Long axial field of view PET/CT in critically ill patients: lessons from a case report.

The introduction of new long axial field of view (LAFOV) scanners is a major milestone in positron emission tomography/computed tomography (PET/CT) imaging. With these new systems a revolutionary reduction in scan time can be achieved, concurrently lowering tracer dose. Therefore, PET/CT has come within reach for groups of patients in whom PET/CT previously was undesirable. In this case report we discuss the procedure of a continuous bed motion (CBM) total-body [18F]FDG PET/CT scan in an intensive care patient. We emphasize the clinical and technical possibilities with this new camera system, a matched clinical protocol, and the added value of a dedicated team.

What is a Quantum Shock Wave?

Shock waves are examples of the far-from-equilibrium behavior of matter; they are ubiquitous in nature, yet the underlying microscopic mechanisms behind their formation are not well understood. Here, we study the dynamics of dispersive quantum shock waves in a one-dimensional Bose gas, and show that the oscillatory train forming from a local density bump expanding into a uniform background is a result of quantum mechanical self-interference. The amplitude of oscillations, i.e., the interference contrast, decreases with the increase of both the temperature of the gas and the interaction strength due to the reduced phase coherence length. Furthermore, we show that vacuum and thermal fluctuations can significantly wash out the interference contrast, seen in the mean-field approaches, due to shot-to-shot fluctuations in the position of interference fringes around the mean.

Evolving injury profiles amid advancing sport: Musculoskeletal injuries in ringball players.

Background: Ringball, a sport historically derived from conventional basketball and netball, demonstrates the evolution of traditional sport. The variations between these sports may predispose players to different risk factors and consequent injuries and their impact, yet they are usually considered comparably. Objective: To determine the prevalence of musculoskeletal injuries and to profile injuries based on location, severity, and mechanisms of occurrence. A further objective was to compare the injuries sustained in ringball with that of basketball and netball. Methods: A questionnaire-based study, administered to 110 ringball players in KwaZulu-Natal, South Africa, was applied. Data were described and compared using frequencies/percentages for categorical variables. Results: Seventy-six ringball players completed the questionnaire (69% response rate). The prevalence of at least one injury during/after the last or current season was 80% (n=61). The most commonly reported injury was to the foot/ankle (36%; n=33) followed by the knee (29%; n=27) and wrist (9%; n=8). The most common mechanisms of injury reported were landing (15%; n=9), jumping (9%; n=5), goal shooting (7%; n=4), defending (7%; n=4) and collision (7%; n=4). Discussion: Ringball shares similar injuries to that of basketball/netball, with foot/ankle injuries being the most prevalent. The prevalence of other injuries in ringball differed from basketball/netball, suggesting variations between these sports as a contributor to the injuries described. Conclusion: The evolution of sport and the modifications in rules/techniques may create a nuanced injury profile to those commonly identified. The combination of a sport's uniqueness/modification and its similarities to other sports warrants the need for more tailored approaches to injury prevention and a platform for future research.

Musculoskeletal pain in South African wheelchair basketball players of different point classifications.

Background: During recent years, wheelchair basketball has gained worldwide popularity. Several studies have demonstrated a high prevalence of injuries amongst wheelchair basketball players. Few studies, however, have investigated the prevalence of musculoskeletal pain in the context of different point classifications - an integral part of wheelchair sport. Objective: The aim of this study was to determine the prevalence of musculoskeletal pain in wheelchair basketball players of different point classifications in South Africa and to provide information on patterns of pain distribution in relation to point classification. Methods: A questionnaire was completed by 48 wheelchair basketball players participating in the SuperSport League Games of South Africa with point classifications ranging from 1.0 to 4.5. The results were used to determine the patterns of musculoskeletal pain distribution in relation to the different point classifications. Results: Forty-three completed questionnaires were analysed. The prevalence of total musculoskeletal pain was 58% (n=25). Shoulder pain presented the highest overall prevalence, regardless of point classification (n=23; 92% since the start of players' wheelchair basketball careers and n=19; 76% over the last 12 months). It was found that lower point classification (1.0-2.5) players commonly experienced arm pain since the start of their wheelchair basketball careers (η=0.358), as well as specifically over the last 12 months (η=0.319), unlike higher point classification (3.0-4.5) players. Discussion: The study contextualises the prevalence of musculoskeletal pain to overall point classification in wheelchair basketball. Such data are important in the formation of injury prevention strategies, as athletes with impairments are predisposed to different types of musculoskeletal pain based on point classification.

Musculoskeletal pain among school teachers are we underestimating its impact?

Background: Musculoskeletal disorders (MSDs) are a common occupational health condition which may significantly impact both work attendance and performance. School teachers represent an occupational group among which there appears to be a high prevalence of neck and/or shoulder pain (NSP) and low back pain (LBP). Epidemiological data on NSP and LBP in South African teachers are limited.Objectives: To determine the prevalence of NSP and LBP among primary school teachers in the Central Durban area of KwaZulu-Natal, South Africa; to identify predominant occupational factors associated with NSP and LBP pain; and to highlight key actions associated with such factors so as to direct future preventive measures/interventions.Methods: A cross-sectional, questionnaire-based study was conducted on teachers from 12 randomly selected primary schools.Results: Among the 97 completed questionnaires, the prevalence of NSP and LBP was 80.4% and 68.0%, respectively. There was no association between age and NSP (p < 0.250) or LBP (p < 0.595). However, there were higher prevalence rates of NSP and LBP among the 45-54 years age group (39.2% and 33.0%, respectively). Factors associated with NSP included marking of assessments (56.7%; n = 55), and writing on a blackboard (39.2%; n = 38); prolonged standing was associated with LBP (83.5%; n = 81). These findings highlighted specific actions, such as forward-bending of the head for prolonged periods (61.9%; n = 60), backward-bending of the head for prolonged periods (20.6%; n = 20), and reaching/stretching with arms above chest height (41.2%; n = 40). Conclusion: Key occupational factors associated with MSP, and associated actions identified in this study can be used as a basis to direct strategies that can be applied to reduce the prevalence of MSP and the onset of MSD in teachers

Training requirements for the administration of intravenous contrast media by radiographers: Radiologists' perspective

Background. The administration of intravenous contrast media (IVCM) is one of the key areas currently under investigation for inclusion in the South African (SA) radiographers' scope of practice. However, for the radiographers to legally administer IVCM, training guidelines must first be identified, developed and accredited by the Health Professions Council of SA.Objective. To investigate the radiologists' perspective of the knowledge, skills and medicolegal training required of radiographers for the administration of IVCM to provide input for the development of national training guidelines. Methods. A quantitative, cross-sectional research study using an online survey, administered by SurveyMonkey, was conducted. The target population included all radiologists residing and practising in the province of KwaZulu-Natal, SA.Results. Fifty-nine participants (60.8%) completed the online survey. Twelve were excluded owing to incomplete surveys, resulting in a final response rate of 48.5% (n=47). The study revealed that various theoretical, clinical/practical and medicolegal study units should be included in the training, i.e. the study of the pharmacology of contrast media, practical training on cardiopulmonary resuscitation and basic life support, as well as the rights and responsibilities of a healthcare professional. In addition, both theory and practical/clinical assessments need to be included.Conclusion. Key data have been provided for the development of national training guidelines for radiographers to administer IVCM, based on scientific evidence that is relevant to the SA context. The study may be of value to other related health professions where scopes of practice are expanded through transforming the education and training curricula

Acute-phase concentrations of soluble fibrinogen inhibit neutrophil adhesion under flow conditions in vitro through interactions with ICAM-1 and MAC-1 (CD11b/CD18).

BACKGROUND: Immobilized fibrinogen and fibrin facilitate leukocyte adhesion, as they are potent ligands for leukocyte MAC-1 (CD11b/CD18). However, fibrinogen in its soluble form also binds to MAC-1, albeit with low affinity. The level of soluble fibrinogen is increased during chronic and acute inflammation, but the function of this increase is unknown. OBJECTIVES: To study the effect of soluble fibrinogen in concentrations found in severe acute inflammation on leukocyte adhesion. METHODS: Isolated leukocytes and soluble fibrinogen were studied in various in vitro settings under static and under flow conditions. RESULTS: Soluble fibrinogen functioned as a natural antagonist of neutrophil functions that are dependent on MAC-1, such as the respiratory burst induced by unopsonized zymosan and adhesion to ICAM-1 and heparin. In addition, soluble fibrinogen inhibited lymphocyte function-associated antigen 1-dependent lymphocyte binding to ICAM-1 through a direct interaction with ICAM-1. Soluble fibrinogen reduced MAC-1-dependent binding of interleukin-8-activated neutrophils to ICAM-1-expressing cells under flow conditions. Importantly soluble fibrinogen in acute-phase concentrations (4-10 mg mL(-1) ) dose-dependently reduced neutrophil firm adhesion to tumor necrosis factor-α-activated endothelium to 40% under flow conditions. CONCLUSIONS: We propose a model in which the increased circulating concentrations of soluble fibrinogen found during the acute-phase response can act as a natural antagonist of leukocyte recruitment, and therefore might contribute to the resolution of inflammation.

Using Lot Quality Assurance Sampling Methodology to Evaluate the uThukela District Child Survival Project of KwaZulu-Natal

Health services programmes and interventions require objective measures on coverage and quality to ensure that managers have the evidence to adopt and expand health interventions effectively and efficiently. Over the past 15 years; the uThukela District Child Survival Project of South Africa achieved this through regular two- to three-year project evaluations using cluster sampling. Results of these surveys have improved the ability of Child Survival Projects to identify priorities; define objectives based on data; and measure progress towards these objectives. However; the inability to disaggregate information to composite Supervision Areas (SAs) was a limitation. Lot quality assurance sampling (LQAS) was adopted as an improved method based on its ability to assess performance in disaggregated units within a study population and to reliably compare coverage and health status indicators for routine monitoring of child survival activities. This study assessed the feasibility and reliability of LQAS to evaluate the Child Survival Project and compare the results of a rapid manual analysis with a secondary electronic analysis of the same data. The accuracy of the manual analysis was comparable and provides evidence that LQAS and rapid manual analysis can be used to evaluate intervention programmes; particularly in settings of limited electronic technology and expertise

The systemic inflammatory response induced by trauma is reflected by multiple phenotypes of blood neutrophils.

Secondary morbidity and mortality after trauma are mainly due to a dysfunctional immune system. Severe injury can trigger a systemic inflammatory response, which is characterised by pre-activation or priming of neutrophils in peripheral blood. Signals initiated as result of local tissue damage can further activate these neutrophils leading to post-injury inflammatory complications. Additional trauma caused by surgical intervention can worsen the inflammatory response, thereby increasing the risk of these inflammatory complications. Limiting surgical procedures through damage control principles can reduce the risk of secondary morbidity. Inflammatory complications after injury cannot adequately be predicted using the current anatomical and physiological-based scoring systems. In this review we propose a methodology focussing on the activation state of the systemic inflammatory response with focus on neutrophils to aid in the risk assessment of secondary morbidity after trauma. Neutrophils are essential effector cells during the post-injury systemic inflammatory response. Neutrophils differentially express an array of surface receptors by which the cells can respond and adapt to changing environmental signals. The determination of specific expression profiles of neutrophil receptors can aid in phenotyping and quantifying the systemic inflammatory response. This article reviews the application of these specific signatures of neutrophil receptors as a consequence of severe injury.

[Retrospective application of the performance indicator 'hip fracture: operate within 24 hours' in 217 patients treated at the University Medical Centre Utrecht in 2000-2003: reduction in postoperative pneumonia but not mortality]. / De prestatie-indicator 'heupfractuur: opereren binnen 24 uur' retrospectief toegepast bij 217 patiënten in het universitair medisch centrum utrecht, 2000-2003: postoperatiefminder vaak pneumonie, maar niet minder sterfte.

OBJECTIVE: To evaluate whether patients with hip fracture who undergo surgery within 24 hours--which has been propagated as an indicator of quality care--is associated with a reduced risk of mortality and complications, compared with later surgery. DESIGN: Retrospective status study based on a prospectively designed electronic medical record. METHOD: Data were collected on patients aged > or =60 years who were admitted to the University Medical Centre Utrecht, the Netherlands, between 1 January 2000 and 31 December 2003 for hip fracture. Outcomes were compared in patients who underwent surgery within 24 hours and those who underwent surgery after more than 24 hours. The primary outcome measure was mortality (in-hospital, after 3 months, 12 year and 3 years after discharge). Secondary outcome measures were postoperative complications, postoperative duration ofhospital stay and admission to long-term care facilities. We corrected for age, gender and pre-existing comorbidity. RESULTS: A total of 217 patients were included. In the 150 patients who underwent surgery within 24 hours, the mean age was 80.5 years, 75% were female and 28% were class III or IV according to the American Society of Anesthesiologists (ASA). In the 67 patients who underwent surgery after more than 24 hours, the mean age was 80.9 years, 82% were female, and 49% were ASA class III or IV. After correcting for published risk factors, there was no relationship between the timing of surgery and mortality. Fewer patients treated within 24 hours developed pneumonia postoperatively. In this study population, the only risk factor for mortality was the preoperative condition of the patient. CONCLUSION: Postoperative pneumonia occurred less frequently in patients with hip fracture who underwent surgery within 24 hours. Postoperative mortality was related to poor patient condition but not the timing of surgery. Early surgery should be avoided in patients with severe comorbidity who are not optimally prepared for surgery.

[Diagnostic image (304). A woman with microcalcifications at mammography]. / Diagnose in beeld (304). Een vrouw met microcalcificaties op het mammogram.

A 72-year-old woman had temporary microcalcifications in the nipple area at mammography, possibly caused by skin care products.

Hands up: a case of bilateral inferior shoulder dislocation.

Inferior shoulder dislocation (luxatio erecta) is a rare form of shoulder dislocation. A case involving bilateral luxatio erecta with bilateral brachial plexus injury and rotator cuff tears is reported. A brief review of presentation and management of this condition is presented.

Injuries sustained by aircrew on ejecting from their aircraft.

This paper describes some of the injuries sustained by the aircrew who ejected from their aircraft after a mid-air collision, and discusses the types of injury that such patients may suffer.