Outcomes of non-operative management of penetrating abdominal trauma.

BACKGROUND: Selective non-operative management (SNOM) of penetrating abdominal trauma (PAT) is routinely practised in our trauma centre. This study aims to report the outcomes of patients who have failed SNOM. METHODS: Patients presenting with PAT from 1 May 2015 - 31 January 2018 were reviewed. They were categorised into immediate laparotomy and delayed operative management (DOM) groups. Outcomes compared were postoperative complications, length of hospital stay and mortality. RESULTS: A total of 944 patients with PAT were reviewed. After excluding 100 patients undergoing damage control surgery, 402 (47.6%) and 542 (52.4%) were managed non-operatively and operatively, respectively. In the SNOM cohort, 359 (89.3%) were managed successfully without laparotomy. Thirty-seven (86.0%) patients in the DOM group had a therapeutic laparotomy, and six (14.0%) had an unnecessary laparotomy. Nine (20.9%) patients in the DOM group developed complications. The DOM group had lesser complications. However, the two groups had no difference in hospital length of stay (LOS). There was no mortality in the non-operative management (NOM) group. CONCLUSION: In this study, we demonstrated no mortality and less morbidity in the DOM group when appropriately selected compared to the immediate laparotomy group. This supports the selective NOM approach for PAT in high volume trauma centres.

Open-source navigation system for tracking dissociated parts with multi-registration.

PURPOSE: During reconstructive surgery, knee and hip replacements, and orthognathic surgery, small misalignments in the pose of prosthesis and bones can lead to severe complications. Hence, the translational and angular accuracies are critical. However, traditional image-based surgical navigation lacks orientation data between structures, and imageless systems are unsuitable for cases of deformed anatomy. We introduce an open-source navigation system using a multiple registration approach that can track instruments, implants, and bones to precisely guide the surgeon in emulating a preoperative plan. METHODS: We derived the analytical error of our method and designed a set of phantom experiments to measure its precision and accuracy. Additionally, we trained two classification models to predict the system reliability from fiducial points and surface matching registration data. Finally, to demonstrate the procedure feasibility, we conducted a complete workflow for a real clinical case of a patient with fibrous dysplasia and anatomical misalignment of the right femur using plastic bones. RESULTS: The system is able to track the dissociated fragments of the clinical case and average alignment errors in the anatomical phantoms of [Formula: see text]  mm and [Formula: see text]. While the fiducial-points registration showed satisfactory results given enough points and covered volume, we acknowledge that the surface refinement step is mandatory when attempting surface matching registrations. CONCLUSION: We believe that our device could bring significant advantages for the personalized treatment of complex surgical cases and that its multi-registration attribute is convenient for intraoperative registration loosening cases.

Multicenter validation of Early Warning Scores for detection of clinical deterioration in COVID-19 hospitalized patients / Validación multicéntrica de Sistemas de Alerta Temprana para la detección precoz de deterioro clínico en pacientes hospitalizados por COVID-19

Objective Investigate the predictive value of NEWS2, NEWS-C, and COVID-19 Severity Index for predicting intensive care unit (ICU) transfer in the next 24h. Design Retrospective multicenter study. Setting Two third-level hospitals in Argentina. Patients All adult patients with confirmed COVID-19, admitted on general wards, excluding patients with non-intubated orders. Interventions Patients were divided between those who were admitted to ICU and non-admitted. We calculated the three scores for each day of hospitalization. Variables We evaluate the calibration and discrimination of the three scores for the outcome ICU admission within 24, 48h, and at hospital admission. Result We evaluate 13,768 days of hospitalizations on general medical wards of 1318 patients. Among these, 126 (9.5%) were transferred to ICU. The AUROC of NEWS2 was 0.73 (95%CI 0.68–0.78) 24h before ICU admission, and 0.52 (95%CI 0.47–0.57) at hospital admission. The AUROC of NEWS-C was 0.73 (95%CI 0.68–0.78) and 0.52 (95%CI 0.47–0.57) respectively, and the AUROC of COVID-19 Severity Index was 0.80 (95%CI 0.77–0.84) and 0.61 (95%CI 0.58–0.66) respectively. COVID-19 Severity Index presented better calibration than NEWS2 and NEWS-C. Conclusion COVID-19 Severity index has better calibration and discrimination than NEWS2 and NEWS-C to predict ICU transfer during hospitalization (AU)

Objetivo Investigar el valor predictivo de los scores NEWS2, NEWS-C y COVID-19 Severity Index para predecir la transferencia de urgencia a la unidad de cuidados intensivos (UCI) en las próximas 24horas. Diseño Estudio multicéntrico retrospectivo. Ámbito Dos hospitales de tercer nivel en Argentina. Pacientes Pacientes adultos con COVID-19, ingresados en salas generales, excluyendo pacientes con órdenes de no intubar. Intervenciones Se dividió a los pacientes entre los que ingresaron en la UCI y los que no ingresaron. Calculamos las tres puntuaciones para cada día de hospitalización. Variables Evaluamos la calibración y discriminación de las tres puntuaciones para predecir el traslado de urgencia a UCI en las 24, 48h previas al pase a UCI y al ingreso hospitalario. Resultados Evaluamos 13.768 días de hospitalización en internación general de 1.318 pacientes, de los cuales 126 (9,5%) fueron trasladados a UCI. El AUROC del NEWS2 fue de 0,73 (IC 95% 0,68-0,78) 24h antes del ingreso en UCI y de 0,52 (IC 95% 0,47-0,57) al ingreso hospitalario. El AUROC de NEWS-C fue de 0,73 (IC 95% 0,68-0,78) y 0,52 (IC 95% 0,47-0,57) respectivamente, y el AUROC del COVID-19 Severity Index fue de 0,80 (IC 95% 0,77-0,84) y 0,61 (IC 95% 0,58-0,66) respectivamente. El COVID-19 Severity Index presentó una mejor calibración que NEWS2 y NEWS-C. Conclusión El COVID-19 Severity Index presentó una mejor calibración y discriminación que NEWS2 y NEWS-C para predecir la transferencia de la UCI durante la hospitalización (AU)

Multicenter validation of Early Warning Scores for detection of clinical deterioration in COVID-19 hospitalized patients.

Objective: Investigate the predictive value of NEWS2, NEWS-C, and COVID-19 Severity Index for predicting intensive care unit (ICU) transfer in the next 24 h. Design: Retrospective multicenter study. Setting: Two third-level hospitals in Argentina. Patients: All adult patients with confirmed COVID-19, admitted on general wards, excluding patients with non-intubated orders. Interventions: Patients were divided between those who were admitted to ICU and non-admitted. We calculated the three scores for each day of hospitalization. Variables: We evaluate the calibration and discrimination of the three scores for the outcome ICU admission within 24, 48 h, and at hospital admission. Results: We evaluate 13,768 days of hospitalizations on general medical wards of 1318 patients. Among these, 126 (9.5%) were transferred to ICU. The AUROC of NEWS2 was 0.73 (95%CI 0.68-0.78) 24 h before ICU admission, and 0.52 (95%CI 0.47-0.57) at hospital admission. The AUROC of NEWS-C was 0.73 (95%CI 0.68-0.78) and 0.52 (95%CI 0.47-0.57) respectively, and the AUROC of COVID-19 Severity Index was 0.80 (95%CI 0.77-0.84) and 0.61 (95%CI 0.58-0.66) respectively. COVID-19 Severity Index presented better calibration than NEWS2 and NEWS-C. Conclusion: COVID-19 Severity index has better calibration and discrimination than NEWS2 and NEWS-C to predict ICU transfer during hospitalization.

Objetivo: Investigar el valor predictivo de los scores NEWS2, NEWS-C y COVID-19 Severity Index para predecir la transferencia de urgencia a la unidad de cuidados intensivos (UCI) en las próximas 24 horas. Diseño: Estudio multicéntrico retrospectivo. Ámbito: Dos hospitales de tercer nivel en Argentina. Pacientes: Pacientes adultos con COVID-19, ingresados en salas generales, excluyendo pacientes con órdenes de no intubar. Intervenciones: Se dividió a los pacientes entre los que ingresaron en la UCI y los que no ingresaron. Calculamos las tres puntuaciones para cada día de hospitalización. Variables: Evaluamos la calibración y discriminación de las tres puntuaciones para predecir el traslado de urgencia a UCI en las 24, 48 h previas al pase a UCI y al ingreso hospitalario. Resultados: Evaluamos 13.768 días de hospitalización en internación general de 1.318 pacientes, de los cuales 126 (9,5%) fueron trasladados a UCI. El AUROC del NEWS2 fue de 0,73 (IC 95% 0,68-0,78) 24 h antes del ingreso en UCI y de 0,52 (IC 95% 0,47-0,57) al ingreso hospitalario. El AUROC de NEWS-C fue de 0,73 (IC 95% 0,68-0,78) y 0,52 (IC 95% 0,47-0,57) respectivamente, y el AUROC del COVID-19 Severity Index fue de 0,80 (IC 95% 0,77-0,84) y 0,61 (IC 95% 0,58-0,66) respectivamente. El COVID-19 Severity Index presentó una mejor calibración que NEWS2 y NEWS-C. Conclusión: El COVID-19 Severity Index presentó una mejor calibración y discriminación que NEWS2 y NEWS-C para predecir la transferencia de la UCI durante la hospitalización.

Multicenter validation of Early Warning Scores for detection of clinical deterioration in COVID-19 hospitalized patients.

OBJECTIVE: Investigate the predictive value of NEWS2, NEWS-C, and COVID-19 Severity Index for predicting intensive care unit (ICU) transfer in the next 24h. DESIGN: Retrospective multicenter study. SETTING: Two third-level hospitals in Argentina. PATIENTS: All adult patients with confirmed COVID-19, admitted on general wards, excluding patients with non-intubated orders. INTERVENTIONS: Patients were divided between those who were admitted to ICU and non-admitted. We calculated the three scores for each day of hospitalization. VARIABLES: We evaluate the calibration and discrimination of the three scores for the outcome ICU admission within 24, 48h, and at hospital admission. RESULTS: We evaluate 13,768 days of hospitalizations on general medical wards of 1318 patients. Among these, 126 (9.5%) were transferred to ICU. The AUROC of NEWS2 was 0.73 (95%CI 0.68-0.78) 24h before ICU admission, and 0.52 (95%CI 0.47-0.57) at hospital admission. The AUROC of NEWS-C was 0.73 (95%CI 0.68-0.78) and 0.52 (95%CI 0.47-0.57) respectively, and the AUROC of COVID-19 Severity Index was 0.80 (95%CI 0.77-0.84) and 0.61 (95%CI 0.58-0.66) respectively. COVID-19 Severity Index presented better calibration than NEWS2 and NEWS-C. CONCLUSION: COVID-19 Severity index has better calibration and discrimination than NEWS2 and NEWS-C to predict ICU transfer during hospitalization.

Obtaining accurate and calibrated coil models for transcranial magnetic stimulation using magnetic field measurements.

Currently, simulations of the induced currents in the brain produced by transcranial magnetic stimulation (TMS) are used to elucidate the regions reached by stimuli. However, models commonly found in the literature are too general and neglect imperfections in the windings. Aiming to predict the stimulation sites in patients requires precise modeling of the electric field (E-field), and a proper calibration to adequate to the empirical data of the particular coil employed. Furthermore, most fabricators do not provide precise information about the coil geometries, and even using X-ray images may lead to subjective interpretations. We measured the three components of the vector magnetic field induced by a TMS figure-8 coil with spatial resolutions of up to 1 mm. Starting from a computerized tomography-based coil model, we applied a multivariate optimization algorithm to automatically modify the original model and obtain one that optimally fits the measurements. Differences between models were assessed in a human brain mesh using the finite-elements method showing up to 6% variations in the E-field magnitude. Our calibrated model could increase the precision of the estimated E-field induced in the brain during TMS, enhance the accuracy of delivered stimulation during functional brain mapping, and improve dosimetry for repetitive TMS. Graphical Abstract Geometrical model of TMS coil based on TAC images is optimally deformed to match magnetic field measurements. The calibrated model's induced electric field in the brain differs from the original.

Failure rates and functional results for intercalary femur reconstructions after tumour resection.

PURPOSE: To compare the results for patients treated with intercalary endoprosthetic replacement (EPR) or intercalary allograft reconstruction for diaphyseal tumours of the femur in terms of: (1) reconstruction failure rates; (2) cause of failure; (3) risk of amputation of the limb; and (4) functional result. METHODS: Patients with bone sarcomas of the femoral diaphysis, treated with en bloc resection and reconstructed with an intercalary EPR or allograft, were reviewed. A total of 107 patients were included in the study (36 EPR and 71 intercalary allograft reconstruction). No differences were found between the two groups in terms of follow-up, age, gender and the use of adjuvant chemotherapy. RESULTS: The probability of failure for intercalary EPR was 36% at 5 years and 22% for allograft at 5 years (p = 0.26). Mechanical failures were the most prevalent in both types of reconstruction. Aseptic loosening and implant fracture are the main cause in the EPR group. For intercalary allograft reconstructions, fracture followed by nonunion was the most common complication. Ten-year risk of amputation after failure for both reconstructions was 3%. There were no differences between the groups in terms of the mean Musculoskeletal Tumor Society score (27.4, range 16-30 vs. 27.6, range 17-30). CONCLUSIONS: We have demonstrated similar failure rates for both reconstructions. In both techniques, mechanical failure was the most common complication with a low rate of limb amputation and good functional results. LEVEL OF EVIDENCE: Level III, therapeutic study.

In Vitro Comparative Study Between Conventional and Computer-Assisted Surgery Methods for Planning and Resection of Bone Sarcomas.

This poster aims to achieve an "in vitro" comparative study between three methods: 2D digital images planning and execution without navigation (freehand with ruler and caliper), 3D planning and execution without navigation (freehand with ruler and caliper) and 3D planning and execution guided with navigation. 3D planning and navigated procedures potentially improve sarcoma resection.

Rate of Gleason 7 or higher prostate cancer on repeat biopsy after a diagnosis of atypical small acinar proliferation.

BACKGROUND: Limited information is known about the clinical significance of cancers diagnosed upon repeat biopsy for the indication of atypical small acinar proliferation (ASAP). With increasing concern regarding overdiagnosis and overtreatment of prostate cancer, and the reported rise in infectious complications related to prostate biopsy, we examined the outcomes of patients rebiopsied for a diagnosis of ASAP. METHODS: Clinical, pathologic and outcomes data of patients diagnosed with ASAP on prostate biopsy at our institutions between 2000 and 2010 were abstracted through chart review. Statistical analyses included Fisher's exact and the two-sample Wilcoxon rank sum tests. Logistic regression evaluated risk factors for the probability of cancer following a diagnosis of ASAP. RESULTS: A total of 349 patients met the inclusion criteria with median follow-up of 4.4 years. Median age was 65.3 years with a median PSA of 5.3 ng ml(-1). Of men diagnosed with ASAP, 250/349 (71.6%) had a repeat biopsy within 1 year with 94/246 (38.2%) demonstrating prostate cancer; only 26/245 (10.6%) had ⩾Gleason 7 disease. Of men diagnosed with ASAP, 284/349 (81.4%) underwent biopsy at some time during follow-up. Prostate cancer was diagnosed in 132/279 (47.3%) of these men, 48/278 (17.3%) with ⩾Gleason 7 disease. Multivariate analyses suggested that older age, no previous biopsy and PSA density were predictive of cancer on repeat biopsy within 1 year from ASAP. Univariate analysis revealed PSA density was associated with the presence of ⩾Gleason 7 disease at 1 year and any time after a diagnosis of ASAP. CONCLUSIONS: The overall rate of intermediate- and high-grade prostate cancer found on repeat biopsy for ASAP is low. Further investigation into ways to further risk stratify these men may be warranted. However, until such tests become available, repeat biopsy of men diagnosed with ASAP remains prudent.

Developing multimetric indices for monitoring ecological restoration progress in salt marshes.

Effective tools for monitoring the status of ecological restoration projects are critical for the management of restoration programs. Such tools must integrate disparate data comprised of multiple variables that describe restoration status, including the condition of environmental stressors, landscape connectivity, ecosystem resilience, and ecological structure and function, while communicating these concepts effectively to a wide range of stakeholders. In this paper we describe the process of constructing multimetric indices (MMIs) for monitoring restoration status for restoration projects currently underway on the eastern coast of Saudi Arabia. During this process, an initial suite of measurements is filtered for response and sensitivity to ecosystem stressors, eliminating measurements that provide little information and reducing future monitoring efforts. The retained measurements are rescaled into comparable domain metrics and assembled into MMIs. The MMIs are presented in terms of established restoration theories, including restoration trajectory and restoration endpoint targets.

Programa de rehabilitación en artrosis avanzada de rodilla / Program of rehabilitation in advanced degenerative osteoarthritis of knee

La Osteoartritis (OA) es una causa mayor de morbilidad, discapacidad y pérdida de la función en la población general. Una variedad de programas para OA de rodilla han sido descriptos en la literatura. Objetivo: Determinar si los efectos de un programa integral de ejercicios solo o combinado con Tens mejora el dolor, la función y la calidad de vida en mujeres con OA de rodilla avanzada. Métodos: Un ensayo clínico randomizado y controlado de 126 mujeres adultas con OA de rodilla fue conducido. Los participantes fueron estratificados según la severidad del dolor y la severidad de la enfermedad, grado 3 o más de la clasificación de Kellgren & Lawrence. Los pacientes fueron randomizados en cuatro grupos: actividad física (AF) (n = 34), Tens (n = 36), AF y Tens (n = 35) y control (n = 21); todos fueron estudiados durante 8 semanas. La función física fue medida por KOOS (Knee Injury and Osteoarthritis Outcome Score). La calidad de vida fue valorada por el cuestionario de salud general SF-36 (Short Form-36). Los pacientes fueron examinados a nivel basal y después de 8 semanas. Resultados: La edad media fue de 68 (9) años, peso 72 (11) kg, e IMC 30 (7) kg/m2. Las diferencias no fueron significativas antes y después del tratamiento en los datos demográficos. Los pacientes tratados con AF tuvieron diferencias significativas en todas las subescalas del KOOS, y ambas SF-36 y WOMAC (p <0,001). Los pacientes tratados con AF y Tens, mostraron diferencias significativas en todos los índices del KOOS, WOMAC y SF-36 (p <0,001). Los análisis del tamaño delefecto mostraron un marcado incremento en el grupo combinado, pre y post-tratamiento Koos (1,81), comparado con el grupo control (0). Conclusión: Un programa de ejercicios de corta duración y fácil aplicación, combinado con Tens, sugiere ser la mejor opción en pacientes con OA de rodilla avanzada.

Osteoarthritis (OA) is a major source of morbidity, disability and loss of function in general population. A variety of programs for knee OA have been described in the literature. Objective: To determine whether the effects of an integral exercise program alone or in combination with tens improves pain, physical function and quality of life in patients advanced Knee OA. Methods: A randomized controlled trial of 126 women older adults, mean age 68 years, with Knee OA was conducted. Participants were stratified by severity of knee pain and disease severity grade 3 or more, according to Kellgren & Lawrence criteria. The subjets were randomized to 4 groups: exercise group (n = 34), tens group (n = 36), combined group (exercise and tens) (n = 35), and control group (n = 21); all of them were studied during 8 weeks. Physical function was measured by KOOS (Knee injury and Osteoarthritis Outcome Score). The quality of life was assessed by the Short Form-36 (SF-36) questionnaire. The patients were examined at baseline and after 8 weeks. Results: Mean age was 68 (9) years, weigth 72 (11) kg, and BMI 30 (7) kg/m2; non significant differences were before and after treatment in demographic data. Patients treated with exercise had significant differences in all KOOS subscales, and both WOMAC and SF-36 (p <0.001). In the other hand, patients treated with exercise and tens, showed significant differences in all KOOS index, and both WOMAC and SF-36 (p <0.001). Size effect analysis showed a marked improvement in the combined group, pre and post treatment KOOS (1.81), compared to control group (0). Conclusion: Short duration and easy application of an exercise program, combined with Tens, suggest to be the best option in patients with advanced knee OA.

Programa de rehabilitación en artrosis avanzada de rodilla / Program of rehabilitation in advanced degenerative osteoarthritis of knee

La Osteoartritis (OA) es una causa mayor de morbilidad, discapacidad y pérdida de la función en la población general. Una variedad de programas para OA de rodilla han sido descriptos en la literatura. Objetivo: Determinar si los efectos de un programa integral de ejercicios solo o combinado con Tens mejora el dolor, la función y la calidad de vida en mujeres con OA de rodilla avanzada. Métodos: Un ensayo clínico randomizado y controlado de 126 mujeres adultas con OA de rodilla fue conducido. Los participantes fueron estratificados según la severidad del dolor y la severidad de la enfermedad, grado 3 o más de la clasificación de Kellgren & Lawrence. Los pacientes fueron randomizados en cuatro grupos: actividad física (AF) (n = 34), Tens (n = 36), AF y Tens (n = 35) y control (n = 21); todos fueron estudiados durante 8 semanas. La función física fue medida por KOOS (Knee Injury and Osteoarthritis Outcome Score). La calidad de vida fue valorada por el cuestionario de salud general SF-36 (Short Form-36). Los pacientes fueron examinados a nivel basal y después de 8 semanas. Resultados: La edad media fue de 68 (9) años, peso 72 (11) kg, e IMC 30 (7) kg/m2. Las diferencias no fueron significativas antes y después del tratamiento en los datos demográficos. Los pacientes tratados con AF tuvieron diferencias significativas en todas las subescalas del KOOS, y ambas SF-36 y WOMAC (p <0,001). Los pacientes tratados con AF y Tens, mostraron diferencias significativas en todos los índices del KOOS, WOMAC y SF-36 (p <0,001). Los análisis del tamaño delefecto mostraron un marcado incremento en el grupo combinado, pre y post-tratamiento Koos (1,81), comparado con el grupo control (0). Conclusión: Un programa de ejercicios de corta duración y fácil aplicación, combinado con Tens, sugiere ser la mejor opción en pacientes con OA de rodilla avanzada.

Osteoarthritis (OA) is a major source of morbidity, disability and loss of function in general population. A variety of programs for knee OA have been described in the literature. Objective: To determine whether the effects of an integral exercise program alone or in combination with tens improves pain, physical function and quality of life in patients advanced Knee OA. Methods: A randomized controlled trial of 126 women older adults, mean age 68 years, with Knee OA was conducted. Participants were stratified by severity of knee pain and disease severity grade 3 or more, according to Kellgren & Lawrence criteria. The subjets were randomized to 4 groups: exercise group (n = 34), tens group (n = 36), combined group (exercise and tens) (n = 35), and control group (n = 21); all of them were studied during 8 weeks. Physical function was measured by KOOS (Knee injury and Osteoarthritis Outcome Score). The quality of life was assessed by the Short Form-36 (SF-36) questionnaire. The patients were examined at baseline and after 8 weeks. Results: Mean age was 68 (9) years, weigth 72 (11) kg, and BMI 30 (7) kg/m2; non significant differences were before and after treatment in demographic data. Patients treated with exercise had significant differences in all KOOS subscales, and both WOMAC and SF-36 (p <0.001). In the other hand, patients treated with exercise and tens, showed significant differences in all KOOS index, and both WOMAC and SF-36 (p <0.001). Size effect analysis showed a marked improvement in the combined group, pre and post treatment KOOS (1.81), compared to control group (0). Conclusion: Short duration and easy application of an exercise program, combined with Tens, suggest to be the best option in patients with advanced knee OA.(AU)

Dynamics of cryopreserved human carotid arteries.

The viscoelastic properties of the arterial wall are responsible for their functional role in the arterial system. Cryopreservation is widely used to preserve blood vessels for vascular reconstruction but is controversially suspected to affect the dynamic behaviour of these allografts. The aim of this study was to determine whether differences in the dynamic behaviour exist or not between fresh and cryopreserved human common carotid arteries (CCA). Using a previously developed mock circulation system, dynamic pressure-diameter tests were performed on segments of human fresh (n=10) and cryopreserved arteries (n=7). A diameter-pressure transfer function was designed to evaluate the wall dynamics. An adaptive model was fit to obtain its frequency response. Three models were tested. Results show that non-significant differences exist between wall dynamics of fresh and cryopreserved segments of human CCA.

Heart rate variability measurement in diabetic neuropathy: review of methods.

Heart rate variability (HRV) is an important tool to analyze the autonomic function. It therefore has a special interest for early detection and ensuing treatment of autonomic neuropathy in diabetic patients. The aim of this work is to present a brief historical review of HRV, as well as a technical review of the most common methods to measure it. In this work is presented a system that performs three measurements of HRV. An overview of methodologies developed to quantify HRV is presented; this technical review covers the most common time and frequency domain techniques, for short and long periods of time, with comments about clinical utility of these tests. A system performing three standard tests of HRV, Anscore Health Management System, is presented. This system performs metronomic breathing (MT), the Valsalva Test (VT), and the Stand Test (ST). A normal range study with 212 healthy subjects in three centers (ages 20-80 years, with even age distribution, and even male and female distribution) was conducted. A subset of 45 subjects from the total number of subjects was selected for the reproducibility study, consisting of three measurements of each test. The normal range study showed a decrease in all the ratios with age and, for the Valsalva test, a difference among genders; 5th percentiles were calculated. The reproducibility study results, expressed as mean CV%, were 4.30% for the MT, 6.26% for the VT, and 6.66% for the ST. HRV is the most reliable measurement of autonomic function; when controlled maneuvers like MT, VT, and ST are performed, high reproducibility is obtained, with results comparable to that observed for nerve conduction studies. Such reproducibility makes autonomic function testing more feasible as a test component in multicenter studies of different neurological disorders.

Building quality practice settings: an attributes model.

To practice effectively nurses need an environment that supports quality professional practice. This article describes the development of a model identifying seven (7) key system attributes of a quality practice setting. The defined attributes are essential in supporting professional practice and quality care. The Quality Practice Setting Attributes Model developed by the College of Nurses of Ontario in Canada provides the foundational framework for the Practice Setting Consultation Program (PSCP), a unique quality improvement approach to creating quality practice environments.

Airborne lead and particulate levels in Semarang, Indonesia and potential health impacts.

Spatial and temporal variation in airborne lead and total suspended particulates was examined in the city of Semarang, Indonesia, and surrounding area. Both airborne lead and TSP varied significantly with the type of urban development. Mean urban airborne lead levels were 0.35 microgram/m3 in the highway zone, 0.95 microgram/m3 in the residential zone, and 0.99 microgram/m3 in the commercial zone. Airborne lead levels in the industrial zone were significantly higher than all other areas, with a mean of 8.41 micrograms/m3. Airborne lead concentrations of this magnitude have not been reported in Indonesia previously. Mean TSP levels ranged from 115.5 micrograms/m3 to 165.8 micrograms/m3 in urban areas. Increased levels of TSP were associated with areas adjacent to major transportation routes. On a seasonal basis, TSP levels were significantly lower during the rainy season, while mean airborne lead levels did not show a significant seasonal trend. Observed ambient pollution levels were translated into potential heath impacts based on previously established relationships. Increased levels of TSP pollution near major roads was estimated to result in a 1.6% increase in mortality for all causes of death and a 7.9% increase in mortality due to respiratory disease. Estimated child blood lead levels indicated possible lead toxicity among Semarang children.

Dynamic abdominal and thoracic aortomyoplasty in heart failure: assessment of counterpulsation.

BACKGROUND: Aortic counterpulsation, either biologic or mechanical, is a useful technique to support circulation during left ventricular dysfunction. METHODS: In this study we used an induced cardiac failure model in acute open chest sheep to compare hemodynamic improvements between thoracic and abdominal aortic counterpulsation. This was achieved with left latissimus dorsi and left hemidiaphragm muscle flaps. RESULTS: Thoracic and abdominal aortic counterpulsation in heart failure resulted in a significant improvement of hemodynamic parameters. Subendocardial viability index, defined as diastolic pressure-time index to systolic tension-time index, in thoracic and abdominal aortomyoplasty showed significant improvement (p<0.05) when cardiac assistance was performed by electrical stimulation of each muscle flap. A new counterpulsation index derived from diastolic and systolic areas beneath the aortic pressure curve was tested, obtaining a correlation coefficient with the subendocardial viability index of 0.758 (p<0.001). Values of subendocardial viability index and counterpulsation index showed minimal variability. CONCLUSIONS: Treatment of experimentally induced cardiac failure with dynamic abdominal aortic counterpulsation allows an effective hemodynamic improvement in open chest sheep. Furthermore, this diastolic arterial pressure augmentation could be evaluated through a new counterpulsation index derived from diastolic and systolic areas beneath the aortic pressure curve.

Establishment and characterization of a simian virus 40-transformed temperature-sensitive rat luteal cell line.

The primary culture of rat luteal cells and their long-term maintenance have been difficult. Low cellular yields have limited the possibility for the study of gene regulation in luteal cells. The goal of this study was to develop a cell line to serve as a model by which to study the expression and regulation of various genes specific to luteal cells. We attempted to develop a luteal cell line by transformation of large luteal cells through infection with a temperature-sensitive simian virus (SV-40 tsA209) mutant that has a temperature-sensitive mutation required for the maintenance of cell transformation. We report here the successful establishment of such a cell line, designated GG-CL cells. Large luteal cells were purified to homogeneity by flow cytometry from corpora lutea of day 14 pregnant rats, cultured for 24 h, and then infected with the SV-40 tsA209 mutant virus. Transformed cells were maintained at the permissive temperature (33 C) until colonies were identified. Several colonies of transformed cells were isolated and passaged. They multiplied at 33 C and formed multilayers. At the nonpermissive temperature (40 C), cells reverted to the normal differentiated phenotype similar to the primary luteal cells in culture. To determine whether GG-CL cells express the genes found in normal luteal cells, messenger RNA (mRNA) expression was examined by either Northern analysis or RT-PCR with primers specific to each mRNA. GG-CL cells were found to express receptors for interleukin-6 and glucocorticoid, as well as the newly discovered estrogen receptor-beta (ER-beta) and the orphan nuclear receptor nur 77. No receptors for ER-alpha, progesterone, LH, or PRL could be detected. This cell line also expressed 20alpha-hydroxysteroid dehydrogenase (20alpha-HSD), but not cholesterol side-chain cleavage cytochrome P450 (P450scc), 3beta-hydroxysteroid dehydrogenase, or aromatase cytochrome P450 (P450arom). Although the cells did not express the PRL receptor, they did express Janus kinase (JAK2) and signal transducers and activators of transcription (Stat5b), and, when transfected with the PRL receptor, they responded to PRL with a marked inhibition in 20alpha-HSD mRNA expression. In addition, estradiol enhanced ER-beta expression in a dose-dependent manner whereas cAMP stimulation caused a marked and rapid increase in the expression of the orphan receptor nur 77. In summary, a temperature-sensitive cell line was successfully established from the large luteal cells of rat corpora lutea. These cells express key genes encoding enzymes and receptors inherent to this defined luteal cell population and respond to stimulation by PRL, estradiol, and cAMP.

Glutamine study in hepatic schistosomiasis and effect of conventional medical therapy.

The liver plays a major role in urea and glutamine metabolism where it maintains ammonia and bicarbonate homeostasis under physiological and pathological conditions. Glutamine assessment in different liver diseases showed deviations from normal serum values. In the present study, glutamine level in serum [serum glutamate values] (SGV) and liver tissue homogenates (liver homogenate glutamine values] (LHGV) in patients with schistosomal hepatic fibrosis with and without conventional supportive medical therapy and anti-schistosomal therapy were correlated. LHGV in liver tissue homogenates from cases were higher than those of matched controls. SGV of patients with late hepatic schistosomiasis were greater than those with early stages of the disease. All patients, whether in early or late schistosomal hepatic fibrosis, showed reduction of SGV after treatment. We came to the conclusion that in patients with schistosomal hepatic fibrosis, whether early or late, there is a derangement of glutamine metabolism which could be corrected partially by the conventional supportive medical therapy. Again, estimation of glutamine in serum could be considered an early and reliable parameter for the assessment of liver function in patients with schistosomal hepatic fibrosis.

Non-invasive assessment of systemic elastic behaviour in hypertensive patients: analysis of possible determinants.

Knowledge about the viscoelastic behaviour of the arterial wall has been proved to have physiological importance and clinical usage. Our purpose was to study the changes of the systemic arterial wall's elastic properties non-invasively, in patients with established essential and with borderline hypertension, and to evaluate its possible determinants. Three groups of normotensive, borderline and established essential hypertensive patients were evaluated. Arterial pulse wave velocity (PWV) was measured and arterial compliance (Cm) was derived in all patients. Pulse wave velocity was obtained from the pressure values of digitized carotid and radial arteries. Arterial compliance (Cm = dD/dP with P pressure and D diameter) was calculated using a formula derived from the Bramwell and Hill equation: Cm = (1,334 x D)/(2 rho x PWV2), where for D humeral diameter was used as measured by high resolution echograph, and rho is the blood density (rho = 1.06). Pulse wave velocity was significantly higher in established essential hypertensive patients with respect to normotensive patients (p < 0.05). Arterial compliance was significantly diminished in established and in borderline hypertensive patients with respect to normotensive patients (p < 0.05), which implies early alterations in hypertensive cardiovascular disease. Multiple regression analysis of the cofactors showed that age and diastolic pressure are independent determinants of Cm. Impairment of the arterial wall's intrinsic elastic properties was demonstrated in established essential hypertension, independent of age and diastolic pressure.