Pain knowledge,attitudes and beliefs of Australian osteopaths drawn from a nationally representative sample of the profession

BackgroundPain has been identified as a global health issue with substantial effects on individuals and society. Health professionals managing pain complaints must have appropriate knowledge of pain neurophysiology, and attitudes and beliefs towards pain management that align with current practice guidelines.ObjectivesEvaluate Australian osteopaths' current level of knowledge of pain neurophysiology and their beliefs and attitudes towards pain, and explore associations with demographic variables.MethodAustralian osteopaths drawn from a nationally representative practice-based research network received the questionnaire. The questionnaire included demographic information, Neurophysiology of Pain Questionnaire (NPQ), Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT) and the Attitudes to Back Pain Scale in Musculoskeletal Practitioners (ABS-mp).ResultsComplete responses were received from 211 osteopaths (21.3% response rate). The mean total NPQ score was equivalent to 72.2% correct responses. The PABS-PT Biomedical scale mean score was 38.8 ( ±9.1, α = 0.81) and the Biopsychosocial scale was 22.3 ( ±3.3, α = 0.38). ABS-mp mean factor scores suggest osteopaths support psychological approaches (22.1, ±3.3, α = 0.71) but endorsed more treatment sessions for those with back pain (15.9, ±4.7, α = 0.71). Trivial correlations between measures and most demographic variables were observed. Osteopaths who undertook further studies in pain had higher mean NPQ scores, with moderate negative correlations with a lower PABS-PT Biomedical subscale score (ρ = −0.45, p < 0.01).ConclusionsAustralian osteopaths demonstrate a range of pain neurophysiology knowledge, and beliefs and attitudes towards pain. The findings support the positive impact of professional development for improving pain knowledge in this population.     

OFx: A method of 4D image construction from free-breathing non-gated MRI slice acquisitions of the thorax via optical flux

PurposeSince real-time 4D dynamic magnetic resonance imaging (dMRI) methods with adequate spatial and temporal resolution for imaging the pediatric thorax are currently not available, free-breathing slice acquisitions followed by appropriate 4D construction methods are currently employed. Self-gating methods, which extract breathing signals only from image information without any external gating technology, have much potential for this purpose, such as for use in studying pediatric thoracic insufficiency syndrome (TIS). Patients with TIS frequently suffer from extreme malformations of the chest wall, diaphragm, and spine, leading to breathing that is very complex, including deep or shallow respiratory cycles. Existing 4D construction methods cannot perform satisfactorily in this scenario, and most are not fully automatic, requiring manual interactive operations. In this paper, we propose a novel fully automatic 4D image construction method based on an image-derived concept called flux to address these challenges.MethodsWe utilized 25 dMRI data sets from 25 pediatric subjects with no known thoracic anomalies and 58 dMRI data sets from 29 patients with TIS where each patient had a dMRI scan before and after surgery. A time sequence of 80 slices are acquired at each sagittal location continuously at a rate of ~480 ms per slice under free-breathing conditions, with 30–40 sagittal locations across the chest for each subject depending on the thoracic size. In our approach, we first extract the breathing signal for each sagittal location based on the flux of the optical flow vector field of the body region from the image time series. Here, for each time point of respiratory phase, the net flux of the body region can be regarded as the flux going into or out of the body region, which we term Optical Flux (OFx). OFx provides a very robust representation of the real breathing motion of the thorax. OFx allows us to perform a full analysis of all respiratory cycles, extract only normal cycles in a robust manner, and map all extracted normal cycles on to one cosine respiration model for each sagittal location. Subsequently, we re-sample one normal cycle from the respiration model for each location independently. The normal cycle models associated with the different sagittal locations are finally composited to form the final constructed 4D image.ResultsWe employ several metrics to evaluate the quality of the 4D construction results: E_ie – error in locating time instants corresponding to end inspiration and end expiration; E_to – deviation from correct temporal order in each detected normal cycle; E_ss – deviation in spatial smoothness; and E_sc – deviation from spatial continuity as scored by a reader. The means and standard deviations of these metrics for normal subjects and TIS patients are found to be, respectively: E_ie: 0.25 ± 0.05 and 0.38 ± 0.16 in units of time instance (ideal value = 0); E_to: 2.7% ± 2.3% and 1.8% ± 2% (ideal value = 0%); E_ss: 0.5 ± 0.17 and 0.54 ± 0.25 in pixel units (ideal value = 0); E_sc: 4.6 ± 0.48 and 4.56 ± 0.98 (score range: best = 5, worst = 1). The results show that the OFx method achieves excellent spatial and temporal continuity and its yield was 100% meaning that it successfully performed 4D construction on every data set tested. Compared to a recently published method, OFx is fully automatic requiring about 5 min of computational time per study starting from acquired dMRI scans. The method achieves high temporal and spatial continuity even on complex TIS data sets that include many abnormal respiratory cycles.ConclusionsA new 4D dMRI construction method based on the concept of optical flux is presented which is fully automatic and very robust in deriving respiratory signals purely from dynamic image sequences even when presented with complex breathing patterns due to severe disease conditions like TIS. Evaluations show that its accuracy is comparable to the variations found in manual annotations. An important characteristic of the method is that it is independent of the number of sagittal locations used in the construction process, which suggests that it is applicable to imaging techniques where data are acquired at only a few sagittal locations instead of the full width of the thorax. The method is not tied to any specific imaging modality, as demonstrated in this paper on not just dMRI but dynamic computed tomography (CT) as well.     

Stability of plasma adrenocorticotrophic hormone (ACTH): Influence of hemolysis,rapid chilling,time, and the addition of a maleimide

ObjectivesThe aim of this study was to examine the effects of hemolysis, rapid chilling, time, and the addition of a maleimide on the stability of human plasma ACTH measurements.Design and methodsPartially hemolyzed EDTA blood (n = 10), initially at 37 °C, was centrifuged at 4 °C either immediately or after rapid chilling in ice/water. Plasma ACTH was then measured either immediately, or after 1 h at 22 °C with or without the addition of 2 mM N-phenyl maleimide (NPM).ResultsFor 0.2% hemolysis compared to no hemolysis, the mean (±SEM) loss with immediate centrifugation and immediate ACTH measurement was 11 ± 1%. This loss was significantly (p < 0.002) reduced to 6 ± 1% by an initial rapid chilling of the samples. For analysis after 1 h at 22 °C, the addition of NPM decreased the loss of ACTH from 15 ± 2% to 2 ± 2% (p < 0.002).ConclusionRapid chilling, prompt analysis, and addition of NPM can each reduce the interference of hemolysis in the measurement of plasma ACTH concentrations.     

A study of the relationship between nurses’ experience,structural empowerment,and attitudes toward computer use

ObjectiveThis study examined the relationship between structural empowerment and nurses’ experience and attitudes toward computer use.MethodsThis study was conducted using a cross-sectional quantitative design. A total of 184 registered nurses from four hospitals in Jordan participated in the current study. Data were collected using a demographics questionnaire, the Conditions for Work Effectiveness Questionnaire-II (CWEQ-II), and the Pretest for Attitudes toward Computers in Healthcare (PATCH).ResultsThe median of experience in years among nurses was 5.0, ranging from one to 26 years. The mean score for the attitudes toward computer use was 61.90 ± 11.38. Almost half of the participants, 45.11%, were in the category of “feel comfortable using user-friendly computers.” The participants’ mean average of the total structural empowerment was 12.40 ± 2.43, and the values for its four subscales were: opportunity 3.57 ± 0.87, resources 2.83 ± 0.85, information 3.06 ± 0.79, and support 2.95 ± 0.86. The frequencies analysis revealed that most participants had a moderate level of empowerment (n = 127, 69.02%). The bivariate correlation between nurses’ experience and attitudes toward computer use was significant (r = −0.17, P < 0.05). The relationship between the total structural empowerment score and attitudes toward computer use was positive but weak (r = 0.20, P < 0.01).ConclusionThe results indicated that more experienced nurses are more reluctant toward computer use. However, creating an empowering work environment can facilitate nurses’ attitudes toward computer use.     

In vitro anticandidal and antioxidant potential of Mezoneuron benthamianum

ObjectiveTo investigate the preliminary phytochemical screening and antioxidant properties of the methanolic extract of Mezoneuron benthamianum (M. benthamianum).MethodThe anti-candidal potential and minimum inhibition concentration (MIC) were evaluated on fresh isolates of Candida species using disc diffusion method. While the lipophilic free radical scavenging activity was examined using the spectrophotometric assay on the reduction of 1,1-diphenyl-2-picrylhydrazyl (DPPH) and compared with standard antioxidant, α-tocopherol.ResultThe anti-candidal activities of M. benthamianum root and leaf revealed zones of inhibition (ZI) against Candida glabrata as (13.6±1.00) mm and (13.7±1.00) mm respectively while, Candida krusei ZI against root (13.7±1.00) mm and leaf (11.8±0.80) mm as the most significant among other candida species (Candida stellatoidea, Candida albicans and Candida torulopsis). Phytochemicals present in the plant extracts includes saponin, anthracquinones, flavonoids and tannins. The antioxidant potential of the plant was significant and dose dependent at the concentrations tested. The extract has IC₅₀ values of 781 μg/mL while the standard, α-tocopherol has 222.3 μg/mL.ConclusionsThe result from this research suggests that M. benthamianum is a potent anti-candida and antioxidant plant and may be a potential anti-candida plant for future prospect in drug development.     

Increased low-density lipoprotein oxidation,but not total plasma protein oxidation,in Alzheimer's disease

ObjectivesThe two most common forms of dementia are Alzheimer's disease (AD), and vascular dementia (VaD). In the overlap of biochemical processes which have been identified in AD and VaD, oxidative stress is believed to contribute to the numerous pathologies of both dementias.Design and methodsThis study assessed oxidative damage in total plasma proteins, and isolated LDL in AD patients and age matched controls, in addition total antioxidant capacity (TAC) was measured.ResultsSignificantly higher LDL protein carbonylation was observed in AD compared to age-matched controls (AD: 4.17 ± 0.73 vs. control: 3.85 ± 0.86 nmol/mg LDL; p = 0.05, 2-tailed Mann–Whitney), in addition to reduced TAC (AD: 924.708 ± 174.429 vs. control: 1078.536 ± 252.633 μM; p = 0.001, 2-tailed Mann–Whitney). No differences were seen in total plasma protein carbonyl content (AD: 3.88 ± 0.31 vs. control: 3.98 ± 0.48 nmol/mg protein).ConclusionThe results further support the view that oxidation events in AD may be specific in nature, and represent functional changes to proteins, rather than random global events.     

Exercise dependence,body dismorphia,and anxiety in crossfit practitioners: A cross-sectional study

IntroductionPhysical exercise provides better body image perception and well-being. However, if practiced compulsively, it may lead to compulsion and psychobiological damage. CrossFit is a method aiming at maximum performance, and it is currently attracting many regular practitioners.ObjectiveEvaluate exercise dependence prevalence, muscle dysmorphia, and trait-state anxiety in CrossFit practitioners.MethodsOne hundred fifty regular male CrossFit practitioners were evaluated and subdivided into two groups: with and without risk for exercise dependence. Trait-state anxiety and muscle dysmorphia were also assessed. Unpaired t-test compared groups, Fisher's exact test was used for associations between categorical variables (p < 0.05), while correlations were verified using Pearson's correlation coefficient.Results122 participants were identified with no risk for exercise dependence and 28 with risk for exercise dependence. Participants presented mean age of 30.3 ± 7.05 years and had been practicing physical exercise for 8.02 ± 8.1 years, with training frequency of 5.3 ± 1.09 days per week and 107.9 ± 50.5 min per training day. Prevalence risk of exercise dependence was 18.6%, and muscle dysmorphia was significantly different between groups with (10.7%, n = 3) and without risk (6.6%, n = 8) for exercise dependence. Participants with risk for dependence chose CrossFit mainly due to appearance (32%).ConclusionPrevalence risk of exercise dependence was 18.6% and satisfaction with muscle appearance may influence exercise behavior.     

Safety and efficacy of vasopressor administration through midline catheters

ContextVasopressors are commonly administered through Central Venous Catheters (CVCs) as it is considered unsafe to administer them via peripheral IVs, mainly due to the concern of local tissue injury. Unlike peripheral IVs, midline catheters provide a wider lumen with the catheter tip ending in a large peripheral vein. The use of vasopressors through midline catheters has not yet been evaluated.ObjectiveThe primary objective of this study is to determine the safety and efficacy of long term administration of vasopressors through a midline catheter.DesignThis is a retrospective study between 2016 and 2019 looking at the outcomes of midline catheters.Setting45 bed Tertiary level ICU in a 600-bed teaching hospital.PatientsA total of 248 patients received vasopressors via midline catheters.ResultsThe average midline dwell time was 14.7 ± 12.8 days and the average duration of continuous vasopressor infusion was 7.8 ± 9.3 days. Vasopressors used with their average dose (AD) were norepinephrine (n = 165, 16.8 CE ± 10.7 μg/min), epinephrine (n = 56, 9.1 CE ± 6.0 μg/min), vasopressin (n = 123, 0.05 CE ± 0.02 units/min), phenylephrine (n = 158, 91.4 CE ± 64.7 μg/min) and Angiotensin II (50 CE ± 27.6 ng/kg/min). Early Complication rate was 3.6% due to Bloodstream infection (n = 6), drug extravasation (n = 1), thrombophlebitis (n = 1) and arterial puncture (n = 1). Late Complication rate was 0.8% (n = 2) due to midline-associated DVTs. There were no complications related to ineffective drug delivery or limb endangerment.ConclusionsMany medical centers are attempting to limit the use of central venous catheters (CVCs) to avoid central line-associated bloodstream infections (CLABSIs). This study demonstrates that midline catheters are a safe alternative to CVCs, for the safe and efficacious administration of vasopressors for prolonged periods of time.     

Comparison of the clinical characteristics of community-acquired acute pyelonephritis between male and female patients

BackgroundCommunity-acquired acute pyelonephritis (CA-APN) is relatively rare in men. This study aimed to compare the clinical characteristics of CA-APN between male and female patients.MethodsWe prospectively collected the clinical and microbiological data of hospitalized CA-APN patients aged ≥19 years in South Korea from March 2010 to February 2011 in 11 hospitals and from September 2017 to August 2018 in 8 hospitals. Only the first episodes of APN of each patient during the study period were included.ResultsFrom 2010 to 2011, 573 patients from 11 hospitals were recruited, and from 2017 to 2018, 340 patients were recruited from 8 hospitals. Among them, 5.9% (54/913) were male. Male patients were older (66.0 ± 15.2 vs. 55.3 ± 19.0 years, P < 0.001), had a higher Charlson comorbidity index (1.3 ± 1.5 vs. 0.7 ± 1.2, P = 0.027), and had a higher proportion of structural problems in the urinary tract (40.7% vs. 6.1%, P < 0.001) than female patients. Moreover, the total duration of antibiotic treatment was longer (21.8 ± 17.8 d vs. 17.3 ± 9.4 d, P = 0.001) and the proportion of carbapenem usage was higher (24.1% vs. 9.5%, P = 0.001) in men than in women. Male patients were hospitalized for longer durations than female patients (median, 10 d vs. 7 d, P < 0.001).ConclusionsMale CA-APN patients were older and had more comorbidities than female CA-APN patients. In addition, male patients received antibiotic treatment for a longer duration than female patients.     

Increased uptake of oxidized LDL by macrophages from type 2 diabetics is inhibited by polyamines

The aim of this study was to evaluate the effect of polyamines putrescine, spermidine and spermine on human LDL oxidation and to assess the ability of macrophages derived from type 2 diabetic patients to uptake oxLDL. Polyamine effect was compared with α-tocopherol. Four healthy subjects and eight type 2 diabetic patients were included in this study. To characterize type 2 diabetic patients and non-diabetic subjects, laboratory test were carried out. Glucose, glycated haemoglobin (HbA_1C), triglycerides, low (LDL) and high density lipoproteins (HDL) and serum lipid peroxidation were measured in blood. The study was performed in three stages. For each stage, ten experimental conditions comparing the effect of polyamines with α-tocopherol (10 μM solutions) on LDL oxidation and the uptake of oxLDL by macrophages were analyzed. MDA concentration was found to be significantly higher in type 2 diabetic patients compared to healthy subjects (5.6 ± 0.58 vs. 2.66 ± 0.31 μM MDA, respectively, (P < 0.05)). Percent of macrophages containing oxLDL was determined by means of red oil staining. The uptake of oxLDL by macrophages derived from diabetic patients was clear. The uptake of oxLDL was inhibited when the oxidation was prevented by polyamines or α-tocopherol. Spermine showed high antioxidant capacity (96.67 ± 1.53% vs. 25.67 ± 2.30%) compared to α-tocopherol (96.67 ± 1.53% vs. 47.00 ± 7.20%) at the concentration tested.In conclusion, polyamines especially spermine, has a potent antioxidant effect compared to α-tocopherol on human LDL oxidation, followed by spermidine and putrescine. The results have clinical relevance in the diabetic complications and add knowledge on the role of polyamines as natural antioxidants. This research is not a clinical evaluation rather a functional analysis utilizing clinical samples.     

Feeding Deterrence Effects of Defatted Jojoba (<Emphasis Type="Italic">Simmondisa chinensis</Emphasis>) Meal Against Indian Gerbil, <Emphasis Type="Italic">Tatera indica</Emphasis> (Hardwicke<Emphasis Type="Bold">)</Emphasis>

In search for safe and eco-friendly management of rodent pests a number of phyto-chemicals have been evaluated as repellent, antifertility agent, antifeedant and toxicant etc. Protein rich residue of seed of Jojoba (Simmondisa chinensis) known as defatted jojoba meal is reported to possess marked suppressive effect on food intake in a variety of animal species. In present study the defatted jojoba meal at a concentration of 5, 10, 15, 20, 25 and 30 % in pearl millet bait (w/w basis) was evaluated for its anti-rodent properties against Tatera indica, a predominant rodent pest of Indian subcontinent. Under no-choice condition the bait consumption during treatment period of 7 days was significantly reduced (3.01 ± 0.40–4.76 ± 0.14 g/100 g bwt/day) in comparison to pre-treatment plain bait consumption (9.33 ± 0.73–10.37 ± 0.29 g/100 g bwt/day). At higher dosages 50 % gerbils died. Besides, weight reduction in the range of 10.63–16.67 % was also observed. In choice test mean consumption of treated food was also significantly reduced (0.64 ± 0.28–1.44 ± 0.20 g/100 g bwt/day) in comparison to plain bait (5.80 ± 0.18–8.80 ± 0.29 g/100 g bwt/day) during 7 days of treatment period. Jojoba treated pearl millet bait when offered with plain sorghum bait, after an exposure period of 5 days left an imprinting effect on Indian gerbil which led to aversion towards plain pearl millet bait for 10–11 days. The findings showed that jojoba defatted meal exert strong dose dependant deterrence in Indian gerbils and also induces condition aversion learning behavior in the gerbils.     

Combined Thumb Abduction and Index Finger Extension Strength: A Comparison of Older Adults With and Without Thumb Carpometacarpal Osteoarthritis

ObjectiveThe objectives of this study were to compare thumb combined abduction/index finger extension (hand opening) strength between subjects with carpometacarpal (CMC) osteoarthritis (OA) and normal controls and to assess the reproducibility of hand opening strength and abduction range of motion (ROM) measurements in patients with thumb CMC OA to establish the cutoff values scores for minimal detectable change.MethodsSeventy-seven subjects, 96% female (age, 77 ± 7 years), participated in the study. The CMC OA group consisted of 39 patients (mean ± SD, 81 ± 7) and 38 healthy subjects (mean ± SD, 78 ± 6). Mixed models analysis of variance was conducted to determine the differences between groups.ResultsThe post hoc testing revealed statistically significant differences in pain pressure threshold, opening strength, and ROM measurements within the CMC OA group as compared with the healthy group (all, P < .01) in the dominant right hand. The average measure of CMC OA in the right hand did differ from that of the left hand for opening strength and abduction measurements. No statistical differences were revealed between groups nondominant left (all, P > .05), except in case of opening strength (P < .001). There was also large effect size between the means of the Disabilities of the Arm, Shoulder, and Hand scores between the healthy group and the CMC OA group of 1.17 (confidence interval, 1.19-2.14).ConclusionSubjects with CMC OA exhibited decreased combined thumb abduction and index finger extension strength, reduced thumb abduction ROM, and increased pain sensitivity when compared with their healthy counterparts. The minimal detectable change score in this patient population was 0.23 to 0.25 kg/cm² for pain pressure threshold, 0.12 to 0.13 lb for opening force, and 1.24° to 1.46° for abduction ROM measurement.     

Comparison of the effects of lidocaine pre-administration and local warming of the intravenous access site on propofol injection pain: Randomized,double-blind controlled trial

BackgroundLidocaine reduces pain that occurs upon the intravenous injection of propofol. But, there are few non-pharmacological nursing interventions to reduce propofol injection pain.ObjectiveTo compare the effects of lidocaine pre-administration and local warming of the intravenous access site on propofol injection pain.DesignProspective, double-blind, randomized controlled trial.SettingThe 555 bed, non-teaching National Cancer Center in Kyunggido, South Korea.ParticipantsA total of 96 patients who underwent thyroidectomy under total intravenous general anesthesia with propofol were randomly allocated to the control, lidocaine pre-administration (LA) or local warming (LW) group.MethodsAll three groups received 2% propofol with an effect-site target at 3 μg/mL for induction dose. The control group received 2% propofol with no intervention. The lidocaine pre-administration group received 2% propofol 30 s after 1% lidocaine 30 mg. The local warming group received 2% propofol after warming of the intravenous access site for 1 min using 43 °C forced air. Propofol injection pain was assessed by four-point verbal categorial scoring (VCS), numerical rating scale (NRS) and surgical pleth index (SPI).ResultsPain VCS of the LA group (mean ± SD, 1.11 ± 0.45) was significantly reduced (U = −3.92, p < .001) compared to the control group (mean ± SD, 1.71 ± 0.74). Pain VCS of the LW group (mean ± SD, 0.76 ± 0.44) was significantly reduced (U = −5.17, p < .001) compared to the control group (mean ± SD, 1.71 ± 0.74). Pain VCS of the LW group was significantly reduced compared to the LA group (U = −3.33, p = .001]. Pain NRS of the LA group (mean ± SD, 4.31 ± 2.32) was significantly reduced (mean difference, 1.82; 95% CI, 0.63–3.00; p = .003) compared to the control group (mean ± SD, 6.13 ± 2.39). Pain NRS of the LW group (mean ± SD, 3.06 ± 2.37) was significantly reduced (mean difference, 3.07; 95% CI, 1.63–4.51; p < .009) compared to the control group. There were significant differences in pain NRS between the LA group and the LW group (mean difference, 1.25; 95% CI, 0.09–2.42; p = .035). SPI of the LA group (mean ± SD, 64.1 ± 16.3) was significantly reduced (mean difference control versus LA, 8.36; 95% CI, 1.64–15.1; p = .016) compared to the control group (mean ± SD, 72.5 ± 9.56). SPI of the LW group (mean ± SD, 55.0 ± 16.2) was significantly reduced (mean difference control versus LW, 17.4; 95% CI, 10.8–24.0; p < .001) compared to the control group. There was a significant difference in SPI between the LA group and LW group (mean difference, 9.06; 95% CI, 1.02–17.1; p = .028).ConclusionLocal warming of the intravenous access site by 43 °C forced air for 1 min is slightly more effective in reducing propofol injection pain compared to lidocaine pre-administration.     

Twenty-four-hour profiles of urinary excretion of calcium,magnesium, phosphorus,urea, and creatinine in healthy prepubertal boys

ObjectivesAvailable data on 24-h urinary solute excretion in healthy children are sparse. We thus documented the daily and overnight variations of urinary electrolytes (calcium, magnesium, and phosphorus), urea, and creatinine in prepubertal (Tanner stage I) boys.Design and methodsNine voluntary healthy prepubertal boys aged 10.8 ± 0.11 years participated in this study. Concentrations of variables were quantified in daytime samples (collected between 07:00 h ± 30 min and 21:00 h ± 30 min) and nighttime samples (collected between 21:00 h ± 30 min and 07:00 h ± 30 min) in spring, during a period of 24-h every 3 h.ResultsSignificant differences were found between daytime and nighttime excretion of calcium (p < 0.05), magnesium (p < 0.001), phosphorus (p < 0.01), and urea (p < 0.05), with high concentrations during the night. The 24-h solute/creatinine ratio was 0.072 ± 0.008 mg/mg for calcium, 0.069 ± 0.008 mg/mg for magnesium, 0.698 ± 0.070 mg/mg for phosphorus, and 0.017 ± 0.001 g/mg for urea. Statistically significant correlation analyses showed that urea and creatinine were positively associated with body mass index (BMI) (R = 0.790, p = 0.0113 for urea; R = 0.889, p = <0.0013 for creatinine) and weight (R = 0.717, p = 0.0297 for urea; R = 0.978, p = < 0.001 for creatinine). The other urinary variables were independent of BMI and body mass.ConclusionThese data are of interest for the diagnosis of certain renal disease in prepubertal children.     

Adolescents and adults with patellofemoral pain exhibit distinct patellar maltracking patterns

BackgroundChronic idiopathic patellofemoral pain is associated with patellar maltracking in both adolescents and adults. To accurately target the underlying, patient-specific etiology, it is crucial we understand if age-of-pain-onset influences maltracking.MethodsTwenty adolescents (13.9 ± 1.4 years) and 20 adults (28.1 ± 4.9 years) female patients with idiopathic patellofemoral pain (age-of-pain-onset: < 14 and > 18 years of age, respectively) formed the patient cohort. Twenty adolescents and 20 adults (matched for gender, age, and body mass index) formed the control cohort. We captured three-dimensional patellofemoral kinematics during knee flexion-extension using dynamic MRI. Patellar maltracking (deviation in patient-specific patellofemoral kinematics, relative to their respective age-controlled mean values) was the primary outcome measure, which was compared between individuals with adolescent-onset and adult-onset patellofemoral pain using ANOVA and discriminant analysis.FindingsThe female adolescent-onset patellofemoral pain cohort demonstrated increased lateral (P = 0.032), superior (P = 0.007), and posterior (P < 0.001) maltracking, with increased patellar flexion (P < 0.001) and medial spin (P = 0.002), relative to the adult-onset patellofemoral pain cohort. Post-hoc analyses revealed increased lateral shift [mean difference ± 95% confidence interval = −2.9 ± 2.1 mm at 10° knee angle], posterior shift [−2.8 ± 2.1 mm, −3.3 ± 2.3 mm & -3.1 ± 2.4 mm at 10°, 20°& 30°], with greater patellar flexion [3.8 ± 2.6 mm & 5.0 ± 2.8 mm, at 20°& 30°] and medial spin [−2.2 ± 1.7 mm & -3.4 ± 2.3 mm at 20°& 30°]. Axial-plane maltracking accurately differentiated the patient age-of-pain-onset (60–75%, P < 0.001).InterpretationAge-of-pain-onset influences the maltracking patterns seen in patients with patellofemoral pain; with all, but 1, degree of freedom being unique in the adolescent-onset-patellofemoral pain cohort. Clinical awareness of this distinction is crucial for correctly diagnosing a patient's pain etiology and optimizing interventional strategies.     

Effect of different calcineurin inhibitors on AOPP and TAS after kidney transplantation

ObjectivesLittle is known about the influence of calcineurin inhibitors on advanced oxidation protein products (AOPP) and total antioxidant status (TAS) after renal transplantation.Design and methodsAOPP and TAS were evaluated in transplanted patients on different calcineurin inhibitors. Thirty-five patients were treated with cyclosporine A (group A) and 33 with tacrolimus (group B).ResultsOver 6 months, the mean levels of AOPP in group A decreased from 205.9 ± 125.7 to 140.9 ± 78.9 µmol/L and TAS from 1.89 ± 0.30 to 1.75 ± 0.27 mmol/L. In group B, the mean levels of AOPP decreased from 196.5 ± 123.9 to 129.6 ± 63.8 µmol/L and TAS from 1.80 ± 0.39 to 1.78 ± 0.23 mmol/L.ConclusionNo significant differences in AOPP and TAS were found with respect to treatment. The only exception was the higher mean concentration of AOPP at month 1 in group A (p = 0.026).     

Physiological demands of quality cardiopulmonary resuscitation performed at simulated 3250 meters high

AimTo analyse the effect of oxygen fraction reduction (O2 14%, equivalent to 3250 m) on Q-CPR and rescuers' physiological demands.MethodologyA quasi-experimental study was carried out in a sample of 9 Q-CPR proficient health care professionals. Participants, in teams of 2 people, performed 10 min CPR on a Laerdal ResusciAnne mannequin (30:2 compression/ventilation ratio and alternating roles between rescuers every 2 min) in two simulated settings: T21-CPR at sea level (FiO2 of 21%) and T14 – CPR at 3250 m altitude (FiO2 of 14%). Effort self-perception was rated from 0 (no effort) to 10 (maximum demand) points.ResultsQuality of chest compressions was good and similar in both conditions (T21 vs T14). However, the percentage of ventilations with adequate tidal volume was lower in altitude than at sea level conditions (35.9 ± 25.2% vs. 54.7 ± 23.2%, p = 0.035). The subjective perception of effort was significantly higher at simulated altitude (5 ± 2) than at sea level (3 ± 2) (p = 0.038). Maximum heart rate during the tests was similar in both conditions; however, mean oxygen saturation was significantly lower in altitude conditions (90.5 ± 2.5% vs. 99.3 ± 0.5%, p < 0.001).ConclusionAlthough performing CPR under simulated hypoxic altitude conditions significantly increases the physiological demands and subjective feeling of tiredness compared to sea level CPR, trained rescuers are able to deliver good Q-CPR in such conditions, at least in the first 10 min of resuscitation.     

The efficacy of the WhisperFlow CPAP system versus high flow nasal cannula in patients at risk for postextubation failure: A Randomized controlled trial

PurposeCompare the efficacy(reintubation rate) between a high-flow nasal cannula(HFNC) and the WhisperFlow CPAP system in patients at risk for postextubation failure.Material and methodsRCT was conducted in patients who had at least one high-risk criterion for postextubation failure. All patients were randomly assigned to CPAP or HFNC for 48 h.ResultsOf 140 patients, sixty-nine were assigned to the CPAP group and 71 to the HFNC group. The reintubation rate was similar between the HFNC and WhisperFlowCPAP [5 cases(7.0%) vs. 6 cases(8.7%); P = 0.76]. The postextubation respiratory failure rate was not significantly different between the HFNC and WhisperFlow CPAP groups [10 cases(14.1%)vs.7cases(10.1%); P = 0.48]. The respiratory rate was lower in the HFNC than CPAP group(P = 0.04). The pain rating scale score was lower in the HFNC group than in the WhisperFlow CPAP group at 24 h (2.8 ± 2.0 vs. 3.7 ± 1.9, P = 0.02) and 48 h (2.8 ± 1.8 vs. 3.8 ± 1.9, P = 0.002).ConclusionsWe are unable to demonstrate a reduction in postextubation respiratory failure in at risk patients with the use of HFNC compared with the WhisperFlow CPAP system probably because small sample size, but HFNC was better tolerated.