Temporary antibiotic-loaded cemented prosthesis for two-stage septic hip arthroplasty

BACKGROUND AND OBJECTIVES: Myofascial pain is the leading cause of chronic low back pain and in most cases can be successfully resolved with trigger point injections of local anesthetics. This type of pain can exist during pregnancy and exceed the analgesia provided by an epidural for labor. METHODS: A 31-year-old primiparous woman received an epidural infusion for labor analgesia. Despite complete resolution of labor pain and a solid, bilateral T10 block, the patient reported discomfort at two discrete locations in her right lumbar paraspinous muscle. RESULTS: The administration of local anesthetic via trigger point injections resulted in successful palliation of the myofascial pain. CONCLUSIONS: Myofascial pain can be an etiology of back pain in the parturient. Trigger point injections, even when used concomitantly with a functioning epidural infusion, can be a valuable aid for the provision of complete analgesia.     

Exceptional convergent evolution in a virus

Replicate lineages of the bacteriophage phiX 174 adapted to growth at high temperature on either of two hosts exhibited high rates of identical, independent substitutions. Typically, a dozen or more substitutions accumulated in the 5.4-kilobase genome during propagation. Across the entire data set of nine lineages, 119 independent substitutions occurred at 68 nucleotide sites. Over half of these substitutions, accounting for one third of the sites, were identical with substitutions in other lineages. Some convergent substitutions were specific to the host used for phage propagation, but others occurred across both hosts. Continued adaptation of an evolved phage at high temperature, but on the other host, led to additional changes that included reversions of previous substitutions. Phylogenetic reconstruction using the complete genome sequence not only failed to recover the correct evolutionary history because of these convergent changes, but the true history was rejected as being a significantly inferior fit to the data. Replicate lineages subjected to similar environmental challenges showed similar rates of substitution and similar rates of fitness improvement across corresponding times of adaptation. Substitution rates and fitness improvements were higher during the initial period of adaptation than during a later period, except when the host was changed.     

MRI of intramedullary sarcoidosis: follow-up of a case

Significative enhancement of free radical formation (FRO) in vivo is an important feature of hypertensive disorders of pregnancy (HDP), namely preeclampsia (PIH). The latest investigations about the pathology of HDP, showed the contribution of placental circulation to the development and evolution of such disease. The placental bed can be a potential source of FRO or activation of cells that can produce FRO. Glutathione, is an important molecule for cellular protection against damage, is a cofactor of many enzymes, in particular, for the glutathione peroxidase of the placental tissue; this enzyme in the placenta bed prevent the production of thromboxan and lipoperoxides; the latter are potentially damaging to the endothelium cells and can cause vasoconstriction, the most important feature of PIH. The activity of that enzyme is deficient in PIH. We studied, by fluorometric assay, the concentrations of the two states of glutathione in placental homogenates (PLH) from pregnant women without pathology (PWN) and from pregnant women with PIH (PWPIH). The data showed significant low concentrations in the PLH of the two states of glutathione in the PWN against high concentrations of this molecule in the PLH from PWPIH. This feature can result from a deficient user of the glutathione by the cellular mechanism for prevention against oxidative factors. In addition, our study shows a biochemical marker that is suggestive that the placental bed is a potential source of FRO production in PIH.     

Apoptosis in the failing human heart

BACKGROUND: Loss of myocytes is an important mechanism in the development of cardiac failure of either ischemic or nonischemic origin. However, whether programmed cell death (apoptosis) is implicated in the terminal stages of heart failure is not known. We therefore studied the magnitude of myocyte apoptosis in patients with intractable congestive heart failure. METHODS: Myocardial samples were obtained from the hearts of 36 patients who underwent cardiac transplantation and from the hearts of 3 patients who died soon after myocardial infarction. Samples from 11 normal hearts were used as controls. Apoptosis was evaluated histochemically, biochemically, and by a combination of histochemical analysis and confocal microscopy. The expression of two proto-oncogenes that influence apoptosis, BCL2 and BAX, was also determined. RESULTS: Heart failure was characterized morphologically by a 232-fold increase in myocyte apoptosis and biochemically by DNA laddering (an indicator of apoptosis). The histochemical demonstration of DNA-strand breaks in myocyte nuclei was coupled with the documentation of chromatin condensation and fragmentation by confocal microscopy. All these findings reflect apoptosis of myocytes. The percentage of myocytes labeled with BCL2 (which protects cells against apoptosis) was 1.8 times as high in the hearts of patients with cardiac failure as in the normal hearts, whereas labeling with BAX (which promotes apoptosis) remained constant. The near doubling of the expression of BCL2 in the cardiac tissue of patients with heart failure was confirmed by Western blotting. CONCLUSIONS: Programmed death of myocytes occurs in the decompensated human heart in spite of the enhanced expression of BCL2; this phenomenon may contribute to the progression of cardiac dysfunction.     

Two-dimensional FDTD analysis of a pulsed microwave confocal systemfor breast cancer detection: fixed-focus and antenna-array sensors

A novel focused active microwave system is investigated for detecting tumors in the breast. In contrast to X-ray and ultrasound modalities, the method reviewed here exploits the breast-tissue physical properties unique to the microwave spectrum, namely, the translucent nature of normal breast tissues and the high dielectric contrast between malignant tumors and surrounding lesion-free normal breast tissues. The system uses a pulsed confocal technique and time-gating to enhance the detection of tumors while suppressing the effects of tissue heterogeneity and absorption. Using published data for the dielectric properties of normal breast tissues and malignant tumors, the authors have conducted a two-dimensional (2-D) finite-difference time-domain (FDTD) computational electromagnetics analysis of the system. The FDTD simulations showed that tumors as small as 2 mm in diameter could be robustly detected in the presence of the background clutter generated by the heterogeneity of the surrounding normal tissue. Lateral spatial resolution of the tumor location was found to be about 0.5 cm     

Impact of local-negative-feedback on the MRS avalanchephotodetector operation

Metal-Resistance-Semiconductor (MRS) photodetectors are characterized by a resistive layer placed in series to an avalanching region. In this paper, we report the characterization of such devices, we define a parameter extraction procedure, and we derive a quantitative model of the MRS operation. Due to the presence of the ohmic layer, the detector works as an ensemble of pixels with separately stabilized operating bias. In this way, compared to avalanche photodiodes (APDs), MRS achieve superior gain uniformity with the same sensitive area. However, there are still aspects of the fabrication technology and of the detector structure which have to be improved     

Analogue micropowered log-domain tone controller for auditoryprostheses

A micropower tone-control circuit comprising two first-order log-domain filters and a subtractor built with MOS transistors in weak inversion is described. The tone-controller is capable of providing bass cut/boost and treble cut operations. This circuit is being used in new designs of a conventional (acoustic) hearing-aid and cochlear implant     

Femorodistal vein grafts: the utility of graft surveillance criteria

PURPOSE: This retrospective review of femorodistal vein grafts was analyzed to determine the usefulness of various graft surveillance criteria. METHOD: The surveillance schedule involved evaluations at 1 month, every 3 months the first year, and then every 6 months. Salvage intervention or graft occlusion occurring within the next follow-up interval defined surveillance end points. One hundred two grafts (329 surveillance visits) had an ankle/brachial index (ABI). A duplex scanning-determined midgraft peak systolic flow velocity (PSFV) was available for 81 grafts (262 visits). Forty-eight grafts (137 visits) had both a PSFV and entire graft duplex scanning (EGDS) to determine stenosis greater than 50%, whereas 40 grafts (91 visits) had simultaneous ABI and EGDS. RESULTS: When a greater than 15% decrease in ABI denoted an abnormal surveillance study result, a positive predictive value (PPV) of 24.3% and negative predictive value of 94.5% were noted. Similarly, a PSFV cutoff of less than 35 cm/sec demonstrated values of 26.3% and 94.2%, respectively. When an EGDS of greater than 50% stenosis or a PSFV of less than 35 cm/sec were the cutoff criteria, the PPV was 36.7% and negative predictive value 99.1%, whereas characterizing abnormal results further with ABI (> 15% decreases) increased the PPV to 83.3%. CONCLUSION: The combination of an EGDS, midgraft PSFV, and ABI provides optimal follow-up for our patients with a femorodistal vein graft.     

Fifteen years of cutaneous and mucocutaneous leishmaniasis in Bolivia: a retrospective study

The photosensitizing properties of p-nitroacetophenone (PNAP), a well-known radiosensitizer, have been studied in near UV region. The mechanism of PNAP photosensitization has been investigated by testing the efficiency of singlet oxygen production using photooxidation of 2,2,6,6-tetramethylpiperidine (TEMP) and photodegradation of guanosine. In both the cases, the enhancement effect of deuterated solvents has been observed. Results of these experiments suggest the significant role of type II mechanisms in PNAP photosensitization.     

Implementation of a quiet hour: effect on noise levels and infant sleep states

It is necessary to decrease environmental stimuli in order to provide developmentally supportive care to the very low birthweight (VLBW) infant, thereby enhancing the sleep/wake cycle and possibly physiologic stability. The purpose of this study was to determine if it was possible to decrease the noise level in the Developmental Unit, and promote sleep states in infants on the unit. After determining control noise levels and infant state, the last hour of each shift was designated a Quiet Hour. During this time, noise levels were monitored in the room in five locations. Infant sleep states were also noted. The results indicate that noise levels decreased significantly on two of the three shifts. Fewer infants were crying during the Quiet Hour than the control period (2.4 vs 14.3 percent), and more were in deep or light sleep (84.5 vs 33.9 percent). This study demonstrates that noise levels in Developmental Units can be significantly decreased, and that the decreased noise levels positively impact infant state. By enhancing sleep states, nurses can enhance the long term developmental outcome of the VLBW infant. However, the reduction of noise is highly dependent on the collaborative efforts of all health care providers within the unit.