To determine the sensitivity of the combined measurement of chronaxie and the accommodation index in the qualitative diagnosis of muscle denervation with needle electromyography and to compare ...quantitative diagnoses.
Ninety-three neurogenic muscles diagnosed by needle electromyography were consecutively included for measurement of chronaxie and the accommodation index in this prospective study. The sensitivity of qualitative diagnosis was assessed for all muscles, separately for the acute and subacute-chronic denervation phase and for the complete and partial denervation.
The combined measurement of chronaxie and the accommodation index showed a 90% sensitivity to needle electromyography for qualitative diagnosis of muscle denervation for all muscles. A 100% sensitivity was found for the acute denervation phase and for complete denervation. The subacute-chronic denervation phase revealed a 86% sensitivity, and partial denervation had a 88% sensitivity. The kappa coefficients did not show satisfactory agreement in quantitative diagnosis, and Bowker's test revealed a statistically significant underestimation of muscle denervation for measurement of chronaxie.
The combined measurement of chronaxie and the accommodation index can be recommended for the screening of neurogenic lesions in the acute denervation phase.
To evaluate the performance of the logistic organ dysfunction (LOD) system for the assessment of morbidity and mortality in multiple organ dysfunction/failure (MOD/F) in an independent database and ...to evaluate the use of sequential LOD measurements for the prediction of outcome.
Prospective, multicentric cohort study in 13 adult medical, surgical, and mixed intensive care units (ICUs) in Austria.
A total of 2,893 consecutive admissions to the ICUs.
Patient vital status at ICU and hospital discharge was recorded. Univariate analysis showed that the LOD was able to distinguish between survivors and nonsurvivors (2 vs. 6 median score). Within organ systems, higher levels of the severity of organ dysfunction were consistently associated with higher mortality. For the prediction of hospital mortality, the original prognostic LOD model did not perform well in our patients, as indicated by the goodness-of-fit C statistic. Using multiple logistic regression we developed a prognostic model with a satisfactory fit in our patients. The integration of further measurements during the ICU stay increased discrimination but not calibration.
The LOD system is well correlated well with the numbers and levels of organ dysfunctions and discriminates well between survivors and nonsurvivors. It can thus be used to quantify the baseline severity of organ dysfunction. Moreover, after customization of the predictive equation the LOD predicted hospital mortality in our patients with high precision. It thus provides a combined measure of morbidity and mortality for critically ill patients with MOD/F.
Our goal was to use high resolution (HR) CT images combined with texture analysis to investigate the trabecular structure of human vertebral specimens and to compare these techniques with bone ...mineral density (BMD) in the prediction of bone strength.
HR CT images with a slice thickness of 1 mm were obtained of 28 bone cubes. Four different groups of texture analysis techniques were used to assess these images. In addition, quantitative CT (QCT) was performed and elastic modulus (EM) was determined biomechanically.
R2 between EM and BMD was 0.78 (p < 0.01). R2 values for EM versus most of the texture measures were also significant. Texture measures in addition to measures of BMD in a multivariate regression model significantly increased R2 up to 0.87.
In an experimental setting, texture parameters calculated using HR CT images correlated significantly with EM. Combining texture measures with BMD improved the prediction of EM significantly.
Objective: To report the effect of supplying new transfemoral amputee patients with a prosthesis with a silicone suspension/ interface system.
Patients and Design: Fifty-eight new transfemoral ...amputee patients were supplied with a contoured adducted trochanteric-controlled alignment method (CAT-CAM) socket (CCS) with a silicone suspension/interface system. This system is called the Icelandic roll-on silicone socket, or the ICEROSS system (IRS). A second group of 18 new amputee patients were supplied with an unlined CCS (uCCS), ie, without silicone sleeve suspension.
Measures: The IRS group was followed up at 1 year, the uCCS group at 9 months. Ambulatory capacity was investigated by first categorizing patients' prosthetic mobility into four different groups based on the distances patients were able to ambulate: 0m (wheelchair ambulation only), <100m, 100 to 500m, and >500m. The change in distance ambulated was then determined for each group for the three time intervals between admission, discharge, and follow-up.
Results: Between discharge and follow-up patients with the IRS had a significantly greater improvement (
p < .001) in distance traversed than patients supplied with the uCCS. Distance traversed had been longer in the uCCS group before they were supplied with the prostheses (
p < .05). Inpatient stay in the rehabilitation center was 5 days less in the group supplied with IRS (
p < .05). Adjustments to the new socket had to be carried out for 67% of the uCCS group during the observation period, compared with only 21% for those using the IRS system. Satisfaction, average duration of daily use, and the use of assistive devices for gait did not differ significantly.
Conclusions: New patients with transfemoral amputations fitted with a silicone suction socket showed greater gains in distances ambulated, and adjustments to their prostheses were significantly fewer. Therefore, it is preferable to provide these sockets to geriatric amputee patients rather than CAT-CAM sockets without silicone suspension sleeves.
Objectives. In Europe, patients with acute pelvic pain are transported to the hospital in an ambulance without an emergency physician. We hypothesized that transcutaneous electrical nerve ...stimulation (TENS) would be an effective noninvasive procedure for pain treatment.
Methods. We conducted a prospective, randomized, blinded study where 100 women were randomly assigned into a real‐ or a sham‐TENS group. TENS began before the transport to the ambulance and was left in place until the arrival at the hospital. Each patient rated her pain on paper using a visual analog scale.
Results. Compared to sham TENS, patients with active TENS felt that their pain was reduced by half after treatment (p < 0.01), anxiety scores significantly decreased (p < 0.01), heart rate and arteriolar vasoconstriction decreased significantly (p < 0.01), and nausea (p < 0.01) was lessened. Overall satisfaction with the received care was significantly higher (p < 0.01).
Conclusion. TENS is a safe, rapid, and effective analgesic treatment for acute pelvic pain.
We have developed a prototype imaging system that can perform simultaneous x-ray transmission CT and SPECT phantom studies. This system employs a 23-element high-purity-germanium detector array. The ...detector array is coupled to a collimator with septa angled toward the focal spot of an x-ray tube. During image acquisition, the x-ray fan beam and the detector array move synchronously along an arc pivoted at the x-ray source. Multiple projections are obtained by rotating the object, which is mounted at the center of rotation of the system. The detector array and electronics can count up to 10(6) cps/element with sufficient energy-resolution to discriminate between x-rays at 100-120 kVp and gamma rays from 99mTc. We have used this device to acquire x-ray CT and SPECT images of a three-dimensional Hoffman brain phantom. The emission and transmission images may be superimposed in order to localize the emission image on the transmission map.
Skeletal fracture represents a serious medical scenario, which must be taken into account in the design of exploration class space missions, such as those proposed for Mars. The risk of skeletal ...fracture represents the probability of encountering a condition in which the applied load to bone exceeds its strength. Ideally, to understand the risk of skeletal fracture incurred by crew members in these missions, we must understand the variety of potential loading conditions applied to the skeleton during the mission and the strength of the skeleton with respect to those loads. Our knowledge in this area is incomplete and requires much study in terms of modeling the range of mechanical loads associated with excursions onto planetary surfaces, how those loads are modified by spacesuit designs, and which skeletal sites are placed most at risk by those loading conditions. While we are far at present from having such an integrated picture of skeletal fracture risk, considerable effort has been made to understand the effect of spaceflight on some of the elements of bone fracture risk and we will summarize that knowledge here.
