Forty year old male, presented to casualty following a road traffic accident, in a state of hemodynamic shock. He was revived with emergency blood transfusion and supportive measures. Primary survey revealed that he had a blunt injury abdomen with associated injury to the knee on the left side. X rays showed Schatzker type six tibial plateau fracture. He was taken for emergency laparotomy, intraoperatively he had splenic rupture for which splenectomy was done. Post operative period was uneventful. All the while he was immobilized in an above knee slab. Patient was taken up for orthopaedic management after two weeks. Fracture fixed with locking compression plate by Minimally Invasive Plate Osteosynthesis. Post operatively he had superficial wound infection at the entry site which settled with antibiotics and dressings.
In our study,a total of 19 patients regained functional use of the knee joint, good axis without pain or instability. Patient’s knee ROM was gradually increasing at consecutive clinical evaluations. After one year follow up the knee ROM ranged from 30º to 130º with an average knee ROM of 102.5º.in similar studies conducted by Babis et al and Ariffin et al,the average ROM was reported as 115º.reduced functional outcome in our study was acceptable and attributed tothe more compound fractures, more typeVI fractures and poor compliance of two patients to the rehabilitation exercises. Moreover two patients had associated injuries like patella fracture and shaft of femur fracture and two patients.
This is to certify that this dissertation in “PROSPECTIVE STUDY OF FUNCTIONAL OUTCOME OF CLOSED SCHATZKER TYPEV AND TYPEVI TIBIAL PLATEAU FRACTURES MANAGED BY OPEN REDUCTION AND INTERNAL FIXATION” is a bonafide work done by Dr. K. R. KANNAN under my guidance during the period June 2006 – November 2008. This has been submitted in partial fulfillment of the award of M.S. Degree in Orthopedic Surgery (Branch – II) by the Tamilnadu Dr. M.G.R. Medical University, Chennai.
A total of 46 patients were included in the study and were followed up for 23–45 months (mean, 31.9 months). Twenty patients were male, and 26 were female, aged 29–77 years, with an average of 53.9 years. According to Schatzker classification, 24 patients of Schatzker type II fracture were divided into group A, and 18 patients of typeV fracture and 4 patients of typeVI fracture were divided into group B. According to the three-column classification, 6 cases involved the posterior column, 18 cases involved the lateral and posterior columns, 6 cases involved the medial and posterior columns, and 16 cases involved three columns. The causes of injury were tum- bles in 28 cases (60.7%), traffic accidents in 14 cases (30.4%), falls in 2 cases (4.3%), and direct impact in 2 cases (4.3%). The injury mechanism was flexion valgus injury in 30 cases (65.2%), flexion varus injury in 4 cases (8.7%), ex- tension injury in 6 cases (13%), and flexion injury in 6 cases (13%). Twenty-two patients had a fibular fracture, and 6 had associated injuries (3 vertebral fractures, 1 skull fracture and pelvic fracture, 1 pelvic fracture, and 1 ankle fracture) (Table 1).
congestion at some instances. With sleep cycles type-III, reaches a maximum of during off-peak hours because the first packet in each burst waits . However, decreases during peak hours due to the following. As the frequent packet arrivals from large bursts, the waiting times of the majority of packets within a burst is low compared to the case of off-peak hours where the burst size is much smaller. This results in a lower average packet delay compared to the case of off- peak hours. This trend is also reflected in the sleep pdf of sleep cycles type-III (Figure 6(a)) where a higher number of vehicles caused the RSU to sleep for shorter durations compared to the case of lower number of vehicles. In the case of sleep cycles type-IV, the RSU does not switch to sleep mode until the buffer is empty unlike the case of sleep cycles type-III. Due to the lower waiting times for newly arrived packets (while the RSU was in service), is lower compared to the case of sleep cycles type-III especially during the peak hours. This mechanism allows the RSU to achieve lower while sleeping longer with a minimum duration of . In the case of sleep cycles type-V, the RSU during off-peak hours takes a considerably longer time to accumulate packets. Therefore, during off-peak hours is significantly higher compared with its value at the peak hours. Sleep cycles type-VI achieve marginal improvements in as both type-V and VI are time independent and are governed by the number of accumulated packets. The marginal improvement is due to the fact that the RSU, while in service, continues to serve until the buffer is empty before switching to sleep mode.
From September 2001 to September 2006, 65 patients with complex (Schatzker typeV or typeVI) tibial plateau fractures were treated with the double-buttress plate fixation in the Orthopedic Surgery Center of the Fourth Military Medical University associated Tangdu Hospital,. The general patient information including the pre-injury status was recorded at admission. All fractures were fixed with a bilcondylar double-plating technique by experienced orthopaedic surgeons. Fifty four of the sixty five patients were investigated for the functional and radiological outcomes, and the other eleven patients were excluded for the following rea- sons: four patients changed their address and could not be contacted, five patients had open fractures, and the other two patients were polytrauma. The pa- tient demographics and fracture types of the 54 pa- tients were collected preoperatively and are shown in Table 1.
Forty-five patients with complex tibial plateau frac- tures were enrolled, and the study group consisted of 21 males (47%) and 24 females (53%) with an average age of 51.68 years (range 18 ~ 83 years). The mechanism of in- jury was a motor vehicle accident in 38 patients, and the others were falls from height. All patients had antero- posterior and lateral view radiographs at our emergency department initially, and a CT scan was performed if the fracture pattern was difficult to classify. There were 25 Schatzker typeV (55.5%) and 20 Schatzker typeVI (44.4%) fractures. The soft tissue condition was the most crucial item on our preoperative planning for the timing of the operation and the choice of surgical equipment. Twelve patients (26.7%) received staged therapy, with an average of a 5.4-day delay (range 3 ~ 9 days) due to open fracture or extreme swelling of soft tissue (external skeletal fixation first, then shifted to an internal fixator). Prophylactic antibiotics with first-generation cephalo- sporin, cefazolin, were administered intravenously in all patients and were prescribed as necessary for at least the
One can identify distant characters in different regions of the image. The lot of work is done in image segmentation, literature review also reported regarding the segmentation and its applications by the , , , , ,  and  are presented different techniques of image segmentation. Segmentation of the image contains two types of methods, 1) model based image segmentation method and 2) heuristic methods. Segmentation methods of the image based on model methods are additional proficient than the heuristic methods of segmentation given by , . The segmentation based on model & the segmentation of the image is done based on finite GMM. Much work is reported on Gaussian mixture model  and . And it becomes a popular because of its simplicity. In GMM, the regions of image are tacit to be meso- kurtic & symmetric in nature. But ,,  and many others developed a different segmentation techniques depending on truncated GMM & new symmetric distribution . The above authors tacit that feature of the regions of the image are symmetric but may not meso-kurtic. In numerous images, feature vector of image regions are associated with skewed distribution. Basing on the skewed distribution, extremely less exertion is done in the literature concerning the model based segmentation. Hence  developed and analyzed segmentation of the image based on Pearson Type I Mixture Distribution. In a few images, the intensities (pixels) of the each part represents the left skewed and asymmetric in nature. Image segmentation methods are empowered and investigated depend on the mixture Pearson Type I and Pearson TypeVI  distributions through K-means & Hierarchical algorithms, when the pixels of image are left skewed in image regions. But in few images, the pixels of the image parts might not be left skewed. But in few images, might have lengthy higher tail by means of a right slanted curve. To segment such images, one has use right skewed distribution. Therefore, segmentation methods of image are implemented and analyzed with long upper tail and right skewed distributions is capable by the (PTIIID) Pearson Type III distribution. Hence, the pixels of each region and complete image is represented by a finite mixture of PTIIID. Under Bayes framework, the segmentation of the image algorithm is empowered from beginning to end by maximizing component likelihood. By calculating, segmentation recital procedures (PRI, GCE, VOI) by carrying out tests with three images from Berkeley dataset namely BOAT, SEA, WATER & performance is evaluated. The utility of proposed method through image segmentation is match up to with segmentation algorithm based on finite GMM through
f gravity have studied by Kiran et al. (2013). Ghate et al. (2014) studied Bianchi type-IX viscous string cosmological model in f ( R , T ) gravity with the special form of declaration parameter. Reddy et al. (2013) have discussed Kaluza-Klein universe with cosmic strings and bulk viscosity in f ( R , T ) gravity. Mahanta et al. (2014) have investigated bulk viscous cosmological model in f ( R , T ) gravity. Reddy et al. (Reddy et al., 2014) have investigated Kantowski-Sachs bulk viscous string cosmological model in f ( R , T ) gravity. Same author (Reddy et al., 2013) have studied LRS Bianchi type-II universe with cosmic strings and bulk viscosity in a modified theory of gravity. Naidu et al. (2013) have studied Bianchi type-V bulk viscous string cosmological model in
also been shown to act as a non-cognate response regu- lator of the histidine kinase EnvZ . Since EnvZ is a known osmolarity sensor for SPI-2 genes , it is likely that YfhA regulates T6SS activation (through RcsB) de- pending on the osmolarity sensed by EnvZ. Binding mo- tifs recognized by FlrC, a transcriptional regulator found in V. cholerae, has also been detected in the upstream regions and within the ORFs of rcsB and sciS (an inner membrane component of T6SS). Cooperative binding of FlrC near the downstream of transcription start sites of two flagellar genes (flaA and flgK) has been shown to en- hance intestinal colonization of V. cholerae . Though FlrC is not found in S. typhimurium, analyses performed on the protein sequences as well as their structures sug- gest that the protein YfhA (from S. typhimurium) is a close homolog of FlrC. It may be noted that, the binding sites predicted in this study are based on the motifs recog- nized by two YfhA homologs from E. coli and V. cholerae. The motifs recognized by the YfhA of S. typhimurium may be different from the ones screened for in this study, which can only be confirmed with further experimental validation. However, these predictions coupled with the in- formation available from literature suggest that inclusion of YfhA in the model is able to bridge the gap pertaining to the anticipated, but hitherto unknown, osmoregulatory cascade controlling T6SS activation. Furthermore, simula- tion of the Boolean model with a ‘mutated’ YfhA did not result in T6SS activation, indicating the probable crucial role of YfhA in the constructed network.
We have shown that lineage-specific serology can identify T. cruzi infecting lineage, without parasite isolation and genotyping. Furthermore, ELISA is replaceable by an at least equally sensitive RDT, the Chagas Sero K-SeT, which incorporates Protein G detection, and is thus directly applicable to humans and several other mammalian spe- cies. We assessed lineage distribution among 83% of the T. cruzi- seropositive human population, showing a sta- tistically significant association of TSSApep-II/V/VI rec- ognition with locality, and with increasing and decreasing age within the Qom and Creole populations, respectively. For dogs TSSApep-II/V/VI seroprevalence was linked to birth before the insecticide spraying programme and
Background: Mucopolysaccharidosis typeVI (Maroteaux-Lamy syndrome; MPS VI) is an autosomal recessive lysosomal storage disorder in which deficiency of N-acetylgalactosamine 4-sulfatase (arylsulfatase B; ARSB) leads to the storage of glycosaminoglycans (GAGs) in connective tissue. The genotype-phenotype correlation has been addressed in several publications but the picture is not complete. Since 2007, enzyme-replacement therapy (ERT) has been available for patients with MPS VI in the Netherlands. The purpose of our study was to learn more about the genotype-phenotype correlations in MPS VI and the antibody response to ERT with galsulfase (recombinant human arylsulfatase B). Methods: We identified ARSB mutations in 12 patients and used site-directed mutagenesis to study their effect. Antibody levels to galsulfase were measured using ELISA and a semi-quantitative immunoprecipitation method. We assessed the in vitro inhibitory effect of antibodies on galsulfase uptake and their effect on clinical outcome. Results: Five patients had a rapidly progressive phenotype and seven a slowly progressive phenotype. In total 9
Type XI collagen is present in low levels in skeletal muscle, trabecular bone, tendons, testis, trachea, articu- lar cartilage, lung, placenta and in the brain. It is a minor fibrillar collagen, which co-polymerize with type II collagen and type IX collagen. In cartilage, it is ex- tremely important for proper function, as absence of type XI collagen lead to abnormal thickening of the tis- sue. Collagen XI has long been suspected to be of high impact in cancer formation, and especially the a1 chain of collagen XI has shown to be an important player in various cancer diseases. The gene signature of type XI collagen is upregulated in breast, gastric, pancreatic, and non-small lung cancer. Interestingly, in both colon and HNSCC the expression is extremely increased with almost no expression in healthy controls [107–114]. Knock down of type XIa1 collagen in HNSCC and ovarian cancer cell lines, significantly decrease proliferation, invasion and mi- gration compared to controls, which highlight type XI col- lagens importance in cancer [107, 115]. In breast and ovarian cancer collagen XIa1 has also been associated with resistant to chemotherapy [116, 117].
hypothalamic hamartomas. Additionally, two new JSRD neuroimaging findings (ascending superior cerebellar peduncles and fused thalami) have been identified. Tongue hamartomas, additional frenula, upper lip notch, and mesoaxial polydactyly are specific findings in OFD VI, while cleft lip/palate and other types of polydactyly of hands and feet are not specific. Involvement of other organs may include ocular findings, particularly colobomas. The majority of the patients have absent motor development and profound cognitive impairment. In OFD VI, normal cognitive functions are possible, but exceptional. Sequencing of known JSRD genes in most patients failed to detect pathogenetic mutations, therefore the genetic basis of OFD VI remains unknown. Compared with other JSRD subgroups, the neurological findings and impairment of motor development and cognitive functions in OFD VI are significantly worse, suggesting a correlation with the more severe neuroimaging findings. Based on the literature and this study we suggest as diagnostic criteria for OFD VI: MTS and one or more of the following: 1) tongue hamartoma(s) and/or additional frenula and/or upper lip notch; 2) mesoaxial polydactyly of one or more hands or feet; 3) hypothalamic hamartoma.
the other species within the genus and to the other type strains within the family Thermaceae. The tree was inferred from 1,442 aligned characters [30,31] of the 16S rRNA gene sequence under the maximum likelihood criterion  and rooted in accordance with the current taxonomy . The branches are scaled in terms of the expected number of substitutions per site. Numbers above branches are support values from 900 bootstrap replicates  if larger than 60%. Lineages with type strain genome sequenc- ing projects registered in GOLD  are shown in blue, published genomes in bold, i.e. Thermus ther- mophilus (AP008226) and the type species of the genus, M. ruber .
The Intolerance of Uncertainty scale (IUS, 27 items; Freeston, Rheaume, Letarte, Dugas, & Ladouceur, 1994) was developed to assess emotional, cognitive, and behavioral reactions to contexts of uncertainty in life situations, implications of life situations, and the future. Although several areas of possible uncertainty are included, the IUS measure is used as a single summary score. Supporting such use is a reported internal consistency of α = 0.91. Items include, for example: “I should be able to organize everything in advance”, “When I am uncertain, I can’t go forward”, and “When it is time to act, uncertainty paralyses me”. These are rated on a Likert-type scale from 1 “Not at all representative [of me]” to 5 “Completely representative [of me]”. Convergent validity is reported (Freeston, et al., 1994) with correlations on related measures of 0.63 with the Penn State Worry Questionnaire (PSWQ), 0.57 with the Beck Anxiety Inventory (BAI), and 0.52 with the Beck Depression Inventory (BDI). Reliability in our sample, calculated across 62 participants with answers for all 27 items, was associated with an internal consistency of α = 0.92.