Ventral hernia repair outcomes predicted by a 5-item modified frailty index using NSQIP variables.

PURPOSE: Frailty is a decrease in physiologic reserve that is separate from the normal aging process. Previously, an 11-item modified frailty index (mFI) using NSQIP variables predicted outcomes for surgical patients. We aim to validate a condensed 5-item mFI in ventral hernia patients and determine outcomes and the relative impact of each frailty variable. METHODS: The NSQIP database was queried from 2011 to 2016 for patients undergoing VHR. Spearman's rho correlation was used to determine the degree of correlation between 11-item and 5-item mFI raw frailty scores. Chi squared testing was used to determine odds ratios (95% CI) for accumulating frailty variables in both indices with regard to complications vs a baseline of zero variables present on the 11-item scale. Complications were defined by the Clavien-Dindo (CD) classification. Univariate and multivariate analyses were performed on each frailty variable to determine their relative weighted impacts on outcomes. RESULTS: 97,905 patients (99.45%) had all five frailty variables recorded. Only 11,549 patients (11.73%) had all variables from the 11-item mFI. No difference existed between groups for the five mutually shared frailty variables, BMI, emergent vs non-emergent procedures, operative time, or operative approach. For accumulating variables in both indices, the 5-item mFI predicts incidence of any complications, major complications, and discharge not to home similarly to the 11-item mFI. The most significantly weighted variable for complications and discharge not to home is functional status. CONCLUSION: A 5-item mFI accurately predicts outcomes similar to the validated 11-item mFI and captures more patients for analysis.

A new multi-line cusp magnetic field plasma device (MPD) with variable magnetic field.

A new multi-line cusp magnetic field plasma device consisting of electromagnets with core material has been constructed with a capability to experimentally control the relative volume fractions of magnetized to unmagnetized plasma volume as well as accurate control on the gradient length scales of mean density and temperature profiles. Argon plasma has been produced using a hot tungsten cathode over a wide range of pressures 5 × 10-5 -1 × 10-3 mbar, achieving plasma densities ranging from 109 to 1011 cm-3 and the electron temperature in the range 1-8 eV. The radial profiles of plasma parameters measured along the non-cusp region (in between two consecutive magnets) show a finite region with uniform and quiescent plasma, where the magnetic field is very low such that the ions are unmagnetized. Beyond that region, both plasma species are magnetized and the profiles show gradients both in temperature and density. The electrostatic fluctuation measured using a Langmuir probe radially along the non-cusp region shows less than 1% (δIisat/Iisat < 1%). The plasma thus produced will be used to study new and hitherto unexplored physics parameter space relevant to both laboratory multi-scale plasmas and astrophysical plasmas.

Pioneering technique using Acellular Dermal Matrix in the rescue of a radiation ulcer.

BACKGROUND: Radiotherapy as an adjuvant to mastectomy is integral to the treatment of breast cancer, but can result in skin ulceration. Skin ulceration following radiotherapy is traditionally managed by removing the implant and allowing the skin to heal by secondary intention. CASE REPORT: A 42-year-old woman underwent radiotherapy following a breast reconstruction. She developed a 2 x 3cm radiation ulcer. The ulcer was managed by removing the implant and performing capsulectomy. A Beckers 50 expander was placed and reinforced with acellular dermal matrix inferolaterally. At follow-up the patient had a good cosmetic outcome. CONCLUSION: Post-radiation skin ulcers present a challenge to treat with no current standardised management. The use of acellular dermal matrix may present a new technique to promote healing in these testing cases.

Temperature-dependent ideal strength and stacking fault energy of fcc Ni: a first-principles study of shear deformation.

Variations of energy, stress, and magnetic moment of fcc Ni as a response to shear deformation and the associated ideal shear strength (τ(IS)), intrinsic (γ(SF)) and unstable (γ(US)) stacking fault energies have been studied in terms of first-principles calculations under both the alias and affine shear regimes within the {111} slip plane along the <112> and <110> directions. It is found that (i) the intrinsic stacking fault energy γ(SF) is nearly independent of the shear deformation regimes used, albeit a slightly smaller value is predicted by pure shear (with relaxation) compared to the one from simple shear (without relaxation); (ii) the minimum ideal shear strength τ(IS) is obtained by pure alias shear of {111}<112>; and (iii) the dissociation of the 1/2[110] dislocation into two partial Shockley dislocations (1/6[211] + 1/6[121]) is observed under pure alias shear of {111}<110>. Based on the quasiharmonic approach from first-principles phonon calculations, the predicted γ(SF) has been extended to finite temperatures. In particular, using a proposed quasistatic approach on the basis of the predicted volume versus temperature relation, the temperature dependence of τ(IS) is also obtained. Both the γ(SF) and the τ(IS) of fcc Ni decrease with increasing temperature. The computed ideal shear strengths as well as the intrinsic and unstable stacking fault energies are in favorable accord with experiments and other predictions in the literature.

Skin puckering as a sign of humeral neck fracture.

To the best of our knowledge, this is the first clinical report of skin puckering associated with fractured neck of humerus. Its significance may vary in different locations and its presence should be added to other physical and radiological signs to aid decision making.

Continuous compartment pressure monitoring vs. clinical monitoring in tibial diaphyseal fractures.

A cohort of 109 consecutive patients with a tibial fracture who underwent continuous compartment pressure monitoring of the anterior compartment of the leg were reviewed and compared to a historical control group of the immediate previous 109 patients who were clinically monitored. Of these patients 33 underwent fasciotomies for acute compartment syndrome in association with tibial diaphyseal fractures. Seventeen patients had continuous compartment pressure monitoring and 16 clinical assessments alone. The fasciotomy rate of patients who underwent continuous compartment pressure monitoring was 15.6%. Patients who were not monitored had a fasciotomy rate of 14.7%. The mean time delay from injury to fasciotomy was 22 h in the monitored group and 23 h in the non-monitored group. Continuous compartment pressure monitoring did not increase the rate of unnecessary fasciotomies. We could not demonstrate a significant difference in terms of clinical outcome and time delay from injury to fasciotomy.

Relationship of body mass index to early complications in knee replacement surgery.

BACKGROUND: The purpose of this study was to evaluate the relationship between body mass index and early complications following knee replacement. METHODS: Five hundred and twenty-seven patients who underwent primary knee replacement were recruited. All these patients were subjected to a pre-operative assessment and follow-up at 6 weeks and 1 year following surgery. Any complication occurring during this period was recorded. Complications were grouped into systemic and local, minor and major. RESULTS: 12.1% (N = 64) patients had an early complication following knee replacement surgery; 9.2% (N = 48) patients had a major complication. Overall BMI did not seem to influence significantly the rate of complication with a P-value of 0.338. A stronger correlation was found between the surgeon and presence of complication with a P-value of 0.004. CONCLUSIONS: BMI has a weak correlation to early complications following joint replacement surgery. The operating surgeon seems to have a stronger correlation to early complications as compared with BMI.

Outcome of traumatic subtrochanteric femoral fractures fixed using cephalo-medullary nails.

We performed a retrospective review of 101 patients sustaining 102 traumatic, non-pathological subtrochanteric fractures treated with cephalo-medullary nailing over a period of 6 years from 1999 to 2005. Mean follow up was 24 weeks (range: 6-96). Twenty patients were lost to follow up and 21 died, whilst 57 of 60 fractures were followed to union. There were 19 fractures fixed in varus, as defined as a varus angulation of greater than 10 degrees at the fracture site. Implant failure, 9 of the 10 malunions and all 3 of the non-unions occurred in the varus group whilst only 1 malunion occurred in the satisfactory reduction group. This difference in outcome is statistically significant (p<0.0001). Twenty four of the 60 patients had undergone open reduction at the time of fixation. There were three malunions and one non-union in the open reduction group compared with six and two, respectively in the closed group (p>0.05). Post-operative recovery rates, infection rates and other complications were similar for both groups. We therefore advocate the use of open reduction where necessary to avoid varus malreduction to avoid such complications, particularly as open reduction was not associated with a higher complication rate in this series. The study supports the use of cephalo-medullary nailing for subtrochanteric fractures with a union rate of 95%.

Relationship of body mass index to early complications in hip replacement surgery : study performed at Hinchingbrooke Hospital, Orthopaedic Directorate, Huntingdon, Cambridgeshire.

The purpose of this study was to evaluate the relationship between body mass index and early complications following total hip replacements. Five hundred and fifty patients who underwent primary total hip replacement were recruited. All these patients were subjected to a pre-operative assessment and follow-up at 6 weeks and 1 year following surgery. Any complications occurring during this period were recorded. Complications were grouped into systemic and local, both subdivided into minor and major depending on the risk involved. Fifty-six patients (10.2%) had an early complication following hip replacement surgery. Forty-four patients (8%) had a major local complication. Overall, there did seem to be a weak correlation between BMI and the rate of complications, with a p value of 0.104. A correlation was also found between the surgeon and presence of complications with a p value of 0.736. There is a weak correlation between BMI and early complications following hip replacement surgery, and there also seems to be a correlation between the operating surgeon and early complications, but this is not statistically significant.

Bone morphogenetic proteins in orthopaedic trauma: recent clinical findings with human bone morphogenetic protein-2 (rhBMP-2).

This article introduces papers based on presentations from a symposium entitled "Bone Morphogenic Protein Advisory Meeting in Orthopaedic Trauma", where recent clinical findings with human bone morphogenetic protein-2 (rhBMP-2) were reviewed. It also presents two case studies which illustrate the clinical problems with the potential morbidity of tibial fractures and the potential benefits of the use of rhBMP-2 at surgery. The article concludes with a summary of the symposium. Tibial shaft fracture repair is associated with a significant financial burden on the patient, the health care providers and the medical insurance companies. It is anticipated that the clinical advantages of rhBMP-2 could lead to cost savings both inside and outside the hospital setting.

Prosodic discrimination in patients with schizophrenia.

Fifteen patients with prominent positive symptoms of schizophrenia and 15 normal controls performed verbal prosodic and pure musical discrimination tasks, with changes in pitch and timing parameters. The patients' performance was comparable to that of controls on the discrimination of terminal pitch changes, but significantly poorer on the more difficult internal pitch discrimination. The latter deficit was positively correlated with the severity of their positive symptoms. The results suggest that patients have a deficit in processing fundamental aspects of prosody, which is associated with the presence of positive symptoms.

Ghrelin stimulates insulin-induced glucose uptake in adipocytes.

The gastric and hypothalamic hormone ghrelin is the endogenous agonist of the growth hormone secretagogue receptor GHS-R1(a). Ghrelin stimulates growth hormone release and appetite via the hypothalamus. However, putative direct peripheral effects of ghrelin remain poorly understood. Rat adipose tissue expresses GHS-R1(a) mRNA, suggesting ghrelin may directly influence adipocyte function. We have investigated the effects of ghrelin on insulin-stimulated glucose uptake in isolated white adipocytes in vitro. RT-PCR confirmed the expression of GHS-R1(a) mRNA in epididymal adipose tissue. However, GHS-R1(a) expression was not detected in the peri-renal fat pads. Ghrelin increased insulin-stimulated deoxyglucose uptake in isolated white adipocytes extracted from the epididymal fat pads of male Wistar rats. Ghrelin 1000 nM significantly increased deoxyglucose uptake by 55% in the presence of 0.1 nM insulin. However, ghrelin administration in the absence of insulin had no effect on adipocyte deoxyglucose uptake, suggesting that ghrelin acts synergistically with insulin. Des-acyl ghrelin, a major circulating non-octanylated form of ghrelin, had no effect on insulin-stimulated glucose uptake. Furthermore, acylated ghrelin had no effect on deoxyglucose uptake in adipocytes from peri-renal fat pads suggesting that ghrelin may influence glucose uptake via the GHS-R1(a). Ghrelin therefore appears to directly potentiate adipocyte insulin-stimulated glucose uptake in selective adipocyte populations. Ghrelin may play a role in adipocyte regulation of glucose homeostasis.

A new approach for plate fixation of midshaft clavicular fractures.

The majority of midshaft clavicle fractures unite uneventfully. Although the indications for operative intervention are limited and reported complication rates high, there are circumstances in which surgery is required. We describe a new, infraclavicular surgical approach to the clavicle used in a series of 89 patients over 9 years. Average time to union was 13.5 weeks. There was one case of deep infection and one of non-union, both of which resolved with further treatment. These results compare very favourably with previously published series and we submit that this operative approach allows safe management of an otherwise potentially hazardous procedure.

Human pitch perception is reflected in the timing of stimulus-related cortical activity.

'Pitch' refers to a sound's subjective highness or lowness, as distinct from 'frequency,' which refers to a sound's physical structure. In speech, music and other natural contexts, complex tones are often perceived with a single pitch. Using whole-head magnetoencephalography (MEG) and stimuli that dissociate pitch from frequency, we studied cortical dynamics in normal individuals who extracted different pitches from the same tone complexes. Whereas all subjects showed similar spatial distributions in the magnitude of their brain responses to the stimuli, subjects who heard different pitches exhibited contrasting temporal patterns of brain activity in their right but not their left hemispheres. These data demonstrate a specific relationship between pitch perception and the timing (phase) of dynamic patterns of cortical activity.