Use of irradiated autologous bone in joint sparing endoprosthetic femoral replacement tumor surgery

Background:

Joint preservation is usually attempted in cases of bone tumors, though insufficient bone following tumour resection may prevent fixation of conventional joint sparing prosthesis. To preserve the hip joint in skeletally immature patients, we have combined autologous proximal femoral irradiation and intercalary re-implantation with custom made distal femoral replacements.

Materials and Methods:

A retrospective cohort study of four patients (aged 4-12 years); in whom irradiated autologous bone was combined with an extendable distal femoral endoprostheses was performed. There were three cases of osteosarcoma and one case of Ewing’s sarcoma.

Results:

At a mean follow-up of 70.5 months (range 26-185 months), all four patients were alive without evidence of local recurrence. There was no evidence of metastatic disease in three patients while one patient showed chest metastatic disease at presentation. In all cases, the irradiated segment of bone united with the proximal femur and demonstrated bone ongrowth at the prosthetic collar. There were no cases of loosening or peri-prosthetic fracture. One implant was revised after 14 years following fracture of the extending component of the endoprosthesis.

Conclusions:

We report encouraging results utilizing irradiated autologous proximal femoral bone combined with distal femoral replacement in skeletally immature patients.     

Psychometric testing of the modified Care Dependency Scale among hospitalized school-aged children in Germany

Abstract   The objectives of this study were to examine the psychometric properties of the modified Care Dependency Scale in a pediatric setting and to explore the extent of dependency of school-aged children regarding their self-care. The data were collected from 130 hospitalized children, aged 6–12 years. The reliability was determined by Cronbach's alpha, which showed a high level of consistency. The subsequent inter-rater reliability revealed moderate-to-substantial agreement. The criterion-related validity was tested by comparing the sum scores of the Care Dependency Scale for Paediatrics and the Visual Analog Scale. Factor analysis was used to investigate the construct validity and resulted in a one-factor solution. In conclusion, this study provides evidence that the Care Dependency Scale for Paediatrics is a valid and reliable measure that offers a comprehensive assessment from a nursing perspective and enables nurses to help children acquire independence.     

The reliability of the Hendrich Fall Risk Model in a geriatric hospital

Aims and objectives. The purpose of this study was to test the interrater reliability of the Hendrich Fall Risk Model, an instrument to identify patients in a hospital setting with a high risk of falling. Background. Falls are a serious problem in older patients. Valid and reliable fall risk assessment tools are required to identify high-risk patients and to take adequate preventive measures. Methods. Seventy older patients were independently and simultaneously assessed by six pairs of raters made up of nursing staff members. Consensus estimates were calculated using simple percentage agreement and consistency estimates using Spearman's rho and intra class coefficient. Results. Percentage agreement ranged from 0.70 to 0.92 between the six pairs of raters. Spearman's rho coefficients were between 0.54 and 0.80 and the intra class coefficients were between 0.46 and 0.92. Conclusions. Whereas some pairs of raters obtained considerable interobserver agreement and internal consistency, the others did not. Therefore, it is concluded that the Hendrich Fall Risk Model is not a reliable instrument. The use of more unambiguous operationalized items is preferred. Relevance to clinical practice. In practice, well operationalized fall risk assessment tools are necessary. Observer agreement should always be investigated after introducing a standardized measurement tool.     

A 4-cm thermoactive viscoelastic foam pad on the operating room table to prevent pressure ulcer during cardiac surgery

Aims and objectives. In this experimental study, a 4‐cm thermoactive viscoelastic foam overlay and a heating source on the operating room table was compared with the standard operating room table with a heating source for the effect on the postoperative pressure ulcer incidence in cardiac surgery patients. Background. Pressure ulcer incidence in the cardiac surgery population is reported to be up to 29·5%. The prolonged compressive forces from lying on the operating room table are one source of pressure ulcer development in this population. Pressure‐reducing devices on the operating room (OR)‐table should reduce the patients’ interface pressure and thus the hazard of skin breakdown. Methods. A randomized controlled trial was performed to test the effect of a 4‐cm thermoactive viscoelastic foam overlay with a water‐filled warming mattress on the OR‐table (test OR‐table) compared with the standard OR‐table (a water‐filled warming mattress, no pressure‐reducing device) on the postoperative pressure ulcer incidence in cardiac surgery patients. Instruments. The pressure ulcer classification system of the European Pressure Ulcer Advisory Panel (EPUAP) was used for pressure ulcer grading. Results. The results show that patients lying on the 4‐cm thermoactive viscoelastic foam overlay suffer slightly more pressure ulcer (17·6%) than patients on the standard OR‐table without the foam overlay (11·1%). Because of the clinical relevance of the results, the randomized controlled trial was terminated after 175 patients at the interim analysis although the power calculation stated 350 patients. Conclusions. The combination of a 4‐cm viscoelastic foam overlay and a warming source cannot be recommended for pressure ulcer prevention on the operating room table. Relevance to clinical practice. Foam overlays are used to prevent pressure ulcers in patients. It is necessary to use such devices according to patient safety and use of resources.     

卵胞质移植、克隆与逆向克隆

目的:最近人类卵细胞间的胞质移植被作为人类辅助生殖生物技术的手段并成为研究热点。本文回顾了该领域的研究进展和存在的问题,并以此为基础提出“逆向克隆技术”这一新概念。资料来源:应用计算机检索PUBMED 1998-01/2006-12期间的相关文章,检索词为“ooplasmic transfer,mitochondria heteroplasmy,animal cloning”,并限定文章语言种类为English。同时计算机检索万方数据库1998-01/2006-12期间的相关文章,检索词为“胞质转移,线粒体异质性,动物克隆”,并限定文章语言种类为中文。资料选择:对资料进行初审,并查看每篇文献后的引文。纳入标准:文章所述内容应与卵胞质移植、克隆或逆向克隆研究相关。排除标准:重复研究或Meta分析类文章。资料提炼:共收集到126篇相关文献,31篇文献符合纳入标准,排除的95篇文献为内容陈旧或重复。符合纳入标准的31篇文献中,17篇涉及卵胞质移植,13篇涉及动物克隆,1篇涉及逆克隆。资料综合:人类的生殖技术领域发展迅速,卵胞质移植技术得到广泛应用。研究表明,卵胞质对受精和胚胎发育具有重要作用,其中线粒体与受精和胚胎发育关系最为密切。大量实验对细胞质与细胞核的相互作用、基因组的重编程机制上进一步研究,同时也在技术上不断改进。克隆技术有广阔的应用前景,同时也存在着不少问题,基于此提出以胞质转移为基础的“逆向克隆技术”。结论:线粒体对卵母细胞的受精和胚胎发育有显著影响,但卵胞质移植可能导致线粒体的异质性及其潜在的问题还需要进一步研究。以卵胞质转移为基础的“逆向克隆技术”是否能达到克隆动物的结果前景喜人。