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The incidence and descriptive factors of calcaneal malunion after surgical fixation of intra-articular calcaneal fractures using the sinus tarsi approach: A retrospective cohort study with binary logistic regression analysis.

BACKGROUND: This study evaluated the incidence of calcaneal malunion after minimally invasive sinus tarsi approach (MIS-STA) in displaced intra-articular calcaneal fractures (I-ACFs) and identified related descriptive factors of calcaneal malunion. METHODS: A retrospective review of 99 displaced I-ACFs treated with MIS-STA was conducted. Demographic data, pre-operative radiographs, and operative details were analyzed. Outcomes included numerical rating scale (NRS) pain scores at rest and during activities of daily living (ADL), Foot and Ankle Ability Measure (FAAM) for ADL and radiographic parameters. Logistic regression was used to identify descriptive factors associated with malunion. RESULTS: Malunion occurred in 33/99 cases (33.3%). The significant descriptive factors were the initial B&#xf6;hler angle <&#x202f;0.5 &#xb0;, time to surgery >&#x202f;12.5 days, and Sanders type &#x2265;&#x202f;III. Malunion patients had significantly worse NRS and FAAM scores (p&#x202f;&#x2264;&#x202f;0.001). CONCLUSION: Calcaneal malunion after MIS-STA occurred in one-third of cases, with three descriptive factors identified and poorer outcomes observed. LEVEL OF EVIDENCE: III, Comparative retrospective study with binary logistic regression analysis.

Humans

Nephritic factor: Description of a new quantitative assay and findings in glomerulonephritis.

A sensitive quantitative test for nephritic factor (NF) in human serum is reported. The test is based on the capacity of NF to initiate fluid phase consumption of the third complement (C) component in the presence of magnesium ions (Mg++) and of factors of the alternative pathway of C activation. These factors as well as C3 and C5 were supplied by the incorporation of normal human serum (NHS) into the assay mixture. In order to prevent C3 (and C5) consumption via the Ca++- and Mg++-dependent classical pathway, the test was performed in the presence of the chelating agent Mg-ethylene bis (oxyethylene-nitrilo) tetraacetic acid (Mg EGTA) which interacts preferentially with Ca++. The Mg EGTA concentration was found to be critical, a final concentration of 5 mM in the assay mixture being required for optimal results. By its heat stability (54 degrees to 56 degrees C, 30 min), NF could be distinguished from other, heat-labile NF-like factors. The NF test was applied to five categories of patients with glomerulonephritis (GN). Heat-stable NF activity was found in seven of 17 sera in the membranoproliferative glomerulonephritis (MPGN) group. Two of the 12 acute poststreptococcal GN sera had NF-like activity which disappeared upon heating. Serum C3 and proactivator (PA) concentrations varied widely in all groups but a clear positive relationship was found between the presence of NF and low serum C3 concentrations in MPGN. Renal immunofluorescence in MPGN indicated a lesser amount of lg deposited in glomeruli from patients with NF when compared to the NF-negative patients. Both groups had heavy C3 deposits. The availability of a sensitive, quantitative assay for NF may help to provide further insight into the various pathogenic mechanisms in different forms of MPGN.

Acute Disease

Relief of pain by transcutaneous stimulation.

A series of 198 patients with chronic pain of diverse etiology was carefully analyzed for epidemiologic and descriptive factors which might influence the response to transcutaneous stimulation. The overall series included 12 1/2% with long-term success, and 68% with partial or short-term relief. There were no consistent specific diagnoses, or epidemiologic or descriptive factors that made good results from stimulation predictable. Stimulation of the painful area itself was not always necessary for pain relief. Favorable responses to transcutaneous stimulation were usually correlated with the continued existence of significant sensory input from the painful region. The authors conclude that transcutaneous stimulation is a valuable therapeutic modality for some patients with chronic pain.

Adult

Dose calculation and measurements for a CT compatible version of the Fletcher applicator.

Experimental measurements in a water phantom were made for a new shielded plastic Fletcher applicator. A dose calculation algorithm which allows the description of asymmetrically shielded source containers is presented. The traditional primary plus build-up factor description of the dose in a homogeneous volume is corrected by using effective attenuation coefficients measured in a water phantom for all the source-shield-container materials. Comparison of the theoretical results to the experimental data shows excellent agreement.

Brachytherapy

Blood glucose area under the curve. Methodological aspects.

To specify the influence of methods used in estimating area under the curve (AUC) and the meaning of total and incremental AUC, 75 glycemic responses to a mixed meal were studied in 75 diabetic patients, 39 with insulin-dependent diabetes mellitus and 36 with non-insulin-dependent diabetes mellitus. AUC was integrated with five computerized methods: polynomial interpolation of third and fourth degree, trapezoidal rule, Simpson's integration, and cubic interpolatory splines. Although these methods gave significantly different results (P less than 0.001), a strong correlation was found between estimations of AUC with different methods (r greater than 0.99, P less than 0.001). In addition, variation between methods was less than or equal to 2%, whereas the coefficient of variation between subjects was 38%. Total AUC was strongly correlated with basal blood glucose value (r = 0.90, P less than 0.001), whereas incremental and positive AUC were not (r = 0.12 and 0.07, respectively, NS). Incremental and positive AUC were strongly correlated with glycemic rise (r = 0.89 and 0.93, respectively, P less than 0.001), whereas total AUC was only slightly so (r = 0.31, P less than 0.01). Incremental and positive AUC gave slightly but significantly different information on glucose response. These results suggest that variations related to the method used in estimating AUC are not clinically relevant and that a simple method such as trapezoidal rule can be used. Total AUC is a descriptive factor related to basal blood glucose value, whereas incremental and positive AUC more accurately describe glycemic response to foods.

Analysis of Variance

[Quantitative descriptive analysis of maxillary arch in unilateral cleft].

The need for a simple, routinely applicable method for morphologic analysis of maxillary arch in cleft patients resulted in development of a new original, objective and computerized method. The authors present the rationale and procedure of this method which is extremely suitable for clinical documentation, follow up and clinical investigation of cleft patients. The descriptive factors are expressed in relative numbers--rations of asymmetry and segment displacement. The relative numbers enable comparative analysis between arches of different size.

Cleft Palate

Serum factors activating the alternative complement pathway in autoimmune disease: description of two different factors from patients with systemic lupus erythematosus.

Serum factors which activated the alternative pathway of complement were detected in 10 of 26 patients with systemic lupus erythematosus (SLE), three of 18 patients with mixed connective tissue disease, one patient with scleroderma, and one with Sjögren's syndrome. This activation was detected by conversion of factor B and C3 into split products and by lysis of glutathione-sensitized human erythrocytes under conditions where classical pathway activation was blocked. The serum factors capable of activating the alternative pathway could be seperated into 7S and 19S-type molecules by sucrose density gradient ultracentrifugation. In two patients with SLE, serum factors were isolated by ion-exchange chromatography, preparative electrophoresis, and molecular sieve chromatography. The serum 7S factor was immunochemically identical to the C3 nephritic factor (C3NeF) of hypocomplementemic chronic glomerulonephritis. Antisera to other complement components failed to react with this purified material. The 7S factor was able to activate the alternative pathway in C2 deficient serum, and in normal human serum under conditions where classical pathway was blocked, but was unable to do so in sera depleted of factor B, factor D, and C3. The activity could be removed by antiserum to C3NeF. In contrast, the serum 19S activator of the alternative pathway was not reactive with antiserum to C3NeF. It had a fast gamma mobility on electrophoresis and the activity could be removed by absorption with anti-IgG and anti-IgM. It was suggested that the 19S factors could consist, in part, of immune complexes.

Absorption

Milwaukee shoulder syndrome. Fifteen additional cases and a description of contributing factors.

Fifteen additional patients with Milwaukee shoulder syndrome are described, bringing our total series to 30 cases. The condition occurred predominantly in elderly women and was characterized by severe glenohumeral joint degeneration and dissolution of the fibrous rotator cuff. Synovial fluids contained few leukocytes, but were often blood tinged. Basic calcium phosphate crystal aggregates and particulate collagens were noted in nearly all fluids, and collagenase activity was detectable in some, but not all, fluids. The knee joints were involved with a similar process in about half of our patients. In contrast to primary osteoarthritis, lateral tibiofemoral compartment involvement was common. Factors that may predispose to this syndrome included deposition of calcium pyrophosphate dihydrate crystals, direct trauma or chronic joint overuse, chronic renal failure, and denervation.

Aged

Mothers' working models of infant feeding: description and influencing factors.

This study examined four aspects of mothers' working models of infant feeding: (1) infant behaviour that cues feeding decisions; (2) infant self-regulative behaviour; (3) importance of infant self-regulative behaviour and maternal effort directed to it; and (4) maternal effort and value given to task-oriented and efficient feeding. The relation of these aspects to maternal experience, age, formal education, family income, and feeding method was also explored. Subjects were 122 mothers of healthy, term infants between 14 and 60 days old. A telephone interview obtained demographic and attribute data and assessed the four aspects with 30 scaled items. Crying before and sleepiness during feeding were relatively compelling cues for maternal action. Most mothers gave only moderate ratings to the importance of infant self-regulative behaviour and to task-oriented and efficient feeding. Parity and feeding method affected response to specific items, with primiparae more concerned about length and regularity of feedings. Mothers who bottle-fed their infants were more concerned about maintaining a feeding once initiated than mothers who breast-fed their infants. Four-factor analysis yielded two item clusters with good internal consistency: Cluster a. Maternal Effort to Accomplish Feeding Goals; and Cluster b. Importance of Infant Self-Regulative Behaviour. Cluster a. and b. were strongly correlated. Feeding method influenced both clusters, and the interaction of parity and feeding method had an effect on Cluster a. Mothers with lower family income had higher scores on Cluster b; multiparae with lower family income on Cluster a. How and when infant self-regulation develops as a goal is a question in need of study.

Adolescent

Adult tics in Gilles de la Tourette's syndrome: description and risk factors.

We studied 58 adults with Gilles de la Tourette's syndrome diagnosed during childhood. Tics persisted in all patients but were moderate/severe in only 24%, compared with 60% at the time of worst function. Coprolalia persisted in 4%, compared with 22% at the time of worst function. For most patients, worst function occurred in adolescence (mode = 13 years). In spite of a high frequency of school and behavioral problems during development, 98% graduated high school and 90% were full-time students or fully employed. Features predictive of mild tic severity in adulthood were mild tics during the patient's worst pre-adulthood function and mild tics during early and late adolescence. Childhood tic severity had no predictive value, and likewise, coprolalia during development did not increase the risk for adult moderate/severe tics.

Adult

[Vertical transmission of HIV infection: descriptive epidemiology, risk factors and survival].

The basic epidemiological characteristics of HIV infection and AIDS among children are described with a particular reference to HIV vertical transmission. The HIV transmission pattern identified in our community is described according to the WHO classification scheme. To describe the epidemic, as well as its temporal evolution, 1.933 cases reported to the population based registry of Catalonia and 287 seropositive children and their mothers are used. We have quantified the importance of intravenous drug usage by the parents in relationship to HIV transmission; 54.7% of the mothers of HIV positive children were intravenous drug users. We predict that during the coming years there will be a continuous increase in AIDS cases as a result of vertical transmission.

Acquired Immunodeficiency Syndrome

[Vertical transmission of HIV: descriptive epidemiology, risk factors and survival (II)].

Up until November 30, 1990, 415 children born to HIV-positive mothers were followed in order to study the vertical transmission rate and the survival of those infected, as well as the associated risk factors. According to CDC criteria, 264 children could be considered definitely classified, with 82 classified as infected (transmission rate: 31.1%) and 182 as sero-negative. The remaining 151 infants were younger than 15 months and classified as PO. Ninety percent of the studied mothers were infected through either the use of intravenous drugs or by sexual intercourse with HIV infected partner. The loss-of-antibody median age was one year. The median for the incubation period was 285 days, with a significant bimodal distribution regarding the child's age at diagnosis. Although the median survival time was longer than the study period, the fatality rate was estimated to be 22.0% and the percentage of children reaching age 4, 27%.

Female

A mathematical description of causative factors and prevention of elevated intraocular pressure after keratoplasty.

In keratoplasty with grafts the same size as the recipient bed, tight sutures and thick recipient corneal periphery distort the angle and may collapse the filtering meshwork. This can cause very high postoperative pressures, which can be avoided by the use of donor grafts larger than the recipient bed. These relationships can be mathematically predicted.

Corneal Transplantation

Measuring affect at work: confirmatory analyses of competing mood structures with conceptual linkage to cortical regulatory systems.

Twenty so-called clear markers of positive and negative mood (Watson & Tellegen, 1985) were applied in the current study to measure affect at work. Confirmatory factor analyses of a bipolar Two-Factor (i.e., positive and negative affect) Model and a competing multifactor model were conducted with three samples: managerial and professional workers in an insurance firm, retail sales personnel, and a heterogeneous group of students who were employed. The first-order Two-Factor Model (i.e., descriptively bipolar positive and negative affect factors) hypothesized to underlie the 20 affect items did not provide a strong fit to the data in the three samples. A first-order Four-Factor Model with descriptively unipolar factors labeled as Positive Arousal (Enthusiasm), Negative Activation (Nervousness), Low Arousal (Fatigue), and Low Activation (Relaxation) provided a better fit across the samples. These results support the measurement of positive and negative mood as descriptively unipolar factors. The measurement implications of these results as well as conceptual linkages between the four mood factors and the two major cortical regulatory systems, left-lateralized dopaminergic activation and right-lateralized noradrenergic arousal, are discussed.

Adult

Assessing the five-factor model of personality description.

Several approaches to assessing the dimensions of the five-factor model are reviewed and evaluated. The items in the assessment instrument may be adjectives or phrases, and the instrument itself may have been developed specifically to measure the five factors or may have been reinterpreted in terms of the five-factor model. Data are presented comparing an adjective-based measure of the model (Goldberg, 1990) with two phrase-based measures (Costa & McCrae, 1985; Hogan, 1986), and recommendations are made for the choice of an instrument in different research contexts. Allport's (1937) distinctions between the structure of the trait lexicon and the structure of personality in individuals are reiterated.

Humans