und fortlaufend das Blutbild und die Konzentrationen des Calcium, Kalium, Phosphor, Bilirubin, NaCl, Rest-N, Kreatin-Kreatinin und des Cholesterin im Serum untersucht. Nach drei Wochen verweigerten die Tiere die Haferaufnahme und zeigten Kaliummangelerscheinungen. Die Serumkaliumwerte fielen auf 11,46 bzw. 14,31 bzw. 14,93 mg% ab. Es wird angenommen, das das Kalium vom Organismus zur Neutralisation und Ausscheidung der mit dem Hafer uberschussig angebotenen Phosphorsaure gebraucht wird, und das es dadurch zu Storungen im Mineral- und Muskelstoffwechsel kommt. Summary Exclusive oat feeding and its effects There occurs among trotting horses a condition known to owners as “Sauerwerden” (going sour) which is caused by a diet consisting almost entirely of oats. The symptoms are loss of appetite and fatigue and they can be cured only by a long period on a different diet. In order to study the toxic effect of oat feeding three horses were kept on a diet consisting entirely of oats and the blood picture and serum levels of Ca, K, P, bilirubin, NaCl, N. P. N., creatine-creatinine and cholesterol were determined at intervals. After 3 weeks the animals refused the oats and showed symptoms of K deficiency. Serum K fell to 11,46, 14,31 and 14,93 mg % in the three animals. It is suggested that K was withdrawn from the body stores for the neutralisation and excretion of the large amounts of phosphoric acid in the oats and this resulted in disturbances in mineral and muscle metabolism. Resume L'alimentation a l'avoine unilaterale et ses consequences Il existe chez les chevaux de course (au trot) une maladie que les proprietaires appellent “Sauerwerden” et qui est causee par une alimentation a l'avoine presque exclusive. Elle se manifeste par de l'inappetance et de la fatigue et ne peut etre guerie que par un changement de nourriture prolonge. Pour permettre d'etudier l'action nocive de l'alimentation a l'avoine, trois chevaux d'experience furent nourris exclusivement avec de l'avoine. On controla regulierement la formule sanguine et la concentration dans le serum du calcium, du potassium, du phosphore, de la bilirubine, du chlorure de sodium, de l'azote restant, de la creatine et creatinine et de la cholesterine. Au bout de trois semaines, les animaux refuserent l'avoine et donnerent des signes de carence en potassium. La teneur du serum en potassium tomba respectivement a 11,46–14,31 et 14,93 mg %. Les auteurs supposent que le potassium est employe par l'organisme pour neutraliser et eliminer l'acide phosphorique contenu en exces dans l'avoine et qu'il en resulte ainsi des troubles dans le metabolisme mineral et musculaire. Resumen La alimentacion unilateral con avena y sus consecuencias En los caballos trotadores aparece una enfermedad, llamada por los propietarios “acidificacion”, y que viene condicionada por la alimentacion casi exclusiva con avena. Se caracteriza por la anorexia y el cansancio y puede curarse solamente despues de un cambio duradero de la alimentacion. Con el fin de estudiar la perniciosa influencia de la alimentacion a base de avena se alimentaron tres caballos con avena exclusivamente, analizando de forma continuada el cuadro sanguineo y las concentraciones en el suero: del calcio, potasio, fosforo, bilirrubina, cloruro sodico, nitrogeno residual, creatina-creatinina y de la colesterina. Despues de tres semanas, los animales se negaron a ingerir mas avena y mostraron sintomas de carencia potasica. Los valores de la potasemia descendieron hasta 11,46, 14,31 y 14,93 mgrs.%, respectivamente. Se supone que el potasio del organismo precisase para la neutralizacion y eliminacion del acido fosforico excesivo ofrecido con la avena, y que de esta manera se originan las alteraciones en los metabolismos mineral y muscular.

Resume Le traitement des deformations rachidiennes du petit enfant (c’est-a-dire arbitrairement âge de moins de 6 ans) est particulierement difficile s’il s’agit de deformations touchant l’ensemble de la colonne vertebrale comme peuvent l’etre celles secondaires a une scoliose idiopathique maligne ou un rachis paralytique. Le traitement chirurgical en effet ne peut pretendre resoudre le probleme malgre toutes les tentatives faites ou le plus souvent le patient et sa deformation ont ete aggraves plutot que corriges. Il faut l’opposer aux deformations tres localisees de type malformatif par exemple ou un traitement chirurgical local simple peut guerir definitivement l’enfant. Il faut connaitre le traitement non operatoire par plâtres souvent repetes et corsets orthopediques alternes, souvent pendant de longues annees, avant de pouvoir effectuer une arthrodese a un âge suffisant qui ne corrigera pas totalement la deformation, mais stabilisera le rachis de maniere durable. Ce traitement long, astreignant, peu brillant, est tres souvent mal connu, mal realise, alors qu’il peut etre extremement utile si la prise en charge est correcte. Chaque cas est different selon l’etiologie, l’etendue et la localisation des deformations et les problemes associes au niveau des autres appareils. Le but de cet article est de faire connaitre ces techniques et leurs indications en se rappelant que chaque patient est unique et doit etre considere comme tel, mais que les techniques et les recommandations exposees peuvent parfaitement etre adaptees a chaque cas.

Six fresh human specimens extending from the 9th thoracic vertebra (T9) to the pelvis were used to study the biomechanical behaviour of the long lumbopelvic segments, including mobility of the sacrum. The loads were applied at T9 using pure couples up to 5 Nm. The displacements were measured by an optoelectronic method (VICON 140). Stress-displacement curves were obtained for the three angular components of the vertebra studied according to the plane of the principal stresses and of the two other planes corresponding to the coupled mobilities. Mobility decreased from T9 to the sacrum. There was mobility of the sacrum in relation to the pelvis in flexion, with a mean of 1.28 degrees (0.5 to 2.8 degrees); 3 sacrums showed a mobility of the order of one degree for torsional stresses. There was no sacral mobility during stresses in lateral flexion. The use of this experimental protocol with low mechanical stresses should allow the evaluation of long osteosyntheses extending to the sacrum.

Cotrel–Dubousset instrumentation (CDI) was developed between 1982 and 1984 and is now widely used for the correction of scoliosis. The several studies performed in order to analyze the three-dimensional corrections did not focus on the intraoperative phenomena. In this paper, we present an intraoperative measurement procedure using the VICON optoelectronic system which allows us to quantify the three-dimensional displacements of the instrumented vertebrae at different stages of the surgery: after the exposure of the spine, after placement of the first rod and the hooks, after the derotation maneuver, and after placement of the second rod. After having been tested on cadaveric specimens, this measurement procedure has been used with six patients suffering from right thoracic idiopathic and scheduled for Cotrel–Dubousset surgery scoliosis at the St. Vincent de Paul Hospital (Paris, France). The results quantify the three-dimensional correction achieved by CDI and furthermore suggest that the role played by the hooks and the second rod in the correction phenomena is not negligible compared to that of the derotation maneuver.

In this paper we study the adaptive behavior of firms which repeatedly have to make a production decision. In a single good market the firms use own experience as well as information gathered by observing competitors to iteratively choose a production technology out of a given set. The adaptive learning of the firms is described in a dynamic model and analyzed in a simulation framework. We show that a small but positive propensity to imitate is optimal for the firms and yields production efficiencies above 95% of the maximal value. Furthermore, we observe that in a competitive situation firms using optimal propensities to imitate outmatch pure imitators and nonimitators in production efficiency as well as in profits.

In this paper, the problem of sequencing PCB assembly jobs on an automatic SMD placement machine is addressed. The objective is to minimize the makespan. Moreover, both the job arrival times and the precedence constraints for those jobs requiring component placement on the primary and secondary side of the same board must be taken into account. A considerable set-up time occurs when switching from one board type to another, which depends on the number of component feeders to be replaced in the magazine of the assembly machine. The exchange of component feeders is complicated by the fact that each feeder occupies a different number of magazine positions. Theoretically, the minimum makespan required for a given batch of jobs could be derived by solving the order sequencing and the component set-up problems simultaneously. However, optimal solutions are practically unattainable for problems of realistic size. Therefore, efficient heuristic solution procedures are developed which exploit component commonality...

In this paper a heuristic solution procedure is developed to deal with the component switching problem, which arises in printed circuit board assembly. In the first stage of the recursive heuristic, we determine the component set-up for a given sequence of board types to be processed on a single placement machine by applying a modification of the so-called ‘keep component needed soonest’ policy. In the second stage, component feeders are assigned to slots in the magazine of the placement machine. Recursions to the first stage allow feasible solutions to be generated very fast for all instances of the numerical experiments. These solutions differ only slightly from those obtained for the relaxed problem for which the assignment restrictions are omitted.

The aim of this study was to establish a non-invasive experimental protocol in order to objectively identify global posture and kinematic characteristics of scoliotic spines, and compare the pre- and post-operative results of treatment. The optical motion capture system Vicon was used to track reflective markers fixed on the body. Three-dimensional records of the posture and motion of 15 normal (healthy) volunteers were analyzed, and the corresponding results of two scoliotic subjects in pre- and post-operative situations were then obtained.

In neuerer Zeit kommen in der Plasmaspritztechnologie auch sogenannte temperatursensitive Werkstoffe zur Anwendung. Bei dieser Werkstoffklasse besteht prozesbedingt die Moglichkeit einer unerwunschten Veranderung des Werkstoffes (Sublimation oder chemische Zersetzung). Eine rein auf empirischen Methoden beruhende Schichtoptimierung ist daher bei diesen Spritzwerkstoffen als kritisch zu bewerten. Es wird gezeigt, das eine Prozesdiagnostik mittels IR-Thermokamera die Parameterstudie unterstutzt und wichtige Hinweise im Hinblick auf den Zusammenhang zwischen Maschineneinstelldaten und Schichteigenschaften liefert. Die Auswahl des Prozesfensters baute auf Erkenntnissen aus Vorversuchen und einer dabei durchgefuhrten on-line Prozesdiagnostik auf. Das ermoglichte definiert Plasmaspritzschichten aus Hydroxylapatit mit unterschiedlichen Schicht- und Bauteileigenschaften herzustellen. Dies ist besonders unter dem Gesichtspunkt von Interesse, das bei Hydroxylapatit nur eine auf den Werkstoff und nicht auf Plasmaspritzschichten bezogene Norm existiert. Die Beschichtungen besasen demzufolge eine geringe, respektive hohe Fremdphasenintensitat, einen unterschiedlichen Kristallinitatsgrad und Haftzugfestigkeiten, die zwischen 5 und 42 MPa lagen. Signifikanten Einflus auf das Beschichtungsergebnis nahmen neben der Leistung und der Art der Leistungseinstellung auch die Tragergasmenge, mit der das Spritzpulver in in den Plasmafreistrahl injiziert wurde. Process-Identification at Plasma Spraying Thermally Sensitive Materials Using an Infra-red Thermal Imaging System Nowadays so called thermally sensitive materials are deposited by thermal spray techniques. Due to the high temperature process an undesired alteration (evaporation, chemical decomposition) of the material could occur. Therefore, optimisation of the deposition based only on empirical methods may be deremental with respect to the coating properties. This study shows the potential of an IR thermal imaging technique as a process control for evaluation and optimisation of the deposition through better understanding of the thermal spray process. The spray trials presented are based on preliminary examinations carried out with diagnostic tools. Therefore it was possible to achieve defined air plasma sprayed coatings of hydroxyapatite with different coating and component properties. This is particularly of interest, since there exists only a standard for hydroxyapatite as starting material but not for plasma sprayed coatings. Hence the coatings had either high or low contents of undesired phases, different degrees of cristallinity and bond strengths-varying from 5 to 42 MPa. Besides the power levels and the way to obtain the power the carrier gas flow significantly influences the properties of the coatings.

Methylcerium dichloride has been found to undergo bis addition to nitriles to produce tertiary carbinamines with retention of optical purity at the α position. This result is used in the development of a short, economical synthesis of the 1,8-naphthyridine antiinfective agent, PD 138312.

fr La forme des membres inferieurs de l'enfant normal inquiete souvent ses parents. La perturbation de la marche qui en resulte constitue un motif frequent de consultation. Or, si la plupart de ces troubles sont benins, cette consultation peut etre l'occasion d'un depistage d'une anomalie pathologique. Le role du medecin ici est double: d'une part, il doit rassurer les parents devant des deformations physiologiques et expliquer leur genie evolutif, le plus souvent favorable au cours de la maturation squelettique de l'enfant. D'autre part, malgre l'apparente banalite des deformations, il doit rester vigilant dans sa demarche diagnostique afin de redresser parfois un diagnostic errone en depistant des troubles pathologiques graves. Ainsi, une evaluation neuro-orthopedique doit etre systematiquement incluse dans le bilan clinique afin de depister des formes frustes d'affections neurologiques telles que myopathie ou infirmite motrice cerebrale (18). Dans ce contexte, on ne saurait trop insister sur la qualite et la rigueur de l'examen clinique qui permettra de soustraire l'enfant a des examens complementaires sans interet.

We present local density functional calculations for magnetic impurities andmagnetic monolayers in non-magnetic metals. The calculations employ a multiple scattering (KKR) Green's function method for impurities in the bulk andfor ideal surfaces and interfaces. In particular we discuss the moment formation of 3d and4d impurities in alkali andnoble metals. Special emphasis is put on an accurate calculation of the host polarization around 3d impurities in Cu andPd. While the calculated impurity hyperfine fields in Cu contain rather large errors due to the local density approximation, the induced fields of the Cu atoms agree very well with experiments. We also present similar calculations for magnetic monolayers andthe corre-sponding induced host polarization in Cu andPd.

We describe the results of beam tests of three uranium-liquid argon calorimeter modules constructed for the DO detector at the Fermilab Tevatron collider. As part of the calibration procedure, these modules were exposed to beams of electrons, pions and muons between 10 and 150 GeV/c before their installation in the end calorimeter of the completed DO detector. We obtain an electromagnetic sampling resolution of 15.7%/√E and constant term of 0.3%. The hadronic sampling resolution is 45%/√E (degraded to 50%/√E by the effects of upstream material) and the constant term is 4%. The calorimeter is linear to 0.5%, and the electromagnetic to hadronic response ratio is between 1.02 and 1.09 over this range of momenta. For an electron efficiency of 95% we obtain a rejection factor against pions of ∼ 900-3000 for particles in the momentum range between 50 and 150 GeV/c. We also compare our results with the predictions of a detailed Monte Carlo simulation.

Etwa 10–15% der Bevolkerung weisen eine Metallkontaktallergie gegenuber Nickel, Kobalt oder Chrom auf mit dem potentiellen Risiko einer Unvertraglichkeit entsprechender Implantatmaterialien. Bislang ist unbekannt, welche Konstellationen eine periimplantare Uberempfindlichkeitsreaktion bei bestehender kutaner Allergie auslosen. Ein neu entwickeltes mehrlagiges Schichtsystem soll langfristig allergische Reaktionen verhindern, die bei unbeschichteten Implantaten auftreten konnen. In einer praklinischen Versuchsreihe (Schichthaftung, Verschleis, Ionenabgabe ins Serum) wurde die Beschichtung auf ihre Stabilitat und ihre Funktionalitat hin uberpruft. Der spezifische 7-lagige Aufbau des Beschichtungssystems gewahrleistet eine sehr gute Haftfestigkeit. Im Verschleissimulator wurde eine Reduktion des Abriebs gegenuber dem unbeschichteten Implantat um ca. 60% gemessen. Die Ionenkonzentrationen im Serum des Verschleisversuchs lagen um Grosenordnungen unter den Referenzwerten der unbeschichteten Komponenten. In der praklinischen Testung konnte die Stabilitat und Funktionalitat des Schichtsystems nachgewiesen werden.

Although alcoholism is often regarded as an intractable disorder that requires intensive treatment, studies of the natural history of alcoholism indicate that unaided, spontaneous recovery may be the most common pathway to remission from alcoholism. Negative environmental consequences of alcoholic drinking have been invoked to explain spontaneous recovery, but a more compelling reason for sudden changes in drinking behavior concerns shifts in the personal meanings surrounding alcohol use. Extensive interviews in a multimodal format were conducted with two groups of alcoholics: one group comprised of 7 subjects who spontaneously recovered without treatment and the other group comprised of 9 people who believed formal treatment was necessary to abstain from drinking. Spontaneously recovered alcoholics reported experiencing vivid sensations and images at the time they decided to quit drinking, and they reported subsequent transformations of their personal identities. Active alcoholics reported no comparable experiences in imaginal, sensory, and cognitive modalities. Implications of the results for current alcoholism treatments are discussed.

International audience; BACKGROUND: To explore clinical heterogeneity of Duchenne muscular dystrophy (DMD), viewed as a major obstacle to the interpretation of therapeutic trials METHODOLOGY/PRINCIPAL FINDINGS: A retrospective single institution long-term follow-up study was carried out in DMD patients with both complete lack of muscle dystrophin and genotyping. An exploratory series (series 1) was used to assess phenotypic heterogeneity and to identify early criteria predicting future outcome; it included 75 consecutive steroid-free patients, longitudinally evaluated for motor, respiratory, cardiac and cognitive functions (median follow-up: 10.5 yrs). A validation series (series 2) was used to test robustness of the selected predictive criteria; it included 34 more routinely evaluated patients (age>12 yrs). Multivariate analysis of series 1 classified 70/75 patients into 4 clusters with distinctive intellectual and motor outcomes: A (early infantile DMD, 20%): severe intellectual and motor outcomes; B (classical DMD, 28%): intermediate intellectual and poor motor outcome; C (moderate pure motor DMD, 22%): normal intelligence and delayed motor impairment; and D (severe pure motor DMD, 30%): normal intelligence and poor motor outcome. Group A patients had the most severe respiratory and cardiac involvement. Frequency of mutations upstream to exon 30 increased from group A to D, but genotype/phenotype correlations were restricted to cognition (IQ>71: OR 7.7, 95%CI 1.6-20.4, p6 at 8 yrs" with "normal or borderline mental status" reliably assigned patients to group C (sensitivity: 1, specificity: 0.94). These criteria were also predictive of "early infantile DMD" and "moderate pure motor DMD" in series 2. CONCLUSIONS/SIGNIFICANCE: DMD can be divided into 4 sub-phenotypes differing by severity of muscle and brain dysfunction. Simple early criteria can be used to include patients with similar outcomes in future therapeutic trials.

End-stage renal disease is a major cause of morbidity and mortality in the U.S. population and a significant contributor to national health-care expenditures. In recent years, a growing body of literature has accumulated from studies in animals and humans to suggest that dietary protein restriction can significantly retard the progression of chronic renal insufficiency. This article reviews the relevant literature and outlines the questions that remain for future investigation.

We present calculations for the vacancy formation energies of some 3d and 4d fcc and hcp transition metals using local density functional theory. We have developed a full potential extension of the KRR-Green's function method and show how reliable total energies can be calculated. For Cu and Ag our calculated vacancy formation energies are within 0.1 eV in agreement with experiments. For the other metals the agreement is reasonable in view of the greater experimental uncertainties.

L'utilisation de segments longs conservant une mobilite du sacrum avec des sollicitations mecaniques faibles est possible. De telles pieces anatomiques doivent permettre d'evaluer le comportement de la transition lombo-sacree ainsi que des art. sacro-iliaques au cours d'osteosyntheses etendues au sacrum.

In order to define the prognostic factors in Perthes’ disease in children older than 12 years, we reviewed 15 patients at the end of growth who were aged 12.1 to 14 years at presentation. The patients with the worst long-term prognosis (Stulberg class V) were compared with the others for age, skeletal maturity and remaining growth (Oxford method), as well as Catterall and Waldenström classifications at presentation. A significant difference (p = 0.001) was found for remaining growth (25% in Stulberg class V and 35% in the others) and also for the results at the end of growth when the remaining growth was over 30%, since this allowed sufficient time for reformation and remodelling of the femoral head.

OraVerseTM, an injectable formulation of phentolamine mesylate (PM), was recently approved by the U.S. Food and Drug Administration (FDA) for reversal of anesthesia of the lip and tongue and associated functional deficits resulting from an intraoral submucosal injection of a local anesthetic containing a vasoconstrictor. Because PM had not been approved previously for submucosal administration, 2 Good Laboratory Practices (GLP) studies in dogs designed to investigate systemic toxicity and the local effects of single and repeated dosing of OraVerse on the inferior alveolar nerve and branches of the superior alveolar nerve and adjacent soft tissues after local administration were conducted. Systemic toxicity was measured by preinjection and postinjection clinical examinations, clinical chemistry, and gross and microscopic examinations of major organs after necropsy. No evidence of systemic toxicity was detected. Local nerve and adjacent tissue damage was assessed by conventional histopathology. Nerve degeneration was evident in 1 animal. Mild perineural inflammation adjacent to the inferior alveolar nerve and inflammatory exudates were observed in submucosal tissues in several animals. No changes were observed in the nerves at injection sites of dogs from any dose group that were considered directly related to the test articles. These data reveal that single and repeated intraoral administrations of OraVerse are well tolerated in beagle dogs.

During the past decade a great deal of progress in our theoretical understanding of the electronic structure of alloys has been made by flrst-principles calculations. On the one hand these calculations have become possible because of the development of density functional theory which reduces the many electron problem to the solution of one particle equations and on the other hand because of the development of efficient methods to treat these equations with the help of large electronic computers. Compared to ideal crystals for which conventional reciprocal k-space methods can be used~the calculations for disordered or diluted alloys are more difficult due to the lack of periodicity. Only recent real space Green function methods have led to such calculations. As one of the different techlques used to calculate the electronic structure of dilute alloys, in section 2 of this paper the Kohn-Korrlnga-Rostoker Green function (KKR-GF) method for isolated impurities is described. This method has originally been proposed by Dupree [i], Beeby [2] and others and has been used extensively by us for many calculations. As examples, in section 3 recent results for vacancies in transition metals are presented and in section 4 magnetic impurities are considered.