A study on the effects of K2ZrF6 as an additive on the microstructure and hydrogen storage properties of MgH2

It was found that the MgH₂ + 10 wt% K₂ZrF₆ sample started to decompose at around 250 °C, which was 100 °C and lower than in as-milled MgH₂. The re/dehydrogenation kinetics had also improved significantly compared to the undoped MgH₂.

Improved hydrogen storage properties of MgH2 by addition of Co2NiO nanoparticles

The result showed that the addition of 10 wt% Co₂NiO to the MgH₂ exhibits a lower onset desorption temperature. The dehydrogenation and rehydrogenation kinetics of MgH₂ + 10 wt% Co₂NiO were also improved compared to un-doped MgH₂.

Uniportal VATS: the first German experience

BACKGROUND

The acceptance of uniportal video-assisted thoracic surgery (VATS) for minor and major thoracic procedures is growing in Europe. This study presents the first experience with uniportal VATS in Germany.

METHODS

In a retrospective study of prospectively collected data, 56 uniportal VATS were analyzed between 06/2012 and 06/2014. The technique was used for diagnostic aims, pleurectomies, wedge resections, segmentectomies and major resections. All procedures were performed without rib spreading. Patients' demographic data, preoperative and postoperative management as well as results were analyzed.

RESULTS

A total of 42 patients (75%) were males. The mean age was 59.2±15 years. The uniportal VATS procedures included one or multiple wedge resections in 30 cases (53.6%), major resections in 9 cases (16.1%), anatomical segment resections in 6 cases (10.7%) and other indications in 11 cases (19.6%). The median operation time was 252, 114, 88 and 73 minutes for major resections, anatomical segment resections, wedge resections and other indications, respectively. There were three conversions in two cases of major resections and in one anatomical segmentectomy. The mean chest tube duration was 3.4±2.1 days. The mean hospital stay was 8.3±5.3 days for the whole group.

CONCLUSIONS

Uniportal VATS is a feasible and safe technique for various indications in thoracic surgery. The perioperative results are promising. It can be performed by thoracic surgeons experienced in the postero-lateral thoracotomy approach.

[Pneumothorax]

The presence of air between the visceral pleura and the parietal pleura with consecutive retraction of the lung from the chest wall is called pneumothorax. Regarding the genesis of the pneumothorax, a distinction is drawn between spontaneous and traumatic pneumothorax. The spontaneous pneumothorax is, depending on whether a congenital or an acquired pulmonary disease can be found, grouped into a primary spontaneous pneumothorax (PSP) without underlying lung disease and a secondary spontaneous pneumothorax (SSP) with the presence of a known lung disease. The traumatic pneumothorax is classified, depending on the cause, into penetrating and non-penetrating (blunt) traumatic events. A special form of the traumatic pneumothorax is the iatrogenic pneumothorax occurring as a result of diagnostic and/or therapeutic interventions. Clinically, a pneumothorax can range from an asymptomatic to an acute life-threatening situation. The required initial measures depend primarily on the patient's clinical condition. They vary from immediate insertion of a chest tube to wait and see with monitoring. The insertion of a chest tube is still the accepted therapeutic standard, but other procedures like aspiration of air through a needle or small catheter, particularly for small spontaneous pneumothoraces, represent alternative therapy options as well. The short-term goal is to treat possibly existing dyspnea and pain; in the long run a recurrence of the pneumothorax should be prevented. Until now, no uniform treatment algorithms or standardised therapy principles exist to achieve the therapeutic intentions of lung expansion and freedom from pain and late relapse.

Measuring depression and stigma towards depression and mental health treatment among adolescents in an Arab-American community

There has been limited research that has examined the prevalence of depression and attitudes towards depression and mental health treatment in Arab-American adolescents; we sought to assess these in a predominantly Arab-American community in metro Detroit. A health survey of adolescents aged 12-17 years was conducted (n=98). Participants were recruited from two local community organizations in Dearborn, MI. Depression was assessed by the Patient Health Questionnaire-9 (PHQ-9) Depression Scale, and attitude towards depression and willingness to seek help for mental health conditions were assessed by the Self-Stigma of Depression Scale (SSDS). To assess whether attitudes might be affected by information about mental health treatment, adolescents were randomized to view either an educational video about mental health, or a control video before responding to questions about their willingness to seek help for mental health conditions. Overall, 14% of Arab-American adolescents in this study endorsed moderate or moderately severe depression (PHQ-9 ≥ 11), suggesting a need to increase awareness of and access to mental health services and screening for Arab-American youth.

[Long-term outcome of lipomodeling in Poland's syndrome: about our first case with an eleven-years' follow-up]

Poland's syndrome is a rare congenital malformation with thoracic and breast deformities very difficult to treat. Several techniques can be used involving, sometimes, implant insertion. Most of the classic techniques could not be used in this patient. Particularly, the transfer of the latissimus dorsi flap could not be performed because of the agenesis of the muscle. Lipomodeling is used, in our team, for breast reconstruction since 1998. This case was described and published one year after the end of the reconstruction in 2004. The immediate outcome appeared very satisfying and effective but some surgeons remained skeptical. An important question remains: what about the long-term efficiency and stability of the reconstruction? In this review, we report our first case of severe Poland's syndrome treated eleven years ago with lipomodeling. The patient was twelve years old. She had a severe form of Poland's syndrome. Five fat grafting sessions were performed between 2001 and 2003, for a total transfer of 809 ml. Today, outcome is very satisfying with a natural breast shape, consistency and sensitivity. An increase of volume in the reconstructed breast is noted. It is due to a rapid and significant weight gain by the patient. We performed two shorts movies describing this outcome one year and ten years after the reconstruction. It confirms the stability and the sustainability of the reconstruction. Lipomodeling does not interfere with breast ultrasound surveillance. Fat grafting deeply improved outcomes and management of thoracic and breast deformities in Poland's syndrome.

Mucoepidermoid lung carcinoma in child

Mucoepidermoid carcinoma (MEC) is a rare malignant tumor arising from the bronchial gland. A case of 6-year-old male child who presented with fever, hemoptysis and wheezing since 1month is reported. Chest X-ray showed features suggestive of foreign body with post-obstructive pneumonia and was treated for the same with medication without much improvement. Subsequently computerized tomography scan chest was carried out, which showed oval mass with speculated margin in right hilar region with distal segmental atelectasis. Bronchoscopy showed small growth with nodularity in the apical segmental bronchus of the right lower lobe with mucosal erosion and hence carried out broncho-alveolar lavage showed few atypical squamous cells. Patient underwent right lower lobectomy, which showed a grey white oval mass with solid and cystic areas in the right hilar region with extension in to the lung parenchyma. Histology of the tumor showed mixed solid and cystic areas with sheets of epidermoid cells and mucus-filled cysts of irregular size. Areas of solid growth were composed of squamoid and intermediate cells. Hence, the final diagnosis of mucoepidermoid carcinoma (MEC) intermediate grade of the lung was made. Early diagnosis can be accomplished if the clinician is alert to persistent pneumonia, coughing and tumor obstruction on image studies. MEC is a comparatively rare low-grade tumor, which reportedly carries a good prognosis with early surgical intervention.

A stable approach for coupling multidimensional cardiovascular and pulmonary networks based on a novel pressure-flow rate or pressure-only Neumann boundary condition formulation

In many biomedical flow problems, reversed flows along with standard treatment of Neumann boundary conditions can cause instabilities. We have developed a method that resolves these instabilities in a consistent way while maintaining correct pressure and flow rate values. We also are able to remove the necessary prescription of both pressure and velocities/flow rates to problems where only pressure is known. In addition, the method is extended to coupled 3D/reduced-D fluid and fluid-structure interaction models. Numerical examples mainly focus on using Neumann boundary condition in cardiovascular and pulmonary systems, particularly, coupled with 3D-1D and 3D-0D models. Inflow pressure, traction, and impedance boundary conditions are first tested on idealized tubes for various Womersley numbers. Both pressure and flow rate are shown to match the analytical solutions for these examples. Our method is then tested on a coupled 1D-3D-1D artery example, demonstrating the power and simplicity of extending this method toward fluid-structure interaction. Finally, the proposed method is investigated for a coupled 3D-0D patient-specific full lung model during spontaneous breathing. All coupled 3D/reduced-D results show a perfect matching of pressure and flow rate between 3D and corresponding reduced-D boundaries. The methods are straight-forward to implement in contrast to using Lagrange multipliers as previously proposed in other studies.

[Thymectomy in myasthenia and/or thymoma]

Thymectomy, the surgical removal of the thymic gland, is essential in cases of thymoma. The majority of cases of a myasthenia gravis (MG) represent a relative indication for thymectomy which requires cooperation with specialized neurologists. Patients with MG may present with a tumor of the thymic gland. In case of suspicious thymoma, the resectability of the tumor has to be evaluated in the preoperative diagnostic. The clinical condition of patients with MG has to be stabilized preoperatively. The aim of thymectomy is the radical removal of thymoma and/or maximal improvement of MG symptoms. This requires the complete extirpation of the thymic gland including all ectopic thymic tissue in the anterior mediastinum. There is a variety of surgical techniques for performing a complete thymectomy. In addition to the conventional techniques with sternotomy, the significance of minimally-invasive approaches is increasing rapidly. Despite the ongoing scarcity of data of higher evidence concerning the procedure of thymectomy an increasing number of equivalent results with minimally-invasive operation techniques for MG and for thymoma are available. The successful surgical performance of a thymectomy is part of an interdisciplinary cooperation in the perioperative treatment of MG as well as the postoperative long-term care for patients with MG and/or thymoma.

Factors affecting response to hepatitis B vaccine among hemodialysis patients in a large Saudi Hemodialysis Center

The aim of this study is to determine the response to hepatitis B virus (HBV) vaccination in patients on hemodialysis (HD) and to identify the factors that could affect this response. This retrospective study was carried out during the period from January 2009 to December 2009 in the Prince Salman Center for Kidney Diseases (PSCKD), Riyadh, and included 144 patients (78 males and 66 females) on regular HD, all of whom received hepatitis B vacci-nation. Patients were divided into two groups according to the level of hepatitis B surface antibodies (HBsAb): Responders group (>10 IU/L) and non-responders group (<10 IU/L). The study looked at the factors that may affect the responsiveness to hepatitis B vaccination, like gender, age, co-existence of hepatitis C virus (HCV) infection, dialysis adequacy that was evaluated by urea reduction ratio (URR) and Kt/V, hemoglobin level, albumin level, protein catabolic rate (PCR), body mass index (BMI), subjective global nutritional status (SGA) and HbA1c. There were 129 patients (89.6%) in the responders group including 69 males and 60 females and 15 patients (10.4%) in the non-responders group including nine males and six females. The mean age in the responders group and the non-responders group was 50.56 ± 15.35 and 56.87 ± 12.52 years, respectively (P = 0.128). The mean value of the PCR was 1.03 ± 0.17 and 0.88 ± 0.17 g/kg/day in the responders group and non-responders group, respectively (P = 0.002). There was no statically significant difference between the two groups regarding the presence or absence of HCV infection, age, gender, diabetes mellitus, URR, Kt/V, hemoglobin level and albumin level. We report a high response rate (89%) for HBV vaccination in our HD patients. The PCR was the only factor that affected the response to HBV vaccination in these patients.

The sustainable development of grassland-livestock systems on the Tibetan plateau: problems, strategies and prospects

The Tibetan plateau is the source of most of the major rivers of Asia and has a huge impact on the livelihoods of the population, who have for centuries engaged in traditional herding practices. Sustainable management of the plateau is of critical importance not only for maintaining livelihoods but also because of its vital ecological function. The major problem of sustainable development in these grassland-livestock systems is the conflict between forage and livestock production. Despite considerable investment of manpower, material resources and capital over many years, attempts to resolve the problem have not been successful. The magnitude of conflict between forage and livestock is addressed by presenting 19 resolution strategies based on numerous research data. Each of these strategies is evaluated in terms of how it can be implemented, its potential benefits for livestock production, current progress and the requirement for further research. The 19 strategies have been divided into four topic categories, namely; grassland-forage, livestock, economy and market, society-culture, which cover the basic elements of sustainable development in this pastoral region. It is argued that improved planning and implementation of the proposed strategies must be based on the background investigation of natural and social status of the pastoral region. Particular attention needs to be given to genetic resources and technology in order to ensure the successful implementation of these proposals. In addition to expanding the use of 18 currently practiced strategies, the authors propose a further novel strategy of replacing the current intensive form of ecological migration with a model incorporating two semi-permanent settlements. The objective of this novel strategy is to retain the nomadic element of pastoral husbandry while increasing the temporal and spatial scale of rotational stocking to reduce pasture degradation on the Tibetan plateau. It is argued that these proposals should be urgently incorporated into two national plans for the pastoral livestock industry, and the construction of an ecologically safe shelter zone on the Tibetan plateau, while ensuring a sustainable livelihood of its pastoral residents. Ensuring a successful implementation of these strategies in resolving the conflict between grassland and livestock, and promoting sustainable development on the Tibetan plateau, requires willing support at the level of national investment and policy commitment and from the herdsmen.

Coupled and reduced dimensional modeling of respiratory mechanics during spontaneous breathing

In this paper, we develop a total lung model based on a tree of 0D airway and acinar models for studying respiratory mechanics during spontaneous breathing. This model utilizes both computer tomography-based geometries and artificially generated lobe-filling airway trees to model the entire conducting region of the lung. Beyond the conducting airways, we develop an acinar model, which takes into account the alveolar tissue resistance, compliance, and the intrapleural pressure. With this methodology, we compare four different 0D models of airway mechanics and determine the best model based on a comparison with a 3D-0D coupled model of the conducting airways; this methodology is possible because the majority of airway resistance is confined to the lower generations, that is, the trachea and the first few bronchial generations. As an example application of the model, we simulate the flow and pressure dynamics under spontaneous breathing conditions, that is, at flow conditions driven purely by pleural space pressure. The results show good agreement, both qualitatively and quantitatively, with reported physiological values. One of the key advantages of this model is the ability to provide insight into lung ventilation in the peripheral regions. This is often crucial because this is where information, specifically for studying diseases and gas exchange, is needed. Thus, the model can be used as a tool for better understanding local peripheral lung mechanics without excluding the upper portions of the lung. This tool will be also useful for in vitro investigations of lung mechanics in both health and disease.

Advanced oxidation for the treatment of chlorpyrifos in aqueous solution

Chlorpyrifos is an organophosphate pesticide and is significant because of its extensive use, persistence in the environment, wide distribution, and its toxicity may lead to lung and central nervous system damage, developmental and autoimmune disorders and vomiting. In the present study, the irradiation of chlorpyrifos in aqueous solution by (60)Co γ-rays was conducted on a laboratory scale and the removal efficiency of chlorpyrifos was investigated. The SPME-GC-ECD method was used for analysis of chlorpyrifos. Aqueous solutions of different concentrations of target compound (200-1000 μg L(-1)) were irradiated through 30-575 Gy. Gamma irradiation showed 100% degradation for a 500 μg L(-1) solution at an absorbed dose of 575 Gy (the dose rate was 300 Gy h(-1)). The radiolysis of chlorpyrifos was pseudo-first order (decay) with respect to dose. The dose constants determined in this study ranged from 8.2×10(-3) to 2.6×10(-2) Gy(-1), and decreased with an increase in the initial concentration of chlorpyrifos, while the radiation chemical yield (G-value) for the loss of chlorpyrifos was found to decrease with increasing absorbed dose. The effect of saturated solutions of N2 and N2O, and radical scavengers tert-butanol, iso-propanol, H2O2, NaNO3 and NaNO2 on the degradation of chlorpyrifos were also studied. The results showed that the oxidative OH was the most important in the degradation of chlorpyrifos, while the reductive radicals, aqueous electron and H, were of less importance for the degradation of chlorpyrifos. The inorganic by-products Cl(-), SO4(2-) and PO4(3-) were quantitatively determined by IC.

Interactions between pregnancy, obstructive sleep apnea, and gestational diabetes mellitus

CONTEXT

Questionnaire studies linked symptoms of obstructive sleep apnea (OSA) to the risk of gestational diabetes mellitus (GDM). Whether this association is present when OSA is assessed objectively by polysomnography is not known.

OBJECTIVE

The objective of the study was to assess the relationship between pregnancy, OSA, and GDM.

DESIGN, SETTING, AND PARTICIPANTS

We conducted observational case-control studies using polysomnography in 15 nonpregnant, nondiabetic women (NP-NGT), 15 pregnant women with normal glucose tolerance (P-NGT), and 15 pregnant women with GDM (P-GDM). The groups were frequency matched for age and race/ethnicity. Pregnant women were studied during the late second to early third trimester.

MAIN OUTCOME MEASURES

Comparisons of OSA diagnosis and sleep parameters between NP-NGT and P-NGT to assess the impact of pregnancy and between P-NGT and P-GDM to explore the association between GDM and OSA were measured.

RESULTS

Compared with NP-NGT, P-NGT women had a higher apnea hypopnea index (AHI) (median 2.0 vs 0.5, P = .03) and more disrupted sleep as reflected by a higher wake time after sleep onset (median 66 vs 21 min, P < .01) and a higher microarousal index (median 16.4 vs 10.6, P = .01). Among the pregnant women, P-GDM had markedly lower total sleep time (median 397 vs 464 min, P = .02) and a higher AHI (median 8.2 vs 2.0, P = .05) than P-NGT women. OSA was more prevalent in P-GDM than in P-NGT women (73% vs 27%, P = .01). After adjustment for prepregnancy body mass index, the diagnosis of GDM was associated with a diagnosis of OSA [odds ratio 6.60 (95% confidence interval 1.15-37.96)]. In pregnancy, after adjusting for prepregnancy body mass index, higher microarousal index significantly associated with higher hemoglobin A1c and fasting glucose levels. Higher oxygen desaturation index was associated with higher fasting glucose levels.

CONCLUSION

Pregnancy is associated with sleep disturbances. Sleep is more disturbed in GDM than in P-NGT women. There is a strong association between GDM and OSA.

Disturbed B cell subpopulations and increased plasma cells in myasthenia gravis patients

Whether there is a general perturbation of B and plasma cell subsets in myasthenia gravis (MG) has not been investigated so far. Here we performed a detailed flow cytometric analysis of blood and if available thymic tissue in order to detect MG-specific and therapy-induced changes. We observed significant differences in the distribution of B cell subsets in MG patients, yet these were mainly attributable to medical treatment. Furthermore MG is associated with significantly increased frequencies of plasma cells that were especially activated in purely ocular disease manifestation. In contrast to thymoma, B cell subset distribution in hyperplastic thymus could be distinguished from peripheral blood, however both tissues were not significantly enriched with plasma cells. Thus B cell differentiation in general is not defective in MG, but modified by therapy and enhanced frequencies of plasma cells can be detected in MG patients.

Herders' perceptions of and responses to climate change in northern Pakistan

Migratory pastoralism is an adaptation to a harsh and unstable environment, and pastoral herders have traditionally adapted to environmental and climatic change by building on their in-depth knowledge of this environment. In the Hindu Kush Himalayan region, and particularly in the arid and semiarid areas of northern Pakistan, pastoralism, the main livelihood, is vulnerable to climate change. Little detailed information is available about climate trends and impacts in remote mountain regions; herders' perceptions of climate change can provide the information needed by policy makers to address problems and make decisions on adaptive strategies in high pastoral areas. A survey was conducted in Gilgit-Baltistan province of Pakistan to assess herders' perceptions of, and adaptation strategies to climate change. Herders' perceptions were gathered in individual interviews and focus group discussions. The herders perceived a change in climate over the past 10-15 years with longer and more intense droughts in summer, more frequent and heavier snowfall in winter, and prolonged summers and relatively shorter winters. These perceptions were validated by published scientific evidence. The herders considered that the change in climate had directly impacted pastures and then livestock by changing vegetation composition and reducing forage yield. They had adopted some adaptive strategies in response to the change such as altering the migration pattern and diversifying livelihoods. The findings show that the herder communities have practical lessons and indigenous knowledge related to rangeland management and adaptation to climate change that should be shared with the scientific community and integrated into development planning.

Self-reported cultural skills from dental students and graduates from Melbourne, Australia

OBJECTIVE

To explore Melbourne Dental School students and graduates' self-assessed levels of competence and skill regarding cultural issues which emerge in dental treatment, and their perceptions of the dental curriculum in addressing socio-cultural issues.

METHODS

Information was derived from a 59-item questionnaire consisting of three parts: socio-demographic; self-assessed level of culture competency within the clinical encounter; and cultural aspects in the dental curriculum. Data was collected from undergraduate dental students enrolled in the fourth year of 2006 and 2007 and fifth year of 2006 and from dentists who graduated in 2002 and 2003.

RESULTS

A total of 133 students and 37 dentists took part in the survey. Response rates were 68.9% among students and 92.6% among dentists. The majority (students: 90.2%; graduates: 62.1%) indicated 'Very often'/'Always' treating patients from different cultural backgrounds. Distribution of competencies showed that participants felt fairly competent in communicating and establishing rapport, but less competent in dealing with patients' cultural practices, and patients' family involvement. The majority (students: 72.1%; graduates: 59.7%) perceived the coverage of socio-cultural aspects in the course as not adequate. Around 40% of participants indicated that inclusion of socio-cultural awareness in the dental curriculum was important or very important.

CONCLUSION

Although there were some significant differences in participants' reports, they generally self-reported having good competency and skill in providing care to patients from different cultural backgrounds. Further exploration of these issues would enhance the future dental workforce's quality of care, professionalism and capacity for cultural competence.

Separation of metadata and pixel data to speed DICOM tag morphing

The DICOM information model combines pixel data and metadata in single DICOM object. It is not possible to access the metadata separately from the pixel data. There are use cases where only metadata is accessed. The current DICOM object format increases the running time of those use cases. Tag morphing is one of those use cases. Tag morphing includes deletion, insertion or manipulation of one or more of the metadata attributes. It is typically used for order reconciliation on study acquisition or to localize the issuer of patient ID (IPID) and the patient ID attributes when data from one domain is transferred to a different domain. In this work, we propose using Multi-Series DICOM (MSD) objects, which separate metadata from pixel data and remove duplicate attributes, to reduce the time required for Tag Morphing. The time required to update a set of study attributes in each format is compared. The results show that the MSD format significantly reduces the time required for tag morphing.

Increased protein-coding mutations in the mitochondrial genome of African American women with preeclampsia

Preeclampsia occurs more frequently in women of African ancestry. The cause of this hypertensive complication is unclear, but placental oxidative stress may play a role. Because mitochondria are the major sites of oxidative phosphorylation, we hypothesized that placentas of preeclamptic pregnancies harbor mitochondrial DNA (mtDNA) mutations. Next-generation sequencing of placental mtDNA in African American preeclamptics (N = 30) and controls (N = 38) from Chicago revealed significant excesses in preeclamptics of nonsynonymous substitutions in protein-coding genes and mitochondrially encoded nicotinamide adenine dinucleotide dehydrogenase 5 gene and an increase in the substitution rate (P = .0001). Moreover, 88% of preeclamptics and 53% of controls carried at least one nonsynonymous substitution (P = .005; odds ratio [OR] = 6.36, 95% confidence interval [CI]: 1.5-39.1). These results were not replicated in a sample of African American preeclamptics (N = 162) and controls (N = 171) from Detroit. Differences in study design and heterogeneity may account for this lack of replication. Nonsynonymous substitutions in mtDNA may be risk factors for preeclampsia in some African American women, but additional studies are required to establish this relationship.

Entonox® inhalation to reduce pain in common diagnostic and therapeutic outpatient urological procedures: a review of the evidence

INTRODUCTION

Entonox(®) (50% nitrous oxide and 50% oxygen; BOC Healthcare, Manchester, UK) is an analgesic and anxiolytic agent that is used to successfully reduce pain and anxiety during dental, paediatric and emergency department procedures. In this article we review the application and efficacy of Entonox(®) in painful local anaesthesia urological procedures by performing a systematic review of the literature.

METHODS

A MEDLINE(®) search was performed using the terms 'nitrous oxide', 'Entonox', 'prostate biopsy', 'flexible cystoscopy' and 'extracorporeal shock wave lithotripsy'. English language publications of randomised studies were identified and reviewed.

RESULTS

The search yielded five randomised studies that investigated the clinical efficacy of Entonox(®) as an analgesic for day case urological procedures. Three randomised controlled trials (RCTs) investigated Entonox(®) in transrectal ultrasonography guided prostate biopsy. All three reported significant reductions in pain score in the Entonox(®) versus control groups. One RCT reported significant reduction in pain during male flexible cystoscopy in the Entonox(®) group compared with the control group. One RCT, which examined the use of Entonox(®) during extracorporeal shock wave lithotripsy, found its use significantly decreased the pain score compared with the control group and this was comparable to intravenous pethidine.

CONCLUSIONS

Evidence from varied adult and paediatric procedures has shown Entonox(®) to be an effective, safe and patient acceptable form of analgesia. All published studies of its use in urological day case procedures have found it to significantly reduce procedural pain. There is huge potential to use this cheap, safe, effective analgesic in our current practice.

Cervical cerclage: one stitch or two?

OBJECTIVE

We sought to determine whether routine placement of a second stitch at the time of cervical cerclage improves its efficacy.

STUDY DESIGN

This is a retrospective cohort study of patients who had cervical cerclage placement at a single institution. Operative reports, ultrasound images, and delivery records were reviewed. Pregnancy outcomes of patients receiving a two-stitch cerclage were compared with those who received a one-stitch cerclage, with a primary outcome of spontaneous preterm delivery at <35 weeks' gestation. Univariable, multivariable, and Kaplan-Meier survival analyses were performed.

RESULTS

Of 146 patients, 63 had two stitches and 83 had one. Baseline characteristics and indications for cerclage were similar except for differences in history of prior cerclage and multiple gestations. The two-stitch approach was associated with a greater median cerclage height (20 mm versus 17 mm, p = 0.008), but there was no difference in spontaneous preterm delivery at <35 weeks' gestation (47.6% versus 41.0%, adjusted odds ratio 1.22, p = 0.630).

CONCLUSION

A two-stitch approach to cervical cerclage increases cerclage height, but may not improve efficacy.

A novel formulation for Neumann inflow boundary conditions in biomechanics

Neumann boundary conditions prescribing the total momentum flux at inflow boundaries of biomechanical problems are proposed in this study. This approach enables the simultaneous application of velocity/flow rate and pressure curves at inflow boundaries. As the basic numerical method, a residual-based variational multiscale (or stabilized) finite element method is presented. The focus of the numerical examples in this work is on respiratory flows with complete flow reversals. However, the proposed formulation is just as well suited for cardiovascular flow problems with partial retrograde flow. Instabilities, which were reported for such problems in the literature, are resolved by the present approach without requiring the additional consideration of a Lagrange multiplier technique. The suitability of the approach is demonstrated for two respiratory flow examples, a rather simple tube and complex tracheobronchial airways (up to the fourth generation, segmented from end-expiratory CT images). For the latter example, the boundary conditions are generated from mechanical ventilation data obtained from an intensive care unit patient suffering from acute lung injury. For the tube, analytical pressure profiles can be replicated, and for the tracheobronchial airways, a correct distribution of the prescribed total momentum flux at the inflow boundary into velocity and pressure part is observed.

Dutasteride/tamsulosin fixed-dose combination for the treatment of benign prostatic enlargement

Fixed-dose dutasteride/tamsulosin is a combination therapy for lower urinary tract symptoms secondary to benign prostatic enlargement (LUTS/BPE), which is composed of two active ingredients, tamsulosin and dutasteride. Tamsulosin is an α-adrenoceptor blocker that is relatively selective for the α(1A)-adrenoceptor subtype within the prostatic smooth muscles. The inhibition of α(1A)-adrenoceptors results in smooth muscle relaxation. Dutasteride is an inhibitor of 5α-reductase, an enzyme that is responsible for the conversion of testosterone to its active form dihydrotestosterone. This occurs in the prostate, liver and skin. 5α-Reductase results in the shrinkage of the prostatic epithelium and reduction in the size of the prostate. No clinical studies have been performed on the fixed-dose dutasteride/tamsulosin combination, although several clinical trials have been conducted on the combination therapy of 5α-reductase and α-adrenoceptor blockers for LUTS/BPE. The CombAT study is a multicenter, randomized, double-blind trial in men with a clinical diagnosis of LUTS/BPE that is comparing tamsulosin or dutasteride as a monotherapy to tamsulosin and dutasteride as combination therapy (as separate tablets). The combination therapy was associated with significant improvements in the symptom score compared to tamsulosin or dutasteride as monotherapy. It is therefore logical to combine the two medications into one tablet.

Transcultural skills content in a dental curriculum: a comparative study

BACKGROUND

Australia has the highest proportion of immigrants in the world (24% of the population is overseas-born, compared to 22% in New Zealand, 19% in Canada and 12% in the USA). In this context, dental students have become increasingly diverse in a milieu where patients are derived from increasingly diverse backgrounds.

AIM

The study aims to analyse the degree to which transcultural and communication skills content is currently embedded in the medical, physiotherapy and dental curricula at a major Australian university.

MATERIALS AND METHODS

  Undergraduate dental, medical and physiotherapy curricula were compared and critically assessed. Researchers considered the amount of transcultural and communication skills content, the number of formal contact hours for each course and the number of teaching staff involved. In addition, 21 interviews were conducted with staff at the three schools, who were involved in the curriculum development process.

RESULTS

The medical and physiotherapy curricula had an explicit focus on transcultural and communication skills as a major and continuing element, delivered by teaching staff from a wide variety of academic and professional backgrounds. In contrast, the dental course showed an under-representation of transcultural and communication skills content which was taught by a limited number of staff from the School of Dental Science.

CONCLUSIONS

In marked contrast to medical and physiotherapy curricula, transcultural and communication skills content had a low formal profile in the dental curriculum. A curriculum review process may be a positive step towards the development of a new training curriculum giving higher priority to transcultural and communication skills to support more effective workforce development.

A randomized, double-blind, prospective study of caspofungin vs. amphotericin B for the treatment of invasive candidiasis in newborn infants

BACKGROUND

Caspofungin is an echinocandin agent with fungicidal activity against Candida species.

OBJECTIVE

To assess the efficacy, safety and tolerability of caspofungin relative to amphotericin B in neonates with invasive candidiasis.

PATIENTS AND METHODS

Thirty-two neonates with invasive candidiasis were randomly assigned to receive either caspofungin (n = 15) or amphotericin B (n = 17). Efficacy was evaluated, with a successful outcome defined as fulfilling all the components of a prespecified five-part composite endpoint. Evaluation of safety was done by monitoring drug-related adverse events.

RESULTS

At the end of intravenous therapy, evaluation showed that caspofungin was superior, with a favorable response in 86.7% of patients as compared with 41.7% of those who received amphotericin B (p = 0.04). There were significantly fewer adverse events in the caspofungin group than in the amphotericin B group.

CONCLUSION

Caspofungin is more effective, safer and alternative to amphotericin B for the treatment of invasive candidiasis in newborn infants.

Effect of host portal and peripheral sera fractions on cell proliferation of Schistosoma mansoni schistosomules

Schistosomules of Schistosoma mansoni were incubated in medium containing hamster (highly susceptible host) portal or peripheral venous serum, or rat (poorly susceptible host) portal or peripheral venous serum or their fractions in the presence of bromodeoxyuridine (BrdU) in order to determine effects of host sera on cell proliferation. BrdU labeling indices (BLIs) were significantly increased in the presence of portal (33.05±0.70, p<0.05), but not in peripheral serum (19.1±0.85, p>0.05) of hamsters, compared to schistosomules cultured in presence of control medium (18.96±0.66). This stimulatory effect was substantially reproduced by fraction 4 (31.03±0.69, p>0.05) separated from hamster portal serum. In contrast, no significant differences were observed in the BLIs in rat portal or peripheral sera as well as their fractions when compared to control medium. Taken together, it was concluded that portal serum of hamster and its fraction which includes a low molecular weight protein (20 kDa) enhanced cell proliferation of S. mansoni schistosomules. This could explain the localization and preference of S. mansoni schistosomules and worms to portal-mesenteric venous system.

Sleep disturbances and their relationship to glucose tolerance in pregnancy

OBJECTIVE

To explore relationships among sleep disturbances, glucose tolerance, and pregnancy outcomes.

RESEARCH DESIGN AND METHODS

Four validated sleep questionnaires were administered to 169 pregnant women at the time of 50-g oral glucose tolerance testing (OGTT) during the second trimester. Pregnancy outcomes were analyzed in 108 women with normal glucose tolerance (NGT).

RESULTS

Of the participants, 41% had excessive daytime sleepiness (Epworth Sleepiness Scale [ESS] >8); 64% had poor sleep quality; 25% snored frequently; 29% had increased risk of sleep-disordered breathing (SDB); 52% experienced short sleep (SS); 19% had both increased SDB risk and SS (SDB/SS); and 14% had daytime dysfunction. Reported sleep duration inversely correlated with glucose values from 50-g OGTT (r = -0.21, P < 0.01). Each hour of reduced sleep time was associated with a 4% increase in glucose levels. Increased likelihood of gestational diabetes mellitus (GDM) was found in subjects with increased SDB risk (odds ratio 3.0 [95% CI 1.2-7.4]), SS (2.4 [1.0-5.9]), SDB/SS (3.4 [1.3-8.7]), and frequent snoring (3.4 [1.3-8.8], after adjustment for BMI). Among NGT subjects, preterm delivery was more frequent in those with increased ESS (P = 0.02), poor sleep quality (P = 0.02), and SS (P = 0.03). Neonatal intensive care unit admissions were associated with increased ESS (P = 0.03), SDB/SS (P = 0.03), and daytime dysfunction (P < 0.01) in mothers.

CONCLUSIONS

Pregnant women experience significant sleep disturbances that are associated with increased risk of GDM and unfavorable pregnancy outcomes. Pregnant women with increased SDB risk, frequent snoring, and sleep duration of <7 h/night have increased risk of developing GDM.

The fate and significance of retained staples after stapled haemorrhoidopexy

AIM

We studied the fate of staples after stapled haemorrhoidectomy (SH) and reviewed the complications they may cause.

METHOD

A survey was carried among 16 surgeons experienced at performing SH to assess their knowledge regarding retained staples. In addition, plain pelvic radiology was used to visualize residual staples at different time intervals after SH in 45 patients.

RESULTS

Ten (63%) surgeons informed their patients that the staples would be shed within 3 months of SH. Regardless of the timing of surgery, part of the staple line was radiologically visible in all patients, and in 19 patients (45%) the staple line was completely visible.

CONCLUSION

Contrary to the common belief, the majority of staples are retained after SH.