bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of Left Ventricular Contractility in Pressure and Volume Overload: A Strain Rate Study in the Clinical Model of Aortic Stenosis and Regurgitation
Authors: Gorgulu Sevket , Norgaz Tugrul , Nurkalem Zekeriya , Ergelen Mehmet , Eksik Abdurrahman , Genc Ahmet , Zencirci Aycan E.
Published: April 2010

Objective: The aim of this study is to compare the impact of two different loading conditions on myocardial contractility in asymptomatic patients with normal EF by using stain rate imaging (SRI). Methods: A total of 27 patients with severe aortic regurgitation (mean age 50 ± 11 years) and 25 patients with severe aortic stenosis (mean age 53 ± 15 years) were prospectively recruited. Fifteen healthy subjects (mean age 50 ± 6 years) were enrolled as the control group. For the evaluation myocardial contractility, longitudinal LV function was chosen and, midventricular segment shortening was analyzed for the septum, LV lateral wall from apical four‐chamber view and for the anterior, inferior wall from apical two‐chamber view. Results: Longitudinal peak systolic strain rate values of each segment derived from analysis of a total of 804 segments were significantly decreased in the patients population (P < 0.001). Global longitudinal peak systolic strain rate was also significantly decreased in aortic stenosis and regurgitation compared to the control group (−1 ± 0.5, −0.9 ± 0.3, and −1.6 ± 0.3, P = 0.001). As far as the comparison between patients with aortic stenosis and aortic regurgitation, neither global strain rate nor strain rate for each wall was found to be different. Conclusion: We conclude that longitudinal LV function is reduced in both pressure and volume overload, and both of this overload patterns are equally harmful to the ventricle. (Echocardiography 2010;27:798‐802)
Telmisartan Improves Morphologic and Functional Changes in Both Left Ventricular Myocardium and Carotid Arterial Wall in Patients with Hypertension: Assessment by Tissue Doppler Imaging and Carotid Ultrasonography
Authors: Mizuguchi Yukio , Oishi Yoshifumi , Miyoshi Hirokazu , Iuchi Arata , Nagase Norio , Oki Takashi
Published: April 2010

Objective: The aim of the present study was to clarify the beneficial effects of telmisartan on the morphologic and functional changes in left ventricular (LV) myocardium and carotid arterial wall in patients with hypertension (HT) using tissue Doppler imaging and carotid ultrasonography. Methods: Telmisartan (20–40 mg daily) was administered to 35 previously untreated patients with HT. Conventional and pulsed tissue Doppler echocardiography were performed after medication had been continued for 1–2 months with normal values for blood pressure (BP) (phase I) and for 12 months (phase II). Subclinical atherosclerosis also was determined by measuring the intima‐media thickness (IMT) and stiffness β of the left and right common carotid arteries using B‐ and M‐mode ultrasonography. Results: In the phase II, the LV mass index and isovolumic relaxation time were lower, the peak systolic and early diastolic mitral annular motion velocities were greater compared to the phase I. The stiffness β and mean IMT were lower in the phase II than in the phase I. On multivariate regression analyses, age, BP, and LV diastolic variables emerged as stronger predictors of carotid arterial IMT and stiffness β. Conclusions: The 1‐year use of telmisartan improved LV hypertrophy, regional LV myocardial contraction and relaxation, and carotid atherosclerosis in patients with HT. Our results support cardio‐ and arterioprotective benefits from continuous long‐term telmisartan monotherapy, and combined analysis of tissue Doppler imaging and carotid ultrasonography may be a useful tool for understanding ventriculoarterial coupling in patients with HT. (Echocardiography 2010;27:864‐872)
Resting Echocardiography for the Early Detection of Acute Coronary Syndromes in Chest Pain Unit Patients
Authors: Parato Vito Maurizio , Mehta Anjlee , Delfino Domenico , Amabili Stenio , Partemi Manrico , Grossi Pierfrancesco , Nardini Emidio
Published: April 2010

Aim: The purpose of this study is to assess the ability of resting echocardiography to detect an acute coronary syndrome (ACS) before the occurrence of ischemic electrocardiogram (ECG) changes or troponin‐T elevations. Methods: Four hundred and three patients who presented to the emergency room (ER) with chest pain, normal ECGs, and normal troponin‐T levels were admitted to the cardiologist‐run Chest Pain Unit (CPU) for further monitoring. They underwent serial resting echocardiography for monitoring of left ventricle wall motion (LVWM), ECG telemetry monitoring, and serial troponin‐T measurements. Results: An ACS was detected in 49 patients (12.1%). These 49 patients were then subdivided into three different groups based on the initial mode of detection of their ACS. In group A, 16 of 49 (32.6%) patients had ACS shown by echocardiographic detection of LVWM abnormalities. In group B, 24 of 49 (48.9%) patients had an ACS detected by ischemic ECG changes. In group C, 9 of 49 (18.3%) patients had an ACS detected by troponin‐T elevations. The shortest time interval between CPU‐admission and ACS‐detection occurred in group A (A vs. B, P < 0.003; A vs. C, P < 0.0001). In group A, cardiac angiogram showed that the culprit coronary lesion was more frequent in the circumflex artery (11 out of 16; 68.7%) (LCx vs. LAD, P < 0.02; LCx vs. RCA, P < 0.001) and of these 11 patients with circumflex lesions, the ECG was normal in eight (72.7%) patients. Conclusion: This study demonstrates the utility of LVWM monitoring by serial echocardiography as part of a diagnostic protocol that can be implemented in a CPU. Furthermore, echocardiography could become an essential tool used in the diagnosis of ACS secondary to circumflex lesions. (Echocardiography 2010;27:597‐602)
‘Travel in parallel with us for a while’: sensory geographies of autism
Authors: DAVIDSON JOYCE , HENDERSON VICTORIA L.
Published: April 2010

Drawing on autobiographies by authors with autistic spectrum disorders (ASDs), we consider how ASD authors use travel analogies and spatial metaphors to explore questions of difference in autistic sensory experience. ASD authors often appeal to the geographical imagination in an effort to communicate with ‘neuro‐typical’ others for whom autistic behaviour can seem so peculiar as to be almost alien. Blurring the boundaries between pathology and normality, ASD authors counter typically negative and/or dismissive assessments of deficiency, disability and deviance with explanations of reasonable difference in environmental response. This paper takes up the challenge of ASD authors to ‘travel in parallel’, circumventing biomedical ‘checkpoints’, if only temporarily, in order to better understand the construction and experience of autistic lifeworlds, wherein spatial and embodied coherence is challenged at every turn and ‘sensory mapping’ is a means of survival. Rather than viewing perceptual and processing challenges characteristic of ASDs as problems to be fixed, we suggest non‐autistic others might instead attempt to understand and appreciate sensory diversity in, and on, authors' own terms.
Emergency Department Staff Satisfaction With Rapid Human Immunodeficiency Virus Testing
Authors: Sohoni Aparajita , Gordon Danielle M. , Vahidnia Farnaz , White Douglas A. E.
Published: April 2010

Objectives:  The authors sought to determine staff satisfaction with an emergency department (ED) rapid human immunodeficiency virus (HIV) testing program.

Methods:  A survey was conducted in an urban ED that has provided rapid HIV testing (routine screening and physician‐initiated testing) since August 2007. From May 1, 2008, to August 31, 2008, the survey was administered to all ED staff involved with HIV testing. The primary outcome was satisfaction, and secondary outcomes were the staff attitudes toward the program.

Results:  Surveys were administered to 215 of the 217 staff members, and 207 surveys were returned (96% response rate); 201 surveys had complete data available for analysis. The response rate by staffing type was as follows: physicians 64/64 (100%), nurses 124/134 (93%), and registration staff 16/19 (84%). The majority of ED staff (99%; 95% confidence interval [CI] = 95% to 100%) were satisfied with the HIV testing program. Physicians, however, rated the program more favorably than nurses or registration staff. Most staff members agreed that HIV testing improved overall care (93%; 95% CI = 89% to 96%) and felt that HIV testing did not interfere with their ability to provide care (82%; 95% CI = 76% to 87%). The majority of staff perceived that patients were satisfied with the procedures for obtaining consent (73%; 95% CI = 67% to 79%) and with the way HIV testing was performed (83%; 95% CI = 77% to 87%).

Conclusions:  Emergency department staff satisfaction and overall attitudes with the HIV testing program is high. ED staff does not appear to be a barrier to program implementation.

ACADEMIC EMERGENCY MEDICINE 2010; 17:561–565 © 2010 by the Society for Academic Emergency Medicine
Emergency Department Information System Implementation and Process Redesign Result in Rapid and Sustained Financial Enhancement at a Large Academic Center
Authors: Shapiro Jason S. , Baumlin Kevin M. , Chawla Neal , Genes Nicholas , Godbold James , Ye Fen , Richardson Lynne D.
Published: April 2010

Objectives:  The objectives were to measure the financial impact of implementing a fully integrated emergency department information system (EDIS) and determine the length of time to “break even” on the initial investment.

Methods:  A before‐and‐after study design was performed using a framework of analysis consisting of four 15‐month phases: 1) preimplementation, 2) peri‐implementation, 3) postimplementation, and 4) sustained effects. Registration and financial data were reviewed. Costs and rates of professional and facility charges and receipts were calculated for the phases in question and compared against monthly averages for covariates such as volume, collections rates, acuity, age, admission rate, and insurance status with an autoregressive time series analysis using a segmented model. The break‐even point was calculated by measuring cumulative monthly receipts for the last three study phases in excess of the average monthly receipts from the preimplementation phase, corrected for change in volume, and then plotting this against cumulative overall cost.

Results:  Time to break even on the initial EDIS investment was less than 8 months. Total revenue enhancement at the end of the 5‐year study period was $16,138,953 with an increase of 69.40% in charges and 70.06% in receipts. This corresponds to an increase in receipts per patient from $50 to $90 for professional services and $131 to $183 for facilities charges. Other than volume, there were no significant changes in trends for covariates between the preimplementation and sustained‐effects periods.

Conclusions:  A comprehensive EDIS implementation with process redesign resulted in sustained increases in professional and facility revenues and a rapid initial break‐even point.

ACADEMIC EMERGENCY MEDICINE 2010; 17:527–535 © 2010 by the Society for Academic Emergency Medicine
Effect of Mandated Nurse–Patient Ratios on Patient Wait Time and Care Time in the Emergency Department
Authors: Chan Theodore C. , Killeen James P. , Vilke Gary M. , Marshall Jean B. , Castillo Edward M.
Published: April 2010

Objectives:  The objective was to evaluate the effect of mandated nurse–patient ratios (NPRs) on emergency department (ED) patient flow.

Methods:  Two institutions implemented an electronic tracking system embedded within the electronic medical record (EMR) of two EDs (an academic urban, teaching medical center—Hospital A; and a suburban community hospital—Hospital B), with a combined census of 60,000/year, to monitor real‐time NPRs and patient acuity, such that compliance with state‐mandated ratios could be prospectively monitored. Data were queried for a 1‐year period after implementation and included patient wait times (WTs), ED care time (EDCT), patient acuity, ED census, and NPR status for each nurse, patient, and the ED overall. Median WT and EDCT with interquartile ranges (IQRs) were analyzed to determine the effect of NPR status of each patient, nurse, and the ED overall. To control for factors that could affect the “within the mandated ratio” and the “outside of the mandated ratio” status, including patient volume and acuity, log‐linear regression models were used controlling for specified factors for each hospital facility and combined.

Results:  There were a total of 30,404 (50.9%) patients who waited in the waiting room prior to being placed in an ED bed (53.8% at Hospital A and 46.4% at Hospital B). Patients who waited at Hospital A waited a median duration of 55 minutes (IQR = 15–128 minutes), compared with 32 minutes (IQR = 12–67 minutes) at Hospital B with a combined median WT of 44 minutes (IQR = 13–101 minutes). In the log‐linear regression analysis, WTs were 17% (95% confidence interval [CI] = 10% to 25%, p < 0.001) longer at Hospital A and 13% (95% CI = 3% to 24%, p = 0.008) longer at Hospital B (combined 16% [95% CI = 10% to 22%, p < 0.001] longer at both sites) when the ED overall was out‐of‐ratio compared to in‐ratio. There were a total of 45,660 patients discharged from both EDs during the study period, from which EDCT data were collected (26,894 in Hospital A and 18,766 in Hospital B). Median EDCT was 184 minutes (IQR = 97–311 minutes) at Hospital A, compared to 120 minutes (IQR = 63–208 minutes) at Hospital B, for a combined median EDCT of 153 minutes (IQR = 81–269 minutes). In the log‐linear regression analysis, the EDCT for patients whose nurse was out‐of‐ratio were 34% (95% CI = 30% to 38%, p < 0.001) longer at Hospital A and 42% (95% CI = 37% to 48%, p < 0.001) longer at Hospital B (combined 37% [95% CI = 34% to 41%, p < 0.001] longer at both sites) when compared to patients whose nurse was in‐ratio.

Conclusions:  In these two EDs, throughput measures of WT and EDCT were shorter when the ED nurse staffing were within state‐mandated levels, after controlling for ED census and patient acuity.

ACADEMIC EMERGENCY MEDICINE 2010; 17:545–552 © 2010 by the Society for Academic Emergency Medicine
Do California Counties With Lower Socioeconomic Levels Have Less Access to Emergency Department Care?
Authors: Ravikumar Deepa , Hsia Renee
Published: April 2010

Objectives:  The study objective was to examine the relationship between number of emergency departments (EDs) per capita in California counties and measures of socioeconomic status, to determine whether individuals living in areas with lower socioeconomic levels have decreased access to emergency care.

Methods:  The authors linked 2005 data from the American Hospital Association (AHA) Annual Survey of Hospitals with the Area Resource Files from the United States Department of Health and Human Services and performed Poisson regression analyses of the association between EDs per capita in individual California counties using the Federal Information Processing Standard (FIPS) county codes and three measures of socioeconomic status: median household income, percentage uninsured, and years of education for individuals over 25 years of age. Multivariate analyses using Poisson regression were also performed to determine if any of these measures of socioeconomic status were independently associated with access to EDs.

Results:  Median household income is inversely related to the number of EDs per capita (rate ratio = 0.83; 95% confidence interval [CI] = 0.71 to 0.96). Controlling for income in the multivariate analysis demonstrates that there are more EDs per 100,000 population in FIPS codes with more insured residents when compared with areas having less insured residents with the same levels of household income. Similarly, FIPS codes whose residents have more education have more EDs per 100,000 compared with areas with the same income level whose residents have less education.

Conclusions:  Counties whose residents are poorer have more EDs per 100,000 residents than those with higher median household incomes. However, for the same income level, counties with more insured and more highly educated residents have a greater number of EDs per capita than those with less insured and less educated residents. These findings warrant in‐depth studies on disparities in access to care as they relate to socioeconomic status.

ACADEMIC EMERGENCY MEDICINE 2010; 17:508–513 © 2010 by the Society for Academic Emergency Medicine
Heat or Cold Packs for Neck and Back Strain: A Randomized Controlled Trial of Efficacy
Authors: Garra Gregory , Singer Adam J. , Leno Richard , Taira Breena R. , Gupta Neeraj , Mathaikutty Beena , Thode Henry J.
Published: April 2010

Objectives:  Acute back and neck strains are very common. In addition to administering analgesics, these strains are often treated with either heat or cold packs. The objective of this study was to compare the analgesic efficacy of heat and cold in relieving pain from back and neck strains. The authors hypothesized that pain relief would not differ between hot and cold packs.

Methods:  This was a randomized, controlled trial conducted at a university‐based emergency department (ED) with an annual census of 90,000 visits. ED patients >18 years old with acute back or neck strains were eligible for inclusion. All patients received 400 mg of ibuprofen orally and then were randomized to 30 minutes of heating pad or cold pack applied to the strained area. Outcomes of interest were pain severity before and after pack application on a validated 100‐mm visual analog scale (VAS) from 0 (no pain) to 100 (worst pain), percentage of patients requiring rescue analgesia, subjective report of pain relief on a verbal rating scale (VRS), and future desire for similar packs. Outcomes were compared with t‐tests and chi‐square tests. A sample of 60 patients had 80% power to detect a 15‐mm difference in pain scores.

Results:  Sixty patients were randomized to heat (n = 31) or cold (n = 29) therapy. Mean (±standard deviation [SD]) age was 37.8 (±14.7) years, 51.6% were female, and 66.7% were white. Groups were similar in baseline patient and pain characteristics. There were no differences between the heat and cold groups in the severity of pain before (75 mm [95% CI = 66 to 83] vs. 72 mm [95% CI = 65 to 78]; p = 0.56) or after (66 mm [95% CI = 57 to 75] vs. 64 mm [95% CI = 56 to 73]; p = 0.75) therapy. Pain was rated better or much better in 16/31 (51.6%) and 18/29 (62.1%) patients in the heat and cold groups, respectively (p = 0.27). There were no between‐group differences in the desire for and administration of additional analgesia. Twenty‐five of 31 (80.6%) patients in the heat group and 22 of 29 (75.9%) patients in the cold group would use the same therapy if injured in the future (p = 0.65).

Conclusions:  The addition of a 30‐minute topical application of a heating pad or cold pack to ibuprofen therapy for the treatment of acute neck or back strain results in a mild yet similar improvement in the pain severity. However, it is possible that pain relief is mainly the result of ibuprofen therapy. Choice of heat or cold therapy should be based on patient and practitioner preferences and availability.

ACADEMIC EMERGENCY MEDICINE 2010; 17:484–489 © 2010 by the Society for Academic Emergency Medicine
Occupational allergic contact dermatitis from tetrazepam in nurses
Authors: Hulst Kim Vander , Kerre Stefan , Goossens An
Published: April 2010

Background: Tetrazepam is a muscle relaxant belonging to the benzodiazepine group. Drug eruptions following ingestion of tetrazepam tablets are well known.

Objective: To draw the attention to occupational airborne dermatitis and/or hand dermatitis in nurses resulting from crushing of tablets for elderly or disabled people.

Methods: Since 2003, 16 nurses with facial (eyelid) and/or hand dermatitis, suspected to be of occupational origin, were patch tested with the medication they handled during work.

Results: Ten nurses presented with a positive patch test reaction to tablets containing tetrazepam, 14 controls remaining negative. Some of them also reacted to other drugs.

Conclusion: Occupational airborne and/or hand contact dermatitis from tetrazepam might be much more common than suspected by dermatologists, particularly in view of the short period in which all cases have been observed.
Variability in patch test reactions – first report from the Norwegian Patch Test Registry*
Authors: Helsing Per , Gjersvik Petter , Holm Jan‐Øivind , Steinkjer Bjarte , Holsen Dag , Johnsson Margareta , Braun Rosemarie , Vårdal Mari , Austad Joar
Published: April 2010

Background: A nation‐wide Norwegian Patch Test Registry (NOLAR) was established in 2005 as a collaboration between six dermatology departments. International, multi‐centre studies have documented great variability in the frequency of positive patch test reactions, considered as mainly due to heterogeneity of test populations.

Objectives: To analyse the variability of positive test reactions by studying patch tests performed at the six collaborating departments, using standardized procedures.

Materials and methods: Data from all patch tests (n = 2089) performed in 2007–2008 as registered in the NOLAR program. Differences between centres were analysed using Exact Pearson χ2 test.

Results: Between the centres, positive test reactions (+, ++, or +++) varied significantly for 8 of the 26 allergens in the European Baseline Series. When considering strong reactions (++ or +++) only, the differences were statistically significant for six of these allergens, i.e. cobalt chloride, potassium dichromate, p‐phenylenediamine, formaldehyde, paraben mix, and mercaptobenzothiazole.

Conclusion: The results indicate regional differences in the prevalence of sensitization to certain allergens within the Norwegian population, although inter‐observer differences cannot be ruled out as a factor.
Motor coordination as predictor of physical activity in childhood
Authors: Lopes V. P. , Rodrigues L. P. , Maia J. A. R. , Malina R. M.
Published: April 2010

This study considers relationships among motor coordination (MC), physical fitness (PF) and physical activity (PA) in children followed longitudinally from 6 to 10 years. It is hypothesized that MC is a significant and primary predictor of PA in children. Subjects were 142 girls and 143 boys. Height, weight and skinfolds; PA (Godin–Shephard questionnaire); MC (Körperkoordination Test für Kinder); and PF (five fitness items) were measured. Hierarchical linear modeling with MC and PF as predictors of PA was used. The retained model indicated that PA at baseline differed significantly between boys (48.3 MET/week) and girls (40.0 MET/week). The interaction of MC and 1 mile run/walk had a positive influence on level of PA. The general trend for a decrease in PA level across years was attenuated or amplified depending on initial level of MC. The estimated rate of decline in PA was negligible for children with higher levels of MC at 6 years, but was augmented by 2.58 and 2.47 units each year, respectively, for children with low and average levels of initial MC. In conclusion MC is an important predictor of PA in children 6–10 years of age.
Positioning and deciding: key factors for talent development in soccer
Authors: Kannekens R. , Elferink‐Gemser M. T. , Visscher C.
Published: April 2010

Talent identification and development implicate recognizing youth players who will be successful in the future and guiding them to the top. A major determinant of this success is tactical skills. To identify possible key factors that help in predicting success over time, this study assesses the tactical skills of 105 elite youth soccer players who participated in a talent development program at an earlier stage of their sport career (mean age 17.8±0.9). These skills were related to their adult performance level, specifically whether they became professionals (n=52) or amateurs (n=53). Defenders, midfielders and attackers completed the Tactical Skills Inventory for Sports with scales for declarative and procedural knowledge in either attacking or defensive situations. A logistic regression analysis was performed to identify the tactical skills that contribute to professional performance level in adulthood. Positioning and deciding appeared to be the tactical skill that best predicts adult performance level (P<0.05). This is especially true for midfielders, with the correct classification of elite youth players in the range of 80%. For players scoring high on this skill, the odds ratios indicated a 6.60 times greater chance that a player became a professional than players scoring low (P<0.05).
REVIEW ARTICLE: Th1/Th2/Th17 and Regulatory T‐Cell Paradigm in Pregnancy
Authors: Saito Shigeru , Nakashima Akitoshi , Shima Tomoko , Ito Mika
Published: April 2010

Citation Saito S, Nakashima A, Shima T, Ito M. Th1/Th2/Th17 and regulatory T‐cell paradigm in pregnancy. Am J Reprod Immunol 2010

T‐helper (Th) cells play a central role in modulating immune responses. The Th1/Th2 paradigm has now developed into the new Th1/Th2/Th17 paradigm. In addition to effector cells, Th cells are regulated by regulatory T (Treg) cells. Their capacity to produce cytokines is suppressed by immunoregulatory cytokines such as transforming growth factor (TGF)‐β and interleukin (IL)‐10 or by cell‐to‐cell interaction. Here, we will review the immunological environment in normal pregnancy and complicated pregnancy, such as implantation failure, abortion, preterm labor, and preeclampsia from the viewpoint of the new Th1/Th2/Th17 and Treg paradigms.
Influence of dentin on pH of 2% chlorhexidine gel and calcium hydroxide alone or in combination
Authors: Freire Laila Gonzales , Carvalho Ceci Nunes , Ferrari Patricia Helena Pereira , Siqueira Evandro Luiz , Gavini Giulio
Published: April 2010

Abstract –  The aims of endodontic treatment in cases of apical periodontitis are to reduce as much as possible the number of microorganisms inside the root canal system and to inactivate toxins produced by them. Most of the times, these objectives are not achieved solely by chemomechanical preparation, and intracanal dressing may be necessary. In these cases, calcium hydroxide is used as a root canal dressing due to its well‐known and recognized antimicrobial activity. Chlorhexidine has a wide spectrum of antimicrobial activity and its association with calcium hydroxide has been recommended in an attempt to amplify antimicrobial effects of calcium hydroxide. It is also known that dentin exerts a buffering effect under wide pH variations, and may be responsible for decreasing the antimicrobial activity of drugs inside the root canal. The objectives of this study were to assess the pH of 2% chlorhexidine gel and calcium hydroxide alone or in combination, as well as the influence of dentin on the pH of these compounds. Dentin powder was obtained from bovine teeth and added as 1.8% to the volume of the medications. All substances were individually stored in plastic flasks, in triplicate. A pH meter was used at five different moments to assess pH in viscous medium: immediately after preparation and after 24 h, and 7, 14, and 21 days. Results were analyzed by paired Student’s t‐test. Statistically significant differences were observed in the 2% chlorhexidine gel group alone or associated with calcium hydroxide and added of dentin powder (P < 0.05). Mean pH values indicated the influence of dentin powder because of a significant increase in pH. Calcium hydroxide with propylene glycol as the vehicle always showed high pH, demonstrating that this compound was not affected by the presence of dentin.
Facial fractures in children and adolescents: a retrospective study of 3 years in a hospital in Belo Horizonte, Brazil
Authors: Chrcanovic Bruno Ramos , Abreu Mauro Henrique Nogueira Guimarães , Freire‐Maia Belini , Souza Leandro Napier
Published: April 2010

Abstract –  Aim:  The purpose of this study was to review the etiology, incidence and treatment of selected oral and maxillofacial fractures in children in Belo Horizonte, Brazil, during a period of 3 years.

Materials and methods:  The data collected for this study included age, gender, etiology, date of trauma, associated maxillofacial trauma, anatomic site of fracture and treatment. The analysis involved descriptive statistics and chi‐squared test, Bonferroni test, Kolmogorov–Smirnov, Kruskal–Wallis and Mann–Whiney tests and analysis of variance.

Results and conclusions:  This study examined 566 facial fractures in 464 children of 18 years of age or less. The majority of fractures were observed in children within the age group of 13–18 years of age. Bicycle accidents were the major cause of trauma, followed by falls. The mandible was found to be the most common fractured bone in the facial skeleton, followed by the nose. A conservative approach was applied in most cases.
Botulinumtoxin A treatment in toddlers with cerebral palsy
Authors: Tedroff K , Löwing K , Haglund‐Åkerlind Y , Gutierrez‐Farewik EM , Forssberg H
Published: April 2010

Aims:  In this study the aim was to evaluate the effect of botulinum toxin A (BoNT‐A) treatment on muscle tone, contracture development and gait pattern in young children with cerebral palsy (CP).

Method:  Fifteen children with spastic CP (mean age = 16 months) were included in a randomized control study. All received a daily stretching programme and children in the BoNT‐A group additionally received two injections, 6 months apart in the gastrocnemius muscle. Outcomes were assessed at baseline, and after 1 and 3.5 years. A 3D gait‐analysis was performed at 5 years of age.

Results:  Plantarflexor muscle tone in the BoNT‐A group was significantly reduced after 3.5 years, while the muscle tone at the ankle and knee in the control group remained unchanged. The change‐score in knee‐flexion muscle tone between the groups was significantly different after 3.5 years. The knee joint ROM was significantly increased at 1 year in the BoNT‐A group but reduced at the knee and ankle joints in the control group after 3.5 years. No group differences were found for gait analysis, GMFM‐66 or PEDI.

Conclusion:  Early treatment of BoNT‐A in children with spastic CP may decrease muscle tone and decelerate contracture development after 3.5 years. The effect on gait development remains inconclusive.
Modern therapeutic strategies for paediatric systemic lupus erythematosus and lupus nephritis
Authors: Marks Stephen D , Tullus Kjell
Published: April 2010

There is still a significant morbidity and mortality associated with childhood‐onset systemic lupus erythematosus (SLE), despite an increasing armamentarium of immunosuppressive agents. The ideal therapeutic strategy for children and adolescents with SLE should provide the right amount of treatment to allow normal growth, development and fertility while reducing the disease activity and damage that can be accrued over the years. Each patient should have individualized treatments tailored to their organ involvement, disease severity and history of flares together with recent clinical, haematological and immunological parameters to avoid further flares of disease activity and side‐effects of treatment, especially severe infections and future malignancies. The most commonly cited side‐effects of medications include Cushingoid features of corticosteroids, infective complications of cyclophosphamide and gastrointestinal side‐effects of mycophenolate mofetil. There is increasing evidence to support the use of oral mycophenolate mofetil as opposed to cyclophosphamide for both induction and maintenance therapies in many children with SLE with or without lupus nephritis (LN). Recently, case series utilizing B‐lymphocyte depletion therapies with rituximab look promising for patients with severe or refractory disease activity. In this article, we explore current evidence to effectively treat children and adolescents with SLE with or without LN.

Conclusion:  Modern therapeutic strategies include reduced doses and use of corticosteroids and intravenous cyclophosphamide respectively, with increased use of azathioprine, MMF and rituximab.
Effects of Local Melatonin Application on Implant Osseointegration
Authors: Tresguerres Isabel F. , Clemente Celia , Blanco Luis , Khraisat Ameen , Tamimi Faleh , Tresguerres Jesús A.F.
Published: April 2010

Purpose: The aim of this study was to assess the effect of local melatonin administration on bone osseointegration around implants in rabbit tibiae.

Material and Methods: Ten female, 6‐month‐old New Zealand rabbits were randomly divided into two groups: the experimental group, where five rabbits were treated with local application of melatonin (3 mg) to implant sites when placed into the rabbit tibia, and the control group, those who where without additive materials. Four weeks later, animals were sacrificed; tibiae were dissected from soft tissues and fixed in buffered formaldehyde, and then included in methacrylate. Histological sections were performed to be studied under light microscopy and analyzed morphometrically to evaluate the amount of bone to implant contact (BIC), trabecular area density, and cortical area density. One‐way analysis of variance test was used for statistical evaluation. p < .05 was considered to be significant.

Results: Histological evaluation showed more trabecular reaction in the melatonin group. Morphometrical analysis showed a statistically significant increase in trabecular BIC in the melatonin group when compared with the control group (24.61% ± 2.87 vs 13.62% ± 1.44; p < .01). Cortical BIC was decreased in the melatonin group, without statistical significance (71.08 ± 3.63 vs 76.28 ± 2.57; p = 0.31). Trabecular area density was increased significantly in the melatonin group (8.68 ± 1.61 vs 4.02 ± 0.36; p < .05). Cortical area density was decreased significantly in the melatonin group (91.31 ± 1.6 vs 95.7 ± 0.5; p < .05).

Conclusion: Within the limitation of this animal study, local melatonin application at the time of implant placement might induce more trabecular bone at implant contact and higher trabecular area density.
Titanium Implants after Alkali Heating Treatment with a [Zn(OH)4]2− Complex: Analysis of Interfacial Bond Strength Using Push‐Out Tests
Authors: Alvarez Kelly , Fukuda Masayuki , Yamamoto Osamu
Published: April 2010

Background: Clinical demands for stronger and faster bone bonding to implants have motivated the development of chemically and topographically modified surfaces capable of chemical bonding. This study presents a new one‐step alkali heat treatment performed with a solution containing [Zn(OH)4]2− complex as an alternative to the conventional NaOH solution.

Purpose: The objective of this work is to assess the effect of a Zn‐modified surface chemistry on bone‐implant shear strength using a rabbit model.

Materials and Methods: The study was conducted on mechanical‐grinded and smooth surfaces of Ti cylindrical implants. The topographical structure, chemical surface composition, and structural properties of the chemically modified titanium surface were studied by scanning electron microscopy, x‐ray photoelectron spectroscopy, and x‐ray diffractometry. Implant‐bone shear strength was evaluated by push‐out tests undertaken at 4, 12, and 24 weeks after insertion in rabbit femora.

Results: Implants with smooth and rough surfaces chemically‐modified with a solution containing [Zn(OH)4]2− complex demonstrated significantly stronger bone fixation than nonmodified implants at all healing times (p < 0.05).

Conclusions: The obtained results suggest that biochemical bonding at the bone‐implant interface, stimulated by the Zn2+ ion release in combination with mechanical interlocking definitively improved the implant fixation.
Assessment of the antimicrobial properties of maggots
Authors: Margolin Leon , Gialanella Philip
Published: April 2010

Chronic bacterial colonisation or infection of wound is one of the major factors interfering proper wound healing, especially in diabetic foot ulcers. This study assesses the potential antimicrobial properties of maggots in vitro. This is a prospective randomised experimental study. Complete lysis of methicillin‐resistant Staphylococcus aureus, Pseudomonas aeruginosa, vancomycin‐resistant Enterococcus and Candida albicans cultures in the area of maggot application was observed 24 hours after application of live maggots in all culture plates and was confirmed by Gram staining. This lysis persisted for more than 5 days after the maggot application. Complete lysis of the bacterial or fungal cultures in the area of maggot application provides convincing evidence for the antimicrobial property of maggots. This effect has a significant implication in management of diabetic foot ulcers and vascular ulcers.
A simple and effective approach for the treatment of diabetic foot ulcers with different Wagner grades
Authors: Nagoba Basavraj S , Gandhi Rajan C , Wadher Bharat J , Rao Arunkumar , Hartalkar Amol R , Selkar Sohan P
Published: April 2010

Diabetic foot infections are the major cause of morbidity. Infection is the common sequel of diabetic foot ulceration that leads to delayed wound healing. These infections are difficult to control. If not addressed well in time, they may lead to amputation of foot. An attempt has been made to develop simple and effective treatment modality by using citric acid as a sole antimicrobial agent to control diabetic foot infections not responding to conventional treatment. Hundred and fifteen cases of diabetic foot ulcers of different Wagner grades infected with a variety of bacteria were investigated for culture and susceptibility, and susceptibility to citric acid. Citric acid gel was applied to ulcer to determine its efficacy in the management of diabetic foot ulcers with different Wagner grades. Citric acid gel was found effective in the control of foot infections; especially in Wagner grades I and II, the success rate was found to be more than 94%. In Wagner grade III also, it was found effective in complete healing of ulcers without deep osteomyelitis. Citric acid treatment is effective in the control of diabetic foot infections and in successful management of diabetic foot ulcers with Wagner grades I and II, and even with Wagner grade III, without deep osteomyelitis.
Allogenic platelet gel in the treatment of pressure sores: a pilot study
Authors: Scevola Silvia , Nicoletti Giovanni , Brenta Federica , Isernia Paola , Maestri Marcello , Faga Angela
Published: April 2010

Although platelet gel is considered one of the most popular tools in the treatment of chronic ulcers, current consensus on its use is not unanimous. A prospective randomised trial was carried out at the Plastic Surgery Unit of the ‘Salvatore Maugeri’ Foundation Hospital of Pavia (Italy). The study involved 13 patients affected by spinal cord injury with 16 pressure sores over a period of 20 months. The ulcer was considered the experimental unit of the study irrespective of the number of ulcers per patient. Each consecutive ulcer was randomised to be treated either with allogenic platelet gel or with current best practice approach to chronic wounds dressing protocol. At the end of the treatment 15 ulcers out of 16 improved clinically. No statistically significant difference was demonstrated in volume reduction between the two groups, although a statistically significant difference could be demonstrated in the onset time of granulation tissue proliferation as in the wounds treated with platelet gel the healing process was triggered earlier. Our study suggests that platelet gel is mostly effective within the first 2 weeks of treatment while a prolonged treatment does not provide any significant advantage versus the current best practice approach to chronic wounds protocols.
A Comparison of Neuroprotective Efficacy of the Oxime K203 and its Fluorinated Analogue (KR‐22836) with Obidoxime in Tabun‐Poisoned Rats
Authors: Kassa Jiri , Karasova Jana Zdarova , Tesarova Sandra , Musilek Kamil , Kuca Kamil , Jung Young‐Sik
Published: April 2010

Abstract:  The ability of the newly developed bispyridinium compound K203 and its fluorinated analogue KR‐22836 to reduce tabun‐induced acute neurotoxic signs and symptoms was compared with the currently available reactivator of acetylcholinesterase–obidoxime. Tabun‐induced neurotoxicity and the neuroprotective effects of all tested oximes in combination with atropine in rats poisoned with tabun at a sublethal dose (200 μg/kg intramuscularly (i.m.); 80% of LD50 value) were monitored by a functional observational battery at 24 hr after tabun challenge. The results indicate that all tested oximes combined with atropine were able to survive tabun‐poisoned rats 24 hr after tabun challenge while one non‐treated tabun‐poisoned rat died within 24 hr after tabun poisoning. All tested oximes combined with atropine were able to decrease tabun‐induced neurotoxicity in the case of sublethal poisoning but they did not eliminate all tabun‐induced acute neurotoxic signs and symptoms. While the ability to reduce tabun‐induced acute neurotoxicity of obidoxime and K203 was similar, the neuroprotective efficacy of KR‐22836 was slightly higher compared to other tested oximes. Thus, the newly developed fluorinated analogue of K203, called KR‐22836, is able to slightly increase the neuroprotective effectiveness of antidotal treatment of acute tabun poisonings compared to K203 and currently available obidoxime.
Does Pregabalin (Lyrica®) Help Patients Reduce their Use of Benzodiazepines? A Comparison with Gabapentin using the Norwegian Prescription Database
Authors: Bramness Jørgen G. , Sandvik Pål , Engeland Anders , Skurtveit Svetlana
Published: April 2010

Abstract:  Pregabalin (Lyrica®) may have an anxiolytic effect. It has also been reported that the use of this drug helps prevent excessive use of benzodiazepines. The aim of the present study was to examine if pregabalin reduced the intake of benzodiazepines. In a pharmacoepidemiological study, we compared pregabalin to the older drug gabapentin (Neurontin®) in the Norwegian Prescription Database. The database has total capture of all prescribed drugs outside institutions. We identified all prescriptions for the two drugs for patients aged 18–69 years between 2004 and 2007. Patients were grouped as psychiatric patients, patients with epilepsy, patients with neuropathic pain or non‐specified users. We measured the use of benzodiazepines 182 days before and after the initiation of treatment with pregabalin and gabapentin. Between 15% and 29% of the patients were able to stop using benzodiazepines after starting pregabalin or gabapentin treatment. Psychiatric patients who started pregabalin were able to reduce the amount of benzodiazepines used by 48%, compared to only 14% among starters of gabapentin. This study shows that some patients reduced their use of benzodiazepines substantially after starting pregabalin.
Gender role attitudes of hospital nurses in Japan: Their relation to burnout, perceptions of physician–nurse collaboration, evaluation of care, and intent to continue working
Authors: USHIRO Rei , NAKAYAMA Kazuhiro
Published: April 2010

Aim:  The purpose of the present study is to examine the relationship between gender role attitudes of nurses and burnout, perceptions of physician–nurse collaboration, evaluation of care, and intent to continue working.

Methods:  The subjects of the study were 798 full‐time female nurses working in non‐managerial positions at three large hospitals. We analyzed five key survey items – gender role attitudes, burnout, perceptions of physician–nurse collaboration, evaluation of care, and intent to continue working – and showed how these items are related using structural equation modeling.

Results:  Whether nurses' gender role attitudes were egalitarian or conservative, we found a direct positive effect on burnout. However, a conservative gender role attitude not only showed a direct positive effect on burnout, but also exhibited a direct negative effect on the intent to continue working and on the collaboration constructs cooperativeness with physicians. Conservative gender role attitudes thus have an indirect positive effect on burnout through the corollaries cooperativeness and intent to continue working. We found that cooperativeness not only has a direct negative effect on burnout, but also an indirect negative effect on burnout through evaluation of care.

Conclusions:  It was found that nurses harboring conservative gender role attitudes are more vulnerable to burnout, and also less likely to improve their quality of care.
Surgical management of retroperitoneal tumours: A 12‐year review
Authors: Tai Dora K.C. , Li Wing‐Hong , Cheung Moon‐Tong
Published: April 2010

Background:  The aim of the present study was to determine the long‐term outcome of patients who had undergone resection of retroperitoneal tumours.

Methods:  This was a retrospective review of 44 patients with preoperative diagnoses of retroperitoneal tumours, who had resections carried out between April 1996 and June 2008 at our institution.

Results:  Forty‐four patients at our hospital underwent resection with curative intent for retroperitoneal tumours. Eight patients developed recurrences, and reoperations were carried out in these patients. Merely 23.1% of the patients underwent fine‐needle aspiration, and of those patients, just 15.4% received the correct diagnosis for their retroperitoneal tumour. Liposarcoma was the most common tumour (31.1%). The overall mean largest diameter of the retroperitoneal tumours was 13.4 ± 8.8 cm, and the median largest diameter was 11.0 cm (range: 2–43 cm). No significant difference was found between the mean largest diameters of benign and malignant tumours (P = 0.08). Simultaneous surgical resection of adjacent organs was required in 46.1% of the patients. The overall survival at 5 years for patients with liposarcomas, other malignancies and benign tumours was 20%, 50% and 100%, respectively. The disease‐free survival at 5 years for patients with liposarcomas was zero (P = 0.013), whereas, for other retroperitoneal malignancies and benign tumours, the disease free survival at 5 years was 38% and 100%, respectively.

Conclusion:  Surgical management of retroperitoneal tumours often requires a multidisciplinary approach. Long‐term survival rates for patients with liposarcomas are relatively poor, and recurrences after surgical resection are common.
Trauma system in Hong Kong
Authors: Leung Gilberto K.K.
Published: April 2010

The presence of a regionalized trauma system has been shown to improve outcome in trauma. Trauma care has undergone significant changes in Hong Kong in recent years. In 2003, five public hospitals were designated as trauma centres. Since then, there has been a progressive improvement in trauma patient outcome in Hong Kong. Trauma centre designation by itself, however, does not constitute a trauma system. The latter is an integration of prehospital care, interhospital transfer, trauma centres, rehabilitation, prevention, education and research. Under the primary trauma diversion policy, trauma patients in Hong Kong are no longer sent to the nearest hospitals, but transferred directly to trauma centres where definitive care can be implemented earlier. The present article describes some of these changes and addresses issues pertinent to the future development of trauma service in Hong Kong.
Destruction of the urinary tract by ketamine abuse: Hong Kong local experience
Authors: Chu Peggy Sau‐Kwan , Ma Wai‐Kit , Yu Cheong , Yiu Ming‐Kwong , Man Chi‐Wai
Published: April 2010

Aim:  To report and analyze the disastrous effects of ketamine abuse on the urinary system seen in young Hong Kong patients.

Methods:  The hospital records of 80 ketamine abusers who attended the urology clinics of Princess Margaret Hospital and Tuen Mun Hospital were retrospectively reviewed. Their blood creatinine level, cystoscopic and urodynamic findings were analyzed.

Results:  Up to 30–50% of our patients had either contracted bladder with diminished bladder capacity (< 100 mL) or sonographic evidence of hydronephrosis

Conclusion:  Ketamine abuse can lead to structural damage of the entire urinary tract, but whether the damage is reversible after quitting ketamine abuse requires further studies.