Alcoholics and drug addicts at the emergency room of the hospital. Analysis of the staff behavior and patients' progressions

The statistical analysis of a large sample (1.707 cases) was carried out using objective variables. These variables consist of the key points in the progression of alcoholics and drug addicts within two emergency departments situated in general hospitals. This study pinpoints a lack of therapeutic work at the emergency room where neither medical diagnoses nor psychopathological analyses seem to be done.     

Power morcellation inside a secure endobag: a pilot study

Introduction: Unprotected power morcellation can lead to a spread of previously undiagnosed malignancy. We present a new containment bag with two closable trocar insertion sites to reduce this risk. This pilot study was designed to assess the feasibility of this device under everyday conditions.

Material and methods: The containment bag was used in ten laparoscopic supracervical hysterectomies. We evaluated time requirement for bag insertion into the abdominal cavity and in-bag morcellation. A 2000?ml polyurethane morcellation bag was used for all interventions. All surgeries were carried out in a three-trocar setting.

Results: We carried out ten supracervical hysterectomies. No intraoperative complications and no bag ruptures occurred. The meantime requirement to insert the bag and prepare the specimen for morcellation was 10.5?min (range, 7–19?min). The mean specimen weight was 191.9?g (range, 32–710?g). Mean morcellation time was 10.5?min (range, 3–28?min), mean weight of remaining tissue and fluid in the bag after morcellation was 12.1?g (range, 7–19?g).

Conclusions: The presented data demonstrate that the endobag can be successfully applied in the clinical routine. Further studies are required to evaluate additional characteristics, such as individual learning curve and time requirements.     

Assisted autogenic drainage in infants and young children hospitalized with uncomplicated pneumonia,a pilot study

Background and purpose

Pneumonia is the most important respiratory problem in low‐to‐middle income countries. Airway clearance therapy continues to be used in children with pneumonia and secretion retention; however, there is lack of evidence to support or reject this treatment. This study aimed to investigate the feasibility of a randomized controlled trial (RCT) on the efficacy and safety of assisted autogenic drainage (AAD) compared to standard nursing care in children hospitalized with uncomplicated pneumonia.

Methods

A single‐blinded pilot RCT was conducted on 29 children (median age 3.5 months, IQR 1.5–9.4) hospitalized with uncomplicated pneumonia. The intervention group received standard nursing care with additional bi‐daily AAD, for 10 to 30 min. The control group only received standard nursing care, unless otherwise deemed necessary by the physician or physiotherapist. The primary outcome measure was duration of hospitalization. The secondary outcome measures included days of fever and supplemental oxygen support; respiratory rate (RR) and heart rate adjusted for age; RR and oxygen saturation pre‐, post‐, and 1‐hr post‐treatment; oxygen saturation; adverse events; and mortality.

Results

No difference was found for duration of hospitalization (median 7.5 and 7.0 days for the control and intervention groups, respectively); however, Kaplan–Meier analysis revealed a strong tendency towards a shorter time to discharge in the intervention group (p = .06). No significant differences were found for the other outcome measures at time of discharge. No adverse events were reported. Within the intervention group, a significant reduction in RR adjusted for age was found.

Discussion

As no adverse events were reported, and AAD did not prolong hospitalization; AAD might be considered as safe and effective in young children with uncomplicated pneumonia. However, a larger multicentred RCT is warranted to determine the efficacy of AAD compared to standard nursing care.     

Evaluation of stair motion contributes to new insights into hip osteoarthritis‐related motion pathomechanics

Stair motion in the presence of hip osteoarthritis (OA) has received less attention than level walking. Its more strenuous aspect may shed the light on different locomotor strategies when compared to walking. We, therefore, aimed to define stair motion features associated to hip OA and to evaluate whether these specific features would differ from level walking and better characterize the hip pathological condition. Principal component and linear discriminant analyses were, respectively, used as data reduction and classification techniques. Our study highlighted that most of stair motion features associated to hip OA were similar to the ones of walking. Stair descent presented with the lowest misclassification error rate, ranging from 12% to 19% (estimated by cross‐validation). But, features that may be considered as a mechanism to reduce demand on the hip abductors were found to be more important in the stair ascent condition. This was reflected by both, greater importance in the classification rule and variance compared with walking, that is, decreased hip internal rotation moment at mid‐stance (72.50% vs. 57.63%) and increased trunk lateroflexion toward affected side (56.43% vs. 29.37%). This study emphasized the importance of investigating stair motion in hip osteoarthritic population by highlighting specific locomotor strategies. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:187–196, 2016.     

Age-related changes in 28S and 18S RNA in antigen-stimulated and non-stimulated rat spleens

The possible changes in rRNA amounts in the spleens of immunized and non-immunized rats during aging were investigated. The cytoplasmic RNA was extracted from intact spleens or spleen cell suspensions and 28S_o/ 18S_o, 28S_y/18S_y, 28S_o/28S_y, 18S_o/18S_y ratios were calculated, the most significant change (P < 0.01) occurring at the level of 28S_o/28S_y ratio; i.e., there was a six-fold increase in the ratio of 28S rRNA in old rats as compared to young rats suggesting a preferential digestion of 26S subunit by neutral and alkaline RNAase whose activities were found to decrease in old non-immunized rats. In immunized rats the situation was different, as there was a considerable decrease (over twenty fold) in rRNA from old animals as compared to young ones, the most significant results being obtained with spleen cell suspensions. As age-related changes in the immune system begin at the time of sexual maturity, we propose the use of rRNA as a marker of rat senescence.     

Long hospitalization is the most important risk factor for early weaning from breast milk in premature babies

Aim: To identify certain variables related to the infants' course that might have an impact on the mothers' decision to breastfeed.
Patients and Method: Retrospective survey including all patients <1500 g birth weight (BW) treated between January 1, 2000 and December 31, 2005 at the Neonatal Intensive Care Unit of the Medical University of Vienna who were not transferred to another hospital. Multiple regression analysis of the following variables was carried out: gestational age (GA), BW, length of stay (LOS), parity, singleton or multiple gestation, sex and severe morbidity.
Results: Of the 239 patients included, 142 (60%) were fed breast milk at the time of final discharge, 97 (40%) were fed formula. LOS was significantly correlated with the probability of being breastfed: the shorter it was, the higher was the probability of being breastfed at the time of final discharge (p = 0.0064 for singletons, p = 0.001 for multiples). Lower GA also increased the probability of being breastfed, but this was only statistically significant for multiples (p = 0.001).
Conclusion: This study shows clearly that the most important influencing factor on the mothers' decision to continue breastfeeding is the LOS. Thus more emphasis should be put on encouraging mothers to continue lactation throughout their babies' hospital stay.     

Hip Resurfacing Data from National Joint Registries: What Do They Tell Us? What Do They Not Tell Us?

Current-generation metal-on-metal hip resurfacing implants (SRAs) have been in widespread global use since the 1990s, and in the United States, specific implants have recently been approved for clinical use. Many recent publications describe short-term survivorship achieved by either implant-designing surgeons or high-volume centers. National joint replacement registries (NJRRs) on the other hand report survivorship achieved from the orthopaedic community at large. We therefore reviewed SRA survivorship from national registry data and compared with that reported from individual centers. Additionally, we compared SRA survivorship reported by registries and compared prognosticators for failure with those of conventional total hip arthroplasty (THA). Although resurfacing was associated with an overall increased failure rate in comparison to THA (Australian registry 5-year cumulative revision rate [CRR], 3.7% and 2.7%, respectively), there were exceptions to this. Male patients younger than 65 years with primary osteoarthritis had equivalent results with SRA and THA (Australian registry 5-year CRR, 2.5% and 2.8%, respectively). Head size over 50 mm in diameter was a predictor of surface replacement arthroplasty survivorship and only females with a head diameter of 50 mm or greater (14% of females) had a comparable survivorship to males. Diagnoses other than primary osteoarthritis bear a higher risk of early revision of SRA as compared with THA. Revision of SRA does not lead to reproducible results with rerevision rates of 11% at 5 years. Given these predictors of failure, our review of data from the NJRR suggests stringent patient selection criteria might enhance the survival rates of SRA.     

The limbus spiralis and its relationship to the developing tectorial membrane in the cochlear duct of the guinea pig fetus

Summary The development of the interdental cells of the limbus spiralis and of the inner spiral sulcus cells as well as the formation of the mesenchymal teeth of Huschke are described during fetal life up to the day of birth in the guinea pig. Additionally, the changes of the developing tectorial membrane are studied. The ultrastructural observations allow the conclusion that during fetal development at least a considerable part of the material of the tectorial membrane is secreted by the interdental cells of the limbus spiralis.Supported by Deutsche Forschungsgemeinschaft