Free energy of critical droplets-from the binodal to the spinodal

Arguably, the main challenge of nucleation theory is to accurately evaluate the work of formation of a critical embryo in the new phase, which governs the nucleation rate. In Classical Nucleation Theory (CNT), this work of formation is estimated using the capillarity approximation, which relies on the value of the planar surface tension. This approximation has been blamed for the large discrepancies between predictions from CNT and experiments. In this work, we present a study of the free energy of formation of critical clusters of the Lennard-Jones fluid truncated and shifted at 2.5σ using Monte Carlo simulations, density gradient theory, and density functional theory. We find that density gradient theory and density functional theory accurately reproduce molecular simulation results for critical droplet sizes and their free energies. The capillarity approximation grossly overestimates the free energy of small droplets. The incorporation of curvature corrections up to the second order with the Helfrich expansion greatly remedies this and performs very well for most of the experimentally accessible regions. However, it is imprecise for the smallest droplets and largest metastabilities since it does not account for a vanishing nucleation barrier at the spinodal. To remedy this, we propose a scaling function that uses all relevant ingredients without adding fitting parameters. The scaling function reproduces accurately the free energy of the formation of critical droplets for the entire metastability range and all temperatures examined and deviates from density gradient theory by less than one k_BT.

Classical density functional theory for interfacial properties of hydrogen, helium, deuterium, neon, and their mixtures

We present a classical density functional theory (DFT) for fluid mixtures that is based on a third-order thermodynamic perturbation theory of Feynman-Hibbs-corrected Mie potentials. The DFT is developed to study the interfacial properties of hydrogen, helium, neon, deuterium, and their mixtures, i.e., fluids that are strongly influenced by quantum effects at low temperatures. White Bear fundamental measure theory is used for the hard-sphere contribution of the Helmholtz energy functional, and a weighted density approximation is used for the dispersion contribution. For mixtures, a contribution is included to account for non-additivity in the Lorentz-Berthelot combination rule. Predictions of the radial distribution function from DFT are in excellent agreement with results from molecular simulations, both for pure components and mixtures. Above the normal boiling point and 5% below the critical temperature, the DFT yields surface tensions of neon, hydrogen, and deuterium with average deviations from experiments of 7.5%, 4.4%, and 1.8%, respectively. The surface tensions of hydrogen/deuterium, para-hydrogen/helium, deuterium/helium, and hydrogen/neon mixtures are reproduced with a mean absolute error of 5.4%, 8.1%, 1.3%, and 7.5%, respectively. The surface tensions are predicted with an excellent accuracy at temperatures above 20 K. The poor accuracy below 20 K is due to the inability of Feynman-Hibbs-corrected Mie potentials to represent the real fluid behavior at these conditions, motivating the development of new intermolecular potentials. This DFT can be leveraged in the future to study confined fluids and assess the performance of porous materials for hydrogen storage and transport.

Equation of state for confined fluids

Fluids confined in small volumes behave differently than fluids in bulk systems. For bulk systems, a compact summary of the system’s thermodynamic properties is provided by equations of state. However, there is currently a lack of successful methods to predict the thermodynamic properties of confined fluids by use of equations of state, since their thermodynamic state depends on additional parameters introduced by the enclosing surface. In this work, we present a consistent thermodynamic framework that represents an equation of state for pure, confined fluids. The total system is decomposed into a bulk phase in equilibrium with a surface phase. The equation of state is based on an existing, accurate description of the bulk fluid and uses Gibbs’ framework for surface excess properties to consistently incorporate contributions from the surface. We apply the equation of state to a Lennard-Jones spline fluid confined by a spherical surface with a Weeks–Chandler–Andersen wall-potential. The pressure and internal energy predicted from the equation of state are in good agreement with the properties obtained directly from molecular dynamics simulations. We find that when the location of the dividing surface is chosen appropriately, the properties of highly curved surfaces can be predicted from those of a planar surface. The choice of the dividing surface affects the magnitude of the surface excess properties and its curvature dependence, but the properties of the total system remain unchanged. The framework can predict the properties of confined systems with a wide range of geometries, sizes, interparticle interactions, and wall–particle interactions, and it is independent of ensemble. A targeted area of use is the prediction of thermodynamic properties in porous media, for which a possible application of the framework is elaborated.

Perturbation theories for fluids with short-ranged attractive forces: A case study of the Lennard-Jones spline fluid

It is generally not straightforward to apply molecular-thermodynamic theories to fluids with short-ranged attractive forces between their constituent molecules (or particles). This especially applies to perturbation theories, which, for short-ranged attractive fluids, typically must be extended to high order or may not converge at all. Here, we show that a recent first-order perturbation theory, the uv-theory, holds promise for describing such fluids. As a case study, we apply the uv-theory to a fluid with pair interactions defined by the Lennard-Jones spline potential, which is a short-ranged version of the LJ potential that is known to provide a challenge for equation-of-state development. The results of the uv-theory are compared to those of third-order Barker–Henderson and fourth-order Weeks–Chandler–Andersen perturbation theories, which are implemented using Monte Carlo simulation results for the respective perturbation terms. Theoretical predictions are compared to an extensive dataset of molecular simulation results from this (and previous) work, including vapor–liquid equilibria, first- and second-order derivative properties, the critical region, and metastable states. The uv-theory proves superior for all properties examined. An especially accurate description of metastable vapor and liquid states is obtained, which might prove valuable for future applications of the equation-of-state model to inhomogeneous phases or nucleation processes. Although the uv-theory is analytic, it accurately describes molecular simulation results for both the critical point and the binodal up to at least 99% of the critical temperature. This suggests that the difficulties typically encountered in describing the vapor–liquid critical region are only to a small extent caused by non-analyticity.

Inverted V-shaped extracapsular stabilisation technique and arthroscopic findings in six dogs with medial shoulder instability

OBJECTIVES

The aim of this case series was to report arthroscopic findings and to evaluate clinical outcomes of dogs treated with an inverted V-shaped extracapsular stabilisation technique without additional external coaptation for medial shoulder instability.

MATERIAL AND METHODS

Medical records of dogs with medial shoulder instability that underwent arthroscopy and an inverted V-shaped extracapsular stabilisation technique were retrospectively reviewed. Extracapsular stabilisation was performed in all dogs using screws and spiked washers as anchor points for the coated polyester prosthetic ligament. No additional external coaptation was used in any dog. A minimum 18-month follow-up period was required for study inclusion. Complications and long-term outcomes were recorded.

RESULTS

The subscapularis tendon and medial glenohumeral ligament were the structures most commonly affected. All dogs had pathological cartilage fibrillations. Implants were successfully placed in all dogs. Implant loosening was recorded in two out of six dogs on recheck but no revision surgery was performed. Function at the time of last clinical follow-up (median, 28 months, range 18 to 33 months) was full in four out of six and acceptable in two out of six dogs.

CLINICAL SIGNIFICANCE

Surgical treatment of medial shoulder instability using the novel inverted V-shaped extracapsular stabilisation technique was successful. Potential complications such as implant loosening may occur. Despite the limited number of cases, the present study suggests that additional postoperative external coaptation may not be necessary for successful management of dogs with medial shoulder instability.

Enterokolitis als Ursache eines akuten unerwarteten Todes eines Orang-Utans in Zoohaltung

Es wird von einem 13 Jahre alt gewordenen weiblichen Orang-Utan berichtet, der 4 Tage vor dem Tod an einer akuten Enterokolitis erkrankte. Die tierärztliche Ultraschalluntersuchung einen Tag vor dem Tod erbrachte den Nachweis von vermehrter Flüssigkeit im Zäkum und einer abschnittsweise verdickten Kolonwand. Nach dem für die Veterinärmediziner und die Zoomitarbeiter unerwarteten Todeseintritt erfolgte eine Obduktion durch Rechtsmediziner der Universitätsmedizin Rostock mit Unterstützung von Ärzten weiterer Fachrichtungen. Dabei wurde als Todesursache eine akute Escherichia-coli-Enterokolitis mit massiver Blutung in den Darm festgestellt. Begünstigend oder ursächlich für die letale Enterokolitis dürften wahrscheinlich zahlreiche rezidivierende Durchfallerkrankungen in der Anamnese des Orang-Utans als Folge eines Verweigerns des Stillens durch die Mutter nach der Geburt gewesen sein.

Comparison of algorithms to suppress artifacts from the natural lens in fluorescence lifetime imaging ophthalmoscopy (FLIO)

Fluorescence lifetime imaging ophthalmoscopy (FLIO) has developed as a new diagnostic tool in ophthalmology. FLIO measurements are taken from 30° retinal fields in two spectral channels (short spectral channel (SSC): 498-560 nm, long spectral channel (LSC): 560-720 nm). Because of the layered structure of the eye, the detected signal is an interaction of the fluorescence decay of the anterior part and of the fundus. By comparing FLIO measurements before and after cataract surgery, the impact of the natural lens was proven, despite the application of a confocal laser scanning (cSLO) technique. The goal of this work was to determine the best algorithmic solution to isolate the sole fundus fluorescence lifetime from the measured signal, suppressing artifacts from the natural lens. Three principles based on a tri-exponential model were investigated: a tailfit, a layer-based approach with a temporally shifted component, and the inclusion of a separately measured fluorescence decay of the natural lens. The mean fluorescence lifetime τ_m,12 is calculated using only the shortest and the intermediate exponential component. τ_m,all is calculated using all three exponential components. The results of tri-exponential tailfit after cataract surgery were considered as a reference, because the implanted artificial lens can be assumed as non-fluorescent. In SSC, the best accordance of τ_m,all of the reference was determined with τ_m,12 of the tailfit before surgery. If high-quality natural lens measurements are available, the correspondence of τ_m,12 is best with τ_m,all of the reference. In LSC, there is a good accordance for all models between τ_m,12 before and after surgery. To study the pure fundus fluorescence decay in eyes with natural lenses, we advise to utilize fluorescence lifetime τ_m,12 of a triple-exponential tailfit, as it corresponds well with the mean fluorescence lifetime τ_m,all of eyes with fluorescence-less artificial intraocular lenses.

Glycemic variability in patients with gastrointestinal cancer: An integrative review

PURPOSE

Glycemic variability is associated with risks for adverse events in patients with cancer. Several studies have evaluated the presence and impact of hyperglycemia and/or hypoglycemia in patients with cancer; however, few studies have evaluated glycemic variability. The purpose of this integrative review of studies in patients with gastrointestinal cancers was to investigate the presence and methods of reporting glycemic variability during and following treatments.

METHODS

A comprehensive review of the literature was conducted. PubMed, CINAHL, EMBASE, and Cochrane databases were searched for publications between 1/1/1969 and 7/24/2019. Studies of patients with gastrointestinal cancer following surgery, during treatment, and <5 years following treatment were included and evaluated by cancer type and method of glucose and glycemic variability measurement.

RESULTS

Among 1526 patients with gastrointestinal cancer across 19 studies, gastric and pancreatic cancers were most prevalent. Timing of glucose testing and methods of analyzing glycemic variability varied. Most analyses used the standard deviation or interquartile range. Glycemic variability was more prevalent among patients with Type 2 Diabetes and among those with pancreatic cancer. In some patients glycemic variability remained notable > one year following surgery despite improvements in glycemic control.

CONCLUSION

Patients with gastrointestinal cancer experience glycemic variability during and up to one year following treatment. There was heterogeneity in methods related to timing of testing and reporting glycemic variability among the 19 studies in this review. Future investigations need to identify the presence and define the methods of measuring glycemic variability in patients with gastrointestinal cancer.

A comparison of postoperative respiratory complications associated with the use of desflurane and sevoflurane: a single-centre cohort study

Sevoflurane and desflurane are the most commonly used volatile anaesthetics for maintenance of anaesthesia. In this study, we aimed to evaluate the relationship between choice of volatile anaesthetic and early postoperative respiratory complications, and to address a critical knowledge gap in safety outcomes between these two commonly used agents. We performed a retrospective analysis of adult (non-cardiac surgery) patients who received sevoflurane or desflurane for the maintenance of general anaesthesia at our institution between 2005 and 2018. We evaluated the association between desflurane exposure (when compared with sevoflurane) and the primary outcome of postoperative respiratory complications, defined by early post-extubation desaturation (S_p O₂  < 90%) or re-intubation within 7 days postoperatively. Multivariable regression analyses were performed and adjusted for confounding factors, including patient, anaesthetic and surgical factors. Propensity matched, interaction and sub-group analyses were performed to assess outcomes in high-risk groups: morbidly obese (BMI > 35 kg.m^-2 ); elderly (age > 65 years); and high risk of respiratory complications as well as the primary outcome at 24 h. Desflurane was used for 23,830 patients and sevoflurane for 84,608 patients. Patients exposed to desflurane did not demonstrate a reduced risk of postoperative respiratory complications when compared with sevoflurane (adjusted odds ratio 0.99, 95%CI 0.94-1.04, p = 0.598). These findings were consistent across all sub-groups of high-risk patients and in the propensity score matched cohort. In summary, desflurane use was not associated with reduced postoperative respiratory complications when compared with sevoflurane. In the context of environmental and cost concerns with volatile anaesthetic agents, our study provides important data to support organisational decisions regarding the use of desflurane.

THU0478 IS NEUROPATHIC PAIN IN INFLAMMATORY RHEUMATIC DISORDERS AN UNDERESTIMATED PROBLEM? RESULTS FROM THE GERMAN PAINDETECT DATABASE

Background:

The aim of the study was to investigate the impact and relevance of neuropathic pain in inflammatory rheumatic disorders (IRD) and osteoarthritis (OA).

Objectives:

Pain is one of the main symptoms in patients with IRD and OA. To enhance a mechanistic based treatment of pain the differentiation between nociceptive and neuropathic pain via screening tools (e.g. painDETECT questionaire) might possibly be helpful. The goal of the study was to investigate (1) if neuropathic pain is a significant burden for patients with IRD and (2) if pain patterns differs from degenerative joint diseases such as OA in over 9.000 patients in each group.

Methods:

painDETECT is a questionnaire that has been evaluated and used in numerous clinical trials to detect neuropathic pain in various diseases. The collected data is centrally managed and evaluated. In total (end of 2019) 395.984 patients have been documented. Out of the painDETECT database 9256 patients with IRD and 9436 patients with OA were extracted, analyzed and compared on their neuropathic pain pattern (screening was performed using the painDETECT-questionaire., PDQ). Secondary parameters were: intensity of pain, functional status, depression, chronicity and sleep disorder. Patients had been recruited from general practitioners (GPs), Rheumatologists, Orthopedics and Neurologists from 862 office-based physicians into the painDETECT-database. This project is an open label registry study in Germany.

Results:

The median PDQ-score of patients with inflammatory rheumatic disorders adds up to 14,2 (1-38) and of OA patients to 13,8. 28.7% of inflammatory rheumatic disorders and 27.2% of OA-patients showed signs for neuropathic pain by positive PDQ. The difference was according to this high patient numbers statistically significant (P=0.0015). VAS-Score, Depressions-Score, Chronicity -Score and Functional -Score showed no clinically relevant differences between these two groups.

Conclusion:

Nearly one third of patients with IRD as well as patients with OA showed neuropathic pain components by using PDQ. Despite increasingly better disease control through more effective therapies, pain still remains a major burden for many patients and has a profound impact on their quality of life. The present data indicate a surprisingly high symptoms of neuropathic pain even in IRD patients and should be considered in the management of our patients. A new documentation system for Rheumatologists (RheumaAssist) could help to address these questions.

Percentage of PDQ-categories (negative/unclear/positive) for patients with inflammatory rheumatic disorders (IRD) or Arthrosis (OA)

Acknowledgments:

This investigation was supported within a grant of Pfizer Deutschland GmbH.

Disclosure of Interests: :

Philipp Sewerin Grant/research support from: AbbVie Deutschland GmbH & Co. KG

Bristol-Myers Squibb Celgene GmbH

Lilly Deutschland GmbH

Novartis Pharma GmbH Pfizer Deutschland GmbH

Rheumazentrum Rhein-Ruhr, Consultant of: AMGEN GmbH AbbVie Deutschland GmbH & Co. KG Biogen GmbHBristol-Myers Squibb Celgene GmbH Chugai Pharma arketing Ltd. / Chugai Europe GmbHHexal Pharma Janssen-CilagGmbH Johnson & Johnson Deutschland GmbHLilly Deutschland GmbH / Lilly Europe / Lilly Global Novartis Pharma GmbH Pfizer Deutschland GmbH Roche Pharma Rheumazentrum Rhein-Ruhr Sanofi-Genzyme Deutschland GmbH Swedish Orphan Biovitrum GmbH UCB Pharma GmbH, Speakers bureau: AMGEN GmbH AbbVie Deutschland GmbH & Co. KG Biogen GmbHBristol-Myers Squibb Celgene GmbH Chugai Pharma arketing Ltd. / Chugai Europe GmbHHexal Pharma Janssen-CilagGmbH Johnson & Johnson Deutschland GmbHLilly Deutschland GmbH / Lilly Europe / Lilly Global Novartis Pharma GmbH Pfizer Deutschland GmbH Roche Pharma Rheumazentrum Rhein-Ruhr Sanofi-Genzyme Deutschland GmbH Swedish Orphan Biovitrum GmbH UCB Pharma GmbH, Rainer Freynhagen Consultant of: AOP Orphan Pharma, Grünenthal, Lilly, Merck, Mitsubishi Tanabe Pharma, Pfizer, Scilex Pharmaceutics

, Speakers bureau: AOP Orphan Pharma, Grünenthal, Lilly, Merck, Mitsubishi Tanabe Pharma, Pfizer, Scilex Pharmaceutics

, Thomas Tölle Consultant of: AOP Orphan, Almiral Hermal, Bionest Partners, Benkitt Renkiser, Grünenthal, Hexal, Indivior, Kaia Health, Lilly, Medscape Mundipharma, MSD, Novartis, Pfizer, Recordati Pharma, Sanofi-Aventis, and TAD Pharma, Speakers bureau: AOP Orphan, Almiral Hermal, Bionest Partners, Benkitt Renkiser, Grünenthal, Hexal, Indivior, Kaia Health, Lilly, Medscape Mundipharma, MSD, Novartis, Pfizer, Recordati Pharma, Sanofi-Aventis, and TAD Pharma, Michael Hammer Consultant of: Abbvie, Pfizer, Medac and Janssen, Speakers bureau: Abbvie, Pfizer, Medac and Janssen, Christoph Baerwald Consultant of: CGB received speaker or consulting fees from AbbVie, Paid instructor for: CGB received speaker or consulting fees from AbbVie, Speakers bureau: CGB received speaker or consulting fees from AbbVie, Jochen Walter Consultant of: Pfizer, Speakers bureau: AbbVie, Frauenhofer Institut, Gilead, Janssen-Cilag, Medac, Novartis, Pfizer, Ralf Schröder Shareholder of: Pfizer Pharma GmbH, Employee of: Pfizer Pharma GmbH, Matthias Schneider Grant/research support from: GSK, UCB, Abbvie, Consultant of: Abbvie, Alexion, Astra Zeneca, BMS, Boehringer Ingelheim, Gilead, Lilly, Sanofi, UCB, Speakers bureau: Abbvie, Astra Zeneca, BMS, Chugai, GSK, Lilly, Pfizer, Sanofi, Ralf Baron Consultant of: RB received speaker or consulting fees from AbbVie, Paid instructor for: RB received speaker or consulting fees from AbbVie, Speakers bureau: RB received speaker or consulting fees from AbbVie

Equation of state and force fields for Feynman-Hibbs-corrected Mie fluids. II. Application to mixtures of helium, neon, hydrogen, and deuterium

We extend the statistical associating fluid theory of quantum corrected Mie potentials (SAFT-VRQ Mie), previously developed for pure fluids [Aasen et al., J. Chem. Phys. 151, 064508 (2019)], to fluid mixtures. In this model, particles interact via Mie potentials with Feynman-Hibbs quantum corrections of first order (Mie-FH1) or second order (Mie-FH2). This is done using a third-order Barker-Henderson expansion of the Helmholtz energy from a non-additive hard-sphere reference system. We survey existing experimental measurements and ab initio calculations of thermodynamic properties of mixtures of neon, helium, deuterium, and hydrogen and use them to optimize the Mie-FH1 and Mie-FH2 force fields for binary interactions. Simulations employing the optimized force fields are shown to follow the experimental results closely over the entire phase envelopes. SAFT-VRQ Mie reproduces results from simulations employing these force fields, with the exception of near-critical states for mixtures containing helium. This breakdown is explained in terms of the extremely low dispersive energy of helium and the challenges inherent in current implementations of the Barker-Henderson expansion for mixtures. The interaction parameters of two cubic equations of state (Soave-Redlich-Kwong and Peng-Robinson) are also fitted to experiments and used as performance benchmarks. There are large gaps in the ranges and properties that have been experimentally measured for these systems, making the force fields presented especially useful.

[Intra-articular injection of cortisone]

Intra-articular injections with glucocorticoids are standard procedures according to therapy guidelines in many rheumatic conditions. There is increasing evidence from clinical trials on the treatment of rheumatoid arthritis that more patients will attain the target of remission using a combination of systemic medication and intra-articular injections with glucocorticoids compared to systemic medication alone. Intra-articular injections with glucocorticoids play an important role in the therapeutic management of pediatric rheumatic diseases. In many countries competency in performing intra-articular injections is among the important skills necessary for certification as a specialist in rheumatology.

Effects of mono-2-ethylhexyl phthalate on the respiratory tract in BALB/c mice

Airborne mono-2-ethylhexyl phthalate (MEHP) was studied for acute airway effects using a bioassay with BALB/c mice. Concentration-and time-dependent effects were obtained by continuous monitoring of the breathing pattern during exposure to 0.3-43.6 mg/m3 MEHP for 60 min. Additionally, inflammatory effects of MEHP were studied from bronchoalveolar lavage (BAL) fluid. MEHP showed no upper airway irritating effect. Lower airway irritation was apparent from a concentration-dependent decrease in tidal volume (shallow respiration) with a no-observed effect level (NOEL) of 0.3 mg/m3. The respiratory rate reached a maximum at about 8 mg/m3, demonstrating a rapid shallow breathing pattern. At concentrations above 4.9 mg/m3, the time of pause, another marker of lung irritation, increased concentration-dependently, resulting in a decrease in respiratory rate at high exposure levels. BAL fluid obtained from 0 to 72 hours after a 60 min exposure to 30 mg/m3 MEHP showed that the number of macrophage reached maximum about 16 hours after exposure. The NOEL was 1.7 mg/m3. BAL content of neutrophils, lymphocytes, eosinophils and epithelial cells was normal after exposure to 30 or 1.7 mg/m3 MEHP. Based on worst case inhalation scenario in the general population, no airway irritation is expected from non-occupational levels of MEHP originating from DEHP.

The symptom phenotype of oncology outpatients remains relatively stable from prior to through 1 week following chemotherapy

Some oncology outpatients experience a higher number of and more severe symptoms during chemotherapy (CTX). However, little is known about whether this high risk phenotype persists over time. Latent transition analysis (LTA) was used to examine the probability that patients remained in the same symptom class when assessed prior to the administration of and following their next dose of CTX. For the patients whose class membership remained consistent, differences in demographic and clinical characteristics, and quality of life (QOL) were evaluated. The Memorial Symptom Assessment Scale (MSAS) was used to evaluate symptom burden. LTA was used to identify subgroups of patients with distinct symptom experiences based on the occurrence of the MSAS symptoms. Of the 906 patients evaluated, 83.9% were classified in the same symptom occurrence class at both assessments. Of these 760 patients, 25.0% were classified as Low-Low, 44.1% as Moderate-Moderate and 30.9% as High-High. Compared to the Low-Low class, the other two classes were younger, more likely to be women and to report child care responsibilities, and had a lower functional status and a higher comorbidity scores. The two higher classes reported lower QOL scores. The use of LTA could assist clinicians to identify higher risk patients and initiate more aggressive interventions.

Assessment of the diagnostic value of dual-energy CT and MRI in the detection of iatrogenically induced injuries of anterior cruciate ligament in a porcine model

INTRODUCTION

Magnetic resonance imaging (MRI) is the standard of reference for the non-invasive evaluation of ligament injuries of the knee. The development of dual-energy CT (DE-CT) made it possible to differentiate between tissues of different density by two simultaneous CT measurements with different tube voltages. This approach enables DE-CT to discriminate ligament structures without intra-articular contrast media injection. The aims of this study were on the one hand to determine the delineation of the anterior cruciate ligament (ACL) and on the other hand to assess the diagnostic value of DE-CT and MRI in the detection of iatrogenically induced injury of the ACL in a porcine knee joint model.

MATERIALS AND METHODS

Twenty porcine hind legs, which were placed in a preformed cast in order to achieve a standardized position, were scanned using DE-CT. Thereafter, a 1.5-T MRI using a standard protocol was performed. The imaging procedures were repeated with the same parameters after inducing defined lesions (total or partial incision) on the ACL arthroscopically. After post-processing, two radiologists and two orthopedic surgeons first analyzed the delineation of the ACL and then, using a consensus approach, the iatrogenically induced lesions. The result of the arthrotomy was defined as the standard of reference.

RESULTS

The ACL could be visualized both on DE-CT and MRI in 100% of the cases. As for the MRI, the sensitivity and specificity of detecting the cruciate ligament lesion respectively compared with the defined arthrotomy was 66.7% and 78.6% for intact cruciate ligaments, 100% and 75% in the case of a complete lesion, 33.3% and 78.6% for lesions of the anteromedial bundle, and 0% and 100% for lesions of the posterolateral bundle. In comparison, DE-CT demonstrated a sensitivity and specificity of 66.7% and 71.4% in the case of intact cruciate ligaments, 75% and 68.8% in the case of completely discontinued ACLs, 0% and 92.9% in the case of lesions of the anteromedial bundle, and 25% and 87.5% in the case of lesions of the posterolateral bundle.

CONCLUSIONS

The present ex vivo experiment shows that both study modalities (DE-CT and MRI) are equal with regard to the delineation of the ACL, while MRI achieved higher sensitivity and specificity regarding iatrogenically induced complete ACL lesions. DE-CT could be a possible alternative to MRI for certain indications in the diagnosis of a knee ligament injury.

Perineuromal stimulation in the treatment of occipital neuralgia: a case study

This case study is presented to exemplify the application of a perineuromal approach in the treatment of recalcitrant occipital neuralgia. The patient was a 49-year-old female with severe and disabling occipital neuralgia. The pain persisted despite several surgical procedures, injections in the affected area, and medications. Threading the electrode into the cervical epidural space and attempts at peripheral stimulation using the Weiner and Reed approach were unsuccessful. Immediate benefit was derived when the electrode was advanced subcutaneously and positioned underneath the neuroma apparently created by a C2 nerve transection. A Medtronic Octad (model #3898) was utilized. The patient was contacted at seven and nine months post implantation. She reported 90% improvement in her pain. The improvements were also noted in numerical pain ratings, Beck Depression Inventory, and Oswestry Disability Scale. These improvements were corroborated by her husband. The Minnesota Multiphasic Personality Inventory (MMPI) remained relatively unchanged. This case illustrates the possible utilization of perineuromal stimulation in the treatment of occipital neuralgia. The specific mechanism of action remains unclear. Replication and controlled studies are required to determine the general applicability of this approach.

Dissolution and pharmacokinetics of a novel micronized aspirin formulation

Aspirin (acetylsalicylic acid, ASA) has been used as an analgesic, antipyretic and antiinflammatory drug for many years. A new 500 mg aspirin tablet formulation containing micronized active ingredient and an effervescent component has been developed for potential improvement in the onset of action for acute pain treatment. This paper describes the dissolution and the pharmacokinetics of the new formulation in comparison with regular aspirin tablets, aspirin granules and aspirin effervescent tablets. Micronized aspirin tablets dissolve significantly faster over a pH range from 1.2 to 6.8 compared to regular 500 mg aspirin tablets. Plasma concentration time curve comparison to regular 500 mg aspirin tablets showed a substantial improvement in the time to maximum plasma concentrations (T(max)) (ASA 17.5 min vs. 45 min) and an increase in maximum plasma concentration (C(max)) (ASA 13.8 μg/ml vs. 4.4 μg/ml) while the overall extent of exposure (AUC) remains almost unchanged. The data suggest a potential improvement for onset of action in treating acute pain with the new micronized aspirin formulation.

Patient-reported outcomes are superior in patients with Type 2 diabetes treated with liraglutide as compared with exenatide, when added to metformin, sulphonylurea or both: results from a randomized, open-label study

AIMS

The Liraglutide Effect and Action in Diabetes 6 trial was an open-label trial comparing liraglutide with exenatide as an 'add-on' to metformin and/or sulphonylurea.

METHODS

Patients with Type 2 diabetes were randomized to liraglutide 1.8 mg once daily or exenatide 10 μg twice daily for 26 weeks. This was followed by a 14-week extension phase, in which all patients received liraglutide 1.8 mg once daily.

RESULTS

Patient-reported outcomes were measured in 379 patients using Diabetes Treatment Satisfaction Questionnaire status (DTSQs) and DTSQ change (DTSQc). The change in overall treatment satisfaction (DTSQs score) from baseline at week 26 with liraglutide was 4.71 and with exentaide was 1.66 [difference between groups 3.04 (95% CI 1.73-4.35), P<0.0001]. Five of the six items on the DTSQs improved significantly more with liraglutide than with exenatide (differences: current treatment 0.37, P=0.0093; convenience 0.68, P<0.0001; flexibility 0.57, P=0.0002; recommend 0.49, P=0.0003; continue 0.66, P=0.0001). Patients perceived a greater reduction in hypoglycaemia at week 26 with liraglutide than with exenatide [difference in DTSQc score 0.48 (0.08-0.89), P=0.0193] and a greater reduction in perceived hyperglycaemia [difference 0.74 (0.31-1.17), P=0.0007]. During the extension phase, when all patients received liraglutide, DTSQs scores remained stable in patients who continued on liraglutide and increased significantly (P=0.0026) in those switching from exenatide.

CONCLUSIONS

These results demonstrate significant improvements in patients' treatment satisfaction with liraglutide compared with exenatide.