WorldWideScience

Sample records for nnis reili prnasalu

  1. "Me kõik tahame saada viisakaid kirju!" / Reili Argus

    Index Scriptorium Estoniae

    Argus, Reili

    2008-01-01

    Aina rohkem äri- ja ametisuhtlust toimub kirjalikult, seetõttu kulutused kirjaliku kommunikatsiooni koolitusele on arukas investeering, soovitab Tallinna Ülikooli koolitaja, filoloogiadoktor Reili Argus. Tallinna Ülikoolis toimub selleteemaline täienduskoolitus

  2. Fonoloogiast piiblitõlkeni. Mati Hindi juubelikogumik / Reili Argus

    Index Scriptorium Estoniae

    Argus, Reili, 1967-

    2012-01-01

    Tutvustus: Pühendusteos emeriitprofessor Mati Hindi 75. sünnipäevaks / koostanud ja toimetanud Reili Argus, Annika Hussar ja Tiina Rüütmaa. Tallinn : Tallinna Ülikool, 2012. (Tallinna Ülikooli eesti keele ja kultuuri instituudi toimetised ; 14)

  3. Fonoloogiast piiblitõlkeni. Mati Hindi juubelikogumik / Reili Argus

    Index Scriptorium Estoniae

    Argus, Reili, 1967-

    2012-01-01

    Tutvustus: Pühendusteos emeriitprofessor Mati Hindi 75. sünnipäevaks / koostanud ja toimetanud Reili Argus, Annika Hussar ja Tiina Rüütmaa. Tallinn : Tallinna Ülikool, 2012. (Tallinna Ülikooli eesti keele ja kultuuri instituudi toimetised ; 14)

  4. Toimetaja on autori teine, täpsem silmapaar / Reili Argus

    Index Scriptorium Estoniae

    Argus, Reili, 1967-

    2010-01-01

    Intervjuu Tallinna Ülikooli eesti keele ja kultuuri instituudi direktori, eesti keele dotsendi Reili Argusega Tallinna Ülikooli referent-toimetaja bakalaureuseõppekavast ja keeletoimetaja magistriõppekavast

  5. Festival 'Sünnisõnad' ئ igaühele midagi / Evi Arujärv

    Index Scriptorium Estoniae

    Arujärv, Evi, 1953-

    2000-01-01

    29. dets. 1999 - 1. jaan. 2000 toimunud festivalist "Sünnisõnad". Lühidalt ka nonstopfilmist 'Sajand arhitektuuri. Elavad pildid' (autor Karin Hallas), arhitektuurimuuseumi näitusest 'Eesti katedraalid'. 30. XII Nyyd Ensemble esitatud Gavin Bryarsi teosest 'Titanicu hukk' (Jaan Toomiku videod) jm.

  6. Märkamatu töötaja kutsestandard / Reili Argus, Urve Pirso, Kadri Rahusaar ; intervjueerinud Aili Künstler

    Index Scriptorium Estoniae

    Argus, Reili, 1967-

    2015-01-01

    Eesti Keeletoimetajate Liit on algatanud keeletoimetaja kutsestandardi koostamise. Keeletoimetaja kutseoskuste teemal arutlevad standardi koostamise töörühma liikmed TLÜ eesti keele professor Reili Argus, Riigikontrolli toimetaja Urve Pirso ja kirjastuse Koolibri peatoimetaja Kadri Rahusaar (Haljamaa) Eesti Kirjastuste Liidu esindajana. Ka ülikoolide keeletoimetaja eriala õppekavadest seoses keeletoimetaja kutsestandardiga

  7. nnis stage 0 and 1 acetabular rim cartilage injuries: Incidence, grade, location and associated pre-surgical factors.

    Science.gov (United States)

    Más Martínez, J; Sanz-Reig, J; Verdú Román, C M; Bustamante Suárez de Puga, D; Morales Santías, M; Martínez Giménez, E

    Articular cartilage lesions have a direct effect on the success of surgical treatment. The aim of this study was to determine the prevalence rate, location, grade, and factors associated with acetabular rim articular cartilage lesions in patients undergoing hip arthroscopy. A prospective study was conducted by analysing the intraoperative data of 152 hips in 122 patients treated with hip arthroscopy for femoroacetabular impingement from January 2011 to May 2016. The prevalence rate, location, and grade were calculated, as well as the pre-operative factors associated with acetabular rim articular cartilage lesions. The mean age of the patients was 38.6 years. The Tönnis grade was 0 in 103 hips, and 1 in 52 hips. Acetabular rim articular cartilage lesions were present in 109 (70.3%) hips. The location of the lesions was superior-anterior. Independent risk factors for the presence of acetabular rim articular cartilage lesions were an alpha-angle equal or greater than 55°, duration of symptoms equal or greater than 20 months, and Tegner activity scale level equal or greater than 6. Although patients were classified as Tönnis grade 0 and 1, and 3tesla MRI reported acetabular lesions in 1.3% of cases, there was a high frequency of acetabular rim cartilage lesions. Knowledge of the independent risk factors associated with acetabular rim articular cartilage lesions may assist the orthopaedic surgeon with the decision to perform hip arthroscopy. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  8. 2013. aasta keeleteolised peavad pidu : Millised muutused meie keeleruumis rõõmu teevad ja millised mitte nii väga? / Reili Argus, Alli Laande, Teele Jakobson, Kristi Pettai ; intervjueerinud Aili Künstler

    Index Scriptorium Estoniae

    2014-01-01

    Keeletegu 2013 kandidaadid vastavad küsimusele oma tegemiste ja meie keeleruumi olukorra kohta. Kandidaadiks on seatud TLÜ eesti keele professor Reili Argus lapse keelelist arengut toetavate mängude eest, Alli Laande "Mulgi sõnastiku" projektijuhina, lapsi teise Eesti kooli ja teise emakeelega peresse eesti keelt õppima viiva programmi VeniVidiVici looja ja eestvedaja Teele Jakobson ning Vastseliina gümnaasiumi direktor, Võrumaa noorte keelelaagri "Keelevarjud kirjanduses" korraldaja Kristi Pettai

  9. Surgical site infection in patients submitted to orthopedic surgery: the NNIS risk index and risk prediction Infección de sitio quirúrgico en pacientes sometidos a cirugías ortopédicas: el índice de riesgo NNIS y la predicción de riesgo Infecção de sítio cirúrgico em pacientes submetidos a cirurgias ortopédicas: o índice de risco NNIS e predição de risco

    Directory of Open Access Journals (Sweden)

    Flávia Falci Ercole

    2011-04-01

    Full Text Available The applicability of the risk index for surgical site infection of the National Nosocomial Infection Surveillance (NNIS has been evaluated for its performance in different surgeries. In some procedures, it is necessary to include other variables to predict. Objective: to evaluate the applicability of the NNIS index for prediction of surgical site infection in orthopedic surgeries and to propose an alternative index. The study involved a historical cohort of 8236 patients who had been submitted to orthopaedic surgery. Statistical analysis was performed using multivariate logistic regression to fit the model. The incidence of infection was 1.41%. Prediction models were evaluated and compared to the NNIS index. The proposed model was not considered a good predictor of infection, despite moderately stratified orthopedic surgical patients in at least three of the four scores. The alternative model scored higher than the NNIS models in the prediction of infection.La aplicabilidad del Índice de Riesgo de Infección Quirúrgica del National Nosocomial Infection Surveillance-NNIS ha sido evaluada en cuanto a su desempeño en diferentes cirugías. En algunos procedimientos es necesaria la inclusión de otras variables de predicción. El objetivo de este estudio fue evaluar la aplicabilidad del Índice NNIS para la predicción de la Infección de Sitio Quirúrgico en cirugías ortopédicas y proponer un índice alternativo. Se realizó un estudio de cohorte histórica en 8.236 pacientes sometidos a cirugías ortopédicas. Se utilizó el modelo logístico multivariado para ajustar el modelo. La incidencia de infección fue 1,41%. Modelos de predicción fueron evaluados y comparados al Índice NNIS. El modelo propuesto fue aquel que presentó mayor precisión en clasificar pacientes con y sin infección. El Índice NNIS no fue considerado un buen factor de predicción de la infección, a pesar de haber estratificado moderadamente a los pacientes quir

  10. Kuidas eesti laps vormimoodustuse omandab / Reili Argus

    Index Scriptorium Estoniae

    Argus, Reili, 1967-

    2008-01-01

    Lisaks reeglipõhisele moodustusele tuleb lapsel omandada hulk erandlikke muutemalle, samuti peab tüvele tunnuste lisamise kõrval saama selgeks ka astme- ja tüvevahelduse. Eesti keele omandamine võrdluses teiste keelte omandamisega

  11. Aastalõpufestival 'Sünnisõnad' / Karin Hallas

    Index Scriptorium Estoniae

    Hallas, Karin, 1957-

    1999-01-01

    Festivali raames arhitektuurimuuseumi näitused: "Eesti katedraalid" "Estonia" kontserdisaali jalutussaalis, 'Tallinna aknad' Tallinna linnavalitsuse akendel Vabaduse väljakul (koostaja Karin Hallas, kujundaja Hanno Grossschmidt). Nonstop näituseseanss "Sajand arhitektuuri. Elavad pildid" ئ Tallinna arhitektuuriline areng ئ "Estonia" kontserdisaali vestibüülis 29.-31. XII (autor Karin Hallas, teostus Helger Gustavson, Peeter Brambat).

  12. Eesti lastekeelekorpuse morfoloogilisest märgendamisest / Reili Argus

    Index Scriptorium Estoniae

    Argus, Reili, 1967-

    2007-01-01

    Artiklis demonstreeritakse, kuidas eesti lastekeelekorpuse ühe keeleüksuse ebajärjekindel või erinev transkribeerimine mõjutab otseselt andmete analüüsitulemusi. Põhjalikumalt on vaatluse all veakodeerimine

  13. 13. rakenduslingvistika kevadkonverents / Reili Argus, Martin Ehala, Annekatrin Kaivapalu ... [jt.

    Index Scriptorium Estoniae

    2014-01-01

    Kolmeteistkümnendast rakenduslingvistika konverentsist teemal "Keel ja haridus mobiilses maailmas", mis oli ühendatud Eesti keeletehnoloogia konverentsiga ning IAIMTE (International Association for the Improvement of Mother Tongue Education) hariduslingvistika huvirühma konverentsiga Tallinnas, 24.-25.4.2014

  14. 13. rakenduslingvistika kevadkonverents / Reili Argus, Martin Ehala, Annekatrin Kaivapalu ... [jt.

    Index Scriptorium Estoniae

    2014-01-01

    Kolmeteistkümnendast rakenduslingvistika konverentsist teemal "Keel ja haridus mobiilses maailmas", mis oli ühendatud Eesti keeletehnoloogia konverentsiga ning IAIMTE (International Association for the Improvement of Mother Tongue Education) hariduslingvistika huvirühma konverentsiga Tallinnas, 24.-25.4.2014

  15. Eesti lastekeelekorpuse morfoloogilisest märgendamisest / Reili Argus

    Index Scriptorium Estoniae

    Argus, Reili, 1967-

    2007-01-01

    Artiklis demonstreeritakse, kuidas eesti lastekeelekorpuse ühe keeleüksuse ebajärjekindel või erinev transkribeerimine mõjutab otseselt andmete analüüsitulemusi. Põhjalikumalt on vaatluse all veakodeerimine

  16. Ain Aaviksoo : arengukava jännis selgete vastuste andmisega / Ain Aaviksoo ; interv. Violetta Riidas

    Index Scriptorium Estoniae

    Aaviksoo, Ain, 1974-

    2008-01-01

    Sügisel sotsiaalministrile kinnitamiseks saadetav esmatasandi tervishoiu arengukava on praegu veel olukorras, kus olulised sõlmkohad on lahendamata. Selleteemalistele küsimustele vastab poliitikauuringute keskuse PRAXIS juhatuse esimees Ain Aaviksoo, kelle sõnul võib arengukavas planeeritud tegevuste realiseerimiseks kuluda kaks korda enam raha kui praegu. Vt. samas: Traditsioonilisest patsiendirollist tuleb loobuda

  17. Meie enda kodune kõrgharidus ja järjest avaram maailm / Reili Argus

    Index Scriptorium Estoniae

    Argus, Reili, 1967-

    2011-01-01

    Tallinna Ülikoolis õpetatavast bakalaureusetaseme erialast eesti keel võõrkeelena ja eesti kultuur. Magistritasemel saab õppida eesti keele kui võõrkeele õpetajaks. Selle eriala Ida-Virumaalt pärit vilistlased ja üliõpilased Anna Šiškova, Maaja Orlova, Deniss Jegorov, Anna Pirk, Jekaterina Ozernova ja Anastassia Šmõreitšik selgitavad eriala valimise, õppimise, Tallinnas kohanemise ja enda edasise elu kohta

  18. Acquisition of epistemic marking in Estonian and Russian / Viktoria V. Kazakovskaya, Reili Argus

    Index Scriptorium Estoniae

    Kazakovskaya, Victoria

    2016-01-01

    Kahe eesti ja kahe vene keelt omandava lapse kogemuse põhjal kirjeldatakse esimeste epideemiliste modaalsuse markerite ilmumist laste keelekasutusse ning tõenäosust väljendavate markerite edasist arengut

  19. Väitekiri suulise kõne grammatikast, lõpuks ometi / Reili Argus

    Index Scriptorium Estoniae

    Argus, Reili, 1967-

    2013-01-01

    Arvustus: Tiit Hennoste. Grammatiliste vormide seoseid suhtlustegevustega eestikeelses suulises vestluses. Tartu : Tartu Ülikooli Kirjastus, 2013. (Dissertationes philologiae Estonicae Universitatis Tartuensis ; 32)

  20. Meie enda kodune kõrgharidus ja järjest avaram maailm / Reili Argus

    Index Scriptorium Estoniae

    Argus, Reili, 1967-

    2011-01-01

    Tallinna Ülikoolis õpetatavast bakalaureusetaseme erialast eesti keel võõrkeelena ja eesti kultuur. Magistritasemel saab õppida eesti keele kui võõrkeele õpetajaks. Selle eriala Ida-Virumaalt pärit vilistlased ja üliõpilased Anna Šiškova, Maaja Orlova, Deniss Jegorov, Anna Pirk, Jekaterina Ozernova ja Anastassia Šmõreitšik selgitavad eriala valimise, õppimise, Tallinnas kohanemise ja enda edasise elu kohta

  1. Acquisition of epistemic marking in Estonian and Russian / Viktoria V. Kazakovskaya, Reili Argus

    Index Scriptorium Estoniae

    Kazakovskaya, Victoria

    2016-01-01

    Kahe eesti ja kahe vene keelt omandava lapse kogemuse põhjal kirjeldatakse esimeste epideemiliste modaalsuse markerite ilmumist laste keelekasutusse ning tõenäosust väljendavate markerite edasist arengut

  2. Surgical Site Infection (SSI) Rates in the United States, 1992-1998: The National Nosocomial Infections Surveillance System Basic SSI Risk Index

    National Research Council Canada - National Science Library

    Robert P. Gaynes; David H. Culver; Teresa C. Horan; Jonathan R. Edwards; Chesley Richards; James S. Tolson; The National Nosocomial Infections Surveillance System

    2001-01-01

    By use of the National Nosocomial Infections Surveillance (NNIS) System's surgical patient surveillance component protocol, the NNIS basic risk index was examined to predict the risk of a surgical site infection (SSI...

  3. Estonia näitas uut logo / Andres Keil

    Index Scriptorium Estoniae

    Keil, Andres, 1974-

    2004-01-01

    Ooperiteatri uue logo autor on Kristjan Kirsfeldt. Liis Kolle lavastab G. Rossini ooperi "Sinjoor Bruschino ehk Poeg juhuse tahtel", kunstnikud Liina Keevallik ja Reili Evart. 2. juunil Rahvusooperis etendunud rahvusooperi näiteringi "Welcome to Estonia" Neeme Kuninga kirjutatud ja lavastatud muusikalist "Minu veetlev Eedi".

  4. Estonia näitas uut logo / Andres Keil

    Index Scriptorium Estoniae

    Keil, Andres, 1974-

    2004-01-01

    Ooperiteatri uue logo autor on Kristjan Kirsfeldt. Liis Kolle lavastab G. Rossini ooperi "Sinjoor Bruschino ehk Poeg juhuse tahtel", kunstnikud Liina Keevallik ja Reili Evart. 2. juunil Rahvusooperis etendunud rahvusooperi näiteringi "Welcome to Estonia" Neeme Kuninga kirjutatud ja lavastatud muusikalist "Minu veetlev Eedi".

  5. Impacts of nonnative invasive species on US forests and recommendations for policy and management

    Science.gov (United States)

    W. Keith Moser; Edward L. Barnard; Ronald F. Billings; Susan J. Crocker; Mary Ellen Dix; Andrew N. Gray; George G. Ice; Mee-Sook Kim; Richard Reid; Sue U. Rodman; William H. McWilliams

    2009-01-01

    The introduction of nonnative invasive species (NNIS) into the United States has had tremendous impacts on the nation's commercial and urban forest resources. Of principal concern are the effects of NNIS on forest composition, structure, function, productivity, and patterns of carbon sequestration. In 2006, the Society of American Foresters commissioned an ad hoc...

  6. Muusika : Vesi, ulme ja alleaa / Anneli Remme

    Index Scriptorium Estoniae

    Remme, Anneli, 1968-

    2000-01-01

    29.-30. dets. 1999 toimunud aastalõpufestivalist "Sünnisõnad" - F. Langi tummfilmist "Metropolis", filmi juurde loodud muusikast Metropolis Projekti esituses, G. Bryarsi teose "Titanicu hukk", A. Pärdi teoste "Cantique des degres" ja "Te Deum", E.-S. Tüüri teose "Ante finem saeculi" ja Tormise teose "Sünnisõnad" ettekannetest

  7. Accounting for incomplete postdischarge follow-up during surveillance of surgical site infection by use of the National Nosocomial Infections Surveillance system's risk index.

    Science.gov (United States)

    Biscione, Fernando Martín; Couto, Renato Camargos; Pedrosa, Tânia M G

    2009-05-01

    We examined the usefulness of a simple method to account for incomplete postdischarge follow-up during surveillance of surgical site infection (SSI) by use of the National Nosocomial Infections Surveillance (NNIS) system's risk index. Retrospective cohort study that used data prospectively collected from 1993 through 2006. Five private, nonuniversity healthcare facilities in Belo Horizonte, Brazil. Consecutive patients undergoing the following NNIS operative procedures: 20,981 operations on the genitourinary system, 11,930 abdominal hysterectomies, 7,696 herniorraphies, 6,002 cholecystectomies, and 6,892 laparotomies. For each operative procedure category, 2 SSI risk models were specified. First, a model based on the NNIS system's risk index variables was specified (hereafter referred to as the NNIS-based model). Second, a modified model (hereafter referred to as the modified NNIS-based model), which was also based on the NNIS system's risk index, was specified with a postdischarge surveillance indicator, which was assigned the value of 1 if the patient could be reached during follow-up and a value of 0 if the patient could not be reached. A formal comparison of the capabilities of the 2 models to assess the risk of SSI was conducted using measures of calibration (by use of the Pearson goodness-of-fit test) and discrimination (by use of receiver operating characteristic curves). Goodman-Kruskal correlations (G) were also calculated. The rate of incomplete postdischarge follow-up varied between 29.8% for abdominal hysterectomies and 50.5% for cholecystectomies. The modified NNIS-based model for laparotomy did not show any significant benefit over the NNIS-based model in any measure. For all other operative procedures, the modified NNIS-based model showed a significantly improved discriminatory ability and higher G statistics, compared with the NNIS-based model, with no significant impairment in calibration, except if used to assess the risk of SSI after operations

  8. Asi ei ole kirjastamises, küsimus on kirjutamises / Jaak Lõhmus

    Index Scriptorium Estoniae

    Lõhmus, Jaak

    2008-01-01

    Veelkord olukorrast eestikeelsete filmiraamatute vallas. (Vt. ka Sirbis 8. augustil ilmunud Jaak Lõhmus "Tumm tünnis ehk Kirjastaja helistas Kruusemendile" ja 15. augustil ilmunud Marge Liiske "Hakake kohe tegutsema!")

  9. Sean WILLIAMS (ed.) : The ethnomusicologists’ Cookbook : Complete Meals from Around the World

    OpenAIRE

    Borel, François

    2011-01-01

    Sous ce titre insolite, une ethnomusicologue américaine s’est mis en tête de rassembler une foule de recettes culinaires recueillies par 49 contributeurs dans 47 différentes régions du monde. En effet, il fallait bien que les ethnomusicologues (parmi lesquels Adrienne Kaeppler, Terry Miller, Bruno Nettl, Suzel Reily, Timothy Rice et Philip Schuyler) s’alignent sur leurs collègues anthropologues, puisque cet ouvrage, pas aussi original qu’on pourrait le penser, fut précédé, il y a près de 30 a...

  10. Kontserdipeegel : Neli pilku aastalõpu kontsertidele / Igor Garshnek

    Index Scriptorium Estoniae

    Garšnek, Igor, 1958-

    2000-01-01

    22. ja 23. dets. Niguliste kirikus toimunud H. Mätliku soolokontsertidest. Kõlas J. S. Bachi lautomuusika. 29. dets. 1999 - 1. jaan. 2000 toimunud aastalõpufestivalist "Sünnisõnad" : F. Langi tummfilmist "Metropolis" ja sellele saatemuusikat mänginud saksa triost, A. Pärdi teoste "Cantique des degres" ja "Te Deum", E.-S. Tüüri teose "Ante finem saeculi" ja V. Tormise kantaadi "Sünnisõnad" ettekannetest. 30. dets. 1999 Estonia kontserdisaalis toimunud kontserdist. Kõlas G. Bryarsi "Titanicu hukk" NYYD Ensemble"i esituses

  11. Kontserdipeegel : Neli pilku aastalõpu kontsertidele / Igor Garshnek

    Index Scriptorium Estoniae

    Garšnek, Igor, 1958-

    2000-01-01

    22. ja 23. dets. Niguliste kirikus toimunud H. Mätliku soolokontsertidest. Kõlas J. S. Bachi lautomuusika. 29. dets. 1999 - 1. jaan. 2000 toimunud aastalõpufestivalist "Sünnisõnad" : F. Langi tummfilmist "Metropolis" ja sellele saatemuusikat mänginud saksa triost, A. Pärdi teoste "Cantique des degres" ja "Te Deum", E.-S. Tüüri teose "Ante finem saeculi" ja V. Tormise kantaadi "Sünnisõnad" ettekannetest. 30. dets. 1999 Estonia kontserdisaalis toimunud kontserdist. Kõlas G. Bryarsi "Titanicu hukk" NYYD Ensemble"i esituses

  12. Zehn Oden = Kümme oodi / Kristjan Jaak Peterson ; Deutsch von Gisbert Jänicke

    Index Scriptorium Estoniae

    Peterson, Kristjan Jaak, 1801-1822

    2001-01-01

    Sisu: An Gott ; Sonnenuntergang ; Herbst ; Der Mensch ; Der Mond ; Freundschaft ; Ich muss trinken. Liedchen ; Hoffnung ; Ich bin wieder glücklich ; Der Sänger. Orig.: Jummalale ; Päva loja-minneminne ; Süggise ; Innimenne ; Kuu ; Söbradus ; Ma pean joma. Lauloke ; Lotus ; Ollen jälle önnis ; Laulja

  13. Vesi, ulme ja alleaa / Anneli Remme

    Index Scriptorium Estoniae

    Remme, Anneli, 1968-

    2000-01-01

    Aastalõpufestival "Sünnisõnad". Ka Gavin Bryarsi 'Titanicu hukust' NYYD Ensemble'i esituses ning kujunduseks olnud Jaan Toomiku videost. "Estonia" kontserdisaalis linastunud Fritz Langi imposantsest tummfilmist "Metropolis" (Saksamaa 1927) ja seda saatnud 3 muusiku ansamblist Metropolis Projekt

  14. Uue paradigma poole monumendikeskustelus / Priit-Kalev Parts

    Index Scriptorium Estoniae

    Parts, Priit-Kalev, 1972-

    2007-01-01

    Autor püstitab küsimuse, kas on üldse sünnis luua igavesi ja muutumatuid vorme. Paindlikumat tõlgendamist võimaldab näiteks muutlik ja hävinev puu, mida võib vesta või istutada. Pingemaandajana sobiks tordist monumendikoopia

  15. Vesi, ulme ja alleaa / Anneli Remme

    Index Scriptorium Estoniae

    Remme, Anneli, 1968-

    2000-01-01

    Aastalõpufestival "Sünnisõnad". Ka Gavin Bryarsi 'Titanicu hukust' NYYD Ensemble'i esituses ning kujunduseks olnud Jaan Toomiku videost. "Estonia" kontserdisaalis linastunud Fritz Langi imposantsest tummfilmist "Metropolis" (Saksamaa 1927) ja seda saatnud 3 muusiku ansamblist Metropolis Projekt

  16. Uue paradigma poole monumendikeskustelus / Priit-Kalev Parts

    Index Scriptorium Estoniae

    Parts, Priit-Kalev, 1972-

    2007-01-01

    Autor püstitab küsimuse, kas on üldse sünnis luua igavesi ja muutumatuid vorme. Paindlikumat tõlgendamist võimaldab näiteks muutlik ja hävinev puu, mida võib vesta või istutada. Pingemaandajana sobiks tordist monumendikoopia

  17. Symptomatic sacroiliac joint disease and radiographic evidence of femoroacetabular impingement.

    Science.gov (United States)

    Morgan, Patrick M; Anderson, Anthony W; Swiontkowski, Marc F

    2013-01-01

    Symptomatic sacroiliac (SI) joint disease is poorly understood. The literature provides no clear aetiology for SI joint pathology, making evaluation and diagnosis challenging. We hypothesised that patients with documented sacroiliac pain might provide insight into the aetiology of these symptoms. Specifically, we questioned whether SI joint symptoms might be associated with abnormal hip radiographs. We reviewed the pelvic and hip radiographs of a prospectively collected cohort of 30 consecutive patients with SI joint pathology. This database included 33 hips from 30 patients. Radiographic analysis included measurements of the lateral centre edge angle, Tönnis angle, and the triangular index, of the ipsilateral hip. Evidence for retrotorsion of the hemipelvis was recorded. Hips were graded on the Tönnis grading system for hip arthrosis. In this cohort 14/33 (42%) of hips had evidence of significant osteoarthrosis indicated by Tönnis grade 2 or greater and 15/33 (45%) displayed subchondral cyst formation around the hip or head neck junction. In assessing acetabular anatomy, 21% (7/33) had retroversion, 12% (4/33) had a lateral centre edge angle >40° with 3% (1/33) >45°. Tönnis angle was arthrosis. The clinician should maintain FAI in the differential diagnosis when investigating patients with buttock pain.

  18. Comparison of two nosocomial infection surveillance in a neonatal ward

    Directory of Open Access Journals (Sweden)

    Masomeh Abedini

    2014-01-01

    Conclusion: It seems that a large part of this considerable differences between the results of this study compared to NNIS based study, is this fact that, for nosocomial infection surveillance in the neonatal field, the presence of a specialist as a performer and leader of the team, is necessary.

  19. Role of Antibiotics on Surgical Site Infection in Cases of Open and ...

    African Journals Online (AJOL)

    patients in Group A was 46 years and in Group B was 44;. Standard deviation ... According to CDC (Centers for Disease Control and .... [12] A study by Yan C suggest that there is no ... infectons surveillance (NNIS) system report, data summary from .... Chang WT, Lee KT, Chuang SC, Wang SN, Kuo KK, Chen JS, et al. The.

  20. Nõmme kino saab 80-aastaseks / V. P.

    Index Scriptorium Estoniae

    V. P.

    2004-01-01

    Nõmme kinomaja juubel toimub kultuuriprogrammi "Diogenese tünnis" saatel. Kavas on kaks lühifilmi seal Olav Neulandi juhtimisel töötanud amatöörfilmistuudiolt "Diogenese tünn" ja Murnau "Nosferatu - õuduste sümfoonia" ansambli Kriminaalne Elevant saatel

  1. Reliability of a New Radiographic Classification for Developmental Dysplasia of the Hip.

    Science.gov (United States)

    Narayanan, Unni; Mulpuri, Kishore; Sankar, Wudbhav N; Clarke, Nicholas M P; Hosalkar, Harish; Price, Charles T

    2015-01-01

    Existing radiographic classification schemes (eg, Tönnis criteria) for DDH quantify the severity of disease based on the position of the ossific nucleus relative to Hilgenreiner's and Perkin's lines. By definition, this method requires the presence of an ossification centre, which can be delayed in appearance and eccentric in location within the femoral head. A new radiographic classification system has been developed by the International Hip Dysplasia Institute (IHDI), which uses the mid-point of the proximal femoral metaphysis as a reference landmark, and can therefore be applied to children of all ages. The purpose of this study was to compare the reliability of this new method with that of Tönnis, as the first step in establishing its validity and clinical utility. Twenty standardized anteroposterior pelvic radiographs of children with untreated DDH were selected purposefully to capture the spectrum of age (range, 3 to 32 mo) at presentation and disease severity. Each of the hips was classified separately by the IHDI and Tönnis methods by 6 experienced pediatric orthopaedists from the United States, Canada, Mexico, United Kingdom, and by 2 orthopaedic senior residents. The inter-rater reliability was tested using the Intra Class Correlation coefficient (ICC) to measure concordance between raters. All 40 hips were classifiable by the IHDI method by all raters. Ten of the 40 hips could not be classified by the Tönnis method because of the absence of the ossific nucleus on one or both sides. The ICC (95% confidence interval) for the IHDI method for all raters was 0.90 (0.83-0.95) and 0.95 (0.91-0.98) for the right and left hips, respectively. The corresponding ICCs for the Tönnis method were 0.63 (0.46-0.80) and 0.60 (0.43-0.78), respectively. There was no significant difference between the ICCs of the 6 experts and 2 trainees. The IHDI method of classification has excellent inter-rater reliability, both among experts and novices, and is more widely

  2. Neurosurgery in Würzburg until World War II.

    Science.gov (United States)

    Arnold, H; Collmann, H

    2012-01-01

    The institution of German neurosurgery as an autonomous surgical specialty, starting in Würzburg in 1934, is closely linked to the names of Fritz König and Wilhelm Tönnis. They were acting at a time when the global economic crisis and a consolidating Nazi dictatorship caused a cascade of alarming changes in political and social life. On the one hand it is fascinating to see how the restless work and energy of Tönnis managed to build up the first independent neurosurgical unit in Germany and to tighten efficient international connections all over the world within a few years. On the other hand-from a present-day perspective-it is difficult to understand how his strive towards a specialist's success, in contrast to that of Otfrid Foerster, was barely affected by the threatening political development, until the Second World War stopped his plans and ideas for many years.

  3. Recognition of minor adult hip dysplasia: which anatomical indices are important?

    Science.gov (United States)

    Pereira, Felipe; Giles, Andrew; Wood, Gavin; Board, Tim N

    2014-01-01

    The rise in popularity of hip arthroscopy has led to a renewed interest in mild hip dysplasia. There is a lack of clarity in the literature regarding both the diagnosis and management of such patients. The aim of this study was to analyse the relative importance of and the inter-relationship between the classically described anatomical indices of dysplasia.One hundred and fifty hips with varying degrees of hip dysplasia were studied. The following were measured: centre-edge (CE), Sharp's and Tönnis angles, acetabular head index (AHI), and acetabular index of depth to width (AIDW). Spearman's correlation coefficient was calculated.Using the CE angle 82 hips were classified as normal and 68 dysplastic. Of the 82 patients with a normal CE angle, 20-39% were dysplastic on at least one other variable. The CE angle did not have a significant correlation to other variables. The remaining four variables showed inter-correlations between 0.26 and 0.54. Overall the Tönnis angle showed the strongest correlation with the other variables. In the patient group with CE angles 21o to 25o (minor dysplasia) 72% of hips had Tönnis angles greater than 10o and 28% had angles greater than or equal to 15o indicating the great variability in the level of dysplasia within this group.In patients with mild dysplasia we have shown that measurement of a single anatomical variable may lead to under-diagnosis. We recommend the measurement the CE angle combined with at least one other variable and suggest the use of the Tönnis angle.

  4. FastTree 2--approximately maximum-likelihood trees for large alignments.

    Directory of Open Access Journals (Sweden)

    Morgan N Price

    Full Text Available BACKGROUND: We recently described FastTree, a tool for inferring phylogenies for alignments with up to hundreds of thousands of sequences. Here, we describe improvements to FastTree that improve its accuracy without sacrificing scalability. METHODOLOGY/PRINCIPAL FINDINGS: Where FastTree 1 used nearest-neighbor interchanges (NNIs and the minimum-evolution criterion to improve the tree, FastTree 2 adds minimum-evolution subtree-pruning-regrafting (SPRs and maximum-likelihood NNIs. FastTree 2 uses heuristics to restrict the search for better trees and estimates a rate of evolution for each site (the "CAT" approximation. Nevertheless, for both simulated and genuine alignments, FastTree 2 is slightly more accurate than a standard implementation of maximum-likelihood NNIs (PhyML 3 with default settings. Although FastTree 2 is not quite as accurate as methods that use maximum-likelihood SPRs, most of the splits that disagree are poorly supported, and for large alignments, FastTree 2 is 100-1,000 times faster. FastTree 2 inferred a topology and likelihood-based local support values for 237,882 distinct 16S ribosomal RNAs on a desktop computer in 22 hours and 5.8 gigabytes of memory. CONCLUSIONS/SIGNIFICANCE: FastTree 2 allows the inference of maximum-likelihood phylogenies for huge alignments. FastTree 2 is freely available at http://www.microbesonline.org/fasttree.

  5. The Spanish national health care-associated infection surveillance network (INCLIMECC): data summary January 1997 through December 2006 adapted to the new National Healthcare Safety Network Procedure-associated module codes.

    Science.gov (United States)

    Pérez, Cristina Díaz-Agero; Rodela, Ana Robustillo; Monge Jodrá, Vincente

    2009-12-01

    In 1997, a national standardized surveillance system (designated INCLIMECC [Indicadores Clínicos de Mejora Continua de la Calidad]) was established in Spain for health care-associated infection (HAI) in surgery patients, based on the National Nosocomial Infection Surveillance (NNIS) system. In 2005, in its procedure-associated module, the National Healthcare Safety Network (NHSN) inherited the NNIS program for surveillance of HAI in surgery patients and reorganized all surgical procedures. INCLIMECC actively monitors all patients referred to the surgical ward of each participating hospital. We present a summary of the data collected from January 1997 to December 2006 adapted to the new NHSN procedures. Surgical site infection (SSI) rates are provided by operative procedure and NNIS risk index category. Further quality indicators reported are surgical complications, length of stay, antimicrobial prophylaxis, mortality, readmission because of infection or other complication, and revision surgery. Because the ICD-9-CM surgery procedure code is included in each patient's record, we were able to reorganize our database avoiding the loss of extensive information, as has occurred with other systems.

  6. New arrivals: an indicator for non-indigenous species introductions at different geographical scales

    Directory of Open Access Journals (Sweden)

    Sergej Olenin

    2016-10-01

    Full Text Available Several legal and administrative instruments aimed to reduce the spread of non-indigenous species, that may pose harm to the environment, economy and/or human health, were developed in recent years at international and national levels, such as the International Convention for the Control and Management of Ship’s Ballast Water and Sediments, the International Council for the Exploration of the Sea Code of Practice on the Introductions and Transfers of Marine Organisms, the EU Regulation on Invasive Alien Species and the Marine Strategy Framework Directive, the US Invasive Species Act, the Biosecurity Act of New Zealand, etc. The effectiveness of these instruments can only be measured by successes in the prevention of new introductions. We propose an indicator, the arrival of new non-indigenous species (nNIS, which helps to assess introduction rates, especially in relation to pathways and vectors of introduction, and is aimed to support management. The technical precondition for the calculation of nNIS is the availability of a global, continuously updated and verified source of information on aquatic non-indigenous species. Such a database is needed, because the indicator should be calculated at different geographical scales: 1 for a particular area, such as port or coast of a country within a Large Marine Ecosystem (LME; 2 for a whole LME; and 3 for a larger biogeographical region, including two or more neighboring LMEs. The geographical scale of nNIS helps to distinguish between a primary introduction and secondary spread, which may involve different pathways and vectors. This, in turn, determines the availability of management options, because it is more feasible to prevent a primary introduction than to stop subsequent secondary spread. The definition of environmental target, size of assessment unit and possible limitations of the indicator are also discussed.

  7. Using hip measures to avoid misdiagnosing early rapid onset osteoarthritis for osteonecrosis.

    Science.gov (United States)

    Nelson, Fred R T; Bhandarkar, Varun S; Woods, Tammy A

    2014-06-01

    In the early phases, subchondral insufficiency fractures and rapidly destructive osteoarthritis of the hip are often mistaken for osteonecrosis of the hip. Three hip measures were used comparing combined subchondral insufficiency fractures and rapidly destructive 18 osteoarthritis patients to 18 osteonecrosis patients. Due to the rarity of these conditions there was no statistical power. Initial diagnoses for the osteoarthritis patients were recorded. The osteoarthritis group had significantly higher means for Tönnis angle (P osteoarthritis. Using hip measures will reduce the misdiagnosis of rapid onset osteoarthritis of the hip for osteonecrosis.

  8. Does bony hip morphology affect the outcome of treatment for patients with adductor-related groin pain?

    DEFF Research Database (Denmark)

    Hölmich, Per; Thorborg, Kristian; Nyvold, Per

    2014-01-01

    BACKGROUND: Adductor-related groin pain and bony morphology such as femoroacetabular impingement (FAI) or hip dysplasia can coexist clinically. A previous randomised controlled trial in which athletes with adductor-related groin pain underwent either passive treatment (PT) or active treatment (AT...... was assessed by a standardised clinical outcome combining patient-reported activity, symptoms and physical examination. Anterioposterior pelvic radiographs were obtained and the centre-edge angle of Wiberg, α angle, presence of a crossover sign and Tönnis grade of osteoarthritis were assessed by a blinded...

  9. Implications to Sources of Ultra-high-energy Cosmic Rays from their Arrival Distribution

    CERN Document Server

    Takami, Hajime

    2008-01-01

    We estimate the local number density of sources of ultra-high-energy cosmic rays (UHECRs) based on the statistical features of their arrival direction distribution. We calculate the arrival distributions of protons above $10^{19}$ eV taking into account their propagation process in the Galactic magnetic field and a structured intergalactic magnetic field, and statistically compare those with the observational result of the Pierre Auger Observatory. The anisotropy in the arrival distribution at the highest energies enables us to estimate the number density of UHECR sources as $\\sim 10^{-4} {\\rm Mpc}^{-3}$ assuming the persistent activity of UHECR sources. We compare the estimated number density of UHECR sources with the number densities of known astrophysical objects. This estimated number density is consistent with the number density of Fanaroff-Reily I galaxies. We also discuss the reproducability of the observed {\\it isotropy} in the arrival distribution above $10^{19}$ eV. We find that the estimated source...

  10. Anomalous frequency characteristics of groundwater levels before major earthquakes in Taiwan

    Directory of Open Access Journals (Sweden)

    C.-H. Chen

    2012-06-01

    Full Text Available Unusual decreases in water levels were consistently observed in 78% (=42/54 of the wells in the Choshuichi Alluvial Fan of central Taiwan roughly 150 days before the Chi-Chi earthquake (M = 7.6 on 20 September 1999 when the influences of barometric pressure, earth tides, precipitation and artificial pumping were removed. Variations in groundwater levels measured in the anomalous wells between 1 August 1997 and 19 September 1999, the time period covering the unusual decreases, were transferred into the frequency domain to examine anomalous frequency bands associated with the Chi-Chi earthquake. Analytical results show that amplitudes at the frequency band between 0.02 day−1 and 0.04 day−1 were generally maintained at the low stage and were enhanced in the few weeks before the Chi-Chi earthquake. Variations in amplitude within this particular frequency band were further examined in association with earthquakes (M > 6 between 1 August 1997 and 31 December 2009. Enhanced amplitude phenomena are consistently observed prior to the other two earthquakes (the Rei-Li and Ming-Jian earthquakes during the 12.5 yr, which sheds a promising light on research into precursors of strong earthquakes when combined with other geophysical observations such as geomagnetic anomalies and crustal displacements.

  11. The Bernese periacetabular osteotomy: clinical, radiographic and mechanical 7-15-year follow-up of 26 hips.

    Science.gov (United States)

    Kralj, Marko; Mavcic, Blaz; Antolic, Vane; Iglic, Ales; Kralj-Iglic, Veronika

    2005-12-01

    The Bernese periacetabular osteotomy is used in dysplastic hips to increase the load-bearing area of the hip and to prevent osteoarthritis. The aim of our work was to determine the contact hip stress before and after the osteotomy and to compare the relief of stress with the long-term radiographic and clinical outcome. We followed 26 dysplastic hips (26 patients) for 7-15 years after the index operation. Clinical evaluation was based on the WOMAC score, osteoarthrosis was evaluated with the Tönnis classification, the angles of lateral (CE) and anterior (VCA) femoral coverage were measured, and biomechanical parameters were studied. Periacetabular osteotomy increased the mean CE from 15 degrees to 37 degrees , and the mean VCA from 22 degrees to 38 degrees . The mean normalized peak contact stress was reduced from 5.2 to 3.0 kPa/N. Four hips required total hip arthroplasty after an average of 4.5 years, 8 hips showed considerable arthrosis progression, and 14 hips had no or mild arthrosis at follow-up. Preoperative WOMAC score, preoperative Tönnis grade and postoperative normalized peak contact stress were the most important predictors of outcome. The Bernese periacetabular osteotomy improves the mechanical status of the hip. Long-term success depends on the grade of arthrosis preoperatively and on the magnitude of operative correction of the contact hip stress.

  12. Ventilator-associated pneumonia: depends on your definition.

    Science.gov (United States)

    Novosel, Timothy J; Hodge, Laura A; Weireter, Leonard J; Britt, Rebecca C; Collins, Jay N; Reed, Scott F; Britt, L D

    2012-08-01

    Reduction of hospital-acquired infections is a patient safety goal and regularly monitored by Performance Improvement committees. There is discordance between the ventilator-associated pneumonia (VAP) rate reported by the Infection Control Committee (ICC) and that observed by our Trauma Service. To investigate this difference, a retrospective evaluation of cases of VAP diagnosed on a single service was undertaken. A prospectively collected database was queried for VAP in intensive care unit patients between January 2010 and June 2011. This was compared with the list of mechanically ventilated patients provided by the ICC. Comparison for criteria used to diagnose pneumonia, ventilator day of the diagnosis, was recorded. The ICC identified two VAPs from 136 potential patients compared with the Trauma Service identifying 36 VAPs. A difference in diagnostic criteria between the ICC and the Trauma Service focused on use of the National Nosocomial Infection Survey (NNIS) algorithm versus quantitative microbiology from bronchoalveolar lavage specimens. Thirty-five of 36 Trauma Service VAPs were not identified as VAPs by the NNIS algorithm as a result of the chest radiographs. Application of differing definitions of VAP results in markedly different VAP rates. The difference has significant implications as infection rates are increasingly reported as a quality metric.

  13. Empiric therapy for pneumonia in the surgical intensive care unit.

    Science.gov (United States)

    Fabian, T C

    2000-02-01

    Empiri c therapy of ventilator-associated pneumonia (VAP) in surgical patients should be based on intensive care unit (ICU)-specific surveillance data, because microbial flora patterns vary widely between geographic regions as well as within hospitals. Surgical ICUs have higher VAP rates than other units. Data from the National Nosocomial Infection Surveillance (NNIS) System report Pseudomonas aeruginosa and Staphylococcus aureus to be the most frequent isolates (each 17.4%). Data from the NNIS documents high resistance patterns in ICUs compared with hospitals at large, as well as unit-specific patterns. VAP risk factors for surgical patients include thoracoabdominal surgery, altered level of consciousness, advanced age, diabetes mellitus, malnutrition, chronic obstructive pulmonary disease, and prior antibiotic administration. Promising prevention strategies include restricting ventilator circuit changes, in-line heat moisture exchange filters, semi-recumbant positioning, and continuous subglottic aspiration. Pharmacodynamics should be considered when choosing antibiotic regimens. Postantibiotic effect and time-dependent versus concentration-dependent killing should be studied in clinical trials. Current guidelines for choosing regimens have been well developed by the American Thoracic Society.

  14. An autopsy case of preclinical multiple system atrophy (MSA-C).

    Science.gov (United States)

    Kon, Tomoya; Mori, Fumiaki; Tanji, Kunikazu; Miki, Yasuo; Wakabayashi, Koichi

    2013-12-01

    Multiple system atrophy (MSA) is divided into two clinical subtypes: MSA with predominant parkinsonian features (MSA-P) and MSA with predominant cerebellar dysfunction (MSA-C). We report a 71-year-old Japanese man without clinical signs of MSA, in whom post mortem examination revealed only slight gliosis in the pontine base and widespread occurrence of glial cytoplasmic inclusions in the central nervous system, with the greatest abundance in the pontine base and cerebellar white matter. Neuronal cytoplasmic inclusions (NCIs) and neuronal nuclear inclusions (NNIs) were almost restricted to the pontine and inferior olivary nuclei. It was noteworthy that most NCIs were located in the perinuclear area, and the majority of NNIs were observed adjacent to the inner surface of the nuclear membrane. To our knowledge, only four autopsy cases of preclinical MSA have been reported previously, in which neuronal loss was almost entirely restricted to the substantia nigra and/or putamen. Therefore, the present autopsy case of preclinical MSA-C is considered to be the first of its kind to have been reported. The histopathological features observed in preclinical MSA may represent the early pattern of MSA pathology.

  15. Surgical wound infection rates in Spain: data summary, January 1997 through June 2012.

    Science.gov (United States)

    Díaz-Agero Pérez, Cristina; Robustillo Rodela, Ana; Pita López, María José; López Fresneña, Nieves; Monge Jodrá, Vicente

    2014-05-01

    The Indicadores Clínicos de Mejora Continua de la Calidad (INCLIMECC) program was established in Spain in 1997. INCLIMECC is a prospective system of health care-associated infection (HAI) surveillance that collects incidence data in surgical and intensive care unit patients. The protocol is based on the National Healthcare Safety Network (NHSN) surveillance system, formerly known as the National Nosocomial Infection Surveillance (NNIS) system, and uses standard infection definitions from the US Centers for Disease Control and Prevention. Each hospital takes part voluntarily and selects the units and surgical procedures to be surveyed. This report is a summary of the data collected between January 1997 and June 2012. A total of 370,015 patients were included, and the overall incidence of surgical wound infection (SWI) was 4.51%. SWI rates are provided by NHSN operating procedure category and NNIS risk index category. More than 27% of the patients received inadequate antibiotic prophylaxis, the main reason being unsuitable duration (57.05% of cases). Today, the INCLIMECC network includes 64 Spanish hospitals. We believe that an HAI surveillance system with trained personnel external to the surveyed unit is a key component not only in infection control and prevention, but also in a quality improvement system. Copyright © 2014. Published by Mosby, Inc.

  16. Management of developmental dysplasia of the hip in less than 24 months old children

    Directory of Open Access Journals (Sweden)

    Mehmet Bulut

    2013-01-01

    Full Text Available Background: There is no consensus on the treatment of developmental dysplasia of the hip in children less than 24 months of age. The aim of this study was to present the results of open reduction and concomitant primary soft-tissue intervention in patients with developmental dysplasia of the hip in children less than 24 months of age. Materials and Methods: Sixty hips of 50 patients (4 male, 46 female with mean age of 14.62 ± 5.88 (range 5-24 months months with a mean followup of 40.00 ± 6.22 (range 24-58 months months were included. Twenty five right and 35 left hips (10 bilaterally involved were operated. Open reduction was performed using the medial approach in patients aged < 20 months (with Tönnis type II-III and IV hip dysplasias and for those aged 20-24 months with Tönnis type II and III hip dysplasias ( n = 47. However for 13 patients aged 20-24 months with Tönnis type IV hip dysplasias, anterior bikini incision was used. Results: Mean acetabular index was 41.03 ± 3.78° (range 34°-50° in the preoperative period and 22.98 ± 3.01° (range 15°-32° at the final visits. Mean center-edge angle at the final visits was 22.85 ± 3.35° (18°-32°. Based on Severin radiological classification, 29 (48.3% were type I (very good, 25 (41.7% were type II (good and 6 (10% were type III (fair hips. According to the McKay clinical classification, postoperatively the hips were evaluated as excellent ( n = 42; 70%, good ( n = 14; 23.3% and fair ( n = 4; 6.7%. Reduction of all hip dislocations was achieved. Additional pelvic osteotomies were performed in 14 (23.3% hips for continued acetabular dysplasia and recurrent subluxation. (Salter [ n = 12]/Pemberton [ n = 2] osteotomy was performed. Avascular necrosis (AVN developed in 7 (11.7% hips. Conclusion: In DDH only soft-tissue procedures are not enough, because of the high rate of the secondary surgery and AVN for all cases aged less than 24 months. Bone procedures may be necessary in the walking

  17. Dicty_cDB: SLB115 [Dicty_cDB

    Lifescience Database Archive (English)

    Full Text Available SL (Link to library) SLB115 (Link to dictyBase) - - - Contig-U16455-1 SLB115Z (Link... to Original site) - - SLB115Z 570 - - - - Show SLB115 Library SL (Link to library) Clone ID SLB115 (Link to...ycdb.biol.tsukuba.ac.jp/CSM/SL/SLB1-A/SLB115Q.Seq.d/ Representative seq. ID SLB11...5Z (Link to Original site) Representative DNA sequence >SLB115 (SLB115Q) /CSM/SL/SLB1-A/SLB115Q.Seq.d/ XXXXX...nnis**iafynk Homology vs CSM-cDNA Score E Sequences producing significant alignments: (bits) Value SLB115 (SLB115Q) /CSM/SL/SLB

  18. Periacetabular Osteotomy Redirects the Acetabulum and Improves Pain in Charcot-Marie-Tooth Hip Dysplasia With Higher Complications Compared With Developmental Dysplasia of the Hip.

    Science.gov (United States)

    Novais, Eduardo N; Kim, Young-Jo; Carry, Patrick M; Millis, Michael B

    2016-12-01

    The Bernese periacetabular osteotomy (PAO) is a well-accepted reorientation pelvic osteotomy used to treat symptomatic acetabular dysplasia secondary to developmental dysplasia of the hip (DDH). However, there are limited data regarding PAO in patients with symptomatic hip dysplasia secondary to Charcot-Marie-Tooth disease. We compared patients who underwent PAO for the treatment of Charcot-Marie-Tooth disease hip dysplasia (CMTHD group) with patients who underwent PAO for treatment of hip dysplasia secondary to DDH in terms of (1) modified Harris Hip scores; (2) radiographic correction of acetabular dysplasia; and (3) the rate of complications. Twenty-seven subjects with Charcot-Marie-Tooth disease who underwent a PAO between January 1991 and December 2010 were matched to 54 subjects with DDH on the basis of sex, age, date of surgery, and body mass index. Preoperative and postoperative hip functional scores and radiographic data were collected with a minimum 2-year follow-up. The modified Harris Hip Scores (mHHS) assessed functional hip outcomes. Radiographic variables included lateral (LCEA) and anterior (ACEA) center-edge angles, Tönnis angle and Tönnis grade of arthritis. Postoperative complications were classified according to a modified Dindo-Clavien system. At latest follow-up mHHS improved in the CMTHD group (preoperative median 63; (interquartile range [IQR]=54-70 to postoperative median 88; IQR=74-91); P=0.004) and in the DDH groups (preoperative median 71; IQR=58-83 to postoperative median 86; IQR=73-96; P=0.002) with no difference between the 2 groups (P=0.631). Radiographic improvement (LCEA: mean difference, 36 degrees, 95% confidence interval [CI], 30-41 degrees, P<0.001; ACEA: mean difference, 27 degrees, 95% CI, 20-33 degrees, P<0.001; Tönnis angles: mean difference, 21 degrees, 95% CI, 15-26 degrees, P<0.001) was achieved in the CMTHD group. Similarly, radiographic improvements in LCEA (mean difference, 33 degrees, 95% CI, 29-37 degrees, P<0

  19. 耐碳青霉烯类鲍曼不动杆菌的耐药机制研究进展%Progress in Mechanisms of Carbapenem Resistance in Acinetobacter baumannii

    Institute of Scientific and Technical Information of China (English)

    陈海红; 李华茵; 何礼贤

    2010-01-01

    @@ 根据美国联邦感染监测系统(NNIS)和中国院内感染病原菌耐药监测资料显示[1,2],鲍曼不动杆菌(Acinetobacter baumannii)在院内感染占第四位,成为仅次于铜绿假单孢菌的非发酵菌.而随着广谱抗生素和免疫抑制剂的广泛使用,世界各地陆续出现了泛耐药或多重耐药鲍曼不动杆菌的报道.

  20. Treatment Algorithm for Patients with Non-arthritic Hip Pain, Suspect for an Intraarticular Pathology

    DEFF Research Database (Denmark)

    Jørgensen, Rasmus Wejnold; Dippmann, Christian; Dahl, L

    2016-01-01

    BACKGROUND: The amount of patients referred with longstanding, non-arthritic hip pain is increasing, as are the treatment options. Left untreated hip dysplasia, acetabular retroversion and femoroacetabular impingement (FAI) may lead to osteoarthritis (OA). Finding the right treatment option...... associated with acetabular retroversion described in the literature were the crossover sign, the posterior wall sign and the ischial spine sign, while Wiberg's lateral center-edge angle (CE-angle) together with Leqeusne's acetabular index indicate hip dysplasia. A Tönnis index >2 indicates osteoarthritis...... for the right patient can be challenging in patients with non-arthritic hip pain. PURPOSE: The purpose of this study was to categorize the radiographic findings seen in patients with longstanding hip pain, suspect for an intraarticular pathology, and provide a treatment algorithm allocating a specific treatment...

  1. Autologous Membrane Induced Chondrogenesis (AMIC) for the treatment of acetabular chondral defect

    Science.gov (United States)

    Fontana, Andrea

    2016-01-01

    Summary Background Acetabular chondral defect are very frequently associated to FAI. Treatment options are still questionable. Methods Between 2008 and 2014, 201 patients over 583 have been arthroscopically treated with the AMIC procedure for grade III and/or IV acetabular chondral lesions. Patients age was between 18 and 50 years; acetabular chondral lesion size was between 2 and 4 cm2; radiological Tönnis degree of osteoarthritis was ≤ 2. Results The mean follow up of the entire group of 201 patients was 5 years (from 8 to 2). Significant improvement, as measured by the mHHS, was observed at 6 months in comparison to preoperative levels (80.3 ± 8.3) (prepair medium-sized chondral defects on the acetabular side of the hip found during treatment of FAI and lead to long-term favourable outcomes. Level of evidence IV. PMID:28066742

  2. [Long-term clinical and radiological outcomes in a serie of 26 cases of symptomatic adult developmental dysplasia of the hip managed with bernese periacetabular osteotomy].

    Science.gov (United States)

    Alcobía Díaz, B; Luque Pérez, R; García Bullón, I; Moro Rodríguez, L E; López-Durán Stern, L

    2015-01-01

    Developmental hip dysplasia is a frequent cause of coxofemoral pain in young adults. Bernese periacetabular osteotomy emerges as a possible option for the management of pain relief and functional limitation, in order to delay the need for arthroplasty in these patients. A descriptive-retrospective study was conducted on 26 selected patients with symptomatic developmental hip dysplasia treated with bernese periacetabular osteotomy between 1996 and 2009 (94% women). Mean age at time of surgery was 39.8 y (15-49 y), with a mean follow-up of 10 years. Osteoarthritis (OA Tönnis scale), acetabular index and Wiberg angle were evaluated by radiology and functionality was valued by using the de Merle-D'Aubigné-Postel scale. The mean hospitalization time was 10 days. At 10 years, the mean radiography value of acetabular index was 9.03° and 38.3° for Wiberg angle (17° and 27° correction, respectively, above the mean pre-operative values). Joint lock was referred to by 43% of patients, and 53% to non-evidence based limb failure. Mean functional value was 14.30 (Good). At 5 years of follow-up, 20% advanced at least by one grade in OA Tönnis scale compared to their pre-operative status, increasing to 55% at 10 years. At 10 years after surgery, 83% patients did not need arthroplasty and 85% showed high satisfaction level. Bernese periacetabular osteotomy is a useful alternative in young adults with symptomatic developmental hip dysplasia that can improve pain relief, femoral head coverage, and slow down coxofemoral osteoarthrosis progression in order to delay arthroplasty. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

  3. Hip dysplasia is more severe in Charcot-Marie-Tooth disease than in developmental dysplasia of the hip.

    Science.gov (United States)

    Novais, Eduardo N; Bixby, Sara D; Rennick, John; Carry, Patrick M; Kim, Young-Jo; Millis, Michael B

    2014-02-01

    Patients with Charcot-Marie-Tooth disease may develop hip dysplasia. Hip geometry in these patients has not been well described in the literature. We compared the hip morphometry in Charcot-Marie-Tooth hip dysplasia (CMTHD) and developmental dysplasia of the hip (DDH) in terms of extent of (1) acetabular dysplasia and subluxation, (2) acetabular anteversion and osseous support, (3) coxa valga and femoral version, and (4) osteoarthritis. Fourteen patients with CMTHD (19 hips; mean age, 23 years) presenting for periacetabular osteotomy were matched to 45 patients with DDH (45 hips; mean age, 21 years) based on age, sex, and BMI. We assessed acetabular dysplasia and subluxation using lateral center-edge angle (LCEA), anterior center-edge angle (ACEA), and acetabular roof angle of Tönnis (TA) on plain pelvic radiographs and acetabular volume, area of femoral head covered by acetabulum, and percentage of femoral head covered by acetabulum on three-dimensional CT reconstruction models. Acetabular version and bony support, femoral version, and neck-shaft angle were measured on two-dimensional axial CT scans. Hip osteoarthritis was graded radiographically according to Tönnis criteria. Acetabular dysplasia was more severe in CMTHD, as measured by smaller LCEA (p Hip subluxation was more pronounced in CMTHD, as demonstrated by lower area of femoral head covered by acetabulum (p = 0.034) and percentage of femoral head covered by acetabulum (p = 0.007). CMTHD was associated with higher acetabular anteversion (p hips were found in CMTHD. The extent of acetabular dysplasia, hip subluxation, acetabular anteversion, coxa valga, and hip osteoarthritis was more severe in CMTHD. These findings are important in choosing the appropriate surgical strategy for patients affected by CMTHD.

  4. Outcome of arthroscopy in patients with advanced osteoarthritis of the hip.

    Science.gov (United States)

    Daivajna, Sachin; Bajwa, Ali; Villar, Richard

    2015-01-01

    Hip arthroscopy has continued to expand its horizons in treating many conditions other than femoroacetabular impingement (FAI). However, the results of hip arthroscopy are known to be poor if the degree of articular cartilage damage is significant. We wanted to assess, whether the procedure might have a role in the management of young and active patients with advanced osteoarthritis (OA) and whether it should be offered as a treatment modality. 77 consecutive patients with Tönnis grade 2 and 3 osteoarthritis of the hip who had undergone hip arthroscopy were included in the study. Patients' medical notes, plain radiographs and outcome scores (modified Harris hip score (mHHS), non-arthritic hip score (NAHS)) preoperatively and postoperatively at six weeks, six months, one year and annually thereafter, were analysed. 77 patients consisted of 63 men and 14 women with mean follow-up of 2.8 years (2.2 to 4.2) and mean age at surgery of 43 years (19 to 64). The mean preoperative mHHS and NAHS scores were 58 (28 to 87) and 64 (27 to 93) respectively. The mean improvements in both the mHHS and NAHS scores were significant (p = 0.003 and p = 0.0001 for mHHS at one and two years, p = 0.002 and p = 0.0003 for NAHS at one and two years, respectively). There were 34 patients (44%) who required a total hip replacement at mean of 18 months (6 to 48) after hip arthroscopy. We conclude that hip arthroscopy improves outcome scores in 56% of patients with severe OA of the hip (Tönnis grade 2 and 3) for at least two years after surgery. We thus consider the procedure to be a reasonable option for patients with hip OA, although success of the procedure will be less than if undertaken for certain other conditions.

  5. Long-term evolution of slipped capital femoral epiphysis treated by in situ fixation: a 26 years follow-up of 11 hips

    Directory of Open Access Journals (Sweden)

    Jérôme Murgier

    2014-06-01

    Full Text Available Slipped capital femoral epiphysis (SFCE may lead to femoro acetabular impingement and long-term function impairment, depending on initial displacement and treatment. There are several therapeutic options which include in situ fixation (ISF. The objective of this study was to evaluate long-term functional and radiographic outcomes of patients with SFCE treated with ISF. We conducted a single-center, retrospective study evaluating the clinical and radiographic outcomes of SCFE in situ fixation with a mean follow-up of 26 years (10- 47. Analysis of preoperative and last follow up radiographs was performed. The functional status of the hip was evaluated according to the Oxford hip score-12 and the radiographic osteoarthritis stage was rated according to Tönnis classification. Signs of femoro acetabular impingement were sought. Ten patients (11 hips were included. The average initial slip was 33.5° (10-62. At final follow up, the average Oxford hip score was 19.3 (12-37, it was good for groups who had a small initial slip (16.7 or moderate (17 and fair for the severe group (27. Average Tönnis grade was 1.3 (0- 3. The average alpha angle was 65.3° (50- 80°. Femoro acetabular impingement was likely in 100% of patients with severe slip, in 50% of patients with moderate slip and in 33% of patients with a slight slip. In situ fixation generated poor functional results, substantial hip osteoarthritis and potential femoro acetabular impingement in moderate to severe SCFE’s. However, in cases with minor displacement, functional and radiographic results are satisfactory. The cut off seems to be around 30° slip angle, above which other treatment options should be considered.

  6. [Post-appendectomy surgical site infection: overall rate and type according to open/laparoscopic approach].

    Science.gov (United States)

    Aranda-Narváez, José Manuel; Prieto-Puga Arjona, Tatiana; García-Albiach, Beatriz; Montiel-Casado, María Custodia; González-Sánchez, Antonio Jesús; Sánchez-Pérez, Belinda; Titos-García, Alberto; Santoyo-Santoyo, Julio

    2014-02-01

    To compare the incidence and profile of surgical site infection (SSI) after laparoscopic (LA) or open (OA) appendicectomy. Observational and analytical study was conducted on patients older than 14years-old with suspected acute appendicitis operated on within a 4-year period (2007-2010) at a third level hospital (n=868). They were divided in two groups according to the type of appendicectomy (LA, study group, 135; OA, control group, 733). The primary endpoint was a surgical site infection (SSI), and to determine the overall rate and types (incisional/organ-space). The risk of SSI was stratified by: i)National Nosocomial Infection Surveillance (NNIS) index (low risk: 0E, 0 and 1; high risk: 2 and 3); ii)status on presentation (low risk: normal or phlegmonous; high risk: gangrenous or perforated). The statistical analysis was performed using the software SPSS. The main result and stratified analysis was determined with χ(2), and the risk parameters using OR and Mantel-Haenszel OR with 95%CI, accepting statistical significance with P<.05. Age, gender, ASA index and incidence of advanced cases were similar in both groups. The overall SSI rate was 13.4% (more than a half of them detected during follow-up after discharge). Type of SSI: OA, 13% (superficial 9%, deep 2%, organ-space 2%); AL, 14% (superficial 5%, deep 1%, organ-space 8%) (overall: not significant; distribution: P<.000). Stratified analysis showed that there is an association between incisional SSI/OA and organ-space SSI/LA, and is particularly stronger in those patients with high risk of postoperative SSI (high risk NNIS or gangrenous-perforated presentation). OA and LA are associated with a higher rate of incisional and organ-space SSI respectively. This is particularly evident in patients with high risk of SSI. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  7. Incidence of and risk factors for surgical-site infections in a Peruvian hospital.

    Science.gov (United States)

    Hernandez, Katherine; Ramos, Elizabeth; Seas, Carlos; Henostroza, German; Gotuzzo, Eduardo

    2005-05-01

    To determine the incidence of and risk factors for surgical-site infections (SSIs) after abdominal surgery. A cohort study was conducted from January to June 1998. CDC criteria for SSI and the NNIS System risk index were used. A tertiary-care hospital in Peru. Adult patients undergoing abdominal surgery who consented were enrolled and observed until 30 days after surgery. Patients who had undergone surgery at another hospital or who died or were transferred to another hospital within 24 hours after surgery were excluded. Four hundred sixty-eight patients were enrolled. Their mean age was 37.2 years. One hundred twenty-five patients developed SSIs, 18% of which were identified after discharge. The overall incidence rate (IR) was 26.7%. The IR was 13.9% for clean, 15.9% for clean-contaminated, 13.5% for contaminated, and 47.2% for dirty interventions. The IR was 3.6% for NNIS System risk index 0 and 60% for index 3. Risk factors for SSI on logistic regression analysis were dirty or infected wound (RR, 3.8; CI95, 1.7-8.4), drain use longer than 9 days (RR, 6.0; CI95, 2.5-12.5), and length of surgery greater than the 75th percentile (RR, 2.1; CI95, 1.0-4.4). Patients with SSI had a longer hospital stay than did non-infected patients (14.0 vs 6.1 days; p < .001). SSI is a major problem in this hospital, which has a higher IR (especially for clean interventions) than those of developed countries. In developing countries, prevention of SSI should include active surveillance and interventions targeting modifiable risk factors.

  8. [Surgical site infections. Effectiveness of polyhexamethylene biguanide wound dressings].

    Science.gov (United States)

    Martín-Trapero, Carlos; Martín-Torrijos, María; Fernández-Conde, Lourdes; Torrijos-Torrijos, Manuela; Manzano-Martín, Elena; Pacheco-del Cerro, J Luis; Díez-Valladares, Luis I

    2013-01-01

    To analyze the effectiveness of a 0,2% polyhexamethylene biguanide dressing against the infection of a superficial surgical incision site (ISSIS) after a laparoscopic cholecystectomy. A randomized longitudinal single-blind study was conducted with two randomly assigned groups consisting of patients diagnosed with cholelithiasis soon to undergo an elective laparoscopic cholecystectomy. The dependent variable was ISSIS using the criteria of the Centre for Disease Control (CDC) (1999). The independent variables were the use of a 0,2% polyhexamethylene biguanide dressing (Group A), or a non occlusive dressing (Group B). The National Nosocomial Infections Surveillance (NNIS) index was used for assessing the risk of infection. The χ(2) test or Fisher test was used to evaluate the correlation between the independent variables. Of the total 197 cases, 96 (48.7%) were in group A and 101 (51.3%) in group B. No statistical differences were found between genders, duration of surgery (51.4 ± 21.2 vs 52.6 ± 23.4 minutes, in group A and B, respectively), or the NNIS index in either group. Six patients had an ISSIS (3.04%): 1 in group A (1.04%) and 5 in group B (4.95%), P=.212. The study was unable to correlate an ISSIS with the type of surgical dressing that was used, although it was not possible to rule out an association, as the study did not have sufficient statistical power. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  9. Radiographic findings of femoroacetabular impingement in capoeira players.

    Science.gov (United States)

    Mariconda, Massimo; Cozzolino, Andrea; Di Pietto, Francesco; Ribas, Manuel; Bellotti, Vittorio; Soldati, Alessandra

    2014-04-01

    Capoeira is a Brazilian martial art that requires extreme movements of the hip to perform jumps and kicks. This study evaluated a group of capoeira players to assess the prevalence of femoroacetabular impingement (FAI) in athletes practicing this martial art. Twenty-four experienced capoeira players (14 men, 10 women) underwent a diagnostic assessment, including clinical examination and standard radiographs of the pelvis and hips. The α-angle, head-neck offset, crossover sign, acetabular index, lateral centre-edge angle, and the Tönnis grade were assessed using the radiographs. Clinical relationships for any radiographic abnormalities indicating FAI were also evaluated. Four subjects (17 %) reported pain in their hips. Forty-four hips (91.7 %) had at least one radiographic sign of CAM impingement, and 22 (45.8 %) had an α-angle of more than 60°. Eighteen hips (37.5 %) had at least one sign of pincer impingement and 16 (33.3 %) a positive crossover sign. Sixteen hips (33.3 %) had mixed impingement. There was a significant positive association between having an α-angle of more than 60° and the presence of groin pain (P = 0.002). A reduced femoral head-neck offset (P < 0.001) and an increased α-angle on the anteroposterior radiograph (P = 0.008) were independently associated with a higher Tönnis grade. High prevalence of radiographic CAM-type FAI among these skilled capoeira players was found. In these subjects, a negative clinical correlation for an increased α-angle was also detected. Additional caution should be exercised whenever subjects with past or present hip pain engage in capoeira.

  10. Standardized infection ratios for three general surgery procedures: a comparison between Spanish hospitals and U.S. centers participating in the National Nosocomial Infections Surveillance System.

    Science.gov (United States)

    Jodra, V Monge; Rodela, A Robustillo; Martínez, E Martín; Fresneña, N López

    2003-10-01

    To compare Spanish surgical wound infection (SWI) rates for three procedures with those published by the U.S. NNIS System, and to analyze quarterly trends. This was a 4-year prospective analysis of SWI using data from a Spanish nosocomial infection surveillance network based on CDC classification criteria. SWI rates were computed as standardized infection ratios (SIRs). Trends for both SWIs and SIRs were evaluated by linear regression. Forty-three Spanish hospitals during 1997 through 2000. Those undergoing cholecystectomy (n = 7,631), appendectomy (n = 5,780), and herniorrhaphy (n = 9,864). For cholecystectomy patients, the SWI rate was 4.38% and the SIR was 3.32. Both of these variables showed a slightly rising, although nonsignificant, linear trend during the study period. For appendectomy patients, the SWI rate was 7.94% and the SIR was 2.86. The linear trend was increasing for both, but only the SWI rate attained significance. For herniorrhaphy patients, the SWI rate was 1.77% and the SIR was 1.64. Both of these variables showed a significant descending tendency during the 4 years. Because the SIR takes into account the patient risk category, it is the best indicator of the trend shown by the SWI rate over time for a given surgical procedure. According to our comparison of SIRs with reference NNIS System values, SWI rates for cholecystectomy and appendectomy were high. Monitoring of the SIR will provide a basis for the design of infection control measures and the assessment of their effectiveness.

  11. Conservative approach versus urgent appendectomy in surgical management of acute appendicitis with abscess or phlegmon Resultados del tratamiento conservador inicial y de la cirugía urgente en la apendicitis aguda evolucionada

    Directory of Open Access Journals (Sweden)

    J. M. Aranda-Narváez

    2010-11-01

    Full Text Available Background: Surgical management of acute appendicitis with appendiceal abscess or phlegmon remains controversial. We studied the results of initial conservative treatment (antibiotics and percutaneous drainage if necessary, with or without interval appendectomy compared with immediate surgery. Methods: We undertook an observational, retrospective cohort study of patients with a clinical and radiological diagnosis of acute appendicitis with an abscess or phlegmon, treated in our hospital between January 1997 and March 2009. Patients younger than 14, with severe sepsis or with diffuse peritonitis were excluded. A study group of 15 patients with acute appendicitis complicated with an abscess or phlegmon underwent conservative treatment. A control group was composed of the other patients, who all underwent urgent appendectomy, matched for age and later randomized 1:1. The infectious risk stratification was established with the National Nosocomial Infections Surveillance System (NNIS index. Dependent variables were hospital stay and surgical site infection. Analysis was with SPSS, with p Introducción: Existe controversia acerca del tratamiento idóneo de la apendicitis aguda evolucionada en forma de absceso o flemón. Realizamos un estudio para la evaluación de resultados del tratamiento conservador inicial (antibiótico y drenaje percutáneo si se precisa, con/sin apendicectomía diferida y del tratamiento quirúrgico urgente. Método: Estudio observacional analítico de cohortes retrospectivas. Criterios de inclusión: pacientes con diagnóstico clínico y radiológico de apendicitis aguda evolucionada en forma de absceso o flemón, tratados en nuestro hospital entre enero 1997 y marzo 2009, excluyendo pacientes pediátricos, con sepsis grave o peritonitis difusa. En 15 pacientes con apendicitis complicada con absceso o flemón (cohorte de estudio se indicó tratamiento conservador inicial. El grupo control se obtuvo del resto de pacientes (en

  12. ANTIMICROBIAL SUSCEPTIBILITY PATTERN OF ORGANISMS CAUSING SURGICAL SITE INFECTIONS (SSI

    Directory of Open Access Journals (Sweden)

    Rohini Murlidhar Gajbhiye

    2017-02-01

    Full Text Available BACKGROUND CDC defines surgical site infection as ‘Infections related to operative procedure that occurs at or near surgical incision within 30 days of operative procedure or within one year if the implant is left in situ’. Surgical site infection (SSI is 3 rd most frequently reported nosocomial infection (12%-16% as per National Nosocomial Infection Surveillance (NNIS. The aim of this study was to investigate the antimicrobial susceptibility pattern of organisms causing SSI. MATERIALS AND METHODS During a two year study period in a tertiary care hospital, 19,127 patients underwent surgeries in various surgical departments. Of these 517 (2.7% developed surgical site infection. The surgical wounds were classified by CDC & NNIS criteria into 4 classes. Two wound swabs were taken and processed by standard microbiological techniques. Antimicrobial susceptibility along with testing of ESBLs, MBLs, AmpCβ lactamases was done for all isolates causing SSI. RESULTS Among 19,127 patients, 517 (2.7% developed SSI. It was highest in patients of perforation peritonitis (11.99%.Among 517 specimens, 340 (65.76% showed growth and 177 (34.23% were culture negative. E.coli (23.33% was the commonest organism isolated followed by Acinetobacter spp. (16%, Klebsiella spp. (15.66%, Pseudomonas spp. (15.33%, S. aureus (10.33%, S. epidermidis(7.3%, Proteus spp. (6.00% and Citrobacter spp. (2.66%.Staphylococcus spp. were 100 % sensitive to Vancomycin & Linezolid. (27.5% S. aureus were MRSA and (17.5% were Inducible Clindamycin resistant (ICR. Enterobacteriaceae isolates showed maximum sensitivity towards Imipenem, Piperacillin-Tazobactam and Amikacin. Klebsiella spp. (40.62%, E.coli (35.89%, Citrobacter spp. (33.33%, Proteus spp. (26.08% were ESBL producers. Klebsiella spp. (17.18%, E.coli (10.25%, Proteus spp. (11.11% and Citrobacter spp. (8.69% were AmpC producers. Acinetobacter spp. (28.57% was commonest MBL producer followed by Klebsiella spp. (20

  13. Are Short-term Outcomes of Hip Arthroscopy in Patients 55 Years and Older Inferior to Those in Younger Patients?

    Science.gov (United States)

    Bryan, Andrew J; Krych, Aaron J; Pareek, Ayoosh; Reardon, Patrick J; Berardelli, Rebecca; Levy, Bruce A

    2016-10-01

    Hip arthroscopy for young patients with femoroacetabular impingement (FAI) has been successful, but the efficacy of hip arthroscopy in older patients is not clearly defined. To evaluate the clinical outcomes of patients 55 years and older who are undergoing hip arthroscopy and to compare outcomes with those of patients younger than 55 years. Cohort study; Level of evidence, 3. A total of 201 (63 male, 138 female) patients undergoing primary hip arthroscopy for FAI without radiographic arthritis (Tönnis grade 55-year and ≥55-year groups. Patients were evaluated preoperatively and 1 and 2 years postoperatively using the modified Harris Hip Score (mHHS) and Hip Outcome Score (HOS: functional scores, as well as Activities of Daily Living [ADL] and Sport subscales). A Wilcoxon signed rank sum test was used to evaluate the differences in outcome scores between the cohorts at each interval. The 55-year group included 174 patients (mean age, 37 ± 12 years), and the ≥55-year group included 27 patients (mean age, 61 ± 5 years). The minimum follow-up time was 2 years in each group. Preoperative Tönnis grades and mHHS scores (59 vs 59; P = .75) were similar between groups. The ≥55-year cohort underwent labral debridement more frequently (78% vs 36%; P =.02) and were more likely to have full-thickness cartilage defects (22% vs 4%; P = .04). Despite this, the mHHS in both groups improved significantly from baseline, without significant differences at 1 year (86 [≥55 years] vs 81 [55 years]; P = .53) or 2 years (73.88 [≥55 years] vs 79.54 [55 years]; P = .06). However, at a minimum 2-year follow-up, patients 55 years had significant improvements over patients ≥55 years in the HOS subscales for ADL score (85.6 vs 75.2; P = .03), ADL rating (80.1 vs 70.0; P = .004), Sport score (70.2 vs 55.6; P = .04), and Sport rating (70.2 vs 58.0; P = .04). Although younger patients had superior HOS outcomes reported at 2 years compared with older patients after hip arthroscopy

  14. What factors predict improvements in outcomes scores and reoperations after the Bernese periacetabular osteotomy?

    Science.gov (United States)

    Beaulé, Paul E; Dowding, Chris; Parker, Gillian; Ryu, Jae-Jin

    2015-02-01

    The Bernese periacetabular osteotomy (PAO) has entered its fourth decade and is frequently used for corrective osteotomy in patients with acetabular dysplasia. Although our capacity to preserve the joint after corrective osteotomy is excellent, gaining a better understanding on how well patients function after this surgery is important as well. (1) What changes in patient-reported outcomes scores occur in patients treated with PAO for hip dysplasia in the setting of a single-surgeon practice? (2) What are the predictors of clinical function and survivorship? All 67 patients presenting to a single surgeon's clinic with hip dysplasia treated with PAO between October 2005 and January 2013 were prospectively followed. Baseline demographic data as well as pre- and postoperative radiographic and functional measurements were obtained with a minimum of 1-year followup. Radiographic criteria included Tönnis grade, Tönnis angle, minimum joint space width, center-edge angle, presence of crossover sign, medial translation of the hip center, and alpha angle. We also used validated outcome measures including the WOMAC, the UCLA Activity Scale, and the SF-12. Multiple regression analysis was used to determine predictors of functional outcome scores. There were increases in WOMAC, UCLA, and SF-12 Physical scores. Higher preoperative alpha angle was associated with a lower postoperative WOMAC score (β=-0.47; 95% confidence interval [CI], -0.92 to -0.02; R2=0.08; p=0.04). The 5-year Kaplan-Meier survivorship was 94.1% (95% CI, 90.7-97.5) with reoperation (ie, hip arthroscopy and/or total hip arthroplasty) used as the endpoint for failure. With the limited numbers available, we could not identify any demographic or radiographic factors associated with reoperation. Overall survivorship for the PAO at our center at 5 years is comparable to other clinical series with overall functional scores improving. A greater alpha angle preoperatively was associated with poorer patient

  15. The Bernese periacetabular osteotomy: is transection of the rectus femoris tendon essential?

    Science.gov (United States)

    Novais, Eduardo N; Kim, Young-Jo; Carry, Patrick M; Millis, Michael B

    2014-10-01

    The Bernese periacetabular osteotomy (PAO) traditionally is performed using the iliofemoral or the ilioinguinal approach with transection of the rectus femoris tendon attachments. Although a rectus-preserving approach has been developed, there is limited direct comparison data regarding the surgical safety, radiographic correction, and improvement in hip pain and function between the rectus-preserving and the classic approaches. The purposes of this study were to determine whether preserving the rectus femoris tendon attachment would (1) reduce intraoperative blood loss and length of surgery; (2) improve Harris hip scores (HHS); (3) decrease the rate of complications; and (4) affect the radiographic correction when compared with the classic approach. A retrospective matched cohort study was used to compare the endpoints listed above after PAO using a rectus-preserving approach versus the classic approach. Operative blood loss, preoperative and postoperative hematocrit, duration of surgery, HHS, and postoperative complications were recorded for the two groups. Pelvic radiographs were reviewed for measurement of the lateral center-edge angle, anterior center-edge angle, and Tönnis acetabular inclination angle. A total of 64 patients were included (32 in each group). Followup was at a minimum of 1 year (mean, 20 months; range, 13-44 months). Blood loss (p = 0.2405), hematocrit change (p = 0.3277), and operative time (p = 0.3960) were similar between groups. At latest followup, the HHS improved in the rectus-preserving (mean improvement, 25; 95% CI, 21-29; p < 0.0001) and control groups (mean improvement, 21; 95% CI, 17-25; p < 0.0001) with no difference in HHS improvement between the groups (mean difference, 4.3; 95% CI, -1.6 to 10.1; p = 0.1523). The complication rate was 12.5% (four of 32) in the rectus-preserving group and 25% (eight of 32) in the classic approach groups, respectively (p = 0.2002). The rectus-preserving approach allowed for similar lateral center

  16. Arthroscopic capsular plication and labral preservation in borderline hip dysplasia: two-year clinical outcomes of a surgical approach to a challenging problem.

    Science.gov (United States)

    Domb, Benjamin G; Stake, Christine E; Lindner, Dror; El-Bitar, Youssef; Jackson, Timothy J

    2013-11-01

    The role of hip arthroscopy in the treatment of patients with dysplasia is unclear because of the spectrum of dysplasia that exists. Patients with borderline dysplasia are generally not candidates for periacetabular osteotomy because of the invasive nature of the procedure. However, arthroscopy in dysplasia has had mixed results and has the potential to exacerbate instability. Patients with borderline dysplasia will demonstrate postoperative improvement, high satisfaction rates, and low reoperation rates after a surgical approach that includes arthroscopic labral repair augmented by capsular plication with inferior shift. Case series; Level of evidence, 4. Between April 2008 and November 2010, patients less than 40 years old who underwent hip arthroscopy for symptomatic intra-articular hip disorders, with a lateral center-edge (CE) angle ≥18° and ≤25°, were included in this study. Patients with Tönnis grade 2 or greater, severe hip dysplasia (CE ≤17°), and Legg-Calve-Perthes disease were excluded. Patient-reported outcome scores, including the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sport-Specific Subscale (HOS-SSS), Hip Outcome Score-Activity of Daily Living (HOS-ADL), and visual analog scale (VAS) for pain were obtained in all patients preoperatively and at 1, 2, and 3 years postoperatively. Revision surgery and complications were recorded for each group. A total of 26 patients met the criteria to be included in the study. Of these, 22 (85%) patients were available for follow-up. The mean (± standard deviation) length of follow-up for this cohort was 27.5 ± 5.5 months (range, 17-39 months) and the average age was 20 years (range, 14-39 years). The mean lateral CE angle was 22.2° (range, 18°-25°) and the mean Tönnis angle was 5.8° (range, 0°-17°). There was significant improvement in all patient-reported outcome scores (mHHS, NAHS, HOS-SSS, and HOS-ADL) (P dysplasia have often fallen into a gray area

  17. Molecular modeling and residue interaction network studies on the mechanism of binding and resistance of the HCV NS5B polymerase mutants to VX-222 and ANA598.

    Science.gov (United States)

    Xue, Weiwei; Jiao, Pingzu; Liu, Huanxiang; Yao, Xiaojun

    2014-04-01

    Hepatitis C virus (HCV) NS5B protein is an RNA-dependent RNA polymerase (RdRp) with essential functions in viral genome replication and represents a promising therapeutic target to develop direct-acting antivirals (DAAs). Multiple nonnucleoside inhibitors (NNIs) binding sites have been identified within the polymerase. VX-222 and ANA598 are two NNIs targeting thumb II site and palm I site of HCV NS5B polymerase, respectively. These two molecules have been shown to be very effective in phase II clinical trials. However, the emergence of resistant HCV replicon variants (L419M, M423T, I482L mutants to VX-222 and M414T, M414L, G554D mutants to ANA598) has significantly decreased their efficacy. To elucidate the molecular mechanism about how these mutations influenced the drug binding mode and decreased drug efficacy, we studied the binding modes of VX-222 and ANA598 to wild-type and mutant polymerase by molecular modeling approach. Molecular dynamics (MD) simulations results combined with binding free energy calculations indicated that the mutations significantly altered the binding free energy and the interaction for the drugs to polymerase. The further per-residue binding free energy decomposition analysis revealed that the mutations decreased the interactions with several key residues, such as L419, M423, L474, S476, I482, L497, for VX-222 and L384, N411, M414, Y415, Q446, S556, G557 for ANA598. These were the major origins for the resistance to these two drugs. In addition, by analyzing the residue interaction network (RIN) of the complexes between the drugs with wild-type and the mutant polymerase, we found that the mutation residues in the networks involved in the drug resistance possessed a relatively lower size of topology centralities. The shift of betweenness and closeness values of binding site residues in the mutant polymerase is relevant to the mechanism of drug resistance of VX-222 and ANA598. These results can provide an atomic-level understanding about

  18. Sorveglianza attiva prospettica delle infezioni ospedaliere nelle unità di terapia intensiva: studio multicentrico e proposta di una rete italiana

    Directory of Open Access Journals (Sweden)

    L. Sodano

    2003-05-01

    Full Text Available

    Obiettivi: la proposta di attivare una rete di sorveglianza delle infezioni ospedaliere (IO nelle Unità di Terapia Intensiva (UTI, preceduta da uno studio multicentrico di sei mesi, ha i seguenti obiettivi: 1 sorveglianza attiva prospettica, secondo un protocollo elaborato sul modello del National Nosocomial Infections Surveillance (NNIS System degli USA; 2 caratterizzazione epidemiologica dei microrganismi associati alle IO identificate durante la sorveglianza.

    Metodi: il GISIO individuerà un gruppo di coordinamento centrale ed eventuali referenti periferici con le specifiche funzioni di: a elaborare un protocollo operativo per l’attuazione della sorveglianza, con l’obiettivo principale di costruire gli indicatori previsti dal NNIS System per la componente UTI; b formare il personale addetto alla rilevazione dei dati e alla validazione dei casi d’infezione; c allestire un foglio elettronico per l’input dei dati, curarne l’elaborazione e la restituzione ai centri partecipanti; d individuare il laboratorio che effettuerà la tipizzazione dei ceppi, mediante Pulsed Field Gel Electrophoresis, e curare l’analisi dei risultati, integrandola con quella relativa alla sorveglianza attiva prospettica. Risultati: lo studio consentirà la costruzione dei tassi di IO per categorie cliniche omogenee di rischio, in modo da rendere possibili confronti nel tempo e nello spazio. I ceppi microbici associati alle IO, collezionati dalle UTI partecipanti, verranno identificati in cloni distinti (pulsotipi mediante criteri internazionali. Per le specie microbiche più rappresentative verrà eseguita l’analisi filogenetica per descrivere le correlazioni genetiche ed epidemiologiche tra i diversi stipiti, con l’obietivo di identificare eventuali cluster.

    Conclusioni: il progetto del GISIO risponde all’esigenza di un confronto a livello nazionale, attraverso la creazione di una sorta

  19. Risk factors for nosocomial infection in a Brazilian neonatal intensive care unit

    Directory of Open Access Journals (Sweden)

    Ana Carolina Vieira Costa Fernandes Távora

    2008-02-01

    Full Text Available This study was designed to describe the epidemiology and risk factors for nosocomial infection (NI in a Brazilian neonatal intensive care unit (NICU. This study was a retrospective cohort from January to December, 2003. All neonates admitted to the NICU. Infection surveillance was conducted according to the NNIS, CDC. Chi-square test and logistic regression model were performed for statistical analyses. The study was conducted at a public, tertiary referral NICU of a teaching hospital in the Northeast of Brazil. A total of 948 medical records were reviewed. Overall NI incidence rate was 34%. The main neonatal NI was bloodstream infection (68.1%, with clinical sepsis accounting for 47.2%, and pneumonia was the second most common NI (8.6%. Multivariate analysis identified seven independent risk factors for NIs: birth weight, exposure to parenteral nutrition, percutaneous catheter, central venous catheter or mechanical ventilation, abruptio placentae and mother's sexually transmitted disease (STD. Neonates from mothers with STD or abruptio placentae, those weighing less than 1,500 g at birth or those who used invasive devices were at increased risk for acquiring NI.

  20. Inhibition of Nitrification by Root Exudates and Plant Materials fromBrachiaria humidicola

    Directory of Open Access Journals (Sweden)

    M.K Suri

    2011-02-01

    Full Text Available Abstract Nitrification inhibitors are synthetic or natural compounds highly specific in inhibiting ammonium oxidation to nitrate. Therefore, they are widely used in combination with ammonium fertilizers. Among plants, grasses always are interested for their role in controlling nitrification, and recently the form of nitrogen (ammonium vs. nitrate was shown to be an important factor in release of natural nitrification inhibitors (NNI from grasses. In this study production and release of natural nitrification inhibitors in Brachiaria humidicola was investigated. To study the effects of nitrogen forms on production and release of NNIs, brachiaria seedlings were grown in nutrient solution culture with either ammonium or nitrate, under controlled conditions. Root exudates were collected in two different mediums, distilled water or ammonium chloride, and with shoot and root homogenates were applied separately for their potential nitrification inhibition effect. The results, however, showed that when root exudates were collected in distilled water, there was no inhibitory effect on nitrification, but when root exudates were collected in a medium containing 1 mM NH4Cl, it showed significant nitrification inhibition in our soil nitrification test (bioassay. Leaf but not root homogenates also showed significant nitrification inhibition, independent of N form. This in turn suggests that synthesis of natural nitrification inhibitors in this grass is independent of nitrogen form. Keywords: Nitrification, Root exudates, Ammonium, Nitrate, Brachiaria humidicola, Leaf and root homogenates

  1. [Preoperative preparation, antibiotic prophylaxis and surgical wound infection in breast surgery].

    Science.gov (United States)

    Rodríguez-Caravaca, Gil; de las Casas-Cámara, Gonzalo; Pita-López, María José; Robustillo-Rodela, Ana; Díaz-Agero, Cristina; Monge-Jodrá, Vicente; Fereres, José

    2011-01-01

    The impact of surgical wound infection on public health justifies its surveillance and prevention. Our objectives were to estimate the incidence of surgical wound infection in breast procedures and assess its protocol of antibiotic prophylaxis and preoperative preparation. Observational multicentre prospective cohort study of incidence of surgical wound infection. Incidence was evaluated, stratified by National Nosocomial Infection Surveillance (NNIS) risk index and we calculated the standardized incidence ratio (SIR). The SIR was compared with Spanish rates and U.S. rates. The compliance and performance of the antibiotic prophylaxis and preoperative preparation protocol were assessed and their influence in the incidence of infection with the relative risk. Ten hospitals from the Comunidad de Madrid were included, providing 592 procedures. The cumulative incidence of surgical wound infection was 3.89% (95% CI: 2.3-5.5). The SIR was 1.82 on the Spanish rate and 2.16 on the American. Antibiotic prophylaxis was applied in 97.81% of cases, when indicated. The overall performance of antibiotic prophylaxis was 75%, and 53% for preoperative preparation. No association was found between infection and performance of prophylaxis or preoperative preparation (P>.05). Our incidence is within those seen in the literature although it is somewhat higher than the national surveillance programs. The performance of prophylaxis antibiotic must be improved, as well as the recording of preoperative preparation data. Copyright © 2010 Elsevier España, S.L. All rights reserved.

  2. Classification of HCV NS5B Polymerase Inhibitors Using Support Vector Machine

    Directory of Open Access Journals (Sweden)

    Changyuan Yu

    2012-03-01

    Full Text Available Using a support vector machine (SVM, three classification models were built to predict whether a compound is an active or weakly active inhibitor based on a dataset of 386 hepatitis C virus (HCV NS5B polymerase NNIs (non-nucleoside analogue inhibitors fitting into the pocket of the NNI III binding site. For each molecule, global descriptors, 2D and 3D property autocorrelation descriptors were calculated from the program ADRIANA.Code. Three models were developed with the combination of different types of descriptors. Model 2 based on 16 global and 2D autocorrelation descriptors gave the highest prediction accuracy of 88.24% and MCC (Matthews correlation coefficient of 0.789 on test set. Model 1 based on 13 global descriptors showed the highest prediction accuracy of 86.25% and MCC of 0.732 on external test set (including 80 compounds. Some molecular properties such as molecular shape descriptors (InertiaZ, InertiaX and Span, number of rotatable bonds (NRotBond, water solubility (LogS, and hydrogen bonding related descriptors performed important roles in the interactions between the ligand and NS5B polymerase.

  3. Frequency of nosocomial pneumonia in ICU Qazvin Razi hospital (2013

    Directory of Open Access Journals (Sweden)

    S. Makhlogi

    2016-12-01

    Full Text Available Background: Nosocomial pneumonia is the most prevalent cause of hospital-acquired infection in intensive care units (ICU. The aim of this research was to detect the frequency and predisposing factors of nosocomial Ventilator Associated Pneumonia, by cross sectional study on 188 patients that were hospitalized in ICU Qazvin Razi Hospital. Using questionnaire based on the national nosocomial infection surveillance system (NNIS data collected and analyzed. The average age of patients was 51±24 years old, 37 hospitalized patients (19/6% in the fourth day of admission were affected Ventilator Associated Pneumonia. The most common pathogenesis of causing nosocomial pneumonia were klebsiella in 13 patients (35/1%, staph in 8 patients (21/6%, sodomona in 8 patients (21/6%, ecoli in 3 patients (8/1%, cetrobacter in 2 patients (5/4%, antrococus and Proteus each of them in 1 patient (each 2/7%. Considering (19/6% frequency of nosocomial pneumonia in this study, it’s necessary to act standard protocols in nursing care and medication process.

  4. Bernese periacetabular osteotomy in males: is there an increased risk of femoroacetabular impingement (FAI) after Bernese periacetabular osteotomy?

    Science.gov (United States)

    Ziebarth, K; Balakumar, J; Domayer, S; Kim, Y J; Millis, M B

    2011-02-01

    The Bernese periacetabular osteotomy (PAO) is a popular option for treating symptomatic acetabular dysplasia. We noted symptomatic impingement after PAO in several male patients. We therefore determined (1) the incidence of clinical signs of FAI after PAO in the male population; and (2) whether any factors were associated with the positive impingement signs after PAO in males. We retrospectively reviewed 38 males who underwent 46 periacetabular osteotomies (PAO) between 2000 and 2007. Clinical and radiographic data were analyzed with the focus on pre- and postoperative incidence of femoroacetabular impingement. Minimum followup was 12 months (average, 43 months; range, 12-90 months). We found a positive impingement sign in 19 of the 46 hips during the preoperative examination compared to 22 (47.8%) hips postoperatively. The ROM (flexion and internal rotation) decreased postoperatively compared to preoperatively. Radiographic parameters of coverage LCE-, ACE- and Tönnis angle improved into the normal range. Twenty hips had postoperative heterotopic ossification to varying degrees, mostly minor. WOMAC scores improved in the function and pain domains postoperatively. Despite normalization of coverage we found a high postoperative rate of clinical signs of FAI after PAO in males. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

  5. Faust. Pühendus : [luuletused] / Johann Wolfgang von Goethe ; tlk. Marie Under, August Sang

    Index Scriptorium Estoniae

    Goethe, Johann Wolfgang von, 1749-1832

    2006-01-01

    Sisu: Faust. Pühendus ; Aardekaevur ; Cophta laul ; Hall sompus hommik ; Thule kuningas ; Kohtumine ja hüvastijätt ; Mailaul ; "Ma koltund väljadele rühin ; Retsensent ; Kannike ; Christel ; Kunstniku õhtulaul ; Uus armastus, uus elu ; Lottchenile ; Järvel ; Mäelt ; Amulett ; Ränduri öölaul : "Kes sa tead, oh taevane..." ; Meresõit ; Julgustus ; Kirjast Auguste zu Stolbergile ; Kuule ; Manitsus ; Inimsoo piirid ; Vaimude laul vete kohal ; Ränduri öölaul : "Harjadel püha..." ; Öömõtted ; Metsavaim ; Kandlemängija : "Kes pole leiba söönud, silmad vees..." ; Reisivarustus ; Jumalik ; Mignon : "Kas maad sa tead, kus apelsinipuul..." ; Pühendus ; Charlotte von Steinile ; Esimene kaotus ; Külaskäik ; Ketraja ; Mignon : "Miks vastust nõuad? Vaikida mul lase..." ; Kandlemängija : "Uste taha hiilin sala..." ; Armastatu lähedus ; Mignon : "Et ükskord olla, pean ma näima..." ; Lahkumine ; Kestvus vahelduses ; Aastad ; Õnnis igatsus ; Märts ; Rännulaul ; Parabaas ; Üks ja kõik ; Testament

  6. Linear genetic programming for time-series modelling of daily flow rate

    Indian Academy of Sciences (India)

    Aytac Guven

    2009-04-01

    In this study linear genetic programming (LGP),which is a variant of Genetic Programming,and two versions of Neural Networks (NNs)are used in predicting time-series of daily flow rates at a station on Schuylkill River at Berne,PA,USA.Daily flow rate at present is being predicted based on different time-series scenarios.For this purpose,various LGP and NN models are calibrated with training sets and validated by testing sets.Additionally,the robustness of the proposed LGP and NN models are evaluated by application data,which are used neither in training nor at testing stage.The results showed that both techniques predicted the flow rate data in quite good agreement with the observed ones,and the predictions of LGP and NN are challenging.The performance of LGP,which was moderately better than NN,is very promising and hence supports the use of LGP in predicting of river flow data.

  7. morePhyML: improving the phylogenetic tree space exploration with PhyML 3.

    Science.gov (United States)

    Criscuolo, Alexis

    2011-12-01

    PhyML is a widely used Maximum Likelihood (ML) phylogenetic tree inference software based on a standard hill-climbing method. Starting from an initial tree, the version 3 of PhyML explores the tree space by using "Nearest Neighbor Interchange" (NNI) or "Subtree Pruning and Regrafting" (SPR) tree swapping techniques in order to find the ML phylogenetic tree. NNI-based local searches are fast but can often get trapped in local optima, whereas it is expected that the larger (but slower to cover) SPR-based neighborhoods will lead to trees with higher likelihood. Here, I verify that PhyML infers more likely trees with SPRs than with NNIs in almost all cases. However, I also show that the SPR-based local search of PhyML often does not succeed at locating the ML tree. To improve the tree space exploration, I deliver a script, named morePhyML, which allows escaping from local optima by performing character reweighting. This ML tree search strategy, named ratchet, often leads to higher likelihood estimates. Based on the analysis of a large number of amino acid and nucleotide data, I show that morePhyML allows inferring more accurate phylogenetic trees than several other recently developed ML tree inference softwares in many cases.

  8. Faust. Pühendus : [luuletused] / Johann Wolfgang von Goethe ; tlk. Marie Under, August Sang

    Index Scriptorium Estoniae

    Goethe, Johann Wolfgang von, 1749-1832

    2006-01-01

    Sisu: Faust. Pühendus ; Aardekaevur ; Cophta laul ; Hall sompus hommik ; Thule kuningas ; Kohtumine ja hüvastijätt ; Mailaul ; "Ma koltund väljadele rühin ; Retsensent ; Kannike ; Christel ; Kunstniku õhtulaul ; Uus armastus, uus elu ; Lottchenile ; Järvel ; Mäelt ; Amulett ; Ränduri öölaul : "Kes sa tead, oh taevane..." ; Meresõit ; Julgustus ; Kirjast Auguste zu Stolbergile ; Kuule ; Manitsus ; Inimsoo piirid ; Vaimude laul vete kohal ; Ränduri öölaul : "Harjadel püha..." ; Öömõtted ; Metsavaim ; Kandlemängija : "Kes pole leiba söönud, silmad vees..." ; Reisivarustus ; Jumalik ; Mignon : "Kas maad sa tead, kus apelsinipuul..." ; Pühendus ; Charlotte von Steinile ; Esimene kaotus ; Külaskäik ; Ketraja ; Mignon : "Miks vastust nõuad? Vaikida mul lase..." ; Kandlemängija : "Uste taha hiilin sala..." ; Armastatu lähedus ; Mignon : "Et ükskord olla, pean ma näima..." ; Lahkumine ; Kestvus vahelduses ; Aastad ; Õnnis igatsus ; Märts ; Rännulaul ; Parabaas ; Üks ja kõik ; Testament

  9. Surgical site infection after caesarean section: space for post-discharge surveillance improvements and reliable comparisons.

    Science.gov (United States)

    Ferraro, Federica; Piselli, Pierluca; Pittalis, Silvia; Ruscitti, Luca E; Cimaglia, Claudia; Ippolito, Giuseppe; Puro, Vincenzo

    2016-04-01

    Surgical site infections (SSI) after caesarean section (CS) represent a substantial health system concern. Surveying SSI has been associated with a reduction in SSI incidence. We report the findings of three (2008, 2011 and 2013) regional active SSI surveillances after CS in community hospital of the Latium region determining the incidence of SSI. Each CS was surveyed for SSI occurrence by trained staff up to 30 post-operative days, and association of SSI with relevant characteristics was assessed using binomial logistic regression. A total of 3,685 CS were included in the study. A complete 30 day post-operation follow-up was achieved in over 94% of procedures. Overall 145 SSI were observed (3.9% cumulative incidence) of which 131 (90.3%) were superficial and 14 (9.7%) complex (deep or organ/space) SSI; overall 129 SSI (of which 89.9% superficial) were diagnosed post-discharge. Only higher NNIS score was significantly associated with SSI occurrence in the regression analysis. Our work provides the first regional data on CS-associated SSI incidence, highlighting the need for a post-discharge surveillance which should assure 30 days post-operation to not miss data on complex SSI, as well as being less labour intensive.

  10. Do Ligamentum Teres Tears Portend Inferior Outcomes in Patients With Borderline Dysplasia Undergoing Hip Arthroscopic Surgery? A Match-Controlled Study With a Minimum 2-Year Follow-up.

    Science.gov (United States)

    Chaharbakhshi, Edwin O; Perets, Itay; Ashberg, Lyall; Mu, Brian; Lenkeit, Christopher; Domb, Benjamin G

    2017-09-01

    Arthroscopic surgery in borderline dysplastic hips remains controversial, but the role of the ligamentum teres (LT) has not been studied in this setting. Borderline dysplastic patients with LT tears have worse short-term outcomes than those without LT tears. Cohort study; Level of evidence, 3. Data were prospectively collected on patients who underwent arthroscopic surgery between February 2008 and April 2014. The inclusion criteria were borderline dysplasia (lateral center-edge angle [LCEA], 18°-25°) and labral tears; arthroscopic treatments including labral preservation and capsular plication; and preoperative patient-reported outcome scores including the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sport-Specific Subscale, and visual analog scale for pain. Patients were excluded for preoperative Tönnis osteoarthritis grade >0, workers' compensation claims, previous ipsilateral hip surgery and conditions, or frank dysplasia (LCEA hip arthroplasty (THA); no patients in the control group required THA. In borderline dysplastic patients undergoing hip arthroscopic surgery with labral treatment and capsular plication, LT tears may indicate advanced instability and portend slightly inferior outcomes when compared with a match-controlled group. Borderline dysplastic patients with LT tears may have increased propensities toward revision arthroscopic surgery and conversion to THA. LT tears in these patients may warrant consideration for additional procedures including periacetabular osteotomy and LT reconstruction.

  11. Delays in diagnosis are associated with poorer outcomes in adult hip dysplasia.

    Science.gov (United States)

    Kennedy, John W; Brydone, Alistair S; Meek, Dominic Rm; Patil, Sanjeev R

    2017-01-01

    Background and Aims Developmental dysplasia of the hip is a common cause of osteoarthritis. Periacetabular osteotomy can restore femoral head coverage; however, it is reserved for patients with minimal articular degeneration. We examined the relationship between delays in diagnosis and outcomes. Methods We identified patients presenting to a hip specialist with a new diagnosis of hip dysplasia. The time taken between patients presenting to their general practitioner and attending the young adult hip clinic was established. Patients were stratified into Early, Moderate and Late Referral groups. Hip and SF-12 questionnaires were completed. Radiographs were graded according to the Tönnis classification system and the outcome following hip specialist review documented. Results Fifty-one patients were identified. Mean time from attending a general practitioner to review at the young adult hip clinic was 40.4 months. Lower hip and SF-12 scores, and higher radiological osteoarthritis grades were found in the Moderate and Late Referral groups. A higher proportion of the Moderate and Late Referral group underwent total hip arthroplasty rather than periacetabular osteotomy. Conclusion Delays in referring a patient to a hip specialist are associated with poorer outcomes. We propose pelvic radiographs are requested early by general practitioners to allow prompt diagnosis and referral to a hip specialist.

  12. Combined Femoral and Acetabular Osteotomy in Children of Walking Age for Treatment of DDH; A Five Years Follow-Up Report

    Directory of Open Access Journals (Sweden)

    Mahdi Mazloumi

    2015-01-01

    Full Text Available Background: The prevalence of neglected developmental dysplasia of the hip (DDH has been decreasing. Nowadays, the disease is rarely seen in walking age children. The purpose of this study is to assess the results of simultaneous osteotomy of femur and pelvic bones in such children. Method: We performed a retrospective study on 30 children aged 3.8±0.9 (range: 1.5-7 years old, with DDH who underwent surgical operation in our hospital from August 2001 to September 2006. Tönnis and Severin grading systems were used to classify the radiographic status of the hip in pre- and postoperative era, respectively. Improvement in function and limp was also evaluated by the modified McKay’s classification. Results: From the 30 cases, six patients excluded in the course of the study and among the remaining patients, 12 had bilateral involvement. The mean follow-up period was 7.6±0.8 (range: 5.1-11.3 years. During the last visit, radiographic status of the operated joints, according to Severin classification was as follows: Class I: 12 patients; Class II: 20 patients; Class III: 3 patients; Class IV: 1 patient; and Class VI: 1 patient. Conclusion: Although through the follow-up, two hips subluxated, necrosis happened in three and one joint was re-dislocated, simultaneous femoral and innominate osteotomy in the walking age children with DDH has relatively good clinical outcomes.

  13. Impact of a surgical site infection (SSI) surveillance program in orthopedics and traumatology.

    Science.gov (United States)

    Mabit, C; Marcheix, P S; Mounier, M; Dijoux, P; Pestourie, N; Bonnevialle, P; Bonnomet, F

    2012-10-01

    Surveillance of surgical site infections (SSI) is a priority. One of the fundamental principles for the surveillance of SSI is based on receiving effective field feedback (retro-information). The aim of this study was to report the results of a program of SSI surveillance and validate the hypothesis that there is a correlation between creating a SSI surveillance program and a reduction in SSI. The protocol was based on the weekly collection of surveillance data obtained directly from the different information systems in different departments. A delay of 3 months was established before extraction and analysis of data and information from the surgical teams. The NNIS index (National Nosocomial Infections Surveillance System) developed by the American surveillance system and the reduction of length of hospital stay index Journées d'hospitalisation évitées (JHE). Since the end of 2009, 7156 surgical procedures were evaluated (rate of inclusion 97.3%), and 84 SSI were registered with a significant decrease over time from 1.86% to 0.66%. A total of 418 days of hospitalization have been saved since the beginning of the surveillance system. Our surveillance system has three strong points: follow-up is continuous, specifically adapted to orthopedic traumatology and nearly exhaustive. The extraction of data directly from hospital information systems effectively improves the collection of data on surgical procedures. The implementation of a SSI surveillance protocol reduces SSI. Level III. Prospective study. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  14. Early and late surgical site infections in ear surgery.

    Science.gov (United States)

    Bastier, P L; Leroyer, C; Lashéras, A; Rogues, A-M; Darrouzet, V; Franco-Vidal, V

    2016-04-01

    A retroauricular approach is routinely used for treating chronic otitis media. The incidence of surgical site infections after ear surgery is around 10% in contaminated or dirty procedures. This observational prospective study describes surgical site infections after chronic otitis media surgery with the retroauricular approach and investigated their potential predictive factors. This observational prospective study included patients suffering from chronic otitis media and eligible for therapeutic surgery with a retroauricular approach. During follow-up, surgical site infections were defined as "early" if occurring within 30 days after surgery or as "late" if occurring thereafter. The data of 102 patients were analysed. Concerning early surgical site infections, four cases were diagnosed (3.9%) and a significant association was found with preoperative antibiotic therapy, wet ear at pre-operative examination, class III (contaminated) in the surgical wound classification, NNIS (National Nosocomial Infection Surveillance) index > 1, and oral post-operative antibiotic use. Seven late surgical site infections were diagnosed (7.1%) between 90 and 160 days after surgery and were significantly correlated to otorrhoea during the 6 months before surgery, surgery duration ≤60 minutes, canal wall down technique and use of fibrin glue. Surgical site infections after chronic otitis media surgery seem to be associated with factors related to the inflammatory state of the middle ear at the time of surgery in early infections and with chronic inflammation in late infections. © Copyright by Società Italiana di Otorinolaringologia e Chirurgia Cervico-Facciale, Rome, Italy.

  15. Nosocomial infection in a newborn intensive care unit (NICU, South Korea

    Directory of Open Access Journals (Sweden)

    Jeong Jae

    2006-06-01

    Full Text Available Abstract Background This study aimed to determine the occurrence of nosocomial infections (NIs, including infection rates, main infection sites, and common microorganisms. Patients included in the study were taken from a newborn intensive care unit (NICU, in a hospital in South Korea. Methods A retrospective cohort study was performed by reviewing chart. The subjects were 489 neonates who were admitted to the NICU, survived longer than 72 hours, and not transferred to another unit, between Jan. 1. 1995 to Sep. 30, 1999. NIs were identified according to the NNIS definition. Data were analyzed with descriptive statistics. Results Cumulative incidence rate for NIs was 30.3 neonates out of 100 admissions, with a total of 44.6 infections. The incidence density was average 10.2 neonates and 15.1 infections per 1000 patient days. The most common infections were pneumonia (28%, bloodstream infection (26%, and conjunctivitis (22%. Major pathogens were Gram-positives such as Staphylococcus aureus and coagulase-negative staphylococci. The factors associated with NI was less than 1500 g of birth weight, less than 32 weeks of gestational age, and less than 8 of apgar score. There's no statistical difference in discharge status between two groups, but hospital stay was longer in subjects with nosocomial infection than those without infection. Conclusion Although the distribution of pathogens was similar to previous reports, a high rate of nosocomial infection and in particular conjunctivitis was observed in this study that merits further evaluation.

  16. Reducing surgical site infection incidence through a network: results from the French ISO-RAISIN surveillance system.

    Science.gov (United States)

    Astagneau, P; L'Hériteau, F; Daniel, F; Parneix, P; Venier, A-G; Malavaud, S; Jarno, P; Lejeune, B; Savey, A; Metzger, M-H; Bernet, C; Fabry, J; Rabaud, C; Tronel, H; Thiolet, J-M; Coignard, B

    2009-06-01

    Surgical-site infections (SSIs) are a key target for nosocomial infection control programmes. We evaluated the impact of an eight-year national SSI surveillance system named ISO-RAISIN (infection du site opératoire - Réseau Alerte Investigation Surveillance des Infections). Consecutive patients undergoing surgery were enrolled during a three-month period each year and surveyed for 30 days following surgery. A standardised form was completed for each patient including SSI diagnosis according to standard criteria, and several risk factors such as wound class, American Society of Anesthesiologists (ASA) score, operation duration, elective/emergency surgery, and type of surgery. From 1999 to 2006, 14,845 SSIs were identified in 964,128 patients (overall crude incidence: 1.54%) operated on in 838 participating hospitals. The crude overall SSI incidence decreased from 2.04% to 1.26% (P<0.001; relative reduction: -38%) and the National Nosocomial Infections Surveillance system (NNIS)-0 adjusted SSI incidence from 1.10% to 0.74% (P<0.001; relative reduction: -33%). The most significant SSI incidence reduction was observed for hernia repair and caesarean section, and to a lesser extent, cholecystectomy, hip prosthesis arthroplasty, and mastectomy. Active surveillance striving for a benchmark throughout a network is an effective strategy to reduce SSI incidence.

  17. Nosocomial infections in a Dutch neonatal intensive care unit: surveillance study with definitions for infection specifically adapted for neonates.

    Science.gov (United States)

    van der Zwet, W C; Kaiser, A M; van Elburg, R M; Berkhof, J; Fetter, W P F; Parlevliet, G A; Vandenbroucke-Grauls, C M J E

    2005-12-01

    The incidence of nosocomial infection in neonatal intensive care units (NICUs) is high compared with other wards. However, no definitions for hospital-acquired infection are available for NICUs. The aim of this study was to measure the incidence of such infections and to identify risk factors in the NICU of the VU University Medical Center, which serves as a level III regional NICU. For this purpose, a prospective surveillance was performed in 1998-2000. We designed definitions by adjusting the current definitions of the Centers for Disease Control and Prevention (CDC) for children risk factors were dichotomized. Analysis of risk factors was performed by Cox regression with time-dependent variables. The relationship between the Clinical Risk Index for Babies (CRIB) and nosocomial infection was investigated. Furthermore, for a random sample of cases, we determined whether bloodstream infection and pneumonia would also have been identified with the CDC definitions. Seven hundred and forty-two neonates were included in the study. One hundred and ninety-one neonates developed 264 infections. Bloodstream infection (N=138, 14.9/1000 patient-days) and pneumonia (N=69, 7.5/1000 patient-days) were the most common infections. Of bloodstream infections, 59% were caused by coagulase-negative staphylococci; in 21% of neonates, blood cultures remained negative. In 25% of pneumonias, Enterobacteriaceae were the causative micro-organisms; 26% of cultures remained negative. Compared with the Nosocomial Infections Surveillance System (NNIS) of the CDC, our device utilization ratios and device-associated nosocomial infection rates were high. The main risk factors for bloodstream infection were birth weight [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.45-2.17] and parenteral feeding with hospital-pharmacy-produced, all-in-one mixture 'Minimix' (HR 3.69, 95%CI 2.03-6.69); administration of intravenous antibiotics (HR 0.39, 95%CI 0.26-0.56) was a protective risk factor. The

  18. Epidemiologically relevant antimicrobial resistance phenotypes in pathogens isolated from critically ill patients in a Brazilian Universitary Hospital Fenótipos de resistência antimicrobiana epidemiologicamente importantes de patógenos isolados de pacientes críticos de um hospital universitário brasileiro

    Directory of Open Access Journals (Sweden)

    Rodolfo Henriques de Carvalho

    2008-12-01

    Full Text Available Antimicrobial resistance is a threat to public health worldwide and is associated with higher mortality and morbidity. Despite the extensive knowledge about this problem, drug resistance has continued to emerge, especially in intensive care units (ICUs. The objective of this study was to evaluate the frequencies of epidemiologically relevant resistance phenotypes in pathogens isolated from ventilator-associated pneumonia (VAP, bloodstream infections (BSI and urinary tract infections (UTI in patients admitted in the adult intensive care unit (AICU of the Clinical Hospital of Federal University of Uberlândia, during an one year period. Additionally, at the period of the study, the antibiotic consumption in AICU was verified. Coagulase-negative staphylococci and S. aureus were the main agents of BSI (43.9%, with 60.0% of oxacilin-resistance for both microorganisms, Klebsiella-Enterobacter group predominated in UTI (23.4%, with resistance to third generation cephalosporins in 58.0% of the isolates; and, Pseudomonas aeruginosa in VAP (42.0%, with 72.0% of resistance to imipenem. Cephalosporins (49.6%, vancomycin (37.4% and carbapenems (26.6% were the most prescribed antibiotics in the unit. The comparison of the results with a publication of the NNIS program evidenced a worse situation in the studied hospital, mainly between Gram-negative, that had surpassed the percentile 90% elaborated by that system. Based on these results a reconsideration on the empirical use of antibiotics and on prevention and control of nosocomial infections practices is recommended.A resistência aos antimicrobianos é uma ameaça a saúde pública mundial e está associada a uma maior mortalidade e morbidade. Apesar dos vastos conhecimentos sobre este problema, a resistência aos antibióticos continua a emergir, especialmente em unidades de terapia intensiva (UTI. O objetivo deste estudo foi avaliar a freqüência de fenótipos de resistência epidemiologicamente

  19. Limited therapeutic benefits of intra-articular cortisone injection for patients with femoro-acetabular impingement and labral tear.

    Science.gov (United States)

    Krych, Aaron J; Griffith, Timothy B; Hudgens, Joshua L; Kuzma, Scott A; Sierra, Rafael J; Levy, Bruce A

    2014-04-01

    Intra-articular (IA) hip cortisone injection is commonly performed as a therapeutic modality in patients with femoral acetabular impingement (FAI). To our knowledge, there is no published data evaluating the clinical benefit of these injections. The purpose of this study was to assess the efficacy of therapeutic IA cortisone injection in these patients. At our institution, patients with FAI and labral tear prospectively recorded their numerical rating scale (NRS) pain scores pre-injection, during post-injection anaesthetic phase, and at 14 days post-injection. From this cohort, all patients treated with guided IA cortisone injection, no radiographic evidence of arthritis (Tönnis grade 0 or 1) and pain relief during the anaesthetic phase of the IA injection were included. An absolute change of two points on the NRS score was considered the minimal amount of clinically significant pain relief. Pain scores were compared between the different types of steroid injected. Fifty-four patients (35 females, 19 males) with a mean age of 32 ± 12 years were included. Average median pre-injection NRS score was 7.0 (range 2.5-10.0), post-injection anaesthetic phase was 1.0 (range 0.0-5.0), and 14 day post-injection was 5.0 (range 0.0-10.0). As a group, NRS scores significantly diminished from post-injection anaesthetic phase to 14 days post-injection (p cortisone injection has limited clinical benefit as a therapeutic modality. However, anaesthetic-only IA injections for patients who may be candidates for hip arthroscopy can be a useful diagnostic tool.

  20. Mesenchymal stem cell therapy in the treatment of hip osteoarthritis

    Science.gov (United States)

    Mardones, Rodrigo; Jofré, Claudio M.; Tobar, L.

    2017-01-01

    Abstract This study was performed to investigate the safety and efficacy of the intra-articular infusion of ex vivo expanded autologous bone marrow-derived mesenchymal stem cells (BM-MSC) to a cohort of patients with articular cartilage defects in the hip. The above rationale is sustained by the notion that MSCs express a chondrocyte differential potential and produce extracellular matrix molecules as well as regulatory signals, that may well contribute to cure the function of the damaged hip joint. A cohort of 10 patients with functional and radiological evidences of hip osteoarthritis, either in one or both legs, was included in the study. BM-MSC (the cell product) were prepared and infused into the damaged articulation(s) of each patient (60 × 106 cells in 3 weekly/doses). Before and after completion of the cell infusion scheme, patients were evaluated (hip scores for pain, stiffness, physical function, range of motion), to assess whether the infusion of the respective cell product was beneficial. The intra-articular injection of three consecutive weekly doses of ex vivo expanded autologous BM-MSC to patients with articular cartilage defects in the hip and proved to be a safe and clinically effective treatment in the restoration of hip function and range of motion. In addition, the statistical significance of the above data is in line with the observation that the radiographic scores (Tönnis Classification of Osteoarthritis) of the damaged leg(s) remained without variation in 9 out of 10 patients, after the administration of the cell product. PMID:28630737

  1. The beginnings of Acta Neurochirurgica and the work of Fritz Loew, chief editor from 1958 - 1997. An historical vignette.

    Science.gov (United States)

    Reulen, Hans-Jürgen; Collmann, Hartmut

    2012-07-01

    Acta Neurochirurgica was founded in 1950, in the difficult time after World War II, by Mario Milletti (Bologna) and Wolfram Sorgo (Innsbruck), and published by Springer press, Vienna. From the beginning the new journal was conceived as an international journal with an impressive list of outstanding neurosurgeons in the editorial board. Only a few years later the issues appeared at irregular intervals due to individual problems of both editors. Wilhelm Tönnis took the initiative to keep the journal alive, when he asked-in consent with Springer press-his staff member Fritz Loew to continue the editorial work and to assemble a new prestigious editorial board. Loew succeeded with both tasks and remained editor-in-chief for nearly 38 years. Initially, all papers were published in the native languages of the authors: English, French, German, Italian and Spanish. With ongoing time the journal accepted manuscripts in English only. The slow progress of this process exemplifies the slow integration of the European countries. In 1971, at the founding meeting of the European Association of Neurosurgical Societies (EANS) in Prague, Acta Neurochirurgica became the official organ of the EANS. Right from the beginning of Acta Neurochirurgica, Supplement volumes were added. Also, the book series Advances and Technical Standards in Neurosurgery is an offspring of Acta Neurochirurgica. Acta Neurochirurgica has become one of the most important neurosurgical journals worldwide. This historical sketch is based on an interview with Fritz Loew, now 91 years old, to which data from the available literature and the Archives of German Neurosurgery, as well as personal information by several colleagues were added.

  2. Arthroscopic treatment of femoroacetabular impingement in patients older than 60 years

    Science.gov (United States)

    Mardones, Rodrigo; Via, Alessio Giai; Rivera, Alvaro; Tomic, Alexander; Somarriva, Marcelo; Wainer, Mauricio; Camacho, Daniel

    2016-01-01

    Summary Background The indications of hip arthroscopy increased over the past decade. Although mostly recommended for treatment of femoroacetabular impingement (FAI) in young patients, well-selected older patients (> 60 years old) may benefit from this surgery. However, the role of hip arthroscopy for the management of older patients is controversial. The aim of the study is to evaluate the clinical outcomes of a series of patients aged 60 years and older who underwent hip arthroscopy for FAI at mid-term follow-up. Materials and methods Sixty-year-old patients and older, with a joint space greater than 2 mm, and a grade I and II hip osteoarthrosis (OA) according Tönnis scale were included into the study. Twenty-three patients (28 hips) met the inclusion criteria. The T-Student test was used to detect for differences between variables (p<0.05). Results The mean age of the patients was 63.4 years, and the mean follow-up was 4.4 years (2–9 years). We found an improvement in mHHS and VAS score from the baseline to the final follow-up in 87% of patients (p<0.05). Three patients (13%) were submitted to a THA at a mean of 12 months, while the survivorship rate at the final follow-up was 75%. No major complications have been reported. Conclusion Arthroscopic treatment of FAI in patients over 60 years old, with no signs of advanced osteoarthrosis, showed a significant improvement of functional score and pain in most of cases, and it can be consider a reasonable option in well selected patients. Level of evidence: IV case series. PMID:28066746

  3. Herbert Olivecrona: founder of Swedish neurosurgery.

    Science.gov (United States)

    Ljunggren, B

    1993-01-01

    Herbert Olivecrona (1891-1980) singlehandedly founded Swedish neurosurgery. At the International Congress in Neurology in Bern in August, 1931, Harvey Cushing invited the cream of the world's medical society to a private banquet. Among the 28 specially invited guests was Herbert Olivecrona. At 40 years old, Olivecrona took his seat with pioneers such as Otfrid Foerster, Percival Bailey, Hugh Cairns, Geoffrey Jefferson, and Sir Charles Sherrington. This suggests that Cushing was impressed by the Swedish aristocrat's didactic deeds when he visited the Serafimer Hospital in Stockholm 2 years earlier. During the mid-1920's, the radiologist Erik Lysholm greatly improved the technique of ventriculography and, challenged by Olivecrona, his diagnostic neuroradiology became of superior quality. In the early 1930's, utilizing technical innovations of his own, Lysholm became a master at demonstrating and localizing posterior fossa tumors, which Olivecrona then operated on. Olivecrona's clinic became the mecca to which many scholars, thirsting for more knowledge, went on a pilgrimage. The international reputation of the clinic was founded, not on epoch-making discoveries, but by the resolute and practical application of methods already launched elsewhere and the exemplary organization that Olivecrona had established in collaboration with Lysholm. In spite of hardships and primitive working conditions, the clinic at the Serafimer Hospital gradually developed into the ideal prototype for a modern neurosurgical department. Olivecrona trained many colorful personalities who later were to lay the foundation for neurosurgery in their home countries; these included Wilhelm Tönnis of Germany, Edvard Busch of Denmark, and Aarno Snellman of Finland. Olivecrona was a true pioneer who made major contributions in practically all fields of conventional neurosurgery.

  4. Radiological findings for hip dysplasia at skeletal maturity. Validation of digital and manual measurement techniques.

    Science.gov (United States)

    Engesæter, Ingvild Øvstebø; Laborie, Lene Bjerke; Lehmann, Trude Gundersen; Sera, Francesco; Fevang, Jonas; Pedersen, Douglas; Morcuende, José; Lie, Stein Atle; Engesæter, Lars Birger; Rosendahl, Karen

    2012-07-01

    To report on intra-observer, inter-observer, and inter-method reliability and agreement for radiological measurements used in the diagnosis of hip dysplasia at skeletal maturity, as obtained by a manual and a digital measurement technique. Pelvic radiographs from 95 participants (56 females) in a follow-up hip study of 18- to 19-year-old patients were included. Eleven radiological measurements relevant for hip dysplasia (Sharp's, Wiberg's, and Ogata's angles; acetabular roof angle of Tönnis; articulo-trochanteric distance; acetabular depth-width ratio; femoral head extrusion index; maximum teardrop width; and the joint space width in three different locations) were validated. Three observers measured the radiographs using both a digital measurement program and manually in AgfaWeb1000. Inter-method and inter- and intra-observer agreement were analyzed using the mean differences between the readings/readers, establishing the 95% limits of agreement. We also calculated the minimum detectable change and the intra-class correlation coefficient. Large variations among different radiological measurements were demonstrated. However, the variation was not related to the use of either the manual or digital measurement technique. For measurements with greater absolute values (Sharp's angle, femoral head extrusion index, and acetabular depth-width ratio) the inter- and intra-observer and inter-method agreements were better as compared to measurements with lower absolute values (acetabular roof angle, teardrop and joint space width). The inter- and intra-observer variation differs notably across different radiological measurements relevant for hip dysplasia at skeletal maturity, a fact that should be taken into account in clinical practice. The agreement between the manual and digital methods is good.

  5. Early results of the Bernese periacetabular osteotomy for symptomatic dysplasia in Charcot-Marie-Tooth disease.

    Science.gov (United States)

    Stover, Michael D; Podeszwa, David A; De La Rocha, Adriana; Sucato, Daniel J

    2013-01-01

    Charcot-Marie-Tooth disease (CMTD) is one of the most common inherited neurologic disorders and can be associated with hip dysplasia. Little is known regarding outcomes of the PAO for patients with CMTD. Our purpose is to document the early results and complications of the PAO for hip dysplasia associated with CMTD. A two centre, retrospective clinical and radiographic review was performed. Demographic and surgical data were recorded. Pre- and postoperative lateral centre edge angle (LCEA), acetabular index (AI), ventral centre edge angle (VCEA), and Tönnis osteoarthritis grade were compared. Hips were classified according to Severin. The Harris Hip Score (HHS) and the Western Ontario and McMasters University (WOMAC) index documented self-reported function. Nineteen hips in 14 patients underwent PAO, mean age 16.2 (range 11.2-21 years). Thirteen concomitant procedures were performed, including seven proximal femoral osteotomies. Average follow-up was 3.4 years (range 0.9-8.5). Postoperative radiographic measurements significantly improved. Complications included femoral head AVN, transient complete bilateral peroneal nerve palsy, inferior rami fractures, and heterotopic ossification (Brooker stage 3). The HHS significantly improved from a mean 49.6 preoperatively to 82.2 at final follow-up of four patients. Seven subjects reported a mean postoperative WOMAC score of 94 (range 58.3-100). Most patients presented with severe dysplasia in the second decade of life. The PAO successfully corrected the radiographic abnormalities. Complications were common. The majority of patients reported improved outcomes, although seven showed signs of radiographic progression of osteoarthritis.

  6. Efficiency and Accuracy of Bernese Periacetabular Osteotomy for Adult Hip Dysplasia.

    Science.gov (United States)

    Luo, Dian-zhong; Zhang, Hong; Xiao, Kai; Cheng, Hui

    2015-11-01

    Bernese periacetabular osteotomy (PAO) has several advantages dealing with adolescents and adults acetabular dysplasia. The authors introduced the details and steps performing PAO, with attached video and schematic diagram which demonstrates a perfect PAO in efficiency and accuracy. The patient is an 18-year-old girl, complaining hip pain on the left side for 6 months. Physical examination shows normal gait and range of motion (ROM) of the left hip. Pelvic anteroposterior X-ray shows acetabular dysplasia on the left, and post operation on the right. She is very satisfied with the PAO on the right one year before, so we recommend PAO for the left hip dysplasia again. The key point of PAO includes 4 cuts: ischial cut, pubic cut, acetabular roof cut, and quadrilateral bone cut, and the four cuts should be accomplished accurately. Then the acetabular fragment should be turned to ideal position with the lateral CE angle (LCE) > 25°, the Tönnis acetabular angle 0°, the anterior CE angle (ACE) > 20°, good congruence joint space, and with the hip center medialized slightly. At lastly the acetabular fragment is fixed with proper nails and instruments. The patient is very happy to the surgery with no hip pain, with normal gait, ROM, and Harris hip scores (HHS). In summary, PAO is a relative new and efficient procedure for adult hip dysplasia, requiring accurate techniques. Cadaveric practice and familiar with the local anatomy can help the surgeon overcome the learning curve quickly. © 2015 Chinese Orthopaedic Association and Wiley Publishing Asia Pty Ltd.

  7. Historical perspective on neurosurgery in Germany after World War II.

    Science.gov (United States)

    Collmann, Hartmut; Vitzthum, Hans-Ekkehart

    2008-11-01

    AFTER THE COLLAPSE of the Third Reich, the specialty of neurosurgery in Germany, although well developed in the late 1930s, had to start anew, and for decades to come, had to deal with the physical and political consequences of World War II. Because of the division of the country, neurosurgery developed separately in the two independent states. In West Germany, the evolution was promoted by a few personalities who represented different schools according to their own training: these "surgical neurologists" emphasized the neurological basis of neurosurgery and were represented by Traugott Riechert and the students of Otfrid Foerster, such as Arist Stender and Hans Kuhlendahl. In contrast, the "neurological surgeons" stressed their origins in general surgery. Their main proponent was Wilhelm Tönnis, who gained particular merit for promoting neurosurgical teaching, the development of new neurosurgical units, and the recognition of neurosurgery as an autonomous specialty. In East Germany, progress was delayed by a weak economy and a repressive political system. Yet several excellent neurosurgeons won international recognition, predominantly Georg Merrem, who came from the school of Fedor Krause. Following a worldwide trend, the number of neurosurgical units in West Germany increased dramatically from 18 in 1950 to 85 in 1988. In 2006, in the unified nation, 1200 certified neurosurgeons in 138 hospital departments and 75 private practices served 82 million people. Since its founding in 1949, the German Neurosurgical Society has promoted the idea of reconciliation and has focused on international collaboration in both science and education. This idea, shared by other European nations, eventually gave rise to the European Association of Neurosurgical Societies. At present, escalating costs in the health sector pose a problem to neurosurgical services and have led to reconsiderations about their structure and financing.

  8. Use of antibacterial agents in an intensive care unit in a hospital in Brazil

    Directory of Open Access Journals (Sweden)

    E.F. dos Santos

    2007-06-01

    Full Text Available It is essential to monitor the utilisation of antibacterial drugs in order to establish appropriate measures for their control. The pattern of usage of antibacterial drugs, and its association with indicators of hospital infection, has been investigated in a non-specialized adult intensive care unit (ICU located in Santa Luzia Hospital (Brasília, DF, Brazil. The study was conducted between January 2001 and June 2004. Data concerning the utilisation of systemic antibacterial drugs, classified according to the Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD system, and indicators of hospital infection, defined according to the National Nosocomial Infections Surveillance (NNIS system, were obtained from appropriate hospital archives. During the study period, the average utilisation of antibacterial drugs was 1918.5 DDD units per 1000 patient-day (DDD1000. The three most used drugs were penicillins/beta-lactamase inhibitors (535.3 DDD1000, third generation cephalosporins (239.1 DDD1000 and quinolones (212.5 DDD1000. The total utilisation of antibacterial drugs was correlated significantly with the incidence of hospital infection (R = 0.62; p < 0.01 and the index of invasive procedures (R = 0.41; p < 0.01. Furthermore, the latter two indicators were significantly and positively correlated with the use of recently commercialised, broad spectrum antibacterial drugs (except for carbapenems. It is concluded that improved infection control procedures, together with more rigorous criteria regarding the use of invasive procedures, should be implemented by the ICU studied in order to diminish the utilisation of antibacterial drugs.

  9. The impact of development o f the special coordination abilities on the general skill ability for table tennis juniors under 12 years old

    Directory of Open Access Journals (Sweden)

    Shawkat Gaber Radwan

    2014-06-01

    Full Text Available Indicates each of Muhama d Allawi (2002, Essam Abdul Khaliq (2003, and Walf Droge (2002 that the coordination abilities are closely related to the development of technical motor skills, and that pra ctitioner athletic activity which determines the quality of this abilities should be developed, where the player can not master the technical skills in the special activity in case lack of special coordination abilities for this activity. Both Manf red Must er (1986, Jürgen Schmicker (2000, Wolfgang and others (2000 and Wohlgefahrt, Karlheinz (2004 refers that the special coordination abilities for table tennis include each of: 1 - The motor adaptation and adjustment ability, 2 - The ability to differentiat e , 3 - reaction speed ability, 4 - orientation ability, 5 - balance ability, 6 - coupling ability, 7 - The ability to sense the rhythm. The aim of this study is design training program to development the special coordination abilities of table tennis and identi fies the impact of this program on the general skill ability for table tennis juniors under 12 years old. The researcher used the experimental method into two groups one experimental and the other control group the strength of each of them is 8 of table te nnis juniors in Ismailia city in Egypt. The duration of the program is three months, three training units a week the duration of each training unit is 90 minutes. The most important results of this study was the training program led to improvement the spec ial coordination abilities of table tennis for the experimental group, which led to high level of the general skill ability in table tennis for the experimental group more than the control group .

  10. Reduction in Surgical Wound Infection Rates Associated with Reporting Data to Surgeons

    Directory of Open Access Journals (Sweden)

    GD Taylor

    1994-01-01

    Full Text Available Several studies have shown that wound infection (surgical site infection [ ssi ] rates fall when surgeons are provided with data on their performance. Since 1987, the authors have been performing concurrent surveillance of surgical patients and confidentially reporting surgeon-specific ssi rates to individual surgeons and their clinical directors, and providing surgeons with the mean rates of their peers. The program has been gradually refined and expanded. Data are now collected on wound infection risk and report risk adjusted rates compared with the mean for hospitals in the United States National Nosocomial Infections Surveillance (nnis data bank. Since inception through to December 1993, ssi rates have fallen 68% in clean contaminated general surgery cases (relative risk [rr] 0.36, 95% ci 0.2 to 0.6, P=0.0001, 64% in clean plastic surgery cases (rr 0.35, 95% ci 0.06 to 1.8, 72% in caesarean section cases (rr 0.23, 95% ci 0.03 to 1.96 and 42% in clean cardiovascular surgery cases (rr 0.59, 95% ci 0.34 to 1.0. In clean orthopedic surgery the ssi rate remained stable from 1987 through 1992. In 1993 a marked increase was experienced. Reasons for this are being explored. Overall there was a 32% decrease in ssi rate between the index year and 1993 or, in percentage terms, 2.8% to 1.9% (rr 0.65, 95% ci 0.51 to 0.86, P=0.002. ssi surveillance should become standard in Canadian hospitals interested in improving the quality of surgical care and reducing the clinical impact and cost associated with nosocomial infection.

  11. Frequent globular neuronal cytoplasmic inclusions in the medial temporal region as a possible characteristic feature in multiple system atrophy with dementia.

    Science.gov (United States)

    Homma, Taku; Mochizuki, Yoko; Komori, Takashi; Isozaki, Eiji

    2016-10-01

    Multiple system atrophy (MSA) is an adult-onset neurodegenerative disease, which is characterized clinically by parkinsonism, cerebellar ataxia and/or autonomic dysfunction, and pathologically by alpha-synuclein-related multisystem neurodegeneration, so-called alpha-synucleinopathy, which particularly involves the striatonigral and olivopontocerebellar systems, with glial cytoplasmic inclusions and neuronal cytoplasmic/nuclear inclusions (NCIs/NNIs). In the recent consensus criteria for the diagnosis of MSA, dementia is described as one of the features not supporting a diagnosis of MSA. However, MSA with dementia has been reported, although the location of the lesion responsible for the dementia remains unclear. In the present study, we aimed to investigate where this lesion may be found, by analyzing 12 autopsy-proven MSA cases, with a particular focus on the medial temporal region. Three of 12 cases with MSA had dementia (MSA-D). Compared with MSA cases without dementia, MSA-D cases had frequent globular NCIs (G-NCIs) in the medial temporal region, especially in their subiculum. In addition, MSA-D cases could be divided into two types; MSA-D with distinct fronto-temporal lobar degeneration (FTLD type) and without distinct fronto-temporal lobar degeneration (non-FTLD type). There was no association between dementia and Alzheimer pathologies, such as neurofibrillary tangles and senile plaques. We suggest that frequent G-NCIs in the medial temporal region, and particularly the subiculum, is one of the important pathological findings of MSA-D, even when a case with MSA-D reveals no significant cerebral atrophy.

  12. Três anos de avaliação das taxas de infecção nosocomial em UTI Tres años de evaluación de las tasas de infección nosocomial en UCI Three-year evaluation of nosocomial infection rates of the ICU

    Directory of Open Access Journals (Sweden)

    Necla Dereli

    2013-02-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Avaliar a incidência de infecções nosocomiais associadas aos dispositivos invasivos permite comparar as infecções associadas aos cuidados em saúde (IACS entre as unidades de terapia intensiva (UTI de diferentes hospitais e unidades do mesmo hospital. MATERIAL E MÉTODOS: De janeiro de 2007 a dezembro de 2010, um estudo de vigilância retrospectivo foi realizado para identificar infecções nosocomiais, taxas de infecções relacionadas a dispositivos e agentes causadores na UTI de anestesiologia. As IACS foram definidas de acordo com os critérios do Centro de Controle e Prevenção de Doenças (CDC e as infecções relacionadas aos dispositivos invasivos definidas de acordo com os critérios do Sistema Nacional de Vigilância de Infecções Nosocomiais (NNIS. RESULTADOS: Durante dois anos, 939 pacientes em um universo de 7.892 pacientes/dia foram avaliados. As taxas de IACS foram de 53% em 2007, 29,15% em 2008, 28,85% em 2009 e 16,62% em 2010. A IACS mais comum foi infecção da corrente sanguínea. A taxa de infecção de tecido mole e pele foi a segunda. Entre os pacientes com infecções nosocomiais, os agentes causadores mais comuns foram Gram (- 56,68%, Gram (+ 31,02% e candidíase 12,3%. CONCLUSÕES: A incidência de IACS na UTI de nosso hospital foi alta, em comparação com as taxas turcas globais obtidas no Refik Saydam Center em 2007. Quando as taxas de infecções relacionadas aos dispositivos foram comparadas entre 2007 e 2008, foram maiores em 2007. A taxas de infecções relacionadas aos dispositivos em 2008 foram reduzidas abaixo da média nacional por causa das medidas de controle de infecção. Como a taxa de infecções relacionada ao cateter urinário ainda permanece alta, devemos exercer esforços contínuos para o controle das infecções.JUSTIfiCATIVA Y OBJETIVOS: La evaluación de la incidencia de las infecciones nosocomiales asociadas con los dispositivos invasivos, permite comparar las

  13. Risk Factors for Nosocomial Infection in the Neonatal Intensive Care Unit by the Japanese Nosocomial Infection Surveillance (JANIS

    Directory of Open Access Journals (Sweden)

    Nakayama,Hideki

    2008-08-01

    Full Text Available We evaluated the infection risks in the neonatal intensive care unit (NICU using data of NICU infection surveillance data. The subjects were 871 NICU babies, consisting of 465 boys and 406 girls, who were cared for between June 2002 and January 2003 in 7 medical institutions that employed NICU infection surveillance. Infections were defined according to the National Nosocomial Infection Surveillance (NNIS System. Of the 58 babies with nosocomial infections, 15 had methicillin-resistant Staphylococcus aureus (MRSA infection. Multiple logistic regression analysis demonstrated that the odds ratio for nosocomial infections was significantly related to gender, birth weight and the insertion of a central venous catheter (CVC. When the birth weight group of more than 1, 500g was regarded as the reference, the odds ratio was 2.35 in the birth weight group of 1,000-1,499g and 8.82 in the birth weight group of less than 1,000g. The odds ratio of the CVC ( for nosocomial infection was 2.27. However, other devices including artificial ventilation, umbilical artery catheter, umbilical venous catheter, and urinary catheter were not significant risk factors. The incidence of MRSA infection rapidly increased from 0.3% in the birth weight group of more than 1,500g to 2.1% in the birth weight group of 1,000-1,499g, and to 11.1% in the birth weight group of less than 1,000g. When the birth weight group of more than 1,500g was regarded as the reference, multiple logistic regression analysis demonstrated that the odds ratio was 7.25 in the birth weight group of 1,000-1,499g and 42.88 in the birth weight group of less than 1,000g. These odds ratios were significantly higher than that in the reference group. However, the application of devices did not cause any significant differences in the odds ratio for MRSA infection.

  14. Bosworth hip shelf arthroplasty in adult dysplastic hips: ten to twenty three year results.

    Science.gov (United States)

    Bartoníček, Jan; Vávra, Jaroslav; Chochola, Antonín

    2012-12-01

    Hip shelf arthroplasty is currently considered to be a salvage procedure. The aim of the study is to present outcomes of Bosworth hip shelf arthroplasty in adolescent dysplastic hips with a minimum ten-year follow-up. The basic group comprised 25 hips in 18 patients with the mean age of 31 years (range, 16-52) at the time of operation. Subgroup A included 20 hips that were evaluated prior to operation as spherical, centric hips without osteoarthritic changes (acetabular dysplasia). The heterogeneous subgroup B comprised five hips. Of these, three hips were evaluated as aspheric, without osteoarthritic changes, and two hips as aspheric, with osteoarthritic changes of grade 2 according to Tönnis. In addition, two hips in subgroup B were evaluated as decentred (subluxated), one hip without and one hip with osteoarthritic changes. The mean follow-up was 15 years (range, ten-23). In subgroup A, the positive effect of operation had lasted at the time of the final follow-up for ten to 22 years postoperatively (average follow-up 14 years) in 19 hips. Only one female patient, 46 years old at the time of operation, developed hip osteoarthritis within ten years, that was treated by THA. In subgroup B, a lasting positive effect of operation was recorded in two cases at the time of the final follow-up (12 and 15 years). The third female patient with an aspheric and decentred hip developed severe hip osteoarthritis 21 years after shelf procedure that was treated by THA. In two patients who had hip osteoarthritis already before the operation, the positive effect of the shelf procedure survived over 13 and 20 years. Although hip osteoarthritis progressed, THA was performed as late as 15 and 23 years after the shelf procedure. The mean Harris hip score in 21 hips with a still functional hip shelf was 68 (range, 56-82) before and 90 (range, 76-100) after the surgery. The best outcomes of Bosworth hip shelf arthroplasty may be expected in a dysplastic spherical centred hip

  15. Risk factors for nosocomial infection in the neonatal intensive care unit by the Japanese Nosocomial Infection Surveillance (JANIS).

    Science.gov (United States)

    Babazono, Akira; Kitajima, Hiroyuki; Nishimaki, Shigeru; Nakamura, Tomohiko; Shiga, Seigo; Hayakawa, Masahiro; Tanaka, Tahei; Sato, Kazuo; Nakayama, Hideki; Ibara, Satoshi; Une, Hiroshi; Doi, Hiroyuki

    2008-08-01

    We evaluated the infection risks in the neonatal intensive care unit (NICU) using data of NICU infection surveillance data. The subjects were 871 NICU babies, consisting of 465 boys and 406 girls, who were cared for between June 2002 and January 2003 in 7 medical institutions that employed NICU infection surveillance. Infections were defined according to the National Nosocomial Infection Surveillance (NNIS) System. Of the 58 babies with nosocomial infections, 15 had methicillin-resistant Staphylococcus aureus (MRSA) infection. Multiple logistic regression analysis demonstrated that the odds ratio for nosocomial infections was significantly related to gender, birth weight and the insertion of a central venous catheter (CVC). When the birth weight group of more than 1, 500 g was regarded as the reference, the odds ratio was 2.35 in the birth weight group of 1,000-1,499 g and 8.82 in the birth weight group of less than 1,000g. The odds ratio of the CVC (+) for nosocomial infection was 2.27. However, other devices including artificial ventilation, umbilical artery catheter, umbilical venous catheter, and urinary catheter were not significant risk factors. The incidence of MRSA infection rapidly increased from 0.3% in the birth weight group of more than 1,500 g to 2.1% in the birth weight group of 1,000-1,499 g, and to 11.1% in the birth weight group of less than 1,000g. When the birth weight group of more than 1,500 g was regarded as the reference, multiple logistic regression analysis demonstrated that the odds ratio was 7.25 in the birth weight group of 1,000-1,499 g and 42.88 in the birth weight group of less than 1,000g. These odds ratios were significantly higher than that in the reference group. However, the application of devices did not cause any significant differences in the odds ratio for MRSA infection.

  16. Importance of medium time in case of device-associated infection

    Directory of Open Access Journals (Sweden)

    Angshuman Jana

    2015-01-01

    Full Text Available Background: Intensive Therapeutic Units (ITUs are unfortunately the epicenters of hospital acquired infection (HAIs. Limited data is available regarding the burden of HAIs in Indian ITU, especially median time of its detection, prevalent organisms and its resistance patterns. We conducted a prospective surveillance aimed to determine the occurrence of device associated infections (DAIs rate, magnitude of device associated infection cases per 1000 bed days, incidence of infections per 1000 device days and median time for detection of DAIs. Study population was taken from a 25 bedded intensive therapeutic unit (ITU, of a government teaching hospital in India. Methods: A prospective cohort study was performed over two years duration from June 2011 to May 2013. Total 596 patients who were admitted in the ITU for more than 48 hours were followed until discharge. CDC/NNIS system definitions for DAIs were used and rates were calculated. Data were analyzed with descriptive statistics. Results: Cumulative incidence rate of HAIs was 23.15 (138/596 and isolated DAIs was 19.96 (119/596. There was high device utilization mainly for urinary catheter (.838 and IV catheter (.742 than ventilator (.310 but the incidence density was more in ventilator associated infection(VAP-7.38% than catheter associated urinary tract infection (CAUTI-7.21% and catheter related blood stream infection (CRBSI-5.37%. Chi-square value for MV(mechanical ventilation was found 42.59 (<0.001 and ODD Ratio (OR was 6.8 at CI 3.44-13.67. For urinary catheter(UC and IVCatheter Chi-square value was 1.13 and 1.94. OR was 1.67 (0.61-4.93 and 4.71 (0.67-94.03. Median time of acquiring VAP, UTI, BSI were maximum in between (9 to 11 days, (17 to 20 days and (12 to 14 days respectively; indicates requirement of regular follow up of devices within thisZ periods. Major pathogens for VAP Klebsiella (28%, Acinetobacter(26.3% and Pseudomonus (21%. For CAUTI Staphylococcus aureus (18.7%, pseudomonas and

  17. Water or realistic compositions in proton radiotherapy? An analytical study.

    Science.gov (United States)

    Rasouli, Fatemeh S; Masoudi, S Farhad

    2017-03-01

    Pre-clinical tests and simulation studies for radiotherapy are generally carried out using water or simplified materials. Investigating the effects of defining compositionally realistic media in proton transport studies was the objective of this work. Accurate modeling of the Bragg curve is a fundamental requirement for such a study. An equation previously validated by experiments provides an appropriate analytical method for proton dose calculation in depth of the target. Owing to the dependency on protons ranges and the probability of undergoing non-elastic nuclear interactions (NNI), this formula comprises three parameters with values specified for initial proton energy and for the target material. As a result, knowledge of the depth-dose distribution using this analytical model is limited to the materials for which the data has been provided in nuclear data tables. In this study, we used our general formulas for calculating the protons ranges and the probability of undergoing NNI in desired compounds and mixtures with an arbitrary number of constituent elements. Furthermore, the protons dose distribution in the depth of these targets was leading off with determining the parameters appeared in the employed model using our mathematically easy to handle relations. For a number of tissues which may be of interest in proton radiotherapy studies but are missing in reference data tables, the mentioned parameters were calculated. Moreover, the resultant values for the protons ranges and the probability of undergoing NNIs were compared with those in water. The results showed that the differences between the position of Bragg peaks in water and realistic media considered in this study were energy dependent, and ranged between a few millimeters. For proton beams of arbitrary chosen initial energies, the maximum dose delivered to the realistic media varied between about -0.02-4.42% in comparison with that to water. The effects observed (both in penetration and in the

  18. Multidrug-resistant Enterobacteriaceae including metallo-β-lactamase producers are predominant pathogens of healthcare-associated infections in an Indian teaching hospital

    Directory of Open Access Journals (Sweden)

    J B Sarma

    2011-01-01

    Full Text Available Purpose: A study was carried out in an Indian teaching hospital in 2009 to detect the rate of surgical site infections (SSI and peripheral vascular access site infections. Materials and Methods: The study was a point-prevalence study involving over 300 patients. The presence of infection was determined according to the CDC criteria. Swabs were taken from the infected sites and identification and sensitivity were carried out using VITEK® 2 automated system. Characterisation of β-lactamase was carried out at ARRML, Colindale, London. Results: The rate of SSI was 15% for the clean and clean-contaminated categories while that for the dirty contaminated category was 85% (NNIS risk index 0. Cultures yielded definite or probable pathogens from 64% (9/14 of the patients with SSI. In 1/3 rd of the cultures, Staphylococcus aureus was grown and the rest had Enterobacteriaceae, either extended-spectrum β-lactamase (ESBL producers or Amp-C hyperproducers and, alarmingly, three isolates were positive for newly recognised New Delhi metallo-β-lactamase-1 (NDM-1. In medicine, 87% (n = 99 of the patients had a peripheral IV access device, 55% developed associated phlebitis/infection and, in seven, probable pathogens were isolated (Candida species and Escherichia coli producing ESBL and NDM-1, respectively, Staphylococcus aureus and Enterococcus faecium. All ESBL and metallo-β-lactamase producers were resistant to multiple classes of antimicrobials, the latter being sensitive only to colistin and tigecycline. The study also found that all post-operative patients were on antibiotics, 92% on IV [213 defined daily doses (DDD/100 post-op patients] limited mainly to the third-generation cephalosporins (26% and aminoglycosides (24% and imidazole derivatives (30%. In medicine, 83% (n = 82 were on IV antibiotics (123 DDD/100 bed-days, limited mainly to the third-generation cephalosporins (74%. Conclusion: Indiscriminate use of antibiotics is a major problem

  19. Chronic hepatitis C: future treatment

    Directory of Open Access Journals (Sweden)

    Wendt A

    2014-01-01

    Full Text Available Astrid Wendt, Xavier Adhoute, Paul Castellani, Valerie Oules, Christelle Ansaldi, Souad Benali, Marc BourlièreDepartment of Hepato-Gastroenterology, Hôpital Saint-Joseph, Marseille, FranceAbstract: The launch of first-generation protease inhibitors (PIs is a major step forward in HCV treatment. However, the major advance is up to now restricted to genotype 1 (GT-1 patients. The development of second-wave and second-generation PIs yields higher antiviral potency through plurigenotypic activity, more convenient daily administration, fewer side effects and, for the second-generation PIs, potential activity against resistance-associated variants. NS5B inhibitors include nucleoside/nucleotide inhibitors (NIs and non-nucleotide inhibitors (NNIs. NIs have high efficacy across all genotypes. Sofosbuvir has highly potent antiviral activity across all genotypes in association with pegylated interferon and ribavirin (PR, thus allowing shortened treatment duration. NS5A inhibitors (NS5A.I have highly potent antiviral activity. It has recently been shown for the first time that NS5A.I in combination with protease inhibitors can cure GT-1b null responders in an interferon-free regimen. Besides, several studies demonstrate that interferon (IFN-free regimens with direct-acting antiviral agent combinations are able to cure a large number of either naïve or treatment-experienced GT-1 patients. Moreover, quadruple regimen with PR is able to cure almost all GT-1 null responders. The development of pan-genotypic direct-acting antiviral agents (NIs or NS5A.I allows new combinations with or without PR that increase the rate of sustained virological response for all patients, even for those with cirrhosis and independently of the genotype. Therefore, the near future of HCV treatment looks promising. The purpose of this article is to provide an overview of the clinical results recently reported for HCV treatment.Keywords: SVR, direct antiviral agents, host

  20. Early Functional Outcomes of Periacetabular Osteotomy After Failed Hip Arthroscopic Surgery for Symptomatic Acetabular Dysplasia.

    Science.gov (United States)

    Ricciardi, Benjamin F; Fields, Kara G; Wentzel, Catherine; Kelly, Bryan T; Sink, Ernest L

    2017-09-01

    Persistent acetabular dysplasia is a common reason for the failure of hip arthroscopic surgery; however, the effect of prior hip arthroscopic surgery on functional outcomes after subsequent periacetabular osteotomy (PAO) is unknown. Hypothesis/Purpose: The purpose of this study was to (1) compare demographic and radiological findings in patients who had and had not undergone previous hip arthroscopic surgery before PAO for symptomatic acetabular dysplasia and (2) compare the short-term, hip-specific patient-reported outcomes in these same patient populations. It was hypothesized that prior hip arthroscopic surgery is associated with worse early functional outcomes in PAO. Cohort study; Level of evidence, 3. A retrospective cohort study design was utilized. Patients undergoing PAO were enrolled from a single-center, prospective hip preservation registry from March 2011 to April 2015. Patients with a minimum of 1-year clinical follow-up with preoperative and postoperative outcome scores undergoing PAO were eligible for inclusion (n = 93 patients; mean clinical follow-up, 24 months [range, 11-58 months]). The study group consisted of patients undergoing PAO for symptomatic hip dysplasia after prior hip arthroscopic surgery (PREVSCOPE group; 22 patients, 25 hips). Patients undergoing PAO without prior hip arthroscopic surgery (PAOALONE group; 71 patients, 85 hips) were included as a comparison group. Demographic and radiological variables were recorded. Postoperative functional outcome scores (modified Harris Hip Score [mHHS], Hip Outcome Score [HOS], and International Hip Outcome Tool [iHOT-33]) were recorded at 6 months and annually postoperatively. There were no demographic differences between the 2 groups at baseline. Acetabular version, femoral version, Tönnis grade, preoperative lateral center edge angle, and intraoperative procedures were not different between the 2 groups. At 1-year follow-up from the last hip surgical procedure, the mean (±SD) mHHS (73 ± 14

  1. Stability of the resistance to the thiosemicarbazone derived from 5,6-dimethoxy-1-indanone, a non-nucleoside polymerase inhibitor of bovine viral diarrhea virus.

    Directory of Open Access Journals (Sweden)

    Eliana F Castro

    Full Text Available Bovine viral diarrhea virus (BVDV is the prototype Pestivirus. BVDV infection is distributed worldwide and causes serious problems for the livestock industry. The thiosemicarbazone of 5,6-dimethoxy-1-indanone (TSC is a non-nucleoside polymerase inhibitor (NNI of BVDV. All TSC-resistant BVDV variants (BVDV-TSCr T1-5 present an N264D mutation in the NS5B gene (RdRp whereas the variant BVDV-TSCr T1 also presents an NS5B A392E mutation. In the present study, we carried out twenty passages of BVDV-TSCr T1-5 in MDBK cells in the absence of TSC to evaluate the stability of the resistance. The viral populations obtained (BVDV R1-5 remained resistant to the antiviral compound and conserved the mutations in NS5B associated with this phenotype. Along the passages, BVDV R2, R3 and R5 presented a delay in the production of cytopathic effect that correlated with a decrease in cell apoptosis and intracellular accumulation of viral RNA. The complete genome sequences that encode for NS2 to NS5B, Npro and Erns were analyzed. Additional mutations were detected in the NS5B of BVDV R1, R3 and R4. In both BVDV R2 and R3, most of the mutations found were localized in NS5A, whereas in BVDV R5, the only mutation fixed was NS5A V177A. These results suggest that mutations in NS5A could alter BVDV cytopathogenicity. In conclusion, the stability of the resistance to TSC may be due to the fixation of different compensatory mutations in each BVDV-TSCr. During their replication in a TSC-free medium, some virus populations presented a kind of interaction with the host cell that resembled a persistent infection: decreased cytopathogenicity and viral genome synthesis. This is the first report on the stability of antiviral resistance and on the evolution of NNI-resistant BVDV variants. The results obtained for BVDV-TSCr could also be applied for other NNIs.

  2. STUDY OF VENTILATOR ASSOCIATED PNEUMONIA IN NEONATAL INTESIVE CARE UNIT: CHARACTERISTICS, RISK FACTORS AND OUTCOME

    Directory of Open Access Journals (Sweden)

    Dr. Shalini Tripathi

    2010-01-01

    Full Text Available Ventilator Associated Pneumonia (VAP, the nosocomial pneumonia developing in mechanically ventilated patients after 48 hours of mechanical ventilation, is the second most common nosocomial infection. Therefore, there is a vital need to study the etiology and risk factors associated with VAP in neonates. Neonates admitted to neonatal intensive care unit (NICU, over a period of 1 year and who required mechanical ventilation for more than 48 hours were enrolled consecutively into the study. Diagnosis of VAP was made by the guidelines given by National Nosocomial infection Surveillance System (NNIS, 1996. Semi-quantitative assay of endotracheal aspirate was used for microbiological diagnoses of VAP. 105CFU/ml was taken as the cut off between evidence of pathological infection and colonization. The risk factors such as birth weight, prematurity (gestational age < 37 weeks, duration of mechanical ventilation, number of reintubations, length of hospital stay, primary diagnosis of neonate, postnatal age and small for gestational age (SGA were studied for the development of VAP. Risk factors found significant on bivariate analysis were subjected to multiple regression analysis to determine the most important predictors of VAP. The study group comprised of 98 neonates out of which, 30 neonates developed VAP (30.6%. VAP rates were 37.2 per 1000 days of mechanical ventilation. Most common bacterial isolated from endotracheal aspirate of VAP patients was Klebsiella spp (32.8%, E.coli (23.2% and Acinetobacter (17.8% being the other two common organisms. Very low birth weight (< 1500 grams, prematurity (gestational age < 37 week, duration of mechanical ventilation, number of reintubations and length of NICU stay were significantly associated with VAP in bivariate analysis. Multiple regression analysis revealed that duration of mechanical ventilation (OR 1.10, 95% CI 1.02, 1.21; P = 0.021 and very low birth weight (OR 3.88, 95% CI 1.05, 14.34; P = 0.042 were

  3. [Ultrasonography of the neonatal hip: state of the art and perspectives].

    Science.gov (United States)

    Ortore, P; Fodor, G; Silverio, R; Milani, C; Psenner, K

    1996-01-01

    Since the first studies by Graf, medical interest for neonatal hip sonography (US) has grown, till the redefinition of the name itself of the pathologic condition, which has been recently renamed developmental dysplasia of the hip. After briefly reviewing our personal series of patients (18,388 hips studied from March, 1986, through June, 1995, with 2.81% positives according to Graf, 0.65% of them with subluxated hips), several issues are discussed relative to US of the neonatal hip in the study of dysplasia, namely: 1) technique, 2) measurements, 3) unstable hips, 4) screening, 5) protocols, 6) perspectives. Relative to the technique, Graf's method is currently the method of choice because it is easy to perform (single scanning) and repeatable, different from what other authors, particularly Novick and Harcke, suggested; they use a dynamic approach with more scans and different stress tests. Moreover, in Graf's technique, special attention is paid to the need for correct measurements, which phase was criticized by Couture who complained of its claimed complexity. Hip measurements are an important step in the study of this condition thanks to the information they yield the physician who can thus customize the therapy. The problem of the unstable hip and focal ligament laxity is discussed, which is hypothesized to be a possible cause of hip dysplasia misdiagnosis; according to Graf and Tönnis, this condition is related mostly to hormonal factors and has no actual clinical importance in the possible evolution to a pathologic condition. US of the neonatal hip must be set in a general screening program for newborns to be carried out by the 6th week of life to achieve optimal recovery in positive newborns, without limiting it to supposedly at risk groups. Moreover, the cost-benefit ratio of US screening is emphasized, provided that both medical staff and units are used correctly. A working diagnostic-therapeutic protocol is needed to plan standard epidemiologic

  4. L'esperienza di un anno di sorveglianza attiva in area intensiva in un grande ospedale romano

    Directory of Open Access Journals (Sweden)

    F. Cerquetani

    2003-05-01

    Full Text Available

    A seguito dei dati emersi dalla sorveglianza di tutte le Infezioni Ospedaliere (i.o. attivata dall’anno 2000 presso l’Azienda Ospedaliera S.F. Neri (837 p.l. di alta specializzazione, DEA di 2° livello, il Comitato i.o. ha deciso di monitorare le i.o. nelle aree intensive dell’ospedale (29 p.l. di cui 10 in Rianimazione e 19 in T.I. post-chirugiche con sistema di rilevazione in grado di fornire dati confrontabili a livello internazionale. È stato applicato il protocollo di sorveglianza predisposto dal NNIS (National Nosocomial Infections Surveillance adottando i criteri di i.o. dei CDC di Atlanta.

    Dal 15 maggio 2002, 4 infermieri ICI della Direzione Sanitaria di Presidio rilevano quotidianamente i parametri clinici di tutti i pazienti ricoverati in area critica, inserendo i dati in un sistema informatizzato appositamente realizzato per l’analisi statistica.

    Al 31 maggio 2003 (382 gg di sorveglianza risultano osservati 1844 pazienti, per un totale di 10367 giornate di degenza intensiva (ggd: sono state rilevate 430 i.o. (23.3% in 126 pz (6.8% con un tasso di 40.4 i.o./1000 ggd (59 in Rianimazione,43.7 in Neurochirurgia, 38.6 in Toracica, 16.1 in Cardiochirurgia e 14.3 in Vascolare; il 43% delle i.o. rilevate ha localizzazione polmonare (incidenza di 17.4 i.o./1000 ggd seguita dal 34.7% delle sepsi/batteriemie (tasso di incidenza di 14 i.o./1000 ggd; i tassi di i.o. associati a dispositivo sono risultati pari a 37.7 per i.o. polmonari associate a ventilazione meccanica (VAP e 19.7 per le batteriemie/sepsi (BSI CVC-correlate.
    La sorveglianza in corso ha consentito di monitorare nel tempo le i.o. confrontandole con i dati internazionali (evidenziando tassi più elevati di VAP e BSI, e consentendo un confronto tra le aree intensive dell’ospedale, con individuazione di indicatori, quali degenza media e mortalità degli infetti, che hanno evidenziato l’importanza di una netta distinzione delle aree di ricovero dei

  5. The RNA template channel of the RNA-dependent RNA polymerase as a target for development of antiviral therapy of multiple genera within a virus family.

    Directory of Open Access Journals (Sweden)

    Lonneke van der Linden

    2015-03-01

    Full Text Available The genus Enterovirus of the family Picornaviridae contains many important human pathogens (e.g., poliovirus, coxsackievirus, rhinovirus, and enterovirus 71 for which no antiviral drugs are available. The viral RNA-dependent RNA polymerase is an attractive target for antiviral therapy. Nucleoside-based inhibitors have broad-spectrum activity but often exhibit off-target effects. Most non-nucleoside inhibitors (NNIs target surface cavities, which are structurally more flexible than the nucleotide-binding pocket, and hence have a more narrow spectrum of activity and are more prone to resistance development. Here, we report a novel NNI, GPC-N114 (2,2'-[(4-chloro-1,2-phenylenebis(oxy]bis(5-nitro-benzonitrile with broad-spectrum activity against enteroviruses and cardioviruses (another genus in the picornavirus family. Surprisingly, coxsackievirus B3 (CVB3 and poliovirus displayed a high genetic barrier to resistance against GPC-N114. By contrast, EMCV, a cardiovirus, rapidly acquired resistance due to mutations in 3Dpol. In vitro polymerase activity assays showed that GPC-N114 i inhibited the elongation activity of recombinant CVB3 and EMCV 3Dpol, (ii had reduced activity against EMCV 3Dpol with the resistance mutations, and (iii was most efficient in inhibiting 3Dpol when added before the RNA template-primer duplex. Elucidation of a crystal structure of the inhibitor bound to CVB3 3Dpol confirmed the RNA-binding channel as the target for GPC-N114. Docking studies of the compound into the crystal structures of the compound-resistant EMCV 3Dpol mutants suggested that the resistant phenotype is due to subtle changes that interfere with the binding of GPC-N114 but not of the RNA template-primer. In conclusion, this study presents the first NNI that targets the RNA template channel of the picornavirus polymerase and identifies a new pocket that can be used for the design of broad-spectrum inhibitors. Moreover, this study provides important new insight

  6. Outbreaks associated to bloodstream infections with Staphylococcus aureus and coagulase-negative Staphylococcus spp in premature neonates in a university hospital from Brazil Surtos associados a infecções sanguíneas por Staphylococcus aureus e Staphylococcus spp coagulase-negativa em neonatos prematuros em um hospital universitário do Brasil

    Directory of Open Access Journals (Sweden)

    Denise Von Dolinger de Brito

    2006-06-01

    Full Text Available Staphylococcus aureus and coagulase-negative staphylococci (CoNS are among the most important nosocomial pathogens in patients from neonatal intensive care units, mainly in bloodstream infections. The main objective of this study is to determine the occurrence of nosocomial infections by these microorganisms using two surveillance systems (Laboratorial Surveillance and National Nosocomial Infection Surveillance System and to determine the most important risk factors during a two-year period (2001-2002. Two outbreaks by both methicillin susceptible S. aureus (MSSA (1.5% and methicillin resistant CoNS (MRCoNS (1.0% were observed, from January to February/02 and August to September/02. Endemic incidence rates of 3.77% and 5.16% of S. aureus and CoNS, respectively were detected. Risk factors included age or = 7 days and utilization of polietilene central vascular catheter (CVC through vein dissection (phlebotomy, but none of these independent factors were confirmed by the multivariate analysis. However, oxacillin resistant CoNS prevailed (66.0% in the epidemic episodes. Molecular analysis by pulsed field gel electrophoresis showed the polyclonal nature of S. aureus isolates. In conclusion, two outbreaks were identified of mixed etiology by MSSA and MRCoNS associated to the lack of an adequate material (central venous catheter for neonates, related invasive procedure. The outbreaks were controlled with the substitution of polietilene CVC for peripherally inserted central catheter.Staphylococcus aureus e Estafilococos coagulase-negativa (ECN estão entre os patógenos hospitalares mais importantes em pacientes de unidades de terapia intensiva neonatal, principalmente em infecções da corrente sanguínea. O principal objetivo deste estudo foi determinar a ocorrência de infecções hospitalares por estes microrganismos usando dois sistemas de vigilância (laboratorial e "National Nosocomial Infection Surveillance" - NNIS e determinar os fatores de

  7. Do Radiographic Parameters of Dysplasia Improve to Normal Ranges After Bernese Periacetabular Osteotomy?

    Science.gov (United States)

    Novais, Eduardo N; Duncan, Stephen; Nepple, Jeffrey; Pashos, Gail; Schoenecker, Perry L; Clohisy, John C

    2017-04-01

    The goal of periacetabular osteotomy (PAO) is to improve the insufficient coverage of the femoral head and achieve joint stability without creating secondary femoroacetabular impingement. However, the complex tridimensional morphology of the dysplastic acetabulum presents a challenge to restoration of normal radiographic parameters. Accurate acetabular correction is important to achieve long-term function and pain improvement. There are limited data about the proportion of patients who have normal radiographic parameters restored after PAO and the factors associated with under- and overcorrection. (1) What is the proportion of patients undergoing PAO in which the acetabular correction as assessed by the lateral center-edge angle (LCEA), anterior center-edge angle (ACEA), acetabular inclination (AI), and extrusion index (EI) is within defined target ranges? (2) What patient and preoperative factors are associated with undercorrection of the acetabulum as defined by a LCEA < 22°, a factor that has been reported to be associated with PAO failure at 10-year followup? Between January 2007 and December 2011 we performed 132 PAOs in 116 patients for treatment of symptomatic acetabular dysplasia. One patient with Legg-Calvé-Perthes disease, one with multiple osteochondromatosis, and two with concomitant femoral osteotomy were excluded. A total of 128 hips (112 patients) were included. The hip cohort was 76% (97 of 128) female and the mean age at surgery was 28.5 years (SD 8.7 years). Correction of LCEA between 25° and 40°, ACEA between 18° and 38°, Tönnis angle between 0° and 10°, and EI ≤ 20% were defined as adequate based on normative values. Values lower than the established parameters were considered undercorrection for the LCEA and ACEA and those higher than the established values were considered overcorrection. Because postoperative LCEA < 22(o) has been previously associated with PAO failure at a minimum of 10-year followup, in this study we sought to

  8. Risk factors and the outcomes of central venous catheter-related bloodstream infections in ICU wards%ICU病房中心静脉导管相关性血流感染的高危因素及预后分析

    Institute of Scientific and Technical Information of China (English)

    肖丽; 卢岩; 彭松林; 李国福; 于晓江; 安春丽

    2012-01-01

    目的 调查ICU住院患者中心静脉导管相关性血流感染(CRBSI)的发生情况、高危因素及预后,为制定合适的防治策略提供依据.方法 应用前瞻性研究方法,采用美国国家院内感染监测(NNIS)规定的统一标准系统,对2007年6月1日至2008年5月31日入住中国医科大学附属盛京医院综合性ICU的所有符合条件的病例进行调查.结果 CRBSI感染率为13.2%(23例次/174),感染密度为12.0/1000导管日.单因素分析结果,中心静脉置管的个数、CRBSI发生前抗生素应用个数、导管日差异具有统计学意义(P<0.05);多因素Logistic回归分析结果,CRBSI发生前抗生素应用个数≥3( OR=6.335)和中心静脉置管个数>1(OR=5.981)是CRBSI发生的独立危险因素(P<0.05);CRBSI组的病患粗死亡率、呼吸机日、住院总费用、药费、ICU内住院日、总住院日和平均日花费均高于非CRBSI的病患(P<0.05).结论 该院CRBSI发生率高,感染密度大,多个中心静脉置管以及抗生素应用频繁是CRBSI的高危因素.CRBSI者的预后及医疗费用的经济负担明显高于非CRBSI者.必须进一步加强有效的预防和控制措施.%Objective To identify the incidence rate, pathogenic characteristics, risk factors, and outcomes of catheter-related bloodstream infections ( CRBSI) in ICU wards. Method From June 2007 to May 2008, qualified cases in the ICU ward at the Affiliated Shengjing Hospital of China Medical University were prospectively surveyed. Result A total of 174 patients were included in the study. The duration of catheterization lasted 1,913 days. Twenty-one patients developed an infection, yielding an infection rate of 12.0/1,000, and the application rate of catheters was 72. 8% . Specifically, nine cases of infection involved G- bacteria, seven cases involved G+ bacteria, and seven cases involved fungi. After applying a single-factorial analysis, the number of catheter implantations, the number of pre-CRBS1

  9. Is DDH still a problem?

    Directory of Open Access Journals (Sweden)

    Reinhard Graf

    2014-03-01

    Full Text Available Developmental dysplasia of the hip (DDH is the most frequent developmental disorder of the locomotor system. It is detected among 0.1–5.2% of newborns (1, 2. This might be the reason, that there is a high interest to detect DDH cases as early as possible. Undetected or late cases lead to catastrophes for the patient and family. Limping, leg length discrepancy, pain, frequent operations and sometimes femoral head necrosis, osteoarthritis, disability and finally total hip replacement even in young ages are results of a dysplastic hip that is not diagnosed on time or left untreated or treated improperly. Independent from individual patient problems the treatment costs for late or neglected cases are enormous. Costs of hospitalization, operations, rehabilitation, and indirect costs because of limited ability to work are incredible high. In countries with poor common health-system these patients have no chance for a normal life because of their disability.   How to solve or reduce the problem Clinical examination (Ortolani,Barlow etc. is used very often in different countries routinely, but not generally worldwide. The literature is quite clear; clinical examinations can reduce but not solve the problem. It need “well trained and experienced doctors”! But what is the definition of a “well trained and experienced doctor”? How it can happen, that in spite of clinical examination we see neglected cases? More than 5o% of DDH cases does not have any “typical” risk factor. The clinical examination is very often so subjective, that even fully dislocated joints cannot be detected and may be missed.   Critical questions 1- What is the Ortolani and the Barlow sign, the Glissement, the dry click sign, the phenomenon of the loose joint capsule and the “click” according to Tönnis D? 2- What sign in what age is normal? When does one of these signs change to the other one? 3- What is the pathology inside the joints, when you feel one of these