3D CAD conceptual design of an artificial knee

Total knee arthroplasty is the end-stage surgical procedure for pain relief in degenerative diseases such as arthritis. There are many models, which were designed so far in five to six decades of arthroplasty history. This research is aimed to design an artificial high-flexion knee, which emphasizes the high-flexion extension range of over 125 deg that would provide the comfort of squatting even after total knee replacement.

Treatment of vasculitic peripheral neuropathy: a retrospective analysis of outcome

BACKGROUND

Vasculitis of the peripheral nervous system (PNS) is rare. There are no controlled treatment trials, and clinical practice is guided by experience from case series and indirectly by analogy with systemic vasculitis.

METHODS

We identified patients (n=212) with possible vasculitic peripheral neuropathy (VPN) from the neuropathology and neurophysiology records of two centres over 28 years. Case-notes were available for 181, from which, 106 cases of clinicopathological VPN were identified. Adequate treatment data were available in 100; follow-up data, in 93.

RESULTS

Of 106 cases, 95 had systemic vasculitis and 11 had vasculitis confined to the PNS. Pharmacological treatment (94/100 cases) was corticosteroid-based, and included cyclophosphamide in 54; 17 received additional agents. Initial stabilization was achieved in all but six. One-year survival was 90.3%. Of the nine who died in the first years (mean age 73 years), seven had received cyclophosphamide, and all but two had severe, multisystem vasculitis. The neurological relapse rate was 10%. Only one relapse occurred after cyclophosphamide treatment. Outcome was reported as good in 72% (78% in those who relapsed).

DISCUSSION

Death and relapse were infrequent in treated patients. Relapse occurred almost exclusively in patients treated with prednisolone alone. Aggressive early treatment with cyclophosphamide may prevent relapse. The current management approach to VPN appears largely effective, especially if cyclophosphamide is used.

Dermatoglyphic peculiarities in children with oral clefts

In humans, the development of the primary palate and the lip is completed by the 7th week of intra uterine life and that of secondary palate by 12th week. The dermal ridges develop in relation to the volar pads, which are formed by the 6th week of gestation and reach maximum size between 12th and 13th weeks. This means that the genetic message contained in the genome--normal or abnormal is deciphered during this period and is also reflected by dermatoglyphics. Hence this study was done in order to observe the differences in dermatoglyphic patterns between the children with oral clefts and normal children and to determine the usefulness of dermatoglyphics in studying the genetic etiology of oral clefts. Dermatoglyphic data from 50 oral cleft children and 50 normal children were collected using the ink method and comparison was done between them. In the present study, we found an increase in the ulnar loop patterns on the distal phalanges of the ten fingers, an increase in the atd angle and an increase in the fluctuating asymmetry of the atd angle in the oral cleft children which indicates the degree of developmental instability of the oral cleft individual.

An in vitro approach to study chromosomal DNA damage

In this study a simple electrophoresis approach has been proposed for assessing DNA damage per chromosome in vitro. Novel procedures of gel casting, sample loading, electrophoresis and quantification of damage have been suggested. Sets of Saccharomyces cerevisiae chromosomes subjected to DNA damage by Bleomycin, Co60-gamma-radiation alone and in combination with Hoechst were studied in detail. Statistical analyses showed that damage induced by Bleomycin bore linear positive correlation with %GA (r = 0.97) and %GT (r = 0.61) contents of chromosomes. Samples pre-treated with Hoechst showed much less damage by Co60-gamma-irradiation as compared to samples not treated with Hoechst but exposed to Co60-gamma-irradiation. The 'protective effect of Hoechst' bore linear positive correlation (r = 0.8) with %TAT content of chromosomes.

Measurements of sulfur dioxide and formaldehyde in Taipei using a differential optical absorption spectrometer

Taipei, the capital city of Taiwan, lies in a basin, and its topography prevents the dispersion of pollutants in the city. As a continuation of our air quality study, from February 1999 through June 1999, we measured the concentrations of SO2 at six different locations and of formaldehyde at five locations using a differential optical absorption spectrometer (DOAS). The average concentration of SO2 varied from 3.5 to 6.6 ppb. The average concentration was highest at Toucheng because of its proximity to point sources. The level in Hsientien was close to that in Toucheng, with Hsinyu showing the lowest concentrations. The DOAS and the Taiwan Air Quality Monitoring Network (TAQMN) measurements for SO2 were highly correlated (r2 > 0.9) for Toucheng, Panchiao, and Hsientien. However, DOAS SO2 concentrations were 2 times higher for Hsientien and slightly lower for Panchiao than the TAQMN concentrations were. The average concentration of formaldehyde varied from 7 to 10 ppb. Diurnal variation of formaldehyde closely followed the variation of ozone, especially when the 1-hr peak ozone concentration was > 60 ppb. Photochemical formation accounted for the ambient levels of formaldehyde in Taipei. Concentration of formaldehyde became significant on days when O3 concentration was high. Our results indicate that DOAS can replace conventional measurement techniques.

Decreased activity of the L-arginine-nitric oxide metabolic pathway in patients with congestive heart failure

BACKGROUND

Impaired endothelium-dependent, nitric oxide (NO)-mediated vasodilation may contribute to increased vasomotor tone in patients with heart failure. Whether decreased endothelium-dependent, NO-mediated vasodilation in patients with heart failure is due to decreased synthesis or increased degradation of NO is unknown.

METHODS AND RESULTS

To specifically assess the synthetic activity of the L-arginine-NO metabolic pathway, urinary excretion of [15N]nitrates and [15N]urea was determined after a primed continuous intravenous infusion of L-[15N]arginine (40 micromol/kg) in 16 patients with congestive heart failure and 9 age-matched normal control subjects at rest and during submaximal treadmill exercise. After infusion of L-[15N]arginine, 24-hour urinary excretion of [15N]nitrates was decreased in patients with congestive heart failure at rest (2.2+/-0.5 versus 8.0+/-2.3 micromol/24 h) and during submaximal exercise (2.4+/-1.2 versus 11. 4+/-4.0 micromol/24 h) compared with control subjects (both P<0.01). After infusion of L-[15N]arginine, 24-hour urinary excretions of [15N]urea at rest in patients with congestive heart failure and control subjects were not different (1.1+/-0.3 versus 1.2+/-0.2 mmol/24 h, P>0.20).

CONCLUSIONS

A specific decrease in synthetic activity of the L-arginine-NO metabolic pathway contributes to decreased endothelium-dependent vasodilation in patients with congestive heart failure.

Cardiovascular responses to application of lower body negative pressure of male volunteers in seated position

Lower body negative pressure (LBNP) has been used to evaluate orthostatic tolerance and for studying the effects of +Gz induced physiological strain and hence has great practical significance in aerospace medicine. Cardiovascular responses in man on application to LBNP (-40 mmHg) in seated (upright) position in a specially designed LBNP chamber have been studied in eight normal healthy male volunteers between the age group of 25-36 yrs. They were subjected to -40 mmHg negative pressure in steps of -10 mmHg for a duration of 5 min each. The total duration of the experiment was 20 min. Heart rate (HR), blood pressure (BP) Cardiac output (CO) were measured and mean blood pressure (MBP) and total peripheral resistance (TPR) were computed. The results indicate a significant increase in HR (P < 0.01), SV (P < 0.01). Studies on limited number of subjects on application to LBNP (40 mmHg) in supine position have also been carried out and compared with the physiological strain induced in subjects in seated position. Study of HR, SV, CO, responses of the subjects on exposure to LBNP in seated position elicit similar response in subjects exposed to +Gz stress as reported by other workers. It is concluded that LBNP technique can be used to study the effects of +Gz induced physiological strain in man.

Calcium sensitising agents in heart failure

Congestive heart failure (CHF) is a common cardiovascular disorder that is characterised, in part, by a decreased cardiac output reserve. Accordingly, there is ongoing interest in the role of positive inotropic agents (e.g. adrenergic agonists and phosphodiesterase type III inhibitors, which mediate their cardiovascular effects via a cyclic adenosine monophosphate-dependent mechanism) in the treatment of CHF. However, enthusiasm for positive inotropic therapy in CHF has been dampened by the results of clinical trials, which have shown that these drugs are associated with an increased risk of mortality. Calcium sensitising agents are a heterogeneous group of positive inotropic agents that mediate their cardiovascular actions (at least in part) by increasing the sensitivity of the contractile elements to calcium. Increased sensitivity to calcium may be related to changes in calcium binding to troponin C, or to direct effects on the actin-myosin complex. In addition, the inhibition of phosphodiesterase type III may contribute to the positive inotropic action of calcium sensitising agents. Five agents with calcium sensitising properties (pimobendan, levosimendan, MCI-154, EMD-53998 and CGP-48506) have been studied as possible therapies for CHF. All of these agents have demonstrated a positive inotropic action in isolated cardiac tissue and in animal models of CHF. In clinical trials, pimobendan, the most extensively studied of these drugs, was well tolerated and was associated with improved exercise tolerance during the first 6 months of therapy; however, it was also associated with a nonsignificant trend towards increased mortality. Because many of the calcium sensitising agents also inhibit phosphodiesterase type III activity, the long term safety of these agents is uncertain. Large-scale survival trials are required to determine the long term safety and efficacy of these agents before their role in the treatment of CHF can be defined.

Effect of amine activators on the properties of chemical cured dental composites

The purpose of this study was to evaluate the reactivity and the effect of concentration of three tertiary amines upon the mechanical properties of a chemical curing dental composite. Chemical cured composite pastes were prepared by keeping peroxide concentration constant at 1 wt% (by weight of resin mixture) and by varying the amine/peroxide molar ratio from 0.25 to 1.5. Composite samples were prepared for all three amine pastes aged for 1, 15, 30, 45, and 60 d stored at 8, 22, and 37 degrees C. The loss in activity of the tertiary amine with time was measured. Changes in compressive strength, diametral tensile strength, and microhardness were also measured. A sharp decrease in working and setting times corresponding to increased activity was noticed with an increased amine content. The activity was found to vary in the order N,N-dimethyl p-toluidine (DMPT) > 2-(4-dimethylaminophenyl)ethanol (DMAPEA) > N,Ndiethanol p-toluidine (DEPT). DMPT is found to be more temperature sensitive than DMAPEA and DEPT. However, DEPT is found to provide better storage stability out of all three amines tested. Each amine was found to possess optimum concentrations at which the mechanical properties showed maximum values. DEPT is preferred for long-term storage stability in chemical-cured dental composites where aging tends to reduce the activity of the amine.

Survey of the practice of electroconvulsive therapy in North Carolina

A survey of North Carolina hospitals was conducted to determine the distribution and characteristics of facilities that offer electroconvulsive therapy (ECT). Parameters examined in the survey included bed size, geographic location, and average volume of ECT treatments. Facilities that offer ECT make up only 14% of total hospitals surveyed. The majority of hospitals with ECT services are located in moderate to large urban areas. Specific areas of practice were surveyed for each facility, including type of ECT device, location of treatments/recovery, methods for monitoring ictal motor seizure, time required to perform treatments, staffing, and potential areas of ECT nursing education. Standard practices at facilities were found to be generally in compliance with American Psychiatric Association recommendations; differences in practices were identified. Potential nursing education topics related to ECT were ranked to determine those most useful to individual nursing staffs.

State of the art: nursing knowledge and electroconvulsive therapy

Nursing services attempting to develop standards for their own facilities will find limited literature specific to nursing and electroconvulsive therapy (ECT) in American publications. From 1966 to December 1994, there were only 19 publications in American nursing journals that provide a specific focus on nursing and ECT. Only one of these articles reported research findings. Twenty-seven citations in Convulsive Therapy included nurse contributors. While the APA Task Force on the Practice of ECT has addressed educational needs of nursing and technical elements of the procedure, there do not currently exist specific standards for nursing practice in ECT. Concerns salient to nursing that have generated articles by nurses include instruction of patients, support to patients and families, safety of patients, assessment of clinical status, informed consent, and nurses' and patients' attitudes about ECT. Nurses are encouraged to join their physician-colleagues in developing and disseminating the information needed for the field of nursing to contribute its own expertise to the care of patients receiving ECT.

Destructive skeletal lesions as the primary initial manifestation of acute childhood leukemia

Bony involvement in leukemia has been long recognized in the medical literature. However, severe osseous changes, as the sole initial manifestation of childhood leukemia is a unique feature of the case reported here.