Knife to Skin Time in Orthopaedics- A New Sub-Speciality Selection Tool

Several selection methods have been used to aid selection into orthopaedic training programs but no process exists to aid in sub-speciality selection. A process which is continuous, unbiased and encompasses technical skill and decision making would be the gold standard. This paper analyses the use of a daily clinical task that assesses many of the desirable traits of a prospective trainee. A retrospective review of 13,474 orthopaedic procedures was under taken. The results showed a clear distinction between orthopaedic sub-specialities in time taken to perform this task. The authors suggest that this could provide a low cost insight into the appropriate subspecialty for orthopaedic trainees.

A national survey of the provision of ultrasound surveillance for the detection of hepatocellular carcinoma.

OBJECTIVE: Hepatocellular carcinoma (HCC), the sixth most common cancer worldwide and third most common cause of cancer related death, is closely associated with the presence of cirrhosis. Survival is determined by the stage of the cancer, with asymptomatic small tumours being more amenable to treatment. Early diagnosis is dependent on regular surveillance and the primary objective of this survey was to gain a better understanding of the baseline attitudes towards and provision of ultrasound surveillance (USS) HCC surveillance in the UK. In addition, information was obtained on the stages of cancer of the patients being referred to and discussed at regional multidisciplinary team meetings. DESIGN: UK hepatologists, gastroenterologists and nurse specialists were sent a questionnaire survey regarding the provision of USS for detection of HCC in their respective hospitals. RESULTS: Provision of surveillance was poor overall, with many hospitals lacking the necessary mechanisms to make abnormal results, if detected, known to referring clinicians. There was also a lack of standard data collection and in many hospitals basic information on the number of patients with cirrhosis and how many were developing HCC was not known. For the majority of new HCC cases was currently being made only at an incurable late stage (60%). CONCLUSIONS: In the UK, the current provision of USS based HCC surveillance is poor and needs to be upgraded urgently.

Shared care in glaucoma: a national study of secondary care lead schemes in England.

PURPOSE: To determine the number and nature of shared care schemes for glaucoma and glaucoma suspects operating in England. METHODS: A two-stage investigational process targeting all secondary-care ophthalmic departments with junior medical staff. An initial telephone contact for basic data (March 2006) was followed by a detailed questionnaire for completion by the scheme lead (May 2006). RESULTS: The telephone contact showed that of the 131 eligible ophthalmic departments, 76 claimed to be operating a glaucoma-based shared care scheme. Questionnaires were returned from 74 of the 76 departments claiming to run a scheme, showing that there were only 66 schemes operating in mid 2006 in association with 62 departments. Of these, 14 were community-based (predominantly run by trained optometrists) and 52 operated 'in-house' (predominantly involving nurses and optometrists). Most schemes were <6 years old and of the 30 schemes seeing new patients, 14 (47%) did not use gonioscopy as part of the assessment. In 8 schemes (12%), the shared care staff members were able to prescribe medication for glaucoma. CONCLUSION: In England, even before the outcome of the Department of Health shared care pilots had been published, approximately 50% of ophthalmic departments were running shared care schemes for glaucoma. However, most schemes contributed only modestly to the overall volume of glaucoma care, indicating that the majority of glaucoma-related consultations still occur directly with ophthalmologists. The Royal College of Ophthalmologists guidelines on gonioscopy are not being followed in almost half of the schemes seeing new patients.

Depletion of cells of monocyte lineage prevents loss of renal microvasculature in murine kidney transplantation.

BACKGROUND: Acute rejection increases the risk of late renal allograft loss with tubular atrophy, interstitial fibrosis, and microvascular rarefaction. Evidence supports a role for macrophages in promoting allograft injury, but the pathogenic mechanisms are unclear. Using a model of acute rejection, we sought evidence of macrophage-mediated endothelial cell cytotoxicity leading to loss of the renal microvasculature. METHODS: We used a transgenic conditional ablation strategy to deplete circulating monocytes and infiltrating renal macrophages after kidney transplantation. CD11b-DTR mice (FVB/nj strain) are transgenic for the human diphtheria toxin receptor gene under the control of the CD11b promoter. Administration of diphtheria toxin results in rapid ablation of circulating monocytes and resident/infiltrating renal macrophages. Transplants were performed between fully mismatched strains (Balb/c donor into control nontransgenic FVB/nj recipient; allograft group), between FVB/nj littermates (isograft group), and from Balb/c donors into CD11b-DTR mice (DT-treated group). Diphtheria toxin was administered at days 3 and 5, and the effect of monocyte/macrophage depletion on changes in renal microvasculature was determined at day 7. RESULTS: Conditional monocyte and macrophage ablation effectively depleted infiltrating macrophages in murine renal allografts at day 7. Macrophage ablation reduced histologic features of rejection (arteritis, tubulitis) and the accompanying rarefaction of peritubular capillaries at 7 days. The identification of macrophages immunopositive for inducible nitric oxide synthase implicated nitric oxide generation as a possible mechanism of endothelial cell cytotoxicity. CONCLUSION: These data indicate a significant role for macrophages in causing acute rejection-related tissue injury that is, at least in part, targeted to the microcirculation.

Phase separation and size effects in Pr(0.70)Ba(0.30)MnO(3+δ) perovskite manganites.

The crystal structure and magnetotransport properties of the A-site ionic ordered state in Pr(0.70)Ba(0.30)MnO(3+δ) (δ = 0, 0.025) have been investigated. It is shown that such a state can be formed in complex manganites with cation ratios [Formula: see text] by using a 'two-step' reduction-reoxidization method. The parent A-site ionic disordered Pr(0.70)Ba(0.30)MnO(3+δ) (δ = 0) compound is an orthorhombic (SG = Imma, Z = 4) ferromagnet with Curie temperature T(C)≈173 K and ground-state spontaneous magnetic moment σ(S)∼3.70 µ(B)/f.u. It exhibits two metal-insulator transitions, at T(I)∼128 K and T(II)∼173 K, as well as two peaks of magnetoresistance ∼74% and ∼79% in a field of 50 kOe. The parent A-site ionic disordered Pr(0.70)Ba(0.30)MnO(3+δ) (δ = 0) sample used in our studies has an average grain size [Formula: see text]. Successive annealing of this sample in vacuum P[O(2)]≈10(-4) Pa and then in air at T = 800 °C leads to the destruction of its initial grain structure and to its chemical separation into two phases: (i) oxygen stoichiometric A-site ordered PrBaMn(2)O(6) with a tetragonal (SG = P4/mmm, Z = 2) perovskite-like unit cell and Curie temperature T(C)≈313 K and (ii) oxygen superstoichiometric A-site disordered Pr(0.90)Ba(0.10)MnO(3.05) with an orthorhombic (SG = Pnma, Z = 4) perovskite-like unit cell and Curie temperature T(C)≈133 K. This processed sample has a spontaneous magnetic moment σ(S)∼2.82 µ(B)/f.u. in its ground state, and σ(S)∼0.59 µ(B)/f.u. at T∼300 K. It also exhibits a magnetoresistance of ∼14% at ∼313 K in a field of 50 kOe. This processed sample has a reduced average grain size [Formula: see text] nm. The two magnetic phases, Pr(0.90)Ba(0.10)MnO(3.05) and PrBaMn(2)O(6), are exchange-coupled. For Pr(0.90)Ba(0.10)MnO(3.05) the temperature hysteresis is ∼22 K in a field of 10 Oe and ∼5 K in a field of 1 kOe. The observed magnetic properties are interpreted in terms of chemical phase separation, grain size, and A-site ionic ordering effects.

Endoscopic sympathectomy in the treatment of facial blushing.

INTRODUCTION: Bilateral endoscopic thoracic sympathectomy (BETS) has been shown to be an effective, permanent, and safe treatment for severe upper limb hyperhydrosis. More recently, the possibility of using BETS to treat facial blushing, a redness of the face bought on by emotional or social stress, has been raised. This followed incidental reports from patients of relief from their blushing following this procedure for hyperhydrosis. At King's College Hospital, 120 patients underwent BETS over a 3-year period for both upper limb hyperhydrosis and facial blushing. In this study we report our results in relation to facial blushing. PATIENTS AND METHODS: The outcome was evaluated by questionnaire and symptoms assessed using the visual analogue scale. Questions on postoperative complications and overall quality of life were included. RESULTS: A total of 80 patients responded to our questionnaire of whom 59 (74%) experienced facial blushing. In 12 patients, this was their only symptom. Severity of facial blushing was reduced from a mean score of 78 before operation to 26 after BETS (P < 0.001); 29% reported complete resolution of their facial blushing. There was no mortality or conversion to open surgery. Quality of life was reported to be much better in 63% of facial blushers following the procedure. CONCLUSIONS: This study demonstrates both a statistically significant reduction in severity of facial blushing as well as a clear improvement in quality of life following a safe procedure with few complication rates. Facial blushing can, therefore, be considered as an indication for BETS on its own merit when not associated with hyperhydrosis.

Extraskeletal Ewings sarcoma of the small bowel: case report and literature review.

Extraskeletal Ewings sarcoma is a tumour of neuroectodermal origin sharing close similarities with Ewings sarcoma of bone. We report the case of a 21 year old 16 week pregnant woman presenting with vomiting and weight loss and found to have an extraskeletal Ewings sarcoma of the small bowel. In a review of the literature there are no previous reports of extraskeletal Ewings sarcoma occurring in the small bowel. The diagnosis of extraskeletal Ewings sarcoma and the complicated management of a young pregnant woman with a malignant tumour are described.

Lanostanes and friedolanostanes from the pericarp of Garcinia hombroniana.

The CH2Cl2 extract from the pericarp of Garcinia hombroniana yielded three 17,14-friedolanostanes [(24E)-3alpha-hydroxy-17,14-friedolanostan-8, 14,24-trien-26-oic acid, methyl (24E)-3alpha,23-dihydroxy-17,14-friedolanostan-8,14,24 -trien-26-oate and methyl (24E)-3alpha,9,23-trihydroxy-17,14-friedolanostan-14,2 4-dien-26-oate] and two lanostanes [3beta- and 3alpha-hydroxy-23-oxo-9,16-lanostadien-26-oic acid]. The structure of (14E)-3alpha-hydroxy-17,14-friedolanostan-8,14,24-trie n-26-oic acid was determined using spectroscopic and X-ray analyses, while the structures of the other compounds were elucidated solely from analysis of spectroscopic data.

Proteolytic processing of the C terminus of the alpha(1C) subunit of L-type calcium channels and the role of a proline-rich domain in membrane tethering of proteolytic fragments.

Although most L-type calcium channel alpha(1C) subunits isolated from heart or brain are approximately 190-kDa proteins that lack approximately 50 kDa of the C terminus, the C-terminal domain is present in intact cells. To test the hypothesis that the C terminus is processed but remains functionally associated with the channels, expressed, full-length alpha(1C) subunits were cleaved in vitro by chymotrypsin to generate a 190-kDa C-terminal truncated protein and C-terminal fragments of 30-56 kDa. These hydrophilic C-terminal fragments remained membrane-associated. A C-terminal proline-rich domain (PRD) was identified as the mediator of membrane association. The alpha(1C) PRD bound to SH3 domains in Src, Lyn, Hck, and the channel beta(2) subunit. Mutant alpha(1C) subunits lacking either approximately 50 kDa of the C terminus or the PRD produced increased barium currents through the channels, demonstrating that these domains participate in the previously described (Wei, X., Neely, a., Lacerda, A. E. Olcese, r., Stefani, E., Perez-Reyes, E., and Birnbaumer, L. (1994) J. Biol. Chem. 269, 1635-1640) inhibition of channel function by the C terminus.