B-type natriuretic peptide and cirrhosis progression

Brain natriuretic peptide (BNP) is used as a marker of cardiac dysfunction to predict heart failure mortality. The significance of the prognostic ability of BNP for liver cirrhosis remains unknown, although the levels of BNP seen in cirrhosis are high. We aimed to determine whether the BNP level is related to the stage of cirrhosis and could serve as a prognostic marker of cirrhosis (predict the 1-year all-cause mortality). We recruited 92 patients at different stages of cirrhosis and 81 controls matched by age and gender for this study. At admission, cardiac physical examination and BNP measurements were performed. Upon discharge, the 89 patients were followed up for 12 months. The median BNP levels of patients with cirrhosis were 167.0 pg/mL, which were significantly higher than those of the control group (167.0 vs 34.8 pg/mL, P = 0.001). Serum BNP levels were positively correlated with the Child score, the grade of esophageal varices, a history of spontaneous bacterial peritonitis, and the presence of ascites and collateral circulation. BNP levels above the median were associated with an increased occurrence of death within 12 months of discharge (log rank P = 0.025), as determined by univariate and multivariate Cox regression analyses. Esophageal varices, large/medium volume ascites, and BNP levels were related to the clinical outcome (P = 0.034, 0.030, and 0.025, respectively). Together, these results suggested that serum BNP levels are significantly correlated with the stage of cirrhosis, suggesting that BNP levels might serve as a significant predictor for 1-year all-cause mortality.

Search for a light sterile neutrino at Daya Bay

A search for light sterile neutrino mixing was performed with the first 217 days of data from the Daya Bay Reactor Antineutrino Experiment. The experiment's unique configuration of multiple baselines from six 2.9 GW(th) nuclear reactors to six antineutrino detectors deployed in two near (effective baselines 512 m and 561 m) and one far (1579 m) underground experimental halls makes it possible to test for oscillations to a fourth (sterile) neutrino in the 10(-3) eV(2)<|Δm(41)(2) |< 0.3 eV(2) range. The relative spectral distortion due to the disappearance of electron antineutrinos was found to be consistent with that of the three-flavor oscillation model. The derived limits on sin(2) 2θ(14) cover the 10(-3) eV(2) ≲ |Δm(41)(2)| ≲ 0.1 eV(2) region, which was largely unexplored.

Establishment of a novel, eco-friendly transgenic pig model using porcine pancreatic amylase promoter-driven fungal cellulase transgenes

Competition between humans and livestock for cereal and legume grains makes it challenging to provide economical feeds to livestock animals. Recent increases in corn and soybean prices have had a significant impact on the cost of feed for pig producers. The utilization of byproducts and alternative ingredients in pig diets has the potential to reduce feed costs. Moreover, unlike ruminants, pigs have limited ability to utilize diets with high fiber content because they lack endogenous enzymes capable of breaking down nonstarch polysaccharides into simple sugars. Here, we investigated the feasibility of a transgenic strategy in which expression of the fungal cellulase transgene was driven by the porcine pancreatic amylase promoter in pigs. A 2,488 bp 5'-flanking region of the porcine pancreatic amylase gene was cloned by the genomic walking technique, and its structural features were characterized. Using GFP as a reporter, we found that this region contained promoter activity and had the potential to control heterologous gene expression. Transgenic pigs were generated by pronuclear microinjection. Founders and offspring were identified by PCR and Southern blot analyses. Cellulase mRNA and protein showed tissue-specific expression in the pancreas of F1 generation pigs. Cellulolytic enzyme activity was also identified in the pancreas of transgenic pigs. These results demonstrated the establishment of a tissue-specific promoter of the porcine pancreatic amylase gene. Transgenic pigs expressing exogenous cellulase may represent a way to increase the intake of low-cost, fiber-rich feeds.

Radiation doses of cerebral blood volume measurements using C-arm CT: A phantom study

BACKGROUND AND PURPOSE

Parenchymal blood volume measurement by C-arm CT facilitates in-room peritherapeutic perfusion evaluation. However, the radiation dose remains a major concern. This study aimed to compare the radiation dose of parenchymal blood volume measurement using C-arm CT with that of conventional CTP using multidetector CT.

MATERIALS AND METHODS

A biplane DSA equipped with C-arm CT and a Rando-Alderson phantom were used. Slab parenchymal blood volume (8-cm scanning range in a craniocaudal direction) and whole-brain parenchymal blood volume with identical scanning parameters, except for scanning ranges, were undertaken on DSA. Eighty thermoluminescent dosimeters were embedded into 22 organ sites of the phantom. We followed the guidelines of the International Commission on Radiation Protection number 103 to calculate the effective doses. For comparison, 8-cm CTP with the same phantom and thermoluminescent dosimeter distribution was performed on a multidetector CT. Two repeat dose experiments with the same scanning parameters and phantom and thermoluminescent dosimeter settings were conducted.

RESULTS

Brain-equivalent dose in slab parenchymal blood volume, whole-brain parenchymal blood volume, and CTP were 52.29 ± 35.31, 107.51 ± 31.20, and 163.55 ± 89.45 mSv, respectively. Variations in the measurement of an equivalent dose for the lens were highest in slab parenchymal blood volume (64.5%), followed by CTP (54.6%) and whole-brain parenchymal blood volume (29.0%). The effective doses of slab parenchymal blood volume, whole-brain parenchymal blood volume, and CTP were 0.87 ± 0.55, 3.91 ± 0.78, and 2.77 ± 1.59 mSv, respectively.

CONCLUSIONS

The dose measurement conducted in the current study was reliable and reproducible. The effective dose of slab parenchymal blood volume is about one-third that of CTP. With the advantages of on-site and immediate imaging availability and saving procedural time and patient transportation, slab parenchymal blood volume measurement using C-arm CT can be recommended for clinical application.

Spectral measurement of electron antineutrino oscillation amplitude and frequency at Daya Bay

A measurement of the energy dependence of antineutrino disappearance at the Daya Bay reactor neutrino experiment is reported. Electron antineutrinos (ν¯(e)) from six 2.9  GW(th) reactors were detected with six detectors deployed in two near (effective baselines 512 and 561 m) and one far (1579 m) underground experimental halls. Using 217 days of data, 41 589 (203 809 and 92 912) antineutrino candidates were detected in the far hall (near halls). An improved measurement of the oscillation amplitude sin(2)2θ(13)=0.090(-0.009)(+0.008) and the first direct measurement of the ν¯(e) mass-squared difference |Δm(ee)2|=(2.59(-0.20)(+0.19))×10(-3)  eV2 is obtained using the observed ν¯(e) rates and energy spectra in a three-neutrino framework. This value of |Δm(ee)2| is consistent with |Δm(μμ)2| measured by muon neutrino disappearance, supporting the three-flavor oscillation model.

Can iterative reconstruction improve imaging quality for lower radiation CT perfusion? Initial experience

BACKGROUND AND PURPOSE

Initial results using IR for CT of the head showed satisfactory subjective and objective imaging quality with a 20-40% radiation dose reduction. The aim of our study was to compare the influence of IR and FBP algorithms on perfusion parameters at standard and lowered doses of CTP.

MATERIALS AND METHODS

Forty patients with unilateral carotid stenosis post-carotid stent placement referred for follow-up CTP were divided into 2 groups (tube currents were 100 mAs in group A and 80 mAs in group B). Datasets were reconstructed with IR and FBP algorithms; and SNRs of gray matter, white matter, and arterial and venous ROIs were compared. CBF, CBV, and MTT means and SNRs were evaluated by using linear regression, and qualitative imaging scores were compared across the 2 algorithms.

RESULTS

The mean effective radiation dose of group B (2.06 mSv) was approximately 20% lower than that of group A (2.56 mSv). SNRs for ROIs in the dynamic contrast-enhanced images were significantly higher than those for the FBP images. Correlations of the SNRs for CBF, CBV, and MTT across the 2 algorithms were moderate (R² = 0.46, 0.23, and 0.44, respectively). ROIs in gray matter rather than the IR algorithm predicted increasing SNRs in all CBF, CBV, and MTT maps. Two cases of significant restenosis were confirmed in both algorithms. CBV, CBF, and MTT imaging scores did not differ significantly across algorithms or groups.

CONCLUSIONS

Lower dose CTP (20% below normal dose) without IR can effectively identify oligemic tissue in poststenting follow-up. IR does not alter the absolute values or increase the SNRs of perfusion parameters. Other methods should be attempted to improve SNRs in settings with low tube currents.

Observation of electron-antineutrino disappearance at Daya Bay

The Daya Bay Reactor Neutrino Experiment has measured a nonzero value for the neutrino mixing angle θ(13) with a significance of 5.2 standard deviations. Antineutrinos from six 2.9 GWth reactors were detected in six antineutrino detectors deployed in two near (flux-weighted baseline 470 m and 576 m) and one far (1648 m) underground experimental halls. With a 43,000 ton-GWth-day live-time exposure in 55 days, 10,416 (80,376) electron-antineutrino candidates were detected at the far hall (near halls). The ratio of the observed to expected number of antineutrinos at the far hall is R=0.940±0.011(stat.)±0.004(syst.). A rate-only analysis finds sin(2)2θ(13)=0.092±0.016(stat.)±0.005(syst.) in a three-neutrino framework.

Monitoring peri-therapeutic cerebral circulation time: a feasibility study using color-coded quantitative DSA in patients with steno-occlusive arterial disease

BACKGROUND AND PURPOSE

Intracranial hemodynamics are important for management of SOAD. This study aimed to monitor peri-stent placement intracranial CirT of patients with SOAD.

MATERIALS AND METHODS

Twenty-five patients received stent placement for extracranial ICA stenosis, and 34 patients with normal CirT were recruited as controls. Their color-coded DSAs were used to define the Tmax of selected intravascular ROI. A total of 20 ROIs of the ICA, OphA, ACA, MCA, FV, PV, OV, SSS, SS, IJV, and MCV were selected. rTmax was defined as the Tmax at the selected region of interest minus Tmax at the cervical segment of the ICA (I1 on AP view and IA on lateral view). rTmax of the PV was defined as intracranial CirT. Intergroup and intragroup longitudinal comparisons of rTmax were performed.

RESULTS

rTmax values of the normal cohorts were as follows: ICA-AP, 0.12; ICA-LAT, 0.10; A1, 0.28; A2, 0.53; A3, 0.81; M1, 0.40; M2, 0.80; M3, 0.95; OphA, 0.35; FV, 4.83; PV, 5.11; OV, 5.17; SSS, 6.16; SS, 6.51; IJV, 6.81; and MCV, 3.86 seconds. Before stent placement, the rTmax values of arterial ROIs, except A3 and M3, were prolonged compared with values from control subjects (P < .05). None of the rTmax of any venous ROIs in the stenotic group was prolonged with significance. After stent placement, the rTmax of all arterial ROIs shortened significantly, except A1and M3. Poststenting rTmax was not different from the control group.

CONCLUSIONS

Without extra contrast medium and radiation dosages, color-coded quantitative DSA enables real-time monitoring of peri-therapeutic intracranial CirT in patients with SOAD .

Assessment of modeled mercury dry deposition over the Great Lakes region

Three sets of model predicted values for speciated mercury concentrations and dry deposition fluxes over the Great Lakes region were assessed using field measurements and model intercomparisons. The model predicted values were produced by the Community Multiscale Air Quality Modeling System for the year 2002 (CMAQ2002) and for the year 2005 (CMAQ2005) and by the Global/Regional Atmospheric Heavy Metals Model for the year 2005 (GRAHM2005). Median values of the surface layer ambient concentration of gaseous elemental mercury (GEM) from all three models were generally within 30% of measurements. However, all three models overpredicted surface-layer concentrations of gaseous oxidized mercury (GOM) and particulate bound mercury (PBM) by a factor of 2-10 at the majority of the 15 monitoring locations. For dry deposition of GOM plus PBM, CMAQ2005 showed a clear gradient with the highest deposition in Pennsylvania and its surrounding areas while GRAHM2005 showed no such gradient in this region; however, GRAHM2005 had more hot spots than those of CMAQ2005. Predicted dry deposition of GOM plus PBM from these models should be treated as upper-end estimates over some land surfaces in this region based on the tendencies of all the models to overpredict GOM and PBM concentrations when compared to field measurements. Model predicted GEM dry deposition was found to be as important as GOM plus PBM dry deposition as a contributor to total dry deposition. Predicted total annual mercury dry deposition were mostly lower than 5 μg m(-2) to the surface of the Great lakes, between 5 and 15 μg m(-2) to the land surface north of the US/Canada border, and between 5 and 40 μg m(-2) to the land surface south of the US/Canada border. Predicted dry deposition from different models differed from each other by as much as a factor of 2 at regional scales and by a greater extent at local scales.

The analysis of decomposition methods for support vector machines

The support vector machine (SVM) is a new and promising technique for pattern recognition. It requires the solution of a large dense quadratic programming problem. Traditional optimization methods cannot be directly applied due to memory restrictions. Up to now, very few methods can handle the memory problem and an important one is the "decomposition method." However, there is no convergence proof so far. In this paper, we connect this method to projected gradient methods and provide theoretical proofs for a version of decomposition methods. An extension to bound-constrained formulation of SVM is also provided.We then show that this convergence proof is valid for general decomposition methods if their working set selection meets a simple requirement.

Automated segmentation for patella from lateral knee X-ray images

X-ray image segmentation is an important issue in medical image analysis. Due to inconsistent X-ray absorption, the intensities are usually unevenly distributed and noisy in the processed organ, thus the object segmentation becomes difficult. In this paper we propose a new segmentation method for patella from the lateral knee X-ray images based on the active shape model (ASM). At first, a patella shape model is constructed by principal component analysis (PCA) of corresponding landmarks obtained from a set of training shape. As the knee X-ray image usually contains many anatomical structures, we design a strategy based on edge tracing to place the initial shape model as close to the patella boundary as possible. Then, the shape model is deformed and fitted to the patella boundary by using a dual-optimization approach that includes a genetic algorithm (GA) to get the global geometric transform and ASM to deform the shape model iteratively. Consequently, the proposed method can cope with different knee X-ray images and can segment the patella in an automatic procedure. In the experiment, 20 images were tested and promising results are obtained by the proposed method. This method is found useful for the clinical evaluation and biomechanical study of knee.

Chromate reduction by zero-valent Al metal as catalyzed by polyoxometalate

In spite of a high reduction potential of zero-valent Al (ZVAl), its ability to reduce Cr(VI), a widespread pollutant, to less toxic Cr(III) remains to be uncovered. In the present study, Cr(VI) reduction by ZVAl was conducted to evaluate the potential application of Al as a reductant for Cr(VI). Polyoxometalate (POM, HNa(2)PW(12)O(40)), a catalyst, was used to accelerate Cr(VI) reduction by Al. The reaction of 0.192mM Cr(VI) on ZVAl was investigated in the presence of N(2) or O(2) at pH 1. A slight decrease in Cr(VI) concentration was observed on as-received (uncleaned) ZVAl due to the presence of oxide layer with a low surface area (ca. 3.4x10(-3)m(2)/g) of ZVAl. On addition of 0.1mM POM, Cr(VI) reduction on uncleaned ZVAl increased significantly. This is attributed to the unique properties of POM, which has a Brphinsted acidity higher than usual inorganic acids such as H(2)SO(4) and HCl. Thus, POM could remove rapidly the oxidize layer on ZVAl, followed by acting as a shuttle for electron transfer from ZVAl to Cr(VI). Under a N(2) atmosphere, one- or two-electron reduction of POM by ZVAl was responsible for Cr(VI) reduction in the early stage of the reaction. However, during reaction with ZVAl over 120min, three-electron reduction of POM predominated over Cr(VI) reduction. On interaction of O(2) with reduced POM, the formation of H(2)O(2) was responsible for subsequent Cr(VI) reduction. The results suggest that POM is an efficient catalyst for Cr(VI) reduction by Al due to the extremely rapid consumption of reduced POM or H(2)O(2) by Cr(VI).

Multiple regression models for the lower heating value of municipal solid waste in Taiwan

A multiple regression analysis was used to develop two predictive models of lower heating value (LHV) for municipal solid waste (MSW), using 180 samples gathered from cities and counties in Taiwan during 2001-2002. These models are referred to as the original proposed model (OPM) and the simplified model (SM). The coefficients of multiple determinations for the OPM and SM were 0.983 and 0.975, respectively. To verify the feasibility of the models, a demonstration program based on sampling of MSW in Kaohsiung City was conducted. As a result, the OPM showed superior precision in terms of relative percentage deviation (RPD) and mean absolute percentage error (MAPE), when compared to the conventional models based on the proximate analysis, physical composition and ultimate analysis. The SM was derived by neglecting the three minor physical components used in the OPM. The resulting SM was less precise when compared to the OPM, but it was still acceptable, with a precision level better than the conventional models. It was concluded that the predictability of empirical models could be improved significantly through selection of the appropriate physical components and multiple regression analysis.

Biocompatibility of electrophoretical deposition of nanostructured hydroxyapatite coating on roughen titanium surface:In vitroevaluation using mesenchymal stem cells

A nano hydroxyapatite (HAp) layer was coated on a roughen titanium surface by means of electrophoretic deposition with an acetic anhydride solvent system. The objectives of this current study are to investigate whether nano-HAp can improve mechanical strength at a lower sintering temperature and biocompatibility. Densification temperature was lowered from usual 1000 to 800 degrees C. The coating interfacial bonding strength, phase purity, microstructure, and biocompatibility were investigated. Degradation of HA phase was not detected in XRD. A porous TiO2 layer acts as a gradient coating layer with an intermediate thermal expansion coefficient between hydroxyapatite and titanium that reduces the thermal stress. From SEM image, the coating does not contain any crack. Mesenchymal stem cell (MSC) is the progenitor cell for various tissues in mature animals, which can improve integration of bone tissue into implant. In this in vitro study, rabbit MSCs culture indicated that the HAp/Ti nanocomposite biomaterial had good biocompatibility and bioactivity. Around materials and on its surface cell grew well with good morphology. Proliferation of the MSCs on the nano-HAp coating was higher than its micron counterpart in XTT assay. These properties show potential for the orthopaedic and dental applications.

Second-trimester diagnosis of limb-body wall complex with literature review of pathogenesis

Three fetuses having limb-body wall complex (LBWC) with craniofacial defects and 9 fetuses having LBWC without craniofacial defects were diagnosed and delivered in the second trimester at Mackay Memorial Hospital during the period January 1990 - May 2006. Cases of LBWC with craniofacial defects showed severe anomalies of the upper limbs, craniofacial defects, constrictive amniotic bands and cranioplacental attachment, whereas, cases of LBWC without craniofacial defects presented major anomalies of the lower limbs, abnormal genitalia, anal atresia, renal defects, abdominoplacental attachment and umbilical cord abnormalities. The perinatal findings of LBWC with or without craniofacial defects were compared and the pathogenesis was discussed.

Association of obesity and chronic diseases in Taiwan

Two systems were used to classify weight status based on body mass index (BMI) of 3,178 Taiwanese adults who participated in the 1993-1996 Nutrition and Health Survey and to explore associations of BMI categories and disease. In the system proposed by the International Association for the Study of Obesity and the International Obesity Taskforce for Asian adults, overweight was associated with one disease (hypertension) and obesity was associated with four diseases: diabetes (OR = 2.66; 95% CI = 1.39-5.09; p < 0.01); gout (OR = 4.33; 95% CI = 1.92-9.75; p < 0.01); hypertension (OR = 4.92; 95% CI = 2.87-8.42; p < 0.01); thyroid disease (OR = 2.29; 95% CI = 1.12-4.67; p < 0.05). In the system devised by Taiwan Health Department for Taiwanese adults, overweight was associated with four diseases (arthritis, diabetes, gout, hypertension), and obesity was associated with three diseases: diabetes (OR = 2.11; 95% CI = 1.07-4.19; p < 0.05); gout (OR = 4.06; 95% CI = 1.77-9.28; p < 0.01); hypertension (OR = 5.28; 95% CI = 3.23-8.63; p < 0.01). The Obesity Taskforce may underestimate the association of excess weight and disease in Taiwan.

Inhibition of 12-lipoxygenase during baicalein-induced human lung nonsmall carcinoma H460 cell apoptosis

Baicalein is known as a 12-lipoxygenase (12-LOX) inhibitor. The 12-LOX is found to be involved in the progression of human cancers and the inhibitor of 12-LOX offers a target for the prevention cancer. We demonstrated the inhibitory effect of baicalein on the gene and protein expression of 12-LOX in H460 human lung nonsmall carcinoma cell line. Treatment of baicalein inhibited the growth of H460 cells in a dose-dependent manner. Following 24h exposure to 50muM baicalein, cell cycle analysis revealed an increase in the cell population in S-phase. During the S-phase arrest, baicalein decreased the protein levels of cdk1 and cyclin B1, which are the regulating proteins of S-phase transition to G2/M-phase, in this study. Furthermore, baicalein induced the most of H460 cell apoptosis after treatment for 48h. H460 cells formed vesicles and apoptotic body, and then floated after treatment with baicalein. Baicalein-induced H460 cell apoptosis was confirmed by DNA condensation and fragmentation. Baicalein-induced apoptosis were also accompanied by decreasing in Bcl-2 and proform of caspase-3 and increasing p53 and Bax protein levels. Pretreatment with a specific caspase-3 inhibitor, Ac-DEVD-CHO, partially reduced baicalein-induced cell death, indicating baicalein induces apoptosis is partially dependent on caspase-3 pathway in H460 cells. These data suggest that baicalein, a 12-LOX inhibitor, inhibits the proliferation of H460 cells via S-phase arrest and induces apoptosis in association with the regulation of molecules in the cell cycle and apoptosis-related proteins.

The effects of continuous epidural analgesia on Doppler velocimetry of uterine arteries during different periods of labour analgesia

BACKGROUND

The transient effects of epidural bupivacaine 0.25-0.5% on the Doppler velocimetry of umbilical and uterine arteries had been reported, but the effects of continuous lower dose epidural bupivacaine (0.05-0.1%) infusion for labour analgesia have never been reported. In this study, we evaluated the effects of continuous epidural bupivacaine 0.075% on the Doppler velocimetry of uterine arteries.

METHODS

Twenty pregnant women for labour analgesia received continuous epidural bupivacaine 0.075% infusion. We used a 4-MHz continuous-wave Doppler probe (Multigon 500A) with a 200 Hz thump filter to detect uterine blood flow velocity. We recorded the velocimetry data for uterine relaxation and contraction during five time periods: pre-epidural insertion, 1, 2, and 4 h post-epidural infusion, and after delivery of fetus.

RESULTS

Our data showed that the velocimetric indices of uterine vascular resistance were significantly increased 1, 2, and 4 h after epidural infusion when compared with the pre-epidural level; these returned to the baseline after delivery.

CONCLUSION

Continuous epidural analgesia with bupivacaine 0.075% increases the resistance of uterine artery and therefore possibly reduces the uterine blood flow.

A comparison of maternal age, sex ratio and associated anomalies among numerically aneuploid, structurally aneuploid and euploid holoprosencephaly

During the period January 1987-July 2003, 59 cases of perinatally detected holoprosencephaly (HPE) with cytogenetic results were identified among 97,306 deliveries at Mackay Memorial Hospital. Among these 59 cases with HPE, 25 had euploidy, 27 had numerical aneuploidy, and 7 had structural aneuploidy. In the euploid cases, the male:female sex ratio was 0.39:1, whereas in the aneuploid cases, the ratio was 1:1. The mean (+/-SD) maternal ages for numerical aneuploidy, structural aneuploidy, and euploidy were 33.0 +/- 5.1 years, 27.9 +/- 2.1 years, and 27.8 +/- 5.0 years, respectively. The frequencies of associated major structural anomalies other than craniofacial defects in the cases with numerical aneuploidy, structural aneuploidy, and euploidy were 85.7%, 0%, and 16%, respectively. The present study of HPE suggests that a female excess appears only in the euploid cases, and advanced maternal age and structural anomalies are more commonly associated with the numerically aneuploid cases than the structurally aneuploid and euploid cases.

Evidence of complete fusion in the sub-barrier 16O+238U reaction

Evaporation residue cross sections in the 16O+238U reaction were measured for the energy range from above- to extreme sub-barrier. The cross sections are reproduced by a statistical model calculation, for which partial cross sections are calculated by a coupled-channel model taking into account the prolate deformation of 238U. Complete fusion was observed in the collision of the projectile with the tips of the 238U target, in the same way as the side collision.

Epidemiology of otitis media in Chinese children

From May to July 2001, 3013 Chinese children, aged 3-6 years old, from 19 kindergartens in Kaohsiung were examined for the prevalence of otitis media. A senior paediatric otolaryngologist performed examinations. Tympanometric and otoscopic records were combined for assessment of middle ear status. The prevalence rate of otitis media was 9.82% for all children, 5.24% for middle ear effusion and 5.34% for retracted tympanic membrane. The prevalence rates of otitis media in different age groups were as follows: 11.3% for 3-year-olds, 12.4% for 4-year-olds, 11.8% for 5-year-olds, and 6.1% for 6-year-olds. Considering the genetic factors and the previous history of otitis media, there was a significant difference between the normal group and the sick group.

Application of locked intramedullary nails in the treatment of complications after distraction osteogenesis

Distraction osteogenesis (callotasis) has been widely used in patients with limb-length inequality or massive bone defects. This procedure, however, may be associated with a high incidence of physical and psychosocial complications. Callotasis telescoping on a locked intramedullary nail has been used to shorten the period of external fixation. Little attention has been given to the use of locked intramedullary nails in the treatment of complications after callotasis. Between 1990 and 1999, we used locked intramedullary nailing in 27 patients for the treatment of complications after distraction osteogenesis. There were 17 men and ten women with a mean age of 33.2 years (16 to 66). The nail was inserted at a mean of 3.4 weeks (0 to 15) after removal of the external fixator. Simultaneous autogenous bone grafting and soft-tissue reconstruction were also undertaken in seven and two patients, respectively. There was consolidation of the callus or docking site in all patients at a mean of 6.4 months (2 to 14) after surgery. The mean shortening of the callus was 0.7 cm (0 to 2.5). Two patients had infection at the site of a distal screw which resolved after removal of the nail. In 17 patients the nail was removed at a mean of 26 months after its insertion. Locked intramedullary nails are useful in treating complications after distraction osteogenesis in skeletally mature patients. The risk of infection should be borne in mind.