Reintroducing the dingo: the risk of dingo predation to threatened vertebrates of western New South Wales

Context The reintroduction of dingoes into sheep-grazing areas south-east of the dingo barrier fence has been suggested as a mechanism to suppress fox and feral-cat impacts. Using the Western Division of New South Wales as a case study, Dickman et al. (2009) recently assessed the risk of fox and cat predation to extant threatened species and concluded that reintroducing dingoes into the area would have positive effects for most of the threatened vertebrates there, aiding their recovery through trophic cascade effects. However, they did not formally assess the risk of dingo predation to the same threatened species. Aims To assess the risk of dingo predation to the extant and locally extinct threatened vertebrates of western New South Wales using methods amenable to comparison with Dickman et al. (2009). Methods The predation-risk assessment method used in Dickman et al. (2009) for foxes and cats was applied here to dingoes, with minor modification to accommodate the dietary differences of dingoes. This method is based on six independent biological attributes, primarily reflective of potential vulnerability characteristics of the prey. Individual-attribute scores were used to derive an overall risk score. Key results Up to 75 (94%) of the 80 extant species were predicted to be at risk of dingo predation (71% at high risk) regardless of any effect dingoes might have on foxes or cats. Up to 17 of the 21 (81%) locally extinct species were predicted to be at high risk of dingo predation using this approach. The re-establishment of even low-density dingo populations may have negative effects on at least 22% of extant threatened vertebrates. Conclusions The generic risk-assessment method was insensitive, and experienced difficulty in describing the true nature of canid predation risk. Despite this weakness, however, it is clear that several threatened vertebrates are susceptible to dingo predation. Prior to the re-establishment of dingoes, we recommend that dingo predation risks to all vertebrates (threatened or otherwise) be assessed using more sensitive and descriptive techniques, and we strongly caution against the positive management of dingoes under current ecological conditions. Implications The results of this study imply that dingoes present similar levels of direct risk to threatened species as foxes and feral cats, and dingo predation of threatened species should be formally considered in any proposal encouraging dingo populations in western New South Wales.

Did dingo control cause the elimination of kowaris through mesopredator release effects? A response to Wallach and O’Neill (2009)

Wallach & O’Neill (2009) recently suggested that poison baiting for dingoes (Canis lupus dingo and hybrids) caused the localized extinctions of kowaris (Dasyuroides byrnei) through mesopredator release effects. However, in this paper I briefly highlight some weaknesses in their approach to show that the information presented adds little to our knowledge of dingo-mesopredator or dingo-kowari interactions. Wallach & O’Neill (2009) visited two cattle properties in northeast South Australia once each in the winter of 2007 where they used sand plot activity indices to compare the relative abundance of several carnivore and herbivore species at each site. Observations of dingo howling and scat counts were used as measures of social structure. In line with the mesopredator release hypothesis (Crooks & Soulé, 1999), the lethal control of dingoes (usually achieved through 1080 baiting campaigns), followed by abundance increases of mesopredators and herbivores was the suggested mechanism that produced the localized extinction of kowaris at one of the sites. Unfortunately though, the study design suffers from multiple critical weaknesses in the methods applied, considerably limiting its ability to make inferences about dingo populations and ecosystem processes. 1. The authors stated that across Australia, ‘it is extremely rare to find dingo populations that are not being subjected to lethal control’ (Wallach & O’Neill, 2009, pg. 127). This is misleading, and in the context of their paper, gives the reader the mistaken impression that stable dingo packs are rare across Australia due to widespread control. Dingoes and dingo packs are, in fact, extremely common (Fleming et al., 2001; West, 2008), and control practices in South Australia are quite conservative (Allen, 2010b). ‘Lethal control’ is also an ambiguous term, because it includes everything from occasional shooting through to intensive and coordinated poison baiting campaigns. Hence, the degree of control can vary immensely, and in the context of their paper, different forms of lethal control are unlikely to influence social structure in the same way. For example, it is possible that occasional shooting may simply replace natural mortality and have a minor overall effect on dingo social structure, though these processes would need to be investigated. Furthermore, in the northeast pastoral district of South Australia where their two sites were located, official 1080 bait supply records (B. Allen, unpublished data, kept since 1972) indicate that poison baiting seldom occurs, with an average rate of 25% properties receiving baits in any given year (range: 0% in 1984 to 68% in 1991). Legislation permits a baiting intensity of up to 10 baits/km2 (APVMA, 2008). But the greatest supply of baits occurred in 1989, and equated to a regional baiting intensity of only 0.07 baits/km2 (Allen, 2010b). Requests for poison baits from the whole of the northern pastoral district have also reduced dramatically over the last five years to the point where only three (out of 19) properties in the northeast region received baits in the three years prior to their study and no baits at all were supplied in 2009. This means that approximately 600,000 km2 of South Australia experienced very little dingo control that year (dingo populations in the indigenous lands in the northwest of the state -255,000 km2- have rarely, if ever, been subject to lethal control by Europeans). On a property level (i.e. 10,000 km2), even the most intensive baiting campaigns in northern pastoral areas rarely exceed 0.25 baits/km2. Therefore, lethal control of any kind may be a relatively minor fraction of total dingo mortality across the region in which Wallach & O’Neill (2009) conducted their study. 2. The use of sand plot activity indices are a common and useful tool for sampling dingo populations. However, their proper use is governed by principles that ensure that the data obtained from them can be used reliably in subsequent analyses. Specifically, activity indices cannot be validly compared between different habitats/land uses, seasons, or species because of the way these factors potentially influence animal activity (Wilson & Delahay, 2001; Engeman, 2005). Scat counts and howling can also be useful indicators of some population parameters when sampled properly (Corbett, 2001; Mitchell & Balogh, 2007). Wallach & O’Neill (2009) understandably chose these useful methods to assess populations, but their application of them did not follow the sampling principles that ensure their reliability. For example: – The ‘index of abundance’ was calculated by multiplying a continuous measure (tracks/transect/night) with a binary measure (presence/absence of tracks on 2 ha plots). This could be argued as providing a potential synergy of assumption violations -leaving little prospect for a valid variance estimate- and unnecessary if the track sampling was representative of animal usage (Engeman et al., 1998; Blaum et al., 2008). – Even before combining them, these measures included invalidated assumptions about the ability to distinguish between “fresh” and “old” tracks and the distance of one track to another as an indication of the same individual animal. Wind can have a dramatic effect on the readability of tracks in sand, often obliterating them within minutes, and the size, shape and direction of footprints on separated but sequential sand plots/transects reveals little about the identity of the individual responsible for them (Triggs, 2004; Funston et al., 2010). – The relative abundance estimates derived from activity indices were invalidly compared between species, potentially confusing abundance differences with behavioural differences (Wilson & Delahay, 2001; Engeman, 2005). – A once-off collection of scats around 119 rabbit warrens, water points and carcasses in two ~500 km2 areas will provide a limited ability to assess the structure of dingo packs (or infer causal processes) at extensive rangeland sites (Wilson & Delahay, 2001; Mitchell & Balogh, 2007), and the representativeness of scats collected from resource points is unknown (Allen, 2010a). – The opportunistic recording of dingo howls at remote water points in the presence of people (and companion dogs, A. Wallach pers. comms.) is also a particularly weak technique for making inferences about pack structure. To be useful, the sampling of vocalizations must be objective and repeatable. Vocalizations are also communicative behaviours, and in the case of Wallach and O’Neill’s observations, dingoes may have simply been alerting any other dingoes to the presence of humans and/or other dogs. Assessments of pack structure or social stability are founded in behavioural observations between individually identifiable animals (Whitehead, 2008), and is usually undertaken through radio collaring and/or direct observations (e.g. Corbett, 1988; Thomson, 1992). Identification of individuals was not attempted by Wallach & O’Neill (2009), and scats or howling cannot provide this information. Moreover, the once-off, opportunistic collection of dingo spoor (i.e. tracks and scats) and vocalizations cannot account for the known seasonal changes in their expression (Corbett, 2001), the multiple explanations for any given observation (Williams et al., 2002; MacKenzie et al., 2006), or the mechanisms/causes underlying any observed correlations (Caughley, 1977). 3. Ignoring these methodological issues, alternative explanations may equally describe the observations of Wallach & O’Neill (2009). For example, the greater abundance of dingoes observed at Pandie Pandie may not be due to relaxed dingo control but may be a symptom of the site’s closer proximity to Goyder’s Lagoon, a well-watered and resource-rich section of the Warburton Creek, which is not fed from local rainfall. Publicly available water-level data recorded upstream in the years preceding the study show significant flows into the lagoon which were not matched by local rainfall events on Mungerannie during the same period. Additionally, the observed rarity of some small mammals on Mungerannie may reflect bottom-up processes, whereby rabbit abundance provides competition for vegetation, reduces it’s availability to invertebrates, and supports larger numbers of feral carnivores (increasing the risk of hyperpredation), which all work in concert to cause the localized extinction of some small mammals. These processes are known to occur with or without dingoes in the landscape. Furthermore, the recorded activity of predators and prey alike can change rapidly in response to environmental perturbations, and their presence or absence on sand plots during a once-off survey may merely reflect such stochastic events. Such surveys have a limited ability to infer causal process because there may be multiple alternative explanations for the data (Caughley, 1977; Williams et al., 2002; MacKenzie et al., 2006). Causal processes involving dingoes are best addressed using rigorous experimental techniques (such as BACI experiments) where confounding factors can be controlled (Glen et al., 2007). In summary, while ecological data is scant for arid areas and is always welcomed, it is important to use research resources wisely in order to provide scientifically defensible information (Platt, 1964), used ultimately to inform threatened species recovery. While the conclusions of Wallach & O’Neill (2009) align nicely with the mesopredator release hypothesis, their foundations, methods, and interpretation are undermined by misleading contextual information, the poor application of otherwise robust sampling methods, and a lack of discussion on alternative explanations. As such, the study contributes little insight into the effect of dingo control on kowaris. The study sites, methods, and results presented in Wallach & O’Neill (2009) have also been used elsewhere (Wallach et al., 2009a, 2009b, 2010), and these criticisms equally apply to those reports, and others similar to them. Researchers, reviewers and readers should therefore be vigilant in looking for design issues that may be more important than initially appears to be the case, before accepting intuitively sound conclusions on face value. Improving the quality of dingo-mesopredator studies is necessary if threatened species are to be managed more effectively.

Pulmonary edema due to Plasmodium vivax malaria in an American missionary

Pulmonary edema is a recognized complication of Plasmodium falciparum malaria but is uncommon with Plasmodium vivax infection. We report the case of a non-immune adult with imported P. vivax malaria who developed pulmonary edema during treatment. The case was further complicated by a recurrent malaria episode after failure of acute quinine and doxycycline treatment followed by terminal primaquine therapy. Prompt recognition and appropriate management of pulmonary edema is needed for optimal outcomes of P. vivax infection, as well as awareness of the potential failure of terminal therapy for liver hypnozoites.

Soil and surface runoff phosphorus relationships for five typical USA midwest soils

Excessively high soil P can increase P loss with surface runoff. This study used indoor rainfall simulations to characterize soil and runoff P relationships for five Midwest soils (Argiudoll, Calciaquaoll, Hapludalf, and two Hapludolls). Topsoil (15-cm depth, 241-289 g clay kg(-1) and pH 6.0-8.0) was incubated with five NH4H2PO4 rates (0-600 mg P kg(-1)) for 30 d. Total soil P (TPS) and soil-test P (STP) measured with Bray-P1 (BP), Mehlich-3 (M3P), Olsen (OP), Fe-oxide-impregnated paper (FeP), and water (WP) tests were 370 to 1360, 3 to 530, 10 to 675, 4 to 640, 7 to 507, and 2 to 568 mg P kg(-1), respectively. Degree of soil P saturation (DPS) was estimated by indices based on P sorption index (PSI) and STP (DPSSTP) and P, Fe, and Al extracted by ammonium oxalate (DPSox) or Mehlich-3 (DPSM3). Soil was packed to 1.1 g cm(-3) bulk density in triplicate boxes set at 4% slope. Surface runoff was collected during 75 min of 6.5 cm h(-1) rain. Runoff bioavailable P (BAP) and dissolved reactive P (DRP) increased linearly with increased P rate, STP, DPSox, and DPSM3 but curvilinearly with DPSSTP. Correlations between DRP or BAP and soil tests or saturation indices across soils were greatest (r > or = 0.95) for FeP, OP, and WP and poorest for BP and TPS (r = 0.83-0.88). Excluding the calcareous soil (Calciaquoll) significantly improved correlations only for BP. Differences in relationships between runoff P and the soil tests were small or nonexistent among the noncalcareous soils. Routine soil P tests can estimate relationships between runoff P concentration and P application or soil P, although estimates would be improved by separate calibrations for calcareous and noncalcareous soils.

Failure of trimethoprim/sulfamethoxazole prophylaxis for Pneumocystis carinii pneumonia with concurrent leucovorin use

Pneumocystis carinii is a common cause of pneumonia in patients with AIDS, however, the incidence has dropped with the availability of effective prophylactic regimens. First-line treatment for both acute Pneumocystis pneumonia and chronic prophylaxis is trimethoprim/sulfamethoxazole (TMP/SMX). This combination can cause hypersensitivity reactions as well as myelosuppression. The simultaneous administration of leucovorin during acute treatment has been shown to reduce the incidence of neutropenia, but may interfere with the efficacy of TMP/SMX. We report a case of P. carinii pneumonia in a patient with AIDS who failed TMP/SMX prophylaxis while taking leucovorin.

Role of heparan sulfate as a tissue-specific regulator of FGF-4 and FGF receptor recognition

FGF signaling uses receptor tyrosine kinases that form high-affinity complexes with FGFs and heparan sulfate (HS) proteoglycans at the cell surface. It is hypothesized that assembly of these complexes requires simultaneous recognition of distinct sulfation patterns within the HS chain by FGF and the FGF receptor (FR), suggesting that tissue-specific HS synthesis may regulate FGF signaling. To address this, FGF-2 and FGF-4, and extracellular domain constructs of FR1-IIIc (FR1c) and FR2-IIIc (FR2c), were used to probe for tissue-specific HS in embryonic day 18 mouse embryos. Whereas FGF-2 binds HS ubiquitously, FGF-4 exhibits a restricted pattern, failing to bind HS in the heart and blood vessels and failing to activate signaling in mouse aortic endothelial cells. This suggests that FGF-4 seeks a specific HS sulfation pattern, distinct from that of FGF-2, which is not expressed in most vascular tissues. Additionally, whereas FR2c binds all FGF-4-HS complexes, FR1c fails to bind FGF-4-HS in most tissues, as well as in Raji-S1 cells expressing syndecan-1. Proliferation assays using BaF3 cells expressing either FR1c or FR2c support these results. This suggests that FGF and FR recognition of specific HS sulfation patterns is critical for the activation of FGF signaling, and that synthesis of these patterns is regulated during embryonic development.

Structure-based design of a bispecific receptor mimic that inhibits T cell responses to a superantigen

Key surface proteins of pathogens and their toxins bind to the host cell receptors in a manner that is quite different from the way the natural ligands bind to the same receptors and direct normal cellular responses. Here we describe a novel strategy for "non-antibody-based" pathogen countermeasure by targeting the very same "alternative mode of host receptor binding" that the pathogen proteins exploit to cause infection and disease. We have chosen the Staphylococcus enterotoxin B (SEB) superantigen as a model pathogen protein to illustrate the principle and application of our strategy. SEB bypasses the normal route of antigen processing by binding as an intact protein to the complex formed by the MHC class II receptor on the antigen-presenting cell and the T cell receptor. This alternative mode of binding causes massive IL-2 release and T cell proliferation. A normally processed antigen requires all the domains of the receptor complex for its binding, whereas SEB requires only the alpha1 subunit (DRalpha) of the MHC class II receptor and the variable beta subunit (TCRVbeta) of the T cell receptor. This prompted us to design a bispecific chimera, DRalpha-linker-TCRVbeta, that acts as a receptor mimic and prevents the interaction of SEB with its host cell receptors. We have adopted (GSTAPPA)(2) as the linker sequence because it supports synergistic binding of DRalpha and TCRVbeta to SEB and thereby makes DRalpha-(GSTAPPA)(2)-TCRVbeta as effective an SEB binder as the native MHC class II-T cell receptor complex. Finally, we show that DRalpha-(GSTAPPA)(2)-TCRVbeta inhibits SEB-induced IL-2 release and T cell proliferation at nanomolar concentrations.

Graphic analysis of femoral growth in young children with Perthes' disease

A cohort of 20 children, younger than 5.5 years at the time of onset of unilateral Perthes' disease, were studied by computer graphic analysis. Graphic outlines derived from each child's series of anterior posterior radiographs of the pelvis and hips were aligned on layers in a computer application such that changes over time could be directly visualized and measured. In these young children, injury to the cartilaginous growth mechanisms accounted for almost all of the abnormal change in the shape of the proximal femur; growth abnormalities had been established by the time of initial radiographs and persisted both as constant growth-rate change and growth-direction change until skeletal maturity. Despite the similar degree of radiographic bone necrosis, outcomes differed, and the specific growth aberrations were highly unique to the individual. At the time of the most recent radiographs, among the diseased hips 7 had spherical femoral heads larger than the normal side, eight had elliptical femoral heads congruent with the acetabulum, and five had elliptical femoral heads with a flat area congruent with the acetabulum. The study did not provide evidence to support a logic for brace or surgical treatment of young children with Perthes' disease.

Surgical management of ankle valgus in children: use of a transphyseal medial malleolar screw

Valgus deformity of the ankle in children is associated with a wide variety of clinical conditions. A retrospective review was performed of 17 children (29 involved extremities) with ankle valgus deformity who had been managed by use of a percutaneously placed, transphyseal medial malleolar screw. Median age at the time of surgery was 11 years, 2 months. Median postoperative follow-up was 2 years, 2 months. Tibiotalar axis and ankle mechanical axis were the best radiographic indicators of ankle valgus deformity. Fibular station and epiphyseal wedging were poor predictors of ankle alignment. Significant improvement in the tibiotalar axis (median, 12 degrees) was noted at follow-up, and the median rate of correction was 0.59 degree/month. Resumption of physeal growth and recurrence of deformity (rate of 0.60 degree/month) was seen when the screws were removed before skeletal maturity. The transphyseal medial malleolar screw is a minimally invasive, minimally morbid, technically simple method of reversible partial epiphysiodesis at the ankle and is an effective technique for the correction of ankle valgus deformity associated with a wide variety of clinical conditions in children.

Same-day versus staged anterior-posterior spinal surgery in a neuromuscular scoliosis population: the evaluation of medical complications

The medical complications occurring in 29 patients with neuromuscular spinal deformity undergoing two-stage anterior-posterior spinal fusion ("staged") were compared with 16 neuromuscular patients undergoing single-stage anterior-posterior spinal fusion ("same day"). Thirty-six (124%) major and minor medical complications occurred postoperatively in the staged patients, whereas 14 (88%) major or minor complication were present in same-day surgery patients. Thirty-five percent of staged patients had no complications, whereas 63% of same-day patients were without complications. Associated findings comparing the two-stage procedure to the single-stage surgery included operative and anesthesia time increase, increased blood-volume loss, increased blood transfusion, decreased nutritional parameters, and longer hospital stays. With either approach, there is the risk of significant complications in this vulnerable population.

Radiographic evaluation of bowed legs in children

Radiographic screening is widely used to distinguish between Blount disease (infantile tibia vara) and physiologic bowing. Thirteen children with Blount disease, evaluated before 3 years of age, with initial radiographs showing no sign of Langenskiold changes, were compared with 50 children with physiologic bowing, also evaluated before 3 years of age with similar radiographic studies. Screening test accuracy was determined retrospectively for measurement of the mechanical axis, the tibial metaphyseal-diaphyseal angle (TDMA), and the epiphyseal-metaphyseal angle (EMA). A radiographic screening method combining the TMDA and the EMA, using cutoff values of 10 degrees and 20 degrees respectively, exhibited the best combination of sensitivity, specificity, and positive predictive value, correctly identifying all cases of Blount disease and 40 of 50 cases of physiologic bowing. Our data suggest that children between 1 and 3 years of age with TMDA <10 degrees, or TMDA > or =10 degrees and EMA < or =20 degrees, are at less risk for development of Blount disease. Children with TMDA > or =10 degrees and EMA >20 degrees are at greater risk for development of Blount disease and should be followed closely.

Epiphyseal changes after proximal femoral osteotomy

This study was conducted to evaluate the risk factors for epiphyseal changes suggestive of osteonecrosis after proximal femoral osteotomy for hip subluxation associated with cerebral palsy. Forty-eight children with 94 hips were reviewed. Two observers rated the radiographs using a written protocol on two occasions each so that reproducibility of these observations could be assured. Concomitant pelvic osteotomy proved to have the greatest association with risk of epiphyseal changes. These findings, suggestive of osteonecrosis, were present in 7 of 68 (10%) hips that had isolated femoral osteotomy, and in 12 of 26 (46%) hips that had concomitant pelvic osteotomy.

Clinical evaluation of bowed legs in children

Early radiographic screening and/or referral to a clinical specialist are often used to distinguish between physiologic bow leg deformity and infantile tibia vara disease in young children. These practices are a consequence of the clinician's inability (based upon the clinical examination) to distinguish between the deformities associated with physiologic and pathologic bow legs. Because the great majority of these children have physiologic bowing, routine radiographic screening and referral are not cost effective and expose children to unnecessary radiation. This study describes and evaluates the efficacy of a simple clinical examination technique, the 'cover up' test, to identify young children with bow legs who are at high risk for having infantile tibia vara. The 'cover up' test qualitatively assesses the alignment of the proximal portion of the shank or lower leg relative to the thigh or upper leg. Obvious valgus alignment is considered a negative test and is indicative of physiologic bowing. Neutral or varus alignment is considered a positive test and suggests that the child is at greater risk for having infantile tibia vara. Eighteen children with infantile tibia vara, evaluated initially prior to 3 years of age, and followed to the time of surgical correction, were compared with 50 children with physiologic bowing, also evaluated initially prior to 3 years of age and followed to resolution (mean follow-up 3 years and 10 months). All of the children with infantile tibia vara had a positive 'cover up' test (sensitivity = 1.00). Eighteen of 25 children with a positive 'cover up' test actually had or developed infantile tibia vara (positive predictive value = 0.72). Forty-three of 50 children with physiologic bowing had a negative 'cover up' test (specificity = 0.86). All of the children with a negative 'cover up' test actually had physiologic bowing (negative predictive value = 1.00). We conclude that the 'cover up' test is an effective screening tool for the assessment of bow legs in children between 1 and 3 years of age. Children with a negative 'cover up' test do not require radiographic evaluation and should be followed clinically for resolution of the bowing. Children with a positive 'cover up' test should have radiographic evaluation of the lower extremities or be referred to a specialist for further evaluation and treatment.

Predictive value of intraoperative clubfoot radiographs on revision rates

The predictive value of intraoperative radiographic assessment and its correlation with short term revision rates is presented for surgical correction of resistant clubfoot. Seventy-three children (115 feet) who underwent a primary procedure at one institution for idiopathic clubfoot between January 1991 and December 1994 were reviewed. A strategy using sequential release guided by intraoperative radiographs was employed in all cases. The intraoperative radiographic findings correlated with the need for early revision surgery, with residual radiographic evidence of cavus deformity associated with the greatest risk for revision. The sequential release strategy resulted in fewer overcorrections compared with historical controls of more complete subtalar release.

Caps on malpractice awards: update

Tort reform for professional liability is in the best interests of not only all physicians, but for industry and the citizenry as a whole. The enormous sums of money donated by the Trial Lawyers Association, whose livelihood is at stake, makes initial passage of tort reform difficult and, once passed, brings it under constant attack. Even if a well-disposed legislature passes a professional liability law, state supreme courts are ever ready to invalidate such laws. Thus, once tort reform has been passed, the next battleground is the state supreme court. ACS chapters should be preparing their membership for educating the public as well as themselves as to the danger of a state supreme court comprised of members opposed to tort reform, and be prepared to help the election of those individuals who are more sympathetic to tort reform.

DNA recognition properties of the N-terminal DNA binding domain within the large subunit of replication factor C

Replication Factor C (RFC) is a five-subunit protein complex required for eukaryotic DNA replication and repair. The large subunit within this complex contains a C-terminal DNA binding domain which provides specificity for PCNA loading at a primer-template and a second, N-terminal DNA binding domain of unknown function. We isolated the N-terminal DNA binding domain from Drosophila melanogaster and defined the region within this polypeptide required for DNA binding. The DNA determinants most efficiently recognized by both the Drosophila minimal DNA binding domain and the N-terminal half of the human large subunit consist of a double-stranded DNA containing a recessed 5' phosphate. DNA containing a recessed 5' phosphate was preferred 5-fold over hairpined DNA containing a recessed 3' hydroxyl. Combined with existing data, these DNA binding properties suggest a role for the N-terminal DNA binding domain in the recognition of phosphorylated DNA ends.

A modified Harrington technique for scoliosis

Post-Harrington techniques for adolescent idiopathic scoliosis have increased the complexity of scoliosis surgery while contributing only biomechanically more secure fixation and sagittal contour preservation. On the the basis of principles defined by Harrington, the authors developed a simplified technique that accomplishes equivalent outcomes.

Distraction instrumentation outcomes in scoliosis

The short-term outcomes of a new distraction technique using a small rod spinal instrumentation system (WRIGHTLOCK) are reported for adolescent idiopathic scoliosis. No caudally directed thoracic hooks were used. Seventy-four children aged 11.7 to 17.5 years who underwent consecutive posterior instrumentations are reviewed. Their curves improved from a mean of 55.6 degrees to 22.7 degrees (average of 59.2% correction). At 2.7 years mean follow-up, coronal curves lost an average of 4.2 degrees correction. Overall, there was a mean increase of 4.4 degrees in kyphosis. Children with the most preoperative hypokyphosis were afforded the greatest gains in kyphosis. Instrumentation resulted in a mean loss of 8.2 degrees lumbar lordosis. These results compare favorably with published results for other multihook systems.

Surgical corrections in scoliosis: a meta-analysis

A meta-analysis of the acute correction outcomes in adolescent idiopathic scoliosis is reported. Posterior instrumentation systems generally gave similar coronal plane corrections with average corrections for differing systems ranging from 48% to 67%. There was significant overlap of corrections reported for each of the systems. Anterior instrumentation gave better results with average corrections ranging from 71% to 93%. No instrumentation demonstrated a consistent ability to restore a normal thoracic kyphosis, but all seemed to maintain preoperative kyphosis measures. All systems, including newer multihook systems, showed a small loss of lumbar lordosis postoperatively. The available data demonstrates that no posterior implant produces vertebral derotation.

Plantar-advancement skin flap for central ray resections in the foot: description of a technique

A surgical technique using an advancement plantar skin flap to maintain the resection gap closure when performing central ray resections is described and illustrated. The concept, applicable to central polydactyly or polysyndactyly of the foot, was developed with goals of providing a skin tether to maintain a normally narrow foot as well as to improve the appearance of the surgical scar.

Comparison of neurologic deficits with atlanto-dens intervals in patients with Down syndrome

Eighty-four patients with Down syndrome had flexion-extension lateral roentgenograms of the C1-C2 articulation for the purpose of dividing the group into subluxators (> or = 4 mm atlanto-dens interval and 2 mm translation) and nonsubluxators (those who did not meet these criteria). Neurologic examinations and chart review were carried out on all patients to ascertain those with a positive neurologic finding or history. Seventeen (20%) were defined as subluxators and 67 (80%) as nonsubluxators. Five (29%) of the subluxators were found to have positive neurologic findings and 18 (27%) of the nonsubluxators had similar types of positive neurologic findings. These percentages are not significantly different. This led us to conclude that positive neurologic findings and an abnormal atlanto-dens interval are not alone adequate criteria to judge need for surgical stabilization of the C1-C2 articulation in patients with Down syndrome.

Replication factor C interacts with the C-terminal side of proliferating cell nuclear antigen

Replication factor C (RF-C) is a heteropentameric protein essential for DNA replication and repair. It is a molecular matchmaker required for loading of proliferating cell nuclear antigen (PCNA) onto double-stranded DNA and, thus, for PCNA-dependent DNA elongation by DNA polymerases delta and epsilon. To elucidate the mode of RF-C binding to the PCNA clamp, modified forms of human PCNA were used that could be 32P-labeled in vitro either at the C or the N terminus. Using a kinase protection assay, we show that the heteropentameric calf thymus RF-C was able to protect the C-terminal region but not the N-terminal region of human PCNA from phosphorylation, suggesting that RF-C interacts with the PCNA face at which the C termini are located (C-side). A similar protection profile was obtained with the recently identified PCNA binding region (residues 478-712), but not with the DNA binding region (residues 366-477), of the human RF-C large subunit (Fotedar, R., Mossi, R., Fitzgerald, P., Rousselle, T., Maga, G., Brickner, H., Messner, H., Khastilba, S., Hübscher, U., and Fotedar, A., (1996) EMBO J., 15, 4423-4433). Furthermore, we show that the RF-C 36 kDa subunit of human RF-C could interact independently with the C-side of PCNA. The RF-C large subunit from a third species, namely Drosophila melanogaster, interacted similarly with the modified human PCNA, indicating that the interaction between RF-C and PCNA is conserved through eukaryotic evolution.

Growth profiles and articular cartilage characterization in a goat model of Legg-Calve-Perthes disease

Numerous animal species, including the goat, have been evaluated as potential models for human Legg-Calve-Perthes disease (LCPD). These models disrupt the vasculature of the femoral head, causing it to collapse, and therefore do not mimic all the clinical patterns of the human disease. Baseline data regarding the weight and femoral length in the growing goat are not available. This study characterized the goat's normal growth for comparison with that of humans. The growth aberrations in the proximal femur created by surgically ablating the capital physis were described and compared with the aberrations observed in human LCPD cases. Age, weight, and femoral length (test and control) data were obtained for goats approximately 1 to 14 months of age. At 4 months of age, a craniolateral surgical approach was used to expose the cranial lateral capital physis so that it could be cauterized. Postoperative radiographs were evaluated by graphic analysis to assess the resultant changes in the morphology of the proximal femur. The articular cartilage of the femoral head and acetabulum was evaluated mechanically, using indentation testing, to determine the apparent modulus of elasticity, and histopathologically regarding its thickness and proteoglycan content. The proximal femurs of goats and humans exhibit similar morphology and growth patterns. There was a positive correlation between age, weight, and femoral lengths in the goat. The surgical procedure was effective in ablating the capital femoral physis as indicated by shorter femoral lengths and fragmented, flattened, and mushroomed femoral heads. The histopathological data revealed that the articular cartilage was significantly thicker in the operated hip joints at the ventrocaudal and cranial acetabula and the dorsal and ventral femoral heads. The test cartilage exhibited significantly less positive staining for proteoglycans in the dorsocaudal and the cranial acetabula as well as the ventral femoral head. The apparent modulus of elasticity, of the test cartilage was significantly lower than the control value at the dorsocaudal acetabulum. These data show that the surgical procedure produced morphological changes that mimic those in human LCPD. The increased thickness of the articular cartilage of the LCPD femoral head may account for the articular degeneration observed in older patients with LCPD, as increased cartilage thickness is associated with decreased tissue quality.

MSCRAMM-mediated adherence of microorganisms to host tissues

Microbial adhesion to host tissue is the initial critical event in the pathogenesis of most infections and, as such, is an attractive target for the development of new antimicrobial therapeutics. Specific microbial components (adhesins) mediate adherence to host tissues by participating in amazingly sophisticated interactions with host molecules. This review focuses on a class of cell surface adhesins that specifically interact with extracellular matrix components and which we have designated MSCRAMMs (microbial surface components recognizing adhesive matrix molecules). MSCRAMMs recognizing fibronectin-, fibrinogen-, collagen-, and heparin-related polysaccharides are discussed in terms of structural organization, ligand-binding structures, importance in host tissue colonization and invasion, and role as virulence factors.

The immature goat as an animal model for Legg-Calvé-Perthes disease

Legg-Calvé-Perthes disease (LCPD) results from avascular necrosis of the capital femoral epiphysis in growing children. This disease often yields a significant deformity of the proximal femur, which may result in osteoarthritis. Its cause is unknown, although extensive radiographic, clinical, and histologic evaluations have been performed. Attempts at developing an animal model for LCPD have been unsuccessful. Previous models have been based predominantly on determining the vascular etiology of the disease. There is a need for an animal model that mimics the growth pattern of the proximal femur seen in LCPD. Such a model would allow for the development and testing of new treatments. Thus far, no treatment strategy has been completely successful. A study involving graphic analysis of radiographs found that arrested anterolateral physeal growth with continued or accelerated perichondrial ring and posteromedial epiphyseal growth would account for the most severe morphologic changes observed in the femoral heads of patients with LCPD. A surgical procedure was performed to ablate the capital femoral physis in goat kids in an attempt to mimic the changes noted in this study. The procedure was evaluated with radiographs, gross specimens, and histopathologic slides. Graphic analysis of the radiographs revealed changes in the shape of the operated femoral head compared with the unoperated femoral head. While bone, fibrous, and fibrocartilaginous bridges were histologically observed across the physis, the resultant deformities did not mimic the changes identified in the graphic analysis study, perhaps because of inconsistencies in the surgical ablative techniques, which will require further modification. This study provides the basis for further research to develop a successful model.

Fimbriation, capsulation, and iron-scavenging systems of Klebsiella strains associated with human urinary tract infection

Thirty-two strains of Klebsiella pneumoniae and seven strains of Klebsiella oxytoca isolated from urinary tract infections in elderly adults were analyzed for capsular antigens, iron-scavenging systems, and fimbriation. All strains were capsulated. Twenty-seven different K antigens were identified among the strains, with no particular antigen dominating. All strains produced the iron-scavenging system enterochelin as analyzed by bioassay and DNA hybridization. In contrast, the aerobactin iron-sequestering system was not detected in any of the strains. All strains caused hemagglutination of tannin-treated human erythrocytes and reacted with an anti-type 3 fimbriae antiserum as well as in DNA hybridization with a type 3 fimbria-specific probe, indicating that the Klebsiella strains possessed this fimbrial type. Possession of type 1 fimbriae was analyzed by agglutination tests and by hybridization with DNA probes from two distinct Klebsiella type 1 fimbria gene clusters. Phenotypic expression of the type 1 fimbriae was found in 29 of 32 K. pneumoniae strains, whereas 30 strains reacted with either of the two type 1 fimbrial cluster DNA probes. In K. oxytoca, however, only three of seven strains expressed type 1 fimbriae and reacted with the DNA probes. The type 3 fimbriae were found to bind to a fraction of epithelial cells exfoliated in normal human urine, whereas the type 1 fimbriae bound strongly to urinary slime. No inhibitors of type 3 fimbrial binding were detected in human urine.

Adherence to respiratory epithelia by recombinant Escherichia coli expressing Klebsiella pneumoniae type 3 fimbrial gene products

We examined the role of Klebsiella fimbrial types 1 and 3 in mediating adherence to human buccal and tracheal cells and to lung tissue sections. We found that clinical isolates of Klebsiella pneumoniae producing type 3 fimbriae and Escherichia coli HB101 containing a recombinant plasmid encoding expression of Klebsiella type 3 fimbriae (pFK10) demonstrated increased adherence to tracheal cells, trypsinized buccal cells, and lung tissue sections, in contrast to nonfimbriate and to type 1 fimbriate bacteria. Adherence by type 3 fimbriate bacteria was inhibited by purified type 3 fimbriae and Fab fragments derived from type 3 fimbrial-specific polyclonal immunoglobulin G. Type 3 fimbriae mediated attachment to the basolateral surface of tracheal cells and to the basal epithelial cells and the basement membrane regions of bronchial epithelia. Using an E. coli transformant (pDC17/pFK52), which expresses nonadherent P fimbrial filaments, along with the type 3 fimbrial adhesin (MrkD), we demonstrated that type 3 fimbrial attachment to respiratory cells was attributable to the MrkD adhesin subunit. Subsequent experiments demonstrated that the epithelial target of the type 3 fimbrial adhesin was most likely a peptide molecule rather than a carbohydrate. The results of this study demonstrate that, in vitro, the Klebsiella type 3 fimbrial adhesin mediates adherence to human respiratory tissue.

Fimbrial types among respiratory isolates belonging to the family Enterobacteriaceae

Bacterial attachment is believed to be an early step in gram-negative nosocomial pneumonia. The frequency of fimbria-associated adhesins among respiratory pathogens has not been studied in detail. In this study isolates belonging to the family Enterobacteriaceae, prospectively obtained from intensive care unit patients who were suspected of having nosocomial pneumonia, were examined for fimbria-associated adhesins. Type 3, P, type 1, and other fimbrial phenotypes were identified by specific hemagglutination and electron microscopy. The Klebsiella type 3 fimbrial phenotype was further characterized by using a monoclonal antibody. Also, both type 3 and Escherichia coli P fimbrial genotypes were detected by using DNA colony blot assays. The frequencies of genera or species isolated were as follows: Enterobacter (38.6%), Klebsiella (26.8%), Serratia (17.7%), E. coli (13%), and Proteus (5.2%). Isolates of Klebsiella oxytoca, K. pneumoniae, and Enterobacter cloacae most commonly possessed the type 3 fimbrial phenotype and genotype. The phenotype and genotype for E. coli P fimbriae (46.2 and 50%, respectively), a known pathogenic determinant in the urinary tract, were detected more frequently than expected. In addition, a previously unspecified hemagglutinin that was specific for porcine erythrocytes was almost uniformly expressed among isolates of Enterobacter aerogenes. Finally, the expression of the type 1 fimbrial phenotype was widely detected among the isolates tested but notably absent among K. oxytoca and Proteus mirabilis isolates. The frequency of the various fimbrial types identified suggests a role for these bacterial organelles in adherence to respiratory epithelia.

Design and evaluation of a posterior laminar clamp spinal fixation system

A new spinal instrumentation system for posterior applications was designed with the intent of minimizing intrusion of hardware into the neural canal during and postinsertion. Basic biomechanical measurements of posterior pullout strength led to the establishment of a clamp as an effective mechanism for gaining purchase on the vertebral lamina. These experiments defined the appropriate instrumentation size, as well as establishing that there was no loss of strength with the spinous process removed and the posterior laminar cortex compromised. There was no statistically significant difference between the maximum pullout strength achievable, using a band around the lamina as a control, and that produced by the implant system, in the thoracic spine. Comparative testing of a prototype system in flexion, extension, lateral bending, and torsion showed that the system, in general, had stiffness greater than segmental wiring and less than or equal to Cotrel-Dubousset fixation.

Nucleotide sequence and functions of mrk determinants necessary for expression of type 3 fimbriae in Klebsiella pneumoniae

The nucleotide sequence of six genes involved in the expression of type 3 fimbriae of Klebsiella pneumoniae was determined. In addition to the genes that encode the fimbrial subunit (mrkA) and adhesion (mrkD), the mrkB, mrkC, and mrkE genes appear to be involved in assembly of the fimbrial filament and regulation of type 3 fimbrial expression. The mrkF gene product is required to maintain the stability of the fimbrial filament on the cell surface.

Type V collagen as the target for type-3 fimbriae, enterobacterial adherence organelles

Tissue-binding specificity of the type-3 fimbriae of pathogenic enteric bacteria was determined using frozen sections of human kidney. A wild-type Klebsiella sp. strain and the recombinant strain Escherichia coli HB101(pFK12), both expressing type-3 fimbriae, as well as the purified type-3 fimbriae effectively bound to sites at or adjacent to tubular basement membranes, Bowman's capsule, arterial walls, and the interstitial connective tissue. Bacterial adherence to kidney was decreased after collagenase treatment of the tissue sections. Recombinant strains expressing type-3 fimbriae specifically adhered to type V collagen immobilized on glass slides, whereas other collagens, fibronectin or laminin did not support bacterial adherence. In accordance with these findings, specific binding of purified type-3 fimbriae to immobilized type V collagen was demonstrated. Specific adhesion to type V collagen was also seen with the recombinant strain HB101(pFK52/pDC17), which expresses the mrkD gene of the type-3 fimbrial gene cluster in association with the pap-encoded fimbrial filament of E. coli, showing that the observed binding was mediated by the minor lectin (MrkD) protein of the type-3 fimbrial filament. The interaction is highly dependent on the conformation of type V collagen molecules since type V collagen in solution did not react with the fimbriae. Specific binding to type V collagen was also exhibited by type-3 fimbriate strains of Yersinia and Salmonella, showing that the ability to use type V collagen as tissue target is widespread among enteric bacteria.

The effect of local controlled release of sodium fluoride on the stimulation of bone growth

This study was performed to test the feasibility of using a biodegradable delivery system for the local controlled release of sodium fluoride as a mechanism for the stimulation of local bone growth. Sodium fluoride grains were mixed with poly-DL-lactic acid (PLA), and the mixture was then dissolved in acetone. After driving off the solvent, sheets of this material were rolled into rods 3.2 mm in diameter and 28.6 mm long. These were inserted into the intramedullary canals of the right femora of adult New Zealand White rabbits. A sham implant, made the same way but containing no fluoride, was inserted into the contralateral left leg. The effects of three different concentrations of sodium fluoride, 0.125 g NaF/g PLA, 0.250 g NaF/g PLA, and 0.500 g NaF/g PLA, were determined after a 4-week implantation period. In a second set of experiments, the concentration was fixed at 0.500 g NaF/g PLA with implantation durations of 4, 8, and 16 weeks. Expressed in terms of property ratios (experimental/control), bending strengths of the femora were significantly raised in most groups with the notable exception of Group 3 (0.500 g NaF/g PLA, 4 weeks). Cross-sectional area ratios in the distal femora were increased in all groups compared to right/left values for a normal unoperated group (p less than 0.05), with the highest ratio being 1.50 (SD = 0.44) for Group 4 (0.500 g NaF/g PLA, 8 weeks). Only Group 4 animals showed significant (p less than 0.05) increases in midshaft area ratio and none had responses proximally. Growth rates, measured by sequential fluorochrome labeling of bone followed the area ratio data and were only significant for the distal femora.

Effect of personal pain experience on pain assessment

The purpose of this study was to determine the effect of nurses' personal pain experiences on the assessment of their patients' pain. The sample consisted of 134 registered nurses employed in three Midwestern hospitals. In response to a personal pain history questionnaire, pain with headache, menstrual distress and dental events were cited most frequently. Most also reported that a family member had experienced pain in their presence (cancer, surgery, orthopedic injuries). Responses to the Standard Measure of Inferences of Suffering (Davitz & Davitz, 1981) showed significant differences between intensity of pain experienced by the nurse and overall perceived patient psychological distress. Furthermore, the intensity of pain experienced by the nurse was the only variable that predicted significantly perceptions of patients' physical suffering and psychological distress. While additional study is warranted, the findings support the notion that nurses who have experienced intense pain are more sympathetic to the patient in pain.

Identification and characterization of the genes encoding the type 3 and type 1 fimbrial adhesins of Klebsiella pneumoniae

Strains of Klebsiella pneumoniae are known to express two morphologically and functionally distinct filaments, the type 3 and the type 1 fimbriae. The gene (mrkD) encoding the adhesion of K. pneumoniae type 3 fimbriae was identified by transcomplementation analysis with the pap fimbrial gene cluster of Escherichia coli. The nucleotide sequence of the mrkD gene was determined. In addition, the determinant coding for the K. pneumoniae type 1 fimbrial adhesion was identified, and its nucleotide sequence was deduced. The predicted amino acid sequences of the K. pneumoniae adhesion proteins are compared, and similarities with the major fimbrial structural proteins (MrkA and FimA) are discussed.

Expression of type 1 fimbriae and mannose-sensitive hemagglutinin by recombinant plasmids

Deletions within the cloned genes (fimA) encoding the type 1 major fimbrial subunits of two isolates of Klebsiella pneumoniae resulted in a nonfimbriate but hemagglutinating phenotype after transformation of Escherichia coli HB101 or ORN103. Phenotypic expression of type 1 fimbriae could be restored by transformation with plasmids containing the fimA genes of the fimbrial gene clusters from different strains. The surface fimbriae expressed were serologically identical to those of the polymerized product of the introduced fimA gene. The fimA gene products of Salmonella typhimurium and Serratia marcescens could utilize the accessory fimbrial genes of K. pneumoniae to produce surface-associated, hemagglutinating fimbriae. The relatedness of the type 1 fimbrial gene clusters from multiple isolates of members of the family Enterobacteriaceae was examined by DNA hybridization techniques. These analyses demonstrated little nucleotide sequence agreement among distinct genera of the enteric bacteria.

Type 3 fimbriae among enterobacteria and the ability of spermidine to inhibit MR/K hemagglutination

The distribution of the gene cluster encoding type 3 fimbriae among various isolates of the family Enterobacteriaceae was investigated by using 112 clinical and nonclinical isolates. Closely related DNA sequences were detected in all Klebsiella strains, in most Enterobacter isolates, in a smaller number of Escherichia coli and Salmonella spp., and in a single isolate each of Yersinia enterocolitica and Serratia liquefaciens but not in isolates of Morganella or Providencia species or Serratia marcescens. Except for E. coli and Salmonella strains, the presence of gene sequences was correlated with the phenotypic expression of either the MR/K hemagglutinin or fimbriae that reacted with specific antibodies. In one isolate of Y. enterocolitica the expression of type 3 fimbriae was plasmid determined. The polyamine spermidine was identified as an inhibitor of MR/K hemagglutinating activity, exhibiting an MIC of 1.2 mM. Spermidine inhibited the hemagglutination of 37 MR/K-positive clinical isolates from various genera. However, one clinical isolate of Enterobacter cloacae and most (four of five) nonclinical Klebsiella isolates were not completely inhibited.

Molecular characterization of the type 3 (MR/K) fimbriae of Klebsiella pneumoniae

The expression of type 3 (MR/K) fimbriae by Klebsiella pneumoniae requires the production of at least four polypeptides with molecular masses of 20.5, 25, 34, and 78 kilodaltons. The genes encoding these polypeptides are located on a gene cluster 5,500 base pairs in length. The nucleotide sequence of the major fimbrial structural gene was determined, and its transcription was shown to initiate in vitro 157 base pairs upstream of the translational start site. The predicted amino acid sequence for the fimbrial subunit comprised 202 residues, including a signal peptide of 22 amino acids. Despite similarities in the organization of the gene cluster, the nucleotide and the amino acid sequence of the major fimbrial subunit revealed little agreement with other known fimbrial subunit sequences.

Biomechanical comparisons of spinal fracture models and the stabilizing effects of posterior instrumentations

In this study, the authors evaluated the stiffness of motion segments in intact spines in two spine fracture models, and with each of five implant systems used for posterior fixation of thoracolumbar spine fractures. The devices represented a cross-section of types, including those employing sublaminar wires with and without laminar hooks, pedicle screws, plates, and rods. Two spine fracture models, one partially and one totally destabilized, were used in the tests of the instrumentation. Stiffness, or the magnitude of load needed to produce a unit displacement of the construct in the direction of the applied load, was measured in flexion, extension, lateral bending, and torsion in combination with a compressive force. Both horizontal plane shear and angular displacements were measured in the two fracture patterns. All evaluations were made by testing the difference in stiffness for statistical significance among groups. The results showed significant differences in stiffness without instrumentation among intact spines, partly destabilized spines (anterior two-thirds of disk and posterior ligaments removed), and totally destabilized spines (only anterior longitudinal ligament intact). The implant/spine constructs were least stiff relative to the intact spine in torsion, followed in increasing order of stiffness with flexion, lateral bending, and extension. In the Roy-Camille plate with six-screw fixation was found to produce the stiffest construct, followed by wired Harrington rods, C-rods and J-rods, and the Vermont internal fixator.(ABSTRACT TRUNCATED AT 250 WORDS)

A 1988 perspective on the Galveston technique of pelvic fixation

The Galveston technique for pelvic fixation was used in 40 patients who underwent scoliosis surgery with pelvic fixation at The University of Texas Medical Branch from February 1980 through June 1987. Analysis of the outcomes indicates that extension of a scoliosis fusion to the pelvis can be undertaken with excellent chance for success and without the necessity of routine postsurgical casting or bracing. Accurate contouring of the L-rod implant and meticulous fusion technique are essential to success.

The Galveston experience with L-rod instrumentation for adolescent idiopathic scoliosis

Eighty patients were treated with L-rod instrumentation (LRI) for adolescent idiopathic scoliosis at the authors' institution from 1978 through 1985. The percentage correction of Cobb angle, the fusion rate, and the neurologic injury rate were similar to that reported for Harrington instrumentation. Avoidance of postoperative casting or bracing, maintenance of secondary spinal contours, secure pelvic fixation when needed, and anterior thoracoplasty in a majority of patients were achievable goals with LRI.

Considerations in the treatment of cerebral palsy patients with spinal deformities

The natural history of spinal deformities in the cerebral palsy patient is different than that in the idiopathic patient. Consequently, the approach to the patient with cerebral palsy and the surgical decision-making are different from that in the idiopathic patient. The present article gives the UTMB approach to the treatment of the cerebral palsy patient and the unique considerations that must be taken into account when treating these patients. Specific references are made to the use of L-rod instrumentation to stabilize the spinal deformity in the cerebral palsy patient.

The biomechanics of decompressive laminectomy

The biomechanical effect of laminectomy as a means of relieving compression of the spinal cord-meningeal complex by an anterior mass was studied in ten grossly normal human cadaver spines. The basic experimental set-up involved drilling a sagittal plane hole transversely across a vertebral body to provide direct access to the anterior aspect of the neural canal. After securing a probe and linearly variable differential transformer (LVDT) assembly at each site to be tested, the probe was gently pushed into the neural canal; contact force against the tip of the probe as well as the depth of probe penetration was measured and recorded. Laminectomy did not alter the resulting contact force/anterior penetration plots at the fifth cervical, seventh thoracic, 12th thoracic, or third lumbar vertebra. Using the probe/LVDT assembly to measure anterior dural displacement and a cantilever displacement device to measure posterior dural displacement after laminectomy at the 12th thoracic vertebra, the authors found that although the anterior dura underwent gross displacement as the probe was pushed into the neural canal, the posterior dura displaced to a minimal degree. The extent of the laminectomy was not a factor. The study did not demonstrate any possible mechanism by which laminectomy could reduce the pressure exerted on the dura and neural elements by an anterior mass in a spine with otherwise normal neural canal dimensions.

Rib regeneration area as an indicator of fusion area in adolescent idiopathic scoliosis

This retrospective study of 24 patients with adolescent idiopathic scoliosis who underwent L-rod instrumentation, posterior thoracoplasty, and rib-bone grafting analyzed the correlation between the quality of rib regeneration and the host response to the rib-bone grafts. A planimetric technique was used to quantitate the coronal plane area of the resected ribs and of an L1-L2 concave fusion area immediately after surgery and at the end of the first postsurgical year. Using computerized regression analysis, these and other variables such as age, Cobb angle, and grafting technique were studied. Rib regeneration correlated with spinal fusion but not with age or Cobb angle. A better host response with strip vs. morseled graft was suggested, but not statistically proven. The data strongly support the belief that systemic biologic factors are a major variable affecting the quality of the fusion procedure.

Computer-assisted instruction in orthopedic biomechanics

A computer-aided instructional (CAI) course in biomechanics was developed at the University of Texas Medical Branch in Galveston. This was used by our residents in preparation for the 1984 OITE. The course was developed on a 256K IBM personal computer with a color graphics board and color monitor. The course requires about 6 hours of user time to complete. The program was written in the Basic computer language and consists of a master and teaching program. The master program keeps track of the name of the user and his or her progress. The teaching program contains the chapters of biomechanical concepts with a quiz after each chapter. The chapters present the basic concepts of biomechanics with interactive color graphics. The quizzes contain about 20 board-type questions. Six residents voluntarily used the CAI and nine residents chose not to use the CAI. There was no difference in the two groups' outside reading of biomechanical texts or other methods of study. There was no statistical difference between the two groups 1983 OITE biomechanics score. There was also no statistical change in the nonusers' score from 1983 to 1984. The users, however, showed a statistically significant improvement (p less than .05) from the previous year. We conclude that with the wide use of properly developed CAI is an effective and efficient method to provide education for orthopedists.

An algorithm for the treatment of unstable thoracolumbar fractures

This article describes a fracture classification used at the University of Texas Medical Branch that takes into account the fracture mechanics and attempts to match the requirements of the fracture to the strong points of a particular spinal implant. The present algorithm for the treatment of thoracolumbar fractures is presented, and its efficacy is demonstrated by comparing it with an evolutionary group of spinal fractures cases