The use of low-osmolar water-soluble contrast in videofluoroscopic swallowing exams

The selection of the contrast agent used during fluoroscopic exams is an important clinical decision. The purpose of this article is to document the usage of a nonionic, water-soluble contrast (iohexol) and barium contrast in adult patients undergoing fluoroscopic exams of the pharynx and/or esophagus and provide clinical indications for the use of each. For 1 year, data were collected on the use of iohexol and barium during fluoroscopic exams. The contrast agent used was selected by the speech language pathologist (SLP) or the radiologist based on the exam's indications. A total of 1,978 fluoroscopic exams were completed in the 12-month period of documentation. Of these exams, 60.6 % were completed for medical reasons and 39.4 % for surgical reasons. Fifty-five percent of the exams were performed jointly by a SLP and a radiologist and 45 % were performed by a radiologist alone. Aspiration was present in 22 % of the exams, vestibular penetration occurred in 38 %, extraluminal leakage of contrast was observed in 4.6 %, and both aspiration and leakage were seen in 1 % of the exams. In cases with aspiration, iohexol was used alone in 8 %, iohexol and barium were both used in 45 %, and barium was used alone in 47 %. In cases with extraluminal leakage, iohexol was used alone in 58 %, iohexol and barium were both used in 31 %, and barium was used alone in 11 %. No adverse effects were seen with the use of iohexol. When barium was used in cases of aspiration and extraluminal leakage, the amount of aspirated barium was small and the extraluminal barium in the instances of leakage was small. Iohexol is a useful screening contrast agent and can safely provide information, and its use reduces the risk of aspiration and the chance of leakage of large amounts of barium.

Selectively expanding subsets of T cells in mice by injection of interleukin-2/antibody complexes: implications for transplantation tolerance

The biological activity of interleukin (IL)-2 and other cytokines in vivo can be augmented by binding to certain anti-cytokine monoclonal antibodies (mAb). Here, we review evidence on how IL-2/anti-IL-2 mAb complexes can be used to cause selective stimulation and expansion of certain T-cell subsets. With some anti-IL-2 mAbs, injection of IL-2/mAb complexes leads to expansion of CD8 T effector cells but not CD4 T regulatory cells (Tregs); these complexes exert less adverse side effects than soluble IL-2 and display powerful antitumor activity. Other IL-2/mAb complexes have minimal effects on CD8 T cells but cause marked expansion of Tregs. Preconditioning mice with these complexes leads to permanent acceptance of MHC-disparate pancreatic islets in the absence of immunosuppression.

Translation and measurement properties of the Swedish version of ACL-Return to Sports after Injury questionnaire

Psychological factors may be a hindrance for returning to sport after an anterior cruciate ligament (ACL) reconstruction. The ACL-Return to Sport after Injury scale (ACL-RSI) measures athletes' emotions, confidence in performance, and risk appraisal in relation to return to sport. The aim of this study was to translate the ACL-RSI scale from English to Swedish and to examine some of the measurement properties of the Swedish version. The ACL-RSI was translated and culturally adapted. A professional expert group and five patients evaluated face validity. One hundred and eighty-two patients completed the translated ACL-RSI, a project-specific questionnaire, the Tampa Scale of Kinesiophobia (TSK), the Knee-Self-Efficacy Scale (K-SES), the Multidimensional Health Locus of Control (MHLC-C), the Knee injury and Osteoarthritis Outcome Score (KOOS), and the Anterior Cruciate Ligament-Quality of Life (ACL-QoL) questionnaires. Fifty-three patients answered the ACL-RSI twice to examine reproducibility. The ACL-RSI showed good face validity, internal consistency (Cronbach's alpha = 0.948), low floor and ceiling effects and high construct validity when evaluated against the TSK, K-SES, MHLC-C, KOOS, and ACL-QoL scales. The reproducibility was also high (intra-class correlation = 0.893). Therefore, the ACL-RSI can be used to evaluate psychological factors relevant to returning to sport after ACL reconstruction surgery.

Clinical medical sciences for undergraduate dental students in the United Kingdom and Ireland - a curriculum

The technical aspects of dentistry need to be practised with insight into the spectrum of human diseases and illnesses and how these impact upon individuals and society. Application of this insight is critical to decision-making related to the planning and delivery of safe and appropriate patient-centred healthcare tailored to the needs of the individual. Provision for the necessary training is included in undergraduate programmes, but in the United Kingdom and Ireland there is considerable variation between centres without common outcomes. In 2009 representatives from 17 undergraduate dental schools in the United Kingdom and Ireland agreed to move towards a common, shared approach to meet their own immediate needs and that might also be of value to others in keeping with the Bologna Process. To provide a clear identity the term 'Clinical Medical Sciences in Dentistry' was agreed in preference to other names such as 'Human Disease' or 'Medicine and Surgery'. The group was challenged to define consensus outcomes. Contemporary dental education documents informed, but did not drive the process. The consensus curriculum for undergraduate Clinical Medical Sciences in Dentistry teaching agreed by the participating centres is reported. Many of the issues are generic and it includes elements that are likely to be applicable to others. This document will act as a focus for a more unified approach to the outcomes required by graduates of the participating centres and act as a catalyst for future developments that ultimately aim to enhance the quality of patient care.

Role of fuel carbon intensity in achieving 2050 greenhouse gas reduction goals within the light-duty vehicle sector

Recent U.S. climate change policy developments include aggressive proposals to reduce greenhouse gas emissions, including cap-and-trade legislation with a goal of an 83% reduction below 2005 levels by 2050. This study examines behavioral and technological changes required to achieve this reduction within the light-duty vehicle (LDV) sector. Under this "fair share" sectoral assumption, aggressive near-term actions are necessary in three areas: vehicle miles traveled (VMT), vehicle fuel economy (FE), and fuel carbon intensity (FCI). Two generic scenarios demonstrate the important role of FCI in meeting the 2050 goal. The first scenario allows deep reductions in FCI to compensate for relatively modest FE improvements and VMT reductions. The second scenario assumes optimistic improvements in FE, relatively large reductions in VMT and less aggressive FCI reductions. Each generic scenario is expanded into three illustrative scenarios to explore the theoretical implications of meeting the 2050 goal by relying exclusively on biofuels and hybrid vehicles, biofuels and plug-in hybrid vehicles, or hydrogen fuel cell electric vehicles. These scenarios inform a discussion of resource limitations, technology development and deployment challenges, and policy goals required to meet the 2050 GHG goal for LDVs.

The effect of operating time on surgeons' muscular fatigue

INTRODUCTION

A study was completed to determine if operating has an effect on a surgeon's muscular fatigue.

SUBJECTS AND METHODS

Six head and neck surgery consultants, two ENT registrars, 20 normal controls from two tertiary referral centres in the West Midlands participated in the study. Electromyography (EMG) measurements were taken throughout a day of operating and fatigue indices were compared to controls performing desk work.

RESULTS

The percentage changes in mean frequency of muscular contractions were examined; there was no significant difference in fatigue levels between consultants and registrars. Operating led to an increase in fatigue in all subjects, compared to no increase in controls performing desk work. It was also found that the brachioradialis muscle is used more than the mid-deltoid muscle and, hence, fatigues at a faster rate.

CONCLUSIONS

Surgeons should be aware that their muscular fatigue levels will increase as an operation progresses; therefore, if possible, more complex parts of the operation should be performed as early as possible, or, in the case of a very long operation, a change in surgeon may be necessary.

Epidemiology and outcome of invasive fungal infection in adult hematopoietic stem cell transplant recipients: analysis of Multicenter Prospective Antifungal Therapy (PATH) Alliance registry

BACKGROUND

With use of data from the Prospective Antifungal Therapy (PATH) Alliance registry, we performed this multicenter, prospective, observational study to assess the epidemiologic characters and outcomes of invasive fungal infection (IFI) in hematopoietic stem cell transplant (HSCT) recipients.

METHODS

Sixteen medical centers from North America reported data on adult HSCT recipients with proven or probable IFI during the period July 2004 through September 2007. The distribution of IFIs and rates of survival at 6 and 12 weeks after diagnosis were studied. We used logistic regression models to determine risk factors associated with 6-week mortality for allogeneic HSCT recipients with invasive aspergillosis (IA).

RESULTS

Two hundred thirty-four adult HSCT recipients with a total of 250 IFIs were included in this study. IA (59.2%) was the most frequent IFI, followed by invasive candidiasis (24.8%), zygomycosis (7.2%), and IFI due to other molds (6.8%). Voriconazole was the most frequently administered agent (68.4%); amphotericin B deoxycholate was administered to a few patients (2.1%). Ninety-three (46.7%) of 199 HSCT recipients with known outcome had died by week 12. The 6-week survival rate was significantly greater for patients with IA than for those with invasive candidiasis and for those with IFI due to the Zygomycetes or other molds (P < .07). The 6-week mortality rate for HSCT recipients with IA was 21.5%. At 6 weeks, there was a trend toward a worse outcome among allogeneic HSCT recipients with IA who received myeloablative conditioning (P = .07); absence of mechanical ventilation or/and hemodialysis (P = .01) were associated with improved survival.

CONCLUSIONS

IA remains the most commonly identified IFI among HSCT recipients, but rates of survival in persons with IA appear to have improved, compared with previously reported data. Invasive candidiasis and IFI due to molds other than Aspergillus species remain a significant problem in HSCT recipients.