A new chart to monitor weight gain during pregnancy

A new chart to monitor maternal weight gain during pregnancy is presented. The chart is based on the adequacy of maternal weight for height, as suggested by a modified table of weight for average frame size, and the data were derived from a low-income racially-mixed population living in New York City. A nomogram accompanies the chart and is used to calculate values of percentage of "standard weight" at various gestational ages. The chart establishes a desirable weight near term which is equivalent to 120 percent of "standard weight" for women with a pre-pregnancy weight equal to or lower than 100 percent of "standard weight". For women with pre-pregnancy weight above 100% of "standard weight" the desirable weight near term varies according to the initial weight but includes a minimal weight gain of 7 kg for women with pre-pregnancy weight over 120% of standard. Women who attained or exceeded body weight near term equivalent to 120 percent of "standard weight" in low income populations in the US and Chile delivered infants with significantly higher mean birth weight than those from mothers who did not meet this goal.     

Recurrence of pulmonary embolism during anticoagulant treatment: a prospective study.

The risk of early recurrence of pulmonary embolism in patients with venous thromboembolic disease treated by anticoagulants is not well established. To determine the risk linked to contemporary proximal deep venous thrombosis, a prospective study was organised to give clinical and scintigraphic surveillance to 50 patients with angiographically proved pulmonary embolism plus phlebographically proved proximal deep vein thrombosis during the first 15 days of anticoagulant treatment. Perfusion lung scans were performed initially and on days 3, 7, and 15. Only two patients had a recurrence of pulmonary embolism during this period; both episodes were revealed by new symptoms, and one recurrence was fatal. The systematic performance of angiography in four patients found to have new scintigraphic defects led to the diagnosis of "spurious scintigraphic recurrence" in three of them. It is concluded that (a) adjusted anticoagulant treatment showed an effectiveness of 96% for preventing early recurrence of pulmonary embolism in this group of supposed high risk patients, and (b) in patients with recent pulmonary embolism new defects on systematic perfusion lung scans are not specific indicators of recurrent pulmonary embolism.     

Liver transplantation versus liver resection for colorectal liver metastasis: a survival benefit analysis in patients stratified according to tumor burden score

Liver transplantation (LT) for colorectal liver metastasis (CRLM) may provide excellent survival rates in patients with unresectable disease. High tumor load is a risk factor for recurrence and low overall survival (OS) after liver resection (LR). We tested the hypothesis that LT could offer better survival than LR in patients with high tumor load. LR performed at Padua University Hospital for CRLM was compared with LT for unresectable CRLM performed both at Oslo and Padua. High tumor load was defined as tumor burden score (TBS) ≥ 9, and inclusion criteria were as in the SECA-I transplant study. 184 patients were eligible: 128 LRs and 56 LTs. 5-year OS after LR and LT was 40.5% and 54.7% (P = 0.102). In the high TBS cohort, 5-year OS after LR and LT was 22.7% and 52.2% (P = 0.055). In patients with Oslo score ≤ 2 and TBS ≥ 9 (13 LR; 24 LT) the 5-year OS after LR and LT was 14.6% and 69.1% (P = 0.002). The corresponding disease-free survival (DFS) was 0% and 22.9% (P = 0.005). Selected CRLM patients with low Oslo score and high TBS could benefit from LT with survival outcomes that are far better than what is achieved by LR.     

Bone and joint transplantation. Alternatives to bridging segmental bone defects and a model for allogenic bone transplantation

Fresh allogeneic diaphyseal bone segments were transplanted into 12 dogs. We attempted to improve the immunogenity and incorporation of the bone segments through "graft manipulation" with and without immunosuppression. Through clinical and radiological study during the 20-week experimental period, we observed transplant healing with differing structural phenomena. After autologous knee joint replantation in 4 dogs and allogeneic transplantation in 2 dogs (with and without revascularization and immunomodulation with Cyclosporin A) we present a canine model to investigate all open questions about the transplantation of allogeneic, fresh joints (i.e. transplant biology, immunology, and vitality).     

Hip axis length in an Italian osteoporotic population

Models proposed so far for the pathogenesis of osteoporosis often do not take into account the factors underlying the different incidences of hip fracture in different populations. To address this issue, we identified 34 female patients with hip fracture (HF) and 16 women with at least four vertebral fractures (VF) in a population-based retrospective study. Each participant had a bone mineral density (BMD) measurement of the lumbar spine and hip using a Hologic QDR-2000 scanner, in single beam mode for the latter site. Hip axis length (HAL) was determined automatically (precision 1.5%). HAL derived from 149 normal subjects (age range 19-75 years) was 10.3 +/- 0.5 cm. BMD values found at the femoral neck were almost similar, but differed significantly at the spine between the two groups. Mean values of femur HAL in HF patients (10.55 +/- 0.5 cm) were significantly higher compared with VF patients (9.85 +/- 0.54 cm; p < 0.001). Interestingly, both mean values differed significantly from the mean for normal subjects. Our results demonstrate that patients with multiple vertebral fractures have significantly lower vertebral BMD values but similar femoral neck values compared with patients who fracture at the hip; furthermore, hip axis length was more than 1 SD higher in these latter patients compared with that of VF patients. These results suggest that the size and shape of the hip can explain part of the observed aetiologic differences between these two types of osteoporotic fractures.     

Weekly paclitaxel as first-line chemotherapy in elderly advanced breast cancer patients: a phase II study of the Gruppo Italiano di Oncologia Geriatrica (GIOGer).

BACKGROUND: First-line chemotherapy regimens suitable for elderly advanced breast cancer patients are still not defined. PATIENTS AND METHODS: Women with stage III or IV breast cancer aged > or =70 years were enrolled in a phase II study aimed to evaluate both activity and toxicity of weekly paclitaxel. Among 46 planned patients, at least 18 responses and not more than seven unacceptable toxic events are required for a favourable conclusion. Paclitaxel 80 mg/m(2) was administered weekly for 3 weeks every 28 days. RESULTS: Unacceptable toxicity occurred in seven out of 46 patients evaluated for toxicity [15.2%; exact 95% confidence interval (CI) 7.6% to 28.2%] and was represented by one case of febrile neutropenia, one case of severe allergic reaction and five cases of cardiac toxicity. Among 41 patients evaluated for response, a complete response occurred in two (4.9%) patients and a partial response in 20 (48.8%), with an overall response rate of 53.7% (exact 95% CI 38.7% to 67.9%). The median progression-free survival was 9.7 months (95% CI 8.5-18.7) and median survival was 35.8 months (95% CI 19-not defined). CONCLUSIONS: Weekly paclitaxel is highly active in elderly advanced breast cancer patients. Data on cardiovascular complications, however, indicate the need for a careful monitoring of cardiac function before and during chemotherapy.     

Diluted magnetic semiconductor properties in TM doped ZnO nanoparticles

The hydrothermal method was used to create dilute magnetic semiconductor nanoparticles of Zn_1−xCo_xO (x = 0, 0.01, 0.05, 0.09). The effect of cobalt doping on the microstructure, morphological and optical properties of Zn_1−xCo_xO was also studied and the Co doping to host ZnO was confirmed from XRD and EDX analysis. The structural analysis showed that doping of cobalt into ZnO decreased the crystallinity, but the preferred orientation didn''t change. SEM analysis revealed that the cobalt dopant did not have a strong influence on the shape of the synthesized nanoparticles. No defect-related absorption peaks were observed in the UV-Vis spectra. The crystallinity of the doped samples was improved by high growth temperature and long growth time. Ferromagnetic behavior above room temperature was detected in co-doped ZnO nanoparticles. The ferromagnetic behavior increased with increasing Co (up to x = 0.05) doping. The ferromagnetic behavior declined when the Co content was further increased. Related research shows that doped ZnO nanoparticles have better dielectric, electrical conductivity, and magnetic properties than pure ZnO. This high ferromagnetism is usually a response reported for dilute magnetic semiconductors. These semiconductor nanoparticles were further used to designed spintronic based applications.

The enlarged central part M–H loop shows for the Co = 0.09 doped ZnO sample, the ferromagnetic (FM) behavior increased, i.e., a M_r of 0.2412 emu g⁻¹ with a H_c of 85 Oe.     

Initial Achilles tendon repair strength-synthesized biomechanical data from 196 cadaver repairs

Purpose

The study aim was to describe what kind of operative technique performs best with respect to initial strength after the surgical repair of acute Achilles tendon ruptures.

Methods

We performed a systematic search of the keywords “Achilles tendon AND (suture strength OR biomechanics) AND (cadaver NOT animal)” in the online databases PubMed, EMBASE, CINAHL, and the Cochrane Library. We included studies that employed open, mini-open, or percutaneous Achilles tendon repair in human cadavers, and assessed some measure of tensile strength as a primary outcome.

Results

Our search produced 11 relevant papers reporting results for Kessler, Bunnell, and Krackow sutures in open repair, as well as the Achillon device, the Ma-Griffith repair technique, the triple bundle technique and the “giftbox” technique. The weighted tensile strengths ranged from 81 to 453 N (mean 222.7 N) with the Triple Bundle technique in combination with # 2 Ethibond performing best with a mean of 453 N.

Conclusions

Due to the small sample sizes, different study designs, and heterogeneity of strength measurement techniques, definite recommendations on surgical technique cannot be made but presented information might help in the decision making process for foot and ankle surgeons.     

Automatic prediction of infarct growth in acute ischemic stroke from MR apparent diffusion coefficient maps

RATIONALE AND OBJECTIVES: We introduce a new approach to the prediction of final infarct growth in human acute ischemic stroke based on image analysis of the apparent diffusion coefficient (ADC) maps obtained from magnetic resonance imaging. Evidence from multiple previous studies indicate that ADC maps are likely to reveal brain regions belonging to the ischemic penumbra, that is, areas that may be at risk of infarction in the few hours following stroke onset. MATERIALS AND METHODS: In a context where "time is brain," and contrarily to the alternative-and still-debated-perfusion-diffusion weighted image (PWI/DWI) mismatch approach, the DWI magnetic resonance sequences are standardized, fast to acquire, and do not necessitate injection of a contrast agent. The image analysis approach presented here consists of the segmentation of the ischemic penumbra using a fast three-dimensional region-growing technique that mimics the growth of the infarct lesion during acute stroke. RESULTS: The method was evaluated with both numerical simulations and on two groups of 20 ischemic stroke patients (40 patients total). The first group of patient data was used to adjust the parameters of the model ruling the region-growing procedure. The second group of patient data was dedicated to evaluation purposes only, with no subsequent adjustment of the free parameters of the image-analysis procedure. Results indicate that the predicted final infarct volumes are significantly correlated with the true final lesion volumes as revealed by follow-up measurements from DWI sequences. CONCLUSION: The DWI-ADC mismatch method is an encouraging fast alternative to the PWI-DWI mismatch approach to evaluate the likeliness of infarct growth during the acute stage of ischemic stroke.