Study of the N=32 and N=34 Shell Gap for Ti and V by the First High-Precision Multireflection Time-of-Flight Mass Measurements at BigRIPS-SLOWRI.

The atomic masses of ^{55}Sc, ^{56,58}Ti, and ^{56-59}V have been determined using the high-precision multireflection time-of-flight technique. The radioisotopes have been produced at RIKEN's Radioactive Isotope Beam Factory (RIBF) and delivered to the novel designed gas cell and multireflection system, which has been recently commissioned downstream of the ZeroDegree spectrometer following the BigRIPS separator. For ^{56,58}Ti and ^{56-59}V, the mass uncertainties have been reduced down to the order of 10 keV, shedding new light on the N=34 shell effect in Ti and V isotopes by the first high-precision mass measurements of the critical species ^{58}Ti and ^{59}V. With the new precision achieved, we reveal the nonexistence of the N=34 empirical two-neutron shell gaps for Ti and V, and the enhanced energy gap above the occupied νp_{3/2} orbit is identified as a feature unique to Ca. We perform new Monte Carlo shell model calculations including the νd_{5/2} and νg_{9/2} orbits and compare the results with conventional shell model calculations, which exclude the νg_{9/2} and the νd_{5/2} orbits. The comparison indicates that the shell gap reduction in Ti is related to a partial occupation of the higher orbitals for the outer two valence neutrons at N=34.

First Direct Mass Measurements of Nuclides around Z=100 with a Multireflection Time-of-Flight Mass Spectrograph.

The masses of ^{246}Es, ^{251}Fm, and the transfermium nuclei ^{249-252}Md and ^{254}No, produced by hot- and cold-fusion reactions, in the vicinity of the deformed N=152 neutron shell closure, have been directly measured using a multireflection time-of-flight mass spectrograph. The masses of ^{246}Es and ^{249,250,252}Md were measured for the first time. Using the masses of ^{249,250}Md as anchor points for α decay chains, the masses of heavier nuclei, up to ^{261}Bh and ^{266}Mt, were determined. These new masses were compared with theoretical global mass models and demonstrated to be in good agreement with macroscopic-microscopic models in this region. The empirical shell gap parameter δ_{2n} derived from three isotopic masses was updated with the new masses and corroborates the existence of the deformed N=152 neutron shell closure for Md and Lr.

Efficacy of standard glucose-based and reduced-osmolarity maltodextrin-based oral rehydration solutions: effect of sugar malabsorption.

Previously we reported that standard oral rehydration salts (ORS) solution is not as effective as a reduced-osmolarity glucose-based ORS for the treatment of children with acute noncholera diarrhoea: with standard ORS the diarrhoea lasts longer, stool output is greater, serum sodium is higher, and there is more need for supplemental intravenous infusion. We studied a reduced-osmolarity maltodextrin (MD)-based ORS to determine whether it had similar benefits, and also the effect of sugar malabsorption on the efficacy of standard and MD-based ORS. A total of 90 boys aged 3-24 months with acute noncholera diarrhoea and moderate dehydration were randomly assigned to either standard ORS (glucose 20 g/l, osmolarity 311 mmol/l) or MD-ORS (MD 50 g/l, osmolarity 227 mmol/l). There were no differences in treatment results. Some 46% of subjects had a high total stool output (> 300 g/kg), which was unrelated to the type of ORS given. High stool output was significantly associated with a longer duration of diarrhoea (33 vs. 15 hours; P < 0.001), a persistently elevated serum sodium (149 vs. 144 mmol/l at 24 h; P < 0.02), the need for intravenous infusion (11/41 vs. 0/48; P < 0.002), and an increase in faecal reducing substances (10.8 vs. 3.4 g/l at 24 h; P < 0.001). We conclude that some children given standard ORS develop osmotic diarrhoea owing to the combined effect of transient sugar malabsorption and slight hypertonicity of the ORS. Earlier studies show that this adverse outcome can largely be avoided when extra water is given in reduced-osmolarity glucose-based ORS. Reduced osmolarity has no benefit, however, when glucose is replaced by maltodextrin, probably because the sugars released by hydrolysis of MD, when malabsorbed, raise the intraluminal osmolarity to equal or exceed that of standard ORS. Thus, reduced-osmolarity glucose-based ORS is superior to both standard ORS and reduced-osmolarity solutions based on maltodextrin and probably other complex carbohydrates. Studies are in progress to define the optimal formulation of reduced-osmolarity glucose-based ORS.

PIP: At the Diarrhoeal Disease Research and Rehydration Centre of Bab El-Sha'reya Hospital in Cairo, Egypt, clinical researchers randomly assigned 90 fully weaned boys aged 3-24 months with non-cholera diarrhea and signs of moderate dehydration to either the treatment group receiving the standard glucose-based oral rehydration solution (ORS) or the group receiving a reduced-osmolarity ORS with minimally hydrolyzed maltodextrins (MD) (50 g/l) in place of glucose (20 g/l). They wanted to determine whether the reduced-osmolarity, MD-based ORS yielded similar benefits as the glucose-based ORS and to examine the effect of sugar malabsorption on the efficacy of both solutions. The osmolarity of the MD-based ORS was 227 mmol/l compared to 311 mmol/l for the standard ORS. There were no significant differences in the clinical outcomes (duration of diarrhea, stool output, ORS intake, serum sodium level, and weight gain at discharge) for each treatment group. High stool output had a significant positive association with longer duration of diarrhea (33 vs. 15 hours for low stool output; p 0.01), a persistently elevated serum sodium concentration (149 vs. 144 mmol/l for low stool output; p 0.02), the need for intravenous infusion (11/41 vs. 0/48 for low stool output; p 0.002), and an increase in substances that reduce feces (10.8 vs. 3.4 g/l for low stool output; p 0.001). Based on these findings, the researchers hypothesized that, like the standard ORS, the reduced osmolarity ORS, in which glucose is replaced with MD, also caused sugar malabsorption. The sugar malabsorption, in turn, increased the effective intraluminal osmolarity to equal or exceed that of the standard ORS. Both sugar malabsorption and intraluminal hypertonicity were responsible for a net flow of water from extracellular fluid into the gut, an increased serum sodium concentration, increased thirst leading to greater intake of ORS, ORS treatment failure, an increase in stool output, and an increase in duration of diarrhea. In conclusion, reduced-osmolarity, glucose-based ORS is superior to the standard glucose-based ORS and reduced-osmolarity, MD-based ORS.

Relationship between retention of the posterior cruciate ligament and postoperative flexion in total knee arthroplasty.

This study was conducted to retrospectively analyzed the outcome of 192 total knee arthroplasties in 132 patients with rheumatoid arthritis (118 women, 14 men). The Okayama Mark II prosthesis, which requires the posterior cruciate ligament (PCL) to be resected, was used in 83 knees (group I), the Mark II prosthesis, which allows the PCL to be retained, was used in 68 knees (group II), and the new Okayama PCL-R prosthesis, which also allows the PCL to be retained, was used in 41 (group III). According to the Japanese Orthopaedic Association knee scoring system, the clinical outcome of groups I, II and III at 1 year after the operation were 64.9, 71.2 and 72.3 points, respectively, and the average flexion angles in each group at 1 year were 78.4, 92.6 and 101.3 degrees. Postoperative flexion in groups III was significantly greater than in groups I and II. These results suggest that postoperative flexion is greater when the posterior cruciate ligament is retained.

An instrument to assess acute respiratory infection case management in Egypt.

UNLABELLED: To develop an instrument to measure the quality of acute respiratory infection (ARI) case management among Egyptian children. METHODS: A baseline survey of all health facilities in a single district, using a multi-data source instrument. Data sources included providers, caretakers, patient records and observation of patient care. MAIN RESULTS: Physicians did not count the respiratory rate and check for subcostal retraction. Eighty-seven per cent of children who did not require antibiotics received them. Of five children who required antibiotics, four (80%) were prescribed an oral regimen. Three of these should have been admitted to a hospital but were not. Antibiotics were available at the facilities an estimated 7.9 months per year. Oxygen for inpatient treatment was available in one of two hospitals. CONCLUSIONS: This instrument was useful for comprehensively evaluating facility capability to provide quality case management. Deficiencies were identified but were not unexpected in a baseline survey. The Egypt ARI program has the potential to have a substantial impact on how children with ARI are diagnosed and treated in health facilities.

PIP: An instrument consisting of 10 questionnaires was developed to assess the ability of facilities to implement acute respiratory infection (ARI) case management guidelines. Data sources included interviews with physicians, nurses and area pharmacists; observation of patient care; review of patient records and an inventory of supplies. All 21 outpatient and two inpatient health facilities as well as 20 of 28 pharmacies in the district were included in the study. Of 93 child assessments observed, physicians asked the age for only 38 (41%). No child was questioned on ability to drink or experience of seizures. In addition, no physician checked for stridor, wheeze or chest indrawing, or counted the respiratory rate. 81 of 93 (87%) children with ARI were prescribed antibiotics. Among the 88 children assessed as not requiring antibiotics, 77 (88%) received them. Five children (2 pneumonia, 2 severe pneumonia, and 1 very severe disease) were determined to require antibiotics; four were prescribed an oral regimen. Of the four children that both required antibiotics and received them, three should have been admitted to the hospital for parenteral antibiotics, but were not. A variety of prescribed antibiotics were used among the 77 children. 27 (35%) children received two or three antibiotics without specifying the dose, frequency or duration on the prescription. Only two physicians mentioned the antibiotic dosage schedule for home care to the mother. Physicians at each of the outpatient facilities estimated the mean availability of antibiotics at 7.9 +or- 3.9 months. Three facilities (14%) had ampicillin suspension, none had amoxicillin and two (9%) had cotrimoxazole for the treatment of outpatient pneumonia. 19 (90%) had aspirin. Oxygen was available for inpatient care for children with pneumonia in one of the two hospitals, no nebulizers were available for treatment of wheezing, and disposable syringes were available in only one hospital. Parenteral bronchodilators were available in both, oral in neither. This instrument was useful for comprehensively evaluating facility capability to provide quality case management in the Egyptian ARI program.

Morphological study of the transverse arch of the foot.

The morphological study of the transverse arch was carried out using serial transverse sections of the foot. Ten specimens of intact feet, composed of bones from the Chopart joint to metatarsal heads, were examined. This part of the foot could be divided into six levels depending on the features of the transverse arch: 1. scaphoid-cuboid level, 2. midtarsal level, 3. cuneiform level, 4. proximal metatarsal level, 5. distal metatarsal level, and 6. sesamoid level. The shape of the articular surfaces and the trabecular arrangement of the midtarsal, metatarsal, and sesamoid bones were also studied.