The difficulty of diagnosing NCSE in clinical practice; external validation of the Salzburg criteria

To improve the diagnostic accuracy of electroencephalography (EEG) criteria for nonconvulsive status epilepticus (NCSE), external validation of the recently proposed Salzburg criteria is paramount. We performed an external, retrospective, diagnostic accuracy study of the Salzburg criteria, using EEG recordings from patients with and without a clinical suspicion of having NCSE. Of the 191 EEG recordings, 12 (12%) was classified as an NCSE according to the reference standard. In the validation cohort, sensitivity was 67% and specificity was 89%. The positive predictive value was 47% and the negative predictive value was 95%. Ten patients in the control group (n = 93) were false positive, resulting in a specificity of 89.2%. The interrater agreement between the reference standards and between the scorers of the Salzburg criteria was moderate; disagreement occurred mainly in patients with an epileptic encephalopathy. The Salzburg criteria showed a lower diagnostic accuracy in our external validation study than in the original design, suggesting that they cannot replace the current practice of careful weighing of both clinical and EEG information on an individual basis.     

Procainamide therapy, physical performance and energy expenditure in the Schwartz-Jampel syndrome

The effects of procainamide administration were assessed in a 5-yr-old boy with Schwartz-Jampel syndrome (chondrodystrophic myotonia). Without procainamide the resting metabolic rate was found to be significantly higher than in an age-matched control group. With a serum level of 3.8 mg l-1 procainamide a reduction of the resting metabolic rate of 22% was observed, and times needed to climb stairs and to re-open eyes after forceful contraction (blepharospasm) were significantly reduced.     

The work of walking: a calorimetric study

Experiments were designed to test the traditional assumption that during level walking all of the energy from oxidation of fuel appears as heat and no work is done. Work is force expressed through distance, or energy transferred from a man to the environment, but not as heat. While wearing a suit calorimeter in a respiration chamber, five women and five men walked for 70 to 90 min on a level treadmill at 2.5, 4.6, and 6.7 km.h-1 and pedalled a cycle ergometer for 70 to 90 min against 53 and 92 W loads. They also walked with a weighted backpack and against a horizontal load. During cycling, energy from fuel matched heat loss plus the power measured by the ergometer. During walking, however, energy from fuel exceeded that which appeared as heat, meaning that work was done. The power increased with walking speed; values were 14, 29, and 63 W, which represented 11, 12, and 13% of the incremental cost of fuel above the resting level. Vertical and horizontal loads increased the fuel cost and heat loss of walking but did not alter the power output. This work energy did not re-appear as thermal energy during 18 h of recovery. The most likely explanation of the work done is in the inter-action between the foot and the ground, such as compressing the heel of the shoe and bending the sole. We conclude that work is done in level walking.     

Gastric emptying of carbohydrate--medium chain triglyceride suspensions at rest.

Nine male volunteers participated in 4 gastric emptying (GE) tests of liquid equicaloric mixtures of CHO (maltodextrins) and MCT of the following composition (% CHO-% MCT): Drink (Dr) 1:70%-30%, Dr2: 80%-20%, Dr3: 90%-10%, Dr4: 100%-0%. GE was measured at rest for 90 min according to the modified double sampling technique. GE rate, expressed as t1/2 (SEM), was 23 (2.3), 24 (1.6), 27 (2.2) and 36 (2.9) min, respectively, from drink 1 to drink 4. Statistical analysis showed that all MCT containing drinks emptied faster than the 100% CHO drink. Two mechanisms may explain this observation: 1) the CHO content and osmolality increases from Dr 1 to Dr 4 (both are regulators of GE); 2) MCT may not inhibit GE as common fat does, due to a better water solubility and absorption in the small intestine, resulting in a decreased duodenal-gastric feedback.     

Coralline hydroxyapatite bone graft substitutes: preliminary report of radiographic evaluation

A new bone graft substitute made by conversion of the calcium carbonate exoskeleton of reef-building sea coral into hydroxyapatite has recently become clinically available. The normal radiographic appearance of two forms of this material is described. In the immediate postoperative period, the exoskeletal architecture of these implants is readily appreciated. With graft incorporation over the ensuing months, their intrinsic structure is gradually lost in association with poor marginal definition. Evolving radiographic findings reflect the biocompatible nature of these implants, which provides the potential for ingrowth of native bone with preservation of the coralline scaffold, resulting in enhanced biomechanical properties.     

Dynamic pressure transmission through agarose gels

In biomedical research, agarose gel is widely used in tissue culture systems because it permits growing cells and tissues in a three-dimensional suspension. This is especially important in the application of tissue engineering concepts to cartilage repair because it supports the cartilage phenotype. Mechanical loading, especially compression, plays a fundamental role in the development and repair of cartilage. It would be advantageous to develop a system where cells and tissues could be subjected to compression so that their responses can be studied. There is currently no information on the pressure response of agarose gel when pressure is applied to the gas phase of a culture system. To understand the transmission of pressure through the gel, we set up an apparatus that would mimic an agarose suspension tissue culture system. This consisted of a sealed metal cylinder containing air as well as a layer of agarose submerged in culture medium. Pressure responses were recorded in the air, fluid, gel center, and gel periphery using various frequencies, pressures, gel volumes, and viscosities. Regression analyses show an almost perfect linear relation between gas and gel pressures (r(2) = 0.99987, p < 0.0001, f(x) = 0.9982 x - 0.0286). The pressure transmission was complete and immediate, throughout the range of the applied pressures, frequencies, volumes, and viscosities tested. Applying dynamic pressure to the gas phase results in reproducible pressure in the agarose and, therefore, validates the use of agarose tissue culture systems in studies employing dynamic pressurization in cartilage tissue engineering.