Prevalence of midline cervical spine tenderness in the non-trauma population.

OBJECTIVE: The Canadian C-Spine Rule (CCR) and the National Emergency X-Radiography Utilization Study (NEXUS) criteria are two commonly used clinical decision rules which use midline cervical spine (c-spine) tenderness on palpation as an indication for c-spine imaging post-trauma. This study was undertaken to determine the prevalence and location of midline c-spine tenderness in the non-trauma population. METHODS: We prospectively evaluated consenting adult patients presenting to an urban ED or university sport medicine clinic in Montreal, Canada between 2018 and 2020 for atraumatic non-head and neck-related reports over a 20-month period. The presence and location of pain during midline c-spine palpation as assessed by two examiners during separate evaluations was recorded. Patient information such as age, neck length and circumference, gender, body mass index (BMI) and scaphoid tenderness was also collected. RESULTS: Of 478 patients enrolled, 286 (59.8%) had midline c-spine tenderness on palpation with both examiners. The majority of those with tenderness were female (70.6%). When examining all patients, tenderness was present in the upper third of the c-spine in 128 (26.8%) patients, middle third in 270 (56.5%) patients and lower third in 6 (1.3%) patients. Factors associated with having increased odds of midline c-spine tenderness on palpation included a lower BMI and the presence of scaphoid tenderness on palpation. CONCLUSIONS: There is a high prevalence of c-spine tenderness on palpation in patients who have not undergone head or neck trauma. This finding may help explain the low specificity in some of the validation studies examining the CCR and the NEXUS criteria.

Physical apparatus parameters and model for vibrating tube densimeters at pressures to 140 MPa and temperatures to 473 K.

Vibrating tube densimeters are well-established tools for measuring fluid densities precisely at elevated temperatures and pressures. However, the conventional method of calibrating them utilises a model in which the apparatus parameters are represented as polynomials of temperature and pressure that contain a variable number of terms. Here a robust, physically-based model is presented and demonstrated for six different instruments at temperatures from (273 to 473) K, pressures from (0 to 140) MPa, and densities from (0 to 1050) kg m(-3). The model's physical basis ensures that only seven apparatus parameters are required to relate the measured resonant period to fluid mass density with an average r.m.s. deviation of ±0.23 kg m(-3) across all six densimeters. Estimates for each of the apparatus parameters were made based on the geometry and material properties of the vibrating tubes, and these estimates were consistent with the parameter values determined by calibration with reference fluids. Three of the apparatus parameters describe the temperature dependence of the resonant period: for the six vibrating tubes tested, the relative standard deviations of these parameters were all within the range of values estimated from the thermoelastic properties of the Hastelloy tubes. Two distinct parameters are required to describe the pressure dependence of the vibrating tube's volume and effective spring constant, both of which are estimable from equations describing the elastic deformation of thick-walled tubes. The extensive calibrations conducted demonstrate that, for these densimeters, the variations with pressure of the tube's spring constant and its volume have a ratio that is neither 0 nor 1, as has been assumed previously. The model's physical basis allows vibrating tube densimeters to be calibrated accurately using fewer reference fluid measurements than required by the conventional method. Furthermore, use of the physically-based model reduces the uncertainty of measurements made at densities, temperatures, or pressures beyond the range of the calibration.

Experimental and modeling study of the phase behavior of (methane + CO2 + water) mixtures.

In this work we report phase equilibrium measurements on the system (methane + carbon dioxide + water) carried out with a high-pressure quasi-static-analytical apparatus. The measurements have been made under conditions of two-phase vapor-liquid equilibrium, three-phase vapor-liquid-liquid equilibrium (VLLE), and four-phase vapor-liquid-liquid-hydrate equilibrium. The compositions of three coexisting fluid phases have been obtained along eight isotherms at temperatures from (285.15 to 303.5) K and at pressures up to either the upper critical end point (UCEP) or up to the hydrate formation locus. Compositions of coexisting vapor and liquid phases have been obtained along three isotherms at temperatures from (323.15 to 423.15) K and pressures up to 20 MPa. The quadruple curve, along which hydrates coexist with the three fluid phases, was also measured along its entire length. The VLLE data obtained for this mixture have been compared with the predictions of the statistical associating fluid theory for potentials of variable range (SAFT-VR), implemented with the square-well potential and using parameters fitted to pure-component and binary-mixture data. Specifically, we used the SAFT-VR parameters reported by Míguez and co-workers [Míguez, J. M.; dos Ramos, M. C.; Piñeiro, M. M.; Blas, F. J. J. Phys. Chem. B 2011, 115, 9604]. The pressure along the quadruple curve was compared with the predictions of two different thermodynamic models. Furthermore, a detailed study of the ternary mixtures was carried out based on comparison with available ternary data of the type (CO2 + n-alkane + water) and available data for the constituent binary subsystems. In this way, we analyzed the observed effects on the solubility when the n-alkane component was changed or a third component was added.

Analysis of inflammatory mediators in type 2 diabetes patients.

The main aim of this study is to assess the inflammatory markers in type 2 diabetes mellitus (T2DM) by measuring some cytokines concentrations and lymphocytes subset and correlate them with other laboratory investigations. Fifty-seven patients with type-2 diabetes and 30 healthy volunteers were enrolled in this study. Data for the C-reactive protein (CRP), haemoglobin, HbA1c, and autoantibody levels were obtained from the patients files. The cytokine concentrations were measured in patient's serum using commercially available ELISA assays. Lymphocytes subsets were measured by flow cytometric methods. The levels of IL-1ß, IL-6, IL-15, and TNF-α were found to be decreased in T2DM patients, whereas the levels of IL-10, IFN-γ, and caspase-1 were increased, compared to normal controls. T2DM patients with hypertension show significantly decreased levels of IL-1ß and caspase-1 compared to patients without hypertension. No significant differences in lymphocytes subset between cases and normal control were observed. Significant correlations were found between HbA1c and IL-6; body mass index (BMI) was significantly correlated with CRP, TNF-α, and phosphate; the weight (Wt) was associated with CRP and IFN-γ. In conclusion, an alteration in the function of the immune system was observed in T2DM patient.

Evaluation of anti-mutated citrullinated vimentin antibodies, anti-cyclic citrullinated Peptide antibodies and rheumatoid factor in omani patients with rheumatoid arthritis.

Rheumatoid factor (RF) is currently used in the diagnosis of rheumatoid arthritis (RA). The discovery of anticitrullinated protein autoantibodies has led to the development of various new tests, such as anti-cyclic citrullinated peptide (anti-CCP) antibodies, and anti-mutated citrullinated vimentin (anti-MCV) antibodies, to diagnose RA. The aims of this study were to determine the sensitivity and specificity of anti-MCV antibodies in comparison with anti-CCP antibodies and RF in Omani Arab patients with RA and compare our findings with published values from different ethnic groups. The sensitivity of anti-MCV antibodies was 72% with 87% specificity. For anti-CCP antibodies the sensitivity was 52% and the specificity was 97%. The sensitivity of RF was 57% with 94% specificity. Anti-CCP antibodies have higher diagnostic specificity and positive predictive value than RF and anti-MCV antibodies. Anti-MCV antibodies have the highest sensitivity when compared to anti-CCP antibodies and RF. Anti-MCV antibodies do not appear to be very useful in the diagnosis of RA. However, long-term study is required to find out whether anti-MCV antibodies can be used as predictive test for incidence of RA.