Unstable bicondylar tibial plateau fractures: a clinical investigation

OBJECTIVE: To evaluate fracture patterns in bicondylar tibial plateau fractures and their impact on treatment strategy. DESIGN: Prospective data analysis with documentation of initial injury and treatment strategy, computed tomography scans, conventional x-rays, long-term evaluation of radiographs, and functional assessments. SETTING: Level 1 regional trauma center. PATIENTS: Prospective data acquisition of 14 consecutive patients (10 male and 4 female) with a bicondylar tibial plateau fracture (AO Type C). INTERVENTION: Application of a stepwise reconstruction strategy of the tibial plateau starting with the reposition and fixation of the posteromedial split fragment using a 3.5 buttress plate, followed by reposition and grafting of the lateral compartment and lateral fixation with a 3.5 plate in 90 degree to the medial fixation device. MAIN OUTCOME MEASUREMENTS: All patients were evaluated with full-length standing film, standardized x-rays, Lysholm score for functional assessment, and patient's self-appraisal. RESULTS: Most of the complex bicondylar fractures follow a regular pattern in that the medial compartment is split in a mediolateral direction with a posteromedial main fragment, combined with various amounts of multifragmental lateral compartment depression. The technique introduced allows for accurate and stable reduction and fixation of this fracture type. The final Lysholm knee score showed an average of 83.5 points (range: 64.5-92). CONCLUSIONS: Complex bicondylar tibial plateau fractures follow a regular pattern, which is not represented in existing 2-dimensional fracture classifications. A 2-incision technique starting with the reduction of the posteromedial edge results in accurate fracture reduction with low complication rates and excellent knee function.

EVALUATION OF THE EVOLVING STRESS FIELD OF THE YELLOWSTONE VOLCANIC PLATEAU FROM 1988 TO 2010 FROM EARTHQUAKE FIRST MOTIONS INVERSION

Within the Yellowstone National Park, Wyoming, the silicic Yellowstone volcanic field is one of the most active volcanic systems all over the world. Although the last rhyolite eruption occurred around 70,000 years ago, Yellowstone is still believed to be volcanically active, due to high hydrothermal and seismic activity. The earthquake data used in this study cover the period of time between 1988 and 2010. Earthquake relocations and a set of 369 well-constrained, double-couple, focal mechanism solutions were computed. Events were grouped according to location and time to investigate trends in faulting. The majority of the events has oblique, normal-faulting solutions. The overall direction of extension throughout the 0.64 Ma Yellowstone caldera looks nearly ENE, consistently with the direction of alignments of volcanic vents within the caldera, but detailed study revealed spatial and temporal variations. Stress-field solutions for different areas and time periods were calculated from earthquake focal mechanism inversion. A well-resolved rotation of σ3 was found, from NNE-SSW near the Hebgen Lake fault zone, to ENE-WSW near Norris Junction. In particular, the σ3 direction changed throughout the years in the Norris Junction area, from being ENE-WSW, as calculated in the study by Waite and Smith (2004), to NNE-SSW, while the other σ3 directions are mostly unchanged over time. The Yellowstone caldera was subject to periods of net uplift and subsidence over the past century, explained in previous studies as caused by expanding or contracting sills, at different depths. Based on the models used to explain these deformation periods, we investigated the relationship between variability in aseismic deformation and seismic activity and faulting styles. Focal mechanisms and P and T axes were divided into temporal and depth intervals, in order to identify spatial or temporal trends in deformation. The presence of “chocolate tablet” structures, with composite dilational faults, was identified in many stages of the deformation history both in the Norris Geyser Basin area and inside the caldera. Strike-slip component movement was found in a depth interval below a contracting sill, indicating the movement of magma towards the caldera.

The mean anatomical shape of the tibial plateau at the knee arthroplasty resection level: an investigation using MRI

Clinical assessments after Total Knee Arthroplasty (TKA) show persisting pain after implantation in over 20% of patients. Impingement of soft tissue around the knee, due to imprecise geometry of the tibial implant, can be one reason for persisting ailment. Two hundred and thirty seven MRI scans were evaluated using an active contour detection algorithm (snake) to obtain a high-resolution mean anatomical shape of the tibial plateau. Differences between female and male, older and younger (40) and left and right averaged shapes were determined. The shapes obtained were asymmetric throughout. Absolute differences between the subgroups fell short of inter-individual variations represented by calculated one-sigma confidence intervals. Our results indicate that a differentiation in TKA tibial plateau design by gender, age, or side is of minor relevance.

Evaluation of peri-operative epidural analgesia with ropivacaine, ropivacaine and sufentanil, and ropivacaine, sufentanil and epinephrine in isoflurane anesthetized dogs undergoing tibial plateau levelling osteotomy

The purpose of this study was to compare four epidural protocols for peri-operative analgesia in dogs undergoing tibial plateau levelling osteotomy. Forty client-owned dogs were randomly assigned to one of four treatments - groups R0.5 and R1 received 0.5mg/kg and 1mg/kg ropivacaine, respectively. Group SR0.5 received 1mug/kg sufentanil plus 0.5mg/kg ropivacaine, and group SER0.5 received 1mug/kg sufentanil, 0.5mg/kg ropivacaine plus 6mug/kg epinephrine. Dilution, when required, was performed with saline, so that the injected volume was always 0.2mL/kg. Intra-operatively, nociception assessment was based on the evaluation of changes in heart rate, respiratory rate and mean arterial pressure. Post-operative pain assessment was performed using the Glasgow visual analogue pain scale, and an ad hoc multifactorial pain score. Motor block was evaluated using a modified Bromage score. Intra-operatively, none of the animals was hypotensive. All groups except SER0.5 required rescue intra-operative fentanyl (40%, 30% and 40% of the animals in groups R0.5, R1 and SR0.5, respectively). Group SER0.5 showed lower post-operative pain scores, and group R1 significantly greater motor block, compared to the other treatment groups. None of the dogs had urinary retention. Epidural sufentanil-epinephrine-ropivacaine provided superior peri-operative analgesia compared to the other treatments, without producing clinically relevant side effects.

Preemptive carprofen for peri-operative analgesia in dogs undergoing Tibial Plateau Leveling Osteotomy (TPLO): a prospective, randomized, blinded, placebo controlled clinical trial

Eighteen client-owned dogs undergoing Tibial Plateau Leveling Osteotomy (TPLO) were included in this blinded clinical study and randomly assigned to one of two treatment groups. Group C (carprofen) received intravenous (IV) carprofen, 4 mg/kg, prior to anesthesia, whereas group P (placebo) received IV saline. General anesthesia was maintained with isoflurane in oxygen and a constant rate infusion (CRI) of sufentanyl IV. Intra-operatively, assessment of nociception was based on changes in physiological parameters and on the analgesics requirement, whereas in the post-operative period evaluation of pain was performed by using a Hellyer and Gaynor pain score and by comparing the doses of rescue buprenorphine required by the two treatment groups. Although no statistically significant differences in intra-operative sufentanyl doses were found between treatment groups, group C had superior cardiovascular stability, and lower post-operative pain scores and rescue buprenorphine doses than group P. Our results indicate that administration of carprofen prior to surgery was effective in improving peri-operative analgesia in dogs undergoing TPLO.

A Targeted Survey for Scrapie in Jos Plateau State, Nigeria

Scrapie, a disease of sheep and goats with a progressive course and fatal outcome, has not been identified in Nigeria. Anecdotal scrapie reports by livestock workers abound. Livestock diseases like scrapie form huddles in livestock economics of countries. For 8 months we surveyed for scrapie targeting emergency/casualty slaughter sheep and goats in Jos, Nigeria. We clinically examined 510 sheep and 608 goats of local breeds, aged from 12 months to 5 years. In total 31 (5.10%) goats and no sheep were clinically suspicious for scrapie. Caudal brainstem tissues of suspect animals collected postmortem were analyzed for the disease specific form of the prion protein, PrPSc, using Bio-Rad’s TeSeE ELISA rapid test kit. No sample was positive for scrapie. Fluorescent antibody test for rabies and H&E staining on samples were carried out for differential diagnosis. These showed no pathological lesions indicative for neurological disease. While our findings do not exclude the presence of scrapie in Jos, we demonstrate that targeted sampling of small ruminants for neuroinfectious disease is feasible in developing countries, pointing to the possibility of implementing such a monitoring scheme in Nigeria to prevent economic losses in small ruminant livestock as scrapie caveats from endemic countries have shown.

Magma differentiation fractionates Mo isotope ratios: Evidence from the Kos Plateau Tuff (Aegean Arc)

We investigated high temperature Mo isotope fractionation in a hydrous supra-subduction volcano-plutonic system (Kos, Aegean Arc, Greece) in order to address the debate on the δ98/95Mo variability of the continental crust. In this igneous system, where differentiation is interpreted to be dominated by fractional crystallization, bulk rock data from olivine basalt to dacite show δ98/95Mo ratios increasing from +0.3 to +0.6‰ along with Mo concentrations increasing from 0.8 to 4.1 μg g−1. Data for hornblende and biotite mineral separates reveal the extraction of light Mo into crystallizing silicates, with minimum partition coefficients between hornblende- silicate melt and biotite-silicate melt of 0.6 and 0.4 δ98/95Mo, respectively. Our data document significant Mo isotope fractionation at magmatic temperatures, hence, the igneous contribution to continental runoff is variable, besides probable source-related variability. Based on these results and published data an average continental δ98/95Mo of +0.3 to +0.4‰ can be derived. This signature corresponds more closely to the average of published data of dissolved Mo loads of large rivers than previous estimates and is consistent with an upper limit of δ98/95Mo = 0.4‰ of the Earth's upper crust as derived from the analysis of molybdenites.

On the counter-radiation of the atmosphere

This paper is the edited translation of the paper by ANDERS ANGSTRÖM ‘‘Über die Gegenstrahlung der Atmosphäre’’ (On the counter-radiation of the atmosphere) that was published 1916 in the Meteorologische Zeitschrift 33, 529–538.

Getting to Know You: Psychoeducational Groups to Counter Social Isolation of Neglectful Mothers

This research indicates a uniformly positive use of psychoeducational groups to counter social isolation of neglectful mothers. This research was supported by a National Child Welfare Fellowship from the U.S. Children 's Bureau to the author. The author thanks Nancy Dickinson, Sherrill Clark, and the staff of the California Social Work Education Center at the University of California for their oversight and guidance during (his fellowship. The author is also grateful to her fellow fellows for their input and guidance during this research effort. Special thanks to Rose Ben ham, Anna Bowen, Judith Brewington, Caron Byington, Scottye Cash. Dottie Dixon, and Verna Rickard for their support of this project.

Response of subfossil Cladocera in Gerzensee (Swiss Plateau) to early Late Glacial environmental change

Sub-fossil Cladocera were studied in a core from Gerzensee (Swiss Plateau) for the late-glacial periods of Oldest Dryas, Bølling, and Allerød. Cladocera assemblages were dominated by cold-tolerant littoral taxa Chydorus sphaericus, Acroperus harpae, Alonella nana, Alona affinis, and Alonella excisa. The rapid warming at the beginning of the Bølling (GI-1e) ca. 14,650 yr before present (BP: before AD 1950) was indicated by an abrupt 2‰ shift in carbonate δ18O and a clear change in pollen assemblages. Cladocera assemblages, in contrast, changed more gradually. C. sphaericus and A. harpae are the most cold-tolerant, and their abundance was highest in the earliest part of the record. Only 150–200 years after the beginning of the Bølling warming we observed an increase in less cold-tolerant A. excisa and A. affinis. The establishment of Alona guttata, A. guttata var. tuberculata, and Pleuroxus unicatus was delayed by ca. 350, 770, and 800 years respectively after the onset of the Bølling. The development of the Cladocera assemblages suggests increasing water temperatures during the Bølling/Allerød, which agrees with the interpretation by von Grafenstein et al. (2013-this issue) that decreasing δ18O values in carbonates in this period reflect increasing summer water temperatures at the sediment–water interface. Other processes also affected the Cladocera community, including the development and diversification of aquatic vegetation favourable for Cladocera. The record is clearly dominated by Chydoridae, as expected for a littoral core. Yet, the planktonic Eubosmina-group occurred throughout the core, with the exception of a period at ca. 13,760–13,420 yr BP. Lake levels reconstructed for this period are relatively low, indicating that the littoral location might have become too shallow for Eubosmina in that period.

Variability in Accumulation Rates from GPR Profiling on the West Antarctic Plateau

lsochronal layers in firn detected with ground-penetrating radar (GPR) and dated using results from ice-core analyses are used to calculate accumulation rates along a 100 km across-flow profile in West Antarctica. Accumulation rates are shown to be highly variable over short distances. Elevation measurements from global positioning system surveys show that accumulation rates derived from shallow horizons correlate well with surface undulations, which implies that wind redistribution of snow is the leading cause of this variability. Temporal changes in accumulation rate over 25-185 year intervals are smoothed to along-track length scales comparable to surface undulations in order to identify trends in accumulation that are likely related to changes in climate. Results show that accumulation rates along this profile have decreased in recent decades, which is consistent with core-derived time series of annual accumulation rates measured at the two ends of the radar profile. These results suggest that temporal variability observed in accumulation-rate records from ice cores and GPR profiles can be obscured by spatial influences, although it is possible to resolve temporal signals if the effects of local topography and ice flow are quantified and removed.

Snow Accumulation Rate on Qomolangma (Mount Everest), Himalaya: Synchroneity With Sites Across the Tibetan Plateau on 50-100 Year Timescales

Annual-layer thickness data, spanning AD 1534-2001, from an ice core from East Rongbuk Coll on Qomolangma (Mount Everest, Himalaya) yield an age-depth profile that deviates systematically from a constant accumulation-rate analytical model. The profile clearly shows that the mean accumulation rate has changed every 50-100 years. A numerical model was developed to determine the magnitude of these multi-decadal-scale rates. The model was used to obtain a time series of annual accumulation. The mean annual accumulation rate decreased from similar to 0.8 m ice equivalent in the 1500s to similar to 0.3 m in the mid-1800s. From similar to 1880 to similar to 1970 the rate increased. However, it has decreased since similar to 1970. Comparison with six other records from the Himalaya and the Tibetan Plateau shows that the changes in accumulation in East Rongbuk Col are broadly consistent with a regional pattern over much of the Plateau. This suggests that there may be an overarching mechanism controlling precipitation and mass balance over this area. However, a record from Dasuopu, only 125 km northwest of Qomolangma and 700 m higher than East Rongbuk Col, shows a maximum in accumulation during the 1800s, a time during which the East Rongbuk Col and Tibetan Plateau ice-core and tree-ring records show a minimum. This asynchroneity may be due to altitudinal or seasonal differences in monsoon versus westerly moisture sources or complex mountain meteorology.

Tertiary Minette and Melanephelinite Dikes, Wasatch Plateau, Utah - Records of Mantle Heterogeneities and Changing Tectonics

A swarm of minette and melanephelinite dikes is exposed over 2500 km2 in and near the Wasatch Plateau, central Utah, along the western margin of the Colorado Plateaus in the transition zone with the Basin and Range province. To date, 110 vertical dikes in 25 dike sets have been recognized. Strikes shift from about N80-degrees-W for 24 Ma dikes, to about N60-degrees-W for 18 Ma, to due north for 8-7 m.y. These orientations are consistent with a shift from east-west Oligocene compression associated with subduction to east-west late Miocene crustal extension. Minettes are the most common rock type; mica-rich minette and mica-bearing melanephelinite occurs in 24 Ma dikes, whereas more ordinary minette is found in 8-7 Ma dikes. One melanephelinite dike is 18 Ma. These mafic alkaline rocks are transitional to one another in modal and major element composition but have distinctive trace element patterns and isotopic compositions; they appear to have crystallized from primitive magmas. Major, trace element, and Nd-Sr isotopic data indicate that melanephelinite, which has similarities to ocean island basalt, was derived from small degree melts of mantle with a chondritic Sm/Nd ratio probably located in the asthenosphere, but it is difficult to rule out a lithospheric source. In contrast, mica-bearing rocks (mica melanephelinite and both types of minette) are more potassic and have trace element patterns with strong Nb-Ta depletions and Sr-Nd isotopic compositions caused by involvement with a component from heterogeneously enriched lithospheric mantle with long-term enrichment of Rb or light rare earth elements (REE) (epsilon Nd as low as - 15 in minette). Light REE enrichment must have occurred anciently in the mid-Proterozoic when the lithosphere was formed and is not a result of Cenozoic subduction processes. After about 25 Ma, foundering of the subducting Farallon plate may have triggered upwelling of warm asthenospheric mantle to the base of the lithosphere. Melanephelinite magma may have separated from the asthenosphere and, while rising through the lithosphere, provided heat for lithospheric magma generation. Varying degrees of interaction between melanephelinite and small potassic melt fractions derived from the lithospheric mantle can explain the gradational character of the melanephelinite to minette suite.

Translocal Practices on the Tibetan Plateau: Motorised Mobility of Pastoralists and Spatial Transformations

Tibetan pastoralist communities in Amdo, the north-eastern region of the Tibetan plateau, have undergone tremendous change due to a number of state induced modernisation processes. Road infrastructure is but one development that aims to facilitate transition from subsistence to a market economy and to link remote pastoralist production into the global or regional market. This paper starts from the local perspective and examines how the expansion of road infrastructure and increased ownership of motorised vehicles has impacted on the mobility of pastoralists. It argues that motorisation and the increased availability of roads creates an interface for pastoralists through which they negotiate a newly emerging translocality. Roads are embedded into everyday movements and provide pastoralists with ways to integrate new developments into their lives.