Changes to level ground transtibial amputee gait with a weighted backpack

Background

Many occupations and hobbies require the use of a weighted pack. To date there has been limited backpack gait studies performed on the amputee population. It is important that we address this knowledge gap in order to further improve individual's quality of living through changes in rehabilitation, and prosthesis development.

Methods

The study population was ten male, unilateral, traumatic, K4-level (ability for prosthetic ambulation with high impact, stress, or energy levels), transtibial amputees. Ten walking trials were collected on level ground; five with a 24.5 kg backpack and five without a backpack. Temporal–spatial parameters and kinematic and kinetic peak values for the ankle, knee, hip, pelvis, and trunk were collected and analyzed for significant differences.

Findings

Temporal–spatial parameters incurred changes that were congruent with the literature on able bodied individuals. Pelvis speeds and range of motion decreased with the pack. Knee flexion during weight acceptance increased, and was supported on the intact limb by increased eccentric knee power during weight acceptance. Hip flexion on both limbs also increased during weight acceptance while wearing the backpack.

Interpretation

The backpack load can be accommodated by people at a K4 functional level for level ground walking. At the prosthetic limb, greater deformation was found at the foot–ankle and further increases in pack weight and higher impact tasks (i.e., jogging) could lead to decreased performance for some prosthetic feet. Gait training programs should focus on removing any gait asymmetries and increasing the strength of both the hip and knee flexors.     

Requirement for a structured algorithm in cardiac arrest following major trauma: Epidemiology,management errors,and preventability of traumatic deaths in Berlin

Background

Despite continuous innovation in trauma care, fatal trauma remains a significant medical and socioeconomic problem. Traumatic cardiac arrest (tCA) is still considered a hopeless situation, whereas management errors and preventability of death are neglected. We analyzed clinical and autopsy data from tCA patients in an emergency-physician-based rescue system in order to reveal epidemiologic data and current problems in the successful treatment of tCA.

Material and methods

Epidemiological and autopsy data of all unsuccessful tCPR cases in a one-year-period in Berlin, Germany (n = 101, Group I) and clinical data of all cases of tCPR in a level 1 trauma centre in an 6-year period (n = 52, Group II) were evaluated. Preventability of traumatic deaths in autopsy cases (n = 22) and trauma-management failures were prospectively assessed.

Results

In 2010, 23% of all traumatic deaths in Berlin received tCPR. Death after tCPR occurred predominantly prehospital (PH;74%) and only 26% of these patients were hospitalized. Of 52 patients (Group II), 46% required tCPR already PH and 81% in the emergency department (ED). In 79% ROSC was established PH and 53% in the ED. The survival rate after tCPR was 29% with 27% good neurological outcome. Management errors occurred in 73% PH; 4 cases were judged as potentially or definitive preventable death.

Conclusion

Trauma CPR is beyond routine with the need for a tCPR-algorithm, including chest/pericardial decompression, external pelvic stabilization and external bleeding control. The prehospital trauma management has the highest potential to improve tCPR and survival. Therefore, we suggested a pilot prehospital tCPR-algorithm.     

Bisphosphonates and glucocorticoid osteoporosis in men: results of a randomized controlled trial comparing zoledronic acid with risedronate

Background

We studied 265 men (mean age 56.4 years; range 18-83 years), among patients enrolled in two arms of a double-blind, 1-year study comparing the effects of zoledronic acid (ZOL) with risedronate (RIS) in patients either commencing (prednisolone 7.5 mg/day or equivalent) (prevention arm, n = 88) or continuing glucocorticoid therapy (treatment arm, n = 177).

Methods

Patients received either a single ZOL 5 mg infusion or RIS 5 mg oral daily at randomization, along with calcium (1000 mg) and vitamin D (400-1200 IU). Primary endpoint: difference in percentage change from baseline in bone mineral density (BMD) at the lumbar spine (LS) at 12 months. Secondary endpoints: percentage changes in BMD at total hip (TH) and femoral neck (FN), relative changes in bone turnover markers (β-CTx and P1NP), and overall safety.

Findings

In the treatment subpopulation, ZOL increased LS BMD by 4.7% vs. 3.3% for RIS and at TH the percentage changes were 1.8% vs. 0.2%, respectively. In the prevention subpopulation, bone loss was prevented by both treatments. At LS the percentage changes were 2.5% vs. − 0.2% for ZOL vs. RIS and at TH the percentage changes were 1.1% vs. − 0.4%, respectively. ZOL significantly increased lumbar spine BMD more than RIS at Month 12 in both the prevention population (p = 0.0024) and the treatment subpopulation (p = 0.0232) in men. In the treatment subpopulation, ZOL demonstrated a significantly greater reduction in serum β-CTx and P1NP relative to RIS at all time-points. In the prevention subpopulation, ZOL significantly reduced β-CTx? at all time-points, and P1NP at Month 3 (p = 0.0297) only. Both treatments were well tolerated in men, albeit with a higher incidence of influenza-like illness and pyrexia events post-infusion with ZOL.

Interpretation

Once-yearly ZOL preserves or increases BMD within 1 year to a greater extent than daily RIS in men receiving glucocorticoid therapy.     

NP与CAP方案治疗晚期非小细胞肺癌临床观察

目的比较NP(去甲长春花碱、顺铂)和CAP(环磷酰胺、阿霉素、顺铂)联合化疗方案治疗晚期非小细胞肺癌(NSCLC)的近期疗效和毒副反应。方法统计分析72例接受NP或CAP方案联合化疗的晚期非小细胞肺癌患者的疗效和毒副反应,其中NP方案42例,CAP方案30例。结果NP组42例,有效19例,有效率为45.24%,CAP组30例,有效11例,有效率为36.67%,两者疗效无显著差异(P>0.05),两者毒副反应主要为骨髓抑制及恶心呕吐,均可耐受。结论NP和CAP方案治疗非小细胞肺癌疗效肯定,毒副反应可耐受,可作为一线治疗方案。     

NP方案治疗晚期非小细胞肺癌疗效观察

目的　观察NVB加PDD治疗晚期非小细胞肺癌疗效。方法　 1999年 7月～ 2 0 0 1年 8月我们应用进口长春瑞滨 (法国皮尔法伯制药公司生产 ) ,NVB 2 5～ 30mg/m2 ,d1,d8,溶于 0 .9%生理盐水15 0ml中快速静滴 ,再以 2 5 0ml0 .9%生理盐水快速静滴 ,DDP 4 0～ 5 0mg/d1,2 ,3,静脉滴注 ,同时给予水化。 2 1天为一周期。结果　本联合化疗方案治疗晚期非小细胞肺癌 4 0例 ,取得了较好疗效 ,其中CR 4例、PR 2 6例 ,总有效率 75 %。结论　NP联合方案治疗晚期肺癌是合理、方便、安全、有效的一种可行的方案 ,可以作为一线方案推荐临床推广。     

Ultracryotomy: development and application (with examples from the yeast cytology) (author's transl)

The preparation steps usually necessary for obtaining ultrathin frozen sections of biological material (chemical prefixation, enclosing, cryoprotective treatment, freezing, sectioning, and post-staining the sections for transmission electron microscopy) are submitted to a critical analysis. The application of cryo-ultramicrotomy, in particularly for cytochemical purposes, is reviewed. Fundamental considerations of chemical prefixation and poststaining are supported by examples from yeast cytology. Furthermore, the efficiency of the cryo-ultramicrotomy (electron optical resolution of ultrastructural details) is demonstrated on yeast cells and protoplasts.     

Carbapenem inactivation: a very affordable and highly specific method for phenotypic detection of carbapenemase-producing Pseudomonas aeruginosa isolates compared with other methods

This investigation was undertaken to compare phenotypic and molecular methods for detection of carbapenemase-producing Pseudomonas aeruginosa. A total of 245 non-duplicated isolates of P. aeruginosa were collected from hospitalized patients. Disc diffusion method was used to identify carbapenem-resistant bacteria. Three phenotypic methods, including Modified Hodge Test (MHT), Modified Carba NP (MCNP) test and Carbapenem Inactivation Method (CIM) were used for investigation of carbapenemase production. In addition, polymerase chain reaction (PCR) was used to detect carbapenemase encoding genes. Of 245 P. aeruginosa isolates investigated, 121 isolates were carbapenem-resistant. Among carbapenem-resistant isolates, 40, 39 and 35 isolates exhibited positive results using MHT, MCNP test and CIM, respectively. PCR indicated the presence of carbapenemase genes in 35 of carbapenem-resistant isolates. MHT showed low sensitivity and specificity for carbapenemase detection among P. aeruginosa isolates in comparison to PCR. CIM was most affordable and highly specific than MCNP test compared with the molecular method.     

Effect of reduced temperature on glycoprotein (Ig, HLA) processing and transport in lymphoid cells

Secretion of Igs and surface expression of HLA antigens was examined in lymphoid cells as a function of temp. Upon reducing the temp from 37 to 20 degrees C a progressive decrease in the secretion of Ig and surface expression of HLA antigens was noted. When the status of the oligosaccharides present on these glycoproteins was examined, conversion of high-mannose [endo-beta-N-acetylglucosaminidase-(Endo H) sensitive] to complex-type (Endo H resistant) oligosaccharides diminished with decreasing temp. At no time was an accumulation of Endo H resistant glycoproteins seen intracellularly. These results show that the phenomenon observed for synthesis and intracellular transport of viral glycoproteins in epithelial cells at reduced temp, namely intracellular accumulation of viral glycoproteins carrying complex sugar moieties, does not necessarily apply to glycoprotein transport in lymphoid cells. A difference in subcellular organization of epithelial and lymphoid cells may be responsible for this discrepancy.     

Binding of the V proteins to the nucleocapsid proteins of human parainfluenza type 2 virus

Interaction of the nucleocapsid (NP) and V proteins of human parainfluenza type 2 virus (HPIV-2) was investigated using a transient expression system. When the NP proteins were co-expressed with the V proteins, some of the NP proteins were translocated into the nuclei. These findings suggest that the NP protein interact with the V proteins. We examined the interaction of the NP proteins and the P, V proteins or deletion mutants of V protein using immunofluorescence and co-immunoprecipitation plus Western blotting analyses, and showed that the V proteins of HPIV-2 bind to the NP proteins and that the N-terminal domain of V protein interacts directly with the NP proteins. When the NP proteins were co-expressed with the V proteins or the N-terminal fragments (aa 1–46), the NP proteins were detected diffusely in the nuclei of the transfected cells, and were also detected in cytoplasmic inclusions. The NP and V proteins were co-localized in the nuclei or cytoplasm. Futhermore, the NP proteins were co-precipitated with the P, V, and V(1–164) proteins by a specific antibody. The P proteins interact more closely with the NP proteins than do the V proteins. These findings indicate that the V proteins have the ability to bind the NP proteins. Received: 4 January 1996     

Comparison of DNA adduct induction in vitro by PAHs and nitro-pahs in freshly isolated rat hepatocytes

Polycyclic aromatic hydrocarbons (PAHs) and nitro-PAHs have been identified widely in occupational and environmental pollution, such as diesel engine emissions and other combustion products. In most cases, hepatic biotransformation is involved in converting these chemicals to their carcinogenic metabolites. It has been demonstrated that isolated hepatocytes possess substantial amounts of the enzymes responsible for metabolizing xenobiotics and are therefore a convenient model for studying chemicals that require activation to exert their carcinogenic effects. In this study, rat hepatocytes were isolated by collagenase digestion and then exposed to benzo[a]pyrene (B) [a]P), benzo[a]anthracene (B[a]A), 1-nitropyrene (1-NP) and 1,6-dinitropyrene (1,6-DNP) at different doses and/or times so that DNA adducts levels, as measured with the ³²P-postlabelling technique, could be compared. Each of the four compounds tested induced significant increases of total DNA adducts with clear dose-related responses. One or more individual adducts were identified as major adducts for each compound. Time-related increases of DNA adducts were also observed from 1 to 4 hr of incubation. Greater amounts of DNA adducts were induced by B[a]P or 1,6-DNP than by B[a]A or 1-NP, with potency being in the order 1,6-DNP > B[a]P > 1-NP B[a]A. These results demonstrate that freshly isolated hepatocytes can be used as an effective in vitro system for the detection of DNA adducts using ³²P-postlabelling, and have shown 1,6-DNP to be the most potent of the tested constituents of diesel emissions.