Use of antibiotic coated intramedullary nails in open tibia fractures: A European medical resource use and cost-effectiveness analysis.

PURPOSE: In patients with open tibial fractures, bone and wound infections are associated with an increased hospital length of stay and higher costs. The infection risk increases with the use of implants. Innovations to reduce this risk include antibiotic-coated implants. This study models whether the use of a gentamicin-coated intramedullary tibial nail is cost-effective for trauma centers managing patients with a high risk of infection. EFFICACY: Absolute infection risk and relative risk reduction, by fracture grade, for antibiotic-coated nails compared to standard nails for patients with open tibial fractures were estimated based on the results of a meta-analysis, which assessed the additional benefit of locally-administered prophylactic antibiotics in open tibia fractures treated with implants. The observed efficacy of antibiotic-coated nails in reducing infections was applied in an economic model. METHODS: The model compared infection rates, inpatient days, theatre usage and costs in high risk patients, with a Gustilo-Anderson (GA) grade III open fracture, for two patient cohorts from a trauma center perspective, with a 1-year time horizon. In one cohort all GAIII patients received a gentamicin-coated nail whilst GAI and GAII patients received a standard nail. All patients in the comparator cohort received a standard nail. Four European trauma centers provided patient-level data (n=193) on inpatient days, procedures and related costs for patients with and without infections. RESULTS: Using the gentamicin-coated nail in patients at high risk of infection (GAIII) was associated with 75% lower rate of infection and cost savings (€477 - €3.263) for all included centers; the higher cost of the implant was offset by savings from fewer infections, inpatient days (-26%) and re-operations (-10%). This result was confirmed by extensive sensitivity analyses. CONCLUSIONS: Analyses demonstrated that infection rates and total costs for in-hospital treatment could be potentially reduced by 75% and up to 15% respectively, by using a gentamicin-coated nail in patients at high risk of infection. Fewer infections, reduced inpatient days and re-operations may be potentially associated with use of antibiotic-coated implants. Results are sensitive to the underlying infection risk, with greatest efficacy and cost-savings when the coated implant is used in high risk patients.

Use of Tracking and Reminder Systems for Colorectal Cancer Screening in Indian Health Service and Tribal Facilities.

BACKGROUND: Colorectal cancer (CRC) is a significant cause of morbidity and mortality among American Indian/Alaska Native (AI/AN) people. Screening at recommended intervals can detect CRC in its early, most treatable stages, or prevent CRC through removal of precancerous polyps. However, CRC screening percentages remain low among AI/AN people. Reminder and tracking systems can be used to improve CRC screening percentages. PURPOSE: In this study we assessed the prevalence of CRC screening reminder and tracking systems in Indian Health Service (IHS), Tribal, or Urban (I/T/U) health facilities. METHODS: A telephone survey of randomly selected small, medium and large I/T/U health facilities nationwide was conducted. Three health facilities from each of the 12 IHS areas nationwide were selected from a list of I/T/U healthcare facilities that provide CRC screening or refer patients to another facility for screening, with the goal of having one small, one medium, and one large I/T/U health facility from each IHS area. RESULTS: Thirty-four facilities (94%) participated in the telephone survey between April 1 and September 24, 2010. All facilities used the IHS Resource and Patient Management System to manage their patient care, and 82% used the Electronic Health Record (EHR) version. Over half of these facilities (55%) performed in-office fecal occult blood tests (FOBT) collected during a digital rectal exam, all of which reported that they also sent FOBT cards home with patients. Fifty-three percent of facilities used an opportunistic, visit-based approach to CRC screening. Nearly a third (32%) of facilities reported using a reminder system to notify patients that they were due for CRC screening. Almost two-thirds (65%) of facilities used a reminder system to notify health care providers that patients were due for CRC screening. While 73% of facilities used a system to track whether patients were due for CRC screening, only 61% used a system to track patient results for CRC screening, and 42% used a system to track patients with a personal history of polyps or CRC. CONCLUSIONS: A majority of facilities performed in-office FOBT tests using a digital rectal exam, which is a practice that is contrary to national CRC screening recommendations. Additionally, the majority of facilities reported not using an organized system for CRC screening. Use of patient reminders was suboptimal. However, facilities did report use of provider reminders, tracking when patients were due for CRC screening, and tracking CRC screening results. As the EHR system becomes more widely used and established, I/T/U facilities could be encouraged to increase their use of the EHR tools available to aid in systematically increasing CRC screening percentages.

Rothmund-Thomson syndrome with myelodysplasia.

Rothmund-Thomson syndrome (RTS) is a rare autosomal recessive disorder that is caused by a DNA repair defect. It is characterized mainly by skin, eye, and skeletal abnormalities. Cutaneous changes appear at between 3 and 6 months of age and include poikiloderma, photosensitivity, scaling, hyperkeratosis, and disturbance of hair growth. Other abnormalities include cataracts, congenital bone defects, soft tissue contractures, and osteogenesis imperfecta. Various malignancies have been reported in association with RTS, including osteosarcoma, fibrosarcoma, and nonmelanoma skin cancers. The myelodysplastic syndromes are a group of hematologic disorders defined by morphologic abnormalities of the three cell lines. The pathogenesis of myelodysplasia is a multistep process that begins with a somatic mutation in the pluripotential stem cell, which is irreversibly altered and acquires a survival advantage. Myelodysplasia in the young and RTS are both rare conditions. We report a patient with RTS and myelodysplasia. This is the second reported case of an association between these two conditions, which are both likely to be due to a common etiologic cause of nonrepair of stem cell DNA damage. Clinicians should be aware of the potential of this complication arising in patients with RTS.

Managing delayed-onset muscle soreness: lack of effect of selected oral systemic analgesics.

OBJECTIVE: To investigate the efficacy of commonly available analgesics in the management of delayed-onset muscle soreness over an 11-day period. DESIGN: Double-blind, placebo-controlled randomized trial. SETTING: University laboratory. PARTICIPANTS: Sixty healthy volunteers (30 men, 30 women) with no current arm pain or pathology completed the experimental procedure. INTERVENTIONS: Subjects were randomly allocated to one of five experimental groups: control; placebo; aspirin (900 mg); codeine (60 mg); and paracetamol (1000 mg) (n = 12 in all groups). Delayed soreness was induced in the nondominant elbow flexors using a standardized exercise protocol of repeated eccentric contractions. MAIN OUTCOME MEASURES: Pain (visual analogue scale; McGill pain questionnaire [MPQ]), range of extension, flexion and resting angle (universal goniometer), and mechanical pain threshold (pressure algometer). Measurements were taken before and after drug administration each day, except for the MPQ, which was completed on the first and third days of the experiment. RESULTS: Analysis of results using repeated-measures analysis of variance and relevant post hoc tests provided no evidence of the effectiveness of any of the preparations. CONCLUSION: There is no beneficial effect from the medications, at least at the doses stated, in the management of delayed-onset muscle soreness.

Evolution and mechanism from structures of an ADP-ribosylating toxin and NAD complex.

A member of the Bacillus-produced vegetative insecticidal proteins (VIPs) possesses high specificity against the major insect pest, corn rootworms, and belongs to a class of binary toxins and regulators of biological pathways distinct from classical A-B toxins. The 1.5 A resolution crystal structure of the enzymatic ADP-ribosyltransferase component, VIP2, from Bacillus cereus reveals structurally homologous N- and C-terminal alpha/beta domains likely representing the entire class of binary toxins and implying evolutionary relationships between families of ADP-ribosylating toxins. The crystal structure of the kinetically trapped VIP2-NAD complex identifies the NAD binding cleft within the C-terminal enzymatic domain and provides a structural basis for understanding the targeting and catalysis of the medically and environmentally important binary toxins. These structures furthermore provide specific experimental results to help resolve paradoxes regarding the specific mechanism of ADP-ribosylation of actin by implicating ground state destabilization and nicotinamide product sequestration as the major driving forces for catalysis.

Lack of effect of combined low intensity laser therapy/phototherapy (CLILT) on delayed onset muscle soreness in humans.

BACKGROUND AND OBJECTIVES: This study, which was approved by the University's Ethical committee, was conducted to investigate the effectiveness of Combined Low Intensity Laser Therapy/Phototherapy (CLILT) in alleviating the signs and symptoms of Delayed Onset Muscle Soreness (DOMS) over an 11-day period. STUDY DESIGN/MATERIALS AND METHODS: Thirty-six subjects (18 M: 18 F) were randomly allocated, under strictly controlled double-blind conditions, to one of three experimental conditions: Control, Placebo, and CLILT (660-950 nm; 11 J/cm2; pulsed at 73 Hz). DOMS was induced in a standardised fashion in the non-dominant elbow flexors using repeated eccentric contractions until exhaustion was reached. Subjects returned on five consecutive days, and two days during the following week, for treatment according to group, and assessment of outcome variables including range of motion, pain, and tenderness. RESULTS: While analysis of results using repeated measures and one factor ANOVA with post-hoc tests showed significant changes in all variables over time (P < 0.05) as a result of the induction procedure, there were no significant differences observed between groups. CONCLUSIONS: CLILT failed to show any beneficial treatment effect on DOMS, at least at the parameters used here. These results therefore provide no evidence for the claimed biostimulating effects of such therapy.

Delayed onset muscle soreness: lack of effect of therapeutic ultrasound in humans.

OBJECTIVE: To investigate the effects of two dosages of pulsed ultrasound therapy (1 MHz, spatial averaged peak intensity 0.8 W/cm2, mark space ratio of 1:4) on acute-stage delayed onset muscle soreness (DOMS). DESIGN: Double-blind, placebo-controlled, randomized trial. SETTING: Laboratory of a university physiotherapy department. PARTICIPANTS: Forty-eight healthy volunteers (24 men, 24 women) with no arm pathology or pain at the time of the study. INTERVENTIONS: Subjects were randomly allocated to one of four treatment groups: control, placebo (sham insonation), low-dosage pulsed ultrasound (mean dosage 172.8 J), or high-dosage pulsed ultrasound (mean dosage 345.6 J). DOMS was induced in the nondominant elbow flexors in a standardized fashion through repeated eccentric exercise until exhaustion. MAIN OUTCOME MEASURES: Elbow extension, flexion, and resting angles (universal goniometer), pain (visual analogue scale), mechanical pain threshold/tenderness (pressure algometer), and a McGill pain questionnaire. Measurements were taken before and after treatment each day except for the McGill pain questionnaire, which was completed at the end of the trial. RESULTS: Significant differences were seen between groups in relation to range of flexion (p = .0032), with the control group losing least range of flexion. There were no other significant differences between the groups. CONCLUSION: No convincing evidence was found to support the use of pulsed ultrasound therapy in the management of DOMS at the parameters discussed here.

Delayed-onset muscle soreness: lack of effect of combined phototherapy/low-intensity laser therapy at low pulse repetition rates.

A double-blind, placebo-controlled study using male subjects (n = 60), was conducted to investigate the efficacy of three different frequencies of combined phototherapy/low-intensity laser therapy (CLILT) in alleviating the signs and symptoms of delayed-onset muscle soreness (DOMS). The study was approved by the University's ethical committee. After screening for relevant pathologies, recent analgesic or steroid drug usage, current pain, diabetes, or current involvement in regular weight-training activities, subjects were randomly allocated to one of five experimental groups: Control, Placebo, or 2.5-Hz, 5-Hz, or 20-Hz CLILT groups (660-950 nm; 31.7 J/cm2; pulsed at the given frequencies for a duration of 12 min; n = 12 all groups). Once baseline measurements were obtained, DOMS was induced in the nondominant arm, which was exercised in a standardized fashion until exhaustion, using repeated eccentric contractions of the elbow flexors. The procedure was repeated twice more to ensure exhaustion was achieved, after which subjects were treated according to group allocation. In the CLILT/placebo groups, the treatment head was applied directly to the affected arm at the level of the musculotendinous junction. Subjects returned on two consecutive days for further treatment and assessment. The range of variables used to assess DOMS included range of movement (universal goniometer), mechanical pain threshold/tenderness (algometer) and pain (visual analogue scale and McGill Pain Questionnaire). Measurements were taken before and after treatment on each day, except for the McGill Pain questionnaire, which was completed at the end of the study. Analysis of results using repeated measures and one-factor analysis of variance with relevant post hoc tests showed significant changes in ranges of movement accompanied by increases in subjective pain and tenderness for all groups over time (p = 0.0001); however, such analysis failed to show any significant differences between groups on any of the days. These results thus provide no convincing evidence for any putative hypoalgesic effect of CLILT upon DOMS at the parameters used here.

Lack of effect of transcutaneous electrical nerve stimulation upon experimentally induced delayed onset muscle soreness in humans.

The aim of the current study, for which ethical approval was obtained, was to assess the hypoalgesic efficacy of transcutaneous electrical nerve stimulation (TENS) upon acute stage (72 h) experimentally induced delayed onset muscle soreness (DOMS). TENS naive subjects (n = 48; 24 male and 24 female) were recruited, screened for relevant pathology and randomly allocated to one of four experimental groups: control, placebo, low TENS (200 microseconds; 4 Hz) or high TENS group (200 microseconds; 110 Hz). DOMS was induced in a standardised fashion in the non-dominant elbow flexors of all subjects by repeated eccentric exercise. Subjects attended on three consecutive days for treatment and measurement of elbow flexion, extension and resting angle (Universal goniometer), Mechanical Pain Threshold/tenderness (algometer) and pain (Visual Analogue Scale (VAS)) on a daily basis, plus McGill Pain Questionnaire on the third day only. Measurements were taken before and after treatment under controlled double blinded conditions. Analysis of results using repeated measures analysis of variance (ANOVA) and post hoc tests showed some inconsistent isolated effects of high TENS (110 Hz) compared to the other conditions upon resting angle and flexion scores; no significant effects were found for any of the other variables. These results provide no convincing evidence for any measurable hypoalgesic effects of TENS upon DOMS-associated pain at the stimulation parameters used here.

Vip3A, a novel Bacillus thuringiensis vegetative insecticidal protein with a wide spectrum of activities against lepidopteran insects.

A novel vegetative insecticidal gene, vip3A(a), whose gene product shows activity against lepidopteran insect larvae including black cutworm (Agrotis ipsilon), fall armyworm (Spodoptera frugiperda), beet armyworm (Spodoptera exigua), tobacco budworm (Heliothis virescens), and corn earworm (Helicoverpa zea) has been isolated from Bacillus thuringiensis strain AB88. VIP3-insecticidal gene homologues have been detected in approximately 15% of Bacillus strains analyzed. The sequence of the vip3A(b) gene, a homologue of vip3A(a) isolated from B. thuringiensis strain AB424 is also reported. Vip3A(a) and (b) proteins confer upon Escherichia coli insecticidal activity against the lepidopteran insect larvae mentioned above. The sequence of the gene predicts a 791-amino acid (88.5 kDa) protein that contains no homology with known proteins. Vip3A insecticidal proteins are secreted without N-terminal processing. Unlike the B. thuringiensis 5-endotoxins, whose expression is restricted to sporulation, Vip3A insecticidal proteins are expressed in the vegetative stage of growth starting at mid-log phase as well as during sporulation. Vip3A represents a novel class of proteins insecticidal to lepidopteran insect larvae.

Cloning of a cryV-type insecticidal protein gene from Bacillus thuringiensis: the cryV-encoded protein is expressed early in stationary phase.

A CryV-type protein (CGCryV) has been isolated from supernatant fluids of Bacillus thuringiensis AB88 cultures. Previous reports have suggested the cryptic nature of the cryV-type genes on the basis of the absence of CryV-type proteins in parasporal crystals. The CryV-type protein reported here is expressed early in stationary phase, and evidence indicates that it is an exported protein. Analysis of the deduced protein sequence from this gene reveals the presence of an N-terminal domain that likely acts as a signal peptide. The CGCryV protein is the first reported case of a delta-endotoxin being a secreted protein, which may influence the biological relevance of these proteins.

Dependency, self-criticism and social interactions.

We investigated the social interactions of college students varying in dependency and self-criticism. Forty-eight college students used a modified version of the Rochester Interaction Record to record quantitative and qualitative features of every 10-minute or longer interaction during a seven-day period. Daily measures of mood were also collected. Dependency was related to more frequent and more intimate interactions, and self-criticism was negatively related to pleasantness of social interactions. Although dependency and self-criticism were both associated with daily dysphoria, the social interaction findings could not be attributed to the effects of mood. The social environments associated with dependency and self-criticism may influence the aetiology and course of depressive episodes.

Beak trimming effects on beak length and feed usage for growth and egg production.

Two experiments were conducted to compare beak treatment effects on pullets of three genetic stocks. Within each stock, equal numbers were assigned to three treatments: no beak trimming (IN), beak trimming once (1X), and beak trimming twice (2X). Beak treatment, genetic stock, and age effects along with interactions among main effects were examined for production-associated traits during rearing and brief periods of early egg production. Beaks of 1X and 2X pullets remained shorter than those of IN pullets through final measurements at 36 and 32 wk of age in Experiments 1 and 2, respectively. However, differences in beak length decreased as age increased. Upper beaks of 2X pullets remained shorter than those of 1X pullets, but lower beaks of 1X and 2X pullets did not differ by 20 wk in Experiment 2. Weight gains, feed usage, and efficiency of growth were affected by beak treatments. Beak trimming reduced gains, feed eaten, feed wasted, and total feed used, and 2X pullets used their feed more efficiently for weight gain and egg production. A general decrease occurred in differences among beak treatments for weight gains, feed eaten, feed wasted, and efficiency of gains with increasing age during rearing. Nevertheless, significant differences in feed consumed, feed wasted, and efficiency of feed used for egg production indicated an economic advantage in favor of beak trimming.

Vitamin and proximate composition of fast-food fried chicken.

As part of the USDA's effort to obtain accurate data for nutrient composition handbooks, we determined proximate composition and vitamin (thiamin, riboflavin, niacin, folacin, pantothenic acid, and vitamins B-6 and B-12) content of fast-food fried chicken. Ninety-four samples were purchased from six chains in 10 cities throughout the United States. Vitamin content of breast and thigh meat portions differed, and slight differences in composition among brands were noted. Thiamin values for breast and thigh muscle, respectively, ranged from 0.062 to 0.136 and from 0.078 to 0.122 mg/100 gm; riboflavin, from 0.176 to 0.205 and 0.249 to 0.328 mg/100 gm; niacin, from 6.32 to 8.46 and 3.86 to 5.57 mg/100 gm; vitamin B-6, from 0.315 to 0.390 and 0.189 to 0.271 mg/100 gm; folacin, from 4.2 to 6.9 and 5.00 to 8.00 micrograms/100 gm; vitamin B-12, from 0.331 to 0.459 and 0.382 to 0.596 micrograms/100 gm; and pantothenic acid, from 1.48 to 1.68 and 1.58 to 1.77 mg/100 gm. Pressure-fried samples tended to have higher percentage moisture and lower percentage fat than crispy, open-vat fried samples. Fat ranged from about 15% to 20%.

Minimizing drug misuse among elders: a proposal.

This proposal is aimed at reducing the risk of adverse drug interactions that may occur when over-the-counter (OTC) preparations are taken in conjunction with prescription drugs in an unsupervised regimen. Such polymedicating is practiced widely among the elderly. A pilot program would be implemented over 12 months at three drugstores of a major retail chain. A barcode-based computer system would be used to identify potential adverse drug interactions for elderly customers. All volunteers admitted to the study, controls and subjects, would agree to buy all their medications, prescriptions and OTC, at the participating pharmacies. In return, the volunteers would receive discounts of 25 percent on prescription and OTC drugs and 10 percent on vitamins. Study subjects (N = 375) would carry barcoded identification (BID) cards that would activate the computerized program to assess each purchase for compatibility with their other medications; controls (N = 375) would carry "dummy" BID cards that would prompt the computer to approve all drug purchases. A final comparison of the subjects with the controls, as well as with a sample of elderly residents selected randomly from the community, would determine whether such a computerized, commercially based drug use review system could reduce the potential for adverse interactions between OTC and prescription drugs among the elderly.

Cisplatin chemotherapy for metastatic squamous cell carcinoma in two dogs.

Cisplatin was used successfully to treat 2 dogs with metastatic squamous cell carcinoma. One dog was observed to have a complete remission and died of unrelated causes 23 months later. The other dog had a partial remission of the tumor, but relapsed and was euthanatized 4 1/2 months after the beginning of treatment. Both dogs tolerated the treatment well.

Corticosteroids and other indicators of hens' well-being in four laying-house environments.

Four presumed criteria of well-being were compared using data from hens of four genetic stocks kept in each of four laying-house environments. Differences between strains selected for increased egg mass and unselected control stocks were not detected, and interactions of selection method with housing environment and periods after housing were not found. Plasma corticosteroid concentrations present during the first 2 weeks after housing were higher than those obtained later. Hens kept in 12-hen, low-density floor pens and 6-hen, high-density cages at 2900 and 310 cm2/hen, respectively, did not differ from each other in corticosteroid levels. However, hens in the floor pens and high-density cages had higher levels than did hens in single-hen, low-density cages and those in 4-hen, moderate-density cages (the latter with floor spaces of 929 and 464 cm2/hen, respectively). Mortality was higher and egg mass per hen housed was less in the 6-hen cages than in floor pens, single-hen cages, and 4-hen cages during the 40-week period following housing. Feather damage and loss increased stepwise and significantly with number of hens per cage. Plasma corticosteroid concentrations did not yield results consistent with other criteria of hens' well-being. There is a need to look beyond the results of corticosteroid assays in establishing hens' well-being in widely different environments.

Effects of intraoperative irradiation on gastric and urinary bladder incisions in the dog.

Fourteen adult dogs of mixed breeding were given intraoperative irradiation (25 Gy) after surgical incisions were made into the greater curvature of the stomach and the ventral surface of the urinary bladder. Sequential biopsy samples were obtained 10 days to 180 days after surgical operation. All irradiated stomachs developed gastritis and persistent ulceration of the irradiated field. Microscopic changes induced by irradiation of both the bladder and stomach progressed from severe submucosal edema to severe submucosal fibrosis. A parallel progression of fibrinoid degeneration of the small blood vessels was seen in both organs. Severe gastric ulceration persisted up to 180 days after irradiation, although a degree of mucous neck cell and gastric gland regeneration did occur. Pathologic changes were less severe in the bladder than in the stomach. The bladder had greater resiliency and capability for healing and, in contrast to the stomach, showed a capability to reepithelialize the radiation-induced ulcers. Conclusions of this study are as follows: (a) the canine urinary bladder tolerated intraoperative radiation therapy after tissue resection better than did the canine stomach, (b) the combination of surgical operation and irradiation resulted in a more prolonged and complicated healing pattern than did either procedure alone, and (c) the introduction of a surgical procedure upon irradiated tissue within an undetermined time span relative to irradiation resulted in a similar pattern of disturbed healing.

Costal bone changes similar to hypertrophic osteopathy associated with pulmonary and abdominal mesothelioma in a dog.

An 8-year-old male Irish Setter was admitted because of nonweight bearing lameness of the left forelimb. Radiography failed to reveal any bony lesions of the forelimb; however, extensive periosteal new bone formation over most rib surfaces and an atypical cardiac silhouette suggestive of a mediastinal mass with pleural effusion were observed. New bone formation was seen on the ilium and a filling defect in the urethra, distal to the prostate, was apparent with contrast urethrocystography. Necropsy revealed scirrhous mesothelioma of the thorax and abdomen, multifocal periosteal exostoses, paraprostatic cyst, and benign prostatic cystic hyperplasia. Tumor cells were associated with the periosteal exostotic costal bone. The specific cause of the lameness was not determined.