Gender disparities in patients undergoing extracorporeal cardiopulmonary resuscitation

Introduction

The use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in extracorporeal cardiopulmonary resuscitation (eCPR) has emerged as a treatment option for selected patients who are experiencing refractory cardiac arrest (CA). In the light of increasing availability, the analyses of outcome-relevant predisposing characteristics are of growing importance. We evaluated the prognostic influence of gender in patients presenting with out-of-hospital cardiac arrest (OHCA) treated with eCPR.

Methods

We retrospectively analysed the data of 377 consecutive patients treated for OHCA using eCPR in our cardiac arrest centre from January 2016 to December 2022. The primary outcome was defined as the survival of patients until they were discharged from the hospital, with a favourable neurological outcome [cerebral performance category (CPC) score of ≤2]. Statistical analyses were performed using baseline comparison, survival analysis, and multivariable analyses.

Results

Out of the 377 patients included in the study, 69 (21%) were female. Female patients showed a lower prevalence rate of pre-existing coronary artery disease (48% vs. 75%, p < 0.001) and cardiomyopathy (17% vs. 34%, p = 0.01) compared with the male patients, while the mean age and prevalence rate of other cardiovascular risk factors were balanced. The primary reason for CA differed significantly (female: coronary event 45%, pulmonary embolism 23%, cardiogenic shock 17%; male: coronary event 70%, primary arrhythmia 10%, cardiogenic shock 10%; p = 0.001). The prevalence rate of witnessed collapse (97% vs. 86%; p = 0.016) and performance of bystander CPR (94% vs. 85%; p = 0.065) was higher in female patients. The mean time from collapse to the initiation of eCPR did not differ between the two groups (77 ± 39 min vs. 80 ± 37 min; p = 0.61). Overall, female patients showed a higher percentage of neurologically favourable survival (23% vs. 12%; p = 0.027) despite a higher prevalence of procedure-associated bleeding complications (33% vs. 16%, p = 0.002). The multivariable analysis identified a shorter total CPR duration (p = 0.001) and performance of bystander CPR (p = 0.03) to be associated with superior neurological outcomes. The bivariate analysis showed relevant interactions between gender and body mass index (BMI).

Conclusion

Our analysis suggests a significant survival benefit for female patients who obtain eCPR, possibly driven by a higher prevalence of witnessed collapse and bystander CPR. Interestingly, the impact of patient age and BMI on neurologically favourable outcome was higher in female patients than in male patients, warranting further investigation.

Prognostic influence of mechanical cardiopulmonary resuscitation on survival in patients with out-of-hospital cardiac arrest undergoing ECPR on VA-ECMO

Introduction

The use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in extracorporeal cardiopulmonary resuscitation (ECPR) in selected patients after out-of-hospital cardiac arrest (OHCA) is an established method if return of spontaneous circulation cannot be achieved. Automated chest compression devices (ACCD) facilitate transportation of patients under ongoing CPR and might improve outcome. We thus sought to evaluate prognostic influence of mechanical CPR using ACCD in patients presenting with OHCA treated with ECPR including VA-ECMO.

Methods

We retrospectively analyzed data of 171 consecutive patients treated for OHCA using ECPR in our cardiac arrest center from the years 2016 to 2022. A Cox proportional hazards model was used to identify characteristics related with survival.

Results

Of the 171 analyzed patients (84% male, mean age 56 years), 12% survived the initial hospitalization with favorable neurological outcome. The primary reason for OHCA was an acute coronary event (72%) followed by primary arrhythmia (9%) and non-ischemic cardiogenic shock (6.7%). In most cases, the collapse was witnessed (83%) and bystander CPR was performed (83%). The median time from collapse to VA-ECMO was 81 min (Q1: 69 min, Q3: 98 min). No survival benefit was seen for patients resuscitated using ACCD. Patients in whom an ACCD was used presented with overall longer times from collapse to ECMO than those who were resuscitated manually [83 min (Q1: 70 min, Q3: 98 min) vs. 69 min (Q1: 57 min, Q3: 84 min), p = 0.004].

Conclusion

No overall survival benefit of the use of ACCD before ECPR is established was found, possibly due to longer overall CPR duration. This may arguably be because of the limited availability of ACCD in pre-clinical paramedic service at the time of observation. Increasing the availability of these devices might thus improve treatment of OHCA, presumably by providing efficient CPR during transportation and transfer.

Clinical and Liver Enzymes among the Patients with Metabolic Syndrome with or without Non Alcoholic Fatty Liver Disease attending a Tertiary Care Hospital

Metabolic syndrome is characterized by central obesity, dyslipidemia, raised blood pressure and impaired blood sugar levels. Patients with metabolic syndrome are at increased risk of type 2 diabetes and atherosclerotic cardiovascular disease. This cross-sectional observational study was carried out from January 2019 to December 2019 at the inpatient and outpatient department of BIRDEM General Hospital, Dhaka, Bangladesh. Adult subjects aged ≥18 years with metabolic syndrome (IDF criteria, 2006) were included and purposive sampling was done. A total of 242 participants were included and the mean age was 40.2±14.1 years ranging from 18-70 years. Among them, 140(57.85%) were female and 102(42.15%) were male. Out of 242 participants, 170(70.25%) subjects had Metabolic Syndrome (MetS) with Non-Alcoholic Fatty Liver (NAFLD) and 72(29.75%) subjects had metabolic syndrome without NAFLD. In the male participants, the mean waist-hip ratio (WHR) of MetS with NAFLD and MetS without NAFLD was 1.01±0.07 vs. 0.96±0.08 respectively (p-value 0.003). In female subjects, the mean waist-hip ratio (WHR) of MetS with NAFLD and MetS without NAFLD group was 0.90±0.10 vs. 0.86±0.08 respectively (p-value 0.026). MetS with NAFLD subjects were more hypertensive than MetS without NAFLD subjects (61.2% vs. 42.7%). In the MetS with NAFLD group (n=170), 11.8% was normoglycemic, 43.5% was prediabetic and 44.7% was diabetic. In the MetS without NAFLD group (n=72), 19.5% was normoglycemic, 50% was prediabetic and 30.5% was diabetic. SGPT value was significantly raised in MetS with NAFLD subjects (56.4%) than MetS without NAFLD (38.9%) subjects (p-value 0.038). SGOT value was significantly raised in MetS with NAFLD subjects (58.8%) than MetS without NAFLD subjects (41.7%); (p-value 0.005). Mean Total Cholesterol and Triglyceride were significantly raised in MetS with NAFLD subjects than MetS without NAFLD subjects (p-value 0.01). In Subjects with grade I fatty liver, mean SGPT and SGOT were 42.27±22.31 vs. 39.59±16.93 respectively. In Subjects with grade II fatty liver, mean SGPT and SGOT were 62.13±32.42 vs. 52.45±28.56 respectively. In grade III fatty liver, mean SGPT and SGOT were 51.50±32.19 vs. 41.00±17.52 respectively (p value <0.001). More than two-third of participants with metabolic syndrome had non-alcoholic fatty liver disease (NAFLD) and a significant elevation of liver enzymes than metabolic syndrome without NAFLD participants. About 85.0% of metabolic syndrome participants had glucose intolerance in the form of prediabetes and diabetes.

Hemadsorption treatment for antithrombotic drug removal in emergency cardiac surgery – cost-benefit analysis comparing patient outcomes

Background

Intraoperative hemadsorption is indicated for ticagrelor and rivaroxaban removal in patients undergoing urgent cardiac surgery and has been previously shown to reduce bleeding complications. However, whether this application is cost effective is currently unknown.

Methods

Between June 2017 and June 2021, we evaluated the outcomes of 72 consecutive patients (age 65±11 years) with acute coronary syndrome (ACS) pretreated with ticagrelor who underwent urgent coronary artery bypass grafting (CABG) at our institution. Intraoperative hemoadsorption (IH) was used in all cases (IH-Pat). We estimated the mean cost per patient, and a bootstrap analysis was performed based on individual data from the case series. We compared the results with “historical patients” who were operated under the same conditions between June 2015 and June 2017 but without IH (n=22).

Results

Bilateral internal mammary artery (BIMA) was used in 67.7% of all cases. Use of IH was associated with significantly shorter operation times (277±65 min vs. 320±75 min; P=0.014) and significantly less postoperative 24-hours chest tube drainage (277±65 mL vs. 866±262 mL; P&lt;0.001). Only two rethoracotomies (2.8%) had to be performed. In addition, patients operated without IH required significantly more blood products and had a significantly higher rate of rethoracotomy, resulting in longer ICU stays. The variable that had the highest impact on the level of cost savings was the operation duration. The overall cost saving with IH were calculated at over 4200±1100€ with operation time, ICU stay and blood product costs being the top contributors.

Conclusions

The results suggest that the clinical benefits derived from IH in ticagrelor-treated patients requiring urgent cardiac surgery patients could result in significant cost savings of over 4200±1100 € per patient.

Funding Acknowledgement

Type of funding sources: None.

Experimental acoustic scene analysis using One-Eighth spherical fraction microphone array

This paper investigates the performance of one-eighth Spherical Fraction Microphone Array through experimental measurement to analyze acoustic scenes in one-eighth of space. The array geometry is designed to be placed in a room corner at the junction of three acoustically rigid walls. Two prototypes are built with 8 and 16 microphones, respectively. The sampling strategy is discussed and a spatial aliasing analysis is carried out both analytically and by numerical simulations. The array performances are evaluated through Spherical Fraction Beamforming (SFB). This approach is based on the decomposition of the acoustic pressure field in a rigid bounded domain. The localization angular error and Directivity Index criterion are evaluated for both arrays. In a first experiment, the arrays are mounted in an eighth of space built inside an anechoic room. The results are compared with simulation and show consistency. The theoretical limitations of SFB in a rigid bounded one-eighth of space are retrieved experimentally. These limitations are also observed in a real configuration: an office room. Further investigations on SFB are also conducted in the case of a virtual scene constructed with two sound sources.

Emerging infectious bronchitis virus (IBV) in Egypt: Evidence for an evolutionary advantage of a new S1 variant with a unique gene 3ab constellation

Infectious bronchitis virus (IBV), a gamma-coronavirus, causes infectious bronchitis (IB), a major respiratory disease of chicken. Its high mutation rate in conjunction with recombination of the RNA genome constantly creates IBV variants that are difficult to control by currently available vaccines. In this study, we addressed the question whether small-scale holdings might harbor IBV variants that serve as a reservoir for newly emerging variants. Egyptian IBV isolate EGY/NR725/2016 (NR725/16) from a small-scale broiler farm was assigned to genotype I, clade 23 (S1:GI-23), based on partial S1 gene sequences and corroborated by full genome sequencing. Analysis of the S1 gene established three subclades for historical IBV strains (S1:GI-23.1, S1:GI-23.2.1 and S1:GI-23.2.2) and confirmed NR725/16 as being part of a separate fourth subclade (S1:GI-23.3). Samples from the years 2018 and 2019 revealed that the new subclade prevails in Egypt, carrying fixed mutations within the hypervariable regions (HVR) 1-3 of the S1 protein that affect two neutralization sensitive epitopes at sites 294F, 297S and 306Y (48.2) and 329R (62.1). In addition, recombination was recognized in isolate NR 725/16, with intra-subtype mixing for the entire genes 3ab and E and inter-subtype mixing for the entire gene 6b with a close match to QX like viruses of genotype GI-19. Further analysis of gene 3ab detected the homologous gene pool to NR725/16 in samples from 2013 (3ab:C) and closely related 3ab genotypes in IBV Egyptian isolates from 2016, 2018 and 2019. These data prove a flourishing exchange between poultry holdings with a common gene pool. The continued circulation of viruses harboring genes S1:GI-23.3 and 3ab:C indicates an evolutionary advantage of this combination possibly by combining antigenic escape with modulated pathogenicity to facilitate IBV spread in the vaccinated poultry population in Egypt.

P6518Radial artery dilatation to improve access and lower complication rates during coronary angiography (RADIAL): a randomized controlled trial

Background

Transradial catheterization has become the preferred access site for coronary angiography. The transradial approach is however not without challenges and complications. Cannulation is technically challenging and may require multiple cannulation attempts or access may fail. Local access site complications may occur postprocedurally.

Purpose

To explore the use of prolonged occlusion flow mediated dilatation (PO-FMD) to dilate the radial artery prior to cannulation to reduce puncture attempts, increase cannulation success and reduce access site complications in transradial coronary angiography.

Methods

1156 patients undergoing transradial coronary angiography were randomized into PO-FMD and sham PO-FMD groups. PO-FMD was achieved by a 10 minute inflation of a blood pressure cuff on the arm to above systolic pressure, followed by deflation with resultant radial artery dilation. In the sham PO-FMD group the cuff was not inflated. The operators were blinded to the intervention.

Results

580 patients were randomized to the sham PO-FMD group and 576 to the PO-FMD group. The number of puncture attempts were reduced with the use of PO-FMD, with a median number of attempts of 1 in the PO-FMD group and 2 in the sham PO-FMD group (p<0.001). Cannulation failure was reduced with PO-FMD FMD with cannulation failure rates of 2.7% in the PO-FMD group and 5.8% in the sham PO-FMD group (p=0.01). Radial artery pulsation loss (RAPL) was reduced with PO-FMD with 1.4% in the PO-FMD group and 3.8% in the sham PO-FMD group (p=0.02).

Conclusion

PO-FMD decreases puncture attempts, reduces cannulation failure rates and decreases RAPL during transradial coronary angiography.

Hong-Ou-Mandel interference between independent III-V on silicon waveguide integrated lasers

The versatility of silicon photonic integrated circuits has led to a widespread usage of this platform for quantum information-based applications, including quantum key distribution (QKD). However, the integration of simple high-repetition-rate photon sources is yet to be achieved. The use of weak-coherent pulses (WCPs) could represent a viable solution. For example, measurement device independent QKD (MDI-QKD) envisions the use of WCPs to distill a secret key immune to detector side channel attacks at large distances. Thus, the integration of III-V lasers on silicon waveguides is an interesting prospect for quantum photonics. Here we report the experimental observation of Hong-Ou-Mandel interference with 46±2% visibility between WCPs generated by two independent III-V on silicon waveguide integrated lasers. This quantum interference effect is at the heart of many applications, including MDI-QKD. This Letter represents a substantial first step towards an implementation of MDI-QKD fully integrated in silicon and could be beneficial for other applications such as standard QKD and novel quantum communication protocols.

A Multi-resolution Approach for Content-based Image Retrieval on the Grid

Objectives: Hospitals and medical centers are producing more and more data that need to be processed. Those data are confidential, heterogeneous, and limited to the geographic site where they have been produced. Unless properly anonymized, they cannot be distributed on wide area networks.

Methods: Grid technologies allow the globalization of storage and processing resources, and enable large-scale experimentations on distributed data. They constitute a promising tool to treat the different data and analyze the knowledge they contain, while offering secured access and high-performance computing capacities to the different users. Our aim is to evaluate the possibilities of grid technologies for handling medical data.

Results and Conclusions: In this paper, we focus on a breast cancer diagnosis assistance tool, based on distributed and incremental knowledge construction and a content-based image retrieval system. We analyze the different scenarios of uses of such a tool. We further propose an algorithm that indexes mammographic images for content-based query purposes. This algorithm is tested on images of different resolutions in order to reduce the indexation time and we analyze its performance with experiments on the grid.

Hemodynamic effects of sodium bicarbonate administration

OBJECTIVE

To describe the hemodynamic changes that occur with sodium bicarbonate (NaHCO₃) administration in premature neonates.

STUDY DESIGN

This retrospective study included premature neonates 23 to 31+6 weeks of gestational age who underwent continuous cardiac and cerebral monitoring as participants in prospective trials at our institution, and who received NaHCO₃ infused over 30 min in the first 24 h of life. Blood pressure (BP), heart rate, cardiac output (CO), SpO₂ and cerebral oximetry (StO₂) were captured every 2 s. A baseline was established for all continuous data and averaged over the 10 min before NaHCO₃ administration. Baseline was compared with measurements over 10 min epochs until 80 min after administration. Arterial blood gases before and within 1 h of administration were also compared. Significance was set at P<0.05.

RESULTS

A total of 36 subjects received NaHCO₃ (1.3±0.3 mEq kg^-1) in the first 24 h (14±8.5 h) of life. NaHCO₃ administration increased pH (7.23 vs 7.28, P<0.01) and decreased base deficit (-8.9 vs -6.8, P<0.01) and PaCO₂ (45 vs 43 mm Hg, P<0.05). There was a transient but significant (P<0.05) decrease in systemic BP coinciding with an increase in cerebral oxygenation without an increase in oxygen extraction. CO did not change.

CONCLUSION

Early postnatal NaHCO₃ administration does not acutely improve CO but does cause transient fluctuations in cerebral and cardiovascular hemodynamics in extremely premature infants.

Bilateral concomitant intravitreal anti-vascular endothelial growth factor injection: Experience in a Nigerian tertiary private eye care facility

OBJECTIVES

To evaluate the indication and safety profile of same-session bilateral intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF).

METHODS

This is a retrospective case series of all the patients that received same-session bilateral intravitreal anti-VEGF in Eye Foundation Hospital, Ikeja, Lagos, from March 2013 to March 2015. Data retrieved from the patients' medical records includes demographics, indications for injections, complications, and systemic comorbidities.

RESULTS

During the study period, a total of 442 injections were performed on 126 eyes of 63 patients (M:F ratio; 1.4:1) whose mean age was 55.7 ± 15.6 standard deviation years. The modal age group was 51-70 years. All the patients received injection Bevacizumab (Avastin; Genentech Inc., South San Francisco, California, USA-1.25 mg). The most common primary indication for initiating bilateral intravitreal therapy was diabetic macular edema 23 (36.5%). Mean follow-up period was 40.6 days (range: 1-364 days). A combined diabetes mellitus and hypertension accounted for most of the systemic comorbidities 28 (44.4%). Subconjunctival hemorrhage was the only complication seen in these patients with 6 (9.5%) occurring intraoperatively and 9 (14.3%) postoperatively. There was no association between intraoperative complication and age (P = 0.66) or gender (P = 0.96). Furthermore, there exist no association between postoperative complication and age (P = 0.49) or gender (P = 0.99).

CONCLUSIONS

No major systemic or ocular adverse events were noted. Given that there are potentially serious complications following anti-VEGF injection, further study with a larger number of patients will be necessary to definitively prove the safety of this treatment modality.

Evaluation of Software Tools for Segmentation of Temporal Bone Anatomy

Surgeons are increasingly relying on 3D medical image data for planning interventions. Virtual 3D models of intricate anatomy, such as that found within the temporal bone, have proven useful for surgical education, planning, and rehearsal, but such applications require segmentation of surgically relevant structures in the image data. Four publicly available software packages, ITK-SNAP, MITK, 3D Slicer, and Seg3D, were evaluated for their efficacy in segmenting temporal bone anatomy from CT and MR images to support patient-specific surgery simulation. No single application provided efficient means to segment every structure, but a combination of the tools evaluated enables creation of a complete virtual temporal bone model from raw image data with reasonably minimal effort.

Do diabetic patients receiving conventional dialysis solutions benefit from peritoneal dialysis?

AIM

The study aimed to evaluate the impact of glucose-based peritoneal dialysis solutions (GBPDS) on diabetic patients on maintenance peritoneal dialysis.

METHODS

In this cross-sectional study we compared the influence of long term use of GBPDS on sixteen parameters related to the peritoneal glucose load, hydration status, inflammation, blood pressure, lipid profile and left ventricular mass in 45 stable PD patients (20 diabetic and 25 non-diabetic) receiving GBPDS.

RESULTS

At 24 months HbA1c, peritoneal glucose load index (PGLI), fluid overload (FO), plasma BNP, hsCRP and IL-6 levels, WBC count, blood pressure, triglycerides, LDL-C and left ventricular mass index (LVMI) were higher in diabetic patients compared to non-diabetic subjects (P ≤ 0.04). Of 16 tested variables, 14 had deteriorated at 24 months in diabetic patients. PGLI values > 3 g/kg/day or FO > 1.0 L were associated with abnormal values of HbA1c, plasma BNP, CRP and plasma IL-6 levels. 60% of diabetic patients had PGLI > 3g/kg/day compared to 32% of non-diabetic patients (P < 0.001). Seventy per cent of diabetic patients had FO > 1.0 L compared to 28% of non-diabetic patients (P < 0.001). Only 12% of diabetic patients had nocturnal blood pressure dipping compared to 45% of non-diabetics (P = 0.03). 57.8% of the studied patients had increased LVMI. Diabetic patients had higher LVMI values compared to non-diabetics (P < 0.001). The presence of DM was found to be the most powerful predictor for the development of LVH (P < 0.001).

CONCLUSION

Utilization of GBPDS in diabetic PD patients may be associated with substantial adverse consequences affecting glycemic control, hydration status, lipid profile, inflammation, blood pressure control and LVM.

Dihedron dielectric loaded surface plasmon athermal polarization converter

We investigate numerically a novel plasmonic polarization converter relying on the excitation of a so-called dihedron dielectric loaded plasmon polariton. The dihedron dielectric loaded waveguide consists of a dielectric ridge implemented at the inner corner of a metal-coated dielectric step. For a dielectric ridge with a square cross section, the plasmon polariton modes supported by each side of the metallized step hybridize to create supermodes with crossed polarizations. We show that the two supermodes can be operated in a dual-mode interferometer configuration to perform an efficient (24 dB) TE-TM/TM-TE polarization conversion over typical distances below 30 μm at telecommunications wavelengths. In addition, on the basis of the thermo-optical properties of our device, we find that the dihedron plasmonic polarization converter is temperature insensitive.

Nanosecond thermo-optical dynamics of polymer loaded plasmonic waveguides

The thermo-optical dynamics of polymer loaded surface plasmon waveguide (PLSPPW) based devices photo-thermally excited in the nanosecond regime is investigated. We demonstrate thermo-absorption of PLSPPW modes mediated by the temperature-dependent ohmic losses of the metal and the thermally controlled field distribution of the plasmon mode within the metal. For a PLSPPW excited by sub-nanosecond long pulses, we find that the thermo-absorption process leads to modulation depths up to 50% and features an activation time around 2 ns whereas the relaxation time is around 800 ns, four-fold smaller than the cooling time of the metal film itself. Next, we observe the photo-thermal activation of PLSPPW racetrack shaped resonators at a time scale of 300 ns followed however by a long cooling time (18 μs) attributed to the poor heat diffusivity of the polymer. We conclude that nanosecond excitation combined to high thermal diffusivity materials opens the way to high speed thermo-optical plasmonic devices.

Photo-thermal modulation of surface plasmon polariton propagation at telecommunication wavelengths

We report on photo-thermal modulation of thin film surface plasmon polaritons (SPP) excited at telecom wavelengths and traveling at a gold/air interface. By operating a modulated continuous-wave or a Q-switched nanosecond pump laser, we investigate the photo-thermally induced modulation of SPP propagation mediated by the temperature-dependent ohmic losses in the gold film. We use a fiber-to-fiber characterization set-up to measure accurately the modulation depth of the SPP signal under photo-thermal excitation. On the basis of these measurements, we extract the thermo-plasmonic coefficient of the SPP mode defined as the temperature derivative of the SPP damping constant. Next, we introduce a figure of merit which is relevant to characterize the impact of temperature onto the properties of bounded or weakly leaky SPP modes supported by a given metal at a given wavelength. By combining our measurements with tabulated values of the temperature-dependent imaginary part of gold dielectric function, we compute the thermo-optical coefficients (TOC) of gold at telecom wavelengths. Finally, we investigate a pulsed photo-thermal excitation of the SPP in the nanosecond regime. The experimental SPP depth of modulation obtained in this situation are found to be in fair agreement with the modulation depths computed by using our values of gold TOC.

Is routine hospital visit after day case inguinal hernia surgery in children necessary?

BACKGROUND

To observe the prospects of day case inguinal hernia surgery in children without routine postoperative hospital visits. The aim was to access the advantages, acceptability and safety of this change in practice in low resource country like Nepal.

METHODS

This was a cross-sectional study in a tertiary care general teaching hospital. Thirty children aged 6 months to 14 years who had elective day case Inguinal Hernia surgery from May 2011 to Oct 2011 were prospectively observed. Children with obstructed hernia, un-descended testis were excluded. Parents were counseled for omission of routine hospital visit after surgery. Main outcome measures were to observe unplanned hospital visit, reasons for visit, post-operative pain, wound infection and overall satisfaction of parents interviewed by telephone. Study was approved by institutional review committee.

RESULTS

There were 28 boys and two girls. Average age was five years. Right Inguinal Hernia patients were 19 in number while 11 patients had left sided hernia. None of the children visited health facility for pain or wound problem. Two children were brought to outpatient because they were mistakenly given appointment slip. Mother noticed recurrence and brought one child to surgical outpatient. All 30 parents responded to telephone enquiry and were satisfied.

CONCLUSIONS

Routine follow up visit after day care Inguinal Hernia surgery in children is not necessary. This practice is safe, economic and well accepted by children and parents.

Efficient photo-thermal activation of gold nanoparticle-doped polymer plasmonic switches

We report on the photo-thermal activation of dielectric loaded plasmonic switches comprised of gold nanoparticle-doped polymer deposited onto a gold film. The plasmonic switches rely on a multi-mode interferometer design and are fabricated by electron beam lithography applied to a positive resin doped with gold nanoparticles at a volume ratio of 0.52%. A cross-bar switching is obtained at telecom wavelengths by pumping the devices with a visible beam having a frequency within the localized surface plasmon resonance band of the embedded nanoparticles. By comparing the switching performances of doped and undoped devices, we show that for the modest doping level we consider, the power needed to activate the doped switches is reduced by a factor 2.5 compared to undoped devices. The minimization of activation power is attributed to enhanced light-heat conversion and optimized spatial heat generation for doped devices and not to a change of the thermo-optic coefficient of the doped polymer.

0.48Tb/s (12x40Gb/s) WDM transmission and high-quality thermo-optic switching in dielectric loaded plasmonics

We demonstrate Wavelength Division Multiplexed (WDM)-enabled transmission of 480Gb/s aggregate data traffic (12x40Gb/s) as well as high-quality 1x2 thermo-optic tuning in Dielectric-Loaded Surface Plasmon Polariton Waveguides (DLSPPWs). The WDM transmission characteristics have been verified through BER measurements by exploiting the heterointegration of a 60 μm-long straight DLSPPW on a Silicon-on-Insulator waveguide platform, showing error-free performance for six out of the twelve channels. High-quality thermo-optic tuning has been achieved by utilizing Cycloaliphatic-Acrylate-Polymer as an efficient thermo-optic polymer loading employed in a dual-resonator DLSPPW switching structure, yielding a 9 nm wavelength shift and extinction ratio values higher than 10 dB at both output ports when heated to 90°C.

Congenital kypho-scoliosis: a case of thoracic insufficiency syndrome and the limitations of treatment

INTRODUCTION

Congenital spinal vertebral anomalies may present with deformity resulting in congenital scoliosis and kyphosis. This leads to abnormal spinal growth. The latter when combined with associated rib fusions may impair normal thoracic cage development and resultant pulmonary hypoplasia. Most congenital scoliosis can be detected in utero by ultrasound scan or recognized in the neonatal period, but a few spinal defects can remain undetected.

MATERIALS AND METHODS

In this Grand Round, we present the case of a 7-year-old girl with a severe scoliosis and thoracic insufficiency syndrome (TIS). 3D CT reconstruction imaging demonstrated a mixed picture of fusion and segmentation abnormalities. A marked kyphoscoliosis was demonstrated at the thoraco-lumbar junction. Via a left thoracotomy, anterior excision of intervertebral discs was performed together with, interbody fusion, and in situ stabilisation of the kyphosis with double allograft (femur) strut grafts.

CONCLUSIONS

This article highlights the features of congenital kypho-scoliosis and TIS. The difficulties of treating kyphosis when combined with TIS are discussed together with the limitations of current surgical techniques.

A preliminary trial of the effect of recombinant human growth hormone on short-term linear growth and glucose homeostasis in children with Crohn's disease

BACKGROUND

It is unclear whether recombinant human growth hormone (rhGH) improves linear growth in children with Crohn's disease (CD).

AIMS

To investigate the effects of rhGH on height velocity (HV) and glucose homeostasis over a 6-month period.

DESIGN AND SETTING

Randomized controlled trial in two tertiary children's hospitals in 22 children with inflammatory bowel disease amongst whom 21 had CD. Duration of disease from diagnosis and number of acute relapses requiring either exclusive enteral nutrition or therapeutic dose of oral prednisolone were similar in the treatment and control groups.

INTERVENTION

Either rhGH (0·067 mg/kg per day) as daily subcutaneous injections (rhGH group; n, 11) or no rhGH, (Ctrl; n, 11) for 6 months.

MAIN OUTCOME MEASURE

Percentage change in HV after 6 months in the two groups. Auxology, puberty, skeletal age, disease factors, treatment and glucose homeostasis were also assessed.

RESULTS

Median HV increased from 4·5 (range, 0·6, 8·9) at baseline to 10·8 (6·1, 15·0) cm/year at 6 month (P = 0·003) in the rhGH group, whereas in the Ctrl group, it was 3·8 (1·4, 6·7) and 3·5 cm/year (2·0, 9·6), respectively (P = 0·58). Median percentage increase in HV after 6 months in the rhGH group was 140% (16·7, 916·7) compared with 17·4% (-42·1%, 97·7%) in the Ctrl group (P < 0·001). There were no significant differences in disease activity and proinflammatory cytokines at baseline and 6 months in both groups and change in bone age for chronological age was also similar in the two groups. In the rhGH group, fasting insulin increased from 4·0 (2·0, 11·0) to 7·0 mU/l (2·0, 16·0) (P = 0·02), whereas in the Ctrl group, it was 3·0 (1·2, 12·7) and 3·8 mU/l (2·1, 7·0) (P = 0·72), respectively.

CONCLUSIONS

Although this pilot trial shows that rhGH can improve short-term linear growth in children with CD, the clinical efficacy of this therapy needs to be further studied in longer-term studies of growth, glucose homeostasis and disease status.

Plasma Renin in ipsilateral renal vein in patients with chronic unilateral pelvic ureteric junction obstruction

Acute experimental hydronephrosis induces increased output of renin from ipsilateral kidney. In most clinical presentation of unilateral hydronephrosis the patients are however, normotensive with normal circulating plasma renin activity. In consideration of this argument we undertook this prospective study of ipsilateral renal vein renin activity in children with congenital Pelvic Ureteric Junction Obstruction (PUJO) and compared with other wise normal children. In this prospective cross-sectional study, started from July 99 to June 2001, twenty patients, age upto 12 years, with unilateral hydronephrosis and in control group ten patients without hydronephrosis were taken. 2ml blood was taken from the renal vein in study group and from infrarenal portion of inferior vena cava during exploratory laparotomy from the control group. All the patients had advanced grade of hydronephrosis and two patients (13%) had mild hypertension. In this study the mean plasma renin activity (PRA) was 45.58 ng/ml/hr (range: 11.69-67.56 ng/ml/hr) in study group. The mean PRA in control group was 5.9ng/ml/hr. The result of study group was significantly higher than normal (P value 0.0003). In Bangladesh we are doing more conservative kidney preserving surgery for PUJO, but need long term follow up of the patients undergoing surgery for PUJO in childhood for potential of developing renin-angiotensin induced hypertension in later life.

The growth hormone insulin-like growth factor 1 axis in children and adolescents with inflammatory bowel disease and growth retardation

CONTEXT

There is scarce knowledge about the growth hormone (GH) insulin-like growth factor-1 (IGF1) axis in children & adolescents with inflammatory bowel disease (IBD) and growth retardation.

OBJECTIVE

To describe the pattern of GH and IGF1 secretion in children & adolescents with IBD.

DESIGN

A retrospective review of 28 patients (23 M) of IBD (25 Crohn's Disease and three Ulcerative Colitis) and growth retardation who had investigation of the GH/IGF-1 axis. Height velocity (HV) and serum IGF1 were converted to standard deviation score (SDS); to account for delayed puberty in girls over 11 years and boys over 12 years, HV and serum IGF1 SDS were adjusted for bone age.

RESULTS

Median (range) age and Ht SDS at the time of endocrine evaluation was 14.3 years (7.7,17.0) and -2.0(-3.6,-0.9), respectively. Median HVSDS over the prior 12 months was -2.2(-7.7,2.8). Median peak serum GH on insulin tolerance test (ITT) was 5.8 mcg/l (1.3, 24.0), and median serum IGF1 SDS was -0.9(-3.1, 0.1). Five of 28 (18%) had a peak serum GH of >12 mcg/l. Overall, four had biochemical evidence of functional GH deficiency (peak GH < 3 mcg/l and IGF1 SDS < 0) and 11 children had biochemical evidence suggesting GH resistance (peak GH > 6 mcg/l and IGF1 SDS < 0). However, only one child had a peak serum GH > 6 mcg/l and a very low IGF1 SDS of <-2.0. There was a negative association between peak serum GH and Ht SDS (r = -0.49, P = 0.008), but there was no association with HV and there was no association between IGF1 SDS and Ht or HV SDS. IGF1 SDS showed a negative association with erythrocyte sedimentation rate (r = -0.41, P = 0.04).

CONCLUSION

Growth retardation in children and adolescents with IBD is commonly associated with a range of biochemical abnormalities ranging from functional GH deficiency to GH resistance. In these children, poor relationship between systemic markers of growth and height velocity point to an important role of growth factors at the target organ level in modulating growth in children with IBD. The value of assessing the GH/IGF-1 axis and whether it predicts subsequent response to growth-promoting therapy requires further exploration.

Acetabular surgical units: a directory for the United Kingdom

We present the first directory of the specialist acetabular surgical units throughout the United Kingdom. Previously there has not been any directory of acetabular surgeons in the UK as held by any governmental or healthcare agency. We have established that acetabular fracture fixation cases were performed at 33 NHS hospitals in the UK in 2003-2004. The total number of cases performed at each centre per year varied greatly (range 2-98). Twenty-one units performed greater than 10 cases per annum, comprising 92% of all operative cases in the UK in 2003-2004. We encourage trauma and orthopaedic units to communicate directly with their local units and familiarise themselves with those units' preferred referral processes. We publish this directory to assist in future research in this field, to help in resource planning in the field of major trauma, to aid training and continued development in this complex area and help with the timely referral of injured patients to these specialist units for this significant injury.

Kikuchi disease in a child

Kikuchi disease, also called histocytic necrotizing lymphadenitis or focal histiocytic lymphadenitis, is a rare, idiopathic and generally self limited cause of lymphadenitis. It was first described in 1972 in Japan. The most common clinical manifestation is cervical lymphadenopathy with or without systemic symptoms & signs. It almost always runs a benign course and resolves in several weeks to months.

The prevalence of methicillin resistant Staphylococus aureus in orthopaedics in a non-selective screening policy

BACKGROUND

The aim of this study was to assess the true incidence and prevalence of MRSA colonisation and infection in the elective and trauma orthopaedic population in Rotherham District General Hospital.

MATERIALS AND METHODS

This prospective study non-selectively screened 690 consecutive trauma and elective orthopaedic patients over three months in 2005.

RESULTS

Of these, 27 were positive for either colonisation or wound infection with MRSA. Of those, 13 were previously known to have been colonised with MRSA and the 14 others were unexpectedly either colonised or subsequently developed wound infections. The new cases would not have been identified using any current selective screening protocol, as they did not fall into a high-risk category. Many were young, had no co-morbidities and no contact with hospitals in the past. Our study seems to indicate that selective screening will miss a significant number of cases.

CONCLUSION

We conclude that MRSA screening for all orthopaedic patients is needed when admitted to hospital, as colonisation is no longer confined to what has been previously identified as high-risk groups. The consequences of a subsequent MRSA infection have significant implications, socially, financially and clinically.

Dietary modifications, nutritional supplements and alternative medicine in paediatric patients with inflammatory bowel disease

BACKGROUND

Data on use of complementary and alternative medicine in children with inflammatory bowel disease are scarce.

AIM

To assess prevalence, predictors and parental attitude to the use of complementary and alternative medicine in a paediatric population with inflammatory bowel disease in the west of Scotland.

METHODS

Questionnaire survey encompassing alternative therapists, nutritional supplements and dietary modifications used in the management of inflammatory bowel disease was used. Demographics, disease and treatment data were also collected.

RESULTS

86 guardians completed the survey. 61% had used at least one type and 37% were using complementary and alternative medicine recently. The most common types were probiotics (44%) and dairy-free diet (28%). Higher parental education and young parental age were predictors of complementary and alternative medicine use. An increased number of oral steroid courses and prior use of complementary and alternative medicine for other health reasons were associated with use of alternative therapists. Personal recommendation and to complement conventional medicine were the main reasons for using complementary and alternative medicine. 48% judged complementary and alternative medicine at least partially effective. 86% agreed that doctors should be supportive of use. 89% would give complementary and alternative medicine to their children.

CONCLUSIONS

Use of complementary and alternative medicine was higher in children with IBD than in adults with the same disease. The gastrointestinal nature of the disease could explain the high use of nutritional supplements and dietary modifications in this survey.

Prosthetic valve thrombosis despite seemingly-adequate anticoagulation: the dangers of transient lapses in anticoagulation

We report a 19-year-old woman with thrombosis of a prosthetic mitral valve that was most likely due to a short dip in anticoagulation in the days preceding the event. Interestingly, at presentation the patient was super-therapeutic, most likely a result of hepatic congestion as the heart began to fail, creating an illusion of thrombosis despite adequate anticoagulation.

The effects of recombinant human growth hormone on linear growth in children with Crohn's disease and short stature

BACKGROUND/AIMS

The efficacy of recombinant human growth hormone (rhGH) in treating the growth failure associated with Crohn's disease (CD) is unclear.

METHODS

Retrospective data analysis at 12 months before (T-12), 6 months before (T-6), at baseline (T+0), 6 months after (T+6) and 12 months after (T+12) rhGH treatment in seven patients with CD (five males).

RESULTS

Median chronological age (CA) and median difference between CA and bone age was 15.9 yr (range, 13.0 to 17.9) and 1.7 yr (-0.7 to 3.3), respectively. Median dose of rhGH at T+0 was 0.23 mg/wk (0.15 to 0.31). Pubertal status remained unchanged in 6/7 patients. Median albumin and C-reactive protein (CRP) were similar at T+0 and T+6. Median height SDS at T+0, T+6 and T+12 was -2.2 (-4.0 to -1.5), -1.9 (-4.1 to -0.8), -1.9 (-4.1 to -0.7), respectively (NS). Median height velocity (HV) SDS at T+0 and T+6 was -2.5 (-4.8 to 1.4) and -0.9 (-5.3 to 3.4), respectively (NS). There was a positive correlation between percentage change in HV SDS at T+6 and dose of rhGH at T+0 (r = 0.8, p = 0.03).

CONCLUSION

Introduction of rhGH therapy was associated with a cessation in the deterioration in linear growth. However, an improvement in height SDS was not observed over the period of the study. Future studies should explore the efficacy of a higher dose of rhGH in CD.