Anatomical consequences of “open-book” pelvic ring disruption. A cadaver experimental study

“Open-book” pelvic fractures associate a diastasis and/or a fracture of the pubic rami with a posterior pelvic disruption of the sacro-iliac joint. These uni or bilateral lesions are potentially lethal mainly due to associated injuries and massive pelvic hemorrhage. The most frequently injured arteries are parietal branch of the commune, internal or external arteries because of their proximity to the bone, the sacro-iliac joint and the inferior ligaments of the pelvis. The pelvic bone dislocation and the increase of pelvic volume facilitate blood effusion. The aim of this study was to determine, on a cadaver fracture model, the direct anatomical consequences of “open-book” pelvic fracture on the ilio-lumbar pedicle and the pelvic cavity volume. Materials and methods: Bilateral open-book pelvic ring injuries were created in ten non-embalmed cadaver specimens by directly disrupting the pubic symphysis, the right and the left sacro-iliac joints. Pelvic volume was determined after total pelvic exenteration. Consequences of this fracture on vascular parietal network, nervous pelvic trunk and pelvic cavity volume were studied. Results: The mean volume of the pelvic cavity after complete visceral exenteration was 872.5 cm³ (extremes 580–756 cm³). The average increase of pelvic volume was 20.8% after 5 cm of pubic diastasis. In all cases, because of a transversal disposition of the ilio-lumbar pedicle with regard to the sacro-iliac joint, reproduction of the open-book fracture caused a venous dilaceration of the ilio-lumbar vein in 12 cases after 5 cm of pubic diastasis (12/20=60%). No arterial dilaceration was observed on the ilio-lumbar artery, but this artery was put in tension. Conclusion: Open-book fractures create an increase of pelvic volume that facilitates blood diffusion from parietal pelvic vascular network. Ilio-lumbar pedicle seems to be very vulnerable in this type of fracture because of its relations to the sacro-iliac joint and its transversal disposition with regard to this joint.     

A new rabbit model for study of lung preservation

In 1983,Cooper successfully performed the first case of right lung transplantation for a patient with end stage pulmonary fibrosis and long survival was achieved,which confirmed that lung transplantation is feasible clinically.The efficient lung transplantation has become the only hope for patients with end stage lung disease since.It′s crucial for the success of lung transplantation that the harvest and protection of the donor′s lung prior to transplantation.The preservation of donor′s lung is key for the function after lung transplantation.Apart from hypothermic approach,the perfusion procedure and the perfusion solution itself are also very important.The aim of this study was to establish an animal model,which could identify the effectiveness of preservation solution that could minimize the disturbance of the non-experimental factors so as to find the better preservation solution for lung protection.     

A detailed pathologic examination of heart tissue from three older patients with Anderson–Fabry disease on enzyme replacement therapy

BackgroundCardiac disease causes considerable morbidity and mortality in men and women with Anderson–Fabry disease (AFD), an X-linked inborn metabolic defect caused by deficiency of the lysosomal enzyme α-galactosidase A. Treatment with recombinant enzyme preparations aims to attenuate and reverse accumulation of the major enzyme substrate, globotriaosylceramide (Gb3). Pathologic data examining the effect of enzyme replacement therapy (ERT) in vivo are scant.MethodsA detailed examination of three whole hearts from patients (all male, aged 55, 59, 73 years) with AFD that had received ERT prior to death (for between 18 months and 4 years) was performed.ResultsIn spite of ERT, Gb3 accumulation was present in myocytes, within both atria and ventricles, endothelial cells, smooth muscle cells, coronary arteries, aorta, and valve tissue. Nearly all myocytes within the right and left ventricles were hypertrophied with marked vacuolization of the cytoplasm. In all three cases, there was focal myocyte apoptosis and myocyte necrosis associated with macrophage accumulation and a small T-lymphocytic infiltrate. Extensive areas of replacement fibrosis (mean, 15%) associated with areas of myocyte disarray were present in all three hearts.ConclusionsThis study highlights the pancardiac nature of AFD; demonstrates the extent of fibrotic changes; and reports, for the first time, myocyte disarray, necrosis, and apoptosis in hearts from patients affected by AFD and receiving ERT. These findings have major implications for the timing and efficacy of ERT in AFD.     

Supporting patients to self-monitor their oral anticoagulation therapy: recommendations based on a qualitative study of patients’ experiences

BackgroundClinical trials suggest that oral anticoagulation therapy (OAT) self-monitoring is safe and effective, however little is known about the patient experience of this process. There is a lack of understanding about how best to train and support patients embarking on OAT self-monitoring.AimTo collect in-depth information about patients’ experiences of OAT self-monitoring outside of clinical trial conditions and to produce a set of recommendations on how best to support such patients.MethodIn total, 26 of the 267 (9.7%) who participated in the Cohort study of Anticoagulation Self-Monitoring (CASM) and were still self-monitoring after 12 months’ follow-up were interviewed. Topics discussed included experiences of OAT self-monitoring, healthcare support, training, and decision making. Framework analysis was used.ResultsFollowing initial problems using the monitoring device, interviewees described a mostly positive experience. Although less effort was expended attending monitoring appointments with health professionals, effort was required to conduct self-monitoring tests and to interpret and act on the results. Desire to self-manage was variable, especially when dosing advice systems worked promptly and reliably. Interviewees overcame patchy healthcare system knowledge and support of self-monitoring by educating themselves. Family and friends provided support with learning to use the monitor and managing OAT dosage adjustments.ConclusionBetter, more-consistent training and health-service support would have alleviated a number of problems encountered by these patients who were self-monitoring. This training and support will become even more important if self-monitoring becomes more accessible to the general population of people on OAT.     

A systematic review of methods for assessing competence in cognitive–behavioural therapy

Effective assessment of Cognitive Behaviour Therapy (CBT) competence is crucial to the success of the current drive to expand CBT training and service provision, and to the widespread dissemination of CBT into routine practice. However, a lack of consensus about how CBT competence should be assessed has resulted in the use of numerous different methods, many of which have been widely criticised. This review describes and evaluates the various methods of assessing CBT competence. A systematic literature search identified 64 articles pertaining to a method of assessing competence in the provision of standard CBT interventions to adults experiencing mental health problems. Ten methods for assessing CBT therapist competence were identified from these articles and are presented within Miller's (Miller, G. E. [1990]. The assessment of clinical skills/competence/performance. Academic Medicine, 65, 63–67) framework for assessing clinical skill. The advantages and disadvantages of each method are examined in relation to reliability, validity and feasibility. The limitations of the current evidence base are outlined and priorities for future research are highlighted. Tentative recommendations for assessing therapist competence are made within the context of the limited evidence base and need for feasibility in clinical practice settings.     

A comparative study on serum-free and serum culture methods of human umbilical cord mecenchymal stem cells北大核心

BACKGROUND: Studies have shown increasing risks and problems in the serum culture system, such as immune rejection, batch differences and virus risk. In addition, with the discovery and application of exosomes, the serum-free culture system is becoming an increasing concern. OBJECTIVE: To compare the similarities and differences between the serum-free culture system and the traditional serum culture system, which lays the foundation for the clinical transformation of human umbilical cord mesenchymal stem cells (hUCMSCs) and provides experimental data. METHODS: Umbilical cord was collected from term infants of cesarean section under aseptic condition, and hUCMSCs were isolated and cultured by expiant tissue technique. hUCMSCs was cultured with 10% fetal bovine serum (FBS) and 15% serum substitutes (AGS) from the criginal generation. Then an inverted microscope was used to observe cell morphological changes. Flow cytometry was used to detect cell surface markers. Cell counting kit-8 was used to detect cell proliferation. Induced differentiation experiment was used to detect cell differentiation potential. Western Blot was used to detect the protein levels of oct4, nanog and sox2. RESULTS AND CONCLUSION: Under the inverted microscope, hUCMSCs cultured with AGS showed more uniform vortex-like growth, and those cultured with FBS gradually appeared with cell differentiation or aging with the increase cf cell generations. hUCMSCs cultured by both methods expressed CD73,CD90 and CD105 but lowly expressed CD34 and CD45, and there was no significant difference between the two culture methods. FBS method was superior to AGS method in proliferation ability. Results from the induced differentiation experiments showed that hUCMSCs cultured by both methods had adipogenic, osteogenic and chondrogenic abilitis, and there was no significant difference between the two culture methods. hUCMSC cultured by both methods expressed oct4 and nanog but showed no significant difference in level, while the expression of sox2 was significantly higher in the hUCMSCs cultured by AGS than by FBS (P < 0.05). To conclude, the hUCMSCs cultured with AGS are in accordance with the international standards of mesenchymal stem cells. The AGS method as an alternative to the FBS method can become a preferred method for hUCMSCs culture. © 2018, Journal of Clinical Rehabilitative Tissue Engineering Research. All rights reserved.     

Escaping the tyranny of the embryo? A new approach to ART regulation based on UK and Australian experiences

The early legislative responses to fertilization of human oocytes in vitro exaggerated the protection of the embryo at the expense of the interests of other parties. Although more recent legislative changes have lessened this embryonic grip, it nonetheless still distorts legal thinking and is fundamentally in conflict with biological understanding. Drawing largely on experiences in the UK and Australia, a proposal is explored that reframes the legislative approach to the regulation of assisted reproductive technology (ART) with the following objectives: (i) to align more closely the legal and biological understandings of the earliest stages of human development; (ii) to place the legislative focus on objective, intent and outcome; and in the process (iii) to disentangle legally and conceptually the status of the embryo from that of the potential child. Experiences in the UK and Australia are drawn on, because these two jurisdictions have a common legal heritage and were among the earliest players both scientifically and legally but have pursued very different legal routes to their current legislative practices.     

Who should access germline genome sequencing? A mixed methods study of patient views

Implementation of any new medical test, including germline genome sequencing (GS) to inform cancer risk, should take place only when a test is effective, ethically justifiable and acceptable to a population. Little empirical evidence exists on patient views regarding GS for cancer risk. The aim of this study was to elicit opinions on who should be offered GS and who should pay for it. Participants with a probable genetic basis for their cancer (n = 335) and blood relatives (n = 199) were recruited to undergo GS and invited to complete questionnaires at baseline. A subset (n = 40) also participated in qualitative interviews about their views regarding access to GS to detect cancer risk. Our response rate was 92% for questionnaires and 100% for interviews. Participants expressed high enthusiasm overall for access to GS for those with a family history of cancer and anyone who requested testing, but enthusiasm was lower for universal access, if opting out was possible and finances not an issue. Rationales for these views reflected maximising the sound use of resources. Challenges to introducing community screening via GS to limit cancer burden were raised, including the current limits of science and individual ability to cope with uncertain results. Participants undergoing GS supported cancer risk testing for those with a family history of cancer but were concerned about the challenges of designing and implementing a population-based GS cancer-screening program.     

Validation of statistical shape model based reconstruction of the proximal femur—A morphology study

Seventeen bones (sixteen cadaveric bones and one plastic bone) were used to validate a method for reconstructing a surface model of the proximal femur from 2D X-ray radiographs and a statistical shape model that was constructed from thirty training surface models. Unlike previously introduced validation studies, where surface-based distance errors were used to evaluate the reconstruction accuracy, here we propose to use errors measured based on clinically relevant morphometric parameters. For this purpose, a program was developed to robustly extract those morphometric parameters from the thirty training surface models (training population), from the seventeen surface models reconstructed from X-ray radiographs, and from the seventeen ground truth surface models obtained either by a CT-scan reconstruction method or by a laser-scan reconstruction method. A statistical analysis was then performed to classify the seventeen test bones into two categories: normal cases and outliers. This classification step depends on the measured parameters of the particular test bone. In case all parameters of a test bone were covered by the training population's parameter ranges, this bone is classified as normal bone, otherwise as outlier bone.Our experimental results showed that statistically there was no significant difference between the morphometric parameters extracted from the reconstructed surface models of the normal cases and those extracted from the reconstructed surface models of the outliers. Therefore, our statistical shape model based reconstruction technique can be used to reconstruct not only the surface model of a normal bone but also that of an outlier bone.     

Effect of contrast water therapy duration on recovery of cycling performance: a dose�Cresponse study

This study investigated whether contrast water therapy (CWT) has a dose?Cresponse effect on recovery from high-intensity cycling. Eleven trained male cyclists completed four trials, each commencing with a 75-min cycling protocol containing six sets of five 15-s sprints and three 5-min time-trials in thermoneutral conditions. Ten minutes post-exercise, participants performed one of four recovery protocols: CWT for 6?min (CWT6), 12?min (CWT12), or 18?min (CWT18) duration, or a seated rest control trial. The CWT commenced in hot water (38.4?±?0.6°C) and alternated between hot and cold water (14.6?±?0.3°C) every minute with a 5-s changeover. The cycling protocol was repeated 2?h after completion of exercise bout one. Prior to exercise bout two, core temperature was lower in CWT12 (?0.19?±?0.14°C, mean?±?90% CL) and CWT18 (?0.21?±?0.10°C) than control. Compared with control, CWT6 substantially improved time-trial (1.5?±?2.1%) and sprint performance (3.0?±?3.1%), and CWT12 substantially improved sprint total work (4.3?±?3.4%) and peak power (2.7?±?3.8%) in exercise bout two. All CWT conditions generally improved thermal sensation, whole body fatigue and muscle soreness compared with control, but no differences existed between conditions in heart rate or rating of perceived exertion. In conclusion, CWT duration did not have a dose?Cresponse effect on recovery from high-intensity cycling; however, CWT for up to 12?min assisted recovery of cycling performance.     

Re-evaluation of the VIDAS® cytomegalovirus (CMV) IgG avidity assay: Determination of new cut-off values based on the study of kinetics of CMV–IgG maturation

BackgroundIn case of cytomegalovirus (CMV) infection, differentiation between primary and non-primary CMV infection can be of major importance for the correct management of pregnant women or immunocompromised patients. Besides CMV–IgM and IgG, CMV–IgG avidity measurement is now commonly used to distinguish primary from non-primary infection.ObjectiveTo re-evaluate the performance of the VIDAS CMV–IgG avidity assay in comparison with 2 other techniques (Architect Abbott and Liaison DiaSorin) and to study the kinetics of CMV–IgG avidity maturation.Study designA panel of 135 sequential samples collected from 31 patients with a proven primary infection (attested by very recent CMV–IgG seroconversion) was tested with VIDAS, Liaison and Architect CMV–IgG avidity assays. Moreover, 235 routinely collected samples, CMV–IgG and CMV–IgM positive, were analyzed with Liaison, VIDAS and an in-house CMV–IgG avidity assay.Results and conclusionsThe analysis of all the data allowed suggesting new VIDAS cut-off values of 0.40 for low avidity and 0.65 for high avidity, which significantly increase the test performance and enable better patient managements. Using these VIDAS new cut-off values, all of the 31 primary infections were correctly dated. Comparatively, 25 out of 31 were correctly dated with the Architect assay and 29 out of 31 with the Liaison assay. We also demonstrated that the VIDAS CMV–IgG avidity assay allows observing correctly the maturation of CMV–IgG avidity, which could be useful as an additional parameter for diagnosis of a recent CMV infection.     

Thermoplastic biodegradable elastomers based on ε-caprolactone and l-lactide block co-polymers: A new synthetic approach

Although biodegradable polymers have found extensive application in medical devices, there are very few commercially available elastomeric biodegradable polymers. In this work, starting with the well-known monomers l-lactide and ε-caprolactone, we developed elastomers using a multiblock co-polymer approach. This ensures that the degradation products of such elastomers are also acceptable from a cytotoxicity standpoint. A series of polymers with various structures was synthesized utilizing a design of experiment approach. The basic structure is that of a diblock, with each block being modified by the addition of co-monomer. The synthesized polymers exhibited a range of mechanical properties from a typical thermoplastic polymer to that approaching a good thermoplastic elastomer. ¹³C nuclear magnetic resonance analysis, size exclusion chromatography and differential scanning calorimetry measurements have been utilized to relate the observed range of mechanical properties to the structure. In addition, the elastomeric nature has been established with the use of creep and recovery measurements. Such elastomers may find a variety of biomedical applications, ranging from stent coatings to atrial septal defect occluders.     

The influence of children’s day care on antibiotic seeking: a mixed methods study

Background

Preschool-aged children are the highest consumers of antibiotics, but consult mainly for viral infections. Little is known about how day care, which is common in this age group, influences primary care consulting and treatment-seeking behaviours.

Aim

To investigate daycare providers’ approaches to excluding and/or readmitting children with infections, and the consequences for parents’ consulting and antibiotic-seeking behaviours.

Design and setting

Cross-sectional survey, document analysis, and qualitative interviews of daycare providers and parents in South East Wales, UK.

Method

A total of 328 daycare providers were asked to complete a survey about infection exclusion practices and to provide a copy of their sickness exclusion policy. Next, 52 semi-structured interviews were conducted with purposively selected questionnaire responders and parents using their services. Questionnaire responses underwent bivariate analysis, policies underwent document analysis, and interviews were thematically analysed using constant comparison methods.

Results

In total 217 out of 328 (66%) daycare providers responded; 82 out of 199 (41%) reported advising parents that their child may need antibiotics and 199 out of 214 (93%) reported advising general practice consultations. Interviews confirmed that such advice was routine, and beliefs about antibiotic indications often went against clinical guidelines: 24% (n = 136) of sickness exclusion policies mentioning infections made at least one non-evidence-based indication for ‘treatment’ or antibiotics. Parent interviews revealed that negotiating daycare requirements lowered thresholds for consulting and encouraged antibiotic seeking.

Conclusion

Daycare providers encourage parents to consult general practice and seek antibiotics through non-evidence-based policies and practices. Parents’ perceptions of daycare providers’ requirements override their own beliefs of when it is appropriate to consult and seek treatment.