Non-bridging Groups Research Articles

Impact of perioperative low-molecular-weight heparin therapy on clinical events of elderly patients with prior coronary stents implanted > 12 months undergoing non-cardiac surgery: a randomized, placebo-controlled trial

BackgroundLittle is known about the safety and efficacy of discontinuing antiplatelet therapy via LMWH bridging therapy in elderly patients with coronary stents implanted for > 12 months undergoing non-cardiac surgery. This randomized trial was designed to compare the clinical benefits and risks of antiplatelet drug discontinuation via LMWH bridging therapy.MethodsPatients were randomized 1:1 to receive subcutaneous injections of either dalteparin sodium or placebo. The primary efficacy endpoint was cardiac or cerebrovascular events. The primary safety endpoint was major bleeding.ResultsAmong 2476 randomized patients, the variables (sex, age, body mass index, comorbidities, medications, and procedural characteristics) and percutaneous coronary intervention information were not significantly different between the bridging and non-bridging groups. During the follow-up period, the rate of the combined endpoint in the bridging group was significantly lower than in the non-bridging group (5.79% vs. 8.42%, p = 0.012). The incidence of myocardial injury in the bridging group was significantly lower than in the non-bridging group (3.14% vs. 5.19%, p = 0.011). Deep vein thrombosis occurred more frequently in the non-bridging group (1.21% vs. 0.4%, p = 0.024), and there was a trend toward a higher rate of pulmonary embolism (0.32% vs. 0.08%, p = 0.177). There was no significant difference between the groups in the rates of acute myocardial infarction (0.81% vs. 1.38%), cardiac death (0.24% vs. 0.41%), stroke (0.16% vs. 0.24%), or major bleeding (1.22% vs. 1.45%). Multivariable analysis showed that LMWH bridging, creatinine clearance < 30 mL/min, preoperative hemoglobin < 10 g/dL, and diabetes mellitus were independent predictors of ischemic events. LMWH bridging and a preoperative platelet count of < 70 × 109/L were independent predictors of minor bleeding events.ConclusionsThis study showed the safety and efficacy of perioperative LMWH bridging therapy in elderly patients with coronary stents implanted > 12 months undergoing non-cardiac surgery. An alternative approach might be the use of bridging therapy with half-dose LMWH.Trial registrationISRCTN65203415.

Risk factors for vertebral bridging in residual adolescent idiopathic scoliosis with thoracolumbar/lumbar curves

BackgroundAlthough vertebral bridging in residual adolescent idiopathic scoliosis (AIS) can make corrective surgery more complicated, no study has investigated the risk factors. The purpose of this research was to determine risk factors for vertebral bridging in individuals with residual AIS with thoracolumbar/lumbar (TL/L) curves. MethodsForty-two pre-operative patients with residual AIS and TL/L curves (3 males, 39 females: age 41.9 ± 18.0 years) were divided into bridging (n = 17) and non-bridging (n = 25) groups. All patients were 20 years or older with a diagnosis of AIS in adolescence. The bridging group consisted of patients with third or more degree bridging by the Nathan classification. ResultsThere were significant differences in age, absolute value of apical vertebral translation (AVT), C7 translation, and L3,4 tilt between groups. There was no significant difference in TL/L Cobb angle. Multivariate analyses and ROC curves demonstrated that older age was a significant risk factor for vertebral bridging (odds ratio [OR]: 1.08; 95% confidence interval: 1.02–1.14; P = 0.004), with a cutoff value of 38.0 years old. ConclusionsThis study indicates that patients >38 years old are at risk for vertebral bridging in residual AIS. Because of the higher risk of vertebral bridging and other degenerative changes, residual AIS patients about 40 years of age are at a critical point for treatment strategy. Because appropriate surgical time should not be missed, regular follow-up is required even after 30 years of age, especially if the patient with residual AIS has a large TL/L curve indicated for surgery.

Relevance of Non-Bridging Therapy with Heparin during Temporary Interruption of Direct Oral Anticoagulants in Patients with Cancer-Associated Venous Thromboembolism.

Objectives: To evaluate the relevance of non-bridging therapy with unfractionated heparin during the temporary, pre-procedural interruption of direct oral anticoagulants (DOACs) in patients with cancer-associated venous thromboembolism (VTE).Materials and Methods: This retrospective study included 142 patients with cancer and VTE who required temporary interruption of DOACs before invasive procedures. Data, including rates of VTE recurrence, non-major bleeding, and major bleeding, were compared between patients who received or not received alternative therapy with unfractionated heparin during interruption.Results: Sixty-eight patients were prescribed heparin, while 74 were not. There were no differences in age, body mass index, white blood cell count, hemoglobin level, or platelet count between the groups. VTE recurrence was observed in four (6%) and one (1%) patient in the heparin bridging and non-bridging groups, respectively (risk ratio [RR]: 4.4, 95% confidence interval [CI]: 0.50–38.0, p=0.19). Non-major bleeding occurred in three (4%) and two (3%) patients in the bridging and non-bridging groups (RR: 1.6, 95%CI: 0.28–9.48, p=0.67), while major bleeding occurred in 0 (0%) and three patients (4%) (p=0.25), respectively.Conclusion: Our findings confirm the relevance of non-bridging therapy with unfractionated heparin for reducing VTE risk during DOAC interruption in patients with cancer.

Cement bridging phenomenon in percutaneous vertebroplasty for adjacent vertebral compression fracture

In some cases of vertebroplasty for adjacent fractures, we observed a cement bridging phenomenon, in which the injected cement flowed from the newly fractured vertebra to the previously cement-augmented vertebra through the space between the abutting anterior longitudinal ligament and the vertebral column. The purpose of this retrospective study was to investigate this phenomenon. From January 2012 to December 2014, patients who sustained new-onset adjacent vertebral compression fracture and who were again treated with vertebroplasty were enrolled. We divided the patients into two groups, the bridging group and the nonbridging group, to analyze the difference between them. Results showed that the cement bridging phenomenon occurred in 18 (22.8%) of the 79 patients. Significant differences between the bridging and nonbridging groups were identified in the following 3 imaging features: severe loss of the anterior vertebral body height at the new-onset adjacent vertebra on plain film (odds ratio [OR] = 4.46, p = 0.014), fluid accumulation (OR = 36.27, p < 0.001) and hypointense signaling (OR = 15.67, p < 0.001) around the space anterior to the abutting vertebral bodies and the corresponding intervertebral disc on MRI. After a 2-year follow-up, both the mean value of the focal kyphotic angle and anterior body height ratio were significantly better in the cement bridging group than in the nonbridging group. The cement bridging phenomenon, which has never been reported in the literature, is not rare in clinical practice. This phenomenon was associated with better maintenance of focal kyphotic angle and anterior body height ratio during the 2-year follow-up.

Electrochemistry of icosahedral cobalt bis(dicarbollide) ions and their carbon and boron substituted derivatives in aqueous phosphate buffers

Herein we present investigations of electrochemical behavior over a series of selected bisicosahedral cobalt bis(heteroborane)(1-) derivatives in aqueous phosphate buffers. This pilot study is focused on distinct effects connected with either exo-skeletal substitutions at boron atoms with bridging and non-bridging groups or by influence of endo-hedral replacement of four cage CH groups present in the parent cobalt bis(dicarbollide) ion by two isolobal sulfur groups. The substitutions can thus be utilized for an easy tuning of the electrochemical properties of these boron polyhedral ions and for optimizing their responses in two quite broad electrochemical windows. The former is found in the negative potential corresponding to the redox process on the central metal atom; the latter, which was not considered in the literature, is located in the positive potential region and is connected with core cage oxidation process. Such properties seem to provide promising potential for electroanalytical sensing of this family of heterometallaboranes in tissues and their use for electrolabelling of biopolymers.

Spatially selective Au nanoparticle growth in laser-quality glass controlled by UV-induced phosphate-chain cross-linkage

Herein we describe how UV excitation of localized electronic states in phosphate glasses can activate structural rearrangements that influence the kinetics of Au nanoparticle (NP) thermal growth in Au-doped glass. The results suggest a novel strategy to address the problem of controlling nano-assembly processes of metal NP patterns in fully inorganic and chemically stable hard materials, such as laser-quality glasses. We show that the mechanism is promoted by opening and subsequent cross-linkage of phosphate chains under UV excitation of non-bridging groups in the amorphous network of the glass, with a consequent modification of Au diffusion and metal NP growth. Importantly, the micro-Raman mapping of the UV-induced modifications demonstrates that the process is restricted within the beam waist region of the focused UV laser beam. This fact is consistent with the need for more than one excitation event, close in time and in space, in order to promote structural cross-linkage and Au diffusion confinement. The stability of the photo-induced modifications makes it possible to design new metal patterning approaches for the fabrication of three-dimensional metal structures in laser-quality materials for high-power nonlinear applications.

Periprocedural Heparin Bridging in Patients Receiving Vitamin K Antagonists

Background— Periprocedural bridging with unfractionated heparin or low-molecular-weight heparin aims to reduce the risk of thromboembolic events in patients receiving long-term vitamin K antagonists. Optimal periprocedural anticoagulation has not been established. Methods and Results— MEDLINE, EMBASE, and Cochrane databases (2001–2010) were searched for English-language studies including patients receiving heparin bridging during interruption of vitamin K antagonists for elective procedures. Data were independently collected by 2 investigators (κ=0.90). The final review included 34 studies with 1 randomized trial. Thromboembolic events occurred in 73 of 7118 bridged patients (pooled incidence, 0.9%; 95% confidence interval [CI], 0.0.0–3.4) and 32 of 5160 nonbridged patients (pooled incidence, 0.6%; 95% CI, 0.0–1.2). There was no difference in the risk of thromboembolic events in 8 studies comparing bridged and nonbridged groups (odds ratio, 0.80; 95% CI, 0.42–1.54). Bridging was associated with an increased risk of overall bleeding in 13 studies (odds ratio, 5.40; 95% CI, 3.00–9.74) and major bleeding in 5 studies (odds ratio, 3.60; 95% CI, 1.52–8.50) comparing bridged and nonbridged patients. There was no difference in thromboembolic events (odds ratio, 0.30; 95% CI, 0.04–2.09) but an increased risk of overall bleeding (odds ratio, 2.28; 95% CI, 1.27–4.08) with full versus prophylactic/intermediate-dose low-molecular-weight heparin bridging. Low-thromboembolic-risk and/or non–vitamin K antagonist patient groups were used for comparison. Study quality was poor with heterogeneity for some analyses. Conclusions— Vitamin K antagonist–treated patients receiving periprocedural heparin bridging appear to be at increased risk of overall and major bleeding and at similar risk of thromboembolic events compared to nonbridged patients. Randomized trials are needed to define the role of periprocedural heparin bridging.

Bridging Evidence-Based Practice and Practice-Based Evidence in Periprocedural Anticoagulation

More than 2 million people are currently treated with oral anticoagulation in North America alone.1 Indeed, chronically anticoagulated patients are expected to become more prevalent as the population ages and the incidence of conditions (for example, atrial fibrillation) requiring anticoagulation increases.2 Article see p 1630 Many of these patients may undergo an invasive or operative procedure at some point, and thus their periprocedural management will be a commonly encountered problem. The challenge in periprocedural management of anticoagulated patients focuses on the need to balance risk of thromboembolism (in case of anticoagulation interruption) against the risk of bleeding during the procedure (in case of anticoagulation continuation). Thus, a crucial first step in the management of such patients is estimation of periprocedural bleeding and thrombotic risk, and balancing both. In certain chronic conditions, such as AF, risk stratification scores assist decision making when risk of thrombosis and bleeding needs to be weighed.3–5 However, when an invasive procedure is involved, thrombosis and bleeding scores have been less well validated, and the optimal management of anticoagulated patients remains controversial. For many years, bridging therapy has been practiced when considering an interventional procedure, and anticoagulation was continued with parenteral heparins whenever the vitamin K antagonists (eg, warfarin) had to be interrupted (Figure).6–8 The rationale of a bridging strategy was to replace coumadins by a parenteral agent with short half-life and rapid onset of action that can be discontinued only a few hours before and commenced a few hours after the procedure.8 However, some argue that this empirical approach lacks robust evidence, and therefore this approach has been subject to some debate.9,10 When considering the balance between risk and benefit, supporters of bridging therapy allege low rates of bleeding complications as the reason …

Three-dimensional measurement of intervertebral range of motion in ossification of the posterior longitudinal ligament: are there mobile segments in the continuous type?

In this paper, the authors' goals were to determine the extent of the effect of continuous-type ossification of the posterior longitudinal ligament (OPLL) of the cervical spine on intervertebral range of motion (ROM) and to examine the relationship between the 3D morphology of OPLL and intervertebral ROM. The authors evaluated 5 intervertebral segments in each of 20 patients (11 men and 9 women) with continuous-type OPLL, for a total of 100 intervertebral segments, using functional CT in anteroposterior (AP) flexion and right and left axial rotation. Three-dimensional kinematics were evaluated using the voxel-based registration method. Ossification was classified on the basis of 3D kinematics and morphology. The authors found 49 ossifications that were obviously of the continuous type. They were divided into 2 types: 1) bridging (13 instances), with thick, continuous ossification of the anterior or posterior longitudinal ligament bridging intervertebral segments and with an ROM of 0.3° in AP flexion and 0.2° in rotation; and 2) nonbridging (36 instances), with a minute gap in the ossification itself or between the ossification and vertebra and with an ROM of 4.9° in AP flexion and 4.0° in rotation. There were 8 stalagmite-type ossifications in the nonbridging group that had the unique kinematics of restricted AP flexion and normal axial rotation. The authors' findings indicate that most continuous-type ossifications that are categorized using the conventional radiographic classification system have mobile segments. The discrimination between bridging and nonbridging on CT scans can be a useful predictive index for dynamic factors.

Synthesis, crystal structure, and magnetic properties of a phenoxo-bridged dinuclear nickel(II) complex

A new dinuclear nickel complex, [(H1.5L)2](ClO4) · 2CH3OH · H2O (1) (H3L = 1,3-bis(salicylamino)-2-propanol), was synthesized and characterized by single-crystal X-ray diffraction, IR spectra, elemental analysis, and magnetic measurements. In contrast to commonly observed alcoholic oxygen bridges in previously reported dinuclear complexes, single-crystal X-ray studies reveal that the H3L is highly distorted and links two NiII through the phenoxo oxygens of the ligands forming a [Ni2O2] core. The remarkable distortion of the ligand brings the two non-bridging phenol groups from different ligands close to share one hydrogen, keeping charge neutrality of the complex. Magnetic studies indicate that an overall antiferromagnetic interaction is operative between the metal centers.

Outcome in Children Bridged and Nonbridged to Cardiac Transplantation

BackgroundHeart transplantation (HTx) in children with end-stage heart disease has become an accepted treatment option. ObjectiveTo evaluate our results of pediatric cardiac transplantation with vs without bridge methods. Patients and MethodsThe study included 31 patients (34 transplantations) younger than 18 years who underwent orthotopic HTx between March 1995 and December 2008. Ten patients were girls, and 21 were boys. Preoperative diagnoses included cardiomyopathy (n = 20), congenital heart disease (n = 7), hypertrophic cardiomyopathy (n = 2), restrictive cardiomyopathy (n = 1), and ischemic cardiomyopathy (n = 1). Mean (SD) ischemia time was 185 (72) minutes. Thirty-day mortality was 6%, and was due to primary graft failure (n = 2). Overall follow-up was 4.36 (3.93) years. Eleven patients underwent bridge techniques before HTx, and 11 patients required perioperative extracorporeal membrane oxygenation or ventricular assist device support. ResultsIn the group that received extracorporeal membrane oxygenation, 8 patients (73%) were successfully weaned and discharged with excellent functional class. There were no differences in operative mortality, functional class, survival, rejection, and infection rates between the bridged and nonbridged groups. Overall actuarial 1- and 5-year survival rates were 93% and 83%, respectively. All survivors had good functional class. ConclusionOur findings demonstrate satisfactory medium-term outcome of HTx in selected pediatric patients with end-stage heart disease. Using bridge methods in children at high risk can increase the opportunity to receive a donor heart. These bridge methods achieve similar postoperative outcomes.

Heterobimetallic Cu(II)–Hg(II) polynuclear complexes containing Hg(SCN) 42− unit – Synthesis, spectroscopic investigations, X-ray studies and magnetic properties

Three novel heterobimetallic polymers with Hg(SCN) 4 2− as a linker have been synthesised and characterized by means of IR, EPR, magnetic measurements and single crystal X-ray. All the obtained compounds [Cu(bpzm)Hg(SCN) 4] n ( 1), [Cu(bdmpzm)Hg(SCN) 4] n ( 2) and [Cu(dpa)Hg(SCN) 4] n ( 3) form supramolecular framework structures. The 1 creates a three-dimensional coordination polymer, and 2 and 3 form two-dimensional nets extending along crystallographic (0 1 0) plane. Each octahedrally coordinated Cu(II) atom of 1 connects to four mercury ions through four thiocyanate bridges, and each Hg(II) ion is bridged with four copper ions via four thiocyanate bridges. The Cu(II) ions of 2 and 3 display a pyramidal coordination geometry, and they are connected to three mercury ions through three thiocyanate bridges, one thiocyanate ion is nonbridging group.

Three-Month Cumulative Incidence of Thromboembolism and Bleeding After Periprocedural Anticoagulation Management of Patients with Active Cancer.

Abstract 491 Introduction:Chronically-anticoagulated patients with active cancer (Ca) often require temporary interruption of warfarin for an invasive diagnostic or therapeutic procedure. While such patients may be at increased risk for periprocedural thromboembolism and bleeding, there are virtually no estimates of these outcomes among Ca patients or the most appropriate periprocedural anticoagulation management. The aims of this study were to estimate rates of these outcomes among Ca patients and to test active cancer and “bridging” low molecular weight heparin (LMWH) as potential predictors of these outcomes. Patients and Methods:In a retrospective cohort study, all chronically-anticoagulated patients referred to the Mayo Clinic Thrombophilia Center for periprocedural anticoagulation management over the 11-year period, 1997-2007, were followed forward in time for the outcomes of venous and arterial thromboembolism (VTE; ATE), major bleeding and vital status within 3 months of consultation. Warfarin was stopped 4-5 days prior to the procedure and patients received bridging LMWH according to the estimated risk of thromboembolism and bleeding. All outcome events were centrally adjudicated using pre specified criteria. Results:The total cohort (n=2517) included 500 patients with Ca. Chronic anticoagulation indications included prior VTE (n=1033), mechanical heart valve (n=669), atrial fibrillation (n=530) and other (mainly vascular bypass; n=285). 65% and 64% of patients with and without Ca received bridging LMWH, respectively. Prior VTE was more common among Ca patients compared to those without CA, both in the bridged (56% vs 37%; p<0.001) and the non-bridged (48% vs 39%; p<0.05) groups. The 3 month rate for the composite of VTE, ATE or bleeding was higher among Ca patients compared to patients without Ca (5% vs 2%; p=0.004) due to higher post procedure rates of VTE (1% vs 0.2%; p<0.001) and major bleeding (4% vs 1.7%; p=0.009); the post procedure ATE rates were low in both groups (0.40% vs 0.45%). For the entire cohort, patients receiving bridging LMWH had a significantly higher rate of post procedure bleeding (5% vs 1%; p<0.05). Finally, there were significantly more deaths in Ca patients compared to non-Ca patients (5% vs. 1%; p<0.001). Conclusions:The three-month rates of VTE, major bleeding and death among patients with Ca in whom anticoagulation is temporarily interrupted for an invasive procedure is significantly higher than in patients without Ca, especially the major bleeding rate. Use of heparin increases this rate even farther, suggesting that bridging should be used with caution in patients with active cancer. Disclosures:No relevant conflicts of interest to declare.

Outcome for Pediatric Cardiac Transplantation With and Without Bridge Methods

Heart transplantation is indicated for children with end-stage heart failure or complex inoperable congenital defects. Due to the shortage of pediatric donor hearts, various bridge techniques have been used for pediatric recipients to prolong patient survival until a heart is available. This study evaluates long-term outcome of bridge and nonbridge support for pediatric heart transplantation. Between March 1995 and June 2004, 18 pediatric patients underwent heart transplantation. Six patients (33.3%) underwent biological or mechanical bridge techniques before transplantation. Eight patients (44.4%) required perioperatively extracorporeal membrane oxygenation (ECMO) support. Patient data and records were retrospectively reviewed. Causes of death and long-term outcome were analyzed. Five of eight patients in the ECMO group (62.5%) were successfully decannulated and discharged home with excellent functional classes. No differences in rejection rate, survival rate, and functional class existed between the bridged and nonbridged groups. Overall 1-year and 5-year survival rates were both 83.3% and all have a good functional class. Pediatric heart transplantation can be accomplished with excellent early survival despite multiple prior cardiac operations and relatively severe illness. For the variety in small, low-body-weight pediatric patients, mechanical circulatory support using ECMO is suitable for managing sudden collapse while waiting for heart transplantation, and graft dysfunction after cardiac transplantation. The mortality rate is acceptable in this very high-risk group of patients and long-term outcome is good.

Process for Non-Agglomerated Nanometer-Sized Barium Titanate Powders by Sol-Gel Auto-Igniting Synthesis

Non-agglomerated nano-sized BaTiO3 powders were prepared by a 3 step decomposition of barium titanyl citric acid chelate derived from Ba(NO3)2-TiO(NO3)2-citric acid-NH4NO3 based complex compound system. The 1st step was the thermal treatment of chelate wet gel at 150°C for 40min to remove water and non-bridging hydroxyl groups and to form expanded gel intermediate. The 2nd step was the decomposition of the organic fuel by igniting expanded gel intermediate at 300°C. The 3rd step was the formation of the high purity BaTiO3 by calcining the decomposed powders at 700°C for 2 hours. The most expanded gel intermediate was found to be a decisive factor for the elimination of hard agglomerate. In addition, the initial oxidant/fuel molar ratio was shown to strongly influence the characteristics of the powders thus obtained. The optimum oxidant/fuel value was 3 for obtaining non-agglomerated pure BaTiO3 powders with a particle size of 50 nm. The agglomerate degree of BaTiO3 powders was determined by particle morphology and uniformity of the green compact microstructure observed by field emission scanning electron microscopy and scanning electron microscope.

Bowl adamanzanes—bicyclic tetraamines: syntheses and crystal structures of complexes with cobalt(iii) and chelating coordinated oxo-anions

Seven cobalt(III) complexes of the macrobicyclic tetraamine ligand [2(4).3(1)]adamanzane ([2(4).3(1)]adz) are reported along with the crystal structure of six of these complexes. The solid state and solution structures are discussed, and a detailed assignment of the NMR spectra of the sulfato complex is provided. Four of the seven complexes contain a chelate coordinating oxo-anion (sulfate, formiate, nitrate, carbonate). Equilibration of these species with the corresponding diaqua complex is generally slow. The rates of equilibration in 5 mol dm(-3) perchloric acid at 25 degrees C have been measured, yielding half lives of 20 min, 10 min and 3 h for the sulfato, formiato and carbonato species respectively. The corresponding reaction for the nitrato complex occurs with a half life of less than 3 min. The concentration acid dissociation constant for the Co([2(4).3(1)]adz)(HCO(3))(2+) ion has been measured to K(a) = 0.33 mol dm(-3) [25 degrees C, I = 2 mol dm(-3)] and K(a) = 0.15 mol dm(-3) [25 degrees C, I = 5 mol dm(-3)]. The propensity for coordination of sulfate was found to be large enough for a quantitative conversion of the carbonato complex to the sulfato complex to occur in 3 mol dm(-3) triflic acid containing a small sulfate contamination. On this basis the decarboxylation in 5 mol dm(-3) triflic acid of the corresponding cobalt(III) carbonato complex of the larger macrobicyclic tetraamine ligand [3(5)]adz was reinvestigated and found to lead to the sulfato complex as well. The difference in exchange rate of the oxo-anion ligands for the cobalt(III) complexes of the two adamanzane ligands is discussed and attributed to fundamental differences in the molecular structure where an inverted configuration of the secondary non-bridged amine groups is seen for the complexes of the larger [3(5)]adz ligand. The high affinity for chelating coordination of oxo-anions for these two cobalt(iii)-adamanzane-moieties is rationalised on basis of the N-Co-N angles. N-Co-N angles are compared for a series of adamanzane complexes, and the structural consequences are discussed.

Wrist-bridging versus non-bridging external fixation for displaced distal radius fractures: A randomized assessor-blind clinical trial of 38 patients followed for 1 year

Background Non-bridging external fixation has been introduced to achieve better fracture fixation and functional outcomes in distal radius fractures, but has not been specifically evaluated in a randomized study in the elderly. The purpose of this trial was to compare wrist-bridging and non-bridging external fixation for displaced distal radius fractures.Method The inclusion criteria were women ≥ 50 or men ≥ 60 years, acute extraarticular or intraarticular fracture, and dorsal angulation of ≥20° or ulnar variance ≥ 5 mm. The patients completed the disabilities of the arm, shoulder and hand (DASH) questionnaire before and at 10, 26 and 52 weeks after surgery. Pain (visual analog scale), range of motion and grip strength were measured by a blinded assessor.Results 38 patients (mean age 71 years, 31 women) were randomized at surgery (19 to each group). Mean operating time was shorter for wrist-bridging fixation by 10 (95% CI 3–17) min. There was no significant difference in DASH scores between the groups. No statistically significant differences in pain score, range of motion, grip strength, or patient satisfaction were found. The non-bridging group had a significantly better radial length at 52 weeks; mean difference in change in ulnar variance from baseline was 1.4 (95% CI 0.1–2.7) mm (p = 0.04). Volar tilt and radial inclination were similar in both groups.Interpretation For moderately or severely displaced distal radius fractures in the elderly, non-bridging external fixation had no clinically relevant advantage over wrist-bridging fixation but was more effective in maintaining radial length.

Au/TiO2 Nanosystems: A Combined RF-Sputtering/Sol−Gel Approach

An original synthetic approach to Au/TiO 2 nanosystems is developed. The adopted technique is based on the RF-sputtering of gold (guest) on porous titania xerogels (host) obtained by the sol-gel route. Such a combined synthetic pathway joins the peculiarities offered by the features of the sol-gel layers (porosity, nonbridging groups) and the advantages of plasmochemical methods (conformal coverage, infiltration power). In particular, host titania substrates were first prepared on silica by dip-coating from ethanolic solutions of Ti(OPr i ) 4 (OPr i =iso-propoxy) and Hacac (2,4-pentanedione). Subsequently, Au depositions were performed on the as-prepared xerogels in Ar plasmas at low temperatures. The resulting samples were finally annealed in air between 200 and 600 °C with the aim of tailoring the system features as a function of thermal treatment and gold content. Their structural, compositional, and morphological evolution was investigated by Glancing Incidence X-ray Diffraction (GIXRD), Transmission Electron Microscopy (TEM), optical absorption spectroscopy, X-ray Photoelectron Spectroscopy (XPS), and Atomic Force Microscopy (AFM). The adopted strategy enabled the synthesis of Au/YiO 2 nanosystems with characteristics strongly dependent on the deposited gold amount and processing conditions. In this way, materials with tunable structure, composition, and optical properties could be synthesized.

Sulfur-Bridged Co III Pt II Co III Trinuclear Complex Acting as an S-Donating Complex-Ligand

The reaction of fac(S) -[Co(aet) 3 ] (aet=H 2 NCH 2 CH 2 S m ) with [PtCl 2 {Co(aet) 2 (en)}] + gave an S-bridged Co III Pt II Co III trinuclear complex, [Pt{Co(aet) 3 }{Co(aet) 2 (en)}] 3+ ([ 1 ] 3+ ). The crystal structure of [ 1 ]Cl 3 was determined by X-ray crystallography. In [ 1 ] 3+ , the central Pt II atom is coordinated by four thiolato S atoms from octahedral C 2 - cis(S) -[Co(aet) 2 (en)] + and mer(S) -[Co(aet) 3 ] units in a square-planar geometry, giving a linear-type S-bridged trinuclear structure with a non-bridging thiolato group. Treatment of [ 1 ] 3+ with linear Au I produced an S-bridged Co III 4 Pt II 2 Au I heptanuclear complex, [Au{Pt[Co(aet) 3 ][Co(aet) 2 (en)]} 2 ] 7+ ([ 2 ] 7+ ), which indicated that [ 1 ] 3+ acts as a new class of S-donating trinuclear complex-ligand. polynuclear complexes cobalt platinum gold S ligands

Redisplaced unstable fractures of the distal radius

A randomised, prospective study was carried out on 60 patients with unstable fractures of the distal radius to compare bridging with non-bridging external fixation using pins placed in the distal fragment of the radius. The radiological results showed significant improvement in the non-bridging group at all stages of review. In particular, normal volar tilt and carpal alignment were regained and maintained. The functional results at six weeks, three months, six months and one year showed statistically better grip strength and flexion in the non-bridging group at all stages of review. Other ranges of movement showed an early advantage in the non-bridging group. Non-bridging external fixation is the treatment of choice for unstable fractures of the distal radius which have sufficient space for the placement of pins in the distal fragment.