Treatment of acute distal biceps tendon ruptures - A survey of the British Elbow and Shoulder Society surgical membership.

Background: Acute distal biceps tendon ruptures result in weakness and deformity. While in other jurisdictions the rate of surgical repair has outpaced rises in incidence, UK practice for distal biceps tendon ruptures is unknown. The aim of this survey was to characterise current UK clinical practice. Methods: An online survey was sent to the surgeon members of the British Elbow and Shoulder Society. Questions covered respondent demographics, clinical decision making, surgical experience and willingness to be involved in future research. Results: A total of 242 surgeons responded; 99% undertook acute distal biceps tendon repairs with 83% repairing at least half of all distal biceps tendon ruptures, and 84% of surgeons would have their own, hypothetical, acute distal biceps tendon rupture repaired in their dominant arm and 67% for their non-dominant arm. Patient age, occupation and restoration of strength were the commonest factors underpinning a recommendation of surgical fixation. Most surgeons (87%) supported a national trial to study operative and non-operative treatments. Conclusions: UK upper limb surgeons currently advise surgical repair of acute distal biceps tendon ruptures for the majority of their patients. This is despite a paucity of evidence to support improved outcomes following surgical, rather than non-operative, management. There is a clear need for robust clinical evaluation in this area.

The use of a patch to augment rotator cuff surgery - A survey of UK shoulder and elbow surgeons.

BACKGROUND: Rotator cuff tears are a common cause of shoulder pain and can result in prolonged periods of pain, disability and absence from work. Rotator cuff repair surgery is increasingly used in an attempt to resolve symptoms but has failure rates of around 40%. There is a pressing need to improve the outcome of rotator cuff repairs. Patch augmentation increasingly being used within the NHS in an attempt to reduce repair failures. The aim of this survey was to determine current UK practice and opinion relating to the factors that influence choice of patch, current patient selection and willingness to assist with generation of improved evidence. METHODS: An online survey was sent to the surgeon members of the British Elbow and Shoulder Society (BESS). Questions covered respondent demographics, experience with patches, indications for patch augmentation and willingness to be involved in a randomised trial of patch augmented rotator cuff surgery. RESULTS: The response rate was 105/550 (19%). 58% of respondents had used a patch to augment rotator cuff surgery. 70% of patch users had undertaken an augmented repair within the last 6 months. A wide surgical experience in augmentation was reported (ranging 1 to 200 implants used). However, most surgeons reported low volume usage, with a median of 5 rotator cuff augmentation procedures performed. At least 10 different products had been used. Most of the patches used were constructed from human decellularised dermis tissue, although porcine derived and synthetic based patches had also been used. Only 3-5% stated they would undertake an augmented repair for small tears across ages, whereas 28-40% and 19-59% would do so for large or massive tears respectively. When assessing patient suitability, patient age seemed relevant only for those with large and massive tears. Half of the surgeons reported an interest in taking part in a randomised controlled trial (RCT) evaluating the role of patch augmentation for rotator cuff surgery, with a further 22% of respondent's undecided. CONCLUSIONS: A variety of patches have been used by surgeons to augment rotator cuff repair with a wide range of operator experience. There was substantial uncertainty about which patch to use and differing views on which patients were most suitable. There is a clear need for robust clinical evaluation and further research in this area.

Time-resolved laser-induced desorption spectroscopy (LIDS) for quantified in-situ hydrogen isotope retention measurement and removal from plasma facing materials.

A laboratory scale laser induced thermal desorption spectroscopy system is developed and tested on tungsten-deuterium and titanium-deuterium codeposits, and its feasibility as a hydrogenic inventory measurement diagnostic is demonstrated over a range of retention values from 5 × 1019 m-2 to 7 × 1023 m-2 for absorbed laser power densities as low as 8 MW m-2. Codeposit layer samples are grown by magnetron sputtering and immersed in a weak argon rf plasma. A 1 kW fiber laser (λ = 1100 nm) heats the samples up to a peak surface temperature ranging from 900 to 1500 K using pulse widths of 0.5 and 1 s. Spectral line emission from Balmer series Dα and Hα from thermally desorbed deuterium and hydrogen, as well as line emission from argon, are monitored as a function of time using an optical spectrometer with maximum temporal resolution of 1 ms. To correct for wall recycling and pumping speed, and to accurately measure the time evolution of the laser-induced thermal desorption, the raw Dα signal is deconvolved with the system response function, which is obtained by injecting a short burst of D2 to approximate an impulse. Calibration is done with a standard D2 leak, and laser induced desorption spectroscopy deuterium retention values are found to be in good agreement with companion measurements made using conventional temperature programmed desorption on samples from the same codeposit batch.

Morphologies of tungsten nanotendrils grown under helium exposure.

Nanotendril "fuzz" will grow under He bombardment under tokamak-relevant conditions on tungsten plasma-facing materials in a magnetic fusion energy device. We have grown tungsten nanotendrils at low (50 eV) and high (12 keV) He bombardment energy, in the range 900-1000 °C, and characterized them using electron microscopy. Low energy tendrils are finer (~22 nm diameter) than high-energy tendrils (~176 nm diameter), and low-energy tendrils have a smoother surface than high-energy tendrils. Cavities were omnipresent and typically ~5-10 nm in size. Oxygen was present at tendril surfaces, but tendrils were all BCC tungsten metal. Electron diffraction measured tendril growth axes and grain boundary angle/axis pairs; no preferential growth axes or angle/axis pairs were observed, and low-energy fuzz grain boundaries tended to be high angle; high energy tendril grain boundaries were not observed. We speculate that the strong tendency to high-angle grain boundaries in the low-energy tendrils implies that as the tendrils twist or bend, strain must accumulate until nucleation of a grain boundary is favorable compared to further lattice rotation. The high-energy tendrils consisted of very large (>100 nm) grains compared to the tendril size, so the nature of the high energy irradiation must enable faster growth with less lattice rotation.

Improving the quality of operative notes for laparoscopic cholecystectomy: Assessing the impact of a standardized operation note proforma.

INTRODUCTION: Operative notes are the recognized standard for documenting the details of an operation yet key procedural details are frequently missing. With the aim of improving standards, based on the Royal College of Surgeons (RCS) and Dutch Society of Surgery (DSS) Guidelines, we introduced an operation note proforma for use following laparoscopic cholecystectomy in a tertiary centre in the UK. METHODS: This study audited 130 consecutive laparoscopic cholecystectomy operation notes against accepted guidelines across three hospital sites within the same NHS Trust. Following analysis of these operation notes a standardized operation note proforma was designed and introduced across the Trust, which included all items from the DSS and RCS guidelines in the form of keyword prompts or simple yes/no responses. A further 128 operation notes were analysed. Guideline compliance was compared pre- and post-introduction of the proforma. Non-parametric data were analysed using Fisher's exact and Mann-Whitney U tests. Statistical significance was set at p < 0.05. RESULTS: On a global assessment of operation note completeness against all guideline items, introduction of an operation note proforma significantly improved documentation rates for both DSS guidelines (p < 0.001) and RCS guidelines (p < 0.001). DISCUSSION: We have demonstrated that the introduction of a procedure-specific proforma to assist with writing the post-operative note following laparoscopic cholecystectomy can result in significant improvements in documentation of generic and procedure-specific items that should be recorded for every operation. Procedure-specific proformas, based on established guidelines can help to produce more complete and medico-legally robust operation notes.

Post-thrombotic syndrome: a clinical review.

Up to half of patients with proximal deep vein thrombosis (DVT) will develop post-thrombotic syndrome (PTS) despite optimal anticoagulant therapy. PTS significantly impacts upon quality of life and has major health-economic implications. This narrative review describes the pathophysiology, risk factors, and diagnosis, prevention and treatment of PTS, to improve our understanding of the disease and guide treatment. Relevant articles were identified through systematic searches of the PubMed, EMBASE and Cochrane databases between 1966 and November 2011. Studies were included for detailed assessment if they met the following criteria: published in English, human study participants, study population aged > 18 years, and lower limb post-thrombotic syndrome. All non-systematic reviews and single patient case reports were excluded. Recurrent thrombosis, thrombus location and obesity are major risk factors, whereas the importance of gender and age remain uncertain. The diagnosis of PTS is based on clinical findings in patients with a known history of DVT. Several clinical scales have been described, with the Villalta Score gaining increasing popularity. Adequate anticoagulation and use of elastic compression stockings (ECS) following DVT can reduce the incidence of PTS. Catheter-directed thrombolysis and mechanical thrombectomy of acute DVT may preserve valvular function. Studies to date of these techniques are encouraging, and have reported improved hemodynamics and a reduced incidence of PTS. The management of established PTS is challenging. Compression therapy, aimed at reducing the underling venous hypertension, remains the mainstay of treatment. This is despite a paucity of high-quality evidence to support its use. Pharmacologic and surgical treatments have also been described, with a number of studies citing symptomatic improvement.

Capillary electrophoretic application of 1-alkyl-3-methylimidazolium-based ionic liquids.

Ionic substances with melting points at or close to room temperature are referred to as ionic liquids. Interest in ionic liquids for their potential in different chemical processes is increasing, because they are environmentally benign and are good solvents for a wide range of both organic and inorganic materials. In this study, a capillary electrophoretic method for resolving phenolic compounds found in grape seed extracts is reported. The method, in which 1-alkyl-3-methylimidazolium-based ionic liquids are used as the running electrolytes, is simple and reproducible. The separation mechanism seems to involve association between the imidazolium cations and the polyphenols. The role of the alkyl substituents on the imidazolium cations was investigated and will be discussed.

Structural and spectroscopic studies of the versatile coordination chemistry of the chiral ligand N,N-bis(1-propan-2-onyl oxime)-L-methionine N'-methylamide with Ni(II) and Zn(II).

The potentially pentadentate, chiral ligand N,N-bis(1-propan-2-onyl oxime)-L-methionine N'-methylamide (L-MABO) shows remarkable versatility in its coordination chemistry with Ni(II) and Zn(II). In the crystal structure of the ZnCl2 complex of L-MABO, the ligand coordinates to the metal only through its three nitrogen donor groups (one amine and two oximes), with two chloride anions completing the distorted trigonal bipyramidal coordination sphere. In the NiCl2 complex, the three nitrogen donors and the thioether sulfur coordinate, along with two chlorides. The crystal structure of the Ni(NO3)2 complex contains two independent molecules, one of which coordinates the three nitrogens, the thioether sulfur, and the amide oxygen of L-MABO in addition to one nitrate anion. The second molecule coordinates the three nitrogen donors, the amide oxygen, one nitrate anion, and a methanol molecule. Thus, in only three crystal structures, L-MABO demonstrates its ability to provide N3, N3S, N3O, and N3OS donor sets. The thioether-bound complexes are unusual in that they have a predominantly nitrogen environment with a nickel-thioether bond that is not constrained by surrounding donor groups in a macrocyclic or linear polydentate motif. Comparison of the thioether-coordinated and methanol-coordinated molecules in the Ni(NO3) salt of L-MABO demonstrate the effect of the thioether bond on the relative "hardness" of the nickel. The electronic absorption and circular dichroism spectra of the aqueous solutions of the nickel complexes are interpreted in terms of a "descent in symmetry" model based on successive C3v and Cs distortions from octahedral geometry. These ligand field spectra indicate that in aqueous solution all ligand groups except for the three nitrogens of L-MABO are displaced by water. In acetonitrile, the non-nitrogen donors in the nitrate salt may also be displaced, while the chlorides remain coordinated.

The effect of protonation on [Mn(IV)(µ2-O)] 2 complexes.

The series of complexes [Mn(IV)(X-SALPN)(µ2-O)]2, 1: X=5-OCH3; 2: X=H; 3: X=5-Cl; 4: X=3,5-diCl; 5: X=5-NO2, contain [Mn2O2](4+) cores with Mn-Mn separations of 2.7 Å. These molecules can be protonated to form [Mn(IV)(X-SALPN)(µ2-O,OH)]2 (+) in which a bridging oxide is protonated. The pKa values for the series of [Mn(IV)(X-SALPN)(µ2-O,OH)]2 (+) track linearly versus the shift in redox potential with a slope of 84 mV/pKa. This observation suggests that the [Mn2O2](4+) core can be considered as a unit in which the free energy of protonation is directly related to the ability to reduce the Mn(IV) ion. The marked sensitivity of the reduction potential to the presence of protons presents a mechanism in which an enzyme can control the oxidizing capacity of an oxo manganese cluster by the degree and timing of oxo bridge protonation.