Initial Lengthening Research Articles

‘This you may NNNNNNEVER have heard before’: initial lengthening of accented negative items as vocal-entangled gestures

‘This you may NNNNNNEVER have heard before’: initial lengthening of accented negative items as vocal-entangled gestures

OSSEOINTEGRATION OUTCOMES FOLLOWING AMPUTEE LENGTHENING

IntroductionPercutaneous EndoProsthetic Osseointegration for Limbs (PEPOL) facilitates improved quality of life (QOL) and objective mobility for most amputees discontent with their traditional socket prosthesis (TSP) experience. Some amputees desiring PEPOL have residual bone much shorter than the currently marketed press-fit implant lengths of 14–16 cm, potentially a risk for failure to integrate. We report on the techniques used, complications experienced, the management of those complications, and the overall mobility outcomes of seven patients who had femur distraction osteogenesis (DO) with a Freedom nail followed by PEPOL.Materials & MethodsRetrospective evaluation of a prospectively maintained database identified nine patients (5 females) who had transfemoral DO in preparation for PEPOL with two years of follow-up after PEPOL. Six patients had traumatic causes of amputation, one had perinatal complications, one was performed to manage necrotizing fasciitis and one was performed as a result of osteosarcoma.ResultsThe average age at which DO commenced was 39.4±15.9 years, and seven patients had their amputation more than ten years prior (average 25.5±18.8 years). The residual femurs on average started at 102.2±39.7 mm and were lengthened 58.1±20.7 mm, 98±45% of goal (99±161% of the original bone length). Five patients (56%) had a complication requiring additional surgery: four events of inadequate regenerate were managed with continued lengthening to desired goal followed by autograft placement harvested from contralateral femur reaming; one patient had the cerclage wires break which required operative replacement. All patients had osseointegration performed, at 355±123 days after the initial lengthening nail surgery. One patient had K-level >2 before DO, at a mean of 3.4±0.6 (2.6–4.4) years following osseointegration six patients had K-level >2. The 6 Minute Walk Test remained unchanged (267±56 vs 308 ± 117 meters). Patient self-rating of prosthesis function, problems, and amputee situation did not significantly change from before DO to after osseointegration. Six patients required additional surgery following osseointegration: six to remove fixation plates placed to maintain distraction osteogenesis length at osseointegration; two required irritation and debridement for infection.ConclusionsExtremely short residual femurs which make TSP use troublesome can be lengthening with externally controlled telescoping nails, and successfully achieve osseointegration. However, it is imperative to counsel patients that additional surgery to address inadequate regenerate or to remove painful hardware used to maintain fixation may be necessary. This may improve the amputee's expectations before beginning on a potentially arduous process.

Constant Light, Pdp1, and Tim Exert Influence on Free-Running Period of Locomotor Rhythms in the Cricket Gryllus bimaculatus.

Most insects show circadian rhythms of which the free-running period changes in a light-dependent manner and is generally longer under constant light (LL) than under constant dark conditions in nocturnal animals. However, the mechanism underlying this LL-dependent period change remains unclear. Here, using the cricket Gryllus bimaculatus, we examined the effects of long-term LL exposure on the free-running period of locomotor rhythms. Initially, the free-running period was considerably longer than 24 h but it gradually became shorter during long-term exposure to LL. The initial lengthening and ensuing gradual shortening under long-term LL exposure were observed even after unilateral removal of the optic lobe. Thus, these changes in the free-running period could be attributable to a single optic lobe clock. RNA interference (RNAi)-mediated silencing of the clock genes Par domain protein 1 (Pdp1) and timeless (tim) revealed that the treatments eliminated the initial period lengthening by LL without reducing circadian photoreceptor gene expression. However, they did not affect the period shortening during long-term LL exposure. The slopes of the regression line for the period change during long-term LL for Pdp1RNAi-treated and timRNAi-treated crickets were not different from that of the dsDsRed2-treated control. These results suggest that the initial period lengthening after transfer to LL requires tim and Pdp1, while the ensuing period shortening during long-term LL exposure is caused by a mechanism independent of tim and Pdp1.

Jejunoileal Atresia: A National Cohort Study.

Purpose: Jejunoileal atresia (JIA) is a rare disease. We aimed to determine the overall incidence of this malformation and associated malformations in a national cohort. Furthermore, we compared the treatment results of this cohort with the current literature.Methods: Data from the major health insurance company, which covers ~30% of the German population, were analyzed. All patients with ICD-10-Code Q41.1-9 (atresia of jejunum, ileum, other parts and not designated parts of the small bowel) who underwent any surgical procedure for small bowel were analyzed in a 10-year period between 2007 and 2016.Results: A total of 435 patients were included in the study. The incidence was 2.1 per 10,000 live births. The male:female ratio was 1:2. Sixty-four percent were premature, 21% had associated cardiac anomalies, 16% had abdominal wall defects, 7% had urogenital malformations, and 7% had cystic fibrosis. Sixty percent of all patients with jejunoileal atresia, 57% of patients with accompanying abdominal wall defects and 72% of patients with associated cystic fibrosis required ostomy as the initial procedure. In 25% of all patients, only one intestinal operation was coded. In 39% of patients, two operations were coded. Twelve percent of all patients required feeding gastrostomy or jejunostomy. Sixteen percent of all patients presented with liver-related complications, i.e., cholestasis or liver insufficiency. Six patients underwent an intestinal lengthening procedure (2 Bianchi, 4 STEP). In five patients, initial lengthening was performed within 1 year after the first intestinal operation. Mortality until 1 year after initial surgery was 5%. Of those who died, 88% were premature, 34% had cardiac anomalies and 16% had abdominal wall defects. None had cystic fibrosis. Patients with ostomy significantly more often needed operative central venous line or operative feeding tube. Short bowel was coded significantly more often in these patients.Conclusion: Patients with JIA present with low mortality. The rate of ostomies is higher than in literature. To give clinical recommendations for the initial surgical approach, further clinical research is needed.

Reproductive Hormone Concentrations and Associated Anatomical Responses: Does Soy Formula Affect Minipuberty in Boys?

Soy formula feeding is common in infancy and is a source of high exposure to phytoestrogens, documented to influence vaginal cytology in female infants. Its influence on minipuberty in males has not been established. To assess the association between infant feeding practice and longitudinally measured reproductive hormones and hormone-responsive tissues in infant boys. The Infant Feeding and Early Development study was a prospective cohort of maternal-infant dyads requiring exclusive soy formula, cow milk formula, or breast milk feeding during study follow-up. In the 147 infant boy participants, serum testosterone, luteinizing hormone, stretched penile length, anogenital distance, and testis volume were longitudinally assessed from birth to 28 weeks. We examined feeding-group differences in age trajectories for these outcomes using mixed-effects regression splines. Median serum testosterone was at pubertal levels at 2 weeks (176 ng/dL [quartiles: 124, 232]) and remained in this range until 12 weeks in all feeding groups. We did not observe differences in trajectories of hormone concentrations or anatomical measures between boys fed soy formula (n = 55) and boys fed cow milk formula (n = 54). Compared with breastfed boys (n = 38), soy formula-fed boys had a more rapid increase in penile length (P = .004) and slower initial lengthening of anogenital distance (P = .03), but no differences in hormone trajectories. Reproductive hormone concentrations and anatomical responses followed similar trajectories in soy and cow milk formula-fed infant boys. Our findings suggest that these measures of early male reproductive development do not respond to phytoestrogen exposure during infancy.

Role of Segmental and Global Left Ventricular Strain in Diagnosis of Acute Coronary Syndrome

Aim To determine the role of left ventricular segmental (SLS) and general longitudinal strain (GLS) in early diagnosis of acute coronary syndrome (ACS).Material and methods The study included 112 patients aged 58±7 years with suspected ACS without a history of ischemic heart disease (IHD) who were admitted to the hospital within 12 h of complaint onset. The control group consisted of 20 healthy, age- and sex-matched subjects. Speckle-tracking echocardiography was performed to assess SLS and GLS on admission and discharge. Ischemia was diagnosed when the SLS was decreased to 14% or lower with a simultaneous post-systolic shortening (PSS) of these segments >20% or when the initial lengthening of the segments was followed by PSS.Results Decreased SLS with PSS of one or more segments was observed in 51.8 % of patients; 16.1% of patients had initial systolic lengthening of one or more segments followed by PSS. In 30.3 % of patients, GLS was 15.5 % or less; 82.3% of these patients had SLS disorders. Later, ACS was diagnosed in 72.3 % of the patients. ACS was not confirmed in 4 (5.2%) of 76 (67.9 %) patients with abnormal SLS changes. All these patients had low SLS values and high PSS values and did not have the initial systolic segmental lengthening. Seven of 9 (8 %) patients with false-negative SLS values had distal narrowing of a coronary artery and two patients had narrowing in the middle part of the artery. All patients with ACS and decreased GSL had a hemodynamically significant narrowing of more than one coronary artery. Incidence of two and more stenosed arteries was higher in patients with PSS and low GSL. Sensitivity and specificity of SLS for diagnosis of acute ischemia were 88.9 and 84.6 %, respectively.Conclusion Assessment of LV strain has high sensitivity and specificity for diagnosis of ACS in patients with the first IHD episode. The presence of PSS associated with decreased GSL may indicate multivascular IHD.

Comportement biomécanique des refixations de tubérosité dans les arthroplasties pour fracture proximale de l’humérus

BackgroundTuberosity repair in shoulder fracture prosthesis implantation still remains a challenge often leading to poor functional outcomes, despite a variety of materials and suggested suture patterns. We aimed to evaluate, which forces currently used suture and cerclage materials withstand and to assess whether they are useful with regard to stability of reconstruction of tuberosities and which failure modes they display. Material and methodsUsing sheep infraspinatus tendons with attached tuberosities three different suture materials (suture 1: Ethibond size 2; suture 2: Orthocord size 2; suture 3: Fiberwire size 5) and a 0.8mm titanium cerclage wire were investigated. For each suture material as well as the cerclage wire 6 tests were carried out. A material testing machine was used to perform cyclic loading tests (20mm/min, Fmin=50N, Fmax=100N, respectively after 50 cycles: Fmax+50N until failure). Outcome measures and thus comparison criteria were the maximum holding force, number of cycles reached, total elongation of the system (tendon and suture) and qualitative appraisal and documentation of the mechanism of failure. ResultsOverall average maximum forces between the fixation materials differed significantly (P=0.003), especially suture 3 (braided polyethylene coating, non-resorbable polyfile UHMW core) displayed superior results in comparison to the cerclage wire (P=0.016). Although, primary elongation of the cerclage technique was significantly lower compared to the suture materials (P=0.002). All tests showed a high initial lengthening and caused incision-like defects in the bone or tendon and led to failure and huge displacement of the tuberosities. DiscussionCurrently used suture and cerclage materials have a limited usefulness for refixation of tuberosities due to an increased risk of obstruction for bony consolidation. Level of evidenceBasic science, biomechanics.

Biomechanical strength and failure mechanism of different tubercula refixation methods within the framework of an arthroplasty for shoulder fracture

BackgroundTuberosity repair in shoulder fracture prosthesis implantation still remains a challenge often leading to poor functional outcomes, despite a variety of materials and suggested suture patterns. We aimed to evaluate, which forces currently used suture and cerclage materials withstand and to assess whether they are useful with regard to stability of reconstruction of tuberosities and which failure modes they display. Material and methodsUsing sheep infraspinatus tendons with attached tuberosities three different suture materials (suture 1: Ethibond size 2; suture 2: Orthocord size 2; suture 3: Fiberwire size 5) and a 0.8mm titanium cerclage wire were investigated. For each suture material as well as the cerclage wire 6 tests were carried out. A material testing machine was used to perform cyclic loading tests (20mm/min, Fmin=50N, Fmax=100N, respectively after 50 cycles: Fmax+50N until failure). Outcome measures and thus comparison criteria were the maximum holding force, number of cycles reached, total elongation of the system (tendon and suture) and qualitative appraisal and documentation of the mechanism of failure. ResultsOverall average maximum forces between the fixation materials differed significantly (P=0.003), especially suture 3 (braided polyethylene coating, non-resorbable polyfile UHMW core) displayed superior results in comparison to the cerclage wire (P=0.016). Although, primary elongation of the cerclage technique was significantly lower compared to the suture materials (P=0.002). All tests showed a high initial lengthening and caused incision-like defects in the bone or tendon and led to failure and huge displacement of the tuberosities. DiscussionCurrently used suture and cerclage materials have a limited usefulness for refixation of tuberosities due to an increased risk of obstruction for bony consolidation. Level of evidenceBasic science, Biomechanics.

Rib-based Distraction Surgery Maintains Total Spine Growth.

For children undergoing treatment of early onset scoliosis (EOS) using spine-based distraction, recently published research would suggest that total spine length (T1-S1) achieved after the initial lengthening procedure decreases with each subsequent lengthening. Our purpose was to evaluate the effect of rib-based distraction on spine growth in children with EOS. This was a retrospective multi-center review of 35 patients treated with rib-based distraction (minimum 5 y follow-up). Radiographs were analyzed at initial implantation and just before each subsequent lengthening. The primary outcome was T1-S1 height, which was also analyzed as: Change in T1-S1 height per lengthening procedure, percent of expected age-based T1-S1 growth per lengthening time interval, percent increase in T1-S1 height as compared with postimplantation total spine height, and percent of expected T1-S1 growth based upon patient age at time of lengthening procedure. Thirty-five patients with a mean age of 2.6 years at initial surgery were studied. Diagnoses included congenital (n=18), syndromic (n=7), idiopathic (n=5), and neuromuscular (n=5). Major Cobb angle was 63.5 degrees and kyphosis was 40.5 degree. Four postoperative time periods were compared: L1 (preoperative first lengthening surgery), L2-L5 (preoperative second lengthening to preoperative fifth lengthening), L6-L10 (preoperative sixth lengthening to preoperative 10th lengthening), L11-L15 (preoperative 11th lengthening to preoperative 15th lengthening). Cobb angle stayed relatively constant for each lengthening period while maximum kyphosis increased. Total spine height was 19.9 cm pre-implantation, 22.1 cm postimplantation, and 28.0 cm by the 15th lengthening (P<0.05). Percent expected T1-S1 growth per lengthening was 62% for L2-L5, 95% for L6-L10, and 52% for L11-L15. As compared with postimplantation spine height, over the course of 15 lengthening procedures, a further 27% increase in spine height was observed. When lengthening procedures were performed when children were under age 5 years, 82% of expected growth was observed; between ages 6 and 10 years, 76% of expected growth was observed; and beyond age 10 years, 14% of expected growth was observed. Patients treated with rib-based distraction surgery had an increase in total spine height from 20 cm preimplantation to 28 cm by the 15th lengthening. They maintained greater than 75% of expected age-matched spine growth until age 10 years and lengthening procedures did not appear to follow a law of diminishing returns. Rib-based distraction is an effective means of maintaining spine growth which is likely beneficial for pulmonary development as compared with the natural history of EOS. Level IV-Therapeutic study, case series.

VEffect of Growing Systems on Hyperkyphotic Deformities

Study Design: Retrospective mini case series, single centre. Objective: To report the efficacy of growing spine distraction-based implants in the treatment of hyperkyphotic and kyphoscoliotic early-onset deformities during initial surgery and lengthening. Background: Growth-sparing implants, such as growing rod and VEPTR-like systems, are distraction-based systems involving repetitive lengthening procedures, which mean that hyperkyphosis may be a relative contraindication in the treatment of early onset deformities. The role of growing implants in the treatment of coronal deformities is now acknowledged, but there are very few studies on the effect of both primary surgery and several lengthening procedures on sagittal balance. Methods: Twenty paediatric patients affected with kyphoscoliosis and surgically treated with growing systems were retrospectively reviewed. Etiology was heterogeneous; there were 10 males and 10 females, aged 7 yrs on average. The dual growing rod technique was used in 9 cases, VEPTR in 11. Preoperative main thoracic scoliosis averaged 64° (range, 10° to 100°) and thoracic kyphosis 71° (60° to 90°),67° in patients with Growing Rods and 77° in those with VEPTR with a history of EOS (Early Onset Scoliosis). At Follow-up ranging from 6 months to 7 years, 31 lengthening procedures had been performed (1.9 per patient). For the purpose of this study, patients were divided into two groups: Growing-Rod Group (GR-group) and VEPTR-like-Group (VL-group); preoperative and postoperative degrees of scoliosis and kyphosis were measured, as well as final results at follow-up. Results: A significant decrease in scoliosis and kyphosis was observed during initial surgery, then a significant loss of correction occurred during the FU period, first on coronal and then on sagittal plane, both in GR-group and in VL-group; however, in the VL-group the loss of correction in terms of kyphosis was significantly higher than in the other group. In particular, after initial surgery, in GR-group thoracic kyphosis was corrected from 67° to 44°, whereas in VLgroup from 77° to 60°. After the lengthening procedures, a loss of correction occurred: in GR-group, thoracic kyphosis increased from 44° to 50° (p<0.05), whereas in VL-group from 58° to 68°. 15 minor complications occurred in 8 patients and revision surgery was performed in 7. Conclusion: Growing implants can be safely used in the treatment of EOS, even in the presence of hyperkyphosis. Distraction procedures inevitably led to the loss of some correction on sagittal plane which was observed at follow-up and was higher in the VL-group. In any case, the final result was mostly related to the correction of kyphosis achieved during initial surgery and in any case the loss of correction was always lower than the first correction obtained. When the cantilever maneuver is performed during initial surgery, growing rods seem to grant a better sagittal plane restoration compared to VEPTR. The complication rate turned out to be a little higher (30%) than the rate observed after general surgical treatment of EOS, thus confirming an increase in complication rate when hyperkyposis is present; the most frequently encountered complication was proximal failure.

Increased Telomere Length in Natural Killer Cells Generated from Human Induced Pluripotent Stem Cells

Telomeres are repetitive DNA protein structures that cap the ends of chromosomes, protect chromosome ends from degradation and fusion, and are essential for maintenance of genomic integrity. Telomere length has been shown to gradually shorten over time as cells divide. When telomeres become critically short, the cells enter a state of senescence; as such, telomere shortening has been implicated in accelerated aging. Natural Killer (NK) cells function as key effector cells of the innate immune system. NK cells have significant cytotoxic activity and are responsible for localized expression of pro-inflammatory cytokines; therefore they play an important role in host defense against malignancy and viral infection. NK cells represent a useful tool for cellular therapy due to their ability to kill target cells in a human leukocyte antigen (HLA) non-restricted manner without prior sensitization. Our lab has pioneered methods for the production of NK cells from human embryonic stem cells (hESCs) and induced pluripotent stem cells (iPSCs). These hESC and iPSC-derived NK cells effectively kill diverse human tumor cells both in vitro and in vivo. One advantage of NK cells from IPSC/hESC sources is the ability to generate a supply of a homogenous NK cell therapy product compared to NK cells isolated from peripheral blood. However, current limitations in therapeutic use of NK cells includes the persistence and expansion of transplanted NK cells in vivo. In order to overcome these barriers, various means for the ex-vivo expansion of large numbers of NK cells prior to administration to patients have been devised. One such method involves propagation of NK cells generated from hESC/iPSC sources with artificial antigen presenting cells (aAPCs). However, aAPC-mediated expansion may lead to telomere shortening. Therefore, aAPCs have been engineered to express either membrane bound IL-15 (mbIL15) or membrane bound IL-21 (mbIL21), which promotes proliferation of NK cells, to ameliorate this effect. We have performed initial studies using real time PCR to measure the telomere length of NK cells generated from iPSC sources and expanded with aAPCs expressing mbIL21 and compared them to aAPC expanded NK cells isolated from peripheral blood. Telomere length in NK cells derived from IPSCs is much longer (200-300kb/diploid genome), compared to those expanded from peripheral blood (<50kb/diploid genome). We will be measuring telomere length and telomerase activity in NK cells expanded using aAPCs expressing mbIL15. In order to better characterize the part that telomeres play in NK cell development, we have also generated iPS cells from fibroblasts of telomerase deficient patients which have mutations in the TERC RNA component. We have demonstrated that these cells appropriately express markers of pluripotency: Oct4, Sox2, SSEA4, and Nanog. We have also demonstrated that these telomerase deficient iPSCs can be differentiated into hematopoietic precursors. The reprogramming of fibroblasts to the pluripotent state results in initial lengthening of telomeres. Telomerase deficient fibroblasts have telomere lengths of 130-150kb/diploid genome compared to normal human fibroblasts with telomeres of ~250kb/diploid genome. After reprogramming, the iPSCs generated from telomerase deficient fibroblasts can have markedly increased telomere lengths to as high as 2000kb/diploid genome. We are currently generating NK cells from these telomerase-deficient iPSCs. We predict that NK cells with longer telomeres from hESC/iPSC sources will persist longer post-transplantation and will be more effective at killing tumor targets and therefore will be superior to those expanded from NK cells from the peripheral blood. We will determine their effectiveness and persistence of these NK cells using in vivo xenograft mouse models. The goal of these studies is to better understand the role of telomerase in lymphocyte development and define methods to better expand or maintain telomeres in therapeutic NK cell-based therapy. DisclosuresNo relevant conflicts of interest to declare.

On the Nature of Blueshifting Hydrogen Bonds

The block-localized wave function (BLW) method can derive the energetic, geometrical, and spectral changes with the deactivation of electron delocalization, and thus provide a unique way to elucidate the origin of improper, blueshifting hydrogen bonds versus proper, redshifting hydrogen bonds. A detailed analysis of the interactions of F(3)CH with NH(3) and OH(2) shows that blueshifting is a long-range phenomenon. Since among the various energy components contributing to hydrogen bonds, only the electrostatic interaction has long-range characteristics, we conclude that the contraction and blueshifting of a hydrogen bond is largely caused by electrostatic interactions. On the other hand, lengthening and redshifting is primarily due to the short-range n(Y)→σ*(X-H) hyperconjugation. The competition between these two opposing factors determines the final frequency change direction, for example, redshifting in F(3)CH⋅⋅⋅NH(3) and blueshifting in F(3)CH⋅⋅⋅OH(2). This mechanism works well in the series F(n)Cl(3)-n CH⋅⋅⋅Y (n=0-3, Y=NH(3), OH(2), SH(2)) and other systems. One exception is the complex of water and benzene. We observe the lengthening and redshifting of the O-H bond of water even with the electron transfer between benzene and water completely quenched. A distance-dependent analysis for this system reveals that the long-range electrostatic interaction is again responsible for the initial lengthening and redshifting.

PHOTON-INDUCED FORMATION OF MOLECULAR HYDROGEN FROM A NEUTRAL POLYCYCLIC AROMATIC HYDROCARBON: 9,10-DIHYDROANTHRACENE

Experimental results from infrared spectroscopy and mass spectrometry provide compelling evidence that UV irradiation of the neutral polycyclic aromatic hydrocarbon (PAH) 9,10-dihydroanthracene (DHA), trapped in solid argon (12 K), results in efficient (i.e., 90% yield) conversion to anthracene and molecular hydrogen. A number of dissociation pathways involving single or double hydrogen loss are investigated computationally. Among these, two mechanisms are most credible for a one-photon dissociation process involving UV photons <5.5 eV. For the lowest-energy pathway (2.3 eV), a simultaneous lengthening of the C-H bonds of H9 and H10 gives rise to an anthracene-H2 complex. A higher-energy mechanism (3.4 eV) involves an initial lengthening of the H9 C-H bond, followed by this hydrogen grabbing H10, and forming H2. The high yield of this photolysis reaction suggests that similar reactions may take place for other neutral PAHs, with implications for the formation of molecular hydrogen in regions of low UV exposure, such as in dark clouds.

POSTERIOR CRUCIATE LIGAMENT (PCL) RECONSTRUCTION BY TRANSTIBIAL TUNNEL: SUGGESTIONS OF LENGTHENING AND SLIPPAGE RATIO

This paper examined the biomechanical fatigue behavior of Achilles tendon autograft after posterior cruciate ligament (PLC) reconstructions. It experimented with various fixation devices and locations on the degree of initial lengthening and slippage to investigate the relationship between lengthening and slippage ratios among calcaneal and soft tissue fixation methods. Eight specimens of proximal tibia and Achilles tendon grafts were harvested from cadavers and classified into four groups according to the type of transtibial fixation technique. A cyclic load ranging from 50N to 250N was applied to each graft when fixed to the proximal tibia at 55 degrees. The soft tissue fixation method, which uses an interference screw, demonstrated a 56.4% ratio of slippage to total elongation. The use of a double cross-pin with the same method demonstrated a 45.4% slippage ratio. The former was associated with approximately 2 mm less total elongation and 13% more slippage than lengthening compared to the latter. This result was predominantly due to the poor standard of fixation compared to the same method using a double cross-pin.

Repeat STEP procedure to establish enteral nutrition in an infant with short bowel syndrome

The serial transverse enteroplasty (STEP) procedure is a safe and successful way to lengthen the small bowel in patients with short bowel syndrome. However, postoperative dilatation of the intestine may occur, which induces bacterial overgrowth and malabsorption leading to liver failure. We describe the case of an infant boy with short bowel syndrome caused by jejunal atresia requiring the STEP procedure twice. The first STEP improved the liver function, and the second STEP allowed 80% of the total calorie intake to be tolerated enterally. One should not hesitate to perform a second STEP if after the initial bowel lengthening procedure the patient develops small bowel dilatation that interferes with enteral nutrition.

사체 아킬레스건을 이용한 경골관통터널방식의 후방십자인대 재건술 - 간섭나사 및 이중고정핀 방식에 따른 초기연신 및 활주율 평가 -

Posterior Cruciate Ligament (PCL) plays an important role in knee extension. Rotational instability due to injured PCL can be restored by various PCL reconstruction methods. In this study, the initial lengthening affected by fixation device and location was demonstrated, and furthermore, the slippage and the relationship between lengthening ratio and slippage ratio in the calcaneus and soft tissue fixation methods was newly suggested. Eight specimens of proximal tibia and Achilles tendon grafts were harvested from four cadavers and divided into four groups in regard to the four different types of transtibial fixation techniques. The cyclic load ranged from 50 N to 250 N applied to each graft fixed to proximal tibia in 55 degrees. The initial lengthening ratio to the total elongation has been approximately constant regardless of the fixation methods. The soft tissue fixation method with an interference screw showed about 56.4% slippage ratio to the total elongation and the same method with a double cross-pin presented about 45.4% slippage ratio. The soft tissue fixation method with an interference screw demonstrated approximately 2 ㎜less total elongation and about 13% more slippage than lengthening because of poor fixation compared to the same method with a double cross-pin.

Spatiotemporal change in China's frost days and frost‐free season, 1955–2000

From 1955 to 2000, China has experienced a decrease in the number of frost days, while the length of the frost‐free season between the last spring freeze and the first fall frost has increased. Three distinct regimes can be detected in the time series: up to about 1973, the annual number of frost days was about 2 d higher than the 1961–1990 average; from 1973 to 1985, the annual number of frost days held close to that average with remarkably little interannual variability; and after 1985, the annual number of frost days decreased rapidly with distinct reversal around 1992. The dates of first and last frost show two patterns: before 1980, these dates fluctuated around the 1961–1990 average, but after 1980 (and especially from 1993) the frost‐free season was rapidly lengthened. The numbers of frost days are highly correlated with minimum temperature (Tmin) in north China in spring and fall; while in south China frost dates correlate with minimum temperatures in winter. Generally, the seasonal relationships between Tmin and frost days are significant in both the temporal and spatial domains when seasonal average Tmin falls within a range of ±10°C. Analyzing annual and seasonal influences on the number of frost days, we find that water vapor plays a significant role. Regionally, the greater influence on the length of the frost‐free season in south China has been the delayed onset of the autumn frost, while in north China the spring and autumn dates each have a comparable influence on the length of the frost‐free season. The initial lengthening of the frost‐free season lagged about 10 years behind the rapid increase in daily minimum temperatures, while the decrease in the annual number of frost days lagged by about 15 years.

Repeat Surgical Bowel Lengthening With the STEP Procedure

Feasibility of repeat lengthening has been demonstrated in animals, but in humans, none of the three clinical case reports have achieved enteral autonomy after secondary lengthening with serial transverse enteroplasty (STEP). Institutional Review Board approved retrospective review of a single center series of repeat intestinal lengthening after prior Bianchi lengthening or STEP. Outcome measures examined include patient survival, weaning from parenteral nutrition, and need for intestinal transplantation. Repeat lengthening with STEP was performed 16 times in 14 patients including 2 adults and 7 male patients after prior Bianchi (n=7) and prior STEP (n=7). Median time after initial lengthening to reSTEP was 12 months (2 months-15 years). Median remnant bowel length before initial lengthening was 35 cm (15-110), before reSTEP was 56.5 cm (27-100) and final length after reSTEP was 90 cm (39-120). Survival is 100% with a median follow-up of 14.5 months (1-65 months). Discontinuation of parenteral nutrition (PN) after reSTEP was achieved in 6 of 14 (43%) patients at a median of 3 months (0.5-13 months) after reSTEP. Intestinal transplant salvage was performed in four patients at 7, 9, 13 months, and 4.6 years, respectively, after reSTEP. All four of those undergoing intestinal transplantation have also subsequently discontinued PN. Repeat lengthening is technically feasible after either of the available surgical lengthening procedures (Bianchi and STEP). In the stable patient, who is unable to wean from PN, repeat lengthening led to discontinuation of TPN in almost half of these carefully selected patients and does not preclude intestinal transplantation.

Prosodic strengthening of German fricatives in duration and assimilatory devoicing

This study addressed prosodic effects on the duration of and amount of glottal vibration in German word-initial fricatives /f, v, z/ in assimilatory and non-assimilatory devoicing contexts. Fricatives following /ə/ (non-assimilation context) were longer and were produced with less glottal vibration after higher prosodic boundaries, reflecting domain-initial prosodic strengthening. After /t/ (assimilation context), lenis fricatives (/v, z/) were produced with less glottal vibration than after /ə/, due to assimilatory devoicing. This devoicing was especially strong across lower prosodic boundaries, showing the influence of prosodic structure on sandhi processes. Reduction in glottal vibration made lenis fricatives more fortis-like (/f, s/). Importantly, fricative duration, another major cue to the fortis-lenis distinction, was affected by initial lengthening, but not by assimilation. Hence, at smaller boundaries, fricatives were more devoiced (more fortis-like), but also shorter (more lenis-like). As a consequence, the fortis and lenis fricatives remained acoustically distinct in all prosodic and segmental contexts. Overall, /z/ was devoiced to a greater extent than /v/. Since /z/ does not have a fortis counterpart in word-initial position, these findings suggest that phonotactic restrictions constrain phonetic processes. The present study illuminates a complex interaction of prosody, sandhi processes, and phonotactics, yielding systematic phonetic cues to prosodic structure and phonological distinctions.

Radius Lengthening for the Treatment of Bayne and Klug Type II and Type III Radial Longitudinal Deficiency

We performed radius lengthening to treat radial deviation of the wrist in patients with Bayne and Klug type II and type III radial longitudinal deficiencies. The purpose of this investigation was to review our results of radius lengthening for radial longitudinal deficiency. Beginning in 1991 radius lengthening was performed to treat 4 patients with radial longitudinal deficiency whose mean age at the initial lengthening was 16 months. The corrections for radial deviation of the wrists were performed simultaneously by soft-tissue distraction of the wrist. According to Bayne and Klug's classification 2 patients had type II and 2 patients had type III deficiencies. All but 1 patient had lengthening several times to correct the recurring discrepancy between the radius and the ulna. The corrections were achieved just after the lengthening but deformities recurred because of growth discrepancies between the radius and the ulna as the children grew. The radius was lengthened by a mean of 28 mm, with a mean length gain of 79%. The mean period in the fixator was 136 days. Two patients had both functionally and cosmetically acceptable correction after several lengthening procedures. In the other patient we abandoned this treatment method because of severe bone absorption at the distal end of the lengthened radius. One patient died of cardiac disease after one lengthening. Radius lengthening for Bayne and Klug type II and type III deficiencies may be accomplished successfully with the primary benefit of maintaining wrist and forearm motion. It is likely that at least 3 lengthenings may be required and this may need to be accompanied by a soft-tissue distraction at the ulnar carpal joint as well. Therapeutic, Level IV.