Should we change our approach to resuscitating victims of femoral fracture?A clinical experience in a busy trauma hospital in Shiraz,Iran

Purpose Traumatic hemorrhagic shock is a life-threatening event worldwide.Severe brain trauma accompanying femoral fractures can trigger inflammatory responses in the body and increase pre-inflammatory cytokines such as TNF-α,IL-1.The primary treatment in these cases is hydration with crystalloids,which has both benefits and complications.The purpose of this study was to investigate the effects of fluid therapy on the hemodynamics,coagulation profiles,and blood gases in such patients.Methods In this cross-sectional study,patients were divided into two groups:femoral fracture group and non-femoral group.The hemodynamic status,coagulation profile,and blood gases of patients in both groups were evaluated upon arrival at the hospital and again 2 h later.Data were analyzed by t-test and ANOVA with repeated data and paired samples t-test.Results A total of 681 trauma patients(605 men and 76 women)participated in this study,including 69(86.3%)men and 11(13.8%)women in femoral fracture group and 536 men(89.2%)and 65 women(10.8%)in non-femoral group.The laboratory parameters were evaluated in response to the equal amount of crystalloid fluid given upon arrival and 2 h later.Blood gases decreased in the fracture group despite fluid therapy(p<0.003),and the coagulation profile worsened although the change was not statistically significant.Conclusion The treatment of multiple-trauma patients with femoral bone fractures should be more concerned with the need for the infusion of vasopressors such as norepinephrine.If there is evidence of clinical shock,excessive crystalloid infusion(limited to 1 L)should be avoided,and blood and blood products should be started as soon as possible.     

Twelve tips for assessment psychometrics

It is incumbent on medical schools to show, both to regulatory bodies and to the public at large, that their graduating students are “fit for purpose” as tomorrow’s doctors. Since students graduate by virtue of passing assessments, it is vital that schools quality assure their assessment procedures, standards, and outcomes. An important part of this quality assurance process is the appropriate use of psychometric analyses. This begins with development of an empowering, evidence-based culture in which assessment validity can be demonstrated. Preparation prior to an assessment requires the establishment of appropriate rules, test blueprinting and standard setting. When an assessment has been completed, the reporting of test results should consider reliability, assessor, demographic, and long-term analyses across multiple levels, in an integrated way to ensure the information conveyed to all stakeholders is meaningful.     

Recent trends in chemistry,structure, and various applications of 1-acyl-3-substituted thioureas: a detailed review

The interest in acyl thioureas has continually been escalating owing to their extensive applications in diverse fields, such as synthetic precursors of new heterocycles, pharmacological and materials science, and technology. These scaffolds exhibit a wide variety of biological activities such as antitumor, enzyme inhibitory, anti-bacterial, anti-fungal, and anti-malarial activities and find utilization as chemosensors, adhesives, flame retardants, thermal stabilizers, antioxidants, polymers and organocatalysts. In addition, the synthesis, and applications of coordination complexes of these ligands have also been overviewed. The current review is a continuation of our previous efforts in this area, focusing on the recent advancements during the period 2017 to present.

This review encapsulates the recently designed acyl thioureas, and their crystal structures, metal complexes and various applications from 2017 to present, including pharmacological aspects, chemosensing and heterogenous catalysis.     

Can a Patient use an App at Home to Measure Knee Range of Motion? Utilizing a Mobile App,Curovate, to Improve Access and Adherence to Knee Range of Motion Measurements

IntroductionKnee range of motion is a critical measure of progress after knee injury and knee surgery. However, many patients do not understand the importance of knee range of motion and most do not have a way to self-monitor their knee range of motion at home. The patient being able to measure their own range of motion can provide improved access to this critical health metric, and could improve adherence with their daily knee range of motion exercises. The purpose of this technical report is to determine if a mobile app, Curovate, can provide reliable measures of knee range of motion compared to standard goniometric measurements.ProceduresThere were four positions of knee flexion and four positions of knee extension each measured twice with a standard goniometer and four different mobile devices with the app Curovate. The reliability and validity of the Curovate app was tested across mobile devices and operating systems and compare to goniometric knee range of motion measurements. A total of 80 measurements were taken. All testing was completed on a healthy 23-year-old male with no knee pathology.ResultsA strong positive correlation, Pearson’s r > = 0.9985, for all positions of knee flexion and extension across all four mobile devices as well as each mobile device compared to standard goniometric measurements.ConclusionsThis article presents a unique method for patients to measure their knee range of motion using the mobile app Curovate. Overall, the mobile app, Curovate, was found to have a strong positive correlation across four mobile devices with varying operating systems and compared to goniometric measurements.Level of evidence4     

Development of the Korea-Polyenvironmental Risk Score for Psychosis

Objective Comprehensive understanding of polyenvironmental risk factors for the development of psychosis is important. Based on a review of related evidence, we developed the Korea Polyenvironmental Risk Score (K-PERS) for psychosis. We investigated whether the K-PERS can differentiate patients with schizophrenia spectrum disorders (SSDs) from healthy controls (HCs). Methods We reviewed existing tools for measuring polyenvironmental risk factors for psychosis, including the Maudsley Environmental Risk Score (ERS), polyenviromic risk score (PERS), and Psychosis Polyrisk Score (PPS). Using odds ratios and relative risks for Western studies and the “population proportion” (PP) of risk factors for Korean data, we developed the K-PERS, and compared the scores thereon between patients with SSDs and HCs. In addition, correlation was performed between the K-PERS and Positive and Negative Syndrome Scale (PANSS). Results We first constructed the “K-PERS-I,” comprising five factors based on the PPS, and then the “K-PERS-II” comprising six factors based on the ERS. The instruments accurately predicted participants’ status (case vs. control). In addition, the K-PERS-I and -II scores exhibited significant negative correlations with the negative symptom factor score of the PANSS. Conclusion The K-PERS is the first comprehensive tool developed based on PP data obtained from Korean studies that measures polyenvironmental risk factors for psychosis. Using pilot data, the K-PERS predicted patient status (SSD vs. HC). Further research is warranted to examine the relationship of K-PERS scores with clinical outcomes of psychosis and schizophrenia.     

Effect of ascorbic acid,ethanol and acetone on adhesion between the treated fiber posts and composite resin cores

PURPOSE

The aim of the present study was to assess the effect of ascorbic acid, ethanol and acetone on microtensile bond strength between fiber posts pre-treated with hydrogen peroxide and composite resin cores.

MATERIALS AND METHODS

Twenty four fiber posts were pre-treated with 24% hydrogen peroxide and divided into 4 groups as follows: G1: no treatment, as control group; G2: treatment with 10% ascorbic acid solution for 5 minutes; G3: treatment with 70% ethanol solution for 5 minutes; and G4: treatment with 70% acetone solution for 5 minutes. Each fiber post was surrounded by a cylinder-shaped polyglass matrix which was subsequently filled with composite resin. Two sections from each sample were selected for microtensile test at a crosshead with speed of 0.5 mm/min. Statistical analyses were performed using one-way ANOVA and a post hoc Tukey HSD test. Fractured surfaces were observed under a stereomicroscope at ×20 magnification. The fractured surfaces of the specimens were observed and evaluated under a SEM.

RESULTS

Means of microtensile bond strength values (MPa) and standard deviations in the groups were as follows: G1: 9.70±0.81; G2: 12.62±1.80; G3: 16.60±1.93; and G4: 21.24±1.95. G4 and G1 had the highest and the lowest bond strength values, respectively. A greater bond strength value was seen in G3 compared to G2. There were significant differences between all the groups (P<.001). All the failures were of the adhesive mode.

CONCLUSION

Application of antioxidant agents may increase microtensile bond strength between fiber posts treated with hydrogen peroxide and composite cores. Acetone increased bond strength more than ascorbic acid and ethanol.