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Concept: Group B

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To improve the management of advanced cancer patients with delirium in an emergency department (ED) setting, we compared outcomes between patients with delirium positively diagnosed by both the Confusion Assessment Method (CAM) and Memorial Delirium Assessment Scale (MDAS), or group A (n = 22); by the MDAS only, or group B (n = 22); and by neither CAM nor MDAS, or group C (n = 199).

Concepts: Hospital, Group A, Group B, Group C, Delirium

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The long-term maintenance of ventriculoperitoneal (VP) shunt function depends on the correct placement of the catheter tip in the lateral ventricle. The relationship between the location of the ventricular catheter tip and VP shunt function was analyzed in 52 patients. The location of the ventricular catheter tip was classified into one of the following five groups: (i) Group A - superior to the foramen of Monro; (ii) Group B - in the center of the lateral ventricle body; (iii) Group C - in the third ventricle; (iv) Group D - contacting the ventricle wall; and (v) Group E - in the septum pellucidum. VP shunt function was defined as well controlled hydrocephalus when the Evan’s ratio of the ventricular size was < 0.3. The VP shunt functioned well in 14 of 52 patients (26.9%), the shunt valve pressure was incorrectly set in 21 (40.4%), and irreversible shunt malfunction was identified in 17 (32.7%). Among the 14 patients with a well-functioning shunt, 13 were in Groups A or B with an odds ratio (OR) of 17.875 (p<0.05). In the 17 irreversible shunt malfunctions, 13 were identified in Groups C, D, or E with an OR of 0.123 (p<0.05). Long term VP shunt function or failure due to irreversible malfunction is directly influenced by the position of the ventricular catheter tip. Ideal points for positioning the ventricular catheter tip are superior to the foramen of Monro and in the center of the lateral ventricle body. Early shunt revision may be required for patients in whom the catheter tip contacts the ventricle wall or is located in the septum pellucidum.

Concepts: Cerebrospinal fluid, Term, Hydrocephalus, Catheter, Ventricular system, Group B, Fourth ventricle, Cerebral shunt

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ObjectTo compare the Sliding with Non-sliding lag screw of a gamma nail in the treatment of A1 and A2 AO-OTA intertrochanteric fractures.Materials and methods80 patients were prospectively collected. In each group, AO/OTA 31-A were classified into group A. AO/OTA 31-A2.1 was classified as group B. We classified the A2.2 and A2.3 as group C. According to the set-screw locking formation of Gamma-III, the cases were randomly allocated to Sliding subgroup and Non-sliding subgroup in A, B and C groups. Follow-ups were performed 1, 3, 6 and 12 months postoperatively. RESULTS: In the Sliding group, the bone healing rate 3, 6, 12 months postoperatively reached 85.00%, 97.50%, 100% in group A, B and C. Meanwhile, in Non-sliding group, postoperatively, bone healing rate were 90.00%, 95.00% and 97.50% in group A, B and C, respectively. Both differences were not significant. Lower limb discrepancy between Sliding and Non-sliding pattern was significantly different in group C which represent fracture types of AO/OTA 31-A2.2 and A2.3 (0.573+/-0.019mm in Non-sliding group, 0.955mm+/-0.024mm in Sliding group, P<0.001 ). Difference of sliding distance among the three groups was significant among group A, B and C: 0.48mm+/-0.04mm, 0.62mm+/-0.07mm and 0.92mm+/-0.04mm (P<0.001). Differences in average healing time and Harris scores also presented no significance in the three groups. CONCLUSIONS: As a result, we can conclude that the sliding distance is minimal in Gamma nails and it is related to the comminuted extent of the intertrochanteric area in A1 and A2 AO-OTA intertrochanteric fractures. For treating these kinds of fractures, the sliding of the lag screw of an Gamma nail does not improve any clinical results and in certain cases, such as highly comminuted A1 and A2 fractures, can therefore even benefit from a locked lag screw by tightening the set-screw.

Concepts: Bone, Bone fracture, Hip fracture, Fracture, Group A, Group B, Group C

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Abstract Objective: There are controversies in the treatment of seborrheic dermatitis. The aim of this study was to compare the efficacy of sertaconazole 2 % cream vs. ketoconazole 2% cream in the treatment of seborrheic dermatitis. Methods: 132 patients, with diagnosis of seborrheic dermatitis were studied. The first group received sertaconazole 2% cream (group A), and the other received ketoconazole 2% cream (group B) . At the beginning of referring and also 2 and 4 weeks after first visit, the patients were examined by a dermatologist to control improvement of clinical symptoms and drug side effects. Results: The mean age of sertaconazole and ketoconazole group was 30.18 ± 12.36 and 34.68 ± 10.16, respectively. Patients with moderate SI had the most frequency (76.6%) at pretreatment stag with ketoconazole 2% cream. This is while patients with mild SI had the highest frequency (53.3%) at post-treatment stage. In patients received the sertaconazole 2 % cream, the highest frequency was observed in 80% of cases with moderate SI at pretreatment stage while patients with slight SI had the highest frequency (83.3%) at post-treatment stage. Conclusion: Sertaconazole 2 % cream may be an excellent alternative therapeutic modality for treating seborrheic dermatitis.

Concepts: Medicine, Comparison, Comparisons, Antifungal drug, Group B, Modality, Ketoconazole, Seborrhoeic dermatitis

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Objectives: To compare the longitudinal changes of the angle of progression (AoP) and the midline angle (MLA) during the active second stage according to the mode of delivery. Methods: A three-dimensional translabial ultrasound volume was acquired in a series of nulliparous women at the beginning of the active second stage (T1) and every 20 minutes thereafter (T2, T3, T4, T5, and T6). Following delivery, all ultrasound volumes were analyzed and AoP and MLA were measured. Results: Among 71 women included in the study, 58 women underwent spontaneous vaginal delivery (group A), and 13 underwent operative delivery (Group B) (8 by vacuum extraction and 5 by cesarean section). When compared with group B, group A had a wider AoP only at T1 (140.0 ± 20.2° vs 122.9 ± 16.7°, P = 0.010) and T2 (149.7 ± 20.7° vs 126.9 ± 17.5°, P = 0.006). On the other hand, MLA was narrower in Group A only at T3 (21.2 ± 11.7° vs 40.8 ± 27.9°, P = 0.043), T4 (18.2 ± 15.0° vs. 47.4 ± 29.6°, P = 0.020) and T5 (18.3 ± 6.0° vs. 34.7 ± 4.2°, P = 0.034). At stepwise forward multiple logistic regressions both AoP and MLA were independently associated with the spontaneous vaginal delivery (OR 1.047 and 0.983, respectively). Conclusions: Ultrasonographic assessment of fetal head descent in the second stage may play a role in the prediction of the mode of delivery. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.

Concepts: Childbirth, Obstetrics, Magnetic resonance imaging, Medical ultrasonography, John Wiley & Sons, Caesarean section, Group B, Ventouse

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Studies have analyzed three-dimensional complex motion of the shoulder in healthy subjects or patients undergoing total shoulder arthroplasty (TSA) or reverse shoulder arthroplasty (RSA). No study to date has assessed the reaching movements in patients with TSA or RSA. Twelve patients with TSA (Group A) and 12 with RSA (Group B) underwent kinematic analysis of reaching movements directed at four targets. The results were compared to those of 12 healthy subjects (Group C). The assessed parameters were hand-to-target distance, target-approaching velocity, humeral-elevation angular velocity, normalized jerk (indicating motion fluidity), elbow extension and humeral elevation angles. Mean Constant score increased by 38 points in Group A and 47 in Group B after surgery. In three of the tasks, there were no significant differences between healthy subjects and patients in the study groups. Mean target-approaching velocity and humeral-elevation angular velocity were significantly greater in the control group than in study groups and, overall, greater in Group A than Group B. Movement fluidity was significantly greater in the controls, with patients in Group B showing greater fluidity than those in Group A. Reaching movements in the study groups were comparable, in three of the tasks, to those in the control group. However, the latter performed significantly better with regard to target-approaching velocity, humeral-elevation angular velocity and movement fluidity, which are the most representative characteristics of reaching motion. These differences, that may be related to deterioration of shoulder proprioception after prosthetic implant, might possibly be decreased with appropriate rehabilitation.

Concepts: Humerus, Elbow, Classical mechanics, Velocity, Upper limb, Group A, Group B, Group C

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Calcium sulfate (CS) can be used as an antibiotically impregnated bone substitute in a variety of clinical constellations. Antibiotically loaded bone substitutes find specific application in orthopedic and trauma surgery to prevent or treat bone infections especially in relation to open bone defects. However, its use as a structural bone graft reveals some concerns due to its fast biodegradation. The addition of calcium carbonate and tripalmitin makes CS formulations more resistant to resorption leaving bone time to form during a prolonged degradation process. The aim of the present study was the evaluation of biocompatibility and degradation properties of newly formulated antibiotically impregnated CS preparations. Three different types of CS bone substitute beads were implanted into the tibial metaphysis of rabbits (CS dihydrate with tripalmitin, containing gentamicin (Group A) or vancomycin (Group B); Group C: tobramycin-loaded CS hemihydrate). Examinations were performed by means of x-ray, micro-computed tomography (micro-CT) and histology after 4, 6, 8 and 12 weeks. Regarding biocompatibility of the formulations, no adverse reactions were observed. Histology showed formation of vital bone cells attached directly to the implanted materials, while no cytotoxic effect in the surrounding of the beads was detected. All CS preparations showed osteogenesis associated to implanted material. Osteoblasts attached directly to the implant surface and revealed osteoid production, osteocytes were found in newly mineralized bone. Group C implants (Osteoset®) were subject to quick degradation within 4 weeks, after 6-8 weeks there were only minor remnants with little osteogenesis demonstrated by histological investigations. Group A implants (Herafill®-G) revealed similar degradation within atleast 12 weeks. In contrast, group B implants (CaSO4-V) were still detectable after 12 weeks with the presence of implant-associated osteogenesis atlatest follow-up. In all of these preparations, giant cells were found during implant degradation on surface and inside of resorption lacunae. None of the analyzed CS preparations triggered contact activation. All implants demonstrated excellent biocompatibility, with implants of Group A and B showing excellent features as osteoconductive and -inductive scaffolds able to improve mechanical stability.

Concepts: Bone, Surgery, Calcium, Calcium carbonate, Group A, Group B, Group C, Gypsum

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This study investigated the welfare consequences of training dogs in the field with manually operated electronic devices (e-collars). Following a preliminary study on 9 dogs, 63 pet dogs referred for recall related problems were assigned to one of three Groups: Treatment Group A were trained by industry approved trainers using e-collars; Control Group B trained by the same trainers but without use of e-collars; and Group C trained by members of the Association of Pet Dog Trainers, UK again without e-collar stimulation (n = 21 for each Group). Dogs received two 15 minute training sessions per day for 4-5 days. Training sessions were recorded on video for behavioural analysis. Saliva and urine were collected to assay for cortisol over the training period. During preliminary studies there were negative changes in dogs' behaviour on application of electric stimuli, and elevated cortisol post-stimulation. These dogs had generally experienced high intensity stimuli without pre-warning cues during training. In contrast, in the subsequent larger, controlled study, trainers used lower settings with a pre-warning function and behavioural responses were less marked. Nevertheless, Group A dogs spent significantly more time tense, yawned more often and engaged in less environmental interaction than Group C dogs. There was no difference in urinary corticosteroids between Groups. Salivary cortisol in Group A dogs was not significantly different from that in Group B or Group C, though Group C dogs showed higher measures than Group B throughout sampling. Following training 92% of owners reported improvements in their dog’s referred behaviour, and there was no significant difference in reported efficacy across Groups. Owners of dogs trained using e-collars were less confident of applying the training approach demonstrated. These findings suggest that there is no consistent benefit to be gained from e-collar training but greater welfare concerns compared with positive reward based training.

Concepts: Psychology, Behavior, Behaviorism, Dog, Pet, Group A, Group B, Group C

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BACKGROUND : Switching between different classes of P2Y12inhibitors, including de-escalation from ticagrelor to clopidogrel, commonly occurs in clinical practice. However, the pharmacodynamic profiles of this strategy have been poorly explored. METHODS : This was a prospective, randomized, open-label study conducted in patients on maintenance dosing (MD) of aspirin (81 mg/d) and clopidogrel (75 mg/d). After a 7-day run-in with ticagrelor (180 mg loading dose [LD] followed by 90 mg twice daily MD), patients (n=80) were randomized into 1 of 4 groups: group A, clopidogrel 600 mg LD 24 hours after the last MD of ticagrelor (C-600 mg-24h); group B, clopidogrel 600 mg LD 12 hours after the last MD of ticagrelor (C-600 mg-12h); group C, clopidogrel 75 mg/d MD 24 hours after the last MD of ticagrelor (C-75 mg-24h); and group D, ticagrelor 90 mg twice daily MD (T-90 mg twice daily). MD of the randomized treatment was maintained for 10±3 days. Pharmacodynamic assessments were performed at baseline, after run-in, and at 2, 24, 48, and 72 hours and 10 days with P2Y12reaction units by VerifyNow; platelet reactivity index was assessed by vasodilator-stimulated phosphoprotein; and maximal platelet aggregation was determined by light transmittance aggregometry. RESULTS : T-90 mg twice daily led to lower platelet reactivity than any clopidogrel regimen using all assays at all time points. P2Y12reaction unit levels were similar between the C-600 mg-24h (group A) and the C-75 mg-24h (group C) (P=0.29), including at 48 hours (primary end point; least mean difference, -6.9; 95% confidence interval, -38.1 to 24.3;P=0.66). P2Y12reaction unit levels were lower with C-600 mg-12h (group B) than with C-75 mg-24h (group C;P=0.024). Maximal platelet aggregation over time was lower with both C-600 mg-24h (group A;P=0.041) and C-600 mg-12h (group B;P=0.028) compared with C-75 mg-24h (group C). Platelet reactivity index profiles paralleled those observed with P2Y12reaction units. There were no pharmacodynamic differences for all tests between C-600 mg-24h (group A) and C-600 mg-12h (group B). In group C (C-75 mg-24h), platelet reactivity increased compared with baseline as early as 24 hours, reaching statistical significance at 48 and 72 hours and up to 10 days. These pharmacodynamic findings were delayed and blunted in magnitude with the administration of an LD, regardless of the timing of administration. CONCLUSIONS : De-escalation from ticagrelor to clopidogrel therapy is associated with an increase in platelet reactivity. The use of an LD before the initiation of an MD regimen of clopidogrel mitigates these observations, although this is not affected by the timing of its administration after ticagrelor discontinuation. CLINICAL TRIAL REGISTRATION : URL: https://www.clinicaltrials.gov. Unique identifier: NCT02287909.

Concepts: Myocardial infarction, Coronary artery disease, Platelet, Aspirin, Group A, Group B, Group C, IMSA GT Championship

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OBJECTIVE: To investigate anti-infective treatments in HIV-infected surgical patients during the perioperative period. METHODS: A retrospective study of sepsis and surgical site infections (SSIs) was conducted in 266 HIV-infected patients. The patients were divided into 3 groups based on CD4+ T cells counts in the preoperative period: group A (0–199 cell/ul), group B (200–349 cell/ul) and group C ([greater than or equal to] 350 cell/ul). When the CD4 count was below 350 cells/uL, anti-retrovirus therapy was started. For patients whose preoperative CD4 counts were [less than or equal to] 200 cells/uL, preoperative antibiotic medication was started. RESULTS: Patients in group A were more likely to get sepsis than patients in the other two groups (p0.01). Among 82 patients with clean wounds, only one patient got SSIs. All patients with dirty wounds had acquired SSIs after surgery. There were only 6 patients dead at 30 days after surgery, a death rate of 2.3%. Sepsis appeared in 110 patients (41%). CONCLUSIONS: Complete evaluation of surgical risk and suitable perioperative anti-infective treatment may lead to better outcome for HIV-infected surgical patients.

Concepts: Medicine, Death, Hospital, Infection, Inequality, Group A, Group B, Equality