Verbal numerical scales are as reliable and sensitive as visual analog scales for rating dyspnea in young and older subjects

This study compared the use of a simple verbal 0-10 numerical rating scale (verbal NRS) and a visual analog scale (VAS) for the rating of dyspnea during exercise in a group of young and older subjects. Twelve younger (32+/-9 yr) and 12 older (71+/-7 yr) subjects used either the verbal NRS or the VAS in a randomised fashion to rate dyspnea during 60 s of uphill treadmill walking (range 5.6-8.8 km h(-1)) performed at either a low (17% grade) or high workload (26% grade) and then during recovery. Rating scales were evaluated twice on separate days (day 1 and day 2) at each workload. While the verbal NRS scores proved to be reliable throughout exercise and recovery, VAS scores were significantly (p<0.05) lower on day 2 during the low workload test (younger group) and the high workload test (older group). Verbal NRS ratings were consistently greater than VAS ratings at both workloads (p<0.001) for both young and older groups. The intra-class correlation coefficients for rating peak dyspnea using either the VAS or verbal NRS were consistently lower for the older subjects (range: r=0.54-0.67) than the younger subjects (range: r=0.70-0.86). Overall, subjects preferred the verbal NRS to the VAS. These results suggest that the verbal NRS compares favourably with the VAS for rating dyspnea during exercise without mask or mouthpiece. However, when rating peak dyspnea both scales appear less reliable when used by the older compared to young subjects.     

The impact of venous occlusion per se on forearm muscle blood flow: implications for the near-infrared spectroscopy venous occlusion technique

The purpose of this study was to examine the effect of venous occlusion per se on forearm muscle blood flow, as determined by the near-infrared spectroscopy (NIRS) venous occlusion technique (NIRS-VOT). NIRS data were obtained from the flexor digitorum superficialis (FDS) muscle on the dominant arm of 16 young, ostensibly healthy participants (14 men and two women; 30 ± 6 year; 73 ± 7 kg). Participants completed a series of five venous occlusion trials while seated at rest, and a series of 12 venous occlusion trials during a reactive hyperaemia induced by 5 min of forearm arterial occlusion. The NIRS-VOT was used to assess FDS muscle blood flow (), beat-by-beat, over the first four cardiac beats during venous occlusions. was also reported as a cumulative value, wherein the first two, first three and first four cardiac beats were used to calculate muscle blood flow. We observed that was highest when calculated over the first cardiac beat during venous occlusions performed at rest and throughout reactive hyperaemia (P<0·05). Moreover, the inclusion of more than one cardiac beat in the calculation of underestimated muscle blood flows, irrespective of the prevailing level of arterial inflow. These findings support the idea that venous occlusion per se affects the measurement of via the NIRS-VOT. Accordingly, it is recommended that is determined over the first cardiac beat when using the NIRS-VOT to assess microvascular blood flow of human forearm muscles.     

Fingertip replantation: Technical considerations and outcome analysis of 24 consecutive fingertip replantations

Fingertip amputations are one of the most common injuries faced in an emergency department. Finger tip replantation though technically possible, are not regularly done due to the presumed complexity of the procedure and doubts about the outcome. This article deals with our experience of 24 fingertip replantations in 24 patients done over a period of 8 years since the year 2000. Twenty-one fingertips survived. The most common affected digit in the series was thumb followed by index, middle, and ring. The overall success rate was 87%. Both arterial and venous repair were done in all cases. Replantation was not done if no suitable vein was found for anastomosis. Nine patients did not have nerve repair. Seven of them survived and all of them had satisfactory sensation when examined after 1 year. No patient suffered from cold intolerance. All patients were satisfied with the functional outcome and aesthetic appearance. This article highlights the technical considerations and the outcome of these fingertip replants.KEY WORDS: Distal replantation, finger tip replantation, tip amputations, technical considerations     

MDM2 SNP309 G allele increases risk but the T allele is associated with earlier onset age of sporadic breast cancers in the Chinese population

Sporadic breast cancer in women <40 years is uncommon inCaucasians, in contrast to a much earlier onset in Chinese Asians.However, the molecular determinants for this earlier onset areunclear. It has been reported that SNP309 in the promoter ofMDM2, the negative regulator of p53, affects the onset age ofcancers in females. Essentially, the G allele, rather than theT allele, has been suggested to accelerate the age of canceronset. Hence, we examined if MDM2 and p53 polymorphisms wouldbe determinants of the early onset phenomenon in Chinese women.Our results indicate that the MDM2 SNP309 G allele is more prevalentin the Chinese population compared with reported frequenciesin Caucasians, and increases breast cancer risk of both sporadiccases and those with family history. However, it was the T/Tgenotype that was associated with earlier onset age of sporadicbreast cancers in contrast to the G allele that was associatedwith the familial cases. Though p53 codon 72 single-nucleotidepolymorphism (SNP) did not affect general cancer risk or ageof onset, arginine homozygozity, in contrast to proline homozygozity,was found to decrease breast cancer risk in the later onsetsporadic cases. Both SNP309 and codon 72 polymorphisms did notaffect the stage of cancer. Together, the data suggest thatthough the MDM2 SNP309 G allele is a risk factor for breastcancer, it does not accelerate, but delays the onset of thesporadic disease in Chinese women, highlighting that differencesin ethnicity and family history may influence the role of MDM2SNP309 in cancer susceptibility. Abbreviations: Arg, arginine; ER, estrogen receptor; OR, odds ratio; PCR, polymerase chain reaction; Pro, proline; SNP, single-nucleotide polymorphism Received September 3, 2007; revised January 17, 2008; accepted January 18, 2008.     

Pedal macrodactyly treated by digital shortening and free nail graft; a report of two cases

Two cases of macrosyndactyly of the foot are reported which were successfully treated by shortening of the affected digits and free nail grafting.