The pre-hospital epidemiology and management of spinal cord injuries in New South Wales: 2004-2008

CONTEXT

Patients who have sustained a traumatic spinal cord injury require appropriate management in the immediate post-injury period for both survival and to reduce the chances of costly and disabling permanent neurological deficits. Emerging time-critical neuroprotective therapies require the prompt recognition and transfer of patients to a specialised centre for early intervention.

METHODS

The Ambulance Research Institute, with the New South Wales State Spinal Cord Injury Service retrospectively linked prehospital data to spinal cord injury unit (SCIU) outcome data for all 324 patients transported by ambulance and subsequently admitted to a SCIU with a persisting traumatic spinal cord injury (SCI) between January 2004 and June 2008, with the aim of identifying factors that impact on the provision of timely and appropriate care.

RESULTS

Paramedics appropriately managed 88% of SCI patients. Only 4.9% of patients had initial vital signs potentially indicative of neurological injury. The median time to a SCIU was 12h, with 60% of patients undergoing multiple transfers. The odds of reaching a SCIU in over 24h were 1.71 times greater for patients injured in a major city (95% CI 1.00-2.90) in comparison to other areas of NSW. More SCI patients with multiple trauma experienced delays in reaching a SCIU (59%), compared to patients with isolated SCI (40%; p=0.039). Patients initially transported to a designated major trauma centre were more likely to be delayed in reaching a SCIU, regardless of whether their injury was an isolated SCI or associated with multiple trauma, compared with other patients. Patients who took greater than 24h to reach a SCIU were 2.5 times more likely to develop a secondary complication (95% CI 1.51-4.17, p=0.0004). Patients who sustained their SCI as a result of a low fall were older and less likely to have their SCI identified and treated early, with less than half of this group reaching a SCIU within 24h compared with other SCI patients (OR 0.42, 95% CI 0.19-0.93, p=0.004).

CONCLUSION

Early recognition, appropriate prehospital management, triage, timely and appropriate interfacility transfers of all SCI patients are critical for access to specialised care and reducing preventable complications. Elderly fallers present particular challenges to early identification.

Tendon regeneration and repair with stem cells

The use of stems cells in tendon repair is of particular interest given the frequency of tendon injuries worldwide together with the technical difficulty often encountered when repairing or augmenting tendons. Stems cells have the capability to differentiate into a variety of different cell types including osteocytes and tenocytes, and if normal architecture of damaged tendon (either macroscopic or microscopic) could be restored, this would significantly improve the management of patients with these injuries. There is already encouraging research on the use of stems cells clinically although considerable further work is required to improve knowledge and clinical applications of stem cells in tissue engineering.

EGFR-dependent pancreatic carcinoma cell metastasis through Rap1 activation

Tyrosine kinase receptors play an essential role in various aspects of tumor progression. In particular, epidermal growth factor receptor (EGFR) and its ligands have been implicated in the growth and dissemination of a wide array of human carcinomas. Here, we describe an EGFR-mediated signaling pathway that regulates human pancreatic carcinoma cell invasion and metastasis, yet does not influence the growth of primary tumors. In fact, ligation/activation of EGFR induces Src-dependent phosphorylation of two critical tyrosine residues of p130CAS, leading to assembly of a CAS/Nck1 complex that promotes Rap1 signaling. Importantly, GTP loading of Rap1 is specifically required for pancreatic carcinoma cell migration on vitronectin, but not on collagen. Furthermore, Rap1 activation is required for EGFR-mediated metastasis in vivo without impacting primary tumor growth. These findings identify a molecular pathway that promotes the invasive/metastatic properties of human pancreatic carcinomas driven by EGFR.

Determination of theophylline in rabbit plasma by triple quadrupole LC/MS

AIM AND BACKGROUND

A simple, sensitive and rapid method was developed for quantitation of theophylline in rabbit plasma utilizing Triple Quadrupole LC/MS.

MATERIALS AND METHODS

An aliquot of 0.1 mL of plasma sample was extracted with ethyl acetate using Heidolph Vortex. The chromatographic separation was performed by using HyPURITY ADVANCE™ C18 Column (3 × 50 mm) with a mobile phase of 80% methanol and 20% 2 mM ammonium acetate buffer followed by MS/MS detection. The analyte was quantitated in positive ionization mode. Multiple reaction monitoring (MRM) using the transition m/z 181.1→124.2 and m/z 180.2→110.1 was performed to quantify theophylline with internal standard (IS, Phenacetin), respectively. The method had a total chromatographic runtime of 3 min and linear calibration curves over the concentration range of 50.418-5062.063 ng/mL. The lower limit of quantification (LLOQ) was 50.418 ng/mL Sodium heparin (3.50%) used as an anticoagulant to prepare rabbit plasma and samples were maintained at 10°C in the auto sampler during the assay period. Inter and intraday batch precision and accuracy of the method were determined by using six quality control samples.

RESULTS

Average accuracies for the assay were 89 to 106%, inter and intra-day coefficients variation (CV) of <9% and the recovery is 39.30% for theophylline and 57.00% for Phenacetin.

CONCLUSION

Currently we are extensively using this method in our laboratory for quantitative analysis of theophylline in rabbit plasma samples and proved to be simple, accurate and precise.

Extremity and Orthopaedic Injuries

The extremities remain the most common sites of wounding in combat, and are often a combination of injures to soft tissues, bones, vessels and nerves. While these injuries are managed only after life threatening injuries are tackled first, precise evaluation and prompt management strategies to attain optimal outcome remain the goals of treatment. With advancements in tourniquet science, broader spectrum antibiotics, use of negative pressure wound therapy, easier options for fracture stabilization and continuously evolving reconstructive procedures have all increased the tools available to the surgeon to salvage severely damaged limbs.

Effect of varying glucose concentrations during in vitro maturation and embryo culture on efficiency of in vitro embryo production in buffalo

This study was aimed to optimize glucose level at different stages of buffalo in vitro embryo production procedure. Three glucose levels (1.5, 5.6 and 10 mm) along with a control (0 mm) were used at three phases of in vitro fertilisation (IVF) procedure viz. in vitro maturation (IVM), in vitro culture (IVC-I) (12-72 hpi) and IVC-II (72 hpi to 7 dpi). Maturation rate of oocytes was found different under different glucose concentrations, and significantly more number of oocytes reached to MII under 5.6 mm glucose. The glucose levels at each phase (IVM, IVC-I and IVC-II) individually had significant effect on blastocyst rate, and the level used at one phase had significant effect on the outcome of next phase. Complete withdrawal of glucose from any of these stages irrespective of concentrations used at subsequent stage/s resulted in significantly lower number of blastocysts. However, the changing levels of glucose had differential effects during different phases of IVF steps. The most prominent effect of glucose level was observed during IVM. The presence of 5.6 mm glucose at all stages was most effective to yield highest blastocyst rate in buffalo IVF system.

Portable cost-effective EEG data acquisition system

Neuro-cognitive dysfunctions are common clinical abnormalities found in society. They require objective analysis by various instruments; an important technique involves monitoring electroencephalogram (EEG) signals. To date, EEG machines have been robust, costly and require patients to come to a hospital for test. Therefore, we have constructed a simple, cheap and portable EEG instrument for wider patient use. It consists of two active digital EEG probes with two channels each, making it a four-channel portable acquisition system. It is further connected through a two-wire serial bus to the acquisition unit, which comprises an analogue to digital converter (ADC) and an ARM board processor with 2 GB memory and USB interface. The whole system is placed in a small box making it highly portable for wider use in clinical settings.

Serial measurements of hepatitis C viral load by real-time polymerase chain reaction among recipients of living-donor renal transplants: a short-term follow-up study from a single center

There is a high prevalence of hepatitis C virus (HCV) infection among immunosuppressed patients including renal transplant recipients. The study investigated serum viral loads for up to 6 months posttransplantation among these patients. Serum viral load was serially monitored using real-time polymerase chain reaction (PCR) in 25 HCV-positive renal transplant recipients pretransplantation as well as day 10 and 6 months posttransplantation. A liver biopsy specimen obtained under vision at the time of transplantation was analyzed for viral load as well as for histological changes. There was increased viremia at day 10 followed by a significant (2 log) reduction at 6 months posttransplantation. Pretransplantation serum and intrahepatic viral load showed significant positive correlations (r = 0.727; P = .001), the latter also reflecting liver fibrosis score (r = 0.423; P = .05). The findings suggested that serum viral load reflects intrahepatic viral load, which in turn correlates with liver fibrosis. At 6 months posttransplantation, the modulatory effects of immunosuppressive drugs and of the host immune response may lead to a reduced viral load.

Fluoride adsorption studies on mixed-phase nano iron oxides prepared by surfactant mediation-precipitation technique

Mixed nano iron oxides powder containing goethite (α-FeOOH), hematite (α-Fe(2)O(3)) and ferrihydrite (Fe(5)HO(8)·4H(2)O) was synthesized through surfactant mediation-precipitation route using cetyltrimethyl ammonium bromide (CTAB). The X-ray diffraction, FTIR, TEM, Mössbauer spectroscopy were employed to characterize the sample. These studies confirmed the nano powder contained 77% goethite, 9% hematite and 14% ferrihydrite. Fluoride adsorption onto the synthesized sample was investigated using batch adsorption method. The experimental parameters chosen for adsorption studies were: pH (3.0-10.0), temperature (35-55°C), concentrations of adsorbent (0.5-3.0 g/L), adsorbate (10-100 mg/L) and some anions. Adsorption of fluoride onto mixed iron oxide was initially very fast followed by a slow adsorption phase. By varying the initial pH in the range of 3.0-10.0, maximum adsorption was observed at a pH of 5.75. Presence of either SO(4)(2-) or Cl(-) adversely affected the adsorption of fluoride in the order of SO(4)(2-)>Cl(-). The FTIR studies of fluoride loaded adsorbent showed that partly the adsorption on the surface took place at surface hydroxyl sites. Mössbauer studies indicated that the overall absorption had gone down after fluoride adsorption that implies it has reduced the crystalline bond strength. The relative absorption area of ferrihydrite was marginally increased from 14 to 17%.

Fluoride release from a new glass-ionomer cement

This study compared the amount and pattern of fluoride release from a new glass-ionomer-based material (nano-ionomer) with other restorative materials and correlated the surface area to volume of nano-sized filler with its capacity to release fluoride in the powder, more quickly increasing the fluoride. The materials evaluated were a nano-ionomer (Ketac N 100), a conventional glass-ionomer cement (GC Fuji II), a resin-modified glass ionomer cement (GC Fuji II LC), a compomer (Dyract F) and a fluoride-releasing resin composite (Tetric N Flow). A resin composite (Synergy Flow) served as the control. Ten specimens were fabricated from each of these materials using a customized metal mold. The fluoride release was measured every 24 hours for the first seven days, and on days 14, 21 and 28, a combination fluoride ion—selective electrode connected to an ion analyzer. The data was analyzed by one-way ANOVA and Tukey HSD test (p=0.05). An initial fluoride “burst effect” was seen with all of the materials, except for the control and compomer. The conventional glass-ionomer cement showed the highest fluoride release on the first three days. The nano-ionomer showed the maximum release of fluoride for the remaining days. A low constant level of fluoride release was seen from the compomer and fluoride-releasing resin composite throughout the study period.

GT-094, a NO-NSAID, inhibits colon cancer cell growth by activation of a reactive oxygen species-microRNA-27a: ZBTB10-specificity protein pathway

Ethyl 2-((2,3-bis(nitrooxy)propyl)disulfanyl)benzoate (GT-094) is a novel nitric oxide (NO) chimera containing an nonsteroidal anti-inflammatory drug (NSAID) and NO moieties and also a disulfide pharmacophore that in itself exhibits cancer chemopreventive activity. In this study, the effects and mechanism of action of GT-094 were investigated in RKO and SW480 colon cancer cells. GT-094 inhibited cell proliferation and induced apoptosis in both cell lines and this was accompanied by decreased mitochondrial membrane potential (MMP) and induction of reactive oxygen species (ROS), and these responses were reversed after cotreatment with the antioxidant glutathione. GT-094 also downregulated genes associated with cell growth [cyclin D1, hepatocyte growth factor receptor (c-Met), epidermal growth factor receptor (EGFR)], survival (bcl-2, survivin), and angiogenesis [VEGF and its receptors (VEGFR1 and VEGFR2)]. Results of previous RNA interference studies in this laboratory has shown that these genes are regulated, in part, by specificity protein (Sp) transcription factors Sp1, Sp3, and Sp4 that are overexpressed in colon and other cancer cell lines and not surprisingly, GT-094 also decreased Sp1, Sp3, and Sp4 in colon cancer cells. GT-094-mediated repression of Sp and Sp-regulated gene products was due to downregulation of microRNA-27a (miR-27a) and induction of ZBTB10, an Sp repressor that is regulated by miR-27a in colon cancer cells. Moreover, the effects of GT-094 on Sp1, Sp3, Sp4, miR-27a, and ZBTB10 were also inhibited by glutathione suggesting that the anticancer activity of GT-094 in colon cancer cells is due, in part, to activation of an ROS-miR-27a:ZBTB10-Sp transcription factor pathway.

Dysglycaemia and the risk of acute myocardial infarction in multiple ethnic groups: an analysis of 15,780 patients from the INTERHEART study

AIMS/HYPOTHESIS

Although diabetes is an established risk factor for myocardial infarction (MI), disease control may vary. HbA(1c) is a reliable index of ambient glucose levels and may provide more information on MI risk than diabetes status.

METHODS

The relationship between HbA(1c) levels in MI patients and controls who participated in the 52 country INTERHEART study was analysed.

RESULTS

In 15,780 participants with a HbA(1c) value (1,993 of whom had diabetes), the mean (SD) levels for HbA(1c) were 6.15% (1.10) in the 6,761 MI patients and 5.85% (0.80) in the control participants. After adjustment for age, sex and nine major MI risk factors (including diabetes), higher HbA(1c) fifths above the lowest fifth (HbA(1c) <5.4%) were associated with progressively higher OR of MI, with OR for the highest HbA(1c) fifth (≥ 6.12%) being 1.55 (95% CI 1.37-1.75). When analysed as a continuous variable after adjustment for the same factors, every 1% higher HbA(1c) value was associated with 19% (95% CI 14-23) higher odds of MI, while every 0.5% higher HbA(1c) was associated with 9% higher odds of MI (95% CI 7-11). Concordant relationships were noted across subgroups, with a higher OR noted in younger people, patients without diabetes or hypertension, and those from some regions and ethnicities.

CONCLUSIONS/INTERPRETATION

The HbA(1c) value provides more information on MI odds than self-reported diabetes status or many other established risk factors. Every 1% increment independently predicts a 19% higher odds of MI after accounting for other MI risk factors including diabetes.

Effects of ethnicity on diabetes incidence and prevention: results of the Diabetes REduction Assessment with ramipril and rosiglitazone Medication (DREAM) trial

AIMS

Risk of Type 2 diabetes varies by ethnicity, but whether ethnicity remains important among those who have impaired glucose tolerance or impaired fasting glucose is uncertain. Whether the effect of thiazolidinedione treatment on diabetes prevention in persons with non-diabetic dysglycaemia varies by ethnicity is also not known. We addressed these questions using data collected in the DREAM trial.

METHODS

A 2-by-2 factorial double-blind randomized controlled trial to compare the effects of rosiglitazone and ramipril on the primary outcome of diabetes or death in persons meeting criteria for impaired glucose tolerance or impaired fasting glucose. The effect of these interventions by ethnicity was estimated using Cox regression analysis.

RESULTS

Of 5269 adults, 2365 were randomly assigned to rosiglitzone and 2634 to placebo. South Asians showed a higher hazard for the primary outcome compared with Europeans (hazard ratio, 95% confidence interval 2.21, 1.41-3.47) adjusted for age, gender, BMI, waist-hip ratio and geographic region. A lesser increase in risk was seen in Black people (1.37, 1.04-1.81). A significant reduction in risk of the primary outcome with rosiglitazone treatment assignment was seen in all ethnic groups, but the treatment effect significantly differed by ethnicity (P=0.0242), with South Asians experiencing a smaller, and Latinos a larger preventive effect.

CONCLUSIONS

Ethnicity is an important risk factor for Type 2 diabetes in dysglycaemic persons. All ethnic groups experienced a large significant reduction in diabetes risk because of rosiglitazone. The magnitude of this reduction differed by ethnicity. Given the post hoc nature of this analysis, further confirmation of these findings is needed.

Inhibition of protein tyrosine phosphatase 1B and regulation of insulin signalling markers by caffeoyl derivatives of chicory ( Cichorium intybus) salad leaves

Evaluations of molecular mechanisms of dietary plants with their active molecules are essential for the complete exploration of their nutritive and therapeutic value. In the present study, we investigated the effect of chicory (Cichorium intybus) salad leaves in inhibiting protein tyrosine phosphatase 1B (PTP1B), and evaluated their role in modulating the key markers involved in insulin cell signalling and adipogenesis using 3T3-L1 adipocytes. Bioactivity-directed purification studies enlightened the additive effects of chlorogenic acid (CGA) along with other caffeic acid derivatives present in methanolic extract of C. intybus (CME). Incubation of CME and CGA with 3T3-L1 adipocytes significantly enhanced the 2-deoxy-d-3[H]-glucose uptake and inhibited adipogenesis through altering the expressions of insulin signalling and adipogenesis markers. Extending to an in vivo model, the effect of CME was also investigated on insulin sensitivity in high-fat diet with low streptozotocin-induced diabetic rats. Supplementation of CME for 2 weeks reinstated the insulin sensitivity along with plasma metabolic profile. The present results demonstrate that the caffeoyl derivatives of chicory salad leaves show promising pharmacological effect on energy homoeostasis via PTP1B inhibition both in vitro and in vivo.

Bayesian methods for meta-analysis of causal relationships estimated using genetic instrumental variables

Genetic markers can be used as instrumental variables, in an analogous way to randomization in a clinical trial, to estimate the causal relationship between a phenotype and an outcome variable. Our purpose is to extend the existing methods for such Mendelian randomization studies to the context of multiple genetic markers measured in multiple studies, based on the analysis of individual participant data. First, for a single genetic marker in one study, we show that the usual ratio of coefficients approach can be reformulated as a regression with heterogeneous error in the explanatory variable. This can be implemented using a Bayesian approach, which is next extended to include multiple genetic markers. We then propose a hierarchical model for undertaking a meta-analysis of multiple studies, in which it is not necessary that the same genetic markers are measured in each study. This provides an overall estimate of the causal relationship between the phenotype and the outcome, and an assessment of its heterogeneity across studies. As an example, we estimate the causal relationship of blood concentrations of C-reactive protein on fibrinogen levels using data from 11 studies. These methods provide a flexible framework for efficient estimation of causal relationships derived from multiple studies. Issues discussed include weak instrument bias, analysis of binary outcome data such as disease risk, missing genetic data, and the use of haplotypes.

Kinematics-coordinated walking pattern based on embedded controls

Electromechanical above-knee prosthetics are widely available, and are reliant on repetitive knee movements of fixed length/angle. This work explores the viability of developing adaptive movements on existing prototypes, through embedded controls from 8051-class 8-bit microcontroller units (MCUs). The system includes an integrated goniometer, intended for measuring the knee angle of the sound limb. The phase delay is subsequently processed to bring about kinematic coordination in the proposed echo-controlled prosthetic.

An overview of common lower extremity soft tissue injuries in athletes

Lower limb soft tissue injuries are commonly encountered in sports medicine especially in athletes and long distance runners. Dilemmas can exist in identifying the correct aetiology as it can frequently be multifactorial. Management of such injuries in lower limbs is evolving as more people perform physical exercise and play sport. This article is an overview of common lower limb soft tissue injuries seen in athletes.

Lower extremity soft tissue injuries are common among athletes and non-athlete runners.1 Running injuries can be defined as pain or symptoms associated with running or starting within a specific time span from the beginning of a training programme, which forces the individual to stop training or decrease intensity.2 The knee is the commonest site involved comprising up to 44% of running injuries.2,3 This article outlines the natural history, pathophysiology, investigation and management of common conditions.

The elderly patients on hemodialysis

Nephrologists care for an increasing number of elderly patients on hemodialysis. As such, an understanding of the overlap among complications of hemodialysis and geriatric syndromes is crucial. This article reviews hemodialysis management issues including vascular access, hypertension, anemia and bone and mineral disorders with an attention towards the distinct medical needs of the elderly. Key concepts of geriatrics frailty, dementia and palliative care are also discussed, as nephrologists frequently participate in decision-making directed toward balancing longevity, functional status and the burden of therapy.

Radio-toxicity of spent fuel of the advanced heavy water reactor

The Advanced Heavy Water Reactor (AHWR) is a new power reactor concept being developed at Bhabha Atomic Research Centre, Mumbai. The reactor retains many desirable features of the existing Pressurised Heavy Water Reactor (PHWR), while incorporating new, advanced safety features. The reactor aims to utilise the vast thorium resources available in India. The reactor core will use plutonium as the make-up fuel, while breeding (233)U in situ. On account of this unique combination of fuel materials, the operational characteristics of the fuel as determined by its radioactivity, decay heat and radio-toxicity are being viewed with great interest. Radio-toxicity of the spent fuel is a measure of potential radiological hazard to the members of the public and also important from the ecological point of view. The radio-toxicity of the AHWR fuel is extremely high to start with, being approximately 10(4) times that of the fresh natural U fuel used in a PHWR, and continues to remain relatively high during operation and subsequent cooling. A unique feature of this fuel is the peak observed in its radio-toxicity at approximately 10(5) y of decay cooling. The delayed increase in fuel toxicity has been traced primarily to a build-up of (229)Th, (230)Th and (226)Ra. This phenomenon has been observed earlier for thorium-based fuels and is confirmed for the AHWR fuel. This paper presents radio-toxicity data for AHWR spent fuel up to a period of 10(6) y and the results are compared with the radio-toxicity of PHWR.

Synthesis of Mg(II) doped goethite and its cation sorption behaviour

Modified goethite samples were prepared with Mg(II) content varying in the range of 0-1.36%. A typical TEM of Mg(II) doped sample showed needle shaped goethite particles having 10-30 nm width and 100-400 nm length. Sorption studies of cations namely Pb(II), Cu(II), Cd(II), Zn(II) and Fe(III) were conducted onto the Mg(II) doped modified goethite surface. Goethite doping with 0.18 M Mg (GMg(2)) showed better sorption capacity for Pb(II), Cu(II) and Cd(II). Therefore, the effect of contact time, solution pH, sorbate and sorbent concentrations on the sorption of various metal ions was studied on this sample in batch experiments. The time data fitted to pseudo-second-order kinetics for all the metal ions. Sorption on GMg(2) sample for the metal ions increased with the increase in pH from 2 to 4. The isothermic data showed good fit to both Langmuir and Freundlich isotherms except for Cd(II) which followed only the later model. The sorption capacities with respect to Pb(II), Cd(II), Zn(II), Cu(II) and Fe(III) were found to be 87.7, 153.25, 86.25, 33.4 and 72.5mg/g respectively. The results of sorption studies on GMg(2) from binary and ternary solutions have also been presented. The XRD patterns of metal ion loaded GMg(2) samples confirmed that metal ion adsorption resulted in shifting of d-values/altering of relative intensity (RI) of major planes of goethite.

Synthesis of Mg(II) doped goethite and its cation sorption behaviour

Modified goethite samples were prepared with Mg(II) content varying in the range of 0-1.36%. A typical TEM of Mg(II) doped sample showed needle shaped goethite particles having 10-30 nm width and 100-400 nm length. Sorption studies of cations namely Pb(II), Cu(II), Cd(II), Zn(II) and Fe(III) were conducted onto the Mg(II) doped modified goethite surface. Goethite doping with 0.18 M Mg (GMg(2)) showed better sorption capacity for Pb(II), Cu(II) and Cd(II). Therefore, the effect of contact time, solution pH, sorbate and sorbent concentrations on the sorption of various metal ions was studied on this sample in batch experiments. The time data fitted to pseudo-second-order kinetics for all the metal ions. Sorption on GMg(2) sample for the metal ions increased with the increase in pH from 2 to 4. The isothermic data showed good fit to both Langmuir and Freundlich isotherms except for Cd(II) which followed only the later model. The sorption capacities with respect to Pb(II), Cd(II), Zn(II), Cu(II) and Fe(III) were found to be 87.7, 153.25, 86.25, 33.4 and 72.5mg/g respectively. The results of sorption studies on GMg(2) from binary and ternary solutions have also been presented. The XRD patterns of metal ion loaded GMg(2) samples confirmed that metal ion adsorption resulted in shifting of d-values/altering of relative intensity (RI) of major planes of goethite.

Antenatal detection of cleft lip with or without cleft palate: incidence of associated chromosomal and structural anomalies

OBJECTIVE

To ascertain how many fetuses with prenatally diagnosed cleft lip with or without cleft palate have associated congenital structural and/or chromosomal abnormalities and whether there is an association with the anatomical type of cleft lip or palate.

METHODS

This was a retrospective review of infants referred to the North-West England Regional Cleft Lip and Palate (CLAP) team between January 2000 and January 2006. Referrals made to the Regional Fetal Management Unit (FMU) in the same time period were investigated to identify the corresponding antenatal ultrasound findings and data on termination of pregnancy and intrauterine fetal death.

RESULTS

Over the 6-year period investigated, 570 infants were referred to the FMU and/or CLAP team. Among these, there were 24 terminations of pregnancy, two intrauterine fetal deaths and one early neonatal death identified. Data on 69 of the 543 patients that survived were incomplete. Of 188 cases with unilateral and 34 cases with bilateral cleft lip +/- palate there were no karyotypical abnormalities without other structural abnormalities. The incidence of associated structural abnormalities varied with the anatomical type of cleft: that of unilateral cleft lip +/- palate was 9.8% (19/194), that of bilateral cleft lip and palate was 25% (11/44) and that of midline cleft lip and palate was 100% (11/11). None of 252 cases with isolated cleft palate was identified antenatally; of these, 5.6% (n = 14) had either karyotypical or associated structural abnormalities and 21.0% (n = 53) had a genetic syndrome as an underlying diagnosis.

CONCLUSIONS

It is essential to tailor the antenatal counseling of patients to the specific scan diagnosis, considering both the anatomical type of cleft and the presence or absence of associated abnormalities. It is inappropriate to offer invasive testing to all patients. The use of three-dimensional ultrasound as an adjunct should be considered in these patients to improve the accuracy of prenatal diagnosis.

Review of fluoride removal from drinking water

Fluoride in drinking water has a profound effect on teeth and bones. Up to a small level (1-1.5mg/L) this strengthens the enamel. Concentrations in the range of 1.5-4 mg/L result in dental fluorosis whereas with prolonged exposure at still higher fluoride concentrations (4-10mg/L) dental fluorosis progresses to skeletal fluorosis. High fluoride concentrations in groundwater, up to more than 30 mg/L, occur widely, in many parts of the world. This review article is aimed at providing precise information on efforts made by various researchers in the field of fluoride removal for drinking water. The fluoride removal has been broadly divided in two sections dealing with membrane and adsorption techniques. Under the membrane techniques reverse osmosis, nanofiltration, dialysis and electro-dialysis have been discussed. Adsorption, which is a conventional technique, deals with adsorbents such as: alumina/aluminium based materials, clays and soils, calcium based minerals, synthetic compounds and carbon based materials. Studies on fluoride removal from aqueous solutions using various reversed zeolites, modified zeolites and ion exchange resins based on cross-linked polystyrene are reviewed. During the last few years, layered double oxides have been of interest as adsorbents for fluoride removal. Such recent developments have been briefly discussed.

A set of EEG parameters to predict clinically anaesthetized state in humans for halothane anaesthesia

This article evaluates all the EEG parameters suggested in the literature that undergo changes due to anaesthetic dose, and suggests a set of EEG parameters that act as best signatures of anaesthetic state of a patient. This set of EEG parameters is validated by an artificial neural network.

PRIMARY OBJECTIVE

The purpose of this study is to arrive at a set of EEG parameters that 'best' distinguish between awake and anaesthetized states of human patients for halothane anaesthesia.

METHODS AND PROCEDURES

A total of 21 EEG parameters were evaluated for 40 patients. Stepwise discriminant analysis (SDA) pruned them to a set of five parameters. They were fed to a 5-3-1 artificial neural network (ANN) for classification into awake and anaesthetized state. To confirm the results, variance analysis was applied to the set of 21 parameters. Five parameters were finalized after validation by the ANN.

MAIN OUTCOMES AND RESULTS

The classification accuracy of the ANN with SDA parameters was found to be 96%. With variance analysis parameters, it returned an accuracy of 100%.

CONCLUSION

The set of five EEG parameters - approximate entropy, average frequency, Lempel Ziv (LZ) complexity, delta power and beta power forms the best set to distinguish between awake and anaesthetized state of human patients. Variance analysis is a better tool to converge at the optimal set than SDA.

Electrical impedance plethysmography technique in estimating pulmonary function status

An attempt has been made to study the appropriateness of electrical impedance plethysmography (EIP) in detecting pulmonary health status. A feasibility study was conducted on normal, obstructive and restrictive subjects aged between 20 and 60 years. Quantitative assessment of pulmonary function was made by way of both EIP and pulmonary function tests (PFT). Amongst the various EIP parameters, a statistically significant difference was observed for the respiratory band power, between normal (129.7) and obstructive (35.8) subjects, indicating that this EIP variable can be used to distinguish between the two pulmonary function states. A significant positive correlation was observed between a spirometry parameter, peak expiratory flow rate (PEFR), and an EIP parameter, respiratory amplitude (r = 0.372, p < 0.05), thereby indicating that EIP information by way of respiratory amplitude is comparable to that provided by PEFR. Hence, both respiratory amplitude and respiratory band power were seen to provide useful information on pulmonary health status.

Visual perceptual learning is similar across the extrafoveal central visual fields

PURPOSE

Visual perceptual learning occurs with the presentation of novel visual stimuli at retinal sites near the fovea to 20 degrees eccentricities. It was unclear if the magnitude and rate of visual learning were similar across the central visual fields or if visual learning decreased with increasing eccentricity. The robustness of learning across the visual fields may affect the magnitude of computer-aided visual recovery after visual brain injury. Therefore we determined if eccentricity was a factor that influenced perceptual learning.

METHODS

Subjects were trained to detect the presence or absence of a single line oriented differently (odd-element) from an array of lines that otherwise had the same orientation. The odd-element line was presented 3 degrees, 9 degrees or 18 degrees from fixation.

RESULTS

Perceptual performance improved during training trials with a similar magnitude and similar learning curve slopes at all 3 eccentricities. Pre- and post-training performance improved to a similar magnitude at 3 vs 9 degrees in 4 of 4 subjects tested and at 9 degrees vs 18 degrees in 4 of 5 subjects. In the fifth subject there was no post-training improvement in performance at 18 degrees.

CONCLUSION

Visual perceptual learning is similar across the extrafoveal central visual fields in almost all subjects.