Radiation exposure in whole-body computed tomography of multiple trauma patients: bearing devices and patient positioning

BackgroundWhole-body computed tomography (WBCT) plays an important role in the management of severely injured patients. We evaluated the radiation exposure of WBCT scans using different positioning boards and arm positions.MethodsIn this retrospective study, the radiation exposure of WBCT using a 16-slice multislice computed tomography scanner was evaluated. Individual effective doses (E, mSV) was calculated. Patients were assigned to two groups according to placement on a plastic transfer mat (PTM, group 1) or on the Trauma Transfer?-Board (TTB, group 2). Data were collected for each group with arm placement on the abdomen (a) or in raising position (b), respectively. The maximum ventro-dorsal diameter [VDD] at the trunk was measured.Results100 patients with potentially life-threatening injuries were analysed. Patient demographics and VDD did not differ in the two groups. Radiation exposure in term of E did not reveal any significant differences between the two positioning boards using same arm position [group 1a (n = 26) vs. 2a (n = 24) (mSV): 16.7 ± 4.7 vs. 17.1 ± 4.4, group 1b (n = 26) vs. 2b (n = 24) (mSV): 13.1 ± 3.9 vs. 14.3 ± 1.5]. The arm raising positioning showed a significant reduction in E in comparison to the placement on abdomen position [group 1b vs. 1a (mSV): 13.1 ± 3.9 vs. 16.7 ± 4.7, p < 0.05, group 2b vs. 2a (mSV): 14.3 ± 1.5 vs. 17.1 ± 4.4, p < 0.05].ConclusionsPatient arm positioning for WBCT has an important influence on radiation exposure. Effective dose was 16–22% lower when arms were raised. An individual placement algorithm may lead to a relevant reduction of radiation exposure of severely injured patients.     

Epidemiology of livestock-related injuries in a major trauma center in Kashan, Iran

Objective:Livestock-related injuries are one of the important factors causing morbidity and mortality in patients admitted to hospital.Treatment of these patients is still a major problem in health car...     

Quality of food intake after bariatric surgery: vertical gastrectomy versus gastric bypass

IntroductionThe different bariatric surgical techniques have an influence on food tolerance and the presence of vomiting. There have been few studies on the impact of these techniques on the quality of food intake.Patients and methodA prospective and comparative study was performed on a consecutive patient cohort operated on due to morbid obesity between May 2008 and November 2010. The quality of the diet was evaluated before and at 3, 6, 12 and 24 months postoperatively, using the questionnaire described by Suter et al.ResultsOne hundred and five patients (64 vertical gastrectomy [VG] and 41 gastric bypass [GB]) completed the questionnaire before the surgery, and 87 at 3 months, 79 at 6 months, 53 at 12 months, and 18 at 24 months after surgery. The overall score of the questionnaire before surgery was 23.5 ± 2.6, with a significant difference at 3 months (20.4 ± 3.8, P<.001), at 6 months (21.3 ± 4.6, P<.001) and at 12 months (22.4 ± 3.3, P<.044), and with no difference at 24 months (23.2 ± 2.5, P<.622), after surgery. On comparing food intake of VG versus GB, the scores were similar before surgery (23.8 ± 2.4 vs 23.0 ± 2.8, P<.125) as well as in the post-surgical follow up at 3 months (20.5 ± 3,9 vs 20.2 ± 3.7, P<.599), 6 months (21.1 ± 5.3 vs 21.7 ± 3.4, P<.243), 12 months (22.3 ± 3.3 vs 22.7 ± 3.4, P<.140) and 24 months (22.9 ± 3.0 vs 23.6 ± 2.2, P = 1.00).ConclusionsThe worsening of the quality of food intake is common in the first months after bariatric surgery, gradually improving and with no differences being seen between VG and GB.     

Accuracy of the AAST organ injury scale for CT evaluation of traumatic liver and spleen injuries

Objective： Detection of abdominal in- jury is a very important component in trauma management, so a precise assessment of liver and spleen injuries includ- ing their severity degree is necessary. There is a good case to believe that in emergency situations the radiologists＇ performance may profit from a systematic approach using established scoring systems. Score systems as the organ injury scale （OIS） drawn up by the American Association for the Surgery of Trauma are a valuable guidance for objec- tive trauma assessment. Aim of this study was to evaluate retrospectively whether a structured approach using the OIS may help improve trauma assessment. Methods： Fifty-three patients, 38 male and 15 female who underwent CT and laparotomy after abdominal trauma were included in this study. The laparotomy was performed by experienced surgeons with a minimum experience of 6 years. While the original CT reports were written by differ- ent radiologists with a minimum experience of 3 years, and then a radiologist with experience of 4 years reviewed the same original CT pictures, resulting in the structured report. Both the original and structured CT results on liver and spleen injuries were transferred into OIS grades. Finally, the initial and structured CT results were compared with theintraoperative findings gathered from the surgery report. Results： Regarding the original CT report we found a mean divergence of 0.68±0.8 （r=-0.45） to the OIS finding in the surgery report for liver injuries （0.69±1.17 for spleen injuries; r=-0.69）. In comparison with the structured approach, where we detected a divergence of 0.8±0.68; r=-0.63 （0.47±0.77 for spleen injuries; r=0.91）, there was no significant difference. However we detected a lower rate of over-diag- nosis in structured approaches. Conclusion： Our study shows that a structured ap- proach to triage abdominal trauma using an imaging check- list does not lead to a significantly higher detection rate, but a nonsignificant trend to reduce the rate of over- diagnoses, thus being more precise in grading the severity grade. Concerning the bias by retrospective study design, further prospective investigations are needed to evaluate the impact of trauma scores on the workflow in emergency department procedure as structured reporting systems are a valuable guidance in other radiological disciplines.     

Biomechanical analysis of locked and non-locked plate fixation of the clavicle

IntroductionDuring plate fixation of clavicular fractures the brachial plexus and subclavian vessels are vulnerable to injury beneath the clavicle. Locking plate fixation allows for mono-cortical fixation, theoretically reducing the risk of injury to these structures. Biomechanical analysis of the performance of such fixation is limited, and this study was designed to explore this further as a treatment option in clavicle fractures.Materials and methodsFixation of fifteen simulated mid-shaft fractures was undertaken using a combination of mono-cortical locked, bicortical locked and bicortical non-locked plating methods in cadaveric clavicles. Samples were then tested via three-point bending to destruction, and the performance of each with respect to failure load, bending stress, bending stiffness and Young's modulus was then analysed. The influence of the number of cortices engaged and locking was also assessed.ResultsClavicles fixed with monocortical locking plates displayed a significantly lower bending stress (12 ± 1 MPa) than both the bicortical locking (28 ± 3 MPa, p = 0.015) and non-locking specimens (24 ± 3 MPa, p = 0.002). Engaging two cortices with the fixation produced a significant increase in failure load (291 ± 28 N vs 138 ± 48 N, p = 0.018) and bending stress (26 ± 2 MPa vs 9.9 ± 3.5 MPa, p = 0.002) compared to single cortex fixation.DiscussionThe greatest influence upon the performance of the fixation was the number of cortices engaged, with bicortical fixation performing significantly better than mono-cortical. Whether or not the fixation device was a locking one did not have a significant bearing upon the performance.ConclusionThis in vitro biomechanical analysis demonstrates that mono-cortical locked plating fails at significantly lower levels of load and stress than bicortical locked and non-locked plating in mid-shaft fractures of the clavicle, and caution would therefore be advised in its use as a fixation modality for these injuries.     

Clinical outcome and complications using a polyaxial locking plate in the treatment of displaced proximal humerus fractures. A reliable system?

IntroductionThe surgical treatment of displaced proximal humeral fractures (ORIF) is a perpetual challenge to the surgeon. For this reason, the principle of polyaxiality was developed to provide an improved primary stability of the fracture through better anchorage of the screws, especially in osteoporotic bone. The aim of this study was to present clinical results with the polyaxial locking plate in the operative treatment of proximal humerus fractures in order to determine whether the technique of polyaxiality leads to better functional outcome and lower complication rates in comparison to monoaxial plates in the literature.Patients and methodsSeventy-three patients with displaced proximal humeral fractures were treated surgically with the polyaxial locking Suture Plate? (Arthrex^®) between 03/2007 and 06/2009. Fifty-two of the patients (mean age, 69.9 ± 12.1) were included in a radiographical and clinical examination using the Constant score (CS) and the Disabilities of the Arm, Shoulder and Hand score (DASH).ResultsThe follow-up examinations were on average 13.9 ± 4.5 months (10–27 months) after surgical treatment. The mean CS of the patients was 66.0 ± 13.7 points, the age- and gender-related CS was 90.9% ± 20.0% and the mean DASH score was 23.8 ± 19.8 points for the injured side. The patients with a nearly anatomical reduction of their fracture (n = 13) reached a significantly higher CS (75.1 ± 8.5; p = 0.004) and DASH-score (13.6 ± 11.6; p = 0.043) and none of these patients had a complication. The complications were identified in 12 (23.1%) cases, 5 of which involved loss of reduction. All of these 5 cases were lacking of initial medial column support and 4 of which were type C2.3 AO-Classification.ConclusionThe data show that the combination of angular stability with the possibility of variable polyaxial screw direction is a good concept for reduction and fixation of displaced proximal humeral fractures, but anatomical reduction and medial support remain important preconditions for a good outcome. However, a significantly lower rate of complications or better clinical outcome than that reported in the literature could not be found.     

Muscle strength and soccer practice as major determinants of bone mineral density in adolescents

ObjectivesTo analyse the relationship between isokinetic strength of the lower limb muscles and bone mineral density and content (BMD, BMC) of adolescent male soccer players and age-matched controls not involved in sport (12–15 years).MethodsA random sample of 151 young males was divided into soccer players (SG; n = 117) and control subjects (CG; n = 34). Peak torque of knee extensors (PTE) and flexors (PTF) was measured during isokinetic knee joint movement (90°/s) of the dominant and non-dominant lower limbs. BMD and BMC of the whole-body, lumbar spine, dominant/non-dominant lower limb were determined by dual-energy X-ray absorptiometry. Physical activity was monitored with accelerometers during 5 days. Estimated maturity offset was used as an indicator of biological maturity status.ResultsWhole-body BMD (1.03 ± 0.01 vs. 0.98 ± 0.01 g/cm², P = 0.003) and dominant (1.09 ± 0.01 vs. 1.02 ± 0.01 g/cm², P < 0.001) and non-dominant (1.09 ± 0.01 vs. 1.01 ± 0.01 g/cm², P < 0.001) lower limb BMD was greater in SG compared to CG. No significant differences were found for BMC. Compared to CG, SG performed better in the YY-IE2 test (780 ± 40 vs. 625 ± 31 m), exhibited higher PTE (dominant limb: 155.2 ± 30.3 vs. 123.4 ± 37.0 N m; non-dominant limb: 156.2 ± 36.1 vs. 120.4 ± 41.1 N m) and PTF muscles (dominant limb: 79.0 ± 25.3 vs. 57.1 ± 25.3 Nm; non-dominant limb: 73.3 ± 20.7 vs. 57.0 ± 24.2 N m). Moreover, the PTE, soccer participation and maturity status were positively associated with the BMD at all body sites (r² = 0.57–0.73, P < 0.05).ConclusionsMuscle strength of knee extensors is associated with BMD and BMC at all body sites. Muscle-skeletal structures respond positively to the weight-bearing and impact-loading imposed by soccer practice. Soccer seemed to be a multilateral balanced sport activity.     

Onset of labor epidural analgesia with ropivacaine and a varying dose of fentanyl: a randomized controlled trial

BackgroundThis study was conducted to investigate the onset of labor epidural analgesia using 0.17% ropivacaine with a varying dose of fentanyl. We hypothesized that the onset of analgesia would be shortened in proportion to an increase in fentanyl dose.MethodsWomen requesting labor epidural analgesia were enrolled in this randomized controlled clinical trial. Each woman was randomly assigned to receive fentanyl 0, 50, 75, or 100 μg with 0.17% ropivacaine 12 mL. The onset and duration of analgesia, the incidence of side effects and patient satisfaction were measured.ResultsData from 102 women were analyzed. The onset of analgesia (mean ± SD) was shortened with an increasing dose of fentanyl (14.3 ± 5.4, 14.2 ± 6.5, 12.1 ± 5.1, and 8.7 ± 3.8 min with fentanyl 0, 50, 75, or 100 μg, respectively, P = 0.001). The duration of analgesia was prolonged with an increasing dose of fentanyl (87.4 ± 20.8, 112.3 ± 19.5, 140.8 ± 18.8, and 143.6 ± 18.6 min with fentanyl 0, 50, 75, or 100 μg, respectively, P < 0.001). The incidence of pruritus increased with an increasing dose of fentanyl (P = 0.027) but there were no differences for other maternal side effects. There was a significant difference in satisfaction score among groups (P = 0.009).ConclusionThe addition of increasing doses of fentanyl to 0.17% ropivacaine contributed to shortened onset as well as prolonged duration of labor epidural analgesia and improved patient satisfaction.     

Assessment of aortic wall stiffness in patients with Familial Mediterranean Fever

IntroductionTo evaluate aortic wall stiffness and its relation between the aortic stiffness and the left ventricular function in patients with Familial Mediterranean Fever (FMF).MethodsThe study population was composed of 31 patients with FMF in attack-free period (12 men, 19 women; mean age: 36 ± 7 years) and 27 healthy subjects (10 men, 17 women; mean age: 34 ± 7 years) who had volunteered to participate. Aortic stiffness indices, aortic strain and distensibility, were calculated from the aortic diameters measured by echocardiography and blood pressure obtained by sphygmomanometry.ResultsThere were significant differences between the control and the patient group in aortic strain (mean (SD), 7.23 ± 2.14 versus 4.91 ± 1.66%, p = 0.01) and distensibility (4.02 ± 1.42 versus 2.84 ± 1.46, 10^?6 cm² dyn^?1, p = 0.001). Although there was no correlation between the aortic stiffness parameters and the left ventricular function parameters, there were significant negative correlations between the disease duration and aortic strain index (r = ?0.29, p < 0.001), and between the disease duration and distensibility (r = ?0.32, p < 0.001).ConclusionAortic stiffness measurements were found abnormal in patients with FMF. We have also demonstrated that there were significant correlations between aortic stiffness parameters and disease duration.     

Prevalence and impact on FEV(1) decline of chronic methicillin-resistant Staphylococcus aureus (MRSA) colonization in patients with cystic fibrosis. A single-center, case control study of 165 patients

BackgroundRisk factors for methicillin-resistant Staphylococcus aureus (MRSA) in Cystic Fibrosis (CF) and the impact on CF disease progression are still under debate.The objectives of this study were to determine clinical variables associated with MRSA colonization and examine impact on FEV₁ evolution in CF patients.MethodsA retrospective case–control study using the University Hospital of Brussels CF clinic patient registry from 2002 to 2010, comparing clinical variables and decline of FEV₁ of MRSA positive patients with age and sex matched controls, chronically colonized with S. aureus.ResultsThirty of the 165 CF patients, chronically colonized with S. aureus, had cultures positive for MRSA (18.2%). Excluding patients under 4 years, the prevalence became 15.2% (23/151). Chronic colonization (i.e., three or more consecutive positive cultures) was found in 19/151 (12.6%).The MRSA positive group showed a higher proportion of patients with genotype F508del, less pancreas sufficient patients, more bronchiectasis and more frequent hospitalization.The FEV₁ recorded one year prior to, and at the moment of MRSA acquisition, was lower but not significantly different from that obtained in controls (72.9% ± 26.6 vs 84.3 ± 21.8 and 68.2% ± 27.1 vs 81.4% ± 24.3 respectively, p > 0.1). However, FEV₁ decline over 2- and 6-year periods, were significantly greater in the chronic MRSA group than in the controls (− 5% ± 5.5 vs −2.5 ± 2.3 over 2 years (p = 0.043) and − 1.8% ± 4.6 vs −1.0% ± 1.9 over a 6-year period (p = 0.026)).ConclusionIn our center the prevalence of MRSA in CF patients, chronically colonized with S. aureus and over the age of 4 years, was 15.2% (12.6% chronic infection). MRSA colonization was shown to be associated with a genotype F508del, presence of bronchiectasis and hospitalization. Our spirometric data also show that a MRSA episode entails an FEV₁ decline that is almost double that predicted for CF patients who can remain unaffected by MRSA.     

The Association between Iliac Fixation and Proximal Stent-graft Migration during EVAR Follow-up: Mid-term Results of 154 Talent Devices

ObjectiveThis study investigated the importance of iliac fixation to secure endograft fixation.Materials and methodsComputed tomography (CT) scans of patients who underwent endovascular aneurysm repair with an endoprosthesis of great columnar strength (Talent? stent graft) were analysed retrospectively. Patients were enrolled consecutively between June 2000 and January 2007 and prospectively followed up with serial CT imaging. The superior mesenteric artery was used as a reference point to determine endograft migration (centerline endograft displacement of ≥10 mm). Proximal and distal fixation lengths were defined as the length of the endograft that was in full apposition to the aortic neck or common iliac arteries, respectively.ResultsProximal endograft migration occurred in 32 of 154 patients (21%) at a follow-up duration of 32 ± 14 months; 13 migrations required treatment (8%). Migration was more frequent in patients treated with aorto-uniiliac devices than bifurcation devices (p < 0.008). The migrator and non-migrator groups had similar demographic and abdominal aortic aneurysm (AAA) characteristics. The migrator group had significantly shorter proximal (30 ± 12 mm vs. 41 ± 13 mm, P < 0.001) and distal endograft fixation lengths (31 ± 18 mm vs. 47 ± 15 mm, P < 0.001). By multivariate regression analysis, proximal and distal endograft fixations were significant predictors for endograft migration at follow-up (P < 0.001).ConclusionIliac endograft fixation, along with proximal fixation, is a significant predictor for endograft migration.     

Early fasciotomy in patients with extremity vascular injury is associated with decreased risk of adverse limb outcomes: a review of the National Trauma Data Bank

Introduction and objectivesLower extremity (LE) arterial trauma and its treatment may lead to extremity compartment syndrome (ECS). In that setting, the decision to perform fasciotomies is multifactoral and is not well delineated. We evaluated the outcomes of patients with surgically treated LE arterial injury who underwent early or delayed fasciotomies.MethodsThe National Trauma Data Bank (NTDB) was retrospectively reviewed for patients who had LE arterial trauma and underwent both open vascular repair and fasciotomies. Exclusion criteria were additional non-LE vascular trauma, head or spinal cord injuries, crush injuries, burn injuries, and declaration of death on arrival. Patients were divided into those who had fasciotomies performed within 8 h (early group) or >8 h after open vascular repair (late group). Comparative analyses of demographics, injury characteristics, complications, and outcomes were performed.ResultsOf the 1469 patient admissions with lower extremity arterial trauma that met inclusion criteria there were 612 patients (41.7%) who underwent fasciotomies. There were 543 and 69 patients in the early and late fasciotomy groups, respectively. There was no significant difference in age, injury severity, mechanism of injury, associated injuries, and type of vascular repair between the groups. A higher rate of iliac artery injury was observed in the late fasciotomy group (23.2% vs. 5.9%, P < .001). Patients in the early fasciotomy group had lower amputation rate (8.5% vs. 24.6%, P < .001), lower infection rate (6.6% vs. 14.5%, P = .028) and shorter total hospital stay (18.5 ± 20.7 days vs. 24.2 ± 14.7 days, P = .007) than those in the late fasciotomy group. On multivariable analysis, early fasciotomy was associated with a 4-fold lower risk of amputation (Odds Ratio 0.26, 95% CI 0.14–0.50, P < .0001) and 23% shorter hospital LOS (Means Ratio 0.77, 95% CI 0.64–0.94, P = .01).ConclusionEarly fasciotomy is associated with improved outcomes in patients with lower extremity vascular trauma treated with surgical intervention. Our findings suggest that appropriate implementation of early fasciotomy may reduce amputation rates in extremity arterial injury.     

Percutaneous radiofrequency sacral rhizotomy in the treatment of neurogenic detrusor overactivity in spinal cord injured patients

IntroductionTo evaluate the effects of percutaneous radiofrequency sacral rhizotomy in spinal cord injured (SCI) patients on urodynamic parameters (maximum cystometric capacity – MCC and detrusor pressure at maximum cystometric capacity - PdetMCC).Material and MethodsThis prospective study assessed eight patients with SCI (four men and four women) with a mean age of 31.3 years (22 to 41). Mean interval period between spinal cord lesion and rhizotomy was 53.5 months (20 to 96). All patients underwent an anesthetic block of the 3rd sacral root bilaterally using 0.5% bupivacaine under fluoroscopic control. Those who responded with an increase on bladder capacity were selected to undergo the percutaneous radiofrequency sacral rhizotomy. All patients underwent urodynamic evaluation at 6 and 12 months following the procedure. MCC and P_detMCC were recorded.ResultsAll patients presented a significant improvement on MCC after 12 months. The mean vesical volume increased from 100.2 ± 57.1 to 282.9 ± 133.4 ml (p<0.05). The P_detMCC reduced from 82.4 ± 31.7 to 69.9 ± 28.7 cmH₂O (p = 0.2). Three patients with autonomic dysreflexia had complete relief of symptoms after the procedure. At 12 months, recurrence of detrusor hyperactivity was observed in all patients. One patient presented abolishment of reflex erections after the procedure. No major complications related to the rhizotomy were noted.ConclusionsPercutaneous radiofrequency sacral rhizotomy is a minimally invasive technique with low morbidity able to increase MCC. There is a trend towards the reduction of the P_detMCC in SCI patients at 12 months, although statistical significance was not reached.     

Mean platelet volume (MPV) as an inflammatory marker in ankylosing spondylitis and rheumatoid arthritis

AimsThe aim of this retrospective study was to investigate the correlation between MPV and the clinical disease activity indices of rheumatoid arthritis and ankylosing spondylitis.MethodsThe study consisted of 32 active RA patients (males/females: 7/25, mean age: 49 ± 13) and 30 active AS patients (males/females: 15/15, mean age: 36 ± 12) along with 26 osteoarthritis (OA) patients (males/females: 4/22, mean age: 52 ± 8) and 29 age-matched healthy subjects (males/females: 5/24, mean age: 41 ± 7) as control groups for RA and AS, respectively.ResultsMPV was significantly lower in both AS patients and RA patients with active disease as compared to controls (RA vs OA p < 0.001, AS vs healthy subjects p < 0.001). After treatment MPV values significantly increased in AS and RA (p < 0.001 for all). However, MPV values remained somewhat lower in RA patients than OA patients (p = 0.019). There was a negative correlation between MPV values and BASDAI scores in AS patients after two months of treatment (r = ?0.507; p = 0.004).ConclusionOur results suggest that assessment of MPV may provide additional information about inflammation in AS and RA.     

The effectiveness of hypertonic saline and pentoxifylline (HTS-PTX) resuscitation in haemorrhagic shock and sepsis tissue injury: comparison with LR, HES, and LR-PTX treatments

PurposeTo compare lung and liver injury and laboratory results in haemorrhagic shock and sepsis models treated with combinations of lactated Ringer's solution (LR), 7.5% hypertonic saline (HTS), hydroxyethyl starch (HES), and pentoxifylline (PTX).MethodsMale Sprague-Dawley rats (200–290 g) were assigned randomly to one of four treatment groups (n = 16 per group): (1) LR; (2) HES; (3) LR–PTX; and (4) HTS–PTX. Each group was subdivided into (1) haemorrhagic shock (n = 8) and (2) sepsis (n = 8) model groups. A venous catheter was used to inject resuscitation fluids, and an arterial catheter was used to withdraw blood and monitor mean arterial pressure (MAP). Lung and liver histology, bronchoalveolar lavage (BAL) fluid, and cytokine levels were evaluated.ResultsThe mean lung injury score was 1.7. At 24 h after treatment, the total leucocyte count in the BAL fluid was significantly (p < 0.05) higher with LR treatment (10 × 10⁶ ± 0.8) than with other treatments in the sepsis model groups (HES, 6 × 10⁶ ± 1.2; LR–PTX, 5 × 10⁶ ± 1.5; HTS–PTX, 5 × 10⁶ ± 0.6). The higher total leucocyte count after LR treatment was attributable to a greater increase in the number of neutrophils (17 ± 1.5%) compared with increases after the other treatments (HES, 6 ± 0.8%; LR–PTX, 10 ± 1.3%; HTS–PTX, 5 ± 0.4%). In the sepsis model groups, the total hepatic injury score was also significantly (p < 0.05) higher with LR treatment (9.9 ± 0.5) than with the other treatments (HES, 6.7 ± 0.8; LR–PTX, 5.6 ± 0.7; HTS–PTX, 3.1 ± 0.9). This also occurred in the shock model (LR, 10.6 ± 2.1; HES, 5.8 ± 0.9; LR–PTX, 7.3 ± 0.9; HTS–PTX, 3.5 ± 0.9). As compared with LR treatment, HTS–PTX resuscitation resulted in a 49% decrease in TNF-α, 29% decrease in IL-1β, and 58% decrease in IL-6 in the shock model at 24 h (p < 0.05), and the respective decreases were 45, 24, and 35% in the sepsis model (p < 0.05).ConclusionHTS–PTX was superior to HES, LR–PTX, and LR for treating shock and sepsis, and LR–PTX and HES gave better results than LR therapy alone.     

Preliminary validation of the Simulap(®) physical simulator and its assessment system for laparoscopic surgery

IntroductionOur aim is to assess the face and content validities of the physical simulator Simulap^®, as well as the construct validity of its assessment method.Material and methodsFive novice surgeons (G1) and five experts (G2) performed seven basic tasks and one suturing exercise on Simulap^®, which were assessed through an exam based on mistakes and performance time. Face and content validations were carried out by novice surgeons and expert surgeons, respectively. Both validations consisted of a questionnaire graded on a five-point scale about the Simulap^® and its tasks. Construct validity of the assessment system was determined by comparing the scores of both groups.ResultsSurgeons rated the Simulap^® simulator and its training program positively, obtaining an average score of 4 ± 1.1 for G1 and of 4.9 ± 0.6 for G2. G2 considered training on Simulap^® very useful for the training of residents and surgeons, obtaining a maximum score of 5. G2 outperformed G1 in all task scores, with statistically significant differences in the eye-hand coordination (G1: 52.2 ± 6.7 vs. G2: 39.6 ± 6.5; P=.027), dissection (G1: 301.8 ± 100.2 vs. G2: 150.8 ± 66.7; P=.028) and suturing exercises (G1: 258.5 ± 87.0 vs. G2: 108.4 ± 20.2; P=.009).ConclusionsThe assessment method for Simulap^® is able to distinguish different levels of experience in laparoscopic surgery. Furthermore, this simulator showed a great acceptance by surgeons for the learning of basic skills.     

No differences of carotid intima-media thickness between young patients with ankylosing spondylitis and healthy controls

ObjectiveAccelerated atherosclerosis in inflammatory rheumatic diseases such as ankylosing spondylitis (AS) stands out among the leading causes of morbidity and mortality. We assessed the correlation between subclinical carotid atherosclerosis and its related clinical parameters in AS patients.MethodsTwenty-eight patients (23 males, 5 females) with AS and 27 sex- and age-matched controls were consecutively recruited to this study. We estimated the carotid intima–media thickness (IMT) and parameters related to arterial elastic properties, including the distensibility coefficient (DC), stiffness index (β), and incremental elastic modulus (E_inc) using high-resolution ultrasonography. Serum levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and monocyte chemoattractant protein-1 (MCP-1) were measured using enzyme-linked immunosorbent assay (ELISA).ResultsCarotid IMT values and arterial elastic parameters in AS patients showed no statistical significance compared to those of controls (0.57 ± 0.07 vs 0.55 ± 0.05, p = 0.387 for IMT, 28.45 ± 9.23 vs 31.93 ± 9.52, p = 0.175 for DC, 2.32 ± 0.18 vs 2.29 ± 0.15, p = 0.559 for stiffness index (β), and 0.14 ± 0.05 vs 0.12 ± 0.03, p = 0.116 for E_inc). The serum level of IL-6 in AS patients was significantly different compared with controls (p = 0.001), but not in serum levels of TNF-α and MCP-1 (p = 0.162, p = 0.087, respectively). Carotid IMT and all arterial elastic parameters calculated in this study were not found to be associated with serum levels of TNF-α, IL-6, and MCP-1.ConclusionThis cross-sectional study showed that carotid IMT and parameters related with arterial elastic properties in young AS patients without clinically evident cardiovascular risk factors were not different from those of sex- and age-matched healthy controls. Serum levels of TNF-α, IL-6, and MCP-1 did not reflect the degree of carotid subclinical atherosclerosis. However, these findings should be confirmed further in a larger population.     

Haemodynamics in obese pregnant women

BackgroundObesity in pregnant women is a serious health issue. Invasive monitoring devices are rarely used in pregnancy due to their risks; however, assessment of cardiac function is often required in these women. Transthoracic echocardiography offers advantages but may be technically difficult to perform. Our aim was to determine the feasibility of transthoracic echocardiography and to quantify left ventricular function and structure using transthoracic echocardiography in obese pregnant women.MethodFifteen obese but otherwise healthy pregnant women (body mass index >30 kg/m²), were compared with 40 healthy non-obese pregnant women. Echocardiography was performed according to American Society of Echocardiography recommendations.ResultsTest completion with key haemodynamic data were obtained in 100% of women. Gestational age (Mean ± SD) was similar between groups (36 ± 5 weeks). Compared with non-obese pregnant women, obese pregnant women had elevated mean arterial pressure (88 ± 6 vs. 81 ± 8 mmHg, P = 0.003), increased left ventricular mass (162.8 ± 35.4 vs. 130.8 ± 21.0 g, P = 0.008) but similar cardiac output (4417 ± 890 vs. 4109 ± 595 mL/min, P = 0.230) and diastolic changes (mitral valve E/se′ > 8 in 33% vs. 15% of patients, P = 0.26). Septal tissue Doppler indices in obese pregnant women were s′ 9.1 ± 1.9 cm/s, e′ 11.6 ± 2.6 cm/s, a′ 8.1 ± 2.7 cm/s. Tei index was reduced in both groups (0.49 ± 0.12 vs. 0.42 ± 0.09, P = 0.05).ConclusionsTransthoracic echocardiography was used to delineate haemodynamics in obese pregnant women. Mean arterial blood pressure and left ventricular mass were increased in obese pregnant woman. The incidence of diastolic impairment and reduced myocardial performance were similar between groups.     

Effect of dynamic hip system blade on the treatment of femoral neck fractures in elderly patients with osteoporosis

Objective：To discuss the curative effect of the dynamic hip system blade （DHS-blade） on the treatment of femoral neck fractures in elderly patients with osteoporosis.Methods：A retrospective study was conducted to analyse the clinical data of 60 elderly patients with osteoporosis who had been treated for femoral neck fractures with DHS-blade in our department between September 2012 and February 2014.There were 22 males and 38 females with a mean age of （66.8±3.2） years.According to the Singh Index Classification,all the patients＇ Singh index was below level 3.The Harris criterion and function recovery after operation were analysed.Results：All patients were followed up for 12-17 months （mean 14 months）.No femoral head necrosis,femoral neck shortening,internal fixation loosening or backing out of the nails occurred.Bone nonunion was found in one case and he had a good recovery after total hip arthroplasty.The time for fracture healing ranged from 3-6 months （average 3.5 months）.According to Harris criterion,35 cases were rated as excellent,22 good,2 fair and 1 poor.The Harris scale was significantly improved from 28.46±2.35 preoperatively to 91.98±3.26 at 6 months postoperatively （P＜0.05）.Conclusion：DHS-blade,being minimally invasive,allowing earlier postoperative exercise and avoiding the complications elicited by traditional internal fixation,is advisable for treatment of femoral neck fractured patients with osteoporosis.     

Vitamin D inadequacy in French osteoporotic and osteopenic women

ObjectiveStudies have shown that low serum vitamin D levels are associated with secondary hyperparathyroidism, which decreases bone strength and increases fracture risk, most notably after 50 years of age. The objective of this study was to evaluate the vitamin D status of postmenopausal women in France.MethodsWe conducted a cross-sectional observational study of 1292 menopausal women with osteoporosis or osteopenia. The age range was 52–94 years. Serum 25-OH-vitamin D was assayed in each patient. Based on data in the literature, we used four 25-OH-D cutoffs to define vitamin D deficiency: 30, 50, 75, and 80 nmol/L (<12, <20, <30, and <32 ng/ml).ResultsMean serum 25-OH-D was 51.5 ± 26.1 nmol/L (about 20.6 ± 10.4 ng/ml). In the 343 (26.5%) patients taking supplemental vitamin D with or without supplemental calcium, the mean serum 25-OH-D level was significantly higher than in the other patients (65.0 ± 26.0 ng/ml vs. 46.6 ± 18.6 ng/ml; P < 0.001). In the subgroup not taking vitamin D supplements, the prevalence of vitamin D deficiency was 27.3%, 54.1%, 89.9%, and 93.2% with the 30, 50, 75, and 80 nmol/L cutoffs, respectively. The mean 25-OH-D level varied across seasons (P < 0.001), with the highest value being obtained in summer (53.4 ± 18.7 nmol/L; about 21.3 ± 7.5 ng/ml).ConclusionVitamin D deficiency is common among postmenopausal women with osteoporosis or osteopenia in France.