Bench-to-bedside review: The importance of the precision of the reference technique in method comparison studies - with specific reference to the measurement of cardiac output

Bland-Altman analysis is used for assessing agreement between two measurements of the same clinical variable. In the field of cardiac output monitoring, its results, in terms of bias and limits of agreement, are often difficult to interpret, leading clinicians to use a cutoff of 30% in the percentage error in order to decide whether a new technique may be considered a good alternative. This percentage error of ± 30% arises from the assumption that the commonly used reference technique, intermittent thermodilution, has a precision of ± 20% or less. The combination of two precisions of ± 20% equates to a total error of ± 28.3%, which is commonly rounded up to ± 30%. Thus, finding a percentage error of less than ± 30% should equate to the new tested technique having an error similar to the reference, which therefore should be acceptable. In a worked example in this paper, we discuss the limitations of this approach, in particular in regard to the situation in which the reference technique may be either more or less precise than would normally be expected. This can lead to inappropriate conclusions being drawn from data acquired in validation studies of new monitoring technologies. We conclude that it is not acceptable to present comparison studies quoting percentage error as an acceptability criteria without reporting the precision of the reference technique

Outcomes in patients sustaining complex periarticular fracture-dislocations of the elbow [abstract]

Periarticular fracture-dislocations (dislocations associated with one or more fractures) of the elbow are difficult injuries to treat. They have historically been associated with poor treatment strategies which resulted in abysmal outcomes for patients. We aimed to review our management strategies for these complex injuries and patient outcomes

A cohort study of 4,190 patients treated with low-intensity pulsed ultrasound (LIPUS): findings in the elderly versus all patients

BACKGROUND: Patient age is one of many potential risk factors for fracture nonunion. Our hypothesis is that older patients (≥ 60) with fracture risk factors treated with low-intensity pulsed ultrasound (LIPUS) have similar heal rate (HR) to the population as a whole. We evaluate the impact of age in conjunction with other risk factors on HR in LIPUS-treated patients with fresh fracture (≤ 90 days old). METHODS: The Exogen Bone Healing System is a LIPUS device approved in 1994 to accelerate healing of fresh fracture. After approval, the FDA required a Post-Market Registry to assess performance. Patient data collected from October 1994 until October 1998 were individually reviewed and validated by a registered nurse. Four distinct data elements were required to report a patient: date fracture occurred; date treatment began; date treatment ended; and a dichotomous outcome of healed v. failed, by clinical and radiological criteria. Data were used to calculate two derived variables; days to treatment (DTT) and days on treatment (DOT). Every validated fresh fracture patient with DTT, DOT, and outcome is reported. RESULTS: The validated registry had 5,765 patients with fresh fracture; 73% (N = 4,190) are reported, while 13% of patients were lost to follow-up, 11% withdrew or were non-compliant, and 3% died or are missing outcome. Among treatment-compliant patients, HR was 96.2%. Logistic estimates of the odds ratio for healing are equivalent for patients age 30 to 79 years and all age cohorts had a HR > 94%. Open fracture, current smoking, diabetes, vascular insufficiency, osteoporosis, cancer, rheumatoid arthritis, and prescription NSAIDs all reduced HR, but older patients (≥ 60) had similar HRs to the population as a whole. DTT was significantly shorter for patients who healed (p < 0.0001). CONCLUSIONS: Comorbid conditions in conjunction with aging can reduce fracture HR. Patients with fracture who used LIPUS had a 96% HR, whereas the expected HR averages 93%. Time to treatment was significantly shorter among patients who healed (p < 0.0001), suggesting that it is beneficial to begin LIPUS treatment early. Older patients (≥ 60) with fracture risk factors treated with LIPUS exhibit similar heal rates to the population as a whole

Relevance of terpenoids on flammability of Mediterranean species: an experimental approach at a low radiant heat flux

One of the major factors influencing forest fuel combustion are terpenoids, a fraction of flammable Biogenic Volatile Organic Compounds (BVOCs) produced and stored by most Mediterranean species. The qualitative and quantitative effect of terpenoids on flammability has been only partially explained. In this study several major terpenoid-storing Mediterranean species (common cypress and three pines) were considered and compared to Holm oak as a reference non-storing species. The terpenoids were quantified via gas chromatography (GC-MS) analysis from both live fine fuel (LFF) and litter samples, and the relations between flammability and the terpenoids content were investigated by categories (Monoterpenoids, oxygenated Monoterpenoids, Sesquiterpenoids). The effect of fuel moisture content and species on ignition probability of LFF was also explored. A very different ignition probability was observed at the same fuel moisture content for the different species (Pinus spp. > C. sempervirens > Q. ilex). The stored terpenoids explained 19% to 50% of the whole flammability of both LFF and litter. Fuel moisture content (FMC) did not substantially change the relative effect of terpenoids on flammability, except in C. sempervirens. Monoterpenoids do not seem to significantly affect flammability, while sesquiterpenoids greatly influenced most flammability components, though their relative effect varied among species. A relation between storing structure of terpenoids and flammability was suggested. The results of this study indicate that isoprenoids should be included in physical models of the prediction and propagation of wildfire in Mediterranean vegetation as significant factors in driving flammability. © SISEF

Functional outcomes of patients undergoing anterolateral versus anteromedial approaches of the ankle for pilon fractures

Pilon fractures of the distal tibia remain a treatment challenge to orthopedists. Careful preoperative planning is crucial to achieving desirable clinical outcomes, but currently the literature does not reach a consensus on which surgical approach is optimal. This study examines functional outcomes of two of the most common surgical approaches for pilon fractures, the traditional anteromedial approach and the more recently described anterolateral approach. The anterolateral approach is thought to produce better outcomes because of the greater amount of visualization into the articular surface and greater soft tissue coverage for the implant

Dimethylmyricacene: An In Vitro and In Silico Study of a Semisynthetic Non-Camptothecin Derivative Compound, Targeting Human DNA Topoisomerase 1B

Human topoisomerase 1B regulates the topological state of supercoiled DNA enabling all fundamental cell processes. This enzyme, which is the unique molecular target of the natural anticancer compound camptothecin, acts by nicking one DNA strand and forming a transient protein–DNA covalent complex. The interaction of human topoisomerase 1B and dimethylmyricacene, a compound prepared semisynthetically from myricanol extracted from Myrica cerifera root bark, was investigated using enzymatic activity assays and molecular docking procedures. Dimethylmyricacene was shown to inhibit both the cleavage and the religation steps of the enzymatic reaction, and cell viability of A-253, FaDu, MCF-7, HeLa and HCT-116 tumor cell lines

Lower lid entropion secondary to treatment with alpha-1a receptor antagonist: a case report

<p>Abstract</p> <p>Introduction</p> <p>The use of alpha-1a receptor antagonists (tamsulosin) is widely accepted in the treatment of benign prostatic hypertrophy (BPH). It has previously been implicated as a causative agent in intra-operative floppy iris syndrome due to its effects on the smooth muscle. We report a case of lower lid entropion that may be related to a patient commencing treatment of tamsulosin.</p> <p>Case presentation</p> <p>A 74-year-old Caucasian man was started on alpha 1-a receptor antagonist (Tamsulosin) treatment for benign prostatic hypertrophy. Eight days later, he presented to the ophthalmology unit with a right lower lid entropion which was successfully treated surgically with a Weiss procedure.</p> <p>Conclusion</p> <p>We report a case of lower lid entropion that may be secondary to the recent use of an alpha-1a blocker (tamsulosin). This can be explained by considering the effect of autonomic blockade on alpha-1 receptors in the Muller's muscle on a patient that may already have an anatomical predisposition to entropion formation due to a further reduction in muscle tone.</p

Spontaneous supercurrent induced by ferromagnetic pi-junctions

We present magnetization measurements of mesoscopic superconducting niobium loops containing a ferromagnetic (PdNi) pi-junction. The loops are prepared on top of the active area of a micro Hall-sensor based on high mobility GaAs/AlGaAs heterostructures. We observe asymmetric switching of the loop between different magnetization states when reversing the sweep direction of the magnetic field. This provides evidence for a spontaneous current induced by the intrinsic phase shift of the pi-junction. In addition, the presence of the spontaneous current near zero applied field is directly revealed by an increase of the magnetic moment with decreasing temperature, which results in half integer flux quantization in the loop at low temperatures.Comment: 4 pages, 4 figure