The end game - A quantitative assessment tool for anastomosis in simulated microsurgery.

With the move towards simulation based microsurgical training and emphasis on the declining usage of animal models, there is a need for an objective method to evaluate microvascular anastomosis in a non-living, simulated microsurgical training environment. Our aim was to create a validated assessment tool to evaluate the intimal surface of the end product to measure skills acquisition. The intimal surface of 200 anastomoses from 23 candidates and 2 experts were assessed using ImageJ to measure 4 parameters: 1) distance between the distal insertion points, 2) distance between the proximal insertion points, 3) length of sutures placed, 4) number of axes.

Cognitive load and autonomic response patterns under negative priming demand in depersonalization-derealization disorder.

Previous studies have yielded evidence for cognitive processing abnormalities and alterations of autonomic functioning in depersonalization-derealization disorder (DPRD). However, multimodal neuroimaging and psychophysiology studies have not yet been conducted to test for functional and effective connectivity under cognitive stress in patients with DPRD. DPRD and non-referred control subjects underwent a combined Stroop/negative priming task, and the neural correlates of Stroop interference effect, negative priming effect, error rates, cognitive load span and average amplitude of skin conductance responses were ascertained for both groups.

A Discussion on the Regulation of Blood Flow and Pressure.

This paper discusses two kinds of regulation essential to the circulatory system: namely the regulation of blood flow and that of (systemic) arterial blood pressure. It is pointed out that blood flow requirements sub-serve the nutritional needs of the tissues, adequately catered for by keeping blood flow sufficient for the individual oxygen needs. Individual tissue oxygen requirements vary between tissue types, while highly specific for a given individual tissue.

Clarification of the circulatory patho-physiology of anaesthesia - implications for high-risk surgical patients.

The paper examines the effects of anaesthesia on circulatory physiology and their implications regarding improvement in perioperative anaesthetic management. Changes to current anaesthetic practice, recommended recently, such as the use of flow monitoring in high risk patients, are already beginning to have an impact in reducing complications but not mortality [1]. Better understanding of the patho-physiology should help improve management even further.

Association of amount and duration of NRT use in smokers with cigarette consumption and motivation to stop smoking: a national survey of smokers in England.

Introduction: Clinical trials have found that the use of nicotine replacement therapy (NRT) to reduce cigarette consumption results in significant declines in cigarette consumption and increases smokers' propensity to quit. However, observational "real-world" studies have found much smaller effects. This may be because of low levels of NRT use.

Latest developments in peri-operative monitoring of the high-risk major surgery patient.

Peri-operative monitoring technology has made great strides in the last 20 years with the introduction of minimally invasive devices to measure inter alia stroke volume, cardiac output, depth of anaesthesia and cerebral and tissue oxygen monitoring. Despite these technological advances, peri-operative management of the high risk major surgery patient has remained virtually unchanged. The vast majority of patients undergo a pre-operative assessment which is neither designed to quantify functional capacity nor predict outcome.

Synchronized mechanical ventilation for respiratory support in newborn infants.

Background: During synchronized mechanical ventilation, positive airway pressure and spontaneous inspiration coincide. If synchronous ventilation is provoked, adequate gas exchange should be achieved at lower peak airway pressures, potentially reducing baro/volutrauma, air leak and bronchopulmonary dysplasia. Synchronous ventilation can potentially be achieved by manipulation of rate and inspiratory time during conventional ventilation and employment of patient triggered ventilation.

The combined effects of TGF-beta, IGF and PDGF on 5alpha-reductase activity on androgen substrates in human gingival tissue.

The combined effects of the growth factors, PDGF, TGF-beta and IGF, on the metabolism of two androgen substrates by human gingival tissue were investigated. Having established their wet weight, duplicate incubations were performed in Eagle's MEM using [(14)C]testosterone/[(14)C]4-androstenedione as substrates and growth factors, PDGF, TGF-beta and IGF, alone and in combination. Steroid metabolites were then isolated, separated and quantified, using a radioisotope scanner.

The relationship between mean platelet volume, stroke subtype and clinical outcome.

Platelets play a crucial role in the pathophysiology of atherothrombotic disease and are involved in the early thromboembolic phase of ischaemic stroke. Large platelets are known to be more active. We hypothesized that thrombomegaly would be limited to patients with cortical infarction as compared with patients with lacunar infarcts, and that it would be associated with functional outcome.

Von Willebrand factor, P-selectin and fibrinogen levels in patients with acute ischaemic and haemorrhagic stroke, and their relationship with stroke sub-type and functional outcome.

Although ischaemic stroke is associated with accentuated platelet function, it remains unclear whether this applies to all sub-types, especially lacunar infarcts, which differ from cortical infarction in their patho-aetiology. Similarly, conflicting evidence suggests that haemorrhagic stroke may, or may not, be associated with a hypothrombotic state. Levels of von Willebrand factor (vWF), fibrinogen, and P-selectin were measured within 48 h of ictus in 163 patients with acute ischaemic stroke and 40 patients with acute primary intracerebral haemorrhage, and 33 age, gender and race matched-controls.

Immediate loading of two single tooth implants in the maxilla: preliminary results after one year.

This clinical report describes the traumatic avulsion of the left maxillary central and lateral incisors with minimal tissue trauma, followed by placement of provisional restorations of two root-form implants in a 14-year old female patient. Ten days following the avulsion, implant therapy was performed with Summers osteotomes and flapless technique using a root-form 3i osseotite NT. Angulated abutments and acrylic provisional crowns were placed.

Depot perphenazine decanoate and enanthate for schizophrenia.

Background: Antipsychotic drugs are usually given orally but compliance with medication given by this route may be difficult to quantify. The development of depot injections in the 1960s gave rise to extensive use of depots as a means of long-term maintenance treatment. Perphenazine decanoate and enanthate are depot antipsychotics that belong to the phenothiazine family and have a piperazine ethanol side chain.

Depot fluphenazine decanoate and enanthate for schizophrenia.

Background: Intramuscular injections (depot preparations) offer an advantage over oral medication for treating schizophrenia by reducing poor compliance. The benefits gained by long acting preparations, however, may be offset by a higher incidence of adverse effects.

Objectives: To investigate the clinical effects of fluphenazine decanoate and enanthate.

Synchronized mechanical ventilation for respiratory support in newborn infants.

Background: During synchronized mechanical ventilation, positive airway pressure and spontaneous inspiration coincide. Thus, if synchronous ventilation is provoked, adequate gas exchange should be achieved at lower peak airway pressures, potentially reducing barotrauma and hence airleak and chronic lung disease. Synchronous ventilation can be achieved by manipulation of rate and inspiratory time during conventional ventilation and employment of patient assisted ventilation.

Studies in the setting of polyelectrolyte cements: part VII. The effect of divalent metal chlorides on the properties of zinc polycarboxylate and glass-ionomer dental cements.

A study is reported in which a zinc polycarboxylate and a glass polyalkenoate dental cement, were prepared from aqueous solutions of divalent metal chlorides, namely ZnCl2, CaCl2, MgCl2 and SrCl2, all at 1.0 mol dm-3 concentration, as well as from pure water. Calcium chloride was employed at additional concentrations, i.

Studies on the setting of polyelectrolyte cements: part VI. The effect of halide salts on the mechanical properties and water balance of zinc polycarboxylate and glass-ionomer dental cements.

A study is reported in which a zinc polycarboxylate and a glass polyalkenoate dental cement, respectively, were prepared from aqueous solutions of NaCl, KCl, KBr and KI, all at 1 mol dm3 concentration, as well as from pure water. For the zinc polycarboxylate, setting as determined by oscillating rheometry was speeded up and water uptake was enhanced by the presence of the salts. Conversely, compressive strength at 24 h was unaffected.

The interaction of dental cements with aqueous solutions of varying pH.

A study is reported in which a series of dental cements of varying types (zinc phosphate, zinc polycarboxylate, glass-ionomer and resin-modified glass-ionomer) was exposed to aqueous solutions of differing pH for time intervals of a week, after which the pH of the storage solutions was determined. The results showed that all of the acid-base cements altered the pH of their storage solution, regardless of whether that initial solution was weakly acidic, weakly alkaline or close to neutral. All cements were found to act as buffers, because they not only increased the pH of the weakly acidic lactic acid solution, but they also decreased the pH of the weakly alkaline artificial saliva.

Urinary levels of creatine and other metabolites in the assessment of polymyositis and dermatomyositis.

Background: A simple and reliable method is needed to assess disease activity and monitor the efficacy of therapy in polymyositis (PM) and dermatomyositis (DM). This study used in vitro proton ((1)H) magnetic resonance spectroscopy (MRS) to explore whether excretion of urinary metabolites can be used as a reliable marker of disease in PM and DM patients.

Methods: Urine samples were obtained from PM/DM patients (n=34), healthy controls (50) and subjects with known muscle-wasting conditions including adult-onset muscular dystrophy (8), stroke patients (10), rheumatoid arthritis (RA) patients on steroids (13) and not on steroids (16) and patients with alcoholic myopathy (12).

Diurnal, week-to-week, and long-term variation in urine deoxypyridinoline cross-link excretion in healthy older women.

Objectives: To establish a reference range for morning and afternoon excretion of urinary deoxypyridinoline (DPD) in apparently healthy older women selected from a volunteer database. To assess the extent of diurnal variation and short and long-term within-subject longitudinal variation.

Design: Prospective, observational, cohort study.

Congenital lumbar hernias: A case report.

Congenital lumbar hernias are rare and associated with other malformations. There have been 42 cases reported to date. The authors report the first case in the literature of isolated bilateral congenital lumbar hernias.

Altered megakaryocyte-platelet-haemostatic axis in patients with acute stroke.

Platelet function is accentuated in acute ischaemic stroke (IS) and may also be altered in haemorrhagic stroke. Whether these changes are a direct reaction to the stroke or are secondary to changes in megakaryocytes (MKs) is unknown. To determine whether MKs are altered in acute stroke we studied 24 patients (18 with ischaemic stroke, six with haemorrhagic stroke) within 3 days of symptom onset, and 14 matched controls.

Assessing structure, process and outcome in palliative day care: a pilot study for a multicentre trial.

Palliative day care is an expanding service which remains under-researched. Study designs need to be developed to evaluate the costs and outcomes of the service in ways which are meaningful to patients, clinicians and policy-makers. At the same time, these must be open to the same criteria for rigour and reliability as techniques used elsewhere in health and social service evaluation.