Comparison of risk scoring systems in congenital heart surgery

Hacettepe University Faculty of Medicine Department of Cardiovascular Surgery; data of 413 patients under 18 years old who had congenital heart surgery were evaluated between 01.01.2011-30.10.2012 and risk scorings were made by "RACHS-1 (Risk Adjustment in Congenital Heart Surgery)", "Aristotle Basic Complexity Score (ABS)" and "Aristotle Comprehensive Complexity Score (ACS)" systems used in evaluation of the risk of mortality and morbidity in (ACS)" systems used in evaluation of the risk of mortality and morbidity in congenital heart surgery. Data obtained were compared by Mann-Whitney U test and how effective these systems were in evaluating mortality and morbidity and their superiorities over each other were examined. Following the research, it was observed that all three systems were effective in evaluating mortality and morbidity; the most successful of them in foreseeing the event was the ACS system, ACS system was followed by RACHS-1 system and ABS system was the most incapable of these in foreseeing the event. It was seen that in detecting time related mortality, rating of these tests changed, RACHS-1 system detected the time related mortality best. It was also seen that with RACHS-1 system, a previously evaluated concept, it was possible to determine morbidity.

3D-Printed ABS and PLA Scaffolds for Cartilage and Nucleus Pulposus Tissue Regeneration

Painful degeneration of soft tissues accounts for high socioeconomic costs. Tissue engineering aims to provide biomimetics recapitulating native tissues. Biocompatible thermoplastics for 3D printing can generate high-resolution structures resembling tissue extracellular matrix. Large-pore 3D-printed acrylonitrile butadiene styrene (ABS) and polylactic acid (PLA) scaffolds were compared for cell ingrowth, viability, and tissue generation. Primary articular chondrocytes and nucleus pulposus (NP) cells were cultured on ABS and PLA scaffolds for three weeks. Both cell types proliferated well, showed high viability, and produced ample amounts of proteoglycan and collagen type II on both scaffolds. NP generated more matrix than chondrocytes; however, no difference was observed between scaffold types. Mechanical testing revealed sustained scaffold stability. This study demonstrates that chondrocytes and NP cells can proliferate on both ABS and PLA scaffolds printed with a simplistic, inexpensive desktop 3D printer. Moreover, NP cells produced more proteoglycan than chondrocytes, irrespective of thermoplastic type, indicating that cells maintain individual phenotype over the three-week culture period. Future scaffold designs covering larger pore sizes and better mimicking native tissue structure combined with more flexible or resorbable materials may provide implantable constructs with the proper structure, function, and cellularity necessary for potential cartilage and disc tissue repair in vivo.

The combined benefits of motorcycle antilock braking systems (ABS) in preventing crashes and reducing crash severity

OBJECTIVE

Several studies have reported the benefits of motorcycle antilock braking systems (ABS) in reducing injury crashes, due to improved stability and braking performance. Both aspects may prevent crashes but may also reduce the crash severity when a collision occurs. However, it is still unknown to what extent the reductions in injury crashes with ABS may be due to a combination of these mechanisms.

METHODS

Swedish hospital and police reports (2003-2012) were used. The risk for permanent medical impairment (RPMI) was calculated, showing the risk of at least 1 or 10% permanent medical impairment. In total, 165 crashes involving ABS-equipped motorcycles were compared with 500 crashes with similar motorcycles without ABS. The analysis was performed in 3 steps. First, the reduction in emergency care visits with ABS was calculated using an induced exposure approach. Secondly, the injury mitigating effects of ABS were investigated. The mean RPMI 1+ and RPMI 10+ were analyzed for different crash types. The distributions of impairing injuries (PMI 1+) and severely impairing injuries (PMI 10+) were also analyzed. In the third step, the total reduction of PMI 1+ and PMI 10+ injured motorcyclists was calculated by combining the reductions found in the previous steps. An additional analysis of combined braking systems (CBS) together with ABS was also performed.

RESULTS

The results showed that emergency care visits were reduced by 47% with ABS. In the second step, it was found that the mean RPMI 1+ and RPMI 10+ with ABS were 15 and 37% lower, respectively. Finally, the third step showed that the total reductions in terms of crash avoidance and mitigation of PMI 1+ and PMI 10+ injured motorcyclists with ABS were 67 and 55%, respectively. However, PMI 1+ and PMI 10+ leg injuries were not reduced by ABS to the same extent. Indications were found suggesting that the benefits of ABS together with CBS may be greater than ABS alone.

CONCLUSIONS

This article indicated that motorcycle ABS reduced impairing injuries, mostly due to fewer emergency care visits but also due to a reduction in crash severity. This may seem reasonable as the improved stability and braking performance provided by ABS could prevent some crashes but would also decrease crash severity if a collision still occurs. As suggested by previous studies, however, the lower extremities would be more exposed in a crash with ABS. It is recommended that future research should follow up these results with additional data.

Can a Boxer Engine Reduce Leg Injuries Among Motorcyclists? Analysis of Injury Distributions in Crashes Involving Different Motorcycles Fitted with Antilock Brakes (ABS)

OBJECTIVES

Several studies have shown that motorcycle antilock braking systems (ABS) reduce crashes and injuries. However, it has been suggested that the improved stability provided by ABS would make upright crashes more frequent, thus changing the injury distributions among motorcyclists and increasing the risk of leg injuries. The overall motorcycle design can vary across different categories and manufacturers. For instance, some motorcycles are equipped with boxer-twin engines; that is, with protruding cylinder heads. A previous study based on a limited material has suggested that these could provide some leg protection; therefore, the aim of this research was to analyze injury distributions in crashes involving ABS-equipped motorcycles with boxer-twin engines compared to similar ABS-equipped motorcycles with other engine configurations.

METHODS

Swedish hospital and police records from 2003-2014 were used. Crashes involving ABS-equipped motorcycles with boxer-twin engines (n = 55) were compared with similar ABS-equipped motorcycles with other engines configurations (n = 127). The distributions of Abbreviated Injury Scale (AIS) 1+ and AIS 2+ were compared. Each subject's injury scores were also converted to the risk for permanent medical impairment (RPMI), which shows the risk of different levels of permanent medical impairment given the severity and location and of injuries. To compare injury severity, the mean RPMI 1+ and RPMI 10+ were analyzed for each body region and in overall for each group of motorcyclists.

RESULTS

It was found that AIS 1+, AIS 2+, and PMI 1+ leg injuries were reduced by approximately 50% among riders with boxer engines. These results were statistically significant. The number of injuries to the upper body did not increase; the mean RPMI to the head and upper body were similar across the 2 groups, suggesting that the severity of injuries did not increase either. Indications were found suggesting that the overall mean RPMI 1+ was lower among riders with boxer engines, although this result was not statistically significant. The mean values of the overall RPMI 10+ were similar.

CONCLUSIONS

Boxer-twin engines were not originally developed to improve motorcycle crashworthiness. However, the present article indicates that these engines can reduce leg injuries among riders of motorcycles fitted with ABS. Though it is recommended that future research should look deeper into this particular aspect, the present findings suggest that the concept of integrated leg protection is indeed feasible and that further engineering efforts in this area are likely to yield significant savings in health losses among motorcyclists.

Effectiveness of motorcycle antilock braking systems (ABS) in reducing crashes, the first cross-national study

OBJECTIVES

This study set out to evaluate the effectiveness of motorcycle antilock braking systems (ABS) in reducing real-life crashes. Since the European Parliament has voted on legislation making ABS mandatory on all new motorcycles over 125 cc from 2016, the fitment rate in Europe is likely to increase in the coming years. Though previous research has focused on mostly large displacement motorcycles, this study used police reports from Spain (2006-2009), Italy (2009), and Sweden (2003-2012) in order to analyze a wide range of motorcycles, including scooters, and compare countries with different motorcycling habits.

METHODS

The statistical analysis used odds ratio calculations with an induced exposure approach. Previous research found that head-on crashes were the least ABS-affected crash type and was therefore used as the nonsensitive crash type for ABS in these calculations. The same motorcycle models, with and without ABS, were compared and the calculations were carried out for each country separately. Crashes involving only scooters were further analyzed.

RESULTS

The effectiveness of motorcycle ABS in reducing injury crashes ranged from 24% (95% confidence interval [CI], 12-36) in Italy to 29% (95% CI, 20-38) in Spain, and 34% (95% CI, 16-52) in Sweden. The reductions in severe and fatal crashes were even greater, at 34% (95% CI, 24-44) in Spain and 42% (95% CI, 23-61) in Sweden. The overall reductions of crashes involving ABS-equipped scooters (at least 250 cc) were 27% (95% CI, 12-42) in Italy and 22% (95% CI, 2-42) in Spain. ABS on scooters with at least a 250 cc engine reduced severe and fatal crashes by 31% (95% CI, 12-50), based on Spanish data alone.

CONCLUSIONS

At this stage, there is more than sufficient scientific-based evidence to support the implementation of ABS on all motorcycles, even light ones. Further research should aim at understanding the injury mitigating effects of motorcycle ABS, possibly in combination with combined braking systems.

Flotability and flotation separation of polymer materials modulated by wetting agents

The surface free energy, surface tension and contact angles were performed to investigate the properties of wetting agents. Adsorption of wetting agents changes wetting behavior of polymer resins. Flotability of polymer materials modulated by wetting agents was studied, and wetting agents change significantly flotability of polymer materials. The flotability decreases with increasing the concentration of wetting agents, and the wetting ability is lignin sulfonate (LS)>tannic acid (TA)>methylcellulose (MC)>triton X-100 (TX-100) (from strong to weak). There is significant difference in the flotability between polymer resins and plastics due to the presence of additives in the plastics. Flotation separation of two-component and multicomponent plastics was conducted based on the flotability modulated by wetting agents. The two-component mixtures can be efficiently separated using proper wetting agent through simple flotation flowsheet. The multicomponent plastic mixtures can be separated efficiently through multi-stage flotation using TA and LS as wetting agents, and the purity of separated component was above 94%, and the recovery was more than 93%.

Atopic disorders and depression: findings from a large, population-based study

BACKGROUND

Atopy, a common disorder characterized by a sensitivity to allergic reactions, affects a large proportion of the adult population and, as with depression, is associated with immune-inflammatory pathway changes. We sought to determine the role of atopic disorders in depression using data from a randomly-selected, population-based study of men and women.

METHODS

Cross-sectional data derived from the Geelong Osteoporosis Study for 942 males and 1085 females were analyzed. Depression [major depressive disorder (MDD), minor depression and dysthymia] was assessed using the Structured Clinical Interview for DSM-IV-TR Research Version, Non-patient edition. Data on medical conditions, including atopic disorders (asthma, hay fever and eczema), smoking status, alcohol consumption, socioeconomic status, and physical activity were documented by self-report. Logistic regression modeling was used to explore the associations between atopic disorders and depression.

RESULTS

Atopic disorders were associated with a 59% increased likelihood of depression [gender and smoking-adjusted odds ratio (OR) 1:50, 95% CI 1.20-1.97]. Sub-group analyses revealed a similar pattern for those with MDD [gender and smoking-adjusted OR 1:54, 95% CI 1.22-1.94]. These associations were independent of socio-demographic characteristics, clinical and lifestyle factors.

LIMITATIONS

Reliance on self-report for allergic symptoms and cross-sectional nature of study.

CONCLUSION

This population-based study provides evidence of the potential contribution of allergic disorders to depression. Further research is required to elucidate the direction of this association and to further explicate its underlying physiology, including immune-inflammation markers.

Fetoscopic approach to amniotic band syndrome

BACKGROUND

Amniotic band syndrome (ABS) is an uncommon complication of pregnancy that can result in fetal demise.

METHODS

We present our experience with fetoscopic amniotic band release.

RESULTS

Five patients underwent fetoscopic amniotic band release for preoperatively diagnosed ABS involving at least one extremity. Four of five patients were found to have involvement of the umbilical cord at the time of fetoscopy. One of these four did not have the band released and underwent fetal demise at 24 weeks. All four survivors had good functional outcomes of affected limbs. Two patients developed membrane separation and had preterm deliveries at 32 weeks gestation whereas the other two carried to term. No maternal complications were noted.

CONCLUSIONS

Fetoscopic amniotic band release is safe. Umbilical cord involvement is difficult to assess preoperatively, but when it is present should be treated to reduce the risk of fetal demise.

The American Brachytherapy Society consensus guidelines for plaque brachytherapy of uveal melanoma and retinoblastoma

PURPOSE

To present the American Brachytherapy Society (ABS) guidelines for plaque brachytherapy of choroidal melanoma and retinoblastoma.

METHODS AND MATERIALS

An international multicenter Ophthalmic Oncology Task Force (OOTF) was assembled to include 47 radiation oncologists, medical physicists, and ophthalmic oncologists from 10 countries. The ABS-OOTF produced collaborative guidelines, based on their eye cancer-specific clinical experience and knowledge of the literature. This work was reviewed and approved by the ABS Board of Directors as well as within the journal's peer-reivew process.

RESULTS

The ABS-OOTF reached consensus that ophthalmic plaque radiation therapy is best performed in subspecialty brachytherapy centers. Quality assurance, methods of plaque construction, and dosimetry should be consistent with the 2012 joint guidelines of the American Association of Physicists in Medicine and ABS. Implantation of plaque sources should be performed by subspecialty-trained surgeons. Although there exist select restrictions related to tumor size and location, the ABS-OOTF agreed that most melanomas of the iris, ciliary body, and choroid could be treated with plaque brachytherapy. The ABS-OOTF reached consensus that tumors with gross orbital extension and blind painful eyes and those with no light perception vision are unsuitable for brachytherapy. In contrast, only select retinoblastomas are eligible for plaque brachytherapy. Prescription doses, dose rates, treatment durations, and clinical methods are described.

CONCLUSIONS

Plaque brachytherapy is an effective eye and vision-sparing method to treat patients with intraocular tumors. Practitioners are encouraged to use ABS-OOTF guidelines to enhance their practice.

Stress cardiomyopathy: case series and the review of literature

BACKGROUND

Apical ballooning syndrome (ABS) or stress cardiomyopathy is increasingly recognized as a cause of acute coronary syndrome with unobstructed coronaries, but remains underdiagnosed.

OBJECTIVES

Retrospective review of the angiographic database (between January 2006 and December 2010) to obtain incidence and clinical presentation of ABS at our center. ABS was defined according to the modified Mayo Clinic criteria.

CASE RESULTS

Normal or unobstructed coronaries on angiography were observed in 1780 (25.4%) of a total of 6983 patients who underwent urgent or emergency coronary angiography. Twelve patients (0.17%) fulfilled the modified Mayo Clinic criteria for ABS. Eleven patients (92%) were aged ≥ 50 years (median 68 years, range 27-86 years), and 10 were female (83%). Four patients (31%) presented with ST-elevation myocardial infarction, and 1 patient presented with cardiogenic shock and acute coronary syndrome. Emotional stress was the precipitant in 4 patients (33%). Unusual precipitants like cold-water immersion and intravenous chemotherapy were observed. All 12 patients had the typical appearance of ABS on left ventriculogram (75%) or echocardiography (25%). Follow-up imaging with either echocardiography or magnetic resonance imaging (done in all 12 patients) up to 16 weeks after discharge showed that left ventricular function had normalized.

CONCLUSIONS

The incidence and clinical features of ABS in our tertiary center are similar to those reported in other settings. Unusual precipitants were observed, but left ventriculograms were performed less frequently and could be contributory to the under-diagnosis of ABS.

A comparative study of two reconstructive methods and different recommendations in intracavitary brachytherapy

Purpose

Intracavitary brachytherapy (ICB) is a widely used technique in the treatment of cervical cancer. In our Institute, we use different reconstructive methods in the conventional planning procedure. The main aim of this study was to compare these methods using critical organ doses obtained in various treatment plans. There is a small difference in the recommendations in selecting bladder dose point between ICRU (International Commission on Radiation Units & Measurements) -38 and ABS (American Brachytherapy Society). The second objective of the study was to find the difference in bladder dose using both recommendations.

Material and methods

We have selected two methods: variable angle method (M1) and orthogonal method (M2). Two orthogonal sets of radiographs were taken into consideration using conventional simulator. All four radiographs were used in M1 and only two radiographs were used in M2. Bladder and rectum doses were calculated using ICRU-38 recommendations. For maximum bladder dose reference point as per the ABS recommendation, 4 to 5 reference points were marked on Foley’s balloon.

Results

64% of plans were showing more bladder dose and 50% of plans presented more rectum dose in M1 compared to M2. Many of the plans reviled maximum bladder dose point, other than ICRU-38 bladder point in both methods. Variation was exceeded in 5% of considerable number of plans.

Conclusions

We observed a difference in critical organ dose between two studied methods. There is an advantage of using variable angle reconstruction method in identifying the catheters. It is useful to follow ABS recommendation to find maximum bladder dose.

A Standard Reference Material for Calibration of the Cup Furnace Smoke Toxicity Method for Assessing the Acute Inhalation Toxicity of Combustion Products

A standard reference material (SRM 1048) has been developed for use with the cup furnace smoke toxicity method. This SRM is to be used to calibrate the apparatus and to enable the user to have confidence that the method is being conducted in a correct manner and that the equipment is functioning properly. The toxicological results from this SRM should not be used to compare with those of other materials (i.e., to determine if the combustion products of a test material are more or less toxic than those from this SRM). SRM 1048 is an acrylonitrile-butadiene-styrene (ABS) and is the same as SRM 1007B which is used for calibrating the flaming mode of the Smoke Density Chamber test method (ASTM E-662 and NFPA 258). For the purposes of calibrating the cup furnace smoke toxicity method, LC₅₀ and N-Gas values plus their respective 95% confidence limits have been determined and certified for two combustion modes (flaming and nonflaming) and two observation periods (for the 30 min exposure only and for the 30 min exposure plus a 14 d post-exposure period). The certified LC₅₀ values plus 95% confidence intervals (in g/m³) are 27 ± 3 (30 min, flaming); 25 ± 3 (30 min+ 14 d, flaming); 58 ± 15 (30 min, nonflaming); and 53 + 12 (30 min+ 14 d, nonflaming). The certified N-Gas values plus 95% confidence intervals are 1.4 ± 0.2 (30 min, flaming); 1.5 ± 0.2 (30 min+ 14 d, flaming); 1.2 ± 0.2 (30 min, nonflaming); and 1.4 ± 0.2 (30 min+ 14 d, nonflaming). It is recommended that this SRM be used with the N-Gas approach to calibrate the cup furnace smoke toxicity method rather than to determine the complete LC₅₀ values. The N-Gas approach has the advantage of providing information on the gases responsible for the lethalities as well as the toxic potency of the smoke. In addition, the N-Gas approach reduces the number of experimental animals, the time necessary to complete the calibration, and the expense.