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The S layer of a particular bacterium is composed Light micrograph of Klebsiella bacteria showing “halo” created by the capsule order allegra 120mg on-line allergy medicine for diabetics. The array visually resembles bacteria retain the crystal violet stain discount allegra 120 mg visa allergy treatment in dogs, while Gram-negative the strings of a tennis racket generic allegra 120mg mastercard allergy symptoms dizziness nausea, except that the spaces between bacteria do not retain this stain and are stained by the second adjacent proteins are very small. While the basis for this differ- teria the surface layer proteins are also associated with the ence was not known at first, scientists suspected that the struc- rigid peptidoglycan layer than lies just underneath. The com- ture of the wall surrounding the contents of the bacteria might bination of the two layers confers a great deal of strength and be involved. Subsequent to the time of Gram, scientists have discov- Bacterial surface layers are the outermost surface com- ered that the cell wall plays only a secondary role in the Gram ponent of bacteria. However, the cell wall of Gram-positive bac- the bacterium with its external environment, and are the first teria is indeed much different than that of Gram-negative bac- line of defense against antibacterial compounds. The study of bacterial ultrastructure relates these example, act as sieves, by virtue of the size of the holes in constituent differences to the intact cell wall. The layer can physically ultrastructure explores the structure of each constituent and restrict the passage of molecules, such as destructive enzymes, the chemical and other associations that exist between these that are larger than the pores. Bdellovibrio bacteriovorans even precludes attack from pred- The exploration of bacterial ultrastructure requires sam- ators of the bacterium. This has been challenging, since much bacteria include Corynebacterium diphtheriae and Bacillus anthracis. Microscopic examination of bacteria found in the of the information that has been obtained has come from the mouth has also revealed S layers. The techniques of conventional by these bacteria aids the bacteria in avoiding the process of transmission electron microscopy and scanning electron phagocytosis. This is thought to be because the protein sur- microscopy require the removal of water from the sample. The increasingly hydrophobic cells are not read- sequences on the structure of the bacteria. Techniques have also been developed that prepare bac- Bacterial ultrastructureBACTERIAL ULTRASTRUCTURE teria for transmission electron microscopy without the neces- Bacterial ultrastructure is concerned with the cellular and sity of removing water from the specimen. The bulk of research in an embedding resin (a substance in which the bacteria are bacterial ultrastructure investigates the ultrastructure of the immersed and, when the resin is hardened, allows thin slices cell wall that surrounds bacteria. This resin is The study of bacterial ultrastructure began with the harder to work with than the conventional resins that are not development of the staining regimen by Danish pathologist water-soluble. Thus, while valuable information can be Christian Gram (1853–1938) that classifies the majority of obtained using water-soluble resins, a great deal of experience bacteria as either Gram-negative or Gram-positive. In contrast, a bacteriocidal treatment is nec- instantaneous freezing of the bacteria. The use of heat is a very pop- enced analyst can produce samples that information concern- ular method of sterilization in a microbiology laboratory. The moist heat of a device like an the ultrastructure information that can be obtained. For exam- autoclave can cause deformation of the protein constituents of ple, the technique of atomic force microscopy can produce the microbe, as well as causing the microbial membranes to information on the atomic associations between adjacent mol- liquefy. The effect of heat depends on the time of exposure in ecules on the surface of bacteria. For example, in an been very useful in ultrastructure studies of the regularly autoclave that supplies a temperature of 121° F (49. More prolonged exposure to the designed in which a particular gene or genes has been ren- heat is necessary to ensure that the spore will not germinate dered incapable of producing a protein product. The relationship involved with cell wall constituents, the analysis of the wall between the temperature and the time of exposure can be com- can reveal the alterations that have occurred in the absence of puted mathematically. An example are the many mutants that are called pasteurization after Louis Pasteur, the inventor of the defective in the construction or assembly of lipopolysaccha- process. Pasteurization achieves total killing of the bacterial ride, a carbohydrate and lipid constituent of the outer mem- population in fluids such as milk and fruit juices without brane of Gram-negative bacteria. The loss of the carbohydrate changing the taste or visual appearance of the product. Filtration is the physical removal of bacteria from a One approach that has been known for decades still fluid by the passage of the fluid through the filter. The filter yields useful information concerning bacterial ultrastructure. If the diameter is less than This is the substitution of the metals present in the cell wall the smallest dimension of a bacterium, the bacterium will be with other metals. Metals act like glue to hold various wall retained on the surface of the filter it contacts. Filtration is indirectly metallic species include calcium and magnesium. Out-com- bactericidal since the bacteria that are retained on the filter peting these species by supplying large concentrations of will, for a time, be alive. However, because they are also another metal, the influence of the normal metallic species can removed from their source of nutrients, the bacteria will even- be assessed. The energy membrane, where the underlying attachment to the rigid pep- of the radiation severs the strands of deoxyribonucleic acid in tidoglycan layer is disrupted. With only The use of specific antibodies to determine the molecu- one exception, the damage is so severe that repair is impossi- lar arrangement of ultrastructural constituent targets greatly ble. The exception is the radiation resistant bacterial genus enhances the effectiveness of agents to be used in drug therapy. This genus has the ability to piece together the fragments of DNA in their original order and enzy- See also Atomic force microscope; Bacterial appendages; matic stitch the pieces into a functional whole. Bacterial surface layers; Caulobacter; Electron microscope, Exposure to chemicals can be bacteriocidal. For exam- transmission and scanning; Electron microscopic examination ple, the gas ethylene oxide can sterilize objects. Solutions con- of microorganisms; Sheathed bacteria taining alcohol can also kill bacteria by dissolving the membrane(s) that surround the contents of the cell. Laboratory benches are routinely “swabbed” with an ethanol solution to BACTERIOCHLOROPHYLL • see PHOTOSYNTHESIS kill bacteria that might be adhering to the bench top. Care must be taken to ensure that the alcohol is left in contact with the bacteria for a suitable time (e. Otherwise, bac- BBacteriocidal, bacteriostaticACTERIOCIDAL, BACTERIOSTATIC teria might survive and can even develop resistance to the bac- tericidal agent. Other chemical means of achieving bacterial Bacteriocidal is a term that refers to the treatment of a bac- death involve the alteration of the pH, salt or sugar concentra- terium such that the organism is killed. Penicillin A bacteriocidal treatment is always lethal and is also referred and its derivatives are bactericidal because they act on the pep- 54 WORLD OF MICROBIOLOGY AND IMMUNOLOGY Bacteriophage and bacteriophage typing tidoglycan layer of Gram-positive and Gram-negative bacte- rial cell, and the host cell commences to transcribe and trans- ria. By preventing the assembly of the peptidoglycan, peni- late the viral genes. One of the first genes that it translates cillin antibiotics destroy the ability of the peptidoglycan to encodes an enzyme that chops up the E. At the end of the lytic because they prevent the manufacture of DNA or protein. The resistance by clinically important bacteria is a major problem destroyed or lysed cell releases up to 200 phage particles ready in hospitals.
If order allegra 120 mg mastercard allergy medicine depression, for example order allegra 120 mg visa wheat allergy symptoms joint pain, insurers suddenly relax their policies and pur- chase power wheelchairs 180 mg allegra mastercard allergy induced asthma, how many requests would arise? Among people reporting major mobility difficulties, al- most 80 percent (an estimated 4. Who knows how many of them would beneﬁt from manual or power wheelchairs? If 10 percent, this translates into roughly 458,500 people; if 5 percent, approximately 229,200 people. With wheel- chairs costing from about $1,500 to over $35,000 for the most technologi- cally sophisticated models, potential costs are substantial, especially for the one-time expense of meeting unﬁlled needs. Among people with major mobility problems, 11 percent say they need railings at home but do not have them, while just over 13 percent need bathroom modiﬁcations, 5 percent need kitchen modiﬁcations or automatic or easy-to-open doors, and around 4 percent need stair lifts or elevators, 268 inal Thoughts alerting devices, or accessible parking. Abbott’s doctor didn’t know who to ask for advice, so they turned to me. I e-mailed Julie Internet addresses of prominent wheelchair manufacturers so she could study their offerings. Nowadays, hundreds of Internet sites relate to dis- ability in general, with many speciﬁc to impaired mobility and pertinent diseases. If people do not have a Mobility Mart nearby, at least they can browse the Internet without leaving their homes. Gerald Bernadine found not only his bright red scooter on the Internet, but also the automatic scooter lift for his station wagon. Wheelchair manufacturers offer Internet sites, as do vendors of various products, including adapted cars and vans, clothing for wheelchair users, travel agents for accessible vacations, and advocacy groups targeting spe- ciﬁc conditions. Because mobility is an intensely physical experience, how- ever, the virtual reality of the Internet only goes so far. Bernadine did not try his scooter before buying it; he had scoured the web and knew what he wanted. Most people need to examine potential purchases in person— sit in the chair, use the cane or walker, see how it feels and maneuvers. Entering the Internet and navigating it success- fully may be especially hard for people who are poor and uneducated, as are many with mobility difficulties. Grocery stores, pharmacies, restaurants, and dry cleaners sometimes make home deliver- ies, albeit for a price. Catalog vendors and television shopping networks provide innumerable products, without people ever leaving their homes. People are often unwilling to accept or request help for basic activities they have always performed for themselves. Almost 25 percent of people reporting major mobility difficul- ties say they need assistance with daily activities but have not tried hiring help, with up to 20 percent of these saying they don’t want a stranger’s aid (Table 18). People with Major Mobility Difficulties Getting Help with Daily Activities Need and Reason Not Met (%) Person needs help but hasn’t tried to hire any 24 If person hasn’t tried to get help, why not? Doesn’t want a stranger for helper 16 Help is too expensive, can’t afford it 47 Isn’t sick enough to get help from agency 15 Income is too high to get help from agency 5 Type of help needed is probably not available 8 Doesn’t know where to look for help 25 Is too sick to look for help 4 all levels of mobility difﬁculty say help is too expensive, and 25 percent re- port they do not know where to look. As elsewhere in health care nowadays, people often must become their own advocates. Most doctors know little about mobility-related equipment and services, and even physical and occupational therapists may not appreci- ate the full menu of options. Sometimes social workers help, but Barbara For- rest wants a “daily living advocate—a worker that makes sure that you get all the services that you can, looks into things for you, like somebody to help with the shopping. There are a lot of programs out there, but they all have re- quirements. For elderly persons, as well as for people with mobility problems, such advocates must reach be- yond health care to other service sectors, including housing and transporta- tion. Still, people like Barbara Forrest wonder why ﬁnding resources must be so complicated. Now that his back is 270 inal Thoughts better, he is playing tennis and running while many contemporaries are having knee surgery, spending months in postoperative physical therapy. He anticipates that his knees too will give out—it’s just a matter of time. Predictions about how many people will have mobility difficulties in the decades ahead depend on several assumptions, most importantly whether patterns of diseases and treatments will change. If the prevalence of major chronic conditions remains unchanged, by the year 2049, the number of older Americans with functional limitations will rise by at least 311 per- cent (Boult et al. By 2020, the number of peo- ple with arthritis will grow to sixty million, with twelve million having ac- tivity limitations (Centers for Disease Control 2001b, 334). Reducing fatal conditions like coronary heart disease and cancer could paradoxically in- crease the number of older persons with limited function—with many more people living into very old age, impairments will arrive after age ninety or even one hundred, following additional decades of vigorous life. Sally Ann Jones feels that government officials have missed the obvious: It amazes me that nobody’s gotten this notion yet: the “boomers” are coming. An acquain- tance in her early ﬁfties recently underwent foot surgery for a bone spur, and beforehand she bought a cache of novels, relishing the notion of being laid up for a week or two, unable to get to work. When I teasingly sug- gested that she could rent a scooter to get into work, she was momentarily disconcerted but soon regained her composure. Yes, she understood my point, but she looked forward to the so- cially acceptable postoperative respite. Afterward, she reported having en- joyed her novels and quiet time, although the scooter suggestion had made her think. One morning, on returning to work, she noticed that the eleva- tors were broken at the South Station train stop. She could walk down the stairs to catch her subway, but what about someone using a wheelchair? Although the 10 percent of adults reporting mobility difficulties re- mains a minority, it is a large minority—a group anyone can join at any time and which many will in the future. The good news is that ways to re- store mobility exist, even in a mechanized form. The bad news is that the Final Thoughts / 271 elevators at subway stations often don’t work—the quintessential symbol of needless societal barriers. For many, health and other policies, public and private, still impede their way. In the future, I hope that members of my rolling focus group won’t have to ask my advice—that they’ll already know how to get what they need. His boss had already jokingly sug- gested he affix a cowcatcher to the front of his scooter to scoop up wayward pedestrians. Exhaustion had enveloped Gerald at our ﬁrst encounter: now he was a man transformed. Yet I cite some people much more than others, and they become familiar voices, recurring across chapters. Here, I intersperse additional descriptions of several key interviewees with shorter sketches of others I frequently quote, listing them alphabetically but changing small details about their lives to pro- tect their anonymity. Arnis Balodis Early sixties; white; never married; high-school education; retired from diverse jobs, including security guard; low income; amputations below the knees of both legs because of diabetes-related gangrene; walked with one or two canes. Several years after our interview, Arnis died suddenly from a heart problem, shortly after his mother’s death.
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It is extremely important to spend time thinking about your project before you move on to the planning stage order generic allegra from india allergy testing vials for sale. Through careful thought you should stop yourself wasting time and energy on inappropriate methods as your research progresses discount 180 mg allegra with amex allergy testing groupon. Consider the follow- ing example: EXAMPLE 1: JAMES James wanted to ﬁnd out about students’ experiences of housing in his university town buy generic allegra on line allergy shots what to expect. When the replies started to come in, he realised that the questionnaires weren’t generating the type of information in which he was interested. When he talked through his concerns 4 / PRACTICAL RESEARCH METHODS with his tutor, it emerged that James was really inter- ested in attitudes towards, and experiences of, rented accommodation. His questionnaire had been poorly de- signed and was not generating this type of information. He had to scrap the questionnaire and construct an- other which he combined with a number of one-to- one interviews to get more in-depth information. He had spent three months designing and administering a questionnaire which had not produced the type of infor- mation he required. If he had spent more time thinking about the research, especially coming to terms with the diﬀerence between qualitative and quantitative research, he would have saved himself a lot of time and energy (see Chapter 2). THE FIVE ‘WS’ When you start to think about your research project, a useful way of remembering the important questions to ask is to think of the ﬁve ‘Ws’: X What? Once you have thought about these ﬁve ‘Ws’ you can move on to think about how you are going to collect your data. One of the hardest parts in the early stages is to be able to deﬁne your project, so much research fails because the researcher has been un- able to do this. If you are unable to do this, the chances are your research topic is too broad, ill thought out or too obscure. Okay, you might have been told to do some research by your tutor or by your boss, but there should be another reason why you have chosen your particular subject. It might be solely to do with the fact that you are interested in the topic. This is a good start as you need to be inter- ested in your research if you are to keep up your enthu- siasm and remain motivated. Or you might have identiﬁed a gap in the research literature – this is good as it shows you have carried out careful background re- search. Or perhaps you want to try to obtain funding for a particular service or enterprise and you need to do some research ﬁrst to ﬁnd out if there is demand for what you are proposing. Whatever your reason, think very carefully about why you are doing the research as this will aﬀect your topic, the way you conduct the research and the way in which you report the results. If you’re doing it for a university dis- sertation or project, does your proposed research provide the opportunity to reach the required intellectual stan- 6 / PRACTICAL RESEARCH METHODS dard? Will your research generate enough material to write a dissertation of the required length? Or will your research generate too much data that would be impossible to summarise into a report of the required length? If you’re conducting research for funding purposes, have you found out whether your proposed funding body re- quires the information to be presented in a speciﬁc for- mat? If so, you need to plan your research in a way which will meet that format. However, you should think about the type of people with whom you will need to get in touch with and whether it will be possible for you to contact them. If you have to conduct your research within a par- ticular time scale, there’s little point choosing a topic which would include people who are diﬃcult or expensive to contact. Also, bear in mind that the Internet now pro- vides opportunities for contacting people cheaply, espe- cially if you’re a student with free internet access. Thinking about this question in geographical terms will help you to narrow down your research topic. Also, you need to think about the resources in terms of budget and time that are HOW TO DEFINE YOUR PROJECT / 7 available to you. If you’re a student who will not receive travel expenses or any other out of pocket expenses, choose a location close to home, college or university. If you’re a member of a community group on a limited bud- get, only work in areas within walking distance which will cut down on travel expenses. Also, you need to think about where you’ll be carrying out your research in terms of venue. If you’re going to con- duct interviews or focus groups, where will you hold them? Is there a room at your institution which would be free of charge, or are you going to conduct them in par- ticipants’ own homes? If you’ve answered ‘no’ to either of these last two questions, maybe you need to think again about your research topic. In 15 years I have encountered only one uncomfortable situation in a stranger’s home. Think very carefully about whether your chosen topic and method might have an inﬂuence on personal safety. Thinking about this question will help you to sort out whether the research project you have proposed is possible within your time scale. It will also help you to think more about your par- ticipants, when you need to contact them and whether they will be available at that time. For example, if you want to go into schools and observe classroom practice, you wouldn’t choose to do this research during the sum- mer holiday. It might sound obvious, but I have found 8 / PRACTICAL RESEARCH METHODS some students present a well-written research proposal which, in practical terms, will not work because the par- ticipants will be unavailable during the proposed data collection stage. Once you have thought about these ﬁve ‘Ws’, try to sum up your proposed project in one sentence. When you have done this, take it to several people, including your boss and/or tutor, and ask them if it makes sense. If they don’t, ask them to explain their confusion, revise your statement and take it back to them. I can’t overemphasise the importance of this stage of the re- search process. If you get it right now, you will ﬁnd that the rest of your work should ﬂow smoothly. EXERCISE 1 Have a look at the three projects below and see if you can spot any potential problems. What questions would you ask to make the researchers focus in on their pro- posed project? Statement 1: This research aims to ﬁnd out what people think about television. HOW TO DEFINE YOUR PROJECT / 9 Statement 2: My project is to do some research into Alz- heimer’s disease, to ﬁnd out what people do when their relatives have it and what support they can get and how nurses deal with it. Statement 3: We want to ﬁnd out how many of the local residents are interested in a play scheme for children dur- ing the summer holiday.
Changes in design and manufacturing technique can result in huge gains in fatigue strength for a small sacriﬁce in tensile strength (Fig 120 mg allegra allergy symptoms 1dpo. As a result of these studies and through changes in ﬁlament design and manufacturing techniques allegra 180 mg lowest price allergy forecast princeton nj, Stryker has been able to substantially increase the fatigue strength of the Dall–Miles cables order allegra with amex allergy treatment breakthrough. A1/B1: thin black-hatched curve represents low-toughness material; A2/B2: thick black-hatched curve repre- sents high-toughness material. A1 and A2 represent the yield points; B1 and B2 represent the ultimate tensile strength; cross-hatched areas represent the material toughness. Signiﬁcant gains in fatigue strength can be obtained for a small sacriﬁce in tensile strength. Tensile performance represented by solid columns; fatigue performance represented by hatched columns The Dall–Miles Cable System 247 approaches and should be combined with distal cerclage cables in these approaches. A trochanter grip plate is currently being developed to be used for extended trochan- teric osteotomy ﬁxation. Allograft Fixation Cortical allografts have proved to be very useful in a variety of situations in revision total hip arthroplasty. Prophylactically, these are particularly indicated when severe cortical thinning has occurred, a cortical window or perforation is present, and in any situation where there is a signiﬁcant risk of fracture. A longer stem should always be considered in addition to supportive allograft struts. They can also be used to support very thin femoral cortices when impaction grafting is the method of choice in revision arthroplasties. The cerclage cable can be applied around supporting mesh and/or supporting cortical allograft struts. Periprosthetic Fracture Fixation in Total Hip Arthroplasty Cable cerclage is particularly useful for primary or adjunctive ﬁxation of peripros- thetic fractures. Intraoperative proximal fractures can be well controlled with cerclage cable. If a postoperative fracture is present in the proximal or middle stem regions and the stem is well ﬁxed, cortical allograft struts ﬁxed with cerclage cables can be used in the ﬁxation of selected fractures. Seventeen patients united their fractures and returned to their preoperative functional status at an average of 4. Distal fractures can be controlled with a Dall–Miles plate, cerclage cables, and screws, but in the majority of cases additional cortical allograft struts should be used to strengthen the construct. Periprosthetic fractures associated with loose stems require revision of the stem (frequently to a long stem femoral component) with or without supportive cortical allograft struts (Fig. Treatment of Fractures Cerclage cables can be useful in a variety of situations, usually as an augmentation to ﬁxation of primary fractures. The ﬁxation of proximal femoral fractures can sometimes usefully be augmented by cerclage cable. This use could apply to head– neck replacements, gamma nails, and dynamic hip screws. Distal femoral fractures ﬁxed with Zichel nails or blade-plates can also be aug- mented in certain cases with cerclage cables. The X-ray on the right shows appearance at 1 year postoperative a b Fig. Gray columns show force required to produce failure of ﬁxation; white columns show rigidity of ﬁxation. Dall Augmentation of Screw Fixation in Soft Bone In a bench study by Schmotzer et al. The cerclage cable therefore becomes a very useful adjunct to screw or screw-plate ﬁxation in patients with osteopenia or osteoporosis. Dall DM, Miles AW (1990) Results of ﬁxation of the greater trochanter using the Dall–Miles Cable Grip System. Presented as a scientiﬁc exhibit, SICOT, September 9– 14, 1990 Montreal 3. McCarthy JC, Bono JV, Turner RH, et al (1999) The outcome of trochanteric reattach- ment in revision total hip arthroplasty with a Cable Grip System: mean 6-year follow- up. Ritter MA, Eizember LE, Keating EM, et al (1991) Trochanteric ﬁxation by cable grip in hip replacement. Silverton CD, Jacobs JJ, Rosenberg AG, et al (1996) Complications of a cable grip system. Kelley SS, Johnson RC (1992) Debris from cobalt-chrome cable may cause acetabular loosening. Schmotzer H (1994) Protocol for determining fatigue strength of multiﬁlament cable. Dall DM (1986) Exposure of the hip by anterior osteotomy of the greater trochanter. Chandler HP, King D, Limbird R, et al (1993) The use of cortical allograft struts for ﬁxation of fractures associated with well-ﬁxed total joint prostheses. Schmotzer H, Tchejayan G, Richardson S, et al (1994) Augmentation of screw ﬁxation using cerclage cables. Test data on ﬁle at Stryker Orthopaedics Index abductor muscle weakness 24 Bombelli 164 abuse of alcohol 130 bone grafts 11, 118 acetabular dysplasia 164 bone marrow 173 acetabular implant designs 206 bone scintigraphy 30, 109 acute on chronic type 28 Boyer’s classiﬁcations 35–37 additional bone formation 132 buoy ﬂap 109 additional surgery 65 AHI 167 alcohol 118, 126 cable cerclage 239 alendronate 108 capital drop 165 allograft ﬁxation 247 careful postoperative management 68 anterior rotational osteotomy (ARO) 81 cementless hip stems 206–207 AO 90° double-angled blade-plate 21 ceramic modular heads 206 apparent collapse 90 cerclage 249 approach technique 189 Charnely’s 163 approaches 185 Chiari’s pelvic osteotomy 167 arthroplasty 245 chondrocytes 174 aseptic necrosis of the femoral head 47 chondroid plug 176 augmentation of screw ﬁxation 250 chondrolysis 4, 35, 43 avascular necrosis 35 chronic type 28 avascular necrosis of the femoral head 15, classiﬁcation 106 43 classiﬁcation of remodeling by Jones 63 AVN 58 clinical endpoint 126 AVN, avascular necrosis 58 clinical evaluations 10, 22 clinical performance 241 clinical results 126, 131, 197 Bicontact hip system 207 collapse 30, 79, 110, 125–128, 130–133 Bicontact N 208 color Doppler ultrasonography 109 bilateral SCFE 10 complications 172 biological function 98 congenital dislocation of the hip 221 biological regenerative capacity 178 conserve plus 196 biomechanical 239 core 99 biomechanical environment 174 core decompression 107, 118, 122 biomechanical support 98 correct lateral radiographs 90 body mass index 71 corrective osteotomy (CO) 33, 38 251 252 Index Crowe classiﬁcation 221 greater trochanter 245 Crowe group III 227 Crowe group IV 225 half-wedged fragment 21 hammer toe 102 Dall–Miles 239 Harris hip score 120 Dall–Miles plate 247 head-preserving 107 deep iliac circumﬂex artery and vein 127 head–shaft angle 70 deep infection 23 high congenital dislocation of the hip 221 deep vein thrombosis 122 high density polyethylene (HDP) 222 demarcation line 24 hinge adduction 167 destructive phase 178 hip navigation 207 developmental dislocation of the hip (DDH) hip resurfacing 195 164 histological ﬁndings 173 DEXA 208 hospitalization 22 dome depression 110 double ﬂoor 165 Drehmann’s sign 59 idiopathic osteonecrosis of the femoral head dynamic method 3 (ION) 125 Imhäuser 39 Imhaeuser’s method 47 early diagnosis 75 Imhaeuser’s osteotomy 47, 54 early-stage 133 impaction bone grafting 108 enlargement of the femoral medullary canal in situ pinning 9, 32, 38–39, 47, 61, 71 231 in situ single-screw ﬁxation 3 enlargement of the medullary canal of the incorporation 111, 132 femur 221 intentional varus angle 90 enlargement of the true acetabulum 221, intertrochanteric ﬂexion osteotomy 3 227 intertrochanteric osteotomy 39 epiphysiodesis 9 etiological factors 97 etiology 100 Japanese Orthopedic Association (JOA) 58 extensive lesions 90 Japanese Orthopaedic Association (JOA) hip extent of the viable area 93 scoring system 22 JOA Hip Score 169 JOA scores 128–129, 132 fastening 240 joint preservation 95 fastening method 241 joint regeneration 176 fatigue strength 244 joint regenerative surgery 179 femoral fractures 249 joint-preserving operation 19 femoral head 117, 130–131 Jones’s classiﬁcation 34, 36–37 femoral head osteonecrosis 89 femoral necrosis 4 femoral osteotomies 95 Kaplan–Meier analysis 128 Ficat stage 121 Kaplan–Meier method 172 ﬁrst-stage operation 236 ﬂat stem 206 ﬂuoroscopy 21 lateral decubitus position 20 fractures 103 lateral femoral circumﬂex artery 99 Frankel’s free-body technique 175 lateral head index 19 Index 253 limping 23 position 132 long-term results 19 posterior rotational osteotomy 89, 96 loosening 222 posterior tilt angle (PTA) 27–28, 31, 34–36, low-friction arthroplasty 163 38 L-shaped osteotomy 225 posterior tilting angle 70 postoperative complications 10, 16 magnetic resonance angiography 109 postoperative intact ratio 84–85 manual reduction 3 postoperative limp 24 manual reduction technique 5 postoperative management 93 mechanical property 132 potential 189 metal-on-metal 195 potential beneﬁts 183 microporous stem coating 208 preoperative collapse 103 microscope 99 preoperative planning 167 mini-incision posterior 189 preoperative stage 100 minimally invasive technique 190 preoperative type 100 minimally invasive total hip arthroplasty preservation of the joint 89 surgery 187 press-ﬁt cup designs 206 MIS 183–185 principle of OA treatment 176 MIS techniques 189 prognosis 106 monoﬁlament 240 progressive joint space narrowing 94 monoﬁlament wire 242 progressive slippage 64 multiﬁlament 240 prophylactic ﬁxation 10 multiﬁlament cable 242 prophylactic ﬁxation of the unaffected side muscle-pedicle-bone graft 122 15 prophylactic pinning 34, 75 natural course 106 prophylaxis 16 neck-shaft angle 54 proximal load transfer 208 necrotic lesion 19 pulmonary embolism 23 nonprimary OA 196 non-union 22 nonvascularized bone graft 123 radiographic evaluation 10 nonvascularized bone grafting 107 radiographic outcome 93 nonvascularized ﬁbular grafts 105 radiographic progression 97, 100, 102–103 NVFG 108 radiographic results 197 radiologic endpoint 128 original plate 34 range of motion (ROM) 47, 95, 129 osteoarthritic (OA) change 59, 127, 133 recollapse 94 osteoarthritis (OA) 33, 35, 59 regenerated bone 111 osteonecrosis 30, 105, 117 regeneration 174 osteonecrosis after manipulative reduction regenerative phase 178 62 rehabilitation program 169 osteonecrosis of the femoral head 19, 79 relay-type treatment 177 osteotomy 9, 29, 79, 117 remodeling 5, 33, 38, 96, 173 remodeling and degree of slip 66 pain 129 remodeling and triradiate cartilage 67 patency of the artery 111 resphericity 94 Pauwels’ 163 resultant force (RF) 175 periprosthetic fracture 247 revascularization 98, 121 physeal ﬁxation 36 risk factors 132, 195 physeal stability 39 rotational angle 91 254 Index S-100 protein 173 three-dimensional osteotomy 47 Safranin-O 173 time-saving surgery 125, 133 sclerotic change 24 tissue engineering 111 screw ﬁxation 249 total hip arthroplasty (THA) 101, 122, 123, second stage of the operation 236 184, 186, 205, 221 secondary OA 164 transtrochanteric anterior rotational secondary osteoarthritis 79 osteotomy (ARO) 24, 80 short hip stem 207 transtrochanteric posterior rotational shortening of the leg 23 osteotomy (PRO) 80 simple ﬂexion osteotomy 7 transtrochanteric rotational osteotomy 27, single-screw ﬁxation 6 107, 123 slender femur 230 treat 230 slipped capital femoral epiphysis (SCFE) 9, treat narrow acetabulum 223 27, 28, 33, 37–39 treatments 9, 15 slipping of the femoral capital epiphysis Trendelenburg’s sign 234 (SFCE) 47 trochanter grip 245 small incision 184 trochanteric osteotomy 4 Southwick intertrochanteric osteotomy 71 true acetabulum 222 Southwick procedure 7 two-stage procedure 225 stage 126 type of ION 126 staging 106 steroid 118, 126 unilateral SCFE 10 steroid-induced osteonecrosis 97, 100–101, 103 strategy of treatment for SCFE 15 valgus-extension osteotomy (VEO) 164 strength 240 valgus-ﬂexion osteotomy (VFO) 164 stress risers 243 varus correction 20 strut 130 varus intertrochanteric osteotomy 19 subcapital femoral neck osteotomy 4 vascularized ﬁbular grafting 97, 98, 103, Sugioka 122 105, 107 Sugioka’s femoral osteotomy 28 vascularized iliac bone 130, 131 Surface Arthroplasty Risk Index 195 vascularized iliac bone graft (VIBG) 125, surgical approach 186 127 survival rates 101, 128, 130–132 venous occlusions 102 survivorship 110, 195 VFG 108 survivorship analysis 171 weight-bearing 132 T-shaped osteotomy 225 weight-bearing portions 20 tensioning 243 THA navigation 207 three-dimensional corrective osteotomy 32 young patients 90 . Professor of Neurology Harvard University School of Medicine Beth Israel Deaconess Medical Center Boston, Massachusetts William C. Friedman Professor of Neurology Co-Director, Alzheimer’s Disease Research Center Washington University School of Medicine St. Warren Magnuson Professor Chair, Department of Neurology University of Washington School of Medicine Seattle, Washington Kapil Sethi, M. Professor of Neurology Director, Movement Disorders Program Medical College of Georgia Augusta, Georgia Mark Tuszynski, M. Associate Professor of Neurosciences Director, Center for Neural Repair University of California–San Diego La Jolla, California 1. Familial Alzheimer’s Disease: Molecular Genetics and Clinical Perspectives, edited by Gary D. Alzheimer’s Disease:Treatment and Long-Term Management, edited by Jeffrey L. Memory Disorders: Research and Clinical Practice, edited byTakehikoYanagihara and Ronald C. Handbook of Amyotrophic Lateral Sclerosis, edited by Richard Alan Smith 13. 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