Defibrotide Interferes With Several Steps of the Coagulation-Inflammation Cycle and Exhibits Therapeutic Potential to Treat Severe Malaria

Objective-The coagulation-inflammation cycle has been implicated as a critical component in malaria pathogenesis. Defibrotide (DF), a mixture of DNA aptamers, displays anticoagulant, anti-inflammatory, and endothelial cell (EC)-protective activities and has been successfully used to treat comatose children with veno-occlusive disease. DF was investigated here as a drug to treat cerebral malaria. Methods and Results-DF blocks tissue factor expression by ECs incubated with parasitized red blood cells and attenuates prothrombinase activity, platelet aggregation, and complement activation. In contrast, it does not affect nitric oxide bioavailability. We also demonstrated that Plasmodium falciparum glycosylphosphatidylinositol (Pf-GPI) induces tissue factor expression in ECs and cytokine production by dendritic cells. Notably, dendritic cells, known to modulate coagulation and inflammation systemically, were identified as a novel target for DF. Accordingly, DF inhibits Toll-like receptor ligand-dependent dendritic cells activation by a mechanism that is blocked by adenosine receptor antagonist (8-p-sulfophenyltheophylline) but not reproduced by synthetic poly-A, -C, -T, and -G. These results imply that aptameric sequences and adenosine receptor mediate dendritic cells responses to the drug. DF also prevents rosetting formation, red blood cells invasion by P. falciparum and abolishes oocysts development in Anopheles gambiae. In a murine model of cerebral malaria, DF affected parasitemia, decreased IFN-gamma levels, and ameliorated clinical score (day 5) with a trend for increased survival. Conclusion-Therapeutic use of DF in malaria is proposed. (Arterioscler Thromb Vasc Biol. 2012; 32:786-798.)

Hematologic Reference Values for Clinically Healthy Captive Golden Conures (Guaruba guarouba)

Golden conures or ararajubas (Guaruba guarouba) are endangered parrots endemic to the Brazilian Amazon forest. Body mass, blood cell counts, and total plasma protein were determined for 70 clinically healthy golden conures captive at zoologic parks and private breeder facilities in Brazil. Hematologic results (mean +/- SD) were: Erythrocytes 3.6 +/- 0.5 x 10(6) cells/mm(3), hemoglobin 12.8 +/- 1.4 g/dl, packed cell volume 46 +/- 3.8%, mean corpuscular volume 132 +/- 20 fl, mean corpuscular hemoglobin (MCH) 36 +/- 5.7 pg, mean corpuscular hemoglobin concentration (MCHC) 28 +/- 3.5%, thrombocytes 26.3 +/- 9.3 x 10(3) cells/mm(3), leukocytes 11.9 +/- 4.5 x 10(3) cells/mm(3), heterophils 6284 +/- 2715 cells/mm(3), lymphocytes 5473 +/- 2408 cells/mm(3), monocytes 113 +/- 162 cells/mm(3), eosinophils 10 +/- 42 cells/mm(3), basophils 27 +/- 64 cells/mm(3). Body mass was 254 +/- 24.9 g and total plasma protein (TPP) was 3.54 +/- 0.58 g/dl. No statistical differences were observed between genders within age groups. Differences between juveniles (J) and adults (A) were identified for TPP < A), MCH (J > A), and MCHC (J > A). These results provide reliable reference values for the clinical interpretation of hematologic results for the species. Hematology may be an important tool for population health investigations on free-ranging golden conure populations and will also be essential to survey the health of release candidates in future reintroduction programs.

Are Multiple Cryoprobes Additive or Synergistic in Renal Cryotherapy?

OBJECTIVE To investigate the relationship between multiple cryoprobes was investigated to determine whether they work in an additive or synergistic fashion in an in vivo animal model because 1.47 mm (17-gauge) cryoprobes have been introduced to the armamentarium for renal cryotherapy. METHODS Laparoscopic-guided percutaneous cryoablation was performed in both renal poles of 3 pigs using 3 IceRod cryoprobes. These 12 cryolesions were compared with 12 cryolesions using a single IceRod cryoprobe. Each cycle consisted of two 10-minute freeze cycles separated by a 5-minute thaw. The iceball volume was measured using intraoperative ultrasonography. The kidneys were harvested, and cryolesion surface area was calculated. The lesions were fixed and excised to obtain a volume measurement. Statistical analysis was used to compare the single probe results multiplied by 3 to the multiple probe group for iceball volume, cryolesion surface area, and cryolesion volume. RESULTS The iceball volume for the first freeze cycle for the single cryoprobe multiplied by 3 was 8.55 cm(3) compared with 9.79 cm(3) for the multiple cryoprobe group (P = .44) and 10.01 cm(3) versus 16.58 cm(3) for the second freeze (P = .03). The cryolesion volume for the single cryoprobe multiplied by 3 was 11.29 cm(3) versus 14.75 cm(3) for the multiple cyroprobe group (P = .06). The gross cryolesion surface area for the single cryoprobe multiplied by 3 was 13.14 cm(2) versus 13.89 cm(2) for the multiple probe group (P = .52). CONCLUSION The cryolesion created by 3 simultaneously activated 1.47-mm probes appears to be larger than that of an additive effect. The lesions were significantly larger as measured by ultrasonography and nearly so (P = .06) as measured by the gross cryolesion volume. UROLOGY 79: 484.e1-484.e6, 2012. (c) 2012 Elsevier Inc. All rights reserved.

A NEW GENUS AND SPECIES OF PHILOPTERIDAE (PHTHIRAPTERA: ISCHNOCERA) FROM THE TRUMPETERS (AVES: GRUIFORMES: PSOPHIIDAE)

A new chewing louse genus and species belonging to the Philopteridae, namely, Palmaellus inespectatus n. gen., n. sp., is described. The new genus is distinguished from the other ischnoceran genera hitherto described by its peculiar characters of the dorsal anterior head plate with 2 postero-lateral projections, pterothorax and abdomen with scarce chaetotaxy, male genitalia with simple mesomere and paramere lacking inner digitiform projection, and the genital region of female with postero-vulvar plates bearing setae. It is a parasite of the trumpeters, an avian family endemic to South America's Amazon Basin.

COMMON GOOSE BARNACLES LEPAS AUSTRALIS (THORACICA, PEDUNCULATA) ON DECEASED MAGELLANIC PENGUINS SPHENISCUS MAGELLANICUS (AVES)

Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP)

Survival and movements of Magellanic penguins rehabilitated from oil fouling along the coast of South America, 2000-2010

Oil pollution is a significant conservation concern. We examined data from six institutions along the coast of South America: Emergency Relief Team of the International Fund for Animal Welfare, Fundacion Mundo Marino, Centro de Recuperacao de Animais Marinhos, Natura Patagonia, Associacao R3 Animal, and Mar del Plata Aquarium and data from resightings in Argentina, Brazil, Chile and Falkland/Malvinas Islands. From 2000 to 2010, 2183 oiled Magellanic penguins were rehabilitated as part of the routine activities of these institutions or during emergency responses to eight oil spills in which they were involved; all rehabilitated penguins were flipper banded and released. Since their release, 41 penguins were resighted until 31 December 2011. The results demonstrate that, when combined with other prevention strategies, the rehabilitation of Magellanic penguins is a strategy that contributes to the mitigation of adverse effects of oil spills and chronic pollution to the species. (C) 2012 Elsevier Ltd. All rights reserved.

The occurrence of defensive alkaloids in non-integumentary tissues of the Brazilian red-belly toad Melanophryniscus simplex (Bufonidae)

The red-belly toads (Melanophryniscus) of southern South America secrete defensive alkaloids from dermal granular glands. To date, all information on Melanophryniscus alkaloids has been obtained by extraction from either skins or whole organisms; however, in other amphibians, tetrodotoxins, samandarines, and bufadienolides have been detected in both skin and other organs, which raise the possibility that lipophilic alkaloids may occur in non-integumentary tissues in Melanophryniscus as well. To test this hypothesis, we studied the distribution of alkaloids in the skin, skeletal muscle, liver, and mature oocytes of the red-belly toad M. simplex from three localities in southern Brazil. Gas chromatography and mass spectrometry of skin extracts from 11 individuals of M. simplex resulted in the detection of 47 alkaloids (including isomers), 9 unclassified and 38 from 12 known structural classes. Each alkaloid that was present in the skin of an individual was also present in the same relative proportion in that individual's skeletal muscle, liver, and oocytes. The most abundant and widely distributed alkaloids were the pumiliotoxins 251D, 267C, and 323A, 5,8-disubstituted indolizidines 207A and 223D, 5,6,8-trisubstituted indolizidine 231B, 3,5-disubstituted pyrrolizidines cis-223B and cis- and trans-251K, and izidine 211C. We report the first record of piperidines in Melanophryniscus, bringing the total number of alkaloid classes detected in this genus to 16. Alkaloid composition differed significantly among the three study sites. The functional significance of defensive chemicals in non-integumentary tissues is unknown.

Developing a provisional definition of flare in patients with established gout

Objective Various nonvalidated criteria for disease flare have been used in studies of gout. Our objective was to develop empirical definitions for a gout flare from patient-reported features. Methods Possible elements for flare criteria were previously reported. Data were collected from 210 gout patients at 8 international sites to evaluate potential gout flare criteria against the gold standard of an expert rheumatologist definition. Flare definitions based on the presence of the number of criteria independently associated with the flare and classification and regression tree approaches were developed. Results The mean +/- SD age of the study participants was 56.2 +/- 15 years, 207 of them (98%) were men, and 54 of them (26%) had flares of gout. The presence of any patient-reported warm joint, any patient-reported swollen joint, patient-reported pain at rest score of >3 (010 scale), and patient-reported flare were independently associated with the study gold standard. The greatest discriminating power was noted for the presence of 3 or more of the above 4 criteria (sensitivity 91% and specificity 82%). Requiring all 4 criteria provided the highest specificity (96%) and positive predictive value (85%). A classification tree identified pain at rest with a score of >3, followed by patient self-reported flare, as the rule associated with the gold standard (sensitivity 83% and specificity 90%). Conclusion We propose definitions for a disease flare based on self-reported items in patients previously diagnosed as having gout. Patient-reported flare, joint pain at rest, warm joints, and swollen joints were most strongly associated with presence of a gout flare. These provisional definitions will next be validated in clinical trials.

Performance Financeira Corporativa e Performance Social Corporativa: desenvolvimento metodológico e contribuição teórica dos estudos empíricos

Um dos papéis da contabilidade é prover informações sobre o desempenho empresarial, quer seja por indicadores contábil-financeiros ou não. Dentro deste escopo do interesse da contabilidade, observa-se que a publicação de estudos teórico-empíricos sobre as relações entre Performance Corporativa Financeira (CFP) e a Performance Social Corporativa (CSP) vem crescendo nos últimos anos, sintoma do desenvolvimento deste campo de pesquisa. Entretanto, a contribuição à teoria pelos trabalhos empíricos se faz de forma pontual, uma vez que normalmente cada estudo foca um aspecto particular da teoria. Periodicamente, portanto, é necessária uma análise que avalie como, de forma agregada, os estudos empíricos contribuíram para a evolução da teoria, e elaborar essa análise constituiu o objetivo do presente estudo. O referencial teórico abrangeu: teoria dos stakeholders, relação entre CSP e CFP, good management theory e slack resource theory. Esta pesquisa abrangeu um período de 15 anos (1996 a 2010) e a coleta de dados empregou a ferramenta de busca das bases de dados: Ebsco, Proquest e ISI. O processo de amostragem obteve um conjunto de 58 artigos exclusivamente teórico-empíricos quantitativos que testam a relação CSP-CFP. Os principais resultados no campo teórico demonstram um reforço da proposição de relação positiva entre CSP e CFP e da good management theory, uma deficiência na explicação na defasagem de tempo (lag) na relação de causalidade entre CSP e CFP, e deficiências na descrição do constructo de CSP. Isto sugere estudos futuros para investigar a defasagem de tempo na relação de causalidade entre CSP e CFP e as possíveis razões que levaram diversos estudos empíricos a não atestarem uma associação positiva entre CSP e CFP.

Viagem sem volta. [Depoimento a Rodrigo de Oliveira Andrade]

Fêmeas de pinguins-de-magalhães morrem mais que machos durante migração anual.

Messung des Wirkungsquerschnitts der Reaktion d(e,e'p)n für fehlende Impulse bis 950 MeV/c und Trennung der longitudinalen und transversalen Reaktionsanteile für fehlende Impulse bis 350 MeV/c

Die Dreispektrometeranlage der A1-Kollaboration am MainzerElektronenbeschleuniger MAMI wurde im Rahmen dieser Arbeitverwendet, um die Elektrodisintegration des Deuteronsmit Hilfe der Reaktion d(e,e'p)n zu untersuchen. Im ersten Teil der Untersuchungen wurde die longitudinaleund transversale Strukturfunktion aus denWirkungsquerschnitten extrahiert. Die Zentralwerte derkinematischen Parameter waren dabei wie folgt eingestellt:1) Der Impulsübertrag wurde für alle Messungen auf 450 MeV/c festgelegt.2) Das Proton wurde in Richtung des Impulsübertrags nachgewiesen (parallele Kinematik).3) Vier Einstellungen des Energieübertrags, und damit korrespondierend des fehlenden Impulses, wurden gemessen: Energieübertrag / MeV : 128, 226, 289, 360. Fehlender Impuls / (MeV/c): 50, 200, 275, 350.4) Für jede dieser vier Kinematiken wurden mindestens drei verschiedene Einschußenergien bzw. Elektronenstreuwinkel eingestellt, um die Strukturfunktionen mit Hilfe der Rosenbluth-Separation zu bestimmen. Im zweiten Teil der Untersuchungen wurde derWirkungsquerschnitt für hohe fehlende Impulse bestimmt.Dessen Zentralwerte wurden von 30 MeV/c bis 906 MeV/cvariiert, wobei für die hohen fehlenden Impulse das Protonweit außerhalb der Richtung des Impulsübertragesnachzuweisen war. Der Energieübertrag lag dabei zwischen180 MeV und 600 MeV und der Impulsübertrag zwischen608 MeV/c und 698 MeV/c.

Analytische und funktionale Charakterisierung von ultradünnen kohlenstoffbasierten Schichten in der Magnetspeichertechnologie

Ein Schwerpunkt der in dieser Arbeit durchgeführten Analysen konzentrierte sich auf den Einfluss der Kohlenstoffschichtdicke auf die resultierenden Schichteigenschaften. Dies erfolgte vor dem Hintergrund, dass ein Anstieg der Speicherdichte auf 100 Gbits/in2 mit einer Dickenreduzierung der magnetisch inaktiven Kohlenstoffschutzschichten auf 2 nm verbunden ist. Im Rahmen der Charakterisierung von wasserstoffhaltigen, mittels einem CVD-Netzhohlkathodenreaktor abgeschiedenen Schichten, wurde eine zuverlässige Anwen-dung der XRR zur Dickenbestimmung ultradünner Kohlenstoffschichten im Bereich von 2-20 nm demonstriert. Die konsistente Verwendung eines optischen Einschichtmodells deutet auf eine homogene Tiefenstruktur ohne deutliche Ausprägung von scharf defi-nierten Grenzflächenbereichen zum Substrat und zur Oberfläche hin. Die Analyse des Schichtdickeneinflusses ergab eine leichte Verminderung der Kratz-härte sowie einen Rückgang des Elastizitätsmoduls von 90 GPa auf etwa 60 GPa, wenn die Schichtdicken bei Raumtemperaturabscheidung von 17 nm auf 2 nm reduziert wer-den. Diese Ergebnisse stehen in guter Übereinstimmung mit gewonnen ramanspektro-skopischen Resultaten, die einen ansteigenden sp2-Bindungsanteil für abnehmende Schichtdicken belegen. Die Charakterisierung von wasserstofffreien, gepulsten Vakuumbogen-Schichten ergab ein heterogenes Tiefenprofil, bestehend aus Oberflächen-, Bulk- und Interfacebereich. Diese Struktur führt zu einer Schichtdickenabhängigkeit von mechanischen und struktu-rellen Parametern, die über die gesamte Schichtdicke gemittelt werden. XRR-Analysen ergaben Bulkdichten von 2.8-3.0 g/cm3 bei Raumtemperaturabscheidung und 2.2 g/cm3 für eine Beschichtung von Speicherplatten bei einer Temperatur von 200 °C. Durchgeführte AFM-Messungen an Schichten auf Silizumsubstraten zeigten nahezu kei-ne Abhängigkeit der RMS-Oberflächenrauhigkeit von der Schichtdicke bis zu 18 nm und lieferten konstante Werte im Bereich der Substratrauhigkeit von etwa 0.1 nm. Bei der Beschichtung von Speicherplatten bewirkt eine Dickenabnahme der aufgebrachten Filme sogar einen glättenden Einfluss auf die Oberflächentopographie. Der Elastizitätsmodul und die mittels Mehrwellenlängen-Ramanspektroskopie ermittelte Raman-G-Peak-Dispersion als Maße für Schichthärte und Schichtstruktur zeigen einen korrelierenden Abfall für verringerte Schichtdicken. Der Elastizitätsmodul fällt im Fall ei-ner Raumtemperaturabscheidung von etwa 450 GPa bei 20 nm Dicke auf ca. 50 GPa bei weniger als 2 nm Dicke ab. Diese Resultate werden durch röntgenabsorptionsspektro-skopische Untersuchungen der Kohlenstoff-K-Kante bestätigt. Kombinierte XPS- und XANES-Analysen der Bedeckungsqualität von Vakuumbogen-Schichten ergaben eine kritische Dicke von nur ca. 1 nm. Bei einer Unterschreitung die-ses Dickenwertes kann eine vollständige Bedeckung bzw. der Korrosionsschutz des un-terliegenden metallischen Mediums nicht mehr uneingeschränkt gewährleistet werden. XPS-Referenzmessungen an konvenzionellen CNx-Schichten weisen demgegenüber oxidische Cobaltsignale bereits im Bereich von 2-3 nm nach.

Extended donor and acceptor molecules for organic electronics

Die Untersuchung von halbleitenden Materialien auf der Basis von organischen Molekülen stellt ein Gebiet der angewandten Forschung an der Schwelle zur industriellen Nutzung dar. Geringes Gewicht und hohe mechanische Flexibilität ermöglichen völlig neue Produkte, die mit anorganischen Halbleitern nicht zu realisieren sind. Die Herstellung von Bauteilen wie Transistoren, Solarzellen oder Leuchtdioden aus organischen Materialien ist ein komplexes Gebiet, das einer Vielzahl von unterschiedlichen Optimierungen bedarf, um eine konkurrenzfähige Leistung zu erreichen. Die synthetische organische Chemie bietet vielfältige Möglichkeiten, mit maßgeschneiderten Lösungen zum Optimierungsprozess beizutragen. Zum einen können neue aktive Materialien hergestellt werden mit besserer Leistung und leichterer Verarbeitbarkeit. Zum anderen sind Substanzen zugänglich, die z.B. bei der Ladungsträgerinjektion hilfreich sein können.rnIn dieser Arbeit wurde an beiden dieser Fronten gearbeitet. Dabei lag die Entwicklungsstrategie darin, ausgedehnte π-konjugierte Moleküle herzustellen, die entweder besonders elektronenarme Akzeptoren oder elektronenreiche Donoren darstellen. Die genaue Kontrolle der elektronischen Niveaus stellt einen wichtigen Bestandteil dar, um niedrige elektrische Kontaktbarrieren zu Metallen zu erreichen und ausreichend stabile Materialien zu erreichen.rnDer erste Fokus der Arbeiten lag in der Funktionalisierung von Coronen. Dieser PAH stellt einen guten Kompromiss bezüglich seiner Größe dar: Er ist groß genug, um Diffusion in andere Schichten von Bauteilen zu vermeiden, aber nicht zu groß, um Verarbeitung durch Vakuumsublimation zu ermöglichen. Bislang sind praktisch keine Coronen-Derivate in der Literatur beschrieben, weshalb eine neue Synthese entwickelt werden musste, die die Einführung starker Donor- und Akzeptorfunktionalitäten erlaubt. Die photochemische Cyclodehydrierung von substituierten [2.2.2]paracyclophan-trienen stellte sich als hervorragende Möglichkeit heraus, dies zu bewerkstelligen. Es wurde eine Reihe von methoxy-substitutierten Coronenen mit unterschiedlicher Symmetrie hergestellt. Mittels optischer Spektroskopie konnte gezeigt werden, dass Methoxygruppen wenig Einfluss auf die elektronischen Eigenschaften von Coronen haben. Unter Spaltung der Methylether und anschließender Oxidation allerdings sind Coronenketone zugänglich, welche bis zu drei α-Diketongruppen besitzen. Diese Moleküle sind enorm starke Akzeptoren, was durch Cyclovoltammetrie und Vergleich zu anderen Akzeptoren eindrucksvoll gezeigt werden konnte. Die Sublimation dieses Akzeptors auf die Oberfläche von Metallen zeigt einen dramatischen Einfluss auf die Austrittsarbeit dieses Metalls, was zur Herstellung eines ohmschen Kontakts zu organischen Halbleitern von außerordentlichem Nutzen ist. rnDen zweiten Teil der Arbeit bilden Benzodithiophen enthaltende Polymere, die für den Einsatz als aktive Komponente in elektronischen Bauteilen entwickelt wurden. Nach systematischer Strukturoptimierung wurde ein Polymer enthalten, welches in einem Feldeffekt-Transistor auf Standard-Silizium-Substraten Ladungsträger-Mobilitäten über 0,1 cm2/Vs erreicht mit großer Reproduzierbarkeit und ausgezeichneter Transistor-Charakteristik. Es konnte gezeigt werden, dass die durch die Monomergeometrie erzeugte Kurvung des Polymers zu einem optimalen Kompromiss aus Löslichkeit und effektiver Packung darstellt. Auf für industrielle Anwendungen besonders interessanten polymer-basierten Substraten wurde eine noch erheblich bessere Leistung gezeigt. Auf einem PET-Substrat wurden Feldeffekt-Mobilitäten von 0,5 cm2/Vs gemessen mit überzeugenden Reproduzierbarkeit und Stabilität.rnDamit konnte in der Arbeit ein bedeutender Beitrag zur Weiterentwicklung von Materialien für den Einsatz in elektronischen Bauteilen geleistet werden. Die Substanzen versprechen noch erhebliches Potenzial nach intensiver Optimierung und wurden deshalb zum Patent angemeldet.rn

Volatile anesthetics influence blood-brain barrier integrity by modulation of tight junction protein expression in traumatic brain injury

Disruption of the blood-brain barrier (BBB) results in cerebral edema formation, which is a major cause for high mortalityrnafter traumatic brain injury (TBI). As anesthetic care is mandatory in patients suffering from severe TBI it may be importantrnto elucidate the effect of different anesthetics on cerebral edema formation. Tight junction proteins (TJ) such as zonularnoccludens-1 (ZO-1) and claudin-5 (cl5) play a central role for BBB stability. First, the influence of the volatile anestheticsrnsevoflurane and isoflurane on in-vitro BBB integrity was investigated by quantification of the electrical resistance (TEER) inrnmurine brain endothelial monolayers and neurovascular co-cultures of the BBB. Secondly brain edema and TJ expression ofrnZO-1 and cl5 were measured in-vivo after exposure towards volatile anesthetics in native mice and after controlled corticalrnimpact (CCI). In in-vitro endothelial monocultures, both anesthetics significantly reduced TEER within 24 hours afterrnexposure. In BBB co-cultures mimicking the neurovascular unit (NVU) volatile anesthetics had no impact on TEER. In healthyrnmice, anesthesia did not influence brain water content and TJ expression, while 24 hours after CCI brain water contentrnincreased significantly stronger with isoflurane compared to sevoflurane. In line with the brain edema data, ZO-1 expressionrnwas significantly higher in sevoflurane compared to isoflurane exposed CCI animals. Immunohistochemical analysesrnrevealed disruption of ZO-1 at the cerebrovascular level, while cl5 was less affected in the pericontusional area. The studyrndemonstrates that anesthetics influence brain edema formation after experimental TBI. This effect may be attributed tornmodulation of BBB permeability by differential TJ protein expression. Therefore, selection of anesthetics may influence thernbarrier function and introduce a strong bias in experimental research on pathophysiology of BBB dysfunction. Futurernresearch is required to investigate adverse or beneficial effects of volatile anesthetics on patients at risk for cerebral edema.

Vascularised fibula grafts for early tibia reconstruction in infants with congenital pseudarthrosis

Congenital pseudarthrosis of the tibia (CPT) is caused by an ill-defined, segmental disturbance of periosteal bone formation leading to spontaneous bowing, followed by fracture and subsequent pseudarthrosis in the first 2 years of life. The results of conventional treatment modalities (e.g., bracing, internal and external fixation and bone grafting) are associated with high failure rates in terms of persisting pseudarthrosis, malunion and impaired growth. As a more promising alternative, a more aggressive approach, including wide resection of the affected bone, reconstruction with free vascularised fibula grafts from the healthy contralateral leg and stable external fixation at a very early stage has been suggested. Between 1995 and 2007, 10 children (age 12-31 months, median 20 months) suffering from CPT were treated at our institutions according to this principle. Two patients were treated before a fracture had occurred. The length of the fibula graft was 7-9cm. End-to-end anastomoses were performed at the level of the distal tibia stump. The follow-up was 80 months (median, range 12 months to 12 years). Radiologic examination at 6 weeks postoperatively showed normal bone density and structure of the transplanted fibula in all cases and osseous consolidation at 19 of the 20 graft/tibia junctions. One nonunion was sucessfully treated with bone grafting and plate osteosynthesis. Pin-tract infection occurred in three patients. Five children sustained graft fractures that were successfully treated with internal or external fixation. Two patients developed diminished growth of the affected limb or foot; all others had equal limb length and shoe size. At long-term follow-up, tibialisation of the transplant had occurred, and normal gait and physical activities were possible in all children. We conclude that in spite of a relatively high complication rate and the reluctance to perform free flap surgery in infants at this young age, the present concept may successfully prevent the imminent severe sequelae associated with CPT.