Inadequate Recovery Research Articles

Treatment of anaerobic infection

Anaerobic bacteria are the predominant flora in the normal human skin and mucous membranes and are, therefore, a common cause of endogenous infections. Since anaerobic infections are generally polymicrobial, where anaerobes are mixed with aerobic organisms, therapy should provide coverage of both types of pathogens. The isolation of anaerobes requires appropriate methods of collection, transportation and cultivation of specimens. The lack of use of any of these methods can lead to inadequate recovery of anaerobes and inappropriate therapy. Treatment of anaerobic infection is complicated by the slow growth of these organisms and the growing resistance of anaerobic bacteria to antimicrobials. The primary role of antimicrobials is to limit the local and systemic spread of infection. Surgical drainage is of primary importance. This includes debriding of necrotic tissue, draining the pus, improving circulation, alleviating obstruction and increasing tissue oxygenation. The most effective antimicrobials against anaerobic organisms are metronidazole, the carbapenems (imipenem, meropenem and ertapenem), chloramphenicol, the combinations of a penicillin and a β-lactamase inhibitor (ampicillin or ticarcillin plus clavulanate, amoxicillin plus sulbactam, and piperacillin plus tazobactam), tigecycline and clindamycin.

An exploration of relational customers' response to service failure

PurposeThe purpose of this paper is to examine how customers with different relational bonds respond to the same service failure. In particular, the framework to service failure and recovery devised by Fournier and Mick is applied.Design/methodology/approachTo uncover rich emotional and cognitive responses to service failure, in‐depth interviews with eight former and current patrons of an Australian opera were used.FindingsThree types of relationship were identified: satisfaction‐as‐love (SaL), satisfaction‐as‐trust (SaT) and satisfaction‐as‐control (SaC). Each responded to the same failure in different ways. SaL customers had emotional bonds with the product category and thus reaffiremed their loyalty following the failure. SaT customers saw the service failure and inadequate recovery as a breach of the brand's implied promise and thus excited the relationship. SaC customers took charge of the situation, using their status to improve their situation and then defended the brand.Practical implicationsThe findings indicate the importance of customizing service recovery strategies, in this case to those customers with the strongest emotional bonds to the brand, not the product class.Originality/valueThis is the first paper to examine how relational customers respond to service failure and identify how different customer‐brand relationships result in different post‐failure reactions and expectations of service recovery.

Lessons from oligodendrocyte biology on promoting repair in multiple sclerosis

The failure of remyelination in multiple sclerosis (MS) contributes to inadequate recovery of neurological function after episodes of active inflammation and demyelination. It is likely that identification of novel strategies to promote remyelination will stem from a better understanding of oligodendrocyte biology. Here we illustrate this point by highlighting four areas where recent advances have important implications for remyelination strategies. First, oligodendrocyte precursor cells arise from different regions during development, and the cells from these distinct sites may have important functional differences. It is, therefore, essential to determine which oligodendrocyte population contributes to remyelination in the adult. Second, the extracellular matrix and its integrin receptors contribute to the regulation of oligodendrocyte behaviour, providing a hitherto unexplored set of drug targets. Third, the mechanisms that regulate myelin sheath formation are distinct from those that promote the earlier stages of differentiation, requiring experimental strategies that model sheath formation rather than simply examining oligodendrocyte differentiation in the absence of axons. Lastly, inflammation can promote remyelination and repair as well as damaging the CNS, and identification of the pro-myelinogenic factors in the immune response may also point to new therapies for MS.

Comparative analysis of T-cell turnover and homeostatic parameters in HIV-infected patients with discordant immune-virological responses to HAART

Inadequate CD4 cell count recovery despite full HIV RNA control occurs in 30% of HAART-treated HIV-infected patients. A better understanding of the relationship between T-cell dynamics and the HIV intracellular reservoir in HIV-infected patients failing to recover CD4 cell count following long-term HAART, is required. In a cross-sectional study T-cell turnover and homeostatic parameters featuring discordant responses were investigated in 27 immunologic non-responders (INR; CD4 count, < or = 200 cells/microl; HIV RNA, < or = 50 copies/ml), 15 virological non-responders (VNR; CD4 count, > or = 350 cells/microl; HIV RNA, > or = 10 000) and 22 full responders (FR; CD4 count, > or = 500 cells/microl; HIV RNA, < or = 50 copies/ml). INR displayed significantly higher activated CD38CD8 than FR (P < 0.05) and was comparable to VNR (P > 0.05). As compared with VNR and FR, INR displayed the highest level of proliferating Ki67CD4 and apoptotic CD4 cells (P < 0.05). VNR presented lower proliferation and apoptosis than FR and INR. INR displayed the lowest levels of naive T cells (P < 0.05) and a predominant memory pattern. Despite the memory/activated/apoptotic phenotype, INR showed a statistically non-significant reduction in T-cell receptor excision circles (TREC) compared to FR (P > 0.05), and substantially heightened interleukin (IL)-7 (P < 0.05), while VNR showed higher naive T-cell counts and TREC. Moreover, the reservoir of infected CD4 cells was increased in INR, with a trend toward highest intracellular HIV DNA within total, naive and memory CD4 cells. The lack of CD4 cell count recovery in INR seems to reflect a highly activated apoptotic T-cell compartment, with elevated IL-7 and thymic impairment. High levels of intracellular HIV-DNA in INR could be strictly involved in the lack of T-cell reconstitution. Immune correlates of an ultimate direction of the response to HAART, could be exploited in clinical practice for the most effective management of discordant patients, to amend immune imbalances and to improve clinical outcome.

Chronic Posterior Dislocation of the Glenohumeral Joint Complicated by a Fractured Proximal Humerus: A Case Report

A 41-year-old right-handed woman was involved in a traffic accident and landed on the right arm while the right shoulder was in flexion. She experienced pain and severe impairment of right shoulder motion immediately following the accident. She was misdiagnosed with a fractured proximal humerus with no displacement and was treated conservatively by immobilisation. There was inadequate recovery in range of motion and gradual development of severe pain. Two years and 4 months after the injury, the patient presented to our hospital where a diagnosis of chronic posterior fracture dislocation of the shoulder with split articular surface of the humeral head was made. A humeral head replacement without resection of the greater tuberosity or the coracoid process was performed. Postoperative recovery was uneventful. The patient returned to work as a cook one year later. At 20-month follow-up, the patient had no pain, and her shoulder range of motion was forward flexion 160 degrees, abduction 140 degrees, external rotation 40 degrees, and internal rotation L3.

Relationship between repetitive work and the prevalence of carpal tunnel syndrome in part-time and full-time female supermarket cashiers: a quasi-experimental study

To investigate the prevalence of Carpal Tunnel Syndrome (CTS) in full-time and part-time supermarket cashiers exposed to a different weekly duration of biomechanical load. All the 269 cashiers and 127 office workers were asked to participate. The protocol included ergonomic risk assessment, collection of personal and clinical data and bilateral electrodiagnostic study of the median nerve. CTS symptoms were defined as past and/or current nocturnal and/or diurnal numbness, tingling, burning or pain involving at least one of the first three fingers. Results were evaluated according to two case definitions based on current symptoms and on the combination of current symptoms and slowing of sensory conduction velocity from wrist to palm, respectively. Difference in proportions of CTS symptoms and cases was evaluated by the Pearson's chi-square (chi(2)) test, univariate and multivariate logistic regression analyses were performed to determine the impact of weekly exposure. The final female study population included 71 full-time cashiers, 155 part-time cashiers and 98 office workers. Ergonomic risk level was rated 5 for hand activity level and 4 for peak of force according to ACGIH. The intersection of the two values fell on the threshold limit value line, confirming the possible exposure to biomechanical risk factors for CTS. The prevalence of current CTS symptoms was higher among full-time (31.0%) than in part-time cashiers (19.3%) or controls (16.3%) (p = 0.055). A similar pattern was found for CTS past symptoms and cases. Univariate analysis showed that full-time cashiers had a 2.3 fold increased risk for CTS specific current symptoms than control subjects. A similar trend also emerged for CTS cases but was not significant (Odds ratios 1.23). Multivariate logistic regression analysis confirmed the increased risk for CTS current symptoms in full-time cashiers. Intensive manual work associated with inadequate recovery time might have generated an impairment of the median nerve at the wrist level proportionally increasing with duration of hand use. Our study can provide useful information both for ergonomic risk assessment and work organization.

Delayed acetyl- l-carnitine administration and its effect on sensory neuronal rescue after peripheral nerve injury

Protection of sensory neurons after peripheral nerve injury is clinically crucial since inadequate sensory recovery is seriously affected by the death of up to 40% of sensory neurons. Immediate acetyl-L-carnitine (ALCAR) treatment eliminates this cell loss, but may not always be clinically feasible, hence we studied the effect of delaying the initiation of ALCAR treatment. Five groups of rats (n=5 per group) underwent unilateral sciatic nerve axotomy. ALCAR treatment (50 mg/kg/day) was initiated immediately, or after delays of 6 h, 24 h or 7 days after injury. A sham-treated group served as control. L4 and L5 dorsal root ganglia were harvested bilaterally 2 weeks after injury and stereological sensory neuron counts were obtained. Immediate sham treatment provided no neuroprotection (25% loss). Cell loss was eliminated when ALCAR was commenced within<or=24 h of axotomy. No statistically significant neuroprotective effect (18% loss) was evident compared to sham when ALCAR administration was initiated 7 days post-axotomy. When commenced within a clinically applicable time frame ALCAR treatment remains highly neuroprotective, potentially improving clinical outcome following peripheral nerve trauma.

English

Evaluation of mine reclamation success is based on examination of aboveground ecosystem components. Recovery of belowground constituents and processes, such as soil structure and nutrient cycling, is crucial to successful reclamation of disturbed lands. Inadequate recovery of belowground ecosystem structure and function during reclamation can lead to future site degradation. Our objective in this study was to test the hypothesis that recovery of plant community properties on reclaimed surface mine land accurately reflect recovery of soil structure, more specifically aggregate size distribution. In this study, above- and belowground constituents were sampled on reclaimed mine sites representing various ages (native rangeland, a 4 month old topsoil stockpile, 14, 26, and 29 year old reclamation) located in northeastern Wyoming. Cool-season grass (native and reclaimed) communities were sampled for aboveground biomass production, cover and species diversity according to Wyoming Department of Environmental Quality standards. Soil samples were analyzed for water stable aggregate size distribution with wet sieving. Soil structure appears to be recovering through time. An increase in macroaggregates (250-2000µm) on a weight basis and a decrease in free microaggregates (53-250 µm) and free silt and clay (<53 µm) on reclaimed sites with time was observed, indicating incorporation of free silt and clay and free microaggregates into macroaggregates. Aboveground biomass production and macroaggregate formation showed a significant relationship (R 2 = 0.457); however, no relationship was evident for microaggregate formation. No significant relationship existed among total cover and species diversity with respect to macro- and microaggregate formation. These preliminary results suggest that soil structural recovery is most closely related to plant biomass production, while other plant community properties do not necessarily reflect this recovery.

Reliability Evaluation of Distributed Computer Systems Subject to Imperfect Coverage and Dependent Common-Cause Failures

Imperfect coverage (IPC) occurs when a malicious component failure causes extensive damage due to inadequate fault detection, fault location or fault recovery. Common-cause failures (CCF) are multiple dependent component failures within a system due to a shared root cause. Both imperfect coverage and common-cause failures can exist in distributed computer systems and can contribute significantly to the overall system unreliability. Moreover they can complicate the reliability analysis. In this study, we propose an efficient approach to the reliability analysis of distributed computer systems (DCS) with both IPC and CCF. The proposed methodology is to decouple the effects of IPC and CCF from the combinatorics of the solution. The resulting approach is applicable to the computationally efficient binary decision diagrams (BDD) based method for the reliability analysis of DCS. We provide a concrete analysis of an example DCS to illustrate the application and advantages of our approach. Due to the consideration of IPC and CCF, our approach can evaluate a wider class of DCS as compared with existing approaches. Due to the nature of the BDD and the separation of IPC and CCF from the solution combinatorics, our approach has high computational efficiency and is easy to implement, which means that it can be easily applied to the accurate reliability analysis of large-scale DCS subject to IPC and CCF. The DCS without IPC or CCF appear to be special cases of our approach.

The Datex-Ohmeda M-NMT Module: A Potentially Confusing User Interface

New York Medical College, Valhalla, New York. akopman@nyc.rr.comA recent editorial in this journal has suggested that“… it is time to … introduce objective neuromuscular monitoring in all operating rooms, not just those occupied by researchers and aficionados of muscle relaxants… . objective neuromuscular monitoring is an evidence-based practice and should consequently be used whenever a nondepolarizing neuromuscular blocking agent is administered… . there are strong reasons to believe that its use can improve patient outcome.”1Our department strongly supports this position and recently introduced one such monitor, the S/5 M-NMT NeuroMuscular Transmission Module (Datex-Ohmeda, Madison, WI) into all of our operating rooms. Although we are generally pleased with this device, we have identified one aspect of the user interface that delivers a confusing message to the clinician. We think this issue may have clinical ramifications and is important enough that an alert to other users of this module is warranted.The M-NMT’s transducer (MechanoSensor; Datex-Ohmeda) consists of a strip of piezoelectric polymer that is applied to a boomerang-shaped spring, which is placed between the thumb and the forefinger. Mechanical movement of the thumb results in a redistribution of the electrical charge on the sensor membrane, a change that can be quantitated. The M-NMT is a movement sensor, and the method is not acceleromyography. To differentiate this monitoring approach from acceleromyography, the company refers to their monitor as using kinemyography. The calculated train-of-four (TOF) ratio is displayed numerically (as a percent) on the patient monitor (S/5 Anesthesia Monitor; Datex-Ohmeda). In addition, the unit displays a bar graph of all four responses so that this ratio may be appreciated visually.Unfortunately, the bar graph and the displayed TOF ratio may appear to disagree (fig. 1). It is a common occurrence during recovery of nondepolarizing neuromuscular block to encounter a numeric TOF ratio indicative of inadequate recovery (e.g. , &lt; 0.70) at a time when all four responses displayed graphically appear identical. The clinician who merely glances at the bar graph without reading the displayed value may incorrectly assume that neuromuscular recovery is complete when this is clearly not the case. The explanation for this disparity between the displayed graphic and numerical values follows.In the absence of neuromuscular block, repeated rapid indirect muscle stimulation produces a steady increase in mechanical twitch height. This is a function of altered muscle contractility and is unrelated to changes in neuromuscular transmission. This phenomenon is known as the “staircase effect.”2Therefore, after 10–15 min of TOF stimulation control, T1 (twitch height) may increase by 50–100%. In the research setting, this is why investigators wait several minutes before doing a final calibration of their baseline values. However, in the clinical setting, anesthesiologists rarely if ever take this effect into account. The usual sequence is (1) induce anesthesia, (2) calibrate the M-NMT, and (3) administer muscle relaxant, all within 2 min or less. This failure to establish stabile baseline values usually results in T1 values far in excess of 100% when spontaneous or induced recovery is complete. Therefore, at the end of the case, the sensor might record the following values: T1 = 165%, T2 = 145%, T3 = 130%, and T4 = 120% with a calculated TOF ratio of 0.73. This value will be corrected displayed numerically on the monitor screen. However, the bar graph attempts to display the absolute value (relative to control) of all four responses. Unfortunately, all values greater than 120% are truncated or “chopped off” at the top. The result in the above hypothetical case is a bar graph displaying a total absence of fade.This situation is unsatisfactory for several reasons. Although the T1 value as a percent of control is only displayed in the monitor’s display trend mode, values greater than 100% will be confusing to most clinicians. When data that “don’t make any sense” are presented to the clinician, there is an understandable tendency to conclude that there must be something wrong with the monitor. If this happens often enough, the offending unit will eventually be destined to occupy to a dusty shelf in a back storage room.Of greater concern, the conflicting information presented by the monitor may contribute to improper clinical decisions. Some clinicians may opt to believe the bar graph rather than the numerical TOF ratio. The result is failure to antagonize residual block when reversal is clearly indicated. We have found the M-NMT module to be a useful addition to our monitoring armamentarium. However, its current user interface needs to be rethought by the manufacturer.New York Medical College, Valhalla, New York. akopman@nyc.rr.com

Prevention, diagnosis and treatment of the Overtraining Syndrome

Successful training must involve overload but also must avoid the combination of excessive overload plus inadequate recovery. Athletes can experience short term performance decrement, without severe psychological, or lasting other negative symptoms. This Functional Overreaching (FOR) will eventually lead to an improvement in performance after recovery. When athletes do not sufficiently respect the balance between training and recovery, Non-Functional Overreaching (NFOR) can occur. The distinction between NFOR and the Overtraining Syndrome (OTS) is very difficult and will depend on the clinical outcome and exclusion diagnosis. The athlete will often show the same clinical, hormonal and other signs and symptoms. A keyword in the recognition of OTS might be ‘prolonged maladaptation’ not only of the athlete, but also of several biological, neurochemical, and hormonal regulation mechanisms. It is generally thought that symptoms of OTS, such as fatigue, performance decline, and mood disturbances, are more severe than those of NFOR. However, there is no scientific evidence to either confirm or refute this suggestion. One approach to understanding the aetiology of OTS involves the exclusion of organic diseases or infections and factors such as dietary caloric restriction (negative energy balance) and insufficient carbohydrate and/or protein intake, iron deficiency, magnesium deficiency, allergies, etc. together with identification of initiating events or triggers. In this paper we provide the recent status of possible markers for the detection of OTS. Currently several markers (hormones, performance tests, psychological tests, biochemical and immune markers) are used, but none of them meets all criteria to make its use generally accepted. We propose a “check list” that might help the physicians and sport scientists to decide on the diagnosis of OTS and to exclude other possible causes of underperformance.

The role of gemtuzumab ozogamicin in acute leukaemia therapy

Gemtuzumab ozogamicin (GO) is an immunoconjugate that binds to CD33 on the surface of acute myeloid leukaemia (AML) blasts and, after internalisation, releases a cytotoxic drug, calicheamicin. GO is approved by the US Food and Drug Administration for the treatment of CD33-positive AML at first relapse in patients 60 years and older who are not candidates for other cytotoxic therapy. GO as a single agent has low antileukaemic activity. When given to patients meeting the criteria noted above, it produces a complete response (CR) rate of only 12%, with another 12% achieving CR with inadequate platelet recovery (CRp). The median survival of patients treated with GO monotherapy is 11.2 months. GO therapy at 9 mg/m(2) is complicated with hepatic veno-occlusive disease in 5-10% of patients, particularly prior to or following stem cell transplantation. GO at lower doses combined with chemotherapy as induction or postremission therapy is promising, however, and phase III trials are ongoing. GO is probably most active in acute promyelocytic leukaemia (APL). It is used for induction regimens in high-risk APL and for the elimination of minimal residual APL. Case reports suggest that GO also has activity in CD33-positive acute lymphoblastic leukaemia. In conclusion, single agent GO can induce responses in patients with CD33-positive AML in first recurrence. The future of GO is its use in combination with other cytotoxic agents. Ongoing clinical trials may better define the role of GO combinations, particularly in untreated AML.

Application of Logical Planning Model for Public Transport Improvement Programs in the City of Addis Ababa

In countries where the development and improvement of public transport (PT) have many constraints, a Logical Planning Model that deals with a logical representation of a multi-dimensional process is essential. Addis Ababa, the capital of Ethiopia, is an area of low level of transit availability. The major modes of public transport in the city are buses and taxis and there is no rail transit within the city. Due to many factors, the existing bus service is of a low quality. Limited number of buses, the poor management and financial insecurity of the solitary government owned bus company and an inadequate cost recovery system are some of these factors. Taxis have many constraints in their operation including bad drivers' behaviour, excessive fare and high accident rate. Limited accessibility, lack of information systems, low frequency, the wider gap between demand and supply and inadequate infrastructure are identified as key problems of the overall public transport service. Therefore, this study has the objective of analyzing the existing situation and prospects of the public transport service and drawing strategic scenarios for future development and improvement. The Logical Planning Model is proposed to plan and evaluate improvement programs for public transportation in the city. Survey analysis, calculation of bus availability indices in each Traffic Analysis Zones (TAZ) and urban transport project documents are implemented for situational assessment and problem identification in order to use the Logical Planning Model.JEL classification: R41, R52

Adiponectin and stress hormone responses to maximal sculling after volume-extended training season in elite rowers

The purpose of this study was to investigate the resting and short-duration exercise-induced hormone responses of male rowers as a result of 6 months of volume-extended training season. Body composition, maximal aerobic capacity, and on-water 2000-m sculling performance were assessed before and after a 24-week training in elite rowers (n = 11; 193.1 ± 5.2 cm; 91.6 ± 5.8 kg; maximum oxygen consumption [V˙ o 2max], 6.2 ± 0.5 L · min −1). Six rowers were selected (SEL; 192.0 ± 6.3 cm; 93.5 ± 7.1 kg; V˙ o 2max, 6.4 ± 0.4 L · min −1) and 5 were not selected (N-SEL; 194.8 ± 4.1 cm; 89.6 ± 4.0 kg; V˙ o 2max, 6.0 ± 0.5 L · min −1) for the national team. Resting adiponectin did not change as a result of prolonged training. Adiponectin did not change after 2000-m rowing at baseline either. No responses were also observed 24 weeks later in SEL rowers, whereas a significant decrease ( P < .05) was observed in N-SEL rowers. At the same time, leptin also decreased after the first 30 minutes of recovery in N-SEL rowers. After the training period, immediate postexercise increases in growth hormone and testosterone were significantly higher in the whole group of rowers. No differences in cortisol responses were observed before and after the training period in SEL and N-SEL rowers. In conclusion, it appears that resting adiponectin does not change as a result of prolonged training. Training may modify adiponectin response to an short-duration exercise depending on the performance level of athletes. Decreased postexercise adiponectin and leptin values in rowers with lower performance capacity may be indicative of the inadequate recovery of these athletes.

Postoperative residual neuromuscular block: a survey of management

To avoid postoperative residual neuromuscular block there is a need for a change in clinician's attitude towards monitoring and reversal. This study aims to evaluate changes of perioperative neuromuscular block management during the last decade in our institution and to quantify the incidence of postoperative residual neuromuscular block. Patients receiving intermediate-acting neuromuscular blocking agents for scheduled surgical procedures during 3-month periods in 1995 (n=435), 2000 (n=130), 2002 (n=101), and in 2004 (n=218) were prospectively and successively enrolled in our study. The management of neuromuscular block in the operating room and the adequacy of the recovery were at the discretion of the anaesthesiologist. An attempt was made between each study period to promote a change in the management of neuromuscular block. In the post-anaesthesia care unit, train-of-four (TOF) stimulations were used to assess the presence of a residual neuromuscular block. Between 1995 and 2004 quantitative measurement and reversal of neuromuscular block in the operating room increased from 2 to 60% and from 6 to 42%, respectively (P<0.001). During the same time, the incidence of residual neuromuscular block defined as a TOF ratio less than 0.9 decreased from 62 to 3% (P<0.001). Use of objective neuromuscular monitoring and/or anticholinesterase drugs was less likely in patients with an inadequate recovery (P<0.001). During the last decade the incidence of residual neuromuscular block strongly decreased in our institution. It confirms the positive impact of neuromuscular monitoring and reversal of neuromuscular block in routine anaesthetic practice.

Oxidants, Antioxidants in Physical Exercise and Relation to Thyroid Function

Intensive muscular exercise promotes the production of reactive oxygen species (ROS) in the working muscles and can impair athletic performance, particularly in conjunction with inadequate recovery. Mammals are protected against oxygen toxicity by a system of ROS scavengers composed of enzymatic and non-enzymatic components. Although antioxidant supplementation has recently been considered as a means to diminish or prevent damage from ROS, the specific antioxidant requirements of athletes are not known. Since thyroid function is essential for athletic performance, thyroid control should be undertaken in cases where there is any sign of thyroid dysfunction "of unknown etiology". Hyperthyroidism and hypothyroidism have been associated with increased production of ROS as well as related inflammatory response and myopathy. There is evidence that antioxidant supplementation combined with antithyroid treatment with methimazole could be useful in decreasing the oxidative stress.

Recovery of parathyroid function after total thyroidectomy: Long‐term follow‐up study

To prevent postoperative hypoparathyroidism following total thyroidectomy, the parathyroid glands are preserved in situ and/or resected or devascularized parathyroid glands are autotransplanted. A retrospective investigation was conducted utilizing biochemical and specific endocrine assessments to evaluate the difference in recovery of parathyroid function in the long term. A total of 103 patients underwent total thyroidectomy at Second Department of Surgery, School of Medicine, Kagawa University between 1990 and 1998. These patients were divided into a preservation group (n = 17), with only preserved glands in situ; a combination group (n = 72), consisting of patients with one or more parathyroid glands preserved in situ and one or more autotransplanted parathyroid glands; and an autotransplantation group (n = 14), with only transplanted glands. The overall incidence of permanent hypoparathyroidism in the preservation group, the combination group, and the autotransplantation group was 0%, 1.4%, and 21.4%, respectively. The mean levels of intact parathyroid hormone in the preservation group, the combination group, and the autotransplantation group recovered to 102%, 107%, and 50% of the preoperative levels at 5-year follow up. The results of the present study suggest that parathyroid glands should be preserved in situ whenever possible, to promote better recovery of postoperative function, and that only autotransplantation produces inadequate recovery of long-term function.

Biocompatibility analysis of poly(glycerol sebacate) as a nerve guide material

No satisfactory method currently exists for bridging neural defects. Autografts lead to inadequate functional recovery, and most available artificial neural conduits possess unfavorable swelling and pro-inflammatory characteristics. This study examined the biocompatibility of a novel biodegradable elastomer, poly(glycerol sebacate) (PGS), for neural reconstruction applications, as the material possesses favorable mechanical property and degradation characteristics. The effect of PGS on Schwann cell metabolic activity, attachment, proliferation, and apoptosis were examined in vitro in comparison with poly(lactide- co-glycolide) (PLGA), a biomaterial widely utilized for tissue engineering applications. The in vivo tissue response to PGS was compared with PLGA implanted juxtaposed to the sciatic nerve; the physical changes in the implant material were measured during the degradation process. PGS had no deleterious effect on Schwann cell metabolic activity, attachment, or proliferation, and did not induce apoptosis; the in vitro effects of PGS were similar to or superior to that of PLGA. In vivo, PGS demonstrated a favorable tissue response profile compared with PLGA, with significantly less inflammation and fibrosis and without detectable swelling during degradation. PGS is an excellent candidate material for neural reconstruction applications given its lack of in vitro Schwann cell toxicity and minimal in vivo tissue response.

Extremity vascular trauma in civilian population: a seven-year review from North India

This is a retrospective study of the experience with extremity vascular trauma at a tertiary level referral centre in North India where the majority of the population lives in villages and the incidence of high-speed automobile accidents and civilian violence is low. The aim was to study the aetiology, pattern of injuries and the mortality and morbidity rates due to vascular trauma in our population. Data relating to 148 patients presenting with vascular trauma requiring surgical intervention other than amputation between January 1996 and December 2002 were collected retrospectively. There were 132 males and 16 females with a mean age of 39 years presenting to the casualty with a median delay of 9.3 h after injury. Blunt trauma accounted for 84% of the injuries with extremities involved in 88%. The brachial artery was the most common artery injured with the femoral next most common. Repair without graft interposition was done in 74% and autogenous vein grafts were used in 23% of cases. Comparison of our results with those that would have been obtained, had the recommendations of Mangled Extremity Severity Score (MESS) been followed, showed that this scoring system had low sensitivity and specificity for prediction of salvageability of limbs. Eight percent patients died due to associated visceral organ injuries. Complications occurred in 32% patients and amputation was required in 6% of patients after an initial surgical repair mainly due to inadequate functional recovery. Eighty-eight percent of the survivors with salvaged limbs were able to achieve full functional recovery. Judicious selection and appropriate intervention can result in satisfactory limb salvage with good functional outcomes even with delayed presentations.

Efficacy and feasibility of standard procarbazine, lomustine, and vincristine chemotherapy in anaplastic oligodendroglioma and oligoastrocytoma recurrent after radiotherapy. A Phase II study.

To the authors' knowledge, there is a scarcity of accurate data regarding the feasibility of standard chemotherapy with procarbazine, lomustine, and vincristine (PCV) in a homogeneous series of patients with primary anaplastic oligodendroglioma (AO) and oligoastrocytoma (AOA) that was recurrent after surgery and standard radiotherapy. The aim of the current study was to evaluate the overall response rate, toxicity, and time to progression (TTP) with the use of standard PCV in this setting. Between November 1994 and September 2000, 37 patients were enrolled in the current study. Of these, 23 had AO (62%) and 14 had AOA (38%). All patients received standard PCV comprised of lomustine (110 mg/m2) on Day 1, procarbazine (60 mg/m2) on Days 8-21, and vincristine (1.4 mg/m2, maximum total 2 mg) on Days 8 and 29. Cycles were repeated every 6 weeks. There were 11 complete responses (CR; 29.7%) and 11 partial responses (PR; 29.7%) reported and 8 patients had stable disease (SD; 21.6%). The response rate was higher in patients with AO compared with patients with AOA (77.2% vs. 22.7%; P = 0. 02). The median TTP, which was 12.3 months overall, was 30.3 months in patients who achieved a CR, 19.1 months in patients who achieved a PR, and 6.1 months in patients with SD. The median TTP was 18.6 months in AO patients and 6.14 in AOA patients. There were no cases of severe toxicity reported although in 16 patients (43%) who were free of disease progression, PCV was discontinued because of toxicity or inadequate recovery after 2 weeks of delay. PCV chemotherapy was reported to achieved a high response rate and TTP but incurred a high risk of persistent toxicity.