MO Group Research Articles

Less invasive polyaxial locking plate fixation in periprosthetic and peri-implant fractures of the femur—A prospective study of 41 patients

BackgroundA great variety of methods for the stabilisation of periprosthetic fractures around total hip (THA) or total knee arthroplasty (TKA) have been described. We present the data of our experience in combining a polyaxial, anatomical locking plate with a standardised less invasive technique in the treatment of periprosthetic and peri-implant (femoral nail) femur fractures in this prospective study. Patients and methodsA consecutive series of 41 patients (33 women; age 79.8±11 years) with 41 fractures (n=17 periprosthetic THA, n=10 periprosthetic TKA, n=3 interprosthetic, n=11 perinail) was treated in a ‘mini-open’ (MO; direct reduction of the fracture and percutaneous plate fixation in two-part fractures; n=22) or a ‘minimally invasive’ (MI; indirect reduction and percutaneous fixation; n=19) technique. All patients were followed up for 12 months postoperatively. ResultsThe polyaxial locking mechanism allowed for the setting of a mean of 5.3 screws around an intramedullary implant. Supported by the less invasive strategy, mainly long plates (n=36; 88% were longer than 24cm) were applied without relevant soft-tissue complication. Five surgical revisions (12.1%) had to be performed. During the first postoperative stay, one seroma was evacuated and in two cases the plate broke due to failed biological healing 6 months after the MO technique. In one case, a revision prosthesis had to be implanted due to ligamentous instability, and in another case, soft-tissue balancing of the patella was performed. In the MO group, four of the five complications requiring surgical revision were seen. There was no infection. No statistical difference was seen between the MO and the MI groups for operating room (OR) time and perioperative need for transfusion. In patients with a poor state of health (n=8; immobile and Glasgow Coma Outcome Scale=3), no local complications were seen. All fractures in the peri-implant fracture group (n=11) healed uneventfully. ConclusionPeriprosthetic fracture fixation can be performed as part of a standardised less invasive strategy, but the MI technique should be the preferred treatment. The NCB® system allows for a stable plate fixation around an intramedullary implant. With the less invasive technique, long plates can be applied with low rates of soft-tissue complication and implant failure.

Effects of babassu nut oil on ischemia/reperfusion-induced leukocyte adhesion and macromolecular leakage in the microcirculation: Observation in the hamster cheek pouch

BackgroundThe babassu palm tree is native to Brazil and is most densely distributed in the Cocais region of the state of Maranhão, in northeastern Brazil. In addition to the industrial use of refined babassu oil, the milk, the unrefined oil and the nuts in natura are used by families from several communities of African descendants as one of the principal sources of food energy. The objective of this study was to evaluate the effects of babassu oil on microvascular permeability and leukocyte-endothelial interactions induced by ischemia/reperfusion using the hamster cheek pouch microcirculation as experimental model.MethodsTwice a day for 14 days, male hamsters received unrefined babassu oil (0.02 ml/dose [BO-2 group], 0.06 ml/dose [BO-6 group], 0.18 ml/dose [BO-18 group]) or mineral oil (0.18 ml/dose [MO group]). Observations were made in the cheek pouch and macromolecular permeability increase induced by ischemia/reperfusion (I/R) or topical application of histamine, as well as leukocyte-endothelial interaction after I/R were evaluated.ResultsThe mean value of I/R-induced microvascular leakage, determined during reperfusion, was significantly lower in the BO-6 and BO-18 groups than in the MO one (P < 0.001). In addition, histamine-induced increase of microvascular permeability was significantly less pronounced in BO groups compared to MO one. No significant differences among groups in terms of leukocyte adhesion, concentrations of tumor necrosis factor alpha, interleukin 1, and interleukin 6 were found.ConclusionsOur findings suggest that unrefined babassu oil reduced microvascular leakage and protected against histamine-induced effects in postcapillary venules and highlights that these almost unexploited nut and its oil might be secure sources of food energy.

Promoting farmer engagement and activity in the control of dairy cattle lameness

Many 'influencers' allied to the agricultural industry support farmers to implement management changes that affect animal welfare. Developing approaches to working with farmers that achieve both engagement and subsequently management changes is critical. As an example, the generation of action points and implementation of change to control dairy cattle lameness is reported and discussed here. Action plans were generated on farms receiving both lameness monitoring and intervention support (MS group; n=117) as part of a 3 year intervention project. At the start of year 1, MS farmers received action planning advice from a veterinary surgeon, and then at the start of years 2 and 3, farmers generated their own lameness control action plans with facilitator support. Engagement was achieved with 114 MS farmers who generated 692 action points in total. Two hundred and sixteen of these resulted from veterinary advice and 476 were generated by the farmers with facilitator support. In terms of activity, MS farms implemented a mean of 8.22 changes per farm as compared to 6.77 on farms which only received annual lameness monitoring (MO group; n=72). While these levels of change were similar, fewer changes implemented on the MS farms (8.5%) were judged 'likely to increase the risk of lameness' compared to the MO farms (16.5%). Farmers generated substantial numbers of lameness control action points for their own farms aided by a facilitator and, crucially, veterinary or facilitator involvement reduced changes that were likely to compromise lameness control.

Evaluating an intervention to reduce lameness in dairy cattle

Lameness in dairy cattle remains a significant welfare concern for the UK dairy industry. Farms were recruited into a 3-yr study evaluating novel intervention approaches designed to encourage farmers to implement husbandry changes targeted toward reducing lameness. All farms completing the study were visited at least annually and received either monitoring only (MO, n=72) or monitoring and additional support (MS, n=117) from the research team. The additional support included traditional technical advice on farm-specific solutions, facilitation techniques to encourage farmer participation, and application of social marketing principles to promote implementation of change. Lameness prevalence was lower in the MO (27.0±1.94 SEM) and MS (21.4±1.28) farms at the final visit compared with the same MO (38.9±2.06) and MS (33.3±1.76) farms on the initial visit. After accounting for initial lameness, intervention group status, and year of visit within a multilevel model, we observed an interaction between year and provision of support, with the reduction in lameness over time being greater in the MS group compared with the MO group. Farms in the MS group made a greater number of changes to their husbandry practices over the duration of the project (8.2±0.39) compared with those farms in the MO group (6.5±0.54). Because the lameness prevalence was lower in the MS group than the MO group at the start of the study, the contribution of the additional support was difficult to define. Lameness can be reduced on UK dairy farms although further work is needed to identify the optimum approaches.

In situ-Raman studies on thermally induced structural changes of porous MoO3 prepared in vapor phase under He and H2

The structural transformations induced by heating on MoO3 mesoporous samples grown in vapor-phase under helium and hydrogen were studied by in situ Raman spectroscopy. The samples were continuously irradiated by a He–Ne laser of 5.5 mW for 105 min and Raman spectra were dynamically acquired every 5 min, in order to evaluate the laser effects. The He-grown sample did not undergo structural transformations due to the laser irradiation while the H2-grown sample underwent changes after just 10 min of irradiation. On the other hand, each type of sample was heated in air from room temperature up to 450 °C using a heating rate of 5 °C min−1 and Raman spectra were recorded each 25 °C. The He-grown sample remained structural unchanged up to 250 °C revealing a high temperature state of its amorphous matrix whereas the H2-grown sample exhibited changes around 70 °C. These changes were attributed to the crystallization onset of its amorphous matrix to β-MoO3. However, this same transition was detected between 250 °C and 275 °C for the He-grown sample. A second transformation was detected in both samples in a temperature range more similar associated to the transition of the formed β-MoO3 phase to α-MoO3. After the heat treatment, the oxide of both samples was slightly reduced, as revealed by XPS analysis.The metastability at low temperatures of the amorphous phase of the H2-grown sample could be associated to release of hydrogen trapped inside the compound and to the break of weak bonds between Mo and OH groups. At high temperatures, above 225 °C, the rapid conversion to β-MoO3 of the amorphous matrix of the H2-grown sample occurred due to the dehydration of the sample.

Anti‐obesity Effect of microalgal oil Supplementation in C57BL/6N Mice Fed a High Fat Diet

This study investigated the antiobesity effects of microalgal oil in C57BL/6J mice with diet‐induced obesity (DIO). Sixty male C57BL/6N mice aged 4 weeks were divided into 6 groups; ND (normal diet control), HD (high fat diet control 60% fat kcal), BT (high fat diet &amp; beef tallow, 5g/kg), CO (high fat diet &amp; corn oil, 5g/kg), FO (high fat diet &amp; fish oil, 5g/kg), and MO (high fat diet &amp; microalgal oil, 5g/kg). Mice in the DIO group were fed a high fat diet to induce obesity. The experiment was carried out for 12 weeks including diet program. The FO and MO groups have significantly decreased body weight gain, epididymal fat pad weights and serum TG, TC levels compared to the HD group and BT group. These results were supported by real time PCR analysis for mRNA expression of genes (ACO, CPT‐I, PPAR‐γ, SREBP‐1, FAS, SCD‐1) related to lipid metabolism. These results indicate that microalgal polyunsaturated oil might have an antiobesity effect on high fat diet‐ induced obese mice. All in all, n‐3 PUFA‐rich oil from microalgae is as good as fish oil regarding chemoprevention in diet induced obesity mice (This work was supported from Korea research institute of Bioscience &amp; Biotechnology, open innovation project).

Kr and Xe ions implanted on the surfaces of Mo, Hf, Ta, W, Re, Au and platinum group elements

Kr and Xe ion bombardment experiments were conducted on Mo, Hf, Ta, W, Re, Au, and five platinum group elements. The implanted Kr and Xe ions were detected, and their concentrations were determined by X-ray photoelectron spectroscopy (XPS) using synchrotron radiation. In the case of 5d transition metals, the binding energies of Kr2p3/2, Xe3d3/2, and Xe3d5/2 in the target metals correlate with the number of d electrons of metals. Furthermore, the Xe concentration in the 5d transition metals correlates with atomic number, but there is no such correlation for Kr. The observed trend for the Xe concentration can approximately be reproduced by a theoretical calculation that takes sputtering yield into consideration. The retentivities of Kr and Xe are defined as the ratio of the experimental and theoretical surface concentrations. Although there is no correlation between retentivity and the atomic number of the target metal, the elastic energies in the cases of Kr and Xe atoms implanted in metals positively correlate with the corresponding retentivities. If the activation energy of noble-gas diffusion in the target metals can be represented in terms of the elastic energy, the noble-gas retentivity can be qualitatively explained.

Metabolism of cyclic GMP in non-alcoholic fatty liver disease in morbid obesity

Methods Patients: MO group: 48 patients (40 women and 8 men) diagnosed of MO with an age of 46.9± 7.9. Control group: 19 subjects without overweight and with normal analytical data and normal ultrasound scan of the liver. The following parameters were measured: A.Clinical data: Age, sex, weight, height, abdominal and hip perimeters, Body Mass Index (BMI), clinical history and pharmacological treatment, Metabolic Syndrome, morfometry and haematic chemistry, Insulin Resistance (HOMA) and viral markers. B Immunomodulators: (Leptin, Adiponectin, CK18Asp396 (CK18), Interleukin-6 (IL-6), aldosterone and rennin). C Histological analysis was performed after obtaining hepatic tissue during surgery for MO. The NAFLD Score was calculated: Steatosis Degree, Fibrosis, Inflammation, hepatocyte lesions and other injuries).

Growth patterns preceding mortality in the first 6 months of life among breastfed infants born to HIV infected women in Malawi

Poor infant nutritional status is a notable underlying cause of mortality. We examined growth patterns preceding death in 34 exclusively breastfed infants born to HIV infected women in the Breastfeeding, Antiretroviral and Nutrition study in Lilongwe, Malawi. Women were randomized to receive either a lipid‐based nutrient supplement during lactation or no supplement. These groups were further randomized to maternal antiretroviral (ARV) drugs, infant nevirapine or no postnatal ARVs. Infants were grouped by age at death (0&lt; 1 mo, n=12; 1&lt; 3 mo, n=11; and 3&lt; 6 mo, n=11). These groups were compared to surviving infants using multinomial logistic regression. Low birth weight (LBW &lt; 2.5 kg) strongly predicted early death (OR 10.27, 95% CI 3.27–32.27 in those 0–1 mo; OR 4.01, 95% CI 1.05–15.30) but not in the 3 &lt; 6 mo group. Measures at regular follow‐up visits showed that lower mean weight, length, and BMI Z‐scores (based on WHO growth standards) more strongly predicted early death than they predicted death during 3&lt; 6 mos. Declining anthropometric Z‐scores were evident in the weeks prior to death. Of the 34 infants who died, 8 were HIV infected and 5 of these 8 deaths occurred in 3&lt; 6 mo. The analysis provides further evidence of the need to prevent LBW and optimize early growth in infants born in developing countries.Supported by the Centers for Disease Control (U48‐DP000059‐01) and by the Bill and Melinda Gates Foundation (OPP53107).Grant Funding Source: Centers for Disease Control (U48‐DP000059‐01) and by the Bill and Melinda Gates Foundation (OPP53107)

PROTEINOGRAMA SÉRICO DE CORDEIROS MESTIÇOS (SANTA INÊS X DORPER) DO NASCIMENTO ATÉ O DESMAME: EFEITO DO DESENVOLVIMENTO ETÁRIO E DO MONITORAMENTO DA INGESTÃO DO COLOSTRO

The failure of passive immunity transfer, which has been a major obstacle in the sheep industry, is an important cause of neonatal diseases and mortality. In search of an effective management measure to solve this problem, the effects of the age and the monitoring of colostrum administration on the dynamics of the serum proteins were evaluated. Forty-four lambs were used and divided into two groups: monitored colostrums intake (MO), with 8 animals, and non-monitored colostrums intake (NM), with 36 animals, along with clinical evaluation, hemogram and total serum protein assessment and its electrophoretic fractioning, 24-72h after birth, at 7, 15, 30, 60 and 90 days of age. The MO group was followed in two additional times: before and six hours after colostrum intake. Total protein and gammaglobulin (g/dL) in the MO group presented the minimum values right after birth (3.62 ± 0.70 and 0.32 ± 0.12) and the maximum 24-72 hours after birth (7.98 ± 1.95 and 3.39 ± 1.13). Such concentrations also showed the same behavior in the NM group, with lower values (5.57 ± 1.45 and 1.80 ± 0.95), and with significant difference (p ≤ 0.05) between groups. Between 15 to 30 days, the values of these variables decreased in both groups, and increased up to 90 days. In all experimental moments, the MO group showed higher values of gammaglobulin than NM group. The conclusions of this paper are that most of protein fractions, mainly total protein and gammaglobulin, undergo changes with the age development, and that the monitoring of colostrum intake increased significantly the levels of gammaglobulin. KEYWORDS: Endogenous antibodies, failure of passive immunity transfer, immunoglobulins, neonatal period, serum proteins.

Abstract P1-12-07: Neo-Adjuvant Exemestane in Post Menopausal Estrogen and/or Progesterone Receptor Positive Breast Cancer: A Randomized Phase II Trial To Investigate Optimal Duration (4 Month Versus 6 Month) of Preoperative Endocrine Therapy (PTEX46 Trial)

Abstract Background: Since the 1990s, primary endocrine therapy has been considered the gold standard in the adjuvant and metastatic treatment settings for estrogen and/or progesterone receptor (ER and/or PgR) positive breast cancer. This therapy has also been shown to be effective as neo-adjuvant endocrine therapy in these indications. In recent years, the focus of clinical interest has shifted to the third-generation aromatase inhibitors from tamoxifen. The optimal treatment duration time and causal relationship between neo-adjuvant endocrine therapy and survival, however, are not clear. We therefore conducted the present study to investigate the potential benefits of neo-adjuvant exemestane (E) therapy with the goal of identifying the optimal treatment duration (4 months versus 6 months). Methods: Conducted at three hospitals in Japan, this study was a multicenter, randomized phase II trial of pre-operative E treatment in postmenopausal women with untreated primary breast cancer. Fifty postmenopausal women with ER positive and/or PgR positive invasive breast cancer were randomly assigned to E (25 mg/day) for 4 months (4 mo) or E (25 mg/day) for 6 months (6 mo). All patient data were collected by UMIN and were analyzed by the National Cancer Center in Japan. Tumor regression (by clinical examination, ultrasound, and MRI), pathological response, shift towards breast-conserving surgery, and safety assessments were the main outcome measures. Results: Of the 50 patients that enrolled, 28 patients had undergone surgery. The mean ages in the 4 mo and 6 mo treatment groups were 66.7 years and 66.8 years, respectively. No significant differences in the patient characteristics were found in the two groups. The response rates (partial or complete responses) by clinical examination in the 4 mo and 6 mo groups were 37.5% and 50%, respectively. Pathological responses (minimal response or better) were found in 13.3% and 41.7% of patients and a partial mastectomy was performed in 50.0% and 58.3% of patients after 4 mo and 6 mo, respectively. Conclusion: To date, the results of this study demonstrate that treatment with E for 6 mo was more efficacious than treatment with E for 4 mo. Further work is in progress to obtain data from additional patients and to identify the optimal duration of neo-adjuvant E. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P1-12-07.

Abstract B91: Predictors of worsened survival among medically underserved hepatocellular carcinoma patients

Abstract Introduction: We reported that hepatocellular carcinoma (HCC) patients in the Harris County Hospital District (HCHD) have an overall survival (OS) of 3.4 months. This is the third largest public hospital district in the U.S. and a high percentage of HCC patients appear to survive less than 1 month (OS&amp;lt;1 mo). We sought to explore possible factors associated with this observed disparity in OS. Methods: An IRB-approved review of the HCHD Tumor Registry was conducted. Insurance and payor status, race, treatment, clinicopathologic parameters were recorded, including liver function tests, alpha-fetoprotein (AFP), international normalized ratio (INR), Child-Pugh score and model for end-stage liver disease (MELD) score. Outcomes were compared using Kaplan-Meier survival analysis and log-rank tests. Chi-square, Student's t-test, univariate, multivariate logistic regression and Cox proportional hazards model statistical tests were also used (p&amp;lt;0.05). Results: A total of 337 HCC patients (N= 272 men and N= 65 female) from 1998-2010 were identified. Only 4% of patients had medicare; whereas 96% relied upon county funding. OS&amp;lt;1mo was noted in 90 patients (26.7%). There were no racial or gender differences between those with an OS&amp;lt;1mo and OS&amp;gt;1 mo. In the OS&amp;lt;1mo group, 22% were Stage I-II, 39% were stage III and 39% were stage IV. In contrast in the OS&amp;gt;1 mo cohort, 38% were Stage I-II, 33% Stage III and 28% were stage IV. Only 6% (N=5) of OS&amp;lt;1mo patients received therapy for HCC, whereas 27% (N=91) patients in the OS&amp;gt;1 mo group received therapy (p=0.00). Both individual laboratory parameters associated with advanced liver disease (elevated bilirubin and decreased albumin) and composite score (Child-Pugh and MELD) were predictive of OS&amp;lt;1 mo. In addition, elevated AFP, elevated creatinine, stage, and lack of treatment were independent predictors of OS&amp;lt;1 mo. A Cox proportional hazards model demonstrated gender, AFP, bilirubin, INR, presence of ascites and stage were predictive of median survival. Conclusions: Median stage-adjusted survival of medically underserved HCC patients seen in a large urban hospital remains lower than the national average. Although advanced stage and advanced liver disease likely preclude treatment in many patients, there are still a large proportion of patients who receive no treatment. Additional studies are necessary to determine the reasons for lack of treatment and survival disparities in this patient population such as lack of early detection, non-referral to surgeons by primary care physicians, lack of availability of advanced treatments such as transplantation, or a combination of these factors. Furthermore, accurate prediction of those patients unlikely to survive beyond one month may prevent futile use of limited resources. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B91.

Increased Apoptotic Lymphocyte Population in the Spleen of Young Chickens Fed on Diets High in Molybdenum

The experiment was conducted with the objective of examining the effects of high molybdenum (Mo) on the apoptosis of splenic lymphocytes in broilers by the methods of experimental pathology and flow cytometry (FCM). Three hundred 1-day-old avian broilers were divided into four groups of 75 each and were fed on control diet (Mo 13 mg/kg) and high Mo diets (Mo 500 mg/kg, high Mo group I; Mo 1,000 mg/kg, high Mo group II; and Mo 1,500 mg/kg, high Mo group III) for 42 days. The results showed that the relative weight of spleen was decreased, and lymphocytes were histopathologically decreased in high Mo groups II and III. Ultrastructurally, the apoptotic cells showed typical condensed nuclei with dark-round, petal-like, and horseshoe-like shapes. The mitochondria were swelled, and the endoplasmic reticulum and the Golgi apparatus were dilated in high Mo groups II and III. The statistical analyses by FCM indicated that the percentage of cellular apoptosis was higher in high Mo groups II and III than in control group. Also, the TUNEL staining was consistent with the results of FCM. It was concluded that dietary molybdenum in 1,000 and 1,500 mg/kg caused splenic lesions and lymphocyte apoptosis, which could inhibit the development of spleen and could impair immune function in broilers.

Low-Dose Ketamine via Intravenous Patient-Controlled Analgesia Device after Various Transthoracic Procedures Improves Analgesia and Patient and Family Satisfaction

Ketamine was recently shown to attenuate postoperative pain when used in combination with morphine in patients who had undergone general and orthopedic surgery. We assessed its effects in 46 patients undergoing minimally invasive direct coronary artery bypass, off-pump coronary artery bypass, or thoracotomy and correlated them with patient and family satisfaction. Patient-controlled analgesia (PCA) was available for 72 hours. One group received 2mg/bolus morphine randomly and double-blindly (group MO), and another group received 1mg morphine plus 5mg ketamine/bolus (group MK), both using IV-PCA. The patients' pain and satisfaction rates were assessed three times daily during hospitalization using a visual analog scale. Their families' satisfaction was assessed as well. Although the 3-day mean amount of morphine used by the MK patients was approximately 60% of that used by the MO patients, their levels of pain and satisfaction were better than those of the MO group. There was an inverted and statistically significant correlation between the patients' level of satisfaction on the second postoperative day (POD) and the satisfaction of their families on POD 2, 3, and 7 and the POD 3 patients' pain assessment in the MK group but not in the MO group. There were no differences in hemodynamic, respiratory, side effects, or complication rates between the groups. The conclusion is that the effects of adding a small ketamine dose to half of the standard morphine dose via IV-PCA after thoracotomy was superior to the standard morphine dose in terms of the patients' self–reported pain score and satisfaction, as well as the family satisfaction rate.

Adesão à terapia em motricidade orofacial no ambulatório de Fonoaudiologia do Hospital das Clínicas da Universidade Federal de Minas Gerais

OBJETIVO: Caracterizar o atendimento em motricidade orofacial no Ambulatório de Fonoaudiologia do Hospital das Clínicas da Universidade Federal de Minas Gerais quanto à adesão e sucesso da terapia, bem como comparar dados dos pacientes que buscaram atendimento ativamente no Ambulatório de Fonoaudiologia e dos pacientes encaminhados pelo Ambulatório do Respirador Oral da mesma instituição. MÉTODOS: Foram investigados 90 prontuários de todos os pacientes em alta ou desligados, que buscaram tratamento pelos Ambulatórios de Fonoaudiologia (Grupo MO) e do Respirador Oral (Grupo RO). Os resultados foram analisados empregando-se os testes Mann-Whitney e Qui-quadrado (5%). RESULTADOS: Pelo cálculo da mediana, a duração da terapia foi equivalente a 6,0 meses, o número total de sessões foi igual a 17, o de atendimentos realizados 12 e o de faltas 4,5. Apenas 41,2% dos pacientes realizava os procedimentos indicados pelo terapeuta. A conclusão do processo terapêutico foi majoritariamente o desligamento (73,3%), sendo a maior causa o excesso de faltas (24,4%). Os grupos diferiram quanto aos motivos de desligamento, havendo predomínio de faltas no grupo RO (p&lt;0,01) e espera por outros profissionais no Grupo MO (p&lt;0,01). Ocorreram associações significantes entre faltas e desligamentos (p&lt;0,01) e adesão e desligamentos (p&lt;0,01) no Grupo RO. CONCLUSÕES: As características pesquisadas foram predominantemente semelhantes nos grupos. Apesar de muitos pacientes seguirem as orientações total ou parcialmente, a adesão ficou prejudicada pelo excesso de faltas. Assim, o sucesso da terapia não foi alcançado na maioria dos casos.

Efficacy of continuous positive airway pressure on arrhythmias in obstructive sleep apnea patients

The purpose of this study was to determine the relationship between obstructive sleep apnea (OSA) and cardiovascular disorders in a large Japanese population, and to assess the efficacy of continuous positive airway pressure (CPAP) in the treatment of OSA-associated arrhythmias. The study population comprised 1394 Japanese subjects (1086 men and 308 women) who were divided into four groups on the basis of polysomnography (PSG) analysis as follows: the no sleep apnea (N-SA) group (n = 44, apnea-hypopnea index [AHI] < 5), the mild OSA (Mi-OSA) group (n = 197, 5 < AHI < 15), the moderate OSA (Mo) group (n = 368, 15 < AHI < 30), and severe OSA (SOSA) group (n = 785, AHI < 30). The following baseline characteristics were significantly associated with OSA: age (P < 0.001), gender (P < 0.001), body mass index (P < 0.001), hypertension (P < 0.001), diabetes (P = 0.009), and hyperlipidemia (P = 0.013). In the OSA group, PSG revealed the predominance of paroxysmal atrial fibrillation (PAF) (P = 0.051), premature atrial complex short run (P < 0.005), premature ventricular complex (PVC, P = 0.004), sinus bradycardia (P = 0.036), and sinus pause (arrest >2 s, P < 0.001) during the PSG recording. A total of 316 patients from the group underwent CPAP titration and were then re-evaluated. Continuous positive airway pressure therapy significantly reduced the occurrences of PAF (P < 0.001), PVC (P = 0.016), sinus bradycardia (P = 0.001), and sinus pause (P = 0.004). The results of this study demonstrate a significant relationship between OSA and several cardiac disorders, and also demonstrate the efficacy of CPAP in preventing OSA-associated arrhythmias in a large population of Japanese patients.

Photochemical Reaction of Mo(CO)6 with Et2GeH2: NMR and DFT Studies of Reaction Products; Crystal Structure of a Novel Complex [{Mo(μ-η2-H−GeEt2)(CO)4}2

The photochemical reaction of Mo(CO)6 with the diethylgermane Et2GeH2 leads to the formation of several new complexes, which were detected by IR and 1H and 13C NMR spectroscopy. From the mixture of compounds, a binuclear complex, [{Mo(μ-η2-H−GeEt2)(CO)4}2], was isolated in crystalline form, and its molecular structure was established by single-crystal X-ray diffraction studies. The agostic hydride ligand of the Mo(μ-η2-H−GeEt2) group was located in the structure at a chemically reasonable position between the Mo and Ge atoms of the Mo−Ge bond of the bridging germyl ligand, and its presence was confirmed by 1H NMR spectroscopy due to a proton resonance at δ = −7.86. Two dihydride complexes were identified by 1H and 13C NMR spectroscopy, due to their differing thermal behavior. A DFT study of the structural properties of possible reaction products was performed.

Molybdenum Exposure and Semen Quality: How Robust Is the Evidence of an Effect?

Meeker et al. (2008) reported on associations between blood levels of nine different metals and four aspects of semen quality found in 219 volunteers attending two infertility clinics. Based on the title of their article, it seems that the authors claimed to have found evidence that molybdenum is a male reproductive toxicant. But how robust is the evidence? Meeker et al. (2008) had no primary prior hypotheses, and their study was essentially a “fishing expedition” involving many statistical tests of many possible associations. The authors (Meeker et al. 2008) did note that “some [findings] may be chance findings because of the number of comparisons that were made.” A much stronger statement is appropriate, namely, that it is very likely that some of the findings were chance findings. The overwhelming majority of study subjects (70%) had blood Mo levels below the study limit of detection of 1 μg/L. If a more sensitive assay method had been used [e.g., the method of Case et al. (2001) with a detection limit of 0.06 μg/L], then a better grouping of subjects could have been used in the data analyses. We also believe the authors made an inappropriate analytical decision. In Table 3 of their article, Meeker et al. (2008) summarized analyses in which dose-dependent associations for each metal were considered in turn while adjusting for age and current smoking. The analysis of associations between Mo concentrations and semen motility were based on data from 147 subjects. The assumption appears to be that 72 (219 – 147) subjects had no useful information to provide on the Mo/sperm motility issue. It would have been more scientifically rigorous to allow the analysis of each semen parameter to make use of data from all study subjects, and not just for the sake of completeness. The current approach has introduced bias into the analysis, because different standards are applied to cases [subjects with the adverse health outcome of interest (e.g. poor sperm concentration)] and controls or referents (subjects without the adverse health outcome). To be concrete, in the analyses of sperm concentrations, cases were allowed to have poor sperm motility, whereas controls were not. The effect of this, in practice, is to load the controls with subjects on high incomes who have never smoked. A more standard analysis involving all study subjects in the analysis of each aspect of sperm quality should have been carried out. Such an analysis would likely have provided very different results to the subset analyses they reported. In commenting on the linear regression analyses shown in their Table 4, Meeker et al. (2008) stated that the Mo groups “were associated with suggestive decreasing trends in sperm concentration and morphology.” However, examination of the table shows that neither of the regression coefficients was significantly different from zero (i.e., the blood Mo level had no significant influence on any of the semen quality parameters). Additional studies would be needed to investigate possible effects in semen quality based on much larger population samples containing a wider range of blood Mo levels.

Morphine With Adjuvant Ketamine vs Higher Dose of Morphine Alone for Immediate Postthoracotomy Analgesia

Thoracotomy is associated with severe pain. We hypothesized that the concomitant use of a subanesthetic dose of ketamine plus a two-third-standard morphine dose might provide more effective analgesia with fewer side effects than a standard morphine dose for early pain control. We conducted a 6-month randomized, double-blind study in patients undergoing thoracotomy for minimally invasive direct coronary artery bypass or for lung tumor resection. After extubation, when objectively awake (>or= 5/10 visual analogue scale [VAS]) and complaining of pain (>or= 5/10 VAS), patients were connected to patient-controlled IV analgesia delivering 1.5 mg of morphine plus saline solution (MO) or 1.0 mg of morphine plus a 5-mg ketamine bolus (MK), with a 7-min lockout time. Rescue IM diclofenac, 75 mg, was available. Follow-up lasted 4 h. Forty-one patients completed the study. MO patients (n = 20) used 6.8 +/- 1.9 mg/h (mean +/- SD) and 5.5 +/- 3.6 mg/h of morphine during the first and second hours, respectively; MK patients (n = 21) used 3.7 +/- 1.2 mg/h and 2.8 +/- 2.3 mg/h, respectively (p < 0.01). The 4-h activation rate of the device was double in the MO patients than in the MK patients (66 +/- 54 vs 28 +/- 20, p < 0.001). The maximal self-rated pain score was 5.6 +/- 1.0 for the MO group vs 3.7 +/- 0.7 for the MK group (p < 0.01). Four MO patients vs one MK patient required diclofenac; 6 MO patients but no MK patients had oxygen saturation by pulse oximetry < 94% on a fraction of inspired oxygen of 0.4 (p < 0.01); two MO patients required reintubation. Paco(2) was higher in the MO group (40 +/- 6 mm Hg vs 33 +/- 5 mm Hg, p < 0.05). Heart rate, BP, and incidence of nausea/vomiting were similar; no ketamine-related hallucinations were detected. Subanesthetic ketamine combined with a 35%-lower morphine dose provided equivalent pain control compared to the standard morphine dose alone, with fewer adverse side effects and a 45% reduction in morphine consumption. ClinicalTrials.gov Identifier: NCT00625911.

Perioperative and short-term advantages of mini-open approach for lumbar spinal fusion

It has been widely reported a vascular and neurologic damage of the lumbar muscles produced in the classic posterior approach for lumbar spinal fusions. The purpose of this study is to demonstrate a better clinical and functional outcome in the postoperative and short term in patients undergoing minimal invasive surgery ("mini-open") for this lumbar spinal arthrodesis. We designed a prospective study with a 30 individuals cohort randomized in two groups, depending on the approach performed to get a instrumented lumbar circumferential arthrodesis: "classic posterior" (CL group) or "mini-open" approach (MO group). Several clinical and functional parameters were assessed, including blood loss, postoperative pain, analgesic requirements and daily life activities during hospital stay and at the 3-month follow-up. Patients of the "mini-open approach" group had a significant lower blood loss and hospital stay during admission. They also had significant lower analgesic requirements and faster recovery of daily life activities (specially moderate efforts) when compared to the patients of the "classic posterior approach" group. No significant differences were found between two groups in surgery timing, X-rays exposure or sciatic postoperative pain. This study, inline with previous investigations, reinforces the concept of minimizing the muscular lumbar damage with a mini-open approach for a faster and better recovery of patients' disability in the short term. Further investigations are necessary to confirm these findings in the long term, and to verify the achievement of a stable lumbar spinal fusion.