of surfactant replacement therapy at Johannesburg Hospital, November 1991 December 1992

Objective. To assess the impact of surfactant replacement therapy (SRl) on the outcome of hyaline membrane disease (HMD) and to assess the cost implications of a policy of selective administration of artificial surfactant. Design. The short-term outcome of 103 newborns ventilated for HMD (61 selected for SRT according to initial and/or ongoing oxygen requirements) was compared with that of a historical control group of 173 infants ventilated for HMD before the introduction of SRT. Main outcome measures. Mortality and morbidity of HMD including death, bronchopulmonary dysplasia, pneumothorax, pulmonary haemorrhage, patent ductus arteriosus and intraventricular haemorrhage. Results. There were significant demographic differences between the treatment and control groups (black patients 74% v. 28%, P < 0,0001; unbooked mothers 72% v. 15%, P < 0,0001) as well as evidence of more severe lung disease in the treatment group (pressor support 44% v. 27%, P < 0,005; and paralysis during ventilation 38% v. 25%, P < 0,005). Pneumothorax was reduced in the SRT group (7% v. 17%, P < 0,01). There were no significant differences between the two groups in the incidence of BPO or mortality. The use of SRT added to the total cost of treating a patient ventilated for HMD. Conclusion. The selective use of SRT had the effect of converting severe -disease into moderate disease rather than achieVing maximal benefit in all cases of HMD through routine use of the product. A policy of restricting use may result in cost savings where resources are limited.S Afr Med J 1995; 85; 646-649

Associations and clinical relevance of aortic-brachial artery stiffness mismatch, aortic reservoir function, and central pressure augmentation

Central augmentation pressure (AP) and index (AIx) predict cardiovascular events and mortality, but underlying physiological mechanisms remain disputed. While traditionally believed to relate to wave reflections arising from proximal arterial impedance (and stiffness) mismatching, recent evidence suggests aortic reservoir function may be a more dominant contributor to AP and AIx. Our aim was therefore to determine relationships among aortic-brachial stiffness mismatching, AP, AIx, aortic reservoir function, and end-organ disease. Aortic (aPWV) and brachial (bPWV) pulse wave velocity were measured in 359 individuals (aged 61 ± 9, 49% male). Central AP, AIx, and aortic reservoir indexes were derived from radial tonometry. Participants were stratified by positive (bPWV > aPWV), negligible (bPWV ≈ aPWV), or negative stiffness mismatch (bPWV < aPWV). Left-ventricular mass index (LVMI) was measured by two-dimensional-echocardiography. Central AP and AIx were higher with negative stiffness mismatch vs. negligible or positive stiffness mismatch (11 ± 6 vs. 10 ± 6 vs. 8 ± 6 mmHg, P < 0.001 and 24 ± 10 vs. 24 ± 11 vs. 21 ± 13%, P = 0.042). Stiffness mismatch (bPWV-aPWV) was negatively associated with AP (r = −0.18, P = 0.001) but not AIx (r = −0.06, P = 0.27). Aortic reservoir pressure strongly correlated to AP (r = 0.81, P < 0.001) and AIx (r = 0.62, P < 0.001) independent of age, sex, heart rate, mean arterial pressure, and height (standardized β = 0.61 and 0.12, P ≤ 0.001). Aortic reservoir pressure independently predicted abnormal LVMI (β = 0.13, P = 0.024). Positive aortic-brachial stiffness mismatch does not result in higher AP or AIx. Aortic reservoir function, rather than discrete wave reflection from proximal arterial stiffness mismatching, provides a better model description of AP and AIx and also has clinical relevance as evidenced by an independent association of aortic reservoir pressure with LVMI

Effects of dietary β-(1,3)(1,6)-D-glucan supplementation on growth performance, intestinal morphology and haemato-immunological profile of mirror carp (Cyprinus carpio L.).

In recent years, aquaculture research has focused on probiotics, prebiotics, and β-glucans, in order to improve health status and growth performance. Information regarding the effects of β-glucan on growth performance and intestinal immunity of mirror carp (Cyprinus carpio L.) is scarce. An experiment was therefore conducted to investigate the effects of a yeast β-glucan preparation (MacroGard(®) ) on growth performance, intestinal morphology and haemato-immunological indices of mirror carp. Carp (initial weight 11.1 ± 0.0 g) were fed highly purified diets supplemented with 0% (control), 0.1%, 1% or 2% MacroGard(®) for 8 weeks. Fish fed diets containing 1% and 2% MacroGard(®) showed significant improvements in weight gain, specific growth rate and feed conversion ratio compared to fish fed both the control and the 0.1% MacroGard(®) containing diet. Histological appraisal of the intestine showed a significantly higher infiltration of leucocytes into the epithelial layer of fish fed diets supplemented with 1% and 2% MacroGard(®) in the anterior intestine compared to fish fed the control and 0.1% MacroGard(®) diet. This effect was not observed in the posterior intestine. There were no significant differences in the intestinal absorptive surface area and number of goblet cells in either intestinal region. At the end of the experiment, the haematological status of the fish was examined. Compared to control fed fish, the haematocrit value was significantly elevated in fish fed the 2% MacroGard(®) diet. Furthermore, the blood monocyte fraction was significantly higher in fish fed the 1% and 2% MacroGard(®) diets. No significant changes were observed in the other blood parameters assessed. The present study shows that high dietary β-glucan inclusion increases growth performance without detrimental effects on the health indicators assessed. Increased intraepithelial leucocytes in the anterior intestine may indicate a localized immune response; no detrimental effects on intestinal morphology were observed

Estimation of Spectroscopic Uncertainty and Correlation in Terahertz Time Domain Spectroscopy

We present a method of calculating the measurement variance-covariance matrix of a spectroscopic sample’s complex refractive index from time-domain statistics in order to estimate uncertainty of a measurement. We compare this method to a numerical analysis and previously derived methodology, and show that our time-based estimate is both accurate and adaptable to complex extraction models

Multilayer Extraction of Complex Refractive Index in Broadband Transmission Terahertz Time-Domain Spectroscopy

In terahertz spectroscopy, multi-layered samples often need to be measured, for instance in a liquid flow cell, and this complicates the extraction of material parameters. We present a spectroscopic parameter extraction algorithm for multilayer samples that can also be used to extract the thickness of an unknown sample laye

Revision shoulder hemiarthroplasty and total shoulder arthroplasty a systematic review and meta-analysis.

The number of shoulder replacements performed each year continues to increase, and the need for revision replacements has grown accordingly. The outcome of a revision replacement may influence which primary implant is selected and the timing of primary surgery, particularly in younger patients. The aim of this study was to establish the expected improvement in shoulder function and implant survival following revision of a hemiarthroplasty and revision of an anatomical total shoulder arthroplasty (TSA). A systematic review and meta-analysis were performed of all studies reporting shoulder scores or implant survival following revision hemiarthroplasty or revision TSA. MEDLINE, EMBASE, CENTRAL, The Cochrane Database of Systematic Reviews and National Joint Registry reports were searched. 15 studies were included, reporting on 593 revision anatomical shoulder replacements. There was large variation in the magnitude of improvement in shoulder scores following revision surgery. Over 80% of revision replacements last 5 years and over 70% last 10 years. There was no significant difference in shoulder scores or implant survival according to the type of primary implant. The belief that revision of a shoulder hemiarthroplasty may lead to improved outcomes compared to revision of a TSA is not supported by the current literature

Limitations of augmentation index in the assessment of wave reflection in normotensive healthy individuals

Objectives Augmentation index (AIx) is widely used as a measure of wave reflection. We compared the relationship between AIx and age, height and sex with ‘gold standard’ measures of wave reflection derived from measurements of pressure and flow to establish how well AIx measures wave reflection. Materials and Methods Measurements of carotid pressure and flow velocity were made in the carotid artery of 65 healthy normotensive individuals (age 21–78 yr; 43 male) and pulse wave analysis, wave intensity analysis and wave separation was performed; waveforms were classified into type A, B or C. AIx, the time of the first shoulder (Ts), wave reflection index (WRI) and the ratio of backward to forward pressure (Pb/Pf) were calculated. Results AIx did not correlate with log WRI or Pb/Pf. When AIx was restricted to positive values AIx and log WRI were positively correlated (r = 0.33; p = 0.04). In contrast log WRI and Pb/Pf were closely correlated (r = 0.66; p<0.001). There was no correlation between the Ts and the timing of Pb or the reflected wave identified by wave intensity analysis. Wave intensity analysis showed that the morphology of type C waveforms (negative AIx) was principally due to a forward travelling (re-reflected) decompression wave in mid-systole. AIx correlated positively with age, inversely with height and was higher in women. In contrast log WRI and Pb/Pf showed negative associations with age, were unrelated to height and did not differ significantly by gender. Conclusions AIx has serious limitations as a measure of wave reflection. Negative AIx values derived from Type C waves should not be used as estimates of wave reflection magnitude

Probing temperature- and solvent-dependent protein dynamics using terahertz time-domain spectroscopy

The effect of temperature on the terahertz-frequency-range material properties of lyophilized and single-crystal hen egg-white lysozyme has been measured using terahertz time-domain spectroscopy, with the results presented and discussed in the context of protein and solvent dynamical and glass transitions. Lyophilized hen egg-white lysozyme was measured over a temperature range from 4 to 290 K, and a change in the dynamical behaviour of the sample at around 100 K was observed through a change in the terahertz absorption spectrum. Additionally, the effect of cryoprotectants on the temperature-dependent absorption coefficient is studied, and it is demonstrated that terahertz time-domain spectroscopy is capable of resolving the true glass transition temperature of single-crystal hen egg-white lysozyme at 150 K, which is in agreement with literature values measured using differential scanning calorimetry