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PubMed1996

Duration of antituberculosis chemotherapy in conjunction with radical surgery in the management of spinal tuberculosis.

STUDY DESIGN: The effectiveness of duration of antituberculous chemotherapy in conjunction with radical surgery for tuberculosis of the spine is reported. One hundred fourteen patients were followed prospectively for a mean period of 14.6 years after radical resection of the tuberculous lesion and reconstruction of the resultant gap with bone graft. OBJECTIVE: To evaluate the efficacy of short-course antituberculous chemotherapy in relation to the standard 18-month chemotherapy in conjunction with radical surgery for tuberculosis of the spine. SUMMARY OF BACKGROUND DATA: One hundred fourteen patients who were subjects of the Medical Research Council's (London, UK) prospective study underwent radical resection of the lesion and anterior arthrodesis of the spine. These patients received 6, 9, and 18 months of antituberculous chemotherapy. Those who received 6- and 9-month chemotherapy received streptomycin, rifampicin, and isoniazid. Streptomycin was given for the first 3 months, and the other two drugs were continued for 6 or 9 months. Those who received 18 months of chemotherapy were given streptomycin (first 3 months), sodium para-aminosalicylic acid, and isoniazid. METHODS: These patients were followed longitudinally, and at each visit, clinical and radiologic data were collected at 1-month intervals up to 3 months postoperatively, at 3-month intervals to 30 months postoperatively, at 6-month intervals up to 5 years postoperatively, and at 12-month intervals to the conclusion of study (minimum, 10 years). For assessment of spinal deformity, the "deformity angle" was measured on lateral spinal radiographs obtained at each visit. RESULTS: Six-month, 9-month, and 18-month chemotherapeutic regimens in association with radical surgery produced similar clinical results with no recurrence or reactivation of tuberculosis. The changes in deformity angles at final follow-up evaluation compared with 6-month postoperative values were not statistically significantly different in the groups who underwent 6 months, 9 months, and 18 months of chemotherapy. CONCLUSIONS: The authors' findings show that a 6-month chemotherapeutic regimen combined with surgical excision and bone grafting is adequate for management of tuberculosis of the spine, as it produced clinical and radiologic results comparable with the 18-month chemotherapeutic regimen.

Adolescent↗
PubMed1992

Prolongation of graft survival in primate allograft transplantation by yttrium-90-labeled anti-Tac in conjunction with granulocyte colony-stimulating factor.

High-affinity IL-2 receptors are expressed by T cells activated in response to foreign histocompatibility antigens but not by normal resting T cells. To exploit this difference in IL-2R expression, anti-Tac, a murine monoclonal antibody specific for the IL-2R alpha subunit, was used to inhibit organ allograft rejection. To enhance its effector function, anti-Tac was armed by chelation with yttrium-90, a pure beta-emitting radionuclide. Animals received no immunosuppression (n = 5, group I, controls), unmodified anti-Tac (n = 5, 1 mg/kg q.o.d., group II), or 90Y-anti-Tac (n = 5, 1.6 mCi/kg divided into four doses, group III). The animals in group IV (n = 4) were treated identically to those in group III with the exception that 5 micrograms/kg/dose of granulocyte colony-stimulating factor was administered intramuscularly on the days when the yttrium-90 was given and on postoperative days 12 through 35 in order to reduce hematopoietic toxicity. Mean graft survival +/- S.E.M. for the control group was 8.2 +/- 0.5 days as compared with 13.8 +/- 2.1 days (P < 0.05) for those monkeys treated with unmodified anti-Tac. Graft survival was further prolonged in animals of group III that received 90Y-anti-Tac, with a mean graft survival of 45.0 +/- 11.8 days; however, three of the five monkeys retained viable grafts within this group but died secondary to bone marrow suppression. In comparison, the monkeys in group IV that were treated with G-CSF in conjunction with 90Y-anti-Tac had a mean graft survival of 49.2 +/- 2.9 days. In contrast to group III there were no deaths in the group (IV) receiving G-CSF. Furthermore, animals in group IV had a reduced magnitude and shortened duration of irradiation-induced neutropenia when compared with that observed in group III animals that did not receive G-CSF. Thus, treatment with 90Y-anti-Tac in conjunction with G-CSF may have potential applications in organ transplantation and the treatment of IL-2 receptor-expressing neoplastic diseases.

Animals↗
PubMed2005

The use of an interspinous implant in conjunction with a graded facetectomy procedure.

STUDY DESIGN: The range of motion (ROM) of lumbar cadaver spines was measured during flexion, extension, axial rotation, and lateral bending following graded facetectomies and implantation of an X STOP interspinous spacer implant. OBJECTIVE: The study was performed undertaken to understand better the influence of the interspinous spacer implant on the kinematics of the lumbar spine following graded facetectomies. SUMMARY OF THE BACKGROUND DATA: Lateral lumbar spinal stenosis is often treated with a unilateral or bilateral facetectomy procedure. Previous biomechanical research has shown that a facetectomy may increase the ROM during flexion and axial rotation. METHODS: Seven cadaver spines (L2-L5) were tested in flexion, extension, axial rotation, and lateral bending, and the individual ROM of each motion segment was measured. Specimens were tested intact and following 3 graded facetectomies (i.e., unilateral medial facetectomy [UMF], unilateral total facetectomy [UTF], and bilateral total facetectomy [BTF]), with and without the X STOP. RESULTS: A BTF caused a significant increase in ROM during flexion and axial rotation but not extension and lateral bending. The UMF and UTF did not affect the ROM during any of the 4 motions. The interspinous implant: (1) significantly decreased the flexion ROM for the intact, UMF, UTF, and BTF treatments; (2) significantly decreased the extension ROM for the intact, UMF, and BTF treatments but not the UTF (P < 0.13); (3) had no significant effect on the axial rotation ROM; and (4) significantly increased the lateral bending ROM for the UMF, UTF, and BTF treatments. CONCLUSIONS: The results suggest that the implant may be used in conjunction with a UMF or UTF. However, the X STOP should not be used in conjunction with BTF.

Biomechanical Phenomena↗
PubMed2004

Clinical experience with linezolid in conjunction with wound coverage techniques for skin and soft-tissue infections and postoperative osteomyelitis.

Gram-positive organisms are emerging as possibly the most important nosocomial pathogens during the past decade. Methicillin-resistant Staphylococcus aureus (MRSA) is a frequent cause of infection in the postoperative patient. Burn victims are at high risk for developing vancomycin-resistant Enterococcus (VRE) and other multidrug-resistant microbial infections as a result of the immunocompromising effects of burn injury, prolonged intensive care unit stays, and broad-spectrum antibiotic therapy. To prevent serious and dreaded complications such as skin graft breakdown, delayed wound healing, loss of a limb, and even death, these infections require a combination of extensive antibiotic therapy and plastic surgical intervention. The objectives of this study were to report clinical experience with linezolid in addition to wound care, debridement, and wound coverage techniques for the treatment of S. aureus (including MRSA) and VRE infections. Forty patients received linezolid for infections of wound coverage such as an infected graft or flap, or received linezolid in conjunction with wound coverage techniques for a S. aureus or VRE infection. The median patient age was 53 years (range, 14-85 years), 55% were female, 28% of patients received intravenous (i.v.) linezolid only, 45% received i.v. with a switch to the oral formulation, and 28% received the oral formulation only. The clinical success rate of linezolid with adjuvant wound coverage techniques was 90.0% for osteomyelitis and was 100% for skin and soft-tissue infections. For infections of wound coverage, the clinical success rate was 83.3%. In conclusion, linezolid was an effective antibiotic for the treatment of S. aureus (including MRSA) and VRE infections in conjunction with wound coverage techniques. In addition, linezolid offers the option of treating these infections with an oral agent that is 100% bioavailable.

Acetamides↗
PubMed2006

Preparation of cultured skin for transplantation using insulin-like growth factor I in conjunction with insulin-like growth factor binding protein 5, epidermal growth factor, and vitronectin.

BACKGROUND: Cultured skin for transplantation is routinely prepared by growing patient keratinocytes in the presence of semidefined sources of growth factors including serum and feeder cells, but these materials require substantial risk remediation and can contribute to transplant rejection. METHODS: We have therefore investigated the potential of a novel combination of recombinant and purified growth factors to replace serum and feeder cells in cultures of human keratinocytes suitable for clinical application. Our technique was investigated with respect to culture establishment, serial propagation, colony-forming efficiency, immunocytochemistry, epidermal reconstruction, and suitability to support transplantation by aerosolization. RESULTS: We demonstrate that insulin-like growth factor (IGF)-I--used in conjunction with epidermal growth factor (EGF), insulin-like growth factor binding protein (IGFBP)-5 and vitronectin--supports growth in the absence of serum. Moreover, a threefold greater number of cells are generated within 7 days compared to those grown under current best practice conditions using serum (P<0.05). The resulting test cultures are suitable for epidermal reconstruction and support the option for delivery in the form of an aerosolized cell suspension. Serial propagation, with the view to producing confluent sheets for extensive injuries, was achieved but with less consistency and this result correlated with a significant decline in colony-forming efficiency compared to controls. CONCLUSIONS: IGF-I used in conjunction with IGFBP-5, EGF, and vitronectin provides a superior alternative to serum for the rapid expansion and transplantation of cultured keratinocytes within the first week of treatment. Nevertheless, further optimization is required with respect to elimination of feeder cells and serial expansion of cultures for treatment of extensive injuries.

Animals↗
PubMed2005

Aplasia of the pubic bone in conjunction with hip dislocation.

We describe here unilateral left hip dislocation in a 2-year-old child in conjunction with ipsilateral absence of the pubic bone. He was admitted to our hospital at 1 year of age and diagnosed with teratogenic dislocation of the left hip, aplasia of the left pubic bone, an undescended palpable left testicle and hypospadias. We performed open reduction through an anterior approach with preliminary skin traction for 1 week and spica cast for 3 months. The acetabular index was high both on admission and in the last radiographic control. Computerized tomography demonstrated dysplasia of the acetabulum and absence of the pubic bone. We concluded that the congenital absence of the left pubis was the major cause of the residual acetabular dysplasia. To our knowledge the conjunction of hip dislocation, aplasia of pubic bone and genitourinary anomalies has not been reported in the orthopaedic literature previously.

Acetabulum↗
PubMed2005

Evaluation of COBAS AmpliPrep nucleic acid extraction in conjunction with COBAS AmpliScreen HBV DNA, HCV RNA and HIV-1 RNA amplification and detection.

BACKGROUND AND OBJECTIVES: This report describes the evaluation of the COBAS AmpliPrep instrument for fully automated generic nucleic acid extraction in conjunction with hepatitis B virus (HBV) DNA, hepatitis C virus (HCV) RNA, and human immunodeficiency virus (HIV)-1 RNA COBAS AmpliScreen amplification and detection using serial dilutions of the WHO international standards (IS) and the PeliCheck reference panels. MATERIALS AND METHODS: Serial diluted samples of the WHO IS and the PeliCheck reference panels were tested 24 times to determine the HBV DNA, HCV RNA and HIV-1 RNA detection limits by Probit analysis. The existence and extent of cross-contamination were assessed by testing alternating high titre HBV DNA-positive and -negative samples. The specificity of the AmpliPrep-AmpliScreen test for HBV was determined by testing 232 minipools consisting of six donations, all negative for HCV/HIV-1 nucleic acid testing (NAT) and HBsAg. In addition, a HBV genotypes A-G panel was tested. RESULTS: The respective 95% detection limits (and 95% CI) on the WHO IS and on the PeliCheck reference panels were 6.7 (4.3-13) IU/ml and 123 (68-301) gEq/ml for HBV DNA, 23 (11-106) IU/ml and 126 (84-233) gEq/ml for HCV RNA, and 187 (108-422) IU/ml and 183 (108-434) gEq/ml for HIV-1 RNA. Based on the WHO IS and the PeliCheck reference panels, no significant differences in sensitivity for HBV and HCV were found between AmpliPrep and the licensed MultiPrep extraction method. The sensitivity of AmpliPrep-AmpliScreen for HIV-1 was probably twofold lower as compared to the MultiPrep-AmpliScreen method. No cross contamination was observed. All 232 minipools were HBV NAT-negative. The AmpliPrep-AmpliScreen test for HBV detected HBV genotypes A-G with equal sensitivity. CONCLUSIONS: The AmpliPrep instrument combined with the AmpliScreen assays for HBV, HCV and HIV-1 is robust and suitable for NAT donor screening. The sensitivity criteria for HIV-1 and HCV as defined by the Paul Ehrlich Institute and the Food and Drug Administration for minipool NAT screening are met by this system. SINGLE SENTENCE SUMMARY: Generic COBAS AmpliPrep nucleic acid extraction in conjunction with COBAS AmpliScreen detection for HBV, HCV and HIV-1.

DNA, Viral↗
PubMed2006

The face you recognize may not be the one you saw: memory conjunction errors in individuals with or without learning disability.

Memory conjunction errors, that is, when a combination of two previously presented stimuli is erroneously recognized as previously having been seen, were investigated in a face recognition task with drawings and photographs in 23 individuals with learning disability, and 18 chronologically age-matched controls without learning disability. Compared to the controls, individuals with learning disability committed significantly more conjunction errors, feature errors (one old and one new component), but had lower correct recognition, when the results were adjusted for different guessing levels. A dual-processing approach gained more support than a binding approach. However, neither of the approaches could explain all of the results. The results of the learning disability group were only partly related to non-verbal intelligence.

Adult↗
PubMed1989

Event-related potentials during memory search and selective attention to letter size and conjunctions of letter size and color.

The analysis of event-related potentials was used in two experiments to investigate the structure of information processing in a task in which subjects selectively attended to letter size (Experiment 1) or a conjunction of letter size and color (Experiment 2) and searched for target letters within the attended stimulus category. The event-related potentials showed that selective attention to letter size resulted in the enhancement of a central N2b component (onset about 200 ms), which was assumed to reflect feature nonspecific orienting of attention. When attention was directed to conjunctions of letter size and color an earlier effect was found (onset about 150 ms) consisting of positivity at the anterior electrodes and negativity at OZ. This earlier effect was assumed to reflect feature-specific selective processing. Although the early effect showed a hierarchical pattern of results, in which the effect of attending to size was contingent on the relevance of the color attribute, the N2b showed a more independent pattern of results, in which the relevance of either the color or the size attribute resulted in an enhancement of this component, independent of the relevance of the other attribute. An increase in the duration of the memory search process resulted in a prolonged negativity with an onset of about 200 ms which was maximal at CZ. In both experiments the initial phase of this negativity was also found in the event-related potentials to the unattended stimulus categories, suggesting that the search process was initiated nonselectively and terminated after the selection cues were identified. Detection of attended target letters resulted in a parietal P3b component. In both experiments there was an earlier effect discriminating targets and nontargets in the range 200-300 ms.

Adult↗
PubMed2006

Dental implants placement in conjunction with osteotome sinus floor elevation: a 12-year life-table analysis from a prospective study on 588 ITI implants.

OBJECTIVES: The purpose of this prospective study was to evaluate the clinical success of placing ITI dental implants in the posterior maxilla using the osteotome technique. MATERIAL AND METHODS: All implants were placed following a one-stage protocol (elevating the sinus floor and placing the implant at the same time). Five hundred and eighty-eight implants were placed in 323 consecutive patients with a residual vertical height of bone under the sinus ranging from 6 to 9 mm. The mean observation follow-up period was 59.7 months (with a range of 12-144 months). This prospective study not only calculated the 12-year cumulative survival and success rates for 588 implants by life-table analysis but also the cumulative success rates for implant subgroups divided per implant length and the percentage of sinus membrane perforation were evaluated. RESULTS: The 12-year cumulative survival and success rates were 94.8% and 90.8%, respectively. The analysis of implant subgroups showed slightly more favourable cumulative success rates for 12 mm long implants (93.4%) compared with 10 and 8 mm long implants (90.5% and 88.9%, respectively). During the study period, only 13 perforations of the Schneiderian membrane were detected with a perforation rate of 2.2% (13 perforations/601 treated sites). Ten perforations out of 13 were caused during the first half of the study period and of these, seven were detected during the first 3 years of this prospective study. CONCLUSION: Based on the results and within the limits of the present study, it can be concluded that ITI implant placement in conjunction with osteotome sinus floor elevation represents a safe modality of treating the posterior maxilla in areas with reduced bone height subjacent to the sinus as survival and success rates were maintained above 90% for a mean observation period of approximately 60 months. Shorter implants (8 mm implants) did not significantly fail more than longer ones (10 and 12 mm implants): the differences were small compared with the number of events; hence, no statistical conclusion could be drawn. But, from the clinical point of view, the predictable use of short implants in conjunction with osteotome sinus floor elevation may reduce the indication for complex invasive procedures like sinus lift and bone grafting procedures.

Adult↗
PubMed2006

Conjunctive representation of position, direction, and velocity in entorhinal cortex.

Grid cells in the medial entorhinal cortex (MEC) are part of an environment-independent spatial coordinate system. To determine how information about location, direction, and distance is integrated in the grid-cell network, we recorded from each principal cell layer of MEC in rats that explored two-dimensional environments. Whereas layer II was predominated by grid cells, grid cells colocalized with head-direction cells and conjunctive grid x head-direction cells in the deeper layers. All cell types were modulated by running speed. The conjunction of positional, directional, and translational information in a single MEC cell type may enable grid coordinates to be updated during self-motion-based navigation.

Animals↗
PubMed1979

Experimental chlamydial salpingitis in immunosuppressed guinea pigs infected in the genital tract with the agent of guinea pig inclusion conjunctivitis.

At necropsy indication of spread of infection to fallopian tubes was found in 25 of 41 (60%) female guinea pigs infected in the genital tract with the chlamydial agent of guinea pig inclusion conjunctivitis and immunosuppressed with cyclophosphamide. Eighteen were examined histologically, and the diagnosis of acute salpingitis was confirmed in 10, based on inflammatory reaction, detection of guinea pig inclusion conjunctivitis in tissue, and formation of cysts (pyosalpinx and hydrosalpinx). Infection of fallopian tube tissue was confirmed by indirect immunofluorescence and electron microscopy. Infection of endometrial tissue and peritoneum was also recognized. Data suggested that the immunosuppression mediated by cyclophosphamide resulted in a prolonged genital tract infection and concomitant ascending infection leading to salpingitis.

Animals↗
PubMed1989

Role of cell-mediated immunity in the resolution of secondary chlamydial genital infection in guinea pigs infected with the agent of guinea pig inclusion conjunctivitis.

Guinea pigs which have recovered from a genital infection with the agent of guinea pig inclusion conjunctivitis demonstrate strong immunity to reinfection for a short period of time but then become susceptible to reinfection. The secondary infection is markedly shortened in duration and decreased in intensity. Previous studies have indicated an important role for humoral immunity in resistance to and in recovery from reinfection. However, the contribution of cell-mediated immunity to immunity toward or recovery from a secondary infection is not clear. Guinea pigs were infected in the genital tract with guinea pig inclusion conjunctivitis and were challenged at either 30 or 75 days after the primary infection. Prior to challenge, one group of animals were injected with rabbit anti-guinea pig thymocyte serum (ATS) while control groups received either normal rabbit serum or no treatment. Treatment was continued daily for the course of the experiment. On day 30, ATS-treated guinea pigs had a slightly higher rate of reinfection, and generally the infection persisted longer than in controls. On day 75, all animals became reinfected upon challenge, but control animals resolved their infections in 3 to 9 days. In contrast, most ATS-treated animals remained infected throughout the course of the experiment. Although the animals became reinfected, the levels of chlamydiae were much lower than those observed during the primary infection. ATS treatment abrogated T-cell responses, but serum and secretory antibody responses remained normal. Histopathological examination revealed some decrease in mononuclear infiltration of endocervical and uterine tissues in ATS-treated animals. These data indicate that previously infected guinea pigs require both cell-mediated immunity and humoral immunity for resolution of a challenge infection.

Animals↗
PubMed1991

Role of solid media when used in conjunction with the BACTEC system for mycobacterial isolation and identification.

This study evaluated the necessity and the contribution of solid media when used in conjunction with radiometric Middlebrook 7H12 (BACTEC 12B; Becton Dickinson, Towson, Md.) medium for recovery and complete identification of mycobacteria. Each of 1,184 digested, decontaminated respiratory specimens was inoculated into one BACTEC 12B vial, one 7H11 plate, and two Lowenstein-Jensen (LJ) slants. When the 12B vial was smear positive for acid-fast bacilli, the organisms were subcultured onto LJ slants and the BACTEC p-nitro-alpha-acetylamino-beta-hydroxypropiophenone (NAP) test system was inoculated with the organisms. Niacin tests were performed by using the growth from the original LJ slants and organisms from the LJ slants subcultured from 12B or 7H11 medium. The times to achieve definitive NAP and niacin test results were recorded. Recovery of all 143 isolates found in this study could not be achieved with a single medium. Among the three media, the highest percentage (92.8%) of Mycobacterium tuberculosis isolate recovered was with BACTEC 12B. The use of either 7H11 medium or LJ slants along with a 12B vial increased by 4 to 6% the total percentage of M. tuberculosis organisms that were isolated. Isolation of the M. tuberculosis complex and NAP differentiation in 12B medium were completed in an average of 17 days. On average, isolation and definitive niacin test results for M. tuberculosis cultures were obtained in 39.3 days by a conventional procedure and in 36.3 days when 12B subcultures were used. These results support the conclusion that LJ slants contribute 4 to 6% increased recovery of M. tuberculosis when used in conjunction with 12B medium. Additionally, a subculture onto LJ slants from 12B medium yielded sufficient growth for niacin testing earlier than an original LJ slant did.

Bacteriological Techniques↗
PubMed1997

Use of the Treponema pallidum-specific captia syphilis IgG assay in conjunction with the rapid plasma reagin to test for syphilis.

The Captia Syphilis IgG enzyme immunoassay (EIA) was evaluated for use in conjunction with the rapid plasma reagin test (RPR) as a method to test for syphilis. A total of 1,288 serum specimens were tested by the routine laboratory protocol of the RPR followed by microhemagluttination assay for Treponema pallidum (MHA-TP) testing of RPR-reactive sera as well as the EIA-RPR protocol in which the automated EIA followed by a manual RPR test for EIA-positive specimens is used. When using the routine protocol, 131 specimens were initially reactive by the RPR, and 113 of these were reactive by MHA-TP. When using the EIA-RPR protocol, 170 specimens were initially positive by EIA, and of these, 112 were RPR reactive, indicating active disease. When compared to the routine protocol, the EIA-RPR protocol had sensitivity, specificity, and positive and negative predictive values of 96.5, 99.7, 97.3, and 99.7%, respectively. After resolution of discrepancies by additional testing, the adjusted sensitivity, specificity, and positive and negative predictive values were 100, 99.8, 98.3, and 100%, respectively. This evaluation demonstrates that when used in conjunction with the RPR, the Captia Syphilis EIA is a reliable method by which to test for syphilis.

Antibodies, Bacterial↗
PubMed1999

Comparison of three dimensional magnetic resonance imaging in conjunction with a blood pool contrast agent and nuclear scintigraphy for the detection of experimentally induced gastrointestinal bleeding.

BACKGROUND AND AIMS: To compare the performance of 3D magnetic resonance imaging (MRI) in conjunction with an intravascular contrast agent with that of scintigraphy, with respect to detection and localisation of gastrointestinal haemorrhage in vivo in pigs. METHODS: Intraluminal bleeding sites were surgically created in the small bowel and colon of six pigs. The animals underwent scintigraphy with (99m)Tc labelled red blood cells and 3D MRI following administration of an intravascular contrast agent (NC100150) at five minute intervals over 30 minutes. For analysis, the intestinal tract was divided into six segments. Based on the two evaluated methods, each segment was characterised on a five point scale regarding the presence of a bleed. At autopsy, the surgically manipulated bowel segments were inspected for the presence of haemorrhage. RESULTS: Bleeding was confirmed at autopsy in 18/36 segments. Contrast extravasation with subsequent movement through the bowel could be documented on MRI data sets. All segments were correctly characterised, resulting in 100% sensitivity and specificity for MRI. Based on scintigraphy, interpretation of seven segments (19%) was false (sensitivity/specificity of 78%/72%). Differences in diagnostic performance were evident in the receiver operator characteristic (ROC) analysis, with an area under the MRI curve of 0.99 and under the scintigraphy curve of 0.85. CONCLUSION: In conjunction with an intravascular contrast agent, 3D MRI permits accurate detection and localisation of gastrointestinal bleeding. The extent and evolution of intestinal bleeding can be determined with repeated data acquisition.

Animals↗
PubMed1998

Tyramide amplification allows anterograde tracing by horseradish peroxidase-conjugated lectins in conjunction with simultaneous immunohistochemistry.

Current protocols for a combined approach of anterograde tracing with carbocyanine dyes or horseradish peroxidase (HRP) conjugates and immunohistochemistry represent a compromise between sensitive detection of the tracer and the immunohistochemical procedure. Therefore, it was investigated whether the use of tyramide amplification allows sensitive anterograde tracing with wheat-germ agglutinin conjugated to horseradish peroxidase (WGA-HRP) in conjunction with simultaneous immunohistochemistry. Vagal afferents were anterogradely labeled by injection of WGA-HRP into the nodose ganglion of rats. By use of tyramide-biotin amplification, a dense fiber plexus of vagal afferents was visualized centrally in the nucleus of the solitary tract and in retrogradely labeled neurons in the dorsal vagal nucleus. In the esophagus and duodenum, large- and small-caliber vagal fibers and terminals could be demonstrated comparably to conventional tracing technique using carbocyanine dyes or WGA-HRP and TMB histochemistry. Combination with immunohistochemistry could easily be done, requiring only one more incubation step, and did not result in loss of sensitivity of the tracing. With this method and confocal microscopy, the presence of Ca binding proteins in vagal afferent terminals could be demonstrated. Tyramide amplification allows sensitive anterograde tracing with low background staining in conjunction with immunohistochemistry of a-axonal markers.

Animals↗
PubMed2006

Recalcitrant patellar tendinosis in elite athletes: surgical treatment in conjunction with aggressive postoperative rehabilitation.

BACKGROUND: Recalcitrant patellar tendinosis is difficult to treat, and results are varied. HYPOTHESIS: Surgical removal of necrotic tissue, surgical stimulation of remaining tendon, and aggressive and specific rehabilitation after patellar tendonectomy will allow athletes to return to sports. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: From December 1996 to July 2002, 16 high-level athletes (4 professional, 2 Olympic, 9 collegiate, 1 preparatory), aged 16 to 25 years (mean, 19.7 years), with 22 symptomatic patellar tendons had failed nonoperative care of their patellar tendinosis symptoms and were unable to compete effectively in their sports. Magnetic resonance imaging showed confirmation of disease, with typical findings being necrosis in the posterior half of an abnormally thick patellar tendon, often in conjunction with partial tearing of the posterior half with a compensatory enlargement of the anterior half. Each patient then underwent tendonectomy of the necrotic portion in conjunction with stimulation of the remaining tendon by making multiple longitudinal cuts in the tendon. Patients participated in a postoperative rehabilitation protocol that included immediate range of motion, full flexion, and immediate high-repetition, low-resistance quadriceps muscle exercise. RESULTS: Subjective improvement was noted in all athletes. Return to the same sport at prior level of intensity was accomplished by 14 of 16 patients (87.5%) at a mean of 8.1 months (range, 3-12 months). CONCLUSION: Overall, tendonectomy, surgical tendon stimulation, and aggressive postoperative rehabilitation were found to be a safe, effective way to return high-level athletes to their sports.

Adolescent↗