Assessing the Fate of Dissolved Organic Compounds in Landfill Leachate and Wastewater Treatment Systems

Landfill leachate and municipal wastewater are major sources of chemical pollutants that contaminate our drinking water sources. Evaluating the dissolved organic chemical composition in wastewater treatment plants is therefore essential to understand how the discharge impacts the environment, wildlife, and human health. In this study, we utilized a nontargeted analysis method coupling liquid chromatography and tandem mass spectrometry (LC-MS/MS) to analyze chemical features at different points along two landfill leachate treatment plants (LLTPs) and two municipal wastewater treatment plants (WWTPs) in the Southeastern United States. Significant feature differences were observed for the WWTPs where activated sludge clarification was employed versus the LLTPs utilizing reverse osmosis. Specifically, even though both LLTPs had the largest number of features in their influent water, their effluent following reverse osmosis yielded a lower number of features than the WWTPs. Additionally, the clarification processes of each WWTP exhibited different efficiencies as chemical disinfection removed more features than UV disinfection. Feature identification was then made using the LC, MS, and MS/MS information. Analysis of the identified molecules showed that lipids were the most effectively removed from all plants, while alkaloid and organic nitrogen compounds were the most recalcitrant.

A complex genetic architecture underlies mandibular evolution in big mice from Gough Island

Some of the most compelling examples of morphological evolution come from island populations. Alterations in the size and shape of the mandible have been repeatedly observed in murid rodents following island colonization. Despite this pattern and the significance of the mandible for dietary adaptation, the genetic basis of island-mainland divergence in mandibular form remains uninvestigated. To fill this gap, we examined mandibular morphology in 609 F2s from a cross between Gough Island mice, the largest wild house mice on record, and mice from a mainland reference strain (WSB). Univariate genetic mapping identifies 3 quantitative trait loci (QTL) for relative length of the temporalis lever arm and 2 distinct QTL for relative condyle length, 2 traits expected to affect mandibular function that differ between Gough Island mice and WSB mice. Multivariate genetic mapping of coordinates from geometric morphometric analyses identifies 27 QTL contributing to overall mandibular shape. Quantitative trait loci show a complex mixture of modest, additive effects dispersed throughout the mandible, with landmarks including the coronoid process and the base of the ascending ramus frequently modulated by QTL. Additive effects of most shape quantitative trait loci do not align with island-mainland divergence, suggesting that directional selection played a limited role in the evolution of mandibular shape. In contrast, Gough Island mouse alleles at QTL for centroid size and QTL for jaw length increase these measures, suggesting selection led to larger mandibles, perhaps as a correlated response to the evolution of larger bodies.

Masticatory Apparatus Performance and Functional Morphology in the Extremely Large Mice from Gough Island

Since their arrival approximately 200 years ago, the house mice (Mus musculus) on Gough Island (GI) rapidly increased in size to become the largest wild house mice on record. Along with this extreme increase in body size, GI mice adopted a predatory diet, consuming significant quantities of seabird chicks and eggs. We studied this natural experiment to determine how evolution of extreme size and a novel diet impacted masticatory apparatus performance and functional morphology in these mice. We measured maximum bite force and jaw opening (i.e., gape) along with several musculoskeletal dimensions functionally linked to these performance measurements to test the hypotheses that GI mice evolved larger bite forces and jaw gapes as part of their extreme increase in size and/or novel diet. GI mice can bite more forcefully and open their jaws wider than a representative mainland strain of house mice. Similarly, GI mice have musculoskeletal features of the masticatory apparatus that are absolutely larger than WSB mice. However, when considered relative to body size or jaw length, as a relevant mechanical standard, GI mice show reduced performance, suggesting a size-related decrease in these abilities. Correspondingly, most musculoskeletal features are not relatively larger in GI mice. Incisor biting leverage and condylar dimensions are exceptions, suggesting relative increases in biting efficiency and condylar rotation in GI mice. Based on these results, we hypothesize that evolutionary enhancements in masticatory performance are correlated with the extreme increase in body size and associated musculoskeletal phenotypes in Gough Island mice. Anat Rec, 2019. © 2018 American Association for Anatomy.

The effect of previous surgery, operating room environment, and preventive antibiotics on postoperative infection following total hip arthroplasty

In 711 consecutive total hip arthroplasty operations, approximately 80% of patients were followed one to 7 years. Per priman operations outnumbered hips having had previous operations 511 to 200. The incidence of infection was higher in the hips having had previous operations (1.6 vs 3.5%). The overall incidence of deep infection was 16/711, or 23%. Analysis of the influences of operating room environment and preventative antibiotics revealed that there was a marked decrease in the attack rate of deep infection (7.6 vs 0.6%) when the Clean Room, personnel-isolator system, and preventative antibiotics were used. Reduced intraoperative wound bacterial contamination is accompanied by a reduced incidence of sepsis.

The ARKdb: genome databases for farmed and other animals

The ARKdb genome databases provide comprehensive public repositories for genome mapping data from farmed species and other animals (http://www.thearkdb.org) providing a resource similar in function to that offered by GDB or MGD for human or mouse genome mapping data, respectively. Because we have attempted to build a generic mapping database, the system has wide utility, particularly for those species for which development of a specific resource would be prohibitive. The ARKdb genome database model has been implemented for 10 species to date. These are pig, chicken, sheep, cattle, horse, deer, tilapia, cat, turkey and salmon. Access to the ARKdb databases is effected via the World Wide Web using the ARKdb browser and Anubis map viewer. The information stored includes details of loci, maps, experimental methods and the source references. Links to other information sources such as PubMed and EMBL/GenBank are provided. Responsibility for data entry and curation is shared amongst scientists active in genome research in the species of interest. Mirror sites in the United States are maintained in addition to the central genome server at Roslin.

The effect of preprocedure teaching, relaxation instruction, and music on anxiety as measured by blood pressures in an outpatient gastrointestinal endoscopy laboratory

A gastrointestinal examination can be frightening to patients. Abnormally elevated blood pressure and pulse caused by anxiety often are present on admission to the hospital. These elevated vital signs are then used as the baseline vital signs for the patient's hospital stay. The first purpose of this study was to determine whether vital signs are elevated because of anxiety on admission to the hospital and how much they decrease after sedation. The second purpose of this study was to explore the effect of instruction about relaxation and the use of music relaxation audio tapes in decreasing patient anxiety. Patients undergoing endoscopic examinations for the first time were randomly assigned into two groups. Patients in the treatment group were given brief instructions in relaxation and provided with an audio tape player and relaxation music. Statistical analysis using multivariate analysis of variance (MANOVA) comparing differences between control and treatment groups over time showed that there was a significant main effect for diastolic blood pressure. Subjects in the treatment group had significantly lower blood pressures throughout the entire GI procedure. There was no significant difference between groups regarding the amount of medication used. Music combined with relaxation is an inexpensive nursing intervention for patients in relaxing during a GI examination.

Ammonium lactate 12% lotion versus a liposome-based moisturizing lotion for plantar xerosis. A double-blind comparison study

Two emollients, ammonium lactate 12% lotion and a liposome-based moisturizing lotion, were compared in a double-blind test for efficacy in the treatment of plantar xerosis. A total of 43 out of 57 participants (75%) with bilateral plantar xerosis followed instructions completely and applied the lotions (one to each foot) twice daily for 4 weeks. Each participant was evaluated once a week for 6 weeks (the final 2 weeks for evaluation of post-treatment regression) to determine xerotic grade (degree of dryness) and treatment effectiveness. With both lotions, significant improvement began during the second week of treatment and continued into the fourth week. There were no significant differences between the two lotions in the 6-week patterns of either xerotic grade or treatment effectiveness.

Future of bradyarrhythmia therapy systems: automaticity

Since the first fixed-rate ventricular pacemaker was introduced in the late 1950s, pacing systems have evolved rapidly. Current developments focus on making devices more sophisticated and less complex--a challenging combination. Automaticity features such as beat-by-beat capture verification, sensitivity threshold adaptation, and algorithms to govern dynamically the maximum sensor rate have either recently been introduced or are likely to be introduced in the near future. Technologic advances are likely to allow meaningful improvements in current drain, battery performance, memory capacity, signal processing, telemetry, and programmer interface. Bradyarrhythmia therapy devices of the future promise to go beyond the pacemaker. Ultimately, pacing systems will become part of integrated cardiac rhythm management systems.

Gender differences in physiological reactivity to infant cries and smiles in military families

OBJECTIVE

The primary purpose of this experiment was to examine gender differences in physiological reactivity to infant cries and smiles in military families.

METHOD

Twenty males and 29 females viewed and listened to videotapes of a crying infant and a smiling infant while heart rate, skin resistance, and respiration rate were monitored. All participants were active-duty U.S. Air Force personnel or their spouses.

RESULTS

Males showed a larger increase in skin conductance than females during the crying infant stimulus. Males also showed an increase in heart rate during the crying infant stimulus, whereas females did not show any increase in heart rate during the crying infant stimulus. No gender differences in physiological reactivity were obtained during the smiling infant stimulus, although both males and females showed a significant increase in heart rate while viewing the smiling infant.

CONCLUSIONS

The results are contrasted with previous reports (e.g., Frodi, Lamb, Leavitt, & Donovan, 1978) of no differences between genders in physiological reactivity to a crying infant. Discussion of the results focuses on models of child physical abuse that involve physiological hyperreactivity. It is hypothesized that the greater physiological reactivity of males than females during a crying infant videotape may partially explain why physical abuse of a child by a male frequently results in more serious damage to the child than physical abuse by a female.

The blood cell transplant program

OBJECTIVES

To discuss the critical components of a blood cell transplantation (BCT) program as they relate to the standards developed by The Foundation for Accreditation of Hematopoietic Cell Therapy (FAHCT).

DATA SOURCES

FAHCT Standards, book chapters, and articles pertaining to developing a BCT program.

CONCLUSIONS

BCT is a burgeoning therapy for oncologic and hematologic diseases. New regulations have emerged to promote quality medical and laboratory practice in blood and marrow transplantation.

IMPLICATIONS FOR NURSING PRACTICE

As BCT increases for oncologic and hematologic diseases, a growing number of oncology nurses will be caring for BCT recipients and their families. Nurses in administration, research, advance practice, and education are increasingly involved in implementing BCT as a standard therapy for a growing number of diseases.

Struggling to gain meaning: living with the uncertainty of breast cancer

Uncertainty is a common experience for women living with breast cancer, particularly when treatment cannot assure disease cure. The study described in this article sought to provide insight into uncertainty experiences for women living with breast cancer. Hermeneutic phenomenology and photographic hermeneutics were used to describe and interpret uncertainty for nine women between 2 and 6 years posttreatment for breast cancer. Data were collected using interviews and interpretations of photographs. Five themes of uncertainty among women were uncovered. Major study findings included support for a reconceptualization of Mishel's Uncertainty in Illness Theory and the explication of growth-producing aspects of uncertainty.

Activation and repression of Drosophila alcohol dehydrogenase distal transcription by two steroid hormone receptor superfamily members binding to a common response element

Developmental activation of the Drosophila alcohol dehydrogenase (Adh) distal promoter is controlled by the Adh adult enhancer (AAE). Within this 150 bp, complex enhancer is a small (12 bp) positive cis-acting element that is required for high levels of distal transcription in adult flies and ADH-expressing tissue culture cells. We previously reported that the steroid receptor superfamily member FTZ-F1 binds to this site. We have identified a second steroid receptor superfamily member, DHR39, which also binds to this site. DHR39 is expressed throughout development in transcripts of several sizes. In situ hybridization to embryos has shown that DHR39 RNA is found primarily in the central nervous system, and not in embryonic tissues that express ADH. FTZ-F1 RNA, however, shows temporal-specific patterns similar to those of the distal promoter. FTZ-F1 and DHR39 have identical amino acids in the 'P-box' of the DNA binding domain, suggesting that they have identical DNA recognition characteristics. By electrophoretic mobility shift analysis we show that a DHR39 fusion protein binds specifically to two FTZ-F1 binding sites. By over expressing the full length DHR39 protein in a transient co-transfection assay we have shown that it represses distal Adh expression in a dosage- and binding site-dependent manner. Over expression of an alternative DHR39 open reading frame that lacks part of the putative ligand binding domain does not alter Adh expression. In contrast, over expression of FTZ-F1 specifically activates distal Adh expression.

Intrapelvic extraction of a total hip prosthesis. A case report

A 69-year-old man with a total hip prosthesis, recurrent infection, and intrapelvic incarceration of the acetabular components required extraction of a long-stem total hip prosthesis through three incisions. Retroperitoneal intrapelvic extraction of the incarcerated prosthesis was necessary. This approach allowed removal of intrapelvically migrated components and the eradication of the infection. The patient had no signs of infection five years postoperatively.

Visions of rural aging: use of photographic method in gerontological research

The use of photography is described as a method embedded within an ethnographic investigation of rural home care for older adults. Photography fostered data generation, elicited participants' stories, and illustrated patterns of rural aging. Analysis of photographic data pooled with interview and observational data facilitated an in-depth understanding of rural aging and home health care.

The vascular history and physical examination

The value of the vascular examination cannot be over-estimated. Symptoms of vascular disease present in the foot and lower extremity may actually be manifestations of severe life-threatening disease. Symptoms, their location, and the frequency and quality of the patient's pain often provide valuable clues for the clinician's diagnosis. Central nervous system symptoms, ocular disturbances, cardiac symptoms, impotence, or constitutional disturbances may all indicate systemic arterial disease. Risk factors for this disease include smoking, hypertension, hyperlipidemia, genetic predisposition, diabetes, emotional stress, and physical inactivity. Those factors attributable to hypercoagulability and venous disease are birth control pill use, estrogen chemotherapy, obesity, prolonged immobilization, paralysis, previous thrombotic episodes, venous stasis disease, and varicose veins. An accurate bilateral assessment of blood pressure, pulses, and capillary perfusion is of critical importance. Careful inspection of the extremity for trophic changes, skin color, texture, temperature, edema, ulceration, atrophy, or paresis, will provide clues of vasculopathy. A relatively accurate assessment of circulatory status may be obtained without the use of exotic instruments. Simple tests such as the elevation and dependency tests, capillary bed return test, venous filling time test, along with blood pressure, pulse, and possibly oscillometry data are valuable in arterial evaluation. Such venous tests as inspection, percussion, Homan's sign, Trendelenburg, and Perthes' tourniquet are useful in the determination of the presence of venous disease. Fortunately, over the past few years tremendous advances have been made in the technology of the vascular laboratory. If symptoms are discovered during the vascular history and physical examination, the complete noninvasive study will provide impressive data to quantitate and specifically establish the diagnosis.

Perceived health, self-esteem, health habits, and perceived benefits and barriers to exercise in women who have and who have not experienced stage I breast cancer

As more women survive the experience of breast cancer, it is essential to discover the impact it has on a woman's life. The purpose of this study was to determine differences in perceived health, self-esteem, health habits, and perceived benefits and barriers to exercise in women who have and who have not experienced stage I breast cancer and its treatment. A random sample of 55 women who have experienced stage I breast cancer and have not received adjuvant therapy was selected and matched to a cohort of women in the community who had not experienced cancer. No significant differences were found in perceived health, self-esteem, and health habits between women who had experienced breast cancer and the matched cohorts. There was a significant difference in both perceived benefits and barriers to exercise between groups (t = 2.4, df = 106, p = 0.18), with the matched cohorts scoring higher on perceived benefits and barriers to exercise.

Malignant fibrous histiocytoma associated with total hip replacement. A case report

This report documents another case of malignancy associated with total hip replacement. A malignant fibrous histiocytoma of the femur was diagnosed approximately 10 years after insertion of a cemented Müller cobalt-chromium prosthesis.

Brain imaging abnormalities in mental disorders of late life

Psychiatric inpatients with dementia (N = 61) or depression (N = 67) in late life were 2.6 times more likely to manifest magnetic resonance imaging abnormalities of the brain than were elderly controls (N = 44). Controlling for the effects of age and gender, demented patients were distinguishable from controls by an increased prevalence of cortical atrophy and infarction, while depressed patients exhibited an increased prevalence of cortical infarctions and leukoencephalopathy. Patients with dementia were distinguishable from those with major depression by an increased prevalence of cortical atrophy. These results indicate that major depression in late life, like dementia, is associated with a remarkable increase in overt pathologic changes in the brain.

The survey: what to expect

Although your hospital will be surveyed only every two or three years, the results of that survey are vital not only to your hospital, but also to your department. And you need to become involved in the process from the presurvey questionnaire to the on-site visit. And you need to prepare for the next survey the day after the last one.

Umbilical cord blood pH and Apgar scores as an index of neonatal health

In an effort to determine the clinical usefulness of Apgar scoring and cord pH in neonatal management, specimens of umbilical cord blood were obtained after 257 of 329 consecutive deliveries at a community-based hospital. A notable number of babies who were born in a vigorous state were in fact acidotic (umbilical arterial pH greater than 1 SD below mean). Seventy-two percent of acidotic babies had an Apgar score greater than 7 at 1 minute, and 92% had an Apgar score greater than 7 at 5 minutes. Correlation coefficients of Apgar scores at 1 and 5 minutes and arterial pH with the health status of newborn infants were poor. A chi 2 analysis of arterial pH and Apgar scores at 1 and 5 minutes indicated that a larger number of sick babies had an Apgar score less than 7 and acidosis than expected by pure chance. However, the sensitivity values of the Apgar score at 1 minute (0.48) and 5 minutes (0.24) and the arterial pH (0.40) for predicting sick children limit the clinical usefulness of these tests. While technically feasible in a community hospital, routine cord pH measurements add little to neonatal evaluation and management.

EEG sleep in elderly depressed, demented, and healthy subjects

In a prospective study of EEG sleep patterns in 25 elderly depressives, 25 elderly demented patients, and 25 healthy, elderly control subjects, the sleep of depressives was characterized by reduced REM sleep latency, increased REM percent and first REM period density, and altered temporal distribution of REM sleep, as well as by diminished sleep maintenance (correlated significantly with Hamilton ratings of depression: multiple R = -0.42, p less than 0.05). In contrast, the sleep of demented patients showed reduced REM sleep percent, but normal REM temporal distribution, increased loss of spindles and K-complexes (the latter correlating significantly with severity of cognitive impairment as measured by the Folstein score: multiple R = -0.59, p less than 0.01), and less severe sleep maintenance difficulty than for depressives. An examination of REM latency demonstrated a skewed distribution in depression (i.e., 42% of nights with sleep-onset REM periods), but a normal distribution in the controls and demented subjects. A REM latency cut-off score of 30 min correctly classified 68% of all patients (kappa = 0.36; p less than 0.005), compared with 78% correctly identified in our retrospective study (Reynolds et al. 1983).

Increasing cardiac rate by measurement of right ventricular temperature

A pacemaker that increases pacing rate in response to exercise enables the pacemaker patient to improve his state of well-being. Possible sensors include atrial rate, Q-T interval, pH, venous oxygen saturation, respiratory rate, cardiac output, body motion, and blood temperature. To determine the efficacy of right ventricular blood temperature as an indicator of exercise, an experimental temperature-controlled pacemaker was developed and was evaluated in dogs. A resulting algorithm was implemented in a microcomputer-based VVI pacemaker which reliably detected exercise and rest from blood temperature when totally implanted. The pacemaker generated two pacing rates to provide increased cardiac output. Data is being obtained to establish feasibility in humans.

Cortical wave amplitude and eye movement direction are correlated in REM sleep but not in waking

Eye movement related potentials were recorded bilaterally from the lateral geniculate body and visual cortex in five cats during REM sleep and waking. During REM sleep polygraphic recordings showed that these potentials have significantly greater amplitudes (primary waves) in the visual cortex and lateral geniculate body ipsilateral to the direction of the corresponding rapid eye movements. This amplitude difference was seen as a mean increase of 38.2% over the contralateral side and was found in 94.0% of wave pairs. The correlation between horizontal eye movement direction and amplitude of the waves is specific to REM sleep as there were no measurable differences in the waking state. These results are discussed with respect to possible mechanisms and functions of this lateralized wave system and its state dependency.

Location and spike-train characteristics of cells in anterodorsal pons having selective decreases in firing rate during desynchronized sleep

Extracellular microelectrode recordings were made from single neurons in the pontomesencephalic brain stem of head-restrained but nonanesthetized cats whose behavioral state was continuously monitored polygraphically. A population of neurons was encountered with the unusual property of progressively decreasing discharge rate as the cats passed from waking (W) through synchronized sleep (S) to desynchronized sleep (D). In many cases there was a complete cessation of firing in desynchronized sleep, suggesting the designation D-off cell for this neuronal subtype. The D-off cell population was distributed in a bandlike zone across the brain stem at the pontomesencephalic junction with dense concentration of cells in aminergic nuclei: the serotonergic dorsal raphe and raphe linearis centralis and noradrenergic locus ceruleus and peribrachial regions. Aside from a sparse distribution in the central tegmental field, there were no D-off cells in pontine reticular nuclei where cells of the D-on type abound. The proportion of cells showing the D-off property and the magnitude of the state-related change were correlated across nuclear groups as follows: raphe and peribrachial (highest), locus ceruleus (intermediate), and reticular (lowest) for both values. The firing rates of D-off cells tended to be low in waking with very regular interspike intervals. This characteristic firing pattern and the anatomical distribution suggests that D-off cells may be tentatively identified as aminergic. The marked contrasts in aminergic neuronal activity between waking and desynchronized sleep are interpreted as possibly playing a role in state generation through progressive distribution of cholinergic neurons postsynaptic to the D-off cell population. Predictable results would not only be a change in the excitability of the postsynaptic population but also a change in response mode related to a shift in neurotransmitter throughout the brain.

REM sleep burst neurons, PGO waves, and eye movement information

Pontogeniculooccipital (PGO) waves appeared almost simultaneously in both lateral geniculate nuclei (LGB), but in each case on had a larger amplitude and preceded the other by a few milliseconds. The larger, earlier wave is called the primary wave. Primary waves were found to appear with equal frequency in each LGB. During rapid eye movement sleep (REM sleep), LGB primary waves were ipsilateral to the direction of rapid eye movements. During REM sleep a group of cat midbrain neurons, which we call PGO burst cells, fired in stereotyped bursts at fixed latencies before ipsilateral primary waves, but they almost never fired bursts when the primary waves were contralateral. PGO burst neuron discharge also correlated with the direction of rapid eye movements during REM sleep. In wakefulness, PGO burst cells fired single spikes, not bursts, which had some correlation with LGB waves when averaged by computer. The results suggest that PGO burst cells are output elements in the PGO wave-generation system ad that PGO waves convey eye movement information to the sensory visual system in REM sleep. They also may have a role in the production of saccade-related waves in the visual system during wakefulness.

Reduction of deep sepsis after total hip arthroplasty

The role of the operating room environment in the development of deep sepsis after total hip arthroplasty was studied at four centers. The incidence of deep sepsis after 5,865 total hip arthroplasties performed in the four centers varied from 0.5% to 2.3%. Procedures performed in a conventional operating room were associated with the highest incidence of deep sepsis (1.3%). The use of a vertical, unidrectional airflow system with a helmet aspirator suite was associated with the lowest incidence of deep sepsis (0.6%). Although patients with previous hip surgery had an increased incidence of deep sepsis regardless of the operating room environment, those procedures performed in a vertical, unidrectional facility had a lower incidence of deep sepsis. Newer techniques designed for the reduction of airborne contamination of the operative wound seem to reduce the incidence of deep-wound sepsis after total hip arthroplasty, especially in patients with previous hip surgery.

Ponto-geniculo-occipital (PGO) burst neurons: correlative evidence for neuronal generators of PGO waves

A newly discovered class of neurons, ponto-geniculo-occipital (PGO) burst neurons, has PGO wave relationships of phase-leading, stereotyped discharge bursts, and the highest reported discharge specificity and coherence; these neurons thus fulfill correlative criteria for output generator neurons for PGO waves. The PGO burst neurons are recorded in a discrete dorsal brainstem area in apposition to the brachium conjunctivum.

Deep infection following total hip arthroplasty

Deep sepsis is a serious postoperative complication of total hip arthroplasty, causing additional suffering, loss of function, need for additional treatment, and possibly early death. In a series of sixteen patients, the only effective treatment was complete extirpation of all implants combined with appropriate long-term administration of antibiotics. In fifteen patients the original operative objectives were not achieved.

Five years experience with operating room clean rooms and personnel-isolator systems

Two horizontal flow, laminar airflow type clean rooms have been used for almost all clean orthopedic surgery at St. Luke's Hospital in Denver since March 1971. This experience covers approximately 4000 cases, including 1100 total hip and total knee arthroplasties. Three different types of helmet aspirator systems have also been evaluated. Our conclusions from this experience are: (1) All types of orthopedic surgery may be easily and conveniently performed in the clean room and with scrubbed personnel wearing helmet aspirator systems; (2) mechanical upkeep of the clean room is minimal; (3) airborne bacteria counts have been reduced at least 80 percent compared to a regular operating room, and more than 90 percent when scrubbed personnel wear the helmet aspirator system; (4) sterile surface contamination, including the wound, has been reduced at least 80 percent; and (5) the deep infection rate for total hip replacements with at least a 2-year follow-up has been 7.6 percent (10/131) in a regular operating room and 1.6 percent (5/319) in the clean room. With the combined use of the clean room, helmet aspirator systems, and perioperative antibiotics, no infections have occurred in an additional 350 cases with a 1-year follow-up.

Solitary bone cyst with epiphyseal involvement: a case report

A large solitary bone cyst involving the epiphysis produced 5.0 cm shortening of the proximal humerus in a 15-year-old girl. Biopsy revealed the cyst was filled with thin yellow fluid under pressure and lined by a fibrous membrane. X-rays 9 months after biopsy demonstrated progressive cyst obliteration. A review of literature revealed no similar case. It is postulated that solitary cysts rarely may involve the physeal and epiphyseal structures and thereby retard longitudinal bone growth.