The provision of a trauma bed in theatre recovery and its impact on trauma theatre efficiency: experience from a high-volume trauma unit.

INTRODUCTION: Inefficiencies in the trauma setting are well known and have been further exacerbated by the COVID-19 pandemic among other factors, resulting in national guidance to aid improvements in resource utilisation. This study introduced a novel surgeon-led intervention, a trauma bed in recovery, with the aim of improving trauma theatre efficiency. METHODS: This quality improvement project was conducted using a Plan Do Study Act (PDSA) methodology and comprised multiple cycles to assess theatre performance. A multidisciplinary team (MDT) approach with relevant stakeholder input enabled intervention implementation, aimed at facilitating 'golden patient' arrival in the anaesthetic room as early as possible. The primary outcome was the time at which the first patient entered the anaesthetic room, and the secondary outcome was the number of cases performed each day. RESULTS: The study period was 1 year and encompassed three PDSA cycles. The intervention achieved its primary outcome by PDSA cycle 1 and its secondary outcome by PDSA cycle 2, demonstrating statistically significantly improved results (p < 0.001). A subanalysis assessed the specific impact of the intervention, and demonstrated a significant improvement in both outcomes when the intervention was used as intended (p < 0.0005). CONCLUSIONS: A ringfenced trauma bed significantly improved theatre start times and thereby theatre efficiency. This is a simple, pragmatic intervention that benefitted the MDT trauma team while also demonstrating a sustained impact. Given that National Health Service efficiency is at the forefront of national healthcare discourse, we recommend that this intervention is implemented in other trauma units to help provide a solution to this longstanding issue.

Posterior stabilised total knee arthroplasty is associated with improved post-operative knee specific function, health related quality of life and greater satisfaction when compared to cruciate retaining protheses.

PURPOSE: To assess whether there were differences in knee specific function, health related quality of life (HRQoL), and satisfaction between patients with a cruciate retaining (CR) or a posterior stabilised (PS) total knee arthroplasty (TKA) at 1 and 2 years postoperatively. METHODS: A retrospective review of TKA (CR and PS) patients from a prospectively collected arthroplasty database. Patient demographics, body mass index and ASA grade, Oxford knee score (OKS) and EuroQol 5-dimension (EQ-5D) 3-level, which was used to assess HRQoL, were collected preoperatively and 1 year and 2 years postoperatively. Regression was used to adjust for confounding factors. RESULTS: The sample included 3122 TKA, of which 1009 (32.3%) were CR and 2112 (67.7%) were PS. The PS group were more likely to be female (odd ratio (OR) 1.26, p = 0.003) and undergo resurfacing of the patella (OR 6.63, p < 0.001). There was a significantly greater improvement in the 1 year OKS in the PS group (mean difference (MD) 0.9, p = 0.016). The PS TKA was independently associated with a greater 1 year (MD 1.1, 95% CI 0.4 to 1.9, p = 0.001) and 2 years (MD 0.8, p = 0.037) post-operative improvements in OKS. PS TKA was also independently associated with a greater 1 year (MD 0.021, p = 0.024) and 2 years (MD 0.022, p = 0.025) post-operative and change in EQ-5D utility compared to the CR group. The PS group was more likely to be satisfied with their outcome at 1 year (OR 1.75, p < 0.001) and at 2 years (OR 1.38, p = 0.001) when adjusting for confounders. CONCLUSION: PS TKA was associated with a better knee specific function and HRQoL when compared to CR, but the clinical significance of this is not clear. However, the PS group was more likely to be satisfied with their outcome compared to the CR group.

Factors associated with a clinically significant improvement in health-related quality of life after total knee arthroplasty.

BACKGROUND: The aim was to identify independent preoperative factors associated with changes in health-related quality of life (HRQoL) following total knee arthroplasty (TKA), and whether these could be used as indicators for surgery. METHODS: A retrospective study of 3127 TKA patients was undertaken that included 1194 (38.2%) male and 1933 (61.8%) female patients, with a mean age of 70.5 years (standard deviation 9.0). Patient demographics, body mass index and ASA grade, Oxford Knee Score (OKS) and EuroQol 5-dimension (EQ-5D) 3-level, which was used to assess HRQoL, were collected preoperatively and 2 years postoperatively. RESULTS: When adjusting for confounding factors, obesity grade II (p = 0.002), ASA grade 3 (p = 0.002), and a better preoperative OKS (p < 0.001) or EQ-5D score (p < 0.001) were associated with a decreased improvement in the HRQoL at 2-years. A preoperative EQ-5D of < 0.8 (95.7% specific, AUC ≥ 67.0%) or an OKS of < 36 (97.1% specific, AUC ≥ 58.1%) was associated with a clinically significant improvement HRQoL. Patella resurfacing (n = 1454, 46.5%) was not independently associated with a clinical or statistically significant improvement in HRQoL. According to preoperative factors, no subgroup of patients benefited more from patella resurfacing according to improvement in their HRQoL. CONCLUSION: ASA grade 3, grade II obesity, a better preoperative EQ-5D or OKS were independently associated with a lesser improvement in HRQoL. The thresholds identified in the EQ-5D or OKS for a clinically significant improvement in HRQoL may be used as potential indicators for referral for TKA. Patella resurfacing was not independently associated with a clinically important improvement in HRQoL. LEVEL OF EVIDENCE: Retrospective diagnostic study, Level III.

Synthesis and characterization of MFe2O4 (M = Co, Ni, Mn) magnetic nanoparticles for modulation of angiogenesis in chick chorioallantoic membrane (CAM).

In this study, we report the synthesis and characterization studies of amine-functionalized MFe2O4 (Co, Ni, Mn) nanoparticles. The synthesis process was accomplished by refluxing metal chloride precursors in ethylene glycol in the presence of sodium acetate and ethanolamine. The average crystallite sizes of the synthesized particles are found to be in the range of 8-10 nm. The synthesized particles are characterized using X-ray diffraction, Brunauer-Emmett-Teller technique, FTIR, dynamic light scattering, Raman and UV-visible spectroscopy for crystal structure, average size, surface area, pore diameter and hydrodynamic diameter, phase and functional group determination. The surface morphology and elemental composition were studied by scanning electron microscope and X-ray fluorescence respectively. Magnetic behavior up to fields of 3 T at room temperature measured in Quantum Design Physical Property Measurement System (QD PPMS) magnetometer showed the superparamagnetic behavior of these particles. Modulation of angiogenesis by the nanoparticles was studied in a chick embryo chorioallantoic membrane model by analysis of blood vessel development and effect on hemoglobin level using imaging and colorimetric methods. An enhancement in the angiogenesis compared to the saline control was observed for all the ferrite nanoparticles with a relatively optimal activity in case of CoFe2O4 nanoparticles.

Focal segmental glomerulosclerosis in renal allografts: Is it possible to diagnose the etiology?

Recurrence of FSGS in renal allo grafts is a major cause of graft loss. In this context, we tried to diagnose and classify FSGS in renal allografts. Indications for biopsy included graft dysfunction and/or proteinuria. Three hundred and sixty-three graft biopsies were studied over a period of 2 years. We classified FSGS into recurrent FSGS, new-onset primary FSGS and FSGS secondary to chronic humoral rejection, calcineurin inhibitor toxicity, and nephron loss and hyperfiltration injury. Twenty-four cases were diagnosed as FSGS, constituting 6.6%. Secondary FSGS was the most common FSGS in grafts in our study. Incidence of recurrent FSGS may not be accurate as pretransplant biopsy is available in very few cases.

Saliva-based biosensors: noninvasive monitoring tool for clinical diagnostics.

Saliva is increasingly recognised as an attractive diagnostic fluid. The presence of various disease signalling salivary biomarkers that accurately reflect normal and disease states in humans and the sampling benefits compared to blood sampling are some of the reasons for this recognition. This explains the burgeoning research field in assay developments and technological advancements for the detection of various salivary biomarkers to improve clinical diagnosis, management, and treatment. This paper reviews the significance of salivary biomarkers for clinical diagnosis and therapeutic applications, with focus on the technologies and biosensing platforms that have been reported for screening these biomarkers.

Karyomegalic interstitial nephritis with focal segmental glomerulosclerosis: A rare association.

Karyomegalic interstitial nephritis (KIN) is a rare form of, progressive chronic interstitial nephritis. We present a case of KIN in a child, who was also found to have nephrotic syndrome because of focal segmental glomerulosclerosis on renal biopsy. To our knowledge, this is the first case of KIN associated with glomerulopathy.

Simultaneous heart and kidney transplantation after bridging with the CardioWest total artificial heart.

End-stage renal failure is often considered a relative contraindication for total artificial heart implantation due to the increased risk of mortality after transplantation. We report the successful treatment of a patient having heart and renal failure with the CardioWest (SynCardia Inc, Tucson, AZ) total artificial heart for bridge-to-cardiac transplantation of a heart and kidney.

Primary marginal zone B-cell lymphoma of appendix.

Primary lymphomas of appendix are extremely rare tumors. The first case of primary lymphoma of appendix was reported by Warren in the year 1898. Incidence of primary lymphoma of appendix is 0.015% of all gastrointestinal lymphomas. This is a report of primary marginal zone B-cell lymphoma of appendix which presented as appendicular mass. As some cases are incidentally discovered, this case emphasizes that histological examination of all appendicectomy specimens is mandatory.

Paratesticular malignant peripheral nerve sheath tumour: a case report.

Primary malignant peripheral nerve sheath tumours (MPNST) of intrascrotal extra testicular site are extremely rare with only few cases reported in literature. These are highly malignant tumours most often associated with neurofibromatosis. The incidence in general population is 0.001%. A 35-year-old male presented with swelling of the scrotal sac of three months duration. There were no features of neurofibromatosis. The lesion was excised and was diagnosed as MPNST. The patient developed recurrence within two months.

Synthesis of the proposed structure of mucoxin via regio- and stereoselective tetrahydrofuran ring-forming strategies.

An enantioselective total synthesis of the proposed structure of mucoxin (1) is described. Mucoxin, an annonaceous acetogenin isolated from bioactive leaf extracts of Rollinia mucosa, is the first acetogenin containing a hydroxylated trisubstituted tetrahydrofuran (THF) ring. This natural product is a highly potent and specific antitumor agent against MCF-7 (breast carcinoma) cell lines (ED50 = 3.7 x 10(-3) microg/mL compared to adriamycin, ED50 = 1.0 x 10(-2) microg/mL). The total synthesis described herein features two regio- and stereoselective THF ring-forming reactions. The 2,3,5-trisubstituted THF portion (C13-C17) was accessed using a highly regioselective cyclization of a methylene-interrupted epoxydiol, and the 2,5-disubstituted THF ring (C8-C12) was conveniently assembled via a 1,2-n-triol cyclization strategy. The spectral data of the synthetic material and two of its diastereomers did not match the reported data for the natural product. On the basis of detailed spectroscopic analysis of the synthesized molecule, we reason that the spectral discrepancies are due to stereochemical misassignment of the natural product.

Versatile and stereoselective syntheses of orthogonally protected beta-methylcysteine and beta-methyllanthionine.

[reaction: see text] Lantibiotics are a class of lanthionine (and/or beta-methyllanthionine)-containing peptides with antibioitic activity against Gram-positive bacteria. As part of our research effort directed toward the synthesis and mechanistic study of the lantibiotic peptide mersacidin (1), we report stereoselective syntheses of orthogonally protected beta-methylcysteine (beta-MeCys) and beta-methyllanthionine (beta-MeLan), two key nonnatural amino acid components of the mersacidin architecture.

Syndrome-related chromosome-specific radiation-induced break points of various inherited human metabolic disorders.

The frequency, distribution pattern and localisation of gamma radiation-induced break points on the chromosomes of patients with various inherited metabolic disorders were studied to detect: (i) whether the break point distribution following irradiation is random and proportional to the length or the DNA content of the chromosome, or non-proportionally distributed on their length and at times clustering to form hot spots on certain region of the chromosomes; and (ii) to find whether there exists a syndrome-related chromosome-specific pattern of radiation-induced break points. Lymphocyte cultures from patients of haemophilia, ichthyosis, Duchenne muscular dystrophy, retinitis pigmentosa and alpha-thalassemia, whose defective gene loci were located by DNA probe method, were subjected to 3Gy of gamma radiation at G(0). The chromosomal break point analysis was carried out on all the 23 types of chromosomes (excluding Y chromosome) using G banding and FISH painting. The exact location of the break points on G-banded chromosomes was identified using a semi-automated microscope densitometer system (Leitz MPV2). In normal individuals in all the chromosomes except the chromosome 1, a random distribution of break points proportional to their length based on their DNA content was observed. However, in all the syndromes studied a mixture of hypersensitive chromosomes with a non-random distribution pattern of chromosomal break points invariably clustering to form hot spots, and chromosomes with random distribution of break points proportional to their length were observed. The hypersensitive chromosomes and their hot spots were syndrome-specific.

Nonvenereal transmission of venereal syphilis in a child.

PIP: A case of nonvenereal acquisition of syphilis in a 2.5 year old male Indian child is discussed. The child had condylomata lata around the anal and prepuce, with enlarged nontender inguinal lymph nodes. Treponema pallidum was found in material from both lesions, and both the VDRL and FTA-Abs tests were positive. There were not other significant findings. The patient was treated with 1.2 million units of benzathine penicillin im, and the lesions resolved in 7 days. This boy had been raised by his grandparents since the age of 6 months. They did not report a primary syphilitic lesion, but the grandmother did admit to kissing the child's genitals, a custom of affection toward babies in the area. Sexual abuse was denied. The grandmother had a buccal lesion, which showed a Treponema on darkfield microscopy, and she had positive syphilis serology. both grandparents were also treated.^ieng