Use of uterine artery embolization to prevent peripartum hemorrhage of placental abruption with fetal demise & severe DIC.

Uterine artery embolization (UAE) is typically not indicated in the pre-operative management of pregnancies with a live fetus, because risk of fetal death from reduced uteroplacental blood flow. However, pre-operative UAE in pregnancies with a fetal demise poses no fetal risk, and may offer maternal benefits. Patients with placental abruption resulting in fetal demise are at high-risk for developing disseminated intravascular coagulation (DIC), which could have devastating complications such as peri-operative hemorrhage and death. This case report describes the first successful execution of a pre-operative UAE that effectively prevented antepartum and postpartum hemorrhage in a patient with DIC secondary to a placental abruption and recent fetal demise.

"FIND Technology": investigating the feasibility, efficacy and safety of controller-free interactive digital rehabilitation technology in an inpatient stroke population: study protocol for a randomized controlled trial.

BACKGROUND: Stroke results in significant disability, which can be reduced by physical rehabilitation. High levels of repetition and activity are required in rehabilitation, but patients are typically sedentary. Using clinically relevant and fun computer games may be one way to achieve increased activity in rehabilitation. METHODS/DESIGN: A single-blind randomized controlled trial will be conducted to evaluate the feasibility, efficacy and safety of novel stroke-specific rehabilitation software. This software uses controller-free client interaction and inertial motion sensors. Elements of feasibility include recruitment into the trial, ongoing participation (adherence and dropout), perceived benefit, enjoyment and ease of use of the games. Efficacy will be determined by measuring activity and using upper-limb tasks as well as measures of balance and mobility. The hypothesis that the intervention group will have increased levels of physical activity within rehabilitation and improved physical outcomes compared with the control group will be tested. DISCUSSION: Results from this study will provide a basis for discussion of feasibility of this interactive video technological solution in an inpatient situation. Differences in activity levels between groups will be the primary measure of efficacy. It will also provide data on measures of upper-limb function, balance and mobility. TRIAL REGISTRATION: ACTRN12614000427673 . Prospectively registered 17 April 2014.

Stimuli-responsive cylindrical hydrogels mimic intestinal peristalsis to propel a solid object.

The emerging field of soft robotics relies on soft, stimuli-responsive materials to enable load transport, manipulation, and mobility in complex unconstrained environments. These materials often need to replicate biological functionality such as muscle contractions and flexibility. Here we demonstrate a soft actuator prototype based on thermosensitive PNIPAAM hydrogels that can transport and manipulate objects. A hollow cylindrical hydrogel was selectively heated and cooled with Peltier devices to yield a traveling wave of shrinking and swelling akin to intestinal peristalsis. A 4 mm diameter bead was placed inside the cylinder and propelled 19.5 mm, equal to distance traveled by the peristaltic wave. We derived conditions that enable peristaltic transport as a function of transporter-cargo design parameters. We conclude that hydrogel-based peristaltic manipulators covering 2 orders of magnitude in stiffness (1-10(2) kPa) could transport cargo spanning 4 orders of magnitude in size (µm-m).

Diagnosis and treatment of vitamin D deficiency.

The recent discovery--in a randomised, controlled trial--that daily ingestion of 1100 IU of colecalciferol (vitamin D) over a 4-year period dramatically reduced the incidence of non-skin cancers makes it difficult to overstate the potential medical, social and economic implications of treating vitamin D deficiency. Not only are such deficiencies common, probably the rule, vitamin D deficiency stands implicated in a host of diseases other than cancer. The metabolic product of vitamin D is a potent, pleiotropic, repair and maintenance, secosteroid hormone that targets > 200 human genes in a wide variety of tissues, meaning it has as many mechanisms of action as genes it targets. A common misconception is that government agencies designed present intake recommendations to prevent or treat vitamin D deficiency. They did not. Instead, they are guidelines to prevent particular metabolic bone diseases. Official recommendations were never designed and are not effective in preventing or treating vitamin D deficiency and in no way limit the freedom of the physician--or responsibility--to do so. At this time, assessing serum 25-hydroxy-vitamin D is the only way to make the diagnosis and to assure that treatment is adequate and safe. The authors believe that treatment should be sufficient to maintain levels found in humans living naturally in a sun-rich environment, that is, > 40 ng/ml, year around. Three treatment modalities exist: sunlight, artificial ultraviolet B radiation or supplementation. All treatment modalities have their potential risks and benefits. Benefits of all treatment modalities outweigh potential risks and greatly outweigh the risk of no treatment. As a prolonged 'vitamin D winter', centred on the winter solstice, occurs at many temperate latitudes, < or = 5000 IU (125 microg) of vitamin D/day may be required in obese, aged and/or dark-skinned patients to maintain adequate levels during the winter, a dose that makes many physicians uncomfortable.

Epidemic influenza and vitamin D.

In 1981, R. Edgar Hope-Simpson proposed that a 'seasonal stimulus' intimately associated with solar radiation explained the remarkable seasonality of epidemic influenza. Solar radiation triggers robust seasonal vitamin D production in the skin; vitamin D deficiency is common in the winter, and activated vitamin D, 1,25(OH)2D, a steroid hormone, has profound effects on human immunity. 1,25(OH)2D acts as an immune system modulator, preventing excessive expression of inflammatory cytokines and increasing the 'oxidative burst' potential of macrophages. Perhaps most importantly, it dramatically stimulates the expression of potent anti-microbial peptides, which exist in neutrophils, monocytes, natural killer cells, and in epithelial cells lining the respiratory tract where they play a major role in protecting the lung from infection. Volunteers inoculated with live attenuated influenza virus are more likely to develop fever and serological evidence of an immune response in the winter. Vitamin D deficiency predisposes children to respiratory infections. Ultraviolet radiation (either from artificial sources or from sunlight) reduces the incidence of viral respiratory infections, as does cod liver oil (which contains vitamin D). An interventional study showed that vitamin D reduces the incidence of respiratory infections in children. We conclude that vitamin D, or lack of it, may be Hope-Simpson's 'seasonal stimulus'.

Standards for informed consent in recovered memory therapy.

Malpractice suits against therapists for either instilling or recovering false memories of sexual abuse have increased in the last few years and some of the awards have been large. Failure to give informed consent, that is, failing to inform patients concerning the risk of recovering false memories, is one of the main allegations increasingly made against therapists in recovered memory cases. In the landmark case on informed consent, Canterbury v. Spence fashioned a standard of disclosure that focused on how material the potential warnings were to the patient's decision and specifically stated the standard would be set by the law, not by the profession. The court ruled that the "risk or cluster of risks" must be disclosed to the patient in a manner that meets the patient's "informational needs." A review of relevant literature shows that a substantial body of information existed by the early 1990s that warned psychotherapists about the risk of false reports of sexual and physical abuse. This article concludes that the "risk or cluster of risks" that must be disclosed to a patient recovering repressed memories in psychotherapy should have included warnings about recovering false memories.

Delayed traumatic recall in adults: a synthesis with legal, clinical, and forensic recommendations.

Despite considerable consensus on what is known and unknown about delayed traumatic recall in adults, this topic remains one of the most polarized issues within both forensic psychiatry and society as a whole. Competing priorities of values contribute to this polarization. So do often subtle confusions of categories: experiential with substantive realities; clinical with legal priorities and criteria; distinctions between explicit and implicit with declarative and procedural memory; conditioned avoidance with declarative knowledge; and prediction of traumatic sequelae from known traumatic events with postdiction of possible traumatic events from symptoms that may imply prior traumatization. Memories are rendered more vulnerable to falsification through social influence and intrinsic suggestibility-- and probably more so when suggestive input bypasses conscious scrutiny. Legal, clinical, and forensic guidelines are proposed to sort out these complexities, balance conflicting professional duties and priorities, balance protection of children with defending legitimate social structures such as the family, and better use our growing knowledge about the vicissitudes of human memory.

Fundamentals of stability testing.

Synopsis The principles on which stability tests are based are reviewed. The need to differentiate between product stability and product-container compatibility is emphasized. Recognition of this distinction is fundamental to the efficient organisation and execution of stability tests. Attention is also drawn to the desirability of having for every product a release specification with which it must comply when manufactured and a broader check specification with which it must comply throughout its shelf-life. Test methods and the interpretation of the data accrued throughout a test are also discussed. It is concluded that stability tests should not be conducted in accordance with a standardized routine pattern but that the objectives of each test should be defined and the test designed to achieve those objectives in the most efficient way.

The use of antimicrobials in the mouth.

The use of antimicrobials in the mouth, particularly in the form of antiseptic mouth-washes, is widely practised. The purposes for which such treatment is used are very diverse and reports are widely scattered throughout the literature. It is the purpose of this review to bring together diverse literature references and to present a short but comprehensive survey of the subject.

The effects of prolonged consumption of wholemeal bread upon metabolism of calcium, magnesium, zinc and phosphorus of two young American adults.

The ability to adapt to a large daily intake of unleavened bread made from wheaten wholemeals of high extraction rate was examined in two young Americans who had not previously consumed fiber, phytate-, and phosphate-rich bread of this type. Adaptation was evaluated by comparing balances of zinc, calcium, magnesium, and phosphorus for a 12 day period after ten days of bread consumption with those during a similar period after 50 days and also by observing changes in blood composition during this period of bread consumption. Significantly negative balances of zinc, magnesium and phosphorus were observed in the initial period. However, all had become positive or nearly so after 50 days. By contrast, calcium balances which were also negative during the initial period remained negative at the end of the study. Plasma calcium and zinc concentrations had declined to low normal or subnormal values at this time. The failure to overcome the disturbing effects of consumption of wholemeal bread upon calcium metabolism occurred despite daily exposure to sunshine for many hours under conditions favorable for Vitamin D biosynthesis.