Bioimpedance spectroscopy for swelling evaluation following total knee arthroplasty: a validation study

BACKGROUND: The evaluation of swelling is important for the outcome of total knee arthroplasty (TKA) surgery. The circumference or volume measurements are applicable at the bedside of the patient but are altered by muscular atrophy and the post-surgical dressing. Bioimpedance spectroscopy might overcome these limitations; however, it should be validated. This study aimed to explore the validity, the reliability and the responsiveness of bioimpedance spectroscopy for measuring swelling after TKA. METHODS: The degree of swelling in 25 patients undergoing TKA surgery was measured using bioimpedance spectroscopy (BIS R0), knee circumference and limb volume. The measurements were performed on D-1 (day before surgery), D + 2 (2 days after surgery) and D + 8 (8 days after surgery). The BIS R0 measurements were repeated twice, alternating between two evaluators. The percentage of the difference between the limbs was calculated for BIS R0, circumference and volume. The intra- and inter-observer intraclass correlation coefficients (ICCs), limits of agreement (LOA), effect size (Cohen's d), correlations between the methods and diagnostic sensitivity were calculated. RESULTS: BIS R0, circumference and volume detected swelling < 3.5% at D-1. The swelling at D2 and D8 was greater with BIS R0 [mean (SD) 29.9% (±9.8) and 38.27 (±7.8)] than with volume [14.7 (±9.5) and 14.9 (±8.2)] and circumference [11.1 (±5.7) and 11.7 (±4.1)]. The BIS R0 intra- and inter-evaluator ICCs ranged from 0.89 to 0.99, whereas the LOA were < 5.2%. The BIS R0 correlation was 0.73 with volume and 0.75 with circumference. The BIS R0 Cohen's d was 3.32 for the D-1-D2 evolution. The diagnostic sensitivity was 83% D2 and 96% at D8. CONCLUSION: Bioimpedance is a valid method for the evaluation of swelling following TKA. BIS R0 also demonstrated excellent intra- and inter-evaluator reliability. The diagnostic sensitivity and responsiveness is superior to that of concurrent methods. BIS R0 is an efficient method for post-surgical follow up at the bedside of the patient. The measurement of BIS R0 is a straightforward, valid, reliable and responsive method for lower limb swelling following TKA surgery that could be used in clinics and research. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT00627770

Arabidopsis ABCG34 contributes to defense against necrotrophic pathogens by mediating the secretion of camalexin

Plant pathogens cause huge yield losses. Plant defense often depends on toxic secondary metabolites that inhibit pathogen growth. Because most secondary metabolites are also toxic to the plant, specific transporters are needed to deliver them to the pathogens. To identify the transporters that function in plant defense, we screened Arabidopsis thaliana mutants of full-size ABCG transporters for hypersensitivity to sclareol, an antifungal compound. We found that atabcg34 mutants were hypersensitive to sclareol and to the necrotrophic fungi Alternaria brassicicola and Botrytis cinerea. AtABCG34 expression was induced by A. brassicicola inoculation as well as by methyl-jasmonate, a defense-related phytohormone, and AtABCG34 was polarly localized at the external face of the plasma membrane of epidermal cells of leaves and roots. atabcg34 mutants secreted less camalexin, a major phytoalexin in A. thaliana, whereas plants overexpressing AtABCG34 secreted more camalexin to the leaf surface and were more resistant to the pathogen. When treated with exogenous camalexin, atabcg34 mutants exhibited hypersensitivity, whereas BY2 cells expressing AtABCG34 exhibited improved resistance. Analyses of natural Arabidopsis accessions revealed that AtABCG34 contributes to the disease resistance in naturally occurring genetic variants, albeit to a small extent. Together, our data suggest that AtABCG34 mediates camalexin secretion to the leaf surface and thereby prevents A. brassicicola infection.117Ysciescopu

Upper- and mid-mantle interaction between the Samoan plume and the Tonga-Kermadec slabs

Mantle plumes are thought to play a key role in transferring heat from the core\u2013mantle boundary to the lithosphere, where it can significantly influence plate tectonics. On impinging on the lithosphere at spreading ridges or in intra-plate settings, mantle plumes may generate hotspots, large igneous provinces and hence considerable dynamic topography. However, the active role of mantle plumes on subducting slabs remains poorly understood. Here we show that the stagnation at 660 km and fastest trench retreat of the Tonga slab in Southwestern Pacific are consistent with an interaction with the Samoan plume and the Hikurangi plateau. Our findings are based on comparisons between 3D anisotropic tomography images and 3D petrological-thermo-mechanical models, which self-consistently explain several unique features of the Fiji\u2013Tonga region. We identify four possible slip systems of bridgmanite in the lower mantle that reconcile the observed seismic anisotropy beneath the Tonga slab (VSH4VSV) with thermo-mechanical calculations

Heterogeneous coupling of the Sumatran megathrust constrained by geodetic and paleogeodetic measurements

Geodetic and paleogeodetic measurements of interseismic strain above the Sumatran portion of the Sunda subduction zone reveal a heterogeneous pattern of coupling. Annual banding in corals provides vertical rates of deformation spanning the last half of the 20th century, and repeated GPS surveys between 1991 and 2001 and continuous measurements at GPS stations operated since 2002 provide horizontal velocities. Near the equator, the megathrust is locked over a narrow width of only a few tens of kilometers. In contrast, the locked fault zone is up to about 175 km wide in areas where great interplate earthquakes have occurred in the past. Formal inversion of the data reveals that these strongly coupled patches are roughly coincident with asperities that ruptured during these events. The correlation is most spectacular for rupture of the M_w 8.7 Nias-Simeulue earthquake of 2005, which released half of the moment deficit that had accumulated since its previous rupture in 1861, suggesting that this earthquake was overdue. Beneath the Mentawai islands, strong coupling is observed within the overlapping rupture areas of the great earthquakes of 1797 and 1833. The accumulated slip deficit since these events is slowly reaching the amount of slip that occurred during the 1833 earthquake but already exceeds the slip that occurred during the 1797 earthquake. Thus, rerupture of part of the Mentawai patch in September 2007 was not a surprise. In contrast, coupling is low below the Batu islands near the equator and around Enggano island at about 5°S, where only moderate earthquakes (M_w < 8.0) have occurred in the past two centuries. The correlation of large seismic asperities with patches that are locked during the interseismic period suggests that they are persistent features. This interpretation is reinforced by the fact that the large locked patches and great ruptures occur beneath persistent geomorphologic features, the largest outer arc islands. Depth- and convergence-rate-dependent temperature might influence the pattern of coupling, through its effect on the rheology of the plate interface, but other influences are required to account for the observed along-strike heterogeneity of coupling. In particular, subduction of the Investigator Fracture Zone could be the cause for the low coupling near the equator

Standard of civilization, nomadism and territoriality in nineteenth-century international society

In this chapter, the encounter between the Russian Empire and the nomads of the Eurasian steppe in the nineteenth century is analyzed using the theoretical framework of the standard of civilization. The creation of the Westphalian state-model in Europe in the seventeenth century, linked to the later emergence of the notion of the standard of civilization led to the ‘othering’ of the nomads of the Eurasian steppe as barbarians, as a threat to the borders of civilized Europe. The chapter presents also an argument to define ‘territoriality’ as not only an institution of international society of the time but also as a distinctive quality and requirement for being considered ‘civilized’. In this analytical framework, the nomads become the ‘other’, the ‘alien’, the ‘menace’, onto which projections of rationality and modernity were cast in order to prevent threats to Russia’s European and civilized identity. The chapter sheds light on the encounter between ‘fixed’ and ‘mobile’ units in the course of expansion of international society; contextualizes the role played by nomadic tribes in resisting the application of Westphalian spatial categories in the Eurasian space; and scrutinizes what the role of nomads was in constructing a European, civilized identity.PostprintPeer reviewe

Significant release of shear energy of the North Korean nuclear test on February 12, 2013

On February 12, 2013 the Democratic People\u27s Republic of Korea (DPRK) carried out an announced nuclear test, which was the third after tests conducted in 2006 and 2009. An important task in discriminating a man-made explosion and a natural tectonic earthquake is the analysis of seismic waveforms. To determine the isotropic and non-isotropic characteristics of the detonation source, I invert long-period seismic data for the full seismic moment tensor to match the observed seismic signals by synthetic waveforms based on a 3D earth model. Here, I show that the inversion of long-period seismic data of the 2013 test reveals a clear explosive (isotropic) component combined with a significant release of shear energy by the double-couple part of the moment tensor. While the isotropic part of the nuclear test in 2009 was similar to that in 2013, the double-couple part was lower by a factor of 0.55 compared to the explosion in 2013. Moreover, the ratio of the isotropic seismic moments of the 2013 and 2009 nuclear tests is 1.4±0.1 and lower than published estimations of the yield ratio, which indicates the importance of considering the release of shear energy. The determined orientation of the double-couple fault plane is parallel to the dominating geologic fault structures NNE-SSW to NE-SW, but the calculated normal faulting mechanism does not correspond to the general tectonic strike-slip regime. Thus, explanations for the enhanced release of shear energy might be induced dip-slip motion pre-stressed by the previous test or near source damaging effects due to a changed containment of the nuclear explosion

Do physician outcome judgments and judgment biases contribute to inappropriate use of treatments? Study protocol

<p>Abstract</p> <p>Background</p> <p>There are many examples of physicians using treatments inappropriately, despite clear evidence about the circumstances under which the benefits of such treatments outweigh their harms. When such over- or under- use of treatments occurs for common diseases, the burden to the healthcare system and risks to patients can be substantial. We propose that a major contributor to inappropriate treatment may be how clinicians judge the likelihood of important treatment outcomes, and how these judgments influence their treatment decisions. The current study will examine the role of judged outcome probabilities and other cognitive factors in the context of two clinical treatment decisions: 1) prescription of antibiotics for sore throat, where we hypothesize overestimation of benefit and underestimation of harm leads to over-prescription of antibiotics; and 2) initiation of anticoagulation for patients with atrial fibrillation (AF), where we hypothesize that underestimation of benefit and overestimation of harm leads to under-prescription of warfarin.</p> <p>Methods</p> <p>For each of the two conditions, we will administer surveys of two types (Type 1 and Type 2) to different samples of Canadian physicians. The primary goal of the Type 1 survey is to assess physicians' perceived outcome probabilities (both good and bad outcomes) for the target treatment. Type 1 surveys will assess judged outcome probabilities in the context of a representative patient, and include questions about how physicians currently treat such cases, the recollection of rare or vivid outcomes, as well as practice and demographic details. The primary goal of the Type 2 surveys is to measure the specific factors that drive individual clinical judgments and treatment decisions, using a 'clinical judgment analysis' or 'lens modeling' approach. This survey will manipulate eight clinical variables across a series of sixteen realistic case vignettes. Based on the survey responses, we will be able to identify which variables have the greatest effect on physician judgments, and whether judgments are affected by inappropriate cues or incorrect weighting of appropriate cues. We will send antibiotics surveys to family physicians (300 per survey), and warfarin surveys to both family physicians and internal medicine specialists (300 per group per survey), for a total of 1,800 physicians. Each Type 1 survey will be two to four pages in length and take about fifteen minutes to complete, while each Type 2 survey will be eight to ten pages in length and take about thirty minutes to complete.</p> <p>Discussion</p> <p>This work will provide insight into the extent to which clinicians' judgments about the likelihood of important treatment outcomes explain inappropriate treatment decisions. This work will also provide information necessary for the development of an individualized feedback tool designed to improve treatment decisions. The techniques developed here have the potential to be applicable to a wide range of clinical areas where inappropriate utilization stems from biased judgments.</p