Pleth variability index can predict spinal anaesthesia-induced hypotension in patients undergoing caesarean delivery.

BACKGROUND: Spinal anaesthesia carries a risk of hypotension. We hypothesized that pleth variability index and perfusion index would assess maternal volume status, and thus, allow identification of patients at higher risk of developing hypotension after spinal anaesthesia for caesarean delivery. METHODS: Fifty patients undergoing elective caesarean delivery were enrolled. All patients received spinal anaesthesia with 0.5% hyperbaric bupivacaine (10 mg) and fentanyl (10 mcg). Blood pressure was measured every minute. Pleth variability index and perfusion index were automatically measured throughout the procedure using pulse oximetry on the index finger. In case of hypotension (systolic blood pressure below 90 mmHg or 80% of the baseline value), ephedrine 5 mg was administered. Receiver-operating characteristic and multivariate logistic regression analyses for spinal anaesthesia-induced hypotension were performed. RESULTS: Hypotension occurred in 32 patients (64%). The areas under the receiver-operating characteristic curve were 0.751 (95% confidence interval: 0.597-0.904) for pleth variability index before anaesthesia, 0.793 (95% confidence interval: 0.655-0.930) for pleth variability index after anaesthesia and 0.731 (95% confidence interval: 0.570-0.892) for perfusion index change (percent change in perfusion index induced by spinal anaesthesia). The optimal threshold value of pleth variability index (after anaesthesia) for predicting hypotension was 18% (sensitivity: 78.1%, specificity: 83.3%). Pleth variability index after spinal anaesthesia was an independent factor for hypotension (odds ratio: 1.21, P = 0.041). CONCLUSIONS: Pleth variability index after spinal anaesthesia was a good predictor of spinal anaesthesia-induced hypotension in patients undergoing caesarean delivery. In addition, perfusion index change after spinal anaesthesia has the potential to predict hypotension.

A prospective comparison of bone-patellar tendon-bone and hamstring tendon grafts for anterior cruciate ligament reconstruction in male patients.

The aim of the study was to compare the results after arthroscopic anterior cruciate ligament (ACL) reconstruction using central-third, bone-patellar tendon-bone (BPTB Group) (n = 45) and four-strand semitendinosus/gracilis (ST/G Group) (n = 78) autografts in male patients. The type of study is non-randomised, prospective consecutive series. A consecutive series of 126 male patients, all with unilateral ACL ruptures, was included in the study. In both groups, interference screw fixation of the graft was used at both ends and 123/126 (97%) of the patients returned for the follow-up examination after a period of 25 (23-33) months. The pre-operative assessments in both groups were similar in terms of the Tegner activity level, the Lysholm knee scoring scale, KT-1000 measurements, one-leg-hop test and knee-walking test. A significant reduction in knee laxity as measured with the KT-1000 arthrometer, compared with the pre-operative assessments, was found in both groups (P < 0.001). No significant differences in the post-operative knee-laxity measurements were found between the groups. Both groups had a significantly improved functional outcome at follow-up in terms of the Lysholm knee scoring scale, Tegner activity level and one-leg-hop test. The BPTB Group had a significantly higher Tegner activity level at follow-up, compared with the ST/G Group (P = 0.02). Moreover, the patients in the BPTB Group were significantly more likely to have a Tegner activity level of 6 or above (P = 0.03). Otherwise, no significant differences were found between the two study groups at the 2-year follow-up. Two years after an ACL reconstruction, the two groups displayed no significant differences in terms of functional outcome and knee laxity. However, more patients in the BPTB Group returned to a higher Tegner activity level than that in the ST/G Group.

A prospective, randomized, clinical and radiographic study after arthroscopic Bankart reconstruction using 2 different types of absorbable tacks.

PURPOSE: The aim of the study was to compare the clinical and radiographic results after arthroscopic Bankart reconstruction using 2 different types of absorbable implant. TYPE OF STUDY: Randomized controlled trial. METHODS: A randomized series of 40 patients who had recurrent, unidirectional, post-traumatic shoulder instability were included in the study. All patients underwent an arthroscopic Bankart reconstruction involving either polygluconate co-polymer (PGACP group, n = 20) or self-reinforced poly-L-lactic acid polymer (PLLA group, n = 20) tack implants. The patients underwent clinical and radiographic assessments preoperatively and at 2 years. Additional radiographic assessments were performed at 6 months. RESULTS: Preoperatively, the study groups were comparable in terms of demographics as well as clinical parameters. One patient in each group had a redislocation (5%) during the follow-up period of 2 years. No subluxations were registered. No statistically significant differences were found between the study groups in terms of strength in abduction, range of motion, and Rowe or Constant scores. There was a significant increase in degenerative changes during the follow-up period in both study groups (P = .004). However, no significant differences in degenerative changes were registered between the study groups either preoperatively or at the 2-year follow-up. There were no significant differences in the radiographic visibility of the drill holes used for the absorbable implants between the study groups at the 6-month assessment. However, at the 2-year assessment, the radiographic visibility of the drill holes was significantly greater (P = .004) in the patients in the PLLA group than those in the PGACP group. At the 2-year assessment, no correlation was found between the appearance of the drill holes and the degenerative findings (PGACP group, rho = 0.44; PLLA group, rho = 0.42). CONCLUSIONS: Two years after arthroscopic Bankart reconstruction using either PGA polymer or PLA polymer implants, the overall clinical results were comparable. Radiographic assessments revealed that the degenerative changes increased in both study groups during the follow-up period. Furthermore, the visibility of the drill holes on the 2-year radiographs was greater after using PLLA implants than after using PGACP implants. LEVEL OF EVIDENCE: Level I.

A prospective comparison of bone-patellar tendon-bone and hamstring grafts for anterior cruciate ligament reconstruction in female patients.

The aim of the study is to compare the results after arthroscopic anterior cruciate ligament (ACL) reconstruction using central-third, bone-patellar tendon-bone (BTB group) (n = 28) and four-strand semitendinosus/gracilis (ST/G group) (n = 31) autografts in female patients. The type of study was non-randomised prospective consecutive series. A consecutive series of 61 female patients, all with unilateral ACL ruptures, was included in the study. In both groups, interference screw fixation of the graft was used at both ends, and 59/61 (97%) of the patients returned for the follow-up examination after a period of 26 (23-31) months. The pre-operative assessments in both groups were similar in terms of the Lysholm score, KT-1000 measurements, one-leg-hop test, and knee-walking test. At the 2-year follow-up, the knee-walking test was significantly worse in the BTB group than in the ST/G group (P = 0.003). Furthermore, the knee-walking test was significantly worse at follow-up than pre-operatively in the BTB group (P < 0.005). The corresponding finding was not made in the ST/G group. A reduction in knee laxity compared with the pre-operative assessments was found in both groups. No significant difference in the post-operative knee laxity measurement was found between the groups. A significant increase in activity level and subjective scores was found in both groups compared with pre-operative values, without any significant differences between the groups. Two years after ACL reconstruction, the groups displayed no significant differences in terms of functional outcome and knee laxity. However, the use of ST/G autografts rendered significantly less discomfort during the knee-walking test than the use of BTB autografts.

The use of 19F spectroscopy and diffusion-weighted MRI to evaluate differences in gene-dependent enzyme prodrug therapies.

To evaluate noninvasive measures of gene expression and tumor response in a gene-dependent enzyme prodrug therapy (GDEPT), a bifunctional fusion gene between Saccharomyces cerevisiae cytosine deaminase (CD) and Haemophilus influenzae uracil phosphoribosyltransferase (UPRT) was constructed. CD deaminates 5-fluorocytosine (5FC) to 5-fluorouracil (5FU), and UPRT subsequently converts 5FU to fluorouridine monophosphate, and both of these reactions can be monitored noninvasively in vitro and in vivo using 19F magnetic resonance spectroscopy (MRS). Following transient transfection the CD-UPRT fusion protein exhibited both UPRT and CD enzymatic activities as documented by 19F MRS. In addition, an increase in CD activity and thermal stability was witnessed for the fusion protein compared to native CD. Stable expression of CD-UPRT in 9L glioma cells increased both 5FC and 5FU sensitivity in vitro compared to CD-expressing and wild-type 9L cells. Noninvasive 19F MRS of both CD and UPRT gene function in vivo demonstrated that in animals bearing CD-expressing tumors there was limited conversion of 5FC to 5FU with no measurable accumulation of cytotoxic fluorinated nucleotides (F-nucs). In contrast, CD-UPRT-expressing tumors had increased CD gene activity with a threefold higher intratumoral accumulation of 5FU and significant generation of F-nucs. Finally, CD-UPRT yielded increased efficacy in an orthotopic animal model of high-grade glioma. More importantly, early changes in cellular water mobility, which are felt to reflect cellular death, as measured by diffusion-weighted MRI, were predictive of both durable response and increased animal survival. These results demonstrate the increased efficacy of the CD-UPRT GDEPT compared to CD alone both biochemically and in a preclinical model and validate both 19F MRS and diffusion-weighted MRI as tools to assess gene function and therapeutic efficacy.

Right and left knee laxity measurements: a prospective study of patients with anterior cruciate ligament injuries and normal control subjects.

PURPOSE: The purpose of this study was to analyze and compare knee laxity in a group of patients with a unilateral right anterior cruciate ligament (ACL) rupture and a group of patients with a unilateral left ACL rupture. Another goal was to analyze and compare the knee laxity of the right and left knees in a group of persons without any known knee problems. TYPE OF STUDY: Prospective examination of the same patients preoperatively and 2 years after the reconstruction with examination of the healthy controls at 2 different occasions. METHODS: Group A was composed of 41 patients with a right-sided chronic ACL rupture, and group B was composed of 44 patients with a left-sided chronic ACL rupture. All patients underwent an arthroscopic ACL reconstruction using patellar tendon autograft. Group C was composed of 35 persons without any known knee problems. One experienced physiotherapist performed all the KT-1000 measurements and the clinical examinations. RESULTS: Group A displayed an increased difference in side-to-side laxity between the injured and non-injured side compared with group B in terms of both anterior and total knee laxity. This difference was found to be statistically significant preoperatively (P =.01, anterior; P =.001, total) and at follow-up evaluation 2 years after the index surgery (P =.008, anterior; P =.006, total). In group C, a significant increase was seen in absolute anterior and total laxity in the right knee compared with the left knee when 2 repeated measurements were performed (P <.0001 and P =.003, anterior; P <.0001 and P =.001, total). CONCLUSIONS: The KT-1000 arthrometer revealed a significant increase in laxity measurements in right knees compared with left knees. This difference was found both preoperatively and postoperatively in patients undergoing ACL reconstruction. The same thing was found in a group of persons without any known knee problems. LEVEL OF EVIDENCE: Level II.

Concomitant partial meniscectomy worsens outcome after arthroscopic anterior cruciate ligament reconstruction.

In this multi-center study involving 412 patients, we assessed the influence of concomitant partial meniscal resection on the medium-term clinical results after anterior cruciate ligament reconstruction. We performed a resection of minimum one-third of the medial or lateral menisci in 137 patients (group M) and found intact menisci in 275 patients (group NM). Those who had undergone previous meniscal surgery, subsequent meniscal surgery or a re-rupture of the anterior cruciate ligament graft during the follow-up were not included. After a median of 3 (2-6) years, the patients were reexamined by independent observers. Group M patients had more pain, swelling and laxity than those in group NM; they also had a worse classification according to the IKDC system, lower Lysholm scores and a greater proportion of patients with loss of motion.

[A case of hereditary sensory and autonomic neuropathy type IV diagnosed following the development of acute encephalopathy due to heat stroke].

A fourteen-month-old girl, who had shown remittent fever frequently from the neonatal period, hypohidrosis, frequent change of face color and self-mutilation of the 1st and 2nd fingers of both hands and tongue in the first months of her life, developed an acute encephalopathy with generalized tonic convulsion outdoors on a sunny hot day. Generalized tonic convulsion subsided within two days, but doll's eye phenomenon, loss of pupillary reaction to light, palpebral myoclonus, and ballismus of arms and legs followed L-dopa showed some effect on the ballismus 1 month after the attack. During the hospital stay, biopsy of sural nerve was performed. Morphometric and ultrastructural studies of the sural nerve demonstrated decreased numbers of unmyelinated and small myelinated fibers. Skin biopsy of the leg revealed sweat glands with no nerve terminals, axons and Schwann cells around them. She was diagnosed as having hereditary sensory and autonomic neuropathy type IV based on the histological and clinical findings. After discharge, bone fracture was found three times without any evidence of trauma. Acute encephalopathy, probably produced in relation to the underlying neuropathy, was considered to be due to heat stroke.

Biotin deficiency in an infant fed with amino acid formula and hypoallergenic rice.

An amino acid formula produced in Japan is not supplemented with biotin since biotin is not permitted as a food additive. Biotin deficiency developed in an 11-month-old Japanese infant who had been diagnosed as a neonate with cow milk and soy bean allergy and fed with an amino acid formula and hypoallergenic rice processed by protease. Serum levels of zinc, essential fatty acids and biotinidase were within the normal range while that of biotin was below the normal range. Urinary 3-hydroxy-isovalerate and slightly elevated levels of plasma branched-chain amino acids disappeared 1 week after oral supplementation with 1 mg day-1 of biotin as did the symptoms of orificial skin lesions, lethargy, hypotonia and alopecia later. In summary, to prevent biotin deficiency, biotin should be added to the Japanese amino acid formula.

Quantity - distance and explosives

The explosive act Canada has jurisdiction over explosives storage and manufacturing sites (except storage at mines) in Canada. The siting of storage and manufacturing facilities takes into consideration a number of factors, with one the most important being Quantity - Distance (Q-D). The Q-D principles adopted by Canada are based on those published by the North Atlantic Treaty Organization (NATO) which were derived from various sources of data such as accidents and trials. Eplosives are classified, usually by testing or analogy, into Hazard Divisions (HD). Q-D tables are based on hazards division and assume that an explosion will occur sometime during the life on the site. Other storage or manufacturing sites or places external to the potential donor site must be taken into consideration when determining how much explosive may be present (quantity) or how far away the site must be (distance) (AU)