High Estimated 24-Hour Urinary Sodium Excretion Is Related to Symptomatic Knee Osteoarthritis: A Nationwide Cross-Sectional Population-Based Study

OBJECTIVES

High salt intake results in various harmful effects on human health including hypertension, cardiovascular disease, and reduced bone density. Despite this, there are very few studies in the literature that have investigated the association between sodium intake and osteoarthritis (OA). Therefore, we aimed to explore these associations in a Korean population.

METHODS

This study used cross-sectional data from adult subjects aged 50-75 years from two consecutive periods of the Korean National Health and Nutrition Examination Survey V-VII (2010-2011 and 2014-2016). The estimated 24-hour urinary sodium excretion (24HUNa) was used as a surrogate marker of salt intake. In the 2010-2011 dataset, knee OA (KOA) was defined as the presence of the radiographic features of OA and knee pain. The association between KOA and salt intake was analysed using univariable and multivariable logistic regression methods. For the sensitivity analysis, the same procedures were conducted on subjects with self-reported OA (SR-OA) with knee pain in the 2010-2011 dataset and any site SR-OA in the 2014-2016 dataset.

RESULTS

Subjects with KOA had significantly lower energy intake, but higher 24HUNa than those without KOA. The restricted cubic spline plots demonstrated a J-shaped distribution between 24HUNa and prevalent KOA. When 24HUNa was stratified into five groups (<2, 2-3, 3-4, 4-5 and ≥5 g/day), subjects with high sodium intake (≥5 g/day) had a higher risk of KOA (odds ratio [OR] = 1.64, 95% confidence interval [CI] 1.03-2.62) compared to the reference group (3-4 g/day) after adjusting for covariates. The sensitivity analysis based on SR-OA with knee pain showed that high sodium intake was also significantly associated with increased prevalence of OA (OR = 1.84, 95% CI 1.10-3.10) compared with the reference group. Regarding SR-OA at any site in the 2014-2016 dataset, estimated 24HUNa showed a significantly positive association with the presence of SR-OA after adjusting for potential confounders.

CONCLUSIONS

This nationwide Korean representative study showed a significant association between symptomatic KOA and high sodium intake (≥5 g/day). Avoidance of a diet high in salt might be beneficial as a non-pharmacologic therapy for OA.

Anterior Bridging Bone in a Newly Designed Cage for Lumbar Interbody Fusion: Radiographic and Finite Element Analysis

OBJECTIVE

To evaluate the distribution of multiple anterior bridging bone (ABB) patterns using a newly designed interbody cage with 4 anterior holes that enable communication between the inside and outside of the cage and to estimate its mechanical effect by finite element analysis (FEA).

METHODS

Patients underwent single-level lumbar interbody fusion using ABB cages. Two raters evaluated the distribution patterns of ABB on computed tomography scans 1 year after surgery. We defined the term H-fusion as the presence of complete anterior extracage and intracage bone bridging, with ≥1 ABBs between them. We performed finite element analysis to investigate the effect of ABB on maximal stiffness.

RESULTS

The study enrolled 98 patients. ABB was most frequently observed in the medial hole of the cages (73.7%). The mean number of ABBs was 3.65, and H-fusion was observed at 135 levels (34%). Postoperative improvement in the Oswestry Disability Index was significantly higher in patients who achieved interbody fusion and H-fusion than in patients who did not. As ABB was added, the increment in the relative maximal stiffness was most affected under flexion and extension forces.

CONCLUSIONS

We observed an average of 3.65 complete ABBs. Finite element analysis demonstrated that ABB could increase the stability in fused segments, especially under flexion and extension stress. Our results suggest that the ABB cage, which allows communicating cross-bridging between inside and outside of the cage, may facilitate a more stable fusion process than a conventionally designed cage.

Determination of maintenance energy requirement and responses of dry ewes to dietary inclusion of lucerne versus concentrate meal

An accurate value for metabolizable energy (ME) requirement for maintenance (ME_m) is essential to enable sheep husbandry practice to reach its potential. The objectives of the study were to use calorimetry chamber data of dry ewes (Hu × thin-tail Han F1 crossbred) to develop updated ME_m, examine effects of substituting concentrate feed with lucerne hay on energy partitioning, and explore the relationships between energy utilization and fasting heat production (FHP). Data were collected from three experiments. In Exps. 1, 2a and 2b, lucerne hay was used to replace concentrates in three levels (0:40%, 15:25% and 30:10%), with diets containing 60% maize stover (Exp. 1), fresh rye forage (Exp. 2a) or dry rye forage (Exp. 2b). Within each experiment, diets were isoenergetic (digestible energy, DE) and isonitrogenous. Exp. 3 aimed at evaluating effects of three BW levels on nutrient utilization of dry ewes offered diets containing 60% maize stover, 15% lucerne hay and 25% concentrates. Energy metabolism data were measured using the respiration calorimeter chamber technique in all three experiments, followed by the measurement of FHP in Exps. 1, 2b and 3. The ME_m derived from the linear regression between energy balance (EB) and ME intake was 0.440 MJ/kg BW^0.75. The average FHP was 0.326 MJ/kg BW^0.75. The fasting metabolism, net energy requirement for maintenance (NE_m) and ME_m were estimated to be 0.336, 0.359 and 0.511 MJ/kg BW^0.75, respectively, through adjustment of FHP using fasting urinary energy output, activity allowance and efficiency of ME use for maintenance. The FHP was negatively correlated to EB/metabolic BW, ME/gross energy (GE), ME/DE, EB/GE intake and EB/ME intake, while positively correlated to HP/GE intake, HP/ME intake and CH₄-E/GE intake. Compared to zero lucerne hay diet, the 15% lucerne hay intake decreased HP (MJ/d), and had no negative effects on EB (MJ/d) or energy utilization efficiencies. The results indicate that nutrient requirement standards currently used across the world are likely to underestimate ME_m for dry ewes, and the selection of low FHP ewes for breeding has the potential to improve sheep production efficiency.

Diagnosing syndesmotic instability with dynamic ultrasound - establishing the natural variations in normal motion

BACKGROUND

Syndesmotic instability, when subtle, is challenging to diagnose and often requires visualization of the syndesmosis during applied stress. The primary aim was to assess normal distal tibiofibular motion in the sagittal plane using dynamic ultrasound under stress conditions. The secondary aim was to evaluate the reliability of dynamic stress ultrasonography.

METHODS

Twenty-eight participants without history of ankle injury were included. Sagittal fibular translation was generated by applying a manual force to the fibula from anterior to posterior and from posterior to anterior. Distance between the ultrasound probe and the fibula was taken at two predefined points: 1) no force applied and, 2) during maximum force application. Each participant was scanned twice by two independent examiners, and each scan was analysed by two independent examiners. Three participants were scanned a second time by the same examiner who analysed these films twice to assess for intraobserver agreement. Means of exam 1 versus exam 2 were compared using a mixed linear model. Agreement among observers was calculated using intraclass correlation coefficients (ICC) interpreted as 0.4, poor; 0.4 〈 ICC < 0.59, acceptable; 0.6 < ICC < 0.74, good; ICC 〉 0.74, excellent.

RESULTS

Fifty-six ankles were included in the study, including 16 (57%) males and 12 (42%) females. Average anterior to posterior fibular sagittal translation was 0.89 ± 0.6 mm and posterior to anterior fibular sagittal translation was 0.49 ± 1.1 mm. Anterior to posterior translation means of exam 1 versus exam 2 showed no significant differences, means of 0.81 mm [0.7-0.9] versus 0.77 mm [0.7-1.0], and posterior to anterior means [95% CI] of 0.42 mm [0.3-0.5] versus 0.44 mm [0.2-0.6] (p-values 0.416 and 0.758, respectively). Excellent Inter- and intraobserver agreement was found for all measurements taken.

CONCLUSION

Dynamic ultrasound allows one to effectively and readily evaluate sagittal translation of the distal tibiofibular joint. It is able to afford bilateral comparisons, which becomes critical as the amount of syndesmotic instability approaches greater degrees of subtlety.

Highly aligned carbon nanotubes and their sensor applications

Flexible electronics comprising carbon nanotube (CNT) membranes and polymer composites are used in diverse applications, including health monitoring. Devices prepared using such electronics need to exhibit acceptable sensitivity at high strains, with the advantage of negligible hysteresis. Herein, we report a simple, physically robust method to fabricate a highly sensitive and stretchable sensor that enables the detection of pressure, strain, and human activity with facial expressions based on the highly aligned carbon nanotubes embedded in polydimethylsiloxane (PDMS). The aligned CNT network in PDMS modulates the electron conduction path in a unidirectional manner and provides multimodal mechanical sensing ability with a wide sensing range and high sensitivity. The highly aligned CNT sensor demonstrates high-pressure sensitivity (1.29 kPa-1), excellent stability and repeatability (over 10 000 cycles) with negligible hysteresis, and a good strain sensitivity over a wide range (up to 65%) with a good linear response. We confirmed the applicability of the sensor to detect small signals, such as heartbeat and pulse rate, expressions, and voice recognition, and that it could distinguish between various human motions with a very short recovery time of approximately 50 ms.

A novel design, analysis and 3D printing of Ti-6Al-4V alloy bio-inspired porous femoral stem

The current study is proposing a design envelope for porous Ti-6Al-4V alloy femoral stems to survive under fatigue loads. Numerical computational analysis of these stems with a body-centered-cube (BCC) structure is conducted in ABAQUS. Femoral stems without shell and with various outer dense shell thicknesses (0.5, 1.0, 1.5, and 2 mm) and inner cores (porosities of 90, 77, 63, 47, 30, and 18%) are analyzed. A design space (envelope) is derived by using stem stiffnesses close to that of the femur bone, maximum fatigue stresses of 0.3σ_ys in the porous part, and endurance limits of the dense part of the stems. The Soderberg approach is successfully employed to compute the factor of safety N_f > 1.1. Fully porous stems without dense shells are concluded to fail under fatigue load. It is thus safe to use the porous stems with a shell thickness of 1.5 and 2 mm for all porosities (18-90%), 1 mm shell with 18 and 30% porosities, and 0.5 mm shell with 18% porosity. The reduction in stress shielding was achieved by 28%. Porous stems incorporated BCC structures with dense shells and beads were successfully printed.

A Rare Case of Douche Injury Sustained during Water Recreation Activities: More Protection will Mean less Injury

Douche injury is a rare consequence of water recreation activities; it can manifest as vaginal laceration or even haemoperitoneum. Such severe trauma can cause massive bleeding and hypovolaemic shock; therefore, it is potentially life threatening. Herein, we present the case of a patient who had vaginal laceration and haemoperitoneum due to water recreation activities; surgery was performed to stop the bleeding. We suggest wearing a rubber or neoprene wetsuit during water recreation activities to prevent such potentially lethal injury.

Influence of functionally graded pores on bone ingrowth in cementless hip prosthesis: a finite element study using mechano-regulatory algorithm

Cementless hip prostheses with porous outer coating are commonly used to repair the proximally damaged femurs. It has been demonstrated that stability of prosthesis is also highly dependent on the bone ingrowth into the porous texture. Bone ingrowth is influenced by the mechanical environment produced in the callus. In this study, bone ingrowth into the porous structure was predicted by using a mechano-regulatory model. Homogenously distributed pores (200 and 800 [Formula: see text]m in diameter) and functionally graded pores along the length of the prosthesis were introduced as a porous coating. Bone ingrowth was simulated using 25 and 12 [Formula: see text]m micromovements. Load control simulations were carried out instead of traditionally used displacement control. Spatial and temporal distributions of tissues were predicted in all cases. Functionally graded pore decreasing models gave the most homogenous bone distribution, the highest bone ingrowth (98%) with highest average Young's modulus of all tissue phenotypes approximately 4.1 GPa. Besides this, the volume of the initial callus increased to 8.33% in functionally graded pores as compared to the 200 [Formula: see text]m pore size models which increased the bone volume. These findings indicate that functionally graded porous surface promote bone ingrowth efficiently which can be considered to design of surface texture of hip prosthesis.

Thoracic Epidural Clonidine Attenuates Haemodynamic Responses Induced by Endobronchial Intubation

Laryngoscopy and endobronchial intubation usually cause transient hypertension and tachycardia. We investigated whether thoracic epidurally injected 3 μg/kg clonidine attenuates cardiovascular responses to intubation compared with 2 μg/kg fentanyl and 1 mg/kg lidocaine. Epidural catheterization was performed at the T6–T7 or T7–T8 intervertebral space, and saline or clonidine in saline was injected 20 min before anaesthetic induction. Anaesthesia was induced using 5 mg/kg thiopental sodium and 0.1 mg/kg vecuronium. Laryngoscopy and endobronchial intubation were performed 2 min later. Mean blood pressure and heart rate were measured throughout anaesthetic induction. In the control group and the fentanyl group, mean blood pressure and heart rate 3 min after endobronchial intubation were elevated significantly compared with baseline. In the clonidine group, however, mean blood pressure and heart rate did not increase compared with baseline. The control group had higher mean blood pressure and heart rate than the clonidine group 3 min after endobronchial intubation. Thoracic epidural clonidine may attenuate the haemodynamic response to endobronchial intubation.

Comparison of Flexor Tendon Suture Techniques Including 1 Using 10 Strands

PURPOSE

To compare mechanical properties of a multistrand suture technique for flexor tendon repair with those of conventional suture methods through biomechanical and clinical studies.

METHODS

We describe a multistrand suture technique that is readily expandable from 6 to 10 strands of core suture. For biomechanical evaluation, 60 porcine flexor tendons were repaired using 1 of the following 6 suture techniques: Kessler (2-strand), locking cruciate (4-strand), Lim/Tsai's 6-strand, and our modified techniques (6-, 8-, or 10-strand). Structural properties of each tenorrhaphy were determined through tensile testing (ultimate failure load and force at 2-mm gap formation). Clinically we repaired 25 flexor tendons using the described 10-strand technique in zones I and II. Final follow-up results were evaluated according to the criteria of Strickland and Glogovac.

RESULTS

In the biomechanical study, tensile properties were strongly affected by repair technique; tendons in the 10-strand group had approximately 106%, 66%, and 39% increased ultimate load to failure (average, 87 N) compared with those in the 4-, 6-, and 8-strand groups, respectively. Tendons in the 10-strand group withstood higher 2-mm gap formation forces (average, 41 N) than those with other suture methods (4-strand, 26 N; 6-strand, 27 N; and 8-strand, 33 N). Clinically, we obtained 21 excellent, 2 good, and 2 fair outcomes after a mean of 16 months (range, 6-53 mo) of follow-up. No patients experienced poor results or rupture.

CONCLUSIONS

The 10-strand suture repair technique not only increased ultimate strength and force at the 2-mm gap formation compared with conventional suture methods, it also showed good clinical outcomes. This multistrand suture technique can greatly increase the gap resistance of surgical repair, facilitating early mobilization of the affected digit.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

The association of radiographic progression with serum R-spondin 1 (RSPO1) levels or Dickkopf-1 (DKK1)/RSPO1 ratios in rheumatoid arthritis patients: clinical evidence for reciprocal inhibition between DKK1 and RSPO1

OBJECTIVES

To investigate the clinical implications of serum levels of R-spondin 1 (RSPO1), a natural antagonist for Dickkopf-1 (DKK1), and of DKK1/RSPO1 ratios in rheumatoid arthritis (RA) patients.

METHOD

Serum DKK1 and RSPO1 levels were measured in 102 RA patients and 39 age- and gender-matched healthy controls. In addition, DKK1 and RSPO1 levels were determined prior to and 3 months after anti-tumour necrosis factor alpha (anti-TNF-α) therapy in 15 RA patients. Clinical and laboratory data and baseline radiographs of the hands and feet were obtained. Serial radiographs were evaluated in 83 RA patients. Radiographic joint damage was assessed by the modified Sharp/van der Heijde score (SHS).

RESULTS

Serum RSPO1 levels were significantly reduced whereas serum DKK1 levels and DKK1/RSPO1 ratios were significantly increased in RA patients compared with controls (all p < 0.0001). Anti-TNF-α treatment significantly suppressed DKK1/RSPO1 ratios (p < 0.01). In contrast to DKK1 or RSPO1 levels, the ratios were significantly associated with erosive disease, elevated acute phase reactants, Disease Activity Score in 28 joints (DAS28) > 3.2, and radiographic progression rate (all p < 0.05). Although the RA patients with radiographic progression exhibited significantly increased DKK1 and reduced RSPO1 levels (p < 0.05), only the DKK1/RSPO1 ratio (log-transformed) was found to be a significant predictor of subsequent radiographic progression [odds ratio (OR) 2.07, p < 0.01].

CONCLUSIONS

In this study, the presence of RSPO1 in the circulation was shown for the first time. Our results suggest that the serum DKK1/RSPO1 ratio represents a better predictor of structural progression than either DKK1 or RSPO1 levels alone in RA patients.

Dynamic layer rearrangement during growth of layered oxide films by molecular beam epitaxy

The A(n+1)B(n)O(3n+1) Ruddlesden-Popper homologous series offers a wide variety of functionalities including dielectric, ferroelectric, magnetic and catalytic properties. Unfortunately, the synthesis of such layered oxides has been a major challenge owing to the occurrence of growth defects that result in poor materials behaviour in the higher-order members. To understand the fundamental physics of layered oxide growth, we have developed an oxide molecular beam epitaxy system with in situ synchrotron X-ray scattering capability. We present results demonstrating that layered oxide films can dynamically rearrange during growth, leading to structures that are highly unexpected on the basis of the intended layer sequencing. Theoretical calculations indicate that rearrangement can occur in many layered oxide systems and suggest a general approach that may be essential for the construction of metastable Ruddlesden-Popper phases. We demonstrate the utility of the new-found growth strategy by performing the first atomically controlled synthesis of single-crystalline La3Ni2O7.

Costs of illness and quality of life in patients with systemic lupus erythematosus in South Korea

OBJECTIVE

To assess the costs of illness, health-related quality of life (HRQOL) and their associated factors in patients with systemic lupus erythematosus (SLE) in South Korea.

METHOD

Two hundred and one patients with SLE were enrolled at the Rheumatology clinic of Seoul National University Hospital. Direct, indirect and total costs and HRQOL were measured using hospital electronic data and face-to-face interview. Socio-demographic and clinical factors associated with cost of illness and HRQOL were analyzed using multiple regression and multivariate logistic regression.

RESULTS

The average total cost of illness was estimated to be KRW 9.82 million (US $ 8993) per year, of which 41.6% was accounted for by direct costs and 58.4% by indirect costs. In multivariate regression, patients with renal involvement and those with depression incurred an average increment in annual total costs of 37.6% (p = 0.050) and 49.1% (p = 0.024), respectively, and an average increment in annual direct costs of 26.4% (p = 0.050) and 43.3% (p = 0.002), respectively, compared with patients without renal involvement and depression, respectively. In addition, disease damage was positively associated with an average increment in annual total and direct costs (55.3%, p = 0.006; 33.3%, p = 0.013, respectively), and the occurrence of indirect costs (OR 2.21, 1.09-4.88). There was no significant difference in HRQOL between patients with and without renal involvement (0.655 vs. 0.693, p = 0.203) CONCLUSION: Renal involvement, depression, and disease damage were major factors associated with higher total and medical costs for patients with SLE in South Korea. Effective treatment of renal disorders and depression may reduce the high economic burden of SLE.

Accuracy and reliability of length measurements on three-dimensional computed tomography using open-source OsiriX software

There is a growing interest in three-dimensional computed tomography (3D-CT) as a research tool for the study of bone, joint anatomy, and kinematics. However, when CT data are processed and handled manually using image processing programs to yield 3D image and coordinate value, systematic and random errors should be validated. We evaluated the accuracy and reliability of length measurement on CT with OsiriX software. 3D-CT scans were made of 14 frozen pig knees with five transosseous holes in the metaphyseal portion of femur. The lengths between tunnel orifices were measured using Mitutoyo Digimatic digital calipers to establish the gold standard, and with the OsiriX program in 3D multi-planar reformatting mode for comparison. All measurements were recorded by a principal (replicate 1, trial 1) and a secondary observer (replicate 2, trial 1) and were repeated once by each observer (trial 2). The mean differences between OsiriX and real measurements were less than 0.1 mm in both replicates, and maximum differences were less than 0.3 mm. There were no significant differences between the replicates and real measurements (p=0.544 and 0.622 for replicates 1 and 2, respectively). The intraclass correlation coefficients (ICC) were very high between trials and between replicates (ICC=0.998 and 0.999, respectively). For kinematic analysis of the knees, length measurements on 3D-CT using OsiriX program can be used as alternatives to real measurements with less than 0.3-mm accuracy and very high reliability.

How isometric are the anatomic femoral tunnel and the anterior tibial tunnel for anterior cruciate ligament reconstruction?

PURPOSE

The purpose of this study was to evaluate the isometry of an anatomic femoral tunnel and anterior tibial tunnel positions.

METHODS

Tibial tunnels were made at 2 different locations in 10 cadaveric knees: the conventional tunnel and a more anterior position. Three-dimensional computed tomography (CT) scanning was then performed at 0°, 30°, 60°, 90°, and 120°. After removal of the anterior cruciate ligament from its femoral attachment, the 2 different femoral tunnels were marked at (1) the vertical femoral tunnel point and (2) the anatomic femoral tunnel point. After scans were repeated for coordinate transformation, the change in length between the tunnels was calculated with imaging software (OsiriX, version 3.2; Apple, Cupertino, CA) and the center of rotation for the femoral tunnels was calculated with a least squares fitting algorithm.

RESULTS

The conventional tibial tunnel-vertical femoral tunnel combination showed the least excursion as knee flexion angle changed. The vertical femoral tunnel combination groups showed a trend toward increasing length as the knee flexion angle increased. In contrast, the anatomic femoral tunnel combination groups displayed a trend toward decreased length with increasing knee flexion. At less than 30° of flexion, the tibial anterior-anatomic femoral tunnel showed the least excursion.

CONCLUSIONS

The anatomic femoral tunnel was nonisometric, and the differences in isometry for each tunnel type were explained primarily by differences in relations between the centers of rotation of tunnels and tunnel position. When a femoral anatomic tunnel is chosen for anterior cruciate ligament reconstruction, the anterior tibial tunnel offers greater isometric benefits than the conventional tibial tunnel, especially in near full extension.

CLINICAL RELEVANCE

The distance between anatomic femoral and tibial tunnels is greatest in full extension and decreases with flexion. This would result in graft laxity. The surgeon should give consideration to a more anterior tibial tunnel position, which shows less excursion in early flexion.

Evaluation of tunnel position of posterolateral corner reconstruction using 3-dimensional computed tomogram

PURPOSE

To evaluate the isometry of different tunnel positions in posterolateral corner (PLC) reconstruction using 3-dimensional computed tomography.

METHODS

In 10 fresh-frozen cadaveric knees, fibular tunnels were made from the anterodistal surface of the fibular neck to the posteroproximal fibular tip. Tibial tunnels were made from just medial to the Gerdy tubercle to a point 1 to 1.5 cm medial to the proximal tibiofibular joint. Femoral condyles were marked at 3 different locations: (1) epicondyle, (2) 5 mm distal-anterior to the epicondyle, and (3) 18 mm distal-anterior to the epicondyle. All specimens were scanned by computed tomography at different ranges of motion. Relative length changes between the tunnels were calculated by use of medical imaging software, and the center of rotation (COR) of each distal tunnel was obtained by use of a least-squares circle-fitting algorithm.

RESULTS

The anterior fibular tunnel to lateral epicondyle and the posterior fibular or posterior tibial tunnel to 5 mm distal-anterior to the lateral epicondyle showed the best results in terms of isometry. The COR of the posterior fibular tunnel is distal and anterior to the epicondyle, whereas the COR of the posterior tibial tunnel is distal and slightly posterior to the epicondyle (8.4 mm away from the epicondyle, with a -8.4° angle along the longitudinal axis of the femur). The COR of the anterior fibular tunnel is located posterior and distal to the epicondyle.

CONCLUSIONS

Contrary to our hypothesis, the distal tunnels for PLC reconstruction each have different isometric points. The isometric point of the posterior fibular tunnel is distal and anterior to the epicondyle, whereas the isometric points of the posterior tibial and anterior fibular tunnels are distal and posterior to the epicondyle.

CLINICAL RELEVANCE

The isometric pattern of each tunnel combination should be considered in PLC reconstruction; currently, popliteus tendon reconstruction is non-isometric.

Control of the haemodynamic response to surgical stimuli in semi-closed circuit or closed circuit anaesthesia using a multifunctional anaesthesia system

This study compared the ability of the Zeus multifunctional anaesthesia system to control haemodynamic response to surgical stimulation in semi-closed (SCA) or closed circuit anaesthesia (CCA) modes. Fifty patients undergoing gynaecological surgery were randomly assigned to SCA or CCA. Anaesthesia was induced with 2 mg propofol and 0.9 mg/kg rocuronium, intravenously, and maintained using sevoflurane (minimum alveolar concentration [MAC], 1.0) using 2 l/min oxygen plus 2 l/min nitrous oxide (SCA 4 l/min group) or 50% oxygen plus 50% nitrous oxide (CCA group). An increase in mean arterial pressure (MAP) > 20% above baseline in response to surgical stimulation provoked a stepwise increase in sevoflurane (1.3 MAC and then 1.6 MAC), followed by fentanyl 1 pg/kg intravenously (rescue drug). The time required for MAP to return to within 10% of baseline was significantly shorter in the CCA group (6.4 +/- 3.6 min) compared with the SCA 4 l/min group (10.2 +/- 6.0 min). The percentage of patients requiring fentanyl was significantly greater in the SCA 4 l/min group than in the CCA group. In conclusion, CCA controlled acute haemodynamic responses to surgical stimuli more successfully and rapidly than SCA 4 l/min, using a multifunctional anaesthesia machine.

Scaling theory for unipolar resistance switching

We investigate a reversible percolation system showing unipolar resistance switching in which percolating paths are created and broken alternately by the application of an electric bias. Owing to the dynamical changes in the percolating paths, different from those in classical percolating paths, a detailed understanding of the structure is demanding and challenging. Here, we develop a scaling theory that can explain the transport properties of these conducting paths; the theory is based on the fractal geometry of a percolating cluster. This theory predicts that two scaling behaviors emerge, depending on the topologies of the conducting paths. We confirm these theoretical predictions experimentally by observing material-independent universal scaling behaviors in unipolar resistance switching.

Search for R-parity violating decays of sneutrinos to eμ, μτ, and eτ pairs in pp collisions at square root s = 1.96 TeV

We present a search for supersymmetric neutrino ν production using the Tevatron pp collision data collected with the CDF II detector and corresponding to an integrated luminosity of 1 fb-1. We focus on the scenarios predicted by the R-parity violating (RPV) supersymmetric models in which sneutrinos decay to two charged leptons of different flavor. With the data consistent with the standard model expectations, we set upper limits on σ(pp→ν)×BR(ν→eμ,μτ,eτ) and use these results to constrain the RPV couplings as a function of the sneutrino mass.

Search for new physics with a dijet plus missing E(T) signature in pp collisions at √s=1.96 TeV

We present results of a signature-based search for new physics using a dijet plus missing transverse energy (E(T)) data sample collected in 2  fb⁻¹ of pp collisions at √s=1.96  TeV with the CDF II detector at the Fermilab Tevatron. We observe no significant event excess with respect to the standard model prediction and extract a 95% C.L. upper limit on the cross section times acceptance for a potential contribution from a nonstandard model process. The search is made by using novel, data-driven techniques for estimating backgrounds that are applicable to first searches at the LHC.

Exclusion of an exotic top quark with -4/3 electric charge using soft lepton tagging

We present a measurement of the electric charge of the top quark using pp collisions corresponding to an integrated luminosity of 2.7 fb(-1) at the CDF II detector. We reconstruct tt events in the lepton + jets final state. We use soft lepton taggers to determine the flavor of the b jets, which we use to reconstruct the top quark's electric charge and exclude an exotic top quark with -4/3 charge at 95% confidence level. This is the strongest exclusion of the exotic charge scenario and the first to use soft leptons for this purpose.

Search for the production of scalar bottom quarks in pp collisions at square root(s) = 1.96 TeV

We report on a search for direct scalar bottom quark (sbottom) pair production in pp collisions at square root(s) = 1.96 TeV, in events with large missing transverse energy and two jets of hadrons in the final state, where at least one of the jets is required to be identified as originating from a b quark. The study uses a collider detector at Fermilab Run II data sample corresponding to 2.65 fb(-1) of integrated luminosity. The data are in agreement with the standard model. In an R-parity conserving minimal supersymmetric scenario, and assuming that the sbottom decays exclusively into a bottom quark and a neutralino, 95% confidence-level upper limits on the sbottom pair production cross section of 0.1 pb are obtained. For neutralino masses below 70 GeV/c2, sbottom masses up to 230 GeV/c2 are excluded at 95% confidence level.

Pain assessment and management in medical wards: an area of unmet need

BACKGROUND

Acute Pain Services (APS) were introduced primarily to improve postoperative pain management. Although pain is similar in prevalence and severity in medical and surgical wards, its assessment and management in non-surgical patients often receives less attention and resources.

OBJECTIVE

To investigate the extent of APS involvement on medical wards and obtain perceptions of deficiencies.

METHOD

A questionnaire was mailed to APS leads in 287 UK NHS hospitals; 229 questionnaires were returned (79.8% response).

RESULTS

Only 36 (16%) of the 225 hospitals with medical wards reported routine APS involvement. Pain scores were not recorded in 75 (33%) hospitals, 11 (5%) denied knowledge about assessments being conducted, and 185 (82.2%) respondents felt that pain management on medical wards was inadequate.

CONCLUSIONS

Perceived lack of training and awareness of healthcare staff were highly ranked contributing factors, and this was attributed to inadequate funding. This study highlights the scope for improvement of pain control in medical patients, with benefits from reduced morbidity and faster recovery.

Measurement of W-boson polarization in Top-Quark Decay in pp collisions at sqrt[s]=1.96 TeV

We report measurements of the polarization of W bosons from top-quark decays using 2.7 fb{-1} of pp collisions collected by the CDF II detector. Assuming a top-quark mass of 175  GeV/c{2}, three measurements are performed. A simultaneous measurement of the fraction of longitudinal (f{0}) and right-handed (f{+}) W bosons yields the model-independent results f{0}=0.88±0.11(stat)±0.06(syst) and f{+}=-0.15±0.07(stat)±0.06(syst) with a correlation coefficient of -0.59. A measurement of f{0} [f{+}] constraining f{+} [f{0}] to its standard model value of 0.0 [0.7] yields f{0}=0.70±0.07(stat)±0.04(syst) [f{+}=-0.01±0.02(stat)±0.05(syst)]. All these results are consistent with standard model expectations. We achieve the single most precise measurements of f{0} for both the model-independent and model-dependent determinations.

Measurement of the ratio σ{tt}/σ{Z/γ{*}→ll} and precise extraction of the tt cross section

We report a measurement of the ratio of the tt to Z/γ{*} production cross sections in sqrt[s]=1.96  TeV pp collisions using data corresponding to an integrated luminosity of up to 4.6  fb{-1}, collected by the CDF II detector. The tt cross section ratio is measured using two complementary methods, a b-jet tagging measurement and a topological approach. By multiplying the ratios by the well-known theoretical Z/γ{*}→ll cross section predicted by the standard model, the extracted tt cross sections are effectively insensitive to the uncertainty on luminosity. A best linear unbiased estimate is used to combine both measurements with the result σ{tt}=7.70±0.52  pb, for a top-quark mass of 172.5  GeV/c{2}.

Search for pair production of supersymmetric top quarks in dilepton events from pp collisions at sqrt[s]=1.96 TeV

We present the results of a search for pair production of the supersymmetric partner of the top quark (the top squark t{1}) decaying to a b quark and a chargino χ{1}{±} with a subsequent χ{1}{±} decay into a neutralino χ{1}{0}, lepton ℓ, and neutrino ν. Using a data sample corresponding to 2.7  fb{-1} of integrated luminosity of pp collisions at sqrt[s]=1.96  TeV collected by the CDF II detector, we reconstruct the mass of top squark candidate events and fit the observed mass spectrum to a combination of standard model processes and t{1}t{1} signal. We find no evidence for t{1}t{1} production and set 95% C.L. limits on the masses of the top squark and the neutralino for several values of the chargino mass and the branching ratio B(χ{1}{±}→χ{1}{0}ℓ{±}ν).

Search for WW and WZ resonances decaying to electron, missing E(T), and two jets in pp collisions at square root(s) = 1.96 TeV

Using data from 2.9  fb(-1) of integrated luminosity collected with the CDF II detector at the Tevatron, we search for resonances decaying into a pair of on-shell gauge bosons, WW or WZ, where one W decays into an electron and a neutrino, and the other boson decays into two jets. We observed no statistically significant excess above the expected standard model background, and we set cross section limits at 95% confidence level on G* (Randall-Sundrum graviton), Z', and W' bosons. By comparing these limits to theoretical cross sections, mass exclusion regions for the three particles are derived. The mass exclusion regions for Z' and W' are further evaluated as a function of their gauge coupling strength.

Measurement of the W+ W- production cross section and search for anomalous WWγ and WWZ couplings in pp collisions at square root(s)=1.96 TeV

This Letter describes the current most precise measurement of the W boson pair production cross section and most sensitive test of anomalous WWγ and WWZ couplings in pp collisions at a center-of-mass energy of 1.96 TeV. The WW candidates are reconstructed from decays containing two charged leptons and two neutrinos. Using data collected by the CDF II detector from 3.6  fb(-1) of integrated luminosity, a total of 654 candidate events are observed with an expected background of 320±47 events. The measured cross section is σ(pp→W+ W- +X)=12.1±0.9(stat)-1.4+1.6(syst)  pb, which is in good agreement with the standard model prediction. The same data sample is used to place constraints on anomalous WWγ and WWZ couplings.

Search for the Higgs boson using neural networks in events with missing energy and b-quark jets in pp collisions at square root(s) = 1.96 TeV

We report on a search for the standard model Higgs boson produced in association with a W or Z boson in pp collisions at square root(s)=1.96 TeV recorded by the CDF II experiment at the Tevatron in a data sample corresponding to an integrated luminosity of 2.1 fb(-1). We consider events which have no identified charged leptons, an imbalance in transverse momentum, and two or three jets where at least one jet is consistent with originating from the decay of a b hadron. We find good agreement between data and background predictions. We place 95% confidence level upper limits on the production cross section for several Higgs boson masses ranging from 110 GeV/c(2) to 150 GeV/c(2). For a mass of 115 GeV/c(2) the observed (expected) limit is 6.9 (5.6) times the standard model prediction.

First measurement of the b-jet cross section in events with a W boson in pp collisions at square root(s) = 1.96 TeV

The cross section for jets from b quarks produced with a W boson has been measured in pp collision data from 1.9 fb(-1) of integrated luminosity recorded by the CDF II detector at the Tevatron. The W+b-jets process poses a significant background in measurements of top quark production and prominent searches for the Higgs boson. We measure a b-jet cross section of 2.74+/-0.27(stat)+/-0.42(syst) pb in association with a single flavor of leptonic W boson decay over a limited kinematic phase space. This measured result cannot be accommodated in several available theoretical predictions.

Search for technicolor particles produced in association with a W Boson at CDF

We present a search for the technicolor particles rho{T} and pi_{T} in the process pp-->rho{T}-->Wpi{T} at a center of mass energy of sqrt[s]=1.96 TeV. The search uses a data sample corresponding to approximately 1.9 fb{-1} of integrated luminosity accumulated by the CDF II detector at the Fermilab Tevatron. The event signature we consider is W-->lnu and pi{T}-->bb, bc or bu depending on the pi{T} charge. We select events with a single high-p{T} electron or muon, large missing transverse energy, and two jets. Jets corresponding to bottom quarks are identified with multiple b-tagging algorithms. The observed number of events and the invariant mass distributions are consistent with the standard model background expectations, and we exclude a region at 95% confidence level in the rho{T}-pi{T} mass plane. As a result, a large fraction of the region m(rho{T})=180-250 GeV/c{2} and m(pi{T})=95-145 GeV/c{2} is excluded.

Measurement of the Lambdab0 lifetime in Lambdab0 --> Lambdac+pi- decays in pp collisions at square root of s = 1.96 TeV

We report a measurement of the lifetime of the Lambda(b)(0) baryon in decays to the Lambda(c)(+)pi(-) final state in a sample corresponding to 1.1 fb(-1) collected in pp collisions at square root of s = 1.96 TeV by the CDF II detector at the Tevatron collider. Using a sample of about 3000 fully reconstructed Lambda(b)(0) events we measure tau(Lambda(b)(0)) = 1.401 +/- 0.046(stat) +/- 0.035(syst) ps (corresponding to ctau(Lambda(b)(0)) = 420.1 +/- 13.7(stat) +/- 10.6(syst) microm, where c is the speed of light). The ratio of this result and the world average B(0) lifetime yields tau(Lambda(b)(0))/tau(B(0)) = 0.918 +/- 0.038 (stat) and (syst), in good agreement with recent theoretical predictions.

Measurement of the WW + WZ production cross section using the lepton + jets final state at CDF II

We report two complementary measurements of the WW + WZ cross section in the final state consisting of an electron or muon, missing transverse energy, and jets, performed using pp collision data at square root of s = 1.96 TeV collected by the CDF II detector. The first method uses the dijet invariant mass distribution while the second more sensitive method uses matrix-element calculations. The result from the second method has a signal significance of 5.4sigma and is the first observation of WW + WZ production using this signature. Combining the results gives sigma(WW + WZ) = 16.0 +/- 3.3 pb, in agreement with the standard model prediction.

Search for new bottomlike quark pair decays QQ-->(tW(+)(-))(tW(+)(-)in same-charge dilepton events

We report the most restrictive direct limits on masses of fourth-generation down-type quarks b{'}, and quarklike composite fermions (B or T{5/3}), decaying promptly to tW{-/+}. We search for a significant excess of events with two same-charge leptons (e, mu), several hadronic jets, and missing transverse energy. An analysis of data from pp collisions with an integrated luminosity of 2.7 fb{-1} collected with the CDF II detector at Fermilab yields no evidence for such a signal, setting mass limits m{b{'}}, m{B}>338 GeV/c{2} and m{T{5/3}}>365 GeV/c{2} at 95% confidence level.

Combination of Tevatron searches for the standard model Higgs boson in the W+W- decay mode

We combine searches by the CDF and D0 Collaborations for a Higgs boson decaying to W+W-. The data correspond to an integrated total luminosity of 4.8 (CDF) and 5.4 (D0) fb(-1) of pp collisions at square root(s) = 1.96 TeV at the Fermilab Tevatron collider. No excess is observed above background expectation, and resulting limits on Higgs boson production exclude a standard model Higgs boson in the mass range 162-166 GeV at the 95% C.L.

Inclusive search for standard model Higgs boson production in the WW decay channel using the CDF II detector

We present a search for standard model (SM) Higgs boson production using pp collision data at square root(s) = 1.96 TeV, collected with the CDF II detector and corresponding to an integrated luminosity of 4.8 fb(-1). We search for Higgs bosons produced in all processes with a significant production rate and decaying to two W bosons. We find no evidence for SM Higgs boson production and place upper limits at the 95% confidence level on the SM production cross section (sigma(H)) for values of the Higgs boson mass (sigma(H)) in the range from 110 to 200 GeV. These limits are the most stringent for m(H) > 130 GeV and are 1.29 above the predicted value of sigma(H) for c = 165 GeV.

A Comparison of Consumption and Recovery Profiles According to Anaesthetic Circuit Mode using a New Multifunctional Closed-Circuit Anaesthesia System during Desflurane Anaesthesia: A Clinical Study

This clinical study compared induction time, consumed anaesthetic dose, and haemodynamic and recovery profiles when using a new type of multifunctional anaesthesia machine (Zeus®) in semi-closed or closed circuit modes. Sixty female patients undergoing gynaecological surgery were randomly assigned to three groups and received desflurane anaesthesia through a semi-closed circuit (SCC) at fresh gas flow rates of 4 l/min (SCC 4 l/min) or 2 l/min (SCC 2 l/min), or through a closed circuit (CC). Anaesthesia was maintained at the minimum alveolar concentration for blocking the adrenergic response to painful stimulus (MACBAR) (4.6% end-tidal desflurane) during each operation. The time required to reach MACBAR was significantly shorter and the dose of desflurane was significantly smaller in the CC group compared with the other groups. There were no differences in haemodynamic and recovery profiles between the groups. It is concluded that the CC mode allowed a faster and more reliable induction, lower anaesthetic consumption and stable haemodynamic and recovery profiles.

Search for supersymmetry with gauge-mediated breaking in diphoton events with missing transverse energy at CDF II

We present the results of a search for supersymmetry with gauge-mediated breaking and chi(1)(0) --> gammaG in the gammagamma + missing transverse energy final state. In 2.6+/-0.2 fb(-1) of pp collisions at square root(s) = 1.96 TeV recorded by the CDF II detector we observe no candidate events, consistent with a standard model background expectation of 1.4+/-0.4 events. We set limits on the cross section at the 95% C.L. and place the world's best limit of 149 GeV/c2 on the chi(1)(0) mass at tau(chi(1)(0)) << 1 ns. We also exclude regions in the chi(1)(0) mass-lifetime plane for tau(chi(1)(0)) approximately < 2 ns.

Effect of type 2 diabetes on mortality risk associated with end-stage kidney disease

AIMS/HYPOTHESIS

Patients with end-stage kidney disease (ESKD) and patients with diabetes mellitus experience higher mortality rates than the general population. Whether ESKD imparts the same excess in mortality risk for those with diabetes as it does for those without diabetes is unknown.

METHODS

Included in the study were all white patients aged > or =25 years with incident ESKD and type 2 diabetes (n = 4,141) or with incident ESKD but without diabetes (n = 13,289) in Australia from 1991 to 2005, and all the individuals aged > or =25 years without ESKD and with type 2 diabetes (n = 909) or without ESKD without diabetes (n = 10,302) enrolled in the AusDiab Study--a nationwide Australian representative cohort--from 1999 to 2005. Excess mortality was analysed in patients with ESKD by diabetes status, using age-, sex- and diabetes-status-specific standardised mortality ratios (SMRs) in the first 8 years after first renal replacement therapy among ANZDATA patients relative to AusDiab participants.

RESULTS

The SMRs in patients with ESKD were, in non-diabetic patients and in those with type 2 diabetes, respectively: 14.2 (95% CI 13.9-14.6) and 10.8 (95% CI 10.4-11.2) (p < 0.01); in people aged <60 years, 28.7 (95% CI 27.2-30.4) and 18.6 (95% CI 17.1-20.4) (p < 0.01); in people aged > or =60 years, 12.5 (95% CI 12.1-12.9) vs 9.7 (95% CI 9.3-10.1) (p < 0.01); in men, 11.0 (95% CI 10.7-11.4) vs 8.9 (95% CI 8.4-9.3) (p < 0.01); and in women, 23.4 (95% CI 22.5-24.3) vs 16.2 (95% CI 15.2-17.3) (p < 0.01).

CONCLUSIONS/INTERPRETATION

ESKD was associated with a greater relative increase in mortality in the non-diabetic study populations than in the type 2 diabetes population. Excess mortality was greater among younger people and women.

Search for the associated production of the standard-model Higgs Boson in the all-hadronic channel

We report on a search for the standard-model Higgs boson in pp collisions at square root(s) = 1.96 TeV using an integrated luminosity of 2.0 fb(-1). We look for production of the Higgs boson decaying to a pair of bottom quarks in association with a vector boson V (W or Z) decaying to quarks, resulting in a four-jet final state. Two of the jets are required to have secondary vertices consistent with B-hadron decays. We set the first 95% confidence level upper limit on the VH production cross section with V(--> qq/qq')H(--> bb) decay for Higgs boson masses of 100-150 GeV/c2 using data from run II at the Fermilab Tevatron. For m(H) = 120 GeV/c2, we exclude cross sections larger than 38 times the standard-model prediction.

Search for Higgs bosons predicted in two-Higgs-doublet models via decays to tau lepton pairs in 1.96 TeV pp collisions

We present the results of a search for Higgs bosons predicted in two-Higgs-doublet models, in the case where the Higgs bosons decay to tau lepton pairs, using 1.8 fb(-1) of integrated luminosity of pp collisions recorded by the CDF II experiment at the Fermilab Tevatron. Studying the mass distribution in events where one or both tau leptons decay leptonically, no evidence for a Higgs boson signal is observed. The result is used to infer exclusion limits in the two-dimensional space of tanbeta versus m(A) (the ratio of the vacuum expectation values of the two Higgs doublets and the mass of the pseudoscalar boson, respectively).

First observation of B(s)(0) --> D(s)(+/-)K(-/+) and measurement of the ratio of branching fractions B(B(s)(0) --> D(s)(+/-)K(-/+)/B(B(s)(0) --> D(s)(+)pi(-))

A combined mass and particle identification fit is used to make the first observation of the decay B(s)(0) --> D(s)(+/-)K(-/+) and measure the branching fraction of B(s)(0) --> D(s)(+/-)K(-/+) relative to B(s)(0) --> D(s)(+)pi(-). This analysis uses 1.2 fb(-1) integrated luminosity of pp collisions at square root(s) = 1.96 TeV collected with the CDF II detector at the Fermilab Tevatron collider. We observe a B(s)(0) --> D(s)(+/-)K(-/+) signal with a statistical significance of 8.1 sigma and measure B(B(s)(0) --> D(s)(+/-)K(-/+) /B(B(s)(0) --> D(s)(+)pi(-) 0.097+/-0.018(stat) +/- 0.009(syst).

Precision measurement of the X(3872) mass in J/psi pi(+) pi(-) decays

We present an analysis of the mass of the X(3872) reconstructed via its decay to J/psi pi(+)pi(-) using 2.4 fb(-1) of integrated luminosity from pp collisions at square root(s)=1.96 TeV, collected with the CDF II detector at the Fermilab Tevatron. The possible existence of two nearby mass states is investigated. Within the limits of our experimental resolution the data are consistent with a single state, and having no evidence for two states we set upper limits on the mass difference between two hypothetical states for different assumed ratios of contributions to the observed peak. For equal contributions, the 95% confidence level upper limit on the mass difference is 3.6 MeV/c(2). Under the single-state model the X(3872) mass is measured to be 3871.61+/-0.16(stat)+/-0.19(syst) MeV/c(2), which is the most precise determination to date.