Wound contraction in an experimental porcine model

Wound contraction is thought to be independent of site, and circular full-thickness skin wounds are thought not to contract completely. To verify these statements four circular full-thickness skin wounds were created on each side of eight pigs and randomised to treatment with either split-thickness skin grafts, or healing by secondary intention under a hydrocolloid dressing. Time to healing, contraction, and final scar shape were evaluated. The median healing time was 12 days (range 6-18) in the grafted wounds and 30 days (range 15-45) in the secondarily healing wounds. There were significant differences in healing time between the different sites on the pigs. In the secondarily healing group, medial-caudal wounds healed in 21 (15-21) days compared with lateral wounds which healed in 36 (21-45) days (p     

Fetal Electrocardiogram Extraction and Analysis Using Adaptive Noise Cancellation and Wavelet Transformation Techniques

Birth defect-related demise is mainly due to congenital heart defects. In the earlier stage of pregnancy, fetus problem can be identified by finding information about the fetus to avoid stillbirths. The gold standard used to monitor the health status of the fetus is by Cardiotachography(CTG), cannot be used for long durations and continuous monitoring. There is a need for continuous and long duration monitoring of fetal ECG signals to study the progressive health status of the fetus using portable devices. The non-invasive method of electrocardiogram recording is one of the best method used to diagnose fetal cardiac problem rather than the invasive methods.The monitoring of the fECG requires development of a miniaturized hardware and a efficient signal processing algorithms to extract the fECG embedded in the mother ECG. The paper discusses a prototype hardware developed to monitor and record the raw mother ECG signal containing the fECG and a signal processing algorithm to extract the fetal Electro Cardiogram signal. We have proposed two methods of signal processing, first is based on the Least Mean Square (LMS) Adaptive Noise Cancellation technique and the other method is based on the Wavelet Transformation technique. A prototype hardware was designed and developed to acquire the raw ECG signal containing the mother and fetal ECG and the signal processing techniques were used to eliminate the noises and extract the fetal ECG and the fetal Heart Rate Variability was studied. Both the methods were evaluated with the signal acquired from a fetal ECG simulator, from the Physionet database and that acquired from the subject. Both the methods are evaluated by finding heart rate and its variability, amplitude spectrum and mean value of extracted fetal ECG. Also the accuracy, sensitivity and positive predictive value are also determined for fetal QRS detection technique. In this paper adaptive filtering technique uses Sign-sign LMS algorithm and wavelet techniques with Daubechies wavelet, employed along with de noising techniques for the extraction of fetal Electrocardiogram.Both the methods are having good sensitivity and accuracy. In adaptive method the sensitivity is 96.83, accuracy 89.87, wavelet sensitivity is 95.97 and accuracy is 88.5. Additionally, time domain parameters from the plot of heart rate variability of mother and fetus are analyzed.     

Acute severe asthma

Acute exacerbations of asthma are very common reasons for a presentation to emergency departments. This paper focuses on defining the high‐risk group, consideration of the concept of phenotypes of acute asthma, the assessment of severe and life‐threatening exacerbations and an emphasis on the management of the more severe end of the exacerbation severity. A number of evidence‐based guidelines exist throughout the world and are all slightly different. This reflects the poor evidence base for some of those recommendations. Thus, a large variation of treatment drugs, doses and regimen are used and clearly not standardised. This paper aims to present a summary of the best evidence and discuss some of these controversies. The most important aspect of treating an exacerbation of acute asthma is to review regularly and assess response to treatment. Severe and life‐threatening episodes should be treated with early use of intravenous treatment in a stepwise manner following the local guidelines. Non‐invasive ventilation and high flow nasal cannulae delivery of oxygen in the emergency department are evolving modalities, but evidence for their use is currently limited.     

Soluble urokinase plasminogen activator receptor is in contrast to high-sensitive C-reactive-protein associated with coronary artery calcifications in healthy middle-aged subjects

Objective

The main objective of this study was to investigate the association between two markers of low-grade inflammation; soluble urokinase plasminogen activator receptor (suPAR) and high-sensitive C-reactive protein (hs-CRP); and coronary artery calcification (CAC) score detected by cardiac computed tomography (CT) scan.

Design

A cross sectional study of 1126 randomly sampled middle-aged men and women.

Methods

CAC score was measured by a non-contrast cardiac CT scan and total 10-year cardiovascular mortality risk was estimated using the Systematic Coronary Risk Evaluation (SCORE). Plasma samples were analysed for suPAR and hs-CRP. The association of suPAR and hs-CRP to CAC was evaluated by logistic regression analyses adjusting for categorised SCORE. The additive effect of suPAR to SCORE was evaluated by comparing area under curve (AUC) and net reclassification improvement (NRI).

Results

The odds of being in a higher CAC category, i.e. having more severe CAC, increased 16% (odds ratio (OR) 1.16, p = 0.02) when plasma suPAR concentration increased 1 ng/ml, and this was more pronounced in women (OR 1.30, p = 0.01) than in men (OR 1.15, p = 0.05). In comparison, hs-CRP was not associated with CAC category (OR 1.00, p = 0.90). When adding suPAR to categorised SCORE, AUC increased from 0.66 to 0.70 (p = 0.04) in women and from 0.65 to 0.68 (p = 0.03) in men. NRI was significant in men (NRI 19.3%, 95% CI 6.1–32.6, p = 0.004) as well as in women (NRI 20.8%, 95%CI 1.0–40.7, p = 0.04), without significant gender difference.

Conclusions

suPAR, but not hs-CRP, appeared to be associated with CAC score independently of SCORE. The association was strongest in women.     

How Do We Define Congenital Heart Defects for Scientific Studies?

Estimates of the prevalence of congenital heart defects (CHD) have been published over many years and from many regions. As they are based on different definitions of which cases to include in the CHD prevalence, published prevalence estimates vary substantially. With the increasing use of echocardiography in neonatal intensive care, a patent ductus arteriosus (PDA) or flow over the atrial septum will often be visible. These findings may be coded as CHD at discharge and in this way falsely increase the CHD prevalence in the population. There are several purposes for which population‐based data on CHD may be used: etiology, planning of treatment, or obtain information on outcome, including mortality. For etiology studies, it is important to include terminations of pregnancy as well as all births with CHD. For mortality studies in live births, inclusion of preterm born infants with PDA will increase overall mortality of CHD. The Danish Register of Congenital Heart Disease is based on hospital discharge diagnoses and diagnoses from outpatient visits. To increase the validity of these data, extensive data cleaning has been carried out based on record review and knowledge on the discharge coding practice. We include PDA and atrial septal defects as CHD cases if these defects are still open 2 months after birth. International consensus on how to define CHD would improve the validity and comparability of epidemiological studies on CHD.     

Fourier analysis of video-keratographic data. A tool for separation of spherical, regular astigmatic and irregular astigmatic corneal power components

Topographic analysis of the cornea and computation of changes in corneal topography is difficult because of the lack of a standardized concept for analysing topographic information. We have used Fourier series harmonic analysis to decompose the often very complex information given in topographic images (TMS-1 video-keratograph). The polar data values arising from each mire were separated into spherical (average power), regular astigmatic (2′ harmonic) and non-regular astigmatic components. The non-regular astigmatic components were further divided into a decentration component (1′ harmonic) and a higher order irregular refractive component (root mean square (r.m.s.) of the residual between original data and the sum of spherical, 1′ and 2′ order components). Algorithms for utilizing the Fourier analysis technique on subjective refractive and on keratometric changes in regular astigmatism were also derived. Averages of the separate refractive components were calculated for groups of normal (right and left eye of 25 patients), keratoconic (13 eyes), and transplanted eyes (20 eyes), and average topographic maps were reconstructed and imaged. Changes in the separate topographic refractive components were compared with subjective refractive changes in eyes that had undergone combined myopic-astigmatic excimer laser ablation (8 eyes). Fourier series analysis was found superior to conventional keratometry in predicting spherical and regular astigmatic changes in subjective refraction. Fourier series analysis seems to be a powerful tool to decompose the information of complex topographic corneal images into rational optical components.