What is the evidence supporting the prevention of osteoarthritis and improved femoral coverage after shelf procedure for Legg-Calvé-Perthes disease?

The evidence supporting continued use of shelf acetabuloplasty in Legg-Calvé-Perthes disease (LCPD) is not well-defined, and there is controversy regarding the long-term benefits related to clinical and functional improvement.

Outcome predictors of radical prostatectomy followed by adjuvant androgen deprivation in patients with clinical high risk prostate cancer and pT3 surgical margin positive disease

Patients with high risk prostate cancer with pT3 tumor and positive surgical margins have a high risk of biochemical failure after radical prostatectomy and adjuvant androgen deprivation therapy. Predictors of cancer related death in this patient group are necessary.

Comparison of visual-tactile, radiographic, and histologic diagnoses of subgingival crown margin caries- an in vitro study

The purpose of this study was to investigate the accuracy of diagnosing interproximal subgingival caries at crown margins. A total of 32 subgingival interproximal crown margin areas were examined by 10 clinicians (n = 320) using conventional diagnostic methods on extracted, crowned teeth mounted in a specially designed cast. Crown margins were located 1.5 mm below the level of the artificial gingiva. Clinical and radiographic diagnoses were compared to the histopathologic findings for each site. Both visual-tactile and radiographic evaluations revealed a weak diagnostic accuracy for interproximal subgingival crown margin caries.

Is a 3-mm intrafractional margin sufficient for daily image-guided intensity-modulated radiation therapy of prostate cancer?

PURPOSE: To determine whether a 3-mm isotropic target margin adequately covers the prostate and seminal vesicles (SVs) during administration of an intensity-modulated radiation therapy (IMRT) treatment fraction, assuming that daily image-guided setup is performed just before each fraction. MATERIALS AND METHODS: In-room computed tomographic (CT) scans were acquired immediately before and after a daily treatment fraction in 46 patients with prostate cancer. An eight-field IMRT plan was designed using the pre-fraction CT with a 3-mm margin and subsequently recalculated on the post-fraction CT. For convenience of comparison, dose plans were scaled to full course of treatment (75.6 Gy). Dose coverage was assessed on the post-treatment CT image set. RESULTS: During one treatment fraction (21.4+/-5.5 min), there were reductions in the volumes of the prostate and SVs receiving the prescribed dose (median reduction 0.1% and 1.0%, respectively, p<0.001) and in the minimum dose to 0.1 cm(3) of their volumes (median reduction 0.5 and 1.5 Gy, p<0.001). Of the 46 patients, three patients' prostates and eight patients' SVs did not maintain dose coverage above 70 Gy. Rectal filling correlated with decreased percentage-volume of SV receiving 75.6, 70, and 60 Gy (p<0.02). CONCLUSIONS: The 3-mm intrafractional margin was adequate for prostate dose coverage. However, a significant subset of patients lost SV dose coverage. The rectal volume change significantly affected SV dose coverage. For advanced-stage prostate cancers, we recommend to use larger margins or improve organ immobilization (such as with a rectal balloon) to ensure SV coverage.

Late Pleistocene Interactions of East and West Antarctic Ice-Flow Regimes: Evidence from the McMurdo Ice Shelf

We present new interpretations of deglaciation in McMurdo Sound and the western Ross Sea, with observationally based reconstructions of interactions between East and West Antarctic ice at the last glacial maximum (LGM), 16 000, 12 000, 8000 and 4000 sp. At the LGM? East Antarctic ice from Mulock Glacier split, one branch turned westward south of Ross Island but the other branch rounded Ross Island before flowing southwest into McMurdo Sound. This flow regime, constrained by an ice saddle north of Ross Island, is consistent with the reconstruction of Stuiver and others (1981a). After the LGM, grounding-line retreat was most rapid in areas with greatest water depth, especially along the Victoria Land coast. By 12 000 sp, the ice-now regime in McMurdo Sound changed to through-flowing Mulock Glacier ice, with lesser contributions from Koettlitz, Blue and Ferrar Glaciers, because the former ice saddle north of Ross Island was replaced by a dome. The modern flew regime was established similar to 4000 BP. Ice derived from high elevations on the Polar Plateau but now stranded on the McMurdo Ice Shelf, and the pattern of the Transantarctic Mountains erratics support our reconstructions of Mulock Glacier ice rounding Minna Bluff but with all ice from Skelton Glacier ablating south of the bluff. They are inconsistent with Drewry's (1979) LGM reconstruction that includes Skelton Glacier ice in the McMurdo-Sound through-flow. Drewry's (1979) model closely approximates our results for 12 000-4000 BP. Ice-sheet modeling holds promise for determining whether deglaciation proceeded by grounding-line retreat of an ice sheet that was largely stagnant, because it never approached equilibrium flowline profiles after the Ross Ice Shelf, grounded, or of a dynamic ice sheet with flowline profiles kept low by active ice streams that extended northward from present-day outlet glaciers after the Ross Ice Shelf grounded.

Fracture and Back Stress Along the Byrd Glacier Flowband on the Ross Ice Shelf

East Antarctic ice discharged by Byrd Glacier continues as a flowband to the calving front of the Ross Ice Shelf. Flow across the grounding line changes from compressive to extensive as it leaves the fjord through the Transantarctic Mountains occupied by Byrd Glacier. Magnitudes of the longitudinal compressive stress that suppress opening of transverse tensile cracks are calculated for the flowband. As compressive back stresses diminish, initial depths and subsequent growth of these cracks, and their spacing, are calculated using theories of elastic and ductile fracture mechanics. Cracks are initially about one millimeter wide, with approximately 30 in depths and 20 in spacings for a back stress of 83 kPa at a distance of 50 kin beyond the fjord, where floating ice is 600 in thick. When these crevasses penetrate the whole ice thickness, they release tabular icebergs 20 kin to 100 kin wide, spaced parallel to the calving front of the Ross Ice Shelf

Catastrophic Ice Shelf Breakup as the Source of Heinrich Event Icebergs

Heinrich layers of the glacial North Atlantic record abrupt widespread iceberg rafting of detrital carbonate and other lithic material at the extreme-cold culminations of Bond climate cycles. Both internal (glaciologic) and external ( climate) forcings have been proposed. Here we suggest an explanation for the iceberg release that encompasses external climate forcing on the basis of a new glaciological process recently witnessed along the Antarctic Peninsula: rapid disintegrations of fringing ice shelves induced by climate-controlled meltwater infilling of surface crevasses. We postulate that peripheral ice shelves, formed along the eastern Canadian seaboard during extreme cold conditions, would be vulnerable to sudden climate-driven disintegration during any climate amelioration. Ice shelf disintegration then would be the source of Heinrich event icebergs.

LGM Summer Climate on the Southern Margin of the Laurentide Ice Sheet: Wet Or Dry?

Regional climate simulations are conducted using the Polar fifth-generation Pennsylvania State University (PSU)-NCAR Mesoscale Model (MM5) with a 60-km horizontal resolution domain over North America to explore the summer climate of the Last Glacial Maximum (LGM: 21 000 calendar years ago), when much of the continent was covered by the Laurentide Ice Sheet (LIS). Output from a tailored NCAR Community Climate Model version 3 (CCM3) simulation of the LGM climate is used to provide the initial and lateral boundary conditions for Polar MM5. LGM boundary conditions include continental ice sheets, appropriate orbital forcing, reduced CO2 concentration, paleovegetation, modified sea surface temperatures, and lowered sea level. The simulated LGM summer climate is characterized by a pronounced low-level thermal gradient along the southern margin of the LIS resulting from the juxtaposition of the cold ice sheet and adjacent warm ice-free land surface. This sharp thermal gradient anchors the midtropospheric jet stream and facilitates the development of synoptic cyclones that track over the ice sheet, some of which produce copious liquid precipitation along and south of the LIS terminus. Precipitation on the southern margin is orographically enhanced as moist southerly low-level flow (resembling a contemporary, Great Plains low-level jet configuration) in advance of the cyclone is drawn up the ice sheet slope. Composites of wet and dry periods on the LIS southern margin illustrate two distinctly different atmospheric flow regimes. Given the episodic nature of the summer rain events, it may be possible to reconcile the model depiction of wet conditions on the LIS southern margin during the LGM summer with the widely accepted interpretation of aridity across the Great Plains based on geological proxy evidence.

Controls on the Basal Water Pressure in Subglacial Channels Near the Margin of the Greenland Ice Sheet

Assuming a channelized drainage system in steady state, we investigate the influence of enhanced surface melting on the water pressure in subglacial channels, compared to that of changes in conduit geometry, ice rheology and catchment variations. The analysis is carried out for a specific part of the western Greenland ice-sheet margin between 66 degrees N and 66 degrees 30' N using new high-resolution digital elevation models of the subglacial topography and the ice-sheet surface, based on an airborne ice-penetrating radar survey in 2003 and satellite repeat-track interferometric synthetic aperture radar analysis of European Remote-sensing Satellite 1 and 2 (ERS-1/-2) imagery, respectively. The water pressure is calculated up-glacier along a likely subglacial channel at distances of 1, 5 and 9 km from the outlet at the ice margin, using a modified version of Rothlisberger's equation. Our results show that for the margin of the western Greenland ice sheet, the water pressure in subglacial channels is not sensitive to realistic variations in catchment size and mean surface water input compared to small changes in conduit geometry and ice rheology.