Finger width as a measure of femoral block puncture site: an ultrasonographic anatomical-anthropometric study.

STUDY OBJECTIVE: Femoral nerve blockade is a regional anesthetic procedure that may be used in prehospital and emergency settings in cases of femoral trauma. Its speed and performance depend on how well the puncture site can be accurately located, something that usually is achieved via visible landmarks and/or by combining various universal preestablished measurements. Most of these methods have been derived from cadaver studies, which often suffer limitations in clinical settings. To facilitate a quick and easy determination of the puncture site, we here attempt to find an in vivo anthropometric measure that closely corresponds to the distance between the femoral artery and femoral nerve. DESIGN: This is a prospective observational study. PATIENTS: The study includes 67 patients presenting for elective surgery. MEASUREMENTS: The distance from the femoral nerve to the femoral artery, projected to the skin, was measured by a 13-MHz ultrasonographic linear probe. Anthropometric measurements of the width of the hand fingers were carried out at the distal interphalangeal joints. RESULTS: The distance from the femoral artery to the femoral nerve projected to the skin was found to closely correspond to the width of the fifth finger of the dominant hand measured at the distal interphalangeal joint. CONCLUSION: Because it relies on individual anthropometric information, this finding offers an individualized approach to determining the puncture site in a given patient. We believe that such an approach can improve and simplify femoral nerve blockade procedures in prehospital and emergency settings.

Influence of arm position on ultrasound visibility of the axillary brachial plexus.

BACKGROUND: Contemporary axillary brachial plexus block is performed by separate injections targeting radial, median, ulnar and musculocutaneous nerve. These nerves are arranged around the axillary artery, making ultrasound visualisation sometimes challenging. In particular, the radial nerve can be difficult to localise deep to the artery. OBJECTIVES: The primary aim of this study was to investigate which arm position optimises the visibility of the radial nerve. Secondary aims were the visibility and position of the other nerves during varying arm positions. DESIGN: A prospective observational study. SETTING: University teaching hospital, November 2012. PARTICIPANTS: Twenty volunteers, recruited by an advertisement on the Department's bulletin board. Inclusion criterion age more than 18 years. EXCLUSION CRITERIA: refusal of ultrasound examination, restricted shoulder movement, local infection, BMI greater than 30 kg m⁻². INTERVENTION: One anaesthesiologist performed bilateral ultrasound examinations of the axillary brachial plexus on 20 volunteers. Each arm was placed in different positions [shoulder (S) 90° or 180° abduction, elbow (E) 0° or 90° extension] and scans were performed proximally in the axilla, and additionally 5 cm distally to this point [proximal (P) vs. distal (D)], resulting in eight different scans stored for off-line analysis performed by two blinded anaesthesiologists. MAIN OUTCOME MEASURES: For radial, median, ulnar and musculocutaneous nerve, visibility was assessed on a six-point visibility scale. Distances and angles of the nerves relative to the axillary artery and distances relative to the skin were measured. RESULTS: No significant differences between arm positions were found in the visibility score of radial (P = 0.359) and musculocutaneous nerves (P = 0.073). Visibility of the median nerve was improved in positions S90°/E0°/D and S180°/E0°/P (P = 0.02). The ulnar nerve was more visible in position S180°/E 0°/P and D (P = 0.007). The greatest distance between artery and radial nerve was 7.4 ±â€Š4.7 mm at an angle of 120 ±â€Š14° in position S180°/E 0°/D. CONCLUSION: The visibility of the radial nerve was not improved by varying positions of the arm. S180°/E0° provided the best overall visibility and accessibility of nerves. TRIAL REGISTRATION: https://www.toetsingonline.nl/to/ccmo_search.nsf/Searchform?OpenForm Identifier: NL42116.018.12.

Public health problems in the medieval statutes of Croatian Adriatic coastal towns: from public morality to public health.

The article seeks out the regulations about public health in the oldest medieval statutes of fourteen cities of the eastern Croatian Adriatic coast, between the thirteenth and sixteenth century. The research revealed numerous examples of direct or indirect ways of protecting public health. Through the analyzed documents, a noteworthy relationship between public morality and public health can be noted. The described rules are important as a reflection of awareness about public health as a condition of survival and progress in the past. They witness a progressive transition from an original common law into a written law as well as the impact that religion had in influencing people's general opinion and lifestyle in light of public health problems.

Effects of enoxaparin in the rat hippocampus following traumatic brain injury.

Purpose of this study was to investigate the effects of low molecular weight heparin, enoxaparin, on different parameters of the hippocampal damage following traumatic brain injury (TBI) in the rat. TBI of moderate severity was performed over the left parietal cortex using the lateral fluid percussion brain injury model. Animals were s.c. injected with either enoxaparin (1mg/kg) or vehicle 1, 7, 13, 19, 25, 31, 37, and 43 h after the TBI induction. Sham-operated, vehicle-treated animals were used as the control group. Rats were sacrificed 48h after the induction of TBI. Hippocampi were processed for spectrophotometric measurements of the products of oxidative lipid damage, thiobarbituric acid-reactive substances (TBARS) levels, as well as the activities of antioxidant enzymes, superoxide dismutase (SOD), and glutathione peroxidase (GSH-Px). Moreover, the Western blotting analyses of the oxidized protein levels, expressions of cyclooxygenase-2 (COX-2), inducible nitric oxide synthase (iNOS), pro- and mature-interleukin-1ß (pro-, and mature-IL-1ß), and active caspase-3 were performed. COX-2 expressions were also explored by using immunohistochemistry. Glial fibrillary acidic protein immunochistochemistry was performed with the aim to assess the level of astrocytic activity. Fluoro-Jade B staining was used to identify the level and extent of hippocampal neuronal injury. TBI caused statistically significant increases of the hippocampal TBARS and oxidized protein levels as well as COX-2, pro-IL-1ß, and active caspase-3 overexpressions, but it did not significantly affect the SOD and GSH-Px activities, the iNOS, and mature-IL-1ß expression levels. TBI also induced hippocampal reactive astrocytosis and neurodegeneration. Enoxaparin significantly decreased the hippocampal TBARS and oxidized protein levels, COX-2 overexpression and reactive gliosis, but it did not influence the SOD and GSH-Px activities, pro-IL-1ß and active caspase-3 overexpressions as well as neurodegeneration following TBI. These findings demonstrate that enoxaparin may reduce oxidative damage, inflammation and astrocytosis following TBI in the rat and could be a candidate drug for neuroprotective treatment of this injury.

Benefit of the minimal invasive ultrasound-guided single shot femoro-popliteal block for ankle surgery in comparison with spinal anesthesia.

BACKGROUND: Ultrasound-guided regional anesthesia has gained popularity for ankle and foot surgery. The aim of our study was to investigate the sufficiency of anesthesia for ankle surgery as well as duration of analgesia in postoperative period, using minimal invasive ultrasound-guided regional anesthesia, and to compare it with anesthesia and postoperative analgesia following spinal anesthesia. METHODS: This prospective study included 40 adult trauma patients with bimalleolar fracture who were scheduled for surgery. They were randomly assigned and divided in two groups. Patients from the first group underwent an Ultrasound-guided femoro-popliteal block (US-FPB), while a spinal anesthesia (SA) was performed for the second group. The local anesthetic 0.5% bupivacaine was used in both groups. RESULTS: Eighteen patients from the first and nineteen patients from the second group completed the study. Levels of anesthesia were sufficient in both groups without significant differences. Duration of postoperative analgesia was significantly higher in US-FPB group in comparison to SA group (12 ± 3 vs. 3 ± 1 h) (p < 0.001). At the same time, onset of complete sensory motor block was significantly faster in SA group in comparison to US-FPB group (5 ± 1 vs. 8 ± 3 min) (p < 0.001). CONCLUSION: Minimal invasive US-FPB provides sufficient anesthesia for ankle fracture. In comparison to the SA group, patients from the US-FPB group achieved significantly longer postoperative analgesia, while faster onset of anesthesia was noted in SA group.

Is there an effective approach to deterring students from plagiarizing?

The purpose of this study was to evaluate the effectiveness of plagiarism detection software and penalty for plagiarizing in detecting and deterring plagiarism among medical students. The study was a continuation of previously published research in which second-year medical students from 2001/2002 and 2002/2003 school years were required to write an essay based on one of the four scientific articles offered by the instructor. Students from 2004/2005 (N = 92) included in present study were given the same task. Topics of two of the four articles were considered less complex, and two were more complex. One less and one more complex articles were available only as hardcopies, whereas the other two were available in electronic format. The students from 2001/2002 (N = 111) were only told to write an original essay, whereas the students from 2002/2003 (N = 87) were additionally warned against plagiarism, explained what plagiarism was, and how to avoid it. The students from 2004/2005 were warned that their essays would be examined by plagiarism detection software and that those who had plagiarized would be penalized. Students from 2004/2005 plagiarized significantly less of their essays than students from the previous two groups (2% vs. 17% vs. 21%, respectively, P < 0.001). Over time, students more frequently choose articles with more complex subjects (P < 0.001) and articles in electronic format (P < 0.001) as a source for their essays, but it did not influence the rate of plagiarism. Use of plagiarism detection software in evaluation of essays and consequent penalties had effectively deterred students from plagiarizing.

"Marina-Trinkkur" and a few more modern-time hydrotherapeutic myths from the Kvarner region of NW Croatia.

PURPOSE: The present paper tries to address the rise and decay of the sea-water "cult" in regional health tourism in NW Croatia, concentrating upon and analysing more thoroughly the example of Marina, chemically processed sea water, an invention of Dr Géza Fodor, the Hungarian physician practicing in that part of Croatia. METHOD: The original documents and archived items related to the topic were examined. Furthermore, we investigated numerous communal bulletins and medical authorities' records of respective time. RESULTS: Our research showed that the sea-water baths, introduced thanks to the influence of balneologists (like J. Glax), and "drinking cures" (advocated by M.-J. Ortel, for instance) were surprisingly popular not only among tourists of the time, but also among the physicians that used them extensively for therapeutical purposes. These baths and "drinking cures" enriched and completed the medical offer of the resorts regardless of their sometimes dubious effectiveness. CONCLUSIONS: This simple distilled sea-water preparation, advertised as a real panacea, demonstrates a paradigm that elucidates the mentality of physicians, merchants, and patients/consumers of the time.

[Correlation and regression]. / Korelacija i regresija.

Correlation and regression are statistical methods that help us determine interactions of variables. Both are being used in statistical analysis of basic and clinical research. Correlation (r) is a measure of linear relationship between two numerical measurements made on the same set of subjects and it is represented by correlation coefficient. Values of correlation coefficient range between -1 and 1. Pearson's and Spearman's coefficients of correlation are the most often used correlation coefficients. Correlation can be linear and non-linear. We calculate the significance of correlation (P) in an effort to determine significance of correlation coefficient. Regression is a statistical method that allows us to predict values of one variable from another. The simplest regression is linear regression. The success of regression equation is valued by analysis of residuals. Multiple regression is used to predict one variable from several known variables.

Prevalence of plagiarism among medical students.

AIM: To determine the prevalence of plagiarism among medical students in writing essays. METHODS: During two academic years, 198 second year medical students attending Medical Informatics course wrote an essay on one of four offered articles. Two of the source articles were available in an electronic form and two in printed form. Two (one electronic and one paper article) were considered less complex and the other two more complex. The essays were examined using plagiarism detection software "WCopyfind," which counted the number of matching phrases with six or more words. Plagiarism rate, expressed as the percentage of the plagiarized text, was calculated as a ratio of the absolute number of matching words and the total number of words in the essay. RESULTS: Only 17 (9%) of students did not plagiarize at all and 68 (34%) plagiarized less than 10% of the text. The average plagiarism rate (% of plagiarized text) was 19% (5-95% percentile=0-88). Students who were strictly warned not to plagiarize had a higher total word count in their essays than students who were not warned (P=0.002) but there was no difference between them in the rate of plagiarism. Students with higher grades in Medical Informatics exam plagiarized less than those with lower grades (P=0.015). Gender, subject source, and complexity had no influence on the plagiarism rate. CONCLUSIONS: Plagiarism in writing essays is common among medical students. An explicit warning is not enough to deter students from plagiarism. Detection software can be used to trace and evaluate the rate of plagiarism in written student assays.

Publishing scientific papers based on Master's and Ph.D. theses from a small scientific community: case study of Croatian medical schools.

AIM: To evaluate publishing activity of medical doctors after they have obtained Master's or Ph.D. degree at the Rijeka and Zagreb University Schools of Medicine in Croatia, and establish the number of journal articles based on these theses. METHODS: Data on Master's and Ph.D. theses defended at the Rijeka and Zagreb University Schools of Medicine in the 1990-1999 period were collected by hand-search of the archive. MEDLINE and Current Contents databases were searched for journal articles resulting from the theses. RESULTS: During the 10-year period, 1,535 Master's and 634 Ph.D. theses were defended at the Rijeka and Zagreb University Schools of Medicine (253 Master's and 138 Ph.D. theses from Rijeka and 1,282 Master's and 496 Ph.D. theses from Zagreb). There were 201 (14%) Master's and 218 (34%) Ph.D. theses that resulted in articles published in journals indexed in MEDLINE (13% of Master's and 11% of Ph.D. theses from Rijeka, and 14% of Master's and 41% of Ph.D. theses from Zagreb). Also, 97 (6%) Master's and 129 (20%) Ph.D. theses that resulted in articles published in Current Contents journals (8% of Master's and 6% of Ph.D. theses from Rijeka, and 6% of Master's and 24% of Ph.D. theses from Zagreb). There was no significant difference between the two Universities with respect to published articles based on Master's theses, but there were significantly more articles from Ph.D. theses in Zagreb (p<0.001). Most of the theses resulted in a single publication (95%), 19 (5%) in 2, and 2 in 3 publications. Out of all 453 journal articles, 31% were published in Croatian and 69% in international journals. CONCLUSION: Most Croatian Master's and Ph.D. theses are not made available to the scientific community. There should be more institutional effort directed at the stimulation of postgraduate students to publish their scientific work.