Extrinsic Forms Research Articles

Classification of elbow stiffness and indications for surgical treatment

An elbow can become stiff for a variety of reasons, such as intra-articular or extra-articular fractures, soft-tissue trauma, prolonged immobilization, thermal injury, infection, inflammatory arthritis, osteoarthrosis and heterotopic bone formation. Elbow stiffness is usually classified into extrinsic (affecting the capsule and extra-articular soft tissues), intrinsic (affecting the synovial and intra-articular structures) and mixed forms. Indications for operative treatment have to be considered in cases of failed conservative treatment with severe functional deficits. The choice of operative treatment has to be based on a thorough analysis of the underlying cause, the affected structures, the pathogenesis and the individual needs. Options are an arthroscopic or open arthrolysis, endoprostheses, hinged external fixators, interposition arthroplasty or combinations of these procedures.

Extrinsic and intrinsic motivations to innovate: tracing the motivation of ‘grassroot’ innovators in India

Extrinsic motivations like intellectual property protections and fiscal incentives continue to occupy the centre stage in debates on innovation policies. Joseph Schumpeter had, however, argued that the motive to accumulate private property can only explain part of innovative activities. In his view, “the joy of creating, of getting things done” associated with the behavioural traits that “seek out difficulties…and takes delight in ventures” stand out as the most independent factor of behaviour in explaining innovation and economic development, especially in early capitalist societies. Taking the case of ‘grassroot’ innovators in India, we re-examine the motivations behind innovative behaviour. Drawing upon the theory of effectance motivation we construct operational indicators of extrinsic and intrinsic motivations to innovate. Interestingly, we find that pure extrinsic forms of motivation drive only a fraction of individual innovative behaviour. A large amount of innovative behaviour is motivated either by intrinsic motivations or by a combination of intrinsic and extrinsic motivations. Also, conceptualising innovation as a three stage process involving idea generation, experimentation and application, we find evidence of motivation-shifts. The importance of intrinsic motivation is comparatively greater during the early stage, when uncertainty about innovation is high. The importance of extrinsic motivation, on the other hand, increases when innovation is complete, awaiting application. We then outline a few implications of these findings for policy making.

Atopic Dermatitis in the Elderly

Though atopic dermatitis (AD) is relatively uncommon in the elderly, elderly patients with AD are gradually increasing in industrialized countries associated with an aging society. Therefore, the clinical features of senile AD are becoming more apparent in some aspects. Three patterns of onset-senile onset, recurrence of AD with a history of classic childhood AD, and recurrence or continuation of adult AD-are associated with AD in the elderly. A male predominance in elderly AD may be a characteristic feature that differs from adult AD. Localized lichenifications in the folds of elbows and knees that are typical of classic AD are uncommon. Similar to AD in the other age groups, both extrinsic and intrinsic forms of AD exist in the elderly, and the major environmental allergens in the extrinsic form are house dust mite, followed by pollens and foods. In addition to the clinical features, this review focuses on the pathogenesis, diagnosis, management and future directions of this new subgroup of AD.

Immunologic advances of atopic dermatitis

Atopic dermatitis (AD) is a pruritic inflammatory skin disease that often occurs in early childhood. AD follows a chronic and relapsing course, and is considered to be the initial clinical manifestation of an atopic state. Two forms of AD have been delineated: extrinsic and intrinsic forms. Both forms are characterized by associated eosinophilia. Acquired immunity involves a complex series of interactions between resident and infiltrating cells, and is mediated by a complex network of proinflammatory cytokines and chemokines. Defects in innate immunity may contribute to the propensity for microbe colonization. Key words: Dermatitis,atopic; Immunity

Afterlife Motivation Scale: Correlations With Maladjustment and Incremental Validity in Iranian Muslims

In a previous study of Iranian Muslims, two scales measuring religious commitments based on a desire to avoid hell and to reach heaven predicted maladjustment. The responding of Iranian university students in this investigation revealed that these two forms of desire could be reduced to a single factor that was adequately operationalized in a brief six-item instrument. This Afterlife Motivation Scale displayed strong internal consistency and correlated positively with the extrinsic personal, extrinsic social, and intrinsic religious orientations and with nearness to God, depression, anxiety, and death anxiety. Multiple regression analyses indicated that this scale recorded a specific form of religious psychological functioning that could not be reduced to more general intrinsic and extrinsic forms of religiousness. This brief instrument could be useful in future efforts to better understand one way in which heaven and hell might be meaningful for Iranian and perhaps other Muslims and for followers of other religious traditions.

The Technologies of Normalization and Self

In this article, the authors discuss the technologies of normalization and self in relation to ethics and the problematization of extrinsic research ethics. They argue that institutional review boards (IRBs) and other similar institutional mechanisms promote extrinsic forms of ethics that are exemplified through institutionalized structures such as (a) the Belmont Report, (b) IRB protocol, (c) informed consent, and (d) localized interpretations of IRB rules and regulations. However, at the same time, institutional normalization enables researchers and participants to construct themselves as ethically responsible participants through resistance and critical reflection. Such “care of the self” and critical awareness of dominant discourses and regimes of power and knowledge are essential to the development and practice of research that is ethical, free, and responsive. Finally, the authors conclude that the discussions about researchers' ethical decision making and freedom of choice need to be separate from discussions related to researchers' compliance, duties, and institutional responsibilities.

Management of ureteral endometriosis: areas of controversy

In this review we critically evaluate what we know and what we still do not know about pathogenesis, diagnosis and treatment of ureteral endometriosis, highlighting areas of controversy. Recent studies have produced new insights into diagnostic and management options for ureteral endometriosis. The diagnosis of ureteral endometriosis entails a high index of suspicion for the disorder. Imaging techniques are of limited value in providing an accurate depiction of extension of ureteral lesions. Preliminary results suggest that magnetic resonance urography is accurate in differentiating between intrinsic and extrinsic forms of ureteral involvement, but further studies are required to define its role in directing better treatment. Current controversies in the treatment of ureteral endometriosis are over whether segmental resection and anastomosis or ureterolysis are indicated, and whether minimal-access procedures are equally effective than their traditional open counterparts. Recent studies suggest that laparoscopic ureterolysis can be an effective treatment option in most patients with ureteral endometriosis but that recurrence rates are not negligible, as suggested in pioneering works. Successful application of laparoscopic surgery, even for procedures that have traditionally necessitated laparotomy, has been reported. Extensive experience with endourological techniques is prerequisite for success.

Nature-inspired Computation — Effective Realization of Artificial Intelligence

Abstract In nature-inspired computation, different intelligent computation modes of agents usually have different extrinsic forms; but can they take on some relative uniform characteristics? To validate this idea, further systematic study on nature-inspired computation from a more macroscopical angle is made in this article and the uniform framework mode of nature-inspired computation is consequently summarized and presented, as well as described with feedback neural network and swarm intelligence algorithms. On the basis of the defined general mode framework, agents of the algorithms in a nature-inspired computation field can show a type of uniform intelligent computation mode.

Atopic dermatitis, extrinsic atopic dermatitis and the hygiene hypothesis: results from a cross‐sectional study

Atopic Dermatitis (AD), hayfever and asthma are commonly summarized as atopic diseases. The spatial distribution of AD differs from that of asthma and hayfever, suggesting that AD might follow a different risk pattern than these diseases. AD can be differentiated into an allergic extrinsic form (EAD) and a non-allergic intrinsic form (IAD). Only EAD might follow the distribution and risk pattern that have been ascribed to asthma and hayfever. To investigate the distribution and risk factor profile of AD and EAD focusing on environmental factors relating to the hygiene hypothesis. Population-based cross-sectional study on 12,601 children aged 5-7 and 9-11 years from Dresden (Eastern Germany) and Munich (Western Germany). Information was obtained by International Study of Asthma and Allergic Childhood questionnaires, dermatological examinations and skin prick testing. AD-diagnosis ever, current AD-symptoms and visible eczema were investigated with their respective extrinsic forms. Maternal and paternal history of AD were equally strong determinants of the child's AD status. Factors related to the hygiene hypothesis like day-care attendance and number of older siblings were not associated with a decreased risk of AD. The proportion of EAD within AD was higher in Eastern than in Western Germany. The determinants of the diseases appeared to be similar for both EAD and IAD. There was no evidence of the hygiene hypothesis holding true for AD or EAD. AD might be a separate entity than respiratory atopic diseases. Little is known about the risk factors of AD and factors different from those of respiratory allergic diseases should be considered in future research.

Structure in amorphous semiconductors: Extrinsic and intrinsic

A detailed study of the atomic-scale structure of amorphous semiconductors utilizing Extended X-ray Absorption Fine Structure (EXAFS) spectroscopy is reported. Samples were examined in both extrinsic (preparation specific) and intrinsic (minimum energy) forms. The amorphous elemental semiconductors exhibit structural disorder in the form of both bond-length and bond-angle distortions. As formed, amorphous Ge displays a fabrication-dependent non-Gaussian inter-atomic distance distribution with implantation-induced defects in the amorphous phase accommodated as three- and five-fold coordinated atoms. Thermal annealing yields a reduction in both bond-length and bond-angle distortion, as measured by EXAFS and Raman spectroscopies, respectively, where the total relaxation enthalpy is consistent with differential scanning calorimetry measurements. In a fully-relaxed state, amorphous Ge retains four-fold coordination and the inter-atomic distance distribution is Gaussian and independent of the implanted ion dose.The amorphous compound semiconductors contain chemical disorder in addition to structural disorder. As formed, amorphous compound semiconductors including the Ga and In phosphides and arsenides all exhibit chemical disorder manifested as homopolar bonding. Though low-temperature thermal annealing lessens the Debye–Waller factor and the homopolar bonding fraction, the latter is not eliminated. Point-defect annealing in the form of homopolar bond annihilation is thus operative during structural relaxation of the amorphous phase. Residual chemical disorder necessitates the presence of odd-membered rings and thus demonstrates the elastic energy required to produce a continuous-random-network without homopolar bonding (or equivalently with only even-membered rings) must exceed the Coulomb energy inherent with anion–anion or cation–cation repulsion.

Doxorubicin activates nuclear factor of activated T-lymphocytes and Fas ligand transcription: role of mitochondrial reactive oxygen species and calcium

Doxorubicin (DOX), a widely used antitumour drug, causes dose-dependent cardiotoxicity. Cardiac mitochondria represent a critical target organelle of toxicity during DOX chemotherapy. Proposed mechanisms include generation of ROS (reactive oxygen species) and disturbances in mitochondrial calcium homoeostasis. In the present study, we probed the mechanistic link between mitochondrial ROS and calcium in the embryonic rat heart-derived H9c2 cell line and in adult rat cardiomyocytes. The results show that DOX stimulates calcium/calcineurin-dependent activation of the transcription factor NFAT (nuclear factor of activated T-lymphocytes). Pre-treatment of cells with an intracellular calcium chelator abrogated DOX-induced nuclear NFAT translocation, Fas L (Fas ligand) expression and caspase activation, as did pre-treatment of cells with a mitochondria-targeted antioxidant, Mito-Q (a mitochondria-targeted antioxidant consisting of a mixture of mitoquinol and mitoquinone), or with adenoviral-over-expressed antioxidant enzymes. Treatment with GPx-1 (glutathione peroxidase 1), MnSOD (manganese superoxide dismutase) or a peptide inhibitor of NFAT also inhibited DOX-induced nuclear NFAT translocation. Pre-treatment of cells with a Fas L neutralizing antibody abrogated DOX-induced caspase-8- and -3-like activities during the initial stages of apoptosis. We conclude that mitochondria-derived ROS and calcium play a key role in stimulating DOX-induced 'intrinsic and extrinsic forms' of apoptosis in cardiac cells with Fas L expression via the NFAT signalling mechanism. Implications of ROS- and calcium-dependent NFAT signalling in DOX-induced apoptosis are discussed.

Towards a proteomic analysis of atopic dermatitis: a two-dimensional-polyacrylamide gel electrophoresis/mass spectrometric analysis of cultured patient-derived fibroblasts.

Atopic dermatitis (AD) is a chronic relapsing inflammatory skin disease typically characterized by a distribution of eczematous skin lesions with lichenification, pruritic excoriations, and dry skin with wide varieties of pathophysiologic aspects. Recently, AD was divided into extrinsic and intrinsic forms according to the presence or absence of an allergy. We investigated alterations in protein expression in primary cultured AD cells from the patient biopsy samples by two-dimensional gel electrophoresis (2-DE) and matrix-assisted laser desorption/ionization-time of flight. In the primary cultured fibroblasts, we obtained 31 candidate proteins from the two-dimensional gel image analysis in which 18 proteins were up-regulated, eight proteins were down-regulated and five proteins were post-translationally modified. From these 2-DE results, we found several candidate genes matched proteomic expression patterns by semiquantitative reverse transcription PCR. Since the exact mechanism of atopic alterations in fibroblasts remains unknown, our results may provide new clues to aid in understanding AD.

Personality and self-determination of exercise behaviour

There is extensive evidence that personality traits are associated with health-related behaviours, but less evidence regarding the underlying mechanisms. In this study, we examined the relationships between personality and self-determination of exercise behaviour. Users of a sports centre completed personality scales (the NEO Five Factor Inventory supplemented with the Eysenck Personality Questionnaire Psychoticism scale) and exercise self-determination scales (Behavioural Regulation in Exercise Questionnaire which measures extrinsic, introjected, identified and intrinsic forms of regulation). Analyses were restricted to 182 individuals in the maintenance stage of exercise participation. Partial correlation analysis was used to examine the relationships between each personality scale and the self-determination scales, controlling for other personality scales, gender and age. Neuroticism was associated with more introjected regulation, extraversion with more identified and intrinsic regulation, openness with less external regulation, conscientiousness with less external regulation and more intrinsic regulation, and psychoticism with more external regulation. Relating these findings to self-determination theory (Deci & Ryan, 2000), it is speculated that extraverted individuals are able to feel self-determined because exercise can satisfy the need for relatedness, conscientious individuals because exercise can satisfy the need for competence. Furthermore, conscientious individuals may have greater wherewithal to advance along the continuum of behavioural regulation.

The Interleukin-13 Production by Peripheral Blood T Cells from Atopic Dermatitis Patients Does Not Require CD2 Costimulation

Background: Although allergic mechanisms appear to be important, the pathogenesis of both extrinsic and intrinsic forms of atopic dermatitis (AD) is unknown. Methods: We compared the cytokine production of peripheral blood mononuclear cells of extrinsic AD (EAD) and intrinsic AD (IAD) patients and normal control individuals after stimulation with anti-CD3 and/or anti-CD28 monoclonal antibodies (mAbs) in the presence or absence of anti-CD2-blocking mAb. The cytokine production was measured by immunoassays in supernatants of 24-hour cultures. Results: EAD patients showed a decreased capacity to synthesize interferon gamma and granulocyte-macrophage colony-stimulating factor upon anti-CD3 mAb stimulation as compared with IAD patients. Both EAD and IAD patients demonstrated an increased production of interleukin (IL)-5 and IL-13. As expected, interferon gamma, granulocyte-macrophage colony-stimulating factor, and IL-5 levels were reduced in the presence of anti-CD2-blocking mAbs. CD28 costimulation restored the release in cultures with anti-CD2 mAbs added, suggesting that CD2 and CD28 have redundant functions in T cell activation and subsequent cytokine production. Strikingly, the IL-13 production was not blocked by anti-CD2 mAbs and also not increased by agonistic anti-CD28 mAb, in particular within the EAD patient group. Conclusion: The signalling pathway initiated by the T cell receptor complex leading to increased IL-13 production in AD patients appears to be highly sensitive and is largely independent on CD2 costimulatory signals.

Memory of vortex matter within and outside the peak effect region

Two types of memory effects have been observed in magnetostriction measurements on NbTi alloy samples within and outside the peak effect region. Intrinsic and extrinsic forms of disorder are argued to be responsible for each of them. The asymmetry between the fields marking the entrance and exit of the peak region is found to scale with the size of the samples, which contradicts the first-order phase transition between the ordered and disordered states.

CD34+ cells in peripheral blood of healthy human beings and allergic subjects: clue to acute and minimal persistent inflammation

There is compelling evidence that hemopoietic precursor cells (HPC) play a crucial role in establishing cellular inflammation in allergic diseases. Increased levels of circulating CD34+ HPC committed to the myeloid lineage have been extensively reported in allergic rhinitis, asthma and eczema, whereas CD34+ cells have been identified within the cellular infiltrates of tissues, at peripheral sites of inflammation. We conducted a pilot study to evaluate CD34+ traffic in the peripheral blood of 22 consecutive patients (13 men and nine women; mean age 28.9 years), independently of treatment. The patients presented rhinitis, asthma, eczema, urticaria and adverse food reactions of suspected allergic origin. Allergic reactions were extrinsic in 18 patients and intrinsic in four. In 12 patients who underwent sublingual specific immunotherapy, CD34+ cells were quantified at enrollment (T0), one year later (T1) and two years later (T2). The severity of symptoms was graded on a five-point scale (0 = absence of symptoms and 4 = severe symptoms). Twenty healthy human subjects (10 men and 10 women; mean age 24.5 years) were evaluated as controls. To obtain information about the total amount of circulating HPC, independently of the lineage commitment (Lin+/-) and the degree of differentiation (CD34bright/dim), we used a modification of the Milan protocol of peripheral blood CD34+ cell estimation. The cells were analyzed using a BD FACScan or FACSCalibur and the results were expressed as the percentage of positive cells. CD34+ cell traffic in the control group was very low since all values were < 0.10 (median value: 0.03 %). Values in the patient group were increased in both extrinsic and intrinsic forms with a median value of 0.25 % (interquartile range: 0.13- 0.33 %). The relationship between CD34+ traffic and the severity score was highly significant (Spearman's rho = 0.954; test of Ho: CD34; independent score: Pr > t = 0.000). The data reported herein suggest that the method employed is effective in assessing acute allergic inflammation, as well as minimal persistent inflammation underlying an asymptomatic clinical condition. Evaluation of CD34bright/dim peripheral traffic, if confirmed by the outcomes of a multicenter study currently being planned together with traditional study of circulating IgE, could be a reliable non-invasive laboratory tool for monitoring allergic inflammation.

Phenotyping of epidermal dendritic cells allows the differentiation between extrinsic and intrinsic forms of atopic dermatitis

Atopic dermatitis (AD) is a clinically characteristic, chronic inflammatory skin disease of unknown origin. IgE-mediated uptake and antigen focusing of environmental allergens by dendritic cells (DCs) is assumed to be a central immunopathogenetic event. A so-called intrinsic type of AD (IAD) has been delineated from the more common extrinsic AD (EAD) by normal serum IgE levels, negative RAST tests and negative immediate-type skin reactions towards environmental allergens. The recently characterized human autoantigen Hom S 1 has been proposed to play a part in the pathogenesis of IAD. To compare clinical and laboratory data between patients with IAD and EAD, and to investigate potential differences in the inflammatory micromilieu of the epidermal compartment in IAD and EAD lesions. Epidermal DC phenotyping, a recently validated technique based on the three-colour flow cytometric analysis of Langerhans cells and the so-called inflammatory dendritic epidermal cells from epidermal single-cell suspensions, was performed on samples from 69 patients with AD (seven with IAD and 62 with EAD) and 94 controls. Patients with EAD tended to have an earlier onset of disease but similar disease duration and family history of atopic diseases. Quantitative analysis of CD36 expression on DCs as a marker of inflammation, as well as the percentage of inflammatory dendritic epidermal cells in the CD1a+ epidermal DC pool, indicated a comparable disease activity in IAD and EAD. EAD was characterized by a significantly higher FcepsilonRI expression on the CD1a+ epidermal DCs than IAD. Using the FcepsilonRI/FcgammaRII expression ratio as a disease marker for AD, values for IAD fell below the diagnostic cut-off level of 1.5 for this ratio. While IAD is clinically similar to EAD, the inflammatory microenvironment in this condition seems different from classical EAD and can be distinguished by phenotyping of epidermal DCs.

Bilateral ureteral endometriosis with end-stage renal failure

Only 16 cases of bilateral ureteral endometriosis have been reported to date. A contiguous spread of the disease in generally thought to be the mechanism of ureteral involvement. We report a case in which the left ureter contains both intrinsic and separated extrinsic forms and the right one an extrinsic form of endometriosis, giving use the opportunity to discuss the different pathogenetic mechanisms and to suggest that dissemination of endometriosis by lymphatic pathways is the most probable explanation.

Effect of respiratory and other virus infections on IgE immunoregulation

An association between respiratory infections and subsequent development of asthma was noted by Hippocrates.’ He also recognized the hereditary nature of asthma, which was confirmed formally first by Cooke and VanderVeer’ and later by others. Asthma was classified into extrinsic (allergic) and intrinsic (infectious) forms by Rackemand; this has been a useful working hypothesis, although we now recognize the inflammatory nature of chronic asthma. Clinicians have known for years that respiratory tract infections often precede asthma attacks. In young children (younger than 5 years) before and during asthma attacks, respiratory syncytial virus and parainfluenza infections were documented by direct isolation or rising antibody titers in 41% of subjects in the classic study by McIntosh et al4 In older children and adults, Minor et a1.5 found that rhinoviruses and influenza were commonly implicated in asthmatic episodes.

Readings in Speech Following Total Laryngectomy

This book represents an extensive compilation of 54 articles concerning basic and clinical research and rehabilitation of alaryngeal speech development. In an attempt to represent a wide variety of topics and disciplines, several outstanding articles are presented. Among them, articles by Diedrich, Snidecor, Berlin, Barney, and Simpson proved interesting. The editor has divided the book into five parts. Part 1 includes two historical papers involving early laryngectomy and rehabilitation. Part 2 presents papers on buccal and pharyngeal contributing to what the editor describes as forms of alaryngeal voice and Continuing with intrinsic forms of alaryngeal part 3 offers an extensive review of the literature involving esophageal speech. Parts 4 and 5 review what the editor refers to as extrinsic forms of alaryngeal voice and speech, including artificial larynges and surgical-prosthetic methods, respectively. One noted omission from part 5 is the puncture technique with a duckbill prosthesis