bluuebunny/crossref_metadata_2025 huggingface dataset:
Oxygen - a limiting factor for brain recovery
Authors: Hadanny Amir , Efrati Shai
Published: September 2015

Effective brain metabolism is highly dependent on a narrow therapeutic window of oxygen. In major insults to the brain (e.g., intracerebral hemorrhage), a slight decrease in oxygen supply, as occurs in a hypobaric environment at high altitude, has devastating effects on the injured brain tissue. Conversely, increasing brain oxygenation, by the use of hyperbaric oxygen therapy, can improve brain metabolism and its dependent regenerative processes.
Subarachnoid hemorrhage: who dies, and why?
Authors: Lantigua Hector , Ortega-Gutierrez Santiago , Schmidt J. Michael , Lee Kiwon , Badjatia Neeraj , Agarwal Sachin , Claassen Jan , Connolly E. Sander , Mayer Stephan A.
Published: September 2015

Introduction

Subarachnoid hemorrhage (SAH) is a devastating form of stroke. Causes and mechanisms of in-hospital death after SAH in the modern era of neurocritical care remain incompletely understood.

Methods

We studied 1200 consecutive SAH patients prospectively enrolled in the Columbia University SAH Outcomes Project between July 1996 and January 2009. Analysis was performed to identify predictors of in-hospital mortality.

Results

In-hospital mortality was 18 % (216/1200): 3 % for Hunt-Hess grade 1 or 2, 9 % for grade 3, 24 % for grade 4, and 71 % for grade 5. The most common adjudicated primary causes of death or neurological devastation leading to withdrawal of support were direct effects of the primary hemorrhage (55 %), aneurysm rebleeding (17 %), and medical complications (15 %). Among those who died, brain death was declared in 42 %, 50 % were do-not-resuscitate at the time of cardiac death (86 % of whom had life support actively withdrawn), and 8 % died despite full support. Admission predictors of mortality were age, loss of consciousness at ictus, admission Glasgow Coma Scale score, large aneurysm size, Acute Physiology and Chronic Health Evaluation II (APACHE II) physiologic subscore, and Modified Fisher Scale score. Hospital complications that further increased the risk of dying in multivariable analysis included rebleeding, global cerebral edema, hypernatremia, clinical signs of brain stem herniation, hypotension of less than 90 mm Hg treated with pressors, pulmonary edema, myocardial ischemia, and hepatic failure. Delayed cerebral ischemia, defined as deterioration or infarction from vasospasm, did not predict mortality.

Conclusion

Strategies directed toward minimizing early brain injury and aneurysm rebleeding, along with prevention and treatment of medical complication, hold the best promise for further reducing mortality after SAH.
Predictors for mechanical ventilation and short-term prognosis in patients with Guillain-Barré syndrome
Authors: Wu Xiujuan , Li Chunrong , Zhang Bing , Shen Donghui , Li Ting , Liu Kangding , Zhang Hong-Liang
Published: September 2015

Introduction

Guillain-Barré syndrome (GBS) is an immune-mediated disorder of the peripheral nervous system. Respiratory failure requiring mechanical ventilation (MV) is a serious complication of GBS. Identification of modifiable risk factors for MV and poor short-term prognosis in mechanically ventilated patients with GBS may contribute to the individualized management and may help improve the outcome of the patients.

Methods

We retrospectively analyzed the clinical data of 541 patients who were diagnosed with GBS from 2003 to 2014. Independent predictors for MV and short-term prognosis in mechanically ventilated patients were identified via multivariate logistic regression analysis.

Results

The mean age was 41.6 years with a male predilection (61.2 %). Eighty patients (14.8 %) required MV. Multivariate analysis revealed that shorter interval from onset to admission (p < 0.05), facial nerve palsy (p < 0.01), glossopharyngeal and vagal nerve deficits (p < 0.01) and lower Medical Research Council (MRC) sum score at nadir (p < 0.01) were risk factors for MV; disease occurrence in summer (p < 0.01) was a protective factor. As to prognostic factors, absence of antecedent infections (p < 0.01) and lower MRC sum score at nadir (p < 0.01) were predictors of poor short-term prognosis in mechanically ventilated patients regardless of treatment modality. We further investigated the predictors of poor short-term prognosis in patients requiring MV with different nadir MRC sum scores. Combined use of intravenous corticosteroids with intravenous immunoglobulin (odds ratio 10.200, 95 % confidence interval 1.068–97.407,p < 0.05) was an independent predictor of poor short-term prognosis in mechanically ventilated patients with a nadir MRC sum score from 0 to 12 points, regardless of existence of antecedent infection.

Conclusions

Clinical predictors of MV and poor short-term prognosis in mechanically ventilated GBS patients were distinct. Add-on use of intravenous corticosteroids was a risk factor for poor short-term prognosis in mechanically ventilated patients with a nadir MRC sum score from 0 to 12 points.
Synergistic use of Py–THM–GCMS, DTMS, and ESI–MS for the characterization of the organic fraction of modern enamel paints
Authors: Kokkori Maria , Sutherland Ken , Boon Jaap , Casadio Francesca , Vermeulen Marc
Published: September 2015

Introduction

In this study, mass spectrometric techniques (THM–Py–GCMS, DTMS and ESI–MS) have been used to characterize the organic fraction of early twentieth century oil-based enamel paints. Analysis has been carried out on dry and liquid samples from historical reference paints, and on color swatches from commercial paint brochures, with a special focus on Ripolin. This renowned French brand of enamel paints, manufactured for household and other uses since 1897, was reportedly used by many avant-garde artists. Confirming the presence of enamel paint such as Ripolin in early twentieth century artworks scientifically through binding medium analysis is challenging because, until the end of the Second World War, the most widely used house paints were oil-based and chemically similar to artists’ oil paints. In addition, artists often modified/reformulated materials including oils, driers, industrial and house paints to customize their handling and optical properties. The challenge of identifying oil-based enamel paints on the basis of chemical composition is illustrated by the analysis of samples from two paintings by Wassily Kandinsky and Pablo Picasso.

Results

Analysis demonstrated that the organic fraction of Ripolin paints is typically composed of heat-bodied linseed oil in mixture with variable amounts of diterpene (Pinaceae) resin, in accordance with the industrial technical literature of the time. Comparative analyses of Lefranc artists’ tube paints suggested a more variable composition with respect to the type(s) of oil and their pre-treatment, and showed the presence of Pinaceae resin at trace levels only in two cases. Beeswax was detected in one of the tube paints tested.

Conclusions

The results of this study indicate that complementary information can be obtained from the study of liquid paint from cans and dried paint-outs, while the media of painted brochures may differ from the original formulation as those were designed for expediency of drying and aesthetics. The results also elucidate how formulations and processing technology influence the physical and drying properties of oil-based enamel paints, in comparison with contemporary artists’ oil tube paints. Further research on a broader range of reference materials should help in the development of refined strategies for characterizing oil-based paints from the early twentieth century.
Ambulatory Care after Acute Kidney Injury: An Opportunity to Improve Patient Outcomes
Authors: Silver Samuel A. , Goldstein Stuart L. , Harel Ziv , Harvey Andrea , Rompies Elizabeth J. , Adhikari Neill K. , Acedillo Rey , Jain Arsh K. , Richardson Robert , Chan Christopher T. , Chertow Glenn M. , Bell Chaim M. , Wald Ron
Published: September 2015

Purpose of review:

Acute kidney injury (AKI) is an increasingly common problem among hospitalized patients. Patients who survive an AKI-associated hospitalization are at higher risk of de novo and worsening chronic kidney disease, end-stage kidney disease, cardiovascular disease, and death. For hospitalized patients with dialysis-requiring AKI, outpatient follow-up with a nephrologist within 90 days of hospital discharge has been associated with enhanced survival. However, most patients who survive an AKI episode do not receive any follow-up nephrology care. This narrative review describes the experience of two new clinical programs to care for AKI patients after hospital discharge: the Acute Kidney Injury Follow-up Clinic for adults (St. Michael's Hospital and University Health Network, Toronto, Canada) and the AKI Survivor Clinic for children (Cincinnati Children's Hospital, USA).

Sources of information:

MEDLINE, PubMed, ISI Web of Science

Findings:

These two ambulatory clinics have been in existence for close to two (adult) and four (pediatric) years, and were developed separately and independently in different populations and health systems. The components of both clinics are described, including the target population, referral process, medical interventions, patient education activities, and follow-up schedule. Common elements include targeting patients with KDIGO stage 2 or 3 AKI, regular audits of the inpatient nephrology census to track eligible patients, medication reconciliation, and education on the long-term consequences of AKI.

Limitations:

Despite the theoretical benefits of post-AKI follow-up and the clinic components described, there is no high quality evidence to prove that the interventions implemented in these clinics will reduce morbidity or mortality. Therefore, we also present a plan to evaluate the adult AKI Follow-up Clinic in order to determine if it can improve clinical outcomes compared to patients with AKI who do not receive follow-up care.

Implications:

Follow-up of AKI survivors is low, and this review describes two different clinics that care for patients who survive an AKI episode. We believe that sharing the experiences of the AKI Follow-up Clinic and AKI Survivor Clinic provide physicians with a feasible framework to implement their own clinics, which may help AKI patients receive outpatient care commensurate with their high risk status.
Editorial: Nck has a knack for T cell differentiation
Authors: Oeste Clara L , Alarcón Balbino
Published: September 2015

Discussion on how the adaptor Nck plays a fundamental role for survival of folicular helper T cells.
Editorial: Mannose-6-phosphate receptor delivers the death sentence
Authors: Mackay Laura K
Published: September 2015

Discussion on the role of mannose-6-phosphate receptor expression in CD8+ T cell contraction following viral infection.
Bulk electric conductivity response to soil and rock CO2 concentration during controlled CO2 release experiments: Observations and analytic modeling
Authors: Jewell Scott , Zhou Xiaobing , Apple Martha E. , Dobeck Laura M. , Spangler Lee H. , Cunningham Alfred B.
Published: September 2015

To develop monitoring technologies for geologic [Formula: see text] storage, controlled [Formula: see text] release experiments at the Zero Emissions Research and Technology (ZERT) site in Bozeman, Montana, USA, were carried out in 2009–2011. To understand the impact on the electric properties of soil and sediment rock due to possible [Formula: see text] leakage, we have developed an analytical model to explain and predict the electric conductivity (EC) for [Formula: see text] impacted soil and sedimentary rock. Results from the model were compared with the measurements at the ZERT site during 2009–2011 and the [Formula: see text]-Vadose Project site in France in 2011–2012 after model calibration at each site. The model was calibrated using the saturation ([Formula: see text]) and cementation ([Formula: see text]) exponents contained in Archie’s equation, and a chemistry coefficient ([Formula: see text]) as tuning parameters that minimized the misfit between observed and modeled soil/rock bulk conductivity data. The calibration resulted in [Formula: see text], [Formula: see text], and [Formula: see text] for the ZERT site, which was within the range of values in the literature. All the ZERT data sets had rms errors of 0.0115–0.0724. For the [Formula: see text]-Vadose site, calibration resulted in [Formula: see text]–9.85 and [Formula: see text]–4.2, [Formula: see text]–5.65, and the rms error of 0.0002–0.0003; the cementation exponents were consistent with the literature. These results found that the model predicted the bulk EC reasonably well in soil and rock once the unmeasurable model parameters ([Formula: see text], [Formula: see text], and [Formula: see text]) were calibrated.
Residence capacity: its nature and assessment
Authors: Hughes Julian C. , Poole Marie , Louw Stephen J. , Greener Helen , Emmett Charlotte
Published: September 2015

This article discusses the importance of residence capacity – an
individual's mental capacity to decide where they should live – and suggests
how it should be assessed. People with dementia or intellectual
disabilities, as well as those with other mental disorders, are sometimes
required to make this decision. Assessments of capacity must be conducted
with considerable care, given the implications for the individual and for
their human rights. The assessment must be objective and functional: the
assessor must be able specifically to demonstrate a lack of decision-making
ability. Yet assessments of capacity still require evaluative decisions to
be made. We suggest some basic information that should be conveyed to the
person faced by the prospect of a change of residence where there is a doubt
about capacity.
Smartphone apps in mental healthcare: the state of the art and potential developments
Authors: Zhang Melvyn W. B. , Ho Cyrus S. H. , Cheok Christopher C. S. , Ho Roger C. M.
Published: September 2015

Previous studies have demonstrated that smartphones are useful tools in everyday, evidence-based medical practice. This article gives an overview of the current use in psychiatry of smartphone apps aimed at patients and the general public, highlighting associated benefits and disadvantages. It also outlines how practising psychiatrists could embrace such technologies at an individual, organisational and national level.
Pharmacological management of antipsychotic-induced akathisia:
an update and treatment algorithm
Authors: Jethwa Ketan Dipak
Published: September 2015

Akathisia is a common and distressing side-effect of antipsychotic
medication. The treatment of this condition is difficult and options are
limited. This review of the literature was performed to develop an
evidence-based algorithm for the management of antipsychotic-induced
akathisia. There is limited high-level evidence to support the use of
anticholinergics. Centrally acting β-adrenergic antagonists are potential
treatments, although their use is limited by troublesome side-effects.
Long-acting benzodiazepines and mirtazapine are potential well-tolerated
treatments for the acute management of akathisia.
When is an expert not an expert? Question time for expert psychiatric witnesses
Authors: Rix Keith J. B.
Published: September 2015

Although medical experts are valued in the administration of justice, the cases in the UK of Meadow and others, including most recently Pool, have all contributed to understandable anxiety on the part of doctors who carry out court work. This article uses an in-depth analysis of these cases and details of some other medical regulatory cases to draw out some lessons for potential medical expert witnesses. Although the most recent judgment in Pool leaves a number of unanswered questions, steps are identified that may be taken to reduce the risk of regulatory investigation by the General Medical Council.
Disorder, not just state of risk: Meta-analysis of functioning and quality of life in people at high risk of psychosis
Authors: Fusar-Poli Paolo , Rocchetti Matteo , Sardella Alberto , Avila Alessia , Brandizzi Martina , Caverzasi Edgardo , Politi Pierluigi , Ruhrmann Stephan , McGuire Philip
Published: September 2015

Background

The nosology of the psychosis high-risk state is controversial. Traditionally conceived as an ‘at risk’ state for the development of psychotic disorders, it is also conceptualised as a clinical syndrome associated with functional impairment.

Aims

To investigate meta-analytically the functional status of patients at high clinical risk for psychosis and its association with longitudinal outcomes.

Method

Three meta-analyses compared level of functioning (n = 3012) and quality of life (QoL) (n = 945) between a high-risk group, a healthy control group and group with psychosis, and baseline functioning in people in the high-risk group who did or did not have a transition to psychosis at follow-up (n = 654).

Results

People at high risk had a large impairment in functioning (P<0.001) and worse QoL (P = 0.001) than the healthy control group, but only small to moderately better functioning (P = 0.012) and similar QoL (P = 0.958) compared with the psychosis group. Among the high-risk group, those who did not develop psychosis reported better functioning (P = 0.001) than those who did.

Conclusions

Our results indicate that the high-risk state is characterised by consistent and large impairments of functioning and reduction in QoL similar to those in other coded psychiatric disorders.
Mental well-being: An important outcome for mental health services?
Authors: de Cates Angharad , Stranges Saverio , Blake Amy , Weich Scott
Published: September 2015

Mental well-being is being used as an outcome measure in mental health services. The recent Chief Medical Officer's (CMO's) report raised questions about mental well-being in people with mental illness, including how to measure it. We discuss whether mental well-being has prognostic significance or other utility in this context.
Polycythemia Vera: An Appraisal of the Biology and Management 10 Years After the Discovery ofJAK2 V617F
Authors: Stein Brady L. , Oh Stephen T. , Berenzon Dmitriy , Hobbs Gabriela S. , Kremyanskaya Marina , Rampal Raajit K. , Abboud Camille N. , Adler Kenneth , Heaney Mark L. , Jabbour Elias J. , Komrokji Rami S. , Moliterno Alison R. , Ritchie Ellen K. , Rice Lawrence , Mascarenhas John , Hoffman Ronald
Published: September 2015

Polycythemia vera (PV) is a chronic myeloproliferative neoplasm that is associated with a substantial symptom burden, thrombohemorrhagic complications, and impaired survival. A decade after the seminal discovery of an activating mutation in the tyrosine kinase JAK2 in nearly all patients with PV, new treatment options are finally beginning to emerge, necessitating a critical reappraisal of the underlying pathogenesis and therapeutic modalities available for PV. Herein, we comprehensively review clinical aspects of PV including diagnostic considerations, natural history, and risk factors for thrombosis. We summarize recent studies delineating the genetic basis of PV, including their implications for evolution to myelofibrosis and secondary acute myeloid leukemia. We assess the quality of evidence to support the use of currently available therapies, including aspirin, phlebotomy, hydroxyurea, and interferon. We analyze recent studies evaluating the safety and efficacy of JAK inhibitors, such as ruxolitinib, and evaluate their role in the context of other available therapies for PV. This review provides a framework for practicing hematologists and oncologists to make rational treatment decisions for patients with PV.
Impact of Tailored Education on Awareness of Personal Risk for Therapy-Related Complications Among Childhood Cancer Survivors
Authors: Landier Wendy , Chen Yanjun , Namdar Golnaz , Francisco Liton , Wilson Karla , Herrera Claudia , Armenian Saro , Wolfson Julie A. , Sun Can-Lan , Wong F. Lennie , Bhatia Smita
Published: September 2015

Purpose

Survivors of childhood cancer carry a substantial burden of long-term morbidity; personal risk awareness is critical to ensure survivors' engagement in early detection/management of complications. The impact of education provided in survivorship clinics on survivors' understanding of their personal health risks is unclear.

Methods

Patients diagnosed with cancer at age 21 years or younger and at 2 or more years off therapy completed questionnaires about awareness of personal risk for therapy-related complications at T0 (first survivorship clinic visit) and at T1 to T5 (subsequent visits). After questionnaire completion at each clinic visit, survivors received education tailored to personal risk.

Results

A total of 369 survivors completed 1,248 visits (median, three visits; range, one to six visits). The median age at cancer diagnosis was 11 years (range, 0 to 21 years); the median age at T0 was 24 years (range, 5 to 57 years); 38% were white; 45% had leukemia; and 34% received hematopoietic cell transplantation. The cohort was at risk for a median of six (range, one to nine) complications. Awareness increased from 38.6% at T0 to 66.3% at T3. Generalized estimating equations (that adjusted for diagnosis, hematopoietic cell transplantation, race/ethnicity, and patient/parent education) showed significant gains in awareness from T0 to T1 (P < .001), T1 to T2 (P = .03), and T2 to T3 (P < .001) but no significant gain thereafter through T5 (P = .7). Predictors of low awareness included education less than a college degree (odds ratio [OR], 1.9; P = .02), longer time from diagnosis (OR, 1.03/year; P = .04), diagnosis of leukemia (OR, 2.1; P = .004), nonwhite race (OR, 2.8; P < .001), and risk for six or fewer complications (OR, 2.1; P = .002).

Conclusion

Risk-based education in a survivorship clinic significantly increases awareness of personal health risk through three sessions, with saturation thereafter. Vulnerable populations with minimal gain in awareness identified in this study could inform targeted interventions.
Brain oxygen tension controls the expansion of outer subventricular zone-like basal progenitors in the developing mouse brain
Authors: Wagenführ Lisa , Meyer Anne K. , Braunschweig Lena , Marrone Lara , Storch Alexander
Published: September 2015

The mammalian neocortex shows a conserved six-layered structure that differs between species in the total number of cortical neurons produced owing to differences in the relative abundance of distinct progenitor populations. Recent studies have identified a new class of proliferative neurogenic cells in the outer subventricular zone (OSVZ) in gyrencephalic species such as primates and ferrets. Lissencephalic brains of mice possess fewer OSVZ-like progenitor cells and these do not constitute a distinct layer. Most in vitro and in vivo studies have shown that oxygen regulates the maintenance, proliferation and differentiation of neural progenitor cells. Here we dissect the effects of fetal brain oxygen tension on neural progenitor cell activity using a novel mouse model that allows oxygen tension to be controlled within the hypoxic microenvironment in the neurogenic niche of the fetal brain in vivo. Indeed, maternal oxygen treatment of 10%, 21% and 75% atmospheric oxygen tension for 48 h translates into robust changes in fetal brain oxygenation. Increased oxygen tension in fetal mouse forebrain in vivo leads to a marked expansion of a distinct proliferative cell population, basal to the SVZ. These cells constitute a novel neurogenic cell layer, similar to the OSVZ, and contribute to corticogenesis by heading for deeper cortical layers as a part of the cortical plate.
Relationships between various temperament dimensions, levels of selected cytokines and Posttraumatic Stress Disorder (PTSD) in males, incurred as a result of mechanical injuries of lower extremities.
Authors: Gierlotka Zbigniew , Sobiś Jarosław , Misiołek Hanna , Kunert Łukasz , Misiołek Aleksandra , Gorczyca Piotr
Published: September 2015

Cel

Celem pracy była analiza zależności różnych wymiarów temperamentu a stężeniami wybranych cytokin i PTSD u mężczyzn po urazach mechanicznych kończyn dolnych.

Metoda

Do oceny PTSD wykorzystano Kwestionariusz PTSD wersja czynnikowa (1, 2). Cechy temperamentu badano za pomocą Formalnej Charakterystyki Zachowania-Kwestionariusz Temperamentu (FCZ-KT) (3). Stężenia wybranych cytokin oznaczono metodą ELISA. Cała populacja osób biorących udział w badaniu została wyselekcjonowana z większej populacji liczącej 80 osób. Wyeliminowano z badań 15 osób u których wystąpiły cechy stanu zapalnego. Grupa z PTSD liczyła 33 osoby, grupa kontrolna 32.

Wyniki

Z PTSD dodatnio statystycznie istotnie korelowały: persewerwtywność i reaktywność emocjonalna, ujemnie: żwawość, wytrzymałość i aktywność. Nie wykazano korelacji statystycznie istotnych między stężeniami wybranych cytokin: rozpuszczalny receptor interleukiny-2 (sIL-2), interleukina-6 (IL-6), interleukna-10 (IL-10),czynnik martwicy nowotworów-alfa (TNF-alfa) i interferonem-gamma (IFN-gamma) a cechami temperamentu. Omówiono także zależności między cechami temperamentu, PTSD a różnymi wymiarami osobowości.

Wnioski

1. U pacjentów z cechami temperamentu takimi jak perseweratywność i reaktywność emocjonalna istniało większe ryzyko wystąpienia PTSD.
2. U pacjentów z cechami temperamentu takimi jak żwawość, aktywność i wytrzymałość ryzyko wystąpienia PTSD było mniejsze.
3. Stężenie badanych cytokin (sIL-2, IL-6, IL-10, TNF-alfa, IFN-gamma) nie było zależne od cech temperamentu.
Transcranial magnetic stimulation in treatment of various psychiatric disorders - review of the most prominent studies and the latest news.
Authors: Poleszczyk Anna
Published: September 2015

Celem niniejszego artykułu było przedstawienie podstawowych informacji na temat przezczaszkowej stymulacji magnetycznej (transcranial magnetic stimulation - TMS) i jej obecnego stosowania w zaburzeniach psychicznych. Uwzględniono sposób jej wykonywania i jego uzasadnienie w poszczególnych zaburzeniach. Przedstawiono wyniki najważniejszych badań. Najwięcej danych dotyczy stosowania przezczaszkowej stymulacji magnetycznej powtarzaną serią bodźców (repetitive transcranial magnetic stimulation-rTMS) w przebiegu zaburzeń depresyjnych nawracających, podczas gdy w innych zaburzeniach psychicznych takich jak depresja w przebiegu zaburzeń afektywnych dwubiegunowych, schizofrenia, zaburzenia obsesyjno-kompulsyjne, otępienie czy uzależnienia wyniki są wstępne i często niejednoznaczne. Istnieje wiele trudności metodologicznych takich jak ustalenie optymalnego miejsca stymulacji u poszczególnych chorych i w różnych zaburzeniach psychicznych czy też zapewnienie warunków placebo. Przezczaszkowa stymulacja magnetyczna wraz z rozwojem nowych rozwiązań technicznych, nowych protokołów leczniczych czy ustaleniem czynników predykcyjnych reakcji na leczenie ma możliwość stania się bardzo użytecznym sposobem terapii dla chorych z zaburzeniami lekoopornymi lub nie tolerujących leczenia farmakologicznego. Zagadnienie z pewnością wymaga dalszych badań.
Non-adaptive reaction to disease - coping, demographic variables and trauma symptoms in cancer patients.
Authors: Laskowska Agnieszka
Published: September 2015

Cel

Celem prezentowanego badania było określenie związku stylów i strategii radzenia sobie ze stresem i zmiennych demograficznych z intensywnością symptomów PTSD u osób chorych onkologicznie. Podjęto próbę określenia, jaki styl radzenia sobie ze stresem jest najlepszym predyktorem symptomów traumy w badanej grupie.

Metoda

Badanie przeprowadzono w grupie 150 pacjentów (55 kobiet i 95 mężczyzn) poddawanych leczeniu przeciwnowotworowemu. Do badania stylów radzenia sobie ze stresem wykorzystano polską wersję Skali Przystosowania Psychicznego do Choroby Nowotworowej - Mini MAC. Do pomiaru nasilenia objawów zespołu stresu pourazowego zastosowano kwestionariusz PTSD w wersji czynnikowej (PTSD-C). Dodatkowo zastosowano ankietę demograficzną zawierającą pytania o wiek, płeć, wykształcenie i czas od postawienia diagnozy.

Wyniki

Wyniki badań wskazują na nieadaptacyjną funkcję stylu destrukcyjnego. W sytuacji narażenia na traumatyczne zdarzenie styl ten jest czynnikiem sprzyjającym rozwojowi symptomów zaburzeń stresowych pourazowych. Indywidualne strategie radzenia sobie, płeć i wiek związane są z wyższym natężeniem objawów potraumatycznych u osób chorych.

Wnioski

Destrukcyjny styl radzenia sobie jest mniej korzystny dla przystosowania się do choroby nowotworowej, mogąc w znaczący sposób wpływać na rozwój patologicznych objawów charakterystycznych dla PTSD.
Acute psychosis in the course of treatment of acute adrenal crisis with hydrocortisone in the patient with secondary adrenal insufficiency – a case study.
Authors: Brykalski Jan , Papierska Lucyna , Załuska Maria
Published: September 2015

Cel

Przedstawienie ryzyka wystąpienia psychozy, jako powikłania leczenia ostrego przełomu nadnerczowego wysokimi dawkami hydrokortyzonu.

Metoda

Analiza przypadku w kontekście literatury.

Wyniki

Z literatury wiadomo o występowaniu psychoz zarówno w niedoczynności jak i w nadczynności kory nadnerczy, Opisywano tez przypadki psychoz występujących przy wdrażaniu substytucyjnego leczenia niewydolności korty nadnerczy małymi dawkami steroidów. Przypuszcza się, że znaczenie patogenetyczne ma tu nadwrażliwość receptora glikokortykoidowego. Nie spotkaliśmy opisu ostrej psychozy w toku podawania steroidów w przełomie nadnerczowym.
Przedstawiamy przypadek 55-letniej pacjentki, dotychczas psychicznie zdrowej, z nie leczoną wtórną niewydolnością kory nadnerczy po radioterapii gruczolaka przysadki (prolaktynoma) zakończonej przed około 3 laty. Pacjentka została przyjęta do szpitala z powodu przełomu nadnerczowego wywołanego infekcją. W 4 dobie leczenia Hydrokortyzonem w dawkach do 400 mg /dobę dożylnie wystąpiła ostra psychoza z urojeniami i omamami oraz zachowaniami zagrażającymi życiu. Pacjentkę przyjęto do oddziału psychiatrii. Po 3 dniach leczenia haloperidolem, i obniżeniu dawki steroidu objawy psychotyczne ustąpiły, nie powracając mimo odstawienia haloperidolu.

Wnioski

Przypadek zwraca uwagę na ryzyko wystąpienia psychozy w toku leczenia przełomu nadnerczowego dużymi dawkami Hydrokortyzonu.
Z uwagi na ryzyko powikłań psychiatrycznych pacjenci leczeni dużymi dawkami kortykosteroidów, wymagają weryfikacji czynników ryzyka zaburzeń psychicznych i odpowiednich zabezpieczeń przy współpracy endokrynologa i psychiatry.
Parotid salivary parameters in bulimic patients – a controlled clinical trial.
Authors: Paszyńska Elżbieta , Słopień Agnieszka , Węglarz Monika , Linden Roger
Published: September 2015

Cel

Celem badania było ustalenie, czy pacjenci chorzy na typ przeczyszczający bulimii i / lub nie - bulimii, leczeni inhibitorem wychwytu zwrotnego serotoniny, SI- 5 -HT (fluoksetyna), mają erozję zębów i zmiany w wybranych składnikach buforowych śliny przyusznej (wodorowęglany, fosforany, mocznik), w stosunku do zdrowej populacji.

Metoda

Kontrolowane badanie kliniczne zostało zaprojektowane dla trzech, dopasowanych co do wieku i płci (młode kobiety) grup 94 pacjentek: z bulimią otrzymujących fluoksetynę 40 mg/dzień, niebulimicznych pacjentek z diagnozą afektywnych zaburzeń dwubiegunowych otrzymujących fluoksetynę 20 mg/dzień i zdrowej grupy kontrolnej. Ślinę ze ślinianki przyusznej pobierano od pacjentów za pomocą kapsuły Lashley’a w spoczynku i po stymulacji chemicznej 3% roztworem kwasu cytrynowego. W badaniu klinicznym określono erozję jako utratę powierzchni zębów poprzez wskaźnik (TWI). W wyselekcjonowanej ślinie oznaczono całkowite stężenia fosforanów nieorganicznych, wodorowęglanów, mocznika i pH.

Wyniki

U pacjentów z bulimią stwierdzono wyższy indeks TWI (24%) oraz niższy poziom pH, wodorowęglanów i fosforanów w ślinie. Nie było istotnych różnic w stężeniu mocznika.

Wnioski

Utrata tkanek zęba o typie erozyjno – abrazyjnym wydaje się być istotnym narzędziem diagnostycznym w bulimii. Występowanie zmian w strukturze zębów może być związana z utratą ochronnej funkcji śliny, czego dowodem jest zmniejszenie wartości pH i stężeń jonów buforujących. U osób z żarłocznością psychiczną o typie przeczyszczającym, leczonych długoterminowo lekami z grupy SI-5-HT wskazany jest monitoring parametrów ślinowych, takich jak szybkość wydzielania śliny, pH, składniki buforowe oraz regularna stomatologiczna kontrola stanu tkanek jamy ustnej.
The perception of relations in the family of origin of patients with eating disorders and the perception of relations in families of origin of their parents
Authors: Pilecki Maciej , Józefik Barbara , Kościelniak Marta
Published: September 2015

Cel

Analiza powiązań pomiędzy oceną bieżących relacji rodzinnych w rodzinach pacjentek z diagnozą zaburzeń odżywania się a oceną relacji w rodzinach pochodzenia ich rodziców.

Metoda

54 pacjentki z anoreksją restrykcyjną, 22 pacjentki z anoreksją żarłoczno-wydalającą, 36 pacjentek z bulimią. Uwzględniono 2 grupy kontrolne: 36 pacjentek z zaburzeniami depresyjnymi oraz 85 uczennic ze szkól krakowskich. Badaniem objęci byli również rodzice dziewcząt.
Metoda: Skala Rodziny Pochodzenia oraz Kwestionariusz Oceny Rodziny FAM (wersja polska).

Wyniki

W rodzinach uczennic szkół krakowskich lepsza ocena doświadczeń autonomii i bliskości z rodzin pochodzenia rodziców badanych dziewcząt wiązała się z ich oraz ich dzieci korzystniejszą percepcją relacji w obecnej rodzinie nuklearnej. Szczególnie znacząca okazała się transgeneracyjna percepcja doświadczeń ojców. We wszystkich grupach klinicznych zaobserwowano jedynie kilka istotnych statystycznie korelacji. U rodziców badanych pacjentek widoczny jest nikły związek oceny bieżących relacji małżeńskich z doświadczeniami transgeneracyjnymi, oraz istotny związek doświadczeń transgeneracyjnych z oceną relacji z córkami.

Wnioski

Stwierdzono brak specyficznych powiązań pomiędzy oceną relacji transgeneracyjnych rodziców i percepcją bieżących relacji w rodzinie nuklearnej w grupie zaburzeń odżywania się. Wyniki w grupie zaburzeń odżywania się sugerują, że relacje rodziców z córkami charakteryzują się większą intensywnością niż relacje małżeńskie.
Conference report: Progress in Biomedicine & Neuromedicine. Workshop with Nobel Prize Winner Professor Erwin Neher), Kraków 21–23.06.2015 r.
Authors: Murawiec Sławomir , Chrobak Adrian
Published: September 2015

brak streszczenia
Hypercalcaemia following the use of antibiotic-eluting absorbable calcium sulphate beads in revision arthroplasty for infection
Authors: Kallala R. , Haddad F. S.
Published: September 2015

Periprosthetic joint infection (PJI) is a devastating complication for patients and results in greatly increased costs of care for both healthcare providers and patients. More than 15 500 revision hip and knee procedures were recorded in England, Wales and Northern Ireland in 2013, with infection accounting for 13% of revision hip and 23% of revision knee procedures.

We report our experience of using antibiotic eluting absorbable calcium sulphate beads in 15 patients (eight men and seven women with a mean age of 64.8 years; 41 to 83) as part of a treatment protocol for PJI in revision arthroplasty.

The mean follow-up was 16 months (12 to 22). We report the outcomes and complications, highlighting the risk of hypercalcaemia which occurred in three patients.

We recommend that serum levels of calcium be routinely sought following the implantation of absorbable calcium sulphate beads in orthopaedic surgery.

Cite this article: Bone Joint J 2015;97-B:1237–41.
The terminal branches of the medial femoral circumflex artery
Authors: Lazaro L. E. , Klinger C. E. , Sculco P. K. , Helfet D. L. , Lorich D. G.
Published: September 2015

This study investigates and defines the topographic anatomy of the medial femoral circumflex artery (MFCA) terminal branches supplying the femoral head (FH). Gross dissection of 14 fresh–frozen cadaveric hips was undertaken to determine the extra and intracapsular course of the MFCA’s terminal branches. A constant branch arising from the transverse MFCA (inferior retinacular artery; IRA) penetrates the capsule at the level of the anteroinferior neck, then courses obliquely within the fibrous prolongation of the capsule wall (inferior retinacula of Weitbrecht), elevated from the neck, to the posteroinferior femoral head–neck junction. This vessel has a mean of five (three to nine) terminal branches, of which the majority penetrate posteriorly. Branches from the ascending MFCA entered the femoral capsular attachment posteriorly, running deep to the synovium, through the neck, and terminating in two branches. The deep MFCA penetrates the posterosuperior femoral capsular. Once intracapsular, it divides into a mean of six (four to nine) terminal branches running deep to the synovium, within the superior retinacula of Weitbrecht of which 80% are posterior. Our study defines the exact anatomical location of the vessels, arising from the MFCA and supplying the FH. The IRA is in an elevated position from the femoral neck and may be protected from injury during fracture of the femoral neck. We present vascular ‘danger zones’ that may help avoid iatrogenic vascular injury during surgical interventions about the hip.

Cite this article: Bone Joint J 2015;97-B:1204–13.
Use of leucocyte esterase reagent strips in the diagnosis or exclusion of prosthetic joint infection
Authors: Shafafy R. , McClatchie W. , Chettiar K. , Gill K. , Hargrove R. , Sturridge S. , Guyot A.
Published: September 2015

Infection is a leading indication for revision arthroplasty. Established criteria used to diagnose prosthetic joint infection (PJI) include a range of laboratory tests. Leucocyte esterase (LE) is widely used on a colorimetric reagent strip for the diagnosis of urinary tract infections. This inexpensive test may be used for the diagnosis or exclusion of PJI. Aspirates from 30 total hip arthroplasties (THAs) and 79 knee arthroplasties (KA) were analysed for LE activity. Semi-quantitative reagent strip readings of 15, 70, 125 and 500 white blood cells (WBC) were validated against a manual synovial white cell count (WCC). A receiver operating characteristic (ROC) curve was constructed to determine the optimal cut-off point for the semi-quantitative results. Based on established criteria, six THAs and 15 KAs were classified as infected. The optimal cut-off point for the diagnosis of PJI was 97 WBC. The closest semi-quantitative reading for a positive result was 125 WBC, achieving a sensitivity of 81% and a specificity of 93%. The positive and negative predictive values of the LE test strip were 74% and 95% respectively.

The LE reagent strip had a high specificity and negative predictive value. A negative result may exclude PJI and negate the need for further diagnostic tests.

Cite this article: Bone Joint J 2015;97-B:1232–6.
Implant-associated mycobacterium tuberculosis infection following surgical management of fractures
Authors: Mahale Y. J. , Aga N.
Published: September 2015

In this retrospective observational cohort study, we describe 17 patients out of 1775 treated for various fractures who developed mycobacterium tuberculosis (MTB) infection after surgery. The cohort comprised 15 men and two women with a mean age of 40 years (24 to 70). A total of ten fractures were open and seven were closed. Of these, seven patients underwent intramedullary nailing of a fracture of the long bone, seven had fractures fixed with plates, two with Kirschner-wires and screws, and one had a hemiarthroplasty of the hip with an Austin Moore prosthesis. All patients were followed-up for two years. In all patients, the infection resolved, and in 14 the fractures united. Nonunion was seen in two patients one of whom underwent two-stage total hip arthroplasty (THA) and the other patient was treated using excision arthoplasty. Another patient was treated using two-stage THA. With only sporadic case reports in the literature, MTB infection is rarely clinically suspected, even in underdeveloped and developing countries, where pulmonary and other forms of TB are endemic. In developed countries there is also an increased incidence among immunocompromised patients. In this paper we discuss the pathogenesis and incidence of MTB infection after surgical management of fractures and suggest protocols for early diagnosis and management.

Cite this article: Bone Joint J 2015;97-B:1279–83.
Early mobilisation following mini-open rotator cuff repair
Authors: Sheps D. M. , Bouliane M. , Styles-Tripp F. , Beaupre L. A. , Saraswat M. K. , Luciak-Corea C. , Silveira A. , Glasgow R. , Balyk R.
Published: September 2015

This study compared the clinical outcomes following mini-open rotator cuff repair (MORCR) between early mobilisation and usual care, involving initial immobilisation. In total, 189 patients with radiologically-confirmed full-thickness rotator cuff tears underwent MORCR and were randomised to either early mobilisation (n = 97) or standard rehabilitation (n = 92) groups. Patients were assessed at six weeks and three, six, 12 and 24 months post-operatively. Six-week range of movement comparisons demonstrated significantly increased abduction (p = 0.002) and scapular plane elevation (p = 0.006) in the early mobilisation group, an effect which was not detectable at three months (p > 0.51) or afterwards. At 24 months post-operatively, patients who performed pain-free, early active mobilisation for activities of daily living showed no difference in clinical outcomes from patients immobilised for six weeks following MORCR. We suggest that the choice of rehabilitation regime following MORCR may be left to the discretion of the patient and the treating surgeon.

Cite this article: Bone Joint J 2015;97-B:1257–63.
Do you have an infection problem?
Authors: Patel A. , Pavlou G. , Ahmad R. A. , Toms A.
Published: September 2015

In England and Wales more than 175 000 hip and knee arthroplasties were performed in 2012. There continues to be a steady increase in the demand for joint arthroplasty because of population demographics and improving survivorship. Inevitably though the absolute number of periprosthetic infections will probably increase with severe consequences on healthcare provision. The Department of Health and the Health Protection Agency in United Kingdom established a Surgical Site Infection surveillance service (SSISS) in 1997 to undertake surveillance of surgical site infections. In 2004 mandatory reporting was introduced for one quarter of each year. There has been a wide variation in reporting rates with variable engagement with the process. The aim of this article is to improve surgeon awareness of the process and emphasise the importance of engaging with SSISS to improve the quality and type of data submitted. In Exeter we have been improving our practice by engaging with SSISS. Orthopaedic surgeons need to take ownership of the data that are submitted to ensure these are accurate and comprehensive.

Cite this article: Bone Joint J 2015;97-B:1170–4.
Fixation of acetabular fractures via the ilioinguinalversuspararectus approach
Authors: Märdian S. , Schaser K. D. , Hinz P. , Wittenberg S. , Haas N. P. , Schwabe P.
Published: September 2015

This study compared the quality of reduction and complication rate when using a standard ilioinguinal approach and the new pararectus approach when treating acetabular fractures surgically. All acetabular fractures that underwent fixation using either approach between February 2005 and September 2014 were retrospectively reviewed and the demographics of the patients, the surgical details and complications were recorded.

A total of 100 patients (69 men, 31 women; mean age 57 years, 18 to 93) who were consecutively treated were included for analysis. The quality of reduction was assessed using standardised measurement of the gaps and steps in the articular surface on pre- and post-operative CT-scans.

There were no significant differences in the demographics of the patients, the surgical details or the complications between the two approaches. A significantly better reduction of the gap, however, was achieved with the pararectus approach (axial: p = 0.025, coronal: p = 0.013, sagittal: p = 0.001).

These data suggest that the pararectus approach is at least equal to, or in the case of reduction of the articular gap, superior to the ilioinguinal approach.

This approach allows direct buttressing of the dome of the acetabulum and the quadrilateral plate, which is particularly favourable in geriatric fracture patterns.

Cite this article: Bone Joint J 2015;97-B:1271-8.
Challenges in reporting surgical site infections to the national surgical site infection surveillance and suggestions for improvement
Authors: Singh S , Davies J , Sabou S , Shrivastava R , Reddy Srinivasulu
Published: August 2015

Introduction

Mandatory orthopaedic surgical site infection (SSI) data in England are used as a benchmark to compare infection rates between participating hospitals. According to the national guidelines, trusts are required to submit their data for at least one quarter of the year but they are free to report for all quarters. Owing to this ambiguity, there is a concern about robust reporting across trusts and therefore the accuracy of these data. There is also concern about the accuracy of collection methods. The aim of this five-year retrospective study was to assess the accuracy of SSI reporting at two hospitals in South East England under the same trust.

Methods

A retrospective review was carried out of five years of electronic medical records, microbiology data and readmission data of all patients who underwent hip and knee replacement surgery at these hospitals. These data were validated with the data submitted to Public Health England (PHE) and any discrepancy between the two was noted.

Results

A significant difference was found in the SSI rates reported by the surveillance staff and our retrospective method.

Conclusions

Our study confirms the findings of a national survey, which raised concerns about the quality of SSI reporting and the usefulness of PHE SSI data for benchmarking purposes. To our knowledge, there are no previously published studies that have looked at the accuracy of the English orthopaedic SSI surveillance. In the light of our findings, there is an urgent need for external validation studies to identify the extent of the problem in the surveillance scheme. The governing bodies should also issue clear guidelines for reporting SSIs to maintain homogeneity and to present the true incidence of SSI. We suggest some measures that we have instituted to address these inadequacies that have led to significant improvements in reporting at our trust.
All in the mind
Authors: Sanders David
Published: August 2015

This month, we look at what goes on inside surgeons' heads.
Who's in charge?
Authors: Marx Clare
Published: August 2015

How the College intends to invest in the clinical leaders of the future.
Game theory and the surgeon
Authors: Marco AP
Published: August 2015

How the controversial study of strategic decision-making plays out in our profession.
Instinct, intuition and surgical decision-making
Authors: Sutton PA , Hornby ST , Vimalachandran D , McNally S
Published: August 2015

When to go with your gut, and when to seek a second opinion.
What does the surgeon need to know about safeguarding children?
Authors: Roderick C , Davies E , Rabb L , Bowley DM
Published: August 2015

How to spot signs of abuse.
The first glimpse of a duty to warn?
Authors: Wheeler Robert
Published: August 2015

Pointing out potential post-op complications is part of the consent process. How detailed do we need to be?
Those stitches were fast as lightning
Authors: Ashken Lucy
Published: August 2015

Lucy Ashken learnt the secret tricks of kung fu, and later got a similar kick out of surgical training.