Erratum: Spectrum of Three-Body Bound States in a Finite Volume [Phys. Rev. Lett. 114, 091602 (2015)].

This corrects the article DOI: 10.1103/PhysRevLett.114.091602.

Need for sedation and analgesia in patients with a history of substance misuse admitted to an intensive care unit.

BACKGROUND: Patients with a history of substance misuse may develop tolerance to analgesics and psychotropic drugs which alter the need for sedation and analgesia after ICU admittance. AIMS: The objective was to qualify and quantify the needs for sedation and analgesia in critically ill patients with and without a history of substance misuse admitted to an intensive care unit (ICU). DESIGN: A 2-year prospective, observational study. METHODS: Patients admitted to an ICU who required sedation and analgesia for ≥72 h were included and were classified as substance misusers and non-substance misusers. We analysed demographic data and the consumption of alcohol and other substances. Comparisons between groups were made using the non-parametric Mann-Whitney test for quantitative variables and Fisher's exact test for qualitative variables. The analysis was made using SPSS version 17.0 (SPSS Inc., Chicago, IL, USA) for Windows. Statistical significance was established as p < 0·05. RESULTS: We included 44 patients, of whom 31 (70·3%) were users of ≥1 substance. The median age was 47 years, 8 (18·2%) patients were female. The most-consumed substances were tobacco (56·8%), alcohol (54·5%), cannabis (13·6%), amphetamines (11·4%) and cocaine (9·1%). Toxicological samples were positive for alcohol (65·2%, mean blood alcohol level 1·38 ± 1·05 g/L). There were no significant differences in the need for sedation between substance misusers and non-substance misusers (p > 0·05). CONCLUSIONS: The prevalence of substance misuse in this population was high. We found no greater need for sedation in patients with a history of substance misuse although these patients often require three or more drugs to achieve optimal sedation. RELEVANCE TO CLINICAL PRACTICE: Physicians and nurses should be aware of substance misuse in order to provide adequate care by optimizing drug administration and dosages in the ICU.

Spectrum of three-body bound States in a finite volume.

The spectrum of a bound state of three identical particles with a mass m in a finite cubic box is studied. It is shown that in the unitary limit, the energy shift of a shallow bound state is given by ΔE=c(κ^{2}/m)(κL)^{-3/2}|A|^{2}exp(-2κL/sqrt[3]), where κ is the bound-state momentum, L is the box size, |A|^{2} denotes the three-body analog of the asymptotic normalization coefficient of the bound state wave function, and c is a numerical constant. The formula is valid for κL≫1.

Modification of Burton and Pellegrini trapeziectomy technique: Medium-term comparative analysis. / [Artículo traducido] Modificación de la técnica de trapeciectomía de Burton-Pellegrini: análisis comparativo a medio término.

INTRODUCTION: Ligament reconstruction and tendon interposition (LRTI) arthroplasty is the procedure of choice of most hand surgeons in the treatment of basal joint arthritis of the thumb. Progressive and natural collapse after trapeziectomy is a common problem. DESCRIPTION OF TECHNIQUE: We performed LRTI with flexor carpi radialis (FCR) hemitendon technique, then proceeded to block the hemitendon plasty with a bone fragment at the base of the metacarpal. This technique allows us to maintain tension and to obtain immediate stability. PATIENTS AND METHODS: We conducted a single-center retrospective longitudinal observational study including 51 patients with diagnosis of symptomatic osteoarthritis of the trapeziometacarpal joint. Group A consisted of 24 thumbs treated with trapeziectomy with LRTI with FCR hemitendon using the Burton-Pellegrini technique. Group B included 27 thumbs treated using the modified technique. The postoperative height of the Scaphometacarpal (SM) space was analyzed. Clinical outcome, opposition, retroversion, patient satisfaction and surgical timing were studied. RESULTS: The difference of the SM space, after applying correction factor, at one and six months postoperative is significantly less in the modified technique group (P = .033 and P = .001, respectively). The average height loss of the SM space from one to six months postoperative measurement was smaller in the study group, showing greater stability of the plasty. CONCLUSIONS: The use of a bone fragment to block the FCR plasty improves the results at one and six months postoperatively, showing a diminished height loss of the SM space, improved thumb opposition and without prolonging surgical timing in our series.

Modification of Burton and Pellegrini trapeziectomy technique: Medium-term comparative analysis.

INTRODUCTION: Ligament reconstruction and tendon interposition (LRTI) arthroplasty is the procedure of choice of most hand surgeons in the treatment of basal joint arthritis of the thumb. Progressive and natural collapse after trapeziectomy is a common problem. DESCRIPTION OF TECHNIQUE: We performed LRTI with flexor carpi radialis (FCR) hemitendon technique, then proceeded to block the hemitendon plasty with a bone fragment at the base of the metacarpal. This technique allows us to maintain tension and to obtain immediate stability. PATIENTS AND METHODS: We conducted a single-center retrospective longitudinal observational study including 51 patients with diagnosis of symptomatic osteoarthritis of the trapeziometacarpal joint. Group A consisted of 24 thumbs treated with trapeziectomy with LRTI with FCR hemitendon using the Burton-Pellegrini technique. Group B included 27 thumbs treated using the modified technique. The postoperative height of the Scaphometacarpal (SM) space was analyzed. Clinical outcome, opposition, retroversion, patient satisfaction and surgical timing were studied. RESULTS: The difference of the SM space, after applying correction factor, at one and six months postoperative is significantly less in the modified technique group (p=0.033 and p=0.001 respectively). The average height loss of the SM space from one to six months postoperative measurement was smaller in the study group, showing greater stability of the plasty. CONCLUSIONS: The use of a bone fragment to block the FCR plasty improves the results at one and six months postoperatively, showing a diminished height loss of the SM space, improved thumb opposition and without prolonging surgical timing in our series.

Sagittal imbalance influences outcome of vertebroplasty in patients with osteoporotic vertebral compression fracture. / Influencia del desequilibrio sagital en el resultado clínico de la vertebroplastia en pacientes con fractura por compresión vertebral osteoporótica.

BACKGROUND AND OBJECTIVES: The correlation between sagittal balance of the spine and clinical outcome after vertebroplasty (VP) in patients with osteoporotic vertebral compression fractures (OVCF) is poorly investigated. We analysed the clinical outcome of patients with OVCF undergoing VP taking into account sagittal balance. MATERIAL AND METHOD: The primary endpoint was the change in axial back pain, disability and health-related quality-of-life using Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) and SF-36, respectively, in correlation to the parameters that define sagittal balance (SVA). Radiographic assessment included full spine standing lateral films. Imaging and clinical data were collected pre- and post-procedure at 1, 3 and 12 months. RESULTS: 51 patients were included presenting a total of 113 OVCF. 30 patients (60.7%) had multiple OVCF. Comparing the evolution of VAS and ODI throughout the follow-up it does not seem that there are significant differences in their behaviour between the SVA>50mm and the SVA<50mm groups (p>0.05). On the contrary, pre-VP SF-36 scores showed worst results in the SVA>50mm group in the physical functioning (PF) section (p<0.05) and in the physical component score (PCS) (p<0.05). These differences were maintained until 3 months of follow-up in the case of the PCS and until the end of follow-up in the case of the PF (p<0.05). CONCLUSIONS: Patients with a SVA>50mm showed a slower recovery of their quality-of-life after VP for OVCF, but without significant differences with respect to pain or disability, when compared patients with SVA<50mm.

[Translated article] Sagittal imbalance influences outcome of vertebroplasty in patients with osteoporotic vertebral compression fracture.

BACKGROUND AND OBJECTIVES: The correlation between sagittal balance of the spine and clinical outcome after vertebroplasty (VP) in patients with osteoporotic vertebral compression fractures (OVCF) is poorly investigated. We analysed the clinical outcome of patients with OVCF undergoing VP taking into account sagittal balance. METHODS: The primary endpoint was the change in axial back pain; disability and health-related quality of life using VAS, ODI and SF-36 respectively in correlation to the parameters that define sagittal balance (SVA). Radiographic assessment included full spine standing lateral films. Imaging and clinical data were collected pre and post procedure at 1, 3 and 12 months. RESULTS: Fifty-one patients were included presenting a total of 113 OVCF. Thirty patients (60.7%) had multiple OVCF. Comparing the evolution of VAS and ODI throughout the follow-up it does not seem that there are significant differences in their behaviour between the SVA>50mm and the SVA<50mm groups (p>0.05). On the contrary, preVP SF-36 scores showed worst results in the SVA>50mm group in the physical functioning section (PF) (p<0.05) and in the physical component score (PCS) (p<0.05). These differences were maintained until 3 months of follow-up in the case of the PCS and until the end of follow-up in the case of the PF (p<0.05). CONCLUSIONS: Patients with a SVA>50mm showed a slower recovery of their quality of life after VP for OVCF, but without significant differences with respect to pain or disability, when compared with patients with SVA<50mm.

[Evaluation of acute poisonings due to chemical agents treated in an emergency department]. / Evaluación de las intoxicaciones agudas por productos químicos atendidas en un servicio de urgencias.

BACKGROUND AND OBJECTIVES: The objective of this study is to evaluate the epidemiological and toxicological characteristics of chemical exposures requiring Emergency Department consultation. METHODOLOGY: Descriptive study of Hospital Emergency Department consultations between 2000 and 2008 derived from exposure to a chemical agent. RESULTS: A total of 992 patients were included; the mean age was 42.7+18 years and 58.1% were female. The main causes were domestic accidents (67.3%), occupational accidents (14.8%), attempted suicides (11.2%) and incidents of violence (3.2%). There was a significantly greater proportion of females involved in domestic accidents and males in occupational accidents (p<0.05). The most-frequently involved products were caustic substances (39.9%), irritating gases (13.8%), detergents (12.3%), solvents (12%) and asphyxiating gases (9.5%). Hospital admission was necessary in 10.8% of patients and 10 deaths occurred (1%), with non-occupational accidents being more severe (p<0.05). CONCLUSIONS: Exposures to chemical agents represent a high number of poisonings in Emergency Department. Domestic accidents, which mainly affect women and often involve caustic substances, are much more frequent than occupational accidents. The general prognosis is good and mortality is very low.

Necrotizing fasciitis: Usefulness of the LRINEC score in a third-level hospital.

AIM: To review patients seen in the emergency room, diagnosed with necrotizing fasciitis (NF) and the correlation of such complications with the Laboratory Risk Indicator for Necrotizing fasciitis scale (LRINEC). The purpose of this study is to assess the use of the LRINEC score for early diagnosis of NF and its prognostic use in a consecutive series of cases treated at our hospital. METHODS: Retrospective observational study including patients with a diagnosis of NF in the emergency room of a tertiary hospital over 11 years. The results are shown as median, interquartile range and absolute range for quantitative variables. In the case of qualitative variables, the results are shown as absolute and relative frequency. The comparison between the categories of the LRINEC scale was performed through a post-hoc comparison from a non-parametric rank-ANOVA analysis. Comparisons between LRINEC groups in the qualitative variables were performed using Fisher's exact test. RESULTS: A total of 45 patients with a mean age of 51 years were identified. There was a 20% mortality rate (9 cases). The highest mortality rate was registered in the high-risk group (LRINEC greater than 8) with 4 deceased individuals (44.44%), while in the low and moderate-risk groups, 3 and 2 deceased individuals (33% and 22%) were registered, respectively, without considering this result statistically significant (p=0.811). There was an amputation rate of 15.6% (7 cases). The average LRINEC score was greater in the cases that required amputation 9 (95% CI 7; 13) in comparison to the other patients, 6 (95% CI 5; 8), p=0.044. The average hospital stay lasted 32.5 days (95% CI: 25; 40); 30 days in the low-risk group, 41 days in the moderate-risk group and 40 days in the high-risk group. Mortality was associated to a smaller number of interventions (p=0.005) and was preceded by septic shock in all cases. CONCLUSIONS: The LRINEC score may be useful to aid diagnosis. However, clinical suspicion is the most important in diagnosis. A LRINEC low score does not exclude NF. In this retrospective series, 35.71% of cases presented a low LRINEC score, making the rate of false negatives high. In view of these results, The LRINEC score cannot be used as a prognostic value since an initial low score does not rule out serious evolution.

Cross-linked polyethylene does not reduce wear in total knee arthroplasty. / El polietileno de alto entrecruzamiento no reduce el desgaste en la artroplastia total de rodilla.

AIM: To compare two different types of inserts: Ultra-high molecular weight polyethylene (UHMWPE) and cross-linked polyethylene with a quantitative and qualitative study of polyethylene wear particles in synovial fluid 3 years after total knee arthroplasty. MATERIAL AND METHODS: A prospective, randomized, controlled cohort study with blinded evaluation was carried out on 25 patients undergoing staged bilateral total knee replacement, 6 months apart. Knee arthrocentesis was performed on 12 patients 3 years after surgery, and the polyethylene particles were analyzed. RESULTS: No significant differences were found in the number of particles generated by the two different types of inserts at 3 years from total knee arthroplasty (3,000×: x¯ cross-linked=849.7; x¯ UHMWPE=796.9; P=.63; 20,000×: x¯ cross-linked=66.3; x¯ UHMWPE=73.1; P=.76). Likewise, no differences in the probability of finding elongated (χ2=0.19; P=.66) or rounded (χ2=1.44; P=.23) particles in both types of inserts were observed. However, the probability of finding fibrillar particles is 3.08 times greater in UHMWPE. CONCLUSIONS: Cross-linked polyethylene does not significantly reduce the generation of polyethylene particles in patients with total knee arthroplasty, 3 years after the surgical procedure.

Necrotizing fasciitis attended in the Emergency Department in a tertiary Hospital: Evaluation of the LRINEC scale. / Infecciones necrosantes de partes blandas atendidas en un servicio de urgencias de tercer nivel: evolución y correlación con la escala laboratory risk indicator for necrotizing fasciitis (LRINEC).

AIM: To describe mortality and complications of patients seen in the emergency room, diagnosed with necrotizing soft tissue infection (NSTI) and the correlation of such complications with the Laboratory Risk Indicator for Necrotizing fasciitis scale (LRINEC). METHODS: Retrospective observational study including patients with a diagnosis of NSTI in the emergency room of a tertiary hospital over 7 years. The results are shown as median, interquartile range and absolute range for quantitative variables. In the case of qualitative variables, the results are shown as absolute and relative frequency. The comparison between the categories of the LRINEC scale was performed through a post-hoc comparison from a non-parametric ANOVA analysis. Comparisons between LRINEC groups in the qualitative variables were performed using Fisher's Exact test. RESULTS: 24 patients with a mean age of 51.9 years were identified. The LRINEC scale was used on 21 patients: in 10, the value indicated low risk (<6), in 4 it indicated intermediate risk (6 or 7) and in 7 it indicated high risk (≥8). The amputation rate in patients with low, intermediate and high risk was 10%, 25% and 66% respectively with a mortality of 4.2%. There was an increase in hospital stay between the low and high level of the scale (p=0,007). CONCLUSIONS: In general, a change in the prognosis between the medium and high levels of the LRINEC scale could not be recorded, but was recorded in hospital stay between the low and the high level, practically tripling the median of days of hospital stay.

Treatment of oil-in-water emulsions: performance of a sawdust bed filter.

The effect of operating conditions on the performance of a sawdust bed filter used for the treatment of an oil-in-water emulsion was investigated. A metalworking fluid (3 vol.% oil) was used as oil-in-water emulsion and sawdust as filter medium and sorbent. Because of the high stability of the emulsion, small amounts of inorganic salt (calcium sulphate) were mixed with the sorbent, acting as coagulant to achieve the emulsion breakdown. The influence of flow rate, bed height, temperature and the amount of coagulant salt added was studied. Experimental results show that several processes are involved in oil removal from oil-in-water emulsions, i.e. coagulation, coalescence, adsorption or straining. More than 99% of oil content in the influent stream was removed. Experimental results show that low-cost sorbents like sawdust are feasible to be used in the treatment of oil-in-water emulsions if small amounts of coagulant salts are added to the filter media.

[Assessment of parental satisfaction in a neonatal unit]. / Valoración de la satisfacción de los padres en una unidad neonatal.

INTRODUCTION: Parental satisfaction in a neonatal unit needs to be checked as a quality element in health care. OBJECTIVES: 1/To measure how the severity of the newborn condition influences parental satisfaction. 2/To compare the results before and after moving to a new building. METHODS: Parental satisfaction in 87 of the newborns admitted to our neonatal unit over a 10 month period was documented using a questionnaire survey. The newborns were divided into 2 categories, depending on the severity of their condition. Parental satisfaction as regards human and environmental issues was checked as to whether it was affected by the severity of the illness. The impact of the move to a new building on satisfaction was also analysed. Statistical descriptive studies and multivariate models were used. RESULTS: A polarised tendency was seen between human and environmental aspects. The following issues were statistically significant: visiting hours for parents, and criticisms about furniture, light and physical space. Parents of seriously ill children appreciated the visiting hours but judged the environment negatively. Pain perception in procedures was higher in serious illnesses, and 66% of parents would rather be present during those procedures. When comparing both hospitals, the only significant value regarding the new centre, was the lower perception of information given by the staff. Breastfeeding improved significantly. General satisfaction was high. CONCLUSIONS: Parents of seriously ill newborns are mainly concerned about access hours and comfort. Parent visiting hours and lack of noise and light are significant parameters predicting satisfaction in children with long stays. Perception of access to information got worse in the new hospital, probably due to lack of staff adaptation.

El papel del trabajo en la construcción del sujeto joven / The role of labor in the construction of a youth subject / O papel do trabalho na construção do sujeito jovem

El concepto “joven” fue construyéndose a lo largo de la historia en función de las necesidades de la sociedad. El trabajo es la palanca principal de cambio. La confrontación ante el desarrollo tecnológico fue exigiendo nuevos actores productivos. En ese punto, surgió la necesidad de abrir un campo laboral que anteriormente no se había vislumbrado: uno en el que cupieran los jóvenes. El objetivo principal de este artículo es que, a través de una revisión histórica, se ofrezca evidencia de que el trabajo capitalista moderno obligó a identificar un sector de población, en este caso la juventud, que fue crucial para la preparación y el aprendizaje de las virtudes laborales exigidas en cada patrón de acumulación.

Society has been influential in the creation of the term youth based on the need of society, with work being the fundamental driver of this change. The confrontation of man with developments in technology required new productive players. At that point it was necessary to open up the notion of work to something that hadn’t been considered previously, the inclusion of young people in labor. The main objective of this article is to provide historical evidence that modern capitalist labor required the identification of a sector of the population, in this case young people, in order to provide them with the necessary skills required in various patterns of accumulation.

O conceito jovem foi se construindo ao longo da história em função das necessidades da sociedade, sendo o trabalho a alavanca fundamental para a mudança. A confrontação do homem frente ao desenvolvimento tecnológico foi exigindo novos atores produtivos. Nesse ponto surgiu a necessidade de abrir um campo de trabalho que anteriormente não tinha sido vislumbrado: um campo para os jovens serem inseridos. O objetivo principal deste artigo é que por meio de uma revisão histórica seja oferecida uma evidência de que o trabalho capitalista moderno obrigou à identificação um setor da população, neste caso a juventude, que foi essencial para a preparação e o aprendizado das virtudes de trabalho exigidas em cada padrão de acumulação.

[Description of sexual assaults treated in the emergency department of a referral hospital]. / Descripción de las agresiones sexuales atendidas en el servicio de urgencias de un centro hospitalario de referencia.

OBJECTIVE: To describe the factors related to adult sexual assaults attended in a referral hospital in the city of Barcelona (Spain). METHODS: We carried out an individual-based cross-sectional study of sexual assaults treated in the emergency department between 2005 and 2008. RESULTS: A total of 712 patients (95.5% female) were treated. The median age of assaulted women was 25 years. Complaints were made in 87.5% of cases and assaults were made by a single attacker in 84.5%. When the perpetrator was known, the profile of the victim (p ≤ 0.05) was as follows: the victim was assaulted at home (81.5%), the perpetrator acted alone (94.2%), the mechanism of aggression was penetration (89.3%) and the attack took place during the week (63.3%). CONCLUSIONS: Analysis of sexual assaults allows for different risk groups to be established, which facilitates the development of specific protocols and guidelines for effective aid and full treatment.

Fifteen-year trends of long-term disability and sick leaves in ankylosing spondylitis.

The aim of this study is to assess the trends in work disability and sick leave in ankylosing spondylitis (AS). In 1993 and 2007, patients diagnosed with AS that attended to a secondary- or a tertiary-care outpatient rheumatology clinics were evaluated for demographics, disease characteristics, axial mobility, working status, and work days missed due to sick leave or permanent disability. Factors that impacted labor status were identified by multiple regression analysis. In 1993, 91 study individuals (mean age 35 years, mean disease duration 10 ± 8 years) included 28 (31%) on permanent disability and 63 currently working; of these 63, 42 (67%) had missed at least 1 work day in the previous 12 months (mean 69 ± 63 days). In the next 5 years, the annual permanent disability was 3%. In 2007, 185 study individuals (mean age 42, mean disease duration 12 ± 10 years) included 53 (39%) on permanent disability and 132 active workers; 35 (66%) out of the 53 began permanent disability between 1999 and 2007 (2.1% annual disability rate), and 53 (40%) out of 132 active workers missed at least 1 work day in the previous 12 months (mean 52 ± 63 days). Only age predicted disability, with 10% and 11% increases in risk per year in 1993 and 2007, respectively (hazard ratios 1.09 and 1.11, respectively; p = 0.03 for both). Although the impact of AS on work seems to decrease slightly during the last 15 years, the actual impact is still substantial. An important proportion of patients went on permanent disability in the three decades before retirement. Extrapolating these results to official data for the year 2005, we may infer that between 1.3 million and nearly 15 million working days were missed that year due to AS.

[Monitoring neurodevelopment in children born as a result of using assisted reproduction techniques]. / Seguimiento del neurodesarrollo de niños nacidos por tecnicas de reproducción asistida.

INTRODUCTION: In recent years a number of publications have reported a higher incidence of congenital defects or chromosome abnormalities linked to conventional in vitro fertilisation (IVF), and some other publications have suggested that intracytoplasmic sperm injection (ICSI) may have a negative influence on neurodevelopment. AIM. To determine whether there were any differences in the medical development and the neurodevelopment of children conceived using conventional IVF techniques and those conceived using ICSI techniques. SUBJECTS AND METHODS: Our sample consisted of 17 babies born after IVF (nine males and eight females) and 40 infants born after ICSI (23 males and 17 females). All of them were the result of pregnancies induced by IVF and ICSI achieved in the assisted reproduction service at our hospital and followed up by the same team of obstetricians and specialists in maternal-foetal medicine. At the chronological age of 24 months all the patients were submitted to a paediatric examination and a neuropsychological examination. The examination was performed in one single session. Neurodevelopment was evaluated specifically by means of the Bayley scales of infant development. RESULTS AND CONCLUSIONS: The health and neurodevelopment of infants from conventional IVF and from ICSI in our study were similar to those of the general population at the age of two years. ICSI proved to be as safe as conventional IVF as regards the children's medical and cognitive progression.

Tendinous and ligamentous derangements in systemic lupus erythematosus.

OBJECTIVE: We assessed the prevalence of selected clinical and radiological features of tendinous and ligamentous derangements in a consecutive sample of patients with systemic lupus erythematosus (SLE). METHODS: Consecutive patients with SLE with no comorbidities attending a tertiary care center were prospectively assessed and underwent plain radiographic evaluation of the pelvis. Radiographs were analyzed by 2 blinded observers; radiographic sacroiliitis was graded 0 to IV. To better assess sacroiliac (SI) involvement, a computed tomography (CT) scan of the SI joints was performed in patients with grade III sacroiliitis. Hip joints and pubis were also assessed as described. RESULTS: Of the 192 included patients, 89% were female, mean age was 36 years, and mean disease duration was 10 years. Inflammatory low back pain was reported by 10% of patients. Sacroiliitis of any grade was observed in 31 patients (16%), and grade III (confirmed on CT scan) sacroiliitis was observed in 6% (95% CI 3% to 9%). Osteitis pubis was diagnosed in 6% (95% CI 3% to 10%) and coxofemoral migration in 8% (95% CI 2% to 9%). Jaccoud's arthropathy was found in 23%. Demographic and clinical variables were not statistically associated with radiographic sacroiliitis. CONCLUSION: Sacroiliitis and other tendinous and ligamentous derangements are not uncommon in patients with SLE. Based on these features and on previous reports, the term "SLE-related tendinous and ligamentous derangements" may be used to establish a common framework for further research and reporting.