Incisional negative pressure wound therapy dressings (iNPWTd) in routine primary hip and knee arthroplasties: A randomised controlled trial.

OBJECTIVES: Wound complications are reported in up to 10% hip and knee arthroplasties and there is a proven association between wound complications and deep prosthetic infections. In this randomised controlled trial (RCT) we explore the potential benefits of a portable, single use, incisional negative pressure wound therapy dressing (iNPWTd) on wound exudate, length of stay (LOS), wound complications, dressing changes and cost-effectiveness following total hip and knee arthroplasties. METHODS: A total of 220 patients undergoing elective primary total hip and knee arthroplasties were recruited into in a non-blinded RCT. For the final analysis there were 102 patients in the study group and 107 in the control group. RESULTS: An improvement was seen in the study (iNPWTd) group compared to control in all areas. Peak post-surgical wound exudate was significantly reduced (p = 0.007). Overall LOS reduction (0.9 days, 95% confidence interval (CI) -0.2 to 2.5) was not significant (p = 0.07) but there was a significant reduction in patients with extreme values of LOS in the iNPWTd group (Moses test, p = 0.003). There was a significantly reduced number of dressing changes (mean difference 1.7, 95% CI 0.8 to 2.5, p = 0.002), and a trend to a significant four-fold reduction in reported post-operative surgical wound complications (8.4% control; 2.0% iNPWTd, p = 0.06). CONCLUSIONS: Based on the results of this RCT incisional negative pressure wound therapy dressings have a beneficial role in patients undergoing primary hip and knee arthroplasty to achieve predictable length of stay, especially to eliminate excessive hospital stay, and minimise wound complications.Cite this article: S. L. Karlakki, A. K. Hamad, C. Whittall, N. M. Graham, R. D. Banerjee, J. H. Kuiper. Incisional negative pressure wound therapy dressings (iNPWTd) in routine primary hip and knee arthroplasties: A randomised controlled trial. Bone Joint Res 2016;5:328-337. DOI: 10.1302/2046-3758.58.BJR-2016-0022.R1

Gauge symmetry and W-algebra in higher derivative systems

The problem of gauge symmetry in higher derivative Lagrangian systems is discussed from a Hamiltonian point of view. The number of independent gauge parameters is shown to be in general {\it{less}} than the number of independent primary first class constraints, thereby distinguishing it from conventional first order systems. Different models have been considered as illustrative examples. In particular we show a direct connection between the gauge symmetry and the W-algebra for the rigid relativistic particle.Comment: 1+22 pages, 1 figure, LaTeX, v2; title changed, considerably expanded version with new results, to appear in JHE

Counting all dyons in N =4 string theory

For dyons in heterotic string theory compactified on a six-torus, with electric charge vector Q and magnetic charge vector P, the positive integer I = g.c.d.(Q \wedge P) is an invariant of the U-duality group. We propose the microscopic theory for computing the spectrum of all dyons for all values of I, generalizing earlier results that exist only for the simplest case of I=1. Our derivation uses a combination of arguments from duality, 4d-5d lift, and a careful analysis of fermionic zero modes. The resulting degeneracy agrees with the black hole degeneracy for large charges and with the degeneracy of field-theory dyons for small charges. It naturally satisfies several physical requirements including integrality and duality invariance. As a byproduct, we also derive the microscopic (0,4) superconformal field theory relevant for computing the spectrum of five-dimensional Strominger-Vafa black holes in ALE backgrounds and count the resulting degeneracies

Accurate energy spectrum for double-well potential: periodic basis

We present a variational study of employing the trigonometric basis functions satisfying periodic boundary condition for the accurate calculation of eigenvalues and eigenfunctions of quartic double-well oscillators. Contrary to usual Dirichlet boundary condition, imposing periodic boundary condition on the basis functions results in the existence of an inflection point with vanishing curvature in the graph of the energy versus the domain of the variable. We show that this boundary condition results in a higher accuracy in comparison to Dirichlet boundary condition. This is due to the fact that the periodic basis functions are not necessarily forced to vanish at the boundaries and can properly fit themselves to the exact solutions.Comment: 15 pages, 5 figures, to appear in Molecular Physic

Mouse models for preeclampsia: disruption of redox-regulated signaling

The concept that oxidative stress contributes to the development of human preeclampsia has never been tested in genetically-defined animal models. Homozygous deletion of catechol-Omethyl transferase (Comt-/-) in pregnant mice leads to human preeclampsia-like symptoms (high blood pressure, albuminurea and preterm birth) resulting from extensive vasculo-endothelial pathology, primarily at the utero-fetal interface where maternal cardiac output is dramatically increased during pregnancy. Comt converts estradiol to 2-methoxyestradiol 2 (2ME2) which counters angiogenesis by depleting hypoxia inducible factor-1 alpha (HIF-1 alpha) at late pregnancy. We propose that in wild type (Comt++) pregnant mice, 2ME2 destabilizes HIF-1 alpha by inhibiting mitochondrial superoxide dismutase (MnSOD). Thus, 2ME2 acts as a pro-oxidant, disrupting redox-regulated signaling which blocks angiogenesis in wild type (WT) animals in physiological pregnancy. Further, we suggest that a lack of this inhibition under normoxic conditions in mutant animals (Comt-/-) stabilises HIF-1 alpha by inactivating prolyl hydroxlases (PHD). We predict that a lack of inhibition of MnSOD, leading to persistent accumulation of HIF-1 alpha, would trigger inflammatory infiltration and endothelial damage in mutant animals. Critical tests of this hypothesis would be to recreate preeclampsia symptoms by inducing oxidative stress in WT animals or to ameliorate by treating mutant mice with Mn-SOD-catalase mimetics or activators of PHD

Benzyne in V4334 Sqr: A Quest for the Ring with SOFIA/EXES

Large aromatic molecules are ubiquitous in both circumstellar and interstellar environments. Detection of small aromatic molecules, such as benzene (C6H6) and benzyne (C6H4), are rare in astrophysical environments. Detection of such species will have major implications for our understanding of the astrochemistry involved in the formation of the molecules necessary for life, including modeling the chemical pathways to the formation of larger hydrocarbon molecules. We conducted a search for the infrared 18 μm spectral signature of benzyne in V4334 Sgr with the Stratospheric Observatory for Infrared Astronomy (SOFIA)/Echelon-Cross-Echelle Spectrograph (EXES) finding no evidence for a feature at the sensitivity of our observations

Patients with Endoscopically Visible Polypoid Adenomatous Lesions Within the Extent of Ulcerative Colitis Have an Increased Risk of Colorectal Cancer Despite Endoscopic Resection.

OBJECTIVES: Ulcerative colitis (UC) is associated with an increased risk of colorectal cancer (CRC). Few studies have looked at long-term outcomes of endoscopically visible adenomatous lesions removed by endoscopic resection in these patients. We aimed to assess the risk of developing CRC in UC patients with adenomatous lesions that develop within the segment of colitis compared to the remainder of an ulcerative colitis cohort. METHODS: We identified patients with a confirmed histological diagnosis of UC from 1991 to 2004 and noted outcomes till June 2011. The Kaplan-Meier method was used to estimate cumulative probability of subsequent CRC. Factors associated with risk of CRC were assessed in a Cox proportional hazards model. RESULTS: Twenty-nine of 301 patients with UC had adenomatous lesions noted within the segment of colitis. The crude incidence rate of developing colon cancer in patients with UC was 2.45 (95 % CI 1.06-4.83) per 1000 PYD and in those with UC and polypoid adenomas within the extent of inflammation was 11.07 (95 % CI 3.59-25.83) per 1000 PYD. Adjusted hazards ratio of developing CRC on follow-up in UC patients with polypoid dysplastic adenomatous lesions within the extent of inflammation was 4.0 (95 % CI 1.3-12.4). CONCLUSIONS: The risk of developing CRC is significantly higher in UC patients with polypoid adenomatous lesions, within the extent of inflammation, despite endoscopic resection. Patients and physicians should take the increased risk into consideration during follow-up of these patients

The Expanding Fireball of Nova Delphini 2013

A classical nova occurs when material accreting onto the surface of a white dwarf in a close binary system ignites in a thermonuclear runaway. Complex structures observed in the ejecta at late stages could result from interactions with the companion during the common envelope phase. Alternatively, the explosion could be intrinsically bipolar, resulting from a localized ignition on the surface of the white dwarf or as a consequence of rotational distortion. Studying the structure of novae during the earliest phases is challenging because of the high spatial resolution needed to measure their small sizes. Here we report near-infrared interferometric measurements of the angular size of Nova Delphini 2013, starting from one day after the explosion and continuing with extensive time coverage during the first 43 days. Changes in the apparent expansion rate can be explained by an explosion model consisting of an optically thick core surrounded by a diffuse envelope. The optical depth of the ejected material changes as it expands. We detect an ellipticity in the light distribution, suggesting a prolate or bipolar structure that develops as early as the second day. Combining the angular expansion rate with radial velocity measurements, we derive a geometric distance to the nova of 4.54 +/- 0.59 kpc from the Sun.Comment: Published in Nature. 32 pages. Final version available at http://www.nature.com/nature/journal/v515/n7526/full/nature13834.htm