Chlorhexidine versus povidone–iodine skin antisepsis before upper limb surgery (CIPHUR) : an international multicentre prospective cohort study

Introduction Surgical site infection (SSI) is the most common and costly complication of surgery. International guidelines recommend topical alcoholic chlorhexidine (CHX) before surgery. However, upper limb surgeons continue to use other antiseptics, citing a lack of applicable evidence, and concerns related to open wounds and tourniquets. This study aimed to evaluate the safety and effectiveness of different topical antiseptics before upper limb surgery. Methods This international multicentre prospective cohort study recruited consecutive adults and children who underwent surgery distal to the shoulder joint. The intervention was use of CHX or povidone–iodine (PVI) antiseptics in either aqueous or alcoholic form. The primary outcome was SSI within 90 days. Mixed-effects time-to-event models were used to estimate the risk (hazard ratio (HR)) of SSI for patients undergoing elective and emergency upper limb surgery. Results A total of 2454 patients were included. The overall risk of SSI was 3.5 per cent. For elective upper limb surgery (1018 patients), alcoholic CHX appeared to be the most effective antiseptic, reducing the risk of SSI by 70 per cent (adjusted HR 0.30, 95 per cent c.i. 0.11 to 0.84), when compared with aqueous PVI. Concerning emergency upper limb surgery (1436 patients), aqueous PVI appeared to be the least effective antiseptic for preventing SSI; however, there was uncertainty in the estimates. No adverse events were reported. Conclusion The findings align with the global evidence base and international guidance, suggesting that alcoholic CHX should be used for skin antisepsis before clean (elective upper limb) surgery. For emergency (contaminated or dirty) upper limb surgery, the findings of this study were unclear and contradict the available evidence, concluding that further research is necessary

Enthalpies of formation and bond dissociation energies of lower alkyl hydroperoxides and related hydroperoxy and alkoxy radicals

The enthalpies of formation and bond dissociation energies, D(ROO-H), D(RO-OH), D(RO-O), D(R-O-2) and D(R-OOH) of alkyl hydroperoxides, ROOH, alkyl peroxy, RO, and alkoxide radicals, RO, have been computed at CBS-QB3 and APNO levels of theory via isodesmic and atomization procedures for R = methyl, ethyl, n-propyl and isopropyl and n-butyl, tert-butyl, isobutyl and sec-butyl. We show that D(ROO-H) approximate to 357, D(RO-OH) approximate to 190 and D(RO-O) approximate to 263 kJ mol(-1) for all R, whereas both D(R-OO) and D(R-OOH) strengthen with increasing methyl substitution at the cc-carbon but remain constant with increasing carbon chain length. We recommend a new set of group additivity contributions for the estimation of enthalpies of formation and bond energies

Quantitative susceptibility mapping as an indicator of subcortical and limbic iron abnormality in Parkinson's disease with dementia

Late stage Parkinson's disease (PD) patients were commonly observed with other non-motor comorbidities such as dementia and psychosis. While abnormal iron level in the substantia nigra was clinically accepted as a biomarker of PD, it was also suggested that the increased iron deposition could impair other brain regions and induce non-motor symptoms. A new Magnetic Resonance Imaging (MRI) called Quantitative Susceptibility Mapping (QSM) has been found to measure iron concentration in the grey matter reliably. In this study, we investigated iron level of different subcortical and limbic structures of Parkinson's disease (PD) patients with and without dementia by QSM.QSM and volumetric analysis by MRI were performed in 10 PD dementia (PDD) patients (73 ± 6 years), 31 PD patients (63 ± 8 years) and 27 healthy controls (62 ± 7 years). No significant differences were observed in the L-Dopa equivalent dosage for the two PD groups (p = 0.125).Putative iron content was evaluated in different subcortical and limbic structures of the three groups, as well as its relationship with cognitive performance. One-way ANCOVA with FDR adjustment at level of 0.05, adjusted for age and gender, showed significant group differences for left and right hippocampus (p = 0.015 & 0.032, respectively, BH-corrected for multiple ROIs) and right thalamus (p = 0.032, BH-corrected). Post-hoc test with Bonferroni's correction suggested higher magnetic susceptibility in PDD patients than healthy controls in the left and right hippocampus (p = 0.001 & 0.047, respectively, Bonferroni's corrected), while PD patients had higher magnetic susceptibility than the healthy controls in right hippocampus and right thalamus (p = 0.006 & 0.005, respectively, Bonferroni's corrected). PDD patients also had higher susceptibility than the non-demented PD patients in left hippocampus (p = 0.046, Bonferroni's corrected). The magnetic susceptibilities of the left and right hippocampus were negatively correlated with the Mini-Mental State Examination score (r = −0.329 & -0.386, respectively; p < 0.05).This study provides support for iron accumulation in limbic structures of PDD and PD patients and its correlation with cognitive performance, however, its putative involvement in development of non-motor cognitive dysfunction in PD pathogenesis remains to be elucidated. Keywords: Dementia, Parkinson's disease, Magnetic resonance imaging, Quantitative susceptibility mapping, Iron deposition, Hippocampus, Amygdal

Women of the wild geese: Irish women migrants in Spain, 1750-1775.

This single-authored article draws upon Irish and Spanish primary sources to show how first and second generation Irish women migrants, succeeded in assimilating in Spanish society in the mid-eighteenth century. The advancement of schools and hospitals is examined, alongside the women’s development of networks of power and influence. It examines women in the key towns of Madrid, Barcelona, Valladolid, Burgos, Santiago, Ferrol, Pontevedra, Seville and Cadiz. The study is a revised and extended version of an invited conference paper given at the Rocky Mountain Medieval and Renaissance conference on ‘Borders and Frontiers in the Medieval and Early Modern World’ held in Las Vegas, Nevada, in 2002

Spatial stability of Avena sterilis ssp. ludoviciana populations under annual applications of low rates of imazamethabenz

9 páginas, ilustraciones y tablas estadísticas.Long-term experiments were conducted in two winter barley fields in central Spain to determine the spatial stability of Avena sterilis ssp. ludoviciana populations under annual applications of low rates of imazamethabenz herbicide. Weed density was sampled every year (over 5 years in the first field and over 3years in the second) on the same grid locations prior to herbicide application. Although weed patches were stable in their location, weed density decreased in most of the years. In the first field, the populations decreased exponentially over the 5-year period. The rates of population decline were dependent on the initial density of the population, being higher for the central core of the patches and lower for the low-density areas. Under the conditions present in this experiment, it was possible to reduce heavy weed patches (up to 1200 seedlings m)2) down to relatively safe levels (18 seedlings m)2) in a period of 3years using a density-specific control programme, applying low rates of herbicides when weed densities were below a given level (1000 seedlings m)2). However, under adverse environmental conditions, half rates of the herbicide failed to control the weed populations adequately. The stability of the location of patches of A.sterilis ssp. ludoviciana suggest that weed seedling distributions mapped in one year are good predictors of future seedling distributions. However, the actual densities established each year will depend on the control level achieved the previous year and the climatic conditions present during the establishment period.(project AGF99-1125), by the Consejerıa de Educacion of the Community of Madrid and by the European Social Programme.Peer reviewe